Drain Paul K, Smith Jennifer S, Hughes James P, Halperin Daniel T, Holmes King K
School of Medicine, University of Washington, Seattle, WA, USA.
J Acquir Immune Defic Syndr. 2004 Apr 1;35(4):407-20. doi: 10.1097/00126334-200404010-00011.
Ecologic analyses of social and developmental correlates of country-level HIV seroprevalence may suggest strategies for combating the HIV/AIDS epidemic.
Regression analyses were performed for 81 variables obtained primarily from United Nation agencies for 122 developing countries. Variable measures were compared between highest and lowest tertiles of HIV seroprevalence.
Geography, religion, and income inequality were independently associated with HIV seroprevalence. Countries with earlier ages at first sex, higher teenage birth rates, and higher fertility rates had higher HIV seroprevalence. Countries with high HIV seroprevalence had fewer women using contraceptives, more persons with casual sex partners, and higher herpes simplex virus 2 seroprevalence. Male circumcision and Muslim religion were colinearly associated with lower HIV seroprevalence. Countries with high HIV seroprevalence had fewer doctors, more midwives, and less access to essential medications, but health spending differences were minor.
Ecologic analyses support population-level behavioral approaches, such as delaying sexual debut and discouraging casual sex partners, and reinforce biologic measures, such as controlling sexually transmitted infections and promoting male circumcision, for HIV prevention. Fewer births attended by skilled personnel, but more midwives, in countries with the highest HIV seroprevalence suggest potential strategies for reducing mother-to-child transmission. Correlations with selected health indicators suggest additional obstacles for implementing HIV treatment programs.
对国家层面艾滋病毒血清流行率的社会和发展相关因素进行生态分析，可能会为抗击艾滋病毒/艾滋病疫情提供策略。
对主要从联合国机构获取的122个发展中国家的81个变量进行回归分析。比较了艾滋病毒血清流行率最高和最低三分位数之间的变量测量值。
地理位置、宗教和收入不平等与艾滋病毒血清流行率独立相关。首次性行为年龄较早、青少年生育率较高和总生育率较高的国家，艾滋病毒血清流行率也较高。艾滋病毒血清流行率高的国家，使用避孕药具的女性较少，有多个性伴侣的人较多，单纯疱疹病毒2血清流行率较高。男性包皮环切术与穆斯林宗教与较低的艾滋病毒血清流行率共线相关。艾滋病毒血清流行率高的国家，医生较少，助产士较多，获得基本药物的机会较少，但卫生支出差异较小。
生态分析支持采取人群层面的行为方法，如推迟首次性行为和劝阻多个性伴侣，以及加强生物措施，如控制性传播感染和推广男性包皮环切术，以预防艾滋病毒。艾滋病毒血清流行率最高的国家，由熟练人员接生的婴儿较少，但助产士较多，这表明了减少母婴传播的潜在策略。与选定卫生指标的相关性表明，实施艾滋病毒治疗方案还存在其他障碍。
