Michelo Charles, Sandøy Ingvild F, Fylkesnes Knut
Department of Community Medicine, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia.
AIDS. 2006 Apr 24;20(7):1031-8. doi: 10.1097/01.aids.0000222076.91114.95.
Higher educational attainment has been associated with a greater risk of HIV infection in sub-Saharan Africa. We investigated change over time in HIV prevalence by educational attainment in the general population.
The data stem from serial population-based HIV surveys conducted in selected urban and rural communities in 1995 (n = 2989), 1999 (n = 3506) and 2003 (n = 4442). Analyses were stratified by residence, sex and age-group. Logistic regression was used to estimate age-adjusted odds ratio of HIV between low (< or = 4 school years) and higher education (> or = 8 years) for the rural population and between low (< or = 7 school years) and higher education (> or = 11 years) for the urban population.
There was a universal shift towards reduced risk of HIV infection in groups with higher than lower education in both sexes among urban young people [odds ratio (OR), 0.20; 95% confidence interval (CI), 0.05-0.73] in men and (OR, 0.33; 95% CI, 0.15-0.72) in women. A similar pattern was observed in rural young men (OR, 0.17; 95% CI, 0.05-0.59) but was less prominent and not statistically significant in rural women. In age 25-49 years, higher educated urban men had reduced risk in 2003 (OR, 0.43; 95%CI, 0.26-0.72) but this was less prominent in women.
The findings suggested a shift in the association between educational attainment and HIV infection between 1995 and 2003. The most convincing sign was the risk reduction among more educated younger groups where most infections can be assumed to be recent. The changes in older groups are probably largely influenced by differential mortality rates. The stable risk among groups with lower education might also indicate limitations in past preventive efforts.
在撒哈拉以南非洲地区，较高的教育程度与感染艾滋病毒的风险增加有关。我们调查了普通人群中按教育程度划分的艾滋病毒流行率随时间的变化情况。
数据来源于1995年（n = 2989）、1999年（n = 3506）和2003年（n = 4442）在选定城乡社区进行的一系列基于人群的艾滋病毒调查。分析按居住地区、性别和年龄组进行分层。采用逻辑回归估计农村人口中低教育程度（≤4学年）和高教育程度（≥8年）之间以及城市人口中低教育程度（≤7学年）和高教育程度（≥11年）之间艾滋病毒感染的年龄调整比值比。
城市年轻人中，无论男女，教育程度较高组的艾滋病毒感染风险普遍下降[男性比值比（OR）为0.20；95%置信区间（CI）为0.05 - 0.73]，女性（OR为0.33；95%CI为0.15 - 0.72）。农村年轻男性中也观察到类似模式（OR为0.17；95%CI为0.05 - 0.59），但在农村女性中不太明显且无统计学意义。在25 - 49岁年龄段，2003年城市中受教育程度较高的男性感染风险降低（OR为0.43；95%CI为0.26 - 0.72），但在女性中不太明显。
研究结果表明1995年至2003年间教育程度与艾滋病毒感染之间的关联发生了变化。最有说服力的迹象是在受教育程度较高的年轻人群中感染风险降低，而这些人群中的大多数感染可能被认为是近期发生的。老年人群体的变化可能在很大程度上受不同死亡率的影响。教育程度较低群体中风险稳定也可能表明过去预防措施存在局限性。
