Kongnyuy Eugene J, Wiysonge Charles S, Mbu Robinson E, Nana Philip, Kouam Luc
Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
BMC Int Health Hum Rights. 2006 Sep 11;6:11. doi: 10.1186/1472-698X-6-11.
The 2004 Demographic and Health Survey (DHS) in Cameroon revealed a higher prevalence of HIV in richest and most educated people than their poorest and least educated compatriots. It is not certain whether the higher prevalence results partly or wholly from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe injections or other HIV risk factors. As unsafe sex is currently believed to be the main driver of the HIV epidemic in sub-Saharan Africa, we designed this study to examine the association between wealth and sexual behaviour in Cameroon.
We analysed data from 4409 sexually active men aged 15-59 years who participated in the Cameroon DHS using logistic regression models, and have reported odds ratios (OR) with confidence intervals (CI).
When we controlled for the potential confounding effects of marital status, place of residence, religion and age, men in the richest third of the population were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.43, 95% CI 0.32-0.56) and more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.38, 95% CI 1.12-1.19) and more than five lifetime sex partners (OR 1.97, 95% CI 1.60-2.43). However, there was no difference between the richest and poorest men in the purchase of sexual services. Regarding education, men with secondary or higher education were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.24, 95% CI 0.16-0.38) and more likely to have started sexual activity at age 17 years or less (OR 2.73, 95% CI 2.10-3.56) and had more than five lifetime sexual partners (OR 2.59, 95% CI 2.02-3.31). There was no significant association between education and multiple concurrent sexual partnerships in the last 12 months or purchase of sexual services.
Wealthy men in Cameroon are more likely to start sexual activity early and have both multiple concurrent and lifetime sex partners, and are less likely to (consistently) use a condom in sex with a non-spousal non-cohabiting partner. These unsafe sexual behaviours may explain the higher HIV prevalence among wealthier men in the country. While these findings do not suggest a redirection of HIV prevention efforts from the poor to the wealthy, they do call for efforts to ensure that HIV prevention messages get across all strata of society.
2004年喀麦隆人口与健康调查（DHS）显示，最富有和受教育程度最高的人群中艾滋病毒感染率高于最贫穷和受教育程度最低的同胞。目前尚不确定感染率较高是部分还是完全由于较富裕的人采取了更多不安全的性行为、因更容易获得治疗和护理而存活时间更长，还是接触了不安全注射或其他艾滋病毒风险因素。由于目前认为不安全的性行为是撒哈拉以南非洲艾滋病毒流行的主要驱动因素，我们设计了这项研究来调查喀麦隆财富与性行为之间的关联。
我们使用逻辑回归模型分析了4409名年龄在15 - 59岁之间参与喀麦隆DHS的性活跃男性的数据，并报告了优势比（OR）及其置信区间（CI）。
当我们控制婚姻状况、居住地点、宗教和年龄的潜在混杂效应时，最富有的三分之一人群中的男性在与非配偶、非同居伴侣的最后一次性行为中使用避孕套的可能性较小（OR 0.43，95% CI 0.32 - 0.56），在过去12个月内有至少两个同时性伴侣的可能性较大（OR 1.38，95% CI 1.12 - 1.19），以及一生中拥有超过五个性伴侣的可能性较大（OR 1.97，95% CI 1.60 - 2.43）。然而，在购买性服务方面，最富有和最贫穷的男性之间没有差异。关于教育程度，受过中等或更高教育的男性在与非配偶、非同居伴侣的最后一次性行为中使用避孕套的可能性较小（OR 0.24，95% CI 0.
