Pettifor Audrey E, Hudgens Michael G, Levandowski Brooke A, Rees Helen V, Cohen Myron S
Division of Infectious Diseases, School of Medicine, Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA.
AIDS. 2007 Apr 23;21(7):861-5. doi: 10.1097/QAD.0b013e3280f00fb3.
Young women in sub-Saharan Africa are at very high risk of HIV acquisition, and high prevalence levels have been observed among women reporting one lifetime partner and few sexual contacts. Such findings have led to hypotheses that the probability of HIV transmission from men to women must be far higher than previously appreciated.
We used the data from a cross-sectional national household survey of HIV among South African women aged 15-24 years to estimate the per-partnership transmission probability from men to women. Estimates were obtained using maximum likelihood methods and a transmission probability model allowing for random error in the self-reported number of lifetime partners. Sensitivity analyses were employed to assess the robustness of the per-partnership transmission probability estimates to the assumed HIV prevalence in male partners.
HIV prevalence in women was 21.2% (95% confidence interval 17.9-24.5). The mean reported number of lifetime partners was 2.3. A significant increase in prevalence was observed with increasing lifetime partner numbers (P = 0.02). For a range of plausible values of the partner prevalence, the estimated per-partnership transmission probability varied from 0.74 to 1.00 with 95% confidence intervals ranging from 0.56 to 1.00.
The per-partnership probability of HIV transmission from men to women in this population was very high. Before this, the majority of studies examining per-partnership transmission probabilities estimated values below 50%. Identifying the factors that may drive the efficient spread of HIV in sub-Saharan Africa is essential for the development of effective prevention interventions.
撒哈拉以南非洲的年轻女性感染艾滋病毒的风险非常高，在报告只有一个终身伴侣且性接触较少的女性中也观察到了高流行率。这些发现引发了一些假设，即男性向女性传播艾滋病毒的概率肯定远高于此前的认识。
我们使用了一项针对南非15至24岁女性的全国性艾滋病毒横断面家庭调查数据，来估计男性向女性的每次性伴侣传播概率。估计值通过最大似然法和一个考虑到自我报告的终身伴侣数量存在随机误差的传播概率模型获得。采用敏感性分析来评估每次性伴侣传播概率估计值对男性伴侣中假定的艾滋病毒流行率的稳健性。
女性中的艾滋病毒流行率为21.2%（95%置信区间17.9 - 24.5）。报告的平均终身伴侣数量为2.3个。随着终身伴侣数量的增加，流行率显著上升（P = 0.02）。对于一系列合理的伴侣流行率值，估计的每次性伴侣传播概率在0.74至1.00之间变化，95%置信区间在0.56至1.00之间。
该人群中男性向女性的每次性伴侣艾滋病毒传播概率非常高。在此之前，大多数研究每次性伴侣传播概率的估计值都低于50%。确定可能推动艾滋病毒在撒哈拉以南非洲高效传播的因素对于制定有效的预防干预措施至关重要。
