Mmbaga Elia J, Hussain Akhtar, Leyna Germana H, Mnyika Kagoma S, Sam Noel E, Klepp Knut-Inge
Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
BMC Public Health. 2007 Apr 19;7:58. doi: 10.1186/1471-2458-7-58.
Variability in stages of the HIV-1 epidemic and hence HIV-1 prevalence exists in different areas in sub-Saharan Africa. The purpose of this study was to investigate the magnitude of HIV-1 infection and identify HIV-1 risk factors that may help to develop preventive strategies in rural Kilimanjaro, Tanzania.
A cross-sectional study was conducted between March and May of 2005 involving all individuals aged between 15-44 years having an address in Oria Village. All eligible individuals were registered and invited to participate. Participants were interviewed regarding their demographic characteristics, sexual behaviors, and medical history. Following a pre-test counseling, participants were offered an HIV test.
Of the 2 093 eligible individuals, 1 528 (73.0%) participated. The overall age and sex adjusted HIV-1 prevalence was 5.6%. Women had 2.5 times higher prevalence (8.0% vs. 3.2%) as compared to men. The age group 25-44 years, marriage, separation and low education were associated with higher risk of HIV-1 infection for both sexes. HIV-1 infection was significantly associated with >2 sexual partners in the past 12 months (women: Adjusted odds ratio [AOR], 2.5 (95%CI: 1.3-4.7), and past 5 years, [(men: AOR, 2.2 (95%CI:1.2-5.6); women: AOR, 2.5 (95%CI: 1.4-4.0)], unprotected casual sex (men: AOR,1.8 95%CI: 1.2-5.8), bottled alcohol (Men: AOR, 5.9 (95%CI:1.7-20.1) and local brew (men: AOR, 3.7 (95%CI: 1.5-9.2). Other factors included treatment for genital ulcers and genital discharge in the past 1 month. Health-related complaints were more common among HIV-1 seropositive as compared to seronegative participants and predicted the presence of HIV-1 infection.
HIV-1 infection was highly prevalent in this population. As compared to our previous findings, a shift of the epidemic from a younger to an older age group and from educated to uneducated individuals was observed. Women and married or separated individuals remained at higher risk of infection. To prevent further escalation of the HIV epidemic, efforts to scale up HIV prevention programmes addressing females, people with low education, lower age at marriage, alcohol consumption, condom use and multiple sexual partners for all age groups remains a top priority. Care and treatment are urgently needed for those infected in rural areas.
撒哈拉以南非洲不同地区的HIV-1流行阶段存在差异，因此HIV-1流行率也有所不同。本研究的目的是调查坦桑尼亚乞力马扎罗农村地区HIV-1感染的程度，并确定可能有助于制定预防策略的HIV-1危险因素。
2005年3月至5月进行了一项横断面研究，涉及所有年龄在15 - 44岁且居住在奥里亚村的个人。所有符合条件的个人均进行登记并受邀参与。就参与者的人口统计学特征、性行为和病史进行了访谈。在进行预测试咨询后，为参与者提供了HIV检测。
在2093名符合条件的个体中，1528人（73.0%）参与了研究。经年龄和性别调整后的总体HIV-1流行率为5.6%。女性的流行率（8.0%）是男性（3.2%）的2.5倍。25 - 44岁年龄组、婚姻状况、分居以及低教育水平与男女双方更高的HIV-1感染风险相关。HIV-1感染与过去12个月内有>2个性伴侣显著相关（女性：调整后的优势比[AOR]，2.5（95%可信区间：1.3 - 4.7），以及过去5年，[男性：AOR，2.2（95%可信区间：1.2 - 5.6）；女性：AOR，2.5（95%可信区间：1.4 - 4.0）]，无保护的随意性行为（男性：AOR，1.8 95%可信区间：1.2 - 5.8），瓶装酒（男性：AOR，5.9（95%可信区间：1.7 - 20.1）和当地酿造的酒（男性：AOR，3.7（95%可信区间：1.5 - 9.2）。其他因素包括过去1个月内有生殖器溃疡和生殖器分泌物的治疗史。与HIV-1血清阴性参与者相比，HIV-1血清阳性参与者中与健康相关的主诉更为常见，并且可预测HIV-1感染的存在。
HIV-1感染在该人群中高度流行。与我们之前的研究结果相比，观察到该流行病从较年轻年龄组向较年长年龄组以及从受过教育的个体向未受过教育的个体转移。女性以及已婚或分居的个体仍然处于较高的感染风险中。为防止HIV疫情进一步升级，扩大针对女性、低教育水平人群、较低结婚年龄人群、饮酒、使用避孕套以及所有年龄组多个性伴侣的HIV预防计划的努力仍然是首要任务。农村地区的感染者迫切需要护理和治疗。
