Speizer Ilene S, Pettifor Audrey, Cummings Stirling, Macphail Catherine, Kleinschmidt Immo, Rees Helen V
Department of Maternal and Child Health, UNC-Gillings School of Global Public Health, CB 8120, Chapel Hill, NC 27599-8120.
Am J Public Health. 2009 Oct;99 Suppl 2(Suppl 2):S425-31. doi: 10.2105/AJPH.2008.136606. Epub 2009 Apr 16.
We studied whether female youths from communities with higher sexual violence were at greater risk of negative reproductive health outcomes.
We used data from a 2003 nationally representative household survey of youths aged 15-24 years in South Africa. The key independent variable was whether a woman had ever been threatened or forced to have sex. We aggregated this variable to the community level to determine, with control for individual-level experience with violence, whether the community-level prevalence of violence was associated with HIV status and adolescent pregnancy among female, sexually experienced, never-married youths.
Youths from communities with greater sexual violence were significantly more likely to have experienced an adolescent pregnancy or to be HIV-positive than were youths from communities experiencing lower sexual violence. Youths from communities with greater community-level violence were also less likely to have used a condom at their last sexual encounter. Individual-level violence was only associated with condom nonuse.
Programs to reduce adolescent pregnancies and HIV risk in South Africa and elsewhere in sub-Saharan Africa must address sexual violence as part of effective prevention strategies.
我们研究了来自性暴力发生率较高社区的年轻女性是否面临更高的负面生殖健康结果风险。
我们使用了2003年南非全国具有代表性的针对15 - 24岁青年的家庭调查数据。关键自变量是女性是否曾受到威胁或被迫发生性行为。我们将此变量汇总到社区层面，在控制个人层面暴力经历的情况下，确定社区层面的暴力流行率是否与有性经历、从未结婚的年轻女性中的艾滋病毒感染状况和青少年怀孕有关。
与来自性暴力发生率较低社区的青年相比，来自性暴力发生率较高社区的青年经历青少年怀孕或艾滋病毒呈阳性的可能性显著更高。来自社区层面暴力发生率较高社区的青年在最近一次性接触时使用避孕套的可能性也较小。个人层面的暴力仅与不使用避孕套有关。
在南非和撒哈拉以南非洲其他地区，减少青少年怀孕和艾滋病毒风险的项目必须将性暴力作为有效预防策略的一部分加以解决。
