London School of Hygiene and Tropical Medicine, London,
AIDS. 2010 Mar 13;24(5):755-61. doi: 10.1097/QAD.0b013e328336672e.
HIV prevalence trends suggest that the epidemic is stable or declining in many sub-Saharan African countries. However, trends might differ between socioeconomic groups. Educational attainment is a common measure of socioeconomic position in HIV datasets from Africa. Several studies have shown higher HIV prevalence among more educated groups, but this may change over time. We describe changes in HIV prevalence by educational attainment in Tanzania from 2003 to 2007.
Analysis of data from two large, nationally representative HIV prevalence surveys conducted among adults aged 15-49 years in Tanzania in 2003-2004 (10 934 participants) and 2007-2008 (15 542 participants). We explored whether changes in HIV prevalence differed between groups with different levels of educational attainment after adjustment for potential confounding factors (sex, age, urban/rural residence and household wealth).
Changes in HIV prevalence differed by educational attainment level (interaction test P value = 0.07). HIV prevalence was stable among those with no education (adjusted odds ratio 2007-2008 vs. 2003-2004 1.03, 95% confidence interval 0.72-1.47), whereas showing a small but borderline significant decline among those with primary education (adjusted odds ratio 0.85, 95% confidence interval 0.69-1.03) and a larger statistically significant decline among those with secondary education (adjusted odds ratio 0.53, 95% confidence interval 0.34-0.84).
Prevalent HIV infections are now concentrating among those with the lowest levels of education in Tanzania. Although HIV-related mortality, migration and cohort effects might contribute to this, different HIV incidence by educational level between the surveys provides the most likely explanation. Urgent measures to improve HIV prevention among those with limited education and of low socioeconomic position are necessary in Tanzania.
艾滋病毒流行趋势表明，在许多撒哈拉以南非洲国家，该流行病处于稳定或下降状态。然而，趋势在社会经济群体之间可能有所不同。教育程度是非洲艾滋病毒数据集用于衡量社会经济地位的常用指标。多项研究表明，受教育程度较高的人群艾滋病毒感染率较高，但这种情况可能会随时间而改变。本研究描述了 2003 年至 2007 年期间，坦桑尼亚按教育程度划分的艾滋病毒流行率变化情况。
分析了 2003-2004 年（10934 名参与者）和 2007-2008 年（15542 名参与者）在坦桑尼亚进行的两次大型全国代表性艾滋病毒流行率调查的数据。在调整了潜在混杂因素（性别、年龄、城乡居住和家庭财富）后，我们探讨了艾滋病毒流行率的变化在不同教育程度的人群中是否存在差异。
艾滋病毒流行率的变化因教育程度而异（交互检验 P 值=0.07）。未受过教育人群的艾滋病毒流行率保持稳定（2007-2008 年相对于 2003-2004 年的调整比值比为 1.03，95%置信区间为 0.72-1.47），而受过小学教育的人群的艾滋病毒流行率略有下降，但具有边缘统计学意义（调整比值比为 0.85，95%置信区间为 0.69-1.03），受过中学教育的人群的艾滋病毒流行率下降更为显著（调整比值比为 0.53，95%置信区间为 0.34-0.84）。
在坦桑尼亚，现有的艾滋病毒感染集中在受教育程度最低的人群中。尽管与艾滋病毒相关的死亡率、迁移和队列效应可能导致这种情况，但两次调查之间不同的教育程度与艾滋病毒发病率最有可能解释这一现象。在坦桑尼亚，迫切需要采取措施，改善教育程度有限和社会经济地位较低人群的艾滋病毒预防工作。
