南非年轻女性中亲密伴侣暴力、关系权力不平等与艾滋病毒感染发生率：一项队列研究。

Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study.

机构信息

Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa.

出版信息

Lancet. 2010 Jul 3;376(9734):41-8. doi: 10.1016/S0140-6736(10)60548-X.

DOI:10.1016/S0140-6736(10)60548-X

PMID:20557928

Abstract

BACKGROUND

Cross-sectional studies have shown that intimate partner violence and gender inequity in relationships are associated with increased prevalence of HIV in women. Yet temporal sequence and causality have been questioned, and few HIV prevention programmes address these issues. We assessed whether intimate partner violence and relationship power inequity increase risk of incident HIV infection in South African women.

METHODS

We did a longitudinal analysis of data from a previously published cluster-randomised controlled trial undertaken in the Eastern Cape province of South Africa in 2002-06. 1099 women aged 15-26 years who were HIV negative at baseline and had at least one additional HIV test over 2 years of follow-up were included in the analysis. Gender power equity and intimate partner violence were measured by a sexual relationship power scale and the WHO violence against women instrument, respectively. Incidence rate ratios (IRRs) of HIV acquisition at 2 years were derived from Poisson models, adjusted for study design and herpes simplex virus type 2 infection, and used to calculate population attributable fractions.

FINDINGS

128 women acquired HIV during 2076 person-years of follow-up (incidence 6.2 per 100 person-years). 51 of 325 women with low relationship power equity at baseline acquired HIV (8.5 per 100 person-years) compared with 73 of 704 women with medium or high relationship power equity (5.5 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 95% CI 1.05-2.17, p=0.027. 45 of 253 women who reported more than one episode of intimate partner violence at baseline acquired HIV (9.6 per 100 person-years) compared with 83 of 846 who reported one or no episodes (5.2 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 1.04-2.21, p=0.032. The population attributable fractions were 13.9% (95% CI 2.0-22.2) for relationship power equity and 11.9% (1.4-19.3) for intimate partner violence.

INTERPRETATION

Relationship power inequity and intimate partner violence increase risk of incident HIV infection in young South African women. Policy, interventions, and programmes for HIV prevention must address both of these risk factors and allocate appropriate resources.

FUNDING

National Institute of Mental Health and South African Medical Research Council.

摘要

背景

横断面研究表明，亲密伴侣暴力和两性关系中的不平等与女性中 HIV 的流行率增加有关。然而，时间顺序和因果关系受到了质疑，很少有 HIV 预防计划解决这些问题。我们评估了亲密伴侣暴力和关系权力不平等是否会增加南非女性感染 HIV 的风险。

方法

我们对 2002-06 年在南非东开普省进行的一项先前发表的群组随机对照试验的数据进行了纵向分析。共纳入了 1099 名年龄在 15-26 岁之间、基线时 HIV 阴性且在 2 年随访期间至少有一次额外 HIV 检测的女性。通过性关系权力量表和世界卫生组织针对妇女的暴力行为工具分别测量性别权力平等和亲密伴侣暴力。使用泊松模型得出 2 年内 HIV 感染发生率比（IRR），并进行了研究设计和单纯疱疹病毒 2 感染调整，用于计算人群归因分数。

结果

在 2076 人年的随访中，有 128 名女性感染了 HIV（发生率为 6.2/100 人年）。基线时关系权力平等度低的 325 名女性中，有 51 名（8.5/100 人年）感染了 HIV，而关系权力平等度中或高的 704 名女性中，有 73 名（5.5/100 人年）感染了 HIV；调整后的多变量泊松模型 IRR 为 1.51，95%CI 为 1.05-2.17，p=0.027。基线时有超过一次亲密伴侣暴力报告的 253 名女性中有 45 名（9.6/100 人年）感染了 HIV，而在 846 名有一次或没有报告的女性中，有 83 名（5.2/100 人年）感染了 HIV；调整后的多变量泊松模型 IRR 为 1.51，1.04-2.21，p=0.032。关系权力不平等的人群归因分数为 13.9%（95%CI 2.0-22.2），亲密伴侣暴力的人群归因分数为 11.9%（1.4-19.3）。