African Population and Health Research Center, 2nd Floor Shelter Afrique Centre, PO Box 10787-00100, Nairobi, Kenya.
BMC Public Health. 2010 Jul 13;10:412. doi: 10.1186/1471-2458-10-412.
HIV counseling and testing is considered an important component of HIV prevention and treatment. This paper examines the characteristics of young males and females at the time of first reported HIV test, including the influence of recent sexual partnerships, and investigates how HIV testing and the cumulative number of tests are associated with sexual behaviors within six months of testing.
The study uses data from a random sample of youth aged 18-24 years living in Kisumu, Kenya, who were interviewed using a 10-year retrospective life history calendar. Cox regression models were used to examine the correlates of the timing of first HIV test. Variance-correction models for unordered repeated events were employed to examine whether having an HIV test in the previous six months and the cumulative number of tests predict unsafe sexual practices in a given month.
Sixty-four percent of females and 55% of males reported at least one HIV test in the last 10 years and 40% of females were pregnant the month of first test. Significant correlates of first HIV test included marital aspirations among non-pregnant females, unprotected sex in the previous six months among pregnant females, and concurrency in the previous six months among males. Having a recent HIV test was associated with a decreased likelihood of unprotected sex among ever-pregnant females, an increased likelihood of unprotected sex and "risky" sexual partnerships among never-pregnant females, and an increased likelihood of concurrency among males. Repeated HIV testing was associated with a lower likelihood of concurrency among males and involvement in "risky" sexual partnerships among males and never-pregnant females.
The high rate of pregnancy at first test suggests that promotion of HIV testing as part of prevention of mother-to-child transmission is gaining success. Further research is warranted to examine how and why behavior change is influenced by client- versus provider-initiated testing. The influence of different sexual partnership variables for males and females suggests that interventions to assess risk and promote testing should be gender- and relationship-specific. The findings also suggest that encouraging repeat or routine testing could potentially increase the uptake of safer sexual behaviors.
艾滋病咨询和检测被认为是艾滋病预防和治疗的重要组成部分。本文考察了首次报告艾滋病检测时青年男女的特征，包括最近性伴侣关系的影响，并调查了艾滋病检测和累计检测次数与检测后六个月内性行为之间的关系。
本研究使用了来自肯尼亚基苏木随机抽样的 18-24 岁青年的调查数据，这些青年使用 10 年回顾性生命史日历接受了访谈。采用 Cox 回归模型来检验首次艾滋病检测时间的相关因素。采用无序重复事件的方差校正模型来检验过去六个月内的艾滋病检测和累计检测次数是否能预测特定月份的不安全性行为。
64%的女性和 55%的男性在过去 10 年内至少进行过一次艾滋病检测，40%的女性在首次检测时怀孕。首次艾滋病检测的显著相关因素包括非怀孕女性的婚姻愿望、怀孕女性在过去六个月内的无保护性行为，以及男性在过去六个月内的同时性伴侣关系。最近进行的艾滋病检测与曾怀孕女性无保护性行为的可能性降低、从未怀孕女性无保护性行为和“高危”性伴侣关系的可能性增加以及男性同时性伴侣关系的可能性增加有关。重复艾滋病检测与男性同时性伴侣关系的可能性降低以及男性和从未怀孕女性“高危”性伴侣关系的可能性增加有关。
首次检测时的高怀孕率表明，推广艾滋病检测作为预防母婴传播的一部分正在取得成功。需要进一步研究，以检验客户发起和提供者发起的检测如何以及为何会影响行为变化。男性和女性不同的性伴侣关系变量的影响表明，评估风险和促进检测的干预措施应该针对性别和关系进行具体设计。研究结果还表明，鼓励重复或常规检测可能会增加采用更安全性行为的可能性。
