Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Int Perspect Sex Reprod Health. 2010 Dec;36(4):178-88. doi: 10.1363/3617810.
In many parts of Africa, women are most likely to become infected with HIV by having unprotected sex with their husbands, who may have acquired the virus through extramarital sex. However, the ways in which aspects of community environments-particularly those related to gender equity-shape men's extramarital sexual risk-taking are not well understood.
Demographic and Health Survey data from eight African countries (Chad, Ghana, Malawi, Nigeria, Tanzania, Uganda, Zambia and Zimbabwe) were used to examine associations between married men's engaging in risky extramarital sex (i.e., having had both unprotected sex and extramarital sex) and indicators of gender equity and other community characteristics. Separate multilevel logistic regression models that incorporated individual, household and community measures were created for each country.
In five countries, men who lived in communities with more equal ratios of women to men with at least a primary education were less likely to report risky extramarital sexual activity (odds ratios, 0.4-0.6). A similar relationship was found in four countries for the ratio of women to men who were employed (0.4-0.5). In three countries, men who lived in communities with more conservative attitudes toward wife-beating or male decision making had elevated odds of extramarital sexual risk-taking (1.1-1.5).
While HIV prevention programs should focus on reducing gender inequities, they also need to recognize the conservative cultural factors that influence the formation of men's masculine identities and, in turn, affect their sexual behavior.
在非洲的许多地区，妇女最有可能通过与丈夫发生无保护的性行为而感染艾滋病毒，而丈夫可能通过婚外性行为感染了该病毒。然而，社区环境的各个方面（尤其是与性别平等相关的方面）如何影响男性的婚外性冒险行为，人们对此还了解甚少。
利用来自 8 个非洲国家（乍得、加纳、马拉维、尼日利亚、坦桑尼亚、乌干达、赞比亚和津巴布韦）的人口与健康调查数据，研究已婚男性从事危险婚外性行为（即发生过无保护性行为和婚外性行为）与性别平等指标以及其他社区特征之间的关联。针对每个国家，都创建了包含个体、家庭和社区措施的单独多层逻辑回归模型。
在五个国家中，生活在男女受教育程度至少为小学的比例较为均衡的社区中的男性报告婚外性冒险行为的可能性较小（比值比，0.4-0.6）。在四个国家中，对于男女就业比例而言，也存在类似的关系（0.4-0.5）。在三个国家中，生活在对打老婆或男性决策持保守态度的社区中的男性，婚外性冒险行为的几率更高（1.1-1.5）。
虽然艾滋病毒预防规划应侧重于减少性别不平等，但还需要认识到影响男性男子气概身份形成并进而影响其性行为的保守文化因素。
