Unite de recherche en santé des populations, Centre de recherche FRSQ du CHA universitaire de Québec, Québec Canada.
PLoS One. 2012;7(8):e43818. doi: 10.1371/journal.pone.0043818. Epub 2012 Aug 28.
To assess changes in the prevalence of HIV and other sexually transmitted infections, as well as in different proximal and distal factors related to HIV infection, in the general population of Cotonou between 1998 and 2008, while an intensive preventive intervention targeting the sex work milieu was ongoing.
A two-stage cluster sampling procedure was used to select the participants in each study. Subjects aged 15-49 who agreed to participate were interviewed and tested for HIV, syphilis, HSV-2, gonorrhoea and chlamydia. We used the Roa-Scott Chi-square test (proportions) and the Student's t test (means) for bivariate comparisons, and adjusted logistic regression models taking into account the cluster effect for multivariate analyses.
HIV prevalence decreased significantly in men (3.4% in 1998 versus 2.0% in 2008, p = 0.048), especially in those aged 15-29 (3.0% to 0.5%, p = 0.002). Among men, the prevalence of gonorrhoea decreased significantly (1.1% to 0.3%, p = 0.046) while HSV-2 prevalence increased from 12.0% to 18.1% (p = 0.0003). The proportion of men who reported condom use at least once (29.3% to 61.0%, p<0.0001) and of those having attained a secondary educational level or more (17.1% to 61.3%, p<0.0001) also increased significantly. There was an overall decrease in the prevalence of syphilis (1.5% to 0.6%, p = 0.0003).
This is the first population-based study reporting a significant decline in HIV prevalence among young men in an African setting where overall prevalence has never reached 5%. The decline occurred while preventive interventions targeting the sex work milieu were ongoing and the educational level was increasing.
评估在科托努，1998 年至 2008 年期间，在性工作环境中进行强化预防干预的同时，一般人群中艾滋病毒和其他性传播感染的流行率以及与艾滋病毒感染相关的不同近端和远端因素的变化。
采用两阶段聚类抽样程序选择各研究的参与者。同意参与的年龄在 15-49 岁的受试者接受访谈和艾滋病毒、梅毒、HSV-2、淋病和衣原体检测。我们使用 Roa-Scott Chi-square 检验（比例）和 Student's t 检验（均值）进行二变量比较，并采用考虑到聚类效应的多变量调整逻辑回归模型。
男性的艾滋病毒流行率显著下降（1998 年的 3.4%降至 2008 年的 2.0%，p = 0.048），尤其是 15-29 岁年龄组（从 3.0%降至 0.5%，p = 0.002）。在男性中，淋病的流行率显著下降（从 1.1%降至 0.3%，p = 0.046），而 HSV-2 的流行率从 12.0%上升至 18.1%（p = 0.0003）。报告至少使用过一次避孕套的男性比例（从 29.3%升至 61.0%，p<0.0001）和获得中等教育或以上学历的男性比例（从 17.1%升至 61.3%，p<0.0001）也显著增加。梅毒的流行率总体下降（从 1.5%降至 0.6%，p = 0.0003）。
这是第一项在非洲背景下报告年轻男性艾滋病毒流行率显著下降的基于人群的研究，在该背景下，总体流行率从未达到 5%。下降发生在针对性工作环境的预防干预正在进行且教育水平不断提高的情况下。
