预测南非城郊地区性伴侣较多的难以接触到的年轻女性中， condom 使用不一致的因素。
Predictors of inconsistent condom use among a hard to reach population of young women with multiple sexual partners in peri-urban South Africa.
机构信息
Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa.
出版信息
PLoS One. 2012;7(12):e51998. doi: 10.1371/journal.pone.0051998. Epub 2012 Dec 20.
BACKGROUND
Evidence suggests that multiple concurrent sexual partnering may be a key driver of the high HIV prevalence among young women in South Africa. However, little is known about whether and to what extent women who have multiple sexual partners also engage in other high risk sexual behaviors such as inconsistent condom use. And yet, multiple concurrent sexual partnering is of little epidemiological relevance if all partners in these sexual networks use condoms consistently. This study assesses the prevalence of sexual risk behaviors and HIV, and predictors of inconsistent condom use among women aged 16-24 with multiple sexual partners in a peri-urban setting in South Africa.
METHODS
We used Respondent Driven Sampling, a sampling strategy for hard-to-reach populations to recruit 259 women aged 16-24 in a bio-behavioral cross-sectional survey in the Western Cape province. Estimates of population proportions and 95% confidence intervals (CIs) were calculated using the Respondent-Driven Sampling Analysis Tool 5.6 (RDSAT). The primary outcome was inconsistent condom use in the past three months.
RESULTS
Young women reported an average of 7 partners in the past 3 months and a high prevalence of sexual risk behaviors: concurrency (87%), transactional sex (91%) and age mixing (59%). Having >5 sexual partners in the last 3 months doubled the risk of unprotected sex (OR 2.43, CI 1.39-4.25). HIV prevalence was 4% among 16-19 year olds, increasing threefold (12%) at age 20-24.
DISCUSSION
Multiple sexual partnering, where a high number of partners are acquired in a short space of time, is a fertile context for unprotected and risky sexual behavior. The young women featured in this survey present with a constellation of high-risk sexual behaviors that cluster to form a risk syndrome. Carefully tailored repeat bio-behavioral surveillance surveys are recommended for this sub-population.
背景
有证据表明，多重性伴可能是南非年轻女性中 HIV 高流行率的一个关键驱动因素。然而，人们对于有多个性伴的女性是否以及在何种程度上从事其他高风险性行为（如不坚持使用安全套）知之甚少。然而，如果这些性网络中的所有伴侣都始终如一地使用安全套，那么多重性伴的情况在流行病学上就没有什么关联了。本研究评估了在南非一个城市周边环境中，有多个性伴的 16-24 岁女性中性风险行为和 HIV 的流行情况，以及不坚持使用安全套的预测因素。
方法
我们使用了回应者驱动抽样（一种针对难以接触到的人群的抽样策略），在西开普省进行了一项生物行为横断面调查，共招募了 259 名 16-24 岁的女性。使用回应者驱动抽样分析工具 5.6（RDSAT）计算了人口比例和 95%置信区间（CI）的估计值。主要结局是过去三个月中不坚持使用安全套。
结果
年轻女性报告过去三个月平均有 7 个性伴，性风险行为的流行率很高：同时有多个性伴（87%）、性交易（91%）和年龄混合（59%）。过去三个月中有>5 个性伴使无保护性行为的风险增加一倍（OR 2.43，CI 1.39-4.25）。16-19 岁人群中的 HIV 流行率为 4%，20-24 岁时增加了三倍（12%）。
讨论
多重性伴，即在短时间内获得大量伴侣，是无保护和高危性行为的沃土。参与这项调查的年轻女性表现出一系列高危性行为，这些行为集中形成了一种风险综合征。建议对这一亚人群进行精心设计的重复生物行为监测调查。
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