乌干达拉凯地区青少年新发 HIV 感染的行为、生物学、人口统计学风险和保护因素。
Behavioral, biological, and demographic risk and protective factors for new HIV infections among youth in Rakai, Uganda.
机构信息
Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
出版信息
J Acquir Immune Defic Syndr. 2013 Jul 1;63(3):393-400. doi: 10.1097/QAI.0b013e3182926795.
BACKGROUND
Prevalence of HIV infection is considerable among youth, although data on risk factors for new (incident) infections are limited. We examined incidence of HIV infection and risk and protective factors among youth in rural Uganda, including the role of gender and social transitions.
METHODS
Participants were sexually experienced youth (15-24 years old) enrolled in the Rakai Community Cohort Study, 1999-2008 (n = 6741). Poisson regression with robust standard errors was used to estimate incident rate ratios (IRR) and 95% confidence intervals (CI) of incident HIV infection.
RESULTS
HIV incidence was greater among young women than young men (14.1 vs. 8.3 per 1000 person-years, respectively); this gender disparity was greater among teenagers (14.9 vs. 3.6). Beyond behavioral (multiple partners and concurrency) and biological factors (sexually transmitted infection symptoms), social transitions such as marriage and staying in school influenced HIV risk. In multivariate analyses among women, HIV incidence was associated with living in a trading village (adjusted IRR (aIRR) = 1.48; 95% CI: 1.04 to 2.11), being a student (aIRR = 0.22; 95% CI: 0.07 to 0.72), current marriage (aIRR = 0.55; 95% CI: 0.37 to 0.81), former marriage (aIRR = 1.73; 95% CI: 1.01 to 2.96), having multiple partners, and sexually transmitted infection symptoms. Among men, new infections were associated with former marriage (aIRR = 5.57; 95% CI: 2.51 to 12.36), genital ulceration (aIRR = 3.56; 95% CI: 1.97 to 6.41), and alcohol use (aIRR = 2.08; 95% CI: 1.15 to 3.77).
CONCLUSIONS
During the third decade of the HIV epidemic in Uganda, HIV incidence remains considerable among youth, with young women particularly at risk. The risk for new infections was strongly shaped by social transitions such as leaving school, entrance into marriage, and marital dissolution; the impact of marriage was different for young men than women.
背景
艾滋病毒感染在青年中相当普遍，尽管有关新（新发）感染危险因素的数据有限。我们研究了乌干达农村青年中的艾滋病毒感染发生率以及风险和保护因素，包括性别和社会转型的作用。
方法
参与者为 1999 年至 2008 年参加拉凯社区队列研究的有性经验的青年（15-24 岁）（n=6741）。使用泊松回归和稳健标准误差来估计艾滋病毒新发感染的发病率比（IRR）和 95%置信区间（CI）。
结果
青年女性的艾滋病毒发病率高于青年男性（分别为 14.1 比 8.3 每 1000 人年）；青少年中的这种性别差距更大（14.9 比 3.6）。除了行为因素（多个性伴侣和同时发生性行为）和生物因素（性传播感染症状）外，社会转型（如婚姻和留在学校）也影响艾滋病毒的风险。在女性的多变量分析中，艾滋病毒发病率与居住在贸易村（调整后的发病率比（aIRR）=1.48；95%置信区间：1.04 至 2.11）、学生（aIRR=0.22；95%置信区间：0.07 至 0.72）、当前婚姻（aIRR=0.55；95%置信区间：0.37 至 0.81）、以前的婚姻（aIRR=1.73；95%置信区间：1.01 至 2.96）、多个性伴侣和性传播感染症状有关。在男性中，新发感染与以前的婚姻（aIRR=5.57；95%置信区间：2.51 至 12.36）、生殖器溃疡（aIRR=3.56；95%置信区间：1.97 至 6.41）和饮酒（aIRR=2.08；95%置信区间：1.15 至 3.77）有关。
结论
在乌干达艾滋病毒流行的第三个十年期间，青年中的艾滋病毒发病率仍然相当高，青年女性的风险尤其高。新感染的风险受到社会转型的强烈影响，例如离开学校、进入婚姻和婚姻解体；婚姻对男女的影响不同。
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