赞比亚年轻人性行为风险行为的下降（2000-2009 年）：邻里环境效应是否发挥了作用？
Decline in sexual risk behaviours among young people in Zambia (2000-2009): do neighbourhood contextual effects play a role?
机构信息
Centre for International Health, University of Bergen, Bergen, Norway.
出版信息
PLoS One. 2013 May 23;8(5):e64881. doi: 10.1371/journal.pone.0064881. Print 2013.
OBJECTIVE
This study examined trends in premarital sex, multiple partnership and condom use among young people (15-24 years) in Zambia from 2000 to 2009, and assessed the effects of individual and neighbourhood variables on these sexual behaviour indicators in 2000 and 2009.
METHODOLOGY
We analysed data from the Zambia Sexual Behaviour Survey, conducted in 2000, 2003, 2005 and 2009. Multi-stage cluster sampling was used to select 385 neighbourhoods, giving a population sample of 6,500 young people. Using linear-by-linear trend test, trends in the three indicators were examined. Multilevel logistic regression was used to assess the effects of individual and neighbourhood variables on the indicators.
RESULTS
Premarital sex among young people decreased significantly from 51 to 42% between 2000 and 2009. Multiple partnerships of men also decreased from 26 to 14% during the same period. The use of condoms by young people remained stable during this period. Full multilevel regression models explained 29 and 34% of the neighbourhood variance of premarital sex in 2000 and 2009. For multiple partnerships and condom use, the explained variance was 29 and 18% in 2000; whereas in 2009 it was extremely low. Urban residence and living in neighbourhood with higher average duration of residence were associated with low premarital sex and higher condom use. Living in a neighbourhood with higher average level of comprehensive knowledge of HIV was associated with less risky sexual behaviour.
CONCLUSION
Declining trends in premarital sex and multiple partnerships are among the factors that might explain the decrease in HIV incidence in Zambia among young people. However, condom use among young people has remained low and stable over the years. The results also suggest that behaviour change interventions should take stock of the social context when introducing individual-level programmes because neighbourhood factors play a considerable role in influencing sexual behaviour.
目的
本研究旨在探讨 2000 年至 2009 年期间赞比亚年轻人（15-24 岁）婚前性行为、多伴侣和避孕套使用的趋势，并评估 2000 年和 2009 年个人和社区变量对这些性行为指标的影响。
方法
我们分析了 2000 年、2003 年、2005 年和 2009 年进行的赞比亚性行为调查的数据。采用多阶段聚类抽样选择 385 个社区，为年轻人提供了 6500 人的样本。使用线性线性趋势检验，检查三个指标的趋势。多水平逻辑回归用于评估个人和社区变量对指标的影响。
结果
2000 年至 2009 年期间，年轻人婚前性行为从 51%下降到 42%，男性多伴侣关系也从 26%下降到 14%。在此期间，年轻人使用避孕套的比例保持稳定。在整个多水平回归模型中，2000 年和 2009 年，婚前性行为的社区方差分别解释了 29%和 34%。对于多伴侣关系和避孕套使用，2000 年的解释方差分别为 29%和 18%；而 2009 年的解释方差极低。城市居住和居住在居住时间平均水平较高的社区与低婚前性行为和高避孕套使用有关。居住在综合艾滋病毒知识水平较高的社区与较低风险的性行为有关。
结论
婚前性行为和多伴侣关系下降是赞比亚年轻人中 HIV 发病率下降的因素之一。然而，多年来，年轻人使用避孕套的比例一直较低且稳定。研究结果还表明，行为改变干预措施在引入个人层面的方案时应考虑社会背景，因为社区因素在影响性行为方面发挥着重要作用。
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