在乌干达维多利亚湖的渔业社区，HIV-1 感染率高，存在高危行为，人们愿意参与 HIV 疫苗试验。
High HIV-1 prevalence, risk behaviours, and willingness to participate in HIV vaccine trials in fishing communities on Lake Victoria, Uganda.
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
出版信息
J Int AIDS Soc. 2013 Jul 22;16(1):18621. doi: 10.7448/IAS.16.1.18621.
INTRODUCTION
HIV epidemics in sub-Saharan Africa are generalized, but high-risk subgroups exist within these epidemics. A recent study among fisher-folk communities (FFC) in Uganda showed high HIV prevalence (28.8%) and incidence (4.9/100 person-years). However, those findings may not reflect population-wide HIV rates in FFC since the study population was selected for high-risk behaviour.
METHODS
Between September 2011 and March 2013, we conducted a community-based cohort study to determine the population representative HIV rates and willingness to participate (WTP) in hypothetical vaccine trials among FFC, Uganda. At baseline (September 2011-January 2012), a household enumeration census was done in eight fishing communities (one lakeshore and seven islands), after which a random sample of 2200 participants aged 18-49 years was selected from 5360 individuals. Interviewer-administered questionnaire data were collected on HIV risk behaviours and WTP, and venous blood was collected for HIV testing using rapid HIV tests with enzyme-linked immunosorbent assay (EIA) confirmation. Adjusted prevalence proportion ratios (adj.PPRs) of HIV prevalence were determined using log-binomial regression models.
RESULTS
Overall baseline HIV prevalence was 26.7% and was higher in women than men (32.6% vs. 20.8%, p<0.0001). Prevalence was lower among fishermen (22.4%) than housewives (32.1%), farmers (33.1%) and bar/lodge/restaurant workers (37%). The adj.PPR of HIV was higher among women than men (adj.PPR =1.50, 95%; 1.20, 1.87) and participants aged 30-39 years (adj.PPR=1.40, 95%; 1.10, 1.79) and 40-49 years (adj.PPR=1.41, 95%; 1.04, 1.92) compared to those aged 18-24 years. Other factors associated with HIV prevalence included low education, previous marriage, polygamous marriage, alcohol and marijuana use before sex. WTP in hypothetical vaccine trials was 89.3% and was higher in men than women (91.2% vs. 87.3%, p=0.004) and among island communities compared to lakeshore ones (90.4% vs. 85.8%, p=0.004).
CONCLUSIONS
The HIV prevalence in the general fisher-folk population in Uganda is similar to that observed in the "high-risk" fisher folk. FFC have very high levels of willingness to participate in future HIV vaccine trials.
简介
撒哈拉以南非洲的艾滋病毒流行呈普遍态势，但在这些流行中存在高风险亚群。乌干达最近对渔民社区（FFC）进行的一项研究显示，艾滋病毒感染率较高（28.8%），发病率（4.9/100 人年）较高。然而，由于研究人群是为高风险行为而选择的，因此这些发现可能无法反映 FFC 中的人群普遍艾滋病毒率。
方法
2011 年 9 月至 2013 年 3 月，我们在乌干达进行了一项基于社区的队列研究，以确定 FFC 的人群代表性艾滋病毒率和参与假设疫苗试验的意愿（WTP）。在基线（2011 年 9 月至 2012 年 1 月），在八个渔业社区（一个湖滨和七个岛屿）进行了家庭普查，之后从 5360 个人中随机选择了 2200 名 18-49 岁的参与者。通过访谈者管理的问卷收集有关艾滋病毒风险行为和 WTP 的数据，并使用快速艾滋病毒检测和酶联免疫吸附试验（EIA）确认收集静脉血进行艾滋病毒检测。使用对数二项式回归模型确定艾滋病毒感染率的调整流行比例比（adj.PPR）。
结果
总体基线艾滋病毒感染率为 26.7%，女性高于男性（32.6%对 20.8%，p<0.0001）。渔民（22.4%）的感染率低于家庭主妇（32.1%）、农民（33.1%）和酒吧/旅馆/餐厅工人（37%）。与男性相比，女性的艾滋病毒 adj.PPR 更高（adj.PPR=1.50，95%；1.20，1.87）和年龄在 30-39 岁（adj.PPR=1.40，95%；1.10，1.79）和 40-49 岁（adj.PPR=1.41，95%；1.04，1.92）的参与者。与 18-24 岁的参与者相比，其他与艾滋病毒流行率相关的因素包括受教育程度低、曾结婚、一夫多妻制婚姻、性前饮酒和吸食大麻。假设疫苗试验中的 WTP 为 89.3%，男性高于女性（91.2%对 87.3%，p=0.004），岛屿社区高于湖滨社区（90.4%对 85.8%，p=0.004）。
结论
乌干达普通渔民人群中的艾滋病毒流行率与观察到的“高危”渔民人群相似。FFC 非常愿意参与未来的艾滋病毒疫苗试验。
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