Wechsberg Wendee M, Doherty Irene A, Myers Bronwyn, Morgan-Lopez Antonio A, Emanuel Andrea, Carney Tara, Kline Tracy L, Zule William A
RTI International, Research Triangle Park, NC, USA; University of North Carolina, Chapel Hill, NC, USA; North Carolina State University, Raleigh, NC, USA; Duke University, Durham, NC, USA.
RTI International, Research Triangle Park, NC, USA; University of North Carolina, Chapel Hill, NC, USA.
Int J Drug Policy. 2014 May;25(3):583-90. doi: 10.1016/j.drugpo.2013.10.016. Epub 2013 Nov 9.
This study was conducted in a large Black African township outside of Cape Town, South Africa, where HIV infection has been endemic at extremely high levels for years. Problems associated with high HIV prevalence are compounded by gender inequality and high rates of gender-based violence exacerbated by heavy alcohol use and increasing methamphetamine use.
Informal drinking establishments (known as shebeens) were geocoded and mapped. Based on visual examination, we identified 36 neighbourhoods, each of which contained between three to seven drinking venues clustered together. Neighbourhoods were separated from each other by at least 200m. We randomly selected 30 of the 36 neighbourhoods. Outreach workers screened males in shebeens and screened their female partners. This analysis includes 580 study participants recruited from 30 neighbourhoods between 2010 and 2012. All participants completed a baseline questionnaire that included individual-level, couple-level, and neighbourhood-level measures of alcohol and other drug use, HIV infection, and HIV risk behaviours. Multilevel fixed effects regression analyses stratified by gender were conducted to examine correlates of HIV infection.
Women were twice as likely as men to be HIV infected, yet they reported fewer sex partners. Neighbourhood prevalence of HIV was correlated with greater likelihood of HIV infection among women, but not men. Neighbourhood methamphetamine use was marginally associated with HIV among women but not among men. At the individual level, heavy alcohol use was marginally associated with HIV infection among men but not among women. Having an HIV positive partner was the strongest correlate of being HIV positive among both men and women.
Findings from this study underscore the need for policy makers to direct scarce resources to the communities, places within communities, and populations, especially vulnerable women, where the impact on HIV prevention and onward transmission will be greatest.
本研究在南非开普敦以外的一个大型黑人非洲城镇进行，多年来艾滋病毒感染一直呈极高的流行态势。与高艾滋病毒流行率相关的问题因性别不平等以及因大量饮酒和甲基苯丙胺使用增加而加剧的基于性别的暴力高发生率而更加复杂。
对非正式饮酒场所（即非法酒吧）进行地理编码并绘制地图。通过目视检查，我们确定了36个社区，每个社区包含三到七个聚集在一起的饮酒场所。社区之间至少相隔200米。我们从36个社区中随机选择了30个。外展工作人员在非法酒吧对男性进行筛查，并对他们的女性伴侣进行筛查。本分析包括2010年至2012年期间从30个社区招募的580名研究参与者。所有参与者都完成了一份基线问卷，其中包括个人层面、伴侣层面和社区层面的酒精和其他药物使用、艾滋病毒感染及艾滋病毒风险行为的测量。进行了按性别分层的多水平固定效应回归分析，以检查艾滋病毒感染的相关因素。
女性感染艾滋病毒的可能性是男性的两倍，但她们报告的性伴侣较少。社区艾滋病毒流行率与女性感染艾滋病毒的可能性增加相关，但与男性无关。社区甲基苯丙胺使用与女性艾滋病毒感染存在微弱关联，但与男性无关。在个人层面，大量饮酒与男性艾滋病毒感染存在微弱关联，但与女性无关。拥有艾滋病毒阳性伴侣是男性和女性艾滋病毒阳性的最强相关因素。
本研究结果强调政策制定者需要将稀缺资源导向社区、社区内的场所和人群，特别是易受伤害的女性，因为在这些地方对艾滋病毒预防和传播的影响将最大。
