Brodish Paul Henry
J Biosoc Sci. 2013 Nov;45(6):853-62. doi: 10.1017/s002193201200082x.
This paper investigates whether ethnic diversity at the Demographic and Health Surveys (DHS) cluster level predicts HIV serostatus in three sub-Saharan African countries (Kenya, Malawi and Zambia), using DHS household survey and HIV biomarker data for men and women aged 15–59 collected since 2006. The analysis relates a binary dependent variable (HIV positive serostatus) and a weighted aggregate predictor variable representing the number of different ethnic groups within a DHS Statistical Enumeration Area (SEA) or cluster, which roughly corresponds to a neighbourhood. Multilevel logistic regression is used to predict HIV prevalence within each SEA, controlling for known demographic, social and behavioural predictors of HIV serostatus. The key finding was that the cluster-level ethnic diversity measure was a significant predictor of HIV serostatus in Malawi and Zambia but not in Kenya. Additional results reflected the heterogeneity of the epidemics: male gender, marriage (Kenya), number of extramarital partners in the past year (Kenya and Malawi, but probably confounded with younger age) and Muslim religion (Zambia) were associated with lower odds of positive HIV serostatus. Condom use at last intercourse (a spurious result probably reflecting endogeneity), STD in the past year, number of lifetime sexual partners, age (Malawi and Zambia), education (Zambia), urban residence (Malawi and Zambia) and employment (Kenya and Malawi) were associated with higher odds of positive serostatus. Future studies might continue to employ multilevel models and incorporate additional, more robust, controls for individual behavioural risk factors and for higher-level social and economic factors, in order to verify and further clarify the association between neighbourhood ethnic diversity and HIV serostatus.
本文利用2006年以来收集的15至59岁男性和女性的人口与健康调查（DHS）住户调查及艾滋病毒生物标志物数据，研究了撒哈拉以南非洲三个国家（肯尼亚、马拉维和赞比亚）DHS聚类层面的种族多样性是否能预测艾滋病毒血清状况。该分析涉及一个二元因变量（艾滋病毒阳性血清状况）和一个加权汇总预测变量，该变量代表DHS统计枚举区（SEA）或聚类（大致相当于一个社区）内不同种族群体的数量。采用多层逻辑回归来预测每个SEA内的艾滋病毒流行率，同时控制已知的艾滋病毒血清状况的人口、社会和行为预测因素。关键发现是，聚类层面的种族多样性指标在马拉维和赞比亚是艾滋病毒血清状况的重要预测指标，但在肯尼亚则不然。其他结果反映了疫情的异质性：男性、婚姻状况（肯尼亚）、过去一年的婚外性伴侣数量（肯尼亚和马拉维，但可能与年龄较小混淆）以及穆斯林宗教信仰（赞比亚）与艾滋病毒阳性血清状况的较低几率相关。最近一次性交时使用避孕套（一个可能反映内生性的虚假结果）、过去一年感染性传播疾病、终身性伴侣数量、年龄（马拉维和赞比亚）、教育程度（赞比亚）、城市居住（马拉维和赞比亚）和就业情况（肯尼亚和马拉维）与阳性血清状况的较高几率相关。未来的研究可能会继续采用多层模型，并纳入更多针对个体行为风险因素以及更高级别的社会和经济因素的更强有力的控制措施，以验证并进一步阐明社区种族多样性与艾滋病毒血清状况之间的关联。
