Gari S, Martin-Hilber A, Malungo J R S, Musheke M, Merten S
a Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , University of Basel , Basel , Switzerland.
AIDS Care. 2014;26(10):1258-62. doi: 10.1080/09540121.2014.897911. Epub 2014 Mar 25.
This study explores socio-structural factors that influence uptake of antiretroviral treatment (ART) in Zambia and assess differences between men and women. We conducted a case-control study nested in a community- and health facility-based survey, between September 2010 and February 2011. Cases were defined as HIV-positive individuals who, while eligible, never started ART and controls were HIV-positive individuals who were on ART. Cases and controls were matched by place of residence. We performed a conditional logistic regression analysis using a discrete logistic model stratified by sex. Overall, a significantly larger proportion of men (32.7%) than women (25.6%) did not uptake ART (Pearson χ(2) = 5.9135; p = 0.015). In the crude analysis, poor health status and low self-efficacy were common factors associated with non-uptake in both sexes. After adjusting for covariates, men were more likely than women to refuse ART even though men's self-rated health was lower than women's. In general, the adjusted analysis suggests that HIV status disclosure affects uptake in both sexes but women's uptake of ART is largely hampered by poverty-related factors while for men, side effects and social pressure, probably associated with masculinity, are more important barriers. Alarmingly men's health seems to deteriorate until they start treatment, in contrast to women. Understanding gender differences in uptake and attitudes to ART is a crucial component to providing effective and appropriate health care to both men and women living with HIV/AIDS in Zambia.
本研究探讨了影响赞比亚抗逆转录病毒治疗（ART）接受情况的社会结构因素，并评估了男性和女性之间的差异。我们在2010年9月至2011年2月期间，在一项基于社区和医疗机构的调查中开展了一项病例对照研究。病例被定义为符合条件但从未开始接受抗逆转录病毒治疗的HIV阳性个体，对照为正在接受抗逆转录病毒治疗的HIV阳性个体。病例和对照按居住地进行匹配。我们使用按性别分层的离散逻辑模型进行了条件逻辑回归分析。总体而言，未接受抗逆转录病毒治疗的男性比例（32.7%）显著高于女性（25.6%）（Pearson χ² = 5.9135；p = 0.015）。在粗分析中，健康状况不佳和自我效能感低是两性未接受治疗的常见相关因素。在对协变量进行调整后，尽管男性自我评定的健康状况低于女性，但男性比女性更有可能拒绝接受抗逆转录病毒治疗。一般来说，调整后的分析表明，HIV状况的披露会影响两性的接受情况，但女性接受抗逆转录病毒治疗在很大程度上受到与贫困相关因素的阻碍，而对男性来说，副作用和社会压力（可能与男子气概有关）是更重要的障碍。令人担忧的是，与女性相比，男性在开始治疗之前健康状况似乎会恶化。了解两性在接受抗逆转录病毒治疗方面的差异以及对其的态度，是为赞比亚感染艾滋病毒/艾滋病的男性和女性提供有效和适当医疗保健的关键组成部分。
