年龄差异大的关系是否会导致年轻女性感染 HIV？来自南非夸祖鲁-纳塔尔省农村地区的一个人群队列研究的证据。
Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa.
机构信息
*Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA; †Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa; ‡Faculty of Medicine, University of Southampton, Southampton, United Kingdom; and §Department of Global Health and Population, Harvard School of Public Health, Boston, MA.
出版信息
J Acquir Immune Defic Syndr. 2014 Aug 1;66(4):443-51. doi: 10.1097/QAI.0000000000000198.
BACKGROUND
Based on ethnographic investigations and mathematical models, older sexual partners are often considered a major risk factor for HIV for young women in sub-Saharan Africa. Numerous public health campaigns have been conducted to discourage young women from relationships with older men. However, longitudinal evidence relating sex partner age disparity to HIV acquisition in women is limited.
METHODS
Using data from a population-based open cohort in rural KwaZulu-Natal, South Africa, we studied 15- to 29-year-old women who were HIV seronegative at first interview between January 2003 and June 2012 (n = 2444). We conducted proportional hazards analysis to establish whether the age disparity of women's most recent sexual partner, updated at each surveillance round, was associated with subsequent HIV acquisition.
RESULTS
A total of 458 HIV seroconversions occurred over 5913 person-years of follow-up (incidence rate: 7.75 per 100 person-years). Age disparate relationships were common in this cohort; 37.7% of women reported a partner 5 or more years older than themselves. The age disparity of women's partners was not associated with HIV acquisition when measured either continuously [hazard ratio (HR) for 1-year increase in partner's age: 1.00, 95% confidence interval (CI): 0.97 to 1.03] or categorically (man ≥5 years older: HR, 0.98; 95% CI: 0.81 to 1.20; man ≥10 years older: HR, 0.98; 95% CI: 0.67 to 1.43). These results were robust to adjustment for known sociodemographic and behavioral HIV risk factors and did not vary significantly by women's age, marital status, education attainment, or household wealth.
CONCLUSIONS
HIV incidence in young women was very high in this rural community in KwaZulu-Natal. Partner age disparity did not predict HIV acquistion. Campaigns to reduce age-disparate sexual relationships may not be a cost-effective use of HIV prevention resources in this setting.
背景
基于民族志调查和数学模型，年龄较大的性伴侣通常被认为是撒哈拉以南非洲年轻女性感染艾滋病毒的一个主要风险因素。为了劝阻年轻女性与年长男性发生性关系，已经开展了许多公共卫生运动。然而，关于性伴侣年龄差距与女性艾滋病毒感染之间的纵向证据有限。
方法
我们利用南非夸祖鲁-纳塔尔省农村地区一项基于人群的开放性队列研究的数据，对 2003 年 1 月至 2012 年 6 月期间首次访谈时艾滋病毒血清阴性的 15 至 29 岁女性（n=2444）进行了研究。我们采用比例风险分析来确定女性最近一次性伴侣的年龄差异（每次监测随访时更新）是否与随后的艾滋病毒感染有关。
结果
在 5913 人年的随访中，共发生了 458 例艾滋病毒血清转换（发生率：每 100 人年 7.75 例）。在该队列中，年龄差距较大的性关系很常见；37.7%的女性报告说她们的伴侣比自己年长 5 岁或以上。当以连续（伴侣年龄每增加 1 年的风险比：1.00，95%置信区间：0.97 至 1.03）或分类（男性≥5 岁：风险比，0.98；95%置信区间：0.81 至 1.20；男性≥10 岁：风险比，0.98；95%置信区间：0.67 至 1.43）来衡量时，伴侣年龄差异与艾滋病毒感染无关。这些结果在调整了已知的社会人口统计学和行为艾滋病毒风险因素后仍然稳健，并且不因女性年龄、婚姻状况、教育程度或家庭财富的不同而有显著差异。
结论
在夸祖鲁-纳塔尔省的这个农村社区，年轻女性的艾滋病毒发病率非常高。伴侣年龄差距并不能预测艾滋病毒感染。在这种情况下，减少年龄差距较大的性关系的运动可能不是艾滋病毒预防资源的一种具有成本效益的利用方式。
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