性别不平等与艾滋病毒传播：一项全球分析。
Gender inequality and HIV transmission: a global analysis.
作者信息
Richardson Eugene T, Collins Sean E, Kung Tiffany, Jones James H, Hoan Tram Khai, Boggiano Victoria L, Bekker Linda-Gail, Zolopa Andrew R
机构信息
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Anthropology, Stanford University, Stanford, CA, USA; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa;
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
出版信息
J Int AIDS Soc. 2014 Jun 27;17(1):19035. doi: 10.7448/IAS.17.1.19035. eCollection 2014.
INTRODUCTION
The HIV pandemic disproportionately impacts young women. Worldwide, young women aged 15-24 are infected with HIV at rates twice that of young men, and young women alone account for nearly a quarter of all new HIV infections. The incommensurate HIV incidence in young - often poor - women underscores how social and economic inequalities shape the HIV epidemic. Confluent social forces, including political and gender violence, poverty, racism, and sexism impede equal access to therapies and effective care, but most of all constrain the agency of women.
METHODS
HIV prevalence data was compiled from the 2010 UNAIDS Global Report. Gender inequality was assessed using the 2011 United Nations Human Development Report Gender Inequality Index (GII). Logistic regression models were created with predominant mode of transmission (heterosexual vs. MSM/IDU) as the dependent variable and GII, Muslim vs. non-Muslim, Democracy Index, male circumcision rate, log gross national income (GNI) per capita at purchasing power parity (PPP), and region as independent variables.
RESULTS AND DISCUSSION
There is a significant correlation between having a predominantly heterosexual epidemic and high gender inequality across all models. There is not a significant association between whether a country is predominantly Muslim, has a high/low GNI at PPP, has a high/low circumcision rate, and its primary mode of transmission. In addition, there are only three countries that have had a generalized epidemic in the past but no longer have one: Cambodia, Honduras, and Eritrea. GII data are available only for Cambodia and Honduras, and these countries showed a 37 and 34% improvement, respectively, in their Gender Inequality Indices between 1995 and 2011. During the same period, both countries reduced their HIV prevalence below the 1% threshold of a generalized epidemic. This represents limited but compelling evidence that improvements in gender inequality can lead to the abatement of generalized epidemics.
CONCLUSIONS
Gender inequality is an important factor in the maintenance - and possibly in the establishment of - generalized HIV epidemics. We should view improvements in gender inequality as part of a broader public health strategy.
引言
艾滋病疫情对年轻女性的影响尤为严重。在全球范围内，15至24岁的年轻女性感染艾滋病毒的比率是年轻男性的两倍，仅年轻女性就占所有新增艾滋病毒感染病例的近四分之一。年轻女性（她们往往较为贫困）中不相称的艾滋病毒感染率凸显了社会和经济不平等如何塑造艾滋病疫情。包括政治暴力和性别暴力、贫困、种族主义和性别歧视在内的多种社会力量阻碍了平等获得治疗和有效护理的机会，但最主要的是限制了女性的自主权。
方法
艾滋病毒流行率数据取自《2010年联合国艾滋病规划署全球报告》。使用《2011年联合国人类发展报告性别不平等指数》（GII）评估性别不平等情况。以主要传播方式（异性传播与男男性行为者/注射吸毒者传播）作为因变量，以性别不平等指数、穆斯林与非穆斯林、民主指数、男性包皮环切率、按购买力平价计算的人均国民总收入对数（GNI）以及地区作为自变量，建立逻辑回归模型。
结果与讨论
在所有模型中，以异性传播为主的疫情与高度的性别不平等之间存在显著相关性。一个国家是否主要为穆斯林、购买力平价下国民总收入高/低、包皮环切率高/低与其主要传播方式之间没有显著关联。此外，过去曾有广泛疫情但现已不再存在的国家只有三个：柬埔寨、洪都拉斯和厄立特里亚。性别不平等指数数据仅适用于柬埔寨和洪都拉斯，这两个国家在1995年至2011年期间的性别不平等指数分别提高了37%和34%。在同一时期，这两个国家的艾滋病毒流行率均降至广泛疫情的1%阈值以下。这代表了有限但有力的证据，即性别不平等的改善可导致广泛疫情的缓解。
结论
性别不平等是维持——甚至可能是导致——广泛艾滋病毒疫情的一个重要因素。我们应将性别不平等的改善视为更广泛公共卫生战略的一部分。
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