现金加关爱：社会保护可累计减轻南非青少年的艾滋病毒风险行为。

Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa.

作者信息

Cluver Lucie D, Orkin F Mark, Boyes Mark E, Sherr Lorraine

机构信息

aCenter for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford and Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa bWits School of Governance, University of the Witwatersrand, Johannesburg and Center for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford cHealth Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia and Center for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford dHealth Psychology Unit, Research Department of Infection and Population Health, University College London, London, UK.

出版信息

AIDS. 2014 Jul;28 Suppl 3:S389-97. doi: 10.1097/QAD.0000000000000340.

DOI:10.1097/QAD.0000000000000340

PMID:24991912

Abstract

OBJECTIVES

It is not known whether cumulative 'cash plus care' interventions can reduce adolescent HIV-infection risks in sub-Saharan Africa. This study investigated whether parental AIDS and other environmental adversities increase adolescent HIV-risk behaviour and whether social protection provision of 'cash' or integrated 'cash plus care' reduces HIV-risk behaviour.

DESIGN

A prospective observational study with random sampling (<2.5% baseline refusal, 1-year follow-up, 96.8% retention).

METHODS

Three thousand five hundred and fifteen 10-18 year-olds (56.7% girls) were interviewed in South Africa between 2009-2010 and 2011-2012. All homes with a resident adolescent were sampled, within randomly selected census areas in two urban and two rural districts in two provinces. Measures included potential environmental risks (e.g. parental HIV/AIDS, poverty), social protection: receipt of cash/food support (e.g. child grants, school feeding), care (e.g. positive parenting) and HIV-risk behaviours (e.g. unprotected sex). Analyses used logistic regression.

RESULTS

Cash alone was associated with reduced HIV risk for girls [odds ratio (OR) 0.63; 95% confidence interval (95% CI) 0.44-0.91, P = 0.02] but not for boys. Integrated cash plus care was associated with halved HIV-risk behaviour incidence for both sexes (girls OR 0.55; 95% CI 0.35-0.85, P = 0.007; boys OR 0.50; 95% CI 0.31-0.82, P = 0.005), compared with no support and controlling for confounders. Follow-up HIV-risk behaviour was reduced from 41 to 15% for girls and from 42 to 17% for boys. Girls in AIDS-affected families and informal-dwelling boys had higher HIV-risk behaviour, but were less likely to access integrated social protection.

CONCLUSION

Integrated cash plus care reduces male and female adolescent HIV-risk behaviours. Increasing adolescent access to social protection may be an effective HIV prevention strategy in Sub-Saharan Africa.

摘要

目的

尚不清楚累积的“现金加关爱”干预措施能否降低撒哈拉以南非洲地区青少年感染艾滋病毒的风险。本研究调查了父母患艾滋病及其他环境逆境是否会增加青少年的艾滋病毒风险行为，以及提供“现金”的社会保护或综合的“现金加关爱”是否会降低艾滋病毒风险行为。

设计

一项前瞻性观察性研究，采用随机抽样（基线拒绝率<2.5%，为期1年的随访，保留率96.8%）。

方法

2009 - 2010年至2011 - 2012年期间，在南非对3515名10 - 18岁青少年（56.7%为女孩）进行了访谈。在两个省份的两个城市和两个农村地区随机选择的普查区域内，对所有有青少年居住的家庭进行抽样。测量指标包括潜在的环境风险（如父母感染艾滋病毒/艾滋病、贫困）、社会保护：获得现金/食品支持（如儿童补助金、学校供餐）、关爱（如积极的养育方式）以及艾滋病毒风险行为（如无保护性行为）。分析采用逻辑回归。

结果

仅现金与女孩艾滋病毒风险降低相关[比值比（OR）0.63；95%置信区间（95%CI）0.44 - 0.91，P = 0.02]，但与男孩无关。与无支持且控制混杂因素相比，综合的现金加关爱与两性艾滋病毒风险行为发生率减半相关（女孩OR 0.55；95%CI 0.35 - 0.85，P = 0.007；男孩OR 0.50；95%CI 0.31 - 0.82，P = 0.005）。随访时，女孩的艾滋病毒风险行为从41%降至15%，男孩从42%降至17%。受艾滋病影响家庭中的女孩和居住在非正式住所的男孩有更高的艾滋病毒风险行为，但获得综合社会保护的可能性较小。