Santelli John S, Edelstein Zoe R, Wei Ying, Mathur Sanyukta, Song Xiaoyu, Schuyler Ashley, Nalugoda Fred, Lutalo Tom, Gray Ron, Wawer Maria, Serwadda David
aColumbia University Mailman School of Public Health bHIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, USA cRakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda dBloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
AIDS. 2015 Jan 14;29(2):211-9. doi: 10.1097/QAD.0000000000000533.
The objective of this study is to understand how trends in HIV acquisition among youth can be influenced by change in HIV risk factors, social factors and prevention and treatment programmes.
Trends in HIV incidence (per 1000 person-years), by sex and age group, were estimated using data from youth (15-24 years: n = 22,164) in the Rakai Community Cohort Study. Trends in HIV incidence were compared with trends in previously identified HIV risk factors, social factors and programmes.
Poisson and linear regression were used to test for statistical significance and decomposition was used to calculate attribution of risk factors to HIV incidence.
Substantial declines between 1999 and 2011 occurred in sexual experience, multiple partners and sexual concurrency among adolescents and young adults. HIV acquisition declined substantially (86%, P = 0.006) among adolescent women (15-19 years) but not among men or young adult women. Changes in HIV incidence and risk behaviours coincided with increases in school enrolment, decline in adolescent marriage, availability of antiretroviral therapy (ART) and increases in male medical circumcision (MMC). Much of the decline in HIV incidence among adolescent women (71%) was attributable to reduced sexual experience; the decline in sexual experience was primarily attributable to increasing levels of school enrolment.
Dramatic decreases in HIV incidence occurred among adolescent women in Rakai. Changes in school enrolment and sexual experience were primarily responsible for declining HIV acquisition over time among adolescent women. Given limited improvement among young men and young adult women, the need for effective HIV prevention for young people remains critical.
本研究旨在了解青年人群中艾滋病病毒感染趋势如何受到艾滋病病毒危险因素、社会因素以及预防和治疗项目变化的影响。
利用拉克依社区队列研究中15至24岁青年（n = 22164）的数据，按性别和年龄组估算艾滋病病毒发病率（每1000人年）趋势。将艾滋病病毒发病率趋势与先前确定的艾滋病病毒危险因素、社会因素及项目趋势进行比较。
采用泊松回归和线性回归检验统计学显著性，并运用分解法计算危险因素对艾滋病病毒发病率的归因。
1999年至2011年间，青少年和青年的性经历、多性伴和性伴重叠现象大幅下降。青少年女性（15至19岁）中艾滋病病毒感染率大幅下降（86%，P = 0.006），但男性和青年女性中未出现此类情况。艾滋病病毒发病率和危险行为的变化与入学率上升、青少年婚姻减少、抗逆转录病毒疗法（ART）可及性提高以及男性包皮环切术（MMC）增加相吻合。青少年女性中艾滋病病毒发病率下降的大部分原因（71%）是性经历减少；性经历减少主要归因于入学率的提高。
拉克依地区青少年女性的艾滋病病毒发病率显著下降。入学率和性经历的变化是青少年女性艾滋病病毒感染率随时间下降的主要原因。鉴于青年男性和青年女性的改善有限，对年轻人进行有效的艾滋病病毒预防仍然至关重要。
