Pitpitan Eileen V, Kalichman Seth C, Eaton Lisa A, Sikkema Kathleen J, Watt Melissa H, Skinner Donald, Pieterse Desiree
Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA.
Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA.
Prev Sci. 2016 May;17(4):472-82. doi: 10.1007/s11121-015-0629-9.
South Africa has among the highest rates of HIV infection in the world, with women disproportionately affected. Alcohol-serving venues, where alcohol use and sexual risk often intersect, play an important role in HIV risk. Previous studies indicate alcohol use and gender inequity as drivers of this epidemic, yet these factors have largely been examined using person-level predictors. We sought to advance upon this literature by examining venue-level predictors, namely men's gender attitudes, alcohol, and sex behavior, to predict women's risks for HIV. We recruited a cohort of 554 women from 12 alcohol venues (6 primarily Black African, and 6 primarily Coloured [i.e., mixed race] venues) in Cape Town, who were followed for 1 year across four time points. In each of these venues, men's (N = 2216) attitudes, alcohol use, and sexual behaviors were also assessed. Men's attitudes and behaviors at the venue level were modeled using multilevel modeling to predict women's unprotected sex over time. We stratified analyses by venue race. As predicted, venue-level characteristics were significantly associated with women's unprotected sex. Stratified results varied between Black and Coloured venues. Among Black venues where men reported drinking alcohol more frequently, and among Coloured venues where men reported meeting sex partners more frequently, women reported more unprotected sex. This study adds to the growing literature on venues, context, and HIV risk. The results demonstrate that men's behavior at alcohol drinking venues relate to women's risks for HIV. This novel finding suggests a need for social-structural interventions that target both men and women to reduce women's risks.
南非是世界上艾滋病毒感染率最高的国家之一，女性受影响的比例尤其高。提供酒精饮料的场所，往往是饮酒行为和性风险的交集所在，在艾滋病毒风险方面起着重要作用。先前的研究表明，饮酒和性别不平等是这一流行病的驱动因素，但这些因素大多是通过个人层面的预测因素进行研究的。我们试图通过研究场所层面的预测因素，即男性的性别态度、饮酒情况和性行为，来预测女性的艾滋病毒风险，从而推进这方面的文献研究。我们从开普敦的12个提供酒精饮料的场所（6个主要是黑人非洲人场所，6个主要是有色人种[即混血人种]场所）招募了554名女性组成一个队列，在四个时间点对她们进行了为期1年的跟踪调查。在每个场所，还对男性（N = 2216）的态度、饮酒情况和性行为进行了评估。使用多层次模型对场所层面男性的态度和行为进行建模，以预测女性随时间推移的无保护性行为。我们按场所种族进行分层分析。正如预测的那样，场所层面的特征与女性的无保护性行为显著相关。分层结果在黑人和有色人种场所之间有所不同。在男性报告饮酒更频繁的黑人场所，以及男性报告更频繁结识性伴侣的有色人种场所，女性报告的无保护性行为更多。这项研究为关于场所、环境和艾滋病毒风险的不断增加的文献增添了内容。结果表明，男性在饮酒场所的行为与女性的艾滋病毒风险有关。这一新发现表明需要针对男性和女性的社会结构干预措施，以降低女性的风险。
