Wall Kristin M, Kilembe William, Vwalika Bellington, Haddad Lisa B, Lakhi Shabir, Onwubiko Udodirim, Htee Khu Naw, Brill Ilene, Chavuma Roy, Vwalika Cheswa, Mwananyanda Lawrence, Chomba Elwyn, Mulenga Joseph, Tichacek Amanda, Allen Susan
Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA.
Sex Transm Infect. 2017 Jun;93(4):259-266. doi: 10.1136/sextrans-2016-052743. Epub 2017 Jan 12.
BACKGROUND: We present temporal trends in self-reported and biological markers of unprotected sex and sex with concurrent partners in discordant couples receiving couples' voluntary HIV counselling and testing (CVCT). METHODS: Heterosexual Zambian HIV-serodiscordant couples were enrolled into longitudinal follow-up in an open cohort (1994-2012). Multivariable Anderson-Gill models explored predictors of self-report and biological indicators of unprotected sex within (including sperm on a vaginal swab, incident pregnancy or incident linked HIV infection) and outside (including self-report, STI and unlinked HIV infection) the union. Measures of secular trends in baseline measures were also examined. RESULTS: At enrolment of 3049 couples, men were 35 years old on average, women were 29 years, and couples had been together for an average of 7 years. reported an average of 16.6 unprotected sex acts in the 3 months prior to enrolment (pre-CVCT), dropping to 5.3 in the >0-3 month interval, and 2.0 in >6 month intervals (p-trend <0.001). Corresponding values for were 22.4 unprotected sex acts in the 3 months prior enrolment, dropping to 5.2 in the >0-3 month interval, and 3.1 in >6 month intervals (p-trend <0.001). Significant reductions in self-report and biological markers of outside partners were also noted. Predictors of unprotected sex between study partners after CVCT included prevalent pregnancy (adjusted HR, aHR=1.6-1.9); HIV+ men being circumcised (aHR=1.2); and HIV- women reporting sex with outside partners (aHR=1.3), alcohol (aHR=1.2), injectable (aHR=1.4) or oral (aHR=1.4) contraception use. Fertility intentions were also predictive of unprotected sex (aHR=1.2-1.4). Secular trends indicated steady declines in reported outside partners and STIs. CONCLUSION: Reductions in self-reported unprotected sex after CVCT were substantial and sustained. Reinforced risk-reduction counselling in pregnant couples, couples desiring children and couples with HIV- women having outside partners or using alcohol or injectable or oral contraception are indicated.
背景：我们呈现了接受夫妻自愿HIV咨询与检测（CVCT）的不一致性伴侣夫妻中，自我报告的无保护性行为及与多名性伴侣发生性行为的生物学标志物的时间趋势。 方法：赞比亚异性恋HIV血清学不一致的夫妻被纳入一个开放队列进行纵向随访（1994 - 2012年）。多变量Anderson - Gill模型探讨了婚姻内（包括阴道拭子上的精子、意外怀孕或意外关联的HIV感染）和婚姻外（包括自我报告、性传播感染和非关联的HIV感染）无保护性行为的自我报告和生物学指标的预测因素。还检查了基线测量的长期趋势指标。 结果：在3049对夫妻入组时，男性平均年龄为35岁，女性为29岁，夫妻在一起的平均时间为7年。报告在入组前3个月（CVCT前）平均有16.6次无保护性行为，在0至3个月期间降至5.3次，在6个月以上期间降至2.0次（p趋势<0.001）。女性相应的值在入组前3个月为22.4次无保护性行为，在0至3个月期间降至5.2次，在6个月以上期间降至3.1次（p趋势<0.001）。婚姻外伴侣的自我报告和生物学标志物也有显著下降。CVCT后研究伴侣间无保护性行为的预测因素包括既往怀孕（调整后风险比，aHR = 1.6 - 1.9）；接受包皮环切术的HIV阳性男性（aHR = 1.2）；报告与婚姻外伴侣发生性行为的HIV阴性女性（aHR = 1.3）、饮酒（aHR = 1.2）、使用注射用（aHR = 1.4）或口服（aHR = 1.4）避孕药。生育意愿也是无保护性行为的预测因素（aHR = 1.2 - 1.4）。长期趋势表明报告的婚姻外伴侣和性传播感染稳步下降。 结论：CVCT后自我报告的无保护性行为显著且持续减少。建议对怀孕夫妻、想要孩子的夫妻以及妻子有婚姻外伴侣或使用酒精、注射用或口服避孕药的HIV阴性夫妻加强降低风险咨询。
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