社会失衡与感染艾滋病毒的风险：南非夸祖鲁-纳塔尔省农村地区的一项多层次研究
Social Disequilibrium and the Risk of HIV Acquisition: A Multilevel Study in Rural KwaZulu-Natal Province, South Africa.
作者信息
Tomita Andrew, Vandormael Alain M, Bärnighausen Till, de Oliveira Tulio, Tanser Frank
机构信息
*College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella, South Africa; †Africa Health Research Institute, University of KwaZulu-Natal, Congella, South Africa; ‡Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; §Institute for Public Health, University of Heidelberg, Heidelberg, Germany; ‖Centre for the AIDS Programme of Research in South Africa (CAPRISA), Congella, South Africa; and ¶School of Nursing and Public Health, University of KwaZulu-Natal, Congella, South Africa.
出版信息
J Acquir Immune Defic Syndr. 2017 Jun 1;75(2):164-174. doi: 10.1097/QAI.0000000000001349.
BACKGROUND
Few population-based multilevel studies have quantified the risks that social context poses in rural communities with high HIV incidence across South Africa. We investigated the individual, social, and community challenges to HIV acquisition risk in areas with high and low incidence of HIV infection (hotspots/coldspots).
METHODS
The cohort (N = 17,376) included all HIV-negative adults enrolled in a population-based HIV surveillance study from 2004 to 2015 in a rural South African community with large labor migrancy. Multilevel survival models were fitted to examine the social determinants (ie, neighborhood migration intensity), community traits (ie, HIV prevalence), and individual determinants of HIV acquisition risk in identified hotspots/coldspots.
RESULTS
The HIV acquisition risk (adjusted hazard ratio [aHR] = 1.05, 95% confidence interval [CI]: 1.01 to 1.09) was greater in hotspots with higher neighborhood migration intensity among men. In women, higher neighborhood migration intensity (aHR = 1.02, 95% CI: 1.01 to 1.02) was associated with a greater HIV acquisition risk, irrespective of whether they lived in hotspot/coldspot communities. HIV acquisition risk was greater in communities with a higher prevalence of HIV in both men (aHR = 1.07, 95% CI: 1.03 to 1.12) and women (aHR = 1.03, 95% CI: 1.01 to 1.05), irrespective of hotspot/coldspot locations.
CONCLUSION
HIV acquisition risk was strongly influenced by gender (ie, young women), behavior (ie, sexual debut, contraception, circumcision), and social determinants. Certain challenges (ie, community disease prevalence) for HIV acquisition risk impacted both sexes, regardless of residence in hotspot/coldspot communities, whereas social determinants (ie, neighborhood migration intensity) were pronounced in hotspots among men. Future intervention scale-up requires addressing the social context that contributes to HIV acquisition risk in rural areas with high migration.
背景
在南非艾滋病毒高发的农村社区，基于人群的多层次研究很少对社会环境所带来的风险进行量化。我们调查了艾滋病毒感染率高和低的地区（热点/冷点）在艾滋病毒感染风险方面的个人、社会和社区挑战。
方法
该队列（N = 17376）包括2004年至2015年在南非一个有大量劳动力迁移的农村社区参加基于人群的艾滋病毒监测研究的所有艾滋病毒阴性成年人。采用多层次生存模型来研究社会决定因素（即邻里迁移强度）、社区特征（即艾滋病毒流行率）以及在确定的热点/冷点地区艾滋病毒感染风险的个人决定因素。
结果
在男性中，邻里迁移强度较高的热点地区艾滋病毒感染风险（调整后风险比[aHR]=1.05，95%置信区间[CI]：1.01至1.09）更大。在女性中，无论她们生活在热点/冷点社区，邻里迁移强度较高（aHR = 1.02，95%CI：1.01至1.02）都与更高的艾滋病毒感染风险相关。无论热点/冷点位置如何，艾滋病毒流行率较高的社区中男性（aHR = 1.07，95%CI：1.03至1.12）和女性（aHR = 1.03，95%CI：1.01至1.05）的艾滋病毒感染风险都更高。
结论
艾滋病毒感染风险受到性别（即年轻女性）、行为（即首次性行为、避孕、包皮环切术）和社会决定因素的强烈影响。艾滋病毒感染风险的某些挑战（即社区疾病流行率）对两性都有影响，无论居住在热点/冷点社区，而社会决定因素（即邻里迁移强度）在男性热点地区更为明显。未来扩大干预规模需要解决在高迁移率农村地区导致艾滋病毒感染风险的社会环境问题。
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