Bunyasi Erick Wekesa, Coetzee David John
South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
BMJ Open. 2017 Nov 20;7(11):e016232. doi: 10.1136/bmjopen-2017-016232.
Studies have shown a mixed association between socioeconomic status (SES) and prevalent HIV infection across and within settings in sub-Saharan Africa. In general, the relationship between years of formal education and HIV infection changed from a positive to a negative association with maturity of the HIV epidemic. Our objective was to determine the association between SES and HIV in women of reproductive age in the Free State (FSP) and Western Cape Provinces (WCP) of South Africa (SA).
Cross-sectional.
SA.
We conducted secondary analysis on 1906 women of reproductive age from a 2007 to 2008 survey that evaluated effectiveness of Prevention of Mother-to-Child HIV Transmission Programmes. SES was measured by household wealth quintiles, years of formal education and employment status. Our analysis principally used logistic regression for survey data.
There was a significant negative trend between prevalent HIV infection and wealth quintile in WCP (P<0.001) and FSP (P=0.025). In adjusted analysis, every additional year of formal education was associated with a 10% (adjusted OR (aOR) 0.90 (95% CI 0.85 to 0.96)) significant reduction in risk of prevalent HIV infection in WCP but no significant association was observed in FSP (aOR 0.99; 95% CI 0.89 to 1.11). There was no significant association between employment and prevalent HIV in each province: (aOR 1.54; 95% CI 0.84 to 2.84) in WCP and (aOR 0.96; 95% CI 0.71 to 1.30) in FSP.
The association between HIV infection and SES differed by province and by measure of SES and underscores the disproportionately higher burden of prevalent HIV infection among poorer and lowly educated women. Our findings suggest the need for re-evaluation of whether current HIV prevention efforts meet needs of the least educated (in WCP) and the poorest women (both WCP and FSP), and point to the need to investigate additional or tailored strategies for these women.
研究表明，在撒哈拉以南非洲地区，社会经济地位（SES）与普遍存在的艾滋病毒感染之间的关联参差不齐。总体而言，随着艾滋病毒疫情的成熟，正规教育年限与艾滋病毒感染之间的关系从正相关转变为负相关。我们的目标是确定南非自由邦（FSP）和西开普省（WCP）育龄妇女的社会经济地位与艾滋病毒之间的关联。
横断面研究。
南非。
我们对2007年至2008年一项评估预防母婴艾滋病毒传播计划有效性的调查中的1906名育龄妇女进行了二次分析。社会经济地位通过家庭财富五分位数、正规教育年限和就业状况来衡量。我们的分析主要使用针对调查数据的逻辑回归。
在西开普省（P<0.001）和自由邦（P=0.025），艾滋病毒感染率与财富五分位数之间存在显著的负相关趋势。在调整分析中，正规教育每增加一年，西开普省艾滋病毒感染率的风险显著降低10%（调整后的比值比（aOR）为0.90（95%置信区间为0.85至0.96）），但在自由邦未观察到显著关联（aOR为0.99；95%置信区间为0.89至1.11）。每个省份的就业与艾滋病毒感染率之间均无显著关联：西开普省为（aOR为1.54；95%置信区间为0.84至2.84），自由邦为（aOR为0.96；95%置信区间为0.71至1.30）。
艾滋病毒感染与社会经济地位之间的关联因省份和社会经济地位衡量标准而异，突出了贫困和受教育程度低的妇女中艾滋病毒感染率负担过高的情况。我们的研究结果表明，需要重新评估当前的艾滋病毒预防措施是否满足受教育程度最低（在西开普省）和最贫困妇女（西开普省和自由邦）的需求，并指出需要为这些妇女研究额外的或量身定制的策略。
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