Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA.
Department of Global Health and Development, London School of Tropical Medicine and Hygiene, London, UK.
AIDS. 2018 Jul 31;32(12):1669-1677. doi: 10.1097/QAD.0000000000001866.
In sub-Saharan Africa, young women who engage in transactional sex (the exchange of sex for money or gifts) with a male partner show an elevated risk of prevalent HIV infection. We analyse longitudinal data to estimate the association between transactional sex and HIV incidence.
We used longitudinal data from a cohort of 2362 HIV-negative young women (aged 13-20 years) enrolled in a randomized controlled trial in rural, South Africa who were followed for up to four visits over 6 years.
The effect of transactional sex on incident HIV was analysed using stratified Cox proportional hazards models and cumulative incidence curves. Risk ratios were estimated using log-binomial models to compare the effects across visits.
HIV incidence was higher for young women that reported transactional sex (hazard ratio 1.59, 95% confidence interval 1.02-2.19), particularly when money and/or gifts were received frequently (at least weekly) (hazard ratio 2.71, 95% confidence interval 1.44-5.12). We also find that effects were much stronger during the main trial and dissipate at the postintervention visit, despite an increase in both transactional sex and HIV.
Transactional sex elevates the risk of HIV acquisition among young women, especially when it involves frequent exchanges of money and/or gifts. However, the effect was attenuated after the main trial, possibly due to the changing nature of transactional sex and sexual partners as women age. These findings suggest that reducing transactional sex among young women, especially during adolescence, is important for HIV prevention.
在撒哈拉以南非洲，与男性伴侣进行性交易（即性换取金钱或礼物）的年轻女性，其普遍存在 HIV 感染的风险较高。我们分析了纵向数据，以估计性交易与 HIV 发病率之间的关联。
我们使用了来自南非农村一项队列研究的纵向数据，该研究共纳入了 2362 名 HIV 阴性的年轻女性（年龄在 13-20 岁之间），这些女性参加了一项随机对照试验，随访时间长达 6 年，共进行了 4 次访视。
使用分层 Cox 比例风险模型和累积发病率曲线分析性交易对 HIV 发病的影响。使用对数二项式模型估计风险比，以比较各访视之间的影响。
报告有性交易的年轻女性 HIV 发病率更高（危险比 1.59，95%置信区间 1.02-2.19），尤其是当金钱和/或礼物经常（每周至少一次）收到时（危险比 2.71，95%置信区间 1.44-5.12）。我们还发现，尽管性交易和 HIV 都有所增加，但在主要试验期间，这种影响要强得多，并且在干预后访视时会减弱。
性交易会增加年轻女性感染 HIV 的风险，尤其是当涉及到频繁的金钱和/或礼物交换时。然而，主要试验结束后，这种影响会减弱，这可能是由于女性年龄增长，性交易和性伴侣的性质发生了变化。这些发现表明，减少年轻女性，特别是青少年时期的性交易，对于 HIV 预防非常重要。
