Population Council, HIV and AIDS Program, Washington D.C., United States of America.
Makerere University Child Health and Development Centre, Kampala, Uganda.
PLoS One. 2018 Aug 10;13(8):e0200920. doi: 10.1371/journal.pone.0200920. eCollection 2018.
Substantial concern exists about the high risk of sexually transmitted HIV to adolescent girls and young women (AGYW, ages 15-24) in Eastern and Southern Africa. Yet limited research has been conducted with AGYW's male sexual partners regarding their perspectives on relationships and strategies for mitigating HIV risk. We sought to fill this gap in order to inform the DREAMS Partnership and similar HIV prevention programs in Uganda.
We conducted 94 in-depth interviews, from April-June 2017, with male partners of AGYW in three districts: Gulu, Mukono, and Sembabule. Men were recruited at community venues identified as potential transmission areas, and via female partners enrolled in DREAMS. Analyses focused on men's current and recent partnerships and HIV service use.
Most respondents (80%) were married and 28 years old on average. Men saw partner concurrency as pervasive, and half described their own current multiple partners. Having married in their early 20s, over time most men continued to seek out AGYW as new partners, regardless of their own age. Relationships were highly fluid, with casual short-term partnerships becoming more formalized, and more formalized partnerships characterized by periods of separation and outside partnerships. Nearly all men reported recent HIV testing and described testing at distinct relationship points (e.g., when deciding to continue a relationship/get married, or when reuniting with a partner after a separation). Testing often stemmed from distrust of partner behavior, and an HIV-negative status served to validate respondents' current relationship practices.
Across the three regions in Uganda, findings with partners of AGYW confirm earlier reports in Uganda of multiple concurrent partnerships, and demonstrate substantial HIV testing. Yet they also unearth the degree to which these partnerships are fluid (switching between casual and/or more long-term partnerships), which complicates potential HIV prevention strategies. Context-specific findings around these partnerships and risk are critical to further tailor HIV prevention programs.
在东非和南非，青少年女孩和年轻妇女（AGYW，年龄在 15-24 岁之间）感染艾滋病毒的风险很高，这引起了极大的关注。然而，针对 AGYW 的男性性伴侣，关于他们对关系的看法以及减轻艾滋病毒风险的策略，相关研究有限。为了填补这一空白，我们旨在为 DREAMS 合作伙伴关系和乌干达类似的艾滋病毒预防计划提供信息。
我们于 2017 年 4 月至 6 月期间在三个地区（古卢、穆科诺和森巴武尔）对 AGYW 的男性伴侣进行了 94 次深入访谈。这些男性是在被认为是潜在传播区域的社区场所和通过参与 DREAMS 的女性伴侣那里招募的。分析重点是男性目前和最近的伴侣关系以及艾滋病毒服务的使用情况。
大多数受访者（80%）已婚，平均年龄为 28 岁。男性认为伴侣间的同时存在是普遍的，有一半的人描述了自己目前有多个伴侣。他们在 20 多岁初婚，随着时间的推移，大多数男性继续寻找 AGYW 作为新伴侣，而不管他们自己的年龄如何。关系非常不稳定，随意的短期伴侣关系变得更加正式，而更加正式的伴侣关系则以分居和外部伴侣关系为特征。几乎所有男性都报告了最近的艾滋病毒检测，并描述了在不同关系点进行的检测（例如，在决定继续一段关系/结婚时，或在分居后与伴侣团聚时）。检测往往源于对伴侣行为的不信任，而艾滋病毒阴性状态证实了受访者目前的关系实践。
在乌干达的三个地区，对 AGYW 男性伴侣的研究结果证实了乌干达早期关于多个同时存在的伴侣关系的报告，并表明了大量的艾滋病毒检测。然而，这些研究结果也揭示了这些关系的不稳定性（在随意的和/或更长期的伴侣关系之间切换），这使得潜在的艾滋病毒预防策略变得复杂。围绕这些伙伴关系和风险的具体背景情况对于进一步调整艾滋病毒预防计划至关重要。
