南非感染人类免疫缺陷病毒的孕妇的性行为与性传播感染相关因素。
Sexual Behaviors of Human Immunodeficiency Virus-Infected Pregnant Women and Factors Associated With Sexually Transmitted Infection in South Africa.
机构信息
Division of Infectious Disease, David Geffen School of Medicine.
Research Unit, Foundation for Professional Development, Pretoria, South Africa.
出版信息
Sex Transm Dis. 2018 Nov;45(11):754-761. doi: 10.1097/OLQ.0000000000000847.
BACKGROUND
Sexual behaviors in human immunodeficiency virus (HIV)-infected pregnant women in South Africa are not well understood.
METHODS
Human immunodeficiency virus-infected pregnant women were recruited into a prospective cohort at first antenatal care visit. Sociodemographic information and self-collected vulvovaginal swab samples were collected from participants. Vulvovaginal swab samples were tested for Chlamydia trachomatis, Neisseria gonorrhoea, and Trichomonas vaginalis using GeneXpert. We investigated sexual behaviors, alcohol use, factors associated with condomless sex during pregnancy, and prevalent sexually transmitted infection (STI) among our cohort. We report descriptive, univariate and multivariable logistic regression results of sexual behaviors and alcohol use, factors associated with condomless sex at last sex, and having any STI during pregnancy adjusting for a priori confounders.
RESULTS
We recruited and enrolled 430 HIV-infected pregnant women. Median age was 30 years; median gestational age was 20 weeks. Eighty-nine percent of women reported sex during pregnancy. At last sex, 68% reported condomless sex; 18% reported having more than 1 sex partner in the past 12 months. Adjusting for age, income and relationship status, condom use at last sex was associated with prior knowledge of HIV status (adjusted odds ratio [aOR], 2.46; 95% confidence interval [CI], 1.54-3.92) and being in a concordant HIV-positive (aOR, 3.17; 95% CI, 1.84-5.50), or serodiscordant relationship (aOR, 6.50; 95% CI, 3.59-11.80). The prevalence of any STI was 41% (95% CI, 36%-45%). Adjusting for mothers' age and employment, odds of having an STI increased if the woman reported alcohol use during pregnancy (aOR, 1.96; 95% CI, 1.06-3.64) or if the father of the child was a non-cohabiting or casual partner (aOR, 1.42; 95% CI, 0.97-2.03).
CONCLUSIONS
Almost all HIV-infected pregnant women were sexually active during pregnancy and most women reported condomless sex at last sex. Condom use was associated with knowledge of serostatus and/or partner's serostatus before first antenatal care visit. Factors associated with having STIs included: alcohol use during pregnancy and father of child being a non-cohabiting partner.
背景
南非人类免疫缺陷病毒（HIV）感染孕妇的性行为尚不清楚。
方法
HIV 感染孕妇在首次产前检查时被招募到前瞻性队列中。从参与者中收集社会人口统计学信息和自我采集的阴道拭子样本。使用 GeneXpert 检测阴道拭子样本是否存在沙眼衣原体、淋病奈瑟菌和阴道毛滴虫。我们调查了我们队列中的性行为、饮酒、与怀孕期间无保护性行为相关的因素以及性传播感染（STI）的流行情况。我们报告了性行为和饮酒的描述性、单变量和多变量逻辑回归结果，以及与上次性行为时无保护性行为相关的因素，以及怀孕期间是否存在任何 STI，同时调整了先验混杂因素。
结果
我们招募并纳入了 430 名 HIV 感染孕妇。中位年龄为 30 岁；中位妊娠周数为 20 周。89%的女性报告在怀孕期间有过性行为。在上次性行为中，68%的人报告有过无保护性行为；18%的人报告在过去 12 个月中有超过 1 个性伴侣。调整年龄、收入和关系状况后，上次性行为时使用避孕套与事先了解 HIV 状况（调整后的优势比 [aOR]，2.46；95%置信区间 [CI]，1.54-3.92）和处于 HIV 阳性一致（aOR，3.17；95%CI，1.84-5.50）或血清不一致关系（aOR，6.50；95%CI，3.59-11.80）相关。任何 STI 的患病率为 41%（95%CI，36%-45%）。如果母亲报告怀孕期间饮酒（aOR，1.96；95%CI，1.06-3.64）或孩子的父亲是非同居或偶然伴侣（aOR，1.42；95%CI，0.97-2.03），则调整母亲的年龄和就业状况后，感染 STI 的几率会增加。
结论
几乎所有 HIV 感染的孕妇在怀孕期间都有性行为，大多数女性在上次性行为中报告无保护性行为。在首次产前检查前，避孕套的使用与对血清状况和/或伴侣血清状况的了解有关。与 STI 相关的因素包括：怀孕期间饮酒和孩子的父亲是非同居伴侣。
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