Southern Africa Labour and Development Research Unit (SALDRU), Department of Economics, University of Cape Town, Cape Town, South Africa
Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
Sex Transm Infect. 2019 Sep;95(6):443-448. doi: 10.1136/sextrans-2018-053577. Epub 2019 Feb 8.
There is an urgent need to understand high HIV-infection rates among young women in sub-Saharan Africa. While age-disparate partnerships have been characterised with high-risk sexual behaviours, the mechanisms through which these partnerships may increase HIV-risk are not fully understood. This study assessed the association between age-disparate partnerships and herpes simplex virus type-2 (HSV-2) infection, a factor known to increase HIV-infection risk.
Cross-sectional face-to-face questionnaire data, and laboratory HSV-2 and HIV antibody data were collected among a representative sample in the 2014/2015 household survey of the HIV Incidence Provincial Surveillance System in KwaZulu-Natal, South Africa. Among 15-24-year-old women who reported having ever had sex (n=1550), the association between age-disparate partnerships (ie, male partner ≥5 years older) and HSV-2 antibody status was assessed using multivariable Poisson regression models with robust variance. Analyses were repeated among HIV-negative women.
HSV-2 prevalence was 55% among 15-24-year-old women. Women who reported an age-disparate partnership with their most recent partner were more likely to test HSV-2 positive compared with women with age-similar partners (64% vs 51%; adjusted prevalence ratio (aPR):1.19 (95% CI 1.07 to 1.32, p<0.01)). HSV-2 prevalence was also significantly higher among HIV-negative women who reported age-disparate partnerships (51% vs 40 %; aPR:1.25 (95% CI 1.05 to 1.50, p=0.014)).
Results indicate that age-disparate partnerships are associated with a greater risk of HSV-2 among young women. These findings point towards an additional mechanism through which age-disparate partnerships could increase HIV-infection risk. Importantly, by increasing the HSV-2 risk, age-disparate partnerships have the potential to increase the HIV-infection risk within subsequent partnerships, regardless of the partner age-difference in those relationships.
迫切需要了解撒哈拉以南非洲年轻女性中艾滋病毒感染率居高不下的原因。虽然年龄差异较大的伴侣关系与高风险性行为有关，但这些伴侣关系如何增加艾滋病毒风险的机制尚不完全清楚。本研究评估了年龄差异较大的伴侣关系与单纯疱疹病毒 2 型（HSV-2）感染之间的关联，HSV-2 感染是已知增加艾滋病毒感染风险的因素。
在南非夸祖鲁-纳塔尔省艾滋病毒发病率省级监测系统 2014/2015 年家庭调查中，对具有代表性的样本进行了面对面的问卷调查，并采集了实验室 HSV-2 和艾滋病毒抗体数据。在报告有过性行为的 15-24 岁女性（n=1550）中，使用多变量泊松回归模型（采用稳健方差）评估了年龄差异较大的伴侣关系（即男性伴侣年长≥5 岁）与 HSV-2 抗体状况之间的关联。在艾滋病毒阴性女性中重复了这些分析。
15-24 岁女性的 HSV-2 感染率为 55%。与年龄相仿的伴侣相比，报告与最近的伴侣存在年龄差异较大的伴侣关系的女性更有可能 HSV-2 检测呈阳性（64%比 51%；调整后患病率比（aPR）：1.19（95%置信区间 1.07 至 1.32，p<0.01））。报告存在年龄差异较大的伴侣关系的艾滋病毒阴性女性的 HSV-2 感染率也显著更高（51%比 40%；aPR：1.25（95%置信区间 1.05 至 1.50，p=0.014））。
研究结果表明，年龄差异较大的伴侣关系与年轻女性的 HSV-2 感染风险增加有关。这些发现表明，年龄差异较大的伴侣关系可能通过增加 HSV-2 感染风险从而增加艾滋病毒感染风险。重要的是，通过增加 HSV-2 风险，年龄差异较大的伴侣关系有可能增加随后伴侣关系中的艾滋病毒感染风险，而与这些关系中伴侣的年龄差异无关。
