Camlin Carol S, Akullian Adam, Neilands Torsten B, Getahun Monica, Bershteyn Anna, Ssali Sarah, Geng Elvin, Gandhi Monica, Cohen Craig R, Maeri Irene, Eyul Patrick, Petersen Maya L, Havlir Diane V, Kamya Moses R, Bukusi Elizabeth A, Charlebois Edwin D
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA; Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, UCSF Mail Code 0886, San Francisco, CA 94158, USA.
Institute for Disease Modeling, 3150 139th Ave SE, Bellevue, WA 98005, USA; Department of Global Health, University of Washington, Seattle, USA.
Health Place. 2019 May;57:339-351. doi: 10.1016/j.healthplace.2019.05.002. Epub 2019 May 29.
Mobility in sub-Saharan Africa links geographically-separate HIV epidemics, intensifies transmission by enabling higher-risk sexual behavior, and disrupts care. This population-based observational cohort study measured complex dimensions of mobility in rural Uganda and Kenya. Survey data were collected every 6 months beginning in 2016 from a random sample of 2308 adults in 12 communities across three regions, stratified by intervention arm, baseline residential stability and HIV status. Analyses were survey-weighted and stratified by sex, region, and HIV status. In this study, there were large differences in the forms and magnitude of mobility across regions, between men and women, and by HIV status. We found that adult migration varied widely by region, higher proportions of men than women migrated within the past one and five years, and men predominated across all but the most localized scales of migration: a higher proportion of women than men migrated within county of origin. Labor-related mobility was more common among men than women, while women were more likely to travel for non-labor reasons. Labor-related mobility was associated with HIV positive status for both men and women, adjusting for age and region, but the association was especially pronounced in women. The forms, drivers, and correlates of mobility in eastern Africa are complex and highly gendered. An in-depth understanding of mobility may help improve implementation and address gaps in the HIV prevention and care continua.
撒哈拉以南非洲地区的人口流动将地理上分散的艾滋病病毒流行情况联系起来，通过促成高风险性行为加剧传播，并扰乱医疗服务。这项基于人群的观察性队列研究测量了乌干达农村和肯尼亚人口流动的复杂维度。从2016年开始，每6个月从三个地区12个社区的2308名成年人的随机样本中收集调查数据，按干预组、基线居住稳定性和艾滋病病毒感染状况分层。分析采用调查加权法，并按性别、地区和艾滋病病毒感染状况分层。在本研究中，不同地区、男女之间以及不同艾滋病病毒感染状况的人群在流动形式和程度上存在很大差异。我们发现，成年人的迁移情况因地区而异，在过去一年和五年内迁移的男性比例高于女性，除了最本地化的迁移规模外，男性在所有迁移规模中都占主导地位：在原籍县内迁移的女性比例高于男性。与劳动相关的流动在男性中比在女性中更常见，而女性更有可能因非劳动原因出行。在调整年龄和地区后，与劳动相关的流动与男性和女性的艾滋病病毒阳性状态均有关联，但这种关联在女性中尤为明显。东非地区人口流动的形式、驱动因素和相关因素很复杂，且具有高度性别差异。深入了解人口流动情况可能有助于改善艾滋病病毒预防和护理连续过程的实施并填补其中的空白。
