Social Aspects of Public Health Research Programme, Humans Sciences Research Council, Durban, South Africa.
Department of Psychology, University of KwaZulu-Natal, 238 Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa.
Int J Equity Health. 2019 Oct 30;18(1):167. doi: 10.1186/s12939-019-1055-6.
In South Africa, persistence of the HIV epidemic and associated gender and racial disparities is a major concern after more than 20 years of democratic dispensation and efforts to create a more healthy and equal society. This paper profiles HIV prevalence and related factors among Black African men and women compared to other race groups in South Africa using the 2012 population-based national household HIV survey.
This secondary data analysis was based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Bivariate and multiple logistic regression analysis were used to assess the relationship between HIV prevalence and associated factors by gender and racial profile.
Overall HIV prevalence was significantly higher (p < 0.001) among both Black African males (16.6%; 95% CI: 15.0-18.4) and females (24.1%; 95% CI: 22.4-26.0) compared to their counterparts from other races. Among Black African males, increased risk of HIV was significantly associated with age group 25-49 years and those 50 years and older compared with young males 15-25 years. Among all males, reported condom use at last sex was significantly associated with increased risk of HIV. High socio-economic status (SES) and perceived risk of HIV were associated with a decreased risk of HIV. Among female condom use at last sex and ever testing for HIV was associated with increased prevalence of HIV only among Black African females. Lower prevalence of HIV was associated with marriage, tertiary education, high SES, having a partner five years younger, perceived risk of HIV, and awareness of HIV status among Black African females.
Gender and racial disparities rooted in structural and contextual inequalities remain important factors for the maintenance of the generalized HIV epidemic in the country. HIV prevention interventions need to cut across all strata of society but also target risk factors salient for specific groups. Alleviating vulnerability to HIV along gender and racial lines should also be viewed as part of a broader public health strategy.
在南非，艾滋病毒的持续流行以及与性别和种族差异相关的问题，是在民主制度实行二十多年后，以及为建立一个更健康和更公平的社会所做出的努力之后，需要重点关注的问题。本文利用 2012 年基于人群的全国家庭艾滋病毒调查，对南非黑非洲男性和女性与其他种族群体的艾滋病毒流行率及相关因素进行了概述。
本二次数据分析基于 2012 年基于人群的全国代表性多阶段分层聚类随机家庭样本。使用双变量和多变量逻辑回归分析，按性别和种族概况评估艾滋病毒流行率与相关因素之间的关系。
总体而言，黑非洲男性（16.6%；95%置信区间：15.0-18.4）和女性（24.1%；95%置信区间：22.4-26.0）的艾滋病毒流行率显著高于其他种族的男性和女性（p<0.001）。在黑非洲男性中，与年轻男性（15-25 岁）相比，年龄在 25-49 岁和 50 岁及以上的男性感染艾滋病毒的风险显著增加。在所有男性中，最近一次性行为时使用安全套与艾滋病毒感染风险增加显著相关。较高的社会经济地位（SES）和对艾滋病毒风险的认知与艾滋病毒感染风险降低有关。在黑非洲女性中，最近一次性行为时使用女用安全套和曾经接受过艾滋病毒检测与艾滋病毒流行率增加有关。与婚姻、高等教育、高 SES、伴侣年轻五岁、对艾滋病毒风险的认知以及对艾滋病毒状况的认识与黑非洲女性艾滋病毒流行率降低有关。
根植于结构性和背景性不平等的性别和种族差异仍然是该国艾滋病毒广泛流行的重要因素。艾滋病毒预防干预措施需要覆盖社会各阶层，但也需要针对特定群体的重要风险因素。缓解性别和种族方面的艾滋病毒易感性也应被视为更广泛的公共卫生战略的一部分。
