Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
Joint Clinical Research Center, Kampala, Uganda.
PLoS One. 2019 Nov 6;14(11):e0211084. doi: 10.1371/journal.pone.0211084. eCollection 2019.
In Uganda, the HIV epidemic is now mature and generalized. Recently, there have been reports of resurgence in the incidence of HIV after several years of successful control. The causes for this resurgence are not clear but suspected to be driven by structural factors that influence large groups of people rather than individuals. The aim of this study was to describe the structural drivers of the HIV epidemic in high prevalence regions and inform the next generation of interventions.
We conducted a total of 35 focus group discussions in 11 districts in Uganda. Due to their high HIV prevalence, the districts had been selected to implement a donor supported program to scale up HIV prevention, care and treatment. Focus groups consisted of men and women including opinion leaders, civil servants including teachers, police officers, religious, political leaders, shop keepers, local residents and other ordinary persons from all walks of life. The qualitative data were transcribed and analyzed manually. Texts were coded using a coding scheme which was prepared ahead of time but emerging themes and codes were also allowed.
Our data indicated there is persistence of several structural drivers and factors for HIV in rural Uganda. The structural drivers of HIV were divided into three categories: Gender issues, socio-cultural, and economic drivers. The specific drivers included several gender issues, stigma surrounding illness, traditional medical practices, urbanization, alcohol and substance abuse and poverty. New drivers arising from urbanization, easy access to mobile phone, internet and technological advancement have emerged. These drivers are intertwined within an existing culture, lifestyle and the mixture is influenced by modernization.
The traditional structural drivers of HIV have persisted since the emergence of the HIV epidemic in Uganda and new ones have emerged. All these drivers may require combined structural interventions that are culturally and locally adapted in order to tackle the resurgence in incidence of HIV in Uganda.
在乌干达，艾滋病疫情现已进入稳定和广泛流行阶段。近年来，在成功控制疫情数年之后，艾滋病发病率出现了回升。其回升的原因尚不清楚，但疑似与影响大量人群而非个体的结构性因素有关。本研究旨在描述高流行地区艾滋病疫情的结构性驱动因素，为下一代干预措施提供信息。
我们在乌干达 11 个区总共开展了 35 次焦点小组讨论。由于这些区的艾滋病发病率较高，已被选中实施一个由捐助方支持的项目，以扩大艾滋病预防、护理和治疗。焦点小组由男性和女性组成，包括意见领袖、公务员（包括教师、警察、宗教、政治领袖、店主、当地居民和其他各行各业的普通人）。将定性数据进行转录并手动分析。使用提前准备的编码方案对文本进行编码，但也允许出现新的主题和代码。
我们的数据表明，在乌干达农村地区，艾滋病的一些结构性驱动因素和因素仍然存在。艾滋病的结构性驱动因素分为三类：性别问题、社会文化和经济驱动因素。具体的驱动因素包括一些性别问题、疾病耻辱感、传统医疗实践、城市化、酒精和药物滥用以及贫困。城市化、手机、互联网和技术进步的普及带来了新的驱动因素。这些驱动因素相互交织在现有的文化、生活方式中，其组合受到现代化的影响。
自艾滋病在乌干达出现以来，艾滋病的传统结构性驱动因素一直存在，新的驱动因素也已经出现。所有这些驱动因素可能都需要结合文化和本地化的结构性干预措施，以应对乌干达艾滋病发病率回升的问题。
