MakSPH-CDC Fellowship Program, Makerere University School of Public Health, Kampala, Uganda.
Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda.
BMC Infect Dis. 2020 Mar 6;20(1):198. doi: 10.1186/s12879-020-4924-0.
Although married couples can be at an elevated risk of HIV infection, few studies have explored the risk factors for HIV infection at the couple-level. We explored the risk factors for HIV infection among married couples in settings with differing HIV prevalence levels in Rakai, Uganda.
This was a cross-sectional study conducted among 664 heterosexual couples living in three HIV prevalence strata (low: 9-11.2%; medium: 11.4-20% or high HIV prevalence: 21-43%) in Rakai District, south-western Uganda, between November 2013 and February 2014. Data were collected on socio-demographic and behavioural characteristics from all consenting adults and aggregated to allow for couple-level analyses. We conducted bivariate and multivariable Logistic regression to assess the factors that were independently associated with HIV infection among married couples. Data were analysed using STATA statistical software (version 14.1).
Of the 664 couples, 6.4% (n = 42) were in HIV-discordant relationships; 5.8% (n = 39) were in concordant HIV-positive relationships while 87.8% (n = 583) were in concordant HIV-negative relationships. At the bivariate analysis, we found that residing in a high HIV prevalence stratum, reporting extra-marital relations, age difference between partners and number of previous marriages were significantly associated with being part of an HIV infected couple. After adjusting for potential cofounders, living in a high HIV prevalence stratum (Adjusted OR [AOR] =2.31, 95% CI: 1.52, 3.52), being in a third or higher order relationship (AOR = 3.80, 95% CI: 2.30, 6.28), and engagement in extra-marital relations (AOR = 1.75; 95% CI: 1.19, 2.59) were associated with couple HIV infection. Individuals that had stayed together for six or more years had 28% odds of being part of an HIV infected couple (AOR = 0.28; 95%CI: 0.18, 0.43).
Living in a high HIV prevalence stratum, engagement in extra-marital relations and having a higher number of previous marriages were significant risk factors for HIV infection among married couples. Long marital duration was associated with reduced risk of HIV infection. Interventions that increase marital stability and those that promote pre-marital couples' HIV testing before marital formation can reduce HIV transmission risk among married couples in this setting.
尽管已婚夫妇可能面临更高的 HIV 感染风险，但很少有研究探讨不同 HIV 流行水平环境下夫妇层面 HIV 感染的风险因素。我们探讨了乌干达拉凯区三个 HIV 流行率分层（低：9-11.2%；中：11.4-20%或高 HIV 流行率：21-43%）中已婚夫妇 HIV 感染的风险因素。
这是一项横断面研究，于 2013 年 11 月至 2014 年 2 月期间在乌干达西南部拉凯区的三个 HIV 流行率分层（低：9-11.2%；中：11.4-20%或高 HIV 流行率：21-43%）中对 664 对异性恋夫妇进行了研究。所有同意的成年人都收集了社会人口统计学和行为特征数据，并进行了汇总，以便进行夫妻层面的分析。我们进行了单变量和多变量逻辑回归分析，以评估与已婚夫妇 HIV 感染相关的独立因素。使用 STATA 统计软件（版本 14.1）进行数据分析。
在 664 对夫妇中，6.4%（n=42）处于 HIV 不一致的关系中；5.8%（n=39）处于 HIV 阳性一致关系中，而 87.8%（n=583）处于 HIV 阴性一致关系中。在单变量分析中，我们发现居住在 HIV 高流行率分层、报告婚外性关系、伴侣年龄差异和以前的婚姻次数与成为 HIV 感染夫妇的一部分显著相关。在调整了潜在的混杂因素后，居住在 HIV 高流行率分层（调整后的 OR [AOR]=2.31，95%CI：1.52，3.52）、处于第三或更高顺序关系（AOR=3.80，95%CI：2.30，6.28）和婚外性关系（AOR=1.75；95%CI：1.19，2.59）与夫妻 HIV 感染相关。在一起生活六年或以上的个体成为 HIV 感染夫妇的几率降低 28%（AOR=0.28；95%CI：0.18，0.43）。
居住在 HIV 高流行率分层、参与婚外性关系和有更多的婚前婚姻是已婚夫妇 HIV 感染的重要危险因素。较长的婚姻持续时间与 HIV 感染风险降低有关。增加婚姻稳定性的干预措施以及促进婚前夫妇在婚姻形成前进行 HIV 检测的干预措施可以降低该环境中已婚夫妇的 HIV 传播风险。
