Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America.
PLoS One. 2020 Jun 25;15(6):e0235203. doi: 10.1371/journal.pone.0235203. eCollection 2020.
Little is known about violence against HIV-positive adolescents and young adults (AYA) in sub-Saharan Africa. This analysis examines experiences of violence victimization, and the perpetrators of this violence, among AYA living with HIV, aged 15-24 years, in Zambia.
We analyzed baseline data from 272 AYA (60.1% female, 71.0% perinatally infected) enrolled in Project YES! (Youth Engaging for Success), a randomized controlled trial conducted in four HIV clinics in Ndola, Zambia. Violence measures were adapted from the ICAST-C and the WHO Multi-Country Study on Women's Health and Domestic Violence. Youth could report up to 12 perpetrator types for past-year experiences of violence. We estimated lifetime and past-year prevalence of physical violence, psychological abuse, and forced sex, disaggregated by sex and age group. Estimates were weighted using sex and age data from the 2013-14 Zambian Demographic and Health Survey to be representative of HIV-positive AYA in Zambia.
Estimated lifetime prevalence of any violence victimization was 78.2%. Past-year prevalence was 72.0% among males and 74.5% among females. Almost half of AYA (46.1%) had ever experienced polyvictimization (2+ types of violence). Psychological abuse was most common (70.4% lifetime, 65.3% past-year), followed by physical violence (50.8% lifetime, 44.7% past-year) and forced sex (10.4% lifetime, 4.7% past-year). Among past-year victims, males experienced more violence than females from a friend/peer (74.3% vs. 45.1%, p<0.001); females experienced more violence than males from a romantic partner (33.3% vs. 5.0%, p<0.001), parent/caregiver (32.4% vs. 17.6%, p = 0.02), and stranger (19.7% vs. 5.2%, p<0.001).
The widespread and overlapping prevalence of multiple types of violence highlights the critical need for prevention and response efforts that are tailored to youths' sex and the perpetrator type. Future research should explore violence victimization and HIV outcomes, and the measurement of psychological abuse and sexual violence, among HIV-positive AYA in the region.
在撒哈拉以南非洲，人们对艾滋病毒阳性青少年和年轻人（AYA）所遭受的暴力行为知之甚少。本分析检查了赞比亚生活在艾滋病毒中的 15-24 岁 AYA 经历的暴力受害情况，以及施暴者的情况。
我们分析了在赞比亚恩多拉的四个艾滋病毒诊所中开展的 YES！项目（青年参与成功）的 272 名 AYA（60.1%为女性，71.0%为围产期感染）的基线数据。该研究采用 ICAST-C 和世界卫生组织多国家妇女健康和家庭暴力研究中的方法来测量暴力行为。年轻人可以报告过去一年中 12 种不同类型的施暴者的暴力经历。我们按性别和年龄组对身体暴力、心理虐待和强迫性行为的终生和过去一年的流行率进行了估计，并使用来自 2013-14 年赞比亚人口与健康调查的性别和年龄数据进行加权，以代表赞比亚的艾滋病毒阳性 AYA。
估计任何暴力受害的终生流行率为 78.2%。过去一年，男性为 72.0%，女性为 74.5%。几乎一半的 AYA（46.1%）曾经遭受过多种暴力侵害（2 种以上类型的暴力）。心理虐待最常见（终生 70.4%，过去一年 65.3%），其次是身体暴力（终生 50.8%，过去一年 44.7%）和强迫性行为（终生 10.4%，过去一年 4.7%）。在过去一年的受害者中，男性从朋友/同伴那里经历的暴力比女性多（74.3%比 45.1%，p<0.001）；女性从浪漫伴侣那里经历的暴力比男性多（33.3%比 5.0%，p<0.001），从父母/照顾者那里经历的暴力比男性多（32.4%比 17.6%，p=0.02），从陌生人那里经历的暴力比男性多（19.7%比 5.2%，p<0.001）。
多种类型的暴力行为广泛且重叠的流行率突显了针对青少年的性别和施暴者类型进行预防和应对的迫切需要。未来的研究应该探讨艾滋病毒阳性 AYA 中暴力受害和艾滋病毒结果，以及心理虐待和性暴力的测量。
