Yang Fan, Li Zhihui, Subramanian S V, Lu Chunling
Nanjing Medical University School of Health Policy and Management, Nanjing, Jiangsu Province, People's Republic of China.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2021 Jan 4;4(1):e2035000. doi: 10.1001/jamanetworkopen.2020.35000.
Knowledge of HIV/AIDS among the younger population is crucial for long-term control. Little research has been done on which groups of young women (aged 15-24 years) in low- and middle-income countries (LMICs) have been left behind with respect to obtaining this knowledge.
To provide an up-to-date assessment of the levels of and changes in knowledge of HIV/AIDS and its associations with socioeconomic disparity among young women in LMICs.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used nationally representative Demographic and Health Surveys with available data on HIV/AIDS knowledge in 51 LMICs between 2003 and 2018. The final data set contained 282 757 young women. For 40 LMICs with multiple surveys available, we examined changes in knowledge and socioeconomic disparities. Analyses of the survey data were conducted between December 1, 2019, and July 31, 2020.
The percentage of young women who were able to (1) correctly identify the 2 major ways of preventing the sexual transmission of HIV, (2) reject the 2 most common local misconceptions about HIV transmission and (3) know that a healthy-looking person can transmit HIV. The level of and changes in young women's knowledge of HIV/AIDS as well as knowledge disparities by residential area, wealth status, and level of education on the aggregate and country levels were assessed.
Of a total of 282 757 young women from 51 LMICs, 29.3% (95% CI, 24.1% to 34.5%) reported having knowledge of HIV/AIDS in the latest years, ranging from 1.0% (95% CI, 0.7% to 1.3%) in Afghanistan in 2015 to 64.9% (95% CI, 63.3% to 66.5%) in Rwanda in 2014 to 2015. Those living in rural areas, living in households in the lowest income quintile, or with low levels of education reported less knowledge about HIV/AIDS than their counterparts (-12.8 [95% CI, -10.6 to -14.9] percentage points; -21.8 [95% CI, -18.3 to -25.3] percentage points; and -19.4 [95% CI, -16.6 to -22.2] percentage points, respectively). Among the 40 countries that had undertaken at least 2 surveys during the period, the surveys indicated that there was a significant increase in knowledge of HIV/AIDS among young women in 24 countries (60.0%), but a significant decrease in 10 countries (25.0%). Less than half of countries experienced significant reductions in disparities associated with residential area (8 countries [20.0%]), wealth (5 countries [12.5%]), or education (17 countries [42.5%]).
This cross-sectional study of women in 51 LMICs found low levels and large gaps in knowledge of HIV/AIDS between groups, suggesting that future HIV-prevention campaigns should emphasize providing easily accessible information to socioeconomically disadvantaged groups.
年轻人群体对艾滋病毒/艾滋病的了解对于长期防控至关重要。关于低收入和中等收入国家（LMICs）中哪些年轻女性群体（年龄在15 - 24岁）在获取这方面知识上滞后的研究较少。
对低收入和中等收入国家年轻女性的艾滋病毒/艾滋病知识水平、变化及其与社会经济差距的关联进行最新评估。
设计、背景和参与者：这项横断面研究使用了具有全国代表性的人口与健康调查，这些调查在2003年至2018年期间提供了51个低收入和中等收入国家关于艾滋病毒/艾滋病知识的可用数据。最终数据集包含282757名年轻女性。对于有多次可用调查的40个低收入和中等收入国家，我们研究了知识变化和社会经济差距。调查数据分析于2019年12月1日至2020年7月31日进行。
能够（1）正确识别预防艾滋病毒性传播的两种主要方式，（2）否定关于艾滋病毒传播的两种最常见的当地错误观念，以及（3）知道外表健康的人也能传播艾滋病毒的年轻女性的百分比。评估了年轻女性对艾滋病毒/艾滋病的知识水平、变化以及在总体和国家层面上按居住地区、财富状况和教育程度划分的知识差距。
在来自51个低收入和中等收入国家的总共282757名年轻女性中，29.3%（95%置信区间，24.1%至34.5%）报告在最近几年了解艾滋病毒/艾滋病，范围从2015年阿富汗的1.0%（95%置信区间，0.7%至1.3%）到2014年至2015年卢旺达的64.9%（95%置信区间，63.3%至66.5%）。与居住在农村地区、收入处于最低五分位数家庭或教育程度低的女性相比，她们的对应人群对艾滋病毒/艾滋病的了解较少（分别低 - 12.8 [95%置信区间， - 10.6至 - 14.9]个百分点； - 21.8 [95%置信区间， - 18.3至 - 25.3]个百分点；以及 - 19.4 [95%置信区间， - 16.6至 - 22.2]个百分点）。在该时期内至少进行了两次调查的40个国家中，调查表明24个国家（60.0%）的年轻女性对艾滋病毒/艾滋病的了解有显著增加，但10个国家（25.0%）有显著下降。不到一半的国家在与居住地区（8个国家[20.0%]）、财富（5个国家[12.5%]）或教育（17个国家[42.5%]）相关的差距方面有显著缩小。
这项对51个低收入和中等收入国家女性的横断面研究发现，艾滋病毒/艾滋病知识水平较低且群体之间存在巨大差距，这表明未来的艾滋病毒预防运动应强调向社会经济弱势群体提供易于获取的信息。
