Department of Community Health, 108123Mbarara University of Science and Technology, Mbarara, Uganda.
Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
Int J STD AIDS. 2021 Aug;32(9):791-798. doi: 10.1177/0956462420987760. Epub 2021 Mar 26.
Key populations have a disproportionate burden of HIV compared with the general population. HIV-related stigma has been recognized as a major barrier to HIV prevention and treatment efforts. It remains unclear whether HIV-related stigma is a significant driver of HIV transmission risk behavior among (motorcycle taxi) riders, a key population in Uganda. We conducted a cross-sectional study among motorcyclists in Mbarara Municipality of southwestern Uganda. Using multistage sampling, we recruited participants aged 18-59 years who had been riding for at least 6 months. The primary explanatory variable of interest was HIV-related stigma, measured using the 7-item STRIVE scale and dichotomized at "no stigma" versus "any stigma." Self-reported HIV transmission risk behaviors included: condomless sexual intercourse, sexual intercourse under the influence of alcohol, having non-primary sexual partners, and sexual intercourse with a commercial sex worker. We used multivariable logistic regression to estimate the association between HIV-related stigma and HIV transmission risk behavior. We enrolled 401 motorcyclists. All were men. Most [330 (82%)] were classified as having HIV-related stigma, particularly among younger men aged 18-29 years. One hundred and thirty-two (34%) participants reported their last sexual encounter was with a non-primary partner, 153 (39%) did not know the serostatus of their last sexual partner, and 138 (36%) reported sexual intercourse with a sex worker in the past 6 months. In multivariable logistic regression, HIV-related stigma (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.06-3.34) had a statistically significant association with any HIV transmission risk behavior. Men who reported either minimal alcohol use (aOR = 1.81, 95% CI: 1.07-2.95) or harmful alcohol use (aOR = 3.5, 95% CI: 1.92-6.54), compared with men who reported no alcohol use, also reported greater odds of HIV transmission risk behavior. HIV transmission risk behavior is common among motorcyclists in the municipality and is associated with both HIV-related stigma and alcohol use. Interventions aimed at reducing HIV-related stigma and alcohol use may potentially reduce the high rates of HIV transmission risk behavior in this key population.
重点人群与一般人群相比，HIV 的负担不成比例。与 HIV 相关的耻辱感已被认为是 HIV 预防和治疗工作的主要障碍。目前尚不清楚与 HIV 相关的耻辱感是否是乌干达重点人群之一（摩的司机）发生 HIV 传播风险行为的重要驱动因素。
我们在乌干达西南部姆巴拉拉市对摩的司机进行了横断面研究。采用多阶段抽样方法，招募了至少已骑行 6 个月、年龄在 18-59 岁的参与者。主要的解释变量是与 HIV 相关的耻辱感，使用 7 项 STRIVE 量表测量，并分为“无耻辱感”和“有耻辱感”。自我报告的 HIV 传播风险行为包括：无保护性行为、酒后性行为、有非主要性伴侣和与性工作者发生性行为。我们使用多变量逻辑回归估计与 HIV 相关的耻辱感与 HIV 传播风险行为之间的关联。
我们招募了 401 名摩的司机。他们都是男性。大多数人（330 人，82%）被归类为有与 HIV 相关的耻辱感，尤其是年龄在 18-29 岁的年轻男性。132 名参与者（34%）报告说，他们最近的性接触对象是次要性伴侣，153 名参与者（39%）不知道他们最近性伴侣的血清状况，138 名参与者（36%）报告说，在过去 6 个月中与性工作者发生过性行为。在多变量逻辑回归中，与 HIV 相关的耻辱感（调整后的优势比[aOR] = 1.88，95%CI：1.06-3.34）与任何 HIV 传播风险行为均有统计学显著关联。与没有饮酒的男性相比，报告少量饮酒（aOR = 1.81，95%CI：1.07-2.95）或有害饮酒（aOR = 3.5，95%CI：1.92-6.54）的男性，报告 HIV 传播风险行为的可能性更高。
摩的司机在该市的 HIV 传播风险行为很常见，与与 HIV 相关的耻辱感和饮酒有关。旨在减少与 HIV 相关的耻辱感和饮酒的干预措施可能会降低这一重点人群中 HIV 传播风险行为的高发生率。
