亲密伴侣暴力与南非 DREAMS 项目中青少年女孩和年轻妇女的艾滋病毒护理和治疗环节脱节。
Intimate Partner Violence and the HIV Care and Treatment Cascade Among Adolescent Girls and Young Women in DREAMS, South Africa.
机构信息
Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
出版信息
J Acquir Immune Defic Syndr. 2022 Feb 1;89(2):136-142. doi: 10.1097/QAI.0000000000002843.
BACKGROUND
Intimate partner violence (IPV) may affect the HIV-treatment cascade.
SETTING
Four high HIV-prevalence DREAMS health districts in South Africa.
METHODS
Secondary analysis of cross-sectional data collected March 2017-June 2018, using random household sample of young (12-24 years) girls and women. Face-to-face interviews assessed IPV and HIV-status knowledge, and finger-prick blood draws assessed ART (antiretroviral therapy) uptake and viral suppression. We used logistic regression to estimate crude and adjusted effects of IPV on HIV knowledge, ART uptake, and viral suppression.
RESULTS
Of 18,230 adolescent girls and young women, 8413 (46%) reported ever having had sex, of whom 1118 (13%) were HIV positive. The 90:90:90 benchmarks were 61% knew their status, 86% had ART present in their blood sample, and 91% were virally suppressed. Among the entire sample of young women living with HIV, 65.6% were virally suppressed. Past year IPV was reported by 15%. In adjusted models, IPV trended toward increasing the odds that a young woman was aware she was living with HIV [adjusted odds ratios (aOR) = 1.40, 2.00-9.98, P = 0.067]. There was no association between IPV and reduced treatment use (aOR = 0.73, 0.41-1.29). IPV was independently associated with reduced viral suppression (aOR = 0.30, 0.13-0.66).
CONCLUSIONS
Addressing the role of IPV in undermining the treatment cascade for adolescent and young women is a critical issue for HIV programming.
背景
亲密伴侣暴力（IPV）可能会影响 HIV 治疗环节。
地点
南非四个 HIV 高流行率的 DREAMS 卫生区。
方法
这是对 2017 年 3 月至 2018 年 6 月期间收集的横断面数据进行的二次分析，使用随机家庭样本对年轻（12-24 岁）女孩和妇女进行了面对面访谈，评估了 IPV 和 HIV 状况知识，并进行了指尖采血，以评估接受抗逆转录病毒治疗（ART）和病毒抑制情况。我们使用逻辑回归来估计 IPV 对 HIV 知识、ART 接受和病毒抑制的直接和调整后的影响。
结果
在 18230 名青少年女孩和年轻妇女中，8413 名（46%）报告曾有过性行为，其中 1118 名（13%）HIV 阳性。90:90:90 的指标是 61%知道自己的状况，86%的血液样本中存在 ART，91%的病毒得到抑制。在所有感染 HIV 的年轻女性样本中，65.6%的病毒得到抑制。过去一年有 15%的人报告了 IPV。在调整后的模型中，IPV 趋势增加了年轻女性意识到自己感染 HIV 的几率[调整后的优势比（aOR）=1.40，2.00-9.98，P=0.067]。IPV 与降低治疗使用率之间没有关联（aOR=0.73，0.41-1.29）。IPV 与降低病毒抑制率独立相关（aOR=0.30，0.13-0.66）。
结论
解决 IPV 破坏青少年和年轻女性治疗环节的作用是 HIV 规划的一个关键问题。
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