Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa.
BMC Public Health. 2022 May 14;22(1):973. doi: 10.1186/s12889-022-13394-4.
HIV incidence among adolescent girls and young women (AGYW) remains high, with their male partners a prominent factor in sustaining these elevated rates. Partnership characteristics remain important metrics for determining HIV risk, with evidence indicating that AGYW engaged in transactional and age-disparate relationships face greater HIV exposure. This study examines the risk posed to AGYW in a relationship with a "Blesser", defined as male who provides his female partner with their material needs or desires in exchange for a sexual relationship, an age-disparate (5 or more years older) partner, and the potential compounded risk of being a relationship with a partner or partners who are considered both a "Blesser" and age-disparate.
A cross -sectional household based representative sample of AGYW (aged between 12-24 years) were enrolled in the study (n = 18 926) from the districts of City of Johannesburg and Ekurhuleni in the Gauteng province and the Districts of eThekwini and uMgungundlovu in the province of KwaZulu-Natal (KZN) in South Africa between March 13, 2017 to June 22, 2018. Participants completed a structured questionnaire and provided finger-prick blood samples for laboratory measurements. Our analysis used descriptive statistics and multiple binary logistic regressions accounting for survey weights, clustering and stratification.
The median age of the sample was 21 years old (Interquartile range: 19-23) and nearly three quarters (73.7%) were currently attending school. Whilst all relationships exposed AGYW to potential HIV risk, multiple binary logistic regression analysis revealed that AGYW in a relationship with both a Blesser and an age-disparate partner were more likely to be HIV positive (AOR: 3.12, 95% CI: 1.76-5.53, p < 0.001), diagnosed with an STI (AOR: 4.60, 95% CI: 2.99-7.08, p < 0.001), had 2 or more sexual partners in the previous 12 months (AOR: 6.37, 95% CI: 3.85-10.54, p < 0.001), engaged in sexual activity at age 15 or younger (AOR: 3.67, 95% CI: 2.36-5.69, p < 0.001) and more likely to have ever been pregnant (AOR: 2.60, 95% CI: 1.24-5.45, p < 0.05) than those not in a relationship with either a Blesser or age-disparate partner.
Different relationships present different HIV risk to AGYW. AGYW who had engaged in relationships with both a Blesser and an age-disparate partner were at greater HIV risk when examined against these relationships independent of one another. The data reveals the compounded HIV risk of being in both a transactional and age-disparate relationship.
少女和年轻妇女（AGYW）中的艾滋病毒发病率仍然很高，她们的男性伴侣是维持这些高发病率的重要因素。伙伴关系特征仍然是确定艾滋病毒风险的重要指标，有证据表明，从事交易性关系和年龄差异较大的关系的 AGYW 面临更大的艾滋病毒暴露风险。本研究考察了与“恩赐者”（定义为提供女性伴侣物质需求或欲望以换取性关系的男性，年龄相差 5 岁或以上的伴侣）的关系对 AGYW 构成的风险，以及与年龄相差较大的伴侣或被认为既是“恩赐者”又是年龄相差较大的伴侣的关系的潜在复合风险。
2017 年 3 月 13 日至 2018 年 6 月 22 日，在南非豪登省约翰内斯堡市和埃库鲁莱尼区以及夸祖鲁-纳塔尔省德班市和乌姆古隆古杜卢区，对年龄在 12-24 岁之间的 AGYW（n=18926）进行了一项基于家庭的代表性横断面抽样研究。参与者完成了一份结构化问卷，并提供了指尖采血样本来进行实验室检测。我们的分析使用了描述性统计和多重二元逻辑回归，考虑了调查权重、聚类和分层。
样本的中位数年龄为 21 岁（四分位距：19-23 岁），近四分之三（73.7%）正在上学。虽然所有的关系都使 AGYW 面临潜在的艾滋病毒风险，但多重二元逻辑回归分析显示，与恩赐者和年龄相差较大的伴侣同时存在关系的 AGYW 更有可能感染艾滋病毒（优势比：3.12，95%置信区间：1.76-5.53，p<0.001）、诊断出性传播感染（优势比：4.60，95%置信区间：2.99-7.08，p<0.001）、在过去 12 个月中有 2 个或更多性伴侣（优势比：6.37，95%置信区间：3.85-10.54，p<0.001）、在 15 岁或更小时开始性行为（优势比：3.67，95%置信区间：2.36-5.69，p<0.001）和更有可能曾经怀孕（优势比：2.60，95%置信区间：1.24-5.45，p<0.05），比那些没有与恩赐者或年龄相差较大的伴侣存在关系的 AGYW 更高。
不同的关系对 AGYW 有不同的艾滋病毒风险。与恩赐者和年龄相差较大的伴侣都有关系的 AGYW，与这些关系独立相比，处于更大的艾滋病毒风险中。数据揭示了从事交易性关系和年龄差异较大的关系的复合艾滋病毒风险。
