Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
School of Public Health, University of Zambia, Lusaka, Zambia.
PLoS One. 2022 Jun 8;17(6):e0268983. doi: 10.1371/journal.pone.0268983. eCollection 2022.
The study examined the association between HIV infection and individual and neighbourhood-level socioeconomic factors in Zambia.
We used multilevel mixed effects logistic regression to examine the association of individual and neighbourhood level variables on HIV prevalence based on data from the 2013-14 and 2018 Zambia Demographic and Health Surveys, population-based cross-sectional surveys. The analysis was restricted to young people (15-24 years) with HIV serostatus results (n = 11,751 and n = 10,154). HIV serostatus was the outcome variable and socioeconomic status was measured by wealth, education and employment.
Overall, at individual level, education was associated with reduced odds of HIV infection among young women and men. Conversely, relative wealth was generally associated with increased odds of infection for both young women and men. Young, employed men were at reduced odds of HIV infection than the unemployed. Living in neighbourhoods with higher average level of education was associated with higher odds of HIV infection. In 2013-14, 13% and 11% of the variation in HIV infection among young men and women was attributed to neighbourhoods, while 20% and 11% variation was attributed to neighbourhoods in 2018. Inclusion of individual and neighbourhood variables in the full regression model accounted for 65.7% and 59.5% of explained variance in 2013-14 and 64.6% and 44.3% in 2018, for women and men, respectively. This reduced unexplained variance by an average of 56% in 2013-14 and 29% in 2018.
We found that HIV infection among young people in Zambia is more strongly associated with individual-level socioeconomic factors compared to neighbourhood factors. Individual-level education remains an important socioeconomic factor associated with reduced odds of HIV infection. This suggests that the HIV response in Zambia should still focus on individual level prevention strategies.
本研究考察了赞比亚艾滋病毒感染与个人和社区层面社会经济因素之间的关系。
我们使用多水平混合效应逻辑回归，根据 2013-14 年和 2018 年赞比亚人口与健康调查（基于人群的横断面调查）的数据，检查个体和社区水平变量与艾滋病毒流行率之间的关联。该分析仅限于具有艾滋病毒血清阳性结果的年轻人（15-24 岁）（n=11751 和 n=10154）。艾滋病毒血清阳性状态是因变量，社会经济地位通过财富、教育和就业来衡量。
总体而言，在个人层面上，教育与年轻人中艾滋病毒感染几率降低有关，而相对财富则普遍与年轻人中感染几率增加有关。年轻的男性就业者感染艾滋病毒的几率低于失业者。居住在教育水平较高的社区与感染艾滋病毒的几率较高有关。2013-14 年，13%和 11%的年轻男性和女性的艾滋病毒感染差异归因于社区，而 2018 年，11%和 11%的感染差异归因于社区。在完全回归模型中纳入个人和社区变量，分别解释了 2013-14 年女性和男性的 65.7%和 59.5%的方差和 2018 年的 64.6%和 44.3%的方差，分别减少了平均 56%和 29%的未解释方差。
我们发现，与社区因素相比，赞比亚年轻人中的艾滋病毒感染与个人层面的社会经济因素更为密切相关。个人层面的教育仍然是与降低艾滋病毒感染几率相关的一个重要社会经济因素。这表明，赞比亚的艾滋病毒应对措施仍应侧重于个人层面的预防策略。
