Population Council, Washington, DC, USA.
IHM-Institute for Health Measurement Southern Africa, Mbabane, Eswatini.
AIDS. 2022 Jun 15;36(Suppl 1):S99-S108. doi: 10.1097/QAD.0000000000003224.
OBJECTIVE: To assess men's experiences of adverse events in both child and adulthood and their effects on violence, HIV risk, and well being in three sub-Saharan countries. DESIGN: We conducted cross-sectional surveys from 2017 to 2018 with men (all 18+) recruited via the PLACE methodology at community hotspots and HIV service sites in Eswatini (n = 1091), South Africa (n = 932), and Malawi (n = 611). METHODS: Prevalence of men's adverse events in childhood (e.g. beaten at home often) and adulthood (e.g. robbed at gunpoint) was described. We examined associations between cumulative effects of these events on health outcomes, via log binomial regression. RESULTS: About 70% of men in each country experienced adverse events in childhood, while adult experience varied from 47 to 64%. There was a dose-response effect of cumulative exposure. Among men with 0, 1-2, and 3+ traumas, for example, 22, 35, and 52% reported depression/anxiety in Malawi, and 8, 17, and 27% perpetrated intimate partner violence (IPV) in South Africa. In multivariate analyses, experiencing at least one event in both childhood and adulthood (vs. neither) was significantly associated with various health outcomes (e.g. multiple sexual partnerships: adjusted risk ratio or aRR = 2.40 in Malawi; IPV perpetration: aRR = 3.59 in South Africa; depression/anxiety: aRR = 1.37 in Eswatini). CONCLUSION: Men who experienced adverse events in childhood or adulthood faced increased HIV risk/negative health outcomes. More events were associated with worse outcomes. Interventions for men addressing trauma in both childhood and adulthood are essential for their (and their partners') health and well being.
目的:评估撒哈拉以南三个国家男性在儿童和成年期经历不良事件及其对暴力、艾滋病毒风险和健康的影响。
设计:我们于 2017 年至 2018 年采用 PLACE 方法,在斯威士兰(n=1091)、南非(n=932)和马拉维(n=611)的社区热点和艾滋病毒服务点招募了 18 岁以上的男性进行横断面调查。
方法:描述了男性在儿童期(例如经常在家挨打)和成年期(例如被持枪抢劫)的不良事件发生率。我们通过对数二项式回归检查了这些事件的累积效应与健康结果之间的关联。
结果:每个国家约有 70%的男性在儿童期经历过不良事件,而成年期的经历则从 47%到 64%不等。累积暴露存在剂量反应效应。例如,在马拉维,0、1-2 和 3+创伤的男性中,分别有 22%、35%和 52%报告有抑郁/焦虑症,而在南非,分别有 8%、17%和 27%的男性实施了亲密伴侣暴力(IPV)。在多变量分析中,与既没有经历过儿童期也没有经历过成年期不良事件的男性相比(与既没有经历过儿童期也没有经历过成年期不良事件的男性相比),至少经历过一次儿童期和成年期不良事件(与既没有经历过儿童期也没有经历过成年期不良事件的男性相比)与各种健康结果显著相关(例如:多重性伴侣关系:马拉维的调整风险比或 aRR=2.40;IPV 实施:南非的 aRR=3.59;抑郁/焦虑:斯威士兰的 aRR=1.37)。
结论:经历过儿童期或成年期不良事件的男性面临更高的艾滋病毒风险/负面健康结果。经历的事件越多,结果越差。针对男性在儿童期和成年期经历的创伤的干预措施对于他们(和他们的伴侣)的健康和福祉至关重要。
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