Department of Pediatrics, University of California, San Francisco.
Department of Medicine, University of California, San Francisco.
JAMA Netw Open. 2022 Sep 1;5(9):e2230282. doi: 10.1001/jamanetworkopen.2022.30282.
Extreme precipitation, including heavy rains and flooding, is associated with poor health outcomes mediated in part by decreases in income and food production. However, the association between heavy rains and HIV burden is unknown.
To investigate the association between heavy rainfall, HIV prevalence, and HIV transmission risk over a 12-year span in sub-Saharan Africa.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional population-based study, using data collected from the 2005-2017 Demographic and Health Surveys, was conducted in 21 countries in sub-Saharan Africa and analyzed from July 29, 2021, to June 14, 2022.
Heavy rainfall was defined based on the extent to which annual rainfall deviated from the historical average (standardized precipitation index ≥1.5) at the enumeration area level.
HIV, self-reported sexually transmitted infections (STIs), and number of sexual partners.
The study included 288 333 participants aged 15 to 59 years; 172 344 were women (59.8%), and 183 378 were married (63.6%). Mean (SD) age was 31.9 (10.0) years. Overall, 42.4% of participants were exposed to at least 1 year of heavy rainfall in the past 10 years. Each year of heavy rainfall was associated with 1.14 (95% CI, 1.11-1.18) times the odds of HIV infection and 1.11 (95% CI, 1.07-1.15) times the odds of an STI in the past 12 months. There was also an association between heavy rainfall and the reported number of sexual partners (incident rate ratio, 1.12; 95% CI, 1.10-1.15). The odds were greater for the association between heavy rainfall and HIV prevalence and STIs among participants aged older than 20 years and participants in rural areas.
The findings of this study suggest that heavy rainfall was associated with a higher HIV burden in sub-Saharan Africa. The association between heavy rainfall and STIs and number of sexual partners suggests that an increase in the risk of sexual transmission is a plausible mechanism for the observed findings around HIV prevalence. Heavy rainfall could also worsen food insecurity, increasing the risk of transactional sex, or cause damage to public health infrastructure, reducing access to STI education, HIV testing, and treatment.
极端降水，包括暴雨和洪水，与部分由收入和粮食生产减少介导的不良健康结果有关。然而，暴雨与 HIV 负担之间的关联尚不清楚。
在撒哈拉以南非洲的 12 年期间，调查暴雨、HIV 流行率和 HIV 传播风险之间的关联。
设计、地点和参与者：这是一项横断面基于人群的研究，使用了 2005 年至 2017 年人口与健康调查收集的数据，在撒哈拉以南非洲的 21 个国家进行，并于 2021 年 7 月 29 日至 2022 年 6 月 14 日进行了分析。
暴雨的定义是基于年降雨量相对于历史平均值的偏差程度（标准化降水指数≥1.5）在计数区层面上。
HIV、自我报告的性传播感染（STI）和性伴侣数量。
研究纳入了 288333 名 15 至 59 岁的参与者；172344 名参与者为女性（59.8%），183378 名参与者已婚（63.6%）。平均（SD）年龄为 31.9（10.0）岁。总体而言，在过去 10 年中，有 42.4%的参与者至少经历了 1 年的暴雨。每年的暴雨都与 HIV 感染几率增加 1.14 倍（95% CI，1.11-1.18）和过去 12 个月内 STI 感染几率增加 1.11 倍（95% CI，1.07-1.15）相关。暴雨与报告的性伴侣数量之间也存在关联（发病率比，1.12；95% CI，1.10-1.15）。在年龄大于 20 岁的参与者和农村地区的参与者中，暴雨与 HIV 流行率和 STI 之间的关联更为显著。
本研究结果表明，暴雨与撒哈拉以南非洲 HIV 负担较高有关。暴雨与 STI 和性伴侣数量之间的关联表明，性传播风险增加是观察到的 HIV 流行率相关发现的一个合理机制。暴雨还可能加剧粮食不安全，增加易发生交易性性行为的风险，或对公共卫生基础设施造成破坏，减少获得性传播感染教育、HIV 检测和治疗的机会。
