Mancuso Noah, Mathebula Florence, Chitukuta Miria, Matambanadzo Kudzai V, Tenza Siyanda, Reddy Krishnaveni, Nobula Lumka, Kemigisha Doreen, Stoner Marie C D
Women's Global Health Imperative, RTI International, Atlanta, GA, United States.
Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
Front Reprod Health. 2023 Oct 30;5:1270419. doi: 10.3389/frph.2023.1270419. eCollection 2023.
INTRODUCTION: The COVID-19 pandemic greatly impacted HIV prevention and care globally. The pandemic also had disproportionate impacts on the financial, emotional, and physical wellbeing of women and girls in East and Southern Africa, who were already at increased HIV vulnerability. This study aimed to understand how the COVID-19 pandemic and its response efforts impacted the sexual behavior, HIV prevention interest, general healthcare access, and other HIV risk factors of women and girls in HIV prevention studies. METHODS: Using the socio-ecological model (SEM), an explanatory sequential mixed-methods analysis was performed with data from four Microbicide Trial Network (MTN) studies on different populations-adolescent girls and young women (AGYW), pregnant persons, breastfeeding persons, and couples-in Malawi, South Africa, Uganda, and Zimbabwe. Descriptive statistics for outcomes of interest were calculated within each study separately and Chi-squared tests of independence were performed to evaluate associations between study population and outcomes. Excerpts from study qualitative interviews were stratified into code reports which were then summarized into memos with key themes and considerations of the SEM framework to provide context to quantitative findings. RESULTS: Few participants (8/731) had known or suspected COVID-19 infection. Sexual frequency and alcohol use decreased most often among AGYW compared to pregnant or breastfeeding women and couples (-value < 0.001). The pandemic had little impact on changes in reported HIV prevention interest or access to HIV prevention study products. Healthcare access was impacted for everyone, with couples most likely to report decreases in access (-value < 0.001). From qualitative interviews, economic instability, adverse mental health, and increased violence due to COVID-19 caused increased strain on other factors related to HIV vulnerability. CONCLUSIONS: While interest in HIV prevention did not change and a few HIV risks decreased for most women and girls, other vulnerabilities to HIV increased due to the COVID-19 pandemic, highlighting the importance of continued access to HIV prevention for women and girls. More research is needed to better understand the long-term impact of COVID-19 on HIV prevention and vulnerability in community populations.
引言：新冠疫情对全球艾滋病预防与护理产生了巨大影响。该疫情对东非和南非的妇女与女童的经济、情感及身体健康也产生了不成比例的影响，她们本就面临着更高的感染艾滋病风险。本研究旨在了解新冠疫情及其应对措施如何影响参与艾滋病预防研究的妇女与女童的性行为、预防艾滋病的意愿、获得常规医疗保健的机会以及其他艾滋病风险因素。 方法：采用社会生态模型（SEM），对来自马拉维、南非、乌干达和津巴布韦的四项杀微生物剂试验网络（MTN）研究的数据进行了解释性序列混合方法分析，这些研究针对不同人群——青春期女孩和年轻女性（AGYW）、孕妇、哺乳期妇女以及夫妇。分别在每项研究中计算感兴趣结果的描述性统计数据，并进行独立性卡方检验以评估研究人群与结果之间的关联。研究定性访谈的摘录被分层整理成代码报告，然后总结成带有关键主题和SEM框架考量因素的备忘录，为定量研究结果提供背景信息。 结果：很少有参与者（8/73）已知或疑似感染新冠病毒。与孕妇、哺乳期妇女及夫妇相比，AGYW中性生活频率和饮酒行为减少的情况最为常见（-值< 0.001）。疫情对报告的预防艾滋病意愿或获得艾滋病预防研究产品的情况变化影响不大。每个人获得医疗保健的机会都受到了影响，夫妇最有可能报告获得机会减少（-值< 0.0））。从定性访谈中可知，新冠疫情导致的经济不稳定、心理健康问题以及暴力事件增加，给与感染艾滋病风险相关的其他因素带来了更大压力。 结论：虽然大多数妇女和女童预防艾滋病的意愿没有改变，一些艾滋病风险有所降低，但由于新冠疫情，她们感染艾滋病的其他脆弱性增加了，这凸显了持续为妇女和女童提供艾滋病预防服务的重要性。需要开展更多研究，以更好地了解新冠疫情对社区人群艾滋病预防和脆弱性的长期影响。
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