乌克兰年轻女性及其性伴侣中的 HIV 传播模式。
Modes of HIV transmission among young women and their sexual partners in Ukraine.
机构信息
European Institute of Public Health Policy, Kyiv, Ukraine.
The International Charitable Foundation "Alliance for Public Health", Kyiv, Ukraine.
出版信息
PLoS One. 2024 Jun 26;19(6):e0305072. doi: 10.1371/journal.pone.0305072. eCollection 2024.
BACKGROUND
Ukraine has the second-largest HIV epidemic in Europe, with most new cases officially attributed to heterosexual transmission. Indirect evidence suggested substantial HIV transmission from people who inject drugs (PWID) to their sexual partners. This study examined the extent of heterosexual HIV transmission between PWID and non-drug-using adolescent girls and young women (AGYW).
METHODS
A cross-sectional survey recruited AGYW diagnosed with heterosexually-acquired HIV between 2016 and 2019 in nine regions of Ukraine. AGYW were asked to identify and refer their sexual partners ('Partners'), who subsequently underwent HIV testing, and, if positive, HCV testing. Both AGYW and Partners completed an interview assessing HIV risk behaviors prior to AGYW's HIV diagnosis.
RESULTS
In August-December 2020, we enrolled 321 AGYW and 64 Partners. Among the Partners, 42% either self-reported IDU or were HCV-positive, indicating an IDU-related mode of HIV transmission. PWID Partners were more likely to report sexually transmitted infections (STI) and had lower educational levels. Of the 62 women who recruited at least one Partner, 40% had a PWID Partner. Within this subgroup, there was a higher prevalence of STIs (52% vs. 24%) and intimate partner violence (36% vs. 3%). Condom use was less common (52% vs. 38% reporting never use), and frequent alcohol or substance use before sex was higher (48% vs 30%) among AGYW with PWID Partner, although this difference did not reach statistical significance. Notably, 52% of women were aware of their Partners' IDU.
CONCLUSION
At least 40% of heterosexual transmission among AGYW in Ukraine can be linked to PWID partners. Intensified, targeted HIV prevention efforts are essential for key and bridge populations (PWID and their sexual partners), addressing the biological and structural determinants of transmission between key and bridge populations, such as IDU- and HIV status disclosure, STIs, IPV, and stigma.
背景
乌克兰是欧洲第二大艾滋病毒流行地区，大多数新病例官方归因于异性传播。间接证据表明，大量艾滋病毒感染者（PWID）向其性伴侣传播艾滋病毒。本研究调查了 PWID 与非吸毒的青少年女孩和年轻妇女（AGYW）之间异性传播艾滋病毒的程度。
方法
一项横断面调查于 2016 年至 2019 年在乌克兰九个地区招募了诊断为异性传播获得艾滋病毒的 AGYW。AGYW 被要求识别并转介其性伴侣（“伴侣”），随后伴侣接受 HIV 检测，如果阳性，则接受 HCV 检测。AGYW 和伴侣均完成了一项访谈，评估了 AGYW 艾滋病毒诊断前的艾滋病毒风险行为。
结果
2020 年 8 月至 12 月，我们招募了 321 名 AGYW 和 64 名伴侣。在伴侣中，42%的人自我报告或 HCV 阳性，表明存在与 IDU 相关的艾滋病毒传播模式。PWID 伴侣更有可能报告性传播感染（STI），并且受教育程度较低。在 62 名至少招募一名伴侣的女性中，40%的伴侣是 PWID。在这个亚组中，STI 的患病率更高（52%对 24%），亲密伴侣暴力（36%对 3%）更高。AGYW 与 PWID 伴侣发生性行为时，使用安全套的情况较少（52%对 48%报告从不使用），性前频繁饮酒或吸毒的情况更多（48%对 30%），尽管这一差异无统计学意义。值得注意的是，52%的女性知道其伴侣的 IDU 情况。
结论
乌克兰至少有 40%的 AGYW 异性传播可归因于 PWID 伴侣。对于关键和桥梁人群（PWID 和他们的性伴侣），必须加强有针对性的艾滋病毒预防工作，解决关键和桥梁人群之间传播的生物学和结构性决定因素，如 IDU 和 HIV 状况的披露、性传播感染、亲密伴侣暴力和耻辱感。
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