人道主义危机背景下与 HIV 获得相关的因素的范围综述。

A Scoping Review of Factors Associated with HIV Acquisition in the Context of Humanitarian Crises.

机构信息

Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA.

Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.

出版信息

AIDS Behav. 2024 Dec;28(12):4224-4273. doi: 10.1007/s10461-024-04504-x. Epub 2024 Sep 18.

Abstract

Humanitarian crises-natural or human-made events that can threaten communities' health, safety, security, and well-being-may affect the HIV epidemic dynamics. Common aspects of humanitarian crises such as poverty, powerlessness, disruptions to the health systems, and social instability can contribute to a person's vulnerability to HIV infection through increased risk behaviors and limited access to health services. Guided by the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, we conducted a scoping review of literature published in English between January 1990 and March 2022 to characterize the global evidence of modifiable and non-modifiable factors for HIV acquisition in the context of humanitarian crises. We systematically searched, screened, and synthesized literature from MEDLINE, Embase, Global Health (all accessed via Ovid), and Scopus, and also grey literature through websites of humanitarian agencies and relevant non-government organizations, the International AIDS Society's abstract databases, and Google Scholar. We considered studies presenting empirical data on HIV prevalence, incidence, or risk factors in humanitarian crises-affected populations, including refugees, asylum seekers, and internally displaced persons. Forty-nine studies met the inclusion criteria. The majority of studies were quantitative (n = 43, 87.8%) and cross-sectional (n = 37, 75.5%) in design. Most were single-country studies (n = 43, 87.8%) and conducted in Sub-Saharan Africa (n = 31, 63.3%). We identified 5 non-modifiable factors for HIV acquisition (i.e., age, gender, location, place of birth or origin, and ethnicity) and 60 modifiable factors that we further classified into five categories, namely 18 policy and structural, 9 sociocultural, 11 health and mental health, 16 sexual practice, and 6 humanitarian crisis-related traumatic event factors. Within the modifiable categories, factors that were most often investigated were education level, marital status, sexually transmitted infection diagnosis, condom use, and experience of rape or sexual trauma, respectively. Informed by the findings, we applied the social-ecological model to map the identified multidimensional factors associated with HIV acquisition at the levels of individual, social and sexual networks, community, public policy, and the context of humanitarian crises. The current review provides a comprehensive, global analysis of the available evidence on HIV prevalence, incidence, and risk factors in humanitarian crises and implications for potential programs and research. Future research is warranted to further understand the directionality of the non-modifiable and modifiable factors affecting HIV acquisition, and the multilevel barriers and facilitators to the uptake of HIV prevention strategies in the context of humanitarian crises. Such research can generate actionable evidence to inform the development of ethical, trauma-informed, and culturally appropriate HIV prevention interventions in humanitarian settings.

摘要

人道主义危机是指可能威胁到社区健康、安全、保障和福祉的自然或人为事件,可能会影响艾滋病毒流行动态。人道主义危机的一些常见方面,如贫困、无力、卫生系统中断和社会不稳定,可能会通过增加风险行为和获取卫生服务的机会有限,导致人们更容易感染艾滋病毒。我们遵循乔安娜·布里格斯研究所(Joanna Briggs Institute)的范围综述方法和用于系统综述和荟萃分析扩展的首选报告项目(PRISMA-ScR)报告指南,对 1990 年 1 月至 2022 年 3 月期间以英文发表的文献进行了范围综述,以描述在人道主义危机背景下可改变和不可改变的艾滋病毒获得因素的全球证据。我们系统地检索、筛选和综合了 MEDLINE、Embase、全球健康(均通过 Ovid 访问)和 Scopus 的文献,以及人道主义机构和相关非政府组织网站、国际艾滋病协会摘要数据库和 Google Scholar 的灰色文献。我们考虑了在受人道主义危机影响的人群中,包括难民、寻求庇护者和国内流离失所者,提出艾滋病毒流行率、发病率或风险因素的实证数据的研究。49 项研究符合纳入标准。大多数研究是定量的(n=43,87.8%)和横断面的(n=37,75.5%)。大多数是单国研究(n=43,87.8%),在撒哈拉以南非洲进行(n=31,63.3%)。我们确定了 5 个不可改变的艾滋病毒获得因素(即年龄、性别、地点、出生地或原籍地和种族)和 60 个可改变的因素,我们进一步将其分为五类,即 18 个政策和结构性因素、9 个社会文化因素、11 个健康和心理健康因素、16 个性实践因素和 6 个人道主义危机相关创伤事件因素。在可改变的类别中,研究最多的因素分别是教育程度、婚姻状况、性传播感染诊断、避孕套使用和强奸或性创伤经历。根据这些发现,我们应用社会生态模型绘制了与个体、社会和性关系网络、社区、公共政策以及人道主义危机背景下艾滋病毒获得相关的多维因素之间的关系。本综述提供了关于人道主义危机中艾滋病毒流行率、发病率和风险因素的全面、全球分析,以及对潜在方案和研究的影响。需要进一步的研究来进一步了解影响艾滋病毒获得的不可改变和可改变因素的方向,以及在人道主义危机背景下,接受艾滋病毒预防策略的多层次障碍和促进因素。这种研究可以产生可操作的证据,为在人道主义环境中制定符合伦理、注重创伤和文化适宜的艾滋病毒预防干预措施提供信息。

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