南非青少年与成年女性在艾滋病病毒风险因素方面的差异及其与性传播感染的关联。

Differences in HIV risk factors between South African adolescents and adult women and their association with sexually transmitted infections.

作者信息

Mkhize Pamela, Mehou-Loko Celia, Maphumulo Nokuthula, Radzey Nina, Abrahams Andrea G, Sibeko Sengeziwe, Harryparsad Rushil, Manhanzva Monalisa, Meyer Bahiah, Radebe Phumla, Liebenberg Lenine J P, Ngcapu Sinaye, Ahmed Nadia, Busakwe Funeka, Mqaba Noluthando, Archary Derseree, Sivro Aida, Samsunder Natasha, Potloane Disebo, Horsnell William, Jordan Christine, Abdool Karim Quarraisha, Bekker Linda-Gail, Passmore Jo-Ann, Jaspan Heather, Humphries Hilton, Masson Lindi

机构信息

Centre for the Aids Programme of Research in South Africa, Durban, South Africa.

Biochemistry Department, University of KwaZulu-Natal, Pietermaritzburg, South Africa.

出版信息

Sex Transm Infect. 2025 Apr 15;101(3):174-182. doi: 10.1136/sextrans-2024-056260.

DOI:10.1136/sextrans-2024-056260

PMID:39632075

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11999788/

Abstract

OBJECTIVES

In sub-Saharan Africa, approximately 86% of HIV infections in adolescents aged 15-19 years occur among girls. Their heightened susceptibility is likely influenced by converging sociobehavioural and biological factors, although the relative contributions remain unclear. To address this, we compared known and hypothesised risk factors for HIV between cisgender adolescent girls and adult women in South Africa and evaluated the relationships between these factors and sexually transmitted infection (STI) status.

METHODS

This cross-sectional observational study included adolescent (n=305; 14-19 years) and adult females (n=114; 25-35 years) in two South African provinces (Western Cape (WC), KwaZulu-Natal (KZN)). Demographic and sociobehavioural data were collected by questionnaire. Colposcopy was conducted to identify cervicovaginal abnormalities, and tests for bacterial vaginosis (BV), , and were performed.

RESULTS

Adults reported higher risk sexual behaviour than adolescents across multiple variables, although adolescents were more likely to have STIs than adults (62.8% vs 34.0%, respectively, p=0.0010 for WC; 42.5% vs 16.4%, respectively, p=0.0002 for KZN). Adolescents did, however, report earlier sexual debut (16 years old vs 17 years old, p<0.0001 for both sites) and KZN adolescents were more likely to use intravaginal sexual enhancers than adults (34.6% vs 20.6%, respectively, p=0.0417). Numbers of sexual partners (β-coefficient: 0.34, SE: 0.12, p=0.0054) and sex acts within the previous 3 months (β-coefficient: 0.25, SE: 0.09, p=0.0062) were associated with STIs in adolescents and trended to significance for adults. Intravaginal sexual enhancer use (KZN only; β-coefficient: 0.95, SE: 0.38, p=0.0118) and biological risk factors, including BV Nugent score (β-coefficient: 0.09, SE: 0.04, p=0.0257) and signs of cervicovaginal injury/inflammation (β-coefficient: 1.07, SE: 0.45, p=0.0171), were associated with STIs in adolescents but not adults.

CONCLUSIONS

Risk factors for STIs including HIV may differ between age groups of girls and women, and mitigation interventions may need to be tailored accordingly.

摘要

目的

在撒哈拉以南非洲地区，15 - 19岁青少年中约86%的艾滋病毒感染发生在女孩中。她们易感性增强可能受到社会行为和生物学因素共同作用的影响，尽管相对贡献尚不清楚。为解决这一问题，我们比较了南非顺性别青少年女孩和成年女性中已知的和假设的艾滋病毒风险因素，并评估了这些因素与性传播感染（STI）状况之间的关系。

方法

这项横断面观察性研究纳入了南非两个省份（西开普省（WC）、夸祖鲁 - 纳塔尔省（KZN））的青少年（n = 305；14 - 19岁）和成年女性（n = 114；25 - 35岁）。通过问卷调查收集人口统计学和社会行为数据。进行阴道镜检查以识别宫颈阴道异常，并进行细菌性阴道病（BV）、[此处原文缺失部分检查项目名称]和[此处原文缺失部分检查项目名称]检测。

结果

在多个变量方面，成年人报告的危险性性行为比青少年更高，尽管青少年比成年人更易患性传播感染（分别为62.8%对34.0%，西开普省p = 0.0010；分别为42.5%对16.4%，夸祖鲁 - 纳塔尔省p = 0.0002）。然而，青少年报告的首次性行为年龄更早（16岁对17岁，两个地点p均<0.0001），且夸祖鲁 - 纳塔尔省的青少年比成年人更有可能使用阴道内性增强剂（分别为34.6%对20.6%，p = 0.0417）。性伴侣数量（β系数：0.34，标准误：0.12，p = 0.0054）和前3个月内的性行为次数（β系数：0.25，标准误：0.09，p = 0.0062）与青少年的性传播感染有关，对成年人而言有显著趋势。使用阴道内性增强剂（仅在夸祖鲁 - 纳塔尔省；β系数：0.95，标准误：0.38，p = 0.0118）以及生物学风险因素，包括BV Nugent评分（β系数：0.09，标准误：0.04，p = 0.0257）和宫颈阴道损伤/炎症迹象（β系数：1.07，标准误：0.45，p = 0.0171），与青少年而非成年人的性传播感染有关。