Makusha Tawanda, Mabaso Musawenkosi, Zungu Nompumelelo, Moyo Sizulu, Naidoo Inbarani, Jooste Sean, Mohapanele Karabo, Zuma Khangelani, Simbayi Leickness
Human Sciences Research Council, Pretoria, South Africa.
University of KwaZulu-Natal, Durban, South Africa.
BMJ Public Health. 2024 Aug 24;2(2):e000674. doi: 10.1136/bmjph-2023-000674. eCollection 2024 Dec.
There is growing recognition that adolescent boys and young men (ABYM) have been left behind in the HIV response and are under-represented in HIV services, leading to poor outcomes across the HIV care cascade. Improved understanding of the HIV epidemic in this population is important for engaging ABYM in the HIV response. This study examined HIV prevalence and associated factors among ABYM aged 15-24 years using the 2017 South African National HIV Prevalence, Incidence, Behaviour and Communication Survey.
The data were collected using a multi-stage stratified cluster randomised sampling design. Descriptive statistics were used to summarise the study sample and HIV prevalence. A multivariate backward stepwise logistic regression model was used to determine factors associated with HIV prevalence. Variables with a significance level of p<0.2 were retained in the final model. Adjusted ORs (AORs) with 95% CI and a p value ≤0.05 were used to determine the level of statistical significance.
Of 3544 ABYM interviewed and tested, 47.8% (n=1 932) were aged 15-19 years and 52.2% (1612) were aged 20-24 years. Overall, 4.8% (95% CI 3.9 to 5.9) were HIV positive, translating to 230 585 ABYM living with HIV in 2017. The odds of being HIV positive were significantly lower among ABYM with tertiary education level (AOR=0.06 (95% CI 0.01 to 0.50), p=0.009), those who were employed (AOR=0.34 (95% CI 0.14 to 0.81), p=0.015) and those who had previously tested for HIV and were aware of their status (AOR=0.29 (95% CI 0.10 to 0.83), p=0.015).
These findings suggest the need to diversify the HIV response to include the implementation of social policies to reduce structural challenges such as low educational attainment and unemployment. They also underscore the importance of promoting the uptake of HIV testing and awareness as the entry point to the treatment and care cascade among ABYM.
人们越来越认识到，在应对艾滋病病毒（HIV）方面，青春期男孩和青年男子（ABYM）被落在了后面，在HIV服务中的代表性不足，导致在整个HIV治疗过程中结果不佳。更好地了解这一人群中的HIV流行情况对于促使ABYM参与HIV应对工作至关重要。本研究利用2017年南非全国HIV流行率、发病率、行为及传播情况调查，对15至24岁的ABYM中的HIV流行率及相关因素进行了研究。
采用多阶段分层整群随机抽样设计收集数据。使用描述性统计来总结研究样本和HIV流行率。采用多变量向后逐步逻辑回归模型来确定与HIV流行率相关的因素。最终模型保留了显著性水平p<0.2的变量。使用95%置信区间（CI）和p值≤0.05的调整后比值比（AOR）来确定统计显著性水平。
在接受访谈和检测的3544名ABYM中，47.8%（n = 1932）年龄在15至19岁之间，52.2%（1612）年龄在20至24岁之间。总体而言，4.8%（95%CI 3.9至5.9）为HIV阳性，这意味着2017年有230585名ABYM感染了HIV。在受过高等教育的ABYM中，HIV阳性的几率显著较低（AOR = 0.06（95%CI 0.01至0.50），p = 0.009），就业者中该几率也较低（AOR = 0.34（95%CI 0.14至0.81），p = 0.015），以及那些之前接受过HIV检测且知晓自身状况的人中该几率同样较低（AOR = 0.29（95%CI 0.10至0.83），p = 0.015）。
这些研究结果表明，需要使HIV应对措施多样化，包括实施社会政策以减少诸如教育程度低和失业等结构性挑战。它们还强调了促进ABYM接受HIV检测并提高知晓率作为其进入治疗和护理过程切入点的重要性。
