Kelly Sophie H, Azizi Steven, Chikwari Chido Dziva, Tembo Mandikudza, Bandason Tsitsi, Dauya Ethel, Mavodza Constancia V, Apollo Tsitsi, Mugurungi Owen, Ferrand Rashida A, Simms Victoria
Department of Medicine, University of Cambridge, Cambridge, UK.
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
BMC Infect Dis. 2025 May 16;25(1):709. doi: 10.1186/s12879-025-11076-1.
BACKGROUND: Youth in southern Africa continue to be at high risk of HIV infection. We investigated the awareness of, access to, and uptake of HIV prevention interventions (pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), voluntary medical male circumcision and condoms) among youth in Zimbabwe. METHODS: A population-based survey of youth aged 18-24 years in 24 communities across three provinces was conducted between October 2021 and June 2022. An interviewer-administered questionnaire collected sociodemographic and sexual behaviour data including awareness of, access to, and use of HIV preventative interventions. Data were analysed using descriptive statistics and mixed-effects logistic regression weighted for clustering. RESULTS: We recruited 17,682 youth (60.8% female, median age 20 years (Interquartile range 19-22)). Altogether 46.8% (n = 3634) of unmarried youth and 5.6% (n = 3538) of married youth reported consistent condom use and 49.8% (n = 3369) of men reported being circumcised. Awareness of PrEP and PEP was 11.2% and 11.9% respectively. 6900 participants (38.4%) reported at least one eligibility criterion for PrEP. Eligibiltiy criteria included having multiple partners or receiving money or goods for sex in the last year, HIV-negative individuals in serodiscordant relationships, those who had ever been treated for an STI, ever injected drugs, been pregnant or taken PEP. In comparison to the non-eligible population (n = 10782), the eligible population were more likely to have heard of PrEP (13.5% vs. 9.9%, p < 0.001), been offered PrEP if they had heard of it (17.0% vs. 6.3%, p < 0.001) and to have ever taken PrEP if offered it (60.7% vs. 27.0%, p < 0.001). Those in the richest wealth quintiles and with higher education level were more likely to have heard of PrEP and report regular condom use. Forty-two of 199 (20.2%) who reported having experienced forced sex in the last year sought healthcare afterwards, of these 17 of 42 (36.0%) had been offered PEP and 12 of 17 (63.7%) had ever taken it. CONCLUSIONS: Use of HIV preventive interventions remains limited among youth despite longstanding HIV programmes. Lack of awareness limits use of PrEP and PEP. There are underlying socioeconomic barriers limiting awareness of and demand for condoms, circumcision and pharmacological prophylaxis. These must be urgently addressed. TRIAL REGISTRATION NUMBER: NCT03719521.
背景：南部非洲的青年仍然面临着较高的艾滋病毒感染风险。我们调查了津巴布韦青年对艾滋病毒预防干预措施（暴露前预防（PrEP）、暴露后预防（PEP）、自愿男性包皮环切术和避孕套）的知晓情况、获取途径及接受情况。 方法：2021年10月至2022年6月期间，在三个省份的24个社区对18至24岁的青年进行了一项基于人群的调查。由访员管理的问卷收集了社会人口学和性行为数据，包括对艾滋病毒预防干预措施的知晓情况、获取途径及使用情况。使用描述性统计和加权聚类的混合效应逻辑回归分析数据。 结果：我们招募了17682名青年（60.8%为女性，中位年龄20岁（四分位间距19 - 22岁））。共有46.8%（n = 3634）的未婚青年和5.6%（n = 3538）的已婚青年报告坚持使用避孕套，49.8%（n = 3369）的男性报告接受了包皮环切术。对PrEP和PEP的知晓率分别为11.2%和11.9%。6900名参与者（38.4%）报告至少符合一项PrEP的适用标准。适用标准包括在过去一年中有多个性伴侣或因性行为获得金钱或物品、血清学不一致关系中的艾滋病毒阴性个体、曾接受过性传播感染治疗的人、曾注射过毒品的人、曾怀孕或接受过PEP的人。与不符合标准的人群（n = 10782）相比，符合标准的人群更有可能听说过PrEP（13.5%对9.9%，p < 0.001），如果听说过PrEP更有可能被提供PrEP（17.0%对6.3%，p < 0.001），并且如果被提供PrEP更有可能接受过PrEP（60.7%对27.0%，p < 0.001）。最富有的五分之一人群和受教育程度较高的人更有可能听说过PrEP并报告经常使用避孕套。在199名报告去年经历过强迫性行为的人中，有42人（20.2%）事后寻求了医疗保健，其中42人中有17人（36.0%）被提供了PEP，17人中有12人（63.7%）接受过PEP。 结论：尽管长期开展了艾滋病毒防治项目，但青年中艾滋病毒预防干预措施的使用仍然有限。缺乏知晓限制了PrEP和PEP的使用。存在潜在的社会经济障碍限制了对避孕套、包皮环切术和药物预防的知晓和需求。必须紧急解决这些问题。 试验注册号：NCT03719５21。
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