High HIV incidence and low uptake of HIV prevention services: The context of risk for young male adults prior to DREAMS in rural KwaZulu-Natal, South Africa
High HIV incidence and low uptake of HIV prevention services: The context of risk for young male adults prior to DREAMS in rural KwaZulu-Natal, South Africa
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DOI：
10.1371/journal.pone.0208689
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发表时间：
2018-12-26
期刊：
影响因子：
3.7
通讯作者：
Shahmanesh, Maryam
中科院分区：
文献类型：
--
作者：
Baisley, Kathy;Chimbindi, Natsayi;Shahmanesh, Maryam
背景年轻男性比年轻女性更不可能从事艾滋病毒的预防和护理，他们与艾滋病毒相关的死亡率更高。我们描述了在DREAM推出之前，南非夸祖鲁-纳塔尔农村地区20-29岁男性的艾滋病毒发病率和艾滋病毒服务的接受情况。方法我们使用了基于人口和艾滋病毒监测队列的数据。HIV发病率是通过每年一次的血清调查中的匿名测试来估计的。2011年和2015年通过两个自我报告的结果对服务接受情况进行了评估：1)过去12个月的艾滋病毒检测(M)；2)自愿医疗男性包皮环切术(VMMC)。结果2011-2015年20-24岁和25-29岁男性HIV感染率分别为2.6/100人年(95%CI=2.0-3.4)和4.2(95%CI=3.1-5.6)，与2006-2010年无显著差异。N=1311名和N=1221名青年男子分别参加了2011年和2015年的调查。在这两年中，有1名伴侣在过去12年或最近一次性行为中使用避孕套，但在报告临时伴侣的人中较低(调整后的(A)OR=0.53，95%CI=0.37-0.75)。VMMC摄取率与调查年份和高等教育有关。25~29岁男性和在职男性(AOR=0.66；95%CI=0.49~0.89)报告VMMC的可能性较低。结论20~29岁男性HIV感染率很高，应考虑在这一人群中进行暴露前预防。对服务的接受程度很低。从2011年到2015年，VMMC的覆盖率大幅增加，特别是在年轻男性中，这表明对这项服务的需求。迫切需要针对青年男子设计的干预措施。
BackgroundYoung men are less likely than young women to engage with HIV prevention and care, and their HIV-related mortality is higher. We describe HIV incidence and uptake of HIV services in men 20-29 years(y) in rural KwaZulu-Natal, South Africa, before the roll-out of DREAMS.MethodsWe used data from a population-based demographic and HIV surveillance cohort. HIV incidence was estimated from anonymised testing in an annual serosurvey. Service uptake was assessed in 2011 and 2015, through two self-reported outcomes: 1) HIV testing in the past 12 months(m); 2) voluntary medical male circumcision(VMMC). Logistic regression was used to estimate odds ratios(OR) and 95% confidence intervals(CI) for factors associated with each outcome.ResultsHIV incidence in 2011-2015 was 2.6/100 person-years (95% CI = 2.0-3.4) and 4.2 (95% CI = 3.1-5.6) among men 20-24y and 25-29y, respectively, with no significant change from 2006-2010. N = 1311 and N = 1221 young men participated in the 2011 and 2015 surveys, respectively. In both years, 1 partner in the past 12m, or condom use at last sex, but lower in those reporting a casual partner (adjusted (a) OR = 0.53, 95%CI = 0.37-0.75). VMMC uptake was associated with survey year and higher education. Men aged 25-29y and those who were employed (aOR = 0.66; 95%CI = 0.49-0.89) were less likely to report VMMC.ConclusionsHIV incidence in men 20-29y was very high, and pre-exposure prophylaxis (PrEP) should be considered in this population. Uptake of services was low. VMMC coverage increased dramatically from 2011 to 2015, especially among younger men, suggesting a demand for this service. Interventions designed with and for young men are urgently needed.