Marked HIV prevalence declines in higher educated young people: evidence from population-based surveys (1995-2003) in Zambia
Marked HIV prevalence declines in higher educated young people: evidence from population-based surveys (1995-2003) in Zambia
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DOI：
10.1097/01.aids.0000222076.91114.95
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发表时间：
2006-04-24
期刊：
影响因子：
3.8
通讯作者：
Fylkesnes, Knut
中科院分区：
文献类型：
--
作者：
Michelo, Charles;Sandoy, Ingvild F.;Fylkesnes, Knut
目的：在撒哈拉以南非洲，受教育程度越高，感染艾滋病毒的风险越大。方法：数据来源于1995年(n=2989)、1999年(n=3506)和2003年(n=4442)在选定的城市和农村社区进行的一系列以人群为基础的HIV调查。分析按居住地、性别和年龄组进行分层。用Logistic回归分析估计农村人群HIV感染的年龄调整优势比(OR=8岁)和城市人群HIV感染风险(OR=11岁)。结果：城市青年男女受教育程度高的人群普遍倾向于降低感染HIV的风险[OR(优势比)，0.20；95%可信区间(0)，0.05~0.73]，女性(OR，0.33；95%CI，0.15~0.72)。在农村年轻男性中也观察到了类似的模式(OR，0.17；95%CI，0.05-0.59)，但在农村女性中不那么显著，在统计学上没有显著意义。2003年，在25-49岁年龄段，受教育程度较高的城市男性降低了HIV感染的风险(OR，0.43；95%CI，0.26-0.72)，但这在女性中不那么明显。结论：研究结果表明，1995-2003年间，受教育程度与HIV感染之间的关联发生了变化。最令人信服的迹象是，受过更多教育的年轻群体的风险降低，可以假设大多数感染是最近发生的。老年人群的变化可能在很大程度上受到不同死亡率的影响。受教育程度较低的人群中的稳定风险也可能表明过去预防工作的局限性。(C)2006年，Lippincott Williams&Wilkins。
Objectives: Higher educational attainment has been associated with a greater risk of HIV infection in sub-Saharan Africa. We investigated change over time in HIV prevalence by educational attainment in the general population.Methods: The data stem from serial population-based HIV surveys conducted in selected urban and rural communities in 1995 (n = 2989), 1999 (n = 3506) and 2003 (n = 4442). Analyses were stratified by residence, sex and age-group. Logistic regression was used to estimate age-adjusted odds ratio of HIV between low (= 8 years) for the rural population and between low (= 11 years) for the urban population.Results: There was a universal shift towards reduced risk of HIV infection in groups with higher than lower education in both sexes among urban young people [odds ratio (OR), 0.20; 95% confidence interval (0), 0.05-0.73] in men and (OR, 0.33; 95% Cl, 0.15-0.72) in women. A similar pattern was observed in rural young men (OR, 0.17; 95% Cl, 0.05-0.59) but was less prominent and not statistically significant in rural women. In age 25-49 years, higher educated urban men had reduced risk in 2003 (OR, 0.43; 95%Cl, 0.26-0.72) but this was less prominent in women.Conclusions: The findings suggested a shift in the association between educational attainment and HIV infection between 1995 and 2003. The most convincing sign was the risk reduction among more educated younger groups where most infections can be assumed to be recent. The changes in older groups are probably largely influenced by differential mortality rates. The stable risk among groups with lower education might also indicate limitations in past preventive efforts. (c) 2006 Lippincott Williams & Wilkins.