Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi
Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi
复制标题
DOI：
10.1136/sti.2008.033969
复制
发表时间：
2009-04-01
影响因子：
3.6
通讯作者：
Heymann, S. J.
中科院分区：
文献类型：
--
作者：
Boileau, C.;Clark, S.;Heymann, S. J.
目的：探讨性和婚姻轨迹与马拉维农村已婚妇女HIV感染的关系。方法：使用马拉维传播和观念改变项目访问的926名已婚妇女的回顾调查数据和HIV生物标志物数据。对HIV感染与四个关键的生命过程转变(首次性行为年龄、婚前性活动、结婚以及离婚或死亡导致的婚姻破裂)之间的关系进行了研究。然后对这些转变进行排序，以构建代表数据中各种模式的轨迹。结果：虽然每个单独的生命过程转变都可能与HIV感染有关，但它们的联合作用似乎取决于它们发生的顺序。虽然早出性接触、没有与第一个性伴侣结婚以及婚姻破裂都会增加感染艾滋病毒的可能性，但它们的风险并不是相加的。既推迟了首次性生活，又没有嫁给第一个伴侣的女性，一旦结婚，就更有可能经历婚姻破裂，成为艾滋病毒阳性的人。然而，与第一个伴侣结婚但在很小的时候发生性行为的女性也面临着相当大的风险。结论：这些发现确认了从生命历程的角度来理解一些女性感染艾滋病毒和其他女性没有感染艾滋病毒的潜力，以及艾滋病毒流行率的差异源于一个人生活中的性和婚姻转变的顺序。然而，分析表明，需要进一步收集数据，以便更好地检查解释生命过程轨迹变化的机制，从而解决艾滋病毒终身感染概率的变化。
Objective: To explore how sexual and marital trajectories are associated with HIV infection among ever-married women in rural Malawi.Methods: Retrospective survey data and HIV biomarker data for 926 ever-married women interviewed in the Malawi Diffusion and Ideational Change Project were used. The associations between HIV infection and four key life course transitions considered individually (age at sexual debut, premarital sexual activity, entry into marriage and marital disruption by divorce or death) were examined. These transitions were then sequenced to construct trajectories that represent the variety of patterns in the data. The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region.Results: Although each life course transition taken in isolation may be associated with HIV infection, their combined effect appeared to be conditional on the sequence in which they occurred. Although early sexual debut, not marrying one's first sexual partner and having a disrupted marriage each increased the likelihood of HIV infection, their risk was not additive. Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive. Women who marry their first partner but who have sex at a young age, however, are also at considerable risk.Conclusions: These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one's life. The analysis suggests, however, the need for further data collection to permit a better examination of the mechanisms that account for variations in life course trajectories and thus in lifetime probabilities of HIV infection.