A cross-sectional assessment of the burden of HIV and associated individual- and structural-level characteristics among men who have sex with men in Swaziland
A cross-sectional assessment of the burden of HIV and associated individual- and structural-level characteristics among men who have sex with men in Swaziland
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DOI：
10.7448/ias.16.4.18768
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发表时间：
2013-12-01
影响因子：
6
通讯作者：
Adams, Darrin
中科院分区：
文献类型：
--
作者：
Baral, Stefan D.;Ketende, Sosthenes;Adams, Darrin
简介：与其他南部非洲国家一样，斯威士兰也受到艾滋病毒的严重影响，估计有四分之一以上的育龄成年人感染了艾滋病毒，相当于估计有17万人感染了艾滋病毒。在过去几年中，人们越来越多地认识到，在艾滋病毒流行同样广泛的邻国，男男性行为者（MSM）的潜在脆弱性。到目前为止，有没有数据特征的负担艾滋病毒和艾滋病毒的预防，治疗和护理需求的男同性恋者在Swaziland.Methods：在2011年，324名男性谁报告的性行为与另一名男子在过去的12个月内累计使用应答者驱动的抽样（RDS）。参加者使用斯威士兰国家指导方针以及由受过培训的工作人员管理的结构化调查工具完成了艾滋病毒检测，其中包括人口统计、个人行为和生物风险因素、社会和结构特征以及接受艾滋病毒服务等模块。使用数据平滑算法分别计算每个变量的群体和个体权重。权重用于估计RDS调整的单变量估计值和95%自举置信区间（BCI）。以HIV作为因变量完成了粗分析和RDS调整的双变量和多变量分析。总体而言，艾滋病毒感染率为17.6%（n = 50/284），尽管在双变量[比值比（OR）1.2，95%BCI 1.15-1.21]和多变量校正分析中，它与年龄密切相关（调整OR 1.24，95%BCI 1.14-1.35）。近70.8%（n = 34/48）的人不知道自己感染了艾滋病毒。与所有性伴侣和避孕套兼容润滑剂的使用与男性的1.3%（95%CI 0.0-9.7）的报告：虽然在斯威士兰的流行是由高风险的异性传播，艾滋病毒的负担和艾滋病毒的预防，治疗和护理需求的男男性接触者已经研究不足。这里提供的数据表明，这些男性有特定的艾滋病毒感染和传播的风险，不同于其他育龄成年人。在过去十年中，艾滋病毒服务的扩大可能对男男性行为者的益处有限，可能导致在一般人群中艾滋病毒流行减缓的情况下，男男性行为者中的艾滋病毒流行扩大，这是世界大多数国家观察到的现实。
Introduction: Similar to other Southern African countries, Swaziland has been severely affected by HIV, with over a quarter of its reproductive-age adults estimated to be living with the virus, equating to an estimate of 170,000 people living with HIV. The last several years have witnessed an increase in the understanding of the potential vulnerabilities among men who have sex with men (MSM) in neighbouring countries with similarly widespread HIV epidemics. To date, there are no data characterizing the burden of HIV and the HIV prevention, treatment and care needs of MSM in Swaziland.Methods: In 2011, 324 men who reported sex with another man in the last 12 months were accrued using respondent-driven sampling (RDS). Participants completed HIV testing using Swazi national guidelines as well as structured survey instruments administered by trained staff, including modules on demographics, individual-level behavioural and biological risk factors, social and structural characteristics and uptake of HIV services. Population and individual weights were computed separately for each variable with a data-smoothing algorithm. The weights were used to estimate RDS-adjusted univariate estimates with 95% bootstrapped confidence intervals (BCIs). Crude and RDS-adjusted bivariate and multivariate analyses were completed with HIV as the dependent variable.Results: Overall, HIV prevalence was 17.6% (n = 50/284), although it was strongly correlated with age in bivariate-[odds ratio (OR) 1.2, 95% BCI 1.15-1.21] and multivariate-adjusted analyses (adjusted OR 1.24, 95% BCI 1.14-1.35) for each additional year of age. Nearly, 70.8% (n = 34/48) were unaware of their status of living with HIV. Condom use with all sexual partners and condom-compatible-lubricant use with men were reported by 1.3% (95% CI 0.0-9.7).Conclusions: Although the epidemic in Swaziland is driven by high-risk heterosexual transmission, the burden of HIV and the HIV prevention, treatment and care needs of MSM have been understudied. The data presented here suggest that these men have specific HIV acquisition and transmission risks that differ from those of other reproductive-age adults. The scale-up in HIV services over the past decade has likely had limited benefit for MSM, potentially resulting in a scenario where epidemics of HIV among MSM expand in the context of slowing epidemics in the general population, a reality observed in most of the world.