Effect of concurrent sexual partnerships on rate of new HIV infections in a high-prevalence, rural South African population: a cohort study.
Effect of concurrent sexual partnerships on rate of new HIV infections in a high-prevalence, rural South African population: a cohort study.
复制标题
DOI：
10.1016/s0140-6736(11)60779-4
复制
发表时间：
2011-07-16
期刊：
影响因子：
168.9
通讯作者：
Newell, Marie-Louise
中科院分区：
文献类型：
--
作者：
Tanser, Frank;Baernighausen, Till;Hund, Lauren;Garnett, Geoffrey P.;McGrath, Nuala;Newell, Marie-Louise
人们普遍认为，同时存在的性伙伴关系是撒哈拉以南非洲艾滋病毒流行的主要驱动因素之一。这一观点得到了理论模型的支持，该模型预测，同时伴侣关系流行率的增加可能会大大增加疾病的传播速度。然而，在撒哈拉以南非洲地区，同时存在的伴侣关系对艾滋病毒发病率的影响尚未得到适当的检验。在这项基于人群的队列研究中，我们使用了来自南非夸祖鲁-纳塔尔的非洲中心人口监测站点的数据，试图为并发性假说找到支持。我们使用移动窗口方法来构建估计的地理变化报告的同时和终身伴侣在性活跃的男性年龄在15-55岁（n=2153）在整个研究区域。然后，我们对人群中7284名HIV阴性女性（≥15岁）进行了随访，并量化了周围当地社区男性性行为特征对女性感染HIV风险的影响。在5年的随访中，发生了693例新的女性艾滋病毒感染（发病率为3.60例/100人年）。我们发现，该人群中性活跃男性的伴侣关系并发性（范围4.0 - 76.3%;平均31.5%）和终生性伴侣平均数量（3.4 - 12.9;平均6.3）的估计点患病率存在显著的社区间异质性。在调整了个人层面的性行为和与艾滋病毒感染相关的人口、社会经济和环境因素后，当地社区男性伴侣的平均终生数量可预测女性感染艾滋病毒的危险（校正风险比[HR] 1.08，95% CI 1.03 - 1.14，p= 0.004），而在同一个地方社区，高流行率的伴侣关系并发症与艾滋病毒感染风险的增加无关（校正HR 1.02，95% CI 0.95 - 1.09，p= 0.556）。我们没有发现任何证据表明，在这一典型的高流行率的非洲农村人口中，同时存在的伴侣关系是艾滋病毒发病率的重要驱动因素。我们的研究结果表明，在类似的高流行性撒哈拉以南非洲地区的环境中，有必要发出直截了当、明确的信息，以减少多重伙伴关系，无论这些伙伴关系在时间上是否重叠。美国国家儿童健康和人类发展研究所;惠康信托基金会。
Concurrent sexual partnerships are widely believed to be one of the main drivers of the HIV epidemic in sub-Saharan Africa. This view is supported by theoretical models predicting that increases in prevalence of concurrent partnerships could substantially increase the rate of spread of the disease. However, the effect of concurrent partnerships on HIV incidence has not been appropriately tested in a sub-Saharan African setting. For this population-based cohort study, we used data from the Africa Centre demographic surveillance site in KwaZulu-Natal, South Africa, to try to find support for the concurrency hypothesis. We used a moving-window approach to construct estimates of the geographical variation in reported concurrent and lifetime partners in sexually active men aged 15–55 years (n=2153) across the study area. We then followed up 7284 HIV-negative women (≥15 years of age) in the population and quantified the effect of the sexual behaviour profiles of men in the surrounding local community on a woman's hazard of HIV acquisition. During 5 years' follow-up, 693 new female HIV infections occurred (incidence 3·60 cases per 100 person-years). We identified substantial intercommunity heterogeneity in the estimated point-prevalence of partnership concurrency (range 4·0–76·3%; mean 31·5%) and mean number of lifetime sexual partners (3·4–12·9; mean 6·3) in sexually active men in this population. After adjustment for individual-level sexual behaviour and demographic, socioeconomic, and environmental factors associated with HIV acquisition, mean lifetime number of partners of men in the immediate local community was predictive of hazard of HIV acquisition in women (adjusted hazard ratio [HR] 1·08, 95% CI 1·03–1·14, p=0·004), whereas a high prevalence of partnership concurrency in the same local community was not associated with any increase in risk of HIV acquisition (adjusted HR 1·02, 95% CI 0·95–1·09, p=0·556). We find no evidence to suggest that concurrent partnerships are an important driver of HIV incidence in this typical high-prevalence rural African population. Our findings suggest that in similar hyperendemic sub-Saharan African settings, there is a need for straightforward, unambiguous messages aimed at the reduction of multiple partnerships, irrespective of whether those partnerships overlap in time. US National Institute of Child Health and Human Development; Wellcome Trust.