Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection
Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection
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DOI：
10.1097/00002030-200108004-00003
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发表时间：
2001-08-01
期刊：
影响因子：
3.8
通讯作者：
Akam, E
中科院分区：
文献类型：
--
作者：
Auvert, B;Buvé, A;Akam, E
目的：确定可能解释撒哈拉以南非洲不同地区之间艾滋病毒传播率差异的因素。设计：横断面研究。方法：研究在两个HIV患病率相对较低的城市（贝宁的科托努和喀麦隆的雅温得）和两个HIV患病率较高的城市（肯尼亚的基苏木和赞比亚的恩多拉）进行。在这些城市中，选取了大约1000名男性和1000名年龄在15-49岁之间的女性作为代表性样本。对同意的男女进行了关于其社会人口背景和性行为的访谈；并接受HIV、单纯疱疹病毒2型（HSV-2）、梅毒、沙眼衣原体和淋病奈瑟菌感染以及（仅限女性）阴道毛滴虫的检测。对各城市、各性别的HIV感染危险因素分别进行分析。通过多因素logistic回归获得校正优势比（aOR）。结果：性活跃男性HIV感染率科托努为3.9%，雅温得为4.4%，基苏木为21.1%，恩多拉为25.4%。女性的相应数字分别为4.0、8.4、31.6和35.1%。高危性行为在艾滋病毒高流行城市中并不比在艾滋病毒低流行城市中更常见，但在艾滋病毒高流行城市中，2型单纯疱疹病毒感染和缺乏包皮环切术始终比在艾滋病毒低流行城市中更为普遍。在多变量分析中，艾滋病毒感染与性行为因素之间的关系在四个城市中是不同的。梅毒在男性和女性中与HIV感染相关[aOR = 2.7, 95%可信区间(CI) = 1.5-4.9] （aOR = 1.7, 95% Cl = 1.1-2.6）。2型单纯疱疹病毒感染与艾滋病毒感染在所有4个城市和两性中均密切相关（aOR在4.4至8.0之间）。在基苏木，包皮环切术对男性感染艾滋病毒有很强的保护作用（aOR = 0.25, 95% Cl = 0.12-0.52）。在Nclola，没有发现包皮环切术和HIV感染之间的联系，但样本量太小，无法完全调整混杂因素。结论：HIV和HSV-2与男性包皮环切术之间的密切联系以及危险因素的分布，使我们认为生物学因素介导的HIV传播效率的差异大于性行为的差异，可以解释四个城市之间HIV传播率的差异。(C) 2001 Lippincott Williams & Wilkins。
Objective: To identify factors that could explain differences in rate of spread of HIV between different regions in sub-Saharan Africa.Design: Cross-sectional study.Methods: The study took place in two cities with a relatively low HIV prevalence (Cotonou, Benin and Yaounde, Cameroon), and two cities with a high HIV prevalence (Kisumu, Kenya and Ndola, Zambia). In each of these cities, a representative sample was taken of about 1000 men and 1000 women aged 15-49 years. Consenting men and women were interviewed about their socio-demographic background and sexual behaviour; and were tested for HIV, herpes simplex virus type 2 (HSV-2), syphilis, Chlamydia trachomatis and Neisseria gonorrhoea infection, and (women only) Trichomonas vaginalis. Analysis of risk factors for HIV infection was carried out for each city and each sex separately. Adjusted odds ratios (aOR) were obtained by multivariate logistic regression.Results: The prevalence of HIV infection in sexually active men was 3.9% in Cotonou, 4.4% in Yaounde, 21.1% in Kisumu, and 25.4% in Ndola. For women, the corresponding figures were 4.0, 8.4, 31.6 and 35.1%. High-risk sexual behaviour was not more common in the high HIV prevalence cities than in the low HIV prevalence cities, but HSV-2 infection and lack of circumcision were consistently more prevalent in the high HIV prevalence cities than in the low HIV prevalence cities. In multivariate analysis, the association between HIV infection and sexual behavioural factors was variable across the four cities. Syphilis was associated with HIV infection in Ndola in men [aOR = 2.7, 95% confidence interval (CI) = 1.5-4.9] and in women (aOR = 1.7, 95% Cl = 1.1-2.6). HSV-2 infection was strongly associated with HIV infection in all four cities and in both sexes (aOR ranging between 4.4 and 8.0). Circumcision had a strong protective effect against the acquisition of HIV by men in Kisumu (aOR = 0.25, 95% Cl = 0.12-0.52). In Nclola, no association was found between circumcision and HIV infection but sample sizes were too small to fully adjust for confounding.Conclusion: The strong association between HIV and HSV-2 and male circumcision, and the distribution of the risk factors, led us to conclude that differences in efficiency of HIV transmission as mediated by biological factors outweigh differences in sexual behaviour in explaining the variation in rate of spread of HIV between the four cities. (C) 2001 Lippincott Williams & Wilkins.