Understanding the uneven spread of HIV within Africa - Comparative study of biologic, behavioral, and contextual factors in rural populations in Tanzania and Zimbabwe
Understanding the uneven spread of HIV within Africa - Comparative study of biologic, behavioral, and contextual factors in rural populations in Tanzania and Zimbabwe
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DOI：
10.1097/01.olq.0000078820.62897.a6
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发表时间：
2003-10-01
影响因子：
3.1
通讯作者：
Urassa, M
中科院分区：
文献类型：
--
作者：
Boerma, JT;Gregson, S;Urassa, M
研究设计：对津巴布韦、马尼卡兰和坦桑尼亚、基萨斯州HIV高流行率和相对低流行率农村地区基于人口的调查数据进行生态比较。结果：马尼卡兰和基萨的HIV流行率在17-44岁的男性中分别为15.4%和5.3%，而在15-44岁的女性中分别为21.1%和8.0%(优势比分别为3.3和3.1)。在马尼卡兰，结婚较晚，空间流动性更普遍，与婚姻伴侣同居的频率较低，教育水平较高，男性割礼不太常见。然而，对这些因素的差异进行调整后，男性和女性在马尼卡兰与基塞萨感染艾滋病毒的优势比分别增加到6.9和4.8。性传播感染水平相似，但梅毒只在基塞萨很常见。Kisesa的受访者开始性行为的时间更早，报告的性伴侣也更多。两地伴侣年龄差异相似。结论：摩尼卡兰州和基塞萨州农村人口的当代社会人口学特征存在显著差异。然而，这些差异没有转化为可获得数据的生物或行为因素的可测量差异，也不能解释马尼卡兰艾滋病毒感染率高得多的原因。这些发现可能反映了津巴布韦更广泛的艾滋病选择性死亡率和行为变化，或者在报告性行为方面存在更大的偏见。
Background: Large differences in the spread of HIV have been observed within sub-Saharan Africa.Goal: The goal was to identify factors that could explain differences in the spread of HIV within sub-Saharan African populations.Study Design: Ecologic comparison of data from population-based surveys in high and relatively low HIV prevalence rural areas in Zimbabwe, Manicaland, and Tanzania, Kisesa.Results: HIV prevalence in Manicaland and Kisesa was 15.4% and 5.3% in men aged 17-44 years and 21.1% and 8.0% in women aged 15-44 years (odds ratios, 3.3 and 3.1, respectively). Marriage is later, spatial mobility more common, cohabitation with marital partners less frequent, education levels are higher, and male circumcision is less common in Manicaland. However, adjustment for differences in these factors increased the odds ratios for HIV infection in Manicaland versus Kisesa to 6.9 and 4.8 for men and women, respectively. Sexually transmitted infection levels were similar, but syphilis was only common in Kisesa. Respondents in Kisesa started sex earlier and reported more sexual partners. Age differences between partners were similar in the 2 locations.Conclusion: Substantial differences exist between the contemporary sociodemographic profiles of rural Manicaland and Kisesa. However, these differences did not translate into measurable differences in the biologic or behavioral factors for which data were available and did not explain the much higher HIV prevalence found in Manicaland. These findings might reflect more extensive AIDS-selective mortality and behavior change or greater bias in reporting of sexual behavior in Zimbabwe.