Structural factors associated with an increased risk of HIV and sexually transmitted infection transmission among street-involved youth
Structural factors associated with an increased risk of HIV and sexually transmitted infection transmission among street-involved youth
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DOI：
10.1186/1471-2458-9-7
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发表时间：
2009-01-09
影响因子：
4.5
通讯作者：
Wood, Evan
中科院分区：
文献类型：
--
作者：
Marshall, Brandon D. L.;Kerr, Thomas;Wood, Evan
背景资料：艾滋病毒和性传播感染（STIs）的患病率在街头参与的青年大大超过一般青少年人口，但是，鲜为人知的是关于结构性因素，影响疾病传播的风险在此population.Methods：在2005年9月至2006年10月，529街头参与的青年被招募在一个前瞻性队列被称为风险青年研究（阿里斯）。我们研究了结构性因素与性伴侣的数量使用准泊松回归和一致的安全套使用logistic regression.Results：在基线，415（78.4%）是性活跃，其中253（61.0%）报告多个性伴侣和288（69.4%）报告不一致的安全套使用在过去的六个月。在多变量分析中，自我报告的卫生服务障碍与安全套的持续使用呈负相关（调整后的比值比[aOR] = 0.52，95%CI：0.25-1.07）。与更多性伴侣相关的结构性因素包括无家可归（调整后的发病率比[aIRR] = 1.54，95% CI：1.11-2.14）和影响获得服务的区域限制（aIRR = 2.32，95% CI：1.28-4.18）。被警察搜查或拘留是显着的男性（aIRR = 1.36，95%CI：1.02-1.81）。结论：虽然其横截面设计的限制，我们的研究发现，一些结构性因素适合政策层面的干预独立相关的性风险行为。这些调查结果意味着，对街头青年的定罪和流离失所可能会增加青年从事危险性行为的可能性，并加剧由此产生的健康后果的负面影响。此外，我们的研究结果表明，环境结构性干预措施可能有助于减少城市环境中街头青年的这些疾病负担。
Background: The prevalence of HIV and sexually transmitted infections (STIs) among street-involved youth greatly exceed that of the general adolescent population; however, little is known regarding the structural factors that influence disease transmission risk among this population.Methods: Between September 2005 and October 2006, 529 street-involved youth were enroled in a prospective cohort known as the At Risk Youth Study (ARYS). We examined structural factors associated with number of sex partners using quasi-Poisson regression and consistent condom use using logistic regression.Results: At baseline, 415 (78.4%) were sexually active, of whom 253 (61.0%) reported multiple sex partners and 288 (69.4%) reported inconsistent condom use in the past six months. In multivariate analysis, self-reported barriers to health services were inversely associated with consistent condom use (adjusted odds ratio [aOR] = 0.52, 95% CI: 0.25-1.07). Structural factors that were associated with greater numbers of sex partners included homelessness (adjusted incidence rate ratio [aIRR] = 1.54, 95% CI: 1.11-2.14) and having an area restriction that affects access to services (aIRR = 2.32, 95% CI: 1.28-4.18). Being searched or detained by the police was significant for males (aIRR = 1.36, 95% CI: 1.02-1.81).Conclusion: Although limited by its cross-sectional design, our study found several structural factors amenable to policy-level interventions independently associated with sexual risk behaviours. These findings imply that the criminalization and displacement of street-involved youth may increase the likelihood that youth will engage in sexual risk behaviours and exacerbate the negative impact of resultant health outcomes. Moreover, our findings indicate that environmental-structural interventions may help to reduce the burden of these diseases among street youth in urban settings.