HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana.
HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana.
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在马拉维，纳米比亚和博茨瓦纳发生与男性发生性关系的男性（MSM）男性中的艾滋病毒流行，艾滋病毒感染的风险以及人权。
DOI：
10.1371/journal.pone.0004997
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发表时间：
2009
期刊：
影响因子：
3.7
通讯作者：
Beyrer C
中科院分区：
文献类型：
--
作者：
Baral S;Trapence G;Motimedi F;Umar E;Iipinge S;Dausab F;Beyrer C
在撒哈拉以南非洲南部普遍存在的艾滋病毒流行中，男男性行为者基本上被排除在艾滋病毒监测和研究之外。南部非洲男男性行为者的流行病学数据是全球最稀疏的，而且大多数国家尚未确定这些男性的艾滋病毒风险特征。对马拉维、纳米比亚和博茨瓦纳的 537 名男性进行了非概率抽样调查，这些男性自称曾与另一名男性发生过性行为，使用结构化调查工具和 OraQuick© 快速检测试剂盒进行艾滋病毒筛查。 18至23岁人群的艾滋病毒感染率为8.3%（20/241）； 24-29 岁人群中 20.0% (42/210)； 30 岁以上人群的患病率为 35.7% (30/84)，总体患病率为 17.4% (95% CI 14.4–20.8)。在多变量逻辑回归中，年龄超过 25 岁（aOR 4.0，95% CI 2.0–8.0）和性行为时不总是戴安全套（aOR 2.6，95% CI 1.3–4.9）与 HIV 阳性显着相关。同时性行为很常见，16.6% 的人与一男一女同时保持稳定的关系，53.7% 的人在过去 6 个月内同时拥有男性和女性性伴侣。无保护的肛交很常见，并且在使用安全套时使用石油基润滑剂也很常见。侵犯人权行为十分普遍，包括勒索、拒绝提供住房和医疗保健，42.1% (222/527) 的受访者报告至少发生过一次侵犯人权行为。在马拉维、纳米比亚和博茨瓦纳，MSM 是艾滋病毒感染和侵犯人权的高危群体。与两性伴侣同时发生性关系可能在这些人群中的艾滋病毒传播中发挥重要作用。需要进一步的流行病学和评估研究来评估男男性行为者对南部非洲艾滋病毒流行的影响以及如何最好地减轻这种影响。这些国家应启动针对 MSM 的循证且有针对性的艾滋病毒预防计划并为其提供充足资金。
In the generalized epidemics of HIV in southern Sub-Saharan Africa, men who have sex with men have been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in southern Africa are among the sparsest globally, and HIV risk among these men has yet to be characterized in the majority of countries. A cross-sectional anonymous probe of 537 men recruited with non-probability sampling among men who reported ever having had sex with another man in Malawi, Namibia, and Botswana using a structured survey instrument and HIV screening with the OraQuick© rapid test kit. The HIV prevalence among those between the ages of 18 and 23 was 8.3% (20/241); 20.0% (42/210) among those 24–29; and 35.7% (30/84) among those older than 30 for an overall prevalence of 17.4% (95% CI 14.4–20.8). In multivariate logistic regressions, being older than 25 (aOR 4.0, 95% CI 2.0–8.0), and not always wearing condoms during sex (aOR 2.6, 95% CI 1.3–4.9) were significantly associated with being HIV-positive. Sexual concurrency was common with 16.6% having ongoing concurrent stable relationships with a man and a woman and 53.7% had both male and female sexual partners in proceeding 6 months. Unprotected anal intercourse was common and the use of petroleum-based lubricants was also common when using condoms. Human rights abuses, including blackmail and denial of housing and health care was prevalent with 42.1% (222/527) reporting at least one abuse. MSM are a high-risk group for HIV infection and human rights abuses in Malawi, Namibia, and Botswana. Concurrency of sexual partnerships with partners of both genders may play important roles in HIV spread in these populations. Further epidemiologic and evaluative research is needed to assess the contribution of MSM to southern Africa's HIV epidemics and how best to mitigate this. These countries should initiate and adequately fund evidence-based and targeted HIV prevention programs for MSM.
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