The effect of migration on sexual risk behaviors and HIV incidence among non-migrating household members: a population-based study

移民对非移民家庭成员性危险行为和艾滋病毒发病率的影响：一项基于人口的研究

• 批准号: 10226864
• 负责人: Ruth Young
• 金额: $ 3.96万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2022-05-20
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10226864
• 关键词: Address; Adolescent; Africa South of the Sahara; Age; Behavior; Behavioral; Caring; Censuses; Cohort Studies; Communities; Contracts; Couples; Data; Decision Making; Destinations; Event; Family; Family Relationship; Family member; Female; Gender; Goals; HIV; HIV Infections; HIV Seronegativity; HIV risk; Heterosexuals; Household; Household Heads; Household and Family; Incidence; Individual; Intercept; Intervention; Interview; Knowledge; Link; Longitudinal cohort study; Mentorship; Migrant; Nonmigrant; Nuclear Family; Out-Migrations; Parents; Participant; Perception; Persons; Population; Population Study; Prevalence; Public Health Schools; Reporting; Research; Research Priority; Risk; Risk Behaviors; Role; Services; Sex Behavior; Sexual Partners; Single Parent; Social support; Socioeconomic Status; Spouses; Stress; Stressful Event; Structure; Subgroup; Supervision; Surveys; Technical Expertise; Time; Training; Transcript; Uganda; Viral; Viral Load result; aged; base; care seeking; caregiving; cohort; condoms; design; doctoral student; experience; family structure; high risk; high risk sexual behavior; member; migration; peer; population based; sexual risk behavior; social; sociodemographics

Background: Migration, a common phenomenon in sub-Saharan Africa (SSA), is linked to an increased risk of acquiring HIV and sexual risk behavior. However, the impact of migration on the risk of acquiring HIV and sexual behaviors amongst non-migrating members of migrant households has not been studied in detail in SSA. Migration can be disruptive and stressful for households and may result in increased HIV risk. Non- migrating persons living in migrant households may be an unidentified high-risk sub-group for HIV in SSA. Aims: The goal is to assess how migration influences the risk of acquiring HIV and sexual risk behaviors of non-migrating members of migrant households in Rakai, Uganda. The study aims to: 1A) Compare sociodemographic and household family structure among in-migrating, out-migrating and non-migrating households; 1B) Compare HIV prevalence, prevalence of sexual risk behaviors, viral load suppression between non-migrating members of in- and out-migrant households with members of non-migrant households; 2) Assess incidence of HIV, and changes in sexual risk behavior of non-migrating household members following the in- or out-migration of a household member; and 3) Qualitatively explore the impact of out- migration amongst couples on non-migrating partners’ HIV and sexual behavior perceptions and practices. Approach: This study will use existing data for Aims 1 and 2 from the Rakai Community Cohort Study (RCCS), an open population-based cohort of approximately 22,000 people aged 15-49 years across 40 communities, collected between 2011 and 2017. Aim 1 will use random intercept Poisson regressions with robust standard errors to assess the prevalence of sexual risk behaviors, viral suppression , and HIV comparing migrant and non-migrant households. Aim 2 will use random intercept Poisson regressions with robust standard errors to determine if in or out-migration events within households are associated with changes in sexual risk behaviors or risk of HIV acquisition. In Aim 3, we will conduct in-depth interviews with RCCS members who reported that their partners had migrated recently. The study will characterize the effect of migration on non-migrating members by (i) detecting differences in HIV prevalence and behavior using cross- sectional data; (ii) assessing the marginal effect of in- and out-migration events on changes in sexual behavior and incident HIV infection; and (iii) exploring how migration may impact sexual risk behavior, risk of HIV acquisition, and care-seeking behavior if HIV+, for couples with migrant spouses. Training: The proposed study will serve as the doctoral dissertation for Ms. Young, a doctoral student at Johns Hopkins Bloomberg School of Public Health. Her mentorship team have extensive experience in Rakai, Uganda and complementary technical skills. The training plan combines coursework, field research, and mentorship. The proposed study aligns with research priorities aiming to understand the social and behavioral factors influencing HIV risk, and linkage to and retention in HIV care.

背景：移民是撒哈拉以南非洲 (SSA) 的常见现象，与增加的风险有关 感染艾滋病毒和危险性行为。然而，移民对感染艾滋病毒风险的影响和 移民家庭中非移民成员的性行为尚未得到详细研究 SSA。移民可能会给家庭带来破坏和压力，并可能导致艾滋病毒风险增加。非- 生活在流动人口家庭中的流动人口可能是撒哈拉以南非洲地区尚未确定的艾滋病毒高危人群。 目的：目的是评估移民如何影响感染艾滋病毒的风险以及性风险行为 乌干达拉凯移民家庭的非移民成员。该研究的目的是： 1A) 比较 迁入者、迁出者和非迁徙者的社会人口和家庭结构 家庭； 1B) 比较 HIV 患病率、性危险行为患病率、病毒载量抑制 迁入和迁出家庭的非移民成员与非移民家庭成员之间； 2）评估非流动家庭成员的艾滋病毒发病率和性危险行为的变化 家庭成员迁入或迁出后； 3）定性探讨out-的影响 移民夫妇之间对非移民伴侣的艾滋病毒和性行为的看法和做法的影响。 方法：本研究将使用 Rakai 社区队列研究中目标 1 和 2 的现有数据 (RCCS)，一个基于人群的开放队列，由 40 岁左右、年龄在 15 岁至 49 岁之间的约 22,000 人组成 社区，2011 年至 2017 年收集。目标 1 将使用 随机截距泊松回归 稳健的标准误 评估危险性行为的流行程度， 病毒抑制 ，和艾滋病毒比较 流动家庭和非流动家庭。目标2将使用 具有鲁棒性的随机截距泊松回归 标准误 确定家庭内部的迁入或迁出事件是否与人口变化有关 性危险行为或感染艾滋病毒的风险。在目标3中，我们将与RCCS进行深度访谈 报告其伴侣最近移居的成员。该研究将描述其影响 通过 (i) 使用交叉检测来检测艾滋病毒流行率和行为的差异 截面数据； (ii) 评估迁入和迁出事件对性行为变化的边际影响 和艾滋病毒感染事件； (iii) 探讨移民如何影响性危险行为、艾滋病毒风险 对于有移民配偶的夫妇来说，艾滋病病毒感染者的获得和寻求护理的行为。 培训：拟议的研究将作为约翰斯大学博士生 Young 女士的博士论文 霍普金斯大学彭博公共卫生学院。她的导师团队在Rakai拥有丰富的经验， 乌干达技术技能互补。培训计划结合了课程作业、实地研究和 指导。拟议的研究与旨在了解社会和行为的研究重点相一致 影响艾滋病毒风险的因素以及艾滋病毒护理的联系和保留。