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

背景：移徙是撒哈拉以南非洲的一个普遍现象，与增加的人口流动风险有关。 感染艾滋病毒和危险性行为。然而，移徙对感染艾滋病毒风险的影响， 移民家庭中非移民成员的性行为尚未得到详细研究， 特别探员移徙可能对家庭造成破坏和压力，并可能导致艾滋病毒风险增加。非 生活在移民家庭中的移民可能是撒哈拉以南非洲艾滋病毒的一个未确定的高风险亚组。 目的：评估移民如何影响艾滋病毒感染风险和性风险行为， 乌干达Rakai的非移民家庭成员。本研究旨在：1A）比较 迁入、迁出和非迁入人口的社会人口和家庭结构 家庭; 1B）比较艾滋病毒流行率、危险性行为流行率、病毒载量抑制 迁入和迁出移民家庭的非移民成员与非移民家庭成员之间的关系; 2)评估艾滋病毒感染率和非移徙家庭成员危险性行为的变化 在家庭成员迁入或迁出后;以及3）Qualitative探讨迁出的影响- 移民对非移民伴侣的艾滋病毒和性行为的认识和做法的影响。 方法：本研究将使用来自Rakai社区队列研究的目标1和2的现有数据 （RCCS），一个开放的基于人群的队列，约22，000人，年龄在15-49岁之间， 社区，收集于2011年至2017年。目标1将使用 随机截点Poisson回归 稳健标准误 为了评估危险性行为的流行程度， 病毒抑制 艾滋病比较 移民和非移民家庭。目标2将使用 稳健随机截点Poisson回归 标准误差 以确定家庭内的迁入或迁出事件是否与 性风险行为或艾滋病毒感染风险。在目标3中，我们将与RCCS进行深入访谈 报告其伴侣最近移民的成员。该研究将描述 （i）使用交叉检测方法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效应 和艾滋病毒感染事件;以及（iii）探索移民如何影响性风险行为，艾滋病毒感染风险 艾滋病毒携带者的艾滋病感染和寻求护理行为。 培训：拟议的研究将作为杨女士的博士论文，杨女士是约翰大学的博士生。 霍普金斯布隆伯格公共卫生学院。她的导师团队在Rakai有丰富的经验， 乌干达和补充技术技能。培训计划结合了课程作业，实地研究， 导师制拟议的研究符合旨在了解社会和行为的研究优先事项 影响艾滋病毒风险的因素，以及与艾滋病毒护理的联系和保留。

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.