Fifteen years of epidemic HIV: Novel risk behavior in South African teens in 2010

描述（由申请人提供）：尽管经过十年协调一致的预防和研究努力，南非的年轻妇女仍然处于全球艾滋病毒流行的中心。南非年轻妇女的怀孕率很高，感染艾滋病毒的可能性是同龄男性的两倍。在Mshiyeni王子纪念医院，一家省政府医院和目前研究的拟议招募地点，所有产前诊所的参与者中有一半被感染。流行率从16岁的7%上升到22岁的54%，这表明青春期后期是大量年轻妇女受到感染的关键时期。今天感染艾滋病毒的南非年轻人成长的时代，他们的父母和家人受到与艾滋病毒有关的疾病、经济困难和死亡的严重影响，但也可能受益于政府和社区对艾滋病毒的更多关注。缺乏关于“第二代”艾滋病毒感染青年如何成长及其对当前爆炸性感染率的影响的系统调查。在PMMH接受治疗的怀孕青少年的初步数据表明，新的行为模式可能导致高感染率，但迄今为止在科学文献中仍未记载。例子包括在24小时聚会（称为nkwari）中参与多次无保护的性接触，同时使用酒精和药物，以及希望怀孕以保持社会关系。为了制定更有效和相关的行为干预措施，以及成功实施和推广生物预防措施，对推动“第二代”艾滋病毒风险行为的不断变化的背景因素进行更广泛的生态理解至关重要。由于估计可行的疫苗推广可能至少需要十年的时间，因此需要有效的干预措施来应对未来几年不断变化的动态流行病。项目概述。拟议的研究将使用定性方法确定影响南非艾滋病毒高流行环境中“第二代”年轻妇女艾滋病毒传播风险的新因素。我们将特别探讨(a)生育愿望，(b)增加获得治疗的机会和未来的生物预防战略；(c)抗逆转录病毒治疗乐观主义、艾滋病毒预防疲劳和艾滋病毒宿宿论(d)以及幼儿创伤和出生和成长在艾滋病毒严重破坏的社区所造成的损失如何影响这些因素。

DESCRIPTION (provided by applicant): Despite a decade of concerted prevention and research efforts, young women in South Africa remain at the epicenter of the global HIV epidemic. Young women in South African experience high rates of pregnancy and are twice as likely to be HIV infected as their same age male peers. At Prince Mshiyeni Memorial Hospital, a provincial government hospital and the proposed recruitment site for the current study, half of all antenatal clinic attendees are infected. Prevalence rises from 7% among 16 year olds to 54% among 22 year olds, suggesting that late adolescence represents a critical period during which large numbers of young women are becoming infected. Young South Africans becoming infected with HIV today grew up in an era where their parents and families were powerfully affected by HIV related illness, economic hardship, and death, but may also benefit from increased government and community attention to HIV. Systematic investigation into how growing up as the "second generation" of HIV-affected youth and its impact on current explosive rates of infection is lacking. Preliminary data from pregnant adolescents receiving care at PMMH suggest new patterns of behavior that likely contribute to high infection rates, but thus far remain undocumented in the scientific literature. Examples include participation in multiple, unprotected sexual encounters at 24-hour parties (known as nkwari) with concomitant alcohol and drug use and the desire to achieve pregnancy to preserve social relationships. A broader, ecological understanding of the evolving contextual factors that drive HIV risk behavior in this "second generation" is crucial in order to develop more effective and relevant behavioral interventions, and for successful implementation and roll-out of biological prevention measures. As estimates for a viable vaccine roll-out could be at least a decade away, effective interventions will need to respond to a dynamic and ever-changing epidemic for years to come. Project overview. The proposed study will use qualitative methods identify novel factors influencing HIV transmission risk in the "second generation" of young women in a South African HIV hyper-endemic setting. We will particularly explore (a) fertility desire, (b) increasing access to treatment and future biological prevention strategies; and (c) ART optimism, HIV prevention fatigue and HIV fatalism (d) and how these may be influenced by early childhood trauma and loss in being born into and raised in a community devastated by HIV. PUBLIC HEALTH RELEVANCE: Rates of HIV infection among young women in South Africa are among the highest in the world. Adolescent women in South Africa represent part of the "second generation" of HIV affected youth, a cohort that remains understudied. Adolescent women coming of age today likely have different experiences related to HIV than the generation before; we plan to explore how the experiences of these women may impact current HIV risk behavior with the ultimate goal of learning how to best intervene in order to reduce rates of HIV in the future.