Effects of Family Environment on HIV Risk Behavior in Ugandan Females, ages 15-19

描述(由申请人提供)：预防青少年女性感染艾滋病毒是全球持续存在的公共卫生问题，特别是在撒哈拉以南非洲，那里青少年女性感染艾滋病毒的可能性是青少年男性的三倍。最近的研究表明，性脆弱的青春期女性比那些没有性脆弱的青少年女性感染艾滋病毒的风险更大。根据Rakai公布的数据，性脆弱被定义为早年性首次出现，经历过性胁迫，并从事跨代性行为。尽管取得了这些进展，但很少有研究考察导致撒哈拉以南非洲青春期女性性行为脆弱的因素。这项拟议的研究提出的理论是，家庭环境在青春期女性的性脆弱性和性危险行为中起着不可或缺的作用。国际上还没有纵向探讨家庭环境对性易感性的影响，也没有研究家庭环境可能通过何种途径影响少女的HIV性危险行为。利用乌干达西南部农村Rakai健康科学计划社区队列研究(RCCS)15年的纵向数据，拟议的研究将使用二次数据分析来检验家庭环境对15至19岁女性性危险行为的影响。本研究的具体目的是：1)检查家庭环境对女性青少年性易感性的影响；2)检查家庭环境影响青春期女性HIV性风险的途径是直接的还是由青春期的性脆弱状态中介的。研究人群是2002至2008年间在青春期成为农村信用社一部分的女性。使用对队列进行的年度调查的答案，将根据避孕套的使用和有多个性伴侣和家庭环境的八个维度来衡量艾滋病毒-性行为危险行为，如艾滋病毒的结构、大小和在家中的存在。研究目标将使用广义估计方程分析、生存分析、结构方程模型和流行病学模型来解决。调查结果将为保护少女免受性脆弱情况和减少青少年中艾滋病毒预防工作的努力提供指导，特别是在发展中环境中。它将有助于研究家庭和家庭如何影响青少年的福祉和发展。这些结果可以提高艾滋病毒干预设计的有效性，这些设计在类似的环境中采用多层次的影响，并为政策提供信息，并创建将家庭纳入其倡议的计划。

DESCRIPTION (provided by applicant): Prevention of HIV infection in adolescent females is a continuing public health problem globally, especially in sub-Saharan Africa, where adolescent females are three times more likely to be HIV-infected than adolescent males. Recent studies have shown that adolescent females who are sexually vulnerable are at greater risk of HIV than those who are not sexually vulnerable. Based on published data from Rakai, sexual vulnerability is defined as early sexual debut, experiencing sexual coercion and engaging in cross- generational sex. Despite such advances, few studies have examined the factors that make adolescent females sexually vulnerable in sub-Saharan Africa. The proposed study theorizes that the family environment plays an integral role in adolescent females' sexual vulnerability as well as sexual risk behaviors. Studies have not longitudinally explored the influence of family environment on sexual vulnerability internationally nor have studies investigated the pathways through which family environment might affect HIV sexual risk behavior in female adolescents. Using 15 years of longitudinal data from the Rakai Health Sciences Program community cohort study (RCCS) in rural southwestern Uganda, the proposed study will use secondary data analysis to examine the influence of family environment on sexual risk behavior among females, ages 15 to 19. The specific aims of this study are to: 1) examine the effects of family environment on female adolescents' sexual vulnerability and 2) examine whether the pathway in which family environment affects female adolescent's HIV sexual risk is direct or is mediated by the adolescent sexual vulnerability status. The study populations are females who were a part of the RCCS during their adolescent years between 2002 and 2008. Using answers from the annual survey administered to the cohort, HIV-sexual risk behaviors will be measured as use of condoms and having multiple sexual partners and family environment will be operationalized in terms of eight dimensions, such as structure, size and presence of HIV in the home. Study aims will be addressed using generalized estimation equation analyses, survival analyses, structural equation models and epidemiological models. Findings will inform efforts to protect female adolescents from sexually vulnerable situations and to reduce HIV prevention efforts among adolescents, especially in developing settings. It will add to research on how families and households affect adolescent well-being and development. The results can enhance the effectiveness of HIV intervention designs that employ multiple levels of influence in similar settings as well as inform policies and create programs that incorporate the family into their initiatives.