Sexual behaviors, sexual networks and reproductive health in Malawi

根据世界卫生组织的数据，不安全的性行为导致低收入国家170万人死亡，是非洲妇女死亡的主要风险因素。在撒哈拉以南非洲国家进行的性行为调查越来越多，以了解和解决性健康/生殖健康不良的主要决定因素，但这种调查存在重大局限性。他们经常受到不可忽略的无反应水平的影响，并且只提供自我报告的，高度不可靠的个人行为数据。几乎所有的调查都是“以自我为中心”的，即，调查只限于引出受访者的性伙伴关系，而不提供受访者的性伙伴的性网络的信息，这些信息间接使受访者处于危险之中。这些间接联系是人群中疾病动态的主要决定因素。2005年，我们对利科马岛（马拉维）人口层面的性网络进行了一项独特的研究，其中包括伴侣追踪。利用这些数据（也被称为“社会中心”），我们能够重建直接和间接联系岛上居民的性关系“地图”。我们还记录了自我报告的性伙伴关系数据中的巨大偏见。2007年，我们对该研究进行了后续研究，产生了第一个关于撒哈拉以南非洲人口全球性网络的纵向数据集。本应用程序的主要目的是记录以前未观察到的纵向动态的性网络，使性不安全的利科马（北方马拉维的一个小岛）。在这个项目中，我们将1）使用调查期间获得的多份性伙伴关系报告来衡量自我报告的性网络数据中的无应答、损耗和误报偏见的程度，2）首次在撒哈拉以南地区描述，性网络的全球结构的变化以及这些网络中的变化和个人轨迹; 3）确定性健康和生殖健康成果是否与观察到的网络结构有关。这将提供关于性关系网的新信息，可为撒哈拉以南非洲国家的预防性干预措施提供信息。它还将提供参数的经验估计数，以便适当校准疾病传播的数学模型。 公共卫生相关性：我们使用一个独特的数据集收集在利科马（马拉维），其中性伙伴关系被追溯到（a）调查模式的报告偏见的性行为，通过比较社会中心和自我中心的性行为的信息，和（B）文件的纵向动态的性网络利科马，以更好地了解性行为如何创造性和生殖健康的风险。这将提供关于性关系网的新信息，为撒哈拉以南非洲国家预防性传播疾病的干预措施提供信息。

DESCRIPTION (provided by applicant): According to the WHO, unsafe sex is responsible for 1.7 million deaths in low income countries and is the leading risk factor for mortality in African women. An increasing number of sexual behavior surveys are conducted in sub-Saharan countries to understand and address the key determinants of poor sexual/reproductive health, but such surveys present major limitations. They are often affected by non-negligible levels of non-response and only provide self-reported, highly unreliable data on individual behaviors. Virtually all surveys have also been "egocentric", i.e., they are limited to eliciting the sexual partnerships of a respondent without providing information on the sexual networks of a respondent's partner(s) that indirectly put the respondent at risk. These indirect connections are a major determinant of disease dynamics in populations. In 2005, we initiated a unique study of population-level sexual networks on Likoma Island (Malawi) that integrated partner tracing. Using these data (also known as "sociocentric"), we were able to reconstruct "maps" of the sexual connections that link inhabitants of the island directly and indirectly. We have also documented large biases in self-reported data on sexual partnerships. In 2007, we conducted a follow-up of that study, yielding the first longitudinal dataset on the global sexual networks of a sub-Saharan population. The main aim of this application is to document previously unobserved longitudinal dynamics of the sexual networks that make sex unsafe in Likoma (a small island of Northern Malawi). During this project, we will 1) use multiple reports of sexual partnerships obtained during the survey to measure the extent of non-response, attrition and misreporting biases in self-reported sexual network data, 2) describe, for the first time in a sub-Saharan setting, changes in the global structure of sexual networks and changes and individual trajectories within these networks and 3) determine whether sexual and reproductive health outcomes are associated with the observed network structures. This will provide new information on sexual networking that could inform preventive interventions in sub-Saharan countries. It will also provide empirical estimates of parameters that will permit the appropriate calibration of mathematical models of disease spread. PUBLIC HEALTH RELEVANCE: We use a unique dataset collected in Likoma (Malawi) and in which sexual partnerships were traced to (a) investigate patterns of reporting biases in sexual behaviors by comparing sociocentric and egocentric information on sexual behaviors, and (b) document the longitudinal dynamics of sexual networks on Likoma to better understand how sexual behaviors create risks for sexual and reproductive health. This will provide new information on sexual networking that could inform preventive interventions against sexually transmitted diseases in sub-Saharan countries.