Understanding causal pathways of HIV acquisition and transmission: a multi-level,

描述(申请人提供)：艾滋病毒/艾滋病大流行对社会的影响在有记录的人类历史上是前所未有的。全球有4000万艾滋病毒/艾滋病患者，其中绝大多数在撒哈拉以南非洲。制定和实施预防干预措施的一个先决条件是了解谁处于危险之中以及为什么。个人、他们所属的社区和感染本身的许多特征有助于确定接触和获得的风险，并且存在多种因果路径，将社会、人口、经济、文化和行为变量联系在一起。虽然通过对不同人群中个体风险因素的研究，在理解艾滋病毒传播方面取得了许多进展，但对于为什么人群经历了不同的流行病，以及将高风险的驱动因素与仅与风险相关的变量进行比较，仍有许多未知之处。该项目将使用一个多层次的框架，以更好地了解在南非农村环境中艾滋病毒感染的原因途径(包括感染的获得和传播)，在那里，基于人口的调查已经测量到艾滋病毒在某些年龄组中的流行率为50%。这项研究旨在确定和量化艾滋病毒发病率和流行率的重要环境、社区、家庭和个人层面的决定因素，以便为干预战略提供信息。特别强调的是地方社区一级，这被视为对了解流行病的传播和有效的预防工作都至关重要。公共卫生相关性：为了能够实施有效的干预措施，有必要更好地了解艾滋病毒流行的复杂、多层次的性质。拟议的研究将通过确定和量化艾滋病毒感染的重要环境、社区、家庭和个人层面的决定因素，使人们更好地了解艾滋病毒感染的原因。这些信息可用于指导有效的预防工作。

DESCRIPTION (provided by applicant): The impact of the HIV/AIDS pandemic on societies is without precedent in recorded human history. Globally, 40 million people are living with HIV/AIDS, the vast majority in sub-Saharan Africa. A prerequisite for the development and implementation of prevention interventions is an understanding of who is at risk and why. Many characteristics of the individual, the community they are from and the infection itself contribute to determining the risk of exposure and acquisition and multiple causal pathways exist linking social, demographic, economic, cultural and behavioural variables. Whilst many advances have been made in understanding the spread of HIV from studies of individual risk factors in a diverse range of populations, much is still unknown about why populations have experienced different epidemics, and what the drivers of high risk are compared with variables that simply correlate with risk. The project will use a multi-level framework to better understand the causal pathways of HIV infection (both in terms of acquisition and transmission of infection) in a rural South African setting where population-based surveys have measured HIV prevalence at >50% in some age-groups. The research aims to identify and quantify important environmental, community, household and individual-level determinants of HIV incidence and prevalence to inform intervention strategies. Particular emphasis is placed at the level of the local community which is seen as being vital both to understanding the spread of the epidemic and to effective prevention efforts. PUBLIC HEALTH RELEVANCE: To be able to implement effective interventions a greater understanding of the complex multi-level nature of the HIV epidemic is necessary. The proposed research will lead to a greater understanding of causal pathways of HIV infection by identifying and quantifying important environmental, community, household and individual-level determinants of HIV infection. This information can be used to guide effective prevention efforts.