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

背景：移民是撒哈拉以南非洲(SSA)的一种常见现象，与患上 感染艾滋病毒和性危险行为。然而，移徙对感染艾滋病毒的风险和 非移民家庭成员的性行为还没有在#年得到详细的研究 SSA。移民可能会对家庭造成破坏和压力，并可能导致艾滋病毒风险增加。非- 居住在移民家庭中的移民可能是SSA中艾滋病毒感染的不明高危亚群。 目标：目的是评估移民如何影响感染艾滋病毒的风险和性行为风险。 乌干达拉凯移民家庭的非移民成员。这项研究的目的是：比较 迁入、迁出和非迁入的社会人口学和家庭结构 家庭； 1b)比较艾滋病毒流行率、性危险行为流行率、病毒载量抑制 在有非移徙家庭成员的迁入和迁出家庭的非移徙成员之间； 2)评估艾滋病毒发病率和非迁徙家庭成员的性危险行为的变化 跟踪家庭成员的迁入或迁出；以及3)定性地探讨迁出- 夫妇之间的迁移对非迁徙伴侣的艾滋病毒和性行为观念和做法的影响。 研究方法：本研究将使用Rakai社区队列研究中的目标1和目标2的现有数据 (RCCS)，这是一个以人口为基础的开放队列，年龄在15-49岁之间，年龄在40岁之间，约有22,000人 社区，在2011至2017年间收集。AIM 1将使用 随机截距泊松回归 稳健标准误差 为了评估性危险行为的流行率， 病毒抑制 ，和HIV比较 移民和非移民家庭。AIM 2将使用 稳健的随机截距泊松回归 标准误差 确定家庭内部的迁入或迁出事件是否与 性危险行为或感染艾滋病毒的风险。在目标3中，我们将深入访谈农村信用社。 报告他们的伴侣最近移民的成员。这项研究将表征 通过以下方式对非迁徙成员进行迁徙：(I)使用交叉法检测HIV感染率和行为的差异 分段数据；(2)评估迁入和迁出事件对性行为变化的边际影响 和艾滋病毒感染事件；以及(3)探讨移徙可能如何影响性行为和艾滋病毒风险 对于有流动配偶的夫妇来说，如果艾滋病毒阳性，他们的获得和寻求护理行为。 培训：这项拟议的研究将作为约翰斯大学博士生杨女士的博士论文 霍普金斯大学彭博公共卫生学院。她的指导团队在Rakai有丰富的经验， 乌干达和互补的技术技能。培训计划结合了课程作业、实地研究和 师徒关系。建议的研究与旨在理解社会和行为的研究优先顺序一致 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.