Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland

IntroductionHIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions.Methods and FindingsThis cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4%) participated, out of which 297 (35.9%) were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14–3.38; P = 0.008), and income below minimum wage (AOR, 1.81; CI, 1.09–3.01; P = 0.021) were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00–5.00; PConclusionsStructural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into consideration these findings. The findings also suggest the importance of future research sensitive to the Swazi and African sociocultural contexts, especially research for family function.

引言：人类免疫缺陷病毒（Human Immunodeficiency Virus，HIV）对撒哈拉以南非洲女性的影响尤为失衡。该区域中，斯威士兰的孕妇HIV感染率高达41%，为全区域最高。此次严峻的HIV疫情凸显了制定本土化干预措施的重要性。除常规HIV监测外，针对女性群体中与HIV感染相关的结构与行为影响因素开展研究，有助于推动现有防控项目的优化升级，并为制定本土化HIV预防干预策略提供科学依据。

方法与结果：本研究为横断面研究（cross-sectional study），于2015年8至9月在斯威士兰霍霍（Hhohho）区域的10家产前保健机构（antenatal health care facilities）开展，采用两阶段整群随机抽样（two-stage random cluster sampling）方法。研究纳入标准为年龄≥18岁且已接受HIV检测的孕妇。研究采用平板电脑自主填写问卷的方式评估HIV感染相关风险因素。所有符合纳入标准的孕妇中，共有827人参与本研究，参与率达92.4%，其中297人（35.9%）自述HIV检测结果为阳性。在结构影响因素方面，家庭功能与自述HIV阳性状态无显著关联；而教育程度低于高中（调整后比值比[Adjusted Odds Ratio，AOR]=1.65，置信区间[Confidence Interval，CI]=1.14~3.38，P=0.008）、月收入低于最低工资标准（AOR=1.81，CI=1.09~3.01，P=0.021）均与自述HIV阳性状态存在显著关联。与自述HIV阳性状态显著相关的行为影响因素包括：终身性伴侣数≥2人（AOR=3.16，CI=2.00~5.00，P