Who are the male sexual partners of adolescent girls and young women? Comparative analysis of population data in three settings prior to DREAMS roll-out

Background
The DREAMS (Determined Resilient Empowered AIDS-free, Mentored and Safe) Partnership aims to reduce HIV incidence among adolescent girls and young women (AGYW,15-24y) with a core package of evidence-based interventions. Some interventions, including voluntary HIV counselling and testing and circumcision, will be targeted at the male sexual partners of AGYW. A priority of DREAMS is to characterise the male partners for effective targeting.
Methods
Using population-based data (2010–2015) in three DREAMS impact evaluation settings in Kenya and South Africa, we describe the demographic characteristics and sexual behaviour of male partners reported by AGYW, and the characteristics of males who report sexual activity with AGYW.
Results
In all settings, over 90% of recent male partners reported by AGYW were aged <35 years. Median ages of spousal and non-spousal partners were 29 and 23 years respectively in uMkhanyakude (rural South Africa) and 21 and 20 years respectively in Nairobi (urban Kenya). Most males reporting an AGYW partner had never been married (89%) and many were in school (39%). Most male partners reported only 1 AGYW partner in the past year; in Gem (rural Kenya) and Nairobi 25%-29% reported 2+(AGYW or older female) partners. Concurrent partners were reported by 16% of male partners in Gem and 3–4% in uMkhanyakude. Two thirds of male partners in Gem reported testing for HIV in the past 6 months and under half in uMkhanyakude reported testing for HIV in the past year. Almost all (96%) partners in Nairobi were circumcised, compared to 45% in Gem and 43% in uMkhanyakude.
Conclusions
With almost all AGYW’s sexual partners aged 15–34 years, this is an appropriate target group for DREAMS interventions. Encouraging young men to reduce their number of partners and concurrency, and uptake prevention and treatment services such as HIV testing, circumcision and ART is crucial in the effort to reduce HIV among both AGYW and young men.

### 研究背景
DREAMS伙伴计划（Determined Resilient Empowered AIDS-free, Mentored and Safe Partnership）旨在通过一套循证干预核心包，降低15-24岁青少年女孩与青年女性（adolescent girls and young women, AGYW）的艾滋病新发感染率。部分干预措施——包括自愿艾滋病咨询与检测、男性包皮环切术——将针对该群体的男性性伴侣开展。DREAMS的一项优先任务是明确男性伴侣的特征，以实现精准干预。

### 研究方法
本研究基于肯尼亚与南非3个DREAMS项目影响评估现场的2010-2015年人群基础调查数据，对青少年女孩与青年女性报告的男性伴侣，以及报告与该群体发生性行为的男性的人口学特征与性行为特征进行描述。

### 研究结果
所有研究现场中，超过90%的青少年女孩与青年女性报告的近期男性伴侣年龄低于35岁。乌姆哈亚库德（南非农村地区）的配偶与非配偶性伴侣的中位年龄分别为29岁与23岁，内罗毕（肯尼亚城市）则分别为21岁与20岁。多数报告拥有青少年女孩与青年女性伴侣的男性未婚（占比89%），且近四成仍在就学。多数男性伴侣在过去一年中仅报告拥有1名青少年女孩与青年女性伴侣；在杰姆（肯尼亚农村地区）与内罗毕，25%~29%的男性报告拥有2名及以上（青少年女孩与青年女性或年长女性）性伴侣。杰姆地区16%的男性伴侣报告存在同时性伴侣，乌姆哈亚库德地区则为3%~4%。杰姆地区三分之二的男性伴侣报告在过去6个月内接受过艾滋病检测，而乌姆哈亚库德地区仅不足半数的男性在过去一年中接受过艾滋病检测。内罗毕地区几乎所有（96%）男性伴侣均接受过包皮环切术，而杰姆与乌姆哈亚库德地区的占比分别为45%与43%。

### 研究结论
由于几乎所有青少年女孩与青年女性的性伴侣年龄均处于15~34岁区间，该群体是DREAMS干预措施的合适目标人群。鼓励年轻男性减少伴侣数量与同时性伴侣行为，并推动其接受艾滋病检测、包皮环切术与抗反转录病毒治疗（Antiretroviral Therapy, ART）等预防与治疗服务，对于降低青少年女孩与青年女性及年轻男性的艾滋病感染率至关重要。