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

移民对非移民家庭成员性危险行为和艾滋病毒发病率的影响：一项基于人口的研究

• 批准号: 10226864
• 负责人: Ruth Young
• 金额: $ 3.96万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2022-05-20
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10226864
• 关键词: Address; Adolescent; Africa South of the Sahara; Age; Behavior; Behavioral; Caring; Censuses; Cohort Studies; Communities; Contracts; Couples; Data; Decision Making; Destinations; Event; Family; Family Relationship; Family member; Female; Gender; Goals; HIV; HIV Infections; HIV Seronegativity; HIV risk; Heterosexuals; Household; Household Heads; Household and Family; Incidence; Individual; Intercept; Intervention; Interview; Knowledge; Link; Longitudinal cohort study; Mentorship; Migrant; Nonmigrant; Nuclear Family; Out-Migrations; Parents; Participant; Perception; Persons; Population; Population Study; Prevalence; Public Health Schools; Reporting; Research; Research Priority; Risk; Risk Behaviors; Role; Services; Sex Behavior; Sexual Partners; Single Parent; Social support; Socioeconomic Status; Spouses; Stress; Stressful Event; Structure; Subgroup; Supervision; Surveys; Technical Expertise; Time; Training; Transcript; Uganda; Viral; Viral Load result; aged; base; care seeking; caregiving; cohort; condoms; design; doctoral student; experience; family structure; high risk; high risk sexual behavior; member; migration; peer; population based; sexual risk behavior; social; sociodemographics

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.

背景：迁移是撒哈拉以南非洲（SSA）的常见现象，与增加的风险有关 获得艾滋病毒和性风险行为。但是，迁移对获取艾滋病毒和的风险的影响 不移民家庭的非移民成员之间的性行为尚未详细研究 SSA。迁移可能会破坏和压力，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人可能是SSA中艾滋病毒的不明身份的高风险子群体。 目的：目标是评估移民如何影响获得艾滋病毒和性风险行为的风险 乌干达Rakai的移民家庭的非迁移成员。该研究的目的是：1a）比较 社会人口统计学和家庭家庭结构之间的迁移，迁移和非迁移 家庭； 1b）比较艾滋病毒患病率，性风险行为的流行率，抑制病毒载荷 在非移民家庭的非迁移成员与非移民家庭成员之间； 2）评估艾滋病毒的发病率以及非迁移家庭成员的性风险行为的变化 遵循家庭成员的进出移民； 3）定性地探索淘汰的影响 夫妻在非迁移伴侣的艾滋病毒和性行为的看法和实践中迁移。 方法：本研究将使用现有数据作为Rakai社区队列研究的目标1和2 （RCC），一个基于人口的开放式队列，大约有22,000人，年龄在40岁的人群中，年龄在15-49岁之间 社区，收集在2011年至2017年之间。AIM1将使用 随机拦截泊松回归 强大的标准错误 为了评估性风险行为的普遍性， 病毒抑制 和HIV比较 移民和非移民家庭。 AIM 2将使用 随机拦截泊松回归稳健 标准错误 确定家庭中的或外移动事件是否与变化有关 性风险行为或艾滋病毒获取风险。在AIM 3中，我们将对RCC进行深入的采访 报告说他们的伴侣最近移民的成员。该研究将表征 通过（i）使用交叉检测艾滋病毒患病率和行为的差异，对非迁移成员进行迁移 部分数据； （ii）评估内部和外移动事件对性行为变化的边际影响 和事件艾滋病毒感染； （iii）探索移民如何影响性风险行为，艾滋病毒的风险 对于有移民配偶的夫妇，获取和寻求护理的行为。 培训：拟议的研究将作为Johns的博士生Young女士的博士学位论文 霍普金斯彭博公共卫生学院。她的Mentalship团队在Rakuten拥有丰富的经验， 乌干达和完整的技术技能。培训计划结合了课程工作，现场研究和 脑膜。拟议的研究与研究优先级保持一致，旨在了解社会和行为 影响艾滋病毒风险的因素，并与艾滋病毒护理联系并保留。