Error al deserializar el cuerpo del mensaje de respuesta para la operación 'Translate'. Se superó la cuota de longitud del contenido de cadena (8192) al leer los datos XML. Esta cuota se puede aumentar cambiando la propiedad MaxStringContentLength en el objeto XmlDictionaryReaderQuotas que se usa para crear el lector XML. Línea 1, posición 9000.
ABSTRACT
The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub-Saharan African countries. The DHS surveys provided data to compute the prevalence of premarital fertility, defined as any birth before the first marriage. The UNAIDS database provided data to compute the prevalence of HIV infection among pregnant women. Results indicate a moderate association between the prevalence of premarital fertility and the prevalence of HIV infection (correlation coefficient = 0.64, P
R?SUM?
F?condit? avant le mariage et le VIH/SIDA en Afrique, Cet article ?tudie les rapports complexes entre la f?condit? avant le mariage et le VIH/SIDA dans les pays africains sub-sahariens. Les enqu?tes men?es par les WFS et DHs ont fourni les donn?es initiales pour ?valuer la pr?valence de la f?condit? avant le mariage. On a d?fini la f?condit? avant le mariage comme toute naissance avant le premier mariage. La pr?valence de la f?condit? avant le mariage a ?t? ?valu?e comme ?tant la proportion des femmes f?condes qui sont ?g?es de 25 ans et plus qui ont eu une naissance ant?rieure avant leur premier mariage. La base de donn?es du Bureau de Recensement a fourni les donn?es qui ont permis d??valuer la pr?valence de l?infection du VIH chez les femmes enceintes. On s'est servi d?un simple mod?le pour normaliser les tendances dans la s?ro-pr?valence du VIH et pour ?valuer la s?ro-pr?valence moyenne au cours de la p?riode 1995 - 1999. Les r?sultats ont montr? un lien mod?r? entre la pr?valence de la f?condit? avant le mariage et la pr?valence de l?infection du VIH (le coefficient de corr?lation = 0,37, P=0, 04). Par rapport aux tendances globales, certains pays africains avaient soit des niveaux plus ?lev?s de la f?condit? avant le mariage et une pr?valence relativement peu ?lev?e basse du VIH (Lib?ria, Madagascar) ou bien le mod?le oppos?, c?st-?-dire des niveaux ?lev?s de la pr?valence du VIH malgr? les niveaux bas de la f?condit? avant le mariage (Ethiopie, Rwanda). Le rapport global a ?t? discut? ? la lumi?re du rapport entre la permissivit? et le manque de protection au cours des rapports sexuels et son impact possible sur ? la fois la f?condit? avant le mariage et l?infection pr?cose du VIH chez les femmes. Les cas des pays comme le Lib?ria et le Madagascar ont ?t? discut?s ? la lumi?re des dynamiques qui sous-tendent le mod?le de la f?condit? avant le mariage et les dynamiques de l??pid?mie du VIH dans des pays particuliers. (Rev Afr Sant? Reprod 2008; 12[2]:64-74)
KEY WORDS: Premarital fertility, Adolescent fertility, HIV-AIDS, Sexual behaviour, Contraception, sub-Saharan Africa.
Introduction
The HIV (Human Immunodeficiency Virus) epidemic emerged in the 1970's, probably somewhere in Central Africa. Its origin is still a matter of academic debate.1 The disease was unknown prior to its identification in the United States in 1981, and the earliest record of an AIDS death goes back to 1959. AIDS soon emerged as a major cause of death in African populations in the mid 1980's, and since then the epidemic has been raging in large parts of sub-Saharan Africa, and much faster than any other part of the world.2 Many questions are raised by the rapid spread of the disease. If core groups such as commercial sex workers (CSW's) played a significant role in the early spread of the disease, their role soon became shadowed by other dynamics.3 When the epidemic became "generalised" in the 1990's, that is when the level of seroprevalence became high in the general population, other dynamics appeared and in particular the disease spread rapidly among young female adults who had no obvious risk factor.4
Among the questions raised by the rapid spread of the disease among young women are the patterns of sexual partnership and the lack of protection from sexually transmitted diseases (STD's) during intercourse. About twenty years after the identification of the disease and the understanding of its sexual transmission, it is striking to note that we poorly understand why large parts of the population, and in particular young women, get infected so quickly. This rapid spread of HIV among young women reveals first an intense exposure and second a lack of protection. This seems to occur throughout Africa, though with different intensity, despite widespread knowledge of disease transmission and ways to prevent it, as shown by numerous surveys, and in particular the Demographic and Health Surveys (DHS).
If young women have frequent and unprotected intercourse, not only do they get infected, but they also become pregnant, unless they use efficient contraceptive methods other than condoms. Various studies on developing countries have addressed the issue of adolescent fertility in a demographic perspective.5-8 More and more in Africa, the first pregnancy occurs before the first marriage, primarily because age at marriage tends to rise, as in many developed countries of Europe and North America. As a consequence, large numbers of women now experience premarital fertility, as exemplified by case studies in Southern Africa.9-12 In earlier periods, most African women were married early, and had their first births within marriage, though there were cases of premarital births in numerous ethnic groups throughout continental Africa as well as in Madagascar. In modern Africa, one can therefore expect a statistical relationship between prevalence of premarital fertility and prevalence of STD's, and in particular HIV, since both phenomenon have the same rationale: unprotected intercourse in teenage years. Of course, the relationship is by no means likely to be a one to one relationship since many divergent situations may happen and many other factors interplay. For instance, premarital intercourse with a regular partner who will become a husband is unlikely to bear a higher risk of contracting STD's than with a formal husband; similarly, premarital intercourse with multiple partners will not lead to infection if they are not infected; obviously intercourse with an infected husband is likely to lead to an infection; hormonal contraception has a strong effect on the risk of pregnancy, but does not decrease the risk of contracting STD's. Lastly, STD's have their own dynamics, and unless a germ is circulating in a population being a priori at risk does not lead to infection.
Several papers have discussed the underlying factors of premarital fertility or HIV infections among young African women. 13-22 A recent review summarizes critical points and major social factors of unsafe sexual behaviour of young adults. 23 Authors categorize factors in three levels: individual, interpersonal (proximal), and societal (distal), and discuss the theoretical and practical issues around risk taking in sexual behaviour in a gender perspective. They cover most known factors which could explain levels of premarital fertility or prevalence of HIV and STD's, though they seldom address the issue of marriage and stable relationships in a cultural perspective. In any case, the main point of interest for our analysis is that most factors of unsafe sexual behaviour, from gender imbalance to peer pressure, are likely to play a similar role for premarital fertility and HIV prevalence, unless other factors interact, such as modern methods of family planning other than condoms. Furthermore, these relationships may be compounded by other socioeconomic factors, such as urbanization and poverty.
The aim of this paper is to investigate the statistical relationship between premarital fertility and HIV prevalence in sub-Saharan Africa countries. This will be done at the country level, trying to understand the possible relationships between the two variables. In fact, as it will be seen below, there are major differences in both the prevalence of HIV/AIDS and the prevalence of premarital fertility among African countries. Some of these differences could be due to socio-demographic factors, such as early versus late marriage, and social control versus permissiveness of the society. These two factors are likely to have an effect on both premarital fertility and HIV prevalence, though may be confounded by other factors, such as other forms of contraception and unexpected dynamics of HIV epidemics. This study is part of a more comprehensive study on premarital fertility in Africa undertaken by the same authors, and supported by the Wellcome Trust.
No hay comentarios:
Publicar un comentario