BACKGROUND Although married couples can be at an elevated risk of HIV infection, few studies have explored the risk factors for HIV infection at the couple-level. We explored the risk factors for HIV infection among married couples in settings with differing HIV prevalence levels in Rakai, Uganda. METHODS This was a cross-sectional study conducted among 664 heterosexual couples living in three HIV prevalence strata (low: 9-11.2%; medium: 11.4-20% or high HIV prevalence: 21-43%) in Rakai District, south-western Uganda, between November 2013 and February 2014. Data were collected on socio-demographic and behavioural characteristics from all consenting adults and aggregated to allow for couple-level analyses. We conducted bivariate and multivariable Logistic regression to assess the factors that were independently associated with HIV infection among married couples. Data were analysed using STATA statistical software (version 14.1). RESULTS Of the 664 couples, 6.4% (n = 42) were in HIV-discordant relationships; 5.8% (n = 39) were in concordant HIV-positive relationships while 87.8% (n = 583) were in concordant HIV-negative relationships. At the bivariate analysis, we found that residing in a high HIV prevalence stratum, reporting extra-marital relations, age difference between partners and number of previous marriages were significantly associated with being part of an HIV infected couple. After adjusting for potential cofounders, living in a high HIV prevalence stratum (Adjusted OR [AOR] =2.31, 95% CI: 1.52, 3.52), being in a third or higher order relationship (AOR = 3.80, 95% CI: 2.30, 6.28), and engagement in extra-marital relations (AOR = 1.75; 95% CI: 1.19, 2.59) were associated with couple HIV infection. Individuals that had stayed together for six or more years had 28% odds of being part of an HIV infected couple (AOR = 0.28; 95%CI: 0.18, 0.43). CONCLUSION Living in a high HIV prevalence stratum, engagement in extra-marital relations and having a higher number of previous marriages were significant risk factors for HIV infection among married couples. Long marital duration was associated with reduced risk of HIV infection. Interventions that increase marital stability and those that promote pre-marital couples' HIV testing before marital formation can reduce HIV transmission risk among married couples in this setting.

中文翻译：

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乌干达拉凯已婚夫妇感染艾滋病毒的危险因素：一项横断面研究。


背景虽然已婚夫妇感染艾滋病毒的风险较高，但很少有研究探讨夫妇层面感染艾滋病毒的危险因素。我们探讨了乌干达拉凯不同艾滋病毒流行水平的已婚夫妇感染艾滋病毒的危险因素。方法 这是一项横断面研究，对象是生活在西南部拉凯区三个 HIV 流行率阶层（低：9-11.2%；中：11.4-20% 或高 HIV 流行率：21-43%）的 664 对异性夫妇。乌干达，2013 年 11 月至 2014 年 2 月。从所有同意的成年人中收集了有关社会人口和行为特征的数据，并将其汇总以进行夫妻层面的分析。我们进行了双变量和多变量 Logistic 回归来评估与已婚夫妇中 HIV 感染独立相关的因素。使用STATA统计软件（版本14.1）分析数据。结果 在 664 对夫妇中，6.4% (n = 42) 的关系与 HIV 不一致； 5.8% (n = 39) 的人处于一致的 HIV 阳性关系，而 87.8% (n = 583) 的人处于一致的 HIV 阴性关系。在双变量分析中，我们发现居住在艾滋病毒高流行阶层、报告婚外关系、伴侣之间的年龄差异和以前的婚姻次数与成为艾滋病毒感染夫妇的一部分显着相关。调整潜在共同创始人后，生活在 HIV 高流行层（调整后 OR [AOR] =2.31，95% CI：1.52，3.52），处于三阶或更高阶关系（AOR = 3.80，95% CI：2.30， 6.28）和婚外关系（AOR = 1.75；95% CI：1.19，2.59）与夫妻 HIV 感染相关。 在一起生活六年或以上的人有 28% 的几率成为 HIV 感染夫妇（AOR = 0.28；95%CI：0.18，0.43）。结论生活在艾滋病毒高流行阶层、有婚外关系和较高的前次婚姻是已婚夫妇感染艾滋病毒的重要危险因素。婚姻存续时间长与艾滋病毒感染风险降低相关。提高婚姻稳定性的干预措施以及促进婚前夫妇在结婚前进行艾滋病毒检测的干预措施可以降低这种情况下已婚夫妇之间的艾滋病毒传播风险。