HIV Prevalence in Uganda Drops 70% Since Early 1990s Because of Public HIV/AIDS Prevention Campaign, Study Says

HIV prevalence in Uganda has dropped 70% since the early 1990s primarily because of a "successful" public HIV/AIDS prevention campaign that encourages avoiding "casual" sexual activity, according to a study published in the April 30 issue of the journal Science, BBC News reports (BBC News, 4/30). Drs. Rand Stoneburner and Daniel Low-Beer of University of Cambridge in the United Kingdom analyzed population-level HIV and behavioral data from Uganda and neighboring countries -- including Kenya, Malawi and Zambia -- to assess the validity and determinants of declines in HIV prevalence and examine the potential influences of prevention interventions. The researchers found that "important" behavioral changes occurred among the Ugandan population between 1989 and 1995, including an increase in the age of first sexual intercourse, a decrease in indicators of casual or nonregular sexual partners and an increase in condom use with both casual and regular sexual partners, according to the study. In addition, an "important and perhaps overlooked" measure of behavior change during this time was a 60% reduction in the number of people in both rural and urban areas who reported casual sexual relationships over the previous year, according to the study. The study suggests that a reduction in the number of sexual partners in the general population and a delay in onset of sexual activity among unmarried youth, especially in urban areas and among males, are the "relevant factors in reducing HIV incidence" (Stoneburner/Low-Beer, Science, 4/30). Although condom use in neighboring countries was just as common as in Uganda, condom use may not be sufficient to cut HIV incidence without a reduction in casual sex as well, according to the study, Reuters Health reports (Reuters Health, 4/29). Stoneburner and Low-Beer also suggest that communication about HIV/AIDS through social networks and personal contact with HIV-positive people or people who have died of AIDS-related causes also helped to lower HIV prevalence in Uganda.

Shift in "Strategic Thinking"
The Ugandan government's national HIV/AIDS prevention campaign "clearly communicated the reality of the AIDS epidemic in terms of a rational fear of the risks of casual sex, which drew on and mobilized indigenous responses at the community level," according to the researchers. The government's messages that AIDS, which is also known as "slim" in Uganda, is fatal and that individuals should practice "zero grazing," or monogamy, were clearly communicated, and condoms were a "minor" component of the original strategy, according to Stoneburner and Low-Beer. The researchers say that the "substantial" reductions in Uganda's HIV prevalence -- which are equivalent to results that might be seen with a "highly effective," although as of yet undeveloped, vaccine -- "resulted from public health interventions that triggered a social process of risk avoidance manifested by radical changes in sexual behaviors." According to the researchers, the behavioral changes resulting from Uganda's prevention messages may not transfer with the same success or be appropriate for other countries. However, in order to successfully replicate the lessons learned from the Uganda model, Stoneburner and Low-Beer conclude that "a shift in strategic thinking on health policy and HIV/AIDS, with greater attention to epidemiological intelligence and communications to mobilize risk avoidance," is needed (Science, 4/30).

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