HIV Decline in Zimbabwe Due to Reductions in Risky Sex? Evidence From a Comprehensive Epidemiological Review
June 16, 2010
In Zimbabwe, recent data from antenatal surveillance and general population surveys suggest substantial declines in the prevalence of HIV. In the current study, the researchers assessed the contributions of rising mortality, falling HIV incidence, and changes in sexual behavior to that decline. The methodology employed was a comprehensive review and secondary analysis of national and local sources on trends in HIV prevalence and incidence, mortality, and sexual behavior from 1985 to 2007.
National estimates indicate HIV prevalence in Zimbabwe fell from 29.3 percent in 1997 to 15.6 percent in 2007. According to national census and survey estimates, vital registration data from Harare and Bulawayo, and prospective local population survey data from eastern Zimbabwe, substantial rises in mortality occurred in the 1990s before leveling off after 2000.
According to direct estimates of HIV incidence in male factory workers and women attending pre- and post-natal clinics, trends in HIV prevalence among 15- to 24-year-olds, and back-calculation estimates based on the vital registration data from Harare, HIV incidence may have peaked in the early 1990s and fallen later in the decade. Household surveys indicated reductions in the number of casual sex partners from the late 1990s, as well as high condom use in nonregular partnerships between 1998 and 2007.
"These findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behavior in a southern African country," the authors concluded. "However, in 2007, one in every seven adults in Zimbabwe was still infected with a life-threatening virus, and mortality rates remained at crisis level."
International Journal of Epidemiology
04.20.2010; doi: 10.1093/ije/dyq055; Simon Gregson and others
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