"Profound" Behavioral Changes Significant Factor in Uganda's Declining HIV Prevalence, Letter to Editor Says

There have been "profound" behavioral changes in Uganda's Rakai district and the country as a whole that have contributed to the nation's declining HIV prevalence, Edward Green, a senior research scientist at the Harvard School of Public Health and author of "Rethinking AIDS Prevention," writes in a New York Times letter to the editor in response to a study presented last week at the 12th Conference on Retroviruses and Opportunistic Infections in Boston (Green, New York Times, 2/26). For the study, researchers interviewed 10,000 people ages 15 to 49 living in 44 villages in the Rakai district of Uganda from 1994 to 2003. They found that the percentage of men reporting multiple sexual partners increased from 28% to 35% over the 10-year period, and the percentage of teenagers who were sexually abstinent declined from about 60% to 50%. Although HIV prevalence in the population decreased over the period, HIV incidence increased slightly. Therefore, the district's declining prevalence could not be attributed to a decrease in the number of new infections. The researchers found that the most important factor in Uganda's declining HIV prevalence was premature death among HIV-positive people who died of AIDS-related causes. They said that increased condom use also could have offset other high-risk behaviors in the district (Kaiser Daily HIV/AIDS Report, 2/24).

Behavioral Changes Occurred Prior to Study
Several "basic" behavioral changes in the Rakai district and all of Uganda between 1987 and 1995 -- before most of the study was conducted -- have "kept HIV prevalence declining up until now," Green says. These changes included decreased "casual sex," increased monogamy and more young people delaying sexual activity, according to Green, who adds that although there was an increase in condom use, consistent use was "too low to have made significant impact." However, there are "indications" that some people in Uganda are "returning to riskier behaviors," possibly because Western donors have "moved Uganda away from its home-grown AIDS prevention program to a medicalized, risk-reduction approach focused on condoms, drugs and testing," Green concludes (New York Times, 2/26).

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