Article written

  • on 15.02.2011
  • at 11:00 AM
  • by Staff

Zim records surprising success in HIV prevention 0

HARAREHIV prevalence rates have declined in Zimbabwe despite the political turmoil that has engulfed the country in the last few years. This is according to a study published in PLoSMedicine, an open access peer reviewed medical journal published by the American Public Library of Sciences.

There is growing recognition that primary prevention, including behaviour change, must be central in the fight against HIV/AIDS. The earlier successes in Thailand and Uganda may not be fully relevant to the severely affected countries of southern Africa. The researchers conducted an extensive multi-disciplinary synthesis of the available data on the causes of the remarkable HIV decline that has occurred in Zimbabwe (29 per cent estimated adult prevalence in 1997 to 16 per cent in 2007), in the context of severe social, political, and economic disruption.

The behavioral changes associated with HIV reduction mainly reductions in extramarital, commercial, and casual sexual relations, and associated reductions in partner concurrency appear to have been stimulated primarily by increased awareness of AIDS deaths and secondarily by the country’s economic deterioration. These changes were probably aided by prevention programmes utilizing both mass media and church-based, workplace-based, and other inter-personal communication activities.

While the often cited prevention success stories of Thailand and Uganda are inspiring and informative, some of the specific socio-cultural, historical, and other factors in the southern African region now the global epicentre of the HIV pandemic are distinctive.

In these “hyper-endemic” settings, where adult HIV prevalence ranges from 12 to 26 per cent , HIV transmission is highly generalized. The unprecedented HIV decline and associated behaviour change in Uganda, mainly involving large reductions in multiple sexual partnerships occurred some 20 years ago and under rather different contextual and programmatic circumstances.

More recent examples of HIV prevalence reduction are emerging, including from Kenya, Haiti, the Dominican Republic, Malawi, and Ethiopia. Given the severe HIV epidemics that continue to plague parts of sub-Saharan Africa, there is an urgent need for studies identifying the proximate as well as underlying causes for these encouraging trends.

In this study, the researchers review and summarize the principal findings of their comprehensive interdisciplinary analysis (commissioned by two United Nations agencies, the United Nations Populations Fund [UNFPA] and United Nations HIV-AIDS Programme [UNAIDS]) of the causes behind the considerable HIV decline in Zimbabwe, including evidence for changes in patterns of sexual behaviour and the contextual and possible programmatic reasons for these changes.

HIV prevalence data from national antenatal clinic surveillance and the household-based 2005/6 Demographic and Health Survey (DHS) were used to fit a mathematical model to estimate trends in HIV incidence and AIDS deaths in Zimbabwe.

Data from the DHS and other longitudinal surveys were used to examine the possible contributions of changes in sexual behaviour to reductions in HIV infection. Published data from focus group discussions with 90 adult men and 110 women in diverse urban and rural sites and several dozen in-depth key informant interviews as well as an extensive historical mapping of prevention programmes were examined in assessing the contributions of different contextual and programmatic factors to observed changes in behaviour.

Finally, DHS data on various potential proximal and contextual determinants of behaviour change for Zimbabwe were compared with similar data for seven other southern African countries to identify distinctive patterns that might help to explain the earlier and faster HIV decline observed in Zimbabwe.

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Direttore Responsabile Giuseppe Frangi