New HIV infections in young women fall by half in East Zimbabwe
Change in sexual behaviour is the cause, and was in turn induced by education, claim researchers.
Did information, education and communication on HIV transmission and risk – or the death of relatives and friends – cause a significant change in sexual behaviour, and a dramatic fall in new HIV infections, in Eastern Zimbabwe?
by Prakash Khanal (March 06)
Significant changes in sexual behaviour among young Zimbabweans are causing a dramatic decline in HIV infections, according to researchers in London, South Africa and Zimbabwe, in a paper published in Science.
According to the study in Eastern Zimbabwe, over the five years 1998-2003 HIV prevalence associated with sexual behaviour fell 49% among women aged 15-24, and 23% among men aged 17-29. HIV prevalence was less among more educated groups. Sexually experienced men and women also reported reduction in casual sex by 49% and 22% respectively. Men also claimed to be using condoms and having fewer partners.
The researchers considered several other factors that might account for the large fall in HIV rates, such as migration or death, but remain convinced that sexual behaviour change is the cause.
“The measures of risk behaviour were all recent – the numbers of partners in the last year, and recent casual partners – and were compared at two time points,” Geoff Garnett, one of the authors of the study, Professor of Microparasite Epidemiology, Department of Infectious Disease Epidemiology, Faculty of Medicine at Imperial College London, told RealHealthNews.
“We did consider whether differential mortality could explain the change by looking at reported number of partners (in the first round) amongst those in the population who subsequently died. This could explain some change but not very much”.
Garnett is certain that there have been definitive changes in sexual behaviour, including increasing use of condoms during casual sex. “If people are aware of the risk of HIV infection and are empowered to decide whether they enter casual sexual relationships or not, then they can have fewer partners,” he said.
Although the study did not identify the exact causes of behaviour change, it indicates the changes were observed equally in areas with or without focused HIV/AIDS interventions. This could mean that information and knowledge about the epidemic is now widespread. Many people have been affected by the premature death of one or both parents and of friends.
“Zimbabwe’s well-educated population and good communications and health service infrastructure could have facilitated HIV prevention” the Science paper concludes. “HIV prevention activities in Zimbabwe have included early control of sexually transmitted infections, social marketing of condoms, voluntary counselling and testing services, TV and radio serial dramas, and the activities of the Zimbabwe National AIDS Trust Fund.”
Garnett told RealHealthNews “It seems that information, education and communication within an affected and mobilized community is ultimately paying off”. Helen Weiss, senior lecturer, MRC Tropical Epidemiology Group at London School of Hygiene and Tropical Medicine, also believes that focused interventions, with the help of radio, television and other communication media, as well as government agencies, are working. “This success, however, should give us the reason to work even harder,” she said Weiss.
Weiss and Garnett say that successful information campaigns empower the people to make informed choices, and lead to behavioural change, and should be applied in other HIV prevalence hotspots. But everything depends on the communities acknowledging the risks of HIV and AIDS, they say.
Other countries that have recorded a decline in HIV incidence and prevalence in the past, arguably due to intensive HIV prevention programme and medical interventions followed by documented changes in reported sexual behaviour, are Uganda and Thailand. Zimbabwe can also now be added to the short list of countries that have seen substantial de-clines in HIV prevalence. The researchers say there is also growing evidence of declining HIV prevalence in Kenya, Burkina Faso, Cambodia and Haiti.