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for HIV decline in Zimbabwe: a comprehensive review of the epidemiological
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Recent data from Zimbabwes national HIV sentinel surveillance
system, collected from women attending antenatal clinics for routine
check-ups indicate that HIV prevalence may have started to decline
in the country. UNAIDS initiated an epidemiological review to: (i)
establish whether this decline in HIV prevalence was genuineor
simply refl ected temporal changes in bias; (ii) assess the relative
contributions of falling HIV incidence and rising mortality to the
decline; and (iii) assess whether past and recent changes in sexual
behaviour had contributed to the decline. In the review, all known
data on trends in HIV and associated behaviours were drawn together,
synthesised and evaluated using triangulation and statistical and
mathematical modelling techniques. The data were presented and considered
at national and international stakeholders meetings.
It was concluded
that HIV prevalence had fallen in Zimbabwe over the past fi ve years.
HIV incidence has also declined; sexual behaviour change has accelerated
these declines beyond what would have been expected given the natural
dynamics of HIV epidemics. The changes in behaviour include increased
condom use in non-regular partnerships commencing in the mid-1990s
and reductions in rates of sexual partner change. However, there
were a number of inconsistencies and biases in the data and the
extent of the decline in HIV prevalence may not be quite as great
as is indicated by the routine antenatal surveillance data. HIV
prevalence and behaviour data to be collected in the 2005 Zimbabwe
Demographic and Health Survey, together with additional estimates
of HIV incidence generated using new diagnostic test procedures
will be available within the next 12 months and will help to further
validate the current conclusions.
are very encouraging and provide the fi rst convincing evidence
of an HIV decline in a southern African country. However, they cannot,
in themselves, be taken as evidence for the success of HIV prevention
programmes. Behaviour change can be the result of linking the growing
personal experience of AIDS mortality to knowledge about HIV transmission.
However, at the population level, the observed changes also include
the effects of higher death rates in individuals with the riskiest
lifestyles. In 2005, it is still the case that one in every fi ve
adults in Zimbabwe is infected with a life-threatening virus. There
is much, therefore, that remains to be done.
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