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Evidence for HIV decline in Zimbabwe: a comprehensive review of the epidemiological data
UNAIDS
November 2005

http://www.unaids.org/html/pub/publications/irc-pub06/zimbabwe_epi_report_nov05_en_pdf.pdf

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Summary
Recent data from Zimbabwe’s 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 genuine—or 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.

These findings 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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