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Risky sex does not equal HIV risk - study
PlusNews
December 07, 2010
http://www.plusnews.org/report.aspx?ReportID=91305
Zimbabwean women reported significantly less risky
sexual behaviour than their counterparts in Tanzania, despite being
almost four times more likely to be HIV-infected, a comparative
study has found.
Researchers from the Universities of Zimbabwe and
Oslo in Norway disseminated data from pregnant women who visited
antenatal clinics in Moshi, Tanzania, and in Harare, capital of
Zimbabwe, between 2002 and 2004. The women answered questions about
their sexual behaviour, medical history and socio-demographic background
and were tested for HIV and several other sexually transmitted infections
(STIs).
HIV prevalence among the Zimbabwean women was nearly
26 percent against about 7 percent among the Tanzanian women. Risk
of infection rose with age for women in both countries up until
the 25 to 29 age group, after which it started to decline for the
Tanzanian women but continued to rise for the Zimbabweans. The Zimbabwean
women also had somewhat higher rates of STIs, but this may have
been the result of more of the women being HIV-positive and more
susceptible to such infections.
In the Journal of the International AIDS Society,
the researchers described the "unexpected phenomenon"
revealed by the data gathered on the women's sexual behaviour.
On virtually every indicator, the Tanzanian women reported more
risky behaviour from having had a casual sexual partner in the last
12 months to early sexual debut to being in a polygamous relationship.
They also reported much higher levels of alcohol consumption, another
behaviour that has been linked to increased sexual risk-taking.
The authors can only speculate about the explanation
for this "paradox". Perhaps by the time the survey was
done, women in Zimbabwe had lowered their sexual risk-taking in
response to an epidemic that had already claimed so many lives;
or maybe they under-reported their sexual risk-taking because such
behaviours by women are considered socially unacceptable in Zimbabwe.
Numerous studies have failed to provide definitive
answers as to why HIV prevalence in sub-Saharan Africa varies so
widely, with some countries recording infection rates of less than
2 percent and others recording rates of more than 20 percent.
It has long been assumed that different norms relating
to sexual risk-taking from one country to another played an important
role, but the recent findings suggest that other factors may be
more important. The result has implications for the design of HIV
prevention programmes, especially those aimed at sexual behaviour
change.
The male partners
of the Tanzanian women were much more likely to be circumcised,
but the effect of male circumcision was not apparent in the study
findings.
One possible
explanation for the severity of Zimbabwe's HIV problem compared
with Tanzania's, write the authors, is the role that non-sexual
transmission of HIV may have played in the early years of Zimbabwe's
epidemic. They cite a 1990s study which found a 2.1 percent HIV
prevalence among 933 women with no reported sexual experience.
"Early
in the epidemic, syringes weren't sterilized properly,"
said lead author of the study, Munyaradzi Mapingure, from the Department
of Community Medicine at the University
of Zimbabwe. "We're not blaming anyone, because
people probably weren't aware of it, but people who grew up
in Zimbabwe in the 1970s were put in a queue and vaccinated with
one needle."
The theory that large-scale non-sexual transmission
of HIV can explain severe epidemics like Zimbabwe's is "very
controversial", admitted Mapingure, but "something we
have to bring into the discussion".
"Most
HIV prevention programmes are failing because they focus on sexual
behaviour," he told IRIN/PlusNews over the telephone from
Harare. "We need to look at the whole sexualization of HIV."
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