Sexual behaviour change in countries with generalised HIV epidemics? Evidence from population-based cohort studies in sub-Saharan Africa
- 1Imperial College London, London, UK
- 2Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- 3London School of Hygiene and Tropical Medicine, London, UK
- Professor S Gregson, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK;
- Accepted 22 January 2009
It has been 27 years since the beginning of the HIV epidemic in Africa and, although we understand more about the transmission and treatment of the disease, our knowledge of how new infections can be prevented remains limited.1 The risk of HIV acquisition is known to be closely associated with unprotected sexual intercourse,2 3 and adoption of safer sexual behaviour is still the main message of most national HIV prevention programmes. However, while declines in HIV prevalence have been associated with changes in sexual behaviour,4 ecological studies have failed to find associations between risk behaviour and the prevalence of HIV5 or other sexually transmitted infections (STI),6 and scientific trials show no evidence for a population-level effect of behavioural interventions.7 8 Measurement and comparison of sexual behaviour is challenging because, for example, variations in social desirability and other reporting bias can distort data on levels and trends in behaviour.9 Thus, limitations in the reliability and consistency of the methods used to collect and analyse data on sexual behaviour, particularly when made across time or space, could contribute to these apparently contradictory findings. This supplement presents 10 recent analyses of sexual behaviour data from longitudinal studies in five countries—Uganda, Tanzania, Malawi, Zimbabwe and South Africa—experiencing different sizes and stages of the HIV epidemic. The results provide valuable information for use in evaluating trends in HIV epidemics and the impact of HIV prevention programmes. An underlying purpose of this is to highlight appropriate methods and to encourage better analysis and presentation of sexual behaviour data, especially as they relate to HIV and HIV prevention.
The Demographic and Health Surveys (DHS) conducted in many African countries have provided a wealth of data on age at first sex. …