PT  - JOURNAL ARTICLE
AU  - T B Hallett
AU  - J Aberle-Grasse
AU  - G Bello
AU  - L-M Boulos
AU  - M P A Cayemittes
AU  - B Cheluget
AU  - J Chipeta
AU  - R Dorrington
AU  - S Dube
AU  - A K Ekra
AU  - J M Garcia-Calleja
AU  - G P Garnett
AU  - S Greby
AU  - S Gregson
AU  - J T Grove
AU  - S Hader
AU  - J Hanson
AU  - W Hladik
AU  - S Ismail
AU  - S Kassim
AU  - W Kirungi
AU  - L Kouassi
AU  - A Mahomva
AU  - L Marum
AU  - C Maurice
AU  - M Nolan
AU  - T Rehle
AU  - J Stover
AU  - N Walker
TI  - Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti
AID  - 10.1136/sti.2005.016014
DP  - 2006 Apr 01
TA  - Sexually Transmitted Infections
PG  - i1--i8
VI  - 82
IP  - suppl 1
4099  - http://sti.bmj.com/content/82/suppl_1/i1.short
4100  - http://sti.bmj.com/content/82/suppl_1/i1.full
SO  - Sex Transm Infect2006 Apr 01; 82
AB  - Objective: To determine whether observed changes in HIV prevalence in countries with generalised HIV epidemics are associated with changes in sexual risk behaviour. Methods: A mathematical model was developed to explore the relation between prevalence recorded at antenatal clinics (ANCs) and the pattern of incidence of infection throughout the population. To create a null model a range of assumptions about sexual behaviour, natural history of infection, and sampling biases in ANC populations were explored to determine which factors maximised declines in prevalence in the absence of behaviour change. Modelled prevalence, where possible based on locally collected behavioural data, was compared with the observed prevalence data in urban Haiti, urban Kenya, urban Cote d’Ivoire, Malawi, Zimbabwe, Rwanda, Uganda, and urban Ethiopia. Results: Recent downturns in prevalence observed in urban Kenya, Zimbabwe, and urban Haiti, like Uganda before them, could only be replicated in the model through reductions in risk associated with changes in behaviour. In contrast, prevalence trends in urban Cote d’Ivoire, Malawi, urban Ethiopia, and Rwanda show no signs of changed sexual behaviour. Conclusions: Changes in patterns of HIV prevalence in urban Kenya, Zimbabwe, and urban Haiti are quite recent and caution is required because of doubts over the accuracy and representativeness of these estimates. Nonetheless, the observed changes are consistent with behaviour change and not the natural course of the HIV epidemic.