RT Journal Article
SR Electronic
T1 Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti
JF Sexually Transmitted Infections
JO Sex Transm Infect
FD BMJ Publishing Group Ltd
SP i1
OP i8
DO 10.1136/sti.2005.016014
VO 82
IS suppl 1
A1 T B Hallett
A1 J Aberle-Grasse
A1 G Bello
A1 L-M Boulos
A1 M P A Cayemittes
A1 B Cheluget
A1 J Chipeta
A1 R Dorrington
A1 S Dube
A1 A K Ekra
A1 J M Garcia-Calleja
A1 G P Garnett
A1 S Greby
A1 S Gregson
A1 J T Grove
A1 S Hader
A1 J Hanson
A1 W Hladik
A1 S Ismail
A1 S Kassim
A1 W Kirungi
A1 L Kouassi
A1 A Mahomva
A1 L Marum
A1 C Maurice
A1 M Nolan
A1 T Rehle
A1 J Stover
A1 N Walker
YR 2006
UL http://sti.bmj.com/content/82/suppl_1/i1.abstract
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.