Researchers have been baffled by the HIV prevalence among Zimbabwean adults which has fallen from 29% in 1997 to 16% in 2007, especially in the context of severe social, political and economic disruption.

Published in the journal PLoS  Medicine, Dr Daniel Halperin from the Harvard School of Public Health and several colleagues summised that the behavioral changes associated with HIV reduction ‘€“ mainly reductions in extramarital, commercial and casual sexual relations, and associated reductions in partner concurrency ‘€“ appear to have been stimulated primarily by increased awareness of AIDS deaths and secondarily by the country’€™s economic deterioration.

‘€œThese changes were probably aided by prevention programmes utlising both mass media and church-based, workplace-based, and other inter-personal communication activities,’€ the researchers said.

Until now Thailand and Uganda have been held up as massive HIV prevention success stories. However, in sub-Saharan Africa, HIV transmission is highly generalised, whereas in Thailand the epidemic was much more concentrated.

In Thailand HIV transmission was driven mainly by brothel-based sex work enabling an aggressive 100% condoms programme to be feasible, enforceable and effective.

The unprecedented HIV decline and associated behaviour change in Uganda, mainly involving large reductions in multiple sexual partnerships, occurred some 20 years ago.

Halperin and colleagues reported that Zimbabwean men and women in focus groups and interviews repeatedly and consistently reported personal exposure to AIDS mortality and the resulting fear of contracting the virus to be the primary motivation for changes in sexual behaviour, particularely reductions in casual sex and other multiple sexual partnerships.

The severe economic decline also appeared to have played a considerable secondary role in amplifying patterns of behaviour change, particularly partner reduction. Many men in focus and interview groups reported having less disposable income which led to a reduced ability to purchase sex or maintain multiple sexual relationships.

Comparing Zimbabwe to other Southern African countries, the researchers found that the country stood out in terms of high levels of both secondary education and marriage, especially in urban men, among who the greatest level of behaviour change evidently occurred.

‘€œIt appears that the unique combination helped facilitate a clearer understanding of how HIV is sexually transmitted and a greater ability to act upon the ‘€˜be faithful’€™ messages, given the stronger marriage pattern Zimbabwe,’€ the researchers said.

Botswana and South Africa also has relatively well-educated populations, but a ‘€œweaker’€ marriage pattern compared to its neighbour.

Read the full article here:    http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000414