Did National HIV Prevention Programs Contribute to HIV Decline in Eastern Zimbabwe? Evidence From a Prospective Community Survey

• Published in: Sexually transmitted diseases 2011-06, Vol.38 (6), p.475-482
• Main Authors: Gregson, Simon, Nyamukapa, Constance, Schumacher, Christina, Mugurungi, Owen, Benedikt, Clemens, Mushati, Phyllis, Campbell, Catherine, Garnett, Geoffrey P.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Cohort Studies; Community Health Services - methods; Disease prevention; Female; General aspects; Health risks; HIV; HIV Infections - epidemiology; HIV Infections - prevention & control; Human immunodeficiency virus; Human infectious diseases. Experimental studies and models; Human viral diseases; Humans; Incidence; Infectious diseases; Interviews as Topic; Male; Medical sciences; Middle Aged; National Health Programs; Original Study; Prevalence; Prevention; Prevention and actions; Prevention programs; Preventive programmes; Program Evaluation; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk taking; Rural Population; Sexual behavior; Sexual Behavior - psychology; Sexual Behavior - statistics & numerical data; Sexually transmitted diseases; Socioeconomic Factors; Statistical analysis; STD; Unemployment; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Women; Young Adult; Zimbabwe; Zimbabwe - epidemiology
• ISSN: 0148-5717; 1537-4521
• DOI: 10.1097/OLQ.0b013e3182080877

Objective: To add to the evidence on the impact of national HIV prevention programs in reducing HIV risk in sub-Saharan African countries. Methods: Statistical analysis of prospective data on exposure to HIV prevention programs, relatives with AIDS and unemployment, and sexual behavior change and HIV incidence, in a population cohort of 4047 adults, collected over a period (1998-2003) when HIV prevalence and risk-behavior declined in eastern Zimbabwe. Results: Exposure to HIV prevention programs and relatives with AIDS—but not unemployment—increased from 1998 to 2003. Men and women exposed to media campaigns and HIV/AIDS meetings had greater knowledge and self-efficacy, attributes that were concomitantly protective against HIV infection. Women attending community HIV/AIDS meetings before recruitment were more likely than other women to adopt lower-risk behavior (96.4% vs. 90.8%; adjusted odds ratio, 3.09; 95% confidence interval [CI], 1.27-7.49) and had lower HIV incidence (0.9% vs. 1.8%; adjusted incidence rate ratio, 0.63; 95% CI, 0.32-1.24) during the intersurvey period. Prior exposure to relatives with AIDS was not associated with differences in behavior change. More newly unemployed men as compared with employed men adopted lowerrisk behavior (84.2% vs. 76.0%; adjusted odds ratio, 2.13; 95% CI, 0.98-4.59). Conclusions: Community-based HIV/AIDS meetings reduced riskbehavior amongst women who attended them, contributing to HIV decline in eastern Zimbabwe.