Skip Navigation



IJE Advance Access published online on May 6, 2004
International Journal of Epidemiology, doi:10.1093/ije/dyh094
© 2004 by International Epidemiological Association
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow Retraction
Right arrow A retraction has been published
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in Int. J. Epidemiol.
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Stoneburner, R. L.
Right arrow Articles by Low-Beer, D.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Stoneburner, R. L.
Right arrow Articles by Low-Beer, D.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Accepted December 1, 2003

Original paper

Sexual partner reductions explain human immunodeficiency virus declines in Uganda: comparative analyses of HIV and behavioural data in Uganda, Kenya, Malawi, and Zambia

Rand L. Stoneburner 1* Daniel Low-Beer 1

1 Health and Population Evaluation Unit, Cambridge University, UK

* To whom correspondence should be addressed. E-mail: randstoneburner{at}netzero.net.


  Abstract

Background A better understanding of behavioural factors associated with the interruption of human immunodeficiency virus (HIV) dynamics in Uganda are fundamental for guiding HIV prevention strategies. A comparative analysis of population level HIV surveillance and behavioural data in Uganda and countries with similar epidemic dynamics offers a framework to identify distinctive elements of the Ugandan success.

Methods We analysed HIV prevalence among pregnant women attending antenatal surveillance sites between 1990-1998 in Uganda, Kenya, Zambia, and Malawi, and AIDS behavioural data collected in Uganda (1989, 1995), Kenya (1998), Zambia, and Malawi (1996).

Results In Uganda between 1991 and 1998, HIV prevalence rates fell 54% overall, with 75% and 57% declines among 15-19 and 20-24 age groups in urban areas, respectively. HIV declines were associated with a 60% reduction in multiple sexual partners between 1989 and 1995, as well as increased condom use and sexual abstinence. The lack of comparable HIV declines in comparison countries with similar rates of abstinence and condom use, but with multiple sexual partnership rates similar to Uganda in 1989, suggests that partner reduction is paramount in interrupting sexual HIV dynamics. Comparatively, Ugandans were more likely to acknowledge people with AIDS and communicate about HIV through personal networks. Modelling suggests an 80% reduction in incidence among youth early in the 1990s, suggesting a preceding behavioural process during the late 1980s, which reduced HIV risk.

Conclusion The distinctive element explaining declines in HIV prevalence in Uganda is sexual partner reduction. The Ugandan response to AIDS involved a primary HIV intervention whose key outcome was risk avoidance through partner reduction. This focus for HIV prevention could prove more effective than other widely advocated strategies in sub-Saharan Africa.

Keywords Epidemiological factors, HIV infection, population surveillance, theoretical models, prevention, social factors, development, sexually transmitted infections, Sub-Saharan Africa


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in Int. J. Epidemiol.:

Retraction
Rand L. Stoneburner and Daniel Low-Beer
Int. J. Epidemiol. 2004 10.1093/ije/dyh141. [PDF]  

Commentary: Still dying of ignorance? Human immunodeficiency virus (HIV) prevention strategies revisited
Margaret May
Int. J. Epidemiol. 2004 10.1093/ije/dyh167. [PDF]  





Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.