Journal
EPIDEMICS
Volume 3, Issue 2, Pages 88-94Publisher
ELSEVIER
DOI: 10.1016/j.epidem.2011.02.004
Keywords
HIV-1 prevalence; HIV-1 incidence; Behavior change; Zimbabwe
Categories
Funding
- Canadian International Development Agency (CIDA) (R/C) [690/M3688, A033749]
- United States Agency for International Development (USAID) [HRN-A-00-97-00015-00]
- Bill and Melinda Gates Foundation, Seattle WA
- Rockefeller Foundation (NY, NY)
- BASF (Ludwigshafen Germany)
- Department of Science and Technology, Government of South Africa
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Background: In several recent papers it has been suggested that HIV prevalence and incidence are declining in Zimbabwe as a result of changing sexual behavior. We provide further support for these suggestions, based on an analysis of more extensive, age-stratified, HIV prevalence data from 1990 to 2009 for perinatal women in Harare, as well as data on incidence and mortality. Methodology/principal findings: Pooled prevalence, incidence and mortality were fitted using a simple susceptible-infected (SI) model of HIV transmission; age-stratified prevalence data were fitted using double-logistic functions. We estimate that incidence peaked at 5.5% per year in 1991 declining to 1% per year in 2010. Prevalence peaked in 1998/9 [35.9% (CI95: 31.3-40.7)] and decreased by 67% to 11.9% (CI95: 10.1-13.8) in 2009. For women <20 y, 20-24 y, 25-29 y, 30-34 y and >= 35 y, prevalence peaked at 25.4%, 34.2%, 47.1%, 44.0% and 33.5% in 1993, 1996, 1997, 1998 and 1999, respectively, declining thereafter in every age group. Among women <25 y, prevalence peaked in 1994 at 28.8% declining thereafter by 69% to 8.9% (CI95: 6.8-11.5) in 2009. Conclusion/significance: HIV prevalence declined substantially among perinatal women in Harare after 1998 consequent upon a decline in incidence starting in the early 1990s. Our model suggests that this was primarily a result of changes in behavior which we attribute to a general increase in awareness of the dangers of AIDS and the ever more apparent increases in mortality. (C) 2011 Elsevier B. V. All rights reserved.
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