TY - JOUR
T1 - Declining HIV prevalence and incidence in perinatal women in Harare, Zimbabwe
AU - Hargrove, John W.
AU - Humphrey, Jean H.
AU - Mahomva, Agnes
AU - Williams, Brian G.
AU - Chidawanyika, Henry
AU - Mutasa, Kuda
AU - Marinda, Edmore
AU - Mbizvo, Michael T.
AU - Nathoo, Kusum J.
AU - Iliff, Peter J.
AU - Mugurungi, Owen
N1 - Funding Information:
None of the authors has any commercial or other association that might pose a conflict of interest. The ZVITAMBO project was supported by the Canadian International Development Agency (CIDA) ( R/C Project 690/M3688 ), United States Agency for International Development (USAID) (cooperative agreement number HRN-A-00-97-00015-00 between Johns Hopkins University and the Office of Health and Nutrition — USAID) and a grant from the Bill and Melinda Gates Foundation , Seattle WA. Additional funding was received from the Rockefeller Foundation (NY, NY) and BASF (Ludwigshafen Germany).
Funding Information:
We thank the Zimbabwe Ministry of Health and Child Welfare for providing antenatal sentinel HIV-1 survey data for Harare and Chitungwiza and Dr. A.D. McNaughten, Centers for Disease Control and Prevention, for preparing databases of some of these data and advising on their analysis and interpretation. We gratefully acknowledge Clemens Benedikt and Annemarie Schuller of UNFPA for collating data on condom distribution in Zimbabwe, and Yasmin Madan of Population Services International for providing data on socially marketed condoms. We thank Liz Corbett, Frances Cowan, Simon Gregson and Eleanor Gouws for helpful comments on the manuscript. SACEMA receives major funding from the Department of Science and Technology, Government of South Africa and from the Canadian International Development Agency (CIDA) Project A033749 .
PY - 2011/6
Y1 - 2011/6
N2 - 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.
AB - 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.
KW - Behavior change
KW - HIV-1 incidence
KW - HIV-1 prevalence
KW - Zimbabwe
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U2 - 10.1016/j.epidem.2011.02.004
DO - 10.1016/j.epidem.2011.02.004
M3 - Article
C2 - 21624779
AN - SCOPUS:79953110935
SN - 1755-4365
VL - 3
SP - 88
EP - 94
JO - Epidemics
JF - Epidemics
IS - 2
ER -