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Changes in sexual behaviour leading to the decline in the prevalence of HIV in Uganda: confirmation from multiple sources of evidence.

Kirby D - Sex Transm Infect (2008)

Bottom Line: To identify the changes in sexual behaviour that led to the dramatic reduction in the prevalence of HIV in Uganda in the early 1990s.All seven types of data produced consistent evidence that people in Uganda first reduced their number of sexual partners prior to or outside of long-term marital or cohabiting relationships, and then increased their use of condoms with non-marital and non-cohabiting partners.Consistent with basic theories about transmission of sexually transmitted infections, first reducing the number of sexual partners and breaking up sexual networks and then reducing the chances of HIV transmission with remaining casual partners by using condoms can be achieved and can dramatically reduce the sexual transmission of HIV in generalised epidemics.

View Article: PubMed Central - PubMed

Affiliation: ETR Associates, 4 Carbonero Way, Scotts Valley, CA 95066-4200, USA. dougk@etr.org

ABSTRACT

Objectives: To identify the changes in sexual behaviour that led to the dramatic reduction in the prevalence of HIV in Uganda in the early 1990s.

Methods: Seven different types of evidence were examined: (1) models of HIV prevalence and incidence in Kampala and other sentinel sites in Uganda; (2) reports of behaviour change in the primary newspaper in Uganda; (3) surveys with questions about perceptions of personal behaviour change; (4) large demographic and health surveys (DHS) collected in 1988/9 and 1995 and large Global Program on AIDS (GPA) surveys in 1989 and 1995 with questions about reported sexual behaviour; (5) smaller less representative surveys of reported sexual behaviour collected in other years; (6) reports of numbers of condoms shipped to Uganda; and (7) historical documents describing the implementation of HIV prevention programmes in Uganda.

Results: All seven types of data produced consistent evidence that people in Uganda first reduced their number of sexual partners prior to or outside of long-term marital or cohabiting relationships, and then increased their use of condoms with non-marital and non-cohabiting partners.

Conclusions: Consistent with basic theories about transmission of sexually transmitted infections, first reducing the number of sexual partners and breaking up sexual networks and then reducing the chances of HIV transmission with remaining casual partners by using condoms can be achieved and can dramatically reduce the sexual transmission of HIV in generalised epidemics.

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(A) Prevalence of HIV in Uganda. (B) Estimated incidence, prevalence and death from HIV in Kampala (Nsambya Hospital) assuming a 1987 peak and period of 8 years.
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U9G-84-S2-0035-f01: (A) Prevalence of HIV in Uganda. (B) Estimated incidence, prevalence and death from HIV in Kampala (Nsambya Hospital) assuming a 1987 peak and period of 8 years.

Mentions: Prevalence data for Kampala indicate that the prevalence increased very rapidly through 1987, increased at a slower rate in 1988 until it peaked in 1992, decreased rapidly in 1993 for several years and continued to decline through 2002 (fig 1A). In the four major towns prevalence also increased, on average, through 1992 and then, as in Kampala, began a rapid decline in 1993 and continued to decline through 2000. In the rural areas the pattern is less clear because the trend line is based on different sites and because prevalence began to decline in different sites at different times. However, in many rural sentinel sites, prevalence began to decline between 1992 and 1997.


Changes in sexual behaviour leading to the decline in the prevalence of HIV in Uganda: confirmation from multiple sources of evidence.

Kirby D - Sex Transm Infect (2008)

(A) Prevalence of HIV in Uganda. (B) Estimated incidence, prevalence and death from HIV in Kampala (Nsambya Hospital) assuming a 1987 peak and period of 8 years.
© Copyright Policy - openaccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2602746&req=5

U9G-84-S2-0035-f01: (A) Prevalence of HIV in Uganda. (B) Estimated incidence, prevalence and death from HIV in Kampala (Nsambya Hospital) assuming a 1987 peak and period of 8 years.
Mentions: Prevalence data for Kampala indicate that the prevalence increased very rapidly through 1987, increased at a slower rate in 1988 until it peaked in 1992, decreased rapidly in 1993 for several years and continued to decline through 2002 (fig 1A). In the four major towns prevalence also increased, on average, through 1992 and then, as in Kampala, began a rapid decline in 1993 and continued to decline through 2000. In the rural areas the pattern is less clear because the trend line is based on different sites and because prevalence began to decline in different sites at different times. However, in many rural sentinel sites, prevalence began to decline between 1992 and 1997.

Bottom Line: To identify the changes in sexual behaviour that led to the dramatic reduction in the prevalence of HIV in Uganda in the early 1990s.All seven types of data produced consistent evidence that people in Uganda first reduced their number of sexual partners prior to or outside of long-term marital or cohabiting relationships, and then increased their use of condoms with non-marital and non-cohabiting partners.Consistent with basic theories about transmission of sexually transmitted infections, first reducing the number of sexual partners and breaking up sexual networks and then reducing the chances of HIV transmission with remaining casual partners by using condoms can be achieved and can dramatically reduce the sexual transmission of HIV in generalised epidemics.

View Article: PubMed Central - PubMed

Affiliation: ETR Associates, 4 Carbonero Way, Scotts Valley, CA 95066-4200, USA. dougk@etr.org

ABSTRACT

Objectives: To identify the changes in sexual behaviour that led to the dramatic reduction in the prevalence of HIV in Uganda in the early 1990s.

Methods: Seven different types of evidence were examined: (1) models of HIV prevalence and incidence in Kampala and other sentinel sites in Uganda; (2) reports of behaviour change in the primary newspaper in Uganda; (3) surveys with questions about perceptions of personal behaviour change; (4) large demographic and health surveys (DHS) collected in 1988/9 and 1995 and large Global Program on AIDS (GPA) surveys in 1989 and 1995 with questions about reported sexual behaviour; (5) smaller less representative surveys of reported sexual behaviour collected in other years; (6) reports of numbers of condoms shipped to Uganda; and (7) historical documents describing the implementation of HIV prevention programmes in Uganda.

Results: All seven types of data produced consistent evidence that people in Uganda first reduced their number of sexual partners prior to or outside of long-term marital or cohabiting relationships, and then increased their use of condoms with non-marital and non-cohabiting partners.

Conclusions: Consistent with basic theories about transmission of sexually transmitted infections, first reducing the number of sexual partners and breaking up sexual networks and then reducing the chances of HIV transmission with remaining casual partners by using condoms can be achieved and can dramatically reduce the sexual transmission of HIV in generalised epidemics.

Show MeSH
Related in: MedlinePlus