News of Zimbabwe's declining HIV prevalence rates have been met with scepticism and confusion, particularly in view of the country's economic and political climate. Can this good news be attributed to behavioural change or skewed statistics?
Earlier this month, findings from the Zimbabwe Demographic Health Survey (ZDHS) for 2005-06 revealed that the prevalence rate had declined from 20.1 percent to 18.1 percent among adults. But women are still the hardest hit, with prevalence figures reaching 21.1 percent, while 14.5 percent of all men were HIV-positive.
Zimbabwe, which has one of the world's highest rates of HIV infection, is going through a severe economic crisis. There are shortages of food and fuel, and inflation has topped 1,200 percent.
Given the severe economic and food security difficulties, a falling prevalence rate might indicate that the number of people dying from AIDS was outnumbering those newly infected with it.
In a presentation at a recent conference on the US President's Emergency Plan for AIDS Relief (PEPFAR), Dr Owen Mugurungi, head of the government's HIV/AIDS unit, told delegates that after the dramatic decline was announced, further investigations revealed that the mortality rate could not cause a reduction by itself, and there had also been lower numbers of new people becoming infected.
DEATH AND BEHAVIOUR CHANGE
Karen Stanecki, a UNAIDS senior advisor in the epidemiology monitoring group, told PlusNews there was evidence of high rates of mortality, as well as "some behaviour change, including reduced number of [sexual] partners and increased condom use".
Dr Simon Gregson, epidemiology senior lecturer at the Imperial College London, agreed, and noted that in the early 1980s, Zimbabwe became one of the first countries in the region to implement programmes to manage sexually transmitted infections, and condom distribution began in the early 1990s, steadily increasing over the years.
One clear example of behaviour change is increased condom use. During the 1990s, the public sector was the principal provider of male condoms but social marketing now accounts for more than a half of all condoms distributed. The fact that most condoms were now purchased rather than freely distributed, made it more credible that people were using condoms more frequently, he said.
"Data from local scientific research studies in Manicaland [province] indicate recent delays in onset of sexual activity, reductions in rates of sexual partner change and, for women with high rates of partner change, further increases in consistent condom use," a UNAIDS review on the HIV decline in Zimbabwe noted.
Pinpointing when the reduction started taking place, however, was difficult. "We cannot be precise as to when it started ... but it looks like behaviour change was occurring in the late 1990s. It is possible that other intervention programmes from the early 1990s may have contributed and could still be contributing [to the decline]," Gregson, who authored the report, told PlusNews.
WHAT HAPPENS NOW?
Nongovernmental organisations (NGOs) have been cautious about the recent drop, preferring to adopt a 'wait and see' approach, but have argued that gains against the disease have been damaged by current conditions.
Last year's Operation Murambatsvina ('Clean Out Garbage'), officially aimed at rooting out the parallel market and criminal activities, also encompassed unapproved housing owned or rented by the poor, making life even more difficult. A year after the campaign, AIDS NGOs are still trying to locate displaced HIV-positive people, and fear that many have had to discontinue their treatment.
NGOs have warned that the vulnerability of women would be heightened, as violence against girls and women was on the increase, and girls would be forced to sell their bodies to survive.
"If it [decline in prevalence] can be attributed to behaviour change, we need to find out what behaviour change took place and why, so we can capitalise on this and see what works and what doesn't. But we have to move fast, before more damage is done," said Lindiwe Chaza, director of Zimbabwe's AIDS Network.
Inevitably, comparisons have been drawn between wealthier countries, such as South Africa and Botswana, which have failed to record any significant declines, while cash-strapped Zimbabwe has managed to bring down its level of HIV infections.
Questions have also been raised about whether the large numbers of Zimbabweans leaving the country, have affected the prevalence rates.
But the UNAIDS review stated: "International migration is believed to have been extensive and the possibility that it contributed in a small way to the decline in HIV prevalence cannot be ruled out given the limited data available. Nonetheless, the evidence available does not support the view that the overall level of migration ... needed to cause a decline in national HIV prevalence in the absence of behaviour change has occurred in Zimbabwe."
Acknowledging the scepticism, Stanecki explained: "People tend to forget that it takes a long time for programmes to have an impact [on statistics]. In the mid- to late [19]90s there were probably more resources available, and community and grassroots programmes being run."
Stressing that the reduced figures were not a reflection of current conditions in Zimbabwe, Stanecki admitted that the present situation "could reverse the trend".
The effects of the clean up operations would only become evident over the next two or three years, Gregson added.
//This article is part of an IRIN/PlusNews series on HIV/AIDS and communities of humanitarian concern. Visit: PlusNews. //
Earlier this month, findings from the Zimbabwe Demographic Health Survey (ZDHS) for 2005-06 revealed that the prevalence rate had declined from 20.1 percent to 18.1 percent among adults. But women are still the hardest hit, with prevalence figures reaching 21.1 percent, while 14.5 percent of all men were HIV-positive.
Zimbabwe, which has one of the world's highest rates of HIV infection, is going through a severe economic crisis. There are shortages of food and fuel, and inflation has topped 1,200 percent.
Given the severe economic and food security difficulties, a falling prevalence rate might indicate that the number of people dying from AIDS was outnumbering those newly infected with it.
In a presentation at a recent conference on the US President's Emergency Plan for AIDS Relief (PEPFAR), Dr Owen Mugurungi, head of the government's HIV/AIDS unit, told delegates that after the dramatic decline was announced, further investigations revealed that the mortality rate could not cause a reduction by itself, and there had also been lower numbers of new people becoming infected.
DEATH AND BEHAVIOUR CHANGE
Karen Stanecki, a UNAIDS senior advisor in the epidemiology monitoring group, told PlusNews there was evidence of high rates of mortality, as well as "some behaviour change, including reduced number of [sexual] partners and increased condom use".
Dr Simon Gregson, epidemiology senior lecturer at the Imperial College London, agreed, and noted that in the early 1980s, Zimbabwe became one of the first countries in the region to implement programmes to manage sexually transmitted infections, and condom distribution began in the early 1990s, steadily increasing over the years.
One clear example of behaviour change is increased condom use. During the 1990s, the public sector was the principal provider of male condoms but social marketing now accounts for more than a half of all condoms distributed. The fact that most condoms were now purchased rather than freely distributed, made it more credible that people were using condoms more frequently, he said.
"Data from local scientific research studies in Manicaland [province] indicate recent delays in onset of sexual activity, reductions in rates of sexual partner change and, for women with high rates of partner change, further increases in consistent condom use," a UNAIDS review on the HIV decline in Zimbabwe noted.
Pinpointing when the reduction started taking place, however, was difficult. "We cannot be precise as to when it started ... but it looks like behaviour change was occurring in the late 1990s. It is possible that other intervention programmes from the early 1990s may have contributed and could still be contributing [to the decline]," Gregson, who authored the report, told PlusNews.
WHAT HAPPENS NOW?
Nongovernmental organisations (NGOs) have been cautious about the recent drop, preferring to adopt a 'wait and see' approach, but have argued that gains against the disease have been damaged by current conditions.
Last year's Operation Murambatsvina ('Clean Out Garbage'), officially aimed at rooting out the parallel market and criminal activities, also encompassed unapproved housing owned or rented by the poor, making life even more difficult. A year after the campaign, AIDS NGOs are still trying to locate displaced HIV-positive people, and fear that many have had to discontinue their treatment.
NGOs have warned that the vulnerability of women would be heightened, as violence against girls and women was on the increase, and girls would be forced to sell their bodies to survive.
"If it [decline in prevalence] can be attributed to behaviour change, we need to find out what behaviour change took place and why, so we can capitalise on this and see what works and what doesn't. But we have to move fast, before more damage is done," said Lindiwe Chaza, director of Zimbabwe's AIDS Network.
Inevitably, comparisons have been drawn between wealthier countries, such as South Africa and Botswana, which have failed to record any significant declines, while cash-strapped Zimbabwe has managed to bring down its level of HIV infections.
Questions have also been raised about whether the large numbers of Zimbabweans leaving the country, have affected the prevalence rates.
But the UNAIDS review stated: "International migration is believed to have been extensive and the possibility that it contributed in a small way to the decline in HIV prevalence cannot be ruled out given the limited data available. Nonetheless, the evidence available does not support the view that the overall level of migration ... needed to cause a decline in national HIV prevalence in the absence of behaviour change has occurred in Zimbabwe."
Acknowledging the scepticism, Stanecki explained: "People tend to forget that it takes a long time for programmes to have an impact [on statistics]. In the mid- to late [19]90s there were probably more resources available, and community and grassroots programmes being run."
Stressing that the reduced figures were not a reflection of current conditions in Zimbabwe, Stanecki admitted that the present situation "could reverse the trend".
The effects of the clean up operations would only become evident over the next two or three years, Gregson added.
//This article is part of an IRIN/PlusNews series on HIV/AIDS and communities of humanitarian concern. Visit: PlusNews. //
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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