Antenatal clinic-based HIV prevalence in Zambia: Declining trends but sharp local contrasts in young women

Centre for International Health, University of Bergen, Bergen, Norway.
Tropical Medicine & International Health (Impact Factor: 2.3). 07/2006; 11(6):917-28. DOI: 10.1111/j.1365-3156.2006.01629.x
Source: PubMed

ABSTRACT To describe regional variation in human immunodefffeciency virus (HIV) prevalence trends in the period 1994-2002 and to assess the effects on prevalence trends of residence, educational level and age, and potential interaction between these variables.
The data were from the national HIV sentinel surveillance system comprising information collected using interviews and unlinked anonymous testing of blood among pregnant women attending antenatal clinics in 22 sites in 1994, 1998 and 2002.
There was a decline in HIV prevalence in the age group 15-24 years in the period 1994-2002 both in rural (by 11%) and urban (by 26%) areas. The decline was strongest among highly educated women. However, this overall decline masked striking differences at community (site) levels with clearly declining epidemics in many sites contrasted by increasing epidemics in some and stability in others. Urban/rural residence, age, educational attainment, marital status and parity were factors closely associated with HIV infection. Having born many children was associated with lower risk of being infected by HIV, even in the age group 15-24.
The HIV prevalence decline in young women is likely to reflect a drop in incidence during the period. However, there were sharp geographical contrasts in trends. Such local contrasts probably indicate differences in effectiveness of preventive interventions. Understanding factors and mechanisms explaining the differences will be of critical importance to better guide preventive interventions.

Download full-text


Available from: Knut Fylkesnes, Jul 01, 2015
1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Concurrent partnerships may cause more rapid spread of HIV in a population. We examined how the prevalence of parallel relationships changed among men and women aged 15-49 in Zambia from 1998 to 2003 using data collected during the Sexual Behavior Surveys 1998, 2000, and 2003. Predictors of concurrent partnerships among men were studied by univariate and multivariate regression analyses. Thirteen percent of rural and 8% of urban men reported more than one ongoing relationship in 1998, and these proportions declined to 8% and 6%, respectively in 2003. The proportion of women reporting concurrent relationships was 0-2%. The most important predictors of concurrency were early sexual debut, being married, early marriage and absence from home. The reduction in concurrent sexual partnerships is consistent with reductions in other sexual risk behaviors found in other studies and may have contributed to the recently observed decline in HIV prevalence in Zambia.
    AIDS and Behavior 11/2008; 14(1):59-71. DOI:10.1007/s10461-008-9472-3 · 3.49 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine to what extent antenatal clinic (ANC)-based estimates reflect HIV prevalence trends among men and women in a high prevalence urban population. Examination of data from serial population-based HIV surveys in 1995 (n = 2115), 1999 (n = 1962) and 2003 (n = 2692), and ANC-based surveillance in 1994 (n = 450), 1998 (n = 810) and 2002 (n = 786) in the same site in Lusaka, Zambia. The population-based surveys recorded refusal rates between 6% and 10% during the three rounds. Among ANC attendees, prevalence declined by 20% (25.0% to 19.9%; P = 0.101) in the age group 15-24 years and was stable overall. In the general population, the prevalence declined by 49% (P < 0.001) and by 32% (P < 0.001) in age group 15-24 and 15-49, respectively. Among women only, HIV prevalence declined by 44% (22.5% to 12.5%; P < 0.001) and by 27% (29.6% to 21.7%; P < 0.001) in age group 15-24 and 15-49 years, respectively. In addition, prevalence substantially declined in higher educated women aged 15-24 years (20.7% to 8.5%, P < 0.001). ANC-based estimates substantially underestimated declines in HIV prevalence in the general population. This seemed to be partially explained by a combination of marked differentials in prevalence change by educational attainment and changes in fertility-related behaviours among young women. These results have important implications for the interpretation of ANC-based HIV estimates and underscore the importance of population-based surveys.
    Tropical Medicine & International Health 03/2008; 13(2):171-9. DOI:10.1111/j.1365-3156.2007.01987.x · 2.30 Impact Factor
  • Source