title: HIV decline in Zimbabwe due to reductions in risky sex? Evidence from a comprehensive epidemiological review.
abstract: BACKGROUND
  Recent data from antenatal clinic (ANC) surveillance and general population surveys suggest substantial declines in human immunodeficiency virus (HIV) prevalence in Zimbabwe. We assessed the contributions of rising mortality, falling HIV incidence and sexual behaviour change to the decline in HIV prevalence.
  
  
  METHODS
  Comprehensive review and secondary analysis of national and local sources on trends in HIV prevalence, HIV incidence, mortality and sexual behaviour covering the period 1985-2007.
  
  
  RESULTS
  HIV prevalence fell in Zimbabwe over the past decade (national estimates: from 29.3% in 1997 to 15.6% in 2007). National census and survey estimates, vital registration data from Harare and Bulawayo, and prospective local population survey data from eastern Zimbabwe showed substantial rises in mortality during the 1990s levelling off after 2000. Direct estimates of HIV incidence in male factory workers and women attending pre- and post-natal clinics, trends in HIV prevalence in 15-24-year-olds, and back-calculation estimates based on the vital registration data from Harare indicated that HIV incidence may have peaked in the early 1990s and fallen during the 1990s. Household survey data showed reductions in numbers reporting casual partners from the late 1990s and high condom use in non-regular partnerships between 1998 and 2007.
  
  
  CONCLUSIONS
  These findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behaviour in a southern African country. However, in 2007, one in every seven adults in Zimbabwe was still infected with a life-threatening virus and mortality rates remained at crisis level.
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK. sajgregson@aol.com
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gonese
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Hallett
authors.forename: Noah
authors.initials: N
authors.lastname: Taruberekera
authors.forename: John W
authors.initials: JW
authors.lastname: Hargrove
authors.forename: Ben
authors.initials: B
authors.lastname: Lopman
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Corbett
authors.forename: Rob
authors.initials: R
authors.lastname: Dorrington
authors.forename: Sabada
authors.initials: S
authors.lastname: Dube
authors.forename: Karl
authors.initials: K
authors.lastname: Dehne
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
mesh_terms: D000293:Adolescent; D000328:Adult; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
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