title: Did national HIV prevention programs contribute to HIV decline in Eastern Zimbabwe? Evidence from a prospective community survey.
abstract: OBJECTIVE
  To add to the evidence on the impact of national HIV prevention programs in reducing HIV risk in sub-Saharan African countries.
  
  
  METHODS
  Statistical analysis of prospective data on exposure to HIV prevention programs, relatives with AIDS and unemployment, and sexual behavior change and HIV incidence, in a population cohort of 4047 adults, collected over a period (1998-2003) when HIV prevalence and risk-behavior declined in eastern Zimbabwe.
  
  
  RESULTS
  Exposure to HIV prevention programs and relatives with AIDS-but not unemployment-increased from 1998 to 2003. Men and women exposed to media campaigns and HIV/AIDS meetings had greater knowledge and self-efficacy, attributes that were concomitantly protective against HIV infection. Women attending community HIV/AIDS meetings before recruitment were more likely than other women to adopt lower-risk behavior (96.4% vs. 90.8%; adjusted odds ratio, 3.09; 95% confidence interval [CI], 1.27-7.49) and had lower HIV incidence (0.9% vs. 1.8%; adjusted incidence rate ratio, 0.63; 95% CI, 0.32-1.24) during the intersurvey period. Prior exposure to relatives with AIDS was not associated with differences in behavior change. More newly unemployed men as compared with employed men adopted lower-risk behavior (84.2% vs. 76.0%; adjusted odds ratio, 2.13; 95% CI, 0.98-4.59).
  
  
  CONCLUSIONS
  Community-based HIV/AIDS meetings reduced risk-behavior amongst women who attended them, contributing to HIV decline in eastern Zimbabwe.
authors.affiliation: Manicaland HIV/STD Prevention Project, Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
authors.forename: Constance
authors.initials: C
authors.lastname: Nyamukapa
authors.forename: Christina
authors.initials: C
authors.lastname: Schumacher
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.forename: Clemens
authors.initials: C
authors.lastname: Benedikt
authors.forename: Phyllis
authors.initials: P
authors.lastname: Mushati
authors.forename: Catherine
authors.initials: C
authors.lastname: Campbell
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Garnett
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003153:Community Health Services / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D015397:Program Evaluation; D011446:Prospective Studies; D012309:Risk-Taking; D012424:Rural Population; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology