Reuters Health
April 30, 2004
HIV Prevalence Rising Rapidly in Much of the UK
By David Douglas

NEW YORK (Reuters Health) Apr 30 - Based on past surveys, UK researchers expect to see a large increase in the number of people with HIV in England, Wales and Northern Ireland. Most of the growth is predicted to be in those infected heterosexually, according to findings published in the April 9th issue of AIDS.

"Although there is some uncertainty in these estimates," senior author Dr. Barry G. Evans told Reuters Health, "they show the rapid rise in people living with HIV in the UK over the last few years and the likely increase in the near future."

Dr. Evans and colleagues at the Health Protection Agency, London, came to these conclusions after examining data from annual surveys covering prevalent HIV infections from 1996 to 2001.

After adjusting for factors including under-reporting, the researchers found that over this period the increase in prevalence of diagnosed HIV in London was 89%. Beyond London, it was 103% and for the country as a whole, with the exclusion of Scotland, it was 94%.

In total, HIV infections due to sex between men were deemed to have increased by 62% and heterosexual transmission was up by 213%, but the increase attributed to other sources including injection drug use was only 3%.

Based on these figures, a binomial model predicted a further overall increase of 56% in diagnosed HIV prevalence between 2001 and 2004. A linear model predicted a 25% increase over the same period.

This projected upsurge, Dr. Evans concluded, "has great implications for those providing treatment and care services and the pressures on clinical colleagues."

AIDS 2004;18:927-932.
 

 

 

The Kaiser Daily HIV/AIDS Report
Friday, April 30, 2004

HIV Prevalence in Uganda Drops 70% Since Early 1990s Because of Public HIV/AIDS Prevention Campaign, Study Says

HIV prevalence in Uganda has dropped 70% since the early 1990s primarily because of a "successful" public HIV/AIDS prevention campaign that encourages avoiding "casual" sexual activity, according to a study published in the April 30 issue of the journal Science, BBC News reports (BBC News, 4/30).
Drs. Rand Stoneburner and Daniel Low-Beer of University of Cambridge in the United Kingdom analyzed population-level HIV and behavioral data from Uganda and neighboring countries -- including Kenya, Malawi and Zambia -- to assess the validity and determinants of declines in HIV prevalence and examine the potential influences of prevention interventions. The researchers found that "important" behavioral changes occurred among the Ugandan population between 1989 and 1995, including an increase in the age of first sexual intercourse, a decrease in indicators of casual or nonregular sexual partners and an increase in condom use with both casual and regular sexual partners, according to the study.
In addition, an "important and perhaps overlooked" measure of behavior change during this time was a 60% reduction in the number of people in both rural and urban areas who reported casual sexual relationships over the previous year, according to the study. The study suggests that a reduction in the number of sexual partners in the general population and a delay in onset of sexual activity among unmarried youth, especially in urban areas and among males, are the "relevant factors in reducing HIV incidence" (Stoneburner/Low-Beer, Science, 4/30).
Although condom use in neighboring countries was just as common as in Uganda, condom use may not be sufficient to cut HIV incidence without a reduction in casual sex as well, according to the study, Reuters Health reports (Reuters Health, 4/29).
Stoneburner and Low-Beer also suggest that communication about HIV/AIDS through social networks and personal contact with HIV-positive people or people who have died of AIDS-related causes also helped to lower HIV prevalence in Uganda.
Shift in 'Strategic Thinking'
The Ugandan government's national HIV/AIDS prevention campaign "clearly communicated the reality of the AIDS epidemic in terms of a rational fear of the risks of casual sex, which drew on and mobilized indigenous responses at the community level," according to the researchers. The government's messages that AIDS, which is also known as "slim" in Uganda, is fatal and that individuals should practice "zero grazing," or monogamy, were clearly communicated, and condoms were a "minor" component of the original strategy, according to Stoneburner and Low-Beer. The researchers say that the "substantial" reductions in Uganda's HIV prevalence -- which are equivalent to results that might be seen with a "highly effective," although as of yet undeveloped, vaccine -- "resulted from public health interventions that triggered a social process of risk avoidance manifested by radical changes in sexual behaviors."
According to the researchers, the behavioral changes resulting from Uganda's prevention messages may not transfer with the same success or be appropriate for other countries. However, in order to successfully replicate the lessons learned from the Uganda model, Stoneburner and Low-Beer conclude that "a shift in strategic thinking on health policy and HIV/AIDS, with greater attention to epidemiological intelligence and communications to mobilize risk avoidance," is needed (Science, 4/30).

Reuters Health
April 29, 2004
Avoidance of Casual Sex Credited With Declining HIV Rates in Uganda
NEW YORK (Reuters Health) Apr 29 - The prevalence of HIV infection in Uganda has dropped 70% since the early 1990s, due in large part to an emphasis on avoidance of risky sexual activities, according to a report published in the April 30th issue of Science. The safe-sex message seems to have been passed primarily through social networks rather than through mass media campaigns.

No other African countries have shown this degree of decline in HIV prevalence, study authors Dr. Rand L. Stoneburner and Dr. Daniel Low-Beer, from Cambridge University in the UK, note. The success seen in Uganda is comparable to a vaccine with 80% effectiveness, they add.

In the study, the authors analyzed population-level data in Uganda and neighboring countries to identify factors associated with a drop in HIV prevalence.

The main reason for the trend seen in Uganda appeared to be a dramatic drop in casual sex. The reduction in HIV prevalence seen since the early 1990s was associated with a 60% reduction in casual sex.

Condom use, which is apparently substantial in other countries, may not be enough to cut HIV rates to the extent seen in Uganda if casual sex is not also reduced, the authors note.

Replicating Uganda's success in controlling the AIDS epidemic "will require changes in global HIV/AIDS intervention policies and their evaluation," the researchers add.

Science 2004;304:714-718.