Sub-Saharan Africa is experiencing an HIV epidemic with substantial variation throughout and inside of nations around the world. The Joint United Nations Plan on HIV/AIDS (UNAIDS) documented that amid the worst afflicted countries, Ethiopia, South Africa, Zambia and Zimbabwe had diminished new HIV infections by a lot more than twenty five% in between 2001 and 2009. Countrywide HIV prevalence declined in Kenya, stabilized in Uganda, Rwanda and Nigeria. Even so HIV prevalence elevated in Mozambique and remained substantial in Swaziland and Botswana. As nations around the world battle to curb and reverse the affect of the HIV epidemic, understanding the affect of demographic, behavioral and organic determinants of the HIV epidemic remains important to proof based programming and coverage formulation. Evidence from the examination of antenatal clinic surveillance (ANC) and Demographic and Overall health Survey (DHS) knowledge has shown that age, sexual intercourse, educational amount and residence are important differentials for HIV epidemics in Sub-Saharan Africa. Heterosexual transmission remains the primary driver of the HIV epidemic in sub-Saharan Africa. Ladies are disproportionately influenced by the epidemic as a consequence of the biological elements and cultural socio-economic disparities Examination of data in Zambia, confirmed substantial declines in HIV prevalence amid women aged 15â19 many years attending sentinel antenatal clinics, while knowledge from DHS confirmed that HIV prevalence declined in urban women aged 15â29 years and in the 15â24 year group between rural women. A follow-up evaluation by Kayeyi et al, evaluating the 2001/two and 2007 DHS and 1994 to 2008 ANC information concluded that national level development evaluation masks important distinctions in the modify in HIV prevalence by geographic setting and amount of academic attained. Analysis of eight national demography and well being surveys conducted between 2003â2005 in Sub Saharan nations around the world (Kenya, Ghana, Burkina Faso, Cameroon, Tanzania, Lesotho, Malawi, and Uganda) confirmed a good affiliation of prosperity and HIV prevalence. This association was partly defined by other variables such as this kind of as place of residence, education, and by variations in sexual behaviour, this sort of as numerous intercourse associates, condom use, and male circumcision. An prolonged investigation of the two DHS conducted in 2003/4 and 2007/eight in Tanzania confirmed that age at 1st marriage, cohabiting, a number of sexual companions and existence of sexually transmitted infections (STI) have been linked with HIV infection between females. Additional, the evaluation showed that whilst overall HIV prevalence decreased by 14% (seven.9% to 6.8%), this decrease was only substantial amongst city males prevalence did not decline drastically in other socio-demographic, behavioral and organic sub-groupings. This and other analyses spotlight the advantage of disaggregated examination of info. Zimbabwe has 1 of the maximum HIV burdens in Southern Africa with a generalized epidemic in which an believed 860,000 grownups (15â49 many years) living with HIV. Antenatal sentinel surveillance has described a decrease from twenty five.7% in 2002, 21.3% in 2004, and 17.7% in 2006 to16.1% in 2009. Because of the constraints of ANC information in representing the common inhabitants, Zimbabwe carried out its first DHS with HIV screening in the standard population in 2005/06 and a comply with-up in 2010/11. These surveys showed a decrease in HIV prevalence in Zimbabwe from eighteen.1% (95% CI 16.9â19.3) (2005/2006) to fifteen.2% (ninety five% CI fourteen.3â16.1)(2010/2011). ] The national development confirmed a lower in HIV prevalence of fifteen% in guys and sixteen% in females in between the 2005/six and 2010 DHS. Because of the expanding evidence that nationwide tendencies are likely to mask crucial differences, we set out to examine the in gender differentials in the modify in HIV prevalence. This examination was focused to recognize the crucial variables influencing this change in prevalence and so we examined distinctions by geographic spot, chosen demographic, behavioural and biological attributes. Results of such an investigation are helpful in concentrating on interventions. The HIV prevalence and proportions of alter in prevalence are summarized , which displays major versions in gender, throughout the diverse variables. Nationally there was a important decrease in HIV prevalence between males of 15% (p = .011), and similarly ladies knowledgeable a related substantial proportional decline of 16% (p = .008) among the 2005/six and 2010/11 surveys. However, there ended up striking variations inside gender for some variables.
Amongst gentlemen, the change within province ranged from (-46%, p <0.001 Harare) to (+29%, p = 0.223 Bulawayo) and for women the range was (-34%, p = 0.055, Mashonaland Central) to (+8% p = 0.530 Bulawayo). While there was a higher decline in prevalence for men in urban (17%, p = 0.089) compared to rural (13%, p = 0.073) settings, the opposite was true among women with a higher and significant change in rural areas (19%, p = 0.002) and no significant change in urban areas 9% (p = 0.144). Younger women (15â34 years) experienced the higher declines ranging from (-35%, p<0.001, age 20â24 years) to (-18%, p = 0.012 age 30â34 years). The only increase in prevalence were observed among men 15â19 years (+10%, p = 0.679) and 45â49 years (+15%, p = 0.307) and among women 45â49 years (+25%, p = 0.111). The highest decline though not statistically significant was experienced in men (-32%, p = 0.351) and women (-24%, p = 0.277) without any educational background however significant declines were observed in both men (-16%, p = 0.012) and women (-19%, p<0.001) with above secondary education. For sexual risk behaviors there was a high proportional decline among both men (-23%, p<0.001) and women (-20%, p<0.001) who were in union and those who had reported their sexual debut at 16 years and older (men 23% p<0.001 and women (- 21% p<0.001). There were variations in decline of prevalence by number of sexual partners but increases were observed in women with 5 to 9 partners. Significant declines were observed for condom use in men (-33%, p<0.001) and women (-32%, p<0.001) while prevalence increased when condom use was not reported for men (29%, p = 0.03) and women (6%, p = 0.508). In the logistic regression analysis , the decline in HIV prevalence remained statistically significant for both men and women in three of ten provinces, i.e Manicaland, Mashonaland East and Harare and for women only in Mashonaland Central. The change in prevalence in rural and urban location which had been masked in the univariate analysis became significant in the regression analysis. The decline in prevalence among young women (15â29 years) and men in the age range 30-44years remained statistically significant. There were significant declines among men and women regardless of educational level except in men with primary and women with no education. Similarly, there were significant declines irrespective of employment or wealth status with the exception of men in the lowest and second quintiles. Analysis of sexual risk behaviours showed non-significant declines only in men who were not currently in union. Regardless of the number of sexual partners, there was a significant decline in both men and women. Other significant determinants included sexual debut above 16 years and condom use in both men and women. Regardless of reported STI history, there was a decline among men and women, although these were significant among those with previous STI exposure.
