Zimbabwe: An HIV Prevention Success Story

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HARARE, Zimbabwe —HIV prevalence in Zimbabwe has declined remarkably in recent years, dropping from 26 per cent to 14 per cent  between 1997 and 2009. In a recent edition of the journal PLoS Medicine, researchers explored the reasons for this decline and examined what lessons can be learned and replicated. In a recent edition of the journal PLoS Medicine, researchers explored the reasons for this decline and examined what lessons can be learned and replicated.

Sponsored by UNFPA, UNAIDS and the Zimbabwean Ministry of Health and Child Welfare, the study pinpointed several key factors in Zimbabwe’s success. These include changes in sexual behaviour, personal experiences related to the high AIDS mortality in the country and correct information about HIV transmission.

“The behaviour changes associated with the HIV decline appear to be largely the result of people increasingly talking about HIV and its link to risky sexual behaviour,” said Clemens Benedikt, HIV prevention manager in the UNFPA office in Zimbabwe and one of the authors of the report.

The most significant cause of the decline was seen to be the reduction in multiple sexual partnerships, with a 30 per cent fall in men reporting extra-marital relationships. This can be partly attributed to the success of HIV prevention programmes, both mass media and those based on inter-personal communication through the church, work-place, friends and family. Such programmes stressed the protective effect of having fewer partners and promoted condom use during casual sex.

Significant shifts in social norms

According to the study, there have been a number of significant shifts in sexual norms. For example, in previous years, men gathering in beer halls and bottle stores tended to be surrounded by women, some of whom were sex workers. Now, it is more typical for such places to be men only.

The entrenched economic crisis has also played a role. Men reported having less money to spend on sustaining multiple partnerships as well as using the services of sex workers. However, this is noted as a secondary factor given that the most severe effects of the financial crisis were felt after 2002 when most of the decline in HIV incidence had already happened.

Another apparent spur in behaviour change was high AIDS mortality. AIDS-related deaths increased significantly during the mid- to late-nineties and stabilized after 2000. Many women and men in the authors’ focus groups reported that knowing people who had died as a result of AIDS was a large motivating factor to modify their own sexual behaviour. According to the study, the policy of home-based care for people living with HIV adopted in Zimbabwe may have also contributed to this phenomenon as people were brought face-to-face with the reality of AIDS in their own homes.

People making informed decisions

“Zimbabwe provides a clear example of the profoundly positive results that behaviour change can bring about in an effective AIDS response,” said Bruce Campbell, co-author of the report and currently UNFPA Representative in Viet Nam. “People can and do look at their individual and collective circumstances and make informed decisions about how to protect themselves and others, especially in an environment where information and education interventions highlight the link between sexual risk behaviour and HIV.”

The authors also argue that Zimbabwe's experience highlights the importance of prevention in an effective and sustained response to HIV, despite the growing availability of antiretroviral drugs. According to UNAIDS, globally there are still two new HIV infections for every one person starting treatment and prevention efforts make up only around 20 per cent of AIDS-related spending in low- and middle-income countries.

Similar to the Zimbabwean example, HIV prevention success has been achieved in a number of countries in sub-Saharan Africa. According to the latest UNAIDS report on the global epidemic, some 22 countries have reduced the rate of new infections by more than 25 per cent between 2001 and 2009. These include several other countries with the region’s highest prevalence, including South Africa and Zambia. And in many cases, it is young people who are leading the ‘prevention revolution ‘and changing their behaviour by deciding to delay sex, having fewer partners and using condoms.