Suchergebnisse

IntroductionIntensified poverty arising from economic decline and crisis may have contributed to reductions in HIV prevalence in Zimbabwe.ObjectivesTo assess the impact of the economic decline on household wealth and prevalent HIV infection using data from a population‐based open cohort.MethodsHousehold wealth was estimated using data from a prospective household census in Manicaland Province (1998 to 2011). Temporal trends in summed asset ownership indices for sellable, non‐sellable and all assets combined were compared for households in four socio‐economic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). Multivariate logistic random‐effects models were used to measure differences in individual‐level associations between prevalent HIV infection and place of residence, absolute wealth group and occupation.ResultsHousehold mean asset scores remained similar at around 0.37 (on a scale of 0 to 1) up to 2007 but decreased to below 0.35 thereafter. Sellable assets fell substantially from 2004 while non‐sellable assets continued increasing until 2008. Small‐town households had the highest wealth scores but the gap to other locations decreased over time, especially for sellable assets. Concurrently, adult HIV prevalence fell from 22.3 to 14.3%. HIV prevalence was highest in better‐off locations (small towns) but differed little by household wealth or occupation. Initially, HIV prevalence was elevated in women from poorer households and lower in men in professional occupations. However, most recently (2009 to 2011), men and women in the poorest households had lower HIV prevalence and men in professional occupations had similar prevalence to unemployed men.ConclusionsThe economic crisis drove more households into extreme poverty. However, HIV prevalence fell in all socio‐economic locations and sub‐groups, and there was limited evidence that increased poverty contributed to HIV prevalence decline.

Social capital—especially through its "network" dimension (high levels of participation in local community groups)—is thought to be an important determinant of health in many contexts. We investigate its effect on HIV prevention, using prospective data from a general population cohort in eastern Zimbabwe spanning a period of extensive behavior change (1998–2003). Almost half of the initially uninfected women interviewed were members of at least one community group. In an analysis of 88 communities, individuals with higher levels of community group participation had lower incidence of new HIV infections and more of them had adopted safer behaviors, although these effects were largely accounted for by differences in socio‐demographic composition. Individual women in community groups had lower HIV incidence and more extensive behavior change, even after controlling for confounding factors. Community group membership was not associated with lower HIV incidence in men, possibly refecting a propensity among men to participate in groups that allow them to develop and demonstrate their masculine identities—often at the expense of their health. Support for women's community groups could be an effective HIV prevention strategy in countries with large‐scale HIV epidemics.

Beginning sexual activity introduces an individual to the risk of acquiring sexually transmitted infections. In this study, cross‐sectional behavioral data linked to HIV‐status from 4,138 men and 4,948 women interviewed in rural Zimbabwe are analyzed to investigate the distribution and consequences of early first sex. We find that age at first sex (at a median age of 19 years for males and 18 years for females) has declined among males over the past 30 years but increased recently among females. Those in unskilled employment, those not associated with a church, and women without a primary education begin to have sex earlier than others. Early sexual debut before marriage precedes a lifetime of greater sexual activity but with more consistent condom use. Women who begin to have sex earlier than others of their age are more likely to be infected with HIV. This finding can be explained by their having a greater lifetime number of sexual partners than those whose first sexual experience occurs later.