A Surprising Prevention Success: Why Did the HIV Epidemic Decline in Zimbabwe?

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Summary Points

• There is growing recognition that primary prevention, including behavior change, must be central in the fight against HIV/AIDS. The earlier successes in Thailand and Uganda may not be fully relevant to the severely affected countries of southern Africa.
• We conducted an extensive multi-disciplinary synthesis of the available data on the causes of the remarkable HIV decline that has occurred in Zimbabwe (29% estimated adult prevalence in 1997 to 16% in 2007), in the context of severe social, political, and economic disruption.
• The behavioral changes associated with HIV reduction—mainly reductions in extramarital, commercial, and casual sexual relations, and associated reductions in partner concurrency—appear to have been stimulated primarily by increased awareness of AIDS deaths and secondarily by the country's economic deterioration. These changes were probably aided by prevention programs utilizing both mass media and church-based, workplace-based, and other inter-personal communication activities.
• Focusing on partner reduction, in addition to promoting condom use for casual sex and other evidence-based approaches, is crucial for developing more effective prevention programs, especially in regions with generalized HIV epidemics.