Fylkesnes K, Musonda R M, Sichone M, Ndhlovu Z, Tembo F, Monze M
Institute of Community Medicine, Faculty of Medicine, University of Tromsø, Norway.
AIDS. 2001 May 4;15(7):907-16. doi: 10.1097/00002030-200105040-00011.
To examine trends in HIV prevalence and behaviours in Zambia during the 1990s.
The core Zambian system for epidemiological surveillance and research has two major components: (i) HIV sentinel surveillance at selected antenatal clinics (ANC) in all provinces; and (ii) population-based HIV surveys in selected sentinel populations (1996 and 1999). The former was refined in 1994 to improve the monitoring of prevalence trends, whereas the latter was designed to validate ANC-based data, to study change in prevalence and behaviour concomitantly and to assess demographic impacts.
The ANC-based data showed a dominant trend of significant declines in HIV prevalence in the 15--19 years age-group, and for urban sites also in age-group 20--24 years and overall when rates were adjusted for over-representation of women with low education. In the general population prevalence declined significantly in urban women aged 15--29 years whereas it showed a tendency to decline among rural women aged 15-24 years. Prominent decline in prevalence was associated with higher education, stable or rising prevalence with low education. There was evidence in urban populations of increased condom use, decline in multiple sexual partners and, among younger women, delayed age at first birth.
The results suggested a dominant declining trend in HIV prevalence that corresponds to declines in incidence since the early 1990s attributable to behavioural changes. Efforts to sustain the ongoing process of change in the well-educated segments of the population should not be undervalued, but the modest change in behaviour identified among the most deprived groups represents the major preventive challenge.
研究20世纪90年代赞比亚艾滋病病毒（HIV）流行趋势及相关行为。
赞比亚流行病学监测与研究核心系统有两个主要组成部分：（i）在所有省份选定的产前诊所（ANC）进行HIV哨点监测；（ii）对选定哨点人群进行基于人群的HIV调查（1996年和1999年）。前者在1994年进行了改进，以加强对流行趋势的监测，而后者旨在验证基于ANC的数据，同时研究流行率和行为的变化，并评估人口统计学影响。
基于ANC的数据显示，15 - 19岁年龄组HIV流行率呈显著下降的主导趋势，城市地区20 - 24岁年龄组以及在对低教育程度女性比例过高进行调整后的总体流行率也呈下降趋势。在一般人群中，15 - 29岁城市女性的流行率显著下降，而15 - 24岁农村女性的流行率呈下降趋势。流行率的显著下降与较高教育程度相关，低教育程度者的流行率则稳定或上升。在城市人群中有证据表明避孕套使用增加、多个性伴侣减少，并且在年轻女性中首次生育年龄推迟。
结果表明，自20世纪90年代初以来，由于行为改变，HIV流行率呈主导下降趋势，这与发病率下降相对应。不应低估为维持受过良好教育人群中正在进行的变化过程所做的努力，但在最贫困群体中发现的行为适度变化才是主要的预防挑战。
