Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Int J Epidemiol. 2010 Oct;39(5):1311-23. doi: 10.1093/ije/dyq055. Epub 2010 Apr 20.
Recent data from antenatal clinic (ANC) surveillance and general population surveys suggest substantial declines in human immunodeficiency virus (HIV) prevalence in Zimbabwe. We assessed the contributions of rising mortality, falling HIV incidence and sexual behaviour change to the decline in HIV prevalence.
Comprehensive review and secondary analysis of national and local sources on trends in HIV prevalence, HIV incidence, mortality and sexual behaviour covering the period 1985-2007.
HIV prevalence fell in Zimbabwe over the past decade (national estimates: from 29.3% in 1997 to 15.6% in 2007). National census and survey estimates, vital registration data from Harare and Bulawayo, and prospective local population survey data from eastern Zimbabwe showed substantial rises in mortality during the 1990s levelling off after 2000. Direct estimates of HIV incidence in male factory workers and women attending pre- and post-natal clinics, trends in HIV prevalence in 15-24-year-olds, and back-calculation estimates based on the vital registration data from Harare indicated that HIV incidence may have peaked in the early 1990s and fallen during the 1990s. Household survey data showed reductions in numbers reporting casual partners from the late 1990s and high condom use in non-regular partnerships between 1998 and 2007.
These findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behaviour in a southern African country. However, in 2007, one in every seven adults in Zimbabwe was still infected with a life-threatening virus and mortality rates remained at crisis level.
最近的产前门诊（ANC）监测和一般人群调查数据表明，津巴布韦的人类免疫缺陷病毒（HIV）流行率大幅下降。我们评估了死亡率上升、HIV 发病率下降和性行为变化对 HIV 流行率下降的贡献。
综合审查和对 1985 年至 2007 年期间 HIV 流行率、HIV 发病率、死亡率和性行为趋势的国家和地方来源的二次分析。
在过去十年中，津巴布韦的 HIV 流行率下降（国家估计：从 1997 年的 29.3%降至 2007 年的 15.6%）。全国人口普查和调查估计数、哈拉雷和布拉瓦约的生命登记数据以及津巴布韦东部的前瞻性当地人口调查数据表明，90 年代死亡率大幅上升，2000 年后趋于平稳。男性工厂工人和产前及产后诊所就诊妇女的 HIV 发病率直接估计数、15-24 岁人群中 HIV 流行率的趋势以及基于哈拉雷生命登记数据的回溯估计数表明，HIV 发病率可能在 90 年代初达到峰值，并在 90 年代下降。家庭调查数据显示，从 90 年代末开始，报告偶然性伴侣的人数减少，1998 年至 2007 年期间非固定性伴侣中的避孕套使用率很高。
这些发现首次提供了在南部非洲国家中，性行为变化加速 HIV 下降的令人信服的证据。然而，2007 年，津巴布韦每七个成年人中仍有一人感染危及生命的病毒，死亡率仍处于危机水平。
