Sexual partner reductions explain human immunodeficiency virus declines in Uganda: comparative analyses of HIV and behavioural data in Uganda, Kenya, Malawi, and Zambia

Background A better understanding of behavioural factors associated with the interruption of human immunodeficiency virus (HIV) dynamics in Uganda are fundamental for guiding HIV prevention strategies. A comparative analysis of population level HIV surveillance and behavioural data in Uganda and countries with similar epidemic dynamics offers a framework to identify distinctive elements of the Ugandan success. Methods We analysed HIV prevalence among pregnant women attending antenatal surveillance sites between 1990‐1998 in Uganda, Kenya, Zambia, and Malawi, and AIDS behavioural data collected in Uganda (1989, 1995), Kenya (1998), Zambia, and Malawi (1996). Results In Uganda between 1991‐1998, HIV prevalence rates fell 54% overall, with 75% and 57% declines among 15‐19 and 20‐24 age groups in urban areas, respectively. HIV declines were associated with a 60% reduction in multiple sexual partners between 1989‐1995, as well as increased condom use and sexual abstinence. The lack of comparable HIV declines in comparison countries with similar rates of abstinence and condom use, but with multiple sexual partnership rates similar to Uganda in 1989, suggests that partner reduction is paramount in interrupting sexual HIV dynamics. Comparatively, Ugandans were more likely to acknowledge people with AIDS and communicate about HIV through personal networks. Modelling suggests an 80% reduction in incidence among youth early in the 1990s, suggesting a preceding behavioural process during the late 1980s, which reduced HIV risk. Conclusion The distinctive element explaining declines in HIV prevalence in Uganda is sexual partner reduction. The Ugandan response to AIDS involved a primary HIV intervention whose key outcome was risk avoidance through partner reduction. This focus for HIV prevention could prove more effective than other widely advocated strategies in sub-Saharan Africa.