Seven-year trends in HIV-1 infection rates, and changes in sexual behaviour, among adults in rural Uganda

The objective was to assess trends in HIV-1 infection rates and changes in sexual behavior over 7 years in rural Uganda. An adult cohort was followed through 8 medical-serological annual surveys since 1989-90. All consenting participants gave a blood sample and were interviewed on sexual behavior. On average 65% of residents gave a blood sample at each round. Overall HIV-1 prevalence declined from 8.2% at round 1 to 6.9% at round 8 (P = 0.008). Decline was most evident among men aged 20-24 years (11.7-3.6%; P 0.2). Age-standardized death rates for HIV-negative individuals were 6.5/1000 PY in 1990 and 8.2/1000 PY in 1996; corresponding rates for HIV-positive individuals were 129.7 and 102.7/1000 PY respectively. There were no significant trends in age-adjusted death rates during follow-up for either group. There was evidence of behavior change towards increase in condom use in males and females marriage at later age for girls later sexual debut for boys and a fall in fertility especially among unmarried teenagers. This is the first general population cohort study showing overall long-term significant reduction in HIV prevalence and parallel evidence of sexual behavior change. There are however no significant reductions in either HIV incidence or mortality. (authors)