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Steep HIV prevalence declines among young people in selected Zambian communities: population-based observations (1995-2003).

Abstract

BACKGROUND

Understanding the epidemiological HIV context is critical in building effective setting-specific preventive strategies. We examined HIV prevalence patterns in selected communities of men and women aged 15-59 years in Zambia.

METHODS

Population-based HIV surveys in 1995 (n = 3158), 1999 (n = 3731) and 2003 (n = 4751) were conducted in selected communities using probability proportional to size stratified random-cluster sampling. Multivariate logistic regression and trend analyses were stratified by residence, sex and age group. Absence, <30% in men and <15% in women in all rounds, was the most important cause of non-response. Saliva was used for HIV testing, and refusal was <10%.

RESULTS

Among rural groups aged 15-24 years, prevalence declined by 59.2% (15.7% to 6.4%, P < 0.001) in females and by 44.6% (5.6% to 3.1%, P < 0.001) in males. In age-group 15-49 years, declines were less than 25%. In the urban groups aged 15-24, prevalence declined by 47% (23.4% to 12.4%, P < 0.001) among females and 57.3% (7.5% to 3.2%, P = 0.001) among males but were 32% and 27% in men and women aged 15-49, respectively. Higher educated young people in 2003 had lower odds of infection than in 1995 in both urban [men: AOR 0.29(95% CI 0.14-0.60); women: AOR 0.38(95% CI 0.19-0.79)] and rural groups [men: AOR 0.16(95% CI 0.11-0.25), women: AOR 0.10(95% CI 0.01-7.34)]. Although higher mobility was associated with increased likelihood of infection in men overall, AOR, 1.71(95% CI 1.34-2.19), prevalence declined in mobile groups also (OR 0.52 95% CI 0.31-0.88). In parallel, urban young people with > or =11 school years were more likely to use condoms during the last casual sex (OR 2.96 95% CI 1.93-4.52) and report less number of casual sexual partners (AOR 0.33 95% CI 0.19-0.56) in the last twelve months than lower educated groups.

CONCLUSION

Steep HIV prevalence declines in young people, suggesting continuing declining incidence, were masked by modest overall declines. The concentration of declines in higher educated groups suggests a plausible association with behavioural change.

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  • Authors+Show Affiliations

    ,

    Department of Community Medicine, School of Medicine, University of Zambia, Lusaka, Zambia. cmi047@student.uib.no

    , , ,

    Source

    BMC public health 6: 2006 Nov 10 pg 279

    MeSH

    Adolescent
    Adult
    Age Distribution
    Educational Status
    Female
    HIV Infections
    Health Behavior
    Health Surveys
    Humans
    Male
    Middle Aged
    Prevalence
    Risk Factors
    Rural Health
    Sex Distribution
    Socioeconomic Factors
    Urban Health
    Zambia

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17096833

    Citation

    Michelo, Charles, et al. "Steep HIV Prevalence Declines Among Young People in Selected Zambian Communities: Population-based Observations (1995-2003)." BMC Public Health, vol. 6, 2006, p. 279.
    Michelo C, Sandøy IF, Dzekedzeke K, et al. Steep HIV prevalence declines among young people in selected Zambian communities: population-based observations (1995-2003). BMC Public Health. 2006;6:279.
    Michelo, C., Sandøy, I. F., Dzekedzeke, K., Siziya, S., & Fylkesnes, K. (2006). Steep HIV prevalence declines among young people in selected Zambian communities: population-based observations (1995-2003). BMC Public Health, 6, p. 279.
    Michelo C, et al. Steep HIV Prevalence Declines Among Young People in Selected Zambian Communities: Population-based Observations (1995-2003). BMC Public Health. 2006 Nov 10;6:279. PubMed PMID: 17096833.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Steep HIV prevalence declines among young people in selected Zambian communities: population-based observations (1995-2003). AU - Michelo,Charles, AU - Sandøy,Ingvild F, AU - Dzekedzeke,Kumbutso, AU - Siziya,Seter, AU - Fylkesnes,Knut, Y1 - 2006/11/10/ PY - 2006/07/27/received PY - 2006/11/10/accepted PY - 2006/11/14/pubmed PY - 2007/5/11/medline PY - 2006/11/14/entrez SP - 279 EP - 279 JF - BMC public health JO - BMC Public Health VL - 6 N2 - BACKGROUND: Understanding the epidemiological HIV context is critical in building effective setting-specific preventive strategies. We examined HIV prevalence patterns in selected communities of men and women aged 15-59 years in Zambia. METHODS: Population-based HIV surveys in 1995 (n = 3158), 1999 (n = 3731) and 2003 (n = 4751) were conducted in selected communities using probability proportional to size stratified random-cluster sampling. Multivariate logistic regression and trend analyses were stratified by residence, sex and age group. Absence, <30% in men and <15% in women in all rounds, was the most important cause of non-response. Saliva was used for HIV testing, and refusal was <10%. RESULTS: Among rural groups aged 15-24 years, prevalence declined by 59.2% (15.7% to 6.4%, P < 0.001) in females and by 44.6% (5.6% to 3.1%, P < 0.001) in males. In age-group 15-49 years, declines were less than 25%. In the urban groups aged 15-24, prevalence declined by 47% (23.4% to 12.4%, P < 0.001) among females and 57.3% (7.5% to 3.2%, P = 0.001) among males but were 32% and 27% in men and women aged 15-49, respectively. Higher educated young people in 2003 had lower odds of infection than in 1995 in both urban [men: AOR 0.29(95% CI 0.14-0.60); women: AOR 0.38(95% CI 0.19-0.79)] and rural groups [men: AOR 0.16(95% CI 0.11-0.25), women: AOR 0.10(95% CI 0.01-7.34)]. Although higher mobility was associated with increased likelihood of infection in men overall, AOR, 1.71(95% CI 1.34-2.19), prevalence declined in mobile groups also (OR 0.52 95% CI 0.31-0.88). In parallel, urban young people with > or =11 school years were more likely to use condoms during the last casual sex (OR 2.96 95% CI 1.93-4.52) and report less number of casual sexual partners (AOR 0.33 95% CI 0.19-0.56) in the last twelve months than lower educated groups. CONCLUSION: Steep HIV prevalence declines in young people, suggesting continuing declining incidence, were masked by modest overall declines. The concentration of declines in higher educated groups suggests a plausible association with behavioural change. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/17096833/Steep_HIV_prevalence_declines_among_young_people_in_selected_Zambian_communities:_population_based_observations__1995_2003__ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-6-279 DB - PRIME DP - Unbound Medicine ER -