3.1.5 HIV/TPHA prevalence trends in ANC population: Basic Health Services project, Kabarole District, Western Uganda.

The Basic Health Services, Western Uganda (GTZ) project has been responsible for sentinel HIV surveillance in urban and rural ANC populations in Fort Portal and Kaborole District since 1990-91. Both HIV and TPHA prevalence from sentinel ANC populations by age is compared for the periods over time and for the periods 1991/92, 1993-94, and 1996/96, by educational status. The results shared by Dr Kilian (GTZ) are presented below in figures 10-12:

Figure: 10: HIV trends by age among antenatal clinic attendees by residence, Kabaorle district, Uganda, 1991-96.

urban

semi-urban

rural

Figure 11: Trends in HIV and TPHA prevalence (%) in pregnant women age 15-20 attending antenatal clinic sentinel surveillance site in Fort Portal, Uganda. 1991-96.

Figure 12: HIV by age and educational status in ANC pregnant women, Kabaorle, 1991-96.

age 15-20

age 21-45

Decreases in HIV prevalence, TPHA, and active syphilis (not shown, but reported) were apparent over time in the 15-20 old age group. Although a syphilis treatment program in ANC clinic populations is on-going, it is not believed to be associated with the declines beginning in the early 1990s (personal communication Dr A Kilian, GTZ). Stratification of the study population by educational level revealed an inverse relationship between current HIV prevalence in 15-20 year olds and educational level; decrease were even more evident among people with secondary education than those with only primary education.

Behavioural survey data were not available, but these findings when coupled with behavioural survey data, could provide insights into the reasons for the less impressive decline in HIV prevalence in rural areas. Prevalence by age from population based sero-survey data provides reasonable comparability to ANC populations, particularly in younger age groups and in urban areas (data not shown).

These findings further corroborate MOH/ANC sentinel data that indicate that a decline in prevalence in younger age groups (15-20) in urban and semi-urban populations. The differential according to educational status also provides additional support to the premise that behaviour change has been a major determinant in the observed declines in HIV prevalence. It is also consistent with the different prevalence by educational status in the AIC data. The lack of major declines in younger cohorts in rural areas may be indicative of lower out-reach coverage by prevention campaigns and less change in high-risk behaviours.