Cover Image
close this bookEmerging Patterns of HIV Incidence in Uganda and other East African Countries (International Center for Migration and Health - ICMH, 1997, 97 pages)
close this folderEpidemics and Behaviours: - A review of changes in Ugandan sexual behaviour in the early 1990s
View the document(introductory text...)
View the documentIntroduction
View the documentCondom use
View the documentSexual debut
View the documentFaithfulness to (regular) partner
View the documentSexual abstinence
View the documentConclusion
View the documentSelected references
View the document(introductory text...)
View the documentEXECUTIVE SUMMARY
View the document1.0 Objective of the Consultation
View the document2.0 Terms of Reference - methods and activities
close this folder3.0 HIV prevalence declines in antenatal sentinel surveillance sites in Uganda
View the document(introductory text...)
close this folder3.1 External validation of apparent declining HIV prevalence in Uganda: Identification and analyses of collateral data.
View the document(introductory text...)
View the document3.1.1 HIV prevalence trends in blood donors: - National Blood Transfusion Services, Nakasero Blood Bank, and Ministry of Health, Kampala, Uganda.
View the document3.1.2 HIV prevalence and incidence trends in Military recruits
View the document3.1.3 HIV prevalence trends in attendees of an AIDS counselling and testing service: - The AIDS Information Centre (AIC)
View the document3.1.4 HIV prevalence trends in Mulago Hospital ANC, Kampala, 1989-96.
View the document3.1.5 HIV/TPHA prevalence trends in ANC population: Basic Health Services project, Kabarole District, Western Uganda.
View the document3.1.6 HIV incidence and prevalence trends in a rural cohort, Masaka district: Medical Research Council (MRC) Programme on AIDS.
View the document3.1.7 HIV prevalence trends in Rakai District: Makerere, Johns Hopkins, and Columbia Universities.
close this folder4.0 Simulation modelling of HIV incidence dynamics in Uganda with validation to Kampala ANC sentinel surveillance.
View the document(introductory text...)
View the document4.1 Basic principles of HIV dynamics: the relationship of HIV incidence, prevalence and mortality illustrated in 3 simulations for Kampala, Uganda.
View the document4.2 HIV prevalence in ANC clinic and by age: Kampala baseline and incidence reduction simulations.
View the document4.3 HIV mortality and demographic impacts: Kampala baseline and incidence reduction simulations.
View the document4.4 HIV incidence modelling simulations for Kampala women and validation to Kampala ANC sentinel surveillance trends.
close this folder5.0 Declines in HIV incidence/prevalence in urban and semi-urban areas of Uganda: - determinants and analyses of data sources.
View the document(introductory text...)
View the document5.1 Determinants of changing HIV incidence and prevalence patterns
View the document5.2 Data sources providing insight on determinants:
close this folder5.3 Data supporting evidence for behavior change: decreasing sexual contacts, decreasing concurrent partnerships/shrinking sexual networks, increase in condom use.
View the document5.3.1 Comparative analyses of the 1989 and 1995 MOH AIDS KABP
View the document5.3.2 Comparative analysis of 1989 and 1995 KABP by urban and rural HIV risk behaviours: possible reasons for urban declines and rural stability in HIV prevalence.
View the document5.3.3 Condom distribution: analyses of SOMARC data and condom availability from 1995 MOH KABP.
View the document5.3.4 Findings from 1995 DHS survey and comparisons to 1995 MOH KABP: future needs.
View the document5.4 Changes in the prevalence of external factors facilitating transmission: improved management STIs
View the document5.5 Increasing mortality, ''natural epidemic dynamics'' or saturation of ''core groups''.
View the document5.6 Measurement error: changing demographic composition of the population as a result of migration; changes in fertility/fecundity of ANC population; laboratory or sampling error.
close this folder6.0 Evidence for a causal association between urban and semi-urban declines in prevalence and behaviour change in Uganda: - External validation of findings and hypothesis testing through comparative analyses of HIV dynamics and risk behaviours in Uganda, Malawi and Zambia.
View the document(introductory text...)
View the document6.1 A comparison of HIV prevalence trends in ANC populations/sentinel sites: Kampala, Uganda; Blantyre, Malawi; and Lusaka, Zambia.
View the document6.2 A comparison of HIV risk behaviour data in urban populations of Uganda, Malawi and Zambia:
View the document6.3 HIV incidence dynamics and demographic impacts: Blantyre, Malawi
close this folder7.0 Population movement and implications for the dynamics of emerging infectious diseases in sub-Saharan Africa: - the social and demographic context.
View the document(introductory text...)
close this folder7.1 Population movement in sub-Saharan Africa and its relationship to HIV
View the document(introductory text...)
View the document7.1.1 An investigation of population movement and its association with differential urban-rural HIV prevalence: - patterns of internal migration as potential geographic vectors for the HIV transmission.
View the document7.1.2 Simulation of population HIV prevalence under three migration patterns: - evidence for the association of rural-urban-rural circulation pattern and a more severe and sustained HIV epidemic.
View the document7.1.3 Military conflict as a magnifier of HIV spread: the ecological association of severely HIV impacted parishes and sites of troop encampments in 1979-80, Rakai District, Uganda.
close this folder8.0 Linkage of HIV incidence and prevalence patterns deduced from surveillance and other data sources and relationship to interventions: - Summary findings and recommendations.
View the document8.1 Summary findings in Uganda and Malawi
View the document8.2 Summary findings: - Population movement and disease dynamics
View the document8.3 Recommendations for USAID
View the document9.0 Recommendations for USAID Mission Uganda
View the document10.0 Annex


· There is now evidence that a major change has occurred in the evolution of HIV incidence in urban areas of Uganda. Between 1992 and 1996 the prevalence of HIV dropped significantly among urban and semi-urban populations, with declines of between 30% and 50% in the case of young pregnant women. The fact that the observed declines in HIV prevalence have been most marked in younger age groups suggests that the trend is still in its infancy, and that further benefits will continue to accrue. The data suggest that a new cohort of HIV-free men and women may be emerging. If this pattern is to be sustained and extended, however, the ingredients underlying it will need to be reinforced and nurtured.

· The emerging picture, for example, constitutes a strong argument for investing in HIV/AIDS prevention strategies based on information, education designed to bring about behavior change. It is indicative of what can be achieved through such strategies and demonstrative of the capacity of young people to absorb and build on relevant education and information. The stable nature of the pandemic in rural areas of Uganda, and it's continuing growth in other countries of sub-Saharan Africa call for greater attention to be paid to these areas, and for the ingredients of the observed successes in Uganda to be adapted to needs of the populations in question. It is also important to recognize that behavior change strategies are in themselves not likely to be sufficient, and that more attention will also need to be paid to improving condom distribution programs, especially in rural and other undeserved areas. The unavailability of condoms was the most frequent impediment to more frequent condom use in Uganda. The role of new STI treatment initiatives also need to be seen as complementing behavioral prevention strategies, and their relative contribution to reducing HIV prevalence in conjunction with HIV counseling and testing, and social marketing of condoms deserves to be evaluated.

· From the perspective of understanding and predicting future trends in HIV trends in Africa, it will be important to meld behavioral and medical research more systematically. Only in this way will it be possible to create an epidemiological surveillance database capable of providing much-needed insights into the dynamics of sexual behavior, HIV population profiles, and the role of prevention interventions. And as part of this, much more needs to be urgently known about how the increasing pace of population up-rooting and movement in Africa is influencing patterns of vulnerability to infectious and social diseases in general, but HIV/AIDS in particular.