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close this bookEmerging Patterns of HIV Incidence in Uganda and other East African Countries (International Center for Migration and Health, 1997, 97 p.)
View the document(introduction...)
View the documentEXECUTIVE SUMMARY
View the document1.0 Objective of the Consultation
View the document2.0 Terms of Reference - methods and activities
Open this folder and view contents3.0 HIV prevalence declines in antenatal sentinel surveillance sites in Uganda
Open this folder and view contents4.0 Simulation modelling of HIV incidence dynamics in Uganda with validation to Kampala ANC sentinel surveillance.
Open this folder and view contents5.0 Declines in HIV incidence/prevalence in urban and semi-urban areas of Uganda: - determinants and analyses of data sources.
Open this folder and view contents6.0 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.
Open this folder and view contents7.0 Population movement and implications for the dynamics of emerging infectious diseases in sub-Saharan Africa: - the social and demographic context.
Open this folder and view contents8.0 Linkage of HIV incidence and prevalence patterns deduced from surveillance and other data sources and relationship to interventions: - Summary findings and recommendations.
View the 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.