Changing behaviour and reduction of HIV prevalence in Tanzania.

In the Bukoba urban area of Kagera, Tanzania, the prevalence of age-adjusted HIV-1 has slowly fallen from 24.2% in 1987 to 18.2% in 1993 and then to 13.3% in 1996. This follow-up of the Kagera AIDS Research Project used in-depth interviews, focus group discussions, field observation and ethnographic assessments to examine the underlying determinants of this gradual decrease. The findings show an increase in condom use, with many participants indicating an acceptability of condoms as the norm, more fidelity to one sexual partner, an increase in abstinence and uptake of voluntary HIV testing. At the same time sexual networking, opportunities for excessive alcohol consumption and traditional practices such as polygamy and widow inheritance appear to be declining. It is encouraging to see such changes, even though it is difficult to know whether it is the severity of the epidemic or the many major interventions such health education, the distribution of condoms, AIDS education in schools and VCT programmes, which have led to these changes. It is nevertheless important to recognise the need for continued intervention and monitoring. (1)

(1.) Lugalla J, Emmelin M, Mutembei A, et al. Social, cultural and sexual behavioural determinants of observed decline in HIV infection trends: lessons from the Kagera Region, Tanzania. Social Science and Medicine 2004;59:185-98.