Reduction in HIV-1 incidence among rural Ugandans gives hope to other African countries

July 04, 2002

A study in this week's issue of THE LANCET highlights a reduction in both HIV-1 incidence (the number of new cases) and prevalence (the number of cases in the population) from the beginning to the end of the past decade among a rural Ugandan population. Authors of the study conclude that the results could offer hope for other sub-Saharan countries where the HIV-1 infection rate remains high.

HIV-1 incidence rates in a community are a more accurate measure of epidemic trends than prevalence rates from surveillance, as they are not influenced by death rates, migration, or survey coverage. In Uganda, there have been encouraging reports of reductions in HIV-1 prevalence, but no reliable data exist for trends in incidence.

James Whitworth from the Medical Research Council Programme on AIDS in Uganda, and colleagues surveyed the adult population of 15 neighbouring villages for HIV-1 infection using annual censuses, questionnaires, and serological surveys.

HIV-1 incidence fell from 8.0 to 5.2 per 1000 person years at risk between 1990 and 1999. Incidence was 37% lower in the second half than the first half of the decade. HIV-1 prevalence fell significantly between the first and tenth annual survey rounds, especially among men aged 20-24 years (6.5% to 2.2%) and 25-29 years (15.2% to 10.9%). There were also substantial reductions in HIV-1 prevalence rates among women aged 13-19 years (2.8% to 0.9%) and 20-24 years (19.3% to 10.1%)

James Whitworth comments: "More than half a million people have died from AIDS in Uganda since the start of the epidemic, which still rages at unacceptably high rates throughout sub-Saharan Africa. However, our findings strengthen evidence from earlier studies of declines in HIV-1 prevalence and increases in risk-lowering sexual behaviour, and gives hope that AIDS control programmes can control the AIDS epidemic with messages about changes in behaviour."

In an accompanying Commentary (p 3), Andrew Grulich from National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia, concludes: "It is now clear that there has been a measure of success, as indicated by declining HIV risk behaviours, prevalence, and probably incidence, in a few sub-Saharan countries. This should be seen as encouraging evidence that well-supported social and behavioural prevention works, and that sentinel surveillance, carefully interpreted, can provide information of the success or otherwise of intervention programmes. Nevertheless, ongoing high rates of HIV transmission across sub-Saharan Africa, even in the more successful countries such as Uganda, and in high-risk populations elsewhere, means that simple, affordable, and effective biomedical means of HIV prevention are desperately needed."

In a Viewpoint article (p 78), Justin Parkhurst from the London School of Hygiene and Tropical Medicine, UK, acknowledges the success of Uganda in slowing the prevalence of HIV/AIDS, but cautions against the use of exaggerated claims and the oversimplification of the Ugandan model. He concludes: "The use of selective evidence as the basis for policy recommendations can be misleading and counterproductive. Countries with HIV-1 prevalence rates of more than 30% (such as some in Southern Africa) would be wrong to assume that by simply copying a few obvious Ugandan government interventions, they can expect to see a two-thirds reduction in their HIV-1 prevalence rate. Although Uganda has indeed done much in its struggle against HIV/AIDS, and the Ugandan experience can provide valuable information to assist other nations in their prevention efforts, inappropriate recommendations based on poor interpretation of evidence must not be used as the basis for policy."
-end-
Contact: Professor James AG Whitworth, Medical Research Programme on AIDS, Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda; T) +256 41 320272; F) +256 41 321137; E) mrc@starcom.co.ug

Dr Andrew Grulich, National Centre in HIV Epidemiology and Clinical Research, 2nd Floor, 376 Victoria Street, Sydney NSW 2010, Australia; T) +61 2 9332 4648; F) +61 2 9332 1837; E) agrulich@nchecr.unsw.edu.au

Justin O Parkhurst, Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK; T) +44 (0)20 7927 2929; F) +44 (0)20 7637 5391; E) justin.parkhurst@lshtm.ac.uk

Lancet

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.