Fall in Zimbabwe's National HIV/AIDs Prevalence

UNCLAS SECTION 01 OF 02 HARARE 001611

SIPDIS

STATE FOR OES DAS, AF/FO AF/S
USAID/W FOR KENT HILL, GH/AA; ROXANA ROGERS, GH/OA; HOPE
SUKIN, AFR/SD; CARL HAWKINS, GH/PRH/CLM; CONSTANCE CARRINO,
GH/HIV-AIDS; RANDALL TOBIAS, S/GAC; MARJORIE COPSON, AFR/SA
HHS FOR STEIGER
HHS/CDC FOR JGERBERDING, SBLOUNT,EMCCRAY, KFENTON, DBRIX,
RSIMONDS

E.O. 12958: N/A
TAGS: KHIV TSPL OSCI TBIO KSCA US ZI HIV AIDS
SUBJECT: Fall in Zimbabwe's National HIV/AIDs Prevalence
Estimate

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Summary
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1. The "Zimbabwe National HIV/AIDS Estimates 2005" will be
officially released November 30 2005. The study's key
finding is that the estimate of HIV/AIDS prevalence in
adults (aged 15 to 49 years) was 20.1% in 2005,
substantially lower than the 2003 estimate of 24.6%. The
new figure represents a true decline in Zimbabwe's HIV
prevalence rate, the first such national decline in a Sub-
Saharan African country since Uganda in the mid-1990s.
Review of other data suggest that behavioral changes appear
to be at least part of the answer. While the estimated
adult prevalence of HIV/AIDS is decreasing, it still remains
alarmingly high and intensive external support from the U.S.
and other donors will continue to be needed. End Summary.

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National Estimates Show Fall in Prevalence Rate
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2. Zimbabwe National HIV/AIDS Estimates 2005 will be
officially released by the Ministry of Health and Child
Welfare (MOHCW) November 30 2005. A preliminary report will
also be distributed, with dissemination of the full report
expected by late February/early March 2005. The study
provides estimates of the prevalence rate, the number of
persons living with HIV/AIDS, the number of HIV/AIDS
orphans, the number of new cases of HIV and AIDS, and the
number of AIDS-related deaths.


3. The study's key finding is that the estimated HIV/AIDS
prevalence in adults (age 15 to 49 years) in Zimbabwe was
20.1% in 2005, with a range from 17.0 to 23.5%. The 2003
study reported an estimated adult HIV/AIDS prevalence in
Zimbabwe of 24.6%. This reflects a true decline in the
proportion of Zimbabweans with HIV/AIDS and is supported by
data from the 2000-2004 Antenatal Clinic Surveys and the
ZVITAMBO clinical trial. This represents the first such
decline in the prevalence rate of a sub-Saharan African
country since Uganda in the mid-1990s.


4. Other estimates included in the report were as follows:
an estimated 1,391,397 Zimbabweans age 15-49 years were
living with HIV/AIDS in 2005, of whom 780,000 were women; an
estimated 1,050,000 HIV/AIDS orphans (age 0 to 14 years)
were living in Zimbabwe at the end of 2005; an estimated
131,370 new HIV infections and 134,990 new AIDS cases
occurred among adults age 15 to 49 years in 2005; an
estimated 26,610 new HIV infections and 29,4670 new AIDS
cases occurred among children age 0 to 14 years in 2005.
Finally, the number of AIDS-related deaths during 2005 was
estimated to be 139,950 among adults and 29,150 among
children.

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Background on the Study and U.S. Role
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5. "Zimbabwe National HIV/AIDS Estimates 2005" was locally-
produced in Zimbabwe, by a working group including MOHCW,
Centers for Disease Control and Prevention (CDC)-Zimbabwe,
the University of Zimbabwe, the Biomedical Research and
Training Institute/Imperial College of London, the World
Health Organization (WHO) and UNAIDS. Data from HIV
surveillance at sentinel antenatal clinics was used to
produce HIV prevalence curves using the Estimates and
Projection Package (EPP) software. The HIV/AIDS estimates
were generated using the software package Spectrum.
Zimbabwe will continue to conduct antenatal clinic
surveillance at the same antenatal clinic sites as in
previous years in an effort to obtain the most accurate
trends and estimates possible, and will continue to examine
the antenatal clinic data and other data sources such as the
nation-wide population-based Zimbabwe Young Adult Survey and
the Zimbabwe Demographic Health Survey Plus to validate and
interpret the estimates.


6. CDC-Zimbabwe has provided intensive technical assistance
to MOHCW in conducting HIV surveillance at sentinel
antenatal clinics since 2000, in analyzing this data to form
the basis for the new estimates, and in coordinating working
group efforts to generate the estimates and produce the
final estimates report. CDC-Zimbabwe and CDC-Atlanta also
provided technical expertise in methodology and training in
analytic software packages. CDC-Zimbabwe financial and
technical investments in developing the MOHCW informatics
infrastructure and the University of Zimbabwe Informatics
Training Unit contributed greatly to this process, and
additional financial support was provided for supplemental
trainings and printing/publication of the report for
widespread dissemination.

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Behavioral Changes Appear Key
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7. The estimates reflect the trends in HIV prevalence, but
not the reasons the trends are occurring. Testing of stored
samples from 2000-2004 antenatal surveys and 2001 and 2005
population-based surveys for HIV incidence (new infections)
later this year will provide further insights into the
pattern of recent declines. Review of other existing
epidemiological data by MOHCW, the Imperial College of
London, UNAIDS, and CDC-Zimbabwe suggests that mortality
from HIV/AIDS has stabilized and that behavior change
(increased condom use, delay in first sex by young women)
starting in the late 1990s is at least partially responsible
for the decline. The results of the second population-based
survey including behavioral indicators and HIV biomarkers
are expected in 2006, which will allow comparisons of
behaviors in 2001 and 2006 and hopefully confirm the key
role of behavior change in the declining prevalence rate.

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Need For Continued Assistance
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8. The 2005 estimates will be used to monitor Zimbabwe's
progress towards the United Nations General Assembly Special
Session on HIV/AIDS (UNGASS) and the Millennium Development
goals. They were shared with UNAIDS and WHO for inclusion
in the "Report on the Global HIV/AIDS Epidemic 2005," which
was released on November 21 2005. The data in the report
will also be used nationally and locally to assist in
planning for prevention and treatment services and to raise
awareness of the differences in HIV/AIDS prevalence, new HIV
infections, new AIDS cases, and AIDS deaths by gender and in
HIV/AIDS prevalence by area of residence. The MOHCW plans
to use the Zimbabwe Demographic Health Survey Plus data to
confirm the prevalence rate.


9. Despite the good news contained in Zimbabwe's second
nationally produced study of HIV/AIDS estimates, the scale
of the pandemic in Zimbabwe is still enormous. Over 1.6
million people and 20.1% of the adult population are living
with HIV/AIDS in Zimbabwe, alarmingly high figures.
Additional interventions for HIV/AIDS prevention and
treatment are greatly needed to minimize the devastating
impact of this disease on Zimbabweans. We are optimistic
that continued USG assistance to HIV/AID programming in
Zimbabwe can help ensure that this declining trend is
maintained.

Schultz