Change in sexual behaviour and decline in HIV infection among young pregnant women in urban Uganda

Abstract

Objective: To describe sexual behaviour that may partly explain a decline in HIV seroprevalence in pregnant women in urban settings in Uganda, East Africa.

Settings: Two major urban districts in Uganda.

Methods: Repeated population-based behavioural surveys in 1989 and 1995, and repeated HIV serological surveys in consecutive pregnant women attending antenatal clinics from 1989 to 1995.

Results: During the study period, a 2-year delay in the onset of sexual intercourse among youths aged 15-24 years and a 9% decrease in casual sex in the past year in male youths aged 15-24 years were reported. Men and women reported a 40% and 30% increase in experience of condom use, respectively. In the same study area, over the same period, there was an overall 40% decline in the rates of HIV seroprevalence among pregnant women attending antenatal clinics. It can be hypothesized that the observed declining trends in HIV correspond to a change in sexual behaviour and condom use, especially among youths.

Conclusions: This is the first report of a change over a period of 6 years in male and female sexual behaviour, assessed at the population level, that may partly explain the observed decline in HIV seroprevalence in young pregnant women in urban Uganda. This result should encourage AIDS control programmes to pursue their prevention activities.

PIP: Repeated serologic surveys conducted in consecutive pregnant women attending antenatal clinics in three urban sites--Nsambya, Rubaga, and Jinja--in Uganda in 1989-95 documented substantial declines (27-47%) in HIV prevalence. Multiple population-based behavioral surveys conducted in urban Uganda in 1989 and 1995 suggest this decline in HIV prevalence among pregnant women may be a result of three key changes in sexual practices: a 2-year delay in the onset of sexual intercourse among young people 15-24 years of age, a 9% decrease in the practice of casual sex among males 15-24 years old, and increases in the experience of condom use of 40% among males and 30% among females. Proportions of male and female youth reporting they had never had sexual intercourse increased from 31% and 26%, respectively, in 1989 to 56% and 46%, respectively, in 1995. The prevalence among men in the past year of sex outside relationships that had lasted more than 12 months declined from 22.6% in 1989 to 18.1% in 1995. The proportion of men and women who reported exchanging sex for money dropped by almost 50%. Finally, the proportion of sexually active respondents who reported ever-use of condoms increased from 15.4% to 55.2% among men and from 5.8% to 38.7% among women from 1989 to 1995. In two of the three urban areas, the decline in HIV prevalence was sharpest among pregnant women in the youngest age group (15-24 years), suggesting a true decrease. The finding of substantial changes in the sexual behavior of urban Ugandan youth confirms the efficacy of AIDS prevention and control interventions.