Death can outdo ABCs of prevention

From Boston, at the Conference on Retroviruses and Opportunistic Infection

The prevalence of HIV has fallen over the past decade in Uganda, but abstinence and monogamy—two elements of a widely advocated prevention strategy—deserve little, if any, credit for the decline in at least one region of the country, a new study suggests.

Of the three directives of the prevention mantra “ABC”—abstain, be faithful, or use condoms—only greater condom use appears to have coincided with a decline in the number of people living with HIV in western Uganda’s Rakai district, according to Maria Wawer of Columbia University.

The investigators reached this conclusion after 10 years of annually polling about 10,000 people, ages 15 to 49, on their number of sex partners and condom use.

Increased death rates, rather than any part of the ABC strategy, may explain the drop since 1994 in people living with HIV infections in Rakai. The incidence of infection declined from 20 to 13 percent in women and from 15 to 9 percent in men during that period. The number of deaths from HIV now exceeds new infections, which have held steady, by a margin of almost 2 to 1 in recent years, Wawer and her U.S. and Ugandan colleagues report.

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