Sexual Behavior, HIV and Fertility Trends: A Comparative Analysis of Six Countries: Phase I of the ABC Study
Bessinger, R., Akwara, P., & Halperin, D. USAID-funded MEASURE Evaluation Project (2003).
Data from Demographic and Health Surveys (DHS) were used to compare abstinence, being faithful, and condom use (ABC) behaviors in three countries where HIV prevalence declined during the 1990s: Uganda, Zambia, and Thailand, with three countries where HIV prevalence did not decline in the 1990s: Cameroon, Kenya, and Zimbabwe. In countries with declines in HIV prevalence, there were increases in all ABC behaviors. The same pattern of behavior change was not evident in the three countries that did not experience declines in HIV prevalence; instead, condom use was observed to increase, though little increase in abstinence or partner reduction was reported. In Uganda, the country with the earliest and greatest reduction in HIV prevalence, declines in non-regular and multiple sexual partnerships were greatest between the late 1980s and the mid 1990s, when the rate of new infections (HIV incidence) most likely began to drop. Throughout this decade in Uganda, levels of premarital sex also declined, along with an increase in the average age at sexual debut. Increases in condom use with non-regular partners occurred throughout the 1990s, although levels of condom use were not substantial until the middle of the decade. While the trends in ABC behaviors within these countries are consistent with trends in HIV prevalence, they were not sufficient to fully explain differences in HIV prevalence between countries.