Santelli, J. S., Edelstein, Z. R., Wei, Y., et al. AIDS (January 2015), DOI: 10.1097/QAD.0000000000000533.
This study examined how changes in local conditions and risk factors affected HIV acquisition among youth (adolescents and young adults) in Rakai, Uganda. Using data from 22,164 participants collected from nine Rakai Community Cohort Study survey rounds between March 1999 and June 2011, the authors compared trends in HIV incidence with trends in previously identified HIV risk factors, social factors, and HIV programs. Overall, the study found significant declines in sexual experience, number of multiple partners, and sexual concurrency among adolescents and young adults. Among adolescent women, HIV incidence decreased by 86 percent between 1999 and 2011; prevalence among all young women declined from 9.1 percent to 6.1 percent. The authors attributed changes in HIV incidence and risk behaviors to several social and environmental factors. These included increases in school enrollment (from 26 percent to 58.9 percent in adolescent women and from 42.6 percent to 65.9 percent in adolescent men); fewer adolescent marriages (from 46.4 percent to 23.7 percent among adolescent women); availability of antiretrovirals; and increased access to medical male circumcision. However, much of the decline in HIV incidence among adolescent women (71 percent) was attributable to reduced sexual experience, which in turn was mainly due to increased school enrollment. The authors called for efforts to increase school attendance as an important component of combination prevention in Uganda.