AFRICA: Prevention efforts and infection patterns mismatched

Photo: UNDP Angola

Few prevention programmes are evidence-based

JOHANNESBURG, 27 May 2009 (PlusNews) - In at least five African countries, scarce resources are being spent on national HIV prevention campaigns that do not reach the people most at risk of infection, new research has found.

Between 2007 and 2008, UNAIDS and the World Bank partnered with the national AIDS authorities of Kenya, Lesotho, Swaziland, Uganda and Mozambique to find out how and where most HIV infections were occurring in each country, and whether existing prevention efforts and expenditure matched these findings.

The recently released reports reveal that few prevention programmes are based on existing evidence of what drives HIV/AIDS epidemics in the five countries surveyed.

In Lesotho, where nearly one in four are living with HIV, an analysis of national prevalence and behavioural data found that most new infections were occurring because people had more than one partner at a time, both before and during marriage. But Lesotho has no prevention strategies to address the problem of concurrent partnerships, or target couples who are married or in long-term relationships.

An evaluation of Mozambique's prevention response found that an estimated 19 percent of new HIV infections resulted from sex work, 3 percent from injecting drug use, and 5 percent from men who have sex with men (MSM), yet there are very few programmes targeting sex workers, and none aimed at drug users and MSM.

The research also found that spending on HIV prevention was often simply too low: Lesotho spent just 13 percent of its national AIDS budget on prevention, whereas Uganda spent 34 percent, despite having an HIV infection rate of only 5.4 percent.

Debrework Zewdie, director of the World Bank's Global HIV/AIDS Unit, noted that the current global economic downturn made it more important than ever to get the most impact out of investments in HIV prevention. "These syntheses use the growing amounts of data and information available to better understand each country's epidemic and response, and identify how prevention might be more effective."

The reports made recommendations on how the countries could move towards more evidence-based prevention strategies to make more efficient use of limited resources.

Lesotho was advised to revise the content of its prevention messages to address multiple concurrent partnerships and integrate partner reduction into all future policies. One of the recommendations to Mozambique was that condom promotion programmes be focused on high-risk groups such as sex workers.

The five-country project also aimed to build capacity to enable these nations to undertake similar studies in future, as part of their ongoing efforts to evaluate and plan HIV responses.

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See also: GLOBAL: Tailor prevention programmes, says UNAIDS