Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe.

Objective: Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake.

Documenting and explaining the HIV decline in east Zimbabwe: the Manicaland General Population Cohort.

Purpose: The Manicaland cohort was established to provide robust scientific data on HIV prevalence and incidence, patterns of sexual risk behaviour and the demographic impact of HIV in a sub-Saharan African population subject to a generalised HIV epidemic. The aims were later broadened to include provision of data on the coverage and effectiveness of national HIV control programmes including antiretroviral therapy (ART).

Participants: General population open cohort located in 12 sites in Manicaland, east Zimbabwe, representing 4 major socioeconomic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas).

Do HIV prevalence trends in antenatal clinic surveillance represent trends in the general population in the antiretroviral therapy era? The case of Manicaland, East Zimbabwe.

Objective: National estimates of HIV trends in generalized epidemics rely on HIV prevalence data from antenatal clinic (ANC) surveillance. We investigate whether HIV prevalence trends in ANC data reflect trends in men and women in the general population during the scale-up of antiretroviral therapy (ART) in Manicaland, Zimbabwe.

Methods: Trends in HIV prevalence in local ANC attendees and adults aged 15-49 years in towns, agricultural estates, and villages were compared using five rounds of parallel ANC (N = 1200) and general-population surveys (N = 10 000) and multivariable log-linear regression.

Effects of cash transfers on Children's health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets.

Background: Unconditional and conditional cash transfer programmes (UCT and CCT) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS (OVC). We address the gap in current understanding about the extent to which household-based cash transfers differentially impact individual children's outcomes, according to risk or protective factors such as orphan status and household assets.

Methods: Data were obtained from a cluster-randomised controlled trial in eastern Zimbabwe, with random assignment to three study arms - UCT, CCT or control.

Grassroots community organizations' contribution to the scale-up of HIV testing and counselling services in Zimbabwe.

Objective: To investigate whether community engagement (participation in grassroots organizations) contributed to increases in HIV testing in Zimbabwe.

Methods: Prospective data on membership of local community organizations (e.g.

Increasing adolescent HIV prevalence in Eastern Zimbabwe--evidence of long-term survivors of mother-to-child transmission?

Recent data from the Manicaland HIV/STD Prevention Project, a general-population open HIV cohort study, suggested that between 2004 and 2007 HIV prevalence amongst males aged 15-17 years in eastern Zimbabwe increased from 1.20% to 2.23%, and in females remained unchanged at 2.

Asset ownership among households caring for orphans and vulnerable children in rural Zimbabwe: the influence of ownership on children's health and social vulnerabilities.

The high prevalence of human immunodeficiency virus/acquired immune deficiency syndrome in sub-Saharan Africa has resulted in a dramatic increase in orphans and vulnerable children (OVC) over the past decade. These children typically rely on extended family networks for support, but the magnitude of the crisis has resulted in traditional familial networks becoming overwhelmed and more economically and socially vulnerable. Previous research consistently demonstrates the positive influence of household asset ownership on children's well-being.

Monitoring trends in HIV prevalence among young people, aged 15 to 24 years, in Manicaland, Zimbabwe.

Background: In June 2001, the United Nations General Assembly Special Session (UNGASS) set a target of reducing HIV prevalence among young women and men, aged 15 to 24 years, by 25% in the worst-affected countries by 2005, and by 25% globally by 2010. We assessed progress toward this target in Manicaland, Zimbabwe, using repeated household-based population serosurvey data. We also validated the representativeness of surveillance data from young pregnant women, aged 15 to 24 years, attending antenatal care (ANC) clinics, which UNAIDS recommends for monitoring population HIV prevalence trends in this age group.

Measuring and correcting biased child mortality statistics in countries with generalized epidemics of HIV infection.

Objective: Under Millennium Development Goal 4, countries are required to reduce child mortality by two-thirds between 1990 and 2015. In countries with generalized epidemics of human immunodeficiency virus (HIV) infection, standard statistics based on fertility history may misrepresent progress towards this target owing to the correlation between deaths among mothers and early childhood deaths from acquired immunodeficiency syndrome.

Methods: To empirically estimate this bias, child mortality data and fertility history, including births to deceased women, were collected through prospective household surveys in eastern Zimbabwe during 1998-2005.

HIV-associated orphanhood and children's psychosocial distress: theoretical framework tested with data from Zimbabwe.

Objectives: We measured the psychosocial effect of orphanhood in a sub-Saharan African population and evaluated a new framework for understanding the causes and consequences of psychosocial distress among orphans and other vulnerable children.

Methods: The framework was evaluated using data from 5321 children aged 12 to 17 years who were interviewed in a 2004 national survey in Zimbabwe. We constructed a measure of psychosocial distress using principle components analysis.

Impact and process evaluation of integrated community and clinic-based HIV-1 control: a cluster-randomised trial in eastern Zimbabwe.

Background: HIV-1 control in sub-Saharan Africa requires cost-effective and sustainable programmes that promote behaviour change and reduce cofactor sexually transmitted infections (STIs) at the population and individual levels.

Methods And Findings: We measured the feasibility of community-based peer education, free condom distribution, income-generating projects, and clinic-based STI treatment and counselling services and evaluated their impact on the incidence of HIV-1 measured over a 3-y period in a cluster-randomised controlled trial in eastern Zimbabwe. Analysis of primary outcomes was on an intention-to-treat basis.

Age at first sex and HIV infection in rural Zimbabwe.

Beginning sexual activity introduces an individual to the risk of acquiring sexually transmitted infections. In this study, cross-sectional behavioral data linked to HIV-status from 4,138 men and 4,948 women interviewed in rural Zimbabwe are analyzed to investigate the distribution and consequences of early first sex. We find that age at first sex (at a median age of 19 years for males and 18 years for females) has declined among males over the past 30 years but increased recently among females.

HIV decline associated with behavior change in eastern Zimbabwe.

Few sub-Saharan African countries have witnessed declines in HIV prevalence, and only Uganda has compelling evidence for a decline founded on sexual behavior change. We report a decline in HIV prevalence in eastern Zimbabwe between 1998 and 2003 associated with sexual behavior change in four distinct socioeconomic strata. HIV prevalence fell most steeply at young ages-by 23 and 49%, respectively, among men aged 17 to 29 years and women aged 15 to 24 years-and in more educated groups.

Beer halls as a focus for HIV prevention activities in rural Zimbabwe.

Objective: The authors conducted an assessment of the role of beer halls in the HIV epidemic of rural Zimbabwe as part of the ongoing identification of risky places for the targeting of prevention activities.

Study: A population-based survey of 9480 adults collected data on number of visits to beer halls in the last month, together with sociodemographics, sexual behavior, and HIV infection from 1998-2000.

Results: Fifty percent of men, but only 4% of women, had been to a beer hall in the last month.

Scale-free networks and sexually transmitted diseases: a description of observed patterns of sexual contacts in Britain and Zimbabwe.

Background: Sexually transmitted infections spread through a network of contacts created by the formation of sexual partnerships. In physics, networks have been characterized as "scale-free" if they follow a power law with an exponent between 2 and 3.

Objective: The objective of this study was to test statistically whether distributions of numbers of sexual partners reported from different populations are well described by power laws.

Methods to reduce social desirability bias in sex surveys in low-development settings: experience in Zimbabwe.

Background: Social desirability bias hampers measurement of risk behavior for acquiring STDs and evaluation of control interventions. More confidential data collection methods reduce this bias in Western countries but generally require technology not available in less developed settings. GOAL The goal of this report was to describe and evaluate an informal, confidential, low-technology method-Informal Confidential Voting Interviews (ICVIs)-for collecting sexual behavior data in less developed settings.

Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe.

Background: HIV-1 prevalence typically rises more rapidly at young ages in women than in men in sub-Saharan Africa. Greater susceptibility to infection on exposure in women is believed to be a contributory factor as is greater exposure to previously infected sexual partners of the opposite sex. We investigated the latter hypothesis using data from a field study in rural Manicaland, Zimbabwe.