Uganda was widely viewed as a public health success for curtailing its AIDS epidemic in the early 1990s. To understand the reasons for the dramatic decline, we build a simulation model of HIV transmission using newly discovered data on HIV status and sexual behavior from the relevant time period. We then model the impact of abstinence, fidelity, condom use and selective mortality on the prevalence of HIV among various subgroups.
Among young women, who experienced the greatest decline in HIV prevalence, the most important component was delaying sexual debut, accounting for 57 percent of the drop in HIV prevalence. Condom use by high risk males and to a lesser extent death (of older males) also played a significant role, accounting for 30 and 16 percent respectively. However, for older women, the trend is reversed, with death being more important than abstinence or condom usage.
All told, we explain 86 percent of the reduction in AIDS in Uganda.
A new paper by Marcella Alsan and David Cutler.