Chris Blattman

What explains the AIDS reduction in Uganda?

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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.

4 Responses

  1. Thanks Mr. Blattman for the model. It’s so important to see what’s working and what’s not so that we can continue the positive trends.

  2. Both sound plausible, Ian. Another explination could be that younger women are more likely to have relationships with older men (aka sugar daddy situations), who are more likely to be postiive. Women who delay may be more likely to be in relationships with men their own age, who are less likely to be positive.

  3. so delaying is a good thing for young women. i wonder why? they are old enough or wise enough or feel empowered enough to demand condoms? or they just get married and then have, presumably, less partners?

  4. Just yesterday the BBC ran an article based on a UN report that HIV seroprevelence in general across many Sub-Saharan African countries was down due to changes in sexual behaviour, but was rising in Uganda because of “complacency” after earlier success. Haven’t had time to dig out the original report and look at specifics though.

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