Other places have also seen HIV prevalence decline

Other places have also seen HIV prevalence decline. HIV prevalence in Zimbabwe declined from 23.7 percent in 2001 to 14.3 percent in 2009.¹⁹ The rate among women attending antenatal clinics in Zimbabwe fell from 32.1% in 2000 to 23.8% in 2004. Other large surveys have found similar trends among different population groups. Part of this decline is likely to have been due to rising death rates, but a drop in new infections is also thought to have played a part. Studies have found increased condom use, longer delays before first sex and fewer casual sexual relationships compared to earlier years. This behaviour change may have been partly due to prevention campaigns, but it may also have resulted from other factors such as increased fear of AIDS, or decreased mobility at a time of high unemployment. Political conditions in Zimbabwe now make it extremely difficult for overseas agencies to run prevention projects.²⁰

In Kenya, the proportion of adults living with HIV fell from around 10% in the late 1990s to about 7% in 2003, and surveys show similar behaviour changes as in Zimbabwe and Uganda. Although Kenya has recently scaled up its prevention efforts, it did so too late to account for the beginning of the decline in HIV prevalence. The causes of the behaviour change and its role in this decline are still not fully understood.²¹ Kenya’s first lady Lucy Kibaki has been accused of endangering the progress made so far by making negative remarks about condoms. She has even been reported as saying that condoms are “causing the spread of AIDS in this country".²²

The belief that abstinence and marital fidelity are the only ways to prevent HIV infection is common among conservative politicians and religious leaders throughout Africa, as in many other parts of the world. Some commentators accuse the US of encouraging this view and of undermining condom promotion. Through its PEPFAR initiative, the US provides substantial funding for HIV prevention in Africa, giving it a strong influence over what activities are carried out. The US still supplies many millions of condoms to Africa, but it prefers to market them only to “high risk” population groups.

Another country often cited as a “success story” is Senegal, in West Africa. This nation has been praised for mobilising its people in an early and vigorous prevention campaign. Since the late 1980s, Senegalese have taught each other about HIV and AIDS through school curricula, peer education, community groups and cultural and sporting events. In this mostly Muslim country, religious authorities have helped by promoting abstinence and fidelity, while others have encouraged condom use and helped sex workers to set up support groups. Businesses and the army have supported the response.^{23 24}

Thanks to these efforts, the age of first sex rose, casual sex declined, and condom use increased dramatically. As a result, HIV prevalence in Senegal has yet to exceed 2%. However, much higher rates are found among sex workers and other groups. A survey in Senegal in 2004 found that 21.5% of men who have sex with men were infected with the virus, and almost all of them reported also having sex with women. Interventions to help this group are virtually non-existent; sex between men is highly stigmatised in Senegal and, as in half of African countries, it is also illegal.²⁵ Furthermore, researchers have recently found evidence of “a dramatic weakening of AIDS preventive attitudes” among the people of Senegal, including reduced perception of risk, less behaviour change and increased stigmatisation of people living with HIV. This suggests that the effects of earlier prevention programmes may be wearing off.