HIV IN ZIMBABWE 1985-2003: MEASUREMENT, TRENDS AND IMPACT
HIV IN ZIMBABWE 1985-2003: MEASUREMENT, TRENDS AND IMPACT
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DOI：
10.1007/978-1-4020-6174-5_10
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发表时间：
2007-01-01
期刊：
影响因子：
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通讯作者：
Grassly, Nicholas C.
中科院分区：
文献类型：
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作者：
Mugurungi, Owen;Gregson, Simon;Grassly, Nicholas C.
1980年代中后期，艾滋病毒在津巴布韦迅速蔓延。到1990年代中期，该国四分之一的成年人感染了艾滋病毒。艾滋病毒-1 C亚型被认为是该国境内的主要亚型，其传播绝大多数是通过异性性行为介导的。受文化和殖民影响形成的性网络，以及相对较高的发展水平和显著的社会经济不平等相结合，促使艾滋病毒感染向大多数农村人口蔓延，从而助长了全国性的大流行病。在流行病期间，通过一项开创性的综合症管理方案，梅毒、淋病和衣原体等传统性传播感染得到了控制，但2型单纯疱疹病毒极为常见。男性割礼只在少数群体中实行。从艾滋病流行的早期阶段就对输血进行了艾滋病毒筛查，几乎没有证据表明受污染的针头对艾滋病毒传播的贡献超过了适度。这一流行病的社会人口影响是毁灭性的，包括持续的危机水平的成年人死亡率，特别是在经济活动最活跃的年龄组，扭转了以前在幼儿生存方面取得的进展，人口增长迅速下降，以及文盲人数不可阻挡地上升。自1990年代后期以来，有迹象表明艾滋病毒流行趋于平稳，艾滋病毒发病率有所下降。有证据表明，年轻人更换性伴侣的比率有所下降，艾滋病毒感染率也有所下降。这些令人鼓舞的趋势可能反映了这种流行病在高风险群体中的饱和，由于艾滋病毒感染者年龄的增长而导致的死亡率上升，以及面对极端的成人死亡率而采取的行为变化。津巴布韦受过良好教育的人口和广泛的初级保健网络有助于对艾滋病毒流行病作出相对迅速的反应，政府在其伙伴的支持下加紧努力控制艾滋病毒的传播，这也可能在遏制全国流行病方面发挥了作用。
HIV spread rapidly in Zimbabwe in the mid-late 1980s. By the mid-1990s, one-quarter of adults in the country were infected with HIV. HIV-1 subtype C is believed to be the predominant sub-type within the country and its spread has been mediated overwhelmingly by heterosexual sex. Sexual networks shaped by cultural and colonial influences, and the combination of a relatively high level of development and marked socio-economic inequalities, have facilitated the spread of HIV infection into the majority rural population, and have thereby fueled the large national epidemic. Classic sexually transmitted infections such as syphilis, gonorrhoea and Chlamydia have been controlled during the epidemic through a pioneering syndromic management programme, but Herpes simplex virus type 2 is extremely common. Male circumcision is only practised in minority groups. Blood transfusions were screened for HIV from an early stage in the epidemic and there is little evidence that contaminated needles have made more than a modest contribution to HIV transmission. The socio-demographic effects of the epidemic have been devastating and include sustained, crisis-level adult mortality, particularly in the most economically-active age-groups, a reversal of previous gains in early childhood survival, a rapid decline in population growth, and an inexorable rise in orphanhood. Since the late 1990s there have been signs of a leveling out in the HIV epidemic and of a decline in HIV incidence. There is evidence of reductions in rates of sexual partner change and of a decline in HIV prevalence in young people. These encouraging trends may reflect saturation of the epidemic within high risk groups, heightened mortality due to ageing of HIV infections, and changes in behaviour adopted in the face of the extreme adult mortality. Zimbabwe's well-educated population and extensive primary health care network are conducive to a relatively rapid response to the HIV epidemic and the Government's intensified efforts to control HIV transmission supported by those of its partners are also likely to have played a part in placing a brake on the national epidemic.