A Stunning Decline in the Most Unlikely of Places

Data has just been presented this week of the most dramatic decline in HIV prevalence rates seen anywhere in the Sub-Saharan region. Based upon testing of pregnant women coming forward for neo-natal care the prevalence of women testing positive for HIV has dropped from 23% in 2001 to a staggering 11% in 2008. So which nirvana of excellent African leadership and highly efficient and effective programming by NGO and health officials can raise their heads high and bask in the glory?

Well the surprisingly unfortunate answer for everyone involved is Zimbabwe! The economic meltdown that the country has experienced since Robert Mugabe stepped up his land reforms in the early 2000’s seems to have had the kind of impact on HIV rates that most prevention programmes can only dream of.

Put simply, taking money out of people’s (read men’s) pockets has reduced their ability to spend it on supporting extra girfriends, soliciting sex workers and generally moving around the country more freely. It has reduced the attractiveness of sugar daddies (older male partners) who start to look less sweet and more like the wrinkly old men minus their wallets to their younger partners. 

On the darker side of the equation, the lack of a stable political situation has also impeded the scale up of HIV treatment seen in other countries during the same period so one can assume that many HIV patients will have simply died during the same time period and will not be counted in the new numbers. Sadly it is also unclear as to whether these positive behaviour changes will be sustained once the economy regains its composure.

All that aside, there is no question that we now have witnessed the most effective behaviour changing mechanism of all – wealth reduction! We have also seen it to have disproportionate impact on that group whose behaviors are hardest to change – men.

What all this means for the rest of the region it is hard to say, as a wise hand here remarked – the greatest risk for a Zambian man is when he gets a job and the greatest risk for a woman is when she marries him. It is difficult to envisage a new strategy that involves making Zambian men poorer en masse in the name of HIV reduction but we can for a moment atleast daydream about where it might take us.

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