A Rapid Assessment in Relation to Alcohol and Other Substance Use and Sexual Behaviour in Zimbabwe

Overview

The HIV epidemic in Zimbabwe currently ranks among the most severe in the world with an estimated 25% of the adult population or 1.4 million Zimbabweans age 15-49 already infected with HIV [1]. Data also demonstrate that the Zimbabwean epidemic is a generalized one, having spread far beyond high-risk core groups and into the general population of sexually active adults who currently make up 50% of Zimbabwe’s total population. An average of 28% of pregnant women seeking antenatal services at surveillance sites nationwide were HIV positive in 1997 [1]. HIV prevalence varied from 7 % to 53% with the capital city, Harare, reporting 28%. In a more recent study of 14,112 pregnant women who gave birth in Harare clinics and hospitals, 33% were HIV positive. Prevalence increased with age, reaching a peak of 44% prevalence among women aged 30 to 34 years.

In countries such as Zimbabwe, where HIV is primarily sexually transmitted and prevalence is high, the use of alcohol and other psychoactive substances may assume particular importance in the transmission dynamics of HIV infection and other sexually transmitted diseases. Epidemiological data gathered in diverse countries around the world point to an association between alcohol/drug use, sexual activity and sexual risk behaviour. For example, six studies conducted with gay men in the U.S. and Australia show that individuals with higher levels of non-injection substance use at baseline were more likely to become infected with HIV over time [3-8]. In addition, epidemiological studies conducted in Zimbabwe, Tanzania, Kenya, Zambia, and Central African Republic have found significant associations between alcohol consumption and high-risk sexual behavior [9-12], prevalent STDs [12-14], prevalent HIV infection [12,15], and incident HIV infection [16,17].