HIV-1 control program fails in Zimbabwe

A trial in Zimbabwe has shown that a programme of integrated peer education, condom distribution, and management of sexually transmitted infections did not reduce the overall incidence of HIV-1.

The study, published in PLoS Medicine, by Simon Gregson and colleagues from Imperial College London, randomised different communities in eastern Zimbabwe over a 3 year period. Six pairs of communities in Eastern Zimbabwe were compared, each of which had its own health center. Control communities received the standard government services for preventing HIV. The other communities received a package of additional strategies including education and condom distribution amongst sex workers and their clients; better services at sexually transmitted infection clinics; and educational HIV/AIDS open days at health centers. This was a large trial with more than 63,000 meetings being conducted and 7 million condoms distributed by trained peer educators. The researchers found that although male participants benefit ed from the programme with a decrease in incidence of HIV-1, a reduction in reporting of unprotected sex with casual partners, and a decrease in symptoms of sexually transmitted infections, overall there was no change in any of these outcomes for the population at large including the incidence of HIV-1 among the population in general - the main outcome of the trial.

These results are disappointing given the urgent need for control measures for HIV-1 in sub-Saharan Africa. The authors conclude that they "emphasise the need for alternative strategies of behaviour-change promotion."