Trends in HIV Prevalence, Incidence and Demographic, Behavioral, and Biological Risk Factors among Youth in Rakai, Uganda, 1999-2011

Zoe R. Edelstein, Columbia University
Ying Wei, Columbia University
Sanyukta Mathur, Columbia University
Fred Nalugoda, Rakai Health Sciences Program
Tom Lutalo, Rakai Project
Ronald H. Gray, Johns Hopkins University
Maria Wawer, Johns Hopkins University
David Serwadda, Makerere University

Significant changes have occurred in HIV treatment and prevention in Uganda over the past decade, as well as change in national policies for universal education. Using the Rakai Community Cohort Study from 1999-2011, we describe trends in HIV prevalence and incidence among youth (15-24 years: n=23,952) and trends in previously identified risk factors. HIV prevalence declined among young women, but not young men. HIV incidence declined among teens, but not among 20-24 year-olds. Substantial declines occurred in marriage and sexual experience, particular among teens. Significant increases occurred in school attendance and male circumcision. Among sexually experienced youth, reporting of multiple partners and sexual concurrency declined. Condom use increased but only among primary partners. Decreases in risk factors and increases in some protective factors were seen in teens, coinciding with a significant decrease in the HIV incidence. This decline in HIV incidence was most directly attributable to increasing access to education.