HIV in Zimbabwe 1985–2003: Measurement, Trends and Impact

  • Owen Mugurungi
  • Simon Gregson
  • A. D. McNaghten
  • Sabada Dube
  • Nicholas C. Grassly
Part of the International Studies in Population book series (ISIP, volume 6)

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 sociodemographic 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.


Child Welfare Male Circumcision Adult Mortality Infectious Disease Epidemiology National AIDS Council 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    World Bank (2002). World Development Report. (Washington, DC: World Bank)Google Scholar
  2. 2.
    Blair Research Institute, Oxford University (1996). The early socio-demographic impact of the HIV-1 epidemic in rural Zimbabwe. (Port Blair: Blair Research Institute)Google Scholar
  3. 3.
    UNAIDS (2002). Report on the global HIV/AIDS epidemic. (Geneva: UNAIDS)Google Scholar
  4. 4.
    Chandiwana, S. K. (2001). Why has HIV spread so rapidly in southern Africa? Zimbabwe Science News, 35(1 & 2), 11–17Google Scholar
  5. 5.
    Chin, J. & Mann, J. (1989). Global surveillance and forecasting of AIDS. Bulletin of the World Health Organization, 67(1), 1–7Google Scholar
  6. 6.
    Projections URGoEMa (2002). Improved methods and assumptions for estimation of the HIV/AIDS epidemic and its impact: Recommendations of the UNAIDS reference group on estimates, modelling and projections. AIDS, 16, W1–W14CrossRefGoogle Scholar
  7. 7.
    Zimbabwe Ministry of Health and Child Welfare (2003). Zimbabwe National HIV and AIDS Estimates. (Harare: Zimbabwe Ministry of Health and Child Welfare)Google Scholar
  8. 8.
    Zimbabwe Central Statistical Office (2002). Census 2002: Zimbabwe Preliminary Report. (Harare, Zimbabwe: CSO)Google Scholar
  9. 9.
    Woelk, G., Kasprzyk, D., Montano, D. E. & Mutsindiri, R. (2002). National survey of STDs and HIV prevalence among residents in rural growth point villages in Zimbabwe. (Barcelona: XIV International AIDS Conference 2002)Google Scholar
  10. 10.
    Gregson, S. & Chandiwana, S. K. (2001). The Manicaland HIV/STD prevention project: Studies on HIV transmission, impact and control in rural Zimbabwe. Zimbabwe Science News, 35(1), 27–42Google Scholar
  11. 11.
    Gregson, S., Mason, P. R., Garnett, G. P., et al. (2001). A rural epidemic in Zimbabwe? Findings from a population-based survey. International Journal of STD and AIDS, 12, 189–196CrossRefGoogle Scholar
  12. 12.
    Zimbabwe Ministry of Health and Child Welfare, Zimbabwe National Family Planning Council, National AIDS Council Zimbabwe, Centers for Disease Control and Prevention Zimbabwe (2004). The Zimbabwe Young Adult Survey (YAS) 2001–2002: (Harare: Zimbabwe Ministry of Health and Child Welfare and Centers for Disease Control and Prevention Zimbabwe)Google Scholar
  13. 13.
    Gregson, S., Terceira, N., Kakowa, M., et al. (2002). Study of bias in antenatal clinic HIV-1 surveillance data in a high contraceptive prevalence population in sub-Saharan Africa. AIDS, 16(4), 643–652CrossRefGoogle Scholar
  14. 14.
    Jackson, H. (1992). AIDS: Action now. 2nd edn. (Harare, Zimbabwe: AIDS Counselling Trust)Google Scholar
  15. 15.
    Decosas, J. & Padian, N. S. (2002). The profile and context of the epidemics of sexually transmitted infections including HIV in Zimbabwe. Sexually Transmitted Infections, 78(Suppl 1), 40–46CrossRefGoogle Scholar
  16. 16.
    Nesara, P., Lee, L. M., Zisengwe, L. M., Magure, T. & McNaghten, A. D. (2003). Trends in HIV prevalence in antenatal attendees in Zimbabwe, 2000–2002. (Nairobi: International Conference on AIDS in Sub-Saharan Africa 2003)Google Scholar
  17. 17.
    Gregson, S., Garnett, G. P., Nyamukapa, C. A., et al. (2006). HIV decline associated with behaviour change in eastern Zimbabwe. Science, 311, 664–666CrossRefGoogle Scholar
  18. 18.
    Mbizvo, M., Machekano, R., McFarland, W., et al. (1996). HIV seroincidence and correlates of seroconversion in a cohort of male factory workers in Harare, Zimbabwe. AIDS, 10(8), 895– 902CrossRefGoogle Scholar
  19. 19.
    Ray, S., Latif, A., Machekano, R. & Katzenstein, D. (1998). Sexual behaviour and risk assessment of HIV seroconvertors among urban male factory workers in Zimbabwe. Social Science and Medicine, 47(10), 1431–1443CrossRefGoogle Scholar
  20. 20.
    Morgan, D., Mahe, C., Mayanja, B., Okongo, J. M., Lubega, R. & Whitworth, J. A. G. (2002). HIV-1 infection in rural Africa: Is there a difference in median time to AIDS and survival compared with that in industrial countries? AIDS, 16(4), 597–603CrossRefGoogle Scholar
  21. 21.
    Collaborative Group on AIDS Incubation and Survival including the CASCADE EU Concerted Action (2000). Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: A collaborative re-analysis. The Lancet, 355, 1131–1137CrossRefGoogle Scholar
  22. 22.
    Anderson, R. M. & May, R. M. (1991). Infectious diseases of humans: dynamics and control. (Oxford: Oxford University Press)Google Scholar
  23. 23.
    Stover, J. & Kirmeyer, S. (2001). DEMPROJ (Version 4): A computer program for making population projections. (Washington, DC: Futures Group International, Policy Project)Google Scholar
  24. 24.
    Over, M. & Piot, P. (1993). HIV infection and sexually transmitted diseases. (In D. T. Jamison, W. H. Mosley, A. R. Measham, J. L. Bobadilla (Eds.), Disease Control Priorities in Developing Countries (pp. 455–528). New York: Oxford University)Google Scholar
  25. 25.
    Dyson, T. (2003). HIV/AIDS and urbanization. Population and Development Review, 29(3), 427–442CrossRefGoogle Scholar
  26. 26.
    Drain, P. K., Smith, J. S., Hughes, J. P., Halperin, D. T. & Holmes, K. K. (2004). Correlates of national HIV seroprevalence: an ecological analysis of 122 developing countries. Journal of Acquired Immune Deficiency Syndromes, 35(4), 407–420CrossRefGoogle Scholar
  27. 27.
    Gregson, S., Waddell, H. & Chandiwana, S. K. (2001). School education and HIV control in sub-Saharan Africa: from discord to harmony? Journal of International Development, 13, 467–485CrossRefGoogle Scholar
  28. 28.
    Bassett, M. T. & Mhloyi, M. (1991). Women and AIDS in Zimbabwe: the making of an epidemic. International Journal of Health Services, 21(1), 143–156Google Scholar
  29. 29.
    Potts, D. H. & Mutambirwa, C. C. (1990). Rural-urban linkages in contemporary Harare: why migrants need their land. Journal of Southern African Studies, 16(4), 177–198CrossRefGoogle Scholar
  30. 30.
    Montano, D. E., Kasprzyk, D., Woelk, G. & St. Lawrence, J. (2002). National survey of behavioural risk for STDs and HIV among residents of rural growth point villages in Zimbabwe. (Barcelona: XIV International AIDS Conference 2002)Google Scholar
  31. 31.
    Gwanzura, L., McFarland, W., Alexander, D., Burke, R., Katzenstein, D. (1998). Association between HIV and HSV-2 seropositivity among male factory workers in Zimbabwe. Journal of Infectious Diseases, 177, 481–484CrossRefGoogle Scholar
  32. 32.
    Weiss, H. A., Buve, A., Robinson, N. J., et al. (2001). The epidemiology of HSV-2 infection and its association with HIV infection in four urban African populations. AIDS, 15(Suppl 4), S97–S108CrossRefGoogle Scholar
  33. 33.
    Gisselquist, D., Rothenberg, R., Potterat, J. & Drucker, E. (2002). HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission. International Journal of STD and AIDS, 13(10), 657–666CrossRefGoogle Scholar
  34. 34.
    Gregson, S., Nyamukapa, C. A., Garnett, G. P., et al. (2005). HIV infection and reproductive health in teenage women orphaned and made vulnerable by AIDS in eastern Zimbabwe. AIDS Care, 17, 785–794Google Scholar
  35. 35.
    Buve, A., Carael, M., Hayes, R. J., et al. (2001). Multicentre study on factors determining differences in rate of spread of HIV in sub-Saharan Africa: Methods and prevalence of HIV infection. AIDS, 15(Suppl 4), S5–S14CrossRefGoogle Scholar
  36. 36.
    Civic, D. & Wilson, D. (1996). Dry sex in Zimbabwe and implications for condom use. Social Science and Medicine, 42(1), 91–98CrossRefGoogle Scholar
  37. 37.
    Ray, S., Gumbo, N. & Mbizvo, M. (1996). Local voices: what some Harare men say about preparation for sex. Reproductive Health Matters, (7), 34–45Google Scholar
  38. 38.
    Dallabetta, G., Miotti, P., Chiphangwi, J., Liomba, G. & Saah, A. (1990). Vaginal tightening agents as risk factors for acquisition of HIV. (San Francisco: Sixth International Conference on AIDS 1990)Google Scholar
  39. 39.
    Machirovi, L. M. (2000). Zimbabwe Demographic and Health Survey, 1999. (Harare: Zimbabwe Central Statistical Office/Macro International)Google Scholar
  40. 40.
    Zimbabwe National AIDS Council MoHaCW, The MEASURE Project, (CDC/Zimbabwe) CfDCaP (2002). AIDS in Africa During the Nineties: A review and analysis of survey and research results. (Chapel Hill: Carolina Population Center, University of North Carolina)Google Scholar
  41. 41.
    Boerma, J. T, Gregson, S., Nyamupaka, C. A. & Urassa, M. (2003). Understanding the uneven spread of HIV within Africa: comparative study of biological, behavioral and contextual factors in rural populations in Tanzania and Zimbabwe. Sexually Transmitted Diseases, 30, 779–787CrossRefGoogle Scholar
  42. 42.
    Mwaluko, G., Urassa, M., Isingo, R., Zaba, B. & Boerma, J. T. (2003). Trends in HIV and sexual behaviour in a longitudinal study in a rural population in Tanzania, 1994–2000. AIDS, 17(18), 2645–2651CrossRefGoogle Scholar
  43. 43.
    Garnett, G. P. & Anderson, R. M. Factors controlling the spread of HIV in heterosexual communities in developing countries: patterns of mixing between different age and sexual activity classes. Philosophical Transactions of the Royal Society of London, Series B, (342), 137–159Google Scholar
  44. 44.
    Zimbabwe Ministry of Health and Child Welfare (2004). Monitoring the HIV/AIDS epidemic and the national response: The Zimbabwe young adult survey (YAS) 2001–2002. (Harare: Zimbabwe Ministry of Health and Child Welfare)Google Scholar
  45. 45.
    Bassett, M. T., McFarland, W. C., Ray, S., et al. (1996). Risk factors for HIV infection at enrollment in an urban male factory cohort in Harare, Zimbabwe. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 13(3), 287–293Google Scholar
  46. 46.
    Lewis, J. J. C., Chandiwana, S. K., Nyamukapa, C. A., Garnett, G. P., Donnelly, C. A. & Gregson, S. (2002). Patterns of sexual behaviour and the risk of HIV infection in rural Zimbabwe. Abstract ThPeC7450. (Barcelona: XIV International AIDS Conference 2002)Google Scholar
  47. 47.
    Gregson, S., Nyamukapa, C., Garnett, G. P., et al. (2002). Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. The Lancet, 359(June), 1896–1903CrossRefGoogle Scholar
  48. 48.
    Mason, P. R., Fiori, P. L., Cappuccinelli, P., Rapelli, P. & Gregson, S. (2005). Seroepidemiology of Trichomonas vaginalis and patterns of association with HIV infection in young women in rural Zimbabwe. Epidemiology and Infection 2001; 2005;133:315–323CrossRefGoogle Scholar
  49. 49.
    Lopman, B., Garnett, G. P., Mason, P. R. & Gregson, S. (2005) Evidence of absence: Injection history and HIV incidence in rural Zimbabwe. Public Library of Science Medicine, 2005; 2(2):142–146Google Scholar
  50. 50.
    Gregson, S. & Garnett, G. P. (2000). Contrasting gender differentials in HIV-1 prevalence and associated mortality increase in eastern and southern Africa: artefact of data or natural course of epidemics? AIDS, 14(Suppl 3), S85–S99Google Scholar
  51. 51.
    Hargreaves, J. R. & Glynn, J. R. (2002). Educational attainment and HIV infection in developing countries: a review of the published literature. Tropical Medicine and International Health, 7, 489–498CrossRefGoogle Scholar
  52. 52.
    US Bureau of the Census (1997). The demographic impact of HIV/AIDS: Perspectives from the world population profile, 1996. (Washington, DC: US Bureau of the Census)Google Scholar
  53. 53.
    Robinson, N. J. & Marindo, R. (1999). Current estimates of and future projections for adult deaths attributed to HIV infection in Zimbabwe. Journal of Acquired Immune Deficiency Syndromes, 20(2), 187–194Google Scholar
  54. 54.
    Murimwa-Moyo, I. M. (1991). Mortality levels, patterns and trends in the city of Harare, Zimbabwe. MSc. in Medical Demography. (London: London School of Hygiene and Tropical Medicine)Google Scholar
  55. 55.
    Gregson, S., Anderson, R. M., Ndlovu, J., Zhuwau, T. & Chandiwana, S. K. (1997). Recent upturn in mortality in rural Zimbabwe: evidence for an early demographic impact of HIV-1 infections? AIDS, 11(10), 1269–1280CrossRefGoogle Scholar
  56. 56.
    Timaeus, I. (1998). Impact of the HIV epidemic on mortality in sub-Saharan Africa: evidence from national surveys and censuses. AIDS, 12(Suppl), S15–S27CrossRefGoogle Scholar
  57. 57.
    Feeney, G. (2001). The impact of HIV/AIDS on adult mortality in Zimbabwe. Population and Development Review, 27(4), 771–780CrossRefGoogle Scholar
  58. 58.
    Gregson, S., Mushati, P., Nyamupaka, C. A. (2007). Adult mortality and erosion of household viability in AIDS-afflicted towns, estates and villages in eastern Zimbabwe. Journal of Acquired Immune Deficiency Syndromes, 44, 188–195CrossRefGoogle Scholar
  59. 59.
    Aiken, C. G. A. (1992). HIV-1 infection and perinatal mortality in Zimbabwe. Archives of Disease in Childhood, 67, 595–599CrossRefGoogle Scholar
  60. 60.
    Terceira, N., Gregson, S., Zaba, B. & Mason, P. R. (2003). The contribution of HIV to fertility decline in rural Zimbabwe. Population Studies, 57(2), 149–164CrossRefGoogle Scholar
  61. 61.
    Gregson, S. (1994). Will HIV become a major determinant of fertility in sub-Saharan Africa? Journal of Development Studies, 30(3), 650–679CrossRefGoogle Scholar
  62. 62.
    Gregson, S., Zhuwau, T., Anderson, R. M. & Chandiwana, S. K. (1997). HIV-1 and fertility change in rural Zimbabwe. Health Transition Review, 7(Suppl 2), 89–112Google Scholar
  63. 63.
    Zaba, B. & Gregson, S. (1998). Measuring the impact of HIV on fertility in Africa. AIDS, 12(Suppl), S41–S50CrossRefGoogle Scholar
  64. 64.
    Grieser, M., Gittelsohn, J., Shankar, A. V., et al. (2001). Reproductive decision making and the HIV/AIDS epidemic in Zimbabwe. Journal of Southern African Studies, 27(2), 225–243CrossRefGoogle Scholar
  65. 65.
    Guilkey, D. K. & Jayne, S. (1997). Fertility transition in Zimbabwe: Determinants of contraceptive use and method choice. Population Studies, 51(2), 173–190CrossRefGoogle Scholar
  66. 66.
    Zimbabwe National AIDS Co-ordination Programme (1998). HIV/AIDS in Zimbabwe: Background, projections, impact and interventions. (Harare: Zimbabwe Ministry of Health and Child Welfare)Google Scholar
  67. 67.
    Low-Beer, D., Stoneburner, R. L. & Mukulu, A. (1997). Empirical evidence for the severe but localized impact of AIDS on population structure. Nature Medicine, 3(5), 553–557CrossRefGoogle Scholar
  68. 68.
    Anderson, R. M., May, R. M. & McLean, A. (1987). Possible demographic consequences of AIDS in developing countries. Nature, 332, 228–234CrossRefGoogle Scholar
  69. 69.
    Gregson, S., Garnett, G. P. & Anderson, R. M. (1994). Assessing the potential impact of the HIV-1epidemic on orphanhood and the demographic structure of populations in sub-Saharan Africa. Population Studies, 48, 435–458CrossRefGoogle Scholar
  70. 70.
    UNAIDS (2005). Evidence for HIV decline in Zimbabwe: A comprehensive review of the epidemiological data. (Geneva: UNAIDS)Google Scholar
  71. 71.
    UNAIDS, UNICEF, USAID (2002). Children on the brink 2002. (Washington, DC: TvT Associates)Google Scholar
  72. 72.
    Nyamukapa, C. A. & Gregson, S. (2005). Extended family’ and women’s roles in safeguarding orphans’ education in AIDS-afflicted rural Zimbabwe. Social Science and Medicine, 60, 2155–2167Google Scholar
  73. 73.
    Grassly, N. C., Lewis, J. J. C., Mahy, M., Walker, N. & Timaeus, I. M. (2004). Comparison of survey estimates with UNAIDS/WHO projections of mortality and orphan numbers in sub-Saharan Africa. Population Studies, 58, 207–217CrossRefGoogle Scholar
  74. 74.
    Gomo, E. & Chandiwana, S. K. (2001). A review of the HIV/AIDS situation in Zimbabwe. Zimbabwe Science News, 35(1 & 2), 4–10Google Scholar
  75. 75.
    Latif, A. S., Katzenstein, D. A., Bassett, M. T., Houston, S., Emmanuel, J. C. & Marowa, E. (1989). Genital ulcers and transmission of HIV among couples in Zimbabwe. AIDS, 3, 519–523Google Scholar
  76. 76.
    Grosskurth, H., Mosha, F., Todd, J., et al. (1995). Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: Randomised controlled trial. The Lancet, 346, 530–536CrossRefGoogle Scholar
  77. 77.
    Dube, N. & Wilson, D. Peer education programs among HIV-vulnerable communities in Southern Africa. (In B. Williams, C. Campbell (Eds.), HIV/AIDS management in southern Africa: Priorities for the mining industry (pp. 107–110). Johannesburg: Epidemiology Research Unit)Google Scholar
  78. 78.
    Morris, M., Podhisita, C. & Wawer, M. J., (1996). Handcock MS. Bridge populations in the spread of HIV/AIDS in Thailand. AIDS, 10(11), 1265–1272CrossRefGoogle Scholar
  79. 79.
    Foster, G., Makufa, C., Drew, R., Kambeu, S. & Saurombe, K. (1996). Supporting children in need through a community-based orphan visiting programme. AIDS Care, 8(4), 389–403CrossRefGoogle Scholar
  80. 80.
    Meekers, D. (1999). Patterns of use of the female condom in urban Zimbabwe. (Washington, DC: Population Services International)Google Scholar
  81. 81.
    Meekers, D. (2001). The role of social marketing in STD/HIV protection in 4600 sexual contacts in urban Zimbabwe. AIDS, 15(2), 285–286CrossRefGoogle Scholar
  82. 82.
    Parirenyatwa, D. (2002). Social Aspects of HIV/AIDS in sub-Saharan Africa 2002. (Pretoria: Zimbabwe National AIDS Trust Fund)Google Scholar
  83. 83.
    Guay, L. A., Musoke, P., Fleming, T., et al. (1999). Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. The Lancet, 354, 795–802Google Scholar
  84. 84.
    Zimbabwe Ministry of Health and Child Welfare (2002). Strategic framework for introducing Nevirapine based prevention of mother-to-child transmission of HIV in Zimbabwe. (Harare: Zimbabwe Ministry of Health and Child Welfare)Google Scholar

Copyright information

© Springer 2007

Authors and Affiliations

  • Owen Mugurungi
    • 1
  • Simon Gregson
    • 2
  • A. D. McNaghten
    • 3
  • Sabada Dube
    • 4
  • Nicholas C. Grassly
    • 4
  1. 1.Ministry of Health & Child WelfareZimbabwe
  2. 2.Department of Infectious Disease EpidemiologyImperial College LondonNorfolk PlaceUK
  3. 3.CDC Zimbabwe and Centers for Disease Control & PreventionAtlantaUSA
  4. 4.Department of Infectious Disease EpidemiologyImperial College LondonNorfolk PlaceUK

Personalised recommendations