In Burkina Faso, a Sharp Decline in HIV Prevalence Coincides with a Shift toward Safer Sexual Behaviors

HIV prevalence in Burkina Faso has declined sharply in recent decades in tandem with a shift toward safer sexual practices, finds an analysis of data from antenatal care surveillance and population-based surveys. (1) The proportion of pregnant women aged 15-49 testing positive for HIV fell by roughly 70% overall between 1998 and 2014, with the greatest reductions seen in younger age-groups; declines were also evident among men, but were more marked in older age-groups. In addition, there was an increase in the proportion of never-married 15-24-year-olds who delayed sexual debut and a decrease in the share having multiple sexual partners in the past year, as well as an uptick in condom use at last sex with nonmarital, noncohabiting partners among 15-49-year-olds with such partners. Investigators analyzed data on HIV prevalence from nine antenatal care surveillance sites in Burkina Faso that were consistently included in surveillance between 1998 and 2014 (totaling 2,010-3,129 pregnant women aged 15-49 per year). In addition, they analyzed data on HIV prevalence and sexual behaviors from three population-based Demographic and Health Surveys (DHS) conducted in 1998-1999, 2003 and 2010, mainly among men and women aged 15-49. With the DHS data, the researchers assessed five sexual behavior indicators (sexual inexperience among never-married youth; multiple partners in the past year among sexually active youth; sex with a nonmarital, noncohabiting partner among all sexually active respondents; condom use at last sex with a nonmarital, noncohabiting partner among all sexually active respondents with such partners; and sexual debut before age 15 among youth) and two general HIV-related indicators among youth (ever having been tested for the virus and knowledge of a formal source of condoms). They calculated survey-specific HIV prevalence, and used chi-square tests to compare HIV prevalence across survey years and to ascertain trends in sexual behaviors. Results of analyses of the antenatal care surveillance data indicated that the proportion of pregnant women aged 15-49 testing positive for HIV fell dramatically in Burkina Faso between 1998 and 2014, by 72% in urban areas (from 7% to 2%) and by 75% in rural areas (from 2% to less than 1%). The greatest reductions during 2007-2014 (the years when age-specific data were available) occurred among younger women: some 55% among 15-19-year-olds, 72% among 20-24-year-olds and 40% among 25-29-year-olds, compared with just 7% among those aged 30 years or older. Analyses of the DHS data showed a similar pattern among women between 2003 and 2010: HIV prevalence fell by 89% among women aged 15-19 (from 1% to nearly zero), by 78% among those aged 20-24 (from 2% to less than 1%) and by 52% among those aged 25-29 (from 3% to 1%), with minimal change among those aged 30 or older. However, the pattern among men was somewhat different, as reductions were more marked in older age-groups: For example, HIV prevalence fell by 43% among men aged 15-19 (from 1% to less than 1%), but by 82% among those aged 25-29 (from 3% to less than 1%). During the same period, the proportion of youth reporting never having had sex increased. Among 15-19-year-olds, this proportion rose for both females (from 76% to 82%) and males (from 74% to 82%); however, among 20-24-year-olds, it rose for women (from 33% to 40%), but remained unchanged for men (33-34%). …