The early socio-demographic impact of the HIV-1 epidemic in rural Zimbabwe
Theoretical work indicates that HIV-1 epidemics in sub-Saharan Africa will cause major demographic changes. The current study assesses the extent to which these changes can already be seen in two rural areas of Manicaland, Zimbabwe and investigates the determinants of the epidemic and its demographic impact. The study utilizes demographic survey methods and qualitative sociological techniques. Data analysis is conducted using statistical packages and is guided by insights generated from mathematical models of the epidemiology and demographic impact of HIV-1 infections. HIV-1 prevalence is high in both areas. Among women, HIV-1 infection is associated with age and marital status. Indirect evidence indicates that religion, education, migration and socio-economic characteristics of husband may also be important determinants. Each of these factors influences the pattern of sexual behaviour. Rates of sexual partner change are heterogeneous for women but appear more homogeneous for men. Mixing patterns are disassortative: men form partnerships with women with high and low rates of partner change. Mortality has undergone a recent upturn, almost certainly associated with HIV-1 infections. Adults aged 20-45 years and men, in particular, are most affected at this (early) stage of the epidemic. Religion is an important local determinant of demographic patterns, whose influence on mortality appears to be changing vua its effect on sexual behaviour and the spread of HIV-1. Orphanhood has increased, but, as yet, there is little change in population structure. Fertility has declined since the late 1970s. It is too early in the AIDS epidemic to see an impact of HIV-1 at the population level. However, some signs of behaviour changes which affect the proximate determinants of fertility were detected. These changes may accelerate the decline in birth rates, especially at younger ages. New demographic projections for Zimbabwe are developed, based on observed trends in HIV- 1 infection and fertility, and underlying behaviour patterns. These indicate substantial further increases in mortality, particularly among women and young children, greatly reduced population growth, relative shortages of young children and older adults, and further increases in orphanhood. Families and communities will require support in facing this slowly unfolding disaster.