Community Context and HIV Prevalence among Women and Men in Zimbabwe

Ilene S. Speizer, University of North Carolina at Chapel Hill
Paul R. Voss, University of North Carolina at Chapel Hill
Anu Manchikanti, University of North Carolina at Chapel Hill
Jay Stewart, University of North Carolina at Chapel Hill

Most studies on HIV risk in sub-Saharan Africa focus on individual-level socio-demographic and behavioral correlates of risk. Only recently have researchers and programmers considered the context within which individuals live. This study uses the 2005-6 Zimbabwe Demographic and Health Survey and applies statistical and spatial analysis methods to examine the correlation between the prevalence of HIV risk-taking behaviors at the community level and the prevalence of HIV at the community level. We show that women living in communities where women and men engage in higher risk behaviors are at greater risk of HIV. In particular, the prevalence of premarital sex is associated with higher HIV prevalence in both urban and rural areas. Programs that target non-marital and premarital sexual behaviors need to address social norms that make these behaviors acceptable and thus increase all women (and men’s) risk of HIV, not just those engaged in these high-risk behaviors.