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This study aimed at assessing the extent to which decline in HIV infection prevalence reflects decline in incidence in 3 areas with contrasting initial exposure to the HIV epidemic in the Kagera region of Tanzania. A population sample was recruited for the baseline study in 1987 through a multistage cluster sampling technique to determine HIV prevalence. Seronegative individuals identified in the baseline and subsequent studies were followed up for 3 years to yield trends in incidence that were compared for the 3 areas. The overall age-adjusted HIV-1 prevalence in the high-prevalence area of Bukoba urban declined significantly from 24.2% in 1987 to 18.2% in 1993 and later to 13.3% in 1996 (P = 0.0001). In the medium-prevalence area of Muleba, overall age-adjusted prevalence declined significantly from 10.0% in 1987 to 6.8% in 1996 and later to 4.3% in 1999 (P = 0.0003), whereas in the low-prevalence area of Karagwe the prevalence declined from 4.5% in 1987 to 2.6% in 1999 (P = 0.01). In all 3 areas, the most significant decline was consistently observed among women in the age group 15-24 years. No age group exhibited a significant upward prevalence trend. The HIV-1 incidence for Bukoba urban declined from 47.5 to 9.1 per 1000 person-years of observation in 1989 and 1996, respectively, whereas in Muleba it decreased from 8.2 to 3.9 in 1989 and 2000, respectively. Sex-specific estimates indicated a significant decline among women in the high-prevalence area of Bukoba urban from 51.5 to 9.2 per 1000 person-years at risk (P = 0.001). It is concluded that the HIV-1 epidemic in Kagera is on the decrease as reflected by the decline in HIV-1 incidence and prevalence trends particularly among the 15-24 year olds. The decline in the 3 areas of differing magnitude implies that the HIV/AIDS epidemic may be arrested early without necessarily peaking to saturation levels.

Like poverty, the HIV/AIDS epidemic is affecting the sub-continent of Saharan Africa more severely than any other parts of the world, with sixty three percent of global AIDS cases occurring in this region. Tanzania is one of the severely affected countries within sub-Saharan Africa. It is evident that AIDS in this continent is transmitted mainly through heterosexual contact. Since a cure is yet to be found, a change in sexual behavior seems to be the only reliable method of controlling the further spread of HIV. Sexual behavior is shaped by a variety of social and cultural factors inherent in the society. Therefore, understanding the social-cultural context within which AIDS is spreading * The Authors wish to acknowledge the Swedish Agency for Research Cooperation with Developing Countries (SAREC) for funding the activities of the Kagera AIDS Research Project. We also appreciate the support provided by our respective institutions for allowing us to work in this project. is important for successful intervention. In order to achieve this, the Kagera AIDS Research Project (KARP) initiated a study aimed at understanding the social cultural processes that shape the dynamics of HIV transmission in the Kagera region of Tanzania. The findings suggest that there are a variety of factors responsible for the rapid transmission of HIV/AIDS in this region, which include political factors such as organized violence (war); economic factors, particularly poverty; and cultural factors or traditions, especially in terms of the way they shape gender inequality, romantic attachments and sex meanings and beliefs. The study proposes that intervention strategies must he multi-dimensional, and must reflect the local cultural conditions as well as involve the local people.

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Faced with the problems of HIV/AIDS, people have to find ways to communicate around them. The aim of this paper is to mirror changes over time in the Kagera people's social cognition regarding HIV/AIDS, using their own language as a tracer of this process. Focus group discussions and personal and group interviews conducted during 1992 to 1995 in urban Bukoba, Kagera, constitute the basis for an analysis of metaphorical expressions in use since 1985. Pronounced uncertainty is later transformed into a deeper understanding of the pandemic and an increased disposition to cope with the situation. Knowledge about the socio-linguistic expressions mapped out in this article can be of help when developing guidelines on how to communicate about interventions.