The objective of this study was to assess factors associated with HIV transmission among HIVpositive adults in Zimbabwe. The study analyzed data collected from a nationally representative sample of adults in the 2005-06 Zimbabwe Demographic and Health Survey (ZDHS), including respondents from whom blood samples for HIV testing were collected. All analysis in this study was limited to HIV-positive women and men age 15-49 who have ever had sex. Our findings show that only about one-fourth of HIV-positive adults age 15-49 were previously tested for HIV and received test results. HIV-positive women were more likely than men to have been previously tested and received results (27% of women versus 20% of men, p<0.05). About two-thirds of HIV-positive adults were currently in a union, with men more likely than women to be in union (74% of men versus 58% of women, p<0.05). Overall, 80% of HIV-positive adults were sexually active in the last 12 months (90% of men and 74% of women, p<0.05). In addition, 42% of all HIV-positive adults reported three or more lifetime sexual partners, while 17% of all HIV-positive adults reported having sex with a non-spousal sexual partner in the past year. Despite high levels of sexual activity among HIV-positive adults, levels of condom use were low. Among HIV-positive adults who had sex in the last 12 months, 83% of last sexual acts were unprotected, and among HIV-positive adults who had sex with a non-spousal partner in the past year, less than half (48%) used condoms. Only 14% of HIV-positive men reported consistent condom use with all most recent sexual partners, while only about one in every two HIV-positive adults (47%) reported currently using any contraceptive method.
These and other study findings suggest a substantial need for more focus on positive prevention, such as scaling up HIV testing and counseling services, including provider-initiated testing and counseling. The results also highlight the importance of promoting condom use among HIV-positive adults, including in marriages in which the partners are discordant in HIV status.