"It's not what you know, but who you knew": examining the relationship between behavior change and AIDS mortality in Africa.

Until there is an effective vaccine, changing sexual behavior (e.g., use of condoms or fewer partners) is still the only course of action that can slow the spread of HIV for most Africans. But exactly which factors influence behavior change and how are still debated. This article examines the notion that as the HIV/AIDS epidemic strengthens and spreads through communities in Africa, and mortality mounts, behaviors that prevent transmission should be changing. We focus on men in three countries--Uganda, Kenya, and Zambia--examining determinants of their behavior change, and analyze the relative importance of knowing someone who has died of AIDS as compared with other factors such as age, education level, knowledge of HIV/AIDS, economic status, and marital status. Data from three DHS surveys in Uganda (1995), Zambia (1996), and Kenya (1998) are fitted to a model predicting behavior change. Results from this cross-sectional, multinational study suggest that married and working men aged 20-40 are significantly more likely to have changed their behavior. Personal experience of AIDS is a significant predictor of behavior change in Uganda and Zambia, and is marginally significant in Kenya. One implication in the context of the epidemic is that behavior change is partly determined by the high level of mortality experienced by African communities. A second implication is that higher levels of disclosure, or lower levels of denial of AIDS as a cause of death, may help individuals change their behavior.