Zambia risks extinction of adult population to AIDS

By Mumba Submitted on 3 February, 2010 - 13:54

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ZAMBIA has become one of the seven countries worldwide, most seriously affected countries by HIV. This is according to the recently released Zambia Demographic and Health Survey statistics.
According to the final report released by the Zambia National HIV/AIDS/STI/TB Council, approximately 82,681 of the entire adult population in the age group of 15 to 49 years became newly infected with HIV in the year 2009 alone, despite the availability of information and free distribution of condoms in public health centers countrywide.
The report was released through the Zambian Ministry of Health and the statistics have been confirmed by UNAIDS and the Global HIV/AIDS Program (GHAP) on funding from the World Bank.
Entitled “Zambia HIV Prevention Response and Modes of Transmission Analysis,” the report further revealed that in the country of 12.5 million inhabitants whose overall adult prevalence rate stands at 14 percent, almost 1.6 percent of the adult population becomes newly infected each year. Furthermore of the next 100 new infections, 71 are estimated to arise through sex with non-regular partners.
The increasing HIV prevalence rate amongst adults has proven to be tenacious despite significant decreases in some populations and in some geographic areas that have so far led Zambia’s HIV epidemic to stabilize at high levels. However, HIV continues to infect many Zambians and most of those who are infected do not even know their status. Fewer than 20 percent have so far undergone an HIV test -- a large number of them being expecting mothers through ante-natal clinics.
Twenty-one percent of new infections are estimated to occur in people who report that they have only one sexual partner. This signals significant HIV risk even for those who are faithful, given the large number of couples in which one person is HIV positive. Low levels of male circumcision in most of the country, still inadequate condom use (female condoms in particular), and a range of social norms increase risk and help drive Zambia’s varied epidemic.
Significantly higher prevalence was also found in women often spending the night away from home compared to women staying at home; men and women with higher education compared to those with no or little school education; urban couples compared to rural couples; and couples with large age gaps compared to couples with partners of similar ages.
On other sources of new infections contributing to transmission other than heterosexual, are is probably not a main contributor to annual HIV incidence. The analysis noted that unprotected anal sex is also practiced by Zambian male and female adolescents.  
The Treatment Advocacy and Literacy Campaign (TALC) in collaboration with partners such as the Prisons Care and Counselling Association (PRISCCA) are seriously advocating to ensure that men who have sex with men have equal and affordable access to Antiretroviral Therapy (ART) services without any prejudices or stigma from the community, breach of confidentiality from health care workers or restrictions and violation of their human rights from law enforcement agents.
Despite such threatening statistics however, Zambia is seeing the benefits of rapid scaling-up of Prevention of Mother-to-Child transmission of HIV (PMTCT) and ART, safe blood supply, and Behaviour Change Communication (BCC) that appears to be showing results in some groups (notably more educated men and women in urban areas, and young women attending antenatal care).
But much more effective efforts are needed with regards to multiple and concurrent partners, transactional and inter-generational sex, and discordant couples in order to reduce incidence. Zambia’s very rapid scale-up of ARV treatment is also an opportunity for concerted “prevention with positives”. Rapid rolling-out of male circumcision (with careful counseling and information) to act on Zambia’s stated commitment has also become a priority, with long queues of adults being seen waiting to register outside male circumcision clinics. In some, there's a three-month waiting list!
To improve the prevention response in Zambia, the country needs to prioritize and target evidence-based programmes for specific populations that will avert the highest number of new infections over the shortest period of time; implement programmes sustainably to excellent quality and equity; and measure rigorously to determine programme effectiveness and efficiency.