‘HIV still a big problem in Zambia’

Ministry of Health permanent secretary Dr Kennedy Malama says the rate of transmission of HIV is at its peak in Zambia among the young people.
Dr Malama says HIV in Zambia was still a big problem.
“In our country we have about 1.2 million people living with HIV,” says Dr Malama. “HIV is still real. Even today it is still being transmitted and the sad news is HIV transmission in our country today is at its peak in young people and when you disaggregate young people it’s at the adolescent, girls and young women and the reason it’s the men who are economically viable that go out with such population but at the same time that age group tends to have boyfriends of their age group so it’s a double-edged sword.”
Indeed, HIV is still a big problem in Zambia. And there is still no cure for HIV. What we are calling treatment, and good as they are, are mere interventions to mitigate the situation. Change of sexual attitudes and behaviours is still very much needed.
Prevalence among adults in Zambia has changed little over the last decade despite decreasing infection rates.
Life expectancy among people living with HIV has improved significantly as a result of scaled-up treatment programmes in recent years.
Among people who have been able to access antiretroviral treatment (ART), 89 per cent are now virally suppressed.
HIV continues to fuel the country’s tuberculosis epidemic.
Women are disproportionately affected by HIV, with prevalence among young women more than double that of young men.
The country has a generalised HIV epidemic driven by heterosexual sex. In 2017, 11.5 per cent of adults were living with HIV, a slight reduction on 2007 levels when 12.8 per cent of adults were HIV positive. Women, particularly adolescent girls and young women, are worse affected than men. In 2017, 14.3 per cent of women aged 15 and over were living with HIV, compared to 8.8 per cent of their male counterparts.
Marginalised groups such as sex workers, transgender people, prisoners, people who inject drugs, gay men and other men who have sex with men are also disproportionately affected by HIV.
In 2017, 75 per cent of people living with HIV were on treatment. As of 2018, the country’s progress towards UNAIDS 90-90-90 targets are unclear due to a lack of 2017 data on the proportion of people living with HIV who were aware of their status, and the proportion of people on treatment who were virally suppressed. In 2016, 66 per cent of people living with HIV were aware of their status and, of the 89 per cent on treatment, 89 per cent were virally suppressed.
Children have been severely affected by the HIV epidemic in Zambia. In 2017, 72,000 children (aged 0-14 years) were living with HIV, and 250,000 children and adolescents (0-17 years) have been orphaned by AIDS since the epidemic began.
Around 7,300 children became newly infected with HIV in 2017.
Although this is a significant decline from the 13,000 children who became HIV positive in 2010, this latest figure indicates an upward trend, as 4,700 children contracted HIV in 2015.
A rigorous elimination of mother-to-child transmission (PMTCT) programme has been implemented, which has seen the percentage of vertical transmission drop by 51 per cent between 2011 and 2012.
Despite these promising changes, new challenges have arisen for babies exposed to HIV at birth, with many struggling to adhere to treatment. Among infants diagnosed with HIV in Lusaka around 40 per cent were reported as presenting resistance to at least one ART drug by 2014 compared to 21.5 per cent in 2009. As a result of ineffective or inaccessible treatment, 3,400 children died of AIDS-related illness in 2017.
In 2016, 72 per cent of people living with HIV in Zambia were aware of their status. In the same year, PEPFAR reported that 42 per cent of young people living with HIV (aged 15-24) were aware of their HIV status.
Zambia’s Demographic and Health Survey (ZDHS) 2013-14 found 46 per cent of female respondents and 37 per cent of male respondents (aged 15-49) reported having an HIV test in the past 12 months and knowing their results.
A study in 2012 found a number of reasons explaining why people were not testing, including a fear of HIV-related stigma, rejection by their sexual partner and a fear of antiretroviral treatment.
Couples counselling and testing is low in the country, despite this being an effective route to testing more people for HIV elsewhere.
In 2017, the government made HIV testing compulsory for any person seeking medical treatment in public health facilities. The move was met with criticism from civil society organisations who argue that compulsory testing is illegal, unethical and unconstitutional and may discourage people from seeking healthcare of any kind.
In 2017, 48,000 people in Zambia were newly diagnosed with HIV, with more women than men becoming positive (23,000 women compared to 17,000 men). This figure includes 7,300 children.
Whilst Zambia’s domestic spending on HIV and AIDS has risen dramatically in recent years, it still remains at just four per cent of the overall budget. Around 90 per cent of these funds is spent on ART. PEPFAR funds the majority of the Zambian HIV response.
Discussions are ongoing as to the possibility of integrating HIV into a National Health Fund via a Social Health Insurance Scheme, which would expand funding and therefore access to HIV services for Zambia’s population.
We need to fully integrate behaviour change communication into all aspects of our HIV response. Providing ART, testing facilities and eMTCT services will not yield results if people are not counselled, informed and educated about the need to adhere to treatment, or get tested regularly. The success of eMTCT in the country is encouraging although some recent gains now appear to be reversing.
A major focus must remain in the creation of an enabling legal and policy environment for adolescent girls, young people and key populations to exercise their sexual and reproductive health and rights, and access welcoming, quality, integrated SRH and HIV services.
More data on key affected populations is also needed to enable better understanding and targeting of future efforts to curb the Zambian HIV epidemic. Without this knowledge it will be impossible to develop robust HIV prevention programmes.

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