HIV/AIDS
In Zambia, UNICEF works with the Government to prevent HIV transmission, and partners with adolescents to raise awareness on HIV prevention and treatment.
The challenge
Over the past decade, Zambia has made progress in the HIV response. According to UNAIDS, annual HIV infections (for all ages) in Zambia have declined from 60,000 in 2010 to 51,000 in 2019. New infections among children 0-14 years declined from an estimated 10,000 in 2010 to 6,000 in 2019. Annual AIDS-related deaths have also declined significantly from 24,000 in 2010 to 19,000 in 2019, a decline of about 30 per cent.
Despite the progress, the HIV burden remains high and disproportionately affects females. In 2019, it was estimated that there were 26,000 new HIV infections among women 15+ years, compared to 19,000 among their males counterparts. The Zambia Demographic and Health Survey (2018) reports that HIV prevalence among females aged 15-49 years is 14.2 per cent, compared to 7.5 per cent for males of the same age. With an HIV prevalence of 15.4 per cent and 15.1 per cent, Copperbelt and Lusaka provinces respectively have the greatest HIV burden, with Muchinga province being the least burdened at 5.4 per cent.
HIV testing among pregnant women at antenatal clinics has increased significantly, with 9 out of 10 pregnant women getting tested and almost all (more than 95 per cent) of those diagnosed with HIV (at the antenatal clinic) being initiated on treatment (ARVs). However, there is a large gap around children – with about 71 per cent of HIV exposed children (born from a mother living with HIV) receiving early infant diagnosis, and 79 per cent of children 0-14 years living with HIV are on treatment. Despite an increasing trend of HIV testing and uptake of voluntary medical male circumcision (VMMC) among adolescents and young people, condom use by sexually active adolescents remains low. The 2018 Demographic and Health Survey reported that only 49 per cent and 30 per cent of adolescent boys and girls aged 15-19 years old respectively used a condom at the last higher-risk sexual intercourse.
Although 65,000 (females 40,000; males 25,000) adolescents are estimated to be living with HIV, only about 60 per cent are on HIV treatment (ARVs).
Other key statistics include:
- There is an encouraging trend in the number of potential HIV infections among children averted thanks to work on the prevention of mother-to-children transmission (PTMCT). Around 12,000 HIV infections were estimated to have been averted in 2020 compared to 1,200 in 2004.
- Only four in 10 adolescents, aged 15-19 years have comprehensive knowledge of HIV (defined as knowing that condom use and limiting sexual intercourse to one uninfected partner are HIV prevention methods, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission).
- Only 6 in 10 adolescent girls and 5 in 10 adolescent boys aged 15-19 years have ever been tested for HIV and know their HIV status, according to the Demographic and Health Survey. (2018)
The solution
During the first half of 2017, the Government of Zambia completed the National AIDS Strategic Framework (NASF) 2017-2021 and the Adolescent Health Strategy 2017-2021. While the HIV Strategic Framework prioritises global treatment and prevention specifically for children, mothers and adolescents; the Adolescent Strategy emphasizes sexual reproductive health and HIV, with prevention of teenage pregnancy, scaling up HIV testing, and condom programming, among priorities.
A mid-term review of the NASF was completed in first quarter of 2020. This will help to guide the HIV/AIDS response framework that will focus on strengthening integration, the five pillars of HIV prevention (i.e. combination prevention for adolescent girls and young women and key populations, condom programming, pre-exposure prophylaxis; and VMMC) while maintaining momentum in improving the quality and coverage of HIV treatment. The dual elimination of Mother To Child Transmission (eMTCT) of HIV and syphilis remains integral to HIV epidemic control for Zambia which is consistent with global goals.
“UNICEF’s HIV programme centres on quality, accessible and proven HIV prevention and treatment interventions for children, adolescents and pregnant women”
UNICEF’s HIV/AIDS programme supports the Government of Zambia in implementing the:
- National Paediatric and Adolescent Prevention, Treatment and Care Implementation Plan 2017-2021
- AIDS Response Fast Track Strategy 2017-2021
- National AIDS Strategic Framework (NASF) 2017-2021
- Adolescent Health Strategy (ADH) 2017-2021
- Elimination of Mother-to-Child Transmission of HIV and Syphilis (eMTCT) Plan 2018-2022.
The programme is centred on quality, accessible and proven HIV prevention, treatment, care and support interventions for children, adolescents and pregnant women. It also focuses on rights- and gender-sensitive quality services, enhanced awareness, demand for services, the use of data and evidence to strengthen accountability.
The UNICEF HIV programme's primary focus is on responding to the HIV burden by supporting the Government of Zambia provide high quality interventions along the continuum of HIV care during the first and second decades of life. This is achieved by increasing coverage of the following high impact interventions to high level targets as below:
- Pregnant women living with HIV receiving antiretroviral treatment, to 90 per cent.
- Children aged 0-14 years living with HIV receiving antiretroviral treatment, to 90 per cent.
- Sexually active adolescents aged 15-19 years who had an HIV test in the last 12 months, to 90 per cent.
- Eligible adolescents living with HIV on antiretroviral treatment, to 90 per cent.
- Consistent condom use among sexually active adolescents aged 15-19-years
- Children, adolescents and women living with HIV achieving viral suppression (significantly low numbers of viruses in the body) to 90 per cent-
In order to achieve these results, UNICEF supports the Government of Zambia at policy level (policy, strategy development, review and monitoring), national and sub-national coordination of service implementation (governance structures like technical working groups), and service delivery for children, adolescents and women. In rendering this support, UNICEF is guided by the following principles: evidence-based programming; innovation; equity; and working in partnership with other stakeholders in the HIV response including development partners, NGOs and civil society.
Resources
These resources represent just a small selection of materials on HIV/AIDS produced by UNICEF and its partners in Zambia. The list is regularly updated to include the latest information.
Zambia Demographic and Health Survey 2018
UNICEF Zambia Country Programme Document (CPD) 2016-2021
National AIDS Strategic Framework 2017-2021
Adolescent Health Strategy 2017-2021
National Implementation Plan for the Adolescent Health Strategy
National Plan for the Elimination of Mother To Child Transmission of HIV and Syphilis