STATUS OF THE HIV/AIDS EPIDEMIC IN THE SEXUALLY ACTIVE POPULATION (15-49 YEARS) 16 th December, 2010 Data source: National HIV Prevention Convention Report

STATUS OF THE HIV/AIDS EPIDEMIC IN THE SEXUALLY ACTIVE POPULATION

(15-49 YEARS)

16th December, 2010

Data source: National HIV Prevention Convention Report and ZDHS 2007

HIV Prevalence by age and sex

15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-490

5

10

15

20

25

30

3.65.1

11.5

17.1

22.4

24.1

18.6

12.3

5.7

11.8

19.9

2624.9

18.3

12.1

16.1

Men DHS 07 Women DHS 07

HIV Prevalence by sex and geographical location

Urban women

Urban men

Rural women

Rural men

0 5 10 15 20 25

23.1

15.9

11

9.4

Percentage


HIV prevalence by marital status

0

10

20

30

40

50

60

70

9.114.6

3.7

14.7

28.8

52.5

4.5 5 3.5

16.1

33.1

63.1

Women Men


HIV Prevalence among the youth

15-19 15-17 18-19 20-24 20-22 23-240

2

4

6

8

10

12

14

16

5.7

4.4

7.9

11.8

9.6

15.2

3.6 3.5 3.8

5.2

2.4

10

Women 15-54 Men 15-24


HIV Prevalence by sexual behaviour among the youth (15-24 years)


Zero One Partner Two Partners0

5

10

15

20

25

30

35

10.2 10.3

33

3.2 4.1

8.9

WomenMen

Key Drivers of the Epidemic

Driver 1: Multiple concurrent partnerships

Bulk of new infections emanate from casual and concurrent multiple sexual relationship

The target is Long term couples and young people especially young women and mobile populations including MSM

Driver 2:Low and Inconsistent condom use

Condom use has not risen enough to impact significantly on HIV transmission

This problems exists in sexually active young people, mobile populations, MSM and discordant couples


Key Drivers of the epidemic

Driver 3:Low Rates of Male Circumcision

Evidence shows that MC offers at least 60% protection against HIV transmission

MC not widely practiced in Zambia except among some ethnic religious groups

Driver 4:Mobility and Migrant Labour Mobility and migration of workers destabilises long-

term partnerships and so facilitate Multiple and partners and sexual relationships with sex workers

Driver 5:Vulnerability and Marginalized Groups

Sub population groups such sex workers, MSM, prisoners, migrants and people with disabilities are the most vulnerable


Key Drivers of the epidemic

Driver 6:Mother to Child Vertical Transmission

HIV infection in children under fourteen constitute about 10% of all HIV Infections in Zambia. Most of these are a result of MTCT

Driver 7: Alcohol and Drug use Decision making impaired under influence of alcohol


The Majority of HIV Infections in Africa are acquired from a spouse, and couples represent the largest risk

group in Africa (National Prevention Convention Report 2007)


Synthesis of Qualitative Research on MCP

By Mandy Dube16 Dec 2010NAC, Lusaka

Background

• Qualitative audience research by HCP and ZCCP – 42 focus group discussions (3 reports)– 8 in-depth interviews– 10 key informant interviews(2 reports)– 2 literature reviews

General FindingsWho• Everyone, but more men than womenWhy• Sexual dissatisfaction• Poverty • Socially accepted/culture and socialization • Experimentation• Looking for love• Search for children• Marital differences /conflict in relationships • Revenge• Rites of passage• Prove manhood • Material gain • Peer pressure• Alcohol use

General Findings

How• Mostly in secret • As long as benefits are accruing to the partners • Little condom use especially when trust enters the picture

Technical Issues: Gender• MCP socially acceptable practice for men but not for women• Women blamed for partners MCP• Women are not to question their partner’s behaviour• Women are more financially dependent on men• Women more forgiving, men less so• Discovery of MCP linked to violence• Discordancy handled differently • Women MCP for income generation, male MCP socially accepted and even

expected• Financial resources often divided between partners particularly by the male • Lack of financial empowerment of women• Women’s independence a threat to men’s position in society• Lack of sense of self-worth among women outside of being linked to a man.• Most women traditionally prepared for marriage, men are not.• Women key drivers of gender inequalities relating to MCP and relationships in

general

Technical Issues: Sexual and Reproductive Health

• It is the woman’s responsibility to ensure she satisfies her partner sexually. This includes having to take herbs to make her body warm and to tighten her vagina

• Desire for a child in general as well as a child of a particular sex fuels MCP particularly for men

• Condom use within MCP reduces with the passage of time and more so when the partners develop a sense of trust for each other

• Knowledge of partner’s MCP or even practice of MCP not a motivation for accessing VCT

• Disclosure of HIV status a difficult decision that is often not carried forward

Technical Issues: Maternal, Newborn and Child Health

• Exposure to HIV• Access to and practice of PMTCT linked none disclosure of HIV

status • Household nutrition and basic needs linked to scarcity of

resources • Family planning linked to desire for a child or particular sex of

a child• Caring for a child who is the ‘wrong’ sex• Maternal mental health • Children witnessing/experiencing violence/conflict between

their parents• Post-partum abstinence

Key Recommendations

• Raise risk awareness• Challenge social norms and address gender

issues • Encourage female empowerment• Targeted communication:

• urban and rural men• More economically empowered, key decision makers

• Sustained and collaborative efforts

Concurrent Sexual Partnerships in Zambia-the Quantitative perspective

Partnership Meeting NACBy John Manda-SFH

17th december,2010

Concurrency

• The Zambia sexual Behaviour Survey (ZSBS 2007), the 2009 PSI/SFH HIV TRaC, and the ZDHS 2007 are among the notable studies that have recently reported on the levels and drivers of multiple and concurrent sexual partnerships in Zambia.

State of multiple & concurrent Sexual Partnerships

• Levels of concurrency in Zambia are reported to be high (5.5%, 23%) as reported by ZSBS 2009, and PSI/SFH TRaC 2009, studies respectively.

Sex, marital Status & Gender Distribution

Male Female

Single 38.5 (43%) 20.4(26%)

Married 35.5 (53%) 5.7(62%)

Formerly married 52.5 (4%) 12.3 (12%)

Total 36.9 8.2

Concurrency by marital status & genderSource: PSI/SFH TRaC 2009

Sex, marital Status & Gender Distribution

• Median age at first marriage: 18 for females (urban & rural) and males (25 urban & 23 rural) for males(24)

• Median age at first sex: 17 for females and 18 for males• Median age at first sex: 16% (TRaC)• Across the two studies, ZSBS 2009 & PSI/SFH HIV TRaC

2009 studies, Concurrency is reported to be more (36.9 Vs 8.2 PSI TRaC ) prevalent among males than females and predominantly among the single and formerly married population for both males and females.

• The 2009 ZSBS report that among sexually active male, 11% of single versus 5% of the monogamously married, had concurrent partners.

Concurrency by age, residence and gender


Rural (22.9%) Urban (22.6%)

age Male (%) Female (%) Male (%) Female (%)

15-24 33.8 11.5 36.7 9.5

25-34 43.9 7.5 44.1 5.6

35-49 28.0 7.2 28.8 6.2

Totals 36.0 8.8 38.3 7.3


• Generally, rural areas reported more concurrency (6.5% of rural Vs 3.8% of urban and 22.9% of rural Vs 22.6% of urban) than the urban areas except that urban males engage in more concurrency than their rural male counterparts as reported by the ZSBS 2009 and the PSI/SFH 2009 HIV TRaC.

• The PSI/SFH study found that men in the age group 25-39 were “statistically” more likely to engage in concurrency than other age groups.

Conclusion1

• Concurrency is higher rural although the difference is not very significant

• Among men concurrency is higher in the 25-39 age group (both rural &urban)

• Among women concurrency is higher 15-25 & about 34-39

OAM Determinants • • Males only • Statistically, men who engage in concurrency

have – Low HIV risky perception. (p<.001, OR=2.5).– Expectation of Sexual benefits. (p<.001, OR=1.8). – Low perception of marital instability related

concerns. (p<.001, OR=1.5). – Poor quality of primary relationship (p<.05, OR=1.4). – Sexual experimentation and age concurrency (p<.05,

OR=1.35)

OAM Determinants

• Females only • Statistically, men who engage in concurrency have – Low HIV risky perception. (p<.001, OR=2.5).– Expectation of Sexual benefits. (p<.001, OR=1.8). – Low perception of marital instability related concerns.

(p<.001, OR=1.5). – Poor quality of primary relationship (p<.05, OR=1.4). – High expectations of financial & material benefits.

(p<.05, OR=1.4).

Other Drivers of concurrency• Availability of partner (including PPA)– Mobility: The 2009 ZSBS report that those who had

spent time away from home in the 12 months before the survey engaged in more concurrency (12% Vs 5%) than those who did not spend time away from home.

– Male circumcision: There is scanty information regarding the relationship between MC and multiple and concurrent sexual partnerships. Preliminary findings of the longitudinal study by Population council report that about 26% of recently circumcised men who reported having had sex within 6 weeks post-MC had multiple partners.

Condom Use

• Among men 14% (19% in urban & 10% in rural) used condom at last sex

• Among women, 11% (14% in urban and 9% in rural) used a condom at last sex

• Marital condom use is very low in both urban and rural• In rural Zambia 26% of those who had multiple

partners used a condom at last sex as compared to 17% in urban areas

• 10% of men in concurrency used a condom at last sex with each of the partners

HIV Prevalence (ZDHS 2007)

• Highest among the formerly married followed by the married or cohabiting partners (30-34% vs15.3%)

• HIV high among population that spent time away from home

• Nationally the age highly affected is 25-44 & 20-39 among women and 25-44 among men

NOTE

• The spread of concurrency networks & how intertwined might explain the HIV prevalence

• Both the urban and rural areas needs concurrency interventions

Communication Support for Health

ONELOVE KWASILA IHIGHLIGHTS (How it was implemented)

PRESENTED BY: Mercy Chisashi- CSHNational AIDS Council, Lusaka16th December 2010

Presentation Outline

• Background to the campaign•Campaign design• Products•Results•Lessons Learnt

Background

• The One Love campaign is a regional initiative (10 countries)

• The 10 countries conceptualized the tag line “ One Love Talk Protect Respect

• The Name was pretested and thorough FDGs in Zambia the tag Line Kwasila came about.

Campaign Design

• The campaign was based on a formative research process.– research design workshop for nine countries– conducted qualitative target audience research– Target audience were adults between 16 and 55.– Results informed the campaign design– Target audience for campaign Male 25-35 in the urban setting

– Communication Objective: Increase self-risk perception and provoke thought, dialogue and action around MCP and mutual rights and responsibilities of partners

– Behavioral Objective: Reduce sexual partners and/or consistent condom use, HIV testing and disclosure (couple testing encouraged)

– Centre piece of the campaign was club risky business

Products• TV/Film: Animated spots, Talk shows, music video and DVDs ( Distributed to

organizations and through Blockbusters with accompanying guide)

Club Risky Business• Audience interacted through Text messaging and call in programms on radio stations.• Topics were picked up for discussion on other radio stations as well as broad cast of PSA’s: Christian Voice, radio 4 and Hot fm.

•Products cont• 26 episode drama series called “Bitter sweet” aired on ZNBC Radio 2 and Radio

Phoenix.• It was also translated into Bemba and was aired on radio 1 and Mkushi community

radio and radio Mano. Print• Print: Newspaper features, supplements, ads, posters, discussion guides,

bumper stickers and tax discs for cars

www.onelovekwasila.org.zmThe Official Campaign Site

Results (As at October 29th 2009 captured by Media365)

Campaign and TV created a buzz and resonated with audience: within the first four weeks 49% of regular non-Lusaka urban television viewers recalled the slogan and 32% had seen or heard of Club Risky Business.

Dialogue and audience engagement sparked and continuing: 17,137 SMS competition entries received; more than 6000 Facebook fans continue to discuss characters’ actions and relevance to their lives as well as sex, relationship, health and surrounding topics

Bulk SMS messages: 10,000 sent 37 Calls & 384 text messages received during radio series Website: 3,466 site visits & 8,960 page views YouTube: 632 channel views & 10,348 upload views Facebook : 6, 000 + fans (28.5% Males 25-55; 25.8% Females 25-55

Results Cont

Branded buses (Inter and Intra city bus operators): 600

Buses also carried Club Risky Business as onboard entertainment

5000 branded tax discs 5000 branded bumper stickers

Lessons Learnt• Full integrated campaigns keep the audience engaged

in a number of ways• Drama’s work- people relate to them and emotions are

stirred• Indigenous and high quality products improve

message delivery and can also contribute to sustainability of the campaign

• Important who delivers the message • Engaging the audience through radio, competitions

and social media is an advantage• Momentum needs to be sustained• Research should involve campaign implementers from

the outset • Partnerships are important to manage multiple aspects • Linkages to trusted and credible resources/support

services key

Other observations

• There is an ongoing audience perception study by ZCCP focusing on the whole Onelove Kwasila campaign (wider geographical coverage).

• Once completed the findings will be shared• The highlights on OneLove Kwasila in this

presentation are limited to program data from ‘Media 365’ and does not include programmatic data from ZCCP


Documents

STATUS OF THE HIV/AIDS EPIDEMIC IN THE SEXUALLY ACTIVE POPULATION (15-49 YEARS) 16 th December, 2010 Data source: National HIV Prevention Convention Report