Abstract
BackgroundThe HIV epidemic remains a concern on the global health agenda, despite progress made in reducing incidence. Investigation of trends among young people is important for monitoring HIV incidence and informing programming. The study examined geographical and sub-population differences in HIV prevalence trends among young people aged 15–24 years in Zambia.MethodsThis study analysed data from Zambia Demographic and Health Surveys (ZDHSs) that were conducted in 2001–2, 2007, and 2013–14. A two-stage cluster stratified sampling procedure was used to select samples of 8050, 7969, and 18,052 for the three surveys, respectively. Young people (15–24 years) with known HIV status were selected for analysis. The outcome variable was HIV status. Log binomial regression analysis of generalised linear models was used to test for trends.ResultsOverall HIV prevalence declined over the period 2001–2 to 2013–14 among women and men aged 15–49 years (17.8 and 12.9% to 15.1 and 11.3%, respectively). There was, however, an increase in HIV prevalence among urban young men over this period, from 3.7% in 2001–2 to 7.3% in 2013–14 (aRR 2.17, 95% CI 0.99˗4.75), and, in rural areas, from 2.6 to 3.6% (aRR 1.46, 95% CI 0.78˗2.75). In contrast, HIV prevalence among women declined over the same period of time. In urban areas, HIV prevalence among women declined from 15.2 to 10.7% (aRR 0.66, 95% CI 0.53˗0.93), while in rural areas it declined from 8.2 to 4.8% (aRR 0.41, 95% CI 0.59˗0.85). In addition, there was a narrowing gender gap in terms of HIV infection, as the prevalence ratio of females to males declined from 4.2 and 3.1 to 1.5 and 1.3, in urban and rural areas, respectively.ConclusionsThe increase in HIV prevalence among urban young men over the past 12 years, contrasting declining trends among young women in both urban and rural populations, suggests differential effects of prevention efforts. Furthermore, findings that Zambia’s overall national HIV prevalence decline masks some striking sex and rural/urban differentials, indicate the need for reconsidering the prevention efforts for young urban men.
Highlights
The Human Immunodeficiency Virus (HIV) epidemic remains a concern on the global health agenda, despite progress made in reducing incidence
The HIV epidemic remains a major concern on the global health agenda, despite the progress made in reducing incidence and improving access to antiretroviral treatment
Details of participation in the 2001/2, 2007, and 2013/14 Zambia Demographic and Health Survey (ZDHS) are published in the detailed reports [22,23,24]
Summary
The HIV epidemic remains a concern on the global health agenda, despite progress made in reducing incidence. Investigation of trends among young people is important for monitoring HIV incidence and informing programming. The study examined geographical and sub-population differences in HIV prevalence trends among young people aged 15–24 years in Zambia. The HIV epidemic remains a major concern on the global health agenda, despite the progress made in reducing incidence and improving access to antiretroviral treatment. In sub-Saharan Africa, Eastern and Southern Africa are the hardest hit, with more than half of people living with HIV residing in this region, despite the fact that only 6.2% of the world’s population resides in this region [2]. The HIV incidence in sub-Saharan Africa peaked during the mid-1990s and substantially declined during the subsequent 10–15 years [3].
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