Zambian Men Research Articles

Dissemination and implementation of an evidence-based voluntary medical male circumcision program: The Spear & Shield program.

Despite compelling evidence linking voluntary medical male circumcision (VMMC) with 60-70% HIV risk reduction in sub-Saharan Africa, Zambian men have been especially reluctant to undergo VMMC. The Government of Zambia set targets for VMMC uptake and promoted community-level interventions. Spear & Shield (S&S) is an innovative, evidence-based, service program promoting VMMC uptake while ensuring both VMMC supply and demand. This study assessed the large-scale provincial rollout of the program (S&S2) utilizing the RE-AIM model for translating interventions into the community. The S&S2 study was conducted between November 2015 and December 2020, and sequentially rolled out over four Zambian provinces in 96 clinics; 24 observation clinics received VMMC training only. Local clinic healthcare workers were trained to conduct the VMMC procedure and HIV counselors were trained to lead S&S group sessions. Using the RE-AIM model, primary outcomes were: Reach, the number, proportion, and representativeness of S&S attendees; Effectiveness, the impact of S&S2 on VMMC uptake; Adoption, the number, proportion, and representativeness of clinics implementing S&S2; Implementation, fidelity to the S&S intervention manual; and Maintenance, the extent to which S&S2 became an element of standard care within community clinics. Initially, n = 109 clinics were recruited; 96 were sustained and randomized for activation (Adoption). A total of 45,630 clinic patients (n = 23,236 men and n = 22,394 women) volunteered to attend the S&S sessions (Reach). The S&S2 program ran over 2,866 clinic-months (Implementation). Although the study did not target individual-level VMMCs, ~58,301 additional VMMCs were conducted at the clinic level (Effectiveness). Fidelity to the S&S intervention by group leaders ranged from 42%-95%. Sustainability of the program was operationalized as the number of CHCs initially activated that sustained the program. Intervention delivery ended, however, when study funding ceased (Maintenance). The S&S2 program successfully utilized the RE-AIM model to achieve study goals for implementation and dissemination in four Zambian provinces. Innovative VMMC programs such as S&S2 can improve the uptake of VMMC, one of the most effective strategies in the HIV prevention arsenal.

Impact of enacted stigma on mental health, substance use, and HIV-related behaviors among sexual minority men in Zambia

Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV-related risk behaviors. This study aimed to investigate the associations between enacted stigma, substance abuse, HIV-related behaviors, and mental health (i.e., depression, anxiety, and post-traumatic stress disorder [PTSD] symptoms) among SMM in Zambia. SMM aged 18–35 years who reported having multiple and/or concurrent sexual partners or low and/or inconsistent condom use in the past three months were recruited from four districts in Zambia between February and November 2021. Participants completed an anonymous interviewer-administered survey. Key variables of interest were compared between participants with higher vs. lower levels of enacted stigma. Independent samples t-tests were used for continuous variables, and chi-squared tests were used for categorical variables. A total of 197 eligible SMM participated in the study (mean age = 24.41 years). Participants with a higher level of enacted stigma showed a higher level of anxiety symptoms (χ2 = 12.91, p ≤ .001), PTSD symptoms (χ2 = 7.13, p < .01), tobacco use (χ2 = 10.47, p < .01), cannabis use (χ2 = 5.90, p < .05), and a higher number of sexual partners (t = 1.99, p < .05) in the past three months. Stigma reduction interventions may help mitigate substance abuse, HIV-related behaviors, and adverse mental health outcomes among SMM in Zambia. Health care providers, especially psychiatric-mental health nurses, can incorporate strategies for recognizing and addressing stigma into their practice through training and integrate multiple resources to create an inclusive and non-judgmental environment for SMM to improve their well-being.

Medical Male Circumcision and HIV Testing Practices among Men Aged 15 to 59 Years Old: Evidence from Zambia Demographics and Health Survey

Medical male circumcision (MMC) and HIV testing have been recommended by the World Health Organization (WHO) as part of a comprehensive approach to HIV prevention. Zambia has integrated MMC with HIV testing interventions. This study examined the syndemic relationship between MMC and HIV testing, as well as sociodemographic characteristics influencing both MMC and HIV testing in Zambia. Data were derived from the 2018 Zambia Demographic and Health Survey (ZDHS), a nationally representative cross-sectional survey conducted among 12,123 men aged 15 to 59 years. Descriptive characteristics were summarized using frequencies and proportions. Two multivariate logistic regression models examined the relationship between independent and dependent variables (HIV testing and MMC alternatively). The results showed that 76.8% of men reported having ever tested for HIV, and 26% performed MMC. The logistic regression results showed that MMC was significantly associated with ever being tested for HIV and vice versa. Sociodemographic characteristics, including province, resident type, age, marital status, education, wealth status, and religion, were also significantly associated with MMC and having tested for HIV among men in Zambia. By and large, this study has identified that both MMC and HIV have an intricate relationship with health benefits to reduce the risk of HIV infections for men in Zambia. There is a need for continuous scaling up the perceived benefits of MMC and HIV testing uptake. In addition, more robust awareness is needed in specific provinces, rural areas, and other sociodemographic variables with lower incidences of MMC and HIV testing practices among men in Zambia. Keywords: HIV testing, Men, Medical male circumcision, Sociodemographic characteristics, Zambia.

Endorsement of Spousal Sexual Violence Across Gender: Evidence from Zambia Demographic and Health Survey

Spousal sexual violence (SSV) constitutes a pressing public health and human rights crisis, exerting detrimental impacts on women's well-being and imposing significant social and economic costs on their lives. This study aimed to ascertain the comprehensive prevalence of SSV endorsement and investigate the factors associated with such endorsement among both men and women in Zambia. The 2013-2014 Zambia Demographic and Health Survey (ZDHS) served as the dataset for this study. Employing chi-square tests and two multiple logistic regression analyses stratified by gender, the research revealed that 36.6% of women and 11.5% of men endorsed SSV. Regression results highlighted significant associations between SSV endorsement and variables such as resident type, marital status, education level, and frequency of reading newspapers/magazines, cutting across genders. Among women, employment, religion, and frequency of listening to/watching television also emerged as significant factors. Conversely, wealth status and alcohol consumption significantly correlated with SSV endorsement exclusively among men in Zambia. Recognizing the potential of media platforms to shape attitudes, the study recommends leveraging them to disseminate messages discouraging SSV endorsement. Furthermore, this study emphasizes the necessity of involving multiple stakeholders, including religious leaders, traditional leaders, and non-governmental organizations (NGOs), to address cultural norms promoting SSV endorsement. The implementation of policies regulating gender-based violence and alcohol becomes imperative in diminishing both the prevalence and tolerance of SSV in Zambia. Finally, this study recommends that future research endeavors delve into men's perspectives on understanding SSV beyond the conventional focus on women victims in Zambia. Keywords: Endorsement, spousal sexual violence, intimate partner violence, gender, media, alcohol, factors, Zambia.

Physician-Patient Interaction Quality Mediates the Association Between HIV-Related Stigma and HIV-Prevention Behaviors Among Sexual Minority Men in Zambia.

HIV-related stigma is a major challenge to HIV prevention for sexual minority men (SMM) in Zambia, but little is known about the underlying mechanisms. This study aimed to investigate whether physician-patient interaction quality mediates the relationship between HIV-related stigma and HIV-prevention behaviors among SMM. Data were collected using a cross-sectional survey from 194 SMM (aged: mean=24.08, SD=4.27) across four districts in Zambia between February and November 2021. Participants were asked about their demographic characteristics, HIV-related stigma, SMM-related stigma, physician-patient interaction quality, HIV-testing intention, and use of pre-exposure prophylaxis (PrEP). Path analysis was used to test the mediation effect of physician-patient interaction quality in the associations of HIV-related stigma/SMM-related stigma with HIV-testing intention and current PrEP use. Higher self-reported physician-patient interaction quality was negatively associated with HIV-related stigma (β=- 0.444, z=- 2.223, p < 0.05), and positively associated with HIV-testing intention (β=0.039, z=5.121, p < 0.001) and current PrEP use (β=0.008, z=2.723, p < 0.01). HIV-related stigma among SMM had a significant and negative indirect effect on HIV-testing intention (β=- 0.017, z = - 2.006, p < 0.05), and current PrEP use (β=- 0.004, z=- 2.009, p < 0.05) through physician-patient interaction quality. Contrary to our expectations, SMM-related stigma did not have a significant and negative indirect effect on HIV prevention behaviors through physician-patient interaction quality. Health interventions need to improve physician-patient interaction quality by offering healthcare provider training, targeting HIV-related stigma in healthcare settings, and devising inclusive healthcare policies to promote HIV prevention efforts.

The association between contraceptive use and desired number of children among sexually active men in Zambia

BackgroundContraceptive methods have been used to space births, but also to limit a couple’s desired number of children. Efforts of family planning programmes have mainly concentrated on females, even though males tend to have large say on the desired number of children a couple should have. In our study, we sought to determine linkages between contraceptive use and desired number of children, as well as associated demographic and socio-economic characteristics, among sexually active males in Zambia.MethodsThe main outcome variable of interest was desired number of children as measured by ideal number of children which is a count variable. Data for this paper was the male dataset from the 2018 Zambia Demographic and Health Survey, a cross-sectional national survey. Binary logistic regression was performed to determine odds ratios of contraceptive use by selected characteristics of sexually active males. Multivariate Poisson Regression Model was used to establish factors associated with desired number of children.ResultsAge of men (20–29, 30–39 and 40–49 years), residence in rural areas, wealth quintile, Protestant or Muslim religious affiliation, media exposure, and having discussed family planning with a health worker in the last few months prior to the survey were associated with contraceptive use. Sexually active males who reported using any contraception method reported 3% less desired number of children compared to those who were not using any method. Older males (age group 30–49 years), resident in rural areas, with primary education, married, employed, Protestant religion, and those labelling women who use contraceptives “as promiscuous” had more desired number of children.ConclusionsThere were minimal differences in the desired number of children among males who reported using and not using any contraceptive method. Strategies aimed at encouraging contraception use should cover all categories of males to achieve universal involvement of men in family planning in Zambia. Future research may consider combining both qualitative and quantitative methods to look holistically at the demographic, socio-economic and cultural factors associated with non-contraception use and desired number of children among sexually active men in Zambia.

Factors influencing neonatal male circumcision uptake among expecting couples in Zambia: formative findings

ABSTRACT Male circumcision is a protective HIV prevention strategy. However, uncircumcised Zambian men are reluctant to undergo voluntary medical male circumcision (VMMC). Tailored interventions are necessary to stimulate the uptake of early infant male circumcision (EIMC) and VMMC in Zambia. This feasibility study presents the formative process of utilising the PRECEDE framework in the development of a family-centred EIMC/VMMC intervention, Like Father Like Son, and its application in an existing VMMC intervention, Spear & Shield. We found that fear of the pain associated with EIMC procedures, foreskin disposal, beliefs in children’s autonomy and rights, and men’s dominance in health decision-making were factors affecting EIMC uptake. Perceived benefits for infants included improved hygiene, protection from HIV infection, and faster recovery. Reinforcing factors included female partners and fathers’ MC status. The availability and access to EIMC services and information, skill and experience of health workers, and engagement and belief in traditional circumcision practices were factors enabling EIMC uptake. These individual, interpersonal, and structural factors positively and negatively influencing EIMC uptake in the Zambian clinic context were integrated into the intervention for expecting parents. Feedback from community advisory boards suggested the process was effective in developing a culturally tailored and acceptable EIMC/VMMC promotion intervention.

Maximizing the Impact of Voluntary Medical Male Circumcision for HIV Prevention in Zambia by Targeting High-Risk Men: A Pre/Post Program Evaluation

A well-documented barrier to voluntary medical male circumcision (VMMC) is financial loss due to the missed opportunity to work while undergoing and recovering from VMMC. We implemented a 2-phased outcome evaluation to explore how enhanced demand creation and financial compensation equivalent to 3 days of missed work influence uptake of VMMC among men at high risk of HIV exposure in Zambia. In Phase 1, we implemented human-centered design-informed interpersonal communication. In Phase 2, financial compensation of ZMW 200 (~ US$17) was added. The proportion of men undergoing circumcision was significantly higher in Phase 2 compared to Phase 1 (38% vs 3%). The cost of demand creation and compensation per client circumcised was $151.54 in Phase 1 and $34.93 in Phase 2. Financial compensation is a cost-effective strategy for increasing VMMC uptake among high-risk men in Zambia, and VMMC programs may consider similar interventions suited to their context.

A model for reconstructing trends and distribution in age at first sex from multiple household surveys with reporting biases

Age at first sex (AFS) is a key indicator for monitoring sexual behaviour risk for HIV and other sexually transmitted infections. Reporting of AFS data, however, suffers social-desirability and recall biases which obscure AFS trends and inferences from the data. We illustrated AFS reporting biases using data from nationally-representative Demographic and Health Surveys conducted between 1992 and 2019 in Ethiopia, Guinea, Senegal, and Zambia. Based on this, we proposed a time-to-event, interval censored model for the distribution of AFS that uses overlapping reports by the same birth cohort in successive surveys to adjust for reporting biases. The three-parameter log-skew-logistic distribution described the asymmetric and nonmonotonic hazard exhibited by empirical AFS data. In cross-validation analysis, incorporating a term for reporting bias as a function of age at report improved model predictions for the trend in AFS over birth cohorts. In the four example applications, the quartiles of the AFS distribution were 16–23 years for Ethiopian and Senegalese women and 15–20 years for Guinean and Zambian men. Median AFS increased by around one to 1.5 years between the 1960 and 1989 birth cohorts for all four datasets. During adolescent and young adult ages, men tended to report an earlier AFS while women tended to report an older AFS than when asked in their late twenties. Above age 30, both male and female respondents tended to report older AFS compared to when surveyed in their late twenties. Simulations validated that the model recovered the trend in AFS in the presence of reporting biases. When there were biases, at least three surveys were needed to obtain reliable estimate for a 20-year trend. Mis-specified reference age at which AFS reporting is assumed unbiased did not affect the trend estimate but resulted in biased median AFS in the most recent birth cohorts.

Characteristics and Sexual Risk Behavior of Men Who Never Tested for HIV in Zambia.

Compared with women and girls, proportionately fewer men and boys in sub-Saharan Africa receive HIV testing, treatment, and other services. This study determined factors associated with never testing for HIV and examined never testing as a predictor of sexual risk behavior among men in Zambia. The sample included 2,609 men aged 15 to 24 from the 2018 Zambia Demographic and Health Survey. Logistic regression results revealed that compared with men who ever tested for HIV, men who never tested were more likely to be younger, have less education, have no children, be unemployed, and belong to the low wealth bracket. They also had a higher likelihood of not using a condom at last sex but were less likely to have more than five lifetime sexual partners. HIV prevention programs can use sociodemographic characteristics to identify those who have a lower likelihood of testing for HIV. Prevention programs can use sociodemographic characteristics to develop profiles of those who may especially need to be targeted by initiatives to promote HIV testing. Awareness does not always engender behavior change; therefore, in addition to knowledge of HIV status, risk reduction should also be emphasized.

Barriers, benefits, and behaviour: Voluntary medical male circumcision ideation in a population-based sample of Zambian men

Reaching ambitious voluntary medical male circumcision (VMMC) coverage targets requires a deeper understanding of the multifaceted processes shaping men’s willingness to access VMMC. Guided by the Ideation Model for Health Communication, this population-based study identifies correlates of Zambian men’s future VMMC intentions. Multistage cluster sampling was used to identify households with adult men in 14 districts. Multivariable Poisson regression with robust standard errors modelled associations of future VMMC intent with ideational factors (e.g. perceived benefits and barriers) and sexual behaviours respectively. Forty per cent (40%) of uncircumcised men (N = 1 204) expressed future VMMC intentions. In multivariable analysis, VMMC intent was associated with secondary education or higher (Adjusted Prevalence Ratio [APR] 1.30, 95% Confidence Interval [95% CI]: 1.02–1.66), perceiving VMMC to increase sexual satisfaction (APR 1.45, 95% CI: 1.11–1.89), reporting distance to services as a barrier to VMMC uptake (APR = 0.54, 95% CI: 1.27–1.87), unprotected last sex (APR 1.54, 95% CI: 1.11–2.14), and ≥ 2 sexual partners in the past 12 months (APR 1.45, 95% CI: 1.05–1.99). Being aged ≥ 45 years (vs 18–24 years: APR 0.23, 95% CI: 0.13–0.40) and perceiving that circumcision: (1) is unimportant (APR 0.71, 95% CI: 0.51–0.98); (2) is incompatible with local customs (APR 0.41, 95% CI: 0.18–0.94); or (3) reduces sexual satisfaction (APR 0.10, 95% CI: 0.02–0.62) were inversely associated with future VMMC intent. Demand-creation efforts must confront salient cognitive and social barriers to VMMC uptake, including concerns around incompatibility with local customs. Simultaneously, promotional efforts should emphasise relevant VMMC benefits beyond HIV prevention that resonate with men (e.g. penile hygiene) without reinforcing harmful gender norms.

Women’s experiences of cultural and traditional health beliefs about pregnancy and childbirth in Zambia: An ethnographic study

Zambian women's pregnancy and childbirth are linked to a variety of cultural and traditional practices, activities and beliefs. These existential events affect the women's health and the newborn's care. In this study we used an interpretative ethnographic design. Individual deep interviews with eight Zambian women were carried out. The formation of family, pregnancy and childbirth are important for strengthening generational traditions and preserving culture. Having many children is especially important for Zambian men as it increases their status in the society. Family continuity is related to the legacy of generations through the spirits of the ancestors.

Mental health, coping and resilience among young men who have sex with men in Zambia

Current law in Zambia criminalises same-sex sexual contact while strong socio-cultural values drive a profoundly negative view of the moral status of gender and sexual minorities. Despite this, Zambia's national HIV programme has recently identified the predominantly young population of men who have sex with men as a priority group for HIV and other sexual health programming. Research in other African settings has shown how the sexual health of these young men is affected by mental health. This mixed-methods study, which drew on the minority stress model as an analytical framework, sought to explore mental health as an initial step towards understanding its influence on other health domains. Findings describe the tension, and its psychological effects, surrounding the trajectory of discovering and affirming same-sex sexuality in an environment replete with social, physical and emotional risks, but one in which young men must nevertheless seek to create and maintain a meaningful, if precarious, social existence. To achieve this, in the absence of supportive mental health services or other programmatic responses, they adopt numerous risk-mitigation or coping strategies to attempt to build resiliency and to preserve their psychological and emotional well-being.

Index and targeted community-based testing to optimize HIV case finding and ART linkage among men in Zambia.

IntroductionCurrent healthcare systems fail to provide adequate HIV services to men. In Zambia, 25% of adult men living with HIV were unaware of their HIV status in 2018, and 12% of those who were unaware of their HIV statu were not receiving antiretroviral therapy (ART) due to pervasive barriers to HIV testing services (HTS) and linkage to ART. To identify men and key and priority populations living with HIV in Zambia, and link them to care and treatment, we implemented the Community Impact to Reach Key and Underserved Individuals for Treatment and Support (CIRKUITS) project. We present HTS and ART linkage results from the first year of CIRKUITS.MethodsCIRKUITS aimed to reach beneficiaries by training, mentoring, and deploying community health workers to provide index testing services and targeted community HTS. Community leaders and workplace supervisors were engaged to enable workplace HTS for men. To evaluate the effects of these interventions, we collected age‐ and sex‐disaggregated routinely collected programme data for the first 12 months of the project (October 2018 to September 2019) across 37 CIRKUITS‐supported facilities in three provinces. We performed descriptive statistics and estimated index cascades for indicators of interest, and used Chi square tests to compare indicators by age, sex, and district strata.ResultsOver 12 months, CIRKUITS tested 38,255 persons for HIV, identifying 10,974 (29%) new people living with HIV, of whom 10,239 (93%) were linked to ART. Among men, CIRKUITS tested 18,336 clients and identified 4458 (24%) as HIV positive, linked 4132 (93%) to ART. Men who tested HIV negative were referred to preventative services. Of the men found HIV positive, and 13.0% were aged 15 to 24 years, 60.3% were aged 25 to 39, 20.9% were aged 40 to 49 and 5.8% were ≥50 years old. Index testing services identified 2186 (49%) of HIV‐positive men, with a positivity yield of 40% and linkage of 88%. Targeted community testing modalities accounted for 2272 (51%) of HIV‐positive men identified, with positivity yield of 17% and linkage of 97%.ConclusionsIndex testing and targeted community‐based HTS are effective strategies to identify men living with HIV in Zambia. Index testing results in higher yield, but lower linkage and fewer absolute men identified compared to targeted community‐based HTS.

Contrasting HIV prevalence trends among young women and men in Zambia in the past 12\u2009years: data from demographic and health surveys 2002\u20132014

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.

Knowledge, attitudes and practices of cervical cancer prevention among Zambian women and men

BackgroundIn Zambia, cervical cancer screening was started in 2006 and the human papillomavirus vaccine was piloted in 2013. Nevertheless, cervical cancer remains the leading cancer. It is assumed that knowledge, social interaction, health behaviors and religion are factors that can influence screening and vaccination practices. This study addresses the question, what is the relationship between knowledge about cervical cancer, attitudes, self-reported behavior, and immediate support system, towards screening and vaccination of cervical cancer of Zambian women and men. The results of this study serve as a basis for future research, an input for improvement and adjustment of the existing prevention program and build on documented health behavior frameworks.MethodsA cross-sectional mixed methods study was conducted from February to May 2016. Two separate questionnaires were used to collect data from women (N = 300) and men (N = 300) residing in Chilenje and Kanyama (two townships in the capital city Lusaka). Respondent’s knowledge of cervical cancer was operationalized by grading their ability to correctly identify causes and protective factors if they were aware of cervical cancer. Besides providing descriptive statistics of all study variables, we tested four research hypotheses concerning the link between knowledge, attitudes and practices suggested by the literature, by applying appropriate statistical tests (chi square test, analysis of variance, logistic regression).ResultsLess than half of the respondents (36.8%) had heard of cervical cancer, 20.7% of women had attended screening and 6.7% of the total sample had vaccinated their daughter. Knowledge of causes and prevention was very low. There was a strong association between having awareness of cervical cancer and practicing screening (odds ratio = 20.5, 95% confidence interval = [9.214, 45.516]) and vaccination (odds ratio = 5.1, 95% confidence interval = [2.473, 10.423]). Social interactions were also found to greatly influence screening and vaccination behaviors.ConclusionsThe low level of knowledge of causes and prevention of cervical cancer suggests a need to increase knowledge and awareness among both women and men. Interpersonal interactions have great impact on practicing prevention behaviors, for instance, vaccination of daughters.

Exclusion of Sexual Minorities in Sexual Health Education in Zambia

Background: Sexual health interventions against sexual contraction and transmission of HIV in most developing countries such as Zambia, are often biased towards heterosexual sexual health interventions. This act tends to exclude minority sexual groups such as men who have sex with men whose existence could affect the transmission and spread of the virus. This paper therefore sought to present an analysis of the exclusion of sexual minorities in sexual health education interventions in Zambia. Methods: This paper employed a desk-based-research study and relied mainly on the review of secondary data in form of Ministry of Health (MOH) and National Aids Council (NAC) strategic documents and scholarly journals, articles and research papers relevant to the topic. Results: A knowledge gap on sexual health education exists amongst the sexual minority groups in the few studies assessed. This can be attributed to the fact that the Zambian society is believed to be heterosexual with most interventions adopting a heterosexual stance towards sexual health education. Limited thought to the sexual health concerns of men who have sex with men in Zambia can be attributed to criminal laws against acts of homosexuality, societal disdain for acts of a non-heterosexual nature, and religious teachings against acts of a non-heterosexual nature. Lack of consideration of sexual minorities and their sexual activities may have serious effects on their sexual health knowledge levels and sexual practices. Conclusion: Legal, societal and religious opposition must be addressed to enable open public discussion and debates on the design of more representative sexual health education.

Alcohol and Tobacco Use among Men in Zambia and Zimbabwe.

BackgroundTo date, there is no country-representative study on tobacco and alcohol use in Zambia and Zimbabwe despite the fact that these two countries rank among the top producers of tobacco worldwide. To fill this research gap, we conducted this study to measure the prevalence of tobacco and alcohol consumption among adolescent and adult men in Zambia and Zimbabwe. Special attention was given to the age differential in the prevalence of smoking and drinking.MethodsCountry-representative data on alcohol and tobacco use along with relevant sociodemographic parameters were collected from Demographic and Health Surveys. Sample population were 23,169 men (14,773 from Zambia and 8,396 from Zimbabwe) aged 15–54 years. Data were analysed using multivariate regression techniques.ResultsPrevalence of tobacco use was 19.9% (19.0–20.9) in Zambia and 18.4% (17.4–19.5) in Zimbabwe, and that of alcohol was 37.6% (36.4–38.9) in Zambia and 50.5 (48.9–52.1) in Zimbabwe. In both of the countries, the majority of the tobacco and alcohol users were aged between 24–39 years. Results of multivariate regression analysis showed a significant positive association between tobacco and alcohol use with age, place of residence, religious affiliation, marital status, education and wealth quintile.ConclusionNearly one-fifth of all men in the age group of 15–54 years smoke tobacco in Zambia and Zimbabwe, with the prevalence being most pronounced among those aged between 25–39 years. The predominantly young age structure of alcohol and tobacco users warrant demographically tailored anti-tobacco and alcohol controlling programmes.

Retinoic acid elicits a coordinated expression of gut homing markers on T lymphocytes of Zambian men receiving oral Vivotif, but not Rotarix, Dukoral or OPVERO vaccines

All-trans retinoic acid (ATRA) up-regulates, in laboratory animals, the expression of the gut homing markers α4β7 integrin and CCR9 on lymphocytes, increasing their gut tropism. Here, we show that, in healthy adult volunteers, ATRA induced an increase of these gut homing markers on T cells in vivo in a time dependent manner. The coordinated increase of α4β7 and CCR9 by ATRA was seen in 57% (12/21) of volunteers and only when given together with an oral Vivotif vaccine. When this coordinated response to ATRA and Vivotif vaccine was present, it was strongly correlated with the gut immunoglobulin A (IgA) specific response to vaccine LPS (ρ = 0.82; P = 0.02). Using RNA-Seq analysis of whole blood transcription, patients receiving ATRA and Vivotif in conjunction showed transcriptomic changes in immune-related pathways, particularly including interferon α/β signaling pathway, membrane-ECM interactions and immune hubs. These results suggest that exogenous ATRA can be used to manipulate responses to a subclass of oral vaccines, so far limited to a live attenuated Vivotif vaccine.

Determinants of condom use among currently married men in Zambia

HIV is one of the leading health threats and cause of morbidity and mortality in Zambia. Among many preventive measures, condom use is the most effective methods of preventing HIV. The aim of this study was to investigate factors associated with condom use among currently married men in Zambia. Secondary data from the 2013 Zambia Demographic Health Survey was used. Results from binary logistic regression analysis showed that condom use is associated with being young (β = -0.71, p &lt; 0.001), being rich (β = 0.25, p &lt; 0.05), paying for sex (β = 0.42, p &lt; 0.001), perceiving risk of contracting HIV (β = 0.38, p &lt; 0.001), and believing in the efficacy of condom use as a protective measure against HIV (β = 0.24, p &lt; 0.01). Condom use in Zambia is associated with socio-demographic characteristics and habits of adult males. Therefore, prevention measures aimed at increased the use of male condoms should integrate social demographic characteristics and habits of adult males to be effective.Keywords: Condom use, married men, determinants, Zambia