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Mobile outreach, community-based testing and door-to-door HTC initiatives are also increasing uptake of HIV testing in Zambia.39 In 2015, UNITAID, Population Services International and partners began implementing self-testing in Malawi, Zambia and Zimbabwe through the four-year STAR Project (HIV Self-Testing Africa Research).

Between 20, the STAR Project will distribute nearly 750,000 self-test kits across the three countries.

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Zambia’s revised National HIV and AIDS Strategic Framework (R-NASF) 2014 – 2016 now includes indicators on sex workers, men who have sex with men, and people who inject drugs.9 Between 20, the Population Council and partners have been conducting the first integrated biological and behavioural research in Zambia to determine the population size, HIV prevalence and incidence among sex workers, men who have sex with men, and people who inject drugs.

This research will also identify social risk factors such as stigma and discrimination, alcohol and drug use, lack of access to services, and the absence of a social support network.10 Once published, the survey’s findings will provide national policymakers with objective evidence to inform HIV prevention, care, and treatment programs for key populations.

28 Although this is a significant decline from 13,000 new infections among children in 2010, these latest statistics also show a turning trend from recent improvements where, in 2015, just 4,700 new infects occurred among children in comparison.29 There has been a rigorous prevention of mother-to-child transmission (PMTCT) programme implemented in Zambia, which has seen the percentage of children born HIV-positive drop by 51% between 20.30 In 2015, 87% of pregnant women living with HIV were receiving effective antiretroviral treatment, just under universal health targets of 90%.31 Despite these promising changes, new challenges have arisen for those infants exposed to HIV at birth, with many struggling to adhere to treatment.

Among infants diagnosed with HIV in Lusaka, the Zambian capital, around 40% were reported as presenting resistance to at least one ART drug by 2014 compared to 21.5% in 2009.

However, much higher HIV prevalence is reported elsewhere, such as 33% by the MSM Global Forum (MSMGF).14 The illegal status, stigma and discrimination that men who have sex with men experience makes them a population that is difficult to reach with HIV prevention messages.

The number of sex workers in Zambia is disputed, as is the HIV prevalence among this population, with studies reporting vastly different statistics.

About 23% had sex with two or more female sex workers in the last 12 months.18 The survey found varying condom use depending on whom the respondents were having sex with.

The results showed that, of the men questioned, condom use was at 86% with sex workers, 77% with non-regular partners, 63% with a regular partner and just 7% with wives.

11 However, until this occurs, data on Zambia’s key populations remains limited.

Same sex intercourse is illegal in Zambia.12 What is currently known about this group is that men who have sex with men experience a heightened vulnerability to HIV for a multitude of reasons including alcohol abuse, low levels of education, being subjected to discrimination and low economic status.13 The Zambian government's own progress report alludes to one small-scale study in 2008, which puts HIV prevalence among this group at just 1%.

This is due to them experiencing exploitation, abuse and gender-based violence both on their journey and at their destination which is more likely when they are temporary migrant with few employment rights.21 In 2015, 640,000 of the 1.1 million adults (aged 15 and over) living with HIV in Zambia were women.22 Prevalence is much higher among younger women than younger men, standing at 11.2% for women and 7.3% for men aged 20-24.23 This reflects three main factors: Zambian society and culture is extremely patriarchal, limiting the power of women in relationships.

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