Transcript Policies_Strategies and Status of AIDS in Zambia

NAC
ZAMBIA
GOVERNMENT OF ZAMBIA
NATIONAL AIDS COUNCIL
Policy Overview and Status of
the AIDS Epidemic in Zambia
Dr Ben Chirwa
Director General
National HIV/AIDS/STI/TB Council
Contents
1. Status of the Epidemic
2. Blind Spots
3. Policy/strategy
4. Achievements
5. Way Forward
1. Status of the Epidemic
HIV Prevalence
 1.3% drop between 2001 and 2007 from 16% to 14.3%
(DHS 2001 and 2007)
 Location: Urban = 20%:
Rural = 10.3%
 Gender: Female = 16%: Male = 12%
Prevalence in Zambia by Province 2001/2 – 2007
Source: ZDHS 2007
01
07
8.3
6.8
0111.2
0713.3
0119.9
019.2
0717.0
076.9
0113.7
0710.3
0115.3
0717.5
0122.0
0113.1
0720.8
0715.2
0117.6
0714.5
01 =
07
year 2001/2
= year 2007
Comparison HIV Prevalence by Province for 2001/2 and
2007
Changes in Provincial HIV Prevalence between 2001/2 and 2007 ZDHS Results
25.0%
22.0%
20.8%
19.9%
20.0%
HIV Prevalence
17.5%
17.6%
17.0%
15.2%
15.3%
15.0%
14.5%
13.2%
13.1%
11.2%
13.7%
10.3%
9.2%
10.0%
8.3%
6.9%
6.8%
5.0%
0.0%
2001-2
Lusaka
22.0%
Central
15.3%
C/belt
19.9%
Western
13.1%
Southern
17.6%
Luapula
11.2%
Eastern
13.7%
N/western
9.2%
Northern
8.3%
2007
20.8%
17.5%
17.0%
15.2%
14.5%
13.2%
10.3%
6.9%
6.8%
Central: Increased 15.3% to 17.5%
Western: Increased 13.1% to 15.2%
Luapula: Increased 11.2% to 13.2%
REMAINING SIX Provinces = Decreased
Highest: Lusaka = 22% (2002)/ 20.8% (2007)
Lowest: Northern = 8.3% (2002)/ 6.8% (2007)
6
Trend of HIV Prevalence Among Youths from 1994 to 2006 showed decline Based
Trend ANC Sentine Surviellance HIV Prevalence 1994-2006
Trends in HIV infection among youths 15-24 from 1994 to 2006
21.0%
25.0%
20.0%
Percentage of Youth Infected
20.0%
19.1%
19.0%
Axis Title
19.0%
18.6%
18.0%
17.0%
21.9%
20.7%
19.2%
20.0%
18.1%
15.5%
15.0%
10.0%
18.8%
16.6%
16.4%
15.9%
14.1%
12.6%
10.9%
12.9%
11.7%
8.7%
5.0%
16.7%
16.0%
15.0%
HIV Prevalence
0.0%
1994
1998
2002
2004
2006
15-19
14.1%
10.9%
12.6%
11.7%
8.7%
1994
1998
2002
2004
2006
20-24
21.9%
20.7%
19.2%
18.1%
15.5%
20.0%
18.6%
19.1%
19.0%
16.7%
15-24
18.8%
16.6%
16.4%
15.9%
12.9%
HSS Report 2006
7
There is increase in HIV prevalence in some sitesHIV % prevalence by year of ANC SS survey, 7 sentinel
sites, Zambia, 1993-2006
Kalabo
Macha
Chelstone
Chilenje
Kalingalinga
Matero
Nchelenge
Mean Rate
40
HIV Prevalence in Survey Sites
35
30
25
20
15
10
5
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Status of the Epidemic
Total population 15 years and older
1400000
1200000
1000000
800000
600000
400000
Total population
Total new infections
Total deaths
200000
0
Year
HIV Incidence in Zambia
HIV Incidence in Zambia
• HIV incidence rate reduces, the absolute number of new
infections increases due to the increase in population
size
• The estimated number of annual new infections in the
adult population aged 15-49 years in 2007 and 2008 was
79,755 and 80,442, respectively.
• The number of annual new HIV infections among adults
aged 15-49 years was estimated to have peaked in 1991
at 107,645.
• The lowest number of new infections among adults 15
years and older was 62,422 in 1997.
• The increase in the number of new cases after 1997
could be due to the increasing population size
Males
Females
Year
Total
2014
2012
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
Percentage of annual new infections
Estimates HIV Incidence trend in Zambia
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Figure
Regression of HIV incidence among adults by year of end of
observation of cohort in different districts in Zambia
100.00
90.00
80.00
HIV incidence
70.00
60.00
50.00
40.00
y = -0.1529x + 314.53
R² = 0.0618
30.00
20.00
10.00
0.00
1986
1988
1990
Source: USBUCEN HIV Global HIV database
1992
1994
1996
End year of cohort
1998
2000
2002
2004
2. Blind Spots
Several blind spots which may
contribute to another wave of
increase exist!!!!!!!!
MSM study of N= 3,000 in four cities and two districts in
Southern, Lusaka, Copperbelt and Luapula
ANAL Practice in different subpop
Kaizar P. Zulu etal, 2004
STI syndromes by Gender based on DHS 2007
7
6
% prevalence
5
4
Total 15-49
3
2
1
0
STI
Bad smelling/ Genital sore/ulcer
STI/genital
abnormal genital
discharge/sore or
discharge
ulcer
STI
Females
ZDHS 2007
Bad smelling/ Genital sore/ulcer
STI/genital
abnormal genital
discharge/sore or
discharge
ulcer
Males
Reporting STI syndromes
LOW RATES OF MALE CIRCUMCISION
• Research shows ‘major’ benefit to males
• Only 13% of men circumcised, despite
general openness to the practice –
significant provincial differences
• HIV prevalence in circumcised men is
slightly lower
• Self-reported male circumcision is not
always accurate
• Barriers exist in non-circumcising
communities
Male Circumcision
Percentage of men 15-49 who
report having been circumcised
Central Copperbelt Eastern Luapula
Lusaka Northern North- Southern Western
Western
TOTAL
MOBILITY & MIGRATION: Being away from home
increases risk of for all in stable employment including
Government staff
• More nights away can increase risk for the
traveller and/or those who stay home, esp
for women
• Mobile workers and migrants form sexual
networks with women who sell sex
• Large mobile groups in Zambia include truck
drivers, sex workers (incl informal),
fishermen/women and fish traders, seasonal
agricultural workers, cross border traders,
miners, uniformed services personnel,
prisoners, and refugees.
MODE OF TRANSMISSION MODELLING OF INCIDENCE:
Adult Risk Behavior
Distribution of new infections by mode of exposure
in the adult population
Injecting Drug Use (IDU)
Medical injections
0.00
0
0.00
557
0.75
Clients
2,997
4.04
Partners of Clients
1,341
1.81
732
0.99
40
0.05
25,222
33.96
27,500
37.03
15,734
21.19
0
0.00
124
16
74,263
0.17
0.02
Sex workers
No risk
Low-risk heterosexual
Partners CHS
Risk group
0
Partners IDU
Blood transfusions
MSM
Casual heterosexual sex
Female partners of MSM
Female partners of MSM
MSM
Casual heterosexual sex
Partners of Clients
Partners CHS
Clients
Sex workers
Low-risk heterosexual
Partners IDU
No risk
Medical injections
Injecting Drug Use (IDU)
0
5
MOT Report 2008
10
15
20
25
Percent
30
35
40
% of
incidence
Incidence
Blood transfusions
TOTAL ADULT POPULATION
What does all these data tell us
about the epidemic?
• There is decline in HIV prevalence in general
population but increase in absolute number due
to successful ART policy
• There hotspots existing which might contribute
to another wave of increase in HIV incidence
• HIV prevalence is highest among widows and
separated in both urban and rural among
women
• HIV prevalence is positively correlated with
employment and educational status
What does all these data tell us
about the epidemic?
• HIV prevalence increases among pregnant
women with increase in age disparity among
partners
• Overall incidence is also on the decline but
increase in absolute numbers due to population
increase.
• Key behavioral indicators supporting this is
partner reduction
determinants of
incidence
Current
response:
prevention
incidence
Current
response:
care and
treatment
prevalence
PLHA
Source: ASAP
Training, 2007
death
high alcohol and drug abuse
ultiple and concurrent sexual partners
Drivers of
Epidemic
lack of male
circumcision
Low Risk Perception
low rates of condom use
High STI
Risky cultural practices
Gender based violence
High mobility
Key Performance Indicators of the
Response
Zambia
ART
PMTCT
HCT
KNOWLEDGE
0%
20%
2005 achievement
40%
60%
2007 achievement
80%
2010 targets
100%
3. Policy/strategy
Multisectoral Response
 ‘3 Ones’ principles application
 One national AIDS strategic framework 20062010
 One national coordinating body - the NAC
 Reports to Cabinet Committee on AIDS
 Decentralised structures
 Stakeholders coordination through self-coordinating groups
including Cooperating partners
 One M&E system
National Goal, Vision and Mission
Scale up
prioritized
actions
Integrated
into
dev agenda
Coordinated
by NAC
Multisectoral
Response
A nation free from
the threat of HIV and
AIDS.
Halt and begin to
revise spread
and mitigate impact
Prevention Response
Package
Comparison of Distribution of Spending by Category for 2005 and
2006
Comparision of Percentage of Total AIDS Funds Spent on Specific Thematic Area Between
2005 and 2006
Percentage Spent on Thematic Area
60.0%
52.3%
50.0%
36.1%
40.0%
30.0%
28.0%
26.1%
19.5%
20.0%
10.0%
4.4%
7.4%
9.5%
1.7% 1.8%
5.2%
8.1%
0.0%
Prevention
Treatment Care
and Support
Advocacy and
Coordination
36.1%
Mitigation and
Social
protection
19.5%
2005
28.0%
2006
26.1%
9.5%
Mainstreaming
and
Decentralization
1.7%
Monitoring
Evaluation and
research
5.2%
52.3%
4.4%
7.4%
1.8%
8.1%
4. Achievements
What is working in the Response
• PMTCT services has reduced transmission
rate from mother to children from 30% to
12.4% (SIDA Report)
• We have 100% blood safety programme
but we do not know the transmission rate
through blood
• Peer programmes for young people are
effective for promoting sexual debut
What is working in the Response
• There is sustained change in perception
through BCC. But messages need to be
segregated
• Condom promotion is effective in casual
sex and among most at risk groups but
need to look at stable relationships
• Positive prevention among PLHIV but
need to scale interventions on
discordant couples
Percentage of donated blood units screened for
HIV in a quality-assured manner
 Zambia maintained 100% screening for HIV of all blood
units collected in a quality assured manner for both
2006 and 2007
 Data does not include blood units collected or
screened by the private sector and rural facility blood
transfusion practices not linked to the nine national
sites.
Percentage of women and men with advanced
HIV infection receiving antiretroviral therapy
 ART programe coverage increased
from 32.9% in 2006 to 70% June 2009
 245,000 total on ART of which 20,000
are children
 427 ART sites established nationwide
with cover.
Percentage of HIV-positive pregnant women who received antiretroviral prophylaxis to reduce the risk of mother-to-child
transmission
• Increased from 29.7% in 2006 to 50% in
June 2009
• The number of sites in all 72 districts have
increased from 67 in 2005 to 307 in 2006 678
in 2007, and 937, 2009
Percentage estimated HIV-positive incident TB cases that
received treatment for TB and HIV
• 39% of co-infected cases receive treatment
for HIV and TB
• Approximately 70 percent of people with TB
are co-infected with HIV
Percentage of women and men aged 15-49 who received an
HIV test in the last 12 months and who know their results
• 15% of women and men aged 15-49
have a received a test in the 12
months and know their results.
• 85% does not know their status
• Over 1500 sites established
nationwide
5. Way Forward
1. Target specific populations with
specific programmes in specific areas
Behaviour change communication
programme
Couples
The youth
Mobile populations
MSM
Social and cultural norm strengthening Community leaders
and change communication
Elders and advisors in the
programme
community
PMTCT programme
All pregnant women and their
partners,
Counselling and Testing programme
Couples in urban areas
Individuals who request the
service
2. Establish AIDS Fund
• This will sustain current investment by
government