What are the factors contributing to the high prevalence of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) in Zambia and other African countries?

From the Guidelines

HIV/AIDS prevalence is high in Zambia and other African countries due to a combination of factors, including limited healthcare infrastructure, poverty, cultural practices, and limited education about HIV prevention, with mother-to-child transmission remaining a significant concern despite prevention efforts. The primary drivers of HIV/AIDS in these countries include restricted access to testing, treatment, and prevention services, high-risk behaviors, and low condom use. Additionally, high rates of other sexually transmitted infections increase HIV transmission risk, and limited education about HIV prevention exacerbates the issue. According to a study published in 2021 1, the transmission of HIV from an HIV-positive mother to her child during pregnancy, labor, delivery, or breastfeeding is a significant contributor to the HIV pandemic, accounting for 9% of new infections globally.

Key factors contributing to the high prevalence of HIV/AIDS in Zambia and other African countries include:

• Limited healthcare infrastructure, which restricts access to testing, treatment, and prevention services
• Poverty, which forces some individuals into high-risk behaviors like transactional sex
• Cultural practices such as polygamy and gender inequality that reduce women's ability to negotiate safe sex
• Low condom use
• High rates of other sexually transmitted infections that increase HIV transmission risk
• Limited education about HIV prevention

Treatment typically involves antiretroviral therapy (ART) regimens, which must be taken daily for life to suppress viral loads. Prevention strategies include pre-exposure prophylaxis (PrEP) for high-risk individuals, male circumcision, condom use, and regular testing. As noted in a study published in 2012 1, targeted PMTCT treatment, including HIV testing and serostatus awareness, improves adherence to ART for PMTCT and is recommended compared to an untargeted approach in high-HIV-prevalence settings. Progress has been made through increased testing, treatment coverage, and prevention programs, but challenges persist in reaching remote populations and maintaining consistent medication supplies. The virus depletes CD4 immune cells, making early detection and treatment crucial to prevent progression to AIDS and reduce transmission. Furthermore, a study published in 2013 1 highlights the impact of HIV/AIDS on mental health in the family and community, emphasizing the need for comprehensive support systems to address the socio-emotional needs of children affected by HIV/AIDS.

From the Research

HIV/AIDS Prevalence in Zambia

• The HIV/AIDS pandemic has had a significant impact on Zambia, with the country being one of the hardest hit in the Eastern and Southern African region 2.
• Studies have shown that there is a considerable geographical variation in the prevalence of HIV in Zambia, with some districts having a prevalence as high as 23.5% 2.
• The prevalence of HIV in Zambia is highest in districts located near international borders, along the main transit routes, and adjacent to other districts with high prevalence 2.

Factors Contributing to HIV/AIDS Prevalence

• Demographic characteristics such as gender, age, and geographical location have been associated with HIV prevalence in Zambia 3, 4.
• Urban residents have been found to have a higher prevalence of HIV than rural residents, with a prevalence of 9.8% compared to 5.0% in rural areas 4.
• Being divorced or widowed has been associated with a threefold higher risk of being HIV positive than being never married 4.
• The risk of being HIV positive is four times higher among those with tuberculosis than those without tuberculosis 4.

Progress in Controlling the HIV Epidemic

• Zambia has made substantial progress in controlling the HIV epidemic, with a decline in HIV incidence from 0.6% to 0.3% and an increase in viral load suppression prevalence from 59.2% to 85.7% between 2016 and 2021 5.
• The implementation of a test-and-treat strategy has been identified as a key factor in the progress made in controlling the HIV epidemic in Zambia 5.

Treatment and Management of HIV

• The use of antiretroviral regimens such as tenofovir DF, emtricitabine, and efavirenz has been shown to be effective in suppressing HIV replication and improving CD4 cell counts 6.
• The combination of tenofovir DF and emtricitabine plus efavirenz has been found to be superior to a fixed dose of zidovudine and lamivudine plus efavirenz in terms of virologic suppression, CD4 response, and adverse events resulting in discontinuation of the study drugs 6.