At a glance: HIV in Zambia

• 1.4 million people with HIV
• 10.8% adult HIV prevalence
• 33,000 new HIV infections
• 19,000 AIDS-related deaths
• 1.3 million people on antiretroviral treatment

The current targets for HIV testing and treatment are called the 95-95-95 targets and must be reached by 2025 in order to end AIDS by 2030.

In 2022 in Zambia:

Did you know?

Life expectancy among people with HIV in Zambia has improved significantly as a result of scaled-up treatment programmes in recent years.

Preventing HIV in Zambia focuses on:

• prevention of mother-to-child transmission
• voluntary medical male circumcision (VMMC)
• social and behaviour change communication
• male and female condoms
• STI management
• PrEP (a daily pill is available; a vaginal ring has been approved for use and injectable PrEP is being rolled out to two provinces)
• PEP (ARV drugs taken just after being exposed to HIV to prevent infection)
• a range of prevention services for young people, particularly adolescent girls and young women.

Did you know?

Despite the outbreak of the COVID-19 pandemic in 2020, Zambia managed to expand its VMMC programme by 15%. But 2021 data suggest coverage is still off track, with only around 30% of men and adolescent boys circumcised – the target is 90%.

Testing for HIV is:

• lower among men and young people than women
• available in health facilities, community spaces, at home (as door-to-door testing or self-testing), workplaces and during testing events
• encouraged for couples, and for the partners and children of people newly diagnosed with HIV (called partner notification and index testing).

Did you know?

HIV tests are offered to young people as part of HIV prevention campaigns, along with free condoms and advice on how to reduce the risks of getting HIV. An analysis of HIV testing in Zambia (based on 2018 data) suggests 65% of young women and 49% of young men are taking yearly tests.

Treatment for HIV is:

• free
• available immediately after diagnosis
• available in multi-month refills (for people who are stable on treatment and virally suppressed)
• monitored by viral load testing
• includes nutrition and psychosocial support to help people stay on treatment
• available in most health facilities
• includes home and community-based adherence support
• first-line treatment is an antiretroviral regimen that contains Dolutegravir, which is recommended by the World Health Organization as it has fewer side effects.

Did you know?

In 2017, Zambia adopted ‘test and treat’, which offers immediate treatment to anyone diagnosed with HIV. Since then, 20% more people with HIV have started treatment. Between 2021 and 2022 alone, 10,000 more people with HIV started treatment.

Prevalence among adults in Zambia has changed little over the last decade despite decreasing infection rates. As a result, HIV prevention has been a key focus in recent years – PrEP has been rapidly scaled up and comprehensive sexuality education is now offered in primary and secondary schools. At the beginning of 2024, around 600,000 people in Zambia were using PrEP. Despite this, UNAIDS analysis suggests the country is still not making enough progress on HIV prevention.

Zambia’s HIV epidemic affects different groups in different ways. Women are far more likely to have HIV than men – young women (ages 15-24) are three times as likely to get HIV than their male peers, for example. But men are more likely than women to die from an AIDS-related illness because they are less likely to test for HV and seek treatment.

There are also regional variations, with HIV prevalence highest in the urban provinces of Lusaka and Copperbelt and in the Western province.

Violence against women remains common and helps to drive the epidemic among females. Around one quarter of Zambian women will experience intimate partner violence. Among young women (aged 20 to 24), this is even more common, with around one-third experiencing partner violence. 

Zambia criminalises men who have sex with men (who face a prison sentence of up to 14 years), sex workers and people who use drugs. This stops many people from these groups from getting the HIV prevention, testing and treatment they need, despite being at high risk of infection. As a result, these groups are extremely vulnerable to HIV, although data on HIV prevalence is limited.

Abortion is only legal in limited circumstances on health grounds (for example, to save a woman’s life or in cases of foetal impairment).

HIV-related stigma remains an issue in Zambia. In 2023, the People Living with HIV Stigma Index found that one third of people with HIV had experienced HIV-related stigma in the past year, and around half had experienced it at some point. This was even higher among key populations at 60-70%.

Zambia’s HIV response is reliant on international funding, which accounts for 95% of HIV-related spending. In 2019, the Zambian Government introduced a National Health Insurance Scheme to increase domestic resources for the health sector, including for HIV. But the fallout of the COVID-19 pandemic means the government is now cutting public spending, which is likely to affect health. By 2026, government spending (as a share of gross domestic product) will be roughly half the amount that was spent in 2020.