Gender differentials in sexual initiation among adolescents in Zambia

The purpose of the present study was to assess gender differentials in factors influencing sexual initiation among adolescents in Zambia. Data employed in this study was derived from the 2013 Zambia Demographic Health Survey. Logistic regression analysis was used to identify gender differentials in sexual initiation by considering socio-economic variables. The data revealed that about 22 per cent of the female and 32.6 per cent of males reported having had sex by the age of 15 years old. About 49.5 per cent of the female and 54.9 per cent of the males reported having had sex by the age of 18 years old. Logistic regression analysis identified age, religion, residence, wealth status, working status, educational level, watching television and drinking alcohol as strong predictors of respondent’s likelihood of sexual initiation by the age of 15 years old. The study found that male youths who drank alcohol were 1.4 times more likely to be sexually active by the age of 15 years old compared to those who did not drink alcohol. Female youths who were working were 1.4 times more likely to report having had sex by the age of 15 years old and those who drank alcohol were 1.3 times more likely to report been sexually active by the age of 15 years old. This study is in agreement with other African and western based studies which have shown that socioeconomic and demographic variables have a significant influence on early sexual initiation among adolescents in Zambia. Interventions that seek to prevent HIV and AIDS and unwanted pregnancies among adolescents through regulation of sexual behaviour would need to seriously account for socio-demographic and economic influences.Keywords: Gender differentials, sexual initiation, youth, Zambi

Traditional healers and the treatment of sexually transmitted illness in rural

Abstract Lately there has been increasing interest regarding the practice of traditional healers and their use of indigenous plants to treat illnesses. Twenty-three local healers (n'ganga) in Chiawa, rural Zambia, were interviewed about knowledge, practices, and their use of indigenous plants in the diagnosis and treatment of sexually transmitted illnesses (STIs) among male clients. They were also asked about their perceptions of modern medicine. The study revealed that all the n'ganga diagnosed and treated three main types of STIs. They named them as: songeya, doroba and bola-bola. They treated the illnesses with Strychnos cocculoides; Musa species; Solanum delegoense; Ximenia caffra; Diplorynchus condylocarpon; and Croton megalobotrys. Ten of the n'ganga perceived modern medicine to be effective against STIs and five of them sometimes referred some of the clients to the local health centre. It is being argued that a scheme to incorporate the n'ganga into STD control activities in which they can be utilised to refer clients to modern medical facilities can be baneficial. Given the necessary health information and support, the n'ganga may effectively execute this scheme

Measurement of HIV Prevention Indicators: A Comparison of the PLACE Method and a Household Survey in Zambia

Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the epidemic. This paper presents, the Priorities for Local AIDS Control Efforts (PLACE) method which focuses on understanding the venues where people are meeting new sexual partners and behaviors which put people at risk. A comparison of data from two PLACE studies in Zambia with a national household survey, the Zambia Sexual Behavior Survey (ZSBS) 2005, indicated that the PLACE population was at greater risk of acquiring HIV. Respondents in the two PLACE studies were significantly more likely to report 1+ new partners in the past 4 weeks, 2+ partners in the past 12 months, 1+ new partner in the past 12 months and transactional sex. Data from the PLACE method is important for targeting interventions for those most likely to acquire and transmit HIV

Engaging communities in supporting HIV prevention and adherence to antiretroviral therapy in Zambia

In Zambia, the prevalence of HIV is estimated at 16 percent among 15–49-year-olds. This brief presents findings from an operations research study to access the outcomes of the Antiretroviral Community Education and Referral (ACER) project in two urban areas in Zambia—Lusaka and Ndola. The ACER project was implemented by the International HIV/AIDS Alliance, based in England, and the Alliance’s Zambia office, in conjunction with local Zambian partners. Launched in mid-2004, the two-year project built on previous formative research that examined knowledge and attitudes about prevention and treatment. The research was conducted by the Institute of Eco­nomic and Social Research in Zambia and the Horizons Program. The study documents many positive trends among people on ART and community members in the research sites, including increased knowledge about HIV prevention and ART, greater uptake of HIV test­ing, increased use of peer networks as an information source, and reduced stigma. Despite these improvements, there were few statisti­cally significant differences between the intervention and comparison sites

National and subnational HIV/AIDS coordination: are global health initiatives closing the gap between intent and practice?

BACKGROUND: A coordinated response to HIV/AIDS remains one of the 'grand challenges' facing policymakers today. Global health initiatives (GHIs) have the potential both to facilitate and exacerbate coordination at the national and subnational level. Evidence of the effects of GHIs on coordination is beginning to emerge but has hitherto been limited to single-country studies and broad-brush reviews. To date, no study has provided a focused synthesis of the effects of GHIs on national and subnational health systems across multiple countries. To address this deficit, we review primary data from seven country studies on the effects of three GHIs on coordination of HIV/AIDS programmes: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank's HIV/AIDS programmes including the Multi-country AIDS Programme (MAP). METHODS: In-depth interviews were conducted at national and subnational levels (179 and 218 respectively) in seven countries in Europe, Asia, Africa and South America, between 2006 and 2008. Studies explored the development and functioning of national and subnational HIV coordination structures, and the extent to which coordination efforts around HIV/AIDS are aligned with and strengthen country health systems. RESULTS: Positive effects of GHIs included the creation of opportunities for multisectoral participation, greater political commitment and increased transparency among most partners. However, the quality of participation was often limited, and some GHIs bypassed coordination mechanisms, especially at the subnational level, weakening their effectiveness. CONCLUSIONS: The paper identifies residual national and subnational obstacles to effective coordination and optimal use of funds by focal GHIs, which these GHIs, other donors and country partners need to collectively address

Can biomedical and traditional health care providers work together? Zambian practitioners' experiences and attitudes towards collaboration in relation to STIs and HIV/AIDS care: a cross-sectional study

BACKGROUND: The World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS. METHODS: We conducted a cross-sectional study in two Zambian urban sites, using structured questionnaires. We interviewed 152 biomedical health practitioners (BHPs) and 144 traditional health practitioners (THPs) who reported attending to patients with STIs and HIV/AIDS. RESULTS: The study showed a very low level of experience of collaboration, predominated by BHPs training THPs (mostly traditional birth attendants) on issues of safe delivery. Intersectoral contacts addressing STIs and HIV/AIDS care issues were less common. However, both groups of providers overwhelmingly acknowledged the potential role of THPs in the fight against HIV/AIDS. Obstacles to collaboration were identified at the policy level in terms of legislation and logistics. Lack of trust in THPs by individual BHPs was also found to inhibit collaboration. Nevertheless, as many as 40% of BHPs expressed an interest in working more closely with THPs. CONCLUSION: There is indication that practitioners from both sectors seem willing to strengthen collaboration with each other. However, there are missed opportunities. The lack of collaborative framework integrating maternal health with STIs and HIV/AIDS care is at odds with the needed comprehensive approach to HIV/AIDS control. Also, considering the current human resources crisis in Zambia, substantial policy commitment is called for to address the legislative obstacles and the stigma reported by THPs and to provide an adequate distribution of roles between all partners, including traditional health practitioners, in the struggle against HIV/AIDS

How HIV/AIDS scale-up has impacted on non- HIV priority services in Zambia

Background: Much of the debate as to whether or not the scaling up of HIV service delivery in Africa benefits non-HIV priority services has focused on the use of nationally aggregated data. This paper analyses and presents routine health facility record data to show trend correlations across priority services. Methods: Review of district office and health facility client records for 39 health facilities in three districts of Zambia, covering four consecutive years (2004-07). Intra-facility analyses were conducted, service and coverage trends assessed and rank correlations between services measured to compare service trends within facilities. Results: VCT, ART and PMTCT client numbers and coverage levels increased rapidly. There were some strong positive correlations in trends within facilities between reproductive health services (family planning and antenatal care) and ART and PMTCT, with Spearman rank correlations ranging from 0.33 to 0.83. Childhood immunisation coverage also increased. Stock-outs of important drugs for non-HIV priority services were significantly more frequent than were stock-outs of antiretroviral drugs. Conclusions: The analysis shows scale-up in reproductive health service numbers in the same facilities where HIV services were scaling up. While district childhood immunisations increased overall, this did not necessarily occur in facility catchment areas where HIV service scale-up occurred. The paper demonstrates an approach for comparing correlation trends across different services, using routine health facility information. Larger samples and explanatory studies are needed to understand the client, facility and health systems factors that contribute to positive and negative synergies between priority services

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

BACKGROUND: Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. METHODS: Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. RESULTS: Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. CONCLUSIONS: This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas

Surviving the impact of HIV-related illness in the Zambian business sector.

The HIV epidemic in sub-Saharan Africa represents an obstacle to productive employment and economic development. Employers in the region are experiencing severe staff shortages, reduced productivity, and increased costs because of protracted ill health and death among their workforce. The scale of the problem has not been fully estimated and the extent to which it could be ameliorated by control measures including effective treatment of opportunistic infections is not well known. Employers and employees (n = 108) in seven Zambian firms were interviewed to assess direct and indirect costs of illness to the firms. Information was collected on diagnosis and treatment received, duration of illness, time off, and strategies adopted to compensate for absent workers using a combination of questionnaires, structured interviews and focus group discussions. The main causes of ill health were tuberculosis (TB) (46.8%), diarrhea (12.9%), and sexually transmitted diseases (STDs; 5.8%). Annual treatment costs to the firm ranged from Zambia Kwacha (K) 60,000 to 405,000 per person treated. Other firm costs included productivity losses because of ill health, paid sick leave, the cost of employee replacement, and funerals. Employees incurred K 67,773 on average per illness episode. The most common causes of ill health were those most frequently associated with HIV. They can be easily but were often ineffectively treated. Improving disease management would thus reduce wastage and costs both to employer and employee. The extent of the impact in these firms shows the need for the private sector to adopt a stronger role in prevention and care. Further research is required to assess what recommended treatment options might be, how they could be financed, and the extent of the economic impact of HIV on firms. This would foster the development of more appropriate responses to the epidemic in Zambia and the region as a whole

Young men's sexuality and sexually transmitted infections in Zambia

Aim: To describe and analyse young Zambian men's sexuality and implications for sexually transmitted infections (STIs) including HIV/AIDS in Chiawa rural community and Lusaka urban compound of Misisi. Methods: Over a period of eight years, 402 men between 16 and 26 years old have participated in the studies; 205 from Chiawa and 197 from Misisi. Random and purposive sampling techniques were used to select the men. Fifty-nine traditional healers were also included in the study. Twenty-three of the traditional healers came from Chiawa and 36 from Misisi. Thirty-seven women in Misisi were included in one of the studies. Data was collected using semi-structured questionnaires, focus group discussions, in-depth interviews, and observations. The questionnaires were administered to the young men twice in Chiawa in 1993 (n=98) and 2001 (it= 79); and once in Misisi in 2001(n=153). Results: The mean age of the young men was 21 in Chiawa and 20 in Misisi. The majority of the men were not married. Almost all the men in Chiawa and Misisi had attended formal schooling. In 1993, and 2001, 39% and 44%, respectively, were formally employed in Chiawa and only 14% were employed in Misisi. A real man was considered to be one who was married, had children, had a decent job, cared for the family, and could sexually satisfy his wife. In Chiawa, 97% and in Misisi 76% of them considered themselves to be real men. Four children were considered to be the ideal number during one's life time due to economic hardships. Forty-three percent and 25% of the men had current pre- or extra sexual marital relationships in 1993 and 2001, respectively. In Misisi, 40% had current pre-or extra marital relationships. Qualitative data revealed that the main reason for these relationships was the need to prove that they were real men. In Chiawa, one-fourth of the men in the two surveys said they had suffered from an STI in the past and most of those in the second survey had sought treatment from the local health facility. In Misisi, 26% had suffered from an STI and many of them had gone to the private clinics for treatment. Majority (91%) of the men in Chiawa, compared with less than half in Misisi (4 1 %) said they considered themselves to be at risk of contracting HIV infection. In Chiawa, they considered themseIves to be at risk because of what they believed to be their inability as men to control sexual desires; their lack of trust in the sexual partner; and, unreliability of the condom. In 1993, only six percent said they used a condom all the time they had sex whilst 27% said so during the 2001 survey. In Misisi, 19% said they used condoms all the time. Qualitative data showed that there were misconceptions surrounding the use of condoms. In Chiawa, the healers reported using up to 19 different species of medicinal plants to treat STIs. Both in Chiawa and Misisi, the healers were treating impotency and infertility. Conclusions: Male sexuality is given prominence mainly because of its role in fertility. Multiple sexual relationships, misconceptions regarding HIV/AIDS, lack of adequate information, and ambiguities about and inconsistent use of condoms, all combine to pose major challenges on the fight against AIDS. The data from Chiawa indicates that sexual behaviour could be changing. The young men in Chiawa are more self-asserting. In Misisi the men's confidence is undermined by unemployment and other social difficulties characteristic of poor urban settlements. In designing interventions to target men's sexual health, we must consider their expressed concerns. Notions about real man that encourage risky behaviours must be targeted. Information, education and communication remain the most effective strategies. The young men's economic plight must also be addressed