More young Zambians are testing for HIV than ever before

An analysis of HIV testing among young people (ages 15-24) in Zambia in the last decade suggests 65% of young women and 49% of young men are taking yearly tests.

Researchers analysed three Zambian Demographic and Health Surveys (2007, 2013–14, and 2018) to assess HIV testing rates over time. During this time efforts to increase HIV testing was underway, through initiatives such as the UNAIDS’ fast track strategy and youth programmes such as ALL IN.

These initiatives appear to have had an effect, with HIV testing among young Zambian women increasing between 2007 and 2018 from 17% to 65% and from 10% to 49% among young men.

The data on young women was analysed in relation to pregnancy to take Zambia’s prevention of mother-to-child transmission of HIV programme into account. HIV testing more than doubled among young pregnant women, rising from 45% to 92%. Among other young women, HIV testing rose from 10% to 58%.

By 2018, roughly 60% of young people who tested for HIV in the past 12 months used a government health centre.

The proportion of HIV tests among young people almost doubled in mobile clinics between 2013 and 2018, reflecting the Zambian government’s attempts to reach underserved groups. By 2018, one-third of all HIV tests among adolescent boys happened in mobile clinics.

In total numbers, HIV tests conducted in government health centres rose from 163,000 in 2007 to 1.3 million in 2018. In mobile clinics, this increased from around 41,000 to 400,000.

Those aged 20 to 24 were more likely to test for HIV than adolescents (ages 15-19). By 2018, 46% of adolescent (non-pregnant) girls and 38% of adolescent boys had tested for HIV in the past 12 months. But this is far short of the testing target of 70% of adolescent girls and 50% of adolescent boys.

Having a higher level of education increased the likelihood of HIV testing among young women.

Among young men, being circumcised and in a workers’ union increased the odds of testing. The finding on circumcision suggests Zambia’s national voluntary medical male circumcision (VMMC) campaign, which began in 2012 and offered HIV testing alongside circumcision, increased testing uptake among young men. VMMC was scaled-up in 2016, mainly through mobile clinics, which might also explain why a large proportion of adolescent boys who tested for HIV were testing in mobile clinics by 2018.

In 2018, along with adolescents, young people living in rural areas, those who were less educated or economically poor were less likely than others to test for HIV.

By 2018, regional differences in testing had increased for young women, with the gap between the highest and the lowest coverage region rising from 4% to 17%. But among young men, this gap reduced from 21% to 9%.

These trends show HIV testing among young Zambians has improved over time while highlighting the sub-groups for which testing initiatives have been less successful, most notably young men and adolescents.

Community-based strategies to reach these groups could include adolescent-focused case finding, which has been implemented in Kenya, home-based HIV testing, HIV self-testing, and peer-led testing in community spaces where people from hard-to-reach groups feel comfortable.