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The 2009 ZSBS was designed to obtain national estimates of a number of key indicators important to monitoring progress of the national HIV/ AIDS/STDS programme. These indicators measure among other things, knowledge, attitudes, sexual behavior, and health-care seeking behavior.

HIV/AIDS-Related Knowledge

HIV/AIDS knowledge is almost universal among adult males and females in Zambia. Almost everyone interviewed (99%) mentioned that they have heard of HIV/AIDS. About 95% of respondents in both rural and urban areas reported knowing that HIV/AIDS can be avoided—an increase from 81% in 2000

The proportions of respondents who spontaneously mentioned abstinence (72%), being faithful/having sex with only one partner (47%), and consistent condom use (65%)—the ABCs of HIV prevention—as the primary methods of prevention have decreased since the 2005 survey (82%, 57%, and 65%, respectively).

Over 80% of respondents recognized that consistent condom use is a way to prevent HIV/ AIDS transmission, however, only about 45% of female respondents and about 53% of male respondents indicated that condoms are “very effective” in preventing the infection. Between 64% and 79% of respondents rejected the common misconceptions about HIV transmission: that mosquito bites (64% of respondents), witchcraft (64% of respondents), or sharing food (79% of respondents) can transmit HIV/AIDS.

Almost all youths aged 15-24 have heard about HIV/ AIDS (98%), more so among young adults aged 20-24 years (99%) than adolescents (97%). The vast majority of youths know that HIV/AIDS can be avoided (94%) and that a healthy-looking person can have AIDS (87%).

 

Among youths aged 15-24, abstinence was the most recognized way to prevent HIV transmission (74%), followed by condom use (62%), and having only one faithful partner (34%). However, only 18% of youths aged 15-24 spontaneously named all three ABCs of prevention (Abstinence, Be faithful, Condom use). About 80% of youths mentioned that they know an acceptable place to purchase a condom.

 

Attitudes toward People Living with HIV/AIDS

Almost one in five (18%) of respondents mentioned that they knew someone who had experienced discrimination or verbal abuse in the past year due to known or suspected HIV status. Percentages were higher in urban areas (22%) versus rural (15%) areas. Overall, the proportion of respondents who expressed negative judgments toward people living with HIV/AIDS (PLWH) declined from about one in three (33%) in 2005 to about one in four (25%) in 2009.

In 2009 those living with HIV/AIDS in rural areas (32%) were more likely to experience negative judgments than their urban counterparts (14%).

The percent of youth aged 15-24 expressing negative attitudes toward PLWH declined since 2005. The reduction was more pronounced among males (from 36% to 24%) compared to females (from 30% to 28%).

 

Voluntary Counseling and Testing

The proportion of respondents who knew where to go for HIV testing increased from 84% in 2005 to 94% in 2009. About 81% said they desired to be tested or retested. Nevertheless, the proportion that has been tested remains low. Slightly less than half of respondents (46%) have ever been tested, although this rate represented a significant increase from 2005 (13%).

The percent of respondents aged 15-49 who have ever voluntarily requested an HIV test, received the test, and received the results increased from 6% to 23%, with proportions higher among urban respondents and females.

Among females who were pregnant in the two years prior to the 2009 survey, about 97% had at least one antenatal care visit. The percent of these females who were counseled for HIV testing during antenatal care, accepted an HIV test, were tested and received the results, increased dramatically, from 13% in 2005 to 67% in 2009, with a much higher percentage in urban (86%) than in rural (58%) areas.

 

Sexual Behaviour and Condom Use

The median age at first penetrative sex among young people aged 15-24 was 19.5 years for males and 17.5 years for females—an increase since 2000 of two years among males and one year among females. Among respondents aged 20-24, 86% have ever had sex, a decline of about 5% since 2000.

 

About 8% of males and 46% of females were married at exact age 18, and about 21% of males and 67% of females were married at exact age 20. On average, the median age at first marriage among respondents aged 20-49 was 23 years for males and 19 years for females. One-third of respondents aged 15-49 were single/never-married, about half were in a monogamous union, and 6% were in polygamous unions. The percent of respondents aged 15-49 reporting multiple sexual partners has declined from about 9% in 2000 to 4% in 2009. The decline among males was from 17% to 9%, and among females from 2% to <1%.

 

About 22% of respondents in urban and 16% in rural areas reported having had sex with a non-marital/non cohabiting (or non-regular) partner in the 12 months prior to the 2009 ZSBS, with the proportion higher among men than women.

 

About 42% of male respondents mentioned that they used condoms during their last sexual encounter with a non regular partner, while the proportion among females was 35%. Condom use was more prevalent in urban (54%) than in rural (28%) areas. Only 53% of adults expressed support for education on condom use for prevention of HIV/AIDS among young people.

 

Among adolescents aged 15-19, a larger proportion of adolescent females (41%) than males (30%) have had sex. Eight percent of youths aged 15-24 have had ‘early sex’ or sex by age 15, declining from about 17% in 2000 to about 8% in 2009. Just over a quarter (26%) of never married youths aged 15-24 had sex in the 12 months prior to the survey. A substantially larger proportion of young men aged 15-24 than women reported sex with a non-regular partner (72% vs. 28%). Compared to young women (2%), young men aged 15-24 were more likely to have more than one sexual partner (15%).

 

There has been a consistent decline in the percent of young people with multiple sexual partnerships, from 11% in 2000 to 7% in 2009. Male youths were more likely to report more than one on-going sexual partnership than females (11% vs. <1%). Percentages reporting condom use with the most recent sexual partner were higher among adolescents (27%) compared to young adults (21%).

 

Only 19% of men and women aged 15-49 who had more than one sexual partner in the preceding 12 months reported using a condom during their last sexual intercourse. There was also an overall decline in condom use among all male respondents, from about 35% in 2000 to 31% in 2009.

 

Condom use among youths aged 15-24 who had practiced sex with a non-marital, non-cohabitating partner (higher risk sex) in the preceding year declined from 39% in 2000 to 36% in 2009. Among adolescents and young adults aged 15-24 who have ever had sex, only 29% reported using a condom the first time they ever had sex, and only 30%-40% of young, single, sexually active people aged 15-24 used a condom at last sex.