1. STATUS OF THE HIV/AIDS EPIDEMIC IN THE SEXUALLY ACTIVE POPULATION (15-49 YEARS) 16 th December, 2010 Data source: National HIV Prevention Convention Report and ZDHS 2007

2. HIV Prevalence by age and sex

3. HIV Prevalence by sex and geographical location Data source: National HIV Prevention Convention Report and ZDHS 2007

4. HIV prevalence by marital status Data source: National HIV Prevention Convention Report and ZDHS 2007

5. HIV Prevalence among the youth Data source: National HIV Prevention Convention Report and ZDHS 2007

6. HIV Prevalence by sexual behaviour among the youth (15-24 years) Data source: National HIV Prevention Convention Report and ZDHS 2007

7. Key Drivers of the Epidemic Driver 1: Multiple concurrent partnerships Bulk of new infections emanate from casual and concurrent multiple sexual relationship The target is Long term couples and young people especially young women and mobile populations including MSM Driver 2:Low and Inconsistent condom use Condom use has not risen enough to impact significantly on HIV transmission This problems exists in sexually active young people, mobile populations, MSM and discordant couples Data source: National HIV Prevention Convention Report and ZDHS 2007

8. Key Drivers of the epidemic Driver 3:Low Rates of Male Circumcision Evidence shows that MC offers at least 60% protection against HIV transmission MC not widely practiced in Zambia except among some ethnic religious groups Driver 4:Mobility and Migrant Labour Mobility and migration of workers destabilises long-term partnerships and so facilitate Multiple and partners and sexual relationships with sex workers Driver 5:Vulnerability and Marginalized Groups Sub population groups such sex workers, MSM, prisoners, migrants and people with disabilities are the most vulnerable Data source: National HIV Prevention Convention Report and ZDHS 2007

9. Key Drivers of the epidemic Driver 6:Mother to Child Vertical Transmission HIV infection in children under fourteen constitute about 10% of all HIV Infections in Zambia. Most of these are a result of MTCT Driver 7: Alcohol and Drug use Decision making impaired under influence of alcohol Data source: National HIV Prevention Convention Report and ZDHS 2007

10. The Majority of HIV Infections in Africa are acquired from a spouse, and couples represent the largest risk group in Africa (National Prevention Convention Report 2007) Data source: National HIV Prevention Convention Report and ZDHS 2007

11. Synthesis of Qualitative Research on MCP By Mandy Dube 16 Dec 2010 NAC, Lusaka

12. Background Qualitative audience research by HCP and ZCCP – 42 focus group discussions (3 reports) – 8 in-depth interviews – 10 key informant interviews(2 reports) – 2 literature reviews

13. General Findings Who Everyone, but more men than women Why Sexual dissatisfaction Poverty Socially accepted/culture and socialization Experimentation Looking for love Search for children Marital differences /conflict in relationships Revenge Rites of passage Prove manhood Material gain Peer pressure Alcohol use

14. General Findings How Mostly in secret As long as benefits are accruing to the partners Little condom use especially when trust enters the picture

15. Technical Issues: Gender MCP socially acceptable practice for men but not for women Women blamed for partners MCP Women are not to question their partners behaviour Women are more financially dependent on men Women more forgiving, men less so Discovery of MCP linked to violence Discordancy handled differently Women MCP for income generation, male MCP socially accepted and even expected Financial resources often divided between partners particularly by the male Lack of financial empowerment of women Womens independence a threat to mens position in society Lack of sense of self-worth among women outside of being linked to a man. Most women traditionally prepared for marriage, men are not. Women key drivers of gender inequalities relating to MCP and relationships in general

16. Technical Issues: Sexual and Reproductive Health It is the womans responsibility to ensure she satisfies her partner sexually. This includes having to take herbs to make her body warm and to tighten her vagina Desire for a child in general as well as a child of a particular sex fuels MCP particularly for men Condom use within MCP reduces with the passage of time and more so when the partners develop a sense of trust for each other Knowledge of partners MCP or even practice of MCP not a motivation for accessing VCT Disclosure of HIV status a difficult decision that is often not carried forward

17. Technical Issues: Maternal, Newborn and Child Health Exposure to HIV Access to and practice of PMTCT linked none disclosure of HIV status Household nutrition and basic needs linked to scarcity of resources Family planning linked to desire for a child or particular sex of a child Caring for a child who is the wrong sex Maternal mental health Children witnessing/experiencing violence/conflict between their parents Post-partum abstinence

18. Key Recommendations Raise risk awareness Challenge social norms and address gender issues Encourage female empowerment Targeted communication: urban and rural men More economically empowered, key decision makers Sustained and collaborative efforts

19. Concurrent Sexual Partnerships in Zambia-the Quantitative perspective Partnership Meeting NAC By John Manda-SFH 17 th december,2010

20. Concurrency The Zambia sexual Behaviour Survey (ZSBS 2007), the 2009 PSI/SFH HIV TRaC, and the ZDHS 2007 are among the notable studies that have recently reported on the levels and drivers of multiple and concurrent sexual partnerships in Zambia.

21. State of multiple & concurrent Sexual Partnerships Levels of concurrency in Zambia are reported to be high (5.5%, 23%) as reported by ZSBS 2009, and PSI/SFH TRaC 2009, studies respectively.

22. Sex, marital Status & Gender Distribution MaleFemale Single38.5 (43%)20.4(26%) Married35.5 (53%)5.7(62%) Formerly married52.5 (4%)12.3 (12%) Total36.98.2 Concurrency by marital status & gender Source: PSI/SFH TRaC 2009

23. Sex, marital Status & Gender Distribution Median age at first marriage: 18 for females (urban & rural) and males (25 urban & 23 rural) for males(24) Median age at first sex: 17 for females and 18 for males Median age at first sex: 16% (TRaC) Across the two studies, ZSBS 2009 & PSI/SFH HIV TRaC 2009 studies, Concurrency is reported to be more (36.9 Vs 8.2 PSI TRaC ) prevalent among males than females and predominantly among the single and formerly married population for both males and females. The 2009 ZSBS report that among sexually active male, 11% of single versus 5% of the monogamously married, had concurrent partners.

24. Concurrency by age, residence and gender

25. Rural (22.9%)Urban (22.6%) ageMale (%)Female (%)Male (%)Female (%) 15-2433.811.536.79.5 25-3443.97.544.15.6 35-4928.07.228.86.2 Totals36.08.838.37.3

26. Concurrency by age, residence and gender Generally, rural areas reported more concurrency (6.5% of rural Vs 3.8% of urban and 22.9% of rural Vs 22.6% of urban) than the urban areas except that urban males engage in more concurrency than their rural male counterparts as reported by the ZSBS 2009 and the PSI/SFH 2009 HIV TRaC. The PSI/SFH study found that men in the age group 25-39 were statistically more likely to engage in concurrency than other age groups.

27. Conclusion1 Concurrency is higher rural although the difference is not very significant Among men concurrency is higher in the 25- 39 age group (both rural &urban) Among women concurrency is higher 15-25 & about 34-39

28. OAM Determinants Males only Statistically, men who engage in concurrency have – Low HIV risky perception. (p<.001, OR=2.5). – Expectation of Sexual benefits. (p<.001, OR=1.8). – Low perception of marital instability related concerns. (p<.001, OR=1.5). – Poor quality of primary relationship (p<.05, OR=1.4). – Sexual experimentation and age concurrency (p<.05, OR=1.35)

29. OAM Determinants Females only Statistically, men who engage in concurrency have – Low HIV risky perception. (p<.001, OR=2.5). – Expectation of Sexual benefits. (p<.001, OR=1.8). – Low perception of marital instability related concerns. (p<.001, OR=1.5). – Poor quality of primary relationship (p<.05, OR=1.4). – High expectations of financial & material benefits. (p<.05, OR=1.4).

30. Other Drivers of concurrency Availability of partner (including PPA) – Mobility: The 2009 ZSBS report that those who had spent time away from home in the 12 months before the survey engaged in more concurrency (12% Vs 5%) than those who did not spend time away from home. – Male circumcision: There is scanty information regarding the relationship between MC and multiple and concurrent sexual partnerships. Preliminary findings of the longitudinal study by Population council report that about 26% of recently circumcised men who reported having had sex within 6 weeks post-MC had multiple partners.

31. Condom Use Among men 14% (19% in urban & 10% in rural) used condom at last sex Among women, 11% (14% in urban and 9% in rural) used a condom at last sex Marital condom use is very low in both urban and rural In rural Zambia 26% of those who had multiple partners used a condom at last sex as compared to 17% in urban areas 10% of men in concurrency used a condom at last sex with each of the partners

32. HIV Prevalence (ZDHS 2007) Highest among the formerly married followed by the married or cohabiting partners (30-34% vs15.3%) HIV high among population that spent time away from home Nationally the age highly affected is 25-44 & 20-39 among women and 25-44 among men

33. NOTE The spread of concurrency networks & how intertwined might explain the HIV prevalence Both the urban and rural areas needs concurrency interventions

34. Communication Support for Health ONELOVE KWASILA I HIGHLIGHTS (How it was implemented) PRESENTED BY: Mercy Chisashi- CSH National AIDS Council, Lusaka 16 th December 2010

35. Presentation Outline Background to the campaign Campaign design Products Results Lessons Learnt

36. Background The One Love campaign is a regional initiative (10 countries) The 10 countries conceptualized the tag line One Love Talk Protect Respect The Name was pretested and thorough FDGs in Zambia the tag Line Kwasila came about.

37. Campaign Design The campaign was based on a formative research process. – research design workshop for nine countries – conducted qualitative target audience research – Target audience were adults between 16 and 55. – Results informed the campaign design – Target audience for campaign Male 25-35 in the urban setting – Communication Objective: Increase self-risk perception and provoke thought, dialogue and action around MCP and mutual rights and responsibilities of partners – Behavioral Objective: Reduce sexual partners and/or consistent condom use, HIV testing and disclosure (couple testing encouraged) – Centre piece of the campaign was club risky business

38. Products TV/Film: Animated spots, Talk shows, music video and DVDs ( Distributed to organizations and through Blockbusters with accompanying guide) Club Risky Business Audience interacted through Text messaging and call in programms on radio stations. Topics were picked up for discussion on other radio stations as well as broad cast of PSAs: Christian Voice, radio 4 and Hot fm.

39. Products cont 26 episode drama series called Bitter sweet aired on ZNBC Radio 2 and Radio Phoenix. It was also translated into Bemba and was aired on radio 1 and Mkushi community radio and radio Mano. Print Print: Newspaper features, supplements, ads, posters, discussion guides, bumper stickers and tax discs for cars

40. www.onelovekwasila.org.zm The Official Campaign Site

41. Results (As at October 29 th 2009 captured by Media365) Campaign and TV created a buzz and resonated with audience: within the first four weeks 49% of regular non-Lusaka urban television viewers recalled the slogan and 32% had seen or heard of Club Risky Business. Dialogue and audience engagement sparked and continuing: 17,137 SMS competition entries received; more than 6000 Facebook fans continue to discuss characters actions and relevance to their lives as well as sex, relationship, health and surrounding topics Bulk SMS messages: 10,000 sent 37 Calls & 384 text messages received during radio series Website: 3,466 site visits & 8,960 page views YouTube: 632 channel views & 10,348 upload views Facebook : 6, 000 + fans (28.5% Males 25-55; 25.8% Females 25-55

42. Results Cont Branded buses (Inter and Intra city bus operators): 600 Buses also carried Club Risky Business as onboard entertainment 5000 branded tax discs 5000 branded bumper stickers

43. Lessons Learnt Full integrated campaigns keep the audience engaged in a number of ways Dramas work- people relate to them and emotions are stirred Indigenous and high quality products improve message delivery and can also contribute to sustainability of the campaign Important who delivers the message Engaging the audience through radio, competitions and social media is an advantage Momentum needs to be sustained Research should involve campaign implementers from the outset Partnerships are important to manage multiple aspects Linkages to trusted and credible resources/support services key

44. Other observations There is an ongoing audience perception study by ZCCP focusing on the whole Onelove Kwasila campaign (wider geographical coverage). Once completed the findings will be shared The highlights on OneLove Kwasila in this presentation are limited to program data fromMedia 365 and does not include programmatic data from ZCCP Data source: National HIV Prevention Convention Report and ZDHS 2007