Knowledge and use of Sexual Reproductive Health and HIV services
among Adolescent Girls and Young Women
in Central and Western Provinces:
A Qualitative Knowledge Attitudes and Practices Study
Reports
The protection and promotion of human rights
and gender equality for people living with HIV,
vulnerable populations and key populations,
including young key populations, is critical to
successful responses to HIV, TB and sexual and
reproductive health.
Zambia has signed and ratified a number
of international and regional human rights
treaties that commit to protecting the
rights of all persons, particularly vulnerable
populations; Zambia also includes the
protection of human rights as a central tenet
of its national Constitution. The Constitution
provides all persons with the right to equality
and non-discrimination, life, privacy, liberty,
association and assembly, health, fair labour
practices, social protection and freedom from
torture or degreated treatment, amongst
other things; these rights are important for
people in the context of health, human rights
and gender equality.
In addition, Zambia has enacted a number
of laws, policies, strategies, guidelines and
plans that further protect the rights of all
persons, some of which are specific to the
context of health, HIV and vulnerable and
key populations. National health, sexual and
reproductive health, HIV, TB, youth and gender
laws and policies recognise the importance
of rights-based development responses that
provide for the health of all persons, regulate
the professional and ethical conduct of health
workers and other service providers, reduce
stigma and discrimination and create an
enabling framework to reduce human rights
and gender-related barriers to the health and
well-being of all people. Some HIV-specific
policies and guidelines, such as HIV testing
and counselling policies and workplace HIV
policies, provide detailed protection for
the rights of people in the context of HIV
and AIDS, including the rights to HIV testing
and treatment only with voluntary and
informed consent, confidentiality and nondiscrimination
in the workplace.
National laws, policies, strategies and plans
also recognise the needs of vulnerable and
key populations such as women, children
and young people and, in some cases, key
populations. Young people’s rights to access
The 2018 Zambia Demographic and Health Survey (ZDHS) is designed to provide data for monitoring the
population and health situation in Zambia. The 2018 ZDHS is the 6th Demographic and Health Survey
conducted in Zambia since 1992, and the objective of the survey was to provide reliable estimates of
demographic and health indicators including fertility, marriage, sexual activity, fertility preferences, family
planning methods, breastfeeding practices, nutrition, childhood and maternal mortality, maternal and child
health, domestic violence, and HIV/AIDS that can be used by programme managers and policymakers to
evaluate and improve existing programmes.
HIV allocative efficiency studies are generally posing the question “How can HIV funding be optimally allocated to the combination of HIV response interventions that will yield the highest impact?”. In this context the government of Zambia approached the World Bank with a request to conduct an allocative efficiency analysis to inform the revised national AIDS strategic framework (R-NASF), prioritisation of the HIV response, and value for money considerations in the context of resource mobilisation. Four main policy questions were posed: (1) What are the estimated and projected HIV epidemic trends until 2030 and the transmission dynamics between sub-populations? (2) What is the optimised HIV resource allocation to minimise HIV incidence and AIDS mortality between 2014 and 2030? (3) What is the minimum spend required to meet moderate or ambitious national strategic impact targets? (4) What are the long-term financial commitments of HIV treatment and healthcare costs?
Zambia, recently reclassified as a low- and middle-income country (LMIC), had an estimated total population of 14.08 million in 2012. The country enjoys positive annual GDP growth—at 6.4% in 2013—and a fairly stable macroeconomic situation. Nevertheless, income levels are highly skewed and in 2010, 60.5% of the population were living below the national poverty line, which impacts negatively on health.
The Joint Mid-Term Review (JMTR) of the NASF was undertaken through August to
the end of September 2013 and was mainly aimed at assessing the implementation of
the NASF using a forward looking approach that would document achievements,
lessons learnt, gaps, obstacles, challenges and opportunities at community, district,
provincial and national level with regard to the four pillars including monitoring and evaluation and financing aspects of the NASF, and to make recommendations for strengthening and improving Zambia’s national HIV response.
Zambia has made important progress in its AIDS response, achieving more than 41% decrease in new infections between 2005 and 2015. Overall, Zambia experienced a decline of about 20% of HIV incidence between 2005 and 2014. The trend is projected to be declining in the near future5.
CSE has demonstrated impact in termsof improving knowledge and self-esteem changing attitudes, gender and social norms,
and building self-efficacy. This is particularlycritical during adolescence, as young people make the transition into adulthood.Integrating content on gender and rights,
and delivering CSE together with effortsto expand access to a full range of highquality,youth-friendly sexual and reproductivehealth services and commodities, makes
sexuality education even more effective.
The National AIDS Spending Assessment (NASA) (2010-2012) is the third effort to track all the HIV/AIDS spending in Zambia from all sources (excluding out-of-pocket) and across all sectors. The first NASA was undertaken for the years 2005 and 2006. For the years 2007 to 2009, the Public Expenditure Tracking (PETS) approach was applied1. The NASA provides an in depth examination of the HIV/AIDS by detailed categories of activities, providers of services and the beneficiaries. NASA applies a standardised and comprehensive methodology for collecting, coding and analysing of HIV expenditure. It allows countries to understand if they are allocating funds according to their priorities and for the greatest investment in terms of impact.
