Behavioral and Biologic Surveillance Survey: Zambia Female Sex Workers  

Introduction

Zambia is one of the countries hardest hit by the HIV epidemic. The 1998 antenatal surveillance found HIV prevalence rates of 27 percent in Zambia's major cities. A Ministry of Health expert group estimated that provincial adult HIV prevalence was 26 percent in Lusaka, 23 percent in the Copperbelt and 19 percent in the Northern Province. National adult HIV prevalence is estimated to be 20 percent, which means that more than one million Zambians are infected with HIV. HIV rates are twice as high in urban areas as in rural areas.

Rates are very high along major highways and borders and in trading centres, farming and mining towns. The 1998 surveillance reported rates of 31 percent in the border town of Livingstone and 27 percent in Chipata. In neighbouring Zimbabwe, very high rates are also observed in border towns. HIV rates among pregnant women are 60% in Beitbridge on the South African border and 45% in Victoria Falls on the Zambian border. Zambia's major highways run alongside the two major rail lines, from Livingstone to Kasumbalesa and from Kapiri Mposhi to Nakonde. Its major trucking borders are Chirundu, Livingstone, Chipata, Nakonde and Kasumbalesa and its major internal trucking town is Kapiri Mposhi, at the junction of the two railway routes. These six sites have an estimated population of 250,000 inhabitants, including 1,500 sex workers and an itinerant population of 2,000 truckers.

Sexually transmitted diseases (STDs) are not well documented in Zambia. The number of reported STD cases rose from 190,344 in 1981 to 307,957 in 1992, the last year for which data are available. In community surveys, up to 10 percent of men report having had an STD in the past year. In a survey of 66,000 pregnant women screened in 1997 in five districts�Chipata, Kitwe, Livingstone, Lusaka and Ndola�10 to 15 percent, with a mean of 12 percent, had syphilis. In a recent community based survey in Ndola, prevalence rates for gonorrhoea and genital chlamydial infection were approximately 2% in the general population and as high as 15% for gonorrhoea and 9% for genital chlamydial infection in female sex workers. Prevalence rates for trichomoniasis and syphilis were 29% and 14% respectively in the general population and 42% for both in sex workers2. This confirms that sexually transmitted diseases remain a major public health problem in Zambia.

Data from the Demographic and Health Surveys (DHS) and other Knowledge, Attitudes and Practices surveys show that, although sexual behaviour seemed to have positively changed in the early 1990s, it has stagnated over recent years3. In a nation-wide sexual behaviour survey performed in 1998, 97% of men and 92% of women had heard of condoms and 90% and 76% respectively knew where to obtain them, but only 42% and 21% respectively had ever used condoms. Only 29% of men and 19% of women who had a non-regular partner in the last year used a condom at their last intercourse. In a survey conducted with female sex workers in Ndola in 1997-1998, only 28% reported using condoms in their most recent contact with a client.