From May to November 2021, a biobehavioral survey (BBS) among men who have sex with men (MSM) was conducted in four cities in Zambia. The BBS estimated the prevalence of HIV, HIV recency, active syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV viral load suppression (VLS), as well as progress towards the UNAIDS 95-95-95 targets. The population size of MSM was also estimated. In collaboration with the Zambia National HIV/AIDS/STI/TB Council (NAC) and the Tropical Diseases Research Centre (TDRC), the BBS was led by ICAP at Columbia University with support from the United States Centers for Disease Control and Prevention (CDC).
Major conclusions from the survey include:
- HIV prevalence varied among MSM across the four sites (range: 5.9%–22.9%) and was highest in Lusaka (22.9%). HIV prevalence increased with age group across all sites and was highest among MSM 30 years of age and older (range: 20.5%–40.1%).
Findings highlight successes and gaps in the progress towards the UNAIDS 95-95-95 targets.
- The first 95 target, the percentage of HIV-positive MSM aware of their HIV status, was less than 95% across the four sites (range: 51.5%–90.9%).
- The second 95 target, ART coverage, was high among HIV-positive MSM aware of their HIV status across the four sites (range: 94.4%–100.0%).
- The third 95 target, the prevalence of viral load suppression, was high among HIV-positive MSM who reported being on ART across the four sites (range: 95.5%–100.0%).
- PrEP awareness and use varied among MSM. Among HIV-negative MSM across all sites, more than half (range: 54.5%–83.0%) were aware of PrEP. However, up to a quarter (range: 17.2%–26.4%) had ever taken PrEP.
- Active syphilis prevalence was highest among MSM in Lusaka (7.9%), more than three times the active syphilis prevalence among men (2.5%) aged 15-59 years in Lusaka region.
- Prevalence of hepatitis B among MSM was higher in Kitwe (7.3%) and Livingstone (6.9%), when compared with the national prevalence (5.6%) among adults aged 15-59 years.