Zambia Demographic and Health Survey 2001-2002 - Measure DHS

PREVALENCE OF HIV AND SYPHILIS 14Kumbutso DzekedzekeZambia has used the antenatal care (ANC) sentinel surveillance data as a principal means ofmonitoring the spread of HIV for almost a decade (Fylkesnes et al., 1998). The ANC sentinel surveillancesystem includes both urban and rural sites with at least two sites in each of the country’s nine provinces.Over time, there has grown a need to expand the tools for monitoring HIV trends in the generalpopulation with population-based surveys.UNAIDS recommends carrying out population-based surveys in catchment areas of ANC sentinelsurveillance sites to calibrate the results of routine surveillance systems (UNAIDS/WHO Working Groupon Global HIV/AIDS and STI Surveillance, 2000). A number of population-based surveys have been carriedout in specific catchment areas of the ANC sentinelsurveillance system in Zambia to calibrate the results ofthe ANC system to the general population and to monitorHIV trends in the general population. (For a comparisonof ANC surveillance estimates and the ZDHS rates, seeSection 14.4.) However, the 2001-2002 ZDHS is the firstnationally-representative population-based survey to estimatethe prevalence of HIV in Zambia. In addition to HIVtesting, syphilis was included from among other sexuallytransmitted infections (STIs) because it is an importantbio-marker of the prevalence of STIs which are a majorrisk factor in the heterosexual transmission of HIV in theZambian population.In the ZDHS, all women and men interviewed inthe one-half of households selected for the men’s surveywere asked to volunteer for a syphilis and HIV test of theirvenous blood. Consent was sought separately for thesyphilis and HIV tests such that respondents could refuseor agree to take one or both of the two tests. Test resultsfor syphilis have been linked to other variables collectedduring the survey while those for HIV are unlinked. A fulldescription of the sample collection, testing, and syphilistreatment procedures is discussed in Chapter 1.14.1 COVERAGE FOR HIV AND SYPHILIS TESTING14.1.1 Coverage for Syphilis Testing by ResidenceTables 14.1 and 14.2 summarise coverage rates forthe syphilis testing component of the ZDHS by residence.Among the women and men eligible for testing, 76 percentconsented to the syphilis test, 15 percent refused to betested, and 6 percent were absent from the household whenTable 14.1 Coverage for syphilis testing by urbanruralresidence (unweighted)Percent distribution of de facto women and meneligible for syphilis testing by testing status, accordingto urban-rural residence, Zambia 2001-2002ResidenceTesting status Urban Rural TotalWomen 15-49Tested 79.6 79.1 79.2Refused 15.1 15.6 15.4Absent/other 3.2 3.0 3.0Interviewed in DHS 1.7 0.7 1.0Not interviewed in DHS 1.5 2.3 2.0Result missing 2.1 2.4 2.3Total 100.0 100.0 100.0Unweighted number 873 1,816 2,689Men 15-59Tested 66.5 76.5 73.1Refused 15.6 14.5 14.8Absent/other 13.3 5.4 8.1Interviewed in DHS 3.6 0.9 1.8Not interviewed in DHS 9.7 4.6 6.3Result missing 4.7 3.6 4.0Total 100.0 100.0 100.0Unweighted number 814 1,604 2,418Total 15-49Tested 73.4 77.8 76.4Refused 15.3 15.1 15.1Absent/other 8.1 4.2 5.5Interviewed in DHS 2.6 0.8 1.4Not interviewed in DHS 5.5 3.4 4.1Result missing 3.2 2.9 3.0Total 100.0 100.0 100.0Unweighted number 1,631 3,297 4,928the nurse/nurse counselor visited. The 2001-2002 ZDHS household record did not include a syphilis resultcode for the remaining individuals (3 percent). Most of the latter individuals were not interviewed inthe 2001-2002 ZDHS, so it is likely they were also absent at the time the household was visited for thetesting.Prevalence of HIV and Syphilis | 225