BACKGROUND: HIV program data in Zambia shows that men are missing from HIV prevention and treatment services despite men having a low HIV prevalence of 8% compared to females (14%), according to ZAMPHIA 2021. The lack of access to services has not only affected men but also contributed to a higher HIV incidence of 5.6 percent among adolescent girls and young women (AGYW) who have been linked to a sexual triangle with men. To reach epidemic control, men must be reached to interrupt the HIV transmission cycle.

The USAID DISCOVER-Health Project implemented by JSI developed an innovative approach known as HIV prevention indexing (HPI) to reach men through AGYW at high HIV risk on PrEP in supported sites in Zambia 2021. 5687 AGYW were offered HPI, from which 4296 were elicited with 2,677 men tested for HIV. The assumption was that contacts elicited could also be at high risk of contracting HIV and may benefit from PrEP, or maybe living with HIV and would benefit from antiretroviral therapy


HPI provided an opportunity to reach unreached men and contributed to 19% of men newly initiated on PrEP. The acceptance of PrEP was high among contacts who tested negative that were at substantial HIV risk 83% of men. The HPI positivity rate of 4.4% was confirmed. high HIV risk remains within these sexual networks and the need for HPI to find men living with HIV and put them on ART is needed to further reduce the risk for AGYWs.


HPI is useful in settings like Zambia where there are men at high HIV risk who feel “shut out” of the health system and do not access HIV services. Through the HPI approach, men can be reached and provided with HIV services, ultimately helping Zambia attain and sustain epidemic control.

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