Characteristics of Individuals Who are Aware of their HIV Status but Have Never Engaged in Care in Malawi and Zimbabwe: A Comparison between 2016 and 2020 Restricted; Files & ToC
Christman, Olivia (Spring 2025)
Abstract
Introduction: Despite having significant progress in reducing new infections and expanding antiretroviral therapy (ART) coverage, East and Southern Africa remain at the epicenter of the global HIV epidemic. Disparities in care engagement persist, particularly among key populations such as men and urban residents.
Methods: We analyzed nationally representative data from Malawi and Zimbabwe's Population-Based HIV Impact Assessment (PHIA) surveys (2015–2020) to characterize individuals aware of their HIV-positive status but who never engaged in care. Weighted proportions and prevalence ratios were calculated to assess associations between demographic, behavioral, and psychological factors and care engagement.
Results: The proportion of respondents living with HIV who had never engaged declined from 2016 to 2020 in both Zimbabwe (2016: 7.2%; 2020: 2.7%) and Malawi (2016: 5.5%; 2020: 3.2%). Men, urban residents, and those with heavy alcohol use (7+ drinks/week) were disproportionately represented among never-engaged populations for both years. Higher rates of depression and anxiety were also observed in those who never engaged in care in 2020.
Discussion: Despite recent progress in the proportion of PLWH who are virally suppressed in Zimbabwe and Malawi, persistent disparities in suppression for men, urban residents and those with heavy alcohol use highlight the need for targeted interventions addressing gender norms, stigma, substance use, and mental health.
Conclusion: Achieving the WHO 95-95-95 targets requires equitable, culturally competent strategies tailored to underserved groups. Integrating mental health and substance use support into HIV programs and ensuring access to services for PLWH who have higher rates of depression, anxiety, and heavy drinking is essential to increasing engagement in HIV care.
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