Zambia Makes Progress in HIV Fight, But Gaps Remain

Two decades ago, an HIV diagnosis in Zambia carried a far heavier weight than it does today. New figures released by the Ministry of Health show just how much has changed, and how much work remains before the country can call the epidemic under control.

WHAT THE NUMBERS SAY

According to the 2025 HIV Spectrum Estimates, released by the Ministry of Health, approximately 1,308,000 Zambians are currently living with HIV, a slight decrease from 1,311,000 in 2023. Speaking at the dissemination of the estimates, Ministry of Health Permanent Secretary for Technical Services Dr Kennedy Lishimpi said that near-stable number actually reflects a balance of three separate trends moving in Zambia's favour, fewer new infections, more people staying on treatment, and fewer deaths from AIDS-related illness. In other words, the number itself is steady, but what sits behind it, is progress.

One of the clearest signs of that progress is what has happened to mother-to-child transmission of HIV. In 2005, more than a third of babies born to HIV-positive mothers, 34.4 percent, went on to contract the virus themselves. By 2025, that figure had fallen to 6.12 percent. Dr Lishimpi said Zambia now needs to push further, toward the World Health Organization's dual elimination threshold of below 5 percent, by closing remaining gaps in antenatal care attendance, early testing of infants, and keeping HIV-positive mothers and their babies engaged in care through the full 18-month follow-up period after birth.

That progress shows up directly in how many children are living with HIV today. The number of children with HIV in Zambia fell from 137,000 in 2005 to 59,000 in 2025, while new HIV infections among children dropped from 23,000 to just 2,700 over the same period, evidence, Dr Lishimpi said, of how effective the country's mother-to-child transmission elimination programme has been.

WHO STILL BEARS THE HEAVIEST BURDEN

The gains have not been shared evenly. Women continue to make up the majority of people living with HIV in Zambia, 64 percent of all cases in 2025. Among adolescents and young people aged 15 to 24, there were 6,000 new HIV infections, accounting for 37 percent of all new infections among adults, and within that age group, 79 percent of new infections were among young women specifically. That pattern, young women bearing a disproportionate share of new infections, remains one of the more stubborn challenges in Zambia's HIV response.

There has, however, been major progress on deaths. Zambia recorded an estimated 16,000 AIDS-related deaths in 2025, down sharply from 66,000 in 2005. Dr Lishimpi said Advanced HIV Disease, cases where the immune system has already been significantly weakened, remains a major driver of the deaths that still occur, and called for stronger screening, treatment and clinical care, particularly for people who are hardest for the health system to reach.

A NEW TOOL JOINS ZAMBIA'S PREVENTION TOOLKIT

It is against this backdrop, real progress, but a persistent gap among young women and hard-to-reach populations, that Zambia has been expanding its HIV prevention options. In December 2025, the country officially launched lenacapavir, a long-acting injectable medicine that offers protection against HIV for six months at a time. Rather than taking a daily pill, a person only needs an injection twice a year to stay protected, a difference that matters enormously in practice. Daily pills only work if someone remembers to take them every single day, something many people find difficult because of cost, inconvenience, side effects, or the stigma that can come with visibly taking HIV medication. A twice-yearly injection removes almost all of that daily pressure.

Lenacapavir belongs to a category of HIV prevention known as PrEP, or pre-exposure prophylaxis, medicine taken by someone who does not have HIV to lower their risk of contracting it. The World Health Organization formally recommended lenacapavir as an additional PrEP option in July 2025, based on clinical trial results it described as exceptionally strong, and has called the approach one of the most significant advances in HIV prevention in years. Dr Lishimpi said government is now working to accelerate the rollout of this long-acting injectable option beyond its initial national launch, expanding access to more Zambians as part of a wider prevention push.

That wider push includes several other initiatives running alongside lenacapavir. Government is expanding DREAMS programming, which specifically targets adolescent girls and young women, the group carrying the heaviest burden of new infections. It is sustaining and scaling up Voluntary Medical Male Circumcision, an established HIV prevention method. And it is strengthening how the health system manages Advanced HIV Disease, aiming to bring down the number of deaths still linked to it.

WHAT COMES NEXT

Zambia has set itself a clear target: reducing new HIV infections to below 10,000 a year by 2030, in line with global goals for ending AIDS as a public health threat. Dr Lishimpi said the 2025 estimates are proof that investment from government, cooperating partners, health workers and communities has genuinely changed the course of the epidemic in Zambia. But he was careful not to overstate where things stand. The country, he said, must renew its commitments, partnerships and strategies, while never losing sight of the human lives behind every number in the report.

Zambia's HIV story today is neither one of victory nor of failure. It is a story of real, measurable progress, alongside a clear-eyed understanding of exactly where the fight is still being lost, and what tools, from expanded testing to new prevention options like lenacapavir, might help close that gap before 2030.