report JUNE 2014
midline EVALUATION OF THE
ZAMBIA-LED PREVENTION
INITIATIVE (ZPI)
Zambia-led Prevention Initiative

MIDLINE EVALUATION OF THE
ZAMBIA-LED PREVENTION
INITIATIVE (ZPI)
Investigators and Affiliate Institutions: 
Waimar Tun PhD1
Robert Haloba2
Chileshe Chilangwa2
Tina Moyo3
Meredith Sheehy4
1Population Council, Washington, DC
2FHI360, Lusaka, Zambia
3Population Council, Lusaka, Zambia
4Population Council, New York
iv ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI)
This document was made possible by the support provided by the American people 
through the United States Agency for International Development (USAID) under the 
terms of Contract No. GHS-I-02-07-00008-00. The contents are the responsibility 
of the authors and do not necessarily reflect the views of USAID or the United States 
Government.
Suggested citation: Zambia-led Prevention Initiative. 2014. “Midline evaluation of the Zambia-Led Prevention 
Initiative (ZPI).” Lusaka, Zambia: USAID.
Published in June 2014.
Copyright ©2014 Population Council.
Acknowledgments
The Zambia-led Prevention Initiative (ZPI) acknowledges the efforts of all those who contributed to the successful 
conduct of the baseline survey and report. Special thanks to Tina Nanyangwe Moyo for overseeing the data 
collection efforts, Benjamin Kayungwa and Scott Geibel for programming the handheld computers for data 
collection, Nancy Ralph for her contributions to the data cleaning and management, Dr. Waimar Tun for leading 
the analysis and writing of this report, Meredith Sheehy for her assistance with the analysis and writing of the 
report, and Dr. Jessica Price for her review and assistance with the interpretation of results. ZPI also extends its 
appreciation to Chileshe Chilangwa, Robert Haloba, Earnest Myunda, Felly Simmonds, and Chad Rathner for their 
thorough review of and input into this report. 
In addition, we gratefully acknowledge the United States Agency for International Development (USAID) for 
supporting the project.
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ v
Table of Contents
Acronyms .................................................................................................................................. vi
Executive Summary ...................................................................................................................1
Background................................................................................................................................3
Zambia’s epidemic and state of HIV prevention science........................................................3
ZPI description ..........................................................................................................................4
ZPI evaluation ............................................................................................................................4
Methods .....................................................................................................................................5
Results........................................................................................................................................7
Sample characteristics..............................................................................................................7
Exposure to HIV prevention interventions................................................................................7
Key outcomes ............................................................................................................................8
Conclusion and Recommendations....................................................................................... 15
References .............................................................................................................................. 18
Appendices.............................................................................................................................. 20
vi ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
Acronyms 
AIDS Acquired immune deficiency syndrome
ART Antiretroviral therapy 
CAGE Cutting down, annoyance by criticism, guilty feeling, and eye-openers (alcohol abuse assessment) 
CBO Community-based organization
CHAMP Comprehensive HIV/AIDS Management Program
CMMB Catholic Medical Mission Board 
GRS Grass Roots Soccer
CSO Central Statistical Office
DHS Demographic Health Survey 
FHI360 Family Health International 360
GEM Gender equitable men
GBV Gender-based violence 
HIV Human immunodeficiency virus
HTC HIV testing and counseling 
KAP Knowledge, attitudes, and practices 
MC Male circumcision
MCP Multiple and concurrent partnerships 
MOT Modes of transmission
NGO Non-governmental organization
PDA Personal digital assistant
PMTCT Prevention of mother-to-child transmission
SEA Standard enumeration areas
STI Sexually transmitted infections
UNZA University of Zambia
USAID US Agency for International Development
ZDHS Zambia Demographic Health Survey
ZHECT Zambia Health Education and Communication Trust 
ZPI Zambia-Led Prevention Initiative 
ZSBS Zambia Sexual Behavioral Survey
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 1
Executive Summary
The Zambia-Led Prevention Initiative Program1 (ZPI) is a USAID-funded initiative designed to increase the delivery 
and uptake of community-led HIV prevention interventions and to generate an evidence base for diffusion of 
effective approaches. The goal of ZPI is to increase utilization of community-level interventions aimed at reducing 
HIV transmission, including promotion of safer sexual practices, HIV testing and counseling (HTC), voluntary 
medical male circumcision, and prevention of mother-to-child transmission (PMTCT). ZPI also implements structural 
interventions to address key drivers of the HIV epidemic such as alcohol and substance abuse, gender-based 
violence (GBV), gender inequitable norms, and economic inequities. Such interventions include entrepreneurship 
skills building; raising awareness about the connection between GBV, alcohol abuse, and HIV; and GBV training for 
men, women, and young people.
We conducted a midline evaluation in Copperbelt, Eastern, Luapula, and Western provinces as part of ZPI’s 
evaluation. The evaluation is based on two cross-sectional community-based behavioral surveys (baseline: July/
August 2011; midline: August/September 2013). Males (15–59 years) and females (15–49 years) were randomly 
selected from the four provinces. At baseline, a total of 845 males and 1,594 females completed the survey; this is 
94 percent of the male and 89 percent of the female target sample size. At midline, 750 males and 1,437 females 
completed the survey. Face-to-face interviews were conducted by interviewers using a handheld personal digital 
assistant (PDA) and responses were entered on the same PDA. Chi-square test was used to compare baseline and 
midline as well as people exposed and not exposed to HIV prevention interventions. Analysis was stratified by sex, 
community, and exposure. 
Increased exposure to HIV prevention activities (including ZPI activities) was associated with positive changes 
in outcomes including HIV testing, condom use in males, income earning among females, and gender equitable 
attitudes2 in both males and females. Among males, those who were exposed to HIV prevention interventions were 
significantly more likely to have been tested for HIV compared to those not exposed (67 percent versus 54 percent). 
This was observed only in Western and Eastern provinces. Furthermore, while there were variations across provinces 
in the change in rates of non-regular partnerships in both males and females, self-reported condom use with the 
last non-regular sex partner increased significantly from baseline to midline in both males (23 percent to 60 percent) 
and females (38 percent to 49 percent) in all provinces, and was significantly higher for males among those exposed 
(72 percent) compared to those unexposed (53 percent). Additionally, a significantly higher proportion of females 
exposed to income generation activities (40 percent) reported earning income compared to those not exposed (25 
percent). Lastly, although the support of inequitable gender norms was significantly lower among those exposed 
to HIV prevention interventions compared to those not exposed among males (27 percent versus 36 percent) and 
females (33 percent versus 38 percent), the difference is minimal. 
The following outcome indicators showed improvements from baseline to midline, although there was no difference 
between exposed and unexposed groups: i) HIV knowledge levels; ii) HIV testing rates; iii) access to condoms; iv) 
1FHI360 is the lead partner implementing ZPI, in collaboration with the Population Council, Catholic Medical Mission Board 
(CMMB), Afya Mzuri, Comprehensive HIV and AIDS Management Program (CHAMP), and Zambia Health Education and Communi￾cations Trust (ZHECT).
2Gender equitable norms was measured using the Gender Equitable Men (GEM) Scale. Pulerwitz, J. and G. Barker. 2008. “Mea￾suring attitudes toward gender norms among young men in Brazil: Development and psychometric evaluation of the GEM scale,” 
Men & Maculinities 10: 322–338.
2 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
self-reported condom use; v) gender norms attitudes; vi) medical male circumcision indicators; vii) women’s financial 
decision-making indicators; viii) self-reported contraceptive use; and ix) self-reported unintended pregnancy rates.
These are encouraging trends and are expected with an effective community-based project. However, attributing 
the improvements in the outcome indicators to the ZPI intervention remains a challenge. It is difficult to know how 
much ZPI activities are behind these changes. In support of ZPI’s contribution to these changes in outcomes, service 
provision and utilization data of the ZPI project do show that ZPI has been implementing HIV prevention activities 
as planned, and has exceeded the target set for many program implementation indicators. For example, through 
September 2013, ZPI had provided HIV testing and counseling to 168,153 individuals, which is above the overall 
project target of 125,000. Additionally, it had reached 82,791 individuals with interventions and services that 
explicitly address GBV (88 percent of its target), and 9,916 individuals with entrepreneurship skills (94 percent of 
its target). In some cases, we found the greatest improvements in outcome indicators in provinces where ZPI has 
had greater coverage and time to implement (Eastern and Copperbelt) with minimal improvements in the province 
where ZPI had just started activities (Western). These data and findings are good indications that ZPI activities have 
positively influenced behaviors and attitudes related to HIV prevention. 
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 3
Background
The Zambia-Led Prevention Initiative Program (ZPI) is a USAID-funded initiative designed to increase the delivery and 
uptake of community-led HIV prevention interventions and to generate an evidence base for diffusion of effective 
approaches. ZPI is implemented by a consortium of organizations3 led by FHI360.4 This report describes the findings 
from the midline survey conducted as part of ZPI’s evaluation.
Zambia’s epidemic and state of HIV prevention science
With an estimated HIV prevalence of 14.3 percent among men and women age 15–49 years, Zambia is one of 
the most affected countries in sub-Saharan African (Zambia Central Statistical Office 2007). As with other highly 
affected African countries, Zambia’s epidemic is shaped by a complex set of social and behavioral factors. High 
rates of partner change and multiple concurrent sexual partners (MCP) have both been implicated in high HIV 
prevalence rates in many African countries (Morris and Kretzschmar 1997, Halperin and Epstein 2004, Mah and 
Halperin 2008, Morris et al. 2010). The Zambia Modes of Transmission (MOT) study (Zambia National HIV/AIDS/
STI/TB Council 2009) estimates that individuals whose partners have casual heterosexual sex contribute most to 
HIV incidence and are responsible for 37 percent of total annual HIV incidence in Zambia, followed by individuals 
reporting casual heterosexual sex, who contribute 34 percent of the annual HIV incidence in Zambia. Further, STIs, 
evidenced as a contributing factor to the epidemic (Steen et al. 2009), are reported annually in about 5 percent of 
the population (Zambia Central Statistical Office 2007) and are found to be rising by some studies (Zambia Central 
Statistical Office 2010). Sexual risk reduction has shown some success with youth (age 15–24 years) (Gouws et 
al. 2008, International Group on Analysis of Trends in HIV Prevalence and Behaviours in Young People in Countries 
most Affected by HIV 2010); however, gaps in basic HIV knowledge exist among this same group (Zambia Central 
Statistical Office 2010). Gaps in HIV prevention are also evident. Zambia has had a fairly robust prevention of 
mother-to-child-transmission (PMTCT) program and has achieved commendable results: 59 percent of seropositive 
mother-infant pairs received maternal and infant Nevirapine in 2007–2008 (Stringer et al. 2010). However, only 28 
percent of HIV positive children aged 0–14 years were put on antiretroviral therapy (Zambia National HIV/AIDS/STI/
TB Council 2012). Lastly, with a low prevalence (13 percent) of male circumcision (MC) (Zambia Central Statistical 
Office 2007), population level benefits of adult MC programs in Zambia remain to be seen (Auvert et al. 2005, Bailey 
et al. 2007, Gray et al. 2007).
In Zambia, the highest HIV prevalence exists among certain sub-populations: female sex workers (65–69 percent), 
STI patients (43–57 percent), TB patients (52–61 percent), MSM (self-reported: 33 percent), and prisoners (27 
percent) (Zambia National HIV/AIDS/STI/TB Council 2009). However, associations between socio-economic status 
(SES) and HIV prevalence in Zambia remain difficult to disentangle (Zambia Central Statistical Office 2007, Gabrysch 
et al. 2008, Malhotra and Yang 2011, Singh et al. 2011). In contrast, excessive alcohol use has been linked to 
unsafe sex in sub-Saharan Africa (Kalichman et al. 2007) and directly to HIV status in Zambia (Malhotra and Yang 
2011), presenting yet another compounding factor to the epidemic. Similarly, gender-based violence (GBV) is 
associated with higher risk of HIV acquisition (Dunkle et al. 2004) and HIV-positive women experience GBV more 
(Maman et al. 2002); with over half of Zambia women experiencing GBV in their lifetime (Zambia Central Statistical 
Office 2007), this presents a substantial risk to women.
3FHI360 as lead, Afya Mzuri, Comprehensive HIV AIDS Management Programme (CHAMP), Hodi, Zambia Health Education and 
Communication Trust (ZHECT), Catholic Medical Mission Board (CMMB), Grass Roots Soccer (GRS), and the Population Council.
4FHI acquired Academy for Educational Development (AED) in July 2011.
4 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
ZPI Description 
The purpose of ZPI is to increase utilization of proven community-level interventions (e.g., Men Taking Action, couples 
counseling) aimed at reducing HIV transmission including promotion of safer sexual practices, HIV testing and 
counseling (HTC), voluntary medical male circumcision, and PMTCT. ZPI also implements structural interventions 
to address key drivers of the HIV epidemic such as alcohol and substance abuse, GBV, gender inequitable norms, 
and economic inequities. Such interventions include entrepreneurship skills building; raising awareness about the 
connection between GBV, alcohol abuse, and HIV; and GBV training for men, women, and young people. 
The conceptual framework (Figure 1) for the project illustrates how its key components are expected to ultimately 
contribute to reduced HIV transmission over the life of the project. This is to be achieved through behavior change 
brought about by building the capacity of communities to become agents of change.
Figure 1 Conceptual Framework for ZPI
ZPI Evaluation
The objective of the evaluation is to examine changes from baseline to midline in project outcome indicators 
including male norms, alcohol abuse, and other HIV knowledge, attitudes, and practices (KAP) indicators. The 
current report presents findings from the midline survey and comparisons of baseline and midline indicators.5 The 
baseline report has been presented elsewhere (Zambia-led Prevention Intiative 2012). This study was approved 
by the Population Council Institutional Review Board in New York and the University of Zambia (UNZA) Ethics 
Committee.
5Appendix 1 in the ZPI baseline report includes indicators and targets for Years 1 and 3 and findings from the 2007 ZDHS.
• Engage and mobilize leaders
• Create an enabling 
environment
• Build capacity
• Coordinate response
• Deliver high quality, 
accessible combination 
prevention services
• Strengthen referrals and 
linkages
Measurable Results 
Achieved
Development, Delivery & 
Testing of Prevention 
Interventions and Approaches
Sustainable 
Impact
Reduced HIV 
transmission
• Increased access to 
and uptake of effective 
prevention services
• Improved male norms
• Reduced high risk traditional 
practices
• Reduced vulnerability
• Reduced high-risk behaviors
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 5
Methods
Study Design
This is a cross-sectional study design with repeated household surveys that measure HIV behavioral indicators 
in three groups of communities: communities where ZPI interventions were initiated in years 1, 2, and 3. This 
evaluation is based on changes over time from baseline (July/August 2011) to midline (August/September 2013). 
Study Population
The study population draws from the population currently covered by the ZPI interventions. Districts were randomly 
selected from among those where ZPI activities were or are to be initiated in years 1, 2, and 3. Half of the selected 
districts were predominantly rural, and the other half had a significant urban or peri-urban population. The midline 
survey was conducted in the same provinces and districts as the baseline. Out of this universe, we randomly 
selected a number of geographical areas known as standard enumeration areas (SEA), within which the study was 
carried out. 
For the midline survey, the survey team recruited and interviewed female and male residents by household in the 
selected SEA using the following inclusion criteria:
• Females aged 15 to 49 years or males aged 15 to 59 years.
• Being a permanent resident of a household or having spent the night before in the household.
Sample Size
A target sample size of 2,700 respondents (1, 800 women and 900 men) was determined to detect a 10 percent 
reduction in high-risk sexual behavior (sex with a non-marital, non-cohabiting partner) between rounds of surveys. 
The 2007 ZDHS reported high-risk sexual behavior to be 17 percent in females and 35 percent in males; thus, 
1,800 women and 900 men were required to detect a 10 percent reduction in this behavior from the ZDHS reported 
prevalence. Households and household members were selected randomly from SEAs that were selected randomly at 
baseline. The target sample size allocated to each province was proportionate to the population of the province. The 
midline survey was implemented in the same SEAs as the baseline with the exception of a few that were impassable 
during the mapping for midline. These SEAs were replaced by an adjacent SEA. The midline survey team interviewed 
1,437 females and 750 males (80 and 83 percent of the target sample size, respectively) between August and 
September 2013. 
Data Collection
Maps and household listings of the SEAs in the districts of operation of ZPI were obtained from the Central Statistical 
Office (CSO). A team of enumerators made advance visits to the randomly selected SEAs to update the household 
listings. Eligible females were randomly selected from the updated household listing. Since the required sample size 
of females was twice that of males, a male respondent was randomly selected from every other household where a 
female was randomly selected using a Kish Grid.
The midline survey consisted of a behavioral questionnaire (one for females and one for males) and a household 
questionnaire. Face-to-face interviews were conducted by interviewers using a handheld PDA and responses were 
entered on the same PDA. The teams of interviewers were introduced to households by a local community guide. In 
the case of legal minors (under 16 years of age in Zambia), consent for their participation was obtained from their 
parents or legal guardians followed by the minor’s assent.
6 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
Data Analysis
Data was analyzed in STATA version 12.1. The sample at midline was weighted for the baseline age structure to 
account for the difference in age between the two samples. The median age at midline was much younger than the 
baseline sample for both males (23 versus 28 years) and females (24 versus 26 years). To reconcile this, weights 
were generated for age and applied to midline indicators compared to their baseline equivalent. The age difference 
across data collection rounds may be due to the fact that the midline data collection was conducted closer to the 
fishing and farming seasons; thus, possibly more adults were out of the households while younger persons were left 
behind. Continuous variables were compared using Student’s t-test and categorical variables with Pearson’s chi￾square test. Comparisons were made between baseline and midline as well as between exposed and unexposed to 
programs among midline participants. Variables were considered significant at p < 0.05 (two-tailed). 
Limitations
A limitation of the midline study was the cross-sectional nature of the design, which limits the ability to make any 
causal inferences. Despite this, an understanding of associations is valuable for targeting programs.6 Additionally, 
the samples at midline showed a disproportionate percentage of younger participants, particularly among males. 
To reconcile this, weights were generated for age and applied to midline indicators compared to their baseline 
equivalent. Tables and figures note when weights were applied. Lastly, because ZPI is not a branded intervention 
(i.e., an intervention with a unique logo or design intended to identify the services) and works through a multitude 
of community-based organizations, there was no simple way to assess exposure to the ZPI program. Other local 
CBOs that were not part of ZPI may have been implementing similar HIV prevention programs. Hence, exposure to 
interventions in this study may reflect exposure to other HIV prevention interventions. 
6See ZPI baseline report for additional limitations resulting from baseline data collection.
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 7
Results
Sample Characteristics
All tables referenced in the report are in the Appendix. At baseline, a total of 845 males and 1,594 females 
completed the survey. At midline, 750 males and 1,437 females completed the survey. 
Table 1 describes background characteristics of the study sample at baseline and midline. The weighted median 
age at baseline and midline was 28 (males) and 26 (females). Midline participants were significantly more likely to 
be never married compared to the baseline sample for both males (42 percent versus 32 percent; p < 0.001) and 
females (35 percent versus 28 percent; p < 0.05). There was no significant difference in residency between baseline 
and midline for males and females; approximately one-third were urban residents.
Exposure to HIV prevention interventions
Various prevention interventions, listed in Figure 1, were delivered either through one-on-one interactions or via 
small group-based activities (maximum 25 people). Participants were more commonly exposed to one-on-one 
interactions (range: 9–56 percent) than group-based activities (range: 7–31 percent)7 (Table 2). The most commonly 
reported information they learned though one-on-one interaction or group-based activities was about HIV and 
AIDS prevention, HTC and referral for ART, PMTCT, male circumcision, and family planning (30–55 percent for one￾on-one interactions and 15–30 percent for group-based activities). Eastern province had the highest proportion 
of participants who indicated learning about these topics (15–76 percent through one-on-one and 8–41 percent 
through group-based activities) while Luapula had the lowest proportion (2–20 percent for one-on-one and 2–6 
percent for group-based activities). The lack of exposure in Luapula is due to the fact that ZPI had not rolled out 
interventions in the sampled districts (Mwense and Kawambwa) in Luapula; much of the ZPI activities in Luapula 
had taken place in the fishing district of Samfya.
For the purpose of this analysis, exposure to HIV prevention intervention was defined as being exposed to at least 
one one-on-one interaction and one group-based activity. Based on this definition, approximately 39–48 percent 
were exposed in Eastern, 31–35 percent in Copperbelt and Western, and 4–6 percent in Luapula. Exposure to 
prevention interventions did not differ significantly by sex (both 29 percent), age, or marital status. (Table 3) 
Participation in economic empowerment activities includes participating in at least one of the following: income 
generation training, financial management and savings education and training, savings and loans groups, and career 
development programs. Approximately 8–13 percent of males and 7–12 percent of females participated in ZPI 
income generation activities with the exception of those in Luapula (1–2 percent).8
7Most of ZPI’s prevention work occurs through small group discussions. However, the high proportion of exposure through one-on￾one interactions could have occurred through HIV testing and counseling.
8Although this is a low percentage in terms of coverage, ZPI has to date (through September 30, 2013) established a membership 
of 2,505 females and 286 males through its GROW program.
8 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
Figure 2 Exposure to HIV prevention interventions in the past year among 
 males and females via one-on-one interactions
Key Outcomes
HIV testing and receiving results 
HIV testing increased significantly from baseline 
to midline in both males and females in Eastern 
(males: 65 percent to 82 percent; females: 76 
percent to 85 percent) and Western (males: 40 
percent to 71 percent; females: 63 percent to 
89 percent) provinces. Additionally, males who 
were exposed to HIV prevention interventions 
were more likely to have been tested compared to 
those not exposed (67 percent versus 54 percent: 
p<0.01). There was no difference by exposure 
among females (Figure 3).
HIV knowledge 
Comprehensive HIV knowledge9 varied greatly 
at baseline, from as low as 21–37 percent in 
Eastern and Western provinces to 49–58 percent 
in Copperbelt (Table 4). Overall, the proportion 
with comprehensive knowledge increased 
9Comprehensive HIV and AIDS knowledge was defined as: i) knowing that both condom use and limiting sex partners to one 
uninfected partner are HIV prevention methods; ii) being aware that a healthy-looking person can have HIV; and iii) rejecting the 
common misconceptions that HIV and AIDS can be transmitted through supernatural means or mosquito bites.
0 10 20 30 40 50 60
Females
Males
Men taking action
Prevention with positives
Nutrition education with PLHIV
HIV prevention in the workplace
Economic empowerment
Violence against children
Alcohol and drug abuse
Gender issues
Sexual and gender-based violence
HIV treatment adherence
Family planning
Male circumcision
PMTCT
HTC and referral for ART
HIV and AIDS prevention
Percentage
Figure 3 Percent of males and females
 ever tested for HIV and received 
 results at baseline and MIDLINE 
 and by exposure
**p<0.01 Percentage
0
20
40
60
80
Exposed Unexposed
Males Females
54
67**
72
76
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 9
significantly from baseline to midline (males: 47 percent to 53 percent; females: 35 percent to 45 percent); however, 
comprehensive HIV knowledge remained low in Western at midline (19–22 percent). There was no difference by 
exposure to HIV prevention interventions. 
Risky sexual behaviors 
Findings are mixed with regard to risky sexual behaviors. First, there was no differences in the level of early sexual 
debut10 among adolescents from baseline to midline (approximately 20 percent in males and 10–15 percent 
in females) or by exposure status. Of note, Western province had the highest level of early sexual debut among 
adolescent boys (28 percent) and girls (24 percent) at midline, while other provinces had rates between 7 to 20 
percent. 
Second, there were significant reductions from 
baseline to midline in the proportion of both 
males (31 percent to 18 percent; p<0.001) and 
females (9 percent to 3 percent; p<0.001) who 
reported multiple sex partners11 in the last 12 
months; there was no difference by exposure 
status (Figure 4). However, condom use at last 
sex with the last partner among those who had 
multiple partners was fairly high (71 percent in 
both males and females). Although there is no 
information on condom use among those with 
multiple sex partners at baseline, the 2007 ZDHS 
reported it to be 27 percent among males and 33 
percent among females. Again, however, condom 
use at last sex with last partner among those 
who had multiple partners did not differ between 
exposed and unexposed groups (72–75 percent). 
Lastly, the proportion of respondents reporting 
non-regular partnerships in the previous 12 
months varied greatly by province. It increased 
among males from baseline to midline in 
Copperbelt (37 percent to 55 percent; p<0.01)12, but decreased among males in Eastern (35 percent to 19 percent; 
p<0.05) and remained steady in Luapula (13–14 percent) and Western (53–59 percent). Moreover, among males 
in Copperbelt only, those who were exposed to HIV interventions were more likely to report non-regular partnerships 
compared to those unexposed (57 percent versus 45 percent; p<0.05). Among females, non-regular partnerships 
remained steady from baseline to midline in all provinces except Western, where it decreased from 51 percent to 38 
percent (p<0.01). 
Despite the mixed findings related to non-regular partnerships, condom use with the last non-regular sex partner 
increased significantly from baseline to midline in both males (23 percent to 60 percent; p<0.001) and females (38 
percent to 49 percent; p<0.05) in all provinces (Figure 5), and was higher among those exposed compared to those 
10Early sexual debut was defined as engaging in sex before the age of 15 among 15 to 24 year olds.
11Multiple partnerships may include both regular and non-regular partners.
12This may be a result of higher proportion of midline respondents in Copperbelt being unmarried compared to the baseline sam￾ple.
Figure 4. Percent of males and females
 having multiple sex partners in 
 the last 12 months at baseline
 and MIDLINE
*** p<0.001 Percentage
0
20
40
60
Baseline Midline
Males*** Females***
31
18
9
3
10 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
unexposed (72 percent versus 53 percent; p<0.01) among males. Indeed, the increased condom use is supported 
by the fact that in all provinces, there was an increase in the proportion who indicated that they could get condoms if 
they wanted to in both males (72 percent to 90 percent; p<0.001) and females (57 percent to 66 percent; p<0.001). 
However, it was not associated with exposure in any of the provinces. 
Figure 5 Percent of males and females who used a condom with the last 
 non-regular partner among those who had a non-regular partner in 
 the last 12 months at baseline and MIDLINE
*p<0.05; ** p<0.01; *** p<0.001
Medical male circumcision 
Male circumcision rates varied greatly across provinces. It increased significantly from baseline to midline in 
all provinces except Eastern where it remained at 6 percent (Figure 6). While Western province had the highest 
circumcision prevalence (63 percent at midline), the greatest increase from baseline to midline was seen in Luapula, 
where circumcision prevalence went from 5 percent to 33 percent. There was no difference by exposure status.
0
20
40
60
80
100
Midline
Baseline
Females Males*** * Males Females ** Males Females * Males Females ** Females Males*** **
Percentage
Copperbelt Eastern Luapala Western All provinces
64
24
32
53
24
74
41
54
10
54
22
45
24
50
43 44
23
60
38
49
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 11
Figure 6 Percent of males reporting that they are circumcised at baseline 
 and MIDLINE
* 
p<0.05; ** p<0.01; *** p<0.001
Clinical alcohol problem 
At baseline, clinical alcohol problems13were the highest in males in Copperbelt and Eastern provinces. However, 
improvements were seen only in Copperbelt in both males (39 percent to 30 percent; p<0.05) and females (13 
percent to 8 percent; p<0.01). Further, in Copperbelt, women who were exposed to HIV prevention programs were 
more likely to have a clinical alcohol problem compared to those not exposed (6 percent versus 11 percent; p<0.01), 
which likely indicates that the programs are reaching those who need the interventions. In Eastern province, clinical 
alcohol problems remained extremely high at 36–47 percent in males. 
Gender-based violence 
Table 5 presents results related to gender-based violence. Experience of any physical violence14 in the past 12 
months increased significantly among females in Copperbelt (3 percent to 7 percent; p<0.01) and Luapula (4 
percent to 8 percent; p<0.05), and remained consistently high among females in Eastern (8–11 percent) from 
baseline to midline. Experience of sexual violence15was reported by only a small number of participants. Support of 
rape myths16 decreased overall among males (46 percent to 35 percent; p<0.001) and females (40 percent to 28 
percent; p<0.001) from baseline to midline.
13Alcohol Problem: Alcohol abuse was assessed using the CAGE 4-item questionnaire Ewing, J. A. (1984). “Detecting alcoholism. 
The CAGE questionnaire,” JAMA 252(14): 1905–1907. The items include feeling the need to cut down on drinking, being annoyed 
by people criticizing drinking, feeling guilty about drinking, and needing an eye-opener first thing in the morning. An affirmative 
response on two or more of the items was considered to be a clinically significant alcohol problem.
14Physical violence was defined specifically as having been kicked, dragged, beaten, choked, burned, or threatened with a gun, 
knife, or other weapon.
15Sexual violence was defined as having been forced in any way to have sexual intercourse or perform any sexual acts. 
16Participants were asked the level of agreement to four myths about rape, which were statements that essentially blame women 
for the sexual violence they experience, such as “If a woman doesn’t fight back, you can’t really say it was rape.”
0
20
40
60
80
100
Midline
Baseline
All provinces Western** *** Luapula*** Copperbelt Eastern ***
Percentage
40
14
66
33
5
63
47
39
18
12 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
Gender equitable norms 
Attitudes toward gender relations were measured using 15 items adapted from the Gender Equitable Men scale.17
A typical item in the scale is, “A man should have the final word about decisions in his home” or “A woman should 
tolerate violence in order to keep her family together.” Table 5 presents results related to gender equitable norms. 
While support of inequitable gender norms increased significantly among females in Copperbelt (19 percent to 30 
percent; p<0.001) and Western (37 percent to 55 percent; p<0.001), those who were exposed to HIV prevention 
activities were significantly less likely to support inequitable gender norms compared to those not exposed among 
males (17 percent versus 34 percent; p<0.001) and females (19 percent versus 34 percent; p<0.001) in Copperbelt.
We also assessed decision-making power related to how one’s earning is used, health care, food and clothing, daily 
purchases, and large investments (i.e., house, car) to see if there were increases in joint decision making or self￾decision making (women only) among those who were cohabiting or had a spouse. Copperbelt was the only province 
with an increase in joint decision making regarding how earnings are used and money is spent on food/clothing 
and large investments among both males and females (Figure 7). There was no clear meaningful finding on these 
indicators in the other three provinces. 
Figure 7 Percent of males and females in Copperbelt whose financial 
 decisions were made jointly at baseline and MIDLINE
*p<0.05; ** p<0.01; *** p<0.001
Unintended pregnancies and contraceptive use 
In all four provinces, there were significant increases in contraceptive use to delay pregnancy (25 percent to 56 
percent; p<0.001; Figure 8). This supports the finding of reduced prevalence of unintended pregnancies that 
was also observed in the four provinces (50 percent to 39 percent; p<0.001; Figure 9. However, neither of these 
indicators was associated with exposure to HIV prevention interventions. 
17Gender equitable norms was measured using the Gender Equitable Men (GEM) Scale.Pulerwitz, J. and G. Barker. 2008. “Mea￾suring attitudes toward gender norms among young men in Brazil: Development and psychometric evaluation of the GEM scale,” 
Men & Maculinities 10: 322–338.
0
20
40
60
80
100
Midline
Baseline
Female Male*** ** Female Male** * Female Male* **
Percentage
How one’s money is spent Money spent on 
food/clothing
Money spent on 
large investments
55
71
49
71
35
59 56
67
46
54
69 72
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 13
Figure 8 Percent of females reporting currently using contraceptives to 
 delay pregnancy at baseline and midline
*** p<0.001
Figure 9 Percent of females reporting that their last pregnancy was
 unintended at baseline and midline
* p<0.05; *** p<0.001
Economic empowerment 
The proportion of participants earning money was compared between those participating specifically in economic 
empowerment activities18 and those who were not. Baseline results are not reported here as the baseline survey’s 
assessment of “earning” differed from that of the midline survey (the baseline included both cash as well as in-kind 
18Exposure to economic empowerment activities includes participating in at least one of the following activities: i) income gener￾ation training; ii) Financial management and savings education and training; iii) savings and loans group; and iv) career develop￾ment programs.
0
20
40
60
80
100
Midline
Baseline
All provinces Western*** *** Luapula*** Eastern*** Copperbelt***
Percentage
52
30
59
27
69
15
55
23
56
25
0
20
40
60
80
100
Midline
Baseline
All provinces Western* *** Eastern Luapula * Copperbelt***
Percentage
39
67
42
55
25
34
49
37 39
50
14 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
earnings while the midline survey was based solely on cash earnings). Based on the midline survey data, those who 
were exposed to income-generating activities were significantly more likely to be earning money compared to those 
not exposed among both males (52 percent versus 43 percent; borderline significant) and females (40 percent 
versus 25 percent; p<0.001). 
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 15
Conclusion and Recommendations
In summary, many positive changes were observed between the two years from baseline to midline surveys. There 
were improvements in HIV knowledge, HIV testing, access to condoms, condom use, gender norms attitudes, 
medical male circumcision, women’s financial decision making, contraceptive use, and decreases in unintended 
pregnancies. 
Comprehensive HIV knowledge rates increased in all provinces except Western. It should be noted, however, that ZPI 
interventions did not start in Western province until July/August 2013, which might help to explain the low rates of 
HIV knowledge. This may suggest that ZPI influenced the improvements in HIV knowledge in the remaining provinces. 
It will be interesting to determine changes in levels of knowledge after more time in Western province. 
HIV testing rates increased only in Eastern and Western provinces; midline rates were over 80 percent. However, they 
remained low in Copperbelt and Luapula where only about half of males and two-thirds of females reported ever 
having been tested at midline. Our results do indicate that males exposed to HIV prevention interventions were more 
likely to be tested for HIV. It is likely that ZPI contributed to this effect. A total of 97,043 individuals were tested and 
received their test results through ZPI in 2013 alone (which is 194 percent of the 2013 target). Promotion of HIV 
testing should be strengthened in Copperbelt and Luapula, particularly among men.
Previous studies have found that early sexual debut is associated with risky sex, pregnancy, and increased HIV and 
STI risk (Duncan et al. 1990, Greenberg et al. 1992, Laga et al. 2001, Pettifor et al. 2004, Kaestle et al. 2005). 
The rates of early sexual debut found in this evaluation remain similar to the 2007 ZDHS, which reported 14 
percent in females and 16 percent in males. Hence, ZPI should strengthen its programs to reach adolescent boys 
and girls to encourage delaying sex. A priority should be youth-centered behavioral risk reduction programming, 
and interventions should include life skills and HIV prevention programs in schools and out of school to promote 
delayed sexual debut. Programs should also promote positive communication with children on sexuality and HIV, and 
improve/provide youth-friendly sexual health services.
Overall, there were improvements in sexual risk behaviors. There were reductions in the proportion having multiple 
sex partners as well non-regular partners. Condom use results are also encouraging; a high proportion of those who 
had multiple partners reported using condoms, and there was an increase from baseline to midline in condom use 
among those who reported having sex with non-regular partners. It is also encouraging that there was a significant 
increase in the proportion reporting that they can access condoms whenever they wanted, although this proportion 
was much lower in women. ZPI implements HIV prevention interventions, including activities aimed at reducing 
risky sexual behaviors among a variety of target populations: in- and out- of-school youth, prisoners, bus/taxi 
drivers, market vendors, fishermen, truckers, sex workers, and uniformed personnel. In 2013 alone, ZPI reached 
66,181 individuals with interventions focused on abstinence and being faithful (147 percent of its 2013 target). ZPI 
likely made a contribution to the reductions in risky sexual behaviors. The availability of female condoms needs to 
increase, and ZPI should develop innovative ways to improve condom access for women. 
Condom distribution programs and IEC related to condom use seem to be improving men’s access to and use of 
condoms. In fact, from baseline to midline, there was an increase in the proportion of men reporting they could get 
condoms if they wanted to, and men exposed to HIV prevention programs were more likely to have used a condom at 
last sex with a non-regular partner. To this effect, ZPI has been conducting demonstrations of correct and consistent 
use of condoms and promoting condom use. Again, this points to ZPI’s contribution to increasing condom access 
and usage, particularly among men. Therefore, condom distribution and behavior change messages around condom 
16 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
use should continue with equal vigor and quality. As previously mentioned, ways to increase women’s access to 
condoms are needed.
Medical male circumcision is still one of the best known methods to reduce the risk for acquiring HIV in men. While 
we saw increases from baseline to midline in male circumcision prevalence in Copperbelt, Luapula, and Western 
provinces, there was no increase in Eastern, and it remained extremely low (approximately 6 percent). This is in line 
with the ZDHS 2007; the low prevalence is likely due to strong traditional beliefs among certain tribes. Programs will 
need to determine how best to tailor the approach for promoting circumcision among men in Eastern province taking 
into account the local cultural/tribal context. 
Alcohol abuse remains high among men in both Copperbelt and Eastern provinces. Programs will need to continue 
to address this issue, particularly in Copperbelt and Eastern provinces. Given the potential to reach a lot more 
men, alcohol risk screening and reduction counseling could be an integral part of HIV counseling sessions. ZPI has 
provided the CAGE screening questionnaires to implementing partner organizations along with alcohol and drug risk 
reduction training. 
HIV prevention programs appear to be having a positive effect on attitudes related to gender norms, as those who 
were exposed to HIV prevention programs were less likely to support inequitable gender norms. ZPI has contributed 
significantly to this effort. For example, provincial teams and partner organizations work to ensure gender sensitive 
programming across the project. Interventions target men and boys and include activities such as conducting 
discussions on gender, masculinity, and power, as well as the promotion of male involvement in PMTCT. Anecdotal 
reports from the Mwenda Chiefdom indicate that the perception of gender roles in the community have started 
to change—men were assisting in drawing water and cooking, which was considered taboo in the past. ZPI should 
continue its efforts to reach men and women with programs that promote positive gender norms. 
It is difficult to determine whether the increase in reported gender-based violence is a real increase in incidents or 
an artificial increase resulting from greater reporting. It may well be the latter, as reporting of GBV cases typically 
goes up when people become aware of an issue. ZPI has conducted numerous activities related to raising awareness 
about GBV. For example, ZPI led GBV and HIV prevention activities for bus and taxi drivers at bus stations, boys and 
young men from the Boy Empowerment project, women and youths in the State Lodge, and other sectors of the 
population such as farmers, traders, and constructions workers. ZPI has also formed Village Anti-GBV Committees to 
address GBV at the chiefdom level; these link to the district and provincial GBV Committees. By September 2013, ZPI 
had reached a total of 94,500 individuals with interventions that explicitly addressed GBV (88 percent of its life of 
project target). Additionally, in recent years in Zambia, there has been progress with the support at the national level 
for protecting women and young girls. In 2011, illustrating the Zambian government’s long-standing commitment 
to responding to sexual and gender-based violence, the Anti-GBV Act was passed. Further, in 2012, the Gender and 
Development Division under the Office of the President released the national guidelines for the management of 
cases of violence. The guidelines integrate medical, legal, and psychosocial responses to GBV. Multisectorial GBV 
committees—at the national and decentralized levels—facilitated the formation and resuscitation of Committees 
where they had not been formed or where they had become dormant. Based on ZPI’s anecdotal reports from the 
field, couples who indicated experiencing GBV have started opening up with regard to the problems they are facing in 
their marriages. They are beginning to seek help and support from older community members, especially those who 
are in the Anti-GBV committees. With these actions, more people are recognizing acts of GBV and reporting them, 
thus potentially explaining the increase seen in these data.
There is increased understanding that women’s economic vulnerability and economic disparities between women 
and men in many high-prevalence countries increases women’s vulnerability to HIV through various channels such 
as increased high-risk behaviors and vulnerability to GBV, limitations on women’s ability to negotiate safer sex, and 
increased dependence on transactional sex. There is evidence that programs that promote economic empowerment 
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 17
combined with HIV prevention offer strategic opportunities to get people involved in HIV prevention programs and 
may contribute to reductions in HIV risk behaviors (Kim et al. 2008, Pronyk et al. 2008). One part of ZPI’s mandates 
is to economically empower Zambian women, but ZPI recognizes that economic approaches alone will not likely 
decrease HIV risk per se. Thus, ZPI’s Grow intervention links economic empowerment activities with HIV prevention. 
By September 2013, it reached 5,944 adults and children with economic strengthening services. Through the Grow
program, 160 Grow Groups for economic empowerment has been created with a membership of 2,505 females 
and 286 males. The Grow Groups together has a savings of 40,656 Kwacha (approximately USD 7,000) and has 
provided 182,585 Kwacha (approximately USD 31,300) in loans. Income-generating activities appear to be having 
a positive impact on people’s earning capacity. Those who were exposed to income-generating activities were 
significantly more likely to be earning money compared to those not exposed among both males and females. This 
was most pronounced in Eastern province where those exposed were two times more likely to be earning money 
compared to those not exposed. Eastern province is also where ZPI’s GROW program has been the most active, with 
1,800 members (which is 64 percent of all GROW members). Thus, the exposure effect seen in the survey findings 
is supported by the program implementation data. While income-generating activities increased, there should be 
increased efforts to improve financial decision-making among couples. Only Copperbelt province showed increases 
in joint financial decision-making related to one’s income, daily purchases such as clothing and food, and large 
investments. 
In conclusion, these are encouraging trends. In some cases, we found the greatest improvements in outcome 
indicators in provinces where ZPI has had greater coverage and time to implement (Eastern and Copperbelt) with 
minimal improvements in the province where ZPI just started activities (Western). These data and findings are good 
indications that ZPI activities have positively influenced behaviors and attitudes related to HIV prevention. In light of 
the conceptual framework for ZPI, these achievements in the intermediate results of the program are expected to 
lead to a sustainable impact of reduced HIV transmission. 
18 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
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20 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
Appendices
Table 1 Background characteristics of the study sample at baseline and midline for males and females 
Background characteristics Males Females
Baseline
(n=845)
%
Midline*
(n=750)
%
p-value Baseline
(n=1,594)
%
Midline*
(n=1,437)
%
p-value
Median age (IQR) with unweighted midline 28 (21-38) 23 (18-34) 26 (20-34) 24 (19-33)
Median age (IQR) with weighted midline 28 (21-38) 28 (20-38) 26 (20-34) 26 (20-34)
Age groups with unweighted midline
15–19
20-24
25-29
30-34
35-39
40+
21 (174)
17 (140)
16 (131)
14 (120)
12 (104)
21 (176)
32 (243)
20 (146)
12 (92)
11 (82)
8 (57)
17 (130)
<0.001 20 (324)
22 (351)
19 (304)
14 (218)
12 (193)
13 (204)
28 (405)
23 (334)
14 (198)
13 (178)
10 (146)
12 (176)
<0.001
Age groups with weighted midline
15–19
20-24
25-29
30-34
35-39
40+
21 (174)
17 (140)
16 (131)
14 (120)
12 (104)
21 (176)
21 (154)
17 (124)
16 (116)
14 (106)
12 (92)
21 (156)
1.0 20 (324)
22 (351)
19 (304)
14 (218)
12 (193)
13 (204)
20 (292)
22 (316)
19 (274)
14 (197)
12 (174)
13 (184)
1.0
Education completed
No education
Primary
Secondary
More than secondary
6 (49)
33 (272)
55 (463)
6 (52)
5 (34)
29 (219)
61 (457)
5 (39)
0.135 11 (179)
44 (690)
41 (650)
4 (58)
7 (102)
42 (597)
48 (685)
4 (52)
<0.001
Marital status
Never married
Married/Living together
Divorced/Sep’d/Wid’d 
32 (189)
65 (384)
3 (15)
42 (316)
55 (410)
3 (24)
<0.001 28 (336)
61 (723)
10 (123)
35 (502)
54 (777)
11 (158)
<0.05
Residence
Urban
Rural
36 (302)
64 (543)
32 (239)
68 (511)
0.103 34 (545)
66 (1,049)
35 (501)
65 (936)
0.697
Province
Copperbelt
Eastern
Luapula
Western
37 (313)
17 (145)
22 (187)
24 (200)
47 (353)
13 (100)
18 (137)
21 (160)
<0.001 36 (569)
20 (325)
21 (326)
23 (374)
46 (660)
14 (200)
18 (260)
22 (317)
<0.001
*Midline variables are weighted to baseline age distribution
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 21
Table 2 Exposure to HIV prevention interventions in the past one year among males and females at midline
Copperbelt Eastern Luapula
Western Total
Male
(n=385)
%
Female
(n=677)
%
Male
(n=83)
%
Female
(n=194)
% 
Male
(n=123)
%
Female
(n=255)
% 
Male
(n=159)
%
Female
(n=311)
% 
Male
(n=750)
%
Female 
(n=1,437)
% 
Learned about following from peer educator or counselor 
(one-on-one)a
HIV and AIDS prevention
HTC and referral for ART
PMTCT
HIV treatment adherence
Nutrition education for PLHIV
HIV prevention in the workplace
Gender issues
Sexual and gender-based violence
Violence against children
Alcohol and drug misuse
Economic empowerment
Male circumcision
Men taking action
Prevention with positives
Family planning 
52 (200)
44 (171)
35 (134)
26 (99)
22 (84)
17 (64)
32 (122)
36 (140)
32 (124)
34 (132)
26 (100)
47 (182)
15 (56)
12 (46)
35 (136)
64 (434)
54 (362)
50 (341)
31 (211)
30 (201)
19 (125)
35 (236)
40 (267)
37 (252)
38 (258)
22 (151)
43 (290)
8 (55)
10 (70)
47 (319)
76 (63)
75 (62)
57 (47)
65 (54)
43 (36)
45 (37)
51 (42)
33 (27)
33 (27)
28 (23)
24 (20)
54 (45)
21 (17)
39 (32)
69 (57)
73 (141)
69 (133)
62 (120)
56 (109)
43 (84)
31 (61)
39 (75)
36 (69)
26 (50)
22 (43)
21 (40)
38 (74)
15 (29)
35 (67)
70 (136)
19 (23)
20 (24)
11 (13)
11 (14)
7 (9)
7 (9)
7 (8)
8 (10)
7 (8)
4 (5)
3 (4)
10 (12)
2 (2)
3 (4)
8 (10)
18 (47)
17 (44)
15 (37)
11 (27)
8 (19)
4 (9)
7 (17)
6 (14)
4 (11)
3 (7)
3 (7)
6 (14)
2 (5)
3 (8)
9 (22)
53 (84)
39 (62)
31 (49)
28 (14)
27 (43)
16 (25)
27 (43)
28 (44)
25 (40)
24 (38)
16 (25)
37 (58)
15 (23)
16 (26)
25 (40)
56 (175)
48 (149)
47 (147)
28 (86)
29 (89)
15 (46)
28 (88)
28 (86)
24 (73)
22 (68)
15 (48)
28 (88)
15 (45)
16 (50)
40 (123)
49 (370)
43 (319)
32 (243)
28 (211)
23 (172)
18 (135)
29 (215)
30 (221)
27 (199)
26 (198)
20 (149)
40 (297)
13 (98)
14 (108)
32 (243)
56 (797)
48 (688)
45 (645)
30 (433)
27 (393)
17 (241)
29 (416)
30 (436)
27 (386)
26 (376)
17 (246)
32 (466)
9 (134)
14 (195)
42 (600)
Participated in sessions on the following issues 
(group-based)b
HIV and AIDS prevention
HTC and referral for ART
PMTCT
HIV treatment adherence
Nutrition education for PLHIV
HIV prevention in the workplace
Gender issues
Sexual and gender-based violence
Violence against children
Alcohol and drug misuse
Economic empowerment
Male circumcision
Men taking action
Prevention with positives
Family planning
34 (130)
24 (94)
15 (56)
13 (49)
12 (45)
10 (37)
18 (70)
21 (79)
20 (75)
20 (76)
12 (46)
31 (119)
7 (28)
9 (34)
19 (72)
33 (223)
24 (165)
19 (129)
13 (90)
12 (80)
7 (46)
19 (129)
23 (153)
20 (133)
18 (124)
10 (69)
20 (137)
5 (32)
7 (50)
22 (146)
41 (30)
38 (28)
27 (20)
27 (20)
24 (18)
22 (16)
20 (15)
12 (9)
14 (10)
12 (9)
14 (10)
34 (25)
10 (7)
24 (18)
28 (21)
36 (69)
37 (72)
34 (66)
28 (54)
20 (39)
18 (34)
18 (35)
16 (30)
13 (25)
11 (21)
10 (20)
18 (34)
8 (16)
21 (40)
37 (71)
4 (5)
4 (5)
3 (4)
3 (4)
3 (4)
3 (4)
3 (4)
2 (3)
2 (2)
2 (2)
2 (3)
4 (5)
2 (3)
2 (3)
3 (4)
6 (14)
6 (14)
5 (13)
3 (8)
3 (8)
3 (7)
4 (10)
3 (7)
4 (9)
2 (5)
2 (6)
3 (8)
2 (5)
3 (7)
4 (9)
40 (64)
35 (55)
24 (38)
19 (30)
21 (33)
16 (26)
24 (38)
24 (38)
20 (31)
21 (32)
15 (24)
32 (50)
15 (23)
16 (25)
21 (33)
45 (140)
37 (116)
39 (121)
24 (74)
28 (86)
19 (58)
28 (87)
27 (84)
24 (76)
21 (64)
18 (55)
23 (72)
16 (51)
19 (58)
34 (105)
31 (229)
25 (182)
16 (118)
14 (103)
14 (100)
11 (83)
17 (127)
17 (129)
16 (118)
16 (119)
11 (83)
27 (199)
8 (61)
11 (80)
18 (130)
31 (446)
26 (367)
23 (329)
16 (226)
15 (213)
10 (145)
18 (261)
19 (274)
17 (243)
15 (214)
10 (150)
18 (251)
7 (104)
11 (155)
23 (331)
22 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) Exposed to HIV prevention interventionc 32 (123) 31 (212) 39 (32) 48 (93) 4 (5) 6 (15) 34 (55) 33 (103) 29 (215) 29 (423) Participated in economic empowerment activitiesd 13 (49) 11 (73) 13 (11) 7 (14) 2 (3) 1 (3) 8 (12) 8 (25) 10 (75) 8 (115)
aThese may include peer educators, Men Taking Action Champion, CATZ facilitator, GBV champions, community mobilizer, community counselor, adherence counselor, DOTS promoters, psychosocial counselors, PLA facilitators, GROW Group facilitators, GROW Group 
book writers, HBC groups, HIV resource persons, caregivers, community volunteer, or community leaders.
bThese include small group discussions in schools, at work, at health clinics, prison, at ART clinics, community centers, markets, in a home or a community meeting place.
cExposure is defined as being exposed to at least one one-on-one intervention and at least one group-based intervention.
dExposure to economic empowerment activities includes participating in at least one of the following activities: i) income generation training; ii) Financial management and savings education and training; iii) Savings and loans group; and iv) Career development 
Tab
program.
le 2 Exposure to HIV prevention interventions in the past one year among males and females at midline (con’t)
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 23
Table 3 Midline sociodemographic comparison of those unexposed and exposed to HIV prevention interventions 
Background characteristics Males Females
Unexposed
(n=535)
%
Exposed
(n=215)
%
p-value Unexposed
(n=1,014)
%
Exposed
(n=423)
%
p-value
Median age (IQR) 24 (18-35) 23 (18-32) 24 (19-33) 24 (19-33)
Age groups
15–19
20-24
25+
32 (173)
19 (99)
49 (263)
33 (70)
22 (47)
46 (98)
0.523 29 (292)
23 (232)
48 (490)
27 (113)
24 (102)
49 (208)
0.705
Education completed
No education
Primary
Secondary
More than secondary
5 (24)
28 (150)
64 (344)
3 (17)
2 (4)
21 (44)
70 (150)
8 (16)
p<0.05 7 (73)
44 (443)
47 (478)
2 (20)
5 (22)
29 (124)
59 (250)
6 (27)
p<0.001
Marital status
Never married
Married/Living together
Divorced/Sep’d/Wid’d 
53 (282)
45 (239)
3 (14)
58 (124)
40 (86)
2 (5)
0.467 40 (402)
50 (511)
10 (101)
45 (189)
45 (189)
11 (45)
0.137
Residence
Urban
Rural
29 (154)
71 (381)
50 (108)
50 (107)
p<0.001 28 (282)
72 (732)
53 (224)
21 (199)
p<0.001
24 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) Table 4 HIV knowledge, testing, male circumcision and HIV-related risk behaviors among males and females by province Copperbelt Eastern Luapula
Western Total
Male
(n=385)
% (n)
Female
(n=677)
% (n)
Male
(n=83)
% (n)
Female
(n=194)
% (n)
Male
(n=123)
% (n)
Female
(n=255)
% (n)
Male (n=159)
% (n)
Female
(n=311)
% (n)
Male (n=750)
% (n)
Female
(n=1,437)
% (n)
Comprehensive HIV 
knowledge
BL
ML
ML-Unexp
ML-Exp
58 (167) **
68 (239)
68 (178)
67 (82)
49 (276)***
60 (393)
56 (258) ††
68 (141)
33 (46)*
50 (49)
47 (24)
47 (15)
21 (66)*
30 (59)
28 (28)
32 (30)
46 (83)
51 (70)
48 (56)
80 (4)
35 (113)**
47 (122)
47 (113)
47 (7)
37 (77)***
22 (36)
19 (20)
26 (14)
28 (101)*
19 (61)
17 (36)
23 (24)
47 (373)*
53 (395)
52 (278)
54 (115)
35 (556)***
45 (635)
43 (435)
48 (202)
Ever tested for HIV BL
ML
ML-Unexp
ML-Exp
54 (156)
58 (204)
50 (132)
58 (71)
71 (401)
73 (478)
71 (327)
62 (130)
65 (80)**
82 (82)
77 (39)
84 (27)
76 (243)*
85 (168)
79 (79)
86 (80)
56 (100)
46 (62)
42 (49)
80 (4)
65 (210)
65 (169)
60 (145)
87 (13)
40 (78)***
71 (114)
66 (69)
76 (42)
63 (228)***
89 (283)
86 (178)
92 (95)
53 (423)**
62 (461)
54 (289) ††
67 (144)
69 (1,082)***
77 (1,099)
72 (729)
76 (318)
Had sex before the age of 
15 among youth (15-24 year 
olds)
BL
ML
ML-Unexp
ML-Exp
7 (4)
15 (16)
15 (12)
16 (5)
7 (11)
7 (13)
6 (9)
13 (5)
21 (6)
20 (4)
14 (2)
40 (2)
20 (17)
10 (7)
8 (3)
14 (5)
20 (6)
20 (3)
19 (3)
0
12 (10)
7 (4)
8 (4)
0
39 (22)
28 (16)
27 (10)
35 (7)
25 (33)
24 (23)
28 (19)
20 (6)
22 (38)
20 (39)
19 (27)
25 (14)
16 (71)
11 (46)
12 (35)
15 (16)
Had 2 or more partners in 
last 12 months (among 
those who had sex in last 12 
months)
BL
ML
ML-Unexp
ML-Exp
28 (43)
20 (41) 
20 (31)
25 (15)
8 (20)*
4 (14)
3 (7) †
9 (8)
35 (34)*
19 (16)
13 (6)
30 (9)
5 (6)
3 (4)
5 (4)
1 (1)
23 (22)**
8 (9)
9 (8)
0
2 (3)
1 (2)
1 (2)
0
37 (38)*
24 (27)
27 (22)
21 (8)
17 (32)***
4 (8)
4 (5)
4 (3)
31 (137)***
18 (93)
18 (67)
24 (32)
9 (61)***
3 (28)
3 (18)
5 (12)
Used condom at last sex 
with last partner (among 
those who had sex with 2+ 
partners in last 12 months)
BL
ML
ML-Unexp
ML-Exp
—a
74 (32)
77 (24)
80 (12)
—a
77 (11)
100 (7)
63 (5)
—a
65 (11)
50 (3)
78 (7)
—a
37 (2)
25 (1)
100 (1)
—a
87 (8)
88 (7)
0
—a
100 (2)
100 (2)
0
—a
64 (19)
64 (14)
63 (5)
—a
73 (6)
60 (3)
100 (3)
—a
71 (70)
72 (48)
75 (24)
—a
71 (21)
72 (13)
75 (9)
Had non-regular sex partner 
in last 12 months (among 
those who had sex in past 
12 month)
BL
ML
ML-Unexp
ML-Exp
37 (40)***
55 (113)
57 (87) †
72 (44)
25 (74)
27 (96)
28 (75)
34 (30)
35 (24)*
19 (16)
15 (7)
33 (10)
10 (18)
13 (20)
20 (16)
11 (8)
13 (12)
14 (15)
18 (16)
0
6 (11)
11 (20)
13 (21)
0
53 (51)
59 (66)
68 (55)
58 (22)
51 (108)**
38 (77)
39 (55)
49 (33)
31 (127)**
42 (210)
45 (165) †
57 (76)
24 (211)
24 (213)
26 (167)
30 (71)
Used condom with last 
non-regular partner (among 
those who had non-regular 
partner in last 12 months)
BL
ML
ML-Unexp
ML-Exp
24 (5)***
64 (83)
59 (51) †
77 (33)
32 (23)**
53 (57)
55 (41)
55 (17)
25 (6)**
74 (13)
43 (3)
78 (7)
41 (7)
54 (12)
50 (8)
63 (5)
10 (1)*
54 (9)
50 (8)
0
22 (2)
45 (10)
43 (9)
0
24 (12)**
50 (36)
46 (25) 
60 (12)
43 (46)
44 (38)
46 (25)
39 (13)
23 (24)***
60 (142)
53 (87) ††
72 (52)
38 (78)*
49 (117)
50 (83)
50 (35)
Could get condoms if 
wanted to
BL
ML
ML-Unexp
ML-Exp
70 (215)***
89 (290)
88 (217)
86 (95)
50 (199)***
66 (368)
62 (241)
66 (121)
75 (106)**
93 (89)
94 (44)
88 (28)
59 (141)**
72 (121)
68 (56)
75 (61)
77 (136)*
89 (95)
87 (79)
80 (4)
66 (161)**
52 (107)
50 (94)
47 (6)
70 (135)***
91 (133)
88 (82)
92 (48)
56 (151)***
74 (200)
71 (128)
72 (63)
72 (592)***
90 (607)
89 (422)
88 (175)
57 (652)***
66 (796)
62 (519) †
69 (251)
Circumcised BL
ML
ML-Unexp
ML-Exp
14 (43)***
40 (140)
39 (101)
43 (53)
n/a 6 (8)
6 (6)
6 (3)
9 (3)
n/a 5 (9)***
33 (45)
29 (34)
60 (3)
n/a 47 (91)**
63 (100)
64 (67)
64 (35)
n/a 18 (151)***
39 (291)
38 (205)
44 (94)
n/a
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 25
Have clinical alcohol 
problemb
BL
ML
ML-Unexp
ML-Exp
39 (118)*
30 (107)
27 (71)
25 (31)
13 (73)**
8 (51)
6 (26) ††
11 (24)
36 (51)
47 (47)
35 (18)
53 (17)
6 (18)
5 (9)
3 (3)
8 (7)
21 (37)
19 (26)
18 (21)
20 (1)
3 (10)
5 (12)
5 (11)
0
22 (43)
17 (27)
11 (11)
18 (10)
8 (30)
6 (18)
6 (13)
4 (4)
30 (249)
28 (207)
23 (121)
27 (59)
8 (131)*
6 (91)
5 (53) †
8 (35)
*p<0.05 comparing ML to BL; ** p<0.01 comparing ML to BL; *** p<0.001 comparing ML to BL
†p<0.05 comparing exposed to unexposed; ††p<0.01 comparing exposed to unexposed; †††p<0.001 comparing exposed to unexposed
aCondom use with the last sex partner at baseline may not be valid due to high proportion of missing data.
bAlcohol Problem: Alcohol abuse was assessed using the CAGE 4-item questionnaire Ewing, J. A. (1984). “Detecting alcoholism. The CAGE questionnaire.” JAMA 252(14): 1905-1907.. The items include feeling the need to cut down on drinking, being annoyed by 
people criticizing drinking, feeling guilty about drinking, and needing an eye-opener first thing in the morning. An affirmative response on two or more of the items was considered to be a clinically significant alcohol problem.
26 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) Table 5 Gender-based violence and gender equitable norms Copperbelt Eastern Luapula
Western Total
Male
(n=385)
% (n)
Female
(n=677)
% (n)
Male
(n=83)
% (n)
Female
(n=194)
% (n)
Male
(n=123)
% (n)
Female
(n=255)
% (n)
Male 
(n=159)
% (n)
Female
(n=311)
% (n)
Male 
(n=750)
% (n)
Female
(n=1,437)
% (n)
Experienced 
physical violence in 
last 12 months
BL
ML
ML-Unexp
ML-Exp
n/a 3 (12)**
7 (48)
7 (32)
6 (13)
n/a 11 (28)
8 (16)
10 (10)
5 (5)
n/a 4 (7)*
8 (21)
7 (17)
13 (2)
n/a 4 (11)
2 (7)
2 (5)
1 (1)
n/a 5 (58)
6 (91)
6 (64)
5 (21)
Experienced sexual 
violence in last 12 
months
BL
ML
ML-Unexp
ML-Exp
n/a 0 (2)
0 (3)
0
1 (2)
n/a 1 (3)
0
0
0
n/a 2 (3)
1 (2)
1 (2)
0
n/a 2 (7)*
0
0
0
1 (15)**
0 (5)
0 (2)
0 (2)
Supported rape 
myths
BL
ML
ML-Unexp
ML-Exp
43 (131)**
33 (115)
29 (77)
38 (47)
38 (208)***
22 (143)
17 (81) †††
30 (63)
38 (54)
42 (42)
36 (18)
50 (16)
50 (156)***
33 (66)
28 (28)
41 (38)
45 (79)***
25 (34)
27 (31)
0
30 (92)
23 (61)
23 (56)
27 (4)
60 (115)**
46 (74)
50 (52)
44 (24)
43 (154)
39 (126)
39 (81)
40 (41)
46 (379)***
35 (264)
33 (178)
41 (87)
40 (610)***
28 (396)
24 (246) †††
35 (146)
Supported 
inequitable gender 
norms
BL
ML
ML-Unexp
ML-Exp
25 (78)
29 (102)
34 (90) †††
17 (21)
19 (107)***
30 (199)
34 (157) †††
19 (40)
49 (70) 38 
(38)
35 (18)
44 (14)
42 (132)
47 (93)
44 (44)
50 (46)
46 (81)**
37 (50)
30 (35)
0
60 (186)***
28 (72)
27 (64)
13 (2)
43 (84)
33 (52)
47 (49)
42 (23)
37 (135)***
55 (173)
57 (118) ††
51 (52)
38 (313)*
36 (267)
36 (192) †
27 (58)
36 (560)
38 (537)
38 (383)
33 (140) †††
*p<0.05 comparing ML to BL; ** p<0.01 comparing ML to BL; *** p<0.001 comparing ML to BL
†p<0.05 comparing exposed to unexposed; ††p<0.01 comparing exposed to unexposed; †††p<0.001 comparing exposed to unexposed
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 27
Table 6 Use of contraceptives and unintended pregnancy among female respondents at baseline and 
midline and by exposure
Copperbelt Eastern Luapula Western Total
Female
(n=677)
% (n)
Female
(n=194)
% (n)
Female
(n=255)
% (n)
Female
(n=311)
% (n)
Female
(n=1,437)
% (n)
Contraceptive use (currently using 
to delay pregnancy)
BL
ML
ML-Unexp
ML-Exp
30 (165) ***
52 (173)
52 (121)
47 (48)
27 (86) ***
59 (63)
53 (27)
61 (36)
15 (49) ***
69 (62)
68 (54)
75 (6)
23 (85) ***
55 (96)
58 (64)
54 (34)
25 (385) ***
56 (395)
56 (266)
54 (124)
Unintended pregnancy BL
ML
ML-Unexp
ML-Exp
67 (249) ***
39 (134)
40 (102)
36 (33)
55 (153) *
42 (67)
43 (36)
43 (33)
34 (90)
25 (48)
25 (45)
33 (3)
37 (95) *
49 (106)
51 (75)
49 (36)
50 (587) ***
39 (355)
39 (258)
42 (105)
*p<0.05 comparing ML to BL; ** p<0.01 comparing ML to BL; *** p<0.001 comparing ML to BL
28 ■ Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) 
Table 7 Economic empowerment among married or cohabiting women 
Copperbelt Eastern Luapula
Western Total
BL ML ML-Unexp ML-Exp BL ML ML-Unexp ML-Exp BL ML ML-Unexp ML-Exp BL ML ML-Unexp ML-Exp BL ML ML-Unexp ML-Exp
Earning money —a 32 (209) 27 (164)*** 48 (35) —a 10 (20) 10 (17) 21 (3) —a 33 (86) 31 (79) 0 —a 26 (83) 24 (69) 32 (8) —a 28 (398) 25 (329)*** 40 (46)
Who decides on following issues:
How one’s money earned is usedb
Self
Spouse/Partner
Jointly
Other
32 (60)**
11 (21)
49 (90)
8 (14)
25 (21)
5 (4)
71 (60)
0
25 (15)
7 (4)
68 (40)
0
23 (6)
0
77 (20)
0
15 (24)
35 (57)
50 (80)
0
28 (3)
49 (5)
23 (2)
0
60 (3) †
0
40 (2)
0
0
83 (5)
17 (1)
0
12 (17)
19 (26)
69 (94)
0
16 (9)
11 (6)
73 (39)
0
16 (8)
12 (6)
72 (36)
0
0
0
100 (3)
0
33 (34)
22 (22)
45 (46)
0
20 (10)
14 (7)
65 (33)
0
16 (5)
16 (5)
68 (21)
0
22 (4)
11 (2)
67 (12)
0
23 (135)***
22 (126)
52 (310)
2 (14)
21 (42)
11 (22)
68 (134)
0
21 (31)
10 (15)
68 (99)
—
19 (10)
13 (7)
68 (36)
—
Money spent on food and clothing
Self
Spouse/Partner
Jointly
Someone else or self with 
someone else
20 (46)*
24 (53)
56 (127)
0
15 (36)
18 (43)
67 (163)
1 (2)
12 (23)
21 (40)
66 (126)
1 (1)
23 (12)
9 (5)
66 (35)
2 (1)
15 (26)*
38 (65)
46 (80)
1 (2)
24 (30)
43 (55)
31 (40)
3 (3)
32 (19) †
30 (18)
33 (20)
5 (3)
18 (13)
52 (37)
28 (20)
1 (1)
21 (36)**
12 (21)
65 (110)
1 (2)
32 (46)
23 (32)
42 (60)
3 (5)
33 (45)
22 (29)
42 (56)
4 (5)
29 (2)
29 (2)
43 (3)
0
17 (19)
23 (25)
59 (65)
1 (1)
18 (23)
27 (35)
54 (68)
1 (1)
13 (11)
33 (27)
53 (44)
1 (1)
26 (11)
19 (8)
56 (24)
0
19 (127)
24 (164)
56 (382)
1 (5)
21 (136)
26 (164)
52 (330)
2 (12)
21 (98)
24 (114)
53 (246)
2 (10)
22 (38)
40 (52)
56 (24)
0
Money spent on large investmentc
Self
Spouse/Partner
Jointly
Someone else or self with 
someone else
5 (11)**
25 (57)
69 (155)
1 (2)
2 (5)
24 (57)
72 (175)
3 (7)
1 (2) †
26 (49)
71 (135)
2 (4)
6 (3)
17 (9)
72 (38)
6 (3)
12 (21)***
43 (74)
44 (76)
1 (1)
1 (2)
47 (60)
35 (45)
17 (21)
0
37 (22)
45 (27)
18 (11)
3 (2)
54 (38)
27 (19)
17 (12)
3 (5)***
23 (38)
73 (122)
2 (3)
3 (5)
22 (32)
59 (84)
16 (23)
4 (5)
20 (27)
60 (81)
16 (22)
0
57 (4)
29 (2)
14 (1)
1 (1)
36 (38)
61 (65)
3 (3)
5 (6)
38 (48)
55 (70)
2 (2)
6 (5)
40 (33)
53 (44)
1 (1)
2 (1)
37 (16)
58 (25)
2 (1)
6 (38)***
31 (207)
62 (418)
1 (9)
3 (18)
31(197)
58 (374)
8 (53)
3 (12) †
28 (131)
61 (287)
8 (38)
2 (1)
37 (16)
58 (25)
2 (1)
Health care
Self
Spouse/Partner
Jointly
Someone else or self with 
someone else
39 (86)***
13 (28)
46 (101)
3 (7)
25 (117)
3 (13)
47 (226)
25 (120)
14 (49) †††
2 (7)
54183)
30 (102)
43 (66)
3 (5)
23 (35)
31 (47)
17 (31)
33 (62)
49 (91)
1 (2)
16 (27)*
24 (40)
53 (88)
7 (12)
14 (11) ††
11 (9)
63 (50)
11 (9)
19 (16)
33 (28)
39 (33)
8 (7)
6 (8)***
13 (18)
81 (116)
1 (1)
27 (49)
10 (18)
57 (103)
5 (9)
27 (44)
11 (17)
56 (17)
6 (10)
42 (5)
0
42 (5)
17 (2)
25 (28)
20 (22)
53 (60)
3 (3)
33 (61)
19 (35)
45 (83)
3 (5)
38 (44)
21 (25)
39 (46)
2 (2)
30(18)
13 (8)
48 (29)
8 (5)
23 (153)***
20 (130)
55 (368)
2 (13)
25 (255)
11 (106)
50 (499)
15 (147)
21 (148) †††
8 (58)
53 (369)
18 (123)
34 (105)
13 (41)
33 (102)
20 (61)
Daily purchases 
Self
Spouse/Partner
Jointly
Someone else or self with 
someone else
31 (68)***
12 (26)
51 (114)
6 (14)
16 (77)
4 (21)
48 (226)
32 (152)
11 (36) †††
4 (15)
52 (178)
33 (112)
24 (36)
3 (5)
26 (39)
48 (73)
19 (36)
33 (62)
46 (86)
2 (3)
15 (25)
36 (61)
45 (74)
4 (7)
18 (14) †
4 (15)
52 (178)
33 (112)
12 (10)
45 (38)
41 (34)
2 (2)
16 (23)**
12 (17)
70 (100)
2 (3)
27 (49)
12 (21)
53 (96)
7 (13)
28 (45)
11 (18)
52 (84)
9 (14)
25 (3)
8 (1)
42 (5)
25 (3)
16 (23)**
12 (17)
70 (100)
2 (3)
36 (67)
18 (34)
39 (72)
6 (12)
33 (39)
21 (24)
39 (45)
8 (9)
43 (26)
12 (7)
35 (21)
10 (6)
19 (21)***
21 (23)
56 (63)
5 (5)
22 (218)
14 (136)
47 (469)
18 (184)
19 (134) †††
11 (76)
50 (346)
20 (142)
24 (75)
17 (51)
32 (99)
27 (84)
*p<0.05 comparing ML to BL; ** p<0.01 comparing ML to BL; *** p<0.001 comparing ML to BL
†p<0.05 comparing exposed to unexposed; ††p<0.01 comparing exposed to unexposed; †††p<0.001 comparing exposed to unexposed
a At baseline, earning money was not assessed. Rather earning money or in-kind earnings was assessed at baseline.
bAmong those earning money.
cLarge investments include car, house and appliances.
Midline Evaluation of the Zambia-Led Prevention Initiative (ZPI) ■ 29
Table 8 Economic empowerment among married or cohabiting men
Copperbelt Eastern Luapula Western Total
BL ML ML-Unexp ML-Exp BL ML ML-Unexp ML-Exp BL ML ML-Unexp ML-Exp BL ML ML-Unexp ML-Exp BL ML ML-Unexp ML-Exp
Earning money —a 50 (176) 42 (336) 49 (24) —a 33 (33) 29 (21) 36 (4) —a 63 (86) 58 (69) 100 (3) —a 47 (75) 42 (62) 67(8) —a 49 (371) 43 (293) 52 (39)
Who decides on following issues:
How one’s money earned is usedb
Self
Spouse/Partner
Jointly
Other
20 (23)*
24 (28)
55 (65)
2 (2)
21 (15)
5 (4)
71 (50)
3 (2)
23 (13)
4 (2)
70 (39)
4 (2)
12 (2)
12 (2)
77 (13)
0
32 (21)
9 (6)
59 (38)
0
23 (6 )
7 (2)
70 (18)
0
25 (4)
13 (2)
63 (10)
0
25 (2)
0
75 (6)
0
22 (10)**
11 (5)
64 (29)
2 (1)
43 (22)
0
58 (23)
0
43 (20)
0
58 (27)
0
75 (3)
0
25 (1)
0
27 (13)
10 (5)
60 (29)
2 (1)
37 (15)
3 (1)
58(23)
2 (1)
33 (7)
0
67(14)
0
39 (7)
6 (1)
50 (9)
6 (1)
24 (67)***
16 (44)
58 (161)
1 (4)
31 (57)
4 (6)
65 (121)
1 (3)
31 (44)
3 (4)
64 (90)
1 (2)
30 (14)
6 (3)
62 (29)
2 (1)
Money spent on food/clothing
Self
Spouse/Partner
Jointly
Someone else or self with 
someone else
43 (55)**
20 (26)
35 (45)
2 (2)
21 (20)
17 (17)
59(58)
3 (3)
27(20)
12 (9)
56 (42)
5 (4)
23 (6)
4 (1)
73 (19)
0
52 (35)
16 (11)
32 (22)
0
47 (33)
24 (17)
29 (20)
1 (1)
44 (19)
30 (13)
23 (10)
2 (1)
64 (16)
0
32 (8)
4 (1)
29 (23)
25 (20)
42 (33)
4 (3)
20 (16)
34 (27)
43 (34)
3 (3)
20 (15)
36 (27)
41 (31)
3 (2)
20 (1)
0
80 (4)
0
23 (16)
19 (13)
55 (38)
3 (2)
41 (29)
15 (10)
44 (30)
0
20 (15)
36 (27)
41 (31)
3 (2)
63 (19)
10 (3)
27 (8)
0
38 (129)
20 (70)
40 (138)
2 (7)
31 (98)
23 (72)
45 (143)
2 (7)
30 (69)
24 (55)
44 (102)
3 (7)
49 (42)
5 (4)
45 (39)
1 (1)
Money spent on large investmentsc
Self
Spouse/Partner
Jointly
Someone else or self with 
someone else
45 (58)***
9 (11)
46 (59)
0
33 (32)
1 (1)
54 (53)
12 (12)
35 (26) †
0
49 (37)
16 (12)
23 (6)
4 (1)
73 (19)
0
63 (43)
2 (1)
35 (24)
0
41 (29)
8 (5)
42 (30)
9 (7)
28 (12) †
14 (6)
44 (19)
14 (6)
64 (16)
0
32 (8)
4 (1)
29 (22)*
7 (5)
61 (46)
3 (2)
13 (10)
6 (5)
72 (58)
9 (7)
13 (10)
7 (5)
717 (53)
9 (7)
20 (1)
0
80 (4)
0
45 (31)**
2 (1)
51 (35)
3 (2)
54 (38)
14 (10)
31 (22)
0
48 (19)
18 (7)
35 (14)
0
63 (19)
10 (3)
27 (8)
0
45 (154)***
5 (18)
48 (164)
1 (4)
34 (109)
7 (22)
51 (163)
8 (25)
19 (67) ††
8 (18)
53 (123)
11 (25)
49 (42)
5 (4)
45 (39)
1 (1)
*p<0.05 comparing ML to BL; ** p<0.01 comparing ML to BL; *** p<0.001 comparing ML to BL
†p<0.05 comparing exposed to unexposed; ††p<0.01 comparing exposed to unexposed
a At baseline, earning money was not assessed. Rather earning money or in-kind earnings was assessed at baseline.
bAmong those earning money.
cLarge investments include car, house and appliances.