Abstract
<title>Abstract</title> <p>Background HIV remains a major public health concern in sub-Saharan Africa, particularly among women due to biological and socioeconomic vulnerabilities. However, updated national evidence on HIV prevalence and its determinants among women in Zambia remains limited. This study aimed to estimate the prevalence and identify factors associated with HIV among women using the most recent Zambia Demographic and Health Survey (ZDHS) 2024. Methods A cross-sectional analytical study was conducted using nationally representative data from the ZDHS 2024. A total of 11,542 women aged 15–49 years with valid HIV test results were included. Weighted descriptive statistics were used to estimate HIV prevalence. Bivariate analysis using the chi-square test assessed associations between HIV status and explanatory variables. A multilevel mixed-effects logistic regression model was employed to identify factors associated with HIV infection. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results The study shows that approximately one in every ten women (9.33%) in the studied population of reproductive-age women in Zambia is living with HIV. HIV prevalence was higher among urban residents, women from wealthier households, and those in Western and Lusaka provinces. Multilevel analysis showed that rural residence was associated with lower odds of HIV (AOR = 0.60), while higher education was protective (AOR = 0.33). Behavioral factors were strong predictors, with increasing odds of HIV among women with multiple sexual partners, particularly those with six or more partners (AOR = 7.40). Women reporting recent sexually transmitted infections had higher odds of HIV (AOR = 1.53). Frequent health facility visits were associated with reduced odds (AOR = 0.65). Additionally, women from higher wealth quintiles had significantly increased odds of HIV, and notable regional disparities were observed. Conclusion HIV among women in Zambia is influenced by a combination of socioeconomic, behavioral, and geographic factors. Targeted interventions focusing on high-risk groups, including urban residents and women with multiple sexual partners, alongside strengthening education and healthcare access, are essential to reduce HIV burden and achieve national HIV control targets.</p>