Sub-Saharan Africa has made the most progress against HIV, cutting the rate of new infections by 30% in the past seven years in contrast to the global average of 18%. Health-e News reports that this is according to the Joint UN Agency on AIDS (UNAIDS), which released its report, Miles to go—closing gaps, breaking barriers, righting injustices, on the 18 July.
UNAIDS reports that 1.8m people were infected with HIV in 2017, in comparison to 2.2m in 2010. “The reduction in new HIV infections has been strongest in the region most affected by HIV, eastern and southern Africa, where new HIV infections have been reduced by 30% since 2010,” according to UNAIDS.
The report says South Africa has done ever better than the sub-Saharan average, slashing new infections by 44% in five years, according to a household survey that was released yesterday.
“However, new HIV infections are rising in around 50 countries. In eastern Europe and central Asia the annual number of new HIV infections has doubled, and new HIV infections have increased by more than a quarter in the Middle East and North Africa over the past 20 years.”
“We are sounding the alarm,” said Michel Sidibé, executive director of UNAIDS. “Entire regions are falling behind, the huge gains we made for children are not being sustained, women are still most affected, resources are still not matching political commitments and key populations continue to be ignored. All these elements are halting progress and urgently need to be addressed head-on.”
In just one year, an additional 2.3m people were newly accessing treatment. This is the largest annual increase to date, bringing the total number of people on treatment to 21.7m.
The report says almost 60% of the 36.9m people living with HIV were on treatment in 2017, an important achievement, but to reach the 30m target there needs to be an annual increase of 2.8m people, and there are indications that the rate of scale-up is slowing down. Last year, around 58% of new HIV infections in people over 15 years old were among women and 6,600 young women between the ages of 15 and 24 years became infected with HIV every week.
“Increased vulnerability to HIV has been linked to violence. More than one in three women worldwide have experienced physical or sexual violence, often at the hands of their intimate partners,” said UNAIDS.
However, the report says, thanks to the impact of antiretrovirals, Aids-related deaths in 2017 were the lowest this century at 940,000. Since 2010, Aids-related deaths have fallen by 42% in eastern and southern Africa. But the current pace of decline is not fast enough to reach the 2020 target of fewer than 500 000 Aids-related deaths.
New HIV infections among children have only declined by 8% in the past two years, and only half (52%) of all children living with HIV are getting ARV treatment.
“Ending the Aids epidemic is not a foregone conclusion and the world needs to heed this wake-up call and kick-start an acceleration plan to reach the targets,” said Sidibe. “Sex workers, gay men and other men who have sex with men, prisoners, migrants, refugees and transgender people are more affected by HIV but are still being left out from HIV programmes. More investments are needed in reaching these key populations,” said Sidibe.
The report says these “key populations” and their sexual partners account for 47% of new HIV infections worldwide and 97% of new HIV infections in eastern Europe and central Asia, where one third of new HIV infections are among people who inject drugs, according to UNAIDS.
Half of all sex workers in Eswatini, Lesotho, Malawi, South Africa and Zimbabwe are living with HIV. The risk of acquiring HIV is 13 times higher for female sex workers, 27 times higher among men who have sex with men, 23 times higher among people who inject drugs and 12 times higher for transgender women.
South Africa’s Health Minister Dr Aaron Motsoaledi said, meanwhile, he was not surprised by the results of a national HIV survey, lamenting the lack of sexual and reproductive education at schools, reports Health-e News.
The South African National HIV Prevalence, Incidence, Behaviour and Communication Survey of 2017 showed that while there has been a significant decline in South Africa’s HIV infection rate, young people are still at risk. The survey found that there were an estimated 231 100 new infections in 2017, with infections among young people having risen to a total of 7.9% – with females at three-times higher risk than their male counterparts.
The report says Motsoaledi recalled how he tried to introduce sexual and reproductive education at schools several years ago, only to have the idea vehemently rejected by parents and unions. He said they were only allowed to do immunisation, eye testing and alcohol and drug campaigns. “They said no sexual and reproductive rights education, saying that children are too young for that. I want to tell parents that kids these days know way too much. Facts are out there pointing to this,” he said, adding that social media was a contributing factor leading children to experiment.
This is the fifth survey 2002 and is a population-based cross-sectional survey of households in South Africa conducted between January and December 2017. Over 33,000 people were interviewed and almost 24,000 agreed to be tested for HIV.
The study further revealed that in 2017 there were 7.9m people living with HIV in South Africa and over 60% or an estimated 4.4m people were on antiretroviral treatment (ART). It was also found that the viral suppression was 87.3% among people living with HIV, with females generally being more likely to be virally suppressed than males among those aged between 15 and 64 years.
“This suggests that the progress is being made in increasing ART coverage. But more still needs to be done,” said Dr Sizulu Moyo of the Human Sciences Research Council (HSRC) which conducted the survey. Furthermore, although viral suppression is high among those on ART, not everyone who is living with HIV is on treatment, and subsequently only 62.3% of all people living with HIV, irrespective of treatment, were found to be virally suppressed.
The report says the study also found that HIV prevalence peaked at 35 to 39 years of age for females and 45 to 49 years of age for males. Kwa-Zulu Natal was found to be the leading province in HIV prevalence, followed by the Free State and the Eastern Cape. The three least affected provinces were Limpopo, Northern Cape and Western Cape.
The report says medical male circumcision was lauded as one of the best interventions to reduce HIV among males. The increase in the number of men who are medically circumcised rose from 18.6% in 2012 to 30.8% in 2017. “Although encouraging, this finding highlights a need to continue promoting and creating a demand for voluntary medical male circumcision with an immediate target among males in the 15-to-34-year-old age group,” said Professor Leickness Simbayi, the overall principal investigator.