Recent alarming research shows that South Africa’s progress in tackling the Aids and HIV crisis has stalled in one of its most populous provinces, reports The Telegraph.
The number of new cases of the infection in KwaZulu-Natal have stopped falling after years of steep declines, according to the scientists.
Data from a long-running study following thousands of people also showed that those with detectable levels of virus in their blood had risen slightly, despite years of medics prescribing antiretroviral drugs.
Researchers said the peer-reviewed study published in The Lancet HIV “provides a stark warning on prevailing HIV trends in rural South Africa, where ground is being lost in the fight against the epidemic”.
The researchers, led by scientists at Durban’s Africa Health Research Institute (AHRI) and Stellenbosch University’s South African Centre for Epidemiological Modelling and Analysis (SACEMA), used a 20-year study which has tested nearly 60 000 people.
Analysis showed that after steep reductions in HIV incidence from 2013 to 2018, incidence rates for both males and females showed little or no decrease from 2019 onwards.
These rates had continued to fall for young people under 35, but that had been offset by a lack of progress for those in middle age.
Second, the proportion of those with HIV who had detectable levels of virus in the blood had also risen.
Under United Nations targets for 2030, 95% of those with HIV should have the virus suppressed in their blood by ARVs. The study found the level was more than 30% below that.
The paper concluded: “Our analyses of more than two decades of HIV testing data from a population cohort in rural South Africa reveal troubling trends in the state of the HIV epidemic.
“Although major strides have been made, our findings show that progress across three key HIV epidemic metrics has stalled (and in some cases begun to reverse) in recent years.
“Taken together, our findings challenge the narrative that South Africa is steadily progressing towards epidemic control and has continued to move closer to the UNAids 2030 targets.
“Rather, data from one of the world’s largest population-based HIV cohorts provide early warning signs that the current HIV response will not suffice to drive the epidemic towards low levels of endemicity.”
The faltering momentum could have been partly caused by early gains from the mass introduction of antiretrovirals having now already been used up, the paper said.
Disruption to HIV services by Covid-19 lockdowns probably also “widened gaps in treatment coverage and viral suppression”.
There has also been a demographic shift in those who are infected. People with HIV have become older, but people of their own age with whom they mix and have sex with do not see themselves as being at risk.
“The ageing of the epidemic has shifted the burden of new infections towards increasingly older adults, who might be less likely to perceive themselves at risk and remain underserved by existing prevention programmes,” the paper suggested.
Elphas Okango, lead author, said: “These results provide a timely insight into the changing dynamics of the HIV epidemic.
“This should be a call to action. We need to build on the successes of the past but use the tools we have at our disposal more effectively to drive the epidemic towards elimination.”
Study details
Epidemiological trends of HIV among individuals aged 15–54 years in South Africa from 2004 to 2025: a population-based, longitudinal cohort study
Elphas Okango, Margot Otto, KhaiHoan Tram, Adrian Dobra, Hae-Young Kim, Paul Mee et al.
Published in The Lancet HIV on 7 October 2026
Summary
Background
South Africa has mounted the largest HIV prevention and treatment programme in history, delivering substantial gains in survival and prevention of new HIV infections; however, service disruptions and recent funding losses might jeopardise these successes. There is a scarcity of high-quality, population-based empirical evidence on key epidemic metrics needed to accurately gauge recent progress towards epidemic control in South Africa. We aimed to evaluate recent progress towards HIV epidemic control in South Africa by quantifying long-term trends in key epidemic control metrics in a large population-based cohort in rural KwaZulu-Natal.
Methods
In this population-based, longitudinal cohort study, we used prospectively collected HIV testing, socio-demographic, behavioural, and population viral load data from the Africa Health Research Institute (AHRI) health and demographic surveillance system in rural KwaZulu-Natal from 2003 to 2025. Population-based HIV surveys (encompassing individual health interview and HIV testing) take place annually in all consenting resident individuals aged 15 years or older. We used Poisson regression models to quantify trends in directly observed HIV incidence in repeat testers (aged 15–54 years) who had initially tested negative for HIV and subsequently received at least one valid HIV test result. We further analysed 11 rounds of population viral load testing conducted between 2011 and 2025. We used generalised estimating equations to quantify population viral suppression metrics and calculated trends in the incidence-to-prevalence ratio, a key metric for evaluating progress towards epidemic control.
Findings
Between June 24, 2003, and May 22, 2025, across the population cohort, 59 806 (65·4%) of 91 367 contacted individuals aged 15–54 years consented to participate at least once in population-based HIV testing. Of those tested, 33 754 (56·4%) were female and 26 052 (43·6%) were male, with a median age of 26·7 years (IQR 19·3–39·1) at testing date. Among 42 662 participants who initially tested HIV negative and were recontacted, 29 702 (69·6%) underwent repeat HIV testing and were included in the incidence analysis. In this group, over 182 112 person-years of observation, we observed 4852 HIV seroconversions. From 2013 to 2018, overall annual HIV incidence rates declined by 52·2% in males and 36·9% in females. We found no evidence of a continued downward trend in HIV incidence between 2019 and 2025 among either females or males. After a period of substantial decline (from 2011 to 2018), population detectable viraemia increased significantly from 2019 to 2025 by 9·6 percentage points (95% CI 5·4–13·8), remaining an estimated 30·7 percentage points (95% CI 27·2–34·3) below the UNAIDS 95–95–95 population viral suppression target. The incidence-to-prevalence ratio decreased substantially across consecutive survey rounds, from 0·132 (95% CI 0·114–0·152) in 2006 to its lowest recorded value of 0·034 (95% CI 0·028–0·042) in 2022, representing an overall 74·2% decline. After 2022, the ratio stagnated above the epidemic control benchmark of 0·03.
Interpretation
These epidemic metrics show that progress towards HIV epidemic control is faltering in KwaZulu-Natal, South Africa. The tools to reverse this trajectory are available; the challenge now is to ensure their sustained and effective implementation through coordinated action across research, policy, government, civil society, and international funding partners. We can, and we should, change course now if we want to achieve an AIDS-free generation in South Africa and the world.
The Telegraph article – Progress against HIV stalls in South Africa, research shows
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