Africa can win HIV/AIDS war. Epidemic could be history by 2030

Just three countries - Nigeria, South Africa and Uganda - accounted for 48% of all new HIV infections.

New HIV infections among children in sub-Saharan Africa fell by 58% since 2001 and dropped below 200,000 for the first time (photo Michael Mistretta/flickr)

New HIV infections among children in sub-Saharan Africa fell by 58% since 2001 and dropped below 200,000 for the first time (photo Michael Mistretta/flickr)

AFRICA could deal HIV/AIDS a big blow, a new reports says.

“The AIDS epidemic can be ended in every region, every country, in every location”, says the first ever Gap Report released by the United Nations Programme on HIV/AIDS (UNAIDS). 

The report, which provides up to date data on the global HIV epidemic, gives great hope to Africa, which accounts for the highest number of people living with HIV – precisely 24.7m of the 35m people infected in the world. Ten countries— Ethiopia, Kenya, Malawi, Mozambique, Nigeria, South Africa, Uganda, Tanzania, Zambia and Zimbabwe account for 81% of all people living with HIV in sub-Saharan Africa, and half of those are in only two countries—Nigeria and South Africa.

“If we accelerate all HIV scale-up by 2020, we will be on track to end the epidemic by 2030,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) at the launch of the report Wednesday.

Good signs

There are several reasons for hope about this goal for Africa. Even though there is nearly one in every 20 adults living with the virus in the sub-Saharan region, the report has presented encouraging statistics and hopeful data.

The report showed that nearly half of the adults living in sub-Saharan Africa know their status and almost 90% of people who tested positive for HIV went on to access antiretroviral therapy (ART). Since 1995, antiretroviral therapy has averted 7.6 million deaths globally, including 4.8 million deaths in sub-Saharan Africa.  Between 2005 and 2013 AIDS-related deaths, because of accessibility to crucial ART, fell by 39%. The decreases were most significant in several countries, including South Africa (51%), Kenya (32%) and Ethiopia (37%).

This success is directly attributable to the rapid increase in the number of people on antiretroviral therapy. Sub-Saharan Africa has witnessed record numbers of people covered by HIV treatment in the past three years. Last year alone, 1.5m additional people living with HIV received antiretroviral therapy. The rapid increase in antiretroviral access has however occurred in a few countries. One- third of the increase in the number receiving antiretroviral therapy was in South Africa, followed by Uganda 6%, and in Nigeria, Mozambique, Tanzania and Zimbabwe 5%.

The use of ART also meant that new HIV infections were reduced – the report showed that in sub-Saharan Africa, 76% of people on ART have achieved viral suppression, where they are unlikely to transmit the virus to their sexual partners.

In general HIV infections have been dropping greatly across the continent. Despite 1.5m new HIV infections in sub-Saharan Africa in 2013, in the past three years alone new HIV infections fell by 13% and just three countries - Nigeria, South Africa and Uganda - accounted for 48% of all new HIV infections. 

North Africa worries

The one African region not faring well in terms of HIV infection rates was northern Africa. Even though North Africa is the region with the lowest number of people living with HIV, the burden is increasing with rising numbers of AIDS-related deaths and new infections in several countries. In 2013, there were an estimated 15,000 AIDS-related deaths in the region, an increase of 66% in the number of annual deaths since 2005. A key factor associated with the rapid spread is inject drugs – the report put HIV prevalence among people who inject drugs as high as 87% in Tripoli, Libya

In the Horn of Africa, there was better news. In Djibouti new infections among children fell by 70% and by 22% in Somalia. 

In sub-Saharan Africa, new HIV infections also fell among children by 58% since 2001 and dropped below 200,000 for the first time in the 21 most affected countries in Africa. With a drop of 67%, Malawi had the largest decline in the rate of children getting HIV infections. New HIV infections among children declined by 50% or more in eight other countries: Botswana, Ethiopia, Ghana, Malawi, Mozambique, Namibia, South Africa and Zimbabwe.

The great success in the decline of HIV infections is owed to various governmental and non-governmental prevention programmes.

Some middle and high-income countries are stepping up the financing of AIDS responses from domestic resources; South Africa is increasingly using domestic resources and, according to the Global AIDS Response Progress Reporting, Cape Verde, Comoros, Kenya, Sao Tome and Principe and Swaziland reported increased domestic investment between 2012 and 2013.

At the grassroots level, the number of men who opted for medical male circumcision in the countries with the highest infection rates tripled in the past two years – there is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. In South Africa increases in the distribution of condoms played a primary role in declines in national HIV incidence that occurred during 2000–2008.

Smart Lesotho

Some countries are also implementing social cash transfer programmes that have had positive results. In Malawi, the Mchinji social cash programme was designed for poverty alleviation, but it had a clear impact on key HIV-relevant behaviours. Since 2006 the programme provides predictable financial assistance (about US$ 14 per month) to all families throughout the country who are in the lowest income quintile and are labour-constrained. Because the families were able to save money, there was improved access and adherence to HIV treatment resulting from reduced transportation barriers to reach health services.

Meanwhile in Lesotho, the government is experimenting with various ways in which to reduce new infection rates. It selected a control group of 18–32 year olds and gave them up to four-monthly sexually transmitted infections tests linked to lottery tickets for a high-value US$ 100 or low-value US$ 50 quarterly lottery. After two years, they found that a 25% odds reduction in HIV prevalence was attributed to the lottery. Overall, the evidence is strong that different modes for providing cash transfers, particularly to young women, can reduce HIV risk and infection rates.

These interventions and programmes are just part of the processes that could assist the scale-up, and keep Africa in the running to stop the epidemic by 2030.


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