NEWS that the world is headed for a “generation free of AIDS” have thrown up the intriguing possibility of eliminating an epidemic that at one time threatened to leave the social-and economic fabric of many countries in tatters.
The UNAIDS just reported a 35% drop in new HIV infections from 15 years ago, despite concerns over spending having plateaued.
“We are on the way to a generation free of AIDS,” UN secretary Ban Ki-moon said. “The world has delivered on halting and reversing the AIDS epidemic. Now we must commit to ending the AIDS epidemic.”
Nowhere is this news likely to be as well received as in sub-Saharan Africa, which remains the region’s worst hit, with 25.8 million people living with HIV.
This however masks the fact the new infections have dropped by 39% from five years ago, and are down 41% on 2000 numbers.
Mail & Guardian Africa looked through the report (pdf) and came up with the numbers that show huge progress in Africa.
1: In sub-Saharan Africa, $113 billion was invested for the AIDS response between 2000 and 2014, the majority of it from donors. Funding needs are projected to rise from the current $11.3 billion to $15.8 billion in 2020. But by last year African governments were investing 35% of their own money into the campaign, led by countries such as Botswana, South Africa and Namibia.
2: When the Millennium Development Goals (MDGs) were adopted in the 2000, a yearly regimen cost $10,000 and only about 10,000 people in sub-Saharan Africa were able to access HIV treatment. Now some 10.7 million Africans are on therapy, and prices of drugs are at less than $100. In the first three months of this year, Zambia alone signed up 46,000 more people on treatment.
3: Coming from a time when the South African government was sued to compel it to make antiretroviral therapy widely available, an estimated 76% of people on treatment in sub-Saharan Africa are now virally suppressed. AIDS-related deaths have fallen 52% in Rwanda since 2010, and 58% in South Africa. There has also been huge progress among high-risk groups:77% of sex workers, 54% of men who have sex with men and 42% of people in the region who inject drugs report having used protection during their most recent episode of sex.
4: It is known people living with HIV are 29 times more likely to develop tuberculosis than HIV-negative individuals, and that the infection accounts for every fifth AIDS-related death, 83% of which are in sub-Saharan Africa. But TB deaths have also fallen by at least a third in the region, because ARV treatment reduces by 65% the chance of a HIV positive individual contracting TB.
5: Just eight condoms are available per year for every sexually active individual in sub-Saharan Africa. And in contrast to global patterns, women are more likely than men to report having used a condom at last sex. But trends show a reduction in sexual risk, as African governments go on a big push. In 2001, just 400 million condoms were procured on the continent. Last year this number rose to 1.7 billion, and is projected to reach 20 billion in the next five years.
6: HIV is a huge burden on an African family, and there are countries that have made big gains cushioning its impact on children and families. In Zimbabwe, which has a national action plan for orphans, introducing cash and in-kind transfers cut school drop out rates by 82%, and pregnancy by 63%, in just two years. In Kenya, increased school enrollment cut the chances of early sexual debut by about 25% among females aged 15-20 years. Delaying sexual debut in the region is key—women in sub-Saharan Africa acquire HIV 5-7 years earlier than men.
7: Some 21 sub-Saharan Africa countries account for 85% of the global HIV burden, but focusing on them with targeted programmes has seen a tremendous change of fortunes. Some 77% of women have been reached with mother to child transmission plans, with enormous gains. Rwanda has reached 90% of pregnant mothers living with HIV. The effect has been significant: in Zimbabwe AIDS-related deaths among children under five fell from 17,000 in 2000 to 3,400 in 2014, and from 25,000 to 3,800 in South Africa over the same period. Essentially, the rate at which HIV is transmitted from mother to child has been halved.
8: The bad news: Regionally, some 1.29 million mothers living with HIV gave birth, or 90% of the global total of such women. And while AIDS-related mortality of children has fallen sharply, findings in sub-Saharan Africa show that women who start antiretroviral therapy to prevent mother-to-child transmission are five times more likely to default on the treatment than those who start the therapy for their own health.
9: There have been impressive gains in HIV testing uptake in sub-Saharan Africa, but in the median country measure, some 71% of women and 83% of men have never been tested. But more encouragingly, an estimated 51% of adults living with HIV know their status, with Ethiopia and Rwanda exhibiting the most pronounced increase in knowledge of HIV status among this group.
10: Some 80% of people living with HIV live in only 20 countries, with 13 being in the region, with the continent’s two biggest economies South Africa and Nigeria, and Uganda, accounting for half the number of global infections.Stigma remains a concern: in at least eight countries in sub-Saharan Africa, more than half of all people surveyed said they would not purchases fresh vegetables from a vendor living with HIV.
11: Women have it particularly bad: at 13.8 million, they represent 59% of all people living with HIV in sub-Saharan Africa, compared to 51% globally. HIV prevalence is also 1.7 times higher among adolescent girls than males, and in South Africa, is a notable eight times higher among females aged 15-19 than among males.
12: Mozambique, Uganda and Tanzania have made especially pronounced progress of the 12 African countries that have voluntary male circumcision programmes. Such programmes are like vaccines, they reduce the risk of HIV transmission from females to males by a staggering 60%. And studies show African men are not any more promiscuous after the cut.