HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential

Abstract

Background: The burden of HIV is especially concerning for Eastern and Southern Africa (ESA), as despite expansion of test-and-treat programmes, this region continues to experience significant challenges resulting from high rates of morbidity, mortality and new infections. Hard-won lessons from programmes on the ground in ESA should be shared.

Objectives: This report summarises relevant evidence and regional experts' recommendations regarding challenges specific to ESA.

Method: This commentary includes an in-depth review of relevant literature, progress against global goals and consensus opinion from experts.

Results: Recommendations include priorities for essential research (surveillance data collection, key and vulnerable population education and testing, in-country testing trials and evidence-based support services to improve retention in care) as well as research that can accelerate progress towards the prevention of new infections and achieving ambitious global goals in ESA.

Conclusion: The elimination of HIV in ESA will require continued investment, commitment to evidence-based programmes and persistence. Local research is critical to ensuring that responses in ESA are targeted, efficient and evaluated.

Keywords: HIV epidemiology; early diagnosis; prevention and control; public health; risk factors; vulnerable populations.

FIGURE 1

(a) Worldwide distribution of new HIV infections identified by UNAIDS in 2019. (b) Distribution of people living with HIV infection in ESA in 2019. (c) Prevalence of HIV infection per 100 000 population among countries in ESA. (d) Incidence of HIV infection per 1000 population among countries in ESA.

FIGURE 2

Data on the ESA 90-90-90 goals in all ages by country from the UNAIDS data 2020 report. (a) First 90; (b) second 90; (c) third 90.