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Review
. 2025 Mar;31(3):762-771.
doi: 10.1038/s41591-025-03535-8. Epub 2025 Feb 13.

Preventing HIV in women in Africa

Frances M Cowan  1   2 , Maryam Shahmanesh  3   4   5 , Paul A Revill  6 , Joanna Busza  7 , Euphemia L Sibanda  8   9 , Sungai T Chabata  8   9 , Natsayi Chimbindi  3   4   5 , Tamara Choola  10 , Owen Mugurungi  11 , James R Hargreaves  7 , Andrew N Phillips  3
Affiliations
Review

Preventing HIV in women in Africa

Frances M Cowan et al. Nat Med. 2025 Mar.

Abstract

HIV incidence is declining globally, but around half of all new infections are in sub-Saharan Africa-where adolescent girls and young women bear a disproportionate burden of new infections. Those who sell sex are at particularly high risk. Despite declining incidence rates and availability of effective biomedical prevention tools, we are not on track, globally or in Africa, to achieve UNAIDS 2025 prevention targets. For those at risk, interventions that strengthen their motivation, capabilities and access to all available HIV prevention technologies are critical-for adolescent girls and women in particular, but also for epidemic control more broadly. Exciting possibilities for scaling up new and highly effective prevention technologies are close, but delivery, implementation and financing models need to be developed and urgently evaluated, in partnership with communities, or these opportunities may be lost. Here, we discuss the evolving landscape of biomedical prevention technologies for women in Africa, their implementation and financing, as well as priorities for HIV prevention research in this setting.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Women and men on the edge of sex work.
The distribution of new HIV infections across key population groups in SSA in 2022 (data from UNAIDS Global AIDS Update 2024). Women who sell sex but do not identify as ‘sex workers’ (for example, when they first start selling sex, they sell sex only sporadically or are transitioning into and out of sex work) may make up a substantial proportion of infections, so that this group may be larger than the data suggest (segment with blue diagonal lines). Their male sex partners may also may make up a substantial proportion of new infections in men (segment with red diagonal lines).
Fig. 2
Fig. 2. A PrEP cascade.
The percentage of female sex workers who are HIV-negative (seronegative)–recruited to the endline survey of the AMETHIST trial,–who engaged with each step of the cascade, highlighting the substantial challenges to successful PrEP rollout.
See this image and copyright information in PMC

References

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    1. UNAIDS. Eastern and Southern Africa regional profile — 2024 global AIDS update The Urgency of Now: AIDS at a Crossroads. 2024. https://www.unaids.org/en/resources/documents/2024/2024-unaids-global-ai... .
    1. UNAIDS. The path that ends AIDS: UNAIDS Global AIDS Update. 2023. https://www.unaids.org/en/resources/documents/2023/global-aids-update-2023 .
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