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Africa: Progress against AIDS
AfricaFocus Bulletin
August 20, 2013 (130820)
(Reposted from sources cited below)
Editor's Note
"During the past 10 years, the AIDS response has been
extraordinary, nowhere more so than in eastern and southern Africa.
The countries in this region are using the latest tools available
to save people's lives, halt HIV transmission and achieve the dream
of ending the AIDS epidemic. ... The rate of new HIV infections has
been reduced by more than 30% overall, and by more than 50% in
seven countries in the region. Since 2005, the number of people
receiving lifesaving antiretroviral therapy (ART) has increased
tenfold—from 625,000 to more than 6 million at the end of 2012.
Botswana, Namibia, Rwanda, Swaziland and Zambia reached universal
access to HIV treatment (80% coverage of people eligible for
treatment) by the end of 2011. Kenya, Malawi, South Africa and
Zimbabwe are on track to reach this goal." - UNAIDS
AIDS-related mortality has declined worldwide from an estimated 2.3
million a year in 2005 to 1.7 million in 2011, 1.2 million of those
dying in 2011 in sub-Saharan Africa (http://tinyurl.com/ad9o4la).
Saving 600,000 lives a year is real progress. But over a million deaths
a year means the fight against AIDS is still far from over. So the title of this new
report from UNAIDS ("Getting to Zero") is a hopeful projection and
a call to action rather than an accomplished fact. As the report
itself stresses, the gains must be consolidated and progress
accelerated.
This AfricaFocus Bulletin contains brief excerpts from the report,
which is available in full, including tables, charts, and
footnotes, at http://tinyurl.com/kqmyk5a
For previous AfricaFocus Bulletins on health issues, visit
http://www.africafocus.org/healthexp.php
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AfricaFocus Editor's Update
AfricaFocus normally takes a break for several weeks about this
time a year. This year the break will be somewhat longer, due
to the pressure of other work deadlines over the next month as well
as vacation travel planned for the second half of September.
Regular publication will resume in early October.
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William Minter
Editor, AfricaFocus Bulletin
P.S. Sometime in the fall I will be doing one or more issues of
AfricaFocus featuring references to recent books likely to be of
interest to readers (See http://www.africafocus.org/docs12/book1212.php for a sample of such
an issue). If you have published a book recently, or have one to
recommend as likely to be particularly interesting to AfricaFocus
readers, please send the suggestion to me at africafocus@igc.org
++++++++++++++++++++++end editor's note+++++++++++++++++
Getting to Zero: HIV in Eastern & Southern Africa
UNAIDS
July 2013
http://www.unaids.org / direct URL: http://tinyurl.com/kqmyk5a
Foreword
During the past 10 years, the AIDS response has been extraordinary,
nowhere more so than in eastern and southern Africa. The countries
in this region are using the latest tools available to save
people's lives, halt HIV transmission and achieve the dream of
ending the AIDS epidemic.
Ten years ago, the magnitude of the epidemic supported the dire
predictions being made for this region, the epicenter of the AIDS
crisis. But in only a few years, some of the most heavily-affected
countries in the region have made extraordinary progress. The rate
of new HIV infections has been reduced by more than 30% overall,
and by more than 50% in seven countries in the region. Since 2005,
the number of people receiving lifesaving antiretroviral therapy
(ART) has increased tenfold—from 625,000 to more than 6 million at
the end of 2012. Botswana, Namibia, Rwanda, Swaziland and Zambia
reached universal access to HIV treatment (80% coverage of people
eligible for treatment) by the end of 2011. Kenya, Malawi, South
Africa and Zimbabwe are on track to reach this goal. Through
reduced infectivity and rapid treatment expansion, some countries
have achieved a "tipping point", where the number of people
starting HIV treatment exceeded the number acquiring infections,
laying the foundation for moving forward country-specific and
economically sustainable responses.
The countries of eastern and southern African are making important
progress towards achieving an AIDS-free generation. Between 2009
and 2012, the number of infants newly infected with HIV has fallen
by more than half in Botswana, Ethiopia, Malawi, Namibia, South
Africa and Zambia, and by more than one-third in Kenya, Mozambique,
Swaziland, the United Republic of Tanzania and Zimbabwe. Malawi has
been a pioneering country in offering lifelong ART to all pregnant
women infected with HIV (Option B+). If we continue to increase
this momentum, we can reach our 2015 goal of eliminating new HIV
infections among children and keeping their mothers alive.
This dramatic turn-around in the course of the AIDS epidemic has
been the result of extraordinary political leadership and
engagement from civil society. From the support of African heads of
state for AIDS Watch Africa, to the advocacy of the Champions for
an HIV-Free Generation, high-level political advocacy and
accountability have been critical to the region's progress. The
majority of countries in this region have embraced the African
Union's Roadmap on shared responsibility and global solidarity for
the AIDS, TB and Malaria response.
South Africa has been an outstanding model of this transformation -
implementing a series of breakthrough policy decisions since 2009.
In 2010, South Africa embarked on an unprecedented national
campaign to provide free treatment to all eligible people living
with HIV, coupled with a massive programme of testing and
counseling for HIV and screening for TB. During the last financial
year (2012-2013), more than 9 million people were tested for HIV.
The country currently has the largest ART programme in the world,
with more than 2.1 million people receiving ART. South Africa's
domestic AIDS investments have increased to US$ 1.9 billion per
year, the second-largest national AIDS investment in the world.
Many other countries in the region have also adopted bold policies
and programmes to increase investments in their national AIDS
response. In Botswana, the government provides more than seventy
percent of all HIV spending. Zimbabwe's three percent AIDS levy on
all taxable income provides invaluable support for its national
AIDS programme. Kenya and Tanzania are considering similar
innovative funding mechanisms.
Although this region is leading the global AIDS response in the
right direction, there is still a lot to be done. In some
countries, HIV incidence has been stagnating or even increasing
(Lesotho, Uganda, United Republic of Tanzania), raising an alarm
for the need to urgently step up prevention efforts. Less than onequarter
of children living with HIV in the region are currently
receiving treatment. Inefficiencies and inequalities still limit
service delivery. Lack of human rights-based responses continues to
fuel HIV-related stigma and discrimination. Many people remain at
risk and are vulnerable to HIV. In some countries, domestic
investments are still inadequate and the challenge for several
countries in this region is to further reduce dependency on
external resources to treat their own citizens.
The eyes of the world are on this region. The pace at which eastern
and southern Africa embraces and acts on new science, evidence and
innovations will determine how quickly we will reach the vision of
zero new infections, zero AIDS-related deaths and zero
discrimination. It is time, through collective innovation, to
consolidate the gains and pursue a bold regional approach to
accelerate progress toward 2015 and beyond. In the words of Nelson
Mandela, "when the water starts boiling it is foolish to turn off
the heat".
Michel Sidibé UNAIDS Executive Director
The State of the HIV Epidemic in Eastern and Southern Africa
The past decade has seen remarkable progress in efforts to respond
to the HIV epidemics in eastern and southern Africa. In every
country, HIV programmes have grown in scale, quality, effectiveness
and impact. Positive results are being observed throughout the
region:
- In 2011, the number of adults who became newly infected with HIV
in eastern and southern Africa was at its lowest level since 1991.
- New HIV infections in children have been halved since 2001.
- AIDS claimed fewer lives in 2011 than in any year since 1998, and
the number of TB deaths in people infected with HIV was at its
lowest since 1998.
- A total of 6.3 million people in the region were receiving
antiretroviral therapy (ART) at the end of 2012.
- In the countries hardest hit by the epidemic, average life
expectancy is rising again (1).
These are the results of determined efforts over the last years to
scale up prevention and treatment programmes in the region. The
rapid scale-up of life-saving HIV treatment, in particular, ranks
among the great public health and human rights achievements of our
time.
New HIV infections among adults and children are declining
The total number of new HIV infections in eastern and southern
Africa has declined substantially in recent years. There were an
estimated 1.2 million [1.1 million-1.3 million] new infections in
2011— the lowest annual number since 1991, when the epidemic was
still expanding rapidly, and about 30% lower than the estimated 1.7
million [1.6 million-1.9 million] new infections that occurred in
2001 (Figure 1). HIV incidence among adults living in the region
decreased from 0.99% [0.93- 1.05%] in 2001 to 0.56% [0.52-0.62%] in
2011.6
Rates of new HIV infections among adults declined significantly in
several countries in the region between 2001 and 2011—by more than
50% in Botswana, Ethiopia, Malawi, Namibia, Rwanda, Zambia and
Zimbabwe, and by between 25% and 49% in Kenya, Mozambique, South
Africa and Swaziland.
The declining trends can be attributed to a combination of factors,
including the natural course of the HIV epidemic, demonstrable
changes in sexual behaviour (especially among young people in most
countries in the region), much wider access to ART, and progress in
preventing new HIV infections among children. Levels of reported
condom use have been increasing in several eastern and southern
African countries, while declines in the number of multiple sexual
partners have also been reported in some countries.
There has also been a steep decline in the number of new HIV
infections among children younger than 15 years, which fell to an
estimated 180,000 [160,000-220,000] in 2011, less than half the
370,000 [330,000-410,000] new infections estimated in 2001. Several
countries have made important progress in preventing new infections
among children in the past three years:
- Between 2009 and 2012, the number of children newly infected with
HIV fell by more than 50% in Botswana, Ethiopia, Malawi, Namibia,
South Africa and Zambia; and by 30-49% in Kenya, Mozambique,
Swaziland, United Republic of Tanzania and Zimbabwe.
This progress is largely due to improved efforts to eliminate new
HIV infections among children through the provision of
antiretroviral (ARV) treatment or prophylaxis to infected mothers
and their infants. In 2011, around 690,000 pregnant women living
with HIV received the recommended drugs8 to prevent transmission to
their babies— 100,000 more than a year earlier. Coverage of
services to eliminate mother-to-child transmission (eMTCT) in this
region increased from 61% [55- 67%] in 2010 to 72% [64-80%] in
2011. It is essential that this momentum be sustained in order to
reach mothers who still do not have access to such services in the
region (estimated at 270,000 in 2011).
AIDS-related deaths are declining
AIDS-related mortality has been declining rapidly since the
dramatic increase in provision of ART in the mid-2000s. The 800,000
[730,000-890,000] lives claimed by AIDS in 2011 were 38% fewer than
the 1.3 million [1.2 million-1.4 million] lives lost in 2005, when
ART became more freely available in eastern and southern Africa
(Figure 2).
AIDS-related mortality declined by more than 50% between 2005 and
2011 in several countries, including Botswana, Ethiopia, Kenya,
Namibia, Rwanda, Zambia and Zimbabwe.
As a result, fewer children are being orphaned because of AIDS.
Despite the decline, a disconcertingly large number of children
living in 2011—estimated at 10.5 million [9.8 million-11.2 million]
—had lost one or both parents to AIDS, and needed care and support.
The strain this causes for extended families, communities, and the
children themselves is enormous.
More effective integration of HIV and TB diagnosis and treatment is
contributing to the decline in AIDS-related mortality. The TB/HIV
death toll in eastern and southern Africa has fallen by about 30%
since 2004-6, when it peaked at an estimated 330,000 deaths per
year. If this declining trend continues, the region is likely to
reach the global target of reducing the number of TB-related deaths
among people living with HIV by 50% by 2015.
Rapid increase in the number of people receiving ART
The number of people receiving life-saving ART in eastern and
southern Africa has risen tenfold since 2005. A total of 6.3
million people were receiving ART in 2012, compared to 5.2 million
people in 2011, and 625,000 in 2005. The region currently accounts
for 65% of the 9.7 million people receiving ART globally. According
to the 2010 WHO treatment eligibility criteria9, an estimated 64%
[61-68%] of people who were eligible were receiving ART in the
region in 2011, up from 16% [15-18%] in 2005 and 45% [43-48%] in
2009.
Botswana, Namibia, Rwanda, Swaziland and Zambia had achieved more
than 80% coverage10 by the end of 2011, while Kenya, Malawi, South
Africa and Zimbabwe had reached more than 60% of people eligible
for treatment (2). Countries with coverage below 60% in 2011
include Angola, Comoros, Eritrea, Ethiopia, Lesotho, Madagascar,
Mauritius, Mozambique, Uganda and the United Republic of Tanzania.
Of 17.1 million people living with HIV in 2011, 8.1 million met the
2010 WHO ART eligibility criteria. However, the revised 2013 WHO
ART guidelines— to initiate ART at CD4 count ? 500 cells/?L and to
offer ART to all serodiscordant couples, pregnant women living with
HIV, people with TB and HIV, people with HIV and hepatitis B, and
all children living with HIV who are younger than five years— will
lead to a substantial increase in the number of people eligible for
treatment (3).
As more people start and stay on ART, survival times of those
infected with HIV are increasing, and the total number of people
living with HIV is rising slowly as a result. The total number of
people living with HIV in eastern and southern Africa rose from
15.4 million [14.6 million-16.3 million] in 2001 to 17.1 million
[16.3 million-17.9 million] a decade later, even though the annual
number of new HIV infections declined during this period (Figure
3).
The HIV epidemic among young people
HIV prevalence has been falling among both young women and men
(aged 15-24 years), and was about 40% lower in 2011 than a decade
earlier. However, the estimated number of new infections among
young people was still high at 450,000 [370,000-550,000] in 2011.
The vulnerability of young women aged 15-24 years remains of
particular concern: the estimated HIV prevalence of 4.5% [3.8-5.6%]
among women in that age group in 2011 was more than double the
prevalence among their male peers.
In some countries in southern Africa (including Lesotho, Swaziland
and South Africa), HIV prevalence among young women aged 15-24
years was still greater than 10%, highlighting the need for
increased efforts that adequately address the epidemic in this
population group.
The progress in the response to the epidemic in the region confirms
that concerted and sustained action can change the course of the
HIV epidemic. This progress is also fundamentally important to the
overall goal of halting the global HIV epidemic in this region.
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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