Nwogo. I.Ekeji, Ph.D., MPH, PHAA member
Human Immunodeficiency Virus (HIV) has thus far infected over 79.3 million people globally, leaving an estimated 40.1 million dead. In 2021, just over 38 million people were estimated to be living with HIV globally, of which 85% were aware of their HIV-positive status and more than 28.7 million were on anti-retroviral treatment (ART). In 2021, just over an estimated two thirds of people living with HIV were virally suppressed. There have been global successes in new HIV prevention research results, and an increase in resources for treatments.
However, new data indicates the globe is in danger following faltered HIV responses and shrinking resources. Global crises including COVID-19 and the Russia-Ukraine war have been implicated in these losses of momentum on HIV response and progress. In 2021, there were over a million more new HIV infections than the global targets. The incidence of HIV only dropped by 3.6% globally between 2020 and 2021 – this is the smallest recorded annual decline in new HIV infections since 2016.
Concerning rises in new HIV infections in some regions
Over the past decade, annual HIV infections are rising in regions including Latin America, North Africa, the Middle East, Central Asia and Eastern Europe. In Asia and the Pacific, where new HIV infections had previously been falling, new data indicates an alarming new infection rise. Since 2015, 38 countries, including South Sudan, Madagascar, the Congo, and the Philippines, have experienced increased new HIV infections.
Positive progress reported
However, countries including India, Nigeria, and South Africa experienced significantly decreased new HIV infection numbers, despite crises like COVID-19. In the Caribbean and western and central Africa, new HIV infections declined significantly in 2021, even while experiencing resource challenges.
Ongoing racial inequalities
In both the United States of America (U.S.A) and the United Kingdom, greater declines in new HIV diagnoses were recorded in white populations compared to black people, highlighting ongoing racial inequalities. In the U.S.A., Canada, and Australia, Indigenous communities had higher HIV acquisition rates than non-Indigenous communities. These inequalities stall progress toward ending HIV prevalence.
Urgent action needed
In 2021, a new HIV infection occurred every two minutes among young women and adolescent girls. This concerning level of infection happened amid major COVID-19 related disruptions to school attendance and HIV preventive services and treatments.
Globally, the risk of new HIV infection among gay men and other men who have sex with men (MSM) has increased. In a 2022 press release, The Joint United Nations Programme on HIV/AIDS (UNAIDS) said that, “as of 2021, UNAIDS key populations data show MSM have 28 times the risk of acquiring HIV compared to people of the same age and gender identity while people who inject drugs have 35 times the risk, sex workers 30 times the risk, and transgender women 14 times the risk”.
The global Acquired Immunodeficiency Syndrome (AIDS) response is clearly in severe danger. Public health professionals, politicians, and all stakeholders must act now to stop HIV gaining ground.
Success in South Africa
An estimated 8.2 million South Africans were living with HIV in 2021, with almost one in five adults aged 15-49 being HIV positive. Yet significant progress has been made since the beginning of the pandemic through HIV testing, counseling, enrollment in treatment, and adherence to treatment. Antiretroviral treatment has immensely improved the health of many HIV-infected individuals.
South Africa also in 2021 outstandingly reached an estimated 96% of pregnant women who live with HIV receiving antiretrovirals for the prevention of mother-to-child-transmission, with an estimated 40 000 new HIV infections averted through the prevention of mother to child transmission (PMTCT) program.
The country has achieved approximately 94% of people living with HIV who are aware of their status, 74% of people living with HIV being on ART, and 67% of HIV-infected people on the treatment being virally suppressed. The success of South Africa’s ART program has also contributed to significant life expectancy improvements. However, unprotected sex, excessive use of alcohol and drugs, injecting drugs, accidental needle stick injuries, untreated sexually transmitted infections, blood transfusions, and tissue transplantation are risk factors for new infections. Other contextual factors such as poverty, violence against women, and more may also hinder progress toward ending the pandemic.
HIV has no cure. However, with effective HIV prevention, diagnosis, treatment, and care, including co-treatment of comorbidities, it has become a treatable and manageable health condition. To stop millions of HIV-related preventable deaths, we must employ equitable, community-led health services, tackle stigmatization, enable legal and policy environments, empower girls and women, and promote equal access to new health technologies and education for all.
Continued funding is needed for HIV treatments, research into HIV vaccines and cures, as well as social behavioral research and implementation. The slowing public health response to HIV is dangerous, and meaningful efforts are needed to avert “the worst-case scenario of 7.7 million HIV-related deaths over the next 10 years”.
Ending HIV/AIDS requires epidemic control through reducing HIV incidence, prevalence, morbidity, and mortality to the point where the reproductive rate of infection (R0) is below one. At this point, HIV will no longer pose a significant public health threat.
However, can we achieve this without any cure? More meaningful research for a cure is highly recommended.
Dr Nwogo Ekeji is a public health consultant and a researcher based in South Africa.
Read Dr Ekeji’s dissertation, ‘Relationship between Treatment Comorbidities and Viral Suppression of HIV Infections in Johannesburg’, here.
Image: Nadezhda Moryak/Pexels