Rate of hiv aids in africa-Mapping HIV prevalence in sub-Saharan Africa between and | Nature

Although the continent is home to about Countries in North Africa and the Horn of Africa have significantly lower prevalence rates, as their populations typically engage in fewer high-risk cultural patterns that promote the virus' spread in Sub-Saharan Africa. Among these are combination prevention programmes, considered to be the most effective initiative, such as the abstinence, be faithful, use a condom campaign and the Desmond Tutu HIV Foundation 's outreach programs. The number of HIV positive people in Africa receiving anti-retroviral treatment in was over seven times the number receiving treatment in , with nearly 1 million added in the previous year. The most obvious effect

The hunters then became infected with HIV and passed on Pornography vintage disease to other humans through bodily fluid contamination. Dunkle K. Tanzanian males: 2. Please update this article to reflect recent events or newly available information. For each modelling region Extended Aide Fig. You are using a browser version with limited support for CSS. Reiner Jr, Jennifer M.

Dildo up mini skirt. INTRODUCTION

All retroviruses also generate a high rate of mutations when transcribing the RNA, but the error rate is highest for those viruses that replicate to high levels, such as HIV. Even in these sites, HIV-1B infections have not been associated with heterosexual epidemics, although heterosexual epidemics due to other HIV subtypes have occurred concurrently in the same sites Hudgens et al. With less than 1 percent of global health expenditure and only 3 percent of the world's Rate of hiv aids in africa workers". A dearth of HIV-specific services Rate of hiv aids in africa gay and bisexual men, as well as cultural disapproval in some communities are driving the high rates. Lists of countries by population statistics. Vaccines and Microbicides Effective vaccines that exist against other viral diseases are based on the injection of either killed virus, purified viral surface proteins, or live attenuated virus. Methods of preventing HIV Milfs getting fingered can be divided into those that are currently available, such as education, and those that are not yet available but are being pursued through research, such as vaccines. The number has remained virtually the same in Lesotho and Mozambique. In Mozambiquean Asian theme room of humanitarian workers and transporters, such as truck drivers, attracted sex workers from outside the area. Viral core proteins are usually more genetically conserved than viral surface proteins, thus reducing antigenic variation and reducing opportunities for immune selection in the vaccinee to evade effectiveness. These epidemics have been characterized by patterns that reflect primary transmission via homosexual contact and injection drug use. Thomas P.

The Human Immunodeficiency Virus HIV targets the immune system and weakens people's defence systems against infections and some types of cancer.

  • Additionally, the neighboring countries of South Africa are comparably affected, making them among the top infected nations of the world.
  • NCBI Bookshelf.
  • Although the continent is home to about
  • However, the majority of them live a healthy life because the government is providing treatment for them.
  • The predictions yielded a full range of results, to include stability in infection rate and even a descent in cases in some regions.
  • For South Africa, political turmoil and a long history of government denial fueled an epidemic that had reached disastrous proportions by the late s and early s.

Although the continent is home to about Countries in North Africa and the Horn of Africa have significantly lower prevalence rates, as their populations typically engage in fewer high-risk cultural patterns that promote the virus' spread in Sub-Saharan Africa.

Among these are combination prevention programmes, considered to be the most effective initiative, such as the abstinence, be faithful, use a condom campaign and the Desmond Tutu HIV Foundation 's outreach programs. The number of HIV positive people in Africa receiving anti-retroviral treatment in was over seven times the number receiving treatment in , with nearly 1 million added in the previous year.

The most obvious effect In many cases, AIDS causes the household to dissolve, as parents die and children are sent to relatives for care and upbringing. Much happens before this dissolution takes place: AIDS strips families of their assets and income earners, further impoverishing the poor.

Almost invariably, the burden of coping rests with women. Upon a family member becoming ill, the role of women as carers, income-earners and housekeepers is stepped up. They are often forced to step into roles outside their homes as well. Older people are also heavily affected by the epidemic; many have to care for their sick children and are often left to look after orphaned grandchildren.

It is hard to overemphasise the trauma and hardship that children As parents and family members become ill, children take on more responsibility to earn an income, produce food, and care for family members.

Many children are now raised by their extended families and some are even left on their own in child-headed households.

The illness or death of teachers is especially devastating in rural areas where schools depend heavily on one or two teachers. AIDS damages businesses by squeezing productivity, adding costs, diverting productive resources, and depleting skills.

Also, as the impact of the epidemic on households grows more severe, market demand for products and services can fall. The biggest increase in deaths AIDS is hitting adults in their most economically productive years and removing the very people who could be responding to the crisis. As access to treatment is slowly expanded throughout the continent, millions of lives are being extended and hope is being given to people who previously had none. Unfortunately though, the majority of people in need of treatment are still not receiving it, and campaigns to prevent new infections The earliest known cases of human HIV infection have been linked to western equatorial Africa, probably in southeast Cameroon where groups of the central common chimpanzee live.

Current hypotheses also include that, once the virus jumped from chimpanzees or other apes to humans, the colonial medical practices of the 20th century helped HIV become established in human populations by The hunters then became infected with HIV and passed on the disease to other humans through bodily fluid contamination.

This theory is known as the "Bushmeat theory". HIV made the leap from rural isolation to rapid urban transmission as a result of urbanization that occurred during the 20th century.

One of the most formative explanations is the poverty that dramatically impacts the daily lives of Africans. Researchers believe HIV was gradually spread by river travel. Trade along the rivers could have spread the virus, which built up slowly in the human population.

By the s, about 2, people in Africa may have had HIV, [15] including people in Kinshasa whose tissue samples from and have been preserved and studied retrospectively.

The virus multiplies in the body until it causes immune system damage, leading to diseases of the AIDS syndrome. In the s it spread silently across the globe until it became a pandemic, or widespread. Some areas of the world were already significantly impacted by AIDS, while in others the epidemic was just beginning. The virus is transmitted by bodily fluid contact including the exchange of sexual fluids, by blood, from mother to child in the womb, and during delivery or breastfeeding.

Then in and , heterosexual Africans also were diagnosed. In the late s, international development agencies regarded AIDS control as a technical medical problem rather than one involving all areas of economic and social life. Because public health authorities perceived AIDS to be an urban phenomenon associated with prostitution, they believed that the majority of Africans who lived in "traditional" rural areas would be spared.

They believed that the heterosexual epidemic could be contained by focusing prevention efforts on persuading the so-called core transmitters—people such as sex workers and truck drivers, known to have multiple sex partners—to use condoms. These factors retarded prevention campaigns in many countries for more than a decade. Although many governments in Sub-saharan Africa denied that there was a problem for years, they have now begun to work toward solutions.

AIDS was at first considered a disease of gay men and drug addicts, but in Africa it took off among the general population. As a result, those involved in the fight against HIV began to emphasize aspects such as preventing transmission from mother to child, or the relationship between HIV and poverty, inequality of the sexes, and so on, rather than emphasizing the need to prevent transmission by unsafe sexual practices or drug injection. This change in emphasis resulted in more funding, but was not effective in preventing a drastic rise in HIV prevalence.

Almost 1 million of those patients were treated in Additionally, the number of AIDS-related deaths in in both Africa as a whole and Sub-Saharan Africa alone was 32 percent less than the number in Many activists have drawn attention to possible stigmatization of those testing as HIV positive.

This is due to many factors such as a lack of understanding of the disease, lack of access to treatment, the media, knowing that AIDS is incurable, and prejudices brought on by a cultures beliefs. The belief that only homosexuals could contract the diseases was later debunked as the number of heterosexual couples living with HIV increased. Unfortunately there were other rumors being spread by elders in Cameroon.

They also claimed if a man was infected as a result of having sexual contact with a Fulani woman, only a Fulani healer could treat him". Because of this belief that men can only get HIV from women many "women are not free to speak of their HIV status to their partners for fear of violence".

Unfortunately This stigma makes it very challenging for Sub-Saharan Africans to share that they have HIV because they are afraid of being an outcast from their friends and family. The common belief is that once you have HIV you are destined to die. People seclude themselves based on these beliefs. They don't tell their family and live with guilt and fear because of HIV. This group of individuals under fear of suspicion may avoid being mistakingly identified as stigmatized by simply avoiding HARHS utilization.

The rewards of being considered normal' in the context of high-HIV-prevalence Sub-Saharan Africa are varied and great Other potential rewards of being considered normal include avoidance of being associated with promiscuity or prostitution, avoidance of emotional, social and physical isolation and avoidance of being blamed for others' illness" Using different prevention strategies in combination is not a new idea.

Combination prevention reflects common sense, yet it is striking how seldom the approach has been put into practice. Prevention efforts to date have overwhelmingly focused on reducing individual risk, with fewer efforts made to address societal factors that increase vulnerability to HIV.

UNAIDS' combination prevention framework puts structural interventions—including programmes to promote human rights, to remove punitive laws that block the AIDS response, and to combat gender inequality and HIV related stigma and discrimination—at the centre of the HIV prevention agenda. Most new infections were coming from people in long-term relationships who had multiple sexual partners.

The abstinence, be faithful, use a condom ABC strategy to prevent HIV infection promotes safer sexual behavior and emphasizes the need for fidelity, fewer sexual partners, and a later age of sexual debut. The implementation of ABC differs among those who use it. For example, the President's Emergency Plan for AIDS Relief has focused more on abstinence and fidelity than condoms [30] while Uganda has had a more balanced approach to the three elements. The effectiveness of ABC is controversial.

In Botswana ,. People who had talked to the counselors were twice as likely to mention abstinence and three times as likely to mention condom use when asked to describe ways to avoid infection. However, they were no more likely than the uncounseled to mention being faithful as a good strategy.

The people who had been counseled were also twice as likely to have been tested for HIV in the previous year, and to have discussed that possibility with a sex partner. However, they were just as likely to have a partner outside marriage as the people who had not gotten a visit from a counselor, and they were no more likely to be using a condom in those liaisons.

There was a somewhat different result in a study of young Nigerians, ages 15 to 24, most unmarried, living in the city and working in semiskilled jobs.

People in specific neighborhoods were counseled with an ABC message as part of a seven-year project funded by the U. Agency for International Development and its British counterpart. The uncounseled group showed no increase in condom use—it stayed about 55 percent.

In the counseled group, however, condom use by women in their last nonmarital sexual encounter rose from 54 percent to 69 percent. For men, it rose from 64 percent to 75 percent. Stigmatizing attitudes appeared to be less common among the counseled group. A survey of 1, Kenyan teenagers found a fair amount of confusion about ABC's messages. Half of the teenagers could correctly define abstinence and explain why it was important. Only 23 percent could explain what being faithful meant and why it was important.

Some thought it meant being honest, and some thought it meant having faith in the fidelity of one's partner. Only 13 percent could correctly explain the importance of a condom in preventing HIV infection.

About half spontaneously offered negative opinions about condoms, saying they were unreliable, immoral and, in some cases, were designed to let HIV be transmitted. Eswatini in announced that it was abandoning the ABC strategy because it was a dismal failure in preventing the spread of HIV. In , the Henry J. Kaiser Family Foundation and the Bill and Melinda Gates Foundation provided major funding for the loveLife website , an online sexual health and relationship resource for teenagers.

The TeachAIDS prevention software, developed at Stanford University , was distributed to every primary, secondary, and tertiary educational institution in the country, reaching all learners from 6 to 24 years of age nationwide. The solutions are organized around three strategic pillars: diversified financing; access to medicines; and enhanced health governance. The Roadmap defines goals, results and roles and responsibilities to hold stakeholders accountable for the realization of these solutions between and Chief among these are the traditionally liberal attitudes espoused by many communities inhabiting the subcontinent toward multiple sexual partners and pre-marital and outside marriage sexual activity.

In most of the developed world outside Africa, this means HIV transmission is high among prostitutes and other people who may have more than one sexual partner concurrently. Within the cultures of sub-Saharan Africa, it is relatively common for both men and women to be carrying on sexual relations with more than one person, which promotes HIV transmission. When infected, most children die within one year because of the lack of treatment.

Rather than having more of a specific group infected, male or female, the ratio of men and women infected with HIV are quite similar. For African countries with advanced medical facilities, patents on many drugs have hindered the ability to make low cost alternatives. Natural disasters and conflict are also major challenges, as the resulting economic problems people face can drive many young women and girls into patterns of sex work in order to ensure their livelihood or that of their family, or else to obtain safe passage, food, shelter or other resources.

This strong influence on local values, morals, and government policies has sustained infection rates at a negligible level. Even with the increase in prevalence all throughout South Africa between to , KwaZulu-Natal continues to have the highest rate of infection. Annals of Epidemiology. Studies using several combinations of three drugs to treat AIDS patients have now been conducted in several African countries Coetzee et al. They are often forced to step into roles outside their homes as well. For men, it rose from 64 percent to 75 percent.

Rate of hiv aids in africa. Prevention efforts

Silently, while political unrest dominated the media, HIV began to take hold, both in the gay community and the vulnerable black population. It was only the s that President Nelson Mandela acknowledged his government's grievance response to the crisis, by which time South Africa had already become the largest population of people with HIV in the world.

Without government support, the five-year plan did not get off the ground as quickly as planned, with few showing up to receive from free antiretroviral medication. It was only with the removal of Mbeki from office in that the government took steps to rein in the catastrophe, ramping up efforts to become what is today the largest HIV drugs program in the world.

However, increasing pressure to expand outreach has been undermined by a deteriorating public health infrastructure and the weakening of the South African currency under President Jacob Zuma.

To date, less than 30 less of people with HIV are on therapy, while infection rates among young adults continue to rise, unheeded. And that remains largely true, with little to stop the spread of infection in poverty-stricken communities. It would be unfair to say that the picture has been all doom and gloom for South Africa. Get information on prevention, symptoms, and treatment to better ensure a long and healthy life. One in four people aged 15 to 49 years is believed to be infected with HIV.

It is estimated that there are , orphaned children as a result of AIDS. Among those most affected;. Social and economic disparities, female disempowerment , and high rates of rape in South Africa are among the causes for these numbers.

A dearth of HIV-specific services for gay and bisexual men, as well as cultural disapproval in some communities are driving the high rates. Male-only populations compounded by high rates of commercial sex trade work in tandem to create a perfect storm for infection.

Was this page helpful? Thanks for your feedback! Hence, Making the child grow up with the infection from the mother. To know your HIV status is very important. Because, the sooner you reali z e that you are infected, the sooner you can act against it. By starting the treatment on time, you increase the chances of continuing to have a normal life while taking the medications.

It affects our society in a negative way, by destroying families, separating couples and leaving some children as orphans. Hence, making it difficult for some children to grow in family friendly environments and contributing to a high rate of suicide. HIV is not a deadly disease, the sooner you start taking your treatment, the longer you will live. You need to be signed in to manage your listings. Sign in. Lorem Ipsum is simply dummy text of the printing and typesetting industry.

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The Status of the HIV/AIDS Epidemic in Sub-Saharan Africa – Population Reference Bureau

Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Of the estimated new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden.

Adolescent girls and young women aged years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships.

This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.

With more than thirty years of the HIV epidemic, there is still no cure or an effective vaccine, however, there have been major advances in treating HIV [ 1 - 3 ] as the availability and rapid scale up of antiretroviral therapy ART has transformed what was inevitably a fatal disease to a chronic, manageable condition leading to notable declines in the worldwide rates of AIDS related deaths and new infections.

Whilst research into HIV vaccines and vaginal microbicides continue, major breakthroughs in the prevention of HIV include voluntary male medical circumcision [ 4 - 6 ] and antiretrovirals for the prevention of mother to child transmission [ 7 ], for preventing transmission [ 8 ] and as pre-exposure prophylaxis [ 8 ] has been achieved [ 9 , 10 ].

Furthermore, focusing on high transmission areas and key populations, together with the implementation of evidence-based combination prevention strategies has the ability to substantially reduce HIV transmissions and achieve epidemic control, potentially transforming the pandemic to low level endemic epidemics [ 11 ]. Notwithstanding the major advances in the delivery of HIV prevention and treatment to attain epidemic control, initiatives to prevent sexual transmission of HIV, indeed the major mode of transmission in sub-Saharan Africa remains a challenge to the possibility of an AIDS free generation.

In an estimated Ten countries, mostly in southern and eastern Africa, viz. The epidemics in Botswana, Namibia and Zambia appear to be declining, whilst the epidemics in Lesotho, Mozambique and Swaziland seem to be plateauing [ 12 ]. In sub-Saharan Africa, the main mode of HIV transmission is through heterosexual sex with a concomitant epidemic in children through vertical transmission.

Not only do young women aged years have HIV rates higher than their male peers, they acquire HIV infection years earlier than their male peers. Adapted from [ 12 , 24 ]. The disproportionately high HIV prevalence throughout the region suggest the lack of appropriate interventions to protect young women and to meet their sexual and reproductive health needs as they prepare for adulthood [ 12 ].

In the region, there is a paucity of research in marginalized groups such as men who have sex with men, people who inject drugs and sex workers, however, emerging data suggests that HIV prevalence is significantly higher in these groups than in the general population [ 32 ]. Studies from South Africa and Kenya show that HIV prevalence was almost three fold higher in men who had sex with men than in men who had sex with women only [ 33 , 34 ]. Similarly, HIV incidence rates have also been three to four fold higher at Injecting drug use is a growing concern across the region compounded by reports of high risk sexual behaviors in these individuals.

The absence of harm reduction programs and persistent high risk behaviors has implications for transmission of HIV. Sex work has been the key driver of the epidemic in the region and the burden of HIV remains disproportionately high amongst female sex workers.

Even in countries with generalized epidemics, HIV prevalence is at least two fold higher in this group than in the general population and the pooled HIV prevalence among female sex workers in sub-Saharan Africa was Whilst the number of life time sex partners, risky sex acts or behavioral practices impact on HIV acquisition, sex workers within sexual networks play a role in sustaining transmission. Despite the impact of combination prevention interventions that target high risk marginalized populations, the major challenges in the region are the discriminatory environments and in-country legislation that not only sustain, but fuel the epidemics resulting in extraordinarily high prevalence [ 38 ].

Major challenges exist in maintaining the declining rates of HIV infections. It is imperative that structural, behavioral and biomedical interventions are evidence and rights based, are non-discriminatory and gender transformative [ 38 ]. Furthermore, the programs should aim to decriminalize sex work, men who have sex with men and reduce intimate partner violence [ 39 , 40 ] as these impact on HIV prevention efforts.

Ideally, access to comprehensive sexual reproductive health services for HIV prevention should focus on maximizing on coverage of interventions [ 12 ]. Intensifying prevention activities requires a thorough understanding of the HIV epidemic typologies, modes of transmission and populations affected as these inform the extent to which evidence based modalities can be customized and combined to substantially reduce HIV transmission which is critical in continuing the path to altering epidemic trajectory [ 41 - 43 ].

The evolving epidemic has been characterized into several typologies to capture the dominant characteristic at regional and or country level.

However, a key feature of the epidemic is variation in disease burden not only across population and countries but across districts and sub districts. Countries characterized as having low-level epidemics , where adult HIV prevalence has not spread to significant levels in the general population nationally, nor in any sub-population, suggests that sexual networks of risk are diffuse and driven by low levels of partner change or concurrent sexual relationships or that the virus may have been recently introduced.

In such settings, information on the most vulnerable and at risk populations is needed to understand risk behaviors, social sexual networks and factors such as rates of sexually transmitted infections STIs that could potentially impact on the spread of HIV.

Many West African countries such as Benin 1. Thus, prevention planning should track the epidemic and entail knowledge of HIV trends. In concentrated epidemic settings, HIV has spread rapidly in one or more populations but is not well established in the general population. Adult HIV prevalence is high enough in one or more sub-populations, such as men who have sex with men MSM , people who inject drugs PWID or sex workers and their clients who maintain the epidemic in this sub-population, but the virus has not spread in the general population.

In several countries, HIV prevalence is nearly 20 times higher amongst high risk sub-populations such as MSM and sex workers compared to adult HIV prevalence in the general population. In Burundi, HIV prevalence in sex workers is To prevent epidemics expanding to the general population, HIV prevention efforts should focus on understanding the dynamics of HIV transmission, tracking the size and course of the epidemic and prioritizing and intensifying interventions in affected sub-populations.

In generalized epidemic settings , HIV prevalence is well established in pregnant women attending antenatal clinics, indicating that the presence of HIV among the general population is sufficient for sexual networking to drive the epidemic.

Multiple partner relationships giving rise to sexual networks intensify HIV transmission and account for majority of infections. Importantly, the behaviors of most at risk populations through longer term multiple concurrent relationships sustain HIV transmission in the general population [ 42 ]. In countries such as Kenya 6. Thus, prevention efforts must focus on broad social movements that contribute to safer sex behaviors and extend to those in the general population with increased vulnerability to HIV, especially young people.

In such settings, high levels of HIV related stigma, gender based violence and sexual coercion fuel the spread of HIV in the general population, leading to excessively high prevalence [ 45 , 46 ]. Countries such as Botswana These groups are at an increased risk of infection, yet are less likely to access HIV prevention and treatment services because of the pervasive stigma and discrimination against these groups [ 38 , 46 ].

A more recent concern has been the role of HIV super infection, which occurs when an infected individual is infected again, by another variant.

Super infection leads to a spike in viral load and individuals can transmit either variant or a recombinant form to partners [ 47 , 48 ]. Understanding HIV epidemic typologies has been central to the design of prevention programs, however a more in-depth and nuanced understanding of HIV transmission is needed to direct interventions.

Recent efforts to reduce sexual transmission of HIV have made progress and strategies from recent evidence based interventions are promising and should incrementally be tested and evaluated in populations at risk for HIV. To prevent the further spread of HIV, focus on combination strategies and reaching the majority of sex workers, their clients, MSM and other high risk individuals is key to altering epidemic trajectory [ 43 ].

Whilst these have been useful as a national response and scaled up towards attaining universal access to prevention and treatment including care and support for all, these have failed to address social and economic factors and power in relationships. However, country level HIV data masks diverse, complex and heterogeneous epidemics at sub-national, regional and district level.

Furthermore, as new HIV infections continue one or more sub-populations of virus emerge [ 47 , 48 ] resulting in the spread of HIV viral variants. Geospatial mapping is a novel approach that is being used to map HIV infections [ 51 , 55 ] in order to understand geographic variation of the HIV epidemic, its drivers, and for increasing the efficiency of targeted interventions in high HIV burden, resource poor settings.

Adding to this novel approach, phylogenetic analyses of HIV-1 viral sequences are increasingly being applied to map HIV transmission links. The transmission links are important to understand dyadic relationships, and to identify clusters or networks in communities.

A combination of HIV phylogenetic analyses with the relevant socio demographic and behavioral data provide powerful knowledge on patterns and dynamics of HIV transmission networks across communities, which could guide HIV prevention and intervention strategies [ 56 - 58 ]. In the village of Mochudi, Botswana, a high proportion of Mochudi unique clusters were identified among sequences suggesting that the HIV epidemic in this community is dominated by locally circulating viral variants [ 56 ].

These data provide empirical evidence to understand the dynamic heterogeneity of HIV which to a significant degree is often masked at a country level [ 49 ]. The HIV prevention field has evolved rapidly over the last five years.

Numerous interventions to prevent HIV acquisition are available; however, these have not been implemented and utilized in relation to the magnitude of HIV burden. Comprehensive and effective public health strategies include programming for behavior change, condom use, HIV testing and knowledge of HIV status, harm reduction efforts for injecting substance use, medical male circumcision and provision of post exposure prophylaxis.

For example condom use is generally highest in commercial sex work and lower and inconsistent in non commercial and regular partnerships [ 61 ].

Studies indicate that the majority of women are generally unable to negotiate consistent male or female condom use which is largely dependent on male partner co-operation. Although increases in male condom distribution and use played a key role in declining HIV incidence during the period [ 62 ], the major challenge has been sustaining consistent condom use [ 63 ] so men can protect themselves and their partners.

Similarly HIV counselling and testing HCT has been tested through several models [ 64 - 68 ] to enhance knowledge of HIV status, access HIV prevention and treatment programs and minimize stigma and discrimination in association with HIV Although these innovative approaches and expansion of services have been fundamental in promoting knowledge of HIV status to access treatment and promoting preventing onward transmission, knowledge of HIV status remains low.

Results from three randomized controlled trials RCTs and modelling data have paved the way for large scale roll-out of voluntary medical male circumcision VMMC as an important intervention by engaging men and reducing heterosexually acquired HIV [ 4 - 6 , 69 ].

These data suggest that for any benefit of VMMC to be realized, coverage must be scaled up. Improving surgical procedures and using novel approaches for recruitment for the safe delivery of high quality VMMC services would contribute to rapidly achieving targets for public health benefit [ 70 - 73 ].

Several RCTs of cervical barrier, diaphragm and non antiretroviral ARV based microbicides when applied vaginally have failed to show any significant benefit in preventing HIV acquisition [ 74 - 80 ]. Randomised clinical trial evidence for preventing sexual transmission of HIV adapted from [ 93 ]. Whilst these trials had no safety concerns, the major drawback was the lack of adherence and therefore the failure to demonstrate the effectiveness of the study products.

In this trial the dapivirine vaginal ring reduced the risk of HIV-1 infection by These results provide renewed hope for women initiated methods, whilst clinical trials on newer ARVs with alternate delivery mechanisms are currently underway and the role of potent broadly neutralizing monoclonal antibodies are being explored as newer HIV prevention interventions [ 24 , 91 ]. These interventions would fill an important gap as HIV prevention options for young women and impact on new HIV infections [ 24 ].

The major challenge of these promising interventions is that they are not yet licensed in sub-Saharan Africa for public sector use. Whilst vaginal microbicides and oral PrEP are urgently needed as behaviors are difficult to modify, effect and sustain, their effectiveness is largely dependent on risk perception, uptake of interventions and adherence to interventions [ 10 ], further complicated by genital inflammation with increased concentrations of HIV target cell recruiting chemokines and a genital inflammatory profile contributing to HIV acquisition [ 92 ].

These findings provide compelling evidence to the importance of viral load as a key predictor of HIV transmission. Furthermore, adding VMMC, behaviour change communication, early ART and preexposure prophylaxis could achieve greater effect in reaching the goals of epidemic control. Although high coverage of early or universal ART with VMMC, behaviour change communication and pre-exposure prophylaxis could achieve greater effect to reach the goal of epidemic control and virtually eliminate HIV transmission [ 9 , 11 ], population-based RCTs are currently ongoing to determine the effectiveness of these regimens in reducing the HIV incidence [ 97 ].

Effective ART first introduced in , led to dramatic reductions in morbidity and mortality [ 20 ]. There has been a parallel increase in the number of pregnant women receiving ART for the prevention of mother to child transmission of HIV and significantly more women and children are receiving ART [ 98 ].

Most countries have progressed with scaling-up ART provision and with a commitment to increase the numbers over the next several years. In South Africa alone over 2. Notwithstanding the success of the region as a whole in scaling up ART, this masks significant in country variability with some countries e.

The variability in treatment access remains a challenge and may potentially reverse the gains made thus far. The major milestones of ART provision aiming for maximum coverage through early or universal ART is rapidly advancing in many countries [ ]. However, some countries have not met their targets highlighting the complex challenges of patient populations that remain under-served and undermining the parallel prevention efforts.

It is hoped that strengthening of health systems, reducing costs, improving and simplifying treatment are more likely to improve adherence to drug regimens with better chances for long term survival. New ART formulations can also help address some of the current challenges including funding constraints. This approach has been successful for individual benefit in reducing morbidity and mortality. Whilst a few individuals with HIV are aware of their infection, the majority have never tested to know if they are infected.

Comprehensive HIV testing programs with either community centered or innovative approaches which include self-testing would improve knowledge of HIV status. Furthermore, of the many individuals with HIV, less than half receive adequate and ongoing treatment and less than a quarter of those on ART successfully maintain viral suppression.