More than a million people were newly infected with HIV last year, which added About 40 million people Currently living with the disease. But then for the first time 1981When the disease first emerged, most new HIV infections occurred outside of sub-Saharan Africa.
This is a big milestone. The region – which includes 49 countries in southern, west, central and east Africa – still bears the brunt of the epidemic. In 2023, 64 percent Most of the people living with HIV were in sub-Saharan Africa, and about 62 percent of all AIDS-related deaths occurred there. But great progress has been made in the last few decades. The number of people newly infected with HIV in sub-Saharan Africa fell from 2.1 million in 1993 to 640,000 in 30 years—a 70 percent reduction.
But as the number of new infections in the region slows, progress in the rest of the world is stalling or even reversing. Recent reports From UNAIDS, the United Nations’ dedicated HIV and AIDS programme.
New HIV infections have been increasing over the past two decades in Eastern Europe and Central Asia, Latin America, and the Middle East/North Africa, because diversity of because Lack of access to HIV testing and treatment, including displacement and migration and an increase in the number of people using intravenous drugs. Before 2009, less than 10 percent of all new HIV infections occurred across the region — but last year, that number rose to more than 20 percent.
It is good news that sub-Saharan Africa, historically the region most affected by HIV, has dramatically reduced the number of people newly infected with HIV. The fight against HIV is not over, however. Growing funding gaps and the possible partial shutdown of the US government’s most important HIV program threaten to stall progress.
But success in Africa has demonstrated that sustained efforts can dramatically reduce the burden of HIV and are worth the investment.
Why is sub-Saharan Africa so successful?
Sub-Saharan African countries have made huge gains in raising awareness of HIV and increasing access to HIV testing and treatment.
In 2023, about 80 percent of people living with HIV there have access Antiretroviral therapy, the highest rate of any region in the world. Antiretroviral therapy, a combination of drugs that treat but not cure HIV, prevents Viruses from replication. almost later six months of Usually On daily treatment, most patients have low levels of the virus that they can no longer infect others. But just a few months or even a few days of missed therapy is enough for HIV to start replicating again.
Antiretroviral therapy is important for reducing the spread of HIV. And because of such high treatment rates, sub-Saharan Africa has the highest proportion of HIV-positive people who are no longer infectious at about 74 percent. (The report classifies Somalia, Djibouti and Eritrea as part of the Middle East and North Africa.)
A major focus of HIV programming over the past few decades has been testing pregnant women and then ensuring that HIV-positive pregnant women receive treatment throughout their pregnancies. this prevents from mothers passing the virus to their babies. In 2010, more than half of HIV-positive pregnant women in East and Southern Africa were receiving HIV treatment, but by 2023, this had risen to an estimated 94 percent.
National governments in sub-Saharan Africa have also prioritized building local capacity to combat the disease. Most funding for HIV services now comes from domestic sources rather than foreign donors. Instead of relying on foreign researchers and international groups to implement HIV interventions, local organizations—which are more integrated The communities they serve and increasingly motivated by local social and cultural challenges — are increasingly running the show. In 2023, local organizations have received 59 percent HIV funding from the US Agency for International Development (USAID), a 72 percent increase since 2018, according to the agency.
Girls and women, gay men and sex workers are disproportionately affected by HIV in sub-Saharan Africa and globally. One of the main ways to get HIV is through sex spreading out. Gender-based violence And Gender-based power inequality Such populations may be exposed to disease. Notably, in sub-Saharan Africa, 62 percent New HIV infections in 2023 were among girls and women, while the majority of new HIV infections in the rest of the world were among men.
In Eastern Europe and Central Asia, social stigmacriminalization, underdiagnosis, and lack of funding are factors in the rise in HIV cases. Ukraine has long been one exception In Europe, HIV infection rates are much higher than in other countries in the region. Most HIV services have been Retrieved from Russia invaded Ukraine in 2022, but continues there fear That conflict could further delay the country’s major progress.
HIV funding is dwindling
The main driver of HIV progress is, of course, sustainable investment.
In sub-Saharan Africa, funding from international donors and local governments has contributed to progress there. The region will need a steady, consistent flow to help sustain and build on success in reducing the burden of HIV. Well-invested money ramping up HIV prevention and response activities can also offset some of the backlog of progress in other areas.
But global funding to end HIV is drying up. Between 2022 and 2023, global funding for HIV in low- and middle-income countries falls by 5 percent or so $1 billion.
Even as the gap between need and funding widens, the US Congress is considering ending one of the world’s largest HIV programs: the President’s Emergency Plan for AIDS Relief, commonly known as PEPFAR. from 2003PEPFAR has provided a total of $100 billion to provide HIV treatment to millions of people and strengthen response and prevention programs. the majority Which includes African countries. Last year, PEPFAR funding represented approx quarter Total HIV funding in low- and middle-income countries from Haiti to Kenya to the Philippines.
PEPFAR is widely considered It may be one of the world’s most successful global health programs, but some US lawmakers have balked at the program because of its inherent ties to sexual and reproductive health. HIV programming around the world has focused on improving safe-sex knowledge and practices. Important to some conservative legislators is that some agencies receiving PEPFAR funds also provide abortion services.
In the wake of this dispute, the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies introduced a bill last year that eliminated approx. $500 million HIV funding for the Centers for Disease Control and Prevention and $3 billion in funding for the National Institutes for Health. Additionally, portions of the PEPFAR Act are subject to reauthorization by Congress.
PEPFAR is reauthorized three times, for five years each. But last year partially after PEPFAR ExpiredMembers of Congress have debated whether to renew it.
After a long stalemate, largely along party lines, the Universal Funds Bill was passed in March 2024. Reauthorization program, but only for one year. Next March, the debate surrounding PEPFAR will resume. Sub-Saharan Africa has made amazing progress but if the program is not scaled up, there will be a huge hole in the global HIV response. Millions of lives could be threatened.
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