UNAIDS 2014 EASTERN AND SOUTHERN AFRICA HIV EPIDEMIC PROFILE

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1 UNAIDS 214 EASTERN AND SOUTHERN AFRICA HIV EPIDEMIC PROFILE

2 214 EASTERN AND SOUTHERN AFRICA Overview The eastern and southern Africa (ESA) region consist of 21 countries, including Angola, Botswana, Comoros, Eritrea, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, South Africa, South Sudan, Swaziland, Uganda, United Republic of Tanzania and Zimbabwe. It is the region that is worst affected by the HIV epidemic in the world and currently accounts for about 5% of the global HIV burden. However, in recent years the region has made significant progress in the AIDS response and by mid-214, more than 8.1 million people, out of a total of 18.5 million people, living with HIV in ESA region were receiving antiretroviral therapy (ART). The rates at which treatment and prevention programmes have been scaled up, and the associated declines in incidence and mortality, have varied substantially among countries but overall have led to a substantial decline in the number of new HIV infections and AIDS-related deaths in the region. The ESA region is on track to reach several of the United National Political Declaration targets, including the elimination of new HIV infections among children, reaching the universal access target for treatment provision to people living with HIV by 215, halving TB deaths among people living with HIV, and eliminating travel related restrictions for people living with HIV. Table 1 HIV epidemic indicators People living with HIV New HIV infections Adult 15+ new HIV infections AIDS-related deaths HIV prevalence (adults aged 15 49) HIV incidence (adults aged 15 49) Children ( 14 years) living with HIV Children ( 14 years) newly infected with HIV Adults 15+ living with HIV Women 15+ living with HIV HIV prevalence among young women (15 24 years) New HIV infections among young men (15 24 years) [ ] 18 5 [ ] 1 3 [ ] 1 1 [ ] 1 1 [1 1 2 ] 94 [84 1 ] 1 [ ] 73 [66 81 ] 7.8% [ %] 7.4% [7. 7.8%].63% [.58.68%].5% [.45.55%] 2 3 [ ] 2 [ ] 21 [18 23 ] 12 [99 15 ] 15 5 [ ] 16 5 [ ] 9 1 [ ] 9 7 [ ] 4.3% [3.9 5.%] 3.7% [ %] 1.9% [ %] 1.8% [ %] New HIV infections among young women (15 24 years) New HIV infections among young women (15 24 years) 14 [12 17 ] 14 [12 17 ] 12 [96 14 ] 12 [96 14 ] Sources: UNAIDS 213 HIV Estimates 1 1. UNAIDS 214 Gap Report and unpublished estimates of the Gap Report 2

3 Fig. 1 HIV prevalence by geographical region Eritrea South Sudan Ethiopia Uganda Kenya Rwanda Seychelles Angola Zambia United Republic of Tanzania Comoros Malawi Mozambique -1% 1.1-5% 5.1-1% % >15% Zimbabwe Namibia Botswana Madagascar Mauritius Swaziland South Africa Lesotho Table 2 HIV programme data Number of adults living with HIV receiving ART Number of children living with HIV receiving ART Adult ART coverage (of all adults living with HIV) Child ART coverage (of all children living with HIV) % [21 23%] 43% [41 45%] 12% [11 13%] 27% [24 29%] Number of women receiving PMTCT services PMTCT coverage 56% [52 61%] 78% [72 86%], UNAIDS 214 Global AIDS Response Progress Reporting 3

4 HIV trend data Fig. 2 Number of people living with HIV Fig. 3 Number of new HIV infections Millions 25 2 Millions The number of people living with HIV reached 18.5 million in 213. The number of new HIV infections declined by 32% from 1.6 million in 25 to 1.1 million in 213 Fig. 4 Number of AIDS-related deaths Millions AIDS-related deaths declined by 46% from 1.4 million in 25 to 73 in 213. Fig. 5 Prevalence (%) among young people (15 24) men women HIV prevalence among young women declined from its peak of 6.7% in 2 to 3.7% in 213. Among young men it declined from 2.9% in 2 to 1.8% in 213. Fig. 6 Fig. 7 ART coverage (%) of all people living ART coverage (%) of children living with HIV with HIV About 41% of all people living with HIV received antiretroviral therapy in 213. About 27% of all children living with HIV received treatment in

5 Fig. 8 PMTCT coverage (%) Fig. 9 Number of new child HIV infections Thousands Significant progress has been made in scaling up PMTCT programmes and by 213, 78% of pregnant women with HIV had access to antiretroviral drugs to prevent mother-to-child transmission of HIV. As a result of the rapid scale-up of PMTCT programmes, there has been a significant reduction in the number of new child infections and the region is on track to reach the Global Plan elimination target by

6 Achievements/progress in the regional HIV response The number of new HIV infections in the region has fallen by 32% between 25 and 213. ART has been scaled up significantly and by mid-214, more than 8.1 million people living with HIV in the region were receiving treatment. This scale-up has led to a decline in AIDS-related deaths of 46% between 25 and 213 and have also started to have an impact on reducing new HIV infections. While there is variation in the rate of scale-up between countries, all countries in the region have made progress in providing treatment to people living with HIV the majority of countries have adopted the 213 WHO treatment guidelines and are committed to starting treatment at a CD4+ cell count of 5/µL. Coverage of PMTCT services among pregnant women living with HIV reached 78% in 213. As a result of this dramatic scale-up of PMTCT services, new infections among children have fallen by 66% between 25 and 213 and the region is on track to reaching the Global Plan elimination target. An increasing number of countries in the region are developing Investment Cases in order to be more strategic in the allocation of resources and to ensure that the HIV response is efficient and sustainable. All countries in the region are in the process of setting new targets for the HIV response for 22 and 23. The UNAIDS treatment target of (9% of people living with HIV to know their status, 9% of those to be on treatment, 9% of those to be virally suppressed) has been endorsed by the SADC and EAC economic communities and have been adopted in the majority of countries in the region. HIV travel restrictions have been eliminated in all but one country in the region. Travel restrictions remain present only in Mauritius. Challenges in the regional HIV response Scale-up of paediatric treatment is lagging behind and only 27% of children living with HIV in 213 were receiving ART. Ways to diagnose and treat children living with HIV need to be scaled up as a matter of urgency. More efforts are needed to close the gap between people who are reached with HIV services and people who are not. While progress has been made in reducing new adult HIV infections, much more needs to be done in order to reach the prevention targets for 215 and 22. Many countries in the region still depend heavily on external resources for funding for the HIV response. Countries must explore ways of sustaining responses by increasing domestic resources, improving efficiency and identifying new funding streams. Stigma and discrimination still pose a problem in many countries. Ways need to be found to better engage communities and civil society in the HIV response. Strategic information on the HIV epidemic needs to be strengthened. While good data are available on HIV in the general population from sentinel surveillance and national surveys, little data are available on key populations, factors driving the epidemic (e.g. sexual behaviour), and critical enablers (e.g. community support, stigma and discrimination, gender inequality) in the region. 6

7 UNAIDS Regional Support Team Eastern and Southern Africa Merafe House, 11 Naivasha Road Sunninghill 2157 Johannesburg Republic of South Africa Tel: unaids.org

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