Latest epidemiological trends from the 2010 "Global Report on the AIDS epidemic"

Southern Africa

• An estimated 11.3 million people were living with HIV in southern Africa in 2009, nearly one third (31%) more than the 8.6 million people living with HIV in the region a decade earlier
• 34% of all people living with HIV in 2009 resided in the 10 countries in southern Africa; 31% of new HIV infections in the same year occurred in these 10 countries, as did 34% of all AIDS-related deaths. About 40% of all adult women with HIV live in southern Africa
• With an estimated 5.6 million [5.4 million–5.8 million] people living with HIV in 2009, South Africa’s epidemic remains the largest in the world.

Eastern Africa

• There was a total number of 4.2 million people living with HIV in eastern Africa in 2009.
• The epidemics in Eastern Africa have declined since 2000 but are stabilizing in many countries.
• The HIV incidence slowed in Tanzania to about 3.4 per 1000 person-years between 2004 and 2008.
• The national HIV prevalence in Kenya fell from about 14% in the mid-1990s to 5% in 2006.
• The HIV prevalence in Uganda has stabilized at between 6.5% and 7.0% since 2001.
• The HIV prevalence in Rwanda has been about 3.0% since 2005.

Regional overview

Eastern and southern Africa remains at the epicentre of the global HIV epidemic with 16.1 million people living with HIV. More than 10% of adults are HIV positive in 9 out of the 20 countries.

The region has only 5.4% of the global population but accounts for 48% of all people living with HIV worldwide.

The HIV epidemic is generalised throughout the region except for the concentrated epidemics present in the Indian Ocean islands. Even in countries with generalised epidemics, there are also concentrated epidemics among populations most vulnerable to HIV infection, such as men who have sex with men, injecting drug users and sex workers.

Heterosexual sex is the main route of HIV transmission across the region except for the epidemics on the Indian Ocean islands where injecting drug use, often combined with sex work, is the key driver.

In several countries including Zimbabwe, Namibia, Ethiopia, Eritrea and Kenya, there have been substantial declines in HIV prevalence in recent years. In most other countries, the epidemic has declined slightly or stabilised.

Significant declines in HIV prevalence of more than 25% among youth have been documented in 9 of the 20 countries in the region over the last decade.

Associated reductions in certain risky sexual behaviours, in particular fewer reported sexual partners, delays in sexual debut and increased condom use, have been variously documented in some countries.

Many countries in the region have developed or are developing policies  to promote voluntary medical male circumcision and roll out is occurring in a few with rapid scale up planned in the coming years.

Access to prevention of mother-to-child transmission of HIV (PMTCT) has expanded substantially across the region. Over 80% of HIV positive pregnant women are now receiving antiretroviral treatment in Namibia, Swaziland, Botswana and South Africa. However, 232,200 infants were still infected with HIV in 2009 which represents 63% of the global total of 370,000 newly infected infants during the same time period.

The tuberculosis epidemic is strongly associated with HIV infection and remains the biggest killer of people living with HIV. The importance of integrating HIV and TB services is widely accepted but actual integration is occurring too slowly.

Injecting drug use is not common in the region but may be growing. There is very little research into this issue and services for IDUs are almost non-existent in the region.

Men who have sex with men are criminalised (except for South Africa, Rwanda and Madagascar), stigmatised and marginalised across the region. Little is known about the prevalence of MSM but Modes of Transmission studies have shown that, together with other key populations, men who have sex with men probably contribute significantly to overall HIV incidence.

Many countries have laws to protect against discrimination and uphold the rights of women but implementation is inconsistent.  Most have punitive laws in place against sex workers.

One of the major achievements of the last 5 years has been the increase in access to antiretrovirals in eastern and southern Africa. Whereas in 2004 there were only 255,600 people on treatment, as of December 2009 there are an estimated 3.18 million people on treatment in the region.

However, for every 2 people going onto treatment programmes, another 3 are becoming newly infected with HIV[1].

The increase in access to to antiretrovirals appears to have had an impact on HIV-related mortality. In 2003 it was estimated that 1.12 million adults and children died from AIDS and this decreased to 0.89 million by 2009.

NOTE

Given the considerable heterogeneity of the HIV epidemic across and within countries in the region, these have been grouped into clusters with similar epidemics:

Hyper-epidemic countries

These countries have generalised epidemics with more than 15% of adults living with HIV and they include Botswana, Namibia, Lesotho, Swaziland and South Africa.  With only 1% of the world’s population, these countries have 20% of the worlds HIV positive population. Apart from being hyper-epidemic countries these countries historically share common political, economic and socio-cultural bonds. They are all members of the oldest custom union in the world which integrates the economies of the region through the Southern Africa Customs Union (SACU). 

High epidemic Southern African countries

Zambia, Zimbabwe, Malawi and Mozambique have comparatively lower rates of prevalence (below 15% but higher than 10%).  They are not as well economically endowed as their hyper-epidemic neighbours and they rely heavily on external financing for their HIV response. 

Post-conflict and protracted humanitarian crisis countries

The epidemics and AIDS responses in Angola, Ethiopia and Eritrea are shaped by the fact that they have emerged from political instability with large population displacements and relatively weak and nascent institutions to support the HIV response. 

Lower prevalence, high population countries

Kenya, Uganda, Tanzania and Rwanda form the East African Community have rates of HIV prevalence lower than 10% but relatively large populations, so their net contribution to regional incidence is high.

Concentrated epidemic countries