Africa is the most affected region by HIV/AIDS in the world, particularly among young women.
- Close to 26 million people were living with HIV, of whom 2.3 million were children under the age of 15 years.
- 90% of the children in the world living with HIV were in sub-Saharan Africa.
- 70% of AIDS-related deaths in the world occurred in the African Region.
- Of the 2.1 million new HIV infections, worldwide in 2015, 1.37 million (65%) occurred in sub-Saharan Africa.
- The overall estimate of HIV/AIDS prevalence in the Region was 4.8%.
Though HIV/AIDS continues to be a major public health problem in the WHO African Region, the Region has made important progress in HIV/AIDS prevention and treatment.
- In 2015, 51% of people living with HIV in the African Region knew their HIV status, and more than 12 million were receiving HIV treatment.
- More than 10 million voluntary medical male circumcisions (which prevent sexual transmission of HIV) had been performed between 2000 and 2015 in 14 priority countries.
- Seventy five per cent of pregnant women living with HIV in the region were receiving medicines for preventing mother-to-child transmission (PMTCT).
- As of 2015, new HIV infections had declined by 41% since 2000, and the number of deaths caused by HIV/AIDS declined by 48% from the peak estimate of 1.5 million deaths in 2005.
Rapid scale up of HIV treatment, existing HIV prevention efforts that have resulted in AIDS- related deaths dropping by half since 2005 show that the Region is on track to reach the target of 23m people on treatment by 2020.
The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months, many are unaware of their status until later stages. The first few weeks after initial infection, individuals may experience no symptoms or an influenza-like illness including fever, headache, rash or sore throat.
As the infection progressively weakens the immune system, an individual can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhoea and cough. Without treatment, they could also develop severe illnesses such as tuberculosis, cryptococcal meningitis, and cancers such as lymphomas and Kaposi's sarcoma, among others.
HIV can be transmitted via the exchange of a variety of body fluids from infected individuals, such as blood, breast milk, semen and vaginal secretions. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water.
Behaviours and conditions that put individuals at greater risk of contracting HIV include:
- having unprotected anal or vaginal sex;
- having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis;
- sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;
- receiving unsafe injections, blood transfusions, tissue transplantation, medical procedures that involve unsterile cutting or piercing; and
- experiencing accidental needle stick injuries, including among health workers.
Serological tests, such as RDTs or enzyme immunoassays (EIAs), detect the presence or absence of antibodies to HIV-1/2 and/or HIV p24 antigen. When such tests are used within a testing strategy according to a validated testing algorithm, HIV infection can be detected with great accuracy. It is important to note that serological tests detect antibodies produced by an individual as part of their immune system to fight off foreign pathogens, rather than direct detection of HIV itself.
Most individuals develop antibodies to HIV-1/2 within 28 days and therefore antibodies may not be detectable early after infection, the so-called window period. This early period of infection represents the time of greatest infectivity; however HIV transmission can occur during all stages of the infection.
It is best practice to also retest all people initially diagnosed as HIV-positive before they enrol in care and/or treatment to rule out any potential testing or reporting error.
HIV testing should be voluntary and the right to decline testing should be recognized. Mandatory or coerced testing by a health-care provider, authority or by a partner or family member is not acceptable as it undermines good public health practice and infringes on human rights.
Some countries have introduced, or are considering, self-testing as an additional option. HIV self-testing is a process whereby a person who wants to know his or her HIV status collects a specimen, performs a test and interprets the test results in private. HIV self-testing does not provide a definitive diagnosis; instead, it is an initial test which requires further testing by a health worker using a nationally validated testing algorithm.
All HIV testing services must include the 5 C’s recommended by WHO: informed Consent, Confidentiality, Counselling, Correct test results and Connection (linkage to care, treatment and other services).
Individuals can reduce the risk of HIV infection by limiting exposure to risk factors. Key approaches for HIV prevention, which are often used in combination, include:
1. Male and female condom use
Correct and consistent use of male and female condoms during vaginal or anal penetration can protect against the spread of sexually transmitted infections, including HIV. Evidence shows that male latex condoms have an 85% or greater protective effect against HIV and other sexually transmitted infections (STIs).
2. Testing and counselling for HIV and STIs
Testing for HIV and other STIs is strongly advised for all people exposed to any of the risk factors. This way people learn of their own infection status and access necessary prevention and treatment services without delay. WHO also recommends offering testing for partners or couples. Additionally, WHO is recommending assisted partner notification approaches so that people with HIV receive support to inform their partners either on their own, or with the help of health care providers.
3. Testing and counselling, linkages to tuberculosis care
Tuberculosis (TB) is the most common presenting illness and cause of death among people with HIV. It is fatal if undetected or untreated and is the leading cause of death among people with HIV- responsible for 1 of every 3 HIV-associated deaths. Early detection of TB and prompt linkage to TB treatment and ART can prevent these deaths. TB screening should be offered routinely at HIV care services. Individuals who are diagnosed with HIV and active TB should be urgently started on TB treatment and ART. TB preventive therapy should be offered to people with HIV who do not have active TB.
4. Voluntary medical male circumcision
Medical male circumcision, when safely provided by well-trained health professionals, reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. This is a key intervention supported in 14 countries in Eastern and Southern Africa with high HIV prevalence and low male circumcision rates.
5. Antiretroviral (ARV) drug use for prevention
5.1 Prevention benefits of ART
A 2011 trial has confirmed if an HIV-positive person adheres to an effective ART regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96%. The WHO recommendation to initiate ART in all people living with HIV will contribute significantly to reducing HIV transmission.
5.2 Pre-exposure prophylaxis (PrEP) for HIV-negative partner
Oral PrEP of HIV is the daily use of ARV drugs by HIV-uninfected people to block the acquisition of HIV. More than 10 randomized controlled studies have demonstrated the effectiveness of PrEP in reducing HIV transmission among a range of populations including serodiscordant heterosexual couples (where one partner is infected and the other is not), men who have sex with men, transgender women, high-risk heterosexual couples, and people who inject drugs.
WHO recommends PrEP as a prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches.
5.3 Post-exposure prophylaxis for HIV (PEP)
Post-exposure prophylaxis (PEP) is the use of ARV drugs within 72 hours of exposure to HIV in order to prevent infection. PEP includes counselling, first aid care, HIV testing, and administering of a 28-day course of ARV drugs with follow-up care. WHO recommendsPEP use for both occupational and non-occupational exposures and for adults and children.
6. Harm reduction for injecting drug users
People who inject drugs can take precautions against becoming infected with HIV by using sterile injecting equipment, including needles and syringes, for each injection and not sharing other drug using equipment and drug solutions. A comprehensive package of interventions for HIV prevention and treatment includes:
- needle and syringe programmes;
- opioid substitution therapy for people dependent on opioids and other evidence based drug dependence treatment;
- HIV testing and counselling;
- risk-reduction information and education;
- HIV treatment and care;
- access to condoms; and
- management of STIs, tuberculosis and viral hepatitis.
7. Elimination of mother-to-child transmission of HIV (EMTCT)
The transmission of HIV from an HIV-positive mother to her child during pregnancy, labour, delivery or breastfeeding is called vertical or mother-to-child transmission (MTCT). In the absence of any interventions during these stages, rates of HIV transmission from mother-to-child can be between 15-45%. MTCT can be nearly fully prevented if both the mother and the child are provided with ARV drugs throughout the stages when infection could occur.
WHO recommends options for prevention of MTCT (PMTCT), which includes providing ARVs to mothers and infants during pregnancy, labour and the post-natal period, and offering life-long treatment to HIV-positive pregnant women regardless of their CD4 count.
In 2015, 77% (69–86%) of the estimated 1.4 (1.3-1.6) million pregnant women living with HIV globally received effective ARV drugs to avoid transmission to their children. A growing number of countries are achieving very low rates of MTCT and some (Armenia, Belarus, Cuba and Thailand) have been formally validated for elimination of MTCT of HIV. Several countries with a high burden of HIV infection are closing in on that goal.
HIV can be suppressed by combination ART consisting of 3 or more ARV drugs. ART does not cure HIV infection but controls viral replication within a person's body and allows an individual's immune system to strengthen and regain the capacity to fight off infections.
In 2016, WHO released the second edition of the "Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection.” These guidelines present several new recommendations, including the recommendation to provide lifelong ART to all children, adolescents and adults, including all pregnant and breastfeeding women living with HIV, regardless of CD4 cell count.
WHO has also expanded earlier recommendations to offer PrEP to selected people at substantial risk of acquiring HIV. Alternative first-line treatment regimens are recommended, including an integrase inhibitor as an option in resource-limited settings and reduced dosage of a key recommended first-line drug, efavirenz, to improve tolerability and reduce costs. By mid-2016, 18.2.0 million people living with HIV were receiving ART globally which meant a global coverage of 46% (43–50%).
Based on WHO’s new recommendations, to treat all people living with HIV and offer antiretroviral drugs as an additional prevention choice for people at "substantial" risk, the number of people eligible for antiretroviral treatment increases from 28 million to all 36.7 million people. Expanding access to treatment is at the heart of a new set of targets for 2020 which aim to end the AIDS epidemic by 2030.
In September 2015, WHO released a new policy recommendation known as Treat All. The policy removes all limitations on eligibility for Antiretroviral Therapy (ART) among people living with HIV, which means that all HIV infected /positive populations and age groups are now eligible for treatment.
The policy also includes a recommendation that people at substantial risk of acquiring HIV should be offered preventive ART. This new recommendation builds on 2014 WHO guidance to offer a combination of antiretroviral drugs to prevent HIV acquisition, through pre-exposure prophylaxis (PrEP), for men who have sex with men. Following further evidence of the effectiveness and acceptability of PrEP, WHO has now broadened this recommendation to support the offer of PrEP to other population groups at significant HIV risk, such as people who inject drugs. PrEP is an additional prevention choice based on a comprehensive package of services, including HIV testing, counselling and support and access to condoms and safe injection equipment. Expanding access to treatment is at the heart of a new set of targets for 2020 with the aim to end the AIDS epidemic by 2030. These targets include 90% of people living with HIV being aware of their HIV infection, 90% of those individuals receiving ART, and 90% of people on ART having no detectable virus in their blood. These three targets have collectively come to be known as the 90-90-90 target.
Ending the AIDS epidemic in the African Region will require rapid acceleration of the response over the next five years and then sustained action through to 2030 and beyond. This can only be achieved through renewed political commitment, additional resources and technical and programmatic innovations.
In June 2016, WHO released its Global Health Sector Strategy on HIV, 2016-2021. The strategy builds on public health achievements made in the HIV response and continues the momentum generated by the Millennium Development Goals and universal access commitments. The Sixty-sixth WHO Regional Committee for Africa adopted a Framework for Action on HIV/AIDS in the WHO African Region 2016-2020.
Johannesburg, 29 April 2016 – According to the new World Health Organization (WHO) guidelines for the prevention, treatment and care of HIV and Hepatitis, all 26 million people currently living with HIV in the African Region are now eligible for antiretroviral treatment (ART). This is more than double the number of the current 11 million on treatment.
“The recommendation that anyone infected with HIV should begin antiretroviral treatment as soon as possible after diagnosis will revolutionize treatment outcomes, where people living with HIV will be able to live long and healthy lives,” says Dr Matshidiso Moeti, WHO Regional Director for Africa, “WHO AFRO will work with countries to provide technical support in the transition from current treatment modalities, to ease burden on national health systems.”
With its “treat-all” recommendation, WHO removed all limitations on eligibility for anti-retroviral therapy (ART) among people living with HIV – all populations and age groups are now eligible for treatment. In the past, people living with HIV had to fulfil certain criteria before receiving treatment.
The expanded use of anti-retroviral treatment is supported by recent findings from clinical trials confirming that early use of ART keeps people living with HIV alive and healthier, and reduces the risk of transmitting the virus to partners.
WHO now also recommends that anyone at “substantial” risk of becoming infected should be offered preventive anti-retroviral treatment, termed as pre-exposure prophylaxis (PrEP). PrEP should be seen as an additional prevention choice based on a comprehensive package of services, including HIV testing, counselling, voluntary male medical circumcision, access to condoms and safe injection equipment.
In addition to the new directions towards expanding ART access to all people living with HIV and broader use of PrEP, the consolidated guidelines make new clinical recommendations on preferred antiretroviral drugs and regimens, new testing strategies for infants, the increasing role of viral load and the appropriate use of CD4 testing. Service delivery recommendations will focus on interventions to reduce losses along the cascade of HIV services from testing to viral suppression, and the role of community-based models of ART delivery.
The WHO guidelines for the prevention and control of HIV and Hepatitis were discussed in detail with 18 countries in the African Region at a workshop held in Johannesburg, South Africa, on 25–29 April 2016.
During the workshop, countries engaged in dialogue on operational and programmatic implications for adoption and implementation of the strategies and guidelines on national health systems. Country plans for in-country dialogue and technical assistance needs for adaptation and implementation were also identified. Countries also developed draft country roll-out plans, including the priority actions for country adaptation along with technical assistance that may be required for timely and effective implementation of the new guidelines.
For more information, please contact:
Dr Frank Lule, Regional Adviser, HIV Programme lulef [at] who.int Tel +47-241-39162,
Loza Mesfin Tesfaye, Communications Officer tesfayel [at] who.int Tel +47-241-39779
C. Boakye-Agyemang, Regional Communications Adviser boakyeagyemangc [at] who.int Tel +47-241-39420
Harare, 27 November 2015 –The world is poised to end the AIDS epidemic by 2030 – provided it can accelerate the pace of progress achieved globally over the past 15 years, according to a new World Health Organization (WHO) report.
Already, much has been achieved. This year, the Millennium Development Goal that called for halting and reversing the spread of HIV on a global basis was met.
By 2014, the number of HIV deaths was reduced by 42% - from a peak of more than 2 million in 2004 to an estimated 1.2 million.
Since 2000, an estimated 7.8 million lives have been saved, fewer people are acquiring HIV, and projections of an end to the epidemic by 2030 – a goal once considered unattainable by many experts – are now realistic, according to the WHO report, Global Health Sector Response to HIV 2000-2015.
The rapid scale-up of access to antiretroviral therapy (ART), one of the greatest public health achievements in recent times, has made treatment available to more than 16 million people living with HIV across the globe. Today, more than 11 million people in the WHO African Region alone are receiving HIV treatment, versus about 11 000 who were taking the medications 15 years ago. That is a thousand-fold increase.
Yet more must be done. Globally 60% of all people living with HIV have not yet enrolled in antiretroviral treatment.
“In the last 15 years, new HIV infections have reduced by 41% in the African Region, more than in any region in the world,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “But the number of people acquiring HIV infection is still too high and young women and adolescent girls continue to be disproportionately at risk.”
Treatment for all people living with HIV
Recent findings from clinical trials have confirmed that the early and expanded use of antiretroviral treatment saves lives by keeping people living with HIV healthier and by reducing the risk that they will transmit the virus to partners.
In September, that confirmation led WHO to recommend that all people living with HIV start ART as soon as possible after diagnosis.
At ICASA, WHO is presenting a set of recommendations to enable countries to expand treatment to all -- rapidly and efficiently. These recommendations include using innovative testing strategies to help more people learn they are HIV positive; moving testing and treatment services closer to where people live; starting treatment faster among people who are at advanced stages of HIV infection when they are diagnosed; and reducing the frequency of clinic visits recommended for people who are stable on ART.
"WHO’s new implementation guidelines showing how to treat all people living with HIV and decrease new infections are transformative,” said Dr Deborah Birx, US Global AIDS Coordinator. “Short of an HIV vaccine or cure, this gives us the critical tools we need to create an AIDS-free generation with the Fast Track Strategy. We must seize this moment and chart a bold course together to end the AIDS epidemic as a public health threat."
Improving HIV prevention
The same drugs that help people living with HIV to remain healthy also prevent people at substantial risk of contracting HIV from becoming infected. Pre-exposure prophylaxis, or PrEP, is the use of an antiretroviral medication to prevent the acquisition of HIV infection by uninfected persons. In a quest to step up prevention, WHO now recommends PrEP be offered to all people at substantial risk of HIV infection.
Other established prevention tools continue to reduce the number of new HIV infections. They include male condoms and female condoms, participation in behavior-change programmes and other prevention services for key populations. For example, more than 10 million men in Africa have volunteered to undergo medical circumcision, which reduces their risk of contracting HIV by 60%.
Ending AIDS as part of the SDG agenda
At the UN General Assembly in September, world leaders endorsed the Sustainable Development agenda. This agenda includes the target of ending the AIDS epidemic by 2030 – by reducing new infections by an additional 75% by 2020 and by ensuring that, in the coming 5years, 90% of people living with HIV are aware their infection, 90% of those are on ART, and 90% of people on ART have no detectable virus in their blood (UNAIDS’ “90-90-90” target).
Increasing emphasis on and targeting of effective prevention alongside increased treatment is also essential to reducing new infections from the current 2 million per year to the UN target of less than 500 000 by 2020 and 200 000 by 2030.
Achieving these targets will require bold action, with the health sectors of nations around the world playing a central role.
“Despite the significant progress, half the people living with HIV globally do not know they have acquired the virus and do not receive treatment that can save their lives and avoid infecting others,” said Dr Winnie Mpanju-Shumbusho, WHO Assistant Director General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases. “We must now step up our efforts to reach the missing half with testing and treatment and the prevention of new infections, or we will miss the unique opportunity to end the AIDS epidemic within a generation,” she added.
The effort is at a critical juncture, with success within reach, and failure likely to result in a resurgence of the disease and its costs.
Note to the editor:
The International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) is a major international AIDS conference which takes place in Africa. Its current biennial hosting alternates between Anglophone and Francophone African countries. The 2015 ICASA will be held in Zimbabwe from 29 November to 4 December 2015.
ICASA 2015 is expected to convene over 10,000 delegates from nearly 150 countries, including 200 journalists. http://icasa2015zimbabwe.org/
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Dr Cory Couillard; Tel: +263 774 725425; Email: couillardc [at] who.int
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30 September 2015, Geneva - Anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible, WHO announced Wednesday. With its "treat-all" recommendation, WHO removes all limitations on eligibility for antiretroviral therapy (ART) among people living with HIV; all populations and age groups are now eligible for treatment.
The expanded use of antiretroviral treatment is supported by recent findings from clinical trials confirming that early use of ART keeps people living with HIV alive, healthier and reduces the risk of transmitting the virus to partners.
This year's World AIDS Day theme is "Right to health". There is a significant progress in the African Region in the prevention and treatment of HIV/AIDS, but the right to health for all is not being realized. Young people, especially young women, continue to be at great risk of HIV infection. Children are often missed out, key populations such as sex workers, men who have sex with men and injecting drug users are not being reached, and men are also left behind. Countries in the West and Central African sub-regions still lag behind the rest of the continent. WHO and its partners are working with these member states to implement catch-up plans to accelerate HIV treatment.
World AIDS Day on 1 December is a chance to unite against HIV, show support for people living with HIV/AIDS, and remember those who have died. This year the theme is “Hands up for HIV Prevention”. It highlights HIV prevention issues like access and the right to health, zero discrimination, testing and condoms in relation to specific groups such as adolescent girls and young women, key populations such as sex workers, and people living with HIV, to ensure no one is left behind.
On 1 December 2015, the world is observing World AIDS Day to raise awareness of HIV/AIDS. The theme for this year’s commemoration is: “On the Fast-Track to end AIDS”. Fast-tracking the AIDS response provides an opportunity to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals.
It is encouraging that we have reached a defining moment in the HIV/AIDS response as a result of the remarkable progress in the scale up of prevention, treatment and care interventions for HIV in the African Region. The region has achieved the Millennium Development Goal 6 of halting and reversing the HIV/AIDS epidemic. In 2014, close to 11 million people were receiving lifesaving antiretroviral treatment. This has led to the number of AIDS related deaths reducing by nearly a half since 2005. New infections have also reduced by 41% in the last 15 years, more than in any region in the world.
On World AIDS Day 2014, the World Health Organization will issue new recommendations to help countries close important gaps in HIV prevention and treatment services.
The guidelines will include advice on providing antiretroviral drugs for people who have been exposed to HIV – such as health workers, sex-workers, survivors of rape. They also include recommendations on preventing and managing common opportunistic infections and diseases such as severe bacterial and malaria infections, cryptococcal meningitis and the many oral and skin infections that can affect people living with HIV.
World AIDS Day on 1 December brings together people from around the world to raise awareness about HIV/AIDS and demonstrate international solidarity in the face of the pandemic. The day is an opportunity for public and private partners to spread awareness about the status of the pandemic and encourage progress in HIV/AIDS prevention, treatment and care in high prevalence countries and around the world.
Between 2011-2015, World AIDS Days will have the theme of "Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths". The World AIDS Campaign focus on "Zero AIDS related deaths" signifies a push towards greater access to treatment for all; a call for governments to act now. It is a call to honor promises like the Abuja declaration and for African governments to at least hit targets for domestic spending on health and HIV.
Getting to Zero: Zero new HIV infections. Zero deaths from AIDS-related illness. Zero discrimination is the theme of World AIDS Day 2012. Given the spread of the epidemic today, getting to zero may sound difficult but significant progress is underway.
In 2011, 2.5 million people were newly infected with HIV. An estimated 1.7 million people died. That is 700,000 fewer new infections worldwide than ten years ago, and 600,000 fewer deaths than in 2005.
Celebration of the 2011 World AIDS Day in the WHO African Region
The World Health Organization declared the first World AIDS Day in 1988. The Day, 1 December, quickly became established as one of the most successful commemorative days and is now recognized and celebrated by a diverse range of constituents every year around the globe. The Day continues to be one of the most visible opportunities for public and private partners to spread awareness about the status of the pandemic, renew commitments and engagement, and encourage progress in HIV/AIDS prevention, treatment and care in high prevalence countries and around the world.
World AIDS Day, which falls on 1 December, draws together people around the world to raise awareness about HIV/AIDS and demonstrate international solidarity in the face of the pandemic. The Day is one of the most visible opportunities for public and private partners to spread awareness about the status of the pandemic, renew commitments and engagement, and encourage progress in HIV/AIDS prevention, treatment and care in high prevalence countries and around the world. The theme of the 2010 World AIDS Day is “Universal Access and Human Rights”.
The latest UNAIDS report, released in November 2010, shows that the AIDS epidemic is beginning to change course as the number of people newly infected with HIV is declining and AIDS-related deaths are decreasing. Globally, new HIV infections have fallen by nearly 20% in the last 10 years, and AIDS-related deaths are down by nearly 20% in the last five years. At the end of 2009, 33.3 million people were estimated to be living with HIV. Sub-Saharan Africa continues to be the region most affected by the epidemic with 69% of all new HIV infections, 67 % of all people living with HIV and 72% of all AIDS-related deaths.
Human rights are fundamental to any response to HIV/AIDS. The promotion and protection of these rights are necessary to empower individuals and communities to respond to the epidemic. World AIDS Day 2010 provides an opportunity to intensify efforts to ensure that the basic human rights of people living with HIV/AIDS are protected; and to continue to strive towards meeting the universal access targets for prevention, treatment and care.