HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential

Abstract

Background: The burden of HIV is especially concerning for Eastern and Southern Africa (ESA), as despite expansion of test-and-treat programmes, this region continues to experience significant challenges resulting from high rates of morbidity, mortality and new infections. Hard-won lessons from programmes on the ground in ESA should be shared.Objectives: This report summarises relevant evidence and regional experts’ recommendations regarding challenges specific to ESA.Method: This commentary includes an in-depth review of relevant literature, progress against global goals and consensus opinion from experts.Results: Recommendations include priorities for essential research (surveillance data collection, key and vulnerable population education and testing, in-country testing trials and evidence-based support services to improve retention in care) as well as research that can accelerate progress towards the prevention of new infections and achieving ambitious global goals in ESA.Conclusion: The elimination of HIV in ESA will require continued investment, commitment to evidence-based programmes and persistence. Local research is critical to ensuring that responses in ESA are targeted, efficient and evaluated.

Analysis of Surgical Mortalities Using the Fishbone Model for Quality Improvement in Surgical Disciplines

“…The association of HIV was recorded as a contributory factor in only 7.8%. This contribution was far below what was expected as the prevalence of HIV in the adult population in South Africa was around 15% [31]. The profile of surgical conditions is influenced by the geographical location and economic status of a community, which would also influence the causes of death.…”

Impact of Poverty on Health

“…This would describe the much higher prevalence of deaths from HIV/AIDS in developing countries compared to developed countries and even the higher deaths in the developed countries among poor people who have limited aces to health care facilities [37][38][39][40][41][42]. This fact is evident in maps 1 and 2 quoted from the WHO website 2017, especially compared to the extreme poverty presented earlier (Figure 3), where Africa carries the primary disease burden and deaths from the disease [43].…”

Hazardous alcohol use and HIV indicators in six African countries: results from the Population‐based HIV Impact Assessments, 2015–2017

“…As of 2020, Eastern and Southern Africa (ESA) account for approximately 20.7 million people living with human immunodeficiency virus (PLHIV), resulting in 55% of all infections globally and 44% of all new global infections occurring in this region [ 1 , 2 ]. Despite a 49% decrease in HIV‐related deaths since 2010–2020, it is estimated that over 310,000 individuals succumbed to HIV‐related illness, as well as 600,000 new infections occurred in 2020 [ 1 ].…”

“…To reach HIV epidemic control, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set its ambitious 95‐95‐95 “Fast‐Track” targets, which entails getting 95% of all PLHIV to know their HIV status, 95% of people who know their status to receive HIV treatment and 95% of people on HIV treatment to have viral load suppression (VLS) by 2030 [ 3 ]. The 2030 target had an interim 90‐90‐90 target to be reached by 2020, a metric that was not met across most of ESA [ 1 , 2 ]. As of 2022, neither a cure nor effective vaccine exists for HIV; therefore, lifelong treatment on antiretroviral therapy (ART) remains the gold standard for disease management [ 4 ].…”