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HIV Treatment Trends in Eastern and Southern Africa

This report highlights antiretroviral therapy coverage and AIDS-related mortality rates among people living with HIV in Eastern and Southern Africa. It provides analysis of key statistics, such as new HIV infections, AIDS-related deaths, and the incidence-prevalence ratio from 2000 to 2018. Additionally, it examines HIV prevalence among key populations like sex workers, people who inject drugs, and gay men. The data showcases progress in HIV testing and treatment cascade, viral load suppression rates, and condom use among young populations in the region. The report aims to shed light on the status of HIV/AIDS management and prevention efforts in Eastern and Southern Africa to inform future strategies and interventions.

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HIV Treatment Trends in Eastern and Southern Africa

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  1. GLOBAL AIDS UPDATE 2019 • REGION PROFILES • EASTERN AND SOUTHERN AFRICA

  2. Antiretroviral therapy coverage and AIDS-related mortality among people living with HIV, eastern and southern Africa 300 Lesotho 250 Antiretroviral therapy coverage: Eswatini Botswana 200 75% and above 55–74% 30–54% Mozambique Less than 30% AIDS-related mortality (per 100 000) 150 Zimbabwe South Africa Namibia 100 Note: Size of bubble is proportional to size of population of people living with HIV. Zambia South Sudan Malawi Uganda Kenya 50 Mauritius Angola United Republic of Tanzania Rwanda Ethiopia Eritrea Comoros Madagascar 0 0 10 20 30 40 50 60 70 80 90 100 Source: UNAIDS 2019 estimates. People living with HIV receiving antiretroviral treatment (%)

  3. Number of new HIV infections and AIDS-relateddeaths, and incidence-prevalence ratio eastern and southern Africa, 2000–2018 New HIV infections AIDS-related deaths Incidence-prevalence ratio 14 1 400 000 Number of AIDS-related deaths Percentage change in new HIV infections since 2010 2 500 000 Percentage change in AIDS- related deaths since 2010 2018 Incidence- prevalence ratio Number of new HIV infections Incidence-prevalence ratio 12 1 200 000 2 000 000 10 1 000 000 8 800 000 1 500 000 -28% -44% 3.9% [3.0–5.1%] 600 000 6 1 000 000 4 400 000 3 500 000 2 200 000 0 0 0 2000 2010 2018 2000 2010 2018 2000 2005 2010 2015 2018 • New HIV infections • AIDS-related deaths • Incidence-prevalence ratio • Target value Source: UNAIDS 2019 estimates.

  4. Percentage change in new HIV infections, by country, eastern and southern Africa, 2010–2018 250 193 200 150 100 Per cent 50 35 6 0 -7 -7 -13 -13 -23 -29 -30 -30 -31 -34 -36 -50 -38 -38 -40 -43 -61 -67 -100 Comoros Rwanda Uganda South Africa Zimbabwe Namibia Botswana Lesotho Eswatini Malawi Kenya Eritrea Ethiopia Zambia United Republic of Tanzania Mauritius Mozambique Angola South Sudan Madagascar Source: UNAIDS 2019 estimates.

  5. HIV prevalence among key populations Distribution of new HIV infections (aged 15–49 years), by population group Eastern and southern Africa, 2014–2018 Eastern and southern Africa, 2018 Sex workers 3% 90 80 70 60 50 40 30 20 10 0 People whoinjectdrugs 8% Per cent Gay men and other men who have sex with men 4% 40.7 Remaining population 75% Clients of sex workers and sex partnersof other keypopulations 10% 28.4 15.2 16.7 13.7 Sex workers, n = 19 Gay men and other men who have sex with men, n = 12 People who inject drugs, n = 6 Transgender people, n = 1 Prisoners, n = 14 Source: UNAIDS Global AIDS Monitoring, 2014–2018. Source: UNAIDS special analysis, 2019.

  6. Estimated size of key populations, eastern and southern Africa, 2018 National population size estimate Local population size estimate Insufficient data No data The regions for which the local population size estimate refers are asfollows: Lesotho: Butha Buthe, Mafeteng, Maseru and Leribe. South Africa: Cape Town Metro, Durban Metro and Johannesburg Metro. • Source: Global AIDS Monitoring, 2018; United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2017 revision. 2018 (custom data acquired via website).

  7. HIV testing and treatment cascade, eastern and southern Africa, 2018 25 20 Gap to reaching the first 90: 1.1 million Gap to reaching the first and second 90s: 3.0 million 15 Gap to reaching all three 90s: 3.0 million Number of people living with HIV (million) 10 85% [75–95%] 67% [52–78%] 58% [50–66%] 5 0 People living with HIV who know their status People living with HIV on treatment People living with HIV whoare virally suppressed • Source: UNAIDS special analysis, 2019; see annex on methods for more details.

  8. Viral load suppression among adults (15 years and older) • living with HIV, by sex, eastern and southern Africa, 2018 100 90 80 70 60 Per cent 50 40 30 20 10 0 Botswana Eswatini Lesotho Malawi Mauritius Namibia Rwanda South Africa Uganda United Republic of Tanzania Zambia Females Males • Source: UNAIDS specialanalysis, 2019.

  9. 90–90–90 country scorecard: eastern and southern Africa, 2018 90–90–90: 85–89% 65–72% 70–84% 40–64% 50–69% 25–39% Less than 50% Less than 25% 90% and above Viral load suppression: 73% and above Source: UNAIDS special analysis, 2019.

  10. Condom use at last higher risk sex with a nonmarital, noncohabiting partner by young people aged 15–24 years, 2012–2018 100 Target condom use 90 80 70 60 Per cent 50 40 30 20 10 0 Lesotho South Africa Zimbabwe Kenya Namibia Rwanda Marawi Comoros Angola Uganda Zambia Ethiopia United Republic of Tanzania Sexually active adolescent girls and young women reporting higher risk sex with a nonmarital, noncohabiting partner in the last 12 months Condom use of adolescent girls and young women at last higher risk sex with a nonmarital, noncohabiting partner Sexually active adolescent boys and young men reporting higher risk sex with a nonmarital, noncohabiting partner in the last 12 months Condom use of adolescent boys and young men at last higher risk sex with a nonmarital, noncohabiting partner Source: Population-basedsurveys, 2012–2018.

  11. Number of people taking PrEP at least once during 2018, • eastern and southern Africa, 2018 35 000 30 000 25 000 20 000 Number of people 15 000 10 000 5000 0 Botswana Eswatini Kenya Lesotho Mauritius Mozambique Namibia Seychelles South Africa Uganda United Republic of Tanzania Zambia Zimbabwe • Source: 2019 Global AIDS Monitoring; and PEPFAR Monitoring, Evaluation, and Reporting Database. In: amfAR.org [Internet]. amfAR; • c2019 (https://mer.amfar.org/?_ga=2.96796184.623148132.1561384951-1316132509.1561384951, accessed 20 June 2019).

  12. Prevalence of male circumcision (aged 15–49 years), • by country (province), eastern and southern Africa, 2013–2017 100 90 Gambela Nyanza 80 70 60 Per cent 50 40 30 20 10 0 Zimbabwe Kenya Ethiopia United Republic of Tanzania Lesotho Mozambique South Africa Uganda Namibia Eswatini Rwanda Zambia Botswana Malawi Note: Surveys included are: Kenya (2014), Nyanza (Kenya) (2014), Ethiopia (2016), Gambela (Ethiopia) (2016), the United Republic of Tanzania (2017), Lesotho (2014), Mozambique (2015), South Africa (2017), Uganda (2016), Namibia (2017), Eswatini (2016), Rwanda (2014), Zambia (2016), Botswana (2013), Malawi (2016) and Zimbabwe (2016). • Source: Population-basedsurveys, 2013–2017.

  13. Proportion of young people reporting sex before the age of 15 years and corresponding parental consent policies regarding young people’s access to sexual and reproductive health services, eastern and southern Africa, 2012–2016 50 45 40 34 35 30 25 24 Per cent 23 22 21 25 19 17 16 20 15 14 13 13 12 12 12 12 15 11 10 9 7 6 10 6 5 5 5 5 5 1 0 Algeria Mozambique Kenya Uganda South Africa Namibia Rwanda Comoros Malawi Lesotho Zambia Zimbabwe United Republic of Tanzania Ethiopia Yes, for adolescents younger than 14 years Yes, for adolescents younger than16 or 18 years Data not available on parental consent No parental consent required Sex before the age of 15 [females] Source: Population-basedsurveys, 2012–2016. Sex before the age of 15 [males]

  14. Percentage of key populations who reported receiving at least two prevention services in the past three months, eastern and southern Africa, 2016–2018 100 90 80 70 60 Per cent 50 40 30 20 10 0 Zimbabwe Malawi Seychelles South Sudan Uganda United Republic of Tanzania Sex workers Gay men and other men who have sex with men People who inject drugs Transgender people Notes: Possible prevention services received among sex workers, gay men and other men who have sex with men and transgender people: condoms and lubricant, counselling on condom use and safe sex, and testing for sexually transmitted infections. Possible prevention services received among people who inject drugs: condoms and lubricant, counselling on condom use and safe sex, and clean needles or syringes. Data for female sex workers in Malawi and the United Republic of Tanzania and for gay men and other men who have sexwith men in Malawi and Zimbabwe come from programmes (which tend to show higher values) and not from a survey. • Source: Global AIDS Monitoring, 2016–2018.

  15. Cascade of services for preventing vertical transmission, numbers of new HIV infections and transmission rate, eastern and southern Africa, 2018 92% [69–>95%] 1 000 000 900 000 68% [56–91%] 800 000 700 000 600 000 Number 500 000 400 000 300 000 Transmission rate: 9%[8–13%] 200 000 100 000 0 Births to women living with HIV Women receiving antiretrovirals to prevent vertical transmission Infants tested by eight weeks of age New child infections Any birth to women living with HIV Children newly infected with HIV • Source: UNAIDS 2019 estimates; 2019 Global AIDS Monitoring.

  16. Percentage of men and women aged 15–49 years with discriminatory attitudes towards people living with HIV, eastern and southern Africa, 2013–2017 60 50 40 Per cent 30 20 10 0 Ethiopia Angola Uganda Mozambique Zambia Zimbabwe Malawi Lesotho Namibia South Africa Kenya Rwanda Sudan People who would not buy vegetables from a shopkeeper living with HIV People who think children living with HIV should not be allowed to attend school with children not living with HIV • Source: Population-based surveys, 2013–2017, countries with available data.

  17. Proportion of women aged 15–49 years who reported ever experiencing physical and/or sexual violence committed by partner/husband or controlling behaviour, 2012–2016 100 90 80 70 60 Per cent 50 40 30 20 10 0 Angola Comoros Ethiopia Kenya Malawi Mozambique Namibia Rwanda South Africa Uganda United Republic of Tanzania Zambia Zimbabwe Women reporting husband/partner displays controlling behaviour Women reporting ever experiencing physical violence committed by husband/partner Women reporting ever experiencing physical or sexual violence committed by husband/partner Women reporting physical or sexual violence committed by male intimate partner in preceding 12 months Source: Population-basedsurveys, 2012–2016.

  18. HIV resource availability, by source, eastern and southern Africa, • 2010–2018, and projected resource needs by 2020 12 000 10 000 Domestic (public and private) United States (bilateral) 8000 US$ (million) Global Fund 6000 Other international Resource needs (Fast-Track) 4000 2000 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2020 • Source: UNAIDS 2019 resource availability and needs estimates.

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