Four African Countries Almost Controlling HIV Epidemics

By Dipo Olowookere

Data from the US President’s Emergency Plan for AIDS Relief (PEPFAR) has shown that the HIV epidemic is coming under control across all age groups in Swaziland, the country with the highest HIV prevalence in the world.

Additional PEPFAR-supported studies released in December 2016 for Malawi, Zambia, and Zimbabwe demonstrate significant progress toward controlling the HIV epidemics in these countries as well.

According to the latest Swaziland HIV Incidence Measurement Survey (SHIMS 2) released today, new HIV infections have been nearly halved among adults, and HIV viral load suppression – a key marker of the body successfully controlling the virus – has doubled in Swaziland since 2011.

These data suggest that Swaziland has met the global target for community viral load suppression among HIV-positive adults four years ahead of schedule. The Swaziland data is particularly important because PEPFAR funded a comprehensive survey in 2011-2012, which provides the critical baseline comparator of current results and progress.

Over the same time period, life-saving antiretroviral treatment (ART) nearly doubled in Swaziland, reaching over 80 percent ART coverage among adults. Voluntary Medical Male Circumcision (VMMC) coverage also rose from 13 to 29 percent in the country.

In addition, the critical PEPFAR-supported public-private DREAMS Partnership (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe), which focuses on reducing HIV infections among girls and women ages 10-24, was launched in 2015.

Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, said, “We now have clear evidence that four African countries are approaching control of their HIV epidemics. These unprecedented findings demonstrate the remarkable impact of the U.S. government’s efforts, through PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria, in partnership with African countries. We now have a historic opportunity to change the very course of the HIV pandemic.”

Data from these four countries were gathered through critical household surveys, known as Population-Based HIV Impact Assessments (PHIAs), which are funded by PEPFAR and conducted by the US Centers for Disease Control and Prevention (CDC) and ICAP at Columbia University’s Mailman School of Public Health, as well as by local governmental and non-governmental partners.

The data from Swaziland draw from two household surveys (SHIMS 1 and SHIMS 2) that directly measured new HIV infections and viral load suppression in 2011 and 2016 respectively.

“The findings from SHIMS 2 are a testimony to the remarkable commitment by the Government of Swaziland to confronting the HIV epidemic,” said Dr. Wafaa El-Sadr, Director of ICAP. “It is a demonstration that all the efforts put into the scale-up of HIV prevention, care, and treatment services have borne fruit.”

While the PHIA results demonstrate tremendous progress, they also reveal key gaps in HIV prevention and treatment programming for younger men and women that require urgent attention and action. In all four surveys, women ages 15-24 and men under age 35 were less likely to know their HIV status, be on HIV treatment, or be virally suppressed than older adults.

These gaps are all areas in which PEPFAR continues to invest and innovate, including efforts to reduce HIV incidence among adolescent girls and young women through the DREAMS Partnership and to reach and link more young men to HIV services.

“These results from Swaziland signal a dramatic transformation in a country where HIV was destabilizing families, communities, and the economy,” said Shannon Hader, M.D., M.P.H., Director of CDC’s Division of Global HIV & TB. “They also show what we must do next to achieve HIV epidemic control. Global efforts are working – we can’t stop now.”

Malawi, Swaziland, Zambia, and Zimbabwe are among the 13 highest-burden countries where PEPFAR is accelerating its efforts toward reaching epidemic control by 2020 through the UNAIDS 90-90-90 framework and expansion of HIV prevention.

PEPFAR also continues to invest in over 50 countries, ensuring access to services by all populations, including the most vulnerable and at-risk groups while partnering with host governments, the Global Fund, UNAIDS, and others.

This includes maintaining life-saving ART for all of the people that PEPFAR currently supports and expanding both HIV prevention and treatment services, where possible, through increased performance, efficiency gains, and shared responsibility of all partners.