By Dr. Gemma Oberth / SAT

Over forty years into the HIV pandemic, East and Southern Africa remains disproportionately affected by the disease. Despite that new HIV infections in the region have declined by 28% since 2010, in 2018 there were still 800,000 new cases – just under half of the global total.

South Africa accounts for over a quarter of new infections in the region, and countries that continue to have high case numbers include Mozambique, Zambia, Malawi and Zimbabwe. Three countries have made significant leaps towards covering 90% of the HIV care cascade: Botswana, Eswatini and Namibia. But other countries in the region lag behind.

As Southern Africa works towards reducing new infections, it is important that donors and governments examine whether their prevention budgets are considering specific populations that are vulnerable to HIV. In the region, young women (aged 15–24 years) make up only 10% of the population, yet account for 26% of new HIV infections. Nearly half of the 254,000 new HIV infections among adolescents globally in 2016 also occurred in the region. And in specific countries, key populations—defined as men who have sex with men, sex workers, people who inject drugs, transgender people and prisoners—also experience unequal infection rates. For example, in Malawi, where 9.2% of the adult population is living with HIV, one in two sex workers in HIV positive.3 Generalised prevention programmes are unlikely to reach or cater to the needs of younger people and key populations. Targeted and increased prevention funding is necessary to accelerate change.