How is the war on HIV going?

HIV is in retreat. New infections and AIDS-related deaths have been declining for over a decade. The Economist attributes this to an increase in anti-retroviral therapy, as shown in this graph.

HIV's slow retrenchment

If you’re wondering what the, difference is between HIV and AIDS, AIDS is basically HIV when it gets really, really bad. More accurately, though:

  • HIV (human immunodeficiency virus) is an infection that weakens a person’s immune system.
  • AIDS (acquired immunodeficiency syndrome) is the final stage of the HIV infection; someone is deemed to have AIDS when their immune system has been severely damaged.

 

How is the war going?

First, we need to decide how to determine that. I’ll use overall prevalence as a proxy for how the war is going. If a smaller percentage of people have HIV, then that’s progress. The World Bank has great data on this. Prevalence has been steady at 0.8% of world population for the last 15 years.

Worldwide HIV prevalence

 

That certainly seems like progress. Prevalence hasn’t declined, but it has plateaued, suggesting that, on a global scale, HIV has been contained. But how does this worldwide rate compare to individual countries? These are the prevalence rates for 113 countries (the World Bank doesn’t have data on all countries, unfortunately).

HIV prevalence for all countries

 

There’s still a trend of declining or plateauing rates, but some countries still have very high rates, suggesting that HIV isn’t totally under control. Which countries are struggling? Here are countries with the 10 highest rates of HIV.

Countries with 10 highest rates of HIV

 

Every one of these countries is in Africa, which isn’t surprising: Sub-Saharan Africa is where HIV originated and is generally regarded as an HIV problem area. Does the data support this assertion, though? Let’s remove African countries from the graph and see what we get:

HIV prevalence without African countries

 

HIV in Africa

That’s pretty striking. Non-African countries have fairly stable rates of HIV below 5%. Let’s dig deeper on Africa. If, like me, your African geography isn’t great, it’s helpful to put the data on a map. This is what HIV in Africa looks like in 2014:

HIV in Africa in 2014

 

It looks like there’s a regional pattern. The farther south we go, the higher the prevalence gets. For example, Egypt has a prevalence of 0.1%, while South Africa has a prevalence of 18.9%. Has this regional trend always existed? Let’s look at how prevalence in Africa has changed from 1990 to 2014.

HIV in Africa from 1990-2014

 

The pattern is consistent, with high prevalence in southern Africa and low prevalence in northern Africa. Why? According to the United Nations Programme on HIV/AIDS (UNAIDS), southern Africa struggles with several issues:

  • Cultural stigmas about key populations (e.g., sex workers, intravenous drug users) result in poor treatment and prevention programmes. Men who have sex with men are especially at risk because of widespread homophobia.
  • Condom use varies wildly, and nowhere was it above 80%, resulting in inadequate prevention practices.
  • Gender inequality and limited education for women has resulted in high infection rates among girls and young women. Sexual abuse, forced marriage, and child marriage are the drivers of infections in this group.

 

How does northern Africa differ?

  • Social norms in many north African countries discourage risky behaviour, like premarital sex and sex outside of marriage. Also, male circumcision, which decreases the risk of transmission, is practised widely.

 

So, to go back to our original question, how is the war on HIV going? Fairly well, but there are still challenges. We’ve learned that cultural attitudes seem to play a big role in prevention and treatment, which the difference in prevalence between northern and southern Africa supports. Cultural attitudes are notoriously slow to change, so we’ve got a long way to go.

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