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East and Southern Africa is the region most affected by HIV globally. Almost 50 per cent of the world’s new HIV infections in 2011 occurred in the region.

HIV remains the single largest source of life-years lost in the region, particularly among young people and people of reproductive age. HIV is also a major contributor to maternal deaths.

SRHR and HIV Linkages Project
UNFPA’s response to the epidemic

Success in the fight against HIV & AIDS

Yet substantial successes in the fight against HIV and Aids have been recorded in the region in recent years. These include:

  • A 38 per cent reduction in AIDS-related deaths between 2005 and 2011;
  • An increase in the number of people receiving lifesaving antiretroviral therapy (ART), from 625,000 in 2005 to more than 6 million at the end of 2012;
  • A 50 per cent reduction in new child infections between 2001 and 2011.

This progress is due to a combination of factors, including demonstrable changes in sexual behaviour (especially among young people in most countries in the region), much wider access to ART, progress in preventing new HIV infections among children, increasing levels of reported condom use in several countries, declines in the number of multiple sexual partners, and the natural course of the HIV epidemic. However, much still needs to be done.

Evidence shows that HIV transmission among sex workers, Men having Sex with Men (MSM) and, in some settings, the use of contaminated drug-injecting equipment, contribute to higher transmission rates. These groups experience substantially higher levels of HIV prevalence than the general population.

Who is affected and why?

The majority of adults living with HIV in East and Southern Africa acquired the virus through unprotected sex. Heterosexual intercourse accounts for 85-95 per cent of all new infections among people above 15 years of age. This highlights the critical importance of preventing sexual transmission. The epidemic in ESA is generalized and has specific characteristics, as HIV is widespread in the general population.

Women and men are both highly affected by the epidemic, with women accounting for nearly 60 per cent of Persons Living with HIV (PLHIV). The higher HIV prevalence among women is due to a combination of factors, including patterns of sexual networks, younger age at infection, and higher mortality among HIV-positive men, who are consequently missing in the data.

Social and gender norms, including multiple partnerships, age-disparate sexual relations and related concepts of masculinity all contribute to HIV transmission. The HIV epidemic shares some of these underlying causes with the region’s epidemic of gender-based violence.

Women’s ability to negotiate condom use and mutually monogamous relations is affected by power dynamics, including gender-based violence (GBV) in relationships.

While women report lower condom use than men, uptake of other HIV services including testing and ART is lower among men. Coverage and uptake of targeted services for key affected populations, like sex workers and MSM, remains limited in many contexts due to discrimination, provider bias and legal barriers.

Young women aged 15-24 are at a particularly high risk of HIV infection. While peaks of HIV incidence in women range between the ages of 18 to 39 years in different countries, incidence is consistently very high among women aged 18-24 years.

Age-disparate sex with older male partners is associated with higher risk of HIV infection. Reducing age-disparate sex is a pathway to reducing teenage pregnancy and HIV incidence. Certain high risk hotspots such as garment factories, urban low-income settings, mining, farming, tourist sites and cross-border transport routes predispose their populations, including young people, to new HIV infection.

SRHR and HIV Linkages Project

UNFPA’s response to the epidemic