HIV Eradication: Progress and Challenges

Ambassador Deborah L. Birx, MD, from the US Department of State, opened today’s session at CROI on “Factors Affecting HIV Care and Outcome: Global Perspective” with an update on the progress and challenges facing the goal of HIV eradication.¹ She gave a ground-level view of the situation in Africa, and focused primarily on the efforts of the PEPFAR (President’s Emergency Plan for AIDS Relief) staff in Botswana and Kenya. It was an inspiring talk, but also highlighted the many challenges that lie ahead.

First, the progress:

1. Last year alone, PEPFAR performed on-site HIV testing of over 56 million people, including over 14 million pregnant women. Almost 750,000 of the women tested positive, for a prevalence rate of around 5.2%, down substantially from a decade earlier.

2. Life expectancy in Sub-Saharan Africa has now returned to pre-AIDS era levels. At the peak of the HIV epidemic, average life expectancy of a child born that year was 20 years less than it was pre-AIDS.

3. New infections have been cut in half since the peak of the epidemic.

4. In Botswana, new infections are down to 10,000 per year, from a peak of 40,000 per year (75% reduction); country-wide prevalence is down to 5%.

5. Overall in Sub-Saharan Africa, the number of new infections was down 32% from 2005 – 2013. For those under the age of 15 (most of whom acquired HIV perinatally), HIV infections were down 63% in the same period of time.

Now the challenges:

1. 28 million new infections are expected over the next 15 years in Sub-Saharan Africa.

2. Currently, 60% of all new HIV infections in the 15 – 24 age group occur in girls/women, who also represent one of the fastest growing population groups. Because of anticipated large increases of persons in this demographic group, efforts on the ground need to be 20% – 30% more effective just to keep infection rates where they are today.

3. There has been no decline in the number of heterosexual infections in Kenya in 8 years. In fact, there are 100,000 new infections per year in Kenya, which represents a net increase of 40,000 persons living with HIV/AIDS per year.

4. In Sub-Saharan Africa, this week alone will see 36,500 new infections, of which 4600 will be in babies born HIV-infected. It will take an extra US$15,000,000 to take care of the new cases (about US$400 per case).

References:

1. Birx DL. Controlling the Epidemic and Delivering on the Promise of an AIDS-Free Generation. Abstract 96; 2015 CROI; Seattle; 23 – 26 February 2015.