Despite the availability of a widening array of effective HIV prevention tools and methods—and a massive scale-up of antiretroviral therapy in recent years—there has been insufficient progress in reducing new HIV infections in young people and adults globally.
Among the 28 countries participating in the Global HIV Prevention Coalition, just three—Eswatini, Uganda and Zimbabwe—have achieved annual infection reductions of more than 40% since 2010. The majority of the coalition countries have made only limited progress (reductions of less than 25%), and a few have made no progress at all.
Since the launch of the Global HIV Prevention Coalition in late 2017, participating countries have reinvigorated their HIV prevention strategies and aligned their responses to global targets. Nevertheless, major gaps still exist in financing for HIV prevention, providing services at scale and addressing underlying policy and structural barriers affecting communities. In 2018, less than half of locations with high HIV incidence had dedicated HIV prevention programmes for adolescent girls and young women,
and less than 50% of key populations were reached with combination prevention services in more than half of the countries that reported data to UNAIDS. The prevalence of people living with unsuppressed HIV remained high high in many locations of eastern and southern Africa (Figure 3.1).
At the same time, examples of successful combination prevention—including condom programming,
pre-exposure prophylaxis (PrEP), voluntary medical male circumcision (VMMC), viral load suppression through antiretroviral therapy, and the prevention and treatment of sexually transmitted infections (STIs)—exist in many settings. Community-based organizations have played a central role in efforts to reach adolescent girls and young women in high-prevalence settings and key populations in all epidemic settings. Innovative web-based and mobile application platforms are generating additional awareness and demand for HIV services.
Replicating these successes remains central to achieving the global target of fewer than 200 000 new infections and ending AIDS as a public health threat by 2030.
A combination tailored to reach the populations in greatest need, can achieve steep reductions in HIV infections.
The latest country data reported to UNAIDS show widely varying coverage of combination HIV prevention services. Efforts to achieve global HIV prevention demand and link people at high adopting PrEP as an additional HIV prevention option.
More than 300 000 people globally took PrEP at least once in 2018.
There has been progress towards the 2020 target for voluntary medical countries since the beginning of 2016.
AT A GLANCE
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HIV DA TA
A COMBINATION APPROACH TO HIV PREVENTION
PART 1
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PART TITLE0 10 20 30 40 50 60 70 80 90 100
Pakistan Tunisia Algeria Sri Lanka Bangladesh South Sudan Dominican Republic United Republic of Tanzania Brazil Sao Tome and Principe Viet Nam Guatemala Nepal* Philippines Malaysia Dominica* Zimbabwe Burkina Faso Tajikistan Lao People's Democratic Republic Niger* Republic of Moldova Morocco* Suriname Malawi* Thailand North Macedonia Costa Rica Belarus Kazakhstan* Nicaragua Côte d'Ivoire Armenia Singapore Panama* Cambodia*
Percent
Notes: Possible prevention services received: condoms and lubricant, counselling on condom use and safe sex, and testing of sexually transmitted infections.
FIGURE 3.2 Percentage of sex workers who reported receiving at least two prevention services in the past three months, selected countries, 2016–2018
Source: Global AIDS Monitoring, 2016–2018.
The use of an asterisk (*) indicates that data for marked countries come from programme data (which tend to show higher values) and not from a survey.
FIGURE 3.1 Prevalence of unsupressed HIV (>1,000 copies/ml) among adults (aged 15 years and older), eastern and southern Africa, 2018
30 25 20 15 10 5 0 Unsupressed HIV (%)
Note: Grey = sub-national data not available.
Source: UNAIDS special analysis, 2019.
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2
0 10 20 30 40 50 60 70 80 90 100
Pakistan Bangladesh Senegal Lao People's Democratic Republic Dominica Algeria Guinea Cambodia* Viet Nam Singapore* Guatemala Ireland Sri Lanka Saint Vincent and the Grenadines* Philippines Brazil Dominican Republic Bolivia Malaysia Kyrgyzstan Colombia Côte d'Ivoire Niger* Morocco North Macedonia Thailand Republic of Moldova Malawi Belarus Honduras Nicaragua Zimbabwe* Burkina Faso Nepal* Sao Tome and Principe Panama*
Percent
Notes: Possible prevention services received: condoms and lubricant, counselling on condom use and safe sex, and testing of sexually transmitted infections.
FIGURE 3.3 Percentage of gay men and other men who have sex with men who reported receiving at least two prevention services in the past three months, selected countries, 2016–2018
Source: Global AIDS Monitoring, 2016–2018.
The use of an asterisk (*) indicates that data for marked countries come from programme data (which tend to show higher values) and not from a survey.
Bolivia (Plurinational State of)
3 PART 1
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PART TITLE0 10 20 30 40 50 60 70 80 90 100
Malaysia Pakistan Sri Lanka Uganda Bangladesh Viet Nam* Iran Myanmar Armenia Republic of Moldova Kyrgyzstan* Morocco Philippines North Macedonia Belarus Tajikistan Nepal* Seychelles Cambodia*
Percent
Notes: Possible prevention services received: condoms and lubricant, counselling on condom use and safe sex, and sterile injecting equipment.
FIGURE 3.4 Percentage of people who inject drugs who reported receiving at least two prevention services in the past three months, selected countries, 2016–2018
The use of an asterisk (*) indicates that data for marked countries come from programme data (which tend to show higher values) and not from a survey.
Iran (Islamic Republic of)
Source: Global AIDS Monitoring, 2016–2018.
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A COMBINATION APPROACH TO HIV PREVENTION
4
TITLE OF THE ARTICLE
0 Dominican Republ
ic
Notes: Possible prevention services received: condoms and lubricant, counselling on condom use and safe sex, and testing of sexually transmitted infections.
The use of an asterisk (*) indicates that data for marked countries come from programme data (which tend to show higher values) and not from a survey.
FIGURE 3.5 Percentage of transgender people who reported receiving at least two prevention services in the past three months, selected countries, 2016–2018
Source: Global AIDS Monitoring, 2016–2018.
TITLE OF THE ARTICLE
0
injecting equipment Opioid substitution
therapy Condom distribution Antiretroviral therapy HIV testing
Number of countries
Number of countries with reported numbers on HIV prevention and treatment services
FIGURE 3.6 Countries with reported numbers on HIV prevention and treatment services in prisons, 2016–2018
Source: Global AIDS Monitoring, 2016–2018.
Key populations left behind in many countries
The United Nations General Assembly’s 2016 Political Declaration on Ending AIDS calls on countries to ensure that 90% of those at risk of HIV infection are reached by comprehensive prevention services by 2020. Across all continents are a common set of key populations at high risk of infection: sex workers, transgender people, prisoners, people who inject drugs, and gay men and other men who have sex with men.
Country data reported to UNAIDS within the last three years show widely varying coverage of combination HIV prevention services. Less than 10% of at least one key population were accessing multiple prevention services in Algeria, Bangladesh, Dominica, the Lao People's Democratic Republic, Malaysia, Pakistan, Senegal, Sri Lanka, Tunisia and Uganda (Figures 3.2–
3.5). Conversely, countries in several regions reported reaching the 90% target for at least one key population, including Armenia, Côte d'Ivoire and Singapore.
Despite the relative ease of reaching individuals within a closed setting, HIV services are not provided in prisons in many countries. Across the last three
years of country reports to UNAIDS, very few countries reported programme data on the provision of condoms (32 countries), opioid substitution therapy (24 countries) and sterile injecting equipment (three countries) in prisons (Figure 3.6).