East Africa Sees Decline in Adult HIV Prevalence

Frontline Aids
Domestic financing for HIV prevention and Abuja Declaration targets Our reports show that funding from international donors remains the highest contributor to HIV prevention in Africa, especially for programmes aimed at key population communities, such as men who have sex with men, transgender people, sex workers and people who use and inject drugs. Beyond HIV prevention, governments of all nine African countries analysed in our reports are falling far short of meeting the target to spend 15% of their national budgets on health, as set out within the Abuja Declaration. This reliance on international donors threatens the sustainability of the HIV prevention response, particularly now with international funding for HIV decreasing and a number of donor countries cutting their aid budgets, or reallocating aid to other areas. It also raises questions about each governments’ commitment to ending AIDS as a public health priority.
5 December 2023
Tanzania Daily News (Dar es Salaam)
By Henry Lyimo

HIV prevalence has been reducing during the past two decades in the East African region thanks to strong shared responsibility between the region's governments, civil society, international donors and the research community.

However, together with southern Africa, the region remains the most affected by the HIV epidemic, accounting for 45 per cent of the world's HIV infections and 53 per cent of people living with HIV globally, according to United Nations Office on Drugs and Crime.

Despite the steady decline in prevalence, the Eastern African region remains the second most affected region by HIV and AIDS in the world after Southern Africa. New areas of concern with regards to infection among the most-at-risk populations are emerging. This is particularly true for injecting drug users, prisoners and uniformed services among others.

Below is a snapshot of HIV epidemic to East African Community (EAC) member states.

Tanzania

Adult HIV prevalence in Tanzania is estimated at 4.5 per cent, according to UNAIDS, 2021, with regional HIV prevalence ranging from 0.5 per cent in Zanzibar to 11.4 per cent in Njombe Region.

Women and girls continue to be disproportionately affected compared to men, with adolescent girls and young women accounting for 80 percent of all new HIV infections.

Tanzania's goal is to reach HIV epidemic control by 2030, with 95 percent of people living with the disease aware of their HIV status, 95 percent of those diagnosed receiving sustained antiretroviral therapy (ART), and 95 percent of those on ART virally suppressed.

President Samia Suluhu Hassan launched Tanzania's fifth Multisectoral National Strategic Framework for HIV and AIDS during commemorations of the AIDS day in 2022 held in Lindi Region.

Under the framework, Tanzania seeks zero new infection, zero discrimination, and zero AIDS-related death by 2026. The global target is to achieve the three zeros by 2030.

The goals come on backdrop of many inequalities in the HIV and AIDS response with the rate of new infections in youth aged 15-24 being higher than in adults and within that group, girls being two to three times more at risk than boys.

Access to HIV prevention and treatment services is lower for children, youth, women, and key populations, including sex workers, people who use drugs and men who have sex with men.

The UNAIDS Executive Director, Ms. Winnie Byanyima highlighted the findings reported in the UNAIDS World AIDS report of 2022 that was launched in Dar es Salaam, Tanzania on 30 November.

According to the report 88 percent of adults who live with HIV in Tanzania are on ART, but only 60 percent of children living with HIV are on ART, which reflects the global picture that three quarters of adults living with HIV are on treatment and only half of the children are on ARVs.

Kenya

Kenya has made laudable progress in the HIV response as shown by the sustained decline in HIV prevalence among adults (15-49 years) in the general population, from a high of ~ 10 per cent in the mid-1990s to 4.5 per cent in 2020.

Whilst overall incidence has been declining, key populations such as men who have sex with men (MSM) still bear a disproportionate burden of the disease.

In Nairobi--Kenya's capital, the prevalence of HIV among MSM is 25 per cent compared to 3.1 per cent in the general male population (15-49 years old) with 15.2 per cent of all new HIV infections in the country occurring among MSM .

Key statistics: 2021

  • 4 million people with HIV
  • 4 per cent adult HIV prevalence
  • 35,000 new HIV infections
  • 22,000 AIDS-related deaths
  • 78 per cent people on antiretroviral treatment

Uganda

Uganda is leading in EAC with highest HIV prevalence rates among the adults.

For the period 2010-2020, Uganda recorded a tremendous improvement in the fight against the HIV and AIDS epidemic.

It is among the (08) countries in the world that had fully achieved the 90-90-90 targets by the end of 2020, the others being Eswatin, Switzerland, Rwanda, Qatar, Botswana, Slovenia and Malawi.

According to the Ministry of Health estimates 2020, the HIV prevalence among adults (15-49 years) in Uganda is 5.4 per cent.

Key statistics: 2021

  • 4 million people with HIV
  • 2 per cent adult HIV prevalence
  • 54,000 new HIV infections
  • 17,000 AIDS-related deaths
  • 2 million people on antiretroviral treatment

Rwanda

The HIV epidemic in Rwanda is generalised, with a prevalence of 3 per cent in the adult population and substantial HIV burdens in key populations such as Female sex workers (FSW) and Men having sex with men.

The 3 per cent HIV prevalence in the adult aged 15-49 years remained stable in all the three Demography Health Surveys (DHS) consecutively (2005, 2010 and 2014/15), according to UNAIDS.

The prevalence of HIV among adults in Rwanda corresponds to approximately 210,200 adults living with HIV in Rwanda with more women (3.7 per cent) than men (2.2 per cent) living with HIV.

The Rwanda Population-Based HIV Impact Assessment (RPHIA), a national household-based survey, was conducted between October 2018 and March 2019 in order to measure the status of Rwanda's national HIV response.

Burundi

The 2016-2017 Burundi Demographic and Health Survey provides the most up-to-date data on the epidemiological situation of human immunodeficiency virus (HIV)/AIDS in the country.

According to this survey, 0.9 per cent of men and women between the ages of 15 and 49 are HIV-positive.

HIV prevalence is slightly higher among women (1.2 per cent) than men (0.6 per cent), and is more than three times higher in urban (2.5 per cent) compared to rural areas (0.7 per cent)

South Sudan

In the Republic of South Sudan, HIV continues to be a public health priority with estimated prevalence of 2.5 per cent among adults aged 15-49 years (2020 UNAIDS estimates) with 18 per cent of the estimated PLHIV (190,000) on treatment.

However, there is concern about the increasing trend in the number of new HIV infections (19,000) with one in every four persons living with HIV knowing their HIV status.

Besides HIV situation among general populations, there were also concerns of higher HIV prevalence among key populations (recent study among FSW in two cities found prevalence of 13.6 and 6.7 percent).

Somalia

The World Health Organization (WHO) announced in 2022 it has in partnership with Somalia managed to keep the HIV/Aids prevalence in the country on a steady decline from above 1 percent in 2013 to 0.10 percent in 2022.

In a joint statement issued in Mogadishu, the capital of Somalia to mark World Aids Day, the WHO said that together with the ministry of health, they have managed to keep the country since 2014 classified as a low-level HIV epidemic country.

"This success rate has been achieved on account of WHO's close monitoring of the HIV/AIDS situation in the country including ensuring equitable access to patient care, close follow-up of patients who are on ART and regular monitoring of clinical conditions of the HIV/AIDS patients," WHO said.

It said the HIV prevalence among the general population has seen statistically a significant decline, with the most recent 2018 sentinel survey showing that antenatal HIV prevalence dropped to 0.15 percent in Somaliland, 0.17 percent in Puntland and 0.04 percent in South Central Somalia.

"The low HIV prevalence in Somalia can be attributed to Somali culture and society, and few risk factors as a result of behaviour," said Dr Sadia Abdisamad Abdullahi, National HIV/AIDS Programme Manager.

However, despite the general decline in HIV prevalence across Somalia, there are locations such as Garowe and Bosasso in Puntland where the infection rates have merely levelled off, with the risk of increasing yet again. The next survey among pregnant women is scheduled for 2023.

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