Southern Africas AIDS epidemic takes nosedive

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Country Country * Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Until now, the most authoritative estimates of HIV infection rates, or incidence, and prevalence have come from the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Geneva, Switzerland. Those are based on mathematical models that largely extrapolate from clinics and nonrandomized surveys conducted by countries. The more rigorous PHIA approach “largely confirms” the UNAIDS estimates, says epidemiologist Peter Ghys, who directs strategic information and evaluation there. The most notable exception is PHIA found an incidence of 0.45 in Zimbabwe in 2016, which is almost half the 0.88 reported by UNAIDS in 2015. (The PHIA assessed adults between 15 and 64 years of age, whereas UNAIDS estimates are for 15- to 49-year-olds.)More important, PEPFAR’s Birx notes that PEPFAR’s own data from sites it supports led them to believe that more than 20% of the people who started treatment were not sticking with it. “We were misled at the program level about retention,” Birx says. The PHIA data’s high level of viral suppression—which UNAIDS does not track—suggests that instead, “people were moving from one clinic to another and it looked like they were lost to follow-up.” She says this suggests that people adhere to treatment more than previously thought. “These programs and the people implementing them have done an extraordinary job of working with the community and the individual clients,” Birx says.The PHIA also has regional data that will enable countries to better target interventions in places where they are not working well. “We know which regions have viral suppression and how many positive people were aware of their status, so the countries will now know where to test more people and where they have to achieve better viral suppression,” ICAP’s El-Sadr says. “The level of interest in the ministries of health is profound.”On a grander scale, the new data show that each of these three countries is approaching the UNAIDS goal to control HIV/AIDS epidemics, which is known as 90-90-90. UNAIDS modeling shows that epidemics will peter out if 90% of infected people know their HIV status, 90% of that group receive antiretrovirals, and 90% on treatment have undetectable viral levels. This translates to 73% of HIV-infected people in a population with undetectable viral levels—including those who don’t know their status and have uncontrolled infections. In the United States, only about 30% of HIV-infected people have achieved this. The PHIA found that Malawi already is at 67.6%, Zimbabwe is 60.4%, and Zambia is 59.8%. “We’re getting very close to the number that shuts down epidemics,” Birx says.center_img Today is World AIDS Day, and three neighboring countries in southern Africa that have been hard-hit by HIV received remarkably good news.As part of a massive, first-of-its-kind survey, researchers randomly visited households in Malawi, Zambia, and Zimbabwe and tested about 80,000 people for HIV. In each country, more than 86% of the people receiving antiretroviral treatment had fully suppressed HIV, which means viral levels are so low they are not detectable on standard blood tests. This not only staves off AIDS, but makes it highly unlikely that they will infect others. The rate of new infections has also plummeted by more than 50% in the region since 2003. “We were amazed when we saw this,” says Wafaa El-Sadr, an epidemiologist who heads an international health-strengthening program called ICAP at Columbia University Mailman School of Public Health, which led the survey. “It’s really a credit to these countries—and they’re not the world’s richest places.”The three countries since 2004 collectively have received nearly $4 billion from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which gave ICAP $125 million to conduct what are known as population-based HIV impact assessments (PHIAs) in 12 sub-Saharan African countries and Haiti. The aim is to help the countries and PEPFAR better target prevention and treatment efforts. The preliminary findings announced today are the first data reported from these assessments. “It’s pretty doggone amazing,” says Deborah Birx, who heads PEPFAR in Washington, D.C. “This really shows us why it’s so important to get community level survey data.” Click to view the privacy policy. Required fields are indicated by an asterisk (*)last_img

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