HIV, or human immunodeficiency virus, is a virus that is spread through certain body fluids, such as blood, and weakens a person’s immune system by attacking cells that help fight off infection, specifically the CD4 cells. If HIV advances, it can lead to acquired immunodeficiency syndrome, or AIDS, if not treated.
Unlike most other viruses, the human body cannot fight off HIV completely; therefore, once it is contracted, the individual has it for life. Luckily, it can be controlled and its progression can be slowed significantly. There are three stages of HIV:
- Acute HIV infection
- Clinical latency (HIV inactivity or dormancy)
- Acquired immunodeficiency syndrome (AIDS)
HIV can be controlled and treated (not cured) through antiretroviral therapy (ART), also known as viral load suppression. ART can keep patients healthy for many years by reducing the amount of virus (viral load) in the blood and body fluids. ART is recommended for all people diagnosed with HIV as it not only helps slow its progression but also reduces the chances of transmitting the virus to other people.
ART is typically taken as a combination of three or more medications that can sometimes be combined into one pill. Those diagnosed with HIV should start ART as soon as possible after diagnosis.
As of 2018, 23.3 million people are receiving antiretroviral treatment for HIV, which means about 62% of the total population of those diagnosed with HIV are being treated with ART. Testing and treatment coverage of HIV has dramatically improved around the world; however, poverty, gender inequality, and HIV stigma and discrimination are major barriers to HIV prevention and treatment in many countries.
UNAIDS, the Joint United Nations Program on HIV/AIDS, is the world’s leading advocate for the comprehensive and coordinated global action against the HIV/AIDS pandemic. In 2014, UNAIDS established the 90-90-90 goals, which called for countries around the world to get 90% of people living with HIV diagnosed; 90% of those diagnosed accessing treatment, and 90% of people on treatment to have suppressed viral loads by 2020.
HIV Around the World
HIV is believed to have come from a type of chimpanzee in Central Africa, where the chimpanzee version of the virus, simian immunodeficiency virus or SIV, was transmitted to humans when they hunted the animal and came into contact with the blood. Once the virus was transmitted to humans, it mutated into HIV. It is believed that HIV was first transmitted in the 1800s and spread slowly across Africa and later into the rest of the world, reaching the United States around the mid to late 1970s.
According to the World Health Organization, there are about 37.9 million people globally living with HIV in 2018. The prevalence of HIV in adults ages 15 to 29 is estimated at about 0.8% of the global population. Unfortunately, being the believed origin of HIV, Africa has the highest prevalence of an estimated 3.9% (anywhere from 3.3-4.5%).
Swaziland (Eswatini) has the highest HIV prevalence and incidence of any country in the world of 27%. Luckily, through the implementation of expanded treatment and prevention services, Swaziland significantly reduced its rate of new infections by nearly half between 2011 and 2016. Additionally, the rates of viral load suppression among adult HIV patients increased from 34.8% to 71.3%. While the HIV epidemic is generalized in Swaziland, certain groups especially those who are marginalized and criminalized are particularly affected. For example, the country has an HIV prevalence among sex workers of 60.5%, the highest in the world.
Lesotho has the second-highest HIV rate in the world of 25%. Lesotho has a total of 340,000 people living with HIV. In 2018, the country saw 13,000 new HIV infections and 6,100 AIDS-related deaths. About 60% of all adults living with HIV and 70% of all children with HIV in Lesotho are receiving ART. About 57% of Lesotho’s population lives in poverty, which couple with HIV/AIDS, has led to the country’s low life expectancy of 52 years for men and 55 years for women.
The country with the third-highest HIV prevalence is Botswana, with an estimated 21.90% of the population diagnosed. About 370,000 people in Botswana are living with HIV. 85% of total adults with HIV and 38% of total children with HIV are on ART. Botswana has one of the highest rates of HIV in the world despite its provision of universal free antiretroviral treatment to all people living with HIV. Botswana has a one-size-fits-all approach to HIV prevention, but the prevention programs are reaching less than half of those most at risk due to the lack of targeted services. Additionally, those affected by HIV in Botswana face barriers such as gender inequality, punitive laws against marginalized groups, and the withdrawal of funding from international groups.
4. South Africa
The HIV prevalence in South Africa is 18.90%, making it the fourth-highest rate in the world. There are 7.7 million people living with HIV in South Africa, the largest HIV epidemic in the world. In 2018, South Africa saw 240,000 new HIV infections. The country has the world’s largest ART program, with 62% of adults with HIV and 63% of children living with HIV receiving ART. The success of South Africa’s ART program is evident in increasing the national life expectancy from 56 years in 2010 to 63 years in 2018.
Namibia has the fifth-highest rate of HIV in the world of 13.80%. HIV is the leading cause of death in the country. About 200,000 people in Namibia are living with HIV with about 6,100 newly infected individuals in 2018. About 92% of adults and children living with HIV in the country are receiving ART. According to the Namibia Population-Based HIV Impact Assessment (NAMPHIA), a household-based survey conducted to assess the progress of Namibia’s HIV response, the country exceeded many of the 90-90-90 targets set by UNAIDS.
Zimbabwe’s HIV rate is 13.50%, the sixth-highest in the world. There are 1.3 million people living with HIV in Zimbabwe. 89% of adults living with HIV and 7% of children living with HIV are receiving ART. Zimbabwe has achieved a decline of new HIV infections among infants thanks to PMTCT services allowing nearly every pregnant woman to receive ART. Women are disproportionately affected in Zimbabwe, especially adolescent girls and young women. One of Zimbabwe’s largest barriers in providing HIV services is the illegal nature of sex work and homosexuality in the country, making it extremely difficult for these groups to seek prevention and treatment help.
Zambia has the seventh-highest HIV rate in the world of 12.40%. 1.2 million people in Zambia have HIV, with 78% of affected adults and 79% of affected children receiving ART. Among those who have access to ART, 75% are virally suppressed and life expectancy among people living with HIV has improved significantly. Unfortunately, the prevalence of HIV in Zambia has caused the tuberculosis epidemic to worsen.
Mozambique’s HIV rate is 12.30%, the eighth-highest in the world. As of 2018, 2.2 million people live with HIV in Mozambique with 150,000 people newly infected. Women are disproportionately affected by HIV in Mozambique: about 60% of the adults living with HIV are women and new HIV infections among young women (ages 15-24) were almost double those among young men. More than 95% of pregnant women living with HIV were able to access ART to prevent transmitting it to their newborns, preventing 18,000 new HIV infections among infants.
Malawi is the first country on the list whose HIV rate is below 10% at 9.20%. This rate is the ninth-highest in the world. About 1 million people live with HIV in Malawi, with young people at particular risk. Around one0third of all new HIV infections in the country occurred among young people age 15 to 24 years old. Among those living with HIV, 79% of adults and 61% of children are receiving ART. One of Malawi’s largest barriers to HIV progress is stigma. Despite this, Malawi very close to reaching the UNAIDS 90-90-90 targets.
Uganda has the tenth-highest HIV rate in the world of 6.50%. 1.4 million people in Uganda live with HIV. As far as Uganda’s 90-90-90 goals, 84% of those affected are aware of their status, 87% are on HIV treatment, and 88% of those on treatment are virally suppressed. Women are disproportionately affected by HIV in Uganda, with 8.8% of adult women living with HIV compared to 4.3% of men. Because of punitive laws against sex workers and homosexuality, these groups are most vulnerable to being infected by HIC and less likely to seek HIV services.