Dr Rachel Baggaley
Coordinator, HIV Testing, Prevention and Populations Department of HIV and Global Hepatitis Programme, World Health Organization
Pictured above: Dodoma, Tanzania – Jema Adamu, a client getting a refill at a care and treatment centre in Dodoma Regional Hospital.
Access to HIV testing services (HTS) and treatment has improved
In 2005, an estimated 10% of people with HIV in Africa were aware of their status. Globally, 12% of people who wanted to test for HIV, were able to do so.
Now, in 2019, an estimated 81% of people with HIV in Africa, and 79% of people with HIV globally, are aware of their status.
Yet substantial testing gaps remain, and many people at the highest HIV risk remain unreached.
New approaches are needed to reach people with undiagnosed HIV earlier
At Independent Communications Authority of South Africa (ICASA), WHO is launching updated, consolidated guidance on HIV testing services (HTS) that will support the development and scale-up of evidence-based HTS approaches in different settings. This includes an updated recommendation on HIV self-testing (HIVST).
WHO recommends HIVST as a discreet and convenient way to test, with the potential to reach people who need HTS who would not otherwise test.
Strengthen the focus on services for criminalised and marginalised populations who have the greatest needs.
Important programmes distributing HIVST have been implemented in six African countries, with more than 4.3 million HIVST kits distributed. HIVST has reached men, young people, first-time testers and people from key populations. The approaches used have provided invaluable lessons on service delivery and community involvement.
This experience has also catalysed HIVST policy development; HIVST is starting to contribute to bridging the testing gap.
Prevention efforts are equally as important
A similar effort to increase the coverage of prevention services is needed. In high-burden countries in East and Southern Africa (ESA) the voluntary medical male circumcision (VMMC) programme is reducing new infections. Nearly 23 million VMMCs were performed in ESA by 2018. The challenge is to build on successful approaches, to reach and engage men and to also provide broader health benefits.
We know that young women in ESA have significantly higher HIV risk than young men. Innovative programmes are reaching them too. In South Africa, for example, a national programme is to provide information and services for women addressing gender-based violence and sexual reproductive health issues, including HIV.
Key populations and partners account for over half of 1.7 million new HIV infections per year
In the criminal justice system, prevalence of HIV and hepatitis C are much higher. Sex workers bear a disproportionate burden of HIV globally, linked to criminalisation and violence, and only a few countries address these structural barriers.
A recent global study indicates a pooled HIV prevalence of 19% among transgender women – who face multiple barriers to accessing HIV services.
Estimated HIV prevalence in men who have sex with men is much greater than in adult men in general populations — six times higher in the Middle East (3%) and 25 times higher in the Caribbean (25%). In sub-Saharan Africa the estimated HIV prevalence for men who have sex with men is 17.9% compared to 5% in the general male population.
Continuing to improve prevention and treatment
As people from key populations continue to face higher HIV risk, and constitute an increasing proportion of new infections, prevention needs to be prioritised. Choices include PrEP, alongside condoms, harm reduction, STI management and addressing structural barriers.
While HIV treatment coverage is increasing overall, key populations still remain less likely to access HIV testing, prevention and treatment; if HIV incidence among those at highest risk is not reduced, epidemic control will not be possible.
Progress in the HIV response is the result of remarkable advances in testing and treatment, effective prevention options, and continuing innovation. The challenge is to maintain the momentum and strengthen the focus on services for criminalised and marginalised populations who have the greatest needs.