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Eastern, Southern Africa Most Affected by HIV Epidemic

FILE - Patients with tuberculosis (TB) and HIV wear masks while awaiting consultation at a clinic in Cape Town's Khayelitsha township, South Africa.
FILE - Patients with tuberculosis (TB) and HIV wear masks while awaiting consultation at a clinic in Cape Town's Khayelitsha township, South Africa.

A report by UNAIDS, "Miles to go—closing gaps, breaking barriers, righting injustices", warns that the global response to HIV is at a critical point. Eastern and southern Africa remain the regions most affected by the HIV epidemic, accounting for 45 percent of the world's HIV infections and 53 percent of people with HIV globally.

An estimated 800,000 people in eastern and southern Africa acquired HIV in 2017, and an estimated 380,000 people died of AIDS-related illness, the report indicated.

Mozambique, South Africa and Tanzania accounted for more than half of the new HIV infections and deaths from AIDS-related illness in the region last year.

The survey also indicated that there was discrimination against HIV positive persons in healthcare settings, especially towards key populations.

Key populations include men who have sex with men, drugs users, transgender persons and sex workers, considered to be most at risk at contracting HIV.

There are nearly 1 million sex workers estimated to need services in the region.

"For us it is important in fact we do have within NASCOP, a key population program, mainly targeting the key populations, the female sex workers, men who have sex with men and injecting drug users," said Dr. Kigen Barmasai, the director at Kenya's National Aids and STI Control Program, NASCOP "One, we know that this contributes to 33 percent of new infections in Kenya, from this key populations, of course the prevalence varies, we have prevalence from 29 percent in female sex workers to 18 percent among the injected drug users. So as a program we are working on this and we are spearheading the HIV prevention, treatment and care efforts to reverse the epidemic. For the last ten years we have been working on that."

More than half of the people surveyed who inject drugs said they avoided health-care services, citing discrimination or fear of law enforcement authorities.

In Kenya homosexuality is illegal and being found guilty can lead to a sentence of up to 14 years in prison. Sex work is also illegal in Kenya.

"The criminal nature of Key populations, and the acts of Key populations that make people shy away from accessing health care and even organizing, coming together so that they can organize," said Grace Kamau, chairperson of the Key population consortium in Kenya. "The main thing is the criminal nature. People fear to be arrested"

The report said about two-thirds of all people living with HIV in the region were accessing antiretroviral therapy in 2017.

Kamau attributes the successes in reaching large numbers of Key populations in Kenya to availability of HIV resources made possible by donor funding, but she says more people are yet to be reached.

"One of the things we have in Kenya is private clinics that are donor funded," said Kamau. "That is where the sex workers feel comfortable and that is where they access their services. And that is what has made the number to go high."

The report indicates that there were 19.6 million people living with HIV in eastern and southern Africa at the end of 2017.

Out of this number 81% were aware of their HIV status, an increase from 77% in 2016.

West and central Africa continues to lag behind as statistics indicated AIDS-related deaths have fallen by only 24% in western and central Africa, compared to a 42% decline in eastern and southern Africa.

Nigeria has more than half of the HIV burden in the region and there has been little progress in reducing new HIV infections there in recent years.