HIV/AIDS
The human immunodeficiency virus (HIV) targets cells in the immune system – the body’s defence against illness – and weakens the body’s ability to fight against infections and some types of cancer. The virus destroys white blood cells in the immune system called CD4 cells and replicates itself inside these cells.
As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. The body becomes increasingly unable to fight infections and disease and vulnerable to opportunistic infections and cancers. Immune function is typically measured by CD4 cell count.
The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which can take from two to 15 years to develop, depending on the individual.
No effective cure for HIV exists at present but HIV can be suppressed by a combination of medicines called antiretroviral (ARV) therapy consisting of three or more ARV drugs. Antiretroviral therapy does not cure HIV infection but suppresses viral replication within a person's body and allows an individual's immune system to strengthen and regain the capacity to fight off infections.
People with HIV can enjoy long, healthy lives by taking ARV treatment.
In 2021, WHO released the Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: Recommendations for a public health approach. These consolidated guidelines on preventing and treating HIV infection bring together a series of recommendations to promote the highest quality, person- centered delivery of care for people living with HIV and affected by HIV
HIV still causes too many avoidable deaths, but by providing the right health services in a timely manner, we can avoid the worst consequences of the virus. The recommendations in these guidelines aim to reduce the number of people dying from HIV and, when fully implemented, will help us to reach our goals of reducing global HIV deaths to less than 200 000 by 2030. For most people living with HIV, it is a chronic, lifelong condition. Evidence and lived experience have shown that with the right support, people can manage their own health according to what works best in their lives. The service delivery approaches put forward in these guidelines aim to promote self-management for the majority of people living with or affected by HIV. This includes an expanded range of options for diagnosing, preventing, and treating HIV that are delivered and monitored in the community.
Treatment and care in children and adolescent
In the African region, an estimated 1.3 million children aged 0-14 were living with HIV at the end of 2022, and 109 000 children were newly infected. An estimated 69 000 children died of AIDS-related illnesses. To reduce HIV-related mortality and morbidity among this highly vulnerable population, early testing and treatment is essential. Without access to testing and treatment, 50% of children with HIV will die by the age of 2, and 80% will not live to their fifth birthday.
WHO recommends that infants born to mothers living with HIV are tested for HIV, at birth, six weeks, during breastfeeding, and when breastfeeding ends given continued risk of transmission during this period. Older children, especially offspring and siblings of persons infected with HIV, should also be tested.
HIV-positive children should be started on antiretroviral drugs (ARV) immediately. Once treatment begins, children must take their medicine regularly to stay healthy into adolescence and adulthood. Failure to suppress the HIV virus remains a serious problem among children, aggravated by a lack of child-friendly formulations of the newest and most effective ARVs designed for adults.
Compared to other populations, adolescents face additional barriers in accessing testing and treatment, including health services that are not adapted to their needs and policies that require parental consent for services. HIV-positive adolescents also are less likely than adults to adhere to their treatment regularly, resulting in lower rates of viral suppression and lower declines in mortality.
Addressing the distinct and diverse needs of adolescents living with HIV to improve their HIV-related outcomes requires a comprehensive and integrated approach that leverages on global commitments and approaches to adolescent health, including the Global Strategy for Women, Children, and Adolescents’ Health (2016–2030) and the Global Accelerated Action for the Health of Adolescents (AA-HA!).
WHO recommends the implementation of adolescent-friendly health services in HIV services to ensure engagement and improved outcomes. Involving and engaging in their own care across the treatment cascade and through the cycle of planning, implementing, monitoring and evaluating programs is key. Peer-driven, adolescent-friendly services, integrated with other services including psychosocial interventions, are effective ways to improve health outcomes for adolescents.
HIV Drug Resistance
Tens of millions of HIV/AIDS patients have had their lives saved thanks to the extraordinary rise in the use of antiretroviral medication (ART) during the last ten years. Of the estimated 25.6 million people living with HIV in the African region, 20.8 million were on antiretroviral therapy (ART) as of the end of 2022.
HIV drug resistance has emerged in tandem with the growing usage of HIV medications; in recent years, the prevalence of this resistance has been progressively rising. Changes in the genetic makeup of HIV impact the medications' capacity to prevent the virus from replicating, leading to HIV drug resistance. Due to the advent of newer kinds of antiretrovirals, all currently available medications have the potential to become partially or completely inactive.
Drug-resistant virus strains have the potential to render all antiretroviral medications, including those from more recent classes, partially or completely inert. HIV drug resistance has the potential to compromise antiretroviral medication effectiveness if it is not addressed, leading to a rise in HIV infections as well as higher rates of morbidity and mortality related to HIV.
The sixty-sixth session of the Regional Committee endorsed the document “HIV/AIDS: Framework for action in the WHO African Region 2016–2020”. The framework is designed to guide Member States in implementing the Global health sector strategy on HIV, 2016–2021. It describes actions to accelerate HIV prevention and treatment interventions in the African Region towards ending the AIDS epidemic. The actions proposed include prioritizing HIV prevention, expanding HIV testing services using diversified approaches and scaling up antiretroviral therapy by adopting innovative service delivery models.
WHO is a cosponsor of the Joint United Nations Programme on AIDS (UNAIDS). Within UNAIDS, WHO leads activities on HIV treatment and care, HIV and tuberculosis coinfection, and jointly coordinates work on the elimination of mother-to-child transmission of HIV with UNICEF.
Key populations
Key populations and their sexual partners accounted for over half of all new infections (an estimated 54%) for the first time in 2018.
Key populations include: men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and their clients, and transgender people. They are at increased risk of HIV infection irrespective of epidemic type or local context.
Key populations, their clients and sexual partners accounted for 64% of new HIV infections in West and Central Africa, and for 25% of new HIV infections in the East and Southern African subregion. Key populations and their partners accounted for around 95% of new HIV infections in eastern Europe and central Asia and in the Middle East and North Africa in 2018.
Key populations often face legal and social barriers that increase their vulnerability to HIV and impede their access to prevention, testing and treatment programmes.
These populations historically have not received adequate priority in the response to the HIV epidemic, especially in countries with generalized HIV epidemics.
The five key populations defined by WHO and UN partners deserve particular and specific attention. In the African Region, these populations face structural barriers to services that compound their risk exposure – barriers such as laws that criminalize their behaviour, stigma, discrimination and violence.
There are gaps in the programming of HIV services as measured against WHO recommendations. The gaps are particularly evident for transgender people, people who inject drugs and prisoners. Overall, national strategic plans pay little specific attention to young members of key populations.
On 1 December 2018, WHO will join global partners to commemorate World AIDS Day under the theme “Know your status”. This will also be an occasion to celebrate the 30th anniversary of World AIDS Day (WAD30) – a pioneering global health campaign first initiated by WHO in 1988. WHO Regional Offices will create additional regionspecific messages and materials under the global theme.
WHO advocacy and communication for World AIDS Day 2018 will aim to achieve the following objectives:
- urge people to know their HIV infection status through testing, and to access HIV prevention, treatment and care services; and
- urge policy-makers to promote a “health for all” agenda for HIV and related health services, such as tuberculosis (TB), hepatitis and noncommunicable diseases.
| World AIDS Day 2010 |
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2023 Annual Report: Universal Health Coverage, Communicable and Noncommunicable Diseases (UCN) Cluster, WHO Regional Office for Africa
This is the second progress report produced by the Universal Health Coverage, Communicable and Noncommunicable Diseases (UCN) Cluster of the World Health Organization (WHO) Regional Office for Africa.
