UNAIDS Miles to Go, Global AIDS update 2018, highlights that the partial success in saving lives and stopping new HIV infections is giving way to complacency. At the halfway point to the 2020 targets, the pace of progress is not matching the global ambition. There is a prevention crisis. The success in saving lives has not been matched with equal success in reducing new HIV infections. New HIV infections are not falling fast enough. HIV prevention services are not being provided on an adequate scale and with sufficient intensity and are not reaching the people who need them the most. Children are being left behind. The good news is that 1.4 million new HIV infections have been averted since 2010, but in 2017, 180 000 children became infected with HIV, far from the 2018 target of eliminating new HIV infections among children. While the overall HIV treatment level is high, there is a huge injustice being committed against our children—only half of under-15's living with HIV were being treated last year.

In South Africa, mapping of epidemiological data has revealed marked diversity in the distribution of HIV infections within a relatively small geographic area with a high overall rate of HIV. Researchers from the Africa Health Research Institute, Kwazulu-Natal Research Innovation and Sequencing, and University of Cincinnati geolocated individual seroconversions from 2010–2014 cohort survey data collected in KwaZulu-Natal province. This analysis reveals an “HIV hot-spot” where 40.8% [39.5– 42.1%] of adults (aged 15 years and older) are living with HIV. People within this geographic area have a 46% higher risk of HIV infection than those living outside of it, and the closer one lives to the hot-spot, the higher one’s risk of infection.
The KwaZulu-Natal data also show that hot-spots play an important role in the spread of HIV in the areas surrounding them. A study of 351 HIV transmission links among adults (aged 15 years and older) found that 72.4% of the links included at least one individual within the HIV hot-spot, whereas in 27.6% of the links, both individuals were located outside of the hot-spot. A separate analysis of cohort survey data collected in rural areas of the province between 2004 and 2014 also found that new HIV infections are clustered in specific geographic locations, forming corridors of transmission, where the rate of new infections among adults (aged 15–54 years) was 70% higher than in neighbouring areas. Intensifying comprehensive HIV prevention and treatment services within the HIV hotspot and transmission corridors could prove critical in efforts to reach Fast-Track Targets in KwaZulu-Natal.

Read the full report at UNAIDS.org