World AIDS Day is a timely reminder that HIV remains omnipresent, despite our attention being diverted to other pressing public health issues, most recently COVID-19 and identification of the new strain, Omicron. Despite significant prevention strides made over the past two decades, sub-Saharan Africa is home to the largest number of people living with HIV in the world. Countries within the region have made substantial progress in combatting HIV; HIV testing, voluntary medical male circumcision (VMMC) and antiretroviral therapy (ART) have been rapidly scaled up. With expanded service delivery and accompanying behavioural interventions, many countries have reached the 90% target of people living with HIV (PLHIV) aware of their status, and viral suppression rates have risen as well.

However, many obstacles remain to achieving HIV epidemic control. There is still much work to be done to ensure PLHIV are have continued access to ART antiretroviral therapy – critical for protecting the health of PLHIV and preventing onward transmission. The coverage of HIV services is also much lower among key populations, and HIV incidence remains stubbornly high among adolescent girls and young women. COVID-19 has undoubtedly impacted HIV efforts, diverting resources, placing already under resourced health systems under further strain, and many have not been able to access HIV services due to lockdown measures and COVID-19 crowding out these and other health services. Heath systems require strengthening if they are to adequately deal with any epidemic, let alone multiple ones.

While the world focuses on COVID-19, World AIDS Day is a reminder that HIV and AIDS efforts must remain in view. World AIDS Day presents an opportunity to call for national, regional, continental and global integration to be amplified if we are to reach epidemic control in Africa. Our collective efforts are required. In the words of Michel Sidibé, the former executive director of UNAIDS: “Whenever AIDS has won, stigma, shame, distrust, discrimination and apathy was on its side. Every time AIDS has been defeated, it has been because of trust, openness, dialogue between individuals and communities, family support, human solidarity, and the human perseverance to find new paths and solutions.”

Words By Dr Gavin George, HEARD Senior Researcher and Programme Leader in Health Systems Strengthening