Manson's Tropical Diseases, 24e - Chapter 14: HIV Epidemiology in the Tropics

Since the first reported case of HIV in 1981, over 70 million people have been infected with HIV and more than 35 million people have died from HIV-related causes. In the tropics, particularly in sub-Saharan Africa, HIV remains a significant public health concern. Sub-Saharan Africa is the most affected region globally, accounting for over two-thirds of all people living with HIV.The high burden of HIV in the tropics can be attributed to a variety of factors and epidemiological studies have shown that HIV disproportionately affects key populations, such as men who have sex with men, people who inject drugs, and sex workers. In addition, adolescent girls and young women in sub-Saharan Africa are particularly vulnerable to HIV infection due to a combination of social, economic, and cultural factors. In 2019, about 70% of new HIV infections among adolescents aged 15 -19 in sub-Saharan Africa were among girls, highlighting the need for targeted interventions that address the specific vulnerabilities of young women in the region.Antiretroviral therapy (ART) has transformed HIV from an inevitably fatal condition to a manageable disease, and it can significantly prolong the lives of those living with the virus. Significant advances have also been made in preventing new HIV infections over the past decade particularly with the use of antiretrovirals as pre-exposure prophylaxis and treatment as prevention. However, preventing new infections remains a challenge and a more nuanced and granular understanding of the specific factors driving new infections at a local level is crucial for developing targeted and tailored combination programs.HIV in the tropics is a complex and multi-faceted challenge that requires a holistic approach. This includes more than providing access to evidence-based treatment and prevention interventions but also needs to address the underlying social, political and economic issues, such as poverty, lack of access to healthcare, and stigma and discrimination that contribute to the high burden of HIV in the region.