In the late 1980s a new and devastating disease began to surface across the world: AIDS (Acquired Immune Deficiency Syndrome), caused by the HIV (Human Immunodeficiency Virus). Since its emergence, global efforts to treat, cure, and prevent HIV have made significant strides. Despite this progress, the HIV epidemic continues to grow at an alarming rate, affecting millions across the globe. While some victories have been achieved, the fight against HIV is far from over, with no corner of the world untouched by its impact.
In 2023, 1.3 million people were newly infected with HIV worldwide, bringing the total number of people living with the virus to 40 million. However, only 30.7 million people were using life-saving antiretroviral treatment (ARVs), and 630,000 people died from AIDS-related conditions.
Among the most vulnerable groups are adolescent girls and young women, gay men and other men who have sex with men, sex workers, substance users, and transgender individuals. In 2023, adolescent girls and young women accounted for 44% of all new infections, a staggering 210,000 cases. In sub-Saharan Africa, this translates to 3,100 new infections every week—one every three minutes. Three times more adolescent girls and young women currently live with HIV than their male counterparts. These young women often face the dual threats of limited autonomy and violence, which significantly increase their risk of HIV infection.
A similarly alarming trend is seen among people who inject drugs. In sub-Saharan Africa, data is scarce, but evidence shows that injecting drug users are five times more likely to contract HIV. Women in this group are especially vulnerable, with a 20% higher chance of infection than their male counterparts. This population requires targeted interventions, including harm reduction programmes and comprehensive healthcare.
Another high-risk group is gay men and other men who have sex with men. In the past decade, new infections in this group have risen by 11%, while other populations have seen declines. In 2022 alone, 210,000 new infections occurred among men who have sex with men. These individuals are 23 times more likely to contract HIV compared to other men, and around 35% lack access to ARVs. Improved healthcare access for this community is critical in the ongoing fight against HIV.
Despite the challenges, significant progress has been made in the treatment of HIV. South Africa, for example, introduced a more effective pill in 2020, replacing the earlier combination therapy with Dolutegravir, Tenofovir, and Lamivudine. This new regimen has fewer side effects and offers better control of the virus, reducing the likelihood of transmission.
In terms of prevention, there have been breakthrough developments. While vaccines remain elusive, pre-exposure prophylaxis (PrEP), such as the daily pill Tenofovir/Emtricitabine, has been widely adopted in many countries, including South Africa. More recently the Dapivirine Vaginal Ring (Dapiring) was approved in South Africa for use by women who are at risk of vaginally acquired HIV and offers a 62% reduction in new infections. Madibeng Centre for Research was key in the research work to show that this ring is safe, effective and acceptable for women to use.
In 2024, hope shines even brighter with the recently announced PURPOSE trial results of Lenacapavir, a groundbreaking injectable medication. Administered every six months, this drug showed a 100% effectiveness in preventing HIV in young women and adolescents during clinical trials, of which Madibeng Centre for Research was a part. The medication also demonstrated a 98% reduction in new infections among gay men, men who have sex with men, and transgender people. Studies are ongoing to test its effectiveness in other high-risk groups, including people who inject drugs.
The development of Lenacapavir marks a historic moment in the fight against HIV, offering a near-perfect preventive solution. If this medication becomes widely available, it has the potential to significantly reduce new infections, bringing the world closer to a future free of HIV and AIDS. The manufacturer, Gilead Sciences, is working to ensure the drug is accessible in countries where it is most needed, especially in regions with high rates of HIV infection.
As we continue to make strides in treatment and prevention, the global community must remain united in its efforts to combat HIV. Individuals can contribute by supporting those at risk, promoting education, and backing research initiatives. With continued commitment and new innovations, the fight against HIV is far from a lost cause.