Overview of the trends in reducing HIV transmission and incidence Peter Ghys, UNAIDS

OVERVIEW INTRODUCTION NEW INFECTIONS, 1990-2016, GLOBALLY New HIV infections, ADULTS (age 15+) IN REGIONS AND COUNTRIES HIV transmission rates (%), ADULTS (age 15+) SWAZILAND INCIDENCE rates (%), ADULTS, 2011 AND 2016 CONCLUSION

INTRODUCTION

No specific target for transmission rate UN (2016 HLM) 75% reduction in new infections between 2010 and 2020, to below 500,000 No specific target for transmission rate Williams et al: incidence rate of 0.1 % per year (for South Africa)

Projected annual number of new HIV infections globally, Fast-Track vs business as usual, 2010–2030

IMPACT FROM SEVERAL PROGRAMMES Treatment (90-90-90) Condom programming VMMC PrEP Key populations, including harm reduction PMTCT Cash transfers “Enablers”

NEW INFECTIONS, 1990-2016, GLOBALLY

NEW HIV INFECTIONS AMONG ALL AGES, GLOBAL, 1990-2016, and 2020 target Source: UNAIDS Global AIDS Update, 217 *The 2020 target is fewer than 500 000 new HIV infections, equivalent to a 75% reduction since 2010.

New HIV infections, children (ages 0‒14), global, 1990–2016, and 2020 target Source: UNAIDS 2017 estimates. New HIV infections 2020 target Number of new HIV infections

NEW HIV INFECTIONS AMONG ADULTS, GLOBAL, 1990-2016, and 2020 target Source: UNAIDS Global AIDS Update, 217 *The 2020 target is fewer than 500 000 new HIV infections, equivalent to a 75% reduction since 2010. New HIV infections 2020 target Number of new HIV infections

New HIV infections, ADULTS (age 15+) IN REGIONS AND COUNTRIES

New HIV infections, ADULTS (ages 15+), BY REGION, 1990–2016, AND % DECLINE 2010-2016 Eastern europe and central asia Eastern and southern africa Asia and the pacific caribbean Latin america Middle east and north western and central WESTERN AND CENTRAL EUROPE AND NORTH AMERICA 24% 9% 0% 2% -60% 4% 11%

New HIV infections, ADULTS (age 15+), SELECTED countries, 1990–2016, AND % DECLINE 2010-2016 – (1) malawi mozambique South africa 25% 41% 27% uganda zimbabwe 35% 42%

New HIV infections, ADULTS (age 15+), SELECTED countries, 1990–2016, AND % DECLINE 2010-2016 – (2) CÔTE D’IVOIRE Dr congo 14% 23% gabon 19%

New HIV infections, ADULTS (age 15+), SELECTED countries, 1990–2016, AND % DECLINE 2010-2016 – (3) THAILAND moROCCO 49% 42% NICARAGUA HAITI 19% 19%

HIV transmission rates (%), ADULTS (age 15+)

HIV transmission rates (%), ADULTS (ages 15+), BY REGION, 1990–2016, AND TRANSMISSION RATE IN 2016 Eastern europe and central asia Eastern and southern africa Asia and the pacific caribbean Latin america Middle east and north western and central WESTERN AND CENTRAL EUROPE AND NORTH AMERICA 4% 3% 6% 12% 8% 5%

SWAZILAND INCIDENCE rates (%), ADULTS, 2011 AND 2016

SWAZILAND SHIMS2 (PHIA) Nkambule et al. Substantial progress in confronting the HIV epidemic in Swaziland: first evidence of national impact. MOAX0204LB, Paris IAS 2017 2016 Population-based HIV Impact Assessment (PHIA or SHIMS2), compared to 2011 SHIMS1 (Swaziland HIV Incidence Measurement Survey) Overall, 44% decrease in incidence rate (among 18-45 year olds) over 5 years from 2.4% to 1.5% Women from 3.2% to 2.0%; men from 1.8% to 0.9%

CONCLUSION

CONCLUSION Globally, decline in new infections of 16% between 2010 and 2016 (11% among adults). In eastern and southern Africa, decline in new infections of 29% between 2010 and 2016 (24% among adults). In the right direction in most regions and many countries, but not fast enough

National estimation teams in all countries ACKNOWLEDGEMENTS National estimation teams in all countries Mary Mahy, Kim Marsh, Keith Sabin, Ehounoud Eby, Juliana Daher, Efren Fadriquela at UNAIDS Reference Group on Estimates, Modelling and Projections, with secretariat at Imperial College, London