HIV Epidemiology and Prevention

Abstract

Three decades after the discovery of the Human Immuno deficiency Virus (HIV) and its causal relationship with Acquired Immune Deficiency Syndrome (AIDS), HIV/AIDS continues to be a global burden, with more than 60 million people being infected resulting in approximately 25 million deaths. The devastating impact of the HIV/AIDS pandemic on morbidity and premature mortality on families, communities and societies is most noticeable in resource limited countries that bear the brunt of the disease burden. By the mid-1990s, following the introduction and success of the life prolonging combination of antiretroviral (ARV) treatment (ART), also known as Highly Active Anti-Retroviral Therapy (HAART), transformed HIV-1 from being an “inherently untreatable” (Broder, 2010) infectious agent to one highly susceptible to a range of therapies. Through global solidarity, political will, effective government and private agency partnerships, ART has become increasing accessible in resource constrained settings, significantly reducing AIDSrelated morbidity and mortality. Despite these major advances in the scale-up of ART provision, the continued spread of HIV remains a challenge in many resource-rich and poor countries, and preventing sexual transmission of HIV remains a public health priority. A key lesson in terms of altering pandemic trajectories at a country level and globally has been the importance of understanding the local epidemic with regard to the virus, modes of transmission and populations most impacted. This will provide information to customize targeted interventions. Recent research on HIV prevention strategies highlights the increasing opportunities available and progress made to prevent HIV transmission, however, implementing these interventions remain a challenge. This chapter reviews the complex diversity of the evolving HIV pandemic, and potential interventions, strategies and challenges in planning access to prevention programmes to alter the course of the disease worldwide.