Background: Despite progress in the HIV response, new infections among adolescents and youth (AY) aged 15-24 in Sub-Saharan Africa (SSA) have only reduced by an average 3%/year since 2010. By 2050, the number of AY in SSA will increase by 85%. This demographic transition may impact the HIV epidemic and service needs for future generations. We used population statistics and recent epidemic trends to characterize the future of the HIV epidemic in SSA.
Methods: For 46 countries, we organized UNAIDS HIV estimates and UN population projections into five-year age groups by sex. HIV incidence and prevalence was calculated from 2010 to 2016. After analyzing trends, 2014-2016 data reflecting recent progress in disease control were selected to inform regression analyses by country, age and sex. An exponential curve was applied for downward incidence trends and a linear curve for upward incidence trends and prevalence. From each regression, HIV incidence and prevalence was predicted until 2050. Incidence and prevalence were applied to projected populations in each year to determine new infection numbers. Results were analysed to assess feasibility of epidemic control among AY 15-24, defined as 95% reduction in new infections since 2016.
Results: By 2050, new HIV infections will decrease by over 70% in Eastern and Southern Africa and by 2% in West and Central Africa (Figure 1). Overall, the SSA region will observe a 53% reduction in new HIV infections. None of 46 SSA countries will achieve epidemic control among AY by 2030. Botswana, Mozambique, Uganda, Zimbabwe, and Swaziland may reach epidemic control by 2050. Of these five countries, Botswana, Swaziland, and Zimbabwe will reduce new infections among boys and men at least two years before they will in girls and young women. Between 2017 and 2050, 9.6 million AY will become newly infected with HIV in SSA, 67% of which will occur among girls and young women.
Conclusions: While the world set a bold target of ending AIDS by 2030, epidemic control is unlikely among AY in SSA. Turning this demographic transition into a dividend will require better access to HIV prevention, sexual and reproductive health, and targeted testing services.