In which region is the Human Immunodeficiency Virus (HIV) currently most prevalent?

HIV is Most Prevalent in Sub-Saharan Africa

Sub-Saharan Africa carries the overwhelming burden of the global HIV pandemic, accounting for approximately 67.5% of all people living with HIV worldwide. 1

Global Distribution of HIV

Sub-Saharan Africa: The Epicenter

• Sub-Saharan Africa is home to more than 70% of the global HIV burden, despite representing only a fraction of the world's population 2
• The region accounted for 75% of AIDS-related deaths globally in 2007, demonstrating not only high prevalence but also significant mortality impact 1
• As of 2012, 25 million people (71% of global HIV infections) were living with HIV in sub-Saharan Africa 3
• Over 65% of all HIV-1 infected individuals worldwide reside in sub-Saharan Africa, making it the clear focal point for any global HIV control efforts 4

Regional Variations Within Sub-Saharan Africa

The epidemic is not uniformly distributed across the continent:

• East and South Africa bear the heaviest burden, with some countries recording adult HIV prevalence rates of 20-50% 5
• South Africa alone accounts for 31% of HIV/AIDS deaths in sub-Saharan Africa, making it the epicenter within the epicenter 3
• West Africa is comparatively less affected, while Central African countries have relatively stable infection rates 5

Disproportionate Impact on Vulnerable Populations

Women and Girls

• Women represent nearly 60% of HIV infections in sub-Saharan Africa, where transmission occurs primarily through heterosexual contact 1
• Young women aged 15-24 years have up to eight-fold higher HIV infection rates compared to their male peers in the region 2
• In 2020, young women and adolescent girls accounted for 63% of all new HIV infections in sub-Saharan Africa 1

Children

• Nearly 90% of the 2 million children under 15 years living with HIV worldwide are in sub-Saharan Africa 1
• The region contributed more than 90% of childhood HIV-related deaths globally 5
• Approximately 90% of the 270,000 AIDS deaths among children in 2007 occurred in Africa 1

Clinical Implications

The concentration of HIV in sub-Saharan Africa creates unique challenges including limited access to antiretroviral therapy (only 36% of HIV-positive patients in South Africa have access to treatment), predominance of non-B HIV-1 subtypes (particularly subtype C) that may respond differently to standard antiretrovirals, and co-infections with tuberculosis and hepatitis C that drive chronic inflammation and complicate management 1, 3

Key Pitfall to Avoid

Do not assume HIV epidemiology or treatment responses observed in North American or European populations (predominantly subtype B) will directly translate to sub-Saharan African contexts, where subtype C predominates and socioeconomic factors significantly impact disease progression and treatment access 3