Abstract
While great progress has been made in the control and management of the HIV epidemic there is still much to be done. Using trends in the rate of new HIV infections in eastern and southern Africa we assess the current state of the epidemic and evaluate the future prospects for controlling it. If we let an incidence of 1 per 1,000 people represent a control threshold then this has been reached, or will probably be reached by 2020, in eastern Africa and is reachable by 2020 in those southern African countries that do not have particularly strong social and economic ties to South Africa if they continue to scale up their treatment programmes. In South Africa and its immediate neighbours Lesotho, Mozambique and Swaziland, the prospects are less certain. These countries are unlikely to reach the control threshold by 2020 but with sufficient political will and commitment to ‘treatment for all’ could do so by 2030.
There are two important caveats. First, reaching the control threshold still leaves 35 thousand new infections a year. As the lessons of polio remind us, finding the last few, hard to reach cases will demand more focussed strategies. Second, ending AIDS will not end HIV and about 35 million people will have to be kept on ART for the next 30 to 40 years unless and until a cure is discovered. Even if we assume a modest cost of, say, US$100 per person per year for ART treatment and support, this corresponds to a continuing financial commitment of US$3.5 Bn per year although this is substantially less than the approximately US$ 40 Bn per year currently committed to HIV and AIDS.
