In recent years, considerable progress has been made in eastern and southern Africa to reduce the number of new HIV infections, which decreased by 21% between 2010 and 2014. The region has also made a significant contribution to achieving the global target of having 15 million people on life-saving antiretroviral medicines by the end of 2015, which was met nine months ahead of schedule in March this year. Despite these advances, however, the region still accounts for over half of all new HIV infections worldwide.

New HIV infections among young women and girls aged between 15 and 24 are especially high, with 3700 new HIV infections per week among young women and adolescent girls across eastern and southern Africa. New HIV infections occur five to seven years earlier in young women and adolescent girls compared with young men and boys of the same age. This means that sexual partners of young women and adolescent girls—who are often much older—are themselves a priority population for HIV prevention and treatment programmes.

Another challenge for the region is reaching key populations at higher risk of HIV infection, such as men who have sex with men, people who use drugs and sex workers. These groups are often marginalized due to legal barriers to accessing services or because of stigma and discrimination. In addition, a lack of strategic information or insufficient resources leads to many high impact HIV prevention programmes not being implemented to the necessary standard or scale.            

At a recent meeting in Johannesburg, South Africa, experts from UNAIDS, the United Nations Population Fund (UNFPA) and the World Bank came together to discuss these challenges. Participants agreed that the way forward included customizing UNAIDS global Fast-Track targets to the regional level and re-positioning HIV prevention strategies based on existing evidence.

UNAIDS Fast-Track targets for 2020 include 90% of people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status on antiretroviral treatment and 90% of people on treatment with suppressed viral loads, keeping them healthy and reducing the risk of HIV transmission. Other targets include reducing the number of new HIV infections to fewer than 500 000 and reaching zero discrimination.

Those taking part in the Johannesburg meeting also concluded that upcoming forums such as ICASA 2015 (International Conference on AIDS and STIs in Africa) and the 21^st International AIDS Conference 2016 in Durban, South Africa, will be crucial in persuading the international community to invest sufficient resources in HIV prevention programmes.