Young bikers join the campaign to promote condom use in Uganda.
UNFPA contributes directly to the global fight against AIDS. Our approach is shaped by our focus on reducing poverty, eliminating gender inequality and ensuring that everybody has access to sexual and reproductive health.
As a co-sponsor of UNAIDS ( United Nations Programme on HIV and AIDS) , we focus on HIV prevention among young people, women and marginalized groups, including sex workers. We support comprehensive programming for male and female condoms. We advocate for the linking and integration of sexual and reproductive health and HIV policies, programmes and services.
We aim to make sure that family planning and maternal health services meet the needs of women living with HIV. This includes interventions to prevent mother-to-child transmission and support for confidential voluntary HIV testing and counselling.
HIV and AIDS is declining in Africa
Thirty years since the emergence of AIDS (Acquired Immuno Deficiency Syndrome) in the early Eighties, there are encouraging signs that the global response to the epidemic has altered its course. The incidence of HIV (Human Immuno-deficiency Virus) is on the decline worldwide. In 22 of the most affected countries in sub-Saharan Africa, the region hardest hit by AIDS, new HIV infections were reduced by 25 per cent in 2010.
The current situation in sub-Saharan Africa
However, progress is uneven and new HIV infections continue at a rate of about 7000 per day. Of 2.6 million new HIV infections in 2010, 70 per cent was recorded in sub-Saharan Africa.  Of these new HIV infections, 83 per cent occur among the population of reproductive age (15 years and older) and 17 per cent among children 0-14 years of age. Heterosexual intercourse is by far the main method of transmission (80 to 95 per cent of all new infections among people above 15 years of age in Africa  ). Transmission from mother to child is the main source of HIV infections among children.
For every person living with HIV and beginning treatment, two more people become infected with HIV. For those most at risk of becoming infected, such as sex workers, men who have sex with men and transgendered people, access to prevention, treatment and care services remains low.
Youth, adolescents and women hardest hit
Demonstrating the use of female condoms.
Legal and cultural barriers often deny adolescents and young people access to information, services and condoms. Young people account for some 40 per cent of all new infections. AIDS remains a leading cause of death in women of reproductive age globally and is a major cause of maternal mortality.
Women and men are both highly affected by the epidemic but women account for nearly 60 per cent of Persons Living with HIV (PLHIV).  This is due to a combination of factors, including patterns of sexual networks and a higher death rate among HIV-positive men, who are therefore missing in the PLHIV prevalence data.
How HIV is transmitted in the region
The transmission of HIV is affected by social and gender norms, including multiple partnerships, age-disparate sexual relations (e.g. young women with much older partners) and related concepts of masculinity. Women’s ability to negotiate condom use and mutually monogamous relations is affected by the power dynamics of the relationships. While women report lower condom use than men, the use of other HIV services including testing and ART is lower among men. HIV services for key affected groups like sex workers and men who have sex with men is limited in most African countries  . HIV prevalence is also higher in some settings with high mobility, migration and spousal separation, while countries and sub-national areas with high levels of male circumcision have lower HIV prevalence.
East and Southern Africa the worst off
The sub-region that is hardest hit globally is East and Southern Africa, which had 47 per cent of the world’s new HIV infections in 2010  . I n 9 of the 20 countries, HIV prevalence among adults is above 10 per cent and over 15 per cent in 4 of them. Each day, 3,500 people are newly infected with HIV and 2,400 die of AIDS.HIV is widely spread in the general population and the main way it is transmitted is through heterosexual sexual relationships, including multiple concurrent partners and age-disparate relationships (such as young women with much older partners ), within long-term sero-discordant partnerships (only one partner is infected) and through paid sex, including other forms of transactional sex.
Fewer people affected in West and Central Africa
In West and Central Africa HIV prevalence ranges between 0.7 per cent in Mauritania and 5.3 per cent in Cameroon. Three countries have an HIV prevalence below 1 per cent, nine countries between 1 and 3 per cent and nine countries above 3 per cent. In most countries, the general population is affected, but some sub-sectors such as female sex workers and their clients face a far higher risk.
HIV incidence on the decline
A number of countries in sub-Saharan Africa have shown a decline in HIV prevalence in young people, which can be taken as a general reduction in HIV incidence.  Data from some countries suggests this is due to behaviour change, especially fewer sexual partners and increases in condom use.
However, as it is difficult to evaluate the effectiveness of interventions targeting people’s behaviour, there is a need to combine behavioural and biomedical interventions. A number of new biomedical prevention options are now available, including male circumcision (which reduces female-to-male transmission by 60 per cent) and ART as prevention (reducing linked HIV infections in discordant couples by 96 per cent). These interventions involve behaviour when it comes to people taking them up and adhering to them.
New vision of getting to zero
Phakama (Rise/Stand Up), a theatre troupe in Seshego township near Pietersburg, South Africa, uses theatre to educate its audiences about HIV/AIDS. UN Photo / Louise Gubb
The vision of the United Nations Programme on HIV and AIDS (UNAIDS) is: Zero new infections. Zero discrimination. Zero AIDS-related deaths.
Within UNAIDS, UNFPA is a partner in 10 of the 15 designated areas for action and is a co-convener in 4 of those 10 areas:
- Reduce sexual transmission of HIV;
- Empower men who have sex with men, sex workers and transgendered people to protect themselves from HIV infection and to fully access antiretroviral therapy;
- Meet the HIV needs of women and girls and stop sexual and gender-based violence;
- Empower young people to protect themselves from HIV.
To be effective in sub-Saharan Africa, the response to HIV needs to be evidence-based, bold, gendered and tailored to country-level epidemics. It must target populations including women, men, young people and key affected populations.
What remains to be done to reduce HIV?
Although most countries in the region have taken steps to expand access to HIV prevention methods, substantial gaps remain. While a small number of countries have achieved a relatively high level of condom use with non-regular and multiple partners, condom use remains below 50 per cent in the majority of countries and is consistently reported to be lower among women. 
Although HIV testing is increasingly available, the volume of couples getting tested and the level of disclosure of HIV status among sero-discordant couples is still inadequate.
Although the success of male circumcision in reducing HIV infection has been proved, and although it is estimated that 4 million HIV infections could be averted through male circumcision  , in high-prevalence countries less than 10 per cent of the circumcision target has been achieved.
Although virtually all countries have implemented some behaviour prevention interventions and youth programmes, this remains low in many countries due to fragmentation and implementation models that could not be scaled up, or due to a lack of resources.
What is UNFPA doing about HIV and AIDS in the region?
UNFPA Country Offices support a broad range of HIV prevention projects and programmes.
At the regional level, UNFPA supports countries with integrating HIV and sexual and reproductive health (SRH) programmes to improve the fight against the disease. It has also helped develop a sub-regional strategy for ridding the region of vertical transmission of HIV (from mother to child) and securing resources for the Global Fund.
UNFPA has assisted with studies on condom quality control in countries and on key factors underlying the reduction of HIV transmission among youth.
As Africa is the region with the most severe HIV epidemics, which are mostly due to sexual transmission, UNFPA is helping countries to scale up effective programmes to reduce the sexual transmission of HIV. We will continue to support HIV-linked programmes that aim to reduce transmission from mother to child, reduce the unmet need for family planning and reduce maternal deaths.
We also work in many contexts, including humanitarian and post-conflict situations, towards the elimination of gender-based violence and prevention of HIV.
- Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations
- Global Guidance Briefs on HIV and Young People
- Rapid Assessment Tool for Sexual & Reproductive Health and HIV Linkages
Other focus areas
 UNAIDS, 2010: Report on the Global AIDS Epidemic 2010. Annex 1. Figures for Ethiopia added as they were not included in the UNAIDS report.
 According to a series of Modes of Transmission studies carried out by UNAIDS/World Bank.
 UNAIDS, 2010: Report on the Global AIDS Epidemic 2010.
 UNAIDS, 2011: Securing the future. Synthesis of Strategic Information on HIV and Young People.
 This and the following percentages and figures are based on UNAIDS: Report on the Global AIDS Epidemic 2010.
 UNAIDS (2010): Young People Are Leading the Prevention Revolution.
 UNAIDS, 2011: Securing the future. Synthesis of Strategic Information on HIV and Young People.
 USAID (2010): The Potential Cost and Impact of Expanding Male Circumcision in 14 African Countries.