The HIV response beyond 2030: preparing for decades of sustained HIV epidemic control in eastern and southern Africa

For countries reaching the UNAIDS 95-95-95 targets, mathematical model projections suggest a further 20% reduction in new HIV infections every 5 years is an ambitious but attainable target to guide prevention strategies.11,12 Where larger care cascade gaps remain, quickly increasing HIV treatment coverage would rapidly reduce population viraemia, enabling steeper HIV incidence declines.13–15 Through a meeting series convened by UNAIDS, the Post-2030 HIV Response Working Group reviewed progress in the HIV response, the evolving nature of the epidemic, how to define long-term epidemic control beyond 2030, and the key programmes, policies, and surveillance required to ensure it is sustained.9,11 Here, we identify four essential priorities to sustain HIV epidemic control in countries in eastern and southern Africa with large HIV epidemics and successful HIV programmes.9 First, effective HIV treatment is the cornerstone of success. [...]HIV prevention approaches need to adapt with evolving individual needs and preferences to ensure continued use of prevention methods at levels that keep HIV infections low. New HIV infections among key populations, including sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people, and people in prisons, are about 9% of all new HIV infections in eastern and southern Africa, but occur at rates four to ten times higher than in all adults.24 Theoretical epidemic dynamics suggest the proportion of HIV infections among key populations could increase as overall infections decline,25 but this rise is not inevitable.26 Services that meet the distinct prevention needs of key populations address health equity and human rights for key populations and ensure long-term epidemic control. [...]ongoing innovation will provide new tools that can support sustaining epidemic control.