These 6 maps reveal why distance is such a crucial factor in tackling HIV in Africa

Imagine having the human immunodeficiency virus (HIV) and needing to take an hour’s car journey for your treatment. That’s the current reality for many patients living with HIV in rural Africa.

Researchers from the University of Cincinnati created maps of sub-Saharan Africa identifying populations living within a 10, 30 and 60 minute walk or drive of a healthcare centre. They found that 1.5 million people living with HIV live more than an hour’s drive from the nearest health facility offering HIV treatment.

As governments scramble to divert healthcare resources to tackle the pandemic, challenges for people living with HIV in rural parts of Africa are growing at a time when the world was seeing robust improvements to HIV infection rates and a steady decline in deaths. In 2020, around 680,000 people died from AIDS-related illnesses worldwide, compared to 1.9 million people in 2004, according to UN AIDS. Furthermore, new HIV infections have been reduced by 52% since the peak in 1997.

To continue the fight in times of disruption, expanding access to healthcare in underserved communities in sub-Saharan Africa is key to improving the response to HIV, the Cincinnati researchers stressed.

Published in the journal PLOS Global Public Health, the maps reveal that across the 17 countries identified, about half of the population with HIV live in places with limited access to healthcare. People living in more than 90% of Sudan and Mauritania drive more than an hour for treatment.

Furthermore, 42% of HIV-positive patients aged 15 and older in Western and Central Africa are not receiving the latest anti-retroviral therapy. This figure is 28% in Eastern and Southern Africa.

“A large number of people living with HIV in Africa are lacking treatment and care, particularly the latest antiretroviral therapy, due to limited health-related resources,” says Hana Kim, a doctoral student in UC’s College of Arts and Sciences and lead author of the study.

Kim noted that transportation in rural Africa is not readily available and that storm damage can cause disruptions on roads and bridges. However, she says some rural communities are filling this void with mobile health. “This strategy has already worked in some countries in Africa such as Malawi and South Africa,” she adds.

Having access to a nearby healthcare facility is an important measure of HIV treatment success, says co-author Diego Cuadros, an assistant professor and director of UC’s Health Geography and Disease Modeling Lab. “Viral suppression is very important because these HIV-positive individuals with viral suppression are healthy individuals that also are not infectious and thus do not transmit the disease.”

Recently, the Executive Director of UN AIDS warned of a rise in HIV infections in West and Central Africa, related to the pandemic, due to stretched healthcare systems.

It’s a point echoed by the researchers from the University of Cincinnati, who stress that people living with HIV are at a higher risk of COVID-19 infection and that having a weakened immune system, coupled with a struggle to access healthcare systems, means they suffer more acute symptoms than the general population.

“It is expected that health outcomes linked to HIV have worsened during this past year in Africa,” Cuadros adds.

Furthermore, HIV drug resistance is on the rise, according to a recent World Health Organization report.

To tackle global health issues, the World Economic Forum launched the Coalition for Epidemic Preparedness Innovations (CEPI), which brings together experts from government, business, health, academia and civil society to speed up the development of vaccines against emerging infectious diseases. The coalition also aims to provide access to these vaccines during outbreaks.