Recency of HIV infections, viral load suppression, and risky sexual behavior among adults living with HIV and are unaware of their HIV status in 10 African countries

According to UNAIDS fast track targets by 2030, 95% of people living with HIV should be aware of their HIV-positive status, 95% of people who know their status are receiving treatment and 95% of people on HIV treatment have a suppressed viral load so their immune system remains strong, and the likelihood of their infection being passed on is greatly reduced. We aimed to determine the recency of HIV infection, viral load suppression, and engagement in risky sexual behavior among adults newly diagnosed with HIV in Africa. An analysis of data from the HIV Impact Assessment Surveys was conducted in 10 African countries between 2016 to 2019. Each country’s data was analyzed separately using its sampling weights in STATA 16. We included people aged 18 years or older who were not aware of their HIV-positive status. Risky sexual behavior was measured by the number of sexual partners in the past 12 months and condom use. Variables of interest included demographic characteristics, viral load, and recency of HIV infection. A laboratory-based recency determination algorithm (HIV-1 limiting antigen (LAg) avidity + viral load (VL) + antiretroviral (ARV) detection) was used to distinguish recent from long-term infections. Of the 4,835 study participants, majority were not virally suppressed [Overall: 78.7%, 95% CI, 77.4 – 80.0] and majority had long term infection [Overall: 97.5%, 95% CI: 97.1 – 98.0]. Of the participants who had a long-term infection and were non-suppressed, majority did not use condoms during sexual intercourse with their partners [Overall: 82.2%, 95% CI: 78.1 – 86.5]. A high number of people have long-term infections with high viral loads, and have at least one sexual partner with whom they had condomless sex. This is evidence that there is need for innovative ways of identifying PLWHIV who are unaware of their HIV-positive status and initiating them on ART.