Over the past decade, there has been a massive scale-up of primary and secondary prevention services to reduce the population-wide incidence of HIV. However, the impact of these services on HIV incidence has not been demonstrated using a prospectively followed, population-based cohort from South Africa—the country with the world’s highest rate of new infections. To quantify HIV incidence trends in a hyperendemic population, we tested a cohort of 22,239 uninfected participants over 92,877 person-years of observation. We report a 43% decline in the overall incidence rate between 2012 and 2017, from 4.0 to 2.3 seroconversion events per 100 person-years. Men experienced an earlier and larger incidence decline than women (59% vs. 37% reduction), which is consistent with male circumcision scale-up and higher levels of female antiretroviral therapy coverage. Additional efforts are needed to get more men onto consistent, suppressive treatment so that new HIV infections can be reduced among women.


University of Lincoln, College of Social Science Research

Alain Vandormael, University of KwaZulu-Natal, Africa Health Research Institute (AHRI), College of Health Sciences, School of Nursing and Public Health and University of Heidelberg, Heidelberg Institute for Global Health (HIGH)

Adam Akullian, University of Washington, Department of Global Health and Institute for Disease Modeling

Mark Siedner, University of KwaZulu-Natal, Africa Health Research Institute (AHRI) and Massachusetts General Hospital, Division of Infectious Diseases, Department of Medicine and Harvard Medical School

Tulio de Oliveira, KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences and University of Washington, Department of Global Health and Centre for the AIDS Programme of Research in South Africa (CAPRISA)

Till Barnghausen, University of KwaZulu-Natal, Africa Health Research Institute (AHRI) and University of Heidelberg and Heidelberg Institute for Global Health (HIGH) and Harvard T.H. Chan School of Public Health, Department of Global Health and Population

Frank Tanser, University of KwaZulu-Natal, Africa Health Research Institute (AHRI), School of Nursing and Public Health  and Centre for the AIDS Programme of Research in South Africa (CAPRISA) and University of Lincoln, Lincoln Institute for Health