Questions

Ending the HIV Epidemic — Questions

Study questions for Ending the HIV Epidemic.

Mock Exam mode

Sit this set one question at a time. Multiple-choice questions mark themselves; written questions reveal a tickable mark scheme so you can score your own answer. You get a combined score at the end.

20 questions: 20 MCQ, 0 written.

Reaching 95% diagnosed, 95% on antiretroviral therapy (ART) and 95% virally suppressed multiplies out to population-level viral suppression of ~86%, the threshold above which onward transmission collapses.

The 95% and 90% values are individual cascade pillars, ~73% is South African TLD (tenofovir, lamivudine and dolutegravir) coverage, and ~77% is the current South African all-PLHIV suppression figure.

Around 40 million people are living with HIV globally, the headline figure that frames the modern response.

The ~21 million figure is the eastern and southern African subtotal, ~7.8 million is South Africa’s national burden, ~1.3 million is annual new infections, and ~232,000 is South Africa’s yearly incidence.

AGYW incidence fell approximately three-fold between 2017 and 2022, from 1.17% to 0.39%, one of the most substantial population-level prevention successes in the global response.

Option E reverses the direction, and the other options misstate the magnitude of the decline.

The cascade began as 90-90-90 in 2014 and was later upgraded to 95-95-95 when the original 2020 milestone came into view and the 2030 horizon needed a more ambitious anchor.

The other options confuse the cascade with the 2030 mortality goal, a national survey, vertical-transmission elimination and long-acting pre-exposure prophylaxis (PrEP), none of which is its origin.

Global new infections have plateaued at ~1.3 million per year, well above the UNAIDS interim target of 370,000 by 2025, so the world is not yet on track.

The 370,000 figure is the target itself rather than the actual count, ~232,000 is South Africa’s national incidence, and the remaining values are implausible.

South Africa carries the largest single national HIV burden in the world, an estimated ~7.8 million people living with HIV, and runs one of the largest medication programmes on earth.

The ~21 million figure is the eastern and southern African regional total, ~40 million is the global figure, and the smaller values are annual incidence counts.

The operational endpoint is a 90% reduction in new infections and AIDS-related deaths against the 2010 baseline, with continued decline thereafter to sustain the gain.

The other options misstate the reduction, the reference year or the metric; the goal is a threat-elimination target, not zero infections or universal suppression.

Incidence is rising in the Middle East and North Africa, in Latin America and in eastern Europe and central Asia, a marker of the epidemic’s regional heterogeneity.

The other options name regions where incidence is falling or countries that have already reached the 95-95-95 target, not regions of rising incidence.

Approximately 73% of treated adults are on a dolutegravir-containing regimen, and drug-resistance mutations in viraemic samples rose from 27.4% (2017) to 36.2% (2022), predominantly NNRTI (non-nucleoside reverse transcriptase inhibitor)-related.

The resistance is the legacy of the long efavirenz-based first-line era, not integrase or protease mutations, and the other options misstate the coverage, the direction of the trend or the resistance class.

U=U means a person with a sustained viral load below the limit of detection does not transmit HIV sexually, the mechanism behind treatment as prevention at scale.

The other options describe unrelated ideas; undetectable status suppresses transmission but is not a cure, and does not equate to programme-wide testing or coverage.

Lenacapavir showed 100% efficacy in cisgender women in Purpose 1 and 96% efficacy in cisgender men and gender-diverse populations in Purpose 2, the most dramatic single advance in HIV prevention in a decade.

The other options understate these results; the trial figures were near-total protection, not the mid-range or cascade-derived percentages listed.

The Strategy targets 20 million people accessing antiretroviral-based prevention, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) at scale by 2030.

The 40 million figure is the parallel treatment-and-suppression target, while the other values are regional or national burden figures rather than prevention targets.

Translated to all people living with HIV, around 77% are virally suppressed, approaching but not yet at the 86% population threshold.

The ~93% and ~90% figures are individual cascade pillars, ~86% is the target threshold itself, and ~73% is TLD (tenofovir, lamivudine and dolutegravir) coverage.

Estimated annual incidence was ~0.44%, around 232,000 new infections per year, down from ~250,000 in 2017.

The ~0.39% and ~1.17% figures are adolescent-girl-and-young-women incidence at each survey, while 12.7% is national prevalence, not incidence.

SABSSM VI put national HIV prevalence at 12.7%, down from 14.0% in 2017.

The 16.4% and 8.8% figures are the female and male prevalence, and 17.4% and 7.4% are the highest and lowest provincial values, not the national rate.

Prevalence was markedly higher in women, at females 16.4% versus males 8.8%.

Option A reverses the sexes, 12.7% and 14.0% are national figures, and 34.2% and 27.1% are the age-specific peak-prevalence values.

The persistent gap is the first 95, undiagnosed people living with HIV, concentrated in men (85% diagnosed versus 92% in women) and youth aged 15 to 24 (73%).

The second and third targets are effectively achieved, so the gap is at diagnosis, not treatment coverage or suppression, and it centres on men and youth rather than women or older adults.

Provincial prevalence ranged from a high of Mpumalanga 17.4% to a low of Western Cape 7.4%.

KwaZulu-Natal at 16.0% and the Northern Cape at 8.9% sit inside that range, and option C reverses the two extreme provinces.

Triple elimination covers HIV, syphilis and hepatitis B, integrated into a single antenatal and postnatal framework rather than three parallel ones.

The other options swap in tuberculosis, hepatitis C or congenital pathogens that are not part of the triple-elimination package.

MCQ
Achieving all three 95-95-95 targets in sequence delivers what level of population viral suppression?
- A. ~95%
- B. ~73%
- C. ~86%
- D. ~90%
- E. ~77%
Show answer
Correct answer: C
Reaching 95% diagnosed, 95% on antiretroviral therapy (ART) and 95% virally suppressed multiplies out to population-level viral suppression of ~86%, the threshold above which onward transmission collapses.

The 95% and 90% values are individual cascade pillars, ~73% is South African TLD (tenofovir, lamivudine and dolutegravir) coverage, and ~77% is the current South African all-PLHIV suppression figure.
MCQ
Approximately how many people are living with HIV worldwide?
- A. ~40 million
- B. ~21 million
- C. ~7.8 million
- D. ~1.3 million
- E. ~232,000
Show answer
Correct answer: A
Around 40 million people are living with HIV globally, the headline figure that frames the modern response.

The ~21 million figure is the eastern and southern African subtotal, ~7.8 million is South Africa’s national burden, ~1.3 million is annual new infections, and ~232,000 is South Africa’s yearly incidence.
MCQ
How did HIV incidence in South African adolescent girls and young women (AGYW) aged 15 to 24 change between 2017 and 2022?
- A. It fell about two-fold, from 0.88% to 0.44%
- B. It stayed level at roughly 1.17% across both surveys
- C. It fell about ten-fold, from 3.90% to 0.39%
- D. It fell about three-fold, from 1.17% to 0.39%
- E. It rose about three-fold, from 0.39% to 1.17%
Show answer
Correct answer: D
AGYW incidence fell approximately three-fold between 2017 and 2022, from 1.17% to 0.39%, one of the most substantial population-level prevention successes in the global response.

Option E reverses the direction, and the other options misstate the magnitude of the decline.
MCQ
How did the 95-95-95 treatment cascade first originate?
- A. As the 2030 end-of-AIDS target adopted by UNAIDS
- B. As a South African SABSSM survey benchmark set in 2022
- C. As the triple-elimination antenatal framework
- D. As the twice-yearly lenacapavir prevention goal
- E. As 90-90-90, launched in 2014
Show answer
Correct answer: E
The cascade began as 90-90-90 in 2014 and was later upgraded to 95-95-95 when the original 2020 milestone came into view and the 2030 horizon needed a more ambitious anchor.

The other options confuse the cascade with the 2030 mortality goal, a national survey, vertical-transmission elimination and long-acting pre-exposure prophylaxis (PrEP), none of which is its origin.
MCQ
How do current global annual new HIV infections compare with the UNAIDS 2025 interim target?
- A. About 370,000 per year, comfortably meeting the 2025 interim target
- B. About 1.3 million per year, well above the 370,000 target
- C. About 232,000 per year, sitting below the 2025 interim target
- D. About 40 million per year, far above the 2025 interim target
- E. About 90,000 per year, already close to full elimination
Show answer
Correct answer: B
Global new infections have plateaued at ~1.3 million per year, well above the UNAIDS interim target of 370,000 by 2025, so the world is not yet on track.

The 370,000 figure is the target itself rather than the actual count, ~232,000 is South Africa’s national incidence, and the remaining values are implausible.
MCQ
How does South Africa's HIV burden compare globally?
- A. The largest regional burden, at ~21 million
- B. The largest single national burden, at ~7.8 million
- C. A mid-sized national burden, at ~1.3 million
- D. The largest single national burden, at ~40 million
- E. A small national burden, at ~232,000
Show answer
Correct answer: B
South Africa carries the largest single national HIV burden in the world, an estimated ~7.8 million people living with HIV, and runs one of the largest medication programmes on earth.

The ~21 million figure is the eastern and southern African regional total, ~40 million is the global figure, and the smaller values are annual incidence counts.
MCQ
How is "the end of AIDS as a public-health threat by 2030" defined?
- A. A 90% reduction in new infections and AIDS-related deaths versus the 2010 baseline
- B. A 50% reduction in new infections and AIDS-related deaths versus the 2020 baseline
- C. Zero new HIV infections recorded in any single world region by 2030
- D. A 95% reduction in AIDS-related deaths measured against the 2014 baseline
- E. Universal viral suppression achieved across every person living with HIV
Show answer
Correct answer: A
The operational endpoint is a 90% reduction in new infections and AIDS-related deaths against the 2010 baseline, with continued decline thereafter to sustain the gain.

The other options misstate the reduction, the reference year or the metric; the goal is a threat-elimination target, not zero infections or universal suppression.
MCQ
In which regions is HIV incidence rising even as it falls across eastern and southern Africa?
- A. Eastern and southern Africa, western and central Africa, and the wider Horn of Africa
- B. Botswana, Eswatini, Lesotho, Namibia, Rwanda, Zambia and Zimbabwe combined
- C. The Middle East and North Africa, Latin America, and eastern Europe and central Asia
- D. Western Europe, North America, Australasia and the wider Pacific island states
- E. India, Thailand, Vietnam, Cambodia, the Philippines and neighbouring Indonesia
Show answer
Correct answer: C
Incidence is rising in the Middle East and North Africa, in Latin America and in eastern Europe and central Asia, a marker of the epidemic’s regional heterogeneity.

The other options name regions where incidence is falling or countries that have already reached the 95-95-95 target, not regions of rising incidence.
MCQ
What are the current South African TLD (tenofovir, lamivudine and dolutegravir) coverage and transmitted-resistance trends?
- A. ~40% on dolutegravir; resistance fell from 36.2% (2017) to 27.4% (2022), mostly integrase-related
- B. ~90% on dolutegravir; resistance held steady near 30% throughout, mostly protease-related
- C. ~77% on dolutegravir; resistance rose from 12.7% (2017) to 14.0% (2022), mostly nucleoside-related
- D. ~86% on dolutegravir; resistance rose from 27.4% (2017) to 36.2% (2022), mostly integrase-related
- E. ~73% on dolutegravir; resistance rose from 27.4% (2017) to 36.2% (2022), mostly NNRTI-related
Show answer
Correct answer: E
Approximately 73% of treated adults are on a dolutegravir-containing regimen, and drug-resistance mutations in viraemic samples rose from 27.4% (2017) to 36.2% (2022), predominantly NNRTI (non-nucleoside reverse transcriptase inhibitor)-related.

The resistance is the legacy of the long efavirenz-based first-line era, not integrase or protease mutations, and the other options misstate the coverage, the direction of the trend or the resistance class.
MCQ
What does the principle U=U (undetectable equals untransmittable) mean?
- A. Untreated HIV progresses uniformly across all patients
- B. Undetectable virus in blood confirms a person is cured of HIV
- C. Universal testing achieves universal treatment coverage
- D. A sustained undetectable viral load means HIV is not transmitted sexually
- E. Undiagnosed cases contribute unequally to onward transmission
Show answer
Correct answer: D
U=U means a person with a sustained viral load below the limit of detection does not transmit HIV sexually, the mechanism behind treatment as prevention at scale.

The other options describe unrelated ideas; undetectable status suppresses transmission but is not a cure, and does not equate to programme-wide testing or coverage.
MCQ
What efficacy did twice-yearly lenacapavir show in the Purpose pre-exposure prophylaxis (PrEP) trials?
- A. 73% in women (Purpose 1) and 66% in men and gender-diverse people (Purpose 2)
- B. 86% in women (Purpose 1) and 77% in men and gender-diverse people (Purpose 2)
- C. 90% in women (Purpose 1) and 95% in men and gender-diverse people (Purpose 2)
- D. 100% in women (Purpose 1) and 96% in men and gender-diverse people (Purpose 2)
- E. 50% in women (Purpose 1) and 40% in men and gender-diverse people (Purpose 2)
Show answer
Correct answer: D
Lenacapavir showed 100% efficacy in cisgender women in Purpose 1 and 96% efficacy in cisgender men and gender-diverse populations in Purpose 2, the most dramatic single advance in HIV prevention in a decade.

The other options understate these results; the trial figures were near-total protection, not the mid-range or cascade-derived percentages listed.
MCQ
What is the UNAIDS 2026 to 2031 top-line target for antiretroviral-based prevention?
- A. 20 million people accessing antiretroviral-based prevention by 2030
- B. 40 million people accessing antiretroviral-based prevention by 2030
- C. 7.8 million people accessing antiretroviral-based prevention by 2030
- D. 1.3 million people accessing antiretroviral-based prevention by 2030
- E. 21 million people accessing antiretroviral-based prevention by 2030
Show answer
Correct answer: A
The Strategy targets 20 million people accessing antiretroviral-based prevention, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) at scale by 2030.

The 40 million figure is the parallel treatment-and-suppression target, while the other values are regional or national burden figures rather than prevention targets.
MCQ
What share of all people living with HIV is carried by eastern and southern Africa?
- A. Around a fifth, roughly 8 million people
- B. Just over half, roughly 21 million people
- C. Around a tenth, roughly 4 million people
- D. Around a third, roughly 13 million people
- E. Around three quarters, roughly 30 million people
Show answer
Correct answer: B
Eastern and southern Africa carry just over half of the global total, approximately 21 million people living with HIV (PLHIV), and remain the regional epicentre.

The other proportions understate or overstate the regional share; western and central Africa, Asia, the Americas and Europe together make up the remaining half.
MCQ
What share of all South African people living with HIV are virally suppressed?
- A. ~93%, above the 86% threshold
- B. ~90%, at the 86% threshold
- C. ~77%, below the 86% threshold
- D. ~86%, exactly at the threshold
- E. ~73%, below the 86% threshold
Show answer
Correct answer: C
Translated to all people living with HIV, around 77% are virally suppressed, approaching but not yet at the 86% population threshold.

The ~93% and ~90% figures are individual cascade pillars, ~86% is the target threshold itself, and ~73% is TLD (tenofovir, lamivudine and dolutegravir) coverage.
MCQ
What was South Africa's estimated annual HIV incidence in SABSSM VI (the Sixth South African National HIV survey)?
- A. ~12.7%, around 232,000 new infections per year
- B. ~0.39%, around 19,000 new infections per year
- C. ~1.17%, around 72,000 new infections per year
- D. ~7.8%, around 250,000 new infections per year
- E. ~0.44%, around 232,000 new infections per year
Show answer
Correct answer: E
Estimated annual incidence was ~0.44%, around 232,000 new infections per year, down from ~250,000 in 2017.

The ~0.39% and ~1.17% figures are adolescent-girl-and-young-women incidence at each survey, while 12.7% is national prevalence, not incidence.
MCQ
What was the national HIV prevalence in South Africa according to SABSSM VI (the Sixth South African National HIV survey, fieldwork 2022)?
- A. 16.4%, unchanged since 2017
- B. 8.8%, down from 12.7% in 2017
- C. 12.7%, down from 14.0% in 2017
- D. 17.4%, up from 16.0% in 2017
- E. 7.4%, down from 8.9% in 2017
Show answer
Correct answer: C
SABSSM VI put national HIV prevalence at 12.7%, down from 14.0% in 2017.

The 16.4% and 8.8% figures are the female and male prevalence, and 17.4% and 7.4% are the highest and lowest provincial values, not the national rate.
MCQ
What was the sex differential in South African HIV prevalence in SABSSM VI (the Sixth South African National HIV survey)?
- A. Females 8.8% versus males 16.4%
- B. Females 12.7% versus males 14.0%
- C. Females 34.2% versus males 27.1%
- D. Females 16.4% versus males 8.8%
- E. Females 17.4% versus males 7.4%
Show answer
Correct answer: D
Prevalence was markedly higher in women, at females 16.4% versus males 8.8%.

Option A reverses the sexes, 12.7% and 14.0% are national figures, and 34.2% and 27.1% are the age-specific peak-prevalence values.
MCQ
Which 95-95-95 target is South Africa's persistent gap, and in whom is it concentrated?
- A. The third 95 (viral suppression), concentrated in older adults
- B. The first 95 (undiagnosed), concentrated in men and youth
- C. The second 95 (on treatment), concentrated in women
- D. The first 95 (undiagnosed), concentrated in adolescent girls
- E. The third 95 (viral suppression), concentrated in key populations
Show answer
Correct answer: B
The persistent gap is the first 95, undiagnosed people living with HIV, concentrated in men (85% diagnosed versus 92% in women) and youth aged 15 to 24 (73%).

The second and third targets are effectively achieved, so the gap is at diagnosis, not treatment coverage or suppression, and it centres on men and youth rather than women or older adults.
MCQ
Which South African provinces had the highest and lowest HIV prevalence in SABSSM VI (the Sixth South African National HIV survey)?
- A. Highest Mpumalanga 17.4%, lowest Western Cape 7.4%
- B. Highest KwaZulu-Natal 16.0%, lowest Northern Cape 8.9%
- C. Highest Western Cape 17.4%, lowest Mpumalanga 7.4%
- D. Highest Northern Cape 16.0%, lowest KwaZulu-Natal 8.9%
- E. Highest Mpumalanga 12.7%, lowest Western Cape 14.0%
Show answer
Correct answer: A
Provincial prevalence ranged from a high of Mpumalanga 17.4% to a low of Western Cape 7.4%.

KwaZulu-Natal at 16.0% and the Northern Cape at 8.9% sit inside that range, and option C reverses the two extreme provinces.
MCQ
Which three infections does the "triple elimination" of vertical transmission cover?
- A. HIV, tuberculosis and syphilis
- B. HIV, hepatitis B and hepatitis C
- C. HIV, cytomegalovirus and rubella
- D. HIV, syphilis and toxoplasmosis
- E. HIV, syphilis and hepatitis B
Show answer
Correct answer: E
Triple elimination covers HIV, syphilis and hepatitis B, integrated into a single antenatal and postnatal framework rather than three parallel ones.

The other options swap in tuberculosis, hepatitis C or congenital pathogens that are not part of the triple-elimination package.