HIV response reaches “critical moment” in the path to ending AIDS

UNAIDS has used its annual global update to urge leaders to boost resources for the HIV response and do more to protect human rights, warning that the “fate of millions of lives is in their hands”.

What is the report about?

Every year, the UNAIDS Global AIDS Update gives an overview of the HIV pandemic. It also reports on the progress being made to end AIDS as a public health threat by 2030. The 2024 report The Urgency of Now: AIDS at a Crossroads is based on 2023 data.

Why is this report important?

It is essential to keep track of what is happening on HIV globally, regionally and nationally. This helps individual governments and the international community understand where progress is being made and where gaps remain. It also highlights any changes that are happening, including where HIV infections may be rising and which groups of people are most at risk.

What does it say?

In 2023, 39.9 million people were living with HIV. Of these:

• 86% knew their HIV status 
• 77% (30.7 million people) were on antiretroviral treatment (ART)
• 72% were virally suppressed
• 1.3 million people got HIV in 2023
• 630,000 people died from an AIDS-related illness. 

The good news

The 95–95–95 targets, which need to be met by 2025, are within reach. In 2023, 86% of people with HIV worldwide knew their HIV status. Of these people, 89% were on ART and 93% were virally suppressed. Some of the most significant progress on testing and treatment has been made in East and Southern Africa.

Around 1 million people began ART in the last year. This means around three out of four people with HIV are now on treatment.

Far fewer children (ages 0-14) are getting HIV than ever before. This is largely due to successes in Eastern and Southern Africa, where the annual number of HIV infections among children has fallen by 73% between 2010 and 2023.

Around 35 million voluntary medical male circumcisions (VMMC) have now taken place in 15 Eastern and Southern Africa countries. This has prevented around 670,000 people from getting HIV between 2008 and 2022.

More countries are adopting national health strategies that integrate HIV services into other services, such as sexual and reproductive health services. In 2023, 39 countries were taking integrated approaches; 7 more than in 2022. Sixty countries have adopted universal health coverage schemes, of which 38 include ART and 21 include PrEP. These changes are helping more people access HIV prevention and treatment than ever before.

The bad news

Around 9.3 million people with HIV are still not on ART. As a result, the world is unlikely to meet the 2025 target to reduce AIDS-related deaths to below 250,000.

People from groups that are most at risk of HIV (sometimes referred to as ‘key populations’) are most likely to miss out on treatment. This includes gay men and other men who have sex with men, transgender women, sex workers and people who inject drugs.

Children and adolescents are also struggling to access treatment. More than one third (36%) of older adolescents (ages 15-19) with HIV were not on ART in 2023.

Around 1.8 million people have advanced HIV disease (AIDS). Progression to AIDS is now most likely to happen as a result of people stopping HIV treatment, rather than being diagnosed too late.

Another target is to ensure no more than 370,000 people get HIV in 2025. But in 2023 new infections were more than three times higher than this. In the Middle East and North Africa, Latin America, Eastern Europe and Central Asia infections are rising.

At least half of all people from key populations still can’t access HIV prevention services.

Infection rates among adolescent girls and young women in parts of Eastern, Southern, Central and Western Africa are still very high. But there are not enough HIV prevention programmes for adolescent girls and young women in the communities where they are needed.

Global drug patents are stopping PrEP from being widely available in the countries that need it the most.

The 2025 targets to reduce stigma, discrimination, social inequalities and gender-based violence will not be reached. Among countries with recent data, almost half (47%) of people still hold discriminatory attitudes towards people with HIV.

Funding for the HIV response is continuing to shrink. There is an annual funding gap of US$ 9.5 billion.

Domestic resources fund 59% of the HIV response in low- and middle-income countries. But domestic HIV budgets fell for the fourth year in a row in 2023. This is because many countries are saddled with unsustainable debt.

What does this mean for HIV services?

HIV prevention and treatment services need to reach the people who need them the most. This report provides further evidence of how essential it is to reach adolescent girls and young women, children and people from key populations.

It shows the need to push for reinvigorated condom programmes, the expansion of VMMC, and widened access to PrEP, particularly as new PrEP products such as twice-yearly PrEP injections become available.

It also shows how important it is to do more to tackle stigma and discrimination, including the criminalisation of key populations. Until groups most at risk of HIV feel safe and confident to get the HIV services they need, HIV infections will continue.

The fact that AIDS is now most common among people who have stopped treatment shows how important adherence support is. Be in the KNOW has lots of shareable advice that can help young people with HIV stay on ART. Stigma and discrimination is one of the biggest reasons young people drop out of care – as this blog on adolescent girls with HIV in Uganda shows.

Advocating for more resources for the HIV response is vital. With so many competing needs for limited resources, this can be a hard ask. But the report shows that financing the HIV response now so that it is integrated with other services will save money in the future. This will also help countries make progress on many Sustainable Development Goals and be better prepared for future pandemics.

In the report’s foreword, Winnie Byanyima, UNAIDS Executive Director, writes: “The path that ends AIDS is not a mystery. It is a political and financial choice. Some are reluctant to provide the scale of resourcing needed for ending AIDS. But, as the report demonstrates, the costs of not ending AIDS would be exponentially higher.

“Some might like to walk away from the HIV response because the end is now in reach. But, as this report sets out, we cannot partly end a pandemic. Leaders can end AIDS as a public health threat only by overcoming it everywhere, for everyone.”