The Global HIV/AIDS Epidemic | KFF

Key Details

HIV, the virus that causes AIDS (acquired immunodeficiency syndrome), is without doubt one of the world’s most critical well being and improvement challenges. Roughly 40 million individuals are at present residing with HIV, and tens of hundreds of thousands of individuals have died of AIDS-related causes for the reason that starting of the epidemic.
Many individuals residing with HIV or in danger for HIV an infection shouldn’t have entry to prevention, remedy, and care, and there may be nonetheless no remedy.
In latest many years, main international efforts have been mounted to deal with the epidemic, and regardless of challenges, important progress has been made in addressing HIV. Present international well being targets are to finish AIDS as a public well being risk by 2030.
The U.S. authorities (U.S.), by PEPFAR (the President’s Emergency Plan for AIDS Reduction), is the one largest donor to worldwide HIV efforts on the earth, together with the biggest donor to the International Fund to Combat AIDS, Tuberculosis and Malaria (International Fund). PEPFAR, which now spans over 50 nations, has directed roughly $120 billion towards HIV prevention, care, and remedy efforts because it launched in 2003.

International Response

HIV, the virus that causes AIDS (see field), has grow to be one of many world’s most critical well being and improvement challenges for the reason that first circumstances had been reported in 1981. Roughly 88 million folks have grow to be contaminated with HIV for the reason that begin of the epidemic. At this time, there are roughly 40 million folks at present residing with HIV, and tens of hundreds of thousands of individuals have died of AIDS-related causes for the reason that starting of the epidemic. 

Over the previous 20 years particularly, main international efforts have been mounted to deal with the epidemic, and important progress has been made. The variety of folks newly contaminated with HIV, particularly youngsters, and the variety of AIDS-related deaths have declined through the years, and the variety of folks with HIV receiving remedy elevated to 30.7 million in 2023.

Nonetheless, remaining challenges proceed to complicate HIV management efforts. Many individuals residing with HIV or in danger for HIV an infection shouldn’t have entry to prevention, remedy, and care, and there may be nonetheless no remedy. HIV primarily impacts these of their best years, and it not solely impacts the well being of people, but additionally impacts households, communities, and the event and financial development of countries. Lots of the nations hardest hit by HIV additionally face critical challenges because of different infectious illnesses, meals insecurity, and extra international well being and improvement issues.

Newest Estimates

International prevalence amongst adults (the % of individuals ages 15-49 who’re contaminated) has leveled since 2001 and was 0.8% in 2023, although prevalence was greater for sure teams of individuals, together with girls and women and key populations (i.e., males who’ve intercourse with males, intercourse employees, individuals who inject medication, transgender folks, and other people in prisons).
There have been 40 million folks residing with HIV in 2023, up from 32 million in 2010, the results of persevering with new infections and other people residing longer with HIV. Of the folks residing with HIV in 2023, 38.6 million had been adults and 1.4 million had been youngsters underneath age 15.
Though HIV testing capability has elevated over time, enabling extra folks to study their HIV standing, about one in seven folks with HIV (14%) are nonetheless unaware they’re contaminated.
Whereas there have been important declines in new infections for the reason that mid-Nineteen Nineties, there have been nonetheless about 1.3 million new infections in 2023, or about 3,500 new infections per day. The tempo of decline varies by age group, intercourse, race, and area, and progress is unequal inside and between nations.
HIV stays a number one explanation for dying worldwide and the main explanation for dying globally amongst girls of reproductive age. Nevertheless, AIDS-related deaths have declined, due partly to antiretroviral remedy (ART) scale-up. 630,000 folks died of AIDS in 2023, a 51% lower from 1.3 million in 2010 and a 69% lower from the height of two.0 million in 2004.
Sub-Saharan Africa, dwelling to roughly two-thirds of all folks residing with HIV globally, is the toughest hit area on the earth, adopted by Asia and the Pacific. Latin America, Western and Central Europe and North America, in addition to Japanese Europe and Central Asia are additionally closely affected. In 2023, nevertheless – for the primary time within the historical past of the epidemic – there have been extra new HIV infections outdoors of sub-Saharan Africa than inside the area.

Affected/Susceptible Populations

Most HIV infections are transmitted heterosexually, though danger elements fluctuate. In some nations, males who’ve intercourse with males, individuals who inject medication, intercourse employees, transgender folks, and prisoners are disproportionally affected by HIV.
Girls and women characterize over half (53%) of all folks residing with HIV worldwide, and HIV (together with issues associated to being pregnant) is the main explanation for dying amongst girls of reproductive age. Gender inequalities, differential entry to service, and sexual violence enhance girls’s vulnerability to HIV, and girls, particularly youthful girls, are biologically extra prone to HIV. In lots of nations in sub-Saharan Africa, HIV incidence amongst adolescent women and younger girls ages 15-24 is greater than thrice that amongst adolescent boys and younger males.
Younger folks particularly face boundaries to accessing HIV and sexual and reproductive well being providers, together with age-appropriate complete sexuality schooling. Over a 3rd (36%) of older adolescents, ages 15-19 years, residing with HIV weren’t on remedy in 2023.
Globally, in 2023, youngsters accounted for 1.4 million folks residing with HIV; amongst youngsters, there have been 76,000 AIDS-related deaths and 120,000 new infections, the bottom variety of new infections in youngsters for the reason that Nineteen Eighties. Since 2010, new HIV infections amongst youngsters have declined by 62%.

HIV & TB

HIV has led to a resurgence of tuberculosis (TB), significantly in Africa, and TB is a number one explanation for dying for folks with HIV worldwide. In 2022, roughly 6% of recent TB circumstances occurred in folks residing with HIV. Nevertheless, between 2010 and 2022, TB deaths in folks residing with HIV declined considerably, largely because of the scale-up of joint HIV/TB providers.   (See the KFF reality sheet on TB.)

Prevention and Therapy

Quite a few prevention interventions exist to fight HIV, and new instruments resembling vaccines, are at present being researched.

Efficient prevention methods embrace habits change applications, condoms, HIV testing, blood provide security, hurt discount efforts for injecting drug customers, and male circumcision.
Moreover, latest analysis has proven that engagement in HIV remedy not solely improves particular person well being outcomes but additionally considerably reduces the chance of transmission (known as “remedy as prevention” or TasP). These with undetectable viral masses (often known as being virally suppressed) have successfully no danger of transmitting HIV sexually.
Pre-exposure prophylaxis (PrEP) has additionally been proven to be an efficient HIV prevention technique in people at excessive danger for HIV an infection. In 2015, the World Well being Group (WHO) really helpful PrEP as a type of prevention for high-risk people together with different prevention strategies. Additional, in 2016, the U.N. Political Declaration on HIV/AIDS acknowledged PrEP analysis and improvement must be accelerated, and in 2022, WHO launched new tips for the usage of long-acting PrEP.
Specialists advocate that prevention be primarily based on “figuring out your epidemic” (tailoring prevention to the native context and epidemiology), utilizing a mixture of prevention methods, bringing applications to scale, and sustaining efforts over time. Entry to prevention, nevertheless, stays unequal, and there have been renewed requires the strengthening of prevention efforts.

HIV remedy contains the usage of mixture antiretroviral remedy (ART) to assault the virus itself, and medicines to stop and deal with the various opportunistic infections that may happen when the immune system is compromised by HIV. In mild of analysis findings, WHO launched a suggestion in 2015 recommending beginning HIV remedy earlier in the midst of sickness. Additional, analysis on long-acting ART is at present underway.

Mixture ART, first launched in 1996, has led to dramatic reductions in morbidity and mortality, and entry has elevated lately, rising to 30.7 million folks (77% of individuals residing with HIV) in 2023.
The proportion of pregnant and breastfeeding girls receiving ART for the prevention of mother-to-child transmission of HIV elevated to 84% in 2023, up from 49% in 2010.
Whereas entry to ART amongst youngsters has elevated, remedy gaps nonetheless stay, and youngsters are much less seemingly than adults to obtain ART; remedy protection in youngsters was 57% in comparison with 77% amongst adults in 2023.
Roughly 72% of all folks residing with HIV are virally suppressed, which implies they’re seemingly more healthy and fewer prone to transmit the virus. Viral suppression varies vastly by area, key inhabitants, age, and intercourse.

International Targets

Worldwide efforts to fight HIV started within the first decade of the epidemic with the creation of the WHO’s International Programme on AIDS in 1987. Over time, new initiatives and financing mechanisms have helped enhance consideration to HIV and contributed to efforts to attain international targets; these embrace:

the Joint United Nations Programme on HIV/AIDS (UNAIDS), which was fashioned in 1996 to function the U.N. system’s coordinating physique and to assist impress worldwide consideration to HIV/AIDS; and
the International Fund to Combat AIDS, Tuberculosis and Malaria (International Fund), which was established in 2001 by a U.N. Normal Meeting Particular Session (UNGASS) on HIV/AIDS as an unbiased, worldwide financing establishment that gives grants to nations to deal with HIV, TB, and malaria (see the KFF reality sheet on the International Fund).

The contributions of affected nation governments and civil society have additionally been essential to the response. These and different efforts work towards attaining main international HIV/AIDS targets which have been set by:

the Sustainable Improvement Targets (SDGs). Adopted in 2015, the SDGs goal to “finish the AIDS epidemic,” or finish AIDS as a public well being risk, by 2030 underneath SDG Aim 3, which is to “guarantee wholesome lives and promote well-being for all in any respect ages.”
UNAIDS targets to finish the epidemic by 2030. On World AIDS Day 2014, UNAIDS set targets aimed toward ending the AIDS epidemic by 2030. To realize this, nations are working towards reaching the interim “95-95-95” targets—95% of individuals residing with HIV figuring out their HIV standing; 95% of people that know their HIV constructive standing on remedy; and 95% of individuals on remedy with suppressed viral masses—by 2025. These targets are successors to the sooner 90-90-90 targets for 2020, which had been missed. Primarily based on the 2023 information and developments (the newest information obtainable), 86% of individuals residing with HIV knew their standing; amongst those that knew their standing, 89% had been accessing remedy; and amongst these accessing remedy, 93% had been virally suppressed. Further interim “95-95-95” targets have additionally been set for 2025, which place a better emphasis on social providers and decreasing stigma and discrimination to deal with inequalities that hinder the HIV response.

Over the previous decade, world leaders reaffirmed commitments to finish AIDS by 2030 and adopted a Political Declaration with international commitments and targets for 2025 to deal with inequalities that impede the AIDS response.

International Assets

UNAIDS estimates that $22.1 billion was obtainable from all sources (home, donor governments, multilaterals, and foundations) to deal with HIV in low- and middle-income nations in 2023. Of this, donor governments offered $7.9 billion (see Determine 1). Different governments and organizations that contribute considerably to funding the worldwide response embrace:

 hard-hit nations, which have additionally offered assets to deal with their epidemics;
the International Fund, which has accredited over $27 billion for HIV efforts in additional than 100 nations to this point; and
the personal sector, together with foundations and firms, which additionally performs a serious position (the Gates Basis, for one, has dedicated greater than $3 billion in HIV grants to organizations addressing the epidemic, in addition to offered further funding to the International Fund).

Trying forward, UNAIDS estimates at the least $29.3 billion yearly might be wanted by 2025 to satisfy international targets to finish AIDS as a worldwide public well being risk by 2030.

U.S. Authorities Efforts

The U.S. authorities (U.S.) has been concerned in HIV efforts for the reason that Nineteen Eighties and, immediately, is the one largest donor to worldwide HIV efforts on the earth, together with the biggest donor to the International Fund. The U.S. first offered funding to deal with the worldwide HIV epidemic in 1986. U.S. efforts and funding elevated slowly over time by focused initiatives to deal with HIV in sure nations in Africa, South Asia, and the Caribbean, however they intensified with the 2003 launch of the President’s Emergency Plan for AIDS Reduction (PEPFAR), which introduced important new consideration and funding to deal with the worldwide HIV epidemic, in addition to TB and malaria.

PEPFAR

Created in 2003, PEPFAR is the U.S. authorities’s international effort to fight HIV. As an interagency initiative, PEPFAR includes a number of U.S. departments, companies, and applications that tackle the worldwide epidemic, and it’s carried out in shut coordination with host nation governments and different organizations, together with multilateral organizations such because the International Fund and UNAIDS. Collectively, U.S. bilateral actions span greater than 50 nations, together with nations reached by regional applications in Asia, West Africa, and the Western Hemisphere, with U.S. assist for multilateral efforts reaching further nations. (For extra data, see the KFF reality sheet on PEPFAR.)

Since its creation, PEPFAR funding, which incorporates all bilateral funding for HIV in addition to U.S. contributions to the International Fund and UNAIDS, has totaled roughly $120 billion. For FY 2024, Congress appropriated $4.8 billion for bilateral HIV, in addition to $50 million for UNAIDS and $1.65 billion for the International Fund, totaling $6.5 billion. (For extra particulars on historic appropriations for U.S. international HIV/AIDS efforts, see the KFF reality sheets on the U.S. International Well being Price range: International HIV, Together with PEPFAR and the U.S. International Well being Price range: The International Fund, in addition to the KFF price range tracker.)