An estimated 1.3 million people became infected with HIV in 2023, three times more than the target of fewer than 370 000 by 2025. While there has been marked progress in sub-Saharan Africa, for the first time, in 2023 more than half of the new HIV infections occurred outside of sub-Saharan Africa.
Rising new HIV infections are evident in several countries, particularly in countries where key populations including men who have sex with men, sex workers, transgender people and people who use drugs, are most affected, and investment in prevention was lower. Key populations and their sexual partners now represent the majority (55%) of new HIV infections globally, up from 44% to 2010.
The Global HIV Prevention Coalition (GBC), established in 2017, is addressing the HIV prevention crisis. Focusing on 40 countries the GPC, a coalition of United Nations Member States and partners including UNAIDS, donors, civil society and private sector organizations, is working to strengthen and sustain political commitment for HIV prevention.
"The HIV epidemic has evolved - now more than ever, we need resilient capacity to deliver and manage integrated, differentiated and equitable HIV prevention interventions," said Prof. Sheila Tlou, GPC Co-chair and Former Minister of Health, Botswana.
There has been great variation in progress among GPC member countries; the biggest declines occurred in countries within eastern and southern Africa including Kenya, Malawi and Zimbabwe, where new HIV infections were reduced by more than 66% and which are on track to achieve the global target of 90% reduction by 2030 - and, to a lesser extent, in western and central Africa. Expansion of access to effective HIV treatment, combined with an ongoing focus on primary prevention, are driving those achievements.
"The moment of opportunity for HIV prevention is now," said Angeli Achrekar, UNAIDS Deputy Executive Director for Programmes. "Today, we have a wider range of prevention options including new long-acting antiretroviral prevention-with the new results about lenacapavir-a twice yearly injection to prevent HIV-providing a promising game-changing option-and new opportunities to communicate about HIV prevention and health."
Long-acting technologies like pre-exposure prophylaxis (PrEP) will play a major role in preventing new infections in the coming years. Access is increasing, but only in a few countries. Around 3.5 million people were accessing PrEP (antiretroviral medicine which prevents HIV) in 2023 up from just 200 000 in 2017, but this remains far short of the 10 million target set for 2025.
New HIV prevention products in the pipeline such as long-acting injectable cabotegravir (CAB-LA) and most recently, lenacapavir, are raising expectations due to their combination of convenience and high efficacy. However, the key is accessibility and affordability. The cost of the new long-acting injectable PrEP options, and the speed with which they are made available to potential users in the countries with the most need will be critical in expanding access to these life-saving technologies.
Persistent gaps remain in HIV prevention coverage (only 61% of areas with high incidence of HIV have programmes for young women, less than half of sex workers, and only about a third of gay men and other men who have sex with men and people who inject drugs regularly access prevention in GPC focus countries).
Condoms remain the most effective low-cost HIV prevention tool, however global condom procurement or distribution in low- and middle-income countries declined by an average of 27% between 2010 and 2022 and procurement by major donors fell by an average 32% in that period. Socially marketed distribution declined from a peak of about 3.5 billion condoms in 2011 to about 1.8 billion in 2022.
Condoms, PrEP, post exposure prophylaxis, antiretroviral therapy to ensure viral suppression thus preventing transmission of the virus, harm reduction and voluntary medical male circumcision are all HIV prevention options that should be real choices available for people at risk of HIV infection. Addressing structural and gender inequalities faced by these priority and key populations is essential in ensuring access to prevention services. The urgency to secure and sustain gains for HIV prevention cannot be overemphasized - programmes need to be community-led and country-led.
"No matter how good the science or community leadership, HIV will not end unless we have significant policy change to reverse criminalization and lessen stigmatization of affected populations. If we can't protect human rights, then we can't end HIV. This is never just about the virus-it's about people, and the people must lead," said Mitchell Warren, GPC co-chair and Executive Director, AVAC.
An enormous unmet need for resources for HIV prevention and societal enabler programmes in almost all regions persists. An estimated US$ 2.4 billion was available for primary prevention programmes in low- and middle-income countries in 2023 compared to the estimated need of USD 9.5 billion in 2025. Investing in HIV prevention now is essential to scale up programmes.
If 1.3 million people continue to acquire HIV every year, the response will become more challenging, more complex and more costly in 2030 and 2050. Increased investments in HIV prevention, strengthened political leadership, enabling legal and policy environments are urgently needed to effectively implement programmes. The time to act is now!
UNAIDS
The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations-UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank-and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org
