EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

THE URGENCY
OF NOW

EXECUTIVE
SUMMARY

AIDS AT A
CROSSROADS
2024 GLOBAL AIDS UPDATE
 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

© Joint United Nations Programme on HIV/AIDS (UNAIDS), 2024

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UNAIDS/JC3116E—Executive summary

Scientific report writer: Hein Marais

Story writers for Asia Pacific, Latin America and eastern and southern Africa: Fifa Rahman and
Gisa Dang (Matahari Global Solutions)

Copyeditor: Colette Holden (Cooinda Communications)

Design: Blossom
 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

THE URGENCY
OF NOW

EXECUTIVE
SUMMARY

AIDS AT A
CROSSROADS
2024 GLOBAL AIDS UPDATE
 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

FOREWORD

WINNIE BYANYIMA
UNAIDS Executive Director

This report shows that world leaders can fulfil their

promise to end AIDS as a public health threat by 2030,
and in so doing prevent millions of AIDS-related deaths,
prevent millions of new HIV infections, and ensure the
almost 40 million people living with HIV have healthy, full
lives. Through powerful case studies and new data, the
report shows how some countries are already on the right
path—and how all countries can get on it.

The report also shows that, right now, the world is not on track to succeed,
and the inequalities that drive the HIV pandemic are not being addressed
sufficiently. It shows that due to the lack of progress on prevention, global
numbers of new HIV infections are not declining fast enough, and in three
regions of the world numbers of HIV infections are rising. It shows that almost
a quarter of people living with HIV are not receiving lifesaving treatment, and
consequently a person dies from AIDS-related causes every minute.

We know what enables success. Progress against HIV has been strongest
in the countries that have invested as required in their responses and
reformed their policies to enable people to access the services they need.
To accelerate the end of AIDS as a public health threat, and to ensure
services and systems are in place to meet the needs of the millions of

2 2024 GLOBAL AIDS UPDATE – EXECUTIVE SUMMARY

EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

people living with HIV for decades to come, resourcing needs to be both
sufficient and sustainable. Building a legal environment that facilitates
access to effective, equitable and person-centred HIV services—including
removing harmful criminalizing laws and tackling discrimination—is key to
advancing and sustaining progress on prevention and treatment.

We know, too, what obstructs success. Progress is imperilled by the fraying

of solidarity between and within countries. When political commitment to
full financing and human rights is put at risk, progress in the HIV response is
put at risk too.

A widening funding gap is holding back the HIV response in low- and
middle-income countries, with fiscal space being tightened even further by
the debt crisis. The recent surge in the promotion of anti-rights, anti-gender
and anti-democracy policies is generating justified fear among people
from marginalized communities who most need HIV prevention, testing,
treatment and care services, and among the heroic frontline workers who
provide them.

Advances in technology, in particular in the development of long-acting

treatment and prevention options, can protect the health of everyone living
with or at risk of HIV—but only if these technologies are shared with all low-
and middle- income countries, and are produced by multiple manufacturers
across the world at scale. Currently, patent-holders are not opening up
access broadly enough to enable this breakthrough.

The HIV response is at a crossroads. Whether the world ends AIDS depends
on the path that leaders take. 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.

Some imply that investments and reforms to end AIDS would detract
from addressing other challenges. But, as the report illustrates, the
actions needed to end AIDS will help advance the achievement of all
the Sustainable Development Goals, ensure countries are prepared to
overcome the pandemics of the future, and help secure a safer, fairer world
for everyone.

I am sometimes asked whether I am an optimist about the HIV response,

because the progress we have made shows the path that ends AIDS—or
whether I am a pessimist, because restrictions on resourcing and rights are
putting progress in danger. The answer is that I am neither an optimist nor
a pessimist—I am an activist, because success depends on rising to the
moment, on recognizing the urgency of now.

We can end AIDS, but only if leaders choose the right path now. We the
people will ensure they do.

3
 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

EXECUTIVE
SUMMARY

Midway to the 2025 milestone set at the United Nations General Assembly
in June 2021 (1), the global HIV response has moved closer to the goal of
ending AIDS as a public health threat by 2030, a commitment enshrined in
the Sustainable Development Goals.

Fewer people acquired HIV in 2023 than at any point since the late 1980s.
Almost 31 million people were receiving lifesaving antiretroviral therapy in
2023, a public health success that has reduced the numbers of AIDS-related
deaths to their lowest level since the peak in 2004 (Figures 0.1 & 0.2)1.
In sub-Saharan Africa, these successes have led to a rebound in average life
expectancy from 56.3 years in 2010 to 61.1 years in 2023 (2).

Figure 0.1 Number of new HIV infections, global, 1990–2023, and 2025 target

4 500 000
Number of New HIV infections

4 000 000
3 500 000
3 000 000
2 500 000
2 000 000
1 500 000
2025
1 000 000
target
500 000
0
1990 2023

Source: UNAIDS epidemiological estimates, 2024 (https://aidsinfo.unaids.org/).

Figure 0.2 Number of AIDS-related deaths, global, 1990–2023, and 2025 target

3 000 000
Number of AIDS-related deaths

2 500 000

2 000 000

1 500 000

1 000 000
2025
500 000 target

0
1990 2023

Source: UNAIDS epidemiological estimates, 2024 (https://aidsinfo.unaids.org/).

1 For more information on UNAIDS data in this report see Annex 2 on Methods.

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EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

The progress is highly uneven, however. The global HIV response is moving
at two speeds: relatively swiftly in sub-Saharan Africa, but hesitantly across
the rest of the world. The numbers of people acquiring HIV are rising in at
least 28 countries, some of which already have substantial epidemics.
Many HIV programmes still neglect people from key populations,2 exposing
them to high risks of acquiring HIV. Programmes are also missing
9.3 million [7.4 million–10.8 million] people who need lifesaving treatment,
with children and adolescents living with HIV especially affected. AIDS is not
over—a great deal of unfinished work lies ahead.

The global AIDS response is at a crossroads: success or failure will be

determined by which path leaders take today. The Urgency of Now, AIDS
at a Crossroads, shows that the decisions leaders make this year will
determine whether (or not) countries can achieve the 2030 target of ending
AIDS as a public health threat and ensure progress beyond 2030.

While progress has been made in providing HIV treatment to over 30

million people, much more effort and urgency is required to accelerate
prevention and break down the barriers that keep people, especially
marginalized people, from both HIV prevention and treatment services.

Leaders, community members, and programme managers must work

together to close the significant gaps that remain in access to HIV services.
Progress on HIV prevention lags far behind what is required. HIV services
will only reach people if human rights are upheld if unfair and harmful laws
are removed, and if discrimination and violence are tackled. Equitable
access to medicines and innovations, including long-acting technologies,
is critical.

Now is the time to invest in ensuring that the 2025 targets are met and a
sustainable response is built for the decades to come. The HIV response
needs to adjust to become a sustainable, integrated pillar of health and
social services with communities and human rights at the centre.

This report provides a summary of progress against the 2025 targets

that were developed with the Global AIDS Strategy 2021–2026.
The chapters describe progress against each target and Annex 1 provides
a summary overview.

The HIV pandemic today

Globally, about 39% fewer people acquired HIV in 2023 compared with
2010, with sub-Saharan Africa achieving the steepest reduction (−56%).
Nonetheless, an estimated 1.3 million [1.0 million–1.7 million] people
acquired HIV in 2023—over three times more than the target of 370 000
or fewer new infections in 2025. Three regions are experiencing rising
numbers of new HIV infections: eastern Europe and central Asia,
Latin America, and the Middle East and North Africa.

2 People from key populations include sex workers, gay men and other men who have sex with men,
people who inject drugs, transgender people, and people in prisons and other closed settings

5
 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

For the first time in the history of the HIV pandemic, more new infections
are occurring outside sub-Saharan Africa than in sub-Saharan Africa. This
reflects both the prevention achievements in much of sub-Saharan Africa
and the lack of comparable progress in the rest of the world, where people
from key populations and their sex partners continue to be neglected in
most HIV programmes.

There is inadequate political will to fund and provide prevention

programmes for people from key populations, and hostile legal and
social conditions further limit their access to lifesaving services. Persistent
stigma and discrimination related to HIV status, gender, behaviours or
sexuality also stand in the way. The HIV-related needs of people from key
populations are being served often by nongovernmental organizations,
including community-led organizations, whose work tends to go
unrecognized and underfunded.

Although decreasing, the incidence of HIV among adolescent girls and

young women aged 15–24 years is extraordinarily high in parts of
sub-Saharan Africa. Prevention programmes and efforts to reduce gender
inequalities, violence against women and harmful gender norms are not
having a big enough impact.

Far fewer children aged 0–14 years are acquiring HIV, a trend that is due
largely to successes in eastern and southern Africa, where the annual
number of new HIV infections in children fell by 73% between 2010 and
2023. The overall decline in vertical HIV infections,3 however, has slowed
markedly in recent years, particularly in western and central Africa. An
estimated 120 000 [83 000–170 000] children acquired HIV in 2023,
bringing the total number of children living with HIV globally to
1.4 million [1.1 million–1.7 million], 86% of whom are in sub-Saharan Africa.

Widening access to antiretroviral therapy—much of it provided free

of charge and through the public health sector—has more than
halved the annual number of AIDS-related deaths, from 1.3 million
[1.0 million–1.7 million] in 2010 to 630 000 [500 000–820 000] in 2023.
Treatment programmes are also driving down the numbers of new HIV
infections.

An estimated 30.7 million [27.0 million–31.9 million] people were receiving

HIV treatment in 2023. The world can reduce the number of AIDS-related
deaths to fewer than the 2025 target of 250 000 if it achieves further rapid
increases in diagnosing and providing HIV treatment to people living with
HIV (Figure 0.3).

3 Vertical transmission of HIV occurs during the pregnancy and breastfeeding period.

6 2024 GLOBAL AIDS UPDATE – EXECUTIVE SUMMARY

 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

Figure 0.3 Percentage change in annual number of AIDS-related deaths between 2010 and 2023, global and by region

40
34

20

0
Per cent

–6

–20

–28

–40 –34

–51 –51
–60 –57 –57 –55

Global Eastern Caribbean Western Asia and Western and Latin Middle East Eastern
and southern and central the Pacific central Europe America and Europe and
Africa Africa and North America North Africa central Asia

Source: UNAIDS epidemiological estimates, 2024 (https://aidsinfo.unaids.org/).

The scale of the HIV pandemic is so large, however, that even these
accomplishments still left about 9.3 million [7.4 million–10.8 million] people
living with HIV without treatment in 2023, almost half (4.7 million [3.8
million-5.4 million]) of whom were in sub-Saharan Africa. Treatment coverage
continued to be lower among men and among people from key populations
especially in sub-Saharan Africa (3), and it was especially low among children.
Approximately 630 000 [500 000–820 000] people around the world lost
their lives to AIDS in 2023, including 76 000 [53 000–110 000] children aged
0–14 years—one in eight people who died due to AIDS in 2023 was a child.

Mixed progress in serving

people’s prevention needs
Globally, the 2025 prevention target (95% of people at risk of HIV infection have
access to and use effective combination prevention options) are not within reach.
The global HIV prevention response is proceeding at an encouraging pace in
sub-Saharan Africa, but it has stalled in other regions. Persistent and, in some
countries, widening gaps in basic HIV prevention must be resolved urgently.

At least half of all people from key populations are not being reached
with prevention services, according to data reported to UNAIDS. Men
and women who inject drugs, gay men and other men who have sex with
men, and transgender people are particularly neglected. In addition, more
than half of the areas with high or moderately high HIV incidence4 in sub-
Saharan Africa are not being served by prevention programmes tailored for
adolescent girls and young women.

4 High HIV incidence denotes one or more new infections per 100 person-years. Moderately high incidence denotes
0.3–0.99 new infections per 100 person-years.

7
 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

Condom use remains the most effective low-cost HIV prevention method
(4, 5), but condom programmes have been defunded and social marketing
schemes cut back in many countries (6). Household survey data suggest
condom use has declined in recent years, including among young people
aged 15–24 years, and it is highly infrequent during sex with non-regular
partners. About 36% of adults in eastern and southern Africa and 25% in
western and central Africa used a condom at last sex.

Sex workers in some countries report high levels of condom use with
clients, but their access to potent prevention tools such as pre-exposure
prophylaxis (PrEP)5 is minimal. The same is true for gay men and other men
who have sex with men and for transgender people, except in a few high-
income countries. Access to harm reduction services for people who inject
drugs is extremely low in all but a few countries.

Rapid, wider access to PrEP could massively reduce the numbers of new
HIV infections, especially among people from key populations and among
women in areas where HIV incidence is currently high. The total number
of people using oral PrEP rose from a little over 200 000 in 2017 to about
3.5 million in 2023 but is far short of the global 2025 target of 21.2 million
people. Only the two regions in sub-Saharan Africa are making progress
to reaching the 2025 PrEP targets (Figure 0.4). A six-month long-acting
injectable PrEP product, lenacapavir, has shown extremely high efficacy in
preventing HIV among adolescent girls and women in Africa. If this PrEP
option is made available rapidly and affordably to potential users, it could
herald a breakthrough for HIV prevention (7).

Figure 0.4 Number of people who used pre-exposure prophylaxis (PrEP) at least once in 2023, by region,
and 2025 target

9
Number of people who received PrEP at least once (millions)

0
Asia and Eastern Europe Eastern and Latin America and Middle East and Western and Western and
the Pacific and central Asia southern Africa the Caribbean North Africa central Africa central Europe
and North America
Number of people who received PrEP at least once 2025 target

Source: Global AIDS Monitoring, 2024 (https://aidsinfo.unaids.org/).

5 PrEP entails taking antiretroviral medicines to prevent the acquisition of HIV.

8 2024 GLOBAL AIDS UPDATE – EXECUTIVE SUMMARY

 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

There are opportunities for voluntary medical male circumcision (VMMC)

programmes to make a bigger impact (8). The 35 million circumcisions
conducted between 2008 and 2022 in 15 priority countries in eastern and
southern Africa averted an estimated 670 000 HIV infections (9). Most of
these countries have scope to increase VMMC uptake further if they can
overcome funding shortages and expand the services to older age groups.

Access to HIV treatment

continues to expand
Approximately 30.7 million [27.0 million–31.9 million] of the estimated
39.9 million [36.1 million–44.6 million] people living with HIV globally were
receiving antiretroviral therapy in 2023 (Figure 0.5). This is a landmark public
health achievement. As recently as 2015, global treatment coverage was
only 47% [38–55%]—but in 2023, it stood at 77% [61–89%].

Figure 0.5 Number of people receiving antiretroviral therapy, 2010–2023, global, and 2025 target

40

2025
35 target

30
Number of people on treatment (millions)

25

20

15

10

0
2010 2023

Source: UNAIDS epidemiological estimates, 2024 (https://aidsinfo.unaids).

9
 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

Supporting people living with HIV to start and stay on antiretroviral

therapy has enormous personal and public health benefits. People
with an undetectable viral load have zero risk of transmitting HIV to
their sexual partners, and people with a suppressed viral load have a
near-zero risk of doing so (10, 11).6 This has given rise to the campaign
Undetectable = Untransmittable, or U=U. The successful treatment of HIV
is crucially important for preventing new HIV infections (12). In 2023, almost
three in four adults (73% [66–81%]) living with HIV globally had a suppressed
viral load, a big improvement compared with the 40% [36–45%] in 2015.

The 95–95–95 targets set for 2025 are within reach.7 Approximately
86% [69–>98%] of people living with HIV worldwide knew their HIV status
in 2023. Among them, approximately 89% [71–>98%] of people were
receiving antiretroviral therapy and 93% [74–>98%] of people on treatment
had a suppressed viral load (Figure 0.6). Some of the biggest gains have
occurred in sub-Saharan Africa, often in unfavourable conditions.

Health and community systems have become better at offering HIV tests
to people who may have been exposed to HIV, and at linking them to
reliable treatment and care services. More tolerable and effective treatment
regimens are making it easier for people to keep taking their antiretroviral
medicines and have suppressed viral loads.

Figure 0.6 Percentage of people living with HIV who know their HIV status, of people who know their
HIV status and are receiving antiretroviral therapy, and of people on HIV treatment who have suppressed
viral load, global, 2023
100
2025 target

90

80

70

60
Per cent

50

40

30

20

10
86 89 93
(69–>98) (71–>98) (74–>98)
0
People living with HIV People who know their HIV People living with HIV on treatment
who know their status status and are on treatment who have a suppressed viral load

Source: Further analysis of UNAIDS epidemiological estimates, 2024.

6 A viral load is undetectable when it is so low that a polymerase chain reaction test cannot measure it.
A suppressed viral load is defined as equal to or below 1000 copies/mL.
7 95% of people living with HIV know their HIV status; 95% of people who know they are living with HIV receive
antiretroviral therapy; and 95% of people receiving antiretroviral therapy have suppressed viral loads.

10 2024 GLOBAL AIDS UPDATE – EXECUTIVE SUMMARY

 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

Figure 0.7 Testing and treatment cascade among children, women and men, global, 2023

100
91
(72–>98)
90 83 83
(66–96) (65–97)
78
80 (70–87)
72
(56–84)
66 67
70 (47–87) (60–75)

57
60 (41–57)
Per cent

48
50 (39–60)

40

30

20

10

0
Children (aged 0–14 years) Women (aged 15+ years) Men (aged 15+ years)
living with HIV living with HIV living with HIV

People living with HIV who know their HIV status People living with HIV who are on treatment People living with HIV who have a suppressed viral load

Source: Further analysis of UNAIDS epidemiological estimates, 2024.

Disparities in access to HIV testing and treatment, however, continue to

undercut the overall impact of these accomplishments (Figure 0.7). Children
(aged 0–14 years) living with HIV remain considerably less likely than adults
to be diagnosed and receive antiretroviral therapy: about 43% [31–57%] of
the global total of 1.4 million [1.1 million–1.7 million] children living with
HIV were not receiving treatment in 2023. Children accounted for 12% of
all AIDS-related deaths, even though they constitute only 3% of people
living with HIV. More than one third (36%), or 370 000 [250 000–470 000],
of older adolescents (aged 15–19 years) living with HIV were not receiving
antiretroviral therapy in 2023.

Across much of the world, adult men (aged 15+ years) living with HIV
are less likely than their female counterparts to know their HIV status and
receive HIV treatment; their treatment outcomes also tend to be poorer.
Antiretroviral therapy coverage among some key populations may have
increased in recent years (13), but people from key populations living with
HIV still have lower antiretroviral therapy coverage and worse treatment
outcomes than other people living with HIV, particularly in sub-Saharan
Africa (3).

Consequently, one quarter (23% [19–27%]) of all people living with HIV
were not receiving antiretroviral therapy in 2023. Access to treatment was
especially low in eastern Europe and central Asia and the Middle East
and North Africa, where only about half of the 2.1 million [1.9 million–2.3
million] and 210 000 [170 000–280 000] people living with HIV, respectively,
were receiving antiretroviral therapy.

11
 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

There are other challenges too. It is estimated that about 12.2 million
[11 million–13.6 million] people have advanced HIV disease (AIDS). AIDS
used to be seen mainly as a problem of late diagnosis and treatment of
HIV infection. These concerns remain, but AIDS is now most common
among people who have received antiretroviral therapy and stopped HIV
treatment (14, 15). This puts their health at risk, increases the risk of HIV
transmission, and adds to the burden on health systems (16, 17). There is
an urgent need for effective interventions and support so people can stay
on HIV treatment and those who have interrupted their treatment can be
re-engaged in care.

The success of HIV treatment has led to a rise in the average age of
people living with HIV. As people living with HIV grow older, they
are likely to encounter a growing range of comorbidities, including
noncommunicable diseases such as hypertension and diabetes, that
require care. Closer integration of HIV and other health services,
equipment and supply chains, and upgraded training for health workers,
will be needed to deal with these changes.

Slow progress in reducing

stigma, discrimination,
social inequalities
and violence
The 10–10–10 and the 30–80–60 targets set for 2025 are not within reach.
Stigma, discrimination, social inequalities and gender-based violence make
it hard for people to stay free of HIV and protect their health (18). People
from key populations are especially vulnerable (19). Recognition of these
hindrances has increased, but it is not yet sufficiently reflected in laws,
policies and practices. Rising authoritarianism and attacks on human and
civil rights are making it even more difficult to remove these barriers (20).

HIV-related stigma and discrimination have declined in some countries but

remain unnervingly common in many others. Gender-based inequalities
continue to be pervasive, to varying degrees depending on the country.
Punitive laws targeting people living with HIV and people from key
populations are still on the statute books in almost all countries. Gender-
based violence, including against women and girls, remains a menace
everywhere.

Across 42 countries with recent survey data, in median almost half (47%) of
people harboured discriminatory attitudes towards people living with HIV
(21). These attitudes are found even at health facilities. Almost one quarter
of people living with HIV reported experiencing stigma when seeking
non-HIV-related health-care services in the previous year, according to an
analysis of Stigma Index surveys conducted in 25 countries (22).

12 2024 GLOBAL AIDS UPDATE – EXECUTIVE SUMMARY

 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

These prejudices are reversible, but very few countries are close to
achieving the 2025 target of reducing to less than 10% the percentage
of people living with HIV and people from key populations experiencing
stigma and discrimination.

Prompted by the activism of affected communities, a few countries have

abandoned or reformed laws that target people living with HIV and people
from key populations. Overall, however, only four8 of 193 countries did
not have any laws that criminalize sex work, same-sex sexual relations,
possession of small amounts of drugs, transgender people, or HIV
nondisclosure, exposure or transmission (Figure 0.8).

Gender-based violence harms hundreds of millions of people, and intimate

partner violence is a painfully common ordeal and a human rights violation
against women and adolescent girls especially.9 Although the prevalence of
physical or sexual violence by an intimate partner in the previous 12 months
was below 10% in a little over half (82) of the 156 countries with available
estimates, the prospect of experiencing physical or sexual violence remains
unacceptably high even in these countries (23). National health policies
increasingly recognize the need to curb such violence, and there is strong
evidence supporting the integration of violence prevention in health-care
settings (24–26). Implementation is often held back, however, by a lack of
training and support for health-care workers and by scarce referral systems
for survivors of violence (27).

Figure 0.8 Number of countries with discriminatory and punitive HIV-related laws, global, 2024

Criminalization or prosecutions
based on general criminal laws
of HIV nondisclosure, exposure
or transmission

Criminalization of
transgender people

Criminalization of any
aspect of sex work

Criminalization of same–sex
sexual acts in private

Criminalization of possession
of small amounts of drugs

2025 target

0 20 40 60 80 100 120 140 160 180 193

Number of countries

No Yes Data not available

Source: National commitments and policy instrument 2017–2024, supplemented by additional sources; 2024 (see references in regional factsheets and http://lawsandpolicies.unaids.org/).
Note: This figure does not capture where key populations may be de facto criminalized through other laws, such as vagrancy or public morality laws, or the use of the above laws for
different populations.

8 Colombia, the Netherlands, Uruguay, Bolivarian Republic of Venezuela.

9 Intimate partner violence is behaviour by an intimate partner or ex-partner that causes physical, sexual or
psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.

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 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

Nongovernmental organizations, including community-led organizations,

help provide services and support to people, especially people from key
populations, whose HIV and other health-care needs tend to be neglected
by public and private health providers (28). These organizations need civic
space, legal and regulatory environments that permit them to receive
funding and operate, and functional links with public health systems. These
conditions are lacking in many countries. Well over two thirds (71%) of the
world’s population lives in 78 countries where civic space is now either
entirely closed or heavily controlled (29)—threatening people’s most basic
human rights, including the right to universal health.

Integration of HIV
and other services
is making an impact
When integrated, HIV and other health services can improve health
outcomes, strengthen health systems, and support progress towards
universal health coverage (30). Integration across sectors has also been
a feature of HIV responses, with the advancement of gender equality
and women’s empowerment, workplace interventions, humanitarian
programmes, and social protection schemes being linked progressively with
HIV-related interventions.

There has been a marked shift towards the integration of HIV and other
health-care services in recent years. Although still in a minority, an increasing
number of countries have national strategic HIV plans that are integrated with
other health issues or diseases, and with broader health strategies or plans.
Thirty-nine of the 151 reporting countries have national health strategies or
policies that integrate the HIV response (seven more than in 2022). Of the 60
countries that have adopted universal health coverage schemes, 38 include
antiretroviral therapy and 21 include pre-exposure prophylaxis (PrEP) in their
health benefit and financing packages (31).

These changes are making a mark. Often, both HIV and other health
outcomes are better within integrated services than in separated services
and the uptake of non-HIV services also tends to rise (30). Linked
or integrated tuberculosis (TB) and HIV treatment for people living
with both HIV and TB, for example, averted an estimated 6.4 million
[5.5 million–7.3 million] deaths between 2010 and 2022 (32). Interventions
that prevent and treat HIV, sexually transmitted infections and viral hepatitis
can be both cost-effective and cost-saving, especially when combined
(33). Recent rapid emergence of mpox has reiterated the importance of
integrated care, which has proved successful in some settings in North
America and western Europe.

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EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

There is great scope for judiciously extending integration. Integrated

services for HIV and sexual and reproductive health are not yet widespread
(34), and neither are functioning examples of integrated HIV and
noncommunicable diseases services, especially in sub-Saharan Africa
(35). The rise in conflict-related and climate change-induced humanitarian
emergencies underscores the need for integrated emergency responses
that address people’s health, nutrition and safety needs.

Integration is not without challenges or costs, however. The benefits are

context-specific, and they require a range of enabling changes, including
adequate staffing levels, efficiently functioning health systems, and decisive
actions to prevent stigma and discrimination (30, 36, 37). Moreover, it is
vital that integration is pursued in ways that strengthen rather than weaken
the person-centred and equity-based principles that define successful HIV
programmes (34).

A growing funding
shortfall is holding
back quicker progress
A widening funding gap is holding back the HIV response. Approximately
US$ 19.8 billion (2019 United States dollars) was available in 2023 for HIV
programmes in low- and middle-income countries—almost US$ 9.5 billion
short of the amount needed in 2025. Total resources available for HIV, adjusted
for inflation, are at their lowest level in over a decade. The regions with the
biggest funding gaps—eastern Europe and central Asia and the Middle East
and North Africa—are making the least headway against their HIV epidemics.

Most funding for HIV comes from domestic resources (about 59%), but
both international and domestic HIV funding are under stress. Adjusted for
inflation, domestic HIV funding declined in 2023 for the fourth year in a row,
and international resources were almost 20% lower than at their peak in 2013.
Financing support from bilateral donors has dwindled dramatically. The overall
reductions in external HIV resources would be much steeper were it not for
sustained and high levels of funding from the Global Fund to Fight AIDS,
Tuberculosis and Malaria and the United States Government. Development
assistance for HIV will continue to be crucial.

The continued underfunding of HIV prevention, societal enabler

programmes and community-led activities does not bode well for the HIV
response. Interventions for people from key populations are especially
neglected, even in regions where the vast majority of new HIV infections
occur in people from these populations (Figure 0.9).

An estimated US$ 1.8 billion–2.4 billion was available for primary prevention
programmes in low- and middle-income countries in 2023, compared
with the US$ 9.5 billion that will be needed in 2025. Spending on societal
enabler programmes amounted to US$ 0.9 billion–1.1 billion, far short of
the US$ 3.0 billion needed in 2025.

15
 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

Figure 0.9 Percentage of total HIV resources spent on programmes for people from key populations and percentage
of new HIV infections occurring among members of key populations and their sex partners, by region, 2023

Eastern Europe and

central Asia

Middle East and

North Africa

Asia and the Pacific

Latin America

Caribbean

Western and central

Africa

Eastern and southern

Africa

0 10 20 30 40 50 60 70 80 90 100
Per cent

Per cent of new HIV infections among people from all key populations, clients of sex workers, and partners of people from key populations
Per cent of total HIV spending on prevention interventions among people from key populations

Source: Korenromp EL, Sabin K, Stover J, Brown T, Johnson LF, Martin-Hughes R, et al. New HIV infections among key populations and their partners in 2010 and 2022, by world region: a
multisources estimation. J Acquir Immune Defic Syndr. 2024;95(1S):e34–e45. doi:10.1097/QAI.0000000000003340.; UNAIDS financial estimates, July 2024 (http://hivfinancial.unaids.org/
hivfinancialdashboards.html).

The prices of vital HIV products are a major factor in countries’ abilities
to sustainably finance their HIV programmes with domestic resources.
Although the prices of many antiretroviral medicines have continued
to decline in recent years, low- and middle-income countries spent
approximately US$ 3 billion on antiretroviral medicines in 2020–2022.
These procurement prices still vary drastically across regions and country
income groups.

Looking beyond
the crossroads
If HIV programmes remain on their current course, UNAIDS projections
show that about 46 million people will be living with HIV in 2050. Even if
the world achieves the 2025 targets and sustains these gains, there will be
almost 30 million people living with HIV in 2050. Each of them will need
lifelong treatment and support for HIV. In the absence of an effective and
universally accessible vaccine or cure, there will also continue to be new
HIV infections. Neither of these scenarios amounts to “the end of AIDS”—
the world will still be contending with a major public health challenge.

16 2024 GLOBAL AIDS UPDATE – EXECUTIVE SUMMARY

EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

The primary objective is to swiftly reduce numbers of new infections

and AIDS-related deaths to levels that approach or achieve disease
control—and to do so in ways that prevent a future resurgence of the
epidemic (38). This requires a resilient and durable HIV response.

Countries that are struggling to control their epidemics can achieve

steeper declines in HIV incidence by rapidly increasing treatment coverage
and adherence (39, 40), and by intensifying their most effective primary
prevention interventions. Projections show that high-burden countries that
reach the 95–95–95 treatment targets could continue reducing new HIV
infections by 20% every five years if they invest simultaneously in effective
HIV primary prevention programmes (41).

But a constantly evolving AIDS pandemic calls for other changes too.
As the population living with HIV ages, the risk of acquiring HIV will
shift towards older age groups, and prevention strategies will have to
adjust to this. HIV programmes will need to make common cause with
broader health programmes by responding to the growing impact of
noncommunicable diseases, including among people living with HIV, and
the ongoing toll exacted by other infectious diseases (34, 42).

As HIV programmes are integrated further into broader health systems,

there will also be ample room for mutual learning. HIV responses have
fortified health and community systems, boosted the roles of affected
communities, singled out the societal and structural factors fuelling
the epidemic, and made human rights and equity central priorities.
More extensive integration with other health programmes can share
these attributes more widely, but it should not dilute the distinctive
features that make HIV responses successful (34, 43). This is especially
urgent when serving populations who may be targeted with stigma,
discrimination or worse.

All of this must be achieved in a context shaped by persistent

inequalities within and between countries, a burgeoning threat of
repressive governance, and ongoing discrimination against people
who are inordinately exposed to HIV and other health threats. The
fiscal constraints imposed by debt distress and low economic growth,
especially in Africa, are also reducing low- and middle-income countries’
abilities to invest more in their HIV responses, while some donors have
diverted their assistance to other priorities.

An evolving pandemic and shifting context have brought the HIV

response to a crossroads. The decisions and actions taken now will have
a lasting impact on the world’s effort to end the AIDS epidemic as a
public health threat.

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 EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

Mixed results at the halfway mark to the 2025 targets

Table 0 Summary of progress against the 2025 targets

COMBINATION HIV PREVENTION FOR ALL TARGET 2023 STATUS

Reduce new HIV infections to under 370 000 370 000 1 300 000
Reduce new HIV infections among adolescent girls and young women to below 50 000 50 000 210 000
50%/40%/39%/39% (medians)
95% of people at risk of HIV access effective combination prevention 95%
(SW/MSM/PWID/TG)
Pre-exposure prophylaxis (PrEP) for 10 million people at substantial risk of HIV
21.2 million 3.5 million
(or 21.2 million who used PrEP at least once during the year)
50% opioid agonist therapy coverage among people who are opioid-dependent 50% 0 of 8 regions
90% sterile injecting equipment at last injection 90% 11 of 27 countries
90% of 15+ men in 15 priority countries have access to voluntary medical male circumcision 90% 67%
95–95–95 FOR HIV TESTING AND TREATMENT TARGET 2023 STATUS
Reduce annual AIDS-related deaths to under 250 000 250 000 630 000
34 million people are on HIV treatment by 2025 34 million 30.7 million
All ages: 86–89–93
Women (15+ years): 91–91–94
95–95–95 testing, treatment and viral suppression targets 95–95–95 Men (15+ years): 83–86–94
Children (0–14 years): 66–86–84
Key populations: unknown
17 million people living with HIV initiated
90% of people living with HIV receive preventive treatment for tuberculosis (TB) by 2025 90%
on TPT between 2005 and 2022
Reduce numbers of TB-related deaths among PLHIV by 80% 80% 71%
PEDIATRIC HIV TARGET 2023 STATUS
75% of children living with HIV have suppressed viral loads by 2023 75% 48%
100% of pregnant and breastfeeding women with HIV
100% 84%
receive ART and 95% achieving viral suppression
GENDER EQUALITY AND EMPOWERMENT OF WOMEN AND GIRLS TARGET 2023 STATUS
<10% of women and girls experienced physical or sexual violence from a male intimate partner in the past
<10% 13% [10%–16%]
12 months
<10% of key populations experience physical and/or 21%/8%/28%/24% (medians)
<10%
sexual violence in the past 12 months SW/MSM/PWID/TG
< 10% people support inequitable gender norms by 2025 <10% 24.2% (median)
Median of 50.8% of women currently married or in union
make their own decisions regarding sexual relations,
95% of women and girls 15-49 get sexual and reproductive health-care service needs met 95%
contraceptive use and their own
health care (data from 16 countries)
REALIZE HUMAN RIGHTS AND ELIMINATE STIGMA AND DISCRIMINATION TARGET 2023 STATUS
<10% of countries criminalize 170 countries
- Sex work 152 countries
- Possession of small amounts of drugs
- Same-sex sexual behaviour 63 countries
- HIV transmission, exposure or non-disclosure 156 countries
52% of countries have mechanisms established by
< 10% of countries lack mechanisms for people living with HIV and for key populations
<10% the government), 66% of countries have mechanisms
to report abuse and discrimination and seek redress
established by communities
< 10% of people living with HIV and key populations lack access to legal services <10% 39% of countries
31% of people
>90% of people living with HIV who experienced rights abuses have sought redress 90%
sought redress
< 10% of general population reports discriminatory attitudes towards people living with HIV <10% 47% (median)
< 10% of PLHIV report internalized stigma <10% 38%
<10% of key populations report experiencing 26%/16%/40%/49% (medians)
<10%
stigma and discrimination SW/MSM/PWID/TG
13% (HIV care) 25% (non-HIV care)
<10% of PLHIV experiencing stigma and discrimination in health-care and community settings <10%
24% (community)
COMMUNITY LEADERSHIP TARGET 2023 STATUS

CLOs deliver 30% of testing and treatment services 30%

CLOs deliver 80% of HIV prevention services for populations at high risk of HIV infection and women 80%
CLOs deliver 60% of programmes to support societal enablers 60%
UNIVERSAL HEALTH COVERAGE AND INTEGRATION TARGET 2023 STATUS
Systems for health and social protection that provide
90%
90% of people living with, at risk of and affected by HIV with integrated HIV services
90% of people in humanitarian settings access integrated HIV services. 90%
45% of people living with, at risk of and affected by HIV and AIDS have access to social protection benefits. 90%
INVESTMENTS AND RESOURCES TARGET 2023 STATUS
Fully fund the HIV response by increasing annual HIV investments in low- and middle income countries to
$29.3 billion $19.8 billion
US$ 29 billion

Progress is off track Moderate progress 2025 are within reach No data is available
Note: SW Sex workers - MSM Gay men and other men who have sex with men - PWID People who inject drugs - TG Transgender persons

18 2024 GLOBAL AIDS UPDATE – EXECUTIVE SUMMARY

EMBARGOED UNTIL 22 JULY 2024, 10:00AM CET / 08:00AM GMT

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