Kenya is one of four countries that have successfully managed to reduce the annual new HIV infections by 77 percent, positioning itself well to achieve the target of a 99 percent reduction in the next six years. Other countries in the world making similar strides are Malawi, Nepal, and Zimbabwe.

According to a new UNAIDS “The Urgency of Now: AIDS at a Crossroad,” report, an additional 18 countries have decreased their annual new HIV infections by over 60 percent since 2010, indicating that, with continued effort, they could hit 90 percent success rate.

The report reveals that nearly half of all new HIV infections in 2023 occurred in eastern and southern Africa, as well as western and central Africa. However, these regions have seen the steepest decline—56 percent—in new infections since 2010.

“For the first time, the number of new HIV infections outside sub-Saharan Africa surpassed the number of new HIV infections in sub-Saharan Africa,” the report states.

While sub-Saharan Africa shows substantial progress in preventing new HIV infections, other regions of the world lag, primarily among key populations. In several countries with significant HIV epidemics, new infections are rising due to weak HIV programs targeting these populations.

Notably, the steepest global declines in new HIV infections have been among children aged 0–14 years, particularly in eastern and southern Africa, where the annual number of children acquiring HIV dropped by an estimated 77 percent between 2010 and 2023.

However, western and central Africa now account for over 44 percent of all new vertical (mother-to-child) infections, a similar proportion to that of eastern and southern Africa.

Eighteen countries or territories have eliminated vertical transmission of HIV, achieving fewer than 50 new HIV infections among children per 100,000 births. Botswana and Namibia, two high-prevalence countries, are nearing the “pathway to elimination” target of fewer than 750 new HIV infections per 100,000 births.

Globally, the decline in new infections is more pronounced among women than men. However, in sub-Saharan Africa, HIV incidence among adolescent girls and young women remains extraordinarily high, particularly in parts of eastern and southern Africa. In at least 22 countries in sub-Saharan Africa, the HIV incidence rate among adolescent girls and young women is more than three times that of their male counterparts.

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Four primary factors contribute to the slow global decline in new HIV infections: inadequate investment in HIV prevention, persistent stigma and discrimination, hostile legal and institutional environments, and gender inequalities. Effective prevention technologies like long-acting injectable cabotegravir (CAB-LA) and lenacapavir (LEN) are raising expectations due to their convenience and high efficacy.

UNAIDS Executive Director Winnie Byanyima highlighted that despite leaders' pledges to reduce annual new infections to below 370,000 by 2025, new HIV infections remain alarmingly high at 1.3 million in 2023.

She cited cuts in resourcing and a rising anti-rights push as factors that are jeopardizing progress. “World leaders pledged to end the AIDS pandemic as a public health threat by 2030, and they can uphold their promise, but only if they ensure that the HIV response has the resources it needs and that the human rights of everyone are protected,” explained Byanyima.

The report observes that HIV prevention and treatment services will only be effective if human rights are upheld, discriminatory laws are abolished, and violence and discrimination are directly addressed.

Most affected populations

Despite the need for 20 percent of HIV resources to be allocated towards prevention for populations most affected, only 2.6 percent of total HIV spending in 2023 was dedicated to interventions for key populations.

Global funding for HIV is also decreasing, hampering progress and even leading to rising epidemics in certain regions. In 2023, the total resources available for HIV ($19.8 billion) dropped by 5 percent from 2022, falling $9.5 billion short of the required amount for 2025 ($29.3 billion).

Domestic funding in low- and middle-income countries, which constitutes 59 percent of total resources for HIV, has been constrained by the debt crisis and has declined for the fourth consecutive year, with a 6 percent drop from 2022 to 2023.

The UNAIDS report concludes that the world is at a critical juncture that will determine whether global leaders meet their commitment to end AIDS as a public health threat by 2030.

The report compiles new data and case studies showing that decisions and policy choices made this year will significantly impact millions of lives and the course of the HIV pandemic. Although the end of AIDS is within reach, the world is currently off track.

Globally, out of the 39.9 million people living with HIV, 9.3 million are not receiving life-saving treatment. Projections indicate that if countries meet the 2025 global targets, about 29 million people will be living with HIV by 2050.

However, if current HIV programs continue unchanged, approximately 46 million people will be living with HIV in 2050, highlighting the critical need to strengthen the HIV response to meet the 2025 targets.

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