The path that ends AIDS

2023 UNAIDS Global AIDS Update Download full report

Foreword

This report makes clear that there is a path to end AIDS. Taking that path will help ensure preparedness to address other pandemic challenges, and advance progress across the Sustainable Development Goals. The data and case studies in the report make it very clear what that path is. It is not a mystery. It is a choice.
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Winnie Byanyima UNAIDS Executive Director
Winnie Byanyima
2023 UNAIDS Global AIDS Update
2023 UNAIDS
Global AIDS
Update Download full report Download Executive Summary | Languages

New report from UNAIDS shows that AIDS can be ended by 2030 and outlines the path to get there

GENEVA, 13 July 2023—A new report released today by UNAIDS shows that there is a clear path that ends AIDS. This path will also help prepare for and tackle future pandemics and advance progress towards achieving the Sustainable Development Goals. The report, 'The Path that Ends AIDS', contains data and case studies which highlight that ending AIDS is a political and financial choice, and that the countries and leaders who are already following the path are achieving extraordinary results.

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Chapter 01

Pathways to success in the HIV response

Numbers of new HIV infections and AIDS-related deaths have continued to decrease globally, bringing the AIDS response closer to achieving Sustainable Development Goal (SDG) 3.3 of ending AIDS as a public health threat by 2030. Many countries with diverse epidemics and economic means are demonstrating that the HIV pandemic can be overcome. Their successes offer lessons for countries and regions where progress is slower, and for broader efforts to improve global public health and advance development.

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Chapter 1
Highlights

Many countries are demonstrating that the HIV pandemic can be overcome. Numbers of new HIV infections and AIDS-related deaths have continued to decrease globally, bringing the AIDS response closer to achieving SDG 3.3 of ending AIDS as a public health threat by 2030. Improved access to treatment has averted an estimated 20.8 million deaths globally.

Remarkable treatment successes are under way in several regions. Five countries have achieved the 95–95–95 targets overall in 2022. At least 16 other countries (eight in sub-Saharan Africa) are within reach of those targets.

Overall, in 2022, about 9.2 million people living with HIV globally were not receiving antiretroviral therapy, and about 2.1 million people were receiving treatment but were not virally suppressed. This means that, despite the progress made, AIDS claimed a life every minute in 2022, and it remains the fourth-leading cause of death in sub-Saharan Africa.

The biggest declines in new HIV infections have been in sub-Saharan Africa. Fewer people acquired HIV in 2022 than at any point since the late 1980s. Countries with diverse epidemics and economic means are combining proven prevention options to bring about large reductions in new HIV infections. Beyond sub-Saharan Africa, progress in preventing new HIV infection is much slower.

2022 saw the lowest number of new infections among children globally since the 1980s. Programmes for preventing the transmission of HIV during pregnancy, birth and breastfeeding have averted an estimated 3.4 million infections in children (aged 0–14 years) since 2000.

Positive changes in removing harmful laws. Several countries removed such harmful laws in 2022 and 2023, yet there have been troubling setbacks in some countries.

Leaving no one behind. The core principles and demands that have propelled the HIV response for decades are echoed in a central theme of the SDGs: the insistence that no one shall be left behind. The HIV response is generating effects that spill over beyond the public health realm and that contribute to progress towards other SDGs.

Chapter contents

Almost 21 million lives saved with antiretroviral therapy
Integrated services are boosting both HIV and tuberculosis (TB) outcomes
Not everyone is benefiting equally

Fewest new HIV infections in decades
Prevention progress is slower outside sub-Saharan Africa.

Over 3 million children protected against HIV since 2000

2022 saw progress in the removal of harmful laws within a divided world

How HIV successes are contributing to the SDGs

Chapter 02

Breaking down barriers: removing the obstacles that hold back HIV responses

The gains made against HIV are a major public health achievement, particularly in the absence of a cure or a vaccine that protects against infection. But in a world marked by multiple intersecting inequalities, not everyone is benefiting from this achievement.

Vulnerability to and risk of HIV infection vary between populations and places, as does people’s access to HIV prevention and treatment services. If we can identify the barriers that prevent people from protecting their health and well-being, we can act more effectively to remove those obstacles.

This chapter surveys the latest evidence on the constraints and HIV-related inequalities that affect people from specific populations. It also reviews the current status of key interventions, including antiretroviral therapy, pre-exposure prophylaxis (PrEP), condom use and voluntary medical male circumcision.

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Chapter 2
Highlights

Providing women with an enabling environment, the information and services they need and social support is essential. Fewer adolescent girls and young women (aged 15–24 years) are acquiring HIV than a decade ago, but many of them still face such high HIV risks that 210 000 [130 000–300 000] acquired HIV in 2022. Long-standing gender inequalities, and discrimination and poverty deny many women and adolescent girls economic autonomy, deprive them of control over their sexual lives, and expose them to constant risk of emotional and bodily harm.

Gaps in services to prevent vertical transmission of HIV still leave hundreds of thousands of children at high risk of HIV each year. Since peaking in the early 2000s, annual numbers of new HIV infections in children (aged 0–14 years) have fallen markedly—but that decline has almost stalled in recent years. Reviving the earlier momentum requires an understanding of why so many children are still acquiring HIV.

HIV risk and incidence vary substantially by population, risk behaviours, age and place. HIV responses, especially prevention programmes, have to be much better at combining and focusing proven interventions where rates of HIV infection are especially high, and at fostering social and legal environments that will make it easier for people to use and benefit from those services.

Globally, the HIV response among people from key populations has stalled. In many places it never really got off the ground, and in some places it is regressing. Weak political will, social conservatism, insufficient funding, rampant stigma and discrimination, and the ongoing use of punitive laws and policies that restrict access to HIV and other health-care services are blocking progress. Consequently, the past decade has seen barely any progress in reducing HIV incidence among people from key populations. There have been reductions globally among sex workers and their clients, but there are expanding epidemics among gay and other men who have sex with men and among transgender people.

Chapter contents

Adolescent girls and young women are at high risk of HIV
Intensified prevention where HIV risk is highest
Women and adolescent girls still lack basic information and services to protect their sexual well-being
Gender-based violence: an epidemic within a pandemic
An overlooked group in the pandemic: women from key populations
New insights that can help unlock HIV prevention in high-burden settings

Mothers and children are being left behind
Targeted efforts are needed to reduce vertical HIV transmission
Reaching all women with services
For children living with HIV, the treatment gaps are still wide

Prevention and treatment services are missing millions of people
The full potential of PrEP is not being realized
Antiretroviral medicines for HIV prevention
Condom programmes are falling off the agenda
VMMC can make an even bigger contribution in eastern and southern Africa
A road map towards boosted HIV prevention
People-centred approaches can close many of the treatment gaps
Children and adolescents with HIV are losing out
Treatment gaps between men and women are wide
Advanced HIV disease is posing new challenges
As people with HIV grow older, new challenges are emerging

HIV responses still neglect key populations
Higher risk, less protection, more HIV infections
Harm reduction services are too scattered and too small
Funding increases will make a big difference
Laws that put people in harm's way
Stigma and discrimination still block progress

Chapter 03

Opportunities for quicker progress to end AIDS

For all the gains made against AIDS, it still claims 630 000 [480 000–880 000] lives each year, most of them in disadvantaged communities and among people from marginalized and vulnerable populations. HIV remains a pandemic that feeds on injustice and reinforces inequalities. But HIV responses also have the tools, evidence and means to end this pandemic—and if those assets are equitably available and used effectively, countries can rapidly close the remaining gaps.

Now is not the time to lose momentum. Seizing the opportunity to invest in a sustainable response will render extraordinary health, social and economic returns. Investing in the HIV pandemic could enhance educational outcomes, especially for young women and girls, reduce gender inequalities and support economic growth in heavily affected parts of sub-Saharan Africa (1). Expanding HIV prevention and advancing health systems integration, gender equality and institutionalized community services will lay the foundations for long-term future gains.

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Video
Highlights

Investing in a sustainable response will render health, social and economic returns. HIV responses succeed when they are anchored in strong political commitment, follow the evidence, have reliable and adequate funding, and reduce the inequalities and discrimination that deny people the services and tools that can protect their health and well-being. HIV responses have the tools, evidence and means to end this pandemic—and if those assets are equitably available and used effectively, countries can rapidly close the remaining gaps.

The HIV funding gap is widening. A total of US$ 20.8 billion was available for HIV programmes in low- and middle-income countries in 2022––2.6% less than in 2021. HIV resources increased substantially in the early 2010s, but they are currently at the same level as in 2013.

Harmful laws, together with stigma and discrimination, combine to increase the risk of HIV. Laws that criminalize people from key populations and HIV non-disclosure, exposure or transmission drive people away from the support and services that can help them protect their health. Increasing support for community and structural interventions would shift the HIV trajectory and help protect the health and human rights of people from marginalized populations.

Inequities and inequalities are blocking quicker and wider success in protecting people against HIV. Investing in a response that supports equitable access to new technologies will lay the foundations for a sustainable AIDS response.

Integration can support the achievement of universal health coverage. Deeper and effective integration can help health services become more convenient and responsive to people’s needs and can accelerate progress towards ending AIDS.

Chapter contents

The HIV funding gap is widening and must match the need
Domestic HIV funding is vital but under stress
International HIV financing remains crucial in many countries
Innovations for sustainable financing of the AIDS response

Programmes that put people first have the biggest impact
Eliminating stigma, discrimination and punitive approaches would reboot HIV programmes
Community-led services can make an even bigger difference
Steer more support to community-led HIV activities

Greater equity will unlock new opportunities and build a sustainable response
Equitable access to new technologies and other innovations
Social safety nets should reach everyone in need and reduce gender inequality

Integrated services can have an even bigger impact
Integrated TB and HIV services can save millions more lives
Making greater use of other integration opportunities

Annex I
Progress towards
the 2025 targets

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The 2021 Political Declaration on HIV and AIDS:

Ending Inequalities and Getting on Track to End AIDS by 2030 commits governments to a set of ambitious, achievable targets for 2025 that reinforce the evidence-informed targets in the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS. Download the Annex to see the progress made towards the 2025 targets.