HIV, the virus responsible for AIDS, is a global health crisis that has claimed millions of lives since the first cases were reported in 1981. Approximately 40 million people live with HIV today, and the epidemic continues to challenge health and development worldwide. Despite significant advancements in prevention, treatment, and care, the fight against HIV/AIDS is far from over.
The U.S. government, through the President’s Emergency Plan for AIDS Relief, is the largest donor to international HIV efforts. Since its inception in 2003, PEPFAR has allocated around $120 billion to combat HIV in over 50 countries. PEPFAR's contributions have been instrumental in the global response, particularly in partnership with the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
The global prevalence of HIV among adults has stabilized at 0.8% since 2001. However, certain groups, including women, girls, and key populations such as men who have sex with men, sex workers, and people who inject drugs, are disproportionately affected. In 2023, around 1.3 million new infections were recorded, highlighting the ongoing transmission and the need for sustained prevention efforts.
Women and girls make up over half of the global HIV-positive population, with gender inequalities and sexual violence exacerbating their vulnerability. In sub-Saharan Africa, the incidence of HIV among adolescent girls and young women is more than three times that of their male counterparts. Young people face significant barriers to accessing HIV and sexual health services, with 36% of older adolescents living with HIV not receiving treatment in 2023.
HIV has also intensified the tuberculosis epidemic, particularly in Africa. TB remains a leading cause of death among people with HIV. However, joint HIV/TB services have led to a substantial decline in TB deaths among HIV-positive individuals between 2010 and 2022.
Prevention strategies for HIV include behavior change programs, condom use, HIV testing, blood supply safety, harm reduction for drug users, and male circumcision. The concept of treatment as prevention has gained traction, with antiretroviral therapy significantly reducing transmission risk. Pre-exposure prophylaxis has also proven effective for high-risk individuals, and recent WHO guidelines recommend long-acting PrEP.
Despite advancements, many challenges remain. Access to prevention and treatment is unequal, and stigma and discrimination continue to hinder progress. In 2023, 72% of people living with HIV were virally suppressed, but regional, population, and age disparities persist. Efforts to scale up ART have increased access, with 30.7 million people receiving treatment in 2023, yet gaps remain, particularly among children.
Global efforts to combat HIV began with the WHO’s Global Program on AIDS in 1987 and have evolved to include initiatives like UNAIDS and the Global Fund. The Sustainable Development Goals aim to end AIDS as a public health threat by 2030. The UNAIDS 95-95-95 targets for 2025 focus on ensuring 95% of people with HIV know their status, 95% of those who know their status receive treatment, and 95% of those on treatment achieve viral suppression.
Funding remains a critical component of the global response. In 2023, an estimated $22.1 billion was available for HIV efforts in low- and middle-income countries. Donor governments, including the U.S., contributed $7.9 billion, with significant support from the Global Fund and private sector entities like the Gates Foundation.
Looking ahead, UNAIDS estimates that $29.3 billion annually will be needed by 2025 to meet global targets. The U.S. continues to play a pivotal role, with PEPFAR leading international efforts and contributing billions annually. The commitment of world leaders and organizations remains crucial as the global community strives to end the AIDS epidemic by 2030.
