New HIV cases rise outside Sub-Saharan Africa for the first time - Report

GENEVA, Switzerland

An estimated 1.3 million people acquired HIV in 2023, according to the 2024 “AIDS at a Crossroads” report by the joint United Nations Program on HIV/AIDS (UNAIDS). This increase brings the total number of people living with HIV globally to 39.9 million.

Notably, the report highlights a significant shift: for the first time, more new infections are occurring outside sub-Saharan Africa than within it. This shift reflects the success of prevention efforts in sub-Saharan Africa and the lack of comparable progress in other regions.

According to the report, Asia and the Pacific recorded 300,000 new cases, while Eastern Europe and Central Asia saw 140,000, Latin America reported 120,000, and the Middle East and North Africa recorded 23,000. In contrast, Eastern and Southern Africa reported 450,000 new cases, and Western and Central Africa reported 190,000.

The incidence of HIV among adolescent girls and young women aged 15–24 years remains alarmingly high in parts of sub-Saharan Africa. In 2023, 120,000 adolescent girls and young women acquired HIV, bringing the global number of children living with HIV to 1.4 million, 86% of whom are in sub-Saharan Africa.

However, the report also notes that the number of new HIV infections among children aged 0–14 years has decreased, largely due to successful interventions in eastern and southern Africa, where new infections in children have fallen by 73% between 2010 and 2023.

Countries like Kenya, Malawi, Nepal and Zimbabwe have reduced their annual new HIV infections by 75%, and 18 other countries have reduced their new infections by more than 60% since 2010.

The report emphasizes that access to anti-retroviral therapy has more than halved the annual number of AIDS-related deaths, from 1.3 million in 2010 to 630,000 in 2023. An estimated 30.7 million people were receiving HIV treatment in 2023.

However, the report also raises concerns about declining condom use, particularly among young people aged 15–24 years. Condom programs have been defunded in many countries, leading to a decrease in usage during sex with non-regular partners. Only 36% of adults in eastern and southern Africa, and 25% in western and central Africa, reported using a condom during their last sexual encounter.

“Condoms remain the most effective low-cost HIV prevention tool,” the report states, noting that they offer triple protection against unintended pregnancy, HIV, and other sexually transmitted infections.

While sex workers in some countries report high levels of condom use with clients, their access to potent prevention tools like pre-exposure prophylaxis (PrEP) remains minimal.

The report suggests that rapid, wider access to PrEP could significantly reduce new HIV infections, particularly among women in high-incidence areas.

Although the number of people using oral PrEP rose from 200,000 in 2017 to about 3.5 million in 2023, this falls short of the global target of 21.2 million by 2025. Only two regions in sub-Saharan Africa are making progress toward the 2025 PrEP targets.

The report also highlights the challenges faced by adult men living with HIV, who are less likely than women to know their HIV status, receive treatment, and achieve positive treatment outcomes.

Consequently, 23% of all people living with HIV were not receiving antiretroviral therapy in 2023. The situation is particularly dire in Eastern Europe, Central Asia, the Middle East, and North Africa, where only about half of the 2.1 million people living with HIV are receiving treatment.

HIV-related stigma and discrimination have decreased in some countries but remain common in many others, further complicating efforts to combat the epidemic.

A growing funding shortfall is also impeding progress. In 2023, approximately $19.8 billion was available for HIV programs in low-and middle-income countries, nearly $9.5 billion short of the amount needed by 2025.

The regions with the biggest funding gaps—Eastern Europe, Central Asia, the Middle East, and North Africa—are making the least progress against their HIV epidemics. HIV funding declined for the fourth consecutive year in 2023.

An estimated $1.8 billion to $2.4 billion was available for primary prevention programs in low- and middle-income countries in 2023, compared to the $9.5 billion needed by 2025. Spending on societal enabler programs, which address the social determinants of health and reduce stigma and discrimination, amounted to just $0.9 billion to $1.1 billion, far short of the $3.0 billion required.

The report paints a complex picture of the global HIV epidemic, highlighting both significant achievements and ongoing challenges in the fight against the virus.