KAMPALA: The latest report from the United Nations Program on HIV/AIDS (UNAIDS), “AIDS at a Crossroads,” reveals a startling global trend: an estimated 1.3 million people acquired HIV in 2023, bringing the total number of people living with the virus to 39.9 million. This figure underscores the ongoing challenge of HIV prevention and treatment worldwide, as well as the shifting geographical landscape of the epidemic.
Global Shifts in HIV Infections
For the first time in the history of the HIV pandemic, more new infections are occurring outside sub-Saharan Africa than within it. While sub-Saharan Africa has long been the epicenter of the HIV crisis, the region’s prevention efforts have led to significant progress. In contrast, regions such as Eastern Europe, Central Asia, Latin America, the Middle East, and North Africa are now seeing rising numbers of new HIV infections. This shift reflects both the successes in sub-Saharan Africa and the lack of comparable progress in other parts of the world.
Asia and the Pacific reported 300,000 new cases in 2023, followed by Eastern Europe and Central Asia with 140,000, Latin America with 120,000, and the Middle East and North Africa with 23,000. In contrast, Eastern and Southern Africa saw 450,000 new cases, and Western and Central Africa reported 190,000.
Prevention and Treatment Challenges
The report highlights several troubling trends in HIV prevention. Condom use, one of the most effective and low-cost methods of HIV prevention, has declined in recent years, particularly among young people aged 15–24. Only 36% of adults in Eastern and Southern Africa and 25% in Western and Central Africa used a condom during their last sexual encounter. The decline in condom use is attributed to defunding of condom programs and cuts in social marketing schemes in many countries.
While access to antiretroviral therapy has improved, with 30.7 million people receiving treatment in 2023, significant gaps remain. One-quarter of all people living with HIV were not receiving antiretroviral therapy, with the most pronounced deficiencies in Eastern Europe, Central Asia, the Middle East, and North Africa. HIV-related stigma and discrimination, though declining in some regions, remain pervasive and hinder access to treatment and support services.
Funding Shortfalls and Global Implications
A growing funding shortfall is exacerbating the challenges of HIV prevention and treatment. In 2023, approximately $19.8 billion was available for HIV programs in low- and middle-income countries, almost $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 also the regions making the least progress against their HIV epidemics.
The funding gap is particularly concerning for primary prevention programs, which received only $1.8–2.4 billion in 2023, compared to the $9.5 billion needed by 2025. Societal enabler programs, which address the social determinants of health and reduce stigma and discrimination, received just $0.9–1.1 billion, far short of the $3.0 billion required.
Implications for the Future
The rising number of new HIV infections outside sub-Saharan Africa, coupled with declining prevention efforts and significant funding shortfalls, presents a critical challenge to global HIV/AIDS response efforts. The shift in the geographical distribution of new infections signals a need for renewed focus and investment in regions that have not made comparable progress in prevention and treatment.
Moreover, the report underscores the importance of addressing social and structural barriers to HIV prevention, such as stigma, discrimination, and lack of access to preventive tools like PrEP and condoms. Without addressing these issues and closing the funding