By late 2024, the world was closer than ever to ending AIDS as a public health threat. The situation changed dramatically in early 2025 when the US announced significant cuts to the US President’s Emergency Plan for AIDS Relief (PEPFAR), which had committed $4.3 billion in bilateral support this year. That immediate stoppage caused a systemic shock across HIV programs, where international assistance financed almost 80% of HIV prevention in sub-Saharan Africa, 66% in the Caribbean, and 60% in the Middle East and North Africa.
UNAIDS projections show that permanent discontinuation of PEPFAR support could cause over 6 million additional HIV infections and 4 million additional AIDS-related deaths by 2029-2030. Immediate impacts included disrupted supply chains and HIV testing, a lack of health care staff, curtailed prevention programs, and thousands of facility closures.
Historic Progress Under Threat
The global AIDS response achieved remarkable success through 2024, with new global HIV infections dropping 40% and AIDS-related deaths in sub-Saharan Africa declining 56% since 2010. New infections decreased to 1.3 million and deaths to 630,000 in 2024, the lowest in over 30 years. Sub-Saharan Africa experienced especially dramatic improvements, with life expectancy rebounding from 56.5 to 62.3 years between 2010 and 2024.
Worldwide, 77% of the 40.8 million people living with HIV received antiretroviral therapy, and 73% had suppressed viral loads; 87% of people living with HIV knew their status; 89% of people who knew their status were receiving treatment; and 94% of those on treatment had suppressed viral loads. Between 2000 and 2024, prevention of mother-to-child transmission programs averted nearly 4.4 million new infections in children.
Persistent Inequalities and Gaps
Despite progress in all regions, the gains have been unevenly distributed. New HIV infections decreased between 2010 and 2024 by 56% in sub-Saharan Africa, 21% in the Caribbean, and 17% in Asia and the Pacific. However, infections rose by 94% in the Middle East and North Africa, 13% in Latin America, and 7% in Eastern Europe and Central Asia. New HIV infections have increased in at least 32 countries since 2010, and the world is expected to miss the 2025 target of 370,000 or fewer new cases by a wide margin.
Key populations—sex workers, men who have sex with men, people who inject drugs, transgender people, and those in prisons and other closed settings—continued facing barriers to services. Children were severely underserved, with only 55% receiving antiretroviral therapy in 2024. Structural barriers, including stigma, discrimination, punitive laws, gender inequalities, and violence, continued to undermine people’s attempts to stay HIV-free or live safe and healthy lives with HIV.
Despite Setbacks, Progress
Despite the crisis, scientific breakthroughs such as the twice-yearly injectable HIV preventive lenacapavir and grassroots organizing in countries including Ethiopia offer hope. Twenty-five countries have planned to increase domestic HIV spending for 2026, while over 30 have developed sustainability roadmaps with UNAIDS support. However, many countries—especially those in sub-Saharan Africa—face financial constraints.
The AIDS response has already saved 26.9 million lives. Ending AIDS as a public health threat by 2030 remains achievable but requires sustained commitment and adequate resources.
Reference
UNAIDS. AIDS, crisis and the power to transform: UNAIDS Global AIDS Update 2025. Geneva: Joint United Nations Programme on HIV/AIDS; 2025. In Person and virtually; Bertha Gxowa Hospital, Angus St, Germiston, Johannesburg, South Africa. Organized by UNAIDS in partnership with the South African National AIDS Council (SANAC). Presented Thursday, July 10, in partnership with IAS 2025, July 13–17, 2025; Kigali, Rwanda, and virtually.
