The Global HIV/AIDS Epidemic
HIV, the virus that causes AIDS, is one of the world’s most serious public health challenges. But there is a global commitment to stopping new HIV infections and ensuring that everyone with HIV has access to HIV treatment.
According to UNAIDS:
Number of People with HIV—There were approximately 38.4 million people across the globe with HIV in 2020. Of these, 36.7 million were adults and 1.7 million were children (<15 years old). In addition, 54% were women and girls.
New HIV Infections—An estimated 1.5 million individuals worldwide acquired HIV in 2021, marking a 32% decline in new HIV infections since 2010. New HIV infections, or “HIV incidence,” refers to the estimated number of people who newly acquired HIV during a given period such as a year, which is different from the number of people diagnosed with HIV during a year. (Some people may have HIV but not know it.) Of these 1.5 million new HIV infections:
- 1.3 million were among adults
- 160,000 were among children (<15 years old)
HIV Testing—Approximately 85% of people with HIV globally knew their HIV status in 2021. The remaining 15% (about 5.9 million people) did not know they had HIV and still needed access to HIV testing services. HIV testing is an essential gateway to HIV prevention, treatment, care, and support services.
HIV Treatment Access—As of the end of 2021, 28.7 million people with HIV (75%) were accessing antiretroviral therapy (ART) globally. That means 9.7 million people are still waiting. HIV treatment access is key to the global effort to end AIDS as a public health threat. People with HIV who are aware of their status, take ART as prescribed, and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex.
HIV Care Continuum—The term HIV care continuum refers to the sequence of steps a person with HIV takes from diagnosis through receiving treatment until his or her viral load is suppressed to undetectable levels. Each step in the continuum is marked by an assessment of the number of people who have reached that stage. The stages are: being diagnosed with HIV; being linked to medical care; starting ART; adhering to the treatment regimen; and, finally, having HIV suppressed to undetectable levels in the blood. UNAIDS reports that in 2021, of all people with HIV worldwide:
- 85% knew their HIV status
- 75% were accessing ART
- 68% were virally suppressed
Perinatal Transmission—In 2021, 81% of pregnant people with HIV had access to ART to prevent transmitting HIV to their babies during pregnancy and childbirth and to protect their own health.
AIDS-related Deaths—AIDS-related deaths have been reduced by 68% since the peak in 2004. In 2021, around 650,000 people died from AIDS-related illnesses worldwide, compared to 2 million people in 2004 and 1.4 million in 2010.
Regional Impact—The vast majority of people with HIV are in low- and middle-income countries. In 2021, there were 20.6 million people with HIV (53%) in eastern and southern Africa, 5 million (13%) in western and central Africa, 6 million (15%) in Asia and the Pacific, and 2.3 million (5%) in Western and Central Europe and North America.
Challenges and Progress
Despite advances in our scientific understanding of HIV and its prevention and treatment as well as years of significant effort by the global health community and leading government and civil society organizations, too many people with HIV or at risk for HIV still do not have access to prevention, care, and treatment, and there is still no cure. Further, the HIV epidemic not only affects the health of individuals, it also impacts households, communities, and the development and economic growth of nations. Many of the countries hardest hit by HIV also suffer from other infectious diseases, food insecurity, and other serious problems.
Despite these challenges, there have been successes and promising signs. New global efforts have been mounted to address the epidemic, particularly in the last decade. The number of people who have newly acquired HIV has declined over the years. In addition, the number of people with HIV receiving treatment in resource-poor countries has dramatically increased in the past decade and dramatic progress has been made in preventing perinatal transmission of HIV and keeping pregnant people alive.
However, despite the availability of a widening array of effective HIV prevention tools and methods and a massive scale-up of HIV treatment in recent years, UNAIDS cautions there has been unequal progress in reducing new HIV infections, increasing access to treatment, and ending AIDS-related deaths, with too many vulnerable people and populations left behind. Stigma and discrimination, together with other social inequalities and exclusion, are proving to be key barriers and our response to HIV/AIDS across the globe may be in danger.
HIV and the COVID-19 Pandemic
According to UNAIDS:
- The COVID-19 pandemic has caused widespread disruption to health services in many countries, with restrictions in population movements and suspension in health services.
- UNAIDS recommends that during the pandemic, HIV services continue to be made available for people with and at risk for HIV, including ensuring the availability of condoms, opioid substitution therapy, sterile needles and syringes, harm reduction, pre-exposure prophylaxis, and HIV testing. The benefits of continuing to provide those life-saving HIV services far outweigh the risk of potential COVID-19-related deaths.
- UNAIDS also recommends access to COVID-19 services for vulnerable people, including a targeted approach to reach those most left behind.
U.S. Response to the Global Epidemic
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government’s response to the global HIV/AIDS epidemic and represents the largest commitment by any nation to address a single disease in history. Through PEPFAR, the U.S. has supported a world safer and more secure from infectious disease threats. It has demonstrably strengthened the global capacity to prevent, detect, and respond to new and existing risks—which ultimately enhances global health security and protects America’s borders. Among other global results, PEPFAR provided HIV testing services for more than 50 million people in Fiscal Year 2021 and, as of September 30, 2021, supported lifesaving ART for nearly 18.96 million men, women, and children. PEPFAR also enabled 2.8 million babies to be born HIV-free to parents living with HIV.
In addition, the National Institutes of Health (NIH) represents the largest public investment in HIV/AIDS research in the world. NIH is engaged in research around the globe to understand, diagnose, treat, and prevent HIV infection and its many associated conditions, and to find a cure.
Read more about the U.S. Government’s global HIV/AIDS activities.