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 37.6 million people across the globe with HIV in 2020. Of these, 35.9 million were adults and 1.7 million were children (<15 years old).
New HIV Infections—An estimated 1.5 million individuals worldwide acquired HIV in 2020, marking a 30% decline in new HIV infections since 2010. (New HIV infections, or “HIV incidence,” refers to the estimated number of people who newly acquired the HIV virus during 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 new HIV infections:
- 1.3 million were among adults
- 160,000 were among children (<15 years old)
HIV Testing—Approximately 84% of people with HIV globally knew their HIV status in 2020. The remaining 16% (about 6.0 million people) still need 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 2020, 27.4 million people with HIV (73%) were accessing antiretroviral therapy (ART) globally. That means 10.2 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 daily as prescribed, and get and keep an undetectable viral load can live long, healthy lives and have effectively no risk of sexually transmitting HIV to their HIV-negative partners.
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’s 90-90-90 goals set as targets that by 2020, 90% of all people with HIV will know their HIV status, 90% of all people who know their status will be on ART, and 90% of all people receiving ART will have viral suppression. Tracking progress toward those goals, UNAIDS reports that in 2020, of all people with HIV worldwide:
- 84% knew their HIV status
- 73% were accessing ART
- 66% were virally suppressed
Mother-to-Child Transmission—In 2020, 84% of pregnant women with HIV received 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 61% since the peak in 2004. In 2020, around 690,000 people died from AIDS-related illnesses worldwide, compared to 1.2 million in 2010.
Regional Impact—The vast majority of people with HIV are in low- and middle-income countries. In 2020, there were 20.6 million people with HIV (55%) in eastern and southern Africa, 4.7 million (13%) in western and central Africa, 5.7 million (15%) in Asia and the Pacific, and 2.2 million (6%) 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 with new HIV infections 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 mother-to-child transmission of HIV and keeping mothers 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.
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. Disruption to HIV services as high as 75% has been reported in some countries.
- UNAIDS recommends that during the pandemic, HIV services continue to be made available for people with and at risk of 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 nearly 50 million people in Fiscal Year 2020 and, as of September 30, 2020, supported lifesaving ART for nearly 18.2 million men, women, and children.
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.