HIV deaths and new infections decline

But not fast enough to meet 2030 targets

ANALYSIS | MELODY CHIRONDA | The Joint United Nations Programme on HIV/AIDS (UNAIDS) has warned that the global AIDS response is in crisis after a major funding collapse at the start of 2025 threatens to reverse decades of progress.

New data reveals that while the world has made progress in expanding treatment and reducing deaths, the response is falling short of critical targets, especially among children, men, and marginalised groups. A new UNAIDS report, AIDS, Crisis and the Power to Transform shows that at the end of 2024, just before a sudden collapse in funding triggered a crisis in the global AIDS interventions, the remarkable efforts of communities and governments had brought down the numbers of new HIV infections by 40% and of AIDS-related deaths by 56% since 2010.

UNAIDS Executive Director Winnie Byanyima said the `2024 Global AIDS Update Report’ highlights both remarkable progress and serious setbacks in the global HIV response. However, she warns that this progress is now at risk due to a major disruption in 2024, especially the sudden withdrawal of the largest HIV donor and gradual funding cuts from other governments.

According to UNAIDS, if the world does not act, there will be six million new HIV infections and four million more deaths due to AIDS by 2029.

“If the world doesn’t plug this hole, we estimate that an additional 6 million people will be newly infected in the next four years,” said Byanyima. “We could have 4 million additional deaths, AIDS-related deaths.”

A reduction in funding can be a “death sentence” for Africans since it leads to clinics closing and stops lifesaving HIV services such as testing, treatment, and prevention. This disruption results in increased HIV infections, treatment interruptions, and more AIDS-related deaths, reversing decades of progress.

Byanyima also raised the alarm over a growing backlash against human rights, including an increase in countries criminalising same-sex relations and gender expression, factors that prevent people from seeking life-saving HIV services. Despite these challenges, she said that governments and communities are taking action by reallocating resources, creating new funding streams, and integrating HIV care into broader health systems in more cost-effective ways.

“Rich countries must also maintain support to end a global disease,” Byanyima said.

Women and girls accounted for 45% of new infections

The global HIV epidemic remains a formidable public health challenge, with 40.8 million people living with the virus, according to UNAIDS 2025 epidemiological estimates. In 2024, 1.3 million people became newly infected with HIV, down 61% from the peak of 3.4 million in 1996. However, this still far exceeds the global target of fewer than 370,000 new infections by 2025. In sub-Saharan Africa, which hosts half of all HIV infections worldwide in 2024, the number of new infections declined even more steeply by 56%. Several countries, mainly from sub-Saharan Africa, are on track to reach 90% reductions in new infections by 2030.

Women and girls account for 45% of new infections globally and 63% in sub-Saharan Africa, face heightened risks, with 4,000 adolescent girls and young women aged 15–24 infected weekly. Key populations, including gay men (7.6% prevalence), transgender people (8.5%), and people who inject drugs (7.1%), remain disproportionately affected due to marginalization and stigma.

The UNAIDS 2025 Global AIDS Update reports that 630,000 people died from AIDS-related illnesses in 2024, a figure it describes as “unacceptably high,” despite representing a 54% decline since 2010. The number of children dying from AIDS also dropped significantly, from 240,000 in 2010 to 75,000 in 2024.

According to the report, this progress is largely due to “the large-scale provision of mostly free-of-charge HIV testing services and treatment”.

In 2024, 77% of the 40.8 million people living with HIV globally were receiving antiretroviral therapy, and 73% had suppressed viral loads – a critical indicator of treatment success and reduced transmission risk.

The report also highlights regional progress. In sub-Saharan Africa, which is home to more than 60% of the global HIV population, expanded access to treatment has helped increase life expectancy from 56.5 years in 2010 to 62.3 years in 2024.

An unprecedented opportunity for HIV prevention

The promise of long-acting HIV prevention tools like lenacapavir, which requires only twice-yearly injections, offers hope for a prevention revolution, but only if global cooperation ensures affordable access.

Long-acting PrEP – such as the injectable antiretroviral medicines cabotegravir and lenacapavir, and the dapivirine vaginal ring – is an exciting addition to HIV prevention. For women who struggle to negotiate condom use with male partners, LGBTQIA+ people who face stigma and discrimination, female sex workers, and people who find it difficult to adhere to oral PrEP, the option of replacing several doses of oral PrEP a week with much less frequent injections could make it easier to avoid acquiring HIV.

The report highlights results from the PURPOSE 1 trial, conducted among adolescent girls and young women in South Africa and Uganda, where lenacapavir demonstrated 100% efficacy. In the PURPOSE 2 trial, which included cisgender men and transgender people across multiple countries, including South Africa, the U.S., Brazil, and Thailand, efficacy reached 96%. UNAIDS said that lenacapavir is safe and well-tolerated, even during pregnancy, and addresses “many of the adherence and continuation challenges associated with oral PrEP.”

A once-a-year injection is currently in development

If scaled equitably, lenacapavir could transform HIV prevention and help bring the epidemic under control. But this momentum was disrupted by the withdrawal of the largest global funder, affecting HIV treatment and prevention programs in low- and middle-income countries, many of which rely on external aid for up to 80% of prevention services.

South Africa’s HIV fight

South Africa remains at the epicenter of the global HIV epidemic, with 7.8 million people living with the virus. Despite remarkable strides in reducing new infections and AIDS-related deaths over the past two decades, significant gaps in treatment access, gender disparities, and persistent stigma continue to hinder progress. The latest 2025 fact sheet reveals the battle is far from over.

According to the latest data, 7.8 million South Africans were living with HIV in 2024, including 7,7 million adults and 150,000 children. Women and girls, who accounted for 65% of those living with HIV, continue to bear a disproportionate burden.

“The AIDS response may be in crisis, but we have the power to transform”

“The AIDS response may be in crisis, but we have the power to transform,” the UNAIDS report states, urging global solidarity and renewed commitment to end AIDS as a public health threat by 2030.

UNAIDS established a target for 95% of those living with HIV to know their status, 95% of those diagnosed to be on antiretroviral therapy (ART), and 95% of those on ART to achieve viral suppression by 2030. Several African countries have achieved or surpassed the UNAIDS 95-95-95 targets. Eswatini, Botswana, Rwanda, Tanzania, Burundi, Malawi, Kenya, Zambia, and Zimbabwe achieved or are very close to achieving the 95-95-95 targets.

South Africa’s Minister of Health, Dr. Aaron Motsoaledi, celebrated a dramatic drop in the number of children born HIV-positive, from 70,000 annually in 2004 to 634 in recent data.

During his Budget speech in Parliament, Motsoaledi urged South Africans not to accept HIV, AIDS, and TB as permanent fixtures requiring annual budgets, but to focus on eliminating these diseases.

“We must start thinking about elimination. We must start thinking about getting rid of this disease. And it’s within our reach,” said Dr. Motsoaledi, “If the West and Europe are expecting to see us die, not this time around.”

Reverend Bulelo-Diasi, Executive Director of the South African Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (SANERELA), challenged assumptions from Western countries that African communities would collapse without aid, asserting that local organisations are now well-equipped to carry the work forward.

African ownership, not charity, key to sustaining HIV progress

“This region, Africa – particularly sub-Saharan Africa – has been the most dependent on external assistance. But it is also the region that has been making the fastest progress against the disease, is the region with the highest burden of the disease, and the region with the best innovations,” said Byanyima.

She said the sudden withdrawal of support by a major donor raises serious concerns about the nature of global partnerships. Such decisions, she said, show that global solidarity was never on stable ground. “True solidarity means shared responsibility, not charity.”

Byanyima criticised the abrupt withdrawal of funding, such as cuts to USAID, as a sign of flawed global solidarity, arguing that such actions highlight the need for stronger, non-charitable partnerships to address a global disease.

True solidarity, she argued, means shared responsibility, not charity.

The UNAIDS Executive Director called on African governments to stop focusing only on what has been lost and instead act quickly to implement solutions. She called for reallocating domestic budgets, finding cost-effective delivery models, and prioritizing affordable new prevention tools, like long-acting injectable treatments for young women. She reminded the audience that South Africa once led a global campaign, under Nelson Mandela, to reduce the cost of ARVs, and said that same spirit must now be used to secure affordable access to the latest HIV prevention tools.

She said that producing medicines locally and reducing new infections could lead to HIV elimination, but global responsibility must remain, as HIV is a shared challenge, not an African invention.

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Source: AllAfrica