Global Trends in HIV/AIDS

Global Trends in HIV/AIDS

Updated October 10, 2019
Global Trends in HIV/AIDS
Global Trends
Progress in Addressing HIV/AIDS
According to the Joint U.N. Program on HIV/AIDS
ART Coverage and Prevention. Antiretroviral therapy
(UNAIDS), more than 75 million people have been infected
(ART) prevents the progression of HIV infection. ART also
with the HIV virus since 1996, when the pandemic began.
often suppresses viral loads to levels that significantly
At the end of 2018, 38 million people were living with
reduce the risk of HIV transmission, and it is a key tool for
HIV/AIDS, including 2.1 million children younger than 15
preventing sexual transmission of HIV. Without treatment,
years. The same year, 770,000 people died of HIV-related
those infected with HIV will die.
illnesses, and 1.7 million people were newly infected with
HIV. Globally, an estimated one out of four people infected
U.S. and international efforts to expand access to ART have
with HIV do not know they have it. In 2018, an estimated
increased coverage rates of those infected with HIV from
79% of people living with HIV knew their status.
2% in 2003 to 62% in 2018. Currently, 61% of those in
need of treatment, or 23 million people, are receiving ART.
Successive U.S. Administrations and Congresses have
Since 2003, new HIV infections among adults have been
supported efforts to combat global HIV/AIDS over the past
reduced by 39%. Among children, new infections have
few decades. The United States provides more funding than
dropped by 56%, largely due to increased access to ART
any other country in the global fight against HIV/AIDS.
for the prevention of mother-to-child transmission.
Since the launch of the President’s Emergency Plan for
AIDS Relief (PEPFAR) in FY2004, the United States has
Between 2003 and 2018, annual global HIV incidence (new
provided a total of about $68 billion for global HIV/AIDS
cases) declined by 32%. This decrease has been largely
programs through FY2018 (averaging about $4.6 billion per
fueled by access to biomedical interventions such as ART,
year). This assistance has been provided through PEPFAR,
though evidence suggests that the scaling up of behavior-
bilateral State Department- and USAID-administered
change strategies, which experts view as a key prevention
programs, and the Global Fund to Fight AIDS, Tuberculosis
approach, will be critical to achieving further declines. Such
and Malaria (the Global Fund).
strategies include counseling to improve knowledge of the
disease, and increased risk awareness and communications.
Despite substantial global investments in response to the
HIV/AIDS pandemic—with $19 billion in international
Care. Care of people living with HIV refers to nonclinical
funding for HIV/AIDS programs in low- and middle-
services (e.g., psychosocial, physical, socioeconomic,
income countries in 2018—advocates argue that substantial
nutritional, and legal support) intended to improve quality
work remains to achieve the UNAIDS “90-90-90” goals.
of life, minimize suffering and ill health, and enable access
to treatment. In 2016, there were 13.4 million orphans and
What are the 90-90-90 goals? As part of its goal to
vulnerable children (OVC) living without one or both
end the AIDS epidemic, UNAIDS has set a target for
parents due to an AIDS-related death. Through PEPFAR,
90% of all people living with HIV knowing their HIV
expanded access to care programs helped to support 6.8
status, 90% of all people diagnosed with HIV receiving
million OVC in 2018.
sustained antiretroviral therapy, and 90% of all people
receiving antiretroviral therapy (ART) experiencing
Figure 1. AIDS-Related Deaths and ART Access,
viral suppression. To achieve these goals, UNAIDS is
2003-2017
seeking an additional $5.4 billion from 2016 to 2020.
On average, low- and middle-income HIV/AIDS-affected
countries funded roughly 56% of HIV/AIDS programs in
2018, though the amount they provided varies. Wealthier
countries, like South Africa and India, self-finance around
80% of their national HIV programs, whereas many low-
income states—including several PEPFAR priority
countries—rely on donors for 75% or more of their funding
needs. PEPFAR funding has remained flat for the past
seven years, and global HIV/AIDS aid declined by 7%
between 2017 and 2018. (Data used in this In Focus derive

primarily from UNAIDS and PEPFAR.)
Source: CRS graphic created from UNAIDS data, 2019.

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link to page 1 Global Trends in HIV/AIDS
AIDS Deaths. Expanded access to prevention
Preventing Mother-to-Child Transmission (MTCT) and
programming and higher ART coverage rates have driven
Treatment Access for Children. Some health experts are
declines in AIDS deaths. Between 2003 and 2018, AIDS-
concerned that gains recorded in improving prevention and
related deaths declined by 59% (Figure 1).
access to treatment differ across age groups. Conference
Challenges
participants noted that the global health community is not
meeting its commitment to end the AIDS epidemic amongst
Some experts believe it is possible to see an AIDS-free
children and adolescents. Scientists discussed how, for
generation, though significant challenges remain.
example, gaps in treatment of pregnant women in eastern
Africa, have led to high rates of MTCT.
HIV/TB Co-infection. The growing global tuberculosis
(TB) burden complicates efforts to reduce HIV/AIDS-
Stigma and Key Populations. Some civil society members
related deaths; co-infection increases the progress of both
and advocates discussed the global stigmatization and
diseases and renders treatment more difficult. Those with
criminalization of homosexuality, injection drug use, and
HIV are 20 times more likely to develop TB, the leading
sex work noting that these issues present challenges to HIV
cause of death for those with HIV. TB accounted for
prevention efforts. Some experts noted that low use of HIV
256,000 deaths in 2018.
services (e.g., HIV testing and treatment) among
stigmatized groups could be improved by uptake of
HIV Treatment and Testing Coverage. While ART
prevention drugs, such as PreP, but reiterated that
treatment rates are climbing, ART coverage is not
decreasing stigma and improving overall service access is
expanding fast enough to meet UNAIDS targets. At the end
still necessary to meet the 90-90-90 goals. Conference
of 2018, 39% of those in need of treatment lacked access to
participants called for a greater focus on these groups, and
ART. Inadequate access to HIV/AIDS testing services is an
for further integration of HIV treatment and prevention
impediment to increasing ART coverage rates. In 2018, 8
services into existing sexual and reproductive health
million people lacked access to HIV testing services.
programs.
Regional Challenges
Gender. Scientific experts presented on interventions to
improve prevention efforts among young women and
Africa. The HIV/AIDS pandemic is concentrated in sub-
adolescent girls, as well as improving women’s knowledge
Saharan Africa. In 2018, two-thirds of all people living with
of their status and uptake of treatment regimens. Experts
HIV/AIDS resided in the region, as did 66% of all HIV-
believe this is a key area in reducing transmission, as
positive children. The region also accounted for over half of
infection rates among women continue to outpace
new infections in 2018. Addressing low testing coverage
infections in men.
within this population remains an impediment to further
reducing HIV transmission rates, where heterosexual sex is
Outlook and U.S. Engagement
the primary mode of HIV transmission. HIV/AIDS testing
rates are particularly low among African men aged 25-34.
In 2018, the United States supported 14 million people with
ART through PEPFAR, the main channel through which
Central Asia and Eastern Europe. Experts are concerned
the United States supports efforts to more rapidly achieve
about a rise in HIV/AIDS infections in Central Asia and
the 90-90-90 goals. Known as PEPFAR 3.0, it seeks to
Eastern Europe, where infection rates grew by 57% from
focus investments in geographic areas and populations with
2010 to 2015, mainly due to increased injection drug use.
the highest HIV/AIDS burden, to maximize the cost-
ART coverage rates are also relatively low in the region:
effectiveness of PEPFAR funding.
36% of people living with HIV receive ART, indicating a
relatively large unmet need for scaling up treatment and
The Trump Administration has proposed reductions in
prevention programs.
PEPFAR funding as well as the U.S. contribution to the
Global Fund. It requested $3.4 billion for PEPFAR in
Middle East and North Africa. Low ART coverage in the
FY2020, a 29% cut from FY2019-enacted levels, including
Middle East and North Africa also concerns observers. At
cuts to funding for PEPFAR programs managed by the
the end of 2018, 32% of infected adults were receiving
State Department and the Global Fund.
ART—the lowest coverage rate in the world. Here,
conservative cultural practices, inadequate HIV/AIDS
Some Members of Congress and HIV/AIDS advocates have
expressed concern regarding the Administration’s
policies, and stigma are key barriers to improving ART
coverage.
willingness to devote resources to combating the global
AIDS epidemic and the prospect that people on ART might
Issues at the 2019 IAS Conference on
lose coverage due to spending cuts. PEPFAR continues to
receive bipartisan support in Congress, which has
HIV Science
appropriated global health and HIV/AIDS funding over the
The follow-on to the UNAIDS 2018 Conference, the
past three years at levels consistent with funding during the
International AIDS Society Conference on HIV Science,
last Administration.
was held in Mexico City in July 2019. Stakeholders
gathered to discuss the state of the science related to the
Sara M. Tharakan, Analyst in Global Health and
HIV/AIDS epidemic. Key issues discussed included the
International Development
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