HIV prevention: which countries are still on track?

HIV infections are falling faster in countries that are part of the Global HIV Prevention Coalition than in the rest of the world, according to new UNAIDS data. 

What is the report about? 

The impact of the Global HIV Prevention Coalition (GPC) on the HIV epidemic. This is a coalition of 38 countries working together to speed up declines in HIV infections. 

HIV Prevention: From Crisis to Opportunity reviews the state of HIV prevention in 40 countries. This includes 28 countries that have been part of the GPC since it began in 2017 and 12 countries that were invited to join in 2023 due to rising infections. Together, these countries are home to 75% of people who got HIV in 2022. 

Why is this research important? 

Progress on HIV prevention has been uneven. Many countries are off track to achieve global HIV prevention targets to end AIDS as a public health threat by 2030.  

What did they find out? 

Eleven GPC countries have reduced annual HIV infections by at least 66% since 2010. (Botswana, Cameroon, Côte d’Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Rwanda, Tanzania and Zimbabwe.) In comparison, the average reduction in new HIV infections since 2010 is 38%. 

The countries with the biggest reductions in infections have scaled up primary prevention, such as condom use and voluntary medical male circumcision. They have also scaled up treatment as prevention. In the seven countries with the biggest falls in infections, at least 85% of people with HIV are virally suppressed. 

Successful countries are also using data to focus programmes on people most at risk of HIV. They are adapting services to fit people’s needs. And they are making community-led interventions part of public health programmes. 

But some GPC countries are not making enough progress on HIV prevention. In Angola, Colombia, the Democratic Republic of the Congo (DRC), Ghana, Mozambique, Namibia, South Africa, Uganda and Zambia infections are not falling fast enough. While prevention programmes in Brazil, Colombia, Congo, Egypt, Madagascar, Iran, Mexico, Myanmar, Pakistan, Papua New Guinea, Peru and Philippines are off-track and “require [a] thorough overhaul”, according to the report. Except for the DRC and Papua New Guinea, most HIV infections in these countries are happening among ‘key populations’ and their sex partners. These ‘key populations’ include sex workers, gay men and other men who have sex with men, and people who inject drugs. 

The report shows that many GPC countries are still failing to reach these populations. In 2022, only 44% of sex workers, 28% of gay men and other men who have sex with men and 37% of people who inject drugs accessed effective HIV prevention services in the previous three months. The target is 90%.  

HIV infections among adolescent girls and young women also remain high in sub-Saharan Africa. Yet only 43% of areas with high HIV infection rates have a prevention programme for adolescent girls and young women. 

What does this mean for HIV services? 

This report shows that progress can be made when countries invest in evidence-based, combined approaches to HIV prevention, at a scale big enough to make a difference. 

But HIV prevention programmes will not fully succeed until key populations are able to access them. Laws that criminalise people from these groups, plus stigma, violence, discrimination and social exclusion, are still stopping the people most at risk of HIV from accessing prevention services and information. There is also a lack of investment in HIV prevention programmes for these groups. Working to change these things is key to ending AIDS as a public health threat.  

More must also be done to reduce infections among adolescent girls and young women in sub-Saharan Africa. Providing comprehensive sexuality education, pushing for gender equality, challenging gender-based violence and increasing access to PrEP, condoms and VMMC are all part of this mix. 

Angeli Achrekar, Deputy Executive Director Programme at UNAIDS, said: “The findings of this report offer crucial lessons for action. The report shows that sustained political leadership, investment in effective HIV prevention programmes, and an enabling policy environment are crucial to end AIDS as a public health threat by 2030.”