The Joint United Nations Programme on HIV/AIDS (UNAIDS) warns 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 revealed 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 marginalized 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 warned 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 criminalizing 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.
UNAIDS modeling shows that without restored funding, an additional 6 million HIV infections and 4 million AIDS-related deaths could occur by 2029. UNAIDS projections show that a permanent discontinuation of support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) for HIV treatment and prevention could lead to more than 4 million additional AIDS-related deaths and more than 6 million additional new HIV infections by 2030. UNAIDS reported that the world is “closer than ever” to reaching the 95–95–95 targets for testing and treatment.
“We are proud to have achieved 94% of the people knowing their status with 83% on treatment and 93% virally suppressed, but we know that the second 95 remains our biggest challenge, especially young people and men in particular,” said Nomantu Nkomo-Ralehoko at the UNAIDS Global AIDS Update Report launch. She said that Gauteng is a pioneer in launching the 1.1 ART Gap campaign, aiming to provide treatment to more than 326,000 individuals. She said that the province is extending its HIV treatment campaign to universities, townships, informal settlements, and hostels through diverse strategies like weekly radio slots and corner-to-corner campaigns.
“The men in that taxi rank were very appreciative of the initiative of building the clinics right where they are, because they are saying they have been scared of going to the clinics or hospitals because of the stigma,” said Nkomo-Ralehoko.
Despite funding cuts affecting some NGOs, the province continues to work with civil society and has expanded youth zones, trained more than 200 HIV Testing Services (HTS) counsellors, and deployed mobile clinics. “We continue working with civil society, including the Health and AIDS Council, and have expanded youth zones, trained over 200 HIV Testing Services (HTS) counsellors, and deployed mobile clinics to reach the most vulnerable.”
She expressed gratitude to UNAIDS, SANEC, and other partners for supporting Gauteng’s fight against HIV and reaffirmed the province’s commitment to the UNAIDS 95-95-95 goals and to ending AIDS as a public health threat by 2030.
The aim of this UNAIDS-established target is 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.
“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.
South Africa’s Minister of Health, Dr. Aaron Motsoaledi, said that South Africa remains one of the countries most severely affected by HIV and AIDS, which is why in 2010, the country launched the world’s largest HIV counselling, testing, and treatment campaign. Today, over 5.9 million people are on antiretroviral therapy.
He said the country has made major strides in key health outcomes. Life expectancy has risen significantly. Maternal mortality, once dangerously high, has dropped from 240 deaths per 100,000 live births to as low as 109 before a temporary rise during COVID-19.
Motsoaledi also celebrated a dramatic drop in the number of children born HIV-positive, from 70,000 annually in 2004 to just 634 in recent data. He urged South Africans not to accept HIV, AIDS, and TB as permanent conditions but to shift focus toward their elimination, arguing that it’s possible, just as the world once eradicated smallpox.
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), expressed concern and frustration on behalf of people living with HIV, particularly in light of the potential withdrawal of PEPFAR funding. Bulelo-Diasi said such a move could undo the significant progress South Africa has made in reducing stigma and improving access to care.
He said that while SANERELA has worked closely with the Department of Health to address stigma and discrimination, there is growing anxiety about the future of services for adolescent girls, young women, and other vulnerable populations. He also said that ongoing efforts by SANERELA to engage men in the HIV response. Through initiatives like the Better Men for Tomorrow campaign and partnerships with men’s forums across the country, SANERELA is working to bring men back into care and reduce harmful gender norms that hinder progress in HIV prevention and treatment.
The Reverend said that despite concerns over international funding cuts, especially the possible withdrawal of PEPFAR, he and many others living with HIV are still receiving treatment without interruption.
“I’m still getting my ARVs. There are no problems. Whether PEPFAR is there or not, I’ll get my ARVs every three months,” he said. “If the West and Europe are expecting to see us die, not this time around. They must forget. We are refusing.”
He challenged any assumptions from Western countries that African communities would collapse without aid, asserting that local organizations are now well-equipped to carry the work forward.
Professor Helen Rees, founder and Executive Director of Wits RHI, said the impact of 30 years of community activism was transformative in changing the landscape of HIV. Rees said activism is crucial in securing access to antiretrovirals and advancing the HIV agenda globally.
“We have made huge strides… that was on the back of probably the reference point globally about what is good community activism – HIV. And that was what got access to antiretrovirals, and that is what has continued to push the agenda,” she said. “We mustn’t stop now. We must continue.”
She warned that cuts in global funding, particularly from the U.S., could have a wide-reaching impact, not only on HIV programs but also on other essential humanitarian services in Africa. She said that HIV is not just a health issue but also a development issue, and untreated HIV can weaken entire systems by increasing vulnerability to other diseases and impacting economic and social stability.
Rees said that South Africa has received significant international support, especially from the U.S. government and the National Institutes of Health. This research has yielded breakthroughs with global benefits, including improved treatments and community-based interventions. She called for continued collaboration and warned against abandoning research commitments made under global pandemic preparedness frameworks.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
“We’ve gone from the original days where people had to have cooler boxes and multiple tablets several times a day to single doses of drugs to combination drugs,” she said. “Vaccines have been shown to be very hard to develop for HIV. So we are still a long way, but that research agenda must continue.”
While a cure and vaccines remain elusive, she said the current pipeline includes highly effective drugs that can prevent new infections. However, access and affordability must be addressed to realize their full impact.
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. 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 criticized 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.
Motsoaledi said the current HIV funding crisis should serve as a critical wake-up call for all governments.
“I understand the issue of solidarity, but every government on this planet has a responsibility to provide for its people. That’s where it must start,” he said.
He expressed concern over the global dependency on a single donor country, questioning how such a fragile setup came to be. Referring to recent cuts, he shared that he had reassured his cabinet by highlighting that South Africa already funds 90% of its own antiretroviral medication, with only 10% coming from the Global Fund.