The global fight against HIV/AIDS faces a critical juncture as funding shifts and the U.S. Government re-evaluates its long-standing commitment to international programs. As of 2024, approximately 40.8 million people are living with HIV worldwide, a figure that has risen from 32 million in 2010, despite significant advances in treatment, and prevention.
The emergence of HIV was first officially reported in 1981, when the U.S. Centers for Disease Control and Prevention (CDC) published a report detailing cases of Pneumocystis carinii pneumonia – a rare lung infection – in five young, previously healthy gay men in Los Angeles. Shortly after, reports surfaced of Kaposi’s sarcoma, another unusual infection, among gay men in New York and California, signaling a new and alarming health crisis.
Over the past two decades, international efforts have yielded progress. The number of new HIV infections, particularly among children, and the number of AIDS-related deaths have declined. In 2024, approximately 31.6 million people were receiving treatment, representing 77% of those living with HIV. However, significant challenges remain, including unequal access to prevention, treatment, and care, and the absence of a cure.
According to the World Health Organization (WHO), approximately 630,000 people died of AIDS-related illnesses in 2022, a 55% decrease from 1.4 million in 2010. Despite this decline, HIV remains a leading cause of death globally, and the leading cause of death among women of reproductive age. Sub-Saharan Africa remains the most heavily affected region, accounting for approximately two-thirds of all people living with HIV globally.
The U.S. Government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), has been the single largest donor to international HIV efforts since the program’s inception in 2003, directing over $130 billion towards prevention, care, and treatment. However, the program is undergoing substantial changes under the current administration. A new U.S. Strategy, outlined in the America First Global Health Strategy, aims to accelerate the transition of PEPFAR services and financing to host country governments, with plans to scale down U.S. Funding over the coming years. This shift requires recipient countries to increasingly co-finance HIV programs.
These changes come as global health leaders function towards achieving the UNAIDS 95-95-95 targets by 2025 – 95% of people living with HIV knowing their status, 95% of those diagnosed receiving treatment, and 95% of those on treatment achieving viral suppression. As of 2024, progress towards these targets is mixed, with 87% of people living with HIV aware of their status, 89% of those diagnosed receiving treatment, and 94% of those on treatment achieving viral suppression.
The future trajectory of the global HIV/AIDS response remains uncertain as the U.S. Government continues to implement its revised strategy and funding levels for PEPFAR are debated. The administration is currently developing bilateral agreements with countries to integrate PEPFAR programming with other global health areas, a move that has raised concerns among some stakeholders about the potential impact on HIV prevention and treatment efforts.
