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1、THE URGENCY OF NOWAIDS AT A CROSSROADS2024 GLOBAL AIDS UPDATE Joint United Nations Programme on HIV/AIDS(UNAIDS),2024Some rights reserved.This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence(CC BY-NC-SA 3.0 IGO;https:/creativecommons.org/licenses/by-

2、nc-sa/3.0/igo/).Under the terms of this licence,you may copy,redistribute and adapt the work for non-commercial purposes,provided the work is appropriately cited,as indicated below.In any use of this work,there should be no suggestion that UNAIDS endorses any specific organization,products or servic

3、es.The use of the UNAIDS logo is not permitted.If you adapt the work,then you must license your work under the same or equivalent Creative Commons licence.If you create a translation of this work,you should add the following disclaimer along with the suggested citation:“This translation was not crea

4、ted by UNAIDS.UNAIDS is not responsible for the content or accuracy of this translation.The original English edition shall be the binding and authentic edition.”Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intelle

5、ctual Property Organization(http:/www.wipo.int/amc/en/mediation/rules).Suggested citation.The urgency of now:AIDS at a crossroads.Geneva:Joint United Nations Programme on HIV/AIDS;2024.Licence:CC BY-NC-SA 3.0 IGO.Third-party materials.If you wish to reuse material from this work that is attributed t

6、o a third party,such as tables,figures or images,it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder.The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the u

7、ser.The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country,territory,city or area or of its authorities,or concerning the delimitation of its frontiers o

8、r boundaries.Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by UNAIDS in preference to others of a similar nature that ar

9、e not mentioned.Errors and omissions excepted,the names of proprietary products are distinguished by initial capital letters.All reasonable precautions have been taken by UNAIDS to verify the information contained in this publication.However,the published material is being distributed without warran

10、ty of any kind,either expressed or implied.The responsibility for the interpretation and use of the material lies with the reader.In no event shall UNAIDS be liable for damages arising from its use.UNAIDS/JC3116ETHE URGENCY OF NOWAIDS AT A CROSSROADS2024 GLOBAL AIDS UPDATECONTENTSForeword 4Executive

11、 summary 6PROGRESS AT THE HALFWAY MARK TO THE 2025 MILESTONES 22Overview:the state of the HIV pandemic 24Accessing HIV services and solutions 32HIV prevention 33Treatment and care for people living with HIV 71Ending paediatric AIDS 99Breaking down barriers:reaching the 101010 and 308060 targets 118E

12、nding HIV-related stigma and discrimination,gender-based violence and criminalizing laws 119Community-led interventions deliver results 152Integrating and resourcing HIV responses 168Integration of strategies,services and systems 169Resourcing the HIV response 188TAKING A SUSTAINABLE HIV RESPONSE TO

13、 2030 AND BEYOND 210Ending AIDS as a public health threat 215What will it take to reach the 2025 and 2030 targets and sustain impact?219Integration can take many shapes and forms 225REGIONAL CHAPTERS 232Asia and the Pacific 234Caribbean 239Eastern Europe and central Asia 243Eastern and southern Afri

14、ca 247Latin America 251Middle East and North Africa 255Western and central Africa 258Western and central Europe and North America 261ANNEX 1 Progress towards the 2025 targets 265ANNEX 2 Methods 2743FOREWORDWINNIE BYANYIMA UNAIDS Executive DirectorThis report shows that world leaders can fulfil their

15、 promise to end AIDS as a public health threat by 2030,and in so doing prevent millions of AIDS-related deaths,prevent millions of new HIV infections,and ensure the almost 40 million people living with HIV have healthy,full lives.Through powerful case studies and new data,the report shows how some c

16、ountries are already on the right pathand how all countries can get on it.The report also shows that,right now,the world is not on track to succeed,and the inequalities that drive the HIV pandemic are not being addressed sufficiently.It shows that due to the lack of progress on prevention,global num

17、bers of new HIV infections are not declining fast enough,and in three regions of the world numbers of HIV infections are rising.It shows that almost a quarter of people living with HIV are not receiving lifesaving treatment,and consequently a person dies from AIDS-related causes every minute.We know

18、 what enables success.Progress against HIV has been strongest in the countries that have invested as required in their responses and reformed their policies to enable people to access the services they need.To accelerate the end of AIDS as a public health threat,and to ensure services and systems ar

19、e in place to meet the needs of the millions of 2024 GLOBAL AIDS UPDATE4people living with HIV for decades to come,resourcing needs to be both sufficient and sustainable.Building a legal environment that facilitates access to effective,equitable and person-centred HIV servicesincluding removing harm

20、ful criminalizing laws and tackling discriminationis key to advancing and sustaining progress on prevention and treatment.We know,too,what obstructs success.Progress is imperilled by the fraying of solidarity between and within countries.When political commitment to full financing and human rights i

21、s put at risk,progress in the HIV response is put at risk too.A widening funding gap is holding back the HIV response in low-and middle-income countries,with fiscal space being tightened even further by the debt crisis.The recent surge in the promotion of anti-rights,anti-gender and anti-democracy p

22、olicies is generating justified fear among people from marginalized communities who most need HIV prevention,testing,treatment and care services,and among the heroic frontline workers who provide them.Advances in technology,in particular in the development of long-acting treatment and prevention opt

23、ions,can protect the health of everyone living with or at risk of HIVbut only if these technologies are shared with all low-and middle-income countries,and are produced by multiple manufacturers across the world at scale.Currently,patent-holders are not opening up access broadly enough to enable thi

24、s breakthrough.The HIV response is at a crossroads.Whether the world ends AIDS depends on the path that leaders take.The path that ends AIDS is not a mystery.It is a political and financial choice.Some are reluctant to provide the scale of resourcing needed for ending AIDS.But,as the report demonstr

25、ates,the costs of not ending AIDS would be exponentially higher.Some might like to walk away from the HIV response because the end is now in reach.But,as this report sets out,we cannot partly end a pandemic.Leaders can end AIDS as a public health threat only by overcoming it everywhere,for everyone.

26、Some imply that investments and reforms to end AIDS would detract from addressing other challenges.But,as the report illustrates,the actions needed to end AIDS will help advance the achievement of all the Sustainable Development Goals,ensure countries are prepared to overcome the pandemics of the fu

27、ture,and help secure a safer,fairer world for everyone.I am sometimes asked whether I am an optimist about the HIV response,because the progress we have made shows the path that ends AIDSor whether I am a pessimist,because restrictions on resourcing and rights are putting progress in danger.The answ

28、er is that I am neither an optimist nor a pessimistI am an activist,because success depends on rising to the moment,on recognizing the urgency of now.We can end AIDS,but only if leaders choose the right path now.We the people will ensure they do.5Midway to the 2025 milestone set at the United Nation

29、s General Assembly in June 2021(1),the global HIV response has moved closer to the goal of ending AIDS as a public health threat by 2030,a commitment enshrined in the Sustainable Development Goals.Fewer people acquired HIV in 2023 than at any point since the late 1980s.Almost 31 million people were

30、receiving lifesaving antiretroviral therapy in 2023,a public health success that has reduced the numbers of AIDS-related deaths to their lowest level since the peak in 2004(Figures 0.1 and 0.2).1 In sub-Saharan Africa,these successes have led to a rebound in average life expectancy from 56.3 years i

31、n 2010 to 61.1 years in 2023(2).EXECUTIVE SUMMARY1 For more information on UNAIDS data in this report,see Annex 2 on methods.Figure 0.1 Number of new HIV infections,global,19902023,and 2025 targetSource:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).Figure 0.2 Number of AIDS-rela

32、ted deaths,global,19902023,and 2025 targetSource:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).Number of new HIV infections01 000 0002 000 0003 000 0004 000 000500 0001 500 0002 500 0003 500 0004 500 000199020232025target1990Number of AIDS-related deaths0500 0001 500 0002 500 00

33、01 000 0002 000 0003 000 00020232025target2024 GLOBAL AIDS UPDATE6The progress is highly uneven,however.The global HIV response is moving at two speeds:relatively swiftly in sub-Saharan Africa,but hesitantly across the rest of the world.The numbers of people acquiring HIV are rising in at least 28 c

34、ountries,some of which already have substantial epidemics.Many HIV programmes still neglect people from key populations,2 exposing them to high risks of acquiring HIV.Programmes are also missing 9.3 million 7.4 million10.8 million people who need lifesaving treatment,with children and adolescents li

35、ving with HIV especially affected.AIDS is not overa great deal of unfinished work lies ahead.The global AIDS response is at a crossroads:success or failure will be determined by which path leaders take today.The Urgency of Now:AIDS at a Crossroads shows that the decisions leaders make this year will

36、 determine whether or not countries can achieve the 2030 target of ending AIDS as a public health threat and ensure progress beyond 2030.While progress has been made in providing HIV treatment to over 30 million people,much more effort and urgency is required to accelerate prevention and break down

37、the barriers that keep people,especially marginalized people,from both HIV prevention and treatment services.Leaders,community members and programme managers must work together to close the significant gaps that remain in access to HIV services.Progress on HIV prevention lags far behind what is requ

38、ired.HIV services will reach people only if human rights are upheld,if unfair and harmful laws are removed,and if discrimination and violence are tackled.Equitable access to medicines and innovations,including long-acting technologies,is critical.Now is the time to invest in ensuring that the 2025 t

39、argets are met and a sustainable response is built for the decades to come.The HIV response needs to adjust to become a sustainable,integrated pillar of health and social services with communities and human rights at the centre.This report provides a summary of progress against the 2025 targets that

40、 were developed with the Global AIDS Strategy 20212026.The chapters describe progress against each target and Annex 1 provides a summary overview.The HIV pandemic todayGlobally,about 39%fewer people acquired HIV in 2023 compared with 2010,with sub-Saharan Africa achieving the steepest reduction(56%)

41、.Nonetheless,an estimated 1.3 million 1.0 million1.7 million people acquired HIV in 2023over three times more than the target of 370 000 or fewer new infections in 2025.Three regions are experiencing rising numbers of new HIV infections:eastern Europe and central Asia,Latin America,and the Middle Ea

42、st and North Africa.2 People from key populations include sex workers,gay men and other men who have sex with men,people who inject drugs,transgender people,and people in prisons and other closed settings.7For the first time in the history of the HIV pandemic,more new infections are occurring outsid

43、e sub-Saharan Africa than in sub-Saharan Africa.This reflects both the prevention achievements in much of sub-Saharan Africa and the lack of comparable progress in the rest of the world,where people from key populations and their sex partners continue to be neglected in most HIV programmes.There is

44、inadequate political will to fund and provide prevention programmes for people from key populations,and hostile legal and social conditions further limit their access to lifesaving services.Persistent stigma and discrimination related to HIV status,gender,behaviours or sexuality also stand in the wa

45、y.The HIV-related needs of people from key populations are often served by nongovernmental organizations,including community-led organizations,whose work tends to go unrecognized and underfunded.Although decreasing,the incidence of HIV among adolescent girls and young women aged 1524 years is extrao

46、rdinarily high in parts of sub-Saharan Africa.Prevention programmes and efforts to reduce gender inequalities,violence against women and harmful gender norms are not having a big enough impact.Far fewer children aged 014 years are acquiring HIV,a trend that is due largely to successes in eastern and

47、 southern Africa,where the annual number of new HIV infections in children fell by 73%between 2010 and 2023.The overall decline in vertical HIV infections,3 however,has slowed markedly in recent years,particularly in western and central Africa.An estimated 120 000 83 000170 000 children acquired HIV

48、 in 2023,bringing the total number of children living with HIV globally to 1.4 million 1.1 million1.7 million,86%of whom are in sub-Saharan Africa.Widening access to antiretroviral therapymuch of it provided free of charge and through the public health sectorhas more than halved the annual number of

49、 AIDS-related deaths,from 1.3 million 1.0 million1.7 million in 2010 to 630 000 500 000820 000 in 2023.Treatment programmes are also driving down the numbers of new HIV infections.An estimated 30.7 million 27.0 million31.9 million people were receiving HIV treatment in 2023.The world can reduce the

50、number of AIDS-related deaths to fewer than the 2025 target of 250 000 if it achieves further rapid increases in diagnosing and providing HIV treatment to people living with HIV(Figure 0.3).3 Vertical transmission of HIV occurs during the pregnancy and breastfeeding period.2024 GLOBAL AIDS UPDATE8Fi

51、gure 0.3 Percentage change in annual number of AIDS-related deaths between 2010 and 2023,global and by regionSource:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).Easternand southernAfricaWesternand centralAfricaWestern and central Europe and North AmericaCaribbeanAsia andthe Pac

52、ificLatinAmericaEastern Europe andcentral AsiaMiddle East andNorth AfricaGlobal60402002040Per cent51575755513428634The scale of the HIV pandemic is so large,however,that even these accomplishments still left about 9.3 million 7.4 million10.8 million people living with HIV without treatment in 2023,a

53、lmost half(4.7 million 3.8 million5.4 million)of whom were in sub-Saharan Africa.Treatment coverage continued to be lower among men and among people from key populations,especially in sub-Saharan Africa(3),and it was especially low among children.Approximately 630 000 500 000820 000 people around th

54、e world lost their lives to AIDS in 2023,including 76 000 53 000110 000 children aged 014 yearsone in eight people who died due to AIDS in 2023 was a child.Mixed progress in serving peoples prevention needsGlobally,the 2025 prevention target(95%of people at risk of HIV infection have access to and u

55、se effective combination prevention options)are not within reach.The global HIV prevention response is proceeding at an encouraging pace in sub-Saharan Africa,but it has stalled in other regions.Persistent and,in some countries,widening gaps in basic HIV prevention must be resolved urgently.At least

56、 half of all people from key populations are not being reached with prevention services,according to data reported to UNAIDS.Men and women who inject drugs,gay men and other men who have sex with men,and transgender people are particularly neglected.In addition,more than half of the areas with high

57、or moderately high HIV incidence4 in sub-Saharan Africa are not being served by prevention programmes tailored for adolescent girls and young women.4 High HIV incidence denotes one or more new infections per 100 person-years.Moderately high incidence denotes 0.30.99 new infections per 100 person-yea

58、rs.9Condom use remains the most effective low-cost HIV prevention method(4,5),but condom programmes have been defunded and social marketing schemes cut back in many countries(6).Household survey data suggest condom use has declined in recent years,including among young people aged 1524 years,and it

59、is highly infrequent during sex with non-regular partners.About 36%of adults in eastern and southern Africa and 25%in western and central Africa used a condom at last sex.Sex workers in some countries report high levels of condom use with clients,but their access to potent prevention tools such as p

60、re-exposure prophylaxis(PrEP)5 is minimal.The same is true for gay men and other men who have sex with men and for transgender people,except in a few high-income countries.Access to harm reduction services for people who inject drugs is extremely low in all but a few countries.Rapid,wider access to

61、PrEP could massively reduce the numbers of new HIV infections,especially among people from key populations and among women in areas where HIV incidence is currently high.The total number of people using oral PrEP rose from a little over 200 000 in 2017 to about 3.5 million in 2023 but is far short o

62、f the global 2025 target of 21.2 million people.Only the two regions in sub-Saharan Africa are making progress to reaching the 2025 PrEP targets(Figure 0.4).A six-month long-acting injectable PrEP product,lenacapavir,has shown extremely high efficacy in preventing HIV among adolescent girls and wome

63、n in Africa.If this PrEP option is made available rapidly and affordably to potential users,it could herald a breakthrough for HIV prevention(7).Figure 0.4 Number of people who used pre-exposure prophylaxis(PrEP)at least once in 2023,by region,and 2025 targetSource:Global AIDS Monitoring,2024(https:

64、/aidsinfo.unaids.org/).5 PrEP entails taking antiretroviral medicines to prevent the acquisition of HIV.Number of people who received PrEP at least onceNumber of people who received PrEP at least once(millions)Asia andthe PacificEastern Europeand central AsiaEastern andsouthern AfricaLatin America a

65、ndthe CaribbeanMiddle East andNorth AfricaWestern andcentral AfricaWestern andcentral Europeand North America01234567982025 target2024 GLOBAL AIDS UPDATE10There are opportunities for voluntary medical male circumcision(VMMC)programmes to make a bigger impact(8).The 35 million circumcisions conducted

66、 between 2008 and 2022 in 15 priority countries in eastern and southern Africa averted an estimated 670 000 HIV infections(9).Most of these countries have scope to increase VMMC uptake further if they can overcome funding shortages and expand the services to older age groups.Access to HIV treatment

67、continues to expandApproximately 30.7 million 27.0 million31.9 million of the estimated 39.9 million 36.1 million44.6 million people living with HIV globally were receiving antiretroviral therapy in 2023(Figure 0.5).This is a landmark public health achievement.As recently as 2015,global treatment co

68、verage was only 47%3855%but in 2023,it stood at 77%6189%.Figure 0.5 Number of people receiving antiretroviral therapy,20102023,global,and 2025 targetSource:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).Number of people on treatment(millions)0102030515253540201020232025target11Su

69、pporting people living with HIV to start and stay on antiretroviral therapy has enormous personal and public health benefits.People with an undetectable viral load have zero risk of transmitting HIV to their sexual partners,and people with a suppressed viral load have a near-zero risk of doing so(10

70、,11).6 This has given rise to the campaign Undetectable=Untransmittable,or U=U.The successful treatment of HIV is crucially important for preventing new HIV infections(12).In 2023,almost three in four adults(73%6681%)living with HIV globally had a suppressed viral load,a big improvement compared wit

71、h the 40%3645%in 2015.The 959595 targets set for 2025 are within reach.7 Approximately 86%6998%of people living with HIV worldwide knew their HIV status in 2023.Among them,approximately 89%7198%of people were receiving antiretroviral therapy and 93%7498%of people on treatment had a suppressed viral

72、load(Figure 0.6).Some of the biggest gains have occurred in sub-Saharan Africa,often in unfavourable conditions.Health and community systems have become better at offering HIV tests to people who may have been exposed to HIV,and at linking them to reliable treatment and care services.More tolerable

73、and effective treatment regimens are making it easier for people to keep taking their antiretroviral medicines and have suppressed viral loads.6 A viral load is undetectable when it is so low that a polymerase chain reaction test cannot measure it.A suppressed viral load is defined as equal to or be

74、low 1000 copies/mL.7 95%of people living with HIV know their HIV status;95%of people who know they are living with HIV receive antiretroviral therapy;and 95%of people receiving antiretroviral therapy have suppressed viral loads.8 The Netherlands,Uruguay,Bolivarian Republic of Venezuela.Figure 0.6 Pe

75、rcentage of people living with HIV who know their HIV status,of people who know their HIV status and are receiving antiretroviral therapy,and of people on HIV treatment who have suppressed viral load,global,2023 Source:Further analysis of UNAIDS epidemiological estimates,2024.86(6998)89(7198)93(7498

76、)People living with HIV who know their statusPeople who know their HIVstatus and are on treatmentPeople living with HIV on treatmentwho have a suppressed viral loadPer cent02040608010305070901002025 target2024 GLOBAL AIDS UPDATE12Disparities in access to HIV testing and treatment,however,continue to

77、 undercut the overall impact of these accomplishments(Figure 0.7).Children aged 014 years living with HIV remain considerably less likely than adults to be diagnosed and receive antiretroviral therapy:about 43%3157%of the global total of 1.4 million 1.1 million1.7 million children living with HIV we

78、re not receiving treatment in 2023.Children accounted for 12%of all AIDS-related deaths,even though they constitute only 3%of people living with HIV.More than one third(36%),or 370 000 250 000470 000,of older adolescents aged 1519 years living with HIV were not receiving antiretroviral therapy in 20

79、23.Across much of the world,adult men aged 15 years and over living with HIV are less likely than their female counterparts to know their HIV status and receive HIV treatment;their treatment outcomes also tend to be poorer.Antiretroviral therapy coverage among some key populations may have increased

80、 in recent years(13),but people from key populations living with HIV still have lower antiretroviral therapy coverage and worse treatment outcomes than other people living with HIV,particularly in sub-Saharan Africa(3).Figure 0.7 Testing and treatment cascade among children,women and men,global,2023

81、Source:Further analysis of UNAIDS epidemiological estimates,2024.66(4787)57(4157)48(3960)Women(aged 15+years)living with HIV91(7298)83(6696)78(7087)Men(aged 15+years)living with HIV83(6597)72(5684)67(6075)Children(aged 014 years)living with HIV0102030405060708090100People living with HIV who know th

82、eir HIV statusPeople living with HIV who are on treatmentPeople living with HIV who have a suppressed viral loadPer centConsequently,one quarter(23%1927%)of all people living with HIV were not receiving antiretroviral therapy in 2023.Access to treatment was especially low in eastern Europe and centr

83、al Asia and the Middle East and North Africa,where only about half of the 2.1 million 1.9 million2.3 million and 210 000 170 000280 000 people living with HIV,respectively,were receiving antiretroviral therapy.13There are other challenges too.It is estimated that at least 1.8 million 1.6 million2.0

84、million people have advanced HIV disease(AIDS).AIDS used to be seen mainly as a problem of late diagnosis and treatment of HIV infection.These concerns remain,but AIDS is now most common among people who have received antiretroviral therapy and then stopped treatment(14,15).This puts their health at

85、 risk,increases the risk of HIV transmission,and adds to the burden on health systems(16,17).There is an urgent need for effective interventions and support so people can stay on HIV treatment and those who have interrupted their treatment can be re-engaged in care.The success of HIV treatment has l

86、ed to a rise in the average age of people living with HIV.As people living with HIV grow older,they are likely to encounter a growing range of comorbidities,including noncommunicable diseases such as hypertension and diabetes,that require care.Closer integration of HIV and other health services,equi

87、pment and supply chains,and upgraded training for health workers will be needed to deal with these changes.Slow progress in reducing stigma,discrimination,social inequalities and violenceThe 101010 and the 308060 targets set for 2025 are not within reach.Stigma,discrimination,social inequalities and

88、 gender-based violence make it hard for people to stay free of HIV and protect their health(18).People from key populations are especially vulnerable(19).Recognition of these hindrances has increased,but it is not yet sufficiently reflected in laws,policies and practices.Rising authoritarianism and

89、attacks on human and civil rights are making it even more difficult to remove these barriers(20).HIV-related stigma and discrimination have declined in some countries but remain unnervingly common in many others.Gender-based inequalities continue to be pervasive,to varying degrees depending on the c

90、ountry.Punitive laws targeting people living with HIV and people from key populations are still on the statute books in almost all countries.Gender-based violence,including against women and girls,remains a menace everywhere.Across 42 countries with recent survey data,in median almost half(47%)of pe

91、ople harboured discriminatory attitudes towards people living with HIV(21).These attitudes are found even at health facilities.Almost one quarter of people living with HIV reported experiencing stigma when seeking non-HIV-related health-care services in the previous year,according to an analysis of

92、Stigma Index surveys conducted in 25 countries(22).2024 GLOBAL AIDS UPDATE14These prejudices are reversible,but very few countries are close to achieving the 2025 target of reducing to less than 10%the percentage of people living with HIV and people from key populations experiencing stigma and discr

93、imination.Prompted by the activism of affected communities,a few countries have abandoned or reformed laws that target people living with HIV and people from key populations.Overall,however,only three8 of 193 countries did not have any laws that criminalize sex work,same-sex sexual relations,possess

94、ion of small amounts of drugs,transgender people,or HIV nondisclosure,exposure or transmission(Figure 0.8).9 Intimate partner violence is behaviour by an intimate partner or ex-partner that causes physical,sexual or psychological harm,including physical aggression,sexual coercion,psychological abuse

95、 and controlling behaviours.Figure 0.8 Number of countries with discriminatory and punitive HIV-related laws,global,2024Source:National Commitments and Policy Instrument,20172024,supplemented by additional sources;2024(see references in regional factsheets and http:/lawsandpolicies.unaids.org/).Note

96、:this figure does not capture where key populations may be de facto criminalized through other laws,such as vagrancy or public morality laws,or the use of the above laws for different populations.020406080100120140160180193Number of countriesYesNoData not available2025 targetCriminalization of posse

97、ssion of small amounts of drugsCriminalization of same-sex sexual acts in privateCriminalization of any aspect of sex workCriminalization of transgender peopleCriminalization or prosecutions based on general criminal laws of HIV nondisclosure,exposure or transmission156169415212372029631341130139Gen

98、der-based violence harms hundreds of millions of people,and intimate partner violence is a painfully common ordeal and a human rights violation against women and adolescent girls especially.9 Although the prevalence of physical or sexual violence by an intimate partner in the previous 12 months was

99、below 10%in a little over half(82)of the 156 countries with available estimates,the prospect of experiencing physical or sexual violence remains unacceptably high even in these countries(23).National health policies increasingly recognize the need to curb such violence,and there is strong evidence s

100、upporting the integration of violence prevention in health-care settings(2426).Implementation is often held back,however,by a lack of training and support for health-care workers and by scarce referral systems for survivors of violence(27).15Nongovernmental organizations,including community-led orga

101、nizations,help provide services and support to people,especially people from key populations,whose HIV and other health-care needs tend to be neglected by public and private health providers(28).These organizations need civic space,legal and regulatory environments that permit them to receive fundin

102、g and operate,and functional links with public health systems.These conditions are lacking in many countries.Well over two thirds(71%)of the worlds population lives in 78 countries where civic space is now either entirely closed or heavily controlled(29)threatening peoples most basic human rights,in

103、cluding the right to universal health.Integration of HIV and other services is making an impactWhen integrated,HIV and other health services can improve health outcomes,strengthen health systems,and support progress towards universal health coverage(30).Integration across sectors has also been a fea

104、ture of HIV responses,with the advancement of gender equality and womens empowerment,workplace interventions,humanitarian programmes,and social protection schemes being linked progressively with HIV-related interventions.There has been a marked shift towards the integration of HIV and other health-c

105、are services in recent years.Although still in a minority,an increasing number of countries have national strategic HIV plans that are integrated with other health issues or diseases,and with broader health strategies or plans.Thirty-nine of the 151 reporting countries have national health strategie

106、s or policies that integrate the HIV response(seven more than in 2022).Of the 60 countries that have adopted universal health coverage schemes,38 include antiretroviral therapy and 21 include PrEP in their health benefit and financing packages(31).These changes are making a mark.Often,both HIV and o

107、ther health outcomes are better within integrated services than in separated services and the uptake of non-HIV services also tends to rise(30).Linked or integrated tuberculosis(TB)and HIV treatment for people living with both HIV and TB,for example,averted an estimated 6.4 million 5.5 million7.3 mi

108、llion deaths between 2010 and 2022(32).Interventions that prevent and treat HIV,sexually transmitted infections and viral hepatitis can be both cost-effective and cost-saving,especially when combined(33).Recent rapid emergence of mpox has reiterated the importance of integrated care,which has proved

109、 successful in some settings in North America and western Europe.2024 GLOBAL AIDS UPDATE16There is great scope for judiciously extending integration.Integrated services for HIV and sexual and reproductive health are not yet widespread(34),and neither are functioning examples of integrated HIV and no

110、ncommunicable diseases services,especially in sub-Saharan Africa(35).The rise in conflict-related and climate change-induced humanitarian emergencies underscores the need for integrated emergency responses that address peoples health,nutrition and safety needs.Integration is not without challenges o

111、r costs,however.The benefits are context-specific,and they require a range of enabling changes,including adequate staffing levels,efficiently functioning health systems,and decisive actions to prevent stigma and discrimination(30,36,37).Moreover,it is vital that integration is pursued in ways that s

112、trengthen rather than weaken the person-centred and equity-based principles that define successful HIV programmes(34).A growing funding shortfall is holding back quicker progressA widening funding gap is holding back the HIV response.Approximately US$19.8 billion(2019 United States dollars)was avail

113、able in 2023 for HIV programmes in low-and middle-income countriesalmost US$9.5 billion short of the amount needed in 2025.Total resources available for HIV,adjusted for inflation,are at their lowest level in over a decade.The regions with the biggest funding gapseastern Europe and central Asia and

114、the Middle East and North Africaare making the least headway against their HIV epidemics.Most funding for HIV comes from domestic resources(about 59%),but both international and domestic HIV funding are under stress.Adjusted for inflation,domestic HIV funding declined in 2023 for the fourth year in

115、a row,and international resources were almost 20%lower than at their peak in 2013.Financing support from bilateral donors has dwindled dramatically.The overall reductions in external HIV resources would be much steeper were it not for sustained and high levels of funding from the Global Fund to Figh

116、t AIDS,Tuberculosis and Malaria and the United States Government.Development assistance for HIV will continue to be crucial.The continued underfunding of HIV prevention,societal enabler programmes and community-led activities does not bode well for the HIV response.Interventions for people from key

117、populations are especially neglected,even in regions where the vast majority of new HIV infections occur in people from these populations(Figure 0.9).An estimated US$1.8 billion2.4 billion was available for primary prevention programmes in low-and middle-income countries in 2023,compared with the US

118、$9.5 billion that will be needed in 2025.Spending on societal enabler programmes amounted to US$0.9 billion1.1 billion,far short of the US$3.0 billion needed in 2025.17Figure 0.9 Percentage of total HIV resources spent on programmes for people from key populations and percentage of new HIV infection

119、s occurring among people from key populations and their sex partners,by region,2023Source:Korenromp EL,Sabin K,Stover J,Brown T,Johnson LF,Martin-Hughes R,et al.New HIV infections among key populations and their partners in 2010 and 2022,by world region:a multisources estimation.J Acquir Immune Defi

120、c Syndr.2024;95(1S):e34e45.Percentage of new HIV infections among people from all key populations,clients of sex workers,and partners of people from key populationsPercentage of total HIV spending on prevention interventions among people from key populationsEastern Europe and central AsiaMiddle East

121、 and North AfricaPer centAsia and the PacificLatin AmericaCaribbeanWestern and central AfricaEastern and southern Africa0102030405060708090100The prices of vital HIV products are a major factor in countries abilities to sustainably finance their HIV programmes with domestic resources.Although the pr

122、ices of many antiretroviral medicines have continued to decline in recent years,low-and middle-income countries spent approximately US$3 billion on antiretroviral medicines in 20202022.These procurement prices still vary drastically across regions and country income groups.Looking beyond the crossro

123、adsIf HIV programmes remain on their current course,UNAIDS projections show that about 46 million people will be living with HIV in 2050.Even if the world achieves the 2025 targets and sustains these gains,there will be almost 30 million people living with HIV in 2050.Each of them will need lifelong

124、 treatment and support for HIV.In the absence of an effective and universally accessible vaccine or cure,there will also continue to be new HIV infections.Neither of these scenarios amounts to“the end of AIDS”the world will still be contending with a major public health challenge.2024 GLOBAL AIDS UP

125、DATE18The primary objective is to swiftly reduce numbers of new infections and AIDS-related deaths to levels that approach or achieve disease controland to do so in ways that prevent a future resurgence of the epidemic(38).This requires a resilient and durable HIV response.Countries that are struggl

126、ing to control their epidemics can achieve steeper declines in HIV incidence by rapidly increasing treatment coverage and adherence(39,40),and by intensifying their most effective primary prevention interventions.Projections show that high-burden countries that reach the 959595 treatment targets cou

127、ld continue reducing new HIV infections by 20%every five years if they invest simultaneously in effective HIV primary prevention programmes(41).But a constantly evolving AIDS pandemic calls for other changes too.As the population living with HIV ages,the risk of acquiring HIV will shift towards olde

128、r age groups,and prevention strategies will have to adjust to this.HIV programmes will need to make common cause with broader health programmes by responding to the growing impact of noncommunicable diseases,including among people living with HIV,and the ongoing toll exacted by other infectious dise

129、ases(34,42).As HIV programmes are integrated further into broader health systems,there will also be ample room for mutual learning.HIV responses have fortified health and community systems,boosted the roles of affected communities,singled out the societal and structural factors fuelling the epidemic

130、,and made human rights and equity central priorities.More extensive integration with other health programmes can share these attributes more widely,but it should not dilute the distinctive features that make HIV responses successful(34,43).This is especially urgent when serving populations who may b

131、e targeted with stigma,discrimination or worse.All of this must be achieved in a context shaped by persistent inequalities within and between countries,a burgeoning threat of repressive governance,and ongoing discrimination against people who are inordinately exposed to HIV and other health threats.

132、The fiscal constraints imposed by debt distress and low economic growth,especially in Africa,are also reducing low-and middle-income countries abilities to invest more in their HIV responses,while some donors have diverted their assistance to other priorities.An evolving pandemic and shifting contex

133、t have brought the HIV response to a crossroads.The decisions and actions taken now will have a lasting impact on the worlds effort to end the AIDS epidemic as a public health threat.19Mixed results at the halfway mark to the 2025 targetsTable 0.1 Summary of progress against the 2025 targetsCOMBINAT

134、ION HIV PREVENTION FOR ALLTARGET2023 STATUSReduce new HIV infections to under 370 000370 000 1 300 000Reduce new HIV infections among adolescent girls and young women to below 50 00050 000 210 00095%of people at risk of HIV access effective combination prevention 95%50%/40%/39%/39%(medians)(sex work

135、ers/gay men and other men who have sex with men/people who inject drugs/transgender people)Pre-exposure prophylaxis(PrEP)for 10 million people at substantial risk of HIV(or 21.2 million who used PrEP at least once during the year)21.2 million3.5 million50%opioid agonist maintenance therapy coverage

136、among people who are opioid-dependent50%0 of 8 regions90%sterile injecting equipment at last injection90%11 of 27 countries90%of men aged 15 years and over in 15 priority countries have access to voluntary medical male circumcision90%67%959595 FOR HIV TESTING AND TREATMENTTARGET2023 STATUSReduce ann

137、ual AIDS-related deaths to under 250 000250 000630 00034 million people are on HIV treatment by 202534 million30.7 million959595 testing,treatment and viral suppression targets959595All ages:868993Women(aged 15+years):919194Men(aged 15+years):838694Children(aged 014 years):668684Key populations:unkn

138、own90%of people living with HIV receive preventive treatment for tuberculosis(TB)by 202590%17 million people living with HIV initiated on TB preventive treatment between 2005 and 2022Reduce numbers of TB-related deaths among people living with HIV by 80%80%71%PAEDIATRIC HIV TARGET 2023 STATUS75%of c

139、hildren living with HIV have suppressed viral loads by 202375%48%100%of pregnant and breastfeeding women with HIV receive antiretroviral therapy and 95%achieving viral suppression100%84%GENDER EQUALITY AND EMPOWERMENT OF WOMEN AND GIRLS TARGET 2023 STATUS10%of women and girls experienced physical or

140、 sexual violence from a male intimate partner in the past 12 months10%13%1016%10%of people from key populations experience physical and/or sexual violence in the past 12 months 10%21%/8%/28%/24%(medians)(sex workers/gay men and other men who have sex with men/people who inject drugs/transgender peop

141、le)10%people support inequitable gender norms by 202510%24.2%(median)95%of women and girls aged 15-49 years have their sexual and reproductive health-care service needs met95%Median of 50.8%of women currently married or in union make their own decisions regarding sexual relations,contraceptive use a

142、nd their ownhealth care(data from 16 countries)REALIZE HUMAN RIGHTS AND ELIMINATE STIGMA AND DISCRIMINATION TARGET 2023 STATUS10%of countries criminalize Sex work Possession of small amounts of drugs Same-sex sexual behaviour HIV transmission,exposure or nondisclosure 169 countries152 countries63 co

143、untries156 countries10%of countries lack mechanisms for people living with HIV and people from key populationsto report abuse and discrimination and seek redress 10%52%of countries have mechanisms established by the government,66%of countries have mechanisms established by communities10%of people li

144、ving with HIV and people from key populations lack access to legal services90%of people living with HIV who experienced rights abuses have sought redress90%31%of people sought redress10%of people in the general population report discriminatory attitudes towards people living with HIV10%47%(median)10

145、%of people living with HIV report internalized stigma10%38%10%of people from key populations report experiencing stigma and discrimination10%26%/16%/40%/49%(medians)(sex workers/gay men and other men who have sex with men/people who inject drugs/transgender people)10%of people living with HIV experi

146、encing stigma and discrimination in health-care and community settings10%13%(HIV care)25%(non-HIV care)24%(community)COMMUNITY LEADERSHIP TARGET 2023 STATUSCommunity-led organizations deliver 30%of testing and treatment services30%Community-led organizations deliver 80%of HIV prevention services for

147、 populations at high risk of HIV infection and women80%Community-led organizations deliver 60%of programmes to support societal enablers60%UNIVERSAL HEALTH COVERAGE AND INTEGRATION TARGET 2023 STATUSSystems for health and social protection that provide 90%of people living with,at risk of,or affected

148、 by HIV with integrated HIV services 90%90%of people in humanitarian settings access integrated HIV services.90%45%of people living with,at risk of,or affected by HIV have access to social protection benefits.90%INVESTMENTS AND RESOURCES TARGET 2023 STATUSFully fund the HIV response by increasing an

149、nual HIV investments in low-and middle-income countries to US$29 billionUS$29.3 billionUS$19.8 billionProgress is off trackModerate progress2025 targets are within reachNo data are available2024 GLOBAL AIDS UPDATE20References1 Political Declaration on HIV and AIDS:ending inequalities and getting on

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162、A.Young key populations and HIV:a special emphasis and consideration in the new WHO Consolidated Guidelines on HIV Prevention,Diagnosis,Treatment and Care for Key Populations.J Int AIDS Soc.2015;18(2 Suppl.1):19438.20 Risks,rights and health:supplement.New York:Global Commission on HIV and the Law;2

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166、tions Population Fund;2022(https:/esaro.unfpa.org/en/publications/best-practices-models-integration-srhr-hiv-and-gbv-services-four-countries).26 Addressing gender-based violence against women and people of diverse gender identity and expression who use drugs:briefing paper.Vienna:United Nations Offi

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169、nce for Citizen Participation;2023(https:/ Bulstra CA,Hontelez JAC,Otto M,Stepanova A,Lamontagne E,Yakusik A,et al.Integrating HIV services and other health services:a systematic review and meta-analysis.PLoS Med.2021;18:e1003836.31 National Commitments and Policy Instrument,20172024.Geneva:Joint Un

170、ited Nations Programme on HIV/AIDS(https:/lawsandpolicies.unaids.org/).32 Global tuberculosis report 2023.Geneva:World Health Organization;2023(https:/iris.who.int/bitstream/handle/10665/373828/9789240083851-eng.pdf?sequence=1).33 Policy brief:consolidated guidelines on HIV,viral hepatitis and STI p

171、revention,diagnosis,treatment and care for key populations.Geneva:World Health Organization;2022(https:/www.who.int/publications/i/item/9789240053274).34 Bekker LG,Alleyne G,Baral S,Cepeda J,Daskalakis D,Dowdy D,et al.Advancing global health and strengthening the HIV response in the era of the Susta

172、inable Development Goals:the International AIDS Society-Lancet Commission.Lancet.2018;392(10144):312358.35 Chireshe R,Manyangadze T,Naidoo K.Integrated chronic care models for people with comorbid of HIV and non-communicable diseases in sub-Saharan Africa:a scoping review.PLoS One.2024;19(3):e029990

173、4.36 Nkhoma L,Sitali DC,Zulu JM.Integration of family planning into HIV services:a systematic review.Ann Med.2022;54(1):393403.37 Zakumumpa H,Rujumba J,Amde W,Damian RS,Maniple E,Ssengooba F.Transitioning health workers from PEPFAR contracts to the Uganda government payroll.Health Policy Plan.2021;3

174、6(9):13971407.38 Neel AH,Rodrguez DC,Sikazwe I,Pillay Y,Barron P,Pereira SK,et al.HIV programme sustainability in southern and eastern Africa and the changing role of external assistance for health.Health Policy Plan.2024;39(Suppl.1):i107i117.39 Larmarange J,Bachanas P,Skalland T,Balzer LB,Iwuji C,F

175、loyd S,et al.Population-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa.PLOS Glob Public Health.2023;3(7):e0002157.40 Hladik W,Stupp P,McCracken SD,Justman J,Ndongmo C,Shang J,et al.The epidemiology of HIV p

176、opulation viral load in twelve sub-Saharan African countries.PLoS One.2023;18(6):e0275560.41 Describing“the end of AIDS as a public health threat”:final report of a technical working meeting held at the Harvard T H Chan School of Public Health,Boston,MA(https:/jointsiwg.unaids.org/wp-content/uploads

177、/2024/02/Describing_End_of_AIDS_HArvard_Technical_Mtg_Edited_Layout_26_Feb_2024.pdf).42 Oberth G,Whiteside A.What does sustainability mean in the HIV and AIDS response?Afr J AIDS Res.2016;15(1):3543.43 Piot P,Abdool Karim SS,Hecht R,Legido-Quigley H,Buse K,Stover J,et al.Defeating AIDSadvancing glob

178、al health.Lancet.2015;386:171218.21PROGRESS AT THE HALFWAY MARK TO THE 2025 MILESTONESOVERVIEW:THE STATE OF THE HIV PANDEMICFewer people are acquiring HIV,but the progress is very slow outside sub-Saharan Africa.The HIV pandemic and the global response have evolved profoundly over the past decade.Fe

179、wer people acquired HIV in 2023 than at any point since the mid 1990s.More people are receiving antiretroviral therapy and are virally suppressed than ever before,and they continue to increase in number.AIDS-related deaths have been reduced to their lowest level since the peak in 2004.These accompli

180、shmentsand the unfinished work that still lies aheadare an index of the progress made against the targets that United Nations Member States agreed to achieve by 2025,as laid out in the 2021 Political Declaration on HIV and AIDS(1).In reviewing that progress,this chapter highlights the opportunitiess

181、ome new,many underusedto bring the world closer to the goal of ending AIDS as a public health threat.Globally,39%fewer people acquired HIV in 2023 compared with 2010.There were still an estimated 1.3 million 1.0 million1.7 million new HIV infections in 2023,howeverwhich is more than three times the

182、2025 target of 370 000 or fewer new infections.Four countries(Kenya,Malawi,Nepal,Zimbabwe)have already reduced their numbers of annual new HIV infections by 75%and are well on track to reach the target of reducing new HIV infections by 90%by 2030.Another 18 countries have reduced their numbers of an

183、nual new HIV infections by more than 60%since 2010and with concerted efforts,they could achieve the 90%reduction.Almost half of the people who acquired HIV in 2023 were living in eastern and southern Africa and western and central Africa(Figure 1.1),the regions that have together achieved the steepe

184、st decline(56%)in new infections since 2010.242024 GLOBAL AIDS UPDATESummary of the 2025 TargetsSource:Ending inequalities and getting on track to end AIDS by 2030:a summary of the commitments and targets within the United Nations General Assemblys 2021 Political Declaration on HIV and AIDS.Geneva:J

185、oint United Nations Programme on HIV/AIDS;2022(https:/www.unaids.org/en/resources/documents/2022/political-declaration_summary-10-targets).For the first time,the number of new HIV infections outside sub-Saharan Africa surpassed the number of new HIV infections in sub-Saharan Africa.While sub-Saharan

186、 Africa is doing well at preventing new HIV infections,comparable progress is less evident elsewhere in the world,where most people acquiring HIV belong to key populations.95%of people at risk of HIV infection have access to and use appropriate,prioritized,person-centred and effective combination pr

187、evention options95%of women of reproductive age have their HIV and sexual and reproductive health service needs met95%of pregnant and breastfeeding women living with HIV have suppressed viral loads95%of children exposed to HIV are tested by two months of age and again after cessation of breastfeedin

188、g75%of all children living with HIV have suppressed viral loads by 2023(interim target)959595 testing and treatment targets are achieved within all subpopulations,age groups and geographic settings,including children living with HIV90%of people living with HIV receive preventive treatment for tuberc

189、ulosisLess than 10%of countries have punitive legal and policy environments that lead to the denial or limitation ofaccess to servicesLess than 10%of people living with HIV and people from key populations experience stigma and discriminationLess than 10%of women,girls,people living with HIV and peop

190、le from key populations experience gender-based inequalities and all forms of gender-based violence30%of testing and treatment services to be delivered bycommunity-led organizations80%of service delivery for HIV prevention programmes for people from key populations and women to be delivered by commu

191、nity-,key population-and women-led organizations60%of programmes support the achievement of societal enablers to be delivered by community-led organizationsIncrease HIV investments in low-and middle-income countries to US$29 billion per year by 202590%of people living with HIV and people at risk are

192、 linked to person-centred and context-specific integrated services for other communicable diseases,noncommunicable diseases,sexual health and gender-based violence,mental health,drug and substance use,and other services they need for their overall health and well-being45%of people living with,at ris

193、k of,or affected by HIV have access to one or more social protection benefits95%of people within humanitarian settings at risk of HIV use appropriate,prioritized,person-centred and effective combination prevention options90%of people in humanitarian settings have access to integrated tuberculosis,he

194、patitis C and HIV services,in addition to programmes to address gender-based violence(including intimate partner violence).Thisincludes post-exposure prophylaxis,emergency contraception and psychological first aid95%of people living with,at risk of,or affected by HIV are better protected against hea

195、lth emergencies and pandemics,including COVID-19IMPACT GOALS Reduce annual new AIDS-related deathsto under 250 000 Reduce annual new HIV infections to under 370 000Fully resourcing and sustaining efficient and integrated HIV responsesAccess to HIV services and solutions Breaking down barriers25Compa

196、red with 2010,the number of people acquiring HIV has risen in eastern Europe and central Asia,the Middle East and North Africa and Latin Americabut the number has decreased in Asia and the Pacific,western and central Europe and North America,the Caribbean,western and central Africa and eastern and s

197、outhern Africa(Figure 1.2).Numbers of new HIV infections are increasing steeply in several countries with sizeable HIV epidemics,due mainly to weak HIV programmes for people from key populations(Figure 1.3).Globally,the steepest declines in numbers of new HIV infections have been among children aged

198、 014 years.This trend is due largely to achievements in eastern and southern Africa,where the annual number of children acquiring HIV fell by an estimated 73%between 2010 and 2023.Progress has been slower in western and central Africa,which now accounts for over 41%of all new vertical infections.Eas

199、tern and southern Africa accounts for a similar proportion of new vertical infections(about 43%).Eighteen countries or territories have eliminated vertical transmission of HIV(fewer than 50 new HIV infections among children per 100 000 births).Two high-prevalence countries(Botswana and Namibia)are w

200、ell on the way to achieving the“pathway to elimination”target of fewer than 750 new HIV infections per 100 000 births.Overall,however,the decline in numbers of new HIV infections among children has slowed(Figure 1.4).A significant share of all new HIV infectionsabout one in 10is due to vertical tran

201、smission.Almost 120 000 83 000170 000 children acquired HIV in 2023,bringing the total number of children living with HIV to an estimated 1.4 million 1.1 million1.7 million,86%of whom are in sub-Saharan Africa.Asia and the Pacific 300 000Caribbean 15 000Eastern Europe and central Asia 140 000Latin A

202、merica 120 000Middle East and North Africa 23 000Western and central Europe and North America 56 000Eastern and southern Africa 450 000Western and central Africa 190 000More than half of new HIV infections in 2023 were outside sub-Saharan AfricaFigure 1.1 Distribution of new HIV infections,by region

203、,2023 Source:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).For the first time,the number of new HIV infections outside sub-Saharan Africa surpassed the number of new HIV infections in sub-Saharan Africa.262024 GLOBAL AIDS UPDATEEasternand southernAfricaWesternand centralAfricaWe

204、stern and central Europe and North AmericaCaribbeanAsia andthe PacificLatinAmericaEastern Europe andcentral AsiaMiddle East andNorth Africa604020020406080100120140Per cent395946242213920116Global0500 0001 000 0001 500 0002 000 0002 500 000Eastern and southern Africa 59%Western and central Africa 46%

205、Asia and the Pacific 13%Eastern Europe and central Asia+20%2023Latin America+9%Western and central Europe and North America 24%Caribbean 22%Middle East and North Africa+116%2010New HIV infections The greatest declines in new infections are in sub-Saharan AfricaFigure 1.2 Distribution of new HIV infe

206、ctions and percentage change between 2010 and 2023,total population,by regionSource:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).New infections are still increasing in some regionsFigure 1.3 Change in new HIV infections between 2010 and 2023,total population,by regionSource:UNA

207、IDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).27Reaching women with prevention of vertical transmission services has not changed in the past 10 yearsFigure 1.4 Annual number of children(aged 014 years)acquiring HIV and percentage of pregnant and breastfeeding women living with HIV

208、receiving antiretroviral therapy,global,20102023Source:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).Globally,the decline in numbers of new infections is stronger among women than men,a trend that holds across different ages groups(Figure 1.5).The opposite is true in sub-Saharan

209、 Africa.Although decreasing,HIV incidence among adolescent girls and young women is still extraordinarily high in parts of eastern and southern Africa and western and central Africa,where respectively 120 000 77 000160 000 and 36 000 21 00055 000 adolescent girls and young women acquired HIV in 2023

210、.The HIV incidence rate among adolescent girls and young women is more than three times that among adolescent boys and young men in at least 22 countries in sub-Saharan Africa.Coverage of dedicated HIV prevention programmes for adolescent girls and young women is still insufficient in areas with mod

211、erately high HIV incidence.Across much of the region,ancillary efforts to reduce violence against women,gender inequalities and harmful gender norms are not yet having a big enough impact on HIV prevention services for women and girls.Also striking is the slow progress made in reducing numbers of ne

212、w HIV infections among people aged over 50 years(Figure 1.5).In sub-Saharan Africa,treatment successes have led to a rebound in average life expectancy from 56.3 years in 2010 to 61.1 years in 2023.498450 000100 000150 000200 000250 000300 000350 000400 000450 000500 00020102011201220132014201520162

213、017201820192020202120222023Per centNumber of new HIV infections among children627277818181828384838382Percentage of pregnant and breastfeeding women living with HIV receiving antiretroviral therapyAnnual number of children acquiring HIV10203040506070809010000282024 GLOBAL AIDS UPDATESharpest decline

214、s in new HIV infections are among childrenFigure 1.5 Percentage change in annual new HIV infections between 2010 and 2023 by age group and sex,globalSource:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).Much greater commitment and effort are needed to reach the people being left

215、behind.Across the world,these tend to be people from key populations and their sex partners,accounting for an estimated 80%of new infections outside sub-Saharan Africa and 25%of new infections in sub-Saharan Africa in 2022(2).The HIV response is proceeding at different speeds inside and outside sub-

216、Saharan Africa.It also varies markedly between different regions and key populations.This reflects the uneven political commitment to HIV prevention for people from key populations and the many ways in which hostile legal and social environments limit their access to HIV services and support.People

217、from key populations continue to face high degrees of violence,stigma and discrimination,much of it underpinned by the existence and enforcement of punitive laws targeting these populations.Basic HIV services are either lacking or beyond the reach of people from key populations in many countries.A g

218、reat deal of the progress being achieved in preventing new HIV infections among key populations is due to the work of nongovernmental organizations,including community-led organizationsbut much of this work is still unrecognized and underfunded.Globally,there were an estimated 51%fewer AIDS-related

219、deaths in 2023 compared with 2010.In sub-Saharan Africa,these successes have led to a rebound in average life expectancy from 56.3 years in 2010 to 61.1 years in 2023(3).This is due principally to widening access to HIV treatment in sub-Saharan Africa,Asia and the Pacific and the Caribbean,much of i

220、t provided free Per cent706050403020100Children(014 years)62514244293424Females(1524 years)Males(1524 years)Females(1549 years)Males(1549 years)Females(50+years)Males(50+years)29of charge and through the public health sector.Nonetheless,approximately 630 000 500 000820 000 people around the world lo

221、st their lives to AIDS in 2023,including 76 000 53 000110 000 children aged 014 years.The world can still reduce the number of AIDS-related deaths in 2025 to fewer than 250 000but doing so requires further rapid increases in diagnosing and providing treatment to people living with HIV,especially in

222、eastern Europe and central Asia,where numbers of AIDS-related deaths have risen(Figure 1.6).Access to HIV testing,treatment and care services has soared since 2010,with 30.7 million 27.0 million31.9 million people living with HIV receiving antiretroviral therapy in 2023.Some regions were close to ac

223、hieving the 959595 targets by 2025.Nine countries have already reached all three of the targets,and a further 10 are on track to do so soon.The remaining gaps in testing and treatment programmes mean that almost a quarter(23%1927%)of people living with HIV were not receiving life-saving treatment in

224、 2023.This amounted to 9.3 million 7.4 million10.8 million people,4.7 million 3.8 million5.4 million of whom were in sub-Saharan Africa.Treatment coverage overall continued to be poorer among men generally and among people from key populations in sub-Saharan Africa.Coverage was especially poor among

225、 children.The HIV epidemic claimed the lives of approximately 76 000 53 000110 000 children in 2023one in eight people who died due to AIDS was a child aged 014 years.With extra effort a number of regions could reach the 2030 targets of reducing AIDS-related deaths by 90%from 2010Figure 1.6 Percenta

226、ge change in annual number of AIDS-related deaths between 2010 and 2023,global and by regionSource:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).Easternand southernAfricaWesternand centralAfricaWestern and central Europe and North AmericaCaribbeanAsia andthe PacificLatinAmericaE

227、astern Europe andcentral AsiaMiddle East andNorth AfricaGlobal60402002040Per cent51575755513428634302024 GLOBAL AIDS UPDATEWith well over a million people acquiring HIV each year but numbers of AIDS-related deaths decreasing steadily,the number of people living with HIV is increasing,totalling 39.9

228、million 36.1 million44.6 million in 2023.Almost two-thirds(65%)of all people living with HIV were in sub-Saharan Africa,with eastern and southern Africa home to more than half(52%)of them(Figure 1.7).If the global HIV response continues at the current effort,projections show there will be about 46 m

229、illion people living with HIV in 2050,each of them needing treatment and care for HIV and related comorbidities(see section“Treatment and care for people living with HIV”).Even if the world achieves the 2025 targets,there will be almost 30 million people needing antiretroviral therapy in 2050a formi

230、dable public health challenge by any measure.More than half of all people living with HIV are in eastern and southern AfricaFigure 1.7 Number of people living with HIV,by region,2023Source:UNAIDS epidemiological estimates,2024(https:/aidsinfo.unaids.org/).References1 Political declaration on HIV and

231、 AIDS:ending inequalities and getting on track to end AIDS by 2030.Resolution adopted by the General Assembly on 8 June 2021.A/RES/75/284.New York:United Nations General Assembly;2021(https:/www.unaids.org/en/resources/documents/2021/2021_political-declaration-on-hiv-and-aids).2 Korenromp EL,Sabin K

232、,Stover J,Brown T,Johnson LF,Martin-Hughes R,et al.New HIV infections among key populations and their partners in 2010 and 2022,by world region:a multisources estimation.J Acquir Immune Defic Syndr.2024;95(1S):e34e45.3 World population prospects:2022 revision.New York:United Nations Department of Ec

233、onomic and Social Affairs,Population Division;2022.Asia and the Pacific 6.7 millionCaribbean 340 000Eastern Europe and central Asia 2.1 millionLatin America 2.3 millionMiddle East and North Africa 210 000Western and central Europe and North America 2.3 millionEastern and southern Africa 20.8 million

234、Western and central Africa 5.1 million52%13%1%5%6%6%0.5%17%31 UNAIDSACCESSING HIV SERVICES AND SOLUTIONSHIV PREVENTIONIntroductionFewer people acquired HIV in 2023 than at any point since the late 1980s,with the strongest declines occurring in regions with the highest HIV burdens.But the 1.3 million

235、 1.0 million1.7 million new HIV infections globally in 2023 were still more than three times higher than the target of having fewer than 370 000 new infections in 2025.The global prevention response is proceeding at two speeds:at an encouraging pace in sub-Saharan Africa,but stalling in other region

236、s.Even continued steep reductions in sub-Saharan Africa will not be enough to reach the 2025 target globally.The 39%decline in numbers of new HIV infections globally is due primarily to progress achieved in sub-Saharan Africa.Between 2010 and 2023,eastern and southern Africa achieved a 59%reduction

237、and western and central Africa a 46%reduction in the annual number of people acquiring HIV.Antiretroviral therapy has played a central role,along with primary prevention programmes,which encompass an increasing range of options.In most sub-Saharan African countries,however,the annual number of new H

238、IV infections has decreased more rapidly among young men than among young women,and women generally continue to be at disproportionate risk of acquiring HIV.In South Africa,for example,almost twice as many women as men aged 15 years and over acquired HIV in 2023:89 000 80 00098 000 women compared wi

239、th 50 000 43 00058 000 men.Some countries have achieved major reductions(over 70%)in new HIV infections among adolescent girls and young women aged 1524 years since 2010(e.g.Eswatini,Kenya,Lesotho,Malawi,Zimbabwe),but a lot more work remains to be done.Outside sub-Saharan Africa,where people from ke

240、y populations and their sex partners account for 80%of people acquiring HIV,the prevention response has lost momentum.The estimated number of annual new infections in these regions increased between 2010 and 2022 among sex workers,their clients,gay men and other men who have sex with men,transgender

241、 women,and the sex partners(non-clients)of people from key populations(1).People from key populations in all regions still face egregious violations of their human rights,with criminalizing laws and widespread stigma and discrimination deterring them from accessing the services,support and other pro

242、tection that can shield them against HIV.2025 TARGETFewer than 370 000 new HIV infections in 2025The global prevention response is proceeding at two speeds:at an encouraging pace in sub-Saharan Africa,but stalling in other regions.33There are four overarching reasons for the comparatively slow decli

243、ne in new HIV infections globally:Too little is being invested in HIV prevention and societal enabler programmes,especially for people from key populations(see section“Resourcing the HIV response”).Persistent stigma and discrimination related to HIV status,gender,behaviour or sexuality,combined with

244、 hostile legal and institutional environments,make it very difficult to serve the prevention needs of people from key populations.Gender inequalities and unequal gender norms still put women in much of sub-Saharan Africa at elevated risk of acquiring HIV.Powerful prevention technologies such as long

245、-acting injectable cabotegravir(CAB-LA)and,most recently,lenacapavir are raising expectations due to their combination of convenience and high efficacy.The cost of the new long-acting injectable pre-exposure prophylaxis(PrEP)options,and the speed with which they are made available to the people who

246、would benefit the most,will be decisive.There are more prevention options available than ever before,along with compelling evidence of their impact when the people who need these tools can access and use them.But such examples are far from the norm,as Table 2.1 illustrates.Data for 2023 show that co

247、verage of prevention services for people from key populations was poor across all regions,and fewer than half of the areas with high or moderately high HIV incidence1 in sub-Saharan Africa were served by a prevention programme focused on adolescent girls and young women.A positive exception was acce

248、ss to antiretroviral therapy,which,thanks to rising levels of viral suppression among people with HIV,is providing a great deal of the momentum for the current declines in numbers of new HIV infections.2025 TARGET95%of people at risk of HIV accessing combination prevention optionsThere are more prev

249、ention options available than ever before,along with compelling evidence of their impact when the people who need these tools can access and use them.1 High HIV incidence denotes one or more new infections per 100 person-years.Moderately high incidence denotes 0.30.99 new infections per 100 person-y

250、ears.342024 GLOBAL AIDS UPDATETable 2.1 Overview of progress across priority elements of HIV prevention,2023COMBINATION HIV PREVENTION FOR ALLTARGET2023 STATUSReduce numbers of new HIV infections to fewer than 370 000370 0001 300 000Reduce numbers of new HIV infections among adolescent girls and you

251、ng women to fewer than 50 00050 000210 00095%of people at risk of HIV access effective combination prevention95%50%/40%/39%/39%(medians)(SW/MSM/PWID/TG)PrEP for 10 million people at substantial risk of HIV(recorded as 21.2 million people using PrEP at least once during the year)21.2 million3.5 milli

252、on50%opioid agonist maintenance therapy coverage among people who are dependent on opioids50%2 of 26 countries90%sterile injecting equipment at last injection90%11 of 27 countries90%of men and boys aged 15 years and over in 15 priority countries have access to voluntary medical male circumcision(VMM

253、C)90%67%80%of men aged 1549 years report condom use with non-regular partner80%56%Source:Global AIDS Monitoring,2024(https:/aidsinfo.unaids.org/).Global 2025 targets for condom use vary by level of HIV incidence in a geographical area and by individual risk.They are set at 95%for people at highest r

254、isk and 70%and 50%for people at moderate and low risk.Since data presented here are for a population at high risk(people with non-regular partners)in an entire country,a benchmark of 80%is used as a proxy for the targets.The benchmark of 21.2 million people who use PrEP is based on the global PrEP t

255、argets,which translates into 10.6 million person-years of PrEP.An assumed average duration of PrEP use of six months per year yields the benchmark of 21.2 million people who use PrEP.There are persistent and,in some countries,widening gaps in basic prevention that must be addressed urgently.At least

256、 half of all people from key populations are not being reached with basic HIV prevention services.Men and women who inject drugs,gay men and other men who have sex with men and transgender people are particularly neglected in prevention programmes(see section“HIV prevention for people from key popul

257、ations”).Although increasing,multisectoral programmes tailored for adolescent girls and young women in sub-Saharan Africa are still piecemeal,especially in areas with moderately high HIV incidence.Promotion and social marketing of condoms need to be revived.Wider access to PrEP can add fresh momentu

258、m to HIV prevention(see section“Access to PrEP”).There is scope for increasing the uptake of voluntary medical male circumcision(VMMC)in several of the priority countries in eastern and southern Africa.In addition,integration of HIV prevention services with other health services continues to be erra

259、tic,even when it involves sexual and reproductive health or antenatal care(see section“Integration of strategies,services and systems”).Although increasing,multisectoral programmes tailored for adolescent girls and young women in sub-Saharan Africa are still piecemeal,especially in areas with modera

260、tely high HIV incidence.35HIV prevention for people from key populations2025 TARGET95%of people at risk of HIV infection use appropriate,prioritized,person-centred and effective combination prevention2 optionsThe need for a full range of HIV prevention services by people from key populations is stil

261、l largely unmet.Gaps exist in all regions and are especially detrimental to HIV responses outside sub-Saharan Africa,where about 80%of new HIV infections occur among people from key populations and their sex partners,including clients of sex workers.2 Combination HIV prevention includes behavioural,

262、biomedical and structural interventions.UNAIDS362024 GLOBAL AIDS UPDATESource:Korenromp EL,Sabin K,Stover J,Brown T,Johnson LF,Martin-Hughes R,et al.New HIV infections among key populations and their partners in 2010 and 2022,by world region:a multisources estimation.J Acquir Immune Defic Syndr.2024

263、;95(1S):e34e45.Note:the number below year is the number of new HIV infections.Figure 2.1 Distribution of adult(aged 1549 years)new HIV infections,by key population and region,2010 and 2022Sex workersGay men and other men who have sex with menTransgender womenPeople who inject drugsClients of sex wor

264、kersSex partners of people from key populations(nonclients)Remaining population0200 000400 000600 000800 0001 000 0001 200 0001 400 0001 600 0001 800 00020101.7 million(1.4 million2.2 million)20221.1 million(910 0001.5 million)Global2010590 000(500 000730 000)2022580 000(490 000710 000)Outside subSa

265、haran Africa20101.1 million(840 0001.5 million)2022550 000(420 000740 000)SubSaharanAfricaNew HIV infections8%8%20%1%10%8%8%45%8%2%1%1%1%14%4%71%7%3%1%10%4%75%7%29%2%18%9%8%28%8%34%2%14%10%12%20%11%7%12%5%56%1%Globally,more than half(55%)of all new HIV infections in 2022 occurred among people from k

266、ey populations and their sex partners.This is an increase from 2010,when the estimated proportion was 44%(Figure 2.1)(1).In 2022,the relative risk of acquiring HIV was 14 times higher for people who inject drugs,23 times higher for gay men and other men who have sex with men,nine times higher for se

267、x workers,and 20 times higher for transgender women than in the wider adult(aged 1549 years)population globally.Aggravating these vulnerabilities are hostile legal and social environments and stigma,discrimination and violence frequently directed at people from key populations.The prospect of abuse

268、or arrest makes it more difficult for people from key populations to adopt behaviours that offer protection against HIV;it also deters them from using HIV and other health services(see section“Breaking down barriers”).Young people and women from key populations are highly vulnerable,but few HIV prev

269、ention programmes cater to their needs(24).Evidence suggests that HIV prevalence is higher among sex workers(5),people who inject drugs(6)and gay men and other men who have sex with men in settings with criminalizing laws(7).37Gay men and other men who have sex with men2025 TARGETSRegular access to

270、appropriate health system or community-led prevention services:90%PrEP use:50%(very high risk),3 15%(high risk)4Condoms and lubricant use at last sex:5 95%Screening and treatment for sexually transmitted infections:80%HIV programmes are failing gay men and other men who have sex with men.Although 10

271、6 countries reported that their HIV prevention strategies included at least half of the core elements of a recommended package of interventions for this key population,the actual status of HIV prevention fell well short of the 2025 targets(Figure 2.2).A median of only 40%of gay men and other men who

272、 have sex with men received at least two HIV prevention interventions in the previous three months(27 reporting countries),according to data reported to UNAIDS for the years 2019 through 2023.6 This leaves them and their sex partners,which may include female partners,at risk of acquiring HIV.Access

273、to oral PrEP has increased in some countries in Asia,the Caribbean,eastern and southern Africa,Latin America and western Europe,but this prevention option is not being used to nearly its full potential(see section below on access to PrEP).Less than 10%of gay men and other men who have sex with men u

274、sed PrEP at least once in 2023 in the 53 countries reporting these data.Encouraging consistent condom use remains a core primary prevention intervention(8).In the 61 countries reporting these data,a median of 63%of gay men and other men who have sex with men said they used a condom at last anal sex

275、with a man.Condom use at last anal sex varied widely,howeverfrom 26%in the United Republic of Tanzania to 95%in Indiaand was below 50%in 10 of the reporting countries.Although some studies have reported low levels of condom use among gay men and other men who have sex with men who are using PrEP(9,1

276、0),others have found increases in condom use when PrEP was provided as part of a combination prevention strategy(11).In a context of such uneven access to HIV prevention servicesand increasingly hostile legal and social environments in many countries(see section“Breaking down barriers”)the annual nu

277、mber of new HIV infections among gay men and other men who have sex with men rose between 2010 and 2022 in Asia and the Pacific,eastern Europe and central Asia,Latin America,and the Middle East and North Africa.Globally,this key population accounts for about 20%of all people acquiring HIV,almost dou

278、ble the 11%it comprised in 2010(1).A median of only 40%of gay men and other men who have sex with men received at least two HIV prevention interventions in the previous three months(27 reporting countries).3 In settings with an estimated HIV incidence over 3.0%among gay men and other men who have se

279、x with men.4 In settings with an estimated HIV incidence of 0.33.0%among gay men and other men who have sex with men.5 Among people not using PrEP with a non-regular partner who may have a detectable viral load(including those who are known to be HIV-negative).6 That is,two of the following interven

280、tions:condoms and lubricants(e.g.through an outreach service,drop-in centre or sexual health clinic);counselling on condom use and safe sex;or testing services for sexually transmitted infections.382024 GLOBAL AIDS UPDATEFigure 2.2 Gap to achieve combination prevention targets among gay men and othe

281、r men who have sex with men,by intervention,global,20192023Source:Global AIDS Monitoring,20202024(https:/aidsinfo.unaids.org/);UNAIDS special analysis 2024.Note:the graph shows median coverage among countries reporting,except for PrEP use.For PrEP,the methods used are described in the section“Calcul

282、ation of pre-exposure prophylaxis(PrEP)coverage for HIV-negative people”in Annex 2.2025 targets are global.Coverage of interventions can be underestimated due to the lack of reporting from some countries.n=number of countries reporting.“HIV prevention programmes coverage”refers to people from key po

283、pulations who reported receiving at least two prevention services in the previous three months.Possible prevention services received include condoms and lubricants,counselling on condom use and safer sex,and testing for sexually transmitted infections.Condom use at last higher-risk sex does not take

284、 into account people taking PrEP and therefore may be underestimated.PrEP targets were calculated based on the number of people who would most benefit from PrEP use,those with greatest vulnerability to HIV exposure within each key population.Reported numbers of PrEP users include all users regardles

285、s of vulnerability.20192023 statusGap to 2025 targetCondom use at last higherrisk sex(n=61)Sexually transmitted infections screening in past 3 months(n=33)Per centPrEP use for HIVnegative people(n=53)HIV prevention programmes coverage(n=27)0102030405060708090100 UNAIDSFigure 2.3 Gap to achieve combi

286、nation prevention targets among sex workers,by intervention,global,20192023Source:Global AIDS Monitoring,20202024(https:/aidsinfo.unaids.org/);UNAIDS special analysis,2024.Note:the graph shows median coverage among countries reporting,except for PrEP use.For PrEP,the methods used are described in th

287、e section“Calculation of pre-exposure prophylaxis(PrEP)coverage for HIV-negative people”in Annex 2.2025 targets are global.Coverage of interventions can be underestimated due to the lack of reporting from some countries.n=number of countries reporting.HIV prevention programmes coverage refers to peo

288、ple from key populations who reported receiving at least two prevention services in the past three months.Possible prevention services received for sex workers include condoms and lubricants,counselling on condom use and safer sex,and testing for sexually transmitted infections.Condom use at last hi

289、gher-risk sex does not take into account people taking PrEP and therefore may be underestimated.PrEP targets were calculated based on the number of people who would most benefit from PrEP use,those with greatest vulnerability to HIV exposure within each key population.Reported numbers of PrEP users

290、include all users regardless of vulnerability.Sex workers and their clients2025 TARGETSRegular access to appropriate health system or community-led prevention services:90%Condoms and lubricant use at last sex with a non-regular partner:90%PrEP use:80%(very high risk),7 15%(high risk)8Screening and t

291、reatment for sexually transmitted infections:80%Sex workers continue to be underprioritized in HIV prevention programmes,which puts them and their sex partners,including their clients,at high risk of acquiring HIV.It is estimated that almost 8%of all new HIV infections globally in 2022 were among se

292、x workers,and their clients accounted for an additional 10%of new infections(1).About half of sex workers(median 50%in 32 reporting countries)stated they had received at least two HIV prevention services in the previous three months,against the global target of 90%(Figure 2.3).Access was especially

293、low in Asia and the Pacific and western and central Africa,where,respectively,a median of only 37%(11 reporting countries)and 38%(seven reporting countries)of sex workers had been reached with at least two prevention services in the previous three months.Service coverage reported to UNAIDS ranged fr

294、om 8%in the Bolivarian Republic of Venezuela,to 15%in Benin,to more than 90%in Kazakhstan and Panama.20192023 statusGap to 2025 targetCondom use at last higherrisk sex(n=64)Sexually transmitted infections screening in past 3 months(n=35)Per centPrEP use for HIVnegative people(n=44)HIV prevention pro

295、grammes coverage(n=32)01020304050607080901007 In countries with an estimated HIV prevalence over 3.0%nationally among adults(aged 1549 years).8 In countries with an estimated HIV prevalence over 0.3%nationally among adults(aged 1549 years).402024 GLOBAL AIDS UPDATEIn Indonesia,community organization

296、s and the Government are focusing on HIV prevention in their strategy to reach the goals of reducing new HIV infections.In 2023,with numbers of new infections hovering around 28 000 and 49%of these among young people aged 1524 years,the Government initiated PrEP in six locations,using a broad approa

297、ch to access.Following UNAIDS and World Health Organization HIV prevention guidelines,women,transgender people,men,sex workers,people who use drugs,men who have sex with men and others are benefiting from the ongoing expansion of the PrEP programme.The programme grew to 21 sites in 2023 and is aimin

298、g for 95 sites by the end of 2024.PrEP is provided by primary health-care centres,hospitals and community organizations.“In Indonesias decentralized system,the national government provides guidelines,but each district implements on their own authority,”says Adi Mantara of Bali Health Foundation,an o

299、rganization working with people at high risk for HIV.Adi,who formerly used drugs and is now a lawyer,also works with the Indonesia Network of People Living with HIV on policy analysis and community-led monitoring.“We must see the big picture of the whole HIV response.We are changing the perspective

300、towards community health services,”says Adi,highlighting that when programmes focus on selected criteria,other criteria get left behind.Dr Putu Ariastuti of Yayasan Kerti Praja is a public health expert working in eastern Indonesia.Her organization and local partners collaborate with the Government

301、to introduce sex workers to the PrEP programme via existing outreach.“The challenge is that it is a new programme and there can be misinformation among the community.Therefore,we train peer leaders to provide correct information and connect community members with the district health office for servi

302、ces.”HIV testing and PrEP initiation are also offered via mobile clinics.Access to PrEP provides sex workers with a self-determined strategy to prevent HIV,not limited by their situational power to negotiate condom use.Wawan from Organisasi Perubahan Sosial Indonesia explains:“PrEP is important for

303、us to prevent HIV.But we also must educate that you still need to use a condom and check regularly for sexually transmitted infections.We want to integrate sexual and reproductive health into HIV prevention.”Indonesias turn towards PrEP for reducing new infections may reduce stigma and discriminatio

304、n by shifting blame away from specific people.“The biggest barriers to ending HIV are stigma,discrimination and internalized stigma,”says Wawan.Adi and others involved in the 2023 Indonesia stigma index assessment agree that continuing to increase intersectional approaches and incorporating the 1010

305、10 targets(targets on laws,discrimination and violence)will proliferate progress for all.Education by communities for communities is a driving factor behind the increase in HIV testing and access to PrEP in Indonesia.Dr Ari points out that more people seek follow-up services when they have a persona

306、l connection to peer leaders,thereby increasing the number of people who know their status and who access antiretroviral therapy.In some places,Government facilities allow community organizations to transport medicines to individuals in their communities who are not able to regularly pick up PrEP th

307、emselves,which helps with adherence.In the first quarter of 2024,over 6000 people used PrEP,three times more than in the same period in 2023.Young people are also benefiting from PrEP.The introduction of new technologies,such as long-acting PrEP and antiretroviral medicines,holds promise for reducin

308、g HIV transmission further.Continued public and community partnerships are crucial for maintaining these advancements.INDONESIAPrEP for all is an important strategy in Indonesias plan to end AIDS by 2023 41People who inject drugsA small number of sex workers can access oral PrEP,although a few count

309、ries(including Cambodia,Kenya,South Africa,Thailand and Zimbabwe)are making it easier to obtain and use this prevention option(12).A systematic review of studies on PrEP use among female sex workers in sub-Saharan Africa noted that current PrEP delivery methods may not adequately address the many ch

310、allenges these women face in accessing and using this prevention tool.More differentiated and responsive forms of service delivery are needed(12).Condoms remain important for avoiding HIV acquisition and for providing protection against other sexually transmitted infections and unintended pregnancy.

311、According to data reported to UNAIDS,a median 87%of sex workers(64 reporting countries)said they had used a condom at last sex with a client,with 27 of these countries reportedly achieving the 90%condom use target.Less than half of sex workers in the Democratic Republic of the Congo,Honduras,Sierra

312、Leone,South Sudan and Zambia said they had used a condom at last sex with a client.More than 80%of male clients of female sex workers in Cameroon,Colombia,Ethiopia,Lesotho,South Africa,Ukraine and Zimbabwe reported using a condom at last paid sex,but less than half of their counterparts did so in th

313、e Democratic Republic of the Congo,Ghana,India,Madagascar,Mozambique and Papua New Guinea(13).More effective ways to reach clients of sex workers,including in workplaces and social venues,need to be pursued.2025 TARGETSRegular access to appropriate health system or community-led prevention services:

314、90%Use of sterile needles and syringes:90%Receiving opioid agonist therapy:9 50%PrEP use:15%(very high risk),10 5%(high risk)11Condoms and lubricant use:12 95%9 Among people who are dependent on opioids.10 In settings with low coverage of needlesyringe programmes and opioid agonist maintenance thera

315、py services.11 In settings with some needlesyringe programmes and opioid agonist maintenance therapy services.12 By people not using PrEP with a non-regular partner whose viral load status is not known to be undetectable(including those who are known to be HIV-negative).The positive public health im

316、pact of comprehensive harm reductionincluding needlesyringe programmes,opioid agonist maintenance therapy and overdose treatmentis well established in scientific literature(14,15).In 2023,a United Nations Human Rights Council resolution on drug policy included explicit support for harm reduction and

317、 decriminalization for people who use drugs(16).Despite this,punitive and coercive policies and practices continue to dominate global drug policy,with prevention services in short supply and difficult to access(see section“Breaking down barriers”).In 2023,a United Nations Human Rights Council resolu

318、tion on drug policy included explicit support for harm reduction and decriminalization for people who use drugs.422024 GLOBAL AIDS UPDATEVery few low-and middle-income countries are on track to reach the 2025 harm reduction targets.Across 22 reporting countries,13 a median of only 39%of people who i

319、nject drugs received at least two relevant prevention services in the previous three months.14 In only five of these 22 countries(Albania,Kazakhstan,Nigeria,Thailand,United Republic of Tanzania)did more than 60%of people who inject drugs reported receiving at least two HIV prevention interventions.C

320、overage was below 30%in seven countries,some of which have substantial HIV epidemics in this key population(e.g.the Islamic Republic of Iran).Although only three countries(Bangladesh,China,Myanmar)met the 2025 target of distributing at least 200 needles and syringes per person who injects drugs per

321、year,12 of 27 report countries reported that at least 90%of people who inject drugs were using safe injecting practices(Figure 2.4).Adequate access to opioid agonist maintenance therapy remains rare:only in Malaysia and Seychelles did 50%or more people who inject drugs report receiving this importan

322、t service(Figure 2.5).Reported median coverage of the intervention was about 10%across the 26 reporting countries.13 These 22 reporting countries represent about 11%of the estimated global population of people who inject drugs.14 For people who inject drugs,this entails having received in the previo

323、us three months at least two of the following interventions:condoms and lubricants(e.g.through an outreach service,drop-in centre or sexual health clinic);counselling on condom use and safe sex;or new,clean needles and syringes.Figure 2.4 Gap to achieve combination prevention targets among people wh

324、o inject drugs,by intervention,global,20192023Source:Global AIDS Monitoring,20202024(https:/aidsinfo.unaids.org/);UNAIDS special analysis,2024.Note:the graph shows median coverage among countries reporting,except for PrEP use.For PrEP,the methods used are described in the section“Calculation of pre-

325、exposure prophylaxis(PrEP)coverage for HIV-negative people”in the Annex.2025 targets are global.Coverage of interventions can be underestimated due to the lack of reporting from some countries.n=number of countries reporting.HIV prevention programmes coverage refers to people from key populations wh

326、o reported receiving at least two prevention services in the previous three months.Possible prevention services received include condoms and lubricants,counselling on condom use and safer sex,and sterile injecting equipment.Condom use at last higher-risk sex does not take into account people taking

327、PrEP and therefore may be underestimated.The use of a clean needle the last time a person has injected tends to come from surveys,which are typically conducted in areas that have services available and thus may not be nationally representative.20192023 statusGap to 2025 targetSterile injecting equip

328、ment at last injection(n=27)Opioid agonist maintenance therapy coverage(n=26)Per centPrEP use for HIVnegative people(n=18)HIV prevention programmes coverage(n=22)0102030405060708090100Condom use at last higherrisk sex(n=34)43Figure 2.5 Progress towards the harm reduction 2025 targets,by country,2019

329、2023Source:Global AIDS Monitoring,20202024(https:/aidsinfo.unaids.org/).Percentage of people who inject drugs reporting using sterile injecting equipment the last time they injectedPercentage of people who inject drugs receiving opioid agonist maintenance therapyNumber of needles and syringes distri

330、buted per person who injects drugs per year by needlesyringe programmes0102030405060708090100Per cent2025 target0102030405060708090100Per cent0255075100125150175200225250275300325Number2025 target2025 targetAL:AlbaniaAM:ArmeniaAZ:AzerbaijanBD:BangladeshBJ:BeninBY:BelarusCA:CanadaCG:Democratic Republ

331、ic of the CongoCN:ChinaCO:ColombiaCZ:CzechiaGE:GeorgiaID:IndonesiaIN:IndiaIR:Islamic Republic of IranKE:KenyaKH:CambodiaKZ:KazakhstanMA:MoroccoMD:Republic of MoldovaME:MontenegroMG:MadagascarMK:North MacedoniaMM:MyanmarMY:MalaysiaNG:NigeriaNP:NepalPH:PhilippinesPK:PakistanRO:RomaniaRS:SerbiaSC:Seych

332、ellesSN:SenegalTG:TogoTH:ThailandTJ:TajikistanTN:TunisiaTZ:United Republic of TanzaniaUA:UkraineVN:Viet NamZA:South AfricaAMMYMMCNBDCZKHVNKZMGNPBJGEMKZAMYKEIRMAAMAZUASNIDCGNGTGMDMETNBYTHRSPKALCOSCGEMARSMKTZMMKEVNALUABDTHSNKZAMTGBYKHZAAZIDIRMDNPSCUAMDNPVNBDINCAIDTJIRGETHAZMYROMAALKZBJRSPHNGCGTGZAME44

333、2024 GLOBAL AIDS UPDATEA systematic review of 195 studies from 2017 to 2022 found very low levels of service coverage.Globally,only about 18 1227 per 100 people who inject drugs were accessing opioid agonist maintenance therapy,and 35 2452 needles and syringes were being distributed per person who injects drugs per year(17).Almost all the countries providing moderate or high coverage of both needl