Actualización Mundial sobre el SIDA 2025 — SIDA, crisis y el poder de transformar

ONUSIDA advierte que una crisis financiera global amenaza décadas de avances contra el VIH, a pesar de la resiliencia de las comunidades y la innovación nacional. Más información, en inglés, está disponible abajo.

The Global HIV Response: Progress and Peril

Decades of hard work and solidarity have brought the number of new HIV infections and AIDS-related deaths to their lowest levels in more than 30 years. By the end of 2024, although progress was not yet sufficient to end AIDS as a public health threat by 2030, the tools and momentum to do so were in place. Countries were seeing more success, governments were taking greater ownership of their HIV responses, and new scientific breakthroughs—such as long-acting injectable antiretrovirals—offered renewed hope.

However, since the beginning of 2025, HIV programmes in low- and middle-income countries have faced sudden and severe financial disruptions. Wars, widening inequalities, geopolitical shifts, and climate change shocks have created instability and strained international cooperation.

Projections warn that if major support from initiatives like the United States President’s Emergency Plan for AIDS Relief (PEPFAR) is permanently withdrawn, millions of additional deaths and new infections could result by 2030. In 2024 alone, an estimated 1.3 million people acquired HIV—40% fewer than in 2010. Sub-Saharan Africa, home to half of those new infections, saw a 56% drop since 2010. Five countries, mostly in that region, were on track to achieve a 90% decline in new infections by 2030.

The number of children acquiring HIV through vertical transmission dropped to 120,000 in 2024—a 62% decrease since 2010 and the lowest figure since the 1980s. Programmes preventing mother-to-child transmission have averted nearly 4.4 million new infections since 2000. AIDS-related deaths also declined to 630,000 in 2024, a 54% decrease from 2010. Among children, the number of deaths dropped from 240,000 in 2010 to 75,000 in 2024.

In 2024, around 77% of the 40.8 million people living with HIV were receiving antiretroviral therapy, and 73% had suppressed viral loads—a major public health success. In sub-Saharan Africa, life expectancy rose from 56.5 years in 2010 to 62.3 years in 2024, thanks to treatment access and other advances.

The world was closer than ever to meeting the 95–95–95 targets for testing and treatment: 87% of people living with HIV knew their status, 89% of those were on treatment, and 94% of those had a suppressed viral load. These achievements put the goal of a 90% reduction in new infections and AIDS-related deaths within reach—until recent setbacks began to threaten this progress.

Yet even before funding disruptions, progress was uneven. Coverage of testing, treatment, and viral suppression remained far behind in Eastern Europe, Central Asia, the Middle East, and North Africa, and required more attention in Asia and the Pacific. Sub-Saharan Africa had half of the 9.2 million people in need of treatment but not receiving it, while another quarter lived in Asia and the Pacific.

Only 55% of children living with HIV were receiving treatment in 2024, up from 17% in 2010—but over 620,000 children still lacked access. Despite accounting for only 3% of the total number of people living with HIV, children represented 12% of all AIDS-related deaths. Men living with HIV were less likely than women to be on treatment or have suppressed viral loads. People from key populations were even less likely to receive treatment, even in countries where overall treatment coverage was high.

In 2024, an estimated 210,000 adolescent girls and young women aged 15–24 acquired HIV, largely due to persistent risk and vulnerability in sub-Saharan Africa. Yet prevention services for these groups and other young people are now being defunded.

Barriers like stigma, discrimination, punitive laws, gender inequality, and violence continue to block progress. In many places, political will is lacking to provide services and protection to those most at risk—including adolescent girls and people from key populations.

While some regions saw declines in new HIV infections between 2010 and 2024—56% in sub-Saharan Africa, 21% in the Caribbean, and 17% in Asia and the Pacific—other regions experienced increases: 94% in the Middle East and North Africa, 13% in Latin America, and 7% in Eastern Europe and Central Asia. In total, 32 countries reported increases in new infections during that period, putting the 2025 global target far out of reach.

In 2024, an estimated 120,000 children acquired HIV, with the vast majority in sub-Saharan Africa. Programmes continue to neglect people from key populations and their sexual partners, who represent a large share of new infections globally.

In early 2025, HIV programmes faced a systemic shock: sudden funding cuts—particularly from the United States—disrupted services globally. Entire supply chains collapsed, health clinics closed, staff shortages intensified, and prevention programmes were scaled back or shut down entirely. Community organizations were forced to reduce or stop their work, threatening critical community-based systems.

There is growing fear that other donor countries may follow suit, abandoning decades of solidarity. If current funding cuts and freezes continue, progress could be reversed, and the goal of ending AIDS as a public health threat could slip out of reach.

PEPFAR was a lifeline for many countries, supporting millions with testing, treatment, prevention services, and health worker training. With funding cut back sharply in 2025, vital components of national HIV responses have been severely impacted.

HIV prevention efforts are particularly vulnerable, as they rely heavily on external funding. In many countries, prevention services—including condom distribution, medical male circumcision, and access to pre-exposure prophylaxis (PrEP)—have been reduced. By 2024, PrEP reached only 3.9 million people, far below the target of 21.2 million for 2025. Services for key populations reached less than half of those who needed them.

People who inject drugs—an estimated 13.9 million globally—remain largely excluded from HIV programmes. Women who inject drugs are especially neglected. Only a handful of countries have met United Nations targets for opioid substitution therapy and needle distribution.

The current wave of cuts is pushing prevention programmes into crisis. Countries are reporting shortages of PrEP, reduced outreach to young women, and paused activities like male circumcision. Services addressing stigma, discrimination, and gender-based violence are also being defunded.

Meanwhile, supply chains for HIV test kits and medicines, laboratory services, and data systems are being disrupted. Frontline workers and essential testing services face critical financing gaps. These effects extend beyond HIV and are straining broader health systems.

For over 40 years, community-led organizations have been at the heart of the global HIV response. They’ve saved lives and delivered services proven to increase testing, treatment adherence, and viral suppression. But funding losses have now forced many of these groups to cut back or shut down entirely.

All of this jeopardizes the progress made—and the possibility of ending AIDS by 2030.

The Path Forward

Countries, civil society, donors, and communities must regroup quickly. The immediate priority is to prevent service disruptions, protect supply chains, and maintain access to high-quality HIV services.

To build sustainable responses, countries should:

• Strengthen HIV testing, treatment, and prevention services, integrating them into primary healthcare and community-led models.
• Invest in systems strengthening, data and surveillance, and the integration of HIV services across sectors.
• Ensure communities can continue playing key roles through inclusive, multisectoral, country-led responses.
• Dismantle structural barriers like stigma, discrimination, gender inequality, and violence.
• Address harmful social norms that increase vulnerability, especially for women and girls.

Diversified, resilient funding mechanisms are urgently needed. The crisis has revealed how fragile many HIV programmes are in low- and middle-income countries. But it also offers an opportunity to build stronger systems that can withstand future shocks.

Many countries are responding by increasing domestic funding for HIV. In 2026, at least 25 countries plan to expand their HIV budgets, even in tough economic conditions. More than 30 countries are developing sustainability roadmaps to strengthen domestic investments and create inclusive, multisectoral HIV strategies.

To support these efforts, it’s crucial to expand fiscal space through tax reform, debt relief, and diversified funding models—such as integrating HIV into national insurance packages and combining public and private sector contributions.

However, not all countries have equal capacity to raise domestic funds. Debt distress, low growth, and weak tax systems leave many—especially in sub-Saharan Africa—without the resources to scale up HIV financing. Continued donor solidarity is essential to prevent a devastating return to the early 2000s, when AIDS was at its deadliest.

The world has come too far to turn back now. The tools to end AIDS are in our hands—but only if we stand together and act with urgency.