Global AIDS Strategy 2021 2026 en
Global AIDS Strategy 2021 2026 en
Global AIDS Strategy 2021 2026 en
END INEQUALITIES.
END AIDS. GLOBAL AIDS
STRATEGY 2021-2026
END INEQUALITIES
A PEOPLE CENTRED GLOBAL AIDS STRATEGY 2021-2026 1
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Recalling that all aspects of UNAIDS work are directed by the following guiding
principles:1
• Aligned to national stakeholders’ priorities;
• Based on the meaningful and measurable involvement of civil
society, especially people living with HIV and populations most at
risk of HIV infection;
• Based on human rights and gender equality;
• Based on the best available scientific evidence and technical
knowledge;
• Promoting comprehensive responses to AIDS that integrate
prevention, treatment, care and support; and
• Based on the principle of nondiscrimination.
In fulfilling these objectives, the programme will collaborate with national Governments,
intergovernmental organizations, non-governmental organizations, groups of people living
with HIV/AIDS, and United Nations system organizations.2
TABLE OF CONTENTS
FOREWORD ...................................................................................................................................................................... 6
EXECUTIVE SUMMARY.............................................................................................................................................. 7
CHAPTER 1: DECADE OF ACTION TO DELIVER THE SDGS: REDUCING INEQUALITIES
AND CLOSING GAPS TO END AIDS AS A PUBLIC HEALTH THREAT ........................................ 17
UN Secretary-General António Guterres .................................................................................................... 17
Chapter 2: Achieving the vision of the Three Zeroes: modelled impact of delivering on the
Strategy .............................................................................................................................................................................. 26
CHAPTER 3: STRATEGIC PRIORITY 1: MAXIMIZE EQUITABLE AND EQUAL ACCESS TO
HIV SERVICES AND SOLUTIONS ..................................................................................................................... 28
Result Area 1: Primary HIV prevention for key populations, adolescents and other
priority populations, including adolescents and young women and men in locations
with high HIV incidence ........................................................................................................................................... 30
Result Area 2: Adolescents, youth and adults living with HIV, especially key
populations and other priority populations, know their status and are immediately
offered and retained in quality, integrated HIV treatment and care that optimize health
and well-being ............................................................................................................................................................... 33
Result Area 3: Tailored, integrated and differentiated vertical transmission and
paediatric service delivery for women and children, particularly for adolescent girls
and young women in locations with high HIV incidence ................................................................... 36
CHAPTER 4: STRATEGIC PRIORITY 2: BREAK DOWN BARRIERS TO ACHIEVING HIV
OUTCOMES .................................................................................................................................................................... 39
Result Area 4: Fully recognized, empowered, resourced and integrated community-led
HIV responses for a transformative and sustainable HIV response ........................................... 40
Result Area 5: People living with HIV, key populations and people at risk of HIV enjoy
human rights, equality and dignity, free of stigma and discrimination .................................... 41
Result Area 6: Women and girls, men and boys, in all their diversity, practice and
promote gender-equitable social norms and gender equality, and work together to end
gender-based violence and to mitigate the risk and impact of HIV ............................................ 43
Result Area 7: Young people fully empowered and resourced to set new direction for
the HIV response and unlock the progress needed to end inequalities and end AIDS . 45
CHAPTER 5: STRATEGIC PRIORITY 3: FULLY RESOURCE AND SUSTAIN EFFICIENT
HIV RESPONSES AND INTEGRATE THEM INTO SYSTEMS FOR HEALTH, SOCIAL
PROTECTION, HUMANITARIAN SETTINGS AND PANDEMIC RESPONSES .......................... 47
Result Area 8: Fully funded and efficient HIV response implemented to achieve the
2025 targets ..................................................................................................................................................................... 48
Result Area 9: Integrated systems for health and social protection schemes that
support wellness, livelihood and enabling environments for people living with, at risk
of and affected by HIV to reduce inequalities and allow them to live and thrive ............... 50
Result Area 10: Fully prepared and resilient HIV response that protects people living
with, at risk of and affected by HIV in humanitarian settings and from the adverse
impacts of current and future pandemics and other shocks .......................................................... 53
CHAPTER 6: CROSS-CUTTING ISSUES ....................................................................................................... 56
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FOREWORD
Twenty years ago, as the AIDS pandemic rapidly spread across the world, the international
community for the first time collectively set an ambitious target to halt and reverse the spread
of HIV by 2015. When this was achieved, we set an even more ambitious goal in 2016—
to end AIDS as a public health threat by 2030. The collective vision of UNAIDS underpins
these targets: zero new HIV infections, zero discrimination, zero AIDS-related deaths.
There is hope. The solutions exist. 40 years of experience in the HIV response has provided
the evidence of what works. Some countries have reached control of their
AIDS epidemics. We know how to end AIDS, and this is the Strategy to get us there.
End Inequalities. End AIDS. Global AIDS Strategy 2021-2026 is a bold new approach to
use an inequalities lens to close the gaps that are preventing progress towards ending AIDS.
The Global AIDS Strategy aims to reduce these inequalities that drive the AIDS epidemic
and prioritize people who are not yet accessing life-saving HIV services. The Strategy sets
out evidence-based priority actions and bold targets to get every country and every
community on-track to end AIDS as a public health threat by 2030.
Drawing on key lessons learned from the intersecting HIV and COVID-19 pandemics, the
Strategy leverages the proven tools and approaches of the HIV response, identifying where,
why and for whom the HIV response is not working. The Strategy outlines the strategic
priorities and actions to be implemented by global, regional, country and community partners
to get ontrack to ending AIDS. It leverages four decades of experience of the HIV response,
supporting governments, partners and communities to “build back better”, supporting
systems for health to be more resilient and place people at the centre. This Strategy also
outlines a new, bold call to action for the UNAIDS Joint Programme to advance our
leadership role in the global HIV response and to implement the Strategy. And the Strategy
demands that the HIV response is fully resourced and implemented with urgency and optimal
efficiency.
This Strategy is the result of extensive analysis of HIV data and an inclusive process of
consultation with member states, communities, and partners. I am deeply grateful to the
thousands of participants from over 160 countries and partners who contributed to its
development.
Let 2021 be a turning point in the history of ending AIDS. It has been forty years since the
first AIDS cases were reported, twenty years since the historic United National General
Assembly Special Session on AIDS and 25 years of UNAIDS. I call on the international
community to rally behind the bold targets and commitments in this Strategy to end the
inequalities that are preventing people from benefitting from HIV services and ensure that we
get on track to ending AIDS by 2030. Let us rededicate ourselves to ensure that we put all
our collective might towards ending AIDS and realizing the right to health for all.
Winnie Byanyima
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EXECUTIVE SUMMARY
1. The new Global AIDS Strategy (2021–2026) seeks to reduce the inequalities that drive
the AIDS epidemic and put people at the centre to get the world on-track to end AIDS as
a public health threat by 2030. Decades of experience and evidence from the HIV
response show that intersecting inequalities are preventing progress towards ending
AIDS.3
3. The Strategy is being adopted during the Decade of Action to accelerate progress
towards the Sustainable Development Goals (SDGs), and makes explicit contributions to
advance goals and targets across the SDGs.6
4. The Strategy builds on an extensive review of the available evidence and a broad-based,
inclusive, consultative process in which over 10,000 stakeholders from 160 countries
participated. The results from the UNAIDS Fast-Track Strategy 2016–2021 informed the
development of the new Strategy, including the Programme Coordinating Board (PCB)
decision to develop the Global AIDS Strategy "by maintaining the critical pillars that have
delivered results in the current Fast-Track Strategy, its ambition and the principles
underpinning it to the end of 2025, but also enhance the current Strategy to prioritize
critical areas that are lagging behind and need greater attention."
5. The Strategy keeps people at the centre and aims to unite countries, communities and
partners across and beyond the HIV response to take prioritized actions to accelerate
progress towards the vision of zero new HIV infections, zero discrimination and zero
AIDS-related deaths. The Strategy seeks to empower people with the programmes and
resources they need to exercise their rights, protect themselves and thrive in the face of
HIV.
6. Drawing on key lessons learned from the intersecting HIV and COVID-19 pandemics, the
Strategy leverages proven tools and approaches of the HIV response. It identifies where,
why and for whom the HIV response is not working. It outlines strategic directions and
priority actions to be implemented by global, regional, country and community partners by
2025 to get the HIV response on-track to end AIDS by 2030.
3 Throughout the Strategy, the term "ending AIDS" is used to refer to the full term "ending AIDS as a
public health threat by 2030", which is defined as a 90% reduction in new HIV infections and AIDS-
related deaths by 2030, compared to a 2010 baseline.
4 The use of UNAIDS in the Strategy refers to the Joint United Nations Programme on HIV/AIDS
(UNAIDS).
5 The Global AIDS Strategy covers the period 2021-2026, but features targets and commitments to be
achieved by the end of 2025. This is to enable a review of these results and the development of the
next Global AIDS Strategy in 2026, which will cover the period up to 2030.
6 The 10 Sustainable Development Goals which are explicitly linked to this Strategy are SDG 1 No
Poverty; SDG 2 Zero Hunger; SDG 3 Good Health and Well-Being; SDG 4 Quality Education; SDG 5
Gender Equality; SDG 8 Decent Work and Economic Growth; SDG 10 Reduced Inequalities; SDG 11
Sustainable Cities and Communities; SDG 16 Peace, Justice and Strong Institutions; and SDG 17
Partnerships for the Goals.
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7. The Strategy also summarizes the role of the Joint United Nations Programme on
HIV/AIDS in implementing the Strategy and its leadership role in coordinating the global
HIV response.
8. Forty years since the first cases of AIDS were identified and twenty-five years since
UNAIDS was created, the world has proof of concept that ending AIDS as a public health
threat by 2030 is possible with the knowledge and tools currently in-hand. With new
diagnostics, prevention tools and treatment, we can move even faster until the day we
have an HIV vaccine, and a functional cure.
9. Much progress has been made among some groups of people and in some parts of the
world. A few countries have reached AIDS epidemic control, and others are close to
doing so. By 2019, more than 40 countries had surpassed or were within reach of the key
epidemiological milestone towards ending AIDS.7 Millions of people living with HIV now
enjoy long and healthy lives and the number of new HIV infections and AIDS-related
deaths are on the decline. Of the 38 million people living with HIV, 26 million were
accessing life-saving antiretroviral therapy (ART) as of June 2020. This treatment results
in viral load suppression which prevents the spread of HIV.
10. Science continues to generate new technologies and mechanisms to advance HIV
prevention, treatment, care and support, including progress towards an HIV vaccine and
a functional cure. Innovative delivery strategies have enhanced the reach and impact of
HIV services.
11. Despite the successes, AIDS remains an urgent global crisis. The world did not reach the
2020 Fast-Track prevention and treatment targets committed to in the 2015 UNAIDS
Fast-Track Strategy and the 2016 United Nations Political Declaration on Ending AIDS.
Most countries and communities are not on-track to end AIDS by 2030.
12. This was true before the COVID-19 pandemic, but the impact of that pandemic is making
continued progress against HIV, including the need for more urgent action, more difficult.
We must identify and address the factors that prevented us from reaching the 2020
targets. And we must do so while simultaneously safeguarding HIV programmes from the
impact of COVID-19 and keeping people living with HIV and affected by HIV safe from
COVID-19 and other imminent threats. When developing priority population groups for
vaccines against COVID-19, the Strategy calls on countries to include all people living
with HIV in the category of high-risk medical conditions.
13. Despite all our efforts, progress against HIV remains fragile in many countries and
acutely inadequate among key populations8 globally and among priority populations,
7 Defined as an HIV incidence:prevalence ratio of 3.0% or less, which 25 countries had achieved by
2019, including: Australia, Barbados, Botswana, Burkina Faso, Burundi, Cambodia, Côte d’Ivoire,
Djibouti, Eritrea, Eswatini, Ethiopia, Gabon, Italy, Kenya, Nepal, Netherlands, Rwanda, Singapore,
South Africa, Spain, Switzerland, Thailand, Trinidad & Tobago, Viet Nam, Zimbabwe. At the end of
2019, an additional 16 countries were on-track to reach a milestone of an incidence:prevalence ratio of
4.0% or lower, including: Cameroon, Dominican Republic, El Salvador, Guatemala, Haiti, Lesotho,
Malawi, Morocco, Namibia, New Zealand, Niger, Peru, Senegal, Sri Lanka, Togo and Uganda.
8 Key populations, or key populations at higher risk, are groups of people who are more likely to be
exposed to HIV or to transmit it and whose engagement is critical to a successful HIV response. In all
countries, key populations include people living with HIV. In most settings, men who have sex with
men, transgender people, people who inject drugs and sex workers and their clients are at higher risk
of exposure to HIV than other groups. However, each country should define the specific populations
that are key to their epidemic and response based on the epidemiological and social context.
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such as children and adolescent girls and young women in Sub-Saharan Africa. A range
of social, economic, racial and gender inequalities,9 social and legal environments that
impede rather than enable the HIV response, and the infringement of human rights are
slowing progress in the HIV response and across other health and development areas.
14. Inequalities exist not only between countries, but also within countries. Even in those
countries that have achieved the 90–90–90 treatment targets, averages conceal the
reality that too many people are still being left behind. The aggregate global and national
averages, while reflecting positive trends, mask areas of continued concern—areas
which, unless addressed, will prevent the world from ending AIDS.
15. In 2019, 1.7 million people newly acquired HIV infection. At the end of 2020, there were
12 million people living with HIV who are likely to die of AIDS-related causes if they do
not receive treatment. Even though effective treatment exists, almost 700 000 people
died of AIDS-related causes in 2019. The HIV response must refocus on how to extend
life-saving services to all who need them, in every country and community.
16. For the majority of key populations and other priority populations, including millions of
people living with HIV who are unaware of their HIV status or lack access to treatment,
the benefits of scientific advances and HIV-related social and legal protection remain
beyond reach. Key populations include people living with HIV, men who have sex with
men, transgender people, people who inject drugs and sex workers and their clients are
at higher risk of exposure to HIV than other groups.1011 In specific contexts, effective HIV
responses must also focus on other priority populations, such as adolescent girls and
young women in sub-Saharan Africa and 47% of children living with HIV globally who are
not receiving access to treatment that will save their lives.
Inequalities in the HIV response remain stark and persistent—they block progress
toward ending AIDS.
18. The majority of people who are newly infected with HIV and who are not accessing life-
saving HIV services belong to key populations and live in vulnerable contexts, where
inadequate political will, funding and policies prevent their access to health care. Key
populations and their sexual partners account for an estimated 62% of new infections
globally and 99%, 97%, 96%, 89%, 98% and 77% of new infections in eastern European
and central Asia, the Middle East and North Africa, western and central Europe and North
America, Asia and the Pacific and Latin America, respectively.
9 Inequality refers to an imbalance or lack of equality. The term “inequalities” in this Strategy
encompasses the many inequities (injustice or unfairness that can also lead to inequality), disparities
and gaps in HIV vulnerability, service uptake and outcomes experienced in diverse settings and
among the many populations living with or affected by HIV.
10 See the glossary in Annex 4, where the definitions of these populations are provided.
11 The term “key populations” is also used by some agencies to refer to populations other than the four
listed above. For example, prisoners and other incarcerated people also are particularly vulnerable to
HIV; they frequently lack adequate access to services, and some agencies may refer to them as a key
population.
12 Evidence review: Implementation of the 2016–2021 UNAIDS Strategy: on the Fast-Track to end
The gaps in HIV responses and resulting HIV infections and AIDS-related deaths lie upon
fault lines of inequality. From its beginning, the HIV epidemic has represented an acute
health inequality, affecting some key populations much more disproportionately. Inequalities
illustrate why the HIV response is working for some people, but not for others. Structural
inequalities and determinants of health: education, occupation, income, home and
community all have direct impact on health and HIV outcomes. The lower someone’s social
and economic status, the poorer their health is likely to be. Societal forces, such as
discrimination based on race, gender and sexual orientation, add to the stress level of
certain population groups. Unequal gender norms that limit the agency and voice of women
and girls, reduce their access to education and economic resources, and stifle their civic
participation contribute to the higher HIV risk faced by women in settings with high HIV
prevalence. Key populations: gay men and other men who have sex with men, sex workers,
transgender people and people who use drugs, particularly those who inject drugs, are
subject to discrimination, violence, and punitive legal and social environments, each of
which contributes to HIV vulnerability. Some people with disabilities, older people living with
HIV and migrants and internally displaced people are often disproportionately affected by
HIV. While new HIV infections declined globally by 23% since between 2010 and 2019, new
infections increased by more than 10% in over 30 countries. Young people (aged 15–24
years) represent about 17% of the global population, but accounted for and estimated 28%
of new HIV infections in 2019. Adolescent girls and young women in high-burden countries
with a high burden of HIV infection are twice as likely as their male peers their own age to
acquire HIV infection. Key populations and their sexual partners comprised an estimated
approximately 62% of all new HIV infections in 2019, but represent a small fraction of the
world’s population. Children living with HIV have poorer HIV treatment coverage than adults
and comprise a higher proportion of AIDS-related deaths. The HIV burden on poorer
households has increased, due in part to the difficulties poor people experience in obtaining
the HIV services and social protection they need. To improve health and HIV outcomes, the
Global AIDS Strategy calls for all policies and future practice to be assessed to determine
whether they do not further stigmatise HIV diagnosis, perpetuate discrimination and
exacerbate health inequalities.
19. The risk of acquiring HIV is 26 times higher among gay men and other men who have
sex with men, 29 times higher among people who inject drugs, 30 times higher for sex
workers, and 13 times higher for transgender people. Every week, about 4,500 young
women aged 15–24 years acquire HIV. In sub-Saharan Africa, 5 in 6 new infections
among adolescents aged 15–19 years are among girls. Young women are twice as likely
to be living with HIV than men. Only 53% of children 0–14 years who are living with HIV
have access to the HIV treatment that will save their lives.
20. A central reason why disparities in the HIV response remain so stark and persistent is
that we have not successfully addressed the societal and structural factors that increase
HIV vulnerability and diminish people's abilities to access and effectively benefit from HIV
services. Recognizing the equal worth and dignity of every person is not only ethical, it is
critical for ending AIDS. Equal access to HIV services and the full protection of human
rights must be realized for all people.
21. Building on the historic achievements of the HIV response and acknowledging the most
pressing challenges and opportunities, this Strategy recognizes that key shifts are
needed if the world is to end AIDS.
22. The Strategy places the SDGs that relate to the reduction of inequalities at the heart of its
approach to guide and drive action in every country and community. The Strategy
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23. The Strategy keeps people at the centre to ensure that they benefit from optimal
standards in service planning and delivery, to remove social and structural barriers that
prevent people from accessing HIV services, to empower communities to lead the way, to
strengthen and adapt systems so they work for the people who are most acutely affected
by inequalities, and to fully mobilize the resources needed to end AIDS.
24. The Strategy calls on national governments, development and financing partners,
communities and the UNAIDS Joint Programme to identify and address these
inequalities. Countries and communities everywhere must achieve the full range of
targets and commitments outlined in the new Strategy––in all geographic areas and
across all populations and age groups––to achieve the Three Zeros: zero new HIV
infections, zero AIDS-related deaths and zero HIV-related discrimination.
25. If the targets and commitments in the Strategy are achieved, the number of people who
newly acquire HIV will decrease from 1.7 million in 2019 to less than 370 000 by 2025,
and the number of people dying from AIDS-related illnesses will decrease from 690 000
in 2019 to less than 250 000 in 2025.
26. To realize the full potential of HIV prevention tools to prevent new HIV infections, the
Strategy calls for the urgent strengthening and rapid scale-up of HIV combination
prevention services that will have the greatest impact. The Strategy includes ambitious
coverage targets for HIV prevention interventions and for all key populations and priority
populations, and calls for total annual investments in prevention to increase to over US$
9.5 billion by 202513. The Strategy also seeks to fulfil the potential of treatment as
prevention, and it recommends the reallocation of finite resources away from less-
effective HIV prevention approaches to those that are high-impact.
27. At the same time, the Strategy emphasizes the importance of avoiding artificial
dichotomies in the HIV response between treatment and prevention, focusing instead on
fully leveraging the synergies between combination prevention and treatment. If the
underlying inequalities are addressed, including gender inequality, stigma and
discrimination, both prevention and treatment outcomes will improve.
The Strategy calls for transformative results that demand ambition, speed and
urgency in implementation
28. Stakeholders across the HIV response will need to do more to ensure that their actions
are strategic, smart and focused on outcomes. The Strategy prioritizes urgent
implementation and scale-up of evidence-based tools, strategies and approaches that will
turn incremental gains into transformative results. Maintaining and further scaling up
existing tools and strategies will be essential.
Communities are at the forefront and must be fully empowered to play their crucial
roles
30. While communities are pivotal in the HIV response, the capacity of community-led
responses, key populations and youth to contribute fully towards ending AIDS by 2030 is
undermined by acute funding shortages, shrinking civic space in many countries and a
lack of full engagement and integration in national responses. The Strategy outlines
strategic actions to provide community-led and youth-led responses with the resources
and support they need to fulfil their role and potential as key partners in the HIV
response.
The Strategy amplifies the broader benefits of the HIV response and ending AIDS
31. A strong body of evidence shows that intersecting inequalities fuel the HIV epidemic and
block progress towards ending AIDS. By reducing inequalities, we will be able to
dramatically reduce new HIV infections and AIDS-related deaths. That, in turn, will
contribute to a host of positive social and economic outcomes and accelerate progress
towards sustainable development for all.
32. Investments in the HIV response have strengthened the functioning and resilience of
systems for health across the world. The Strategy was developed while the COVID-19
pandemic disrupted many HIV services, exacerbating inequalities and undermining
national economies. It therefore features actions that are needed to protect people living
with or affected by HIV and the HIV response from current and future pandemics.
Recognizing the pivotal role that the HIV infrastructure has played in helping diverse
countries respond to COVID-19, the Strategy aims to leverage the HIV response to
prepare for and respond to future pandemics, and enhance synergies with other global
health and development movements.
34. Priority actions across 10 result areas and five cross-cutting issues are proposed to
accelerate progress towards realizing the vision of zero new infections, zero
discrimination and zero AIDS-related deaths. The 10 result areas include:
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Result Area 1: Primary HIV prevention for key populations, adolescents and other
priority populations, including adolescents and young women and men in locations
with high HIV incidence
Result Area 2: Adolescents, youth and adults living with HIV, especially key
populations and other priority populations, know their status and are immediately
offered and retained in quality, integrated HIV treatment and care that optimize health
and well-being
Result Area 3: Tailored, integrated and differentiated vertical transmission and
paediatric service delivery for women and children, particularly for adolescent girls
and young women in locations with high HIV incidence
Result Area 4: Fully recognized, empowered, resourced and integrated community-
led HIV responses for a transformative and sustainable HIV response
Result Area 5: People living with HIV, key populations and people at risk of HIV enjoy
human rights, equality and dignity, free of stigma and discrimination
Result Area 6: Women and girls, men and boys, in all their diversity, practice and
promote gender-equitable social norms and gender equality, and work together to
end gender-based violence and to mitigate the risk and impact of HIV
Result Area 7: Young people fully empowered and resourced to set new direction for
the HIV response and unlock the progress needed to end inequalities and end AIDS
Result Area 8: Fully funded and efficient HIV response implemented to achieve the
2025 targets
Result Area 9: Systems for health and social protection schemes that support
wellness, livelihood, and enabling environments for people living with, at risk of, or
affected by HIV to reduce inequalities and allow them to live and thrive
Result Area 10: Fully prepared and resilient HIV response that protects people living
with, at risk of, and affected by HIV in humanitarian settings and from the adverse
impacts of current and future pandemics and other shocks
The cross-cutting issues include:
i. Leadership, country ownership and advocacy: leaders at all levels must renew
political commitment to, ensure sustained engagement with, and catalyze action
from key and diverse stakeholders.
ii. Partnerships, multisectorality and collaboration: partners at all levels must align
strategic processes and enhance strategic collaboration to fully leverage and
synergize the contributions to ending AIDS.
iii. Data, science, research and innovation: data, science, research, and innovation
are critically important across all areas of the Strategy to inform, guide and reduce
HIV related inequalities and accelerate the development and use of HIV services
and programmes.
iv. Stigma, discrimination, human rights and gender equality: human rights and
gender inequality barriers that slow progress in the HIV response and leave key
populations and priority populations behind must be addressed and overcome in
all areas of the Strategy.
v. Cities, urbanization and human settlements: cities and human settlements as
centres for economic growth, education, innovation, positive social change and
sustainable development to close programmatic gaps in the HIV response.
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Ambitious targets and commitments for 2025 to put the world on course to end AIDS
35. The Strategy features ambitious, new targets and commitments14 to be achieved in every
country and community for all populations and age groups by 2025.15
36. The Strategy’s three strategic priorities are reflected in the three categories of the targets
and commitments: comprehensive, people-centred HIV services; breaking down barriers
by removing societal and legal impediments to an effective HIV response; and robust and
resilient systems to meet the needs of people.
37. To implement tailored and differentiated responses, individual regions and countries will
need to adapt the Strategy in ways that respond to their epidemiological and economic
circumstances, address key HIV-related inequalities, promote and protect human rights
and drive progress towards ending AIDS by 2030.The Strategy includes profiles of seven
regions, outlining priority actions to put regional HIV responses on-track.
38. Country ownership is emphasized as a sustainable driver of change in the HIV response,
through diversified funding, service integration and by matching the response to national,
subnational and community needs.
39. Achieving the goals and targets of the new Strategy will require annual HIV investments
in low- and middle-income countries to rise to a peak of US$ 29 billion by 2025. Upper-
middle-income countries account for 51% of the total resource needs in the Strategy. The
majority of resources are expected to come from domestic resources, while development
partners must commit to sustainably funding remaining resource needs. The Strategy
calls for sufficient resources to achieve these targets and commitments in order to
change the dynamics of the epidemic and get on track to ending AIDS by 2030.
40. Chronic under-investment in the global HIV response has not only translated to millions
of additional new HIV infections and AIDS-related deaths but also increased the global
resource needs to reach the Strategy’s targets and commitments. Significantly greater
investments are needed in three areas:
i. HIV Prevention: an almost two-fold increase in resources for evidence-based
combination prevention, from US$5.3 billion per year in 2019 to US$9.5 billion in
2025. Resources should also be reallocated from ineffective prevention methods
to the evidence-based prevention programmes and interventions called for in the
Strategy.
ii. HIV testing and treatment: investments must increase by 18%, from US$8.3
billion in 2019 to US$9.8 billion by 2025, but the number of people on treatment
will increase by 35%, due to efficiency gains from the price reductions in
commodities and costs to deliver the services. Reaching such treatment targets
will contribute to additional reductions in new HIV infections, which will in turn lead
to reductions in resource needs for testing and treatment from 2026–2030.
iii. Societal Enablers: investment in societal enablers must more than double to
US$3.1 billion in 2025 (representing 11% of total resources). These investments
should focus on establishing the legislative and policy environment required to
implement the Strategy. Societal enablers will need to be co-financed by the HIV
response and non-health sectors.
41. As a joint programme, UNAIDS brings together the diversity and expertise of the UN
system, Member States and civil society around a shared vision of ending AIDS and
achieving the Three Zeroes. UNAIDS is a unique vehicle to drive transformation, incubate
innovative multisectoral approaches and address the crosscutting challenges essential to
implement this Strategy.
42. UNAIDS will work to catalyse the rapid implementation of the priority actions outlined in
the Strategy. Upon adoption of the Strategy, UNAIDS will align its footprint, capacity,
ways of working and resource mobilization efforts with the Strategy’s strategic priorities
and result areas. UNAIDS will measure its performance, contributions, and results
against progress in country, regional and global HIV responses, with a specific focus on
how it will work with countries and communities to reduce inequalities by 2025 to get the
response on-track to ending AIDS by 2030.
43. In summary, the Strategy aims to unite countries, communities and partners across and
beyond the HIV response to take prioritized actions that will accelerate progress towards
the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. It
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seeks to empower people with the programmes, knowledge and resources they need to
claim their rights, protect themselves and thrive in the face of HIV. The Strategy identifies
where, why and for whom the response is not working. Drawing on key lessons learned
from the intersecting AIDS and COVID-19 pandemics, the Strategy leverages the proven
tools and approaches of the HIV response. And it outlines strategic priorities and priority
actions to get the HIV response on-track to end AIDS as a public health threat by 2030.
It is at the heart of the 2030 Agenda for Sustainable Development, our agreed
blueprint for peace and prosperity on a healthy planet, captured in SDG 10: reduce
inequality within and between countries.
UN Secretary-General António Guterres 16
44. Over the last five years of the global HIV response, the seemingly impossible proved
possible. During the implementation of the UNAIDS Fast-Track Strategy 2016–2021,
some communities and countries experienced significant declines in HIV infections and
AIDS-related deaths, even without an HIV vaccine or a cure. Dozens of countries took
major strides towards achieving the 90–90–90 targets. By 2019, more than 40 countries
were on-track to end AIDS as a public health threat by 2030. This progress was
facilitated by scientific advances that delivered new technologies for HIV prevention and
treatment, and new clarity on the optimal combination of services and delivery strategies.
Also crucial was the compelling evidence regarding the value and necessity of removing
laws and policies that discriminate or otherwise undermine human rights. The leadership
by communities and people stepping forward to claim their right to health, reinforced by
continued global solidarity, were also key drivers of this success.
45. Yet, despite the evidence that we can end AIDS, the HIV response is currently not on
track to end AIDS by 2030, as envisioned in the SDGs. The AIDS epidemic remains a
global crisis. Despite many successful government-funded and community-led prevention
and treatment programmes, progress in reducing new HIV infections and in connecting
more people living with HIV to treatment has slowed markedly in recent years in some
countries and communities. In other countries and communities, the numbers of new HIV
infections and AIDS-related deaths are rising. The AIDS epidemic remains dynamic, with
evolving shifts and variations in epidemiological patterns and burdens of disease within,
and among, a wide spectrum of communities, countries and regions.
46. An urgent, strategic course correction is needed to get the global HIV response back on-
track. The Global AIDS Strategy 2021–2026 builds on lessons from the previous
Strategy. It is guided by human rights principles, norms and standards, commitments to
achieve gender equality, and approaches that put communities at the centre of the global
response. The Strategy aims to address the specific factors that have slowed progress
and caused the response to fail the people who are most vulnerable to HIV, especially
those who are experiencing social, economic, racial and/or gender inequality.
47. The world did not reach the 2020 Fast-Track targets because of worsening inequalities
within and across countries. Gaps are widening between people and communities
16Secretary-General's Nelson Mandela Lecture: “Tackling the Inequality Pandemic: A New Social
Contract for a New Era”; 18 July 2020.
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experiencing rapid declines in new HIV infections and AIDS-related deaths and those
denied such improvements.
48. The rapid progress made in many countries and communities shows what can be
achieved. However, the lack or slow pace of progress elsewhere reflects what happens
when human rights, gender equality and communities are not placed at the centre of the
HIV response.
49. Millions of people living with HIV and tens of millions of people at risk are still not able to
benefit from HIV prevention and health-protecting and life-saving HIV treatment and care
services. Inequalities affect not only the people who are excluded, they burden entire
populations and societies. We cannot end AIDS without reducing these inequalities.
50. Inequalities mean that some people obtain immediate access to HIV prevention and
treatment, while others must wait months or even years, with hundreds of thousands of
people dying every year while waiting. Cutting-edge biomedical interventions and
essential services reach only some people and some communities and countries. We
cannot end AIDS unless we end these inequalities.
51. The AIDS and COVID-19 pandemics follow, and deepen, societal fault lines. Inequalities
exacerbate vulnerability to infectious diseases and magnify the impact of pandemics.
Within countries, structural inequalities and inadequate funding mean that cutting-edge
biomedical interventions and essential social services frequently cannot be reached by
people and communities who need them most. HIV programmes designed to deliver the
benefits of scientific advances are often not tailored to the complex needs and realities
of people who experience these multiple, often intersecting inequalities.
52. This is why the Global AIDS Strategy focuses on reaching the people and communities
who are being left behind. It calls for understanding who and where these people and
communities are, the patterns and causes of their vulnerability and marginalization, and
why the efforts to date have not reached or not worked for them. It requires that we
prioritize and scale up HIV programmes that put those people and communities at the
centre of global, regional, national, subnational and community responses.
53. The inequalities blocking progress towards ending AIDS emerge when HIV intersects
with complex fault lines across social, economic, legal and health systems. These
inequalities operate along multiple axes, with some compounding others. They are often
aggravated by laws and policies and are reflected in unequal HIV outcomes,
discriminatory and oppressive practices, and violence.
54. Inequalities often express the ways in which health systems are designed, financed,
organized and managed. Financial barriers cause health systems to fail poor people and
low-income communities. The focus of many health services on curative interventions
also diminishes attention and funding for preventive interventions that could help reduce
inequalities in HIV and other health outcomes.
55. As a result of persisting inequalities, HIV responses work for some but not for others.
HIV infections have declined among young women in many parts of the world, but
adolescent girls and young women (aged 15–24 years) in sub-Saharan Africa are up to
5 times more likely to acquire HIV infection than their male peers.
56. Sexual and gender-based violence and harmful gender norms which no country in the
world has ended, continue to be major drivers of the AIDS epidemic, with immediate and
long-term consequences for individuals, families, communities and societies. HIV
responses are also largely failing key populations.
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57. Globally, men living with HIV are HIV and COVID-19
less likely to access HIV testing
and treatment services than From the start of the COVID-19 pandemic,
women living with HIV. In Europe UNAIDS has worked alongside people living with
and North America, even as and affected by HIV across the world to manage its
cutting-edge technologies offer impacts. It also investigated how the experience of
the means for ending the tackling HIV could help inform and guide effective,
epidemic in some populations, efficient, people-centred and sustainable COVID-
many gay men and other men 19 responses. Decades of investment in the HIV
who have sex with men of response have created platforms that are proving
different racial or ethnic useful against COVID-19—just as they were in
minorities, transgender women, responding to the 2014–2015 Ebola outbreak in
people who inject drugs and low- western and central Africa.
income people have been left
behind. Inequalities are reflected Successful international efforts to respond to HIV
in the deterioration and have been rooted in innovation, respect for human
inaccessibility of health-care rights and gender equality, community-based
services for children, solutions and a commitment to leave no-one
adolescents, young people and behind. Guidance on how to combat stigma and
adults living with or affected by discrimination during COVID-19 also draws on 40
HIV in climate disasters and/or years of experience from the HIV response.
conflict settings, including
refugees, internally displaced
persons, returnees and asylum UNAIDS highlights several vital actions:
seekers, and vulnerable migrants. • Put gender equality at the centre of COVID-19
People living in informal responses and show how governments can
settlements often lack access to confront the gendered and discriminatory
essential services. impacts of COVID-19.
• Protect the most vulnerable people, particularly
58. Children are being left behind. those belonging to key populations who are at
Only 53% of children living with higher risk of HIV infection, to respond to
HIV are accessing treatment. human rights concerns in the evolving context
Without a voice in the response, of COVID-19.
they have an unequal opportunity • Leverage the experience and infrastructure of
to call for solutions to their needs. the HIV response to ensure a more robust
response to both pandemics.
59. While significant progress has
been made against HIV in many By heeding the lessons of the HIV response, the
high-burden countries, progress responses to COVID-19 and other pandemics can
is fragile or lacking in many be people-centred, flexible, innovative, equitable
countries where HIV prevalence and outcome-driven. By being smart and strategic,
is lower. This is partly due to the countries can leverage their HIV infrastructure to
diminished attention on HIV as accelerate responses to COVID-19 and other
the burden of noncommunicable pandemic threats to deliver on the promise of the
diseases increases. 2030 Agenda for Sustainable Development for the
health and well-being of all.
60. Evidence shows that the
disparities in HIV service access,
HIV incidence and AIDS-related mortality are the result of multiple, overlapping
inequalities, and unequal access to education, employment and economic opportunities.
61. Renewed political and financial commitments are needed to scale up interventions that
will address the different structural, financial and economic inequalities and transform
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62. The HIV response has shown that when countries take legal, policy and programmatic
measures to address inequalities, gaps in the response can be quickly reduced and
overall progress towards ending AIDS accelerates.
63. Twenty years ago, when the international community first resolved to halt and reverse
the AIDS epidemic, such outcomes were considered unrealistic.17 Today, the rate of new
HIV infections has declined fastest in some of the low-income countries most heavily
affected by HIV.
64. In a diverse range of settings, the solidarity, ambition and innovations of the HIV
response are saving lives.
Using an inequalities lens to accelerate
65. Innovative service delivery, such as progress towards ending AIDS: An
multimonth dispensing, and community inequalities lens requires an understanding of
leadership have sustained access to HIV the nature and causes of inequalities in
services even during COVID-19 lockdowns. different locations and among different
population groups, and how they interact with
66. Adolescent girls and young women in some
HIV. Focusing on where, why and for whom
settings in Africa are experiencing sharp
the HIV response is not working can help
reductions in their risk of acquiring HIV due
identify the additional or modified actions
to multisectoral HIV programmes that
advance gender equality and focus on needed to achieve better and more equal
women and girls' health. They include programmatic outcomes. By using an
sexual and reproductive health inequalities lens, countries, communities,
programmes, including contraception, UNAIDS and partners can craft better
education, comprehensive sexuality evidence-based approaches to reduce or
education, and economic empowerment. eliminate inequalities, identify where
modifications in approaches are needed and
67. Inequalities exist also between key strengthen efforts to monitor progress towards
populations in different countries and ending AIDS as a public health threat.
regions. In some settings, key populations
have been able to maintain access to life-saving HIV services, such as pre-exposure
prophylaxis (PrEP) and harm reduction, even during COVID-19 lockdowns. But
elsewhere, key populations continue to face severe inequalities that limit their access to
HIV services.
68. Political and financial commitments are needed to scale up interventions that will
address the structural, financial and economic inequalities and transform the harmful
sociocultural norms, gender-based inequalities and gender-based violence that drive the
HIV epidemic.
69. The Strategy’s inequalities lens shifts the focus to the people and communities who are
still being left behind in HIV response. In implementing this Strategy, the HIV response
will use differentiated approaches that are tailored to the needs of specific contexts,
populations, and locations and prioritize the people and populations most in need.
17The Millennium Development Goals, adopted in September 2000, featured the MDG6 goal to halt
and begin to reverse the spread of HIV by 2015; see A/RES/55/2: United Nations Millennium
Declaration.
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Shifting to an inequalities lens will ensure that the global HIV response works for
everyone and leaves no one behind
70. Several key principles underpin the inequalities lens in the new Global AIDS Strategy.
i. Prioritize actions that will reduce HIV-related inequalities and disparities in health
outcomes. The Strategy will promote a new, urgent focus to close the gaps created
by inequalities and reduce disparities in health outcomes for people living with and
affected by HIV who are still not benefitting from HIV services.
All people living with and affected by HIV should benefit from HIV prevention,
testing, treatment, care and achieve viral load suppression, regardless of who they
are and where they live. This includes new technologies such as adherence-friendly
injectable antiretroviral regimens for treatment and prevention, point-of-care
diagnostics for children, HIV self-tests or antiretroviral-containing vaginal rings for
PrEP for women.
ii. Address intersecting structural and social inequalities and prioritize actions that may
be difficult but are needed the most, rather than focus on easier actions that do not
confront persistent inequalities.
iii. Act holistically to address the epidemiological, socioeconomic, cultural and legal
determinants of HIV.
Globally and in each country and community, comprehensive, integrated and
targeted responses must ensure progress across all aspects of the HIV response.
iv. Recognize that tailored HIV responses are needed to tackle the intersecting
inequalities that drive the AIDS epidemic.
The approach of "know your epidemic, know your response" requires all countries
and communities to refocus on understanding where, for whom and why the HIV
response is working; who has been left behind and where; and which inequalities
and patterns of vulnerability are causing these gaps. The HIV response must be
shifted and finetuned. This includes developing tailored tools, prioritizing funding and
actions to transform harmful social norms, reforming legal environments as required,
and introducing supportive policy and programmatic frameworks.
v. Measure our success in reducing inequalities.
We must build and refine national data collection and monitoring systems in a
sustainable manner to better capture, analyze and monitor progress on reducing
HIV-related inequalities.
71. The Strategy will promote the scale-up of proven HIV interventions to combat
inequalities. Urgent efforts will focus on closing the gaps in HIV prevention, through
tailored, scaled-up combination HIV prevention packages and services that can sharply
reduce HIV infection rates among key populations and priority populations such as
adolescent girls and young women in sub-Saharan Africa. The Strategy prioritizes
service delivery models and funded community-led responses that can ensure access
even when health facilities are inaccessible, macroeconomic policies that expand fiscal
space for priority investments (including essential social protection), and partnerships
that shift social norms and influence removal of punitive laws, policies and practices that
perpetuate inequalities and otherwise undermine human rights.
Using an inequalities lens across the Strategy’s Targets and Commitments, Strategic
Priorities and Result Areas
72. An inequalities lens that is rooted in human rights, gender equality and community-led
responses is the key unifying feature of the new Strategy. It calls for bold, urgent action
to ensure 95% coverage in all populations, age groups and geographic areas of
essential, evidence-based HIV services, including combination prevention, prevention of
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vertical transmission and sexual and reproductive health services, HIV testing,
treatment, care and support.
73. The Strategy also includes targets for societal enablers: reducing to no more than 10%
the proportion of people living with or affected by HIV who experience stigma and
discrimination, or who experience gender-based inequalities and gender-based violence,
and the number of countries which have punitive laws and policies in place. While no
instance of discrimination, violence or human rights violation is tolerable, the Strategy
includes these targets to focus attention on the unconscionable prevalence of these
realities and to drive urgent progress towards their elimination.
74. The Strategy’s vision for reducing inequalities and laying the foundation to reach the
2030 targets builds on its three Strategic Priorities:
• maximize equitable and equal access to HIV services and solutions;
• break down barriers to achieving HIV outcomes; and
• fully resource efficient HIV responses and integrate HIV in systems for health, social
protection, and humanitarian and pandemic responses.
75. The Strategy outlines strategic results for each of these interdependent, strategic
priorities. For each Strategic Priority and Result Area, it explains how they advance
progress towards the Three Zeros and link with the 10 relevant SDGs. It outlines clear,
quantifiable targets and commitments for 2025, with a specific focus on ensuring that no
population, community, country or region is left behind in the global effort to end AIDS.
76. For each Result Area, high-priority actions are proposed to guide policy makers and
implementing partners. Those actions do not preclude the core, ongoing actions that
constitute the standard package of HIV interventions, programmes, services and policies
and which must also be undertaken as part of an effective, comprehensive and
evidence-based HIV response.
77. Recognizing that no single actor or sector can, on their own, end the AIDS epidemic, the
Strategy is designed for the global HIV response as a whole. It seeks to unite diverse
stakeholders around a common goal and enable all stakeholders to determine how they
can contribute to ending the AIDS epidemic. The Strategy provides a framework for
countries to leverage their leadership and ownership of the response, and tailor national
strategies in ways that reduce inequalities, strengthen the response and maximize public
health impact. The Strategy specifically describes how the Joint Programme will
contribute to the achievement of the strategic results and targets.
Reducing the inequalities that drive HIV can be an entry point for transformation
across the 2030 Agenda for Sustainable Development
78. Since the first cases of AIDS were reported 40 years ago, HIV has exposed structural
inequalities and discrimination in societies across the world. HIV has had a
disproportionate impact on communities that were already marginalized and
disenfranchised––be it gay men and other men who have sex with men , young women
and girls in sub-Saharan Africa, sex workers across the world, people who inject drugs,
or people in prisons and other closed settings, seasonal and mobile labourers, and
migrants. The COVID-19 pandemic is repeating this pattern and reinforcing inequalities.
While the impact of COVID-19 is felt by all, the pandemic is particularly damaging to
people who are most vulnerable and who already experience discrimination and
exclusion.
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79. The world has met those realities with pioneering responses, which the Strategy seeks
to leverage in order to promote healthier, more resilient and equal societies. There may
be no vaccine or cure for inequalities, but it is possible to reduce them. Empowering the
people and communities who are left behind can have a positive, transformative impact
on all of society. Reducing inequalities within and among countries is one of the 17
SDGs (Goal 10). By reducing and ending inequalities that perpetuate and exacerbate
the AIDS epidemic, transformative outcomes for society as a whole are set in motion.
80. Getting the HIV response on-track to end AIDS by 2030 will ensure achievement of the
HIV specific target in the 2030 Agenda for Sustainable Development Goals (SDG 3.3),
as well as accelerate gains towards at least 10 SDGs. Table 1 below outlines the
synergies and linkages between the Strategy and the SDGs––how progress towards
specific SDGs contributes to ending AIDS, and how gains in the HIV response
accelerate progress towards achievements of these SDGs.
81. Putting inequalities at the heart of the Strategy will not only unblock progress towards
ending AIDS. During this Decade of Action to deliver the SDGs, the Strategy will
accelerate progress to reduce inequalities within and between countries, and to reach
the furthest left behind first, as envisaged in the 2030 Agenda for Sustainable
Development.
Table 1: How the Strategy reduces inequalities that inhibit progress on HIV and select
Sustainable Development Goals
SDG How select SDGs How HIV affects Illustrative examples of how
impact the HIV progress towards the Strategy contributes to the
epidemic and this SDG SDGs
response
SDG 1 Poverty can Countries and The Strategy prioritizes social
exacerbate households protection interventions for
vulnerability to HIV disproportionately people living with HIV, key
and undermine affected by HIV are populations and priority
people’s capacity more vulnerable to populations to reduce gender
to mitigate its falling into and and income inequalities and
impact. remaining in poverty, eliminate social exclusion, and
creating a cycle of thereby diminish the risk of HIV
vulnerability. due to poverty.
SDG How select SDGs How HIV affects Illustrative examples of how
impact the HIV progress towards the Strategy contributes to the
epidemic and this SDG SDGs
response
SDG 3 HIV prevention The Strategy calls for HIV-
and treatment sensitive Universal Health
access is Coverage that is equitable,
People living with HIV
undermined when holistic and integrated with
are at increase risk of
Universal Health rights-based services for co-
some non-
Coverage is morbidities and other health
communicable
lacking, or when issues experienced by people
diseases, including
people do not living with, at risk of or affected
mental health
have access to by HIV.
conditions. Women
sexual and
living with HIV are
reproductive
more likely to develop Investing in HIV services
health services.
and die from cervical strengthens health systems,
Lack of access by
cancer than women including pandemic
people living with
not living with HIV. preparedness, as shown during
HIV to integrated
the COVID-19 crisis, and helps
care impact on
reduce maternal and under 5
health outcomes
mortality for AIDS-related causes
and quality of life.
SDG 4 Globally, about 7 The Strategy pursues
in 10 adolescent HIV-related illness transformative change through
girls and young impedes school quality education, including
women have poor attendance and comprehensive sexuality
knowledge of HIV. learning, as does education. The latter empowers
Education is one stigma and young people with the
of the best HIV discrimination in knowledge and skills they need
prevention tools school settings. to take responsible and informed
available. Each decisions regarding their health
additional year of and well-being.
secondary Rights literacy can empower
schooling can lead people living with HIV to become
to a reduction in more active citizens who know
the cumulative risk and claim their rights beyond the
of HIV infection, in right to health, inspiring others
particular among as they do so.
adolescent girls
and young
women.
SDG 5 Violence against The Strategy prioritizes
women, denial of HIV is a leading resources for the empowerment
legal rights and cause of death of women and girls,
women’s limited among women of guaranteeing their rights so that
participation in reproductive age. they can protect themselves
decision-making Women living with from acquiring HIV, overcome
exacerbate HIV and women in stigma and gain greater access
vulnerability to HIV key populations are to HIV testing, treatment, care
infection. Harmful more likely to and support as well as to sexual
gender norms also experience gender- and reproductive health services.
impact on men’s based violence. Ensuring that adolescent girls
health seeking and young women get an
behaviour. education and are economically
empowered is a sound HIV
prevention Strategy which also
empowers those women and
girls to lead transformative
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SDG How select SDGs How HIV affects Illustrative examples of how
impact the HIV progress towards the Strategy contributes to the
epidemic and this SDG SDGs
response
change in their communities.
The Strategy also calls for
reforms to ensure women’s
rights to land and other forms of
property.
Gender-transformative HIV
programmes that involve women
and girls along with men and
boys can reduce gender-based
violence, empower women and
transform harmful gender norms,
including those related to
masculinity.
SDG 8 Safe and secure People living with HIV The Strategy addresses HIV in
work can experience the world of work by advocating
environments unemployment rates for the protection of labour rights
facilitate access to three times higher to ensure that people living with
HIV services, than national and affected by HIV enjoy full
including for unemployment rates. and productive employment, free
workers in from discrimination.
informal
employment and
migrants.
SDG 10 HIV affects HIV-related stigma The Strategy is centred on
vulnerable and and discrimination reducing and ending the
disempowered inequalities that drive the AIDS
communities most epidemic, while simultaneously
severely. Social leveraging the HIV response as
and economic an entry point to drive
exclusion and transformative change across
marginalization the SDGs by addressing
impacts on the inequalities.
ability of people to
protect
themselves from
HIV.
SDG 11 With rapid HIV particularly The Strategy advocates for city-
urbanization, affects cities and led HIV responses at the local
many cities urban areas, with 200 level to support positive social
contend with cities accounting for transformation by strengthening
growing AIDS more than one health and social systems to
epidemics. People quarter of the world’s reach the most marginalized in
living in slums people living with HIV. society.
often are at As centres for economic growth,
greater risk of education, innovation, positive
acquiring HIV, social change and sustainable
partly due to poor development, cities are uniquely
access to basic positioned to address complex
services. multidimensional problems such
as HIV through inclusive
participation from diverse
stakeholders.
Local ownership and leadership
in the HIV response ensure
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SDG How select SDGs How HIV affects Illustrative examples of how
impact the HIV progress towards the Strategy contributes to the
epidemic and this SDG SDGs
response
greater substantive equality and
helps to ensure health as a right
for everyone.
SDG 16 Exclusion, stigma, The HIV response, The Strategy prioritizes
discrimination, led by people living participatory governance,
human rights with and affected by including community-led
violation, and HIV, has demanded responses, in order to drive more
violence fuel the access to justice and relevant, rights-based
AIDS epidemic pioneered people- programmes and strengthen
among adults and centred accountability accountability for health and
children. Lack of mechanisms, yielding development.
access to justice benefits that extend
impacts on the far beyond the HIV
ability of people response.
living with HIV and
key populations to
get redress for
HIV-related
human rights
violations.
SDG 17 Partnerships and Efforts to ensure the The Strategy calls for
global solidarity affordability of and mobilization of domestic and
are key elements access to HIV-related international investments in
of the HIV products and health evidence based HIV-
response and technologies can programmes. It also calls for
mobilizing benefit wider health enhanced global collective action
domestic and and equity agendas, to improve the affordability of
international including for and access to HIV commodities
resources to meet tuberculosis, hepatitis critical to ending the AIDS
the HIV-related C and epidemic, including through
resource needs is noncommunicable promoting advocacy to leverage
essential for diseases. The HIV the use of Trade-Related
ending AIDS as a response has been at Aspects of Intellectual Property
public health the forefront of Rights flexibilities, and optimizing
threat by 2030. innovating the use of voluntary licensing
partnerships and and technology sharing
placing communities mechanisms to meet public
at the centre. health objectives. The Strategy
also calls for the strengthening of
regional and interregional
exchange and cooperation in
science, research and
innovation.
Chapter 2: Achieving the vision of the Three Zeroes: modelled impact of delivering on
the Strategy
82. The failure to achieve the targets in the 2020 Fast-Track Strategy and the 2016 Political
Declaration on Ending AIDS has had a tragic human cost: an additional 3.5 million
people acquired HIV and an additional 820 000 people died of AIDS-related illnesses
than would have been the case if the targets had been reached. As a result, millions
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more people are living with HIV and tens of millions of people who are still at risk of HIV
infection require targeted, comprehensive services.
83. The world can get on-track to end AIDS as a public health threat by 2030, which
requires a 90% reduction in new infections and AIDS-related deaths (against the 2010
baseline). Achieving the full range of the 2025 targets in this Strategy in all geographic
areas and across all populations will put every country and every community on-track to
end AIDS.
84. Epidemic modelling shows that achieving the comprehensive 2025 targets will reduce
annual HIV infections from an estimated 1.7 million in 2019 to less than 370 000 in 2025
and will reduce annual adult and children AIDS-related deaths, including tuberculosis
(TB) deaths among people living with HIV, from an estimated 690 000 in 2019 to less
than 250 000 in 2025. This degree of success in the HIV response will put the
international community firmly on-track to end the AIDS epidemic in all settings and for
all populations by 2030.
Figure 1. Reaching the 2025 targets will reduce new HIV infections to under 370 000 in
202518
Figure 2. Reaching the 2025 targets will reduce AIDS-related deaths to under 250 000
in 2025
18The epidemiological impact between 2026–2030 assumes that the 2025 targets are met. The 2026–
2030 epidemiological impact will be revisited closer to 2025, by which time it will be possible to assess
programmatic achievements through 2025.
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Figure 3. Reaching the societal enabler targets will prevent 2.5 million new HIV
infections and 1.7 million AIDS-related deaths by 2030
85. Reaching the societal enabler targets in this Strategy is crucial. Modelling indicates that
failure to reach the targets for stigma and discrimination, criminalization and gender
equality will prevent the world from achieving the other ambitious targets in the Strategy
and will lead to an additional 2.5 million new HIV infections and 1.7 million AIDS-related
deaths between 2020 and 2030.
86. The full set of 2025 targets and commitments is provided in Annex 1. The resources
required to achieve these results in low- and middle-income countries are discussed in
greater detail in Chapter 7 and in Annex 2.
87. We have the potential and commitment to end AIDS. However, people-centred services
remain limited. The lack of comprehensive, high-quality, rights-based, gender-
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responsive, context-tailored services at the scale and intensity required have resulted in
inequalities that slow global progress towards ending AIDS. Current HIV services are not
always designed or tailored for the populations or age groups who are most affected by
HIV, and they often fail to meet the needs of those populations. Stigma, discrimination
and persistent gender inequalities leave many key populations and people from priority
populations unreached and unserved. In addition, HIV services are often not
complemented by broader rights-based, gender-sensitive access to age-tailored health
care, sexual and reproductive health services, education (including comprehensive
sexuality education both in and out of school), sustainable livelihoods, support systems
and social protection.
88. This new people-centred Strategy calls for urgent action to link all individuals living with
or at risk of HIV with the services they need. Recognizing that "one size does not fit all",
the Strategy prioritizes the tailoring of differentiated service packages and service
delivery approaches to the unique needs of people, communities and locations, using
granular data to focus programmes most effectively.
89. To ensure sufficient service coverage, the new Strategy prioritizes actions to first benefit
the people who are not being reached, such as key, priority and underserved
populations. Tailored, combination HIV prevention packages must receive substantially
greater prioritization––including scale-up of underutilized prevention approaches and
community-led responses, such as comprehensive sexuality education, sexual and
reproductive health (including contraception), harm reduction services, condoms,
lubricants, PrEP and U=U,19 and emerging prevention tools, such as antiretroviral
containing vaginal rings. Prioritized actions are also required to close the gaps in access
to treatment and care that undermine the benefits of ART.
people within the subpopulation who are living with HIV and who know their HIV status are on ART;
95% of people within the subpopulation who are on ART have suppressed viral loads.
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• 90% of people living with HIV and people at risk are linked to people-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-
being.
Result Area 1: Primary HIV prevention for key populations, adolescents and other
priority populations, including adolescents and young women and men in locations
with high HIV incidence
90. HIV prevention efforts are not currently having the impact needed to end AIDS. The
estimated 1.7 million people who newly acquired HIV in 2019 far exceeded the 2020
target of fewer than 500 000 new HIV infections. Insufficient resources and inadequate
focus on preventing new HIV infections among key populations and their sexual partners
and adolescent girls and young women in Sub-Saharan Africa are the biggest reasons for
the slow progress.
91. The risk of HIV transmission among key populations and their sexual partners is the
major contributor to new HIV infections globally and in every region outside of eastern
and southern Africa. Although the likelihood of key populations acquiring HIV exceeds the
risk among other populations, the gaps in HIV investment are disproportionately large for
HIV prevention among key populations. HIV prevention efforts have also been slow to
address how harmful alcohol or non-injecting drug use, such as “chem-sex” and the use
of other stimulant drugs that affect sexual behaviours and increase risks of HIV
acquisition.
92. HIV prevention efforts have also yet to fully engage the broader health sector as well as
non-health sectors to address underlying inequalities and structural factors that contribute
to HIV vulnerability. To close the gaps in HIV prevention, the urgent strengthening of
tailored, high-impact, evidence- and rights-based combination HIV prevention, including
the realization of the full potential of treatment as prevention, are key, transformative
elements of the new Strategy.
93. The number of adolescent girls and young women who acquired HIV in 2019 (280 000)
was nearly three times higher than the Fast-Track target for 2020 (100 000). In sub-
Saharan Africa, high rates of HIV acquisition persist among adolescent girls and young
women, stemming from multiple vulnerabilities such as harmful social norms and
practices (i.e. female genital mutilation), sexual and gender-based violence,lack of
access to education or completion of secondary school, poverty and age-disparate sex.
Combination HIV prevention, including primary prevention, especially for young people,
is also vital to eliminate vertical HIV transmission.
94. Political commitment and resources for evidence- and rights-based combination HIV
prevention remains inadequate, and harmful social norms, stigma, discrimination and
punitive laws still obstruct prevention efforts. Key populations continue to face these and
other barriers to access HIV prevention services. Even though people in key populations
are at a much greater risk of acquiring HIV, investments in HIV prevention for key
populations are disproportionately low.
95. There are important opportunities to strengthen and transform HIV prevention efforts,
including primary prevention, over the next five years and reduce the inequalities in
access to HIV prevention. Marked progress in reducing new HIV infections has been
made in diverse countries, including Cambodia, Estonia, South Africa, Thailand, Viet
Nam and Zimbabwe. These and other countries that have achieved significant declines
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in new HIV infections have mobilized strong political commitment, strategically targeted
resources to high impact HIV prevention programmes, and supported community-led
responses to HIV prevention.
96. The toolbox for combination HIV prevention continues to expand, with recent evidence
validating the effectiveness of antiretroviral-containing vaginal rings and long-acting
injectable antiretrovirals and PrEP. Drawing inspiration from the rapid development and
deployment of vaccines to prevent COVID-19, the Strategy aims to minimize the delays
between scientific discoveries of prevention breakthroughs and their implementation.
97. The Global HIV Prevention Coalition has helped mobilize global attention on HIV
prevention, with all 28 of the Coalition’s focus countries having adopted ambitious
national HIV prevention targets. The Strategy builds on the efforts of the Global HIV
Prevention Coalition to adequately resource, intensify and scale up effective and
innovative prevention interventions as an urgent priority.
98. The new Strategy prioritizes the implementation and scale-up of evidence-informed,
rights-based, community-led combination prevention packages that are tailored to
address the diverse needs, circumstances and preferences of the populations who need
effective prevention the most and that can yield the greatest programmatic impact.
99. Under the new Strategy, total annual spending on primary prevention should increase to
US$ 9.5 billion by 2025, with the aim of reaching the ambitious prevention targets for all
populations.
100. While the priority populations for prevention efforts vary across local and community
settings, the Strategy calls for focused efforts to reduce inequalities and close prevention
gaps for key populations and for adolescent girls and young women in locations with
high HIV incidence.
101. Countries need to ensure that population size estimates of key populations are updated
to allow national programmes and implementation partners to invest in HIV services at a
level that is commensurate with actual needs and track progress on reaching HIV
prevention, testing and treatment 95-95-95 targes. The failure to provide HIV prevention,
diagnosis and treatment interventions to key populations at scale will likely lead to failure
in general epidemic control at the national level. The Strategy prioritizes actions to
empower and meaningfully engage these and other priority and underserved
populations, especially in decision-making regarding the HIV response.
102. Female genital schistosomiasis represents a risk for the acquisition of HIV infection in
areas where schistosomiasis is endemic. Preventive treatment of schistosomiasis, with
HIV prevention and the promotion of sexual and reproductive health is important to
protect the health of women and girls.
Result Area 2: Adolescents, youth and adults living with HIV, especially key
populations and other priority populations, know their status and are immediately
offered and retained in quality, integrated HIV treatment and care that optimize health
and well-being
104. Remarkable gains have been made in the past five years in scaling up HIV testing and
treatment services and in preventing AIDS-related deaths. Many countries have reached
the 90–90–90 HIV testing and treatment targets22 and more people than ever are
accessing ART and achieving viral suppression. However, the impact of ART has been
blunted by inequalities in HIV outcomes, including gaps in people's knowledge of their
HIV status, the lack of timely treatment initiation and retention, and achieving and
sustaining viral suppression.
105. Efforts to optimize the health and HIV prevention benefits of ART face several
challenges. Inequalities in treatment access and outcomes arise when services do not
specifically meet the needs of underserved populations who are not well served by
mainstream health services. Many people who initiate ART achieve viral suppression,
but some are not linked to care early enough or do not remain engaged in care.
Differentiated approaches and support are often not in place to ensure quality and
continuity of care. At the end of 2019, gaps across the testing and treatment cascade
meant that an estimated 15.7 million people living with HIV globally did not have
suppressed viral loads, which endangers their health and facilitates the further spread of
HIV.
106. Adolescents and young people living with HIV are in particular need of tailored services
that address their physical and mental health and well-being, and that support them as
they transition to adult health services. Poor access to treatment experienced by young
men compromises their own health and well-being and it contributes to high levels of
new infections among adolescent girls and young women.
107. Stigma, discrimination, gender inequalities, age-of-consent laws that limit young
people’s access, punitive laws and policies, and a failure to address basic human needs
limit many people’s ability or willingness to access testing and treatment services or
remain engaged in care.
22The 90–90–90 targets aimed to ensure that by 2020: 90% of all people living with HIV know their
HIV status, 90% of people with an HIV diagnosis receive ART and 90% of people receiving ART
achieve viral suppression.
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108. People in informal, humanitarian and fragile settings, people with disabilities, indigenous
populations, migrant and mobile populations, key populations and other priority
populations face unique challenges in accessing HIV testing, treatment and care.
109. Strong momentum already exists for addressing these many challenges. Nationally, 10
countries had attained the 73% target for HIV viral suppression by 2019.23 Eswatini and
Switzerland, for example, have exceeded the 95–95–95 targets for testing, treatment
and viral suppression. Differentiated service delivery approaches, developed in many
cases with or by communities to respond to their specific needs and circumstances, are
now being taken up widely. The COVID-19 pandemic provides additional impetus for
expedited roll-out to preserve service access during national or local lockdowns.
110. Scientific research continues to reveal ways to optimize treatment regimens. For
example, two recent clinical trials found that monthly or two-monthly injections with
cabotegravir and rilpivirine as long-acting formulations of antiretroviral medications are
as effective as standard daily oral therapy. Future long-acting agents in trials have
potential to improve treatment outcomes in low- and middle-income countries. Four large
intervention trials have also validated service delivery strategies to reduce inequalities in
testing and treatment uptake and outcomes among men and young people.
111. HIV self-testing has emerged as an important option for people who might otherwise
avoid testing services due to stigma and discrimination. The rapid development of
COVID-19 treatments and vaccines underscores the importance of science as a key
pillar of every pandemic response.
112. Drawing on such momentum, the Strategy prioritizes actions to reduce inequalities in
testing, treatment and care access and outcomes. It demands the achievement of 95–
95–95 targets in all populations affected by the epidemic, and in all regions, countries
and localities. This will require both political commitment and the strategic use of
granular data to identify and address the specific testing and treatment needs of
populations that are yet to experience the full health benefits of ART. Prioritized,
population-focused and context-specific actions are urgently required to address gaps
that diminish rates of viral suppression, including late diagnosis and loss to follow-up.
23Achieving the 90–90–90 targets means that at least 73% of all people living with HIV achieve viral
suppression.
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e. Scale up and fully resource community-led service delivery and monitoring, which
has been proven to improve the HIV and wider health outcomes of people living with
HIV.
f. Strengthen the capacity of the education sector to meet the needs of young people
living with and affected by HIV, including through scaling up access to school health
and nutrition programmes, linkages to health and social protection services, and
provision of good-quality comprehensive sexuality education.
g. Expand and promote equitable, affordable access to high-quality medicines, health
commodities, science, technology, innovations and solutions for people living with
HIV, key populations and other priority populations.
h. Accelerate research and development for more effective HIV technologies, including
more effective treatment regimens and solutions, an HIV cure and an HIV vaccine,
and invest further in implementation research to build the evidence base for the
effective delivery and optimal impact of new technologies.
i. Address the impact of social and structural drivers of the AIDS epidemic, including
unequal gender norms and power dynamics, and human rights violations across HIV
prevention, treatment and care efforts.
Optimizing quality of life and well-being across the life-course, through integrated,
people-centred services
115. Although many people could benefit from service integration, critical intersecting
inequalities and integration gaps undermine HIV, health, well-being and quality-of-life
outcomes for people living with HIV. For example, although TB is preventable and
treatable, it is the leading cause of death among people living with HIV. Less than half of
the estimated incident TB cases among people living with HIV are diagnosed and
treated appropriately, and there is poor uptake of treatment regimens for latent TB
infection.
116. Similarly, women living with HIV are six times more likely to experience invasive cervical
cancer and are more likely than HIV-negative women to die of cervical cancer even
when receiving ART. Yet services for prevention, screening and treatment of cervical
cancer are insufficiently integrated with HIV services and typically are not available at
scale. Mental health, treatment services for drug and substance use, and services for
the prevention and treatment of hepatitis C are rarely integrated and linked with HIV
services, notwithstanding the high prevalence of HIV among people who use drugs,
particularly people who inject drugs. Linking HIV programmes with services for the
prevention, testing and treatment of sexually transmitted infections is vital.
117. The Strategy prioritizes the context-specific integration of HIV with other health services
and in primary health care, with particular attention to ensuring that the needs of key and
priority populations are addressed. The Strategy outlines concrete, quantifiable targets
to drive service integration, address inequalities, and promote holistic, people-centred
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health services. With TB still accounting for roughly one in three deaths among people
living with HIV, the Strategy calls for urgent attention to the unfinished agenda of
addressing the twin epidemics of HIV and TB.
119. One of the most glaring disparities in the HIV response is the failure to meet the needs
of children living with or at risk of HIV. While 85% of pregnant women living with HIV
were accessing HIV treatment services in 2019, only 53% of children living with HIV
were doing so. Only 37% of children living with HIV were virally suppressed in 2019,
compared to 60% of adults. An estimated 850 000 children living with HIV were not
receiving treatment services, two-thirds of whom were aged five years and older—the
result of many years of missed opportunities for prevention, diagnosis and treatment.
Only 60% of HIV-exposed infants are tested by two months of age. Adoption and
integration of new point-of-care diagnostic technologies can help close the testing gaps,
but these have yet to be brought to scale in most settings.
120. Development and uptake of optimal child-friendly HIV treatment lag far behind adults,
leading to much poorer health outcomes. Although children accounted for 5% of people
living with HIV in 2019, they represented 14% of all AIDS-related deaths. As they
progress through childhood and into adolescence and early adulthood, children living
with HIV often lack the psychosocial support, good parenting and prevention services
they need to stay in HIV care.
121. Reductions in the number of children acquiring HIV constitute one of the most important
achievements of the HIV response. Yet in 2019, there were 150 000 new HIV infections
among children – far from the global 2020 target of 20 000 with declines in new child
infections having slowed dramatically after 2016. Global coverage of ART among
pregnant and breastfeeding women remains high (85% in 2019), but coverage
expansion has also stagnated. There are many issues that require urgent attention to
accelerate progress to eliminate vertical HIV transmission and to end paediatric AIDS.
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• Some women living with HIV still do not access antenatal services during pregnancy
and breastfeeding.
• Not all pregnant and breastfeeding women who access services for vertical HIV
transmission, including ART, remain in treatment and care throughout pregnancy
and breastfeeding.
• Women still acquire HIV during pregnancy and breastfeeding due to the lack of
tailored combination HIV prevention, including PrEP for women at substantial risk for
HIV. Repeat HIV testing during pregnancy and breastfeeding can help identify new
infections and trigger acute interventions to prevent vertical HIV transmission.
• Women receiving ART who are pregnant or breastfeeding but not virally suppressed
require additional interventions and support—being on ART is not sufficient to
ensure optimal outcomes for women or children.
122. A range of socioeconomic and structural factors undermine the ability of many women,
particularly women from key populations, to access and remain engaged in services.
They include unequal power dynamics and gender norms, gender-based violence,
poverty, user fees, and stigma and discrimination from health care workers, family
members and the community. Identifying where new child infections are occurring will
enable countries to take a targeted approach to eliminate vertical transmission of HIV
(see figure below).
Figure 4. New child infections can occur at any time during pregnancy and
breastfeeding and for various reasons.
123. Rapid strengthening of political commitment, global solidarity and dedicated funding will
help close the inequalities gaps in HIV prevention and treatment for children. The world
must build on and learn from key successes, including the proven ability of diverse
countries to support women of all ages to achieve viral load suppression throughout
pregnancy and breastfeeding.
124. Tailored strategies can improve service delivery and reduce inequalities in access to
services, including the abolition of user fees, greater male involvement, peer mentoring,
use of text messages for appointment reminders, clinic dashboards to track progress,
integrated and differentiated service delivery and socioeconomic and psychological
support. These strategies have proven effective in increasing treatment coverage,
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retention and adherence among pregnant and breastfeeding women living with HIV and
in encouraging caregivers to bring HIV-exposed children for testing and retesting, and to
retain children living with HIV on optimal treatment.
125. Although still limited, antiretroviral regimens and formulations for children have
improved, including approval in 2020 of a generic WHO-preferred, first-line, child-friendly
dolutegravir-based HIV treatment for children under 20 kilograms. If the evolving needs
of children living with HIV are met, programmes will be able to ensure a continuum of
care as children grow and progress through adolescence, youth and into adulthood.
126. The Strategy prioritizes smarter programming to end vertical transmission and to reduce
the inequalities that worsen outcomes for HIV-exposed infants and children living with
HIV. Prioritized actions include an emphasis on linking and retaining all pregnant and
breastfeeding women in a tailored continuum of testing, prevention and treatment
services, and the urgent scale-up of efforts to find, diagnose and link children living with
HIV to optimal child-friendly treatment.
128. A central reason why inequalities in the HIV response persist is that we have not
successfully addressed the social and structural determinants that increase HIV
vulnerability and diminish the ability of many people to access and effectively use HIV
services.
129. Recognizing the equal worth and dignity of every person is not only an ethical imperative
and an obligation arising from international human rights instruments, it is central for
ending AIDS as a public health threat. SDG 3 cannot be achieved if stigma,
discrimination, criminalization of key populations, violence, social exclusion and other
human rights violations in the context of HIV are allowed to continue and if HIV-related
inequalities persist. The evidence consistently shows that the criminalization of people
living with HIV and key populations reduces service uptake and increases HIV
incidence. Gender inequalities also increase the HIV vulnerability of women and girls,
with women who experience intimate partner violence in high-prevalence settings more
than 50% more likely to be living with HIV.
131. With its new targets for societal enablers, the Strategy demands that the same
commitment and attention to technical detail that has characterized the HIV response’s
programmatic efforts be applied to the urgent business of addressing the social and
structural factors that slow progress against AIDS. The Strategy prioritizes lessons from
recent successes and applies them more broadly, especially in countries where
inequalities are enabled by punitive legal and policy frameworks. Communities of people
living with, affected by, or most at risk of HIV must be supported and effectively
resourced to galvanize actions that can reduce inequalities in the response and to
ensure that responses meet the needs of all people.
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132. If we are to reduce HIV-related inequalities and get the response on-track to end AIDS
by 2030, communities living with or affected by HIV must lead the way. Communities
living with and affected by HIV have been the backbone of the HIV response at every
level, from global to national to community. They advocate for effective action; they
inform local, national, regional and international responses regarding communities’
needs; and they plan, design and deliver services. They also advance the realization of
human rights and gender equality, and support the accountability and monitoring of HIV
responses. Communities give voice to people who are often excluded from decision-
making processes. Effective community-led HIV responses must be adequately
resourced and supported to enable communities to play their vital roles as equal, fully-
integrated partners in national systems for health and social services.
133. Progress in recent years demonstrates the essential role of community-led HIV
responses in global efforts to end AIDS. Communities have led efforts to identify and
address key inequalities; expanded the evidence base for action to end AIDS as a public
health treat; supported the planning and implementation of national HIV responses;
identified key issues and gaps for national and multilateral governance and coordination
bodies; expanded the reach, scale, quality and innovation of HIV services; and played a
visible role as defenders of human rights. As of 2019, community and key population-led
HIV prevention programmes that exceeded 80% coverage in many countries were
among the most effective. With acute resource constraints, it is critical to prioritize HIV
programmes that deliver optimal results in prevention, testing, linkages to treatment,
treatment literacy and adherence support that are led by people living with HIV, key
populations and women.
24 These are the high-level, aggregated targets for this Strategic Priority. The complete set of targets
and commitments in this Strategy are in Annex 1 and Annex 2.
25 With focus on enhanced access to HIV testing, linkage to treatment, adherence and retention
support, treatment literacy, and components of differentiated service delivery, e.g. distribution of ARV
(antiretroviral treatments).
26 For an organization to be considered community-led, the majority (at least fifty percent plus 1) of
governance, leadership, and staff comes from the community being served.
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134. Social contracting, whereby governments partner with and procure services from civil
society organizations, has emerged as a potentially powerful, though underutilized,
option for reaching marginalized or hard-to-reach populations. Although the pivotal roles
of communities are recognized in HIV governance, their meaningful engagement in
national systems for health as leaders, decision-makers and partners remains limited.
136. Reducing inequalities in the response will require the robust resourcing, engagement,
capacity building and leadership of community-led responses. The false dichotomy
between government-led health system responses and community-led health system
responses must be transcended in national systems for health and social services, with
communities fully integrated as essential partners in each and every aspect of the HIV
response.
Result Area 5: People living with HIV, key populations and people at risk of HIV enjoy
human rights, equality and dignity, free of stigma and discrimination
138. Stigma, discrimination and other human rights violations in the context of HIV both
reflect and drive the inequalities that undermine HIV responses. Everyone, including
people living with and affected by HIV, should enjoy human rights, equality and dignity.
139. The goal of zero discrimination still eludes the world. In 25 of 36 countries with recent
data, more than 25% of people aged 15–49 years displayed discriminatory attitudes
towards people living with HIV. Denial of health services to people living with HIV
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remains distressingly common, and the prevalence and effects of discrimination are
often especially acute for members of key populations, who face multiple, overlapping
forms of discrimination. In humanitarian settings, people living with HIV, key populations
and survivors of sexual and gender-based violence often experience social exclusion,
mandatory HIV testing, stigma, and discrimination, as well as access barriers that are
exacerbated by HIV criminalization laws and travel restrictions. In 2019, one in three
women living with HIV reported to have experienced at least one form of discrimination
related to their sexual and reproductive health in the previous 12 months.
140. Punitive laws, the absence of enabling laws and policies, and inadequate access to
justice contribute to the inequalities that undermine HIV responses. At least 92 countries
criminalize HIV exposure, nondisclosure and/or transmission, and 48 countries or
territories continue to block people living with HIV from entry, stay or residence. Among
countries reporting data to UNAIDS in 2019, 32 criminalized and/or prosecuted
transgender persons, 69 criminalized same-sex sexual activity, 129 criminalized some
aspect of sex work, and 111 criminalized the use or possession of drugs for personal
use. The health and well-being of people living in prisons or other closed settings are
routinely put at risk by punitive laws and policies, including denial of access to essential
health services.
141. Efforts to anchor HIV responses in human rights principles and approaches, including
the priority actions outlined below, can only be achieved through strong political
leadership and the active engagement and leadership of community-led responses that
are adequately resourced to advocate for, monitor and implement rights-based
responses.
142. In working towards the goal of zero discrimination, important progress needs to be
continued, accelerated, scaled up and funded. Stigmatizing attitudes have declined
notably in numerous countries, and U=U has the potential to accelerate anti-stigma
efforts. Since 2016, over 89 countries have reviewed and reformed punitive and
discriminatory laws and policies in line with the recommendations of the Global
Commission on HIV and the Law. The Global Fund’s Breaking Down Barriers initiative
has channeled critical new funding for initiatives to reduce human rights barriers to HIV,
TB and malaria services. In a sign of important commitment to a human rights-based
response, 18 countries have joined the Global Partnership for Action to Eliminate All
Forms of HIV-related Stigma and Discrimination. They have pledged to address HIV-
related stigma and discrimination in health care, education, workplace, justice,
individuals and communities and emergency and humanitarian settings.
143. This Strategy includes ambitious targets to sharply reduce the prevalence and impact of
social and structural drivers. The Strategy seeks to ensure that, by 2025, less than 10%
of countries have punitive legal and policy environments, less than 10% of people living
with HIV and key populations experience stigma and discrimination, and less than 10%
of women, girls, people living with HIV and key populations experience gender inequality
and violence.
Result Area 6: Women and girls, men and boys, in all their diversity, practice and
promote gender-equitable social norms and gender equality, and work together to end
gender-based violence and to mitigate the risk and impact of HIV
145. Gender inequality is a key driver of the AIDS epidemic. Unequal power dynamics
between men and women and harmful gender norms increase the HIV vulnerability of
women and girls in all their diversity, deprive them of voice and the ability to make
decisions regarding their lives, reduce their ability to access services that meet their
needs, increase their risks of violence or other harms, and hamper their ability to
mitigate the impact of AIDS.
146. Women and girls account for 48% of new HIV infections worldwide and 59% of new
infections in sub-Saharan Africa, and AIDS remains one of the leading causes of death
for women aged 15–49 years globally. The epidemic’s impact is especially pronounced
among adolescent girls and young women. Women who belong to key populations, as
well as women who are partners of key population members, experience alarmingly high
risks of acquiring HIV and are less likely to access services.
147. Women and girls confront multiple, intersecting forms of violence, oppression, stigma
and discrimination. National HIV strategies in at least 40 countries do not address the
needs of women and girls in the context of HIV, and most countries lack a dedicated
budget for activities to address women’s HIV-related needs. Only about one third of
young women in sub-Saharan Africa have accurate, comprehensive knowledge about
HIV. Nearly one in three women worldwide have experienced physical and/or sexual
violence by an intimate partner, nonpartner sexual violence or both in their lifetime.
During displacement and times of crisis, the risk of gender-based violence significantly
increases for women and girls.
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148. Policy barriers, such as age-of-consent laws for accessing HIV testing or sexual and
reproductive health services, as well as the social stigma associated with using those
services, hinder adolescent girls from making decisions about their own sexual and
reproductive health. Discriminatory laws and practices should be repealed, using the
Convention on Elimination of All Forms of Discrimination Against Women as a
monitoring tool to highlight violations of the rights of women living with and affected by
HIV.
149. There has been important recent progress in identifying progress and creating strategic
opportunities to develop HIV responses that work for women. Notable progress has
been made in expanding women’s access to HIV treatment, with 73% of women living
with HIV receiving ART in 2019. New biomedical prevention tools, including
antiretroviral-containing vaginal rings for PrEP for women, as well as oral and injectable
PrEP, offer women increased options for making informed choices about their sexual
lives and reproductive health. These biomedical innovations should be accompanied by
evidence-based, gender-transformative community-led interventions that involve women
and girls and men and boys in transforming unequal gender norms, attitudes and
behaviours, and in increasing demand and up-take of HIV services.
150. A lack of education and economic opportunities and insufficient or nonexistent access to
comprehensive sexuality education also increase women and girls' vulnerability to HIV.
Research evidence confirms that completion of secondary education can help protect
girls against HIV acquisition, while also yielding broader social and economic benefits.
Comprehensive sexuality education helps improve young people’s knowledge about HIV
and counters misinformation about sexual and reproductive health. A growing body of
data has validated numerous, intersectoral, gender-transformative interventions.
Important, though still inadequate, investments by the Global Fund, the United States
President's Emergency Plan for AIDS Relief (PEPFAR), UN Women, UNICEF and other
partners are supporting the empowerment, mobilization and leadership of women living
with HIV, women from key populations, and adolescent girls and young women.
151. The Strategy prioritizes substantially greater financing for women-led initiatives to
transform unequal gender norms and reduce the gender-related inequalities and
injustices that undermine HIV responses. Services must be adapted to be truly gender-
responsive and holistic, and the HIV response must take concerted steps to ensure that
women are served in all their diversity.
152. Achievement of this Result Area will support global efforts to achieve SDG Target 5.1
(“end all forms of discrimination against women and girls”) and SDG Target 5.6 to
“ensure universal access to sexual and reproductive health care.”
Result Area 7: Young people fully empowered and resourced to set new direction for
the HIV response and unlock the progress needed to end inequalities and end AIDS
154. At the forefront of every social movement are leaders of change who can envision new
realities and who are determined to create the change they wish to see. More often than
not, these pioneers are young people, as the #BlackLivesMatter and modern climate
change movements show. The HIV response must leverage youth leadership to enable
the radical changes needed to deliver on the Strategy.
155. In today’s complex, unpredictable and fast-changing world, young peoples' roles in
leading change are both crucial and under-utilized. The world is home to 1.8 billion
young people, the largest generation of young people in history. Almost 90% of young
people live in low- and middle-income countries, where they constitute a large proportion
of the population.
156. Today’s young people are adept at connecting across multiple digital platforms, using
social media to crowdsource ideas across continents, initiating local groups and global
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movements, and channeling and focusing people’s desire to bring about social change.
Keeping pace with technological change and using its advantages while mitigating its
risks will be crucial for HIV responses. Young people are ideally equipped to take up
these challenges. Facilitated by information technologies, new leadership models are
emerging that are collaborative, networked and self-organizing. They can be deployed in
the HIV response in ways that reflect young people’s realities and realize their potential
for leadership and social change.
157. The HIV response needs to reflect the fact that young people experience the world
differently than the general adult population and have different needs. While steep
reductions in new infections among young people have occurred in some countries,
especially in eastern and southern Africa, the world missed the Fast-Track target on
reducing HIV incidence among young people. Young people are also less likely than
adults to know their HIV status, receive ART and achieve viral suppression. These
disparities have been compounded during the COVID-19 pandemic.
159. Meaningful inclusion and empowerment of young people requires removing barriers to
their participation in HIV-related decision-making spaces and processes. The Strategy
aims to empower, support and celebrate young people as essential change agents in
the global effort to end AIDS. COVID-19 underscores the transformative role that youth
leadership can play in responding to a pandemic. Youth-led organizations have brought
resilience and innovation to efforts to mitigate the colliding effects of the AIDS and
COVID-19 pandemics.
160. Financial and programmatic support to youth leadership and youth-led initiatives is
required to ensure the sustainability and impact of youth-led responses.
162. Reducing inequalities will require systems that are robust, resilient and specifically
designed to meet the needs of the people and communities most heavily affected by
HIV. Ending AIDS demands a concerted push to ensure that every country develops a
truly sustainable response which:
• receives sustainable, efficiently-used resourcing with equitable, evidence-based
allocations that fully leverage technological innovations;
• leverages and supports the systems integration that is needed to ensure that people
affected by HIV have effective and equal access to the full range of services
(medical and nonmedical) they need to protect themselves against infection and to
survive and thrive when living with HIV;
• is resilient enough to deliver services to all people when and where they need them,
with systems that operate effectively in both normal and emergency conditions; and
• ensures a comprehensive, whole-of-system response that includes greater
cooperation, coherence, coordination and complementarity among development and
humanitarian actors.
28These are the high-level, aggregated targets for this Strategic Priority. The complete set of targets
and commitments in this Strategy are provided in Annex 1 and Annex 2.
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• 95% of people within humanitarian setting at risk of HIV use appropriate, prioritized,
people-centred and effective combination prevention options.
• 90% of people in humanitarian settings have access to integrated TB, hepatitis C and
HIV services, in addition to programmes to address gender-based violence (including
intimate-partner violence), which include HIV post-exposure prophylaxis, emergency
contraception and psychological first aid.
• 95% of people living with, at risk of and affected by HIV are better protected against
health emergencies and pandemics including COVID-19.
Result Area 8: Fully funded and efficient HIV response implemented to achieve the
2025 targets
163. The inequalities that are slowing progress in the HIV response have increased the
resource needs for the global response and have underscored the urgent need for
sustainable HIV financing. Additional resources will be needed to reduce inequalities,
account for deficits resulting from the failure to achieve the Fast-Track targets, close
service gaps resulting from the COVID-19 pandemic and to put the world on-track to end
AIDS by 2030.
164. HIV must remain a priority for health systems and financing, including to support
Universal Health Coverage and achievement of the relevant SDGs. In working to
mobilize robust, sustainable financing, there are important opportunities that must be
seized. In light of the demonstrated value of HIV infrastructure for national COVID-19
responses, the HIV response should showcase how HIV investments build capacity,
strengthen programme infrastructure, support pandemic preparedness and create
platforms to address other health conditions, including noncommunicable diseases.
165. Domestic financing accounts for approximately 56% of available financing for the global
HIV response. Although domestic financing overall has not increased quickly enough,
domestic HIV investments in 2015–2019 rose substantially in several countries. That
trend, while promising, masks disparities in funding allocation. Domestic funding is
mainly allocated to treatment services, while prevention programmes for key
populations, adolescent girls and young women and programmes that address human
rights barriers and structural inequalities are predominantly funded from international
sources or are barely funded at all. The impact of domestic funding is further
undermined in many countries by inefficiencies, including failure to allocate limited
resources towards the most effective interventions or to focus resources strategically by
location or population.
166. The negative economic impact of the COVID-19 pandemic has created additional
challenges for many low- and middle-income countries to mobilize new domestic
resources for their HIV responses. Declines in tax revenues and increases in
government spending have resulted in higher debt and deficit levels, adding to existing
unsustainable levels of debt in over 30 low-income countries. Several high burden
countries now face the dual challenge of AIDS and COVID-19, while high levels of
debt servicing significantly reduce their fiscal space to invest in their health and social
sectors.
167. Financing for domestic HIV responses must leverage traditional and new partnerships to
meet the challenging macrofiscal environment, resist a new era of austerity and identify
a range of methods for mobilizing domestic and market resources. The Strategy calls for
reforms that broaden the vision of financing for HIV and health financing to promote
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168. Maintaining global solidarity and international donor funding is critical to reach the
targets and commitment in the Strategy. Overall international HIV assistance declined by
nearly 10% from 2015 to 2019, with support from a few donors increasing while many
others reduced their funding for HIV. Encouraging evidence of continued global
solidarity in financing the HIV response can be found in the successful replenishment of
the Global Fund in October 2019, the sustained and robust financial support of the
United States of America for PEPFAR, and the important support for social spending
provided by the World Bank.
169. The Strategy prioritizes transformative action in three areas to ensure that the HIV
response is fully funded. Firstly, the Strategy underscores the importance of global
solidarity and shared responsibility in mobilizing significant new resources to get the
response on-track to end AIDS as a public health threat and to address the impact of
COVID-19 on the HIV response. Secondly, it calls for urgent action to improve the
equality and strategic impact of resource allocations to achieve sustainable solutions for
underserved populations. Third, the Strategy prioritizes actions to focus finite resources
on the settings, populations and game-changing approaches that will have the greatest
impact.
ii. focus resources on highly effective and efficient interventions for priority gaps and
populations, including increased funding for scaling programmes for key
populations and addressing structural drivers; and
iii. leverage appropriate technologies to reach people through differentiated
approaches––tools that put services in the hands of people.
c. Develop and implement context-specific sustainability financing strategies (including
multisectoral contributions to HIV responses) that ensure universal access and
improved health outcomes, by taking actions to:
i. implement country-tailored financing frameworks that raise domestic revenues for
the HIV response and social spending, increase the quality and coverage of HIV
and health services, and improve resilience and sustainability of financing;
ii. ensure that financing, governance and social financing frameworks for Universal
Health Coverage drive progress towards HIV targets, removing structural barriers
and reducing inequalities; progress should be measured by the integration of the
full range of HIV prevention, treatment and care services, reaching all populations
with stigma free services, and public financing of community-led responses;
iii. abolish user fees for HIV-related and other health-care services, starting with the
most marginalized populations, women, girls, people living with HIV, key
populations and other priority populations;
iv. build on the platforms and structures of the HIV response to promote Universal
Health Coverage that includes gender and other equity considerations beyond
socioeconomic status and income towards realization of people's right to health;
v. shift towards progressive health financing that provides Universal Health
Coverage for the full range of HIV services, inclusion in national schemes and
general tax contributions for resource pooling, and shifts away from voluntary or
contributory schemes that are linked to benefit entitlements; and
vi. implement transition strategies and plans that ensure sustainable financing,
engage with communities, donors and partners to identify country-tailored
solutions, and secure sustainable funding for programmes for key populations
and community-led programmes.
d. Improve the collection and use of granular sex-, gender-, population- and age-
disaggregated data to track funding for key populations, women and girls and other
people underserved by the response, aiming to maximize impact and transparency,
accountability and efficiency of resources and policy decisions.
Result Area 9: Integrated systems for health and social protection schemes that
support wellness, livelihood and enabling environments for people living with, at risk
of and affected by HIV to reduce inequalities and allow them to live and thrive
171. Existing health services often fail to address the HIV-related and other needs of people
who need them most, due to discriminative attitudes or lack of sensitivity to the needs of
key populations and priority populations and system capacity deficiencies. Dedicated
HIV services do not always meet the broader health needs of people living with or
affected by HIV.
172. When integrated service packages are tailored and delivered in ways that place people
at the centre, they can help rapidly reduce inequalities in the HIV response as well as
support Universal Health Coverage. People-centered systems for health must ensure
that health and community systems, and social and structural enablers optimize the
impact and sustainability of HIV programmes. This can be achieved through inclusive
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173. Health systems must be transformed to be truly stigma- and discrimination-free. Key
health system functions, including health information, procurement and supply chain
management, human resource and financing, should be strengthened to support the
effective delivery of HIV and integrated services, including access to quality medicines
and other health commodities and technologies. Community-led responses, in particular,
help to reduce HIV-related inequalities by enabling the tailoring of approaches to meet
the needs of the people who need services the most. Communities are also essential to
the effective governance of systems for health, with the efforts for primary health care
and Universal Health Coverage highlighting inclusive governance as critical to ensuring
effective and sustainable health systems. Attention to social and structural enablers
helps to remove impediments to service uptake and quality, such as multidimensional
stigma, discrimination, gender inequalities, sexual and gender-based violence, poverty,
inadequate living conditions and insufficient investments in social protection and
education focusing on poor girls and women.
29 HIV-related products and health technologies refer to generic and branded products, and health
technologies, including HIV antiretrovirals and other essential commodities, including contraceptives,
medicines for prophylaxis and treatment of coinfections and comorbidities (TB, viral hepatitis,
STIs), laboratory diagnostics, including but not limited to rapid test kits, monitoring tools, viral load
reagents and, equipment and consumables, and HIV prevention technologies, including male and
female condoms and lubricants, voluntary medical male circumcision, PrEP and post-exposure
prophylaxis, syringes and needles, and medication for prevention of drug overdose (naloxone) and
opioid substitution therapy.
30 In alignment with WHA Resolution 72.8
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175. Robust, people-centred social protection has a key role to play in reducing the
intersecting inequalities that slow progress towards ending AIDS and enhancing the
well-being, human dignity and productivity of households affected by HIV. Social
protection reduces vulnerability, systematically removes barriers to service utilization
and improves health, well-being, quality of life, enables food security and nutrition and
social inclusion. All people living with and affected by HIV have an equal right to social
protection, which must be mandated in national policy, legal and programmatic
frameworks. These can include access to universal health services, social safety net
transfers, insurance and pension benefits, and other state-facilitated systems that are
available to the population.
176. Countries are failing to ensure ready access to the social protection that people living
with and vulnerable to HIV infection need. Only 29% of the world’s population has
access to adequate social protection coverage; two thirds of children have no social
protection coverage, and key populations are recognized as social protection
beneficiaries in only 26 countries. Women and girls continue to bear the brunt of unpaid
care work in the context of HIV.
177. Pandemics such as AIDS and COVID-19 highlight the pivotal role of social protection in
addressing and mitigating the impact of health crises. Countries have expanded or
started hundreds of new social assistance interventions in response to the COVID-19
pandemic and national expenditure levels for social protection have more than tripled.
Many of these actions also help mitigate the impact of HIV and TB, reduce HIV risk and
enhance access to HIV and TB services. In eastern and southern African countries,
where health systems are fragile and overburdened, grassroots women’s organizations
have often filled gaps in formal services by helping to deliver antiretroviral and other
medicines, sanitary pads, personal protective equipment, COVID-19 information, food,
and cash support to individuals and families in need.
178. The Strategy calls for an intensified push to encourage meaningful, equitable
investments by diverse sectors in inclusive, HIV-sensitive social protection safety nets
and systems. This will strengthen and help sustain the HIV response, enhance access
to HIV prevention and treatment programmes, contribute to delivering broad-based
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Result Area 10: Fully prepared and resilient HIV response that protects people living
with, at risk of and affected by HIV in humanitarian settings and from the adverse
impacts of current and future pandemics and other shocks
Humanitarian settings
180. Reducing inequalities demands focused efforts to meet the needs of people who are
most vulnerable and underserved, recognizing that people living with HIV and key
populations in emergency and humanitarian settings are highly vulnerable to the
socioeconomic impact of emergencies. They typically are least protected by national
social safety nets and often experience multilayered inequalities which heighten their
vulnerability. The Strategy calls for equal access to HIV services for people living with
and affected by HIV in humanitarian emergencies (including refugees and internally
displaced persons) and for ensuring that their health, food, nutrition, shelter and water
basic needs are covered in humanitarian responses.
181. The magnitude and frequency of humanitarian emergencies are increasing, including
complex crises, protracted conflicts, food insecurity, and climate change events. Conflict,
disasters and displacement deplete health services, isolate communities and increase
vulnerabilities, particularly among refugees, internally displaced persons, vulnerable
migrants and key populations. Many countries facing ongoing humanitarian
emergencies have weak health systems and governance, with poor delivery of basic
HIV services.
182. Humanitarian situations often result in populations moving internally or across frontiers.
Displacement can increase vulnerability and risk-taking and can interrupt HIV treatment.
Even where treatment and other HIV services are available in humanitarian settings,
people encounter multiple, practical barriers to accessing these services. Fearing
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183. Women and girls in all their diversity are disproportionately affected by violence and
other expressions of gender inequality in the context of humanitarian emergencies.
Addressing HIV and conflict-related sexual violence in the context of humanitarian crises
requires advance planning, coordinating and synergizing the activities of multiple actors
and communities, meeting a multiplicity of health and service needs, and dealing with
stigma and discrimination.
184. Efforts to address HIV in humanitarian settings can build on important, existing strengths
and achievements. Clear guidelines and coordination mechanisms for addressing HIV in
humanitarian settings exist. Important progress has been made in integrating HIV
services in these settings, including among refugees and internally displaced people. A
survey of 48 refugee hosting countries found that in 90% of countries refugees living
with HIV have the right to access ART through national health systems, while refugees
are receiving certain HIV services through Global Fund grants in 82% of countries.
Despite these important achievements, the most vulnerable groups––including irregular
migrants, key populations, unaccompanied minors and adolescents and children––often
struggle to obtain meaningful access to HIV services in humanitarian settings.
186. Given the profound and continuing effects of the COVID-19 pandemic, urgent efforts will
be needed to enable HIV services and broader responses to build back better, address
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187. As AIDS and COVID-19 pandemics demonstrate, pandemic outbreaks are a perennial
threat in an interconnected world. COVID-19 constitutes an emergency, a public health
crisis and socioeconomic shock to the world. Even high-income and conflict- or
emergency-free countries are experiencing serious difficulties in ensuring prevention,
diagnosis and treatment, and in sustaining health services to the general
population. The pandemic has had major effects on health and well-being, including
alarming rises in the incidence of gender-based violence. The AIDS and COVID-19
pandemics underscore the need for the HIV response and systems for health to be
resilient, adaptable, people-centred and prepared to respond to future pandemics.
188. Specific steps are needed to ensure that all people living with HIV, key populations and
other people at risk of HIV are better protected in health emergencies (based on SDG
indicator 3.d.1. International Health Regulations capacity and health emergency
preparedness) and have access to health and other support services. Lessons from the
HIV and COVID-19 responses should be used to strengthen preparedness. The COVID-
19 pandemic has highlighted the fault lines of a deeply unequal world, where women in
their diversity and traditionally marginalized groups experienced loss of livelihood,
evictions and abuse. But it has also spurred rapid uptake of key HIV-related innovations,
including HIV self-testing, multimonth dispensing of medicines and use of virtual
platforms for support, counselling and information dissemination.
189. The most recent data indicates that people living with HIV are at increased risk for
severe outcomes with COVID-19, including COVID-19 mortality, compared with people
without HIV.
191. The Strategy will reinforce, advance and effectively leverage five cross-cutting issues
across all areas of the Strategy.
192. The COVID-19 pandemic and its impact on countries and communities afford
governments and partners the opportunity to “build back better”––creating systems and
approaches that are more resilient and that place people and communities at the centre.
As leaders make political choices during the recovery from COVID-19, it is important that
gains made in the HIV response are not just sustained but enhanced. Renewed political
will and leadership is needed at every level to implement this Strategy in order to reduce
inequalities by 2025 and accelerate progress towards ending the AIDS epidemic by
2030.
193. Strengthened leadership is needed to reinforce and advance the principles, targets and
commitments in this Strategy as well as those made by all UN Member States in the
2030 Agenda for Sustainable Development and other political declarations.
194. The Strategy emphasizes country ownership. National governments must work in
partnership with organizations led by and for people living with HIV, key populations,
and other priority groups, affected communities, as well as with civil society
organizations, the private sector, academia and international partners.
196. In addition to mobilizing increased and sustained political commitment, the Strategy
prioritizes the engagement and empowerment of people living with HIV, key populations
and other priority groups in all their diversity. People living with HIV and key populations
are key and indispensable decision makers for the HIV response.
197. Bold advocacy and communications will be critical to refocus the world’s attention on the
urgent need to reduce inequalities by 2025 and ending AIDS as a public health threat by
2030. The Strategy seeks to harness the power of key influencers and the media to
advance breakthrough progress on the underlying social, legal and structural barriers
that impede gains towards HIV-related targets and commitments.
198. Reducing inequalities by 2025 and getting the HIV response on-track to end AIDS by
2030 are immense challenges that require strengthened partnerships and collaboration
at all levels. The Strategy also requires the alignment of strategic processes and
collaboration among global partners, including UNAIDS, the Global Fund, PEPFAR,
Unitaid, the StopTB Partnership, the Medicines Patent Pool, the International Federation
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of the Red Cross and Red Crescent Societies, GNP+, bilateral donors and private
foundations, governments and communities.
199. The Strategy will ensure full alignment between global and national strategic processes,
such as the Global AIDS Strategy, the Global Fund’s post-2022 Strategy, PEPFAR’s
Country Operational Plans and its new Strategy, the strategies of UNAIDS Cosponsors
(including campaigns to unlock societal enablers, such as Generation Equality), the UN
Sustainable Development Cooperation Frameworks and the SDGs, as well as national
HIV, health and development planning processes and mechanisms.
200. During the Decade of Action to deliver the SDGs, the Strategy calls for bold, inclusive,
multisectoral approaches to HIV to reduce inequalities, protect human rights and
strengthen collaboration and synergies between HIV-specific and broader health and
development initiatives and systems at all levels. The Strategy will advance a whole-of-
government, whole-of-society response to ending AIDS. The Strategy will strengthen
inclusive, transparent, accountable and multisectoral country-level governance
mechanisms to effectively support inclusive, multisectoral strategic partnerships,
coordination and collaboration.
201. The Strategy prioritizes engaging, leveraging and synergizing the contributions of all
relevant partners in every aspect of the HIV response.31 The Strategy will also leverage
and accelerate partnerships between the HIV response and other global and local
movements for Universal Health Coverage, gender, human rights, nondiscrimination on
the basis of sexual orientation and gender identities, economic justice, youth, anti-
racism, ending violence against women, and climate change.
202. The Strategy will accelerate engagement with the private sector as a key provider of
employment for people living with, at risk of or affected by HIV, and as a partner for
mobilizing and accelerating expertise and systems to reduce inequalities, drive
innovation and develop new technologies to accelerate progress to end AIDS as a
public health threat, and as a complementary source of financial resources.
203. The Strategy places special emphasis on the role and contributions of faith-based
organizations, religious leaders and faith communities. Their positions of trust at the
heart of communities and their missions to serve communities equip them to provide
services and support that extend beyond the reach of many conventional services and
systems. The Strategy will leverage the distinctive and extensive contributions of faith-
based organizations and faith communities in providing HIV services, care and support
to the key populations and affected communities.
204. The Strategy will ensure alignment with the global health and development architecture,
including through the Global Action Plan for Healthy Lives and Well-being for All.
205. The Strategy can be effectively implemented only by leveraging the potential of data,
science, research and innovation to guide the HIV response. Data is essential to identify
31 Including national governments, the UNAIDS Joint Programme and other relevant UN agencies and
programmes, regional and subregional organizations, people living with, at risk of and affected by HIV,
key populations, political and community leaders, parliamentarians, justice and law enforcement
officials, communities, families, faith-based organizations, scientists, health professionals, donors, the
philanthropic community, the workforce, the private sector, the media and civil society, including
women’s and community-led organizations, feminist groups, youth-led organizations, key population-
led organizations, national human rights institutions and human rights defenders.
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the ways in how and why the HIV response is working for some but failing others, inform
strategic actions to reduce inequalities, and guide and accelerate implementation.
Achieving the Strategy targets require using data to map the impediments to service
access, including human rights barriers and inequalities, and to clearly identify the
approaches, investments and tools that can close the gaps. The Strategy calls for
tangible actions to remove barriers and translate scientific advances (in biomedical and
clinical, social and behavioural, political and economic, and implementation sciences)
into meaningful interventions that benefit all people equally. Global, regional and
country-level data to assess progress will also become increasingly important.
206. The Strategy calls for improved collection, analysis and use of data to better inform
AIDS epidemic responses, including through the greater use of community-generated
and -owned data to monitor the affordability, availability, accessibility, acceptability and
quality of the HIV response for different groups. The Strategy prioritizes collecting and
effectively using timely granular data, in collaboration with communities and in rights-
affirming ways, for location- and population-specific actions that reduce inequalities in
HIV outcomes.
207. Continued innovation will be needed to develop new biomedical technologies and even
more effective service delivery strategies to accelerate progress towards ending AIDS.
Implementation of biomedical advances needs to be rights-based and occur as part of
inclusive, community-led approaches. Greater investments are needed in the
development of an HIV vaccine and a cure. Those efforts should draw inspiration and
lessons from the unprecedented speed with which COVID-19 vaccines have been
developed. A comparable spirit of innovation is required to inform and guide efforts to
address the social and structural factors that increase HIV vulnerability and diminish
access to and uptake of HIV services. Artificial intelligence and data science
breakthroughs can be used to improve diagnostics and personalize HIV prevention and
treatment options and services in ways that uphold human rights.
208. The Strategy also aims to embrace new partnerships with the information technology
community to use the potential of digital and social innovations to connect people, share
experiences through social media, access information, deliver services and support
social movements to reduce HIV related inequalities. Across all such efforts, care will be
needed to ensure that the innovations work for and not against vulnerable communities,
and that they are used in accordance with human rights principles.
209. The Strategy renews and further underscores anchoring the HIV response in principles
of human rights and gender equality, which must be consistently and explicitly reflected
in all aspects of the response. Unless this vision is realized, it will be impossible to end
AIDS by 2030.
210. The Strategy is informed by a central lesson from 40 years of responding to HIV: a
human rights-based approach is essential to create enabling environments for
successful HIV responses and to affirm the dignity of people living with, or vulnerable to,
HIV. The Strategy highlights and builds on the obligations of all governments under
international human rights law to reduce inequalities and ensure equal enjoyment of
rights, including the right to health. It calls on all governments and partners to ground the
response in a human rights approach.
211. The Strategy seeks to ensure that data and research on human rights in the context of
HIV are used to inform the HIV response, and that challenges and gaps in current efforts
to remove human rights barriers and end human rights violations are identified and
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overcome. It also aims to ensure that the intersecting forms of HIV-related stigma and
discrimination are addressed with evidence-based and adequately funded programmes,
and that opportunities for greater integration of human rights in the HIV response are
seized. The Strategy also makes explicit calls to maintain a bedrock of human rights
principles such as confidentiality, privacy and informed consent.
213. The effects of social exclusion and marginalization are visible in the AIDS epidemic’s
disproportionate impact on laws, policies and social norms, frequently creating barriers
for people to participate fully in the HIV response and benefit from the services and
support they need. To end AIDS, societies need to be transformed to be inclusive, and
to respect, protect and fulfil the rights of everyone.
214. Approximately 55% of the world’s population currently lives in urban areas and that
proportion is expected to increase to 68% by 2050. In most countries, cities account for
a large and growing proportion of the national HIV burden; in some countries, a single
city can account for up to 30% of the HIV burden. Risk and vulnerability to HIV is often
higher in urban than in rural areas.
215. While the global HIV response has historically focused on national-level public sector
actions, the Strategy highlights the centrality of cities and other human settlements in
the HIV response. As centres for economic growth, education, innovation, positive social
change and sustainable development, the Strategy underscores the role of cities and
human settlements as being uniquely positioned to address complex multidimensional
challenges such as HIV through inclusive participation from diverse stakeholders.
216. The Strategy calls on all partners to reinforce the leading roles of cities in addressing
rights issues, reducing inequalities and social exclusion, and protecting against risks and
vulnerabilities, while using the HIV response as a pathfinder in those efforts.
217. Moving forward, more resources will be needed to put the world on track to end AIDS by
2030. Achieving the goals and targets of the new Strategy requires that annual HIV
investments in low- and middle-income countries rise to a peak of US$ 29 billion (in
constant 2019 dollars) by 2025. Closing resource gaps will be especially critical to
accelerating progress in parts of the world where gains in the response are lagging,
including West and Central Africa, the Middle East and North Africa and eastern Europe
and central Asia. Although mobilizing the additional funding needed will encounter
important challenges, especially in a world buffeted by the health and economic effects
of COVID-19, summoning the political will and ingenuity needed to meet these
challenges is critical to the future health and well-being of our world. Investing too little,
too late will not only cause the AIDS epidemic to worsen and mean that ambitious
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targets in the Strategy will not be met, but it will further add to the long-term costs of the
HIV response. However, by fully funding the 2025 resource targets and using those
resources to efficiently implement the Strategy, the year-on-year growth in resource
needs can be halted after 2025.
218. During implementation of the Fast-Track Strategy, annual funding for HIV in low- and
middle-income countries rose to an all-time high in 2017 but was about US$ 4.2 billion
short of the US$ 26.2 billion annual target committed to in the 2016 Political Declaration
on Ending AIDS. Like other aspects of the HIV response, resource mobilization efforts
reflect the inequalities which this Strategy seeks to address. In settings where funding
was sufficient and spent well, people living with and affected by HIV obtained the
services they needed, leading to declines in new HIV infections and AIDS-related
deaths. However, in too many countries and communities, resources remained
inadequate, contributing to needless new HIV infections and AIDS-related deaths.
219. This Strategy provides a roadmap to enable the response to get ahead of the AIDS
epidemic. It harnesses two key tactics to achieve a fully-resourced response: efficient
and effective use of resources to reduce costs associated with a rapid expansion of the
response; and mobilizing funding from national and international sources to support
ready, equitable access to a comprehensive range of HIV programmes and services.
220. Focusing on addressing inequalities, the Strategy requires a shift in both allocation and
volume of HIV investments to meet the specific needs of different countries and
communities. To estimate the resources that will be needed to implement the Strategy,
UNAIDS undertook a rigorous review of documented and anticipated service costs to
project resources needed in 2021–2030 to end AIDS as a public health threat.
221. As the epidemic has evolved, the allocation of resources among regions and income
groupings has changed. The resource needs in upper-middle-income countries amount
to 53% of the total resources required to achieve the results and targets outlined in the
new Strategy. The majority of resource needs are concentrated in key geopolitical
groupings––specifically, the BRICS (Brazil, Russian Federation, India, China and South
Africa) represent 41% and three other countries from the MINT group (Mexico,
Indonesia, and Nigeria) represent 9% of all resource needs.
222. Eastern and southern Africa has the largest per capita resource needs, reflecting its high
HIV prevalence, and it accounts for 28% of total estimated resource needs by 2025.
While Asia and the Pacific region has a lower disease burden and lower per-capita
resource needs than eastern and southern Africa, the region nevertheless accounts for
32% of the total resource needs. Asia and the Pacific's substantial share of total
resource needs stems from its much larger population, combined with unit costs which in
many countries are higher than those in sub-Saharan Africa. Higher unit costs (e.g. for
human resources and antiretroviral medicines) also contribute to the relatively high per
capita resource needs in Latin America and in eastern Europe and central Asia.
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Figure 5. Breakdown of Peak Resource needs of US$29 billion for the HIV
response in 2025
223. The resource needs projected for 2021–2030 reflect the total costs for HIV treatment,
HIV prevention (taking into account the size of key populations and type of epidemic),
commodities (diagnostics, antiretrovirals, condoms etc.) and service delivery. Resource
needs for different countries reflect each country’s unique HIV-related needs. For
example, the resource needs in China and India are shaped by the size of the
populations in need of HIV prevention services. By contrast, countries with a higher
burden of disease have higher aggregate costs for the provision of ART. Selected
upper-middle-income countries have comparatively higher costs due to higher unit
costs.
Shifting spending to increase impact and reduce the cost of rapid scale-up of services
and progammes
224. This Strategy advances a prioritized, synergistic approach to rectify chronic under-
funding and to cover the costs of reaching ambitious results by 2025. The imperative of
identifying and eliminating HIV-related inequalities requires increased financial
resources across every aspect of the HIV response. However, some areas require more
rapid increases of resources than others, and the combination of priorities will differ
significantly between countries and regions.
225. In many countries, investments in HIV have fallen short in recent years because the
scale-up of some programme areas has been achieved at the expense of other areas.
This Strategy explicitly calls for synergies that will only be available by achieving an
effective, simultaneous scale-up of programmes and services, including across the
range of HIV prevention, treatment and social enablers.
226. The HIV prevention targets in the Strategy include the rapid expansion of evidence-
based, combination prevention options, which will require spending on primary HIV
prevention to increase from US$ 5.3 billion in 2019 to US$ 9.5 billion by 2025. The
Strategy opts against incremental progress and instead requires rapidly ramping up
funding. This is necessary to catalyze swift gains in coverage for key populations and
other populations who are at very high risk of HIV infection in order to achieve steep and
sustained reductions in new HIV infections. A massive increase in spending on HIV
prevention will enable urgent, transformational scale-up of HIV prevention services.
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HIV estimated expenditures by major programmatic area, 2019 HIV resource needs by major programmatic area, 2025
227. Alongside increased funding for combination HIV prevention, the Strategy targets the
reallocation of approximately US$ 1.15 billion in annual spending on HIV prevention
services which are not optimally efficient, thereby optimizing the strategic mix of proven
HIV interventions. This reallocation away from suboptimal approaches is essential to
enable rapid scale-up for programmes to reach people and communities experiencing
high rates of HIV transmission, such as key populations. The prevention-related
resource needs in specific countries and subnational settings vary considerably,
reflecting substantial differences in HIV disease burden, population size, the specific
programmes needed to address the communities at greatest risk, unit costs and other
variables.
228. In some countries with large numbers of people on ART, the percentage of overall HIV
spending needed for prevention might be small even if the cost per person is adequate.
In countries with lower treatment needs, a similar level of prevention spending per
person may comprise a larger proportion of the total HIV spending.
229. Reducing the price of medicines and ART through the strategic use of TRIPS flexibilities
and greater efficiency in procurement and supply management is a key achievable
outcome of this Strategy. If fully implemented, the Strategy would increase the number
of people receiving HIV treatment by 35% by 2025, but the treatment-related resource
needs would rise by only 17% due to efficiency gains and projected reductions in unit
costs (not including above-site costs and programme management, or the investment in
societal enablers which are necessary to enhance the programme effectiveness).
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Figure 7. A 17% increase in investment in HIV treatment can result in a 35% increase
in treatment coverage by 2025
230. Recent progress in preventing new HIV infections among children has helped minimize
the cost of antiretroviral drugs to achieve the Strategy's target of eliminating vertical
transmission. Initially, the cost of non-antiretroviral services to prevent vertical
transmission of HIV will increase to overcome the persistent coverage and outcomes
gaps which undermined the achievement of the elimination target by 2020. However, as
countries get closer to eliminating vertical transmission and achieving the 95–95–95
treatment targets, the need for investments in standalone services for prevention vertical
transmission will decline.
231. Societal enablers are essential if HIV programmes are to be effective. Annual funding to
improve the social enabling environment will need to reach US$ 3.1 billion by 2025 if we
are to end AIDS by 2030. In the expanded envelope for societal enablers, the largest
investments are for legal literacy, programmes to reduce internalized stigma, gender
equality programmes and legal services.
232. Efforts to end AIDS as a public health threat are integrally linked to broader efforts to
end poverty and hunger, fulfill the right to health, and succeed across all the SDGs.
UNAIDS’ projections of the resources needed to meet the 2025 targets include
important spending on key societal enablers. However, HIV budgets are unable on their
own to address the many social and structural factors that affect success in the
response, underscoring the need for strategic investments by sectors beyond health.
233. Renewed political will is needed to transform regional HIV responses and achieve the
Three Zeroes. Within each region, countries in the vanguard should be leveraged to
help spur gains in those where progress is lagging, to help accelerate country-level
progress, adopt innovative approaches, and ensure comprehensive services for key
populations.
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234. Earlier gains in the regional response in Asia and the Pacific are under threat, as many
countries in the region experience new waves of HIV infection. In 2019, 98% of new HIV
infections in the region were among key populations and their partners or clients, and
one third of new infections were among young people.
235. The status of the response varies considerably. Several countries have experienced a
decline in new HIV infections of more than 50% between 2010 and 2019, but new
infections have fallen by only 12% across the region as a whole, far short of the Fast-
Track targets. New HIV infections have increased between 17% and 207% in seven
countries since 2010. Three countries (Maldives, Sri Lanka and Thailand) have been
certified as having eliminated vertical transmission of HIV and syphilis, but substantial
gaps in access to prevention services persist in many other parts of the region. Slow
progress in the response underscores the failure to prioritize HIV prevention, bring
services to scale and tailor approaches to address the needs of key populations.
236. Service scale-up has been insufficient to meet the needs of the 5.8 million people living
with HIV in Asia and the Pacific. Regionally, one quarter of people living with HIV (and
almost half of key population members living with HIV) do not know their HIV status and
40% are not receiving treatment. About 160 000 people die of AIDS-related causes
annually in this region, and AIDS-related mortality has decreased by only 29% since
2010.
237. To close the gaps in its HIV response, Asia and the Pacific should build on and replicate
more broadly the important AIDS leadership that is evident in some countries. That
leadership has facilitated successful and diverse models of differentiated HIV service
delivery, including HIV self-testing, multimonth dispensing of antiretroviral regimens and
key population-led health services that bridge gaps in traditional programming. It has
also increased adoption of innovative approaches such as telehealth, take-home opioid
substitution therapy, needle-syringe services and PrEP services, and it has built highly
multisectoral response that capitalize on the strengths of civil society and other partners.
239. Eastern Europe and central Asia is one of three regions in the world (along with Middle
East, and North Africa and Latin America) where new HIV infections have risen since
2010. The annual number of new HIV infections in eastern Europe and central Asia
increased by an estimated 72% from 2010 to 2019, making it the fastest growing
epidemic in the world. Key populations and their sexual partners (including clients)
accounted for the majority of new HIV infections (with an estimated 48% of new
infections occurring among people who inject drugs). The HIV burden in the region is
growing also among gay men and other men who have sex with men (with the most
recent reported average HIV prevalence of 5.4%), among women and girls (with new
infections rising by 71% in 2010–2019), and among middle-aged people. Unequal power
dynamics and violence against women, especially among key populations and young
women, threaten women’s ability to access HIV prevention, treatment and care services.
240. All countries in the region criminalize HIV transmission and nearly all of them also
criminalize HIV exposure and nondisclosure of HIV status. Many countries criminalize
key populations, especially people who inject drugs, gay men and other men who have
sex with men, and sex workers. In some countries the evidence-based effective
interventions for HIV prevention for people who use drugs, particularly people who inject
drugs, are not being implemented or are being implemented at a low scale. Stigma and
discrimination towards key populations and people living with HIV, including in health-
care settings, persists. The withdrawal or reduction of external donor financing for HIV
programmes in the region has challenged efforts to preserve and expand access to
essential HIV services. Services provided by civil society and community-led
organizations are rare. HIV services in prisons are typically lacking, with only two
countries in the region having brought to scale a comprehensive HIV response in prison
settings. Persons released from prisons where services are provided often experience
service disruptions when they integrate into the community.
241. Prevention programmes are heavily dependent on donor financing and generally fail to
achieve meaningful coverage. Regionally, an estimated 70% of people living with HIV
knew their HIV status in 2019, 44% were receiving ART and 41% achieved viral
suppression. AIDS-related deaths increased by 24% from 2010 to 2019, due primarily to
late diagnosis and a failure to link many people with an HIV diagnosis with ART. TB
morbidity and mortality remain high in eastern Europe and central Asia.
242. However, there are important signs of strengthened leadership which the region can
build on to close the gaps in its HIV response. These include the roll-out of community-
led PrEP services in Moldova, the launch of a plan by Ukraine to cover 80% of its HIV
response through domestic resources by the end of 2020, and a number of countries
that have either achieved or are on track to eliminate vertical transmission of HIV.
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243. Implementing these priority actions will help ensure that the region is on-track to realize
the Three Zeroes, which in turn would ensure that all children in the region are born
free of HIV, all people on treatment (including key populations, women and girls and
other vulnerable populations) achieve viral suppression and overall good health and
well-being, key populations are economically empowered and socially included, stigma
is eliminated and national responses are characterized by a spirit of innovation and the
meaningful participation of all partners and stakeholders.
245. Eastern and southern Africa remains the region most heavily affected by HIV,
accounting for approximately 55% of all people living with HIV and for two-thirds of all
children living with HIV. Women comprised three in five new HIV infections among
adults in the region in 2019, and adolescent girls and young women (aged 15–24 years)
are up to 5 times more likely to acquire HIV than their male peers.
246. It is also the region where progress towards global AIDS targets is most evident. New
HIV infections declined by 38% from 2010 to 2019, including a 63% reduction in the
number of children newly infected with HIV, the sharpest reduction in any region. This
means eastern and southern Africa reached the 2020 target for reductions in new HIV
infections. Historic gains have also been made towards the 90–90–90 HIV testing and
treatment targets: 87% of people living with HIV knew their HIV status in 2019, 72%
received ART and 65% achieved viral suppression. Gains in preventing new HIV
infections have continued, with coverage among pregnant and breastfeeding women
exceeding 90% in 12 countries. Women and girls, particularly adolescent girls and
young women, continue to bear the brunt of the epidemic in this region.
247. Political commitment remains strong across the region. Most countries have adopted
ambitious targets for programme expansion and have increased domestic funding for
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their HIV responses. Total financing for the response (estimated at US$ 10.6 billion in
2017) exceeds the 2020 regional financing target by about US$ 500 million.
248. However, the region also faces important challenges, and inequalities within and
between countries in HIV responses persist. Some populations (including adolescent
girls and young women, young and adult female sex workers (age 18+), people who
inject drugs, gay men and other men who have sex with men, and transgender people,
adolescent girls and young women and their male partners) are not benefiting equally
from regional advances in the fight against HIV. Children have experienced much slower
progress across the testing and treatment cascade than adults. Stigma in health-care
settings and a lack of community involvement remain barriers to meaningful service
access and robust service uptake. Structural barriers and unequal gender norms,
including gender-based violence perpetuate inequities in access to essential HIV
programmes.
249. The space for civil society organizations remains limited in many countries in the region,
thus limiting their roles in HIV programmes. The response remains dependent on
external resources for the majority of countries in the region, despite increases in
domestic funding. This poses a threat to the long-term sustainability of the response.
The COVID-19 pandemic has adversely affected national HIV programmes, including
through service disruptions and economic challenges.
250. Ending AIDS as a public health threat will require translating political commitment into
programmatic actions, including sustained efforts to scale up what works and focusing
on settings where progress is slow and populations who are left behind. It will also
require brave political leadership to lead transformative policy and programming on
issues such as independent adolescent and youth access to health services, gender
equality, and other inclusive changes. Countries such as Eswatini, Namibia and Zambia
have shown tremendous leadership in advancing towards the 90–90–90 targets, with
Eswatini already reaching 95–95-95 targets. South Africa has developed effective
models of community involvement in designing, implementing and monitoring
programmes using a people-centred approach. It is also funding the majority of its
response from domestic sources, while Namibia has committed to spending one-quarter
of its HIV budget on prevention.
251. A properly resourced and sustainable HIV response, embedded in a human rights-
based approach, is the pathway to end AIDS as a public health threat in this region.
253. Although some progress is evident, the HIV response in western and central Africa is
not advancing fast enough. New HIV infections declined by only 25% from 2010 to
2019––well short of the Fast-Track targets––and the incidence:prevalence ratio of 5% is
well above the epidemic transition benchmark of 3%.
254. In 2019, key populations and their sexual partners accounted for an estimated 69% of
new HIV infections, with women and girls representing 58% of new infections.
Adolescent and girls are heavily affected, and violence against women and girls is
pervasive. The region accounted for more than one third of new HIV infections among
children globally in 2019. Early infant diagnosis and antiretroviral coverage for children
remains inadequate. Nearly 1 in 3 people living with HIV did not know their HIV status,
only 58% of people living with HIV obtained ART and only 45% of people living with HIV
were virally suppressed in 2019. In many parts of the region, user fees for health
services reduce service access and uptake.
255. COVID-19 has exacerbated the many vulnerabilities at play in this region, including
protracted insecurity and conflict, rapid population growth, increasingly fragile states,
already fragile financial and health systems, extreme poverty, food insecurity and
environmental shocks. These intersecting vulnerabilities shape the regional political
agenda and affect the allocation of finite resources. Gender inequalities, financial
barriers to service access through user fees and other out-of-pocket costs, shrinking
civic space for civil society, stigma and discrimination, and hostile legal and social
environments for key populations and women and girls undermine efforts to respond
effectively to HIV.
256. Across the region, renewed efforts to accelerate the HIV response hold promise. They
include the new regional Strategy for HIV, TB, Hepatitis B & C and Sexual and
Reproductive Health and Rights among Key Populations, adopted by the Economic
Community of West African States (ECOWAS); the establishment of the Civil Society
Institute for HIV and Health in West and Central Africa; and Cabo Verde’s leadership on
the elimination of vertical transmission of HIV.
258. Although the region of Middle East and North Africa has among the lowest HIV
prevalence in the world, it is also home to one of the fastest growing epidemics. New
HIV infections in the region have increased by 22% since 2010 and are concentrated
among key populations and their sexual partners. Although AIDS-related deaths have
declined by 16% among women since 2010, they have increased by 10% among men.
The region lags behind in efforts to fully leverage the health benefits of HIV treatment:
only 52% of people living with HIV knew their status in 2019, 38% of those living with
HIV were accessing ART and only one third of people living with HIV were virally
suppressed. Results were even poorer among pregnant women and children. Total
resources available for the regional response amount to less than one fifth of the 2020
funding target.
259. These gaps reflect longstanding challenges across the region, including restrictive
sociocultural norms mirrored in proscriptive laws and policies, widespread stigma and
discrimination and sharp gender inequalities, as well as modest political leadership and
minimal financial investment in HIV. Several countries in the region are facing
humanitarian crises due to direct and indirect effects of conflict and instability. However,
recent years have seen important advances in the regional response, including the
emergence of coordinated community-led networks representing people living with HIV
and key populations (e.g. MENA Human Rights Coalition); legal reforms (e.g.
combatting stigma and discrimination in Iran and ending the mandatory HIV testing of
foreigners in Sudan); innovations in services (among them PrEP in Morocco, HIV self-
testing in Lebanon and opioid substitution therapy in Egypt); and developments in
funding (e.g. increased domestic financing for HIV treatment in Algeria and in the Global
Fund’s Middle East Response Grant).
260. Because of its low HIV prevalence, it is wholly feasible for the Middle East and North
Africa to move from aspiration to realization in the quest to end AIDS as a public health
threat. This will require helping governments to commit to ending the epidemic, by
positioning the HIV response in the broader context of the SDGs and by linking it to other
priority issues, such as the COVID-19 response, youth engagement and gender equality.
261. These transformative steps will require innovative alliances, with community-led
organizations and other new partners, to break the siloes characterizing the regional
response to date. Such integration will allow new linkages between HIV and the broader
efforts on Universal Health Coverage, social protection, sexual and reproductive health
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and noncommunicable diseases, thereby weaving HIV into the fabric of development
across the region.
263. Between 2010 and 2019, new infections increased by 21% in Latin America but
decreased by 29% in the Caribbean. Key populations are most affected. In 2019 in Latin
America, an estimated 44% of new infections occurred among gay men and other men
who have sex with men and 6% were among transgender women. In the Caribbean, key
populations and their sexual partners or clients accounted for 60% of new infections.
Overall, one quarter of new infections in 2019 in the Caribbean were among young
people.
264. AIDS-related deaths declined by 8% in 2010–2019 in Latin America and by 37% in the
Caribbean. Both regions lag behind the global averages in outcomes along the testing
and treatment continuum. In Latin America in 2019, an estimated 77% of people living
with HIV knew their HIV status, 60% were receiving ART and 53% were virally
suppressed. In the Caribbean, 77% of people living with HIV knew their status, 63%
were receiving treatment and 50% were virally suppressed. There were significant
variations between countries.
265. The COVID19 pandemic has accentuated fundamental shortcomings in health systems,
including financial, technical and human resources. The socioeconomic impact has been
severe for key populations and it threatens the sustainability of national HIV responses
in a region affected by the largest displacement of people in its history (Venezuela’s
migrant and refugee situation), systemic inequities and inequalities, political instability,
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conservative backlashes, high levels of stigma and discrimination, as well as high rates
of hate crimes, xenophobia and homophobia. In 2019, 88% of the countries in Latin
America and 50% in the Caribbean had approved social protection strategies or policies
and were implementing them, though only a few of those programmes were benefiting
people living with HIV and key populations and priority populations.
266. Recent years have seen important signs of political leadership and commitment to the
HIV response on which Latin America and the Caribbean can build. Twenty-one of the
24 countries in the region had by December 2020 implemented multimonth dispensing
of antiretroviral medicines, including 13 countries that did so during the COVID19
pandemic. Seven countries and their territories (Anguilla, Antigua and Barbuda,
Bermuda, the Cayman Islands, Cuba, Montserrat, and Saint Kitts and Nevis) have been
certified as having eliminated vertical HIV transmission. In the Bahamas, Barbados,
Brazil, Chile, Cuba, Dominican Republic, Ecuador, and Haiti, comprehensive prevention
packages which include PrEP are offered through the public health system.
268. The region of West and central Europe and North America has reached the benchmark
incidence prevalence ratio of 3.0%, with high levels of ART coverage (81% of people
living with HIV) and viral suppression (67% of people living with HIV). However, progress
is uneven across and within the countries included in this regional grouping. Service
access and uptake is frequently lower for people who inject drugs, migrant populations
and racial and ethnic minority groups, due to stigma at the community level, structural
discrimination and barriers to accessing health insurance and services (often due to
migration status and xenophobia). Treatment cascade outcomes lag in some countries,
most notably the United States of America, home to the largest epidemic in the regional
grouping, and in central Europe, where the increase in new HIV infections is associated
with high rates of late diagnosis and low treatment coverage and viral suppression. HIV
responses in central Europe face important challenges, including limited political
commitment, human rights violations, and antipathy towards lesbian, gay, bisexual,
transgender and intersex populations and other key populations.
269. There are important signs of AIDS leadership across this regional grouping. Plans to end
AIDS as a public health threat have been put in place in France, Germany, the
Netherlands, Sweden, Switzerland, the United Kingdom and the United States, and in
major cities across the region. PrEP coverage has increased, due to a combination of
cost reductions, increased insurance coverage, communication campaigns, and
dedicated services provision in countries such as Belgium, France, the United Kingdom
and the United States. The Netherlands has put in place strategies to facilitate the early
detection of new HIV infections.
270. Follow-through on ending AIDS as a public health threat in this regional grouping can
generate important lessons to accelerate success against COVID-19 and future
pandemics. This can also serve as a bridge to an overarching health policy for West and
central Europe and North America. Success in high-income countries can inspire
confidence in the feasibility of transformative gains against the epidemic in other
regions.
h. Remove legal, regulatory and financial barriers to affordable and easily accessed
HIV prevention, including needle-syringe services, diagnostics and treatment, and
reduce high out-of-pocket expenditure for people on ART and for those using PrEP.
i. Remove punitive and discriminatory laws and policies that affect the HIV response
for LGBTI communities, sex workers, people who inject drugs, people living with HIV
and migrants.
j. Increase community engagement and leadership in local responses, including
through the engagement and leadership of young people.
k. Improve the quality and timeliness of data collection, reporting and use to improve
programme outcomes, inform resource allocations to maximize the return on
investment, and use data disaggregation to expose and address inequities
l. Increase investments in HIV research, with particular attention to priority research
on long-acting antiretrovirals, HIV vaccines and cure.
272. While this Strategy, “End Inequalities. End AIDS. Global AIDS Strategy 2021-2026” is a
global Strategy developed by UNAIDS in accordance with its mandate from ECOSOC,
this chapter describes specific roles and focus of the Joint United Nations Programme
on HIV/AIDS – Cosponsors and Secretariat, in leading the coordination efforts of the
global HIV response.
273. UNAIDS provides support and leadership, strategic intelligence and convening capacity
towards ending AIDS as a public health threat by 2030 and advances the vision of zero
new HIV infections, zero discrimination and zero AIDS-related deaths.
274. A champion and forerunner of UN reform, UNAIDS unites the efforts of 11 UN agencies
as Joint Programme Cosponsors (UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC,
UN Women, ILO, UNESCO, WHO and the World Bank) and the UNAIDS Secretariat.
UNAIDS' mandate, as laid out in its founding Economic and Social Council (ECOSOC)
resolution,32 remains as relevant and important today as when it was drafted.
275. UNAIDS’ work is grounded in the 2030 Agenda. During this Decade of Action to deliver
the Global Goals, UNAIDS supports global collective action, based on the values and
norms of the UN in accordance with the three pillars of the UN Charter: human rights,
peace and security, and development. The health and human rights of people living
with, at risk of and affected by HIV, who often are left farthest behind and who face
exclusion, inequality and instability, remain at the forefront of the Joint Programme's
work. UNAIDS’ inclusive governance structure is an embodiment of the whole-of-society
response to HIV, bringing to the table the voices of the people who are most affected by
HIV.
276. The innovative model of the Joint Programme enables a multisectoral response to the
multidimensional nature of the global AIDS epidemic and in support of the SDGs.
277. The Joint Programme is an integral part of the implementation of the Global AIDS
Strategy. Building on the achievements and lessons from 40 years of the HIV response,
as well as its 25 years of experience, UNAIDS leverages its collective competencies,
skills and contributions to strategically support countries and communities to attain the
new, bold and ambitious targets and commitments of the Strategy, and to implement
prioritized actions that place people at the centre and reduce the inequalities that drive
the AIDS epidemic.
278. As its specific contribution to the implementation of the Strategy, and working across the
three strategic priority areas, UNAIDS will apply an inequalities lens and support
countries and communities to identify and reduce inequalities, HIV-related human rights
violations, injustice and exclusion that stand in the way of achieving equitable outcomes
for people living with, at risk of, and affected by HIV in every country and every
community, with a particular focus on low- and middle-income countries. It will inspire
and support vital innovations, including the development of an HIV vaccine or cure and
practical improvements that emerge from communities most impacted by the epidemic.
279. To close the gaps, save lives and ensure equitable HIV responses, UNAIDS will build on
its strengths and sharpen its actions particularly in three areas: leadership, global public
goods, and countries and communities.
Leadership
280. The Joint Programme will provide vision and strategic guidance, and unite the efforts of
governments and civil society, communities, the private sector and other global, regional
and national partners to drive transformative progress on HIV. The Joint Programme will:
a. build political will to recognize and reduce inequalities that underlie current gaps
and shortcomings of the HIV response, and leverage ongoing learning from these
efforts to understand and broadly apply what works;
b. work with governments, communities and other partners to translate political will
into people-centred targets, investment and implementation, and inclusive
governance platforms;
c. foster and expand partnerships with the Global Fund, PEPFAR and other bilateral
and multilateral partners for collective leadership and alignment of actions and
resources that can advance equitable policies and programmes and tailored
responses that reach those furthest behind first;
d. bolster the UNAIDS financing agenda to drive visionary leadership towards
equitable financing for HIV and health;
e. serve as a trailblazer for transforming financing for health and development, by
pioneering and championing approaches that increase country ownership and
empower communities;
f. develop and enhance alliances with movements within and beyond HIV response,
building synergies to advance Universal Health Coverage, promoting human rights
and gender equality, advancing equitable financing, and promoting sustainable
development to reduce inequalities and inequities in the HIV response;
g. contribute to the future architecture of global health in the post-COVID era; and
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281. The Joint Programme will provide leadership and accelerate action to create and ensure
equitable distribution of global public goods critical for ending AIDS as a public health
threat in the context of integrated SDG agenda. The Joint Programme will:
a. develop and support the implementation of normative guidance to drive
transformative action to reduce inequalities and ensure that all people
living with and affected by HIV, as well as key populations and priority populations,
including children and young people, and adolescent girls and young women are
empowered and access affordable, high-quality, gender-responsive HIV and other
services that are evidence- and rights-based;
b. advance inclusion to ensure whole-of-society responses and assert the leadership
of communities;
c. lead the world’s most extensive data collection on the status of the AIDS epidemic,
response and financing, and publish authoritative and up-to-date strategic
information and analyses to monitor progress and track gaps (including through
more systematic community-led monitoring), and to strengthen the relevance of
interventions and evidence for informed, impactful global, regional, national and
local responses;
d. provide thought leadership and facilitate knowledge sharing and of leveraging
science, technology and innovation for impactful, cost-effective, inclusive and
sustainable programming;
e. leverage partnerships to build financial capacity to access to unaffordable
technologies and support under-financed public systems for health, and to ensure
the sustainability of inclusive, equitable, rights-based responses, with special
attention on collaboration with the Global Fund, PEPFAR, Unitaid, the Stop TB
Partnership, Gavi (the Vaccine Alliance) and the Medicines Patent Pool; and
f. explore alternative mechanisms to incentivize innovation within the health sector,
ensuring coordination and sustainable financing of research and development of
health technologies, promoting access to innovation for all, and advance analyses
on the patent landscape of HIV-related products and health technologies.
282. The Joint Programme will support countries and communities to use an inequalities lens
to identify people who are still being left behind and to urgently reduce the inequalities,
inequities and exclusion experienced by key populations, adolescent girls and young
women, children and young people, and people in humanitarian or other extreme
circumstances in the context of HIV. The Joint Programme will:
a. mobilize and support inclusive country leadership for equitable, sustainable HIV
responses that are integral to and integrated with national health and development
efforts;
b. provide expertise and enhance capacity to generate, interrogate and utilize strategic
information to recognize and reduce HIV-related inequalities, and guide and support
prioritization of programming and tailored service delivery, with a particular
emphasis on reaching first the people who are furthest behind;
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283. Using the Strategy’s inequality framework, UNAIDS will bring those elements together to
strengthen and leverage its capacity to partner with governments and communities in
order to reduce the inequalities driving the AIDS epidemic across all the strategic
priorities and result areas of the Strategy.
284. With an urgent focus on mobilizing and enhancing expertise and resources at the
country-level, UNAIDS will ensure it has the following capacities:
a. Using strategic information to identify the inequalities driving epidemic.
Knowing who we need to reach next to achieve impact, with a focus on those most
in need, will require enhanced data systems and analysis that shifts from averages
to specifics, and from aggregates to gaps. UNAIDS will support countries and
communities to develop robust and sustainable information and surveillance
systems that provide the required information and data in a timely and meaningful
manner. Through the field and virtual presence of the Joint Programme, HIV
programme managers will be encouraged to use data to transform their response
and close the gaps leading to inequalities. UNAIDS will continue to compile data
through the Global AIDS Monitoring reporting system and HIV estimates.
b. Convening and building political will to reduce inequalities. Reducing
inequalities requires UNAIDS to mobilize political will to advance bold, cross-
sectoral action, with commitments and mobilization from governments, civil society,
affected communities, faith-based organizations, the private sector and other
sectors.
c. Providing technical capacity to reduce inequalities and support transformative
HIV priority actions. To support the shifts toward transformative, evidence-based
prevention, accessible models of testing, treatment and care, and laws and policies
that reduce inequalities and advance progress to ending AIDS, UNAIDS will ensure
technical capacity is available to support planning and implementation and to
enhance the efficiency and impact of HIV funding.
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285. To support the implementation of the Global AIDS Strategy, the Joint Programme will
review and take steps to ensure that its operating model (i.e. its geographic and
programmatic footprint, capacities and ways of working, resource mobilization Strategy,
resource allocation principles and mechanisms, and results and accountability
frameworks) remains aligned with the focus and priorities of the Strategy.
286. UNAIDS will translate the Strategy’s three strategic priorities and its 10 result areas into
a new UNAIDS Budget, Results and Accountability Framework (UBRAF). Evidence
reviews and a detailed theory of change will highlight the areas where the Joint
Programme’s engagement is of critical importance and will inform prioritization of the
UNAIDS’ contributions and results for the UBRAF.
287. The new UBRAF will align with the global response targets to deliver prioritized UNAIDS
support and articulate the collective role of UNAIDS, as well as the specific contributions
of individual Cosponsors and the UNAIDS Secretariat in the implementation of the
Strategy at global, regional and country levels. The updated monitoring and evaluation
framework of the UBRAF will capture the Joint Programme’s collective and entities’
individual contributions towards global, regional and country-level progress in reducing
inequalities, achieving the targets and closing the response gaps. The UBRAF will
demonstrate the priorities for different funding levels and highlight different funding
scenarios.
288. To deliver on the commitments reflected in the UBRAF, UNAIDS will strategically
prioritize its programmatic focus and geographic footprint, based on a set of specific
criteria that reflect the epidemic trends, persistent response gaps and inequalities,
political and socioeconomic contexts, and capacities and needs in communities and
countries, as well as the Joint Programme’s global leadership role.
289. The UNAIDS Joint Programme will ensure it has a workforce with the right skills,
performing the right functions, in the right locations, and which is enabled to deliver the
best support to countries to achieve their goals. The UBRAF will guide the deployment
of staff for the greatest impact on inequalities and on improving the health and well-
being of people living with, at risk of or affected by HIV. Implementation of diversified
support modalities and scale-up of virtual assistance will ensure flexibility and timely
adjustment of programmatic and geographic focus, for the maximum impact and results
for people.
290. The UNAIDS resource mobilization Strategy will align with the Joint Programme’s
priorities and commitments, to ensure funding is mobilized and allocated to deliver on
the specific country-level, regional and global commitments and results.
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291. UNAIDS will advance its joint work and collaborative action at country, regional and
global levels with greater cohesion across all levels. Within their mandates, Cosponsors
will further adapt to provide needs-based, demand-driven support to reduce the specific
inequalities and gaps in the HIV response. The UNAIDS Division of Labour will be
updated as needed to reflect the evolving contexts and demands. The UNAIDS
Cosponsorship principles will guide the Cosponsoring agencies’ engagement in
supporting the implementation of the Global AIDS Strategy. The 2020 Quadrennial
Comprehensive Policy Review will guide UNAIDS’ activities for development and
support to countries in the context of the UN Development System repositioning and
efforts to work in an effective and impactful way across development, peace,
humanitarian affairs and human rights.
292. The Joint Programme’s accountability rests within the global HIV response and the
UNAIDS PCB. UNAIDS will measure its performance, contributions and results against
the progress towards achievement of the national, regional and global commitments and
targets. It will also provide analysis of where adjustments are required in the responses
of other actors and sectors. The extent to which, within the next five years, inequalities
are reduced and response gaps are closed within countries and communities will serve
as the ultimate measure of the Joint Programme’s success.
[Annexes follow]
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ANNEXES
For the past 20 years, the HIV response has relied on concrete, time-bound targets to drive
progress in addressing AIDS. With the aim of ensuring accountability and transparency in the
response and of uniting diverse stakeholders around the shared goal of ending AIDS by
2030, the new Strategy outlines a series of new targets and commitment for 2025 to get the
HIV response on-track to achieve the 2030 SDG target of ending AIDS as a public health
threat. In addition to broad global targets, the Strategy demands achievement of ambitious
targets in all populations and settings.
To develop the targets for 2025, UNAIDS worked with partners to review available evidence,
including modelling to ascertain the specific actions needed to make the 2030 goal possible.
As in prior target-setting exercises, this latest process used an investment framework to
identify the level and allocation of resources required for achievement of the targets.
A series of technical consultations with experts and stakeholders was held across different
domains of the response. These consultations reviewed evidence and determined what is
currently working and needs to be continued, what is not working and needs to be changed,
and which key gaps in the response need to be addressed. A team of epidemiological
modelling experts was assembled to project the impact of various approaches and
combinations of services.
95% of people at risk of HIV infection use appropriate, prioritized, person-centred and
effective combination prevention options
Condom/lube use
at last sex with a
client or 90% -- -- -- 90%
nonregular
partner
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Sterile needles
-- -- 90% -- 90%
and syringes
Opioid
substitution
therapy among -- -- 50% -- --
people who are
opioid dependent
STI screening
80% 80% -- 80% --
and treatment
Regular access to
appropriate health
system or 90% 90% 90% 90% 100%
community-led
services
Access to post-
exposure
prophylaxis (PEP)
as part of 90% 90% 90% 90% 90%
package of risk
assessment and
support
Access to PEP
(nonoccupational
All ages and exposure) as part of
90% 50% 5% 0%
genders package of risk
assessment and
support
Access to PEP
(nosocomial) as part
of package of risk 90% 80% 70% 50%
assessment and
support
Adolescent girls
Economic
and young 20% 20% 0% 0%
empowerment
women
Condoms/lubricant
use at last sex by
those not taking PrEP
and who have a 95%
nonregular partner
whose HIV viral load
People within status is not known
serodiscordant
PrEP until HIV-positive
partnerships
partner has 30%
suppressed viral load
High needle–
syringe
Some needle– programme
Low needle–syringe syringe coverage with
People who UNAIDS analysis programme and opioid programme; adequate needles
inject drugs by country/region substitution therapy some opioid and syringes per
coverage substitution person who
therapy injects drugs;
opioid substitution
therapy available
Criterion High and very high Moderate Low
Combination of
[national or 0.3–<1%
subnational incidence and
incidence in high-risk
1–3% <0.3% incidence
women 15–24 reported
incidence OR
Adolescent years] AND behaviour
AND >3% 0.3–<1%
girls and [reported OR
high-risk incidence incidence and
young women behaviour from 1–3%
reported low-risk reported
DHS or other (>2 incidence and
behaviour behaviour
partners; or low-risk
reported STI in reported
previous 12 behaviour
months)]
Combination of
0.3–<1%
[national or
incidence and
subnational
high-risk
incidence in men 1–3% <0.3% incidence
reported
15–24 years] incidence OR
Adolescent behaviour
AND [reported AND >3% 0.3–<1%
boys and OR
behaviour from high-risk incidence incidence and
young men 1–3%
DHS or other (>2 reported low-risk reported
incidence and
partners; or behaviour behaviour
low-risk
reported STI in
reported
previous 12
behaviour
months)]
Combination of
[national or 0.3–<1%
subnational incidence and
incidence in high-risk
1–3% <0.3% incidence
adults 25–49 reported
incidence OR
years] AND behaviour
Adults (aged AND >3% 0.3–<1%
[reported OR
25 and older) high-risk incidence incidence and
behaviour from 1–3%
reported low-risk reported
DHS or other (>2 incidence and
behaviour behaviour
partners; or low-risk
reported STI in reported
previous 12 behaviour
months)]
Estimated number
of HIV-negative Risk stratification depends on choices within the partnership:
Serodiscordant regular partners choice of timing and regimen of antiretroviral therapy for the
partnerships of someone newly HIV-positive partner; choice of behavioural patterns
starting on (condoms, frequency of sex); choice of PrEP
treatment
95% of women of reproductive age have their HIV and sexual and reproductive health
service needs met
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Women of
reproductive age
in high HIV
prevalence 95% have their HIV prevention and sexual and reproductive health service
settings, within needs met
key populations
and living with
HIV
95% of pregnant women are tested for HIV, syphilis and hepatitis B surface
Pregnant and antigen at least once and as early as possible. In settings with high HIV
breastfeeding burdens, pregnant and breastfeeding women with unknown HIV status or
women who previously tested HIV-negative should be retested during late
pregnancy (third trimester) and in the post-partum period.
95% of pregnant and breastfeeding women living with HIV have suppressed viral loads
90% of women living with HIV on antiretroviral therapy before their current
pregnancy
Pregnant and
All pregnant women living with HIV are diagnosed and on antiretroviral
breastfeeding
therapy, and 95% achieve viral suppression before delivery
women living with
HIV All breastfeeding women living with HIV are diagnosed and on antiretroviral
therapy, and 95% achieve viral suppression (to be measured at 6–12
months)
95% of HIV-exposed children are tested at two months and after the cessation of
breastfeeding
95% of HIV-exposed infants receive a virologic test and parents are provided
with the results by age 2 months
Children (aged 0– 95% of HIV-exposed infants receive a virologic test and parents are provided
14 years) with the results after cessation of breastfeeding
95–95–95 testing and treatment targets achieved among children living with
HIV
95–95–95 testing and treatment targets achieved within all subpopulations and age
groups
95% of people within the subpopulation who are living with HIV know their HIV status
95% of people within the subpopulation who are living with HIV and know their HIV status are on
antiretroviral therapy
95% of people within the subpopulation who are on antiretroviral therapy have suppressed viral
loads
90% of people living with HIV and people at risk are linked to people-centred and
context-specific integrated services for other communicable diseases,
noncommunicable diseases, sexual and gender-based violence, mental health and
other services they need for their overall health and well-being
90% of patients entering care through HIV or TB services are referred for TB
People living with and HIV testing and treatment at one integrated, co-located or linked facility,
HIV depending on the national protocol
90% of people living with HIV receive TB preventive treatment
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90% have access to integrated or linked services for HIV treatment and
cardiovascular diseases, cervical cancer, mental health, diabetes diagnosis
and treatment, education on healthy lifestyle counselling, smoking cessation
advice and physical exercise
95% of HIV-exposed newborns and infants have access to integrated
Children (0–14
services for maternal and newborn care, including prevention of the triple
years)
vertical transmission of HIV, syphilis and hepatitis B virus
Adolescent boys 90% of adolescent boys and men (aged 15–59 years) have access to
and young men voluntary medical male circumcision integrated with a minimum package of
(15–24 years) services [1] and multidisease screening [2] within male-friendly health-care
Adult men (25+) service delivery in 15 priority countries
School-aged 90% of school-aged young girls in priority countries have access to HPV
young girls (9–14 vaccination, as well as female genital schistosomiasis (S. haematobium)
years) screening and/or treatment in areas where it is endemic [3]
Adolescent girls 90% have access to sexual and reproductive health services that integrate
and young women HIV prevention, testing and treatment services. These integrated services
(15–24 years) can include, as appropriate to meet the health needs of local population,
HPV, cervical cancer and STI screening and treat, female genital
schistosomiasis (S. haematobium) screening and/or treatment, intimate
Adult women (25+ partner violence (IPV) programmes, sexual and gender-based violence
years) (SGBV) programmes that include post-exposure prophylaxis (PEP),
emergency contraception and psychological first aid. [4]
Pregnant and 95% have access to maternal and newborn care that integrates or links to
breastfeeding comprehensive HIV services, including for prevention of the triple vertical
women transmission of HIV, syphilis and hepatitis B virus
Gay men and 90% have access to HIV services integrated with (or linked to) STI, mental
other men who health and IPV programmes, SGBV programmes that include PEP and
have sex with men psychological first aid
90% have access to HIV services integrated with (or linked to) STI, mental
Sex workers health and IPV programmes, SGBV programmes that include PEP and
psychological first aid
90% of transgender people have access to HIV services integrated with or
Transgender linked to STI, mental health, gender-affirming therapy, IPV programmes, and
people SGBV programmes that include PEP, emergency contraception and
psychological first aid
People who inject 90% have access to comprehensive harm reduction services integrating or
drugs linked to hepatitis C, HIV and mental health services
People in prisons
and other closed 90% have access to integrated TB, hepatitis C and HIV services
settings
People on the 90% have access to integrated TB, hepatitis C and HIV services, in addition
move (migrants, to IPV programmes, SGBV programmes that include PEP, emergency
refugees, those in contraception and psychological first aid. These integrated services should
humanitarian be person-centred and tailored to the humanitarian context, the place of
settings, etc.) settling and place of origin.
Less than 10% of countries have punitive legal and policy environments that deny or
limit access to services
Less than 10% of countries criminalize sex work, possession of small amounts of drugs, same-sex
sexual behaviour, and HIV transmission, exposure or nondisclosure by 2025
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Less than 10% of countries lack mechanisms for people living with HIV and key populations to
report abuse and discrimination and seek redress by 2025
Less than 10% of people living with HIV and key populations lack access to legal services by 2025
More than 90% of people living with HIV who experienced rights abuses have sought redress by
2025
Less than 10% of people living with HIV and key populations experience stigma and
discrimination
Less than 10% of people living with HIV report internalized stigma by 2025
Less than 10% of people living with HIV report experiencing stigma and discrimination in health
care and community settings by 2025
Less than 10% of key populations (i.e., gay men and other men who have sex with men, sex
workers, transgender people and people who inject drugs) report experiencing stigma and
discrimination by 2025
Less than 10% of the general population reports discriminatory attitudes towards people living with
HIV by 2025
Less than 10% of health workers report negative attitudes towards people living with HIV by 2025
Less than 10% of health workers report negative attitudes towards key populations by 2025
Less than 10% of law enforcement officers report negative attitudes towards key populations by
2025
Less than 10% of women, girls, people living with HIV and key populations experience
gender inequality and violence
Less than 10% of women and girls experience physical or sexual violence from an intimate partner
by 2025
Less than 10% of key populations (i.e., gay men and other men who have sex with men, sex
workers, transgender people and people who inject drugs) experience physical or sexual violence
by 2025
Less than 10% of people living with HIV experience physical or sexual violence by 2025
Less than 10% of people support inequitable gender norms by 2025
Greater than 90% of HIV services are gender-responsive by 2025
Achieve SDG targets critical to the HIV response (i.e., 1, 2, 3, 4, 5, 8, 10, 11, 16 and 17) by 2030
• [1] The minimum package of services delivered along with voluntary medical male circumcision
includes safer sex education, condom promotion, the offer of HIV testing services and
management of STIs.
• [2] Additional services such as diabetes, hypertension and/or TB screening, and malaria
management. To be adjusted depending on the location.
• [3] Low- and middle-income countries with HPV and HIV coinfections.
• [4] For all subpopulations, PEP includes HIV testing and risk exposure assessment.
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As part of the Global AIDS Strategy development process a comprehensive evidence review
and consultations were undertaken to identify critical gaps and priority actions needed to get
the HIV response on track to end AIDS as public health threat by 2030. Stakeholders
identified additional targets in addition to the 2025 targets around the following areas:
people-centred, integrated services; Covid-19 and future pandemics; and community-led
responses.
90% of people living with HIV and people at risk are linked to people-centred and context-
specific integrated services they need for overall health and well-being
Children (aged 0–
14 years) 75% of all children living with HIV have suppressed viral loads by 2023 (interim
target).
People on the 95% of people within humanitarian settings at risk of HIV use appropriate,
move (migrants, prioritized, people-centred and effective combination prevention options.
refugees, those in
humanitarian
settings, etc.) 95% of people within humanitarian settings at risk of HIV use appropriate,
prioritized, people-centred and effective combination prevention options.*
90% of people in humanitarian settings have access to integrated TB, hepatitis
C and HIV services, in addition to programmes to address gender-based
violence, including intimate-partner violence, that include HIV post-exposure
prophylaxis, emergency contraception and psychological first aid.
Covid-19 and
95% of people living with, at risk of and affected by HIV are better protected
other Global
from health emergencies and pandemics including COVID-19.
Pandemics
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Commit to providing community-led responses with the resources and support they need to
fulfil their role and potential as key partners in the HIV response
30% of testing and treatment services to be delivered by community-led organizations, with focus on:
enhanced access to testing, linkage to treatment, adherence and retention support, treatment literacy,
and components of differentiated service delivery, e.g. distribution of ARV (antiretroviral treatments) 33
80% of service delivery for HIV prevention programmes for key populations to be delivered
by community-led organizations34
80% services for women, including prevention services for women at increased risk to acquire HIV,
as well as programmes and services for access to HIV testing, linkage to treatment (ART), adherence
and retention support, reduction/elimination of violence against women, reduction/elimination of HIV
related stigma and discrimination among women, legal literacy and legal services specific for women-
related issues, to be delivered by community-led organizations that are women-led.
60% of the programmes supporting the achievement of societal enablers, including programmes to
reduce/eliminate HIV-related stigma and discrimination, advocacy to promote enabling legal
environments, programmes for legal literacy and linkages to legal support, and reduction/elimination
of gender-based violence, to be delivered by community-led organizations.
33 With focus on enhanced access to HIV testing, linkage to treatment, adherence and retention
support, treatment literacy, and components of differentiated service delivery, e.g. distribution of ARV
(antiretroviral treatments).
34 For an organization to be considered community-led, the majority (at least fifty percent plus 1) of
governance, leadership, and staff comes from the community being served.
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In 2016, UN Member States committed to reach US$ 26 billion by 2020 in annual investment
in the HIV response by 2020 in low- and middle-income countries. Every year, HIV resources
have fallen far short of these global targets. Increases in resources in these countries peaked
in 2017, and started decreasing since 2018. The annual funding gap has continued to widen,
with only US$ 19.8 billion (in constant 2016 US dollars) available in 2019 (76% of the 2020
target). If the resource and programmatic targets had been met by 2020, overall resource
needs for the global HIV response would have peaked in 2020, and then decreased to US$
25.6 billion in 2025 and US$ 23.9 billion in 2030. However, the cost of investing too little, too
late is reflected in new, larger resource needs to reach the new targets and commitments by
2025 and end AIDS by 2030.
30
26,2
25
21,3
19,5 20,3 19,8
20
US$ (billions)
15
10
0
2016 2017 2018 2019 2020
Source: UNAIDS financial estimates, July 2020; UNAIDS financial estimates and projections, 2016
Notes: Countries included are those classified as low- and middle-income. Estimates are presented
in constant 2016 US dollars.
Chronic under-investment in the global HIV response has translated into millions of additional
new HIV infections and AIDS-related deaths. This accounts for the increase in the global cost
of reaching the targets and commitments in the Strategy to US$ 29 billion in 2025 and the
future annual cost of ending AIDS in low- and middle-income countries of US$ 28 billion (in
constant 2019 dollars) in 2030.
The lack of sufficient resources for HIV by 2020 has moved the peak of resource needs from
2020 to 2025. However, the long-term increase in resource needs can be halted by ensuring
that all future investments in HIV are done through the optimized allocation of efficient
services, with more ambitious programmatic targets and meaningful progress on societal
enablers.
By contrast, if the resource needs in the Strategy are not fully and efficiently allocated, the
long-term costs of ending AIDS will continue to increase.
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HIV estimated expenditures, 2019, and resource needs estimates in low- and
middle-income countries, 2021–2030
35
$ 29.0 $ 28.0
30
25 $ 22.4
21.6
20
US$ (billions)
15
10
0
2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Compared to other regions, the high prevalence of HIV in eastern and southern Africa
accounts for the high per capita resource needs (US$ 15.8) in that region. In the Caribbean,
Latin America and in eastern Europe and central Asia, higher unit costs for HIV services
account for relatively high per-capita resource needs. Asia and the Pacific has the lowest
per-capita resource needs, but the region’s large population (in particular in China and India)
result in 32% of total resource needs in the Strategy.
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Ten countries account for more than half (55%) of total resource needs in low- and middle-
income countries. The countries accounting for half of the needs include 4 countries in sub-
Saharan Africa (Mozambique Nigeria, Tanzania and South Africa), 6 upper-middle-income
countries (Brazil, China, Indonesia, Mexico, Russian Federation and South Africa), and 7 of
the 10 of the world’s most populous countries.
An additional 9 countries ranking below those 10 countries, account for 15% of the resource
needs (including 5 in sub-Saharan Africa), while the remaining 99 other countries account for
the 30% of total resource needs.
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HIV investment by country income level in 2019 How the HIV investment will increase in countries with different income
levels
Low-income 6
(US$ 3.7 Bn) 5,3
12% 5 4,5
4 3,6 3,5
2,9
3
US$
2,2
Upper-middle-
income (US$ 2
15.4 Bn) 51%
Lower-middle- 1
income (US$
11.2 Bn) 0
37% Low-income Lower-middle-income Upper-middle-income
Sources: UNAIDS financial estimates and projections, 2021; UNDP World Population Prospects, 2020.
Upper-middle-income countries account for 53% of the total resource needs in the Strategy.
The large proportion of resource needs in upper-middle-income countries reflects their higher
unit costs, including higher human resource costs and costs of health technologies, including
medication).
The largest per-capita gaps between estimated expenditures in 2019 and the 2025 resources
needs are in upper-middle-income countries and low-income countries. Closing the resource
gaps in upper-middle-income countries and lower-middle-income countries should primarily
come from additional domestic resource allocations, with only some exceptions for high-
burden countries that will continue to need significant international resources in order to meet
the targets and commitments in the Strategy. By contrast, the majority of low-income
countries require additional external support to close their resource gaps and meet the
targets and commitments in the Strategy.
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BRICS
Rest of low- and middle- 39%
income countries
50%
MINT
11%
Note: BRICS grouping includes Brazil, Russian Federation, India, China and South Africa; MINT grouping includes Mexico,
Indonesia, Nigeria and Turkey.
Two countries, one in BRICS and one in MINT, are lower-middle-income countries (i.e. India and Nigeria).
HIV estimated expenditure, 2019, and resource needs, 2025 by major programmatic areas
12
$ 9.8
10 $ 9.5
Constant 2019 US$ (billions)
$ 8.3
8
6
$ 5.3
4 $ 3.6
$ 3.1
$ 2.8
$ 2.5
$ 1.9
2 $ 1.3
$ 0.3 $ 0.2
0
Primary prevention Testing and Prevention of Societal enablers Above site level Programme
treatment mother-to-child HIV management
transmission
Investment in societal enablers must more than double, from US$ 1.3 billion in 2019 to US$
3.1 billion in 2025, and grow to 11% of total resource needs. By contrast, while an additional
US$ 1.25 billion in resources are needed to close the gap between 2019 expenditures and
2025 resource needs for HIV testing and treatment, the proportion of total resources for HIV
testing and treatment will reduce from 43% of estimated expenditures in 2019 to 34% of the
2025 resource needs. In absolute terms, this will increase the total expenditures for HIV
testing and treatment from US$ 8.3 billion in 2019 to US$ 9.9 billion by 2025, and due to
efficiency gains, more people can be on treatment.
10
0
2019 2025
Half of HIV investments for adolescent girls and young women will be on economic empowerment by 2025
Much of the additional resource needs for evidence-based HIV prevention should be focused
on key populations, which account for 60% of the total primary prevention resource needs in
the Strategy (not including PrEP for key populations). Within interventions among key
populations, a significant increase in resources is needed for combination harm reduction
services for people who inject drugs. Greater resources are also needed for condom
promotion, PrEP and interventions focused on adolescent girls and young women in high-
prevalence settings.
Investing in combination HIV prevention for adolescent girls and young women is critical in
high-burden countries in sub-Saharan Africa. More than half of the primary prevention
resource needs for adolescent girls and young women should be targeted towards economic
empowerment activities, reflecting the evidence that keeping girls in school and empowering
them economically reduces their risk and vulnerability to HIV.
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The Strategy calls for a modest 17% increase in resources for testing and treatment by 2025
because of reductions in the prices of commodities and forecasted reductions of costs to
deliver the services. Together with the more effective use of these resources, this will enable
a 35% increase in the number of people on treatment and enable the world to reach the 95–
95–95 targets by 2025. Reaching such high treatment coverage levels will contribute to
additional reductions in new HIV infections, which will in turn lead to reductions in resource
needs for testing and treatment in 2026–2030.
Resource needs to prevent HIV vertical transmission, excluding antiretroviral medicines, will fall each
year
300
250
200
US$ (millions)
150
100
50
0
2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Antiretroviral therapy for all includes women, women of reproductive age and pregnant
women, so related costs are included under overall cost for ART. The additional costs
include mainly additional testing efforts as part of antenatal care, counselling, linkage to care
and retention, contact tracing from partners, follow-up of the newborn, nutrition counselling
including breast feeding, retesting of mothers, etc.
The high coverage of antiretroviral treatment for pregnant women living with HIV in high-
prevalence countries has greatly reduced the number of children born with HIV and reduced
resource needs for the prevention of vertical transmission. The acceleration of efforts to
eliminate vertical transmission of HIV outlined in the Strategy would lead to further declines
in nontreatment resource needs in this programme area.
The Strategy calls for much greater investments in societal enablers—reaching US$ 3.1
billion in 2025— in order to enable access to and quality of services needed to end AIDS as
a global public health threat by 2030. These investments should be focused on establishing
the legislative and policy environment required to implement the Strategy, including the
removal of legal and social barriers to HIV services, ending the criminalization of key
populations at high risk of HIV infection, providing legal literacy training and legal aid to
people living with HIV and key populations whose rights are violated, and contributing to
efforts to achieve gender equality.
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Access to justice and legal reform will account for 45% of 2025 resource needs for an improved enabling environment
Gender equality/gender-based
violence programmes
14%
Legal literacy
23%
Annex 4. Glossary
Combination prevention includes both primary prevention (focused on people who are HIV-
negative) as well as prevention of onward transmission from people living with HIV.
Sources: Combination HIV prevention: tailoring and coordinating biomedical, behavioural and
structural strategies to reduce new HIV infections. Geneva: UNAIDS; 2010.
Combination prevention: addressing the urgent need to reinvigorate HIV prevention responses
globally by scaling up and achieving synergies to halt and begin to reverse the spread of the AIDS
epidemic. Geneva: UNAIDS; 2013 (UNAIDS/ PCB(30)/12.13).
Source: United Nations Educational, Scientific and Cultural Organization (UNESCO), UNAIDS, United
Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF) and WHO. International
technical guidance on sexuality education. Volume I. Paris: UNESCO; 2009.
Many different names are used, reflecting an emphasis on various aspects of CSE by
different countries. As with all curricula, CSE must be delivered in accordance with national
laws and policies.
Essential topics
• Human growth and development
• Sexual anatomy and physiology
• Family life, marriage, long-term commitment and
• interpersonal relationships
• Society, culture and sexuality: values, attitudes, social norms
• and the media in relation to sexuality
• Reproduction
• Gender equality and gender roles
• Sexual abuse/resisting unwanted or coerced sex
• Condoms
• Sexual behaviour (sexual practices, pleasure and feelings)
• Transmission and prevention of sexually transmitted infections
Desirable topics
• Pregnancy and childbirth
• Contraception other than condoms
• Gender-based violence and harmful practices/rejecting violence
• Sexual diversity
• Sources for sexual and reproductive health services/seeking services
• Other content related to sexual and reproductive health/sexuality education
Essential topics
• Transmission of HIV
• Prevention of HIV: 98racticing safer sex, including condom use
• Treatment of HIV
Desirable topics
• HIV-related stigma and discrimination
• Sources of counselling and testing services/seeking counselling, treatment, care and
support
• Other HIV and AIDS-related specific content
Source: Measuring the education sector response to HIV and AIDS—guidelines for the construction
and use of core indicators. Paris: UNESCO; 2013.
UNESCO has developed a set of “essential” and “desirable” topics of a life skills-based HIV
and SE programme: The essential topics are those that have the greatest direct impact on
HIV prevention. Desirable topics are those that have an indirect impact on HIV prevention but
that are important as part of an overall sexuality education programme.
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HIV-sensitive social protection enables people living with HIV and other vulnerable
populations to be provided with services together with the rest of the population; this
prevents the exclusion of equally needy groups. HIV-sensitive social protection is the
preferred approach as it avoids the stigmatization that can be caused by focusing exclusively
on HIV. Approaches to HIV-sensitive social protection include the following: financial
protection through predictable transfers of cash, food or other commodities for those affected
by HIV and those who are most vulnerable; access to affordable quality services, including
treatment, health and education services; and policies, legislation and regulation to meet the
needs (and uphold the rights) of the most vulnerable and excluded people.
Key populations, or key populations at higher risk, are groups of people who are more likely
to be exposed to HIV or to transmit it and whose engagement is critical to a successful HIV
response. In all countries, key populations include people living with HIV. In most settings,
men who have sex with men, transgender people, people who inject drugs and sex workers
and their clients are at higher risk of exposure to HIV than other groups. However, each
country should define the specific populations that are key to their epidemic and response
based on the epidemiological and social context.
UNAIDS considers gay men and other men who have sex with men, sex workers and their
clients, transgender people and people who inject drugs as the four main key population
groups. These populations often suffer from punitive laws or stigmatizing policies, and they
are among the most likely to be exposed to HIV. Their engagement is critical to a successful
HIV response everywhere—they are key to the epidemic and key to the response. Countries
should define the specific populations that are key to their epidemic and response based on
the epidemiological and social context. The term “key populations” is also used by some
agencies to refer to populations other than the four listed above. For example, prisoners
and other incarcerated people also are particularly vulnerable to HIV; they frequently lack
adequate access to services, and some agencies may refer to them as a key population. The
term key populations at higher risk also may be used more broadly, referring to additional
populations that are most at risk of acquiring or transmitting HIV, regardless of the legal and
policy environment. In addition to the four main key populations, this term includes people
living with HIV, seronegative partners in serodiscordant couples and other specific
populations that might be relevant in particular regions (such as young women in southern
Africa, fishermen and women around some African lakes, long-distance truck drivers and
mobile populations).
In addition, UNAIDS also uses the term priority populations to describe groups of people who
in a specific geographical context (country or location) are important for the HIV response
because they are at increased risk of acquiring HIV or disadvantaged when living with HIV,
due to a range of societal, structural or personal circumstances. In addition to people living
with HIV and the globally defined key populations that are important in all settings, countries
may identify other priority populations for their national responses, if there is clear local
evidence for increased risk of acquiring HIV, dying from AIDS or experiencing other negative
HIV related health outcomes among other populations. In line with the country epidemiology
of HIV, associated factors and inequalities, this may include populations such as adolescent
girls, young women and their male partners in locations with high HIV incidence, sexual
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partners of key populations, people on the move, people with disabilities, indigenous
peoples, mine workers, as well as others in specific countries. However, in the vast majority
of settings, key populations and people living with HIV are the most important priority
populations for achieving global targets.
Men who have sex with men describes males who have sex with males (including young
males), regardless of whether or not they also have sex with women or have a personal or
social gay or bisexual identity. This concept is useful because it also includes men who self-
identify as heterosexual but who have sex with other men. Gay can refer to same-sex sexual
attraction, same-sex sexual behaviour and same-sex cultural identity.
Transgender
Transgender is an umbrella term for people whose gender identity and expression does not
conform to the norms and expectations traditionally associated with the sex assigned to them
at birth; it includes people who are transsexual, transgender or otherwise gender
nonconforming. Transgender people may self-identify as transgender, female, male,
transwoman or transman, transsexual or, in specific cultures, as hijra (India), kathoey
(Thailand), waria (Indonesia) or one of many other transgender identities. They may express
their genders in a variety of masculine, feminine and/or androgynous ways.
Source: Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations.
Geneva: WHO; 2014.
Young People
Young people are people aged 15–24 as per the GARPR indicators.
Source: Global AIDS response progress reporting, 2015. Geneva: WHO; 2015
(http://www.unaids.org/sites/default/files/ media_asset/JC2702_GARPR2015guidelines_en.pdf,
accessed 25 September 2015).
WHO identifies adolescence as the period in human growth and development that occurs
after childhood and before adulthood, from ages 10 to 19.
Source: Adolescent development: a critical transition. In: WHO [website]. WHO; 2015
(http://www.who.int/maternal_ child_adolescent/topics/adolescence/dev/en/, accessed 25 September
2015).
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Annex 5. Abbreviations
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