The global pandemic of HIV/AIDS (human immunodeficiency virus infection and acquired immunodeficiency syndrome) began in 1981, and is an ongoing worldwide public health issue. According to the World Health Organization (WHO), by 2023, HIV/AIDS had killed approximately 40.4 million people, and approximately 39 million people were infected with HIV globally. Of these, 29.8 million people (75%) are receiving antiretroviral treatment. There were about 630,000 deaths from HIV/AIDS in 2022. The 2015 Global Burden of Disease Study estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year. Incidence of HIV has continued to fall, decreasing by 23% from 2010 to 2020, with progress dominated by decreases in Eastern Africa and Southern Africa. As of 2023, there are about 1.3 million new infections of HIV per year globally.
HIV originated in nonhuman primates in Central Africa and jumped to humans several times in the late 19th or early 20th century. One reconstruction of its genetic history suggests that HIV-1 group M, the strain most responsible for the global epidemic, may have originated in Kinshasa, the capital of the Democratic Republic of the Congo, around 1920. AIDS was first recognized in 1981, and in 1983 HIV was discovered and identified as the cause of AIDS.
In some countries, HIV disproportionately affects certain key populations (sex workers and their clients, men who have sex with men, people who inject drugs, and transgender people) and their sexual partners. In Sub-Saharan Africa, 63% of new infections are women, with young women (aged 15 to 24 years) twice as likely as men of the same age to be living with HIV. In Western Europe and North America, men who have sex with men account for almost two thirds of new HIV infections.
Climate change impacts HIV risk, and the availability of and access to HIV prevention and treatment services, contributing to poor nutrition, impaired immunity, and poor adherence to treatment.
In 2018, the prevalence of HIV in the Africa Region was estimated at 1.1 million people. The African Region accounts for two thirds of the incidence of HIV around the world. Sub-Saharan Africa is the region most affected by HIV. In 2020, more than two thirds of those living with HIV were living in Africa. HIV rates have been decreasing in the region: From 2010 to 2020, new infections in eastern and southern Africa fell by 38%. Still, South Africa has the largest population of people with HIV of any country in the world, at 8.45 million, 13.9% of the population as of 2022.
In the developed world, most people with HIV are able to access treatment and live long and healthy lives. In 2020, 88% of people living with HIV in this region knew their HIV status, and 67% have suppressed viral loads. In 2019, approximately 1.2 million people in the United States had HIV. 13% did not realize that they were infected. In Canada in 2016, there were about 63,110 cases of HIV. In 2020, 106,890 people were living with HIV in the UK and 614 died (99 of these from COVID-19 comorbidity). In Australia, in 2020, there were about 29,090 cases.
Global HIV data
Since the first case of HIV/AIDS reported in 1981, this virus continues to be one of the most prevalent and deadliest pandemics worldwide. The Center for Disease Control mentions that the HIV disease continues to be a serious health issue for several parts of the world. Worldwide, there were about 1.7 million new cases of HIV reported in 2018. About 37.9 million people were living with HIV around the world in 2018, and 24.5 million of them were receiving medicines to treat HIV, called antiretroviral therapy (ART). Roughly an estimated 770,000 people died from AIDS-related illnesses in 2018.
Although AIDS is a global disease, the CDC reports that Sub-Saharan Africa has the highest prevalence of HIV and AIDS worldwide, and accounts for approximately 61% of all new HIV infections. Other regions significantly affected by HIV and AIDS include Asia and the Pacific, Latin America and the Caribbean, Eastern Europe, and Central Asia.
Worldwide there is a common stigma and discrimination surrounding HIV/AIDS. Respectively, infected patients are more subject to judgement, harassment, and acts of violence and come from marginalized areas where it is common to engage in illegal practices in exchange for money, drugs, or other exchangeable forms of currency.
AVERT, an international HIV and AIDS charity created in 1986, makes continuous efforts to prioritize, normalize, and provide the latest information and education programs on HIV and AIDS for individuals and areas most affected by this disease worldwide. AVERT suggested that discrimination and other human rights violations may occur in health care settings, barring people from accessing health services or enjoying quality health care.
Accessibility to tests have also played a significant role in the response and speed to which nations take action. Approximately 81% of people with HIV globally knew their HIV status in 2019. The remaining 19% (about 7.1 million people) still need access to HIV testing services. HIV testing is an essential gateway to HIV prevention, treatment, care and support services.
It is crucial to have HIV tests available for individuals worldwide since it can help individuals detect the status of their disease from an early onset, seek help, and prevent further spread through the practice of suggestive safety precautions. Testing can be done for those between the ages of 13 and 64. The CDC recommends testing for HIV at least once for routine health care. HIV tests have a high accuracy and the tests come in the form of antibody tests, antigen/antibody tests, and NATS (nucleic acid test).
There were approximately 38 million people across the globe with HIV/AIDS in 2019. Of these, 36.2 million were adults and 1.8 million were children under 15 years old.
Historical data for selected countries
HIV/AIDS in World from 2001 to 2014 – adult prevalence – data from CIA World Factbook
By region
The global epidemic is not homogeneous within regions, with some countries more affected than others. Even at the country level, there are wide variations in infection levels between different areas and different population groups. New HIV infections are falling globally on average (a decrease of 23% from 2010 to 2020), but continue to rise in many parts of the world. Sub-Saharan Africa is by far the worst-affected region, and targeted interventions in the region have decreased the spread of HIV.
New infections fell in eastern and southern Africa by 38% from 2010 to 2020, but HIV in western and central Africa has not received the same attention, and as a result has made less progress. HIV rates have declined slightly in Asia and the Pacific, with HIV decreasing in Mainland Southeast Asia, but increasing in the Philippines and Pakistan. From 2010 to 2020, HIV infections increased by 21% in Latin America, 22% in the Middle East and North Africa, and 72% in Eastern Europe and central Asia.
Most people in North America and western and central Europe with HIV are able to access treatment and live long and healthy lives. Annual AIDS deaths have been continually declining since 2005 as antiretroviral therapy has become more widely available.
Sub-Saharan Africa
Sub-Saharan Africa remains the hardest-hit region. As of 2011, HIV infection was becoming endemic in sub-Saharan Africa, which is home to just over 12% of the world's population but two-thirds of people who are infected with HIV. As of 2022, it is estimated that the adult HIV prevalence rate is 6.2%, a 1.2% increase from data reported in the 2011 UNAIDS World Aids Day Report. However, the actual prevalence varies between regions. The UNAIDS 2021 data estimates that about 58% of the HIV 4000 incidences per day are in Sub-Saharan Africa.
Southern Africa is the hardest hit region, with, as of 2024, adult prevalence rates of 23.4% in Eswatini, 17.2% in South Africa and 15.7% in Botswana, having previously exceeded 20% in most countries in the region, and 30% in Eswatini and Botswana. Analysis of prevalence across sub-Saharan Africa between 2000 and 2017 found high variation in prevalence at a subnational level, with some countries demonstrating a more than five-fold difference in prevalence between different districts. Although Eastern and Southern Africa have a heavier burden of disease they have also shown much resilience in their response to HIV.
Across Sub-Saharan Africa, more women are infected with HIV than men, with 13 women infected for every 10 infected men. This gender gap continues to grow. Throughout the region, women are being infected with HIV at earlier ages than men. The differences in infection levels between women and men are most pronounced among young people (aged 15–24 years). In this age group, there are 36 women infected with HIV for every 10 men. The widespread prevalence of sexually transmitted diseases, the promiscuous culture, the practice of scarification, unsafe blood transfusions, and the poor state of hygiene and nutrition in some areas may all be facilitating factors in the transmission of HIV-1 (Bentwich et al., 1995).
Due to a lack of testing, a shortage in antenatal therapies and through the feeding of contaminated breast milk, 590,000 infants born in developing countries are infected with HIV-1 per year. In 2000, the World Health Organization estimated that 25% of the units of blood transfused in Africa were not tested for HIV, and that 10% of HIV infections in Africa were transmitted via blood.
Poor economic conditions (leading to the use of dirty needles in healthcare clinics) and lack of sex education contribute to high rates of infection. In some African countries, 25% or more of the working adult population is HIV-positive. Poor economic conditions caused by slow onset-emergencies, such as drought, or rapid onset natural disasters and conflict can result in young women and girls being forced into using sex as a survival strategy. Worse still, research indicates that as emergencies, such as drought, take their toll and the number of potential 'clients' decreases, women are forced by clients to accept greater risks, such as not using contraceptives. If there is no reduction in carbon emissions it is expected that there will be an increase of between 11 million and 16 million HIV cases in countries in sub-Saharan Africa by 2050 as a result of increasing temperatures.
AIDS-denialist policies have impeded the creation of effective programs for distribution of antiretroviral drugs. Denialist policies by former South African President Thabo Mbeki's administration led to several hundred thousand unnecessary deaths. UNAIDS estimates that in 2005 there were 5.5 million people in South Africa infected with HIV — 12.4% of the population. According to a graph done by UNAIDS, there were 4,200,000 people living with HIV in South Africa in 2005. This was an increase of 400,000 people since 2003.
In 2018, the prevalence of HIV in Eastern and Southern Africa combined was 1.8 million. This number only represents children and adolescents (Ages 0–19). As for those ages 15–24 in this region of Africa, the incidence rate (2018) was 290,000. About 203,000 of those infected were females. The statistical release form the Republic of South Africa in 2020 states that the prevalence rate of HIV infections among adults ages 15–49 was 18.7% but the overall population in South Africa has a prevalence rate of 13%. As of 2021, UNAIDS data from the eastern and southern countries in Africa showed the HIV prevalence rate to be 6.2% in adults ages 15–49.
Females in Sub-Saharan Africa continue to be adversely affected by HIV with data that reveals women 15–24 years of age are two times as likely to contract HIV compared to their male counterparts. However, it has been noted, that empowering women when it comes to education has an effect on lowering their risk of becoming infected with HIV. Data from Sub-Saharan Africa also shows that women are more likely to get tested for HIV, therefore a higher percentage of women compared to men are aware that they have HIV. There are also a higher percentage of women who are receiving treatment and women are more likely to continue with treatment once started.
Although HIV infection rates are much lower in Nigeria than in other African countries, the size of Nigeria's population meant that by the end of 2003, there were an estimated 3.6 million people infected. On the other hand, Uganda, Zambia, Senegal, and most recently Botswana have begun intervention and educational measures to slow the spread of HIV, and Uganda has succeeded in actually reducing its HIV infection rate.
During COVID-19, some countries in South and East Africa were able to set up treatment sites that provided 1.8 million individuals with a larger supply of antiretroviral (ART) medication that could sustain them for longer than the typical 3 months. In the quarterly report following lockdown, they saw a 10% decrease in the number of individuals that experienced treatment interruptions from the quarter before lockdown. South Africa also saw that those infected with HIV had a great risk of complications if they contracted the COVID-19 virus, and more so if they were not receiving ART. The other issue seen before the COVID-19 pandemic arrived was the lack of health care workers. In a bar graph created by the World Health Organization (WHO) comparing regions and globally, Sub-Saharan Africa had the least number of health professionals per 10 000 people.
Middle East and North Africa
HIV/AIDS prevalence among the adult population (15-49) in the Middle East and North Africa (MENA) is estimated less than 0.1 between 1990 and 2018. This is the lowest prevalence rate compared to other regions in the world.
In the MENA, roughly 230,000 people are living with HIV as of 2020, a slight decrease from 240,000 in 2018 where Iran accounted for approximately one-quarter (61,000) of the population with HIV followed by Sudan (59,000). As well as, Sudan (5,200), Iran (4,400) and Egypt (3,600) took up more than 60% of the number of new infections themselves in the MENA (20,000). Roughly two-thirds of AIDS-related deaths in this region happened in these countries for the year 2018.
Although the prevalence is low, concerns remain in this region. First, unlike the global downward trend in new HIV infections and AIDS-related deaths, the numbers have continuously increased in the MENA. Second, compared to the global rate of antiretroviral therapy (62%), the MENA region's rate is far below in 2020 (43%). The low participation of antiretroviral therapy (ART) increases not only the number of AIDS-related deaths but the risk of mother-to-baby HIV infections, in which the MENA (24.7%) shows relatively high rates compared to other regions, for example, southern Africa (10%), Asia and the Pacific (17%). It is estimated that only one in five individuals in need of ART will receive it, and even less than 10% in women and children.