Publications

The evidence supporting U = U addresses the drivers of criminalization of HIV transmission by challenging the outdated norms that HIV infection is a death sentence and that HIV is easily transmitted to sexual partners. HIV stigma and criminalization remain key barriers in many countries to reaching the targets in the 2021 Political Declaration on HIV and AIDS and the Global AIDS Strategy 2021–2026.  

As the UN's only cosponsored Joint Programme, UNAIDS has spearheaded a coordinated, multisectoral HIV response for nearly 30 years. The 2021 UN Political Declaration on HIV and AIDS, supported by UNAIDS' Global AIDS Strategy 2021-2026, charts a clear path to end AIDS as a public health threat by 2030. Taking this path is a sound political and financial choice that will save lives.   

On 1 January 2024, the Journal of Acquired Immune Deficiency Syndromes (JAIDS)  published an article describing the findings from UNAIDS and co-authors on new HIV infections among key populations1 and their sexual partners in 2010 and 2022, by world region. For the first time, UNAIDS and partners have used expanded data sources and refined, dynamic HIV transmission models to make estimates of new HIV infections with time trends within each country and key population. This article, prepared by UNAIDS and partners, highlights the new methods used to gain a better understanding of new HIV infections among key populations. The article focuses primarily on the new methods and necessary improvements for future estimates. This document places the findings in the wider context of the AIDS epidemic and response for their advocacy and programmatic use. For additional information, data and nuances it is suggested to refer to the full article.

In 2019, UNAIDS published Health, rights and drugs: harm reduction, decriminalization and zero discrimination for people who use drugs which laid out the irrefutable evidence that people who use drugs were being left behind in the HIV response. The report demonstrated how the war on drugs was failing in its efforts to reduce the supply and demand of illicit substances, while at the same time causing untold harm to the health and well-being of people who use drugs. In 2024, five years later, the data show that people who inject drugs are still being left behind in the response. In 2022, the global median HIV prevalence among people who inject drugs was 5% across 50 reporting countries, seven times higher than among the rest of the adult population (aged 15–49 years). This figure hides significant geographical and population-based disparities. Among reporting countries, HIV prevalence ranged from 0% to 51%. Among the 16 countries with gender disaggregated data, the reported median HIV prevalence among men who inject drugs was 9%, while it was nearly double (15%) among women who inject drugs. There is some good news: the Global AIDS Strategy 2021–2026: end inequalities. end AIDS contains, for the first time, targets on law reform, reduction in stigma and discrimination, and community leadership in the response. In 2023, a United Nations Human Rights Council resolution on drug policy included explicit support for harm reduction and decriminalization for people who use drugs.

A new report, HIV Prevention: From Crisis to Opportunity shows that HIV infections continue to decline in countries that are part of the Global HIV Prevention Coalition (GPC) faster than in the rest of the world. Eleven GPC focus countries have reduced their annual number of new HIV infections by at least 66% since 2010. By comparison, the average reduction in new HIV infections since 2010 globally is 38%. The GPC is a coalition of 38 countries working together to accelerate declines in new HIV infections to achieve the target of having 95% of the people who are at risk of HIV accessing effective combination prevention options.

The Global Fund strategy for 2023-2028 has three mutually reinforcing contributory objectives. One critical objective is Maximizing the Engagement and Leadership of Most Affected Communities to Leave No One Behind, which specifically applies to GC7.

Ethics is a discipline or area of study concerned with issues such as benefits, harms, fairness, and rights. As an area of study and practice, ethics covers moral values and questions about what actions should be taken and which policies should be implemented. Ethical answers to these questions depend on what (beneficial or harmful) outcomes are likely to occur, but also the extent to which these outcomes will be distributed fairly through relevant populations, and the rights and interests of the people affected by actions and policies. This is the third brief in a set discussing phylogenetics and HIV in public health will discuss ethics and human rights considerations. Throughout, we keep in mind Article 8 of the Helsinki Declaration: While the primary purpose of medical research is to generate new knowledge, this goal can never take precedence over the rights and interests of individual research subjects.

Phylogenetic approaches have been used to study HIV biology and epidemiology since the early 1980s. In the last 15 years, advances in sequencing have led to an increase in the information obtained and a sharp drop in costs, making it feasible to use phylogenetics in larger studies and public health HIV surveillance programmes. This is the second brief in a series of three on HIV phylogenetics. The first brief, The Application of Phylogenetics to HIV—Insights into Biology and Epidemiology of HIV, explains the methods and approaches used to generate genetic and phylogenetic data and analyses. This brief summarises the ways in which phylogenetic (and other sequence-based) analyses are currently being used and reflects on how they could be used in the future in the field of HIV research and public health. The third brief discusses the ethical challenges of using HIV phylogenetics in research and public health surveillance.

Phylogenetics is the study of the evolution of organisms based on their genetic similarity. Phylogenetic techniques, laboratory methods to read genetic code present in all living organisms, can be used to compare different species or to compare different members of the same species. They can also be used to compare viruses like HIV. Phylogenetic techniques are used to detect the subtle changes that occur in the genetic code of each organism from one generation to the next. These changes are particularly pronounced in HIV making it a good candidate for phylogenetic studies. This brief introduction to HIV phylogenetics is the first of three briefs on the phylogenetics of HIV. This brief introduces phylogenetics, explains how the genetic code can be read, and shows how the sequences can reveal insights into HIV biology and epidemiology.

Achieving the 2025 and 2030 goals will require strong political leadership and the active engagement of people living with HIV and key and vulnerable populations across multiple sectors. Resources will need to be mobilized from both domestic and international sources. Sustainability will require different measures and approaches in diverse settings, highlighting the importance of tailoring sustainability planning and implementation for specific contexts, with existing efforts being leveraged. Flexibility and resilience will be essential in the face of changes in national HIV epidemics as well as in economic, political and social contexts. This Primer document outlines a new approach to planning and implementing sustainable national HIV responses, that aims to galvanize efforts and to drive sustainable HIV Response transformations to reach and maintain epidemic control beyond 2030, by upholding the right to health for all. Through country driven and owned processes based on the most recent data, countries will develop specific HIV Response Sustainability Roadmaps. These Roadmaps will identify high-level outcomes across key domains of sustainability, including political leadership, quality access to services, system capacities, enabling policies, and domestic and international financing.