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HIV, the virus that causes AIDS (see box), has become one of the world’s most serious health and development challenges since the first cases were reported in 1981. Approximately 86 million people have become infected with HIV since the start of the epidemic.1 Today, there are approximately 39 million people currently living with HIV, and tens of millions of people have died of AIDS-related causes since the beginning of the epidemic.2
Over the past two decades in particular, major global efforts have been mounted to address the epidemic, and significant progress has been made. The number of people newly infected with HIV, especially children, and the number of AIDS-related deaths have declined over the years, and the number of people with HIV receiving treatment increased to 29.8 million in 2022.4
Still, remaining challenges continue to complicate HIV control efforts. Many people living with HIV or at risk for HIV infection do not have access to prevention, treatment, and care, and there is still no cure. HIV primarily affects those in their most productive years, and it not only affects the health of individuals, but also impacts households, communities, and the development and economic growth of nations. Many of the countries hardest hit by HIV also face serious challenges due to other infectious diseases, food insecurity, and additional global health and development problems. In addition, the COVID-19 pandemic disrupted the HIV/AIDS response in low- and middle-income countries, including access to antiretroviral medicines, preventive services, and testing, though the response now has mostly recovered.5
HIV has led to a resurgence of tuberculosis (TB), particularly in Africa, and TB is a leading cause of death for people with HIV worldwide.12 In 2021, approximately 7% of new TB cases occurred in people living with HIV.13 However, between 2000 and 2020, TB deaths in people living with HIV declined substantially, largely due to the scale-up of joint HIV/TB services, and among HIV-positive people, TB mortality fell even faster. 14 (See the KFF fact sheet on TB.)
Numerous prevention interventions exist to combat HIV, and new tools such as vaccines, are currently being researched.16
HIV treatment includes the use of combination antiretroviral therapy (ART) to attack the virus itself, and medications to prevent and treat the many opportunistic infections that can occur when the immune system is compromised by HIV. In light of research findings, WHO released a guideline in 2015 recommending starting HIV treatment earlier in the course of illness.21
International efforts to combat HIV began in the first decade of the epidemic with the creation of the WHO’s Global Programme on AIDS in 1987. Over time, new initiatives and financing mechanisms have helped increase attention to HIV and contributed to efforts to achieve global goals; these include:
The contributions of affected country governments and civil society have also been critical to the response. These and other efforts work toward achieving major global HIV/AIDS goals that have been set through:
In 2016, world leaders reaffirmed commitments to end AIDS by 2030, and in 2017, the U.N. Secretary-General called for the global community to reinvigorate global efforts to respond to AIDS.28 More recently, at the June 2021 U.N. High-Level Meeting on AIDS, world leaders adopted a new Political Declaration featuring global commitments and targets for 2025 to address inequalities impeding the AIDS response, including social, economic, racial, and gender-based inequalities.29
UNAIDS estimates that $22.4 billion was available from all sources (domestic, donor governments, multilaterals, and foundations) to address HIV in low- and middle-income countries in 2022.30 Of this, donor governments provided $8.2 billion (see Figure 1).31 Other governments and organizations that contribute substantially to funding the global response include:
Looking ahead, UNAIDS estimates at least $29.3 billion will be needed by 2025 to meet global targets to end AIDS as a global public health threat by 2030.34
The U.S. government (U.S.) has been involved in HIV efforts since the 1980s and, today, is the single largest donor to international HIV efforts in the world, including the largest donor to the Global Fund.35 The U.S. first provided funding to address the global HIV epidemic in 1986. U.S. efforts and funding increased slowly over time through targeted initiatives to address HIV in certain countries in Africa, South Asia, and the Caribbean, but they intensified with the 2003 launch of the President’s Emergency Plan for AIDS Relief (PEPFAR), which brought significant new attention and funding to address the global HIV epidemic, as well as TB and malaria.36
Created in 2003, PEPFAR is the U.S. government’s global effort to combat HIV. As an interagency initiative, PEPFAR involves multiple U.S. departments, agencies, and programs that address the global epidemic, and it is carried out in close coordination with host country governments and other organizations, including multilateral organizations such as the Global Fund and UNAIDS.37 Collectively, U.S. bilateral activities span more than 50 countries, including countries reached through regional programs in Asia, West Africa, and the Western Hemisphere, with U.S. support for multilateral efforts reaching additional countries.38 (For more information, see the KFF fact sheet on PEPFAR.)
Since its creation, PEPFAR funding, which includes all bilateral funding for HIV as well as U.S. contributions to the Global Fund and UNAIDS, has totaled more than $110 billion.39 For FY 2023, Congress appropriated $4.8 billion for bilateral HIV, as well as $50 million for UNAIDS and $2.0 billion for the Global Fund, totaling $6.9 billion.40 (For more details on historical appropriations for U.S. global HIV/AIDS efforts, see the KFF fact sheets on the U.S. Global Health Budget: Global HIV Funding, Including PEPFAR and the U.S. Global Health Budget: The Global Fund, as well as the KFF budget tracker.)
UNAIDS, Global HIV statistics 2023 fact sheet; July 2023.
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UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023. UNAIDS, AIDSinfo website; accessed July 2023, available at: http://aidsinfo.unaids.org/. UNAIDS, 2023 Core epidemiology slides; July 2023.
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AIDS is the last and most severe stage of HIV infection, during which the immune system is so weak that people with AIDS acquire an increasing amount of severe illnesses. CDC HIV Website, https://www.cdc.gov/hiv/basics/whatishiv.html.
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UNAIDS, Global HIV statistics 2023 fact sheet; July 2023.
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UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023.
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UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023. UNAIDS, AIDSinfo website; accessed July 2023, http://aidsinfo.unaids.org/. UNAIDS, 2023 Core epidemiology slides; July 2023. UNAIDS, Global HIV statistics 2023 fact sheet; July 2023; UNAIDS, UNAIDS data 2023; July 2023.
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UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023.
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UNAIDS, Women and HIV – A spotlight on adolescent girls and young women; March 2019.
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Sub-Saharan Africa constitutes as East and Southern Africa and West and Central Africa.
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UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023. UNAIDS, AIDSinfo website; accessed July 2023, http://aidsinfo.unaids.org/. UNAIDS, Global HIV statistics 2023 fact sheet; July 2023.
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UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023. UNAIDS, Global HIV statistics 2023 fact sheet; July 2023. UNAIDS, UNAIDS 2016-2021 Strategy; Aug. 2015.
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WHO, Tuberculosis, fact sheet, https://www.who.int/news-room/fact-sheets/detail/tuberculosis.
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WHO, Global Tuberculosis Report 2022; 2022.
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WHO, Global Tuberculosis Report 2022; 2022.
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UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023. UNAIDS, AIDSinfo website; accessed July 2023, http://aidsinfo.unaids.org/. UNAIDS, 2023 Core epidemiology slides; July 2023. UNAIDS, Global HIV statistics 2023 fact sheet; July 2023; UNAIDS, UNAIDS data 2023; July 2023.
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UNAIDS, Get on the Fast Track; 2016. Global HIV Prevention Working Group, Behavior Change for HIV Prevention: (Re) Considerations for the 21st Century; Aug. 2008.
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UNAIDS, UNAIDS Explainer: Undetectable = untransmittable; July 2018.
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WHO, Guideline on When to Start antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV; Sept. 2015. WHO, WHO expands recommendation on oral pre-exposure prophylaxis of HIV infection (PrEP); Nov. 2015.
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United Nations, Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight Against HIV and to End the AIDS Epidemic by 2030; June 8, 2016.
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UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023. United Nations, Reinvigorating the AIDS response to catalyse sustainable development and United Nations reform: Report of the Secretary-General; June 2017.
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UNAIDS, Get on the Fast Track; 2016. WHO, Guideline on When to Start antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV; September 2015. WHO, Press Release: NIAID START Trial confirms that immediate treatment of HIV with antiretroviral drugs (ARVs) protects the health of people living with HIV; May 28, 2015. NIAID, Starting Antiretroviral Treatment Early Improves Outcomes for HIV-Infected Individuals; May 27, 2015.
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United Nations, Transforming our world: the 2030 Agenda for Sustainable Development; 2015.
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UNAIDS, Fast-Track: ending the AIDS epidemic by 2030; 2014.
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These goals and targets were reiterated in the UNAIDS 2016-2021 Strategy, which also aligns with the SDGs. UNAIDS., Fast-Track: ending the AIDS epidemic by 2030; 2014. UNAIDS., UNAIDS 2016-2021 Strategy; Aug. 2015.
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UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023. See also KFF Dashboard: Progress Toward Global HIV Targets in PEPFAR Countries, August 2021.
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UNAIDS, Global HIV statistics 2023 fact sheet; July 2023.
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UNAIDS, Press Release: UNAIDS calls on countries to step up global action and proposes bold new HIV targets for 2025; November 26, 2020. UNAIDS, “2025 AIDS Targets,” webpage, https://aidstargets2025.unaids.org/#. UNAIDS, World AIDS Day Report 2020: Prevailing Against Pandemics by Putting People at the Centre; November 2020.
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The 2016 U.N. General Assembly High-Level Meeting on Ending AIDS reaffirmed commitments made in the 2001 Declaration of Commitment on HIV/AIDS and the 2006 and 2011 political declarations on HIV/AIDS. UNAIDS, Declaration of Commitment on HIV/AIDS; 2001, https://www.unaids.org/sites/default/files/sub_landing/files/aidsdeclaration_en_0.pdf. UNAIDS, 2006 Political Declaration on HIV/AIDS; 2006, https://www.unaids.org/sites/default/files/sub_landing/files/20060615_hlm_politicaldeclaration_ares60262_en_0.pdf. UNAIDS, 2011 Political Declaration on HIV/AIDS; 2011, http://www.unaids.org/en/aboutunaids/unitednationsdeclarationsandgoals/2011highlevelmeetingonaids/. United Nations, 2016 Political Declaration on HIV and AIDS; 2016, https://www.unaids.org/sites/default/files/media_asset/2016-political-declaration-HIV-AIDS_en.pdf. UNAIDS, Press Release: Bold Commitments to Action Made at the United Nations General Assembly High-Level Meeting on Ending AIDS; June 10, 2016. UNAIDS, Reinvigorating the AIDS response to catalyse sustainable development and United Nations reform; 2017.
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These commitments and targets align with the more recent UNAIDS 2021-2026 Global AIDS Strategy, which is focused on reducing inequalities. UNAIDS, Global AIDS Strategy 2021-2026 – Ending Inequalities. End AIDS.; March 2021. United Nations, Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030; June 2021. UNAIDS, Press release: United Nations High-Level Meeting on AIDS draws to a close with a strong political declaration and bold new targets to be met by 2025; June 2021.
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UNAIDS estimates that US$20.8 billion was available for HIV from all sources (domestic resources, donor governments, multilaterals, and philanthropic organizations) in 2022, expressed in 2019 USD. For purposes of this fact sheet, this estimate was converted to 2022 USD, or $22.4 billion. KFF/UNAIDS, Donor Government Funding for HIV in Low- and Middle-Income Countries in 2022; July 2023.
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KFF/UNAIDS, Donor Government Funding for HIV in Low- and Middle-Income Countries in 2022; July 2023.
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Global Fund, The Global Fund Data Explorer, accessed July 2023, https://data.theglobalfund.org.
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Bill & Melinda Gates Foundation, HIV Strategy Overview, accessed July 2023, http://www.gatesfoundation.org/What-We-Do/Global-Health/HIV#OurStrategy.
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KFF/UNAIDS, Donor Government Funding for HIV in Low- and Middle-Income Countries in 2022; July 2023. UNAIDS, 2023 Global AIDS Update: The Path That Ends AIDS; July 2023.
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KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional Appropriations Bills. KFF/UNAIDS, Donor Government Funding for HIV in Low- and Middle-Income Countries in 2022; July 2023.
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U.S. Congress, P.L. 108-25, May 27, 2003. KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional Appropriations Bills. KFF/UNAIDS, Donor Government Funding for HIV in Low- and Middle-Income Countries in 2022; July 2023.
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KFF, The U.S. Government and Global Health, Sep. 2022. CRS, PEPFAR Reauthorization: Key Policy Debates and Changes to U.S. International HIV/AIDS, Tuberculosis, Malaria and Programs and Funding; Jan. 2009.
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KFF analysis of data from congressional budget justification documents; PEPFAR, “Where We Work” webpage, https://www.state.gov/where-we-work-pepfar/; PEPFAR 2023 Country Operational Plan Guidance for all PEPFAR Countries; and CDC’s “Where We Work” webpage, https://www.cdc.gov/globalhivtb/where-we-work/index.html.
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KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional Appropriations Bills. Totals include funding for bilateral HIV and contributions to multilateral organizations (specifically, the Global Fund and UNAIDS).
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Totals represent funding specified by Congress in annual appropriations bills and/or identified by agencies for the Department of State, USAID, CDC, and DoD. In addition, international HIV research activities are supported by the NIH Office of AIDS Research (OAR) through its annual appropriated budget, but these amounts are not considered part of PEPFAR. See KFF’s “Breaking Down the U.S. Global Health Budget by Program Area” for additional information.
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