The Global HIV/AIDS Epidemic

Key Facts

  • HIV, the virus that causes AIDS (acquired immunodeficiency syndrome), is one of the world’s most serious health and development challenges. Approximately 38 million people are currently living with HIV, and tens of millions of people have died of AIDS-related causes since the beginning of the epidemic.
  • 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.
  • In recent decades, major global efforts have been mounted to address the epidemic, and despite challenges, significant progress has been made in addressing HIV.
  • Under Sustainable Development Goal 3, the global community agreed to aim to end the AIDS epidemic by 2030. However, while gains have been made, they have been uneven, and the interim “90-90-90” targets were missed. A U.N. high-level meeting reviewing progress toward the 2030 goals will take place in June 2021.
  • The U.S. government (U.S.), through PEPFAR (the President’s Emergency Plan for AIDS Relief), is the single largest donor to international HIV efforts in the world, including the largest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).
  • As COVID-19 continues to spread globally, its detrimental effects on HIV/AIDS efforts worldwide have already been seen, including disruptions of essential health services, such as testing, treatment, and prevention programs.

Global Response

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 76 million people have become infected with HIV since the start of the epidemic.1 Today, there are approximately 38 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

HIV: A virus that is transmitted through certain body fluids and weakens the immune system by destroying cells that fight disease and infection, specifically CD4 cells (often called T cells). Left untreated, HIV reduces the number of CD4 cells in the body, making it more difficult for the immune system to fight off infections and other diseases. HIV can lead to the development of AIDS, “acquired immunodeficiency syndrome.”3

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 25.4 million in 2019.4

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, as COVID-19 continues to spread globally, its detrimental effects on the HIV/AIDS response in low- and middle-income countries have already been seen, including disruptions in access to antiretroviral medicines and preventive services.5 While the full impact of COVID-19 on HIV services and progress remains to be seen, it is estimated that such interruptions could result in many more additional HIV-related deaths.6

Latest Estimates7

  • Global prevalence among adults (the percent of people ages 15-49 who are infected) has leveled since 2001 and was 0.7% in 2019 (see Figure 1).
  • There were 38 million people living with HIV in 2019 (see Table 1), up from 30.7 million in 2010, the result of continuing new infections and people living longer with HIV. Of the people living with HIV in 2018, 36.2 million were adults and 1.8 million were children under age 15.
  • Although HIV testing capacity has increased over time, enabling more people to learn their HIV status, about one in five people with HIV (19%) are still unaware they are infected.
  • Although there have been significant declines in new infections since the mid-1990s, there were still about 1.7 million new infections in 2019, or about 5,000 new infections per day. Recent data show that while progress has been made, that progress is unequal within and between countries.8 Furthermore, the pace of decline varies by age group, sex, and region.
  • HIV remains a leading cause of death worldwide and the leading cause of death globally among women of reproductive age.9 However, AIDS-related deaths have declined, due in part to antiretroviral treatment (ART) scale-up. 690,000 people died of AIDS in 2019, a 37% decrease from 1.1 million in 2010 and a 59% decrease from the peak of 1.7 million in 2004.
Table 1: Snapshot of Global Epidemic Today, by Region
Region % of Adults Living with HIV
(Adult Prevalence)
# of People Living with HIV (% of Global Total) # of People Newly Infected with HIV # of AIDS-Related Deaths
Global, Total 0.7% 38.0 million (100%) 1.7 million 690,000
Eastern and Southern Africa 6.7% 20.7 million   (54%) 730,000 300,000
Western and Central Africa 1.4% 4.9 million   (13%) 240,000 140,000
Asia and the Pacific 0.2% 5.8 million   (15%) 300,000 160,000
Western and Central Europe and North America 0.2% 2.2 million     (6%) 65,000 12,000
Latin America 0.4% 2.1 million     (6%) 120,000 37,000
Eastern Europe and Central Asia 0.9% 1.7 million     (4%) 170,000 35,000
The Caribbean 1.1% 330,000   (<1%) 13,000 6,900
Middle East and North Africa <0.1% 240,000   (<1%) 20,000 8,000
NOTES: Reflects 2019 data.
SOURCES: UNAIDS. AIDSinfo website; accessed July 2020. UNAIDS. Core Epidemiology Slides; July 2020.
Affected Areas

Sub-Saharan Africa,10 with more than two-thirds of all people living with HIV globally, is the hardest hit region in the world, followed by Asia and the Pacific (see Table 1). The Caribbean as well as Eastern Europe and Central Asia are also heavily affected.

  • Eastern and Southern Africa. An estimated 20.7 million people are living with HIV in Eastern and Southern Africa, more than half (54%) of all people living with HIV. Two-thirds of children living with HIV (67%) are found in this region. Despite the significant impact, new infections in the region have declined by 38% since 2010. Almost all of the region’s nations have generalized HIV epidemics – that is, their national HIV prevalence is greater than 1%. South Africa has the highest number of people living with HIV in the world (7.5 million). Eswatini (formerly known as Swaziland) has the highest prevalence in the world (27%).
  • Western and Central Africa. An estimated 4.9 million people are living with HIV in Western and Central Africa. New HIV infections among adults declined by 25% between 2010 and 2019. Women and girls account for 58% of the estimated 240,000 new HIV infections in the region. Another issue facing the region is coverage of antiretroviral therapy for pregnant women, which has been declining in recent years (from 62% in 2016 to 58% in 2019).
  • Asia and the Pacific. An estimated 5.8 million people are living with HIV in Asia and the Pacific. The region’s annual number of new HIV infections declined by 12% since 2010. However, trends vary from country to country, and the decline in the region may obscure increases in some countries. The region is also home to the two most populous nations in the world – China and India – and even relatively low prevalence translates into large numbers of people.
  • Western and Central Europe and North America. An estimated 2.2 million people are living with HIV in this region. High coverage of ART plays a key role in the reduction of AIDS-related deaths in the region; since 2010, the number of AIDS-related deaths decreased by 40%. 4 in 5 people living with HIV (81%) are on treatment, and 2 in 3 people living with HIV (67%) are virally suppressed.
  • Latin America. An estimated 2.1 million people are living with HIV in Latin America. Between 2010 and 2019, new HIV infections increased by 21% while the number of AIDS-related deaths fell by 8% in the region overall. In 2019, 40% of new HIV infections in Latin America occurred in Brazil, which has the greatest number of people living with the disease (920,000) in the region.
  • Eastern Europe and Central Asia. An estimated 1.7 million people are living with HIV in this region, including 170,000 newly infected in 2019. New HIV infections in the region increased by 72% and AIDS-related deaths increased by 24% between 2010 and 2019. Most of the new infections (99%) in the region are among key populations and their sexual partners, including 48% of infections occurring among people who inject drugs.
  • The Caribbean. An estimated 330,000 people are living with HIV in the Caribbean. The number of people living with HIV on treatment more than doubled since 2010 (from 68,000 in 2010 to approximately 210,000 in 2019). However, the percentage of people living with HIV who have suppressed viral loads in the region (50%) is below the global average (59%).
  • Middle East and North Africa. An estimated 240,000 people are living with HIV in the Middle East and North Africa. New infections increased by 25% from 2010 to 2019, while AIDS-related deaths remained stable. Treatment coverage among people living with HIV in this region is 38%, the lowest of any region.
Affected/Vulnerable Populations
  • Most HIV infections are transmitted heterosexually, although risk factors vary. In some countries, men who have sex with men, people who inject drugs, sex workers, transgender people, and prisoners are disproportionally affected by HIV.
  • Women represent over half (55%) of all adults (15-49 years) living with HIV worldwide, and HIV (along with complications related to pregnancy) is the leading cause of death among women of reproductive age.11 Gender inequalities, differential access to service, and sexual violence increase women’s vulnerability to HIV, and women, especially younger women, are biologically more susceptible to HIV.
  • Young people, ages 15-24, account for approximately a third of new HIV infections, and in some areas, young women are disproportionally impacted. In sub-Saharan Africa, among adults age 15 and older, young women ages 15-24 accounted for 19% of new HIV infections in the region in 2019.
  • Globally, children account for 1.8 million people living with HIV; among children, there were 95,000 AIDS-related deaths and 150,000 new infections in 2019. Since 2010, new HIV infections among children have declined by 52%.
HIV & TB

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 2019, approximately 9% of new TB cases occurred in people living with HIV.13 However, between 2000 and 2019, TB deaths in people living with HIV declined substantially, largely due to the scale up of joint HIV/TB services. (See the KFF fact sheet on TB.)

Prevention and Treatment14

Numerous prevention interventions exist to combat HIV, and new tools such as vaccines, are currently being researched.15

  • Effective prevention strategies include behavior change programs, condoms, HIV testing, blood supply safety, harm reduction efforts for injecting drug users, and male circumcision.
  • Additionally, recent research has shown that engagement in HIV treatment not only improves individual health outcomes but also significantly reduces the risk of transmission (referred to as “treatment as prevention” or TasP). Those with undetectable viral loads (known as being virally suppressed) have effectively no risk of transmitting HIV sexually.16
  • Pre-exposure prophylaxis (PrEP) has also been shown to be an effective HIV prevention strategy in individuals at high risk for HIV infection. In 2015, the World Health Organization (WHO) recommended PrEP as a form of prevention for high-risk individuals in combination with other prevention methods.17 Further, in 2016, the U.N. Political Declaration on HIV/AIDS stated PrEP research and development should be accelerated.18
  • Experts recommend that prevention be based on “knowing your epidemic” (tailoring prevention to the local context and epidemiology), using a combination of prevention strategies, bringing programs to scale, and sustaining efforts over time. Access to prevention, however, remains limited, and there have been renewed calls for the strengthening of prevention efforts.19

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 recent research findings, WHO released a guideline in 2015 recommending starting HIV treatment earlier in the course of illness.20

  • Combination ART, first introduced in 1996, has led to dramatic reductions in morbidity and mortality, and access has increased in recent years, rising to 25.4 million people (67% of people living with HIV) in 2019.
  • The percentage of pregnant women receiving ART for the prevention of mother-to-child transmission of HIV increased to 85% in 2019, up from 45% in 2010.
  • Access to ART among children has more than doubled since 2010, with treatment coverage rising from 18% in 2010 to 53% in 2019.
  • Approximately 59% of all people living with HIV are virally suppressed, which means they are likely healthier and less likely to transmit the virus. Viral suppression varies greatly by region, key population, and sex.

Global Goals

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 Joint United Nations Programme on HIV/AIDS (UNAIDS), which was formed in 1996 to serve as the U.N. system’s coordinating body and to help galvanize worldwide attention to HIV/AIDS; and
  • the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), which was established in 2001 by a U.N. General Assembly Special Session (UNGASS) on HIV/AIDS as an independent, international financing institution that provides grants to countries to address HIV, TB, and malaria (see the KFF fact sheet on the Global Fund).

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:

  • the Sustainable Development Goals (SDGs). Adopted in 2015, the SDGs aim to end the AIDS epidemic by 2030 under SDG Goal 3, which is to “ensure healthy lives and promote well-being for all at all ages.” 21 The SDGs are the successor to the Millennium Development Goals (MDGs), which included an HIV target under MDG 6: to halt and begin to reverse the spread of HIV/AIDS by 2015 and achieve universal access to treatment for HIV/AIDS by 2010.22 As of 2015, the AIDS-related targets of MDGs were met.23
  • UNAIDS targets to end the epidemic by 2030. On World AIDS Day 2014, UNAIDS set targets aimed at ending the AIDS epidemic by 2030. To achieve this, countries had been working toward reaching the interim “90-90-90” targets – 90% of people living with HIV knowing their HIV status; 90% of people who know their HIV positive status on treatment; and 90% of people on treatment with suppressed viral loads—by 2020.24 However, gains that were achieved in some countries and regions were unequal, and these targets were missed. Based on the 2019 data and trends (the latest data available),25 81% of people living with HIV knew their status; among those who knew their status, 82% were accessing treatment; and among those accessing treatment, 88% were virally suppressed.26 The focus now is on reaching “95-95-95” (or, 95% of people living with HIV knowing their HIV status; 95% of people who know their HIV positive status on treatment; and 95% of people on treatment with suppressed viral loads). Additional interim targets have also been set for 2025, which place a greater emphasis on societal aspects and social services to address the inequalities of HIV.27

At the June 2016 U.N. General Assembly High-Level Meeting on Ending AIDS, world leaders adopted a new Political Declaration that reaffirmed commitments and called for an intensification of efforts to end AIDS by 2030.28In 2017, a report of the U.N. Secretary-General emphasized these commitments, calling for the global community to reinvigorate global efforts to respond to AIDS.29 Another U.N. high-level meeting on HIV/AIDS will take place in June 2021; in addition to reviewing progress toward achievement of the 2030 goal, it will address the impacts of COVID-19.30

Global Resources

UNAIDS estimates that $19.8 billion was available from all sources (domestic, donor governments, multilaterals, and foundations) to address HIV in low- and middle-income countries in 2019.31 Of this, donor governments provided $7.8 billion, representing a reduction from the $8 billion in 2018 and nearly the same as the funding levels of a decade ago (see Figure 2).32 Other governments and organizations that contribute substantially to funding the global response include:

  • hard-hit countries, which have also provided resources to address their epidemics;
  • the Global Fund, which has approved over $23 billion for HIV efforts in more than 100 countries to date;33 and
  • the private sector, including foundations and corporations, which also plays a major role (the Bill & Melinda Gates Foundation, for one, has committed more than $3 billion in HIV grants to organizations addressing the epidemic, as well as provided additional funding to the Global Fund).34

Looking ahead, UNAIDS estimates at least $26.2 billion will be needed annually by 2020 to meet global targets to end AIDS as a global public health threat by 2030.35

U.S. Government Efforts

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.36 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.37

PEPFAR

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.38 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.39 (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 $100 billion.40 For FY 2021, Congress appropriated $5.4 billion for bilateral HIV, as well as $45 million for UNAIDS and $1.56 billion for the Global Fund, totaling $7 billion.41 (See the KFF fact sheets on the U.S. Global Health Budget: HIV/PEPFAR (bilateral funding), the U.S. Global Health Budget: Global Fund, and trends in U.S. federal funding for HIV/AIDS, as well as the KFF budget tracker for more details on historical appropriations for U.S. global HIV/AIDS efforts.)

 

Endnotes
  1. UNAIDS. Global HIV & AIDS statistics – 2020 fact sheet, July 2020.

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  2. UNAIDS. 2020 Global AIDS Update: Seizing the Moment; July 2020. UNAIDS. AIDSinfo website; accessed July 2020, available at: http://aidsinfo.unaids.org/. UNAIDS. Core Epidemiology Slides; July 2020.

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  3. 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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  4. UNAIDS. 2020 Global AIDS Update: Seizing the Moment; July 2020.

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  5. UNAIDS. Press release: UNAIDS report on the global AIDS epidemic shows that 2020 targets will not be met because of deeply unequal success; COVID-19 risks blowing HIV progress way off course; July 2020.

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  6. UNAIDS. 2020 Global AIDS Update: Seizing the Moment; July 2020. UNAIDS. Press release: UNAIDS report on the global AIDS epidemic shows that 2020 targets will not be met because of deeply unequal success; COVID-19 risks blowing HIV progress way off course; July 2020. Global Fund. Results Report 2020; September 2020. UNAIDS. COVID-19 and HIV: 1 Moment, 2 Epidemics, 3 Opportunities, September 2020.

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  7. UNAIDS. 2020 Global AIDS Update: Seizing the Moment; July 2020. UNAIDS. AIDSinfo website; accessed July 2020, http://aidsinfo.unaids.org/. UNAIDS. Core Epidemiology Slides; July 2020. UNAIDS. Global HIV & AIDS statistics – 2020 fact sheet; July 2020; UNAIDS. UNAIDS data 2020, July 2020.

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  8. UNAIDS. Press release: UNAIDS report on the global AIDS epidemic shows that 2020 targets will not be met because of deeply unequal success; COVID-19 risks blowing HIV progress way off course; July 2020.

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  9. UNAIDS. Women and HIV – A spotlight on adolescent girls and young women, March 2019.

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  10. Sub-Saharan Africa constitutes as East and Southern Africa and West and Central Africa.

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  11. UNAIDS. 2020 Global AIDS Update: Seizing the Moment; July 2020. UNAIDS. UNAIDS 2016-2021 Strategy; Aug. 2015.

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  12. WHO. Tuberculosis, fact sheet, http://www.who.int/mediacentre/factsheets/fs104/en/index.html.

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  13. WHO. Global tuberculosis report; 2020.

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  14. UNAIDS. 2020 Global AIDS Update: Seizing the Moment; July 2020. UNAIDS. AIDSinfo website; accessed July 2020, http://aidsinfo.unaids.org/. UNAIDS. Core Epidemiology Slides; July 2020. UNAIDS. Global HIV & AIDS statistics – 2020 fact sheet; July 2020; UNAIDS. UNAIDS data 2020, July 2020.

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  15. UNAIDS. 2020 Global AIDS Update; July 2020. 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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  16. UNAIDS. UNAIDS Explainer: Undetectable = untransmittable; July 2018.

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  17. 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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  18. 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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  19. UNAIDS. 2020 Global AIDS Update; July 2020. 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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  20. 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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  21. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development; 2015.

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  22. United Nations, “Official List of MDG Indicators,” webpage, http://unstats.un.org/unsd/mdg/Host.aspx?Content=Indicators/OfficialList.htm.

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  23. UNAIDS. Global AIDS Update 2016; 2016.

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  24. 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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  25. UNAIDS. 2020 Global AIDS Update; July 2020. KFF. Assessing Global HIV Targets in PEPFAR Countries: A Dashboard, February 2021.

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  26. UNAIDS. Global HIV & AIDS statistics – 2020 fact sheet; July 2020.

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  27. 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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  28. UNAIDS. 2011 Political Declaration on HIV/AIDS; 2011, http://www.unaids.org/en/aboutunaids/unitednationsdeclarationsandgoals/2011highlevelmeetingonaids/. UNAIDS. Press Release: Bold Commitments to Action Made at the United Nations General Assembly High-Level Meeting on Ending AIDS; June 10, 2016.

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  29. UNAIDS. Reinvigorating the AIDS response to catalyse sustainable development and United Nations reform; 2017.

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  30. U.N. Draft Resolution: Organization of the 2021 high-level meeting on HIV/AIDS, January 2021, https://www.un.org/pga/75/wp-content/uploads/sites/100/2021/01/HIV-AIDS-consultations-1.pdf.

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  31. UNAIDS estimates that US$18.6 billion was available for HIV from all sources (donor governments, domestic spending, multilateral organizations, and foundations) in 2019, expressed in 2016 USD. For purposes of this fact sheet, this estimate was converted to 2019 USD, or $19.8 billion. KFF/UNAIDS. Donor Government Funding for HIV in Low- and Middle-Income Countries in 2019; July 2020.

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  32. KFF/UNAIDS. Donor Government Funding for HIV in Low- and Middle-Income Countries in 2019; July 2020.

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  33. Global Fund. The Global Fund Data Explorer; accessed December 2020, https://data.theglobalfund.org.

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  34. Bill & Melinda Gates Foundation. HIV Strategy Overview; accessed January 2021, http://www.gatesfoundation.org/What-We-Do/Global-Health/HIV#OurStrategy.

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  35. Total funding needed is in constant 2016 dollars. KFF/UNAIDS. Donor Government Funding for HIV in Low- and Middle-Income Countries in 2019, July 2020. UNAIDS. 2020 Global AIDS Update: Seizing the Moment; July 2020.

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  36. 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 2019; July 2020.

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  37. 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 2019; July 2020.

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  38. KFF. The U.S. Government Engagement in Global Health: A Primer; Feb. 2019. 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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  39. KFF analysis of data from congressional budget justification documents; PEPFAR, “Where We Work” webpage, https://www.state.gov/where-we-work-pepfar/; PEPFAR 2021 Country Operational Plan Guidance for all PEPFAR Countries; 2018 PEPFAR Progress Report on the PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020); and CDC’s “Where We Work” webpage, https://www.cdc.gov/globalhivtb/where-we-work/index.html. PEPFAR. Press release, “Secretary Pompeo Announces Latest Lifesaving PEPFAR Results,” November 27, 2018.

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  40. KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional Appropriations Bills. Totals include funding for HIV and the Global Fund.

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  41. Bilateral funding for global HIV includes funding from the State Department, USAID, DoD, CDC, and research activities at NIH.

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