Yes, HIV is declining. Globally, new infections dropped 40% between 2010 and 2024, falling from 2.2 million to approximately 1.3 million per year. AIDS-related deaths have fallen even more sharply, down 69% from their peak. But the decline is uneven, with some regions and populations seeing dramatic progress while others are moving in the wrong direction.
The Global Picture
The two numbers that matter most in tracking any epidemic are new infections and deaths. Both are heading down for HIV. In 2004, at the worst point of the crisis, roughly 2 million people died from AIDS-related illnesses in a single year. By 2022, that figure had dropped to around 630,000. New infections followed a similar trajectory, falling steadily from their peak in the late 1990s through today.
The main driver behind these improvements is the massive expansion of antiretroviral treatment. When someone with HIV takes effective medication and reaches an undetectable viral load, they stay healthy and cannot transmit the virus to sexual partners. This creates a double benefit: fewer deaths and fewer new infections from the same intervention. Prevention tools like PrEP, a daily or injectable medication that keeps HIV-negative people from acquiring the virus, have added another layer of protection in communities where they’ve been widely adopted.
Where Infections Are Falling Fastest
Sub-Saharan Africa, the region hardest hit by HIV, has also seen the steepest declines. Eastern sub-Saharan Africa recorded the most significant drop in infection rates between 1990 and 2021 of any world region. Countries like Burkina Faso and the Democratic Republic of the Congo have achieved some of the sharpest reductions at the national level. This progress reflects decades of investment in testing, treatment programs, and community-based prevention, particularly among young women and girls who bear a disproportionate burden of new infections in the region.
Where Infections Are Rising
Not every part of the world is on the same trajectory. Eastern Europe saw infection rates increase more than thirteenfold between 1990 and 2021. Central Asia experienced a nearly fourfold rise over the same period. Pakistan recorded the single largest national increase in infection rates of any country studied, driven by limited access to prevention services and stigma that keeps people from getting tested.
Oceania also saw a notable rise in infection rates from 1990 to 2021, the largest regional increase measured. These counter-trends mean that global averages can mask serious local crises. In regions where prevention infrastructure is thin, where injection drug use is common, or where laws criminalize the populations most at risk, HIV continues to spread.
Trends in the United States
In the U.S., estimated HIV infections declined 12% overall between 2018 and 2022. The most striking progress was among young people aged 13 to 24, where new infections dropped 30%. Black and African American communities, long the most affected demographic, saw an 18% decline. Infections in the South, which accounts for more than half of new U.S. cases, fell 16%.
PrEP has played a measurable role. In Australia’s New South Wales, a rapid, targeted PrEP rollout among men who have sex with men led to a 25% decline in new diagnoses and a 40% drop in recent infections between 2015 and 2019. In England’s PROUD study, men offered PrEP immediately had an infection rate of 1.2 per 100 person-years compared to 9 per 100 person-years in those who waited, a difference so large the trial was stopped early so everyone could receive the drug.
In the U.S., however, PrEP access remains unequal. Among non-Hispanic white men who have sex with men, more than two-thirds of those who could benefit were on PrEP by 2019, and their infection rate fell by a third. Nationally, though, new diagnoses among all men who have sex with men declined only about 8% over the same period. The gap reflects ongoing disparities in healthcare access, insurance coverage, and awareness.
Why the Decline Isn’t Fast Enough
The international community set an ambitious target: end AIDS as a public health threat by 2030. That goal rests on getting 95% of people with HIV diagnosed, 95% of those diagnosed on treatment, and 95% of those on treatment virally suppressed. Progress toward these benchmarks varies widely. Even in countries with strong health systems, gaps remain. Ghana, for example, had 72% of people with HIV aware of their status by 2022 and 87% of those diagnosed on treatment, both well short of the 95% targets.
A 2024 analysis published in The Lancet HIV was blunt in its assessment: current global efforts are not sufficient to meet the 2030 goals. The biomedical tools exist, including effective treatment, PrEP, and newer long-acting injectable prevention options. But scaling them up to the populations that need them most has not happened fast enough. The authors argued that scientists and policymakers need to be honest about how far off the targets remain, not to abandon the goal but to sustain the advocacy and funding required to close the gap.
What’s Driving the Progress That Exists
Three factors explain most of the global decline. First, treatment as prevention: when people with HIV achieve viral suppression, they don’t transmit the virus. This single advance has reshaped the epidemic in countries with strong treatment programs. Second, PrEP: where it has been rolled out at scale, new infections drop measurably within a few years. Third, better testing: getting people diagnosed earlier means they start treatment sooner, which protects both their health and their partners.
The challenge is that all three depend on reaching people who face the highest barriers to care. In many countries, the populations most affected by HIV, including men who have sex with men, transgender women, sex workers, and people who inject drugs, face criminalization or social stigma that keeps them away from health services. Until prevention tools reach the people who need them most, the global decline will continue to slow before reaching the finish line.