HIV is found on every continent, but its impact is distributed unevenly. Of the 40.8 million people living with HIV worldwide at the end of 2024, roughly two-thirds are concentrated in sub-Saharan Africa. The rest are spread across Asia and the Pacific, eastern Europe and central Asia, western Europe, the Americas, and smaller pockets in the Middle East and North Africa.
Sub-Saharan Africa Carries the Heaviest Burden
Sub-Saharan Africa remains the epicenter of the global HIV epidemic. An estimated 67% of all people living with HIV reside in this region, and it accounted for roughly 670,000 of the 1.5 million new infections reported in 2021. The countries with the highest prevalence rates are clustered in eastern and southern Africa, including South Africa, Eswatini, Lesotho, Botswana, and Mozambique. Eswatini has the highest adult prevalence of any country in the world, with more than one in four adults living with the virus.
The region also bears a disproportionate share of AIDS-related deaths and pediatric HIV. Of the 1.37 million children living with HIV globally, the vast majority are in sub-Saharan Africa. An estimated 120,000 new HIV infections occurred in children aged 0 to 14 in 2023, almost entirely through mother-to-child transmission during pregnancy, delivery, or breastfeeding. Treatment access has expanded dramatically in the region over the past two decades, which is a major reason global AIDS-related deaths have dropped 70% since their peak in 2004, but gaps remain.
Asia and the Pacific: The Second-Largest Epidemic
Asia and the Pacific is home to 6.7 million people living with HIV, making it the second-largest regional epidemic after eastern and southern Africa. The region accounts for about 23% of all new HIV infections globally, with an estimated 300,000 new cases in 2023.
The picture varies enormously from country to country. India has the largest absolute number of people living with HIV in the region, though its national prevalence rate is relatively low given its population size. Epidemics are actively growing in several countries, including Afghanistan, Bangladesh, the Philippines, Papua New Guinea, Fiji, and Laos. The Philippines has seen one of the sharpest rises in new infections of any country in the world over the past decade. In most of these countries, the epidemic is concentrated among men who have sex with men, people who inject drugs, and transgender populations rather than spreading broadly through the general population.
Eastern Europe and Central Asia: The Fastest-Growing Epidemic
While sub-Saharan Africa has the largest epidemic, eastern Europe and central Asia has the fastest-growing one. New infections in the region rose 48% over a ten-year period, reaching 160,000 in 2021, and AIDS-related deaths climbed 32% during the same window. Russia and Ukraine account for the majority of cases, but countries like Kazakhstan and Uzbekistan are seeing rising numbers as well.
The epidemic in this region was originally driven largely by injection drug use, but heterosexual transmission has become the leading route of infection in many countries. Access to harm-reduction services like needle exchange programs and medication-assisted treatment for opioid dependence remains extremely limited, with regional coverage of opioid treatment sitting at just 4%, far below the 50% target set by international health bodies. Migrant workers moving from central Asia to larger economies face additional risk because of stigma, poor working conditions, and limited access to healthcare and prevention tools.
Western Europe and North America
HIV in western Europe and North America looks very different from the epidemic in lower-income regions. Prevalence rates are far lower, treatment access is widespread, and the number of people who become seriously ill or die from AIDS is comparatively small. In western Europe, the epidemic is concentrated among three groups: men who have sex with men (accounting for about 42% of new diagnoses), heterosexual individuals who acquired HIV abroad (about 35%), and people who inject drugs (about 5%).
In the United States, roughly 1.2 million people are living with HIV. New diagnoses are heavily concentrated in the southern states, among Black and Latino men who have sex with men, and in urban areas. Pre-exposure prophylaxis (PrEP) and widespread treatment access have helped bring new infections down, but late diagnosis remains a persistent problem. In Europe, about half of people diagnosed with HIV in recent years already had significantly weakened immune systems at the time of diagnosis, meaning they had been living with the virus undetected for years. Late diagnosis is most common among heterosexual men and in southern European countries like Greece, Italy, Spain, and Portugal.
Middle East, North Africa, and Latin America
The Middle East and North Africa has one of the smaller regional epidemics in absolute numbers, but it is also one of the least well-documented. Stigma, criminalization of key affected populations, and limited surveillance make it difficult to get an accurate picture. New infections in the region have been rising rather than falling, running counter to global trends.
Latin America is home to approximately 2.2 million people living with HIV. Brazil accounts for the largest share, followed by Mexico and Colombia. As in western Europe, the epidemic is concentrated among men who have sex with men and transgender women. Treatment coverage in the region is generally higher than in eastern Europe or the Middle East, but access varies widely between and within countries.
Why Geography Matters for the Global Response
The global picture of HIV is not static. In 2024, 630,000 people died from HIV-related causes worldwide, a dramatic improvement from the early 2000s but still far from the targets set by international health agencies. The regions where the epidemic is growing, particularly eastern Europe, central Asia, and parts of the Asia-Pacific, are often places where stigma, criminalization, and underfunded healthcare systems make prevention and treatment harder to deliver.
Where you live shapes nearly every aspect of the HIV experience: your likelihood of exposure, your access to testing and treatment, how early you get diagnosed, and ultimately whether the virus shortens your life. In countries with strong treatment programs, people living with HIV can expect a near-normal lifespan. In regions with limited healthcare infrastructure, HIV still kills hundreds of thousands of people each year from conditions that are entirely preventable with medication.