Antiretroviral medication is used to both control HIV and prevent its transmission, helping to reduce the incidence of AIDS.Credit: Arlette Bashizi/For The Washington Post via Getty Images
The year 2016 was one for the history books. It saw Donald Trump winning the US presidential election, the United Kingdom voting to leave the European Union and the declaration of Zika virus — a mosquito-borne and sexually transmitted virus that causes severe birth defects — as a global public-health emergency.
It was also the year that the United Nations committed to eliminating AIDS.
AIDS was first defined in 1983 as a disease caused by HIV, which is thought to have jumped into humans — most probably from chimpanzees or monkeys — in the early to mid-twentieth century. The virus destroys immune cells responsible for fighting off infection. Since then, more than 44 million people around the world have died of AIDS or HIV-related diseases, as a result of their immune system no longer being able to defend against even common infections. An estimated 41 million people are currently living with the virus.
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Antiretroviral drugs are highly effective at suppressing HIV to undetectable levels, transforming what was once a death sentence into a manageable chronic condition. People with undetectable viral levels also can’t transmit the virus, and those same antiretroviral drugs can prevent infection in healthy individuals who are exposed to the virus. But despite decades of research, a complete cure or an effective vaccine have proved elusive.
In January 2016, the UN’s 17 Sustainable Development Goals (SDGs) — a global initiative to address poverty, inequality and climate change — came into force as part of the 2030 Agenda for Sustainable Development. Among them was SDG target 3.3, a strategy targeted at ending the AIDS epidemic, along with epidemics of other communicable diseases, by 2030. The initiative aimed to reduce the number of new infections by 90%; from 0.24 infections per 1,000 people in 2016 to 0.025 infections by 2030. Later that year, at the UN General Assembly High-Level Meeting on Ending AIDS in New York City, member states set a goal to reduce both new HIV infections and the number of deaths from AIDS-related illnesses to fewer than 500,000 by 2020, and made a commitment to end AIDS as a public-health threat by 2030.
Only one human disease has ever been completely eradicated. In 1980, after a 13-year vaccination campaign by the World Health Organization, smallpox — a deadly infectious disease caused by the variola virus — was eliminated worldwide, in what has been described as humanity’s greatest public-health achievement. At the time of its creation, SDG target 3.3 seemed bold but achievable.
By 2020, the world had made major gains towards achieving this aim, which included the targets of having 90% of people living with HIV diagnosed, 90% of those diagnosed being on antiretroviral therapy and 90% of those on antiretroviral therapy being virologically suppressed. The ‘90-90-90’ targets were then raised to 95-95-95 by 2030.
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Today, however, the 2030 goal is looking increasingly unattainable, despite new HIV infections globally declining by 40% since 2010. “Unless we have some dramatic changes to the way we are doing things, then it’s highly unlikely that we are going to meet that goal,” says Kenneth Ngure, president of the International AIDS Society (IAS) and a public-health researcher at Jomo Kenyatta University of Agriculture and Technology in Nairobi.
The problem is not scientific or medical; it’s political. According to a 2026 report by the Joint UN Programme on HIV/AIDS (UNAIDS), the big barriers to overcome are funding cuts to essential treatment and prevention services and a lack of health-infrastructure investment to enable access to them; stigmatization of people with HIV; and the high cost of new, more-effective medications1.
Speaking at the 2026 IAS conference in July in Rio de Janeiro, Brazil, Winnie Byanyima, executive director of UNAIDS, warned that the HIV pandemic was far from over and could resurge without urgent action. “When prevention disappears, infections rise; when treatment is interrupted, people die,” Byanyima said during a press conference. “We’ve seen this before; we know how this story ends if we fail to act.”
Finding funding
Funding from high-income nations around the world for HIV-related projects in low- and middle-income countries dropped from nearly US$8.3 billion in 2024 to $6.2 billion in 2025, according to one report2.
Much of that decline was the result of cuts to US funding, which decreased from $6.7 billion to $4.6 billion. The Trump administration shut down the US Agency for International Development (USAID) and cut support for the long-running President’s Emergency Plan for AIDS Relief (PEPFAR) — an initiative that has saved around 26 million lives since its creation (see go.nature.com/4avmfao). Instead, the administration launched the America First Global Health Strategy that promised fundamental changes to the structure of HIV funding and support, shifting the focus to the United States and reducing funding to other countries.
Angeli Achrekar speaks at the AIDS 2024 Conference in Munich, Germany. Credit: UNAIDS
The funding cuts have hit community-based prevention services the hardest. For instance, in sub-Saharan Africa, which currently accounts for around half of all new HIV infections, programmes providing pre-exposure prophylaxis (PrEP) — involving antiretroviral drugs being taken to prevent infection rather than to treat it — greatly declined in 2025. Cameroon, Nigeria and Zambia all reported that the number of people receiving PrEP that year had fallen by at least half1. Multiple countries have also seen major declines in HIV testing, condom programmes and programmes designed to increase access to prevention services through changes to laws, regulations and policies that stigmatize or criminalize service users.
New infections have continued to increase in some Asian countries — such as Bangladesh, the Philippines, Pakistan and Sri Lanka, for example — and other nations including Brazil, Venezuela, Egypt and Fiji1,3.
“There are countries that, over time, they had gotten to a point of relative control of their epidemics, and then the minute you take your eyes off of it, you see these outbreaks,” says Angeli Achrekar, deputy executive director and global practice lead at UNAIDS.
“They may be small numbers, but the issues are still very real because when the virus continues to spread faster than we’re getting population-based viral suppression, we’re in a real bind,” she adds.
Barriers to treatment
The goal of eliminating a disease as a public-health threat provides “a sort of escape clause”, says John Kaldor, an epidemiologist at the Kirby Institute at UNSW in Sydney, Australia. “We’re not actually trying to rid the earth of this condition,” Kaldor says. Elimination as a public-health threat means that new and existing cases are managed as an individual clinical problem, rather than requiring population or community-level responses such as mass screening, testing and treatment programmes. If those larger programmes are still needed and cost-effective, then elimination as a public-health threat hasn’t been achieved, Kaldor says.
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To end AIDS as a public-health threat, no groups or communities can be left behind. The idea of ending AIDS is problematic, says sociologist Jaime Garcia Iglesias, at the University of Edinburgh, UK, “because AIDS has always been defined … by the inequalities at a global scale, as well as inequalities in countries at the level of different communities. If we don’t tackle that, we’re not going to end AIDS — or we may end talking about AIDS but not actually end the epidemic and the conditions that made it possible.”
For example, Fiji had very few cases of HIV/AIDS for many years, but now has the fastest growing epidemic in the world, with a 14-fold increase in infections since 2021. A survey of those starting HIV treatment in 2024 found that nearly half reported injecting drugs as the main behaviour that puts them at risk of HIV infection3, suggesting that people who inject drugs are a group that needs targeted prevention and treatment interventions.