Table:
Global HIV control—target regions, remaining challenges, and solutions2
| Remaining challenges | Priority solutions | |
|---|---|---|
| Sub-Saharan Africa (25·6 million people with HIV) | Gaps in HIV testing between children and adults, ART coverage, and viral load suppression; HIV incidence is still 3-fold higher among adolescent girls vs boys and young men; missed opportunities for early infant diagnosis; insufficient paediatric antiretroviral drug formulations and paediatric ART coverage; poor antepartum and postpartum adherence and retention; rebound in viraemia, particularly during postpartum period; fear of HIV status disclosure; low social and male-partner support; postpartum depression; criminalisation of LGBT people; and stigma | Implement novel interventions to address social, cultural, and structural barriers to HIV service access, uptake, and continuity; provide point-of-care virological diagnostic testing; improve access to newer antiretroviral drugs in paediatric formulations; prioritise viral load testing in pregnant and breastfeeding women; provide peer-based psychosocial support; assist with disclosure and improving male-partner involvement; screen for depression and substance misuse; provide case management; provide long-acting antiretroviral agents; advocate for human rights; and scale up PrEP and male circumcision |
| Western and central Europe and North America (2·3 million people with HIV) | Reaching men who have sex with men (40%), heterosexual men (19%), and migrants (from sub-Saharan Africa, Latin America and Caribbean); PrEP underused; and stigma. In the USA: racism; fragmented heath care; housing and food insecurity; poverty; mental illness; and substance misuse. | Improve prevention, treatment, and care interventions targeting men who have sex with men at risk of infection need to be scaled up and strengthened together with linkage to immediate care and ART for those found to be positive; improve testing, prevention, and care services for migrants with HIV or who are at risk of HIV; provide long-acting antiretroviral agents; and scale up PrEP. In the USA: advocate for human rights focused on early diagnosis; scale up PrEP; provide long-acting antiretroviral agents; expand the Ryan White Program; scale up opioid agonist therapies; and scale up syringe services programmes |
| Latin America (2’2 million people with HIV) | Reaching men who have sex with men, transgender people, sex workers, and people who inject drugs; stigma; discrimination; and criminalisation of LGBTQ+ people | Advocate for human rights; improve the HIV testing and treatment and prevention programmes including scaling up PrEP; enable safer injection practices; integrate and link HIV and drug misuse treatment; and provide long-acting antiretroviral agents |
| Eastern Europe and central Asia (1·8 million people with HIV) | Insufficient access to sterile injecting equipment and the unavailability of opioid substitution therapy; stigma; and criminalisation of key populations making them targets of violence in some countries; and armed conflicts (eg, Ukraine) | Make safer sex possible; advocate for human rights; produce decentralised, community-based differentiated service delivery models including testing, access to ART, adherence counselling, and viral load monitoring; scale up PrEP and long-acting antiretroviral agents; scale up opioid agonist therapies; and scale up syringe services programmes |
| Middle East and north Africa (180 000 people with HIV) | Reaching key populations; stigma; and criminalisation of key populations in some countries | Advocate for human rights; adapt services including outreach for testing and ART; make adherence support targeted; integrate and link HIV and drug misuse treatment; scale up PrEP; scale up opioid agonist therapies; and provide long-acting antiretroviral agents |
ART=antiretroviral therapy. PrEP=pre-exposure prophylaxis.