HIV/AIDS Notifications in Korea, 2023

Abstract

This report is the result of the analysis of data on human immunodeficiency virus (HIV)-positive cases reported in the year 2023. In 2023, 1,005 new cases of HIV infection were reported in the Republic of Korea. Of these, 749 people (74.5%) were Koreans and 256 (25.5%) were foreigners. Men accounted for 903 (89.9 %) of the total cases. By age group, those in their 30s accounted for 35.4% (356 people); those in their 20s, for 28.7% (288 people); and those in their 40s, 15.7% (158 people). Thus, people in their 20s and 30s accounted for 64.1% of the total. The reporting agencies included hospitals (637 cases, 63.4%) and public health centers (284 cases, 28.3%). The most common reason for HIV testing was voluntary testing, with 32.1% (228 people) and 99.6% (564 people) responding that their infection occurred through sexual contact. The number of new cases of HIV infection in 2023 increased by 5.7% (61 cases) compared to that in 2022. The number of Koreans infected decreased by 9.2% (76 cases), whereas the number of foreigners infected increased by 6.2% (15 cases). The number of foreigners infected is increasing annually, and identifying and continuously managing their epidemiological characteristics is essential. In March, the Korea Disease Control and Prevention Agency established “The 2nd National Action Plan on HIV/AIDS Prevention and Control (2024–2028)” and will actively pursue the goal of reducing new infections by 50% by 2030 compared to the rate in 2023.

Key messages

① What is known previously?

More than 1,000 new human immunodeficiency virus (HIV) infections in Republic of Korea were reported every year.

② What new information is presented?

The proportion of foreigners among newly infected people in 2023 was 25.5% (256 cases), up 2.9% from the previous year. Among all infected people, foreigners continue to account for 19.5% in 2020, 20.7% in 2021, 22.6% in 2022 and 25.5% in 2023.

③ What are implications?

As the proportion of people in their 20s and 30s and foreigners among newly infected continues to increase, it is necessary to prepare for aging population due to the increase in people living with HIV. The Korea Disease Control and Prevention Agency established 「The 2nd National Action Plan on HIV/AIDS Prevention and Control (2024–2028)」 in March this year and will actively strive to end acquired immunodeficiency syndrome (AIDS) by 2030.

Introduction

Human immunodeficiency virus (HIV) is the etiological agent of acquired immunodeficiency syndrome (AIDS). HIV infection primarily destroys CD4+ T cells, which are involved in cellular immunity. An individual diagnosed with AIDS is defined as a person who has developed immunodeficiency subsequent to becoming infected with HIV and presents with compatible clinical symptoms or laboratory findings. Antiretroviral therapy (ART) has the potential to halt the transmission and progression of HIV to AIDS [1].

The Joint United Nations Programme on HIV/AIDS (UNAIDS), reported 1.3 million new HIV infections globally in 2023, representing a 60.6% decrease from the 1995 peak of 3.3 million. In 2023, 630,000 deaths related to AIDS were reported, and approximately 39.9 million individuals were living with HIV. Estimates indicated that 86% of people living with HIV were aware of their HIV status (i.e., 86% infection awareness rate), and 89% of those who were aware of their status were being treated with ART (i.e., 89% treatment rate). Furthermore, 93% of those being treated experienced suppression of the HIV in their bodies (i.e., 93% viral suppression rate) [2]. UNAIDS has established a target recognition rate for HIV infection of 95%, as well as 95% treatment and 95% viral suppression rates, by 2025, highlighting the initiatives undertaken by countries to achieve this goal.

The Korea Disease Control and Prevention Agency (KDCA) analyzed the status of reporting for HIV prevention and management in the Republic of Korea (ROK) and published and distributed the “Yearbook of HIV/AIDS Reporting Status in 2023” in June 2024 [3]. The yearbook is divided into two sections: the primary report on the persons infected with HIV and a detailed statistical table on domestic patients who are infected with HIV. This report provides a breakdown of the characteristics of the yearbook, focusing on the characteristics of HIV infection and the number of new cases reported, transmission routes, and motivation for testing.

Methods

1. Subjects

The HIV/AIDS reporting statistics are based on data reported to the Integrated Healthcare Management System from January 1, 2023, to February 28, 2024, for HIV test-positive cases confirmed by a confirmatory testing agency (i.e., KDCA, Research institute of Public Health and Environment) in 2023. In the event of a diagnosis of infection in a person or dead body, a report was made by a healthcare provider or institution. Report HIV infection through academic research or testing of blood products. Epidemiological surveys were conducted by health centers based on the number of cases reported in the current year, and the resulting data were analyzed.

2. Analysis Contents

By analyzing reports of detection (including deaths) of cases of HIV infection, patients with AIDS, and epidemiological surveys in the Integrated Disease Health Management System, demographic characteristics (e.g., gender, age group, reporting organization, transmission route, and motivation for testing) were analyzed.

For reporting, Form Nos. 1, 2, and 5 of the “Enforcement Rules of the Prevention of Acquired Immunodeficiency Syndrome Act” were used, while the epidemiological survey was used for the analysis of information collected via the aforementioned forms, as outlined in the HIV/AIDS Management Guidelines [4]. The reporting forms contain personal information, such as gender, age, and nationality, and the epidemiological survey contains data on the motivation for testing, transmission route, and immunity at the time of detection. The same form is used for both domestic and international reporting, and epidemiologic survey results are only published for domestic data. The incidence rate is calculated by dividing the number of reported cases by the reference population, and the result is expressed per 100,000 people; the reference population is the annualized population for the year.

Results

1. Distribution of Reports of New HIV Infections

In 2023, 1,005 new HIV infections were reported (1.96 per 100,000 people), representing a 5.7% (61) decrease from the previous year. Of individuals infected, 749 (74.5%) were nationals, representing a decrease of 9.2% (76) year-over-year, while 256 (25.5%) were foreign nationals, representing an increase of 6.2% (15) year-over-year (Table 1) [3]. The proportion of foreign nationals among all infections has consistently increased over the past four years, reaching 25.5% in 2023. In 2020, the proportion was 19.5%, rising to 20.7% in 2021, 22.6% in 2022, and reaching the current level.

Table 1. Notified HIV/AIDS cases, 2021–2023.

		2021				2022				2023
		Total	Korean	Foreigner		Total	Korean	Foreigner		Total	Korean	Foreigner
Total		975	773	202		1,066	825	241		1,005	749	256
Incidence rate per 100,000 peoplea)		1.88	1.49	0.39		2.08	1.61	0.47		1.96	1.46	0.50
Gender	Men	897	742	155		984	790	194		903	718	185
	Women	78	31	47		82	35	47		102	31	71
Age (yr)	0–9	0	0	0		0	0	0		0	0	0
	10–19	17	16	1		13	12	1		12	8	4
	20–29	352	286	66		336	257	79		288	226	62
	30–39	293	216	77		372	275	97		356	252	104
	40–49	148	106	42		175	126	49		158	102	56
	50–59	112	98	14		96	88	8		120	97	23
	60–69	41	39	2		55	49	6		55	48	7
	≥70	12	12	0		19	18	1		16	16	0
Screening site	Clinic or hospital	712	555	157		761	567	194		637	457	180
	Public health center	157	129	28		206	179	27		284	222	62
	Others	106	89	17		99	79	20		84	70	14

Unit: person. HIV=human immunodeficiency virus; AIDS=acquired immunodeficiency syndrome. ^a)Mid-year population (resident registration), Statistics Korea. Data from Korea Disease Control and Prevention Agency [3].

In terms of gender distribution, the majority of those infected were men (i.e., 903, or 89.9% men; 102, or 10.1%, women). However, when classified into nationals and foreign nationals, 95.9% (718) of the nationals (749) were men, as were 72.3% (185) of the foreign nationals (256). Notably, the proportion of women among foreign nationals increased by 8.2% from 19.5% to 27.7% in 2022.

By age, 35.4% (356 cases) were in their 30s, followed by 28.7% (288 cases) in their 20s, 15.7% (158 cases) in their 40s, 11.9% (120 cases) in their 50s, 5.5% (55 cases) in their 60s, 1.6% (16 cases) in their 70s and older, and 1.2% (12 cases) in their teens, with 64.1% (644 cases) in their 20s and 30s. This figure represents a slight decrease from the previous year, when 66.4% were in their 20s and 30s.

By reporting organization, hospitals and clinics accounted for 63.4% (637); public health centers, for 28.3% (284); and other organizations (e.g., private organizations, blood centers, military offices, military units), for 8.4% (84). The proportion of reports from health centers increased by 9.0% (78) compared to that of the previous year (206, or 19.3%). Of the remaining organizations, blood centers had the highest number of reports (i.e., 41, or 4.1%).

2. Reporting of Deaths of Nationals Infected with HIV

Among nationals with HIV, 158 people died of AIDS in 2023, an increase of 16 from the previous year (142), but 25 of these deaths reflected delayed reporting of deaths from 2015 to 2022, requiring caution in interpretation.

The gender distribution of deaths is comparable to that of infections: 148 men (93.7%) and 10 women (6.3%). The largest number of respondents were in their 60s (41), representing 25.9% of the total. This group was followed by 39 (24.7%) in their 50s, 37 (23.4%) in their 70s and older, and 41 (25.9%) in their 40s and younger. The mortality rate among those infected with HIV was 50.6%, which exceeded the death rate among Koreans aged 50 and under (12.6%), as reported by Statistics Korea in 2022.

3. Surviving Nationals Infected with HIV

By the end of 2023, 19,745 cumulative reports of nationals infected with HIV were obtained. Of these, 18,495 (93.7%) were men and 1,250 (6.3%) were women. Further, 16,467 nationals infected with HIV were recorded at the end of 2023 (i.e., 15,448, or 93.8%, men; and 1,019, or 6.2%, women), an increase proportional to the number of new infections. By age, 3,194 (19.4%) were 60 years or older, while 13,273 (80.6%) were under age 60. Notably, the proportion of those aged 60 and older has been on the rise in recent years, with the figures for 2020, 2021, and 2022 being 16.4%, 17.3%, and 18.4%, respectively.

4. Transmission Routes and Motivation for Testing in New Cases of HIV Infection among Nationals

The analysis of the epidemiologic surveys of new cases of HIV infection among nationals revealed that 75.6% (566) of those infected responded to the question about their transmission route, representing a 5.0% increase from the previous year (70.5%). In terms of the transmission route, sexual contact was identified as the primary source of infection, accounting for 99.6% (564) of cases. This was followed by shared injection drug use, which represented 0.4% (2) of infections. Among the men nationals who were infected (540) and reported sexual contact as their transmission route, 56.7% (306) indicated same-sex sexual contact, while all (100.0%) of the women nationals infected (24) reported heterosexual sexual contact.

Among new HIV infections among nationals, 94.8% (710) of those infected responded to the item on motivation for testing, yielding a response rate consistent with that observed in the previous year. Of the cases surveyed, 32.1% (228) were found among those who voluntarily sought HIV testing at a testing institution (e.g., private organization, health center, hospital, clinic) (hereafter, “voluntary testing”); 28.2% (200) were identified through diagnostic testing to ascertain the underlying cause of the disease; 18.6% (132) were identified through routine screening for surgical or hospital admission; and 12.0% (85) were identified through medical examinations. The proportion of respondents who underwent voluntary testing demonstrated a sustained upward trajectory, reaching 24.9% in 2021, 28.3% in 2022, and 32.1% in 2023.

Conclusions

In ROK, 1,005 new cases of nationals infected with HIV in 2023 were reported, representing a decrease of 5.7% from 2022. Of these, 749 were nationals, a decrease of 9.2% year-over-year, while 256 were foreign nationals, an increase of 6.2% year-over-year. In 2023, new cases of HIV infection among foreign nationals accounted for 25.5% of all infections, representing a notable increase from 20.7% in 2021 and 22.6% in 2022. While the number of registered nationals decreased to 51.64 million in 2021, 51.44 million in 2022, and 51.33 million in 2023, the number of foreign nationals in the country increased to 2.04 million in 2020, then decreased to 1.96 million in 2021, increasing again to 2.25 million in 2022 and 2.51 million in 2023 [5]. The ratio of foreign nationals to Koreans increased to 3.8% in 2021, 4.4% in 2022, and 4.9% in 2023, which might have contributed to the increase in new HIV infections among foreign nationals.

In ROK, the number of nationals surviving HIV infections increased by 3.7% (591) year-over-year, and the proportion of those aged 60 and older increased year-over-year to 12.4% in 2021, 18.5% in 2022, and 19.4% in 2023, whereas the number of new cases reported by hospitals and clinics decreased by 8.0% (124) year-over-year. The number reported by public health centers increased by 9.0% (78) year-over-year. Health center reporting accounted for 30.0% (367) in 2019, 16.3% (166) in 2020, 16.1% (157) in 2021, 19.3% (206) in 2022, and 28.3% (284) in 2023, with the increase in reporting likely due to health centers resuming HIV testing in 2022 after focusing on preventing the spread of coronavirus disease 2019 (COVID-19).

Reports indicate that 99.6% of new HIV infections were transmitted through sexual contact, with 54.3% of these cases involving same-sex sexual contact. However, this figure might be underestimated, particularly given the disproportionate number of new infections among men (95.9%). To enhance the quality of data gathered for the purpose of HIV control within the country, implementing improvements is necessary. Such improvements include the reinforcement of epidemiologic survey techniques and enhancement of the capacity of epidemiologists to elicit verifiable responses to sensitive inquiries pertaining to sexuality.

In a recent statement, UNAIDS asserted that the AIDS pandemic would end by 2030. However, given the progress made thus far, considering whether policy changes are required to achieve this goal is necessary. The report, “The Urgency of Now: AIDS at a Crossroads,” established the objective of reducing new infections to 370,000 and deaths to 250,000 or fewer by 2025. In 2023, 1.3 million new infections and 690,000 deaths—nearly three times the targets—were reported. Furthermore, the goal is to achieve a 95% HIV infection recognition rate, 95% treatment rate, and 95% viral suppression rate by 2025. With an 86% recognition rate, 89% treatment rate, and 93% suppression rate in 2023, reaching the targets by 2025 appears difficult (Table 2) [6].

Table 2. Mixed results at the halfway mark to the 2025 targets.

Goal	Target	2023 Status
Combination HIV prevention for all	-	-
Reduce new HIV infections to under 370,000	370,000	1,300,000
Reduce new HIV infections among adolescent girls and young women to below 50,000	50,000	210,000
95% of people at risk of HIV access effective combination prevention	95%	50%/40%/39%/39%(sex workers/gay men and other men who have sex with men/people who inject drugs/transgender people)
PrEP for 10 million people at sub-stantial risk of HIV (or 21.2 million who used PrEP at least once during the year)	21.2 million	3.5 million
50% opioid agonist maintenance therapy coverage among people who are opioid-dependent	50%	0 of 8 regions
90% sterile injecting equipment at last injection	90%	11 of 27 countries
95–95–95 for HIV testing and treatment	-	-
Reduce annual AIDS-related deaths to under 250,000	250,000	630,000
34 million people are on HIV treatment by 2025	34 million	30.7 million
95-95-95 testing, treatment and viral suppression targets (%)	95-95-95	All ages: 86-89-93
		Women (aged 15+ years): 91-91-94
		Men (aged 15+ years): 83-86-94
		Children (aged 0-14 years): 66-86-84
90% of people living with HIV receive preventive treatment for tuberculosis (TB) by 2025	90%	17 million people living with HIV initiated on TB preventive treatment between 2005 and 2022
Reduce numbers of TB-related deaths among people living with HIV by 80%	80%	71%

UNAIDS=The Joint United Nations Programme on HIV/AIDS; HIV=human immunodeficiency virus; PrEP=pre-exposure prophylaxis; AIDS=acquired immunodeficiency syndrome. Data from UNAIDS [6].

UNAIDS has underscored the necessity of allocating sufficient financial resources and safeguarding human rights in the context of the HIV response, both of which are indispensable conditions for achieving the ambitious goal of ending the epidemic by 2030. Success will probably not depend on the efforts of any one country, as close international collaboration is essential for attaining the shared vision of zero HIV infections and zero AIDS-related deaths [6].

The number of new HIV infections increased in 2020 and 2021, possibly because of the limited accessibility of HIV testing and treatment at public health centers and healthcare institutions constrained by the impact of the COVID-19 pandemic. This trend continued in 2022 but reversed in 2023. HIV/AIDS reporting forms are divided into two distinct categories: real-name and anonymous reporting forms. A limitation to the data collected is that individuals infected with HIV who report anonymously are not included in the statistics of people infected with the virus because such individuals are reluctant to disclose personal information. Furthermore, immunologic tests (CD4+ T-cell counts) are not included in epidemiologic questionnaires unless an individual has been diagnosed at a hospital or higher level healthcare facility, leading to a relatively low response rate. Considerable improvement in the form of initial immunologic test values that can be used in epidemiologic surveys to help link diagnosis to faster treatment is anticipated.

In March 2024, the KDCA announced the “Second Plan for the Prevention and Control of Acquired Immunodeficiency Syndrome (2024–2028),” a strengthened version of the “First Plan for the Prevention and Control of Acquired Immunodeficiency Syndrome (2019–2023)” to achieve the global goal of ending the HIV epidemic by 2030. The plan encompasses five driving strategies, 15 core tasks, and 45 subtasks, collectively aimed at preventing new infections, actively detecting patients, providing prompt and continuous treatment, and establishing a foundation for ensuring the right to health and managing care. The overarching goal is to reduce new infections by 50% compared to the number in 2023 by 2030. Furthermore, to accelerate the end of the HIV epidemic, the “Second Plan for the Prevention and Control of Acquired Immunodeficiency Syndrome” will be proactively implemented in cooperation with local governments, relevant ministries, private organizations, and relevant academic institutions.