2025 Aids targets

Putting People living with HIV and communities at risk at the centre

About

As the Fast-Track era draws to a close, a global effort to plot the future course of the HIV response has developed a set of interim targets for 2025 that need to be achieved to reach the 2030 HIV targets within the Sustainable Development Goals.

A nearly three-year target-setting process involving a broad array of stakeholders conducted an extensive review of available evidence on the approaches that have effectively reduced HIV infections and AIDS-related morbidity and mortality, as well as the gaps and challenges that have resulted in the world falling short of its 2020 targets.

The 2025 targets place far greater emphasis on the removing societal and legal impediments to service delivery, and on linking or integrating the provision of HIV services with the other services needed by people living with HIV and communities at risk to stay healthy and build sustainable livelihoods. Achieving the targets for societal enablers and integrated service delivery are critical to achieving the high coverage called for within the six areas of HIV service targets. Each of the three target areas defines packages of targets for people living with HIV and communities at risk that are tailored to their needs. The braiding together of efforts to achieve all three categories of targets is critical to successful and sustainable scale up.

The 2025 targets also recognize that the HIV response sits within a wider effort to end poverty, fulfill the right to health and other human rights and other goals within the 2030 Agenda for Sustainable Development. Frameworks and concepts for the achievement of the Sustainable Development Goals cut across the 2025 targets.

The 10s
The 95s
The integration

These targets address the inequalities on which HIV, COVID-19 and other pandemics thrive and put people at the centre, especially the people most at risk and the marginalized.

Winnie Byanyima UNAIDS Executive Director

Less than 10% of countries have punitive legal and policy environments that deny access to justice

Less than 10% of countries criminalize sex work, possession of small amounts of drugs, same-sex sexual behaviour, and HIV transmission, exposure or non-disclosure by 2025.

Less than 10% of countries lack mechanisms for people living with HIV and key populations to report abuse and discrimination and seek redress by 2025.

Less than 10% of people living with HIV and key populations lack access to legal services by 2025.

More than 90% of people living with HIV who experienced rights abuses have sought redress by 2025.

This target area aims to build on and accelerate encouraging momentum towards legal reform and access to justice in numerous countries and regions, applying lessons learned more broadly to bring legal and policy frameworks into line with the human rights underpinnings of an effective HIV response.

The target takes into consideration the following issues:

The impact of criminalization on people affected by HIV
Understanding the process of decriminalization
Building on successes to close the legal and policy gap
Learning from recent successes in rolling back punitive laws

Less than 10% of people living with HIV and key populations experience stigma and discrimination

Less than 10% of people living with HIV report internalized stigma by 2025.

Less than 10% of people living with HIV report experiencing stigma and discrimination in healthcare and community settings by 2025.

Less than 10% of key populations (i.e., gay men and other men who have sex with men, sex workers, transgender people and people who inject drugs) report experiencing stigma and discrimination by 2025.

Less than 10% of the general population reports discriminatory attitudes towards people living with HIV by 2025.

Less than 10% of health workers report negative attitudes towards people living with HIV by 2025.

Less than 10% of health workers report negative attitudes towards key populations by 2025.

Less than 10% of law enforcement officers report negative attitudes towards key populations by 2025.

Nearly four decades since AIDS was first documented, stigma and discrimination continue to slow or entirely block progress towards ending the epidemic. In 25 of 36 countries with recent survey data on a composite index of discriminatory attitudes, more than half of people aged 15 to 49 years displayed discriminatory attitudes towards people living with HIV (Figure 28). While discriminatory attitudes have consistently declined in some countries, notably in eastern and southern Africa, they are on the rise in others. This new target aims to reduce sharply the prevalence of HIV-related stigma and discrimination. Taking account of the growing HIV burden among key populations and the pernicious effects of stigma and discrimination on efforts to address the HIV-related needs of key populations, this target area includes more detailed, population-specific targets.

The target takes into consideration the following issues:

The alarming prevalence of discrimination within health care settings
Effectively resourcing and scaling up evidence-informed human rights and anti-stigma interventions
Supporting and empowering communities to fight stigma and discrimination
Leveraging new visibility of efforts to eliminate stigma and discrimination

Less than 10% of women, girls, people living with HIV and key populations experience gender inequality and violence

Less than 10% of women and girls experience physical or sexual violence from an intimate partner by 2025.

Less than 10% of key populations (i.e., gay men and other men who have sex with men, sex workers, transgender people and people who inject drugs) experience physical or sexual violence by 2025.

Less than 10% of people living with HIV experience physical or sexual violence by 2025.

Less than 10% of people support inequitable gender norms by 2025.

Greater than 90% of HIV services are gender-responsive by 2025.

This target area emphasizes the importance of ending violence against women, girls, people living with HIV and key populations. Genderbased violence is but one manifestation of gender inequality, which reduces the ability of women and girls to protect themselves from HIV. It perpetuates a gendered distribution of caretaking responsibilities and diminishes the educational and employment opportunities of women and girls. The new target also recognizes how unequal gender norms contribute to the vulnerability of key populations.

The target takes into consideration the following issues:

The unacceptably high prevalence of violence against women, girls and key populations
The effects of violence on HIV risk and health outcomes
Multisectoral approaches to increase gender equality and reduce the vulnerability of women and girls

HIV testing and treatment targets

95–95–95 testing and treatment targets achieved among people living with HIV within all subpopulations and age groups by 2025.

As the 90–90–90 targets were the most successful element of the Fast-Track agenda, new testing and treatment targets for 2025 maintain the same overall approach but adopt the more ambitious 95% objectives. They also clarify the need for achieving these targets within each subpopulation of people living with HIV.

The greater attention paid to subpopulations of people living with HIV reflects the current heterogeneity of testing and treatment coverage across these populations, which undermines the population-level preventative impact of treatment.

Meeting sexual and reproductive service needs and eliminating vertical transmission of HIV

95% of women of reproductive age have their HIV and sexual and reproductive health service needs met.

95% of pregnant and breastfeeding women living with HIV have suppressed viral loads.

95% of HIV-exposed children are tested by 2025.

The 2025 targets prioritize sexual and reproductive health services for women living with HIV and women at elevated risk of HIV infection, and they reinvigorate the global push to eliminate new HIV infections among children and ensure that children living with HIV have timely access to life-saving treatment services.

Efforts to increase coverage of antiretroviral therapy among pregnant women living with HIV over the past decade—coverage reached 84% in 2019—has driven reductions in HIV transmission to their infants. These gains are insufficient on their own, however, as substantial numbers of children continue to acquire HIV. This is primarily due to a failure to continue providing women living with HIV and women at elevated risk of HIV with the HIV services they need throughout pregnancy and breastfeeding.

Sexual and reproductive health services are critical for preventing HIV acquisition through sexual intercourse and mother-to-child HIV transmission during pregnancy, childbirth and breastfeeding.

Appropriate, prioritized, person-centred and effective combination prevention options

95% of people at risk of HIV infection use appropriate, prioritized, person-centred and effective combination prevention options by 2025.

HIV transmission dynamics differ greatly across and within regions and countries, as well as by modes of transmission and within and between population groups. Effective HIV prevention requires a granular, combination approach differentiated according to location, population groups and risk of HIV acquisition.

Combination prevention recognizes that individuals need to be provided with a choice of multiple tools to prevent HIV infection—including behavioural and biomedical approaches—to better ensure that at least one will fit one’s current needs. Such choices are not fixed. The most appropriate tool will vary with the specific situation.

These tools must also be person-centred. However, the 2025 targets recognize that people in different geographic and social settings—as well as different behavioural attributes—have different levels of risk. The most effective tools and approaches are different across sub-populations and the preferences also differ within sub-populations.

The failure to date of expanded treatment access to achieve rapid reductions in HIV incidence has underscored the critical importance of primary HIV prevention.

Political support for HIV prevention is still lacking, due to numerous factors, including the inherent complexity of HIV prevention, challenges in measuring impact (by showing that something did not occur), lack of comfort in addressing issues of sexuality and drug use (especially among young people) and the fact that prevention needs are often greatest among populations that are socially marginalized and politically disfavoured.

Effective HIV prevention involves a combination approach that offers multiple prevention options to people at risk of HIV. Efforts to reach the 95-95-95 testing and treatment targets must be combined with robust efforts scale up condom promotion, comprehensive sexuality education, voluntary medical male circumcision, PrEP and harm reduction.

Integrated approaches that are people-centred and context-specific

Adoption of people-centred and context-specific integrated approaches that support the achievement of 2025 HIV targets and result in at least 90% of people living with HIV and individuals at heightened risk of HIV infection linked to services for other communicable diseases, noncommunicable diseases, sexual and gender-based violence, mental health and the other services they need for their overall health and well-being.

Rather than a disease or the capacity of health facilities, it should be people who are the guidepost for designing, delivering and assessing health services. One way to make health systems more people-centred is through service integration, with the goal of providing people-tailored, co-located or well-coordinated services that are optimally convenient, seamless and easy to navigate. Health integration aims to improve health programme performance across four dimensions: efficiency, effectiveness, equity and responsiveness.

The target takes into consideration the following issues:

Prioritizing high-value interventions that deliver spillover benefits
Evidence regarding the benefits of service integration
Deciding when and how to integrate
Integrating approaches for specific populations
Leveraging progress towards universal health coverage
Migrant access to services

Removing societal and legal barriers to HIV services

The high levels of HIV service coverage called for in the 2025 targets can only be achieved within an environment where people living with HIV and people at risk of HIV infection feel safe to utilize those services. Unfortunately, this is currently not the case in many countries. HIV-related stigma and discrimination, gender inequality, and the criminalization of drug use, sex work and same-sex sexual relationships are powerful barriers to HIV services. The 2025 targets emphasize that countries must invest in specific efforts to remove these impediments and establish an enabling environment that is free of societal, political, legal and economic barriers.

The targets within this section are framed as impediments to focus global attention on the reality of stigma and discrimination based on HIV status, punitive or harmful laws and policies, inequalities (gender-based, racial, economic and educational), and limited access to justice for people living with HIV, key populations and vulnerable populations (i.e., women, adolescent girls, migrants, refugees and incarcerated people). The targets call for more rapid removal of these impediments. The values for these targets (i.e., fewer than 10%) might seem numerically lower than the HIV service targets that call for 95% coverage, but the baselines for societal enablers often are lower and social change often is a slower process than programmatic scale-up. Nonetheless, achievement of these targets is central to progress across the full array of ambitious targets for 2025 and towards realizing the vision of zero new infections, zero discrimination and zero AIDS-related deaths.