The global
epidemic is not homogeneous within regions, with some countries more affected than others. Even at the country level, there are wide variations in infection levels between different areas and different population groups. New HIV infections are falling globally on average (a decrease of 23% from 2010 to 2020), but continue to rise in many parts of the world. Sub-Saharan Africa remains the hardest-hit region. As of 2011, HIV infection was becoming
endemic in sub-Saharan Africa, which is home to just over 12% of the world's population but two-thirds of were people infected with HIV.
Southern Africa is the hardest hit region, with, as of 2024, adult prevalence rates of 23.4% in Eswatini, 17.2% in South Africa and 15.7% in Botswana, having previously exceeded 20% in most countries in the region, and 30% in
Eswatini and
Botswana. Analysis of prevalence across sub-Saharan Africa between 2000 and 2017 found high variation in prevalence at a subnational level, with some countries demonstrating a more than five-fold difference in prevalence between different districts. Although Eastern and Southern Africa have a heavier burden of disease they have also shown much resilience in their response to HIV. Across Sub-Saharan Africa, more women are infected with HIV than men, with 13 women infected for every 10 infected men. This gender gap continues to grow. Throughout the region, women are being infected with HIV at earlier ages than men. The differences in infection levels between women and men are most pronounced among young people (aged 15–24 years). In this age group, there are 36 women infected with HIV for every 10 men. The widespread prevalence of
sexually transmitted diseases, the
promiscuous culture, the practice of
scarification,
unsafe blood transfusions, and the poor state of
hygiene and
nutrition in some areas may all be facilitating factors in the transmission of HIV-1 (Bentwich et al., 1995). Due to a lack of testing, a shortage in antenatal therapies and through the feeding of contaminated breast milk, 590,000 infants born in developing countries are infected with HIV-1 per year. In 2000, the
World Health Organization estimated that 25% of the units of blood transfused in Africa were not tested for HIV, and that 10% of HIV infections in Africa were transmitted via blood. Poor economic conditions (leading to the use of dirty needles in healthcare clinics) and lack of
sex education contribute to high rates of infection. In some African countries, 25% or more of the working adult population is HIV-positive. Poor economic conditions caused by slow onset-emergencies, such as drought, or rapid onset natural disasters and conflict can result in young women and girls being forced into using sex as a survival strategy. Worse still, research indicates that as emergencies, such as drought, take their toll and the number of potential 'clients' decreases, women are forced by clients to accept greater risks, such as not using contraceptives.
AIDS-denialist policies have impeded the creation of effective programs for distribution of antiretroviral drugs. Denialist policies by former South African President
Thabo Mbeki's administration led to several hundred thousand unnecessary deaths.
UNAIDS estimates that in 2005 there were 5.5 million people in South Africa infected with HIV — 12.4% of the population. According to a graph done by
UNAIDS, there were 4,200,000 people living with HIV in South Africa in 2005. This was an increase of 400,000 people since 2003. In 2018, the prevalence of HIV in Eastern and Southern Africa combined was 1.8 million. This number only represents children and adolescents (Ages 0–19). As for those ages 15–24 in this region of Africa, the incidence rate (2018) was 290,000. About 203,000 of those infected were females. As of 2021, UNAIDS data from the eastern and southern countries in Africa showed the HIV prevalence rate to be 6.2% in adults ages 15–49. However, it has been noted, that empowering women when it comes to education has an effect on lowering their risk of becoming infected with HIV. During COVID-19, some countries in South and East Africa were able to set up treatment sites that provided 1.8 million individuals with a larger supply of antiretroviral (ART) medication that could sustain them for longer than the typical 3 months. In the quarterly report following lockdown, they saw a 10% decrease in the number of individuals that experienced treatment interruptions from the quarter before lockdown.
Middle East and North Africa HIV/AIDS prevalence among the adult population (15-49) in the Middle East and North Africa (MENA) is estimated less than 0.1 between 1990 and 2018. This is the lowest prevalence rate compared to other regions in the world. In the MENA, roughly 230,000 people are living with HIV as of 2020, As well as, Sudan (5,200), Iran (4,400) and Egypt (3,600) took up more than 60% of the number of new infections themselves in the MENA (20,000). Roughly two-thirds of AIDS-related deaths in this region happened in these countries for the year 2018. Second, compared to the global rate of
antiretroviral therapy (62%), the MENA region's rate is far below in 2020 (43%). Key population at high risk in this region is identified as injection drug users, female sex workers and men who have sex with men. Migrants, in particular, are vulnerable and 67% of those infected in
Bangladesh and 41% in
Nepal are migrants returning from India. This is in part due to
human trafficking and exploitation, but also because even those migrants who willingly go to India in search of work are often afraid to access state health services due to concerns over their immigration status.
Antiretroviral therapy has been successful in
Thailand in eliminating mother-to-child transmission of both HIV and
syphilis. Throughout the region, countries have seen a decrease in AIDS-related deaths and new HIV infections from 2010 to 2015, with the exception of
Indonesia. East Asia has an estimated 3.5 million people living with HIV, with prevalence low in the 15-49 age range. HIV/AIDS has remained somewhat stable with an approximated 3.5 million cases since 2005. Thailand is the only east Asian country with an over 1% HIV prevalence, which has declined from 1.7% in 2001 to 1.1% in 2015. No cases have been reported in the Democratic People's Republic of Korea. In the early 1990s, HIV spread in rural China through commercial plasma donations due to the lack of adequate infection prevention and control. In Japan, just over half of
HIV/AIDS cases are officially recorded as occurring amongst
homosexual men, with the remainder occurring in heterosexual contact, injection
drug use, and unknown means. In East Asia, men who have sex with men account for 18% of new HIV/AIDS cases and are therefore a key affected group along with sex workers and their clients who makeup 29% of new cases. This is also a noteworthy aspect because men who have sex with men had a prevalence of at least 5% or higher in countries in Asia and Pacific.
Americas Caribbean The Caribbean is the second-most affected region in the world. Among adults aged 15–44, AIDS has become the leading cause of death. However, there has been a significant decrease in the number of infections per year in the Caribbean. There is a visible decrease in a graph presented by UNAIDS showing the number of new HIV infections from years 2015–2020. HIV transmission occurs largely through heterosexual intercourse. A greater number of people who get infected with HIV/AIDS are heterosexuals. with two-thirds of AIDS cases in this region attributed to this route. Sex between men is also a significant route of transmission, even though it is heavily stigmatized and illegal in many areas. HIV transmission through injecting drug use remains rare, except in Bermuda and Puerto Rico. According to the UNAIDS Global AIDS Update 2022, there is a significant gap when it comes to children and adults alike receiving treatments which is playing a part in inhibiting the world from reaching its 2023 goal of 75% viral suppression among children. This could be in part due to the high cost for treatment and services rounding to an estimated US$725 per person per year. In these regions of the American continent, only
Guatemala and
Honduras have national HIV prevalence of over 1%. In these countries, HIV-infected men outnumber HIV-infected women by roughly 3:1. With HIV/AIDS incidence levels rising in Central America, education is the most important step in controlling the spread of this disease. In Central America, many people do not have access to treatment drugs. This results in 8–14% of people dying from AIDS in Honduras. To reduce the incidence levels of HIV/AIDS, education and drug access needs to improve. In a study of immigrants traveling to Europe, all asymptomatic persons were tested for a variety of infectious diseases. The prevalence of HIV among the 383 immigrants from Latin America was low, with only one person testing positive for a HIV infection. This data was collected from a group of immigrants with the majority from Bolivia, Ecuador and Colombia.
United States Since the epidemic began in the early 1980s, 1,216,917 people have been diagnosed with AIDS in the US. In 2016, 14% of the 1.1 million people over age 13 living with HIV were unaware of their infection. The most recent CDC HIV Surveillance Report estimates that 38,281 new cases of HIV were diagnosed in the United States in 2017, a rate of 11.8 per 100,000 population.
Men who have sex with men accounted for approximately 8 out of 10 HIV diagnoses among males. Regionally, the population rates (per 100,000 people) of persons diagnosed with HIV infection in 2015 were highest in the South (16.8), followed by the Northeast (11.6), the West (9.8), and the Midwest (7.6). Since 2015, HIV infections have decreased 8%, with 30,635 new cases reported in 2020. The highest incidence rates have continued to be measured in the South, with approximately 13% of the population unaware of their HIV status. The most frequent mode of transmission of HIV continues to be through male homosexual sexual relations. In general, recent studies have shown that 1 in 6 gay and bisexual men will be infected with HIV in their lifetime. As of 2014, in the United States, 83% of new HIV diagnoses among all males aged 13 and older and 67% of the total estimated new diagnoses were among homosexual and bisexual men. Those aged 13 to 24 also accounted for an estimated 92% of new HIV diagnoses among all men in their age group. A review of studies containing data regarding the prevalence of HIV in transgender women found that nearly 11.8% self-reported that they were infected with HIV. Along with these findings, recent studies have also shown that transgender women are 34 times more likely to have HIV than other women. In the National Transgender Discrimination Survey, 20.23% of black respondents reported being HIV-positive, with an additional 10% reporting that they were unaware of their status. AIDS is one of the top three causes of death for African American men aged 25–54 and for African American women aged 35–44 years in the United States of America. In the United States, African Americans make up about 48% of the total HIV-positive population and make up more than half of new HIV cases, despite making up only 12% of the population. The main route of transmission for women is through unprotected heterosexual sex. African American women are 19 times more likely to contract HIV than other women. By 2008, there was increased awareness that young
African-American women in particular were at high risk for HIV infection. In 2010, African Americans made up 10% of the population but about half of the HIV/AIDS cases nationwide. This disparity is attributed in part to a lack of information about AIDS and a perception that they are not vulnerable, as well as to limited access to health-care resources and a higher likelihood of sexual contact with at-risk male sexual partners. Since 1985, the incidence of HIV infection among women had been steadily increasing. In 2005 it was estimated that at least 27% of new HIV infections were in women. There has been increasing concern for the concurrency of violence surrounding women infected with HIV. In 2012, a meta-analysis showed that the rates of psychological trauma, including Intimate Partner Violence and PTSD in HIV positive women were more than five times and twice the national averages, respectively. In 2013, the White House commissioned an Interagency Federal Working Group to address the intersection of violence and women infected with HIV. 1996 would mark the first year since the beginning of the epidemic that the number of new HIV/AIDS cases would decline. A significant 47% decline compared to the previous year would also be reported in 1997. Rates are lower in
Utah,
Texas, and Northern
Florida.
Canada In 2016, there were approximately 63,100 people living with HIV/AIDS in Canada. It was estimated that 9090 persons were living with undiagnosed HIV at the end of 2016.
Eastern Europe and Central Asia There is growing concern about a rapidly growing epidemic in
Eastern Europe and
Central Asia, where an estimated 1.23–3.7 million people were infected as of December 2011, though the adult (15–49) prevalence rate is low (1.1%). The rate of HIV infections began to grow rapidly from the mid-1990s, due to social and economic collapse, increased levels of intravenous drug use and increased numbers of sex workers. By 2010 the number of reported cases in Russia was over 450,000 according to the
World Health Organization, up from 15,000 in 1995 and 190,000 in 2002. In June 2021, there are over 1.1 million people in Russia living with HIV.
Ukraine and
Estonia also have growing numbers of infected people, with estimates of 240,000 and 7,400 respectively in 2018. Also, transmission of HIV is increasing through sexual contact and drug use among the young (<30 years). In this region there were between 130,000 and 180,000 new HIV infections reported in 2021.
Western Europe In most countries of Western Europe, AIDS cases have fallen to levels not seen since the original outbreak; many attribute this trend to aggressive educational campaigns, screening of blood transfusions and increased use of condoms. Also, the death rate from AIDS in Western Europe has fallen sharply, as new AIDS therapies have proven to be an effective (though expensive) means of suppressing HIV. In this area, the routes of transmission of HIV is diverse, including paid sex, injecting drug use, mother to child, male with male sex and heterosexual sex. == AIDS research and society ==