1、Key findings from the 2023 Global HIV Prevention Coalition scorecardsHIV Prevention:From Crisis to OpportunityKey findings from the 2023 Global HIV Prevention Coalition scorecardsHIV Prevention:From Crisis to OpportunityHIV PREVENTION:FROM CRISIS TO OPPORTUNITY2 Joint United Nations Programme on HIV

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11、no event shall UNAIDS be liable for damages arising from its use.UNAIDS/JC3110EHIV PREVENTION:FROM CRISIS TO OPPORTUNITY3CONTENTSIntroduction 4Strong progress in parts of Africa,but less so in other regions 5HIV incidence is declining among adolescents and young people in parts of Africa 9Gains are

12、uneven and there are some big gaps 12Progress across the five prevention pillars 14Pillar 1.Combination prevention for key populations 15Pillar 2.Combination prevention for adolescent girls and young women in high-prevalence locations 23Pillar 3.Combination prevention for men and adolescent boys in

13、settings with high HIV incidence 27Pillar 4.Promotion and distribution of condoms and lubricants 31Pillar 5.Wider access to antiretroviral-based prevention 34Progress on the ten main action points in the HIV Prevention 2025 Road Map 40Conclusion:Realize the full potential of HIV prevention 52How to

14、do better:Combination prevention and treatment to achieve the global HIV incidence targets 53How to do better:Boost and sustain impact 55How to do better:Scale up differentiated prevention services 55Now is the time to invest in prevention 56Annex:Status of HIV prevention in GPC member countries 58I

15、ntroduction to country summaries 58Country reports 66References 138HIV PREVENTION:FROM CRISIS TO OPPORTUNITY4INTRODUCTIONLaunched in 2017,the Global HIV Prevention Coalition(GPC)is striving to revitalize HIV prevention,secure greater investment for prevention programmes and map a viable path towards

16、 reaching the global prevention targets.This sixth progress report of the GPC reviews the status of HIV prevention in 40 countries:the 28 initial focus countries of the Coalition and the 12 countries that were invited to join the Coalition in 2023.1 It tracks progress in the 28 initial focus countri

17、es and serves as a baseline assessment for the 12 newly invited countries.In 2016,before the launch of the Coalition,the initial 28 focus countries accounted for about 76%of all new HIV infections globally.Due to their progress in preventing HIV infections,that share declined to 67%of all new infect

18、ions in 2022.The new total of 40 GPC focus countries accounted for just over one million new HIV infections,or 76%of all people globally who acquired HIV in 2022.This report describes and analyses key developments in HIV prevention by 2022,identifies the main challenges and opportunities and outline

19、s priorities for the years ahead.It is divided into two main sections.1 The 28 initial focus countries which joined the coalition in 2017 and 2018 are:Angola,Botswana,Brazil,Cameroon,China,Cte dIvoire,Democratic Republic of the Congo,Eswatini,Ethiopia,Ghana,India,Indonesia,Islamic Republic of Iran,K

20、enya,Lesotho,Malawi,Mexico,Mozambique,Myanmar,Namibia,Nigeria,Pakistan,South Africa,Uganda,Ukraine,United Republic of Tanzania,Zambia and Zimbabwe.Twelve countries were invited to join the Coalition in 2023:Central African Republic,Colombia,Congo,Egypt,Madagascar,Papua New Guinea,Peru,Philippines,Rw

21、anda,South Sudan,Thailand and Viet Nam.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY5STRONG PROGRESS IN PARTS OF AFRICA,BUT LESS SO IN OTHER REGIONSGlobally,fewer people acquired HIV in 2022 than at any point since the late 1980s.The estimated 1.3 million 1.01.7 million new HIV infections globally in 20

22、22 represented a 38%reduction since 2010 and a 28%reduction since 2015.The overall progress largely reflects achievements in the initial 28 GPC focus countries,which together accounted for about two thirds of all new HIV infections in 2022.Reductions in annual new HIV infections(since 2016)continued

23、 to be considerably steeper in those focus countries than elsewhere(Figure 1).Countries that are providing proven prevention optionsincluding both primary prevention and the use of treatment as preventionat the required scale to the people most at risk of acquiring HIV are achieving large reductions

24、 in new HIV infections(1).The Global HIV Prevention CoalitionThe Global HIV Prevention Coalition was created in 2017 to accelerate progress on HIV prevention.The Coalition brings together governments,UNAIDS Cosponsors,donors,international and regional organizations,funding partners,and civil society

25、 organizations.In July 2022,the coalition launched a new Global HIV Prevention Road Map 2025 to further accelerate action towards achieving the prevention targets set in the 2021 UN Political Declaration on HIV and AIDS and the Global AIDS Strategy 20212026.A core objective is to reduce new HIV infe

26、ctions globally to fewer than 370 000 annually by 2025 by ensuring that 95%of people at risk of HIV infection can access and use effective combination prevention options.Achieving that target would put countries on track to end AIDS as a public health threat.In 2023,the Coalition invited 12 addition

27、al countries to join,in part due to their rising numbers of new HIV infections.The main body of the report reviews progress made across the five main prevention pillars,examines implementation of the ten action points in the 2025 HIV Prevention Road Map(based on results from the Scorecard survey)and

28、 discusses key priorities for the immediate future.The annex comprises country fact sheets for all 40 focus countries.Those fact sheets present in detail the progress made in implementing HIV prevention programmes at the country level,as represented by country HIV prevention scorecards and Road Map

29、action plans in the 28 initial focus countries and as a baseline for the 12 newly invited countries.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY6There have been shifts also in the distribution of new HIV infections between different UNAIDS regions(Figure 2).In 2010,eastern and southern Africa and weste

30、rn and central Africa accounted for about two thirds(68%)of new HIV infections globally.Since then,those two regions have recorded steep reductions in new HIV infections:declines of 55%and 50%respectively.Together they accounted for an estimated 660 000 new infections in 2022approximately half of al

31、l new infections globally.For the first time in the history of the pandemic,roughly equal numbers of new HIV infections are occurring in and beyond sub-Saharan Africa.That reflects both the prevention successes achieved in much of sub-Saharan Africa and the lack of comparable progress in much of the

32、 rest of the world,where the pandemic primarily affects key populations and their sexual partners who continue to be neglected in many HIV prevention programmes.New research indicates that,globally,the share of new HIV infections among key populations and their sexual partners increased from 44%of a

33、ll new HIV infections in 2010 to 55%in 2022.Outside of sub-Saharan Africa,the numbers of new HIV infections have stabilized overall,though this masks the fact that annual new infections have decreased in some countries but increased in others.The absolute numbers of new HIV infections among gay men

34、and other men who have sex with men and transgender women outside of sub-Saharan Africaand their share of total new infectionshave possibly increased since 2010(2).This underscores the fact that the global 2025 and 2030 HIV targets2 cannot be achieved unless there are also steep reductions in new HI

35、V infections among key populations and their sexual partner globally.2 The 2021 Political Declaration on HIV and AIDS commits countries to prioritize HIV prevention and reduce new HIV infections to fewer than 370 000 per year by 2025.The prevention target for 2030 entails a 90%reduction in new HIV i

36、nfections compared with 2010.Figure 1.Percentage change in the numbers of new HIV infections among adults(aged 15 years and older),children(014 years)and adolescent girls and young women(1524 years)in the initial 28 GPC focus countries and in other countries,20162022Source:UNAIDS 2023 estimates Note

37、:This chart includes the initial GPC focus countries which published UNAIDS estimates in 2023 and other countries outside the GPC which published 2023 estimates.The countries which were invited to join the GPC in 2023 are grouped among“other countries”.Change in new HIV infections(20162022)-40%-30%-

38、20%-10%0%-33%-7%-33%-6%-37%-18%-41%-11%GPC focus countries(28)Other countriesAdolescent girls and young women(1524 years)Adults(15 years and older)All agesChildren(014 years)HIV PREVENTION:FROM CRISIS TO OPPORTUNITY7Figure 2.Trends in the numbers of new HIV infections(all ages)and in the proportions

39、 of new HIV infections in specific UNAIDS regions and locations,20102022a)Progress in selected regional groupings and 2025 and 2030 global targetsSource:UNAIDS 2023 estimates.Note:Eastern and southern Africa accounted for approximately 52%of all new HIV infections(all ages)globally in 2010;therefore

40、,data for that region are disaggregated further.Separate data are also shown for South Africa,which accounted for more new HIV infections in 2010 than any UNAIDS region outside southern Africa.b)Change in proportions of new HIV infections(all ages)in selected regional groupingsNumber of new HIV infe

41、ctions0500 0001 000 0001 500 000 2 000 000Global targets370 000200 000Eastern AfricaWestern and central Europe and North AmericaSouth AfricaOther southern AfricaWestern and central AfricaAsia and the PacificLatin America and CaribbeanEastern Europe and central AsiaMiddle East and North Africa2010201

42、220020202220252030Percentage of all new HIV infections0%10%20%30%40%50%60%70%80%90%100%Eastern AfricaWestern and central Europe and North AmericaSouth AfricaOther southern AfricaWestern and central AfricaAsia and the PacificLatin America and CaribbeanEastern Europe and central AsiaMiddle

43、East and North Africa2000002222%16%12%10%12%4%12%10%23%18%14%15%16%6%5%4%HIV PREVENTION:FROM CRISIS TO OPPORTUNITY8Figure 3.Percentage change in the numbers of people(all ages)newly acquiring HIV infections in GPC focus countries,20102022Source:UNAIDS esti

44、mates 2023.20022Change in number of new HIV infections(all ages)in per cent100%80%60%40%20%0%-20%-40%-60%-80%On trackModerate progress Limited progress Off track-78%-74%-73%-72%-72%-70%-69%-68%-68%-66%-66%-58%-57%-56%-53%-52%-48%-45%-45%-41%-42%-40%-35%-27%-21%-14%-12%13%57%97%131%151%379

45、%418%-35%2025 target(82.5%reduction)ZimbabweLesothoRwandaEswatiniMalawiEthiopiaCameroonKenyaUnited Republic of TanzaniaBotswanaCte dIvoireDemocratic Republic of the CongoSouth AfricaViet NamZambiaIndonesiaNamibiaAngolaThailandIndiaMozambiqueUgandaMyanmarSouth SudanGhanaIslamic Republic of IranColomb

46、iaCentral African RepublicMexicoPeruCongoPapua New GuineaMadagascarEgyptPhilippinesHIV PREVENTION:FROM CRISIS TO OPPORTUNITY9There have been consistent reductions in new HIV infections in most of the GPC focus countries in eastern and southern Africa,along with marked reductions in some countries in

47、 western and central Africa(including Cameroon,Cte dIvoire and Democratic Republic of the Congo).The more recent trends in countries such as the United Republic of Tanzania and Zambia are especially notable,given the disruptions to HIV programmes caused by the COVID-19 pandemic in 2020.Indeed,the la

48、test data analysed by the GPC indicate that prevention programmes in most countries have recovered after the initial disruptions due to the COVID-19 pandemic.Data from the Global Fund support that conclusion.They show that the number of people reached with Global Fund-supported HIV prevention progra

49、mmes fell by 10%in 2020,but quickly recovered to exceed the 2019 levels,with coverage increasing by 47%in 2021 and by another 22%in 2022(3).HIV INCIDENCE IS DECLINING AMONG ADOLESCENTS AND YOUNG PEOPLE IN PARTS OF AFRICAImportant patterns are evident within the overall trends.Among adolescents and y

50、oung people(1524 years),new HIV infections have tended to decrease more rapidly among males than females.3 The steepest declines among adolescent boys and young men were in Kenya,Lesotho,Malawi,South Africa,Uganda and the United Republic of Tanzania,where at least 70%fewer adolescent boys and young

51、men acquired HIV in 2022,compared with 2010.HIV incidence among adolescent girls and young women remains exceptionally high in parts of eastern and southern Africa and in specific areas in western and central Africa.But some GPC focus countries with high HIV burdens have achieved major reductions(70

52、%)in new HIV infections in that priority population(e.g.Cameroon,Lesotho,Malawi and Zimbabwe)and are within reach of achieving an 88%reduction by 2025(Figure 4).The reductions in new HIV infections among adolescent girls and young women in a few countries(e.g.Botswana,Cameroon,Cte dIvoire,Eswatini a

53、nd Ethiopia)equalled or exceeded reductions among their male peers.3 Among GPC focus countries,the male/female gap in HIV incidence decline among young people was widest in Angola,Ghana,Indonesia,Mozambique,Namibia,Uganda and Zambia.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY10Figure 4.Percentage chan

54、ge in the numbers of adolescent girls and young women(aged 1524 years)newly acquiring HIV infection in 24 GPC focus countries with mixed HIV epidemics,20102022Source:UNAIDS estimates 2023.Change in new HIV infections(all ages in per cent)20022On trackModerate progress Limited progress Off

55、 trackZimbabweCameroonLesothoMalawiRwandaEswatiniKenyaUnited Republic of TanzaniaBotswanaEthiopiaDemocratic Republic of the CongoSouth AfricaCte dIvoireZambiaAngolaNamibiaMozambiqueUgandaGhanaSouth SudanCentral African RepublicMadagascarCongoPapua New Guinea2025 target(88%reduction or fewer than 50

56、000 globally)-80%-73%-73%-72%-70%-69%-68%-66%-65%-64%-63%-61%-59%-45%-37%-27%-26%-26%-18%-13%4%137%141%172%100%80%60%40%20%0%-20%-40%-60%-80%HIV PREVENTION:FROM CRISIS TO OPPORTUNITY11Driving the reductions are factors that combine in different ways,depending on the setting.Along with the natural ev

57、olution of the HIV epidemic,behaviour changes(such as delayed sexual debut and fewer risky sexual encounters)are reducing the risk of acquiring HIV,as studies in countries such as Cameroon(4),4 Zimbabwe(5)and several others(6)have documented.Moderately high levels of condom use during risky sex in a

58、 majority of countries with large epidemics are tempering HIV transmission,while the rising numbers of men and boys who have undergone voluntary medical male circumcision(VMMC)is reducing their chances of acquiring HIV in the countries where VMMC programmes have been prioritized or where male circum

59、cision is a common religious or cultural practice.Programmes focusing on the prevention needs of people belonging to key populations5 are also contributing,depending on the population and the country.However,the single largest additional gain since 2010 has almost certainly been the historic increas

60、e in the effective use of antiretrovirals against HIV.Some of the steepest declines in new HIV infections are being seen in countries that are diagnosing and successfully treating very large proportions of people living with HIV.Eleven GPC focus countries have reduced their annual number of new HIV

61、infections by over 66%since 2010.6 Viral suppression levels in those 11 countries have risen impressivelyto such a degree that,in seven of them,at least 85%of people living with HIV had suppressed viral loads in 2022.The fact that it is near impossible for a person with a suppressed HIV viral load(b

62、elow 1000 copies/mL)to transmit the virus to another person during sex(7)is providing a great deal of the current momentum for reducing HIV incidence.Wide coverage of services to prevent vertical transmission of HIV has drastically reduced the number of children(014 years)acquiring HIV.By reaching o

63、ver 80%of pregnant and breastfeeding HIV positive women with effective treatment in most of the GPC focus countries in sub-Saharan Africa,those services are also reducing onward transmission of HIV to the partners of people living with HIV.Underpinning these achievements is the use of granular,disag

64、gregated data to focus interventions more precisely for maximum impact;a growing emphasis on adapting services to fit peoples needs;and moves towards functionally integrating community-led interventions with public health programmes.In sub-Saharan Africa particularly,recognition of the inordinately

65、high risk of HIV infection among adolescent girls and young women has led to much greater emphasis on reaching them with comprehensive prevention services.Increased investments,including from the Global Fund and PEPFAR(the United States Presidents Emergency Plan for AIDS Relief),has enabled focus co

66、untries in that region to implement dedicated combination prevention programmes for young women in at least 60%of 4 The Cameroon experience remains an instructive example.The new analysis in the cited article provides a handy thumb-sketch of the factors at play,including behaviour changes and increa

67、sed HIV treatment coverage.5 For the purposes of primary prevention,people belonging to key populations include sex workers,gay men and other men who have sex with men,people who inject drugs,transgender people,and prisoners and other incarcerated people.6 Botswana,Cameroon,Cte dIvoire,Eswatini,Ethi

68、opia,Kenya,Lesotho,Malawi,Rwanda,United Republic of Tanzania and Zimbabwe.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY12locations with high HIV incidence.But that coverage has to increase further to reduce the ongoing high risks of HIV infection among adolescent girls and young women in the region.Also

69、 increasing is an awareness of the need to remove the underlying barriers(e.g.,punitive criminal laws and policies,gender and other inequalities,HIV-related stigma and discrimination,and other human rights violations)that hold back quicker and more equitable progress,though forthright action on thos

70、e fronts is still erratic.Large-scale investments,some from domestic resources but most from the Global Fund and PEPFAR,have enabled countries to sustain and,in some cases,expand their HIV prevention programmes.The Global Funds HIV prevention investments,for example,grew from US$705 million in the 2

71、0182020 period to over US$850 million in the 20212023 period.It invested more than US$140 million in condom programmes in the 20212023 period and doubled its investments in pre-exposure prophylaxis(PrEP)to US$24.1 million.GAINS ARE UNEVEN AND THERE ARE SOME BIG GAPSThe gains are not uniform across G

72、PC focus countries,though.As the prevention scorecards show in greater detail(see Chapter 2),the performances of HIV prevention programmes vary considerably from country to country.A few countries in sub-Saharan Africa lag far behind,but progress generally has been slowest outside that region,in cou

73、ntries with HIV epidemics that primarily affect people belonging to key populations and their sex partners.Angola,Ghana,Islamic Republic of Iran,Mozambique,Myanmar,Namibia and Uganda failed to reduce annual new HIV infections by more than 50%between 2010 and 2022.In South Africa,approximately 160 00

74、0 people acquired HIV in 2022;it continues to have the largest HIV epidemic in the world.Meanwhile,the number of people acquiring HIV has been rising in Brazil and Mexico(each of which is home to large numbers of people with HIV),as well as in Egypt,Madagascar,Peru and the Philippines.(Note that rec

75、ent HIV estimates were not available for China,Nigeria,Pakistan and Ukraine.)Several handicaps are holding back quicker and more uniform gains against HIV.Subdued top-level political commitment for HIV prevention is reflected in the large shortfalls in prevention financing.Prevention programmes are

76、not being implemented at the required scale and proven interventions,such as harm reduction services for people who use drugs,are still being neglected or ignored.There have been reductions in investment in both condom and VMMC programmes in countries with some of the largest HIV epidemics in the wo

77、rld(8),and breakthrough prevention options like PrEP are available to only a small fraction of the people who need them.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY13Faltering political commitment is reflected also in the persistence of legal and structural obstacles that undercut prevention programmes

78、.More than four decades into the global AIDS pandemic,necessary HIV prevention services for people from key populations are still scarce in many countries.Punitive laws remain on the statute books,and social stigma and discrimination are rife.The violence,discrimination and social exclusion which ke

79、y populations experience continue to reduce their access to health-care services and information,and magnify their risk of acquiring HIV.Those and other priorities are highlighted in the HIV Prevention 2025 Road Map(9)(see Chapter 3),which sets out actions that can bring the world close to reducing

80、the total number of annual new HIV infections to under 370 000 by 2025.If that milestone can be reached,the world will be on track for the historic achievement of ending AIDS as a public health threat by 2030.To reach the 2025 milestone,countries will have to reduce the annual number of new HIV infe

81、ctions by at least 83%compared with 2010.By 2022,11 countriesBotswana,Cameroon,Cte dIvoire,Eswatini,Ethiopia,Kenya,Lesotho,Malawi,Rwanda,United Republic of Tanzania and Zimbabwehad reduced new infections by at least 66%since 2010,which puts the 2025 milestone within their reach.Elsewhere,major chang

82、es and improvements are required:Several focus countries are achieving slow reductions and will have to intensify their prevention efforts.They include Angola,Colombia,Democratic Republic of the Congo,Ghana,Mozambique,Namibia,South Africa,Uganda and Zambia.The prevention programmes in several other

83、focus countries are not on track and require thorough overhaul.They include Brazil,Colombia,Congo,Egypt,Madagascar,Islamic Republic of Iran,Mexico,Myanmar,Pakistan,Papua New Guinea,Peru and Philippines.It should be noted that,except for Congo and Papua New Guinea,most HIV infections in these countri

84、es are occurring among people belonging to key populations and their sex partners.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY14PROGRESS ACROSS THE FIVE PREVENTION PILLARSThe HIV Prevention 2025 Road Map(10)has redefined the five main pillars for national HIV prevention responses to increase focus,emph

85、asize people-centred approaches,address persistent inequalities in access to services,promote integration between service delivery platforms,and speed up the introduction of new prevention technologies(Figure 5).The Coalition has developed a set of scorecards to track and summarize country progress

86、across the five pillars.Their purpose is to identify where and in what respects programmes can improve,with a view to increasing their strategic focus,effectiveness and eventual impact.The scorecards are presented in a format that allows for comparisons between the GPC focus countries.HIV PREVENTION

87、:FROM CRISIS TO OPPORTUNITY15Figure 5.The five GPC prevention pillars for 2025Source:HIV Prevention 2025 Road Map:getting on track to end AIDS as a public health threat by 2030.Geneva:UNAIDS;2022.PILLAR 1.COMBINATION PREVENTION FOR KEY POPULATIONSThe prevention of HIV infections among people belongi

88、ng to key populations and their sex partners continues to be a weakness of HIV responses in a vast majority of countries.Good examples of effective programmes exist,but prevention services for key populations are unevenly available and often difficult to access.The obstacles include weak political w

89、ill,insufficient funding,rampant stigma and discrimination,and the ongoing use of punitive laws and policies that restrict access to HIV and other health-care services.The most recent data compiled and analysed by the GPC show encouraging examples of improvement in a few focus countries.But there ar

90、e major shortcomings in programme investment,coverage and quality for preventing HIV among key populations in the other countries.Indeed,most of the focus countries with substantial recent increases in the numbers of new HIV infections have epidemics that are primarily affecting key populations and

91、their partners.At the same time,countries with high HIV prevalence in the general population will struggle to close their remaining gaps in prevention if they continue to neglect the HIV prevention needs of key populations.A surprising number of countries lack the basic data that are needed to guide

92、 prevention programmes for key populations,such as size estimates that are less than five years old and other data on HIV prevalence,programme coverage and outcomes.Fewer than 370 000 new HIV infections per year by 2025.95%of people at risk of HIV have equitable access to and use appropriate,priorit

93、ized,person-centred and effective combination prevention optionsKEYPOPULATIONSADOLESCENTGIRLS AND YOUNG WOMENADOLESCENTBOYS AND MENCONDOMPROGRAMMINGARV BASEDPREVENTION12345Combinationprevention packages in settings with high HIV incidence(based on differentiated,layered packages)Promotionand distrib

94、utionof male and femalecondoms as wellas lubricants.ACCESS THROUGHCommunity-based and community-led outreach,health facilities including sexual and reproductive health services,schools,private sector,virtual platforms and other innovations FOUNDATIONS-SOCIETAL AND SERVICE ENABLERS AND ADDRESSING UND

95、ERLYING INEQUALITIESSexual and reproductive health and rights/Gender equality/Ending stigma and discriminationConducive policies and environment/Multisectoral,integrated&differentiated approach Sustained investment in HIV preventionCombination prevention packages in settings with high HIV incidence(

96、including voluntary medical male circumcision and promoting access to testing and treatment)Pre-exposure prophylaxis,post-exposure prophylaxis,treatment as prevention including for elimination of vertical transmissionCombination preventionand harm reductionpackages for and withSex workers.Gay men an

97、d other menwho have sex with men.People who inject drugs.Transgender people.Prisoners.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY16Only about two thirds of the focus countries have prepared recent size estimates for sex workers(28/40)or for gay men and other men who have sex with men(27/40),and a litt

98、le over half have done so for people who inject drugs(22/40).Those estimates indicate that substantial numbers of people belong to these key populations,underlining the need to serve them with effective prevention programmes.Size estimates for transgender people were available for a little over one

99、third(16/40)of the focus countries(Tables 1&2).It should be noted,as well,that some existing size estimates for gay men and other men who have sex with men and for transgender people may be underestimated in settings where these populations are highly stigmatized and/or criminalized.Coalition focus

100、countries have been slow to remove legal and other human rights-related impediments,despite clear evidence that they stop people from getting the information,services and support they need to protect themselves and their partners against HIV infection.7 All but four of the 40 GPC countries still cri

101、minalize sex work in some respects,half of the countries(20)criminalize same-sex sexual relationships,and five countries criminalize transgender people(Table 3).All but four(Cameroon,Democratic Republic of the Congo,Mexico and Thailand)of the 32 countries reporting these data criminalize drug use or

102、 the possession of drugs for personal use,despite strong evidence linking the criminalization of drug use with increased risk of HIV transmission(11).There is compelling evidence that any form of criminalization increases HIV risk for sex workers(including through decreasing condom use because of ru

103、shed negotiations and a reluctance to carry condoms in a bid to avoid police harassment)(12).A recent ten-country study from sub-Saharan Africa reported that HIV prevalence among gay men and other men who have sex with men was over five times higher in countries that criminalized same-sex relationsh

104、ips than in non-criminalized settings,and 12 times higher in settings where recent prosecutions had occurred(13).8 Data describing the status of HIV prevention services for key populations in GPC focus countries are incomplete,especially for transgender people and people who inject drugs.Very few co

105、untries reported data on key populations experiences of stigma and discrimination at health-care facilities(Table 3).In addition,data on programme outcomes are derived mostly from surveys,which tend to be done irregularly.It is therefore difficult to assess current trends in programme coverage and i

106、mpact.7 Some countries have adopted even harsher laws that criminalize key populations.Ugandas Anti-Homosexuality Act(2023),signed into law in May 2023,provides for severe punishments against lesbian,gay,bisexual,transgende and intersex persons and organizations,while Indonesias new criminal code co

107、ntains articles that violate the rights of women and sexual minorities.8 Burkina Faso,Cameroon,Cte dIvoire,Eswatini,Gambia,Guinea-Bissau,Nigeria,Senegal,Rwanda and Togo.Regular access to HIV prevention remains insufficient among key populations.On average,49%of sex workers,29%of gay men and other me

108、n who have sex with men,and 36%of people who inject drugs accessed two or more HIV prevention services in the previous three monthsagainst a target of 90%.Both data quality and programme coverage for key populations must improve.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY17LEVEL OF RESULTINDICATORBraz

109、ilChinaColombiaEgyptIndiaIndonesiaIran(Islamic Republic of)MadagascarMexicoMyanmarPakistanPeruPhilippinesThailandUkraineViet NamOUTCOMECondom use of sex workers with most recent client,%(reported by sex workers)id95idid966761idid90idid85959290Condom use at last anal sex among MSM(%)id88idid9270ididi

110、d57id5540787769Condom use among transgender people(%)71id75id9669idid75ididid417979idCondom use at last paid sex act,%(reported by men)idid85id46idid13id77idididid84id%of PLHIV on ART-sex workers*idid86id6022ididid5911idid97821%of PLHIV on ART-men who have sex with men*id9390id6038ididid443ididid553

111、2%of PLHIV on ART-people who inject drugs*na8868id5458idididid29idid438654Safe injecting practices (people who inject drugs,%)naididid969073idid91ididid959794%of opioid users who receive opioid substitution therapynaididid2315id922ididid81128COVERAGESex workersPopulation size estimate for female sex

112、 workers in 1000s*idididid868278id68231818786%of all sex workers who received at least two HIV prevention interventions in the past three months22id90id77463593id9063372864418Men who have sex with menPopulation size estimate for men who have sex with men in 1000s*idid505id357761id17120026

113、8id260693608179256%of all MSM who received at least two HIV prevention interventions in the past three months30id1416654228id2962430502531People who inject drugsPopulation size estimate for people who inject drugs in 10005*naid8id17727902id116idid758350189%of all people who inject drugs who received

114、 at least two HIV prevention interventions in the past three monthsidid429465926100id5737id0354444Number of needles and syringes per person who inject drugsna24621id3373idid1541147%of people who inject drugs who avoided health care because of stigma and discriminationnaididid29idididididi

115、didid510idPrevention strategy includes core elements of PWID harm reduction packageNoneAll Half Half Half HalfNoneAll Half Half Half HalfNoneCriminalization of drug use/consumption or possession for personal useYesYesididYesYesYesYesNoYesYesidYesNoYesidTransgender peoplePopulation size estimate for

116、transgender people in 1000s*idid6id703510id123idid7207id139%of all TG people who received at least two HIV prevention interventions in the past three months59id75idid67idididid28038442318Table 1.HIV prevention service coverage and outcomes among key populations in 16 GPC focus countries with HIV epi

117、demics primarily affecting key populations and their sex partnersNotes:ART:antiretroviral therapy;MSM:gay men and other men who have sex with men;PLHIV:people living with HIV;TG:transgender.Source:Global HIV Prevention Coalition 2023 scorecard.*Note that ART data reported can either be from surveys

118、or programmes,and the latter usually give higher values.This limits comparability across countries.*The population size estimates reported can either be nationally representative or only for regions within the country where data is available.This limits comparability across countries.Data sources fo

119、r key population program coverage:Global Aids Monitoring 2022,Global Fund and PEPFAR reports obtained in 2022.Note:some of the data are triangulated and thus not nationally representive.Very goodInsufficient dataNot applicableGoodMediumLowVery lowHIV PREVENTION:FROM CRISIS TO OPPORTUNITY18Table 2.HI

120、V prevention service coverage and outcomes among key populations in 24 GPC focus countries with mixed HIV epidemicsNotes:ART:antiretroviral therapy;MSM:men who have sex with men;PLHIV:people living with HIV;TG:transgender.Source:Global HIV Prevention Coalition 2023 scorecard.LEVEL OF RESULTINDICATOR

121、AngolaBotswanaCameroonCentral African RepublicCongoCte dIvoireDemocratic Republic of the CongoEswatiniEthiopiaGhanaKenyaLesothoMalawiMozambiqueNamibiaNigeriaPapua New GuineaRwandaSouth AfricaSouth SudanUgandaUnited Republic of TanzaniaZambiaZimbabweOUTCOMECondom use of sex workers with most recent c

122、lient,%(reported by sex workers)id76id808692485095idid6265id4286id82id35id72id95Condom use at last anal sex among MSM(%)id78id3064755780ididid4679id5570id5672ididid5869Condom use among transgender people(%)ididididid5052ididididid50idid66idid77idididid82Condom use at last paid sex act,%(reported by

123、men)71id83id756334id8144id90753id73id5690%of PLHIV on ART-sex workers*42889961ididididid9934id90idid24idid707565id8683%of PLHIV on ART-men who have sex with men*id749760ididididid9539id93idid26idid44id66idid83%of PLHIV on ART-people who inject drugs*idididididididididid26idididid25idididi

124、d78idididSafe injecting practices (people who inject drugs,%)idididididid23ididid88idididid36idididididididid%of opioid users who receive opioid substitution therapyidididididididididid13ididididididid1idid26ididCOVERAGESex workersPopulation size estimate for female sex workers in 1000s*idid1264id67

125、5267idid07523814645130id126id%of all sex workers who received at least two HIV prevention interventions in the past three months589798532316857id8849id34394090id79Men who have sex with menPopulation size estimate for men who have sex with men in 1000s*idid73id561954idid33650642

126、24039id310id24id2023%of all MSM who received at least two HIV prevention interventions in the past three months3329id532026653133967id10id204526People who inject drugsPopulation size estimate for people who inject drugs in 1000s*idid4idid3168 Half None None Half Some None None None Half N

127、one None Half None None Half None None Half Half NoneCriminalization of drug use/consumption or possession for personal useidYesNoYesidYesNoYesYesYesYesYesYesYesYesYesYesidYesidYesYesYesYesTransgender peoplePopulation size estimate for transgender people in 1000s*ididididid157ididid4id5idid69idid179

128、ididid4id%of all TG people who received at least two HIV prevention interventions in the past three monthsididididid3912ididid22idididid79idid2ididid628*Note that ART data reported can either be from surveys or programmes,and the latter usually give higher values.This limits comparability across cou

129、ntries.*The population size estimates reported can either be nationally representative or only for regions within the country where data is available.This limits comparability across countries.Data sources for key population program coverage:Global Aids Monitoring 2022,Global Fund and PEPFAR reports

130、 obtained in 2022.Note:some of the data are triangulated and thus not nationally representive.Very goodInsufficient dataNot applicableGoodMediumLowVery lowHIV PREVENTION:FROM CRISIS TO OPPORTUNITY19Table 3.Policy and structural factors affecting key populations in 40 GPC focus countriesSource:Global

131、 HIV Prevention Coalition 2023 scorecard.COUNTRIESKEY POPULATIONSNational strategy includes key elements of recommended packagePercent who avoided health care due to stigma&discriminationCriminalization of key populationsSex workersGay men&other MSMPeople who inject drugsTransgender peoplePrisonersS

132、ex workersGay men&other MSMPeople who inject drugsTransgender peopleSex workersGay men&other MSMPeople who inject drugsTransgender peopleAngola Half HalfNone Half Half HalfNone Half Half Half Half Half Half4.7idididYesYesNoNoCentral African Republic HalfNone Half84.8idididYesNoYesNoCongo Half HalfNo

133、ne Half Half Half Half Half Half13.95.59.322.6YesNoYesNoDemocratic Republic of the CongoAll HalfSome Half Half HalfNone Half34idididYesYesYesNoEthiopia HalfidNoneidNone30.6idididYesYesYesYesGhana Half HalfNone HalfididididYesYesYesNoKenya Half Half Half Half HalfididididYesYesYesNoLesotho Half HalfN

134、oneidid8idididYesNoYesNoMalawi Half Half Half Half Half HalfNoneidNoneididididYesYesYesNoNigeria Half Half Half HalfididididYesYesYesNoPapua New Guinea HalfNone Half Half HalfNone Half Half Half Half Half HalfididididYesNoYesNoSouth Sudan HalfNoneNone Half12.1idididYesYesidNoUganda HalfidNone Half9.

135、3idididYesYesYesNoUnited Republic of Tanzania Half Half Half HalfididididYesYesYesNoZambia Half Half Half Half HalfididididYesYesYesYesZimbabwe Half HalfNone Half Half39.38.3id10.8YesYesYesNoBrazil Half HalfNone Half Half12.1idnaidYesNoYesNoChina Half HalfAllidNoneididididYesNoYesNoColombia Half Hal

136、f Half Half Half Half Half Half Half Half Half Half HalfididididYesNoYesNoIndonesia Half Half Half Half HalfididididYesYesYesNoIran(Islamic Republic of)Half Half Half Half27.8idididYesYesYesNoMadagascar HalfNone Half Half HalfAllidSomeididididNoNoNoNoMyanmarAllAll Half Half HalfididididYesYesYesNoPa

137、kistan Half Half HalfididididYesYesYesNoPeruNoneNoneNone Half HalfididididYesNoidNoPhilippines Half Half Half Half Half Half Half Half5.19.34.75.9YesNoNoNoUkraine Half Half Half Half Half21.36.310.38.4YesNoYesNoViet Nam Half HalfNone Half80%),but very low levels in the Democratic Republic of the Con

138、go,Ghana,Madagascar,Mozambique and Papua New Guinea(75%)in 7 of the 14 countries reporting those data(Colombia,India,Mexico,South Africa,Thailand,Ukraine and Zimbabwe).In the seven countries reporting this information,between 6%(Thailand)and 54%(Viet Nam)of transgender people said they had avoided s

139、eeking health care due to stigma and discrimination.People in prisonsHalf of the 38 focus countries reporting these data have HIV prevention strategies that include at least half of the core elements of a prevention package for prisoners and other incarcerated persons.But the actual provision of HIV

140、 prevention services for this key populations is very limited.Other data reported to the Global AIDS Monitoring system indicate that,among GPC focus countries,Angola,Malawi,Peru,South Africa,Thailand and Ukraine were implementing HIV programmes in prisons on a significant scale.HIV PREVENTION:FROM C

141、RISIS TO OPPORTUNITY23PILLAR 2.COMBINATION PREVENTION FOR ADOLESCENT GIRLS AND YOUNG WOMEN IN HIGH-PREVALENCE LOCATIONSSubstantially fewer adolescent girls and young women(aged 1524 years)are acquiring HIV in the GPC focus countries in sub-Saharan Africa.The greatest progress has been in Botswana,Ca

142、meroon,Eswatini,Kenya,Lesotho,Malawi,Rwanda,the United Republic of Tanzania and Zimbabwe,where new HIV infections among adolescent girls and young women decreased by at least 65%between 2010 and 2022.These trends are due primarily to increasing coverage of combination prevention programmes,with anti

143、retroviral-based prevention playing a major role(see Pillar 5)alongside targeted primary prevention programmes.Changes in sexual behaviour may also have contributed,particularly during earlier stages of the epidemic.It is important to note that HIV incidence among adolescent girls and young women va

144、ries considerably between locations,even in eastern and southern Africa(where incidence tends to be highest).Across sub-Saharan Africa,there is a greater than 1000-fold difference in HIV incidence between locations with the lowest and the highest incidence.Overall,HIV incidence among adolescent girl

145、s and young women is low to moderately high in large parts of eastern and southern Africa;high in parts of southern Africa among those with non-regular partners;and extremely high across much of the latter sub-region among women aged 1825 years who sell or trade sex(16).It is vital that prevention p

146、rogrammes reach the girls and women who are at high risk of acquiring HIV infection.In 2022,the number of locations with high HIV incidence(above 1 per 100 person-years)declined further.13 In combination with programme expansion and adjustments in geographical coverage made over recent years,this me

147、ant that 61%of sub-national areas with high HIV incidence had a dedicated programme for adolescent girls and young women(mostly either a DREAMS programme14 supported by PEPFAR,or a Global Fund-supported initiative).In locations with moderately high HIV incidence(between 0.3 and 0.99 per 100 person-y

148、ears)only 36%had a dedicated programme,according to the Coalition scorecards,which also draw on Global Fund and PEPFAR reporting.However,locations with moderately high incidence are now much more numerous in southern and eastern Africa and in parts of western and central Africaand they contribute la

149、rge absolute numbers of new HIV infections among girls and women.13 High HIV incidenceabove 1 per 100 person-years in the entire population of women aged 1524 yearswas found only in specific sub-national areas in Eswatini,Mozambique,Namibia and South Africa(in southern Africa)and in a few areas in t

150、he Republic of the Congo and Equatorial Guinea(in central Africa).14 “Determined,Resilient,Empowered,AIDS-free,Mentored,and Safe”,a public-private partnership that is implemented across 15 countries in sub-Saharan Africa.Among the locations with high HIV incidence,61%had a dedicated prevention progr

151、amme for adolescent girls and young womenmore than ever before.But womens and girls access to prevention options need to increase further.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY24The latest data show that,among the 11 GPC focus countries reporting these data,at least 80%of priority districts were

152、being serviced with dedicated programmes for young women and their male partners in Eswatini,Kenya,Lesotho and Zimbabwe(Table 4).Geographical coverage was 50%or lower in 5 of the 7 other countries reporting this information.It is important to note that wide geographical coverage does not automatical

153、ly translate into reaching large proportions of adolescent girls.Coverage of comprehensive prevention packages for adolescent girls and young women in communities with moderate and high HIV incidence has remained very low in the majority of countries reporting these data(under 40%in 12 out of 15 cou

154、ntries)(see the right-hand column in Table 4).There is a greater need than ever to apply approaches that increase access of women and girls to prevention options on a large scale.Table 4.Selected prevention service outcome indicators among adolescent girls and young women (1524 years)in 24 GPC focus

155、 countries with mixed HIV epidemics,2022Source:Global HIV Prevention Coalition 2023 scorecard.IndicatorCondom use with non-regular partners (young women,1524 years)Condom use with non-regular partners (young men,1524 years,%)%of priority districts(administrative areas)with dedicated programmes for y

156、oung women&male partners(full package)%of adolescent girls and young women in high HIV incidence communities reached with a comprehensive package of prevention interventionsAngola3146ididBotswanaidid564Cameroon5065id9Central African RepublicididididCongo4566ididCte dIvoire4267ididDemocratic Republic

157、 of the Congo2533ididEswatini557480100Ethiopia2251id17Ghana204420idKenya437010017Lesotho84839034Malawi5373id21Mozambique51483346Namibia68844219Nigeria3862ididPapua New Guinea1831ididRwanda4678id8South Africa6173506South SudanididididUganda4357389United Republic of Tanzaniaididid61Zambia34492837Zimba

158、bwe54818917Very goodInsufficient dataNot applicableGoodMediumLowVery lowHIV PREVENTION:FROM CRISIS TO OPPORTUNITY25Prevention programmes are improving in other respects,though they are hampered by underlying obstacles.For example,most of the GPC focus countries in sub-Saharan Africa reported that th

159、ey were integrating provider-initiated condom promotion and HIV testing services in sexual and reproductive health services.However,societal inequalities mean that many adolescent girls and young women,especially those with low education levels and incomes,still struggle to take their own informed d

160、ecisions about their sexual lives(17).15 This is reflected,for example,in the data on condom use,which show that in 12 of 20 focus countries reporting these data,less than half of adolescent girls and young women used a condom the last time they had sex with a non-regular partner(see also Pillar 4)(

161、Table 4).All but one of the 23 focus countries reporting this information have introduced education policies that include the provision of HIV and sexuality education in secondary schools(Table 5).But the bigger challenge of improving outcomes for the education of girls still exists:less than half o

162、f girls completed their lower-secondary schooling in 10 of the 23 focus countries reporting these data and only 5060%graduated in another 6 countries.There is evidence from different settings that women and girls with poor school attendance and lower education attainment face elevated risks in relat

163、ion to sexual health and HIV(18,19,20,21).15 Based on 17 Demographic and Health Surveys,20182022.Launched in 2023,the HIV Prevention Choice Manifesto for Women and Girls in Africa focuses on reducing HIV infections by translating existing and new HIV prevention options into actual choices for women

164、and girls.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY26Table 5.Selected indicators on policy and structural barriers affecting adolescent girls and young women in 24 GPC focus countries with mixed epidemicsSource:Global HIV Prevention Coalition 2023 scorecard.COUNTRIESADOLESCENT GIRLS AND YOUNG WOMENP

165、roportion of women who experienced intimate partner violence (age 1549)Girls who completed lower secondary educationPolicies on life skills-based HIV and sexuality education(secondary schools)Laws requiring parental consent for adolescents to access HIV testing services,age of consentHIV testing ser

166、vices integrated within sexual and reproductive healthAngolaid32YesYes,12yesBotswanaid92YesYes,16partialCameroon21.543YesYes,16yesCentral African Republicid10YesYes,18yesCongoid45YesYes,14partialCte dIvoireid22yesYes,16idDemocratic Republic of the Congoid52idYes,18no/idEswatiniid54YesYes,12yesEthiop

167、iaid22NoYes,16partialGhanaid50YesYes,14partialKenyaid69YesYes,18yesLesothoid55YesYes,12yesMalawiid21YesYes,14yesMozambiqueid11YesYes,12YesNamibiaid62YesYes,14yesNigeria13,859YesYes,18yesPapua New Guinea47.6idYesYes,18yesRwanda23.830YesYes,12yesSouth Africa30.391YesYes,12yesSouth Sudanid10YesYes,18pa

168、rtialUgandaid23YesYes,12yesUnited Republic of Tanzaniaid27YesYes,14yesZambia25.350YesYes,16partialZimbabwe1953YesYes,16yesVery goodInsufficient dataNot applicableGoodMediumLowVery lowHIV PREVENTION:FROM CRISIS TO OPPORTUNITY27PILLAR 3.COMBINATION PREVENTION FOR MEN AND ADOLESCENT BOYS IN SETTINGS WI

169、TH HIGH HIV INCIDENCEThe steep drop since 2010 in new HIV infections among men and boys across much of sub-Saharan Africa reflects the cumulative impact of combination prevention and treatment.Due to this decline,there are hardly any locations with high HIV incidence above 1 per 100 person-years amo

170、ng all men,though HIV incidence remains high among certain sub-populations of men.A remaining challenge is to bring combination prevention services and tools to the men and boys for whom current programmes are inadequate,many of whom live in poorly served peri-urban and rural areas.The scorecards tr

171、acked progress in three of the core components of prevention for men and boys in GPC focus countries:ART coverage and viral suppression rates;voluntary medical male circumcision(VMMC)(in the 15 countries in eastern and southern Africa where this intervention is recommended);16 and condom use with no

172、n-regular partners.Though not as high as among girls and women,HIV treatment coverage among men and boys(15 years and older)was at least 80%in 9 of the 23 GPC focus countries with mixed HIV epidemics17 and it was 90%or higher in 5 others.18 Coverage was very low(85%in six countries19(implying achiev

173、ement of the 959595 targets)and 80%in three others20(putting them close to reaching those targets).Since people with suppressed viral loads have a near-zero risk of transmitting HIV to their sex partners(7,24),21 very high rates of viral suppression among men are vitally important for reducing HIV i

174、nfections among women,as well as among their male sex partners,in the GPC focus countries(25).It is notable that most of the countries with comparatively low viral suppression rates among men and boys are also experiencing slower reductions in new HIV infections among adolescent girls and young wome

175、n(see the Conclusion).19 Botswana,Eswatini,Rwanda,United Republic of Tanzania,Zambia and Zimbabwe .20 Kenya,Malawi and Namibia.21 When effective HIV treatment is taken consistently,it leads to suppression of the virus to a point where it becomes undetectable.The evidence shows that people with an un

176、detectable viral load have zero risk of transmitting HIV to others during sexual intercourse,and people with a suppressed viral have a near-zero risk of transmitting HIV during sex.There are many under-utilized opportunities to reach adolescent boys and men with effective HIV testing,prevention and

177、treatment services.Using them will help improve treatment outcomes for men and reduce HIV incidence among men and their sexual partners.Table 6.GPC scorecard for HIV prevention among adolescent boys and menSource:Global HIV Prevention Coalition 2023 scorecard.INDICATORBotswanaEswatiniEthiopiaKenyaLe

178、sothoMalawiMozambiqueNamibiaRwandaSouth AfricaSouth SudanUgandaUnited Republic of TanzaniaZambiaZimbabweOUTCOMENational male circumcision prevalence(1524 years)(%)2358894702966227360id49823719National male circumcision prevalence(1549 years)(%)2629930idid46803214Condom use with non-regula

179、r partners(men 1549 years)(%)id8357068id58355482%of PLHIV on ART(men 15+years)88928993%of PLHIV virally suppressed(men 15+years)87907684798170818962id75908788OUTPUTNumber of VMMCs performed per year(2022,in thousands)9171Number of VMM

180、Cs performed in the previous year(2021,in thousands)472855953736380571488151%change in number of VMMCs in the two most recent years(2021 and 2022)28-49-38736-21-2113%performance towards 2025 targets (1534 years)513id32581241009025VMMC coverage(1534 years)(%)5147id

181、8054447665id51id67947834Very goodInsufficient dataNot applicableGoodMediumLowVery lowHIV PREVENTION:FROM CRISIS TO OPPORTUNITY29VMMC is a“once-off”prevention method that protects males against HIV infection without requiring any subsequent change in behaviour.Longstanding evidence from studies shows

182、 that it reduces the risk to men and boys of acquiring HIV during unprotected heterosexual intercourse by about 60%(26,27),while also reducing the risk of acquiring syphilis(28).There is new evidence that VMMC continues to be cost-effective for HIV prevention in sub-Saharan Africa(29).The scale-up o

183、f VMMC programmes has added momentum to prevention programmes in many of the 15 countries in eastern and southern Africa where this method has been prioritized since 2007.Those countries are providing VMMC as part of a package of prevention interventions,which includes safer sex education,condom edu

184、cation and provision,HIV testing and linkage to care and treatment(if a person is HIV-positive),and managing STIs.By the end of 2022,almost 35 million men and boys had opted for VMMC in the 15 priority countries,with Uganda,the United Republic of Tanzania and Zambia accounting for more than half of

185、all VMMC procedures performed in those countries.But recent trends in the uptake of VMMC have been mixed.The number of procedures performed in 2021 and 2022 rose in 9 out of the 15 priority countries,including in Botswana and Malawi,where VMMC coverage had been low previously.But VMMC programmes hav

186、e struggled to recover from the COVID-19 disruptions in several other countries(notably Eswatini,Rwanda,South Africa and Zambia)(Table 6).Overall in sub-Saharan Africa,the national prevalence of male circumcision among men and boys surpassed 90%in eight GPC focus countries(Angola,Cameroon,Cte dIvoir

187、e,Democratic Republic of the Congo,Ethiopia,Ghana,Kenya and Nigeria).22 But VMMC programmes in several focus countries can be making a bigger contribution to HIV prevention leading up to 2030including in Botswana,Eswatini,Malawi,Namibia,Rwanda,Zambia and Zimbabwe,where national prevalence of male ci

188、rcumcision was still 30%or lower(Table 6).VMMC programmes face two major challenges:reduced funding(there has been heavy reliance on PEPFAR,which,as the leading funding partner,has enabled the progress to date)and the need to reach more men in their twenties and older(services in some countries have

189、 focused especially on adolescents).Other research suggests that VMMC programmes are missing men with lower incomes and men living in rural areas,23 which may account partially for the wide variations in the uptake of VMMC programmes at subnational levels.2422 In many of those countries,male circumc

190、ision was a widespread cultural or religious practice before the advent of VMMC programmes.23 Based on Population-based HIV Impact Assessments,20152019.24 Based on a special analysis by Avenir Health using the DMPPT2 VMMC.Data analysed were from Botswana,Eswatini,Kenya,Lesotho,Mozambique,Rwanda,Sout

191、h Sudan,the United Republic of Tanzania,Zambia and Zimbabwe.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY30As discussed in greater detail under Pillar 4,condom use among men is still irregular in many of the focus countries with mixed epidemics.Only in 4(Eswatini,Lesotho,Namibia and Zimbabwe)of the 21 G

192、PC countries reporting these data did more than 80%of adult men(1549 years)say they used a condom at last sex with a non-regular partner;fewer than 50%did so in 6 countries(Angola,Democratic Republic of the Congo,Ghana,Mozambique,Papua New Guinea and the United Republic of Tanzania).Yet,the data als

193、o show that in most focus countries the vast majority of men know that condoms are a safe prevention method(Table 7).(Levels of condom use among sex workers,gay men and other men who have sex with men,and transgender women are discussed under Pillar 1,above.)In the absence of other standard preventi

194、on indicators for men,the scorecard still focuses on VMMC as an outcome for Pillar 4(see Figure 12 and the country Annex).Overall,four countries(Lesotho,Rwanda,United Republic of Tanzania and Zambia)scored“high”or“very high”on VMMC,while five countries scored very low(Botswana,Eswatini,Malawi,Namibi

195、a,and South Sudan.The relatively higher uptake of VMMC in eastern Africa since the onset of VMMC programming suggests that the procedure was more acceptable in that sub-region,where traditional male circumcision was more common.In southern Africa,condom programming could build on existing family pla

196、nning programmes.It is striking that hardly any of the prevention programmes in focus countries in sub-Saharan Africa fared well on the scorecard for both women and men.In Botswana,Eswatini,Lesotho and Zimbabwe,programmes focused on adolescent girls and young women scored well,but those focused on b

197、oys and men scored poorly.The inverse was seen in Ethiopia,Rwanda,United Republic of Tanzania and Zambia,where HIV prevention programmes among boys and men scored well,but those targeting adolescent girls and young women scored poorly.These patterns are influenced by long-term factors that go beyond

198、 the delivery of HIV programmes in recent years.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY31PILLAR 4.PROMOTION AND DISTRIBUTION OF CONDOMS AND LUBRICANTS Condoms are a low-cost prevention option that offers protection against HIV,other STIs and unintended pregnancies.The UN Population Fund(UNFPA)has

199、estimated that the more than five billion condoms it provided to low and middle-income countries between 2018 and 2022 had the potential to avert 24.9 million STIs,570 000 HIV infections and 16.3 million unintended pregnancies(30).In recent years,though,condom programmes have been steadily defunded

200、in many GPC focus countries and social marketing programmes have been cut back.Table 7.Condom use,selected determinants of use,and reported condom distribution in 24 GPC focus countries with mixed HIV epidemicsSource:Global HIV Prevention Coalition 2023 scorecard.Note:Data on condom distribution are

201、 often reported incompletely,which can give rise to apparent contradictions,such as countries with high reported use and low distribution of condoms(e.g.,Lesotho).INDICATORCondom use with non-regular partners(%)Knows condom as prevention method(%)Woman justified to insist on condom use if husband ha

202、s STI (men 1549 years)(%)Number of condoms distributed/sold per couple-year*(age range 1564 years-2021)%of condom distribution need met (2021)Women 1549 yearsMen 1549 yearsWomen 1549 yearsMen 1549 yearsAngola274666785913Botswanaididididid54idCameroon4363777771316Central African Republicididididididi

203、dCongo4064788785ididCte dIvoire3863608078ididDemocratic Republic of the Congo243356736801Eswatini66839187942879Ethiopia2051587761235Ghana26Kenya3768idid83211Lesotho788192889226Malawi497375758222100Mozambique4247556561ididNamibia66828890931546Nigeria3665737877870Papua New Guinea

204、idRwanda4670929592873South Africa6068ididid2063South Sudanididididid0idUganda37588788871160United Republic of Tanzania2835ididid842Zambia3554838773316Zimbabwe658284888730100Very goodInsufficient dataNot applicableGoodMediumLowVery lowHIV PREVENTION:FROM CRISIS TO OPPORTUNITY32Mathematical models sug

205、gest that condom use still has a major role in slowing the spread of HIV in all settings and they point to a continued need to sustain high levels of condom use(31,32).Condom distribution,however,is far below the level of need,with 15 or fewer condoms distributed per couple per year in 15 of the 20

206、GPC focus countries reporting those data(Table 7).Most of those focus countries did not meet even half their estimated condom distribution needs.Only 3 countries(Eswatini,Malawi and Zimbabwe)fared well,while 4 others managed to meet at least 60%of their condom needs.Data quality on national condom d

207、istribution and sales remains low in several countries and reporting is incomplete,indicating a need to strengthen data collection from public,social marketing and private sectors.Among adolescent girls and young women(1524 years),condom use with non-regular partners is very infrequent in most of th

208、e focus countries with mixed HIV epidemics(Table 4).Only in Lesotho did more than 75%of this priority population report using a condom the last time they had sex with a non-regular partner;in 12 of the other 20 countries reporting these data less than half of adolescent girls and young women said th

209、ey had done so.It is notable that the levels of condom use with non-regular partners were low in most of the countries where HIV incidence declines among adolescent girls and young women since 2010 have been particularly slow.Condom use was also highly irregular among adult women:in 16 of the 21 foc

210、us countries reporting these data less than half of women aged 1549 years said they had used a condom at last sex with a non-regular partner.Their male counterparts were significantly more likely to say they used a condom in similar circumstances,though levels of reported condom use surpassed 80%in

211、only 4 countries(Eswatini,Lesotho,Namibia and Zimbabwe)(Table 7).Knowledge about condoms appears not to be a major obstacle:at least two thirds of adolescent girls and young women knew a formal source for condoms in 6 of the 9 countries reporting these data.Similarly,knowledge about condoms as an HI

212、V prevention method was widespread among women aged 1549 years in 11 of the 18 GPC countries with data and among their male counterparts in 15 of those countries.This suggests that,while demand creation remains important,affordable access to condoms is a major stumbling block,especially in low-incom

213、e groups.Indeed,other evidence indicates that wealthier men and women are most likely to have used condoms the last time they had sex with a non-regular partner(33).Modelling indicates that consistently high levels of condom use are still needed to achieve impact and sustain gains in HIV responses.H

214、IV PREVENTION:FROM CRISIS TO OPPORTUNITY33Figure 6 depicts the downward trend in investment in condom procurement and distribution after 2011.Considering the rapidly growing young adult population in Africa,this suggests that a decline in the availability of and access to free and subsidized condoms

215、 may be underway.Other information sources also point to worrying trends in condom use.Analysis of Demographic and Health Survey data indicate that among young women aged 1524 years,condom use at last sex with a non-regular partner declined substantially between 2011 and 2015 and between 2015 and 20

216、20 in western and central Africa,from an average 42%to 25%,while it remained steady but low in eastern and southern Africa,at about 36%(34).Figure 7 also shows a downward trend in condom use during premarital sex among young people in four countries with recent survey data.Figure 6.Trends in condom

217、distribution via major condom procurers and distributors,20102022Source:Mann Global Health.Understanding the global condom landscape.Seattle,Geneva 2024.Note:Donors include UNFPA(including third-party procurement);the United States Agency for International Development;and the Global Fund.Data for do

218、nors reflect global procurement;condoms may not have been distributed in the same fiscal year.Data for social marketing organizations reflect the reported distribution as per the DKT social marketing statistics report.The data for South Africa reflect procurement through domestic resources.Other dom

219、estic procurement is not reflected.Condoms procuredMajor donor fundingSouth AfricaSocial marketing(all organizations)1 000 000 0002000222 000 000 0003 000 000 0004 000 000 0005 000 000 0006 000 000 0007 000 000 0000HIV PREVENTION:FROM CRISIS TO OPPORTUNITY34Figure 7.Trends in c

220、ondom use among young people during premarital sex,four countries in sub-Saharan AfricaSource:Mann Global Health.Understanding the global condom landscape.Seattle,Geneva 2024.Note:Analysis based on data from Demographic and Health Surveys,available at The DHS Program STATcompiler(http:/).PILLAR 5.WI

221、DER ACCESS TO ANTIRETROVIRAL-BASED PREVENTIONAntiretroviral-based prevention has a central role in achieving the steep reductions in new HIV infections that are required to reach the 2025 prevention targets and in sustaining those reductions beyond that milestone.Increased access to antiretroviral t

222、herapy(ART)and the growing proportion of people living with HIV who are virally suppressed have provided much of the impetus for the steep drop in the number of adults(15 years and older)acquiring HIV in the past decade.When effective HIV treatment is taken regularly,it suppresses the virus to a poi

223、nt where it becomes undetectable.Study evidence shows that there is zero risk for people living with HIV with an undetectable viral load to transmit HIV sexually and near-zero risk for people with a suppressed viral load(7,35,36).Most GPC countries where HIV circulates widely in the general populati

224、on are doing very well at diagnosing and treating people living with HIV,and at enabling those on treatment to suppress their HIV viral loads to levels that almost rule out onward transmission of the virus(Table 8).Twelve of the 24 focus countries with mixed epidemics,mostly in sub-Saharan Africa,ha

225、ve achieved the 909090 target(i.e.,at least 73%of people living with HIV were virally suppressed)and,among them,8 have already reached the 959595 target(i.e.,at least 86%of people living with HIV were virally suppressed)(Table 8).Those achievements can be credited to strong political commitment and

226、sustained infusions of funding for HIV testing and treatment,price reductions for recommended antiretroviral regimens,implementation of international treatment guidelines,and maturing collaborations between public and community health systems.35%39%41%34%49%52%54%49%36%41%60%43%50%68%77%69%39%50%22%

227、51%55%41%47%44%68%51%Zambia(20022018)Kenya(20032022)United Republic of Tanzania(20042022)South Africa(20122023)Women 1520 yearsMen 1524 years2003202220022200020%100%200%HIV PREVENTION:FROM CRISIS TO OPPORTUNITY35Table 8.Antiretroviral-based prevention scorecard for 2

228、4 GPC focus countries with mixed HIV epidemicsTable 9.Antiretroviral-based prevention scorecard for 16 GPC focus countries with HIV epidemics primarily affecting key populations and their sexual partnersSource:Global HIV Prevention Coalition 2023 scorecard.INDICATORAngolaBotswanaCameroonCentral Afri

229、can RepublicCongoCte dIvoireDemocratic Republic of the CongoEswatiniEthiopiaGhanaKenyaLesothoMalawiMozambiqueNamibiaNigeriaPapua New GuineaRwandaSouth AfricaSouth SudanUgandaUnited Republic of TanzaniaZambiaZimbabweOUTCOME%of all PLHIV diagnosed5897935729494948695id709594id90959395%of all

230、 PLHIV on ART469388492472829583639486938191id69094%of all PLHIV virally supressedid9379idid62id9375id8985877186idid9069id79928789%of all PLHIV virally supressed(women 15+)id9784idid69id9580439388937490idid9174id83968993%of all PLHIV virally supressed(men 15+)id8777idid54789076id8479817081

231、idid8962id75908788OUTPUTRegulatory approval in place(0=no,1=yes)010ididid1101111PrEP guidelines in place(0=no,1=in preparation,2=yes)022idid22222222222id2222222%of estimated PrEP need met(%)id4840id04012id3862idid53ididididid611id75ididNumber of people who received PrEP at least once in t

232、he past 12 months(Dec 2022)id13 3804377idid6768650id21 6848088155 526 28 12823 104id29 826 384 429id10 775 406 170153195 743 162 477 162 695 79 602Number of people who received PrEP at least once in the past 12 months(Dec 2021)id90644426idid2427785313 74613 7792135117 174 22 69510 97157 71718 344 14

233、8 952id8556346 667id120 524 41 335 147 397 37 916Change in PrEP coverage between Dec 2021 and December 2022(%)id48-1idid55010id572793324111id63158id2617id6229310110PrEP coverage score*id31idid21id31772id7idid3313755Composite PrEP score(0-10 points based on regulatory,guidelines and coverage)id63idid

234、53id5410105id10idid66361088INDICATORBrazilChinaColombiaEgyptIndiaIndonesiaIran(Islamic Republic of)MadagascarMexicoMyanmarPakistanPeruPhilippinesThailandUkraineVietnamOUTCOME%of all PLHIV diagnosed91idid7479id51idid0id866390id89%of all PLHIV on ART74idid47683337181id73%of all PLHIV virall

235、y supressed70idid3963id33id58idid61id79id72%of all PLHIV virally supressed(women 15+)ididid44idid34id51idid58id81id68%of all PLHIV virally supressed(men 15+)idididididid32id59idid63id78id74OUTPUTRegulatory approval in place(0=no,1=yes)111id001010010101PrEP guidelines in place(0=no,1=in preparation,2

236、=yes)212id2%of estimated PrEP need met(%)16id0id0110312id374131850Number of people who received PrEP at least once in the past 12 months(Dec 2022)55 746id1636id26975942702id51911 80314 914907551 493Number of people who received PrEP at least once in the past 12 months(Dec 2021)

237、40 737id598id2700idid0idididididid9833idChange in PrEP coverage between Dec 2021 and December 2022(%)37id174id-3ididididididididid-8idPrEP coverage score*idid0id111011id112id7Composite PrEP score(0-10 points based on regulatory,guidelines and coverage)idid0id224043id425id10Very goodInsufficient data

238、Not applicableGoodMediumLowVery lowVery goodInsufficient dataNot applicableGoodMediumLowVery lowSource:Global HIV Prevention Coalition 2023 scorecard.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY36However,the overall achievements hide notable imbalances.In sub-Saharan African countries,levels of viral s

239、uppression were consistently higher among adult women,compared with adult men.Unless corrected,that disparity will continue to have major implications for HIV prevention in the years ahead.A recent study from Uganda,for example,estimates that HIV incidence among women could be reduced by half if vir

240、al suppression rates among men were as high as those among women(37).Achieving and sustaining very high levels of ART coverage and viral load suppression among people of all sexes is vital for breaking the cycles of HIV transmission.Similarly,UNAIDS estimates show that the coverage of ART remains mu

241、ch lower among adolescents(aged 1019 years)than among adults overall.Globally,a little over half of adolescents were receiving HIV treatment in 2022,much lower than the 76%coverage among adults.Viral load suppression rates among adolescents are also much lower than for adults(38,39).Treatment progra

242、mmes are performing poorly in most of the GPC focus countries where the HIV epidemics are primarily affecting key populations and their sex partners:only in Thailand did the percentage of people living with HIV who were virally suppressed exceed 73%(the threshold indicative of achieving 909090 targe

243、ts)(Table 9)and it exceeded 60%in only 4 other countries.Those data are symptomatic of a wider failure of HIV programmes to enable people belonging to key populations to avoid or manage HIV infection successfully.PrEP is a potentially crucial tool for HIV prevention among people belonging to key pop

244、ulations and their sex partners,and among women and adolescent girls in settings where HIV incidence is high.Most of the GPC focus countries in sub-Saharan Africa have issued regulatory approval for the provision of oral PrEP and almost all of them have included oral PrEP in their national guideline

245、s.Eight of 16 focus countries with concentrated epidemics had regulatory approval and ten had completed national guidelines for PrEP provision.Actual provision of oral PrEP has expanded considerably,especially in the focus countries with mixed epidemics.The numbers of people who received PrEP at lea

246、st once in the previous 12 months more than doubled between 2021 and 2022 in 6 of the 17 countries reporting these data,including in some countries where PrEP provision was already fairly well-established(e.g.,Kenya,South Africa,Uganda and Zambia).At least 100 000 people received PrEP at least once

247、in 2022 in each of the latter Access to HIV testing and treatment remains unequal.Levels of viral suppression are lower among adolescents and men and in regions where key populations are most affected.Widescale,trusted service platforms are urgently needed to increase access to prevention,testing an

248、d treatment for key populations and men,and to achieve the 2025 and 2030 targets for everyone.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY374 countries,as well as in Nigeria and the United Republic of Tanzania(Table 8).But PrEP coverage(measured as a percentage of the estimated national need for PrEP)w

249、as higher than 50%in only 4 of the 11 countries with mixed epidemics that reported such estimates(Ghana,Malawi,South Africa and the United Republic of Tanzania)(Table 8).PrEP coverage is very low in the focus countries where the epidemic is primarily affecting key populations and their partners,with

250、 study evidence supporting that finding(40).Only Viet Nam managed to meet at least half of the estimated PrEP need(Table 9).Low coverage of PrEP and ART heightens the importance of condoms as HIV prevention tools among key populations.PrEP access varies greatly between regions,as well.Significant pr

251、ogress relative to the 2025 global targets has only been made in eastern and southern Africa and western and central Africa(Figure 8),though access to PrEP there remains highly uneven.Country progress in terms of PrEP access also varies greatly within and between regions(Figure 9).Figure 8.Number of

252、 people using PrEP in 2022,relative to 2025 targetsSource:Prepared based on 2023 prevention scorecards and Global AIDS Monitoring.0,10.02.04.06.08.020162022Asia-PacificMillion8.20,00.00.20.40.6Eastern Europe and central AsiaMillion0.620162022Target(users)1,30.01.02.03.04.0Eastern and southern Africa

253、Million3.620162022Target(users)0,10.00.51.01.52.02.5Latin America and the CaribbeanMillion2.30,00.00.10.20.320162022Target(users)20162022Target(users)Middle East and North AfricaMillion0.30,40.00.20.40.60.81.0Western and central AfricaMillion0.92,50.05.010.015.020.025.0GlobalMillion21.2 2025 Target(

254、Note:In the global model to estimate PrEP need to achieve 2025 targets,PrEP need was defined as person-years of PrEP meaning use for a period of 12 months.Country reporting,however,is done using the indicator people who used PrEP at least once in the past 12 months.For the purpose of this chart it w

255、as assumed that average duration of PrEP use was 6 months.Based on this assumption,the global target of 10.6 million person years of PrEP use was translated into an indicative estimated target of 21.2 million PrEP users.The same logic was applied to regional targets.)Target(users)20162022Target(user

256、s)20162022Target(users)HIV PREVENTION:FROM CRISIS TO OPPORTUNITY38Figure 9.Number of people using PrEP,relative to country epidemic sizeNote:The assumptions made for the levels of PrEP use that are required to come close to achieving the global targets are the same as in Figure 8.It was assumed that

257、 two people using PrEP in the past 12 months equals one person-year of PrEP use.In interpreting Figure 9,it should be noted that PrEP targets are not a direct function of the number of new HIV infections in a country:the relationship is only broadly indicative.Source:Based on 2023 prevention scoreca

258、rds and Global AIDS Monitoring.a)Countries with fewer than 12 000 new HIV infectionsb)Countries with more than 12 000 new HIV infectionsDR CongoNumber of people who used PrEP in the past 12 months10 000020 00030 00040 00050 00060 00070 00080 00090 000100 000Number of new HIV infections20004000600080

259、0010 00012 000Indicative level of PrEP use required for countries to reach level of PrEP use proposed in global targetsViet NamNamibiaZimbabweMalawiBotswanaIslamic Republic of IranPeruColombiaMadagascarCameroonMyanmarSouth Sudan EthiopiaCte dIvoireThailandRwandaLesothoNumber of people who used PrEP

260、in the past 12 months50 0000100 000150 000200 000250 000300 000350 000400 000450 000500 000Number of new HIV infections10 00020 00030 00040 00050 00060 000Indicative level of PrEP use required for countries to reach level of PrEP use proposed in global targetsIndonesiaUgandaKenyaUnited Republic of T

261、anzaniaGhanaMexicoPhilippinesEastern and southern Africa Western and central AfricaLatin AmericaAsia and the PacificZambiaHIV PREVENTION:FROM CRISIS TO OPPORTUNITY39Recently,two new,long-acting PrEP options have become available:the dapivirine vaginal ring and long-acting injectable cabotegravir(CAB

262、-LA).Since 2021,WHO has recommended the dapivirine vaginal ring for women who are at substantial risk of acquiring HIV.By mid-2023,Botswana,Eswatini,Kenya,Lesotho,Malawi,Namibia,Rwanda,South Africa,Uganda,Zambia and Zimbabwe had either granted regulatory approval for use of the vaginal ring option o

263、r authorized its importation(41).In 2022,WHO recommended CAB-LA for people at substantial risk of HIV infection.By late 2023,CAB-LA had been registered in 13 focus countries,including Botswana,Brazil,Malawi,Peru,Philippines,South Africa,Zambia and Zimbabwe.Along with increased provision of PrEP,ther

264、e is a need to increase awareness,acceptability and demand for this powerful prevention option.Increasing PrEP coverage at scale requires that countries pay attention not only to the availability of PrEP,but also to the acceptability and accessibility of PrEP services.Differentiated service delivery

265、 for PrEP is therefore important(42).Coverage depends both on initial uptake and on effective use of PrEP(i.e.,individuals are using PrEP as directed at times of substantial risk).In studies and demonstration projects in Africa,adherence to oral PrEP often has been low,however(43,44).The reasons cit

266、ed include fear of stigma,concerns about side-effects,and insufficient knowledge about this prevention method(45,46,47).Many low-and middle-income countries outside eastern and southern Africa have fallen behind in enabling PrEP access.They have an opportunity to follow the examples of Kenya,Lesotho

267、,Thailand and Viet Nam,which have increased access to combination prevention,including PrEP,and have recorded substantial declines in HIV incidence.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY40PROGRESS ON THE TEN MAIN ACTION POINTS IN THE HIV PREVENTION 2025 ROAD MAPThe GPC focus countries in 2022 end

268、orsed a new iteration of the HIV Prevention Road Map(48),which sets out ten country-level actions to accelerate progress towards the 2025 HIV prevention targets and to sustain those gains(Figure 10).Aligned with the 2021 Political Declaration on HIV and AIDS,the actions centre on widening the availa

269、bility and use of proven HIV prevention options(such as antiretrovirals,condoms,VMMC in eastern and southern Africa,and harm reduction services)alongside new ones.Also emphasized is the importance of adopting rights-based,people-centred approaches and reducing the discrimination,inequalities and vio

270、lence that heighten peoples risk of acquiring HIV,while restricting their access to prevention services.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY41The 2025 Road Map reflects lessons from implementation of the 2020 Road Map and considers the shifting context in which HIV responses operate,including t

271、he evolving epidemic itself,financing challenges and the diminishing space in many countries for civil society-led activities.It therefore emphasizes policy,legal and societal changes that can make it easier for people to avoid acquiring HIV infection.It also highlights the powerful interplay betwee

272、n primary HIV prevention,testing,treatment and the prevention of vertical transmission of HIV.Evident across the Road Map is an intensified focus on reaching key populations everywhere and adolescent girls and young women and their male partners in sub-Saharan Africa;addressing inequalities that hei

273、ghten the risk of acquiring HIV;and strengthening the roles of communities in HIV prevention.The Road Map guides the use of scarce resources in ways that can achieve maximum impact and it emphasizes the need to facilitate wider availability and use of innovative HIV prevention tools(such as long-act

274、ing formulations for PrEP)and approaches(such as telemedicine and other virtual services).The Road Map survey was conducted to gauge progress in implementation of the action plan and identify important hindrances and gaps.The survey was done in March 2023 among 35 GPC focus countries;it did not yet

275、include the five other countries which were invited to join the Coalition later in 2023.The survey results allow comparisons to be made between countries.2525 Comprising 45 key questions,the survey was completed by HIV prevention focal points from National AIDS Commissions,Ministries of Health,UNAID

276、S and UNFPA,as well as by National AIDS Commission directors,UNAIDS country directors and regional directors,and UNFPA representatives.Generally,each country response was then compiled by a technical working group,led by the leadership of the National AIDS Council or equivalent structure.Thirty-five

277、 countries submitted their results,which were then verified by national HIV programmes.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY42Figure 10.The HIV Prevention 2025 Road Maps ten-point action planSource:UNAIDS Global HIV Prevention Coalition.HIV prevention 2025 Road Map:getting on track to end AIDS a

278、s a public health threat by 2030.Geneva:UNAIDS;2022.Strengthen accountability of all stakeholders for progress in HIV preventionEstablish real-time prevention programme monitoring systems with regular reportingStrengthen accountability of all stakeholders for progress in HIV preventionStr

279、engthen and expand community-led HIV prevention services and set up social contracting mechanismsReinforce HIV prevention leadership entities for multisectoral collaboration,oversight,and management of prevention responsesConduct a data-driven assessment of HIV prevention programme needs and barrier

280、sInstitute mechanisms for rapid introduction of new HIV prevention technologies and programme innovationsPromote integration of HIV prevention into essential related services to improve HIV outcomesDefine country investment needs for an adequately scaled HIV prevention response and ensure sustainabl

281、e financingAdopt a prevision prevention approach focused on key and priority populations including differentiated national 2025 prevention targetsHIV PREVENTION:FROM CRISIS TO OPPORTUNITY43Survey results show that,overall in 2023,more countries reported using granular data to assess and plan around

282、their HIV prevention needs,including their funding requirements.People-centered planning was also becoming more widespread,along with awareness of the value of community-led prevention activities(Figure 11).26 However,not nearly enough was being done to integrate HIV prevention and other services,in

283、troduce solid accountability frameworks,or remove social and legal barriers.Community-led service delivery remained a work-in-progress in many focus countries,as did the overhaul of national structures to lead and coordinate national prevention programmes,and the introduction of real-time programme

284、monitoring systems.The survey results for each of the ten action points are discussed below.Figure 9 provides a global overview,while Table 10 shows the highly varied progress in countries with mixed HIV epidemics in sub-Saharan Africa(Table 10).In other regions(Table 11),less progress was reported

285、against the ten action points in most countries.26 The term“community-led”refers to leadership by and for people living with and affected by HIV,including and especially key populations,women and young people.The 306080 targets are defined as follows in the Global AIDS Strategy:30%of testing and tre

286、atment services to be delivered by community-led organizations;60%of the programmes to support the achievement of societal enablers to be delivered by community-led organizations;80%of service delivery for HIV prevention programmes for key populations and women to be delivered by community-,key popu

287、lation-and women-led organizations.Figure 11.Progress on each of the ten action points in the HIV Prevention 2025 Road Map in 35 GPC focus countries,2023Source:Global Prevention Coalition Progress Survey,2023.Number of Countries055DoneIn progressNot yet done260281620

288、302501.Data-driven needs assessment2.Precision prevention approach3.Define investment needs4.HIV prevention leadership agencies5.Expand community-led services6.Remove social and legal barriers7.Integration with related services8.Introduction of new technologies9.Real-time programme monito

289、ring10.Accountability for HIV progressHIV PREVENTION:FROM CRISIS TO OPPORTUNITY44Table 10.Implementation of the ten Road Map action points in 21 GPC countries with mixed HIV epidemics,2023Source:Global Prevention Coalition Progress Survey,2023.Note:The upper part of Tables 15 and 16(rows 1 to 10)is

290、a summary of the lower part(rows 1.1 to 10.2).Hence,the score on individual rows in the upper part does not provide a full status assessment of the relevant thematic area.For example,a positive score on social and legal barriers would reflect progress on country-specific Road Map actions,but would n

291、ot necessarily indicate the removal of all social and legal barriers.For the status on barriers see Tables 3 and 5.CompletedPartially completedNot yet doneNRROAD MAP BASELINE SURVEY COMPONENTS CONSIDERED FOR OVERALL ROAD MAP ACTION SCORINGAngolaBotswanaCameroonCte dIvoireDemocratic Republic of the C

292、ongoEswatiniEthiopiaGhanaKenyaLesothoMalawiMozambiqueNamibiaNigeriaRwandaSouth AfricaSouth SudanUgandaUnited Republic of TanzaniaZambiaZimbabweSUMMARY ON COMPLETION OF TEN ROAD MAP ACTIONS1Data-driven needs assessment2Precision prevention approach3Define investment needs4HIV prevention leadership ag

293、encies5Expand community-led services6Remove social and legal barriers7Integration with related services8Introduction of new technologies9Real-time programme monitoring10Accountability for HIV progressPROGRESS ON DETAILED MILESTONES AND COMMITMENTS1.1HIV epidemic pattern and prevention programme anal

294、ysis1.2Consultation meetings to identify barriers1.2.1.Listing of the identified barriers2.1Developed a prevention road map or plan2.2Set granular HIV prevention targets2.3Translate national targets into subnational targets2.4Differentiated HIV prevention packages2.5Packages for young women where re

295、levant2.7Standard operating procedures/guidelines for relevant pillars3.1Budgeted or costed national HIV prevention plan3.2Dialogue to address prevention funding gap4.1Multi-sector HIV prevention leadership exists4.2The entity is functional and relevant meetings are held4.3Milestones to reinforce pr

296、evention leadership entities5.1Government convening includes relevant communities 5.2Public funds are being allocated to NGOs 5.3Any laws or policies impacting NGOs5.4Any targets set on community-led services5.5Milestones on community-led services6.1Legal,policy and structural barriers identified in

297、 strategy6.2Milestones to addess the country-specific barriers7.1Milestone on promoting integration7.1.1Milestones on integration listed8.1Actions for new prevention technologies8.2.Milestones on new prevention technologies9.1Data triangulation for coverage of programmes9.3Developed subnational scor

298、ecards9.4HIV prevention funding expenditure analysis done9.5Cost-effectiveness included in programe reviews10.1Road Map table on accountability adapted and adopted10.2Accountability framework in line with Road MapHIV PREVENTION:FROM CRISIS TO OPPORTUNITY45Table 11.Implementation of the ten Road Map

299、action points in 14 GPC countries with HIV epidemics that primarily affect key populations,2023 Source:Global Prevention Coalition Progress Survey 2023.CompletedPartially completedNot yet doneNRROAD MAP BASELINE SURVEY COMPONENTS CONSIDERED FOR OVERALL ROAD MAP ACTION SCORINGBrazilChinaColombiaEgypt

300、IndonesiaIslamic Republic of IranMadagascarMexicoMyanmarPakistanPeruPhilippinesUkraineSUMMARY ON COMPLETION OF TEN ROAD MAP ACTIONS1Data-driven needs assessment2Precision prevention approach3Define investment needs4HIV prevention leadership agencies5Expand community-led services6Remove social and le

301、gal barriers7Integration with related services8Introduction of new technologies9Real-time programme monitoring10Accountability for HIV progressPROGRESS ON DETAILED MILESTONES AND COMMITMENTS1.1HIV epidemic pattern and prevention programme analysis1.2Consultation meetings to identify barriers1.2.1.Li

302、sting of the identified barriers2.1Developed a prevention road map or plan2.2Set granular HIV prevention targets2.3Translate national targets into subnational targets2.4Differentiated HIV prevention packages2.5Packages for young women where relevant2.7Standard operating procedures/guidelines for rel

303、evant pillars3.1Budgeted or costed national HIV prevention plan3.2Dialogue to address prevention funding gap4.1Multi-sector HIV prevention leadership exists4.2The entity is functional and relevant meetings are held4.3Milestones to reinforce prevention leadership entities5.1Government convening inclu

304、des relevant communities 5.2Public funds are being allocated to NGOs 5.3Any laws or policies impacting NGOs5.4Any targets set on community-led services5.5Milestones on community-led services6.1Legal,policy and structural barriers identified in strategy6.2Milestones to addess the country-specific bar

305、riers7.1Milestone on promoting integration7.1.1Milestones on integration listed8.1Actions for new prevention technologies8.2.Milestones on new prevention technologies9.1Data triangulation for coverage of programmes9.3Developed subnational scorecards9.4HIV prevention funding expenditure analysis done

306、9.5Cost-effectiveness included in programe reviews10.1Road Map table on accountability adapted and adopted10.2Accountability framework in line with Road MapHIV PREVENTION:FROM CRISIS TO OPPORTUNITY461.Conduct an evidence-driven assessmentof HIV prevention programme needs and barriers Action point 1

307、entails conducting an HIV prevention response and epidemic analysis,holding consultative meetings to identify the main barriers,and compiling a list of those barriers.Most countries are conducting data-driven needs assessments that include analyses of their epidemic patterns and prevention responses

308、,but only 14 out of 35 have completed all relevant analyses.In addition,all but 5 of the countries that responded to the survey have identified and listed the main barriers that hinder their prevention programmes.It is particularly important to identify barriers to effective prevention in the severa

309、l countries which are not recording strong declines in new HIV infections.2.Adopt a precision prevention approach to develop national HIV prevention goals and aligned 2025 targets It is vital,but not enough,for countries to understand their HIV epidemic:they also should put that knowledge to use.Eve

310、n in countries with high overall HIV incidence,the risk of acquiring HIV varies dramatically from place to place.Programmes will be most effective if they target interventions in the locations and communities where HIV incidence is high,rather than spreading resources thinly across settings where th

311、e risk of acquiring HIV may be very low.The potential efficiency gains are also obvious.Action point 2 therefore focuses on developing a national prevention Road Map or plan and setting detailed HIV prevention targets.27The survey found that GPC focus countries are gradually adjusting their preventi

312、on efforts with greater precision.Almost two thirds of countries(22/35)have established granular prevention targets and 21 countries were in the process of translating their national targets into sub-national ones.Three quarters of the countries(26/35)have developed differentiated HIV prevention pac

313、kages,including ones for adolescent girls and young women(in countries with mixed epidemics).27 Assessed under this action point was whether a country had:translated national targets into sub-national targets;developed differentiated HIV prevention packages,including packages for adolescent girls an

314、d young girls where relevant;and had standard operating practices or implementation guides in place for the relevant pillars.Many countries have assessed their HIV epidemics,set granular targets,adapted their Road Maps and developed costed HIV plans.But more focus is needed on sub-national targets a

315、nd plansand on allocating investments in ways that will scale up and sustain national prevention programmes.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY473.Determine country investment needs for adequately scaled HIV prevention responses and ensure sustainable financingShortfalls in funding for prevent

316、ion programmes remain a major handicap.Very few GPC focus countries have raised their HIV prevention spending close to the levels required.HIV prevention programmes typically depend heavily on international resources(principally PEPFAR and the Global Fund)and that reliance is especially strong for p

317、rogrammes aimed at servicing the specific prevention needs of women and girls and people belonging to key populations.In a context where overall funding for HIV is stagnating and where donor funding priorities are shifting unpredictably,it is even more important for countries to clearly define and c

318、ost their HIV prevention needs and pursue new ways of financing those programmes.Action point 3 requires countries to develop costed HIV prevention plans and stage dialogues to address their prevention funding gaps.A majority of focus countries(22/35)now have a budgeted or costed plan to achieve the

319、 2025 HIV prevention targets.However,the countries lacking such a plan include some where HIV incidence remains high(e.g.,Eswatini,Lesotho,Mozambique,the United Republic of Tanzania and Zambia)or is rising rapidly(e.g.,Madagascar).Most focus countries(28/35)have held dialogues with key partners to a

320、ddress HIV prevention funding gaps.Those engagements have generally involved national ministries of health,national AIDS councils,the Global Fund and PEPFAR,and various civil society and community networks.In some instances,national treasuries or ministries of finance,and various UN agencies were al

321、so involved.4.Reinforce HIV prevention leadership entities for multisectoral collaboration,oversight and management of prevention responsesStrong political leadership has been the bedrock of successful HIV responses everywhere.It is especially important for HIV prevention,which requires mobilizing f

322、inancing and supporting interventions which may take some time to yield demonstrable results.It is also important for promoting policies which may attract controversy from some quarters.Action point 4 expects countries to have a functional multisectoral HIV prevention leadership in place and to have

323、 established milestones for that entity.The Multi-sector HIV Leadership Forum,with support from the Global Prevention Coalition,has developed a position paper on sustaining effective response leadership,including through country-owned prevention systems.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY48All

324、 but three of the focus countries now have a designated entity to lead and manage a multisectoral and collaborative prevention response,and in most of them(20/32)that entity met at least once in the previous 12 months.In most countries,the entities include representation from other sectors,including

325、 social welfare and education,as well as from civil society.However,they continue to struggle to influence funding and budgeting decisions and their ability to effectively coordinate prevention activities across sectors also remains a concern.Only seven focus countries have gone on to develop milest

326、ones to reinforce these entities.5.Strengthen and expand community-led HIV prevention services and set up social contracting mechanisms The importance of community-led HIV prevention activities,especially for serving marginalized and vulnerable populations,is increasingly recognized.However,progress

327、 has been mixed for action point 5,which covers key elements that can facilitate the delivery of HIV prevention services by community-led organizations.A small minority of countries(4/35)have significantly expanded their support for community-led prevention services.Countries are not making adequate

328、 use of community-based knowledge,networks and resources to lead and boost prevention efforts.While most countries(25/35)reported allocating at least some public funding to non-governmental organizations(NGOs,some of which may be community-led)for prevention,this typically was in addition to externa

329、l financing,which remains the mainstay funding source for those organizations.Several countries noted that staffing and technical capacities remained barriers for NGOs,yet only a few(9/35)have set milestones to strengthen and expand community-led prevention services.About one third of the countries(

330、13/35)reported that they had laws or policies that hinder the registration,funding or contracting of NGOsmost of them countries with HIV epidemics that primarily affected key populations.Countries have put in place important elements of country-and community-led HIV prevention.However,most countries

331、 are yet to define specific actions to strengthen genuine country-and community-led prevention systems.HIV PREVENTION:FROM CRISIS TO OPPORTUNITY496.Remove societal and legal barriers to HIV prevention services for key and priority populationsThe legal and societal environments in GPC focus countries

332、 remain less than ideal and,in some cases,are undermining prevention efforts.While prevention strategies for most focus countries(26/35)identify relevant legal,policy and structural barriers,far fewer countries(11)have set milestones to clear those barriers.This hesitancy is occurring in a wider con

333、text where,in recent years,several countries have introduced additional legal barriers,including harsh punishments directed at certain key populations,making it even more difficult to reach those populations with HIV prevention services.Part of the problem may be that the government departments tasked with enforcing obstructive laws and policies are not the ones that draw up and manage HIV prevent