HIV prevention 2025 road map — Getting on track to end AIDS as a public health threat by 2030

HIV PREVENTION

2025

Getting on track to end AIDS

as a public health threat by 2030

ROAD MAP

Fewer than

370,000

annual new HIV

infections by 2025

1.5 million

new HIV

infections

in 2020

CONTENTS

About the HIV Prevention 2025 Road Map 02

Getting HIV prevention on track to end AIDS 08

Ten-point plan for country-level actions to reach the 2025

targets and get on track to end AIDS by 2030

Staying focused on the ve prevention pillars 20

An accountability framework for HIV prevention 26

Annexes 30

Annex 1 Commitments towards reducing new HIV infections

to fewer than 370 000 by 2025 30

Annex 2 Detailed HIV prevention targets in the Global AIDS Strategy

2021–2026 32

Annex 3 Members of the Global HIV Prevention Coalition 37

Annex 4 Successful HIV prevention supports achievement of the

Sustainable Development Goals 38

Annex 5 Summary of achievements and lessons from implementation

of the 2020 HIV Prevention Road Map 39

Annex 6 The Global HIV Prevention Coalition in the context of other

initiatives 41

Annex 7 Reference list and further reading 42

ABOUT THE HIV PREVENTION 2025

ROAD MAP

The Global HIV Prevention Coalition works to accelerate progress on HIV prevention with

a particular focus on countries where numbers of new HIV infections are highest or where

they are rising. Created in 2017, the coalition seeks to build commitment, momentum,

investment and accountability across governments, civil society, donors and the private

sector to implement large-scale, high-coverage, equitable and high-quality prevention

programmes that can end the AIDS epidemic as a public health threat by 2030.

The HIV Prevention 2025 Road Map offers guidance to all stakeholders who are seeking

to reduce new HIV infections. All countries––whether or not they participated in the

Global HIV Prevention Coalition in the past––have to intensify their HIV prevention efforts

to end the AIDS epidemic. The 28 focus countries of the Coalition together accounted

for almost three quarters of annual new HIV infections globally in 2020. Exceptional

international and national efforts are needed in those countries.

Several countries, regions and cities are experiencing rising numbers of new HIV

infections and those with ongoing, high burdens of new HIV infections are especially

encouraged to implement the new Road Map and report on progress through the Global

AIDS Monitoring systems.

2-42,3,4

This new Road Map charts a way forward for country-level actions (Figure 1) to achieve

an ambitious set of HIV prevention targets by 2025. Those targets emerged from the

2021 Political Declaration on HIV and AIDS, which the United Nations General Assembly

adopted in June 2021 (Figure 2 and Table 1) and they are underpinned by the Global

AIDS Strategy (2021–2026). The Strategy sets out the principles, approaches, priority

action areas and programmatic targets for the global HIV response.

1 Angola, Botswana, Brazil, Cameroon, China, Côte d’Ivoire, Democratic Republic of the Congo, Eswatini, Ethiopia, Ghana, India, Indonesia,

Islamic Republic of Iran, Kenya, Lesotho, Malawi, Mexico, Mozambique, Myanmar, Namibia, Nigeria, Pakistan, South Africa, United Republic

of Tanzania, Uganda, Ukraine, Zambia and Zimbabwe.

2 Decisions of the 47th session of the UNAIDS Programme Coordinating Board, Geneva, Switzerland, 15–18 December 2020

(https://www.unaids.org/sites/default/les/media_asset/Decisions_(PCB47)_Final_EN_rev1.pdf).

3 2021 Global AIDS Monitoring. Geneva: UNAIDS; 2021

(https://www.unaids.org/sites/default/les/media_asset/GAM_reporting_process_en.pdf).

4 2021 Political Declaration on HIV and AIDS. A/RES/75/284. New York: United Nations General Assembly; 2021.

5 Global AIDS Strategy 2021–2026: End inequalities, end AIDS. Geneva: UNAIDS; 2021

(https://www.unaids.org/sites/default/les/media_asset/global-AIDS-strategy-2021-2026_en.pdf).

Member States, in the

2021 Political Declaration

on HIV and AIDS,

agreed to prioritize HIV

prevention and reduce

new HIV infections to

fewer than 370 000 per

year by 2025.

Adopt a precision prevention

approach focused on key and

priority populations including

differentiated national

2025 prevention targets

Strengthen and expand

community-led HIV

prevention services and set

up social contracting

mechanisms

Deﬁne country investment

needs for an adequately

scaled HIV prevention

response and ensure

sustainable ﬁnancing

Conduct a data-driven

assessment of HIV

prevention programme

needs and barriers

Remove social and

legal barriers to HIV

prevention services for

key and priority

populations

Promote integration of

HIV prevention into

essential related services

to improve HIV outcomes

Establish real-time

prevention programme

monitoring systems with

regular reporting

Strengthen accountability

of all stakeholders for

progress in HIV prevention

Institute mechanisms for rapid

introduction of new HIV

prevention technologies and

programme innovations

Reinforce HIV prevention

leadership entities for

multisectoral collaboration,

oversight, and management of

prevention responses and set up

social contracting mechanisms

FIGURE 1.

The HIV Prevention 2025 Road Map: Ten-point Action Plan

This Road Map builds on the previous HIV Prevention 2020 Road Map

and responds

to the need for stronger action against the inequalities that hold back progress. It takes

account of an evolving context that is marked by persistent inequalities and overlapping

pandemics, economic challenges, shrinking space for civil society activities, and an

erosion of human rights.

It reects an intensied focus on reaching key populations everywhere and adolescent girls

and young women and their male partners in sub-Saharan Africa, addressing inequalities

that fuel new HIV infections, 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 prepare for wider availability and use of innovative

HIV prevention tools (such as long-acting formulations for pre-exposure prophylaxis (PrEP)

methods) and approaches (such as telemedicine and other virtual services).

Figure 2 summarizes overarching prevention targets. Detailed programmatic outcome

targets disaggregated by population and level of risk are summarized in Annex 2.

FIGURE 2.

The 2025 high-level HIV prevention targets and commitments

People-cent red precision

prevention responses

The 2025 Road Map focuses on scaling up primary prevention of HIV infections and on

introducing policy, legal and societal enablers that can prevent people from acquiring HIV

infection. It also highlights the considerable complementarity and interaction between

primary HIV prevention, testing, treatment and the prevention of vertical transmission of HIV.

6 HIV Prevention 2020 Road Map. Geneva: Global HIV Prevention Coalition; 2020 (https://hivpreventioncoalition.unaids.org/road-map/).

The commitments are anchored in the 2025 Global AIDS Strategy

targets, which include the: 95–95–95 targets for access to HIV

services; the 10–10–10 targets for removing social and legal

impediments to accessing or using HIV services; and the use of

integrated approaches to link at least 90% of people who are at

heightened risk of HIV infection to the services they need for their

overall health and well-being.

TABLE 1.

The 2025 targets and commitments:

What is new in the 2021 Political Declaration on HIV and AIDS

Ending inequalities: Take urgent and

transformative action to end the social,

economic, racial and gender inequalities that

perpetuate the HIV pandemic.

Equitable outcomes and granular targets:

Achieve HIV combination prevention,

testing and treatment targets across

relevant demographics, populations and

geographical settings.

Prioritized combination HIV prevention:

Prioritize comprehensive packages of HIV

prevention services and ensure they are

available and used by 95% of people at risk

of HIV infection.

Key populations: Act on the recognition

that key populations—including gay men

and other men who have sex with men,

people who inject drugs, sex workers,

transgender people, and people in prisons

and other closed settings—are at high risk

of HIV infection.

New HIV cascade: Reach the new 95–95–95

testing, treatment and viral suppression

targets across all demographics, populations

and geographical settings.

Undetectable = Untransmittable (U = U):

Recognize that viral suppression through

antiretroviral therapy is a powerful

component of combination HIV prevention

(since people living with HIV who have

undetectable viral loads cannot transmit the

infection to others).

Elimination of new HIV infections in

children: Ensure that 95% of pregnant

and breastfeeding women have access

to combination HIV prevention, antenatal

testing and retesting; 95% of women living

with HIV achieve and sustain viral suppression

before delivery and during breastfeeding;

and 95% of HIV-exposed children are tested

within two months of birth and, if HIV-

positive, receive optimized treatment.

Fully fund the HIV response: Invest

US$29billion annually in low- and

middle-income countries, including at least

US$3.1billion for societal enablers.

10–10–10 targets for societal enablers:

Reduce to less than 10% the number of women,

girls and people living with, at risk of and affected

by HIV who experience gender-based inequalities

and sexual and gender-based violence.

Ensure that less than 10% of countries have

restrictive legal and policy environments that lead

to the denial or limitation of access to HIV services.

Ensure that less than 10% of people living with,

at risk of and affected by HIV experience stigma

and discrimination.

Sexual and reproductive health: Ensure that

95% of women and girls of reproductive age

have their HIV and sexual and reproductive

health care service needs met.

Access to affordable medicines, diagnostics,

vaccines and health technologies: Ensure the

global accessibility, availability and affordability

of safe, effective and quality assured medicines

and other health technologies for preventing,

diagnosing and treating HIV infection and its

coinfections and comorbidities.

Service integration: Invest in health and

social protection systems to provide 90% of

people living with, at risk of and affected by

HIV with people-centred and context specic

integrated services.

Community leadership, service delivery

and monitoring: Increase the proportion of

community-led HIV services to achieve 30–

60–80 targets

and ensure relevant networks

and organizations are sustainably nanced,

participate in decision-making and can

generate data through community monitoring

and research.

GIPA: Uphold the Greater Involvement of

People Living with or Affected by HIV principle.

Source: UNAIDS, Global AIDS Update 2021

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 30–60–80 targets are dened as follows in the Global AIDS Strategy: 30% of testing and treatment 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 population and women-led organizations.

8 Confronting inequalities: Lessons for pandemic responses from 40 years of AIDS. Global AIDS Update 2021. Geneva: UNAIDS; 2021

(https://www.unaids.org/sites/default/les/media_asset/2021-global-aids-update_en.pdf).

The “Hands up for #HIVprevention” campaign in 2016 in Tajikistan united more than 500 people,

including Government ofcials, health professionals, celebrities and young people. Credit: UNAIDS

The new Road Map draws on lessons emerging from implementation of the 2020 Road

Map (see Annex 5). Specically, it builds on the ndings of regular prevention programme

progress reports

9-12

and on the recommendations of an external review of the Global

HIV Prevention Coalition and the previous Road Map, conducted in 2020.

Table 2

summarizes the progress made in implementing the 2020 Road Map and the key gaps

remaining that require action.

910111213

The development of the new Road Map built on the consultative processes that shaped

the Global AIDS Strategy (2021–2026) and involved additional consultations with partners

in the Global HIV Prevention Coalition including national AIDS coordinating authorities

from all regions, United Nations teams at global, regional and country levels, funding

partners, civil society organizations and networks of key populations and adolescent girls

and young women.

9 Global HIV Prevention Coalition. Implementation of the HIV Prevention 2020 Road Map. First progress report, March 2018. Geneva:

UNAIDS; 2018 (https://hivpreventioncoalition.unaids.org/wp-content/uploads/2018/06/JC2927_UNAIDS-WHA-Report.pdf).

10 Global HIV Prevention Coalition. Implementation of the HIV Prevention 2020 Road Map. Second progress report, April–December 2018.

Geneva: UNAIDS; 2019 (https://hivpreventioncoalition.unaids.org/wp-content/uploads/2019/05/Second-Progress-Report_HIV-Prevention-

Roadmap_2019.pdf).

11 Global HIV Prevention Coalition. Implementation of the HIV Prevention 2020 Road Map. Third progress report, October 2019. Geneva:

UNAIDS; 2019 (https://www.unaids.org/en/resources/documents/2019/PCB45_HIV_Prevention-2020-Road-Map).

12 Global HIV Prevention Coalition. Implementation of the HIV Prevention 2020 Road Map. Fourth progress report, November 2020.

Geneva: UNAIDS; 2020 (https://www.unaids.org/en/resources/documents/2020/fourth-annual-progress-report-of-the-global-hiv-prevention-

coalition).

13 de Zalduondo BO, Gelmon L, Jackson H. External review of the Global HIV Prevention Coalition. Geneva: UNAIDS; 2020

(https://www.unaids.org/sites/default/les/media_asset/PCB47_CPR2_External_Review_GPC.pdf).

TABLE 2.

Progress made and actions for addressing the remaining HIV prevention gaps

KEY BARRIERS

IDENTIFIED IN 2017 PROGRESS MADE ACTIONS TO BE TAKEN BY 2025

Limited political

leadership in HIV

prevention

HIV prevention rmly established on

the global agenda and in the Global

AIDS Strategy (2021–2026).

Active national HIV prevention

coalitions and working groups in

several focus countries.

Commitment of leaders at all levels

to increase investments in HIV

prevention, recognizing the increased

resource needs.

National leadership structures to

mobilize all relevant sectors to

take meaningful actions for HIV

prevention.

Policy and structural

obstacles to HIV

prevention services

Greater recognition of key

populations in national plans

everywhere.

Stronger commitment to address

multifaceted vulnerability of

adolescent girls and young women

and their male partners in sub-

Saharan Africa.

Advocate for and take practical

steps to address barriers to service

access and adopt all recommended

elements of HIV prevention and harm

reduction packages.

Accelerate policy reform and

decriminalization of key populations,

and reduce discrimination against key

and priority populations.

Strengthen collaboration with

other initiatives such as the Global

Partnership for Action to Eliminate

All Forms of HIV-Related Stigma and

Discrimination and the Education

Plus Initiative.

Limited HIV

prevention nancing

Large and stable PEPFAR investment

in HIV prevention.

Trend of declining HIV prevention

nancing through the Global Fund

halted and reversed.

Increasing number of countries

providing domestic nancing for HIV

prevention.

Make an evidence-based investment

case for HIV prevention (including

a focus on key populations, new

prevention technologies and

community-led responses), mobilize

sustainable nancing, and improve

allocative efciency to close the large

remaining nancing gap.

Manage nancing transitions to

enable full domestic funding of

HIV prevention in middle-income

countries.

Limited

implementation at

scale

Increased coverage of voluntary

medical male circumcision and pre-

exposure prophylaxis.

Increased coverage of specic

programmes for adolescent girls and

young women.

Increases in key population service

access in countries.

Scale up HIV prevention services for

all populations and locations with

high or growing HIV incidence.

Develop and implement systematic

and sustainable HIV prevention

programmes (not just projects).

Set up systems to manage and

coordinate decentralized services.

GETTING HIV PREVENTION

ON TRACK TO END AIDS

Every region offers inspiring examples of countries that have shown the commitment, mobilized the

resources and applied rights-based public health approaches to curb their HIV epidemics. Themost

successful countries have directed resources towards high-impact combination HIV prevention

programmes and they have supported and worked with community-led responses that reach

thepopulations and places most in need (see box).

HIV PREVENTION TARGETS CAN BE ACHIEVED IN

DIVERSE EPIDEMICS

Several countries have had striking success in reducing HIV incidence by scaling up

combination prevention programmes. Zimbabwe has reduced new HIV infections

by nearly 90% since the late 1990s, while Côte d’Ivoire’s early expansion of key

population programmes and an increase in antiretroviral coverage contributed to a

72% decline in new HIV infections in 2010–2020. In South Africa, new HIV infections

decreased by 45% in that same period as the country expanded HIV treatment and

voluntary medical male circumcision, while Kenya used the same approach, along

with high coverage of prevention services among key populations, to reduce HIV

incidence by 44%.

In other regions, several countries have achieved steep reductions in new HIV

infections by focusing their combination prevention programmes on the needs of key

populations. In Cambodia, Thailand and Viet Nam, new HIV infections declined

by more than 60% in 2010–2020, and they declined by about half in El Salvador,

Republic of Moldova and Sri Lanka. In Estonia, the expansion of comprehensive

harm reduction services was followed by a 61% countrywide reduction in HIV

infections and a 97% reduction in new diagnoses among people who inject drugs

between 2007 and 2016.

Sources: Evidence review: Implementation of the 2016–2021 UNAIDS Strategy: on the fast-

track to end AIDS. Geneva: UNAIDS; 2020 (https://www.unaids.org/sites/default/les/media_

asset/PCB47_CRP3_Evidence_Review_EN.pdf);

Confronting inequalities: Lessons for pandemic responses from 40 years of AIDS. Global AIDS

Update 2021. Geneva: UNAIDS; 2021 (https://www.unaids.org/sites/default/les/media_

asset/2021-global-aids-update_en.pdf).

However, the progress in reducing new infections has been too slow and it is occurring in too few

countries to reach the global targets. The number of new infections among adults decreased by

only 31% in 2010–2020, far short of the 75% target for 2020 which the UN General Assembly had

set in 2016. A much steeper decline is needed very quickly if the 2025 global target is to be reached

(Figure 3). Doing so demands that countries employ evidence-based prevention methods on a

sufcient scale, remove structural hindrances, such as punitive laws and policies, that impede their HIV

responses, and tackle the inequalities and the stigma and discrimination that fuel their epidemics.

FIGURE 3.

Estimated new HIV infections globally and by region, 2010–2020,

and projected new infections if the 2025 targets are met

Source: Prevailing against pandemics by putting people at the centre—World AIDS Day report. Geneva: UNAIDS; 2020

(https://www.unaids.org/en/resources/documents/2020/prevailing-against-pandemics).

In every region of the world, populations which face the highest risk of HIV are being

left behind when it comes to accessing and using HIV prevention services and tools.

Persistent inequalities, harassment and discrimination push them to the margins

and sabotage their health and well-being. Those experiences typify the lives of key

populations such as gay men and other men who have sex with men, people who

inject drugs, sex workers, transgender people, and people in prisons and other closed

settings. Key populations and their sexual partners accounted for an estimated 65% of

new HIV infections worldwide in 2020 and 93% of infections outside sub-Saharan Africa.

Systematic inequalities also blight the lives of women and girls, who account for half of all

new HIV infections globally. In high-incidence settings in sub-Saharan Africa, adolescent

girls and young women (aged 15–24 years) accounted for 25% of HIV infections in 2020,

even though they represented only 10% of the total population.

The COVID-19 pandemic and other international crises add further challenges. They have

widened inequalities and threaten to push the HIV response further off track. COVID-

19-related demands on health services, reallocations of health and other resources, and

disrupted HIV and other health programmes threaten to set back progress made against

the HIV pandemic. Social restrictions and shutdowns have thrust many millions of people

(especially women) deeper into poverty and have interrupted the education of hundreds

of millions more. COVID-19 has been characterized by worsening gender inequalities

and increased violence against women and girls and key populations. It has also seen

an erosion of human rights and a surge in punitive legal and policy measures in some

settings. The provision of HIV services to key and priority populations is also threatened

in conict situations and humanitarian crises.

The HIV Prevention 2025 Road Map lays out the actions that must be taken to overcome

these and other challenges. It recognizes that the HIV epidemic is constantly evolving and

that it differs across and within countries. National, regional and local epidemics often

have distinct characteristics that may shift over time and that make xed, one-size-ts-all

responses inappropriate and ineffective. Differentiated programmes and interventions

that correspond to their specic contexts are needed.

14 Confronting inequalities: Lessons for pandemic responses from 40 years of AIDS. Global AIDS Update 2021. Geneva: UNAIDS; 2021

(https://www.unaids.org/sites/default/les/media_asset/2021-global-aids-update_en.pdf).

15 Preventing HIV infections at the time of a new pandemic: a synthesis report on programme disruptions and adaptations during the

COVID-19 pandemic in 2020. Geneva: UNAIDS; 2021 (https://www.unaids.org/en/resources/documents/2021/20210701_HIVPrevention_new_

pandemic).

Crucially, the Road Map sharpens the focus on achieving the 95% coverage target for

all individuals who are at risk of HIV infection.

It emphasizes high-impact prevention

programmes for key and priority populations and the vital roles of community-led

activities to implement them on a scale that will decisively reduce new HIV infections. It

calls for discontinuing investments in interventions of limited effectiveness and efciency,

and for reallocating those resources. It underscores the need to end the inequalities that

fuel the HIV epidemic and hold back efforts to end it. And it highlights the importance of

sound management and accountability processes as part of a multisectoral response.

HIV thematic party for adolescents and young people organized by Teenergizer’s team in Kyiv,

Ukraine, in June 2019. Teenergizer provides peer psychological support to adolescents living with HIV,

HIV prevention, testing and counselling services and supports youth leadership in the region.

Credit: Teenergizer

16 Prevailing against pandemics by putting people at the centre: World AIDS Day report 2020. Geneva: UNAIDS; 2020 (https://www.unaids.

org/sites/default/les/media_asset/prevailing-against-pandemics_en.pdf).

TEN-POINT ACTION PLAN FOR

COUNTRY-LEVEL ACTIONS TO REACH

THE 2025 TARGETS AND GET ON TRACK

TO END AIDS BY 2030

The 2025 Road Map identies ten priority actions that countries must take to resolve the

remaining gaps and rebuild momentum to end AIDS as a public health threat by 2030.

1. CONDUCT AN EVIDENCE-DRIVEN ASSESSMENT OF HIV PREVENTION

PROGRAMME NEEDS AND BARRIERS

MILESTONES DUE BY

12-week Road Map

acceleration phase–dene

country-specic action

agendas for accelerating

HIV prevention up to 2025

February 2023

Identify key country-level

barriers and priorities

related to (1) leadership,

(2) nancing, (3) policy

and structural barriers, (4)

implementation at scale

April 2023

•

Using disaggregated data, conduct an up-to-date

analysis of epidemic patterns and trends at national

and subnational levels for all key populations and

priority populations (including new infections in

children using stack bar analysis).

•

Conduct a stock-taking exercise (with the participation

of relevant national stakeholders) to review national

progress in implementing prevention programmes at

scale.

•

Ensure that stock-taking identiﬁes the policy, legal

and societal obstacles affecting service access and

use by key and priority populations, as well as critical

technical and capacity needs to address gaps.

•

Draw on available data in annual country HIV

prevention scorecards to identify priorities and gaps.

2. ADOPT APRECISION PREVENTION APPROACH FOCUSED ON KEY AND

PRIORITY POPULATIONS INCLUDING DIFFERENTIATED NATIONAL 2025

PREVENTION TARGETS

MILESTONES DUE BY

All countries translate global

HIV prevention targets

into granular national and

subnational HIV prevention

targets based on detailed

subnational and population-

specic data

February 2023

Update national HIV

Prevention Road Map

based on new global

and national targets and

country-specic barriers

April 2023

•

Organize inclusive national consultations for

agreement on programme priorities based on

evidence-driven assessments.

•

Identify the populations and locations with the

greatest HIV prevention needs, as well as those who

are not being reached with services.

•

Adopt or adjust interventions and approaches shown

to reduce new HIV infections, with an appropriate

balance between biomedical, behavioural and

structural approaches.

•

Focus resources and set coverage and uptake targets

that are high enough to achieve large impact.

3. DETERMINE COUNTRY INVESTMENT NEEDS FOR ADEQUATELY SCALED

HIV PREVENTION RESPONSES AND ENSURE SUSTAINABLE FINANCING

MILESTONES DUE BY

All countries dene HIV

prevention investment

needs for 2023–2026 and

identify viable nancing

sources

February 2023

All countries develop

and begin implementing

fundraising strategies

to address key gaps in

current response

May 2023

All countries accurately

report annual prevention

budget allocations and

spending

December 2023

•

Develop country-speciﬁc ﬁnancing targets and

benchmarks for HIV prevention, in line with national

priorities and global recommendations.

•

Prioritize allocations to evidence-based interventions

and programmes for people at greatest risk,

respecting equity and efﬁciency, and ensure

proportionate allocations for all essential components

of a combination prevention response.

•

Promote complementarity of resources (not

competition) for a holistic HIV response and as part

of the overall resource planning, mobilization, and

allocation. Avoid pitting prevention against testing

and treatment, or biomedical interventions against

behavioural and structural ones.

•

Identify and resolve inefﬁciencies. Reallocate

investments from low-impact and low-efﬁciency

interventions to evidence-based alternatives that have

greater impact, equity and efﬁciency.

•

Promote public ﬁnancing of community-led

prevention services through social contracting and

similar mechanisms.

•

Pursue diversiﬁed resource mobilization approaches

and partnerships (as appropriate to the country

context).

•

Identify opportunities for multisectoral investment in

combination prevention components––with multiple

sectors investing in mutually supportive interventions

(e.g. education, social protection, violence mitigation,

legal reform, access to justice, and reduction of stigma

and discrimination).

March in support of AIDS response in South Africa in 2016. Credit: UNAIDS

INVESTING ADEQUATELY IN HIV PREVENTION

More resources are needed to get the HIV pandemic response back on track to

end AIDS as a public health threat by 2030. UNAIDS has calculated that annual

HIV investments in low- and middle-income countries need to rise from the

US$ 21.5 billion in resources available in 2020 to US$ 29 billion in 2025. International

resources have at-lined in recent years and have been prioritized in low-income and

high-burden settings. The majority of the funding to reach the 2025 targets may be

expected from domestic resources; development partners must commit to sustainably

fund the remaining resource needs.

Signicantly larger investments are needed in three areas:

• Primary HIV prevention. An almost two-fold increase in resources for evidence-based

prevention, from US$ 5.3 billion per year in 2019 to US$ 9.5 billion in 2025 (Figure 4).

• HIV testing and treatment. Investments must increase by 18%, from US$ 8.4 billion

in 2019 to US$ 10.1 billion by 2025. Even though the number of people on HIV

treatment is expected to increase by 35%, efciency gains from price reductions in

commodities and cost savings in service delivery are estimated to keep the overall

costs down. Reaching the treatment targets will contribute to additional reductions in

new HIV infections and in treatment costs in the long term.

• Societal enablers. Investments in societal enablers in low- and middle-income

countries need to increase from US$ 1.3 billion in 2019 to US$ 3.1 billion in 2025 (to

11% of total resource needs). These investments should be focused on removing

legal and policy barriers to HIV services, ending the criminalization of key populations,

providing legal literacy training and aid to people living with HIV and key populations

whose rights are violated, and contributing to efforts to achieve gender equality.

FIGURE 4.

Estimated global resource needs by populations and

primary prevention interventions, 2019 and 2025

2019 2025

2019 CONSTANT BILLION DOLLARS

Sex workers

Gay men and other men who have sex with men

Transgender people

People who inject drugs

Prisoners

Adolescent girls and young women

Adolescent boys and young men

Pre-exposure prophylaxis

Sexually transmitted infections Condoms Voluntary medical male circumcision

Prevention programmes for key populations and core services to achieve the targets,

low- and middle-income countries, 2019 and 2025 (2019 US$ billion).

Source: UNAIDS financial estimates and projections, 2021.

4. REINFORCE HIV PREVENTION LEADERSHIP ENTITIES FOR

MULTISECTORAL COLLABORATION, OVERSIGHT AND MANAGEMENT

OF PREVENTION RESPONSES

MILESTONES DUE BY

Nationally Developed

Milestones: three strategic

milestones are determined

February 2023

Report on achievement of

Nationally Dened Milestones

December 2023

•

Strengthen national and subnational entities

responsible for overseeing implementation of HIV

prevention programmes, including those outside the

public health sector.

•

Maximize synergies between different components of

combination prevention programmes.

•

Build unity of purpose between government,

communities, implementers, and other partners

around an evidence-based HIV prevention agenda,

with clearly deﬁned roles and functions and in line

with their comparative advantages.

•

Include community-led organizations and other civil

society actors in mechanisms for coordination, decision-

making and oversight of prevention responses.

•

Provide the assigned national entity with adequate

resources to lead cross-sectoral collaboration, support

joint planning processes, and support the management

of programme implementation at all levels.

•

Assign sufﬁcient authority to the national entity to hold

all actors accountable for progress towards national

targets and commitments (national AIDS commissions

typically perform this role).

5. STRENGTHEN AND EXPAND COMMUNITY-LED HIV PREVENTION

SERVICES AND SET UP SOCIAL CONTRACTING MECHANISMS

MILESTONES DUE BY

All countries have convened

government entities,

programme implementers

and communities of key and

priority populations to dene

the scaling-up of trusted

community access platforms

for HIV prevention, testing,

treatment and support

February 2023

Nationally Developed

Milestones: three strategic

milestones are determined

by local communities, and

achieved

December 2023

•

Promote community leadership and foster

community-led activities so that communities have

the knowledge, power and capacity to decide on

priorities in HIV prevention programmes and deliver

services.

•

Set national and subnational targets for increasing

the proportion of HIV prevention services delivered

by community-led organizations, in line with

commitments in the 2021 Political Declaration on HIV

and AIDS, and the Global AIDS Strategy (2021–2026).

•

Provide adequate funding to community-led and other

civil society organizations that are active in HIV prevention.

•

Establish legal frameworks, effective mechanisms

and transparent procedures for social contracting to

enable public ﬁnancing of community-led and other

nongovernmental organizations to implement HIV-

related programmes, provide services and conduct

advocacy work.

•

Invest in strengthening technical and managerial

capacity of community-led organizations.

•

Facilitate augmenting international ﬁnancing of

community-led services with domestic funding to

enhance programme ownership and sustainability.

THE IMPORTANCE OF COMMUNITY

LEADERSHIP IN HIV PREVENTION

Communities play vital roles in the HIV response by promoting accountability, driving

prevention activism, implementing activities and contributing innovations that are

crucial for sustainable progress.

17,18

Community-led service delivery platforms are often

more effective than formal health facility-based platforms for reaching marginalized

and under-served populations, especially in settings where stigma and discrimination

are rife.

Community-led organizations are well placed to identify gaps in services,

constraints that hold back service delivery and uptake, and opportunities to make

services more people-centred, convenient and effective.

Community-led service delivery extends beyond the health domain. This is seen in the

valuable contributions made to advocacy for legal and policy reforms, the monitoring

of human rights violations, and actions to support communities with violence

mitigation, legal literacy and livelihood assistance.

The 2021 Political Declaration on HIV and AIDS, and the Global AIDS Strategy (2021–

2026) call for increasing the proportion of HIV services delivered by communities,

including by ensuring that, by 2025, community-led organizations deliver, as

appropriate in the context of national programmes:

• 30% of testing and treatment services, with a focus on HIV testing, linkage to

treatment, adherence and retention support, and treatment literacy;

• 80% of HIV prevention services for populations at high risk of HIV infection, including

for women within those populations;

• 60% of programmes to support the achievement of societal enablers.

20, 21

Empowering young Brazilians to talk to their peers about HIV as part of the Viva Melhor Sabendo

Jovem (VMSJ) Salvador project led by UNICEF in 2019. The project goal is to raise awareness among

other young people about the importance of HIV testing and prevention. Credit: UNICEF

17 Communities at the centre: Global AIDS Update 2019. Geneva: UNAIDS; 2019 (https://www.unaids.org/sites/default/les/media_

asset/2019-global-AIDS-update_en.pdf).

18 Preventing HIV infections at the time of a new pandemic: a synthesis report on programme disruptions and adaptations during the

COVID-19 pandemic in 2020. Geneva: UNAIDS; 2021.

19 Communities at the centre: Global AIDS Update 2019. Geneva: UNAIDS; 2019 (https://www.unaids.org/sites/default/les/media_

asset/2019-global-AIDS-update_en.pdf).

20 Political Declaration on HIV and AIDS: ending inequalities and getting on track to end AIDS by 2030. New York: United Nations; 2021

(https://www.unaids.org/sites/default/les/media_asset/2021_political-declaration-on-hiv-and-aids_en.pdf).

21 Global AIDS Strategy 2021–2026: End inequalities, end AIDS. Geneva: UNAIDS; 2021 (https://www.unaids.org/sites/default/les/media_

asset/global-AIDS-strategy-2021-2026_en.pdf).

6. REMOVE SOCIAL AND LEGAL BARRIERS TO HIV

PREVENTION SERVICES FOR KEY AND PRIORITY

POPULATIONS

22 2021 Global AIDS Monitoring. Geneva: UNAIDS; 2021 (https://www.aidsdatahub.org/sites/default/les/resource/unaids-global-aids-

monitoring-2021.pdf).

23 See AIDSInfo website: https://onlinedb.unaids.org/ncpi/libraries/aspx/Home.aspx.

24 Global Partnership for Action to Eliminate All Forms of HIV-Related Stigma and Discrimination. Geneva: UNAIDS; 2018

(https://www.unaids.org/sites/default/les/media_asset/global-partnership-hiv-stigma-discrimination_en.pdf).

25 Every adolescent girl in Africa completing secondary school, safe, strong, empowered: Time for Education Plus. Geneva: UNAIDS; 2021

(https://www.unaids.org/sites/default/les/media_asset/JC3016_EducationPlusBrochure_En.pdf).

26 For example, the Global Fund’s Breaking Down Barriers Initiative and the Global Commission on HIV and the Law.

MILESTONES DUE BY

All countries have dened

and are implementing specic

actions to address policy and

structural barriers

February 2023

Nationally Developed

Milestones: local

communities decide on

and achieve three to ve

strategic milestones

December 2023

•

Support the creation of enabling legal and policy

environments (including by achieving the 10-10–10

targets, see box), and increased access to justice, gender

equality and freedom from stigma and discrimination, in

line with the Global AIDS Strategy (2021–2026).

•

Act to address key impediments blocking access to

and utilization of prevention services (e.g. HIV-

related stigma and discrimination; the criminalization

of drug use, sex work and same-sex sexual

relationships; gender inequalities and obstructive

age related consent policies and practices). Base the

actions on the ﬁndings of available assessments of

policy, legal and societal environments (e.g. the HIV

Stigma Index, legal environment assessments,

integrated biobehavioural surveys, Global AIDS

Monitoring and the National Commitments and

Policy Instrument databases

22, 23

gender assessment

tools and community-led research).

•

Engage national policy-makers and opinion leaders

to participate in cross-country brieﬁngs on reducing

policy barriers.

•

Strengthen collaboration between the Global HIV

Prevention Coalition and other global initiatives, such

as the Global Partnership for Action to Eliminate All

Forms of HIV-Related Stigma and Discrimination

the Education Plus Initiative

and others.

THE 10–10–10 TARGETS FOR REMOVING SOCIETAL AND

LEGAL BARRIERS TO HIV SERVICES

The 2025 targets can only be achieved in an environment where people living with HIV and

people at risk of HIV infection can use the services and adopt the behaviours that will protect

their health. Those conditions are lacking in many countries. As a result, HIV-related stigma and

discrimination, gender inequalities, the criminalization of drug use, sex work and same sex sexual

relationships, and age related consent requirements continue to undermine people’s health.

The 2021 UN Political Declaration on HIV and AIDS and the Global AIDS Strategy (2021–2026)

require that countries undertake reforms so that, by 2025:

• Less than 10% of countries have legal and policy frameworks that lead to the denial or limitation of

access to HIV-related services;

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

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

inequality and violence.

Source: UNAIDS Global AIDS Strategy 2021–2026

7. PROMOTE THE INTEGRATION OF HIV PREVENTION INTO ESSENTIAL

RELATED SERVICES TO IMPROVE HIV OUTCOMES

MILESTONES DUE BY

Nationally Developed

Milestones: three strategic

milestones are determined

February 2023

Report on achievement of

Nationally Dened Milestones

December 2023

•

Capitalize on programme synergies to achieve the

best possible HIV outcomes.

•

Colocate, link or integrate services so they respond

to people’s needs, and are convenient and easy

to use. Of particular relevance is the integration of

HIV prevention services with services for sexual and

reproductive health, mental health, prevention and

care of sexual and gender-based violence, drug

dependence treatment, hepatitis C prevention

and care, tuberculosis control, prison health,

noncommunicable diseases, and legal and social

support services.

•

Support service integration for people who are

typically underserved by formal health systems,

including people who use drugs, people in prisons

and other closed settings, people on the move

(such as migrants), and people in emergency and

humanitarian contexts (such as refugees, displaced

populations and asylum seekers).

8. SET UP MECHANISMS FOR THE RAPID INTRODUCTION OF NEW HIV

PREVENTION TECHNOLOGIES AND PROGRAMME INNOVATIONS

MILESTONES DUE BY

All countries dene specic

actions for adapting new

HIV prevention technologies

(additional PrEP options,

virtual HIV intervention

approaches)

February 2023

Nationally Developed

Milestones: three strategic

milestones are determined

February 2023

Report on achievement of

Nationally Dened Milestones

December 2023

•

Promote the adoption of proven new HIV prevention

technologies as part of combination prevention

packages (e.g. antiretroviral drug releasing vaginal

rings or long-acting PrEP regimens).

•

Take forward a consultative process involving all

stakeholders (including community representatives,

training institutions and professional bodies) to

support the use of effective new technologies and

approaches.

•

Resolve policy, regulatory, logistical and guidance

challenges, and ensure the availability and

affordability of new technologies over time.

•

Support community delivery models to achieve

wide availability and use of HIV services and

technologies, including by strengthening virtual

interventions across prevention planning, community

engagement, outreach, demand generation, retention

and programme monitoring. Draw on innovations

pioneered or popularized by health service providers

and community-led organizations during the

COVID-19 pandemic (e.g. HIV self-testing, multimonth

dispensing of HIV treatment and prevention, digital

platforms and virtual meeting spaces).

9. ESTABLISH REAL-TIME PREVENTION PROGRAMME MONITORING

SYSTEMS WITH REGULAR REPORTING

MILESTONES DUE BY

Assess gaps in monitoring

and evaluation systems

and processes that lead to

incomplete HIV prevention

scorecards (coverage and

outcomes of programmes)

February 2023

Nationally Developed

Milestones: 3 strategic

milestones determined to

address gaps

February 2023

Complete reporting to Global

AIDS Monitoring allows for

full country scorecard report

March 2023

Strengthen subnational

monitoring and evaluation

systems, including non

health data, and put the

subnational scorecard

system into operation

December 2023

•

Make real-time tracking of progress central to

implementation of the ten-point Action Plan.

•

Regularly update global, national and subnational HIV

prevention scorecards.

•

Monitor the strengthening of national HIV prevention

coordination and management institutions.

•

Incorporate assessments of cost, cost-effectiveness

and value for money into traditional programme

performance measurements.

•

Include data from civil society and community-led

organizations when reporting on progress in relation

to the ten-point Action Plan.

•

Introduce regular high-level dialogues, joint reviews

and data reviews at subnational, national, regional

and global levels to inform prevention programme

improvements, course corrections and strategic

planning.

10. STRENGTHEN ACCOUNTABILITY OF ALL STAKEHOLDERS

FOR PROGRESS IN HIV PREVENTION

MILESTONES DUE BY

Institutionalize annual national

HIV prevention performance

review and accountability

process / meeting involving

government, communities

and other partners

April 2023

Establish quarterly

subnational performance

and accountability process

that involves government,

communities and other

partners

June 2023

Annual global and regional

meetings for accountability

Annually by

December

•

Strengthen data systems to underpin strong

accountability among all stakeholders.

•

Track national and subnational progress in

implementing the Road Map actions to identify

weaknesses and take corrective steps, and share

lessons learned and good practices.

•

Clearly identify, for each of the ten Action Plan points,

the key milestones that can realistically be achieved

by each country by the end of 2025.

•

Invest adequate resources in accountability processes

for optimal functionality and sustainability.

•

Given the pivotal role of community-led and other civil

society organizations in the HIV response, ensure that

accountability processes involve those organizations

in leading roles and reﬂect their assessments of

progress, and empower and fund them to expand

community-led monitoring capacity and systems.

•

Develop and monitor an accountability framework

that is grounded in government and community

leadership, transparency and sustainability (see pages

26-29 for more details).

STAYING FOCUSED ON THE

FIVE PREVENTION PILLARS

Alongside the HIV testing and antiretroviral treatment scale-up, countries have to

continue implementation of combination HIV prevention responses that encompass

biomedical, behavioural and structural interventions. The ve central pillars for national

HIV prevention responses described in the 2020 Road Map remain fundamentally

important to orient those efforts (Figure 5).

The ve-pillar approach has been rened in the 2025 Road Map to reect the emphasis

in the Global AIDS Strategy (2021–2026) and the demands of an evolving epidemic.

Highlighted now are people-centred approaches, addressing persistent inequalities in

access to and use of services and promoting integration and complementarity between

service delivery platforms.

Pillars 1–3 describe people-centred combination prevention packages for key populations

everywhere and for adolescents and young adults in geographical areas with high HIV

incidence. Programmes in these pillars include population specic behavioural and

structural actions that ensure access by communities to the full range of prevention

choices. Pillar 4 on condoms and Pillar 5 on antiretroviral-based prevention describe high-

impact prevention tools that are relevant to all populations. Pillar 5 emphasizes the vital

complementarity between HIV prevention and HIV treatment and care services.

Pillar 1, on key populations, applies globally, while Pillars 2 and 3 apply mostly in eastern

and southern Africa and in some locations in western and central Africa (settings with

high HIV incidence). Pillar 4 is also relevant globally, although outside sub-Saharan Africa

it mostly relates to prevention programmes for key populations (due to low HIV incidence

among other populations and generally widespread availability of condoms on the

commercial market). Pillar 5 is also relevant globally, with a focus on key populations and

HIV-discordant couples, though it is relevant for other populations as well as in settings in

eastern and southern Africa where HIV incidence is high.

The pillars rest on a foundation of other enhancements. These include sustained

investments, integrated service delivery platforms, the use of a multisectoral approach,

the creation of enabling environments, and actions to reduce inequalities. There is a

strong focus on addressing policy and structural barriers that hinder access to prevention

services, on ending stigma and discrimination, and on advancing gender equality.

FIGURE 5.

The ﬁve prevention pillars for 2025

KEY

POPULATIONS

ARV -BASED

PREVENTION

CONDOM

PROGRAMMING

ADOLESCENT

BOYS AND MEN

ADOLESCENT

GIRLS AND

YOUNG WOMEN

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,

prioritized, person-centred and effective combination prevention options

ACCESS THROUGH

1 2 3 4

Combination

prevention and harm

reduction packages

for and with

· Sex workers

· Gay men and other

men who have sex

with men

· People who inject

drugs

· Transgender

people

· Prisoners

Combination

prevention packages

in settings with high

HIV incidence

(based on

differentiated,

layered packages)

Combination

prevention packages

in settings with high

HIV incidence

(including voluntary

medical male

circumcision and

promoting access to

testing and

treatment)

Promotion and

distribution of male

and female condoms

as well as lubricants

Pre-exposure

prophylaxis,

post-exposure

prophylaxis,

treatment as

prevention including

for elimination of

vertical transmission

Community-based and community-led outreach, health facilities including sexual and reproductive

health services, schools, private sector, virtual platforms and other innovations

Sexual and reproductive health and rights • Gender equality • Ending stigma and discrimination

Conducive policies and environment • Multisectoral, integrated & differentiated approach • Sustained investment in HIV prevention

FOUNDATIONS

SOCIETAL AND SERVICE ENABLERS AND ADDRESSING UNDERLYING INEQUALITIES

PILLAR 1.

Combination prevention for key populations

Much stronger and more extensive prevention programmes are needed for key populations,

which now account for almost two thirds of new HIV infections globally. Good examples of

programmes and required policy changes exist for all key populations, but coverage of HIV

services remains low and structural hindrances persist in a majority of countries.

Programmes for key populations must be evidence- and human rights-based, driven

by key population leadership and empowerment, and they must ensure stigma- and

discrimination-free access to services. That requires removing structural, policy and

legal barriers, including the criminalization of key populations, and ending stigma and

discrimination by health workers, law enforcement, justice sector, employers, education

providers and others. Trusted service platforms require robust outreach systems that

are peer-led and clinical services that are nonjudgmental, accessible and competent

in addressing key populations’ needs on the continuum of prevention, testing and

treatment services. Universal health coverage systems need to be structured in ways that

make these services accessible to all key populations.

Strengthened programmes should be implemented at scale and should be tailored to the HIV

and wider health needs of key populations. The programmes must encompass services for

preventing and treating HIV, tuberculosis, viral hepatitis and sexually transmitted infections

(including provision of condoms, lubricants and, where appropriate, PrEP and post-exposure

prophylaxis). Given the prominence of unsafe injecting drug use due to the limited availability

of needle and syringe programmes in the HIV epidemics in many countries, comprehensive

harm reduction services are vitally important, including in prisons and other closed settings.

The services therefore should include needle and syringe programmes, opioid substitution

therapy and naloxone, and should address the specic needs of women who use drugs.

All forms of compulsory drug and HIV testing and compulsory drug treatment should be

replaced with voluntary schemes.

Methadone distribution as opioid substitution therapy at Putao District

Hospital in Myanmar, 2019. Credit: UNAIDS

PILLAR 2.

Combination prevention for adolescent girls and young women in

high-prevalence locations

Despite a 39% decline in HIV incidence among young women aged 15–24 years in sub-

Saharan Africa between 2010 and 2020, adolescent girls and young adult women remain

greatly affected by HIV in parts of the region. Increased investment, including through the

United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund,

has enabled more than 40% of locations with high HIV incidence in 19 focus countries

in sub-Saharan Africa to implement dedicated combination prevention programmes for

young women. Those efforts must become more widespread to ensure access in 95% of

locations with high HIV incidence.

Combination prevention for adolescent girls and young women entails layered

programmes that address risk, vulnerability and service barriers and that provide a range

of reinforcing services. Recommended service packages include comprehensive sexuality

education (in and out of school), HIV and sexual and reproductive health services

(including male and female condoms and other contraceptive tools), antiretroviral-based

prevention and harm reduction for women who use drugs.

Gender inequalities and discrimination deny women and girls the ability to realize their

basic rights, including their right to education, good health, bodily autonomy and economic

well-being––all of which can also reduce their risk of HIV infection. Combination prevention

packages therefore comprise interventions to: change harmful gender norms; end gender-

based discrimination, inequalities and violence; improve social protection; and support

economic empowerment. These approaches feature in programmes such as Stepping

Stones, SASA!, South Africa’s national She Conquers programme and the PEPFAR-supported

Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) programmes.

There are opportunities to strengthen synergies between HIV and other endeavours, such

as those taken under the Education Plus Initiative and the Generation Equality Forum Action

Coalitions, as well as a range of sexual and reproductive health and rights initiatives.

PILLAR 3.

Combination prevention for men and adolescent boys in settings

with high HIV incidence

HIV prevention programmes for boys and men remain essential for their own health

and for the health of their female partners. Therefore, an expanded package on HIV

prevention for men and boys in settings with high HIV incidence is prioritized in the 2025

Road Map, while maintaining a strong focus on the provision of condoms, as well as on

voluntary medical male circumcision in 15 priority countries.

HIV prevention for men

and boys requires greater focus on increasing access to services within and outside clinic

settings including male-friendly services. This could entail community-based HIV testing,

self-testing, linkages to early antiretroviral treatment as required, condoms, pre-exposure

and post-exposure prophylaxis, comprehensive sexuality education and other sexual and

reproductive health services, and harm reduction.

27 United Nations Population Fund. Sexual and reproductive health and rights: an essential element of

universal health coverage. New York: UNFPA; 2019 (https://www.unfpa.org/sites/default/les/pub-pdf/

UF_SupplementAndUniversalAccess_30-online.pdf).

28 Voluntary medical male circumcision should continue to be promoted in 15 priority countries in

eastern and southern Africa: Botswana, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia,

Rwanda, South Africa, South Sudan, United Republic of Tanzania, Uganda, Zambia and Zimbabwe.

Voluntary medical male circumcision services need to reach greater numbers of adult

uncircumcised men who are at high risk of acquiring HIV infection. That calls for adaptations

to build demand and improve access, especially for men with lower incomes. It is essential

that these services be viewed as part of broader sexual and reproductive health services

for men and boys. They therefore should be offered as part of a package of services that

includes education on safe sex, on condom use and provision, and on healthy gender

norms, as well as information on HIV testing (and linkages to care and treatment, if

required), and prevention and management of sexually transmitted infections.

It is important to support these services with systematic efforts to promote gender

equitable norms and reduce gender-based violence. Several gender-transformative

programmes implemented in sub-Saharan Africa, such as One Man Can and others,

have shown potential for helping improve gender norms, address harmful aspects of

masculinities and reduce gender-based violence.

PILLAR 4.

Promotion of condoms and lubricants

Condoms remain the most widely used HIV prevention method and they are a low cost

option for the large numbers of people who are at moderately high risk of acquiring

HIV. Increased condom use is estimated to have averted more than 100 million new

HIV infections globally since 1990.

It also carries other sexual and reproductive health

benets, including the prevention of other sexually transmitted infections and unintended

pregnancies. However, gaps and inequities in condom access and use persist, and they

are widening in several countries in the context of reduced investment.

Strengthened national condom programmes are required.

This entails enhanced demand

creation (especially for new generations of potential users), procurement and supply of

male and female condoms as well as lubricants through free distribution, social marketing

and private sector sales to ensure full-scale access. Countries should act urgently to revive

condom programme stewardship, evidence-based design and total market approaches in

which the public, private and social marketing sectors complement one another.

Condom demand generation needs to reach a new generation of users. Credit: UNFPA

29 Engaging men and boys in gender equality and health: a global toolkit for action. New York: UNFPA;

2010 (https://www.unfpa.org/sites/default/les/pub-pdf/Engaging Men and Boys in Gender Equality.pdf).

30 Global sexual and reproductive health package for men and adolescent boys. New York: UNFPA;

2017. (https://www.unfpa.org/sites/default/les/pub-pdf/IPPF_UNFPA_GlobalSRHPackageMenAndBoys_

Nov2017.pdf).

31 Stover J, Teng Y. The impact of condom use on the HIV epidemic [version 1]. Gates Open Res. 2021;5:91.

PILLAR 5.

Wider access to antiretroviral based prevention, including PrEP

Pre-exposure prophylaxis is highly effective in preventing HIV infection. Despite progress

made in providing PrEP in a few Coalition focus countries, access in low- and middle-

income countries remains very low (less than 10% of the 2025 target). It is particularly

important to ensure access to key populations and other populations in settings with high

HIV incidence, as specied in Global AIDS Strategy (2021–2026) targets.

Such a scale-up requires increased investment and actions that address barriers to consistent

use. It calls for linking the roll-out of PrEP with related services (for example, HIV testing and

sexual and reproductive health) and with supportive social networks. Also needed are rapid

response mechanisms to introduce new prevention technologies and approaches as they

become available. The latter include the Dapivirine vaginal ring, which expands the choices

for HIV prevention available to women and adolescent girls at substantial risk of HIV infection,

and long-acting injectable antiretroviral formulations for PrEP.

Post-exposure prophylaxis has been under-utilized in HIV prevention response. It has

been a critical component of the clinical management of rape survivors

and in reducing

occupational risk, but remains largely unavailable outside clinical settings. There is

urgent need to address demand and supply-side barriers to the use of post-exposure

prophylaxis and increase access outside the health sector for key and priority populations.

Gaps in HIV testing and treatment, including among key populations and men, need to be

addressed urgently to realize the full benets of HIV testing and treatment. Necessary actions

include capitalizing more effectively on HIV testing as an entry for prevention and on HIV

prevention as an entry point for testing and treatment. Knowledge of HIV prevention benets

of treatment (undetectable = untransmittable, or U=U) also needs to increase.

Primary prevention, HIV treatment and programmes for elimination of vertical transmission

need to work hand-in-hand. New infections in children are also driven by newly acquired

maternal HIV infections during pregnancy and the breastfeeding period. This requires

increased focused on primary prevention for women and their partners through platforms for

the prevention of vertical transmission of HIV. HIV prevention for women and their partners

should be included in national guidelines for preventing vertical transmission and proven HIV

prevention choices, including PrEP, should be promoted for pregnant and lactating women

and their partners in areas of high HIV incidence.

32 Clinical management of rape and intimate partner violence survivors: developing protocols for use in

humanitarian settings. Geneva: WHO; 2022. https://www.who.int/publications/i/item/9789240001411

AN ACCOUNTABILITY FRAMEWORK

FOR HIV PREVENTION

Accountability is a priority in the 2025 Prevention Road Map as outlined earlier in Road

Map Action 10. Political leaders, HIV authorities, funding partners, private sector and civil

society partners have to be held accountable for promoting and managing multisectoral

prevention responses, and for mobilizing and allocating adequate nancing. They are

also responsible for implementing prevention programmes that match the scale and

characteristics of HIV epidemics in countries, and for establishing enabling environments

for those programmes.

A sound accountability framework (Table 3) achieves clarity and transparency about the

respective commitments and responsibilities. It is backed by adequate resources and

support for action, and it draws on regular monitoring and reliable reporting on progress.

Country teams using the Coalition scorecard for reviewing prevention results, GPC High-Level

Meeting, 2019, Kenya, Nairobi. Credit: UNAIDS

TABLE 3.

Accountability framework at all levels for HIV prevention

ACCOUNTABILITY FOR

ENSURING ACCOUNTABILITY AT THE COUNTRY-LEVEL

LED BY NATIONAL AIDS COORDINATING BODIES AND

SUPPORTED BY IN-COUNTRY COALITION MEMBERS

CROSS-CUTTING

MECHANISMS

Strong political

leadership in HIV

prevention

Semi-annual senior political leadership briengs.

Semi-annual reviews of political action agenda.

Annual high-level

global and regional HIV

Prevention Coalition

meetings.

National Coalition

multistakeholder

consultations before and

after annual global and

regional meetings.

Global tracking of

commitments followed

by problem-solving

dialogues.

Addressing legal and

policy barriers

Annual briengs with senior legislators and/or policy-makers.

Semi-annual dialogues on actions to address legal and

policy barriers (in collaboration with the Global Partnership

for Action to Eliminate All Forms of HIV-related Stigma and

Discrimination and building on the Global Commission on

HIV and the Law).

Adequate HIV

prevention nancing

Annual HIV prevention nancing dialogues with senior

leadership in health and nance ministries.

Annual prevention nance and investment tracking at global

and country levels.

Implementation

at scale

Annual performance reviews based on national and

subnational scorecards.

Quarterly programmatic progress-tracking and problem-

solving dialogues.

Ideally, accountability processes go beyond the necessary monitoring and evaluation

of performance (see box). In addition to being transparent regarding data and other

evidence, they should involve inclusive dialogue, set pragmatic deliverables and focus

on actions. Crucially, these processes need to involve all stakeholders in HIV prevention,

particularly the communities of people most affected by the HIV epidemic.

CORE CHARACTERISTICS OF WELL-FUNCTIONING

ACCOUNTABILITY PROCESSES

Accountability processes should be:

• Participatory, inclusive, government-led and community-led. All

stakeholders in HIV prevention should participate in the design and

implementation of accountability processes. Affected communities have

key roles in these processes.

• Transparent. The processes should be developed and conducted in a

transparent manner providing access to data, programme reviews, reports

and scorecards to the public and communities.

• Contextualized. The processes should be adapted to their contexts. They

should reect the political context and the level of civic participation in

governance and decision-making.

• Distinct. Monitoring and evaluation are crucial for accountability processes

(e.g. providing evidence to assess the performance of HIV prevention

activities). Accountability also involves assessing aspects of the prevention

response that go beyond indicators and targets; it includes aspects such

as transparency of decision-making, dialogue among stakeholders and the

upholding of human rights.

Several practical steps can be taken to strengthen the accountability processes related to

the HIV Prevention 2025 Road Map:

•

Host initial multistakeholder dialogues at national level shortly after the launch of the

2025 Road Map. These meetings will customize milestones and set annual progress

markers for each of the ten Action Plan points in the Road Map. The progress markers

can be selected by drawing on existing in-country work and can be supported

through existing facilities such as the UNAIDS Technical Support Mechanism. Ideally, a

minimum of three progress markers should be identiﬁed for each of the ten Action Plan

points. Where possible, markers can be aligned to indicators in the UNAIDS National

Commitments and Policy Instrument.

•

Make national dialogues inclusive (e.g. national AIDS councils, ministries of health

and other frontline ministries, donors, HIV service implementers, community-led

organizations and other civil society organizations, and the private sector) and uphold

the Greater Involvement of People living with or affected by HIV principle.

•

Incorporate the milestones and annual progress markers into a national accountability

plan, to be published on the Global HIV Prevention Coalition website. The

multistakeholder dialogues can be repeated annually to evaluate progress towards the

milestones.

•

Prepare a joint accountability report incorporating government and community

perspectives and data. The report complements the national prevention scorecards and

encompasses a broader scope of accountability.

•

Actively use the HIV Prevention Scorecard, with scores based on a combination of

coverage, output and outcome indicators for key programme components and societal

enablers in the Global AIDS Monitoring system. The Prevention Scorecard would

continue to guide the regular review of performance at all implementation levels and

highlight gaps in data that need to be addressed.

•

Collaborate with learning networks and create a knowledge-sharing platform on

accountability where countries can share their experiences. The Global HIV Prevention

Coalition Secretariat can convene discussions of signiﬁcant problems and challenges.

•

Convene an initial global meeting of Global HIV Prevention Coalition members to review

national accountability plans and decide which progress markers for which the Coalition

Secretariat and other members will be accountable. Using country-level national

accountability plans as a starting point, Global Coalition members can determine the

speciﬁc actions and targets for which they are responsible.

•

Annually review progress in the Global HIV Prevention Working Group and the National

AIDS Council managers’ community of practice before presenting results at annual high-

level Coalition meetings.

The international community must lead a global push towards investment in HIV prevention.

Executive Directors of UNAIDS and UNFPA, Co-Conveners of the Global Prevention Coalition

during the 45th PCB of UNAIDS. Credit: UNAIDS

ANNEXES

ANNEX 1.

Commitments towards reducing new HIV infections

to fewer than 370000 per year by 2025

Governments will:

•

Lead the implementation of the ten-point Action Plan.

•

Set ambitious national and subnational HIV prevention programme, ﬁnancing and

impact targets for 2025, in accordance with the 2021 Political Declaration and the Global

AIDS Strategy (2021–2026).

•

Develop national action plans that are in line with the scale-up targets. The plans should

be based on population size estimates and should deﬁne priority locations, populations

and service packages, and should emphasize delivery platforms for differentiated

services.

•

Adjust national result frameworks to ensure that 95% of key and priority groups in

settings with high HIV prevalence are accessing high-impact prevention services.

•

Take practical steps to achieve adequate and sustainable investments in HIV primary

prevention as part of a fully funded national HIV response.

•

Strengthen the national entity leading HIV prevention and empower it to hold actors

accountable, strengthen national and local accountability frameworks, and increase

national and local HIV prevention management capacity.

•

Build the capacity of the national entity leading HIV prevention to advance the

systematic integration of gender-transformative approaches in national HIV responses.

•

Provide the necessary funding and support to ensure the meaningful engagement

of community-led and other civil society organizations—including organizations

and networks of key populations and young people—in all aspects of the design,

implementation, and monitoring and evaluation of HIV policies and programmes.

•

Develop or revise social contracting mechanisms to facilitate government funding

for civil society implementers, and increase investments towards fulﬁlling the global

commitments for community-led service delivery.

•

Accelerate the necessary legal reforms and policy changes to remove legal, social,

economic and gender-related barriers that hold back HIV prevention.

•

Adopt proven new technologies and innovative strategies for HIV prevention.

Community-led and other civil society organizations will:

•

Sensitize decision-makers at all levels about the continued importance of primary

prevention, alongside the 95–95–95 testing and treatment agenda, and advocate for

evidence-informed policies and adequate investments.

•

Participate in the design and implementation of prevention programmes, as well as in

monitoring and accountability structures.

•

Advocate for funding, capacity building and support to expand community service

delivery platforms for key and priority populations.

•

Strengthen community systems, including community-led monitoring and surveillance,

to improve the quality of prevention services and of data, progress tracking and

reporting.

•

Hold governments and other actors accountable for progress towards prevention

targets through constructive advocacy, and further develop community accountability

structures for feedback, communication and problem solving between community

entities and government systems.

•

Advocate for legal and policy reforms, including the removal of punitive laws, the

lowering of obstructive age of consent requirements, and the abandonment of HIV-

related travel restrictions.

•

Develop and implement interventions to reduce HIV-related stigma and discrimination

across health, community, justice, workplace, education and humanitarian settings.

Funding and other development partners will:

•

Intensify their support for HIV prevention, considering the need to scale up both

treatment and prevention, including by ﬁnancing implementation of the HIV Prevention

2025 Road Map.

•

Place greater emphasis on actions for achieving the HIV prevention targets, as well as

share lessons and promote best practices in planning, implementing and managing

prevention interventions.

•

Where needed, provide new or additional resources to neglected prevention

components such as condom programming and key population programmes, and

support community-led implementation and advocacy.

•

Support and facilitate price and access negotiations for making new prevention

technologies, including pharmaceutical products available at affordable prices in low-

and middle-income countries.

•

Increase and sustain adequate funding for HIV prevention across the ﬁve pillars in

countries that need donor support, and sustain funding in other countries to allow them

sufﬁcient time to transition to domestic ﬁnancing of prevention programmes.

•

Establish and/or support ﬁt for purpose mechanisms for technical assistance for HIV

prevention, develop and disseminate implementation tools, and collect best practice

examples with designated leads for each pillar’s key functions.

•

Invest in scaling up gender-transformative interventions to change harmful gender

norms and end gender-based violence and harmful practices.

•

Provide support for creating and operating harmonized accountability mechanisms

(e.g. scorecards or dashboards).

The private sector will:

•

Expand corporate responsibility schemes to ensure comprehensive primary prevention

services for employees, their families and communities, and act to reduce stigma and

discrimination.

•

Support innovations in HIV prevention commodities, interventions and service delivery

approaches, and invest in health-related communication technologies and systems.

•

Share lessons for strengthening results based planning and service delivery systems,

such as logistics, supply chain management systems and the use of new media

technologies, as well as provide technical and other necessary support in those areas.

ANNEX 2.

Detailed HIV prevention targets in the

Global AIDS Strategy 2021–2026

The Global AIDS Strategy 2021–2026 requires the achievement of ambitious targets in all

populations and settings. To develop the targets for 2025, UNAIDS worked with partners

to review available evidence, including modelling, to determine the specic actions

needed to make the 2030 goal possible. As in prior target-setting exercises, this process

used an investment framework to identify the level and allocation of resources required

for achievement of the targets. A technical consultation on prevention targets was held

involving experts and stakeholders to review evidence and determine what is currently

working and needs to be continued, what is not working and needs to be changed, and

which key gaps in the response need to be addressed.

Detailed prevention targets were set for key populations (Table 4) and young people

and adults (Table 5). Both sets of targets are differentiated by the level of risk and are

based on the principle that higher coverage and more comprehensive services should be

provided where risk is higher.

Prevention targets for key populations were dened as follows:

•

Speciﬁc targets were set for all ﬁve key populations for all programme areas.

•

Within key populations, PrEP targets are further disaggregated by three risk categories.

•

Risk categories for PrEP targets are based on the following criteria (see Table 6 for details):

•

For sex workers and prisoners, risk categories are based on HIV prevalence in the

overall population as a proxy for the risk in the two populations.

•

For gay men and other men who have sex with men and transgender people, risk

categories are based on the estimated level of HIV incidence.

•

For people who inject drugs, risk categories for PrEP are based on the coverage of

harm reduction services.

Prevention targets for young people and adults were dened along the following lines:

•

Targets are disaggregated by age and sex.

•

Risk categories were deﬁned based on the level of HIV incidence in speciﬁc

geographical areas and individual risk behaviours (see Table 7 for details).

•

For some programme areas, risk categories are deﬁned based on the level of HIV

incidence by geography alone. This includes programmes that reduce susceptibility and

vulnerability over longer periods of time including voluntary medical male circumcision

and economic empowerment of women. It also includes post-exposure prophylaxis.

•

For other programme areas, risk categories are deﬁned based on a combination of

behaviours and HIV incidence in the geographical area. This includes targets for services that

respond more directly to individual risk exposures such as condoms, PrEP and STI screening.

In addition to programmatic targets, the Global AIDS Strategy calls for ensuring that

80% of service delivery for HIV prevention programmes for key populations and women

be delivered by community, key population and women-led organizations. This target

specically refers to those programme components designed to reach key populations,

young people and women.

TABLE 4.

Prevention targets for key populations

KEY POPULATIONS

SEX

WORKERS

GAY MEN

AND OTHER

MEN WHO

HAVE SEX

WITH MEN

PEOPLE

WHO INJECT

DRUGS

TRANS-

GENDER

PEOPLE

PRISONERS

AND OTHERS

IN CLOSED

SETTINGS

Condom/lubricant use at

last sex by those not taking

PrEP with a nonregular

partner whose HIV viral

load status is not known to

be undetectable (includes

those who are known to be

HIV negative)

— 95% 95% 95% —

Condom/lubricant use at

last sex with a client or

nonregular partner

90% — — — 90%

PrEP use (by risk category)

Very high

High

Moderate and low

80%

15%

50%

15%

50%

15%

Sterile needles and syringes — — 90% — 90%

Opioid substitution therapy

among people who are

opioid dependent

— — 50% — —

STI screening and treatment 80% 80% — 80% —

Regular access to

appropriate health system

or community-led services

90% 90% 90% 90% 100%

Access to post-exposure

prophylaxis as part of a

package of risk assessment

and support

90% 90% 90% 90% 90%

TABLE 5.

Targets for young people and adults by level of risk

YOUNG PEOPLE AND ADULTS 15–49

RISK BY PRIORITIZATION STRATUM

VERY HIGH

MODERATE

LOW

ALL AGES AND

GENDERS

Condoms/lubricant use at last

sex by those not taking PrEP with

a nonregular partner whose HIV

viral load status is not known to be

undetectable (includes those who are

known to be HIV negative)

95% 70% 50%

PrEP use (by risk category) 50% 5% 0%

STI screening and treatment 80% 10% 10%

ADOLESCENTS

AND YOUNG

PEOPLE

Comprehensive sexuality education in

schools, in line with UN international

technical guidance

90% 90% 90%

STRATA BASED ON GEOGRAPHY ALONE

VERY

HIGH

(>3%)

HIGH

(1–3%)

MODERATE

(0.3–1%)

LOW (<0.3%)

ALL AGES AND

GENDERS

Access to post-exposure prophylaxis

(nonoccupational exposure) as part

of package of risk assessment and

support

90% 50% 5% 0%

Access to post-exposure prophylaxis

(nosocomial) as part of package of risk

assessment and support

90% 80% 70% 50%

ADOLESCENT

GIRLS AND

YOUNG WOMEN

Economic empowerment 20% 20% 0% 0%

ADOLESCENT

BOYS AND MEN

Voluntary medical male circumcision 90% in 15 priority countries

PEOPLE WITHIN

SERODISCORDANT

PARTNERSHIPS

Condoms/lubricant use at last sex

by those not taking PrEP with a

nonregular partner whose HIV viral

load status is not known

95%

PrEP until positive partner has

suppressed viral load

30%

Post-exposure prophylaxis 100% after high-risk exposure

TABLE 6.

Thresholds for the prioritization of HIV prevention methods for key populations

CRITERION VERY HIGH HIGH MODERATE AND LOW

SEX WORKERS

National adult

(15–49 years)

HIV prevalence

>3% >0.3% <0.3%

PRISONERS

National adult

(15–49 years)

HIV prevalence

>10% >1% <1%

GAY MEN AND

OTHER MEN

WHO HAVE SEX

WITH MEN

UNAIDS analysis

by country/

region

Proportion of

populations

estimated to

have incidence:

>3%

Proportion of populations

estimated to have incidence:

0.3–3%

Proportion of populations

estimated to have incidence:

<0.3%

TRANSGENDER

PEOPLE

Mirrors gay men

and other men

who have sex

with men in the

absence of data

Proportion of

populations

estimated to

have incidence:

>3%

Proportion of populations

estimated to have incidence:

0.3–3%

Proportion of populations

estimated to have incidence:

<0.3%

PEOPLE WHO

INJECT DRUGS

UNAIDS analysis

by country/

region

Small needle–

syringe

programme

and low opioid

substitution

therapy

coverage

Limited needle–syringe

programme; limited opioid

substitution therapy

Wide needle–syringe

programme coverage

with adequate needles

and syringes per person

who injects drugs; opioid

substitution therapy

available

TABLE 7.

Thresholds for the prioritization of HIV prevention methods for young people and adults

CRITERION HIGH AND VERY HIGH MODERATE LOW

Adolescent

girls and young

women

Combination of national

or subnational incidence in

women 15–24 years AND

reported behaviour from

DHS or other ≥2 partners;

or reported STIs in previous

12 months

1–3%

incidence

AND

high-risk

reported

behaviour

>3%

incidence

0.3–<1%

incidence

and high-risk

reported

behaviour

1–3%

incidence

and low-risk

reported

behaviour

<0.3%

incidence

0.3–<1%

incidence

and low-risk

reported

behaviour

Adolescent

boys and

young men

Combination of national

or subnational incidence

in men 15–24 years AND

reported behaviour from

DHS or other ≥2 partners;

or reported STIs in previous

12 months

1–3%

incidence

AND

high-risk

reported

behaviour

>3%

incidence

0.3–<1%

incidence

and high-risk

reported

behaviour

1–3%

incidence

and low-risk

reported

behaviour

<0.3%

incidence

0.3–<1%

incidence

and low-risk

reported

behaviour

Adults (aged

25 and older)

Combination of national

or subnational incidence

in adults 25–49 years AND

reported behaviour from

DHS or other ≥2 partners;

or reported STI in previous

12 months

1–3%

incidence

AND

high-risk

reported

behaviour

>3%

incidence

0.3–<1%

incidence

and high-risk

reported

behaviour

1–3%

incidence

and low-risk

reported

behaviour

<0.3%

incidence

0.3–<1%

incidence

and low-risk

reported

behaviour

Serodiscordant

partnerships

Estimated number of HIV

negative regular partners

of someone newly starting

on treatment

Risk stratication depends on choices in the partnership: choice of timing

and regimen of antiretroviral therapy for the HIV positive partner; choice of

behavioural patterns (condoms, frequency of sex); choice of PrEP

ANNEX 3:

Members of the Global HIV Prevention Coalition

Co-conveners

Winnie Byanyima, Executive Director, Joint United

Nations Programme on HIV/AIDS

Natalia Kanem, Executive Director, United Nations

Population Fund

Focus countries

Angola

Botswana

Brazil

Cameroon

China

Côte d’Ivoire

Democratic Republic of the Congo

Eswatini

Ethiopia

Ghana

India

Indonesia

Islamic Republic of Iran

Kenya

Lesotho

Malawi

Mexico

Mozambique

Myanmar

Namibia

Nigeria

Pakistan

South Africa

Uganda

Ukraine

United Republic of Tanzania

Zambia

Zimbabwe

Donor countries

France

Germany

Netherlands

Norway

Sweden

United Kingdom

United States of America

International and regional organizations

African Union

Bill & Melinda Gates Foundation

Children’s Investment Fund Foundation

Joint United Nations Programme on HIV/AIDS Secretariat

and Cosponsors

Reproductive Health Supplies Coalition

Southern African Development Community

The Global Fund

United States President’s Emergency Plan for AIDS Relief

Civil society organizations and networks

African Youth and Adolescent Network on Population

and Development (AFRIYAN)

AVAC

FP2020

Frontline AIDS

Global Action for Trans Equality (GATE)

Global Action for Gay Men’s Health and Rights (MPACT)

Global Network of People living with HIV (GNP+)

Global Network of Sex Work Projects (NSWP)

International Association of Providers of AIDS Care

(IAPAC)

International Community of Women Living with HIV

(ICW)

International Network of People Who Use Drugs

(INPUD)

International Network of Religious Leaders Living

with or personally affected by HIV and AIDS (INERELA+)

International Planned Parenthood Federation (IPPF)

Others

Centre for the AIDS Programme of Research in South

Africa (CAPRISA)

International AIDS Society (IAS)

Reference Group on HIV and Human Rights

ANNEX 4.

Successful HIV prevention supports achievement of the Sustainable

Development Goals

Preventing HIV is vital for ending the AIDS epidemic as a public health threat and for

achieving the Sustainable Development Goals.

TABLE 8.

The HIV response in the context of the Sustainable Development Goals

Healthy lives

and well-being

for all, at all

ages

Universal

health

coverage,

including HIV

prevention

services

Universal

access to

sexual and

reproductive

health

Universal

access to drug

dependence

treatment and

harm reduction

Inclusive and

equitable

quality

education and

promotion of

lifelong learning

opportunities

for all

High-quality

education,

including on

comprehensive

sexual and

reproductive

health

Empowerment

of young

people and

life skills for

responsible

and informed

sexual and

reproductive

health decisions

Gender

equality and

empowerment

of all women

and girls

Sexual and

reproductive

health and

rights

Elimination of

violence and

harmful gender

norms and

practices

Reduced

inequality

within and

among

countries

Protection

against

discrimination

alongside legal

services

Rights literacy,

access to

justice and

international

protection

Empowerment

of people to

claim their

rights and

enhance access

to HIV services

Global

partnership

for sustainable

development

Policy

coherence

International

support

for

implementing

effective

capacity

building

Reduced

violence

including

against key

populations

and people

living with HIV

Promotion of

the rule of law

Effective,

accountable

and transparent

institutions

Inclusive,

participatory

and

representative

decision-

making

ANNEX 5.

Summary of achievements and lessons from implementation of

the2020 HIV Prevention Road Map

The ten-point Action Plan described in the 2020 Prevention Road Map laid out the

steps which each country needed to take to accelerate progress in HIV prevention.

Itcalled for a streamlined but robust strategic planning and programme management

effort. It also offered a framework for supporting monitoring and accountability by

using country scorecards and the Coalition’s progress reports.

Guided by the Action Plan and Road Map, countries have made considerable progress,

as shown in Table 9. Key elements of those achievements included strong political

commitment, increased investments in HIV prevention, a clear vision and practical

strategy that encompasses well-dened core packages, decentralized service delivery,

community-led action and peer led outreach, and continuous monitoring and quality

assurance. Partnerships with civil society and community engagement have markedly

strengthened national and subnational responses.

According to the nal survey of the 2020 Road Map actions, however, none of the focus

countries had completed all ten steps. Côte d’Ivoire, India, Kenya and South Africa had

completed or initiated action on all but two of the steps, while Cameroon, Democratic

Republic of the Congo and Lesotho had done so for all but three of the steps. Even

though the overall targets were not met, there had been heartening progress against

most of the ten Action Plan points.

Almost all the focus countries had carried out prevention needs assessments, set

prevention targets and drafted or updated their prevention strategies. There was

increased action towards legal and policy reforms, and a large majority of focus

countries had done nancial gap analyses and had strengthened their programme

monitoring and performance review processes. But key population size estimates had

been completed in only four of the 28 reporting countries (although they were under

way in all but two countries) and policy reforms to facilitate more effective prevention

among key populations were progressing too slowly. Dened service packages for

key populations were not yet in place in most of the focus countries. Progress on

capacity building and technical support plans was also slow and social contracting was

uncommon and becoming more difcult.

Underlying factors included insufcient political commitment and investment,

inadequate attention to data systems and management, and insufcient action

to address the social and contextual complexities experienced by vulnerable and

marginalized groups––particularly key populations and adolescent girls and women.

These populations continue to face numerous barriers in accessing HIV and sexual

and reproductive health services, including legal and policy hindrances, stigma and

discrimination, gender inequalities, and gender-based violence. Laws that criminalize

key populations remain in place in most countries, although they have been relaxed

or reformed in some. With such minimal progress, such laws and prohibitions remain

a major barrier to HIV prevention programming in many countries. In most of the

focus countries, prevention programmes are still weakest in delivering and monitoring

interventions with and for key populations.

The 2020 HIV Prevention

Road Map helped to anchor

HIV prevention within

national HIV responses.

Coalition members have

all reported using the

Road Map to chart the

way forward at a national

level. Other countries have

also used it to guide their

national responses. The

Road Map has provided

many leaders and decision-

makers with a basis for

implementing the Global

HIV Prevention Coalition

vision by developing

frameworks and crafting

strategies to scale up

country-led HIV prevention

programmes.

HIV PREVENTION ROADMAP

10-POINT PLAN ACTIONS

Timeline

Lesotho

United Republic of Tanzania

Democratic Republic of the Congo

Cameroon

Eswatini

South Africa

Côte d’Ivoire

Kenya

Namibia

Zimbabwe

Nigeria

Uganda

India

Malawi

Pakistan

Islamic Republic of Iran

China

Ethiopia

Zambia

Angola

Indonesia

Mozambique

Myanmar

Mexico

Brazil

Ukraine

Ghana

Botswana

1. HIV prevention needs assessment

2017

2. HIV prevention targets

3. HIV prevention strategy

4. Legal and policy reform actions

5a. Key population size estimates*

5b. Dened key population service packages*

5c. Adolescent girls and young women size estimates

5d. Dened adolescent girls and young women service package

6. Capacity building and technical assistance plan

7. Social contracting mechanisms

8. Financial gap analysis

9. Strengthened programme monitoring

10. Programme performance review

1. HIV prevention needs assessment

2018

2. HIV prevention targets

3. HIV prevention strategy

4. Legal and policy reform actions

5a. Key population size estimates*

5b. Dened key population service packages*

5c. Adolescent girls and young women size estimates

5d. Dened adolescent girls and young women service package

6. Capacity building and technical assistance plan

7. Social contracting mechanisms

8. Financial gap analysis

9. Strengthened programme monitoring

10. Programme performance review

1. HIV prevention needs assessment

2019

2. HIV prevention targets

3. HIV prevention strategy

4. Legal and policy reform actions

5a. Key population size estimates*

5b. Dened key population service packages*

5c. Adolescent girls and young women size estimates

5d. Dened adolescent girls and young women service package

6. Capacity building and technical assistance plan

7. Social contracting mechanisms

8. Financial gap analysis

9. Strengthened programme monitoring

10. Programme performance review

1. HIV prevention needs assessment

2020

2. HIV prevention targets

3. HIV prevention strategy

4. Legal and policy reform actions

5a. Key population size estimates*

5b. Dened key population service packages*

5c. Adolescent girls and young women size estimates

5d. Dened adolescent girls and young women service package

6. Capacity building and technical assistance plan

7. Social contracting mechanisms

8. Financial gap analysis

9. Strengthened programme monitoring

10. Programme performance review

TABLE 9.

Summary of implementation of 2020 Road Map actions

Done In progress Not done

Not applicable Progress not submitted

*Countries are scored as “done” if they report having conducted population size estimates and

dened service packages for all 5 key population groups: (i) gay men and other men who have sex

with men, (ii) sex workers, (iii) people who inject drugs, (iv) transgender persons and (v) people in

prison. In progress” reects actions on 3-4 groups and “not done” reects actions on 0-2 groups.

HIV PREVENTION ROADMAP

10-POINT PLAN ACTIONS

Timeline

Lesotho

United Republic of Tanzania

Democratic Republic of the Congo

Cameroon

Eswatini

South Africa

Côte d’Ivoire

Kenya

Namibia

Zimbabwe

Nigeria

Uganda

India

Malawi

Pakistan

Islamic Republic of Iran

China

Ethiopia

Zambia

Angola

Indonesia

Mozambique

Myanmar

Mexico

Brazil

Ukraine

Ghana

Botswana

1. HIV prevention needs assessment

2017

2. HIV prevention targets

3. HIV prevention strategy

4. Legal and policy reform actions

5a. Key population size estimates*

5b. Dened key population service packages*

5c. Adolescent girls and young women size estimates

5d. Dened adolescent girls and young women service package

6. Capacity building and technical assistance plan

7. Social contracting mechanisms

8. Financial gap analysis

9. Strengthened programme monitoring

10. Programme performance review

1. HIV prevention needs assessment

2018

2. HIV prevention targets

3. HIV prevention strategy

4. Legal and policy reform actions

5a. Key population size estimates*

5b. Dened key population service packages*

5c. Adolescent girls and young women size estimates

5d. Dened adolescent girls and young women service package

6. Capacity building and technical assistance plan

7. Social contracting mechanisms

8. Financial gap analysis

9. Strengthened programme monitoring

10. Programme performance review

1. HIV prevention needs assessment

2019

2. HIV prevention targets

3. HIV prevention strategy

4. Legal and policy reform actions

5a. Key population size estimates*

5b. Dened key population service packages*

5c. Adolescent girls and young women size estimates

5d. Dened adolescent girls and young women service package

6. Capacity building and technical assistance plan

7. Social contracting mechanisms

8. Financial gap analysis

9. Strengthened programme monitoring

10. Programme performance review

1. HIV prevention needs assessment

2020

2. HIV prevention targets

3. HIV prevention strategy

4. Legal and policy reform actions

5a. Key population size estimates*

5b. Dened key population service packages*

5c. Adolescent girls and young women size estimates

5d. Dened adolescent girls and young women service package

6. Capacity building and technical assistance plan

7. Social contracting mechanisms

8. Financial gap analysis

9. Strengthened programme monitoring

10. Programme performance review

ANNEX 6

The Global HIV Prevention Coalition in the context of other initiatives

The Global HIV Prevention Coalition operates alongside other key initiatives (Table 10).

TABLE 10.

The Global HIV Prevention Coalition and its complementarity to other global initiatives

GLOBAL HIV

PREVENTION

COALITION

95–95–95 AND

ASSOCIATED

WORKING

GROUPS

10–10–10

TARGETS AND

ASSOCIATED

INITIATIVES

GLOBAL

ALLIANCE TO

END AIDS IN

CHILDREN

EDUCATION

PLUS INITIATIVE

FOCUS

HIV prevention

among young

people and

adults

HIV testing and

treatment, and

differentiated

service delivery

Includes the

The Global

Partnership

to Eliminate

all forms of

HIV-related

Stigma and

Discrimination

Elimination

of vertical

transmission of

HIV, treatment

of children and

prevention

services for

adolescent

girls and young

women

Access to

education for

girls and young

women, gender

equality

CONTRIBUTION

TO THE

PREVENTION

AGENDA

Lead and track

the global HIV

prevention

response

Increased viral

suppression

directly reduces

new HIV

infections

HIV testing is an

entry point for

prevention

HIV treatment

is an entry point

for prevention

for partners

Reduce legal and

policy barriers

to accessing

HIV prevention

services affecting

key populations,

young people

and women

in settings

with high HIV

incidence

Reduce new

HIV infections in

children

Reduction of

new infections

in adolescent

girls and young

women and

pregnant and

breastfeeding

women

Increase

access through

secondary

education plus

comprehensive

sexuality

education; access

to sexual and

reproductive

health services;

end violence

against

women and

girls; promote

women’s

economic

empowerment;

strengthen

leadership of

women living

with and affected

by HIV

AREAS OF

COLLABORATION

Key population community access platforms for prevention,

testing, treatment and rights

Access platforms for women, particularly adolescent girls and young women as well as women and their

partners, and actions to address harmful gender norms and gender inequalities that affect HIV prevention

National strategic planning and coordination to minimize duplication and maximize complementarity

ANNEX 7.

Reference list and further reading

1. Peter Sands interview (https://hivpreventioncoalition.unaids.org/wp-content/

uploads/2021/06/Mr-Peter-Sands.pdf, accessed 1 October 2021).

2. Global HIV Prevention Coalition. Implementation of the HIV Prevention 2020

Road Map. First progress report, March 2018. Geneva: UNAIDS; 2018 (https://

hivpreventioncoalition.unaids.org/wp-content/uploads/2018/06/JC2927_UNAIDS-

WHA-Report.pdf, accessed 18 August 2021).

3. Global HIV Prevention Coalition. Implementation of the HIV Prevention 2020 Road

Map. Second progress report, April–December 2018. Geneva: UNAIDS; 2019 (https://

hivpreventioncoalition.unaids.org/wp-content/uploads/2019/05/Second-Progress-

Report_HIV-Prevention-Roadmap_2019.pdf, accessed 18 August 2021).

4. Global HIV Prevention Coalition. Implementation of the HIV Prevention 2020

Road Map. Third progress report, October 2019. Geneva: UNAIDS; 2019 (https://

hivpreventioncoalition.unaids.org/wp-content/uploads/2020/02/20200205_JC2980_

GPC-Report-2019_En.pdf, accessed 18 August 2021).

5. Global HIV Prevention Coalition. Implementation of the HIV Prevention 2020 Road

Map. Fourth progress report, November 2020. Geneva: UNAIDS; 2020 (https://

hivpreventioncoalition.unaids.org/wp-content/uploads/2020/11/fourth-annual-

progress-report.pdf, accessed 18 August 2021).

6. de Zalduondo BO, Gelmon L, Jackson H. External review of the Global HIV Prevention

Coalition. Geneva: UNAIDS; 2020 (https://www.unaids.org/sites/default/les/media_

asset/PCB47_CPR2_External_Review_GPC.pdf, accessed 18 August 2021)

7. Decisions of the Virtual 47th Session of the UNAIDS Programme Coordinating Board.

Geneva: 15-18 December 2020 (https://www.unaids.org/sites/default/les/media_

asset/Decisions_(PCB47)_Final_EN_rev1.pdf, accessed 9 September 2021).

8. Political Declaration on HIV and AIDS: ending inequalities and getting on track to end

AIDS by 2030. New York, United Nations; 2021 (https://www.unaids.org/sites/default/

les/media_asset/2021_political-declaration-on-hiv-and-aids_en.pdf), accessed

18August 2021.

9. Stover J, Teng Y. The impact of condom use on the HIV epidemic [version 1]. Gates

Open Res. 2021;5:91. doi: 10.12688/gatesopenres.13278.1

10. Global Partnership for Action to Eliminate all forms of HIV-related Stigma and

Discrimination. Geneva: UNAIDS; 2018 (https://www.unaids.org/sites/default/

les/media_asset/global-partnership-hiv-stigma-discrimination_en.pdf, accessed

24November 2021).

11. HIV Prevention 2020 Road Map. Accelerating HIV prevention to reduce new infections

by 75%. Geneva: UNAIDS; 2018 (https://hivpreventioncoalition.unaids.org/wp-

content/uploads/2018/03/JC2909_INCLUSION-GAP_013_En-2.pdf, accessed

18August 2021).

12. Communities at the centre: Global AIDS Update 2019. Geneva: UNAIDS; 2019

(https://www.unaids.org/sites/default/les/media_asset/2019-global-AIDS-update_

en.pdf, accessed 26 November 2021)

13. Prevailing against pandemics by putting people at the centre: World AIDS Day report

2020. Geneva: UNAIDS; 2020 (https://www.unaids.org/sites/default/les/media_

asset/prevailing-against-pandemics_en.pdf, accessed 18 August 2021)

14. Key population trusted access platforms: considerations in planning and budgeting

for a key population platform to deliver scaled quality HIV prevention and

treatment services and for addressing critical enablers. Geneva: UNAIDS; 2020

(https://hivpreventioncoalition.unaids.org/wp-content/uploads/2020/04/Budget-

Considerations-for-KP-Trusted-Access-Platforms-April-2-2020-Final-V-1.1a-no-TCs-1.

pdf, accessed 9 September 2021).

15. Evidence review: implementation of the 2016-2021 UNAIDS Strategy: on the fast-

track to end AIDS. Geneva: UNAIDS; 2020 (https://www.unaids.org/sites/default/les/

media_asset/PCB47_CRP3_Evidence_Review_EN.pdf, accessed 18 August 2021).

16. Seizing the moment. Tackling entrenched inequalities to end epidemics. Global

AIDS Update 2020. Geneva: UNAIDS; 2020 (https://www.unaids.org/en/resources/

documents/2020/global-aids-report, accessed 9 September 2021).

17. Confronting inequalities: lessons for pandemic responses from 40 years of AIDS.

Global AIDS Update 2021. Geneva: UNAIDS; 2021 (https://www.unaids.org/sites/

default/les/media_asset/2021-global-aids-update_en.pdf, accessed 9 September

2021).

18. Global AIDS Strategy 2021–2026: end inequalities, end AIDS. Geneva: UNAIDS;

2021. (https://www.unaids.org/sites/default/les/media_asset/global-AIDS-

strategy-2021-2026_en.pdf, accessed 18 August 2021).

19. Preventing HIV infections at the time of a new pandemic: a synthesis report on

programme disruptions and adaptations during the COVID-19 pandemic in 2020.

Geneva: 2021 (https://www.unaids.org/en/resources/documents/2021/20210701_

HIVPrevention_new_pandemic, accessed 18 August 2021).

20. Every adolescent girl in Africa completing secondary school, safe, strong,

empowered: Time for Education Plus. Geneva: UNAIDS; 2021 (https://www.unaids.

org/sites/default/les/media_asset/JC3016_EducationPlusBrochure_En.pdf, accessed

24November 2021).

21. Sexual and reproductive health and rights: an essential element of universal health

coverage. New York: United Nations Population Fund; 2019 (https://www.unfpa.

org/sites/default/les/pub-pdf/UF_SupplementAndUniversalAccess_30-online.pdf,

accessed 7 September 2021)

22. Engaging men and boys in gender equality and health: a global toolkit for action.

New York: United Nations Population Fund; 2010 (https://www.unfpa.org/sites/

default/les/pub-pdf/Engaging Men and Boys in Gender Equality.pdf, accessed

9September 2021).

23. Global sexual and reproductive health package for men and adolescent boys. New

York: UNAIDS; 2017 (https://www.unfpa.org/sites/default/les/pub-pdf/IPPF_UNFPA_

GlobalSRHPackageMenAndBoys_Nov2017.pdf, accessed 9 September 2021).

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