The 2020–2021 biennium marked the end of one era in the HIV response and the beginning of a new one, moving towards the ultimate goal of ending AIDS as a public health threat by 2030. This pivotal transition in the response occurred at the same time as the realization that, despite much progress in many countries, the 2020 global AIDS targets were not reached. In addition, the COVID-19 pandemic, which upended virtually every aspect of life in every region of the world, had a devastating impact on countries and communities and put at risk hard-won HIV and other Sustainable Development Goals (SDG) gains that are important for effective HIV response.

Through leadership provided by the Joint Programme and the active engagement of thousands of AIDS stakeholders across the world, the global HIV response transitioned from the Fast-Track approach towards an focus on ensuring that all populations and settings are on-track to end AIDS. Outlined in the Global AIDS Strategy 2021–2026 and endorsed in the 2021 Political Declaration on HIV and AIDS, this new era demands the use of an inequalities lens across all aspects of the response, including renewed attention to addressing the social and structural factors that increase HIV vulnerability and reduce people’s ability to access essential HIV services. Though ending AIDS will not be possible without increased domestic investment and international donor commitments, the effects of past under-investment in HIV have now been magnified by a tightened financing landscape for HIV and development.

The Joint Programme and its many partners in the response are now focused on achieving the 95–95–95 service targets for all subpopulations, age groups and settings, and on the 10–10–10 targets to enable countries and empower communities and remove societal and legal barriers to effective responses by 2025.

The Joint Programme continued in 2020–2021 to serve as a catalytic force in the HIV  response. It this through its global leadership and social mobilization; its strong presence in and support to countries and communities; the many partnerships it nurtures and the innovation it galvanizes; the strategic information it collects and leverages for evidence-informed programmes and investments; and the specialized expertise and normative guidance that drive progress and on which diverse actors in the response rely.

It is clearer than ever that it is feasible to end AIDS as a public health threat. As of 2020, 44 countries were on-track to achieve at least a 90% reduction in AIDS-related deaths by 2030 and 35 were on-track to reduce new HIV infections by at least 90%.

However, progress in the response remains uneven and inadequate. None of the 2020 Fast-Track targets were achieved globally, and the rate at which new HIV infections are declining is too slow, as no region reached the 2020 target of reducing new HIV infections by 75%. While eastern and southern Africa, the region most heavily affected by AIDS, has recorded striking progress in reducing new HIV infections and AIDS-related deaths, gains are less pronounced in other regions, and epidemics continue to expand in eastern Europe and central Asia and the Middle East and North Africa.

Overall global and regional advances in the response also obscure the many populations who are not benefiting equitably. Globally, 53% of all people living with HIV were women and girls and they accounted for 50% of all new infections in 2020. There is an HIV crisis among adolescent girls and young women in sub-Saharan Africa, where around 4,200 adolescent girls and young women aged 15–24 years acquired HIV per week in 2020.

Reflecting a spirit of innovation and a people-centred ethos, aspects of the HIV response proved remarkably resilient and quite innovative in the face of challenges posed by COVID-19. However, the COVID-19 pandemic slowed progress towards global AIDS targets, had a serious socioeconomic impact, and injected new uncertainty into the sustainability of the HIV response. COVID-19 has shown that without a health system that is fit for purpose, hard-fought gains in HIV, immunization, antenatal care, and child and adolescent health are at risk when a global pandemic occurs. Many people living with HIV found themselves unable to access care, treatment refills and other essential services. These devastating outcomes were compounded by the impact of broader health, social and economic developments related to the COVID-19 response, including school closings, travel restrictions, loss of formal and informal income-generating activities, and increased gender inequality and violence against women.

COVID-19 has highlighted the vital role of social protection for mitigating the direct and indirect effects of disease. There is increasing emphasis on social protection instruments, such as cash and in-kind transfers, as well as social protection systems, to address systemic vulnerabilities at scale and mitigate the impacts of pandemics and the multiple inequalities they expose. Although the importance of social protection is clearer than ever, efforts to expand it remain insufficient. Making up ground lost due to COVID-19 and reminding the world of the continued urgency of ending AIDS remain key areas of focus for the Joint Programme.

Find out more in the UNAIDS Performance Monitoring Report (PMR) package.