Despite proven effectiveness, UNAIDS is alarmed by a decrease in condom use in several countries

Geneva, 13 February 2025– On International Condom Day, UNAIDS and partners are calling for HIV prevention efforts to be stepped up. In 2023, around 3,500 people became newly infected with HIV every day, bringing the total number of people newly infected in 2023 to 1.3 million.

One of the most effective, low-cost HIV prevention tools available today are condoms which are 98% effective when used correctly and consistently. Condom use has averted an estimated 117 million new HIV infections globally from 1990 to 2019 however, new data reveal that there has been a decline of 6-15% in condom use in a number of countries, according to the Demographic and Health Surveys (DHS), a Condom Landscape Analysis, and the World Health Organization (WHO.)

For the past few years, the estimated global public sector and subsidized condom procurement declined by an average of 30% from peak procurement in 2011. This decline occurred despite the population in Africa growing to an estimated 400 million since 2010.  As a consequence, fewer free or subsidized condoms are available per capita in Africa now than a decade ago.

"Condoms are a critical part of a comprehensive approach to HIV prevention and public health.. We also want to make sure medical breakthroughs like long-acting HIV medicines are affordable and accessible to all to give people most at risk additional HIV prevention options,” said Angeli Achrekar, UNAIDS Deputy Executive Director for Programmes.

Public and international investment in condom distribution, education, and social marketing has decreased in recent years. As a result, a new generation of young people has not been exposed to condom promotion.

As new drugs and injectable HIV prevention methods gain ground in the next few years, condoms as well as PrEP (pills for people who may be at risk of acquiring HIV), voluntary medical male circumcision and treatment remain essential to achieving global health targets related to HIV and sexual and reproductive health.

Your Health. Your Power. Your Choice. Your Future.

International Condom Day is a reminder of the importance of protecting one’s own health. This year's theme focuses on the importance of ensuring equitable access to condoms, combating myths and misconceptions, and encouraging open conversations about preventing new HIV infections.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Ethiopia has made significant progress in its HIV response in recent years and is on track to reach the UNAIDS 95-95-95 targets with 90% of people living with HIV in the country being aware of their HIV status; 94% of those diagnosed with HIV receiving antiretroviral (ARV) therapy; and 96% of people on ARV therapy achieving viral suppression.   

But now, that progress is at risk. The recent pause in United States foreign assistance poses a direct threat to the lives and well-being of thousands of people living with HIV in Ethiopia and millions globally. Critical services are grinding to a halt, leaving people who rely on them facing an uncertain and dangerous future. 

Ethiopia is heavily reliant on external funding for its AIDS response. PEPFAR provides 53% of HIV funding in the country. In 2023, UNAIDS’ estimates show that there were 610 000 people living with HIV in Ethiopia, 510 000 of whom were accessing antiretroviral treatment.  

For women living with HIV, uncertainty is growing. Limited and unclear communication from healthcare providers and policymakers has left them in the dark about treatment changes, medication availability, and service disruptions. With no clear answers, they are forced to rely on rumors, fueling fear and anxiety. 

“We don’t know what’s happening. Are services being cut permanently? Will we still get our medication next month? No one is telling us anything,” one woman shared. 

To make matters worse, case workers and counsellors—once a vital source of medical and emotional support—are disappearing. These professionals were more than healthcare providers; they were trusted confidants who ensured women received care in a stigma-free environment. Their absence is leaving many feeling abandoned. 

“They understood our struggles, checked in on us, and made sure we had what we needed,” another woman explained. “Without them, we feel forgotten.” 

As services become increasingly unreliable, distress and fear are taking hold. 

Shortages and desperate measures  

Funding cuts bring shortages, and for women living with HIV, the fear of running out of medication is overwhelming. Access to antiretroviral therapy (ART) is essential—it keeps people alive. Yet many are already facing supply disruptions, and whispers of medication shortages are spreading panic. 

“If I can’t get my medicine, what happens to me?” one woman asked. Women living with HIV who have been healthy for years now fear an uncertain future where their treatment is no longer guaranteed. People living with HIV who do not access antiretroviral therapy will eventually develop AIDS and die. To cope, many have resorted to stockpiling medication, traveling long distances and spending entire days at clinics in hopes of securing extra supplies. While understandable, this survival strategy comes at a heavy cost—disrupting work, family life, and daily routines. No one should have to live in fear of their next refill. The urgent need for stable, uninterrupted HIV treatment cannot be overstated. 

Adding to the crisis, shortages extend beyond medication. The dwindling supply of test kits, including viral load tests, is threatening the future of diagnosis and monitoring. These tests are crucial to ensure that people living with HIV maintain undetectable viral levels, reducing transmission risks and protecting their health.  

Fears have also been expressed around the availability of medications for HIV prevention, particularly for the prevention of vertical transmission of HIV. If the current pause in the supply of medical resources continues, the availability of these vital medications could be severely compromised, putting the lives of women and children at even greater risk.   For women living with HIV who are pregnant, a lack of lifesaving medications for themselves also means their children can be born with HIV even though this is entirely preventable.

Without test kits and prevention measures, undiagnosed and untreated cases could rise dangerously. “We can’t afford to go backward,” one woman said. 

A Plea for Action 

The voices of these women reveal a stark and urgent reality—funding cuts have left people living with HIV in a state of uncertainty, with no clear path forward. 

"Urgent intervention is needed,” stressed Tina Boonto, Country Director for UNAIDS Ethiopia. “UNAIDS is gathering information and developing funding solutions to address the shortfall, with proposals for both the government and external partners to ensure continuity of critical services. We hope Ethiopia's government will step up and lead in covering these essential services. We must act now to safeguard gains that have been made and succeed in securing sustainable support to people living with HIV." 

While the future remains uncertain, one thing is clear: without swift action, the hard-won progress in Ethiopia’s HIV response is at risk. 

GENEVA, 29 January 2025— The United States Secretary of State, Marco Rubio, has approved an “Emergency Humanitarian Waiver”, which will allow people to continue accessing HIV treatment funded by the US across 55 countries worldwide. More than 20 million people living with HIV, representing two-thirds of all people living with HIV receiving treatment globally, are directly supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR) - the world’s leading HIV initiative.

“UNAIDS welcomes this waiver from the US government which ensures that millions of people living with HIV can continue to receive life-saving HIV medication during the assessment of US foreign development assistance,” said UNAIDS Executive Director, Winnie Byanyima. “This urgent decision recognizes PEPFAR’s critical role in the AIDS response and restores hope to people living with HIV.”

In recent days, the US Department of State announced an immediate 90-day funding pause for all foreign assistance, including for funding and services supported by PEPFAR. The executive order announcing a “90-day pause in United States foreign development assistance for assessment of programmatic efficiencies and consistency with United States foreign policy” was one of the first major foreign policy decisions of the new administration. This waiver approves the continuation or resumption of “life-saving humanitarian assistance” which applies to core life-saving medicine and medical services, including HIV treatment, as well as to supplies necessary to deliver such assistance.

UNAIDS will continue efforts to ensure that all people living with or affected by HIV are served and that other key components of PEPFAR’s life-saving efforts, including service delivery and services for HIV prevention, care, and support for orphans and vulnerable children are continued.

UNAIDS is serving in its essential role to mobilize and convene partners, governments, and communities across the globe at the country level to assess and mitigate the impact of the pause on the continuity of essential HIV services.   

UNAIDS has encouraged President Donald J. Trump to prioritize the U.S. Government’s leadership in the global HIV response to achieve the shared goal of ending AIDS.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Marouane Abouzid, a 25-year-old from Casablanca, grew up in an environment where social challenges and gender stereotypes were pervasive. However, his perspective changed the day he joined "The Ball is Your Protection" program, an initiative by Tibu Africa in partnership with UNAIDS, which uses sports to raise awareness about HIV, gender equality, and gender-based violence. 

Before joining the program, Marouane had limited knowledge about HIV and gender equality. “The training on HIV awareness led by UNAIDS and Tibu Africa was a transformative experience,” he says. “It equipped me with essential skills like effective communication and active listening.” Thanks to the program, Marouane discovered how sports can be a powerful tool to engage young people on often-overlooked topics, such as HIV prevention and breaking gender stereotypes. 

Now, trained to be a change ambassador in his community, Marouane leads sports activities and participates in educational sessions, becoming a role model for his peers. “I talk openly about what I’ve learned. I encourage my friends to get tested for HIV and respect the rights of others,” he shares. 

For Marouane, this program was more than just training. “Today, I feel ready to take action and share what I’ve learned with my community,” he says. 

During the closing ceremony of the "The Ball is Your Protection” project, Marouane facilitated workshops and sports activities with other young participants. “I saw how sports could become a tool for awareness and social mobilization,” he explains. These activities created a safe space for young people to discuss issues related to HIV and gender equality, free from societal judgment. 

In Morocco, approximately 23,000 people live with HIV, nearly 50% of whom are women. Although the prevalence rate is relatively low, vulnerable groups such as sex workers, men who have sex with men, and people who inject drugs are particularly at risk. “Before, I thought HIV didn’t have a real impact on those around me. Now, I understand that we all have a role to play,” Marouane adds. 

Marouane is not alone on this journey. Assia Ezzahraoui, 25, a participant in Tibu Africa’s Sports Vocational School program, reflects: “HIV awareness was a profoundly enriching experience. It gave me new insights into symptoms, prevention methods, and available treatments.” For Assia, taking part in the educational event deepened her understanding of HIV and reinforced the importance of protecting her health and that of those around her. 

“I want to thank everyone who contributed to this initiative. Their commitment to young athletes in Morocco is truly inspiring,” says Assia, emphasizing the value of such events in educating youth about HIV. 

Thanks to initiatives like "The Ball is Your Protection," young people like Marouane and Assia are playing an active role in addressing gender inequalities and HIV-related stigma. These young leaders are helping to build a healthier and more equitable future, proving that change can start with something as simple as a ball. 

NAIROBI, 10 December 2024—Today, at the 55th Programme Coordinating Board for the Joint United Nations Programme on HIV/AIDS (UNAIDS), HIV leaders from across the world called for access to long-acting medicines for everyone who would benefit from them, to build toward a new era in the AIDS response.

Over the last two years, scientific breakthroughs have brought to the fore a new class of anti-HIV medicines with long-acting effects, allowing people at risk of HIV infection and those living with the virus to take medicines every few months. One is injected just twice a year. Recent studies have shown these medicines to be among the most effective ever developed. One study showed zero new infections among young African women using long-acting prevention drugs, while a study among key populations showed them more effective than oral medicines. Another study highlighted at the session showed encouraging results using long-acting HIV treatment in low- and middle-income countries.

At the “Leadership in the AIDS Response” session at the UNAIDS board, government officials, researchers, manufacturers, and civil society called for accelerating global access to use these scientific breakthroughs to interrupt the continuing AIDS pandemic. Despite existing HIV prevention tools, in 2023 an estimated 1.3 million people newly contracted HIV – two every minute. Despite HIV treatment, there is still one AIDS-related deaths every minute.

Winnie Byanyima, Executive Director of UNAIDS, said: “We can usher in a new era by connecting technological innovation with access for all. Let us act boldly together, bring down the curve of new infections, and dramatically accelerate the HIV response.

“Let us learn from the painful lessons of the past so that we write a new story now. In the late 1990s and early 2000s, even after antiretroviral medicines were proven to be effective and rolled out in high-income countries, 12 million people on this continent still died waiting for those drugs. We can - and must – do better with long-actings. We urge the companies producing these medicines to expand their generics licenses. And we support governments making use of all their legal flexibilities to get access to affordable medicines.

“The usual trajectory is that the Global South waits years before the science reaches them. What if we do not wait for years, what if we ensure that science is treated as the public good it is? What if we disrupt the far too slow trajectory we are on and shift to a trajectory that accelerates progress, ends the pandemic, enables sustainability, and can be a model for the world?"

Secretary Ethel Maciel, Secretary of Health of Brazil, said: “Brazil has a long history of making use of technology in the HIV response. The possibility of having new long-acting medicines in the global response is a great opportunity. But we have the huge challenge of the high cost of these medicines, and the difficulty for a range of countries, including ours, to access them.

“Brazil is committed to work together in the fight to ensure that this new technology is made available to all people all over the world who are at risk of and living with HIV.”

Dr Cissy Kityo, Executive Director of the Joint Clinical Research Centre, Uganda, a leading scientist working on trials of long-acting medicines said:  “We have these fantastic new tools. The technology of long-acting ARV’s antiretrovirals is remarkable. The evidence is now clear that long acting medicines will be game-changers for both prevention and treatment. The science is in, the question is how well we will use it.”

Mr Javier Padilla Bernáldez, Secretary of State for Health, Spain, said: “This new long-acting technology puts us in an exceptional situation, not an ordinary one, an opportunity that we cannot afford to miss. Long-acting medicines can change the landscape of the HIV response. But if this game-changing innovation did not reach the people it would be a nothing-changer!

“We need to remember the 2000s’ fight for universal access. We cannot repeat the same mistakes and delays of before. We need to ensure that no countries should be pressured if they choose to use the safeguards in the TRIPS agreement. The inequality gap is a global problem. We need a universal perspective, so that all countries, including middle-income countries, are included.”

Dr Sylvia Vito, Africa Head of EVA Pharma, a company in Egypt licensed to produce a generic version of lenacapavir, said: “We are a company that will not sit comfortably, but rather be in a good hurry to support the unmet HIV medical needs for our people. We intend to move fast on product development, production, and eventual registration. It is our intention that high quality long-acting generic ARV medicine will not only be available, but made accessible and affordable as well. We intend to beat the current standard of care in HIV treatment and prevention by going further to improve on the current options for patients in low and middle-income countries.”

The importance of generic production was central to the interventions of speakers. Several speakers noted the obstacle that much of Latin America, a region of rising HIV infections, has been excluded from companies’ voluntary licenses for generic versions. This is despite Brazil, Peru, Mexico and Argentina participating in clinical trials. Speakers highlighted the importance of using TRIPS flexibilities for enabling access under World Trade Organization rules, which can enable governments to supply its citizens with generic versions of patented treatments either through domestic production or imports. In the 2021 Political Declaration on HIV/AIDS, countries committed to make use of TRIPS flexibilities, specifically geared to promoting access to medicines.

Although Gilead Sciences, the producer of lenacapavir, one of the new class of long-acting medicines, has not yet announced the price of its product for use as PrEP, it costs around $40,000 per person per year in the United States where it is used for treatment. However, experts have estimated that it could be produced and sold for $40 per person per year, in line with UNAIDS estimates for sustainable pricing in low- and middle-income countries. Speakers highlighted opportunities to bring down the price of these medicines through generics, expanded local and regional production, and the use of TRIPS flexibilities by member states.

One important opportunity for progress emphasized by speakers was to build on the progress on multilateral collaboration made by Brazil, which as chair of the G20 in 2024, successfully secured worldwide support for the Global Coalition for Local and Regional Production, Innovation and Equitable Access, laying the foundations for a greatly expanded and more equitable access to medicines.

Speakers noted also the importance of choice, and of widening access to a range of new technologies, of which lenacapavir is just one. Speakers highlighted important current innovations including 2-monthly injectable cabotegravir and a three-month dapivirine vaginal ring, as well as new technologies currently in the pipeline including a once-a-month pill may move into phase 3 trials next year.

Reinforcing the importance of accelerating access to long-acting medicines, The New England Journal of Medicine has today published an article by UNAIDS Executive Director Winnie Byanyima, Linda-Gail Becker of the Desmond Tutu HIV Centre, and Matthew Kavanagh of Georgetown University’s Center for Global Health Policy and Politics, entitled “Long-Acting HIV Medicines and the Pandemic Inequality Cycle — Rethinking Access”.

The article showed that the “pandemic inequality cycle” in HIV has usually meant a decade delay between access to breakthrough HIV technologies in the global North and the global South.

In their article the authors write: “The world may look back on 2024 as a pivotal time in the fight against AIDS — the start of a revolution in the global biomedical response to HIV using long-acting antiretroviral medicines. Whether they will do so depends on whether policymakers and pharmaceutical companies avoid repeating past mistakes.”

The authors call for “a nonlinear approach to global access to ARVs that combines far more rapid sharing of technology, decentralized global production, and research and development of products that meet the needs in Africa, Asia, Latin America, and the Caribbean.”

They highlight the need for progress on long-acting treatment as well as prevention and “to break the long-standing pattern of failing to get HIV technologies to the people who need them most, to stop playing catch-up, stop accepting that innovations must reach people in the Global South years late, and use long-acting medicines to help end the pandemic.” The article is available at https://www.nejm.org/doi/full/10.1056/NEJMms2412286

The importance of long-actings, and what is at stake in the discussions on access, was summed up by Jerop Limo, a 26 year old Kenyan activist born living with HIV who is Executive Director of the Ambassador for Youth and Adolescent Reproductive Health Program (AYARHEP):

“Taking a pill every day is not easy. It is a constant reminder of being different, and the stigmatising and shaming we experience because of it can discourage us from taking our medicines.

“This is not just about convenience. Young people living with HIV, and young people at risk of HIV, are clear: with all the pressures we face, long-acting medicines would help us stay on the medicines and help transform, and save, our lives.

“We deserve to live, and to live fully. We can’t have access on paper only. We need access for all people in all countries.

“I am inspired to see leaders coming together to centre communities and to call for access to long-acting HIV medicines. With partnership we can do this. We don’t have time to wait.”

The UNAIDS Programme Coordinating Board brings together governments, civil society and the United Nations to help guide the HIV response. UNAIDS sees the development of long-actings as a vital disruptive innovation.

“The arrival of long-acting injections is a game-changer which can help prevent millions of new HIV infections, if we ensure access to all who would benefit from them,” said Ms Byanyima. “Today, in Nairobi, leaders in the global HIV response took a bold and vital step forward on the path to access for all.”

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.