A historic funding crisis is threatening to unravel decades of progress unless countries can make radical shifts to HIV programming and funding. The report highlights the impact that the sudden, large-scale funding cuts from international donors are having on countries most affected by HIV. Yet it also showcases some inspiring examples of resilience, with countries and communities stepping up in the face of adversity to protect the gains made and drive the HIV response forward.

P.7  Key populations include sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people, and people in prisons and other closed settings.

P.12 The estimated 13.9 million [10.2 million–19.9 million] people who inject drugs around the world continue to be left behind in HIV programmes, with women who inject drugs especially neglected (12). Only two of 32 reporting countries have achieved the 2025 United Nations-recommended levels of coverage for opioid agonist maintenance therapy, and only 13 of 35 countries have achieved the United Nations targets for needle and syringe distribution. No country has reported that it has met both of these targets.

P.20 Figure 1.3. HIV prevalence among people from key populations compared with adults (aged 15–49 years), global, 2020–2024

P.37 Antiretroviral therapy coverage and treatment outcomes among people from key populations are difficult to determine because of challenges in confidentially collecting information about modes of HIV transmission within health data systems. The most comprehensive analysis of HIV data among key populations in sub-Saharan Africa has shown that antiretroviral therapy coverage was correlated with, but lower than, antiretroviral therapy coverage for the total population. As in the rest of the world, coverage levels varied widely. Yet even in countries with high treatment coverage in the general population (80%), estimated coverage tended to be significantly lower among key populations—25% less for people who inject drugs, 19% less for gay men and other men who have sex with men, 13% less for transgender women and 11% less for female sex workers (16)...