HIV & AIDS

High rates of sexually transmitted infections have been recorded in certain populations, including women and girls and key population groups, as described below. The most detailed data are on HIV, and these data indicate the likely situation for all sexually transmitted infections.

HIV is a leading cause of death among women and girls of reproductive age. It contributes significantly to maternal mortality, due to the progression of the disease and to higher rates of sepsis, anaemia and other pregnancy-related conditions. Other sexually transmitted infections can also have serious health consequences, leading to stigma, gender-based violence,  infertility, cancers and pregnancy complications. Gonorrhoea and chlamydia are major causes of pelvic inflammatory disease, leading to infertility in women, while mother-to-child transmission of sexually transmitted infections, especially congenital syphilis, can result in stillbirth, neonatal death, low birth weight and prematurity, sepsis, pneumonia, neonatal conjunctivitis and congenital deformities.

Key populations disproportionately affected:

• Sex workers of all genders face an increased burden of sexually transmitted infections. Women in sex work are 38 times more likely to be living with HIV than other women of reproductive age.
• People who inject drugs are 29 times more likely to acquire HIV than people who do not, and are at increased risk of tuberculosis and viral hepatitis B and C.
• Men who have sex with men are 28 times more likely to acquire HIV than other adults. They also face higher rates of hepatitis C – especially those living with HIV or using pre-exposure prophylaxis.
• Transgender women are 22 times more likely to acquire HIV than other adults. 
• People in prisons and other closed settings face nearly five times the HIV risk of the general adult population, with global prevalence in prisons estimated at 3 per cent. Tuberculosis and hepatitis are other major concerns; available data demonstrate that 1 in 4 detainees are hepatitis C virus positive.

Key populations make up less than 5 per cent of the global population; however, these populations and their sexual partners represent 70 per cent of new HIV infections. Outside of Sub-Saharan Africa, their representation stands at 94 per cent – and their significance is rising in Sub-Saharan Africa as well, where they accounted for the majority (51 per cent) of new HIV infections for the first time in 2021. Stigma and discrimination, restrictive and punitive laws and policies, and inadequate medical and social services expose them to unfair risks of infection, illness, morbidities and death. Achieving their rights and access to services are key to ending the crisis.

UNFPA is following an integrated strategy to prevent sexually transmitted infections, including HIV, and to improve sexual health. Among the initiatives:

• Leveraging partnerships to achieve strategic investments and action, including among United Nations agencies, the Global Fund and PEPFAR.
• Invigorating programming for male and female condoms and lubricants.
• Leading the procurement of sexual and reproductive health supplies within the UN, including the strengthening of national logistic management systems.
• Improving continuity and quality of services for HIV, sexually transmitted infections, sexual and reproductive health, and gender-based violence.
• Supporting an integrated approach in universal health coverage and primary health care and specific efforts such as elimination of mother-to-child transmission of HIV. 
• Strengthening health and community system governance and capacity of health providers and peer educators.
• Strengthening capacities of field staff in people-centred and evidence-based interventions, service delivery and information systems. 
• Financing, procuring, educating and advocating for access and utilization of condoms and lubricants for everyone at risk of HIV and sexually transmitted infections, regardless of age, sexual orientation, economic status or HIV status.
• Advocating for increased use of health management information systems and surveillance systems, with data disaggregated by gender identity, sexual orientation, age, disability status and geographical setting.
• Mobilizing the development community, governments, civil society, academics and the private sector to commit to end AIDS and control sexually transmitted infections.  
• Incentivizing youth-friendly approaches, including life skills and comprehensive sexuality education in and out of school.
• Advocating to remove structural barriers that prevent key and vulnerable populations from accessing treatment and prevention of HIV and sexually transmitted infections.
• Working with communities of people living with HIV and key and vulnerable populations in planning, budgeting, implementing, monitoring and reporting on community-led programmes.

Further, UNFPA co-convenes the Global HIV Prevention Coalition and the Global Prevention Working Group, which work to strengthen HIV prevention programming and policy in dozens of focus countries. In 2022, UNAIDS and UNFPA launched the HIV Prevention 2025 Roadmap, outlining a people-centred approach to prevention for key populations, young people, and women and men in areas with high HIV incidence. It proposes a 10-point action plan, defining transformative country-level actions and requiring governments, communities and implementers to come together and build a stronger HIV prevention movement. Progress is tracked through annual scorecards.

When used correctly and consistently, condoms offer one of the most effective methods of protection against sexually transmitted infections, including HIV, as well as unintended pregnancy.

Among other initiatives, UNFPA and partners procured more than 5 billion condoms (male and female) and more than 526 million lubricant sachets for developing countries from 2018 through 2022. Most of these supplies were donated to Sub-Saharan countries. These condoms had the potential to avert 24.9 million sexually transmitted infections, 570,000 HIV infections and 16.3 million unintended pregnancies. In addition, the CONDOMIZE! campaign, a joint effort of UNFPA and the Condom Project, aims to destigmatize condoms and lubricants. You can learn more here. 

Updated 21 December 2023