Political decisions taken this year will determine whether a target to end Aids as a public health threat by 2030 can be reached, the United Nations said on Monday.
Figures from 2023 show a drop in new infections and fatalities and improvement in access to treatment for HIV-positive patient.
But while those figures look positive, the Unaids agency warned that the progress remained fragile.
“Decisions leaders make this year will determine whether (or not) countries can achieve the 2030 target of ending Aids as a public health threat and ensure progress beyond 2030,” the report said.
In the over four decades since the Aids epidemic burst onto the global scene, it has killed more than 42 million people.
While Aids-related deaths have been steadily declining, falling from 670,000 in 2022 to 630,000 last year, the number still remains dizzyingly high.
“A person dies from Aids-related causes every minute,” Unaids chief Winnie Byanyima pointed out in the report, warning the world remains off track to reach ambitious 2030 objectives.
“The inequalities that drive the HIV pandemic are not being addressed sufficiently.”
Nearly 40 million people live with HIV, the virus that can cause Aids, the report said.
Around 1.3 million new infections were recorded last year, a decline of 100,000 compared to 2022 and a dramatic 60-per cent fall since a peak of 3.3 million in 1995.
But the long-term trend is still way off track to hit the Unaids target of just 330,000 new infections in 2025.
Access to anti-retroviral medication has also greatly improved, but remains a major issue.
Last year, a full 30.7 million people received such treatment compared to just 7.7 million in 2010.
But it remains unlikely the world will manage to hit a target of reaching 34 million by next year.
Byanyima stressed the need to dramatically scale up access.
She urged US pharmaceutical giant Gilead to “make history” by allowing generic manufacturing of its new anti-retroviral medication Lenacapavir, which requires just two injections a year.
Bringing down the price, currently expected to be in the tens of thousands annually, to below $100 could be “a game-changer”, she told a news conference on Monday at the start of the 25th International Aids Conference in Munich.
Eastern and southern Africa remain the most-affected regions, with 20.8 million people living with HIV, 450,000 infected last year and 260,000 fatalities.
But the region is also the one that has seen the greatest progress, with a 59-per cent drop in new infections there since 2010, the report said.
In regions like Eastern Europe, Central Asia and Latin America infections are “moving in the wrong direction and rising”, Byanyima warned.
In Eastern Europe and Central Asia, only half of people with HIV are treated, similar to the figure for the Middle East and North Africa.
A major obstacle to progress was a wide and growing funding gap, she said.
In 2023, total resources available for HIV stood at $19.5 billion — down five per cent from 2022, and $9.5 billion short of what is needed, Unaids said.
Unaids highlighted how stigma, discrimination and sometimes criminalisation affects certain groups, resulting in much higher infection rates because people are unable to seek help and treatment without danger.