Children are increasingly bearing the brunt of the global HIV response as funding cuts disrupt prevention, testing and treatment services, with 2.27 million children and adolescents aged 0-19 living with HIV in 2025.
The UNAIDS Special Report for AIDS 2026, released Monday at the International AIDS Conference in Rio de Janeiro, showed that about 240,000 children and adolescents acquired HIV and 74,000 died from AIDS-related causes last year.
Among children aged 0-14, about 1.26 million were living with HIV, 93,000 acquired the virus and 61,000 died. This translates to about 255 children acquiring HIV and 167 dying from AIDS-related causes every day in 2025.
UNAIDS warned that although the world has made major progress against HIV, declining international financing could reverse the gains.
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"The world is not on track to achieve the 2030 goal of ending AIDS as a public health threat," UNAIDS warned.
The disparity between children and adults in access to HIV services remains particularly stark. Only 65 per cent of children aged 0-14 living with HIV knew their status in 2025, compared with 89 per cent of adults.
Only 55 per cent of children were receiving antiretroviral treatment, compared with 79 per cent of adults, while 47 per cent had achieved viral suppression, leaving more than 570,000 children without treatment.
Although children account for about three per cent of people living with HIV globally, they represented approximately 11 per cent of AIDS-related deaths.
However, the report also highlighted significant global gains. Between 2010 and 2025, AIDS-related deaths fell by 57 per cent, from about 1.3 million to 570,000, while new HIV infections dropped 42 per cent, from roughly 2.1 million to 1.2 million.
New HIV infections among children aged 0-14 also declined by 69 per cent since 2010 to about 93,000 in 2025. UNAIDS estimated that prevention programmes averted nearly 4.8 million HIV acquisitions among children between 2000 and 2025.
But the report noted that the gains are now under financial pressure. Only $17.6 billion was available for HIV programmes in low- and middle-income countries in 2025, compared with the $21.9 billion required annually by 2030, leaving a $4.3 billion funding gap.
"International HIV financing fell by 18 per cent, or about $1.6 billion, during the year, disrupting prevention, testing, supply chains and community-led programmes in several countries.
"Nigeria is among countries where the impact is already visible, with the number of people receiving pre-exposure prophylaxis, PrEP, at least once in 2025 falling by more than half in Nigeria, Cameroon and Zambia, according to national data submitted to UNAIDS."
The report noted that the development is particularly worrying in sub-Saharan Africa, which accounts for about half of all new HIV infections globally. About 83 per cent of HIV prevention financing in the region came from external sources in 2024.
In one major bilateral donor programme, HIV testing fell 22 per cent between 2024 and 2025 in countries with high HIV burdens. Funding for condom programming plunged 93 per cent, while financing for programmes supporting access to prevention services dropped 80 per cent.
UNAIDS said domestic investment could help cushion the impact, citing Ethiopia and Uganda, which expanded PrEP access using domestic and other resources. South Africa recorded only an eight per cent decline in people reached by PrEP despite a substantial reduction in international financing.
The prevention crisis is also affecting adolescent girls and young women. In sub-Saharan Africa, women account for six out of every 10 new HIV acquisitions.
About 160,000 adolescent girls and young women aged 15-24 acquired HIV in the region in 2025, equivalent to about 3,000 every week, with HIV incidence estimated to be three to four times higher than among males.
UNAIDS said addressing the trend requires comprehensive sexual and reproductive health education, wider access to PrEP and other prevention options, as well as action against gender inequality, violence, stigma and discrimination.
The agency also warned that domestic financing cannot easily replace international support. In Africa, 28 countries now spend more on debt servicing than on health, while in western and central Africa, debt service in some countries is, on average, 5.5 times greater than public health allocations.
Community-led organisations have also been hit. A 2026 study of 79 such organisations across 47 countries found that PrEP delivery had fallen 50 per cent. Services for gay men and other men who have sex with men declined 85 per cent, services for sex workers 82 per cent and services for people experiencing gender-based violence by 72 per cent.
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Despite the setbacks, UNAIDS said there is still a pathway to ending AIDS as a public health threat.
At the UN High-Level Meeting on HIV/AIDS in June 2026, countries committed to reaching 40 million people living with HIV with treatment by 2030, including 38 million with suppressed viral loads, while expanding access to antiretroviral-based prevention.
New prevention technologies also offer hope. By June 2026, more than 50,000 people in nine sub-Saharan African countries had received twice-yearly injectable lenacapavir, with its price for lower-income countries expected to fall to about $40 per person annually from 2027.
But UNAIDS cautioned that new technologies cannot substitute for strong health systems, uninterrupted treatment and adequate prevention financing.
For children, the report stressed, the challenge goes beyond access to antiretroviral medicines. Diagnosis, nutrition, maternal and newborn care, tuberculosis prevention, sexual and reproductive health services and adherence support must work together.
