AIDS is caused by HIV, the human immunodeficiency virus. The disease once sparked apocalyptic forecasts: in early 2002 some reckoned that in certain southern African countries half of new mothers would soon die of it. The creation of PEPFAR in 2003 helped bring the epidemic under control.
HIV-related deaths in 2024 numbered 630,000, down from a peak of 2m two decades earlier. Annual new infections peaked in 1995 at 3.4m and have fallen to 1.3m, though this figure was unchanged from the previous year, reflecting the difficulty of reaching remaining cases and at-risk individuals. UNAIDS had hoped to end AIDS as a major public-health threat by 2030.
UNAIDS set a target of scoring at least 95% on three objectives: the share of infected people who are aware of their status, the share being treated, and the share whose drugs are suppressing their infections. Rwanda is one of seven African countries to have reached this target. Malawi is within a whisker, at 95-94.9-94.9.
An injectable, long-lasting form of pre-exposure prophylaxis (PrEP) called lenacapavir was approved by America's FDA on June 18th 2025. A single injection every six months replaces a daily pill. Trials showed it was 100% effective in preventing infections in women and 96% effective in a group of gay men, transgender and non-binary individuals. The drug is made by Gilead. The Global Fund announced a deal with Gilead on July 9th 2025 to offer the drug to 2m people within three years.
A monthly PrEP pill, code-named MK8527 by its developer Merck, is in late-stage clinical trials. A pair of long-lasting HIV treatments based on cabotegravir are also in development; cabotegravir is already available as a PrEP but requires injection every two months, compared with every six for lenacapavir.
One consequence of PEPFAR's involvement is that many countries' AIDS programmes operate separately from mainstream national-health services. Integration could yield savings but is often opposed by patients who wish to hide their HIV-positive or at-risk status. In South Africa, Linda-Gail Bekker of the Desmond Tutu Health Foundation has developed a network allowing those on ARV drugs to pick them up at school, university or the hairdresser.
Malawi's Blantyre Prevention Strategy, named after the country's second city, revolves around a purpose-built online dashboard that makes infection data available to all who need them.
By working faithfully eight hours a day, you may eventually get to be boss and work twelve.