Chapter 2: 2020 commitments
Combination prevention
The HIV test-and-treat cascade

Gains in HIV testing and treatment

More people living with HIV than ever before know their HIV status, are accessing antiretroviral therapy and are virally suppressed, reflecting strong progress towards the 90–90–90 targets:

  • 90% of people living with HIV know their HIV status.
  • 90% of people who know their HIV-positive status are accessing treatment.
  • 90% of people on treatment have suppressed viral loads.


When all three 90s are achieved, 73% of all people living with HIV have suppressed viral loads. An estimated 25.4 million [24.5 million–25.6 million] of the 38.0 million [31.6 million–44.5 million] people living with HIV worldwide were on antiretroviral therapy in 2019, a number that has more than tripled since 2010. In spite of this impressive increase, the world may not achieve its target of 30 million on treatment by the end of 2020.

There have been gains across the HIV testing and treatment cascade. At the end of 2019, 81% [68–95%] of people living with HIV knew their HIV status, more than two thirds (67% [54–79%]) were on treatment, and almost 59% [49–69%] had suppressed viral loads. Gains in treatment effectiveness, as well as increases in the number of people who know their status and are on treatment, are reflected in the fact that rates of viral load suppression among all people living with HIV have risen by 44% (or 18 percentage points) between 2015 and 2019.

Once people living with HIV start treatment, most are able to stay on treatment and achieve viral suppression, reflecting improvements in both antiretrovial medicines and differentiated care. Progress towards the third 90 within the 90–90–90 targets—the percentage of people on treatment who have durable viral suppression—stood at 88% [71–100%] in 2019. Progress has also been made towards the second 90, with 82% [66–97%] of people who know their HIV status on treatment. However, gaps across the testing and treatment cascade add up to 15.7 million people living with HIV globally who have an unsuppressed viral load, which endangers their health and facilitates the further spread of HIV.

Globally, and in nearly all regions, greater percentages of women are accessing antiretroviral therapy than men. In 2019, treatment coverage globally was 12 percentage points lower among men living with HIV than women living with HIV. This gap was largest in western and central Africa (67% treatment coverage among women and 49% treatment coverage among men), while treatment coverage among both sexes in western and central Europe and North America was equal at 81%.