The gaps in HIV responses and resulting HIV infections and AIDS-related deaths lie upon fault lines of inequality.

Data from 46 countries in sub-Saharan Africa show a positive relationship between HIV prevalence and income disparity. After controlling for education, gender inequality and income per capita, a one-point increase in a country’s 20:20 ratio corresponds to a two-point increase in HIV prevalence.

Unequal gender norms that limit the agency and voice of women and girls, reduce their access to education and economic resources, and stifle their civic participation contribute to the higher HIV risk faced by women in settings with high HIV prevalence.

Younger women are at particular risk. In sub-Saharan Africa, adolescent girls and young women (aged 15 to 24 years) accounted for 24% of HIV infections in 2019, more than double their 10% share of the population. Women and girls of all ages accounted for 59% of new HIV infections in sub-Saharan Africa.

Outside of sub-Saharan Africa, older adult men (aged 25 and above) account for the majority of new HIV infections. A considerable proportion of these men are gay men and other men who have sex with men. Transgender people are also at extremely high risk of acquiring HIV: on average, they have a 13 times greater risk of infection than adults in the general population. Gender norms in many cultures—including binary concepts of gender and taboos about sexuality—also perpetuate stigma, homophobia and transphobia. Lesbian, gay, bisexual, transgender and intersex (LGBTI) persons and marginalized women (such as sex workers or women who use drugs) who fear judgement, violence or arrest struggle to access sexual and reproductive health services, especially those related to contraception and HIV prevention.

Additional key populations at higher risk of HIV infection include people who inject drugs, sex workers and prisoners. Although they are a small proportion of the general population, key populations and their sexual partners accounted for more than 60% of new adult HIV infections globally in 2019.