Global, regional and national burden of HIV/AIDS among individuals aged 15-79 from 1990 to 2021

Abstract

Background: HIV/AIDS persists as a global health challenge despite significant advancements in antiretroviral therapy (ART). The transformation of HIV into a chronic condition, coupled with regional disparities and evolving epidemiological trends, necessitates an updated analysis of the disease burden.

Methods: We conducted a comprehensive analysis of HIV/AIDS burden among individuals aged 15-79 years from 1990 to 2021 using the latest data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database. Multiple statistical approaches were employed to investigate temporal trends, geographic variations, and health inequalities.

Results: From 1990 to 2021, global HIV/AIDS age-standardized incidence rates (ASIR) decreased by 41%, while age-standardized prevalence rates (ASPR), mortality rates (ASMR), and disability-adjusted life year rates increased by 222%, 57%, and 59%, respectively. Sub-Saharan Africa demonstrated the highest HIV/AIDS ASPR in 2021, with High-middle and Middle SDI regions, particularly Oceania, South Asia, and Eastern Europe, experiencing the most significant ASPR growth over three decades. Joinpoint analysis identified 1997 and 2015 as critical years for ASIR declines, and 2004 for ASMR reductions. Decomposition analysis revealed population growth as the primary driver of increasing incidence in lower SDI regions, while epidemiological changes were more influential in higher SDI areas. The age-period-cohort model showed peak HIV/AIDS incidence among individuals aged 25-34, with diminishing incidence risk across successive birth cohorts and periods. Health inequality analysis from 1990 to 2021 revealed a substantial widening of disparities across countries, with the slope index of inequality rising from 265 to 1006.

Conclusion: While global efforts have reduced HIV/AIDS incidence, increasing prevalence due to extended survival with antiretroviral therapy presents ongoing challenges. Regional disparities and rising incidence among specific demographics underscore the need for sustained, targeted interventions.

Keywords: Age-period-cohort analysis; Global Burden of Disease (GBD); HIV/AIDS; Health inequalities; Socio-Demographic Index (SDI).

Fig. 1

Global trends in ASIR and ASMR for HIV/AIDS among individuals aged 15–79 years (1990–2021), analyzed using the Joinpoint regression model

Fig. 2

Projected trends and age-specific patterns of HIV/AIDS epidemiological indicators through 2040, based on BAPC model. (A) BAPC model forecasts of ASIR, ASPR, and ASMR for HIV/AIDS, 2021–2040; (B) The projected age-specific incidence rate of HIV/AIDS by 2040

Fig. 3

Global HIV/AIDS distribution among individuals aged 15–79 in 2021. (A) Map of ASPR; (B) Relationship Between SDI and ASPR

Fig. 4

Population growth drives increases in HIV/AIDS incidence, while epidemiological improvements alleviate the burden in most regions (1990–2021). Note: The bars illustrate changes in HIV/AIDS incidence attributed to three factors: demographic aging (purple), population growth (green, indicating increases in total population size), and epidemiological changes (yellow, representing shifts in disease transmission patterns, prevention efforts, and treatment access)

Fig. 5

Age-period-cohort analysis reveals declining HIV/AIDS incidence and mortality rates with distinct gender differences from 1990 to 2021. Note: Annual percentage changes in rates (top-left); age-specific incidence and mortality patterns (top-right); birth cohort risk ratios (bottom-left); and period-specific rate ratios (bottom-right) are displayed for males, females, and both sexes combined

Fig. 6

Absolute inequality in HIV/AIDS burden quadrupled from 1990 to 2021 while relative inequality persisted among lower-income countries. Note: The top panels display the slope index of inequality (SII), which measures absolute differences in DALYs across countries ranked by SDI, with steeper slopes indicating greater absolute inequality. The bottom panels present the concentration index (negative values indicate the concentration of disease burden in disadvantaged populations) and Lorenz curves that illustrate the distribution of DALYs relative to the population distribution by socioeconomic status