The long road to ending AIDS: How close are we?

Editor's note: World AIDS Day is observed annually on December 1 to spotlight the ongoing global effort to end the AIDS epidemic. In this article, Professor Li Taisheng, director of the Department of Infectious Diseases at the Peking Union Medical College Hospital, traces the journey from crisis to control, explains the pivotal scientific breakthroughs and public health strategies in China, and outlines the critical challenges that remain on the path to worldwide eradication.

The fight against AIDS: A timeline

1981: The world's first case of AIDS is reported.

1996: The introduction of Highly Active Antiretroviral Therapy (HAART) revolutionizes treatment, and the subsequent establishment of immune reconstitution theory has changed AIDS from a terminal diagnosis to a manageable condition.

2010: The "Treatment as Prevention" strategy is established as a core public health policy, confirming that effective treatment also reduces transmission.

2015: The "Test and Treat" approach is rapidly adopted worldwide, significantly improving the long-term prognosis for people living with HIV. Progress in preventing mother-to-child transmission and the development of PrEP (Pre-Exposure Prophylaxis) provide powerful biological prevention tools in the continued absence of a vaccine.

2025: Global AIDS-related mortality has fallen dramatically compared to a decade ago. The life expectancy of an HIV-positive person on consistent treatment is nearly the same as that of an HIV-negative person. Daily management is simpler than ever, with options ranging from a single daily pill to a bimonthly injection, allowing for long-term viral suppression and a life largely unaffected by the virus, despite a widespread cure not yet being a reality.

Progress in China

China's fight against AIDS, beginning with its first reported case in 1985, mirrors the global progress. After the virus spread across the country over the following decade, China, like the rest of the world, was shrouded in uncertainty. But the national AIDS response strategy has yielded remarkable achievements.

In 2003, China launched a program to provide free antiretroviral drugs to low-income and rural citizens living with HIV, free voluntary testing and counseling nationwide, free treatment for HIV-positive pregnant women to prevent transmission to their babies, free schooling for children orphaned by AIDS, as well as economic assistance and social support to affected families. The program ensured that prevention, treatment and care were accessible to the most vulnerable.

In those early days, treatment options were limited, reliant on generic drugs with significant side effects that impacted efficacy. Thanks to sustained investment in national science and technology programs that fueled local basic and clinical research, hundreds of thousands of people living with HIV in China have benefited from constantly evolving drug regimens. Documents such as the "Chinese Guidelines for Diagnosis and Treatment of HIV/AIDS" synthesized this local experience with international best practices to effectively steer clinical work.

The results speak for themselves. The mortality rate among Chinese AIDS patients plummeted from 22.6 per 100 person-years in 2003, to 3.1 in 2014, and further down to 1.7 in 2021. In practical terms, AIDS in China is now a preventable and treatable chronic condition. Its management has evolved beyond a traditional infectious disease model into a new, long-term healthcare paradigm.

China has taken a global lead in proposing the concepts of "whole-course management" and "HIV-vulnerable populations." Moreover, it has researched and reported the only new small-molecule drug derived from traditional Chinese medicine in recent years that can improve immune reconstitution insufficiency after long-term treatment. These contributions have played a significant role in further enhancing the long-term survival and prognosis of people living with HIV.

What 'ending' AIDS really means

Despite substantial progress, one question has persisted: When can we end AIDS? While the world has committed to ending AIDS by 2030, rates of new infections and deaths are not falling rapidly enough to meet that target. 

There are still 40.8 million people living with HIV globally, of whom 9.2 million are not receiving treatment, according to the World Health Organization. In 2024, there were 1.3 million new HIV infections worldwide.

At each annual International AIDS Conference, the "Towards a Cure" forum underscores the enduring hope for a definitive solution. Pretty much like Hepatitis B, while we can prevent and control AIDS, a true cure that eradicates the virus from the human body remains elusive. The scientific pursuit is unrelenting, but it prompts a deeper question: Must we have a cure to end an epidemic?

Theoretically, no. From the perspective of infectious disease control, an epidemic can be ended by protecting susceptible populations, cutting transmission routes and controlling the source of infection. In this framework, a cure, while monumental, is just one method of controlling the source. Its scientific and psychosocial value is immense, but for population-level control, protecting the vulnerable and interrupting transmission are equally, if not more, critical.

The final hurdles

What is missing in our final push to end AIDS? A look beyond the impressive statistics reveals stark realities. New infections are still concentrated in specific geographic and demographic hot spots, rooted in deep-seated social inequities. In many regions, discrimination remains a major barrier to prevention, testing and treatment. 

Since 2025, many countries have seen significant cuts in funding for AIDS-targeted programs and research, while the development of innovative drugs and vaccines faces both a lack of drive and technical hurdles. These challenges pose a significant threat to achieving UNAIDS's goals of "three zeros": zero new HIV infections, zero AIDS-related deaths and zero discrimination by 2030.

Beyond the ongoing quest for new drugs, vaccines and a cure, we must develop and deploy precise interventions and flexible screening for high-risk groups. For every link in the chain, prevention, diagnosis, treatment and monitoring, we need to bridge the last mile of delivery to effectively connect healthcare services with those who need them.

Ultimately, eliminating discrimination and building robust social support systems and equitable care structures are the essential prerequisites for any medical service to succeed. 

Ending AIDS requires both individual responsibility for self-protection and collective societal efforts to provide technological, medical, social and psychological support.