While the world’s attention was riveted on the Covid pandemic and the war in Ukraine, the fight against an older foe lost crucial ground: More than 1.5 million people became infected with H.I.V. last year, roughly three times the global target, the United Nations reported on Wednesday.
Roughly 650,000 people died of AIDS in 2021, about one every minute, according to U.N.AIDS, the organization’s program on H.I.V. and AIDS. Progress against the disease has faltered, and global infections have held steady since 2018.
The toll in 2021 was uneven, as people ages 15 to 24 years — and young women in particular — carried a disproportionate share of the burden. One new infection in an adolescent girl or young woman occurred every two minutes, the program said.
In sub-Saharan Africa, young people accounted for 31 percent of new infections, and nearly four in five of them were among girls and young women. In El Salvador, the prevalence of H.I.V. almost doubled among men who have sex with men and rose about eightfold among transgender people.
In Asia and the Pacific, new H.I.V. infections were rising where they had been falling. And about 160,000 children worldwide became infected, despite the availability of prevention methods.
“These numbers should represent more than just a sounding of the alarm — this should represent a full stop,” said Stephaun Wallace, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle.
In most countries, including the United States, only privileged groups tend to have consistent access to prevention and treatment for H.I.V., Dr. Wallace said. “Groups that are oppressed in different parts of the world, or essentially lower on the social hierarchy, are not given the same access,” he said.
An estimated 40 million people are living with H.I.V. worldwide. About 10 million of them, including about half of infected children, do not have access to treatment.
Fortunately, many of those who were already receiving treatment continued to do so in 2021, thanks in part to innovative H.I.V. programs in some countries. But the past two years have brought unrelenting waves of hardship, especially in low- and middle-income countries, that have disrupted the prevention and diagnosis of H.I.V.
Millions of girls were out of school as the coronavirus spread, and teenage pregnancies and gender-based violence soared. The pandemic sent poverty rates and fuel costs skyrocketing.
The Ukraine war has led to a further spike in food prices and constraints in supply chains.
“When there’s an economic crisis, women — particularly young women — are going to be more reliant on transactional sex as a source of income,” said Harsha Thirumurthy, an economist at the University of Pennsylvania. “It is not exclusively, but by and large, an economic story.”
In 2021, debt repayment for low-income countries comprised 171 percent of the spending on health care, education and social protection combined. Donor countries tightened the purse strings, and H.I.V. funding from countries other than the United States fell by 57 percent over the past decade, according to the report.
Low- and middle-income countries will need an estimated $29 billion to tackle H.I.V. through 2025, but will face a shortfall of about $8 billion.
“These figures are about political will,” Winnie Byanyima, the executive director of U.N.AIDS, said in a statement.
“Do we care about empowering and protecting our girls?” she added. “Do we want to stop AIDS deaths among children? Do we put saving lives ahead of criminalization? If we do, then we must get the AIDS response back on track.”
The response in some countries has been colored by the fact that people in marginalized communities are among those at highest risk.
In Australia, Canada and the United States, new H.I.V. infections are higher among Black people and Indigenous communities, compared with white people. Men who have sex with men, drug users and sex workers — who together account for about 70 percent of global infections — have about 30 times the risk of infection, compared with others in the population.
Effective global policies should take these realities into account; it’s about “more than handing people condoms and lube,” Dr. Wallace said.
In an ideal world, for example, young women would have unfettered access to reproductive health services without stigma or judgment from their families, communities or houses of worship. Dr. Thirumurthy suggested that cash transfer programs might be just as essential as medical tools in slowing new infections among girls.
At a meeting in 2016, U.N. member countries set new goals for 2020: fewer than 500,000 new H.I.V. infections annually, fewer than 500,000 AIDS-related deaths annually, and elimination of H.I.V.-related discrimination. The nations did not meet those targets.
The world is also unlikely to reach another goal: a reduction to 370,000 new infections annually by 2025. The new report estimated that the real number is likely to be three times as high.