Barrier #1
Political deprioritization and limited stakeholder awareness & collaboration across sectors
Political deprioritization and limited stakeholder awareness and collaboration across sectors have weakened momentum toward the 2030 goals, leading to limited policy attention and constrained domestic funding. Core dimensions of this barrier include widespread misconceptions that HIV is already under control; competition for attention and investment with other health priorities such as COVID-19 and NCDs; insufficient awareness and coordination across non-health sectors, including finance, education, justice, and religious institutions; and declining support for community organizations, civil society, and networks of PLHIV. Stigma and discrimination compound these challenges by making political decision-making and resource allocation for HIV politically sensitive and less visible.
Barrier #2
Restrictive laws & policies that conflict with public health evidence & objectives
Restrictive laws and policies that conflict with public health evidence and objectives undermine the effectiveness of HIV responses across the region. These laws and policies discourage individuals, especially those from key populations, from seeking prevention, testing, or treatment services, and they weaken public trust in health institutions. The dimensions of this barrier include the criminalization of same-sex relations, sex work, and drug use; restrictive age-of-consent laws that limit access to HIV testing and PrEP for adolescents and young people; residency or identity requirements that exclude migrants and undocumented individuals from care; mandatory registration of HIV status or reporting of key populations to authorities; and prohibitions on NSPs, opioid substitution therapy, and community-based prevention.
Barrier #3
Limited access to & underutilization of PrEP, harm reduction & other HIV prevention tools
Barrier #4
Inadequate HIV testing coverage & weak linkage to care
Inadequate HIV testing coverage and weak linkage to care continue to delay diagnosis and disrupt the continuum of care, resulting in missed opportunities for early treatment initiation and viral suppression. Testing services are limited in number, geography, or hours of operation, and in some cases, fees remain a barrier to access. Stigma and fear of discrimination discourage individuals, particularly those from key populations, from seeking testing or returning for results. HIV self-testing and routine opt-out testing in healthcare settings remain underutilized, and confirmatory testing procedures are frequently cumbersome. Fragmented referral and intake systems, including inefficient registration and case management processes, further weaken linkage to care.
Barrier #5
Delays in HIV treatment initiation & challenges to treatment retention
Delays in HIV treatment initiation and challenges to treatment retention continue to limit progress toward viral suppression and long-term treatment success. People newly diagnosed with HIV experience delays in beginning ART due to the absence of same-day or rapid-start protocols. Health workforce shortages, long wait times, and limited service hours or geographic coverage further reduce accessibility, particularly for people living in rural areas or without stable transportation. Stigma and fear of disclosure combined with inadequate peer support, psychosocial counseling, and community engagement discourage ongoing engagement in care. Weak health information systems impede the ability to track missed appointments and proactively re-engage patients, while inconsistent access to routine viral load testing and drug resistance surveillance prevents timely identification of treatment failure.
Barrier #6
Regulatory & reimbursement barriers for long-acting HIV prevention, testing, and treatment innovation
Regulatory & reimbursement barriers for long-acting HIV prevention, testing, and treatment innovation continue to delay or restrict access to innovative HIV tools. While new technologies offer substantial potential to transform the HIV response, they often face slow and fragmented approval pathways. Many economies make limited use of fast-track regulatory mechanisms, reliance models, or regional joint review processes, resulting in duplicative and lengthy reviews. Even after approval, delays in coverage and reimbursement decisions persist, particularly where HTA capacity is limited or narrowly focused on short-term cost rather than long-term public health impact. Inclusion of new products in national formularies and procurement systems is often slow or incomplete, and integration into UHC and insurance schemes remains inconsistent.
Barrier #7
Insufficient & unsustainable domestic HIV funding and dependence on external funds
Insufficient and unsustainable domestic HIV funding and dependence on external funds continue to undermine the long-term effectiveness and scalability of HIV responses. Many economies lack stable domestic financing mechanisms or dedicated budget lines for HIV, leaving prevention, testing, and community-based programs vulnerable to political and fiscal shifts. Over-reliance on international donors, especially for prevention and key population services, creates structural fragility when external funding declines or transitions as it has been recently. Spending also remains misaligned with epidemiological realities, with insufficient allocation toward high-impact interventions such as PrEP, harm reduction, and community outreach. Limited use of social contracting to fund NGOs further constrains program delivery. Underlying these issues is a persistent lack of awareness of the return on investment that well-targeted HIV funding delivers in terms of long-term cost savings, productivity, and health system resilience.