People most at risk of HIV infection, including gay men, transgender people, and those who inject drugs, are facing an alarming rise in criminalisation around the world, according to a new report by UNAids.
For the first time in over a decade of monitoring global laws, the UN agency reports an increase in countries enforcing punitive legislation against same-sex relations and gender expression. The shift threatens to undermine decades of progress in the fight against HIV/Aids, especially in the wake of significant US funding cuts.
Mali recently introduced legislation criminalising homosexuality and transgender identity, where previously only “public indecency” was outlawed. Trinidad and Tobago’s court of appeal has reversed a landmark 2018 ruling that decriminalised same-sex relations, reinstating colonial-era prohibitions. Uganda’s controversial 2023 Anti-Homosexuality Act has further intensified penalties, while Ghana is also considering legislation that would increase sentences for same-sex acts.
The crackdown on LGBTQ+ rights coincides with what UNAids calls “unprecedented” global challenges, including humanitarian crises, the climate emergency, and now, the abrupt withdrawal of US funding, a move that risks derailing the global target of ending Aids as a public health threat by 2030.
Although 2024 saw the lowest rates of new infections and Aids-related deaths in more than 30 years, 1.3 million and 630,000 respectively, progress is inconsistent. Sub-Saharan Africa recorded a 56% drop in infections since 2010, while the Middle East and North Africa saw a 94% surge.
The report stresses that several “key populations” are disproportionately affected by HIV: sex workers, gay men and other men who have sex with men, people who inject drugs, transgender individuals, and people in prisons. Yet these groups are often criminalised, excluded from mainstream healthcare, and heavily reliant on donor-funded prevention services.
Eight of 193 countries non-disclosure of HIV status
In 2025, only eight out of 193 countries globally had refrained from criminalising any key populations, behaviours linked to HIV transmission, or the non-disclosure of HIV status.
The funding crisis has already had a devastating impact. In Nigeria, the number of people receiving pre-exposure prophylaxis (PrEP) plummeted from approximately 43,000 in November 2024 to fewer than 6,000 by April 2025 following the cuts.
Dr Beatriz Grinsztejn, president of the International Aids Society (IAS), described key populations as being “always left behind”. Many relied on community-based clinics now forced to close due to the sudden withdrawal of financial support.
The report, released ahead of the IAS Conference in Kigali, warns of serious consequences if US funding through the President’s Emergency Plan for Aids Relief (Pepfar) is not replaced. UNAids modelling projects up to 4 million additional deaths and 6 million new infections by 2029 without alternative funding sources. Similarly, research from the University of Bristol suggests that just one year of halted US support in sub-Saharan Africa could cause 700,000 people to lose access to PrEP and result in 10,000 additional HIV infections over the next five years.
Still, there are glimmers of hope. UNAids executive director Winnie Byanyima said 25 out of 60 low- and middle-income countries have begun increasing domestic HIV spending through to 2026. “This is the future of the HIV response – nationally owned and led, sustainable, inclusive and multisectoral,” she said.
