New WHO data show that new infections from HIV/AIDS are not declining fast enough. Also, syphilis along with other sexually transmitted infections (STIs) are increasing in many regions of the world, contrary to the ambitious targets set by the Sustainable Development Goals and WHO member states for ending the epidemics of AIDS, viral hepatitis B and C and sexually transmitted infections by 2030.

Altogether STIs caused 2.5 million deaths in 2022, according to the new WHO report, Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022–2030, published Wednesday.

And the estimated number of deaths from viral hepatitis rose from 1.1 million deaths in 2019 to 1.3 million in 2022 despite the availability of effective prevention, diagnosis, and treatment tools. In 2022, around 1.2 million new hepatitis B cases and nearly 1 million new hepatitis C cases were recorded, the report also finds.

“The rising incidence of syphilis raises major concerns”, said WHO Director-General Dr Tedros Adhanom Ghebreyesus, in a press briefing on Wednesday. “Fortunately, there has been important progress on a number of other fronts including in accelerating access to critical health commodities including diagnostics and treatment.

“We have the tools required to end these epidemics as public health threats by 2030, but we now need to ensure that, in the context of an increasingly complex world, countries do all they can to achieve the ambitious targets they set themselves”.

Increasing incidence of sexually transmitted infections

Four curable STIs – syphilis, gonorrhoea, chlamydia, and trichomoniasis – account for over 1 million infections daily. The report notes a surge in adult and maternal syphilis (1.1 million) and associated congenital syphilis (523 cases per 100,000 live births per year) during the COVID-19 pandemic. In 2022 alone, there were 230,000 syphilis-related deaths.

In 2022, member states set a target to reduce adult syphilis infections tenfold by 2030, reducing cases from 7.1 million to 0.71 million. Yet, new syphilis cases among adults aged 15-49 years actually increased by over a million cases in 2022 reaching as much as eight million, with the biggest increase in the Americas and the African Region, the WHO report found.

Meanwhile, new HIV infections only declined from 1.5 million in 2020 to 1.3 million in 2022 – an inadequate trajectory to meet SDG target 3.3 to ‘eliminate the epidemic of AIDS’ by 2030. Five key population groups — men who have sex with men, people who inject drugs, sex workers, transgender individuals, and individuals in prisons and other closed settings — still experience significantly higher HIV prevalence rates than the general population. An estimated 55% of new HIV infections occur among these populations and their partners.

The picture is no better with HIV-related deaths, still reaching high numbers. In 2022, there were 630,000 HIV-related deaths, 13% of these occurring in children under the age of 15 years.

New data also show an increase in multi-resistant gonorrhoea. As of 2023, out of 87 countries where enhanced gonorrhoea antimicrobial resistance surveillance was conducted, 9 countries reported elevated levels (from 5% to 40%) of resistance to ceftriaxone, the last line treatment for gonorrhoea. WHO is monitoring the situation and has updated its recommended treatment to reduce the spread of this multi-resistant gonorrhoea strain.

Gains in expanding service access

Efforts by countries and partners to expand services for STIs, HIV and hepatitis are nonetheless chalking up gains. WHO has validated 19 countries for eliminating mother-to-child transmission of HIV and/or syphilis, reflecting investments in testing and treatment coverage for these diseases among pregnant women. Botswana and Namibia are on the path to eliminating HIV, with Namibia being the first country to submit a dossier to be evaluated for the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis.

Globally, HIV treatment coverage reached 76%, with 93% of people receiving treatment achieving suppressed viral loads. Efforts to increase HPV vaccination and screening for women with HIV are ongoing. Diagnosis and treatment coverage for hepatitis B and C have seen slight improvements globally.

Image Credits: JB Russel/ The Global Fund/ Panos, WHO.