Every year, on December 1st, World AIDS Day is commemorated. This day is dedicated to solidarity with people living with HIV, the prevention of the disease’s spread, and raising awareness about the progress and challenges in the global AIDS response. Despite the fact that modern medicine has transformed HIV into a manageable chronic condition, new HIV cases and AIDS-related deaths still pose a serious public health problem worldwide.
The situation is particularly concerning in Eastern Europe and Central Asia (EECA), where UNAIDS data indicate that HIV infection is increasing faster than anywhere else in the world. This year’s global theme, “Overcoming Disruption,” calls upon all countries to remove stigma, discrimination, and structural barriers that limit access to HIV prevention and treatment services, especially for vulnerable groups.
In this interview, Natalia Zakareishvili, Programme Analyst at the United Nations Population Fund (UNFPA) Georgia Country Office, discusses the main global challenges related to HIV prevention, the structural drivers of the epidemic in the EECA region, the changing epidemiological context in Georgia, and the importance of introducing stigma-free and integrated health services.
This year’s World AIDS Day focuses on “Overcoming Disruption.” What are the main global challenges that threaten HIV prevention, especially in low- and middle-income countries? And what impact is the funding crisis having on access to prevention services?
Before speaking about challenges, it is important to reflect on the global, regional, and national situation. According to the UNAIDS 2025 report, an estimated 40.8 million people are living with HIV worldwide. Despite access to treatment and prevention, 1.3 million new infections and 630,000 AIDS-related deaths were recorded in 2024 alone. These numbers demonstrate the severity of the situation and the immense scale of the challenge. Without a rapid reversal in course, the forecast is grim. By 2030, 3.3 million more people could acquire HIV. A disproportionate number of adolescent girls and young women are at risk of infection.
Prevention remains the most effective and cost-efficient way to stop new infections, yet many global disruptions hinder access to prevention services. Stigma and discrimination continue to be major barriers everywhere, preventing people from seeking testing, counseling, and treatment even when these services exist. Infrastructure gaps, human rights restrictions, and limited geographic accessibility further exacerbate the problem. In low- and middle-income countries, financial limitations are especially severe: shortages of medicines and medical supplies, weakened community programs, and cuts in school-based and youth programs reduce prevention coverage at a critical time. The global funding crisis intensifies these issues, significantly reducing the scope of NGO activities and outreach services. Ultimately, reduced financial investment means fewer prevention efforts, fewer testing opportunities, and a weakened health system overall. The Funding Crisis critically endangers prevention services. Reduced investments lead to the curtailment of programs, decreased resources for community-based initiatives, and delays in introducing technological innovations (e.g., injectable PrEP). The funding crisis directly puts the sustainability of the healthcare system at risk due to the deficiency of qualified personnel. Ultimately, the funding crisis means less prevention, less testing, and fewer life-saving services.
Eastern Europe and Central Asia is the only region where AIDS-related mortality continues to rise. What explains the fact that HIV infection is not decreasing in this region, and how serious is the epidemiological threat?
The data from the EECA region are particularly alarming. Since 2010, the number of new HIV infections has been steadily increasing. Although countries in this region differ in culture and context, they share a common trend: rising HIV cases and insufficient access to treatment. In fact, around 50% of people living with HIV in the region do not receive treatment. Georgia is an exception within the region, where access to treatment is 100%. However, the region as a whole remains the only one worldwide where AIDS-related mortality continues to rise, reflecting a systemic failure in both prevention and treatment.
Key Populations — including people who inject drugs, sex workers, men who have sex with men, and others — are disproportionately affected. Repressive legal environments, criminalization of drug use and sex work, and widespread stigma and discrimination create conditions where people fear seeking services. In healthcare settings, stigmatizing attitudes from medical personnel drive many to avoid testing altogether. Prevention programs, including PrEP, are limited or entirely lacking in many countries. The ongoing war in Ukraine and mass displacement have further disrupted testing and treatment services, interrupting antiretroviral therapy and increasing transmission risks. These combined structural factors create the fastest-growing HIV epidemic in the world, with only 42% of people achieving viral suppression and a significant co-epidemic of tuberculosis, particularly drug-resistant TB.
In Georgia, the epidemic is concentrated, and sexual transmission has become the dominant route. How has this change influenced the priorities of prevention services in the country?
Georgia remains a low HIV prevalence country with concentrated epidemics in key populations, mainly. Sexual transmission has become the dominant route, in Georgia, as in other countries in Eastern Europe and Central Asia, the dominant mode of HIV transmission has shifted from injecting drug use to sexual transmission.
Although HIV testing and counseling are free in Georgia, stigma and low awareness discourage many — particularly youth — from seeking these services. The strategic response has evolved accordingly. safer sex practices and condom accessibility have become priorities, as have educational programs in schools and community centers. The integration of HIV services with broader sexual and reproductive health services has been strengthened to ensure that prevention, testing, and counseling are offered in a more comprehensive way. Traditional harm reduction programs remain vital, but the rise of sexual transmission has led to the inclusion of prevention tools such as PrEP, which is now being integrated into national programs. Testing strategies are also expanding: decentralized testing, mobile clinics, and self-testing are increasingly emphasized to reach individuals who may otherwise avoid traditional healthcare settings. These changes reflect the need to prevent late diagnoses and prevent the concentrated epidemic from expanding into the general population.
High-risk populations still face serious barriers to accessing services. What are the most acute challenges in this area today?
The most acute challenges remain stigma and discrimination in healthcare settings, uneven geographical access to services, restrictive legal frameworks, and limited availability of accurate information. Funding constraints also affect the stability of outreach programs, which are vital for Key Populations.
Self-stigma remains a major barrier, as many fear judgment or exposure and therefore avoid testing or treatment. Discriminatory attitudes among healthcare personnel — including disrespectful behavior or refusal of care — further discourage people from seeking services. In small communities, fear of confidentiality breaches is especially strong. Legal restrictions affecting transgender people, sex workers, and people who use drugs create an additional layer of psychological stress, driving individuals away from the health system. These challenges are not unique to Georgia; they reflect global trends affecting vulnerable groups everywhere.
Risk-taking behaviors are increasing among adolescents and young people. What problems remain in HIV prevention and Youth-Friendly Sexual and Reproductive Health and Rights (SRHR) programs?
Young people are among the most vulnerable population groups. Increasing risk-taking behaviors signal that prevention and SRHR programs are not adequately reaching or addressing their needs. Comprehensive Sexuality Education (CSE) is not fully implemented in schools, and the information that is provided is often incomplete, overly biological, or based on abstinence-only approaches. As a result, adolescents rely on the internet or peers, which often leads to misinformation. Fear of stigma affects young people strongly. Many avoid clinics because they worry their parents or teachers will find out about their sexual activity or substance use. confidentiality concerns remain a major obstacle. Many health services are not youth-friendly, the location, working hours, or environment may feel uncomfortable or judgmental. Fragmentation of SRH services means that young people seeking contraception may not receive information about HIV prevention, or vice versa. A comprehensive approach is needed: mandatory implementation of Comprehensive Sexuality Education, expansion of youth-friendly clinics, and strong efforts to combat stigma at all levels of society.
Progress on HIV prevention is the surest path to an AIDS-free generation. However, this progress is facing major setbacks. Unprecedented funding cuts in international aid have hit HIV prevention programmes particularly hard.
Stigma in medical institutions remains a major obstacle. Which forms of stigma are the most harmful in Georgia, and how is the UN Population Fund (UNFPA) working to reduce them?
Stigma in healthcare settings is one of the biggest barriers to accessing HIV and SRHR services in Georgia. The most harmful form is direct discrimination, when healthcare workers refuse to provide services or behave in a judgmental manner. Equally damaging is anticipated stigma — the fear that a person will be judged, rejected, or have their confidentiality violated. This fear alone prevents many from ever entering a medical facility. UNFPA has long been engaged in stigma reduction work, supporting studies such as the Stigma Index and helping translate evidence into policy. Capacity-building for healthcare providers is central to this work. UNFPA helps equip doctors, nurses, and other professionals with training on nondiscriminatory, patient-centered service delivery. The organization also supports youth-friendly services and public education campaigns aimed at promoting positive sexual and reproductive health norms. Through community centers, targeted outreach, and the integration of HIV and SRHR services, UNFPA works to create a more enabling environment for all groups, especially the most vulnerable.
Gender inequality and Gender-Based Violence (GBV) continue to increase HIV infection risks for women and girls. How is this problem manifested in Georgia, and in what aspect does it require urgent attention?
Gender inequality and gender-based violence significantly heighten women’s vulnerability to HIV. Many women lack the power to negotiate safe sexual practices or request condom use due to fear of violence or abandonment. Sexual and physical violence, including rape, directly increase the risk of HIV transmission and cause psychological trauma that can hinder preventive actions. Women who experience violence often face serious barriers in accessing health and legal services because they fear stigma, blame, or further violence.
In Georgia, these issues manifest through intimate partner violence, sexual coercion, and unequal economic dependence. Urgent attention is needed to strengthen GBV prevention programs, expand access to SRHR services, ensure women’s economic empowerment, and improve multisectoral responses that connect health, social services, and justice systems.
How does UNFPA support Georgia in creating stigma-free, integrated HIV infection and Sexual and Reproductive Health and Rights (SRHR) services?
UNFPA supports Georgia through a comprehensive approach that includes expanding access to universal testing, counseling, and education. The organization provides stigma-reduction training for healthcare workers and helps strengthen their capacity to deliver nondiscriminatory services. UNFPA also invests in community centers and targeted outreach programs to ensure that high-risk populations receive services without judgment or barriers.
A human rights-based approach is at the core of UNFPA’s work. The organization supports the development of laws and policies that protect vulnerable groups and promote equal access to healthcare. UNFPA also works closely with community organizations and civil society to strengthen their role in prevention efforts and service delivery. Through these combined efforts, UNFPA aims to create a stigma-free, integrated system where HIV and SRHR services are accessible to all.
What message would you like to share with the communities most affected by HIV infection in Georgia on World AIDS Day?
The most important message is that HIV is no longer a death sentence. It is a manageable chronic condition, and with treatment, people living with HIV can lead full, healthy lives. Your voice, your experience, and your resilience are powerful tools against stigma and discrimination. Know your status, stay informed, protect your health, and make use of all available services. Do not allow stigma to stand in your way. UNFPA, as Chair of the United Nations HIV/AIDS Thematic Group, is fully committed to support in sustaining and improving HIV prevention, particularly for adolescent girls, young women and key populations, along with providing treatment and related services.
