The Statistical Illusion of a Global HIV Endgame

This study analyzes prevalence growth rates across regions using UNAIDS data and statistical modeling to forecast trends through 2050. Globally, the 95-95-95 targets are projected to be achieved by 2035, 2034, and 2025, respectively, largely due to the success of robust interventions in Eastern and Southern Africa. However, this masks the continued high burden and rapid accumulation of new infections in Asia and the Pacific, the Caribbean, and the Middle East and North Africa, where persistent transmission and limited treatment coverage reveal stark disparities. These regional crises challenge the framework’s global applicability, suggesting Africa’s progress cannot be extrapolated universally. Relying solely on the 95-95-95 framework risks creating an illusory sense of achieving an ‘endgame’ without tailored strategies that address diverse epidemiological contexts. This study used a random forest model analyzing feature correlations with HIV growth. The new infection is most strongly correlated, while the first 95 target is also highly correlated, indicating that prevention and high testing significantly reduces the growth rate. The LGBT score and urban population are positive correlated, suggesting that HIV growth is primarily driven by the LGBT community in highly urbanized areas. The third 95 target displays weaker correlations, showing that HIV growth is driven by those who have not been tested. Prevention efforts should prioritize encouraging untested individuals to undergo testing in the urban LGBT populations.