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 targets are projected for 2033, 2030, and 2025, driven by Eastern and Southern Africa’s success from robust interventions. However, this masks rapid growth in Asia and the Pacific, the Caribbean, and the Middle East and North Africa, where rising infections 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 on 95-95-95 risks an illusory “endgame” without tailored strategies for diverse epidemiological contexts. This study used a random forest model analyzing feature correlations with HIV growth. The first 95 targets exhibit strong negative correlations, indicating that higher testing substantially reduces growth. Conversely, the LGBT score and urban population show positive correlations, suggesting elevated growth in urbanized LGBT communities. The third 95 targets display weaker correlations, showing that growth is driven by those who have not been tested. Prevention should prioritize encouraging untested individuals to undergo testing in urban LGBT populations.