The world is not on track to end the AIDS pandemic. New infections are rising and AIDS deaths are continuing in too many communities.

This report reveals why: inequalities are holding us back.

In frank terms, the report calls the world’s attention to the painful reality that dangerous inequalities are undermining the AIDS response and jeopardising the health security of everyone. The report highlights three specific areas of inequality for which concrete action is immediately possible—gender inequalities and harmful masculinities driving HIV; marginalisation and criminalisation of key populations, which our data show is resulting in starkly little progress for those populations and undermining the overall response; and inequalities for children whose lives must matter more than their market share.

But this is not a counsel of despair, it is a call to action. Through bold action to confront these inequalities, we can end AIDS.

The world will not be able defeat AIDS while reinforcing patriarchy. The only effective route map to ending AIDS and achieving the sustainable development goals is a feminist route map. We can take action now to tackle gender inequalities and promote healthy masculinities—to take the place of the harmful behaviours which exacerbate risks for everyone.

Gender based violence is increasing women’s risks of HIV infection and constraining the access of women living with HIV to life-savings services.

Adolescent girls and young women (aged 15 to 24 years) are three times more likely to acquire HIV than adolescent boys and young men of the same age group in sub-Saharan Africa. One study showed that enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV infection by up to 50%. By interrupting the power dynamics, policies can reduce girls’ vulnerability to HIV.

Harmful masculinities are discouraging men from seeking care. While 80% of women were accessing treatment in 2021, only 70% of men were on treatment.

Meanwhile, we need to tackle inequalities in the realisation of human rights.

Discrimination against, stigmatization and criminalization of gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners are costing lives and preventing the world from achieving agreed AIDS targets.

Data in this report shows no significant decline in new infections among men who have sex with men in either western and central Africa or eastern or outhern Africa. But a better approach for key populations is achievable. For example, while key populations generally have lower access to HIV services, this report highlights several counties in Kenya where female sex workers living with HIV are accessing HIV treatment services at equal or better rates than women overall. This is the result of community-led services. Meanwhile, we highlight research showing countries that remove or avoid criminalization have seen greater progress.