Oral (14–16) and long-acting (LA) PrEP options (17, 18) have been shown to be very effective in reducing the risk of HIV acquisition, overcoming the limitations of adherence and lack of persistence associated with oral regimens, and are considered the most effective and potentially game-changing opportunities in the fight against HIV to date (18, 19). However, PrEP implementation is slowed down by social and structural barriers for some groups of individuals, making them vulnerable people (19, 20). Oral PrEP programs among adolescent women in Africa have shown a high discontinuation rate (up to 80%) at 6 months (21). Black/African American and Hispanic/Latino individuals, who account for 47 and 39% of estimated new infections in the US (22) have a low level of PrEP uptake (19). In Europe, 13 countries reported that PrEP had not even been implemented by 2023 (23) confirming the slowness of the process. Adolescent girls, who account for 76% of all new infections worldwide (10–19 years) (24), need strong PrEP interventions.

Ung et al. explored the preferences for HIV prevention strategies (PrEP, condom use or no strategy) among 286 Asian-born MSM living in Australia. The higher preference for the PrEP option (52%) confirms its high attractiveness. PrEP needs to be implemented rapidly and extensively in order to cover all the geographical areas, diverse populations, and especially the most vulnerable.

Antenatal testing is a crucial step in preventing mother-to-child transmission of HIV. Inequalities in the use of health services in pregnant women in Sub-Saharan Africa have been confirmed (25), with significant differences between countries, as only 74% of women were tested for HIV during antenatal care. Socioeconomic status, area of residence and level of education/knowledge about HIV/AIDS influenced testing rates.

Birhanu et al., who interviewed more than 10,000 women in Ethiopia, confirmed that only 21% of study participants reported pre-marital testing which is quite alarming as HIV testing should be part of a public health program.

Tsega et al. report on the low uptake (34%) of HIV testing during prenatal services in 4,152 women in Ethiopia. Level of education, recent health visits, stigma-free attitudes and not living in rural areas are associated with the rate of testing. Such demographic and cultural determinants are not new, unknown or unpredictable, confirming the persistence of traditional barriers.

Zhou et al., in a meta-analysis, reviewed the effectiveness of interventions to improve ART adherence in 2,900 pregnant women, according to nine studies. Their findings acknowledge the role of enhanced standard of care (±supporter) and device reminders as important tools to improve adherence during pregnancy.

For a number of reasons minorities lack HIV literacy (defined as one's ability to acquire, communicate and manage basic health information and services), are at higher risk of infection, have lower ARV coverage, and are therefore less likely to be on treatment and virologically suppressed (26).

Shi et al. reported on the average viral suppression rate among PLWH in 46 counties in South Carolina (USA). Their findings revealed that counties with high racial/ethnic residential segregation were more likely to have virologically unsuppressed individuals, confirming that health disparities in HIV treatment and care exist in underserved populations.

An et al. investigated factors associated with patient activation (defined as an individual's knowledge, skills and confidence) among Yi minority PLWH in China. Their low level of activation was associated with lower ART efficacy, suggesting the necessity for targeted strategies.

MSM are still at high risk for HIV and other sexually transmitted infections (STIs) worldwide.

Guo et al. reported on the risk of HIV and STIs among 572 MSM using mobile geosocial networking applications in southern China. Although app users were more likely to engage in high-risk sexual behaviors, the prevalence of HIV and other STIs appeared similar to non-app users.

New HIV infections among intravenous drug users (IVDUs) are increasing in some European countries (27). In 2022, no European country had achieved all 95-95-95 targets (28) for the continuum of care among IVDUs, confirming that they are less likely to be diagnosed, linked to care and virologically suppressed.

Roshanfekr et al. reported low levels of testing in IVDUs in Iran, with only 70% of them reporting lifetime HIV testing. These data suggest that much work still needs to be done to reach individuals traditionally at risk.

In 2021, an estimated 2.73 million children aged 0–19 years were living with HIV, with the majority (80–90%) in sub-Saharan Africa (29). In 2022, only 52% of children aged 14 or younger were on treatment, while 60% of children aged 5–14 years were still not being treated (30). In a meta-analysis including 4,422 young participants, the prevalence of good treatment adherence was 73% (31). Virological response in this subset is still a challenge due to adherence issues, family and patient factors, education, stigma, and relationships with healthcare personnel, and is hampered by limited pediatric formulations (32).

Ally et al. described the determinants of virological suppression in 1,980 children in Tanzania. Despite a remarkable rate of virological suppression (85%), predictors of successful outcomes include the presence of support groups, health insurance, food security, and family size, confirming the multifaceted nature of treatment success.

Lao et al. reported on the 13-year treatment efficacy of an LPV/r-based regimen in 458 children in China. Their findings confirm the lower ART performance in rural settings and the insufficient implementation of INSTI-based regimens in the pediatric population.

Chakakala-Chaziya et al. compared the clinical outcomes in 27,229 PLWH of different age groups in Malawi, suggesting that younger and older adolescents were less likely to achieve virological suppression compared to adults, mainly due to adherence issues.

A growing number of people living with HIV are aging, with approximately one-fifth of this population aged 50 years and older worldwide. PLWH experience more comorbidities and geriatric syndromes than aged-matched negative individuals, along with social isolation, stigma, mental health problems and care integration challenges that deserve further study (33).

Late presentation (i.e., HIV diagnosis with a CD4 count < 350 cells/μL or an AIDS-defining event) is one of the major obstacles to achieving control of the HIV epidemic worldwide. A recent European survey reported that 28,889 PLWH (50.4% of those included between 1981 and 2019) were classified as late presenters (34).

Xu et al. presented real-world data on HIV late presentation and its determinants in China. A high rate (57% out of 2,300 newly diagnosed individuals) were late presenters, confirming the current issue and the need for targeted measures.

Sharafi et al. estimated the duration of delayed diagnosis in Iran through a CD4 depletion model analysis. Many PLWH have no history of regular HIV testing, they are unaware of their disease and delay the opportunity to seek treatment and avoid transmission.