TOP 10 Countries by HIV Prevalence Among Adults (15–49, 2025)
HIV remains one of the most closely monitored infectious diseases worldwide. While global adult prevalence has fallen to well below 1%, a small group of countries – predominantly in Eastern and Southern Africa – still live with a very high burden of infection, despite major progress in treatment scale-up.
According to recent UNAIDS and WHO estimates, about 39–41 million people are living with HIV globally, and roughly 0.7% of adults aged 15–49 are HIV-positive on average worldwide. But this global mean hides enormous variation. In several countries of Southern Africa, more than one in five adults in this age group lives with HIV, even as incidence and deaths decline thanks to antiretroviral therapy (ART) scale-up.
For this analysis, we focus on ten countries that consistently appear at the top of global rankings of adult HIV prevalence in recent UNAIDS country profiles and regional syntheses: Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, South Africa, Uganda, Zambia and Zimbabwe. All of them are located in Eastern or Southern Africa and share common structural drivers of the epidemic: long-standing socio-economic inequality, gender power imbalances, and initially late access to treatment and prevention.
The figures below use the latest available national estimates for each country (mostly between 2020 and 2023). They are rounded to one decimal place and should be interpreted as indicative values rather than exact point measurements for calendar year 2025, but they capture the current order of magnitude and relative ranking very well.
| Country | Adult HIV prevalence (15–49, %, approx.) | Latest data year* |
|---|---|---|
| Eswatini (Swaziland) | ≈ 27–28% | 2021–2023 |
| Lesotho | ≈ 22–24% | 2021–2023 |
| Botswana | ≈ 20–22% | 2020–2023 |
| South Africa | ≈ 17–19% | 2020–2023 |
| Mozambique | ≈ 11–13% | 2020–2023 |
| Namibia | ≈ 11–13% | 2018–2022 |
| Zimbabwe | ≈ 11–13% | 2021–2023 |
| Malawi | ≈ 8–10% | 2021–2023 |
| Zambia | ≈ 9–10% | 2021–2023 |
| Uganda | ≈ 5–7% | 2020–2023 |
Even within this high-burden group there is variation. Eswatini, Lesotho and Botswana have prevalence levels roughly 30–40 times higher than the global adult average, whereas Uganda and Zambia are closer to 5–10 times higher. Yet all ten countries face similar long-term challenges: sustaining financing for life-long ART, preventing new infections among young women, and protecting health systems that carry a dual burden of HIV and tuberculosis.
Antiretroviral therapy coverage: where treatment is catching up with prevalence
High prevalence does not automatically imply poor programme performance. Several of the countries in Table 1 have built some of the most successful HIV treatment programmes in the world. Eswatini, Botswana, Lesotho, Tanzania and Zimbabwe, for example, have already met or exceeded the UNAIDS 95-95-95 targets: at least 95% of people living with HIV (PLHIV) know their status, 95% of those diagnosed are on ART, and 95% of those on ART are virally suppressed by 2025.
The next table summarises approximate coverage of ART among all PLHIV in each of the ten high-prevalence countries. Values are based on the most recent UNAIDS or World Bank estimates, typically for 2021–2023, and rounded to whole percentages. They show both remarkable success in some settings and persistent gaps in others.
| Country | ART coverage (% of PLHIV, approx.) | Latest data year* |
|---|---|---|
| Eswatini (Swaziland) | ≈ 94% meets 95-95-95 trend | 2022–2023 |
| Lesotho | ≈ 94% | 2023–2024 |
| Botswana | ≈ 93% | 2022 |
| Zimbabwe | ≈ 92% | 2021–2022 |
| Malawi | ≈ 90% | 2022 |
| Tanzania | ≈ 87% | 2022 |
| Mozambique | ≈ 82% | 2022–2023 |
| Namibia | ≈ 83% | 2017–2020 |
| South Africa | ≈ 80–81% | 2023–2024 |
| Uganda | ≈ 82–85% | 2021–2023 |
Several patterns stand out. First, in countries such as Eswatini, Lesotho, Botswana and Zimbabwe, ART coverage has caught up with – and in some respects outpaced – the epidemic: the vast majority of PLHIV are on treatment and virally suppressed. Second, large high-prevalence countries like South Africa and Mozambique have made huge gains but still face the operational challenge of reaching scattered and mobile populations in rural areas, informal settlements and key populations.
The bar chart underlines just how exceptional these prevalence levels are in global perspective. Even the “lowest” countries in this group have adult HIV prevalence more than ten times the global mean, while Eswatini, Lesotho and Botswana remain extreme outliers despite substantial declines in incidence since the early 2000s.
Long-term dynamics: from a generalised epidemic to a treated chronic condition
Adult HIV prevalence in these countries is the end result of processes playing out over decades. In the 1990s and early 2000s, incidence rose steeply while effective treatment was scarce or inaccessible. This produced the very high prevalence levels that still characterise Southern Africa today. Since around 2010, however, expanded HIV testing and rapid ART scale-up have reversed many of these trends: new infections are falling, AIDS-related deaths have declined sharply, and prevalence has stabilised or even begun to decrease in some countries.
The stylised line chart below tracks the combined evolution of adult prevalence and ART coverage for two emblematic countries – Eswatini and South Africa – using simplified values informed by their UNAIDS time-series estimates between 2000 and 2024. The exact numbers are not meant to reproduce every annual data point; instead, they summarise the direction and magnitude of change.
Three broad messages emerge from these trajectories:
1. Prevalence peaked many years ago. In both Eswatini and South Africa, adult HIV prevalence rose rapidly through the 1990s and early 2000s, then plateaued and began to decline slowly once ART became widely available. Because people now survive much longer on treatment, prevalence remains high even as incidence falls – a sign of improved survival rather than failure.
2. ART coverage has grown from single digits to well over 80%. In 2000, only a tiny fraction of PLHIV in these countries had access to ART. Today, coverage above 90% in Eswatini and around 80% in South Africa means that millions of lives have been saved, and many more infections prevented, through “treatment as prevention”.
3. The remaining gap is increasingly about equity and quality. The people who are not yet on treatment tend to be those who face overlapping vulnerabilities: young men, highly mobile workers, key populations, or residents of remote rural areas. Closing the last 10–20% gap will therefore require not just drugs, but differentiated service delivery, stigma reduction and stronger community-based systems.
This ranking and the accompanying visualisations are based on an integration of several authoritative datasets and reports. Key sources include:
-
UNAIDS – AIDSInfo & Country Data.
National time-series of adult HIV prevalence and ART coverage, accessed via UNAIDS country
data pages and the AIDSInfo platform.
https://aidsinfo.unaids.org/ -
UNAIDS Global AIDS Update and 95-95-95 progress reports.
Global and regional summaries of people living with HIV, treatment coverage and progress
towards the 95-95-95 targets.
https://www.unaids.org/en/resources/documents -
WHO Global Health Observatory (GHO) HIV indicators.
Complementary indicators on HIV prevalence, incidence and mortality, especially for trend
analysis from 1990 onwards.
https://www.who.int/data/gho -
World Bank – HIV prevalence and ART coverage indicators.
Cross-country comparable indicators for adult HIV prevalence (15–49) and ART coverage,
used to align values across the top-10 high-prevalence countries.
https://data.worldbank.org/indicator -
Peer-reviewed syntheses (PHIA surveys, national investment cases).
Used to confirm the composition of the “top 10” high-prevalence countries and to validate
qualitative descriptions of trends and programme performance.
https://phia.icap.columbia.edu
