Global analysis of pre-exposure prophylaxis to need ratios in 2025

BACKGROUND: Despite substantial progress, global HIV incidence remains far above the UNAIDS 2030 target of 220 000 annual acquisitions. Pre-exposure prophylaxis (PrEP) is highly effective, including long-acting agents with 96-100% efficacy, but population-level impact depends on delivery at scale. OBJECTIVE: To assess global PrEP coverage relative to need and estimate the implications for HIV epidemic control. METHODS: We conducted a cross-sectional analysis of country-level HIV acquisitions and PrEP coverage across 184 countries using UNAIDS and supplementary data sources. For countries lacking 2025 data, the most recent estimates were used; PEPFAR-supported countries without current data were adjusted using a 34% reduction to reflect impact of funding cuts. We calculated the PrEP-to-need ratio (PrEP users per new HIV acquisition) and defined a target of 40 : 1, based on number-needed-to-treat estimates from recent trials. RESULTS: Globally, 1.28 million new HIV acquisitions and 2.39 million PrEP users were identified, yielding a PnR of 1.88. Sixty-eight percentage of countries had low coverage (