HIV / AIDS burden in South Asia , 1990–2023: Temporal trends, sex differences and attributable risk factors from the Global Burden of Disease study 2023

Abstract Objectives To describe levels and trends of the HIV/AIDS burden in the Global Burden of Disease (GBD) South Asia region and its five countries, 1990–2023, including sex differences and risk‐attributable burden. Methods We analysed GBD 2023 estimates of HIV/AIDS incidence, prevalence, deaths and disability‐adjusted life years (DALYs) for Bangladesh, Bhutan, India, Nepal and Pakistan. Joinpoint regression was applied to all 72 location–sex–measure series of age‐standardized rates (ASRs) to estimate average annual percentage changes (AAPCs) and the annual percentage change (APC) of the most recent segment. Risk‐attributable burden was obtained from the GBD comparative risk assessment. Results In 2023, South Asia had 99 748 new HIV infections, 58 627 HIV/AIDS deaths and 3 056 866 DALYs; India accounted for 80.9% of deaths. Regional ASRs peaked in 1997 (incidence) and 2006 (deaths) and have since declined (AAPC 2010–2023: incidence −4.61% (95% CI −4.83 to −4.40); deaths −7.80% (95% CI −8.06 to −7.55)). Pakistan was the only country in which incidence, prevalence and mortality were still increasing (incidence APC 2005–2023: 5.54% (95% CI 3.87 to 7.24)) and had the highest incidence ASR (14.55 per 100 000). Male rates exceeded female rates for incidence and prevalence, whereas regional mortality rates converged (male‐to‐female ratio 1.03). Unsafe sex was associated with 69.3% of regional HIV/AIDS deaths and drug use with 39.6% of deaths in Pakistan. Conclusions The regional HIV/AIDS burden in South Asia has declined since the mid‐2000s, but this conceals a continuing increase in Pakistan and slower progress in Bangladesh. Country‐specific prevention, testing and harm‐reduction responses, supported by stronger surveillance, are needed.