Top 10 African Countries with the Highest Prevalence of HIV/AIDS in 2025

In Summary

• Eswatini reports the world’s highest adult HIV prevalence at around 27.5%, and together with Lesotho and Botswana, represents the epicentre of the epidemic in southern Africa.
• South Africa has the largest number of people living with HIV—over 7.7 million adults despite having a lower prevalence rate (about 16.6%)
• Mozambique, Zimbabwe, Namibia, Zambia, Malawi, and Uganda round out the top ten, with prevalence rates ranging from 11.8% to 5.6% and HIV-positive populations from ~1.3 million to ~2.4 million.

Deep Dive!!

Lagos, Nigeria - HIV prevalence among adults aged 15–49 remains the most telling indicator of national epidemic severity, it reflects both the scale of infection and the effectiveness of treatment and prevention programs. In 2025, southern Africa remains the hardest hit region globally, hosting the highest prevalence rates alongside some of the largest HIV-positive populations.

Despite decades of progress in antiretroviral therapy (ART) rollout reaching 77% of people living with HIV globally in 2024 funding cuts and rising inequality are threatening to roll back gains in many countries. With sub-Saharan Africa accounting for around 65% of all people living with HIV and 86% of children with HIV, the epidemic’s burden remains heavily regional.

Treatment programs have dramatically reduced HIV-related deaths: globally, mortality dropped by over 50% since 2010, and by over 70% since the early 2000s . But prevention efforts especially among key populations and adolescent girls face serious setbacks as U.S. and international funding declines, risking rising incidence rates .

Below, we explore the top ten African countries by adult HIV prevalence in 2025, examining what drives their epidemic and how each is managing treatment, prevention, and health system challenges

10. Uganda

With an adult HIV prevalence of 5.6% in 2025 and an estimated 1.5 million people living with the virus, Uganda remains one of East Africa’s most affected countries. While there has been commendable progress over the past decade through government-led awareness campaigns and free access to antiretroviral therapy, new infections continue to rise among adolescents and young adults. Social stigma, low testing rates among men, and high-risk sexual behavior—especially in fishing communities around Lake Victoria—are major drivers of the epidemic. The government’s push to integrate HIV services into routine health care and expand community-led interventions is ongoing, but systemic gaps in rural healthcare delivery continue to hold the country back.

9. Malawi

Malawi has maintained a steady fight against HIV/AIDS, but with an adult prevalence rate of 7.6% and nearly 980,000 people living with the virus, the epidemic remains deeply rooted. Nationwide programs have improved access to treatment, with over 90% of diagnosed individuals receiving ART. However, poverty, teenage pregnancies, and gender-based violence continue to exacerbate vulnerabilities, particularly in southern regions like Blantyre, Chikwawa, and Zomba. Additionally, rural clinics still struggle with drug stockouts and poor health infrastructure, threatening long-term adherence and viral suppression. Despite these hurdles, Malawi is noted for its strong policy commitment to HIV education and the deployment of community health workers.

8. Zambia

Zambia’s adult HIV prevalence in 2025 stands at 11%, with approximately 1.3 million people living with HIV across the country. Although access to antiretroviral therapy has improved significantly, prevention efforts lag behind, especially in urban slums and rural provinces. Key populations, including sex workers and men who have sex with men, face high levels of discrimination, making them less likely to seek care. The Copperbelt and Lusaka regions remain among the most affected, driven by migration, transactional sex, and limited access to reproductive health services. While the Zambian government continues to invest in community testing and mobile clinics, the gains are unevenly distributed and highly dependent on international donor support.

7. Namibia

In Namibia, 11.5% of adults live with HIV, and the country has about 230,000 people currently living with the virus. Namibia has often been praised for its proactive HIV response, particularly in terms of high ART coverage and viral suppression rates. Yet, deep rural-urban divides persist. Northern regions like Ohangwena and Omusati bear a heavier burden, compounded by limited healthcare access and cross-border migration from Angola. Young women remain disproportionately affected, often due to gender power imbalances and economic dependency. Namibia’s integration of HIV services into maternal and reproductive care has helped curb mother-to-child transmission, but the country still faces hurdles in reaching marginalized populations such as the LGBTQ+ community.

6. Zimbabwe

Zimbabwe’s adult HIV prevalence stands at 11.7%, with around 1.3 million people living with the virus in 2025. After a devastating peak in the early 2000s, Zimbabwe has made considerable strides in HIV testing and treatment. However, persistent economic instability has undermined the country’s health infrastructure, leading to medication stockouts and limited diagnostic capacity in rural areas. The epidemic is particularly severe in provinces like Matabeleland South and Mashonaland Central, where outmigration and transactional sex fuel new infections. The government’s commitment to a “Treat All” policy has helped improve access to ART, but stigma and misinformation remain widespread, especially among youth and older adults.

5. Mozambique

With a prevalence rate of 11.8% and approximately 2.4 million people living with HIV, Mozambique ranks among the most affected countries in the world. The epidemic is especially concentrated in the central and southern regions, including Maputo, Gaza, and Zambézia. Mozambique’s challenges stem from a combination of factors: poor literacy rates, high levels of gender inequality, and one of the lowest healthcare worker-to-patient ratios on the continent. Although international partners like PEPFAR and the Global Fund have provided significant support for treatment rollout, ongoing conflict in northern provinces and cyclone-driven displacement continue to disrupt service delivery. The government’s focus on youth-centered prevention and testing campaigns is crucial, but scale and sustainability remain key concerns.

4. South Africa

With an adult HIV prevalence rate of 16.6% and around 7.7 million people living with the virus in 2025, South Africa continues to face the continent’s largest HIV burden by numbers. Although the country has made significant strides in expanding access to antiretroviral therapy, provinces like KwaZulu-Natal and Mpumalanga still record exceptionally high infection rates, particularly among women and young people.

South Africa’s HIV response is often described as the most ambitious in Africa. It runs the world’s largest publicly funded ART program and is one of the first African nations to adopt injectable PrEP and self-testing kits nationwide. Despite these achievements, long-standing issues such as unequal access to healthcare, stigma, and the rise of drug-resistant strains remain serious obstacles. South Africa’s epidemic may be stabilizing, but its size and complexity mean that it remains a critical focus in the continent’s broader fight against HIV/AIDS.

3. Botswana

With an adult prevalence rate of 19.7% and about 360,000 people living with HIV in 2025, Botswana remains among the top three most affected countries in Africa. However, it also stands out for its remarkable response. The government’s early adoption of free antiretroviral therapy and consistent public awareness campaigns have helped reduce AIDS-related deaths. Still, challenges persist in rural areas, where testing uptake and treatment adherence lag behind urban centers. Youth and adolescent girls remain particularly vulnerable, and health experts warn of rising complacency among younger generations despite the country’s early success.

2. Lesotho

Lesotho’s HIV epidemic remains dire, with 20.5% of adults living with the virus and an estimated 270,000 people infected. The country’s small size and mountainous terrain complicate healthcare access, especially in rural communities where HIV services are limited. Migration to and from South Africa also plays a role in sustained transmission, particularly among miners and laborers. While Lesotho has improved ART access and maternal HIV prevention, the national health system still suffers from a shortage of trained workers and inconsistent drug supply chains. These issues continue to hinder long-term viral suppression and treatment continuity.

1. Eswatini

Eswatini holds the highest adult HIV prevalence in Africa in 2025 at 27.5%, with approximately 230,000 people living with the virus. Though small in population, the burden of HIV has defined much of its health agenda over the past two decades. To its credit, Eswatini has made major strides in reducing mother-to-child transmission and increasing access to treatment—over 90% of diagnosed individuals are on ART. Yet, social stigma, gender inequality, and gaps in male testing remain serious barriers. Despite being a leader in policy reform and donor-supported programs, the country’s health infrastructure is still fragile, especially outside urban hubs like Mbabane and Manzini.