At a crossroads: confronting setbacks and advancing the 95-95-95 HIV targets in sub-Saharan Africa

Sub-Saharan Africa (SSA) remains at the epicentre of the global HIV epidemic and faces a decisive moment in its journey toward achieving the UNAIDS 95-95-95 targets. This review aims to provide a comprehensive overview of the progress toward these targets in SSA, identifying key challenges, barriers to viral load suppression, and potential strategies to improve treatment adherence and health outcomes. These goals-ensuring that 95% of people living with HIV know their status, 95% of those diagnosed are receiving treatment, and 95% of those receiving treatment achieve VLS-represent a bold vision to end HIV as a public health threat by 2030. However, across the region, progress is threatened by persistent structural barriers, entrenched stigma, health system weaknesses, and recent global funding disruptions, including the 2025 freeze on U.S. foreign aid. This review explores the multifaceted obstacles that continue to hinder the HIV response in SSA, from testing gaps to challenges in care retention and VLS, particularly among vulnerable populations. It further examines the potential consequences of funding cuts for health system resilience and epidemic control. Emphasising the need for equity-driven, locally adapted, and innovative strategies-such as community-based service delivery, digital health tools, long-acting therapies, and integrated care models-this article argues for renewed political commitment, sustainable financing, and stronger local and global partnerships. When setbacks loom large, this piece calls for urgent, coordinated action to protect progress, address persistent inequities, and secure a future where epidemic control is truly within reach.