PHWR Public Health Weekly Report

Human immunodeficiency virus (HIV) infection remains a major global public health concern. In 2023, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported approximately 1.3 million new HIV infections, 630,000 acquired immune deficiency syndrome (AIDS)-related deaths, and an estimated 39.9 million people living with HIV (PLHIV) worldwide. Regionally, new HIV infections in 2023 were reported as follows: 300,000 in Asia and the Pacific; 450,000 in Eastern and Southern Africa; 190,000 in Western and Central Africa; 140,000 in Eastern Europe and Central Asia; 120,000 in Latin America; 56,000 in Western and Central Europe and North America; and 15,000 in the Caribbean. Compared to that reported in 2010, the number of new HIV infections in 2023 decreased in most regions; however, the incidence of infections increased by 116% in the Middle East and North Africa, 20% in Eastern Europe and Central Asia, and 9% in Latin America [1].

Population mobility stemming from globalization and international migration accelerates the spread of infectious diseases and exacerbates outbreaks, regardless of geographical boundaries [2,3]. In the context of frequent international exchanges and cross-border movements, discriminatory practices against foreign nationals—such as restrictions on entry, travel, immigration, or asylum due to HIV infection—violate the right to equal protection under the law, as outlined in the UN Commission on Human Rights’ “International Guidelines on HIV/AIDS and Human Rights” (1998) [4]. The management of HIV-infected foreign nationals has become a critical policy challenge in global HIV prevention and control. In their 2004 “Statement on HIV/AIDS-related Travel Restrictions,” UNAIDS and the International Organization for Migration (IOM) stated that mandatory HIV testing for entrants, with entry and residency restrictions for individuals living with or suspected of having HIV, promotes stigma and discrimination. They recommended that effective HIV/AIDS prevention and control policies ensure that no individual—regardless of nationality—is subjected to discrimination or disadvantage due to HIV infection status [5]. Although some countries still require HIV testing as a visa condition or impose travel restrictions on HIV-positive travelers [6], the Republic of Korea (ROK) has accepted the recommendations of UNAIDS and other organizations. In January 2010, ROK amended its Immigration Control Act to eliminate all entry and exit restrictions for HIV-infected foreign nationals. Given the advancements in medical technology and the development of effective treatments that enable HIV infection to be managed as a chronic condition, it is preferable to establish appropriate support measures within domestic HIV infection management policies. Such measures would allow foreign nationals with HIV to manage their health and minimize community transmission, rather than relying on coercive approaches that restrict freedom of movement.

Therefore, this report aims to identify the demographic characteristics of foreign nationals diagnosed with HIV in ROK in 2023 and to use these findings as foundational data for developing appropriate management policies for this population.

HIV/AIDS statistics used to characterize infected foreign nationals were obtained from the Integrated Disease and Health Management System, encompassing 256 cases reported in 2023. Among these, 196 individuals underwent epidemiological investigations conducted by public health centers. For these cases, demographic characteristics—including nationality, reporting status by local government, reporting institutions, reasons for testing, and transmission routes—were analyzed. During epidemiological investigations by public health centers, translated versions of the survey questionnaire were provided in eight languages, including English, Chinese, Thai, and Vietnamese.

The overall reporting status was analyzed for all 256 newly reported HIV-infected foreign nationals in 2023. Data on reasons for testing and transmission routes were analyzed for the 196 individuals who participated in epidemiological investigations.

1. General Characteristics of Newly Diagnosed HIV-infected Foreign Nationals in 2023

In 2023, a total of 1,005 new HIV infections were reported in ROK, representing a 5.7% decrease (61 individuals) compared to that reported in the previous year. While the incidence of infections among Korean nationals decreased by 9.2% (76 individuals) to 749 (74.5% of the total), the incidence of infections among foreign nationals increased by 6.2% (15 individuals) to 256 (25.5%) (Table 1) [7]. The proportion of foreign nationals among the total individuals with HIV infections has steadily increased over the past 4 years: 19.5% in 2020, 20.8% in 2021, 22.6% in 2022, and 25.5% in 2023.

Table 1 Foreigners notified HIV/AIDS cases, 2021–2023

HIV/AIDS	2021	2022	2023
Total	975 (100.0)	1,066 (100.0)	1,005 (100.0)
Korean	773 (79.2)	825 (77.4)	749 (74.5)
Foreigner	203 (20.8)	241 (22.6)	256 (25.5)
Gender
Men	156 (76.8)	194 (80.5)	185 (72.3)
Women	47 (23.2)	47 (19.5)	71 (27.7)
Age (yr)
0–9	0 (0.0)	0 (0.0)	0 (0.0)
10–19	1 (0.5)	1 (0.4)	4 (1.6)
20–29	66 (32.5)	79 (32.8)	62 (24.2)
30–39	77 (37.9)	97 (40.2)	104 (40.6)
40–49	42 (20.7)	49 (20.3)	56 (21.9)
50–59	14 (6.9)	8 (3.3)	23 (9.0)
60–69	3 (1.5)	6 (2.5)	7 (2.7)
≥70	0 (0.0)	1 (0.4)	0 (0.0)
Country*
Thailand	40 (21.9)	42 (18.9)	52 (21.4)
Korean-Chinese	26 (14.2)	26 (11.7)	33 (13.6)
Uzbekistan	18 (9.8)	18 (8.1)	23 (9.5)
Vietnam	23 (12.6)	25 (11.3)	16 (6.6)
Russia	12 (6.6)	14 (6.3)	17 (7.0)
Philippines	8 (4.4)	12 (5.4)	11 (4.5)
Cambodia	8 (4.4)	8 (3.6)	12 (4.9)

Unit: person (%). HIV=human immunodeficiency virus; AIDS=acquired immune deficiency syndrome. *Excluding responses with less than 10 people and no response. Data from Korea Disease Control and Prevention Agency [7]..

By age group, the highest proportion of HIV-infected foreign nationals was among individuals in their 30s (40.6%, 104 individuals), followed by those in their 20s (24.2%, 62 individuals), 40s (21.9%, 56 individuals), 50s (9.0%, 23 individuals), 60s (2.7%, 7 individuals), and teens (1.6%, 4 individuals). Compared to that reported in 2022, the proportion of new infections among those aged 40 years and above increased by 7.0 percentage points in 2023.

Among the individuals reported, nationality was confirmed for 243 at the time of case notification. The highest proportion was from Thailand (21.4%, 52 individuals), followed by China (13.6%, 33 individuals), Uzbekistan (9.5%, 23 individuals), Russia (7.0%, 17 individuals), Vietnam (6.6%, 16 individuals), Cambodia (4.9%, 12 individuals), and the Philippines (4.5%, 11 individuals) (Table 1) [7].

Among the 60 HIV-infected individuals whose visa status was confirmed, the most common visa categories were Overseas Korean (F-4) at 21.7%, Miscellaneous (G-1) at 20.0%, and Student (D-2) at 10.0%. The relatively high proportion of Miscellaneous (G-1) visas among HIV-infected individuals is attributed to the inclusion of undocumented foreign nationals in this category (Table 2) [8]. An analysis of visa status trends among HIV-infected foreign nationals residing in ROK from 2013 to 2023 shows a decrease in the proportion of Work and Visit (H-2) visas and an increase in the proportion of Miscellaneous (G-1) visas, a temporary visa category that includes undocumented foreign nationals (Figure 1).

Figure 1. HIV-infected people by sojourn status (2013–2023)
HIV=human immunodeficiency virus.

Table 2 Status of foreign residents and HIV-infected people by sojourn status

	2022 residents (person)	2022 vs. 2023 residents (%)	2023 residents	2023 HIV-infected people
Total	2,245,912	11.7	2,507,584 (100.0)	60 (100.0)
Visa Exempted (B-1)	224,817	–0.4	223,851 (8.9)	0 (0.0)
Tourist‧Transit (B-2)	100,793	36.0	137,116 (5.5)	4 (6.7)
Short-term Visit (C-3)	137,642	28.0	176,235 (7.0)	1 (1.7)
Student (D-2)	134,062	13.5	152,094 (6.1)	6 (10.0)
General Trainee (D-4)	65,204	17.5	76,644 (3.1)	0 (0.0)
Foreign Language Instructor (E-2)	14,251	–1.7	14,005 (0.6)	3 (5.0)
Arts and Performances (E-6)	3,989	18.1	4,711 (0.2)	0 (0.0)
Special Occupation (E-7)	24,083	86.8	44,993 (1.8)	3 (5.0)
Seasonal Work (E-8)	4,767	196.7	14,143 (0.6)	0 (0.0)
Non-professional (E-9)	268,413	15.8	310,825 (12.4)	5 (8.3)
Maritime Crew (E-10)	19,874	8.1	21,476 (0.9)	0 (0.0)
Family Visitor (F-1)	105,293	6.6	112,260 (4.5)	4 (6.7)
Resident (F-2)	44,561	19.7	53,325 (2.1)	0 (0.0)
Dependent Family (F-3)	24,917	22.9	30,613 (1.2)	1 (1.7)
Overseas Korean (F-4)	502,451	6.8	536,374 (21.4)	13 (21.7)
Permanent Resident (F-5)	176,107	5.3	185,441 (7.4)	0 (0.0)
Marriage Migrant (F-6)	136,266	4.2	142,042 (5.7)	2 (3.3)
Miscellaneous (G-1)	36,446	28.9	46,961 (1.9)	12 (20.0)
Work and Visit (H-2)	105,567	–1.5	103,981 (4.1)	4 (6.7)
Others	70,761	–1.1	69,965 (2.8)	2 (3.3)

Unit: person (%). HIV=human immunodeficiency virus. Data from Korea Immigration Service, Ministry of Justice [8]..

2. Reporting Status by Region and Institution

Among the 256 HIV-infected foreign nationals, excluding 3 reported by blood banks whose specific region could not be identified, 253 were categorized by local governments as follows: Gyeonggi Province accounted for the highest proportion (24.9%, 63 individuals), followed by Seoul (24.5%, 62 individuals), Gwangju and Chungcheongnam-do (each 7.1%, 18 individuals), Incheon (6.3%, 16 individuals), and Daegu (5.9%, 15 individuals). Collectively, the Seoul metropolitan area (Seoul, Gyeonggi, and Incheon) comprised 55.7% (141 individuals) of all reported cases.

By reporting institution, hospitals and clinics accounted for 70.3% (180 individuals), public health centers for 24.2% (62 individuals), and other institutions (including non-governmental organizations [NGOs], blood banks, the Military Manpower Administration, and military units) for 5.5% (14 individuals). The proportion of reports from public health centers increased from 12.4% in 2022 to 24.2% in 2023, marking an 11.8 percentage point increase from that reported in the previous year. Conversely, the proportion of reports from medical institutions decreased from 89.4% in 2022 to 70.3% in 2023, a 19.1 percentage point decrease.

3. Reasons for Testing

Among the 193 respondents in epidemiological investigations who provided reasons for testing, voluntary testing—defined as visiting testing facilities such as NGOs, public health centers, or medical institutions on one’s own initiative—was the most common reason, reported by 40.4% (78 individuals). This was followed by testing to determine the cause of an illness (23.3%, 45 individuals), detection during a health check-up (16.1%, 31 individuals), and detection during routine pre-surgical or pre-admission screening (14.0%, 27 individuals). The proportion of voluntary testing has increased annually: from 17.6% (21 individuals) in 2020, to 25.6% (40 individuals) in 2021, 30.8% (57 individuals) in 2022, and 40.4% (78 individuals) in 2023.

4. Transmission Routes

Among foreign nationals, 58.6% (150 individuals) responded to the item regarding transmission route—an increase of 13.0 percentage points from that reported in the previous year (45.6%, 110 individuals). Among the respondents, 94.7% (142 individuals) identified sexual contact as the transmission route, accounting for the vast majority of cases. This included heterosexual contact (60.0%, 90 individuals), homosexual contact (34.7%, 52 individuals), and shared injection drug use (2.7%, 4 individuals). Among men respondents who reported sexual contact as the transmission route (104 individuals), 50.0% (52 individuals) reported homosexual contact. Among women respondents (46 individuals), 89.1% (41 individuals) reported infection through heterosexual contact.

Among infected foreign nationals, the incidence of domestic infections (52.7%, 79 individuals) was 5.4 percentage points higher than the incidence of imported infections (47.3%, 71 individuals). For imported infections, heterosexual contact (70.4%) was 3.8 times more prevalent than homosexual contact (18.3%). In contrast, domestic infections showed comparable proportions of heterosexual contact (50.6%) and homosexual contact (49.4%).

5. Cumulative HIV-infected Foreigners

By the end of 2023, the cumulative number of reported HIV-infected foreign nationals in ROK reached 3,037, comprising 2,226 men (73.3%) and 811 women (26.7%). Excluding individuals who had left the country or were deceased by the end of 2023, 1,739 foreign nationals remained under active management, including 1,292 men (74.3%) and 447 women (25.7%). By age group, individuals in their 30s accounted for the largest proportion at 36.2% (630 individuals), followed by those in their 40s at 30.1% (524 individuals); together, these two age groups represented 66.3% (1,154 individuals) of the total.

Of the total 3,037 foreign nationals, the largest group was from Thailand (17.0%, 515 individuals), followed by China (14.2%, 431 individuals), Uzbekistan (6.8%, 206 individuals), and Vietnam (5.8%, 175 individuals).

In ROK, 1,005 new HIV infections were reported in 2023, of which 256 were among foreign nationals, accounting for 25.5% of all new infections. While the overall number of new infections decreased by 5.7% compared to that reported in 2022, infections among foreign nationals increased by 6.2%, reflecting a steady annual increasing trend of approximately 2–3 percentage points since 2021 (Table 1) [7]. Among foreign nationals, men accounted for 72.3% (185 individuals) and women for 27.7% (71 individuals), indicating a higher proportion of men. However, the proportion of women increased by 8.2 percentage points compared to that in 2022. By age group, individuals in their 30s represented the largest proportion at 40.6% (104 individuals), followed by those in their 20s (24.2%, 62 individuals) and 40s (21.9%, 56 individuals). According to UNAIDS HIV/AIDS statistics, women and girls constitute 53% of PLHIV globally and accounted for 44% of new infections in 2023 (62% in sub-Saharan Africa and 27% in other regions) [1]. In ROK, while women account for approximately 4.1% of HIV infections among Korean nationals, the proportion among foreign nationals is 27.7%, approximately seven times higher. This highlights the need for targeted strategies for managing HIV infection among women foreign nationals. Additionally, active outreach and promotional campaigns aimed at foreign women regarding pre-exposure prophylaxis (PrEP) for HIV prevention are essential.

Among the 196 HIV-infected foreign nationals who participated in epidemiological investigations, 94.7% (142 out of 150 respondents who answered inquiries about transmission routes) reported sexual contact as the route of infection; this comprised heterosexual contact (60.0%, 90 individuals) and homosexual contact (34.7%, 52 individuals). Among foreign nationals infected abroad, infection due to shared injection drug use accounted for 2.7% (4 individuals), nine times higher than the 0.3% (2 individuals) among Korean nationals infected through the same route [9]. Given the increasing trend of domestic infections due to shared injection drug use, collaboration with relevant authorities managing drug use and drug offenders is necessary to expand HIV/AIDS prevention education and public awareness efforts to reduce HIV transmission through shared needles.

Given the increasing trend of infections among foreign nationals, the accuracy of information during reporting and epidemiological investigations should be ensured. However, initial reports by testing institutions for HIV-infected foreign nationals residing in ROK are often made anonymously due to language barriers or unclear contact information. Additionally, communication difficulties during epidemiological investigations at public health centers hinder accurate information collection, thereby limiting statistical accuracy. To address these challenges, it is necessary to improve the effectiveness of epidemiological investigations by developing translated versions of survey questionnaires in commonly used languages, establishing translation and interpretation services, enhancing training for investigators, and creating comprehensive manuals.

The principle of U=U (Undetectable=Untransmittable) emphasizes that individuals with an undetectable viral load cannot transmit the virus to others, highlighting the importance of promptly initiating effective antiretroviral therapy [10]. Accordingly, for HIV infection, prompt testing following suspected exposure and immediate initiation of treatment upon a positive diagnosis are crucial. Registered foreign nationals receive the same support as Korean citizens for HIV testing and medical treatment costs. However, undocumented foreign nationals are excluded from these supports, potentially creating gaps in HIV prevention and management efforts.

According to the “2023 Test Survey on Immigrants’ Living Conditions and Labor Force” by Statistics Korea and the Ministry of Justice (which includes registered foreign nationals and excludes undocumented immigrants), 50.6% of wage-earning foreign nationals in ROK earned a monthly average income between KRW 2 million and KRW 3 million. Regarding economic hardships experienced in the past year (multiple responses allowed), inability to receive medical care due to high hospital expenses was the most frequently reported difficulty, cited by 35.0% of respondents [11]. If HIV-infected individuals receiving medical treatment are not enrolled in national health insurance, they are ineligible for special co-payment reduction programs, resulting in annual out-of-pocket treatment costs of approximately KRW 10 million.

In 2024, the Korea Disease Control and Prevention Agency (KDCA) launched the “Medical Expensive Assistance Program for Unregistered Foreigners Living with HIV” (October 28–December 31). This program aimed to prevent domestic transmission and improve individual health management for undocumented foreign nationals and refugee applicants with HIV infection who were unable to access antiretroviral therapy due to financial constraints. Three medical institutions in Seoul and Gyeonggi-do participated. Public health centers identified and registered eligible individuals, referring them to the participating medical institutions. After treatment, these medical institutions submitted reimbursement requests to the public health centers for HIV/AIDS-related medical expenses (including testing and medication costs), which were then reviewed and paid by the public health centers. To ensure continuous treatment and management, participants were required to cover 10% of their treatment costs. Since January 2025, this program has been expanded nationwide, maintaining the 10% out-of-pocket co-payment for participants. The remaining 90% of the costs (50% funded by the national government and 50% by local governments) is subsidized, with a maximum annual subsidy of KRW 8 million per individual. Additionally, to prevent the spread of HIV through early detection among foreign nationals, the Korea Federation for HIV/AIDS Prevention has been commissioned to continuously provide counseling, HIV testing, and comprehensive sexually transmitted infection screening programs targeting this population.

In March 2024, the KDCA announced the “2nd National Action Plan on HIV/AIDS Prevention and Control (2024–2028),” which aims for a 50% reduction in new infections by 2030 compared to 2023 levels. To achieve this goal, it will be necessary to continually analyze trends among foreign HIV-infected individuals, implement targeted support projects, and evaluate their outcomes to effectively design policies that can reduce the increasing number of infections among foreign nationals.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: KUK. Supervision: JHY. Writing – original draft: KUK. Writing – review & editing: SNK, TYK, JHY.