PHWR Public Health Weekly Report

Since the first domestic case of human immunodeficiency virus (HIV) infection was reported in the Republic of Korea (ROK) in 1985, more than 1,000 new infections have been recorded annually. With remarkable advancements in antiretroviral therapy (ART) and improved access to treatment, HIV has become a manageable chronic disease, as a single daily pill can effectively suppress viral replication and restore immune function. Previously, ART was initiated in adults with severe or progressive HIV disease or in those with a CD4+ T cell count of 350 cells/μl or less. However, in 2015, the World Health Organization recommended initiating ART immediately upon diagnosis, regardless of CD4+ T cell count. This guideline review has been associated with reductions in mortality, severe HIV-related morbidity, and disease progression, as well as improvements in treatment adherence, linkage to initial care, immune recovery, and reductions in HIV transmission [1].

In 2023, an estimated 1.3 million new HIV infections occurred worldwide, and 630,000 individuals died from acquired immune deficiency syndrome (AIDS)-related causes—representing approximately a 50% reduction in AIDS-related deaths compared with 2010 [2]. Since 2004, the global AIDS-related mortality rate has decreased by approximately 69%, and the rate of new infections has declined by approximately 39%. More than 30.7 million people are currently receiving ART, and approximately 77% of individuals with HIV are on treatment.

By comparing global HIV/AIDS trends with the domestic situation—including new HIV infections, treatment status, and causes of HIV/AIDS-related mortality—this study aims to generate evidence to inform national policy development.

1. Status of HIV Infections and HIV/AIDS Medical Treatment

The reporting status of HIV/AIDS for 2023 was analyzed using data from confirmatory testing institutions, including the Korea Disease Control and Prevention Agency (KDCA) and the Health and Environment Research Institute. Positive HIV test results were reported through the Disease and Health Integrated Management System, in accordance with the reporting requirements outlined in the 「Prevention of Acquired Immunodeficiency Syndrome Act」. The analysis included sex, age, route of infection, and testing motivation.

The current status of HIV/AIDS treatment was examined using data from the National Health Insurance Service and the Health Insurance Review & Assessment Service, which jointly publish the Health Insurance Statistical Annual Report and the Medical Aid Statistical Yearbook. The Health Insurance Statistical Annual Report provides a wide range of statistical information—including health insurance coverage population, financial status, benefit expenditure, review performance, and disease statistics—derived from healthcare data collected through the national health insurance system. The Medical Aid Statistical Yearbook includes information on medical aid recipients and institutions, benefit performance, review performance, and disease statistics. Using the Health Insurance Statistical Annual Report (based on patient visit dates) and the Medical Aid Statistical Yearbook (based on medical institution claim dates), the status of treatment for HIV disease (International Classification of Diseases 10th Revision [ICD-10] codes B20–B24) was analyzed to assess the current status of HIV/AIDS medical care [3,4].

2. Current Status of Medical Services Utilization¹⁾

The Ministry of Health and Welfare publishes data on the utilization of medical services through the National Statistical Portal. These data include indicators such as the number of outpatient visits per capita—calculated by dividing the total annual number of outpatient visits by the total population—and the average length of hospital stay, calculated by dividing the total annual bed-days by the number of discharges. In this calculation, stays of less than 1 day, clinic visits, same-day admissions and discharges, and day-hospital services are excluded. The portal also provides information on the average length of stay per patient by diagnostic category [5,6].

3. Mortality Statistics

Ministry of Data and Statistics publishes annual mortality data for Korean nationals based on death reports and certificates submitted by local governments. In October 2024, the 2023 mortality data were released, including analyses of major causes of death and HIV/AIDS-related mortality (ICD-10 codes B20–B24) by year and age group [7].

1. Status of New HIV/AIDS Infections

In 2023, a total of 1,005 new HIV infections were reported, representing a 5.6% (60 individuals) decrease from the previous year. Among Korean nationals, new infections declined by 9.1% (75 individuals) to 749 (74.5%), whereas infections among foreign nationals increased by 6.2% (15 individuals) to 256. The proportion of foreigners in the total population increased from 22.6% in 2022 to 25.5% (Table 1) [8].

Table 1 Demographic characteristics of notified HIV/AIDS cases (2014–2023)

Category	2014	2015	2016	2017	2018	2019	2020	2021	2022	2023
Total	1,191	1,151	1,196	1,190	1,206	1,223	1,013	973	1,065	1,005
Incidence rate per 100,000 peoplea)	2.3	2.3	2.3	2.3	2.4	2.4	2.0	1.9	2.1	2.0
Foreigner	110	133	137	182	218	217	197	203	241	256
Korean	1,081	1,018	1,059	1,008	988	1,006	816	770	824	749
People living with HIV	9,481	10,346	11,246	12,083	12,936	13,819	14,528	15,186	15,868	16,459
Sex
Male	8,761 (92.4)	9,587 (92.7)	10,436 (92.8)	11,235 (93.0)	12,053 (93.2)	12,891 (93.3)	13,580 (93.5)	14,214 (93.6)	14,871 (93.7)	15,441 (93.8)
Female	720 (7.6)	759 (7.3)	810 (7.2)	848 (7.0)	883 (6.8)	928 (6.7)	948 (6.5)	972 (6.4)	997 (6.3)	1,018 (6.2)
Age (yr)
0–9	2 (0.0)	2 (0.0)	2 (0.0)	2 (0.0)	1 (0.0)	1 (0.0)	1 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
10–19	68 (0.7)	64 (0.6)	54 (0.5)	55 (0.5)	43 (0.3)	49 (0.4)	34 (0.2)	29 (0.2)	23 (0.1)	18 (0.1)
20–29	1,482 (15.6)	1,692 (16.4)	1,892 (16.8)	2,025 (16.8)	2,103 (16.3)	2,171 (15.7)	2,135 (14.7)	2,009 (13.2)	1,823 (11.5)	1,638 (10.0)
30–39	2,199 (23.2)	2,281 (22.0)	2,448 (21.8)	2,619 (21.7)	2,858 (22.1)	3,139 (22.7)	3,400 (23.4)	3,770 (24.8)	4,161 (26.2)	4,488 (27.3)
40–49	2,708 (28.6)	2,894 (28.0)	3,028 (26.9)	3,154 (26.1)	3,277 (25.3)	3,379 (24.5)	3,473 (23.9)	3,467 (22.8)	3,552 (22.4)	3,596 (21.8)
50–59	1,935 (20.4)	2,148 (20.8)	2,372 (21.1)	2,563 (21.2)	2,755 (21.3)	2,951 (21.4)	3,108 (21.4)	3,279 (21.6)	3,384 (21.3)	3,526 (21.4)
≥60	1,087 (11.5)	1,265 (12.2)	1,450 (12.9)	1,665 (13.8)	1,899 (14.7)	2,129 (15.4)	2,377 (16.4)	2,632 (17.3)	2,925 (18.4)	3,193 (19.4)

Unit: person (%). HIV/AIDS=human immunodeficiency virus/acquired immune deficiency syndrome. ^a)Mid-year population(Resident registration), Ministry of Data and Statistics. Reused from Korea Disease Control and Prevention Agency (2024) [8]..

Overall, 89.9% (903 individuals) of newly reported infections occurred in males and 10.1% (102 individuals) in females. Among the 749 Korean nationals, 95.9% (718 individuals) were male, compared with 72.3% (185 individuals) among the 256 foreign nationals, indicating a notable difference in the male-to-female distribution. By age, individuals in their 30s accounted for the largest proportion at 35.4% (356 individuals), followed by those in their 20s at 28.7% (288 individuals) and those in their 40s at 15.7% (158 individuals). Collectively, individuals in their 20s and 30s comprised 64.1% of all new infections. Among newly infected Korean nationals who completed the epidemiological survey, 564 of 566 individuals (99.6%) reported sexual contact as the route of transmission. Among male infected individuals (540 individuals) who reported sexual contact as the route of transmission, 56.7% (306 individuals) were infected through homosexual contact.

The number of surviving Korean patients with HIV reached 16,459 in 2023, an increase of 591 from the previous year. Of these, 93.8% (15,441 individuals) were male, and 6.2% (1,018 individuals) were female. By age group, 3,193 individuals (19.4%) were 60 years or older, and 13,266 individuals (80.6%) were under 60 years of age. The proportion of patients aged 60 years or older has increased annually: 16.4% in 2020, 17.3% in 2021, 18.4% in 2022, and 19.4% in 2023.

2. Current Status of HIV/AIDS Treatment

According to statistics published by the National Health Insurance Service, the number of individuals receiving treatment for HIV/AIDS (ICD-10 codes B20–B24)²⁾, including both health insurance subscribers and medical aid beneficiaries, was 8,962 in 2014. This number has steadily increased, reaching 16,963 in 2023. The annual out-of-pocket expense per health insurance subscriber was 993,792 KRW in 2014, decreasing to 888,439 KRW in 2023. Among medical aid beneficiaries, approximately 2,000 individuals receive treatment for HIV each year, and out-of-pocket expenses for HIV-related care are fully exempt. The annual institution-borne expense per medical aid beneficiary³⁾ was 11,739 KRW in 2014, declining to 9,387 KRW in 2023 (Table 2).

Table 2 HIV/AIDS treatment status by medical security

Category		2014	2015	2016	2017	2018	2019	2020	2021	2022	2023
Patients		8,962	9,883	10,905	11,877	13,412	13,070	14,525	15,352	16,188	16,963
Per 100,000 peoplea)		17.7	19.4	21.3	23.2	26.1	25.5	28.3	29.9	31.6	33.2
Cost per person	Total	1,005,531	1,022,905	1,040,260	1,060,249	1,038,837	1,018,581	986,832	950,222	910,524	897,826
	National Health Insurance	993,792	1,011,923	1,029,208	1,049,231	1,030,365	1,002,960	976,311	940,533	901,522	888,439
	Medical Aidb)	11,739	10,982	11,052	11,018	8,472	15,621	10,521	9,689	9,001	9,387

Unit: person, won. HIV/AIDS=human immunodeficiency virus/acquired immune deficiency syndrome. ^a)Mid-year population (resident registration), Ministry of Data and Statistics. ^b)Institutional contribution. Reused from Health Insurance Review and Assessment Service, National Health Insurance Service (2024) [3,4]..

3. Current Status of Medical Services Utilization

In 2023, the average number of outpatient visits per person to doctors in the country was 18.0 per year, the highest among OECD member states. The average length of hospital stay⁴⁾ per patient was 17.5 days, ranking second among OECD countries after Japan (26.3 days) and exceeding twice the OECD average of 8.1 days. Published data by diagnostic category include a broad range of conditions, such as infectious diseases, neoplasms, blood disorders, endocrine disorders, mental and behavioral disorders, neurological conditions, eye and ear diseases, and diseases of the circulatory, respiratory, digestive, skin, musculoskeletal, and genitourinary systems, as well as conditions related to pregnancy and childbirth, injuries, poisoning, external causes, and emerging diseases. Among these categories, statistics for specific infectious and parasitic diseases (A00–B99) indicate that in 2023, the longest average hospital stay occurred in cases of sepsis (A40–A41) at 119.9 days, followed by HIV-related diseases (B20–B24) at 32.6 days—longer than that for pneumonia (J12–J18; 22.6 days) and tuberculosis (A15–A19; 22.1 days) [6].

4. Mortality Statistics

In 2023, a total of 352,511 deaths occurred in ROK, representing a 5.5% decrease (20,428 fewer deaths) compared with the previous year. Cancer, heart disease, and pneumonia accounted for 41.9% of all deaths. Among specific infectious and parasitic diseases (A00–B99), coronavirus disease 2019 (COVID-19) caused 7,442 deaths (14.6 per 100,000 population), falling from the third leading cause of death in 2022 to the 10th in 2023. Tuberculosis (A15–A19) accounted for 1,331 deaths (2.6 per 100,000 population), ranking 15th, while HIV/AIDS (B20–B24) caused 45 deaths (0.1 per 100,000 population), remaining comparatively low.

Deaths caused by HIV/AIDS peaked at 124 in 2011 and have continued to decline each year since. In the 1990s, most deaths occurred among individuals in their 30s. From 2005 to 2012, the highest number of deaths occurred among those in their 40s, whereas since 2013, individuals in their 50s have accounted for the largest proportion of HIV/AIDS-related deaths. In comparison, COVID-19–related mortality was most prevalent among individuals aged 60 years or older, while tuberculosis-related deaths were highest among those aged 80 years or older (Table 3).

Table 3 Death statistics by infectious disease

Category	2014	2015	2016	2017	2018	2019	2020	2021	2022	2023
HIV
Total	121	104	88	91	85	76	54	64	54	45
Incidence rate per 100,000 peoplea)	0.2	0.2	0.2	0.2	0.2	0.1	0.1	0.1	0.1	0.1
Sex
Male	106 (87.6)	100 (96.2)	82 (93.2)	83 (91.2)	79 (92.9)	70 (92.1)	51 (94.4)	61 (95.3)	48 (88.9)	41 (91.1)
Female	15 (12.4)	4 (3.8)	6 (6.8)	8 (8.8)	6 (7.1)	6 (7.9)	3 (5.6)	3 (4.7)	6 (11.1)	4 (8.9)
Age (yr)
0–9	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
10–19	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
20–29	4 (3.3)	3 (2.9)	4 (4.5)	1 (1.1)	2 (2.4)	1 (1.3)	1 (1.9)	2 (3.1)	0 (0.0)	2 (4.4)
30–39	12 (9.9)	9 (8.7)	8 (9.1)	6 (6.6)	7 (8.2)	9 (11.8)	4 (7.4)	4 (6.3)	8 (14.8)	9 (20.0)
40–49	29 (24.0)	22 (21.2)	15 (17.0)	24 (26.4)	20 (23.5)	14 (18.4)	9 (16.7)	14 (21.9)	7 (13.0)	6 (13.3)
50–59	35 (28.9)	29 (27.9)	30 (34.1)	30 (33.0)	20 (23.5)	22 (28.9)	19 (35.2)	22 (34.4)	17 (31.5)	10 (22.2)
60–69	26 (21.5)	22 (21.2)	16 (18.2)	13 (14.3)	19 (22.4)	14 (18.4)	10 (18.5)	13 (20.3)	12 (22.2)	10 (22.2)
≥70	15 (12.4)	19 (18.3)	15 (17.0)	17 (18.7)	17 (20.0)	16 (21.1)	11 (20.4)	9 (14.1)	10 (18.5)	8 (17.8)
Pneumonia	12,021	14,718	16,476	19,378	23,280	23,168	22,257	22,812	26,710	29,422
COVID-19b)	-	-	-	-	-	-	950	5,030	31,280	7,442
Tuberculosisc)	2,305	2,209	2,186	1,816	1,800	1,610	1,356	1,430	1,322	1,331
Viral hepatitis	720	667	628	548	584	649	536	493	447	459

Unit: person (%) or person only. HIV=human immunodeficiency virus; COVID-19=coronavirus disease 2019. ^a)Mid-year population (resident registration), Ministry of Data and Statistics. ^b)COVID-19 (U07.1, U07.2, U10). ^c)Respiratory tuberculosis (A15–A16), other tuberculosis (A17–A19). Reused from Ministry of Statics Korea Press release (2024) [7]..

In 2023, a total of 1,005 HIV infections were reported, of which 749 cases (74.5%) occurred among Korean nationals and 256 cases (25.5%) among foreign nationals. Males accounted for 903 cases (89.9%). The proportion of new infections among foreign nationals has shown a steady upward trend, increasing from 20.7% in 2021 to 22.6% in 2022 (Figure 1).

Figure 1. Annual trends in new HIV infections
HIV=human immunodeficiency virus.

The number of surviving Korean individuals living with HIV was 16,459 in 2023 (32.2 per 100,000 population), marking a 3.7% increase (591 individuals) from the previous year. New infections continued to occur most frequently among individuals in their 20s and 30s, and those in their 30s represented the largest proportion of people currently living with HIV. Notably, the proportion of individuals aged 60 years or older has been steadily increasing, rising from 17.3% in 2021 to 18.4% in 2022 and 19.4% in 2023.

In 2023, ROK recorded 18.0 outpatient doctor visits per person, the highest among OECD countries. This rate is approximately 2.8 times higher than the OECD average of 6.5 visits, suggesting that Koreans generally have favorable perceptions of medical services and tend to utilize them frequently [9]. The average length of hospital stay for HIV-related diseases, based on OECD disease classifications, was 33 days, longer than that for pneumonia (28 days) and tuberculosis (22 days). These findings indicate that when individuals with HIV are hospitalized, their hospital stays tend to be prolonged, extending treatment duration and contributing to greater economic burdens. Therefore, continuous ART is essential to prevent complications and disease progression. In mortality statistics, the persistently high number of HIV-related deaths among individuals in their 50s since 2013 is largely attributable to late diagnosis of HIV infection. Many individuals are diagnosed only after significant disease progression to advanced-stage AIDS, thereby missing the optimal treatment window and resulting in increased mortality [10].

Advances in medical technology have improved early diagnostic accuracy, and the development of diverse ART regimens has expanded treatment options, increasing the number of patients eligible for therapy. In ROK, the annual treatment cost per person decreased to approximately 890,000 KRW in 2023. However, as the life expectancy of individuals living with HIV increases, the incidence of age-related chronic conditions is expected to rise. In the United States, although mortality from AIDS and opportunistic infections has declined, the incidence of liver diseases (often associated with viral hepatitis co-infection), hyperlipidemia, diabetes mellitus, cardiovascular disease, and osteopenia has increased. Notably, cardiovascular diseases have become the third leading cause of death or hospitalization among long-term survivors [11]. In ROK, improvements in access to care have been facilitated by expanded health insurance coverage for individuals with infectious diseases (including the application of special 10% copayment rates since 2009), enhanced medical aid benefits (exemption from out-of-pocket expenses for HIV-related medical services), and further reductions in out-of-pocket costs to 10% through health center support (funded jointly by national and local governments). Additionally, post-payment collaboration with medical institutions has increased the accessibility and convenience of medical services.

According to the mortality statistics from Ministry of Data and Statistics, deaths due to HIV/AIDS peaked at 124 in 2011 and have decreased steadily, reaching 45 in 2023. Each year, the age distribution of deceased individuals shifted toward older age groups. Although the highest proportion of new HIV infections continues to occur among individuals in their 20s and 30s, the number of people aged 60 years or older living with HIV has doubled to 2,106 in 2023 compared with 2014. The number of patients receiving treatment increased from 8,962 in 2014 to 16,963 in 2023—an approximately 1.9-fold increase (8,001 additional individuals). Meanwhile, HIV/AIDS-related mortality has shown a consistent annual decline. These trends suggest that as individuals living with HIV maintain viral suppression through adherence to ART, their life expectancy improves, enabling them to live longer.

This study has some limitations. First, the health insurance statistics used are based on data compiled according to eligibility criteria for health insurance subscribers, which include Korean nationals, foreign residents, and Koreans residing abroad. Second, disease statistics are derived from the primary diagnosis recorded in insurance claims, which is assigned based on the patient’s presenting symptoms—even when the final diagnosis has not yet been confirmed. Thus, these diagnoses may not fully correspond to the patient’s definitive clinical diagnosis. Consequently, the results may differ from the surveillance statistics collected and reported by the KDCA.

Furthermore, this study distinguishes between the Health Insurance Statistical Yearbook and the Medical Aid Statistical Yearbook because the two systems have markedly different cost-sharing structures, affecting the interpretation of terms such as total medical care assistance costs (total medical expenditures) and institutional contributions (fund contributions or benefits). Notably, the basis for benefit data also differs: the Health Insurance Statistical Yearbook is organized by the year of service use (actual treatment dates), whereas the Medical Aid Statistical Yearbook is based on the year and month of payment decisions made by the Health Insurance Review & Assessment Service, leading to differences in reporting reference points. In addition, because the OECD revised and updated certain statistics after their initial publication on July 10, 2025, the figures cited in this report may vary depending on the extraction date. OECD statistics are based on data from hospital-level and higher medical institutions, whereas KOSIS includes all healthcare facilities, including clinics, public health centers, and maternity centers, which may result in discrepancies between the two sources.

The aging of individuals with HIV infections is influencing patterns of healthcare utilization and related expenditures, underscoring the need for appropriate preparation. In response, the KDCA has established the “2nd National Action Plan on HIV/AIDS Prevention and Control (2024–2028)” for 2024. By 2028, the plan aims to strengthen prevention strategies to reduce new HIV infections, expand testing for early detection, improve diagnostic systems, support rapid initiation and sustained adherence to treatment, and develop comprehensive support systems to enhance the quality of life and reduce stigma among people living with HIV.

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. Data curation: KUK. Investigation: KUK. Methodology: KUK. Project administration: JHY. Supervision: JHY. Writing – original draft KUK. Writing – review & editing: SSC, JHH, JHY.