HIV in Gaza: From Chronic Under‐Detection to Acute Collapse

In Gaza, the devastation of the healthcare system following years of blockade and recurrent armed conflict has transformed HIV from a chronically under-detected condition into an acute, invisible public-health emergency. Prior to the 2023 escalation of violence, the Palestinian Ministry of Health had officially documented 125 people living with HIV (PLHIV) and AIDS in Palestine, including 50 in Gaza [1]. Even then, this figure reflected long-standing structural barriers to detection—stigma, limited screening and fragile surveillance—rather than relatively low acquisition rates or the successful public health management of HIV/AIDS. Today, following the destruction of medical infrastructure, displacement of healthcare personnel and depletion of essential medicines, the actual number of PLHIV and AIDS in Gaza is unknown. The breakdown of testing, treatment and reporting systems has erased epidemiological visibility and placed those requiring continuous care at immediate risk [2, 3]. Before the 2023 escalation, HIV care in Gaza existed within a constrained but functioning public health framework. Despite chronic underfunding and the effects of an ongoing blockade, HIV diagnosis and treatment were formally integrated into the Palestinian health system. The Ministry of Health, supported by international partners such as World Health Organization (WHO), United Nations Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA), the Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria, the United Nations Population Fund (UNFPA), United Nations International Children's Emergency Fund (UNICEF) and the European Union, provided free HIV testing, antiretroviral therapy (ART) and limited patient support, involving sexually transmitted infection counselling, condom distribution, peer-to-peer education, psychosocial support following an HIV diagnosis, or HIV/AIDS awareness campaigns [4]. Routine HIV screening was implemented for blood donors and select occupational groups. The most recent pre-2023 data, from 2021, indicate that approximately 42,000 Palestinians were tested for HIV, hepatitis B and C, and syphilis through blood-bank channels rather than voluntary or community-based initiatives [1]. However, this pre-2023 conflict system was marked by systematic under-detection. Testing among key and priority populations, antenatal women and the general population remained limited. Stigma, fear of disclosure and moralized perceptions of HIV strongly discouraged voluntary testing. Surveys conducted before 2023 consistently showed low levels of comprehensive HIV knowledge and widespread misconceptions about transmission [5]. As a result, the officially low prevalence of HIV in Gaza reflected a combination of political containment, social stigma and weak surveillance capacity rather than epidemiological certainty. During and after the 2023 escalation, these already fragile arrangements collapsed almost entirely. As of March 2026, ART was available in approximately 2% of all health service institutions in Gaza, with only 12 of the 52 facilities expected to provide this service currently offering it [6]. By April 2026, 94% of hospitals were destroyed and only 1.5% of primary healthcare centres operated at full capacity [7]. Diagnostic laboratories, HIV testing services and patient follow-up mechanisms have been disrupted or destroyed. ART supplies have reached critical or zero stock levels, forcing treatment interruptions for PLHIV [8]. Healthcare workers have been killed, displaced or unable to work safely, while power outages and damage to storage facilities have further undermined medication management [9]. The contrast is stark: a pre-2023 conflict system characterized by limited but continuous care and partial epidemiological visibility has given way to a post-escalation context defined by treatment discontinuity, data absence and total invisibility. Where HIV once existed at the margins of public health, it is now almost entirely submerged beneath the broader humanitarian crisis. The collapse of HIV services has severe consequences for both individual and public health. ART interruption increases the risk of viral rebound, opportunistic infections, drug resistance and mortality among PLHIV. At the population level, treatment gaps undermine prevention efforts by increasing the likelihood of onward transmission. In addition, the absence of routine antenatal testing threatens to reverse progress in preventing vertical transmission of HIV. Pre-exposure prophylaxis has not been systematically implemented in Gaza, while post-exposure prophylaxis, including for healthcare workers and survivors of violence, is likely severely disrupted or unavailable under current conditions, further exacerbating gaps in HIV prevention. These risks are amplified by Gaza's current living conditions. Overcrowding, displacement, poverty, and the breakdown of sanitation and infection-control systems increase vulnerability to a wide range of infectious diseases. Previous assessments documented rising substance use among Palestinian youth, including injecting drug use—an established risk factor for HIV and hepatitis B and C transmission [10]. In the current context, harm reduction services and targeted prevention efforts are entirely absent, further heightening long-term risk. Healthcare workers face extreme physical and psychological strain, operating without sufficient supplies, protection or institutional support. Their exposure to acquisition risks and burnout further erodes Gaza's capacity to respond to HIV as part of an integrated public health strategy. Available evidence indicates that the collapse of Gaza's health system has affected all major health conditions, including infectious diseases, non-communicable diseases, maternal health and trauma, rather than disproportionately impacting HIV alone. However, HIV is uniquely vulnerable in this context, as it depends on uninterrupted lifelong treatment and monitoring, making it particularly sensitive to disruptions in care and at risk of long-term adverse outcomes. HIV-related stigma, already a major barrier before the 2023 escalation, has intensified amid institutional collapse. Pre-conflict surveys documented secrecy, subjective framing of HIV as caused by “a lack of moral and religious commitment,” and, as the 2015 MIFTAH Country Assessment for Palestine indicated, only 7.9% met the UN standard for “comprehensive knowledge” in the area of HIV/AIDS prevention, all of which discouraged testing and care-seeking. In the current context of limited confidentiality and precarious access to services, fear of exposure further deepens HIV's invisibility, reinforcing delayed diagnosis and untreated infections [5, 11]. The situation in Gaza constitutes a complex humanitarian crisis [12]. The right to health—including access to HIV prevention, testing and treatment—remains protected under international human rights law and should be enforced even during armed conflict [13]. Failure to ensure access to ART and essential services for people living with HIV represents a breach of fundamental legal and ethical obligations [14, 15]. Guarantee uninterrupted ART supply through protected humanitarian corridors and emergency stockpiles, delivered to PLHIV through simplified treatment protocols. Integrate HIV services into emergency healthcare, including primary care, maternal health and mobile clinics, alongside decentralized, community-based and outreach testing adapted to fragile settings. Actively address stigma, through community-based communication, engagement with trusted leaders and strict protection of confidentiality. Re-establish minimal HIV data systems to monitor treatment continuity, medicine availability and new diagnoses. Addressing these gaps requires sustained international financing, including support from multilateral agencies, global health financing mechanisms and humanitarian donors, alongside facilitation of unimpeded access for medical supplies and personnel. HIV in Gaza has shifted from a chronically under-recognized condition to a fully obscured emergency. The comparison between pre- and post-escalation realities reveals not a sudden emergence of HIV, but the collapse of the structures that once kept it partially visible. Without urgent, rights-based intervention, the epidemic will continue to grow silently beneath the devastation of war—at profound human and public-health cost. RM and SA contributed equally to the conception, data collection, analysis, interpretation, and manuscript drafting and revision. Both authors approved the final version of the manuscript. The authors have no acknowledgements. Authors declare no conflicts of interest. Rafał Majka is an Assistant Professor at Andrzej Frycz Modrzewski Krakow University, Poland, with research interests spanning medical anthropology, sexual health, gender and queer studies, migration and refugee studies, and HIV/AIDS activism. He holds a PhD in culture studies and postgraduate in gender studies and has conducted research internationally, with experience at institutions in France, Germany, Canada and the United States. Samer Abuzerr is an Assistant Professor of Public Health at the University College of Science and Technology in Khan Younis, Gaza Strip, where he conducts research on environmental health, communicable diseases and quantitative microbial risk assessment. He holds a PhD in environmental health engineering from Tehran University of Medical Sciences and completed a research visiting fellowship at the School of Public Health, University of Montreal, Canada.