Altering the Trajectory of HIV in Europe

While global HIV incidence has declined by 39% since 2010, many member states of the World Health Organisation (WHO) are witnessing a rise in new diagnoses, with certain regions in Europe disproportionately affected. Alarmingly, over half of those diagnosed in the WHO European region in 2023 were identified at a late stage, and nearly a third had already progressed to an advanced stage of the disease. For the first time, the number of new HIV infections occurring outside sub-Saharan Africa has surpassed those within the region, signalling a troubling slowdown in progress. These trends underscore the urgent need for targeted interventions, equitable healthcare access, and renewed policy efforts to curb the epidemic’s trajectory across Europe.

In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched a strategic framework to accelerate efforts to end the HIV epidemic by 2030. This initiative was driven by global consensus and established a series of targets designed to achieve this goal. A key component of this strategy is the 95-95-95 target (updated in 2021 from 90-90-90). This approach aims to ensure that 95% of people living with HIV are aware of their status, 95% of those diagnosed receive appropriate treatment, and 95% of those on treatment achieve viral suppression.

This report examines the ongoing HIV epidemic in Europe, highlighting key barriers to progress towards the UNAIDS’ 2030 targets and proposing solutions. We also explore the cost of continuing on the current trajectory, which we label the ‘cost of complacency’. Finally, we provide a case study analysing the impact of a key emergent technology, to alter the current trajectory.

We conducted targeted literature reviews to explore the barriers to progress, solutions, and related costs. To validate and refine our findings, we held two rounds of interviews – first with expert stakeholders, including clinicians and policymakers, and then with patient advocates. Additionally, we convened a roundtable with experts to prioritise key barriers and solutions and held two meetings with healthcare professionals to validate projected trends, cost analyses, and the quantitative impact of proposed solutions.

The cost of complacency

While HIV treatment is cost-effective, care remains expensive across Europe, with each new case adding a substantial lifetime burden to healthcare systems. The median lifetime cost of managing HIV in high income countries is estimated at $377,820. Another study estimated that if 3,000 men who have sex with men had contracted HIV in 2013, their projected lifetime healthcare costs could surpass £1 billion. Failing to provide timely prevention and treatment exacerbates the epidemic by enabling continued transmission. Ensuring individuals achieve an undetectable viral load prevents HIV transmission, ultimately reducing diagnoses and leading to cost savings.

On the current trajectory, the 2030 UNAIDS goals will not be met. Projections indicate that without additional focus and targeted intervention, the number of people living with HIV will continue to rise, leading to increases in healthcare costs and broader societal impact. The total estimated cost of HIV care between 2025 and 2030 is estimated at €56.7bn across France, Germany, Italy, Spain and Ireland. . Countries where new cases are increasing will see a significant ‘cost of complacency’ from a health system and societal perspective. The total estimated cost of new diagnoses between 2025 and 2030 is estimated at €4.4bn across France, Germany, Ireland, Italy, Spain, Poland and the UK.

The failure to meet UNAIDS’ 2030 targets will significantly increase economic and health burdens across Europe. Beyond the financial impact, addressing these challenges through early diagnosis and comprehensive care is a critical medical necessity and public health priority.

Key barriers to progress

Significant barriers continue to hinder efforts to eliminate HIV transmission in Europe. This report highlights key barriers, which exist at multiple levels:

• Individual barriers: Low awareness of risk and prevention methods, mistrust in healthcare systems, and adherence challenges for treatments.
• Societal barriers: Stigma surrounding HIV remains a major challenge, discouraging testing and treatment uptake. Regional inequalities also affect access to care.
• Healthcare barriers: Limited access to testing and treatment in underserved groups, availability of medication, and healthcare provider biases contribute to gaps in testing and care.
• Policy and research barriers: Inconsistent surveillance, lack of government commitment and funding, and insufficient research hinder the development of effective interventions.

Solutions for addressing HIV in Europe

The potential solutions to the barriers outlined in this report are diverse, and a range of approaches will be needed to get Europe back on track. However, the following five actions are vital:

1. Expanding access to services: It is essential that people have easy access to HIV testing, prevention, and treatment. Increasing the availability of home testing kits and outreach programs for underserved populations, as well as offering pre-exposure prophylaxis (PrEP) in safe, stigma-free, non-medical settings (such as those led by community organisations), will improve accessibility and help to prevent HIV infections. Improved access to all elements of healthcare for people living with HIV is required, beyond initial diagnosis and medical treatment.
2. Engaging communities: Partnering with community organisations to develop and deliver tailored and targeted education and support programs for underserved groups, will be essential for ensuring they receive the resources and services they need, preventing them from being overlooked. These organisations are often better positioned to engage diverse communities which can be out of reach of healthcare systems and services.
3. Combating stigma: Stigma around HIV still exists and continues to have a far-reaching impact on people living with HIV, as well as on the rate of new diagnoses. On an individual level, stigma can prevent someone from testing and accessing care and discourage adherence to medication due to fear of disclosure. Systemically, it can influence the quality of care received by people living with HIV due to biases among healthcare professionals, and socially, it can lead to isolation, as individuals may withdraw from their communities out of fear of rejection. Public awareness campaigns to combat stigma that are co-created with affected communities, use people-first language, and are targeted at both general populations and healthcare professionals, have the potential to educate and reduce prejudice and stigma.
4. Diversifying treatment options: PrEP and antiretroviral therapy (ART) are highly effective in preventing new infections. However, adherence to daily pills can be challenging for some people, for a wide range of reasons, leading to reduced protection and risk of antiretroviral resistance. Future ART formulations with long-acting modalities may offer important options that may better align with people’s preferences and ultimately improve HIV prevention, adherence, and equity of access, contributing towards the 95-95-95 targets.
5. Strengthening data collection: Prioritising robust data collection across Europe is essential for accurately assessing the true burden of HIV. Incomplete or inconsistent data – whether due to gaps in evidence or irregular surveillance – hampers effective policymaking and limits the ability to design targeted, impactful interventions. Special effort must be made to address data gaps for vulnerable groups that are less visible to the healthcare system (e.g. migrants).

A strong and sustained commitment is key to addressing the HIV epidemic in Europe. This is supported by several calls to action from various stakeholders who have voiced the need for a new EU Action Plan for HIV. The consensus was reinforced by a group of 30 stakeholders convened in the European Parliament who urged the European Commission to address pressing issues related to the HIV threat in Europe. Additionally, members of the WHO European Region endorsed Regional action plans to end AIDS and other transmissible diseases, while G7 leaders reaffirmed their commitment to ending HIV by 2030.

Moreover, significant geopolitical and financial changes are impacting the global HIV response and consequently pose additional considerations for achieving the goal of ending HIV in Europe. In the last six months there have been significant cuts in global HIV financing from key donors. A study recently published in The Lancet HIV has warned that the significant reductions in global HIV funding could result in over 10 million new HIV acquisitions and nearly three million deaths by 2030, threatening decades of progress in the fight against HIV. Traditional donors are reducing health commitments without proper transition planning, creating leadership vacuums, putting pressure on the EU and Member States to demonstrate responsible and accountable leadership.

On the current trajectory, the 2030 UNAIDS goals will not be met. However, with decisive action, increased political will, and meaningful investment in prevention, treatment, and data-driven strategies, it is still possible to alter the trajectory and get Europe back on track to achieving the goal of ending the HIV epidemic.

The contract research report, Altering the Trajectory of HIV in Europe, was commissioned and funded by ViiV Healthcare.