Under- and late diagnosis of HIV is holding back progress to end AIDS in the European Region

Ahead of World AIDS Day on 1 December, a new report, "HIV/AIDS surveillance in Europe 2024", has been released today by WHO/Europe and the European Centre for Disease Prevention and Control (ECDC). The report shows that since the beginning of the epidemic in the early 1980s, over 2.6 million people have been diagnosed with HIV in the WHO European Region, including more than 650 000 in the European Union and European Economic Area (EU/EEA). Despite significant progress made since then, nearly 1 in 3 people living with HIV in the Region still do not know their HIV status.

Key findings

• Nearly 113 000 HIV diagnoses were reported in 47 out of 53 countries of the WHO European Region in 2023, an increase of 2.4% compared to the previous year.
• 21 of the 47 reporting countries saw an increase in HIV diagnoses in 2023 compared to 2022, and several countries reported their highest number of HIV diagnoses in a single year over the past decade. This increase can partly be explained by countries' increased testing efforts, new testing policies and a rebound in HIV testing and case detection since the COVID-19 pandemic.
• While overall HIV diagnoses in the EU/EEA have shown a general decline in the last 10 years, with 24 731 cases reported across all 30 countries in 2023, a different trend appears when examining newly diagnosed cases (excluding previously known HIV diagnoses). There, the EU/EEA rate of new HIV diagnoses rose by nearly 12% from 2022 to 2023, likely as a result of increased HIV testing and increased diagnoses in migrant populations.
• Across the WHO European Region, including EU/EEA countries, more than half (52% for the total WHO European Region, 53% for the EU/EEA) of HIV diagnoses are made late, leading to higher morbidity and an increased risk of AIDS-related death.

The key findings demonstrate the critical need for prevention, early testing, diagnosis and access to treatment to improve people's health outcomes and reduce transmission, as well as the urgent need to reduce stigma around HIV.

Despite higher numbers diagnosed, many people living with HIV are still not aware of their status

There is a worrying gap between the number of HIV diagnoses and the estimated number of infections across the WHO European Region. Estimates show that overall only 70% of all people living with HIV in the WHO European Region are aware of their status. While 92% of those in the EU/EEA are aware of their status, in eastern Europe and central Asia roughly 60% of all people living with HIV are aware of their status. This discrepancy emphasizes the urgent need for renewed testing strategies across the Region.

Dr Hans Henri P. Kluge, WHO Regional Director for Europe, highlighted the importance of putting people first: "The biggest remaining hurdles in the fight against HIV/AIDS in our region are restrictive and intolerant environments, stigma, discrimination and even criminalization of HIV transmission, as well as inconsistent uptake of evidence-based interventions. We must create safe spaces for people to access health-care services, normalize testing and ensure that policies are compassionate, not punitive. We also need to increase funding for prevention, stopping new HIV infections from happening in the first place and halting transmission".

Equitable access to prevention, testing and treatment for all

The report brings to light the significant impact of HIV on specific populations, particularly those diagnosed at a late stage, and migrants, who accounted for almost half (48%) of all HIV diagnoses in the EU/EEA in 2023.

Pamela Rendi-Wagner, Director of ECDC, emphasized the need to reduce the number of people diagnosed late: "The EU/EEA has made strong progress on improving access to testing and reducing the number of people unknowingly living with HIV, but we still have more work to do. With more than half of diagnoses still being made late, it is vital that we focus on engaging with key populations and those who are most vulnerable, to make sure they can be diagnosed early and access the prevention, treatment and care they need to live long, fulfilling lives".

Trends for the route of transmission diverge across subregions. The most common route of HIV transmission across the WHO European Region is sexual transmission. In eastern parts of the Region, the majority of transmission is due to heterosexual sex. In the west and centre and the EU, a significant proportion of transmission occurs due to sex between men; however, heterosexual sex is becoming an increasingly predominant route of transmission in the EU/EEA. In some countries, a substantial number of people still acquire HIV through injecting drug use.

The need for tailored interventions for subregions within the WHO European Region is clear, taking into account each subregion's specific epidemiological contexts and transmission patterns. In the eastern and central subregions, where a rebound in HIV testing has been observed, efforts should focus on expansion of innovative testing policies aimed at increasing case detection and comprehensive combination prevention. For the EU/EEA and western subregion, which have experienced a rise in HIV diagnoses among migrants, it is paramount to expand access to primary prevention, including pre-exposure prophylaxis in populations at high risk of HIV infection. Addressing barriers to HIV care, including those related to residency or migration status, is crucial to ensure equitable access to services.