Underdiagnosis and late HIV diagnoses are holding back progress to end AIDS in the European Region

Key findings

• In 2023, nearly 113 000 HIV diagnoses were reported in 47 of the 53 countries in the WHO European Region, representing a slight increase of 2.4% compared to the previous year. 
• In total, 21 of the 47 reporting countries saw an increase in HIV diagnoses in 2023 compared to 2022 and several of them reported that they had seen their highest number of HIV diagnoses in a single year at any point during the past decade. This can partly be explained by increased testing efforts, new testing policies and a rebound in HIV testing and case detection since the COVID-19 pandemic.
• Although there has been a general decline in HIV diagnoses in the EU/EEA over the last 10 years, with 24 731 cases reported across all 30 countries in 2023, an examination of newly diagnosed cases (excluding previously known HIV diagnoses) reveals a different trend. The EU/EEA rate for new HIV diagnoses rose by nearly 12% between 2022 and 2023, probably as a result of increased HIV testing and diagnoses in migrant populations.
• Across the WHO European Region, more than half (52% for the total WHO European Region, 53% for EU/EEA) of HIV diagnoses are made late, leading to higher morbidity and an increased risk of AIDS-related death. 

These 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 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 people in the EU/EEA know their status, in Eastern Europe and Central Asia roughly 40% of all those living with HIV are unaware of theirs. This discrepancy emphasises 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 healthcare 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 highlights the significant impact that HIV has on specific populations, particularly those diagnosed late and also migrants, who accounted for almost half (48%) of all HIV diagnoses in the EU/EEA in 2023. 

Dr 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.”

Although trends for the route of transmission vary across sub-regions, the most common route of HIV transmission across Europe is sexual transmission. In eastern parts of the region, the majority of transmission is due to heterosexual sex. In the West, the Centre and across 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.

It is clear there is a need to specifically tailor interventions to different sub-regions within the WHO European Region, taking into account their specific epidemiological context and transmission patterns. In the Eastern and Central regions, where a rebound in HIV testing has been observed, efforts should focus on expanding innovative testing policies to increase case detection, and comprehensive combination prevention. For the EU/EEA and the Western region, which have experienced a rise in HIV diagnoses among migrants, expanding access to primary prevention, including pre-exposure prophylaxis in populations at high risk of HIV (PrEP), is paramount. It is also crucial to address barriers to HIV care, including those related to residency or migration status, in order to ensure equitable access to services