Underdiagnosis and late HIV diagnoses slow progress against AIDS in Europe

A new report by the WHO Regional Office for Europe and the European Centre for Disease Prevention and Control (ECDC) highlights critical gaps in HIV detection and care across the WHO European Region. Despite decades of progress, nearly one-third of people living with HIV in the region remain unaware of their status, hampering efforts to end AIDS.

Since the start of the epidemic in the early 1980s, more than 2.6 million people have been diagnosed with HIV in the region,

including over 650,000 in the European Union and European Economic Area (EU/EEA). However, a worrying trend of underdiagnosis and late-stage detection persists. In 2023, 52% of HIV diagnoses in the region were made late, increasing the risk of AIDS-related deaths and worsening health outcomes.

WHO Regional Director for Europe Dr Hans Henri P. Kluge stressed the urgency of addressing structural barriers such as stigma, discrimination, and punitive policies. "We must create safe spaces for people to access healthcare, normalize testing, and increase funding for prevention to stop new HIV infections," Kluge said.

The 2024 HIV/AIDS Surveillance Report shows a slight rise in HIV diagnoses, with 113,000 new cases reported in 47 countries in 2023—a 2.4% increase from 2022. This uptick reflects intensified testing efforts and policies in the wake of disruptions caused by the COVID-19 pandemic.

In the EU/EEA, while the overall number of HIV diagnoses has declined over the past decade, new diagnoses increased by 12% in 2023 compared to 2022. This rise is linked to expanded testing and increased diagnoses among migrant populations, who accounted for 48% of new cases in the EU/EEA.

Transmission patterns vary across subregions. In Eastern Europe and Central Asia, heterosexual sex remains the primary mode of transmission. In Western Europe, Central Europe, and the EU/EEA, sex between men continues to be a significant transmission route, although heterosexual transmission is on the rise. Injecting drug use remains a key concern in certain areas.

The report reveals a stark disparity in HIV awareness between different parts of the region. While 92% of people with HIV in the EU/EEA know their status, only 40% in Eastern Europe and Central Asia are aware of theirs. This discrepancy underlines the urgent need for innovative testing strategies, particularly in regions with low awareness.

Dr Pamela Rendi-Wagner, Director of ECDC, called for prioritizing early diagnosis to improve outcomes. "With more than half of diagnoses still made late, we must focus on reaching vulnerable populations to ensure they can access timely testing, prevention, and care to live fulfilling lives," she said.

The report underscores the need for targeted interventions tailored to subregional challenges. For Eastern and Central Europe, the focus must be on expanding testing policies and comprehensive prevention strategies. In the EU/EEA and Western Europe, increasing access to primary prevention measures like pre-exposure prophylaxis (PrEP) is critical, especially for migrants and other high-risk populations.

Structural barriers, including those related to residency and migration status, remain significant obstacles to equitable HIV care. Tackling these barriers is essential to improving access to testing, treatment, and support services.

The findings call for intensified efforts across the region to address the underdiagnosis and late detection of HIV, emphasizing prevention, compassionate policies, and equitable access to care. As the global community marks World AIDS Day, the report highlights the ongoing challenges in the fight against AIDS and the need for renewed commitment to ending the epidemic.

HT