EACS 2025: Europe has the tools — so why are HIV targets off track?

PARIS, October 20, 2025 — Europe has the tools to reverse its HIV epidemic but is falling short of its 2025 targets, public health leaders warned at the European AIDS Clinical Society (EACS) 2025 Annual Meeting last week. Teymur Noori, MSc, who monitors the HIV response at the European Centre for Disease Prevention and Control (ECDC), said progress has stalled due to persistent gaps in prevention, late diagnosis, and uneven access to care — especially in Central and Eastern Europe* — and underscored that stigma in healthcare settings remains a major barrier. “Tackling stigma within healthcare settings and sustaining political and financial commitment will be critical to closing the gaps and reigniting momentum across the region,” he said, adding, “We have all the tools available, except possibly how to address stigma and discrimination.”

In a keynote that doubled as a call to action, Noori pointed to practical steps with immediate payoff: scale up pre-exposure prophylaxis (PrEP), broaden routine and emergency department opt-out testing, and guarantee treatment access — including for undocumented migrants.

He urged a sharper focus on the 95-95-95 care cascade — the goal that 95% of people living with HIV (PLHIV) know their status, 95% of those are on treatment, and 95% of those on treatment are virally suppressed — because progress at each step lifts overall suppression. In the World Health Organization (WHO) European Region (53 countries across Europe and Central Asia), suppression among those on treatment meets the benchmark, but overall suppression across all PLHIV remains below the level implied by 95-95-95.

“The trajectory tells us prevention, testing, and treatment scale-up are still not happening fast enough,” he said.

Regional snapshot and cascade

• 2.1 million PLHIV in the WHO European Region
  • 57% in Eastern Europe (eg, Azerbaijan, Russian Federation)
  • 40% in Western Europe (eg, UK, France)
  • 3% in Central Europe (eg, Hungary)
• Cascade: 86% diagnosed; 86% of those diagnosed on treatment; 95% of those on treatment virally suppressed → only 70% overall suppression vs ~86% implied by 95-95-95
• Undiagnosed share fell from 25% to 14% (~225,000 more people now know their status)

Inequities and Missed Benchmarks

Noori said PrEP remains the region’s most underused high-impact tool. Uptake is concentrated in a handful of countries, with use among women and migrants particularly low. He cited stigma, difficulty reaching certain groups, and patchy national availability as key barriers.

Regionwide, most PLHIV know their status, but the Eastern European region still accounts for the majority of new diagnoses, and more than half of new cases are identified late — a pattern that has barely shifted in a decade and disproportionately affects men. “If you’re diagnosed late, you’ve probably been living with HIV for 3-4 years, and you have an eight-fold higher risk of dying within the first year,” Noori said.

Performance is bifurcated across the region: Western Europe is largely on track, Central Europe is lagging, and outcomes in Eastern Europe are worse. Among those treated, viral suppression is strong, yet overall suppression remains too low.

Noori highlighted England’s emergency department opt-out testing as “one of the most important interventions,” and added that inequities in services are among the most influential reasons targets are being missed. He also noted that many countries do not provide treatment to undocumented migrants, leaving a hard‑to‑reach population without care. In the European Union, a large share of HIV diagnoses is among people born abroad, with many acquiring HIV after arrival to Europe due to limited access and language barriers. Treatment scale-up continues, but Europe still trails the global average among all PLHIV.

The region also remains far from the 2025 incidence goal. New infections are rising overall even as they decline within the EU, and deaths are increasing in the wider European region, driven by gaps in treatment access.

PrEP and diagnosis

• WHO PrEP goal: ≥ 500,000 people taking PrEP by 2025
  • By end of 2024: ~345,000 had accessed PrEP at least once
  • 71% of users are in the UK, France, Germany, and Spain; 2.5% are women; 4% are migrants
• In 2023, 110,000 were newly diagnosed; ~70% in Eastern Europe
• 52% of new cases are diagnosed late; men most affected

Stigma Inside and Outside the Clinic

Noori called stigma “probably the most important, and most difficult, gap to close.” Among PLHIV, disclosure remains low, and many avoid healthcare due to fears of differential treatment. An ECDC survey of healthcare workers found high levels of stigma and poor awareness of PrEP, with reports of confidentiality breaches and some unwilling to treat PLHIV.

“In our region, inequities in services are the major issue and one of the most influential reasons for not meeting targets,” Noori told Medscape Medical News.

Milosz Parczewski, MD, PhD, vice president of the EACS, echoed the urgency: “We are not on track with the UNAIDS targets, especially with regards to the first ‘95’ across Europe, especially in Central and Eastern Europe where the number of new infections and transmissions is increasing.” Over the next 5 years, he said, the region must “double or triple our efforts to diagnose the undiagnosed and prevent the preventable,” including rolling out PrEP and other new and existing technologies across Central and Eastern Europe to reduce transmission and ensure effective treatment.

Regional disparities and outcomes

• PLHIV who know their status:
  • Western Europe: 94%
  • Central Europe: 88%
  • Eastern Europe: 80%
• Treatment coverage:
  • West: 96%
  • Central: 94%,
  • East: 79%
• Treatment scale-up: +540,000 on ART in 2024 vs 2017; yet overall, ART coverage is lower in Europe (71%) than globally (77%)
• Incidence: The 2025 goal is 75% fewer new infections than in 2010. As of 2024, the WHO European Region is instead 5% higher than 2010 (154,000 vs 150,000), whereas the European Union is 20% lower than 2010
• Mortality: declining in the EU, increasing in the wider European region
• Stigma snapshot:
  • Among PLHIV, 1/3 have not told any family members, 1 in 5 have not told any friends, and half avoid healthcare
  • Among healthcare workers, 6 in 10 did not know what PrEP is, 18% witnessed an unauthorized disclosure of HIV status, and 20% saw colleagues unwilling to treat PLHIV

Noori reported no relevant financial relationships. Parczewski reported receiving project funding from the Polish National Science Centre, Polish National Research and Development Centre, and the European Commission, and receiving honoraria or consultation fees from Gilead Sciences, AbbVie, MSD, Janssen-Cilag, Roche, and ViiV/GSK. 

*Editor’s note: Except where the European Union is specifically mentioned, all other references to Europe are to the WHO European Region, which spans 53 countries across Europe and Central Asia, including EU and non-EU states.

By Becky McCall, MSc, MScPh