EACS 2025: More Europeans are dying from HIV now than 15 years ago

Europe, taken as a whole, is losing some of the gains it has made in tackling the burden of HIV, the 20^thEuropean AIDS Conference (EACS 2025) heard in Paris.

Teymur Noori of the European Centre for Disease Prevention and Control (ECDC) told delegates that Europe would miss out on achieving most of the targets UNAIDS had set for the year 2030.

UNAIDS first proposed the targets in 2014, although they were revised in 2021 to include interim targets for 2025, in recognition of the impact of the COVID pandemic. Since then, however, war in many places including Palestine and Ukraine, deep cuts to global HIV budgets from the US and European countries, and a general rightward shift in world politics have all served to deprioritise HIV as a global health issue. So falling short of those ambitious targets is no great surprise.

Nonetheless, Europe as a whole is the only region of the globe that, according to UNAIDS’ 2023 report, saw more deaths due to HIV in 2022 than it did in 2010: while deaths have halved since 2010 globally, they have risen by a third in the World Health Organization’s European region, which stretches from western Europe to central Asia.

The UNAIDS targets included a 75% reduction in HIV-related deaths by this year relative to 2010 and a 90% reduction by 2030. Instead, deaths due to HIV have risen by 37%, from 37,000 to 51,000 in the European region. This figure is 5.5 times the target aimed at for 2025 (9250 deaths) and 13.8 times the 2030 target.

Many of these deaths are occurring in the two warring countries of Russia and Ukraine, which already had the highest HIV prevalence in Europe before 2010. However, even in the richer countries of western and central Europe, targets are not being met. In the countries of the European Union and the European Economic Area (which adds Iceland, Liechtenstein and Norway to the EU), HIV-related deaths fell from 4300 in 2010 to 2300 in 2025, but this is over twice the 2025 target and over five times the 2030 target.

Concerning HIV transmission, ECDC estimates that new infections in Europe as a whole rose from 149,000 in 2010 to 156,000 in 2025 – a 5% increase instead of the 75% reduction aimed for. And in the EU/EEA, while infections fell by 20%, from 24,000 to 19,000, this is far short of the 75% fall needed to meet the 2025 target.

How did we get here? If everyone with HIV in Europe was on treatment and virally suppressed, then there would be no further growth in its epidemic. But ECDC estimates that about 30% of all people with HIV in Europe live with transmissible levels of HIV – about 620,000 people or more than twice the overall 95-95-95 target for 2030 of 14%. This is a considerable improvement since 2017, when 57% of all people with HIV had an unsuppressed viral load, but it is notable that an acceleration in the number of people who were virally suppressed halted in 2020 when COVID hit, and the rate of improvement has been much slower since then.

This is more due to people not being diagnosed than not being treated: in eastern Europe, it is thought that 50% of people with transmissible levels of HIV are those that remain undiagnosed, but western and central Europe are not far behind, with 43-44% of transmissible HIV due to lack of diagnosis. In these parts of Europe, it is also the case that a surprisingly high one-third of people with transmissible viral loads are on antiretroviral therapy but not virally suppressed.

In terms of the individual 95-95-95 targets – which say that 95% of people with HIV should be diagnosed, 95% of those on treatment, and 95% virally suppressed – Noori said that the only target Europe as a region had reached was the third one, with 95% of people on treatment across the region virally suppressed and 62% of reporting countries having achieved this goal. With the second target, the proportion of diagnosed people on treatment rose from 64% in 2017 to 85% in 2020, but, again, has scarcely changed since COVID. If we look at the proportion of all people with HIV on antiretroviral therapy, the figure of 71% in the European region is considerably lower than the global average of 77%.

There has been more progress on the first 95. In 2016, 75% of people with HIV in the region knew their status; in 2024 it was 86% – still way off 95%, but the proportion continues to rise.

Achieving viral suppression is only one-half of the response needed to bring HIV infections down to target levels. The other is prevention and especially PrEP. The target for the number of people receiving PrEP in Europe is half a million; the number who have received PrEP ‘at least once’ currently stands at 345,000 or about 70% of the target, though this does not mean they are current users.

This figure is misleading, however, as over 70% of people on PrEP are in just four countries – the UK leads the way with over 111,000 people who have started PrEP, followed by France (59,999), Germany (40,000) and Spain (34,000). Last year several countries offered people PrEP for the very first time, including Kyrgyzstan, Cyprus, Montenegro, Azerbaijan and Armenia, but these are small countries with only tens to hundreds of people on PrEP. Among large countries, Ukraine saw the biggest increase with just over half of its 14,000 PrEP initiators starting last year.

While 27% of Ukrainian PrEP users are women, this is in stark contrast to the rest of Europe. On a continent where there may be as many cisgender women at high risk of HIV infection as gay and bisexual men and trans women, only the UK matches Ukraine’s absolute number of women on PrEP as Ukraine (about 3800). However, in the UK, women represent just 3.4% of all PrEP users, and no other European country has more than 400 women taking PrEP. This is a huge contrast to the global situation where it is estimated that, though many countries do not disaggregate their PrEP provision by sex, the majority of PrEP users are women.

Teymur Noori finished his presentation by saying it “was not all doom and gloom” in Europe and that “several countries in all three sub-regions are making great strides in many of the target areas, with western Europe as a sub-region meeting or close to meeting several key targets”.

But he added: “It must be acknowledged that inequity in the provision of novel services pertaining to prevention, integrated testing, and gold-standard treatment is rampant across the European region.”

By Gus Cairns

Reference

Noori T. “Five years left!” What targets are in reach in Europe and which will we struggle to make? 20^thEuropean AIDS Conference, Paris, plenary presentation PL3, 2025.