What will it take to end the HIV epidemic in Europe?

According to the European Centre for Disease Prevention and Control (ECDC), EU/European Economic Area (EEA) countries are progressing towards meeting the 95-95-95 targets, but progress is uneven.¹ Increased efforts are needed to improve prevention, testing, and treatment services to ensure these targets are achieved universally and no one is left behind.

The 2024 EU elections will mark the start of the last full Commission mandate before 2030, presenting the last opportunity to deliver on the commitment to end HIV/AIDS as part of the 2030 agenda for Sustainable Development Goals (SDGs). Today, we are speaking with stakeholders across government, civil society, and industry to discuss the status and ongoing cross-sectoral advocacy needed to ensure the elimination targets become a reality.

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What’s the state of the European Union on HIV/AIDS and why should we talk about this now?

MEP Engerer:

HIV has been a priority in Europe’s health policy agenda for years, aligning with the EU’s commitment towards achieving the 2030 SDGs. The Dublin Declaration² , adopted in 2004, was the first regional commitment to ‘end the epidemic of AIDS’. Subsequently, two successive action plans were implemented to combat HIV/AIDS in the EU and neighboring countries, supported by continuous funding from the EU4Health program for community-based HIV testing projects.  While progress has been made, achieving the 2030 targets requires much more work.

HIV diagnoses have increased in Europe in recent years,³ reflecting a broader trend of increasing sexually-transmitted infections (STIs)⁴ in the general population. Additionally, there is a compounded burden of HIV with other infectious diseases, including viral hepatitis and tuberculosis. HIV remains a pressing issue and the next EU mandate must recognize the urgency in addressing this epidemic.

With elections approaching, we will soon have a Parliament filled with new officials responsible for shaping policies and funding to potentially end the HIV epidemic. Therefore, it’s essential to listen to all stakeholders involved to ensure this vital conversation happens before it’s too late.

What should be the focus of the new EU mandate?

Bertrand Audoin, IAPAC:

Europe needs a plan and dedicated funding to implement it. If then we start looking at the gaps to fill, there is work to be done on several fronts.

We need to incentivize screening — especially opportunistic screening — early diagnosis and integrated programs for HIV, TB, STIs and hepatitis. Innovative methods such as social network-based testing and self-testing should be explored to encourage testing and eliminate stigma barriers.

We need to incentivize screening — especially opportunistic screening — early diagnosis and integrated programs for HIV, TB, STIs and hepatitis.

Strengthening primary prevention strategies is crucial, including improving access to condoms, PrEP and PEP as part of combination prevention programs, with a focus on key populations at higher risk of HIV infection, including sex workers, migrants and prisoners.

On treatment, the new EU mandate should focus on investing in long-term holistic and person-centered approaches that improve the management of HIV, co-infections and comorbidities, thereby improving the health-related quality of life of people with HIV.

Jean Bernard Simeon, ViiV Healthcare:

Addressing the unmet needs of marginalized groups, including intersecting forms of stigma, self-stigma and discrimination, is crucial to ending the epidemic. We must continue investing in innovative options across testing, prevention, and treatment to improve the quality of life for those affected by or living with HIV.

We must continue investing in innovative options across testing, prevention, and treatment to improve the quality of life for those affected by or living with HIV.

We need to recognize the added value of new products and formulations able to overcome stigma barriers – including self-stigma due to discreet methods – and improve adherence and retention in care. The broader the array of choices available, the higher the chances of reaching the ones who need it most and to deliver health equity across Europe.  

What is the general consensus on next steps to get us to 2030 targets and beyond?

MEP Engerer:

This was the focus of a roundtable that I hosted in the Parliament earlier this year. Over 30 stakeholders representing international organizations, national governments, civil society and industry discussed priority actions to ensure Europe stays on track to end HIV/AIDS as a public health threat by 2030.

Bertrand and Jean Bernard have already listed many of these actions, which are compiled in an upcoming multistakeholder consensus statement open for endorsement. At political level, it is crucial to increase the EU’s commitment and leadership in the fight against HIV/AIDS by providing guidance to member countries and supporting UNAIDS, the Global Fund and the WHO Regional Office for Europe globally.

At political level, it is crucial to increase the EU’s commitment and leadership in the fight against HIV/AIDS by providing guidance to member countries and supporting UNAIDS, the Global Fund and the WHO Regional Office for Europe globally.

In addition to national efforts, EU institutions can play a unique role in implementing an overarching framework able to steer regional action towards achieving 2030 targets.

Bertrand Audoin, IAPAC:

Another consensus point emphasizes strengthening community leadership by ensuring active involvement of civil society in policy formulation and decision-making. The EU should have a more active role in ensuring consistent implementation of GIPA⁵ and MIPA⁶ principles.

This is not to say that we don’t have a leadership role already. The roundtable mentioned by MEP Engerer followed a letter sent by IAPAC and other civil society organizations to Commissioner Kyriakides advocating for a new EU HIV action plan. We tend to be the ones pushing for more, but to be effective, we need a permanent and meaningful seat at the table, which the next EU mandate should ensure.

We tend to be the ones pushing for more, but to be effective, we need a permanent and meaningful seat at the table, which the next EU mandate should ensure.

Jean Bernard Simeon, ViiV Healthcare:

We are at a critical juncture in the journey to end the HIV epidemic in Europe, and it is very encouraging to see the political momentum of HIV over the past few months — including during the Spanish Presidency of the Council of the EU — and the upcoming multistakeholder consensus statement, which calls for strategic thinking and collective action in filling the gaps in the EU’s HIV response.

This includes current and future gaps, ensuring that long after the end of the epidemic, people living with HIV have broad access to innovative effective tools that reduce disparities, improve health outcomes and guarantee quality of life for people living with HIV. At ViiV Healthcare, we will continue to urge EU institutions for systems able to harness the value of innovation and incentivize research and development that offers added clinical and social benefits beyond viral suppression.

The EU’s new mandate must recommit to the fight to end new HIV acquisitions and ensure Europe achieves the U.N. global HIV targets by 2030. We need a plan that integrates and funds strategies for a future where the burden of HIV/AIDS ceases to exist for everyone.

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[1] The 95-95-95 targets are: 95 percent of people living with HIV knowing their HIV status; 95 percent of people living with HIV who know their status on treatment; 95 percent of people living with HIV on treatment with suppressed viral loads. According to the latest data from the ECDC, the European Union (EU)/European Economic Area (EEA) countries are at 91 percent of people living with HIV knowing their status, 93 percent of those on treatment, and 92 percent of those on treatment being virally suppressed.

[2] Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia – https://www.osce.org/files/f/documents/b/a/29873.pdf

[3] According to the WHO and EDCD HIV/AIDS surveillance in Europe 2023 (2022 data) report, in 2022 a rise in HIV diagnoses occurred across the larger European region, and in particular in 26 countries of the EU/EEA region^[2], largely as a result of the increasing population movement from Eastern to Western Europe. https://www.ecdc.europa.eu/en/publications-data/hivaids-surveillance-europe-2023-2022-data

[4] Sexually Transmitted Infectious

[5] MIPA – Meaningful Involvement of People Living with HIV. For some, MIPA—the meaningful involvement of people living with HIV—is a preferred term to GIPA because it the fact that people living with HIV are active and equal agents of change, not passive recipients of services.

[6] GIPA -Greater Involvement of People Living with HIV. The GIPA Principle is a principle that aims to realize the rights and responsibilities of people living with HIV, including their right to self-determination and participation in decision-making processes that affect their lives. It was formalized at the 1994 Paris AIDS Summit and endorsed by 189 UN countries in 2001. Source: https://data.unaids.org/pub/briefingnote/2007/jc1299_policy_brief_gipa.pdf