Control of HIV Across the WHO European Region: Progress and Remaining Challenges

Despite the ambitious global goal to control HIV transmissions by 2030, more than 30% of people with HIV from the WHO European Region show persistent transmissible levels of the virus. Successful introduction of oral pre-exposure prophylaxis (PrEP) has led to significant decreases in new HIV transmissions in some areas of Europe, particularly among men who have sex with men. However, the limited PrEP access or lack of state funding in many European countries underlines the need to increase efforts to make PrEP consistently and equitably available for all individuals in need. The success of modern antiretroviral therapy (ART) is evident throughout the WHO European region, with more than 90% of treated individuals with viral suppression. Remaining barriers to control HIV include disparities in access to testing facilities such as community-based centers, persistently high levels of late diagnosis, delayed linkage to care especially for undocumented migrant populations, and inequalities in access to treatment. Retention in care and maintenance of viral suppression are additional challenges. The ongoing war in Ukraine is causing service disruption for people with HIV. Combating HIV associated stigma and discrimination, particularly in Eastern Europe and Central Asia, seems paramount in removing barriers to testing; new testing strategies, such as emergency room opt-out testing, could enable earlier diagnosis of HIV in transmission groups that have been difficult to reach. This review summarizes the barriers, opportunities, and pathways towards improvement of the HIV response in the WHO European region.