On its current trajectory, Europe’s target for ending HIV as a public health threat by 2030 — a key UN goal — will not be met. Whereas once we talked of this being realized, we now find ourselves discussing the need to adjust our approach and accelerate action if we are to get back on track.
This is not where we want, or can afford, to be. But it is where we are.
While the global incidence of HIV has declined by 39 percent since 2010, parts of Europe are now seeing infections rise.1
A key concern is that over half of those diagnosed in the World Health Organization’s (WHO) European region in 2023 were identified at a late stage. Late diagnoses lead to higher mortality and morbidity, and significantly increase healthcare costs, adding a considerable burden to European governments, reaching billions of euros annually. Mortality risk is estimated to be nine times higher in those diagnosed late, while medical costs in the first year are nearly double those of early diagnosed patients.2,3,4
A broader concern is that a failure to provide timely prevention and treatment exacerbates the epidemic by enabling continued transmission.
Altering the Trajectory of HIV In Europe, a report by the Office for Health Economics (OHE) and commissioned by ViiV Healthcare, clearly demonstrates the significant consequences of a failure to effectively prevent and treat HIV for patients, healthcare professionals and governments.5
European governments must also manage the complex and evolving healthcare needs of an increasingly elderly HIV community.6 Based on observed trends in prevalence across eight European countries, the report suggests there could be ~100,000 new diagnoses by 2030.
The total estimated cost of new diagnoses alone could reach €4.4 billion between 2025 and 2030 across seven European countries. This figure, however, represents only a fraction of the overall financial burden – the total estimated cost of all HIV care in just five European countries for the same period is projected to be €56.7 billion.
Given the substantial financial implications, an urgent reality check is needed. Europe cannot afford to be complacent when it comes to its HIV response. Failure to act decisively now will result in significant long-term financial and societal burdens.
How, then, should we move forward?
Ultimately, what the OHE report delivered was recognition of the urgent need for a coordinated effort, one that addresses the challenges facing the European HIV community while acknowledging the consequences if we fail to do so. This is also reinforced by a powerful consensus statement published last year urging the European Commission to address pressing issues related to HIV’s threat in Europe.
Signed by multiple stakeholders in the HIV community, including ViiV Healthcare, it sets out a series of recommendations for how Europe should move forward. These include:
- Increasing access and adherence to antiretroviral therapies;
- Adopting the latest European AIDS Clinical Society guidelines;
- Advancing research into new and accessible medicines to enhance the HIV response in Europe; and
- Ensuring that underserved populations, including migrants and refugees, have access to healthcare.
In addition, the statement calls for community, health organizations, governments and other stakeholders to play a greater role in policy shaping, and for Europe’s institutions to recognize the crucial role civil society can play in reaching key populations.
Other goals should include:
- Scaling up testing among key populations, particularly hard-to-reach migrant and refugee groups;
- Promoting early diagnosis;
- Strengthening primary prevention by expanding access to condoms, PrEP (pre-exposure prophylaxis), PEP (post-exposure prophylaxis) and ART (antiretroviral treatment); and
- Improving data monitoring and collection by developing closer relationships with partner organizations such as the European Centre for Disease Prevention and Control and WHO Europe.
However, these goals will only have real impact if they are pursued in an environment that supports and incentivizes new patient-centric medicines and solutions, which will be key to driving positive change in HIV treatment and prevention.
For example, while oral pills for HIV prevention treatment are highly effective, we know that some people find it unsuitable and difficult to adhere to, a reticence that affects both health outcomes and overall wellbeing.
Long-acting injectables (LAIs) will ultimately enhance adherence7 rates and help reduce the stigma that some users may face through daily pill intake.8 ViiV Healthcare, as the sole global company entirely dedicated to HIV, has been at the forefront of this scientific advancement, pioneering the world’s first long-acting injectables for both treatment and prevention. Our extensive research and development of LAIs underscore our conviction that they are set to play a vital role in ending the HIV epidemic.
To drive impact at scale, these transformative solutions must be delivered, and adequately funded, in partnership with governments and other key stakeholders. Now is not the time for complacency or cutbacks; too much is at stake.
We stand at a critical juncture, and it is imperative we recognize that prioritizing HIV is not merely a public health imperative, but an economic and social necessity demanding a collective effort.
With a new European Parliament in place, politicians committed to Europe meeting the UNAIDS’ target of ending the HIV epidemic as a public health threat by 2030 have the opportunity to advocate for this. This leadership is essential, particularly as global political attention to HIV challenges appears to be diminishing.
While some may argue Europe cannot afford to address these challenges, the reality is that the cost of complacency is far greater. The clock is ticking. But there is still time and, by coming together, we can change the trajectory of this epidemic.
References:
1 The urgency of now: AIDS at a crossroads. Geneva: Joint United Nations Programme on HIV/AIDS (2024). Available at: https://www.unaids.org/sites/default/files/media_asset/2024-unaids-global-aids-update_en.pdf.
2 Boardman E, Boffito M, Chadwick DR, Cheserem E, Kabagambe S, Kasadha B, Elliott C. Tackling late HIV diagnosis: Lessons from the UK in the COVID-19 era. International journal of STD & AIDS. 2024 Mar;35(4):244-53.
3 Guaraldi G, Zona S, Menozzi M, Brothers TD, Carli F, Stentarelli C, Dolci G, Santoro A, Da Silva AR, Rossi E, Falutz J. Late presentation increases risk and costs of non-infectious comorbidities in people with HIV: an Italian cost impact study. AIDS research and therapy. 2017 Feb 16;14(1):8.
4 The Late Presentation Working Groups in EuroSIDA and COHERE. Estimating the burden of HIV late presentation and its attributable morbidity and mortality across Europe 2010–2016. BMC Infect Dis 20, 728 (2020). https://doi.org/10.1186/s12879-020-05261-7
5 Radu P, Hayes H, Tunnicliffe E, Mott D, Hampson G. Altering the Trajectory of HIV in Europe. OHE Contract Research Report, London: Office of Health Economics. Available at: https://www.ohe.org/publications/altering-the-trajectory-of-hiv-in-europe/.
6 Kiplagat J, Tran DN, Barber T, Njuguna B, Vedanthan R, Triant VA, Pastakia SD. How health systems can adapt to a population ageing with HIV and comorbid disease. The Lancet HIV. 2022 Apr 1;9(4):e281-92.
7 Zhang C, Liu Y. Understanding the association between PrEP stigma and PrEP cascade moderated by the intensity of HIV testing. Tropical Medicine and Infectious Disease. 2022 May 16;7(5):74.
8 Brooks RA, Cabral A, Nieto O, Fehrenbacher A, Landrian A. Experiences of pre-exposure prophylaxis stigma, social support, and information dissemination among Black and Latina transgender women who are using pre-exposure prophylaxis. Transgender health. 2019 Aug 1;4(1):188-96.
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