Europe is facing a hidden HIV crisis. More than half of diagnoses are detected late.
Brussels, November 27, 2025 – Europe is facing a "hidden HIV crisis," warns the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe, after new data shows that more than half of the people diagnosed with HIV in the region are diagnosed too late for optimal treatment. In 2024, 54% of all reported HIV diagnoses in Europe were late, and in the EU/EEA nearly one in two patients learned of their infection only after the disease had reached an advanced stage.
In short:
In Europe, many people find out too late that they have HIV, which complicates treatment and increases the risk of transmission.
Official data shows that more than half of new cases are diagnosed at an advanced stage, especially in the eastern countries of the region.
Experts say that easier and more frequent testing can save lives and help Europe stop the spread of the virus by 2030.
The annual surveillance report shows that in 2024, there were 105,922 HIV diagnoses reported in the WHO European Region, corresponding to a rate of 11.8 cases per 100,000 inhabitants. This is a decrease of nearly 8% compared to 2023, but experts emphasize that this decline hides significant differences between sub-regions and may also reflect reporting delays, not just a real reduction in transmission. In the EU and the European Economic Area, 24,164 diagnoses were reported, corresponding to a rate of 5.3 per 100,000 inhabitants, a decrease of 14.5% compared to 2015.
Behind these figures, however, two alarming signals emerge: the very high proportion of late diagnoses and the increasing number of people living with HIV without knowing it. According to the report, 54% of people diagnosed in the European Region had a CD4 cell count below 350/mm³ at the time of diagnosis, indicating an infection that had been present for several years. In the EU/EEA, nearly 48% of cases were diagnosed at a late stage, and about one-third of patients already had advanced infection, with CD4 below 200/mm³. In 2024, 7,161 AIDS diagnoses were reported in 43 countries of the region, but the authors warn that underreporting and delays in recording deaths may mask the true burden of the disease.
Data compared with global estimates show that, across the European Region, more people are infected with HIV annually than are diagnosed, suggesting an increase in the number of people living with undiagnosed HIV. The situation is particularly problematic in the eastern part of the region, where incidence rates are the highest, and access to testing and treatment remains uneven. In contrast, in the EU/EEA, the number of reported diagnoses is slightly higher than the estimated number of new infections, indicating relatively better performance in detection, but does not eliminate the problem of those who remain outside the system.
Geographical differences remain very pronounced. The diagnosis rate in the eastern European Region was 27.2 cases per 100,000 inhabitants in 2024, about five times higher than in the west and center, where values are around 5-6 cases per 100,000 inhabitants. Additionally, the structure of transmission modes differs significantly. At the level of the entire region, approximately 70% of cases with known transmission mode are attributed to heterosexual contact, while sex between men accounts for about 15%, and injection drug use approximately 14%. In the EU/EEA, the dynamics are reversed: sex between men remains the main mode of transmission, with 48.3% of cases with available information, while heterosexual transmission has increased to about 45.7% of cases, especially among women and migrants.
The report also highlights the role of migrants in the HIV epidemic in Europe. In 2024, nearly 30% of diagnoses in the region were recorded among people born in another country, with even higher proportions in the western part of the continent. In the EU/EEA, 55.7% of people with known origin diagnosed with HIV were migrants; of these, 32.2% came from Sub-Saharan Africa, 26.4% from Central and Eastern Europe, and 24.4% from Latin America and the Caribbean. ECDC and WHO warn that, in many cases, the infection is acquired after arriving in Europe, and language barriers, uncertain legal status, lack of insurance, and fear of stigma limit access to testing and care.
Late diagnosis is particularly common among people infected through heterosexual contact, those who inject drugs, and older adults. In 2024, over 60% of heterosexual men infected were diagnosed with a CD4 cell count below 350/mm³, and similar proportions were recorded among people who inject drugs and those over 50 years old. In comparison, men who have sex with men show the lowest levels of late diagnosis, around 39-41%, reflecting a higher degree of awareness and better access to services in this category.
In the joint statement, ECDC and WHO warn that these gaps risk compromising the goal of ending AIDS as a public health threat by 2030. "In the EU/EEA, nearly half of all diagnoses are made late. We urgently need to innovate testing strategies, expand community testing and self-testing, and ensure a rapid link to care services. We can end AIDS only if people know their status," said ECDC Director Dr. Pamela Rendi-Wagner. WHO Regional Director for Europe Dr. Hans Kluge described the situation as a "silent crisis" of undiagnosed individuals, fueling transmission and amplified by stigma and discrimination.
Despite declining diagnosis rates and progress in expanding antiretroviral treatment, the authors of the report insist that accelerating testing remains the only way to close the "invisible gap" between actual infections and diagnosed cases. Recommendations include integrating testing into primary care, emergency services, and prenatal care, expanding self-testing and community testing, implementing indicator condition-guided testing – such as other sexually transmitted infections or tuberculosis – and removing financial and administrative barriers that discourage access to diagnosis.
The report shows that over 3.2 million people live with HIV in the WHO European Region, and approximately 63% of them are on antiretroviral treatment. In the EU/EEA, it is estimated that one in nine infected individuals does not know their status. To achieve the 95-95-95 targets and stop the epidemic, experts say testing must become a routine practice, and the central message must be clear: early diagnosis is not a privilege, but a condition for a long and healthy life – and the key to interrupting the transmission of the virus.
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