Many European countries are lagging behind in efforts to detect life-threatening infections such as HIV and hepatitis B and C, leaving thousands at risk of late diagnosis and preventable deaths, a new analysis by the European Centre for Disease Prevention and Control (ECDC) has found.
The report reviewed testing policies in the 27 EU member states plus Iceland, Liechtenstein and Norway, comparing them against ECDC’s 2018 guidance designed to get people diagnosed earlier, treated faster and reduce onward transmission.
Instead, the agency found that in many countries, testing strategies are “out of date” and not aligned with ECDC recommendations, particularly for groups most at risk. More than half of the countries examined have not updated their HIV or hepatitis testing recommendations since 2018.
Across the region, over 650,000 people are living with diagnosed HIV, including nearly 25,000 new diagnoses in 2023, while an estimated 5.4 million people have chronic hepatitis B or C.
In 26 countries with sufficient data, around 92% of people with HIV are thought to have been diagnosed – close to the global target of 95%. But the ECDC warns that more than half are diagnosed late, often after living with the virus for three to five years without knowing it.
These late diagnoses mean patients are at significantly higher risk of serious illness and death, respond worse to treatment, and are more likely to unknowingly transmit HIV to others.
A similar pattern exists for hepatitis B and C: many people only learn they are infected once they develop severe complications such as cirrhosis, liver failure or liver cancer.
Global health goals say 95% of people with HIV and 60% of those with chronic hepatitis B and C should know their status. The ECDC says the HIV target may be achievable in the coming years, but reaching the hepatitis target will be “more challenging,” especially given limited national planning and patchy access to testing.
The report highlights stark gaps in affordability and policy:
- HIV testing is free in only 24 countries
- Hepatitis testing is free in just 17 countries
- Only 22 countries report having a national hepatitis response plan
HIV and hepatitis B are primarily spread through body fluids – including during sex or through shared needles – while hepatitis C is a blood-borne virus often transmitted in unsafe medical settings or via injecting drug use.
The ECDC is urging countries to expand free, accessible testing, especially for higher-risk groups including men who have sex with men, people who inject drugs, transgender people and those in prison.
It is the latest warning that Europe is off track to meet its 2030 goals on HIV, viral hepatitis, other sexually transmitted infections and tuberculosis without major new investment in public health services and targeted testing programmes.
