HIV in Europe and the UK:
A Different Kind of Progress

UKHSA’s 2026 monitoring report estimates England’s 2024 care continuum at 95–95–98: 95% of adults with HIV diagnosed, 95% of those diagnosed on treatment, and 98% of those on treatment suppressed. The second figure was revised from earlier reporting because the new model better accounts for people not seen in care. Treatment coverage among people actually seen for care remained 99%. These are surveillance estimates, not exact population counts.^[11]

England’s results offer useful lessons about access to treatment, testing and prevention. Comparisons with U.S. or state-level figures require matching years, populations and definitions; a single headline percentage does not capture every difference between health systems.^[11]

The European epidemic: remarkable variation

Europe is not a single epidemic. It is dozens of distinct epidemics with different transmission patterns, different population burdens, and dramatically different trajectories.

The WHO European Region spans 53 countries, including countries in Central Asia. For 2024, 49 countries reported 105,922 HIV diagnoses, including 24,164 in the EU/EEA. The region’s overall diagnosis rate fell from 2023, while 11 reporting countries recorded increases. A diagnosis may occur years after acquisition, so diagnoses and new infections are different measures.1

The UK story: from crisis to model

The UK’s response has combined treatment, prevention, testing and community support over decades. The latest England estimates show high treatment coverage and suppression while also identifying people who have not been diagnosed or are not in care.2

What changed was systematic. Not one intervention but a combination of policies, investments, and cultural shifts that compounded over time:

• Free HIV services: HIV diagnosis and treatment are exempt from overseas-visitor charges in England under the applicable rules. This does not mean every NHS service is free for every visitor, or that everyone has insurance. Ask the clinic about eligibility for other services.^[12]
• National planning: England’s 2025–2030 HIV Action Plan sets out prevention, testing, care and equity priorities. A published plan is a commitment; it does not establish that funding has always been stable.^[13]
• Routine PrEP services: England introduced routine provision in autumn 2020. In 2024, 111,123 people initiated or continued PrEP through sexual health services, 7.7% more than in 2023.^[3][4]
• Opt-out testing: participating emergency departments offer blood-borne-virus testing to eligible patients already having routine blood tests, unless they decline. It is not a test for every attendee. This programme contributed 8% of England’s new HIV diagnoses in 2024.^[11]
• Community information and support: Terrence Higgins Trust and HIV i-Base provide resources for people with HIV. NAM closed as an independent charity in 2024; aidsmap became part of Terrence Higgins Trust in 2025 and continues providing HIV information.^[14]

NHS PrEP: what free access does

In England, eligible people can obtain PrEP free through NHS sexual health services. Removing the medication charge can help, but clinic access, awareness and follow-up still matter. U.S. access depends on the person’s insurance and available assistance; neither system’s experience should be reduced to one cause.^[3]

Routine PrEP services began in England in autumn 2020. From 2023 to 2024, new HIV diagnoses among gay and bisexual men fell 6% across England and 8% in London. These surveillance trends are consistent with progress in prevention, but they do not by themselves measure how much of the decline was caused by PrEP.34

Among HIV-negative sexual-health-service attendees assessed as having a PrEP need in 2024, initiation or continuation was 79.4% for White gay and bisexual men, 77.8% for ethnic-minority gay and bisexual men, 34.6% for Black African heterosexual women, and 36.4% for Black African heterosexual men. These percentages are not uptake among all people in those communities. They show disparities within the service population.^[4]

London: a specific story

London’s response brings together testing, treatment, PrEP and community programmes. The city is useful to study, but the surveillance data do not establish that it historically had the highest HIV burden or the most intensive interventions of every Western European city.5

New diagnoses among London residents fell from 1,027 in 2023 to 971 in 2024, a 5% decrease. Outside London, the total changed from 1,811 to 1,802. These are diagnosis counts, not direct estimates of infections acquired during each year.^[5]

London’s experience supports studying coordinated local services. Applying lessons elsewhere requires attention to the local population, funding, health system and testing patterns; similar policies do not guarantee identical outcomes.^[13]

The persistent problem of late diagnosis

In England in 2024, 928 of 2,196 newly diagnosed people with a CD4 result within 91 days were classified as diagnosed late (42%). UKHSA defines late diagnosis as CD4 below 350 cells/mm³ within that period, without evidence of recent infection. The denominator is not every new diagnosis; missing CD4 results matter.6

Late diagnosis is associated with greater risk of illness and death, making earlier testing and timely treatment important. It cannot establish how long a particular person has had HIV, whether they transmitted it, or their individual prognosis after treatment.^[6]

Among people with the necessary CD4 data, late diagnosis in 2024 affected 52% of heterosexual men, 46% of heterosexual women and 30% of gay and bisexual men. Separately, 60% of people newly diagnosed in England were born abroad; birthplace does not establish where HIV was acquired. Testing must reach people beyond those already using specialist services.^[6]

Eastern Europe: a different epidemic

UNAIDS estimated treatment coverage at 56% in Eastern Europe and Central Asia in 2025. Its 2025 report describes rising incidence over 2010–2024 and barriers including stigma, punitive policies and gaps in services. These factors are important, but the data do not show that the epidemic is entirely caused by policy.7

Russia’s experience illustrates barriers to harm reduction. A UNAIDS account in March 2022 described the Russian Federation’s rejection of opioid agonist therapy and restrictions affecting community services in occupied areas. This documented policy history should not be turned into a claim that every heterosexual infection originates with a partner who injects drugs, or that all harm-reduction activity is absent.8

War and displacement have threatened continuity of HIV care in Ukraine. UNAIDS’s February 2026 account describes people arriving at a community shelter after days or weeks without treatment, as well as national and community efforts to maintain services. The account documents real interruptions without implying that every clinic or patient lost access.^[15]

What the United States can learn from Europe

The UK experience offers several direct lessons for the US HIV response — particularly relevant for states like Florida that are dealing with ADAP cuts and coverage gaps10:

• Reduce financial barriers: reliable coverage can help people remain in care. Ryan White and ADAP support U.S. patients with gaps in access; changing one funding mechanism alone cannot guarantee England’s outcomes.^[10]
• Offer routine testing with consent: opt-out programmes can reach people who have not sought an HIV test, and need clear pathways into care after a positive result.^[11]
• Pair affordable PrEP with equitable access: England’s uptake increased, but substantial disparities persist. Cost reduction should be accompanied by accessible services and community engagement.^[4]
• Plan and measure progress: sustained services need clear targets, resources and monitoring that identifies who is being missed.^[13]

Persistent disparities: the work that remains

England's headline numbers are impressive. But the UK Health Security Agency data for 2024 documents persistent and in some cases widening disparities that the headline numbers obscure.

New diagnoses among Black African heterosexual men rose 15% from 2023 to 2024, while testing in that group also increased. Among people aged 15–24, the HIV testing rate at sexual health services fell 7%. PrEP uptake figures of roughly 35% for Black African heterosexual attendees refer to people assessed as needing PrEP, not everyone in that population.9

National progress can coexist with serious disparities. England’s updated 95–95–98 estimate is a meaningful achievement, while late diagnoses and gaps in prevention show why accessible, culturally appropriate and community-led services still matter. Both findings should be reported with their definitions and years.^[11]