The path to 2030: Innovations for an HIV-free generation.

The path to 2030: Innovations for an HIV-free generation

The HIV epidemic in Europe is at a critical juncture. According to the latest European Centre for Disease Prevention and Control (ECDC) surveillance report, 37 of the 49 countries in Europe saw an increase in HIV diagnoses since 2021, with some reporting record-high numbers in a single year. Reversing this trend means broadening our prevention efforts, expanding access to antiretroviral therapy, and reinforcing community-based interventions. To truly make an impact, we must redesign our HIV strategy to integrate innovative solutions for prevention and treatment, ensuring it is flexible, inclusive, and tailored to the unique needs of each region and people living with or impacted by HIV.

To truly make an impact, we must redesign our HIV strategy to integrate innovative solutions for prevention and treatment, ensuring it is flexible, inclusive, and tailored to the unique needs of each region and people living with or impacted by HIV.

The consensus statement – a roadmap for action​

As the EU embarks on a new mandate – the last full cycle before the 2030 deadline, it has a unique opportunity to reinvigorate political leadership for an HIV response. This urgency for action has been gathering momentum under calls for a new EU HIV Action Plan. A recent multi-stakeholder consensus statement is the first stepping stone toward building this vision. In it, national governments, the World Health Organization (WHO), UNAIDS, civil society and industry outline a list of persistent unmet needs and gaps in the EU’s HIV response. This could serve as a roadmap for action for the European Commission’s new mandate. As EU institutions set their priorities for the new political cycle, immediate policy action and concrete proposals are needed. These include:

• strengthening primary prevention programs and simplifying access to prevention methods;
• increasing funding at local and regional levels;
• empowering community-based and -led organizations as key drivers of the HIV response; and
• creating an environment that supports innovative solutions, enabling them to reach their full potential in ending the HIV epidemic.

Long-acting therapies – a game changer ​

Experts across the HIV stakeholder community recognize that, to end the HIV epidemic, the new wave of innovations is key, particularly in reaching communities that are disproportionately impacted by HIV. Long-acting medicines are both the present and the future, and they are here, paving the way for an HIV-free generation. These options are no longer a theoretical possibility, being tested in the lab or in clinical trials. They are real, tangible solutions and are already setting a new standard of care for HIV – one that puts health-related quality of life and person-partnered care first.

Long-acting therapies are no longer a theoretical possibility; they are real, tangible solutions that are already setting a new standard of care for HIV – one that puts health-related quality of life first.

While daily oral pills for HIV prevention and antiretroviral treatments are highly effective, some people find it difficult or undesirable to take pills every day, impacting both their health outcomes and overall wellbeing.

Daily oral pills may still be the preferred and the most appropriate choice for some, but by offering extended dosing intervals and simplified regimens, long-acting medicines provide a highly effective alternative in line with people’s preferences and needs. In expanding choice, long-acting therapies will ultimately enhance adherence rates¹ and help reduce the stigma that some users may face through daily pill intake².

Surveys already show a high preference for long-acting pre-exposure prophylaxis (PrEP) options among key populations. Findings from a study running across 21 European countries – the PROTECT study – revealed that over 80%³ of respondents, in particular men who have sex with men (MSM) and transgender women, showed high interest and intention to use long-acting PrEP. At the same time, long-acting injectables are a promising option to expand choice and access to and uptake of PrEP among groups that still face significant unmet prevention needs and have experienced rising infection rates in the past years, such as cisgender heterosexuals⁴.

Policy and community engagement – key to success

To fully realize the potential of innovations in the HIV space, strategic actions are needed at the European level to address the policy and regulatory barriers precluding widespread access to long-acting medicines. These therapies must be integrated into national health plans and the necessary funding and resources must be allocated for the deployment of these tools alongside oral daily regimens and across national healthcare systems. This includes considerations for the prescription, reimbursement, dispensation and administration of these long-acting prevention and treatment therapies – both in terms of infrastructure and of training and education healthcare providers.

Investing in a healthcare workforce that is aware of the value of these technologies and can communicate this to users should become a priority. Their inclusion in clinical guidelines and the decentralization of care towards primary and community-led care can be the true gamechanger for the HIV response in Europe.

The EU mandate we need to end HIV in Europe

The path to ending HIV in Europe requires a comprehensive and coordinated approach that leverages the full potential of innovation in prevention and treatment.

The path to ending HIV in Europe requires a comprehensive and coordinated approach that leverages the full potential of innovation in prevention and treatment.

Access to regular testing, ongoing sexual health education, access to condoms, PrEP, post-exposure prophylaxis and antiretroviral therapy as part of combination prevention programs, along with better pathways to long-acting options, must be essential components of any forthcoming EU HIV Action Plan.

Ensuring these methods reach those in need requires increased funding and resources from governments and continued collaboration and partnership across the community. Patient-led organisations like the European AIDS Treatment Group and multi-stakeholder initiatives such as HIV Outcomes and Nobody Left Outside work to improve health outcomes and ensure equitable access to HIV care for marginalized populations, highlighting the importance of this approach and offering valuable insights for future EU-level initiatives.

By co-creating concrete policy recommendations and taking strategic actions at the European level, we can chart a path toward a future free of HIV. The time to act is now, and together we can change the lives of those living with HIV while empowering everyone to take steps to prevent it.

References:

1. Zhang C, Liu Y. Understanding the Association between PrEP Stigma and PrEP Cascade Moderated by the Intensity of HIV Testing. Trop Med Infect Dis. 2022 May 16;7(5):74. doi: 10.3390/tropicalmed7050074. PMID: 35622701; PMCID: PMC9147022.
2. 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. Transgend Health. 2019 Aug 30;4(1):188-196. doi: 10.1089/trgh.2019.0014. PMID: 31482134; PMCID: PMC6716188.
3. Intention to use long-acting PrEP among MSM in Europe – results from the PROTECT survey from Spain, Italy, Germany, France and the United Kingdom. K. Jonas , et al. (2024), poster presented at IAS 2024.
4. European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2023 – 2022 data. Stockholm: ECDC; 2023.