This was the question posed to us recently by a young person from our Youth4Health network.  Our answer, both simple and sad: the reasons are not medical.

As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions.

Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals.

Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms.

We need to depoliticise the HIV response

Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers.

In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late.

Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus.

To end AIDS once and for all, we have to overcome stubborn hurdles and take action.

First, countries have to depoliticize the HIV response.

Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns.

HIV-related stigma is a problem almost everywhere

But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing.  

Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love.

Second, countries and development partners need to invest in the HIV response to leverage new innovations.

In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections.

Reaching the  ’95 goals’

We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 

• 95% of people living with HIV knowing their status;
• 95% of people with diagnosed HIV infection receiving sustained ART;
• and 95% of people receiving ART having viral suppression.

We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve.

Third, we need to reach people with information, prevention, testing. and treatment.

The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions.

The human right to health

In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit.

In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections.

We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done.

But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need?

In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself.

Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health.

Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS.