As the world makes progress against HIV/AIDS, Eastern Europe and Central Asia face a worsening crisis. Explore the complex factors behind this divergence and the scientific breakthroughs that could change the trajectory.
In the global narrative of HIV/AIDS, we've become accustomed to stories of progress. The world has witnessed a 40% decline in new HIV infections and a 56% drop in AIDS-related deaths since 2010 1 . Scientific breakthroughs have transformed HIV from a death sentence into a manageable chronic condition for millions. Yet, as you read this, one region stands in stark contrast to this encouraging trend: Eastern Europe and Central Asia.
Increase in new HIV infections in Eastern Europe (2010-2023) 2
Increase in AIDS-related deaths in Eastern Europe (2010-2023) 2
This divergence represents one of the most significant failures in global public health today—a complex story of scientific advancement hampered by political indifference, funding crises, and persistent stigma.
To understand the exceptional nature of Eastern Europe's HIV crisis, we must first recognize the broader global context. Worldwide, approximately 39.9 million people were living with HIV at the end of 2024 3 . The global health community has established ambitious "95-95-95" targets for 2030: 95% of people living with HIV knowing their status, 95% of those knowing their status receiving antiretroviral therapy, and 95% of those on treatment having suppressed viral loads 4 .
In 2023, nearly 113,000 people were newly diagnosed with HIV across the WHO European Region 5 6 . The rate of diagnosis has increased by 2.4% compared to the previous year, with 21 of 47 reporting countries seeing rises in new diagnoses 6 .
| Region | New HIV Diagnoses | Trend Since 2010 | Awareness of Status |
|---|---|---|---|
| EU/EEA | 24,731 | Declining | 92% |
| Eastern Europe & Central Asia | ~88,152 | 20% increase | ~60% |
| WHO European Region Total | 112,883 | Mixed | 70% |
In Eastern Europe and Central Asia, unsafe drug-injecting practices drive approximately 27% of new infections 2 .
The region has witnessed a 144% increase in HIV acquisitions among gay men and other men who have sex with men since 2010 2 .
Across the WHO European Region, nearly 1 in 3 people living with HIV do not know their status 5 . This figure obscures a critical divergence: while 92% of people living with HIV in the EU/EEA are aware of their status, in Eastern Europe and Central Asia, only about 60% of this population knows they have the virus 5 .
Just as Eastern Europe's epidemic worsens, HIV prevention science is experiencing what experts call a "prevention revolution" 1 . For years, the mainstay of HIV prevention beyond condoms has been oral pre-exposure prophylaxis (PrEP)—daily pills that reduce the risk of acquiring HIV. While effective, daily pill-taking presents challenges for many people, leading to what researchers call "sub-optimal persistence" 7 .
Effective but requires daily adherence, leading to persistence challenges.
Long-acting injectable administered every two months with better persistence.
Twice-yearly injection offering potential for just two shots per year.
UNAIDS estimates that embracing new technologies and approaches could reduce the annual cost of the global HIV response by approximately $7 billion while dramatically cutting new infections 1 .
The excitement surrounding lenacapavir stems primarily from two landmark clinical trials: PURPOSE 1 and PURPOSE 2. These phase 3, double-blind, randomized, controlled trials represent the gold standard in clinical research 2 .
The PURPOSE 1 trial enrolled 5,338 women aged 16-25 in South Africa and Uganda—a population experiencing high HIV incidence rates 2 . Researchers divided participants into three groups:
Received twice-yearly injections of lenacapavir (2,134 participants)
Received daily oral emtricitabine/tenofovir alafenamide (2,136 participants)
Received daily oral emtricitabine/tenofovir disoproxil fumarate (1,068 participants)—an established standard of care
The findings, released in 2025, were unprecedented: 100% protection against HIV among the 2,134 women who received lenacapavir 2 . Not a single participant acquiring HIV in this group over the study period.
| Intervention | Frequency | Participants | HIV Infections | Efficacy |
|---|---|---|---|---|
| Lenacapavir injection | Twice yearly | 2,134 | 0 | 100% |
| Oral emtricitabine/tenofovir alafenamide | Daily | 2,136 | 39 | Not calculated |
| Oral emtricitabine/tenofovir disoproxil fumarate | Daily | 1,068 | 16 | Baseline |
These results represent what Dr. Andrew Hill, senior visiting fellow at the University of Liverpool, calls "the closest we have ever come to an HIV vaccine" 2 . The twice-yearly administration schedule addresses the primary challenge of adherence that has limited the impact of daily oral PrEP.
Despite these extraordinary scientific advances, Eastern Europe and Central Asia risk being left behind. The region faces a convergence of barriers that prevent cutting-edge tools from reaching those who need them most.
In October 2024, manufacturer Gilead announced a deal allowing six manufacturers to produce generic lenacapavir in 120 low- and middle-income countries 2 . While seemingly expansive, this arrangement excludes several middle- and high-income countries in Eastern Europe and Central Asia, despite their high HIV incidence rates.
Experts note that 41% of new HIV infections occur in upper-middle-income countries, many of which are excluded from the licensing deal 2 .
Professor Miłosz Parczewski, President-Elect of the European AIDS Clinical Society, identifies "political stigma" as a fundamental barrier: "I define this as a lack of political will and full engagement in the HIV response, mostly due to the inadequate perception that the epidemic is limited to the LGBTQI community who are still persecuted in some countries" 2 .
The region faces a dual funding challenge: constrained domestic resources due to competing government priorities, and restricted eligibility for international funding because many EECA countries are classified as upper-middle or high-income 2 . This creates a "pronounced funding gap" exactly when resources are most needed 2 .
International assistance accounts for 80% of prevention programs in low- and middle-income countries 1 .
UNAIDS modeling shows that if current funding permanently disappears, there could be an additional 6 million HIV infections and 4 million AIDS-related deaths by 2029 1 .
As formal systems fray, community organizations have become first responders in the region's HIV crisis. When funding froze in Tajikistan, the Tajikistan Network of Women Living with HIV—whose support group sessions provide psychological support and connection to medical services—faced potential collapse 8 .
"People are panicking," said Tahmina Haidarova, Head of the Network. "They fear that if our support services shut down, women affected by HIV, families with children living with HIV and people from key populations will have nowhere to turn for support" 8 .
In Ethiopia, when formal systems broke down, young volunteers formed WhatsApp groups to check on peers, mothers banded together to support children's treatment, and youth collectives used community radio to share health information 1 .
These grassroots efforts represent what UNAIDS calls "the future of the HIV response—nationally owned and led, sustainable, inclusive and multisectoral" 1 .
"This is not just a financial crisis. It is a crisis of global values and priorities. Right now, the future of our dignity, health, and human rights is uncertain. Community organizations are the first responders in this crisis—yet they're being forced to survive without oxygen" — Ganna Dovbakh from the Eurasian Harm Reduction Association 8 .
The story of HIV in Eastern Europe represents one of the most challenging chapters in the global AIDS response. The region stands at a crossroads: it faces a worsening epidemic, political indifference, and an unprecedented funding crisis just as science delivers the most powerful prevention tools ever developed.
Governments must recognize HIV as a critical public health issue affecting all citizens, not just marginalized groups.
International partners and national governments must develop transition plans to fund community-led services through domestic resources.
Pharmaceutical companies, governments, and international organizations must collaborate to ensure life-saving tools like lenacapavir reach all regions with high HIV incidence.
The remarkable resilience of community organizations must be supported and integrated into national health systems.
The world has the scientific tools to end AIDS as a public health threat. The question is whether we can overcome the political, economic, and social barriers that prevent these tools from reaching everyone. As the UNAIDS Global AIDS Update 2025 declares: "The AIDS response may be in crisis, but we have the power to transform" 1 .
The people of Eastern Europe and Central Asia, like people everywhere, deserve access to the revolutionary advances in HIV prevention that could protect their health, their futures, and their communities. Ensuring they're not left behind is both a scientific imperative and a moral one.