HIV-relevant policies in European countries: A comprehensive landscape of policies hindering or facilitating access to HIV prevention, testing, treatment, and care of key populations

Abstract

Background In Europe, there are variations in epidemic patterns, trends, and progress toward achieving the UNAIDS target of ending the AIDS epidemic. Complex social, economic, cultural, and behavioral dynamics make key population groups more vulnerable to HIV, and health and health-related policies play a significant role in ensuring progress towards eliminating HIV. This study aims to characterize and compare how HIV-relevant policies may directly or indirectly hinder or facilitate HIV prevention, testing, treatment, and care of key populations within selected European countries. Methods This study consists of a targeted search of policies that may impact the HIV continuum of care for priority populations and a literature review to contextualize findings and explore policy implementation barriers. Analysis was conducted on a sample of 15 countries and six subregions. Data collection and analysis were done according to pre-defined policy areas (n = 57) identified through a review of international frameworks. Findings A total of 445 policies and 69 studies met the eligibility criteria. In the broader analysis, 438 policies were identified across 57 policy areas, of which 248 policies across 27 policy areas were considered relevant to this manuscript. These policy areas address HIV prevention, testing, treatment, care, and structural support for key populations. In most countries, policies were identified covering 40 or more policy areas, highlighting substantial variation in policy scope across settings. Interpretation Not all key and priority populations are equitably or adequately prioritized, with some policies leading to their needs and vulnerabilities being overlooked. Despite the presence of well-structured policies, misalignment between decision-makers’ attitudes and evidence-based recommendations, political constraints, and structural, cultural, and stigma-related factors persist. Health systems must address barriers faced by key and priority populations to achieve the UNAIDS targets.