Europe’s HIV response cannot succeed without migrant health equity

Migration dominates political debate across the continent. Governments argue about borders, asylum systems, returns, integration, and security. Election campaigns are built around it. Entire ministries are dedicated to it. Yet one issue remains largely absent: access to healthcare.

This is no marginal issue. Many migrants in Europe still struggle to access even the most basic HIV and STI services.

At AIDS Healthcare Foundation (AHF) Europe, we work with migrants, refugees, undocumented people, labour migrants, international students, and other vulnerable communities across several European countries.

Every day, our teams and partners provide frontline HIV and STI services designed to reach people who would otherwise be excluded. Many of these services are multilingual, community based, anonymous, and specifically designed to reduce fear and stigma. In 2025, AHF Europe provided HIV prevention, testing and linkage-to-care services to more than 28,000 migrants.

For many migrants, accessing healthcare in Europe is far from straightforward. Some do not understand the language used in clinics or hospitals. Others are unsure whether they are legally entitled to care. Some fear that seeking healthcare could negatively affect their migration status. Others simply do not know where services exist or how to navigate an healthcare system that can already be difficult for citizens themselves.

From a public health perspective, this simply makes no sense. Viruses do not care about residency permits or asylum procedures. HIV does not distinguish between documented and undocumented people. If people are pushed away from prevention, testing, and treatment services, infections are diagnosed later, transmission risks increase, and healthcare systems ultimately face higher costs.

Excluding migrants from healthcare does not protect public health; it undermines it. And yet, across Europe, barriers remain everywhere.

The scale of the issue is reflected in the latest ECDC data. In 2024, migrants accounted for more than 55% of new HIV diagnoses in the EU/EEA, up from 38.3% in 2015. Many migrants also acquire HIV after arriving in Europe, highlighting the need for accessible testing and prevention.

AHF Europe recently conducted a comparative analysis of migrants’ access to HIV and STI services across the nine European countries where AHF operates, including countries in both the EU and Eastern Europe. None fully guaranteed comprehensive access to care, and practical barriers including language, stigma, administrative requirements, and lack of information were identified across all countries reviewed.

Some countries have relatively strong legal frameworks on paper. But reality looks very different once someone tries to navigate the system. Can you access testing without health insurance? What documents do you need? Is interpretation available? Will seeking care affect your migration process? Can undocumented people safely access treatment? Who explains any of this?

These questions matter enormously in practice, and what we see repeatedly is that community organisations often become the bridge between migrants and healthcare systems that are difficult to navigate, even for citizens.

Across Europe, AHF supports community based and low threshold services, including checkpoints, multilingual testing, and outreach programmes that help migrants access care. These approaches are essential because healthcare is not only about services, but about trust. And right now, that trust is fragile.

That fragility risks becoming even worse under parts of the EU’s increasingly punitive migration agenda. Proposed changes to EU return and migration policies risk creating an environment where undocumented migrants become even more afraid to access healthcare services because of fears around surveillance, detention, deportation, or data sharing between institutions.

This is not a theoretical concern: when healthcare systems become entangled with migration enforcement, people disappear from care. Fear of detection pushes people further underground, weakening public health and eroding trust in healthcare systems, while placing healthcare workers in situations where medical ethics risk colliding with migration enforcement priorities. This is not just a migrant issue; it is a public health issue.

Taken together, this exposes a deeper contradiction in Europe’s current political direction. Since COVID-19, European leaders have repeatedly emphasised preparedness, resilience, and health security, highlighting the importance of early detection, strong public health systems, and rapid responses to infectious diseases. The EU has invested heavily in strengthening its health security architecture and improving preparedness for future pandemics. At the same time, however, parts of Europe’s migration policies risk pushing vulnerable communities further away from healthcare systems altogether.

Europe cannot claim to prioritise early detection and prevention while supporting policies that make people afraid to seek care. You cannot build resilient health systems while creating environments where undocumented people fear that visiting a clinic could expose them to detention or deportation. Europe should have learned this lesson already during COVID-19: health systems are only effective when people trust them enough to use them. If migrants avoid testing or treatment because healthcare systems are perceived as connected to migration enforcement, everyone becomes more vulnerable.

Across Europe, migration is increasingly discussed through the language of crisis and control. Health easily disappears in that political climate. Migrants are often portrayed as a burden on healthcare systems, even though excluding people from early prevention and care almost always creates worse health outcomes and higher long-term costs.

The solutions themselves are not particularly complex. We know what works: multilingual services, low threshold community testing, peer outreach, culturally competent care, and partnerships with civil society organisations. But these approaches require political commitment and sustained funding, not temporary pilot projects that disappear after two years.

The European Union has previously played an important role in coordinating HIV responses and setting common public health priorities. Renewing a strong EU HIV Action Plan, with a serious focus on migrant access and health equity, would be an important step forward.

Europe cannot seriously claim to pursue health equity while some of the most vulnerable people on the continent still face barriers to basic HIV and STI services. Migrant health is public health. When migrant health is neglected, public health fails us all.