32 years after pioneering prevention of mother-to-child HIV transmission in Europe: achievements, persistent inequities, and the imperative for a coordinated response.

BACKGROUND: Over the past three decades, Europe has led efforts to prevent mother-to-child transmission of HIV, reducing transmission rates to below 1-2% in many Western and Northern countries. Universal antenatal screening, the early initiation of combination antiretroviral therapy, and integrated obstetric-HIV care have made paediatric HIV largely preventable.

MAIN BODY: However, national averages obscure persistent inequities within the WHO European Region and inside individual countries. In Eastern Europe and Central Asia, late diagnosis, incomplete screening, and fragmented maternal health services continue to sustain preventable transmission. Even in Western Europe and its overseas territories, subnational and sociodemographic disparities challenge claims of elimination. Structural barriers, including delayed prenatal care, legal insecurity, language barriers, socioeconomic disadvantage, and fragile health systems, remain key determinants of risk. We argue that elimination must be defined not only by national indicators but also by equity, subnational accountability, and harmonised surveillance capable of identifying disparities within the same territory.

CONCLUSION: A response is urgently needed to ensure HIV elimination in all populations.

CLINICAL TRIAL NUMBER: not applicable.