Drug-related infectious diseases – the current situation in Europe (European Drug Report 2026)
People who inject drugs are at risk of contracting infections through the sharing of drug use paraphernalia. On this page, you can find the latest analysis of drug-related infectious diseases in Europe, including key data on infections with HIV and hepatitis C, B and A viruses. These infections can cause acute and chronic diseases that may result in severe health-related harms, including death.
This page is part of the European Drug Report 2026, the EUDA’s annual overview of the drug situation in Europe.
Last update: 9 June 2026
Public health risks from drug-related infectious diseases remain a concern
People who inject drugs are at high risk of becoming infected by hepatitis C, B and A viruses (HCV, HBV and HAV, respectively) and the human immunodeficiency virus (HIV) through the sharing of drug use paraphernalia. Stimulant use is associated with increased risk of sexually transmitted infections, while poor living conditions may expose people who use drugs to infections transmitted through close contact. These infections can lead to acute or chronic diseases that may result in severe health-related harms, including death.
Potential for HIV outbreaks driven by wider stimulant use and harm reduction gaps
New HIV notifications are a proxy for the level of transmission. The total number of HIV notifications in the European Union linked to injecting drug use declined to 822 in 2024 (991 in 2023). However, the notification rate of 1.83 new infections per million population remained higher than the 2025 UNAIDS target of 0.9 per million, which represents a 75% reduction from the 2010 baseline (Figure 10.1).
Harm reduction approaches are fundamental to reducing HIV transmission among people who inject drugs. One essential element is the provision of sterile injecting equipment. This is a cost-effective intervention that may be delivered through various modalities and in a range of settings, including prisons and through pharmacies. Nonetheless, levels of needle and syringe provision are inadequate in relation to estimated needs in several EU Member States, including Bulgaria, Cyprus, Lithuania, Hungary, Poland and Slovakia (Figure 10.2). In Bulgaria, where harm reduction services face critical funding challenges, the number of sterile syringes distributed decreased by more than 90% between 2014 and 2024.
The results from a cross-sectional study conducted in 2024 among 480 people who inject drugs in Sofia showed that 12.7% tested positive for HIV (via rapid diagnostic tests). This figure is higher than the 1.7% HIV prevalence reported in the previous seroprevalence study conducted in 2016 across multiple cities in the country, suggesting a possible increase over time. Over the last decade, Europe has witnessed at least seven documented HIV outbreaks that were attributable to stimulant injecting. Countries with inadequate needle and syringe exchange provision levels with respect to the size of their estimated injecting drug use problems remain more exposed to potential HIV outbreaks. Such outbreaks are costly and can be mitigated through adequate levels of harm reduction services (Figure 10.3).
While people who inject drugs are at much higher risk of HIV transmission when sharing injecting material, non-injecting stimulant use also exposes people to HIV and other infections through risky and unprotected sexual intercourse, requiring appropriate prevention measures (access to condoms and pre- and post-exposure prophylaxis). The availability of stimulants continues to increase in Europe, creating a more diverse risk group. The European Union’s experience has shown that higher levels of integrated prevention and harm reduction service provision are required to prevent and contain HIV transmission related to stimulant use. Service funding and access barriers remain a key challenge for policymakers and frontline staff.
Late HIV diagnosis remains a cause of preventable illnesses and deaths
Ensuring the linkage of people who use drugs and who are HIV-positive to treatment remains a challenge within the European Union. In 2024, more than half (52%) of newly notified HIV infections attributable to injecting drug use were diagnosed late, which suggests that more and targeted testing would allow earlier treatment and stop transmission. In the same year, EU Member States reported 118 AIDS notifications linked to injecting drug use (0.3 per million population), indicating either late HIV diagnosis, poor treatment access or low adherence for some patients, factors that contribute to preventable illness and death.
Integrating prevention, testing and treatment to reduce chronic HCV infections
In Europe, people who inject drugs also have a high burden of chronic viral hepatitis, and injecting drug use remains the most common risk factor for new HCV diagnoses. Although there is no vaccine for HCV, unlike HBV and HAV, effective treatments exist. It was estimated that, in 2019, at least 36% of the 1.8 million chronic HCV infections in the EU Member States and Norway were associated with injecting drug use. There is also evidence that harm reduction services, such as needle and syringe programmes, as well as the provision of opioid agonist treatment, can reduce the risk of HCV transmission (see Harm reduction – the current situation in Europe). It is important to identify individuals who remain chronically infected with the virus, as they are at risk of cirrhosis and cancer. Also, they can transmit the virus to others through the sharing of any injecting paraphernalia that has been in contact with their blood. However, in many countries, people who use drugs face barriers to HCV testing and treatment at the system, service provider and client levels, resulting in many HCV infections not being diagnosed or treated.
Time trends in the prevalence of viraemic or active HCV infection among people who inject drugs are useful for monitoring the impact of prevention and treatment. The EUDA monitors progress through its viral hepatitis elimination barometer. Among the countries reporting to the EUDA, Spain, Sweden and Norway have evidence of significant reductions in viraemic HCV prevalence over time, as measured by HCV-RNA in city-level seroprevalence studies among people who inject drugs and use harm reduction services (Figure 10.4). Cities in these countries achieved reductions in viraemic HCV prevalence of more than 50% during the past decade, with Oslo reaching the 80% reduction target set by the WHO for 2030. These encouraging trends are reported from cities where a decentralised and integrated approach to prevention, testing and treatment has been implemented for the key population of people who use drugs. Different aspects of this approach, endorsed in the joint EUDA-ECDC guidelines, are present across the cities. For example, Madrid provides increased access to harm reduction for outreach service clients and offers free testing and personalised referrals to care when a hospital visit is required. In Stockholm, testing and treatment offers are, as much as possible, made in the same location. Overall, while the decentralised approach requires sufficient financial resources, it is considered cost-effective, as it can save lives and reduce the burden on other resources in the long term.
Enhanced access to HBV and HAV vaccination needed for people who use drugs
Surveillance data from the European Centre for Disease Prevention and Control (ECDC) reveal that 15% of the 567 acute HBV cases notified in 2023 were attributable to injecting drug use. People with chronic HBV infection are at risk of long-term complications, including liver cirrhosis and cancer. As part of Europe’s Beating Cancer Plan , the European Union has committed to improving HBV vaccination coverage across the population, including better access for groups with low uptake. Systematically offering HBV (and HAV) vaccination in prison settings is supported by the joint ECDC-EUDA toolkit, which highlights the sharing of injecting material as a risk factor for HBV infection.
In 2025, a large HAV outbreak with person-to-person transmission affected Czechia, Hungary, Slovakia and Austria. Czechia and Austria observed a significant number of infections among people experiencing homelessness and people who use drugs. In Czechia, 27 deaths were linked to the virus. Most of these fatalities were among people aged 55 to 74, many of whom were using drugs or alcohol and experiencing homelessness. Promoting HAV vaccination through routine or one-off vaccination services delivered through outreach activities can benefit people who use drugs and have difficulty accessing and attending healthcare services.
Key data and trends
HIV/AIDS
- In 2024, the number of new HIV notifications linked to injecting drug use in the European Union decreased to 822 (1.83 per million population), compared with 991 the previous year.
- HIV notification rates attributable to injecting drug use exceeded 5 per million population in Bulgaria, Greece, Latvia and Lithuania.
- New HIV cases related to injecting drug use accounted for 4.7% of all new notifications with a known route of transmission in 2024. In the same year, HIV cases related to injecting drug use accounted for more than 10% of new notifications in Greece (24%), Latvia (15%), Lithuania (15%), Bulgaria (13%), Austria (11%), Norway (11%) and Germany (10%).
HCV and HBV
- Recent estimates of viraemic or active HCV infection (as measured by HCV-RNA) among people who inject drugs and access harm reduction services are available from six European countries, although only at subnational level. The prevalence of HCV-RNA derived from seroprevalence studies ranged from 5.8% in Oslo (2024) to 56% in Tallinn (2022). Intermediate levels were observed in Madrid (20% in 2022), Budapest (24% in 2021), Bavaria (27% in 2022) and Stockholm (30% in 2021).
- Estimates for HBV infection (as measured by the presence of the hepatitis B surface antigen), derived from the latest seroprevalence studies among people who inject drugs, were highest in Hungary (5.8% in 2021), Latvia (5.6% in 2022) and Romania (5.6% in 2023).
HAV
- In 2025, more than 6 500 cases of HAV were reported to ECDC: Czechia (2 310), Slovakia (2 482), Hungary (1 548) and Austria (216).
- The primary populations affected by the outbreak varied nationally. Austria and Czechia observed a significant number of cases among people experiencing homelessness and people who use drugs. Injecting drug use was linked to 25% of cases in Austria and 8% of cases in Czechia.
- Where data are available, between 41% (Slovakia) and 80% (Czechia) of cases required hospitalisation. In total, 39 deaths related to the HAV outbreak were reported in 2025.
Additional detailed information can be found in the EUDA’s Drug-related infectious diseases: health and social responses.
Source data
The data used to generate infographics and charts on this page may be found below.
The complete set of source data for the European Drug Report 2026, including metadata and methodological notes, is available in our data catalogue.
A subset of this data, used to generate infographics, charts and similar elements on this page, may be found below.