IPM Take
An infectious-disease service is not accessible because a clinic exists somewhere in the health system. It is accessible when the people most likely to need it can actually enter, understand, afford and remain in care.
ECDC’s new assessment exposes the gap between those two definitions. Europe has highly effective tools for preventing and treating HIV, tuberculosis and viral hepatitis, yet access remains fragmented for some migrant populations, particularly undocumented people. That is both an equity failure and an infectious-disease control problem.
Executive Summary
ECDC has published a new assessment of migrant access to prevention, testing and treatment for HIV, tuberculosis, viral hepatitis and sexually transmitted infections across the EU/EEA.
The report identifies recurring structural and social barriers, including legal restrictions, lack of health coverage, language difficulties, stigma and discrimination. Most countries include migrant populations in national HIV and TB strategies, but inclusion is less consistent in policies addressing viral hepatitis and STIs, while undocumented migrants face additional restrictions.
ECDC also identifies gaps in access to PrEP, systematic screening for tuberculosis infection, hepatitis B testing and vaccination, and migrant-friendly testing options such as community services, self-testing, self-sampling and mobile outreach.
Why it matters
- Public authorities: Infectious-disease strategies need to measure whether services are reachable by migrant populations, not simply whether national programmes formally exist.
- Clinicians: Language, administrative status and continuity of care can materially affect whether patients complete testing, treatment and follow-up.
- Communities: Trusted community services and culturally appropriate models can improve uptake without creating parallel or lower-quality systems of care.
Europe does not lack the medical tools needed to prevent many infections among migrant populations. HIV pre-exposure prophylaxis can prevent infection. Tuberculosis can be detected and treated. Hepatitis B vaccination works, hepatitis C can be cured, and sexually transmitted infections can usually be diagnosed and managed effectively. The persistent weakness is what happens between the existence of those interventions and the person expected to use them.
ECDC’s latest review shows how easily that distance becomes a public-health problem. Legal entitlements vary, health coverage is inconsistent, administrative procedures can interrupt care and language barriers can make even formally available services difficult to navigate. For undocumented migrants, those obstacles can become substantially higher.
The pattern differs by disease. Migrants are widely recognised within national HIV and tuberculosis strategies, reflecting longstanding evidence about the importance of accessible testing and treatment. Inclusion is less consistent in hepatitis and STI policies. PrEP guidance does not always explicitly address migrants despite groups within migrant populations being at substantial HIV risk, while systematic testing for tuberculosis infection and access to preventive treatment remain uneven.
This should not be mistaken for an argument that migrants themselves create infectious risk. The policy issue is almost the opposite. People become more vulnerable when prevention is inaccessible, diagnosis is delayed or treatment is interrupted. A person unable to access HIV testing does not become less likely to have HIV because the barrier exists. Tuberculosis does not respect administrative status, and hepatitis does not stop progressing while someone waits to establish eligibility for care.
Service design can reduce those gaps. Community-based testing, mobile tuberculosis screening, HIV self-testing and self-sampling for certain infections can take healthcare closer to populations that conventional clinics do not reach effectively. ECDC also emphasises person-centred approaches that connect testing to treatment rather than counting a diagnostic encounter as success while losing the patient during referral.
There is a financing argument here as well. Late diagnosis is expensive. Untreated infection can lead to more advanced disease, greater healthcare use and additional transmission. Restrictions that appear to save money at the entry point can simply shift costs downstream into hospitals and emergency services.
The same logic applies to public trust. Migrants who fear that healthcare encounters may expose them to immigration consequences, discrimination or unaffordable bills have rational reasons to delay engagement. Health systems cannot simultaneously depend on early diagnosis and build conditions that make early diagnosis risky for the patient.
Europe’s infectious-disease capacity is often measured through laboratories, medicines and surveillance networks. Those are essential. But an intervention that cannot be reached by the population for whom it was designed is only partially implemented.
The clinic door is part of the disease-control system
