Addressing the needs of people who use drugs in the context of HIV and co-infection(s) is not just a health issue but also a matter of social justice and human rights. The pursuit of health equity, as enshrined in the SDGs, calls for a comprehensive approach that encompasses harm reduction, integrated care models, and supportive policies. This report aims to explore these dimensions in detail, offering insights into the challenges faced, the progress made, and the path forward in ensuring equitable access to health services for people who use drugs in Europe.