Responding effectively to unmet needs in testing, treatment and care for people infected with HIV is of critical importance in securing and maximizing individual and public health benefits across Europe. Ahead of a gathering of key European stakeholders in Brussels in November 2007, we review approaches used to inform understanding of unmet need in support of HIV control. In this paper, we address the notion of unmet need according to levels of service access: access to testing, antiretroviral treatment and care. We reflect on the needs of individuals that health services struggle to meet effectively, and make recommendations for a coherent, cross-European approach to surveillance and monitoring of unmet need in order to support improvements in service provision and, ultimately, public health.