Objective. To assess the level of access to highly active antiretroviral therapy (HAART) for women and children in the WHO European Region. Methods. Analysis of data from three national surveys of 53 WHO European Member States. The comparative level of access to HAART for women and children was assessed by comparing the percentage of reported HIV cases with the percentage of HAART recipients in women at the end of 2002 and 2006 and in children at the end of 2004 and 2006. Findings. Overall, the data suggest that there is equivalence of access to antiretroviral therapy by gender and age in Europe. However, in central and eastern Europe women were disproportionately more likely to receive HAART when compared with men in 2006, representing 29% of HIV cases when compared with 39% of HAART recipients in central Europe, and 34% of HIV cases when compared with 42% of HAART recipients in eastern Europe. In comparison with adults, children (<15 years of age) were over-represented among HAART recipients when compared with HIV cases in eastern Europe, accounting for 1% of HIV cases and 9% of people on HAART in 2004 and 1% of HIV cases and 8% HAART recipients in 2006. Conclusion. Access to HAART remains inequitable in terms of gender in central and eastern Europe, favouring women over men, and in terms of age in eastern Europe, favouring children over adults. Despite high and increasing coverage with HAART in many European countries, countries must address how to further increase the number of people on treatment while ensuring equitable access for all population groups in need.