For the first time, the cumulative number of HIV cases in the WHO European Region increased to over 2 million. More than 153 000 new HIV cases contributed to this figure in 2015 – a 7% increase compared to the previous year and the highest annual number since reporting began in the 1980s. These are the main findings of the new report “HIV/AIDS surveillance in Europe 2015”, released jointly by the WHO Regional Office for Europe and the European Centre for Disease Prevention and Control (ECDC) ahead of World AIDS Day 2016.
“Despite significant efforts, HIV remains among the main public health concerns in the WHO European Region, in particular in its eastern part. 2015 recorded the highest number of new cases in one year, contributing to an appalling 2 million cumulative cases,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “To address this critical situation, we have made available a new action plan that all European countries endorsed in September 2016. We now call on countries’ leaders to use this plan for an urgent, accelerated and innovative response to HIV in the Region, to reverse the AIDS epidemics immediately and end it by 2030.”
“The facts we know about the HIV epidemic are based on the number of new diagnoses reported each year, which represents the cornerstone of European HIV surveillance,” explains ECDC Acting Director Andrea Ammon. “But we also know that these figures do not reflect the true picture. ECDC estimates that currently more than 122 000 people in the [European Union/European Economic Area (EU/EEA)] are infected with HIV but are not aware of their infection – that is every 1 in 7 people living with HIV in the EU/EEA. To reach the estimated 15% who are not aware of their infection, we need to increase efforts to promote and facilitate more testing for HIV, and link those diagnosed to care.”
Patterns and trends of HIV epidemic vary widely across the Region
With 153 407 people newly diagnosed with HIV in 50 countries of the Region in 2015, the annual increase in new HIV cases continued with the following geographical breakdown.
- 27 022 new HIV cases were diagnosed in western European countries (18%). This shows no substantial decline over the last decade.
- 5297 new HIV cases were diagnosed in central European countries (3%). Although the intensity of the epidemic remains low in the area, this is a substantial increase compared with 10 years ago.
- 121 088 new HIV cases were diagnosed in eastern European countries (79%). This more than doubled in a decade. The number of AIDS cases in this area increased by 80% in 10 years.
The main transmission mode also varied by geographical area. HIV infections increased consistently among men who have sex with men in the western and central parts of the Region, while in the eastern part heterosexual transmission increased. Transmission through injecting drug use still accounted for one third of new cases in eastern European countries.
Interventions should be adapted to the local epidemiologic context
The new HIV action plan builds on previous achievements and reformulates the public health response to HIV/AIDS. It sets concrete actions for countries to achieve 3 ambitious 90–90–90 targets by 2020: 90% of people living with HIV know their HIV status, 90% of diagnosed people living with HIV receive treatment and 90% of people on treatment achieve viral suppression. To achieve these objectives, each country should define and implement an essential package of prevention, testing, treatment and care interventions contextualized to its local epidemic, resources and capacity.
Data on trends and patterns of HIV transmission in today’s published report point to the following recommendations.
- In western European countries, prevention and control interventions targeted to men who have sex with men should remain the cornerstone of the HIV response. New strategies, such as pre-exposure prophylaxis for HIV as part of the comprehensive prevention strategy, could help to curb growing trends. The recently observed increase in some countries of HIV cases among people who inject drugs shows that harm-reduction programmes need to be maintained or strengthened.
- In central European countries, where the HIV epidemic is low, the priority is to decrease it further by focusing particularly on prevention in men who have sex with men, the main driver of the recent increase in new cases. Community involvement and efforts to reduce stigma and discrimination will be key to achieving this.
- In eastern European countries, there is an urgent need to deliver integrated services through health systems that better address the social determinants of health. This includes: prevention for people at risk of sexual and drug-related HIV transmission; targeted HIV testing; community involvement in the design and delivery of services; and a “treat all” approach within the WHO-recommended regimen. The large number of new infections in injecting drug users shows that it is critical to base policies on evidence, target key populations and strengthen harm reduction programmes.
- The cumulative number of HIV cases – 2 003 717 – refers to the number of people diagnosed with HIV in the Region since reporting began in the 1980s. This figure includes 992 297 people reported to the joint ECDC–WHO Regional Office for Europe surveillance system and 1 011 377 diagnosed in the Russian Federation.
- The ECDC’s estimate for EU/EEA countries is based on a modelling exercise conducted with the ECDC HIV-modelling tool, which used existing HIV and AIDS surveillance data for the years 2003 to 2015.
- The WHO European Region comprises 53 countries with a total population of nearly 900 million people, of which around 508 million live in the EU/EEA (28 EU Member States plus Iceland, Liechtenstein and Norway).
- The Region celebrates World AIDS Day on 1 December each year. It has become one of the most recognized international health days and a key opportunity to raise awareness, commemorate those who have passed on and celebrate victories, such as increased access to treatment and prevention services.