New HIV diagnoses at high levels in the European Region but progress in EU

With nearly 160 000 people newly diagnosed with HIV, 2017 marked another year of alarming numbers of new HIV diagnoses in the WHO European Region. Encouragingly, the overall increasing trend is not as steep as before. The eastern part of the Region recorded over 130 000 new HIV diagnoses, the highest number ever. In contrast, the European Union and European Economic Area (EU/EEA) countries reported a decline in rates of new diagnoses, mainly driven by a 20% decrease since 2015 among men who have sex with men. The European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe release the latest data on the HIV epidemic in the European Region, marking the 30th anniversary of World AIDS Day.

The European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe release the latest data on the HIV epidemic in the European Region, marking the 30th anniversary of World AIDS Day.

Vytenis Andriukaitis, the European Commissioner for Health and Food Safety, said: “Despite our efforts, HIV still damages the lives of so many people, and causes not only much suffering and illness, but also discrimination and stigmatisation. A lot of progress has been made, but there is still much more we must do. We need to capitalise on the full potential of our joint and sustained actions, as well as increased collaboration with our partners across borders if we want to achieve the Sustainable Development Goal of eliminating HIV – in Europe and worldwide – by 2030. We must overcome the stigma of HIV infection and treatment and continue our efforts in dispelling false beliefs about how HIV and AIDS are spread. It is important for our public health services to support easy and affordable access to testing and medical care for vulnerable groups at risk of HIV infection”.

“It is an important signal for Europe’s HIV response that we see a decline in new HIV diagnoses in the EU/EEA. Especially since we see this drop among men who have sex with men. This was the only population in the EU/EEA that experienced constant increases in reported HIV cases during the past decade”, stresses ECDC Director Andrea Ammon. “There are several reasons that can explain the decline across the EU/EEA. They include successful programmes to offer more frequent and targeted HIV testing to promote earlier diagnosis. This allows rapid linkage to care and immediate start of antiretroviral treatment for those tested positive and wider uptake of evidence-based prevention such as pre-exposure prophylaxis. This decline also shows that a stronger focus on addressing and including vulnerable populations in the HIV response, as outlined in new ECDC testing guidance, makes the difference.”

“It’s hard to talk about good news in the face of another year of unacceptably high numbers of people infected with HIV. While efforts to prevent new HIV infections are gradually showing signs of progress, we are not on course to meet the 90-90-90 targets by the 2020 deadline. My call to governments, ministers of health and decision-makers is bold: scale up your response now”, says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “To support people living with HIV and protect those at higher risk of infection, we need to fast track action by tailoring interventions. This means investing wisely in prevention, testing and treatment particularly in key populations to end the AIDS epidemic as we promised.”

Key findings

• The increase in new HIV diagnoses continued for the WHO European Region as a whole, but its pace was slower than in previous years. One reason for the persistent HIV epidemic in Europe is that late diagnosis remains a challenge across the whole Region. Every second person diagnosed with HIV has already reached an advanced stage in the infection.
• With over 130 000 new HIV diagnoses in 2017, the eastern part of the Region observed a rate of increase of 68% in 2008-2017, compared with 95% in 2007-2016. In the central part of the Region, the increase was 121% compared with 142% respectively.
• Of new HIV diagnoses in the eastern part of the Region, 59% are reported to be from heterosexual transmission. Data need to be carefully considered as they depend on the transmission mode reported by the individuals.
• Men are suffering disproportionately from HIV across the entire Region: 70% of new HIV diagnoses are in men.
• In 2017, over 25 000 people were diagnosed with HIV in 30 of the 31 countries of the EU/EEA. This translates into a decline from a rate of 6.9 per 100 000 population in 2008, to 6.2 per 100 000 in 2017.
• The overall decline in the EU/EEA resulted primarily from a 20% drop in new diagnoses among men who have sex with men between 2015 and 2017, which remains the predominant mode of HIV transmission (38% in 2017) in this part of Europe. There was also a reduction in diagnoses attributed to heterosexual transmissions involving people from countries with generalised HIV epidemics.
• Despite this measurable progress in reducing the number of new HIV diagnoses, overall rates continue to increase in about one third of EU/EEA countries.
• The number of AIDS cases continued to decline in the Region as a whole. In the eastern part, the situation has begun to stabilise, and numbers of AIDS cases between 2012 and 2017 declined by 7%.
• In the EU/EEA, 9 out of 10 (89%) AIDS diagnoses in 2017 happened within only 90 days of the HIV diagnosis, indicating that the majority of AIDS cases in the EU/EEA could have been avoided with early diagnosis.

Because it is better to know: improving HIV testing

Reaching and testing those at risk of infection with HIV is still a public health challenge across Europe. In order to diagnose HIV early, interrupt existing transmission chains and prevent further infections, Europe needs to work more closely with vulnerable populations.

The new ECDC guidance on integrated HIV and viral hepatitis testing provides countries with the latest scientific evidence to help develop, implement, improve, monitor and evaluate national or local testing guidelines and programmes for both HIV and viral hepatitis. Such programmes should contribute significantly to the elimination of viral hepatitis and HIV as public health threats by 2030 as outlined by the Sustainable Development Goals (SDG).

Revamping political commitment: the game changers

The momentum to revamp political commitment to end AIDS by 2030 has never been so strong in the European Region.

The ministerial policy dialogue on HIV organized by WHO in cooperation with the Government of the Netherlands and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Amsterdam in July 2018, registered the highest ministerial attendance ever recorded at such a meeting, with 11 ministers or deputy ministers of health attending. Participants expressed governments’ firm commitment to scale up efforts to implement the Action Plan for the Health Sector Response to HIV in the WHO European Region and achieve the 90-90-90 targets. As a result, country-specific roadmaps are in development to reinforce a common agenda among key policy-makers, partners, funders and implementers.

Another recent milestone towards ending AIDS is the United Nations Common Position on Ending HIV, TB and Viral Hepatitis through Intersectoral Collaboration launched at the 73rd Session of the United Nations General Assembly on 27 September 2018. For the first time, 14 United Nations agencies have joined forces to end the epidemics of the European Region deadliest communicable diseases. The Common Position, coordinated by WHO, is an unprecedented step by the United Nations to scale up efforts by 2030, as demanded by SDG 3.

###

Notes to the editor

The WHO European Region comprises 53 countries, with a 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).

World AIDS Day was introduced by WHO in 1988 and is observed annually on 1 December to raise awareness of the AIDS pandemic caused by HIV infection.

HIV/AIDS: The human immunodeficiency virus (HIV) is a virus that attacks the immune system and causes a lifelong severe illness with a long incubation period. The end stage of the untreated infection, acquired immunodeficiency syndrome (AIDS), results from the destruction of the immune system. AIDS is defined by the presence of one or more opportunistic illnesses (due to decreased immunity).

Late diagnosis is defined as having a CD4 cell count below 350 cells/mm3 blood at the time of diagnosis. This is a measure of the person’s immune system functioning.

Pre-exposure prophylaxis (PrEP) is an antiretroviral therapy-based HIV prevention strategy to prevent, or at least reduce, the risk of HIV infection in adults who have not been infected with the virus but are at high risk of infection. Use of antiretroviral medication for PrEP has been approved in the EU. As an additional prevention option, it has the potential to reduce HIV transmission and contribute to reversing the increase in new infections in Europe.

90-90-90 targets: In 2014, UNAIDS and partners launched the 90-90-90 targets; the aim was to diagnose 90% of all HIV-positive people, provide antiretroviral therapy for 90% of those diagnosed, and achieve viral suppression for 90% of those treated by 2020.

Resources

ECDC-WHO HIV/AIDS surveillance in Europe 2018 2017 data:
https://ecdc.europa.eu/en/publications-data/hivaids-surveillance-europe-2018-2017-data

ECDC

World AIDS Day 2018

Public health guidance on HBV, HCV and HIV testing in the EU/EEA

ECDC-EMCDDA Guidance in brief: Prevention and control of blood-borne viruses in prison settings