Spain (pop. 43 379 000)

By the end of 2006, Spanish authorities had reported a cumulative total of 73 977 cases of AIDS, and a total of 40 157 deaths among these AIDS cases. For the year 2006, they reported 1519 new AIDS cases and 198 deaths among AIDS cases, the lowest number of deaths among AIDS cases reported since the mid-1980s.
Spain does not report national HIV data, though HIV case-reporting does exist in some regions. Underreporting for deaths is thought to be around 20%. Data from the regions that do report HIV cases show that during the 1980s, HIV spread widely among IDUs and, to a much lesser extent, MSM. The large number of sexually active young adults among HIV-positive IDUs led to the infection of non-injecting sexual partners and, through vertical transmission, children. By the start of the 1990s, more than 100 000 people had already been infected with HIV, and HIV-related mortality ranked first in 1994 among the major causes of adult death and potential years of life lost. In the 1990s, intensified targeted interventions led to marked reductions in the number of newly reported cases among IDUs, MSM and female SWs.

As of December 2006, most of Spain's cumulative reported AIDS cases (63%) were IDUs. A further 16% had been infected heterosexually, and 14% were MSM. Spain has the largest cumulative total of AIDS cases, and the largest cumulative total of IDUs with AIDS, of any European country.

In 2006, AIDS cases were still most frequently found among IDU/ex-IDUs, however a decline of 15% since 2005 was reported. The number of AIDS cases among heterosexuals decreased by 8%, while the number of reported MSM cases remained stable. The vast majority of AIDS cases are seen in Madrid and Barcelona and the proportion of AIDS cases in people whose country of origin was not Spain, reached 21.2% in 2006. Of these cases 39.5% originated from Africa, 37% from Latin America, and 20.7% from Europe.

A study among male SW’s in 2002, found 12% to be infected with HIV, while a survey among SW’s attending medical facilities in 18 larger cities during 2003 showed 0.7% to be infected with HIV. Sentinel surveys at HIV testing centers in the period 2000 - 2004 have shown a relatively stable HIV prevalence of approximately 5% among MSM and 9-15% among IDUs.
A large proportion (almost 40%) of all people diagnosed with AIDS in 2006 was not aware that they were infected with HIV at the time of diagnosis. This tendency is most prevalent among MSM and heterosexuals.

The Spanish AIDS epidemic appears to have peaked in 1994, followed thereafter by a rapid decline in the number of annually reported cases: from 7428 new cases in 1994 to 1519 in 2006. The number of AIDS deaths peaked in the mid-1990s with approximately 5000 deaths annually. Since then, there has been a rapid decline in the number of deaths, reflecting the impact of HAART since its introduction in 1996.

3604 facilities across Spain provide HIV testing and testing is free of charge. According to national HIV testing policies, partner notification was not mandatory, nor was there a requirement or systematic testing of any particular individuals/groups.
In 2004, of all PLHIV seen for care, less than 10% were hepatitis B coinfected and 35-45% were coinfected with hepatitis C.

By the end of 2002, approximately 60 000 patients were receiving HAART in Spain. During 2006, about 100 000 PLHIV were seen for treatment of their condition, and an estimated 77 500 Spaniards (53% IDUs, 74% males) were receiving HAART. In addition, 34% of IDUs on HAART were also receiving opioid substitution therapy.

Updated 19 June 2008

References:

European Centre for Epidemiological Monitoring of AIDS (EuroHIV). HIV/AIDS surveillance in Europe. End-year report 2006. Saint-Maurice: Institut de Veille Sanitaire, 2007. No. 75.

Secretariat of the National Plan on AIDS. HIV/AIDS Epidemiological Surveillance in Spain, National register of AIDS cases, 2007. Semester Report nº 1, 2007. Spanish National Center of Epidemiology

WHO Regional Office for Europe. Sexually transmitted infections/HIV/AIDS programme. WHO/Europe survey on HIV/AIDS and antiretroviral therapy 2006. WHO: Copenhagen; 2007

The European HIV Prevalence Database: (webpage) http://eurohiv-database.invs.sante.fr