HIV/AIDS in the European Region

WHO

Experts reflect on the new WHO guidelines on the use of antiretroviral drugs for treating and preventing HIV infection

HIV infections in Europe continue to increase. Scaling up preventive measures and antiretroviral treatment is key to effectively addressing the epidemic.

Over 131 000 new HIV cases were reported in the WHO European Region in 2012, 10 000 more than in 2011, according to the latest surveillance report by the European Centre for Disease Prevention and Control (ECDC) and WHO/Europe. Of these new cases, almost 102 000 were in countries in eastern Europe and central Asia while just over 29 000 in countries in the European Union and the European Economic Area (EU/EEA).

The average incidence of HIV in the east of the Region (22.0 per 100 000) is more than 3 times that in the west (6.6 per 100 000) and 12 times that of the centre (1.9 per 100 000).

HIV transmission

HIV is still highly concentrated in key populations: men who have sex with men and people coming from countries with generalized HIV epidemics in the west of the Region, and people who inject drugs in eastern countries. Nevertheless, data for the last few years indicate a continuing increase in heterosexual transmission in the east. In 2012, it was the predominant transmission mode in many eastern countries, and accounted for close to 50% of cases in the Region as a whole.

New AIDS cases

The number of new AIDS cases per year has continued to decline in many countries in the west and centre of the Region, and continued to rise in the east. While reported AIDS cases declined by 54% in western countries, the number of people newly diagnosed with AIDS increased by 113% in the east between 2006 and 2012. New AIDS cases were over 3 times higher in the east than in the west and centre in 2012.

Role model for HIV testing and counselling: Denmark

Denmark is testing, treating and counselling people living with and affected by HIV/AIDS. It is estimated to have 5500–7500 people living with HIV (an adult prevalence of 0.2%).

At every testing facility in Denmark, HIV testing is free of charge, anonymous and accessible by all. In addition, many organizations test undocumented people living in Denmark free of charge. Testing is always combined with pre- and post-test counselling. If a rapid test turns out to be positive, the patient receives counselling and is referred to appropriate follow-up services and treatment.

European HIV testing and counselling initiative

HIV testing and counselling services must be continuously promoted and accessible by all, to ensure earlier diagnosis and linkage to care and the initiation of treatment. WHO/Europe supports the European Union (EU) initiative HIV testing week, taking place on 22–29 November 2013, to make more people aware of their HIV status and reduce late diagnosis by communicating the benefits of testing.

Antiretroviral therapy suboptimal

The rise in new HIV and AIDS cases in eastern Europe and central Asia is closely linked to poor coverage of testing, prevention measures and antiretroviral therapy (ART). While the number of people receiving ART increased by 45% from 2011 to 2012 (rising to almost 200 000), only about a third (35%) of the people who needed ART were receiving it. Coverage rates were much higher in countries in western Europe.

New guidelines to increase treatment coverage

In June 2013, WHO published new consolidated guidelines on the use of ART. They call on all countries to initiate treatment in adults living with HIV when their CD4 cell counts fall to or below 500 cells/mm³: when their immune systems are still strong. This updates the 2010 recommendation of offering treatment to those at or below 350 CD4 cells/mm³.

Implementation of the new guidelines will mean that more people in the Region are eligible for ART, preventing more people from developing AIDS and reducing further transmission of HIV infection. 

Equal access to HIV prevention, testing, treatment and care for all population groups throughout the Region is essential to reach the global goal of universal access for all in need.