HIV cases continue to rise in Europe: WHO European Region launches new action plan to bring the epidemic under control

Copenhagen, 30 November 2011

The HIV epidemic is still not under control, according to a new surveillance report issued today. Over 118 000 cases of HIV were diagnosed in Europe in 2010, according to new data from 51 of the 53 of Member States in the WHO European Region, which were released today by WHO/Europe and the European Centre for Disease Prevention and Control (ECDC). Over three quarters of newly reported infections were from the eastern part of the Region.

Since 2001, there has been a 2.5-fold increase in the total number of HIV infections reported in Europe. A cumulative total of 712 477 HIV infections was reported to WHO/Europe and ECDC by the end of 2010, points out the new report, “HIV/AIDS surveillance in Europe 2010”. In addition to these, at least 500 000 cases were diagnosed in the Russian Federation and almost 180 000 AIDS cases were diagnosed in countries with no HIV surveillance data from before 2002–2004 (France, Italy and Spain). The total cumulative number of people diagnosed with HIV in the Region can therefore be adjusted to about 1.4 million.

Faced with this alarming rise, the 53 Member States in the Region endorsed the new European Action Plan for HIV/AIDS 2012–2015, also officially released today.

“Current activities to reduce HIV infection rates are not enough to control and reverse the HIV epidemic in Europe. Above all, we need to address those who are most at risk, as they are often stigmatized and excluded from health and other social services, including HIV treatment. I am delighted that countries in Europe are committed to the new European Action Plan for HIV/AIDS, which addresses these issues and provides comprehensive solutions. Now is the time for action by all stakeholders, including governments and civil society, both inside the health sector and beyond,” says Zsuzsanna Jakab, WHO Regional Director for Europe.

Although the main transmission routes for HIV vary by geographical area, in all European countries the virus disproportionally affects groups that are socially marginalized (such as migrants) and people whose behaviour is socially stigmatized (such as men who have sex with men) or illegal (such as people who inject drugs). The new data confirm that the HIV epidemic in Europe remains concentrated in these key populations.

In eastern Europe and central Asia, 43% of the new cases reported in 2010 were in people who inject drugs, slightly less than the 48% in people infected through heterosexual contact. In recent years, eastern countries have experienced an increasing proportion of heterosexually transmitted HIV cases, which are likely to be associated with sexual transmission from drug injectors; the proportion of cases among men who have sex with men is low and likely to be underreported.

In the western part of the Region, the epidemic remains concentrated among men who have sex with men (accounting for 39% of newly diagnosed cases in 2010) and migrants from countries with generalized epidemics (accounting for at least a third of heterosexually acquired infections).

“Joint WHO/Europe and ECDC activities to collect and analyse data on the HIV epidemic in Europe have once again revealed crucial intelligence for responding to it in countries and regionally. The collaboration that we have been fostering since 2008 has been strengthened each year, and the fact that we have more countries reporting than ever before demonstrates this success,” says Marc Sprenger, Director of ECDC.

Underreporting of HIV

Because of low access to and uptake of HIV testing and counselling, especially among the populations most at risk of infection and transmission, all cases in Europe are not diagnosed. In the eastern European and central Asian countries that provided data to WHO on progress towards achieving universal access to HIV prevention, treatment and care services in 2008–2010, less than half of sex workers and only a third of men who have sex with men and people who inject drugs had received an HIV test in the previous 12 months and knew the results.

The “Global HIV/AIDS response – Epidemic update and health sector progress towards universal access: progress report 2011”, released today by WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Children’s Fund (UNICEF), shows that reported cases probably represent less than half of all people living with HIV across Europe. This group was estimated at 1.5 million people (range: 1.3–1.7 million) in eastern Europe and central Asia in 2010, including 160 000 (range: 110 000–200 000) who acquired the infection during the year. While the HIV epidemic appears to be stabilizing and declining in other regions – including sub-Saharan Africa, the Caribbean and South and South-East Asia – it continues to grow at an alarming and accelerating pace in Europe.

The estimated number of people dying from AIDS-related causes in eastern Europe and central Asia increased more than 11-fold between 2001 and 2010, from 7800 (range: 6000–11 000) to 90 000 (range: 74 000–110 000). AIDS-related deaths continue to rise in these countries, in contrast to most other regions.

Limited access to treatment

The biggest challenge to the HIV response in Europe is increasing access to effective and life-saving treatment, especially in eastern Europe and central Asia, where only 23% of those believed to need antiretroviral treatment were receiving it in 2010. This is well below the global average of 47% for low- and middle-income countries. The new data from the 2011 progress report reveal glaring inequities in access to treatment, especially for those most affected. For example, people who inject drugs represented 62% of the cumulative number of reported HIV cases with a known route of transmission, but 22% of those receiving antiretroviral therapy.

Mother-to-child transmission

Although the HIV epidemic continues its alarming spread in the European Region and treatment is not keeping pace with new infections, there are some reasons for optimism. To reduce mother-to-child transmission, the European Region had a rate of 88% coverage with antiretrovirals for HIV-positive pregnant women in 2010, surpassing the United Nations (1) target (80%) and the global average for low- and middle-income countries (59%).

European Action Plan

The new European Action Plan for HIV/AIDS 2012–2015, adopted in September 2011 by the 53 countries in the WHO European Region and officially released today, is an urgent call for action on this public health challenge.

“This dramatic surge in HIV cases would not be so worrying if we knew that countries were gearing up their response,” said Mr Martin Donoghoe, Programme Manager for HIV/AIDS, Sexually Transmitted Infections and Viral Hepatitis at WHO/Europe. “Parts of Europe, especially countries in the east, still need to introduce and scale up evidence-informed activities to curb the epidemic. The European Action Plan represents an excellent roadmap for national strategies and responses.”  

For further information, contact:

Martin Donoghoe
Programme Manager for HIV/AIDS, Sexually Transmitted Infections and Viral Hepatitis
WHO/Europe
Tel.: +45 39 17 12 07
E-mail: MDO@euro.who.int

Liuba Negru
Communications Officer
WHO/Europe
Tel: +45 39 17 13 44, +45 20 45 92 74 (mobile)
E-mail: LNE@euro.who.int

(1) Declaration of Commitment on HIV/AIDS. "Global Crisis — Global Action". New York, United Nations, 2001