HIV/AIDS burden still increasing in Europe

HIV-infection remains of major public health importance in Europe, with still increasing numbers of HIV cases being reported, especially in a number of countries adjacent to the EU. The incidence of AIDS continues to decline in Western and Central Europe, but has increased in Eastern European countries.

The prevalence of HIV infection in the EU is estimated at 700,000 people of whom 30% may not know of their infection. Data from 23 EU Member States (no national data available for Italy and Spain) showed that the number of new HIV cases amounted to about 25 – 30,000 in the year 2005.

The majority of new infections in the EU are in immigrants from countries with a generalised HIV epidemic and in men having sex with men (MSM). With the increased availability of efficient antiretroviral drugs, the incidence of AIDS is generally declining in the EU. Exceptions are Portugal and the Baltic States, where access to antiretroviral therapy may be more limited than elsewhere in the EU.

Variable transmission dynamics throughout Europe

In Eastern European countries where AIDS incidence is still increasing, the predominant transmission group for HIV is injecting drug users (IDU). Comorbidity is high in this group because of simultaneous infections with tuberculosis and/or hepatitis B or C. Tuberculosis is thus becoming an AIDS-defining illness in many European countries.

In Central and Western Europe, the predominant HIV transmission group is heterosexual, but there have also been increases in the number of new cases in the MSM group. About 50% of the heterosexual contact risk within the EU is attributable to infections in persons originating from high prevalence countries outside the EU. Heterosexual contact is now the largest overall risk factor in the EU at large. In some Member States (Czech Republic, Denmark, Germany, Greece, Hungary, the Netherlands, Slovenia) the largest risk group is MSM. In Latvia, Lithuania, Poland and probably Estonia, the largest risk group is IDU.

HIV testing should still be promoted; new prevention strategies needed

In all European regions HIV testing should be promoted to ensure early access to treatment and counselling to prevent disease progression and reduce further transmission. MSM remains the group with the highest risk in most EU countries for which new methods of implementing prevention messages are needed. HAART (Highly Active Antiretroviral Therapy) for people living with HIV (PLHIV) remains a major health policy target for EU Member States. A major policy issue is the question of how to reach the groups of immigrants from high-risk countries and their communities.