HIV infection rates vary greatly across Europe

In 2006, 86,912 newly diagnosed HIV cases were reported from 50 of the 53 countries in the WHO European region, of which 26,220 (30%) cases were reported in the 27 countries of the European Union. The rate of HIV-infection varies considerably across Europe, as shown by the Newly diagnosed HIV infection rates in four European regions. The highest rates are observed in the East (210.8 per million population), nearly three times the rates reported in the west (82.5 per million) and over twenty times that in the centre (9.4 per million). Of the 27 EU member states, 16 are assigned to the ‘west’ region, eight to the ‘centre’ and three to the ‘east’. Due to the large proportion of western European countries within the EU, the epidemiology of HIV in the EU reflects that of the west region. It should be noted that the HIV-infection rate in western Europe is underestimated, due to the fact that no national data are reported for Italy and Spain (countries with high rates of HIV infection) (EuroHIV, 2007a, EuroHIV, 2007b).

HIV prevalence relatively low but on the rise in western and central Europe

An estimated 0.3% of the adult population in western and central Europe are infected by HIV (www.unaids.org). After the introduction of highly active antiretroviral therapy (HAART) in 1996, the number of AIDS cases and AIDS related deaths dropped significantly in Western Europe. However, the number of reported HIV infections has continued to rise. The parallel or diverging trends of newly diagnosed HIV and AIDS rates are shown in Trends in HIV incidence rates in selected countries, Newly diagnosed HIV infection rates in four European regions, Trends in AIDS incidence rates in selected countries, and Newly diagnosed AIDS cases in four European regions. The number of new HIV diagnoses among men who have sex with men (MSM) increased by almost 50% since 2000, underlining the need for renewed prevention efforts targeted at MSM. The increasing prevalence of infection among heterosexuals is largely due to immigration. The proportion of heterosexually acquired HIV cases in persons originating from high prevalence countries varied from 22% in Portugal to 71% in Belgium and Sweden, reinforcing the need to ensure that prevention and care services are adapted to reach immigrant populations (EuroHIV, 2007a, EuroHIV, 2007b).

HIV infection rate highest in Eastern Europe

HIV prevalence among adults living in eastern Europe is estimated at 0.9% (www.unaids.org). Although the rate of new HIV infections appears stable after the steep increase observed in 2001, an increase in the number of new HIV cases was again reported in 2005. Nearly 90% of the newly reported HIV diagnoses in this region in 2006 were from two countries: the Russian Federation (66%) and Ukraine (21%). A map shows the HIV cases diagnosed in the WHO European region, 2006. The corresponding AIDS incidence rates are shown by AIDS cases diagnosed in the WHO European region, 2006.

The HIV epidemic in eastern Europe is mainly driven by injecting drug use. Additionally, the number of infections that were reported as heterosexually acquired has doubled since 2005, which highlights the need for initiatives to control transmission in the heterosexually active population. The relative importance of four transmission routes is shown in Predominant transmission route for HIV by country.

Strong link between STI incidence and possible spread of HIV-infection

Having other sexually transmitted infections (STI) increases the risk of HIV infection for both men and women. The prevalence of HIV is relatively low in Europe and HIV infections are largely restricted to high risk groups. Therefore, the monitoring of HIV prevalence among STI patients can give an early indication of how HIV is likely to spread in the general population.

Tuberculosis is an AIDS-defining illness in Europe

In 2005, 33% of those with AIDS had been diagnosed as having tuberculosis (TB) as well, making TB an AIDS-defining illness. In eastern Europe over half of the AIDS cases (54%) were diagnosed with TB and in western and central Europe this was 22%. Thus, tuberculosis is one of the most important indicators of AIDS. In western European countries, the prevalence of TB among new AIDS cases is largely due to the immigration of persons from sub-Saharan African countries, while Kaposi sarcoma, another AIDS-defining illness, is more often related with sex between men.