Health burden

The prognosis for people with HIV has changed considerably since the first cases of AIDS were diagnosed in the early 1980s. The use of Highly Active Antiretroviral Therapy (HAART) from the mid-1990s onwards, has led to dramatic improvements in the prognosis of people with HIV. By the end of 2006, HAART had become available in 51 out of the 53 countries in the WHO European region, but access to treatment varies between countries (WHO, 2006f). People living with HIV who receive HAART before the immune system is damaged, are drug-compliant and are able to tolerate the therapy, can live a more or less normal life span. However, many HIV infected people do not know their HIV status, and are in some cases too far advanced when finally diagnosed, to fully benefit from treatment and care.

Late presentation is detrimental for both individual morbidity and mortality, and for public health because people who are unaware of their HIV status can further spread the virus. Access to HIV testing, treatment and care is fairly good in western and central Europe, but remains a challenge in eastern Europe, in particular for intravenous drug users. In western Europe, migrant populations face more difficulties in accessing testing and treatment services.

Financial burden

HIV treatment is costly. The total cost comprises the costs of HAART, disease monitoring and hospitalisation. The costs of first line therapy (per patient per year) tend to vary considerably across Europe (estimates of average costs range between €600 and 14,000), depending on various factors such as financial support by the Global Fund for AIDS, TB and Malaria (Mounier-Jack et al., 2008).