2010 HIV/AIDS surveillance in Europe European Centre for Disease Prevention and Control, Stockholm WHO Regional Office for Europe, Copenhagen

HIV/AIDS surveillance Describes the HIV epidemic and its characteristics, and identifies population groups at risk and in need for targeted prevention measures. Monitors trends in HIV/AIDS over time in order to assess the situation and compare trends across Europe. Improves and harmonises European HIV/AIDS surveillance methods and catalyses national efforts to improve HIV/AIDS surveillance. Supplies relevant data for evidence-based public health policies. 1

HIV/AIDS surveillance in Europe Framework for data collection 2 ECDC Competent Bodies for surveillance Provides non-EU/EEA HIV national contact point nomination HIV contact points nominated Data sent to the joint HIV/AIDS database hosted by ECDC Provide EU/EEA HIV national contact point nomination WHO EURO = 'Competent Body' for non-EU/EEA countries Data validation performed by ECDC WHO/Europe HIV experts ECDC HIV experts Full access to the HIV/AIDS validated data HIV national contact points WHO/Europe As from 2008, ECDC and the WHO Regional Office for Europe jointly coordinate HIV/AIDS surveillance in 54 countries. A sustainable surveillance system is crucial when informing about prevention efforts and healthcare planning.

European Union, Iceland and Norway 3

HIV infections diagnosed in 2010, WHO European Region and EU/EEA 4 No data from Austria, Liechtenstein ** Excludes individuals originating from countries with generalised epidemics. Characteristics of cases EU/EEA countries* Number of HIV cases Rate per population 5.7 Percentage of cases: Age 15–24 years 10.9% Female 26.3% Transmission mode Heterosexual 25%** Men who have sex with men 38% Injecting drug use 4% Unknown 15.1% Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

< 2 2 to < to < 20 ≥ 20 Missing or excluded data HIV infections diagnosed, 2010 All cases, EU/EEA Rate as number per population Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

< 1 1 to < 3 3 to < 5 ≥ 5 Missing or excluded data HIV infections diagnosed, 2010 Men who have sex with men, EU/EEA Rate as number per male population Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

< to < 1 1 to < 3 ≥ 3 Missing or excluded data HIV infections diagnosed, 2010 Injecting Drug Use, EU/EEA Rate as number per population Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

HIV infections diagnosed 1984–2010, EU/EEA 8 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

HIV infection by transmission group and origin in EU/EEA, 2004–10 9 Predominant transmission group: men who have sex with men Data were not included or not available from Austria, Estonia and Poland. Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

Heterosexually acquired HIV infections Proportion of cases among persons originating from countries with generalised epidemics, Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

Conclusions HIV infection is of major public health importance in Europe, with evidence of continuing transmission and no clear signs of decrease. Large heterogeneity exists in HIV epidemics in the EU/EEA: –Predominant mode of transmission is sex between men. –Considerable proportion among heterosexually acquired cases comes from countries with a generalised epidemic. –Continued HIV transmission among IDUs in eastern EU countries. 11

12 WHO European Region

HIV infections diagnosed in 2010 per population: all cases 13 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

HIV infections diagnosed in 2010 per male population: men who have sex with men 14 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

HIV infections diagnosed in 2010 per population: injecting drug users 15 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

HIV infections diagnosed in 2010 per population: heterosexual cases 16 Excludes persons from countries with generalised epidemics. Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

Geographical areas: WHO European Region 17 West Centre East

HIV infections diagnosed in 2010 WHO European Region 18 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010 Characteristics of cases WHO European Region* West*Centre*East Number of HIV cases Rate per population Percentage of cases Age 15–24 years** 11.6%10.0%17%13% Female 38%27%19%42% Transmission mode** Heterosexual 43%24%***24%48% Men who have sex with men 20%39%29%0.7% Injecting drug use 23%4% 43% Unknown 13%16%41%7% *No data from the following countries: Austria, Liechtenstein, Monaco. ** Countries with no data on age or transmission mode excluded. *** Excludes individuals originating from countries with generalised epidemics.

HIV infections 1984–2010, WHO European Region 19

HIV infection in the three geographical areas and EU/EEA, WHO European Region, 2004–10 20 Data not reported or not available from Austria, Russia, Monaco. Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

HIV infections, 2004–10: transmission groups in WHO European Region, East 21 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

HIV infections, 2004–09: transmission groups in WHO European Region, Centre 22 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

AIDS diagnoses, 2004–10 WHO European Region 23 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010 Countries that have consistently reported AIDS since 2004 included: West Austria, Belgium, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Netherlands, Norway, Portugal, Spain, San Marino, Switzerland, United Kingdom; Centre: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, the former Yugoslav Republic of Macedonia, Hungary, Montenegro, Poland, Romania, Serbia, Slovakia, Slovenia; East: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kyrgyzstan, Latvia, Lithuania, Moldova, Tajikistan, Turkmenistan, Uzbekistan.

Distribution of three most common AIDS indicative diseases by transmission group, WHO European Region, *pulmonary in adults and adolescents

Limitations of data Coverage: –Data from a number of countries is not reported to TESSy and for several others reported at sub-national level. Reporting and testing: –Reporting systems may differ across countries; –Testing patterns may have changed over time. Data quality –Completeness is insufficient for several variables; –Under-reporting, reporting delays influence interpretation of recent trends. 25

Conclusions (1) HIV infection is a disease of major public health importance in Europe, with evidence of continuing HIV transmission in European countries. Overall, the number of diagnosed cases of HIV infection has shown no clear sign of decrease, while AIDS diagnoses continue to decline in the WHO European Region, except in several Eastern and Central European countries. 26

Conclusions (2) Heterosexual transmission: increasing in many countries in the East; in the West, a considerable proportion are individuals originating from countries with generalised epidemic. Transmission among injecting drug users: continuing transmission in many countries in the East; low-level epidemic in the West and Centre. Transmission among men who have sex with men: increasing and predominant epidemic in many countries in the West; increasing transmission in Central Europe. 27

28 The full report is available from: