1. ecdc.europa.eu Estonian Ministry of Social Affairs 23 November 2007 Zsuzsanna Jakab Director, ECDC Press Briefing on HIV/AIDS

2. Purpose of today’s press conference To celebrate World AIDS Day and remember the millions of people suffering from HIV/AIDS across the globe; To focus attention on Estonia, which is the country with the highest infection rate in the EU; To launch the annual EuroHIV Report on HIV/AIDS surveillance in Europe.

3. Why was ECDC established? Emerging and re-emerging communicable diseases revitalised through globalisation, bioterrorism, interconnectivity, and EU without internal borders Health implications of enlarging EU Strengthen EU Public health capacity to help meet EU citizen’s concerns

4. EU level disease surveillance Scientific opinions and studies Early Warning system and response Technical assistance and training Epidemic intelligence Communication to scientific community Communication to the public What does ECDC do? Identify, assess & communicate current & emerging health threats to human health from communicable diseases

5. How is ECDC organised? Administrative Services Health communication Preparedness & response SurveillanceScientific advice Director and Director's Cabinet Management Governance External relations Country cooperation Antimicrobial resistance & healthcare-associated infections Food- & waterborne diseases HIV, STI & Hepatitis Influenza Other diseases of environmental & zoonotic origin Tuberculosis Vaccine preventable diseases & invasive bacterial infections

6. ECDC role in HIV/AIDS prevention Despite many EU & national initiatives, HIV infection remains a major public health concern across the EU; ECDC called on by EU Health Commissioner to evaluate and assess national control programmes, and provide support to Member States, particularly to strengthen prevention and care in high burden countries; ECDC/WHO-EURO to take over the European HIV surveillance activities as from 2008, crucial for informing prevention efforts and health care planning; ECDC priority to reduce barriers to HIV testing - we estimate that 30% of people living with HIV in EU are unaware of infection - and will be working on scientific guidance to achieve this; HIV/AIDS will be a HIGH priority in the years to come.

7. Total: 33.2 (30.6–36.1) million Source: UNAIDS/WHO Adults and children estimated to be living with HIV in 2007 75 000 1.3 million 1.6 million 230 000 22.5 million 380 000 760 000 1.6 million 800 000 4.0 million

8. 10 76 4 12 14 9 504 62 8 130 29 8 148 20 8 275 5 17 288 14 HIV cases per million < 20 20 - 99 100 - 199 200+ 205 92 80 149 37 41 37 45 95 65 33 53 51 72 4 Not available 104 Source: EuroHIV New HIV diagnoses reported in 2006 per million population, Europe

9. New HIV diagnoses 2001-2006 EU & EEA/EFTA countries

10. New HIV diagnoses 2001-2006 per million pop, EU15 and EEA/EFTA countries Note: the graphs are on a different scale!

11. New HIV diagnoses 2001-2006 per million pop, Member States which have joined EU since 2004 Note: the graphs are on a different scale!

12. New HIV diagnoses 2001-2006 per million pop, EU neighbourhood Note: the graphs are on a different scale!

13. Source: EuroHIV Predominant mode of HIV transmission, cases reported in 2006 Heterosexual contact Men having sex with men Injecting drug users Data not available

14. New HIV diagnoses by mode of transmission, EU, 1996-2006 * Countries with data available for the whole period: Belgium, Cyprus, Czech Republic, Denmark, Finland, Germany, Greece, Hungary, Ireland, Latvia, Lithuania, Luxembourg, Poland, Slovakia, Slovenia, Sweden, United Kingdom.

15. Median age at HIV diagnosis by country (2005) Median age at HIV diagnosis in the EU: 35 years

16. Men having sex with men MSM are the group at highest risk for acquiring HIV in many countries; HIV prevalence: 5 - 15%; HIV incidence: ~3% per year; Multiple epidemics of other STI (syphilis, gonorrhoea, LGV); Resurgence of high risk sexual behaviours.

17. New drugs & new technologies influencing high risk sexual behaviours in men having sex with men Viagra Crystal methamphetamin Internet

18. Injecting Drug Users Steady declines in unsafe injection practices and HIV prevalence in most western European countries; BUT HIV prevalence remains very high (>25%) in eastern Europe and in some cities of western Europe; Very high prevalence of hepatitis C (>60%).

19. Major transformation in the sex industry worldwide; Western Europe: Relatively low HIV prevalence, <2%; Little effect on the initial spread of HIV; HIV remains highly associated with drug use; Shift to a primarily migrant workforce; Eastern Europe: Close relationship between sex work and IDU. Sex workers

20. People living with HIV The number of people living with HIV keeps increasing; In the EU, an estimated 30% of people living with HIV are not aware of their infection; These people disproportionately contribute to the spread of HIV.

21. Awareness of Serostatus Among People with HIV and Estimates of Transmission ~25% Unaware of Infection ~75% Aware of Infection People Living with HIV/AIDS: 1,039,000-1,185,000 New Sexual Infections Each Year: ~32,000 Accounting for: ~54% of New Infections ~46% of New Infections Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006 Jun 26;20(10):1447-50.

22. % from a country with a originating generalised epidemic among heterosexually infected persons diagnosed with HIV in 2006 Source: EuroHIV

23. Latvia Estonia Cases per millio n HIV infections newly diagnosed 1996-06 per million pop, Baltic States EuroHIV Lithuania Update at 31 December 2006

24. Latvia AIDS incidence 1988-2006 per million pop, EU as a whole compared to Baltic States Data adjusted for reporting delays Update at 31 December 2006 Estonia Lithuania

25. Situation in Estonia Estonia has the highest rate of new HIV diagnoses in Europe (504 new cases per million inhabitants); Spread of HIV associated with injecting drug use - Young males; - High infection rate; - Most are non-Estonian ethnic background However, HIV is increasingly spread through heterosexual contact The proportion of women has increased from 20% in 2000 to 36% in 2006.

26. ECDC supporting Estonia ECDC delegation first visited Estonia in April 2007 to review, together with the country experts, the status of HIV & STI surveillance, prevention and control; As a result, we agreed a number of areas for ECDC support, including −Sharing good practice and providing technical support in surveillance; −Assisting with reviews of HIV estimates; −Providing advice on development of prevention and media campaigns; −Scientific guidelines on HIV/AIDS & STI testing.

27. Conclusions Priorities for prevention in the EU −Securing HIV surveillance activities to inform prevention & healthcare planning; −Reducing barriers to HIV testing, including scientific guidance to achieve this; −Developing innovative prevention approaches for MSM; −Providing specific services for migrant communities; −Strengthening prevention and care in high-burden countries such as Estonia ECDC is supportive of the work being done by the Estonian government to reverse the trend of increasing HIV infection rates; Political commitment is key – what happens in Estonia is important for whole EU.

28. ecdc.europa.eu Thank you ! Zsuzsanna Jakab Director, ECDC info@ecdc.eu.int info@ecdc.eu.int