HIV/AIDS Surveillance in Europe 2011 HIV/AIDS Surveillance in Europe 2013 HIV/AIDS Surveillance in Europe European Centre for Disease Prevention and Control, Stockholm WHO Regional Office for Europe, Copenhagen

HIV/AIDS Surveillance in Europe 2011 European Union and European Economic Area (EU/EEA)

HIV diagnoses in the EU/EEA, 2013 HIV/AIDS Surveillance in Europe 2011 HIV diagnoses in the EU/EEA, 2013 Reporting countries/Number of countries 30/31 Number of HIV diagnoses 29 157 Rate per 100 000 population 5.7 Percentage age 15-24 years 10.9 Male-to-female ratio 3.3 Transmission mode (%)   Sex between men 42 Heterosexual 32 Injecting drug use 5 Mother to child transmission <1 Unknown 20 Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

New HIV diagnoses, 2013, EU/EEA HIV/AIDS Surveillance in Europe 2011 New HIV diagnoses, 2013, EU/EEA Rate per 100 000 population > 20 10 to <20 2 to <10 < 2 Not included or not reporting Non-visible countries Lichtenstein Luxembourg Malta Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 Male-to-female ratio, new HIV diagnoses, by country, EU/EEA, 2013 (n= 29 086) Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV diagnoses in females, 2013, EU/EEA HIV/AIDS Surveillance in Europe 2011 HIV diagnoses in females, 2013, EU/EEA Rate per 100 000 female population > 20 10 to <20 2 to <10 < 2 Not included or not reporting Non-visible countries Lichtenstein Luxembourg Malta Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV diagnoses in males, 2013, EU/EEA HIV/AIDS Surveillance in Europe 2011 HIV diagnoses in males, 2013, EU/EEA Rate per 100 000 male population > 20 10 to <20 2 to <10 < 2 Not included or not reporting Non-visible countries Lichtenstein Luxembourg Malta Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Proportion of HIV diagnoses, by route of transmission, 2013, EU/EEA Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Proportion of HIV diagnoses, males, by route of transmission, 2013, EU/EEA Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Proportion of HIV diagnoses, females, by route of transmission, 2013, EU/EEA Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Percentage of new HIV diagnoses, per age group and transmission mode, EU/EEA, 2013 (n=22 472) Injecting drug use Heterosexual (from generalised epidemic countries) Heterosexual (excluding persons from generalised epidemic countries) Sex between men Data from persons <15, other/unknown transmission, mother-to-child transmission, transfusion-related transmission, and nosocomial transmission not shown here. Data from Estonia and Poland excluded. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV diagnoses attributed to sex between men, 2013, EU/EEA HIV/AIDS Surveillance in Europe 2011 HIV diagnoses attributed to sex between men, 2013, EU/EEA Rate per 100 000 male population > 5 3 to <5 1 to <3 < 1 Not included or not reporting Non-visible countries Lichtenstein Luxembourg Malta Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 Percentage of new HIV diagnoses* acquired through sex between men, EU/EEA, 2013 (n=23 416) Percentage * Out of all reported HIV diagnoses with known mode of HIV transmission; No cases reported from Iceland in 2013 Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV diagnoses acquired through injecting drug use, 2013, EU/EEA HIV/AIDS Surveillance in Europe 2011 HIV diagnoses acquired through injecting drug use, 2013, EU/EEA Rate per 100 000 population > 5 3 to <5 1 to <3 < 1 Not included or not reporting Non-visible countries Lichtenstein Luxembourg Malta Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 Proportion HIV diagnoses among migrants*, by country of report, EU/EEA, 2013 (n= 29 157) Percentage * Among cases with known region of origin; There were no cases reported among migrants in Croatia, Latvia or Poland Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 Rate of reported HIV diagnoses, by year of diagnosis, in the EU/EEA, 1984–2013 Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV diagnoses, by mode of transmission, 2004-2013, EU/EEA HIV/AIDS Surveillance in Europe 2011 HIV diagnoses, by mode of transmission, 2004-2013, EU/EEA Injecting drug use Heterosexual (from generalised epidemic countries) Heterosexual (excluding persons from generalised epidemic countries) Sex between men Unknown Mother-to-child transmission Data is adjusted for reporting delay. Cases from Estonia and Poland excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 Proportion of HIV cases diagnosed late (CD4<350 cells/mm3), 2013, EU/EEA > 50% 40 to 50% 30 to <40% < 30% Not included or not reporting Non-visible countries Lichtenstein Luxembourg Malta *Among cases with CD4 count at diagnosis reported Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Proportion of HIV cases with CD4 cell count <350/mm3 and <200/mm3 at diagnosis, by mode of transmission, EU/EEA, 2013 (n=17 526) Percentage Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Percentage of reported cases with a CD4 cell count <350/mm3 and <200/mm3 at diagnosis, by age category, EU/EEA, 2013 (n=17 526) Percentage Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

AIDS cases reported, 2013, EU/EEA HIV/AIDS Surveillance in Europe 2011 AIDS cases reported, 2013, EU/EEA Rate per 100 000 population > 5 3 to <5 1 to <3 < 1 Not included or not reporting Non-visible countries Lichtenstein Luxembourg Malta Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 Most common AIDS-indicative diseases by transmission mode, EU/EEA, 2013 Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 Conclusions (1) HIV infection is of major public health importance in the EU/EEA, with no clear signs of overall decrease. During the past decade (2004-2013) there have been important epidemiological changes in HIV diagnoses in the EU/EEA: Sex between men accounted for the majority of cases diagnosed in 2013 and cases in this group increased by 33%; Heterosexual cases declined, driven by a 61% decline among those from countries with generalised HIV epidemics Still, 35% of HIV diagnoses in 2013 were among people originating from outside the reporting country HIV cases attributed to injecting drug use declined by 36%, with an increase since 2011 in two countries due to localised outbreaks Nearly half (47%) of newly reported cases were diagnosed late, with a CD4 cell count <350/mm3.

HIV/AIDS Surveillance in Europe 2011 Conclusions (2) Evidence-based HIV prevention interventions tailored to the local epidemiological context and targeted at those most at risk should be sustained and scaled-up. Programmes for men who have sex with men should be a cornerstone of HIV prevention in all EU/EEA countries Given the high proportion of HIV cases among migrants in many EU/EEA countries, migrant sensitive prevention services is crucial Keeping harm reduction levels high will continue to prevent HIV among people who inject drugs Expansion of HIV counselling and testing will ensure early diagnosis and access to treatment; this will reduce the number of late presenters and improve treatment outcomes.

HIV/AIDS Surveillance in Europe 2011 WHO European Region

Characteristics of HIV diagnoses reported in the WHO European Region, the EU/EEA, and by geographical area, 2013 Geographical areas WHO European Region* West Centre East* Reporting countries/Number of countries 50/53 (51/53) 23/23 15/15 13/15 (14/15) Number of HIV diagnoses 56 507 (136 235) 26 847 4166 25 494 (105 222) Rate per 100 000 population 7.8 (15.7) 6.3 2.2 22.7 (41.2) Percentage age 15-24 years 10.2% 10.3% 14.4% 9.5% Male-to-female ratio 2.2 (1.7) 3.3 4.9 1.3 (1.4) Transmission mode   Men who have sex with men 23.6% (10.1%) 43.1% 30.1% 2% (0.8%) Heterosexual 46.1% (30.6%) 33.6% 24.8% 62.7% (30.0%) Injecting drug use 16.2% (21.3%) 4.1% 5.9% 30.6% (26.3%) Mother to child transmission 0.9% (0.6%) 0.7% 1.1% 1.1% (0.6%) Unknown 13% (37.3%) 18.2% 37.9% 3.6% (42.2%) No data received from Lichtenstein, Turkmenistan or Uzbekistan. *Figures including Russia are presented for the WHO Region and East in (brackets) Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013; data for Russia which were published by the Russian Federal Scientific and Methodological Center for Prevention and Control of AIDS .

Rate of new HIV diagnoses, EU/EEA and WHO European Region, 1984–2013 Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Cumulative number of new HIV diagnoses in the EU/EEA and other countries of the WHO European Region, 1984–2013 Data from Russia not included Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Rates of new HIV diagnoses, by geographical area and year of diagnosis, WHO European Region, 2004–2013 Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2004–2013 Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Estonia, Poland and Turkey excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Data are not adjusted for reporting delays and numbers of cases reported for recent years are likely to increase in future reports. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Rate of AIDS cases per 100 000 population, by geographical area and year of diagnosis, 2004-2013 Cases from Sweden, Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

New HIV diagnoses, 2013 Rate per 100 000 population HIV/AIDS Surveillance in Europe 2011 New HIV diagnoses, 2013 Rate per 100 000 population No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

New HIV diagnoses in females, 2013 Rate per 100 000 female population No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

New HIV diagnoses in males, 2013 Rate per 100 000 male population No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

New HIV diagnoses attributed to heterosexual transmission, 2013 Rate per 100 000 population No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

New HIV diagnoses attributed to injecting drug use, 2013 Rate per 100 000 population No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

New HIV diagnoses attributed to sex between men, 2013 Rate per 100 000 male population No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

AIDS cases diagnosed, 2013 Rate per 100 000 population No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Geographical/epidemiological division of the WHO European Region HIV/AIDS Surveillance in Europe 2011 Geographical/epidemiological division of the WHO European Region West East Centre Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 WHO European Region: East

New HIV diagnoses, by transmission mode and year of diagnosis, East, 2004-2013 Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Estonia excluded due to incomplete reporting on transmission mode during the period Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Most common AIDS-indicative diseases by transmission mode, East, 2013 Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 WHO European Region: Centre

New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2004-2013 Cases from Poland and Turkey excluded due to incomplete reporting on transmission mode during the period Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Most common AIDS-indicative diseases by transmission mode, Centre, 2013 Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 WHO European Region: West

New HIV diagnoses, by transmission mode and year of diagnosis, West, 2004-2013 Cases from Spain and Italy excluded due to increasing national coverage of reporting during the period. Data are not adjusted for reporting delay and numbers of cases reported for recent years are likely to increase in future reports. Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

Most common AIDS-indicative diseases by transmission mode, West, 2013 Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013

HIV/AIDS Surveillance in Europe 2011 Data limitations Data completeness Data lacking from a small number of countries Reporting and testing Reporting systems may differ across countries, and testing patterns are subject to change over time Data quality Completeness remains low for select variables for some countries (transmission route, CD4 at diagnosis) Under-reporting and reporting delays influence interpretation of the most recent trends

HIV/AIDS Surveillance in Europe 2011 Conclusions (1) HIV infection remains of major public health importance in Europe, with continuing HIV transmission and an overall 80% increase in new HIV diagnoses in 2013 compared to 2004 Wide geographic variation in rates of new HIV diagnoses per 100 000 population: 41.2 in the East; 6.3 in the West and 2.2 in the Centre Almost half (49%) of new HIV cases were diagnosed late (CD4<350/mm3) and more than a quarter (27%) were diagnosed with advanced HIV infection (CD4<200/mm3) New AIDS diagnoses increased three-fold in the East but continued to decrease in the West

HIV/AIDS Surveillance in Europe 2011 Conclusions (2) Heterosexual transmission Increasing and predominant in most countries in the East A considerable proportion is diagnosed in people originating from countries with generalised epidemics in the West Injecting drug use Continuing but decreasing transmission in many countries in the East Low-level in the West and Centre, two recent outbreaks aside Men who have sex with men Increasing and predominant in most countries in the West and Centre Low but rapidly increasing in the East

HIV/AIDS Surveillance in Europe 2011 Conclusions (3) Countries in the East Evidence based policies targeting key populations, including harm reduction programmes and early access to treatment for people who inject drugs, should remain the cornerstone of the HIV response Heterosexual transmission in couples where one partner is engaged in high-risk behaviour to be strengthened Antiretroviral therapy should be used strategically to treat and prevent HIV transmission and reduce the growing number of AIDS cases. Countries in the Centre and West Interventions to prevent, test and treat HIV among men who have sex with men remains the priority Access to services for migrant populations must be ensured Harm reduction programmes to prevent outbreaks among people who inject drugs need to be maintained or scaled-up

HIV/AIDS Surveillance in Europe 2011 Full report and tables and can be downloaded at: www.ecdc.europa.eu and www.euro.who.int/aids