ecdc.europa.eu Epidemiological Situation of HIV/AIDS in the EU and its Neighbouring Countries German Presidency Conference Responsibility & Partnership – Together Against HIV/AIDS 13 March 2007 Zsuzsanna Jakab Director, ECDC

Mid – late 1980s: HIV response in western Europe 25 years into the HIV epidemic 1981: first AIDS cases described 1996: Highly active antiretroviral treatment (HAART)

“Total media coverage of HIV/AIDS increased during the early 1980's, peaked in 1987, and declined steadily through 2001.” From Kaiser Family Foundation 2004 press release on AIDS at 21: media coverage of the HIV Epidemic * [* Following US based media] 25 years into the HIV epidemic

Presentation outline Geographic and time trends Populations at highest risk Implications for public health

Total: 39.5 (34.1–47.1) million Source: UNAIDS/WHO Adults and children estimated to be living with HIV in 2006

New AIDS Cases, deaths among persons with AIDS & people living with AIDS, 1986–2005, EU Data adjusted for reporting delays * Excluding Andorra, Netherlands and Norway: data not available for the whole period

New HIV diagnoses in the EU & EEA/EFTA countries,

HIV cases per million < Not available 100 Source: EuroHIV New HIV diagnoses reported in 2005 per million population, Europe

New HIV diagnoses in the EU15 and EEA/EFTA countries, Note: the graphs are on a different scale!

New HIV diagnoses in new EU Member States, Note: the graphs are on a different scale!

New HIV diagnoses in EU neighbouring countries Note: the graphs are on a different scale!

Source: EuroHIV Predominant mode of HIV transmission, cases reported in 2005 Heterosexual contact Men having sex with men Injecting drug users Data not available

New HIV diagnoses by mode of transmission, EU, * 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.

New HIV diagnoses in persons infected through heterosexual contact, EU,

Age at HIV diagnosis by sex Cases reported in the EU in 2005

Median age at HIV diagnosis by country Median age at HIV diagnosis in the EU: 35 years

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

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

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%).

Sex workers 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.

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.

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 Jun 26;20(10):

Migrant populations

% from a country with a originating generalised epidemic among heterosexually infected persons diagnosed with HIV in 2005 Source: EuroHIV

Conclusions HIV remains a major public health problem both in the EU and in neighbouring countries; Priorities for prevention in the EU –Increasing uptake of HIV testing and counselling; –Strengthening prevention and care in high-burden countries; –Developing innovative prevention approaches for men having sex with men; –Providing specific services for migrant communities; HIV is a global epidemic and the EU response needs to be seen in this context.

ecdc.europa.eu Thank you ! Zsuzsanna Jakab Director, ECDC