1. 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

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

3. 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 population
5.7
Percentage age 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

4. New HIV diagnoses, 2013, EU/EEA
HIV/AIDS Surveillance in Europe 2011
New HIV diagnoses, 2013, EU/EEA
Rate per 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

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

6. HIV diagnoses in females, 2013, EU/EEA
HIV/AIDS Surveillance in Europe 2011
HIV diagnoses in females, 2013, EU/EEA
Rate per 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

7. HIV diagnoses in males, 2013, EU/EEA
HIV/AIDS Surveillance in Europe 2011
HIV diagnoses in males, 2013, EU/EEA
Rate per 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

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

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

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

11. 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

12. 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 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

13. 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

14. 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 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

15. HIV/AIDS Surveillance in Europe 2011
Proportion HIV diagnoses among migrants*, by country of report, EU/EEA, 2013 (n= )
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

16. 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

17. HIV diagnoses, by mode of transmission, 2004-2013, EU/EEA
HIV/AIDS Surveillance in Europe 2011
HIV diagnoses, by mode of transmission, , 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

18. 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

19. 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

20. 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

21. AIDS cases reported, 2013, EU/EEA
HIV/AIDS Surveillance in Europe 2011
AIDS cases reported, 2013, EU/EEA
Rate per 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

22. 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

23. 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 ( ) 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.

24. 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.

25. HIV/AIDS Surveillance in Europe 2011 WHO European Region

26. 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
( )
26 847
4166
( )
Rate per population
7.8 (15.7)
6.3
2.2
22.7 (41.2)
Percentage age 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 .

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

28. 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

29. 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

30. 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

31. 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

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

33. 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

34. 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

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

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

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

38. 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

39. 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

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

41. 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

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

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

44. 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

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

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

47. 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

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

49. 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

50. 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 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

51. 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

52. 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

53. HIV/AIDS Surveillance in Europe 2011
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