HIV rising in Europe
HIV/AIDS is a major public health challenge in the WHO European Region, and evidence indicates that HIV transmission is rapidly increasing in many countries. Countries in the eastern part of the Region now have the fastest-growing HIV epidemic in the world.
The latest reports on the global HIV epidemic and the situation in the European Region highlight the need to increase efforts to halt the spread of HIV, especially in key populations, such as injecting drug users, sex workers, prisoners and men who have sex with men.
Global situation improving; Europe’s causing concern
The Joint United Nations Programme on HIV/AIDS (UNAIDS) report on the global AIDS epidemic, released on 23 November 2010, emphasizes global success in curbing the HIV epidemic: new HIV infections and AIDS-related deaths are decreasing. In eastern Europe and central Asia, however, the number of people living with HIV almost tripled between 2000 and 2009, and AIDS-related deaths continued to rise. An estimated 1.4 million (1.3–1.6 million) people in these countries were living with HIV in 2009.
In addition, the joint report by WHO/Europe and European Centre for Disease Prevention and Control (ECDC) on HIV/AIDS surveillance in Europe in 2009, launched on 1 December 2010, finds numbers of HIV cases increasing in both western and eastern countries in the European Region. In 2009, 49 of the 53 countries in the Region reported 53 427 newly diagnosed HIV cases (data were not available from Austria, Monaco, Russian Federation or Turkey). An additional 58 448 new cases were registered in 2009 in the Russian Federation, according to the official Progress Report of the Russian Federation on the implementation of the Declaration of the commitment on HIV/AIDS January 2008 – December 2009. Between 2004 and 2009, HIV incidence rose by almost 30%: from 6.6 to 8.5 per 100 000 population (based on the 49 countries consistently reporting surveillance data to WHO and ECDC).
Although more people received antiretroviral therapy (ART) in 2009 than in 2008, coverage among low- and middle-income countries in Europe and central Asia remains critically low. According to a progress report by WHO, UNAIDS and the United Nations Children's Fund (UNICEF), only 19% of those in need in eastern Europe and central Asia received the life-saving treatment in 2009.
Socially marginalized most at risk
The HIV epidemic in the European Region is concentrated in socially marginalized groups. Those most at risk include people who inject drugs and their sexual partners, men who have sex with men, sex workers, prisoners and migrants. They face structural barriers that restrict access to HIV prevention, diagnosis, treatment and care services; these need to be dismantled. The barriers include the criminalization of behaviour, stigma and discrimination, and restrictions, rules and regulations both within and outside the health care system.
What can be done
Although the epidemic continues to increase at an alarming rate, the countries in the European Region can change the situation. Projects and interventions implemented in the Region have generated sufficient scientific evidence and experience to support the development of policies and interventions that could drive an effective response to the HIV epidemic. Strengthening political mobilization and leadership in the response and concentrating on key populations have demonstrated value.
WHO/Europe is leading the development of a European action plan on HIV/AIDS to guide Member States and stakeholders working in the health sector in 2011–2015. The European action plan will be framed by the global health sector strategy for HIV/AIDS for this period (due to be adopted by the World Health Assembly in May 2011) and its four strategic directions:
- to optimize HIV prevention, diagnosis, treatment and care outcomes;
- to leverage broader health outcomes through HIV responses;
- to build strong and sustainable systems; and
- to reduce vulnerability and structural barriers to accessing high-quality services.
WHO/Europe will seek contributions to the action plan from a range of constituencies and key stakeholders, including Member States; civil-society, donor and development agencies; nongovernmental organizations; multilateral agencies; scientific and technical institutions and networks; the private sector; and leaders and experts in HIV and related programmes. The development process will include web-based and in-country consultations and a regional meeting with key stakeholders. The draft action plan will be submitted to the Standing Committee of the Regional Committee in March 2011 and to the WHO Regional Committee for Europe, WHO/Europe’s governing body, in September 2011.