2010 HIV/AIDS surveillance in Europe European Centre for Disease Prevention and Control, Stockholm WHO Regional Office for Europe, Copenhagen

2010

HIV/AIDS surveillance in Europe

European Centre for Disease Prevention and Control, StockholmWHO Regional Office for Europe, Copenhagen

2

HIV/AIDS surveillance

• Describes the HIV epidemic and its characteristics, and identifies population groups at risk and in need for targeted prevention measures.

• Monitors trends in HIV/AIDS over time in order to assess the situation and compare trends across Europe.

• Improves and harmonises European HIV/AIDS surveillance methods and catalyses national efforts to improve HIV/AIDS surveillance.

• Supplies relevant data for evidence-based public health policies.

3

HIV/AIDS surveillance in EuropeFramework for data collection

ECDC

Competent Bodies for surveillance

Provides non-EU/EEA HIV national contact

point nomination

HIV contact points nominated

Data sent to the joint HIV/AIDS database hosted by ECDC

Provide EU/EEAHIV national contact

point nomination

WHO EURO = 'Competent Body' for non-EU/EEA countries

Data validation performed by ECDC

WHO/EuropeHIV experts

ECDC HIV

experts

Full access to the HIV/AIDS

validated data

HIV national contact points

WHO/Europe As from 2008, ECDC and the WHO Regional Office for Europe jointly coordinate HIV/AIDS surveillance in 54 countries.

A sustainable surveillance system is crucial when informing about prevention efforts and healthcare planning.

European Union, Iceland and Norway

4

5

HIV infections diagnosed in 2010,WHO European Region and EU/EEA

• No data from Austria, Liechtenstein • ** Excludes individuals originating from countries with generalised epidemics.

Characteristics of cases

EU/EEA countries*

Number of HIV cases 27116Rate per 100 000 population 5.7Percentage of cases: Age 15–24 years 10.9%Female 26.3%Transmission mode Heterosexual 25%**Men who have sex with men 38%Injecting drug use 4%Unknown 15.1%

Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

< 22 to < 1010 to < 20≥ 20Missing or excluded data

HIV infections diagnosed, 2010All cases, EU/EEA

Rate as number per 100 000 population


< 11 to < 33 to < 5≥ 5Missing or excluded data

HIV infections diagnosed, 2010Men who have sex with men, EU/EEA

Rate as number per 100 000 male population


< 0.20.2 to < 11 to < 3≥ 3Missing or excluded data

HIV infections diagnosed, 2010Injecting Drug Use, EU/EEA

Rate as number per 100 000 population


9

HIV infections diagnosed 1984–2010, EU/EEA

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0

50000

100000

150000

200000

250000

300000

350000

400000

Cumulative totals

HIV diagnoses by year

Num

ber

of

case

s


10

HIV infection by transmission group and origin in EU/EEA, 2004–10

Predominant transmission group: men who have sex with men

Data were not included or not available from Austria, Estonia and Poland.


11

Heterosexually acquired HIV infections Proportion of cases among persons originating from countries with generalised epidemics, 2010


Portugal

Finland

Iceland

EU/EEA

Germany

Netherlands

Slovenia

Greece

Norway

Luxembourg

Ireland

Malta

Sweden

United Kingdom

Belgium

0 10 20 30 40 50 60 70

%

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Conclusions

• HIV infection is of major public health importance in Europe, with evidence of continuing transmission and no clear signs of decrease.

• Large heterogeneity exists in HIV epidemics in the EU/EEA:– Predominant mode of transmission is sex between

men.– Considerable proportion among heterosexually

acquired cases comes from countries with a generalised epidemic.

– Continued HIV transmission among IDUs in eastern EU countries.

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WHO European Region

14

HIV infections diagnosed in 2010 per 100 000 population: all cases


15

HIV infections diagnosed in 2010 per 100 000 male population: men who have sex with men


16

HIV infections diagnosed in 2010 per 100 000 population: injecting drug users


17

HIV infections diagnosed in 2010 per 100 000 population: heterosexual cases

Excludes persons from countries with generalised epidemics.


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Geographical areas: WHO European Region

West

Centre

East

19

HIV infections diagnosed in 2010 WHO European Region


Characteristics of cases

WHO Europea

n Region*

West* Centre* East

Number of HIV cases 118 335 25 659 2 478 90 198Rate per 100 000 population 13.7 6.6 1.3 31.7Percentage of cases Age 15–24 years** 11.6% 10.0% 17% 13%Female 38% 27% 19% 42%Transmission mode** Heterosexual 43% 24%*** 24% 48%Men who have sex with men 20% 39% 29% 0.7%Injecting drug use 23% 4% 4% 43%Unknown 13% 16% 41% 7%

*No data from the following countries: Austria, Liechtenstein, Monaco.** Countries with no data on age or transmission mode excluded.*** Excludes individuals originating from countries with generalised epidemics.

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HIV infections 1984–2010, WHO European Region

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0

100000

200000

300000

400000

500000

600000

700000

cumulative totals

HIV diagnoses by year

Num

ber

of

case

s

HIV infection in the three geographical areas and EU/EEA, WHO European Region, 2004–10

Data not reported or not available from Austria, Russia, Monaco.


2004 2005 2006 2007 2008 2009 20100

5

10

15

20

WestWest adjustedEU/EEAEU/EEA adjustedCentreEast

Case

s per

100 0

00 p

opula

tion

22

HIV infections, 2004–10: transmission groups in WHO European Region, East


2004 2005 2006 2007 2008 2009 20100

2000

4000

6000

8000

10000

12000

14000

IDUHeterosexual Men who have sex with menMother-to-child-transmission Other/undeterminedN

um

ber

of

case

s

HIV infections, 2004–09: transmission groups in WHO European Region, Centre

23Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

2004 2005 2006 2007 2008 2009 20100

100

200

300

400

500

600

700

Injecting drug usersHeterosexual casesMen who have sex with menMather-to-child-transmission-casesOthers

Num

ber

of

case

s

24

2004 2005 2006 2007 2008 2009 20100

0.5

1

1.5

2

2.5

West*EU/EEACentreEast**

Case

s per

100 0

00 p

opula

tion

AIDS diagnoses, 2004–10WHO European Region


Countries that have consistently reported AIDS since 2004 included: West Austria, Belgium, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Netherlands, Norway, Portugal, Spain, San Marino, Switzerland, United Kingdom; Centre: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, the former Yugoslav Republic of Macedonia, Hungary, Montenegro, Poland, Romania, Serbia, Slovakia, Slovenia; East: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kyrgyzstan, Latvia, Lithuania, Moldova, Tajikistan, Turkmenistan, Uzbekistan.

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Distribution of three most common AIDS indicative diseases by transmission group, WHO European Region, 2010

Candidiasis, oesophageal

Mycobacterium tuberculosis*

Pneumocystis pneumonia

Wasting syndrome due to HIV


Mycobacterium tuberculosis*


Kaposis sarcoma

Pneumocystis pneumonia

Hete

roID

UM

SM

0 100 200 300 400 500 600 700 800

Number of cases

*pulmonary in adults and adolescents

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Limitations of data

• Coverage:– Data from a number of countries is not reported to

TESSy and for several others reported at sub-national level.

• Reporting and testing:– Reporting systems may differ across countries; – Testing patterns may have changed over time.

• Data quality – Completeness is insufficient for several variables;– Under-reporting, reporting delays influence

interpretation of recent trends.

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Conclusions (1)

• HIV infection is a disease of major public health importance in Europe, with evidence of continuing HIV transmission in European countries.

• Overall, the number of diagnosed cases of HIV infection has shown no clear sign of decrease, while AIDS diagnoses continue to decline in the WHO European Region, except in several Eastern and Central European countries.

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Conclusions (2)

Heterosexual transmission:• increasing in many countries in the East; • in the West, a considerable proportion are individuals

originating from countries with generalised epidemic.

Transmission among injecting drug users: • continuing transmission in many countries in the East;• low-level epidemic in the West and Centre.

Transmission among men who have sex with men:• increasing and predominant epidemic in many countries in the

West;• increasing transmission in Central Europe.

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The full report is available from:www.ecdc.europa.eu2010

Documents

2010 HIV/AIDS surveillance in Europe European Centre for Disease Prevention and Control, Stockholm WHO Regional Office for Europe, Copenhagen