Europe still has a long road ahead in its fight against HIV, according to a new report by the European Centre for Disease Prevention and Control (ECDC), which identifies key targets such as prevention, testing, and ending discrimination.
The United Nations Global AIDS Strategy aims to end AIDS as a public health threat by 2030 with all countries reaching a 95% target compliance rate by 2025, to ensure they are on track.
But while HIV infections and AIDS mortality rates are decreasing in Europe, the region is still far from ending the AIDS epidemic by 2030 as “progress is variable across the region”, notes the report.
This report shows that only 83% of people with HIV know they are infected; out of them, 85% are being treated, a far cry from the target of 95% by 2025.
The number of new HIV infections in Europe and Central Asia remains high, with over 33000 new infections in 2021, despite advances in HIV prevention and increased accessibility to prevention services, such as PrEP (pre-exposure prophylaxis) – medicine that reduces chances of getting HIV from sex or injection drug use.
While in comparison to 2010, there is a 34% decrease in the number of yearly infections, it is far from the targeted 90% decrease.
According to the Joint United Nations Programme on HIV and AIDS (UNAIDS), 8,077 people died from AIDS-related causes in 2021, representing a 63% decrease since 2010. The target is set to reach zero AIDS-related deaths.
Another guideline for tracking the HIV situation is the number of people receiving antiretroviral therapy that reach viral suppression. Currently, the number is at 93%, only 2% below the target.
These numbers show that none of the targets have been reached yet despite having only two more years to the deadline set by UNAIDS. To accelerate the pace, the report identifies the main areas in which work is needed: focussing on prevention, increasing accessible testing, and ending stigma and discrimination.
For prevention, PrEP is a very effective tool, and its availability has increased in Europe in the last years, however, it is still not accessible in 17 countries. The report calls on governments to investigate the barriers to access to this medication and create monitoring systems to know the population at risk better.
The same is needed to improve treatment access, for which ECDC encourages countries to implement new testing interventions such as community and self-testing, a method that is gaining popularity as it allows you to take the test at home and get the result within 20 minutes.
The report highlights the most vulnerable groups, as they are most affected by the barriers to accessing treatment. These key population groups include prisoners, sex workers, undocumented migrants, people who inject drugs, men who have sex with other men and transgender people.
They also suffer the most stigma and discrimination, which can lead to the non-disclosure of their condition or risk factors to their close environment and even healthcare professionals.
Differences between countries
ECDC’s publication shows the differences between regional countries regarding implementing the recommendations and working towards the common target.
Countries like Norway, Sweden, Germany and Spain are above the 95% target of people receiving treatment after being diagnosed with HIV, while Latvia, Albania and Moldova, among others, fall behind with around 70%.
It is the same situation regarding the percentage of all people who know they are living with HIV. Monaco, Kosovo, Iceland and Austria reached the set target, while Moldova, North Macedonia and Albania still fell short.
In general, as shown in the report, the Western region of Europe is more on track towards 2030 than Eastern countries.
Ending the HIV epidemic has been a priority for international agencies for a long time. It is part of the UN Sustainable Development Goals (SDGs) and combating tuberculosis and hepatitis.
The first policy instrument to address HIV at the EU level was implemented in 2005 with a European Commission communication on combating HIV/AIDS.
Later, in 2016, the Commission committed to helping EU countries reach the SDGs in a Communication on Next Steps for a Sustainable European Future.
The European Parliament also adopted a report in 2021 aiming to end AIDS as a public health threat by 2030.
The most recent mention of HIV in the EU’s work is the drug strategy for 2021-2025, where the action plan includes drug-related infectious diseases, such as HIV, in their measures for health promotion.
The fight against HIV and the need to increase efforts aiming to 2030 seems to have rekindled the conversation at the EU level.
On Friday (15 September), there will be a high-level meeting as part of the Spanish Presidency of the Council programme. The aim is to discuss a political declaration, “HIV and Human Rights: Political action to achieve ZERO stigma”, which will be later proposed for adoption in the European Parliament on 1 December 2023, marking World AIDS Day.
[Edited by Alice Taylor]