2013
HIV/AIDS Surveillance in Europe
European Centre for Disease Prevention and Control, Stockholm
WHO Regional Office for Europe, Copenhagen
European Union and European
Economic Area (EU/EEA)
1
HIV diagnoses in the EU/EEA, 2013
Reporting countries/Number of countries
Number of HIV diagnoses
Rate per 100 000 population
Percentage age 15-24 years
Male-to-female ratio
Transmission mode (%)
Sex between men
Heterosexual
Injecting drug use
Mother to child transmission
Unknown
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
30/31
29 157
5.7
10.9
3.3
42
32
5
<1
20
New HIV diagnoses, 2013, EU/EEA
Rate per 100 000 population
<2
2 to <10
10 to <20
> 20
Not included or
not reporting
Non-visible countries
Lichtenstein
Luxembourg
Malta
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
Male-to-female ratio, new HIV diagnoses,
by country, EU/EEA, 2013 (n= 29 086)
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
HIV diagnoses in females, 2013, EU/EEA
Rate per 100 000 female population
<2
2 to <10
10 to <20
> 20
Not included or
not reporting
Non-visible countries
Lichtenstein
Luxembourg
Malta
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
HIV diagnoses in males, 2013, EU/EEA
Rate per 100 000 male population
<2
2 to <10
10 to <20
> 20
Not included or
not reporting
Non-visible countries
Lichtenstein
Luxembourg
Malta
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
Proportion of HIV diagnoses, by route of
transmission, 2013, EU/EEA
20%
Heterosexual (excluding cases
from generalised epidemic
countries)
Heterosexual (from generalised
epidemic countries)
21%
Sex between men
<1%
5%
n = 29 157
11%
Injecting drug use
Mother-to-child transmission
42%
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
Unknown
Proportion of HIV diagnoses, males, by
route of transmission, 2013, EU/EEA
16%
19%
<1%
5%
5%
Heterosexual (excluding
persons from countries with
generalised epidemics)
Heterosexual (persons from
countries with generalised
epidemics)
Sex between men
n = 22 354
Injecting drug use
Mother-to-child transmission
54%
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
Unknown/Other
8
Proportion of HIV diagnoses, females, by
route of transmission, 2013, EU/EEA
Heterosexual (excluding persons
from countries with generalised
epidemics)
23%
42%
1.7%
4%
n = 6 732
Heterosexual (persons from
countries with generalised
epidemics)
Injecting drug use
Mother-to-child transmission
30%
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
Unknown/Other
9
Percentage of new HIV diagnoses, per
age group and transmission mode, EU/EEA,
2013 (n=22 472)
Sex between men
Heterosexual
(excluding persons from
generalised epidemic
countries)
Heterosexual (from
generalised epidemic
countries)
Injecting drug use
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
HIV diagnoses attributed to sex between
men, 2013, EU/EEA
Rate per 100 000 male population
<1
1 to <3
3 to <5
>5
Not included or
not reporting
Non-visible countries
Lichtenstein
Luxembourg
Malta
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
Percentage of new HIV diagnoses* acquired
through sex between men, EU/EEA, 2013 (n=23 416)
100
90
80
Percentage
70
60
50
40
30
20
10
0
* 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
HIV diagnoses acquired through injecting
drug use, 2013, EU/EEA
Rate per 100 000 population
<1
1 to <3
3 to <5
>5
Not included or
not reporting
Non-visible countries
Lichtenstein
Luxembourg
Malta
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
Proportion HIV diagnoses among migrants*,
by country of report, EU/EEA, 2013 (n= 29 157)
90
New diagnoses among persons
originating from other countries
80
70
New diagnoses among persons
originating from countries with
generalised HIV epidemics
Percentage
60
50
40
30
20
10
0
* 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
Rate of reported HIV diagnoses, by year
of diagnosis, in the EU/EEA, 1984–2013
8
Adjusted for reporting delay
7
Rate per 100 000 population
Reported
6
5
4
3
2
1
0
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 2011 2012 2013
Year of diagnosis
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
HIV diagnoses, by mode of transmission,
2004-2013, EU/EEA
Sex between men
Unknown
Heterosexual (excluding
persons from generalised
epidemic countries)
Heterosexual (from
generalised epidemic
countries)
Injecting drug use
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
Proportion of HIV cases diagnosed late
(CD4<350 cells/mm3), 2013, EU/EEA
< 30%
30 to <40%
40 to 50%
> 50%
Not included or
not reporting
Non-visible countries
Lichtenstein
Luxembourg
Malta
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
*Among cases with CD4 count at diagnosis reported
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)
70
% <350
60
% <200
Percentage
50
40
30
20
10
0
Heterosexual, cases Other Heterosexual Injecting drug use
from countries with
cases
generalised HIV
epidemics
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
Sex between men
Mother-to-child
transmission
18
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)
70
% <200
% <350
60
Percentage
50
40
30
20
10
0
15-19
20-24
25-29
30-39
40-49
50+
Age category (years)
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
19
AIDS cases reported, 2013, EU/EEA
Rate per 100 000 population
<1
1 to <3
3 to <5
>5
Not included or
not reporting
Non-visible countries
Lichtenstein
Luxembourg
Malta
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
Most common AIDS-indicative diseases by
transmission mode, EU/EEA, 2013
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
21
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 (2004-2013) 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.
22
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.
23
WHO European Region
24
Characteristics of HIV diagnoses reported
in the WHO European Region, the
EU/EEA, and by geographical area, 2013
Geographical areas
Reporting countries/Number of countries
Number of HIV diagnoses
Rate per 100 000 population
Percentage age 15-24 years
Male-to-female ratio
Transmission mode
Men who have sex with men
Heterosexual
Injecting drug use
Mother to child transmission
Unknown
WHO European
Region*
50/53 (51/53)
56 507 (136 235)
7.8 (15.7)
10.2%
2.2 (1.7)
West
Centre
East*
23/23
26 847
6.3
10.3%
3.3
15/15
4166
2.2
14.4%
4.9
13/15 (14/15)
25 494 (105 222)
22.7 (41.2)
9.5%
1.3 (1.4)
23.6% (10.1%)
43.1%
30.1%
2% (0.8%)
46.1% (30.6%)
16.2% (21.3%)
33.6%
4.1%
0.7%
24.8%
5.9%
1.1%
62.7% (30.0%)
30.6% (26.3%)
18.2%
37.9%
0.9% (0.6%)
13% (37.3%)
1.1% (0.6%)
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 .
25
Rate of new HIV diagnoses, EU/EEA and
WHO European Region, 1984–2013
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
26
Cumulative number of new HIV diagnoses in
the EU/EEA and other countries of the WHO
European Region, 1984–2013
900000
800000
Other countries of the WHO European
Region
Number of cases
700000
EU/EEA
600000
500000
400000
300000
200000
100000
0
1984
1987
1990
1993
1996
1999
2002
2005
2008
2011
Year of diagnosis
Data from Russia not included
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
27
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
28
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
29
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
30
New HIV diagnoses, 2013
Rateper 100 000 population
No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan.
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
31
New HIV diagnoses in females, 2013
Rateper 100 000 femalepopulation
No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan.
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
32
New HIV diagnoses in males, 2013
Rateper 100 000 malepopulation
No data received from Liechtenstein, Russia, Turkmenistan and Uzbekistan.
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
33
New HIV diagnoses attributed to heterosexual
transmission, 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
34
New HIV diagnoses attributed to injecting drug
use, 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
35
New HIV diagnoses attributed to sex between
men, 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
36
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
37
Geographical/epidemiological division
of the WHO European Region
West
East
Centre
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
38
WHO European Region: East
39
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
40
Most common AIDS-indicative diseases by
transmission mode, East, 2013
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
41
WHO European Region: Centre
42
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
43
Most common AIDS-indicative diseases by
transmission mode, Centre, 2013
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
44
WHO European Region: West
45
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
46
Most common AIDS-indicative diseases by
transmission mode, West, 2013
Source: ECDC/WHO (2014). HIV/AIDS Surveillance in Europe, 2013
47
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
48
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 100 000
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
49
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
50
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 highrisk 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
51
Full report and tables
and can be
downloaded at:
www.ecdc.europa.eu
and
www.euro.who.int/aids
52