The numbers of new HIV infections and AIDS-related deaths have fallen in recent years at the global level, but are rising in the WHO European Region. 1 December is World AIDS Day.

In 2011, over 121 000 new HIV diagnoses were reported in the Region, but estimates indicate that the real figure is more than 170 000 new infections and there are more than 2.3 million people living with HIV.

Timely treatment vital

Today, a person who gets HIV and starts timely treatment has a similar life expectancy to someone without HIV. Data reported to WHO/Europe and the European Centre for Disease Prevention and Control (ECDC), however, indicate that half of diagnoses are made late, when the infection is at an advanced stage. Indeed, people are still dying of AIDS in the European Region.

Early diagnosis and timely treatment of HIV are a key element of the European Action Plan for HIV/AIDS 2012–2015, agreed by all 53 countries in the Region.

Vulnerable and marginalized people most affected

Trends in HIV transmission vary across the Region, but vulnerable and marginalized groups are most affected: people who inject drugs, men who have sex with men, sex workers, prisoners and migrants.

In western countries, HIV was most often diagnosed in men who have sex with men, closely followed by people infected through heterosexual transmission. In the eastern part of the European Region, however, heterosexual transmission accounted for well over half of new HIV diagnoses reported, and drug injection for over a third. Heterosexual transmission is linked to having a sexual partner who injects drugs.

The cities of Porto and Vila Nova de Gaia, Portugal, have integrated treatment services for HIV, tuberculosis (TB) and drug dependence, focusing them on people’s needs, not diseases. This model encourages people who inject drugs to maintain their treatment for HIV and TB, and improves treatment outcomes.

Each part of the Region must intensify its work with different groups to respond effectively to the epidemic. Investment in HIV services must be maintained, even in times of economic crisis, as scaling down or stopping key services has immediate effects. In two countries that recently cut services, new HIV cases have increased tenfold among people who inject drugs, where numbers had previously been stable.

HIV linked to other health conditions

People living with HIV have a far greater risk of developing TB, especially if the infection is not treated. In Europe, TB remains one of the leading causes of death among people with HIV.

Estimates show that more than half of those living with HIV are also chronically infected with the hepatitis C virus. Having both diseases can lead to life-threatening liver failure. Hepatitis is difficult and still very expensive to treat, and this situation is likely to lead to tens of thousands of unnecessary deaths in future.

People who inject drugs are not only often at risk of HIV, and diseases such as TB and hepatitis C, but also more likely to be affected by social factors that threaten health, such as poverty, homelessness, lack of access to health care and imprisonment. The HIV epidemic is concentrated in this group in most countries in the eastern part of the Region.

Treatment as prevention

Antiretroviral drugs (ARVs) can prevent HIV transmission from pregnant women to their babies. The timely use of effective ARV combinations in both mother and infant reduces the risk of transmission to less than 2%.

Research published in 2011 showed that earlier treatment of people with HIV – called treatment as prevention – can reduce the sexual transmission of HIV by 96%.

In a couple in which only one partner has HIV, WHO recommends offering ARV therapy to this person, regardless of the strength of his or her immune system, to reduce the likelihood of transmission to the other partner.

Another study has shown that people who do not have HIV can reduce the risk of sexual transmission by 73% by taking ARVs before exposure.

ARVs’ preventive effects, shown in these findings, add to the demand for greater access to these medications.