Assessment of HIV situation and

trends among PWID in Europe

DRID Expert meeting 2016

Lisbon, Portugal

6 - 8 June 2016

HIV diagnoses: 2005-2014, EU/EEA

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 (2015). HIV/AIDS Surveillance in Europe, 2014

Injecting drug use

Heterosexual (Women)

Heterosexual (Men)

Sex between men

Mother-to-child transmission

Other/undetermined

Main HIV transmission modes in EU/EEA, 2014

3

Fig. 1. Logged HIV incidence in 28 European countries (1995–2011).

Phillip L. Marotta, Charlotte A. McCullagh

A cross-national analysis of the effects of methadone maintenance and needle and syringe program implementation on incidence rates of HIV in Europe from 1995 to 2011

International Journal of Drug Policy, Volume 32, 2016, 3–10

http://dx.doi.org/10.1016/j.drugpo.2016.02.007

HIV diagnoses fall, but localised outbreaks

5

� 1 236 newly reported HIV diagnoses — lowest number for a decade

� Localised outbreaks: Greece, Romania (2011/12), Ireland, Scotland, Luxembourg

New HIV diagnoses among PWID in Greece and Romania, 2004-2014

Nu

mb

er

of

ne

w H

IV d

iag

no

ses

Source: ECDC/WHO 2015

November 2011

November 2011November 2013

Eurosurveillance

HIV prevalence among injecting drug users – studies

with national and subnational coverage 2013-2014

Source: 2016 EMCDDA Data and Statistics

New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, EU/EEA, 2014

Source: ECDC/WHO (2015). HIV/AIDS Surveillance in Europe, 2014

>500 cells/mm3

200 to <350 cells/mm3

< 200 cells/mm3

350 to <500 cells/mm3

Late diagnosis is associated with increased morbidity and

mortality, higher health costs and more HIV transmission

Source: ECDC (2015). Hepatitis C Surveillance in Europe, 2013

HIV prevalence, selected subnational data

1

0.0

0.0

0.5

1.6

1.6

2.6

3.0

3.8

5.0

5.7

8.7

9.1

12.5

14.9

32.1

48.3

0 10 20 30 40 50

Vienna,AT

Ljubljana, Koper, Maribor ,SI

Zagreb, RijeKa, Split,HR

Cologne,DE

Bratislava ,SK

Oslo,NO

Munich ,DE

Sofia,BG

Hamburg,DE

Antwerp,BE

Hannover,DE

Frankfurt,DE

Alytus, Visaginas, Klaipeda,LT

Attica,GR

Riga,LV

Narva,EE

Prevalence of HIV (%)

Prevalence of HIV among people who inject drugs in selected cities/regions

HIV prevalence data, 2013-2014

1

HIV Risk Assessment

1

Source: SQ23, 2013, experts opinionN.I: DE, DK,IE,HU,PL,SI,SE,FI

Additional Indicators for the RA

Recent/on-going transmission: HCV antibody prevalence amongst recent PWID (<2 yrs)

15

Likely indication of

recent infection

and ongoing

transmission among

PWID

Source: 2015 EMCDDA Data and Statistics

Prevalence of injection among clients entering treatment with opioid as their primary drug

16Source: 2015 EMCDDA Data and Statistics

Significant level of drug treatment provision

17Source: 2016 EMCDDA Data and Statistics

anti-HCV prevalence: local & national studies

18

Multi-indicator risk assessment

19

HIV situation among PWID

- New case reports attributed to drug injecting, trends

- HIV prevalence and trends

Risk indicators

⁻ High or increasing HCV prevalence

⁻ High injecting drug use

Intervention coverage

⁻ OST, syringe provision

Additional indicators: Market changes, e.g. appearance of new psychoactive substances/switching, new risk behaviours

Percentage of high-risk opioid users receiving substitution treatment

20

47%77% ES: > 50%

Source: EDR 2016

Syringes distributed through specialised programmes per estimated IDU

21

AT:

340-463

/PWID/year

GR:

72/PWID/year

Source: 2016 EMCDDA Data and Statistics

22

23Source: 2015 EMCDDA Rapid Communication Drug-related infections in Europe

Baral et al., 2013 Modified ecological model for HIV risk in PWID

24

Stage of HIV EpidemicStage of HIV Epidemic

PUBLIC POLICY: Drugs Laws, Legal and regulatory aspects of

response

PUBLIC POLICY: Drugs Laws, Legal and regulatory aspects of

response

COMMUNITY: Availability and access to services

COMMUNITY: Availability and access to services

NETWORK: Prevalence, Transmission knowledge,

Dual-Risk Populations

NETWORK: Prevalence, Transmission knowledge,

Dual-Risk Populations

INDIVIDUAL: sharing,

unprotected sex, incarceration,

frequent injecting

INDIVIDUAL: sharing,

unprotected sex, incarceration,

frequent injecting

25

Adapted from : Baral et al., 2013 Modified ecological model for HIV risk in PWID (BMC Public Health

Rating on presence of risk factors

26

27

emcdda.europa.eu

Results: HIV situation among PWID

• Most EU/EEA countries with stable or declining rates of HIV

diagnoses in PWID

• Outbreaks in Greece and Romania have declined but rates still

high

� Greece: mostly confined to Athens region

� Romania: most cases male residents of Bucharest under 30 years.

• HIV prevalence high (>10%) in local/national studies: • Bulgaria, Estonia, Latvia, Luxembourg and Lithuania (12.5%)

• Italy, Portugal, Spain: “Old” HIV epidemics

28

emcdda.europa.eu

Results: Risk indicators

• HCV prevalence among PWID > 60% (local and/or national: 11

countries)

• HCV prevalence trend 2008-2014: increases in 8 countries;

• Injection prevalence not low: 7 countries (no data: 14 countries)

29

emcdda.europa.eu

Results: Intervention coverage

• OST coverage low in some settings: < 30% of POU in opioid

substitution treatment: 7 countries

• Lithuania: 11%

• NSP coverage below 100 syringes/PWID/year: 8 countries

• Lithuania: no coverage data (no recent PWID estimate)

• Declining number of syringes: in 2015 only 80% of volume

given out in 2010;

• steady decline in number of NSP sites; lack of

geographical coverage.

30

emcdda.europa.eu

Conclusions

• HIV among PWID stable or declining in most EU/EEA countries;

though outbreaks have been observed during recent years

• Late HIV diagnosis is an issue for many patients in Europe but

even more so for injecting drug users

• Harm reduction prevention coverage remains inadequate in

one-third of countries posing a potential risk for further

outbreaks;

• Harm reduction coverage and injecting risk varies widely across

the EU/EEA

• Urgent consideration of scaling up harm reduction in some

settings is merited

31

emcdda.europa.eu

Acknowledgements

EMCDDA Reitox Focal Points

ECDC HIV/AIDS Surveillance Contact Points

ECDC and EMCDDA colleagues

32

emcdda.europa.eu

Latest news: peachi.eu

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