ecdc.europa.eu

Estonian Ministry of Social Affairs 23 November 2007

Zsuzsanna JakabDirector, ECDC

Press Briefing on HIV/AIDS

Purpose of today’s press conference

• To celebrate World AIDS Day and remember the millions of people suffering from HIV/AIDS across the globe;

• To focus attention on Estonia, which is the country with the highest infection rate in the EU;

• To launch the annual EuroHIV Report on HIV/AIDS surveillance in Europe.

Why was ECDC established?

•Emerging and re-emerging communicable diseases revitalised through globalisation, bioterrorism, interconnectivity, and EU without internal borders

•Health implications of enlarging EU•Strengthen EU Public health capacity to help

meet EU citizen’s concerns

• EU level disease surveillance

• Scientific opinions and studies

• Early Warning system and

response

• Technical assistance and training

• Epidemic intelligence

• Communication to scientificcommunity

• Communication to the public

What does ECDC do?

Identify, assess & communicate current & emerging health threats to human health from communicable diseases

How is ECDC organised?

Administrative

Services

Healthcommunication

Preparedness &

response

SurveillanceScientificadvice

Director and Director's CabinetManagement Governance External relations Country

cooperation

Antimicrobial resistance & healthcare-associated infections

Food- & waterborne diseases

HIV, STI & Hepatitis

Influenza

Other diseases of environmental & zoonotic origin

Tuberculosis

Vaccine preventable diseases & invasive bacterial infections

ECDC role in HIV/AIDS prevention

• Despite many EU & national initiatives, HIV infection remains a major public health concern across the EU;

• ECDC called on by EU Health Commissioner to evaluate and assess national control programmes, and provide support to Member States, particularly to strengthen prevention and care in high burden countries;

• ECDC/WHO-EURO to take over the European HIV surveillance activities as from 2008, crucial for informing prevention efforts and health care planning;

• ECDC priority to reduce barriers to HIV testing - we estimate that 30% of people living with HIV in EU are unaware of infection - and will be working on scientific guidance to achieve this;

• HIV/AIDS will be a HIGH priority in the years to come.

Total: 33.2 (30.6–36.1) million Source: UNAIDS/WHO

Adults and children estimated to be living with HIV in 2007

75 000

1.3 million

1.6 million

230 000

22.5 million

380 000

760 0001.6 million

800 000

4.0 million

10

76

4

12

14

9

504

62

8

13029

8

148

20

8

275

5

17

288

14

HIV cases per million

< 20

20 - 99

100 - 199

200+

205

92

80

149

37

4137

45

9565 33

53

51

72

4

Not available

104

Source: EuroHIV

New HIV diagnoses reported in 2006per million population, Europe

0

5000

10000

15000

20000

25000

2001 2002 2003 2004 2005 2006

New HIV diagnoses 2001-2006EU & EEA/EFTA countries

0

50

100

150

200

250

300

2000

2001

2002

2003

2004

2005

2006

PortugalUKLux Belgium FranceIreland NetherAustria Greece

New HIV diagnoses 2001-2006per million pop, EU15 and EEA/EFTA countries

Note: the graphs are on a different scale!

0

10

20

30

40

50

60

70

2000

2001

2002

2003

2004

2005

2006

Norway Denmark Sweden Finland Iceland Germany

0

200

400

600

800

1000

1200

2000

2001

2002

2003

2004

2005

2006

Estonia Latvia Lithuania

New HIV diagnoses 2001-2006per million pop, Member States which have joined EU since 2004

Note: the graphs are on a different scale!

0

10

20

30

40

50

60

70

80

2000

2001

2002

2003

2004

2005

2006

MaltaCyprus Poland Slovenia Bulgaria Czech RRomania Hungary Slovakia

New HIV diagnoses 2001-2006per million pop, EU neighbourhood

0

100

200

300

400

500

600

2000 2001 2002 2003 2004 2005 2006

Ukraine

RussianFedMoldova,RepKazakhstan

Uzbekistan

Belarus 0

10

20

30

40

50

60

2000 2001 2002 2003 2004 2005 2006

Georgia

Kyrgyzstan

Tajikistan

Azerbaijan

Armenia

Croatia

Serbia

Albania

FYROM. Note: the graphs are on a different scale!

Source: EuroHIV

Predominant mode of HIV transmission, cases reported in 2006

Heterosexual contact

Men having sex with men

Injecting drug users

Data not available

0

2500

5000

7500

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

Heterosexual

Men having sex with men

Injecting drug users

New HIV diagnoses by mode of transmission, EU, 1996-2006

* Countries with data available for the whole period: Belgium, Cyprus, Czech Republic, Denmark, Finland, Germany, Greece, Hungary, Ireland, Latvia, Lithuania, Luxembourg, Poland, Slovakia, Slovenia, Sweden, United Kingdom.

Median age at HIV diagnosisby country (2005)

20 25 30 35 40

FranceDenmarSloveniaSwitzerlBelgiumGermanFinlandGreece

PortugalSweden

UKMalta

IrelandCzech

HungaryLuxembPoland

LithuaniSlovakia

Latvia

Age (years)

Median age at HIV diagnosis in the EU: 35 years

Men having sex with men

• MSM are the group at highest risk for acquiring HIV in many countries;

• HIV prevalence: 5 - 15%;• HIV incidence: ~3% per

year;• Multiple epidemics of other

STI (syphilis, gonorrhoea, LGV);

• Resurgence of high risk sexual behaviours.

New drugs & new technologies influencing high risk sexual behaviours in men having sex with men

ViagraCrystal methamphetamin Internet

Injecting Drug Users

• Steady declines in unsafe injection practices and HIV prevalence in most western European countries;

BUT• HIV prevalence remains

very high (>25%) in eastern Europe and in some cities of western Europe;

• Very high prevalence of hepatitis C (>60%).

• Major transformation in the sex industry worldwide;• Western Europe:

• Relatively low HIV prevalence, <2%; • Little effect on the initial spread of HIV;• HIV remains highly associated with drug use;• Shift to a primarily migrant workforce;

• Eastern Europe:• Close relationship between sex work and IDU.

Sex workers

People living with HIV

• The number of people living with HIV keeps increasing;

• In the EU, an estimated 30% of people living with HIV are not aware of their infection;

• These people disproportionately contribute to the spread of HIV.

Awareness of Serostatus Among People

with HIV and Estimates of Transmission

~25% Unaware

of Infection

~75% Aware of Infection

People Living with HIV/AIDS: 1,039,000-1,185,000

New Sexual Infections Each Year: ~32,000

Accounting for: ~54% of New

Infections

~46% of New

Infections

Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA.

AIDS. 2006 Jun 26;20(10):1447-50.

% from a country with a originating generalised epidemic among heterosexually infected persons diagnosed with HIV in 2006

0%

10%

20%

30%

40%

50%

60%

70%

Icel

and

Swed

en

Belgiu

m

Irela

nd UK

Luxem

bourg

Ger

man

y

France

Gre

ece

Switz

erla

nd

Finla

nd

Denm

ark

Portuga

l

Source: EuroHIV

0

200

400

600

800

1000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year of report

Latvia

Estonia

Cases per

million

HIV infections newly diagnosed 1996-06per million pop, Baltic States

EuroHIV

Lithuania

Upd

ate

at 3

1 D

ecem

ber

2006

0

10

20

30

40

50

60

1988 1990 1992 1994 1996 1998 2000 2002 2004 2006

Year of diagnosis

Cases per million

Latvia

AIDS incidence 1988-2006per million pop, EU as a whole compared to Baltic States

Data adjusted for reporting delays

Upd

ate

at 3

1 D

ecem

ber

2006

Estonia

Lithuania

Situation in Estonia

•Estonia has the highest rate of new HIV diagnoses in Europe (504 new cases per million inhabitants);

•Spread of HIV associated with injecting drug use- Young males;- High infection rate;- Most are non-Estonian ethnic background

•However, HIV is increasingly spread through heterosexual contact

•The proportion of women has increased from 20% in 2000 to 36% in 2006.

ECDC supporting Estonia

•ECDC delegation first visited Estonia in April 2007 to review, together with the country experts, the status of HIV & STI surveillance, prevention and control;

•As a result, we agreed a number of areas for ECDC support, including

−Sharing good practice and providing technical support in surveillance;

−Assisting with reviews of HIV estimates;−Providing advice on development of prevention and

media campaigns;−Scientific guidelines on HIV/AIDS & STI testing.

Conclusions

• Priorities for prevention in the EU− Securing HIV surveillance activities to inform prevention &

healthcare planning;− Reducing barriers to HIV testing, including scientific

guidance to achieve this; − Developing innovative prevention approaches for MSM;− Providing specific services for migrant communities;− Strengthening prevention and care in high-burden

countries such as Estonia• ECDC is supportive of the work being done by the

Estonian government to reverse the trend of increasing HIV infection rates;

• Political commitment is key – what happens in Estonia is important for whole EU.

ecdc.europa.eu

Thank you ! Zsuzsanna JakabDirector, ECDC

info@ecdc.eu.int