In Europe, seven in ten HIV diagnoses are in men

Just under 26,000 people were diagnosed with HIV in the European Union in 2009 and 72% of those diagnosed were men, researchers report in the December 2 issue of Eurosurveillance. Rates of infection in gay and bisexual men are on the rise, but are falling in heterosexuals.

The report comes from the European Centre for Disease Prevention and Control, which collates data from national public health bodies. There are some inconsistencies in the ways in which these bodies collect information, there are reporting delays and some data are missing. Nonetheless, there is some information from all of the 27 European Union countries except Austria, and the two non-EU countries of Norway and Iceland are also included in the analysis.

Across Europe, the average is for there to be 5.7 new diagnoses per year for every 100,000 people in the population. However this rate is far higher for men (8.3 per 100,000) than for women (3.2 per 100,000). Moreover, some countries have diagnosis rates significantly above the average - Estonia (30.7), Latvia (12.2), the United Kingdom (10.7) and Belgium (10.3).

Looking at trends since 2004, the overall diagnosis rate in the population is broadly stable. However, the proportion of men diagnosed has risen (from 64 to 72%). This rise reflects a 24% increase in diagnoses in gay and bisexual men (from 7263 men in 2004 to 8974 in 2009), occurring at the same time as a 24% fall in diagnoses in heterosexual men and women (from 13,148 to 9975).

The number of diagnoses in injecting drug users has fallen by 40% - from 1952 to 1171 cases. However in several East European countries, injecting drug use remains the predominant mode of transmission.

Over this five-year period, HIV diagnoses have tripled in Bulgaria, Iceland and Slovakia, and doubled in Hungary and Slovenia. They have decreased by more than 20% in Denmark, Estonia, Italy, Luxembourg and Romania.

Returning to the 2009 figures, only eleven countries supplied enough information on CD4 counts to provide estimates of the proportion of people who were diagnosed late (with a CD4 cell count below 350 cells/mm³). However, in ten of these countries the results were very consistent - between 40 and 52% were diagnosed late. The one honourable exception is Luxembourg, where only 24% were diagnosed late. Individuals whose country of origin is outside Europe are more likely to be diagnosed late than Europeans.

The authors say that the figures on late diagnosis, whilst incomplete, “suggest that access to testing and treatment needs to be improved among those at risk”. Accordingly, the European Centre for Disease Prevention and Control has issued guidance on increasing the uptake of HIV testing. Among this document’s core principles are that political commitment is required, HIV stigma must be tackled and legal obstacles removed. HIV testing should be normalised and treatment made available for all, including undocumented migrants. Moreover, each country needs its own national HIV testing strategy, developed with the involvement of a wide range of stakeholders.