HIV infection is a notifiable disease in all the countries in the region. In the Nordic countries, Germany and the Baltic countries, clinicians (and in some countries laboratories) report anonymously newly diagnosed HIV infections to a national HIV database. Codes are used to allow for detection of duplicate reports. In Russia and in Poland, diagnosed HIV infections are generally reported by name, although anonymous testing is possible in most major cities.
In Russia, cases diagnosed in prisons or in military institutions are not included in the supplied data.
During the 1990s and early 2000s the Nordic countries, Poland and Germany have experienced stable and relatively low figures of newly diagnosed HIV infections. Among these countries, highest incidence rates are found in Denmark. The numbers of diagnosed AIDS cases have decreased dramatically in the Nordic countries and in Germany since 1995 due to introduction of improved therapy.
In Russia, however, there has been a steep increase of diagnosed HIV cases since 1998, especially in the Northwest region. In Northwest Russia, the highest incidence of new diagnosed cases of HIV is found in the Saint Petersburg, Murmansk and Kaliningrad area. No cases of HIV infection have so far been diagnosed in Nenets autonomous area. Since the late 1990s, Estonia and Latvia have reported increasing high incidence rates while the number of diagnosed cases in Lithuania has remained relative low compared with the other Baltic countries and Russia. For the first half-year of 2002 a declining overall incidence has been observed in Estonia and Latvia. In contrast to the high numbers of HIV cases, reported AIDS incidence remain generally low in the eastern part of the region. This may partly be a reflection of the long incubation period, but may also be due to under-diagnosis and under-reporting.
In the Nordic countries, HIV infection is diagnosed mostly among homosexuals and to a less extent among heterosexuals. However, the majority of cases diagnosed in the Nordic countries are among immigrants from highly endemic areas who were infected before arriving to their new countries. In the Baltic countries, Poland and Northwest Russia, intravenous drug users dominate strongly. According to figures from the EuroHIV, 60% of HIV cases in Eastern Europe during the period 1996-2000 were intravenous drug users, compared to 14% in Western Europe. In the last few years, heterosexual spread is increasing in the eastern part of the region. This is clearly seen in the Kaliningrad area. The mean age of diagnosed persons with HIV is considerably low in the eastern part of the region compared with the western part. HIV infection among inmates in prisons in Northwest Russia is an increasing problem.
HIV infection prevention measures are primarily aimed at reducing risk of transmission through sexual contact and intravenous drug use. In addition, reducing the risk of mother-to-child and nosocomial transmission are also important measures. In the Nordic countries and Germany much emphasis have been put on the triad of offering free HIV-testing and screening of pregnant women, offering adequate treatment to a limited cost for the patient, and active case-finding around each diagnosed case.
Generally, it is important to raise the level of awareness and knowledge of the disease in the general population, and to target varied information to various high-risk groups. Condom availability is an essential preventive measure in all countries in the region. Harm reduction is obtained by ensuring clean needles and syringes. These are available at pharmacies in the region. In addition, local health authorities in the region, except for Iceland and Sweden, have introduced extensive free needle programmes, needle exchange programmes or both.