HIV in Northern Europe – Still a Major Challenge

 1 Published: 09.02.06 Updated: 09.02.2006 13:43:20

P. Aavitsland
Norwegian Institute of Public Health, Norway

In this issue of EpiNorth, three articles deal with challenges of the HIV epidemic in our region of Europe.

From the EuroHIV team comes an update of the HIV epidemic in Europe based on the 2004 EuroHIV report. The number of newly diagnosed cases reported in Estonia, Latvia and Lithuania in 2004 was down by 49% as compared to data for 2001. Despite this declining trend, Russia, Estonia, Latvia and Lithuania still report some of the highest number of new HIV cases in Europe. Most cases have been infected as a result of injecting drug use. There are two trends that are concerning. Firstly, there seems to be an increase in heterosexually infected cases. This may indicate that the epidemic is moving from the drug users to the general population. An increase in cases among children born to HIV positive mothers is also to be expected. Secondly, the AIDS incidence is still increasing. This may indicate that many persons with HIV do not receive optimal treatment for their infection.

Petrova and colleagues describe the experiences from a three-year project (2000-2002) in which low threshold services for intravenous drug users were established in St Petersburg, Russia. These services were based on a Swedish model. In a mobile bus and in a drop-in clinic the project offered information, condoms, syringes and needles, and counselling and testing for HIV infection, viral hepatitis and syphilis. Approximately 15% of the clients had HIV infection. The prevalence of hepatitis B and hepatitis C was much higher. The project reached some 3000 of the citys estimated 60 000 to 120 000 drug users. Approximately 210 000 syringes and needles and 168 000 condoms were distributed. The project is an example of how to work with this hard to reach group. Fortunately, the city authorities have scaled up the project by opening three new centres.

Tsereteli gives an overview of the Barents HIV/AIDS Programme. With supplementary funding primarily from Finland and Norway, the programme will work with partners in the north-western regions of the Russian Federation to curb the spread of HIV and assure accessibility of treatment for HIV.

In addition to the countries of the Barents Euro-Arctic Council, the European Union is a major contributor to HIV prevention efforts in northern Europe. The European Commission recently communicated its strategy for 2006-2009 (1) including a policy for collaboration with the Russian Federation. The document outlines concrete proposals for collaboration, the organisation of joint EU-Russia expert seminars on HIV/AIDS and related issues. The Commission will also invite representatives of the Russian Federation to participate in the HIV/AIDS Think Tank and the Civil Society Forum.

Zsuzsanna Jakab, Director of the European Centre for Disease Prevention and Control (ECDC), recently stated: The continuing high numbers of newly diagnosed HIV cases in Europe and the changing nature of the epidemic show that ongoing surveillance and analysis of the data are crucial. However, it is necessary to use these findings to better target Europes prevention efforts and revitalise the fight against this insidious disease. Improving our knowledge of the epidemic in Europe and of the kind of measures that are effective in protecting the at-risk groups will be priorities for ECDC in 2006 and beyond.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) recommends a programme of harm reduction to stop the spread of HIV among intravenous drug users. The programme consists of outreach to injecting drug users; sterile needle and syringe access and disposal; drug dependence treatment, particularly substitution treatment; voluntary and confidential HIV testing and counselling; prevention of sexual transmission among drug users, including condoms and prevention and treatment of sexually transmitted infections; HIV/AIDS treatment and care, including antiretroviral therapy for drug users; and primary health care, such as hepatitis B vaccination and vein care. Comprehensive drug control measures complement these interventions by aiming to reduce the number of people using drugs, such as through primary prevention programmes targeting young people.

In central and eastern Europe, a network of AIDS centres known as the Central and Eastern Europe Harm Reduction Network has been formed.  The aim is to support, develop and advocate for harm reduction approaches in the field of drugs, HIV, public health and social exclusion by following the principles of humanism, tolerance, partnership and respect for human rights and freedoms. The web site of this network (see contains a lot of training material and practical advice in English and Russian for everyone who works to prevent HIV among drug users.

EpiNorth monitors the HIV epidemic in northern Europe (3). This will continue and we will also highlight prevention efforts and report on recent developments.


1. Communication from the Commission to the Council and the European Parliament on combating HIV/AIDS within the European Union and in the neighbouring countries, 2006-2009. Brussels: Commission of the European communities, 2005.

2. Joint UNAIDS statement on HIV prevention and care strategies for drug users. Geneva: UNAIDS, 2004.

3. Blystad H, Blad L, Tulisov A, Aavitsland P. Status on some important infectious diseases in Northwest Russia and the Nordic and Baltic countries 1999-2003. EpiNorth 2004-2005; 5/6: 1-32.