In 2008, 299 cases of HIV infection were diagnosed in Norway, of which 182 (61%) were men and 117 were women. This is the highest number of HIV cases diagnosed annually in Norway since the introduction of HIV surveillance in 1986.
The increase compared with 2007 is mainly due to a significantly higher number of cases among immigrants infected prior to arrival in Norway and among men who have sex with men (MSM) (Table 1). In total, 4,086 cases of HIV infection have been detected in Norway (2,748 men and 1,338 women). Of the 4,086 reported HIV-positive cases some have left the country, 618 are reported to have died of AIDS and some have died for other reason. The Norwegian Institute of Public Health estimates that by the end of 2008 approximately 3,000 of those diagnosed are living with HIV in Norway.
Table 1. HIV infection in Norway by transmission route and year of diagnosis
Men who have sex with men (MSM)
The number of newly diagnosed HIV cases among MSM has more than doubled since the 1990s. Of the 92 cases diagnosed in 2008, 46 are believed to have been infected in Oslo, 15 were infected in other places in Norway, 23 were infected abroad and in eight cases the place of infection was unknown. During the last three years, there has been a marked increase in HIV infection among MSM outside Oslo. Of the cases reported in 2008, 60% had been infected during the last two years.
Sixteen of the 92 cases are people with immigrant backgrounds who were infected after coming to Norway. This proportion has been stable for the last five years, with approximately 15-20% of the HIV cases in MSM being among immigrants. Relatively few immigrants infected before coming to Norway report homosexual practices as a possible route of transmission (4 cases in 2008). Quantitatively, their contribution to the increase in HIV cases in the group is small. Transmission among MSM is most often during anonymous sex in Norway or on trips abroad. In 2008, 62 (67%) of the newly diagnosed stated that they were infected by a casual partner, 15 by their regular partners and in 15 cases the relationship with the sexual contact was unknown. The median age for new cases in 2008 was 36 years (range: 20-72 years).
Heterosexually infected persons
The majority of persons infected with HIV through heterosexual contact are born abroad. Based on clinical observations and information on previous negative HIV tests complied by the Norwegian Surveillance System for Communicable Diseases (‘Meldingssystem for smittsomme sykdommer’ – MSIS), it can generally be assessed whether people with foreign backgrounds were infected before or after entering Norway. In order to give a clearer picture of the HIV epidemic among heterosexuals, we have divided the heterosexually infected into two groups, those who were living in Norway when they were infected and those who were infected before coming to Norway (Tables 2 and 3, respectively).
Infected while living in Norway
In 2008, 46 people (28 men and 18 women) were diagnosed as heterosexually infected while living in Norway. Until recently, most of the cases in this group (85%) were born in Norway, but this picture is changing. Eleven of the 18 women and three of the 28 men reported to be infected in 2008 are foreign born. These 14 people with immigrant backgrounds were mainly infected within the immigrant community in Norway or during visits to their former country of residence.
The number of Norwegian-born men who are infected with HIV in Thailand is still increasing, with 16 new cases in 2008. Only one man was infected heterosexually in Norway in 2008. The median age at the time of diagnosis was 46 years (range: 27-76 years) for men and 32 years (range:18-49 years) for women. There are still very few cases of HIV infection reported among heterosexual youth in Norway.
Table 2. Place of infection with HIV and transmission route for heterosexually infected persons while residing in Norway, by year of diagnosis
Infected before coming to Norway
In 2008, 92 women and 47 men were diagnosed with HIV after coming to Norway as asylum seekers, refugees or for family reunification. Approximately half were infected in their former countries of residence in Eastern Africa. As in previous years, Thai women married to Norwegian men constitute a relatively large group of infected immigrants (14 in 2008). The median age for the cases in 2008 infected before coming to Norway was 36 years (range:20-53 years) for men and 30 years (range:17-58 years) for women.
Table 3. Continent of origin for people heterosexually infected with HIV before coming to Norway by year of diagnosis
Injecting drug users
The incidence of HIV among injecting drug users in Norway remains at a very low level. The 12 cases reported in 2008 include seven men and five women. Four of the cases were immigrants infected in their countries of origin before arriving to Norway. Of the eight cases infected in Norway, four were infected in Oslo and four in other municipalities. The median age for the cases in 2008 was 34 years (range: 25-53 years).
Other cases reported in 2008
The four children reported as being infected perinatally in 2008 were born in Africa. The last diagnosed case of perinatal infection in children born in Norway was in 2000. For five men and one woman route of infection is ‘other’ or ‘unknown’. Four are immigrants and two cases are Norwegian men.
The situation of HIV infection among MSM in Norway is of great concern. In addition, HIV in Norway increasingly reflects the global HIV epidemic. The number of immigrants with HIV is increasing as more persons seeking asylum or family reunification come to Norway. The Norwegian Institute of Public Health estimates that approximately 1,000 – 1,200 immigrants living with HIV reside in Norway. It is necessary to ensure follow-up to immigrants living with HIV and provide the growing immigrant population in Norway with sufficient knowledge about HIV. This will help to counter the increasing risk of infection in immigrant communities domestically and when travelling outside Norway.
Three out of four Norwegians with HIV are men who have been infected by another man or by a Thai woman. This indicates that many Norwegian men continue to practise unprotected anal and/or vaginal intercourse in well-known risk environments despite the presumed high level of knowledge of the risk of HIV infection. The increasing number of new cases of HIV infection in these groups underlines the challenges facing those working with prevention. The key to success continues to lie in providing information about the risk of infection and the need for safer sexual behaviour. The Norwegian Ministry of Health and Care Services published in June 2009 a new HIV strategy. This document emphasizes that society should accept and manage HIV in a way that will help to reduce the number of new cases and ensure a good quality of life for persons living with HIV.