A total of 53,427 HIV-infection cases were reported by 49 of the 53 countries of the WHO European Region in 2009. The incidence of HIV was 8.5 per 100,000 population: 11.4 and 5.8 for men and women, respectively. HIV-infection among 15-24-year-old individuals accounted for 12% of the cases and 35% were among females. Heterosexual transmission was responsible for 43% of the total number of cases, 18% among men who have sex with men (MSM), 22% among injecting drug users (IDUs) and 1% were infected through mother-to-child transmission (MTCT). Data regarding mode of transmission were missing for 16% of the cases. HIV-infection incidence for 2004-2009 increased by 29%, from 6.6 to 8.5 cases per 100,000 population: heterosexual transmission increased by 16%, MSM by 27%, IDU by 19%, MTCT by 8%, and nosocomial transmission increased from 24 cases in 2004 to 55 cases in 2009.
In the EU/EEA countries the incidence of HIV-infection was 5.7 per 100,000 population: 8.3 and 3.2 for men and women, respectively. The countries with the highest incidence were Estonia (30.7), Latvia (12.2), the United Kingdom (10.7) and Belgium (10.3). HIV-infection among 15-24-year-old individuals accounted for 12% of the cases and 28% were among females. Heterosexual transmission was responsible for 24% of the total number of cases, 35% among MSM, 5% among IDUs and 1% were infected through MTCT. The mode of transmission was unknown for 20,3% cases. Trends in HIV-infection for 2004-2009 were stable: 6.5 and 5.7 per 100, 000 population in 2004 and 2009, respectively. The number of heterosexually acquired cases decreased by 24%, among MSM by 24%, among IDUs by 40% and MTCT by 44%.
The countries in the EpiNorth network that have been most affected by HIV are Estonia, Latvia, and Lithuania. Incidence increased rapidly in 2001-2002, thereafter declined before resurgence in Latvia during 2007-2008 and Lithuania in 2009. HIV-infection incidence was low in Finland (3.4), Denmark (4.3), Poland (1.7), Sweden (4.2), and Norway (5.8). The highest incidence of HIV-infection among females was in Estonia (23.2) while the lowest was in Poland (0.6) and Finland (2.6).
A total of 6,568 AIDS cases were notified in the WHO European Region during 2009 with an incidence of 1 case per 100,000 population: 1.5 and 0.5 for men and women, respectively. The highest incidence was in Belarus (4.8), Georgia (6.5) and Moldova (7.3). Since 2004 the incidence of AIDS cases has declined from 2.0 to 1.0 in 2009.
In the EU/EEA the highest AIDS incidence rates were in Latvia (4.3), Portugal (2.8), Estonia (2.8), Spain (2.3), and Lithuania (1.1). In other EpiNorth network countries the AIDS incidence was 0.4 in Finland, 0.7 in Denmark, 0.4 in Norway, 0 in Iceland, 0.2 in Poland and 0.3 in Ukraine. The Russian Federation does not report HIV-infection and AIDS cases to WHO/Europe. In 2009 the Russian Federal AIDS Centre registered 58,448 newly diagnosed HIV-infection cases of which 61% were among IDUs1.
WHO/Europe and ECDC continue to report an epidemic spread of HIV in 18 priority European countries. At the same time, it is evident that the number of HIV-infection and AIDS cases is greatly underestimated, particularly in the Eastern Europe countries. In addition to the countries that do not report any national data on HIV/AIDS (Russia, Monaco, Liechtenstein, Turkey) to WHO, there are several other countries that do not report epidemiologically important HIV-infection mode of transmission data (Estonia, Russia, Monaco, Turkey). Information on CD4 cell count at time of HIV diagnosis, which is important for an assessment of treatment outcome, is not reported by several EpiNorth network countries (Estonia, Poland, Sweden, Iceland, Norway, Belarus, Russia and Ukraine).
Consequently, several countries in Eastern Europe and the EpiNorth network need to improve surveillance and reporting of HIV/AIDS cases. This information is necessary to monitor the epidemic and guide the public health response to control the transmission of HIV-infection. To enhance surveillance, WHO recommends that national HIV/AIDS programmes implement the revised WHO definitions and classifications2.
- ECDC/WHO Europe. HIV/AIDS surveillance in Europe 2009. Stockholm; ECDC, 2009:6.
- WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. WHO; 2007. http://www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf