EU/EEA: HIV diagnoses rise for the first time in a decade

Across the 30 countries of the European Union and European Economic Area (EU/EEA), 22,995 new HIV diagnoses were reported in 2022. Almost every second new HIV diagnosis (49%, n=11,103) was among migrants, i.e. among people who were not born in in the country they were diagnosed in. 

In the aftermath of Russia’s invasion of Ukraine in 2022, more than 4 million Ukrainians took refuge in countries of the European Union and European Economic Area (EU/EEA). In a rapid communication published in Eurosurveillance prior to World AIDS Day 2023 on 1 December, Reyes-Urueña et al. look at most recent surveillance data to assess potential impact on HIV case reporting in the region since the start of the war in Ukraine. [1]

Based on 2022 data, EU/EEA countries have observed an increase in new HIV diagnoses which is attributed to several factors including restoring surveillance activities,  scale-up and introduction of novel testing strategies in many countries, migration patterns, lifting of COVID-19 restrictions and the arrival of refugees. However, 10% of all new HIV diagnoses in the EU/EEA last year were made among Ukrainian refugees (n=2,338). This constitutes a 10-fold increase compared with 2021 (n=223).

Among the 2,338 Ukrainian refugees diagnosed with HIV in the EU/EEA in 2022, 9% (n=217) were diagnosed for the first time in the reporting country while the majority (59%, n=1,368) had been notified about their HIV status before 2022. For around a third (32%), this information was unknown. Half of those that had previously been diagnosed with HIV were on antiretroviral treatment at the time of reporting in 2022.

Host countries need tailored early testing and treatment approaches
Overall, the EU/EEA notification rate of HIV cases in 2022 was 5.1 per 100,000 population which constitutes a 31% increase compared with 2021 (3.9/100,000 population), but a decrease of 3.8% compared with 2019 (5.3/100,000 population).

In the group of Ukrainian people diagnosed with HIV, women are the most affected accounting for the bigger part of new diagnoses (n=1,585) with heterosexual sex as primary transmission mode.

The authors also highlight that “among cases with known data on previous diagnosis, the prevalence of late HIV diagnosis (47.0%) and AIDS (18.9%) among newly diagnosed people underscores the urgent need for tailored early testing and linking to care in host countries.”

According to Reyes-Urueña et al., the results of their study have important implications for HIV prevention, testing, treatment, stigma-reduction and surveillance in EU/EEA countries: “Prevention that is accessible to new migrant populations, including pre-exposure prophylaxis for HIV (PrEP) as well as needle and syringe programmes and drug treatment for people who use drugs are crucial, especially given that refugees have well-documented vulnerabilities that may incur higher HIV acquisition risk.”

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References/notes to editors:
[1] Reyes-Urueña Juliana, Marrone Gaetano, Noori Teymur, Kuchukhidze Giorgi, Martsynovska Violetta, Hetman Larysa, Basenko Anton, Bivol Stela, van der Werf Marieke J, Pharris Anastasia, on behalf of the EU/EEA HIV network, Euro Surveill. 2023;28(48):pii=2300642. Available from: https://doi.org/10.2807/1560-7917.ES.2023.28.48.2300642

[2] See also the paper in the same Eurosurveillance issue from Wärnberg et al. on “The molecular epidemiology of HIV-1 in Sweden 1996 to 2022, and the influence of migration from Ukraine”. The authors look at the distribution of HIV-1 subtypes in Sweden since the beginning of the AIDS epidemic. Available from: https://doi.org/10.2807/1560-7917.ES.2023.28.48.2300224

[3] World AIDS Day was introduced by the World Health Organization (WHO) in 1988 and is observed annually on 1 December to raise awareness of the AIDS pandemic caused by HIV infection. See also: World AIDS Day 2023 (europa.eu)

[4] HIV/AIDS: The human immunodeficiency virus (HIV) is a virus, which attacks the immune system and causes a lifelong severe illness with a long incubation period. The end-stage of the untreated infection, acquired immunodeficiency syndrome (AIDS), results from the destruction of the immune system. AIDS is defined by the presence of one or more “opportunistic” illnesses (other illnesses due to decreased immunity).

[5] Late diagnosis is defined as having a CD4 cell count below 350 cells/mm3 blood at the time of diagnosis. This is a measure of the person’s immune system functioning. 

[6] Sustainable Development Goals (SDG) and 90–90–90 targets: in 2015, 17 Sustainable Development Goals (SDGs), each with specific targets for 2030, were introduced by the UN, including target 3.3 to end AIDS as a public health threat by 2030. In 2014, UNAIDS and partners launched the so-called ‘90–90–90 targets’ with the aim for 2020 that 90% people living with HIV are diagnosed (early) and 90% of those diagnosed receive antiretroviral treatment (ART), which leads to viral suppression among 90% of those on such treatment, i.e. the virus is no longer detectable in the blood. Such an undetectable viral load also means that HIV-positive people on effective treatment do not transmit the virus. In 2021, the Joint United Nations Programme on HIV/AIDS (UNAIDS) updated the HIV targets for 2025 as part of the global strategy to end HIV transmission by 2030. The latest data on progress towards these 95-95-95 targets across Europe and Central Asia can be found here: Continuum of HIV care - Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2022 progress report (europa.eu)