{"id":32021,"date":"2014-07-23T09:27:38","date_gmt":"2014-07-23T08:27:38","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=32021"},"modified":"2014-10-29T12:38:04","modified_gmt":"2014-10-29T11:38:04","slug":"aser-garcia-rada-the-resurgence-of-hivaids-in-europe-lets-focus-on-priorities","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2014\/07\/23\/aser-garcia-rada-the-resurgence-of-hivaids-in-europe-lets-focus-on-priorities\/","title":{"rendered":"Aser Garcia Rada: The resurgence of HIV\/ AIDS in Europe\u2014let’s focus on priorities"},"content":{"rendered":"

\"Aser<\/a>I was recently invited to a meeting on HIV\/AIDS<\/a> that was hosted in Athens by the European Commission. Although the grass is greener on the EU side, the epidemic still poses relevant challenges. Contrary to the overall global\u00a0decline in new HIV infections<\/a>, 29 381 people were newly diagnosed<\/a> across the EU in 2012, 1% more than in 2011. Late presenters represent 49% of new diagnoses. In the WHO European region\u2014which includes Central Asia\u2014131 202 new cases were reported (8% higher than in 2011). On the whole, 2.2m people live with HIV<\/a> in the European region, with around half of those people unaware that\u00a0they are infected.<\/p>\n

This\u00a0increase is heterogeneous, affecting mostly eastern Europe and certain key population groups. Since 2006, HIV diagnoses have more than doubled in Greece, Romania, the Czech Republic, and Hungary. Lithuania, Bulgaria, Slovakia, and Iceland have reported increases of more than 50%.<\/p>\n

According to Alessandro Pirona from the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), there are more than 80 million drug users in the EU<\/a>, 1.3m of them\u00a0problem opioid users. During the 90s, people who inject drugs (PWID) drove the HIV epidemic in southern and western European countries, but during the last decade, they are driving it in eastern Europe and central Asia. Eastern Europe is a big\u00a0concern, both for the surge\u00a0of new cases among PWID, and for the lack of\u00a0response from their authorities. For instance, while Greece and Romania contributed to around\u00a02% of the total number of newly reported HIV diagnoses among PWID in 2010, by 2012 this had shot up\u00a0to an alarming 37%.<\/p>\n

Cases in these\u00a0countries may even be underreported because of\u00a0institutional denial and social stigma, while harm reduction strategies are widely underused or virtually nonexistent. In Russia, for example, opioid substitution treatment remains banned. This was denounced by Luis Mendao, from the European AIDS Treatment Group, who recalled the demagogy and populism with which evidence based public health interventions<\/a> are systematically denied, and the discrimination it poses for patients.<\/p>\n

Men having sex with men (MSM) represent 40% of all new cases throughout the EU, an increase of 11% since 2006. This too may be underreported in eastern Europe, as many patients won\u2019t reveal their sexual orientation to their healthcare providers. Among MSM, condom use is less than 60% in half of EU countries. Anastasia Pharris, from the European Centre for Disease Prevention and Control (ECDC), announced that a new ECDC guide on preventing\u00a0infection among MSM will\u00a0be released by the end of 2014.<\/p>\n

Migrants represent two fifths of the HIV cases reported in the EU<\/a> (2007-11). New HIV cases in migrants increased until 2010, but have since decreased. There has been a discrete\u00a0decrease among Latin Americans, and a sharper decline among heterosexual sub-Saharan African migrants (52% fewer cases from 2006 to 2012), according to Pharris [1]. The causes for these declines remain debatable: better access to therapies in Africa, lower immigration levels, a growing number of policies that restrict access<\/a> to healthcare for migrants, etc. It’s worth noting though that in the UK\u2014one of the countries with the highest rates of new cases<\/a>\u00a0for each 100 000 inhabitants, together with Estonia, Latvia, and Belgium\u2014an increasing number of migrants are acquiring the infection<\/a>\u00a0once in the country.<\/p>\n

Although more than 85% of those who require\u00a0antiretroviral therapy<\/a> (ART) in EU countries receive it, vulnerable groups still find access difficult. For instance, less than half of EU countries make ART available for undocumented migrants, especially northern and eastern European countries.<\/p>\n

Generally, ART costs \u20ac10 000-12 000 for a year’s treatment of a patient. A joint procurement agreement<\/a> was signed in June at EU level to help with regulating costs and certain patents will expire soon, but an increasing number of diagnoses will mean ART continues to be a big expense. This will also have to be added to the high cost of new hepatitis C (HVC) therapies<\/a>\u2014up to $80 000<\/a>\u00a0for each patient\u2014for those coinfected. On average, 25% of all HIV patients across the EU are coinfected with HVC, with higher rates among PWID [up to 80%] and those in\u00a0eastern European countries. NGOs, patient associations, and other civil society organisations should take advantage of recent governmental efforts <\/a>being made to pressure pharmaceutical companies to lower the pricing of HVC therapies.<\/p>\n

The World Health Organization has also drawn attention to the health inequalities that affect the most vulnerable of HIV patients. In the lead up to the International AIDS Conference<\/a> in Melbourne, Australia, which started earlier this week, the agency stated that globally the\u00a0people most at risk of HIV are not getting the health services they need. The agency warned that<\/a>: \u201cFailure to provide adequate HIV services for key groups\u2014MSM, people in prison, PWID, sex workers,\u00a0and transgender people\u2014threatens global progress on the HIV response.\u201d New WHO guidelines<\/a> on HIV prevention, diagnosis, treatment, and care for such populations have just been released.<\/p>\n

It may seem too early to make conclusions, but in the EU the general trends show\u00a0that austerity measures may very well\u00a0be enhancing health inequalities<\/a>. Therefore, although a general public health perspective remains necessary, efforts and resources should be increasingly focused in specific regions and population groups.<\/p>\n

[1]\u00a0HIV among migrants in the EU\/EEA: epidemiological trends 2007-2012. V Hernando, A Pharris, D Alvarez, Y Rivero, S Monge, T Noori, AJ Amato-Gauci, J del Amo. Fifth European Conference on Migrant and Ethnic Minority Health. Granada, Spain 10-12 April 2014. Research not yet published.<\/p>\n

Aser Garc\u00eda Rada<\/strong> is a paediatrician who currently works at the primary care center Las Calesas in Madrid, Spain. He is also a freelance journalist.<\/em><\/p>\n

Competing interests: I was paid expenses by the EU Commission for attending the HIV meeting in Athens that is mentioned in this blog.<\/p>\n

See\u00a0more on Aser’s biography<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

I was recently invited to a meeting on HIV\/AIDS that was hosted in Athens by the European Commission. Although the grass is greener on the EU side, the epidemic still poses relevant challenges. Contrary to the overall global\u00a0decline in new HIV infections, 29 381 people were newly diagnosed across the EU in 2012, 1% more […]<\/p>\n

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