The number of people living with undiagnosed HIV is increasing in the WHO European Region overall. According to data published today by ECDC and WHO/Europe, more than 136 000 people were newly diagnosed in 2019. Roughly 20% of these diagnoses were in the European Union (EU)/European Economic Area (EEA) and 80% were in the eastern part of the WHO European Region.
Every second HIV diagnosis (53%) happens at a late stage of the infection when the immune system has already started to fail. This is a sign that testing strategies in the Region are not working properly to diagnose HIV early.
The number of people diagnosed with AIDS, the end-stage of an untreated HIV infection, has gone down by more than half in the last decade, and the Sustainable Development Goal target of ending the AIDS epidemic by 2030 is achievable. However, in the EU/EEA for example, 74% of the 2772 AIDS diagnoses in 2019 were made very soon after the initial HIV diagnosis – within 3 months. This shows a significant problem with late diagnosis of HIV infection. This late diagnosis contributes to ongoing HIV transmission as, often for years at a time, people do not know they have HIV and are not getting treatment.
Though the trend in the Region as a whole has stabilized in recent years, the number of people newly diagnosed with HIV has gone up by 19% since 2010. In contrast, the proportion of new diagnoses across EU/EEA countries has declined by 9% over the same period.
The number of newly reported HIV diagnoses and the estimated number of new HIV infections in the whole Region show that more people have become infected with HIV over the last decade than have been diagnosed. This indicates that the number of people living with undiagnosed HIV is increasing in the Region. In the EU/EEA, the opposite trend has been observed: the number of people living with undiagnosed HIV has been going down.
Dr Hans Kluge, WHO Regional Director for Europe, says: “I remember when a diagnosis of HIV seemed like a death sentence. Now, with proper treatment, people with HIV can live without fear of AIDS. These data are from 2019, and the question in 2020 has to be what effect the pandemic will have had on testing by the end of 2021. For now, our message has to be to protect the progress of the last decade by continuing to prioritize HIV testing and getting treatment to those who need it. We cannot allow the pandemic to rob us of an AIDS-free future that is within our grasp.”
Dr Andrea Ammon, ECDC Director, highlights: “Despite the focus on COVID-19 right now, we must not lose sight of other public health issues like HIV. Earlier diagnosis of HIV is an urgent priority. We cannot reach the Sustainable Development Goal target if it takes an average of 3 years for people to find out that they are HIV positive after infection with the virus – 3 years during which live-saving treatment is not available to them and during which they can unknowingly pass on HIV. If we want to reduce the high proportion of people diagnosed late, it is essential to diversify our HIV testing strategies as outlined in the ECDC testing guidance, for example.”
Early diagnosis: higher life expectancy and less transmission
The HIV/AIDS surveillance data for 2019 show that the proportion of those who are diagnosed late increases with age. Across the whole Region, 67% (EU/EEA: 65%) of people aged 50 and older were diagnosed late in the course of their HIV infection. In 2019, 1 in 5 new HIV diagnoses was in a person over 50 years of age.
The reasons for this are not yet fully understood. It may be that older adults themselves, or the health-care workers looking after them, underestimate the risk of infection. Older adults may be more affected by the stigma associated with the disease and feel less comfortable asking to be tested.
WHO/Europe and ECDC stress that to reduce the number of future HIV infections, Europe needs to focus on 3 main areas:
- prioritizing a range of prevention measures such as awareness-raising, the promotion of safer sex and condom use, the provision of needle exchange programmes and opioid substitution therapy, and pre-exposure prophylaxis for HIV (also known as PrEP);
- providing efficient HIV counselling and testing services including rapid diagnostic services, community-based HIV testing and HIV self-testing; and
- ensuring rapid access to quality treatment and care for those diagnosed.
Early diagnosis is important because it allows people to start HIV treatment sooner, which in turn increases their chances of living a long and healthy life and prevents further transmission.
Guidance to improve testing in Europe
In their guidelines, both WHO/Europe and ECDC recommend that HIV testing services include self-testing and community-based testing by lay providers using rapid tests.