HIV infection is an important public health challenge in the Eastern part of the WHO European Region and EpiNorth project collaborating countries. Despite incomplete notification, the number of newly diagnosed cases of HIV in 2008 has increased, while the number of new AIDS cases has continued to decline in the region except in the Eastern European countries.
Since 2000, the rate of newly diagnosed cases of HIV has more than doubled from 44 to 89 per million population in 2000 and 2008, respectively. Incidence rates of HIV infection diagnosed during 2008 in the EpiNorth project collaborating countries were highest in Estonia (406.4 per million population), Ukraine (340.7), Latvia (157.6), Belarus (90.7), and much lower in Norway (63.1), Sweden (39.1), Iceland (31.7), Finland (29.1), and Lithuania (28.2). A major limitation in using HIV diagnosis to determine the actual HIV epidemic is that this indicator does not represent the true incidence. New HIV diagnoses may include recently infected individuals as well as those infected several years ago. This is influenced by the uptake of HIV testing, patterns of reporting, the long incubation period and slow disease progression. According to EuroHIV, estimates of underreporting range from 2% to 37%.
The predominant HIV transmission mode varies by geographical areas. In the Central European countries transmission is primarily among men who have sex with men (MSM) followed by heterosexual contact, while in the Eastern European countries injecting drug use is the predominant route. The cumulative prevalence of HIV transmission modes in EU/EEA countries for 2004-2008 has varied: 32.8% MSM, 37.7% heterosexual contact, 12.3% injecting drug use, 1.2% mother-to-child (MTCT), 1.2% transfusion recipients, 0.3% nosocomial infections, and 15.4% unknown route. The cumulative prevalence of HIV transmission modes in the Eastern part of the WHO/Euro region countries for 2004-2008 was different: 60.3% injecting drug use, 31.0% heterosexual contact, 0.4% MSM, 0.7% MTCT, 0.04% transfusion recipients, 0.1% nosocomial infections, and 7.5% unknown route. The most affected age groups in EU/EEA countries in 2004-2008 were 30-39 (36%) and 25-29 (18%) years of age, and in the Eastern part of the WHO/Euro region countries - 30-39(33%) and 40-49 (11%) years of age. The cumulative prevalence of women living with HIV in EU/EEA countries during the same period was 29% and 34% in the Eastern part of the WHO/Euro region.
The HIV epidemic in the Eastern part of the WHO/Euro region that includes several EpiNorth project collaborating countries is still primarily driven by injecting drug users (IDUs). However, the proportion of cases acquired by heterosexual contact is increasing. Without the implementation of comprehensive national HIV prevention strategies for IDUs, the HIV epidemic cannot be controlled, and treatment and care cannot be provided in this region. To achieve this target, countries in the region need to ensure high quality surveillance data, especially regarding routes of HIV transmission, and implement effective harm reduction programmes.
EpiNorth c/o Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O.Box 4404 Nydalen, N-0403 Oslo, Norway. Tel: + 47 21 07 67 45, Fax: + 47 21 07 65 13, E-mail: