Written by Nicole Scholz.
Every year, 1 December marks World AIDS Day, proclaimed by the United Nations (UN) in 1988 and aimed mainly at raising awareness. This year’s specific theme, ‘Communities make a difference’, draws attention to the crucial role of community health workers and communities of people living with HIV, highlighting their contribution to ending the epidemic. World AIDS Day also offers an opportunity to take stock of progress, globally and in the EU.
Infection with human immunodeficiency virus (HIV) causes a person’s immune system to deteriorate, making them vulnerable to often life-threatening opportunistic infections. Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of HIV infection. Although HIV/AIDS does not yet have a cure, it is treatable and preventable. HIV medicines (antiretroviral therapy) can slow progression of the virus in the body to a near halt and reduce the risk of transmission. Measures such as practising safer sex or using sterile needles help to avoid HIV infection and prevent AIDS. As an additional prevention method, HIV-negative people at a high risk of infection can use pre-exposure prophylaxis (PrEP), which involves taking a specific combination of HIV medicines daily. PrEP effectively prevents infection and has the potential to help reverse the increase in new HIV infections. HIV has claimed more than 32 million lives since the beginning of the epidemic some 35 years ago, and continues to be a major global public health issue. Considerable advances have been made, however, and HIV infection has become a manageable chronic health condition. People living with HIV can expect to live a normal lifespan.
Facts and figures from Europe
Despite the progress made – the number of AIDS cases and AIDS-related deaths has declined steadily in Europe since the 1990s – HIV transmission remains a problem in the EU and its neighbouring countries (i.e. the World Health Organization (WHO) European Region, spanning Europe and central Asia). According to the 2018 joint report by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe, the rates and overall numbers of people diagnosed with HIV are highest in the east of the region, lower in the west and in the EU/European Economic Area (EEA), and lowest in the centre.
The report’s data show that in 2017, 25 353 people were diagnosed with HIV, in 30 of the 31 EU/EEA countries. The rate of new HIV diagnoses was higher among men than women. Sex between men remained the predominant mode of HIV transmission, accounting for 38 % of all new diagnoses. Heterosexual contact was the second most common transmission mode among people newly diagnosed (33 %, equally divided between men and women). Transmission due to injecting drug use accounted for 4 % of HIV diagnoses. 41 % of people diagnosed in the EU/EEA were migrants. The overall EU/EEA trend in reported HIV diagnoses appeared to have declined slightly over the last decade, but contrasting trends were seen at national level: while some countries reported a decline in HIV diagnoses, rates had more than doubled in others.
United Nations-led global efforts to end AIDS
Ending the AIDS epidemic by 2030 counts among the targets under Goal 3 (target 3) of the sustainable development goals (SDGs), adopted by the UN in September 2015. UNAIDS, the joint UN programme on HIV/AIDS, is leading global efforts. Recent UNAIDS statistics show that there were an estimated 37.9 million people living with HIV in 2018. Of those, 23.3 million were accessing antiretroviral therapy, up from 7.7 million in 2010. Around 1.7 million were newly infected with HIV, compared with 2.9 million in 1997 – a 40 % decrease. In 2018, around 700 000 people died from AIDS-related illnesses worldwide, compared with 1.7 million in 2004. With increasing access to HIV prevention, diagnosis, treatment and care, AIDS-related deaths have been reduced by more than 56 % since the peak in 2004. As the WHO points out, although the coverage of services has been steadily increasing, not everyone is able to access HIV testing, treatment and care. Some key populations (men who have sex with men; people who inject drugs; prisoners; sex workers and their clients; and transgender people) are more at risk of HIV, but have less access to care (the ‘PrEP gap‘). In 2018, these population groups accounted for an estimated 54 % of new HIV infections globally (and 88 % in western and central Europe).
On World AIDS Day 2019, the WHO’s five main messages to global decision-makers are:
- Today, four out of five people with HIV get tested and two out of three get treatment – HIV-affected communities have played a major role in achieving this success.
- Countries should adopt community-based HIV testing, prevention, treatment and care as a core strategy.
- Community-based HIV treatment and monitoring saves money and reduces workloads for healthcare professionals.
- Expanding the role of communities and community-based healthcare will help countries meet global HIV and universal healthcare targets.
- Community and civil society engagement must remain a key strategy to boost primary healthcare.
EU action on HIV/AIDS
Whereas the Member States have the main responsibility for health, the EU complements national action. EU HIV/AIDS policy focuses on prevention and on supporting people living with the disease. The 2009 Commission communication on combating HIV/AIDS identified policies to help reduce the number of new infections and to improve quality of life for those living with the disease. An action plan on HIV/AIDS in the EU and neighbouring countries, introduced in 2014 to support the implementation of the communication, ended in 2016 and has not been renewed. The Commission’s 2018 staff working document on combatting HIV/AIDS, viral hepatitis and tuberculosis (TB) in the EU and neighbouring countries gives an overview of policy initiatives to help Member States achieve SDG 3. The EU has invested significantly in HIV/AIDS research over the years, and is financing projects under Horizon 2020. One example is EHVA, a platform for the development of prophylactic and therapeutic HIV vaccines. HIV/AIDS-related projects funded under the EU health programme (2014-2020) include the joint action on integrating prevention, testing and linkage to care strategies for HIV, viral hepatitis, TB and sexually transmitted diseases in Europe (INTEGRATE). At the August 2019 G7 summit in Biarritz, the Commission pledged €550 million to The Global Fund against AIDS, TB and malaria, which new Health Commissioner Stella Kyriakides intends to translate into action. At her hearing, she committed to ensure access to innovation and medicines for people with TB, HIV/AIDS and hepatitis.
The European Parliament, in its 2017 resolution on HIV/AIDS, TB and viral hepatitis, urges the Commission and Member States to develop a comprehensive EU policy framework to address the three diseases. It advocates for the EU to play a strong role in dialogue with neighbouring countries in eastern Europe and central Asia. On HIV/AIDS, in particular, it calls on the Commission and the Member States to facilitate treatment, including for the most vulnerable groups, and to work on combating the stigma associated with HIV infection.