Written by Laurence Amand-Eeckhout.
World AIDS Day, proclaimed by the United Nations in 1988, takes place each year on 1 December. It aims at raising awareness, fighting prejudice, encouraging progress in prevention, and improving treatment around the world. Although the human immunodeficiency virus (HIV) is preventable, significant HIV transmission remains a challenge to EU Member States’ health systems. This year’s theme ‘End inequalities. End AIDS.’ underlines the urgent need to tackle economic, social and cultural inequalities in order to end AIDS by 2030.
Background
Attacking the body’s immune system (the white blood cells or ‘CD4 cells’), HIV weakens its defence against other infections and diseases, including tuberculosis and some types of cancer (such as lymphomas and Kaposi’s sarcoma). The most advanced stage of HIV infection (with a CD4 count below 200) is acquired immunodeficiency syndrome (AIDS). Found in a variety of body fluids, such as blood, semen, vaginal secretions and breast milk, HIV can be transmitted through sex, blood transfusion, the sharing of contaminated needles and between mother and child during pregnancy, delivery and breastfeeding. People who are at high risk of getting HIV can take pre-exposure prophylaxis (PrEP) medicine to reduce the risk of infection. People diagnosed with HIV and treated early can now expect to live a normal lifespan. Infections can be treated to prevent progression to AIDS by decreasing viral load in an infected body (antiretroviral therapy, ‘ART’). However ART does not cure HIV infection and there is no vaccine.
There is some evidence that people living with HIV experience more severe outcomes and have higher comorbidities from Covid‑19. Moreover the coronavirus pandemic had indirect effects as, in some countries, lockdowns or other restrictions disrupted HIV or AIDS testing or treatment services.
The United Nations (UN) Programme on HIV/AIDS (UNAIDS) is leading the global effort to end the AIDS epidemic by 2030, as part of the Sustainable Development Goals adopted by the UN in 2015 (Goal 3). UNAIDS unites the efforts of 11 UN organisations, including the World Health Organization (WHO).
| On World AIDS Day 2021, the WHO’s four main messages to global decision-makers are: re-commit to end HIV, as the challenges posed by the coronavirus pandemic require a renewed effort to address this public health threat by 2030; tackle HIV and Covid‑19 together, by confronting the special challenges presented by the Covid‑19 pandemic for people living with HIV; focus on equality to ensure that everyone, everywhere, has equal access to HIV prevention, testing, treatment and care, including Covid‑19 vaccination; concentrate on those left behind, to include the diverse groups of people being marginalised in each country. |
Facts and figures
UNAIDS data show that, in 2020, 1.5 million people contracted HIV, 37.7 million people were living with HIV and nearly 700 000 people died of AIDS-related causes.
According to the 2020 report on ‘HIV/AIDS surveillance in Europe’ (2019 data), published jointly by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe, HIV affects more than 2 million people in the European region (as defined by WHO), particularly in the east. In 2019, 25 000 people were diagnosed with HIV in the EU and the European Economic Area (EEA), with more men than women as in previous years. It is estimated that about 120 000 people are living with undiagnosed HIV in the EU/EEA, implying that about one in seven of those living with HIV are not aware of their status. The number of AIDS-related deaths reported in the EU has more than halved in the past decade.
EU action on HIV/AIDS
EU Member States are responsible for their own healthcare policies and systems. However, according to Article 168 of the Treaty on the Functioning of the European Union, the EU complements national policies while also fostering cooperation between Member States. In the EU, HIV/AIDS policy focuses on prevention and on supporting people living with the disease.
The European Commission has mobilised measures and instruments across several policy areas in the fight against HIV/AIDS. This includes support to Member States to help them to reach the global objective under target 3 of the UN SDGs, to end the AIDS epidemic by 2030. In that context, the Commission facilitates the exchange of best practices through the Health Security Committee, as well as dedicated networks on the EU Health Policy Platform. The new 2021‑2027 EU4Health programme supports actions to address the consequences for mental health on patients suffering from cancer and other vulnerable situations, including people living with HIV/AIDS. The Commission’s work programme for 2021 encourages the development of community-based services, the setting-up of Union-wide networks and the design of tools/guides for community-based services (notably prevention towards hard-to-reach populations and early diagnosis). Since the early years of the AIDS epidemic in the 1980s, the EU has significantly invested in HIV/AIDS research. Horizon 2020 and the 2021‑2027 Horizon Europe programme support research ranging from basic research to the development and testing of new treatments, new vaccine and microbicide candidates, and novel diagnostic tools.
On the world stage, the EU supports the Global Fund against AIDS, malaria and tuberculosis (in 2019, the EU pledged €550 million for 2020‑2022).
| In its May 2021 resolution on accelerating progress and tackling inequalities towards ending AIDS as a public health threat by 2030, the European Parliament calls on the Commission to address AIDS as a global public health crisis, to prioritise health as part of the EU-Africa strategy, to work with Member States and partners to invest in community engagement and community-led responses as key components in the fight against HIV/AIDS-related stigma and discrimination, as well as to integrate HIV prevention and care with other local healthcare service offers, as an entry point for HIV information, education, communication and training. |
Challenges
Despite the progress made, communicable diseases such as HIV/AIDS are examples of epidemics that pose significant public health and economic challenges and require a multi-sectoral approach and multi-level cooperation. Progress needs to be made in terms of diagnosis, which often comes too late. According to ECDC, in Europe, every second HIV diagnosis (53 %) happens at a late stage of infection, when the immune system has already started to fail. Delayed treatment can also lead to the spread of HIV infection to others.
Better prevention tools (awareness-raising, PrEp, needle exchange programmes, promotion of safer sex) are crucial, in particular for people who are reluctant to use health services. The fear of discrimination and stigmatisation can reduce the incentive to take an HIV test (HIV self-testing and community-based HIV testing can help). On 4 November 2021, ECDC announced the launch of a survey to gather information on stigma and discrimination against people living with HIV in Europe and central Asia.
Research and innovative solutions are required to find an effective prophylactic vaccine and therapeutic HIV vaccines or cure, to fight the threat of HIV drug resistance, and to improve the quality of life for those living with the disease, including long-term management of patients.
HIV infection has become a manageable chronic health condition. However many people living with HIV face inequalities. In addition to the prospect of reduced quality of life and poorer health outcomes than the rest of population, many of them are economically disadvantaged, have lower levels of education and do not have rapid access to quality treatment and care. In 2020, 65 % of new adult HIV infections globally were among key affected populations and their partners, including sex workers, people who inject drugs, prisoners, transgender people, gay men and other men who have sex with men (these populations accounted for 96 % of new HIV infections in western and central Europe). These key populations are most at risk but are sometimes more difficult to reach. The UNAIDS 2021‑2026 Global AIDS Strategy underlines the need for a new approach that reduces the inequalities that drive the AIDS epidemic and puts people at its centre, involving communities, and prioritising human rights, respect, and dignity.
Read this ‘at a glance’ on ‘World AIDS Day 2021: 1 December‘ in the Think Tank pages of the European Parliament.
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