Written by Laurence Amand-Eeckhout.
World AIDS Day, proclaimed by the United Nations in 1988, takes place each year on 1 December. The aim is to raise awareness, fight prejudice, encourage progress in prevention, and improve treatment around the world. Although infection with the human immunodeficiency virus (HIV) is preventable, significant HIV transmission remains a challenge to EU Member States’ health systems. This year’s theme ‘Equalize’ underlines the urgent need to address the inequalities that are holding back progress in ending acquired immunodeficiency syndrome (AIDS), and give equal access to essential HIV services.
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. The most advanced stage of HIV infection (with a CD4 count below 200) is 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.
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 (SDGs) 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 2022, the WHO’s three 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; focus on equality to ensure that everyone, everywhere, has equal access to HIV prevention, testing, treatment and care; and focus on those who have been left behind in the global response to HIV and AIDS (children and key populations – men who have sex with men, transgender people, people who use drugs, sex workers, prisoners and migrants – and their partners).|
Facts and figures
UNAIDS data show that, in 2021, 1.5 million people contracted HIV, 38.4 million people were living with HIV, and 650 000 people died of AIDS-related causes.
According to the 2022 report on ‘HIV/AIDS surveillance in Europe’ (2021 data), published jointly by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe, HIV affects over 2.3 million people in the WHO European region (made up of 53 countries covering a vast geographical region from the Atlantic to the Pacific Oceans), including over 590 000 people in the EU/European Economic Area (EEA).
In the EU/EEA specifically, 16 624 people were newly diagnosed with HIV in 2021. The decline in new cases being diagnosed in 2020 and 2021 is probably due, in part, to decreased case detection because of less testing and limited surveillance capacity during lockdown, and may also result from reduced transmission owing to fewer physical contacts during the pandemic. The use of formal and informal PrEP may also have played a role in the decline in numbers of new HIV diagnoses.
An estimated 88 000 people are living with undiagnosed HIV in the EU/EEA, implying that about one in eight of those living with HIV are not aware of their status.
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 for Member States to help them reach the global target under Goal 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.
Since the early years of the AIDS epidemic in the 1980s, the EU has invested significantly in HIV/AIDS research. Both the EU’s former programme for research and innovation, 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 (e.g. through the European HIV Vaccine Alliance and the European AIDS Vaccine Initiative 2020), and novel diagnostic tools.
The ECDC has developed operational guidance to support countries in their efforts to integrate PrEP into their existing HIV prevention packages for those most at risk of HIV infection. Its July 2022 progress report underlines that certain key populations, such as people who inject drugs, prisoners and undocumented migrants, remain ineligible for PrEP in many countries.
On the world stage, the EU supports the Global Fund against AIDS, malaria and tuberculosis (in 2019, the EU pledged €550 million for the 2020‑2022 period, and in September 2022, €715 million for the 2023-2025 period). In addition, in March 2022, the Global Fund approved US$15 million in emergency funding to support the continuity of HIV and tuberculosis prevention, testing and treatment services in Ukraine.
|In its May 2021 resolution on accelerating progress and tackling inequalities towards ending AIDS as a public health threat by 2030, the European Parliament called 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, and to integrate HIV prevention and care with other local healthcare service offers, as an entry point for HIV information, education, communication and training.|
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, 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).
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 lack rapid access to quality treatment and care. The UNAIDS 2021‑2026 Global AIDS Strategy highlights 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.
This updates an ‘at a glance’ note from November 2021.
Read this ‘at a glance’ on ‘World AIDS Day 2022: 1 December‘ in the Think Tank pages of the European Parliament.