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In the Western area of Europe, AIDS incidence decreased by 12% in
2000 compared to 1999 (22 cases per million population). In the Eastern
area, the incidence of notified cases remained low, but newly diagnosed
cases are still rising. In the Centre, the rates of AIDS cases and HIV
infections remain low.
EuroHIV (European Centre for the Epidemiological of AIDS) coordinates
the surveillance of AIDS in the WHO European Region since 1984 and of
newly diagnosed HIV infection since 1999. The main findings of the latest
update at end 2000 are presented here (1). To take into account the diversity
of the epidemiological situation in the region, countries have been grouped
into three geographic areas: the West (the 15 countries of the European
Union plus Norway, Switzerland, Iceland, Israel, Malta) the East (the
15 Newly Independent States of the former Soviet Union) and the Centre
(the remaining countries of the region) (1).
In the West, AIDS incidence continues to decline (overall: 22 cases per
million population in 2000, –12% compared with 1999) except among those
infected heterosexually who now account for as many new cases as do injecting
drug users (IDU). Rates of newly diagnosed HIV infections show no clear
time trends overall (e.g. Denmark: 48 cases per million in 2000; United
Kingdom: 59; Switzerland: 80). They are, however, rising among heterosexually
infected persons, many of whom are migrants from a country with a generalised
epidemic
(in 2000, Denmark: 46%, Greece: 56%, United Kingdom: 71%) (2). In the
East, while reported AIDS incidence remains low (though increasing now
in Ukraine [12 cases per million in 2000] and Latvia [10 per million]),
rates of new HIV diagnoses (mostly in IDU) continue to rise steeply, particularly
in Russia (55 123 cases or 375 per million population in 2000; +173% compared
with 1999), Latvia (195 per million, +93%) and notably, for the first
time, in Estonia (276 per million, 30-fold increase). In the Centre, levels
of AIDS (5 cases per million) and new HIV diagnosis (8 per million) remain
low.
The HIV epidemic in Europe is the result of a multitude of epidemics
which differ in terms of their timing, their amplitude and the populations
they affect. In the West, the situation is now endemic and the current
decrease in AIDS incidence, which is largely explained by the effects
of highly active antiretroviral treatment (HAART), is slowing down and
will probably not last. In addition, as indicated by the increases in
other reported sexually transmitted infections (see the article by Kevin
Fenton, in this issue), relapses of risky sexual practices are to be feared.
Such relapses could result, at least partly, from the availability of
HAART since 1996 (3). A sizeable proportion of new HIV diagnoses are due
to heterosexual transmission, particularly in persons originating from
countries where the epidemic is generalised. Surveillance data indicate
that most countries of the Centre have, so far, avoided a large diffusion
of HIV (1,4). It is nevertheless crucial to monitor the situation closely
and to continue to pursue and to strengthen, where necessary, prevention
in this area. The East represents a vast geographic zone where the situation
remains heterogeneous. Whereas several countries are confronted with explosive
epidemics, others (e.g. Kyrkgyzstan) have registered only a few cases
of HIV infection to date (1). HIV spread in the East is intimately linked
with an epidemic wave of injecting drug use which predominantly affects
adolescents and young adults (4). The concomitant syphilis outbreak suggests
that HIV epidemics associated with drug use may be rapidly followed by
sexual HIV epidemics. It is urgent to strengthen HIV prevention in Eastern
Europe.
HIV/AIDS surveillance should remain flexible and continue to evolve in
response to changing needs and objectives. At the present time, it is
essential to obtain more specific epidemiological data in order to improve
the understanding of the effects of treatment on the epidemic, and to
design better prevention and control interventions in migrant populations,
while avoiding stigmatisation and discrimination of these populations.
Acknowledgements
The authors wish to thank the national coordinators for the surveillance
of HIV/AIDS in Europe and the staff who work in the surveillance centres.
Compilation of the European HIV and AIDS datasets is made possible by
the continuing participation of clinicians in the national HIV/AIDS reporting
systems.
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