In 2002, 542 new HIV diagnoses were registered in Latvia. This is a decrease of 33% compared to the number of registered new diagnoses in 2001, and it is the first time since 1998 that a fall in the annual number of HIV diagnoses has been observed in Latvia.

The first diagnosis of HIV infection in Latvia was registered in 1987. From 1987 until the end of 1997, HIV in Latvia was transmitted through sexual contact only, and most of the cases were in men who have sex with men (MSM). Until the end of 1997 the incidence of the infection was very low, and the total number of HIV infected individuals registered between 1987 and 1997 was 88 (statistics available from the AIDS Profilakses Centrs (AIDS Prevention Centre) http://www.aids-latvija.lv/).

Following the HIV epidemic among injecting drug users (IDUs) in eastern Europe (for example, Kaliningrad, Ukraine, Belarus, and Poland), a survey among IDUs was conducted in Latvia in 1997. Of 198 IDUs, 6 (3%) were found to be HIV positive. These were the first HIV infected IDUs registered in Latvia. After analysis of epidemiological information from the IDUs, the summer of 1997 was determined as the possible infection period. The results of the survey gave evidence of HIV spread in this group. Since 1998, the main route of HIV transmission has been intravenous drug use, and as a result the number of new HIV diagnoses has increased rapidly (Table 1). In 1998 the number of new HIV diagnoses reported was 6.5 times higher than in 1997 and in 1999 the annual increase in the number of new diagnoses rose to 1.7 times higher than the 1998 figure.

Table 1. Annual numbers of new HIV diagnoses registered in Latvia.

Four fifths of HIV infected patients live in Latvia's capital city, Riga. A syringe exchange and counselling programme (SECP) has operated in Riga since 1997, support for which comes mainly from foreign donors.

In 2002 HIV prevalence in 250 tested SECP clients in Riga was 21%, and the prevalences of prior hepatitis B infection and prior hepatitis C infection were 73% and 81% respectively. Twenty eight per cent of clients reported sharing drug injecting equipment during the previous month.

Continuation of the SECP in Riga remains critical. Outside Riga, eight local municipalities took part in SECP in 2001 and 2002 and two outreach programmes were started in 2002.

In 2002 the SECP had 44 232 contacts with IDUs, and 94 146 syringes were distributed. Ninety seven per cent of distributed syringes and needles were returned. It is estimated that SECP reached (had at least one contact with) 37% of Latvian IDUs between 1997 and 2002. This estimate was based on police information that there are up to 28 000 IDUs in Latvia.

The second largest risk group for HIV in Latvia is female sex workers (FSW), of whom 92 were tested in 2002, and 15 were found to be HIV positive (14 of these 15 reported current or past intravenous drug use). Since 2001, outreach work for HIV and sexually transmitted infections has been carried out with FSWs in Riga and on highways near to Riga. Prevention activities targeted at FSWs include information on bloodborne disease, syringe exchange (up to 60% of FSWs are also IDUs), condom distribution, counselling, and encouraging them to have regular medical examinations.

Primary and secondary HIV prevention is now targeted at schoolchildren, teenagers, and the general public.

Although the number of new HIV diagnoses was lower in 2002 than in 2001, the problem of HIV transmission has evolved so that heterosexual transmission appears to have increased. Twelve per cent of new diagnoses in 2002 were infected through heterosexual contact, compared to only 8% in 2001.

Changes in the age distribution of new HIV diagnoses have also been observed. Eighteen per cent of new diagnoses in 2002 were in the 10-19 year age group compared to 27% in this age group in 2001, but the percentage of new HIV diagnoses in all other age groups increased in 2002.

The AIDS Profilakses Centrs expects heterosexual transmission to increase again in 2003.