Rising reports of sexually acquired HIV infections in both
western and eastern Europe
The European Centre for the Epidemiological Monitoring
of AIDS (EuroHIV, http://www.eurohiv.org
this month released the latest biannual report, HIV/AIDS Surveillance
presenting data on cases of newly diagnosed HIV infections and AIDS reported
by the end of 2002. For the purposes of this report, Europe is divided into
three regions: West (23 countries of western Europe, plus Israel), East (the
15 Newly Independent States of the former Soviet Union), and Centre (the 13
remaining countries of the World Health Organization European Region).
For the first time data are presented by country or subcontinent of patient
origin. This variable is not yet fully standardised across the countries
contributing to EuroHIV’s data, however. Table 9 on p.26 of the report shows
information used in national surveillance to determine country or subcontinent
A cumulative total of 165 454 HIV infections have been reported. This is
a considerable underestimate of the true number, as the three countries
with the largest HIV/AIDS epidemic (France, Italy, and Spain) have not yet
fully implemented national HIV reporting systems.
During 2002, 14 439 new diagnoses were reported, of which 44% were probably
acquired heterosexually, 26% through sex between men (SBM) and 12% through
injecting drug use (IDU). Thirty five per cent were female and 30% were
aged less than thirty.
The number of new diagnoses during 2002 represented a 23% increase on the
number newly diagnosed during 2001. This increase was due to sharp increases
in the United Kingdom and Germany, with the former accounting for 42% of
all HIV infections reported in the West during 2002. Both countries have
seen rises in the numbers of diagnoses of infections acquired abroad heterosexually.
While most newly reported HIV infections in the West (France, Italy, and
Spain excluded) are heterosexually acquired, Portugal’s epidemic remains
IDU dominated, and in Germany, Greece, and the Netherlands, transmission
through SBM predominates.
Data on patient origin are available for 11 countries. In these countries,
origin was known for 50% of 12 538 individuals reported HIV positive in
2002. Thirty eight per cent of these were from sub-Saharan Africa. Among
heterosexual cases, the proportion was 66%.
In 2002, 9757 cases of AIDS were diagnosed in the West. Thirty eight per
cent of these individuals probably acquired HIV heterosexually, 29% through
IDU and 21% through SBM. Twenty five per cent were female and 13% were under
thirty years of age. Tuberculosis and Pneumocystis carinii pneumonia
(PCP) were the most common AIDS indicator diseases.
After several years of decline following the introduction of combination
antiretroviral treatment, AIDS incidence has now largely levelled off, and
in some countries shows signs of increasing once more. AIDS related mortality,
however, continues to decrease.
During 2002, 1427 HIV infections and 539 AIDS cases were diagnosed in the
Centre, rates remaining low and relatively static. Excluding Romania, 26%
of new HIV infections were female and 43% were in persons aged less than
Dominant modes of transmission included: nosocomial (health care acquired)
(Romania), IDU (Poland, Yugoslavia), SBM (Bosnia and Herzegovina, the Czech
Republic, Hungary, Slovakia, and Slovenia), and heterosexual (Bulgaria,
Croatia, FYR Macedonia, and Turkey). Six countries collected information
on patients’ country of origin. Where origin was known, it was outside the
country of report for 21% of new HIV diagnoses.
Four diseases predominate at AIDS diagnosis in this region: HIV wasting
syndrome, tuberculosis, PCP and oesophageal candidiasis.
A cumulative total of 300 184 HIV infections have been reported. As in the
West and Centre, this number is an underestimate.
During 2002, 64 222 new HIV diagnoses were reported. Of these, 41% were
IDU and 10% were heterosexual; while only 0.1% were SBM. For 43% the risk
group was unknown. Thirty three per cent were female, and 77% were under
thirty years of age. Seven countries provided information about origin.
In these countries, 99% of new HIV diagnoses were in persons from the country
After increasing steeply for several years, the number of new HIV diagnoses
declined for the first time in 2002 by 36%. This decrease was due to a sharp
decline in the number of IDU cases (-53%). By contrast, heterosexually acquired
cases increased by 32% in 2002, and the number of reports of children born
to HIV positive mothers doubled. The decline in HIV diagnoses in the East
is probably due to the saturation of the IDU population (that is, most of
those IDU who would be infected with HIV have already been infected)
AIDS is thought to be grossly underreported in several countries of the
East. However, incidence, previously extremely low, has started to rise
slowly. Seventy seven per cent of individuals newly diagnosed with AIDS
were thought to have been infected through IDU and 20% heterosexually; while
only 0.6% were thought to have been infected through SBM. A substantial
proportion of cases presented with tuberculosis.
The report also contains information about total numbers of diagnostic HIV
tests and the prevalence of HIV infection among sex workers.