Anastasia Pharris desarrolla su labor profesional en el European Centre for Disease Prevention and Control, nos hará en nuestro Congreso un análisis de los retos a los que se enfrentará la lucha contra el VIH en Europa en la próxima década.
Your view on the current situation of the HIV epidemic in Europe is not particularly positive. What evolution do you foresee in the next ten years?
Overall, we see that estimated new HIV infections are going down globally while they are increasing in the WHO European Region. This means that Europe is lagging behind in its HIV response and is not on track to meet the Sustainable Development Goals for 2020 which include a reduction in new HIV infections to fewer than 63 000 for Europe and Central Asia.
In the 53countries of the WHO European Region, however, the annual increase in new HIV diagnoses continued in 2016 with 160 453 newly reported HIV diagnoses (a rate of 18.2 per 100 000 population). This, once again, represents the highest annual number and rate since reporting started in the 1980s.
Across the countries of the European Union and European Economic Area, the trend in reported HIV diagnoses remained relatively stable during the period 2007–2016, with rates of 6.8 and 6.9 per 100 000 in the earlier part of the period and a slight decline to 6.5 per 100 000 in more recent years, and to 5.9 in 2016. For the first time in recent years, several countries have reported a decline in new HIV diagnoses, even after adjusting for reporting delay.
But as incidence declines in some populations and regions in Europe, it will be concentrated in even harder to reach populations and places.
In addition, uneven application and use of evidence-based prevention and treatment policies could intensify already existing inequalities in HIV incidence and outcomes in Europe.
What are the main mistakes that are currently being made in the fight against HIV?
Basically, we have sufficient tools and knowledge to end the HIV epidemic in Europe – but we are not using them properly. Effective interventions – from frequent testing and immediate linkage to care and treatment after HIV diagnosis to the use of pre-exposure prophylaxis, to name just a few – are not applied at scale in many European countries.
One reason for this persistent HIV epidemic in Europe: over half (51% in the WHO Region, 48% in the EU/EEA) of those diagnosed are diagnosed in a late stage of infection. This high proportion of late diagnoses suggests persistent problems with access to, and uptake of, HIV testing and counselling in many countries.
Diversifying and complementing testing opportunities is probably the best strategy to address this issue. Testing in community setting and self-testing could be valuable additions to increase access and promote normalisation of HIV testing to ensure all ages are appropriately targeted by sexual health services. Particularly health professionals can help a lot by engaging in discussions about sexual risks – and by routinelyoffering an HIV test that people can then opt out of. That way they help to normalise HIV testing instead of making this an exceptional test.
For example we see first signs of reduced incidence in men who have sex with men (one of the main groups at-risk of HIV infection in the EU) in selected countriesin mother-to-child transmission and transmission among people who inject drugs.
General awareness raising and prevention initiatives such as condom promotion campaigns can also help and are not widely seen in many countries.
If HIV prevention and new infections rate stay as nowadays, what is the scenario for the coming years? Could we talk about a rebound in HIV cases?
In short: Europe will not meet the SDG targets and the epidemic will persist.
Would it be positive to establish the same HIV prevention measures throughout Europe? What model or concrete measures would you implement for the entire European continent?
The HIV epidemics in Europe vary, as do health systems and, therefore, prevention and control strategies cannot be the same across the continent.
What we can say, is that Europe needs to focus its efforts on three main areas:
- Prioritising effective comprehensive prevention measures such ascondom promotion,pre-exposure prophylaxis for HIV; opiate substitution therapy and needle exchange; health promotion.
- Promoting diverse and effective ways to test for HIV including:provision of efficient HIV counselling and testing services, including rapid diagnostic services, community-based HIV testing and HIV self-testing; for those found HIV-positive, the offer of voluntary partner referral is an efficient way to identify persons exposed to HIV
- Ensuring rapid access to quality treatment and care for those diagnosed.