Early HIV testing key to Europe’s 2030 targets – report

A new World Health Organisation (WHO) report released ahead of Friday (1 December), World AIDS Day, argues that there is still a long way to go to hit global HIV reduction targets by 2030, underlining the importance of early and tailored testing.

Aiming to end AIDS – the most advanced stage of HIV, which affects 39 million people worldwide – as a public health threat by 2030, the United Nations Global AIDS Strategy (UNAIDS) has set several targets that countries should reach. 

However, a new HIV/AIDS report presented by the World Health Organisation (WHO) and the European Center for Disease Prevention and Control (ECDC) on Tuesday, on data gathered in 2022, shows that European countries still have considerable work to do to reach the targets. 

The targets, updated in 2021, set a 95% compliance rate by 2025 to ensure countries are on track. The updated targets are for 95% of all people living with HIV to be diagnosed, 95% of those diagnosed to be on antiretroviral treatment and 95% of those on treatment to be virally suppressed by 2025.

Reaching these numbers will ensure that 86% of all people living with HIV will be virally suppressed, meaning that they have reduced the amount of HIV in the body to a very low level, which keeps the immune system working and prevents illness. 

For the first target, the 2022 report shows that the EU diagnosis average sits at 86% – nine points below the target. The other two reference points show better numbers, with the second target being reached as 95% of people diagnosed are receiving treatment. Among them, 93% are virally suppressed. 

The number of diagnoses in 2022 saw a 4% increase on numbers from 2021, though still a decrease of 20.5% compared to 2019 prepandemic.

“An increase in new cases in 2022 might seem like a bad thing, but it is evidence that in the EU/EEA, we are trending in the right direction, with people living with HIV better able to access testing, treatment and support services they need,” said ECDC’s director Andrea Ammon during the presentation of the report. 

The study attributes the increase to various factors, including the resumption of normal services after the COVID-19 pandemic, expanded and targeted HIV testing services, and the implementation of new testing strategies. 

According to Ammon, this new data reveals a clear picture of the progress across Europe, “as well as the significant challenges that remain because we can and must do more”. 

Fragmented European landscape

The new report also highlights the diverse landscape of HIV in Europe where there are currently 2.4 million people living with the disease.

In 2022, out of the more than 110,000 people diagnosed in the WHO European Region, over 71% were diagnosed in the East, 20% in the West, and 8% in the centre of the region.

The highest rates per 100,000 population were observed in the Russian Federation, followed by Ukraine and the Republic of Moldova. This latter reported the highest number of cases in a single year, with 90% of infections coming from inside the country. 

Anastasia Pharris, an epidemiologist working on HIV at ECDC, explained during its presentation that this year’s report shows an increasingly complex epidemiology of HIV in Europe. 

The 2022 surveillance data indicates a wide variation in epidemic patterns and trends across the WHO European Region. Together with the increasing movement of people across Europe, there are changes in the way of transmission and access to testing and treatment in different countries which hinders the identification of a pattern.

The fragmentation is not only limited to geographic regions but also specific communities. The report highlights the most vulnerable groups, as they are most affected by the barriers to accessing treatment. 

These key population groups include prisoners, sex workers, undocumented migrants, people who inject drugs, men who have sex with other men and transgender people.  

They also suffer the most stigma and discrimination, which can lead to the non-disclosure of their condition or risk factors to their close environment and even healthcare professionals. 

Ammon said that one in six people living with HIV avoid healthcare services because of fear of being treated differently, which contributes to late diagnosis and treatment. 

Half of new diagnoses in 2022 had a late diagnosis, which according to her, indicates an urgent need to explore underlying challenges that make people unable or unwilling to access timely testing and being linked to care.

This can be changed by “implementing patient-centred services in a non-stigmatising and inclusive environment, preferably with the involvement of civil society”, she said.

Ammon explained the need to recognise the unique needs of each community, to be able to offer tailor-prevention services, including developing initiatives that resonate with the diverse cultural, social and economic contexts of migrant populations.

[Edited by Giedrė Peseckytė/Nathalie Weatherald]

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