Fighting against complacency

World Aids Day will be observed on Saturday (1 December). Judith Crosbie reports that although HIV/AIDS is less visible than it was 20 years ago, it has not gone away.

The number of people diagnosed with HIV is steadily on the increase in Europe, according to the latest United Nations figures. Some 2.4 million people in Europe and central Asia are living with HIV with approximately half of them unaware that they carry the virus.

But how the disease affects people across Europe differs greatly from western to eastern Europe.

The most alarming trends are being registered in eastern Europe and central Asia. Today 1.6 million are living with the virus compared with 630,000 in 2001. The new infections are largely down to people injecting drugs, says Ton Coenen, executive director of the organisation STI AIDS, based in the Netherlands, and a member of the steering committee of AIDS Action Europe. "When people get tested they often don’t have access to treatment. There is a lot of discrimination against these people and many of them are not even aware that they have HIV. If people don’t know they are infected they will infect others more easily," says Coenen.

Russia and Ukraine have shown a steady increase in HIV infection rates. In 2006, 39,000 new HIV diagnoses were recorded, bringing the total number of HIV cases in Russia to about 370,000, according to UN figures released last week (20 November).

In Ukraine, HIV diagnoses have more than doubled since 2001, reaching 16,094 in 2006 and exceeding 8,700 in the first six months of 2007, according to the UN.

Coenen says political leadership is needed to tackle the problem of access to treatment. "There is also a need to tackle the stigma associated with the virus," he says. The EU should also more comprehensively build in tackling the virus into its dealings with countries to the east of its border, he adds.

For western and central Europe, where there are up to 800,000 people with HIV, the virus is mainly on the increase among heterosexuals and homosexual men. Among heterosexuals, immigrants account for most new infections and represent 42% of HIV diagnoses in 2006. Immigrants are also a vulnerable group owing to difficulties in encouraging testing for the virus. "There are real issues around the taboo factor in a community that already has limited access to services," says Coenen.

"Testing in itself is not the only solution. We need to look at what the barriers are. If we want to have people tested we need to ensure confidentiality," he adds.

HIV rates among homosexuals in the EU member states have been increasing for the last five years. "It is not that people do not see the risk but that they estimate that the risk is lower since HIV/AIDS is less visible than it was 20 years ago," says Coenen. The fact that the virus does not have the same fear factor among the gay community that it did in the 1980s, given that anti-retroviral drugs greatly lower the mortality rate, is also creating complacency.

Until recently, little was being done at EU level to tackle HIV/AIDS. But since 2004, when ten mostly eastern European states joined the Union, the issue has come onto the EU’s agenda culminating in a European Commission paper which proposes an integrated approach to tackling the increase of HIV/AIDS.

Coenen says there is a need for EU-level co-ordination. He points to the fact that new member states lost funding from outside donors when they joined the EU but are not yet rich enough properly to fund treatment and other programmes related to HIV. Moreover, they do not have the same tradition as other parts of the EU of non-governmental organisations promoting ways of tackling the stigma and highlighting gaps in services for people with HIV. "This is where the EU needs to step in," says Cloenen.

HIV by region

• Overall

Number of people living with HIV in 2007: 33.2 million;

People newly infected with HIV in 2007: 2.5 million

AIDS deaths in 2007: 2.1 million

• Sub-Saharan Africa

Number of new HIV infections: 1.7 million;

Overall number of infections: 22.5 million

• Asia

Number of new HIV infections: 440,000;

Overall number of infections: 4.9 million

• Eastern Europe and central Asia

Number of new HIV infections: 150,000;

Overall number of infections: 1.6 million

• North America, Western Europe

Number of new HIV infections: 78,000;

Overall number of HIV infections: 2.1.million

World Aids Day will be observed on Saturday (1 December). Judith Crosbie reports that although HIV/AIDS is less visible than it was 20 years ago, it has not gone away.