Human immunodeficiency virus (HIV) is an infection that attacks the body’s immune system, specifically the white blood cells called CD4 cells. HIV destroys these CD4 cells, weakening a person’s immunity against infections such as tuberculosis (TB) and some cancers. If the person’s CD4 cell count falls below 200, their immunity is severely compromised, leaving them more susceptible to infections. Someone with a CD4 count below 200 is described as having AIDS (acquired immunodeficiency syndrome).
Over the past decade, notable progress has been made in the WHO European Region towards the 90-90-90 goals, developed by UNAIDS for 2020, of 90% of people living with HIV knowing their HIV status, 90% of people with diagnosed HIV infection receiving sustained antiretroviral therapy (ART), and 90% of people receiving ART having viral suppression.
In the Region, in 2020, 77% of people living with HIV knew their HIV status, 83% of people with diagnosed HIV infection received ART, and 95% of people receiving ART had viral suppression.
However, progress towards these goals is uneven across the Region. According to the most recent data, the majority (80% or almost 85 000) of newly diagnosed people were from the eastern part of the Region, while countries in the European Union and European Economic Area (EU/EAA) mostly showed a decrease in the rates of new diagnoses.
An estimated 2.6 million people live with HIV in the Region today, among whom an estimated 600 000 are unaware of their infection. Testing for HIV is a critical public health intervention because it’s the first step towards treatment and care. With current antiretroviral treatment, people who test positive can expect to live a healthy life with HIV without passing it on to anyone else.
COVID-19 pandemic and late diagnosis puts progress in danger
A 24% drop in the rate of newly diagnosed HIV cases between 2019 and 2020 is largely due to reduced HIV testing during 2020 caused by COVID-19 restrictions and disruptions in service. This is an alarming situation, considering that over the last decade, new HIV infections have been on an increasing trend in the WHO European Region. Latest data indicate that the number of people in the region living with undiagnosed HIV is on the increase.
Unfortunately, late HIV diagnosis remains a challenge for most countries in the Region, indicating the need for countries to explore ways of increasing testing access and uptake, such as self-testing and community-based testing. HIV treatment works most effectively when it is initiated as soon as possible after a positive diagnosis. When people living with HIV are diagnosed late and already have symptoms of widespread immune system damage when they begin ART, they are more vulnerable to AIDS and TB. TB is the leading killer of people with AIDS in the Region. Delayed treatment initiation can also lead to the spread of HIV infection to others, since the virus is not suppressed and can still be transmitted.
Improve access to treatment
Coverage of HIV treatment services is low in a number of countries in the eastern part of the Region. As a result, too many people develop AIDS and die from AIDS-related causes in this area. Low access to treatment and care, fear of discrimination, and stigmatization collectively reduce the incentive to take an HIV test.
Threat of hepatitis C co-infection
HIV and hepatitis C virus (HCV) co-infection is not uncommon, especially among vulnerable populations, such as people who inject drugs. If left untreated, HCV infection often leads to life-threatening liver disease, which progresses faster in people co-infected with HIV. Luckily, recent developments in hepatitis C treatment have paved the way for the elimination of hepatitis. All people living with HIV should be offered testing for viral hepatitis to allow early diagnosis and life-saving treatment.