World AIDS Day 2021: Concerning number of HIV infections going undiagnosed, shows new data from ECDC & WHO Europe

A new report marking World AIDS Day, published jointly by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO)’s Regional Office for Europe, shows a 24% drop in the rate of newly diagnosed HIV cases between 2019 and 2020. This drop is largely due to reduced HIV testing during 2020 as a result of COVID-19 restrictions and disruptions to services.

This situation is worrying, given that over the last decade new HIV infections have been increasing in the WHO European Region and it suggests that the number of people in the Region living with undiagnosed HIV is on the rise again.

Despite the potential under-diagnosis and under-reporting in 2020, 104 765 new HIV infections were diagnosed in 46 of the 53 countries in the European Region, including 14 971 from countries of the European Union/European Economic Area (EU/EEA). This corresponds to 11.8 newly diagnosed infections per 100 000 population overall in the European Region.

EU Health Commissioner Stella Kyriakides said:

“Ahead of World AIDS Day, in the middle of the COVID-19 pandemic, it is important to recognise the impact of the crisis on patients and healthcare systems. It is clear that we must do more for people living with HIV in regard to health-related quality of life. Thanks to advances in treatment, life expectancy has significantly increased for people living with HIV and the HIV population is larger than ever. This includes bringing HIV services closer to our communities and tailoring healthcare provisions to the needs of patients. We must also invest in new approaches to prevention, treatment and care. Together, we will put the needs of patients first, and end stigma and discrimination for so many people living with HIV every day”.

According to ECDC Director, Dr Andrea Ammon:

“2020 was a key year for HIV, when we needed to be reaching the 90-90-90 testing, treatment and viral suppression targets to be on track to meet the Sustainable Development Goals by 2030. While we have seen a decline in cases in 2020, it is likely that a substantial proportion of that decline is due to fewer cases detected early, given that HIV testing services were reduced or unavailable during a portion of 2020 due to COVID-19 measures. In this context, I think it is fair to say that most of Europe will not be reaching the 2030 targets, unless we address some major gaps in the prevention, testing and treatment continuum.

In the coming years, we need to monitor trends closely to ensure that the setbacks due to COVID-19 have not made the situation of late HIV diagnosis worse. Also, we need to scale up primary prevention across the Region, including pre-exposure prophylaxis (PrEP), scaled up testing, and making HIV treatments available immediately after diagnosis for as many people as possible. Finally, there is one additional aspect which I think has been overlooked and needs addressing: we really need to improve our understanding of HIV stigma.”

Dr Hans Henri P. Kluge, WHO Regional Director for Europe, said:

“With the world’s attention focused on the COVID-19 pandemic, we cannot forget another deadly virus that has been devastating lives and communities for nearly 40 years. Since the HIV virus was first identified in 1984, it has claimed more than 35 million lives, making it one of the most destructive pandemics in history. 

In recent years, many countries of the European Region have worked to increase testing and treatment while addressing social stigma. But new data gathered since the emergence of COVID-19 paint a worrying picture, suggesting that many people living with HIV are not being diagnosed in time, which could have long-term consequences on their quality of life. 

As we continue to tackle the COVID-19 pandemic we must get back on track in our fight against HIV/AIDS. There is still too much stigmatisation, discrimination and misinformation surrounding this virus, with huge disparities in diagnoses and treatment within the European Region. Together, we can end AIDS by 2030.”

Multiple HIV services impacted by COVID-19

Preliminary data from ECDC show that several types of HIV service across the continuum of HIV care are being impacted by COVID-19, from prevention outreach and the provision of PrEP, to in-clinic and community-based HIV testing, treatment and care programmes.

Countries must concentrate on reaching key populations

The findings of the report clearly show that the HIV pandemic is not over. While progress has been made, global targets for 2020 were not met and there is a real danger that the 2030 Goals will not be achieved either.

The mode of transmission varies across the Region, with sexual transmission between men as the most common mode in the EU/EEA, while heterosexual transmission and injecting drug use were the main reported transmission modes in the eastern part of the European Region.

Some important groups and populations, including children and men, are not being sufficiently reached by HIV testing, prevention, and care services. These inequalities have been further compounded by complications caused by the COVID-19 pandemic.

Countries need to focus on user-friendly prevention and testing services, with a focus on reaching key populations. These could be assisted partner notification, PrEP, HIV testing performed by trained lay providers and self-testing in line with ECDC guidance and WHO recommendations.

On World AIDS Day 2021, WHO is calling on global leaders and citizens to rally to confront inequalities and reach people left behind to overcome the growing disparities in access to essential HIV services.