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Living on the margins drives HIV epidemic in Europe and central Asia

Social and structural factors – such as poverty, marginalisation and stigma – and not just individual behaviours are shaping the HIV epidemic in Europe and central Asia.

This is the main conclusion of a new report released by the London School of Hygiene & Tropical Medicine, the World Bank Group and WHO/Europe. The study systematically reviews evidence on HIV vulnerability and response in all countries of the WHO European Region.

The report, HIV in the European Region: vulnerability and response, focuses on key populations most at risk of HIV infection: people who inject drugs, sex workers and men who have sex with men. It confirms that they are disproportionately affected by the growing HIV epidemic in Europe, where the number of reported HIV cases reached over 1.5 million in 2011.

HIV cases in these three groups account for about 50% of total diagnoses. Economic volatility and recession risks are increasing vulnerability to HIV and infections.

Key findings in the report include the following.

  • 25% of HIV diagnoses in Europe were associated with injecting drug use, with much higher proportions in eastern Europe (33%) than in western Europe (5%) and central Europe (7%).
  • HIV remains relatively low among female sex workers in Europe who do not inject drugs (less than 1%), but higher among those who inject drugs (over 10%) as well as among male and transgender sex workers.
  • Sex between men accounted for 10% of all HIV diagnoses in Europe, with higher rates reported in western Europe (36%), followed by central Europe (22%) and eastern Europe (0.5%). The increase was higher, however, in central and eastern Europe.

The analysis highlights the pivotal role of environmental factors in shaping HIV epidemics and HIV prevention responses. Barriers to successful HIV responses include the criminalisation of sex work, of sex between men, and of drug use, combined with social stigmatisation, violence and rights violations.

Co-author of the report, Professor Tim Rhodes from the London School of Hygiene & Tropical Medicine, said: “We need to maintain the momentum of HIV prevention for vulnerable populations in Europe. The need for scaling-up HIV prevention for people who inject drugs remains most urgent in the east of Europe. Not only do we need to promote treatment interventions tailored to individuals, we need to strengthen efforts to bring about social, structural and political changes”.

The report calls for policy-makers and HIV programme implementers to target the right policies and programmes to maximise the health and social impacts of Europe’s HIV responses and get higher returns on HIV-related investments

Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine, added: “Now is an important time for Europe. The momentum of HIV prevention must be maintained in a climate of economic and funding uncertainty. The evidence gathered through our collaborations with the World Bank Group and the World Health Organization show how institutions can work together to generate the evidence and the policy to do this.”