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 today (Friday 7 June) by the World Bank Group, WHO/Europe and the London School of Hygiene & Tropical Medicine. 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.
"The appalling HIV rates among poor and marginalised communities of drug users in eastern Europe and central Asia underscore the critical importance and global relevance of the World Bank's newly adopted goals: to end extreme poverty and promote shared prosperity," said David Wilson, Global HIV/AIDS Program Director at the World Bank. "At the same time, the increases in HIV in southern European countries hit hardest by recession underscore the profound, reciprocal interactions between poverty, exclusion and illness."
"Social exclusion is the core driver of HIV epidemics in Europe. It is a vicious circle: social marginalisation increases the risk of being affected by HIV, and HIV exacerbates social marginalisation, adding another layer of stigma. Exclusion from life-saving HIV prevention, treatment and care is often the end result," said Martin Donoghoe, programme manager for HIV/AIDS, STIs & Viral Hepatitis at WHO/Europe. "We are confident that our new regional policy framework, Health 2020, will support health systems strengthening for universal access to health for even our most marginalised citizens."
"Now is an important time for Europe. The momentum of HIV prevention must be maintained in a climate of economic and funding uncertainty," said Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine. "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."
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 criminalization of sex work, of sex between men, and of drug use, combined with social stigmatization, violence and rights violations.
HIV prevention requires social and environmental change, and the report calls for policy-makers and HIV programme implementers to target the right policies and programmes to maximize the health and social impacts of Europe's HIV responses and get higher returns on HIV-related investments.
The World Bank Group, WHO/Europe and the London School of Hygiene & Tropical Medicine will launch these new findings and recommendations on 7 June in London. The event includes a debate among high-level experts and policy-makers on maintaining the momentum to prevent HIV.