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HIV/AIDS in the European Region with a focus on women and eastern Europe

HIV/AIDS in the European Region with a focus on women and eastern Europe. A European overview A focus on women and MTCT? Some key WHO reproductive health documents Jeffrey Victor Lazarus [jla@euro.who.int]

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HIV/AIDS in the European Region with a focus on women and eastern Europe

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  1. HIV/AIDS in the European Regionwith a focus on women and eastern Europe • A European overview • A focus on women and MTCT? • Some key WHO reproductive health documents Jeffrey Victor Lazarus [jla@euro.who.int] “Women and HIV/AIDS in CEE: Bringing Different Communities Together to Advance Common Goals” Warsaw, 11 November 2005 STI/HIV/AIDS Programme WHO/Europe

  2. The 52 Member States of WHO Regional Office for Europe Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia,Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania,Luxembourg, Malta, Monaco, Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Serbia and Montenegro, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, The former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, UnitedKingdom of Great Britain and Northern Ireland, Uzbekistan Bold = central and eastern Europe (28) Underlined and blue = European Union Member State (15) Shaded and greenish = EU recently acceded Member State (10) STI/HIV/AIDS Programme WHO/Europe

  3. WHO by geographic area East West Centre STI/HIV/AIDS Programme WHO/Europe Source:EuroHIV.org

  4. New reported HIV cases19892003 STI/HIV/AIDS Programme WHO/Europe

  5. Different HIV Epidemics in the European Region • West • Previously endemic situation but now number of cases increasing • New heterosexual cases “imported” • Older IDU epidemics continue to contribute to high HIV prevalence rates • Impact of HIV prevention (HR) and treatment (ART) • Centre • Stable situation (majority of cases in Poland and Romania) • No evidence of rapid HIV spread • Enabling conditions for transmission, including drug injection • East • Explosive situation (though new diagnoses fell in 2002 and 2003) • Epidemics driven by injecting drug use • Prevention and treatment inadequate STI/HIV/AIDS Programme WHO/Europe

  6. HIV/AIDS epidemic in Europe WHO/UNAIDS estimates, end of 2004: PLWHA: 2,010,000 (1.40 – 2.86m) Estimated prevalence: 0.44% (range: 0.22-0.69%) Number of cases reported to WHO/Europe (10/10/05): New HIV infections: 884 060 New AIDS cases: 303 377 New AIDS deaths: 173 138 STI/HIV/AIDS Programme WHO/Europe

  7. Infectious diseases have skyrocketed in the fSU 240 220 200 180 160 Cyprus 140 Greece EU members before May 2004 EU members since May 2004 120 Commonwealth of Ind. States central Asia 100 80 60 40 20 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Syphilis incidence per 100 000 population STI/HIV/AIDS Programme WHO/Europe

  8. Millennium Development Goals (MDGs) • Eight major goals: • Eradicate poverty and hunger • Achieve universal primary education • Promote gender equality and empower women • Reduce child mortality • Improve maternal health • Combat HIV/AIDS, malaria and other diseases • Ensure environmental sustainability • Develop a global partnership for development STI/HIV/AIDS Programme WHO/Europe http://www.developmentgoals.org/

  9. Two dilemmas “Although evidence proves that investment in tackling the social determinants of health is more cost-effective, health care services are perceived as a priority by the population and thus by politicians.” EURO Health Report, RC51/7 However, in the case of HIV/AIDS in eastern Europe, services, be they prevention (eg harm reduction or condom promotion) or treatment (HAART), are not always considered acceptable or a priority. STI/HIV/AIDS Programme WHO/Europe

  10. < 0.1% 200 100 0.1 – 0.3% 0.3 - 0.6% 0.6 – 1.0% > 1.0% 3 300 1 900 8 000 8 000 860 000 5 500 5 500 7 000 20 000 53 000 3 000 17 000 15 000 20 000 15 000 44 000 600 3 000 150 000 1 500 260 000 400 17 000 11 000 3 000 20 000 3 000 27 000 40 6 000 200 50 450 150 000 15 000 60 250 6 000 100 140 000 3 000 50 1 000 6 000 200 2 000 300 10 000 5 000 230 Adults and children living with HIV/AIDS and prevalence among 15-49 old, 2004 450 4 500 STI/HIV/AIDS Programme WHO/Europe

  11. 11% <20% 20-40% 40-60% 60-80% >80% 17% 19.3% 14.5% 90% 33.7% 87% 10% 81.2% 6.03% 82.9% 84% 71.1% 12.9% 82% 16% 80% 5% 23.5% 71% 1.3% 29.2% 25% 81.6% 50% 1% 73.6% 86% 7.4% 32% 11% 64% 0.12% 15% 51% 60% 68% 4% 60% 3% 14% 56.5% 10% 3.8% 16% 16% 0% 5.9% 6% 25% N/A IDU as % of all HIV/AIDS reported cases NOTE: % of AIDS cases in countries not reporting HIV Sources: EuroHIV; national reports; 1,8% STI/HIV/AIDS Programme WHO/Europe

  12. <20% 20-40% 40-60% 60-80% >80% 71% 75% 77% 68% 72% 73% 76% 88.6% 61% 71% 78% 62.5% 79% 80% 81% 66% 85% 61.2% 84% 83% 85% 73% 72% 97% 80% 80.3% 77% 70.9% 80% 72% 75% 70% 80% 64% 78% 62% 75% 75% 78% 77% 81% 80% 80% 63% 90% 74% N/A 68% 82% Males as % of all HIV/AIDS reported cases NOTE: % of AIDS cases in countries not reporting HIV Sources: EuroHIV; national reports; 82,8% STI/HIV/AIDS Programme WHO/Europe

  13. <20% 20-40% 40-60% 60-80% >80% 30% 29.5% 53% 2% 65% 35% 31% 47% 2% 43% 44% 38% 45% 22.7% 46%* 0.6% 36% 45% 56% 3% 3% 49% 23% 35% 25% 15% 4% 5% 21% 15% Non-nationals or immigrants as % of all HIV/AIDS reported cases NOTE: % of AIDS cases in countries not reporting HIV Sources: EuroHIV; national reports; 41,6% STI/HIV/AIDS Programme WHO/Europe 46.8%

  14. New HIV cases reported since the beginning of reporting, WHO/Europe, end of 2003 STI/HIV/AIDS Programme WHO/Europe Source: EuroHIV, Report 70

  15. WHO EURO ART Survey 200532 Countries reporting sex and age of patients on HAART on 31/12-2004. STI/HIV/AIDS Programme WHO/Europe

  16. HAART Coverage in WHO EURO, March 2003number of countries by level of coverage STI/HIV/AIDS Programme WHO/Europe

  17. ART Coverage in 52 member states, September 2004number of countries by level of coverage STI/HIV/AIDS Programme WHO/Europe

  18. HAART Coverage 28 September 2005number of countries by level of coverage STI/HIV/AIDS Programme WHO/Europe

  19. HAART Coverage in WHO EURO, estimate for end 2005number of countries by level of coverage STI/HIV/AIDS Programme WHO/Europe

  20. Number of patients on HAART,WHO EURO 26 CEE countries 23 CEE countries 9 CEE countries 7 CEE countries STI/HIV/AIDS Programme WHO/Europe

  21. MTCT of HIV in EURO in 2004 Western Europe: • 1 case in 84,375 pregnancies Central and SE Europe: • 1 case in 43,929 pregnancies Eastern Europe (without UKR and RUS): • 1 case in 30,513 pregnancies Russian Federation: • 1 case in 26,636 pregnancies * * Russian Federation has very limited testing of children born to HIV positive mothers to confirm HIV diagnosis STI/HIV/AIDS Programme WHO/Europe

  22. PMTCT in 2004 (2) 35 WHO EURO countries reporting STI/HIV/AIDS Programme WHO/Europe

  23. HIV positive pregnant women in 2004 Western Europe: • 1 case in 1,522 pregnancies Central and SE Europe: • 1 case in 30,750 pregnancies Eastern Europe (without UKR and RUS): • 1 case in 3,617 pregnancies Russian Federation: • 1 case in 264 pregnancies Average in all WHO/Europe: • 1 case in 608pregnancies STI/HIV/AIDS Programme WHO/Europe

  24. Key messages: epi • Mainly IDU-related transmission in Eastern Europe • 68-85% of all cases are male • Up to 30% of infected females are IDUs and 50% are partners of IDUs • Only 30-50% of all HIV infections are among younger than 25 years • Vulnerable Groups: IDU, sex workers, prisoners, ethnic minorities, migrants • More than 1 million in need of treatment (2010) STI/HIV/AIDS Programme WHO/Europe

  25. Key messages: women • PMTCT needs likely to increase • Reproductive rights of women with HIV • Synergise harm reduction services and reproductive health services (www.aidsnet.dk) STI/HIV/AIDS Programme WHO/Europe

  26. The swimming IDU or the epidemiology of HIV in Estonia STI/HIV/AIDS Programme WHO/Europe

  27. Trafficking to Denmark STI/HIV/AIDS Programme WHO/Europe

  28. The WHO global Reproductive health strategy Adopted by WHO's 192 Member States in May 2004 STI/HIV/AIDS Programme WHO/Europe

  29. WHO/Europe SRH Strategy • Reproductive Choice • Safe Motherhood • STI/HIV control • Sexual abuse and violence • Trafficking of women • Breast cancer • Adolescents’ SRH • Refugees and displaced persons • Migrant populations • Aging people STI/HIV/AIDS Programme WHO/Europe

  30. Safe abortion guidelines STI/HIV/AIDS Programme WHO/Europe

  31. New publication Forthcoming World AIDS Day 2005 Free at: www.euro.who.int/aids STI/HIV/AIDS Programme WHO/Europe

  32. Useful websites www.euro.who.int/aids - STI/HIV/AIDS programme, WHO/Europe www.euro.who.int - access to the Health for all statistical database www.euro.who.int/entrenous - Entre Nous magazine www.euro.who.int/reproductivehealth - Reproductive health and programme, WHO/Europe www.eurohiv.org - HIV/AIDS surveillance reports Jeff Lazarus [JLA@euro.who.int] World Health Organization Regional Office for Europe STI/HIV/AIDS Programme WHO/Europe

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