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MSM and HIV in Europe

Euro. HIV. WHO & UNAIDS Collaborating Centre. WHO & UNAIDS Collaborating Centre. MSM and HIV in Europe. European Gay Health Seminar East-West exchanges on the sexual health of Men who have Sex with Men (HIV prevention, support and related issues) Paris, France June, Thursday 28, 2007.

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MSM and HIV in Europe

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  1. Euro HIV WHO & UNAIDS Collaborating Centre WHO & UNAIDS Collaborating Centre MSM and HIV in Europe European Gay Health Seminar East-West exchanges on the sexual health of Men who have Sex with Men(HIV prevention, support and related issues) Paris, France June, Thursday 28, 2007 Giedrius Likatavicius EuroHIV, Institut de Veille Sanitaire

  2. EuroHIV Introduction • Monitoring HIV prevalence among specific groups of population is a part of HIV surveillance and it is important in order to: • better understand HIV epidemic • evaluate public health interventions and policies

  3. Objectives • To describe HIV prevalence among MSM in Europe: • General context: the overall HIV epidemic • Geographic comparisons • Time trends • Prevalence studies and behavior surveillance • Further developments EuroHIV

  4. Methods: geographic areas in Europe and data supply West East Centre • HIV surveillance data are provided annually by national correspondents: • Newly diagnosed HIV and AIDS case reports • HIV prevalence in specific populations of which one MSM EuroHIV

  5. Newly diagnosed cases of HIV infection reported in 2005, WHO European Region EuroHIV * No data for Italy, Monaco, Spain

  6. Cases per million < 20 20 - 99 100 - 199 200 + Data unavailable EuroHIV Newly diagnosed HIV infections reported in 2005, WHO European Region * Cases per million Cases per million < 20 < 20 20 20 - - 99 99 100 100 - - 199 199 200 + 200 + Data unavailable Data unavailable

  7. Predominant transmission group Homo/bisexual men Heterosexual Injecting drug use Data unavailable Predominant route of transmission of newly diagnosed cases of HIV infection reported in 2005, WHO European Region Predominant transmission group Predominant transmission group Homo/bisexual men Homo/bisexual men Heterosexual Heterosexual Injecting drug use Injecting drug use Data unavailable Data unavailable

  8. HIV infections newly diagnosed: cases reported among homo/bisexual men in 2005 per million population, WHO European Region HIV cases per million 50 + 30 - 49 10 - 29 < 10 Not available Update 31 December 2005 EuroHIV

  9. Newly diagnosed HIV infections by transmission group, East *, 1995-2005 EuroHIV * Excluding Estonia, Uzbekistan: data not available for the whole period † 94% cases reported by Russian Federation

  10. HIV infections newly diagnosed by transmission group, West *, 1995-2005, Update at 31 December 2005 EuroHIV * Data reported from 13 countries in western Europe

  11. HIV infections newly diagnosed by transmission group, 1995-2005, central Europe * Persons infected heterosexually Risk not reported † Homo/bisexual men Injecting drug users Update at 31 December 2005 EuroHIV * Excluding Croatia, Serbia & Montenegro: data not available for the whole period † Most cases reported before 1999 were from Romania and concern children

  12. HIV infections newly diagnosed by transmission group (%) reported in 2005, selected countries, central Europe % of cases Homo/bisexual men Injecting drug users Persons infected heterosexually Risk not reported Update at 31 December 2005 Hungary Poland Romania Serbia & Montenegro Turkey EuroHIV

  13. Proportion of HIV cases among MSM defined as late diagnoses* by region, 2000-2003 *diagnosed with AIDS at the same time or within 12 months of an HIV diagnosis

  14. Newly diagnosed HIV cases among MSM in Eastern and central Europe

  15. Newly diagnosed HIV cases among MSM in Western Europe

  16. HIV prevalence studies among MSM in gay community settings in Western Europe 2000-2004 SR - self reported, UAT – unliked anonymous testing

  17. HIV prevalence studies among MSM in gay community settings in East and Centre, 2000-2004 SR - self reported, UAT – unliked anonymous testing

  18. Surveys of high risk sexual behaviour among MSM in Europe, 2000-2004 UAI – unlinked anonymous testing, sd – serodiscordant, CU – condom use

  19. Discussion: Changes of high risk behavior and HIV prevalence Elford J, Bolding G, Davis M et al. Trends in sexual behaviour among London homosexual men 1998-2003: implications for HIV prevention and sexual health promotion. Sex transm Infec 2004;80:451-54.

  20. % of the first diagnoses that were (p<.001) 42% 28% 35% 40% 50% 55% 15% 34% 19% 51% incident 100 90 80 70 First HIV diagnoses 60 Number 50 number incident infection 40 30 20 10 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year MSM - incident infection on first diagnosis (Brighton) J.Parry, National HIV incidence study, HPA, UK

  21. Conclusions: HIV epidemic in Europe among MSM • Increasing number diagnoses among MSM in the West • High proportion of MSM were diagnosed with HIV at advanced stage in the East – evidence of a hidden epidemic • HIV+ MSM are younger in the east and centre and their proportion is increasing • HIV studies in community settings reported higher HIV prevalence levels in the West • Levels of high risk sexual behaviour are high throughout Europe • Behaviour indicators used, differed widely

  22. Recommendations • New approaches should be adopted and the existing should be harmonised in order to help to develop national and international prevention strategies • Need to harmonise measures of high risk sexual behaviour • Epidemiological surveillance must be maintained and improved to inform public health prevention and control

  23. EuroHIV Acknowledgements EuroHIV Team: Jane Alix, Isabelle Deavux, Anthony Nardone National Correspondents: Albania: Institute of Public Health, Tirana. Andorra: Ministry of Health and Welfare, Andorra la Vella. Armenia: National Centre for AIDS Prevention, Yerevan. Austria: Federal Ministry for Health and Women, Vienna. Azerbaijan: Azerbaijan Centre for AIDS Prevention, Baku. Belarus: National Centre for AIDS Prevention, Minsk. Belgium: Scientific Institute of Public Health, Brussels. Bosnia & Herzegovina: Federal Ministry of Health, Sarajevo & National Public Health Institute of Republic Srpska, Banja Luka. Bulgaria: Ministry of Health, Sofia. Croatia: Croatian National Institute of Public Health, Zagreb. Cyprus: Ministry of Health, Nicosia. Czech Republic: National Institute of Public Health, Prague. Denmark: Statens Serum Institute, Copenhagen. Estonia: Health Protection Inspectorate, Tallin. Finland: National Public Health Institute, Helsinki. France: Institut de Veille Sanitaire, Saint-Maurice. Georgia: Georgian AIDS and Clinical Immunology Research Centre, Tbilisi. Germany: Robert Koch-Institut, Berlin. Greece: Hellenic Centre for Infectious Disease Control, Athens. Hungary: National Centre for Epidemiology, Budapest. Iceland: General Directorate of Public Health, Reykjavik. Ireland: Health Protection Surveillance Centre, Dublin. Israel: Ministry of Health, Jerusalem. Italy: Istituto Superiore di Sanità, Rome. Kazakhstan: Centre for AIDS Prevention and Control, Almaty. Kyrgyzstan: National Centre for AIDS Prevention and Control, Bishkek. Latvia: AIDS Prevention Centre, Riga. Lithuania: Lithuanian AIDS Centre, Vilnius. Luxembourg: Direction de la Santé, Luxembourg. Former Yugoslav Republic of Macedonia: Republic Institute for Health Protection, Skopje. Malta: Department of Public Health, Msida. Republic of Moldova: National Centre for AIDS Prevention and Control, Chisinau. Monaco: Direction de l'Action Sanitaire et Sociale, Monaco. Netherlands: National Institute for Public Health & the Environment, Bilthoven. Norway: National Institute of Public Health, Oslo. Poland: National Institute of Hygiene, Warsaw. Portugal: National Institute of Health Dr Ricardo Jorge, Lisbon. Romania: National Institute of Infectious Diseases Matei Bals, Ministry of Health, Bucharest. Russian Federation: Russian Federal AIDS Centre, Moscow. San Marino: San Marino State Hospital, San Marino. Serbia & Montenegro: Institute of Public Health of Serbia, Belgrade & Institute of Health of Montenegro, Podgorica. Slovakia: National Public Health Institute, Bratislava. Slovenia: Institute of Public Health, Ljubljana. Spain: Ministerio de Sanidad y Consumo, Instituto de Salud "Carlos III", Madrid. Sweden: Swedish Institute for Infectious Disease Control, Solna. Switzerland: Swiss Federal Office of Public Health, Bern. Tajikistan: National AIDS Centre, Dushanbe. Turkey: Ministry of Health, Ankara. Turkmenistan: National AIDS Prevention Centre, Ashgabat. Ukraine: Ukrainian AIDS Centre, Kiev. United Kingdom: Health Protection Agency, London & Scottish Centre for Infection and Environmental Health, Glasgow. Uzbekistan: Republican Centre for AIDS Prevention and Control, Tashkent. Thank you

  24. 1000 HIV negative 1000 HIV negative 40 HIV + 20 HIV + 10 RI 10 RI Other approaches: measurments of recent infectionExample of a relation between RI proportion and incidence Incidence ~ 2% RI Proportion = 25% Prevalence = 4% Incidence ~ 2% RI Proportion = 50% Prevalence = 2%

  25. Anti-HIV IgG Concn Prevalent Infection Detuned Assay threshold Recent/Incident Infection Sensitive Assay threshold 133 / 170 days Time How the “detuned” assays identifies recent HIV infections

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