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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 l.jpg

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


Introduction l.jpg

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


Objectives l.jpg
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


Slide4 l.jpg

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


Slide5 l.jpg

Newly diagnosed cases of HIV infection reported in 2005, WHO European Region

EuroHIV

* No data for Italy, Monaco, Spain


Newly diagnosed hiv infections reported in 2005 who european region l.jpg

Cases per million WHO European Region

< 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


Slide7 l.jpg

Predominant transmission group WHO European Region

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


Slide8 l.jpg

HIV infections newly diagnosed: WHO European Region

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


Slide9 l.jpg

Newly diagnosed HIV infections WHO European Region

by transmission group, East *, 1995-2005

EuroHIV

* Excluding Estonia, Uzbekistan: data not available for the whole period

† 94% cases reported by Russian Federation


Slide10 l.jpg

HIV infections newly diagnosed WHO European Region

by transmission group, West *, 1995-2005,

Update at 31 December 2005

EuroHIV

* Data reported from 13 countries in western Europe


Slide11 l.jpg

HIV infections newly diagnosed WHO European Region

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


Slide12 l.jpg

HIV infections newly diagnosed by WHO European Region

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


Proportion of hiv cases among msm defined as late diagnoses by region 2000 2003 l.jpg
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




Hiv prevalence studies among msm in gay community settings in western europe 2000 2004 l.jpg
HIV prevalence studies among MSM in gay community settings in Western Europe 2000-2004

SR - self reported, UAT – unliked anonymous testing


Hiv prevalence studies among msm in gay community settings in east and centre 2000 2004 l.jpg
HIV prevalence studies among MSM in gay community settings in East and Centre, 2000-2004

SR - self reported, UAT – unliked anonymous testing


Surveys of high risk sexual behaviour among msm in europe 2000 2004 l.jpg
Surveys of high risk sexual behaviour among MSM in Europe, 2000-2004

UAI – unlinked anonymous testing, sd – serodiscordant, CU – condom use


Discussion changes of high risk behavior and hiv prevalence l.jpg
Discussion: Changes of high risk behavior and HIV prevalence 2000-2004

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.


Slide20 l.jpg

% of the first 2000-2004

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


Slide21 l.jpg

Conclusions: HIV epidemic in Europe among MSM 2000-2004

  • 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


Recommendations l.jpg
Recommendations 2000-2004

  • 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


Slide23 l.jpg

EuroHIV 2000-2004

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


Slide25 l.jpg

1000 HIV negative 2000-2004

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%


How the detuned assays identifies recent hiv infections l.jpg

Anti-HIV IgG 2000-2004

Concn

Prevalent Infection

Detuned Assay threshold

Recent/Incident

Infection

Sensitive Assay threshold

133 / 170 days

Time

How the “detuned” assays identifies recent HIV infections