Newly released HIV figures for Europe and Central Asia illuminate a story of two epidemics. The European Centre for Disease Prevention and Control and the WHO Regional Office for Europe report that new diagnoses over the past 10 years have in Eastern Europe and 121 per cent in Central Europe. There have been more than 137,000 new diagnoses across both regions in just the past year. Meanwhile in Western Europe, there has been a 20 per cent decrease in the past two years, with around 25,000 new diagnoses last year.
In 2014, UNAIDS set ambitious targets to help end the global HIV epidemic, known as . These were that by 2020, 90 per cent of all people living with HIV would know their status, 90 per cent of those diagnosed would be in treatment and 90 per cent of those on treatment would be virally supressed. Western Europe has, on average, reached two of these three goals and is close to reaching them all. Central and Eastern Europe have yet to reach any.
More starkly than ever, the figures show just how well an effective HIV response can work, and the startling impact when it does not. Let us begin by looking at what works.
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Combination prevention is a package of measures that work together at a population level to turn the tide. Incontrovertible evidence now shows that a person on effective HIV treatment isn鈥檛 infectious and cannot pass the virus on. There has been an increase in frequent testing for HIV by those most vulnerable to infection, meaning that the time during which someone may unknowingly pass it on is greatly reduced. This is followed by swift access to HIV medication, which means better long-term outcomes for the individual, and also means those newly diagnosed quickly become uninfectious.
Finally, across Western Europe, there has been increasing access to PrEP, a drug that prevents HIV infection. Alongside continued high rates of condom use and behavioural interventions to support individuals, the experience in Western Europe shows the potential this approach has for success.
Fighting stigma
But to be effective, the population most vulnerable to HIV must be aware of their risk, know how and where to get tested and access treatment, and be able to do this easily. All this relies on continued efforts at public education and health messaging targeted at populations at high risk. Second, and perhaps most importantly, it relies on reducing HIV-related stigma. Such stigma has a huge negative impact on the fight against HIV, discouraging people from being tested, from seeking treatment and from telling people and getting much needed support.
It is no coincidence therefore that those countries struggling the most to combat the HIV epidemic share a number of damaging characteristics. Half of HIV diagnoses come to light months or years after they should have. Slow linkage to care leads to low treatment levels and therefore low levels of viral suppression among those diagnosed, all compounded by a lack of access to PrEP. There is political disengagement from the epidemic. Perhaps most damaging of all, there are high levels of public stigma concerning HIV, often alongside the interconnected stigmas of homophobia and anti-migrant sentiments targeted at those most vulnerable to HIV.
The message for Europe couldn鈥檛 be clearer. We have everything we need to beat this epidemic, except the political will to make it happen.
