2015年-世界发展银行全球_HIV_Epidemics_in_the_European_Region___Vulnerability_and_Response_369页_29mb

Summary of HIV Epidemics in the European Region: Vulnerability and Response

Core Content

This document provides an analysis of HIV epidemics in the European Region, focusing on high-risk key populations such as people who inject drugs (PWID), sex workers (SWs), and men who have sex with men (MSM). It outlines the current state of HIV surveillance and prevention efforts, highlights the epidemiological trends, and discusses the environmental and structural factors that contribute to HIV vulnerability in these groups. The study is conducted by a team of researchers from the London School of Hygiene and Tropical Medicine and supported by various international organizations.

Main Findings

HIV Trends in Europe

• Despite a decline in the rate of HIV spread over the last decade, the number of new HIV diagnoses in Europe continues to rise.
• By 2011, over 1.2 million individuals were diagnosed with HIV in Europe, with more than 500,000 reported in the last five years.
• Between 2006 and 2010, the annual average of new HIV diagnoses per million people was 127 in the East, 74 in the West, and 11 in Central Europe.
• The East has seen a 30% increase in new diagnoses, with the highest rates in Estonia, Russia, and Ukraine.
• The proportion of HIV cases among women has declined in Western and Central Europe but remains 41% in the East.

HIV Diagnoses and Prevalence

• 25% of HIV case reports in Europe were associated with injecting drug use (IDU), with higher proportions in the East (33%) than in the West (5%) and Central Europe (7%).
• The highest levels of HIV diagnoses among PWID were in Ukraine (153 per million), Russia (98 per million), and Kazakhstan (78 per million).
• HIV prevalence among female sex workers (FSWs) is generally low in the West (under 1%) but ranges from 2% to 8% in the East and Central Europe.
• Among male and transgender sex workers (SWs), HIV prevalence is higher than among FSWs in the West, likely due to the higher prevalence of HIV among MSM.
• MSM account for 10% of all HIV diagnoses in Europe, with the highest proportion in the West (36%) and lower in Central Europe (22%) and the East (0.5%).
• The annual average number of diagnoses linked to MSM per million people was 27 in the West, 2.5 in Central Europe, and 1.4 in the East, with the highest rates in the United Kingdom (43.4), the Netherlands (43), and Spain (37.3).
• The East has experienced significant increases in reported MSM-related diagnoses over the last five years, although case reports among MSM are still underreported.

Risk Factors and Prevention

• Multivariate analyses show that injecting with previously used equipment, higher frequency of injecting, and longer injecting history are associated with higher HIV prevalence among PWID.
• Inconsistent condom use, unprotected anal intercourse (UAI), and a history of STIs are linked to higher HIV risk among MSM.
• The core group of MSM and HIV-positive MSM with a high number of sex partners may be perpetuating the epidemic in the West.
• There is emerging evidence of sexual transmission of HIV among PWID involved in sex work, particularly in Central Asia, Moldova, Russia, and Ukraine.
• Syphilis is prevalent among SWs in these regions, indicating a potential for increased sexual transmission of HIV.

Structural and Environmental Factors

• Social stigma, legal restrictions, and homophobic policies in the East may contribute to underreporting of HIV cases among MSM.
• In Portugal, there has been a trend toward an enabling environment for SWs, with an increase in services and legal reforms.
• Injecting drug use and sex work are closely linked in the East, with a significant overlap in risk behaviors.
• Legal status of sex work and criminal justice system involvement are key structural factors influencing HIV risk and prevention outcomes.

Surveillance and Prevention Strategies

• HIV surveillance systems are crucial for understanding the spread of the epidemic and informing prevention strategies.
• Prevention efforts should focus on PWID and their sexual partners in Eastern Europe, MSM in the East and Central Europe, and reinvigorating prevention responses among MSM in the West.
• Strengthening HIV surveillance and targeted prevention programs are recommended to address the growing burden in the East and the persistent challenges in the West.

Key Populations and Their Status

• PWID: Highest HIV prevalence in the East, with significant risk factors related to injecting practices.
• SWs: Higher prevalence among those involved in injecting drug use, particularly in the East. Social and legal factors influence their risk.
• MSM: Highest prevalence in the West, with risk factors including UAI and inconsistent condom use. Underreporting remains a concern in the East.

Conclusion

• HIV epidemics in Europe are most pronounced in the East, where they are primarily driven by injecting drug use.
• In the West, the epidemic is more closely linked to MSM.
• Prevention and surveillance need to be tailored to the specific needs of key populations, with a focus on structural and social interventions to reduce vulnerability and transmission.

References and Data Sources

• The study draws on data from the European Centre for Disease Prevention and Control (ECDC), Eurasian Harm Reduction Network (EHRN), European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), WHO Europe, Harm Reduction International, TAMPEP, and EMIS.
• The review also includes contributions from in-country experts and systematic reviews of prevalence and risk factor studies.

Appendices and Supporting Data

• Appendix A provides a systematic review of the search strategy for PWID, SWs, and MSM.
• Appendix B includes data tables and statistics on HIV case reports, prevalence, and risk factors.
• Appendix C summarizes studies and prevalence estimates for each key population across Europe.