Social and structural factors - like poverty, marginalization and stigma - and not just individual behaviors are shaping the HIV epidemic in Europe and Central Asia. This is the main conclusion of a new report released today by the World Bank Group, the World Health Organization Regional Office for Europe and the London School of Hygiene & Tropical Medicine.
The study systematically reviews evidence on HIV vulnerability and response in all 53 countries of the WHO European Region, stretching from Iceland to the borders of China.
The report focuses on key populations most at risk of HIV infection: people who inject drugs, sex workers and men who have sex with men. It confirms that they are disproportionately affected by the growing HIV epidemic in Europe, where the number of reported HIV cases reached more than 1.5 million in 2011.
HIV cases in these three groups account for approximately 50% of total diagnoses. Economic volatility and recession risks are increasing vulnerability to HIV and infections.
Key findings in the report include:
- 25% of HIV diagnoses in Europe were associated with injecting drug use, with much higher proportions in Eastern Europe (33%) than in Western Europe (5%) and Central Europe (7%).
- HIV remains relatively low among female sex workers in Europe who do not inject drugs, (less than 1%), but higher among those who inject drugs (over 10%) as well as among male and transgender sex workers.
- Sex between men accounted for 10% of all HIV diagnoses in Europe, with higher rates reported in Western Europe (36%), followed by Central Europe (22%) and Eastern Europe (0.5%). However, the increase was higher in Central and Eastern Europe.
The analysis highlights the pivotal role of environmental factors in shaping HIV epidemics and HIV prevention responses. Barriers to successful HIV responses include the criminalization of sex work, of sex between men, and of drug use combined with social stigmatization, violence and rights violations.
HIV prevention requires social and environmental change, and the report calls for policymakers and HIV program implementers to target the right policies and programs to maximize the health and social impacts of Europe’s HIV responses and get higher returns on HIV-related investments.
Read the Synthesis Report