Reference: The figures used for Western Europe here come from the latest HIV/AIDS Surveillance in Europe report from the European Centre for the Epidemiological Monitoring of AIDS. See www.eurohiv.org/

It is surprisingly difficult to get accurate HIV figures for the whole of Europe and to compare rates between countries. This is because three of the highest-prevalence countries, the Netherlands, France and Spain, have only ever reported AIDS cases and do not systematically collect data on HIV diagnoses: France and the Netherlands finally started doing this in 2003. Italy has collected data since 1999 from six out of its 20 regions which are then extrapolated to form an estimated total. Several other countries only started collecting HIV (as opposed to AIDS) data relatively recently. Portugal, which has the highest HIV prevalence in Western Europe, started in 2000, and Austria in 1998.

In the 16 out of 23 countries for which reporting data is available at least since 1998, HIV cases, which had been rising slowly since 1998, increased markedly from 9,657 in 2001 to 12,135 in 2002 (a 28% increase) and again by a further 9% to 13,184 cases in 2003.

Heterosexual sex accounted for an increasing proportion of cases, rising from 43% of reported risk factors in 1998 to 59% in 2003, and is now the predominant mode of transmission in newly diagnosed people in every country in Western Europe except for Germany and the Netherlands, where gay men still make up the largest proportion of new diagnoses.

However after slow declines up to 2001, cases in gay men also rose by 22% in 2002 and remained at the 2002 level in 2003. Some of this may be due to an increased uptake in testing – half of the gay men diagnosed in the UK in 2002 had been infected for more than six years – but, as UNAIDS comments, “HIV infection is now the fastest-growing serious health condition in England.” In Germany testing campaigns had already boosted uptake in the late 1990s so an increase in diagnoses from 642 in 2000 to 742 in 2001 probably reflects a real increase.

In contrast, and unlike the situation in Eastern Europe, cases due to injecting drug use have declined across the region since 1998, even in the countries (France, Portugal, Switzerland and Spain) where it contributed to what was for Europe very high prevalence. In countries where aggressive HIV prevention efforts targeted at injecting drug users have been implemented, the HIV prevalence rate among injecting drug users has been contained at below 5-7%.

To a certain extent if diagnoses in people who acquired HIV outside Europe are excluded, the historical difference in HIV prevalence in Europe is very largely to do with how quickly each country moved to tackle HIV infections in injecting drug users.

Spain recorded 16,000 new HIV cases a year in the mid-80s but levels have declined considerably since due to a comprehensive harm-reduction programme, though up to a third of IDUs in Catalonia are HIV-positive. In Portugal, which has only begun to tackle its HIV and drug problem, over 50% of new HIV infections were still due to injecting drug use in 2002, 40% were among heterosexuals, and only 10% among gay men.

In the 11 countries that give source of infection, an increasing proportion of these cases were in people who caught their HIV in countries with generalised epidemics, from 30% of heterosexual infections in 1998 to 58% of them in 2003, over 90% of whom were migrants from sub-Saharan Africa.

In line with this the proportion of people diagnosed who were women increased from 27% in 1998 to 36% in 2003.

The HIV/AIDS Surveillance in Europe Report comments that: “Trends in the West are largely driven by the United Kingdom, which accounts for 28% of the population but for 53% of all reported HIV infections in recent years.”

This statement is not quite so startling as it looks, as without figures from France, Spain, Portugal and the Netherlands in this list of 16, the UK’s contribution to the figures is disproportionate. But it does underline the fact that from having been one of the lowest-prevalence countries in Western Europe the UK is now among the higher prevalence ones.

Furthermore this is not entirely due to heterosexual cases among immigrants. In 2003 the United Kingdom had:

• The second-highest rate of new HIV infections (117 new cases per million) behind Portugal (228 cases per million) – Italy and Spain excluded (the tiny country of San Marino also had a higher rate of cases).
• The highest rate of new diagnoses in gay men in the whole of Europe (33 cases per million) after San Marino –  Italy, Spain and Austria excluded
• The second-highest rate of heterosexual cases after Portugal (65 cases per million – higher than the official figure in Ukraine) – Spain, Italy and Austria again excluded.

The ‘home grown’ epidemic in the Northern European countries such as the United Kingdom, the Netherlands, Germany and Scandinavia has therefore continued to be primarily concentrated among gay and bisexual men, and although most countries have reported an increase in the number of heterosexually acquired infections over time, much of this is among migrant populations from Africa and other regions where heterosexual transmission is dominant, rather than heterosexual transmission in-country. In the UK 48% of all infections in 2004 and 88% of heterosexual infections were acquired abroad. In Sweden in 2003, more than 80% of all infections were heterosexual ones acquired abroad.

AIDS cases are reported by all countries so some degree of cross-country comparison is possible. Cases of AIDS have declined every year from 1996, when 21,786 cases were reported in Western Europe, to 2003, when 6496 cases were reported. In 1996 the countries with the highest AIDS burden were (in order of rate per million) Spain, Portugal, Italy, Switzerland and France, with the UK in eighth place. In 2003 that order remained little changed with the exception of Portugal, which last year had more than twice as many AIDS cases per head of population as the next country, Spain.

France

It is estimated that 120,000 people are living with HIV/AIDS, or 0.4% of the adult population.

To date, 55,000 AIDS cases have been reported. Accurate figures are unavailable for France because testing is anonymised. In September 1999 French doctors recommended to the Health Ministry that anonymised reporting of HIV diagnoses should become mandatory in order to improve surveillance, and this came into force in 2003.

In France, HIV prevalence among injecting drug users rates ranged between 10% and 23% in 2000.

Spain

130,000 people living with HIV/AIDS, or 0.7% of the adult population. In 1999 there were 71 cases of AIDS per million population reported. In total there have been 63,000 cases of AIDS reported to the end of 1999.

Although injecting drug use remains the main mode of transmission in Spain, about one-quarter of all HIV infections have been heterosexually transmitted.

Reported HIV prevalence among injecting drug users in Spain in 2000 was 20–30% nationwide.

Italy

Portugal

In Portugal there are 36,000 people living with HIV/AIDS, or 0.74% of the adult population. Decreases in AIDS incidence were observed in all countries across Europe, except Portugal, where the epidemic began later. Portugal now has the highest AIDS incidence in Europe (88 cases per million population in 1999. Portugal is the only country in Europe to report a significant number of cases of HIV-2 infection. To the end of 1999 there had been 6,558 cases of AIDS reported.

Portugal’s serious epidemic among injecting drug users still accounts for half of newly diagnosed HIV infections, though the number of reported HIV infections among injecting drug users has declined significantly since 2001.

Further information on AIDS in Europe can be obtained from the European Centre for the Epidemiological Monitoring of AIDS, Hôpital National de Saint-Maurice, 14 rue du val d'Osne, F-94410, France. Quarterly European HIV & AIDS statistics are also available online at http://www.eurohiv.org/

This site and other statistical sources are included in the Statistics links selection at NAM's website aidsmap.com