HIV/AIDS surveillance in Europe 2018: 2017 data

HIV/AIDS surveillance in Europe 2017 data 2018

HIV/AIDS surveillance in Europe 2017 data 2018 ii Abstract HIV transmission remains a major public health concern and affects more than 2 million people in the WHO European Region, particularly in the eastern part of the Region. This report is the latest in a series published jointly by European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe that has been reporting data on HIV and AIDS in the WHO European Region and in the European Union and European Economic Area (EU/EEA) since 2007. It finds that while epidemic patterns and trends vary widely across European countries, nearly 160 000 peo- ple were diagnosed with HIV in the European Region in 2017, including 25 000 in the EU/EEA. The increasing trend in new HIV diagnoses continued for the Region overall, despite decreasing rates of new diagnoses in the EU/EEA. The report calls for urgent action for countries and areas (especially in the eastern part) to revamp their political commitment and scale up efforts to implement the Action plan for the health sector response to HIV in the WHO European Region. Keywords ACQUIRED IMMUNODEFICIENCY SYNDROME – EPIDEMIOLOGY AIDS – PREVENTION AND CONTROL DISEASE OUTBREAKS – STATISTICS HIV INFECTIONS – EPIDEMIOLOGY POPULATION SURVEILLANCE Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permis- sion to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2018 All rights reserved. Upon request to the World Health Organization Regional Office for Europe, the right to trans- late or reproduce this publication, in part or in full, may be granted. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufac- turers’ products does not imply that they are endorsed or recommended by the World Health Organization in prefer- ence to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. The WHO Regional Office for Europe is responsible for the accuracy of the translation of the Russian summary. © European Centre for Disease Prevention and Control 2018 This publication follows WHO terminological practice. The names and designations of countries used in this publica- tion should not be understood as an endorsement by ECDC of the terminology used. The designations used, and the presentation of the maps therein, do not represent ECDC’s official position on the legal status of any country, territory, city or area or of its authorities, or the delimitation of its frontiers and boundaries. Cover picture: NIAID Suggested citation for full report. European Centre for Disease Prevention and Control, WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2018 – 2017 data. Copenhagen: WHO Regional Office for Europe; 2018. Suggested citation for tables and figures. European Centre for Disease Prevention and Control, WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2018 – 2017 data. ECDC Paper ISBN 978-92-9498-285-8 ISSN 1831-9483 doi:10.2900/523723 TQ-AL-18-001-EN-C ECDC PDF ISBN 978-92-9498-284-1 ISSN 2363-3085 doi:10.2900/848493 TQ-AL-18-001-EN-N WHO ISBN 978-92-8905-377-8 iii Contents Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Overview of HIV and AIDS in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 This report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 European Union and European Economic Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Данный доклад . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Краткий обзор . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Европейский союз и Европейская экономическая зона . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Европейский регион ВОЗ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Выводы . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Библиография . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 1. HIV and AIDS in the EU/EEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Trends in HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 AIDS cases, morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2. HIV and AIDS in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 HIV and AIDS diagnoses in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 HIV and AIDS diagnoses in the East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 HIV and AIDS diagnoses in the Centre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 HIV and AIDS diagnoses in the West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Figures Fig. A. Rate of new HIV diagnoses per 100 000 population, by year of diagnosis and adjusted for reporting delay, in the EU/EEA and WHO European Region, 1985–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Fig. B. Cumulative number of new HIV diagnoses in the EU/EEA and other countries of the WHO European Region, 1984–2017 . . . . . . . . . . . . . . . 2 Fig. C. Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission, WHO European Region, 2017 (n = 36 596) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Fig. D. Linkage to care after HIV diagnosis in the EU/EEA, WHO European Region and West, Centre and East, 2017 (n = 26 147) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Fig. E. Estimated new HIV infections and reported new HIV diagnoses in the EU/EEA and WHO European Region, 2008–2017, and target for 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Рисунок A. Частота зарегистрированных новых случаев ВИЧ-инфекции на 100 000 населения, с разбивкой по году постановки диагноза, в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 1985–2017 гг. – с поправкой на задержки в предоставлении данных . . . . . . . . . . . . . . . 12 Рисунок B. Совокупное число новых случаев ВИЧ-инфекции в ЕС/ЕЭЗ и других странах Европейского Региона ВОЗ, 1984–2017 гг. . . . . . 13 Рисунок C. Доля лиц с поздно поставленным диагнозом (число клеток CD4 < 350/мм3) с разбивкой по полу, возрасту и пути передачи, Европейский регион ВОЗ, 2017 г. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Рисунок D. Впервые выявленные ВИЧ-инфицированные пациенты, начавшие получать медицинскую помощь после постановки диагноза в ЕС/ЕЭЗ, в Европейском регионе ВОЗ, на Западе, в Центре и на Востоке, 2017 г. (n = 26 147) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 iv Рисунок E. Расчетное число новых инфекций и новые диагностированные случаи в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 2007–2017 гг., и цель на 2020 г. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Fig. 1.1. Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2017 (n = 25 210) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Fig. 1.2. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2017 (n = 25 210) . . . . . . . . . . . . . . . . . . . . . . . . . 24 Fig. 1.3. New HIV diagnoses, by age group (in years) and transmission mode, EU/EEA, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Fig. 1.4. Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2017 (n = 25 255) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Fig. 1.5. Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2017 (n = 19 230) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Fig. 1.6. Percentage of new HIV diagnoses among migrants out of all reported cases with known information on region of origin, by country of report, EU/EEA, 2017 (n = 21 184) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Fig. 1.7. Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Fig. 1.8. People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Fig. 1.9a. Age-specific trends in new HIV diagnoses in men, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Fig. 1.9b. Age-specific trends in new HIV diagnoses in women, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Fig. 1.10. Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2008–2017 . . . . . . . . . . 29 Fig. 1.11a. HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA, 2008–2017 . . . . . . . . . . . . . . . . . . 29 Fig. 1.11b. Percentage of HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA, 2008–2017 . . . . . 30 Fig. 1.12. New HIV diagnoses, by year of diagnosis, transmission and migration status, EU/EEA, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fig. 1.13. Median CD4 cell count per mm3 at HIV diagnosis, by year of diagnosis and transmission group, EU/EEA, 2008–2017 . . . . . . . . . . . . . . 31 Fig. 1.14. Percentage of AIDS diagnoses within 90 days of HIV diagnosis, EU/EEA, 2017 (n = 1671) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Fig. 1.15. AIDS diagnoses, by transmission mode, EU/EEA, 2008–2017 (logarithmic scale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Fig. 1.16. Percentage of people diagnosed with AIDS with TB as an AIDS-defining illness, EU/EEA, 2017 (n = 2825) . . . . . . . . . . . . . . . . . . . . . . . . 33 Fig. 2.1. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, WHO European Region, 2017 (n = 54 828) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Fig. 2.2. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2017 (n = 33 840) . . . . . . 39 Fig. 2.3a. New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region,a 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Fig. 2.3b. Rate of new HIV diagnoses, by year of diagnosis, WHO European Region,a 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Fig. 2.4. New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Fig. 2.5. AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2008–2017 . . . . . . . . . . 41 Fig. 2.6. Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country, East, 2017 (n = 26 459; 5751) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Fig. 2.7. New HIV diagnoses, by country and transmission mode, East, 2017 (n = 26 459) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Fig. 2.8. New HIV diagnoses, by age group and transmission mode, East, 2017 (n = 25 286) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Fig. 2.9. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2017 (n = 19 254) . . . . . . . . . . . . . . . . . . . . . . 44 Fig. 2.10. New HIV diagnoses, by transmission mode and year of diagnosis, East, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Fig. 2.11. Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . 47 Fig. 2.12. AIDS diagnoses, by transmission mode and year of diagnosis, East, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Fig. 2.13. Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Fig. 2.14. Male-to-female ratio in new HIV diagnoses, by country, Centre, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Fig. 2.15. New HIV diagnoses, by country and transmission mode, Centre, 2017 (n = 6383) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Fig. 2.16. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, Centre, 2017 (n = 1501) . . . . . . . . . . . . . . . . . . . . . 50 Fig. 2.17. New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Fig. 2.18. New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Fig. 2.19. New HIV diagnoses, by transmission mode and year of diagnosis, West, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Fig. 2.20. New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Tables Table A. Characteristics of new HIV diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the WHO European Region, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Таблица A. Характеристики случаев ВИЧ-инфекции, зарегистрированных в Европейском регионе ВОЗ, в ЕС/ЕЭЗ, в западной, центральной и восточной частях Европейского региона ВОЗ, 2017 г. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 2. HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 3. HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 4. New HIV diagnoses in men infected through sex between men, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 5. New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 vTable 6. New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 7. New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 8. HIV diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region 70 Table 9. HIV diagnoses in 2017, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . 72 Table 10. HIV diagnoses in people infected through heterosexual contact, by country and transmission subcategory, cases diagnosed in 2017, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table 11. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2017, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 12. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2017 . . . . . . . . . 78 Table 12a. EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 12b. West, Centre, East of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 13. New HIV diagnoses, by country of report and probable region of infection, in 2017, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 14. Percentage of new HIV diagnoses (2017) among people > 14 years reported with information about CD4 cell count, by CD4 cell count level (< 200 and < 350 cells per mm³ blood) and by transmission mode in cases with CD4 < 350, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 15. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table 16. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 17. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 18. AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Table 19. AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Table 20. AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 21. AIDS diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Table 22. AIDS diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table 23. The most common AIDS-indicative diseases diagnosed in 2017, ordered by frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Table 24. AIDS-related deaths, by geographic area, country and year of death (2008–2017) and cumulative totals in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Table 25. AIDS-related deaths, by sex, transmission mode and year of death (2008–2017) and cumulative totals . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Table 25a. EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Table 25b. West, Centre, East of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table 26. Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2008–2017) and number of tests per 1000 population in 2017, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . 102 Maps Map 1. New HIV diagnoses per 100 000 population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Map 2. New HIV diagnoses in men per 100 000 male population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Map 3. New HIV diagnoses in women per 100 000 female population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Map 4. New HIV diagnoses in men who have sex with men per 100 000 male population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Map 5. New HIV diagnoses acquired through injecting drug use per 100 000 population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Map 6. New HIV diagnoses acquired through heterosexual transmission per 100 000 population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Map 7. Percentage of adult (>14 years) HIV diagnoses with CD4 <350 cells/mm3 at diagnosis, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Map 8. AIDS diagnoses reported per 100 000 population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Annexes Annex 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115 Annex 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115 Annex 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Annex 4a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Annex 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Annex 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119 Annex 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Annex 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Acknowledgements This report is published jointly by ECDC and the WHO Regional Office for Europe. The Regional Office developed the analysis and report sections covering the WHO European Region and validated the data of the non-member countries and areas of the European Union (EU)/European Economic Area (EEA) and ECDC developed the analysis and report sections covering the EU/EEA and validated the data of the EU/EEA countries. The data collection, validation, analysis and overall preparation of this report was coordinated by Anastasia Pharris1 and Annemarie Stengaard.2 Review and production support was provided by Andrew J. Amato-Gauci,1 Mike Catchpole,1 Sara Croxford,3 Masoud Dara,2 Esther Kissling,4 Vicky Lefevre,1 Antons Mozalevskis,2 Stine Nielsen,5 Teymur Noori,1 Adrian Prodan,1 Chantal Quinten,1 Elena Vovc,2 and Phillip Zucs.1 1. ECDC 2. WHO Regional Office for Europe 3. Public Health England 4. EpiConcept 5. Freelance consultant ECDC and the WHO Regional Office for Europe would like to thank the nominated operational contact points for HIV/AIDS surveillance from European Union/European Economic Area (EU/EEA) Member States and areas and the HIV/AIDS surveil- lance focal points from the non-EU/EEA Member States and areas of the WHO European Region for providing data and valuable comments on this report: Albania: Marjeta Dervishi; Andorra: Jennifer Fernández Garcia; Armenia: Trdat Grigoryan; Austria: Daniela Schmid, Ziad El-Khatib; Azerbaijan: Farhad Singatulov, Shahin Khasiyev; Belarus: Svetlana Sergeenko, Pavel Yurovski; Belgium: Andre Sasse, Dominique Van Beckhoven; Bosnia and Herzegovina: Serifa Godinjak; Bulgaria: Tonka Varleva; Croatia: Tatjana Nemeth Blazic; Cyprus: Linos Hadjihannas, Maria Koliou; Czech Republic: Marek Maly; Denmark: Susan Cowan; Estonia: Kr sti Rüütel; Finland: Kirsi Liitsola, Mika Salminen; France: Françoise Cazein, Josiane Pillonel, Florence Lot; Georgia: Otar Chokoshvili, Maia Tsereteli; Germany: Barbara Gunsenheimer-Bartmeyer; Greece: Vasilios Raftopoulos, Stavros Patrinos; Hungary: Maria Dudas; Iceland: Haraldur Briem, Gudrun Sigmundsdottir; Ireland: Derval Igoe, Kate O’Donnell; Israel: Daniel Chemtob, Yana Roshal; Italy: Barbara Suligoi; Kazakhstan: Lolita Ganina, Gulnar Temirkhanov; Kyrgyzstan: Aigul Solpueva; Latvia: Šarlote Konova; Liechtenstein: Andrea Leibold, Marina Jamnicki; Lithuania: Irma Čaplinskienė; Luxembourg: Aurelie Fischer, Jean-Claude Schmit; Malta: Jackie Maistre Melillo, Tanya Melillo; Monaco: Dominique De Furst; Montenegro: Alma Cicic; Netherlands: Eline Op de Coul, Ard van Sighem; Norway: Hans Blystad; Poland: Magdalena Rosinska; Portugal: Isabel Aldir, Helena Cortes Martins; Republic of Moldova: Silvia Stratulat, Stepan Gheorghita; Romania: Mariana Mardarescu; San Marino: Andrea Gualtieri, Mauro Fiorini; Serbia: Danijela Simic; Slovakia: Peter Truska; Slovenia: Irena Klavs, Tanja Kustec, Maja Milavec; Spain: Asuncion Diaz; Sweden: Maria Axelsson; Switzerland: Martin Gebhardt; Tajikistan: Kholnazarov Ramshed, Zukhra Nurlaminova; the former Yugoslav Republic of Macedonia: Milena Stefanovic, Zarko Karadzovski, Vladimir Mikic, Rumena Gerdovska; Turkey: Emel Özdemir Şahin; Ukraine: Ihor Kuzin, Violetta Martsynovska; and United Kingdom: Valerie Delpech. Also Kosovo:1 Luljeta Gashi. 1 For the purposes of this publication, all references to “Kosovo”, including in the bibliography, should be understood/read as “Kosovo (in accordance with Security Council resolution 1244 (1999))”. vi vii ART antiretroviral therapy CI confidence interval ECDC European Centre for Disease Prevention and Control EECA eastern Europe and central Asia EU/EEA European Union/European Economic Area MSM men who have sex with men PrEP pre-exposure prophylaxis TB tuberculosis SDGs (United Nations) Sustainable Development Goals UNAIDS Joint United Nations Programme on HIV/AIDS WHO World Health Organization Abbreviations

1HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT This report The European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe have jointly carried out the enhanced surveillance of HIV/AIDS in Europe since 2008. Both organizations strive to ensure a high quality of standardized HIV and AIDS surveillance data from the 53 countries of the WHO European Region, including the 28 countries of the European Union (EU) and three countries of the European Economic Area (EEA), referred to in this report as EU/EEA. This report is the latest in a series published jointly by ECDC and the WHO Regional Office for Europe that has been reporting data on HIV and AIDS in the WHO European Region since 2007. The data presented in the text are augmented by 47 figures and 27 tables: Fig. A–E and Table A in the Overview, Fig. 1.1–2.19 in Chapters 1 and 2, and Tables 1–26 in a discrete section towards the end of the report. The report has three main sections: • this Overview, which effectively summarizes and cap- tures the key issues of the report; • Chapter 1, providing a comprehensive review of HIV and AIDS in the EU/EEA, focusing on HIV diagnoses, trends in HIV diagnoses, AIDS cases and their morbid- ity and mortality, and HIV testing; and • Chapter 2, which presents data on HIV and AIDS diag- noses in the WHO European Region, focusing on HIV diagnoses, trends in HIV diagnoses, AIDS cases and their morbidity and mortality in the Region as a whole and in three geographic areas of the Region. The data in the report are also augmented by seven annexes: • Annex 1, which presents the framework for data col- lection, validation and presentation; • Annex 2, focusing on completeness of key variables presented for the EU/EEA and the WHO European Region as a whole; • Annex 3, defining completeness of key variables pre- sented by country and area; • Annexes 4a and 4b, providing information on country and area HIV and AIDS surveillance systems; • Annex 5, detailing country-specific notes regarding the reported data and differences in surveillance sys- tems across countries; • Annex 6, which lists countries and areas with the number of reported diagnoses adjusted for reporting delay; and • Annex 7, which lists the participating countries and areas and national institutions. Overview Although HIV infection is preventable, significant HIV transmission continues across the WHO European Region. In 2017, 159 420 newly diagnosed HIV infec- tions were reported in 50 of the 53 countries of the WHO Overview of HIV and AIDS in Europe Table A. Characteristics of new HIV diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the WHO European Region, 2017 WHO European Regiona West Centre Easta EU/EEA Reporting countries/number of countriesb 49/53 (50/53) 22/23 15/15 12/15 (13/15) 30/31 Number of new HIV diagnoses 55 018 (159 420) 22 354 6 205 26 459 (130 861) 25 353 Rate of HIV diagnoses per 100 000 populationc 8.3 (20.0) 6.9 3.2 23.6 (51.1) 6.2 Percentage age 15–24 years 9.3% 11.0% 13.7% 6.9% 11.1% Percentage age 50+ years 16.1% 20.7% 13.1% 13.0% 19.3% Male-to-female ratio 2.2 2.9 5.8 1.6 3.1 Percentage new diagnoses CD4 < 350 cells/mm3 53.1% 48.0% 52.5% 57.2% 48.6% Transmission mode Sex between men 21.2% 39.7% 28.4% 3.9% 38.2% Heterosexual transmission (men) 25.3% 16.7% 19.4% 33.9% 16.6% Heterosexual transmission (women) 24.1% 17.5% 7.3% 33.7% 16.5% Injecting drug use 13.0% 2.7% 2.7% 24.1% 3.7% Mother-to-child transmission 0.7% 0.5% 0.6% 0.9% 0.5% Unknown 15.4% 22.5% 41.2% 3.4% 24.2% Number of new AIDS diagnosesd 14 703 2 426 823 11 454 3 130 Rate of AIDS diagnoses per 100 000 population 2.3 0.7 0.4 10.2 0.7 a Numbers in parentheses include data from the Russian Federation for the WHO European Region and the East. b No data received from Germany, the Russian Federation, Turkmenistan and Uzbekistan. All data presented were reported to ECDC/WHO through the European Surveillance System (TESSy), except for data for the Russian Federation, which were obtained through publicly available national sources (1). c EU/EEA and West rates are adjusted for reporting delay (Annex 6); the corresponding estimated number of new diagnoses adjusted for reporting delay are 27 055 and 23 976, respectively. d No data received from Belgium, Germany, Sweden, the Russian Federation, Turkmenistan and Uzbekistan. 2SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data European Region,1 which corresponds to a rate of 20.0 newly diagnosed infections per 100 000 population (Table  A). This number includes 55 018 new diagnoses reported by 49 countries to the joint ECDC and WHO 1 No data were available from Germany (no data export for 2017 due to technical problems), Turkmenistan or Uzbekistan. Liechtenstein is an EEA Member but not a WHO Member State, so its data are included in the totals for the EU/EEA but not for the WHO European Region. No official data were reported by the Russian Federation, but citable data were obtained through publicly available sources (1) and included within the other countries’ reported data for the overall number, rate and trend of HIV diagnoses in the European Region (see “HIV and AIDS diagnoses in the WHO European Region” (Chapter 2)) and the East of the Region (see “HIV and AIDS diagnoses in the East” (Chapter 2)). This allows a more complete presentation of the epidemiology of HIV in the WHO European Region. Other regional figures presented in this report (including those by age and gender) are based on data from the 49 countries that provided data to the joint ECDC/WHO European HIV surveillance system. Regional Office for Europe surveillance system, includ- ing 25 353 from the EU/EEA, while information about 104 402 new diagnoses in the Russian Federation was published by the Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS (1) (Fig. A). Over the course of the last three dec- ades, over 2.3 million people have been diagnosed and reported with HIV in the WHO European Region, includ- ing over 650 000 people in the EU/EEA (Fig. B). Carrying on a trend that has persisted over the last dec- ade, rates and overall numbers of people diagnosed with HIV were highest in the East of the Region (51.1 per 100 000 population), lower in the West and the EU/ EEA (6.9 and 6.2 per 100 000, respectively) and lowest Fig. A. Rate of new HIV diagnoses per 100 000 population, by year of diagnosis and adjusted for reporting delay, in the EU/EEA and WHO European Region, 1985–2017 0 2 4 6 8 10 12 14 16 18 20 2016201420122010200820062004200220001998199619941992199019881986 25 27 36 36 39 4242 42 42 44 43 45 48 48 47 47 49 46 50 52 52 52 52 52 52 51 51 50 50 50 505152 Ne w H IV d ia gn os es p er 10 0 00 0 po pu la tio n WHO European Region EU/EEA Countries reporting Year of diagnosis Rates may increase in the coming years due to reporting delays Note: rates for the EU/EEA and the WHO European Region include data for all countries reporting during the given year, including the Russian Federation (1), and an estimated rate for Germany in 2017. Rates for 2017 presented here therefore are slightly lower than rates presented elsewhere in the report. Fig. B. Cumulative number of new HIV diagnoses in the EU/EEA and other countries of the WHO European Region, 1984–2017 0 500 000 1 000 000 1 500 000 2 000 000 2 500 000 2015201020052000199519901985 Other countries of the WHO European Region EU/EEA N um be r o f H IV d ia gn os es Year of diagnosis 3HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT in the Centre2 (3.2 per 100 000) (Table A, Fig.  A). The main transmission mode varied by geographical area, illustrating the diversity in the epidemiology of HIV in Europe. Sexual transmission between men was the most common mode in the EU/EEA and heterosexual contact and injecting drug use were the main reported transmis- sion modes in the East of the Region. The rate of new diagnoses in the Region was higher among men than women in all age groups, except among people under 15 years. Just over half (53%) of those diagnosed with HIV in 2017 in the European Region were diagnosed at a late stage of infection (CD4 cell count < 350 cells/mm3 at diagnosis). This percentage was highest in the East (57%), lower in 2 The grouping of countries into the West (23 countries), Centre (15 countries) and East (15 countries) of the WHO European Region is based on epidemiological considerations and follows the division of countries used in reports published by EuroHIV since 1984: see Annex 1, Figure A1.1 for details. the Centre (53%) and lowest in the West (49%), while 49% were diagnosed late in the EU/EEA (Table A, Fig. C). Linkage to care, measured as having a CD4 count per- formed and reported, was assessed among the 26 147 new HIV diagnoses in the Region for whom data on date of diagnosis and date of CD4 count were reported. Among those who were linked to care, 86% had evidence of linkage within three months of diagnosis. This per- centage was highest in the Centre (96%) and lowest in the East (82%); in the EU/EEA, it was 92% (Fig. D). In 2017, 14 703 people were diagnosed with AIDS, as reported in 47 countries3 of the WHO European Region, and the rate of new diagnoses was 2.3 per 100 000 pop- ulation (Table A, see also Table 15 in the Tables section). In the EU/EEA, 3130 people were diagnosed with AIDS 3 No data were reported by Belgium, Germany, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. Fig. C. Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission, WHO European Region, 2017 (n = 36 596) 0 2010 30 40 50 60 70 Sex between men Injecting drug use Heterosexual transmission (women) Heterosexual transmission (men) 50+ 40–49 30–39 25–29 20–24 15–19 Women Men Total Percentage G en de r Ag e gr ou p (y ea rs ) Tr an sm is si on Fig. D. Linkage to care after HIV diagnosis in the EU/EEA, WHO European Region and West, Centre and East, 2017 (n = 26 147) Percentage 0 20 40 60 80 100 EU/EEA WHO European Region West East Centre 0–4 days 15–28 days 5–14 days 29–91 days 92–365 days > 365 days 4SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data in 2017, giving a rate of 0.7 per 100 000 population. The number of AIDS cases has continued to decline steadily in the West and the EU/EEA during the last decade, and while it has nearly doubled in the East, it has begun to stabilize and even declined by a slight 7% between 2012 and 2017 (see Fig. 1.12 and 2.4). European Union and European Economic Area In 2017, 25 353 people were diagnosed with HIV in 30 of the 31 countries of the EU/EEA, with a rate of 6.2 per 100 000 when adjusted for reporting delay (Table  1, Annex  6). Countries with the highest rates of new HIV diagnoses reported in 2017 were Latvia (18.8; 371 cases) and Estonia (16.6; 219 cases), and the lowest rates were reported by Slovakia (1.3; 70 cases) and Slovenia (1.9; 39 cases). The rate of new HIV diagnoses was higher among men (9.0 per 100 000 population; Table  2) than women (2.8 per 100 000 population; Table 3). The overall male- to-female ratio was 3.1 (Table A). This ratio was highest in Croatia (20.2) and Slovenia (18.5) and was above 1 in all countries in the EU/EEA (Fig. 1.1). The predomi- nant mode of transmission in these countries was sex between men. Men had higher age-specific rates than women in all age groups except among young people under 15 years, where age-specific rates were similar (Fig. 1.2). The highest overall age-specific rate of HIV diagnoses was observed among 25–29-year-olds (14.4 per 100  000 population), largely because this group has the highest age-specific rate for men at 22.2 per 100 000 population, while rates for women were highest in the 30–39-year age group (6.9 per 100 000 population) (Fig. 1.2). Sex between men remains the predominant mode of HIV transmission reported in the EU/EEA, accounting for 38% (9694) of all new HIV diagnoses in 2017 and half (50%) of diagnoses where the route of transmis- sion was known (Table 4, Table 8, Fig. 1.5). Among those with known route of HIV transmission, sex between men was the most commonly reported and accounted for more than 60% of new HIV diagnoses in 10 countries (Austria, Croatia, the Czech Republic, Hungary, Ireland, the Netherlands, Poland, Slovakia, Slovenia and Spain) (Fig. 1.5). Heterosexual contact was the second most common transmission mode among people newly diagnosed in 2017 (33%, equally divided between men and women). Transmission due to injecting drug use accounted for 4% of HIV diagnoses, but the transmission mode was not reported or was reported to be unknown for 24% of new HIV diagnoses (Table A). Forty-one per cent of those diagnosed in the EU/EEA in 2017 were migrants, defined as originating from outside of the country in which they were diagnosed (Fig.  1.6), with 18% originating from countries in sub-Saharan Africa, 8% from countries in Latin America and the Caribbean, 6% from other coun- tries in central and eastern Europe, and 4% from other countries in western Europe. The trend in reported HIV diagnoses declined slightly between 2008 and 2017. In the earlier part of this period, rates were 6.9 per 100  000, decreasing slightly to 6.5 in more recent years, and 6.2 in 2017 (see Table 1, Fig. 1.8 and Annexes 1, 5 and 6). While the overall EU/EEA trend appears to have declined slightly during the last decade, contrasting trends are seen at national level. Several countries, including Austria, Belgium, Denmark, Estonia, the Netherlands, Norway, Spain and the United Kingdom, have reported a decline in rates of new diag- nosis in recent years, even after adjusting for reporting delay. Conversely, since 2008, and taking reporting delay into account, rates of HIV diagnoses have more than doubled in Bulgaria, Cyprus and Lithuania, and have increased by over 50% in the Czech Republic, Hungary, Malta and Poland (Table 1, Annex 6). Trends differ by gender and age group. Age-specific rates have declined since 2008 in all age groups except for adults over 50 years, with rates among 25–29-year- olds and 30 –39-year-olds consistently higher than other groups throughout the period in both women and men (Fig. 1.9a, 1.9b). Trends by transmission mode show that the number of new HIV diagnoses among men who have sex with men (MSM) in the EU/EEA decreased slightly in 2017 compared to recent years (Fig. 1.11a). Although reporting delay may contribute to this decline, it appears that the drop may be substantial in certain countries, including Belgium, Greece, the Netherlands, Spain and the United Kingdom. Conversely, increases in new diagnoses among MSM have been noted in Bulgaria, Cyprus, Ireland, Malta, Poland and Romania in recent years. Cases attributed to MSM born outside of the reporting country increased between 2008 and 2017, declining slightly between 2015 and 2017 but not to the same extent as observed in EU/ EEA-native MSM (Fig. 1.12). The number of heterosexually acquired cases decreased steadily over the last decade (Fig.  1.11a), with sharper declines among women and foreign-born heterosexual people than among men and non-foreign-born people (Fig. 1.11a, 1.12). The number of HIV diagnoses reported as due to injecting drug use has declined since 2008 in both foreign-born and non-foreign-born groups, but localized outbreaks were seen in 2011–2012, which affected the EU/EEA trend in this group, and smaller local outbreaks were also noted in some countries during the period (Table  5, Fig.  1.10, Fig.  1.11a). Mother-to-child transmission and transmission through nosocomial infection or blood transfusion also decreased steadily between 2008 and 2017; these types of transmission now represent less than 1% of new cases diagnosed (Table  8). The number of cases reported to have an unknown mode of transmission increased from 13% in 2008 to 24% in 2017. Information on CD4 cell count at the time of HIV diagno- sis was provided by 25 countries (Table  14) for 16 858 adults and adolescents diagnosed and reported in those countries (71% of the total). As in previous years, nearly half (49%) of all cases with a CD4 cell count available 5HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT were diagnosed several years after being infected, with a count below 350 cells per mm3; 28% of cases were con- sidered to have advanced HIV infection (CD4 < 200 cells/ mm3). When analysing CD4 cell count by transmission mode, the proportion of people presenting several years after being infected (CD4 < 350 cells/ mm3) was highest among women (52%), older adults (56% in 40–49-year-olds and 63% in those over 50), men and women infected by heterosexual sex (63% and 53%, respectively), peo- ple who acquired HIV through injecting drug use (52%), and migrants from south and south-east Asia (53%) and sub-Saharan Africa (56%) (Table 14, Fig. 1.7). The lowest proportions of late diagnosis, indicated by CD4 counts below 350 cells per mm3 at diagnosis, were observed among younger age groups (33% of 15–19-year-olds and 32% of those aged 20–24 years), men who acquired HIV through sex with another man (37%) and migrants from other western European countries (34%). While many people are still diagnosed late, several years after being infected with HIV, the median CD4 cell count at HIV diag- nosis has increased significantly over the past decade, from 330 cells/mm3 (95% confidence interval (CI): 322– 338) in 2007 to 391 cells/mm3 (95% CI: 381–400) in 2017. The group with the highest median CD4 cell count at diagnosis is MSM, with 452 cells/mm3 in 2017 (Fig. 1.13). For 2017, 3130 diagnoses of AIDS were reported by 28 EU/EEA countries,4 giving a rate of 0.7 cases per 100 000 population (Table  15). Overall, 89% of these AIDS diag- noses were made within 90 days of the HIV diagnosis, indicating that most AIDS cases in the EU/EEA are due to late diagnosis of HIV infection. This pattern holds for all transmission groups except people who acquired HIV through injecting drug use, where 59% of AIDS diagno- ses occur within 90 days of the HIV diagnosis (Fig. 1.14). Fifteen countries reported tuberculosis (TB) (pulmonary and/or extrapulmonary) as an AIDS-defining illness in 14% of those newly diagnosed with AIDS in 2017 (Fig. 1.16). In the EU/EEA, the numbers of AIDS cases and AIDS-related deaths have declined consistently since the mid-1990s. WHO European Region With 159 420 people newly diagnosed with HIV in the WHO European Region in 2017, corresponding to a rate of 20.0 per 100 000 population, the annual increase in new HIV diagnoses continued – but at a slower pace than previously (Fig. A). The increase is mainly driven by the continuing upward trend in the East and the Centre, whereas the rate of new diagnoses is declining in the West (Fig. 2.3a). Of the 159 420 people diagnosed in 2017, 82% were diag- nosed in the East (130 861), 14% in the West (22 354) and 4% in the Centre of the Region (6205) (Table A). The rate was also highest in the East (51.1 per 100 000 popula- tion), being disproportionately higher than in the West (6.9 per 100 000 population, adjusted for reporting 4 These were all EU/EEA countries except Sweden and Belgium. delay5) and the Centre (3.2 per 100 000 population) (Table A). Rates of newly diagnosed HIV infections for 2017 var- ied significantly among countries in the WHO European Region, with the highest rates per 100 000 population observed in the Russian Federation (71.1) (1), Ukraine6 (37.0), Belarus (26.1) and the Republic of Moldova (20.6), and the lowest in Bosnia and Herzegovina (0.3), Slovakia (1.3) and Slovenia (1.9) (Table 1). Among the 49 countries that reported to ECDC/WHO for 20177 (the Russian Federation not included), the overall rate for men was 11.9 per 100 000 population (Table  2) and for women 5.1 per 100 000 population (Table 3). The largest proportion of those newly diagnosed in the 49 reporting countries were in the age group 30–39 years (36%), while 9% were young people aged 15–24 years and 16% were 50 years or older at diagnosis. The male- to-female ratio was 2.2, lowest in the East (1.6), higher in the West (2.9) and highest in the Centre (5.8). People most commonly were infected through heterosexual sex (49%), with 11% of these cases originating from countries with generalized HIV epidemics, while 21% were infected through sex between men, 13% through injecting drug use and 0.7% through mother-to-child transmission. Information about transmission mode was unknown or missing for 15% of the new diagnoses (Table A). When combining data from the Russian Federation8 within data reported by the other 49 countries, hetero- sexual transmission accounted for 56% of new diagnoses with a known mode of HIV transmission, injecting drug use for 30%, sex between men for 14% and mother-to- child transmission for 0.6%. In the East, when combining data from the Russian Federation within data reported by the other 12 coun- tries on people for whom the mode of HIV transmission was known, heterosexual transmission accounted for 59% of new diagnoses, transmission through injecting drug use for 37%, sex between men for 3% and mother- to-child transmission for 0.5%. In the 12 reporting countries alone, 68% were infected through heterosex- ual transmission and 24% through injecting drug use, while reported transmission through sex between men remained low (4% of cases) (Tables  4–6, Table 8). Sex between men (30%) and heterosexual sex (26%) were the main reported transmission modes in the Centre, but 40% of those newly diagnosed lacked this information. Sex between men was the predominant mode of trans- mission in 12 of the 15 countries in the Centre. In the 5 See Annex 1 for methods and Annex 6 for results. 6 Without taking into account data from Crimea, Sevastopol city and parts of the non-government controlled areas of Ukraine; adjusting population denominator data to exclude Crimea and Sevastopol city; and excluding infants born to HIV-positive mothers whose HIV status is undetermined. 7 No data were received from Germany, the Russian Federation, Turkmenistan or Uzbekistan. 8 Among new diagnoses in the Russian Federation with a known mode of HIV transmission, injecting drug use and heterosexual sex both accounted for 49% of the new cases, sex between men for < 2% and mother-to-child transmission for < 1% (1). 6SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data West, sex between men remained the main transmission mode (40% of cases) followed by heterosexual transmis- sion (34% of cases, among whom 41% originated from generalized epidemic countries); information was lack- ing for 23% of new diagnoses. The rate of newly diagnosed HIV infections in the 50 countries increased by 37% over the past 10 years, from 14.6 per 100 000 population in 2008 (107 385 cases) to 20.0 per 100 000 population in 2017 (159 420 cases) (Fig. 2.3a). The increase is mainly driven by the continu- ing upward trend in the East, where the rate increased by 68%, from 30.4 per 100 000 (77 228 cases) to 51.1 per 100 000 (130 861 cases). The rate increased by a much smaller 18% in the 12 officially reporting countries in the East (the Russian Federation not included), from 20.0 in 2008 to 23.6 in 2017. In the Centre, the rate increased by 121%, the largest relative increase among the three geo- graphical areas, from 1.4 to 3.1 per 100 000 population between 2008 and 2017, while in the West it decreased by 27%, from 9.4 to 6.9 per 100 000 population over the same period (Fig. 2.3b). Analysing the overall regional trend for the 49 countries that reported to ECDC and WHO (not including Germany, the Russian Federation, Turkmenistan or Uzbekistan), the rate for the Region decreased by a slight 5%, from 8.8 in 2008 to 8.4 in 2017. However, when adjusting the 2017 rate for reporting delay, the decline is less evident. Consistent data on transmission mode were available from 44 countries for the period 2008–2017 (Fig.  2.4). The overall increase in the East was driven by an upsurge in the number of HIV diagnoses with reported sexual transmission, which increased by 69% for heterosexual transmission and eight-fold for transmission through sex between men. The increase was considerably larger among men with heterosexual transmission (a 107% increase) than women with heterosexual transmission (21% increase). Transmission through injecting drug use, while still substantial, decreased by 36% (Fig.  2.10). In the Centre, new diagnoses in people infected through sex between men doubled between 2008 and 2017; this was the predominant mode of transmission in 12 of the 15 countries, while heterosexual transmission increased by 43%. Transmission through injecting drug use has levelled off after an outbreak in Romania dur- ing 2011–2013, resulting in an overall increase of 43% in comparison with the 2008 level (Fig. 2.17). In the West, heterosexual transmission continued its steady decline and decreased by 49% over the 10-year period overall and an even steeper decline among hetero- sexual women; injecting drug use-related transmission decreased by 57% between 2008 and 2017 and is now decreasing again after a peak in 2012 caused by an out- break in Greece. New diagnoses due to sex between men decreased by 21% in comparison with 2008; not all of this decline can be explained by reporting delay. New diagnoses with unknown transmission mode increased by 51% in the West (Fig. 2.19). Late HIV diagnosis remains a challenge in the Region. Among people newly diagnosed (> 14 years) for whom information about CD4 cell count at the time of HIV diagnosis was available, just over half (53%) were late presenters, with CD4 cell counts below 350 cells per mm3, including 32% with advanced HIV infection (CD4 < 200 cells/mm3). The percentage of people newly diag- nosed who were late presenters (CD4 < 350/mm3) varied across transmission categories and age groups and was highest for people with reported heterosexual transmis- sion (58%; 62% for men with heterosexual transmission and 54% for women with heterosexual transmission) and injecting drug use (55%), and lowest for men infected through sex with men (39%) (Fig.  C). The percentage increased with age, ranging from 34% and 32% among people aged 15–19 and 20–24 years at diagnosis, respectively, to 66% among those aged 50 years or older. By gender, the percentage of late presenters was simi- lar overall (52% for men and 54% for women) which, for men, conceals the difference between MSM (who tend to get diagnosed earlier) and heterosexual men (who tend to get diagnosed later). Additionally, there was variation across the Region, with 57% late presenters in the East, 53% in the Centre and 48% in the West. In 2017, 14 703 people were newly diagnosed with AIDS in 47 countries of the WHO European Region,9 correspond- ing to a rate of 2.3 per 100 000 population. Overall, 78% of AIDS cases were diagnosed in the East, where the rate per 100 000 was also highest (10.2), 17% in the West (with a rate of 0.7 per 100 000) and 6% in the Centre of the Region (0.4 per 100 000) (Table 15). Twenty per cent of people diagnosed with AIDS presented with TB as an AIDS-defining illness, ranging from 15% of cases in the West and 19% in the Centre to 26% in the East. The rate of new AIDS diagnoses remained largely stable between 2008 and 2017. There was, however, great variation across the Region, with a doubling of the rate in the East for the decade (from 5.1 to 10.2 per 100 000) but also a slight 7% decrease between 2012 and 2017, a stable rate of 0.4 per 100 000 in the Centre and a steady decline, by 67% overall, in the West, from 2.1 to 0.7 per 100 000 (Fig. 2.5). Conclusions HIV transmission remains a major public health con- cern and affects more than 2 million people in the WHO European Region, in particular in the eastern part of the Region. Nearly 160 000 people were diagnosed with HIV in 2017 at a rate of 20.0 per 100 000 population, once again the highest rate ever reported for one year. An increasing majority, 82%, were diagnosed in the East of the Region and 16% in the EU/EEA. Newly diag- nosed infections from two countries alone (the Russian Federation and Ukraine) contributed 75% of all cases in the WHO European Region and 92% of cases in the East. The new surveillance data presented in this report indi- cate, on the one hand, that the increasing trend in new HIV diagnoses continued for the WHO European Region, particularly in the eastern and central parts, but at a slower rate for the decade than previously. On the other 9 No data were available from Belgium, Germany, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. 7HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT hand, the data confirm stabilizing and even decreasing rates in several EU/ EEA countries in more recent years. The current increasing trends indicate that the Region is not on track to meet the WHO and Joint United Nations Programme on HIV/AIDS (UNAIDS) targets (2–4) outlin- ing the path to attaining United Nations Sustainable Development Goal (SDG) 3.3, which calls to “End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne and other communicable diseases” (5). Estimated new infections, currently at an historic high, would need to decrease by 78% by 2020 for the Region to achieve the target. Even in the EU/EEA, where the overall trend has declined slightly in recent years, achieving the target would require a decline in estimated new infections of 74% by 2020 (Fig. E). While epidemic patterns and trends vary widely across European countries, sustained increases have been seen in the number of newly diagnosed infections in certain transmission groups in parts of the Region: MSM in the Centre and East, and heterosexual transmission in the East. Heterosexual transmission has decreased substantially in the EU/EEA and the West, particularly among women, as has the number of cases due to sex between men in selected countries in the EU/EEA and West in recent years. Transmission through injecting drug use has continued to decrease in many countries, although it still accounted for 37% of reported new diag- noses with a known mode of transmission in the East in 2017. Too many people throughout the WHO European Region are diagnosed late (53%), which is increasing their risk of ill health, death and onward HIV transmission. The high number of AIDS diagnoses in the East confirms that late HIV diagnosis, delayed initiation of antiretroviral treat- ment (ART) and low treatment coverage remain major challenges. At the same time, the stabilizing AIDS trend observed since 2012 may be the result of the increasing majority of countries in the East that have now imple- mented so-called treat-all policies, which aim to support everyone living with HIV to be offered ART regardless of disease stage. One in five people living with HIV in the Region are unaware of their infection (6) (for more details on esti- mates, see UNAIDS (7)). New strategies are required to decrease the number of people who are diagnosed late or are unaware of their infection, expanding diversified and user-friendly approaches to more widely available HIV testing. WHO consolidated guidelines on HIV self- testing and partner notification and ECDC guidance on integrated HIV and hepatitis B and C testing recommend implementation of innovative approaches that include self-testing and testing provided by lay providers as part of overall HIV testing services (8–10). Policy-monitoring in the Region, however, indicates that implementation of community-based testing, self-testing and voluntary partner notification are limited or non-existent in many European countries (11). HIV testing services should focus on reaching the most affected population groups in the local epidemic context, be tailored to the spe- cific needs of these groups and support timely linkage to HIV prevention, treatment and care. This will ensure earlier diagnoses and treatment initiation, and result in improved treatment outcomes and reduced morbidity, mortality and HIV incidence in support of the 90–90– 9010 and other regional and global targets (2–4). Evidence that early initiation of ART is beneficial both to the health of the person being treated and in prevent- ing onward HIV transmission is now solidly confirmed (12–17). Nearly 90% of countries in the WHO European Region have a policy to provide treatment regardless of CD4 count (6,18). Interventions to control the epidemic should be based on evidence and adapted to national and local epide- miology. From the comprehensive epidemiological data presented in this report, the following can be concluded. 10 The 90–90–90 targets are that 90% of people living with HIV know their HIV status, 90% of diagnosed people living with HIV receive treatment, and 90% of people on treatment achieve viral suppression. Fig. E. Estimated new HIV infections and reported new HIV diagnoses in the EU/EEA and WHO European Region, 2008–2017, and target for 2020 0 20 000 40 000 60 000 80 000 100 000 120 000 140 000 160 000 180 000 2020201920182017201620152014201320122011201020092008 WHO European Region estimated infections 2020 target, WHO European Region WHO European Region diagnoses EU/EEA estimated infections 2020 target, EU/EEA EU/EEA diagnoses Re po rte d ne w H IV d ia gn os es a nd es tim at ed n ew H IV in fe ct io ns Sources: estimated infections, UNAIDS (7); new diagnoses, authors. 8SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data • For the countries in the EU/EEA and West, given the predominance of HIV transmission among MSM and increases in some countries, it would appear that cur- rent prevention and control interventions need to be scaled up and strengthened and should remain the priority cornerstone of the HIV response. Countries with declines have demonstrated the impact of chang- ing the culture towards more frequent testing for at-risk gay men and linkage to immediate care and ART for those found to be positive (19). Multicomponent interventions and the inclusion of pre-exposure prophylaxis (PrEP) for HIV, self-testing and assisted voluntary partner notification into the package of prevention and control interventions could help to curb this increased trend (8,20,21). The 2011–2012 increase in HIV cases among people who inject drugs and continued reported local outbreaks in a number of countries (22–25) demonstrates the need to maintain or scale up harm-reduction programmes. • For the countries in the Centre, new diagnoses over- all are increasing faster than in any other part of the WHO European Region. There is a very strong gender disparity in the rate of new HIV diagnoses in this part of the Region, with alarming increases among men, particularly MSM, compared with a fairly stable rate among women. Sex between men is the predominant mode of transmission in 12 of the 15 Centre countries. Introduction of PrEP for high-risk groups, HIV test- ing by lay providers, HIV rapid diagnostic tests, HIV self-testing and voluntary assisted partner notifica- tion alongside policies and practices to offer ART to all people living with HIV are needed. Some countries went through a transition to domestic financing of the HIV response after withdrawal of funding from the Global Fund. This has posed sustainability challenges, particularly in relation to financing of HIV prevention programmes. Increased political will and attention, alongside intensified involvement of civil society, is needed to mitigate some of these challenges and pre- vent the epidemic from accelerating (26). • For the countries in the East, there is an urgent need to continue the scale up of bold, evidence-based interven- tions and deliver more effective, integrated services through health systems that better address the social determinants of health. Comprehensive combination- prevention and innovative HIV-testing strategies are needed, with a particular focus on reaching key popu- lations. This can be achieved through user-friendly prevention and testing services, including assisted partner notification, PrEP, HIV testing performed by trained lay providers and self-testing in line with WHO recommendations; these should be integrated into national policies and programmes and implemented (4,8,9,27). Community involvement in the design and delivery of services is essential to reduce the rate of new HIV infections and increase the number of peo- ple linked to care and initiated and retained on ART, with the ultimate aim of reducing the high number of AIDS diagnoses and AIDS-related deaths. Innovative HIV prevention interventions should address the risk of heterosexual transmission, particularly in couples where one partner is engaged in a high-risk behav- iour (such as injecting drug use) or is spending longer periods of time abroad. The large number of new diag- noses in people infected through injecting drug use emphasizes that evidence-based policies focused on key populations, including high coverage of harm- reduction programmes for people who inject drugs, remain critical to the HIV response in the eastern part of the Region. Following repeat calls for urgent action, most recently by the WHO Regional Director for Europe during a ministerial policy dialogue on HIV and related comorbidities in eastern Europe and central Asia (EECA) attended by 11 ministers or deputy ministers of health from 11 EECA countries in July 2018 (28), coun- tries in the eastern part of the Region are revamping their political commitment and efforts to implement the action plan for the health sector response to HIV in the WHO European Region, including through the development of roadmaps for accelerating efforts to reach the UNAIDS and WHO 2020 targets (2–4). To facilitate the sharing of lessons learned in the HIV response across European countries, national health authorities, national and international experts and civil society organizations involved in the provision of HIV prevention, testing, treatment and care services were solicited to share their examples of good practices in the health sector response to HIV. This resulted in 52 exam- ples from 33 Member States being published in the first compendium of good practices from the WHO European Region (29). Robust surveillance data are critical for monitoring and informing the public health response to the European HIV epidemic in an accurate and timely fashion. The number of countries conducting enhanced HIV surveil- lance and reporting surveillance data at European level has gradually increased over time. In 2017, 41 countries submitted linked HIV and AIDS data, enabling greater understanding of the clinical status of people diag- nosed with HIV. This approach increases possibilities for longer-term monitoring of HIV continuum-of-care out- comes, such as modelling of the undiagnosed fraction, and measurement of linkage to care, treatment and viral suppression following diagnosis. It can also support national and global efforts to monitor progress towards the 90–90–90 and other global and regional targets. References11 1. Information note ‘Spravka’ on HIV infection in the Russian Federation as of 31 December 2017. Moscow: Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS; 2018. 2. Global health sector strategy on HIV, 2016–2021 – towards ending AIDS. Geneva: World Health Organization; 2016 (http://www.who. int/hiv/strategy2016-2021/ghss-hiv/en/). 3. Ambitious treatment targets: writing the final chap- ter of the AIDS epidemic. Geneva: UNAIDS; 2014 (http:// w w w . u n a i d s . o r g / s i t e s / d e f a u l t / f i l e s / m e d i a _ a s s e t / JC2670_UNAIDS_Treatment_Targets_en.pdf). 4. Action plan for the health sector response to HIV in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2017 (http://www.euro.who.int/en/health-topics/communicable- diseases/hivaids/publications/2017/action-plan-for-the-health- sector-response-to-hiv-in-the-who-european-region-2017). 11 All weblinks in this overview and subsequent chapters were accessed on 12 November 2018. 9HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT 5. United Nations Sustainable Development Goals. About the Sustainable Development Goals. In: United Nations [website]. New York (NY): United Nations; 2018 (https://www.un.org/ sustainabledevelopment/sustainable-development-goals/). 6. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: thematic report on the HIV continuum of care: Stockholm: ECDC; in press. 7. Annex on methods. In: Miles to go. Global AIDS update 2018. Geneva: UNAIDS; 2018:255–64 (http://www.unaids.org/sites/ default/files/media_asset/miles-to-go_en.pdf). 8. Guidelines on HIV self-testing and partner notification. Supplement to consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2017 (http://www.who.int/hiv/pub/ self-testing/hiv-self-testing-guidelines/en/). 9. Consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2016 (http://www.who.int/hiv/pub/ guidelines/hiv-testing-services/en/). 10. Public health guidance on HIV, hepatitis B and C testing in the EU/EEA. Stockholm: ECDC; 2018 (https://ecdc.europa.eu/sites/por- tal/files/documents/HIV-hepatitis-B-and-C-testing-public-health- guidance.pdf). 11. HIV testing. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: 2017 pro- gress report. Stockholm: ECDC; 2017 (https://ecdc.europa.eu/sites/ portal/files/documents/HIV%20testing.pdf). 12. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstr eam/10665/208825/1/9789241549684_eng.pdf?ua=1). 13. Guidelines on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstr eam/10665/186275/1/9789241509565_eng.pdf). 14. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016;373(9):795–807. 15. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N et al. Prevention of HIV-1 infection with early antiret- roviral therapy. N Engl J Med. 2011;365(6):493–505. 16. Guidelines version 9.0. October 2017. Brussels: European AIDS Clinical Society; 2017 (http://www.eacsociety.org/files/ guidelines_9.0-english.pdf). 17. Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, Corbelli CM et al. Risk of HIV transmission through condomless sex in gay cou- ples with suppressive ART: the PARTNER2 study expanded results in gay men.  In: AIDS 2018. 22nd International AIDS Conference, Amsterdam, the Netherlands, 23–27 July 2018 [website]. Geneva: International AIDS Society; 2018 (Abstract WEAX0104LB, 2018; https://programme.aids2018.org/Abstract/Abstract/13470). 18. 2017 global AIDS monitoring (GAM). In: AIDSinfo [website]. Geneva: UNAIDS; 2017 (www.AIDSinfoonline.org). 19. Brown AE,  Mohammed H,  Ogaz D,  Kirwan PD,  Yung M,  Nash SG. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)?  Euro Surveill.  2017;22(25):pii=30553  (https://doi.org/10.2807/1560- 7917.ES.2017.22.25.30553). 20. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014 (http://ecdc.europa.eu/en/pub- lications/Publications/hiv-sti-prevention-among-men-who-have- sex-with-men-guidance.pdf). 21. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infec- tion (PROUD): effectiveness results from the pilot phase of a prag- matic open-label randomised trial. Lancet 2017;378:53–60. 22. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L et al. Human immunodeficiency virus among people who inject drugs: is risk increasing in Europe? Euro Surveill. 2013;18(48):pii=20648. (http://www.eurosurveillance.org/ ViewArticle.aspx?ArticleId=20648). 23. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow asso- ciated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2016. Euro Surveill. 2016;20(40):pii=30036. doi:http://dx.doi.org/10.2807/1560-7917. ES.2016.20.40.30036. 24. Public Health England, Health Protection Scotland, Public Health Wales, Public Health Agency Northern Ireland. Shooting up: infec- tions among people who inject drugs in the UK, 2016. London: Public Health England; 2017 (https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/567231/Shooting_ Up_2017_Update.pdf). 25. HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre for Drugs and Drug Addiction; 2018 (http://sante.public.lu/fr/ publications/h/hiv-joint-technical-mission/index.html). 26. Lost in transition. Three case studies of Global Fund withdrawal in south eastern Europe. New York (NY): Open Society Foundations; 2017 (https://www.opensocietyfoundations.org/publications/ lost-transition). 27. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. 2016 update. Geneva: World Health Organization; 2016 (https://www.who.int/hiv/pub/guidelines/ keypopulations-2016/en/)). 28. Ministerial policy dialogue on HIV and related comorbidities in east- ern Europe and central Asia. In: WHO Regional Office for Europe [web- site]. Copenhagen: WHO Regional Office for Europe; 2018 (http:// w w w.euro.who.int/en/media-centre/events/events/2018/07/ ministerial-policy-dialogue-on-hiv-and-related-comorbidities-in- eastern-europe-and-central-asia). 29. Compendium of good practices in the health sector response to HIV in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/ compendium-of-good-practices-in-the-health-sector-response-to- hiv-in-the-who-european-region).

11 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе Данный доклад Европейский центр профилактики и контроля забо- леваний (ECDC) и Европейское региональное бюро Всемирной организации здравоохранения (ВОЗ) совместно осуществляют усиленный эпиднадзор за ВИЧ/СПИДом в Европе с 2008 г. Обе организации стремятся обеспечить высокое качество стандарти- зированных данных эпиднадзора за ВИЧ/СПИДом, проводимого в 53 странах Европейского региона ВОЗ, включая 28 стран Европейского союза (ЕС) и три страны Европейской экономической зоны (ЕЭЗ), кото- рые упоминаются в настоящем обзоре как ЕС/ЕЭЗ. Настоящий доклад является новейшей публикацией из серии докладов, выпущенных совместно ECDC и Европейским региональным бюро ВОЗ с целью пре- доставления данных о ВИЧ-инфекции и СПИДе в Европейском регионе ВОЗ в период с 2007 г. Данные, приведенные в тексте, дополняются 47 рисунками и 27 таблицами: рисунки A–E и таблица A в кратком обзоре, рисунки 1.1–2.19 в главах 1 и 2 и таблицы 1–26 в отдельном разделе ближе к концу доклада. Доклад состоит из трех основных разделов: • краткий обзор, в котором в сжатом виде представ- лены все ключевые положения доклада; • Глава 1, содержащая всеобъемлющий обзор эпиде- миологической ситуации по ВИЧ/СПИДу в ЕС/ЕЭЗ с акцентом на показателях и динамике заболеваемо- сти ВИЧ-инфекцией и динамике заболеваемости и смертности от СПИДа, а также показателях тести- рования на ВИЧ; и • Глава 2, в которой представлены данные о зареги- стрированных случаях ВИЧ-инфекции и СПИДа в Европейском регионе ВОЗ с акцентом на показате- лях и динамике заболеваемости ВИЧ-инфекцией и динамике заболеваемости и смертности от СПИДа как в Регионе в целом, так и в его трех географи- ческих частях. Данные в докладе также дополнены семью приложе- ниями: • Приложение 1, в котором излагаются основные принципы сбора, проверки и представления дан- ных; • Приложение 2, акцент в котором поставлен на пол- ноте ключевых переменных, отражающих эпиде- миологическую ситуацию в ЕС/ЕЭЗ и Европейском регионе ВОЗ в целом; • Приложение 3, в котором анализируется полнота ключевых переменных, представленных в раз- бивке по странам и частям Региона; • Приложения 4a и 4b, содержащие информацию о системах эпиднадзора за ВИЧ-инфекцией и СПИДом в странах и частях Региона; • Приложение 5, содержащее подробные замечания по конкретным странам в отношении предостав- ленных данных и различий в системах эпиднадзора между странами; • Приложение 6, в котором перечислены страны и части Региона с числом зарегистрированных диа- гнозов с поправкой на задержку отчетности; и Таблица A. Характеристики случаев ВИЧ-инфекции, зарегистрированных в Европейском регионе ВОЗ, в ЕС/ЕЭЗ, в западной, центральной и восточной частях Европейского региона ВОЗ, 2017 г. Европейский регион ВОЗа Запад Центр Восток а ЕС/ЕЭЗ Страны, предоставившие отчетные данные/Число странб 49/53 (50/53) 22/23 15/15 12/15 (13/15) 30/31 Число новых случаев ВИЧ-инфекции 55 018 (159 420) 22 354 6 205 26 459 (130 861) 25 353 Частота случаев на 100 000 населенияв 8,3 (20,0) 6,9 3,2 23,6 (51,1) 6,2 Процент случаев у людей в возрасте 15–24 лет 9,3% 11,0% 13,7% 6,9% 11,1% Процент случаев у людей в возрасте старше 50 лет 16,1% 20,7% 13,1% 13,0% 19,3% Соотношение мужчины/женщины 2,2 2,9 5,8 1,6 3,1 Процент новых случаев с числом CD4 <350 клеток/мм3 53,1% 48,0% 52,5% 57,2% 48,6% Путь передачи инфекции Сексуальные контакты между мужчинами 21,2% 39,7% 28,4% 3,9% 38,2% Гетеросексуальные контакты (мужчины) 25,3% 16,7% 19,4% 33,9% 16,6% Гетеросексуальные контакты (женщины) 24,1% 17,5% 7,3% 33,7% 16,5% Употребление инъекционных наркотиков 13,0% 2,7% 2,7% 24,1% 3,7% От матери ребенку 0,7% 0,5% 0,6% 0,9% 0,5% Путь неизвестен 15,4% 22,5% 41,2% 3,4% 24,2% Число новых случаев СПИДаг 14703 2426 823 11454 3130 Частота случаев СПИДа на 100 000 населения 2,3 0,7 0,4 10,2 0,7 a Данные по Российской Федерации включены в цифры в скобках для Европейского региона и для восточной его части. б Отсутствуют данные Германии, по Российской Федерации, Туркменистану и Узбекистану. Все данные, представленные в ВОЗ и ECDC, были получены через Европейскую систему эпиднадзора (TESSy) – за исключением данных по Российской Федерации, которые были получены через публично доступные национальные источники (1). в Показатели для ЕС/ЕЭЗ и Запада скорректированы с учетом задержки отчетности (приложение 6). Расчетное число новых случаев ВИЧ-инфекции с учетом задержки отчетности составляет 27 055 и 23 976, соответственно. r Отсутствуют данные Бельгии, Германии, Швеции, по Российской Федерации, Туркменистану и Узбекистану. 12 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data • Приложение 7, в котором перечислены участвую- щие страны, части Региона и национальные учреж- дения. Краткий обзор Несмотря на то, что распространение ВИЧ-инфекции можно остановить с помощью эффективных мер общественного здравоохранения, число случаев передачи ВИЧ в Европейском регионе ВОЗ продол- жает оставаться высоким. В 2017 г. в 50 из 53 госу- дарств-членов Европейского региона ВОЗ,1 было зарегистрировано 159 420 новых случаев ВИЧ- инфекции, что соответствует 20,0 впервые диа- гностированным случаям на 100 000 населения (таблица А). В это число входят 55 018 новых диагно- стированных случаев, о которых 49 стран сообщили в единую систему эпиднадзора ECDC и Европейского регионального бюро ВОЗ, включая 25 353 слу- чая в ЕС/ЕЭЗ, а информация о 104 402 новых диа- гностированных случаях в Российской Федерации была опубликована российским Федеральным 1 Отсутствуют данные по Германии (экспортирование данных за 2017 г. не могло быть выполнено из-за технических проблем), Туркменистану и Узбекистану. Лихтенштейн является членом ЕЭЗ, но не государством-членом ВОЗ, поэтому данные по Лихтенштейну включены в общие цифры по ЕС/ЕЭЗ, но не включены в общие цифры по Европейскому региону ВОЗ. Официальные данные по Российской Федерации отсутствуют, однако, соответствующие данные, полученные через общедоступные источники информации (1), были включены в сводные данные о количестве и частоте диагностированных случаев ВИЧ-инфекции и динамике этих показателей в Европейском регионе ВОЗ (см. раздел “HIV and AIDS diagnoses in the WHO European Region” [Диагностированные случаи ВИЧ-инфекции и СПИДа в Европейском регионе ВОЗ] (Глава 2)) и в восточной части Региона (см. Раздел “HIV and AIDS diagnoses in the East” [Диагностированные случаи ВИЧ- инфекции и СПИДа в восточной части Региона] (Глава 2)). Это позволяет получить более полную картину эпидемиологической ситуации по ВИЧ-инфекции в Европейском регионе ВОЗ. Другие региональные данные, представленные в этом докладе (в том числе в разбивке по возрасту и полу), основаны на данных из 49 стран, предоставивших данные в единую европейскую систему эпиднадзора за ВИЧ-инфекцией ECDC/ВОЗ. научно-методическим центром по профилактике и борьбе со СПИДом (1) (рис. A). В течение последних трех десятилетий в Европейском регионе ВОЗ было выявлено и зарегистрировано более 2,3 млн. случаев ВИЧ-инфекции, в том числе более 650 000 в странах ЕС/ЕЭЗ (рис. B). Продолжая тенденцию последнего десятилетия, показатели ВИЧ-инфицирования и общее число впервые выявленных случаев ВИЧ-инфекции были самыми высокими на Востоке Региона (51,13 на 100 000 населения), более низкими на Западе и в стра- нах ЕС/ЕЭЗ (6,9 и 6,2 на 100 000 населения, соответ- ственно) и самыми низкими в Центре2 (3,2 на 100 000 населения) (таблица А, рис. А). Преобладающие пути передачи ВИЧ различались в зависимости от геогра- фической зоны, указывая на неоднородность эпиде- миологической ситуации по ВИЧ-инфекции в рамках Европы. Преобладающими путями передачи в странах ЕС/ЕЭЗ были половые контакты между мужчинами, а в восточной части Региона – гетеросексуальные кон- такты и употребление инъекционных наркотиков. Показатели зарегистрированной заболеваемости ВИЧ-инфекцией в рамках Региона были выше среди мужчин, чем среди женщин во всех возрастных груп- пах, за исключением лиц моложе 15 лет. Чуть более половины (53%) случаев ВИЧ-инфекции, диагностированных в Регионе в 2017 г. , были выяв- лены на поздней стадии (количество лимфоцитов CD4 < 350 клеток/мм3 на момент постановки диа- гноза). Этот показатель был самым высоким в стра- нах Востока (57%), несколько ниже в странах Центра 2 Группировка стран Европейского региона ВОЗ на страны Запада (23 страны), Центра (15 стран) и Востока (15 стран) основана на эпидемиологических характеристиках и соответствует разделению стран в предыдущих обзорах, опубликованных EuroHIV в период с 1984 г. Подробнее см. приложение 1, рис. A1.1. Рисунок A. Частота зарегистрированных новых случаев ВИЧ-инфекции на 100 000 населения, с разбивкой по году постановки диагноза, в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 1985–2017 гг. – с поправкой на задержки в предоставлении данных 0 2 4 6 8 10 12 14 16 18 20 2016201420122010200820062004200220001998199619941992199019881986 25 27 36 36 39 4242 42 42 44 43 45 48 48 47 47 49 46 50 52 52 52 52 52 52 51 51 50 50 50 505152 Европейский регион ВОЗ ЕС/ЕЭЗ Ч ис ло с лу ча ев н а 10 0 00 0 на се ле ни я Год постановки диагноза Страны, предоста- вившие данные В ближайшие годы эти показатели могут увеличиться из-за задержек в предоставлении данных. Примечание: показатели заболеваемости для ЕС/ЕЭЗ и Европейского региона ВОЗ включают данные по всем странам, предоставившим отчетность за анализируемый год, включая Российскую Федерацию (1), а также расчетные показатели по Германии за 2017 г. Поэтому показатели за 2017 г., представленные здесь, немного ниже, чем показатели, приведенные в других разделах доклада. 13 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT (53%) и самым низким в странах Запада и ЕС/ЕЭЗ (49%) (таблица А, рис. С). На основе выборки 26 147 новых случаев ВИЧ- инфекции, по которым имелась соответствующая информация (дата постановки диагноза и дата опре- деления количества лимфоцитов CD4), была про- ведена оценка охвата диспансерным наблюдением. Этот показатель определяется как процент впер- вые выявленных ВИЧ-инфицированных пациентов, начавших получать медицинскую помощь в связи с ВИЧ-инфекцией в течение установленного периода времени. Среди ЛЖВ, взятых на диспансерное наблю- дение, у 86% был документально зафиксирован факт взятия на диспансерное наблюдение в течение трех месяцев после постановки диагноза. Этот показатель был самым высоким в Центре (96%), несколько ниже в ЕС/ЕЭЗ (92%) и самым низким на Востоке (82%) (рис. D). В 2017 г. в 47 государствах-членах3 Европейского региона ВОЗ было зарегистрировано 14 703 новых случая СПИДа и заболеваемость СПИДом по Региону, таким образом, составила 2,3 случая на 100 000 насе- ления (см. таблицу А, а также таблицу 15 в разделе «Таблицы»). В 2017 г. в странах ЕС/ЕЭЗ было зареги- стрировано 3130 случаев заболевания СПИДом, что составило 0,7 случая на 100 000 населения. В тече- ние последнего десятилетия число случаев СПИДа продолжало последовательно снижаться на Западе и в ЕС/ЕЭЗ. На Востоке этот показатель почти удвоился в этот же период времени – в последнее время он начал стабилизироваться, а в период с 2012 по 2017 г. он даже снизился на 7% (см. рис. 1.12 и 2.4). 3 Отсутствуют данные по Бельгии, Германии, Российской Федерации, Туркменистану, Узбекистану и Швеции. Рисунок B. Совокупное число новых случаев ВИЧ-инфекции в ЕС/ЕЭЗ и других странах Европейского Региона ВОЗ, 1984–2017 гг. 0 500 000 1 000 000 1 500 000 2 000 000 2 500 000 2015201020052000199519901985 Чи сл о вп ер вы е ди аг но ст ир ов ан ны х сл уч ае в В И Ч- ин ф ек ци и Другие страны Европейского региона ВОЗ ЕС/ЕЭЗ Год постановки диагноза Рисунок C. Доля лиц с поздно поставленным диагнозом (число клеток CD4 < 350/мм3) с разбивкой по полу, возрасту и пути передачи, Европейский регион ВОЗ, 2017 г. 0 2010 30 40 50 60 70 Секс между мужчинами Употребление инъек-ционных наркотиков Гетеросексуальные контакты (женщины) Гетеросексуальные контакты (мужчины) 50+ 40–49 30–39 25–29 20–24 15–19 Женщины Мужчины Всего Процентная доля П ол Во зр ас т П ут ь пе ре да чи 14 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Европейский союз и Европейская экономическая зона В 2017 г. в 30 из 31 страны ЕС/ЕЭЗ диагноз ВИЧ- инфекции был установлен у 25 353 человек, что соот- ветствует частоте, равной 6,2 на 100 000 населения с поправкой на задержку отчетности (таблица 1, приложение 6). В 2017 г. самые высокие показатели заболеваемости новыми случаями ВИЧ-инфекции на 100 000 населения были зарегистрированы в Латвии (18,8; 371 случай) и Эстонии (16,6; 219 слу- чаев), а самые низкие – в Словакии (1,3; 70 случаев) и Словении (1,9; 39 случаев). Показатели заболеваемо- сти были выше у мужчин (9,0 на 100 000 населения; таблица 2), чем у женщин (2,8 на 100 000 населе- ния; таблица 3). В целом соотношение случаев ВИЧ- инфицирования у мужчин и женщин составило 3,1 (Таблица А). Это соотношение было самым высоким в Хорватии (20,2) и Словении (18,5) и оно превышало 1 во всех странах ЕС/ЕЭЗ (рис. 1.1). Преобладающим путем передачи ВИЧ-инфекции в этих странах были половые контакты между мужчинами. У мужчин наблюдаются более высокие повозраст- ные показатели, чем у женщин, во всех возрастных группах, за исключением молодых людей в воз- расте до 15 лет, у которых пововозрастные показа- тели аналогичны (рис. 1.2). Самый высокий общий повозрастной показатель диагностированных слу- чаев ВИЧ-инфекции наблюдался среди 25–29-летних (14,4 на 100 000 населения); в основном из-за самого высокого повозрастного показателя среди мужчин этой группы, равного 22,2 на 100 000 населения, в то время как самый высокий повозрастной показатель у женщин наблюдался в возрастной группе 30–39 лет (6,9 на 100 000 населения) (рис. 1.2). Половые контакты между мужчинами остаются преобладающим путем передачи ВИЧ в ЕС/ЕЭЗ. В 2017 г. на этот путь пришлось 38% (9694) всех впервые диагностированных случаев ВИЧ-инфекции и 50% таких случаев с известным путем заражения (таблица 4, таблица 8, рис. 1.5). Среди новых случаев ВИЧ-инфекции с известным путем заражения преоб- ладали случаи инфицирования при половых контак- тах между мужчинами, на долю которых приходилось более 60% впервые поставленных диагнозов ВИЧ- инфекции в 10 странах (Австрия, Венгрия, Ирландия, Испания, Нидерланды, Польша, Словакия, Словения, Хорватия и Чешская Республика) (рис. 1.5). Гетеросексуальные контакты были на втором месте в списке наиболее распространенных путей передачи ВИЧ-инфекции среди лиц, впервые диагностирован- ных в 2017 г. (33%, с одинаковой частотой у мужчин и женщин). На заражение ВИЧ при употреблении инъек ционных наркотиков приходится 4% впервые диагностированных случаев ВИЧ-инфекции. При этом в 24% случаев ВИЧ-инфицирования путь передачи ВИЧ был либо не указан, либо указан как неизвест- ный (таблица А). В 2017 г. в ЕС/ЕЭЗ 41% новых случаев ВИЧ-инфекции был диагностирован у мигрантов, родившихся за пределами страны, где был постав- лен диагноз (рис. 1.6) (18% у мигрантов из стран Африки к югу от Сахары, 8% – из стран Латинской Америки и Карибского бассейна, 6% – из других стран Центральной и Восточной Европы, 4% – из дру- гих стран Западной Европы). В период с 2008 по 2017 г. наметилась тенденция к незначительному снижению зарегистрирован- ных новых случаев ВИЧ-инфекции. Эти показатели составляли 6,9 на 100 000 в начале этого периода, 6,5 в последующие годы и 6,2 в 2017 г. (см. таблицу 1, рис. 1.8 и приложения 1, 5 и 6). Хотя общая динамика показателей в ЕС/ЕЭЗ, по-видимому, несколько сни- зилась за последнее десятилетие, на национальном уровне наблюдаются противоположные тенденции. Несколько стран, включая Австрию, Бельгию, Данию, Испанию, Нидерланды, Норвегию, Соединенное Королевство и Эстонию, сообщили о снижении частоты впервые диагностированных случаев в Рисунок D. Впервые выявленные ВИЧ-инфицированные пациенты, начавшие получать медицинскую помощь после постановки диагноза в ЕС/ЕЭЗ, в Европейском регионе ВОЗ, на Западе, в Центре и на Востоке, 2017 г. (n = 26 147) 0 20 40 60 80 100 ЕС/ЕЭЗ Европейский регион ВОЗ Запад Востокa Центр Процентная доля 0–4 дней 15–28 дней 5–14 дней 29–91 дней 92–365 дней > 365 дней 15 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT последние годы, даже с поправкой на задержку отчет- ности. С другой стороны, с 2008 г. с учетом задержки отчетности показатели диагностированных случаев ВИЧ-инфекции более чем удвоились в Болгарии, на Кипре и в Литве и увеличились более чем на 50% в Венгрии, Мальте, Польше и Чешской Республике (таблица 1, приложение 6). Тенденции различаются по половому признаку и по возрастным группам. За период с 2008 г. повозраст- ные показатели снизились во всех возрастных груп- пах, за исключением людей старше 50 лет. При этом среди 25–29-летних и 30 –39-летних показатели были последовательно выше, чем в других группах на про- тяжении всего периода как у женщин, так и мужчин (рис. 1.9a и 1.9b). Анализ динамики заболеваемости ВИЧ-инфекцией в разбивке по путям передачи показывает, что число впервые диагностированных случаев ВИЧ-инфекции среди мужчин, имеющих половые контакты с мужчи- нами (МСМ), в ЕС/ЕЭЗ в 2017 г. несколько сократилось по сравнению с предыдущими годами (рис.  1.11a). Хотя задержка отчетности может частично объяснить такое снижение, это снижение, по-видимому, может быть весьма выраженным в некоторых странах, включая Бельгию, Грецию, Испанию, Нидерланды и Соединенное Королевство. И наоборот, в таких стра- нах, как Болгария, Ирландия, Кипр, Мальта, Польша и Румыния в последние годы имело место увели- чение числа новых диагнозов ВИЧ-инфекции среди МСМ. Число случаев ВИЧ-инфицирования среди МСМ, родившихся за пределами страны, предостав- ляющей данные, увеличилось в период с 2008 по 2017 г., незначительно снизившись в период с 2015 по 2017 г., но не в такой степени, которая наблюдалось среди МСМ в странах ЕС/ЕЭЗ (рис. 1.12). В течение последнего десятилетия число случаев гетеросексуальной передачи последовательно сни- жалось (рис. 1.11а), причем более выражено это происходило среди женщин и гетеросексуалов ино- странного происхождения, чем среди мужчин и лиц коренного населения (рис. 1.11a, 1.12). Число диа- гностированных случаев ВИЧ-инфекции, связан- ных с употреблением инъекционных наркотиков, снизилось с 2008 г. как среди лиц иностранного происхождения, так и среди лиц коренного насе- ления – за исключением локальных вспышек в 2011–2012 гг., повлиявших на тенденцию пока- зателей ЕС/ЕЭЗ в этой группе, и менее широких локальных вспышек, отмеченных в этот период в некоторых странах (табл. 5, рис.  1.10, рис.  1.11a). Показатели передачи ВИЧ от матери ребенку, внутрибольничного инфицирования и инфици- рования при переливании крови также после- довательно снижались в период между 2008 и 2017 гг., и теперь они составляют менее 1% новых диагностированных случаев ВИЧ-инфекции (таблица 8). Частота случаев с неизвестным путем заражения увеличилась с 13% в 2008 г. до 24% в 2017 г. От 25 стран была получена информация о количе- стве лимфоцитов CD4 на момент постановки диа- гноза ВИЧ-инфекции (таблица 14) у 18 282 взрослых и подростков (71% от общего количества впервые диагностированных случаев ВИЧ-инфекции). Как и в предыдущие годы, почти половина (49%) всех слу- чаев с известным количеством лимфоцитов CD4 была диагностирована через несколько лет после инфици- рования, когда число лимфоцитов CD4 было менее 350 клеток/мм3; при этом у 28% пациентов наблюдалась продвинутая стадия ВИЧ-инфекции (CD4 < 200 клеток/мм3). При анализе количества лимфоцитов CD4 в зависи- мости от пути передачи ВИЧ процент людей, которым диагноз был поставлен через несколько лет после инфицирования (CD4 < 350 клеток/мм3), был самым высоким среди женщин (52%), людей среднего и пожилого возраста (56% в возрасте 40–49 лет и 63% в возрасте старше 50 лет), мужчин и женщин, инфици- рованных при гетеросексуальных половых контактах (63% и 53% соответственно), людей, которые были инфицированы ВИЧ при употреблении инъекцион- ных наркотиков (52%), а также мигрантов из Южной и Юго-Восточной Азии (53%) и из стран Африки к югу от Сахары (56%) (табл. 14, рис. 1.7). Самый низ- кий процент случаев поздней диагностики, о которой свидетельствовал уровень лимфоцитов CD4 менее 350 клеток/мм3 на момент постановки диагноза, был зарегистрирован в более молодых возрастных груп- пах (15–19 лет – 33%, 20–24 года – 32%), среди муж- чин, которые заразились при половых контактах с мужчинами (37%), и среди мигрантов из других стран Западной Европы (34%). Хотя у многих людей диагноз ВИЧ-инфекции все еще ставится на поздней стадии, то есть через несколько лет после заражения ВИЧ, медианное количество лимфоцитов CD4 на момент постановки диагноза значительно увеличилось за последнее десятилетие – с 330 клеток/мм3 (95% доверительный интервал (ДИ): 322–338) в 2007 г. до 391 клеток/мм3 (95% ДИ: 381–400) в 2017 г. Группа с наибольшим медианным количеством лимфоци- тов CD4 на момент постановки диагноза – это МСМ, среди которых этот показатель в 2017 г. был равен 452 клеткам/мм3 (рис. 1.13). В 2017 г. в 28 странах ЕС/ЕЭЗ было диагностировано и зарегистрировано 3130 случаев СПИДа4, что соста- вило 0,7 случая на 100 000 населения (таблица 15). В целом, 89% этих диагнозов были сделаны в тече- ние 90 дней с момента постановки диагноза ВИЧ- инфекции, свидетельствуя о том, что большинство случаев СПИДа в ЕС/ЕЭЗ – это результат поздней диа- гностики ВИЧ-инфекции. Эта закономерность харак- терна для всех групп пациентов, сформированных в зависимости от пути заражения ВИЧ-инфекцией, за исключением людей, зараженных при употребле- нии инъекционных наркотиков, у которых в течение 90 дней с момента выявления ВИЧ-инфекции диагноз СПИДа ставится 59% пациентов (рис. 1.14). В 2017 г. 4 Все они были странами ЕС/ЕЭЗ, за исключением Швеции и Бельгии. 16 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data 14 стран сообщили о выявлении туберкулеза (легоч- ного и/или внелегочного) как СПИД-индикаторного заболевания в 14% новых случаев СПИДа (рис. 1.16). С середины 1990-х гг. в странах ЕС/ЕЭЗ наблюдается последовательное снижение числа новых случаев СПИДа и случаев смерти от СПИДа. Европейский регион ВОЗ В 2017 г. в Европейском регионе ВОЗ было зареги- стрировано 159 420 новых случаев ВИЧ-инфекции (20,0 на 100 000 населения). Таким образом ежегод- ный рост количества новых диагнозов ВИЧ-инфекции продолжался, но более медленными темпами, чем прежде (рис. А). Этот рост обусловлен главным обра- зом продолжающейся тенденцией к повышению забо- леваемости ВИЧ-инфекцией на Востоке и в Центре, в то время как на Западе Региона частота новых слу- чаев ВИЧ-инфекции снижается (рис. 2.3a). Из 159 420 случаев ВИЧ-инфекции, впервые диа- гностированных в 2017 г., 82% были выявлены на Востоке (130 861), 14% на Западе (22 354) и 4% в Центре Региона (6205) (таблица А). В восточной части Региона также были зарегистрированы самые высо- кие показатели заболеваемости ВИЧ-инфекцией (51,1 на 100 000 населения), что значительно выше, чем на Западе (6,9 на 100 000, с поправкой на задержку отчетности5) и в Центре Региона (3,2 на 100 000) (таблица А). Показатели новых диагностированных случаев ВИЧ- инфекции в 2017 г. существенно различались между странами Европейского региона ВОЗ. Самые высо- кие показатели на 100 000 населения наблюдались в Российской Федерации (71,1) (1), Украине6 (37,0), Беларуси (26,1) и Республике Молдова (20,6), а самые низкие – в Боснии и Герцеговине (0,3), Словакии (1,3) и Словении (1,9) (Таблица 1). Для 49 стран, предоставивших данные в ECDC/ВОЗ за 2017 г.7 (Российская Федерация не включена), общий показатель заболеваемости для мужчин составил 11,9 (таблица 2), а для женщин – 5,1 на 100 000 насе- ления (таблица 3). Наибольшая доля лиц с впервые диагностированной ВИЧ-инфекцией в 49 странах, предоставивших данные, приходится на возрастную группу 30–39 лет (36%), 9% – на молодежь в возрасте 15–24 года и 16% – на людей в возрасте 50 лет и старше на момент постановки диагноза. Соотношение слу- чаев ВИЧ-инфекции у мужчин и женщин было равно 2,2 – с самым низким значением в восточной части Региона (1,6), более высоким значением в западной части Региона (2,9) и самым высоким значением в 5 Более подробная информация приведена в приложении 1 и приложении 6. 6 Без учета данных по Крыму, городу Севастополю и ряду территорий Украины, не контролируемых государством; с корректировкой знаменателя (численность населения), чтобы исключить Крым и город Севастополь; и за исключением детей, рожденных ВИЧ-инфицированными матерями, чей ВИЧ-статус еще не определен. 7 Никаких данных от Германии, Российской Федерации, Туркменистана и Узбекистана получено не было. центральной части Региона (5,8). Распределение случаев ВИЧ-инфекции по путям передачи является следующим: гетеросексуальные контакты – 49%, в том числе 11% у выходцев из стран с генерализован- ной эпидемией ВИЧ-инфекции; половые контакты между мужчинами – 21%; употребление инъекци- онных наркотиков – 13%; передача ВИЧ от матери ребенку – 0,7%. По 15% новых случаев ВИЧ-инфекции информация о пути передачи вируса неизвестна или отсутствует (Таблица А). После того, как данные по Российской Федерации8 были объединены с данными, предоставленными дру- гими 49 странами, среди людей с известным путем заражения распределение случаев было следующим: гетеросексуальные контакты – 56%, употреб ление инъекционных наркотиков – 30%, половые кон- такты между мужчинами – 14%, передача от матери ребенку – 0,6%. На Востоке Региона (после того, как данные по Российской Федерации были объединены с данными, предоставленными 12 другими странами) среди людей с известным путем передачи ВИЧ распреде- ление случаев было следующим: гетеросексуальные контакты – 59%, употребление инъекционных нарко- тиков – 37%, половые контакты между мужчинами – 3%, передача от матери ребенку – 0,5%. В 12 предо- ставивших данные государствах 68% ВИЧ-позитивных людей заразились при гетеросексуальных контактах, 24% – при употреблении инъекционных наркотиков и 4% – при половых контактах между мужчинами (таблицы 4–6, таблица 8). Основными путями пере- дачи ВИЧ-инфекции в центральной части Региона были половые контакты между мужчинами (30%) и гетеросексуальные контакты (26%). У 40% пациен- тов с впервые диагностированной ВИЧ-инфекцией информация о пути заражения отсутствовала. Половые контакты между мужчинами были преоб- ладающим путем передачи ВИЧ-инфекции в 12 из 15 стран центральной части Региона. В западной части Региона половые контакты между мужчинами остаются основным путем передачи ВИЧ-инфекции (40% случаев), за которым следуют гетеросексуаль- ные контакты (34%, среди которых 41% приходился на выходцев из стран с генерализованной эпидемией ВИЧ-инфекции). Для 23% пациентов с впервые диа- гностированной ВИЧ-инфекцией информация о пути заражения отсутствовала. За последние десять лет в 50 странах показатели впервые диагностированных случаев ВИЧ-инфекции увеличились на 37% (с 14,6 на 100 000 населения в 2008 г. (107 385 случаев), до 20,0 на 100 000 населе- ния в 2017 г. (159 420 случаев) (рис. 2.3а). Увеличение происходило, главным образом, за счет сохра- нения восходящей тенденции в восточной части Региона, где этот показатель увеличился на 68% – с 8 В Российской Федерации новые случаи ВИЧ-инфекции с известным путем заражения распределялись следующим образом: употребление инъекционных наркотиков и гетеросексуальные контакты – 49%, половые контакты между мужчинами – 1,5% и передача от матери ребенку – 0,8% (1). 17 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT 30,4 на 100 000 (77 228 случаев) до 51,1 на 100 000 (130 861 случай). В 12 странах восточной части Региона (Российская Федерация не входит в их число), официально предоставляющих отчетность, этот показатель увеличился гораздо меньше (на 18%) – с 20,0 в 2008 г. до 23,6 в 2017 г. В период с 2006 по 2015 г. в центральной части Региона этот показатель увеличился на 121% (наибольшее относительное уве- личение среди всех трех географических зон) – от 1,4 до 3,1 на 100 000 населения, в то время как в запад- ной части Региона он снизился на 27% – от 9,4 до 6,9 на 100 000 населения (рис. 2.3b). Анализ общей региональной тенденции для 49 стран, предоставивших отчеты в ECDC и ВОЗ (не включая Германию, Российскую Федерацию, Туркменистан и Узбекистан), показывает, что показатель для всего региона снизился на 5% с 8,8 в 2008 г. до 8,4 в 2017 г. За период 2007–2017 гг. соответствующие данные о пути передачи инфекции поступили из 44 стран (рис. 2.4). На Востоке общий рост был обусловлен быстрым увеличением числа диагностированных случаев передачи ВИЧ-инфекции половым путем – на 69% для гетеросексуальной передачи и в восемь раз для передачи при половых контактах между мужчи- нами. Этот рост был значительно выше среди мужчин, зараженных при гетеросексуальных контактах (уве- личение на 107%), чем среди женщин, зараженных таким же путем (увеличение на 21%). Частота случаев передачи инфекции при употреблении инъекцион- ных наркотиков снизилась на 36%, хотя она про- должает оставаться на достаточно высоком уровне (рис. 2.10). В Центре в период с 2008 по 2017 г. число впервые выявленных ВИЧ-позитивных лиц, инфици- рованных при половых контактах между мужчинами, увеличилось почти втрое, и этот путь заражения пре- обладает в 11 из 15 стран; в то же время число слу- чаев передачи ВИЧ-инфекции при гетеросексуальных контактах увеличилась на 43%. Уровень передачи ВИЧ при употреблении инъекционных наркотиков стабилизировался после вспышки, наблюдавшейся в Румынии в 2011–2013 гг., и повысился в целом на 43% по сравнению с уровнем 2008 г. (рис. 2.17). На Западе частота передачи ВИЧ при гетеросексуальных контактах продолжала последовательно снижаться и за 10-летний период в целом уменьшилась на 49% с еще более выраженным снижением среди гетеросек- суальных женщин. В период с 2008 по 2017 г. частота заражения ВИЧ при употреблении инъекционных наркотиков снизилась на 57% и после пика в 2012 г., вызванного вспышкой в Греции, в настоящее время опять снижается. Число впервые диагностированных случаев передачи инфекции при половых контактах между мужчинами снизилось на 21% по сравнению с 2008 г. Это снижение не всегда можно объяснить задержкой отчетности. Число новых диагнозов ВИЧ- инфекции с неизвестным путем передачи увеличи- лось на Западе на 51% (рис. 2.19). Поздняя диагностика ВИЧ-инфекции остается в Регионе проблемой, требующей неотложного реше- ния. Среди впервые выявленных инфицированных (старше 14 лет) с имеющейся информацией о коли- честве лимфоцитов CD4 на момент постановки диа- гноза, у чуть более половины (53%) диагноз был поставлен поздно; число лимфоцитов CD4 было менее 350 клеток/мм3, включая 32% пациентов с про- двинутой стадией ВИЧ-инфекции (CD4 < 200 клеток/ мм3). Процентная доля людей с впервые выявленной ВИЧ-инфекцией на поздней стадии (CD4 < 350/мм3) варьировалась в зависимости от пути передачи и возрастной группы, и была самой высокой у инфици- рованных при гетеросексуальных половых контактах (58%; 62% для мужчин и 54% для женщин) и при упо- треблении инъекционных наркотиков (55%) и самой низкой у мужчин, инфицированных при половых кон- тактах с мужчинами (39%) (рис. C). Эта доля повыша- ется с увеличением возраста на момент постановки диагноза: от 34% и 32% у людей в возрасте 15–19 и 20–24 лет до 66% у людей в возрасте 50 лет и старше. Каких-либо значительных различий в частоте случаев поздней диагностики у мужчин и женщин выявлено не было (соответственно 52% и 54%). Однако общий показатель для мужчин не позволяет увидеть разли- чие в частоте случаев поздней диагностики у МСМ (у которых, как правило, диагноз ставится раньше) и у гетеросексуальных мужчин (у которых, это, как пра- вило, происходит позже). Показатели поздней диа- гностики различались и в рамках Региона – 57% на Востоке, 53% в Центре и 48% на Западе. В 2017 г. в 47 государствах-членах Европейского региона ВОЗ9 было зарегистрировано 14 703 новых случая СПИДа, и заболеваемость СПИДом, таким образом, составила 2,3 случая на 100 000 населе- ния. В целом 78% случаев СПИДа были диагностиро- ваны на Востоке, где показатель на 100 000 человек также был самым высоким (10,2), 17% на Западе (0,7 на 100 000) и 6% в Центре Региона (0,4 на 100 000) (таблица 15). Туберкулез был СПИД-индикаторным заболеванием у 20% людей с диагнозом СПИДа. В рамках Региона этот показатель варьировался сле- дующим образом: 15% на Западе, 19% в Центре и 26% на Востоке. В период с 2008 по 2017 г. частота новых диагнозов СПИДа оставалась в основном ста- бильной. Однако в этот же период времени были отмечены очень большие различия в показателях в рамках Региона: их увеличение на 100% на Востоке (от 5,1 до 10,2 на 100 000) с небольшим снижением в период с 2012 по 2017 г., их стабилизация в Центре (0,4 на 100 000) и их устойчивое снижение на Западе (от 2,1 до 0,7 на 100 000) (рис. 2.5). Выводы Эпидемия ВИЧ-инфекции, которая затрагивает более 2 миллионов человек в Европейском регионе ВОЗ, особенно в восточной его части, остается одной из важнейших нерешенных проблем здравоохранения. В 2017 г. ВИЧ-инфекция была диагностирована почти у 160 000 человек или у 20,0 человек на 100 000 насе- ления, продолжая сохраняться на самом высоким 9 Отсутствуют данные по Бельгии, Германии, Российской Федерации, Туркменистану, Узбекистану и Швеции. 18 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data уровне за всю историю регистрации случаев ВИЧ- инфицирования в течение года. Подавляющая доля случаев (82%) была диагностирована в восточной части Региона и 16% в странах ЕС/ЕЭЗ. На случаи ВИЧ-инфекции, впервые диагностированные в двух странах (Российская Федерация и Украина), прихо- дится 75% всех случаев в Европейском регионе ВОЗ и 92% случаев на Востоке Региона. Новые данные эпиднадзора, представленные в этом обзоре, ука- зывают, с одной стороны, на продолжающееся уве- личение числа новых диагностированных случаев ВИЧ-инфекции в Европейском регионе и особенно в его восточной и центральной частях, несмотря на снижение темпов роста показателей за последнее десятилетие по сравнению с предыдущими. С другой стороны, данные подтверждают стабилизацию и даже снижение показателей в ряде стран ЕС/ЕЭЗ в послед- ние годы. Нынешние тенденции указывают на то, что Регион не сможет обеспечить достижение поставленных ВОЗ и Объединенной программой ООН по ВИЧ/СПИДу (ЮНЭЙДС) целевых показателей (2–4), намеченных в качестве вех на пути к достижению Цели устойчивого развития ООН (ЦУР) 3.3, которая призывает “поло- жить конец эпидемиям СПИДа, туберкулеза, малярии и тропических болезней, которым не уделяется долж- ного внимания, и обеспечить борьбу с гепатитом, заболеваниями, передаваемыми через воду, и дру- гими инфекционными заболеваниями” (5). Расчетное количество новых инфекций, которое в настоящее время достигло исторического максимума, должно сократиться к 2020 г. на 78%, чтобы Регион смог достичь этой цели. Даже в ЕС/ЕЭЗ, где общая тен- денция к повышению частоты новых случаев ВИЧ- инфекции несколько снизилась в последние годы, для достижения установленного целевого показателя расчетное количество новых случаев должно быть снижено на 74% к 2020 г. (рис. Е). Хотя эпидемические модели и тенденции в разных странах Европы широко варьируются, в некоторых частях Региона наблюдается устойчивое увеличе- ние числа случаев вновь диагностированных инфек- ций, связанных с определенными путями передачи, например, среди мужчин, имеющих половые кон- такты с мужчинами, на Западе и в Центре и среди гетеросексуалов на Востоке Региона. В последние годы частота случаев передачи ВИЧ-инфекции при гетеросексуальных контактах существенно сократи- лась в ЕС/ЕЭЗ и на Западе, особенно среди женщин, равно как и частота случаев передачи ВИЧ-инфекции при половых контактах между мужчинами в отдель- ных странах ЕС/ЕЭЗ и на Западе. Во многих странах продолжала снижаться частота передачи ВИЧ при употреблении инъекционных наркотиков. Однако, в 2017 г. на этот путь заражения в восточной части Региона по-прежнему приходилось 37% новых заре- гистрированных случаев с известным путем зараже- ния. У слишком большого числа людей во всем Европейском регионе диагноз ВИЧ-инфекции уста- навливается на поздней стадии (53%), что повы- шает риск развития заболеваний, летального исхода и дальнейшего распространения ВИЧ-инфекции. Большое число диагностированных случаев СПИДа в восточной части Региона указывает на сохране- ние таких серьезных проблем, как поздняя диагно- стика ВИЧ-инфекции, отсроченное начало АРТ и низкий охват лечением. В то же время тенденция к стабилизации показателей заболеваемости СПИДом, наблюдаемая с 2012 года, может быть результатом растущего большинства стран Востока, которые в настоящее время проводят так называемую политику «Лечить всех», согласно которой АРТ предлагается всем людям, живущим с ВИЧ, независимо от стадии заболевания. Каждый пятый человек, живущий с ВИЧ в Регионе, не знает о своей инфекции (6) (более подробные дан- ные приведены в докладе UNAIDS (7)). Для умень- шения числа людей с поздно диагностированной ВИЧ-инфекцией или людей, которые не знают о том, Рисунок E. Расчетное число новых инфекций и новые диагностированные случаи в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 2007–2017 гг., и цель на 2020 г. 0 20 000 40 000 60 000 80 000 100 000 120 000 140 000 160 000 180 000 2020201920182017201620152014201320122011201020092008 За ре ги ст ри ро ва нн ы е но вы е ди аг но ст ир ов ан ны е сл уч аи В И Ч и ра сч ет но е чи сл о но вы х сл уч ае в ин ф иц ир ов ан ия В И Ч Расчетное число инфекций в Европейском регионе ВОЗ Цель на 2020 г., Европейский регион ВОЗ Диагностированные случаи в Европейском регионе ВОЗ Расчетное число инфекций, ЕС/ЕЭЗ Цель на 2020 г., ЕС/ЕЭЗ Диагностированные случаи, ЕС/ЕЭЗ Источники: оценочное число новых случаев ВИЧ-инфекции – ЮНЭЙДС (7); новые диагностированные случаи ВИЧ-инфекции – авторы. 19 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT что они инфицированы, необходимы новые страте- гии по расширению разнообразных и удобных для пользователей подходов к повышению доступно- сти тестирования на ВИЧ. Руководство ВОЗ по само- тестированию на ВИЧ и информированию партнеров и руководство ECDC по комплексному тестированию на ВИЧ-инфекцию и гепатиты B и C содержат реко- мендации о внедрении инновационных подходов, которые включают самотестирование и тестирова- ние, проводимое поставщиками услуг, не имеющими медицинского образования (8–10). Однако резуль- таты мониторинга политики в рамках Региона сви- детельствуют о том, что во многих европейских странах внедрение таких подходов, как тестирова- ние на уровне общин, самотестирование и оказание помощи в добровольном информировании полового партнера о наличии ВИЧ-инфекции, ограничено или вообще отсутствует (11). Услуги по тестированию на ВИЧ должны быть ориентированы на охват наибо- лее пострадавших групп населения с учетом местных эпидемиологических особенностей, быть адаптиро- ваны к конкретным потребностям этих групп, а также содействовать своевременному охвату таких групп диспансерным наблюдением, включающим такие составляющие, как профилактика, диагностика и лечение ВИЧ-инфекции и оказание помощи ЛЖВ. Это обеспечит раннюю диагностику и начало лечения и приведет к улучшению результатов лечения и сниже- нию ВИЧ ассоциированной заболеваемости и смерт- ности в поддержку достижения целей «90-90-90»10 и других региональных и глобальных целей (2–4). В настоящее время уже имеются убедительные дока- зательства того, что раннее начало АРТ полезно как для здоровья человека, получающего лечение, так и для предотвращения дальнейшей передачи ВИЧ (12–17). Почти 90% стран Европейского региона ВОЗ имеют политику предоставления лечения незави- симо от количества лимфоцитов CD4 (6,18). Меры по противодействию эпидемии ВИЧ-инфекции должны основываться на научных данных и они должны быть адаптированы к национальной и мест- ной эпидемиологической ситуации. На основании данных эпиднадзора, приведенных в этом докладе, можно сделать следующие выводы: • Что касается стран ЕС/ЕЭЗ и западной части Региона, то ввиду повышения частоты ВИЧ- инфицирования среди МСМ в некоторых стра- нах и преобладания передачи ВИЧ среди МСМ существующие мероприя тия по профилактике и борьбе с ВИЧ-инфекцией должны быть расширены и укреплены, оставаясь приоритетным направ- лением противодействия ВИЧ-инфекции. Страны со снижением показателей продемонстрировали влияние изменения культуры поведения, выра- жающееся в более частом прохождении тестов 10 Цели “90-90-90” заключаются в том, что 90% людей, живущих с ВИЧ, должны знать свой ВИЧ-статус, 90% людей с диагностированной ВИЧ-инфекцией должны получать лечение и у 90% людей, проходящих лечение, должна быть неопределяемая вирусная нагрузка. мужчинами гомосексуальной ориентации из групп риска и немедленном обращении выявленных ВИЧ- позитивных лиц за медицинской помощью и антире- тровирусным лечением (19). Многокомпонентные вмешательства и включение в пакет мероприятий по противодействию ВИЧ-инфекции таких новых стратегий, как доконтактная профилактика ВИЧ- инфекции, самотестирование и оказание помощи в информировании полового партнера о нали- чии ВИЧ-инфекции, могут способствовать пре- одолению этой восходящей тенденции (8,20,21). Увеличение в 2011–2012 гг. числа случаев ВИЧ- инфекции у людей, употребляющих инъекционные наркотики, и продолжающиеся местные вспышки в ряде стран (22–25) свидетельствует о необходимо- сти поддерживать или расширять программы сни- жения вреда. • В странах, расположенных в Центре, число новых случаев ВИЧ-инфекции в целом растет быстрее, чем в любой другой части Европы. В этой части Региона наблюдаются большие различия в частоте новых случаев ВИЧ-инфекции между мужчинами и женщинами. Среди мужчин, особенно среди МСМ, наблюдается тревожный рост этого показа- теля по сравнению с довольно стабильной дина- микой среди женщин. Половые контакты между мужчинами являются преобладающим путем пере- дачи ВИЧ-инфекции в 12 из 15 стран в центральной части Региона. Для улучшения ситуации помимо стратегий и практических мер, направленных на охват АРВ-терапией всех людей, живущих с ВИЧ, необходимо следующее: внедрение услуг докон- тактной профилактики для групп высокого риска; тестирование на ВИЧ, проводимое работниками, не имеющими медицинского образования; экс- пресс-тестирование на ВИЧ; самотестирование на ВИЧ; и оказание профессиональной помощи в добровольном уведомлении полового партнера. Некоторые страны перешли на внутреннее финан- сирование мер противодействия ВИЧ-инфекции после прекращения финансирования со стороны Глобального фонда для борьбы со СПИДом, тубер- кулезом и малярией. Это создает проблемы устой- чивости, особенно в отношении финансирования программ профилактики ВИЧ-инфекции. Для смяг- чения некоторых из этих проблем и предотвраще- ния ускорения темпов распространения эпидемии необходимы более активная политическая воля и внимание наряду с более активным участием граж- данского общества (26). • В странах восточной части Региона существует настоятельная необходимость расширить мас- штабы смелых и научно-обоснованных мер и обес печить предоставление гражданам эффектив- ных, высококачественных и комплексных услуг с помощью хорошо функционирующих систем здра- воохранения, одной из задач которых является улучшение социальных детерминант здоровья. Имеется необходимость в комплексных стратегиях комбинированной профилактики и во внедрении инновационных способов тестирования на ВИЧ, 20 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data уделяя особое внимание охвату ключевых групп населения. Это может быть достигнуто с помо- щью удобных для пользователя услуг по профи- лактике ВИЧ-инфекции и тестированию на ВИЧ, включая оказание профессиональной помощи в добровольном уведомлении полового партнера, доконтактную профилактику, тестирование на ВИЧ, проводимое обученными поставщиками услуг, не имеющими медицинского образования, и само- тестирование в соответствии с рекомендациями ВОЗ. Все эти виды услуг должны быть интегриро- ваны в национальную политику и программы и вне- дрены в практику (4,8,9,27). Участие общественных организаций в разработке и предоставлении лечебно-профилактических услуг имеет решаю- щее значение для сокращения числа новых случаев инфицирования ВИЧ и увеличения числа людей, охваченных диспансерным наблюдением и полу- чающих АРТ, с конечной целью снижения большого количества случаев СПИДа, в том числе с летальным исходом. Инновационные мероприятия по профи- лактике ВИЧ-инфекции должны быть направлены на снижение риска гетеросексуальной передачи, особенно среди пар, где один из партнеров скло- нен к поведению высокого риска (например, упо- требляет инъекционные наркотики) или в течение длительных периодов времени находится за грани- цей. Большое количество новых диагностирован- ных случаев ВИЧ-инфекции у людей, зараженных при употреблении инъекционных наркотиков, ука- зывает на то, что основанная на фактических дан- ных политика, направленная на ключевые группы населения и предусматривающая широкий охват людей, употребляющих инъекционные наркотики, программами снижения вреда, по-прежнему имеет решающее значение для эффективного противо- действия ВИЧ-инфекции в восточной части Региона. После ряда призывов к принятию срочных мер, самым недавних из которых был призыв дирек- тора Европейского регионального бюро ВОЗ в ходе министерского диалога по вопросам политики в отношении ВИЧ-инфекции и сочетанных заболева- ний в Восточной Европе и Центральной Азии (ВЕЦА) с участием 11 министров или заместителей мини- стров здравоохранения из 11 стран ВЕЦА в июле 2018 г. (28), страны восточной части Региона акти- визировали усилия по осуществлению Плана действий сектора здравоохранения по борьбе с ВИЧ-инфекцией в Европейском регионе ВОЗ, в том числе путем разработки дорожных карт для уско- рения усилий по достижению целевых показателей ЮНЭЙДС и стратегии ВОЗ Здоровье-2020 (2–4). Для содействия обмену накопленным опытом в рамках Европейского региона ВОЗ национальным органам здравоохранения, национальным и между- народным экспертам и организациям гражданского общества, занимающимся оказанием услуг по профи- лактике, диагностике и лечению ВИЧ-инфекции, было предложено поделиться информацией о своих успеш- ных мерах и программах по борьбе с ВИЧ-инфекцией. Благодаря этой инициативе был подготовлен первый сборник примеров передовой практики в сфере про- тиводействия ВИЧ-инфекции в 33 государствах-чле- нах Европейского региона ВОЗ (29). Надежные эпидемиологические данные имеют реша- ющее значение для мониторинга ситуации и при- нятия службами общественного здравоохранения информированных решений относительно своевре- менных и эффективных мер противодействия эпи- демии ВИЧ-инфекции в Европейском регионе ВОЗ. Постепенно увеличивается число стран, которые про- водят расширенный эпиднадзор за ВИЧ-инфекцией и сообщают собранные эпидемиологические данные на европейский уровень. В 2017 г. 41 страна предоста- вила связанные данные о случаях ВИЧ-инфекции и СПИДа, что позволяет лучше понять клинический ста- тус людей с диагностированной ВИЧ-инфекцией. Этот подход расширяет возможности долгосрочного мони- торинга результатов оказания медицинской помощи при ВИЧ-инфекции, например, путем моделирова- ния доли недиагностированных случаев инфекции и количественной оценки таких параметров, как охват людей с диагностированной ВИЧ-инфекцией диспан- серным наблюдением и АРВ-терапией и подавление вирусной нагрузки. Он может также внести вклад в национальные и глобальные усилия по мониторингу достижения целей «90-90-90» и других глобальных и региональных целей. Библиография11 1. 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(http://www.eurosurveillance.org/ ViewArticle.aspx?ArticleId=20648). 23. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow asso- ciated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2016. Euro Surveill. 2016;20(40):pii=30036. doi:http://dx.doi.org/10.2807/1560-7917. ES.2016.20.40.30036. 24. Public Health England, Health Protection Scotland, Public Health Wales, Public Health Agency Northern Ireland. Shooting up: infec- tions among people who inject drugs in the UK, 2016. London: Public Health England; 2017 (https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/567231/Shooting_ Up_2017_Update.pdf). 25. HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre for Drugs and Drug Addiction; 2018 (http://sante.public.lu/fr/ publications/h/hiv-joint-technical-mission/index.html). 26. Lost in transition. Three case studies of Global Fund withdrawal in south eastern Europe. New York (NY): Open Society Foundations; 2017 (https://www.opensocietyfoundations.org/publications/ lost-transition). 27. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. 2016 update. Geneva: World Health Organization; 2016 (https://www.who.int/hiv/pub/guidelines/ keypopulations-2016/en/)). 28. Министерский диалог по вопросам политики в отношении ВИЧ- инфекции и сочетанных заболеваний в Восточной Европе и Центральной Азии. Источник: Европейское региональное бюро ВОЗ [веб-сайт]. Копенгаген: Европейское региональное бюро ВОЗ, 2018 г. (http://www.euro.who.int/ru/media-centre/events/ events/2018/07/ministerial-policy-dialogue-on-hiv-and-related- comorbidities-in-eastern-europe-and-central-asia). 29. Сборник примеров передовой практики здравоохранения в сфере противодействия ВИЧ-инфекции в Европейском регионе ВОЗ. Копенгаген: Европейское региональное бюро ВОЗ, 2018 г. (http://www.euro.who.int/en/publications/abstracts/compendium- of-good-practices-in-the-health-sector-response-to-hiv-in-the- who-european-region).

23 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT HIV diagnoses In 2017, 25  353 new HIV diagnoses were reported in the 30 countries of the EU/EEA, with a rate of 6.2 per 100  000 when adjusted for reporting delay (Table  1, Annex  6). The highest rates were reported by Latvia (18.8; 371 cases) and Estonia (16.6; 219 cases), and the lowest by Slovakia (1.3; 70 cases) and Slovenia (1.9; 39 cases). More men than women were diagnosed with HIV in 2017 (19 032 and 6178, respectively), resulting in an overall male–female ratio of 3  :  1) (Tables 2 and 3, Fig. 1.1). This ratio was highest in Croatia (20.2) and Slovenia (18.5) and was above 1 in all countries in the EU/EEA (Fig. 1.1). The predominant mode of transmission in these countries was sex between men. The overall rate of new diagnoses in men was 9.0 per 100  000 popula- tion (Table 2) and for women 2.8 per 100 000 population (Table 3). Men had higher age-specific rates than women in all age groups except among people under 15 years, where age- specific rates were similar (Fig. 1.2). The highest overall age-specific rate of HIV diagnoses was observed among 25–29-year-olds (14.4 per 100  000 population), largely because this age group has the highest age-specific rate for men at 22.2 per 100 000 population, while rates for women were highest in the 30–39 age group (6.9 per 100 000 population) (Fig. 1.2). The median age at diagnosis was lower for MSM (34 years) than for cases attributed to injecting drug use (37 years) or heterosexual transmission (39 years over- all, 37 in women and 41 in men). The 30–39 age group accounted for most HIV diagnoses overall (32%) and in all transmission groups (Fig.  1.3). Thirty-four per cent of cases attributed to sex between men are diagnosed before age 30, while half (48%) of HIV infections due to sex between men and women are diagnosed at 40 years or above, and nearly one quarter (24%) at 50 or above. Data on transmission mode provide information on the groups that are most affected by HIV in the EU/EEA (Tables 4–12(a,b), Fig. 1.5). • Sex between men remains the predominant mode of HIV transmission reported in the EU/EEA, account- ing for 38% (9694) of all new HIV diagnoses in 2017 and half (50%) of diagnoses where the route of transmission was known (Table  4, Table 8, Fig.  1.5). Sex between men was the most commonly reported route of transmission among those for whom route of 1. HIV and AIDS in the EU/EEA Fig. 1.1. Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2017 (n = 25 210) 0 4 8 12 16 20 24 Sweden Finland Latvia France Estonia Belgium Portugal Norway Luxembourg Romania United Kingdom EU/EEA Ireland Italy Cyprus Malta Denmark Greece Austria Lithuania Spain Netherlands Iceland Poland Hungary Bulgaria Czech Republic Slovakia Slovenia Croatia Male-to-female ratio Note: Germany did not report data for 2017. 24 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data transmission was known, accounting for more than 60% of new HIV diagnoses in 10 countries (Austria, Croatia, the Czech Republic, Hungary, Ireland, the Netherlands, Poland, Slovakia, Slovenia and Spain) (Fig. 1.5). • Sex between men and women is the second most commonly reported mode of transmission in the EU/EEA, accounting for 33% (8402) of HIV diagnoses and 44% of diagnoses where the route of transmis- sion was known (Table  6, Table 8, Fig.  1.5). These proportions are divided roughly equally between men and women. Heterosexual transmission is the most commonly reported known mode of transmission in 10 EU/EEA countries (Estonia, Finland, France, Italy, Latvia, Luxembourg, Norway, Portugal, Romania and Sweden). More than one third (37%; 1982) of newly diagnosed cases due to heterosexual transmission are among migrants originating from countries with generalized HIV epidemics. The highest proportions of these were observed in Ireland (58%), France (52%) and Sweden (51%) (Table 10). • Four per cent (929 cases) of new HIV diagnoses over- all and 5% with known route of HIV transmission were attributed to injecting drug use (Table  5, Table 8, Fig. 1.5). Injecting drug use was the probable route of transmission for one quarter or more of the cases reported in Lithuania (62%), Iceland (33%) and Latvia (33%) (Fig. 1.5). • Of the remainder, 136 diagnoses (less than 1%) were reported as being due to vertical transmission during pregnancy, childbirth or breastfeeding (Table 7); 82 of these cases (60%) were born outside of the coun- try in which the case was later reported. Fifty-nine diagnoses were reported to be due to contaminated transfusion of blood and its products, and 10 to hospital-acquired infections (Table 8). Nearly all of these nosocomial and transfusion-related cases were reported to have been acquired outside of the country where the case was reported (Table 12a). • Transmission mode was reported as unknown for 6123 diagnoses (24%), with wide variation among countries: less than 5% of diagnoses were reported as unknown in Bulgaria, Croatia, Cyprus, the Czech Republic, Norway, Portugal and Romania, and over 60% in Iceland and Poland (Table 8). Young people aged 15 to 24 years comprised 12% of the EU/EEA population and 12% of HIV diagnoses in 2017. Romania and Hungary reported more than 15% of their HIV diagnoses in this age group (Fig. 1.4). Thirty-nine Fig. 1.2. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2017 (n = 25 210) 0 5 10 15 20 25 50+40–4930–3925–2920–2415–19 < 15 Men Women N ew H IV d ia gn os es p er 1 00 0 00 p op ul at io n Age category (years) Fig. 1.3. New HIV diagnoses, by age group (in years) and transmission mode, EU/EEA, 2017 0 20 40 60 80 100 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years 50+ years Injecting drug use n = 928 Heterosexual contact n = 8397 Sex between men n = 9691 Percentage Tr an sm is si on m od e 25 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT per cent of the EU/EEA population is considered to consist of older adults (50 years and above), who con- tributed 19% of new HIV diagnoses reported in 2017. In the Netherlands, Portugal and Slovenia, older adults comprised more than 25% of those newly diagnosed with HIV (Table 9). Twenty-eight EU/EEA countries provided information on the country of birth, country of nationality or region of origin for 21 184 (84%) HIV diagnoses in 2017 (Fig. 1.6). In the EU/EEA, 8711 diagnoses (41% of those with known information on region of origin) were made among peo- ple originating from outside of the reporting country. Of these, 3723 (18% of those with known information on region of origin), irrespective of transmission mode, were among people originating from countries with gen- eralized HIV epidemics (Fig. 1.6, Table 11). An additional 23% of new diagnoses with known region of origin (4988 cases) were among people born outside of the reporting country, but did not originate from a country experienc- ing a generalized epidemic, including 8% from countries in Latin America and the Caribbean (1709 cases), 6% from other countries in central and eastern Europe (1310 cases) and 4% from other countries in western Europe (828 cases). Countries with at least half of their new HIV diagnoses among people originating from outside of the reporting country were Belgium, Denmark, Cyprus, Finland, France, Iceland, Ireland, Luxembourg, Malta, Norway, Sweden and the United Kingdom. About 4% of people diagnosed with HIV in the EU/EEA in 2017 were reported to have been previously diag- nosed with HIV in another country prior to their 2017 diagnosis in the reporting country (data not shown). The proportion of 2017 diagnoses that had previously been diagnosed was higher than the EU/EEA average in some countries, including Cyprus (29%), the Czech Republic (13%), Denmark (41%), Iceland (29%), Ireland (34%), France (7%), Malta (33%), Norway (24%) and Sweden (34%). Information on CD4 cell count at the time of HIV diag- nosis was provided by 25 countries (Table 14) for 16 585 (72%) adults and adolescents diagnosed in those countries. All countries reporting such data were able to provide CD4 cell counts for 50% or more of their reported cases, apart from Estonia, Lithuania and France, which provided data for 36%, 40% and 45% of new diagnoses, respectively. Nearly half (49%) of all cases with a CD4 cell count available were considered to have been diag- nosed several years after being infected, with a count of below 350 cells per mm3, including 28% of cases considered to have advanced HIV infection (CD4 < 200 cells/mm3). The proportion of those diagnosed late, with a CD4 count below 350 cells per mm3, was above 60% Fig. 1.4. Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2017 (n = 25 255) Note: Germany did not report data for 2017, and no cases were reported by Liechtenstein. 0 20 40 60 80 100 Romania Iceland Cyprus Czech Republic Hungary Poland Ireland Bulgaria Netherlands Spain Sweden United Kingdom EU/EEA Italy Slovakia Austria Denmark France Estonia Croatia Portugal Norway Belgium Slovenia Latvia Greece Lithuania Luxembourg Finland Malta 15–19 years < 15 years 20–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Percentage 26 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Fig. 1.5. Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2017 (n = 19 230) 0 20 40 60 80 100 Lithuania Latvia Estonia Romania Luxembourg Finland Sweden Portugal Norway Italy Iceland France Belgium Bulgaria EU/EEA Denmark United Kingdom Greece Cyprus Malta Ireland Spain Austria Poland Slovenia Czech Republic Netherlands Slovakia Hungary Croatia Heterosexual contact (males) Sex between men Heterosexual contact (females) Injecting drug use Other Percentage Note: Germany did not report data for 2017, and no cases were reported by Liechtenstein; unknown route of transmission is excluded from proportions presented here. Fig. 1.6. Percentage of new HIV diagnoses among migrants out of all reported cases with known information on region of origin, by country of report, EU/EEA, 2017 (n = 21 184) Romania Latvia Poland Bulgaria Lithuania Slovenia Slovakia Estonia Croatia Greece Czech Republic Portugal Italy Spain Netherlands EU/EEA Austria Finland Denmark France United Kingdom Belgium Cyprus Iceland Norway Malta Ireland Luxembourg Sweden 0 20 40 60 80 100 Percentage Central and eastern Europe Sub-Saharan Africa Western Europe Latin America and Caribbean South and south-east Asia Other Note: Germany did not report data for 2017, and no cases were reported among people born abroad in Hungary and Liechtenstein. 27 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT among cases with known CD4 cell count at diagnosis in Lithuania (66%) and Latvia (62%). Among all cases diagnosed where a CD4 cell count was available, 20% (3349) had a CD4 cell count of between 350 and 500 cells per mm3 and 32% (5277) of above 500 cells per mm3 (data not shown), indicating more recent infection. When analysing CD4 cell count by transmission mode, higher proportions of people presenting at a later stage of HIV infection (CD4 < 350 cells/mm3) were observed among women (52%), older adults (56% in 40–49-year- olds and 63% in people over 50), men and women infected by heterosexual sex (63% and 53%, respectively), people who acquired HIV through injecting drug use (52%), and migrants from south and south-east Asia (53%) and sub- Saharan Africa (56%) (Fig. 1.7, Table 14). The lowest proportions of late diagnosis, indicated by CD4 counts below 350 cells per mm3 at diagnosis, were observed among younger age groups (33% of 15–19-year-olds and 32% of those aged 20–24 years), men who acquired HIV through sex with another man (37%) and migrants from other western European coun- tries (34%). CD4 count and date were used as a proxy for linkage to care and, among cases where CD4 data were reported and it was possible to calculate linkage to care, 92% of those diagnosed in 2017 were linked to care within three months of HIV diagnosis. Trends in HIV diagnoses The trend in reported HIV diagnoses for the period 2008–2017 has declined slightly in recent years. Rates in the earlier part of this period were 6.9 per 100  000, decreasing slightly to 6.5 in more recent years, and 6.2 in 2017 (27 055 cases when adjusted for reporting delay; see: Table 1, Fig. 1.8, and Annexes 1 (for reporting delay adjustment methods), 5 (for country comments) and 6 (results)). While the overall EU/EEA trend appears to have declined slightly during the last decade, trends at national level are contrasting. Several countries, including Austria, Belgium, Denmark, Estonia, the Netherlands, Norway, Spain and the United Kingdom, have reported a decline in rates of new diagnoses, even after adjust- ing for reporting delay. Conversely, since 2008, and taking reporting delay into account, rates of HIV diag- noses have more than doubled in Bulgaria, Cyprus and Lithuania, and have increased by over 50% in the Czech Republic, Hungary, Malta and Poland (Table 1, Annex 6). Reporting delay affects some countries more than others: decreases in the rates of new HIV diagnoses may therefore be overestimated and increases in rates underestimated. Fig. 1.7. Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2017 0 10 20 30 40 50 60 70 Sub-Saharan Africa South and south-east Asia Latin America and Caribbean Central and eastern Europe Western Europe Native to reporting country Sex between men Injecting drug use Heterosexual women Heterosexual men 50+ 40–49 30–39 25–29 20–24 15–19 Women Men Total Percentage Ge nd er Ag e gr ou p (y ea rs ) Tr an sm is si on Re gi on o f o rig in Note: cases with unknown CD4 count are excluded from proportions presented here. 28 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Trends differ by gender and age group. Age-specific rates have declined since 2008 in all age groups except for adults over 50 years, with rates among 25–29-year- olds and 30–39-year-olds consistently higher than other groups throughout the period in both women and men. Age-specific rates in women have declined more markedly in women under 40 years, while rates among women 40 years and older have been stable. Among men, rates among 20–29-year-olds peaked in 2015 and have declined since. Rates in men aged 30–49 years have declined during the period. Rates in males aged 15–19 years and men over 50 have remained stable (Fig. 1.9a, 1.9b). The median age at HIV diagnosis increased from 35 years in 2008 to 37 years in 2017 overall (from 33 to 37 years among women and 36 to 37 in men). A larger proportion of diagnoses is being reported in older age groups; 13% of people diagnosed in 2008 were over 50 years at HIV diagnosis, rising to 19% in 2017. In women, 11% of diag- noses in 2007 and 19% in 2017 were made in those aged 50 years or above, while in men, 14% of diagnoses in 2008 and 19% in 2017 were made in men of 50 or above (data not shown). HIV diagnoses among people born outside of the report- ing country comprised 44% of all new diagnoses in 2008, decreasing slightly to 37% in 2013 and increasing to 41% in 2017 (Fig. 1.10). New diagnoses among people originating from sub-Saharan Africa decreased from 24% of all new diagnoses in 2008 to 18% in 2017, while new diagnoses among people originating from other countries in central and eastern Europe increased from 4% to 6% of all new diagnoses. The proportion of people originating from other regions has remained stable. Since 2008, most EU/EEA countries have consistently reported data on transmission mode. Data from Estonia and Poland were excluded from EU/EEA presentation of trends (Fig. 1.11a, 1.11b, 1.12), as more than 50% of the data on transmission mode were missing. Data from Spain and Italy were also excluded because coverage by the surveillance system has been gradually expand- ing on a national basis over the last decade. Germany did not report data for 2017. Data on transmission mode Fig. 1.9a. Age-specific trends in new HIV diagnoses in men, 2008–2017 0 5 10 15 20 2017201620152014201320122011201020092008 Ne w d ia gn os es p er 10 0 00 0 po pu la tio n Year of diagnosis 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Fig. 1.8. People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2008–2017 HIV AIDS AIDS-related death Ne w H IV d ia gn os es p er 10 0 00 0 po pu la tio n Year of diagnosis 0 1 2 3 4 5 6 7 8 2017201620152014201320122011201020092008 Note: rates exclude countries not reporting consistently over the period: Belgium and Sweden (AIDS and AIDS-deaths), Italy (AIDS deaths) and Germany (AIDS, AIDS deaths and HIV). 29 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Fig. 1.9b. Age-specific trends in new HIV diagnoses in women, 2008–2017 0 3 6 9 12 15 2017201620152014201320122011201020092008 Ne w d ia gn os es p er 10 0 00 0 po pu la tio n Year of diagnosis 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Fig. 1.10. Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2008–2017 0 10 20 30 40 50 2017201620152014201320122011201020092008 Pe rc en ta ge Year of diagnosis Western Europe Sub-Saharan Africa Central and Eastern Europe Latin America and Caribbean South and Southeast Asia Other Note: data from 27 EU/EEA countries included. HIV diagnoses reported by Estonia and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Italy and Spain excluded due to increasing national coverage during the period Fig. 1.11a. HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA, 2008–2017 0 2000 4000 6000 8000 10 000 2017201620152014201320122011201020092008 N um be r o f H IV d ia gn os es Year of diagnosis Heterosexual (men) Sex between men Heterosexual (women) Injecting drug use Vertical transmission Other/undetermined Note: data from 26 EU/EEA countries included. HIV diagnoses reported by Estonia and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Germany, Italy and Spain excluded due to incomplete reporting during a portion of the period. 30 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Fig. 1.12. New HIV diagnoses, by year of diagnosis, transmission and migration status, EU/EEA, 2008–2017 0 1000 2000 3000 4000 5000 6000 7000 2017201620152014201320122011201020092008 Sex between men (born in reporting country) Sex between men (foreign-born) Heterosexual (born in reporting country) Heterosexual (foreign-born) Injecting drug use (born in reporting country) Injecting drug use (foreign-born) Nu m be r o f H IV d ia gn os es Year of diagnosis Note: data from 26 EU/EEA countries included. HIV diagnoses reported by Estonia and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Germany, Italy and Spain excluded due to incomplete reporting during a portion of the period. Fig. 1.11b. Percentage of HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/ EEA, 2008–2017 0 20 40 60 80 100 2017201620152014201320122011201020092008 Pe rc en ta ge Year of diagnosis Heterosexual (men) Sex between men Heterosexual (women) Injecting drug use Vertical transmission Other/undetermined Note: data from 26 EU/EEA countries included. HIV diagnoses reported by Estonia and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Germany, Italy and Spain excluded due to incomplete reporting during a portion of the period. from those countries consistently reporting indicate the trends below. • The proportion of all HIV diagnoses attributed to sex between men increased from 34% of cases in 2008 to 41% in 2014 and 2015, then decreased to 37% in 2017. The number of HIV diagnoses reported among MSM in countries reporting consistently increased from 7369 cases in 2008 and peaked at 8297 in 2013. Although fewer cases were reported in 2017 (6294), reporting delay probably plays a partial role in this decline. Most of the decline appears to be due to fewer diagno- ses among MSM in Belgium, Greece, the Netherlands, Spain and the United Kingdom. Increases were observed in many EU/EEA countries between 2008 and 2017 (Table 4), with substantial increases noted in Bulgaria, Cyprus, Ireland, Malta, Poland and Romania in recent years. Cases attributed to MSM born outside of the reporting country increased over the period, declining slightly between 2015 and 2017 but not to the same extent as observed in EU/EEA-native MSM (Fig. 1.12). • The number of heterosexually acquired cases decreased steadily in women, from 5638 in 2008 to 2949 in 2017, and in men, from 4577 to 2747 during the same period (Fig. 1.11a). The proportion of all HIV diagnoses attributed to heterosexually acquired infec- tion in women decreased from 26% of cases in 2008 to 17% in 2017, and to heterosexually acquired infec- tion in men from 21% to 16% over the same period (Fig. 1.11b). The number of cases among women and foreign-born heterosexuals between 2008 and 2017 decreased at a greater rate than cases among men and non-foreign-born people (Fig. 1.11a, 1.12). The decline in foreign-born cases is mainly due to sharp decreases among migrants originating from countries with gen- eralized HIV epidemics (6291 in 2008 and 3723 in 2017). Despite the overall decline in heterosexually 31 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT acquired cases during this period, new diagnoses in Estonia and Lithuania increased substantially. • The number of HIV diagnoses reported among peo- ple who inject drugs has also declined since 2007 (from 1091 cases to 689) in both foreign-born and non-foreign-born people (Fig. 1.11a, 1.12). A tempo- rary increase in overall numbers for the EU/EEA was observed in 2011 and 2012 due to localized outbreaks reported in Greece and Romania, but the overall down- ward trend in the number of reported cases continued for the EU/EEA in 2017 (Table 5). Although diagnoses attributed to injecting drug use nearly tripled between 2015 and 2017 in Lithuania, other countries, such as Austria, Belgium, Estonia, France, Italy, Portugal and Spain, have seen a sharp decrease in the rate of HIV diagnoses due to injecting drug use over the last decade. • The number of diagnoses reported to be due to verti- cal transmission of HIV decreased from 258 in 2008 to 115 in 2017 (Fig. 1.11a). Throughout the period, between two thirds and three quarters of these cases originated from outside the reporting country. • The number of HIV diagnoses reported to be due to nosocomial infection has remained stable over the period, with 12 cases in 2008 and nine in 2017. The number of cases reported to be due to contaminated transfusion of blood and its products decreased from 78 in 2008 to 48 in 2017. A large and growing pro- portion of these cases was among people who had migrated to the EU/EEA and were later diagnosed in the reporting country (50% in 2008 to 77% in 2017 among nosocomial cases, and 78% in 2008 to 86% in 2017 among transfusion-related cases). • The number of cases with an unknown mode of trans- mission increased from 2848 in 2008 to 4178 in 2017 (13% of cases in 2008 and 24% in 2017). This increase is affected by reporting delay and will probably decrease slightly in future reporting. • Reporting delays differ significantly among trans- mission categories for some countries. When standardized adjustments for reporting delay are introduced, they increase the number of reported HIV cases in all transmission categories by between 8% and 19%, depending on the category. Fig. 1.9a, 1.11a and 1.12 show these adjusted trends. • While many people are still diagnosed late, several years after being infected with HIV, the median CD4 cell count at HIV diagnosis has increased significantly over the past decade, from 330 (95% CI: 322–338) cells/mm3 in 2008 to 391 (95% CI: 381–400) cells/ mm3 in 2017. The group with the highest median CD4 cell count at diagnosis is MSM, with 452 cells/mm3 in 2017. This has also improved over the last dec- ade, however, indicating earlier diagnosis (Fig. 1.13). Median CD4 count at diagnosis was lower in cases attributed to heterosexual transmission but similarly increased over the period (from 290 cells/mm3 in 2008 to 347 cells/mm3 in 2017 in women, and 239 cells/mm3 in 2008 to 278 cells/mm3 in 2017 in men). AIDS cases, morbidity and mortality Despite improvements in early diagnosis of HIV, 3130 diagnoses of AIDS were reported by 28 EU/EEA coun- tries12 in 2017, giving a rate of 0.7 cases per 100  000 population (Table 15). The highest rate was reported by Latvia (6.0 per 100 000 population; 118 cases). Overall, 89% of AIDS diagnoses were made within 90 days of the HIV diagnosis. The only group where more than half of AIDS cases (59%) occurred after the immediate HIV diagnosis was among people whose HIV infection was attributed to injecting drug use (Fig. 1.14). 12 This included all EU/EEA countries except Belgium, Germany and Sweden. Fig. 1.13. Median CD4 cell count per mm3 at HIV diagnosis, by year of diagnosis and transmission group, EU/EEA, 2008–2017 0 100 200 300 400 500 2017201620152014201320122011201020092008 CD 4 ce ll co un t/ m m 3 a t d ia gn os is Year of diagnosis Heterosexual (men) Sex between men Heterosexual (women) Injecting drug use Overall Note: excludes countries with > 60% incomplete data on CD4 cell count during any year over the period (Bulgaria, Croatia, Estonia, Germany, Hungary, Italy, Ireland, Latvia, Lithuania, Malta, Norway, Poland, Portugal and Sweden). Acute infections are excluded from this analysis. 32 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data The rate of reported AIDS cases has halved in the last decade, from 1.6 per 100  000 reported in 2008 (Fig. 1.8). This decline is noted in men and women and in all transmission groups, but appears greatest among cases attributed to heterosexual transmission and injecting drug use (Tables 16–22, Fig. 1.15). Despite the general EU/EEA-wide decline, an increase has been reported in the rate of AIDS diagnoses since 2008 in Bulgaria, the Czech Republic and Hungary. The most common AIDS-indicative diseases diagnosed in 2017 in the EU/EEA were Pneumocystis pneumonia (21%), pulmonary and/or extrapulmonary TB (14%), wasting syndrome due to HIV (11%) and oesophageal candidiasis (10%) (Table 23). Seventeen countries reported TB (pulmonary and/or extrapulmonary) as an AIDS-defining illness in people newly diagnosed with AIDS in 2017. Fourteen per cent of people diagnosed with AIDS in these countries presented with TB as an AIDS- defining illness, ranging from 6% of cases in Finland to more than 35% in Romania (Fig. 1.16). Twenty-seven EU/EEA countries (all but Belgium, Germany, Italy and Sweden, which did not report consist- ently over the period) reported data on deaths of people diagnosed with AIDS. Overall, 772 were reported to have died due to AIDS-related causes during 2017 (Table 24), although these data are affected by underreport- ing due to the challenges in many countries in linking to death registries. Nevertheless, AIDS-related death reports have consistently been decreasing since 2008, when 2147 deaths were reported in countries reporting consistently over time, although delays in reporting and underreporting may affect the latest figures (Table 25, Fig. 1.8). From the beginning of the HIV epidemic to the end of 2017, the cumulative total of people diagnosed with AIDS in the EU/EEA is 358 722 (Table 15). The cumu- lative total of cases reported as known to have died due to AIDS-related causes by the end of 2017 was 188 638 (Table 24). HIV testing Fourteen countries reported data on HIV tests performed, excluding unlinked anonymous testing and testing of Fig. 1.15. AIDS diagnoses, by transmission mode, EU/EEA, 2008–2017 0 400 800 1200 1600 2000 2017201620152014201320122011201020092008 Nu m be r o f A ID S di ag no se s Year of diagnosis Heterosexual transmission (men) Sex between men Heterosexual transmission (women) Injecting drug use Other/undetermined Note: data from Germany, Belgium and Sweden excluded due to inconsistent reporting during the period. Fig. 1.14. Percentage of AIDS diagnoses within 90 days of HIV diagnosis, EU/EEA, 2017 (n = 1671) 0 20 40 60 80 100 Injecting drug use Heterosexual transmission (females) Heterosexual transmission (males) Sex between men Percentage AIDS diagnosis within 90 days of HIV diagnosis AIDS diagnosis > 90 days after HIV diagnosis 33 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT blood donations. The number of tests increased by 12% in countries reporting consistently since 2008 (Table 26). Changes in overall testing activity do not appear to explain the decrease in cases reported, par- ticularly among MSM, in some European countries. It is important to note that numbers provided are collected in a heterogeneous manner and comparison between country rates should be undertaken with caution, but the numbers can provide an indication of large changes in overall testing policy or provision to support the inter- pretation of HIV cases notified. Conclusions HIV surveillance data for 2017 contribute to demonstrat- ing important changes in the epidemiology of HIV in EU/EEA countries over the past decade. Rates of AIDS and AIDS-related deaths in the EU/EEA as a whole have decreased significantly over the past decade, reflecting greater access to treatment and better case manage- ment, and sustained progress towards the SDG of ending the AIDS epidemic and decreasing AIDS-related deaths. There is a clear decline in the rate of new HIV diagno- ses per 100 000 population, with an adjusted rate of 6.2 reported in 2017. While the notification rate is lower than in previous years, it is expected to be revised upwards in future reporting cycles due to reporting delay, which is common for HIV generally and for certain countries in the EU/EEA in particular. Despite the evidence of some progress in reducing the number of new HIV diagnoses in the EU/EEA overall, rates continue to increase in about one third of EU/EEA countries. There appears to be evidence of a true decrease in HIV diagnoses among MSM in select EU/EEA countries that seems to be driving the overall decline observed in the EU/EEA. This is significant because MSM still account for the largest number of new HIV diagnoses in the EU/EEA; until recently, this was the only population in the EU/EEA in which HIV cases were increasing during most of the last decade. The decline at EU/EEA level is driven by sub- stantial declines in specific EU/EEA countries – Austria, Belgium, Denmark, Estonia, the Netherlands, Norway, Spain and the United Kingdom. Reasons for the decrease may include successful programmes to offer more frequent and targeted HIV testing to promote earlier diag- nosis, rapid linkage to care and immediate initiation of ART for those found to be positive, which results in higher rates of viral suppression and a decline in HIV incidence (1,2). A trend toward earlier diagnosis is evident in the mean CD4 count data at diagnosis, which has increased significantly over the last decade in all people diagnosed, including MSM; this indicates improvements in case ascertainment, which could be a result of more effective testing policies. In addition to more frequent testing and linkage to care, the use of formal and informal PrEP may also have played a role in the decline of HIV diagnoses observed in at least some of these settings (2,3). Fig. 1.16. Percentage of people diagnosed with AIDS with TB as an AIDS-defining illness, EU/EEA, 2017 (n = 2825) 0 5 10 15 20 25 30 35 40 Finland United Kingdom Denmark Netherlands Italy Ireland Portugal Austria Czech Republic EU/EEA Poland Lithuania Norway France Bulgaria Spain Latvia Romania Percentage Note: countries that did not report AIDS (Belgium, Germany and Sweden) or reported no cases of TB as an AIDS-defining illness (Croatia, Cyprus, Estonia, Greece, Hungary, Iceland, Ireland, Luxembourg, Norway, Slovakia and Slovenia) are excluded. 34 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data The positive trend described above is countered, however, by the prevailing situation in other EU/EEA countries where HIV continues to increase among MSM. Substantial increases have been reported in Bulgaria, Cyprus, Ireland, Malta, Poland and Romania in recent years. Overall in the EU/EEA and even in some settings with declines in rates among MSM, new HIV diagnoses in migrant MSM have not declined at the same rate as those who are not foreign-born. There is an urgent need for significant scaling up of more effective combination- prevention programmes for this at-risk population. This includes promoting the uptake of regular, easy-to-access HIV testing, accompanied by immediate linkage to care and treatment for those found positive, and condoms, peer support and possible PrEP for some populations of high-risk HIV-negative men (4). The substantial decrease in the number of HIV infections transmitted through heterosexual contact, particularly among women, represents an important epidemiologi- cal trend observed over the past decade. Heterosexual transmission nevertheless remains the second most common mode of HIV transmission reported in the EU/EEA and is the most common transmission mode in some countries. Part of the declining trend in het- erosexual cases is probably influenced by the decline (since 2008) in the number of heterosexually acquired cases in migrants originating from countries with gener- alized HIV epidemics (5). Migrants (or people originating from outside of the reporting country) again constituted a considerable proportion (41%) of new HIV diagno- ses in the EU/EEA in 2017. It is important to recognize the emerging evidence that a significant proportion of migrants, even those originating from high HIV-endemic areas, acquire HIV after arrival in the EU/EEA (6–8). This indicates the need for targeted prevention directed at this vulnerable group from the moment of their arrival. Despite the overall declines, heterosexual transmission increased substantially in Estonia and Lithuania. Transmission among people who inject drugs con- tinues to decline and remains at a low level in most EU/EEA countries, thanks to well-established harm- reduction programmes throughout most of the Region, but sudden increases have been observed since 2016 in Lithuania. Outbreaks have been observed in recent years in Romania and Greece — countries with previ- ously very low levels of HIV among people who inject drugs (9,10) — and, more recently, localized outbreaks have been reported in Ireland, Luxembourg and United Kingdom (Scotland) (11–13). This reinforces the impor- tance of maintaining adequate scale and coverage of harm-reduction services and recognizing that trends can change quickly in this at-risk group in the absence of effective prevention delivered at scale (14). It is estimated that 120  000 people were living with undiagnosed HIV in the EU/EEA in 2015, implying that about 15% of those living with HIV are not aware of their status (15). Estimates also indicate that it takes 2.9 years from HIV infection to diagnosis in the EU/EEA, with variation by geographical area within the EU from 2.2 to 3.6 years (16). In addition to the clinical and personal benefits for the person diagnosed, early diagnosis and treatment can also benefit sexual and injecting partners by inhibiting onward HIV transmission. Nearly half of those diagnosed (49%) have a CD4 cell count of below 350 cells per mm3 at diagnosis, including 28% of cases with advanced HIV infection (CD4 < 200 cells/mm3), indicating the need to improve testing programmes to diagnose people living with HIV at an earlier stage. This is a clear indication that they were infected many years previously and suggests problems with access to, and uptake of, HIV testing for those most at risk in these countries. One of the subgroups to emerge with the highest rate of late diagnosis is older adults (people aged over 50 years), particularly older men reported as hav- ing acquired HIV heterosexually. The trend during the last decade has been towards increasing median age at HIV diagnosis, particularly among women. In 2017, nearly one in five new HIV diagnoses was of a person over 50 years. This may be the result of stigma, or low or inaccurate risk perception among older adults or the health-care providers who serve them (17). To address the high proportion of people diagnosed late, it is essential to diversify HIV testing through augment- ing routine testing for health conditions associated with HIV (indicator condition-guided testing), increasing HIV testing during screening for other sexually transmitted infections, and continuing to expand community-based testing, self-testing/home-sampling and partner noti- fication. New European guidance on setting-based approaches for HIV and viral hepatitis testing, including best practices for effective implementation, can help countries seeking to implement more effective testing programmes (18). Testing provides not only a gateway to HIV treatment for people found to be positive, but can also serve as an entry point for high-risk HIV-negative people to effective prevention, including PrEP. Despite clear evidence of the benefits of introducing ART early for the health of HIV-positive people (19,20) and the fact that this should serve as an incentive for people to know their HIV status, many continue to be diagnosed with HIV years after becoming infected and having reached an advanced stage of illness. Overall, 89% of AIDS diagnoses were made within 90 days of the HIV diagnosis, indicating that most AIDS cases in the EU/EEA are due to late diagnosis of HIV infection. The only group where half of AIDS cases occurred after the immediate HIV diagnosis was among people whose HIV infection was attributed to injecting drug use, possibly indicating that AIDS diagnoses in this group are associ- ated with lack of engagement with effective ART. Once tested, rapid linkage to high-quality care (includ- ing ART) is essential. Ninety-two per cent of people diagnosed in 2017 who had evidence of linkage to care were linked to care within three months of HIV diag- nosis. Timely linkage to care following HIV diagnosis is crucial, as delayed access can result in poor patient outcomes (21). Once linked to care, there is evidence that high proportions of people diagnosed with HIV in 35 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT the EU/EEA have access to ART and achieve viral sup- pression (22). Recent years have seen a worrying trend of reduced data completeness on the HIV transmission route, with about one quarter of cases reported in 2017 lacking this important information. While this proportion may have been affected by the earlier reporting deadline and by reporting changes in several countries that have tempo- rarily affected data completeness, the trend has been evident in recent years. Information on probable route of transmission is crucial to better inform HIV prevention interventions and programme planning. Greater efforts to improve collaboration with clinicians and follow up with other data providers may improve the transmission data. Meanwhile, statistical adjustments for missing data are being explored (23). The changing epidemiology of HIV infections observed in the EU/EEA over the last decade suggests that some progress has been achieved, particularly on reducing infections attributed to heterosexual transmission and injecting drug use and, more recently, the decline of HIV resulting from sex between men in some EU/EEA countries. These epidemiological trends also indicate, however, that it is crucial to sustain, and in some places strengthen, evidence-based HIV prevention interven- tions tailored to the local epidemiological context and targeting those most at risk. Programmes on the prevention and control of HIV infec- tion adapted to key populations and maintained to scale remain important in EU/EEA countries. For most EU/EEA countries, this means a strong focus on MSM, including intra-European and other migrant MSM. Other migrants, both those from countries with generalized HIV epidem- ics and others, are also a key vulnerable population that needs specific prevention and control efforts in most EU/EEA countries. Given the increasing evidence of post-migration HIV acquisition, it is important that migrant-sensitive services for prevention and HIV test- ing, combined with policies that promote and ensure linkage and access to care, are delivered in all EU/EEA countries. Harm-reduction programmes among people who inject drugs and their sexual partners are crucial and should be maintained and scaled up where service coverage is low, particularly when patterns of drug use change. Finally, strengthening the offer and effectiveness of HIV testing programmes to increase the frequency of testing in high-risk individuals will help to decrease late diagno- sis and, ultimately, the proportion of people living with undiagnosed HIV in the EU/EEA. References 1. Brown AE,  Mohammed H,  Ogaz D,  Kirwan PD,  Yung M,  Nash SG et al. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveill.  2017;22(25):pii=30553 (http://www.eurosurveillance.org/ content/10.2807/1560-7917.ES.2017.22.25.30553). 2. Nwokolo N, Whitlock G, MacOwan A. Not just PrEP: other reasons for London’s HIV decline. Lancet HIV 2017;4(4):e153 (http://www. thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30044-9/ fulltext). 3. Evidence brief: pre-exposure prophylaxis for HIV prevention in Europe. Stockholm: ECDC; 2016 (https://ecdc.europa.eu/sites/por- tal/files/media/en/publications/Publications/pre-exposure-proph- ylaxis-hiv-prevention-europe.pdf). 4. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014 (http://ecdc.europa.eu/en/pub- lications/Publications/hiv-sti-prevention-among-men-who-have- sex-with-men-guidance.pdf). 5. Hernando V, Alvarez-del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T et al. HIV infection in migrant populations in the European Union and European Economic Area in 2007–2012: an epidemic on the move. J Acquir Immune Defic Syndr.  2016;70(2):204–11. 6. Rice BD, Elford J, Yin Z, Delpech VC. A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV. AIDS 2012;26(15):1961–6. 7. Fakoya I, Alvarez-del Arco D, Woode-Owusu M, Monge S, Rivero- Montesdeoca Y, Delpech V et al. A systematic review of post- migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: implications for effec- tively managing HIV prevention programmes and policy. BMC Public Health 2016;15:561 (http://www.biomedcentral.com/content/pdf/ s12889-015-1852-9.pdf). 8. Fakoya I, Alvarez-Del Arco D, Monge S, Copas AJ, Gennotte A-F et al. HIV testing history and access to treatment among migrants living with HIV in Europe. J Int AIDS Soc. 2018;21(Suppl. 4):e25123 (https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.25123). 9. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L et al. Human immunodeficiency virus among people who inject drugs: is risk increasing in Europe? Euro Surveill. 2013;18(48):pii=20648 (http://www.eurosurveillance.org/ ViewArticle.aspx?ArticleId=20648). 10. Paraskevis D, Nikolopoulos G, Tsiara C, Paraskeva D, Antoniadou A, Lazanas M et al. HIV-1 outbreak among injecting drug users in Greece, 2011: a preliminary report. Euro Surveill. 2011;16(36):pii=19962 (http://www.eurosurveillance.org/ ViewArticle.aspx?ArticleId=19962). 11. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow asso- ciated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2016. Euro Surveill. 2016;20(40):pii=30036. doi:http://dx.doi.org/10.2807/1560-7917. ES.2016.20.40.30036. 12. Public Health England, Health Protection Scotland, Public Health Wales, Public Health Agency Northern Ireland. Shooting up: infec- tions among people who inject drugs in the UK, 2016. London: Public Health England; 2017 (https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/567231/Shooting_ Up_2017_Update.pdf). 13. HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre for Drugs and Drug Addiction; 2018 (http://sante.public.lu/fr/ publications/h/hiv-joint-technical-mission/index.html). 14. ECDC, European Monitoring Centre for Drugs and Drug Addiction. Prevention of infections among people who inject drugs. Stockholm: ECDC; 2011 (http://ecdc.europa.eu/en/publications/ Publications/111012_Guidance_Infectious_diseases_IDU_brief. pdf). 15. Pharris A,  Quinten C,  Noori T,  Amato-Gauci AJ,  van Sighem A, the ECDC HIV/AIDS Surveillance and Dublin Declaration Monitoring Networks. Estimating HIV incidence and number of undiagnosed individuals living with HIV in the European Union/European Economic Area, 2015.  Euro Surveill.  2016;21(48):pii=30417 (http://www.eurosurveillance.org/content/10.2807/1560-7917. ES.2016.21.48.30417). 16. van Sighem A,  Pharris A,  Quinten C,  Noori T,  Amato-Gauci AJ, the ECDC HIV/AIDS Surveillance and Dublin Declaration Monitoring Networks. Reduction in undiagnosed HIV infection in the European Union/European Economic Area, 2012 to 2016.  Euro Surveill.  2017;22(48):pii=17-00771 (https://doi.org/10.2807/1560- 7917.ES.2017.22.48.17-00771). 17. Tavoschi L, Gomes Dias J, Pharris A, on behalf of the HIV Surveillance Network. New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004–15: an analysis of surveillance data. Lancet HIV 2017;4(11):e514–21. 18. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016:373(9):795–807. 19. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstr eam/10665/208825/1/9789241549684_eng.pdf?ua=1). 20. Public health guidance on HIV, hepatitis B and C testing in the EU/ EEA. Stockholm: ECDC; 2018 (https://ecdc.europa.eu/sites/por- tal/files/documents/HIV-hepatitis-B-and-C-testing-public-health- guidance.pdf). 21. Croxford S, Yin Z, Burns F, Copas A, Town K, Desai S et al. Linkage to HIV care following diagnosis in the WHO European Region: a systematic review and meta-analysis, 2006–2017. 36 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data PLoS One 2018;13(2):e0192403 (https://doi.org/10.1371/journal. pone.0192403). 22. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and central Asia: thematic report on the HIV continuum of care. Stockholm: ECDC; in press. 23. Rosinska M, Pantazis N, Janiec J, Pharris A, Amato-Gauci AJ, Quinten C et al. Potential adjustment methodology for missing data and reporting delay in the HIV Surveillance System, European Union/ European Economic Area, 2015.  Euro Surveill.  2018;23(23):pii=170 0359 (https://doi.org/10.2807/1560-7917.ES.2018.23.23.1700359). 37 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT 2. HIV and AIDS in the WHO European Region HIV and AIDS diagnoses in the WHO European Region HIV diagnoses In 2017, 159 420 people were newly diagnosed with HIV in the WHO European Region, corresponding to a rate of 20.0 per 100 000 population (Table A). This number includes 55 018 new diagnoses reported by 49 coun- tries13 to the joint ECDC and WHO Regional Office for Europe surveillance system and 104 402 cases from the Russian Federation  (1).14 It brings the cumulative number of reported HIV diagnoses in the Region since reporting began in the 1980s to 2 332 391 (1 174 313 peo- ple reported to ECDC and the WHO Regional Office for Europe (Table 1, Fig. B)15 and 1 220 659 from the Russian Federation16) (1). As in previous years, most (82%) of the 159 420 people newly diagnosed with HIV in 2017 were from the East of the Region (130 861), 14% from the West (22 354) and 4% from the Centre (6205). The rate was also highest in the East (51.1 per 100 000 population), eight times higher than in the West (6.9 per 100 000, adjusted for reporting delay; see Annex 1 for methods and Annex 6 for results) and 16 times higher than in the Centre (3.2 per 100 000) (Table  A). Two countries (the Russian Federation and Ukraine) continue to bear a large share of the burden in Europe, contributing 75% of newly diagnosed HIV infections in the Region and 92% in the East. In the 49 countries that provided data to ECDC/WHO,13 the 55 018 new diagnoses resulted in a rate of 8.4 per 100 000 population (not adjusted for reporting delay17) (Table 1), which is 9% higher than the 2016 rate reported in the 2017 HIV/AIDS surveillance in Europe report. In these 49 countries, 48% of new diagnoses (26 459) were reported in the East, with a rate of 23.6 per 100 000, 41% in the West and 11% in the Centre. For men, the rate was 11.9 per 100 000 population (Table 2) and for women it was 5.1 per 100 000 population (Table 3). 13 No data were received from Germany (no data export for 2017 due to technical problems), the Russian Federation, Turkmenistan or Uzbekistan. Liechtenstein is an EU Member State but not a WHO Member State, so its data are included in the totals for the EU/EEA but not for the WHO European Region. 14 The cited data source from the Russian Federation enabled the inclusion of Russian Federation data within the other countries’ reported data for the overall number, rate and trend of HIV diagnoses in the WHO European Region (see “HIV and AIDS diagnoses in the WHO European Region” (below)) and the East of the Region (see “HIV and AIDS diagnoses in the East” (below)). This allows a more complete presentation of the epidemiology of HIV in the WHO European Region. Other regional figures presented in this report (including those by age and gender) are based on data from the 49 countries that provided data to the joint ECDC/WHO European HIV surveillance system. 15 This does not include the 62 581 cases officially reported to ECDC/ WHO by the Russian Federation in 2010. 16 This is minus the 62 581 cases officially reported to ECDC/WHO by the Russian Federation in 2010. 17 When adjusting the 2017 rate to take into account reporting delay (which is common in some countries, particularly in the western part of the Region), it increases from 8.4 to 8.7 per 100 000 population (56 720 cases) (see Annex 1 for methods and Annex 6 for results). Rates of newly diagnosed HIV infections varied widely across countries in the WHO European Region in 2017. The highest rates per 100 000 population (> 15.0) were observed in the Russian Federation (71.1) (1) followed by Ukraine (37.0),18 Belarus (26.1), Republic of Moldova (20.6), Latvia (18.8), Estonia (16.6), Kazakhstan (16.6) and Georgia (16.1). The lowest rates (< 3.0) were reported by Bosnia and Herzegovina (0.3), Slovakia (1.3), Slovenia (1.9), Serbia (2.1), the former Yugoslav Republic of Macedonia (2.1), Hungary (2.3), the Czech Republic (2.4), Croatia (2.5) and Finland (2.9) (Table 1). The largest proportion of people newly diagnosed in the 49 reporting countries13 were in the age group 30–39 years (36%), while 9% were young people aged 15–24 years and 16% were 50 years or older at diagnosis (Table A, Table 9). The male-to-female ratio was 2.2, low- est in the East (1.6), higher in the West (2.9) and highest in the Centre (5.8). The highest male-to-female ratios (> 15.0) at country level among countries with more than 10 new cases were observed in Montenegro (25.0), Croatia (20.2), Slovenia (18.5) and Serbia (17.10), and the lowest (≤ 1.5) in the Republic of Moldova (1.3), Kyrgyzstan (1.4), Kazakhstan (1.5) and Ukraine (1.5) (see the “HIV diagnoses” section in Chapter 1 and “HIV diag- noses in the East” and “Trends in HIV diagnoses in the East” below). Men had higher age-specific rates than women in all age groups except among people under 15 years. The high- est age-specific rate of new HIV diagnoses was observed among 30–39-year-olds (21.2 per 100  000 population) – considerably higher among men (29.2 per 100 000 population) than among women (13.0 per 100 000 popu- lation) (Fig. 2.1). Data on transmission mode (Table  A, Tables  4–8, the Russian Federation not included) provide information about risk exposure among people newly diagnosed with HIV and indicate the following for 2017. • Heterosexual contact remained the main reported mode of HIV transmission in the WHO European Region, accounting for half (49%) of people newly diagnosed in 2017 (27 204) and 58% of new HIV diag- noses with a known mode of transmission (Table 6). Among those, 11% originated from countries with gen- eralized epidemics (data not shown). • Sex between men was the second most common transmission mode, accounting for 21% of new diag- noses overall (11 673) and 25% of new HIV diagnoses with a known mode of transmission (Table 4). 18 Without taking into account data from Crimea, Sevastopol city and parts of the non-government controlled areas of Ukraine; adjusting population denominator data to exclude Crimea and Sevastopol city; and excluding infants born to HIV-positive mothers whose HIV status is undetermined. 38 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data • Injecting drug use accounted for 13% of new diag- noses (7147) and 15% of new HIV diagnoses with a known mode of transmission (Table 5). • One per cent (0.7%, 397) was infected through mother-to-child transmission (0.9% of those with a known mode of transmission) (Table  7) and 0.2% (105) through other transmission routes (nosocomial infection, transfusion or use of other blood products) (Table 8). • Transmission mode was reported as unknown or missing for 15% (8492 cases) (Table  8). Reporting completeness regarding mode of transmission mode varies greatly across the Region, with information lacking for 3% of new diagnoses in the East, 41% in the Centre and 23% in the West. When combining data from the Russian Federation (see “HIV diagnoses in the East” below) within data reported by the other 49 countries for the WHO European Region, heterosexual transmission accounted for 56% of new diagnoses among people for whom the mode of HIV transmission was known, transmission through injecting drug use 30%, sex between men 14% and mother-to- child transmission 0.6%. Information about country of birth, country of national- ity or region of origin was provided by 46 countries for 54 791 people newly diagnosed in 2017. Among people with known origin (50 677), 19% (9753) originated from outside of the reporting country, including 14% (7032) from outside the WHO European Region and 5% (2721) from a European country other than the country of report (Table 11). Information about probable country of infection was reported by 37 countries for 30 201 people newly diag- nosed. Among people for whom the probable country of infection was known (19 599), 19% (3654) were infected abroad, including 6% in sub-Saharan Africa, 5% in central and eastern Europe, 3% in western Europe, 3% in south and south-east Asia and 2% in Latin America (Table 13). Forty countries provided information about CD4 cell count at the time of HIV diagnosis in 2017. Information was reported for 36 441 people over 14 years at diag- nosis (covering 66% of all new diagnoses and 77% of diagnoses in the 40 reporting countries) (Table  14). Just over half (53%) of people newly diagnosed were late presenters, with CD4 cell counts below 350 per mm3 blood at the time of HIV diagnosis, including 32% with advanced HIV infection (CD4 < 200/mm3). Twenty per cent had a CD4 cell count of between 350 and 500 cells per mm3 and 29% had a count above 500 per mm3 (data not shown). The percentage of people newly diag- nosed who were late presenters (CD4 < 350/mm3) varied across the Region and was highest in the East (57%), lower in the Centre (53%) and lowest in the West (48%). The countries with the highest percentages of late pre- senters (≥ 60%, in countries with more than five cases) were Kyrgyzstan (68%), Lithuania (66%), Serbia (66%), Tajikistan (63%), Latvia (62%), Montenegro (62%) and Romania (60%), and those with the lowest percent- ages (< 45%) were the Czech Republic (33%), the former Yugoslav Republic of Macedonia (38%), Cyprus (41%), the United Kingdom (41%) and Belgium (42%). The percentage of late presenters was higher than the regional average of 53% in 15 countries (seven in the East, five in the Centre and three in the West). The per- centage also varied across transmission categories and was highest for people with reported heterosexual trans- mission (58%, 62% for men and 54% for women) and through injecting drug use (55%), and lowest for men infected through sex with men (39%) (Table 14, Fig. 2.2, Fig. C). The percentage of people diagnosed at or below 350 CD4 cells per mm3 increased with age, ranging from 34% and 32% among people aged 15–19 and 20–24 years at diagnosis, respectively, to 66% among people aged 50 or above. By gender, overall, the percentage of late presenters was similar (52% for men and 54% for women), which is confounded by transmission mode and conceals, for men, the difference between MSM (who tend to get diagnosed earlier) and men with reported Fig. 2.1. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, WHO European Region, 2017 (n = 54 828) 0 5 10 15 20 25 30 50+40–4930–3925–2920–2415–19 < 15 Men Women Ne w H IV d ia gn os es p er 10 0 00 0 po pu la tio n Age category (years) Note: no data from Germany, Russian Federation, Turkmenistan and Uzbekistan. 39 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT heterosexual transmission (who tend to get diagnosed later) (Fig. C). Trends in HIV diagnoses The rate of newly diagnosed HIV infections in the WHO European Region19 increased by 37% for the period 2008–2017, from 14.6 per 100 000 population (107 385 cases) to 20.0 per 100 000 population (159 420 cases) (Fig.  2.3a). The increase is mainly driven by an upward trend in the East, where the rate increased by 68%, from 30.4 in 2008 (77 228 cases) to 51.1 in 2017 (130 861 cases). In the 49 countries that reported to ECDC and WHO,13 the regional rate decreased by a slight 5%, from 8.8 in 2008 (52 435 cases) to 8.4 in 2017 (55 018 cases) (not adjusted for reporting delay20) (Fig. 2.3b): in the East, the rate increased by 18%, from 20.0 (22 278 cases) to 23.6 (26 459 cases); in the Centre, by 129% – the largest rela- tive increase across the three geographical areas – from 1.4 (2627 cases) to 3.2 (6205 cases); and in the West, the rate decreased by 27%, from 9.4 (27 530 cases) to 6.9 (23 976 cases, adjusted for reporting delay21). Forty-four countries have consistently reported data on transmission mode for the period 2008–2017 (Fig.  2.4). Data from Estonia, Poland and Turkey were excluded because more than 50% of the data on trans- mission mode were missing for the period; data from Spain and Italy were excluded because coverage of the national surveillance system increased over this time period; and data from Germany, the Russian Federation, 19 No data were received from Turkmenistan and Uzbekistan; data from the Russian Federation were derived from the Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS (1–3). 20 When adjusting the 2017 regional rate for reporting delay, the trend for the decade remains stable at 8.8 in 2008 and 8.7 in 2017; see Annex 1 for methods and Annex 6 for results. 21 See Annex 1 for methods and Annex 6 for results (see also “HIV and AIDS diagnoses in the West” below and Fig. 2.3b). Turkmenistan and Uzbekistan were not consistently reported during the period. Data on transmission mode from the countries with consistent data indicate that: • the number of new diagnoses in people with reported heterosexual transmission increased by 13% in the Region, from 21 094 in 2008 to 23 735 in 2017, while the percentage of all new HIV diagnoses attributed to heterosexual contact increased from 47% of cases in 2008 to 54% in 2017; • the number of new diagnoses in people infected through sex between men decreased by 2%, from 7945 in 2008 to 7779 in 2017, and the percentage of all new HIV diagnoses attributed to sex between men remained stable at 18%; • the number of new diagnoses in people infected through injecting drug use decreased by 38%, from 11 034 in 2008 to 6893 in 2017, while the percentage of all HIV diagnoses attributed to injecting drug use decreased from 25% in 2008 to 16% in 2017; • the number of new diagnoses in children infected through mother-to-child transmission decreased by 47%, from 673 in 2008 to 360 in 2017, representing 1.4% of all new HIV diagnoses in 2008 and 0.8% in 2017; • of the new diagnoses in people infected by other means, nosocomial infections decreased by 76% from a peak of 98 cases in 2008, which was related to a localized outbreak in central Asia, to 24 in 2017 (with another peak of 104 cases in 2012); new diagnoses attributed to transfusion of blood and its products decreased by 34%, from 87 in 2008 to 57 in 2017; and • the number of new diagnoses for which information about transmission mode was unknown or missing increased by 39%, from 3672 in 2008 to 5086 in 2017 – representing 8% of all new HIV diagnoses in 2008 and 12% in 2017. Fig. 2.2. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2017 (n = 33 840) 0 20 40 60 80 100 Injecting drug use Heterosexual transmission Sex beween men < 200 cells/mm3 200 to < 350 cells/mm3 350 to < 500 cells/mm3 ≥ 500 cells/mm3 n = 8976 n = 20 638 n = 5226 Percentage Tr an sm is si on m od e Note: no data from Andorra, Belarus, Germany, Hungary, Iceland, Latvia, Monaco, Norway, Poland, Russian Federation, San Marino, Turkey, Turkmenistan and Uzbekistan. 40 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Fig. 2.3a. New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region,a 2008–2017 0 10 20 30 40 50 60 2017201620152014201320122011201020092008 West Centre East WHO European Region Ne w H IV d ia gn os es p er 10 0 00 0 po pu la tio n Year of diagnosis a In 50 countries (data from Germany, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period), data from the Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS (1–3). Fig. 2.3b. Rate of new HIV diagnoses, by year of diagnosis, WHO European Region,a 2008–2017 0 5 10 15 20 25 2017201620152014201320122011201020092008 West Centre East WHO European Region Ne w H IV d ia gn os es p er 10 0 00 0 po pu la tio n Year of diagnosis a In 49 reporting countries (no data from Russian Federation, and data from Germany, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period). AIDS cases, morbidity and mortality In 2017, 14 703 people in 47 countries of the WHO European Region22 were diagnosed with AIDS, which corresponds to a rate of 2.3 per 100 000 population (Table  15). Of the 14 703 people who had an AIDS diag- nosis in 2017, 78% (11 454) were diagnosed in the East, 17% (2426) in the West and 6% (823) in the Centre of the Region. The rate was also highest in the East (10.2 per 100 000 population), more than 10 times higher than in the West (0.7 per 100 000) and more than 20 times higher than in the Centre (0.4 per 100 000 population). At country level, the rate of new AIDS diagnoses varied widely, with the highest rates (≥ 3.0) reported in Ukraine (21.9), the Republic of Moldova (6.9), Georgia (6.6), Latvia (6.0), Armenia (4.9) and Belarus (4.6), and the 22 No data were available from Belgium, Germany, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. lowest rates (< 0.3) reported in Bosnia and Herzegovina (0.1), the former Yugoslav Republic of Macedonia (0.1), Turkey (0.1)23 and Slovakia (0.2). Andorra, Iceland, Malta, Monaco and San Marino reported zero cases. Twenty per cent of people diagnosed with AIDS pre- sented with TB as an AIDS-defining illness, ranging from 15% of cases in the West and 19% in the Centre to 26% in the East. The overall rate of new AIDS diagnoses in the Region increased between 2008 and 2017 by 10%, from 2.1 per 100 000 population (13 328 cases) to 2.3 per 100 000 (14 703 cases), in the 47 countries with consistent AIDS 23 AIDS data for Turkey only include people diagnosed with AIDS at the time of HIV diagnosis and are therefore not comparable with AIDS data from other countries. 41 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT data24 (Fig. 2.5). Since there are reporting delays in some countries, this decrease is expected to even out over the coming years. AIDS trends varied greatly across the three geographi- cal areas. In the East, the rate doubled, from 5.1 in 2008 to 10.2 in 2017. In the Centre, the rate remained stable at 0.4 per 100 000 population, while in the West, the steady downward trend continued, with a 67% decrease from 2.1 in 2008 to 0.7 in 2017 (Fig. 2.5). Information about AIDS-related deaths, or deaths among people previously diagnosed with AIDS for countries and years where cause of death (AIDS or non-AIDS related) was unknown or could not be reported, was provided by 24 Data from Belgium, Germany, the Russian Federation, Sweden, Turkmenistan and Uzbekistan are excluded or not available. 47 countries in the WHO European Region25 and included 4933 people who were reported to have died during 2017. This represented a 14% decrease compared with the 5718 deaths reported in the same countries in 2008. Of the 4933 deaths in 2017, 84% were reported from the East of the Region, 11% from the West and 5% from the Centre (Table  24). It is important to note that delays in reporting and underreporting have a significant impact on these numbers at European level, particularly when the death occurs long after HIV or AIDS diagnosis. The numbers presented here should therefore not be inter- preted as being representative of the true AIDS mortality burden in the European Region. According to a country survey from 2006, only about one third of countries in the WHO European Region were able to match their 25 No data were received from Italy, the Russian Federation, Sweden, Turkmenistan and Uzbekistan. Fig. 2.4. New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2008–2017 0 5000 10 000 15 000 20 000 25 000 30 000 2017201620152014201320122011201020092008 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined N um be r o f n ew H IV d ia gn os es Year of diagnosis Note: data from Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; data from Estonia, Poland and Turkey excluded due to incomplete reporting on transmission mode during the period; data from Italy and Spain excluded due to increasing coverage of national surveillance during the period. Fig. 2.5. AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2008–2017 0 2 4 6 8 10 12 2017201620152014201320122011201020092008 A ID S di ag no se s pe r 1 00 0 00 p op ul at io n Year of diagnosis West Centre East WHO European Region Note: data from Belgium, Russian Federation, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. 42 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data HIV/ AIDS registries with their national mortality or vital statistics registries (4). HIV and AIDS diagnoses in the East HIV diagnoses in the East In 2017, 130 861 people were newly diagnosed with HIV across 13 countries26 in the East of the WHO European Region, giving a rate of 51.1 per 100 000 population. This number includes 26 459 new diagnoses reported to the joint WHO/ECDC surveillance system by 12 countries27 and 104 402 cases from the Russian Federation (1), con- tinuing the alarming trend of previous years by once again being the highest number and rate ever observed in the East – a slight 2% increase compared with the rate of 50.2 reported for 2016 in the 2017 HIV surveillance in Europe report (5). For the 12 countries that reported to WHO/ECDC, the rate was 23.6 per 100 000 population. At country level, the highest rates (> 20.0) for 2017 were observed in the Russian Federation (71.1 per 100 000 population) (1), Ukraine (37.0),28 Belarus (26.1) and the Republic of Moldova (20.6), while the lowest (< 10.0) reported by Azerbaijan (5.8) and Lithuania (9.1). In the 12 East countries that reported to WHO/ECDC, most people newly diagnosed (40%) were in the age group 30–39 years, while only 7% were young people aged 15–24 years; 13% were 50 years or older at the time of diagnosis (Table A, Table 9). The male-to-female ratio was 1.6, the lowest of the three geographical areas, cor- responding to 39% of new diagnoses being in women in the East in 2017. The male-to-female ratio was highest (> 2.0) in Lithuania (5.1), Georgia (3.5) and Armenia (2.5), and lowest (< 1.5) in the Republic of Moldova (1.3) and Kyrgyzstan (1.4) (Fig. 2.6). Among people infected with reported heterosexual transmission, the male-to-female ratio was ≥ 1.5 in three countries (Armenia (2.0), Georgia (1.6) and Lithuania (1.5)), suggesting that more men than women were reported as infected through heterosexual contact in these countries. As this pattern differs from other countries where more heterosexual cases tend to be in women, it cannot be excluded that some of these men may in fact have been infected through injecting drug use or sex with other men, but were misclassified into the heterosexual category. Heterosexual contact and injecting drug use remain the main reported modes of HIV transmission in the East of the Region. Reported transmission related to sex between men remains low, although it is increasing. When combining data for the Russian Federation within data reported by the 12 East countries that provided data 26 No data were received from Turkmenistan and Uzbekistan. 27 No data were received from the Russian Federation, Turkmenistan and Uzbekistan. 28 Without taking into account data from Crimea, Sevastopol city and parts of the non-government controlled areas of Ukraine; adjusting population denominator data to exclude Crimea and Sevastopol city; and excluding infants born to HIV-positive mothers whose HIV status is undetermined. to WHO/ECDC, among people for whom the mode of HIV transmission was known, heterosexual sex accounted for 59% of new diagnoses, transmission through inject- ing drug use for 37%, sex between men for 3% and mother-to-child transmission for 0.5% of new diagnoses in 2017. In the 12 reporting countries alone, 2017 data by mode of transmission suggest the following (Table A, Tables 4–8, Fig. 2.7). • Sixty-eight per cent of those newly diagnosed and 70% of new HIV diagnoses with a known mode of transmission were infected heterosexually (17 882), making it the main reported transmission mode in all East countries except Lithuania, where the num- ber of people infected through injecting drug use has tripled in just two years and become the leading mode of HIV transmission, primarily due to injecting drug use-related transmission in prison settings or among former inmates with a history of drug injection (Table 6). • Twenty-four per cent of those newly diagnosed and 25% of new HIV diagnoses with a known mode of transmission were infected through injecting drug use (6375) (Table  5). Transmission through injecting drug use accounted for 20% or more of new diagnoses with a known transmission mode in eight countries (Lithuania (62%), Latvia (33%), Kazakhstan (31%), Kyrgyzstan (27%), Ukraine (25%), Georgia (24%), Tajikistan (22%) and Belarus (20%)). • Four per cent were infected through sex between men (1036) (Table 4), but three countries (Estonia, Georgia and Latvia) reported that sex between men accounted for 10% or more of new diagnoses with a known trans- mission mode. • One per cent (0.9%) was infected through mother- to-child transmission (242) (Table  7) and 0.1% (21) through other transmission routes (nosocomial infec- tion, transfusion or use of other blood products). • Transmission mode was reported as unknown or miss- ing for only 3% of those newly diagnosed across the 12 East countries (903), but at country level, transmis- sion mode information was lacking for more than 15% of cases in five countries: Estonia (46%), Latvia (36%), the Republic of Moldova (23%), Azerbaijan (18%) and Lithuania (16%). Analysing the new diagnoses by age group and trans- mission mode for the 12 reporting countries in the East (Fig. 2.8) shows that 30–39-year-olds accounted for most HIV diagnoses across all transmission groups (50% of people infected through injecting drug use, 38% with reported heterosexual transmission and 35% through sex between men). People in the younger age groups tended to be infected through sex between men: among MSM, 48% of adults (aged 15–49) were under 30 years at diagnosis compared with only 14% and 21% among those infected through injecting drug use and heterosexual sex, respectively. People aged 50 years and above were more frequently infected through heterosexual sex (16% 43 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Fig. 2.7. New HIV diagnoses, by country and transmission mode, East, 2017 (n = 26 459) Lithuania Latvia Estonia Georgia Kyrgyzstan Azerbaijan Kazakhstan Tajikistan Republic of Moldova Ukraine Belarus Armenia Sex between men Injecting drug use Heterosexual transmission Mother-to-child transmission Other Unkown Percentage 0 20 40 60 80 100 Note: no data were received from the Russian Federation, Turkmenistan and Uzbekistan. Fig. 2.6. Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country, East, 2017 (n = 26 459; 5751) Male-to-female ratio 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Kyrgyzstan Republic of Moldova Kazakhstan Ukraine East average Tajikistan Azerbaijan Belarus Latvia Estonia Armenia Georgia Lithuania 5.121.5 3.53 2.47 2 1.85 1.22 1.34 1.66 1.73 1.57 1.04 2 1.01 1.48 0.95 0.88 1.07 1.31 0.78 1.53 1.41 1.17 1.62 1.96 All new diagnoses New diagnoses with heterosexual transmission Note: no data were received from the Russian Federation, Turkmenistan and Uzbekistan. 44 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data compared with 7% and 5% for injecting drug use and MSM, respectively) (Fig. 2.8). Eleven countries in the East provided information about CD4 cell count at the time of HIV diagnosis for 19 472 people above 14 years (covering 74% of the 26 459 new diagnoses reported by the 12 East countries and 81% of new diagnoses in the 11 countries with data on CD4 cells (Table  14)). Fifty-seven per cent of these people were late presenters with CD4 cell counts below 350 per mm3, including 35% with advanced HIV infection (CD4 < 200/mm3) at the time of HIV diagnosis. The percent- age of people diagnosed with a CD4 count of less than 350/mm3 was higher than 50% in all 11 countries except Kazakhstan (46%). The percentage of late presenters varied across transmission categories; it was highest for people infected heterosexually (59%) and through injecting drug use (55%), and lowest for men infected through sex with men (43%) (Fig. 2.9). Nine countries provided information on the probable source of infection for 6611 people with reported het- erosexual transmission (Table  10), covering 37% of the heterosexually acquired cases reported by the 12 East countries. Among those for whom the probable source of infection was known (which was only 1855 cases), 73% had a heterosexual partner from a non-generalized epidemic country (other than the reporting country) and 24% had sexual contact with a person who injected drugs. Although these data are scarce, they suggest ongoing heterosexual transmission outside the report- ing country and related to partners with a history of injecting drug use. Nine countries in the East provided information about the probable country of infection for 9571 people newly diagnosed in 2017 (covering 36% of all new diagnoses reported by the 12 East countries) (Table 13). Among the 8263 cases for whom the probable country of infection was known, only 8% (620 cases) were infected abroad, including 7% in central and eastern Europe. These data suggest that most of those newly diagnosed with HIV in the East of the Region are infected in the reporting country and that those infected abroad are infected in neighbouring countries of central and eastern Europe. Fig. 2.8. New HIV diagnoses, by age group and transmission mode, East, 2017 (n = 25 286) 0 20 40 60 80 100 Injecting drug use Heterosexual transmission Sex between men 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years n = 6374 n = 17 876 n = 1036 Percentage Tr an sm is si on m od e Note: no data were received from the Russian Federation, Turkmenistan and Uzbekistan. Fig. 2.9. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2017 (n = 19 254) 0 20 40 60 80 100 Sex between men Heterosexal transmission Injecting drug use < 200 cells/mm3 200 to < 350 cells/mm3 350 to < 500 cells/mm3 ≥ 500 cells/mm3 n = 851 n = 13 743 n = 4660 Percentage Tr an sm is si on m od e Note: no data were received from from Belarus, Turkmenistan, Ukraine and Uzbekistan. 45 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Trends in HIV diagnoses in the East The increasing trend in newly diagnosed HIV infections continued in the East29 over the last decade, with a 68% increase in the rate of new diagnoses per 100 000 popu- lation, from 30.4 in 2008 (77 228 cases) to 51.1 in 2017 (130 861 cases) (Fig. 2.3a). In the 12 East countries that reported to WHO/ECDC, the rate increased by a more modest 18%, from 20.0 in 200830 (22 278 cases) to 23.6 in 2017 (26 459 cases) (Fig.  2.3b). The rate more than doubled between 2008 and 2017 in four countries (Armenia, Belarus, Lithuania and Tajikistan), whereas the increase remained more moderate (< 30% increase) in another five countries (Azerbaijan, Kazakhstan, Latvia, the Republic of Moldova and Ukraine). In Estonia, the only country that has seen a sustained decrease in new diagnoses over the decade, the rate continued the steady decline that began after the 2001 peak in new diagnoses and which sustained through to 2017 (Table 1). The number of newly diagnosed women increased by 16% across the 12 countries, from 8913 in 2008 to 10 329 in 2017, and the number of newly diagnosed men increased by 23%, from 13 082 to 16 130 (Tables 2 and 3). Information about mode of transmission for the period 2008–2017 (Fig. 2.10) from the 11 countries with consist- ent data31 suggests the following. • The number of new diagnoses in people with reported heterosexual transmission increased by 69%, from 10 505 in 2008 to 17 793 in 2017. The increase was considerably larger among men with heterosexual transmission (a 107% increase) than women with het- erosexual transmission (21% increase). At the same time, the percentage of all new HIV diagnoses attrib- uted to heterosexual contact increased from 48% of cases in 2008 to 68% in 2017. • The number of new diagnoses in people infected through injecting drug use decreased by 36%, from 10 006 in 2008 to 6361 in 2017, but the number tripled in just three years in Lithuania and more than doubled over the decade in Belarus, despite a small decline in 2016–2017 that followed a peak in 2015 (Table  5). The percentage of all new HIV diagnoses attributed to injecting drug use decreased from 46% in 2008 to 24% in 2017. • The number of new diagnoses in people infected through sex between men increased eight-fold, from 126 in 2008 to 1020 in 2017. This is by far the high- est relative increase across the various transmission 29 No data were received from Turkmenistan and Uzbekistan; data from the Russian Federation were derived from the Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS (1–3). 30 The drop in new diagnoses starting from 2014–2015 (Fig. 2.2b) is caused mainly by a decrease reported by Ukraine, which is partly related to a lack of data from parts of Ukraine since then. 31 Data from the Russian Federation, Turkmenistan and Uzbekistan are not included due to inconsistent reporting during the period; data from Estonia were excluded due to incomplete reporting on transmission mode during the period. modes and geographical areas. It is clearly visible on the logarithmic scale of Fig. 2.10, which enables easier comparison of rates of change regardless of starting point. The percentage of all new HIV diagno- ses attributed to sex between men, while increasing, nevertheless remained low at 0.6% in 2008 and 4% in 2017. • The number of children infected through mother-to- child transmission decreased by 30%, from 348 in 2008 to 242 in 2017, representing 1.6% of new HIV diagnoses in 2008 and 0.9% in 2017. • The number of new diagnoses for which the mode of transmission was unknown increased by 22%, from 658 in 2008 to 803 in 2017. The percentage of new HIV diagnoses with unknown mode of transmission remained low and stable at 3% in both 2008 and 2017. When combining data from the Russian Federation (1,2) within data from the 11 reporting countries with con- sistent data on mode of transmission in the East, the percentage of new HIV diagnoses with reported het- erosexual transmission, among those with a known transmission mode, increased from 42% in 2008 to 59% in 2017, while the percentage acquired through injecting drug use decreased from 55% in 2008 to 37% in 2017. Further analysis of the increase in new diagnoses attrib- uted to heterosexual transmission in the East by gender and age groups (Fig.  2.11, no data from the Russian Federation) reveals continuing increases in older age groups for both men and women (it is highest in those aged ≥ 50 years, followed by the 40–49 and 30–39 age groups). Heterosexual transmission has nevertheless continued to decrease among young women of 15–24 and 25–29 years, by 59% and 36%, respectively. The number of new diagnoses among all men with reported heterosexual transmission doubled over the decade, while it increased only by 21% among women. AIDS cases, morbidity and mortality in the East In 2017, 11 454 people were diagnosed with AIDS from the 12 countries in the East that provided AIDS data, giving a rate of 10.2 per 100 000 population. The high- est rates (> 5.0) were reported in Ukraine (21.9), the Republic of Moldova (6.9), Georgia (6.6) and Latvia (6.0) (Table 15). The AIDS rate doubled between 2008 and 2017, from 5.1 per 100 000 population (5685 cases) to 10.2 (11 454 cases) in the 12 countries (Fig. 2.5). The rate of new AIDS diagnoses increased in all countries in the East except Estonia, most noticeably in Tajikistan and the Republic of Moldova, where the rate tripled, and in Azerbaijan and Ukraine, where it more than doubled. By mode of trans- mission, both in men infected through sex between men and in people infected heterosexually, the rate of new AIDS diagnoses increased four-fold between 2017 and 2008. AIDS cases in people infected through injecting drug use remained stable in comparison with 2007 but decreased by 40% in comparison with 2011 (Fig. 2.12). 46 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data The trend for more recent years, however, is that the AIDS rate has slowly been stabilizing and has even declined by a slight 7% since 2012. The most common AIDS-indicative diseases diagnosed in 2017 were wasting syndrome due to HIV (17% of all disease events reported), pulmonary TB (13%) and oesophageal candidiasis (9%) (Table  23). By transmis- sion mode, pulmonary TB, wasting syndrome due to HIV and oesophageal candidiasis were the most common AIDS-defining diseases among people infected through heterosexual sex (the three diseases together account- ing for 37% of reported events). The most common AIDS-defining diseases reported among people with AIDS infected through injecting drug use were extrapul- monary TB, pulmonary TB and wasting syndrome due to HIV (together accounting for 50% of reported events). Among the few AIDS cases infected through sex between men, Pneumocystis pneumonia, wasting syndrome due to HIV and pulmonary TB were the most common dis- eases (Fig. 2.13). AIDS-related mortality remains high in the East, with 4120 reported AIDS-related deaths or deaths among people previously diagnosed with AIDS where cause of death (AIDS or non-AIDS related) was unknown or could not be reported in the 12 countries for 2017, compris- ing 84% of all deaths reported in the Region. This is a 22% increase in comparison with 2008 but a slight 11% decrease compared with 2012, which had the highest number of deaths reported for the decade (Table 25). HIV and AIDS diagnoses in the Centre HIV diagnoses in the Centre The HIV epidemic in the Centre remains at a relatively low level compared to other parts of the Region, but the number of new diagnoses is increasing more rapidly here than elsewhere, notably in people infected through sex between men. A total of 6205 people were newly diagnosed with HIV in 2017 from the 15 countries in the Fig. 2.10. New HIV diagnoses, by transmission mode and year of diagnosis, East, 2008–2017 0 5000 10 000 15 000 20 000 2017201620152014201320122011201020092008 N um be r o f n ew H IV d ia gn os es Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Note: data from the Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; data from Estonia excluded due to incomplete reporting on transmission mode during the period. 2017201620152014201320122011201020092008 Nu m be r o f n ew H IV d ia gn os es Year of diagnosis 1 10 100 1000 10 000 100 000 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Arithmetic scale Logarithmic scale 47 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Centre of the WHO European Region, giving a rate of 3.2 per 100 000 population (Table  1). The highest rates (> 3.0) were reported by Cyprus (10.0), Montenegro (4.1), Poland (3.5), Turkey (3.5), Bulgaria (3.4), Romania (3.3) and Albania (3.2), and the lowest (< 2.0) by Bosnia and Herzegovina (0.3), Slovakia (1.3) and Slovenia (1.9). The most affected age group in 2017 was 30–39-year- olds (35% of cases), while 14% of cases were diagnosed in young people aged 15–24 years – the largest per- centage of young people among the three geographical areas (Table  A, Table 9). The male-to-female ratio was 5.8, higher than in both the West and the East, reflect- ing that the central part of the Region is seeing a high number of young MSM among newly diagnosed cases compared with other parts of the Region. The high- est male-to-female ratios (> 15.0) were observed in Montenegro (25.0), Croatia (20.2), Slovenia (18.5) and Serbia (16.8) (Fig. 2.14). All 15 countries provided information on the transmis- sion mode, and the 2017 data (Table  A, Tables  4–7) indicate the following. • Twenty-eight per cent of those newly diagnosed and 48% of new HIV diagnoses with a known route of transmission were infected through sex between men (1765) (Table  4). Sex between men was the predomi- nant reported mode of transmission in 12 countries in 2017 (Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, the Czech Republic, Hungary, Montenegro, Serbia, Slovakia, Slovenia, Poland and the former Yugoslav Republic of Macedonia) (Fig. 2.15). • Twenty-seven per cent of those newly diagnosed and 45% of new HIV diagnoses with a known route of transmission were infected through heterosexual transmission (1658) (Table  6), which was the main reported mode of transmission in three countries (Albania, Romania and Turkey) (Fig. 2.15). • Three per cent of those newly diagnosed and 5% of new HIV diagnoses with a known route of transmission Fig. 2.11. Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2008–2017 0 1000 2000 3000 4000 2017201620152014201320122011201020092008 15–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Nu m be r o f n ew H IV d ia gn os es Year of diagnosis Note: data from Estonia, Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. 0 1000 2000 3000 4000 2017201620152014201320122011201020092008 15–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Nu m be r o f n ew H IV d ia gn os es Year of diagnosis Females East, heterosexual transmission Males East, heterosexual transmission 48 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Fig. 2.12. AIDS diagnoses, by transmission mode and year of diagnosis, East, 2008–2017 0 2000 4000 6000 8000 2017201620152014201320122011201020092008 Nu m be r o f A ID S di ag no se s Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Note: data from the Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. 2017201620152014201320122011201020092008 Year of diagnosis 1 10 100 1000 10 000 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined N um b er o f A ID S di ag no se s Arithmetic scale Logarithmic scale Fig. 2.13. Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2017 0 5 10 15 20 25 6 7 4 86 88 90 116 90 143 Mycobacterium tuberculosis, pulmonary Wasting syndrome due to HIV Pneumocystis carinii pneumonia Wasting syndrome due to HIV Mycobacterium tuberculosis, pulmonary Mycobacterium tuberculosis, extrapulmonary Candidiasis, oesophageal Wasting syndrome due to HIV Mycobacterium tuberculosis, pulmonary Percentage Se x be tw ee n m en In je ct in g dr ug u se He te ro se xu al tra ns m is si on Note: no data from the Russian Federation, Turkmenistan and Uzbekistan. 49 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT were infected through injecting drug use (169) (Table 5). • One per cent (0.6) was infected through mother-to- child transmission (35) (Table 7). • Transmission mode was unknown for 41% of those newly diagnosed (2556) (Table  8). The two countries with the highest number of new HIV diagnoses in 2017 (Turkey and Poland – together accounting for 67% of all new HIV diagnoses reported in the Centre in 2017) also had the highest percentage of new HIV diagnoses with an unknown transmission mode (Poland 66% and Turkey 54%). Twelve of 15 countries provided information about CD4 cell count at HIV diagnosis for 1504 people aged over 14 years (covering 24% of new diagnoses in the 15 Centre countries and 86% in the 12 countries with CD4 cell data) (Table 14). Fifty-three per cent were late presenters, with CD4 cell counts below 350 per mm3 at HIV diagnosis, including 34% with advanced HIV infection (CD4 < 200/ mm3). In all, 20% had a CD4 cell count of between 350 and 500 cells per mm3 and 28% had a CD4 cell count above 500 per mm3. The proportion diagnosed with CD4 counts of less than 350/mm3 was above 50% in five countries: Serbia (66%), Montenegro (62%), Romania (60%), Albania (59%) and Croatia (58%). The percentage of late presenters varied across transmission catego- ries and was highest for those infected heterosexually (61%) and through injecting drug use (59%), and lowest for men infected through sex with men (43%) (Table 14, Fig. 2.16). Trends in HIV diagnoses in the Centre The rate of new HIV diagnoses increased by 121% between 2008 and 2017 in the 15 countries of the Centre, from 1.4 per 100 000 population (2627 cases) to 3.1 (6205 cases) (Fig.  2.3a, b). Rates increased in all countries, particularly in the former Yugoslav Republic of Macedonia (10-fold) and Turkey (five-fold), but it also more than doubled in Bulgaria, Cyprus and Montenegro. Information on trends by reported mode of HIV transmis- sion for the period 2008–2017 in the 13 countries with consistent data32 (Fig. 2.17) indicates the following. • The number of new diagnoses in those infected through sex between men doubled, from 470 to 953. The percentage of new HIV diagnoses attributed to sex between men also increased, from 34% in 2008 to 47% in 2017. • The number of new diagnoses in those infected through heterosexual transmission increased by 43%, from 550 to 789. The percentage of new HIV diagno- ses attributed to heterosexual transmission remained stable at 39%. • The number of new diagnoses in those infected through injecting drug use increased by 47%, from 87 to 128. The 2011–2013 outbreak in Romania that caused higher numbers of cases during this period has levelled off, as evidenced by the decrease in new diagnoses since 2013. The percentage of new 32 Data from Poland and Turkey were excluded due to incomplete reporting on transmission mode over the period. Fig. 2.14. Male-to-female ratio in new HIV diagnoses, by country, Centre, 2017 0 5 10 15 20 25 30 Albania Romania Cyprus Turkey Centre average Poland Hungary Bulgaria Czech Republic Slovakia Serbia Slovenia Croatia Montenegro Male-to-female ratio 50 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data diagnoses attributed to injecting drug use remained stable at 6%. • The number of new diagnoses as a result of mother- to-child transmission was similar in 2008 (18) and 2017 (20), but with slightly higher numbers during 2009–2013. • The number of new diagnoses reported with unknown transmission mode, although still high at 41% in the 15 countries in 2017, decreased by 49% from 273 to 138 in the 13 countries with consistent data on transmission mode. The percentage of new diagnoses with missing information about transmission mode deceased from 19% in 2008 to 7% in 2017 in the 13 countries included in the trend assessment. AIDS cases, morbidity and mortality in the Centre In 2017, 823 people were diagnosed with AIDS in the 15 reporting countries in the Centre, corresponding to a rate of 0.4 per 100 000 population (Table  15). The highest rates (> 1.0) were reported by Montenegro (2.1), Fig. 2.15. New HIV diagnoses, by country and transmission mode, Centre, 2017 (n = 6383) 0 20 40 60 80 100 Albania Turkey Romania Poland Centre average Hungary Bulgaria Cyprus Serbia Slovenia Czech Republic Slovakia Bosnia and Herzegovina The former Yugoslav Republic of Macedonia Montenegro Croatia Heterosexual contact Sex between men Injecting drug use Other Unkown Percentage Fig. 2.16. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, Centre, 2017 (n = 1501) 0 20 40 60 80 100 Injecting drug use Heterosexual transmission Sex between men < 200 cells/mm3 200 to < 350 cells/mm3 350 to < 500 cells/mm3 ≥ 500 cells/mm3 n = 264 n = 649 n = 109 Percentage Tr an sm is si on m od e Note: no data from Hungary, Poland and Turkey. 51 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Cyprus (1.9), Romania (1.4) and Albania (1.1). AIDS rates remained below 0.8 per 100 000 population in other countries in the Centre. Contrary to the distribution of transmission modes for new HIV diagnoses in the Centre (where sex between men is the predominant mode), more AIDS diagnoses are reported in people infected through heterosexual contact (41% of new diagnoses) compared with sex between men (25% of new diagnoses). The rate of new AIDS diagnoses remained stable at 0.4 per 100 000 between 2008 and 2017, with almost no change during the period (Fig.  2.5). Trends were more heterogeneous at country level. Of the 12 coun- tries reporting more than 10 AIDS cases in 2017, the rate increased by more than 50% in five (Bulgaria, the Czech Republic, Hungary, Montenegro and Serbia) and decreased by 40% or more in one (Poland) (Table  15). In terms of the mode of transmission, new AIDS diag- noses increased mostly among men infected through sex between men (by 65% for the decade) but have sta- bilized or started to decline in all transmission groups since 2014 (Fig. 2.18). The most common AIDS-indicative diseases diagnosed in 2017 were wasting syndrome due to HIV (19% of all recorded disease events), Pneumocystis pneumonia (13%) and pulmonary TB (12%) (Table 23). Mortality also remained stable in the Centre, with 261 deaths reported by the 15 countries in 2008 and 291 in 2017, with little variation over the decade (and slightly higher numbers during 2011–2015) (Table  24). As men- tioned in the “AIDS cases, morbidity and mortality” section above, these numbers do not represent the true burden of AIDS-related mortality due to underreporting of deaths in countries that do not match their HIV/AIDS registries with the national mortality registry. HIV and AIDS diagnoses in the West HIV diagnoses in the West The epidemiological pattern of HIV infection in the West largely mirrors that of the EU/EEA, as described in Fig. 2.17. New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2008–2017 0 200 400 600 800 1000 2017201620152014201320122011201020092008 Nu m be r o f A ID S di ag no se s Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Note: data from Poland and Turkey excluded due to incomplete reporting on transmission mode during the period. Fig. 2.18. New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2008–2017 0 100 200 300 400 2017201620152014201320122011201020092008 Nu m be r o f A ID S di ag no se s Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Note: data from Turkey excluded due to incomplete reporting on transmission mode during the period. 52 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Chapter 1. In 2017, 22 354 people were newly diagnosed with HIV in the 22 reporting countries33 in the West of the WHO European Region, giving a rate of 6.4 per 100 000 population (not adjusted for reporting delay) (Table  A, Table 1). When adjusting the 2017 West rate for reporting delay,34 it increases to 6.9 per 100 000 population (23 976 cases). In 2017, the highest proportion of newly diagnosed HIV infections (30%) were in 30–39-year-olds, 11% were aged 15–24 years and the male-to-female ratio was 2.9 (Table  A). Sexual transmission between men remained the main transmission mode in 2017, followed by het- erosexual transmission, together accounting for 74% of all new diagnoses and 94.5% of all cases with a known route of transmission. In the 17 countries reporting information on CD4 cell count at HIV diagnosis for 15 433 people over 14 years (covering 69% of all new diagnoses from the 22 report- ing countries in the West and 70% of new diagnoses from the 17 countries reporting information on CD4 cell counts), 48% were late presenters with CD4 cell counts below 350 per mm3 at HIV diagnosis, including 28% with advanced HIV infection (CD4 < 200/mm3) (Table 14). Late presentation varied by transmission category and was more common in people infected heterosexually (57%) or through injecting drug use (52%) and less common in men infected through sex with men (39%) (Table 14). Information about transmission mode (Table  A, Tables 4–7) suggests the following. • Forty per cent of all people newly diagnosed and 51% of those with a known mode of transmission were infected through sex between men (8872) (Table 4). • Thirty-four per cent of all people newly diagnosed and 44% of those with a known mode of transmission were infected heterosexually (7664) (Table  6). Of these, 60% were born abroad and 41% originated from gen- eralized epidemic countries (data not shown). • Three per cent of all people newly diagnosed were infected through injecting drug use (603) (Table 5). • Mother-to-child transmission accounted for 0.5% of all new diagnoses and 0.7% of those with a known route of transmission (120 cases) (Table  7). Of these, 78% were born abroad and 62% originated from countries with a generalized epidemic (data not shown). • Transmission mode was unknown for 23% of all new diagnoses (5032). Information about country of birth, country of national- ity or region of origin was provided by 20 countries for 22 350 new diagnoses in 2017 (covering nearly 100% of all new diagnoses). Region of origin was unknown for 15% (3406). Among 18 944 people with known origin (85%), 47% (8950) originated from outside of the report- ing country, including 36% (6783) from outside the WHO 33 Due to technical problems, no data export for 2017 was available from Germany. 34 See Annex 1 for methods and Annex 6 for results. European Region and 11% (2167) from a European coun- try other than the country of report (Table 11). Trends in HIV diagnoses in the West The crude rate of new diagnoses in the 22 reporting countries declined by 32% between 2008 and 2017, from 9.4 per 100 000 population (27 530) to 6.4 (22 354) (not adjusted for reporting delay35). After adjusting the 2017 rate for reporting delay, the decline was 27% (from 9.4 to 6.9 per 100 000 population, with 23 976 cases in 2017). HIV rates increased (by 10% or more in countries with > 10 cases in both 2008 and 2017) in only three countries, Iceland, Ireland and Malta, and decreased (by 10% or more) in 14 (Table 1), not taking into account the impact of reporting delays in several countries. Information about trends by reported transmission mode during the period 2008–2017 in the 20 countries with consistent data36 (Fig. 2.19) suggests the following. • New diagnoses of people infected through sex between men decreased by 21%, from 7349 to 5806. The percentage of new diagnoses attributed to sex between men increased from 34% in 2008 to 37% in 2017. • New diagnoses of people with reported heterosexual transmission decreased by 49%, from 10 039 to 5153, with the steepest decline among women and foreign- born heterosexuals, the latter being mainly due to sharp declines among migrants originating from countries with generalized HIV epidemics (data not shown; see also Fig.  1.11 and 1.12 and the “Trends in HIV diagnoses” section of Chapter 1). The percentage of new diagnoses attributed to heterosexual contact decreased from 47% of cases in 2008 to 33% in 2017. • New diagnoses of people infected through inject- ing drug use decreased by 57%, from 941 in 2008 to 404 in 2017, representing 4% of new HIV diagnoses in 2008 and 3% in 2017. • New diagnoses of children infected through mother- to-child transmission decreased by 60%, from 253 in 2008 to 102 in 2017. • The number of new diagnoses with missing informa- tion about transmission mode increased by 51%, from 2741 to 4145, corresponding to 13% of new diagno- ses in 2008 to 26% in 2017. Delays in the reporting of probable mode of transmission to national and European surveillance systems intensify the increase. AIDS cases, morbidity and mortality in the West Twenty of the 23 countries in the West37 reported that 2426 people were diagnosed with AIDS in 2017, giving a rate of 0.7 per 100 000 population (Table 15). The steady decline in new AIDS diagnoses that began in the late 35 See Annex 1 for methods and Annex 6 for results. 36 Data from Italy and Spain were excluded due to increasing coverage of national surveillance over the period; data from Germany were excluded due to lack of data for 2017. 37 No data were available from Belgium, Germany or Sweden. 53 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT 1990s continued through to 2017, with a 59% decrease in the rate of new AIDS cases over the decade from 2.1 per 100 000 population (6516 cases) in 2008 to 0.7 (2426 cases) in 2017 (Fig. 2.5). New AIDS diagnoses decreased in all transmission groups, but most notably among peo- ple who inject drugs (an 84% decline) (Fig. 2.20). The most common AIDS-indicative diseases diagnosed in the West in 2017 were Pneumocystis pneumonia (24% of all disease events reported), oesophageal candidiasis (11%) and Kaposi’s sarcoma (9%) (Table 23). In the West, 552 people were reported to have died in 2017 in the 19 countries for which consistent data were available38 (Table  24). The number of AIDS-related deaths has continued to decline during the decade from 2026 in 2008 to 552 in 2017, representing a 73% decrease. As mentioned in the “AIDS cases, morbidity and mortality” section  above, these numbers do not reflect the true burden of AIDS-related mortality in the 38 No data were available from Belgium, Germany, Italy and Sweden. West of the Region due to reporting delays and, particu- larly, underreporting of deaths in countries without the ability to link their HIV/AIDS registries with their vital statistics registries. HIV testing Data on the number of HIV tests can support the inter- pretation of trends in newly diagnosed HIV infections. A total of 24 153 146 HIV tests (excluding unlinked anon- ymous tests and screening of blood donations) were reported by 30 countries (12 East, 10 Centre and 8 West) for 2017. Countries in the East tended to report higher testing rates than those in the West and Centre, but rates varied greatly across countries from all parts of the Region, and more data were available from countries in the Centre and East than the West (Table 26). The overall number of tests performed in the Region increased by 34%, from 17 551 854 in 2008 to 23 436 301 in 2017 in 28 countries with data for both 2008 and 2017. Increases in large countries with high testing Fig. 2.20. New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2008–2017 0 1000 2000 3000 4000 2017201620152014201320122011201020092008 N um b er o f A ID S di ag no se s Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Note: data from Belgium, Germany and Sweden excluded due to inconsistent reporting during the period. Fig. 2.19. New HIV diagnoses, by transmission mode and year of diagnosis, West, 2008–2017 0 2000 4000 6000 8000 10 000 12 000 2017201620152014201320122011201020092008 N um b er o f n ew H IV d ia gn os es Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Note: data from Germany excluded due to lack of data for 2017, data from Italy and Spain excluded due to increasing coverage of national surveillance during the period. 54 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data numbers, such as Belarus, France, Kazakhstan, Turkey and Ukraine, had a considerable impact on the overall increase. The number of tests more than doubled in eight countries, but information about testing yield or coverage among key populations at higher risk of HIV infection is not available here. The number of HIV tests from the 12 reporting countries in the East of the Region increased by 46%, from 5 818 930 in 2008 to 8 506 795 in 2017 (Table 27). Information about the types of populations tested is not avail- able, however, and increasing numbers of HIV tests do not necessarily generate higher testing yields if large numbers of HIV tests are performed among people at low risk of HIV infection. It is nevertheless possible that increased testing activity has contributed to the observed increase in new diagnoses. This is supported by improved estimates of the first of the three UNAIDS and WHO 90–90–90 targets: at the end of 2017, an esti- mated 74% of people living with HIV knew their status, up from 66% in 2015 (for more details on estimates, see UNAIDS (6)). The rate of new HIV diagnoses in the Centre more than doubled during the last decade, while the number of HIV tests increased by 42% (from 6 010 936 in 2008 to 8 506 941 in 2017) in the 10 countries for which consistent data were available.39 While it is difficult to make assess- ments based on these crude numbers, it appears less likely that increased testing has substantially contrib- uted to the observed increase in new diagnoses. The number of HIV tests conducted in the West is not reported separately here. Contrary to countries in the East and Centre, many in the West do not systematically collect data on the number of HIV tests performed. This results in data that are too sparse to allow for meaning- ful interpretation. Conclusions HIV infection continues to affect the health and well- being of more than 2 million people in the WHO European Region and to be of serious public health concern, par- ticularly in the central and eastern parts of the Region. New surveillance data for 2017 show that the increas- ing trend in new HIV diagnoses continued for the WHO European Region, but at a slower rate for the last decade than previously. The slowing rate of increase appears to be due mainly to fewer new diagnoses among women than men, with some variation across the Region. Nearly 160 000 people were diagnosed with HIV infec- tion in 2017, at a rate of 20.0 diagnoses per 100 000 population – once again the highest rate ever reported for the Region. The vast (and increasing) majority of people newly diagnosed (82%) were from the East, with a soaring rate of 51.1 per 100 000 population, while 14% were diagnosed in the West with a rate of 6.4 per 100 000 population, and 4% in the Centre with a rate of 39 The 10 countries are Albania, the Czech Republic, Montenegro, Poland, Romania, Serbia, Slovenia, Slovakia, the former Yugoslav Republic of Macedonia and Turkey. 3.2 per 100 000 population. Two countries (the Russian Federation and Ukraine) continued to have a major influ- ence on the overall epidemiology of HIV in the WHO European Region in 2017, contributing 75% of newly diagnosed infections in the Region and 92% in the East. The 2017 HIV surveillance data also confirm the great variation of epidemic patterns and trends across the WHO European Region. Overall, among the 160 000 new diagnoses for whom the mode of HIV transmission was known, heterosexual transmission accounted for just over half, injecting drug use for a third and sex between men for 15%. These overall numbers conceal a complex mix of transmission patterns, trends and country con- texts in which transmission through sex between men tends to predominate in the western and central parts of the Region, heterosexual transmission remains sub- stantial across large parts of the Region – particularly among migrants, travellers and partners of people who inject drugs – and injecting drug use remains an impor- tant risk factor, mainly in the eastern part of the Region. The increase in new diagnoses in the East of the Region continued, with 2017 continuing the trend of recent years in becoming the year with the highest number and rate ever recorded. The relative burden of new diagno- ses reported in the East is high and increasing, reaching 82% in 2017. The rate of increase appears to be levelling off, however, with a 68% increase for the decade (com- pared with a doubling for the decade identified in last year’s report) and a slight 2% increase for the last year. The rate increased more slowly for the decade among women than men.40 In terms of modes of HIV transmission, the overall increase is mainly the result of sustained increases among people with reported heterosexual transmission in all countries, meaning that this mode dominates, with 59% of new diagnoses in 2017 for whom the mode of HIV transmission was known. Transmission through inject- ing drug use continued to decrease during the decade but still accounted for 37% of new diagnoses in the East with a known transmission mode. Transmission through sex between men remains low in absolute terms but increased nearly eight-fold over the decade – the largest increase in any transmission category and any geo- graphical area of the Region. Limited available data on the probable source of infection among people infected through heterosexual contact suggests ongoing hetero- sexual transmission occurring outside of the reporting countries and related to partners with a history of inject- ing drug use. There is also some evidence to suggest that a proportion of men reported as heterosexually infected may in fact be men who have sex with men or people with a history of drug injection who may have been misclassified as heterosexually infected (7). While most new diagnoses (61%) were in men and new diagno- ses increased more rapidly among men than women, the 40 A drop in new diagnoses reported by Ukraine from 2014–2015 onwards is affecting the trend for the East and is partly related to a lack of data from parts of Ukraine since then. 55 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT proportion of new diagnoses among women was much higher in the East than elsewhere in the Region. Following repeat calls for urgent action, most recently by the WHO Regional Director for Europe during a ministe- rial policy dialogue on HIV and related comorbidities in EECA (8), countries in the East of the Region are revamp- ing their political commitment and scaling up efforts to implement the evidence-based actions and interven- tions outlined in the WHO action plan for the health sector response to HIV in the WHO European Region (9), unanimously endorsed by all 53 Member States during the 66th Regional Committee for Europe in September 2016. Country-specific roadmaps for accelerating and scaling up efforts to reach the UNAIDS and WHO 2020 targets are being prepared as a follow-up action from the ministerial policy dialogue with the goal of strength- ening political commitment and reinforcing a common agenda among key policy-makers, partners, funders and implementers. The recommended actions and inter- ventions of the action plan include: comprehensive HIV combination-prevention strategies for people at risk of heterosexual and drug-injection-related transmission, including harm-reduction interventions for people who use drugs; condom and lubricant programming; diversi- fied HIV testing services (use of rapid diagnostic tests, HIV testing provided by lay providers and HIV self-test- ing); assisted voluntary partner notification (10,11); PrEP; prevention and management of co-infections; and a treat-all approach (12,13). Further interventions aimed at reducing stigma and discrimination and eliminating laws and policies that hamper access to, and uptake of, crucial HIV prevention and treatment services for key populations are needed to facilitate further progress in the reduction of HIV transmission (14). The rate of new diagnoses is increasing more rapidly in the central part of the Region than anywhere else in the WHO European Region, with a strong gender dis- parity and very steep increases among men (both MSM and heterosexual men) compared with a fairly stable rate among women. Sexual transmission prevails in all countries, with sex between men being the predominant mode of transmission in 12 of the 15 Centre countries and reported heterosexual transmission prevailing in three. Drug-injection-related transmission remains low but recent outbreaks (15) suggest that HIV pre- vention services for people who inject drugs continue to be important and must be retained with sufficient coverage among people who inject drugs to prevent outbreaks. The percentage of young people among the new diagnoses is also higher in this part of the Region than elsewhere. HIV prevention, diagnostics and treat- ment interventions should accommodate the needs of key populations, particularly MSM, with relevant evidence-based interventions, including: condom and lubricant programming; diversified HIV testing services; assisted voluntary partner notification; PrEP; prevention and management of co-infections (particularly sexually transmitted infections); and rapid HIV treatment initia- tion. Services should be patient-centred and provided in a friendly environment, preferably with the involvement of civil society along the entire HIV continuum of ser- vices, ranging from HIV prevention, to adherence, to ART. In the western part of the Region, there is a clear decline in the overall rate of new HIV diagnoses for the decade, resulting primarily from decreases in new diagnoses among MSM in specific countries (Austria, Belgium, Denmark, the Netherlands, Norway, Spain and the United Kingdom) and from declines among people infected heterosexually, particularly women and people origi- nating from countries with generalized HIV epidemics. Continued strong HIV combination prevention, including the use of formal and informal PrEP, implementation of diversified and user-friendly HIV testing services with more frequent testing to facilitate earlier diagnosis, early linkage to care and rapid initiation of ART, and a strong focus on interventions designed to reach MSM (16,17) have all contributed to the observed declines. While a certain proportion of migrants, even those originating from HIV-endemic areas, are known to acquire HIV after arrival in the EU/EEA (18–20), the extent to which the observed decreases can be explained by lower incidence of HIV in the migrant populations, reduced testing-seek- ing or opportunities, changed migration patterns or a combination of factors, is unclear. Across the WHO European Region where migrations occur widely in various forms, the public health chal- lenge of ensuring access to health services for migrant populations, including HIV services, and promoting cross-border collaboration and sharing of data remains essential to a robust and people-centred public health response. As in previous years, it remains a major concern that over half (53%) of those newly diagnosed with HIV are only detected once their CD4 cell counts have fallen to below 350 per mm3. Importantly, the 2017 data provide once again information about variations in late presen- tation by geography, transmission mode and age, and confirm that the proportion diagnosed at a late stage of infection was highest in the East, among people infected heterosexually (particularly men) and through injecting drug use, and among people in older age groups. Late presentation reflects insufficient access to, and uptake of, HIV testing and counselling by those most at risk, as well as poor linkage to care after a positive HIV diagnosis. HIV testing strategies need to be recon- sidered and diversified, including through innovative approaches that involve community-based organiza- tions and focus on the most affected population groups. Multiple entry points to HIV testing should be available through, for example, HIV self-testing, HIV testing per- formed by lay providers and civil society, home sampling, routine indicator condition-guided HIV testing offered in the health system and assisted partner notifications. HIV testing should also be available in settings such as prisons, drug-dependence programmes, sexual and reproductive health clinics and migrant health services, depending on the local context. Support for timely link- age to HIV treatment and care is essential for reducing late presentation and progressing toward the UNAIDS 56 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data and WHO 90–90–90 targets (21), improving treatment outcomes and reducing further HIV transmission. AIDS trends varied greatly across the three geographi- cal areas. While the rate continued its steady decline in the West, it remained stable in the Centre and, while still soaring and doubling over the decade in the East of the Region, the AIDS rate has begun to stabilize and has even declined by a slight 7% in the East since 2012. The high number of AIDS cases is indicative of late HIV diag- nosis, delayed initiation of life-saving HIV treatment and low treatment coverage. However, increasing implemen- tation of a treat-all approach and having policies in place in most countries in the East to support everyone living with HIV to be offered ART regardless of disease stage has helped stabilize AIDS trends and will, ultimately, help prevent people from dying and reduce AIDS-related deaths in line with global and regional targets (9,22,23). To help address the ongoing transmission of HIV in Europe, countries are urged to implement the action plan for the health sector response to HIV in the WHO European Region as part of an urgent, accelerated and innovative response to HIV that aims to meet the regional targets for 2020 and end the AIDS epidemic in Europe by 2030,  in line with the SDGs (24). From December 2017 to April 2018, the WHO Regional Office for Europe collected examples of good practices in implementa- tion of the action plan solicited from national health authorities, national and international experts and civil society organizations involved in HIV prevention, test- ing, treatment and care, and published 52 examples from 33 Member States in the first compendium of good practices from the WHO European Region (25). Other recently published documents also share experiences of successful HIV, viral hepatitis and tuberculosis interven- tions and good practices (26), as well as principles and actions for stronger intersectoral collaboration (27 ) aim- ing to reach the SDGs and improving health outcomes and quality of life for people at risk of, or living with, the three diseases. References 1. Information note ‘Spravka’ on HIV infection in the Russian Federation as of 31 December 2017. Moscow: Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS; 2018. 2. Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS. HIV-infection Bulletin No. 41. Moscow: Federal Service for Surveillance of Consumer Rights Protection and Human Well-being; 2016. 3. Information note ‘Spravka’ on HIV infection in the Russian Federation as of 31 December 2016. Moscow: Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS; 2017. 4. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire; 2007. 5. ECDC/WHO Regional Office for Europe. HIV/AIDS sur- veillance in Europe 2017–2016 data. Stockholm: ECDC; 2017 (https://ecdc.europa.eu/en/publications-data/ hivaids-surveillance-europe-2017-2016-data). 6. Annex on methods. In: Miles to go. Global AIDS update 2018. Geneva: UNAIDS; 2018:255–64 (http://www.unaids.org/sites/ default/files/media_asset/miles-to-go_en.pdf). 7. Čakalo JI, Božičević I, Vitek CR, Mandel JS, Salyuk TO, Rutherford GW. Misclassification of men with reported HIV infection in Ukraine. AIDS Behav. 2015;19:1938–40. 8. Ministerial policy dialogue on HIV and related comorbidities in east- ern Europe and central Asia. In: WHO Regional Office for Europe [web- site]. 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Stockholm: ECDC; 2014 (http://ecdc.europa.eu/en/pub- lications/Publications/hiv-sti-prevention-among-men-who-have- sex-with-men-guidance.pdf). 17. United Nations Population Fund, Global Forum on MSM and HIV, United Nations Development Programme, World Health Organization, United States Agency for International Development, the US President’s Emergency Plan for AIDS Relief, the Bill & Melinda Gates Foundation. Implementing comprehensive HIV and STI programmes with men who have sex with men. New York (NY): United Nations Population Fund; 2015 (https://www.unfpa.org/pub- lications/implementing-comprehensive-hiv-and-sti-programmes- men-who-have-sex-men). 18. Rice BD, Elford J, Yin Z, Delpech VC. A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV. AIDS 2012;26(15):1961–6. 19. Fakoya I, Alvarez-del Arco D, Woode-Owusu M, Monge S, Rivero- Montesdeoca Y, Delpech V et al. A systematic review of post- migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: implications for effec- tively managing HIV prevention programmes and policy. BMC Public Health 2015;15:561. 20. Fakoya I, Alvarez-Del Arco D, Monge S, Copas AJ, Gennotte A-F, et al. HIV testing history and access to treatment among migrants living with HIV in Europe. J Int AIDS Soc. 2018;21(Suppl. 4):e25123 (https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.25123). 21. Ambitious treatment targets: writing the final chap- ter of the AIDS epidemic. Geneva: UNAIDS; 2014 (http:// w w w . u n a i d s . o r g / s i t e s / d e f a u l t / f i l e s / m e d i a _ a s s e t / JC2670_UNAIDS_Treatment_Targets_en.pdf). 22. Global health sector strategy for HIV 2016–2021. Geneva: World Health Organization; 2016 (http://www.who.int/hiv/ strategy2016-2021/ghss-hiv/en/). 23. On the fast-track to end AIDS. 2016–2021 strategy. Geneva: UNAIDS; 2015 (http://www.unaids.org/sites/default/files/media_ asset/20151027_UNAIDS_PCB37_15_18_EN_rev1.pdf). 24. United Nations General Assembly resolution A/RES/70/1. Transforming our world: the 2030 Agenda for Sustainable Development. New York (NY): United Nations; 2015 (https://sustain- abledevelopment.un.org/post2015/transformingourworld). 25. Compendium of good practices in the health sector response to HIV in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/ compendium-of-good-practices-in-the-health-sector-response-to- hiv-in-the-who-european-region). 57 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT 26. European Commission Staff Working Document on Combatting HIV/AIDS, viral hepatitis and tuberculosis. Brussels: European Commission; 2018 (https://ec.europa.eu/health/sites/health/files/ communicable_diseases/docs/swd_2018_387_en.pdf). 27. 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Tables 60 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 1980 381 4.6 337 4.0 352 4.2 351 4.2 357 4.2 294 3.5 279 3.3 300 3.5 269 3.1 270 3.1 9 543 Austria West Belgium 1985 1 092 10.2 1 112 10.3 1 182 10.9 1 170 10.6 1 226 11.1 1 124 10.1 1 055 9.4 1 015 9.0 908 8.0 890 7.9 30 618 Belgium Centre Bulgaria 1986 123 1.6 171 2.3 163 2.2 201 2.7 157 2.1 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 2 747 Bulgaria Centre Croatia 1985 73 1.7 55 1.3 71 1.7 74 1.7 73 1.7 85 2.0 92 2.2 117 2.8 109 2.6 106 2.5 1 538 Croatia Centre Cyprus 1986 37 4.8 38 4.8 41 5.0 54 6.4 58 6.7 54 6.2 56 6.5 80 9.4 80 9.4 85 10.0 1 148 Cyprus Centre Czech Republic 1985 148 1.4 156 1.5 180 1.7 153 1.5 212 2.0 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 3 160 Czech Republic West Denmark 1990 285 5.2 236 4.3 275 5.0 266 4.8 201 3.6 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 7 591 Denmark East Estonia 1988 545 40.7 411 30.8 376 28.2 366 27.5 315 23.8 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 9 711 Estonia West Finland 1980 147 2.8 172 3.2 184 3.4 172 3.2 156 2.9 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 3 911 Finland West France 2003 5 768 9.0 5 462 8.5 5 548 8.6 5 419 8.3 5 671 8.7 5 564 8.5 5 683 8.6 5 284 7.9 5 420 8.1 5 211 7.8 83 306 France West Germanyc 1993 2 824 3.4 2 857 3.5 2 695 3.3 2 661 3.3 2 952 3.7 3 236 4.0 3 501 4.3 3 699 4.6 3 419 4.2 – – 60 688 Germanyc West Greece 1984 623 5.6 619 5.6 648 5.8 965 8.7 1 157 10.4 896 8.1 776 7.1 777 7.2 644 6.0 628 5.8 16 669 Greece Centre Hungary 1985 145 1.4 140 1.4 182 1.8 162 1.6 219 2.2 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 3 567 Hungary West Iceland 1983 10 3.2 15 4.7 24 7.6 23 7.2 19 5.9 11 3.4 11 3.4 12 3.6 28 8.4 24 7.2 385 Iceland West Irelandd 1985 404 9.1 395 8.7 330 7.3 328 7.2 349 7.6 342 7.4 377 8.2 483 10.4 510 10.8 483 10.2 8 838 Irelandd West Italy 2004 2 486 6.7 3 845 6.7 4 018 6.8 3 895 6.6 4 155 7.0 3 832 6.4 3 823 6.3 3 598 5.9 3 649 6.0 3 443 5.7 44 139 Italy East Latvia 1987 358 16.3 275 12.7 274 12.9 299 14.4 339 16.6 340 16.8 347 17.3 393 19.8 365 18.5 371 18.8 7 343 Latvia Liechtenstein 1985 0 0.0 1 2.8 4 11.1 1 2.8 0 0.0 0 0.0 1 2.7 0 0.0 2 5.3 0 0.0 67 Liechtenstein East Lithuania 1988 95 3.0 180 5.7 153 4.9 166 5.4 160 5.3 177 6.0 141 4.8 157 5.4 214 7.4 263 9.1 3 012 Lithuania West Luxembourgd 1983 61 12.6 66 13.4 61 12.1 59 11.5 67 12.8 69 12.8 83 15.1 67 11.9 71 12.3 59 10.2 1 641 Luxembourgd West Malta 2001 28 6.9 19 4.6 18 4.3 21 5.1 30 7.2 36 8.5 40 9.4 61 14.2 63 14.5 45 10.4 432 Malta West Netherlands 1980 1 345 8.2 1 242 7.5 1 253 7.6 1 202 7.2 1 126 6.7 1 083 6.5 938 5.6 920 5.4 798 4.7 716 4.2 26 129 Netherlands West Norway 1984 299 6.3 282 5.9 258 5.3 269 5.5 242 4.9 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 6 291 Norway Centre Poland 1985 832 2.2 961 2.5 955 2.5 1 113 2.9 1 101 2.9 1 098 2.9 1 132 3.0 1 278 3.4 1 313 3.5 1 325 3.5 22 798 Poland West Portugal 1985 2 238 21.2 2 034 19.3 1 937 18.3 1 737 16.4 1 695 16.1 1 660 15.8 1 331 12.8 1 343 12.9 1 313 12.7 1 068 10.3 57 913 Portugal Centre Romania 1987 577 2.8 575 2.8 577 2.8 819 4.1 909 4.5 961 4.8 855 4.3 821 4.1 705 3.6 661 3.3 23 063 Romania Centre Slovakia 1985 53 1.0 53 1.0 28 0.5 49 0.9 50 0.9 83 1.5 86 1.6 86 1.6 88 1.6 70 1.3 869 Slovakia Centre Slovenia 1985 48 2.4 48 2.4 35 1.7 55 2.7 47 2.3 46 2.2 51 2.5 50 2.4 57 2.8 39 1.9 836 Slovenia West Spain 2003 3 630 13.0 3 768 11.5 3 884 11.8 3 641 11.1 3 893 10.3 4 331 9.3 4 396 9.5 4 181 9.0 3 963 8.5 3 249 7.0 48 636 Spain West Sweden 1983 392 4.3 403 4.4 420 4.5 461 4.9 441 4.7 457 4.8 473 4.9 447 4.6 429 4.4 434 4.4 12 569 Sweden West United Kingdom 1981 7 176 11.7 6 596 10.6 6 327 10.1 6 148 9.8 6 211 9.8 5 983 9.4 6 185 9.6 6 043 9.3 5 280 8.1 4 363 6.7 155 267 United Kingdom Total EU/EEA 32 223 6.9 32 524 6.6 32 453 6.6 32 300 6.5 33 588 6.7 33 385 6.5 33 457 6.5 32 918 6.4 31 286 6.1 25 353 5.8 654 425 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 52 1.7 64 2.2 43 1.5 78 2.7 81 2.8 120 4.1 79 2.7 96 3.3 127 4.3 94 3.2 1 101 Albania West Andorra 2004 4 4.8 2 2.4 6 7.1 2 2.4 2 2.4 5 6.2 6 7.6 3 3.8 2 2.6 6 7.8 83 Andorra East Armeniad 1988 136 4.7 149 5.2 149 5.2 182 6.3 229 7.9 238 8.2 333 11.5 295 10.1 303 10.4 354 12.1 2 907 Armeniad East Azerbaijan 1987 434 4.9 455 5.1 459 5.1 548 6.0 517 5.6 514 5.5 604 6.4 727 7.6 556 5.7 570 5.8 6 755 Azerbaijan East Belarus 1981 881 9.3 1 072 11.3 1 069 11.3 1 196 12.6 1 223 12.9 1 533 16.2 1 811 19.1 2 305 24.3 2 391 25.2 2 468 26.1 24 686 Belarus Centre Bosnia and Herzegovinad 1986 9 0.2 6 0.2 1 0.0 27 0.7 25 0.7 2 0.1 23 0.6 15 0.4 24 0.7 12 0.3 281 Bosnia and Herzegovinad East Georgia 1989 358 8.2 391 9.1 460 10.9 429 10.3 543 13.2 482 11.9 542 13.6 683 17.3 719 18.3 631 16.1 6 762 Georgia West Israel 1981 394 5.6 388 5.3 418 5.6 447 5.9 480 6.2 464 5.9 452 5.7 409 5.1 363 4.4 405 4.9 9 592 Israel East Kazakhstan 1987 2 317 14.5 2 077 12.8 1 982 12.1 1 998 12.0 2 004 11.8 2 131 12.4 2 342 13.4 2 478 14.0 2 899 16.1 3 019 16.6 32 563 Kazakhstan East Kyrgyzstan 1987 553 10.5 696 13.0 567 10.5 614 11.2 701 12.5 503 8.8 649 11.2 653 11.1 764 12.8 840 13.9 8 019 Kyrgyzstan West Monaco 1987 0 0.0 0 0.0 0 0.0 0 0.0 1 2.6 0 0.0 1 2.6 1 2.6 0 0.0 3 7.8 40 Monaco Centre Montenegro 1989 11 1.8 14 2.2 15 2.4 9 1.4 14 2.2 10 1.6 20 3.2 19 3.0 34 5.4 26 4.1 254 Montenegro East Republic of Moldova 1987 793 19.3 704 17.2 703 17.2 721 17.7 757 18.6 706 17.3 833 20.5 816 20.1 833 20.5 836 20.6 11 858 Republic of Moldova East Russian Federatione 2010 – – – – 62 581 43.7 – – – – – – – – – – – – – – 62 581 Russian Federatione West San Marino 1985 4 13.2 1 3.3 6 19.3 8 25.4 5 15.7 1 3.1 3 9.2 2 6.1 2 6.0 1 3.0 90 San Marino Centre Serbia 1984 122 1.3 137 1.5 151 1.7 134 1.5 135 1.5 153 1.7 136 1.5 184 2.1 179 2.0 181 2.1 3 778 Serbia Centre Serbia excluding Kosovof 1984 118 1.7 131 1.9 148 2.2 128 1.8 131 1.8 150 2.1 130 1.8 181 2.6 168 2.4 178 2.5 3 665 Serbia excluding Kosovof Centre Kosovof 1999 4 0.2 6 0.3 3 0.1 6 0.3 4 0.2 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 113 Kosovof West Switzerland 1985 763 10.0 654 8.5 605 7.7 560 7.1 621 7.7 576 7.1 517 6.3 536 6.4 531 6.3 443 5.2 35 969 Switzerland East Tajikistan 1991 364 5.0 446 6.0 1 002 13.1 987 12.6 828 10.4 871 10.7 1 009 12.1 1 157 13.5 1 043 11.9 1 208 13.5 9 956 Tajikistan Centre The former Yugoslav Republic of Macedonia 1993 4 0.2 6 0.3 5 0.2 1 0.0 15 0.7 15 0.7 30 1.4 25 1.2 30 1.4 44 2.1 201 The former Yugoslav Republic of Macedonia Centre Turkey 1985 393 0.6 470 0.7 489 0.7 699 1.0 1 068 1.4 1 313 1.7 1 838 2.4 2 107 2.7 2 438 3.1 2 844 3.5 15 990 Turkey East Turkmenistan 1990 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 2 Turkmenistan East Ukraine 1987 15 444 33.4 16 268 35.4 16 617 36.3 17 305 38.0 16 850 37.2 17 844 39.6 15 796 35.2 13 000 30.4 14 262 33.5 15 680 37.0 262 469 Ukraine East Uzbekistan 1981 3 061 11.0 4 055 14.4 3 795 13.3 – – – – – – – – – – – – – – 24 018 Uzbekistan Total non-EU/EEA 26 097 11.1 28 055 11.8 91 123 23.8 25 945 12.2 26 099 12.2 27 481 12.7 27 024 12.4 25 511 11.7 27 500 12.5 29 665 13.4 519 955 Total non-EU/EEA WHO European Region WHO European Region West 30 354 8.1 30 505 7.6 30 449 7.5 29 805 7.4 31 057 7.5 30 587 7.2 30 634 7.2 29 853 7.0 28 306 6.6 22 354 6.4 620 340 West Centre 2 627 1.4 2 894 1.5 2 936 1.5 3 628 1.9 4 164 2.2 4 615 2.4 5 148 2.7 5 642 2.9 5 900 3.0 6 205 3.2 81 331 Centre East 25 339 18.2 27 179 19.5 90 187 31.8 24 811 22.2 24 466 21.8 25 664 22.8 24 698 21.9 22 934 20.6 24 578 22.0 26 459 23.6 472 642 East Total WHO European Region 58 320 8.3 60 578 8.3 123 572 14.1 58 244 8.2 59 687 8.4 60 866 8.4 60 480 8.3 58 429 8.0 58 784 8.0 55 018 8.4 1 174 313 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d The following countries use "date of statistics" instead of "date of diagnosis" for presenting surveillance data in their national reports; the numbers displayed here may therefore not fully align with the numbers in their national statistics. These are, for 2017: Armenia (358), Bosnia and Herzegovina (14), Ireland (495) and Luxembourg (101). 61 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT e No official data were reported by the Russian Federation, except for 2010. Information about new and cumulative HIV diagnoses was obtained from the Federal Scientific and Methodological Centre for Prevention and Control of AIDS (number (year)): 54 950 (2008), 58 209 (2009), 58 303 (2010), 62 509 (2011), 70 887 (2012), 79 810 (2013), 89 808 (2014), 98 232 (2015), 103 438 (2016), 104 402 (2017), and cumulative 1 220 659 as of 31 December 2017. References (1,2,4), Chapter 2. f For the purposes of this publication, all references to "Kosovo” in the tables and annexes, should be understood/read as “Kosovo (in accordance with Security Council resolution 1244 (1999))". Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 1980 381 4.6 337 4.0 352 4.2 351 4.2 357 4.2 294 3.5 279 3.3 300 3.5 269 3.1 270 3.1 9 543 Austria West Belgium 1985 1 092 10.2 1 112 10.3 1 182 10.9 1 170 10.6 1 226 11.1 1 124 10.1 1 055 9.4 1 015 9.0 908 8.0 890 7.9 30 618 Belgium Centre Bulgaria 1986 123 1.6 171 2.3 163 2.2 201 2.7 157 2.1 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 2 747 Bulgaria Centre Croatia 1985 73 1.7 55 1.3 71 1.7 74 1.7 73 1.7 85 2.0 92 2.2 117 2.8 109 2.6 106 2.5 1 538 Croatia Centre Cyprus 1986 37 4.8 38 4.8 41 5.0 54 6.4 58 6.7 54 6.2 56 6.5 80 9.4 80 9.4 85 10.0 1 148 Cyprus Centre Czech Republic 1985 148 1.4 156 1.5 180 1.7 153 1.5 212 2.0 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 3 160 Czech Republic West Denmark 1990 285 5.2 236 4.3 275 5.0 266 4.8 201 3.6 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 7 591 Denmark East Estonia 1988 545 40.7 411 30.8 376 28.2 366 27.5 315 23.8 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 9 711 Estonia West Finland 1980 147 2.8 172 3.2 184 3.4 172 3.2 156 2.9 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 3 911 Finland West France 2003 5 768 9.0 5 462 8.5 5 548 8.6 5 419 8.3 5 671 8.7 5 564 8.5 5 683 8.6 5 284 7.9 5 420 8.1 5 211 7.8 83 306 France West Germanyc 1993 2 824 3.4 2 857 3.5 2 695 3.3 2 661 3.3 2 952 3.7 3 236 4.0 3 501 4.3 3 699 4.6 3 419 4.2 – – 60 688 Germanyc West Greece 1984 623 5.6 619 5.6 648 5.8 965 8.7 1 157 10.4 896 8.1 776 7.1 777 7.2 644 6.0 628 5.8 16 669 Greece Centre Hungary 1985 145 1.4 140 1.4 182 1.8 162 1.6 219 2.2 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 3 567 Hungary West Iceland 1983 10 3.2 15 4.7 24 7.6 23 7.2 19 5.9 11 3.4 11 3.4 12 3.6 28 8.4 24 7.2 385 Iceland West Irelandd 1985 404 9.1 395 8.7 330 7.3 328 7.2 349 7.6 342 7.4 377 8.2 483 10.4 510 10.8 483 10.2 8 838 Irelandd West Italy 2004 2 486 6.7 3 845 6.7 4 018 6.8 3 895 6.6 4 155 7.0 3 832 6.4 3 823 6.3 3 598 5.9 3 649 6.0 3 443 5.7 44 139 Italy East Latvia 1987 358 16.3 275 12.7 274 12.9 299 14.4 339 16.6 340 16.8 347 17.3 393 19.8 365 18.5 371 18.8 7 343 Latvia Liechtenstein 1985 0 0.0 1 2.8 4 11.1 1 2.8 0 0.0 0 0.0 1 2.7 0 0.0 2 5.3 0 0.0 67 Liechtenstein East Lithuania 1988 95 3.0 180 5.7 153 4.9 166 5.4 160 5.3 177 6.0 141 4.8 157 5.4 214 7.4 263 9.1 3 012 Lithuania West Luxembourgd 1983 61 12.6 66 13.4 61 12.1 59 11.5 67 12.8 69 12.8 83 15.1 67 11.9 71 12.3 59 10.2 1 641 Luxembourgd West Malta 2001 28 6.9 19 4.6 18 4.3 21 5.1 30 7.2 36 8.5 40 9.4 61 14.2 63 14.5 45 10.4 432 Malta West Netherlands 1980 1 345 8.2 1 242 7.5 1 253 7.6 1 202 7.2 1 126 6.7 1 083 6.5 938 5.6 920 5.4 798 4.7 716 4.2 26 129 Netherlands West Norway 1984 299 6.3 282 5.9 258 5.3 269 5.5 242 4.9 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 6 291 Norway Centre Poland 1985 832 2.2 961 2.5 955 2.5 1 113 2.9 1 101 2.9 1 098 2.9 1 132 3.0 1 278 3.4 1 313 3.5 1 325 3.5 22 798 Poland West Portugal 1985 2 238 21.2 2 034 19.3 1 937 18.3 1 737 16.4 1 695 16.1 1 660 15.8 1 331 12.8 1 343 12.9 1 313 12.7 1 068 10.3 57 913 Portugal Centre Romania 1987 577 2.8 575 2.8 577 2.8 819 4.1 909 4.5 961 4.8 855 4.3 821 4.1 705 3.6 661 3.3 23 063 Romania Centre Slovakia 1985 53 1.0 53 1.0 28 0.5 49 0.9 50 0.9 83 1.5 86 1.6 86 1.6 88 1.6 70 1.3 869 Slovakia Centre Slovenia 1985 48 2.4 48 2.4 35 1.7 55 2.7 47 2.3 46 2.2 51 2.5 50 2.4 57 2.8 39 1.9 836 Slovenia West Spain 2003 3 630 13.0 3 768 11.5 3 884 11.8 3 641 11.1 3 893 10.3 4 331 9.3 4 396 9.5 4 181 9.0 3 963 8.5 3 249 7.0 48 636 Spain West Sweden 1983 392 4.3 403 4.4 420 4.5 461 4.9 441 4.7 457 4.8 473 4.9 447 4.6 429 4.4 434 4.4 12 569 Sweden West United Kingdom 1981 7 176 11.7 6 596 10.6 6 327 10.1 6 148 9.8 6 211 9.8 5 983 9.4 6 185 9.6 6 043 9.3 5 280 8.1 4 363 6.7 155 267 United Kingdom Total EU/EEA 32 223 6.9 32 524 6.6 32 453 6.6 32 300 6.5 33 588 6.7 33 385 6.5 33 457 6.5 32 918 6.4 31 286 6.1 25 353 5.8 654 425 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 52 1.7 64 2.2 43 1.5 78 2.7 81 2.8 120 4.1 79 2.7 96 3.3 127 4.3 94 3.2 1 101 Albania West Andorra 2004 4 4.8 2 2.4 6 7.1 2 2.4 2 2.4 5 6.2 6 7.6 3 3.8 2 2.6 6 7.8 83 Andorra East Armeniad 1988 136 4.7 149 5.2 149 5.2 182 6.3 229 7.9 238 8.2 333 11.5 295 10.1 303 10.4 354 12.1 2 907 Armeniad East Azerbaijan 1987 434 4.9 455 5.1 459 5.1 548 6.0 517 5.6 514 5.5 604 6.4 727 7.6 556 5.7 570 5.8 6 755 Azerbaijan East Belarus 1981 881 9.3 1 072 11.3 1 069 11.3 1 196 12.6 1 223 12.9 1 533 16.2 1 811 19.1 2 305 24.3 2 391 25.2 2 468 26.1 24 686 Belarus Centre Bosnia and Herzegovinad 1986 9 0.2 6 0.2 1 0.0 27 0.7 25 0.7 2 0.1 23 0.6 15 0.4 24 0.7 12 0.3 281 Bosnia and Herzegovinad East Georgia 1989 358 8.2 391 9.1 460 10.9 429 10.3 543 13.2 482 11.9 542 13.6 683 17.3 719 18.3 631 16.1 6 762 Georgia West Israel 1981 394 5.6 388 5.3 418 5.6 447 5.9 480 6.2 464 5.9 452 5.7 409 5.1 363 4.4 405 4.9 9 592 Israel East Kazakhstan 1987 2 317 14.5 2 077 12.8 1 982 12.1 1 998 12.0 2 004 11.8 2 131 12.4 2 342 13.4 2 478 14.0 2 899 16.1 3 019 16.6 32 563 Kazakhstan East Kyrgyzstan 1987 553 10.5 696 13.0 567 10.5 614 11.2 701 12.5 503 8.8 649 11.2 653 11.1 764 12.8 840 13.9 8 019 Kyrgyzstan West Monaco 1987 0 0.0 0 0.0 0 0.0 0 0.0 1 2.6 0 0.0 1 2.6 1 2.6 0 0.0 3 7.8 40 Monaco Centre Montenegro 1989 11 1.8 14 2.2 15 2.4 9 1.4 14 2.2 10 1.6 20 3.2 19 3.0 34 5.4 26 4.1 254 Montenegro East Republic of Moldova 1987 793 19.3 704 17.2 703 17.2 721 17.7 757 18.6 706 17.3 833 20.5 816 20.1 833 20.5 836 20.6 11 858 Republic of Moldova East Russian Federatione 2010 – – – – 62 581 43.7 – – – – – – – – – – – – – – 62 581 Russian Federatione West San Marino 1985 4 13.2 1 3.3 6 19.3 8 25.4 5 15.7 1 3.1 3 9.2 2 6.1 2 6.0 1 3.0 90 San Marino Centre Serbia 1984 122 1.3 137 1.5 151 1.7 134 1.5 135 1.5 153 1.7 136 1.5 184 2.1 179 2.0 181 2.1 3 778 Serbia Centre Serbia excluding Kosovof 1984 118 1.7 131 1.9 148 2.2 128 1.8 131 1.8 150 2.1 130 1.8 181 2.6 168 2.4 178 2.5 3 665 Serbia excluding Kosovof Centre Kosovof 1999 4 0.2 6 0.3 3 0.1 6 0.3 4 0.2 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 113 Kosovof West Switzerland 1985 763 10.0 654 8.5 605 7.7 560 7.1 621 7.7 576 7.1 517 6.3 536 6.4 531 6.3 443 5.2 35 969 Switzerland East Tajikistan 1991 364 5.0 446 6.0 1 002 13.1 987 12.6 828 10.4 871 10.7 1 009 12.1 1 157 13.5 1 043 11.9 1 208 13.5 9 956 Tajikistan Centre The former Yugoslav Republic of Macedonia 1993 4 0.2 6 0.3 5 0.2 1 0.0 15 0.7 15 0.7 30 1.4 25 1.2 30 1.4 44 2.1 201 The former Yugoslav Republic of Macedonia Centre Turkey 1985 393 0.6 470 0.7 489 0.7 699 1.0 1 068 1.4 1 313 1.7 1 838 2.4 2 107 2.7 2 438 3.1 2 844 3.5 15 990 Turkey East Turkmenistan 1990 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 2 Turkmenistan East Ukraine 1987 15 444 33.4 16 268 35.4 16 617 36.3 17 305 38.0 16 850 37.2 17 844 39.6 15 796 35.2 13 000 30.4 14 262 33.5 15 680 37.0 262 469 Ukraine East Uzbekistan 1981 3 061 11.0 4 055 14.4 3 795 13.3 – – – – – – – – – – – – – – 24 018 Uzbekistan Total non-EU/EEA 26 097 11.1 28 055 11.8 91 123 23.8 25 945 12.2 26 099 12.2 27 481 12.7 27 024 12.4 25 511 11.7 27 500 12.5 29 665 13.4 519 955 Total non-EU/EEA WHO European Region WHO European Region West 30 354 8.1 30 505 7.6 30 449 7.5 29 805 7.4 31 057 7.5 30 587 7.2 30 634 7.2 29 853 7.0 28 306 6.6 22 354 6.4 620 340 West Centre 2 627 1.4 2 894 1.5 2 936 1.5 3 628 1.9 4 164 2.2 4 615 2.4 5 148 2.7 5 642 2.9 5 900 3.0 6 205 3.2 81 331 Centre East 25 339 18.2 27 179 19.5 90 187 31.8 24 811 22.2 24 466 21.8 25 664 22.8 24 698 21.9 22 934 20.6 24 578 22.0 26 459 23.6 472 642 East Total WHO European Region 58 320 8.3 60 578 8.3 123 572 14.1 58 244 8.2 59 687 8.4 60 866 8.4 60 480 8.3 58 429 8.0 58 784 8.0 55 018 8.4 1 174 313 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d The following countries use "date of statistics" instead of "date of diagnosis" for presenting surveillance data in their national reports; the numbers displayed here may therefore not fully align with the numbers in their national statistics. These are, for 2017: Armenia (358), Bosnia and Herzegovina (14), Ireland (495) and Luxembourg (101). 62 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 2. HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 291 7.2 262 6.5 286 7.0 278 6.8 285 7.0 249 6.0 221 5.3 263 6.3 224 5.3 224 5.3 7 276 Austria West Belgium 748 14.3 735 14.0 787 14.8 782 14.5 835 15.3 787 14.3 737 13.4 698 12.6 648 11.6 598 10.7 19 447 Belgium Centre Bulgaria 102 2.8 133 3.7 132 3.7 163 4.5 123 3.4 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 2 176 Bulgaria Centre Croatia 70 3.4 49 2.4 68 3.3 63 3.0 70 3.4 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 1 356 Croatia Centre Cyprus 24 6.3 26 6.7 34 8.5 39 9.5 49 11.7 46 10.9 49 11.7 72 17.5 65 15.8 65 15.8 847 Cyprus Centre Czech Republic 121 2.4 130 2.5 159 3.1 139 2.7 185 3.6 211 4.1 209 4.0 248 4.8 262 5.1 232 4.5 2 715 Czech Republic West Denmark 204 7.5 179 6.6 201 7.3 192 7.0 146 5.3 178 6.4 196 7.0 205 7.3 191 6.7 192 6.8 5 560 Denmark East Estonia 315 50.6 243 39.1 230 37.0 226 36.5 209 33.8 200 32.5 182 29.6 167 27.2 139 22.5 146 23.7 6 498 Estonia West Finland 105 4.0 106 4.1 130 5.0 112 4.2 111 4.2 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 2 827 Finland West France 3 748 12.1 3 600 11.6 3 656 11.7 3 589 11.4 3 820 12.1 3 728 11.7 3 820 12.0 3 536 11.0 3 575 11.1 3 390 10.5 53 760 France West Germanyc 2 337 5.8 2 386 5.9 2 289 5.7 2 238 5.7 2 498 6.4 2 656 6.7 2 842 7.2 2 943 7.4 2 704 6.7 – – 48 154 Germanyc West Greece 518 9.5 523 9.6 570 10.4 823 15.1 979 18.0 808 15.1 674 12.7 687 13.0 532 10.2 520 10.0 13 800 Greece Centre Hungary 110 2.3 107 2.2 142 3.0 122 2.6 186 3.9 191 4.1 214 4.5 196 4.2 171 3.6 148 3.2 2 712 Hungary West Iceland 7 4.4 6 3.7 17 10.6 12 7.5 13 8.1 8 5.0 9 5.5 10 6.1 22 13.2 21 12.6 281 Iceland West Ireland 258 11.6 258 11.5 241 10.7 239 10.5 251 11.1 257 11.3 273 12.0 373 16.3 395 16.9 367 15.7 5 082 Ireland West Italy 1 818 10.1 2 893 10.3 3 028 10.6 2 924 10.2 3 268 11.4 2 995 10.4 3 036 10.3 2 787 9.4 2 809 9.5 2 623 8.9 33 493 Italy East Latvia 231 22.9 170 17.1 170 17.5 196 20.7 218 23.3 203 21.9 236 25.7 264 29.0 230 25.4 241 26.7 4 985 Latvia Liechtenstein 0 0.0 1 5.7 2 11.3 1 5.6 0 0.0 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 41 Liechtenstein East Lithuania 65 4.4 131 8.9 125 8.6 134 9.5 114 8.2 125 9.1 90 6.6 115 8.5 165 12.4 220 16.5 2 402 Lithuania West Luxembourg 49 20.5 46 18.8 43 17.2 44 17.3 47 18.0 56 20.9 52 18.9 53 18.8 57 19.7 43 14.9 1 208 Luxembourg West Malta 17 8.4 10 4.9 16 7.8 17 8.2 23 11.1 30 14.3 36 16.9 53 24.7 51 23.4 35 16.1 335 Malta West Netherlands 1 134 14.0 1 029 12.6 1 057 12.9 1 027 12.5 945 11.4 936 11.3 799 9.6 779 9.3 684 8.1 619 7.4 21 060 Netherlands West Norway 182 7.7 183 7.6 173 7.1 190 7.7 166 6.6 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 4 274 Norway Centre Poland 611 3.3 733 4.0 711 3.9 914 5.0 921 5.0 937 5.1 933 5.1 1 084 5.9 1 146 6.2 1 172 6.4 17 897 Poland West Portugal 1 524 30.1 1 372 27.1 1 293 25.5 1 207 23.9 1 194 23.7 1 174 23.5 948 19.1 989 20.1 942 19.2 768 15.7 41 824 Portugal Centre Romania 325 3.2 344 3.5 357 3.6 564 5.7 660 6.8 676 6.9 597 6.1 592 6.1 508 5.3 487 5.0 13 732 Romania Centre Slovakia 48 1.8 48 1.8 25 1.0 46 1.8 44 1.7 71 2.7 75 2.8 76 2.9 81 3.1 64 2.4 757 Slovakia Centre Slovenia 45 4.6 40 4.0 31 3.1 48 4.7 44 4.3 40 3.9 46 4.5 43 4.2 55 5.4 37 3.6 737 Slovenia West Spain 2 893 21.0 3 022 18.7 3 192 19.8 3 003 18.6 3 293 17.7 3 706 16.1 3 743 16.4 3 595 15.7 3 348 14.7 2 736 12.0 39 992 Spain West Sweden 245 5.4 263 5.7 250 5.4 291 6.2 265 5.6 293 6.1 273 5.7 276 5.7 269 5.5 273 5.5 8 438 Sweden West United Kingdom 4 580 15.2 4 437 14.6 4 319 14.1 4 397 14.2 4 497 14.4 4 502 14.3 4 628 14.6 4 614 14.4 4 000 12.4 3 236 10.0 109 309 United Kingdom Total EU/EEA 22 725 10.0 23 465 9.8 23 734 9.8 24 020 10.0 25 459 10.4 25 561 10.3 25 540 10.2 25 299 10.1 23 826 9.4 19 032 9.0 472 975 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 35 2.3 45 3.0 28 1.9 55 3.7 58 3.9 82 5.6 61 4.1 67 4.5 104 7.0 69 4.7 798 Albania West Andorra 4 9.6 2 4.8 6 14.4 2 4.8 2 4.9 4 10.1 6 15.4 3 7.8 2 5.3 3 7.9 69 Andorra East Armenia 104 7.6 96 7.1 98 7.3 115 8.5 159 11.8 161 11.9 215 15.8 206 15.0 211 15.3 252 18.3 2 019 Armenia East Azerbaijan 350 8.0 377 8.5 365 8.2 410 9.0 356 7.7 329 7.1 375 7.9 495 10.3 354 7.3 361 7.4 4 937 Azerbaijan East Belarus 454 10.3 562 12.7 563 12.8 621 14.1 659 15.0 802 18.2 1 052 23.8 1 395 31.6 1 490 33.8 1 540 35.0 14 818 Belarus Centre Bosnia and Herzegovina 7 0.4 6 0.3 1 0.1 23 1.3 23 1.3 2 0.1 20 1.1 14 0.8 22 1.3 12 0.7 237 Bosnia and Herzegovina East Georgia 252 12.3 276 13.6 327 16.3 305 15.4 394 20.1 363 18.8 391 20.5 520 27.6 553 29.5 492 26.3 5 034 Georgia West Israel 250 7.1 267 7.4 287 7.8 296 7.9 350 9.2 346 8.9 325 8.3 289 7.2 252 6.2 292 7.1 6 356 Israel East Kazakhstan 1 640 21.2 1 392 17.8 1 252 15.8 1 207 15.0 1 167 14.3 1 203 14.4 1 334 15.8 1 443 16.8 1 684 19.3 1 824 20.7 21 065 Kazakhstan East Kyrgyzstan 309 11.9 514 19.5 399 14.9 422 15.5 406 14.7 292 10.4 369 12.9 364 12.5 446 15.1 491 16.4 5 170 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.3 1 5.3 0 0.0 3 15.8 26 Monaco Centre Montenegro 8 2.6 12 3.9 15 4.9 8 2.6 13 4.2 10 3.2 17 5.5 17 5.5 32 10.3 25 8.1 221 Montenegro East Republic of Moldova 438 22.2 400 20.3 341 17.4 377 19.2 375 19.1 381 19.5 454 23.2 460 23.5 472 24.2 474 24.4 6 840 Republic of Moldova East Russian Federation – – – – 36 172 54.5 – – – – – – – – – – – – – – 36 172 Russian Federation West San Marino 2 13.6 1 6.7 6 39.7 6 39.2 2 12.9 0 0.0 3 18.9 2 12.5 2 12.4 1 6.1 71 San Marino Centre Serbia 102 2.3 127 2.9 134 3.0 116 2.6 123 2.8 139 3.2 119 2.7 178 4.1 164 3.8 171 4.0 3 047 Serbia Centre Serbia excluding Kosovod 98 2.9 122 3.7 132 4.0 111 3.2 120 3.4 137 4.0 113 3.3 176 5.1 153 4.5 168 4.9 2 964 Serbia excluding Kosovod Centre Kosovod 4 0.4 5 0.5 2 0.2 5 0.6 3 0.3 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 83 Kosovod West Switzerland 550 14.6 468 12.3 444 11.5 422 10.8 462 11.7 421 10.5 385 9.5 408 9.9 412 9.9 341 8.1 22 924 Switzerland East Tajikistan 283 7.7 330 8.8 791 20.5 692 17.6 535 13.3 527 12.8 576 13.7 687 16.0 626 14.3 738 16.5 6 622 Tajikistan Centre The former Yugoslav Republic of Macedonia 3 0.3 6 0.6 5 0.5 0 0.0 10 1.0 15 1.4 29 2.8 24 2.3 28 2.7 44 4.2 176 The former Yugoslav Republic of Macedonia Centre Turkey 271 0.8 342 1.0 350 1.0 531 1.5 819 2.2 1 072 2.9 1 497 4.0 1 770 4.6 2 065 5.3 2 389 6.0 12 633 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 1 Turkmenistan East Ukraine 8 641 40.5 9 089 42.8 9 521 45.0 9 472 45.0 9 400 44.9 10 011 48.1 8 991 43.4 7 519 38.0 8 389 42.5 9 351 47.6 155 814 Ukraine East Uzbekistan 1 830 13.3 2 248 16.1 2 062 14.5 – – – – – – – – – – – – – – 16 234 Uzbekistan Total non-EU/EEA 15 533 13.6 16 560 14.4 53 167 29.1 15 080 14.8 15 313 14.8 16 160 15.5 16 220 15.4 15 862 15.0 17 308 16.3 18 873 17.6 321 284 Total non-EU/EEA WHO European Region WHO European Region West 21 464 11.7 22 048 11.2 22 291 11.3 22 091 11.2 23 452 11.7 23 394 11.3 23 344 11.2 22 840 10.9 21 397 10.2 16 541 9.7 445 566 West Centre 1 882 2.1 2 148 2.3 2 192 2.4 2 831 3.1 3 328 3.6 3 730 4.0 4 150 4.4 4 686 4.9 4 976 5.2 5 234 5.4 60 041 Centre East 14 912 22.4 15 828 23.7 52 416 39.3 14 177 26.8 13 992 26.3 14 597 27.4 14 265 26.7 13 635 25.8 14 759 27.8 16 130 30.3 288 611 East Total WHO European Region 38 258 11.2 40 024 11.3 76 899 18.1 39 099 11.4 40 772 11.7 41 721 11.8 41 759 11.7 41 161 11.5 41 132 11.5 37 905 11.9 794 218 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 63 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 2. HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 291 7.2 262 6.5 286 7.0 278 6.8 285 7.0 249 6.0 221 5.3 263 6.3 224 5.3 224 5.3 7 276 Austria West Belgium 748 14.3 735 14.0 787 14.8 782 14.5 835 15.3 787 14.3 737 13.4 698 12.6 648 11.6 598 10.7 19 447 Belgium Centre Bulgaria 102 2.8 133 3.7 132 3.7 163 4.5 123 3.4 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 2 176 Bulgaria Centre Croatia 70 3.4 49 2.4 68 3.3 63 3.0 70 3.4 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 1 356 Croatia Centre Cyprus 24 6.3 26 6.7 34 8.5 39 9.5 49 11.7 46 10.9 49 11.7 72 17.5 65 15.8 65 15.8 847 Cyprus Centre Czech Republic 121 2.4 130 2.5 159 3.1 139 2.7 185 3.6 211 4.1 209 4.0 248 4.8 262 5.1 232 4.5 2 715 Czech Republic West Denmark 204 7.5 179 6.6 201 7.3 192 7.0 146 5.3 178 6.4 196 7.0 205 7.3 191 6.7 192 6.8 5 560 Denmark East Estonia 315 50.6 243 39.1 230 37.0 226 36.5 209 33.8 200 32.5 182 29.6 167 27.2 139 22.5 146 23.7 6 498 Estonia West Finland 105 4.0 106 4.1 130 5.0 112 4.2 111 4.2 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 2 827 Finland West France 3 748 12.1 3 600 11.6 3 656 11.7 3 589 11.4 3 820 12.1 3 728 11.7 3 820 12.0 3 536 11.0 3 575 11.1 3 390 10.5 53 760 France West Germanyc 2 337 5.8 2 386 5.9 2 289 5.7 2 238 5.7 2 498 6.4 2 656 6.7 2 842 7.2 2 943 7.4 2 704 6.7 – – 48 154 Germanyc West Greece 518 9.5 523 9.6 570 10.4 823 15.1 979 18.0 808 15.1 674 12.7 687 13.0 532 10.2 520 10.0 13 800 Greece Centre Hungary 110 2.3 107 2.2 142 3.0 122 2.6 186 3.9 191 4.1 214 4.5 196 4.2 171 3.6 148 3.2 2 712 Hungary West Iceland 7 4.4 6 3.7 17 10.6 12 7.5 13 8.1 8 5.0 9 5.5 10 6.1 22 13.2 21 12.6 281 Iceland West Ireland 258 11.6 258 11.5 241 10.7 239 10.5 251 11.1 257 11.3 273 12.0 373 16.3 395 16.9 367 15.7 5 082 Ireland West Italy 1 818 10.1 2 893 10.3 3 028 10.6 2 924 10.2 3 268 11.4 2 995 10.4 3 036 10.3 2 787 9.4 2 809 9.5 2 623 8.9 33 493 Italy East Latvia 231 22.9 170 17.1 170 17.5 196 20.7 218 23.3 203 21.9 236 25.7 264 29.0 230 25.4 241 26.7 4 985 Latvia Liechtenstein 0 0.0 1 5.7 2 11.3 1 5.6 0 0.0 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 41 Liechtenstein East Lithuania 65 4.4 131 8.9 125 8.6 134 9.5 114 8.2 125 9.1 90 6.6 115 8.5 165 12.4 220 16.5 2 402 Lithuania West Luxembourg 49 20.5 46 18.8 43 17.2 44 17.3 47 18.0 56 20.9 52 18.9 53 18.8 57 19.7 43 14.9 1 208 Luxembourg West Malta 17 8.4 10 4.9 16 7.8 17 8.2 23 11.1 30 14.3 36 16.9 53 24.7 51 23.4 35 16.1 335 Malta West Netherlands 1 134 14.0 1 029 12.6 1 057 12.9 1 027 12.5 945 11.4 936 11.3 799 9.6 779 9.3 684 8.1 619 7.4 21 060 Netherlands West Norway 182 7.7 183 7.6 173 7.1 190 7.7 166 6.6 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 4 274 Norway Centre Poland 611 3.3 733 4.0 711 3.9 914 5.0 921 5.0 937 5.1 933 5.1 1 084 5.9 1 146 6.2 1 172 6.4 17 897 Poland West Portugal 1 524 30.1 1 372 27.1 1 293 25.5 1 207 23.9 1 194 23.7 1 174 23.5 948 19.1 989 20.1 942 19.2 768 15.7 41 824 Portugal Centre Romania 325 3.2 344 3.5 357 3.6 564 5.7 660 6.8 676 6.9 597 6.1 592 6.1 508 5.3 487 5.0 13 732 Romania Centre Slovakia 48 1.8 48 1.8 25 1.0 46 1.8 44 1.7 71 2.7 75 2.8 76 2.9 81 3.1 64 2.4 757 Slovakia Centre Slovenia 45 4.6 40 4.0 31 3.1 48 4.7 44 4.3 40 3.9 46 4.5 43 4.2 55 5.4 37 3.6 737 Slovenia West Spain 2 893 21.0 3 022 18.7 3 192 19.8 3 003 18.6 3 293 17.7 3 706 16.1 3 743 16.4 3 595 15.7 3 348 14.7 2 736 12.0 39 992 Spain West Sweden 245 5.4 263 5.7 250 5.4 291 6.2 265 5.6 293 6.1 273 5.7 276 5.7 269 5.5 273 5.5 8 438 Sweden West United Kingdom 4 580 15.2 4 437 14.6 4 319 14.1 4 397 14.2 4 497 14.4 4 502 14.3 4 628 14.6 4 614 14.4 4 000 12.4 3 236 10.0 109 309 United Kingdom Total EU/EEA 22 725 10.0 23 465 9.8 23 734 9.8 24 020 10.0 25 459 10.4 25 561 10.3 25 540 10.2 25 299 10.1 23 826 9.4 19 032 9.0 472 975 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 35 2.3 45 3.0 28 1.9 55 3.7 58 3.9 82 5.6 61 4.1 67 4.5 104 7.0 69 4.7 798 Albania West Andorra 4 9.6 2 4.8 6 14.4 2 4.8 2 4.9 4 10.1 6 15.4 3 7.8 2 5.3 3 7.9 69 Andorra East Armenia 104 7.6 96 7.1 98 7.3 115 8.5 159 11.8 161 11.9 215 15.8 206 15.0 211 15.3 252 18.3 2 019 Armenia East Azerbaijan 350 8.0 377 8.5 365 8.2 410 9.0 356 7.7 329 7.1 375 7.9 495 10.3 354 7.3 361 7.4 4 937 Azerbaijan East Belarus 454 10.3 562 12.7 563 12.8 621 14.1 659 15.0 802 18.2 1 052 23.8 1 395 31.6 1 490 33.8 1 540 35.0 14 818 Belarus Centre Bosnia and Herzegovina 7 0.4 6 0.3 1 0.1 23 1.3 23 1.3 2 0.1 20 1.1 14 0.8 22 1.3 12 0.7 237 Bosnia and Herzegovina East Georgia 252 12.3 276 13.6 327 16.3 305 15.4 394 20.1 363 18.8 391 20.5 520 27.6 553 29.5 492 26.3 5 034 Georgia West Israel 250 7.1 267 7.4 287 7.8 296 7.9 350 9.2 346 8.9 325 8.3 289 7.2 252 6.2 292 7.1 6 356 Israel East Kazakhstan 1 640 21.2 1 392 17.8 1 252 15.8 1 207 15.0 1 167 14.3 1 203 14.4 1 334 15.8 1 443 16.8 1 684 19.3 1 824 20.7 21 065 Kazakhstan East Kyrgyzstan 309 11.9 514 19.5 399 14.9 422 15.5 406 14.7 292 10.4 369 12.9 364 12.5 446 15.1 491 16.4 5 170 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.3 1 5.3 0 0.0 3 15.8 26 Monaco Centre Montenegro 8 2.6 12 3.9 15 4.9 8 2.6 13 4.2 10 3.2 17 5.5 17 5.5 32 10.3 25 8.1 221 Montenegro East Republic of Moldova 438 22.2 400 20.3 341 17.4 377 19.2 375 19.1 381 19.5 454 23.2 460 23.5 472 24.2 474 24.4 6 840 Republic of Moldova East Russian Federation – – – – 36 172 54.5 – – – – – – – – – – – – – – 36 172 Russian Federation West San Marino 2 13.6 1 6.7 6 39.7 6 39.2 2 12.9 0 0.0 3 18.9 2 12.5 2 12.4 1 6.1 71 San Marino Centre Serbia 102 2.3 127 2.9 134 3.0 116 2.6 123 2.8 139 3.2 119 2.7 178 4.1 164 3.8 171 4.0 3 047 Serbia Centre Serbia excluding Kosovod 98 2.9 122 3.7 132 4.0 111 3.2 120 3.4 137 4.0 113 3.3 176 5.1 153 4.5 168 4.9 2 964 Serbia excluding Kosovod Centre Kosovod 4 0.4 5 0.5 2 0.2 5 0.6 3 0.3 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 83 Kosovod West Switzerland 550 14.6 468 12.3 444 11.5 422 10.8 462 11.7 421 10.5 385 9.5 408 9.9 412 9.9 341 8.1 22 924 Switzerland East Tajikistan 283 7.7 330 8.8 791 20.5 692 17.6 535 13.3 527 12.8 576 13.7 687 16.0 626 14.3 738 16.5 6 622 Tajikistan Centre The former Yugoslav Republic of Macedonia 3 0.3 6 0.6 5 0.5 0 0.0 10 1.0 15 1.4 29 2.8 24 2.3 28 2.7 44 4.2 176 The former Yugoslav Republic of Macedonia Centre Turkey 271 0.8 342 1.0 350 1.0 531 1.5 819 2.2 1 072 2.9 1 497 4.0 1 770 4.6 2 065 5.3 2 389 6.0 12 633 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 1 Turkmenistan East Ukraine 8 641 40.5 9 089 42.8 9 521 45.0 9 472 45.0 9 400 44.9 10 011 48.1 8 991 43.4 7 519 38.0 8 389 42.5 9 351 47.6 155 814 Ukraine East Uzbekistan 1 830 13.3 2 248 16.1 2 062 14.5 – – – – – – – – – – – – – – 16 234 Uzbekistan Total non-EU/EEA 15 533 13.6 16 560 14.4 53 167 29.1 15 080 14.8 15 313 14.8 16 160 15.5 16 220 15.4 15 862 15.0 17 308 16.3 18 873 17.6 321 284 Total non-EU/EEA WHO European Region WHO European Region West 21 464 11.7 22 048 11.2 22 291 11.3 22 091 11.2 23 452 11.7 23 394 11.3 23 344 11.2 22 840 10.9 21 397 10.2 16 541 9.7 445 566 West Centre 1 882 2.1 2 148 2.3 2 192 2.4 2 831 3.1 3 328 3.6 3 730 4.0 4 150 4.4 4 686 4.9 4 976 5.2 5 234 5.4 60 041 Centre East 14 912 22.4 15 828 23.7 52 416 39.3 14 177 26.8 13 992 26.3 14 597 27.4 14 265 26.7 13 635 25.8 14 759 27.8 16 130 30.3 288 611 East Total WHO European Region 38 258 11.2 40 024 11.3 76 899 18.1 39 099 11.4 40 772 11.7 41 721 11.8 41 759 11.7 41 161 11.5 41 132 11.5 37 905 11.9 794 218 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 64 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 3. HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 89 2.1 75 1.8 66 1.5 73 1.7 72 1.7 44 1.0 58 1.3 37 0.8 45 1.0 45 1.0 2 263 Austria West Belgium 339 6.2 374 6.8 393 7.1 388 6.9 389 6.9 337 5.9 316 5.6 312 5.5 258 4.5 278 4.8 10 838 Belgium Centre Bulgaria 21 0.5 38 1.0 31 0.8 38 1.0 34 0.9 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 571 Bulgaria Centre Croatia 3 0.1 6 0.3 3 0.1 11 0.5 3 0.1 8 0.4 9 0.4 6 0.3 5 0.2 5 0.2 182 Croatia Centre Cyprus 13 3.3 12 2.9 7 1.7 15 3.5 9 2.0 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 301 Cyprus Centre Czech Republic 27 0.5 26 0.5 21 0.4 14 0.3 27 0.5 24 0.4 23 0.4 18 0.3 24 0.4 22 0.4 445 Czech Republic West Denmark 81 2.9 57 2.1 74 2.7 74 2.6 54 1.9 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 2 030 Denmark East Estonia 230 32.1 168 23.5 146 20.5 140 19.7 106 15.0 125 17.8 109 15.6 103 14.7 90 12.9 73 10.4 3 201 Estonia West Finland 42 1.6 66 2.4 54 2.0 60 2.2 45 1.6 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 1 084 Finland West France 1 999 6.1 1 842 5.5 1 880 5.6 1 827 5.5 1 829 5.4 1 814 5.4 1 837 5.4 1 708 5.0 1 801 5.2 1 767 5.1 29 247 France West Germanyc 462 1.1 455 1.1 396 0.9 416 1.0 452 1.1 578 1.4 657 1.6 753 1.8 710 1.7 – – 11 722 Germanyc West Greece 105 1.9 96 1.7 78 1.4 142 2.5 177 3.1 88 1.6 100 1.8 90 1.6 111 2.0 106 1.9 2 820 Greece Centre Hungary 9 0.2 15 0.3 9 0.2 12 0.2 14 0.3 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 361 Hungary West Iceland 3 1.9 9 5.7 7 4.4 11 6.9 6 3.8 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 104 Iceland West Ireland 146 6.5 137 6.0 89 3.9 89 3.9 98 4.2 85 3.7 104 4.5 110 4.7 115 4.8 116 4.9 2 553 Ireland West Italy 668 3.5 952 3.2 986 3.2 971 3.2 887 2.9 837 2.7 787 2.5 811 2.6 840 2.7 820 2.6 10 642 Italy East Latvia 127 10.7 105 9.0 104 9.0 103 9.1 121 10.9 137 12.5 111 10.2 129 12.0 135 12.7 130 12.2 2 358 Latvia Liechtenstein 0 0.0 0 0.0 2 11.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 Liechtenstein East Lithuania 30 1.7 49 2.9 28 1.7 32 1.9 46 2.8 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 610 Lithuania West Luxembourg 11 4.5 19 7.6 18 7.1 15 5.8 18 6.8 13 4.8 31 11.3 14 5.0 14 4.9 16 5.6 428 Luxembourg West Malta 11 5.4 9 4.4 2 1.0 4 1.9 7 3.3 6 2.8 4 1.9 8 3.7 11 5.1 10 4.6 96 Malta West Netherlands 211 2.5 213 2.6 196 2.3 175 2.1 181 2.1 147 1.7 139 1.6 141 1.7 114 1.3 97 1.1 5 069 Netherlands West Norway 117 4.9 99 4.1 85 3.5 79 3.2 76 3.1 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 2 017 Norway Centre Poland 149 0.8 161 0.8 156 0.8 159 0.8 159 0.8 148 0.8 186 0.9 175 0.9 140 0.7 148 0.8 4 279 Poland West Portugal 713 13.0 662 12.0 644 11.7 530 9.6 501 9.1 486 8.8 383 7.0 354 6.5 371 6.8 300 5.5 16 080 Portugal Centre Romania 252 2.4 231 2.2 220 2.1 255 2.5 249 2.4 285 2.8 258 2.5 229 2.3 197 1.9 174 1.7 9 331 Romania Centre Slovakia 5 0.2 5 0.2 3 0.1 3 0.1 6 0.2 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 112 Slovakia Centre Slovenia 3 0.3 8 0.8 4 0.4 7 0.7 3 0.3 6 0.6 4 0.4 7 0.7 2 0.2 2 0.2 98 Slovenia West Spain 737 5.2 746 4.5 692 4.1 638 3.8 600 3.1 625 2.6 653 2.8 586 2.5 615 2.6 513 2.2 8 644 Spain West Sweden 146 3.2 139 3.0 170 3.6 169 3.6 175 3.7 163 3.4 198 4.1 171 3.5 160 3.3 161 3.3 4 122 Sweden West United Kingdom 2 594 8.3 2 152 6.8 1 996 6.3 1 747 5.4 1 708 5.3 1 476 4.5 1 544 4.7 1 414 4.3 1 270 3.8 1 117 3.4 45 818 United Kingdom Total EU/EEA 9 343 3.9 8 926 3.5 8 560 3.4 8 197 3.2 8 052 3.1 7 748 3.0 7 819 3.0 7 488 2.8 7 334 2.8 6 178 2.8 177 449 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 17 1.1 19 1.3 15 1.0 23 1.6 23 1.6 38 2.6 18 1.2 29 2.0 23 1.6 25 1.7 303 Albania West Andorra 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 0 0.0 0 0.0 3 7.6 14 Andorra East Armenia 32 2.1 53 3.5 51 3.3 67 4.4 70 4.6 77 5.0 118 7.7 89 5.8 92 5.9 102 6.6 888 Armenia East Azerbaijan 84 1.9 78 1.7 94 2.1 138 3.0 161 3.5 185 3.9 229 4.8 232 4.8 202 4.1 209 4.2 1 818 Azerbaijan East Belarus 427 8.4 510 10.0 506 10.0 575 11.3 564 11.1 731 14.4 759 15.0 910 17.9 901 17.8 928 18.3 9 868 Belarus Centre Bosnia and Herzegovina 2 0.1 0 0.0 0 0.0 4 0.2 2 0.1 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 41 Bosnia and Herzegovina East Georgia 106 4.6 115 5.1 133 6.0 124 5.7 149 6.9 119 5.6 151 7.2 163 7.9 166 8.1 139 6.8 1 728 Georgia West Israel 144 4.0 121 3.3 131 3.5 151 3.9 130 3.3 116 2.9 125 3.1 120 3.0 109 2.6 113 2.7 3 124 Israel East Kazakhstan 677 8.2 685 8.2 730 8.6 791 9.2 837 9.6 928 10.5 1 008 11.2 1 035 11.3 1 215 13.1 1 195 12.7 11 498 Kazakhstan East Kyrgyzstan 182 6.8 182 6.7 168 6.1 192 6.9 295 10.4 211 7.4 280 9.6 289 9.8 318 10.6 349 11.5 2 780 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Monaco Centre Montenegro 3 1.0 2 0.6 0 0.0 1 0.3 1 0.3 0 0.0 3 0.9 2 0.6 2 0.6 1 0.3 33 Montenegro East Republic of Moldova 355 16.6 304 14.3 362 17.1 344 16.3 382 18.1 325 15.4 379 17.9 356 16.9 361 17.1 362 17.2 5 000 Republic of Moldova East Russian Federation – – – – 26 409 34.4 – – – – – – – – – – – – – – 26 409 Russian Federation West San Marino 2 12.8 0 0.0 0 0.0 2 12.3 3 18.3 1 6.0 0 0.0 0 0.0 0 0.0 0 0.0 19 San Marino Centre Serbia 20 0.4 10 0.2 17 0.4 18 0.4 12 0.3 14 0.3 17 0.4 6 0.1 15 0.3 10 0.2 731 Serbia Centre Serbia excluding Kosovocd 20 0.6 9 0.3 16 0.5 17 0.5 11 0.3 13 0.4 17 0.5 5 0.1 15 0.4 10 0.3 701 Serbia excluding Kosovocd Centre Kosovod 0 0.0 1 0.1 1 0.1 1 0.1 1 0.1 1 0.1 0 0.0 1 0.1 0 0.0 0 0.0 30 Kosovod West Switzerland 203 5.2 180 4.6 160 4.0 132 3.3 150 3.7 151 3.7 124 3.0 122 2.9 112 2.6 99 2.3 10 317 Switzerland East Tajikistan 81 2.2 116 3.1 211 5.6 295 7.6 293 7.4 344 8.5 433 10.4 470 11.1 417 9.6 470 10.6 3 334 Tajikistan Centre The former Yugoslav Republic of Macedonia 1 0.1 0 0.0 0 0.0 0 0.0 4 0.4 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 18 The former Yugoslav Republic of Macedonia Centre Turkey 122 0.3 128 0.4 139 0.4 166 0.4 249 0.7 241 0.6 341 0.9 337 0.8 373 0.9 455 1.1 3 355 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 1 Turkmenistan East Ukraine 6 582 26.5 7 002 28.3 6 915 28.0 7 697 31.4 7 301 29.9 7 722 31.8 6 683 27.7 5 481 23.9 5 873 25.7 6 329 27.8 104 747 Ukraine East Uzbekistan 1 231 8.8 1 807 12.8 1 733 12.1 – – – – – – – – – – – – – – 7 783 Uzbekistan Total non-EU/EEA 10 271 8.5 11 312 9.5 37 774 19.2 10 720 9.9 10 627 9.6 11 204 10.3 10 671 9.7 9 643 8.6 10 182 9.1 10 789 9.8 193 823 Total non-EU/EEA WHO European Region WHO European Region West 8 823 4.6 8 403 4.1 8 117 3.9 7 693 3.7 7 559 3.6 7 156 3.3 7 233 3.3 6 944 3.2 6 837 3.1 5 729 3.2 169 065 West Centre 647 0.7 661 0.7 625 0.7 726 0.8 795 0.8 840 0.9 946 1.0 888 0.9 860 0.9 909 0.9 20 161 Centre East 10 144 14.0 11 174 15.4 37 590 25.1 10 498 17.9 10 325 17.5 10 956 18.6 10 311 17.4 9 299 15.9 9 819 16.8 10 329 17.6 182 023 East Total WHO European Region 19 614 5.5 20 238 5.4 46 332 10.3 18 917 5.2 18 679 5.1 18 952 5.1 18 490 5.0 17 131 4.6 17 516 4.7 16 967 5.1 371 249 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 65 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 3. HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 89 2.1 75 1.8 66 1.5 73 1.7 72 1.7 44 1.0 58 1.3 37 0.8 45 1.0 45 1.0 2 263 Austria West Belgium 339 6.2 374 6.8 393 7.1 388 6.9 389 6.9 337 5.9 316 5.6 312 5.5 258 4.5 278 4.8 10 838 Belgium Centre Bulgaria 21 0.5 38 1.0 31 0.8 38 1.0 34 0.9 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 571 Bulgaria Centre Croatia 3 0.1 6 0.3 3 0.1 11 0.5 3 0.1 8 0.4 9 0.4 6 0.3 5 0.2 5 0.2 182 Croatia Centre Cyprus 13 3.3 12 2.9 7 1.7 15 3.5 9 2.0 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 301 Cyprus Centre Czech Republic 27 0.5 26 0.5 21 0.4 14 0.3 27 0.5 24 0.4 23 0.4 18 0.3 24 0.4 22 0.4 445 Czech Republic West Denmark 81 2.9 57 2.1 74 2.7 74 2.6 54 1.9 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 2 030 Denmark East Estonia 230 32.1 168 23.5 146 20.5 140 19.7 106 15.0 125 17.8 109 15.6 103 14.7 90 12.9 73 10.4 3 201 Estonia West Finland 42 1.6 66 2.4 54 2.0 60 2.2 45 1.6 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 1 084 Finland West France 1 999 6.1 1 842 5.5 1 880 5.6 1 827 5.5 1 829 5.4 1 814 5.4 1 837 5.4 1 708 5.0 1 801 5.2 1 767 5.1 29 247 France West Germanyc 462 1.1 455 1.1 396 0.9 416 1.0 452 1.1 578 1.4 657 1.6 753 1.8 710 1.7 – – 11 722 Germanyc West Greece 105 1.9 96 1.7 78 1.4 142 2.5 177 3.1 88 1.6 100 1.8 90 1.6 111 2.0 106 1.9 2 820 Greece Centre Hungary 9 0.2 15 0.3 9 0.2 12 0.2 14 0.3 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 361 Hungary West Iceland 3 1.9 9 5.7 7 4.4 11 6.9 6 3.8 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 104 Iceland West Ireland 146 6.5 137 6.0 89 3.9 89 3.9 98 4.2 85 3.7 104 4.5 110 4.7 115 4.8 116 4.9 2 553 Ireland West Italy 668 3.5 952 3.2 986 3.2 971 3.2 887 2.9 837 2.7 787 2.5 811 2.6 840 2.7 820 2.6 10 642 Italy East Latvia 127 10.7 105 9.0 104 9.0 103 9.1 121 10.9 137 12.5 111 10.2 129 12.0 135 12.7 130 12.2 2 358 Latvia Liechtenstein 0 0.0 0 0.0 2 11.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 Liechtenstein East Lithuania 30 1.7 49 2.9 28 1.7 32 1.9 46 2.8 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 610 Lithuania West Luxembourg 11 4.5 19 7.6 18 7.1 15 5.8 18 6.8 13 4.8 31 11.3 14 5.0 14 4.9 16 5.6 428 Luxembourg West Malta 11 5.4 9 4.4 2 1.0 4 1.9 7 3.3 6 2.8 4 1.9 8 3.7 11 5.1 10 4.6 96 Malta West Netherlands 211 2.5 213 2.6 196 2.3 175 2.1 181 2.1 147 1.7 139 1.6 141 1.7 114 1.3 97 1.1 5 069 Netherlands West Norway 117 4.9 99 4.1 85 3.5 79 3.2 76 3.1 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 2 017 Norway Centre Poland 149 0.8 161 0.8 156 0.8 159 0.8 159 0.8 148 0.8 186 0.9 175 0.9 140 0.7 148 0.8 4 279 Poland West Portugal 713 13.0 662 12.0 644 11.7 530 9.6 501 9.1 486 8.8 383 7.0 354 6.5 371 6.8 300 5.5 16 080 Portugal Centre Romania 252 2.4 231 2.2 220 2.1 255 2.5 249 2.4 285 2.8 258 2.5 229 2.3 197 1.9 174 1.7 9 331 Romania Centre Slovakia 5 0.2 5 0.2 3 0.1 3 0.1 6 0.2 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 112 Slovakia Centre Slovenia 3 0.3 8 0.8 4 0.4 7 0.7 3 0.3 6 0.6 4 0.4 7 0.7 2 0.2 2 0.2 98 Slovenia West Spain 737 5.2 746 4.5 692 4.1 638 3.8 600 3.1 625 2.6 653 2.8 586 2.5 615 2.6 513 2.2 8 644 Spain West Sweden 146 3.2 139 3.0 170 3.6 169 3.6 175 3.7 163 3.4 198 4.1 171 3.5 160 3.3 161 3.3 4 122 Sweden West United Kingdom 2 594 8.3 2 152 6.8 1 996 6.3 1 747 5.4 1 708 5.3 1 476 4.5 1 544 4.7 1 414 4.3 1 270 3.8 1 117 3.4 45 818 United Kingdom Total EU/EEA 9 343 3.9 8 926 3.5 8 560 3.4 8 197 3.2 8 052 3.1 7 748 3.0 7 819 3.0 7 488 2.8 7 334 2.8 6 178 2.8 177 449 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 17 1.1 19 1.3 15 1.0 23 1.6 23 1.6 38 2.6 18 1.2 29 2.0 23 1.6 25 1.7 303 Albania West Andorra 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 0 0.0 0 0.0 3 7.6 14 Andorra East Armenia 32 2.1 53 3.5 51 3.3 67 4.4 70 4.6 77 5.0 118 7.7 89 5.8 92 5.9 102 6.6 888 Armenia East Azerbaijan 84 1.9 78 1.7 94 2.1 138 3.0 161 3.5 185 3.9 229 4.8 232 4.8 202 4.1 209 4.2 1 818 Azerbaijan East Belarus 427 8.4 510 10.0 506 10.0 575 11.3 564 11.1 731 14.4 759 15.0 910 17.9 901 17.8 928 18.3 9 868 Belarus Centre Bosnia and Herzegovina 2 0.1 0 0.0 0 0.0 4 0.2 2 0.1 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 41 Bosnia and Herzegovina East Georgia 106 4.6 115 5.1 133 6.0 124 5.7 149 6.9 119 5.6 151 7.2 163 7.9 166 8.1 139 6.8 1 728 Georgia West Israel 144 4.0 121 3.3 131 3.5 151 3.9 130 3.3 116 2.9 125 3.1 120 3.0 109 2.6 113 2.7 3 124 Israel East Kazakhstan 677 8.2 685 8.2 730 8.6 791 9.2 837 9.6 928 10.5 1 008 11.2 1 035 11.3 1 215 13.1 1 195 12.7 11 498 Kazakhstan East Kyrgyzstan 182 6.8 182 6.7 168 6.1 192 6.9 295 10.4 211 7.4 280 9.6 289 9.8 318 10.6 349 11.5 2 780 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Monaco Centre Montenegro 3 1.0 2 0.6 0 0.0 1 0.3 1 0.3 0 0.0 3 0.9 2 0.6 2 0.6 1 0.3 33 Montenegro East Republic of Moldova 355 16.6 304 14.3 362 17.1 344 16.3 382 18.1 325 15.4 379 17.9 356 16.9 361 17.1 362 17.2 5 000 Republic of Moldova East Russian Federation – – – – 26 409 34.4 – – – – – – – – – – – – – – 26 409 Russian Federation West San Marino 2 12.8 0 0.0 0 0.0 2 12.3 3 18.3 1 6.0 0 0.0 0 0.0 0 0.0 0 0.0 19 San Marino Centre Serbia 20 0.4 10 0.2 17 0.4 18 0.4 12 0.3 14 0.3 17 0.4 6 0.1 15 0.3 10 0.2 731 Serbia Centre Serbia excluding Kosovocd 20 0.6 9 0.3 16 0.5 17 0.5 11 0.3 13 0.4 17 0.5 5 0.1 15 0.4 10 0.3 701 Serbia excluding Kosovocd Centre Kosovod 0 0.0 1 0.1 1 0.1 1 0.1 1 0.1 1 0.1 0 0.0 1 0.1 0 0.0 0 0.0 30 Kosovod West Switzerland 203 5.2 180 4.6 160 4.0 132 3.3 150 3.7 151 3.7 124 3.0 122 2.9 112 2.6 99 2.3 10 317 Switzerland East Tajikistan 81 2.2 116 3.1 211 5.6 295 7.6 293 7.4 344 8.5 433 10.4 470 11.1 417 9.6 470 10.6 3 334 Tajikistan Centre The former Yugoslav Republic of Macedonia 1 0.1 0 0.0 0 0.0 0 0.0 4 0.4 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 18 The former Yugoslav Republic of Macedonia Centre Turkey 122 0.3 128 0.4 139 0.4 166 0.4 249 0.7 241 0.6 341 0.9 337 0.8 373 0.9 455 1.1 3 355 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 1 Turkmenistan East Ukraine 6 582 26.5 7 002 28.3 6 915 28.0 7 697 31.4 7 301 29.9 7 722 31.8 6 683 27.7 5 481 23.9 5 873 25.7 6 329 27.8 104 747 Ukraine East Uzbekistan 1 231 8.8 1 807 12.8 1 733 12.1 – – – – – – – – – – – – – – 7 783 Uzbekistan Total non-EU/EEA 10 271 8.5 11 312 9.5 37 774 19.2 10 720 9.9 10 627 9.6 11 204 10.3 10 671 9.7 9 643 8.6 10 182 9.1 10 789 9.8 193 823 Total non-EU/EEA WHO European Region WHO European Region West 8 823 4.6 8 403 4.1 8 117 3.9 7 693 3.7 7 559 3.6 7 156 3.3 7 233 3.3 6 944 3.2 6 837 3.1 5 729 3.2 169 065 West Centre 647 0.7 661 0.7 625 0.7 726 0.8 795 0.8 840 0.9 946 1.0 888 0.9 860 0.9 909 0.9 20 161 Centre East 10 144 14.0 11 174 15.4 37 590 25.1 10 498 17.9 10 325 17.5 10 956 18.6 10 311 17.4 9 299 15.9 9 819 16.8 10 329 17.6 182 023 East Total WHO European Region 19 614 5.5 20 238 5.4 46 332 10.3 18 917 5.2 18 679 5.1 18 952 5.1 18 490 5.0 17 131 4.6 17 516 4.7 16 967 5.1 371 249 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 66 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 4. New HIV diagnoses in men infected through sex between men, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 171 155 173 173 179 160 137 156 152 158 3 692 West Belgium 387 391 432 430 435 464 393 403 375 306 7 839 Centre Bulgaria 17 28 32 47 59 72 97 111 96 120 748 Centre Croatia 53 42 61 47 65 70 79 99 95 97 1 015 Centre Cyprus 9 9 22 27 31 35 39 51 47 47 505 Centre Czech Republic 95 107 131 113 155 180 171 210 213 181 2 145 West Denmark 133 108 112 113 82 116 132 126 121 123 3 163 East Estonia 0 0 1 2 1 9 3 18 9 16 152 West Finland 49 43 48 36 47 43 55 53 48 32 1 207 West France 1 499 1 442 1 515 1 430 1 625 1 614 1 677 1 479 1 360 1 239 21 343 West Germanyc 1 575 1 646 1 584 1 458 1 695 1 727 1 894 1 867 1 725 – 28 716 West Greece 345 354 399 362 356 394 400 445 310 292 8 074 Centre Hungary 93 87 126 106 149 163 175 133 118 110 2 019 West Iceland 2 2 5 0 1 0 0 0 8 4 117 West Ireland 105 138 134 145 173 155 181 252 275 249 2 875 West Italy 718 1 190 1 258 1 282 1 581 1 515 1 552 1 459 1 389 1 324 15 135 East Latvia 21 14 18 20 18 27 28 33 24 24 394 Liechtenstein 0 0 0 0 0 0 1 0 0 0 3 East Lithuania 9 11 7 12 11 31 12 28 27 18 250 West Luxembourg 30 27 26 31 32 32 27 21 24 15 616 West Malta 0 4 6 4 8 16 25 45 38 23 184 West Netherlands 876 797 807 791 736 755 628 588 531 474 15 333 West Norway 92 87 85 97 76 98 115 70 87 88 2 081 Centre Poland 64 86 167 318 353 280 336 358 401 318 3 502 West Portugal 478 447 469 497 526 501 414 518 475 391 10 266 Centre Romania 50 61 68 107 92 96 135 125 137 132 1 192 Centre Slovakia 33 35 21 32 28 58 53 55 60 50 562 Centre Slovenia 34 29 28 35 35 27 34 35 46 26 542 West Spain 1 737 1 787 1 919 1 862 2 020 2 235 2 453 2 316 2 155 1 742 23 629 West Sweden 106 115 102 106 137 147 119 118 136 128 4 088 West United Kingdom 2 682 2 727 2 738 2 843 3 033 3 043 3 126 3 037 2 467 1 967 70 088 Total EU/EEA 11 463 11 969 12 494 12 526 13 739 14 063 14 491 14 209 12 949 9 694 231 475 Non-EU/EEA Centre Albania 7 6 5 15 9 11 9 13 11 6 121 West Andorra 4 1 3 1 1 3 5 2 2 2 34 East Armenia 3 5 0 4 4 13 10 12 15 17 91 East Azerbaijan 2 2 7 5 13 11 11 34 16 38 152 East Belarus 5 9 14 29 31 41 53 58 71 72 416 Centre Bosnia and Herzegovina 1 3 0 12 21 2 16 10 18 9 114 East Georgia 5 7 27 24 44 69 66 159 130 130 705 West Israel 125 142 145 159 156 171 151 139 128 145 2 453 East Kazakhstan 14 20 20 26 20 37 45 80 120 143 563 East Kyrgyzstan 0 0 0 0 3 14 17 20 35 45 136 West Monaco 0 0 0 0 0 0 1 1 0 2 18 Centre Montenegro 6 6 11 5 8 6 13 14 25 22 141 East Republic of Moldova 2 12 6 5 4 4 9 10 18 29 115 East Russian Federationd – – – – – – – – – – – West San Marino 0 0 0 4 0 0 0 0 0 0 21 Centre Serbia 72 84 81 68 86 97 84 134 114 119 1 353 Centre Serbia excluding Kosovoe 68 84 81 67 84 96 79 132 111 119 1 333 Centre Kosovoe 4 0 0 1 2 1 5 2 3 0 20 West Switzerland 265 250 245 211 228 198 220 208 233 168 5 301 East Tajikistan 0 0 0 1 1 0 3 3 12 12 32 Centre The former Yugoslav Republic of Macedonia 0 3 5 1 7 13 26 21 18 34 136 Centre Turkey 0 2 32 59 142 187 281 350 403 494 2 134 East Turkmenistan 0 0 0 0 0 – – – – – 0 East Ukraine 65 94 90 143 152 262 277 368 436 492 2 537 East Uzbekistan 0 1 0 – – – – – – – 29 Total non-EU/EEA 576 647 691 772 930 1 139 1 297 1 636 1 805 1 979 16 602 WHO European Region West 11 379 11 853 12 205 12 035 13 127 13 387 13 705 13 303 12 039 8 872 226 273 Centre 534 588 790 992 1 240 1 297 1 548 1 719 1 802 1 765 16 229 East 126 175 190 271 302 518 534 823 913 1 036 5 572 Total WHO European Region 12 039 12 616 13 185 13 298 14 669 15 202 15 787 15 845 14 754 11 673 248 074 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d No official data were reported by the Russian Federation. Latest available data on the number of new HIV diagnoses in men infected through sex between men was obtained from the Federal Scientific and Methodological Centre for Prevention and Control of AIDS (number (year)): 278 (2008), 370 (2009), 360 (2010), 385 (2011), 302 (2012), 383 (2013), 559 (2014), 695 (2015). Reference (4), Chapter 2. e (in accordance with Security Council resolution 1244 (1999)). 67 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 5. New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2008– 2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of diagnosis Cumulative total**2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 46 37 47 49 50 28 29 27 18 12 2 024 West Belgium 21 15 17 19 16 18 15 16 4 7 762 Centre Bulgaria 54 74 56 63 40 33 48 28 22 31 557 Centre Croatia 1 0 2 4 0 0 0 2 0 0 67 Centre Cyprus 1 0 0 0 0 0 3 1 2 0 15 Centre Czech Republic 8 4 5 9 6 6 10 6 7 5 125 West Denmark 13 14 8 10 11 13 11 8 9 6 553 East Estonia 36 85 118 110 86 81 67 55 30 14 4 169 West Finland 7 13 8 8 7 3 7 7 6 10 404 West France 143 131 129 120 128 108 100 76 58 43 1 962 West Germanyc 115 91 79 77 80 99 111 136 127 – 3 690 West Greece 10 18 29 319 523 270 120 94 98 86 1 900 Centre Hungary 2 0 0 0 0 1 1 2 3 1 30 West Iceland 0 5 9 12 3 1 1 0 9 3 65 West Ireland 40 30 23 18 16 22 30 47 21 14 1 650 West Italy 213 281 268 186 216 179 142 118 103 94 2 512 East Latvia 100 78 86 90 94 77 74 88 62 78 3 345 Liechtenstein 0 0 0 1 0 0 0 0 0 0 5 East Lithuania 44 118 108 90 68 64 38 44 84 136 1 785 West Luxembourg 5 2 1 1 5 6 17 14 19 9 212 West Malta 2 0 0 0 0 3 0 0 1 0 10 West Netherlands 8 9 8 6 7 5 1 2 1 2 784 West Norway 12 11 11 10 11 8 7 8 8 7 634 Centre Poland 60 69 47 72 49 46 50 51 36 27 6 352 West Portugal 370 277 221 145 134 115 60 61 42 18 19 136 Centre Romania 8 19 23 179 305 318 180 165 103 86 1 440 Centre Slovakia 3 1 2 1 1 0 1 3 1 0 17 Centre Slovenia 0 0 0 0 1 2 2 1 1 0 20 West Spain 287 312 253 235 206 187 154 117 141 105 3 561 West Sweden 22 24 23 15 22 13 14 15 26 20 1 267 West United Kingdom 171 139 145 127 119 124 136 184 133 115 6 280 Total EU/EEA 1 802 1 857 1 726 1 976 2 204 1 830 1 429 1 376 1 175 929 65 333 Non-EU/EEA Centre Albania 0 1 0 0 1 0 1 0 0 0 5 West Andorra 0 0 0 0 0 0 0 0 0 0 11 East Armenia 36 46 49 41 44 32 42 36 35 38 655 East Azerbaijan 288 293 276 319 218 205 184 179 153 87 3 063 East Belarus 195 212 223 254 247 201 376 790 600 485 8 812 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 20 East Georgia 202 223 215 190 235 169 176 165 206 148 2 853 West Israel 41 42 40 41 78 71 44 39 25 32 1 257 East Kazakhstan 1 491 1 250 1 100 922 793 730 779 827 896 900 16 677 East Kyrgyzstan 294 466 347 355 255 188 183 172 200 204 3 725 West Monaco 0 0 0 0 0 0 0 0 0 0 8 Centre Montenegro 0 0 0 0 1 0 0 0 0 1 6 East Republic of Moldova 136 62 59 61 40 20 61 38 40 42 2 882 East Russian Federationd – – – – – – – – – – – West San Marino 0 0 0 0 0 0 0 0 0 0 11 Centre Serbia 10 10 6 9 5 11 5 4 1 4 979 Centre Serbia excluding Kosovoe 10 9 6 9 5 11 5 4 1 4 977 Centre Kosovoe – 1 – – – – – – – – 2 West Switzerland 30 26 20 21 24 13 8 10 12 20 2 885 East Tajikistan 211 262 682 472 292 239 242 250 195 246 3 841 Centre The former Yugoslav Republic of Macedonia 0 0 0 0 0 0 0 0 0 0 2 Centre Turkey 0 1 0 6 6 4 10 13 8 14 144 East Turkmenistan 0 0 0 0 0 – – – – – 0 East Ukraine 7 009 7 105 6 934 6 588 5 933 5 847 4 670 3 449 3 707 3 997 121 038 East Uzbekistan 1 561 612 1 850 – – – – – – – 11 390 Total non-EU/EEA 11 504 10 611 11 801 9 279 8 172 7 730 6 781 5 972 6 078 6 218 180 264 WHO European Region West West 1 556 1 477 1 339 1 419 1 656 1 286 1 007 979 861 603 51 578 Centre Centre 147 179 141 343 415 421 311 276 184 169 9 779 East East 11 603 10 812 12 047 9 492 8 305 7 853 6 892 6 093 6 208 6 375 184 235 Total WHO European Region 13 306 12 468 13 527 11 254 10 376 9 560 8 210 7 348 7 253 7 147 245 592 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d No official data were reported by the Russian Federation. Latest available data on the number of new HIV diagnoses in people infected through injecting drug use was obtained from the Federal Scientific and Methodological Centre for Prevention and Control of AIDS (number (year)): 17099 (2008), 16370 (2009), 16673 (2010), 17418 (2011), 18546 (2012), 20637 (2013), 23566 (2014), 23737 (2015). Reference (4), Chapter 2. e (in accordance with Security Council resolution 1244 (1999)). 68 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 6. New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 144 129 104 108 111 85 89 93 73 78 3 005 West Belgium 421 447 465 475 500 418 403 359 337 306 11 249 Centre Bulgaria 52 68 71 89 58 70 94 87 84 87 1 364 Centre Croatia 16 12 7 21 7 13 12 13 13 8 383 Centre Cyprus 22 27 15 23 23 16 10 26 27 32 566 Centre Czech Republic 43 43 38 26 41 45 45 45 53 58 761 West Denmark 122 105 141 132 96 90 102 126 100 93 3 343 East Estonia 3 17 173 146 170 188 162 144 116 89 1 568 West Finland 59 91 94 88 71 67 70 79 83 70 1 592 West France 2 498 2 275 2 216 2 062 2 190 2 170 2 184 1 762 1 591 1 432 33 503 West Germanyc 511 506 444 511 481 584 771 961 865 – 13 679 West Greece 170 131 123 152 157 124 142 128 141 139 3 586 Centre Hungary 17 23 18 19 24 24 28 22 28 22 487 West Iceland 6 8 10 6 0 0 0 0 9 2 111 West Ireland 190 166 127 126 135 134 126 126 144 142 3 269 West Italy 1 154 1 861 1 882 1 822 1 771 1 697 1 663 1 637 1 739 1 578 20 217 East Latvia 164 133 131 144 112 125 132 150 138 131 2 037 Liechtenstein 0 1 3 0 0 0 0 0 1 0 13 East Lithuania 29 39 29 38 51 55 72 63 67 65 672 West Luxembourg 26 32 32 27 28 26 33 26 25 30 671 West Malta 24 9 10 13 15 10 9 15 21 17 182 West Netherlands 364 350 355 302 305 253 236 261 208 161 7 857 West Norway 185 170 157 155 142 123 140 138 120 115 3 320 Centre Poland 69 84 108 93 102 90 108 112 108 94 1 767 West Portugal 1 337 1 264 1 200 1 061 1 007 1 000 816 727 750 612 26 549 Centre Romania 303 318 313 351 356 371 403 432 457 428 6 725 Centre Slovakia 8 9 4 12 14 21 18 23 18 15 207 Centre Slovenia 4 6 7 8 4 9 5 9 9 10 139 West Spain 1 277 1 269 1 264 1 110 1 134 1 152 1 096 1 012 1 000 933 15 275 West Sweden 194 194 222 260 227 218 229 211 202 212 5 657 West United Kingdom 3 821 3 226 2 995 2 774 2 576 2 238 2 264 1 973 1 837 1 443 66 898 Total EU/EEA 13 233 13 013 12 758 12 154 11 908 11 416 11 462 10 760 10 364 8 402 236 652 Non-EU/EEA Centre Albania 43 52 34 60 66 101 62 77 115 87 910 West Andorra 0 1 2 1 1 1 0 0 0 2 23 East Armenia 86 83 86 127 162 176 263 231 240 281 1 978 East Azerbaijan 101 117 131 191 244 272 376 438 334 334 2 867 East Belarus 656 823 789 881 919 1 265 1 349 1 416 1 671 1 868 14 909 Centre Bosnia and Herzegovina 8 3 1 14 4 0 7 4 6 2 123 East Georgia 134 152 204 205 247 236 291 347 372 341 3 024 West Israel 200 177 206 206 197 172 197 199 189 167 4 832 East Kazakhstan 666 733 794 987 1 112 1 266 1 390 1 440 1 745 1 868 13 743 East Kyrgyzstan 162 173 186 181 307 276 392 404 421 490 3 338 West Monaco 0 0 0 0 1 0 0 0 0 1 13 Centre Montenegro 4 6 3 4 5 1 4 3 9 3 84 East Republic of Moldova 588 574 606 613 664 325 618 576 548 561 7 385 East Russian Federationd – – – – – – – – – – 0 West San Marino 0 0 0 4 3 0 0 0 0 0 23 Centre Serbia 27 26 38 42 29 22 34 28 35 29 850 Centre Serbia excluding Kosovoe 27 23 35 37 28 20 33 28 30 27 792 Centre Kosovoe 3 3 5 1 2 1 0 5 2 58 West Switzerland 278 253 222 210 219 223 174 181 163 131 6 950 East Tajikistan 139 169 293 434 388 497 617 720 667 779 4 965 Centre The former Yugoslav Republic of Macedonia 3 2 0 0 7 2 4 4 10 8 53 Centre Turkey 273 217 195 263 376 428 495 583 646 775 5 619 East Turkmenistan 0 0 0 0 0 – – – – – 0 East Ukraine 7 780 8 541 9 122 10 248 10 440 11 472 10 648 9 043 10 018 11 075 131 296 East Uzbekistan 716 955 852 – – – – – – – 4 711 Total non-EU/EEA 11 864 13 057 13 764 14 671 15 391 16 735 16 921 15 694 17 189 18 802 207 696 WHO European Region West 12 981 12 664 12 271 11 605 11 367 10 785 10 744 10 014 9 597 7 664 231 804 Centre 892 896 852 1 025 1 116 1 213 1 329 1 468 1 618 1 658 20 038 East 11 224 12 509 13 396 14 195 14 816 16 153 16 310 14 972 16 337 17 882 192 493 Total WHO European Region 25 097 26 069 26 519 26 825 27 299 28 151 28 383 26 454 27 552 27 204 444 335 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d No official data were reported by the Russian Federation. Latest available data on the number of new HIV diagnoses in people infected through heterosexual contact was obtained from the Federal Scientific and Methodological Centre for Prevention and Control of AIDS (number (year)): 10191 (2008), 10925 (2009), 12641 (2010), 13251 (2011), 14664 (2012), 16668 (2013), 19084 (2014), 20496 (2015). Reference (4), Chapter 2. e (in accordance with Security Council resolution 1244 (1999)). 69 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 7. New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 1 2 1 2 0 0 1 0 1 0 56 West Belgium 9 7 11 18 10 7 9 12 8 5 432 Centre Bulgaria 0 1 4 2 0 5 1 1 0 3 24 Centre Croatia 1 0 0 1 0 0 1 0 0 0 14 Centre Cyprus 0 0 0 0 1 0 0 1 0 0 4 Centre Czech Republic 0 0 0 0 2 0 1 0 2 0 9 West Denmark 4 0 3 3 4 5 5 4 1 5 111 East Estonia 8 3 3 3 4 2 5 1 0 0 54 West Finland 1 2 1 1 2 2 2 3 2 0 31 West France 29 34 41 36 49 36 48 42 25 18 535 West Germanyc 16 11 20 15 20 21 25 26 21 – 408 West Greece 1 0 3 4 0 0 1 0 3 1 69 Centre Hungary 0 2 0 0 1 1 1 2 1 2 17 West Iceland 0 0 0 0 0 0 0 0 0 0 1 West Ireland 7 5 9 3 5 3 2 5 3 0 85 West Italy 7 19 14 25 16 13 14 16 9 12 194 East Latvia 8 2 4 2 7 10 4 3 6 3 75 Liechtenstein 0 0 0 0 0 0 0 0 0 0 1 East Lithuania 0 0 0 1 0 1 2 0 1 1 7 West Luxembourg 0 1 0 0 1 0 2 0 0 0 13 West Malta 0 0 0 0 0 0 0 0 2 0 2 West Netherlands 23 20 24 14 18 9 11 9 2 2 340 West Norway 4 4 1 4 7 1 3 2 2 2 85 Centre Poland 12 12 11 7 4 4 3 8 1 3 217 West Portugal 16 14 15 10 5 9 7 3 3 3 448 Centre Romania 14 23 27 22 19 24 18 18 6 14 740 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 0 Centre Slovenia 0 0 0 1 0 0 0 0 0 0 7 West Spain 11 15 16 11 7 18 4 3 8 6 136 West Sweden 10 9 13 22 14 7 7 15 10 14 249 West United Kingdom 130 133 111 113 93 86 88 47 45 42 2 777 Total EU/EEA 312 319 332 320 289 264 265 221 162 136 7 141 Non-EU/EEA Centre Albania 1 2 0 3 3 6 3 1 1 1 33 West Andorra 0 0 0 0 0 0 0 0 0 0 1 East Armenia 0 3 3 2 3 5 7 4 1 5 45 East Azerbaijan 5 5 11 9 14 10 18 16 10 10 119 East Belarus 17 15 22 23 16 16 15 26 20 13 304 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 1 East Georgia 12 4 13 7 9 3 5 6 4 3 99 West Israel 16 11 7 8 7 9 9 4 4 6 255 East Kazakhstan 44 22 21 18 30 36 22 25 24 34 347 East Kyrgyzstan 25 16 19 20 33 10 14 25 17 16 207 West Monaco 0 0 0 0 0 0 0 0 0 0 1 Centre Montenegro 1 0 0 0 0 0 0 0 0 0 4 East Republic of Moldova 17 8 10 16 9 13 19 14 10 11 176 East Russian Federationd – – – – – – – – – – 0 West San Marino 0 0 0 0 0 0 0 0 0 0 1 Centre Serbia 1 4 0 1 1 4 1 1 2 0 50 Centre Serbia excluding Kosovoe 1 2 0 1 0 4 1 0 2 0 46 Centre Kosovoe 0 2 0 0 1 0 0 1 0 0 4 West Switzerland 2 4 7 4 2 3 1 4 4 4 179 East Tajikistan 3 11 14 26 37 47 57 56 53 60 373 Centre The former Yugoslav Republic of Macedonia 0 0 0 0 0 0 0 0 0 0 2 Centre Turkey 7 7 0 5 12 11 22 23 15 12 154 East Turkmenistan 0 0 0 0 0 – – – – – 0 East Ukraine 217 169 177 136 149 111 122 98 77 86 2 150 East Uzbekistan 57 96 73 – – – – – – – 363 Total non-EU/EEA 425 377 377 278 325 284 315 303 242 261 4 864 WHO European Region West 287 291 297 293 260 229 239 195 153 120 6 409 Centre 37 51 42 42 43 55 51 55 28 35 1 276 East 413 354 370 263 311 264 290 274 223 242 4 319 Total WHO European Region 737 696 709 598 614 548 580 524 404 397 12 004 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d No official data were reported by the Russian Federation. Latest available data on the number of new HIV diagnoses in children infected through mother-to-child transmission was obtained from the Federal Scientific and Methodological Centre for Prevention and Control of AIDS (number (year)): 690 (2008), 619 (2009), 563 (2010), 548 (2011), 507 (2012), 438 (2013), 416 (2014), 423 (2015). Reference (4), Chapter 2. e (in accordance with Security Council resolution 1244 (1999)). 70 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 8. HIV diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa MSM Injecting drug users Heterosexual Mother-to-child transmission Nosocomial Haemophiliac/transfusion Unknown Totalb Country, territory or areaaMale Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 157 158 3 9 12 37 41 78 0 0 0 1 1 2 0 0 0 4 16 20 270 Austria West Belgium 306 306 2 5 7 178 126 306 3 2 5 0 0 0 7 1 8 88 158 258 890 Belgium Centre Bulgaria 120 120 2 29 31 19 68 87 2 1 3 0 0 0 0 0 0 0 0 0 241 Bulgaria Centre Croatia 97 97 0 0 0 5 3 8 0 0 0 0 0 0 0 0 0 0 1 1 106 Croatia Centre Cyprus 47 47 0 0 0 18 14 32 0 0 0 0 0 0 2 1 3 0 3 3 85 Cyprus Centre Czech Republic 181 181 0 5 5 19 39 58 0 0 0 2 0 2 0 1 1 1 6 7 254 Czech Republic West Denmark 123 123 1 5 6 43 50 93 3 2 5 0 0 0 1 0 1 2 12 14 242 Denmark East Estonia 16 16 3 11 14 41 48 89 0 0 0 0 0 0 0 0 0 29 71 100 219 Estonia West Finland 32 32 2 8 10 34 36 70 0 0 0 0 0 0 2 0 2 19 25 44 158 Finland West France 1 192 1 239 13 30 43 823 604 1 432 8 10 18 0 0 0 4 4 8 919 1 550 2 471 5 211 France West Germanyc – – – – – – – – – – – – – – – – – – – – – Germany West Greece 290 292 10 76 86 73 66 139 0 1 1 0 0 0 0 0 0 23 87 110 628 Greece Centre Hungary 110 110 0 1 1 14 8 22 1 1 2 0 0 0 0 0 0 3 28 88 223 Hungary West Iceland 4 4 1 2 3 1 1 2 0 0 0 0 0 0 0 0 0 1 14 15 24 Iceland West Ireland 249 249 2 12 14 88 54 142 0 0 0 0 0 0 0 1 1 26 51 77 483 Ireland West Italy 1 324 1 324 17 77 94 707 871 1 578 7 5 12 0 0 0 3 1 4 86 345 431 3 443 Italy East Latvia 24 24 11 67 78 59 72 131 2 1 3 0 0 0 0 0 0 58 77 135 371 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 18 18 11 125 136 26 39 65 1 0 1 0 0 0 0 0 0 5 38 43 263 Lithuania West Luxembourg 15 15 5 4 9 10 20 30 0 0 0 0 0 0 0 0 0 1 4 5 59 Luxembourg West Malta 23 23 0 0 0 10 7 17 0 0 0 0 0 0 0 0 0 0 5 5 45 Malta West Netherlands 474 474 0 2 2 78 83 161 2 0 2 0 0 0 0 0 0 17 60 77 716 Netherlands West Norway 88 88 1 6 7 57 58 115 0 2 2 0 0 0 0 0 0 0 1 1 213 Norway Centre Poland 318 318 3 24 27 43 51 94 2 1 3 0 1 1 0 1 1 100 776 881 1 325 Poland West Portugal 391 391 2 16 18 283 329 612 2 1 3 0 0 0 1 0 1 12 31 43 1 068 Portugal Centre Romania 132 132 12 74 86 156 272 428 6 8 14 0 0 0 0 0 0 0 1 1 661 Romania Centre Slovakia 50 50 0 0 0 6 9 15 0 0 0 0 0 0 0 0 0 0 5 5 70 Slovakia Centre Slovenia 26 26 0 0 0 2 8 10 0 0 0 0 0 0 0 0 0 0 3 3 39 Slovenia West Spain 1 742 1 742 22 83 105 435 498 933 3 3 6 0 0 0 3 3 6 50 407 457 3 249 Spain West Sweden 128 128 5 15 20 120 92 212 7 7 14 0 0 0 3 1 4 26 30 56 434 Sweden West United Kingdom 1 967 1 967 27 88 115 790 648 1 443 24 18 42 2 3 5 12 7 19 262 505 772 4 363 United Kingdom Total EU/EEA 9 644 9 694 155 774 929 4 175 4 215 8 402 73 63 136 5 5 10 38 21 59 1 732 4 310 6 123 25 353 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 6 6 0 0 0 25 62 87 0 1 1 0 0 0 0 0 0 0 0 0 94 Albania West Andorra 2 2 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 1 1 2 6 Andorra East Armenia 17 17 1 37 38 95 186 281 4 1 5 0 0 0 0 0 0 2 11 13 354 Armenia East Azerbaijan 38 38 1 86 87 167 167 334 6 4 10 0 0 0 0 0 0 35 66 101 570 Azerbaijan East Belarus 72 72 113 372 485 800 1 068 1 868 6 7 13 0 0 0 1 0 1 8 21 29 2 468 Belarus Centre Bosnia and Herzegovina 9 9 0 0 0 0 2 2 0 0 0 0 0 0 0 1 1 0 0 0 12 Bosnia and Herzegovina East Georgia 130 130 3 145 148 130 211 341 0 3 3 0 0 0 3 2 5 3 1 4 631 Georgia West Israel 145 145 10 22 32 82 85 167 3 3 6 0 0 0 0 0 0 18 37 55 405 Israel East Kazakhstan 143 143 145 755 900 996 872 1 868 17 17 34 0 0 0 0 0 0 37 37 74 3 019 Kazakhstan East Kyrgyzstan 45 45 29 175 204 276 214 490 10 6 16 7 6 13 0 0 0 27 45 72 840 Kyrgyzstan West Monaco 2 2 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 3 Monaco Centre Montenegro 22 22 0 1 1 1 2 3 0 0 0 0 0 0 0 0 0 0 0 0 26 Montenegro East Republic of Moldova 29 29 4 38 42 271 290 561 5 6 11 0 0 0 0 0 0 82 111 193 836 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 San Marino Centre Serbia 119 119 2 2 4 7 22 29 0 0 0 0 0 0 1 0 1 0 28 28 181 Serbia Centre Serbia excluding Kosovod 119 119 2 2 4 7 20 27 0 0 0 0 0 0 1 0 1 0 27 27 178 Serbia excluding Kosovod Centre Kosovod 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0 0 0 1 1 3 Kosovod West Switzerland 168 168 6 14 20 61 69 131 1 3 4 0 0 0 1 0 1 30 87 119 443 Switzerland East Tajikistan 12 12 12 234 246 381 398 779 31 29 60 0 2 2 0 0 0 46 63 109 1 208 Tajikistan Centre The former Yugoslav Republic of Macedonia 34 34 0 0 0 0 8 8 0 0 0 0 0 0 0 0 0 0 2 2 44 The former Yugoslav Republic of Macedonia Centre Turkey 494 494 4 10 14 141 634 775 6 6 12 2 6 8 2 2 4 300 1 237 1 537 2 844 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 492 492 605 3 392 3 997 5 671 5 404 11 075 42 44 86 0 0 0 0 0 0 11 19 30 15 680 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 1 979 1 979 935 5 283 6 218 9 106 9 695 18 802 131 130 261 9 14 23 8 5 13 600 1 767 2 369 29 665 Total non-EU/EEA WHO European Region WHO European Region West 8 822 8 872 129 474 603 3 912 3 739 7 664 63 57 120 3 4 7 37 18 55 1 585 3 427 5 033 22 354 West Centre 1 765 1 765 23 146 169 456 1 202 1 658 17 18 35 4 7 11 5 6 11 404 2 090 2 556 6 205 Centre East 1 036 1 036 938 5 437 6 375 8 913 8 969 17 882 124 118 242 7 8 15 4 2 6 343 560 903 26 459 East Total WHO European Region 11 623 11 673 1 090 6 057 7 147 13 281 13 910 27 204 204 193 397 14 19 33 46 26 72 2 332 6 077 8 492 55 018 Total WHO European Region a Country-specific comments are in Annex 5. b Totals include transgender and persons with unknown gender and may, therefore, not equal the sum of the columns or may differ slightly from the totals presented for 2017 in tables 4–7. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 71 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 8. HIV diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa MSM Injecting drug users Heterosexual Mother-to-child transmission Nosocomial Haemophiliac/transfusion Unknown Totalb Country, territory or areaaMale Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 157 158 3 9 12 37 41 78 0 0 0 1 1 2 0 0 0 4 16 20 270 Austria West Belgium 306 306 2 5 7 178 126 306 3 2 5 0 0 0 7 1 8 88 158 258 890 Belgium Centre Bulgaria 120 120 2 29 31 19 68 87 2 1 3 0 0 0 0 0 0 0 0 0 241 Bulgaria Centre Croatia 97 97 0 0 0 5 3 8 0 0 0 0 0 0 0 0 0 0 1 1 106 Croatia Centre Cyprus 47 47 0 0 0 18 14 32 0 0 0 0 0 0 2 1 3 0 3 3 85 Cyprus Centre Czech Republic 181 181 0 5 5 19 39 58 0 0 0 2 0 2 0 1 1 1 6 7 254 Czech Republic West Denmark 123 123 1 5 6 43 50 93 3 2 5 0 0 0 1 0 1 2 12 14 242 Denmark East Estonia 16 16 3 11 14 41 48 89 0 0 0 0 0 0 0 0 0 29 71 100 219 Estonia West Finland 32 32 2 8 10 34 36 70 0 0 0 0 0 0 2 0 2 19 25 44 158 Finland West France 1 192 1 239 13 30 43 823 604 1 432 8 10 18 0 0 0 4 4 8 919 1 550 2 471 5 211 France West Germanyc – – – – – – – – – – – – – – – – – – – – – Germany West Greece 290 292 10 76 86 73 66 139 0 1 1 0 0 0 0 0 0 23 87 110 628 Greece Centre Hungary 110 110 0 1 1 14 8 22 1 1 2 0 0 0 0 0 0 3 28 88 223 Hungary West Iceland 4 4 1 2 3 1 1 2 0 0 0 0 0 0 0 0 0 1 14 15 24 Iceland West Ireland 249 249 2 12 14 88 54 142 0 0 0 0 0 0 0 1 1 26 51 77 483 Ireland West Italy 1 324 1 324 17 77 94 707 871 1 578 7 5 12 0 0 0 3 1 4 86 345 431 3 443 Italy East Latvia 24 24 11 67 78 59 72 131 2 1 3 0 0 0 0 0 0 58 77 135 371 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 18 18 11 125 136 26 39 65 1 0 1 0 0 0 0 0 0 5 38 43 263 Lithuania West Luxembourg 15 15 5 4 9 10 20 30 0 0 0 0 0 0 0 0 0 1 4 5 59 Luxembourg West Malta 23 23 0 0 0 10 7 17 0 0 0 0 0 0 0 0 0 0 5 5 45 Malta West Netherlands 474 474 0 2 2 78 83 161 2 0 2 0 0 0 0 0 0 17 60 77 716 Netherlands West Norway 88 88 1 6 7 57 58 115 0 2 2 0 0 0 0 0 0 0 1 1 213 Norway Centre Poland 318 318 3 24 27 43 51 94 2 1 3 0 1 1 0 1 1 100 776 881 1 325 Poland West Portugal 391 391 2 16 18 283 329 612 2 1 3 0 0 0 1 0 1 12 31 43 1 068 Portugal Centre Romania 132 132 12 74 86 156 272 428 6 8 14 0 0 0 0 0 0 0 1 1 661 Romania Centre Slovakia 50 50 0 0 0 6 9 15 0 0 0 0 0 0 0 0 0 0 5 5 70 Slovakia Centre Slovenia 26 26 0 0 0 2 8 10 0 0 0 0 0 0 0 0 0 0 3 3 39 Slovenia West Spain 1 742 1 742 22 83 105 435 498 933 3 3 6 0 0 0 3 3 6 50 407 457 3 249 Spain West Sweden 128 128 5 15 20 120 92 212 7 7 14 0 0 0 3 1 4 26 30 56 434 Sweden West United Kingdom 1 967 1 967 27 88 115 790 648 1 443 24 18 42 2 3 5 12 7 19 262 505 772 4 363 United Kingdom Total EU/EEA 9 644 9 694 155 774 929 4 175 4 215 8 402 73 63 136 5 5 10 38 21 59 1 732 4 310 6 123 25 353 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 6 6 0 0 0 25 62 87 0 1 1 0 0 0 0 0 0 0 0 0 94 Albania West Andorra 2 2 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 1 1 2 6 Andorra East Armenia 17 17 1 37 38 95 186 281 4 1 5 0 0 0 0 0 0 2 11 13 354 Armenia East Azerbaijan 38 38 1 86 87 167 167 334 6 4 10 0 0 0 0 0 0 35 66 101 570 Azerbaijan East Belarus 72 72 113 372 485 800 1 068 1 868 6 7 13 0 0 0 1 0 1 8 21 29 2 468 Belarus Centre Bosnia and Herzegovina 9 9 0 0 0 0 2 2 0 0 0 0 0 0 0 1 1 0 0 0 12 Bosnia and Herzegovina East Georgia 130 130 3 145 148 130 211 341 0 3 3 0 0 0 3 2 5 3 1 4 631 Georgia West Israel 145 145 10 22 32 82 85 167 3 3 6 0 0 0 0 0 0 18 37 55 405 Israel East Kazakhstan 143 143 145 755 900 996 872 1 868 17 17 34 0 0 0 0 0 0 37 37 74 3 019 Kazakhstan East Kyrgyzstan 45 45 29 175 204 276 214 490 10 6 16 7 6 13 0 0 0 27 45 72 840 Kyrgyzstan West Monaco 2 2 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 3 Monaco Centre Montenegro 22 22 0 1 1 1 2 3 0 0 0 0 0 0 0 0 0 0 0 0 26 Montenegro East Republic of Moldova 29 29 4 38 42 271 290 561 5 6 11 0 0 0 0 0 0 82 111 193 836 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 San Marino Centre Serbia 119 119 2 2 4 7 22 29 0 0 0 0 0 0 1 0 1 0 28 28 181 Serbia Centre Serbia excluding Kosovod 119 119 2 2 4 7 20 27 0 0 0 0 0 0 1 0 1 0 27 27 178 Serbia excluding Kosovod Centre Kosovod 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0 0 0 1 1 3 Kosovod West Switzerland 168 168 6 14 20 61 69 131 1 3 4 0 0 0 1 0 1 30 87 119 443 Switzerland East Tajikistan 12 12 12 234 246 381 398 779 31 29 60 0 2 2 0 0 0 46 63 109 1 208 Tajikistan Centre The former Yugoslav Republic of Macedonia 34 34 0 0 0 0 8 8 0 0 0 0 0 0 0 0 0 0 2 2 44 The former Yugoslav Republic of Macedonia Centre Turkey 494 494 4 10 14 141 634 775 6 6 12 2 6 8 2 2 4 300 1 237 1 537 2 844 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 492 492 605 3 392 3 997 5 671 5 404 11 075 42 44 86 0 0 0 0 0 0 11 19 30 15 680 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 1 979 1 979 935 5 283 6 218 9 106 9 695 18 802 131 130 261 9 14 23 8 5 13 600 1 767 2 369 29 665 Total non-EU/EEA WHO European Region WHO European Region West 8 822 8 872 129 474 603 3 912 3 739 7 664 63 57 120 3 4 7 37 18 55 1 585 3 427 5 033 22 354 West Centre 1 765 1 765 23 146 169 456 1 202 1 658 17 18 35 4 7 11 5 6 11 404 2 090 2 556 6 205 Centre East 1 036 1 036 938 5 437 6 375 8 913 8 969 17 882 124 118 242 7 8 15 4 2 6 343 560 903 26 459 East Total WHO European Region 11 623 11 673 1 090 6 057 7 147 13 281 13 910 27 204 204 193 397 14 19 33 46 26 72 2 332 6 077 8 492 55 018 Total WHO European Region a Country-specific comments are in Annex 5. b Totals include transgender and persons with unknown gender and may, therefore, not equal the sum of the columns or may differ slightly from the totals presented for 2017 in tables 4–7. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 72 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 9. HIV diagnoses in 2017, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa < 15 years 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years 50+ years Unknown age Totalb Country, territory or areaaFemale Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 0 0 0 2 4 6 5 15 20 6 41 47 13 73 86 11 61 73 8 30 38 0 0 0 270 Austria West Belgium 4 6 10 10 9 20 18 39 58 45 83 130 86 184 278 59 142 202 56 133 189 0 2 3 890 Belgium Centre Bulgaria 2 1 3 0 0 0 2 22 24 6 40 46 7 100 107 3 43 46 3 12 15 0 0 0 241 Bulgaria Centre Croatia 0 0 0 0 0 0 0 14 14 1 12 13 1 35 36 2 30 32 1 10 11 0 0 0 106 Croatia Centre Cyprus 0 0 0 2 0 2 2 8 10 4 13 17 7 21 28 3 10 13 2 13 15 0 0 0 85 Cyprus Centre Czech Republic 1 0 1 0 5 5 1 29 30 3 47 50 9 77 86 5 47 52 3 27 30 0 0 0 254 Czech Republic West Denmark 3 1 4 0 3 3 4 11 15 5 37 42 21 61 82 12 42 54 5 37 42 0 0 0 242 Denmark East Estonia 0 0 0 2 0 2 6 8 14 10 30 40 30 56 86 17 32 49 8 20 28 0 0 0 219 Estonia West Finland 1 0 1 0 0 0 3 6 9 7 4 11 28 31 59 10 29 39 8 31 39 0 0 0 158 Finland West France 16 18 34 56 83 139 128 342 476 222 472 705 618 882 1 524 401 755 1 164 326 838 1 169 0 0 0 5 211 France West Germanyc – – – – – – – – – – – – – – – – – – – – – – – – – Germanyc West Greece 0 1 1 4 6 10 7 30 38 14 66 80 33 192 225 24 139 163 24 86 111 0 0 0 628 Greece Centre Hungary 1 1 2 1 1 2 0 24 24 2 25 27 7 56 64 3 23 26 4 18 22 0 0 56 223 Hungary West Iceland 0 0 0 0 2 2 0 0 0 2 5 7 1 7 8 0 3 3 0 4 4 0 0 0 24 Iceland West Ireland 0 0 0 1 2 3 5 33 38 15 91 106 54 127 181 29 61 90 12 53 65 0 0 0 483 Ireland West Italy 8 6 14 31 46 77 115 215 330 140 377 517 228 685 913 142 659 801 156 635 791 0 0 0 3 443 Italy East Latvia 3 1 4 1 3 4 4 15 19 21 36 57 42 97 139 29 60 89 30 29 59 0 0 0 371 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 1 0 1 1 2 3 4 10 14 8 26 34 13 98 111 6 56 62 10 28 38 0 0 0 263 Lithuania West Luxembourg 0 0 0 0 0 0 2 4 6 1 3 4 7 16 23 4 9 13 2 11 13 0 0 0 59 Luxembourg West Malta 0 0 0 0 0 0 1 0 1 1 3 4 5 13 18 2 9 11 1 7 8 0 3 3 45 Malta West Netherlands 10 4 14 3 15 18 10 56 66 11 105 116 27 146 173 19 127 146 17 166 183 0 0 0 716 Netherlands West Norway 0 2 2 2 0 2 2 15 17 12 17 29 25 55 80 12 37 49 5 29 34 0 0 0 213 Norway Centre Poland 1 2 3 1 13 14 8 118 126 27 227 254 59 478 539 29 198 227 19 107 127 4 29 35 1 325 Poland West Portugal 2 2 4 5 14 19 17 82 99 29 107 136 88 195 283 66 163 229 93 205 298 0 0 0 1 068 Portugal Centre Romania 7 9 16 11 12 23 23 49 72 37 103 140 49 167 216 27 96 123 20 51 71 0 0 0 661 Romania Centre Slovakia 0 0 0 0 1 1 1 5 6 1 11 12 2 21 23 1 17 18 1 9 10 0 0 0 70 Slovakia Centre Slovenia 0 0 0 0 0 0 0 3 3 0 6 6 0 10 10 1 9 10 1 9 10 0 0 0 39 Slovenia West Spain 3 4 7 14 46 60 35 290 325 69 486 555 169 922 1 091 137 585 722 86 402 488 0 1 1 3 249 Spain West Sweden 7 6 13 7 8 15 6 20 26 22 45 67 60 81 141 37 51 88 22 62 84 0 0 0 434 Sweden West United Kingdom 19 10 29 28 68 96 75 331 406 132 535 669 345 938 1 287 277 723 1 003 241 631 873 0 0 0 4 363 United Kingdom Total EU/EEA 89 74 163 182 343 526 484 1 794 2 286 853 3 053 3 921 2 034 5 824 7 897 1 368 4 216 5 597 1 164 3 693 4 865 4 35 98 25 353 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 1 1 0 1 1 2 6 8 2 8 10 6 18 24 7 17 24 8 18 26 0 0 0 94 Albania West Andorra 0 0 0 0 0 0 0 0 0 0 0 0 2 2 4 1 0 1 0 1 1 0 0 0 6 Andorra East Armenia 5 1 6 2 0 2 10 11 21 11 24 35 31 88 119 24 66 90 19 62 81 0 0 0 354 Armenia East Azerbaijan 10 4 14 4 1 5 24 21 45 36 70 106 63 119 182 54 94 148 18 52 70 0 0 0 570 Azerbaijan East Belarus 6 8 14 15 8 23 62 76 138 125 187 312 366 714 1 080 208 381 589 146 166 312 0 0 0 2 468 Belarus Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 3 3 0 0 0 0 4 4 0 2 2 0 3 3 0 0 0 12 Bosnia and Herzegovina East Georgia 0 3 3 2 5 7 11 48 59 9 74 83 40 167 207 44 126 170 33 68 101 0 1 1 631 Georgia West Israel 2 2 4 3 5 8 3 22 25 8 40 48 39 94 133 35 71 106 22 57 79 1 1 2 405 Israel East Kazakhstan 19 21 40 21 18 39 89 120 209 208 271 479 410 774 1 184 282 419 701 166 201 367 0 0 0 3 019 Kazakhstan East Kyrgyzstan 17 13 30 8 5 13 34 31 65 60 67 127 108 194 302 75 133 208 47 48 95 0 0 0 840 Kyrgyzstan West Monaco 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 0 0 0 3 Monaco Centre Montenegro 0 0 0 0 0 0 0 3 3 0 8 8 1 9 10 0 4 4 0 1 1 0 0 0 26 Montenegro East Republic of Moldova 5 6 11 16 5 21 43 36 79 68 73 141 116 185 301 58 89 147 56 80 136 0 0 0 836 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 San Marino Centre Serbia 0 0 0 0 1 1 1 18 19 0 31 31 3 66 69 1 34 35 5 21 26 0 0 0 181 Serbia Centre Serbia excluding Kosovod 0 0 0 0 1 1 1 18 19 0 31 31 3 65 68 1 32 33 5 21 26 0 0 0 178 Serbia excluding Kosovod Centre Kosovod 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 2 2 0 0 0 0 0 0 3 Kosovod West Switzerland 2 2 5 1 2 3 5 24 29 12 43 56 35 110 145 22 76 98 22 84 107 0 0 0 443 Switzerland East Tajikistan 57 67 124 5 9 14 41 33 74 82 99 181 169 269 438 84 197 281 32 64 96 0 0 0 1 208 Tajikistan Centre The former Yugoslav Republic of Macedonia 0 0 0 0 0 0 0 7 7 0 14 14 0 15 15 0 6 6 0 1 1 0 1 1 44 The former Yugoslav Republic of Macedonia Centre Turkey 8 10 18 12 58 70 40 339 379 87 448 535 165 757 922 71 404 475 72 372 444 0 1 1 2 844 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 52 48 100 106 59 165 445 334 779 890 958 1 848 2 370 4 152 6 522 1 517 2 681 4 198 949 1 119 2 068 0 0 0 15 680 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 183 186 370 195 177 372 810 1 132 1 942 1 598 2 415 4 014 3 924 7 738 11 662 2 483 4 802 7 285 1 595 2 419 4 015 1 4 5 29 665 Total non-EU/EEA WHO European Region WHO European Region West West 77 64 142 167 313 481 441 1 535 1 984 753 2 560 3 329 1 884 4 815 6 735 1 300 3 744 5 057 1 106 3 503 4 617 1 7 9 22 354 West Centre Centre 20 24 44 27 92 119 80 648 728 170 993 1 163 316 1 834 2 153 153 940 1 093 139 672 812 4 31 93 6 205 Centre East East 175 172 347 183 115 298 773 743 1 516 1 528 1 915 3 443 3 758 6 913 10 671 2 398 4 334 6 732 1 514 1 937 3 451 0 1 1 26 459 East Total WHO European Region 272 260 533 377 520 898 1 294 2 926 4 228 2 451 5 468 7 935 5 958 13 562 19 559 3 851 9 018 12 882 2 759 6 112 8 880 5 39 103 55 018 Total WHO European Region a Country-specific comments are in Annex 5. b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 73 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 9. HIV diagnoses in 2017, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa < 15 years 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years 50+ years Unknown age Totalb Country, territory or areaaFemale Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 0 0 0 2 4 6 5 15 20 6 41 47 13 73 86 11 61 73 8 30 38 0 0 0 270 Austria West Belgium 4 6 10 10 9 20 18 39 58 45 83 130 86 184 278 59 142 202 56 133 189 0 2 3 890 Belgium Centre Bulgaria 2 1 3 0 0 0 2 22 24 6 40 46 7 100 107 3 43 46 3 12 15 0 0 0 241 Bulgaria Centre Croatia 0 0 0 0 0 0 0 14 14 1 12 13 1 35 36 2 30 32 1 10 11 0 0 0 106 Croatia Centre Cyprus 0 0 0 2 0 2 2 8 10 4 13 17 7 21 28 3 10 13 2 13 15 0 0 0 85 Cyprus Centre Czech Republic 1 0 1 0 5 5 1 29 30 3 47 50 9 77 86 5 47 52 3 27 30 0 0 0 254 Czech Republic West Denmark 3 1 4 0 3 3 4 11 15 5 37 42 21 61 82 12 42 54 5 37 42 0 0 0 242 Denmark East Estonia 0 0 0 2 0 2 6 8 14 10 30 40 30 56 86 17 32 49 8 20 28 0 0 0 219 Estonia West Finland 1 0 1 0 0 0 3 6 9 7 4 11 28 31 59 10 29 39 8 31 39 0 0 0 158 Finland West France 16 18 34 56 83 139 128 342 476 222 472 705 618 882 1 524 401 755 1 164 326 838 1 169 0 0 0 5 211 France West Germanyc – – – – – – – – – – – – – – – – – – – – – – – – – Germanyc West Greece 0 1 1 4 6 10 7 30 38 14 66 80 33 192 225 24 139 163 24 86 111 0 0 0 628 Greece Centre Hungary 1 1 2 1 1 2 0 24 24 2 25 27 7 56 64 3 23 26 4 18 22 0 0 56 223 Hungary West Iceland 0 0 0 0 2 2 0 0 0 2 5 7 1 7 8 0 3 3 0 4 4 0 0 0 24 Iceland West Ireland 0 0 0 1 2 3 5 33 38 15 91 106 54 127 181 29 61 90 12 53 65 0 0 0 483 Ireland West Italy 8 6 14 31 46 77 115 215 330 140 377 517 228 685 913 142 659 801 156 635 791 0 0 0 3 443 Italy East Latvia 3 1 4 1 3 4 4 15 19 21 36 57 42 97 139 29 60 89 30 29 59 0 0 0 371 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 1 0 1 1 2 3 4 10 14 8 26 34 13 98 111 6 56 62 10 28 38 0 0 0 263 Lithuania West Luxembourg 0 0 0 0 0 0 2 4 6 1 3 4 7 16 23 4 9 13 2 11 13 0 0 0 59 Luxembourg West Malta 0 0 0 0 0 0 1 0 1 1 3 4 5 13 18 2 9 11 1 7 8 0 3 3 45 Malta West Netherlands 10 4 14 3 15 18 10 56 66 11 105 116 27 146 173 19 127 146 17 166 183 0 0 0 716 Netherlands West Norway 0 2 2 2 0 2 2 15 17 12 17 29 25 55 80 12 37 49 5 29 34 0 0 0 213 Norway Centre Poland 1 2 3 1 13 14 8 118 126 27 227 254 59 478 539 29 198 227 19 107 127 4 29 35 1 325 Poland West Portugal 2 2 4 5 14 19 17 82 99 29 107 136 88 195 283 66 163 229 93 205 298 0 0 0 1 068 Portugal Centre Romania 7 9 16 11 12 23 23 49 72 37 103 140 49 167 216 27 96 123 20 51 71 0 0 0 661 Romania Centre Slovakia 0 0 0 0 1 1 1 5 6 1 11 12 2 21 23 1 17 18 1 9 10 0 0 0 70 Slovakia Centre Slovenia 0 0 0 0 0 0 0 3 3 0 6 6 0 10 10 1 9 10 1 9 10 0 0 0 39 Slovenia West Spain 3 4 7 14 46 60 35 290 325 69 486 555 169 922 1 091 137 585 722 86 402 488 0 1 1 3 249 Spain West Sweden 7 6 13 7 8 15 6 20 26 22 45 67 60 81 141 37 51 88 22 62 84 0 0 0 434 Sweden West United Kingdom 19 10 29 28 68 96 75 331 406 132 535 669 345 938 1 287 277 723 1 003 241 631 873 0 0 0 4 363 United Kingdom Total EU/EEA 89 74 163 182 343 526 484 1 794 2 286 853 3 053 3 921 2 034 5 824 7 897 1 368 4 216 5 597 1 164 3 693 4 865 4 35 98 25 353 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 1 1 0 1 1 2 6 8 2 8 10 6 18 24 7 17 24 8 18 26 0 0 0 94 Albania West Andorra 0 0 0 0 0 0 0 0 0 0 0 0 2 2 4 1 0 1 0 1 1 0 0 0 6 Andorra East Armenia 5 1 6 2 0 2 10 11 21 11 24 35 31 88 119 24 66 90 19 62 81 0 0 0 354 Armenia East Azerbaijan 10 4 14 4 1 5 24 21 45 36 70 106 63 119 182 54 94 148 18 52 70 0 0 0 570 Azerbaijan East Belarus 6 8 14 15 8 23 62 76 138 125 187 312 366 714 1 080 208 381 589 146 166 312 0 0 0 2 468 Belarus Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 3 3 0 0 0 0 4 4 0 2 2 0 3 3 0 0 0 12 Bosnia and Herzegovina East Georgia 0 3 3 2 5 7 11 48 59 9 74 83 40 167 207 44 126 170 33 68 101 0 1 1 631 Georgia West Israel 2 2 4 3 5 8 3 22 25 8 40 48 39 94 133 35 71 106 22 57 79 1 1 2 405 Israel East Kazakhstan 19 21 40 21 18 39 89 120 209 208 271 479 410 774 1 184 282 419 701 166 201 367 0 0 0 3 019 Kazakhstan East Kyrgyzstan 17 13 30 8 5 13 34 31 65 60 67 127 108 194 302 75 133 208 47 48 95 0 0 0 840 Kyrgyzstan West Monaco 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 0 0 0 3 Monaco Centre Montenegro 0 0 0 0 0 0 0 3 3 0 8 8 1 9 10 0 4 4 0 1 1 0 0 0 26 Montenegro East Republic of Moldova 5 6 11 16 5 21 43 36 79 68 73 141 116 185 301 58 89 147 56 80 136 0 0 0 836 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 San Marino Centre Serbia 0 0 0 0 1 1 1 18 19 0 31 31 3 66 69 1 34 35 5 21 26 0 0 0 181 Serbia Centre Serbia excluding Kosovod 0 0 0 0 1 1 1 18 19 0 31 31 3 65 68 1 32 33 5 21 26 0 0 0 178 Serbia excluding Kosovod Centre Kosovod 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 2 2 0 0 0 0 0 0 3 Kosovod West Switzerland 2 2 5 1 2 3 5 24 29 12 43 56 35 110 145 22 76 98 22 84 107 0 0 0 443 Switzerland East Tajikistan 57 67 124 5 9 14 41 33 74 82 99 181 169 269 438 84 197 281 32 64 96 0 0 0 1 208 Tajikistan Centre The former Yugoslav Republic of Macedonia 0 0 0 0 0 0 0 7 7 0 14 14 0 15 15 0 6 6 0 1 1 0 1 1 44 The former Yugoslav Republic of Macedonia Centre Turkey 8 10 18 12 58 70 40 339 379 87 448 535 165 757 922 71 404 475 72 372 444 0 1 1 2 844 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 52 48 100 106 59 165 445 334 779 890 958 1 848 2 370 4 152 6 522 1 517 2 681 4 198 949 1 119 2 068 0 0 0 15 680 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 183 186 370 195 177 372 810 1 132 1 942 1 598 2 415 4 014 3 924 7 738 11 662 2 483 4 802 7 285 1 595 2 419 4 015 1 4 5 29 665 Total non-EU/EEA WHO European Region WHO European Region West West 77 64 142 167 313 481 441 1 535 1 984 753 2 560 3 329 1 884 4 815 6 735 1 300 3 744 5 057 1 106 3 503 4 617 1 7 9 22 354 West Centre Centre 20 24 44 27 92 119 80 648 728 170 993 1 163 316 1 834 2 153 153 940 1 093 139 672 812 4 31 93 6 205 Centre East East 175 172 347 183 115 298 773 743 1 516 1 528 1 915 3 443 3 758 6 913 10 671 2 398 4 334 6 732 1 514 1 937 3 451 0 1 1 26 459 East Total WHO European Region 272 260 533 377 520 898 1 294 2 926 4 228 2 451 5 468 7 935 5 958 13 562 19 559 3 851 9 018 12 882 2 759 6 112 8 880 5 39 103 55 018 Total WHO European Region a Country-specific comments are in Annex 5. b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)).

75 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 10. HIV diagnoses in people infected through heterosexual contact, by country and transmission subcategory, cases diagnosed in 2017, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Case from a generalized epidemic country Partner from a generalized epidemic country Partner from a non- generalized epidemic country Partner injecting drug user Bisexual partner Other Unknown Total N % N % N % N % N % N % N % N EU/EEA West Austria 18 23.1 1 1.3 0 0.0 1 1.3 0 0.0 0 0.0 58 74.4 78 West Belgium 142 46.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 164 53.6 306 Centre Bulgaria Centre Croatia 0 0.0 0 0.0 0 0.0 0 0.0 1 12.5 0 0.0 7 87.5 8 Centre Cyprus 6 18.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 26 81.3 32 Centre Czech Republic 3 5.2 1 1.7 6 0.0 1 1.7 1 1.7 0 0.0 46 79.3 58 West Denmark 27 29.0 29 31.2 33 35.5 1 1.1 1 1.1 0 0.0 2 2.2 93 East Estonia 0 0.0 0 0.0 0 0.0 4 4.5 0 0.0 0 0.0 85 95.5 89 West Finland 13 18.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 57 81.4 70 West France 750 52.4 180 12.6 31 2.2 8 0.6 4 0.3 0 0.0 459 32.1 1 432 West Germanyb – – – – – – – – – – – – – – – West Greece – – – – – – – – – – – – – – – Centre Hungary – – – – – – – – – – – – – – – West Iceland 1 50.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 50.0 2 West Ireland 82 57.7 17 12.0 0 0.0 1 0.7 1 0.7 0 0.0 41 28.9 142 West Italy – – – – – – – – – – – – – – – East Latvia – – – – – – – – – – – – – – – Liechtenstein – – – – – – – – – – – – – – – East Lithuania – – – – – – – – – – – – – – – West Luxembourg 7 23.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 76.7 30 West Malta 8 47.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 9 52.9 17 West Netherlands 26 16.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 135 83.9 161 West Norway 0 0.0 43 37.4 58 50.4 0 0.0 0 0.0 0 0.0 14 12.2 115 Centre Poland 0 0.0 0 0.0 1 1.1 0 0.0 0 0.0 0 0.0 93 98.9 94 West Portugal 143 23.4 21 3.4 124 20.3 2 0.3 0 0.0 0 0.0 322 52.6 612 Centre Romania 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 427 99.8 428 Centre Slovakia – – – – – – – – – – – – – – – Centre Slovenia 0 0.0 0 0.0 0 0.0 0 0.0 1 10.0 0 0.0 9 90.0 10 West Spain – – – – – – – – – – – – – – – West Sweden 107 50.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 105 49.5 212 West United Kingdom 648 44.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 795 55.1 1 443 Total EU/EEA 1 982 36.5 292 5.4 253 4.7 18 0.3 9 0.2 0 0.0 2 878 53.0 5 432 Non-EU/EEA Centre Albania – – – – – – – – – – – – – – – West Andorra 0 0.0 0 0.0 2 100.0 0 0.0 0 0.0 0 0.0 0 0.0 2 East Armenia 0 0.0 0 0.0 261 92.9 10 3.6 0 0.0 0 0.0 10 3.6 281 East Azerbaijan 1 0.3 0 0.0 77 23.1 34 10.2 1 0.3 0 0.0 221 66.2 334 East Belarus 1 0.1 0 0.0 112 6.0 53 2.8 0 0.0 0 0.0 1 702 91.1 1 868 Centre Bosnia and Herzegovina – – – – – – – – – – – – – – – East Georgia 0 0.0 47 13.8 0 0.0 34 10.0 0 0.0 0 0.0 260 76.2 341 West Israel 58 34.7 32 19.2 0 0.0 2 1.2 1 0.6 0 0.0 74 44.3 167 East Kazakhstan 0 0.0 0 0.0 340 18.2 194 10.4 1 0.1 0 0.0 1 333 71.4 1 868 East Kyrgyzstan 0 0.0 0 0.0 0 0.0 72 14.7 5 1.0 0 0.0 413 84.3 490 West Monaco – – – – – – – – – – – – – – – Centre Montenegro – – – – – – – – – – – – – – – East Republic of Moldova 0 0.0 0 0.0 458 81.6 0 0.0 0 0.0 0 0.0 103 18.4 561 East Russian Federation – – – – – – – – – – – – – – – West San Marino – – – – – – – – – – – – – – – Centre Serbia 0 0.0 0 0.0 2 6.9 0 0.0 1 3.4 0 0.0 26 89.7 29 Centre Serbia excluding Kosovoc 0 0.0 0 0.0 1 3.7 0 0.0 1 3.7 0 0.0 25 92.6 27 Centre Kosovoc 0 0.0 0 0.0 1 50.0 0 0.0 0 0.0 0 0.0 1 50.0 2 West Switzerland 27 20.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 104 79.4 131 East Tajikistan 0 0.0 0 0.0 114 14.6 36 4.6 0 0.0 0 0.0 629 80.7 779 Centre The former Yugoslav Republic of Macedonia – – – – – – – – – – – – – – – Centre Turkey – – – – – – – – – – – – – – – East Turkmenistan – – – – – – – – – – – – – – – East Ukraine – – – – – – – – – – – – – – – East Uzbekistan – – – – – – – – – – – – – – – Total non-EU/EEA 87 1.3 79 1.2 1 366 19.9 435 6.3 9 0.1 0 0.0 4 875 71.2 6 851 WHO European Region West 2 057 41.0 323 6.4 248 4.9 15 0.3 7 0.1 0 0.0 2 363 47.1 5 013 Centre 10 1.5 1 0.2 9 1.4 1 0.2 4 0.6 0 0.0 634 96.2 659 East 2 0.0 47 0.7 1 362 20.6 437 6.6 7 0.1 0 0.0 4 756 71.9 6 611 Total WHO European Region 2 069 16.8 371 3.0 1 619 13.2 453 3.7 18 0.1 0 0.0 7 753 63.1 12 283 a Country-specific comments are in Annex 5. Countries that do not report on the optional variable "transmission partner" are excluded and, thus, regional totals may not equal those presented in Table 6. b Due to technical problems no data export for 2017 from Germany was available. c (in accordance with Security Council resolution 1244 (1999)). 76 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 11. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2017, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Country of report Western Europe Central and eastern Europe Sub-Saharan Africa Latin America and Caribbean South and south-east Asia Other Unknown Total Country, territory or areaaN % N % N % N % N Rate N % N % N % EU/EEA EU/EEA West Austria 141 52.2 15 5.6 68 25.2 21 7.8 7 2.6 12 4.4 5 1.9 1 0.4 270 Austria West Belgium 266 29.9 64 7.2 39 4.4 211 23.7 48 5.4 26 2.9 31 3.5 205 23.0 890 Belgium Centre Bulgaria 234 97.1 3 1.2 4 1.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 241 Bulgaria Centre Croatia 87 82.1 1 0.9 14 13.2 1 0.9 0 0.0 1 0.9 2 1.9 0 0.0 106 Croatia Centre Cyprus 32 37.6 13 15.3 20 23.5 10 11.8 1 1.2 8 9.4 1 1.2 0 0.0 85 Cyprus Centre Czech Republic 176 69.3 4 1.6 55 21.7 3 1.2 7 2.8 5 2.0 4 1.6 0 0.0 254 Czech Republic West Denmark 112 46.3 15 6.2 34 14.0 32 13.2 13 5.4 21 8.7 15 6.2 0 0.0 242 Denmark East Estonia 99 45.2 0 0.0 8 3.7 0 0.0 0 0.0 3 1.4 0 0.0 109 49.8 219 Estonia West Finland 70 44.3 3 1.9 31 19.6 20 12.7 3 1.9 11 7.0 3 1.9 17 10.8 158 Finland West France 1 324 25.4 67 1.3 79 1.5 1 090 20.9 216 4.1 52 1.0 124 2.4 2 259 43.4 5 211 France West Germanyb – – – – – – – – – – – – – – – – – Germanyb West Greece 430 68.5 8 1.3 70 11.1 60 9.6 2 0.3 28 4.5 16 2.5 14 2.2 628 Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 9 37.5 5 20.8 6 25.0 1 4.2 0 0.0 1 4.2 2 8.3 0 0.0 24 Iceland West Ireland 117 24.2 29 6.0 35 7.2 104 21.5 83 17.2 18 3.7 7 1.4 90 18.6 483 Ireland West Italy 2 249 65.3 24 0.7 174 5.1 652 18.9 233 6.8 45 1.3 51 1.5 15 0.4 3 443 Italy East Latvia 365 98.4 1 0.3 3 0.8 0 0.0 0 0.0 0 0.0 0 0.0 2 0.5 371 Latvia Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 253 96.2 4 1.5 4 1.5 0 0.0 0 0.0 0 0.0 2 0.8 0 0.0 263 Lithuania West Luxembourg 15 25.4 19 32.2 4 6.8 14 23.7 2 3.4 1 1.7 4 6.8 0 0.0 59 Luxembourg West Malta 16 35.6 8 17.8 7 15.6 8 17.8 3 6.7 3 6.7 0 0.0 0 0.0 45 Malta West Netherlands 419 58.5 22 3.1 43 6.0 59 8.2 72 10.1 34 4.7 36 5.0 31 4.3 716 Netherlands West Norway 74 34.7 16 7.5 24 11.3 43 20.2 15 7.0 20 9.4 7 3.3 14 6.6 213 Norway Centre Poland 809 61.1 0 0.0 11 0.8 0 0.0 0 0.0 0 0.0 0 0.0 505 38.1 1 325 Poland West Portugal 692 64.8 23 2.2 8 0.7 198 18.5 110 10.3 3 0.3 0 0.0 34 3.2 1 068 Portugal Centre Romania 653 98.8 2 0.3 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 5 0.8 661 Romania Centre Slovakia 64 91.4 0 0.0 5 7.1 1 1.4 0 0.0 0 0.0 0 0.0 0 0.0 70 Slovakia Centre Slovenia 33 84.6 0 0.0 3 7.7 0 0.0 0 0.0 0 0.0 0 0.0 3 7.7 39 Slovenia West Spain 1 974 60.8 110 3.4 119 3.7 236 7.3 609 18.7 20 0.6 66 2.0 115 3.5 3 249 Spain West Sweden 97 22.4 13 3.0 65 15.0 152 35.0 25 5.8 48 11.1 23 5.3 11 2.5 434 Sweden West United Kingdom 1 663 38.1 359 8.2 377 8.6 806 18.5 260 6.0 259 5.9 123 2.8 516 11.8 4 363 United Kingdom Total EU/EEA 12 473 49.6 828 3.3 1 310 5.2 3 723 14.8 1 709 6.8 619 2.5 522 2.1 3 946 15.7 25 130 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 94 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 94 Albania West Andorra 2 33.3 4 66.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 6 Andorra East Armenia 354 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 354 Armenia East Azerbaijan 559 98.1 0 0.0 10 1.8 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 570 Azerbaijan East Belarus 2 464 99.8 0 0.0 2 0.1 1 0.0 0 0.0 1 0.0 0 0.0 0 0.0 2 468 Belarus Centre Bosnia and Herzegovina 12 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 Bosnia and Herzegovina East Georgia 629 99.7 0 0.0 2 0.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 631 Georgia West Israel 133 32.8 5 1.2 104 25.7 78 19.3 14 3.5 9 2.2 62 15.3 0 0.0 405 Israel East Kazakhstan 2 864 94.9 0 0.0 136 4.5 0 0.0 0 0.0 1 0.0 18 0.6 0 0.0 3 019 Kazakhstan East Kyrgyzstan 796 94.8 1 0.1 35 4.2 1 0.1 0 0.0 7 0.8 0 0.0 0 0.0 840 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 26 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 26 Montenegro East Republic of Moldova 836 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 836 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia 179 98.9 0 0.0 2 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 181 Serbia Centre Serbia excluding Kosovoc 176 98.9 0 0.0 2 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 178 Serbia excluding Kosovoc Centre Kosovoc 3 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 Kosovoc West Switzerland 191 43.1 53 12.0 18 4.1 50 11.3 23 5.2 13 2.9 11 2.5 84 19.0 443 Switzerland East Tajikistan 1 204 99.7 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 3 0.2 0 0.0 1 208 Tajikistan Centre The former Yugoslav Republic of Macedonia 44 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 44 The former Yugoslav Republic of Macedonia Centre Turkey 2 384 83.8 35 1.2 175 6.2 63 2.2 6 0.2 36 1.3 61 2.1 84 3.0 2 844 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 15 680 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 15 680 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 28 451 95.9 98 0.3 485 1.6 194 0.7 43 0.1 67 0.2 155 0.5 168 0.6 29 661 Total non-EU/EEA WHO European Region WHO European Region West West 9 994 44.7 862 3.9 1 305 5.8 3 835 17.2 1 738 7.8 624 2.8 586 2.6 3 406 15.2 22 350 West Centre Centre 4 827 80.7 58 1.0 289 4.8 79 1.3 14 0.2 50 0.8 68 1.1 597 10.0 5 982 Centre East East 26 103 98.7 6 0.0 201 0.8 3 0.0 0 0.0 12 0.0 23 0.1 111 0.4 26 459 East Total WHO European Region 40 924 74.7 926 1.7 1 795 3.3 3 917 7.1 1 752 3.2 686 1.3 677 1.2 4 114 7.5 54 791 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the variables "country of birth", "country of nationality" or "region of origin" are excluded and therefore regional totals may not equal those presented in Table 1. b Due to technical problems no data export for 2017 from Germany was available. c (in accordance with Security Council resolution 1244 (1999)). 77 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 11. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2017, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Country of report Western Europe Central and eastern Europe Sub-Saharan Africa Latin America and Caribbean South and south-east Asia Other Unknown Total Country, territory or areaaN % N % N % N % N Rate N % N % N % EU/EEA EU/EEA West Austria 141 52.2 15 5.6 68 25.2 21 7.8 7 2.6 12 4.4 5 1.9 1 0.4 270 Austria West Belgium 266 29.9 64 7.2 39 4.4 211 23.7 48 5.4 26 2.9 31 3.5 205 23.0 890 Belgium Centre Bulgaria 234 97.1 3 1.2 4 1.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 241 Bulgaria Centre Croatia 87 82.1 1 0.9 14 13.2 1 0.9 0 0.0 1 0.9 2 1.9 0 0.0 106 Croatia Centre Cyprus 32 37.6 13 15.3 20 23.5 10 11.8 1 1.2 8 9.4 1 1.2 0 0.0 85 Cyprus Centre Czech Republic 176 69.3 4 1.6 55 21.7 3 1.2 7 2.8 5 2.0 4 1.6 0 0.0 254 Czech Republic West Denmark 112 46.3 15 6.2 34 14.0 32 13.2 13 5.4 21 8.7 15 6.2 0 0.0 242 Denmark East Estonia 99 45.2 0 0.0 8 3.7 0 0.0 0 0.0 3 1.4 0 0.0 109 49.8 219 Estonia West Finland 70 44.3 3 1.9 31 19.6 20 12.7 3 1.9 11 7.0 3 1.9 17 10.8 158 Finland West France 1 324 25.4 67 1.3 79 1.5 1 090 20.9 216 4.1 52 1.0 124 2.4 2 259 43.4 5 211 France West Germanyb – – – – – – – – – – – – – – – – – Germanyb West Greece 430 68.5 8 1.3 70 11.1 60 9.6 2 0.3 28 4.5 16 2.5 14 2.2 628 Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 9 37.5 5 20.8 6 25.0 1 4.2 0 0.0 1 4.2 2 8.3 0 0.0 24 Iceland West Ireland 117 24.2 29 6.0 35 7.2 104 21.5 83 17.2 18 3.7 7 1.4 90 18.6 483 Ireland West Italy 2 249 65.3 24 0.7 174 5.1 652 18.9 233 6.8 45 1.3 51 1.5 15 0.4 3 443 Italy East Latvia 365 98.4 1 0.3 3 0.8 0 0.0 0 0.0 0 0.0 0 0.0 2 0.5 371 Latvia Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 253 96.2 4 1.5 4 1.5 0 0.0 0 0.0 0 0.0 2 0.8 0 0.0 263 Lithuania West Luxembourg 15 25.4 19 32.2 4 6.8 14 23.7 2 3.4 1 1.7 4 6.8 0 0.0 59 Luxembourg West Malta 16 35.6 8 17.8 7 15.6 8 17.8 3 6.7 3 6.7 0 0.0 0 0.0 45 Malta West Netherlands 419 58.5 22 3.1 43 6.0 59 8.2 72 10.1 34 4.7 36 5.0 31 4.3 716 Netherlands West Norway 74 34.7 16 7.5 24 11.3 43 20.2 15 7.0 20 9.4 7 3.3 14 6.6 213 Norway Centre Poland 809 61.1 0 0.0 11 0.8 0 0.0 0 0.0 0 0.0 0 0.0 505 38.1 1 325 Poland West Portugal 692 64.8 23 2.2 8 0.7 198 18.5 110 10.3 3 0.3 0 0.0 34 3.2 1 068 Portugal Centre Romania 653 98.8 2 0.3 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 5 0.8 661 Romania Centre Slovakia 64 91.4 0 0.0 5 7.1 1 1.4 0 0.0 0 0.0 0 0.0 0 0.0 70 Slovakia Centre Slovenia 33 84.6 0 0.0 3 7.7 0 0.0 0 0.0 0 0.0 0 0.0 3 7.7 39 Slovenia West Spain 1 974 60.8 110 3.4 119 3.7 236 7.3 609 18.7 20 0.6 66 2.0 115 3.5 3 249 Spain West Sweden 97 22.4 13 3.0 65 15.0 152 35.0 25 5.8 48 11.1 23 5.3 11 2.5 434 Sweden West United Kingdom 1 663 38.1 359 8.2 377 8.6 806 18.5 260 6.0 259 5.9 123 2.8 516 11.8 4 363 United Kingdom Total EU/EEA 12 473 49.6 828 3.3 1 310 5.2 3 723 14.8 1 709 6.8 619 2.5 522 2.1 3 946 15.7 25 130 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 94 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 94 Albania West Andorra 2 33.3 4 66.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 6 Andorra East Armenia 354 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 354 Armenia East Azerbaijan 559 98.1 0 0.0 10 1.8 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 570 Azerbaijan East Belarus 2 464 99.8 0 0.0 2 0.1 1 0.0 0 0.0 1 0.0 0 0.0 0 0.0 2 468 Belarus Centre Bosnia and Herzegovina 12 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 Bosnia and Herzegovina East Georgia 629 99.7 0 0.0 2 0.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 631 Georgia West Israel 133 32.8 5 1.2 104 25.7 78 19.3 14 3.5 9 2.2 62 15.3 0 0.0 405 Israel East Kazakhstan 2 864 94.9 0 0.0 136 4.5 0 0.0 0 0.0 1 0.0 18 0.6 0 0.0 3 019 Kazakhstan East Kyrgyzstan 796 94.8 1 0.1 35 4.2 1 0.1 0 0.0 7 0.8 0 0.0 0 0.0 840 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 26 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 26 Montenegro East Republic of Moldova 836 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 836 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia 179 98.9 0 0.0 2 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 181 Serbia Centre Serbia excluding Kosovoc 176 98.9 0 0.0 2 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 178 Serbia excluding Kosovoc Centre Kosovoc 3 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 Kosovoc West Switzerland 191 43.1 53 12.0 18 4.1 50 11.3 23 5.2 13 2.9 11 2.5 84 19.0 443 Switzerland East Tajikistan 1 204 99.7 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 3 0.2 0 0.0 1 208 Tajikistan Centre The former Yugoslav Republic of Macedonia 44 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 44 The former Yugoslav Republic of Macedonia Centre Turkey 2 384 83.8 35 1.2 175 6.2 63 2.2 6 0.2 36 1.3 61 2.1 84 3.0 2 844 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 15 680 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 15 680 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 28 451 95.9 98 0.3 485 1.6 194 0.7 43 0.1 67 0.2 155 0.5 168 0.6 29 661 Total non-EU/EEA WHO European Region WHO European Region West West 9 994 44.7 862 3.9 1 305 5.8 3 835 17.2 1 738 7.8 624 2.8 586 2.6 3 406 15.2 22 350 West Centre Centre 4 827 80.7 58 1.0 289 4.8 79 1.3 14 0.2 50 0.8 68 1.1 597 10.0 5 982 Centre East East 26 103 98.7 6 0.0 201 0.8 3 0.0 0 0.0 12 0.0 23 0.1 111 0.4 26 459 East Total WHO European Region 40 924 74.7 926 1.7 1 795 3.3 3 917 7.1 1 752 3.2 686 1.3 677 1.2 4 114 7.5 54 791 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the variables "country of birth", "country of nationality" or "region of origin" are excluded and therefore regional totals may not equal those presented in Table 1. b Due to technical problems no data export for 2017 from Germany was available. c (in accordance with Security Council resolution 1244 (1999)). 78 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 12. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2017 Table 12a. EU/EEA and non-EU/EEA countries Transmission mode Country of report Western Europe Central and eastern Europe Sub-Saharan Africa Latin America and Caribbean South and south-east Asia Other Unknown Total Transmission modeN % N % N % N % N % N % N % N % EU/EEA EU/EEA Sex between men 6 153 63.5 548 5.7 510 5.3 228 2.4 1 144 11.8 317 3.3 270 2.8 524 5.4 9 694 Men who have sex with men Injecting drug use 708 76.2 38 4.1 121 13.0 7 0.8 9 1.0 9 1.0 9 1.0 28 3.0 929 Injecting drug use Heterosexual contact 3 777 45.0 158 1.9 480 5.7 2 932 34.9 396 4.7 202 2.4 171 2.0 286 3.4 8 402 Heterosexual contact Mother-to-child 48 35.3 5 3.7 5 3.7 64 47.1 0 0.0 4 2.9 4 2.9 6 4.4 136 Mother-to-child Haemophiliac/transfusion recipient 13 22.0 2 3.4 12 20.3 24 40.7 3 5.1 4 6.8 0 0.0 1 1.7 59 Haemophiliac/transfusion recipient Nosocomial infection 3 30.0 0 0.0 2 20.0 2 20.0 0 0.0 3 30.0 0 0.0 0 0.0 10 Nosocomial infection Other/undetermined 1 771 28.9 77 1.3 180 2.9 466 7.6 157 2.6 80 1.3 68 1.1 3 324 54.3 6 123 Other/undetermined Total EU-EEA 12 473 49.2 828 3.3 1 310 5.2 3 723 14.7 1 709 6.7 619 2.4 522 2.1 4 169 16.4 25 353 Total EU-EEA Non-EU/EEA Non-EU/EEA Sex between men 1 839 92.9 37 1.9 31 1.6 0 0.0 24 1.2 11 0.6 19 1.0 18 0.9 1 979 Men who have sex with men Injecting drug use 6 137 98.7 3 0.0 69 1.1 0 0.0 2 0.0 0 0.0 5 0.1 2 0.0 6 218 Injecting drug use Heterosexual contact 18 372 97.7 20 0.1 211 1.1 108 0.6 12 0.1 24 0.1 37 0.2 18 0.1 18 802 Heterosexual contact Mother-to-child 247 94.6 0 0.0 3 1.1 7 2.7 0 0.0 0 0.0 2 0.8 2 0.8 261 Mother-to-child Haemophiliac/transfusion recipient 10 76.9 0 0.0 1 7.7 1 7.7 0 0.0 0 0.0 1 7.7 0 0.0 13 Haemophiliac/transfusion recipient Nosocomial infection 22 95.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 4.3 23 Nosocomial infection Other/undetermined 1 824 77.0 38 1.6 170 7.2 78 3.3 5 0.2 32 1.4 91 3.8 130 5.5 2 368 Other/undetermined Total non-EU/EEA 28 451 95.9 98 0.3 485 1.6 194 0.7 43 0.1 67 0.2 155 0.5 171 0.6 29 664 Total non-EU/EEA Table 12b. West, Centre, East of the WHO European Region Transmission mode Country of report Western Europe Central and eastern Europe Sub-Saharan Africa Latin America and Caribbean South and south-east Asia Other Unknown Total Transmission modeN % N % N % N % N % N % N % N % West West Sex between men 5 589 63.0 566 6.4 474 5.3 226 2.5 1 162 13.1 312 3.5 277 3.1 266 3.0 8 872 Men who have sex with men Injecting drug use 360 59.7 39 6.5 149 24.7 7 1.2 11 1.8 9 1.5 9 1.5 19 3.2 603 Injecting drug use Heterosexual contact 2 987 39.0 171 2.2 481 6.3 3 023 39.4 403 5.3 209 2.7 187 2.4 203 2.6 7 664 Heterosexual contact Mother-to-child 25 20.8 5 4.2 5 4.2 71 59.2 0 0.0 4 3.3 5 4.2 5 4.2 120 Mother-to-child Haemophiliac/transfusion recipient 12 21.8 2 3.6 9 16.4 25 45.5 3 5.5 3 5.5 0 0.0 1 1.8 55 Haemophiliac/transfusion recipient Nosocomial infection 2 28.6 0 0.0 0 0.0 2 28.6 0 0.0 3 42.9 0 0.0 0 0.0 7 Nosocomial infection Other/undetermined 1 019 20.3 79 1.6 187 3.7 481 9.6 159 3.2 84 1.7 108 2.1 2 915 57.9 5 032 Other/undetermined Total West 9 994 44.7 862 3.9 1 305 5.8 3 835 17.2 1 738 7.8 624 2.8 586 2.6 3 409 15.3 22 353 Total West Centre Centre Sex between men 1 384 78.4 19 1.1 58 3.3 2 0.1 6 0.3 14 0.8 10 0.6 272 15.4 1 765 Men who have sex with men Injecting drug use 155 91.7 0 0.0 4 2.4 0 0.0 0 0.0 0 0.0 0 0.0 10 5.9 169 Injecting drug use Heterosexual contact 1 452 87.6 6 0.4 82 4.9 15 0.9 5 0.3 10 0.6 9 0.5 79 4.8 1 658 Heterosexual contact Mother-to-child 30 85.7 0 0.0 1 2.9 0 0.0 0 0.0 0 0.0 1 2.9 3 8.6 35 Mother-to-child Haemophiliac/transfusion recipient 5 45.5 0 0.0 4 36.4 0 0.0 0 0.0 1 9.1 1 9.1 0 0.0 11 Haemophiliac/transfusion recipient Nosocomial infection 8 72.7 0 0.0 2 18.2 0 0.0 0 0.0 0 0.0 0 0.0 1 9.1 11 Nosocomial infection Other/undetermined 1 793 70.1 33 1.3 138 5.4 62 2.4 3 0.1 25 1.0 47 1.8 455 17.8 2 556 Other/undetermined Total Centre 4 827 77.8 58 0.9 289 4.7 79 1.3 14 0.2 50 0.8 68 1.1 820 13.2 6 205 Total Centre East East Sex between men 1 019 98.4 0 0.0 9 0.9 0 0.0 0 0.0 2 0.2 2 0.2 4 0.4 1 036 Men who have sex with men Injecting drug use 6 330 99.3 2 0.0 37 0.6 0 0.0 0 0.0 0 0.0 5 0.1 1 0.0 6 375 Injecting drug use Heterosexual contact 17 710 99.0 1 0.0 128 0.7 2 0.0 0 0.0 7 0.0 12 0.1 22 0.1 17 882 Heterosexual contact Mother-to-child 240 99.2 0 0.0 2 0.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 242 Mother-to-child Haemophiliac/transfusion recipient 6 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 6 Haemophiliac/transfusion recipient Nosocomial infection 15 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 15 Nosocomial infection Other/undetermined 783 86.7 3 0.3 25 2.8 1 0.1 0 0.0 3 0.3 4 0.4 84 9.3 903 Other/undetermined Total East 26 103 98.7 6 0.0 201 0.8 3 0.0 0 0.0 12 0.0 23 0.1 111 0.4 26 459 Total East Total WHO European Region 4 0 924 74.4 1 852 1.7 3 590 3.3 7 834 7.1 3 504 3.2 1 372 1.2 1 354 1.2 8 680 7.9 55 017 Total WHO European Region 79 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 12. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2017 Table 12a. EU/EEA and non-EU/EEA countries Transmission mode Country of report Western Europe Central and eastern Europe Sub-Saharan Africa Latin America and Caribbean South and south-east Asia Other Unknown Total Transmission modeN % N % N % N % N % N % N % N % EU/EEA EU/EEA Sex between men 6 153 63.5 548 5.7 510 5.3 228 2.4 1 144 11.8 317 3.3 270 2.8 524 5.4 9 694 Men who have sex with men Injecting drug use 708 76.2 38 4.1 121 13.0 7 0.8 9 1.0 9 1.0 9 1.0 28 3.0 929 Injecting drug use Heterosexual contact 3 777 45.0 158 1.9 480 5.7 2 932 34.9 396 4.7 202 2.4 171 2.0 286 3.4 8 402 Heterosexual contact Mother-to-child 48 35.3 5 3.7 5 3.7 64 47.1 0 0.0 4 2.9 4 2.9 6 4.4 136 Mother-to-child Haemophiliac/transfusion recipient 13 22.0 2 3.4 12 20.3 24 40.7 3 5.1 4 6.8 0 0.0 1 1.7 59 Haemophiliac/transfusion recipient Nosocomial infection 3 30.0 0 0.0 2 20.0 2 20.0 0 0.0 3 30.0 0 0.0 0 0.0 10 Nosocomial infection Other/undetermined 1 771 28.9 77 1.3 180 2.9 466 7.6 157 2.6 80 1.3 68 1.1 3 324 54.3 6 123 Other/undetermined Total EU-EEA 12 473 49.2 828 3.3 1 310 5.2 3 723 14.7 1 709 6.7 619 2.4 522 2.1 4 169 16.4 25 353 Total EU-EEA Non-EU/EEA Non-EU/EEA Sex between men 1 839 92.9 37 1.9 31 1.6 0 0.0 24 1.2 11 0.6 19 1.0 18 0.9 1 979 Men who have sex with men Injecting drug use 6 137 98.7 3 0.0 69 1.1 0 0.0 2 0.0 0 0.0 5 0.1 2 0.0 6 218 Injecting drug use Heterosexual contact 18 372 97.7 20 0.1 211 1.1 108 0.6 12 0.1 24 0.1 37 0.2 18 0.1 18 802 Heterosexual contact Mother-to-child 247 94.6 0 0.0 3 1.1 7 2.7 0 0.0 0 0.0 2 0.8 2 0.8 261 Mother-to-child Haemophiliac/transfusion recipient 10 76.9 0 0.0 1 7.7 1 7.7 0 0.0 0 0.0 1 7.7 0 0.0 13 Haemophiliac/transfusion recipient Nosocomial infection 22 95.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 4.3 23 Nosocomial infection Other/undetermined 1 824 77.0 38 1.6 170 7.2 78 3.3 5 0.2 32 1.4 91 3.8 130 5.5 2 368 Other/undetermined Total non-EU/EEA 28 451 95.9 98 0.3 485 1.6 194 0.7 43 0.1 67 0.2 155 0.5 171 0.6 29 664 Total non-EU/EEA Table 12b. West, Centre, East of the WHO European Region Transmission mode Country of report Western Europe Central and eastern Europe Sub-Saharan Africa Latin America and Caribbean South and south-east Asia Other Unknown Total Transmission modeN % N % N % N % N % N % N % N % West West Sex between men 5 589 63.0 566 6.4 474 5.3 226 2.5 1 162 13.1 312 3.5 277 3.1 266 3.0 8 872 Men who have sex with men Injecting drug use 360 59.7 39 6.5 149 24.7 7 1.2 11 1.8 9 1.5 9 1.5 19 3.2 603 Injecting drug use Heterosexual contact 2 987 39.0 171 2.2 481 6.3 3 023 39.4 403 5.3 209 2.7 187 2.4 203 2.6 7 664 Heterosexual contact Mother-to-child 25 20.8 5 4.2 5 4.2 71 59.2 0 0.0 4 3.3 5 4.2 5 4.2 120 Mother-to-child Haemophiliac/transfusion recipient 12 21.8 2 3.6 9 16.4 25 45.5 3 5.5 3 5.5 0 0.0 1 1.8 55 Haemophiliac/transfusion recipient Nosocomial infection 2 28.6 0 0.0 0 0.0 2 28.6 0 0.0 3 42.9 0 0.0 0 0.0 7 Nosocomial infection Other/undetermined 1 019 20.3 79 1.6 187 3.7 481 9.6 159 3.2 84 1.7 108 2.1 2 915 57.9 5 032 Other/undetermined Total West 9 994 44.7 862 3.9 1 305 5.8 3 835 17.2 1 738 7.8 624 2.8 586 2.6 3 409 15.3 22 353 Total West Centre Centre Sex between men 1 384 78.4 19 1.1 58 3.3 2 0.1 6 0.3 14 0.8 10 0.6 272 15.4 1 765 Men who have sex with men Injecting drug use 155 91.7 0 0.0 4 2.4 0 0.0 0 0.0 0 0.0 0 0.0 10 5.9 169 Injecting drug use Heterosexual contact 1 452 87.6 6 0.4 82 4.9 15 0.9 5 0.3 10 0.6 9 0.5 79 4.8 1 658 Heterosexual contact Mother-to-child 30 85.7 0 0.0 1 2.9 0 0.0 0 0.0 0 0.0 1 2.9 3 8.6 35 Mother-to-child Haemophiliac/transfusion recipient 5 45.5 0 0.0 4 36.4 0 0.0 0 0.0 1 9.1 1 9.1 0 0.0 11 Haemophiliac/transfusion recipient Nosocomial infection 8 72.7 0 0.0 2 18.2 0 0.0 0 0.0 0 0.0 0 0.0 1 9.1 11 Nosocomial infection Other/undetermined 1 793 70.1 33 1.3 138 5.4 62 2.4 3 0.1 25 1.0 47 1.8 455 17.8 2 556 Other/undetermined Total Centre 4 827 77.8 58 0.9 289 4.7 79 1.3 14 0.2 50 0.8 68 1.1 820 13.2 6 205 Total Centre East East Sex between men 1 019 98.4 0 0.0 9 0.9 0 0.0 0 0.0 2 0.2 2 0.2 4 0.4 1 036 Men who have sex with men Injecting drug use 6 330 99.3 2 0.0 37 0.6 0 0.0 0 0.0 0 0.0 5 0.1 1 0.0 6 375 Injecting drug use Heterosexual contact 17 710 99.0 1 0.0 128 0.7 2 0.0 0 0.0 7 0.0 12 0.1 22 0.1 17 882 Heterosexual contact Mother-to-child 240 99.2 0 0.0 2 0.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 242 Mother-to-child Haemophiliac/transfusion recipient 6 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 6 Haemophiliac/transfusion recipient Nosocomial infection 15 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 15 Nosocomial infection Other/undetermined 783 86.7 3 0.3 25 2.8 1 0.1 0 0.0 3 0.3 4 0.4 84 9.3 903 Other/undetermined Total East 26 103 98.7 6 0.0 201 0.8 3 0.0 0 0.0 12 0.0 23 0.1 111 0.4 26 459 Total East Total WHO European Region 4 0 924 74.4 1 852 1.7 3 590 3.3 7 834 7.1 3 504 3.2 1 372 1.2 1 354 1.2 8 680 7.9 55 017 Total WHO European Region 80 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 13. New HIV diagnoses, by country of report and probable region of infection, in 2017, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Country of report Western Europe Central and eastern Europe Sub-Saharan Africa Latin America and Caribbean South and south-east Asia Other Unknown Total Country, territory or areaaN % N % N % N % N Rate N % N % N % EU/EEA EU/EEA West Austria 26 9.6 3 1.1 3 1.1 3 1.1 0 0.0 5 1.9 0 0.0 230 85.2 270 Austria West Belgium 174 19.6 23 2.6 13 1.5 83 9.3 10 1.1 14 1.6 12 1.3 561 63.0 890 Belgium Centre Bulgaria – – – – – – – – – – – – – – – – – Bulgaria Centre Croatia – – – – – – – – – – – – – – – – – Croatia Centre Cyprus 39 45.9 15 17.6 5 5.9 9 10.6 1 1.2 5 5.9 1 1.2 10 11.8 85 Cyprus Centre Czech Republic 13 5.1 4 1.6 15 5.9 1 0.4 2 0.8 4 1.6 3 1.2 212 83.5 254 Czech Republic West Denmark 110 45.5 16 6.6 25 10.3 29 12.0 7 2.9 32 13.2 11 4.5 12 5.0 242 Denmark East Estonia 101 46.1 3 1.4 3 1.4 0 0.0 0 0.0 3 1.4 0 0.0 109 49.8 219 Estonia West Finland 28 17.7 8 5.1 40 25.3 18 11.4 1 0.6 23 14.6 3 1.9 37 23.4 158 Finland West France 1 150 22.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 4 061 77.9 5 211 France West Germanyb – – – – – – – – – – – – – – – – – Germanyb West Greece – – – – – – – – – – – – – – – – – Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 9 37.5 5 20.8 5 20.8 1 4.2 0 0.0 1 4.2 0 0.0 3 12.5 24 Iceland West Ireland 93 19.3 28 5.8 12 2.5 50 10.4 58 12.0 19 3.9 14 2.9 209 43.3 483 Ireland West Italy – – – – – – – – – Italy East Latvia 219 59.0 2 0.5 5 1.3 0 0.0 0 0.0 1 0.3 0 0.0 144 38.8 371 Latvia Liechtenstein – – – – – – – – – Liechtenstein East Lithuania 0 0.0 4 1.5 6 2.3 0 0.0 0 0.0 0 0.0 0 0.0 253 96.2 263 Lithuania West Luxembourg 19 32.2 1 1.7 0 0.0 0 0.0 1 1.7 0 0.0 0 0.0 38 64.4 59 Luxembourg West Malta 16 35.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 29 64.4 45 Malta West Netherlands 411 57.4 21 2.9 11 1.5 18 2.5 24 3.4 19 2.7 13 1.8 199 27.8 716 Netherlands West Norway 0 0.0 20 9.4 19 8.9 53 24.9 15 7.0 40 18.8 8 3.8 58 27.2 213 Norway Centre Poland 0 0.0 0 0.0 2 0.2 0 0.0 0 0.0 0 0.0 0 0.0 1 323 99.8 1 325 Poland West Portugal 659 61.7 23 2.2 3 0.3 125 11.7 45 4.2 1 0.1 1 0.1 211 19.8 1 068 Portugal Centre Romania 653 98.8 2 0.3 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 5 0.8 661 Romania Centre Slovakia 0 0.0 6 8.6 5 7.1 0 0.0 0 0.0 0 0.0 1 1.4 58 82.9 70 Slovakia Centre Slovenia 25 64.1 1 2.6 3 7.7 0 0.0 0 0.0 1 2.6 1 2.6 8 20.5 39 Slovenia West Spain – – – – – – – – – – – – – – – – – Spain West Sweden 77 17.7 38 8.8 58 13.4 141 32.5 18 4.1 63 14.5 21 4.8 18 4.1 434 Sweden West United Kingdom 1 915 43.9 230 5.3 170 3.9 491 11.3 108 2.5 227 5.2 83 1.9 1 139 26.1 4 363 United Kingdom Total EU/EEA 5 737 32.9 453 2.6 403 2.3 1 023 5.9 290 1.7 458 2.6 172 1.0 8 927 51.1 17 463 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 89 94.7 5 5.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 94 Albania West Andorra – – – – – – – – – Andorra East Armenia 142 40.1 0 0.0 198 55.9 0 0.0 0 0.0 0 0.0 0 0.0 14 4.0 354 Armenia East Azerbaijan 293 51.4 0 0.0 133 23.3 1 0.2 0 0.0 2 0.4 1 0.2 140 24.6 570 Azerbaijan East Belarus 2 424 98.2 4 0.2 37 1.5 1 0.0 0 0.0 2 0.1 0 0.0 0 0.0 2 468 Belarus Centre Bosnia and Herzegovina 7 58.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5 41.7 12 Bosnia and Herzegovina East Georgia 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 630 99.8 631 Georgia West Israel 207 51.1 4 1.0 60 14.8 52 12.8 8 2.0 9 2.2 12 3.0 53 13.1 405 Israel East Kazakhstan 2 864 94.9 0 0.0 136 4.5 0 0.0 0 0.0 1 0.0 0 0.0 18 0.6 3 019 Kazakhstan East Kyrgyzstan 763 90.8 1 0.1 67 8.0 1 0.1 0 0.0 8 1.0 0 0.0 0 0.0 840 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro – – – – – – – – – – – – – – – – – Montenegro East Republic of Moldova 836 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 836 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia 0 0.0 0 0.0 2 1.1 0 0.0 0 0.0 0 0.0 0 0.0 179 98.9 181 Serbia Centre Serbia excluding Kosovoc 0 0.0 0 0.0 2 1.1 0 0.0 0 0.0 0 0.0 0 0.0 176 98.9 178 Serbia excluding Kosovoc Centre Kosovoc – – – – – – – – – – – – – – – – – Kosovoc West Switzerland 154 34.8 30 6.8 9 2.0 36 8.1 13 2.9 17 3.8 5 1.1 179 40.4 443 Switzerland East Tajikistan – – – – – – – – – – – – – – – – – Tajikistan Centre The former Yugoslav Republic of Macedonia 44 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 44 The former Yugoslav Republic of Macedonia Centre Turkey 2 384 83.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 460 16.2 2 844 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine – – – – – – – – – – – – – – – – – Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 10 208 80.1 44 0.3 642 5.0 91 0.7 21 0.2 39 0.3 18 0.1 1 675 13.1 12 738 Total non-EU/EEA WHO European Region WHO European Region West 5 048 33.6 450 3.0 428 2.8 1 100 7.3 308 2.1 470 3.1 183 1.2 7 037 46.8 15 024 West Centre 3 254 58.0 33 0.6 32 0.6 11 0.2 3 0.1 10 0.2 6 0.1 2 257 40.3 5 606 Centre East 7 643 79.9 14 0.1 585 6.1 3 0.0 0 0.0 17 0.2 1 0.0 1 308 13.7 9 571 East Total WHO European Region 15 945 52.8 497 1.6 1 045 3.5 1 114 3.7 311 1.0 497 1.6 190 0.6 10 602 35.1 30 201 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the variables "country of birth", "country of nationality" or "region of origin" are excluded and therefore regional totals may not equal those presented in Table 1. b Due to technical problems no data export for 2017 from Germany was available. c (in accordance with Security Council resolution 1244 (1999)). 81 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 13. New HIV diagnoses, by country of report and probable region of infection, in 2017, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Country of report Western Europe Central and eastern Europe Sub-Saharan Africa Latin America and Caribbean South and south-east Asia Other Unknown Total Country, territory or areaaN % N % N % N % N Rate N % N % N % EU/EEA EU/EEA West Austria 26 9.6 3 1.1 3 1.1 3 1.1 0 0.0 5 1.9 0 0.0 230 85.2 270 Austria West Belgium 174 19.6 23 2.6 13 1.5 83 9.3 10 1.1 14 1.6 12 1.3 561 63.0 890 Belgium Centre Bulgaria – – – – – – – – – – – – – – – – – Bulgaria Centre Croatia – – – – – – – – – – – – – – – – – Croatia Centre Cyprus 39 45.9 15 17.6 5 5.9 9 10.6 1 1.2 5 5.9 1 1.2 10 11.8 85 Cyprus Centre Czech Republic 13 5.1 4 1.6 15 5.9 1 0.4 2 0.8 4 1.6 3 1.2 212 83.5 254 Czech Republic West Denmark 110 45.5 16 6.6 25 10.3 29 12.0 7 2.9 32 13.2 11 4.5 12 5.0 242 Denmark East Estonia 101 46.1 3 1.4 3 1.4 0 0.0 0 0.0 3 1.4 0 0.0 109 49.8 219 Estonia West Finland 28 17.7 8 5.1 40 25.3 18 11.4 1 0.6 23 14.6 3 1.9 37 23.4 158 Finland West France 1 150 22.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 4 061 77.9 5 211 France West Germanyb – – – – – – – – – – – – – – – – – Germanyb West Greece – – – – – – – – – – – – – – – – – Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 9 37.5 5 20.8 5 20.8 1 4.2 0 0.0 1 4.2 0 0.0 3 12.5 24 Iceland West Ireland 93 19.3 28 5.8 12 2.5 50 10.4 58 12.0 19 3.9 14 2.9 209 43.3 483 Ireland West Italy – – – – – – – – – Italy East Latvia 219 59.0 2 0.5 5 1.3 0 0.0 0 0.0 1 0.3 0 0.0 144 38.8 371 Latvia Liechtenstein – – – – – – – – – Liechtenstein East Lithuania 0 0.0 4 1.5 6 2.3 0 0.0 0 0.0 0 0.0 0 0.0 253 96.2 263 Lithuania West Luxembourg 19 32.2 1 1.7 0 0.0 0 0.0 1 1.7 0 0.0 0 0.0 38 64.4 59 Luxembourg West Malta 16 35.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 29 64.4 45 Malta West Netherlands 411 57.4 21 2.9 11 1.5 18 2.5 24 3.4 19 2.7 13 1.8 199 27.8 716 Netherlands West Norway 0 0.0 20 9.4 19 8.9 53 24.9 15 7.0 40 18.8 8 3.8 58 27.2 213 Norway Centre Poland 0 0.0 0 0.0 2 0.2 0 0.0 0 0.0 0 0.0 0 0.0 1 323 99.8 1 325 Poland West Portugal 659 61.7 23 2.2 3 0.3 125 11.7 45 4.2 1 0.1 1 0.1 211 19.8 1 068 Portugal Centre Romania 653 98.8 2 0.3 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 5 0.8 661 Romania Centre Slovakia 0 0.0 6 8.6 5 7.1 0 0.0 0 0.0 0 0.0 1 1.4 58 82.9 70 Slovakia Centre Slovenia 25 64.1 1 2.6 3 7.7 0 0.0 0 0.0 1 2.6 1 2.6 8 20.5 39 Slovenia West Spain – – – – – – – – – – – – – – – – – Spain West Sweden 77 17.7 38 8.8 58 13.4 141 32.5 18 4.1 63 14.5 21 4.8 18 4.1 434 Sweden West United Kingdom 1 915 43.9 230 5.3 170 3.9 491 11.3 108 2.5 227 5.2 83 1.9 1 139 26.1 4 363 United Kingdom Total EU/EEA 5 737 32.9 453 2.6 403 2.3 1 023 5.9 290 1.7 458 2.6 172 1.0 8 927 51.1 17 463 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 89 94.7 5 5.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 94 Albania West Andorra – – – – – – – – – Andorra East Armenia 142 40.1 0 0.0 198 55.9 0 0.0 0 0.0 0 0.0 0 0.0 14 4.0 354 Armenia East Azerbaijan 293 51.4 0 0.0 133 23.3 1 0.2 0 0.0 2 0.4 1 0.2 140 24.6 570 Azerbaijan East Belarus 2 424 98.2 4 0.2 37 1.5 1 0.0 0 0.0 2 0.1 0 0.0 0 0.0 2 468 Belarus Centre Bosnia and Herzegovina 7 58.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5 41.7 12 Bosnia and Herzegovina East Georgia 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 630 99.8 631 Georgia West Israel 207 51.1 4 1.0 60 14.8 52 12.8 8 2.0 9 2.2 12 3.0 53 13.1 405 Israel East Kazakhstan 2 864 94.9 0 0.0 136 4.5 0 0.0 0 0.0 1 0.0 0 0.0 18 0.6 3 019 Kazakhstan East Kyrgyzstan 763 90.8 1 0.1 67 8.0 1 0.1 0 0.0 8 1.0 0 0.0 0 0.0 840 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro – – – – – – – – – – – – – – – – – Montenegro East Republic of Moldova 836 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 836 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia 0 0.0 0 0.0 2 1.1 0 0.0 0 0.0 0 0.0 0 0.0 179 98.9 181 Serbia Centre Serbia excluding Kosovoc 0 0.0 0 0.0 2 1.1 0 0.0 0 0.0 0 0.0 0 0.0 176 98.9 178 Serbia excluding Kosovoc Centre Kosovoc – – – – – – – – – – – – – – – – – Kosovoc West Switzerland 154 34.8 30 6.8 9 2.0 36 8.1 13 2.9 17 3.8 5 1.1 179 40.4 443 Switzerland East Tajikistan – – – – – – – – – – – – – – – – – Tajikistan Centre The former Yugoslav Republic of Macedonia 44 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 44 The former Yugoslav Republic of Macedonia Centre Turkey 2 384 83.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 460 16.2 2 844 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine – – – – – – – – – – – – – – – – – Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 10 208 80.1 44 0.3 642 5.0 91 0.7 21 0.2 39 0.3 18 0.1 1 675 13.1 12 738 Total non-EU/EEA WHO European Region WHO European Region West 5 048 33.6 450 3.0 428 2.8 1 100 7.3 308 2.1 470 3.1 183 1.2 7 037 46.8 15 024 West Centre 3 254 58.0 33 0.6 32 0.6 11 0.2 3 0.1 10 0.2 6 0.1 2 257 40.3 5 606 Centre East 7 643 79.9 14 0.1 585 6.1 3 0.0 0 0.0 17 0.2 1 0.0 1 308 13.7 9 571 East Total WHO European Region 15 945 52.8 497 1.6 1 045 3.5 1 114 3.7 311 1.0 497 1.6 190 0.6 10 602 35.1 30 201 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the variables "country of birth", "country of nationality" or "region of origin" are excluded and therefore regional totals may not equal those presented in Table 1. b Due to technical problems no data export for 2017 from Germany was available. c (in accordance with Security Council resolution 1244 (1999)).

83 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 14. Percentage of new HIV diagnoses (2017) among people > 14 years reported with information about CD4 cell count, by CD4 cell count level (< 200 and < 350 cells per mm³ blood) and by transmission mode in cases with CD4 < 350, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Number of cases with CD4 cell count Completeness (%) CD4b CD4 < 200 (%) CD4 < 350 (%) CD4 < 350 mm³ (%) N % N % Heterosexualb Injecting drug userb MSM b EU/EEA West Austria 261 96.7 78 29.9 125 47.9 60.8 58.3 38.3 West Belgium 599 68.3 137 22.9 251 41.9 49.0 0.0 36.8 Centre Bulgaria 184 77.3 43 23.4 88 47.8 60.3 27.8 43.7 Centre Croatia 102 96.2 38 37.3 59 57.8 75.0 – 55.9 Centre Cyprus 75 88.2 16 21.3 31 41.3 56.7 – 26.8 Centre Czech Republic 230 90.9 49 21.3 75 32.6 48.1 – 27.4 West Denmarkd 129 92.1 32 24.8 60 46.5 52.9 – 39.4 East Estonia 78 35.6 22 28.2 42 53.8 62.0 14.3 75.0 West Finland 124 79.0 38 30.6 60 48.4 58.5 33.3 40.7 West France 2 374 45.9 637 26.8 1 144 48.2 55.3 43.8 37.3 West Germanyc – – – – – – – – – West Greece 431 68.7 155 36.0 245 56.8 68.2 55.4 49.4 Centre Hungary – – – – – – – – – West Iceland – – – – – – – – – West Irelandd 155 49.1 44 28.4 82 52.9 63.6 – 44.0 West Italy 2 701 78.8 977 36.2 1 511 55.9 61.9 63.2 46.0 East Latvia 213 58.0 80 37.6 132 62.0 67.8 28.2 84.6 Liechtenstein – – – – – – – – – East Lithuania 104 39.7 39 37.5 69 66.3 70.8 46.7 76.5 West Luxembourg 46 78.0 17 37.0 23 50.0 70.8 11.1 30.0 West Malta 31 73.8 9 29.0 17 54.8 57.1 – 42.9 West Netherlands 637 90.7 161 25.3 287 45.1 57.9 – 38.2 West Norway – – – – – – – – – Centre Poland – – – – – – – – – West Portugal 901 84.7 280 31.1 464 51.5 57.7 69.2 39.9 Centre Romania 607 94.1 234 38.6 364 60.0 63.6 65.1 44.9 Centre Slovakia 58 82.9 21 36.2 27 46.6 45.5 – 45.7 Centre Slovenia 33 84.6 12 36.4 15 45.5 44.4 – 47.8 West Spain 2 726 84.1 749 27.5 1 307 47.9 57.8 51.9 41.5 West Sweden 326 77.4 85 26.1 153 46.9 58.9 31.3 30.4 West United Kingdom 3 460 79.8 737 21.3 1 424 41.2 52.4 48.9 31.0 Total EU/EEA 16 585 71.7 4 690 28.3 8 055 48.6 57.6 51.2 38.9 Non-EU/EEA Centre Albania 58 62.4 25 43.1 34 58.6 60.0 – – West Andorra – – – – – – – – – East Armenia 281 80.7 104 37.0 154 54.8 54.3 66.7 35.7 East Azerbaijan 229 41.2 78 34.1 119 52.0 49.7 75.9 16.7 East Belarus – – – – – – – – – Centre Bosnia and Herzegovina 4 33.3 2 50.0 2 50.0 – – – East Georgia 546 87.1 187 34.2 285 52.2 56.8 63.3 29.3 West Israel 231 57.9 57 24.7 108 46.8 59.8 42.9 35.2 East Kazakhstan 2 206 74.1 444 20.1 1 007 45.6 49.0 39.1 42.4 East Kyrgyzstan 351 43.3 120 34.2 237 67.5 70.1 63.4 60.0 West Monaco – – – – – – – – – Centre Montenegro 26 100.0 12 46.2 16 61.5 – – 54.5 East Republic of Moldova 638 77.3 191 29.9 340 53.3 52.2 52.6 57.1 East Russian Federation – – – – – – – – – West San Marino – – – – – – – – – Centre Serbia 125 69.1 58 46.4 82 65.6 66.7 – 63.1 Centre Serbia excluding Kosovoe 123 69.1 57 46.3 81 65.9 68.8 – 63.1 Centre Kosovoe 2 66.7 1 50.0 1 50.0 – – – West Switzerland 301 68.7 83 27.6 142 47.2 56.2 50.0 38.3 East Tajikistan 918 84.7 342 37.3 574 62.5 62.0 63.4 66.7 Centre The former Yugoslav Republic of Macedonia 34 79.1 7 20.6 13 38.2 – – 34.5 Centre Turkey – – – – – – – – – East Turkmenistan – – – – – – – – – East Ukraine 13 908 89.3 5 194 37.3 8 172 58.8 59.8 57.9 43.0 East Uzbekistan – – – – – – – – – Total non-EU/EEA 19 856 82.7 6 904 34.8 11 285 56.8 58.4 55.7 42.3 WHO European Region West 15 433 71.1 4 276 27.7 7 403 48.0 57.1 52.0 38.5 Centre 1 536 85.8 517 33.7 806 52.5 61.3 58.7 43.2 East 19 472 82.3 6 801 34.9 11 131 57.2 58.5 55.4 43.2 Total WHO European Region 36 441 77.3 11 594 31.8 19 340 53.1 58.2 55.2 39.4 a Country-specific comments are in Annex 5. b There is some variation by country, territory or area for CD4 cell count completeness by transmission group and numbers of cases by transmission group (MSM, heterosexual, injecting drug users), so percentages based on five or fewer cases are censored. c Due to technical problems no data export for 2017 from Germany was available. d People who were previously diagnosed HIV positive abroad are excluded in numbers reported for Denmark and Ireland and the data presented in the table are therefore not comparable with other countries. e (in accordance with Security Council resolution 1244 (1999)). 84 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 15. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 1982 100 1.2 95 1.1 83 1.0 80 1.0 100 1.2 67 0.8 82 1.0 73 0.9 61 0.7 56 0.6 3 175 Austria West Belgium 1983 134 1.3 142 1.3 120 1.1 98 0.9 106 1.0 100 0.9 118 1.1 95 0.8 – – – – 4 841 Belgium Centre Bulgaria 1987 29 0.4 30 0.4 32 0.4 40 0.5 65 0.9 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 665 Bulgaria Centre Croatia 1986 25 0.6 22 0.5 21 0.5 26 0.6 28 0.7 17 0.4 23 0.5 16 0.4 22 0.5 20 0.5 481 Croatia Centre Cyprus 1986 12 1.5 8 1.0 11 1.3 12 1.4 11 1.3 9 1.0 11 1.3 13 1.5 22 2.6 16 1.9 328 Cyprus Centre Czech Republic 1986 32 0.3 24 0.2 28 0.3 29 0.3 36 0.3 33 0.3 32 0.3 38 0.4 44 0.4 52 0.5 596 Czech Republic West Denmark 1980 40 0.7 36 0.7 44 0.8 59 1.1 41 0.7 38 0.7 30 0.5 40 0.7 24 0.4 28 0.5 2 989 Denmark East Estonia 1992 61 4.6 38 2.8 26 2.0 38 2.9 36 2.7 26 2.0 18 1.4 18 1.4 41 3.1 20 1.5 513 Estonia West Finland 1983 28 0.5 24 0.5 31 0.6 24 0.4 19 0.4 20 0.4 20 0.4 18 0.3 30 0.5 18 0.3 703 Finland West France 1980 1 072 1.7 957 1.5 986 1.5 862 1.3 830 1.3 705 1.1 638 1.0 595 0.9 482 0.7 392 0.6 71 655 France West Germanyc 1981 590 0.7 629 0.8 514 0.6 506 0.6 490 0.6 429 0.5 370 0.5 299 0.4 120 0.1 – – 31 119 Germanyc West Greece 1981 112 1.0 104 0.9 103 0.9 103 0.9 123 1.1 140 1.3 126 1.2 137 1.3 136 1.3 112 1.0 4 094 Greece Centre Hungary 1986 23 0.2 23 0.2 28 0.3 32 0.3 48 0.5 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 944 Hungary West Iceland 1985 2 0.6 0 0.0 1 0.3 2 0.6 1 0.3 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 71 Iceland West Ireland 1983 36 0.8 35 0.8 38 0.8 47 1.0 38 0.8 28 0.6 33 0.7 20 0.4 14 0.3 16 0.3 1 277 Ireland West Italy 1982 1 342 2.3 1 206 2.0 1 149 1.9 1 055 1.8 1 073 1.8 1 075 1.8 927 1.5 860 1.4 827 1.4 690 1.1 69 734 Italy East Latvia 1990 103 4.7 101 4.7 132 6.2 112 5.4 142 6.9 133 6.6 171 8.5 132 6.6 114 5.8 118 6.0 1 888 Latvia Liechetenstein 1989 0 0.0 0 0.0 0 0.0 1 2.8 1 2.7 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 12 Liechetenstein East Lithuania 1988 54 1.7 37 1.2 33 1.1 21 0.7 38 1.3 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 552 Lithuania West Luxembourg 1983 9 1.9 5 1.0 8 1.6 12 2.3 8 1.5 11 2.0 9 1.6 9 1.6 11 1.9 6 1.0 323 Luxembourg West Malta 1986 9 2.2 1 0.2 6 1.4 5 1.2 6 1.4 1 0.2 4 0.9 2 0.5 5 1.2 0 0.0 114 Malta West Netherlands 1999 315 1.9 309 1.9 318 1.9 266 1.6 290 1.7 264 1.6 212 1.3 241 1.4 202 1.2 115 0.7 7 148 Netherlands West Norway 1983 18 0.4 18 0.4 22 0.5 19 0.4 25 0.5 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 1 172 Norway Centre Poland 1986 180 0.5 131 0.3 173 0.5 184 0.5 157 0.4 162 0.4 148 0.4 128 0.3 102 0.3 101 0.3 3 567 Poland West Portugal 1985 841 8.0 720 6.8 751 7.1 635 6.0 607 5.8 495 4.7 352 3.4 317 3.1 337 3.3 234 2.3 22 102 Portugal Centre Romania 1985 347 1.7 278 1.4 255 1.3 328 1.6 332 1.7 356 1.8 395 2.0 349 1.8 321 1.6 283 1.4 9 859 Romania Centre Slovakia 1985 1 0.0 4 0.1 2 0.0 4 0.1 7 0.1 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 105 Slovakia Centre Slovenia 1986 11 0.5 18 0.9 7 0.3 15 0.7 12 0.6 11 0.5 16 0.8 11 0.5 10 0.5 7 0.3 257 Slovenia West Spain 1981 1 567 3.4 1 434 3.1 1 447 3.1 1 285 2.8 1 163 2.5 852 1.8 664 1.6 597 1.8 500 1.5 406 1.2 87 286 Spain West Sweden 1982 – – – – – – – – – – – – – – – – – – – – 2 168 Sweden West United Kingdom 1981 805 1.3 634 1.0 652 1.0 409 0.6 434 0.7 345 0.5 365 0.6 398 0.6 312 0.5 262 0.4 28 984 United Kingdom Total EU/EEA 7 898 1.6 7 063 1.4 7 021 1.4 6 309 1.2 6 267 1.3 5 509 1.1 4 966 1.0 4 559 0.9 3 916 0.8 3 130 0.7 358 722 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 32 1.1 34 1.1 26 0.9 46 1.6 49 1.7 65 2.2 50 1.7 65 2.2 58 2.0 33 1.1 562 Albania West Andorra 2004 3 3.6 0 0.0 0 0.0 1 1.2 0 0.0 2 2.5 1 1.3 3 3.8 0 0.0 0 0.0 13 Andorra East Armenia 1988 83 2.9 84 2.9 94 3.3 87 3.0 134 4.6 144 5.0 172 5.9 162 5.6 162 5.5 144 4.9 1 476 Armenia East Azerbaijan 1995 59 0.7 99 1.1 250 2.8 195 2.1 235 2.5 189 2.0 200 2.1 193 2.0 161 1.7 168 1.7 2041 Azerbaijan East Belarus 1991 351 3.7 532 5.6 475 5.0 590 6.2 598 6.3 547 5.8 474 5.0 490 5.2 512 5.4 439 4.6 5 985 Belarus Centre Bosnia and Herzegovina 1986 5 0.1 2 0.1 6 0.2 7 0.2 4 0.1 7 0.2 7 0.2 7 0.2 7 0.2 4 0.1 152 Bosnia and Herzegovina East Georgia 1989 232 5.3 284 6.6 339 8.0 395 9.5 359 8.7 303 7.5 268 6.7 270 6.8 270 6.9 258 6.6 3 730 Georgia West Israel 1981 53 0.7 53 0.7 40 0.5 55 0.7 51 0.7 47 0.6 68 0.9 42 0.5 38 0.5 26 0.3 1 658 Israel East Kazakhstan 1993 179 1.1 208 1.3 252 1.5 237 1.4 239 1.4 259 1.5 246 1.4 268 1.5 352 2.0 361 2.0 3 223 Kazakhstan East Kyrgyzstan 1999 36 0.7 75 1.4 130 2.4 90 1.6 88 1.6 67 1.2 85 1.5 125 2.1 72 1.2 59 1.0 938 Kyrgyzstan West Monaco 1985 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 2.6 0 0.0 0 0.0 0 0.0 51 Monaco Centre Montenegro 1990 6 1.0 8 1.3 7 1.1 2 0.3 7 1.1 7 1.1 7 1.1 11 1.8 14 2.2 13 2.1 135 Montenegro East Republic of Moldova 1989 92 2.2 262 6.4 306 7.5 439 10.8 183 4.5 234 5.7 300 7.4 293 7.2 366 9.0 278 6.9 3 289 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 1986 0 0.0 0 0.0 0 0.0 1 3.2 2 6.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 San Marino Centre Serbia 1985 42 0.4 53 0.5 50 0.4 60 0.6 56 0.5 49 0.5 49 0.5 49 0.5 61 0.6 62 0.7 1 974 Serbia Centre Serbia excluding Kosovod 1985 39 0.4 52 0.6 49 0.5 53 0.6 54 0.6 46 0.5 48 0.5 46 0.5 56 0.6 56 0.6 1 902 Serbia excluding Kosovod Centre Kosovod 2005 3 0.1 1 0.0 1 0.0 7 0.4 2 0.1 3 0.2 1 0.1 3 0.2 5 0.3 6 0.0 72 Kosovod West Switzerland 1980 164 2.1 155 2.0 165 2.1 134 1.7 95 1.2 102 1.3 77 0.9 61 0.7 61 0.7 51 0.6 9 926 Switzerland East Tajikistan 1998 55 0.8 75 1.0 106 1.4 149 1.9 182 2.3 190 2.3 225 2.7 282 3.3 233 2.7 247 2.8 1 813 Tajikistan Centre The former Yugoslav Republic of Macedonia 1989 9 0.4 2 0.1 6 0.3 8 0.4 10 0.5 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 166 The former Yugoslav Republic of Macedonia Centre Turkey 1985 55 0.1 67 0.1 60 0.1 81 0.1 95 0.1 96 0.1 125 0.2 118 0.2 99 0.1 120 0.1 1 576 Turkey East Turkmenistan 2002 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 1 Turkmenistan East Ukraine 1988 4 380 9.5 4 437 9.6 5 861 12.8 9 189 20.2 10 073 22.2 9 362 20.8 9 844 21.9 8 468 19.8 8 852 20.8 9 308 21.9 10 2207 Ukraine East Uzbekistan 1992 184 0.7 129 0.5 220 0.8 – – – – – – – – – – – – – – 651 Uzbekistan Total non-EU/EEA 6 020 2.5 6 559 2.7 8 393 3.5 11 766 5.5 12 460 5.8 11 680 5.4 12 215 5.6 10 913 5.0 11 327 5.1 11 573 5.2 14 1590 Total non-EU/EEA WHO European Region WHO European Region West West 7 240 1.7 6 557 1.6 6 478 1.5 5 658 1.4 5 502 1.3 4 750 1.1 4 142 1.0 3 829 0.9 3 186 0.8 2 426 0.7 35 0626 West Centre Centre 809 0.4 704 0.4 712 0.4 874 0.5 917 0.5 941 0.5 998 0.5 907 0.5 874 0.4 823 0.4 2 1367 Centre East East 5 869 4.2 6 361 4.6 8 224 5.9 11 542 10.3 12 307 11.0 11 498 10.2 12 040 10.7 10 736 9.7 11 183 10.0 11 454 10.2 12 8307 East Total WHO European Region 13 918 1.9 13 622 1.8 15 414 2.1 18 074 2.5 18 726 2.6 17 189 2.4 17 180 2.4 15 472 2.2 15 243 2.1 14 703 2.3 50 0300 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 85 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 15. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 1982 100 1.2 95 1.1 83 1.0 80 1.0 100 1.2 67 0.8 82 1.0 73 0.9 61 0.7 56 0.6 3 175 Austria West Belgium 1983 134 1.3 142 1.3 120 1.1 98 0.9 106 1.0 100 0.9 118 1.1 95 0.8 – – – – 4 841 Belgium Centre Bulgaria 1987 29 0.4 30 0.4 32 0.4 40 0.5 65 0.9 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 665 Bulgaria Centre Croatia 1986 25 0.6 22 0.5 21 0.5 26 0.6 28 0.7 17 0.4 23 0.5 16 0.4 22 0.5 20 0.5 481 Croatia Centre Cyprus 1986 12 1.5 8 1.0 11 1.3 12 1.4 11 1.3 9 1.0 11 1.3 13 1.5 22 2.6 16 1.9 328 Cyprus Centre Czech Republic 1986 32 0.3 24 0.2 28 0.3 29 0.3 36 0.3 33 0.3 32 0.3 38 0.4 44 0.4 52 0.5 596 Czech Republic West Denmark 1980 40 0.7 36 0.7 44 0.8 59 1.1 41 0.7 38 0.7 30 0.5 40 0.7 24 0.4 28 0.5 2 989 Denmark East Estonia 1992 61 4.6 38 2.8 26 2.0 38 2.9 36 2.7 26 2.0 18 1.4 18 1.4 41 3.1 20 1.5 513 Estonia West Finland 1983 28 0.5 24 0.5 31 0.6 24 0.4 19 0.4 20 0.4 20 0.4 18 0.3 30 0.5 18 0.3 703 Finland West France 1980 1 072 1.7 957 1.5 986 1.5 862 1.3 830 1.3 705 1.1 638 1.0 595 0.9 482 0.7 392 0.6 71 655 France West Germanyc 1981 590 0.7 629 0.8 514 0.6 506 0.6 490 0.6 429 0.5 370 0.5 299 0.4 120 0.1 – – 31 119 Germanyc West Greece 1981 112 1.0 104 0.9 103 0.9 103 0.9 123 1.1 140 1.3 126 1.2 137 1.3 136 1.3 112 1.0 4 094 Greece Centre Hungary 1986 23 0.2 23 0.2 28 0.3 32 0.3 48 0.5 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 944 Hungary West Iceland 1985 2 0.6 0 0.0 1 0.3 2 0.6 1 0.3 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 71 Iceland West Ireland 1983 36 0.8 35 0.8 38 0.8 47 1.0 38 0.8 28 0.6 33 0.7 20 0.4 14 0.3 16 0.3 1 277 Ireland West Italy 1982 1 342 2.3 1 206 2.0 1 149 1.9 1 055 1.8 1 073 1.8 1 075 1.8 927 1.5 860 1.4 827 1.4 690 1.1 69 734 Italy East Latvia 1990 103 4.7 101 4.7 132 6.2 112 5.4 142 6.9 133 6.6 171 8.5 132 6.6 114 5.8 118 6.0 1 888 Latvia Liechetenstein 1989 0 0.0 0 0.0 0 0.0 1 2.8 1 2.7 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 12 Liechetenstein East Lithuania 1988 54 1.7 37 1.2 33 1.1 21 0.7 38 1.3 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 552 Lithuania West Luxembourg 1983 9 1.9 5 1.0 8 1.6 12 2.3 8 1.5 11 2.0 9 1.6 9 1.6 11 1.9 6 1.0 323 Luxembourg West Malta 1986 9 2.2 1 0.2 6 1.4 5 1.2 6 1.4 1 0.2 4 0.9 2 0.5 5 1.2 0 0.0 114 Malta West Netherlands 1999 315 1.9 309 1.9 318 1.9 266 1.6 290 1.7 264 1.6 212 1.3 241 1.4 202 1.2 115 0.7 7 148 Netherlands West Norway 1983 18 0.4 18 0.4 22 0.5 19 0.4 25 0.5 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 1 172 Norway Centre Poland 1986 180 0.5 131 0.3 173 0.5 184 0.5 157 0.4 162 0.4 148 0.4 128 0.3 102 0.3 101 0.3 3 567 Poland West Portugal 1985 841 8.0 720 6.8 751 7.1 635 6.0 607 5.8 495 4.7 352 3.4 317 3.1 337 3.3 234 2.3 22 102 Portugal Centre Romania 1985 347 1.7 278 1.4 255 1.3 328 1.6 332 1.7 356 1.8 395 2.0 349 1.8 321 1.6 283 1.4 9 859 Romania Centre Slovakia 1985 1 0.0 4 0.1 2 0.0 4 0.1 7 0.1 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 105 Slovakia Centre Slovenia 1986 11 0.5 18 0.9 7 0.3 15 0.7 12 0.6 11 0.5 16 0.8 11 0.5 10 0.5 7 0.3 257 Slovenia West Spain 1981 1 567 3.4 1 434 3.1 1 447 3.1 1 285 2.8 1 163 2.5 852 1.8 664 1.6 597 1.8 500 1.5 406 1.2 87 286 Spain West Sweden 1982 – – – – – – – – – – – – – – – – – – – – 2 168 Sweden West United Kingdom 1981 805 1.3 634 1.0 652 1.0 409 0.6 434 0.7 345 0.5 365 0.6 398 0.6 312 0.5 262 0.4 28 984 United Kingdom Total EU/EEA 7 898 1.6 7 063 1.4 7 021 1.4 6 309 1.2 6 267 1.3 5 509 1.1 4 966 1.0 4 559 0.9 3 916 0.8 3 130 0.7 358 722 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 32 1.1 34 1.1 26 0.9 46 1.6 49 1.7 65 2.2 50 1.7 65 2.2 58 2.0 33 1.1 562 Albania West Andorra 2004 3 3.6 0 0.0 0 0.0 1 1.2 0 0.0 2 2.5 1 1.3 3 3.8 0 0.0 0 0.0 13 Andorra East Armenia 1988 83 2.9 84 2.9 94 3.3 87 3.0 134 4.6 144 5.0 172 5.9 162 5.6 162 5.5 144 4.9 1 476 Armenia East Azerbaijan 1995 59 0.7 99 1.1 250 2.8 195 2.1 235 2.5 189 2.0 200 2.1 193 2.0 161 1.7 168 1.7 2041 Azerbaijan East Belarus 1991 351 3.7 532 5.6 475 5.0 590 6.2 598 6.3 547 5.8 474 5.0 490 5.2 512 5.4 439 4.6 5 985 Belarus Centre Bosnia and Herzegovina 1986 5 0.1 2 0.1 6 0.2 7 0.2 4 0.1 7 0.2 7 0.2 7 0.2 7 0.2 4 0.1 152 Bosnia and Herzegovina East Georgia 1989 232 5.3 284 6.6 339 8.0 395 9.5 359 8.7 303 7.5 268 6.7 270 6.8 270 6.9 258 6.6 3 730 Georgia West Israel 1981 53 0.7 53 0.7 40 0.5 55 0.7 51 0.7 47 0.6 68 0.9 42 0.5 38 0.5 26 0.3 1 658 Israel East Kazakhstan 1993 179 1.1 208 1.3 252 1.5 237 1.4 239 1.4 259 1.5 246 1.4 268 1.5 352 2.0 361 2.0 3 223 Kazakhstan East Kyrgyzstan 1999 36 0.7 75 1.4 130 2.4 90 1.6 88 1.6 67 1.2 85 1.5 125 2.1 72 1.2 59 1.0 938 Kyrgyzstan West Monaco 1985 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 2.6 0 0.0 0 0.0 0 0.0 51 Monaco Centre Montenegro 1990 6 1.0 8 1.3 7 1.1 2 0.3 7 1.1 7 1.1 7 1.1 11 1.8 14 2.2 13 2.1 135 Montenegro East Republic of Moldova 1989 92 2.2 262 6.4 306 7.5 439 10.8 183 4.5 234 5.7 300 7.4 293 7.2 366 9.0 278 6.9 3 289 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 1986 0 0.0 0 0.0 0 0.0 1 3.2 2 6.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 San Marino Centre Serbia 1985 42 0.4 53 0.5 50 0.4 60 0.6 56 0.5 49 0.5 49 0.5 49 0.5 61 0.6 62 0.7 1 974 Serbia Centre Serbia excluding Kosovod 1985 39 0.4 52 0.6 49 0.5 53 0.6 54 0.6 46 0.5 48 0.5 46 0.5 56 0.6 56 0.6 1 902 Serbia excluding Kosovod Centre Kosovod 2005 3 0.1 1 0.0 1 0.0 7 0.4 2 0.1 3 0.2 1 0.1 3 0.2 5 0.3 6 0.0 72 Kosovod West Switzerland 1980 164 2.1 155 2.0 165 2.1 134 1.7 95 1.2 102 1.3 77 0.9 61 0.7 61 0.7 51 0.6 9 926 Switzerland East Tajikistan 1998 55 0.8 75 1.0 106 1.4 149 1.9 182 2.3 190 2.3 225 2.7 282 3.3 233 2.7 247 2.8 1 813 Tajikistan Centre The former Yugoslav Republic of Macedonia 1989 9 0.4 2 0.1 6 0.3 8 0.4 10 0.5 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 166 The former Yugoslav Republic of Macedonia Centre Turkey 1985 55 0.1 67 0.1 60 0.1 81 0.1 95 0.1 96 0.1 125 0.2 118 0.2 99 0.1 120 0.1 1 576 Turkey East Turkmenistan 2002 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 1 Turkmenistan East Ukraine 1988 4 380 9.5 4 437 9.6 5 861 12.8 9 189 20.2 10 073 22.2 9 362 20.8 9 844 21.9 8 468 19.8 8 852 20.8 9 308 21.9 10 2207 Ukraine East Uzbekistan 1992 184 0.7 129 0.5 220 0.8 – – – – – – – – – – – – – – 651 Uzbekistan Total non-EU/EEA 6 020 2.5 6 559 2.7 8 393 3.5 11 766 5.5 12 460 5.8 11 680 5.4 12 215 5.6 10 913 5.0 11 327 5.1 11 573 5.2 14 1590 Total non-EU/EEA WHO European Region WHO European Region West West 7 240 1.7 6 557 1.6 6 478 1.5 5 658 1.4 5 502 1.3 4 750 1.1 4 142 1.0 3 829 0.9 3 186 0.8 2 426 0.7 35 0626 West Centre Centre 809 0.4 704 0.4 712 0.4 874 0.5 917 0.5 941 0.5 998 0.5 907 0.5 874 0.4 823 0.4 2 1367 Centre East East 5 869 4.2 6 361 4.6 8 224 5.9 11 542 10.3 12 307 11.0 11 498 10.2 12 040 10.7 10 736 9.7 11 183 10.0 11 454 10.2 12 8307 East Total WHO European Region 13 918 1.9 13 622 1.8 15 414 2.1 18 074 2.5 18 726 2.6 17 189 2.4 17 180 2.4 15 472 2.2 15 243 2.1 14 703 2.3 50 0300 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 86 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 16. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 81 2.0 67 1.7 64 1.6 61 1.5 79 1.9 48 1.2 57 1.4 56 1.3 43 1.0 46 1.1 2 414 Austria West Belgium 85 1.6 91 1.7 69 1.3 58 1.1 65 1.2 70 1.3 77 1.4 59 1.1 – – – – 3 254 Belgium Centre Bulgaria 20 0.5 22 0.6 21 0.6 38 1.1 47 1.3 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 517 Bulgaria Centre Croatia 24 1.2 20 1.0 20 1.0 25 1.2 26 1.3 14 0.7 21 1.0 15 0.7 21 1.0 19 0.9 429 Croatia Centre Cyprus 10 2.6 8 2.1 8 2.0 7 1.7 9 2.1 5 1.2 10 2.4 9 2.2 17 4.1 9 2.2 250 Cyprus Centre Czech Republic 25 0.5 18 0.4 21 0.4 20 0.4 28 0.5 27 0.5 23 0.4 30 0.6 38 0.7 43 0.8 485 Czech Republic West Denmark 33 1.2 25 0.9 34 1.2 40 1.5 35 1.3 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 2 544 Denmark East Estonia 44 7.1 26 4.2 21 3.4 31 5.0 25 4.0 19 3.1 13 2.1 11 1.8 24 3.9 15 2.4 370 Estonia West Finland 25 1.0 15 0.6 22 0.8 17 0.6 16 0.6 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 566 Finland West France 726 2.3 680 2.2 673 2.2 630 2.0 571 1.8 507 1.6 432 1.4 408 1.3 319 1.0 278 0.9 56 220 France West Germanyc 490 1.2 509 1.3 428 1.1 425 1.1 388 1.0 341 0.9 313 0.8 245 0.6 96 0.2 – – 26 616 Germanyc West Greece 98 1.8 82 1.5 84 1.5 87 1.6 102 1.9 120 2.2 103 1.9 113 2.1 102 2.0 83 1.6 3 420 Greece Centre Hungary 21 0.4 17 0.4 26 0.5 27 0.6 45 1.0 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 814 Hungary West Iceland 2 1.2 0 0.0 1 0.6 1 0.6 1 0.6 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 62 Iceland West Ireland 27 1.2 27 1.2 27 1.2 34 1.5 29 1.3 20 0.9 23 1.0 15 0.7 11 0.5 11 0.5 978 Ireland West Italy 992 3.5 909 3.2 849 3.0 803 2.8 783 2.7 811 2.8 709 2.4 675 2.3 636 2.2 508 1.7 53 758 Italy East Latvia 77 7.6 67 6.7 86 8.9 80 8.4 102 10.9 90 9.7 110 12.0 89 9.8 90 10.0 73 8.1 1 312 Latvia Liechetenstein 0 0.0 0 0.0 0 0.0 1 5.6 1 5.5 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 11 Liechetenstein East Lithuania 45 3.0 28 1.9 27 1.9 15 1.1 28 2.0 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 448 Lithuania West Luxembourg 5 2.1 3 1.2 4 1.6 8 3.1 5 1.9 10 3.7 6 2.2 5 1.8 9 3.1 5 1.7 248 Luxembourg West Malta 9 4.4 1 0.5 4 1.9 3 1.5 5 2.4 1 0.5 4 1.9 2 0.9 5 2.3 0 0.0 100 Malta West Netherlands 255 3.1 260 3.2 253 3.1 211 2.6 231 2.8 218 2.6 176 2.1 201 2.4 157 1.9 94 1.1 5 764 Netherlands West Norway 11 0.5 13 0.5 20 0.8 17 0.7 23 0.9 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 912 Norway Centre Poland 139 0.8 99 0.5 132 0.7 142 0.8 120 0.7 131 0.7 115 0.6 97 0.5 90 0.5 89 0.5 2 824 Poland West Portugal 619 12.2 521 10.3 526 10.4 468 9.3 431 8.6 344 6.9 270 5.4 230 4.7 241 4.9 170 3.5 17 460 Portugal Centre Romania 188 1.9 164 1.6 146 1.5 203 2.1 207 2.1 242 2.5 281 2.9 241 2.5 228 2.4 209 2.2 5 850 Romania Centre Slovakia 0 0.0 3 0.1 2 0.1 4 0.2 7 0.3 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 92 Slovakia Centre Slovenia 9 0.9 16 1.6 7 0.7 12 1.2 11 1.1 10 1.0 15 1.5 11 1.1 8 0.8 7 0.7 227 Slovenia West Spain 1 190 5.3 1 100 4.8 1 129 4.9 994 4.3 891 3.9 665 2.9 534 2.8 482 2.9 408 2.4 321 1.9 69 566 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 1 773 Sweden West United Kingdom 501 1.7 431 1.4 427 1.4 282 0.9 303 1.0 248 0.8 248 0.8 299 0.9 235 0.7 188 0.6 22 828 United Kingdom Total EU/EEA 5 751 2.4 5 222 2.2 5 131 2.1 4 744 2.0 4 614 1.9 4 135 1.7 3 740 1.5 3 458 1.4 2 976 1.2 2 344 1.1 282 112 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 23 1.5 32 2.2 18 1.2 35 2.4 34 2.3 50 3.4 36 2.4 50 3.4 50 3.4 24 1.6 436 Albania West Andorra 3 7.2 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 1 2.6 2 5.2 0 0.0 0 0.0 10 Andorra East Armenia 62 4.5 57 4.2 73 5.4 65 4.8 96 7.1 103 7.6 125 9.2 128 9.3 115 8.4 111 8.1 1 105 Armenia East Azerbaijan 51 1.2 83 1.9 231 5.2 171 3.8 209 4.5 162 3.5 162 3.4 150 3.1 125 2.6 114 2.3 1 709 Azerbaijan East Belarus 231 5.2 326 7.4 291 6.6 365 8.3 375 8.5 369 8.4 308 7.0 278 6.3 311 7.1 274 6.2 3 793 Belarus Centre Bosnia and Herzegovina 4 0.2 2 0.1 6 0.3 4 0.2 4 0.2 6 0.3 7 0.4 7 0.4 6 0.3 4 0.2 126 Bosnia and Herzegovina East Georgia 177 8.6 209 10.3 243 12.1 277 14.0 248 12.7 219 11.4 201 10.6 196 10.4 197 10.5 194 10.4 2 762 Georgia West Israel 34 1.0 34 0.9 24 0.7 37 1.0 37 1.0 36 0.9 46 1.2 26 0.7 21 0.5 16 0.4 1 188 Israel East Kazakhstan 132 1.7 129 1.6 180 2.3 160 2.0 181 2.2 190 2.3 183 2.2 179 2.1 232 2.7 224 2.5 2 245 Kazakhstan East Kyrgyzstan 24 0.9 61 2.3 111 4.1 69 2.5 65 2.3 49 1.7 58 2.0 89 3.1 55 1.9 36 1.2 715 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.3 0 0.0 0 0.0 0 0.0 40 Monaco Centre Montenegro 4 1.3 6 2.0 7 2.3 2 0.6 7 2.3 7 2.3 4 1.3 11 3.6 14 4.5 12 3.9 115 Montenegro East Republic of Moldova 59 3.0 166 8.4 179 9.1 269 13.7 93 4.7 128 6.5 184 9.4 179 9.2 210 10.8 173 8.9 1 999 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0.0 0 0.0 0 0.0 1 6.5 2 12.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 21 San Marino Centre Serbia 32 0.6 46 0.8 43 0.8 50 0.9 51 1.0 41 0.8 43 0.8 46 0.9 57 1.1 56 1.3 1 526 Serbia Centre Serbia excluding Kosovod 29 0.7 45 1.0 42 1.0 45 1.0 50 1.1 39 0.9 42 1.0 44 1.0 52 1.2 50 1.2 1 471 Serbia excluding Kosovod Centre Kosovod 3 0.3 1 0.1 1 0.1 5 0.6 1 0.1 2 0.2 1 0.1 2 0.2 5 0.6 6 0.0 55 Kosovod West Switzerland 116 3.1 111 2.9 123 3.2 96 2.5 66 1.7 70 1.7 61 1.5 49 1.2 41 1.0 38 0.9 7 389 Switzerland East Tajikistan 47 1.3 66 1.8 91 2.4 116 2.9 136 3.4 138 3.4 154 3.7 186 4.3 171 3.9 169 3.8 1 327 Tajikistan Centre The former Yugoslav Republic of Macedonia 5 0.5 2 0.2 6 0.6 5 0.5 8 0.8 9 0.9 13 1.3 5 0.5 6 0.6 2 0.2 123 The former Yugoslav Republic of Macedonia Centre Turkey 48 0.1 60 0.2 46 0.1 66 0.2 83 0.2 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 1 311 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 0 Turkmenistan East Ukraine 3 060 14.3 3 019 14.2 3 988 18.9 6 141 29.2 6 498 31.0 6 013 28.9 6 119 29.5 5 328 26.9 5 462 27.7 5 612 28.6 67 288 Ukraine East Uzbekistan 141 1.0 92 0.7 163 1.1 – – – – – – – – – – – – – – 494 Uzbekistan Total non-EU/EEA 4 253 3.7 4 501 3.9 5 823 5.0 7 930 7.6 8 193 7.8 7 668 7.3 7 805 7.3 7 001 6.6 7 159 6.7 7 162 6.7 95 722 Total non-EU/EEA WHO European Region WHO European Region West 5 302 2.6 4 879 2.5 4 761 2.3 4 274 2.1 4 063 2.0 3 576 1.7 3 135 1.6 2 923 1.5 2 387 1.2 1 804 1.1 27 7131 West Centre 552 0.6 515 0.6 509 0.5 640 0.7 687 0.7 716 0.8 763 0.8 697 0.7 715 0.7 661 0.7 15 125 Centre East 4 150 6.2 4 329 6.5 5 684 8.5 7 759 14.7 8 056 15.2 7 511 14.1 7 646 14.3 6 839 12.9 7 033 13.3 7 041 13.2 85 567 East Total WHO European Region 10 004 2.8 9 723 2.7 10 954 3.0 12 673 3.7 12 806 3.7 11 803 3.3 11 544 3.3 10 459 3.0 10 135 2.9 9 506 3.0 377 823 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 87 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 16. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 81 2.0 67 1.7 64 1.6 61 1.5 79 1.9 48 1.2 57 1.4 56 1.3 43 1.0 46 1.1 2 414 Austria West Belgium 85 1.6 91 1.7 69 1.3 58 1.1 65 1.2 70 1.3 77 1.4 59 1.1 – – – – 3 254 Belgium Centre Bulgaria 20 0.5 22 0.6 21 0.6 38 1.1 47 1.3 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 517 Bulgaria Centre Croatia 24 1.2 20 1.0 20 1.0 25 1.2 26 1.3 14 0.7 21 1.0 15 0.7 21 1.0 19 0.9 429 Croatia Centre Cyprus 10 2.6 8 2.1 8 2.0 7 1.7 9 2.1 5 1.2 10 2.4 9 2.2 17 4.1 9 2.2 250 Cyprus Centre Czech Republic 25 0.5 18 0.4 21 0.4 20 0.4 28 0.5 27 0.5 23 0.4 30 0.6 38 0.7 43 0.8 485 Czech Republic West Denmark 33 1.2 25 0.9 34 1.2 40 1.5 35 1.3 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 2 544 Denmark East Estonia 44 7.1 26 4.2 21 3.4 31 5.0 25 4.0 19 3.1 13 2.1 11 1.8 24 3.9 15 2.4 370 Estonia West Finland 25 1.0 15 0.6 22 0.8 17 0.6 16 0.6 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 566 Finland West France 726 2.3 680 2.2 673 2.2 630 2.0 571 1.8 507 1.6 432 1.4 408 1.3 319 1.0 278 0.9 56 220 France West Germanyc 490 1.2 509 1.3 428 1.1 425 1.1 388 1.0 341 0.9 313 0.8 245 0.6 96 0.2 – – 26 616 Germanyc West Greece 98 1.8 82 1.5 84 1.5 87 1.6 102 1.9 120 2.2 103 1.9 113 2.1 102 2.0 83 1.6 3 420 Greece Centre Hungary 21 0.4 17 0.4 26 0.5 27 0.6 45 1.0 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 814 Hungary West Iceland 2 1.2 0 0.0 1 0.6 1 0.6 1 0.6 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 62 Iceland West Ireland 27 1.2 27 1.2 27 1.2 34 1.5 29 1.3 20 0.9 23 1.0 15 0.7 11 0.5 11 0.5 978 Ireland West Italy 992 3.5 909 3.2 849 3.0 803 2.8 783 2.7 811 2.8 709 2.4 675 2.3 636 2.2 508 1.7 53 758 Italy East Latvia 77 7.6 67 6.7 86 8.9 80 8.4 102 10.9 90 9.7 110 12.0 89 9.8 90 10.0 73 8.1 1 312 Latvia Liechetenstein 0 0.0 0 0.0 0 0.0 1 5.6 1 5.5 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 11 Liechetenstein East Lithuania 45 3.0 28 1.9 27 1.9 15 1.1 28 2.0 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 448 Lithuania West Luxembourg 5 2.1 3 1.2 4 1.6 8 3.1 5 1.9 10 3.7 6 2.2 5 1.8 9 3.1 5 1.7 248 Luxembourg West Malta 9 4.4 1 0.5 4 1.9 3 1.5 5 2.4 1 0.5 4 1.9 2 0.9 5 2.3 0 0.0 100 Malta West Netherlands 255 3.1 260 3.2 253 3.1 211 2.6 231 2.8 218 2.6 176 2.1 201 2.4 157 1.9 94 1.1 5 764 Netherlands West Norway 11 0.5 13 0.5 20 0.8 17 0.7 23 0.9 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 912 Norway Centre Poland 139 0.8 99 0.5 132 0.7 142 0.8 120 0.7 131 0.7 115 0.6 97 0.5 90 0.5 89 0.5 2 824 Poland West Portugal 619 12.2 521 10.3 526 10.4 468 9.3 431 8.6 344 6.9 270 5.4 230 4.7 241 4.9 170 3.5 17 460 Portugal Centre Romania 188 1.9 164 1.6 146 1.5 203 2.1 207 2.1 242 2.5 281 2.9 241 2.5 228 2.4 209 2.2 5 850 Romania Centre Slovakia 0 0.0 3 0.1 2 0.1 4 0.2 7 0.3 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 92 Slovakia Centre Slovenia 9 0.9 16 1.6 7 0.7 12 1.2 11 1.1 10 1.0 15 1.5 11 1.1 8 0.8 7 0.7 227 Slovenia West Spain 1 190 5.3 1 100 4.8 1 129 4.9 994 4.3 891 3.9 665 2.9 534 2.8 482 2.9 408 2.4 321 1.9 69 566 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 1 773 Sweden West United Kingdom 501 1.7 431 1.4 427 1.4 282 0.9 303 1.0 248 0.8 248 0.8 299 0.9 235 0.7 188 0.6 22 828 United Kingdom Total EU/EEA 5 751 2.4 5 222 2.2 5 131 2.1 4 744 2.0 4 614 1.9 4 135 1.7 3 740 1.5 3 458 1.4 2 976 1.2 2 344 1.1 282 112 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 23 1.5 32 2.2 18 1.2 35 2.4 34 2.3 50 3.4 36 2.4 50 3.4 50 3.4 24 1.6 436 Albania West Andorra 3 7.2 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 1 2.6 2 5.2 0 0.0 0 0.0 10 Andorra East Armenia 62 4.5 57 4.2 73 5.4 65 4.8 96 7.1 103 7.6 125 9.2 128 9.3 115 8.4 111 8.1 1 105 Armenia East Azerbaijan 51 1.2 83 1.9 231 5.2 171 3.8 209 4.5 162 3.5 162 3.4 150 3.1 125 2.6 114 2.3 1 709 Azerbaijan East Belarus 231 5.2 326 7.4 291 6.6 365 8.3 375 8.5 369 8.4 308 7.0 278 6.3 311 7.1 274 6.2 3 793 Belarus Centre Bosnia and Herzegovina 4 0.2 2 0.1 6 0.3 4 0.2 4 0.2 6 0.3 7 0.4 7 0.4 6 0.3 4 0.2 126 Bosnia and Herzegovina East Georgia 177 8.6 209 10.3 243 12.1 277 14.0 248 12.7 219 11.4 201 10.6 196 10.4 197 10.5 194 10.4 2 762 Georgia West Israel 34 1.0 34 0.9 24 0.7 37 1.0 37 1.0 36 0.9 46 1.2 26 0.7 21 0.5 16 0.4 1 188 Israel East Kazakhstan 132 1.7 129 1.6 180 2.3 160 2.0 181 2.2 190 2.3 183 2.2 179 2.1 232 2.7 224 2.5 2 245 Kazakhstan East Kyrgyzstan 24 0.9 61 2.3 111 4.1 69 2.5 65 2.3 49 1.7 58 2.0 89 3.1 55 1.9 36 1.2 715 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.3 0 0.0 0 0.0 0 0.0 40 Monaco Centre Montenegro 4 1.3 6 2.0 7 2.3 2 0.6 7 2.3 7 2.3 4 1.3 11 3.6 14 4.5 12 3.9 115 Montenegro East Republic of Moldova 59 3.0 166 8.4 179 9.1 269 13.7 93 4.7 128 6.5 184 9.4 179 9.2 210 10.8 173 8.9 1 999 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0.0 0 0.0 0 0.0 1 6.5 2 12.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 21 San Marino Centre Serbia 32 0.6 46 0.8 43 0.8 50 0.9 51 1.0 41 0.8 43 0.8 46 0.9 57 1.1 56 1.3 1 526 Serbia Centre Serbia excluding Kosovod 29 0.7 45 1.0 42 1.0 45 1.0 50 1.1 39 0.9 42 1.0 44 1.0 52 1.2 50 1.2 1 471 Serbia excluding Kosovod Centre Kosovod 3 0.3 1 0.1 1 0.1 5 0.6 1 0.1 2 0.2 1 0.1 2 0.2 5 0.6 6 0.0 55 Kosovod West Switzerland 116 3.1 111 2.9 123 3.2 96 2.5 66 1.7 70 1.7 61 1.5 49 1.2 41 1.0 38 0.9 7 389 Switzerland East Tajikistan 47 1.3 66 1.8 91 2.4 116 2.9 136 3.4 138 3.4 154 3.7 186 4.3 171 3.9 169 3.8 1 327 Tajikistan Centre The former Yugoslav Republic of Macedonia 5 0.5 2 0.2 6 0.6 5 0.5 8 0.8 9 0.9 13 1.3 5 0.5 6 0.6 2 0.2 123 The former Yugoslav Republic of Macedonia Centre Turkey 48 0.1 60 0.2 46 0.1 66 0.2 83 0.2 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 1 311 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 0 Turkmenistan East Ukraine 3 060 14.3 3 019 14.2 3 988 18.9 6 141 29.2 6 498 31.0 6 013 28.9 6 119 29.5 5 328 26.9 5 462 27.7 5 612 28.6 67 288 Ukraine East Uzbekistan 141 1.0 92 0.7 163 1.1 – – – – – – – – – – – – – – 494 Uzbekistan Total non-EU/EEA 4 253 3.7 4 501 3.9 5 823 5.0 7 930 7.6 8 193 7.8 7 668 7.3 7 805 7.3 7 001 6.6 7 159 6.7 7 162 6.7 95 722 Total non-EU/EEA WHO European Region WHO European Region West 5 302 2.6 4 879 2.5 4 761 2.3 4 274 2.1 4 063 2.0 3 576 1.7 3 135 1.6 2 923 1.5 2 387 1.2 1 804 1.1 27 7131 West Centre 552 0.6 515 0.6 509 0.5 640 0.7 687 0.7 716 0.8 763 0.8 697 0.7 715 0.7 661 0.7 15 125 Centre East 4 150 6.2 4 329 6.5 5 684 8.5 7 759 14.7 8 056 15.2 7 511 14.1 7 646 14.3 6 839 12.9 7 033 13.3 7 041 13.2 85 567 East Total WHO European Region 10 004 2.8 9 723 2.7 10 954 3.0 12 673 3.7 12 806 3.7 11 803 3.3 11 544 3.3 10 459 3.0 10 135 2.9 9 506 3.0 377 823 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 88 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 17. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 19 0.4 28 0.7 19 0.4 19 0.4 21 0.5 19 0.4 25 0.6 17 0.4 18 0.4 10 0.2 761 Austria West Belgium 49 0.9 51 0.9 51 0.9 39 0.7 41 0.7 30 0.5 40 0.7 35 0.6 – – – – 1 581 Belgium Centre Bulgaria 9 0.2 8 0.2 11 0.3 2 0.1 18 0.5 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 148 Bulgaria Centre Croatia 1 0.0 2 0.1 1 0.0 1 0.0 2 0.1 3 0.1 2 0.1 1 0.0 1 0.0 1 0.0 52 Croatia Centre Cyprus 2 0.5 0 0.0 3 0.7 5 1.2 2 0.5 4 0.9 1 0.2 4 0.9 5 1.1 7 1.6 78 Cyprus Centre Czech Republic 7 0.1 6 0.1 7 0.1 9 0.2 8 0.1 6 0.1 9 0.2 8 0.1 6 0.1 9 0.2 111 Czech Republic West Denmark 7 0.3 11 0.4 10 0.4 19 0.7 6 0.2 9 0.3 6 0.2 12 0.4 5 0.2 3 0.1 445 Denmark East Estonia 17 2.4 12 1.7 5 0.7 7 1.0 11 1.6 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 143 Estonia West Finland 3 0.1 9 0.3 9 0.3 7 0.3 3 0.1 3 0.1 6 0.2 5 0.2 5 0.2 8 0.3 137 Finland West France 342 1.0 275 0.8 309 0.9 231 0.7 256 0.8 193 0.6 206 0.6 183 0.5 159 0.5 110 0.3 15 390 France West Germanyc 100 0.2 120 0.3 86 0.2 81 0.2 102 0.2 88 0.2 57 0.1 54 0.1 24 0.1 – – 4 503 Germanyc West Greece 14 0.2 22 0.4 19 0.3 16 0.3 21 0.4 20 0.4 22 0.4 24 0.4 34 0.6 27 0.5 671 Greece Centre Hungary 2 0.0 6 0.1 2 0.0 5 0.1 3 0.1 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 130 Hungary West Iceland 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 9 Iceland West Ireland 9 0.4 8 0.4 11 0.5 13 0.6 9 0.4 8 0.3 10 0.4 5 0.2 3 0.1 5 0.2 297 Ireland West Italy 350 1.2 297 1.0 300 1.0 252 0.8 290 0.9 264 0.9 218 0.7 185 0.6 191 0.6 182 0.6 15 976 Italy East Latvia 26 2.2 34 2.9 46 4.0 32 2.8 40 3.6 43 3.9 61 5.6 43 4.0 24 2.3 45 4.2 576 Latvia Liechetenstein 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 Liechetenstein East Lithuania 9 0.5 9 0.5 6 0.4 6 0.4 10 0.6 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 104 Lithuania West Luxembourg 4 1.6 2 0.8 4 1.6 4 1.6 3 1.1 1 0.4 3 1.1 4 1.4 2 0.7 1 0.3 74 Luxembourg West Malta 0 0.0 0 0.0 2 1.0 2 1.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Malta West Netherlands 60 0.7 49 0.6 65 0.8 55 0.7 59 0.7 46 0.5 36 0.4 40 0.5 45 0.5 21 0.2 1 384 Netherlands West Norway 7 0.3 5 0.2 2 0.1 2 0.1 2 0.1 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 260 Norway Centre Poland 41 0.2 32 0.2 41 0.2 42 0.2 37 0.2 31 0.2 33 0.2 31 0.2 12 0.1 12 0.1 743 Poland West Portugal 222 4.0 199 3.6 225 4.1 167 3.0 176 3.2 151 2.7 82 1.5 87 1.6 96 1.8 64 1.2 4 641 Portugal Centre Romania 159 1.5 114 1.1 109 1.0 125 1.2 125 1.2 114 1.1 114 1.1 108 1.1 93 0.9 74 0.7 4 009 Romania Centre Slovakia 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 13 Slovakia Centre Slovenia 2 0.2 2 0.2 0 0.0 3 0.3 1 0.1 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 30 Slovenia West Spain 377 1.6 334 1.4 318 1.4 291 1.2 272 1.1 187 0.8 130 0.7 115 0.7 92 0.5 85 0.5 17 716 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 395 Sweden West United Kingdom 304 1.0 202 0.6 224 0.7 127 0.4 131 0.4 96 0.3 117 0.4 99 0.3 77 0.2 73 0.2 6 147 United Kingdom Total EU/EEA 2 143 0.8 1 838 0.7 1 885 0.7 1 563 0.6 1 650 0.7 1 368 0.5 1 224 0.5 1 096 0.4 936 0.4 779 0.4 76 539 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 9 0.6 2 0.1 8 0.5 11 0.8 15 1.0 15 1.0 14 1.0 15 1.0 8 0.6 9 0.6 126 Albania West Andorra 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 0 0.0 0 0.0 3 Andorra East Armenia 21 1.4 27 1.8 21 1.4 22 1.4 38 2.5 41 2.7 47 3.0 34 2.2 47 3.0 33 2.1 371 Armenia East Azerbaijan 8 0.2 16 0.4 19 0.4 24 0.5 26 0.6 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 332 Azerbaijan East Belarus 120 2.4 206 4.1 184 3.6 225 4.4 223 4.4 178 3.5 166 3.3 212 4.2 201 4.0 165 3.3 2 192 Belarus Centre Bosnia and Herzegovina 1 0.1 0 0.0 0 0.0 3 0.2 0 0.0 1 0.1 0 0.0 0 0.0 1 0.1 0 0.0 24 Bosnia and Herzegovina East Georgia 55 2.4 75 3.3 96 4.3 118 5.4 111 5.2 84 4.0 67 3.2 74 3.6 73 3.6 64 3.1 968 Georgia West Israel 19 0.5 19 0.5 16 0.4 18 0.5 14 0.4 11 0.3 22 0.5 16 0.4 17 0.4 10 0.2 470 Israel East Kazakhstan 47 0.6 79 0.9 72 0.8 77 0.9 58 0.7 69 0.8 63 0.7 89 1.0 120 1.3 137 1.5 978 Kazakhstan East Kyrgyzstan 9 0.3 14 0.5 19 0.7 21 0.8 23 0.8 18 0.6 27 0.9 36 1.2 17 0.6 23 0.8 220 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 11 Monaco Centre Montenegro 2 0.6 2 0.6 0 0.0 0 0.0 0 0.0 0 0.0 3 0.9 0 0.0 0 0.0 1 0.3 20 Montenegro East Republic of Moldova 33 1.5 96 4.5 127 6.0 170 8.0 90 4.3 106 5.0 116 5.5 114 5.4 156 7.4 105 5.0 1 290 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 San Marino Centre Serbia 10 0.2 7 0.1 7 0.1 10 0.2 5 0.1 8 0.1 6 0.1 3 0.1 4 0.1 6 0.1 448 Serbia Centre Serbia excluding Kosovod 10 0.2 7 0.2 7 0.2 8 0.2 4 0.1 7 0.2 6 0.1 2 0.0 4 0.1 6 0.1 431 Serbia excluding Kosovod Centre Kosovod 0 0.0 0 0.0 0 0.0 2 0.2 1 0.1 1 0.1 0 0.0 1 0.1 0 0.0 0 0.0 17 Kosovod West Switzerland 48 1.2 43 1.1 42 1.1 38 0.9 29 0.7 32 0.8 16 0.4 12 0.3 19 0.4 12 0.3 2 534 Switzerland East Tajikistan 8 0.2 9 0.2 15 0.4 33 0.9 46 1.2 52 1.3 71 1.7 96 2.3 62 1.4 78 1.8 486 Tajikistan Centre The former Yugoslav Republic of Macedonia 4 0.4 0 0.0 0 0.0 0 0.0 2 0.2 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 36 The former Yugoslav Republic of Macedonia Centre Turkey 7 0.0 7 0.0 14 0.0 15 0.0 12 0.0 19 0.0 26 0.1 26 0.1 13 0.0 17 0.0 265 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 1 Turkmenistan East Ukraine 1 320 5.3 1 418 5.7 1 873 7.6 3 048 12.4 3 575 14.6 3 349 13.8 3 725 15.4 3 140 13.7 3 390 14.8 3 696 16.2 34 919 Ukraine East Uzbekistan 43 0.3 37 0.3 57 0.4 – – – – – – – – – – – – – – 157 Uzbekistan Total non-EU/EEA 1 764 1.5 2 057 1.7 2 570 2.1 3 833 3.5 4 267 3.9 4 012 3.6 4 410 4.0 3 912 3.5 4 166 3.7 4 410 4.0 45 853 Total non-EU/EEA WHO European Region WHO European Region West 1 934 0.9 1 674 0.8 1 712 0.8 1 382 0.6 1 436 0.7 1 168 0.5 1 005 0.5 901 0.4 794 0.4 614 0.4 73 421 West Centre 257 0.3 189 0.2 203 0.2 231 0.2 230 0.2 225 0.2 235 0.2 210 0.2 158 0.2 162 0.2 6 233 Centre East 1 716 2.4 2 032 2.8 2 540 3.5 3 783 6.4 4 251 7.2 3 987 6.8 4 394 7.4 3 897 6.7 4 150 7.1 4 413 7.5 42 737 East Total WHO European Region 3 907 1.0 3 895 1.0 4 455 1.2 5 396 1.5 5 917 1.6 5 380 1.5 5 634 1.5 5 008 1.4 5 102 1.4 5 189 1.6 122 391 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 89 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 17. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 19 0.4 28 0.7 19 0.4 19 0.4 21 0.5 19 0.4 25 0.6 17 0.4 18 0.4 10 0.2 761 Austria West Belgium 49 0.9 51 0.9 51 0.9 39 0.7 41 0.7 30 0.5 40 0.7 35 0.6 – – – – 1 581 Belgium Centre Bulgaria 9 0.2 8 0.2 11 0.3 2 0.1 18 0.5 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 148 Bulgaria Centre Croatia 1 0.0 2 0.1 1 0.0 1 0.0 2 0.1 3 0.1 2 0.1 1 0.0 1 0.0 1 0.0 52 Croatia Centre Cyprus 2 0.5 0 0.0 3 0.7 5 1.2 2 0.5 4 0.9 1 0.2 4 0.9 5 1.1 7 1.6 78 Cyprus Centre Czech Republic 7 0.1 6 0.1 7 0.1 9 0.2 8 0.1 6 0.1 9 0.2 8 0.1 6 0.1 9 0.2 111 Czech Republic West Denmark 7 0.3 11 0.4 10 0.4 19 0.7 6 0.2 9 0.3 6 0.2 12 0.4 5 0.2 3 0.1 445 Denmark East Estonia 17 2.4 12 1.7 5 0.7 7 1.0 11 1.6 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 143 Estonia West Finland 3 0.1 9 0.3 9 0.3 7 0.3 3 0.1 3 0.1 6 0.2 5 0.2 5 0.2 8 0.3 137 Finland West France 342 1.0 275 0.8 309 0.9 231 0.7 256 0.8 193 0.6 206 0.6 183 0.5 159 0.5 110 0.3 15 390 France West Germanyc 100 0.2 120 0.3 86 0.2 81 0.2 102 0.2 88 0.2 57 0.1 54 0.1 24 0.1 – – 4 503 Germanyc West Greece 14 0.2 22 0.4 19 0.3 16 0.3 21 0.4 20 0.4 22 0.4 24 0.4 34 0.6 27 0.5 671 Greece Centre Hungary 2 0.0 6 0.1 2 0.0 5 0.1 3 0.1 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 130 Hungary West Iceland 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 9 Iceland West Ireland 9 0.4 8 0.4 11 0.5 13 0.6 9 0.4 8 0.3 10 0.4 5 0.2 3 0.1 5 0.2 297 Ireland West Italy 350 1.2 297 1.0 300 1.0 252 0.8 290 0.9 264 0.9 218 0.7 185 0.6 191 0.6 182 0.6 15 976 Italy East Latvia 26 2.2 34 2.9 46 4.0 32 2.8 40 3.6 43 3.9 61 5.6 43 4.0 24 2.3 45 4.2 576 Latvia Liechetenstein 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 Liechetenstein East Lithuania 9 0.5 9 0.5 6 0.4 6 0.4 10 0.6 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 104 Lithuania West Luxembourg 4 1.6 2 0.8 4 1.6 4 1.6 3 1.1 1 0.4 3 1.1 4 1.4 2 0.7 1 0.3 74 Luxembourg West Malta 0 0.0 0 0.0 2 1.0 2 1.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Malta West Netherlands 60 0.7 49 0.6 65 0.8 55 0.7 59 0.7 46 0.5 36 0.4 40 0.5 45 0.5 21 0.2 1 384 Netherlands West Norway 7 0.3 5 0.2 2 0.1 2 0.1 2 0.1 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 260 Norway Centre Poland 41 0.2 32 0.2 41 0.2 42 0.2 37 0.2 31 0.2 33 0.2 31 0.2 12 0.1 12 0.1 743 Poland West Portugal 222 4.0 199 3.6 225 4.1 167 3.0 176 3.2 151 2.7 82 1.5 87 1.6 96 1.8 64 1.2 4 641 Portugal Centre Romania 159 1.5 114 1.1 109 1.0 125 1.2 125 1.2 114 1.1 114 1.1 108 1.1 93 0.9 74 0.7 4 009 Romania Centre Slovakia 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 13 Slovakia Centre Slovenia 2 0.2 2 0.2 0 0.0 3 0.3 1 0.1 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 30 Slovenia West Spain 377 1.6 334 1.4 318 1.4 291 1.2 272 1.1 187 0.8 130 0.7 115 0.7 92 0.5 85 0.5 17 716 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 395 Sweden West United Kingdom 304 1.0 202 0.6 224 0.7 127 0.4 131 0.4 96 0.3 117 0.4 99 0.3 77 0.2 73 0.2 6 147 United Kingdom Total EU/EEA 2 143 0.8 1 838 0.7 1 885 0.7 1 563 0.6 1 650 0.7 1 368 0.5 1 224 0.5 1 096 0.4 936 0.4 779 0.4 76 539 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 9 0.6 2 0.1 8 0.5 11 0.8 15 1.0 15 1.0 14 1.0 15 1.0 8 0.6 9 0.6 126 Albania West Andorra 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 0 0.0 0 0.0 3 Andorra East Armenia 21 1.4 27 1.8 21 1.4 22 1.4 38 2.5 41 2.7 47 3.0 34 2.2 47 3.0 33 2.1 371 Armenia East Azerbaijan 8 0.2 16 0.4 19 0.4 24 0.5 26 0.6 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 332 Azerbaijan East Belarus 120 2.4 206 4.1 184 3.6 225 4.4 223 4.4 178 3.5 166 3.3 212 4.2 201 4.0 165 3.3 2 192 Belarus Centre Bosnia and Herzegovina 1 0.1 0 0.0 0 0.0 3 0.2 0 0.0 1 0.1 0 0.0 0 0.0 1 0.1 0 0.0 24 Bosnia and Herzegovina East Georgia 55 2.4 75 3.3 96 4.3 118 5.4 111 5.2 84 4.0 67 3.2 74 3.6 73 3.6 64 3.1 968 Georgia West Israel 19 0.5 19 0.5 16 0.4 18 0.5 14 0.4 11 0.3 22 0.5 16 0.4 17 0.4 10 0.2 470 Israel East Kazakhstan 47 0.6 79 0.9 72 0.8 77 0.9 58 0.7 69 0.8 63 0.7 89 1.0 120 1.3 137 1.5 978 Kazakhstan East Kyrgyzstan 9 0.3 14 0.5 19 0.7 21 0.8 23 0.8 18 0.6 27 0.9 36 1.2 17 0.6 23 0.8 220 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 11 Monaco Centre Montenegro 2 0.6 2 0.6 0 0.0 0 0.0 0 0.0 0 0.0 3 0.9 0 0.0 0 0.0 1 0.3 20 Montenegro East Republic of Moldova 33 1.5 96 4.5 127 6.0 170 8.0 90 4.3 106 5.0 116 5.5 114 5.4 156 7.4 105 5.0 1 290 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 San Marino Centre Serbia 10 0.2 7 0.1 7 0.1 10 0.2 5 0.1 8 0.1 6 0.1 3 0.1 4 0.1 6 0.1 448 Serbia Centre Serbia excluding Kosovod 10 0.2 7 0.2 7 0.2 8 0.2 4 0.1 7 0.2 6 0.1 2 0.0 4 0.1 6 0.1 431 Serbia excluding Kosovod Centre Kosovod 0 0.0 0 0.0 0 0.0 2 0.2 1 0.1 1 0.1 0 0.0 1 0.1 0 0.0 0 0.0 17 Kosovod West Switzerland 48 1.2 43 1.1 42 1.1 38 0.9 29 0.7 32 0.8 16 0.4 12 0.3 19 0.4 12 0.3 2 534 Switzerland East Tajikistan 8 0.2 9 0.2 15 0.4 33 0.9 46 1.2 52 1.3 71 1.7 96 2.3 62 1.4 78 1.8 486 Tajikistan Centre The former Yugoslav Republic of Macedonia 4 0.4 0 0.0 0 0.0 0 0.0 2 0.2 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 36 The former Yugoslav Republic of Macedonia Centre Turkey 7 0.0 7 0.0 14 0.0 15 0.0 12 0.0 19 0.0 26 0.1 26 0.1 13 0.0 17 0.0 265 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – – – – – – – – – 1 Turkmenistan East Ukraine 1 320 5.3 1 418 5.7 1 873 7.6 3 048 12.4 3 575 14.6 3 349 13.8 3 725 15.4 3 140 13.7 3 390 14.8 3 696 16.2 34 919 Ukraine East Uzbekistan 43 0.3 37 0.3 57 0.4 – – – – – – – – – – – – – – 157 Uzbekistan Total non-EU/EEA 1 764 1.5 2 057 1.7 2 570 2.1 3 833 3.5 4 267 3.9 4 012 3.6 4 410 4.0 3 912 3.5 4 166 3.7 4 410 4.0 45 853 Total non-EU/EEA WHO European Region WHO European Region West 1 934 0.9 1 674 0.8 1 712 0.8 1 382 0.6 1 436 0.7 1 168 0.5 1 005 0.5 901 0.4 794 0.4 614 0.4 73 421 West Centre 257 0.3 189 0.2 203 0.2 231 0.2 230 0.2 225 0.2 235 0.2 210 0.2 158 0.2 162 0.2 6 233 Centre East 1 716 2.4 2 032 2.8 2 540 3.5 3 783 6.4 4 251 7.2 3 987 6.8 4 394 7.4 3 897 6.7 4 150 7.1 4 413 7.5 42 737 East Total WHO European Region 3 907 1.0 3 895 1.0 4 455 1.2 5 396 1.5 5 917 1.6 5 380 1.5 5 634 1.5 5 008 1.4 5 102 1.4 5 189 1.6 122 391 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 90 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 18. AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 29 33 31 33 31 22 24 21 19 19 1 063 West Belgium 30 41 36 34 31 33 38 34 – – 1 531 Centre Bulgaria 4 4 5 2 8 12 9 12 11 15 114 Centre Croatia 12 17 19 18 22 11 18 12 21 17 281 Centre Cyprus 4 4 5 3 2 4 5 5 10 6 136 Centre Czech Republic 8 11 10 15 15 16 13 19 24 28 293 West Denmark 16 12 15 13 13 11 10 11 7 8 1 742 East Estonia 1 0 0 0 1 0 1 0 1 1 29 West Finland 11 6 6 6 2 4 6 7 5 3 308 West France 262 264 251 240 194 202 153 157 128 104 28 436 West Germanyc 273 281 257 219 216 195 171 127 56 – 18 191 West Greece 59 51 63 55 51 53 42 63 52 45 2 177 Centre Hungary 16 13 23 24 37 30 37 33 41 29 654 West Iceland 1 0 0 0 0 0 0 0 1 0 44 West Ireland 8 10 13 17 15 6 12 10 7 7 405 West Italy 299 293 254 265 260 305 268 282 247 181 12 325 East Latvia 3 7 10 7 4 10 7 5 4 10 126 Liechetenstein 0 0 0 0 0 0 1 0 0 0 2 East Lithuania 7 1 0 2 2 5 3 3 9 7 90 West Luxembourg 0 2 2 6 3 7 3 3 6 2 139 West Malta 1 0 0 1 0 1 1 0 2 0 44 West Netherlands 153 153 146 129 143 139 102 118 92 50 3 524 West Norway 6 7 9 9 10 15 18 4 4 2 514 Centre Poland 28 26 29 45 25 48 40 30 31 20 714 West Portugal 108 83 85 88 87 60 57 66 74 43 2 921 Centre Romania 10 15 13 13 7 16 25 18 23 25 239 Centre Slovakia 0 1 1 3 3 2 2 2 7 5 57 Centre Slovenia 7 10 7 7 9 7 10 10 6 3 150 West Spain 327 318 400 364 354 269 232 209 169 144 13 628 West Sweden – – – – – – – – – – 1 085 West United Kingdom 226 181 196 142 156 110 127 133 108 98 15 184 Total EU/EEA 1 909 1 844 1 886 1 760 1 701 1 593 1 435 1 394 1 165 872 106 146 Non-EU/EEA Centre Albania 6 6 1 5 6 6 8 8 3 1 60 West Andorra 2 0 0 1 0 1 1 1 0 0 7 East Armenia 3 0 1 2 2 4 7 1 2 4 28 East Azerbaijan 1 1 4 1 1 3 1 1 2 0 18 East Belarus 0 0 2 6 3 3 4 3 4 6 34 Centre Bosnia and Herzegovina 0 0 5 2 4 3 6 4 4 1 43 East Georgia 6 3 10 12 11 16 21 24 18 21 167 West Israel 5 8 6 8 7 10 13 4 2 5 328 East Kazakhstan 0 0 1 1 0 4 1 2 2 2 17 East Kyrgyzstan 0 0 0 0 0 0 0 0 0 0 1 West Monaco 0 0 0 0 0 0 1 0 0 0 22 Centre Montenegro 2 4 5 1 4 3 3 8 9 11 65 East Republic of Moldova 0 2 2 2 0 0 3 2 1 8 25 East Russian Federation – – – – – – – – – – – West San Marino 0 0 0 1 2 0 0 0 0 0 11 Centre Serbia 17 26 22 22 31 20 27 28 35 28 486 Centre Serbia excluding Kosovod 15 25 22 21 30 19 27 26 35 28 476 Centre Kosovod 2 1 0 1 1 1 0 2 0 0 10 West Switzerland 50 45 62 37 33 32 24 23 22 19 3 353 East Tajikistan 0 0 0 0 0 0 0 0 2 3 5 Centre The former Yugoslav Republic of Macedonia 2 1 1 4 3 3 5 2 4 2 45 Centre Turkey 11 2 3 0 0 12 15 12 17 14 151 East Turkmenistan 0 0 0 0 0 – – – – – 0 East Ukraine 10 10 10 31 45 50 55 72 116 69 496 East Uzbekistan 0 0 0 – – – – – – – 1 Total non-EU/EEA 115 108 135 136 152 170 195 195 243 194 5 363 WHO European Region West 1 866 1 788 1 832 1 668 1 608 1 475 1 303 1 273 1 001 730 106 982 Centre 127 140 149 164 176 193 223 203 246 205 3 488 East 31 24 40 64 69 95 103 113 161 131 1 037 Total WHO European Region 2 024 1 952 2 021 1 896 1 853 1 763 1 629 1 589 1 408 1 066 111 507 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 91 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 19. AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 29 19 15 13 27 14 20 17 10 8 892 West Belgium 9 5 3 4 1 3 7 1 – – 287 Centre Bulgaria 4 7 10 17 39 29 26 11 14 17 177 Centre Croatia 0 0 1 1 1 0 0 1 0 2 26 Centre Cyprus 0 0 0 0 0 0 1 0 0 0 4 Centre Czech Republic 6 2 4 1 2 3 2 3 4 2 45 West Denmark 6 3 4 4 4 5 1 0 1 1 252 East Estonia 41 26 14 20 15 9 6 4 17 3 265 West Finland 1 2 3 0 4 2 0 0 1 1 57 West France 86 57 60 61 45 39 26 29 16 12 13 884 West Germanyc 54 48 35 41 40 31 23 17 5 – 4 350 West Greece 3 7 3 9 22 41 45 30 25 17 317 Centre Hungary 0 0 0 0 0 0 0 2 2 1 11 West Iceland 0 0 0 0 0 0 0 0 2 0 7 West Ireland 11 8 6 10 3 1 0 0 0 1 375 West Italy 318 275 228 194 179 178 113 96 83 78 35 017 East Latvia 60 49 70 57 70 62 73 51 36 38 960 Liechetenstein 0 0 0 1 0 0 0 0 0 0 7 East Lithuania 35 20 20 9 22 19 16 15 19 23 253 West Luxembourg 0 0 0 1 0 1 1 1 0 1 45 West Malta 0 0 0 0 0 0 1 0 0 0 4 West Netherlands 7 13 8 8 3 4 1 4 4 1 372 West Norway 2 1 3 0 1 1 0 0 1 0 156 Centre Poland 74 55 70 62 59 46 32 34 23 23 1 583 West Portugal 271 232 232 159 159 107 62 44 35 24 9 427 Centre Romania 3 5 14 28 59 82 107 102 94 65 575 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 1 Centre Slovenia 0 0 0 0 0 0 1 0 0 0 7 West Spain 548 456 429 364 297 195 130 84 62 51 50 404 West Sweden – – – – – – – – – – 242 West United Kingdom 26 15 22 12 12 9 14 10 10 5 1 500 Total EU/EEA 1 594 1 305 1 254 1 076 1 064 881 708 556 464 374 121 502 Non-EU/EEA Centre Albania 0 0 0 1 0 0 1 0 0 0 3 West Andorra 1 0 0 0 0 0 0 0 0 0 2 East Armenia 30 33 41 33 42 24 34 22 30 18 430 East Azerbaijan 40 64 183 148 160 123 110 92 76 50 1 239 East Belarus 191 265 208 266 242 193 150 139 130 116 2 508 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 18 East Georgia 134 168 184 191 160 142 120 99 110 86 1 870 West Israel 12 7 4 7 10 15 12 9 6 4 258 East Kazakhstan 122 116 174 147 153 158 148 154 174 170 2 017 East Kyrgyzstan 27 53 102 58 55 38 40 73 30 23 583 West Monaco 0 0 0 0 0 0 0 0 0 0 19 Centre Montenegro 0 0 0 0 1 0 0 0 0 0 4 East Republic of Moldova 55 103 95 101 17 22 42 46 39 31 853 East Russian Federation – – – – – – – – – – – West San Marino 0 0 0 0 0 0 0 0 0 0 6 Centre Serbia 6 11 6 12 5 9 5 5 0 5 659 Centre Serbia excluding Kosovod 6 11 6 12 5 9 5 5 0 5 658 Centre Kosovod 0 0 0 0 0 0 0 0 0 0 1 West Switzerland 19 14 11 18 6 10 4 2 4 7 3 318 East Tajikistan 38 51 61 73 87 58 74 96 84 71 732 Centre The former Yugoslav Republic of Macedonia 0 0 0 0 0 0 0 0 0 0 9 Centre Turkey 1 4 2 2 1 1 2 0 2 1 64 East Turkmenistan 0 0 0 0 0 – – – – – 0 East Ukraine 2 868 2 732 3 458 4 979 4 933 4 273 3 856 3 050 2 939 2 872 47 465 East Uzbekistan 116 70 131 – – – – – – – 380 Total non-EU/EEA 3 660 3 691 4 660 6 036 5 872 5 066 4 598 3 787 3 624 3 454 62 437 WHO European Region West 1 403 1 162 1 066 905 813 656 460 344 265 211 121 191 Centre 94 84 107 124 167 170 177 158 139 116 3 186 East 3 757 3 750 4 741 6 082 5 956 5 121 4 669 3 841 3 684 3 501 59 555 Total WHO European Region 5 254 4 996 5 914 7 111 6 936 5 947 5 306 4 343 4 088 3 828 183 932 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 92 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 20. AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 36 37 30 28 35 25 35 26 20 25 910 West Belgium 79 87 76 52 68 54 65 50 – – 2 531 Centre Bulgaria 15 19 14 20 15 20 25 22 17 17 338 Centre Croatia 10 4 1 6 4 6 5 2 1 1 149 Centre Cyprus 7 4 5 9 6 4 3 8 11 9 163 Centre Czech Republic 14 11 13 13 14 12 16 16 15 21 221 West Denmark 16 18 23 40 22 21 17 27 14 16 803 East Estonia 17 10 7 9 16 10 8 14 16 12 167 West Finland 11 12 12 15 10 12 9 6 16 11 255 West France 597 512 534 444 493 374 370 337 268 200 20 811 West Germanyc 152 158 120 156 130 124 112 90 36 – 4 207 West Greece 45 36 31 34 42 31 33 37 45 31 1 086 Centre Hungary 5 8 4 7 6 10 12 7 10 19 188 West Iceland 0 0 1 2 1 0 0 0 0 0 15 West Ireland 13 15 12 17 20 17 17 8 7 6 366 West Italy 605 527 559 503 513 500 449 421 426 350 17 759 East Latvia 25 32 36 34 55 37 59 58 51 49 563 Liechetenstein 0 0 0 0 1 0 0 0 0 0 3 East Lithuania 6 15 11 9 13 15 17 16 18 18 170 West Luxembourg 9 2 6 5 4 2 5 4 3 3 118 West Malta 5 1 6 3 5 0 2 1 3 0 41 West Netherlands 113 117 128 93 109 86 77 82 81 45 2 374 West Norway 10 10 10 9 12 11 27 17 16 11 441 Centre Poland 34 24 53 45 37 35 34 33 18 15 699 West Portugal 443 391 419 381 348 314 227 199 219 150 8 997 Centre Romania 135 121 117 166 149 144 173 174 176 169 2 732 Centre Slovakia 1 1 1 1 3 4 2 3 3 3 38 Centre Slovenia 1 0 0 3 1 3 0 0 4 4 49 West Spain 542 498 446 416 377 272 211 196 173 148 16 144 West Sweden – – – – – – – – – – 665 West United Kingdom 510 394 383 240 248 207 198 216 168 127 10 701 Total EU/EEA 3 456 3 064 3 058 2 760 2 757 2 350 2 208 2 070 1 835 1 460 93 704 Non-EU/EEA Centre Albania 26 28 24 39 40 55 40 52 55 31 480 West Andorra 0 0 0 0 0 1 0 2 0 0 4 East Armenia 46 45 42 50 84 103 121 129 123 113 933 East Azerbaijan 14 31 42 44 68 57 84 93 76 105 730 East Belarus 145 254 246 305 348 344 309 333 367 312 3 266 Centre Bosnia and Herzegovina 5 2 1 4 0 3 1 2 3 2 76 East Georgia 77 104 134 180 184 139 123 145 138 145 1 578 West Israel 34 35 27 38 31 21 42 28 29 17 921 East Kazakhstan 48 45 65 80 77 82 90 95 158 166 990 East Kyrgyzstan 6 17 24 26 27 24 39 40 35 30 287 West Monaco 0 0 0 0 0 0 0 0 0 0 7 Centre Montenegro 4 4 2 1 2 1 3 1 5 2 54 East Republic of Moldova 31 101 146 321 118 139 211 208 275 189 1 943 East Russian Federation – – – – – – – – – – – West San Marino 0 0 0 0 0 0 0 0 0 0 5 Centre Serbia 13 9 12 17 9 9 11 11 8 17 449 Centre Serbia excluding Kosovod 12 9 11 11 9 7 10 11 6 12 416 Centre Kosovod 1 0 1 6 0 2 1 0 2 5 33 West Switzerland 74 76 84 69 50 53 32 33 25 17 2 723 East Tajikistan 14 22 41 61 69 90 108 144 120 137 834 Centre The former Yugoslav Republic of Macedonia 4 1 3 3 6 6 10 4 3 0 91 Centre Turkey 32 28 26 37 35 41 58 39 28 29 689 East Turkmenistan 0 0 0 0 0 – – – – – 0 East Ukraine 1 342 1 509 2 264 3 944 4 873 4 875 5 806 5 250 5 708 6 243 45 737 East Uzbekistan 51 40 68 – – – – – – – 183 Total non-EU/EEA 1 966 2 351 3 251 5 219 6 021 6 043 7 088 6 609 7 156 7 555 61 980 WHO European Region West 3 294 2 926 2 907 2 545 2 518 2 125 1 928 1 780 1 549 1 157 91 884 Centre 306 264 276 371 327 353 393 374 357 339 6 416 East 1 822 2 225 3 126 5 063 5 932 5 915 6 975 6 525 7 085 7 519 57 381 Total WHO European Region 5 422 5 415 6 309 7 979 8 777 8 393 9 296 8 679 8 991 9 015 155 681 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 93 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 21. AIDS diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 1 2 0 1 0 0 0 0 1 0 13 West Belgium 5 2 0 1 2 1 1 3 – – 143 Centre Bulgaria 0 0 2 1 0 3 0 0 0 0 7 Centre Croatia 0 0 0 1 0 0 0 0 0 0 4 Centre Cyprus 0 0 0 0 0 0 0 0 0 0 2 Centre Czech Republic 0 0 0 0 0 0 0 0 1 0 1 West Denmark 0 0 1 0 0 1 0 0 0 1 26 East Estonia 0 0 0 0 0 0 0 0 0 0 2 West Finland 0 1 0 0 0 0 1 0 0 0 8 West France 9 10 5 8 10 10 3 5 4 3 788 West Germanyc 0 0 1 3 2 1 1 0 0 – 118 West Greece 0 0 1 0 0 0 0 0 0 0 24 Centre Hungary 0 1 0 0 1 0 0 1 0 2 7 West Iceland 0 0 0 0 0 0 0 0 0 0 0 West Ireland 3 1 1 0 0 1 0 0 0 0 36 West Italy 2 5 3 3 4 7 2 0 1 0 739 East Latvia 5 1 0 2 1 2 0 0 2 1 21 Liechetenstein 0 0 0 0 0 0 0 0 0 0 0 East Lithuania 0 0 0 0 0 1 0 0 0 0 1 West Luxembourg 0 0 0 0 1 0 0 0 0 0 4 West Malta 0 0 0 0 0 0 0 0 0 0 1 West Netherlands 4 3 8 4 3 5 3 3 1 0 102 West Norway 0 0 0 0 0 1 0 0 0 1 8 Centre Poland 5 7 1 3 1 0 1 1 0 0 69 West Portugal 4 2 1 1 1 3 1 1 2 1 124 Centre Romania 7 13 8 12 11 16 8 6 0 8 315 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 0 Centre Slovenia 0 0 0 0 0 0 0 0 0 0 2 West Spain 8 8 3 3 3 4 1 2 4 1 986 West Sweden – – – – – – – – – – 22 West United Kingdom 6 4 4 2 3 3 2 5 2 0 52 Total EU/EEA 59 60 39 45 43 59 24 27 18 18 3 625 Non-EU/EEA Centre Albania 0 0 0 1 2 4 0 0 0 1 10 West Andorra 0 0 0 0 0 0 0 0 0 0 0 East Armenia 0 2 1 1 0 4 7 2 0 2 24 East Azerbaijan 0 2 1 1 3 3 2 0 1 0 15 East Belarus 12 10 13 12 4 3 9 10 5 2 123 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 0 East Georgia 10 4 11 8 1 3 2 0 0 1 64 West Israel 1 1 1 1 1 1 0 0 0 0 39 East Kazakhstan 3 14 6 4 2 5 1 5 3 7 55 East Kyrgyzstan 2 0 0 3 4 1 0 5 1 2 19 West Monaco 0 0 0 0 0 0 0 0 0 0 0 Centre Montenegro 0 0 0 0 0 0 0 0 0 0 1 East Republic of Moldova 6 1 3 3 1 9 8 2 4 5 60 East Russian Federation – – – – – – – – – – – West San Marino 0 0 0 0 0 0 0 0 0 0 0 Centre Serbia 2 1 1 0 1 1 0 1 0 0 28 Centre Serbia excluding Kosovod 2 1 1 0 0 1 0 0 0 0 26 Centre Kosovod 0 0 0 0 1 0 0 1 0 0 2 West Switzerland 0 1 2 0 1 1 0 0 0 1 110 East Tajikistan 0 0 1 7 6 15 10 4 6 5 55 Centre The former Yugoslav Republic of Macedonia 0 0 1 0 1 1 0 0 0 0 6 Centre Turkey 0 2 0 0 1 0 1 3 0 1 17 East Turkmenistan 0 0 0 0 0 – – – – – 0 East Ukraine 73 86 129 118 88 59 60 48 67 93 1 286 East Uzbekistan 6 3 8 – – – – – – – 22 Total non-EU/EEA 115 127 178 159 116 110 100 80 87 120 1 934 WHO European Region West West 43 40 31 27 31 39 15 19 15 8 3 343 Centre Centre 14 24 13 18 18 25 10 12 1 12 469 East East 117 123 173 159 110 105 99 76 89 118 1 747 Total WHO European Region 174 187 217 204 159 169 124 107 105 138 5 559 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 94 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 22. AIDS diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa MSM Injecting drug users Heterosexual Mother-to-child transmission Nosocomial Haemophiliac/transfusion Unknown Totalb Country, territory or areaaMale Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 19 19 2 6 8 7 18 25 0 0 0 0 0 0 0 0 0 1 3 4 56 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 15 15 5 12 17 5 12 17 0 0 0 0 0 0 0 0 0 0 0 0 49 Bulgaria Centre Croatia 17 17 0 2 2 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 20 Croatia Centre Cyprus 6 6 0 0 0 6 3 9 0 0 0 0 0 0 1 0 1 0 0 0 16 Cyprus Centre Czech Republic 28 28 1 1 2 8 13 21 0 0 0 0 0 0 0 0 0 0 1 1 52 Czech Republic West Denmark 8 8 0 1 1 3 13 16 0 1 1 0 0 0 0 0 0 0 2 2 28 Denmark East Estonia 1 1 0 3 3 4 8 12 0 0 0 0 0 0 0 0 0 1 3 4 20 Estonia West Finland 3 3 1 0 1 6 5 11 0 0 0 0 0 0 0 0 0 1 2 3 18 Finland West France 101 104 1 11 12 88 111 200 3 0 3 0 0 0 1 1 2 17 54 71 392 France West Germanyc – – – – – – – – – – – – – – – – – – – – – Germanyc West Greece 43 45 4 13 17 21 10 31 0 0 0 0 0 0 0 1 1 2 16 18 112 Greece Centre Hungary 29 29 0 1 1 15 4 19 1 1 2 0 0 0 0 0 0 0 1 1 52 Hungary West Iceland 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Iceland West Ireland 7 7 0 1 1 5 1 6 0 0 0 0 0 0 0 0 0 0 2 2 16 Ireland West Italy 181 181 21 57 78 140 210 350 0 0 0 0 0 0 0 0 0 21 60 81 690 Italy East Latvia 10 10 9 29 38 25 24 49 1 0 1 0 0 0 0 0 0 10 10 20 118 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 7 7 3 20 23 5 13 18 0 0 0 0 0 0 0 0 0 0 6 6 54 Lithuania West Luxembourg 2 2 1 0 1 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 6 Luxembourg West Malta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Malta West Netherlands 50 50 0 1 1 18 27 45 0 0 0 0 0 0 0 0 0 3 16 19 115 Netherlands West Norway 2 2 0 0 0 3 8 11 0 1 1 0 0 0 0 0 0 0 0 0 14 Norway Centre Poland 20 20 1 22 23 8 7 15 0 0 0 0 0 0 0 1 1 3 39 42 101 Poland West Portugal 43 43 3 21 24 58 92 150 0 1 1 0 0 0 0 0 0 3 13 16 234 Portugal Centre Romania 25 25 6 59 65 54 115 169 6 2 8 4 1 5 2 1 3 2 6 8 283 Romania Centre Slovakia 5 5 0 0 0 0 3 3 0 0 0 0 0 0 0 0 0 0 1 1 9 Slovakia Centre Slovenia 3 3 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 7 Slovenia West Spain 144 144 12 39 51 65 83 148 0 1 1 0 0 0 1 0 1 7 54 61 406 Spain West Sweden – – – – – – – – – – – – – – – – – – – – – Sweden West United Kingdom 98 98 0 5 5 65 61 127 0 0 0 0 1 1 0 3 3 8 20 28 262 United Kingdom Total EU/EEA 867 872 70 304 374 610 848 1 460 11 7 18 4 2 6 5 7 12 79 309 388 3 130 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1 1 0 0 0 9 22 31 0 1 1 0 0 0 0 0 0 0 0 0 33 Albania West Andorra 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Andorra East Armenia 4 4 1 17 18 28 85 113 2 0 2 0 0 0 0 0 0 2 5 7 144 Armenia East Azerbaijan 0 0 0 50 50 48 57 105 0 0 0 0 0 0 0 0 0 6 7 13 168 Azerbaijan East Belarus 6 6 23 93 116 141 171 312 0 2 2 0 0 0 0 0 0 1 2 3 439 Belarus Centre Bosnia and Herzegovina 1 1 0 0 0 0 2 2 0 0 0 0 0 0 0 1 1 0 0 0 4 Bosnia and Herzegovina East Georgia 21 21 2 84 86 58 87 145 0 1 1 0 0 0 2 1 3 2 0 2 258 Georgia West Israel 5 5 2 2 4 8 9 17 0 0 0 0 0 0 0 0 0 0 0 0 26 Israel East Kazakhstan 2 2 33 137 170 94 72 166 2 5 7 0 0 0 0 0 0 8 8 16 361 Kazakhstan East Kyrgyzstan 0 0 1 22 23 18 12 30 2 0 2 0 2 2 0 0 0 2 0 2 59 Kyrgyzstan West Monaco 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Monaco Centre Montenegro 11 11 0 0 0 1 1 2 0 0 0 0 0 0 0 0 0 0 0 0 13 Montenegro East Republic of Moldova 8 8 9 22 31 76 113 189 1 4 5 0 0 0 0 0 0 19 26 45 278 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 San Marino Centre Serbia 28 28 3 2 5 3 14 17 0 0 0 0 0 0 0 0 0 0 11 11 62 Serbia Centre Serbia excluding Kosovod 28 28 3 2 5 3 9 12 0 0 0 0 0 0 0 0 0 0 11 11 56 Serbia excluding Kosovod Centre Kosovod 0 0 0 0 0 0 5 5 0 0 0 0 0 0 0 0 0 0 1 1 6 Kosovod West Switzerland 19 19 3 4 7 8 8 17 0 1 1 0 0 0 0 0 0 1 6 7 51 Switzerland East Tajikistan 3 3 4 67 71 60 77 137 2 3 5 0 0 0 0 0 0 12 19 31 247 Tajikistan Centre The former Yugoslav Republic of Macedonia 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 The former Yugoslav Republic of Macedonia Centre Turkey 14 14 0 1 1 6 23 29 1 0 1 0 0 0 0 0 0 10 65 75 120 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 69 69 474 2 398 2 872 3 166 3 077 6 243 44 49 93 0 0 0 0 0 0 12 19 31 9 308 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 194 194 555 2 899 3 454 3 724 3 830 7 555 54 66 120 0 2 2 2 2 4 75 169 244 11 573 Total non-EU/EEA WHO European Region WHO European Region West West 725 730 50 161 211 495 659 1 157 3 5 8 0 1 1 2 5 7 64 248 312 2 426 West Centre Centre 205 0 16 100 116 116 223 339 8 4 12 4 1 5 3 3 6 15 125 140 823 Centre East East 131 0 559 2 942 3 501 3 723 3 796 7 519 54 64 118 0 2 2 2 1 3 75 105 180 11 454 East Total WHO European Region 1 061 1 066 625 3 203 3 828 4 334 4 678 9 015 65 73 138 4 4 8 7 9 16 154 478 632 14 703 Total WHO European Region a Country-specific comments are in Annex 5. b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns or may differ slightly from the totals presented for 2017 in tables 18–21. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 95 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 22. AIDS diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa MSM Injecting drug users Heterosexual Mother-to-child transmission Nosocomial Haemophiliac/transfusion Unknown Totalb Country, territory or areaaMale Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 19 19 2 6 8 7 18 25 0 0 0 0 0 0 0 0 0 1 3 4 56 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 15 15 5 12 17 5 12 17 0 0 0 0 0 0 0 0 0 0 0 0 49 Bulgaria Centre Croatia 17 17 0 2 2 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 20 Croatia Centre Cyprus 6 6 0 0 0 6 3 9 0 0 0 0 0 0 1 0 1 0 0 0 16 Cyprus Centre Czech Republic 28 28 1 1 2 8 13 21 0 0 0 0 0 0 0 0 0 0 1 1 52 Czech Republic West Denmark 8 8 0 1 1 3 13 16 0 1 1 0 0 0 0 0 0 0 2 2 28 Denmark East Estonia 1 1 0 3 3 4 8 12 0 0 0 0 0 0 0 0 0 1 3 4 20 Estonia West Finland 3 3 1 0 1 6 5 11 0 0 0 0 0 0 0 0 0 1 2 3 18 Finland West France 101 104 1 11 12 88 111 200 3 0 3 0 0 0 1 1 2 17 54 71 392 France West Germanyc – – – – – – – – – – – – – – – – – – – – – Germanyc West Greece 43 45 4 13 17 21 10 31 0 0 0 0 0 0 0 1 1 2 16 18 112 Greece Centre Hungary 29 29 0 1 1 15 4 19 1 1 2 0 0 0 0 0 0 0 1 1 52 Hungary West Iceland 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Iceland West Ireland 7 7 0 1 1 5 1 6 0 0 0 0 0 0 0 0 0 0 2 2 16 Ireland West Italy 181 181 21 57 78 140 210 350 0 0 0 0 0 0 0 0 0 21 60 81 690 Italy East Latvia 10 10 9 29 38 25 24 49 1 0 1 0 0 0 0 0 0 10 10 20 118 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 7 7 3 20 23 5 13 18 0 0 0 0 0 0 0 0 0 0 6 6 54 Lithuania West Luxembourg 2 2 1 0 1 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 6 Luxembourg West Malta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Malta West Netherlands 50 50 0 1 1 18 27 45 0 0 0 0 0 0 0 0 0 3 16 19 115 Netherlands West Norway 2 2 0 0 0 3 8 11 0 1 1 0 0 0 0 0 0 0 0 0 14 Norway Centre Poland 20 20 1 22 23 8 7 15 0 0 0 0 0 0 0 1 1 3 39 42 101 Poland West Portugal 43 43 3 21 24 58 92 150 0 1 1 0 0 0 0 0 0 3 13 16 234 Portugal Centre Romania 25 25 6 59 65 54 115 169 6 2 8 4 1 5 2 1 3 2 6 8 283 Romania Centre Slovakia 5 5 0 0 0 0 3 3 0 0 0 0 0 0 0 0 0 0 1 1 9 Slovakia Centre Slovenia 3 3 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 7 Slovenia West Spain 144 144 12 39 51 65 83 148 0 1 1 0 0 0 1 0 1 7 54 61 406 Spain West Sweden – – – – – – – – – – – – – – – – – – – – – Sweden West United Kingdom 98 98 0 5 5 65 61 127 0 0 0 0 1 1 0 3 3 8 20 28 262 United Kingdom Total EU/EEA 867 872 70 304 374 610 848 1 460 11 7 18 4 2 6 5 7 12 79 309 388 3 130 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1 1 0 0 0 9 22 31 0 1 1 0 0 0 0 0 0 0 0 0 33 Albania West Andorra 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Andorra East Armenia 4 4 1 17 18 28 85 113 2 0 2 0 0 0 0 0 0 2 5 7 144 Armenia East Azerbaijan 0 0 0 50 50 48 57 105 0 0 0 0 0 0 0 0 0 6 7 13 168 Azerbaijan East Belarus 6 6 23 93 116 141 171 312 0 2 2 0 0 0 0 0 0 1 2 3 439 Belarus Centre Bosnia and Herzegovina 1 1 0 0 0 0 2 2 0 0 0 0 0 0 0 1 1 0 0 0 4 Bosnia and Herzegovina East Georgia 21 21 2 84 86 58 87 145 0 1 1 0 0 0 2 1 3 2 0 2 258 Georgia West Israel 5 5 2 2 4 8 9 17 0 0 0 0 0 0 0 0 0 0 0 0 26 Israel East Kazakhstan 2 2 33 137 170 94 72 166 2 5 7 0 0 0 0 0 0 8 8 16 361 Kazakhstan East Kyrgyzstan 0 0 1 22 23 18 12 30 2 0 2 0 2 2 0 0 0 2 0 2 59 Kyrgyzstan West Monaco 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Monaco Centre Montenegro 11 11 0 0 0 1 1 2 0 0 0 0 0 0 0 0 0 0 0 0 13 Montenegro East Republic of Moldova 8 8 9 22 31 76 113 189 1 4 5 0 0 0 0 0 0 19 26 45 278 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 San Marino Centre Serbia 28 28 3 2 5 3 14 17 0 0 0 0 0 0 0 0 0 0 11 11 62 Serbia Centre Serbia excluding Kosovod 28 28 3 2 5 3 9 12 0 0 0 0 0 0 0 0 0 0 11 11 56 Serbia excluding Kosovod Centre Kosovod 0 0 0 0 0 0 5 5 0 0 0 0 0 0 0 0 0 0 1 1 6 Kosovod West Switzerland 19 19 3 4 7 8 8 17 0 1 1 0 0 0 0 0 0 1 6 7 51 Switzerland East Tajikistan 3 3 4 67 71 60 77 137 2 3 5 0 0 0 0 0 0 12 19 31 247 Tajikistan Centre The former Yugoslav Republic of Macedonia 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 The former Yugoslav Republic of Macedonia Centre Turkey 14 14 0 1 1 6 23 29 1 0 1 0 0 0 0 0 0 10 65 75 120 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 69 69 474 2 398 2 872 3 166 3 077 6 243 44 49 93 0 0 0 0 0 0 12 19 31 9 308 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 194 194 555 2 899 3 454 3 724 3 830 7 555 54 66 120 0 2 2 2 2 4 75 169 244 11 573 Total non-EU/EEA WHO European Region WHO European Region West West 725 730 50 161 211 495 659 1 157 3 5 8 0 1 1 2 5 7 64 248 312 2 426 West Centre Centre 205 0 16 100 116 116 223 339 8 4 12 4 1 5 3 3 6 15 125 140 823 Centre East East 131 0 559 2 942 3 501 3 723 3 796 7 519 54 64 118 0 2 2 2 1 3 75 105 180 11 454 East Total WHO European Region 1 061 1 066 625 3 203 3 828 4 334 4 678 9 015 65 73 138 4 4 8 7 9 16 154 478 632 14 703 Total WHO European Region a Country-specific comments are in Annex 5. b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns or may differ slightly from the totals presented for 2017 in tables 18–21. c Due to technical problems no data export for 2017 from Germany was available. d (in accordance with Security Council resolution 1244 (1999)). 96 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 23. The most common AIDS-indicative diseases diagnosed in 2017,a ordered by frequency Diseases Men Women Children TotalN % N % N % N % EU/EEA Pneumocystis carinii pneumonia 600 21.2 195 21.2 3 7.1 798 21.0 Wasting syndrome due to HIV 323 11.4 89 9.7 10 23.8 422 11.1 Candidiasis; oesophageal 296 10.4 88 9.6 2 4.8 386 10.2 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 253 8.9 78 8.5 3 7.1 334 8.8 Kaposi's sarcoma 237 8.4 30 3.3 0 0.0 267 7.0 Toxoplasmosis of brain in a patient over 1 month of age 135 4.8 74 8.0 1 2.4 210 5.5 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 148 5.2 56 6.1 4 9.5 208 5.5 Mycobacterium tuberculosis; extrapulmonary 138 4.9 56 6.1 0 0.0 194 5.1 Encephalopathy; HIV-related 99 3.5 38 4.1 8 19.0 145 3.8 Progressive multifocal leukoencephalopathy 81 2.9 19 2.1 2 4.8 102 2.7 Non-EU/EEA Wasting syndrome due to HIV 293 15.4 172 18.8 20 18.2 485 16.6 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 250 13.2 88 9.6 11 10.0 349 11.9 Candidiasis; oesophageal 178 9.4 96 10.5 7 6.4 281 9.6 Mycobacterium tuberculosis; extrapulmonary 142 7.5 51 5.6 6 5.5 199 6.8 Pneumocystis carinii pneumonia 123 6.5 59 6.4 12 10.9 194 6.6 Encephalopathy; HIV-related 76 4.0 35 3.8 4 3.6 115 3.9 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 62 3.3 18 2.0 3 2.7 83 2.8 Kaposi's sarcoma 53 2.8 11 1.2 1 0.9 65 2.2 Toxoplasmosis of brain in a patient over 1 month of age 26 1.4 16 1.7 1 0.9 43 1.5 Herpes simplex: chronic ulcer(s) (over one month's duration); or bronchitis, pneumonitis or oesophagitis in a patient over 1 month of age 28 1.5 8 0.9 3 2.7 39 1.3 West Pneumocystis carinii pneumonia 506 24.1 157 22.4 2 28.6 665 23.7 Candidiasis; oesophageal 242 11.5 67 9.6 0 0.0 309 11.0 Kaposi's sarcoma 210 10.0 30 4.3 0 0.0 240 8.5 Wasting syndrome due to HIV 171 8.1 46 6.6 0 0.0 217 7.7 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 132 6.3 55 7.8 2 28.6 189 6.7 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 130 6.2 52 7.4 2 28.6 184 6.5 Mycobacterium tuberculosis; extrapulmonary 116 5.5 52 7.4 0 0.0 168 6.0 Toxoplasmosis of brain in a patient over 1 month of age 101 4.8 64 9.1 1 14.3 166 5.9 Progressive multifocal leukoencephalopathy 61 2.9 15 2.1 0 0.0 76 2.7 Encephalopathy; HIV-related 55 2.6 20 2.9 0 0.0 75 2.7 Centre Wasting syndrome due to HIV 158 18.4 48 22.4 10 26.3 216 19.4 Pneumocystis carinii pneumonia 117 13.6 29 13.6 2 5.3 148 13.3 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 109 12.7 18 8.4 1 2.6 128 11.5 Candidiasis; oesophageal 86 10.0 20 9.3 2 5.3 108 9.7 Encephalopathy; HIV-related 51 5.9 20 9.3 8 21.1 79 7.1 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 38 4.4 8 3.7 4 10.5 50 4.5 Kaposi's sarcoma 47 5.5 3 1.4 0 0.0 50 4.5 Mycobacterium tuberculosis; extrapulmonary 28 3.3 7 3.3 0 0.0 35 3.1 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 22 2.6 5 2.3 3 7.9 30 2.7 Lymphoma(s); not specified 17 2.0 7 3.3 2 5.3 26 2.3 East Wasting syndrome due to HIV 287 16.2 167 18.1 20 18.7 474 16.9 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 262 14.8 93 10.1 11 10.3 366 13.0 Candidiasis; oesophageal 146 8.2 97 10.5 7 6.5 250 8.9 Mycobacterium tuberculosis; extrapulmonary 136 7.7 48 5.2 6 5.6 190 6.8 Pneumocystis carinii pneumonia 100 5.6 68 7.4 11 10.3 179 6.4 Encephalopathy; HIV-related 69 3.9 33 3.6 4 3.7 106 3.8 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 47 2.6 16 1.7 2 1.9 65 2.3 Toxoplasmosis of brain in a patient over 1 month of age 42 2.4 18 2.0 1 0.9 61 2.2 Kaposi's sarcoma 33 1.9 8 0.9 1 0.9 42 1.5 Herpes simplex: chronic ulcer(s) (over one month's duration); or bronchitis, pneumonitis or oesophagitis in a patient over 1 month of age 13 0.7 10 1.1 4 3.7 27 1.0 a Numbers and percentages relate to AIDS indicative disease events reported; some people diagnosed with AIDS have more than one event reported at the time of diagnosis. 97 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 24. AIDS-related deaths,a by geographic area, country and year of death (2008–2017) and cumulative totals in EU/EEA and other countries of the WHO European Region Area Country, territory or areab Year of diagnosis Cumulative totalc2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 17 11 21 19 13 15 15 14 15 12 1 169 West Belgium 26 27 19 31 29 37 33 21 – – 2 061 Centre Bulgaria 9 2 14 17 16 14 13 8 9 10 183 Centre Croatia 7 7 9 6 9 8 5 15 3 2 199 Centre Cyprus 0 3 1 4 2 1 4 3 2 1 97 Centre Czech Republic 14 12 9 14 15 12 14 10 17 13 259 West Denmark 3 9 3 6 2 4 0 1 2 1 2 017 East Estonia 8 0 2 7 5 2 2 2 2 4 116 West Finland 6 6 10 6 13 8 5 6 5 9 231 West France 232 178 209 172 155 132 121 99 116 91 36 684 West Germanyd 130 130 114 122 84 105 99 64 47 – 14 735 West Greece 29 23 38 43 44 40 22 31 24 30 1 700 Centre Hungary 4 9 10 12 9 7 15 11 11 8 388 West Iceland 0 0 0 1 1 0 0 0 0 0 39 West Ireland 3 5 5 4 1 0 0 1 1 1 417 West Italy 704 649 599 595 598 647 572 531 0 0 42 835 East Latvia 58 69 57 80 88 107 72 38 37 31 819 Liechtenstein 0 0 0 0 0 0 0 0 0 0 6 East Lithuania 13 13 10 7 8 13 10 7 23 4 166 West Luxembourg 4 3 1 5 7 3 2 4 4 1 147 West Malta 0 0 0 1 2 0 1 1 3 0 65 West Netherlands 57 61 46 56 41 39 38 50 79 64 1 255 West Norway 3 3 0 1 1 2 3 2 0 2 632 Centre Poland 69 43 48 66 52 40 32 33 24 17 1 329 West Portugal 347 326 337 302 254 268 197 165 178 134 10 550 Centre Romania 144 120 134 215 187 199 237 195 187 170 4 561 Centre Slovakia 0 2 1 1 3 0 0 4 2 1 46 Centre Slovenia 6 1 1 1 2 7 4 5 3 1 104 West Spain 860 541 454 425 364 307 227 172 164 87 48 806 West Sweden – – – – – – – – – – 1 323 West United Kingdom 254 214 253 129 132 160 144 108 86 78 15 795 Total EU/EEA 3 007 2 467 2 405 2 348 2 137 2 177 1 887 1 601 1 044 772 188 638 Non-EU/EEA Centre Albania 3 13 11 11 12 10 13 12 12 4 162 West Andorra 1 0 0 0 0 0 0 3 0 0 4 East Armenia 31 39 23 26 36 45 50 62 53 74 521 East Azerbaijan 43 27 45 43 49 37 50 36 29 18 630 East Belarus 177 151 146 158 188 129 169 125 118 67 1 921 Centre Bosnia and Herzegovina 0 1 0 0 0 2 1 4 2 0 64 East Georgia 55 42 59 82 64 63 48 52 107 80 869 West Israel 23 17 18 31 30 31 32 23 20 11 768 East Kazakhstan 135 135 190 199 171 173 144 164 186 209 2 230 East Kyrgyzstan 15 21 26 19 19 6 8 38 13 27 275 West Monaco 0 0 0 0 0 0 0 0 0 0 18 Centre Montenegro 1 2 4 2 1 1 2 6 1 3 51 East Republic of Moldova 65 54 72 127 11 23 38 45 55 50 854 East Russian Federation – – – – – – – – – – – West San Marino 0 0 0 0 0 0 0 0 0 0 8 Centre Serbia 23 21 25 29 21 18 9 13 13 14 1 155 Centre Serbia excluding Kosovoe 21 21 25 27 17 17 9 12 10 14 1 110 Centre Kosovoe 2 0 0 2 4 1 0 1 3 0 45 West Switzerland 34 41 23 13 3 4 5 5 1 2 5 900 East Tajikistan 27 26 41 52 77 95 77 93 103 135 752 Centre The former Yugoslav Republic of Macedonia 1 0 1 4 0 3 0 0 0 2 66 Centre Turkey 0 0 0 0 0 10 11 4 4 4 107 East Turkmenistan 0 0 0 0 0 – – – – – 1 East Ukraine 2 710 2 591 3 096 3 736 3 870 3 514 3 426 3 032 3 253 3 298 45 008 East Uzbekistan 124 40 66 – – – – – – – 323 Total non-EU/EEA 3 468 3 221 3 846 4 532 4 552 4 164 4 083 3 717 3 970 3 998 61 672 WHO European Region West 2 733 2 244 2 150 1 962 1 774 1 802 1 516 1 301 745 529 187 063 Centre 281 236 268 382 329 332 360 323 290 250 8 771 East 3 461 3 208 3 833 4 536 4 586 4 207 4 094 3 694 3 979 3 997 54 485 Total WHO European Region 6 475 5 688 6 251 6 880 6 689 6 341 5 970 5 318 5 014 4 776 250 319 a This table includes deaths reported as due to AIDS and excludes deaths reported as not due to AIDS-related cases. In countries and years for which cause of death (AIDS or non-AIDS related) was unknown or could not be reported, deaths among people (ever) diagnosed with AIDS were included. b Country-specific comments are in Annex 5. c Cumulative total is the total number of cases reported by country since the start of reporting. d Due to technical problems no data export for 2017 from Germany was available. e (in accordance with Security Council resolution 1244 (1999)). 98 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 25. AIDS-related deaths,a by sex, transmission mode and year of death (2008–2017) and cumulative totalsb Table 25a. EU/EEA and non-EU/EEA countries Transmission mode 2008 2009 2010 2011 2012 2013 2014 2015 Transmission modeFemale Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc EU/EEA EU/EEA Men who have sex with men 326 326 273 273 318 318 296 296 257 258 242 242 221 222 206 207 Men who have sex with men Injecting drug use 178 729 907 107 509 616 91 440 531 97 401 498 98 356 454 82 355 437 56 287 343 60 201 261 Injecting drug use Heterosexual contact 238 385 623 228 317 545 212 368 580 200 348 548 169 296 465 184 307 491 167 257 425 125 237 362 Heterosexual contact Mother-to-child 5 7 12 4 3 7 10 10 4 8 12 4 5 9 5 4 9 2 2 4 5 1 6 Mother-to-child Haemophiliac/transfusion recipient 7 26 33 4 10 14 4 18 22 8 14 22 8 19 27 8 14 22 7 14 21 6 8 14 Haemophiliac/transfusion recipient Nosocomial infection 18 21 39 14 21 35 13 21 34 28 19 47 25 21 46 18 16 34 16 22 38 12 22 34 Nosocomial infection Other/undetermined 62 145 207 52 119 171 42 136 178 63 114 177 40 127 167 54 99 153 31 99 130 22 79 101 Other/undetermined Total EU/EEA 508 1 639 2 147 409 1 252 1 661 372 1 301 1 673 400 1 200 1 600 344 1 081 1 426 351 1 037 1 388 279 902 1 183 230 754 985 Total EU/EEA Non-EU/EEA Non-EU/EEA Men who have sex with men 22 22 22 22 21 21 18 18 19 19 22 22 26 26 18 18 Men who have sex with men Injecting drug use 55 286 342 51 257 308 49 316 365 44 333 377 33 326 359 36 271 307 25 241 266 39 268 307 Injecting drug use Heterosexual contact 103 141 244 110 120 230 133 134 267 163 199 362 128 154 282 104 165 269 134 191 325 126 183 309 Heterosexual contact Mother-to-child 4 4 8 3 2 5 2 3 5 3 8 11 5 3 8 7 5 12 3 2 5 4 1 5 Mother-to-child Haemophiliac/transfusion recipient 1 1 0 1 1 2 0 0 0 0 0 Haemophiliac/transfusion recipient Nosocomial infection 0 1 1 2 0 0 0 0 1 1 2 3 3 Nosocomial infection Other/undetermined 3 14 17 7 16 23 9 15 24 10 18 28 1 13 14 12 28 40 12 21 33 13 30 43 Other/undetermined Total non-EU/EEA 165 468 634 172 418 590 194 490 684 220 576 796 167 515 682 159 491 650 175 482 657 182 503 685 Total non-EU/EEA Total WHO European Region 673 2 107 2 781 581 1 670 2 251 566 1 791 2 357 620 1 776 2 396 511 1 596 2 108 510 1 528 2 038 454 1 384 1 840 412 1 257 1 670 Total WHO European Region Transmission mode 2016 2017 Cumulative total d Female Male Totalc Female Male Totalc Female Male Unkown Total EU/EEA Men who have sex with men 208 208 173 174 0 40 029 4 34 361 Injecting drug use 51 219 270 38 149 187 9 298 39 678 0 46 300 Heterosexual contact 130 240 370 110 187 297 9 675 14 572 2 23 103 Mother-to-child 2 2 4 1 4 5 539 620 3 999 Haemophiliac/transfusion recipient 7 4 11 3 4 7 1 262 3 315 0 3 541 Nosocomial infection 10 15 25 12 8 20 660 958 0 1 604 Other/undetermined 17 92 109 18 64 82 1 516 5 688 1 6 872 Total EU/EEA 217 780 997 182 589 772 22 950 104 860 10 116 780 Non-EU/EEA Men who have sex with men 16 16 21 21 0 2 534 0 2 154 Injecting drug use 25 237 262 38 234 272 1 546 6 074 1 7 349 Heterosexual contact 164 223 387 148 211 359 2 210 2 899 0 5 016 Mother-to-child 4 1 5 2 3 5 99 94 1 181 Haemophiliac/transfusion recipient 1 1 2 0 62 187 0 202 Nosocomial infection 2 2 1 1 5 12 0 17 Other/undetermined 15 28 43 16 24 40 166 457 1 594 Total non-EU/EEA 209 508 717 204 494 698 4 088 12 257 3 15 513 Total WHO European Region 426 1 288 1 714 386 1 083 1 470 27 038 117 111 13 132 287 a This table includes deaths reported as due to AIDS and excludes deaths reported as not due to AIDS-related cases. In countries and years for which cause of death (AIDS or non-AIDS related) was unknown or could not be reported, deaths among people (ever) diagnosed with AIDS were included. b Data from Belgium, Germany, Italy, Russian Federation, Sweden, Turkmenistan, Ukraine and Uzbekistan excluded due to inconsistent reporting or lack of data on deaths by transmission mode during the period. Therefore, totals by gender and overall differ from totals presented in Table 24. c Yearly totals include people diagnosed whose gender was unknown. d Cumulative total is the total number of cases reported by the country since the start of reporting. 99 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 25. AIDS-related deaths,a by sex, transmission mode and year of death (2008–2017) and cumulative totalsb Table 25a. EU/EEA and non-EU/EEA countries Transmission mode 2008 2009 2010 2011 2012 2013 2014 2015 Transmission modeFemale Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc EU/EEA EU/EEA Men who have sex with men 326 326 273 273 318 318 296 296 257 258 242 242 221 222 206 207 Men who have sex with men Injecting drug use 178 729 907 107 509 616 91 440 531 97 401 498 98 356 454 82 355 437 56 287 343 60 201 261 Injecting drug use Heterosexual contact 238 385 623 228 317 545 212 368 580 200 348 548 169 296 465 184 307 491 167 257 425 125 237 362 Heterosexual contact Mother-to-child 5 7 12 4 3 7 10 10 4 8 12 4 5 9 5 4 9 2 2 4 5 1 6 Mother-to-child Haemophiliac/transfusion recipient 7 26 33 4 10 14 4 18 22 8 14 22 8 19 27 8 14 22 7 14 21 6 8 14 Haemophiliac/transfusion recipient Nosocomial infection 18 21 39 14 21 35 13 21 34 28 19 47 25 21 46 18 16 34 16 22 38 12 22 34 Nosocomial infection Other/undetermined 62 145 207 52 119 171 42 136 178 63 114 177 40 127 167 54 99 153 31 99 130 22 79 101 Other/undetermined Total EU/EEA 508 1 639 2 147 409 1 252 1 661 372 1 301 1 673 400 1 200 1 600 344 1 081 1 426 351 1 037 1 388 279 902 1 183 230 754 985 Total EU/EEA Non-EU/EEA Non-EU/EEA Men who have sex with men 22 22 22 22 21 21 18 18 19 19 22 22 26 26 18 18 Men who have sex with men Injecting drug use 55 286 342 51 257 308 49 316 365 44 333 377 33 326 359 36 271 307 25 241 266 39 268 307 Injecting drug use Heterosexual contact 103 141 244 110 120 230 133 134 267 163 199 362 128 154 282 104 165 269 134 191 325 126 183 309 Heterosexual contact Mother-to-child 4 4 8 3 2 5 2 3 5 3 8 11 5 3 8 7 5 12 3 2 5 4 1 5 Mother-to-child Haemophiliac/transfusion recipient 1 1 0 1 1 2 0 0 0 0 0 Haemophiliac/transfusion recipient Nosocomial infection 0 1 1 2 0 0 0 0 1 1 2 3 3 Nosocomial infection Other/undetermined 3 14 17 7 16 23 9 15 24 10 18 28 1 13 14 12 28 40 12 21 33 13 30 43 Other/undetermined Total non-EU/EEA 165 468 634 172 418 590 194 490 684 220 576 796 167 515 682 159 491 650 175 482 657 182 503 685 Total non-EU/EEA Total WHO European Region 673 2 107 2 781 581 1 670 2 251 566 1 791 2 357 620 1 776 2 396 511 1 596 2 108 510 1 528 2 038 454 1 384 1 840 412 1 257 1 670 Total WHO European Region Transmission mode 2016 2017 Cumulative total d Female Male Totalc Female Male Totalc Female Male Unkown Total EU/EEA Men who have sex with men 208 208 173 174 0 40 029 4 34 361 Injecting drug use 51 219 270 38 149 187 9 298 39 678 0 46 300 Heterosexual contact 130 240 370 110 187 297 9 675 14 572 2 23 103 Mother-to-child 2 2 4 1 4 5 539 620 3 999 Haemophiliac/transfusion recipient 7 4 11 3 4 7 1 262 3 315 0 3 541 Nosocomial infection 10 15 25 12 8 20 660 958 0 1 604 Other/undetermined 17 92 109 18 64 82 1 516 5 688 1 6 872 Total EU/EEA 217 780 997 182 589 772 22 950 104 860 10 116 780 Non-EU/EEA Men who have sex with men 16 16 21 21 0 2 534 0 2 154 Injecting drug use 25 237 262 38 234 272 1 546 6 074 1 7 349 Heterosexual contact 164 223 387 148 211 359 2 210 2 899 0 5 016 Mother-to-child 4 1 5 2 3 5 99 94 1 181 Haemophiliac/transfusion recipient 1 1 2 0 62 187 0 202 Nosocomial infection 2 2 1 1 5 12 0 17 Other/undetermined 15 28 43 16 24 40 166 457 1 594 Total non-EU/EEA 209 508 717 204 494 698 4 088 12 257 3 15 513 Total WHO European Region 426 1 288 1 714 386 1 083 1 470 27 038 117 111 13 132 287 a This table includes deaths reported as due to AIDS and excludes deaths reported as not due to AIDS-related cases. In countries and years for which cause of death (AIDS or non-AIDS related) was unknown or could not be reported, deaths among people (ever) diagnosed with AIDS were included. b Data from Belgium, Germany, Italy, Russian Federation, Sweden, Turkmenistan, Ukraine and Uzbekistan excluded due to inconsistent reporting or lack of data on deaths by transmission mode during the period. Therefore, totals by gender and overall differ from totals presented in Table 24. c Yearly totals include people diagnosed whose gender was unknown. d Cumulative total is the total number of cases reported by the country since the start of reporting. 100 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 25. AIDS-related deaths,a by sex, transmission mode and year of death (2008–2017) and cumulative totalsb Table 25b. West, Centre, East of the WHO European Region Transmission mode 2008 2009 2010 2011 2012 2013 2014 2015 Transmission modeFemale Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc West West Men who have sex with men 309 309 257 257 290 290 262 262 232 233 215 215 191 192 165 166 Men who have sex with men Injecting drug use 168 663 831 102 453 555 78 401 479 76 339 415 72 273 345 60 273 333 41 212 253 45 151 196 Injecting drug use Heterosexual contact 218 354 572 216 286 502 194 319 513 154 269 423 139 253 392 137 239 376 117 179 297 85 167 252 Heterosexual contact Mother-to-child 5 5 10 3 3 5 5 2 3 5 3 2 5 1 1 1 1 1 1 Mother-to-child Haemophiliac/transfusion recipient 6 17 23 1 6 7 2 7 9 4 9 13 7 7 4 6 10 1 5 6 4 4 8 Haemophiliac/transfusion recipient Nosocomial infection 0 1 1 0 0 0 0 0 0 Nosocomial infection Other/undetermined 31 97 128 26 87 113 23 99 122 23 73 96 13 68 81 15 63 78 10 53 63 14 48 62 Other/undetermined Total West 428 1 445 1 873 349 1 089 1 438 302 1 116 1 418 259 955 1 214 227 835 1 063 216 797 1 013 170 640 812 149 535 685 Total West Centre Centre Men who have sex with men 33 33 36 36 46 46 45 45 38 38 36 36 51 51 55 55 Men who have sex with men Injecting drug use 8 36 44 5 25 30 8 20 28 13 37 50 17 46 63 11 43 54 8 50 58 12 47 59 Injecting drug use Heterosexual contact 25 50 75 26 42 68 27 53 80 54 86 140 24 52 76 37 78 115 52 78 130 42 83 125 Heterosexual contact Mother-to-child 1 3 4 2 4 6 6 6 2 7 9 4 3 7 7 3 10 2 2 4 5 1 6 Mother-to-child Haemophiliac/transfusion recipient 1 10 11 3 4 7 3 12 15 4 5 9 8 12 20 4 8 12 6 9 15 2 4 6 Haemophiliac/transfusion recipient Nosocomial infection 18 21 39 13 21 34 13 21 34 28 19 47 25 21 46 18 16 34 16 22 38 12 22 34 Nosocomial infection Other/undetermined 30 45 75 22 33 55 19 40 59 36 46 82 24 55 79 32 39 71 20 44 64 6 32 38 Other/undetermined Total Centre 83 198 281 71 165 236 76 192 268 137 245 382 102 227 329 109 223 332 104 256 360 79 244 323 Total Centre East East Men who have sex with men 6 6 2 2 3 3 7 7 6 6 13 13 5 5 4 4 Men who have sex with men Injecting drug use 57 316 374 51 288 339 54 335 389 52 358 410 42 363 405 47 310 357 32 266 298 42 271 313 Injecting drug use Heterosexual contact 98 122 220 96 109 205 124 130 254 155 192 347 134 145 279 114 155 269 132 191 323 124 170 294 Heterosexual contact Mother-to-child 3 3 6 2 1 3 1 3 4 3 6 9 2 3 5 5 5 10 2 2 4 3 1 4 Mother-to-child Haemophiliac/transfusion recipient 0 0 0 0 0 0 0 0 Haemophiliac/transfusion recipient Nosocomial infection 0 1 1 2 0 0 0 0 1 1 2 3 3 Nosocomial infection Other/undetermined 4 17 21 11 15 26 9 12 21 14 13 27 4 17 21 19 25 44 13 23 36 15 29 44 Other/undetermined Total East 162 464 627 161 416 577 188 483 671 224 576 800 182 534 716 185 508 693 180 488 668 184 478 662 Total East Total WHO European Region 673 2 107 2 781 581 1 670 2 251 566 1 791 2 357 620 1 776 2 396 511 1 596 2 108 510 1 528 2 038 454 1 384 1 840 412 1 257 1 670 Total WHO European Region Transmission mode 2016 2017 Cumulative total d Female Male Totalc Female Male Totalc Female Male Unkown Total West Men who have sex with men 163 163 141 142 0 41 111 4 35 136 Injecting drug use 40 150 190 27 99 126 9 850 40 234 0 47 171 Heterosexual contact 98 177 275 71 131 202 9 567 14 169 2 22 543 Mother-to-child 2 2 2 2 512 544 3 886 Haemophiliac/transfusion recipient 1 1 2 1 1 1 078 3 032 0 3 076 Nosocomial infection 0 0 7 6 0 12 Other/undetermined 11 55 66 8 42 50 1 067 5 037 1 5 756 Total West 150 548 698 107 415 523 22 081 104 133 10 114 580 Centre Men who have sex with men 50 50 39 39 0 1 305 0 1 232 Injecting drug use 12 50 62 12 41 53 304 1 180 0 1 450 Heterosexual contact 34 67 101 31 64 95 786 1 348 0 2 097 Mother-to-child 2 2 1 2 3 86 126 1 211 Haemophiliac/transfusion recipient 6 3 9 2 4 6 244 466 0 661 Nosocomial infection 10 15 25 12 8 20 653 952 0 1 592 Other/undetermined 6 35 41 5 27 32 475 851 1 1 315 Total Centre 70 220 290 63 185 248 2 548 6 228 2 8 558 East Men who have sex with men 11 11 14 14 0 146 0 146 Injecting drug use 24 256 280 37 243 280 690 4 335 1 5 025 Heterosexual contact 162 219 381 156 203 359 1 532 1 952 0 3 477 Mother-to-child 4 1 5 2 3 5 40 44 0 83 Haemophiliac/transfusion recipient 1 1 2 0 2 4 0 6 Nosocomial infection 2 2 1 1 5 12 0 17 Other/undetermined 15 30 45 21 19 40 140 257 0 395 Total East 206 520 726 216 483 699 2 409 6 750 1 9 149 Total WHO European Region 426 1 288 1 714 386 1 083 1 470 27 038 117 111 13 132 287 a This table includes deaths reported as due to AIDS and excludes deaths reported as not due to AIDS-related cases. In countries and years for which cause of death (AIDS or non-AIDS related) was unknown or could not be reported, deaths among people (ever) diagnosed with AIDS were included. b Data from Belgium, Germany, Italy, Russian Federation, Sweden, Turkmenistan, Ukraine and Uzbekistan excluded due to inconsistent reporting or lack of data on deaths by transmission mode during the period. Therefore, totals by gender and overall differ from totals presented in Table 24. c Yearly totals include people diagnosed whose gender was unknown. d Cumulative total is the total number of cases reported by the country since the start of reporting. 101 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Table 25. AIDS-related deaths,a by sex, transmission mode and year of death (2008–2017) and cumulative totalsb Table 25b. West, Centre, East of the WHO European Region Transmission mode 2008 2009 2010 2011 2012 2013 2014 2015 Transmission modeFemale Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc Female Male Totalc West West Men who have sex with men 309 309 257 257 290 290 262 262 232 233 215 215 191 192 165 166 Men who have sex with men Injecting drug use 168 663 831 102 453 555 78 401 479 76 339 415 72 273 345 60 273 333 41 212 253 45 151 196 Injecting drug use Heterosexual contact 218 354 572 216 286 502 194 319 513 154 269 423 139 253 392 137 239 376 117 179 297 85 167 252 Heterosexual contact Mother-to-child 5 5 10 3 3 5 5 2 3 5 3 2 5 1 1 1 1 1 1 Mother-to-child Haemophiliac/transfusion recipient 6 17 23 1 6 7 2 7 9 4 9 13 7 7 4 6 10 1 5 6 4 4 8 Haemophiliac/transfusion recipient Nosocomial infection 0 1 1 0 0 0 0 0 0 Nosocomial infection Other/undetermined 31 97 128 26 87 113 23 99 122 23 73 96 13 68 81 15 63 78 10 53 63 14 48 62 Other/undetermined Total West 428 1 445 1 873 349 1 089 1 438 302 1 116 1 418 259 955 1 214 227 835 1 063 216 797 1 013 170 640 812 149 535 685 Total West Centre Centre Men who have sex with men 33 33 36 36 46 46 45 45 38 38 36 36 51 51 55 55 Men who have sex with men Injecting drug use 8 36 44 5 25 30 8 20 28 13 37 50 17 46 63 11 43 54 8 50 58 12 47 59 Injecting drug use Heterosexual contact 25 50 75 26 42 68 27 53 80 54 86 140 24 52 76 37 78 115 52 78 130 42 83 125 Heterosexual contact Mother-to-child 1 3 4 2 4 6 6 6 2 7 9 4 3 7 7 3 10 2 2 4 5 1 6 Mother-to-child Haemophiliac/transfusion recipient 1 10 11 3 4 7 3 12 15 4 5 9 8 12 20 4 8 12 6 9 15 2 4 6 Haemophiliac/transfusion recipient Nosocomial infection 18 21 39 13 21 34 13 21 34 28 19 47 25 21 46 18 16 34 16 22 38 12 22 34 Nosocomial infection Other/undetermined 30 45 75 22 33 55 19 40 59 36 46 82 24 55 79 32 39 71 20 44 64 6 32 38 Other/undetermined Total Centre 83 198 281 71 165 236 76 192 268 137 245 382 102 227 329 109 223 332 104 256 360 79 244 323 Total Centre East East Men who have sex with men 6 6 2 2 3 3 7 7 6 6 13 13 5 5 4 4 Men who have sex with men Injecting drug use 57 316 374 51 288 339 54 335 389 52 358 410 42 363 405 47 310 357 32 266 298 42 271 313 Injecting drug use Heterosexual contact 98 122 220 96 109 205 124 130 254 155 192 347 134 145 279 114 155 269 132 191 323 124 170 294 Heterosexual contact Mother-to-child 3 3 6 2 1 3 1 3 4 3 6 9 2 3 5 5 5 10 2 2 4 3 1 4 Mother-to-child Haemophiliac/transfusion recipient 0 0 0 0 0 0 0 0 Haemophiliac/transfusion recipient Nosocomial infection 0 1 1 2 0 0 0 0 1 1 2 3 3 Nosocomial infection Other/undetermined 4 17 21 11 15 26 9 12 21 14 13 27 4 17 21 19 25 44 13 23 36 15 29 44 Other/undetermined Total East 162 464 627 161 416 577 188 483 671 224 576 800 182 534 716 185 508 693 180 488 668 184 478 662 Total East Total WHO European Region 673 2 107 2 781 581 1 670 2 251 566 1 791 2 357 620 1 776 2 396 511 1 596 2 108 510 1 528 2 038 454 1 384 1 840 412 1 257 1 670 Total WHO European Region Transmission mode 2016 2017 Cumulative total d Female Male Totalc Female Male Totalc Female Male Unkown Total West Men who have sex with men 163 163 141 142 0 41 111 4 35 136 Injecting drug use 40 150 190 27 99 126 9 850 40 234 0 47 171 Heterosexual contact 98 177 275 71 131 202 9 567 14 169 2 22 543 Mother-to-child 2 2 2 2 512 544 3 886 Haemophiliac/transfusion recipient 1 1 2 1 1 1 078 3 032 0 3 076 Nosocomial infection 0 0 7 6 0 12 Other/undetermined 11 55 66 8 42 50 1 067 5 037 1 5 756 Total West 150 548 698 107 415 523 22 081 104 133 10 114 580 Centre Men who have sex with men 50 50 39 39 0 1 305 0 1 232 Injecting drug use 12 50 62 12 41 53 304 1 180 0 1 450 Heterosexual contact 34 67 101 31 64 95 786 1 348 0 2 097 Mother-to-child 2 2 1 2 3 86 126 1 211 Haemophiliac/transfusion recipient 6 3 9 2 4 6 244 466 0 661 Nosocomial infection 10 15 25 12 8 20 653 952 0 1 592 Other/undetermined 6 35 41 5 27 32 475 851 1 1 315 Total Centre 70 220 290 63 185 248 2 548 6 228 2 8 558 East Men who have sex with men 11 11 14 14 0 146 0 146 Injecting drug use 24 256 280 37 243 280 690 4 335 1 5 025 Heterosexual contact 162 219 381 156 203 359 1 532 1 952 0 3 477 Mother-to-child 4 1 5 2 3 5 40 44 0 83 Haemophiliac/transfusion recipient 1 1 2 0 2 4 0 6 Nosocomial infection 2 2 1 1 5 12 0 17 Other/undetermined 15 30 45 21 19 40 140 257 0 395 Total East 206 520 726 216 483 699 2 409 6 750 1 9 149 Total WHO European Region 426 1 288 1 714 386 1 083 1 470 27 038 117 111 13 132 287 a This table includes deaths reported as due to AIDS and excludes deaths reported as not due to AIDS-related cases. In countries and years for which cause of death (AIDS or non-AIDS related) was unknown or could not be reported, deaths among people (ever) diagnosed with AIDS were included. b Data from Belgium, Germany, Italy, Russian Federation, Sweden, Turkmenistan, Ukraine and Uzbekistan excluded due to inconsistent reporting or lack of data on deaths by transmission mode during the period. Therefore, totals by gender and overall differ from totals presented in Table 24. c Yearly totals include people diagnosed whose gender was unknown. d Cumulative total is the total number of cases reported by the country since the start of reporting. 102 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Table 26. Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2008–2017) and number of tests per 1000 population in 2017, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Number of HIV tests Tests/1000 population2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 EU/EEA West Austria 751 749 – – – – – – – – – – West Belgium 619 418 635 150 651 095 679 655 703 160 695 485 697 530 692 559 726 085 714 255 63.1 Centre Bulgaria 110 000 140 000 160 000 180 000 190 000 210 000 230 000 290 000 320 000 – – Centre Croatia 38 996 – – – – – – – – – – Centre Cyprus 42 294 48 158 48 385 49 074 54 120 50 235 – – 52 385 – – Centre Czech Republic 342 223 347 135 353 507 334 569 349 205 341 583 349 448 345 274 350 234 351 650 33.3 West Denmark 279 135 112 185 168 923 137 877 134 709 137 537 151 970 153 050 163 779 158 331 27.7 East Estonia 74 357 78 735 78 054 85 025 73 367 82 279 82 266 87 587 90 136 102 863 78.2 West Finland 186 822 190 380 – – – – – – – – – West France 5 051 821 5 023 833 5 009 580 5 213 049 5 242 541 5 218 563 5 253 834 5 370 787 5 430 106 5 604 096 83.9 West Germany – – – – – – – – – – – West Greeceb 33 558 35 171 31 070 31 918 34 622 32 241 22 455 20 412 20 079 – – Centre Hungary 83 408 91 181 89 137 84 464 93 060 95 861 93 289 91 793 – – – West Iceland 9 522 7 794 7 318 – – – – – – – – West Ireland – 184 980 180 055 184 521 175 488 150 597 168 028 178 267 192 956 223 609 47.3 West Italy – – – – – – – – – – – East Latvia 72 444 59 331 58 826 58 799 60 491 58 302 60 614 65 552 79 715 82 608 42.0 Liechtenstein – – – – – – – – – – – East Lithuania 162 381 100 799 178 554 102 234 101 042 102 161 108 781 105 486 104 132 113 917 39.4 West Luxembourg 13 366 – – – – – – – 71 200 100 529 174.5 West Malta – – – – – – – – – – – West Netherlands – – – – – – – – – – – West Norway – – – – – – – – – – – Centre Poland 181 118 213 138 229 783 317 286 358 953 313 341 272 102 318 458 440 365 430 266 11.3 West Portugalb – – 315 381 266 853 235 455 228 321 236 832 259 751 252 715 251 396 24.3 Centre Romania 282 248 285 948 291 915 306 679 293 204 302 898 332 422 346 032 360 893 338 898 17.2 Centre Slovakia 66 926 132 990 109 261 110 025 110 506 114 574 126 187 127 109 104 876 111 340 20.5 Centre Slovenia 31 183 37 105 36 977 38 110 33 602 33 457 35 498 34 366 35 788 37 315 18.1 West Spain – – – – – – – – – – – West Sweden – – – – – – – – – – – West United Kingdom – – – – – – – – – – – Non-EU/EEA Centre Albania 2 458 2 143 2 168 3 260 3 140 3 063 4 156 5 442 5 582 7 149 2.4 West Andorra – 2 810 2 678 2 590 2 062 2 310 2 378 2 212 2 340 2 591 33.7 East Armenia 60 701 60 103 60 731 68 449 71 957 83 431 94 122 117 012 99 270 119 628 40.8 East Azerbaijan 322 525 340 048 353 772 365 090 514 434 482 282 612 860 714 621 500 469 657 704 66.9 East Belarus 430 175 459 032 517 625 621 780 683 125 770 136 1 157 072 1 249 712 1 464 386 1 514 635 160.0 Centre Bosnia and Herzegovina – – – – – – – – – – – East Georgia 18 792 17 562 25 370 21 799 15 562 18 091 86 290 78 261 119 868 207 175 53.0 West Israel 271 641 278 887 286 995 274 294 233 516 – – – – – – East Kazakhstan 1 643 938 1 758 026 1 786 289 1 897 476 2 026 174 2 127 136 2 190 757 2 388 347 2 587 065 2 742 741 150.7 East Kyrgyzstan 268 134 325 855 297 959 381 295 470 355 370 160 410 331 376 284 331 609 376 431 62.3 West Monaco – – – – – – – – – – – Centre Montenegro 4 229 5 812 6 492 6 914 6 781 6 970 6 571 6 607 6 324 5 606 8.9 East Republic of Moldova 355 711 204 702 207 018 207 830 212 964 146 105 133 476 146 762 124 010 160 947 39.7 East Russian Federationc – – 25 209 546 – – – – – – – – West San Marino 3 825 4 181 5 090 3 961 3 845 4 004 3 427 1 548 3 600 3 685 110.3 Centre Serbia 44 806 48 729 52 868 57 275 65 366 67 079 56 282 63 189 68 426 80 918 Centre Serbia excluding Kosovod 44 555 47 734 51 727 56 086 64 031 65 829 56 282 61 877 65 827 76 367 10.9 Centre Kosovod 251 995 1 141 1 189 1 335 1 250 – 1 312 2 599 4 551 2.6 West Switzerland – – – – – – – – – – – East Tajikistan 129 330 214 207 280 281 438 532 447 636 514 701 634 791 597 426 509 092 612 123 68.6 Centre The former Yugoslav Republic of Macedonia 10 426 11 842 18 721 17 811 18 105 24 562 27 430 28 601 30 211 36 248 17.4 Centre Turkey 5 045 319 4 475 874 5 010 334 5 693 965 5 952 148 6 515 931 6 663 547 7 203 959 6 263 020 7 107 551 88.0 East Turkmenistan – – – – – – – – – – – East Ukraine 2 280 442 2 347 084 2 319 946 2 392 970 2 343 099 2 941 748 1 853 626 1 695 926 1 697 479 1 816 023 42.8 East Uzbekistan 796 371 987 464 1 506 724 – – – – – – – – a Country-specific comments are in Annex 5. b HIV tests in Greece refer only to those performed in reference centres and do not include all tests carried out in public hospitals or private laboratories. Number of tests in Portugal refer only to those requested at public primary health-care centres and do not include those requested in hospitals and private sector. c Number of HIV tests in the Russian Federation: 23 7118 66 (2008), 25 509 617 (2009), 25 071 010 (2010), 24 734 075 (2011), 26 037 319 (2012), 26 826 067 (2013), 27 982 810 (2014), 28 336 911 (2015), 30 752 828 (2016), 33 870 850 (2017). Sources: Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS. Information notes ”Spravka” on HIV infection in the Russian Federation as of 31 December 2016 and 2017 and HIV-infection Bulletin number 41. d (in accordance with Security Council resolution 1244 (1999)). Maps 104 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Map 2. New HIV diagnoses in men per 100 000 male population, 2017 Andorra Luxembourg Malta Monaco San Marino < 2 2 to < 5 5 to < 10 10 to < 20 20 to < 50 ≥ 50 Missing or excluded data Map 1. New HIV diagnoses per 100 000 population, 2017 Andorra Luxembourg Malta Monaco San Marino < 2 2 to < 5 5 to < 10 10 to < 20 20 to < 50 ≥ 50 Missing or excluded data Note: all data presented were reported to ECDC/WHO through the European Surveillance System (TESSy), except for data for the Russian Federation (source for data from the Russian Federation: Information note ‘Spravka’ on HIV infection in the Russian Federation as of 31 December 2017. Moscow: Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS; 2018). 105 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Map 3. New HIV diagnoses in women per 100 000 female population, 2017 Andorra Luxembourg Malta Monaco San Marino < 2 2 to < 5 5 to < 10 10 to < 20 20 to < 50 ≥ 50 Missing or excluded data Andorra Luxembourg Malta Monaco San Marino < 1 1 to < 3 3 to < 5 ≥ 5 Missing or excluded data Map 4. New HIV diagnoses in men who have sex with men per 100 000 male population, 2017 106 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Andorra Luxembourg Malta Monaco San Marino < 1 1 to < 3 3 to < 5 ≥ 5 Missing or excluded data Map 6. New HIV diagnoses acquired through heterosexual transmission per 100 000 population, 2017 Map 5. New HIV diagnoses acquired through injecting drug use per 100 000 population, 2017 Andorra Luxembourg Malta Monaco San Marino < 1 1 to < 3 3 to < 5 ≥ 5 Missing or excluded data 107 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Map 7. Percentage of adult (> 14 years) HIV diagnoses with CD4 < 350 cells/mm3 at diagnosis, 2017 Andorra Luxembourg Malta Monaco San Marino 30% to < 40% 40% to < 50% > 50% Missing or excluded data Map 8. AIDS diagnoses reported per 100 000 population, 2017 Andorra Luxembourg Malta Monaco San Marino < 1 1 to < 3 3 to < 5 ≥ 5 Missing or excluded data

Annexes

111 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Reporting The Member States’ Coordinating Competent Bodies in European Union (EU) and European Economic Area (EEA) (jointly referred to as EU/EEA) countries have nominated national operational contact points for HIV/AIDS surveil- lance to work on reporting surveillance data to the joint European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO) Regional Office for Europe database for HIV/AIDS surveillance. For non-EU/EEA countries, nominations for national HIV/AIDS surveillance focal points were received directly by the WHO Regional Office for Europe via the respective ministries of health. Data are submitted directly by reporting countries through a web-based platform to a joint database known as The European Surveillance System (TESSy). Four types of data are collected: HIV (case-based and aggregate), AIDS (case-based and aggregate), HIVAIDS (case-based data that link HIV and AIDS diagnoses) and number of HIV tests performed (aggregate). AIDS- related deaths are reported as part of case-based AIDS or HIVAIDS data. All new HIV diagnoses, irrespective of whether the case is diagnosed simultaneously with AIDS and reported as a new AIDS diagnosis, are classified as HIV cases. Implementation of WHO and EU case definitions for HIV and AIDS surveillance means that only confirmed cases are reported at European level (1,2). It is recognized that the HIV and AIDS case definitions currently used in a number of countries may differ across the WHO European Region, but the EU and WHO case definitions are compatible for surveillance purposes. A built-in set of validation rules ensures verification of the data within the database during the data-uploading process, improv- ing data quality and allowing each country to test their datasets prior to submission. Further validation checks are carried out by ECDC and the WHO Regional Office in collaboration with the countries before the data are con- sidered of sufficient quality to be used for analysis. The Russian Federation, Turkmenistan and Uzbekistan did not report any HIV data through this system for 2017, and Germany’s 2017 data were delayed and not included due to a temporary data-extraction issue. HIV data for the Russian Federation were obtained through publicly available national sources, on the assumption that the data have been validated to the same standard as for the other countries, and then incorporated with the data reported by other countries to the extent possible to enable a more complete presentation of the epidemiol- ogy of HIV and AIDS in the WHO European Region (that is, for the overall number, rate and trend of HIV diag- noses in the European Region and the East and for new diagnoses by mode of transmission, as described within the text). Germany, Belgium, the Russian Federation, Sweden, Turkmenistan and Uzbekistan did not report any AIDS data for 2017 (or prior years for some of the countries, see Table 15). Completeness of key variables is presented for the EU/EEA and the WHO European Region as a whole in Annex 2 and by country in Annex 3. Surveillance systems – data sources To describe the national source of data and specify the national surveillance system from which the reported data originate, information on the country data source is included as a compulsory part of reporting; this is detailed in Annex 4a and 4b. Some cross-country data comparisons are hampered by differences in surveillance systems as the quality and coverage of national surveil- lance differ for some years of reporting. Particularly in the early part of the period covered in this report (2008– 2017), some countries did not have national HIV/AIDS data. These issues are detailed in Annex 5 and should be taken into account when interpreting and comparing trends across countries. Data collection and validation Data collection 2017 The 2017 data submission for HIV and AIDS surveillance took place between 15 March and 3 October 2018. Data presented in this report were extracted from the joint database on 4 October 2018. Individual country datasets Data were uploaded, validated and approved in the joint database for HIV/AIDS surveillance by the report- ing countries. Once the data were submitted, individual datasets were reviewed by ECDC and the Regional Office and validated by countries. The HIVAIDS record type was used for the first time in 2014 to collect case-based joined HIV and AIDS data (Annex 4a and 4b). Forty-one countries used the joined record type for combined HIVAIDS 2017 reporting, and an additional two used it for HIV-only reporting, an increase on the 33 countries that used it when first implemented in 2014. Of the 41, 28 uploaded all historical data in the new format, allow- ing for retrospective updates of missing variables or de-duplication of cases. Three countries (Italy, Spain and Switzerland) uploaded all historical data in the older separate HIV and AIDS formats while the rest uploaded only 2017 data, or data for a few years, in either the old separate HIV and AIDS formats or new record type. One country (San Marino) reported aggregated HIV data. Ukraine reported aggregated AIDS data, while all other countries reported case-based AIDS data. Annex 1. Framework for data collection, validation and presentation 112 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Reporting of aggregated HIV and AIDS data has an impact on the data presentation and analysis and the epidemiological overview of HIV/AIDS in Europe because fewer variables are available from the aggregated data- sets, reducing the amount of data that can be presented in certain tables and figures. Data re-coding and adjustments Dates used for data presentation HIV and AIDS data are presented in this report by date of diagnosis. If countries could not provide this date or preferred to present their data by the date of statistics to avoid discrepancies with their national surveillance reports, this date was used instead. This was the case for eight countries: Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Turkey, Tajikistan and Ukraine. Region of origin Where available, countries were encouraged to provide data on the specific country of origin or nationality of the case. This information was used first and, if absent, the variable “region of origin” was used to group cases into region of origin, presented in Table 11 (stratified by reporting country) and Table 12 (all countries stratified by mode of transmission). Origin of reported cases Cases originating from countries outside of the report- ing country, including those from outside of Europe or from countries with generalized HIV epidemics, are occasionally separated from other cases for the analy- ses presented here. This approach has been taken to inform epidemiological understanding and guide public health resource allocation and prevention efforts. To compare the impact of the epidemic on all transmission modes, cases reported as originating from regions or countries of sub-Saharan Africa were used as a proxy for countries with generalized HIV epidemics (in Tables 11, 12 and in selected figures). As most of the cases origi- nating from sub-Saharan Africa were reported from west European countries within the EU/EEA, this information is presented in detail in Chapter 1. Reporting delay Reporting delays refer to the time delay between HIV/ AIDS diagnosis and the report of this event at national level, identified by date of notification. Due to delays in reporting, HIV trends analysed at European level are often biased downwards for the most recent year (2017) and, to a lesser extent, for the two to three years prior to the reporting period. To provide a more precise pic- ture of trends, surveillance data should be corrected to describe the trends in HIV diagnoses more accurately. This report applies a statistical approach, as described by Heisterkamp et al. (3) and adapted by Rosinska et al. (4), to adjust the surveillance data for reporting delays. Annual reporting delay probabilities were estimated using historical data from 2006 to 2016. Countries were excluded from reporting delay adjustment when: • they showed an inconsistent and non-stationary pat- tern in their reporting delay distribution during the period 2008–2017; or • they reported aggregated data during the period 2008–2017. Adjusting for reporting delay can help to indicate HIV trends in recent years more precisely. Adjustments also provide insight into the timeliness of data collection and reporting from subnational to national and European levels. Adjustment for reporting delays was applied to the graphs showing trends where noted. The list of coun- tries with the number of reported diagnoses adjusted for reporting delay are presented in Annex 6. Data presentation Geographical presentation Data are presented for the WHO European Region and the EU/EEA. The EU comprises 28 Member States and the EEA comprises an additional three countries (Iceland, Liechtenstein and Norway) which are included in the overview of the EU/EEA. The tables are presented for EU/EEA countries, non- EU/EEA countries and as totals. The 53 countries of the WHO European Region are also subdivided into three geographical areas, based on epidemiological consid- erations and in accordance with the division used in previous reports on HIV/AIDS surveillance in Europe: West (23 countries), Centre (15 countries) and East (15 countries) (Fig. A1.1). The division reflects similarities in epidemiological dynamics such as epidemic levels, trends over time and transmission patterns. Of the EU/EEA countries, 19 Member States are classified as being in the West, nine in the Centre and three in the East. Liechtenstein is not a WHO Member State so its data are included in the totals for the EU/EEA but not for the WHO European Region. Totals for West, Centre and East there- fore may not always equal the EU/EEA and non-EU/EEA totals. Data from Serbia include HIV cases notified in Kosovo1 in all figures while these are stratified in tables to allow separate epidemiological presentation of the reported data. Population data and rates Data are presented in absolute numbers and rates as cases per 100 000 population. The population estimates up to 2017 were derived from Eurostat for all EU/EEA countries and from the United Nations Population Division for non-EU/EEA countries (5). 1 For the purposes of this publication, all references, including in the bibliography, to “Kosovo” should be understood/read as “Kosovo (in accordance with Security Council resolution 1244 (1999))”. 113 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT The Eurostat data are from 10 August 2017 (6) and the United Nations population data from August 2017. The population data used for HIV and AIDS in Spain and for HIV in Italy were adjusted according to the extent of subnational coverage for the relevant years. The popula- tion data used for Ukraine were adjusted to exclude the areas from which no surveillance data were reported in 2014–2017 (7). Rates for data presented by gender and age were cal- culated using relevant male and female population denominators from the sources described above. For maps presenting figures for men who have sex with men, rates were calculated using the male population. Data are presented by year but also as cumulative totals per country. The cumulative total includes all data reported by that particular country since the beginning of national reporting and is not limited to the selected number of years presented. Trend data Only countries reporting consistently were included for presentation of the overall trends; these are noted in the footnotes to the trend graphs. When presenting HIV trends for 2008–2017 by trans- mission mode, countries reporting transmission mode inconsistently or incompletely (such as Estonia, Poland and Turkey) were excluded from relevant figures report- ing trends by transmission mode. Countries with varying geographic coverage of the national surveillance system over time (Spain and Italy) or that did not report for part of the period (Germany) were also excluded from graphs showing HIV trends. When presenting trends for AIDS deaths, only countries reporting consistently were included (Belgium, Germany, Italy, the Russian Federation, Sweden, Turkmenistan, Ukraine and Uzbekistan were not included in the pres- entation of trends for AIDS deaths in Table 25 or the description in the text). Andorra Luxembourg Malta Monaco San Marino West Centre East Fig. A1.1. Geographical/epidemiological division of the WHO European Region The countries covered by the report are grouped as follows: • West, 23 countries: Andorra, Austria,a Belgium,a Denmark,a Finland,a France,a Germany,a Greece,a Iceland, Ireland,a Israel, Italy,a Luxembourg,a Malta,a Monaco, Netherlands,a Norway, Portugal,a San Marino, Spain,a Sweden,a Switzerland, United Kingdom.a • Centre, 15 countries: Albania, Bosnia and Herzegovina, Bulgaria,a Croatia,a Cyprus,a Czech Republic,a Hungary,a Montenegro, Poland,a Romania,a Serbia, Slovakia,a Slovenia,a the former Yugoslav Republic of Macedonia, Turkey. • East, 15 countries: Armenia, Azerbaijan, Belarus, Estonia,a Georgia, Kazakhstan, Kyrgyzstan, Latvia,a Lithuania,a Republic of Moldova, Russian Federation, Tajikistan, Turkmenistan, Ukraine, Uzbekistan. a Countries constituting the European Union as of 1 July 2014. 114 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Data limitations Surveillance systems are not identical across Europe, and differences in testing policies and data-collection methods could affect the results and introduce bias into comparisons between countries. Factors such as under- reporting and reporting delay may influence the country figures and rankings presented in the report. The data in the report are to be considered as provisional because they are subject to regular updates (such as detection and deletion of duplicate cases, and inclusion of new information about cases already reported). The limitations described below, the country comments in Annex 5 and the information on HIV and AIDS case report- ing systems available in Annex 4 and 5 should be taken into account when interpreting the data presented here. Official reports of newly diagnosed HIV cases do not represent true incidence. Newly reported HIV diagnoses include recently infected individuals as well as those who were infected several years ago but only recently tested for HIV. These reports are also influenced by several factors, such as the uptake of HIV testing, pat- terns of reporting, the long incubation period and a slow progression of the disease. To better interpret trends in HIV case-reporting data, the total numbers of HIV tests performed annually for diagnostic purposes (excluding unlinked anonymous tests and screening of blood dona- tions) are presented to help provide some background on HIV testing patterns. Although the table in Annex 6 adjusts for reporting delay for those countries where this is possible, no overall regional adjustments are made for underreporting or under-ascertainment bias. Few European countries have evaluated their surveillance systems for underreport- ing and published the results (8,9). Previous estimates of underreporting range from 0% to 25% for AIDS cases (8), while national estimates of underreporting for HIV can range from 10% (Iceland and Italy) to around 40% (Germany and the UK) (9) (Françoise  Cazein, Santé publique France, personal communication to ECDC, 8 November 2012). Estimates on the underreporting of AIDS-related deaths are not available, but according to a country survey from 2006, only about a third of coun- tries were able to link HIV and AIDS surveillance death registries with national statistics or death certificate information, which results in underreporting of AIDS- related deaths (8). References 1. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva: World Health Organization; 2007 (http://www.who.int/hiv/pub/vct/hivstaging/en/index.html). 2. Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. OJ L 27.09.12:6–7 (http://eur-lex.europa.eu/LexUriServ/LexUriServ.do? uri=CONSLEG:2002D0253:20120927:EN:PDF). 3. Heisterkmap SH, Jager JC, Ruitenberg EJ, van Druten JAM, Downs AM. Correcting reported Aids incidence: a statistical approach. Stat Med. 1989;8:963–76. 4. Rosinska M, Pantazis N, Janiec J, Pharris A, Amato-Gauci AJ, Quinten C et al. Potential adjustment methodology for missing data and reporting delay in the HIV Surveillance System, European Union/ European Economic Area, 2015.  Euro Surveill.  2018;23(23):pii=170 0359 (https://doi.org/10.2807/1560-7917.ES.2018.23.23.1700359). 5. World population prospects: the 2017 revision, DVD Edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017. 6. Eurostat [online database]. Brussels: Eurostat; undated (http:// ec.europa.eu/eurostat/data/database). 7. Total resident population. In: State Statistics Service of Ukraine documents publishing [online database]. Kyiv: State Statistics Service of Ukraine; 2018 (https://ukrstat.org/en/operativ/opera- tiv2007/ds/nas_rik/nas_e/nas_rik_e.html). 8. EuroHIV. Completeness of AIDS case reporting in Europe. HIV/AIDS surveillance in Europe, quarterly report 1996. Paris: Institut de médecine et d’épidémiologie africaines; 1996:30–3. 9. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire; 2007 (http://invs.santepubliquefrance.fr/publications/2007/ eurohiv_2006/HIV_AIDS_Web.pdf). 115 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Annex 2 Completeness of variables for data reported in 2016 and 2017 2016 2017 Number of countries Completeness % Minimal Maximal Number of countries Completeness % Minimal Maximal EU/EEA Countries Age 31 99.7 86.0 100.0 29 99.6 74.9 100.0 Gender 31 99.6 84.2 100.0 29 99.4 74.4 100.0 Date of diagnosis 31 100.0 100.0 100.0 29 100.0 100.0 100.0 Date of notification 29 84.8 80.9 100.0 27 84.1 80.2 100.0 Transmission 31 79.1 41.7 100.0 29 75.8 33.5 100.0 Date of AIDS diagnosis 29 30.4 2.5 100.0 26 24.9 3.3 83.2 Date of death 25 1.7 0.4 100.0 23 1.5 0.4 8.0 Country of birth 25 58.0 2.3 100.0 23 52.1 34.7 100.0 Region of origin 25 81.4 59.6 100.0 24 77.5 50.2 100.0 CD4 cell counta 26 64.6 22.9 97.4 25 66.3 35.6 96.7 Probable country of infection 24 31.8 2.8 100.0 23 33.8 0.2 99.2 WHO European Region Age 52 99.8 50.0 100.0 51 99.8 74.9 100.0 Gender 52 99.8 84.2 100.0 51 99.7 74.4 100.0 Date of diagnosis 52 100.0 100.0 100.0 51 100.0 100.0 100.0 Date of notification 49 91.9 80.9 100.0 48 92.7 80.2 100.0 Transmission 51 85.2 41.7 100.0 50 84.6 33.5 100.0 Date of AIDS 47 28.0 2.5 100.0 44 25.3 3.2 100.0 Date of death 43 9.3 0.4 100.0 40 5.1 0.4 99.3 Country of birth 43 52.1 2.3 100.0 41 47.8 34.7 100.0 Region of origin 45 89.4 50.0 100.0 43 88.6 50.2 100.0 CD4 cell counta 46 67.8 4.3 97.4 42 67.2 33.3 100.0 Probable country of infection 36 32.0 2.8 100.0 38 35.6 0.2 100.0 a CD4 completeness is calculated on all new diagnoses; Table 14 (see Tables section) completeness calculations are restricted to new diagnoses in countries reporting the variables CD4Cells or FirstCD4Count. 116 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Annex 3 Completeness by country and variable, 2017 Area Country, territory or areaa Date of diagnosis Date of notification Age Gender Transmission CD4 cell count Country of birth b EU/EEA West Austria 100.0 100.0 100.0 100.0 92.6 96.7 99.6 West Belgium 100.0 100.0 99.7 100.0 71.0 67.8 77.0 Centre Bulgaria 100.0 100.0 100.0 100.0 100.0 77.2 100.0 Centre Croatia 100.0 100.0 100.0 100.0 99.1 96.2 100.0 Centre Cyprus 100.0 100.0 100.0 100.0 96.5 88.2 100.0 Centre Czech Republic 100.0 100.0 100.0 100.0 97.2 90.9 100.0 West Denmark 100.0 100.0 100.0 100.0 94.2 54.1 100.0 East Estonia 100.0 100.0 100.0 100.0 54.3 35.6 50.2 West Finland 100.0 100.0 100.0 100.0 72.2 79.1 89.2 West France 100.0 100.0 100.0 100.0 52.6 45.7 56.6 West Germany – – – – – – – West Greece 100.0 99.5 100.0 100.0 82.5 68.8 97.8 Centre Hungary 100.0 100.0 74.9 99.7 60.5 0.0 0.0 West Iceland 100.0 100.0 100.0 100.0 37.5 0.0 100.0 West Ireland 100.0 100.0 100.0 100.0 84.1 64.2 81.4 West Italy 100.0 80.2 100.0 100.0 87.5 78.7 99.6 East Latvia 100.0 100.0 100.0 100.0 63.6 57.7 99.5 Liechtenstein – – – – – – – East Lithuania 100.0 100.0 100.0 100.0 83.7 39.9 100.0 West Luxembourg 100.0 100.0 100.0 100.0 91.5 78.0 100.0 West Malta 100.0 100.0 93.3 100.0 88.9 73.3 100.0 West Netherlands 100.0 100.0 100.0 100.0 89.2 89.0 95.7 West Norway 100.0 100.0 100.0 100.0 99.5 0.0 93.4 Centre Poland 100.0 100.0 97.4 100.0 33.5 0.0 61.9 West Portugal 100.0 100.0 100.0 100.0 96.0 84.7 96.8 Centre Romania 100.0 100.0 100.0 100.0 99.8 94.3 99.2 Centre Slovakia 100.0 100.0 100.0 100.0 92.9 82.9 100.0 Centre Slovenia 100.0 100.0 100.0 100.0 92.3 84.6 92.3 West Spain 100.0 0.0 100.0 100.0 85.9 84.0 96.5 West Sweden 100.0 100.0 100.0 100.0 87.1 77.6 97.5 West United Kingdom 100.0 100.0 100.0 100.0 82.3 79.5 88.2 Non-EU/EEA Centre Albania 100.0 100.0 100.0 100.0 100.0 61.7 100.0 West Andorra 100.0 100.0 – – – – – East Armenia 100.0 100.0 100.0 100.0 96.3 80.5 100.0 East Azerbaijan 100.0 100.0 100.0 100.0 82.3 41.4 100.0 East Belarus 100.0 100.0 100.0 100.0 98.8 0.0 100.0 Centre Bosnia and Herzegovina 100.0 100.0 100.0 100.0 100.0 33.3 100.0 East Georgia 100.0 100.0 99.8 100.0 99.4 87.0 100.0 West Israel 100.0 100.0 99.5 100.0 86.4 57.5 100.0 East Kazakhstan 100.0 100.0 100.0 100.0 97.5 74.3 100.0 East Kyrgyzstan 100.0 100.0 100.0 100.0 91.4 44.0 100.0 West Monaco – – – – – – – Centre Montenegro 100.0 100.0 100.0 100.0 100.0 100.0 100.0 East Republic of Moldova 100.0 100.0 100.0 100.0 76.9 77.5 100.0 East Russian Federation – – – – – – – West San Marino – – – – – – – Centre Serbia 100.0 100.0 100.0 100.0 84.5 69.1 100.0 Centre Serbia excluding Kosovoc 100.0 100.0 100.0 100.0 84.8 69.1 100.0 Centre Kosovoc – – – – – – – West Switzerland 100.0 100.0 99.6 100.0 73.1 68.4 81.0 East Tajikistan 100.0 100.0 100.0 100.0 91.0 85.3 100.0 Centre The former Yugoslav Republic of Macedonia 100.0 100.0 97.7 100.0 95.5 77.3 100.0 Centre Turkey 100.0 100.0 100.0 100.0 46.0 0.0 97.1 East Turkmenistan – – – – – – – East Ukraine 100.0 100.0 100.0 100.0 99.8 89.2 100.0 East Uzbekistan – – – – – – – a Completeness not computed on countries, territories or areas with fewer than five diagnoses reported in 2017 (Liechtenstein, Monaco and San Marino, and Kosovoc). b Completeness provided is based on country of birth, region of origin or, for Italy and Switzerland, country of nationality. c (in accordance with Security Council resolution 1244 (1999)). 117 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Annex 4a HIV surveillance system overview: data source information Country HIV data source Recorda type for 2017 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-HIV HIVAIDS 1980–2017 V Co Belgium BE-HIV/AIDS HIVAIDS 1978–2017 V Co Bulgaria BG-HIV HIVAIDS 1986–2017 C Co HIV aggregate record type used through 2006; HIV record type 2007–2013 Cyprus CY-HIV/AIDS HIVAIDS 1986–2017 C Co Croatia HR-CNIPH HIVAIDS 1985–2017 C Co HIV record type used prior to 2016 Czech Republic CZ-HIV/AIDS HIVAIDS 1985–2017 C Co Denmark DK-HIV HIVAIDS 1990–2017 C Co HIV record type used 1990–2013 Estonia EE-NAKIS HIVAIDS 1988–2017 C Co Data source EE-HIV used 1988–2012; HIV aggregate record type used through 2006; HIV record type prior to 2015 Finland FI-NIDR HIVAIDS 1980–2017 C Co HIV record type used prior to 2016 France FR-HIVAIDS HIVAIDS 2003–2017 C Co Although compulsory, HIV diagnoses are not exhaustively reported; underreporting was estimated at 30% in 2014 Germany DE-SURVNET@RKI7.3-HIV 1993–2016 C Co Data source DE-HIV-Pre-IfSG used 1993–2001; HIV recordtype used to report data up to 2016 Greece EL-HIV/AIDS HIVAIDS 1981–2017 C Co Hungary HU-HIV/AIDS HIVAIDS 1985–2017 C Co Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1983–2017 C Co HIV record type used prior to 2017 Ireland IE-CIDR HIVAIDS 1981–2017 C Co Data source IE-HIV/AIDS used for years 1981–2011; HIV aggregate used for reporting through 2002; HIV record type 2003–2011 Italy IT-COA-ISS HIV 2004–2017 C Co See country comments about historical coverage; HIV aggregate record type used through 2009 Latvia LV-HIV/AIDS HIVAIDS 1987–2017 C Co HIV record type used 1987–2013; HIVAIDS record type used from 2014 Liechtenstein CH-SFOPH-LI HIV 1985–2017 V NS/unk Cases reported through Switzerland's surveillance system using another data source Lithuania LT-AIDS_CENTRE HIVAIDS 1988–2017 C Co Luxembourg LU-HIVAIDS HIVAIDS 1983–2017 V Co Malta MT-DISEASE_SURVEILLANCE HIVAIDS 1986–2017 C Co HIV record type used in years 1986–2014 Netherlands NL-HIV/AIDS HIVAIDS 1980–2017 V Co Norway NO-MSIS_B HIVAIDS 1980–2017 C Co HIV record type used in years 1980–2013 Poland PL-HIV HIVAIDS 1984–2017 C Co Portugal PT-HIVAIDS HIVAIDS 1983–2017 C Co Romania RO-RSS HIVAIDS 1985–2017 C Co Slovakia SK-EPIS HIVAIDS 1985–2017 C Co HIV record type used in years 1985–2013 Slovenia SI-HIVAIDS HIVAIDS 1985–2017 C Co Spain ES-HIV HIV 2003–2017 C Co See country comments about historical coverage Sweden SE-SmiNet HIVAIDS 1983–2017 C Co Data source SE-SweHIVReg used 1983–2009; HIV record type used prior to 2014 United Kingdom UK-HIVAIDS HIVAIDS 1981–2017 V Co Non-EU/EEA Albania AL-NIoPH HIVAIDS 1993–2017 C Co Andorra AD-MoHWFH HIVAIDS 2004–2017 V Co Armenia AM-NAC HIVAIDS 1988–2017 V Co Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1987–2017 V Se Belarus BY-NAC HIVAIDS 1981–2017 C Co HIVAIDS record type used only for HIV reporting (no linked HIV and AIDS reporting); HIV record type used in years 1981–2013 Bosnia and Herzegovina BA-FMoH-MoHSWRS HIVAIDS 1986–2017 C Co HIV record type used in years 1993–2013 Georgia GE-IDACIRC HIVAIDS 1989–2017 C Co Israel IL-MOH HIVAIDS 1981–2017 C Co Kazakhstan KZ-RCfAPC HIVAIDS 1987–2017 NS/ unk NS/unk Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1987–2017 V Co HIV record type used in years 1987–2000 Montenegro ME-IOPH HIVAIDS 1989–2017 C Co Monaco MC-MoSH-GEN HIV 1985–2017 C Co Republic of Moldova MD-NAC HIVAIDS 1987–2017 V Other Russian Federation RU-MOH - 2010 C Co San Marino SM-AIDS/HIV HIVAGGR 1985–2017 C Co Serbiad RS-NAC HIVAIDS 1984–2017 C Co HIV aggregate record type used in years 1984–2001 Switzerland CH-FOPH HIV 1985–2017 C Co Tajikistan TJ-RHAC HIVAIDS 1991–2017 C Co The former Yugoslav Republic of Macedonia MK-NHASS HIVAIDS 1993–2017 C Co HIV record type used in years 1993–2016 Turkey TR-MOH HIV 1984–2017 C Co Turkmenistan TM-NAC - 1981–2012 V Co Ukraine UA-NAC HIVAIDS 1987–2017 V Other HIVAIDS record type used only for HIV reporting (no linked HIV and AIDS reporting); HIVAGGR record type used in years 1987–2015. Uzbekistan UZ-RAC - 1981–2010 V Co Did not report data 2011–2017; used HIV record type in years 1981–2010 a Type: HIVAIDS (HIV and AIDS joined case-based record type); HIV (HIV case-based record type); AIDS (AIDS case-based record type); HIVAGGR (HIV aggregate record type); AIDSAGGR (AIDS aggregate record type). b Legal: voluntary reporting (V); compulsory reporting (C); not-specified/unknown (NS/unk). c Coverage: sentinel system (Se); comprehensive (Co); not-specified/unknown (NS/unk). d HIV data from Kosovo (in accordance with Security Council resolution 1244 (1999)) were reported through data source XK-HIVAIDS for 1986–2017; HIVAIDS record type used for all years. 118 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Annex 4b AIDS surveillance system overview: data source information Country HIV data source Recorda type for 2017 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-AIDS HIVAIDS 1980-2017 V Co Belgium BE-HIV/AIDS 1978-2015 V Co Did not report 2016 or 2017 data Bulgaria BG-AIDS HIVAIDS 1986-2017 C Co AIDS record type was used for cases prior to 2014 Cyprus CY-HIV/AIDS HIVAIDS 1986-2017 C Co Croatia HR-CNIPH HIVAIDS 1985-2017 C Co AIDS record type used prior to 2016 Czech Republic CZ-HIV/AIDS HIVAIDS 1985-2017 C Co Denmark DK-HIV HIVAIDS 1980-2017 C Co AIDS record type from data source DK-MIS used 1980-2013 Estonia EE-NAKIS HIVAIDS 1988-2017 C Co AIDS record type used prior to 2015 Finland FI-NIDR AIDS 1980-2017 C Co AIDS record type used prior to 2016 France FR-HIVAIDS; FR-AIDS HIVAIDS 2003-2017 C Co Additional data from record type AIDS used for the years 1978-2016 Although compulsory, AIDS diagnoses are not exhaustively reported. Underreporting was estimated 41% in 2007-2009 Germany DE-AIDS 1970-2016 V Co Did not report 2017 data, AIDS record type used through 2016 Greece EL-HIV/AIDS HIVAIDS 1981-2017 C Co Hungary HU-HIV/AIDS HIVAIDS 1985-2017 C Co Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1983-2017 C Co Ireland IE-CIDR HIVAIDS 1981-2017 V Co Data source IE-HIV/AIDS and AIDS record type used for years 1981-2011 Italy IT-COA-ISS AIDS 1982-2017 C Co Latvia LV-AIDS HIVAIDS 1990-2017 C Co Same data source in AIDS record type used for 1990-2013 Liechtenstein CH-SFOPH-LI AIDS 1985-2017 V NS/unk Cases reported through Switzerland's surveillance system Lithuania LT-AIDS_CENTRE HIVAIDS 1988-2017 C Co Luxembourg LU-HIVAIDS HIVAIDS 1983-2017 V Co Malta MT-DISEASE_SURVEILLANCE HIVAIDS 1986-2017 C Co Same data source and AIDS record type used 1986-2014 Netherlands NL-HIV/AIDS HIVAIDS 1980-2017 V Co Norway NO-MSIS_B HIVAIDS 1980-2017 C Co Data source NO-MSIS-A and record type AIDS used in years 1980-2013 Poland PL-HIV HIVAIDS 1984-2017 C Co Portugal PT-HIVAIDS HIVAIDS 1983-2017 C Co Romania RO-RSS HIVAIDS 1985-2017 C Co Slovakia SK-EPIS HIVAIDS 1985-2017 C Co AIDS record type used in years 1985-2013 Slovenia SI-HIVAIDS HIVAIDS 1985-2017 C Co Spain ES-AIDS AIDS 1981-2017 C Co See country comments about coverage Sweden 1983-2007 V Co AIDS surveillance discontinued in 2008 United Kingdom UK-HIVAIDS HIVAIDS 1981-2017 V Co Non-EU/EEA Albania AL-NIoPH HIVAIDS 1993-2017 C Co Andorra AD-MoHWFH HIVAIDS 2004-2017 V Co Armenia AM-NAC HIVAIDS 1988-2017 V Se Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1995-2017 V Co Belarus BY-NAC AIDS 1991-2017 C Co Bosnia and Herzegovina BA-FMoH-MoHSWRS HIVAIDS 1986-2017 C Co AIDS record type used in years 1986–2013 Georgia GE-IDACIRC HIVAIDS 1989-2017 C Co Israel IL-MOH HIVAIDS 1981-2017 C Co Kazakhstan KZ-RCfAPC HIVAIDS 1993-2017 NS NS Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1999-2017 V Co AIDS record type used in years 1987-2000 Montenegro ME-IOPH HIVAIDS 1990-2017 C Co Monaco MC-MoSH-GEN HIV 1985-2017 C Co Republic of Moldova MD-NAC HIVAIDS 1989-2017 V Co Russian Federation - - - - - San Marino SM-AIDS/HIV AIDS 1986-2017 C Co Serbiad RS-NAC HIVAIDS 1985-2017 C Co AIDS record type used in years 1985-2001 Switzerland CH-FOPH AIDS 1980-2017 C Co Tajikistan TJ-RHAC HIVAIDS 1998-2017 C Co The former Yugoslav Republic of Macedonia MK-NHASS HIVAIDS 1989-2017 C Co AIDS record type used in years 1993–2016 Turkey TR-MOH AIDS 1985-2017 C Co Turkmenistan TM-NAC - 2002-2012 V Co Ukraine UA-NAC AIDSAGGR 1988-2017 V Co HIVAIDS record type used only for HIV reporting (i.e. no linked HIV and AIDS reporting). Uzbekistan UZ-RAC - 1992-2010 V Co Did not report data 2011-2017; used AIDS record type in years 1992-2010 a Type: HIVAIDS (HIV and AIDS joined case-based record type); HIV (HIV case-based record type); AIDS (AIDS case-based record type); HIVAGGR (HIV aggregate record type); AIDSAGGR (AIDS aggregate record type). b Legal: voluntary reporting (V); compulsory reporting (C); not-specified/unknown (NS/unk). c Coverage: sentinel system (Se); comprehensive (Co); not-specified/unknown (NS/unk). d HIV data from Kosovo (in accordance with Security Council resolution 1244 (1999)) were reported through data source XK-HIVAIDS for 1986–2017; HIVAIDS record type used for all years. 119 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Annex 5 Country-specific comments regarding national HIV and AIDS reporting Country Comments EU/EEA Austria Belgium Due to a temporary data merger issue, information on AIDS diagnoses for 2016 and 2017 were not available but will be reported to TESSy in the future. Bulgaria Case-based reporting of HIV is available from 2007 onwards. Croatia Cyprus Population rates presented in this report may differ slightly from rates presented in the national report due to the use of different Eurostat population extracts. Czech Republic Foreigners with short-term stays in the Czech Republic are not included in cases notified. Denmark Estonia The surveillance system was modified substantially in 2008. Previously, the probable mode of HIV transmission was not reported by Estonia (from 2003 to 2007, Estonia supplied partial information on people who inject drugs only). Finland France Case-based data reported through TESSy are not exhaustive because of reporting delays (cases reported several months or years after the diagnosis) and underreporting (cases that are diagnosed but never reported). The most recent estimates of underreporting in France are 41% in 2007–2009 for AIDS and 30% in 2015 for HIV. To assess the real numbers and trends of HIV and AIDS diagnoses in France, it is essential to use adjusted data, which take into account reporting delays, underreporting and missing data (incomplete reports). Adjusted data for 2017 was not available at the time of the production of this report. The French HIV/AIDS reporting system was changed in 2016 to report AIDS and HIV diagnoses online, and physicians should report HIV diagnoses spontaneously, without waiting for the laboratory report. The use of this new tool by laboratories and physicians has increased over time, but clinicians are less compliant than laboratories. In 2016–2017, thererfore, the proportion of missing data on variables (such as route of transmission) is increased. Germany Due to technical problems, no data export for 2017 HIV or AIDS data was possible. These data will be reported when available and included in future reports. Greece Hungary Iceland Ireland HIV was made a notifiable disease in September 2011. The HIV reporting system was modified substantially in 2012. AIDS cases and deaths among AIDS cases are now only reported if at the time of HIV diagnosis. HIV diagnoses include a growing proportion of "previous-positive" people, who are transferring their HIV care when moving to Ireland and tested positive and notified within the Irish system when moving to the country. There was a change in the implementation of the case definition in 2015 (requiring confirmatory testing on a single sample rather than two samples) which resulted in more people being notified to the surveillance system. Italy New HIV diagnoses were reported by 10 of the 21 Italian regions between 2004 and 2006, 11 regions in 2007, 12 in 2008, 18 in 2009, and all of the 21 regions of Italy since 2012. Between 2004 and 2011, population denominators are based on the annual resident population in the regions reporting cases. From 2012, the coverage of the surveillance system is national, so the total Italian population is used as a denominator. AIDS deaths are not reported after 2014 due to lack of updated data from the national mortality register. Latvia Population rates presented in this report may differ slightly from rates presented in the national report due to the use of different Eurostat population extracts. Liechtenstein Liechtenstein, with only 35 000 inhabitants, has small numbers of communicable diseases. Public health authorities therefore refrain from collecting data due limited public health added value. In 1970, Liechtenstein adopted the Swiss Law of Epidemiology. Since then, all communicable disease data are reported to officials in Switzerland, as demanded by the Federal Office of Public Health. These data are reported through Switzerland to TESSy but may not represent all cases diagnosed in Liechtenstein. Lithuania Luxembourg HIV tests reported through 2010 include only tests performed at two major public laboratories, so underestimate the total number of HIV tests performed during those years. From 2011, tests reported include all laboratories in the country. Malta A new HIV reporting system started in 2004. Netherlands HIV surveillance is based on the ATHENA cohort, which includes 98% of people who entered HIV care in the Netherlands. Data collection started from 1996 onwards and HIV diagnoses before 1996 are incomplete. Norway Poland Portugal The PT-HIV database is now fully case-based, containing details of cases diagnosed from 1983. In 2013 and 2014, the Portuguese HIV/AIDS programme implemented a strategy to address underreporting and reporting delay, resulting in significant increases of the number of reported cases diagnosed between 1983 and 2012. Romania Slovakia Slovenia Spain HIV reporting has existed since the 1980s in some of the 19 Autonomous Regions of Spain. For 2003–2011, data are available only for nine regions: Asturias, Balearic Islands, Basque Country, Canary Islands, Catalonia, Ceuta, Extremadura, La Rioja and Navarre. Since 2004, data are available for 10 regions (+ Galicia). Since 2007, data are available for 11 regions (+Madrid). Since 2008, data are available for 14 regions (+ Aragón, Castilla-La Mancha and Melilla). Since 2009, data are available for 17 regions (+ Cantabria, Castilla-León and Murcia). Since 2012, data are available for 18 regions (+Valencia). Since 2013, data are available for all the 19 regions of Spain (+ Andalucía). Rates are based on the corresponding populations for each year. It has not been possible to include data from several regions for AIDS reporting in 2014–2017, so rates for those years are based on the corresponding population. Sweden Due to changes in the HIV/AIDS surveillance system, AIDS reporting has not been mandatory since 2000. Since 2008, AIDS data are not reported from Sweden because the national AIDS surveillance system had been discontinued. United Kingdom The United Kingdom has moved toward surveillance of AIDS within three months of HIV diagnoses. As a result, the AIDS figures provided from 2015 are likely to be lower than those previously reported. 120 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Country-specific comments regarding national HIV and AIDS reporting (contd) Country Comments Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus All data are presented by "date of statistics" (instead of "date of diagnosis"). Bosnia and Herzegovina Georgia Data for 2016 are presented by "date of statistics" (instead of "date of diagnosis"). Israel Kazakhstan Kyrgyzstan Monaco Montenegro Republic of Moldova Russian Federation San Marino Serbia Data on HIV tests refer to the number of people tested and do not include people tested in the reference laboratory or private laboratories. Switzerland Tajikistan The former Yugoslav Republic of Macedonia AIDS cases include only people diagnosed with AIDS at the time of HIV diagnosis. Turkey Reported HIV cases exclude people diagnosed with AIDS at the time of HIV diagnosis. Reported AIDS cases only include people diagnosed with AIDS at the time of HIV diagnosis. Table 14 (see Tables section): CD4 cell count data exclude people diagnosed with AIDS at the time of HIV diagnosis. All data are presented by "date of statistics" (instead of "date of diagnosis"). Turkmenistan Ukraine All data are presented by “date of statistics” (instead of “date of diagnosis”). Data reported from Ukraine exclude data from Crimea and Sevastopol City for 2014–2017 and parts of the non-government controlled areas for 2015–2017; corresponding population denominators were used to compute rates. Table 7 (see Tables section): mother-to-child transmission cases for 2016–2017 are provisional and may be adjusted in the coming few years. Uzbekistan 121 HIV/AIDS surveillance in Europe 2018 – 2017 dataSURVEILLANCE REPORT Annex 6 New HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients,a 2014–2017 Country, territory or areab 2014 2015 2016 2017 Adjustment coefficientsN Rate N Rate N Rate N Rate 2014 2015 2016 2017 EU/EEA Austria 287 3.4 317 3.7 298 3.4 316 3.6 1.03 1.06 1.11 1.17 Belgium 1 055 9.4 1 015 9.0 908 8.0 890 7.9 1.00 1.00 1.00 1.00 Bulgaria 247 3.4 227 3.2 202 2.8 241 3.4 1.00 1.00 1.00 1.00 Croatia 92 2.2 117 2.8 109 2.6 106 2.5 1.00 1.00 1.00 1.00 Cyprus 56 6.5 80 9.4 80 9.4 85 10.1 1.00 1.00 1.00 1.01 Czech Republic 232 2.2 266 2.5 286 2.7 254 2.4 1.00 1.00 1.00 1.00 Denmark 256 4.5 277 4.9 244 4.3 244 4.3 1.00 1.00 1.00 1.01 Estonia 291 22.1 270 20.5 229 17.4 219 16.6 1.00 1.00 1.00 1.00 Finland 181 3.3 174 3.2 180 3.3 159 2.9 1.00 1.00 1.00 1.01 Francec 5 683 8.6 5 285 7.9 5 439 8.1 5 442 8.2 1.00 1.00 1.00 1.04 Germany 3 501 4.3 3 699 4.6 3 427 4.2 – – 1.00 1.00 1.00 – Greece 793 7.3 799 7.4 667 6.2 659 6.1 1.02 1.03 1.04 1.05 Hungary 271 2.7 271 2.7 228 2.3 223 2.3 1.00 1.00 1.00 1.00 Iceland 11 3.4 12 3.6 28 8.4 24 7.2 1.00 1.00 1.00 1.00 Ireland 377 8.2 483 10.4 510 10.8 483 10.2 1.00 1.00 1.00 1.00 Italy 3 853 6.3 3 633 6.0 3 717 6.1 3 704 6.1 1.01 1.01 1.02 1.08 Latvia 347 17.3 393 19.8 365 18.5 371 19.0 1.00 1.00 1.00 1.01 Liechtenstein 1 2.7 0 0.0 2 5.3 0 0.0 1.00 1.00 1.00 1.00 Lithuania 141 4.8 157 5.4 214 7.4 263 9.1 1.00 1.00 1.00 1.00 Luxembourg 119 21.7 92 16.3 103 17.9 96 16.7 1.44 1.37 1.45 1.63 Malta 40 9.4 61 14.2 63 14.5 45 10.4 1.00 1.00 1.00 1.00 Netherlands 945 5.6 938 5.5 835 4.9 791 4.7 1.01 1.02 1.05 1.11 Norway 267 5.2 221 4.3 220 4.2 223 4.3 1.00 1.00 1.00 1.04 Poland 1 132 3.0 1 278 3.4 1 318 3.5 1 402 3.7 1.00 1.00 1.00 1.06 Portugal 1 431 13.7 1 497 14.4 1 553 15.0 1 470 14.2 1.08 1.12 1.18 1.38 Romania 855 4.3 821 4.1 705 3.6 661 3.3 1.00 1.00 1.00 1.00 Slovakia 86 1.6 86 1.6 88 1.6 70 1.3 1.00 1.00 1.00 1.18 Slovenia 51 2.5 50 2.4 57 2.8 39 1.9 1.00 1.00 1.00 1.00 Spain 4 396 9.5 4 181 9.0 3 963 8.5 3 249 7.0 1.00 1.00 1.00 1.00 Sweden 473 4.9 447 4.6 429 4.4 434 4.4 1.00 1.00 1.00 1.00 United Kingdom 6 185 9.6 6 043 9.3 5 280 8.1 4 363 6.7 1.00 1.00 1.00 1.00 Total EU/EEA 33 739 6.6 33 307 6.5 31 934 6.2 27 055 6.2 1.01 1.01 1.02 1.07 Non-EU/EEA Albania 79 2.7 96 3.3 127 4.3 94 3.2 1.00 1.00 1.00 1.00 Andorra 6 7.6 3 3.8 2 2.6 6 7.8 1.00 1.00 1.00 1.00 Armenia 333 11.5 295 10.1 303 10.4 354 12.1 1.00 1.00 1.00 1.00 Azerbaijan 604 6.4 727 7.6 556 5.7 570 5.8 1.00 1.00 1.00 1.00 Belarus 1 811 19.1 2 305 24.3 2 391 25.2 2 468 26.1 1.00 1.00 1.00 1.00 Bosnia and Herzegovina 23 0.6 15 0.4 24 0.7 12 0.3 1.00 1.00 1.00 1.00 Georgia 542 13.6 683 17.3 719 18.3 631 16.1 1.00 1.00 1.00 1.00 Israel 452 5.7 409 5.1 363 4.4 405 4.9 1.00 1.00 1.00 1.00 Kazakhstan 2 342 13.4 2 478 14.0 2 899 16.1 3 019 16.6 1.00 1.00 1.00 1.00 Kyrgyzstan 649 11.2 653 11.1 764 12.8 840 13.9 1.00 1.00 1.00 1.00 Monaco 1 2.6 1 2.6 0 0.0 3 7.8 1.00 1.00 1.00 1.00 Montenegro 20 3.2 19 3.0 34 5.4 26 4.1 1.00 1.00 1.00 1.00 Republic of Moldova 833 20.5 816 20.1 833 20.5 836 20.6 1.00 1.00 1.00 1.00 Russian Federation – – – – – – 1.00 1.00 1.00 1.00 San Marino 3 9.2 2 6.1 2 6.0 1 3.0 1.00 1.00 1.00 1.00 Serbiad 136 1.5 184 2.1 179 2.0 181 2.1 1.00 1.00 1.00 1.00 Serbia excluding Kosovod 130 1.8 181 2.6 168 2.4 178 2.5 1.00 1.00 1.00 1.00 Kosovod 6 0.3 3 0.2 11 0.6 3 0.2 1.00 1.00 1.00 1.00 Switzerland 517 6.3 536 6.4 531 6.3 443 5.2 1.00 1.00 1.00 1.00 Tajikistan 1 009 12.1 1 157 13.5 1 043 11.9 1 208 13.5 1.00 1.00 1.00 1.00 The former Yugoslav Republic of Macedonia 30 1.4 25 1.2 30 1.4 44 2.1 1.00 1.00 1.00 1.00 Turkey 1 838 2.4 2 107 2.7 2 438 3.1 2 844 3.5 1.00 1.00 1.00 1.00 Turkmenistan – – – – – – 1.00 1.00 1.00 1.00 Ukraine 15 796 35.2 13 000 30.4 14 262 33.5 15 680 37.0 1.00 1.00 1.00 1.00 Uzbekistan – – – – – – 1.00 1.00 1.00 1.00 Total non-EU/EEA 27 024 12.4 25 511 11.7 27 500 12.5 29 665 13.4 1.00 1.00 1.00 1.00 WHO European Region West 30 916 7.3 30 242 7.1 28 948 6.8 23 976 6.9 1.01 1.01 1.02 1.07 Centre 5 148 2.7 5 642 2.9 5 905 3.0 6 282 3.2 1.00 1.00 1.00 1.01 East 24 698 21.9 22 934 20.6 24 578 22.0 26 462 23.6 1.00 1.00 1.00 1.00 Total WHO European Region 60 762 8.3 58 818 8.1 59 432 8.1 56 720 8.7 1.01 1.01 1.01 1.03 a The coefficients present the adjustments for the current year of reporting. Number of diagnosed cases for the last four years were adjusted compared to Table 1 (see Tables section) only if the adjusted number of cases for year of diagnosis was higher than the number of cases uploaded for that specific year. b Country-specific comments are in Annex 5. c French data for 2014–2017 are adjusted but not fully according to the national method which includes underreporting. For this reason numbers here may differ from those presented in the national report. d (in accordance with Security Council resolution 1244 (1999)). 122 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2018 – 2017 data Annex 7 HIV/AIDS surveillance in Europe: participating countries and national institutions Country National institutions EU/EEA Austria Federal Ministry of Health, Family and Youth Belgium Scientific Institute of Public Health Bulgaria Ministry of Health Croatia Croatian National Institute of Public Health Cyprus Ministry of Health Czech Republic National Institute of Public Health Denmark Statens Serum Institut Estonia Health Board Finland National Public Health Institute (KTL) France Santé Publique France (French National Public Health Agency) Germany Robert Koch Institute Greece Hellenic Centre for Disease Control and Prevention Hungary National Centre for Epidemiology (Országos Epidemiológiai Központ) Iceland Health Protection Agency Centre for Infections Ireland Health Protection Surveillance Centre (HPSC) Italy Ministry of Health DG Prevention – Unit V Latvia Centre for Disease Prevention and Control of Latvia Liechtenstein Principality of Liechtenstein Lithuania Centre for Communicable Diseases and AIDS Luxembourg National Service of Infectious Diseases, Centre Hospitalier Malta Department of Health Promotion and Disease Prevention Netherlands National Institute for Public Health and the Environment (RIVM) Norway Norwegian Institute of Public Health – Department of Infectious Disease Epidemiology Poland National Institute of Public Health – National Institute of Hygiene (NIZP-PZH) Portugal Directorate-General of Health (Direção-Geral da Saúde) and National Institute of Health Dr Ricardo Jorge (Instituto Nacional de Saúde Doutor Ricardo Jorge, I.P.) Romania Institute of Public Health and National Institute for Infectious Diseases "Prof. Dr. Matei Bals" Slovakia Regional Public Health Authority of capital Bratislava Slovenia National Institute of Public Health Spain Instituto de Salud Carlos III Centro Nacional de Epidemiologia Sweden Public Health Agency of Sweden United Kingdom Public Health England Non-EU/EEA Albania National Institute of Public Health Andorra Ministry of Health, Social Welfare and Family Armenia National Centre for AIDS Prevention Azerbaijan Azerbaijan AIDS Centre Belarus National Centre for Hygiene, Epidemiology and Public Health Bosnia and Herzegovina Ministry of Civil Affairs of Bosnia and Herzegovina; Federal Ministry of Health; Ministry of Health and Social Welfare the Republica Srpska and Public Health Institutes of the Federation of Bosnia and Herzegovina and Republica Srpska Georgia Infectious Diseases, AIDS & Clinical Immunology Research Centre Israel Ministry of Health Kazakhstan National Centre for the Prevention and Control of AIDS Kyrgyzstan Republic Centre for AIDS Prevention and Control Monaco Ministry of Social Health Montenegro Institute of Public Health of Montenegro Republic of Moldova National AIDS Centre; National Centre for Preventative Care Russian Federation Federal Scientific and Methodological Centre for Prevention and Control of AIDS San Marino Ospedale di Stato Serbiaa Institute of Public Health of Serbia Switzerland Bundesamt für Gesundheit Tajikistan Republican HIV/AIDS Centre The former Yugoslav Republic of Macedonia Institute of Public Health of the Republic of Macedonia Turkey Public Health Institute of Turkey, Ministry of Health Turkmenistan National AIDS Prevention Centre Ukraine State Institution "Public Health Centre of the Ministry of Health of Ukraine" Uzbekistan Republican AIDS Centre a Data for Kosovo (in accordance with Security Council resolution 1244 (1999)) were provided by the National Institute of Public Health of Kosova. 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Paper TQ -A L-18-0 01-EN -C PDF TQ -A L-18-0 01-EN -N European Centre for Disease Prevention and Control (ECDC) Gustav den III:s Boulevard 40, SE-169 73, Solna, Sweden Tel. +46 858 60 10 00 Fax +46 858 60 10 01 www.ecdc.europa.eu Contact us publications@ecdc.europa.eu Follow us on Twitter @ECDC_EU Like our Facebook page www.facebook.com/ECDC.EU World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel. +45 45 33 70 00 Fax +45 45 33 70 01 www.euro.who.int Contact us eurocontact@who.int Follow us on Twitter @WHO_EUROPE Like our Facebook page www.facebook.com/WHOEurope ECDC Paper ISBN 978-92-9498-285-8 ECDC PDF ISBN 978-92-9498-284-1 WHO ISBN 978-92-8905-377-8