HIV/AIDS surveillance in Europe 2020: 2019 data

HIV/AIDS surveillance in Europe 2019 data 2020

HIV/AIDS surveillance in Europe 2019 data 2020 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 the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe that has been summarizing 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 137 000 people were diagnosed with HIV in the European Region in 2019, including 25 000 in the EU/EEA. Keywords ACQUIRED IMMUNODEFICIENCY SYNDROME – EPIDEMIOLOGY AIDS – PREVENTION AND CONTROL DISEASE OUTBREAKS – STATISTICS HIV INFECTIONS – EPIDEMIOLOGY POPULATION SURVEILLANCE © World Health Organization 2020 Some rights reserved. 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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 2020 – 2019 data. Copenhagen: WHO Regional Office for Europe; 2020. Suggested citation for tables and figures. European Centre for Disease Prevention and Control, WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2020 – 2019 data. ECDC PDF ISBN 978-92-9498-527-9 doi 10.2900/073965 TQ-02-20-965-EN-N WHO ISBN 978-92-8905a-534-5 iii Contents Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii This report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viii Overview of HIV and AIDS in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 1. HIV and AIDS in the EU/EEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 1.1 HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 1.2 Trends in HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 1.3 AIDS cases, morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 1.4 HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 1.5 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 2. HIV and AIDS in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 2.1 HIV and AIDS diagnoses in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 2.2 HIV and AIDS diagnoses in the East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 2.3 HIV and AIDS diagnoses in the Centre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 2.4 HIV and AIDS diagnoses in the West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 2.5 HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 2.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 2.7 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Figures Fig. A. Estimated new HIV infections and reported new HIV diagnoses in the EU/EEA and WHO European Region, 2010–2019, and target for 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Fig. B. Rate of new HIV diagnosis per 100 000 population, by year of diagnosis and gender, EU/EEA and WHO European Region, 2010–2019 . . . 3 Fig. C. Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission, WHO European Region, 2019 (n = 39 496) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Рисунок A. Данные по ЕС/ЕЭЗ и Европейскому региону ВОЗ: расчетное число новых случаев ВИЧ-инфекции и число впервые выявленных случаев ВИЧ-инфекции, 2010-2019 гг., а также цель на 2020 год . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Рисунок B. Частота впервые выявленных случаев ВИЧ-инфекции на 100 000 населения (с разбивкой по полу и году постановки диагноза) в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 2009-2018 гг. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Рисунок C. Доля лиц с поздно выявленной ВИЧ-инфекцией (CD4 < 350 клеток/мм3) с разбивкой по полу, возрасту и пути заражения, Европейский регион ВОЗ, 2019 г. (n = 39 496) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Fig. 1.1. Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2019 (n = 24 674) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Fig. 1.2. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2019 (n = 22 318) . . . . . . . . . . . . . . . . . . . . . . . . . 24 Fig. 1.3. New HIV diagnoses, by age group and transmission mode, EU/EEA, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Fig. 1.4. Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2019 (n = 24 715) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Fig. 1.5. Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2019 (n = 18 957) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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, 2019 (n = 20 430) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Fig. 1.7. Acute infection or CD4 cell count per mm3 at HIV diagnosis, overall and by transmission group, EU/EEA, 2018 . . . . . . . . . . . . . . . . . . . . . 27 iv Fig. 1.8. Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Fig. 1.9. Linkage to care after HIV diagnosis, EU/EEA, 2019 (n = 2593) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Fig. 1.10. People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Fig. 1.11a. Age-specific trends in new HIV diagnoses in men, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fig. 1.11b. Age-specific trends in new HIV diagnoses in women, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fig. 1.12. Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2010–2019 . . . . . . . . . . 30 Fig. 1.13a. HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay and missing transmission imputed, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Fig. 1.13b. Percentage of HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Fig. 1.14. New HIV diagnoses, by year of diagnosis, transmission and migration status, adjusted for reporting delay, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Fig. 1.15. Number of people diagnosed late (CD4 < 350 cells/mm3), by year of diagnosis and transmission mode, EU/EEA, 2010–2019 . . . . . . . . 32 Fig. 1.16. Percentage of AIDS diagnoses within 90 days of HIV diagnosis, EU/EEA, 2019 (n = 1763) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Fig. 1.17. AIDS diagnoses, by transmission mode, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Fig. 1.18. Percentage of people diagnosed with AIDS where TB is an AIDS-defining illness, EU/EEA, 2019 (n = 2650) . . . . . . . . . . . . . . . . . . . . . . . 34 Fig. 2.1. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2019 (n = 37 774) . . . . . . 39 Fig. 2.2. New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Fig. 2.3. New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Fig. 2.4. New AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2010–2019 . . . . . . 41 Fig. 2.5. Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country, East, 2019 (n = 107 842; 19 112) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Fig. 2.6. New HIV diagnoses, by country and transmission mode, East, 2019 (n = 27 718) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Fig. 2.7. New HIV diagnoses, by age group and transmission mode, East, 2019 (n = 27 332) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Fig. 2.8. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2019 (n = 22 984) . . . . . . . . . . . . . . . . . . . . . 44 Fig. 2.9. New HIV diagnoses, by transmission mode and year of diagnosis, East, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Fig. 2.10. Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . 46 Fig. 2.11. New AIDS diagnoses, by transmission mode and year of diagnosis, East, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Fig. 2.12. Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Fig. 2.13. Male-to-female ratio in new HIV diagnoses, by country, Centre, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Fig. 2.14. New HIV diagnoses, by country and transmission mode, Centre, 2019 (n = 6713) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Fig. 2.15. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, Centre, 2019 (n = 1847) . . . . . . . . . . . . . . . . . . . . 50 Fig. 2.16. New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Fig. 2.17. New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Fig. 2.18. New HIV diagnoses, by transmission mode and year of diagnosis, West, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Fig. 2.19. New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Tables Table A. Characteristics of new HIV and AIDS diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the WHO European Region, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Таблица A. Эпидемиологические характеристики впервые установленных диагнозов ВИЧ-инфекции и СПИДа, зарегистрированных в Европейском регионе ВОЗ, ЕС/ЕЭЗ, а также в западной, центральной и восточной частях Региона, 2019 г. . . . . . .11 Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 2. New HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 3. New HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 4. New HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 5. New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 6. New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 7. New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 8. HIV diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 9. HIV diagnoses in 2019, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . 70 vTable 10. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2019, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 11. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2019 . . . . . . . . 74 Table 12. New HIV diagnoses, by country of report and probable region of infection, in 2019, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 13. Percentage of new HIV diagnoses (2019) among persons > 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 14. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 15. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 16. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table 17. AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 18. AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table 19. AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 20. AIDS diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table 21. AIDS diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Table 22. The most common AIDS-indicative diseases diagnosed in 2019, ordered by frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 23. AIDS-related deaths, by geographic area, country and year of death (2010–2019) and cumulative totals in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Table 24. Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2010–2019) and number of tests per 1000 population in 2019, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . 94 Table A2.1. Completeness of variables for data reported in 2018 and 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Table A3.1. Completeness by country and variable, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Table A4a.1. HIV surveillance system overview: data source information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Table A4a.1. AIDS surveillance system overview: data source information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table A5.1. Country-specific comments regarding national HIV and AIDS reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Table A6.1. New HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients,a 2016–2019 . . . . 112 Table A7.1. HIV/AIDS surveillance in Europe: participating countries and national institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113 Maps Map 1. New HIV diagnoses, per 100 000 population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Map 2. New HIV diagnoses in men, per 100 000 male population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Map 3. New HIV diagnoses in women, per 100 000 female population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Map 4. New HIV diagnoses in men who have sex with men, per 100 000 male population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Map 5. New HIV diagnoses acquired through injecting drug use, per 100 000 population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Map 6. New HIV diagnoses acquired through heterosexual transmission, per 100 000 population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Map 7. Percentage of adult (> 14 years) HIV diagnoses with CD4 < 350 cells/mm3 at diagnosis, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Map 8. AIDS diagnoses reported, per 100 000 population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Annexes Annex 1. Framework for data collection, validation and presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Annex 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Annex 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Annex 4a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Annex 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Annex 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Annex 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Annex 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113 Acknowledgements The report was coordinated by Anastasia Pharris (European Centre for Disease Prevention and Control (ECDC)) and Giorgi Kuchukhidze (WHO Regional Office for Europe). Review and production support was provided by Nino Berdzuli (WHO Regional Office for Europe), Mike Catchpole (ECDC), Masoud Dara (WHO Regional Office for Europe), Karl Ekdahl (ECDC), Esther Kissling (EpiConcept), Vicky Lefevre (ECDC), Antons Mozalevskis (WHO Regional Office for Europe), Stine Nielsen (freelance consultant), Teymur Noori (ECDC), Adrian Prodan (ECDC), Nicole Seguy (WHO Regional Office for Europe), Marieke J. van der Werf (ECDC) and Elena Vovc (WHO Regional Office for Europe). 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 the HIV/AIDS surveillance 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: Gohar Mirzoyan; Austria: Daniela Schmid, Ziad El-Khatib; Azerbaijan: Farhad Singatulov, Shahin Khasiyev; Belarus: Svetlana Sergeenko; Belgium: Andre Sasse, Dominique Van Beckhoven; Bosnia and Herzegovina: Dušan Kojić; Bulgaria: Tonka Varleva; Croatia: Tatjana Nemeth Blazic; Cyprus: Linos Hadjihannas, Anna Demetriou; Czechia: Marek Maly; Denmark: Susan Cowan; Estonia: Kristi 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: Marianna Thordardottir, Gudrun Aspelund; 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: Carole Devaux, Jean-Claude Schmit; Malta: Jackie Maistre Melillo, Tanya Melillo; Monaco: Dominique De Furst; Montenegro: Alma Cicic; Netherlands: Eline Op de Coul, Ard van Sighem; North Macedonia: Milena Stefanovic, Zarko Karadzovski, Rumena Gerdovska; Norway: Hans Blystad, Hilde Klovstad; Poland: Magdalena Rosinska; Portugal: Isabel Aldir, Helena Cortes Martins; Republic of Moldova: Silvia Stratulat, Stepan Gheorghita; Romania: Mariana Mardarescu; Russian Federation: Inna Kulikova, Oleg Sonin, Lyalya Gabbasova; San Marino: Andrea Gualtieri, Mauro Fiorini; Serbia: Danijela Simic; Slovakia: Peter Truska; Slovenia: Irena Klavs, Tanja Kustec; Spain: Asuncion Diaz; Sweden: Maria Axelsson; Switzerland: Martin Gebhardt; Tajikistan: Kholnazarov Ramshed, Zukhra Nurlaminova; Turkey: Emel Özdemir Şahin; Ukraine: Ihor Kuzin, Violetta Martsynovska; and United Kingdom: Valerie Delpech. For Kosovo:1 Luljeta Gashi. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). vi vii ART antiretroviral treatment EECA Eastern Europe and Central Asia ECDC European Centre for Disease Prevention and Control EU/EEA European Union/European Economic Area MSM men who have sex with men PrEP pre-exposure prophylaxis TB tuberculosis TESSy The European Surveillance System UNAIDS Joint United Nations Programme on HIV/AIDS Abbreviations viii The European Centre for Disease Prevention and Control (ECDC) and the 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 Member States 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 2008. The data presented in the text are augmented by 40 figures and 31 tables: Fig. A–C and Table A in the Overview, Fig. 1.1–2.19 in Chapters 1 and 2, Tables 1–24 in a discrete section towards the end of the report, maps 1–8 and six tables (A2.1–A7.1) in the annexes. The report has three main sections: • an Overview, which effectively summarizes and captures 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, and AIDS cases and their morbidity and mortality; and • Chapter 2, which presents data on HIV and AIDS diagnoses 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, and HIV testing. The data in the report are also augmented by seven annexes: • Annex 1, which presents the framework for data collection, 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 presented by country and area; • Annexes 4 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 systems 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. This report 1HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Overview of HIV and AIDS in Europe Table A. Characteristics of new HIV and AIDS diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the WHO European Region, 2019 WHO European Region West Centre East EU/EEA Reporting countries/number of countriesa 47/53 20/23 14/15 13/15 30/31 Number of new HIV diagnoses 136 449 21 793 6 814 107 842 24 801 Rate of HIV diagnoses per 100 000 populationb 15.6 5.7 3.4 41.7 5.4 Percentage age 15–24 years 8.5% 10.2% 15.0% 5.7% 10.3% Percentage age 50+ years 17.8% 22.0% 13.7% 16.1% 20.4% Male-to-female ratio 1.8 2.9 5.5 1.6 3.1 Transmission mode Sex between men 20.7% 39.9% 27.3% 3.9% 38.7% Heterosexual transmission (men) 26.4% 16.2% 18.2% 36.3% 16.1% Heterosexual transmission (women) 23.8% 17.8% 7.2% 32.6% 16.7% Injecting drug use 13.0% 3.4% 2.1% 23.2% 3.9% Mother-to-child transmission 0.7% 0.7% 0.5% 0.8% 0.7% Unknown 15.3% 21.6% 44.5% 3.1% 23.6% AIDS and late HIV diagnosis Percentage new HIV diagnoses CD4 < 350 cells/mm3 53.2% 48.8% 55.9% 55.7% 49.7% Number of new AIDS diagnosesc 12 535 2156 802 9577 2772 Rate of AIDS diagnoses per 100 000 population 2.0 0.5 0.4 8.3 0.5 a No data received from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and Uzbekistan. b EU/EEA and West rates are adjusted for reporting delay (Annex 6); the corresponding estimated number of new diagnoses adjusted for reporting delay are (27 231 and 23 971 respectively). c No data received from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan. The data in this report present new HIV diagnoses through to the end of 2019, the period just before the global COVID-19 pandemic began. The impact of the pandemic on laboratory, clinical and public health institutions involved in HIV surveillance and response has been felt during the data collection and preparation stages of this report, with several countries requiring more time than usual to submit their 2019 HIV and AIDS data or indicating that reporting delays may increase. Several countries reported that it was not possible to report some variables at all or at levels concordant with the past. The European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe, in collaboration with Member States and partners, will look carefully at the impact of COVID-19 on HIV surveillance to ensure the continuing high standard of European HIV and AIDS data. Although HIV infection is preventable, significant HIV transmission continues across the WHO European Region. In 2019, 136 449 newly diagnosed HIV infections were reported in 47 of the 53 Member States in the Region,2 including 24 801 from countries of the European Union/European Economic Area (EU/EEA). This corresponds to a crude rate of 15.6 newly diagnosed infections per 100 000 population (Table A). The trend that has persisted over the last decade continues, with rates and overall numbers of people diagnosed with HIV highest in the East of the Region 2 No data were received from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan or Uzbekistan. Liechtenstein is an EEA 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. (41.7 per 100 000 population), lower in the West and in the EU/ EEA (5.7 and 5.4 per 100 000, respectively) and lowest in the Centre3 (3.4 per 100 000) (Table A). The main transmission mode also varies 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, while heterosexual transmission and injecting drug use were the main reported transmission modes in the East of the Region. The number of people newly diagnosed with HIV in the WHO European Region increased by 19% over the last decade, while the number of new diagnoses among countries in the EU/EEA declined by 9% over the same period (Fig. A). When comparing the number of new diagnoses to the estimated number of new HIV infections over the last decade in the Region, it is evident that for most of this period, more people became infected with HIV than had been diagnosed, indicating that the number of people living in the Region with undiagnosed HIV is increasing. In contrast, it is estimated that more people in the EU/EEA have been diagnosed than are becoming infected, indicating that the proportion of those living with undiagnosed HIV is decreasing. The rate of new HIV diagnoses in men in the Region overall has increased at a faster pace than in women; by 2019, it was twice as high as the rate in women. The rate of new HIV diagnoses in the EU/EEA has declined in both men and women, but more rapidly in women; by 2019, 3 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, Fig. A1.1 for details. 2SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data the rate of new diagnoses in men was three times higher than that in women (Fig. B). The rate of new diagnoses in the Region was also higher among men than women in all age groups, except for people under 15 years (see Table 9). In 2019, just over half (53%) of those diagnosed with HIV in the European Region were diagnosed at a late stage of infection (CD4 cell count less than 350 cells/mm3 at diagnosis). This percentage was highest in the East (56%) and Centre (56%) and lowest in the West (49%), while 50% were diagnosed late in the EU/EEA (Table A). In 2019, 12 535 people were diagnosed with AIDS, reported in 45 countries4 of the WHO European Region, and the rate of new diagnoses was 1.7 per 100 000 population (Table A; see also Table 14). In the EU/EEA, 2772 people were diagnosed with AIDS in 2019, giving a rate of 0.5 per 100 000 population. The number of AIDS cases continued to decline steadily in the West and the EU/EEA during the last decade (see Fig. 1.17 and 2.4). At the same time, it has been increasing in the East, although it began to stabilize between 2012 and 2018 and even declined in 2019. European Union and European Economic Area In 2019, 24 801 people were diagnosed with HIV in the 30 countries of the EU/EEA, with a rate of 5.4 per 100 000 when adjusted for reporting delay (Table 1, Annex 6). Countries with the highest rates were Malta (16.2; 80 cases), Latvia (15.4; 295) and Estonia (13.4; 178), and the lowest were reported by Slovakia (1.9; 101 cases) and Slovenia (1.6; 34) (Table 1, Map A). The rate of new HIV 4 No data were reported by Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. The Russian Federation reported only data on new HIV diagnoses by sex and data on HIV testing. diagnoses was higher among men (7.5 per 100 000 population; Table 2) than women (2.4 per 100 000 population; Table 3). The overall male-to-female ratio was 3.1 (Table A). This ratio was highest in Croatia (19.4) and Hungary (13.0) and was above one in all countries in the EU/EEA (Fig. 1.1). The predominant mode of transmission in countries with the highest male-to- female ratios was sex between men. Men had higher age-specific rates than women in all age groups except among people under 15 years, where age- specific rates were similarly low (Fig. 1.2). The highest overall age-specific rate of HIV diagnoses for men was in the 20–29-year-old age group (18.0 per 100 000 population), while rates for women were highest in the 30–39 age group (6.1 per 100 000 population) (Fig. 1.2). Young people aged 15–24 years comprised 11% of the EU/EEA population and 11% of HIV diagnoses in 2019. Forty-one per cent of the EU/EEA population consists of older adults (50 years and above), who comprised 21% of the new HIV diagnoses reported in 2019 (Fig. 1.4). Sex between men remains the predominant mode of HIV transmission reported in the EU/EEA, accounting for 39% (9598) of all new HIV diagnoses in 2019 and more than half (51%) of diagnoses where the route of transmission was known (Table 4, Table 8, Fig. 1.5). Among those with known route of HIV transmission, sex between men accounted for more than 60% of new HIV diagnoses in 10 countries (Croatia, Czechia, Germany, Hungary, Iceland, the Netherlands, Poland, Slovakia, Slovenia and Spain) (Fig. 1.5). Heterosexual contact was the second most common reported mode of HIV transmission in the EU/EEA in 2019, accounting for 33% (8164) of HIV diagnoses and 43% of diagnoses where the route of transmission was known (Table 6, Table 8, Fig. 1.5). Heterosexual transmission was the most commonly reported known Fig. A. Estimated new HIV infections and reported new HIV diagnoses in the EU/EEA and WHO European Region, 2010–2019, and target for 2020 20202019201820172016201520142013201220112010 Re op 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 Year of diagnosis 0 50 000 100 000 150 000 200 000 2020 target, EU/EEA 2020 target, WHO European Region EU/EEA estimated infections EU/EEA diagnoses WHO European Region diagnoses WHO European Region estimated infections Note: data from Andorra, Belgium, Italy, Monaco, North Macedonia, Spain, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. 3HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT mode of transmission in nine EU/EEA countries (Cyprus, Estonia, France, Latvia, Luxembourg, Norway, Portugal, Romania and Sweden). Transmission due to injecting drug use accounted for 4% of HIV diagnoses in 2019 and was the probable route of transmission for one quarter or more of the cases reported in Latvia (26%) and Lithuania (38%) (Table 5, Table 8, Fig. 1.5). Vertical transmission accounted for less than 1% of new HIV diagnoses in the EU/EEA in 2019 while the transmission mode was not reported or reported to be unknown for 24% of new HIV diagnoses (Table A). Forty-four per cent of those diagnosed in the EU/EEA in 2019 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, 9% from countries in Latin America and the Caribbean, 8% from other countries in central and eastern Europe, and 3% from other countries in western Europe. The trend in rates of reported HIV diagnoses declined slightly between 2010 and 2019. Rates were 6.6 per 100 000 in the early part of this period, decreasing steadily thereafter to 5.4 per 100 000 in 2019 (Table 1, Fig. 1.10, Annexes 1, 5 and 6). The number of diagnoses in countries reporting consistently over the period declined by 9% between 2010 and 2019. While the overall EU/EEA trend has declined during the past decade, trends at national level vary. Several countries, including Austria, Denmark, Estonia, Finland, France, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom, have also reported a decline in rates of new diagnoses, even after adjusting for changes in population coverage of surveillance and reporting delay. Conversely, and taking reporting delay into account, rates of HIV diagnoses have more than doubled since 2010 in Cyprus, Malta and Slovakia and have increased by more than 50% in Bulgaria and Poland (Table 1, Annex 6). Some countries are affected disproportionately by reporting delay, with the result that decreases in the rates of new HIV diagnoses may be overestimated and increases in rates underestimated. Trends differ by gender and age group. Age-specific rates have declined since 2010 in all age groups except for women 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. 1.11a, Fig. 1.11b). The median age at HIV diagnosis increased from 34 to 37 years among women between 2010 and 2019, while remaining stable in men at 37 years. A larger proportion of diagnoses is being reported in older age groups: 15% of people diagnosed in 2010 were over 50 years on diagnosis, rising to 20% in 2019. The proportion of all HIV diagnoses with known route of transmission that were attributed to sex between men in countries reporting consistently over the period increased from 45% of cases in 2010 to 52% in 2015, then decreased to 47% in 2019 (Fig 1.13). The number of HIV diagnoses reported among men who have sex with men (MSM) in countries reporting consistently increased from 8730 cases in 2010 and peaked at 9839 in 2014. Even after adjusting for reporting delay, fewer cases were reported in 2019 (6888) in this same group of countries. Most of the decline in recent years appears to be due to fewer diagnoses among MSM in Austria, Finland, France, Germany, Greece, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom (Table 4), with substantial increases noted in Bulgaria, Cyprus, Estonia, Lithuania, Poland, Romania and Slovakia in recent years. Cases attributed to MSM born outside of the reporting country increased over the period, declining slightly between 2016 and 2019 but not to the same extent as observed in EU/EEA-native MSM (Fig. 1.14). The number of heterosexually acquired cases decreased steadily over the last decade (Fig. 1.13a), with sharper declines among women and foreign-born heterosexual Fig. B. Rate of new HIV diagnosis per 100 000 population, by year of diagnosis and gender, EU/EEA and WHO European Region, 2010–2019 0 5 10 15 20 25 Men (EU/EEA) Men (WHO European Region) Women (EU/EEA) Women (WHO European Region) 2019201820172016201520142013201220112010 Ne w H IV d ia gn os es p er 10 0 00 0 po pu la to in Year of diagnosis 4SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data people than among men and non-foreign-born people (Fig. 1.13a, Fig. 1.14). Despite the overall decline in heterosexually acquired cases during this period, new diagnoses in Lithuania and Slovakia increased substantially in this group. The number of HIV diagnoses reported as being due to injecting drug use has declined since 2010 in both foreign-born and non-foreign-born groups, but localized outbreaks that affected the EU/EEA trend in this group were seen in 2011–2012, and smaller local outbreaks were also noted in some countries during the last decade (Table 5, Fig. 1.13a, Fig. 1.14). Mother-to-child transmission and transmission through nosocomial infection or blood transfusion also decreased steadily between 2010 and 2019; 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 14% in 2010 to 22% in 2019. Information on CD4 cell count at the time of HIV diagnosis was provided by 25 countries (Table 13). Among all cases diagnosed in 2019 where information on CD4 count or acute HIV infection was available, 12% (1896) of cases were reported as acute infections and 26% (4122) as more recent infection (with a CD4 count above 500 cells per mm3 at diagnosis). Among MSM diagnosed in 2019 where information was available, 15% (1116) were reported as acute infections and 30% (2192) had a CD4 count above 500 cells per mm3 at diagnosis (Fig.1.7). As in previous years, half (50%) of all cases with a CD4 cell count were diagnosed several years after being infected, with a count of less than 350 cells per mm3; 30% of cases were considered to have advanced HIV infection at the time of diagnosis (CD4 less than 200 cells/mm3). The highest proportions of people presenting at a later stage of HIV infection (CD4 less than 350 cells/mm3) were observed among women (53%), older adults (54% in 40–49-year-olds and 65% in people over 50), men or women infected by heterosexual sex (61% and 53%, respectively), people who acquired HIV through injecting drug use (52%), migrants from sub-Saharan Africa (57%) and migrants from south and south-east Asia (54%) (Fig. 1.8, Table 13). In countries reporting consistently on transmission route and CD4 cell count at diagnosis over time, the number of persons diagnosed late (CD4 cell count less than 350 cells/mm3 at diagnosis) decreased by 29%, from 7441 in 2010 to 5265 in 2019. A reduced number was observed in all transmission groups (Fig. 1.15), with a 42% reduction in late diagnoses in heterosexually transmitted HIV in women (2056 in 2010, 1201 in 2019), 40% reduction where the route of transmission was injecting drug use (319 in 2010, 191 in 2019), 29% reduction in heterosexual men (1906 in 2010, 1353 in 2019) and a 24% reduction in transmission due to sex between men (2529 in 2010, 1914 in 2019) (Fig. 1.15). In 2019, 2772 diagnoses of AIDS were reported by 29 EU/EEA countries,5 giving a rate of 0.5 cases per 100 000 population (Table 14). Overall, 74% of these 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. This pattern holds for all transmission groups except people who acquired HIV through injecting drug use, where over half (60%) of the AIDS cases occurred more than 90 days after the HIV diagnosis (Fig. 1.16). Twenty-one countries reported tuberculosis (TB) (pulmonary and/or extrapulmonary) as an AIDS-defining illness in 14% of those newly diagnosed with AIDS in 2019 (Fig. 1.18). In the EU/EEA, the number of AIDS cases more than halved in the past decade (Fig. 1.10). This decline is noted in men and women and in all transmission groups, but appears greatest among cases attributed to injecting drug use (Tables 15–20, Fig. 1.17). Despite the general EU/EEA-wide decline, an increase has been reported in the rate of AIDS diagnoses since 2010 in Czechia and Hungary. AIDS-related deaths have declined steadily in the EU/EEA since the mid-1990s. 5 All EU/EEA countries except Belgium and Sweden. Fig. C. Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission, WHO European Region, 2019 (n = 39 496) 0 10 20 30 40 50 60 70 Percentage 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 Ge nd er Ag e gr ou p (y ea rs ) Tr an sm is si on 5HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT WHO European Region With 136 449 people newly diagnosed with HIV in 2019, corresponding to a rate of 15.6 per 100 000 population, halted growth in new HIV diagnoses continued to be observed in the WHO European Region, mainly due to the continuous decrease in the West and the overall stabilizing trend in the East. One third of countries in the East nevertheless reported annual increases in new HIV diagnoses. Of the 136 449 people diagnosed in 2019, 79% were diagnosed in the East (107 842), 16% in the West (21 793) and 5% in the Centre of the Region (6814) (Table A). The rate was also highest in the East (41.7 per 100 000 population), being disproportionately higher than in the West (5.7 per 100 000 population) and the Centre (3.4 per 100 000 population) (Table A). Rates of newly diagnosed HIV infections for 2019 varied significantly among countries in the WHO European Region, with the highest rates per 100 000 population being observed in the Russian Federation (54.9), Ukraine (39.0), the Republic of Moldova (22.8) and Belarus (22.6), and the lowest in Bosnia and Herzegovina (0.9) and Slovenia (1.6) (Table 1). The overall rate for men was 20.8 per 100 000 population (Table 2) and for women 10.6 per 100 000 population (Table 3). The largest proportion of new diagnoses in the 46 reporting countries6 were in the age group 30–39 years (34%), while 9% were young people aged 15–24 years and 18% were 50 years or older at the time of diagnosis. The male-to-female ratio was 1.8, lowest in the East (1.6), higher in the West (2.9) and highest in the Centre (5.5). The most common form of infection was through heterosexual sex (50%), with 10% of these cases originating from countries outside of the Region that have 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). Among the new diagnoses reported by 12 countries in the East for whom the mode of HIV transmission was known, 71% were infected through heterosexual transmission and 24% through injecting drug use, while reported transmission through sex between men remained low, at 4% of cases (Tables 4–6, 8). Sex between men (49%) and heterosexual sex (46%) were the main reported transmission modes in the Centre, but 44% of the new diagnoses lacked transmission-mode information. Sex between men was the predominant mode of transmission in 10 of the 14 countries in the 6 Data reported by the Russian Federation were limited to new HIV diagnosis by sex for 2009–2019 and data on HIV testing, which enabled the inclusion of the Russian Federation’s data in Tables 1–3 and 25 and in the figures showing the trend in HIV diagnosis. Data on age and modes of transmission presented in this report include countries that provided a full set of data to the joint ECDC/WHO European HIV surveillance system. Centre. In the West, sex between men remained the main transmission mode (40% of cases) followed by heterosexual transmission (34% of cases, among whom 39% originated from generalized epidemic countries). Information was lacking for 22% of new diagnoses. The rate of newly diagnosed HIV infections in the 47 countries with consistent reporting over the past 10 years increased by 9%, from 14.1 per 100 000 population in 2010 (118 726 cases) to 15.4 per 100 000 population in 2019 (136 449 cases) (Fig. 2.2). The increase is driven mainly by the continuing upward trend in the East, where the rate increased by 23%, from 39.9 per 100 000 (86 266 cases) to 41.7 per 100 000 (107 842 cases). In the Centre, the rate increased by 113%, the largest relative increase among the three geographical areas, from 1.6 to 3.4 per 100 000 population between 2010 and 2019, while in the West it decreased by 31%, from 7.5 to 5.7 per 100 000 population over the same period (Fig. 2.2). Consistent data on transmission mode were available from 39 countries for the period 2010–2019 (Fig. 2.3). Transmission in the East was driven by a rise in the number of HIV diagnoses with reported sexual transmission, which increased by 57% for heterosexual transmission and more than five-fold for transmission through sex between men. The increase with heterosexual transmission was considerably larger among men (103%) than women (21%). Transmission through injecting drug use, while still substantial, decreased by 36% (Fig. 2.9). In the Centre, new diagnoses in people infected through sex between men nearly doubled between 2010 and 2019; this was the predominant mode of transmission in 12 of the 14 countries, while heterosexual transmission increased by 48%. Transmission through injecting drug use has levelled off after an outbreak in Romania during 2011–2013. The percentage of new diagnoses attributed to injecting drug use was 6% in both 2010 and 2019 (Fig. 2.16). In the West, heterosexual transmission continued its steady decline and decreased by 37% over the 10-year period overall. Injecting drug use-related transmission decreased by 34% between 2010 and 2019 and is now decreasing again after a peak in 2012 caused by an outbreak in Greece. New diagnoses due to sex between men decreased by 29% compared to 2009. New diagnoses with unknown transmission mode increased by 37% in the West (Fig. 2.18). Late HIV diagnosis remains a challenge in the Region. Among those newly diagnosed people over 14 years for whom information about CD4 cell count at the time of HIV diagnosis was available, over half (53%) were late presenters, with CD4 cell counts below 350 cells per mm3, including 31% with advanced HIV infection (CD4 less than 200 cells/mm3). The percentage of people newly diagnosed who were late presenters (CD4 less than 350/mm3) varied across transmission categories and age groups but was highest for people with reported heterosexual transmission (58%; 60% for men and 55% for women) and injecting drug use (52%), and lowest for 6SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data men infected through sex with men (42%) (Fig. C). The percentage increased with age, ranging from 35% among people aged 15–19 and 20–24 years at diagnosis, to 67% among those aged 50 years or older. In terms of gender, the percentage of late presenters was similar overall (53% 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 mild variation across the Region, with 56% late presenters in the East and in the Centre and 49% in the West. In 2019, 12 535 people were newly diagnosed with AIDS in 45 countries of the WHO European Region,7 corresponding to a rate of 1.7 per 100 000 population. Overall, 76% of AIDS cases were diagnosed in the East, where the rate per 100 000 was also highest (8.3), 18% in the West (with a rate of 0.5 per 100 000) and 6% in the Centre of the Region (0.4 per 100 000) (Table 14). Twenty per cent of people diagnosed with AIDS presented with TB as an AIDS-defining illness, ranging from 13% of cases in the West and 21% in the Centre to 28% in the East. The overall rate of new AIDS diagnoses in the Region decreased by 23% between 2010 and 2019 but the AIDS trends varied greatly across the three geographical areas. In the East, the rate increased by 15%, from 7.2 in 2010 to 8.3 in 2019. 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 69% decrease from 1.6 in 2010 to 0.5 in 2019 (Fig. 2.4). Conclusions HIV transmission is still a major public health concern and affects millions of people in the WHO European Region, particularly in the eastern part of the Region. Over the course of the last three decades, over 2.1 million people have been diagnosed and reported with HIV in the WHO European Region, including over 710 000 people in the EU/EEA. In 2019, more than 136 000 people were diagnosed with HIV, at a rate of 15.6 per 100 000 population. The vast majority of new diagnoses, 79%, were reported from the East of the Region and 16% from the West. Newly diagnosed infections in the Russian Federation contributed 59% of all cases in the WHO European Region and 74% of cases in the East. An increasing trend in new HIV diagnoses has been observed in one third of the reporting countries in the East, although this is at a slower rate than in previous years. Over the last three years, halted growth in reported newly diagnosed HIV has been observed in the Russian Federation and some signs of stabilization have been noted in Ukraine, which contributed to the overall stabilization of the epidemic in the East. The number of people living with undiagnosed HIV is increasing in the WHO European Region. Over the last decade, more people have been estimated to be newly 7 No data were reported from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. infected annually than have been diagnosed. In contrast, the proportion of those living with undiagnosed HIV is decreasing in the EU/EEA. While epidemic patterns and trends vary widely across WHO European Region countries, sustained increases have been seen in the number of newly diagnosed infections within certain transmission groups across parts of the Region: men who have sex with men in the Centre and East, and heterosexual transmission in the East, though some studies suggest that the latter increase needs to be interpreted with caution (1,2). 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 the West in recent years. Transmission through injecting drug use has continued to decrease in many countries, although it still accounted for 24% of reported new diagnoses with a known mode of transmission in the East in 2019. Too many people throughout the WHO European Region are diagnosed late (53%), 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 remains a major challenge. At the same time, the stabilizing AIDS trend observed since 2012 may be the result of a majority of countries having now implemented treat-all policies, which aim to offer anyone living with HIV the opportunity to receive antiretroviral therapy (ART) regardless of the stage of disease. New strategies are required to improve early diagnosis and make more people aware of their infection by expanding diversified and user-friendly approaches to more widely available HIV testing. WHO consolidated guidelines on HIV testing services, including guidelines on HIV self-testing and partner notification, and ECDC public health guidance on an integrated approach to HIV and hepatitis B and C testing recommend implementation of innovative approaches that include self-testing and community testing by lay providers using rapid tests as part of overall HIV testing services (3–5). WHO issued a policy brief on moving away from the use of western blotting and line immunoassays in HIV testing strategies and algorithms towards supporting decentralized testing and rapid linkage to treatment (6). While the provision of HIV testing services has improved over time and self-testing and community-based HIV testing have seen a substantial increase in implementation in recent years, policy-monitoring in the Region indicates that some testing modes remain limited or non-existent in many European countries (7). HIV testing services should focus on reaching the key population groups in the local epidemic context, be tailored to the specific 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 HIV incidence, morbidity and mortality in support of the 90–90–90 goals and other regional and global targets (8–10). 7HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT A robust body of evidence shows that early initiation of ART is beneficial both to the health of the person receiving the treatment and in preventing onward HIV transmission (11–16). Nearly 90% of countries in the WHO European Region have a policy to initiate ART regardless of CD4 cell count (17,18). The WHO Regional Office for Europe organized a regional workshop on advancing implementation science on HIV and viral hepatitis in Eastern Europe and Central Asia (EECA) in February 2020 (19). The workshop aimed to support countries in EECA to conduct and use implementation science and programme data to guide practical implementation of WHO recommendations within their HIV and viral hepatitis programmes, including, but not limited to: assessing the validity of routine surveillance data, with a particular focus on data on modes of HIV transmission; identifying barriers to the target of 90% of all infections being diagnosed and to optimizing testing interventions; implementing and scaling-up pre-exposure prophylaxis (PrEP); and improving linkage to, and retention in, care, quality of care and management of comorbidities. The workshop also aspired to foster collaboration among researchers, scientists, donors and partners to conduct and support implementation science in EECA. Interventions to control the epidemic should be based on evidence and adapted to national and local epidemiology. From the comprehensive epidemiological data presented in this report, the following can be concluded. • 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 current prevention, treatment and care interventions targeting MSM need to be further scaled-up and strengthened and should remain the priority of the HIV response. Countries with declines have demonstrated the impact of changing the culture towards more frequent testing for at-risk gay men and linkage to immediate care and ART for those found to be positive (20). Multicomponent interventions, and the inclusion of PrEP for HIV, screening and treatment for sexually transmitted infections, and self-testing and assisted voluntary partner notification, in the package of prevention and control interventions could help to curb the increasing trends being seen in some countries. In most European countries, reported use of PrEP is well below perceived need (3,21–23). Effective and accessible testing, prevention and care services for the increasingly diverse group of migrants at risk of, and living with, HIV need to be implemented more widely in many countries in the West of the Region. The 2011–2012 increase in HIV cases among people who inject drugs and continued reported local outbreaks in a number of countries (24–28) demonstrate the need to maintain or scale-up harm- reduction programmes. • For the countries in the Centre, new diagnoses 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 13 of the 14 reporting Centre countries. Interventions to address this situation are needed, such as PrEP for high-risk groups, HIV testing by lay providers, HIV rapid diagnostic tests, HIV self- testing and voluntary assisted partner notification, alongside policies and practices to offer ART to all people living with HIV. Some countries have undergone a transition to domestic financing of the HIV response after withdrawal of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. This has posed sustainability challenges, particularly in relation to the 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 prevent the epidemic from accelerating (29). • For the countries in the East, there is an urgent need to continue the scale-up of bold, evidence-based interventions 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 populations. 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. All of these services should be integrated into national policies and programmes and then implemented (3,4,10,30). Community involvement in the design and delivery of services is essential to reducing the rate of new HIV infections and increasing the number of people linked to care and initiated and retained on ART, with the ultimate aim of reducing HIV incidence and AIDS-related deaths. Innovative HIV prevention interventions should address the risk of heterosexual transmission, particularly in couples where one partner is engaged in high-risk behaviour (such as injecting drug use) or is spending longer periods of time working abroad. The large number of new diagnoses in people infected through injecting drug use emphasizes that evidence-based policies focused on key populations and other evidence-based approaches, 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. 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 completeness of data on reported mode of transmission and CD4 cell count at the time of diagnosis is suboptimal in the Region, mainly due to incomplete or no data 8SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data reported from large countries like Germany, Poland, the Russian Federation and Turkey. Some studies conducted in the East found that the information about mode of transmission among newly diagnosed patients may be biased, with many cases registered as heterosexually acquired having a history of injecting drug use or, among male cases, sex with men (1,2). This highlights the importance of assessing the validity of routine surveillance data in relation to mode of transmission, especially in countries where injecting drug use and homosexuality are stigmatized. The number of countries conducting enhanced HIV surveillance and reporting surveillance data at European level has increased gradually over time. In 2019, 41 countries submitted linked HIV and AIDS data, enabling greater understanding of the clinical status of people diagnosed with HIV. This approach increases the possibilities for longer-term monitoring of HIV continuum-of-care outcomes, such as modelling 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 goals and other global and regional targets. In September 2020, reflecting the COVID-19 pandemic situation, the WHO Regional Office for Europe and ECDC organized a joint virtual meeting with major national stakeholders involved in the response to TB, HIV and viral hepatitis, including key partners, donors, affected communities and civil society organizations. The aim was to exchange information and good practices on the maintenance of essential TB, HIV and viral hepatitis services. Countries and partners discussed their experiences in ensuring access to, and continuity of, quality HIV services during the COVID-19 pandemic and on how they monitor the impact of the COVID-19 pandemic on HIV services. Latest WHO policy guidance and recommendations on TB, HIV, viral hepatitis and comorbidities were also discussed during the meeting. References8 1. Dumchev K, Kornilova M, Kulchynska R, Azarskova M, Vitek C. Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk. BMC Public Health 2020;20(1):1288. doi:10.1186/s12889-020-09373-2. PMID:32843008; PMCID: PMC7449084. 2. Čakalo JI, Božičević I, Vitek C, Mandel JS, Salyuk T, Rutherford GW. Misclassification of men with reported HIV infection in Ukraine. AIDS Behav. 2015;19(10):1938–40. doi:10.1007/s10461-015-1112-0. PMID: 26070886. 3. Guidelines on HIV self-testing and partner notification. Supplement to consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2017 (https://www.who.int/hiv/pub/vct/hiv- self-testing-guidelines/en/). 4. Consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2015 (https://www.who.int/hiv/pub/guide- lines/hiv-testing-services/en/). 5. Public health guidance on HIV, hepatitis B and C testing in the EU/ EEA. Stockholm: ECDC; 2018 (https://www.ecdc.europa.eu/en/ publications-data/public-health-guidance-hiv-hepatitis-b-and-c- testing-eueea). 6. WHO recommends countries move away from the use of western blotting and line immunoassays in HIV testing strategies and algo- rithms. Policy brief. Copenhagen: WHO Regional Office for Europe; 8 All weblinks were accessed on 12 November 2020. 2019 (https://www.euro.who.int/en/health-topics/communicable- diseases/hivaids/publications/2019/who-recommends-countries- move-away-from-the-use-of-western-blotting-and-line-immunoas- says-in-hiv-testing-strategies-and-algorithms.-policy-brief-2019). 7. 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). 8. Global health sector strategy on HIV, 2016–2021 – towards ending AIDS. Geneva: World Health Organization; 2016 (https://www.who. int/hiv/strategy2016-2021/ghss-hiv/en/). 9. Ambitious treatment targets: writing the final chapter of the AIDS epidemic. Geneva: UNAIDS; 2014 (http://www.unaids.org/sites/ default/files/media_asset/JC2670_UNAIDS_Treatment_Targets_ en.pdf). 10. 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. Consolidated guidelines on the use of antiretroviral drugs for treat- ing and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2016 (https://www.who.int/hiv/pub/arv/arv-2016/ en/). 12. Guideline on when to start antiretroviral therapy and on pre-expo- sure prophylaxis for HIV. Geneva: World Health Organization; 2015 (https://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/). 13. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016;373(9): 795–807. 14. 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. 15. Guidelines version 10.1. October 2020. In: European AIDS Clinical Society [website]. Brussels: European AIDS Clinical Society; 2020 (https://www.eacsociety.org/files/guidelines-10.1_5.pdf). 16. Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, Degan O et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with HIV-positive partner taking suppressive antiretro- viral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019;393(10189):2428–38. 17. Continuum of HIV care. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2018 (https://www. ecdc.europa.eu/sites/default/files/documents/HIV-continuum-of- care-monitoring-dublin-declaration-progress-report-2018.pdf). 18. 2019 Global AIDS Monitoring (GAM). In: AIDSinfo [website]. New York (NY): UNAIDS; 2019 (https://aidsinfo.unaids.org/). 19. Regional Workshop on Advancing Implementation Science on HIV and Viral Hepatitis in Eastern Europe and Central Asia. Report (10– 11 February 2020, Berlin, Germany). Copenhagen: WHO Regional Office for Europe; 2020 (https://www.euro.who.int/en/health-top- i c s/co mmu ni c a b l e - dis e a s e s/hi v ai d s/p u b l i c a t i o ns/2020/ regional-workshop-on-advancing-implementation-science-on-hiv- and-viral-hepatitis-in-eastern-europe-and-central-asia.-report- 1011-february-2020,-berlin,-germany). 20. 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). 21. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014 (https://www.ecdc.europa.eu/ sites/default/files/media/en/publications/Publications/hiv-sti-pre- vention-among-men-who-have-sex-with-men-guidance.pdf). 22. 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. 23. Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P et al. and the ECDC Dublin Declaration Monitoring Network. Estimating the “PrEP gap”: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019;24(41):pii=1900598 (https://doi.org/10.2807/1560- 7917.ES.2019.24.41.1900598). 24. 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). 25. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015. Euro Surveill. 2015;20(40):pii=30036 (http://dx.doi.org/10.2807/1560-7917.ES.2016.20.40.30036). 26. HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre 9HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT for Drugs and Drug Addiction; 2018 (http://sante.public.lu/fr/ publications/h/hiv-joint-technical-mission/index.html). 27. McAuley A, Palmateer NE, Goldberg DJ, Trayner KMA, Shepherd SJ, Gunson RN et al. Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross-sec- tional analysis. Lancet HIV 2019;6(5):e315–24. 28. Des Jarlais DC, Sypsa V, Feelemyer J, Abagiu AO, Arendt V, Broz D et al. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV 2020;7(6):e434–42. 29. 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/pub- lications/lost- transition). 30. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. 2016 update. Geneva: World Health Organization; 2017 (https://www.who.int/hiv/pub/guidelines/key- populations-2016/en/).

11 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе В настоящем отчете представлены данные о диагностированных случаях ВИЧ-инфекции в период до конца 2019 г. – времени, непосредственно предшествующего началу глобальной пандемии COVID-19. Влияние пандемии на лабораторный потенциал, клинические учреждения и организации общественного здравоохранения, принимающие участие в эпиднадзоре за ВИЧ-инфекцией и ответных мерах в связи с ВИЧ/СПИД, наблюдалось на этапах сбора данных и подготовки настоящего отчета. Нескольким странам для предоставления своих данных по ВИЧ/СПИДу за 2019 г. потребовалось больше времени, чем обычно, а некоторые предупредили об увеличении задержек с подачей отчетности. Ряд стран вовсе заявил о невозможности подать сведения по некоторым переменным или подать их на тех уровнях, что соответствуют прошлой отчетности. Европейский центр профилактики и контроля заболеваний (ECDC) и Европейское региональное бюро ВОЗ в сотрудничестве с государствами-членами и партнерами внимательно изучат воздействие COVID-19 на эпиднадзор за ВИЧ- инфекцией ради обеспечения поддержания высоких стандартов европейских данных по ВИЧ/СПИДу. Несмотря на то, что заражение ВИЧ-инфекцией предотвратимо, показатели ВИЧ-инфицирования в Европейском регионе ВОЗ продолжают оставаться высокими. В 2019 г. в 47 из 53 стран Региона было зарегистрировано 136 449 новых случаев ВИЧ-инфекции,1 включая 24 801 случай в странах Европейского союза/Европейской экономической зоны (ЕС/ЕЭЗ). Это соответствует показателю заболеваемости, равному 15,6 впервые установленных диагнозов ВИЧ-инфекции на 100 000 населения (таблица A). По-прежнему, как и в течение всего последнего десятилетия, частота ВИЧ-инфицирования и общее число впервые выявленных случаев ВИЧ-инфекции были самыми высокими на востоке Региона (41,7 на 100 000 населения), более низкими на западе и в ЕС/ЕЭЗ (5,7 и 5,4 на 100 000, соответственно) и самыми низкими – в центральной его части2 (3,4 на 100 000 населения) (таблица A). Преобладающие пути передачи ВИЧ также различались в зависимости от географической зоны, указывая на неоднородность эпидемиологической ситуации по ВИЧ-инфекции в Европе. Преобладающими путями передачи ВИЧ- инфекции в странах ЕС/ЕЭЗ были половые контакты между мужчинами, а в восточной части Региона 1 Отсутствуют данные по Андорре, Бельгии, Монако, Северной Македонии, Туркменистану и Узбекистану. Лихтенштейн является членом ЕЭЗ, но не государством-членом ВОЗ, поэтому сведения о Лихтенштейне включены в итоговые данные по ЕС/ЕЭЗ, но не включены в итоговые данные по Европейскому региону ВОЗ. 2 Группировка стран Европейского региона ВОЗ на страны западной части Региона (23 страны), центральной его части (15 страны) и восточной (15 стран) основана на эпидемиологических характеристиках и соответствует разделению стран в предыдущих обзорах, опубликованных EuroHIV в период с 1984 г.: подробнее см. приложение 1, рисунок A1.1. Таблица A. Эпидемиологические характеристики впервые установленных диагнозов ВИЧ-инфекции и СПИДа, зарегистрированных в Европейском регионе ВОЗ, ЕС/ЕЭЗ, а также в западной, центральной и восточной частях Региона, 2019 г. Европейский регион ВОЗ Запад Центр Восток ЕС/ЕЭЗ Страны, предоставляющие данные/число странa 47/53 20/23 14/15 13/15 30/31 Number of new HIV diagnoses 136 449 21 793 6 814 107 842 24 801 Число впервые выявленных случаев ВИЧ-инфекцииb 15,6 5,2 3,4 41,7 5,4 Доля случаев в возрастной группе 15-24 лет 8,5% 10,2% 15,0% 5,7% 10,3% Доля случаев в возрастной группе 50+ 17,8% 22,0% 13,7% 16,1% 20,4% Соотношение мужчины/женщины 1,8 2,9 5,5 1,6 3,1 Путь передачи инфекции Половые контакты между мужчинами 20,7% 39,9% 27,3% 3,9% 38,7% Гетеросексуальная передача (мужчины) 26,4% 16,2% 18,2% 36,3% 16,1% Гетеросексуальная передача (женщины) 23,8% 17,8% 7,2% 32,6% 16,7% Употребление инъекционных наркотиков 13,0% 3,4% 2,1% 23,2% 3,9% Передача ВИЧ от матери ребенку (вертикальный путь) 0,7% 0,7% 0,5% 0,8% 0,7% Неизвестный 15,3% 21,6% 44,5% 3,1% 23,6% СПИД и поздняя диагностика ВИЧ-инфекции Доля впервые выявленных случаев ВИЧ-инфекции с числом CD4 <350 клеток/мм3 53,2% 48,8% 55,9% 55,7% 49,7% Число новых случаев СПИДаc 12535 2156 802 9577 2772 Частота новых случаев СПИДа на 100 000 населения 2,0 0,5 0,4 8,3 0,5 a Отсутствуют данные по Андорре, Бельгии, Монако, Северной Македонии, Туркменистану и Узбекистану. b Показатели заболеваемости в ЕС/ЕЭЗ скорректированы с учетом задержки отчетности (приложение 6); Расчетное число новых случаев с учетом задержки отчетности составляет 27 231 и 23 971 , соответственно. c Отсутствуют данные по Северной Македонии, Швеции, Туркменистану и Узбекистану 12 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data – гетеросексуальные контакты и употребление инъекционных наркотиков. В Европейском регионе ВОЗ за последнее десятилетие число людей с впервые выявленной ВИЧ-инфекцией увеличилось на 16%. В то же время в странах ЕС/ЕЭЗ в этот же период число новых диагнозов ВИЧ- инфекции сократилось на 9% (рис. A). При сопоставлении числа новых диагностированных случаев ВИЧ-инфекции с предполагаемым числом новых ВИЧ-инфекций за последнее десятилетие становится очевидным, что в течение большей части этого периода количество людей, заразившихся ВИЧ, превышает количество диагностированных случаев ВИЧ-инфекции, что свидетельствует о росте числа людей, живущих с не диагностированной ВИЧ- инфекцией в Регионе. Напротив, в ЕС/ЕЭЗ, согласно расчетным данным, число впервые выявленных случаев ВИЧ-инфекции превышает число людей, инфицированных ВИЧ, что свидетельствует о сокращении доли людей, живущих с не диагностированной ВИЧ-инфекцией. В Регионе в целом частота новых случаев ВИЧ- инфекции среди мужчин увеличивалась более быстрыми темпами, чем среди женщин; к 2019 г. этот показатель у мужчин был в два раза выше, чем у женщин. В ЕС/ЕЭЗ частота новых диагнозов ВИЧ- инфекции снизилась как у мужчин, так и у женщин, но у женщин темпы снижения были более быстрыми; к 2019 г. этот показатель у мужчин был в три раза выше, чем у женщин (рис. B). Уровень зарегистрированной заболеваемости ВИЧ- инфекцией в Регионе также был выше среди мужчин, чем среди женщин во всех возрастных группах, за исключением лиц моложе 15 лет (таблица 9). В Европейском регионе в 2019 г. чуть более половины (53%) впервые выявленных случаев заражения ВИЧ были диагностированы на поздней стадии инфекции (количество CD4-лимфоцитов < 350 клеток/мм3 на момент установления диагноза). Этот показатель был самым высоким в странах восточной части Региона (56%) и в центре (56%) и самым низким в странах западной его части (49%), в то время как в странах ЕС/ЕЭЗ поздняя диагностика отмечалась в 50% случаев (таблица А). В 2019 г. в 45 государствах-членах в Европейском регионе ВОЗ было зарегистрировано 12 535 новых случаев СПИДа,3 что соответствует показателю заболеваемости СПИДом, равному 1,7 на 100 000 населения (см. таблицу A, а также таблицу 14). В 2019 г. в странах ЕС/ЕЭЗ было зарегистрировано 2 772 случая заболевания СПИДом – 0,5 случаев на 100 000 населения. В течение последнего десятилетия заболеваемость СПИДом в западной части Региона и в странах ЕС/ЕЭЗ продолжала неуклонно снижаться (см. рис. 1.17 и 2.4). В то же время в восточной его части заболеваемость СПИДом продолжала увеличиваться, хотя в период с 2012 по 2018 г. она начала стабилизироваться и даже снизилась в 2019 г. Европейский союз и Европейская экономическая зона В 2019 г. в 30 странах ЕС/ЕЭЗ диагноз ВИЧ-инфекции был поставлен 26 24 801 человеку, что соответствует частоте, равной 5.4 на 100 000 населения с поправкой на задержку отчетности (таблица 1, приложение 6). Самые высокие показатели ВИЧ-инфицирования 3 Отсутствуют данные по Андорре, Бельгии, Монако, Российской Федерации, Северной Македонии, Туркменистану, Узбекистану и Швеции. (Российская Федерация подала сведения только по впервые установленным диагнозам ВИЧ-инфекции с разбивкой по полу и данные о тестировании на ВИЧ). Рисунок A. Данные по ЕС/ЕЭЗ и Европейскому региону ВОЗ: расчетное число новых случаев ВИЧ-инфекции и число впервые выявленных случаев ВИЧ-инфекции, 2010-2019 гг., а также цель на 2020 год 20202019201820172016201520142013201220112010 Чи сл о вп ер вы е вы яв ле нн ы х сл уч ае в ВИ Ч- ин ф ек ци и и ра сч ет но е чи сл о но вы х сл уч ае в ВИ Ч- ин ф ек ци и Год постановки диагноза 0 50 000 100 000 150 000 200 000 Цель на 2020 г., ЕС/ЕЭЗ Цель на 2020 г., Европейский регион ВОЗ Расчетное число новых случаев ВИЧ-инфекции, ЕС/ЕЭЗ Впервые выявленные случаи ВИЧ-инфекции, ЕС/ЕЭЗ Впервые выявленные случаи ВИЧ-инфекции, Европейский регион ВОЗ Расчетное число новых случаев ВИЧ- инфекции в Европейском регионе ВОЗ 13 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT были зарегистрированы на Мальте (16,2; 80 случаев), в Латвии (15,4; 295 случаев) и Эстонии (13,4; 178 случаев), а самые низкие – в Словакии (1,9; 101 случаев) и Словении (1,6; 34 случая) (таблица 1, карта A). Частота новых случаев ВИЧ-инфекции была выше среди мужчин (7,5 на 100 000 населения; таблица 2), чем среди женщин (2,4 на 100 000 населения; таблица 3). Общее процентное соотношение случаев ВИЧ- инфицирования у мужчин и женщин составило 3,1 (таблица A). Это соотношение, которое было самым высоким в Хорватии (19,4) и Венгрии (13,0), превышало 1 во всех странах ЕС/ЕЭЗ (рис. 1.1). Преобладающим путем передачи в странах с наиболее высоким процентным соотношением случаев ВИЧ-инфицирования у мужчин и женщин были половые контакты между мужчинами. Анализ половозрастных показателей указывает на то, что заболеваемость ВИЧ-инфекцией у мужчин была выше, чем у женщин во всех возрастных группах, за исключением возрастной группы до 15 лет, в которой показатели заболеваемости мужчин и женщин были аналогично низкими (рис. 1.2). Наибольший повозрастной показатель впервые выявленных случаев ВИЧ-инфекции отмечался в возрастной группе 25–29 лет (18,0 на 100 000 населения), в то время как наиболее высокий повозрастной показатель у женщин отмечался в возрастной группе 30–39 лет (6,1 на 100 000 населения) (рис. 1.2). Молодые люди в возрасте от 15 до 24 лет составляют 11% населения ЕС/ЕЭЗ, и среди них в 2019 г. было установлено 11% диагнозов ВИЧ- инфекции. Сорок один процент населения ЕС/СЭЗ составляют пожилые люди (50 лет и старше), на долю которых приходится 21% новых случаев ВИЧ- инфекции, зарегистрированных в 2019 г. (рис. 1.4). Половые контакты между мужчинами остаются преобладающим путем передачи ВИЧ-инфекции в ЕС/ ЕЭЗ; на этот путь инфицирования пришлось39% (9598) всех случаев ВИЧ-инфекции, диагностированных в 2019 г., и более половины (51%) таких случаев с известным путем передачи (таблица 4, таблица 8, рис. 1.5). Среди диагнозов ВИЧ- инфекции с известным путем передачи ВИЧ-инфекции преобладали случаи инфицирования при половых контактах между мужчинами, на долю которых приходилось свыше 60% впервые установленных диагнозов ВИЧ-инфекции в 10 странах (Венгрия, Германия, Исландия, Испания, Нидерланды, Польша, Словакия, Словения, Хорватия и Чешская Республика; рис. 1.5). Гетеросексуальные контакты были вторым наиболее распространенным путем передачи ВИЧ-инфекции среди лиц, впервые диагностированных в ЕС/ЕЭЗ в 2019 г.; на этот путь заражения пришлось 33% (8 164 случая) новых диагностированных случаев ВИЧ- инфекции и 43% таких случаев с известным путем передачи (таблица 6, таблица 8, рис. 1.5). Гетеросексуальные контакты были наиболее распространенным известным путем передачи ВИЧ- инфекции в девяти странах ЕС/ЕЭЗ (Кипр, Латвия, Люксембург, Норвегия, Португалия, Румыния, Франция, Швеция и Эстония). На заражение ВИЧ при употреблении инъекционных наркотиков пришлось 4% случаев ВИЧ-инфекции диагностированных в 2019 г.; употребление инъекционных наркотиков является вероятным путем ВИЧ-инфицирования для одной четверти или более новых случаев ВИЧ-инфекции, зарегистрированных в Латвии (26%) и Литве (38%) (таблица 5, таблица 8, рис. 1.5). В 2019 г. в странах ЕС/ЕЭЗ на вертикальную передачу пришлось менее 1% новых диагностированных случаев ВИЧ-инфекции, а в 24% таких случаев путь заражения либо не был указан, либо был указан как неизвестный (таблица A). Сорок четыре процента новых случаев ВИЧ- инфекции, зарегистрированных в ЕС/ЕЭЗ в 2019 г., были диагностированы у мигрантов, родившихся за пределами страны, где им был поставлен диагноз (рис. 1.6). По месту рождения мигрантов Рисунок B. Частота впервые выявленных случаев ВИЧ-инфекции на 100 000 населения (с разбивкой по полу и году постановки диагноза) в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 2009-2018 гг. 0 5 10 15 20 25 Мужчины (ЕС/ЕЭЗ) Мужчины (Европейский регион ВОЗ) Женщины (ЕС/ЕЭЗ) Женщины (Европейский регион ВОЗ) 2019201820172016201520142013201220112010 Ча ст от а вп ер вы е вы яв ле нн ы х сл уч ае в В И Ч- ин ф ек ци и на 1 00 0 00 н ас ел ен ия Год постановки диагноза 14 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data распределение было следующим: 18% – страны Африки к югу от Сахары, 9% – страны Латинской Америки и Карибского бассейна, 8% – другие страны Центральной и Восточной Европы и 3% – другие страны Западной Европы. В период с 2010 г. по 2019 г. наметилась тенденция к незначительному снижению частоты установления диагнозов ВИЧ-инфекции. Данные показатели составляли 6,6 на 100 000 населения в начале этого периода, с последующим постепенным снижением до 4,9 на 100 000 в 2019 г. (таблица 1, рис. 1.10, приложения 1, 5 и 6). Хотя в последнее десятилетие в ЕС/ЕЭЗ отмечено снижение показателей в целом, на страновом уровне наблюдаются различные тенденции. Ряд стран, включая Австрию, Данию, Испанию, Италию, Люксембург, Нидерланды, Норвегию, Португалию, Соединенное Королевство, Финляндию, Францию и Эстонию, также сообщили о снижении частоты впервые диагностированных случаев ВИЧ-инфекции даже после корректировки на изменения в охвате населения эпиднадзором и задержку отчетности. И, наоборот, с учетом задержки отчетности, количество диагнозов ВИЧ более чем удвоилось с 2010 г. на Кипре, Мальте и в Словакии и увеличилось более чем на 50% в Болгарии и Польше (таблица 1, приложение 6). В некоторых странах наблюдаются диспропорционально большие задержки подачи отчетности, что сопряжено с риском как завышения показателей, указывающих на снижение частоты новых случаев ВИЧ-инфекции, так и занижения показателей, указывающих на увеличение частоты таких случаев. Тенденции различаются и по половому, и по возрастному признаку. За период с 2010 г. повозрастные показатели снизились во всех возрастных группах, за исключением женщин старше 50 лет. Сравнение возрастных групп показывает, что показатели частоты выявления новых случаев ВИЧ- инфекции были устойчиво выше в группах 25–29 лет и 30–39 лет на протяжении всего анализируемого периода как у женщин, так и у мужчин (рис. 1.11a, 1.11b). Среди женщин средний возраст на момент установления диагноза ВИЧ-инфекции увеличился с 34 лет в 2010 г. до 37 лет в 2019 г., оставаясь стабильным у мужчин на уровне 37 лет. В старших возрастных группах регистрируется более высокая доля новых диагнозов ВИЧ-инфекции; так, если в 2010 г. 15% лиц, которым был впервые поставлен диагноз ВИЧ-инфекции, были старше 50 лет, то в 2019 г. этот показатель повысился до 20%. В структуре всех впервые выявленных случаев ВИЧ- инфекции доля случаев, обусловленных половыми контактами между мужчинами, увеличилась с 45% случаев в 2010 г. до 52% в 2015 г., а затем уменьшилась до 47% в 2019 г. (рис 1.13). В странах, регулярно подававших сведения, число диагнозов ВИЧ- инфекции среди МСМ стабильно увеличивалось с 8 730 случаев в 2010 г., достигнув в 2014 г. пикового значения, равного 9 839 случаев. В 2019 г. было зарегистрировано меньшее количество новых случаев ВИЧ-инфекции (6688), в этой же группе стран, даже после корректировки на задержку отчетности. Однако главным образом снижение, вероятнее всего, объясняется меньшим количеством новых случаев ВИЧ-инфекции среди мужчин, практикующих секс с мужчинами (МСМ) в Австрии, Германии, Греции, Испании, Италии, Люксембурге, Нидерландах, Норвегии, Португалии, Соединенном Королевстве, Финляндии и Франции (таблица 4) со значительным повышением в последние годы этих показателей, отмеченном в Болгарии, на Кипре, в Литве, Польше, Румынии, Словакии, Эстонии. В анализируемый период число случаев ВИЧ- инфицирования среди МСМ, родившихся за пределами подающей сведения страны, увеличилось, несколько снизившись в 2016-2019 гг., но не в той же степени, что наблюдалась среди МСМ, родившихся в странах ЕС/ЕЭЗ (рис. 1.14). Рисунок C. Доля лиц с поздно выявленной ВИЧ-инфекцией (CD4 < 350 клеток/мм3) с разбивкой по полу, возрасту и пути заражения, Европейский регион ВОЗ, 2019 г. (n = 39 496) 0 10 20 30 40 50 60 70 Процентная доля 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 П ол Во зр ас т П ут ь пе ре да чи 15 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT В течение последнего десятилетия число новых случаев ВИЧ-инфекции с гетеросексуальным путем передачи последовательно снижалось (рис. 1.13а), причем такое снижение было более выраженным среди женщин и гетеросексуалов, родившихся за границей, чем среди мужчин и коренных жителей Региона (рис. 1.13a, 1.14). Несмотря на общее снижение частоты новых случаев ВИЧ-инфекции вследствие гетеросексуальных контактов, в Литве и Словакии было отмечено существенное повышение этого показателя. Число впервые диагностированных случаев ВИЧ- инфекции, обусловленных употреблением инъекционных наркотиков, в период с 2010 г. снизилось как среди лиц, родившихся за границей, так и среди коренных жителей – за исключением локальных вспышек в 2011–2012 гг., повлиявших на тенденцию показателей в этой группе населения в странах ЕС/ЕЭЗ, и менее широких локальных вспышек, отмеченных в этот же период времени в ряде других стран (таблица 5, рис. 1.13a, 1.14). Частота передачи от матери ребенку, внутрибольничного инфицирования и инфицирования при переливании крови также последовательно снижались в период с 2010 г. по 2019 г., и теперь такие пути передачи обусловливают менее 1% впервые диагностированных случаев ВИЧ-инфекции (таблица 8). Число случаев с неизвестным путем передачи увеличился с 14% в 2010 г. до 22% в 2019 г. Информация о количестве CD4-лимфоцитов на момент установления диагноза ВИЧ-инфекции была предоставлена 26 странами (таблица 13). Среди всех случаев ВИЧ-инфекции, диагностированных в 2019 г., по которым имелась информация о количестве CD4- лимфоцитов или об острой стадии ВИЧ-инфекции, 12% (1 896) случаев были зарегистрированы как острая стадия ВИЧ-инфекции и 26% (4 122) – как случаи недавнего заражения ВИЧ (с количеством CD4-лимфоцитов выше 500 клеток/мм3 на момент установления диагноза). Среди тех МСМ, у которых ВИЧ-инфекция была впервые выявлена в 2019 г. и о которых имелась соответствующая информация, 15% (1 116) случаев были зарегистрированы как случаи острой ВИЧ-инфекции, а у 30% (2 192) количество CD4- лимфоцитов было выше 500 клеток/мм3 на момент установления диагноза (рис.1.7). Как и в предыдущие годы, почти в половине (50%) всех случаев ВИЧ-инфекции с определением количества CD4-лимфоцитов диагноз был поставлен через несколько лет после заражения, когда количество CD4-лимфоцитов было менее 350 клеток/мм3; при этом считается, что 30% пациентов на момент установления диагноза были на поздних стадиях ВИЧ-болезни (количество CD4 < 200 клеток/мм3). Наибольшая доля людей с ВИЧ-инфекцией, впервые выявленной на поздних стадиях (CD4 <350/мм3) отмечалась среди женщин (53%), людей среднего и пожилого возраста (54% в возрасте 40–49 лет и 65% в возрасте старше 50) лет, мужчин и женщин, инфицировавшихся при гетеросексуальных контактах (61% и 53%, соответственно), людей, инфицировавшихся ВИЧ вследствие употреблении инъекционных наркотиков (52%), мигрантов из стран Африки, расположенных к югу от Сахары (57%), а также мигрантов из Южной и Юго-Восточной Азии (54%) (рис. 1.8, таблица 13). В странах, регулярно подававших сведения о путях передачи и количестве клеток CD4-лимфоцитов на момент установления диагноза в динамике, количество лиц, которым диагноз был поставлен на поздних стадиях (количество CD4-лифоцитов < 350 клеток/мм3 на момент установления диагноза), сократилось на 29%, с 7 441 в 2010 г. до 5 265 в 2019 г. Снижение числа случаев поздней диагностики наблюдалось при всех путях передачи (рис. 1.15) с сокращением на 42% в группе женщин, инфицировавшихся ВИЧ гетеросексуальным путем (2 056 в 2010 г., 1 201 в 2019 г.), с сокращением на 40% в группе лиц, инфицировавшихся вследствие употребления инъекционных наркотиков (319 в 2010 г., 191 в 2019 г.), с сокращением на 29% среди гетеросексуальных мужчин (1 906 в 2010 г., 1 353 в 2019 г.) и с сокращением на 24% частоты передачи инфекции вследствие половых контактов между мужчинами (2 529 в 2010 г., 1 914 в 2019 г.) (рис. 1.15). В 2019 г. сведения о 2 772 диагнозах СПИДа были поданы 29 странами ЕС/ЕЭЗ,4 что соответствует показателю 0,5 случаев на 100 000 населения (таблица 14). В общей сложности, в 74% этих случаев диагноз СПИДа ставился в период, превышающий 90 дней с момента установления диагноза ВИЧ- инфекции, указывая на то, что большинство случаев СПИДа в странах ЕС/ЕЭЗ являются результатом поздней диагностики ВИЧ-инфекции. Эта закономерность характерна для всех пациентов вне зависимости от путей передачи ВИЧ-инфекции, за исключением людей, инфицировавшихся при употреблении инъекционных наркотиков, среди которых более половины (60%) случаев СПИДа диагностировались в период, превышающий 90 дней с момента установления диагноза ВИЧ-инфекции (рис. 1.16). В 2019 г. двадцать одна страна сообщила о выявлении (легочного и/или внелегочного) туберкулеза (ТБ) как СПИД-индикаторного заболевания у 14% лиц, которым диагноз СПИДа был установлен в 2019 г. (рис. 1.18). В ЕС/ЕЭЗ число случаев заболевания СПИДом за последнее десятилетие сократилось более чем вдвое (рис. 1.10). Такое снижение отмечается и среди мужчин, и среди женщин, а также среди всех категорий инфицированных, сгруппированных по путям передачи, но оно представляется наиболее выраженным у пациентов, заражение которых обусловлено употреблением инъекционных наркотиков (таблицы 15–20, рис. 1.17). Несмотря на общее сокращение частоты случаев СПИДа в масштабах ЕС/ЕЭЗ, в Венгрии и Чешской Республике в период с 2010 г. отмечался рост заболеваемости 4 Все страны ЕС/ЕЭЗ, за исключением Бельгии и Швеции. 16 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data СПИДом. Показатели смертности вследствие СПИДа в ЕС/ЕЭЗ неуклонно снижаются с середины 1990-х годов. Европейский регион ВОЗ В 2019 г. число зарегистрированных новых случаев ВИЧ-инфекции составило 136 449, что соответствует показателю 15,6 на 100 000 населения, то есть в Европейском регионе ВОЗ наблюдалось продолжение сокращения роста новых случаев ВИЧ- инфицирования, главным образом благодаря постоянному снижению этого показателя на западе и общей тенденции к его стабилизации на востоке. Тем не менее, треть стран в восточной части Региона отмечала ежегодный прирост новых случаев установления диагноза ВИЧ. Из 136 449 случаев ВИЧ-инфекции, выявленных в 2019 г., 79% были диагностированы в восточной части (107 842), 16% – в западной части (21 793) и 5% – в центральной части Региона (6 814) (таблица A). Наиболее высокий показатель заболеваемости также зафиксирован на востоке (41,7 на 100 000 населения), будучи диспропорционально выше, чем на западе (5,7 на 100 000 населения) и в центре Региона (3,4 на 100 000 населения) (таблица A). Частота новых диагностированных случаев ВИЧ- инфекции в 2019 г. существенно различались между странами Европейского региона ВОЗ. Самые высокие показатели на 100 000 населения отмечались в Российской Федерации (54,9), Украине (39,0), Республике Молдова (22,8) и Беларуси (22,6), а самые низкие – в Боснии и Герцеговине (0,9) и в Словении (1,6) (таблица 1). Общий показатель ВИЧ-инфицирования среди мужчин составлял 20,8 на 100 000 населения (таблица 2) и среди женщин – 10,6 на 100 000 населения (таблица 3). Наибольшая доля лиц с впервые диагностированной ВИЧ-инфекцией в 46 странах, предоставивших данные,5 на момент установления диагноза принадлежали к возрастной группе 30–39 лет (34%), 9% были молодыми людьми в возрасте 15–24 лет и 18% – людьми в возрасте 50 лет и старше. Соотношение новых случаев ВИЧ-инфекции у мужчин и женщин равнялось 1,8 с самым низким значением в восточной части Региона (1,6), более высоким значением в западной его части (2,9) и наивысшим значением – в центре (5,5). Наиболее распространенным путем передачи инфекции были гетеросексуальные контакты (50%), причем 10% таких случаев отмечены среди выходцев из стран, 5 Данные, предoставленные Российской Федерацией, ограничивались сведениями о новых случаях ВИЧ-инфекции с разбивкой по полу за 2009-2019 гг. и данными о тестировании на ВИЧ, что позволило включить российские данные в таблицы 1-3 и 25 и в рисунки, демонстрирующие динамику показателей ВИЧ-инфицирования. Данные о возрасте пациентов и путях передачи, представленные в настоящем докладе, охватывают страны, подавшие полный набор данных в единую европейскую систему эпиднадзора за ВИЧ-инфекцией ECDC/ВОЗ. расположенных за пределами Региона, с генерализованной эпидемией ВИЧ-инфекции, 21% инфицировались вследствие половых контактов между мужчинами, 13% – вследствие употребления инъекционных наркотиков и 0,7% – в результате передачи инфекции от матери ребенку. В 15% новых случаев ВИЧ-инфекции информация о пути передачи была неизвестна или отсутствовала (таблица A). В восточной части Региона в 12 странах, предоставивших данные о новых случаях ВИЧ- инфекции с известным путем передачи, 71% пациентов инфицировались при гетеросексуальных контактах и 24% – при употреблении инъекционных наркотиков; частота заражения при половых контактах между мужчинами оставалась низкой – на уровне 4% случаев (таблицы 4–6, 8). Основными путями передачи ВИЧ-инфекции в центральной части Региона были половые контакты между мужчинами (49%) и гетеросексуальные контакты (46%), но у 44% пациентов с впервые диагностированной ВИЧ- инфекцией информация о пути передачи отсутствовала. Половые контакты между мужчинами были преобладающим путем передачи ВИЧ-инфекции в 10 из 14 стран центральной части Региона. В западной части Региона основными путями заражения ВИЧ были половые контакты между мужчинами (40% случаев) и гетеросексуальные контакты (34% случаев, среди которых 39% приходилось на выходцев из стран с генерализованной эпидемией ВИЧ-инфекции). По 22% случаев новых диагнозов ВИЧ-инфекции подобная информация отсутствовала. За последние 10 лет в 47 странах, регулярно подававших сведения, частота выявления ВИЧ- инфекции увеличились на 9% с 14,1 на 100 000 населения в 2010 г. (118 726 случаев) до 15,4 на 100 000 населения в 2019 г. (136 449 случаев) (рис. 2.2). Увеличение происходило, главным образом, за счет сохранения восходящей тенденции в восточной части Региона, где этот показатель увеличился на 23%, с 39,9 на 100 000 (86 266 случаев) до 41,7 на 100 000 (107 842 случаев). В период с 2010 г. по 2019 г. в центральной части Региона этот показатель увеличился на 113% – с 1,6 до 3,4 на 100 000 населения (наибольшее относительное увеличение среди всех трех географических зон), в то время как в западной части Региона за тот же период он снизился на 31% – с 7,5 до 5,7 на 100 000 населения (рис. 2.2). В период 2010–2019 гг. сведения о путях передачи ВИЧ-инфекции регулярно подавались 39 странами (рис. 2.3). На востоке общий рост был обусловлен быстрым увеличением числа заражений ВИЧ- инфекцией половым путем – прирост на 57% для передачи при гетеросексуальных половых контактах и пятикратное увеличение для передачи при половых контактах между мужчинами. При гетеросексуальной передаче увеличение показателей было значительно более выраженным среди мужчин (103%), чем среди женщин (21%). Частота передачи инфекции 17 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT вследствие употребления инъекционных наркотиков снизилась на 36%, продолжая при этом оставаться на достаточно высоком уровне (рис. 2.9). В центре в период с 2010 г. по 2019 г. число инфицировавшихся при половых контактах между мужчинами, удвоилось; этот путь передачи преобладал в 12 из 14 стран при параллельном увеличении числа случаев передачи ВИЧ-инфекции гетеросексуальным путем на 48%. Частота передачи ВИЧ при употреблении инъекционных наркотиков стабилизировалась после вспышки, наблюдавшейся в Румынии в 2011– 2013 гг. (рис. 2.1). Доля новых случаев ВИЧ-инфекции вследствие употребления инъекционных наркотиков оставалась на уровне 6% и в 2010 г., и в 2019 г. (рис. 2.16). На Западе частота новых случаев ВИЧ- инфекции, обусловленных гетеросексуальными контактами, продолжала неуклонно снижаться, и в целом за десятилетний период она сократилась на 37%. В период с 2010 г. по 2019 г. частота заражения ВИЧ при употреблении инъекционных наркотиков снизилась на 34% и после пика в 2012 г., вызванного вспышкой в Греции, в настоящее время опять снижается. Число впервые выявленных случаев ВИЧ- инфекции, обусловленных половыми контактами между мужчинами, в сравнении с 2009 г. снизилось на 29%. Число новых диагнозов ВИЧ-инфекции с неизвестным путем передачи увеличилось на Западе на 37% (рис. 2.18). Поздняя диагностика ВИЧ-инфекции в Регионе остается проблемой. Среди людей старше 14 лет с впервые выявленной ВИЧ-инфекцией, по которым имелась информация о количестве CD4-лимфоцитов на момент установления диагноза, более чем у половины (53%) диагноз был поставлен поздно, когда число CD4-лимфоцитов снизилось до менее 350 клеток/мм3, включая 31% пациентов на поздних стадиях ВИЧ-болезни с количеством CD4 <200 клеток/ мм3. Доля людей с впервые выявленной ВИЧ- инфекцией на поздних стадиях (CD4 <350/мм3) варьировала в зависимости от пути передачи и возрастной группы, но была самой высокой среди инфицировавшихся при гетеросексуальных половых контактах (58%; 60% для мужчин и 55% для женщин) и при потреблении инъекционных наркотиков (52%), а самой низкой – среди мужчин, инфицировавшихся при половых контактах с мужчинами (42%) (рис. C). Эта доля повышается с увеличением возраста на момент установления диагноза в диапазоне от 35% среди людей в возрасте 15–19 лет до 67% среди людей в возрасте 50 лет и старше. Каких-либо значительных различий в частоте поздней диагностики в зависимости от пола выявлено не было (53% для мужчин и 54% для женщин), но в отношении мужчин эта схожесть маскирует различие между МСМ (которым, как правило, диагноз ставится раньше) и гетеросексуальными мужчинами (которым, как правило, диагноз ставится позже). Кроме того, отмечались незначительные различия в поздней диагностике и в зависимости от географии внутри Региона – 56% на востоке и в центре и 49% на западе. В 2019 г. в 45 государствах-членах в Европейском регионе ВОЗ6 СПИД был впервые диагностирован у 12 535 человек, и, таким образом, заболеваемость СПИДом составила 1,7 случая на 100 000 населения. В целом по Региону 76% случаев СПИДа были диагностированы на востоке, где показатель заболеваемости на 100 000 населения также был самым высоким (8,3); 18% случаев диагностировались на Западе (показатель 0,5 на 100 000 населения) и 6% – в центре Региона (0,4 на 100 000 населения) (таблица 14). У двадцати одного процента людей с диагностированным СПИДом были выявлен туберкулез как СПИД-индикаторное заболевание, частота которого варьировала от 13% случаев на Западе и 21% в центре до 28% на востоке. В период с 2010 г. по 2019 г. общая частота новых диагнозов СПИДа в Регионе сократилась на 23%, но тенденции развития СПИДа значительно различаются между тремя географическими регионами. На востоке показатель увеличился на 15%, с 7,2 в 2010 г. до 8,3 в 2019 г. В центральной части показатель оставался стабильным на уровне 0,4 на 100 000 населения, в то время как на Западе Региона продолжилась тенденция устойчивого снижения – сокращение на 69% с 1,6 в 2010 г. до 0,5 в 2019 г. (рис. 2.4). Выводы Передача ВИЧ-инфекции остается одной из важнейших нерешенных проблем общественного здравоохранения, которая затрагивает миллионы людей в Европейском регионе ВОЗ, особенно в восточной его части. На протяжении последних трех десятилетий в Европейском регионе ВОЗ ВИЧ- инфекция была диагностирована с официальной регистрацией у 2,1 миллионов, в том числе у свыше 710 000 людей, проживающих в ЕС/ЕЭЗ. В 2019 г. ВИЧ- инфекция была диагностирована более чем у 136 000 человек, что соответствует показателю 15,6 на 100 000 населения. Подавляющее большинство новых случаев ВИЧ-инфекции (79%) были выявлены в восточной части Региона, а 16% – на Западе. На Российскую Федерацию приходится 59% всех новых случаев ВИЧ-инфекции, зарегистрированных в Европейском регионе ВОЗ, и 74% – в восточной части Региона В трети стран в восточной части Европейского региона ВОЗ, подавших сведения, наблюдается тенденция к увеличению числа новых диагнозов ВИЧ-инфекции, хотя и в более медленном, нежели ранее, темпе. В последние три года в Российской Федерации отмечалось приостановление темпов прироста числа зарегистрированных новых случаев ВИЧ-инфекции; некоторые признаки стабилизации наблюдались также в Украине, что способствовало общей стабилизации эпидемии на востоке Региона. 6 Отсутствуют данные по Андорре, Бельгии, Монако, Российской Федерации, Северной Македонии, Туркменистану, Узбекистану и Швеции. 18 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data В Европейском регионе ВОЗ растет число людей, живущих с ВИЧ, с неустановленным диагнозом. По оценкам, за последнее десятилетие ежегодно инфицируется больше людей, чем ставится диагнозов. Напротив, в ЕС/ЕЭЗ доля людей, живущих с ВИЧ, с неустановленным диагнозом, сокращается. Хотя эпидемические модели и тенденции в разных странах Европейского региона ВОЗ варьируют в широких пределах, в некоторых частях Региона наблюдалось стойкое увеличение числа новых случаев заражения, связанных с определенными путями передачи инфекции, а именно: среди мужчин, имеющих половые контакты с мужчинами, в центре и на востоке, а также среди гетеросексуалов на востоке Региона, хотя некоторые исследования дают основания полагать, что последнее утверждение следует интерпретировать с осторожностью (1,2). За прошлые годы частота гетеросексуальной передачи ВИЧ-инфекции существенно сократилась в ЕС/ЕЭЗ и западной части Региона, особенно среди женщин, равно как и частота случаев передачи ВИЧ-инфекции при половых контактах между мужчинами в отдельных странах ЕС/ЕЭЗ и западной части Региона. Во многих странах продолжала снижаться частота передачи ВИЧ при употреблении инъекционных наркотиков, хотя в 2019 г. на этот путь заражения в восточной части Региона по-прежнему приходилось 24% впервые зарегистрированных случаев ВИЧ- инфекции с известным путем передачи. У слишком большого числа людей во всем Европейском регионе ВОЗ диагноз ВИЧ-инфекции ставится на поздних стадиях (53%), что повышает риск ухудшения состояния здоровья, летального исхода и дальнейшего распространения ВИЧ- инфекции. Большое число диагнозов СПИДа на востоке подтверждает, что поздняя диагностика ВИЧ- инфекции остается серьезной проблемой. В то же время тенденция к стабилизации заболеваемости СПИДом, наблюдаемая с 2012 г., может быть результатом того, что большинство стран восточной части Региона в настоящее время проводят политику «Лечить всех», согласно которой возможность получения антиретровирусной терапии (АРТ) предлагается всем людям, живущим с ВИЧ, независимо от стадии заболевания. Для обеспечения ранней диагностики и повышения числа людей, осведомленных о своем ВИЧ-статусе, требуются новые стратегии с расширением диапазона разнообразных и дружественных пользователю подходов к более широкодоступному тестированию на ВИЧ. Сводное руководство ВОЗ по самотестированию на ВИЧ и информированию партнеров и Руководство ECDC по комплексному тестированию на ВИЧ-инфекцию и гепатиты B и C содержат рекомендации по внедрению в практику тестирования инновационных подходов, включая самотестирование и тестирование на уровне местных сообществ, проводимое обученными поставщиками услуг без медицинского образования с использованием быстрых тестов как части общих услуг по тестированию на ВИЧ (3–5). ВОЗ выпустила аналитическую записку об отказе от использования вестерн-блоттинга и линейного иммуноанализа в стратегиях и алгоритмах тестирования на ВИЧ и переходе на поддержку децентрализованного тестирования и незамедлительного направления на лечение (6). Хотя предоставление услуг по тестированию на ВИЧ в Регионе со временем улучшилось и степень внедрения таких подходов, как самотестирование и тестирование на местных сообществ, значительно повысилась в последние годы, результаты мониторинга политики в рамках Региона указывают на то, что во многих европейских странах некоторые подходы к тестированию используются в ограниченных масштабах или вообще не применяются (7). Услуги по тестированию на ВИЧ должны сосредоточиваться на ключевых группах населения с учетом местных эпидемиологических особенностей, адаптироваться к конкретным потребностям этих групп, а также содействовать своевременному охвату такими услугами, как профилактика, лечение и помощь в связи с ВИЧ- инфекцией. Такой подход обеспечит более раннюю диагностику и начало лечения и приведет к улучшению исходов лечения и снижению ВИЧ- ассоциированной заболеваемости, болезненности и смертности, способствуя достижению целей «90-90- 90» и других региональных и глобальных целевых ориентиров (8–10). Имеются убедительные фактические данные о том, что раннее начало АРТ полезно как для здоровья людей, получающих лечение, так и для предотвращения дальнейшей передачи ВИЧ (11–16). Почти в 90% стран Европейского региона ВОЗ существует политика назначения АРТ вне зависимости от количества CD4-лимфоцитов (17,18). В феврале 2020 г. Европейское региональное бюро ВОЗ организовало в Восточной Европе и Центральной Азии (ВЕЦА) региональный семинар, посвященный науке внедрения в практику методов борьбы с ВИЧ- инфекцией и вирусными гепатитами (19). Семинар проводился с целью оказания поддержки странам ВЕЦА в проведении научных исследований и применении научных и программных данных как руководящих указаний при реализации рекомендаций ВОЗ в практике программ по борьбе с ВИЧ и вирусными гепатитами. Помимо прочего, обсуждалась оценка валидности данных планового эпиднадзора с сосредоточением внимания на сведениях о путях передачи ВИЧ и выявление препятствий на пути к достижению цели – 90% всех инфекций должно диагностироваться путем оптимизации вмешательств по тестированию, а также внедрение и расширение масштабов доконтактной профилактики (ДКП). Рекомендовалось улучшение связей с системой оказания помощи и удержания в ней, повышение качества помощи и ведения коморбидных состояний. Семинар был также направлен на содействие сотрудничеству между 19 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT исследователями, учеными, донорами и партнерами для проведения научного поиска и оказания поддержки науки внедрения в странах ВЕЦА. Меры противодействия эпидемии ВИЧ-инфекции должны основываться на научных данных и адаптироваться к национальной и местной эпидемиологической ситуации. На основании исчерпывающих данных эпиднадзора, приведенных в настоящем докладе, можно сделать следующие выводы: • Что касается стран ЕС/ЕЭЗ и западной части Региона, то с учетом преобладания передачи ВИЧ- инфекции среди МСМ и повышения частоты ВИЧ- инфицирования МСМ в некоторых странах представляется, что существующие вмешательства по профилактике, лечению и оказанию помощи в связи с ВИЧ, направленные на МСМ, требуют даль- нейшего расширения и укрепления; они должны оставаться приоритетным направлением ответных мер в связи с ВИЧ. Страны со снижением показате- лей продемонстрировали воздействие изменения характера деятельности, выражающееся в более частом тестировании на ВИЧ подвергающихся риску гомосексуальных мужчин и незамедлитель- ном охвате диспансерным наблюдением и антире- тровирусной терапией всех выявленных ВИЧ-положительных лиц (20). Многокомпонентные вмешательства и включение в комплекс мероприя- тий по профилактике и противодействию таких подходов, как ДКП ВИЧ-инфекции, скрининг и лече- ние инфекций, передаваемых половым путем, самотестирование и содействие добровольному информированию партнера, могли бы помочь оста- новить тенденции к росту показателей, наблюдае- мые в некоторых странах. В большинстве европейских стран уровень использования ДКП значительно ниже предполагаемой потребности (3,21–23). Во многих странах западной части Региона необходимо более широко внедрять эффективные и доступные услуги по тестирова- нию, профилактике и помощи, предназначенные для становящейся все более разнообразной группы мигрантов, подвергающихся риску заражения ВИЧ или живущих с ВИЧ. Увеличение в 2011–2012 гг. числа случаев ВИЧ-инфекции у людей, употребляю- щих инъекционные наркотики, и продолжающиеся в ряде стран местные вспышки (24–28) свидетель- ствуют о необходимости поддержания или расши- рения масштабов программ снижения вреда. • В странах в центральной части Региона заболевае- мость ВИЧ-инфекцией растет быстрее, чем в любой другой части Европейского региона ВОЗ. В центре отмечается очень значительные различия в частоте новых случаев ВИЧ-инфекции между мужчинами и женщинами: среди мужчин, особенно среди МСМ, наблюдается тревожный рост этого показателя по сравнению с довольно стабильной динамикой среди женщин. Половые контакты между мужчи- нами являются преобладающим путем передачи ВИЧ-инфекции в 13 из 14 стран центральной части Региона. Для изменения подобной ситуации необ- ходимы вмешательства, такие как ДКП для групп высокого риска, тестирование на ВИЧ, проводимое поставщиками услуг без медицинского образова- ния; экспресс-тестирование на ВИЧ, самотестиро- вание на ВИЧ и содействие добровольному информированию партнера, наряду с политикой и практикой предложения АРТ всем людям, живущим с ВИЧ. В ряде стран после прекращения финанси- рования со стороны Глобального фонда для борьбы со СПИДом, туберкулезом и малярией произошел переход на практику внутреннего финансирования мер реагирования на ВИЧ. Однако в связи с таким переходом возникла проблема с устойчивостью финансирования, что особенно сказалось на финансировании программ профилактики ВИЧ- инфекции. Для смягчения некоторых возникающих проблем и предотвращения ускорения темпов рас- пространения эпидемии необходимо усиление политической поддержки и помощи наряду с акти- визацией вовлечения гражданского общества (29). • В странах в восточной части Региона существует настоятельная необходимость продолжить расши- рение масштабов смелых, научно-обоснованных вмешательств и обеспечить предоставление более эффективных, комплексных услуг в рамках систем здравоохранения, обращающих больше внимания на социальные детерминанты здоровья. Нужны комплексные и инновационные стратегии тестиро- вания на ВИЧ с особым упором на охват ключевых групп населения. Этого можно достичь с помощью дружественных пользователю услуг по профилак- тике и тестированию, включая содействие инфор- мированию партнера, ДКП, тестирование на ВИЧ, проводимое обученными поставщиками услуг без медицинского образования и самотестирование в соответствие с рекомендациями ВОЗ. Все эти услуги должны быть интегрированы в националь- ную политику и программы, а затем осуществлены на практике (3,4,10,30). Привлечение обществен- ности к разработке и оказанию лечебно-профилак- тических услуг имеет решающее значение для сокращения числа новых случаев инфицирования ВИЧ и увеличения числа людей, охваченных дис- пансерным наблюдением и получающих АРТ, с конечной целью снижения высоких показателей заболеваемости ВИЧ и смертности вследствие СПИДа. Инновационные вмешательства по профи- лактике ВИЧ-инфекции должны быть направлены на снижение риска гетеросексуальной передачи, особенно среди пар, в которых один из партнеров склонен к поведению высокого риска (такого как, например, употребление инъекционных наркоти- ков) или в течение длительных периодов времени работает за рубежом. Большое количество впер- вые диагностированных случаев ВИЧ-инфекции у людей, инфицировавшихся при употреблении инъ- екционных наркотиков, подчеркивает, что научно- обоснованная политика, сосредоточенная на ключевых группах населения и предусматриваю- щая высокий уровень охвата программами 20 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data снижения вреда людей, употребляющих инъекци- онные наркотики, и других научно-обоснованных подходов, по-прежнему играет важнейшую роль в эффективном противодействии ВИЧ-инфекции в восточной части Региона. Надежные данные эпиднадзора имеют решающее значение для мониторинга ситуации и принятия службами общественного здравоохранения информированных решений относительно точных и своевременных мер реагирования на европейскую эпидемию ВИЧ-инфекции. Полнота данных об известных путях передачи и количестве клеток CD4- лимфоцитов на момент установления диагноза в Регионе субоптимальна, главным образом из-за неполноты сведений, подаваемых такими крупными странами, как Германия, Польша, Российская Федерация и Турция, или отсутствия данных. Некоторые исследования, проводившиеся в восточной части Региона, выявили, что информация о путях передачи может содержать погрешность, так как у многих пациентов, зарегистрированных как случаи заражения гетеросексуальным путем, есть анамнез употребления инъекционных наркотиков или, в случае мужчин, – половые контакты между мужчинами (1,2). Это обстоятельство подчеркивает важность оценки достоверности данных планового эпиднадзора, касающихся путей передачи, особенно в странах, где употребление инъекционных наркотиков и гомосексуальность стигматизированы. Постепенно увеличивается число стран, проводящих усиленный эпиднадзор за ВИЧ-инфекцией и подающих собранные сведения об эпидемиологической обстановке на европейский уровень. В 2019 г. 41 страна предоставила сопряженные данные о ВИЧ- инфекции и СПИДе, что позволило лучше понять клиническое состояние людей с диагностированной ВИЧ-инфекцией. Такой подход расширяет возможности более долгосрочного мониторинга конечных результатов оказания преемственной медицинской помощи в связи с ВИЧ-инфекцией, например, путем моделирования доли не диагностированных случаев инфекции и количественной оценки таких параметров, как направление людей с диагностированной ВИЧ- инфекцией в систему оказания помощи и лечения для достижения вирусной супрессии. Кроме того, это может поддержать национальные и глобальные усилия по мониторингу прогресса в достижении целей 90–90–90 и иных глобальных и региональных целевых ориентиров. В сентябре 2020 г., отражая ситуацию с пандемией COVID-19, Европейское региональное бюро ВОЗ и ECDC организовали совместное виртуальное совещание с основными национальными заинтересованными сторонами, участвующими в принятии мер реагирования на туберкулез, ВИЧ и вирусные гепатиты, включая ключевых партнеров, доноров, затронутые сообщества и организации гражданского общества. Цель заключалась в обмене информацией и передовым опытом по поддержанию оказания основных услуг по борьбе с туберкулезом, ВИЧ и вирусными гепатитами. Страны и партнеры обсудили свой опыт в обеспечении доступа к качественным услугам в связи с ВИЧ и преемственности оказания помощи во время пандемии COVID-19, а также о том, как они отслеживают воздействие пандемии COVID-19 на услуги в связи с ВИЧ. В ходе совещания обсуждались также последнее руководство и рекомендации ВОЗ по вопросам политики борьбы с туберкулезом, ВИЧ и вирусными гепатитами и ведения коморбидных состояний. Ссылки7 1. 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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). 27. McAuley A, Palmateer NE, Goldberg DJ, Trayner KMA, Shepherd SJ, Gunson RN et al. Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross-sec- tional analysis. Lancet HIV 2019;6(5):e315–24. 28. Des Jarlais DC, Sypsa V, Feelemyer J, Abagiu AO, Arendt V, Broz D et al. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV 2020;7(6):e434–42. 29. 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). 30. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. 2016 update. Geneva: World Health Organization [Сводное руководство по ВИЧ-инфекции в ключевых группах населения: профилактика, диагностика, лечение и уход. Обновление 2016 г. Женева: Всемирная организация здравоохранения]; 2017 (https://www.who.int/hiv/ pub/guidelines/keypopulations-2016/en/).

23 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT 1.1 HIV diagnoses In 2019, 24 801 new HIV diagnoses were reported in 30 countries of the EU/EEA,9 with a rate of 5.4 per 100 000 when adjusted for reporting delay (Table 1, Annex 6). The highest rates were reported by Malta (16.2; 80 cases), Latvia (15.4; 295) and Estonia (13.4; 178), and the lowest by Slovakia (1.9; 101 cases) and Slovenia (1.6; 34) (Table 1, Map 1). As in previous years, more men than women were diagnosed with HIV in 2019 (18 588 and 6086, respectively), resulting in an overall male-to-female ratio of 3.1 : 1 (Tables 2 and 3, Fig. 1.1). This ratio was highest in Croatia (19.4) and Hungary (13.0) and was above one in all countries in the EU/EEA (Fig. 1.1). The predominant mode of transmission in countries with the highest male-to-female ratios was sex between men. The overall rate of new diagnoses in men was 7.5 per 100 000 population (Table 2) and for women 2.4 per 100 000 population (Table 3). In addition to the 24 674 cases with male or female gender, 127 individuals with 9 Besides Belgium, all EU/EEA countries and the United Kingdom reported data for 2019. unknown or “other” gender were diagnosed with HIV in 2019. Current reporting systems at European level are not able effectively to differentiate how many of these cases are transgender men or women and how many are cases with unknown information reported on gender. Age-specific rates were lowest in persons under 15 years of age (0.2 per 100 000 population for both males and females) (Fig. 1.2). In all other age groups, men had higher age-specific rates than women. The highest overall age-specific rate of HIV diagnoses was observed among 25–29-year-olds (12.0 per 100 000 population), largely because this age group has the highest age- specific rate for men at 18.0 per 100 000 population, while rates for women were highest in the 30–39 age group (6.1 per 100 000 population) (Fig. 1.2). The mean age at diagnosis was lower for MSM (36.4 years) than for cases attributed to injecting drug use (38.8 years) or heterosexual transmission (41.1 years overall, 38.9 in women and 43.4 in men). The 30–39 age group accounted for most HIV diagnoses overall (31%) and in all transmission groups (Fig. 1.3). One third of diagnoses attributed to sex between men were made Fig. 1.1. Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2019 (n = 24 674) 0 4 8 12 16 20 Latvia Estonia Sweden France Norway Cyprus Portugal United Kingdom Lithuania Ireland Finland Total EU/EEA Romania Denmark Luxembourg Greece Germany Malta Italy Iceland Slovenia Netherlands Bulgaria Austria Poland Spain Czechia Slovakia Hungary Croatia Male-to-female ratio Note: Belgium did not report data and Liechtenstein reported zero cases in 2019. 1. HIV and AIDS in the EU/EEA 24 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data before age 30, while 51% of HIV infections due to sex between men and women were diagnosed at 40 years or above, and more than one quarter (26%) at 50 or above. The age pattern among those newly diagnosed with HIV differed across countries, with 30% or more of new diagnoses among persons under 30 years in Czechia, Hungary, Ireland, Malta, Poland, Romania and Slovakia and 50% or more of new diagnoses among persons 40 years and older in Denmark and Italy (Fig. 1.4). Young people aged 15–24 years comprised 11% of the EU/EEA population and 11% of HIV diagnoses in 2019. Romania reported more than 15% of its HIV diagnoses in this age group (Fig. 1.5, Table 9). Forty-one per cent of the EU/EEA population consists of older adults (50 years and above), who comprised 21% of the new HIV diagnoses reported in 2019. Older adults comprised more than 25% of those newly diagnosed with HIV in Denmark, Finland and Italy (Fig. 1.4, Table 9). Data on transmission mode provide information on the groups in the EU/EEA who are most affected by HIV (Tables 4–8, Fig. 1.5). • Sex between men remains the most common mode of HIV transmission reported in the EU/EEA, accounting for 38.7% (9 598) of all new HIV diagnoses in 2019. Sex between men was the predominant route of transmission (50.6%) among those for whom route of transmission was known (Table 4, Table 8, Fig. 1.5) and accounted for more than 60% of new HIV diagnoses in 10 countries (Croatia, Czechia, Germany, Hungary, Iceland, 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% (8164) of all HIV diagnoses and 43% of diagnoses where the route of transmission 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 nine EU/EEA countries (Cyprus, Estonia, France, Latvia, Luxembourg, Norway, Portugal, Romania and Sweden). More than one third (41%; 2346) 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 Cyprus (79%) and Ireland (72%). Fig. 1.2. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2019 (n = 22 318) 0 5 10 15 20 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: this figure does not include Belgium (due to non-reporting) or Spain (due to non-national coverage of the surveillance data for 2019). Fig. 1.3. New HIV diagnoses, by age group and transmission mode, EU/EEA, 2019 0 20 40 60 80 100 Sex between men Heterosexual contact Injecting drug use 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years 50+ years n = 9598 n = 955 n = 8164 Percentage Tr an sm is si on m od e 25 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT • Four per cent (955 cases) of all new HIV diagnoses and 5% of those with known route of HIV transmission were attributed to injecting drug use (Table 5, Table 8, Fig. 1.4). Injecting drug use was the probable route of transmission for one fourth or more of the cases reported in Latvia (26%) and Lithuania (38%) (Fig. 1.5). • Of the remaining cases, 167 diagnoses (less than 1%) were reported as being due to vertical transmission during pregnancy, childbirth or breastfeeding (Table 7); 123 of these cases (74%) were born outside of the country in which the case was reported (Table 11). Fifty-two (0.3%) diagnoses were reported to be due to contaminated transfusion of blood and its products, and 21 cases to hospital-acquired infections (Table 8). The majority of these nosocomial and transfusion- related cases originated from outside of the country where the case was reported (Table 11). • Transmission mode was reported as unknown for 5844 diagnoses (23.6%), with wide variation among countries: less than 5% of diagnoses were reported with unknown transmission mode in Bulgaria, Czechia, Denmark, Luxembourg, Norway and Romania, and over 50% in Ireland and Poland (Table 8). Twenty-six EU/EEA countries provided information on the country of birth, country of nationality or region of origin for 20 430 (82%) HIV diagnoses in 2019 (Fig. 1.6). In the EU/EEA, 8977 diagnoses (44% of those with known information on region of origin) were reported among people originating from outside of the reporting country. Of these, 3619 (18% of those with known information on region of origin), irrespective of transmission mode, were reported among people originating from countries with generalized HIV epidemics in sub-Saharan Africa (Fig. 1.6, Table 10). An additional 26% of new diagnoses with known region of origin (5383 cases) were among people born outside of the reporting country who did not originate from a country experiencing a generalized epidemic, including 9% from countries in Latin America and the Caribbean (1858 cases), 8% from other countries in central and eastern Europe (1579 cases) and 3% from other countries in western Europe (712 cases). The countries with more than half of their new HIV diagnoses among people originating from outside of the reporting country were Cyprus, Denmark, Finland, France, Iceland, Ireland, Luxembourg, Norway, Sweden and the United Kingdom. In 2019, 16 countries reported data on whether the new HIV diagnosis reported had previously been diagnosed with HIV in another country, prior to their 2019 diagnosis in the reporting country. Of the 11 178 new HIV diagnoses in these 16 countries, 954 (8.5%) were previous positives. The proportion of 2019 diagnoses that had previously been diagnosed was higher than the EU/EEA Fig. 1.4. Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2019 (n = 24 715) Note: graph organizes countries in order of proportion of population < 50 years. Belgium did not report data and Liechtenstein reported zero cases in 2019. Unknown route of transmission is excluded from the proportions presented here. 0 20 40 60 80 100 Italy Finland Denmark Latvia Norway Portugal Austria France Germany United Kingdom Netherlands Estonia Luxembourg Malta Lithuania Total EU/EEA Sweden Greece Spain Romania Bulgaria Hungary Ireland Slovenia Czechia Poland Iceland Croatia Cyprus Slovakia 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 2020 – 2019 data Fig. 1.5. Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2019 (n = 18 957) 0 20 40 60 80 100 Latvia Estonia Lithuania Romania Norway Sweden Portugal Finland Cyprus France Italy Luxembourg Bulgaria United Kingdom Greece Total EU/EEA Denmark Ireland Austria Germany Spain Slovenia Iceland Slovakia Netherlands Czechia Poland Hungary Croatia Heterosexual contact (males) Sex between men Heterosexual contact (females) Injecting drug use Other Percentage Note: Belgium did not report data, Liechtenstein reported zero cases and Malta did not report transmission data in 2019. Unknown route of transmission is excluded from the 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, 2019 (n = 20 430) 0 20 40 60 80 100 Romania Poland Lithuania Croatia Bulgaria Estonia Italy Slovakia Czechia Slovenia Spain Greece Germany Total EU/EEA Austria Portugal Netherlands Denmark France Finland United Kingdom Cyprus Norway Luxembourg Sweden Ireland Iceland Percentage Central and eastern Europe Sub-Saharan Africa Western Europe Latin America and Caribbean South and south-east Asia Other Note: Belgium did not report data in 2019 and Hungary, Latvia and Malta did not report data on country of birth or region of origin. 27 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT average in some countries, including Cyprus (21%), Czechia (15%), Denmark (24%), Iceland (32%), Ireland (20%), Malta (16%), Norway (31%), Sweden (43%) and Slovakia (32%). Information on CD4 cell count at the time of HIV diagnosis was provided for 15 279 (68%) adults and adolescents diagnosed in 25 countries (Table 13). All countries reporting such data were able to provide CD4 cell counts for 50% or more of their reported cases, apart from Croatia, Estonia, Germany, Ireland, Latvia and Slovenia, all of which provided data for 35% of cases or fewer. Half (50%) of all cases with a CD4 cell count were considered to have been diagnosed several years after being infected, with a count of less than 350 cells per mm3, including 30% of cases considered to have advanced HIV infection (CD4 cell count less than 200 cells/mm3). The proportion of those diagnosed late (CD4 cell count below 350 cells per mm3) was above 60% among cases with known CD4 cell count at diagnosis in Bulgaria (62%), Cyprus (91%), Latvia (70%) and Romania (63%). Among all cases diagnosed in 2019 where information on CD4 cell count or acute HIV infection was available, 12% (1896) were reported as acute infections and 26% (4122) as more recent infection (with a CD4 cell count above 500 cells per mm3 at diagnosis) (data not shown). Among MSM diagnosed in 2019 where information was available, 15% (1116) were reported as acute infections and 30% (2192) had a CD4 cell count above 500 cells per mm3 at diagnosis (Fig. 1.7). When analysing CD4 cell count, the highest proportions of people presenting at a later stage of HIV infection (CD4 less than 350 cells/mm3) were observed among women (53%), older adults (54% in 40–49-year-olds and 65% in people over 50 years), men or women infected by heterosexual sex (61% and 53% respectively), people who acquired HIV through injecting drug use (52%), and migrants from sub-Saharan Africa (56%) and south and south-east Asia (54%) (Fig. 1.8, Table 13). The lowest proportions of late diagnosis (CD4 less than 350 cells/mm3) were observed among younger age groups (35% of those aged 15–24 years), men who acquired HIV through sex with another man (42%) and migrants from other western European countries (38%) (Fig. 1.8). The interval between the date of diagnosis and the date of the CD4 count was used as a proxy for time to linkage to care and, among cases where CD4 data were reported, 81% of those diagnosed in 2019 were linked to care within four days of HIV diagnosis and 99% were linked to care within three months (Fig. 1.9). 1.2 Trends in HIV diagnoses The trend in reported HIV diagnoses for the period 2010–2019 declined in recent years. Rates in the earlier part of this decade were 6.6 per 100 000 in 2010, increasing to 6.8 in 2012 and decreasing steadily thereafter to 5.4 in 2019 (27 231 cases when adjusted for reporting delay; see Table 1, Fig. 1.10 and Annexes 1 (for reporting delay adjustment methods), 5 (for country comments) and 6 (for results)). While the overall EU/EEA trend appears to have declined during the past decade, trends at national level vary. Several countries, including Austria, Denmark, Estonia, Finland, France, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom, have also reported a decline in rates of new diagnoses, even after adjusting for changes in population coverage of surveillance over time and for reporting delay. In contrast, since 2010, and taking reporting delay into account, rates of HIV diagnoses have more than doubled in Cyprus, Malta and Slovakia and have increased by more than 50% in Bulgaria and Poland (Table 1, Annex 6). Some countries are more affected by reporting delay, meaning that decreases in the rates of new HIV diagnoses may be overestimated and increases in rates underestimated. Trends differ by gender and age group. Age-specific rates have declined since 2010 in all age groups except for female adults over 50 years, where they have remained stable. HIV diagnosis rates in both women and Fig. 1.7. Acute infection or CD4 cell count per mm3 at HIV diagnosis, overall and by transmission group, EU/EEA, 2018 0 20 40 60 80 100 Total EU/EEA Sex between men Pe rc en ta ge Injecting drug useHeterosexual contact Acute infection 500+ 350 to < 500 200 to < 350 < 200 28 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Fig. 1.9. Linkage to care after HIV diagnosis, EU/EEA, 2019 (n = 2593) 0 20 40 60 80 100 0–4 days 5–28 days 29–91 days > 91 days Percentage Total Injecting drug use Sex between men Heterosexual contact Tr an sm is si on m od e Fig. 1.8. Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2019 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 and individuals previously diagnosed abroad are excluded from the proportions presented here. Note: cases with no or missing data on CD4 count or date and those who died within 91 days of diagnoses are excluded here. 29 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Fig. 1.10. People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2010–2019 0 1 2 3 4 5 6 7 8 2019201820172016201520142013201220112010 Year of diagnosis HIV AIDS Deaths Ra te p er 10 0 00 0 po pu la tio n Note: rates exclude countries not reporting consistently over the period: Belgium (HIV, AIDS and AIDS deaths), Sweden (AIDS and AIDS deaths), Italy and Denmark (AIDS deaths). men have consistently been higher among 25–29-year- olds and 30–39-year-olds throughout the period compared to other age groups. Age-specific rates in women have declined most markedly in those under 40 years. Rates among 20–29-year-old men peaked in 2015 and have declined since. Rates in men aged 15–24 and 30–49 years have declined since 2015. Meanwhile, rates in men over 50 have remained stable (Fig. 1.11a and 1.11b). The median age at HIV diagnosis between 2010 and 2019 increased from 36 years to 37 years overall (and from 34 to 37 years among women, while remaining at 37 years in men). The proportion of diagnoses reported in older age groups is growing; 15% of people diagnosed in 2010 were over 50 years at HIV diagnosis, rising to 20% in 2019. In women, 14% of diagnoses in 2010 and 20% in 2019 were among those aged 50 years or above, while in men, 16% of diagnoses in 2010 and 20% in 2019 were among those aged 50 years or above (data not shown). HIV diagnoses among those born outside of the reporting country comprised 40% of all new diagnoses in 2010, decreasing slightly to 37% in 2013 but increasing again in 2019 to 44% (Fig. 1.12). While the proportion of migrants from most regions has remained relatively stable since 2020, new diagnoses among people originating from countries in central and eastern Europe increased from 5% to 8% of all new diagnoses. Since 2010, most EU/EEA countries consistently have reported data on transmission mode. From those countries consistently reporting, and adjusting for reporting delay, the data over the past decade indicate the following. • The proportion of all HIV diagnoses attributed to sex between men increased from 45% of cases in 2010 to 52% in 2015, then decreased to 47% in 2019 (Fig. 1.13a and 1.13b). The number of HIV diagnoses reported among MSM in countries reporting consistently increased from 8730 cases in 2010 and peaked at 9839 in 2014. Even after adjusting for reporting delay, fewer cases were reported in 2019 (6888) in this same group of countries. Most of the decline in recent years appears to be due to fewer diagnoses among MSM in Austria, Finland, France, Germany, Greece, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom. Increases were observed in many EU/EEA countries between 2010 and 2019 (Table 4), with substantial increases noted in Bulgaria, Cyprus, Estonia, Lithuania, Poland, Romania and Slovakia in recent years. Cases attributed to MSM born outside of the reporting country increased during the period, declining slightly between 2016 and 2019 but not to the same extent as observed in MSM who were natives of the EU/EEA (Fig. 1.14). • The number of heterosexually acquired cases decreased steadily in women, from 4948 in 2010 to 3682 in 2019, and from 4118 to 3131 in men during the same decade (Fig. 1.13a). The proportion of all HIV diagnoses attributed to heterosexually acquired infection in women decreased from 22% of cases in 2010 to 19% in 2019, and that attributed to heterosexually acquired infection in men decreased from 19% to 16% during the same period (Fig. 1.13b). Between 2010 and 2019, the number of cases among women and foreign-born heterosexual people decreased at a greater rate than cases among men and non-foreign-born people (Fig. 1.13a and 1.14). The decline in foreign-born cases is due mainly to sharp decreases among migrants originating from countries with generalized HIV epidemics (5441 in 2010 and 3619 in 2019). Despite the overall decline in heterosexually acquired cases during this period, new diagnoses in Lithuania and Slovakia increased substantially in this group. • The number of HIV diagnoses reported among people who inject drugs has also declined since 2010 (from 1120 cases to 812) in both foreign-born and 30 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Fig. 1.12. Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2010–2019 0 10 20 30 40 50 2019201820172016201520142013201220112010 Pe rc en ta ge Year of diagnosis Western Europe Sub-Saharan Africa Central and eastern Europe Latin America and Caribbean South and south-east Asia Other Note: data from Belgium are excluded due to inconsistent reporting during the period. Fig. 1.11b. Age-specific trends in new HIV diagnoses in women, EU/EEA, 2010–2019 Ne w 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 2019201820172016201520142013201220112010 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Note: these figures contain data for 28 countries. Data from Belgium, Italy and Spain are excluded due to incomplete coverage of the surveillance for a portion of the period. Fig. 1.11a. Age-specific trends in new HIV diagnoses in men, EU/EEA, 2010–2019 2019201820172016201520142013201220112010 0 5 10 15 20 25 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 31 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT non-foreign-born people (Fig. 1.13a and 1.14). A temporary 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 downward trend in the number of reported cases continued for the EU/EEA in 2019 (Table 5). Several countries, including Austria, Bulgaria, Estonia, France, Italy, Portugal and Spain, have seen a sharp decrease in the rate of HIV diagnoses due to injecting drug use during the past decade. • The number of diagnoses reported to be due to vertical transmission of HIV decreased from 272 in 2010 to 194 in 2019 (Fig. 1.13a). 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 remained stable over the period, with 14 cases in 2010 and 21 in 2019. The number of cases reported to be due to transfusion of contaminated blood and its products remained stable at 52 in 2010 and 49 in 2019. The majority of these cases were among people who had migrated to the EU/EEA and were later diagnosed in the reporting country (80% in 2010 to 76% in 2019 among nosocomial cases, and 75% in 2010 to 90% in 2019 among transfusion-related cases). The number of cases with an unknown mode of transmission increased significantly from 3009 in 2010 to 3967 in 2019 (14% of cases in 2010 and 22% in 2019). This increase is affected by gaps in reporting and is expected to decrease slightly in future reporting. Fig. 1.13a. HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay and missing transmission imputed, EU/EEA, 2010–2019 0 2000 4000 6000 8000 10 000 Nu m 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 2019201820172016201520142013201220112010 Note: data from 24 EU/EEA countries included. HIV diagnoses reported by Iceland, Ireland, Malta and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Belgium, Italy and Spain excluded due to incomplete reporting during a portion of the period. Fig. 1.13b. Percentage of HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA, 2010–2019 0 20 40 60 80 100 2019201820172016201520142013201220112010 Pe rc en ta ge Year of diagnosis Heterosexual (women) Sex between men Heterosexual (men) Injecting drug use Vertical transmission Note: data from 24 EU/EEA countries included. HIV diagnoses reported by Iceland, Ireland, Malta and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Belgium, Italy and Spain excluded due to incomplete reporting during a portion of the period. 32 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Reporting delays differ significantly among transmission 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. 1.13a and Fig. 1.14 show these adjusted trends). While many people are still being diagnosed several years after being infected with HIV, the median CD4 cell count at HIV diagnosis increased from 341 cells/mm3 in 2010 to 370 cells/mm3 in 2015, declining again to 342 cells/mm3 in 2019. The group with the highest median CD4 cell count at diagnosis is MSM, with 397 cells/mm3 in 2019; this indicates earlier diagnosis in this group compared to others with lower median CD4 cells counts at diagnosis (data not shown). Median CD4 cell count at diagnosis was lower in cases attributed to heterosexual transmission; while there was an increase from 308 cells/mm3 to 325 cells/mm3 in women, median CD4 cell counts at diagnosis in men remained stable at around 260 cells/mm3. In countries reporting consistently on transmission route and CD4 count at diagnosis over time, the number of persons diagnosed late (CD4 cell count less than 350 cells/mm3 at diagnosis) decreased by 29%, from 7441 in 2010 to 5265 in 2019. A reduced number was observed in all transmission groups (Fig. 1.15), with a 42% reduction in late diagnoses in heterosexually transmitted HIV in women (2056 in 2009, 1201 in 2019), 40% reduction where the route of transmission was injecting drug use (319 in 2009, 191 in 2010), 29% reduction in heterosexual men (1906 in 2010, 1352 in 2019) and a 24% reduction in Fig. 1.14. New HIV diagnoses, by year of diagnosis, transmission and migration status, adjusted for reporting delay, EU/EEA, 2010–2019 0 1000 2000 3000 4000 5000 6000 7000 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 2019201820172016201520142013201220112010 Note: data from 26 EU/EEA countries included. HIV diagnoses reported by Malta and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Belgium, Italy and Spain excluded due to incomplete reporting during a portion of the period. Fig. 1.15. Number of people diagnosed late (CD4 < 350 cells/mm3), by year of diagnosis and transmission mode, EU/EEA, 2010–2019 0 500 1000 1500 2000 2500 3000 2019201820172016201520142013201220112010 Nu m be r o f l at e HI V di ag no se s Year of diagnosis Heterosexual (men) Sex between men Heterosexual (women) Injecting drug use Overall Note: data from Iceland, Ireland, Malta and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Belgium, Italy and Spain excluded due to incomplete reporting during a portion of the period. This graph does not account for cases that are missing CD4-count information. 33 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT transmission due to sex between men (2529 in 2010, 1914 in 2019). 1.3 AIDS cases, morbidity and mortality Although there have been improvements in the early diagnosis of HIV, 2772 diagnoses of AIDS were reported by 29 EU/EEA countries10 in 2019 – a crude rate of 0.5 cases per 100 000 population (Table 14). The highest rate was reported by Latvia (4.7 per 100 000 population; 90 cases). Overall, 74% of AIDS diagnoses in 2019 were made within 90 days of the HIV diagnosis, although this is affected by reporting practices in countries that only 10 This includes all EU/EEA countries except Belgium and Sweden. report AIDS at the time of HIV diagnosis. Among people whose HIV infection was attributed to injecting drug use, over half (60%) of AIDS diagnoses were made more than 90 days following the HIV diagnosis (Fig. 1.16). The rate of reported AIDS cases has more than halved in the past decade, down from 1.4 per 100 000 reported in 2010 (Fig. 1.10). This decline is noted in men and women and in all transmission groups, but appears greatest among cases attributed to injecting drug use (Tables 16–20, Fig. 1.17). Despite the general EU/EEA- wide decline, an increase has been reported in the rate of AIDS diagnoses since 2010 in Bulgaria and Hungary (Table 14). The most common AIDS-indicative diseases diagnosed in 2019 in the EU/EEA were Pneumocystis pneumonia Fig. 1.16. Percentage of AIDS diagnoses within 90 days of HIV diagnosis, EU/EEA, 2019 (n = 1763) 0 20 40 60 80 100 Injecting drug use Sex between men Heterosexual transmission (females) Heterosexual transmission (males) Percentage Tr an sm is si on m od e AIDS diagnosis within 90 days of HIV diagnosis AIDS diagnosis > 90 days after HIV diagnosis Fig. 1.17. AIDS diagnoses, by transmission mode, EU/EEA, 2010–2019 0 400 800 1200 1600 2000 AI DS d ia gn os es Year of diagnosis Heterosexual transmission (men) Sex between men Heterosexual transmission (women) Injecting drug use Other/undetermined 2019201820172016201520142013201220112010 Note: data from Belgium and Sweden excluded due to inconsistent reporting during the period. 34 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data (21% of all AIDS-indicative diseases), pulmonary and/or extrapulmonary TB (12%), wasting syndrome due to HIV (12%) and oesophageal candidiasis (11%) (Table 22). Twenty-one countries reported at least one case with TB (pulmonary and/or extrapulmonary) as an AIDS-defining illness in people newly diagnosed with AIDS in 2019. Fourteen per cent of people diagnosed with AIDS in these countries presented with TB as an AIDS-defining illness, ranging from 2% of cases in Austria to more than 60% in Lithuania (Fig. 1.18). Twenty-seven EU/EEA countries (all but Belgium, Denmark, Italy and Sweden, which did not report consistently over the past decade) reported data on deaths of people diagnosed with AIDS. Overall, 774 people were reported to have died due to AIDS-related causes during 2019 (Table 23), although these data are affected by underreporting due to the challenges for many countries in linking to death registries. AIDS- related death reports have been decreasing consistently since 2010, when 1920 deaths were recorded in the countries reporting consistently over time, although delays in reporting affect the latest figures and underreporting has affected AIDS-deaths reporting throughout the period (Fig. 1.10). From the beginning of the HIV epidemic to the end of 2019, the cumulative total of people diagnosed with AIDS in the EU/EEA was 367 890 (Table 14). The cumulative total of cases reported as known to have died due to AIDS-related causes by the end of 2019 was 196 164 (Table 23). 1.4 HIV testing Nine countries reported data on HIV tests performed, excluding unlinked anonymous testing and testing of blood donations. The number of tests increased by 21% in countries reporting consistently over the last decade (Table 24). Changes in overall testing activity do not appear to explain the decrease in cases reported, particularly among MSM, in some European countries. It is important to note that numbers provided are collected in a heterogeneous manner and comparisons between country testing rates should be undertaken with caution, but these data can indicate large changes in overall testing policy or be used to support the interpretation of HIV cases notified. 1.5 Conclusions HIV surveillance data for 2019 continue to underscore important changes in the epidemiology of HIV in EU/EEA countries occurring over the past decade. Rates of AIDS and AIDS-related deaths in the EU/EEA as a whole have decreased substantially over the past decade, reflecting greater access to treatment and better case management, indicating sustained progress towards Fig. 1.18. Percentage of people diagnosed with AIDS where TB is an AIDS-defining illness, EU/EEA, 2019 (n = 2650) 0 10 20 30 40 50 60 70 Austria Germany Hungary Norway Netherlands United Kingdom Italy Poland Denmark Slovenia Estonia Total EU/EEA Spain France Bulgaria Latvia Czechia Portugal Finland Romania Luxembourg Lithuania Percentage Note: countries that did not report AIDS (Belgium and Sweden) or reported no cases of TB as an AIDS-defining illness (Croatia, Cyprus, Greece, Iceland, Ireland and Slovakia) are excluded. 35 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT the Sustainable Development Goal of ending the AIDS epidemic as a public health threat and decreasing AIDS-related deaths. There has been a clear, continuous decline in the rate of new HIV diagnoses per 100 000 population in the EU/EEA overall, with an adjusted rate of 5.4 reported in 2019. 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. Data for 2019 may suffer specifically from this due to non- or incomplete reporting in some countries due to extra workload induced by the COVID-19 pandemic. 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 quarter of EU/EEA countries. Evidence of a decline in diagnoses among MSM in certain EU/EEA countries appears to be the main determinant behind 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 and, until recently, was the only population in the EU/EEA in which HIV cases were increasing for most of the past decade. The decline at EU/EEA level is driven by substantial declines in specific EU/EEA countries – Austria, Finland, France, Germany, Greece, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom. Reasons for the decrease may include successful programmes to offer more frequent and targeted HIV testing to promote earlier diagnosis, 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 transmission (1,2). 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, as it is noted that PrEP has been made available through the health system or pilot projects in all of these countries (2,3). The positive trends described above nevertheless are countered by the prevailing situation in several EU/EEA countries in which HIV continues to increase among MSM. Substantial increases have been reported in Bulgaria, Cyprus, Estonia, Lithuania, Poland, Romania and Slovakia 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 in people who are not foreign-born. There is an urgent need to significantly scale up 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 providing condoms, peer support and access to PrEP for 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 epidemiological trend observed over the past decade. Heterosexual transmission nevertheless remains the second most common mode of HIV transmission reported in the EU/EEA and, in some countries, is the most common transmission mode. Despite the overall declines, heterosexual transmission increased substantially in Lithuania and Slovakia. The declining trend in heterosexual cases is probably influenced by the decrease (since 2010) in the number of heterosexually acquired cases in migrants originating from countries with generalized HIV epidemics (5). Migrants (or people originating from outside of the reporting country) again constituted a considerable proportion (44%) of new HIV diagnoses in the EU/EEA in 2019. 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 specific HIV-prevention campaigns for migrants from the moment of their arrival, including the offer of HIV testing to newly arrived migrants to the EU (9). Transmission among people who inject drugs continues to decline and remains at a low level in most EU/EEA countries, thanks to well established and effective harm-reduction programmes throughout most of the Region. The most drastic decline is noted in Estonia, where new diagnoses among people who inject drugs in 2019 are one quarter of what they were a decade ago. Increases nevertheless were observed in 2016–2017 in Lithuania, and increases in this population have also been reported from Germany in recent years. There were also outbreaks reported in 2011–2012 in Romania and Greece – countries with previously very low levels of HIV among people who inject drugs (10,11). More localized outbreaks have been reported in Ireland, Luxembourg and the United Kingdom (Scotland) (12–14). This reinforces the importance of maintaining adequate scale and coverage of harm-reduction services and recognizing that trends can change quickly for this group in the absence of effective prevention delivered at scale (15). It is estimated that about 120 000 people are living with undiagnosed HIV in the EU/EEA, implying that about one in seven of those living with HIV are not aware of their status (16). Modelled estimates also indicate that it takes an average of 2.9 years from HIV infection to diagnosis in the EU/EEA, with variation by geographical area from 2.2 to 3.6 years (17). In addition to the clinical and personal benefits for the person diagnosed, early diagnosis and effective ART can also benefit sexual and injecting partners by inhibiting onward HIV transmission. Half of those newly diagnosed (50%) have a CD4 cell count of below 350 cells per mm3, including 30% of cases with advanced HIV infection (CD4 less than 200 cells/mm3), indicating the need to improve testing programmes to diagnose people living with HIV at an earlier stage. These data indicate that the people were 36 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data infected many years previously and suggest problems with access to, and uptake of, HIV testing for some segments of the population 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 having acquired HIV heterosexually. The trend during the past decade has been towards an increasing median age at HIV diagnosis, particularly among women. In 2019, one in five new HIV diagnoses was in 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 (18). To reduce the high proportion of people diagnosed late, it is essential to diversify HIV testing by augmenting 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 notification. 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 (19). 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 for the health of HIV-positive people of introducing ART early (20,21) 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 when they are at an advanced stage of illness. Overall, 74% of AIDS diagnoses were reported to have been 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 in which more than half of the AIDS cases occurred more than 90 days after the initial HIV diagnosis was among people whose HIV infection was attributed to injecting drug use, possibly indicating that AIDS diagnoses in this group are associated with lack of engagement with, or retention in, clinical services. Once tested, rapid linkage to high-quality care (including ART) is essential. Ninety-nine per cent of people diagnosed in 2019 who had evidence of linkage to care were linked to care within three months of HIV diagnosis; those not linked to care, however, are less likely to be included in the data used to calculate this indicator, so this is likely to be an underestimate of poor linkage to care. This bias is slightly countered by the use of the date of the CD4 cell count as a proxy for time to linkage to care, as this would tend to slightly overestimate the time interval. Timely linkage to care following HIV diagnosis is crucial, as delayed access can result in poor patient outcomes (22). Once linked to care, there is evidence that high proportions of people diagnosed with HIV in the EU/EEA have access to ART and achieve viral suppression (23). Recent years have seen a worrying trend of reduced data completeness on the HIV transmission route, with nearly one quarter of cases reported in 2019 lacking this important information. 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 were used in select figures presented in this chapter to partially address this issue (24). The changing epidemiology of HIV infections observed in the EU/EEA over the past decade suggests that some progress has been achieved, particularly in reducing infections attributed to heterosexual transmission and injecting drug use. More recently, progress has also been made in reducing the number of HIV infections resulting from sex between men in selected EU/EEA countries. These epidemiological trends also indicate, however, that it is crucial to sustain, and in some places strengthen, evidence-based HIV prevention interventions tailored to the local epidemiological context and targeting those most at risk. Programmes on the prevention and control of HIV infection 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 epidemics and others, are also a key vulnerable population who need 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 testing, 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 diagnosis and, ultimately, the proportion of people living with undiagnosed HIV in the EU/EEA. The data in this report present new HIV diagnoses through to the end of 2019, the period just before the global COVID-19 pandemic. The impact of the pandemic on human resources in laboratory, clinical and public health institutions has already been observed. One country (Belgium) was unable to report 2019 HIV and/or AIDS data due to the need to focus public health capacity on COVID-19 surveillance and response. The majority of ECDC operational contact points for HIV reported also working on COVID-19 surveillance and response issues 37 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT during 2020. About half of EU/EEA countries needed more time than usual to submit their 2019 HIV and AIDS data and several mentioned that reporting delay may be increased for 2019 data, or that some variables (CD4 at diagnosis, viral load) were not possible to report at all or at concordant levels with the past. The ECDC, in collaboration with EU/EEA Member States, the WHO Regional Office for Europe, and clinical and community partners, will look carefully at the impact on HIV surveillance and prevention response to support the continued high standard of European HIV and AIDS data to guide the response in the Region and to understand how the ongoing pandemic may affect HIV incidence, particularly in regions and groups most at-risk. References11 1. 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). 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. Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P et al. and the ECDC Dublin Monitoring Network. Estimating the “PrEP gap”: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019;24(41):pii=1900598 (https://doi.org/10.2807/1560- 7917.ES.2019.24.41.1900598). 4. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014 (https://www.ecdc.europa.eu/ sites/default/files/media/en/publications/Publications/hiv-sti-pre- vention-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-migra- tion 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. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants in the EU/EEA. Stockholm: ECDC; 2019 (https://www.ecdc.europa.eu/sites/default/files/documents/ Public%20health%20guidance%20on%20screening%20and%20 vaccination%20of%20migrants%20in%20the%20EU%20EEA.pdf). 11 All weblinks were accessed on 12 November 2020. 10. 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). 11. 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). 12. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2016. Euro Surveill. 2016;20(40):pii=30036 (http://dx.doi.org/10.2807/1560-7917.ES.2016.20.40.30036). 13. 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). 14. 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). 15. 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). 16. Brown AE, Hayes R, Noori T, Azad Y, Amato-Gauci AJ, Pharris A et al. and the Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90–90– 90 targets. Euro Surveill. 2018;23(48):pii=1800622 (https://doi. org/10.2807/1560-7917.ES.2018.23.48.1800622). 17. 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). 18. 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. 19. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016:373 (9):795–807 20. Consolidated guidelines on the use of antiretroviral drugs for treat- ing and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2017 (https://www.who.int/hiv/pub/arv/arv-2016/ en/). 21. Public health guidance on HIV, hepatitis B and C testing in the EU/ EEA. Stockholm: ECDC; 2018 (https://ecdc.europa.eu/sites/portal/ fi l e s/d o c u m e n t s/ H I V - h e p a t i t i s - B - a n d - C- t e s t i n g - p u b l i c- healthguidance.Pdf). 22. 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. PLoS One 2018;13(2):e0192403 (https://doi.org/10.1371/journal.pone.0192403). 23. 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. 24. 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=1700 359 (https://doi.org/10.2807/1560-7917.ES.2018.23.23.1700359). 38 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data 2.1 HIV and AIDS diagnoses in the WHO European Region 2.1.1 HIV diagnoses In 2019, 136 449 people in the WHO European Region were newly diagnosed with HIV, corresponding to a rate of 15.6 per 100 000 population (Table A, Table 1). This number includes new diagnoses reported by 47 countries12 to the joint ECDC and WHO Regional Office for Europe surveillance system.13 It brings the cumulative number of reported HIV diagnoses in the Region since reporting began in the 1980s to 2 114 520. As in previous years, most (79%) of the 136 449 people newly diagnosed with HIV in 2019 were from the East of the Region (107 842), 16% from the West (21 793) and 5% from the Centre (6814). The rate was also highest in the East (41.7 per 100 000 population), eight times higher than in the West (5.7 per 100 000, adjusted for reporting delay; see Annex 1 for methods and Annex 6 for results) and 12 times higher than in the Centre (3.4 per 100 000) (Table A, Table 1). For men, the rate was 20.8 per 100 000 population (Table 2) and for women 10.6 per 100 000 population (Table 3). Rates of newly diagnosed HIV infections varied widely across countries in the WHO European Region in 2019. The highest rates per 100 000 population (more than 15.0) were observed in the Russian Federation (54.9) followed by Ukraine (39.0), the Republic of Moldova (22.8), Belarus (22.6), Kazakhstan (19.8), Georgia (16.7), Malta (16.2), Latvia (15.4) and Armenia (15.1). The lowest rates (under 3.0) were reported by Bosnia and Herzegovina (0.9), Slovenia (1.6), Slovakia (1.9), Serbia (2.0), Czechia (2.1), Hungary (2.4), Austria (2.5), Croatia (2.5) and Finland (2.7). No new HIV cases were diagnosed in San Marino in 2019. The male-to-female ratio was 1.8, lowest in the East (1.6), higher in the West (2.9) and highest in the Centre (5.5). The highest male-to-female ratios (more than 15.0) at country level among countries with more than 10 new cases were observed in Croatia (19.4) and the lowest (1.5 or less) in Kyrgyzstan (1.4), Tajikistan (1.4) and the Republic of Moldova (1.4) (see section 1.1 (HIV diagnoses) in Chapter 1 and sections 2.2 (HIV diagnoses in the East) and 2.2.2 (Trends in HIV diagnoses in the East) below). 12 No data were received from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan or Uzbekistan. Liechtenstein is an EEA 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. 13 The data reported by the Russian Federation were limited to new HIV diagnosis by sex for 2010–2019 and data on HIV testing, which enabled the inclusion of the Russian Federation’s data in Tables 1–3 and 25 and in the figures showing the trend of HIV diagnosis. Data on age and modes of transmission presented in this report include countries that provided a full set of data to the joint ECDC/WHO European HIV surveillance system, excluding the Russian Federation. The largest proportion of people newly diagnosed in the 46 countries reporting HIV data by age were in the age group 30–39 years (34%), while 9% were young people aged 15–24 years and 18% were 50 years or older at diagnosis (Table A, Table 9). Data on transmission mode (Table A, Tables 4–8, no data received from the Russian Federation) provide information about risk exposure among people newly diagnosed with HIV and indicate the following for 2019. • Heterosexual contact was still the main reported mode of HIV transmission in the WHO European Region, accounting for half (50%) of people newly diagnosed in 2019 (28 273) and 59% of new HIV diagnoses with a known mode of transmission (Table 6). Among those, 10% originated from countries with generalized epidemics (data not shown). • Sex between men was the second most common transmission mode, accounting for 21% of new diagnoses overall (11 645) and 24% of new HIV diagnoses with a known mode of transmission (Table 4). • Injecting drug use accounted for 13% of new diagnoses (7309) and 15% of new HIV diagnoses with a known mode of transmission (Table 5). • One per cent (0.7%, 401) of cases were infected through mother-to-child transmission (0.8% of those with a known mode of transmission) (Table 7) and 0.2% (94) 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% (8603 cases) (Table 8). Reporting completeness regarding transmission mode varies greatly across the Region, with information lacking for 3% of new diagnoses in the East, 44% in the Centre and 22% in the West. Information about country of birth, country of nationality or region of origin was provided by 43 countries for 55 792 people newly diagnosed in 2019. Among those with known origin (51 812), 20% (10 189) originated from outside of the reporting country, including 14% (7210) from outside the WHO European Region and 6% (2979) from a European country other than the country of report (Table 10). Information about probable country of infection was reported by 32 countries for 27 415 people newly diagnosed. Among people for whom the probable country of infection was known (19 583), 23% (4517) were infected abroad, including 7% in sub-Saharan Africa, 7% in central and eastern Europe, 3% in western 2. HIV and AIDS in the WHO European Region 39 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Europe, 3% in south and south-east Asia and 2% in Latin America (Table 12). Forty-one countries provided information about CD4 cell count at the time of HIV diagnosis in 2019. Information was reported for 39 496 people over 14 years at diagnosis (covering 74% of all new diagnoses in the reporting countries) (Table 13). Just over half (53%) of those newly diagnosed were late presenters, with CD4 cell counts below 350 per mm3 at the time of HIV diagnosis, including 31% with advanced HIV infection (CD4 above 200/mm3). Nineteen per cent had a CD4 cell count of between 350 and 500 cells per mm3 and 27% had a count above 500 per mm3 (data not shown). The percentage of those newly diagnosed who were late presenters (CD4 below 350/mm3) varied across the Region, but was highest in the East and in the Centre (both 56%) and lowest in the West (49%). The countries with the highest percentages of late presenters (over 60%, in countries with more than five cases) were Cyprus (91%), Albania (75%), Latvia (70%), Montenegro (64%), Romania (63%) and Bulgaria (61%). Those with the lowest percentages (less than 40%) were Iceland (20%), Slovakia (28%), Luxembourg (36%) and Czechia (40%). The percentage of late presenters was higher than the regional average of 53% in 19 countries (seven in the East, seven in the Centre and five in the West). The percentage also varied across transmission categories and was highest for people with reported heterosexual transmission (58%; 60% for men and 55% for women) and as a result of injecting drug use (52%), and lowest for men infected through sex with men (42%) (Table 14, Fig. 2.1, Fig. C). The percentage of people diagnosed at or below 350 CD4 cells per mm3 increased with age, ranging from 35% among people aged 15–19 and 20–24 years at diagnosis, respectively, to 67% among people aged 50 years or above. Overall, the percentage of late presenters by gender was similar (53% for men and 54% for women), but this is confounded by transmission mode and conceals, for men, the difference between MSM (who tend to get diagnosed earlier) and men with reported heterosexual transmission (who tend to get diagnosed later) (Fig. C). 2.1.2 Trends in HIV diagnoses The rate of newly diagnosed HIV infections in the WHO European Region14 increased by 9% for the period 2010–2019, from 14.1 per 100 000 population (118 726 cases) to 15.4 per 100 000 population (136 449 cases) (Fig. 2.2). The increase mainly is driven by an upward trend in many countries of the East; overall for the East, the rate increased by 23%, from 33.9 in 2010 (86 266 cases) to 41.7 in 2019 (107 842 cases). In the Centre, the rate increased by 113% – the largest relative increase across the three geographical areas – from 1.6 (3097 cases) to 3.4 (7029 cases); and in the West, the rate decreased by 24%, from 7.5 (29 515 cases) to 5.7 (23 971 cases, adjusted for reporting delay).15 Thirty-nine countries have consistently reported data on transmission mode for the period 2010–2019 (Fig. 2.3). Data from Iceland, Ireland, Poland and Turkey were excluded because over 50% of the data on transmission mode were missing for some years in the period. Data from Spain and Italy were excluded because coverage of the national surveillance system increased during this time period. No data on modes of transmission were reported from the Russian Federation and Malta, and data from Andorra, Belgium, North Macedonia, Monaco, Turkmenistan and Uzbekistan were not consistently reported during the period. Data on transmission mode from the countries with consistent data indicate that: 14 No data were received from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan or Uzbekistan. Liechtenstein is an EEA 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. 15 See Annex 1 for methods and Annex 6 for results (see also section 2.4 (HIV and AIDS diagnoses in the West) below). Fig. 2.1. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2019 (n = 37 774) 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 = 8589 n = 23 300 n = 5885 Percentage Tr an sm is si on m od e Note: no data from Andorra, Belgium, Hungary, Malta, Monaco, North Macedonia, Norway, Poland, the Russian Federation, San Marino, Turkmenistan or Uzbekistan. 40 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Fig. 2.3. New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2010–2019 0 5000 10 000 15 000 20 000 25 000 30 000 2019201820172016201520142013201220112010 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Ne w H IV d ia gn os es Year of diagnosis Note: data from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; data from Iceland, Ireland, Malta, 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. Data were not reported from the Russian Federation. (In total, data from 39 countries are included for Fig. 2.3.) Fig. 2.2. New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region, 2010–2019 0 10 20 30 40 50 2019201820172016201520142013201220112010 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 Note: data from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. • the number of new diagnoses in people with reported heterosexual transmission increased by 17% in the Region, from 21 762 in 2010 to 25 402 in 2019, while the percentage of all new HIV diagnoses attributed to heterosexual contact increased from 47% of cases in 2010 to 55% in 2019; • the number of new diagnoses in people infected through sex between men decreased by 13%, from 9385 in 2010 to 8189 in 2019, and the percentage of all new HIV diagnoses attributed to sex between men also decreased slightly, from 20% to 18%; • the number of new diagnoses in people infected through injecting drug use decreased by 36%, from 10 977 in 2010 to 7053 in 2019, while the percentage of all HIV diagnoses attributed to injecting drug use decreased from 24% in 2009 to 15% in 2019; • the number of new diagnoses in children infected through mother-to-child transmission decreased by 35%, from 576 in 2010 to 373 in 2019, representing 1.2% of all new HIV diagnoses in 2010 and 0.8% in 2019; • of the new diagnoses in people infected by other means, nosocomial infections increased by 31%, from 26 cases in 2010 to 34 in 2019 (peaking at 105 cases in 2012); new diagnoses attributed to transfusion of blood and its products decreased by 23%, from 69 in 2010 to 53 in 2019; and • the number of new diagnoses for which information on transmission mode was unknown or missing increased by 31%, from 3596 in 2010 to 4869 in 2019 – representing 8% of all new HIV diagnoses in 2010 and 11% in 2019. 41 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Fig. 2.4. New AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2010–2019 0 2 4 6 8 10 12 2019201820172016201520142013201220112010 AI DS d ia gn os es p er 10 0 00 0 po pu la tio n Year of diagnosis West Centre East WHO European Region Note: data from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Fig. 2.5. Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country, East, 2019 (n = 107 842; 19 112) Male-to-female ratio All new diagnoses New diagnoses with heterosexual transmission 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Kyrgyzstan Tajikistan Republic of Moldova Latvia Ukraine Russian Federation East Belarus Estonia Azerbaijan Kazakhstan Armenia Lithuania Georgia Note: no data from Turkmenistan and Uzbekistan. No data on mode of transmission from the Russian Federation. 42 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data 2.1.3 AIDS cases, morbidity and mortality In 2019, 12 535 people in 45 countries of the WHO European Region16 were diagnosed with AIDS, which corresponds to a rate of 1.7 per 100 000 population (Table 14). Of the 12 535 people who received a diagnosis of AIDS in 2019, 76% (9577) were diagnosed in the East, 18% (2156) in the West and 7% (802) in the Centre of the Region. The rate was also highest in the East (8.3 per 100 000 population), 17 times higher than in the West (0.5 per 100 000) and more than 20 times higher than in the Centre (0.4 per 100 000 population). The rate of new AIDS diagnoses varied widely among the countries, with the highest rates (3.0 or above) reported in Ukraine (17.9), the Republic of Moldova (7.0), Georgia (6.6), Armenia (5.8), Latvia (4.7) and Belarus (4.0), and the lowest rates (under 0.3) reported in Turkey (0.1),17 Slovakia (0.1), Germany (0.1), Ireland (0.1), Bosnia and Herzegovina (0.2) and Poland (0.2). Malta and San Marino reported zero cases. TB represented 17% of all reported AIDS-defining illness events in 2019, ranging from 9% of reports in the West and 15% in the Centre to 30% in the East. In the 45 countries with consistent AIDS data,18 the overall rate of new AIDS diagnoses in the Region decreased by 23% between 2010 and 2019, from 2.2 per 100 000 population (15 148 cases) to 1.7 per 100 000 (12 535 cases) (Fig. 2.4). Since there are reporting delays in some countries, this decrease is expected to even out in the coming years. AIDS trends varied greatly across the three geographical areas. In the East, the rate increased by 15%, from 7.2 in 2010 to 8.3 in 2019. 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 69% decrease, from 1.6 in 2010 to 0.5 in 2019 (Fig. 2.4). 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 recorded was provided by 43 countries in the Region19 and included 4618 people who were reported to have died during 2019. This represented a 20% decrease compared with the 5760 deaths reported for the same countries in 2010. Of the 4618 deaths in 2019, 83% were reported from the East of the Region, 11% from the West and 6% from the Centre (Table 23). It is important to note that delays in reporting and underreporting have a significant impact on these numbers at European level, 16 No data were reported from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. 17 AIDS data for Turkey only include those diagnosed with AIDS at the time of HIV diagnosis and are therefore not comparable with AIDS data from other countries. 18 Data from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan are excluded or not reported. 19 No data were received from Andorra, Belgium, Denmark, Italy, North Macedonia, Monaco, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. particularly when the death occurs long after HIV or AIDS diagnosis. The numbers presented here should therefore not be interpreted 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 HIV/ AIDS registries with their national mortality or vital statistics registries (1). 2.2 HIV and AIDS diagnoses in the East 2.2.1 HIV diagnoses in the East In 2019, 107 842 people were newly diagnosed with HIV across 13 countries20 in the East of the WHO European Region, giving a rate of 41.7 per 100 000 population. This number includes 80 124 new diagnoses reported from the Russian Federation21 and 27 718 from the remaining 12 reporting countries in the East of the Region. The highest rates of HIV diagnoses (more than 20.0) for 2019 were observed in the Russian Federation (54.9 per 100 000 population), Ukraine (39.0), the Republic of Moldova (22.8) and Belarus (22.6), while the lowest (under 10.0) were reported by Azerbaijan (7.2) and Lithuania (5.4). Among the 12 countries in the East22 reporting age distribution, most of those newly diagnosed (38%) were in the age group 30–39 years, while only 6% were young people aged 15–24 years and 16% 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, with 38% of new diagnoses among women in the East in 2019. The male-to-female ratio was highest (over 2.0) in Georgia (3.2), Lithuania (2.7) and Armenia (2.3), and lowest (under 1.5) in the Republic of Moldova (1.4), Tajikistan (1.4) and Kyrgyzstan (1.4) (Fig. 2.5). Among those reported as infected through heterosexual transmission, the male-to-female ratio was 1.5 or above in two countries (Georgia (1.9) and Armenia (1.7)), 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 ruled out that some of these men may in fact have been infected through injecting drug use or sex with other men, but misclassified in the heterosexual category. Heterosexual contact and injecting drug use are still the main modes of HIV transmission reported in the East of the Region. Reported transmission related to sex between men remains relatively low. 20 No data were received from Turkmenistan or Uzbekistan. 21 This year, the Russian Federation has reported data to the surveillance system, including historic data for 2010–2019, but the reporting was limited to the new HIV diagnosis by sex and data on HIV testing. Detailed information on the status of the data submitted by the Russian Federation can be found in Annex 5. 22 Data from the Russian Federation were not included. 43 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Fig. 2.6. New HIV diagnoses, by country and transmission mode, East, 2019 (n = 27 718) Sex between men Injecting drug use Heterosexual transmission Mother-to-child transmission Other Unkown Percentage 0 20 40 60 80 100 Latvia Lithuania Estonia Kazakhstan Kyrgyzstan Georgia Ukraine Tajikistan Azerbaijan Republic of Moldova Belarus Armenia Note: no data were received from the Russian Federation, Turkmenistan and Uzbekistan. In 2019, 27 718 new HIV diagnoses were reported from 12 countries in the East, with data by transmission mode suggesting the following (Table A, Tables 4–8, Fig. 2.6): • 69% of those newly diagnosed and 71% of new HIV diagnoses with a known mode of transmission were infected heterosexually (19 112), making it the main mode of transmission reported in all countries in the East (Table 6); • 23% of those newly diagnosed and 24% of new HIV diagnoses with a known mode of transmission were infected through injecting drug use (6424) (Table 5), with transmission through injecting drug use accounting for 25% or more of new diagnoses with a known transmission mode in four countries (Lithuania (38%), Kazakhstan (34%), Latvia (26%) and Ukraine (26%)); • 4% were infected through sex between men (1079) (Table 4), but five countries (Lithuania, Estonia, Georgia, Armenia and Latvia) reported that sex between men accounted for more than 10% of new diagnoses with a known transmission mode; • 0.8% of those diagnosed were infected through mother-to-child transmission (215) (Table 7) and 0.07% (19) through other transmission routes (nosocomial infection, transfusion or use of other blood products); and • transmission mode was reported as unknown or missing for only 3% of those newly diagnosed across the 12 countries in the East of the Region (869), but at country level, transmission-mode information was lacking for 15% or more of cases in five countries: Latvia (42%), Estonia (36%), Lithuania (16%), the Republic of Moldova (16%) and Kyrgyzstan (15%). Analysis of the new diagnoses by age group and transmission mode for the 12 reporting countries in the East (Fig. 2.7) shows that 30–39-year-olds accounted for most HIV diagnoses across all transmission groups (48% of people infected through injecting drug use, 36% with reported heterosexual transmission and 32% through sex between men). People in the younger age groups tended to be infected through sex between men; among MSM, 51% of adults (aged 15–49 years) were under 30 years at diagnosis, compared with only 12% and 20% among those infected through injecting drug use and heterosexual sex, respectively. People aged 50 years and above were more frequently infected as a result of heterosexual sex (19% compared with 8% and 5% for injecting drug use and MSM, respectively) (Fig. 2.7). Twelve countries in the East provided information about CD4 cell count at the time of HIV diagnosis for 23 141 people above 14 years (covering 85% of the 27 718 new 44 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data diagnoses in the 12 countries (Table 13)). Fifty-six per cent of these people were late presenters, with CD4 cell counts below 350 per mm3, including 32% with advanced HIV infection (CD4 below 200/mm3) at the time of HIV diagnosis. The percentage of people diagnosed with a CD4 count of less than 350/mm3 was higher than 50% in eight of the 12 countries. The percentage of late presenters varied across transmission categories, being highest for people infected heterosexually (58%) and through injecting drug use (52%) and lowest for men infected through sex with men (43%) (Fig. 2.8). Ten countries in the East provided information about the probable country of infection for 10 041 people newly diagnosed in 2019 (Table 12). Among the 9337 cases for whom the probable country of infection was known, only 8% (740 cases) were infected abroad, including 7% in central and eastern Europe. The data suggest that most of those newly diagnosed with HIV in the East of the Region were infected in the reporting country and that those infected abroad were infected in neighbouring countries of central and eastern Europe. 2.2.2 Trends in HIV diagnoses in the East The increasing trend in newly diagnosed HIV infections continued in the East23 over the last decade, with a 31% increase in the rate of new diagnoses per 100 000 population, from 31.8 in 2010 (90 061 cases) to 41.7 in 2019 (107 842 cases) (Fig. 2.2). The decrease in new diagnoses from 2015 to 2016 (Fig. 2.2) coincided with a change in the case definition in the Russian Federation.24 The rate doubled in two countries (Armenia and Belarus) between 2010 and 2019, whereas four countries had an increase of 30–62% over the decade: Kazakhstan (62%), Georgia (50%), Azerbaijan (41%) and the Republic of Moldova (33%). 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 23 For the analysis of trends, data from Turkmenistan and Uzbekistan were excluded. The Russian Federation provided data only for Tables 1–3 and 25 and therefore is included only for overall trends (not by, for instance, age or modes of transmission). Estonia is excluded for the trend analysis regarding modes of transmission due to incomplete reporting on transmission mode during the period. 24 Detailed information on the status of the data submitted by the Russian Federation can be found in Annex 5. Fig. 2.8. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2019 (n = 22 984) 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 = 933 n = 16 643 n = 5 348 Percentage Tr an sm is si on m od e Note: no data from the Russian Federation, Turkmenistan and Uzbekistan. Fig. 2.7. New HIV diagnoses, by age group and transmission mode, East, 2019 (n = 27 332) 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 = 6424 n = 19 111 n = 1079 Percentage Tr an sm is si on m od e Note: no data from the Russian Federation, Turkmenistan and Uzbekistan. 45 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT peak in new diagnoses and continued through to 2019 (Table 1). The number of newly diagnosed women increased by 10% across the 13 countries, from 37 567 in 2010 to 41 404 in 2019, and the number of newly diagnosed men increased by 27%, from 52 313 to 66 438 (Tables 2 and 3). The overall trend largely reflects the situation in the Russian Federation, which accounts for the vast majority of new cases reported in 2019. The other countries have significant variations. Three (Azerbaijan, Kyrgyzstan and Tajikistan) have all experienced much larger increases among women over the decade (11–191%) compared to the increase among men (11–30%). Information about mode of transmission for the period 2010–2019 (Fig. 2.9) from the 12 countries with consistent data suggests the following. • The number of new diagnoses in people with reported heterosexual transmission increased by 57%, from 12 354 in 2010 to 19 034 in 2019. The increase was considerably larger among men with heterosexual transmission (a 103% increase) than women with heterosexual transmission (21% increase). At the same time, the percentage of all new HIV diagnoses attributed to heterosexual contact increased from 53% of cases in 2010 to 69% in 2019. • The number of new diagnoses in people infected through injecting drug use decreased by 36%, from 9985 in 2010 to 6404 in 2019, but a moderate increase was seen between 2018 and 2019 in two countries (Kazakhstan and Ukraine) (Table 5). The percentage of all new HIV diagnoses attributed to injecting drug use decreased from 43% in 2010 to 23% in 2019. • The number of new diagnoses in people infected through sex between men increased more than five- fold, from 190 in 2010 to 1063 in 2019. This is by far the highest relative increase across the various transmission modes and geographical areas. It is Fig. 2.9. New HIV diagnoses, by transmission mode and year of diagnosis, East, 2010–2019 0 5000 10 000 15 000 20 000 Ne w H IV d ia gn os es Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined 2019 201820172016201520142013201220112010 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. Ne w 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 2019 201820172016201520142013201220112010 Arithmetic scale Logarithmic scale 46 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data clearly visible on the logarithmic scale of Fig. 2.9, which facilitates the comparison of rates of change regardless of starting point. Although it has increased, the percentage of all new HIV diagnoses attributed to sex between men nevertheless has remained low at 0.8% in 2010 and 4% in 2019. • The number of children infected through mother-to- child transmission decreased by 27%, from 293 in 2010 to 215 in 2019, representing 1.3% of new HIV diagnoses in 2010 and 0.8% in 2019. • The number of new diagnoses for which the mode of transmission was unknown increased by 71%, from 471 in 2010 to 805 in 2019. The percentage of new HIV diagnoses with unknown mode of transmission remained low and stable at 2–3% in 2010 and 2019. Further analysis of the increase in new diagnoses attributed to heterosexual transmission in the East by gender and age groups (Fig. 2.10) reveals continuing increases in older age groups for both men and women (it is highest in those aged 50 years and above, followed by the 40–49 and 30–39 age groups). Heterosexual transmission nevertheless has continued to decrease among young women aged 15–24 and 25–29 years, by 60% and 48%, respectively. 2.2.3 AIDS cases, morbidity and mortality in the East In 2019, 9577 people were diagnosed with AIDS from the 12 countries in the East that provided AIDS data, giving a rate of 8.3 per 100 000 population. The highest rates (above 5.0) were reported in Ukraine (17.9), the Republic of Moldova (7.0), Georgia (6.6) and Armenia (5.8) (Table 14). The AIDS rate increased by 15% between 2010 and 2019, from 7.2 per 100 000 population (8038 cases) to 8.3 (9577 cases) in the 12 countries (Fig. 2.4). The rate of new AIDS diagnoses increased in five of the 12 countries in the East, most noticeably in Armenia, Kazakhstan and Ukraine. The rate declined over the last decade in seven Fig. 2.10. Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2010–2019 0 1000 2000 3000 4000 15–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Ne w H IV d ia gn os es Year of diagnosis 2019 201820172016201520142013201220112010 Females, East, heterosexual transmission Note: no data by age for the Russian Federation. Data from Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. 0 1000 2000 3000 4000 15–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Ne w H IV d ia gn os es Year of diagnosis 2019201820172016201520142013201220112010 Males, East, heterosexual transmission 47 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT countries: Azerbaijan, Belarus, Georgia, Kyrgyzstan, Latvia, Lithuania and the Republic of Moldova. By mode of transmission, both in men infected through sex between men and in people infected heterosexually, the number of new AIDS diagnoses more than doubled between 2010 and 2019. AIDS cases in people infected as a result of injecting drug use decreased by 49% in comparison with 2010 (Fig. 2.11). The trend in more recent years, however, has been for the AIDS rate to decline – from 10.2 in 2017 to 8.3 in 2019. The most common AIDS-indicative diseases diagnosed in 2019 were wasting syndrome due to HIV (17% of all disease events reported), pulmonary TB (16%) and oesophageal candidiasis (13%) (Table 22). By transmission mode, wasting syndrome due to HIV, pulmonary TB and Kaposi’s sarcoma were the most common AIDS-defining diseases among people infected through heterosexual sex (the three diseases together accounting for 53% of reported events). The most common AIDS-defining diseases reported among people with AIDS infected through injecting drug use were extrapulmonary TB, pulmonary TB and wasting syndrome due to HIV (together accounting for 56% of reported events). Among the few AIDS cases infected as a result of sex between men, pulmonary TB, Pneumocystis pneumonia and Kaposi’s sarcoma were the most common diseases (Fig. 2.12). AIDS-related mortality remains high in the East, with 3830 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 concerned for 2019. This figure represents 83% of all AIDS-related deaths reported in the Region, a 19% decrease compared with 2012, which had the highest number of deaths reported for the decade (Table 23). Fig. 2.11. New AIDS diagnoses, by transmission mode and year of diagnosis, East, 2010–2019 0 2000 4000 6000 8000 Ne w 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 2019 201820172016201520142013201220112010 Arithmetic scale Note: data from the Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Year of diagnosis 2019 201820172016201520142013201220112010 1 10 100 1000 10 000 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Ne w A ID S di ag no se s Logarithmic scale 48 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data 2.3 HIV and AIDS diagnoses in the Centre 2.3.1 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, particularly in people infected as a result of sex between men. A total of 6814 people were newly diagnosed with HIV in 2019 from the 14 countries in the Centre of the WHO European Region, giving a rate of 3.4 per 100 000 population (Table 1). The highest rates (over 3.0) were reported by Cyprus (11.4), Montenegro (4.1), Poland (3.9), Turkey (3.9), Bulgaria (3.7), Romania (3.6) and Albania (3.5), and the lowest (under 2.0) by Bosnia and Herzegovina (0.9), Slovenia (1.6) and Slovakia (1.9). The most affected age group in 2019 was 30–39-year- olds (32% of cases), while 15% of cases were diagnosed in young people aged 15–24 years – the largest percentage of young people among the three geographical areas (Table A, Table 9). The male-to- female ratio was 5.5, higher than in both the West and the East. This reflects the higher number of young MSM among newly diagnosed cases in the central part of the Region compared with other parts of the Region. The highest male-to-female ratios (over 10.0) were observed in Croatia (19.4), Hungary (13.0), Montenegro (12.0) and Serbia (10.3) (Fig. 2.13). All 14 countries reporting 2019 data provided information on transmission mode, and the 2019 data (Table A, Tables 4–7) indicate the following: • 27% of those newly diagnosed and 49% of new HIV diagnoses with a known route of transmission were infected through sex between men (1863) (Table 4); in 2019, sex between men was the predominant reported mode of transmission in 10 countries (Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Hungary, Montenegro, Serbia, Slovakia, Slovenia and Poland) (Fig. 2.14); • 25% of those newly diagnosed and 46% of new HIV diagnoses with a known route of transmission were infected through heterosexual transmission (1730) (Table 6), which was the main reported mode of transmission in four countries (Albania, Cyprus, Romania and Turkey) (Fig. 2.14); • 2% of those newly diagnosed and 4% of new HIV diagnoses with a known route of transmission were infected through injecting drug use (146) (Table 5); • 1% of those with a known route of transmission were infected through mother-to-child transmission (36) (Table 7); and • transmission mode was unknown for 44% of those newly diagnosed (3029) (Table 8), with the two countries with the highest number of new HIV diagnoses in 2019 (Turkey and Poland – together accounting for 69% of all new HIV diagnoses reported in the Centre in 2019) also having the highest percentage of new HIV diagnoses with an unknown transmission mode (Poland 72% and Turkey 58%). Twelve of 15 countries provided information on CD4 cell count at HIV diagnosis for 2034 people aged over 14 years (covering 30% of all new diagnoses in the Centre countries and 40% in the 14 countries with CD4 cell data) (Table 13). Fifty-six per cent were late presenters, with CD4 cell counts below 350 per mm3 at HIV diagnosis, including 35% with advanced HIV infection (CD4 under 200/mm3). In all, 18% had a CD4 cell count of between 350 and 500 cells per mm3 and 27% had a CD4 cell count above 500 per mm3. The proportion diagnosed with CD4 counts of less than 350/mm3 was 50% or above in nine countries: Cyprus (91%), Albania (75%), Montenegro (64%), Romania (63%), Bulgaria (62%), Serbia (60%), Bosnia and Herzegovina (54%), Slovenia (52%) and Croatia (50%). The percentage of late presenters varied across transmission categories and was highest for Fig. 2.12. Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2019 9 0 5 10 15 20 25 30 35 96 93 79 3 3 201 191 142 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 Russian Federation, Turkmenistan and Uzbekistan. 49 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Fig. 2.13. Male-to-female ratio in new HIV diagnoses, by country, Centre, 2019 0 5 10 15 20 25 Cyprus Albania Romania Slovenia Bulgaria Centre average Turkey Poland Czechia Bosnia and Herzegovina Slovakia Serbia Montenegro Hungary Croatia Male-to-female ratio Fig. 2.14. New HIV diagnoses, by country and transmission mode, Centre, 2019 (n = 6713) 0 20 40 60 80 100 Heterosexual contact Sex between men Injecting drug use Other Unkown Percentage Albania Turkey Poland Romania Centre average Cyprus Bulgaria Slovakia Montenegro Slovenia Czechia Bosnia and Herzegovina Hungary Croatia Serbia 50 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data those infected as a result of injecting drug use (73%) and heterosexually (65%) and lowest for men infected through sex with men (47%) (Table 13, Fig. 2.15). 2.3.2 Trends in HIV diagnoses in the Centre The rate of new HIV diagnoses increased by 113% between 2010 and 2019 in the 14 reporting countries of the Centre, from 1.6 per 100 000 population (2945 cases) to 3.4 (6814 cases) (Fig. 2.2). Rates increased in all countries except Slovenia. The largest increases were in Bosnia and Herzegovina, Slovakia and Turkey. Information on trends by reported mode of HIV transmission for the period 2010–2019 in the 12 countries with consistent data25 (Fig. 2.16) indicates the following. • The number of new diagnoses in those infected as a result of sex between men nearly doubled, from 593 to 1025. The percentage of new HIV diagnoses attributed to sex between men also increased, from 40% in 2010 to 48% in 2019. • The number of new diagnoses in those infected through heterosexual transmission increased by 48%, from 568 to 841. The percentage of new HIV diagnoses attributed to heterosexual transmission decreased slightly from 40% in 2010 to 38% in 2019. • The number of new diagnoses in those infected as a result of injecting drug use increased from 96 to 117. 25 Data from North Macedonia, Poland and Turkey were excluded due to incomplete reporting on transmission mode during the period. Fig. 2.16. New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2010–2019 0 200 400 600 800 1000 Ne w 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 2019201820172016201520142013201220112010 Note: data from North Macedonia, Poland and Turkey excluded due to incomplete reporting on transmission mode during the period. Fig. 2.15. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, Centre, 2019 (n = 1847) 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 = 824 n = 873 n = 102 Percentage Tr an sm is si on m od e Note: no data from Hungary, North Macedonia or Poland. 51 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT 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 diagnoses attributed to injecting drug use was 6% in both 2010 and 2019. • The number of new diagnoses as a result of mother-to- child transmission decreased from 31 cases in 2010 to 16 cases in 2019. • The number of new diagnoses reported with unknown transmission mode in 2019, although still high at 44% for the 15 countries, decreased by 47%, from 211 to 112 in the 12 countries with consistent data on transmission mode. The percentage of new diagnoses with missing information about transmission mode decreased from 14% in 2010 to 5% in 2019 in the 12 countries included in the trend assessment. 2.3.3 AIDS cases, morbidity and mortality in the Centre In 2019, 802 people were diagnosed with AIDS in the 14 reporting countries in the Centre, corresponding to a rate of 0.4 per 100 000 population (Table 14). The highest rates (1.0 or above) were reported by Montenegro (1.6), Romania (1.5), Albania (1.4) and Bulgaria (1.0). AIDS rates remained below 0.8 per 100 000 population in other countries in the Centre. In contrast 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 (52% of new diagnoses) than with sex between men (32% of new diagnoses). The rate of new AIDS diagnoses remained stable at 0.4 per 100 000 between 2010 and 2019, with almost no change during the period (Fig. 2.4). Trends were more heterogeneous at country level. Of the nine countries reporting more than 10 AIDS cases in 2019, the rate increased by more than 50% in four (Albania, Bulgaria, Croatia and Hungary) (Table 14). In terms of the mode of transmission, new AIDS diagnoses increased most among men infected as a result of sex between men (by 93% for the decade) but have been relatively stable or declining since 2014 in those infected heterosexually or through injecting drug use (Fig. 2.17). The most common AIDS-indicative diseases diagnosed in 2019 were wasting syndrome due to HIV (21% of all recorded disease events), Pneumocystis pneumonia (13%) and pulmonary TB (12%) (Table 22). Mortality also remained stable in the Centre, with 282 deaths reported by the 14 countries in 2010 and 260 in 2019 and little variation being seen during the decade (though the numbers were slightly higher during 2011–2015) (Table 23). 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. 2.4 HIV and AIDS diagnoses in the West 2.4.1 HIV diagnoses in the West The epidemiological pattern of HIV infection in the West largely mirrors that of the EU/EEA, as described in Chapter 1. In 2019, 21 793 people were newly diagnosed with HIV in the 20 reporting countries comprising the West of the WHO European Region, giving a rate of 5.2 per 100 000 population (not adjusted for reporting delay) (Table A, Table 1). When adjusting the 2019 West rate for reporting delay,26 it increases to 5.7 per 100 000 population (23 971 cases). In 2019, the highest proportion of newly diagnosed HIV infections (30%) were in 30–39-year-olds, 10% were aged 15–24 years and the male-to-female ratio was 2.9 26 See Annex 1 for methods and Annex 6 for results. Fig. 2.17. New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2010–2019 0 100 200 300 400 Ne w 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 2019201820172016201520142013201220112010 Note: data from North Macedonia, Poland and Turkey excluded due to incomplete reporting during the period. 52 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data (Table A). Sexual transmission between men remained the main transmission mode in 2019, followed by heterosexual transmission, together accounting for 74% of all new diagnoses and 94% of all cases with a known route of transmission. Seventeen countries reported information on CD4 cell count at HIV diagnosis for 14 321 people over 14 years (67% of new diagnoses from the 17 countries reporting information on CD4 cell counts). Of these, 49% were late presenters with CD4 cell counts below 350 per mm3 at HIV diagnosis, including 29% with advanced HIV infection (CD4 under 200/mm3) (Table 13). Late presentation varied by transmission category and was more common in people infected heterosexually (56%) or through injecting drug use (49%) and less common in men infected through sex with men (41%) (Table 13). Information about transmission mode (Table A, Tables 4–7) suggests the following: • 40% of all people newly diagnosed and 51% of those with a known mode of transmission were infected through sex between men (8703) (Table 4); • 34% of all people newly diagnosed and 43% of those with a known mode of transmission were infected heterosexually (7431) (Table 6); of these, 63% were born abroad and 39% originated from generalized epidemic countries (Table 11); • 3% of all people newly diagnosed were infected through injecting drug use (739) (Table 5); • mother-to-child transmission accounted for 0.7% of all new diagnoses and 0.9% of those with a known route of transmission (150 cases) (Table 7); of these, 88% were born abroad and 63% originated from countries with a generalized epidemic (Table 11); and • transmission mode was unknown for 22% of all new diagnoses (4705). Information about country of birth, country of nationality or region of origin was provided for all 21 793 new diagnoses in 2019. Region of origin was unknown for 14% (3034). Among 18 759 persons with known origin (86%), 49% (9192) originated from outside of the reporting country, including 36% (6845) from outside the WHO European Region and 13% (2347) from a European country other than the country of report (Table 11). 2.4.2 Trends in HIV diagnoses in the West The crude rate of new diagnoses in the 20 reporting countries declined by 44% between 2010 and 2019, from 7.5 per 100 000 population (29 515) to 5.2 (21 793) (not adjusted for reporting delay).27 After adjusting the 2019 rate for reporting delay, the decline was 32% (from 7.5 to 5.7 per 100 000 population, with 23 971 cases in 2019). HIV rates increased (by 10% or more in countries with more than 10 cases in both 2010 and 2019) in four countries – Germany, Iceland, Ireland and Malta – and 27 See Annex 1 for methods and Annex 6 for results. decreased (by 10% or more) in 13 (Table 1), not taking into account the impact of reporting delays in several countries. Information about trends by reported transmission mode during the period 2010–2019 in the 15 countries with consistent data28 and taking standardized adjustments for reporting delay into account (Fig. 2.18) suggests the following. • New diagnoses of people infected through sex between men decreased by 27%, from 8601 to 6274. The percentage of new diagnoses attributed to sex between men decreased from 41% in 2010 to 36% in 2019. • New diagnoses of people with reported heterosexual transmission decreased by 30%, from 8667 to 6097, with the steepest decline among women and foreign- born heterosexual people, the latter being due mainly to sharp declines among migrants originating from countries with generalized HIV epidemics (data not shown; see also Fig. 1.11 and 1.12 and section 1.2 (Trends in HIV diagnoses) in Chapter 1). The percentage of new diagnoses attributed to heterosexual contact decreased from 41% of cases in 2010 to 35% in 2019. • New diagnoses of people infected through injecting drug use decreased by 29%, from 778 in 2010 to 554 in 2019, representing 4% of new HIV diagnoses in 2010 and 3% in 2019. • New diagnoses of children infected through mother- to-child transmission decreased by 42%, from 249 in 2010 to 145 in 2019. • The number of new diagnoses with missing information about transmission mode increased by 47%, from 2833 to 4164, corresponding to 13% of new diagnoses in 2010 and 24% in 2019. Delays in the reporting of probable mode of transmission to national and European surveillance systems intensify the increase. 2.4.3 AIDS cases, morbidity and mortality in the West In 2019, 19 of the 23 countries in the West29 reported that 2156 people were diagnosed with AIDS, giving a rate of 0.5 per 100 000 population (Table 14). The steady decline in new AIDS diagnoses that began in the late 1990s continued through to 2019, with a 69% decrease in the rate of new AIDS cases over the decade from 1.6 per 100 000 population (6539 cases) in 2010 to 0.5 (2156 cases) in 2019 (Fig. 2.4). New AIDS diagnoses decreased in all transmission groups but most notably among people who inject drugs (an 85% decline) (Fig. 2.19). The most common AIDS-indicative diseases diagnosed in the West in 2019 were Pneumocystis pneumonia (24% of all disease events reported), oesophageal candidiasis (12%) and Kaposi’s sarcoma (11%) (Table 22). In the West, 527 people were reported to have died in 2019 in the 17 countries for which consistent data were 28 Data from Italy and Spain were excluded due to increasing coverage of national surveillance over the period. 29 No data were available from Andorra, Belgium, Monaco or Sweden. 53 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT available30 (Table 23). The number of AIDS-related deaths has continued to decline during the decade, from 2325 in 2010 to 527 in 2019, representing a 77% decrease. These numbers do not reflect the true burden of AIDS-related mortality in the West of the Region due to reporting delays. In particular, there is a risk of deaths being underreported in those countries that do not have the ability to link their HIV/AIDS registries with their vital statistics registries. 2.5 HIV testing Data on the number of HIV tests can support the interpretation of trends in newly diagnosed HIV infections. In 2019, a total of 66 879 048 HIV tests were 30 No data were available from Andorra, Belgium, Denmark, Italy, Monaco or Sweden. reported by 22 countries (12 East, nine Centre and one West). These tests do not include unlinked anonymous testing and all countries except the Russian Federation also exclude the HIV tests performed as part of blood- donor screening. In 2019, the Russian Federation reported a total of 47 206 251 HIV tests, accounting for 71% of all HIV tests reported in the Region for that year. 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 24). The overall number of tests performed in the Region increased by 77%, from 37 650 358 in 2010 to 66 918 147 in 2019, in the 21 countries with data for both 2010 and 2019. Increases in large countries with high testing numbers, such as Belarus, Kazakhstan, the Russian Fig. 2.19. New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2010–2019 0 1000 2000 3000 2019201820172016201520142013201220112010 Ne w 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: Andorra, Belgium, Monaco and Sweden excluded due to inconsistent reporting during the period. Fig. 2.18. New HIV diagnoses, by transmission mode and year of diagnosis, West, 2010–2019 0 2000 4000 6000 8000 10 000 2019201820172016201520142013201220112010 Year of diagnosis Ne w H IV d ia gn os es Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Note: data from Andorra, Belgium and Monaco excluded due to inconsistent reporting during the period; data from Iceland, Ireland and Malta 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. (In total, data from 45 countries included for Fig 2.18 in 2019.) 54 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Federation and Turkey, had a considerable impact on the overall increase. The number of tests more than doubled in six 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 77%, from 31 793 139 in 2010 to 56 127 346 in 2019 (Table 24). Information about the types of populations tested is not available, but an increasing number 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 nevertheless is possible that increased testing activity has contributed to the observed increase in new diagnoses. The rate of new HIV diagnoses in the Centre more than doubled during the last decade, while the number of HIV tests increased by 76% (from 5 924 413 in 2010 to 10 415 092 in 2019) in the eight countries for which consistent data were available.31 The number of HIV tests conducted in the West is not reported separately here. In contrast 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 being too sparse to allow for meaningful interpretation. 2.6 Conclusions HIV infection continues to affect the health and well- being of millions of people in the WHO European Region and to pose a serious public health concern, particularly in the eastern part of the Region. More than 136 000 people were diagnosed with HIV infection in 2019, at a rate of 15.6 diagnoses per 100 000 population. The vast majority of people newly diagnosed (79%) were from the East, with a rate of 41.7 per 100 000 population, while 16% were diagnosed in the West, with a rate of 5.7 per 100 000 population, and 5% in the Centre, with a rate of 3.4 per 100 000 population. An increasing trend in new HIV diagnoses has been observed in one third of the reporting countries in the East, although this is at a slower rate than in previous years. Halted growth in reported newly diagnosed HIV has been observed in the Russian Federation. Some signs of stabilization have been noted in Ukraine. This contributed to the overall stabilization of the epidemic in the East. The 2019 HIV surveillance data also confirm the great variation in epidemic patterns and trends across the WHO European Region. Overall, among the new diagnoses for which the HIV transmission mode was known, heterosexual transmission accounted for 59%, sex between men for 24% and injecting drug use for 15%. These overall numbers conceal a complex mix of transmission patterns, trends and country contexts in 31 The eight countries are Albania, Bulgaria, Czechia, Montenegro, Poland, Serbia, Slovenia and Turkey. which transmission through sex between men tends to predominate in the western and central parts of the Region, heterosexual transmission remains substantial across large parts of the Region (particularly among migrants, travellers and partners of people who inject drugs) and injecting drug use remains an important risk factor, mainly in the eastern part of the Region. Transmission as a result of injecting drug use continued to decrease during the decade but still accounted for 24% of new diagnoses in the East with a known transmission mode. Although the reported transmission through sex between men remains low in absolute terms in the East, it has increased nearly five-fold during the decade – the largest increase in any transmission category and any geographical area of the Region. There is 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 (2,3). While most new diagnoses (65%) were in men and new diagnoses increased more rapidly among men than women, the proportion of new diagnoses among women was much higher in the East than elsewhere in the Region. The rate of new diagnoses is increasing more rapidly in the central part than anywhere else in the Region, with a strong gender disparity and very steep increases among men (both MSM and heterosexual) compared with a fairly stable rate among women. Sexual transmission outweighs all other types of transmission 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 (4–8) suggest that HIV prevention services for people who inject drugs continue to be important and must be maintained with sufficient coverage 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 treatment 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 coinfections (particularly sexually transmitted infections); and rapid HIV treatment initiation. Services should be patient-centred and provided in a friendly environment, preferably with the involvement of civil society along the entire HIV continuum of services, ranging from HIV prevention to adherence and ART. In the western part of the Region, there has been a clear decline in the overall rate of new HIV diagnoses during 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 among people infected heterosexually, particularly women and people 55 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT originating 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 (9,10) have probably all contributed to the observed decline. While a certain proportion of migrants, even those originating from HIV-endemic areas, are known to acquire HIV after arrival in the EU/EEA (11–13), the extent to which the observed decreases can be explained by lower incidence of HIV in the migrant populations, reduced test-seeking or opportunities, changed migration patterns or a combination of factors, is unclear. Where migration is a common occurrence and takes a variety of forms, the public health challenge of ensuring access to health services for migrant populations (including HIV services and the promotion of 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. Once again, it is significant that the 2019 data provide information about variations in late presentation according to geography, transmission mode and age. Moreover, the data confirm that the proportion diagnosed at a late stage of infection was highest in the East, among people infected heterosexually (particularly men) and as a result of injecting drug use, and among those in older age groups. Late presentation reflects insufficient access to, and uptake of, appropriate HIV testing and counselling by those who have a higher risk of acquiring HIV. HIV testing strategies need to be reconsidered and diversified to include innovative approaches that involve community- based organizations and focus on the key population groups. Multiple entry points to HIV testing should be available through, for example, HIV self-testing, HIV testing performed 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 treatment programmes, sexual and reproductive health clinics and migrant health services, depending on the local context. Support for timely linkage to HIV treatment and care is essential to reduce late presentation and to make progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO 90–90–90 targets, improving treatment outcomes and further reducing HIV transmission. In September 2020, considering the COVID-19 pandemic situation, the WHO Regional Office for Europe and the ECDC organized a joint virtual meeting with major national stakeholders involved in the response to TB, HIV and viral hepatitis, including key partners, donors, affected communities and civil society organizations, to exchange information and good practices on the maintenance of essential TB, HIV and viral hepatitis services. Countries and partners discussed their experiences in ensuring access to, and continuity of, quality HIV services during the COVID-19 pandemic and on how they monitored the impact of the COVID-19 pandemic on HIV services. Latest WHO policy guidance and recommendations on TB, HIV, viral hepatitis and comorbidities were also discussed during the meeting. AIDS trends varied greatly across the three geographical areas. While the rate continued its steady decline in the West, it remained stable in the Centre and, although it increased by 15% over the decade in the East of the Region, overall there was a 23% decrease in the rate of new AIDS diagnoses in the Region between 2010 and 2019. The high number of AIDS cases is indicative of late HIV diagnosis, delayed initiation of life-saving HIV treatment and low treatment coverage. Increasing implementation of a treat-all approach and having policies in place in most countries in the Region to ensure that everyone living with HIV is offered ART regardless of the stage of disease has helped to stabilize AIDS trends and will, ultimately, help reduce AIDS- related deaths in line with global and regional targets (14–17). 2.7 References32 1. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire (French National Institute of Health Surveillance); 2007. 2. 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. 3. Dumchev K, Kornilova M, Kulchynska R, Azarskova M, Vitek C. Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk. BMC Public Health 2020;20(1):1288. doi:10.1186/s12889-020-09373-2. PMID: 32843008. PMCID: PMC7449084. 4. 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). 5. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2016. Euro Surveill. 2016;20(40):pii=30036 (http://dx.doi.org/10.2807/1560-7917.ES.2016.20.40.30036). 6. 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). 7. McAuley A, Palmateer NE, Goldberg DJ, Trayner KMA, Shepherd SJ, Gunson RN et al. Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross-sec- tional analysis. Lancet HIV 2019;6(5):e315–24. 8. Des Jarlais DC, Sypsa V, Feelemyer J, Abagiu AO, Arendt V, Broz D et al. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV 2020;7(6):e434–42. 9. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014 (http://ecdc.europa.eu/en/publi- cations/ Publications/hiv-sti-prevention-among-men-who-havesex- with-men-guidance.pdf). 10. 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. 32 All weblinks were accessed on 12 November 2020. 56 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data unfpa.org/publications/ implementing-comprehensive-hiv-and-sti- programmesmen- who-have-sex-men). 11. 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. 12. Fakoya I, Alvarez-del Arco D, Woode-Owusu M, Monge S, Rivero- Montesdeoca Y, Delpech V et al. A systematic review of postmigra- tion 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. 13. Fakoya I, Alvarez-Del Arco D, Monge S, Copas AJ, Gennotte A-F, Volny-Anne A 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). 14. Ambitious treatment targets: writing the final chapter of the AIDS epidemic. Geneva: UNAIDS; 2014 (www.unaids.org/sites/default/ files/media_asset/JC2670_UNAIDS_Treatment_Targets_en.pdf). 15. Action plan for the health sector response to HIV in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2017 (https://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). 16. Global health sector strategy for HIV 2016–2021. Geneva: World Health Organization; 2016 (https://www.who.int/hiv/strat- egy2016-2021/ghss-hiv/en/). 17. 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). Tables 58 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 363 4.3 361 4.3 365 4.3 307 3.6 304 3.6 324 3.8 291 3.3 302 3.4 199 2.3 225 2.5 10 188 Austria West Belgium 1985 1 184 10.9 1 171 10.6 1 228 11.1 1 128 10.1 1 057 9.5 1 020 9.1 909 8.0 899 7.9 882 7.7 – – 31 540 Belgium Centre Bulgaria 1986 163 2.2 201 2.7 157 2.1 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 311 4.4 258 3.7 3 316 Bulgaria Centre Croatia 1985 71 1.7 74 1.7 73 1.7 85 2.0 92 2.2 117 2.8 109 2.6 106 2.6 94 2.3 102 2.5 1 734 Croatia Centre Cyprus 1986 41 5.0 54 6.4 58 6.7 54 6.2 56 6.5 80 9.4 80 9.4 85 9.9 78 9.0 100 11.4 1 326 Cyprus Centre Czechia 1985 180 1.7 153 1.5 212 2.0 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 208 2.0 222 2.1 3 590 Czechia West Denmark 1990 275 5.0 266 4.8 201 3.6 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 219 3.8 190 3.3 8 000 Denmark East Estonia 1988 376 28.2 366 27.5 315 23.8 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 190 14.4 178 13.4 10 079 Estonia West Finland 1980 184 3.4 172 3.2 156 2.9 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 153 2.8 149 2.7 4 213 Finland West France 2003 5 559 8.6 5 426 8.4 5 680 8.7 5 572 8.5 5 691 8.6 5 313 8.0 5 444 8.2 5 388 8.1 5 078 7.6 4 923 7.3 93 688 France West Germany 1993 2 809 3.4 2 763 3.4 3 027 3.8 3 235 4.0 3 525 4.4 3 642 4.5 3 378 4.1 3 155 3.8 2 867 3.5 3 093 3.7 71 163 Germany West Greece 1984 648 5.8 966 8.7 1 161 10.5 901 8.2 779 7.1 778 7.2 649 6.0 647 6.0 723 6.7 603 5.6 16 171 Greece Centre Hungary 1985 182 1.8 162 1.6 219 2.2 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 229 2.3 238 2.4 4 034 Hungary West Iceland 1983 24 7.6 23 7.2 19 5.9 11 3.4 11 3.4 12 3.6 28 8.4 24 7.1 38 10.9 28 7.8 451 Iceland West Irelandc 1985 330 7.3 328 7.2 350 7.6 343 7.4 378 8.2 483 10.3 511 10.8 499 10.4 508 10.5 533 10.9 9 901 Irelandc West Italy 1985 4 024 6.8 3 898 6.6 4 162 7.0 3 843 6.4 3 831 6.3 3 598 5.9 3 687 6.1 3 579 5.9 3 003 5.0 2 531 4.2 49 882 Italy East Latvia 1987 274 12.9 299 14.4 339 16.6 340 16.8 350 17.5 400 20.1 369 18.7 376 19.3 328 17.0 295 15.4 7 985 Latvia – Liechtenstein 1985 4 11.1 1 2.8 0 0.0 0 0.0 1 2.7 0 0.0 2 5.3 0 0.0 0 0.0 0 0.0 67 Liechtenstein East Lithuania 1988 153 4.9 166 5.4 160 5.3 177 6.0 141 4.8 157 5.4 214 7.4 263 9.2 160 5.7 151 5.4 3 323 Lithuania West Luxembourgc 1983 65 12.9 61 11.9 70 13.3 75 14.0 89 16.2 75 13.3 81 14.1 67 11.3 57 9.5 48 7.8 1 830 Luxembourgc West Malta 2001 18 4.3 21 5.1 30 7.2 36 8.5 40 9.3 61 13.9 63 14.0 45 9.8 73 15.3 80 16.2 585 Malta West Netherlands 1980 1 277 7.7 1 233 7.4 1 167 7.0 1 132 6.7 1 001 5.9 990 5.9 891 5.2 825 4.8 691 4.0 563 3.3 28 083 Netherlands West Norway 1984 258 5.3 269 5.5 242 4.9 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 191 3.6 172 3.2 6 654 Norway Centre Poland 1985 955 2.5 1 113 2.9 1 104 2.9 1 100 2.9 1 134 3.0 1 278 3.4 1 319 3.5 1 419 3.7 1 210 3.2 1 468 3.9 25 591 Poland West Portugal 1985 1 989 18.8 1 821 17.2 1 804 17.1 1 772 16.9 1 454 13.9 1 495 14.4 1 508 14.6 1 336 13.0 1 109 10.8 778 7.6 61 433 Portugal Centre Romania 1987 590 2.9 837 4.1 940 4.7 1 019 5.1 907 4.5 884 4.4 774 3.9 796 4.1 732 3.7 690 3.6 24 990 Romania Centre Slovakia 1985 28 0.5 49 0.9 50 0.9 83 1.5 86 1.6 86 1.6 88 1.6 72 1.3 102 1.9 101 1.9 1 074 Slovakia Centre Slovenia 1985 35 1.7 56 2.7 48 2.3 47 2.3 53 2.6 52 2.5 60 2.9 40 1.9 37 1.8 34 1.6 923 Slovenia West Spain 2003 3 914 11.9 3 676 11.2 3 944 10.4 4 374 9.4 4 429 9.5 4 189 9.0 4 175 9.0 3 795 8.2 2 527 6.4 2 483 5.6 54 673 Spain West Sweden 1983 420 4.5 461 4.9 441 4.7 457 4.8 473 4.9 447 4.6 429 4.4 434 4.3 481 4.8 449 4.4 13 499 Sweden West United Kingdom 1981 6 328 10.1 6 153 9.8 6 190 9.7 5 964 9.3 6 296 9.8 6 198 9.6 5 231 8.0 4 653 7.1 4 537 6.8 4 116 6.2 164 417 United Kingdom Total EU/EEA 32 721 6.6 32 600 6.6 33 912 6.8 33 678 6.6 33 923 6.6 33 385 6.5 31 879 6.2 30 355 5.9 27 015 5.3 24 801 4.9 714 403 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 43 1.5 78 2.7 81 2.8 120 4.1 79 2.7 96 3.3 127 4.4 94 3.3 102 3.5 101 3.5 1 304 Albania West Andorra 2004 6 7.1 2 2.4 2 2.4 5 6.2 5 6.3 3 3.8 3 3.9 6 7.8 12 15.6 – – 96 Andorra East Armeniac 1988 149 5.2 183 6.4 230 8.0 239 8.2 339 11.6 296 10.1 304 10.4 355 12.1 420 14.2 446 15.1 3 785 Armeniac East Azerbaijan 1987 459 5.1 548 6.0 517 5.6 514 5.5 604 6.4 727 7.6 556 5.7 567 5.8 656 6.6 721 7.2 8 129 Azerbaijan East Belarus 1981 1 069 11.3 1 196 12.7 1 223 13.0 1 533 16.3 1 811 19.2 2 305 24.4 2 391 25.3 2 468 26.1 2 386 25.2 2 137 22.6 29 209 Belarus Centre Bosnia and Herzegovinac 1986 1 0.0 27 0.7 25 0.7 2 0.1 23 0.7 15 0.4 24 0.7 15 0.4 24 0.7 30 0.9 338 Bosnia and Herzegovinac East Georgia 1989 455 11.1 424 10.4 526 12.9 490 12.1 564 14.0 717 17.8 719 17.9 631 15.7 672 16.8 668 16.7 8 102 Georgia West Israel 1981 419 5.7 450 6.0 483 6.3 465 6.0 462 5.9 413 5.2 368 4.5 415 5.0 452 5.4 408 4.8 10 495 Israel East Kazakhstan 1987 1 982 12.2 1 997 12.1 2 004 12.0 2 131 12.5 2 342 13.5 2 475 14.1 2 898 16.3 3 014 16.7 3 215 17.5 3 673 19.8 39 439 Kazakhstan East Kyrgyzstan 1987 567 10.5 614 11.1 701 12.5 503 8.8 649 11.1 653 11.0 764 12.6 840 13.6 876 13.9 850 13.2 9 745 Kyrgyzstan West Monaco 1987 0 0.0 0 0.0 1 2.7 0 0.0 1 2.7 1 2.7 0 0.0 3 7.8 0 0.0 – – 40 Monaco Centre Montenegro 1989 15 2.4 9 1.4 13 2.1 11 1.8 20 3.2 19 3.0 34 5.4 26 4.1 23 3.7 26 4.1 303 Montenegro Centre North Macedonia 1993 5 0.2 1 0.0 15 0.7 15 0.7 30 1.4 25 1.2 30 1.4 44 2.1 45 2.2 – – 246 North Macedonia East Republic of Moldova 1987 703 17.2 721 17.7 757 18.6 706 17.3 831 20.4 818 20.1 832 20.5 835 20.6 905 22.3 922 22.8 13 679 Republic of Moldova East Russian Federation 2009 62 581 43.6 67 317 46.8 75 708 52.6 81 698 56.6 92 613 64.0 100 220 69.1 86 855 59.8 85 802 59.0 85 995 59.0 80 124 54.9 881 258 Russian Federation West San Marino 1985 6 19.2 8 25.3 5 15.6 1 3.1 3 9.1 2 6.0 2 6.0 1 3.0 3 8.9 0 0.0 93 San Marino Centre Serbia 1984 152 1.7 134 1.5 137 1.5 156 1.7 137 1.5 183 2.1 179 2.0 186 2.1 188 2.1 215 2.0 4 192 Serbia Centre Serbia excluding Kosovo1 1984 149 2.2 128 1.8 133 1.9 153 2.1 131 1.8 180 2.5 168 2.4 183 2.6 180 2.6 210 2.4 4 066 Serbia excluding Kosovo1 Centre Kosovo1 1999 3 0.1 6 0.3 4 0.2 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 8 0.4 5 0.3 126 Kosovo1 West Switzerland 1985 605 7.7 562 7.1 621 7.8 576 7.1 517 6.3 536 6.5 533 6.4 446 5.3 425 5.0 421 4.9 36 822 Switzerland East Tajikistan 1991 881 11.7 880 11.4 770 9.8 817 10.1 986 11.9 1 149 13.6 1 038 12.0 1 205 13.6 1 421 15.6 1 320 14.2 11 986 Tajikistan Centre Turkey 1985 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 3 248 3.9 3 229 3.9 22 467 Turkey East Turkmenistan 1990 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 2 Turkmenistan East Ukraine 1987 16 617 36.3 17 305 37.9 16 850 37.1 17 844 39.4 15 796 35.0 13 000 30.4 14 241 33.4 15 625 36.8 15 686 37.2 16 357 39.0 294 436 Ukraine East Uzbekistan 1981 3 795 13.3 – – – – – – – – – – – – – – – – – – 24 018 Uzbekistan Total non-EU/EEA 90 999 23.8 93 155 26.2 101 737 28.4 109 139 30.3 119 650 33.0 125 760 34.7 114 336 31.3 115 422 31.4 116 754 31.6 111 648 30.1 1 400 184 Total non-EU/EEA WHO European Region WHO European Region West West 30 705 7.6 30 091 7.4 31 349 7.6 30 820 7.3 31 050 7.3 30 252 7.1 28 825 6.7 27 132 6.3 24 228 5.7 21 793 5.2 673 917 West Centre Centre 2 950 1.6 3 647 1.9 4 200 2.2 4 680 2.4 5 205 2.7 5 706 2.9 5 978 3.1 6 445 3.3 6 631 3.4 6 814 3.4 95 428 Centre East East 90 061 31.8 92 016 36.1 100 100 39.1 107 317 41.8 117 317 45.6 123 187 48.1 111 410 43.4 112 200 43.6 112 910 43.7 107 842 41.7 1 345 175 East Total WHO European Region 123 716 14.1 125 754 14.8 135 649 15.8 142 817 16.4 153 572 17.5 159 145 18.2 146 213 16.6 145 777 16.5 143 769 16.3 136 449 15.6 2 114 520 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 The numbers displayed here may not fully align with the numbers in the country's national statistics as these are presented by the "date of notification" instead of the "date of diagnosis" as here. The national statistics numbers are, for 2019, 448 (Armenia ), 31 (Bosnia and Herzegovina ), 538 (Ireland) and 96 (Luxembourg). 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 59 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 363 4.3 361 4.3 365 4.3 307 3.6 304 3.6 324 3.8 291 3.3 302 3.4 199 2.3 225 2.5 10 188 Austria West Belgium 1985 1 184 10.9 1 171 10.6 1 228 11.1 1 128 10.1 1 057 9.5 1 020 9.1 909 8.0 899 7.9 882 7.7 – – 31 540 Belgium Centre Bulgaria 1986 163 2.2 201 2.7 157 2.1 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 311 4.4 258 3.7 3 316 Bulgaria Centre Croatia 1985 71 1.7 74 1.7 73 1.7 85 2.0 92 2.2 117 2.8 109 2.6 106 2.6 94 2.3 102 2.5 1 734 Croatia Centre Cyprus 1986 41 5.0 54 6.4 58 6.7 54 6.2 56 6.5 80 9.4 80 9.4 85 9.9 78 9.0 100 11.4 1 326 Cyprus Centre Czechia 1985 180 1.7 153 1.5 212 2.0 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 208 2.0 222 2.1 3 590 Czechia West Denmark 1990 275 5.0 266 4.8 201 3.6 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 219 3.8 190 3.3 8 000 Denmark East Estonia 1988 376 28.2 366 27.5 315 23.8 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 190 14.4 178 13.4 10 079 Estonia West Finland 1980 184 3.4 172 3.2 156 2.9 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 153 2.8 149 2.7 4 213 Finland West France 2003 5 559 8.6 5 426 8.4 5 680 8.7 5 572 8.5 5 691 8.6 5 313 8.0 5 444 8.2 5 388 8.1 5 078 7.6 4 923 7.3 93 688 France West Germany 1993 2 809 3.4 2 763 3.4 3 027 3.8 3 235 4.0 3 525 4.4 3 642 4.5 3 378 4.1 3 155 3.8 2 867 3.5 3 093 3.7 71 163 Germany West Greece 1984 648 5.8 966 8.7 1 161 10.5 901 8.2 779 7.1 778 7.2 649 6.0 647 6.0 723 6.7 603 5.6 16 171 Greece Centre Hungary 1985 182 1.8 162 1.6 219 2.2 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 229 2.3 238 2.4 4 034 Hungary West Iceland 1983 24 7.6 23 7.2 19 5.9 11 3.4 11 3.4 12 3.6 28 8.4 24 7.1 38 10.9 28 7.8 451 Iceland West Irelandc 1985 330 7.3 328 7.2 350 7.6 343 7.4 378 8.2 483 10.3 511 10.8 499 10.4 508 10.5 533 10.9 9 901 Irelandc West Italy 1985 4 024 6.8 3 898 6.6 4 162 7.0 3 843 6.4 3 831 6.3 3 598 5.9 3 687 6.1 3 579 5.9 3 003 5.0 2 531 4.2 49 882 Italy East Latvia 1987 274 12.9 299 14.4 339 16.6 340 16.8 350 17.5 400 20.1 369 18.7 376 19.3 328 17.0 295 15.4 7 985 Latvia – Liechtenstein 1985 4 11.1 1 2.8 0 0.0 0 0.0 1 2.7 0 0.0 2 5.3 0 0.0 0 0.0 0 0.0 67 Liechtenstein East Lithuania 1988 153 4.9 166 5.4 160 5.3 177 6.0 141 4.8 157 5.4 214 7.4 263 9.2 160 5.7 151 5.4 3 323 Lithuania West Luxembourgc 1983 65 12.9 61 11.9 70 13.3 75 14.0 89 16.2 75 13.3 81 14.1 67 11.3 57 9.5 48 7.8 1 830 Luxembourgc West Malta 2001 18 4.3 21 5.1 30 7.2 36 8.5 40 9.3 61 13.9 63 14.0 45 9.8 73 15.3 80 16.2 585 Malta West Netherlands 1980 1 277 7.7 1 233 7.4 1 167 7.0 1 132 6.7 1 001 5.9 990 5.9 891 5.2 825 4.8 691 4.0 563 3.3 28 083 Netherlands West Norway 1984 258 5.3 269 5.5 242 4.9 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 191 3.6 172 3.2 6 654 Norway Centre Poland 1985 955 2.5 1 113 2.9 1 104 2.9 1 100 2.9 1 134 3.0 1 278 3.4 1 319 3.5 1 419 3.7 1 210 3.2 1 468 3.9 25 591 Poland West Portugal 1985 1 989 18.8 1 821 17.2 1 804 17.1 1 772 16.9 1 454 13.9 1 495 14.4 1 508 14.6 1 336 13.0 1 109 10.8 778 7.6 61 433 Portugal Centre Romania 1987 590 2.9 837 4.1 940 4.7 1 019 5.1 907 4.5 884 4.4 774 3.9 796 4.1 732 3.7 690 3.6 24 990 Romania Centre Slovakia 1985 28 0.5 49 0.9 50 0.9 83 1.5 86 1.6 86 1.6 88 1.6 72 1.3 102 1.9 101 1.9 1 074 Slovakia Centre Slovenia 1985 35 1.7 56 2.7 48 2.3 47 2.3 53 2.6 52 2.5 60 2.9 40 1.9 37 1.8 34 1.6 923 Slovenia West Spain 2003 3 914 11.9 3 676 11.2 3 944 10.4 4 374 9.4 4 429 9.5 4 189 9.0 4 175 9.0 3 795 8.2 2 527 6.4 2 483 5.6 54 673 Spain West Sweden 1983 420 4.5 461 4.9 441 4.7 457 4.8 473 4.9 447 4.6 429 4.4 434 4.3 481 4.8 449 4.4 13 499 Sweden West United Kingdom 1981 6 328 10.1 6 153 9.8 6 190 9.7 5 964 9.3 6 296 9.8 6 198 9.6 5 231 8.0 4 653 7.1 4 537 6.8 4 116 6.2 164 417 United Kingdom Total EU/EEA 32 721 6.6 32 600 6.6 33 912 6.8 33 678 6.6 33 923 6.6 33 385 6.5 31 879 6.2 30 355 5.9 27 015 5.3 24 801 4.9 714 403 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 43 1.5 78 2.7 81 2.8 120 4.1 79 2.7 96 3.3 127 4.4 94 3.3 102 3.5 101 3.5 1 304 Albania West Andorra 2004 6 7.1 2 2.4 2 2.4 5 6.2 5 6.3 3 3.8 3 3.9 6 7.8 12 15.6 – – 96 Andorra East Armeniac 1988 149 5.2 183 6.4 230 8.0 239 8.2 339 11.6 296 10.1 304 10.4 355 12.1 420 14.2 446 15.1 3 785 Armeniac East Azerbaijan 1987 459 5.1 548 6.0 517 5.6 514 5.5 604 6.4 727 7.6 556 5.7 567 5.8 656 6.6 721 7.2 8 129 Azerbaijan East Belarus 1981 1 069 11.3 1 196 12.7 1 223 13.0 1 533 16.3 1 811 19.2 2 305 24.4 2 391 25.3 2 468 26.1 2 386 25.2 2 137 22.6 29 209 Belarus Centre Bosnia and Herzegovinac 1986 1 0.0 27 0.7 25 0.7 2 0.1 23 0.7 15 0.4 24 0.7 15 0.4 24 0.7 30 0.9 338 Bosnia and Herzegovinac East Georgia 1989 455 11.1 424 10.4 526 12.9 490 12.1 564 14.0 717 17.8 719 17.9 631 15.7 672 16.8 668 16.7 8 102 Georgia West Israel 1981 419 5.7 450 6.0 483 6.3 465 6.0 462 5.9 413 5.2 368 4.5 415 5.0 452 5.4 408 4.8 10 495 Israel East Kazakhstan 1987 1 982 12.2 1 997 12.1 2 004 12.0 2 131 12.5 2 342 13.5 2 475 14.1 2 898 16.3 3 014 16.7 3 215 17.5 3 673 19.8 39 439 Kazakhstan East Kyrgyzstan 1987 567 10.5 614 11.1 701 12.5 503 8.8 649 11.1 653 11.0 764 12.6 840 13.6 876 13.9 850 13.2 9 745 Kyrgyzstan West Monaco 1987 0 0.0 0 0.0 1 2.7 0 0.0 1 2.7 1 2.7 0 0.0 3 7.8 0 0.0 – – 40 Monaco Centre Montenegro 1989 15 2.4 9 1.4 13 2.1 11 1.8 20 3.2 19 3.0 34 5.4 26 4.1 23 3.7 26 4.1 303 Montenegro Centre North Macedonia 1993 5 0.2 1 0.0 15 0.7 15 0.7 30 1.4 25 1.2 30 1.4 44 2.1 45 2.2 – – 246 North Macedonia East Republic of Moldova 1987 703 17.2 721 17.7 757 18.6 706 17.3 831 20.4 818 20.1 832 20.5 835 20.6 905 22.3 922 22.8 13 679 Republic of Moldova East Russian Federation 2009 62 581 43.6 67 317 46.8 75 708 52.6 81 698 56.6 92 613 64.0 100 220 69.1 86 855 59.8 85 802 59.0 85 995 59.0 80 124 54.9 881 258 Russian Federation West San Marino 1985 6 19.2 8 25.3 5 15.6 1 3.1 3 9.1 2 6.0 2 6.0 1 3.0 3 8.9 0 0.0 93 San Marino Centre Serbia 1984 152 1.7 134 1.5 137 1.5 156 1.7 137 1.5 183 2.1 179 2.0 186 2.1 188 2.1 215 2.0 4 192 Serbia Centre Serbia excluding Kosovo1 1984 149 2.2 128 1.8 133 1.9 153 2.1 131 1.8 180 2.5 168 2.4 183 2.6 180 2.6 210 2.4 4 066 Serbia excluding Kosovo1 Centre Kosovo1 1999 3 0.1 6 0.3 4 0.2 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 8 0.4 5 0.3 126 Kosovo1 West Switzerland 1985 605 7.7 562 7.1 621 7.8 576 7.1 517 6.3 536 6.5 533 6.4 446 5.3 425 5.0 421 4.9 36 822 Switzerland East Tajikistan 1991 881 11.7 880 11.4 770 9.8 817 10.1 986 11.9 1 149 13.6 1 038 12.0 1 205 13.6 1 421 15.6 1 320 14.2 11 986 Tajikistan Centre Turkey 1985 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 3 248 3.9 3 229 3.9 22 467 Turkey East Turkmenistan 1990 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 2 Turkmenistan East Ukraine 1987 16 617 36.3 17 305 37.9 16 850 37.1 17 844 39.4 15 796 35.0 13 000 30.4 14 241 33.4 15 625 36.8 15 686 37.2 16 357 39.0 294 436 Ukraine East Uzbekistan 1981 3 795 13.3 – – – – – – – – – – – – – – – – – – 24 018 Uzbekistan Total non-EU/EEA 90 999 23.8 93 155 26.2 101 737 28.4 109 139 30.3 119 650 33.0 125 760 34.7 114 336 31.3 115 422 31.4 116 754 31.6 111 648 30.1 1 400 184 Total non-EU/EEA WHO European Region WHO European Region West West 30 705 7.6 30 091 7.4 31 349 7.6 30 820 7.3 31 050 7.3 30 252 7.1 28 825 6.7 27 132 6.3 24 228 5.7 21 793 5.2 673 917 West Centre Centre 2 950 1.6 3 647 1.9 4 200 2.2 4 680 2.4 5 205 2.7 5 706 2.9 5 978 3.1 6 445 3.3 6 631 3.4 6 814 3.4 95 428 Centre East East 90 061 31.8 92 016 36.1 100 100 39.1 107 317 41.8 117 317 45.6 123 187 48.1 111 410 43.4 112 200 43.6 112 910 43.7 107 842 41.7 1 345 175 East Total WHO European Region 123 716 14.1 125 754 14.8 135 649 15.8 142 817 16.4 153 572 17.5 159 145 18.2 146 213 16.6 145 777 16.5 143 769 16.3 136 449 15.6 2 114 520 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 The numbers displayed here may not fully align with the numbers in the country's national statistics as these are presented by the "date of notification" instead of the "date of diagnosis" as here. The national statistics numbers are, for 2019, 448 (Armenia ), 31 (Bosnia and Herzegovina ), 538 (Ireland) and 96 (Luxembourg). 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 60 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 2. New HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 296 7.3 287 7.0 292 7.1 261 6.3 241 5.8 283 6.7 244 5.7 256 5.9 170 3.9 190 4.4 7 827 Austria West Belgium 788 14.8 783 14.5 837 15.4 789 14.4 738 13.4 701 12.7 649 11.7 601 10.8 603 10.7 – – 20 073 Belgium Centre Bulgaria 132 3.7 163 4.5 123 3.4 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 276 8.1 217 6.4 2 669 Bulgaria Centre Croatia 68 3.3 63 3.0 70 3.4 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 88 4.4 97 4.9 1 541 Croatia Centre Cyprus 34 8.5 39 9.5 49 11.7 46 10.9 49 11.7 72 17.5 65 15.8 65 15.6 65 15.4 69 16.1 981 Cyprus Centre Czechia 159 3.1 139 2.7 185 3.6 211 4.1 209 4.0 248 4.8 262 5.1 231 4.4 186 3.6 193 3.7 3 093 Czechia West Denmark 201 7.3 192 7.0 146 5.3 178 6.4 196 7.0 205 7.3 191 6.7 192 6.7 170 5.9 146 5.1 5 876 Denmark East Estonia 230 37.0 226 36.5 209 33.8 200 32.5 182 29.6 167 27.2 139 22.5 146 23.6 131 21.1 113 18.1 6 742 Estonia West Finland 130 5.0 112 4.2 111 4.2 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 104 3.8 112 4.1 3 043 Finland West France 3 662 11.7 3 597 11.4 3 826 12.1 3 734 11.8 3 823 11.9 3 554 11.0 3 590 11.1 3 517 10.9 3 257 10.1 3 136 9.7 60 406 France West Germany 2 378 5.9 2 326 5.9 2 553 6.5 2 655 6.7 2 861 7.2 2 888 7.2 2 658 6.6 2 502 6.1 2 229 5.5 2 421 5.9 56 345 Germany West Greece 570 10.4 825 15.1 983 18.1 812 15.1 678 12.8 688 13.1 538 10.3 538 10.3 584 11.2 468 9.0 13 501 Greece Centre Hungary 142 3.0 122 2.6 186 3.9 192 4.1 214 4.5 196 4.2 171 3.6 148 3.2 195 4.2 208 4.4 3 115 Hungary West Iceland 17 10.6 12 7.5 13 8.1 8 5.0 9 5.5 10 6.1 22 13.2 21 12.3 24 13.5 23 12.6 328 Iceland West Ireland 241 10.7 239 10.5 252 11.1 258 11.3 274 11.9 372 16.1 396 16.9 375 15.8 399 16.7 396 16.3 5 890 Ireland West Italy 3 030 10.6 2 928 10.2 3 276 11.4 3 000 10.4 3 042 10.3 2 790 9.5 2 836 9.6 2 725 9.3 2 351 8.0 2 025 6.9 38 026 Italy East Latvia 170 17.5 196 20.7 218 23.3 203 21.9 239 26.1 269 29.5 233 25.8 244 27.2 222 25.0 180 20.3 5 401 Latvia – Liechtenstein 2 11.3 1 5.6 0 0.0 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 0 0.0 0 0.0 41 Liechtenstein East Lithuania 125 8.6 134 9.5 114 8.2 125 9.1 90 6.6 115 8.5 165 12.4 220 16.8 118 9.1 110 8.5 2 630 Lithuania West Luxembourg 46 18.4 46 18.1 50 19.1 61 22.7 57 20.7 60 21.3 62 21.4 48 16.2 41 13.6 37 12.0 1 348 Luxembourg West Malta 16 7.8 17 8.2 23 11.1 30 14.3 36 16.8 53 24.0 51 22.5 35 15.1 62 25.8 55 21.8 452 Malta West Netherlands 1 065 13.0 1 043 12.7 972 11.7 963 11.6 848 10.2 825 9.9 763 9.1 701 8.3 581 6.8 456 5.3 22 508 Netherlands West Norway 173 7.1 190 7.7 166 6.6 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 122 4.6 112 4.2 4 508 Norway Centre Poland 712 3.9 914 5.0 924 5.0 937 5.1 933 5.1 1 084 5.9 1 150 6.3 1 256 6.8 1 049 5.7 1 249 6.8 20 291 Poland West Portugal 1 329 26.2 1 266 25.1 1 267 25.2 1 254 25.1 1 043 21.0 1 102 22.4 1 087 22.2 963 19.7 791 16.3 539 11.1 44 288 Portugal Centre Romania 365 3.7 578 5.9 685 7.0 720 7.4 636 6.5 647 6.7 564 5.8 593 6.2 546 5.7 523 5.5 15 186 Romania Centre Slovakia 25 1.0 46 1.8 44 1.7 71 2.7 75 2.8 76 2.9 81 3.1 66 2.5 94 3.5 91 3.4 944 Slovakia Centre Slovenia 31 3.1 49 4.8 45 4.4 41 4.0 48 4.7 45 4.4 58 5.7 38 3.7 36 3.5 28 2.7 816 Slovenia West Spain 3 218 19.9 3 035 18.8 3 334 18.0 3 743 16.3 3 782 16.6 3 609 15.8 3 540 15.5 3 228 14.1 2 147 11.2 2 126 9.8 45 197 Spain West Sweden 250 5.4 291 6.2 265 5.6 293 6.1 273 5.7 276 5.7 269 5.5 273 5.4 306 6.0 288 5.6 9 032 Sweden West United Kingdom 4 318 14.1 4 399 14.2 4 490 14.4 4 493 14.3 4 707 14.9 4 712 14.8 3 973 12.3 3 451 10.6 3 360 10.3 2 980 9.1 116 031 United Kingdom Total EU/EEA 23 923 9.9 24 258 10.1 25 708 10.5 25 776 10.4 25 905 10.4 25 628 10.2 24 310 9.6 23 008 9.1 20 307 8.1 18 588 7.5 518 129 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 28 1.9 55 3.7 58 3.9 82 5.6 61 4.1 67 4.6 104 7.1 69 4.7 76 5.2 74 5.0 948 Albania West Andorra 6 14.4 2 4.8 2 4.9 4 10.1 5 12.8 3 7.8 3 7.9 3 7.9 8 21.1 – – 78 Andorra East Armenia 98 7.3 116 8.6 160 11.8 162 11.9 221 16.2 207 15.1 212 15.4 252 18.2 284 20.5 312 22.4 2 626 Armenia East Azerbaijan 365 8.2 410 9.0 356 7.7 329 7.1 375 7.9 495 10.3 355 7.3 359 7.3 437 8.8 474 9.5 5 847 Azerbaijan East Belarus 563 12.9 621 14.2 659 15.1 802 18.3 1 052 24.0 1 395 31.8 1 490 33.9 1 540 35.0 1 499 34.1 1 354 30.8 17 671 Belarus Centre Bosnia and Herzegovina 1 0.1 23 1.3 23 1.3 2 0.1 20 1.2 14 0.8 22 1.3 15 0.9 22 1.4 27 1.7 289 Bosnia and Herzegovina East Georgia 322 16.5 300 15.4 381 19.7 367 19.0 413 21.4 545 28.4 553 28.8 492 25.7 506 26.5 508 26.7 6 048 Georgia West Israel 288 7.9 298 8.1 353 9.4 347 9.1 330 8.5 292 7.4 257 6.4 297 7.3 297 7.1 268 6.3 6 950 Israel East Kazakhstan 1 252 15.9 1 206 15.1 1 167 14.4 1 203 14.6 1 334 15.9 1 442 16.9 1 684 19.5 1 822 20.8 2 005 22.6 2 416 26.8 25 481 Kazakhstan East Kyrgyzstan 399 14.9 422 15.5 406 14.6 292 10.3 369 12.8 364 12.3 446 14.8 491 16.0 0 0.0 496 15.6 5 666 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.5 1 5.5 0 0.0 3 16.1 0 0.0 – – 26 Monaco Centre Montenegro 15 4.9 8 2.6 12 3.9 11 3.6 17 5.5 17 5.5 32 10.3 25 8.1 21 6.8 24 7.7 266 Montenegro Centre North Macedonia 5 0.5 0 0.0 10 1.0 15 1.4 29 2.8 24 2.3 28 2.7 44 4.2 45 4.3 – – 221 North Macedonia East Republic of Moldova 341 17.4 377 19.2 375 19.1 382 19.5 452 23.1 462 23.6 471 24.1 468 24.0 537 27.6 544 28.1 7 917 Republic of Moldova East Russian Federation 36 172 54.4 39 410 59.2 44 066 66.0 48 025 71.8 55 469 82.8 62 118 92.5 53 689 79.8 53 209 78.9 52 720 78.1 49 177 72.7 529 594 Russian Federation West San Marino 6 39.7 6 39.1 2 12.9 0 0.0 3 18.8 2 12.4 2 12.3 1 6.1 2 12.2 0 0.0 73 San Marino Centre Serbia 135 3.1 116 2.6 124 2.8 142 3.3 120 2.8 177 4.1 164 3.8 175 4.1 174 4.0 196 3.8 3 425 Serbia Centre Serbia excluding Kosovo1 133 4.0 111 3.2 121 3.5 140 4.0 114 3.3 175 5.1 153 4.4 172 5.0 167 4.9 192 4.5 3 331 Serbia excluding Kosovo1 Centre Kosovo1 2 0.2 5 0.6 3 0.3 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 7 0.8 4 0.5 94 Kosovo1 West Switzerland 444 11.5 424 10.9 462 11.7 421 10.5 385 9.5 408 9.9 413 10.0 343 8.2 332 7.9 326 7.7 23 587 Switzerland East Tajikistan 693 18.2 608 15.7 495 12.5 490 12.0 557 13.4 679 15.9 621 14.2 735 16.4 878 19.1 772 16.4 7 700 Tajikistan Centre Turkey 350 1.0 531 1.5 819 2.2 1 072 2.9 1 497 3.9 1 770 4.6 2 065 5.3 2 389 6.0 2 717 6.7 2 748 6.7 18 098 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 9 521 45.0 9 472 45.0 9 400 44.8 10 011 47.8 8 991 43.1 7 519 32.7 8 374 42.5 9 312 47.4 9 543 48.8 9 982 51.3 175 285 Ukraine East Uzbekistan 2 062 14.5 – – – – – – – – – – – – – – – – – – 16 234 Uzbekistan Total non-EU/EEA 53 066 29.1 54 405 32.3 59 330 34.8 64 159 37.4 71 701 41.5 78 001 44.3 70 985 40.8 72 044 41.2 72 103 41.7 69 698 39.4 854 031 Total non-EU/EEA WHO European Region WHO European Region West West 22 472 11.4 22 318 11.3 23 675 11.8 23 564 11.4 23 669 11.4 23 110 11.1 21 822 10.4 20 329 9.6 17 940 8.6 16 104 7.8 485 393 West Centre Centre 2 202 2.4 2 846 3.1 3 357 3.6 3 780 4.0 4 192 4.4 4 742 5.0 5 039 5.3 5 433 5.6 5 590 5.8 5 744 5.9 71 883 Centre East East 52 313 39.2 53 498 44.8 58 006 48.4 62 591 52.1 69 744 57.8 75 777 61.5 68 432 56.8 69 290 57.4 68 880 58.4 66 438 54.7 814 843 East Total WHO European Region 76 987 18.2 78 662 19.2 85 038 20.5 89 935 21.4 97 605 23.1 103 629 24.3 95 293 22.4 95 052 22.2 92 410 21.9 88 286 20.8 1 372 119 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 61 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 2. New HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 296 7.3 287 7.0 292 7.1 261 6.3 241 5.8 283 6.7 244 5.7 256 5.9 170 3.9 190 4.4 7 827 Austria West Belgium 788 14.8 783 14.5 837 15.4 789 14.4 738 13.4 701 12.7 649 11.7 601 10.8 603 10.7 – – 20 073 Belgium Centre Bulgaria 132 3.7 163 4.5 123 3.4 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 276 8.1 217 6.4 2 669 Bulgaria Centre Croatia 68 3.3 63 3.0 70 3.4 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 88 4.4 97 4.9 1 541 Croatia Centre Cyprus 34 8.5 39 9.5 49 11.7 46 10.9 49 11.7 72 17.5 65 15.8 65 15.6 65 15.4 69 16.1 981 Cyprus Centre Czechia 159 3.1 139 2.7 185 3.6 211 4.1 209 4.0 248 4.8 262 5.1 231 4.4 186 3.6 193 3.7 3 093 Czechia West Denmark 201 7.3 192 7.0 146 5.3 178 6.4 196 7.0 205 7.3 191 6.7 192 6.7 170 5.9 146 5.1 5 876 Denmark East Estonia 230 37.0 226 36.5 209 33.8 200 32.5 182 29.6 167 27.2 139 22.5 146 23.6 131 21.1 113 18.1 6 742 Estonia West Finland 130 5.0 112 4.2 111 4.2 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 104 3.8 112 4.1 3 043 Finland West France 3 662 11.7 3 597 11.4 3 826 12.1 3 734 11.8 3 823 11.9 3 554 11.0 3 590 11.1 3 517 10.9 3 257 10.1 3 136 9.7 60 406 France West Germany 2 378 5.9 2 326 5.9 2 553 6.5 2 655 6.7 2 861 7.2 2 888 7.2 2 658 6.6 2 502 6.1 2 229 5.5 2 421 5.9 56 345 Germany West Greece 570 10.4 825 15.1 983 18.1 812 15.1 678 12.8 688 13.1 538 10.3 538 10.3 584 11.2 468 9.0 13 501 Greece Centre Hungary 142 3.0 122 2.6 186 3.9 192 4.1 214 4.5 196 4.2 171 3.6 148 3.2 195 4.2 208 4.4 3 115 Hungary West Iceland 17 10.6 12 7.5 13 8.1 8 5.0 9 5.5 10 6.1 22 13.2 21 12.3 24 13.5 23 12.6 328 Iceland West Ireland 241 10.7 239 10.5 252 11.1 258 11.3 274 11.9 372 16.1 396 16.9 375 15.8 399 16.7 396 16.3 5 890 Ireland West Italy 3 030 10.6 2 928 10.2 3 276 11.4 3 000 10.4 3 042 10.3 2 790 9.5 2 836 9.6 2 725 9.3 2 351 8.0 2 025 6.9 38 026 Italy East Latvia 170 17.5 196 20.7 218 23.3 203 21.9 239 26.1 269 29.5 233 25.8 244 27.2 222 25.0 180 20.3 5 401 Latvia – Liechtenstein 2 11.3 1 5.6 0 0.0 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 0 0.0 0 0.0 41 Liechtenstein East Lithuania 125 8.6 134 9.5 114 8.2 125 9.1 90 6.6 115 8.5 165 12.4 220 16.8 118 9.1 110 8.5 2 630 Lithuania West Luxembourg 46 18.4 46 18.1 50 19.1 61 22.7 57 20.7 60 21.3 62 21.4 48 16.2 41 13.6 37 12.0 1 348 Luxembourg West Malta 16 7.8 17 8.2 23 11.1 30 14.3 36 16.8 53 24.0 51 22.5 35 15.1 62 25.8 55 21.8 452 Malta West Netherlands 1 065 13.0 1 043 12.7 972 11.7 963 11.6 848 10.2 825 9.9 763 9.1 701 8.3 581 6.8 456 5.3 22 508 Netherlands West Norway 173 7.1 190 7.7 166 6.6 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 122 4.6 112 4.2 4 508 Norway Centre Poland 712 3.9 914 5.0 924 5.0 937 5.1 933 5.1 1 084 5.9 1 150 6.3 1 256 6.8 1 049 5.7 1 249 6.8 20 291 Poland West Portugal 1 329 26.2 1 266 25.1 1 267 25.2 1 254 25.1 1 043 21.0 1 102 22.4 1 087 22.2 963 19.7 791 16.3 539 11.1 44 288 Portugal Centre Romania 365 3.7 578 5.9 685 7.0 720 7.4 636 6.5 647 6.7 564 5.8 593 6.2 546 5.7 523 5.5 15 186 Romania Centre Slovakia 25 1.0 46 1.8 44 1.7 71 2.7 75 2.8 76 2.9 81 3.1 66 2.5 94 3.5 91 3.4 944 Slovakia Centre Slovenia 31 3.1 49 4.8 45 4.4 41 4.0 48 4.7 45 4.4 58 5.7 38 3.7 36 3.5 28 2.7 816 Slovenia West Spain 3 218 19.9 3 035 18.8 3 334 18.0 3 743 16.3 3 782 16.6 3 609 15.8 3 540 15.5 3 228 14.1 2 147 11.2 2 126 9.8 45 197 Spain West Sweden 250 5.4 291 6.2 265 5.6 293 6.1 273 5.7 276 5.7 269 5.5 273 5.4 306 6.0 288 5.6 9 032 Sweden West United Kingdom 4 318 14.1 4 399 14.2 4 490 14.4 4 493 14.3 4 707 14.9 4 712 14.8 3 973 12.3 3 451 10.6 3 360 10.3 2 980 9.1 116 031 United Kingdom Total EU/EEA 23 923 9.9 24 258 10.1 25 708 10.5 25 776 10.4 25 905 10.4 25 628 10.2 24 310 9.6 23 008 9.1 20 307 8.1 18 588 7.5 518 129 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 28 1.9 55 3.7 58 3.9 82 5.6 61 4.1 67 4.6 104 7.1 69 4.7 76 5.2 74 5.0 948 Albania West Andorra 6 14.4 2 4.8 2 4.9 4 10.1 5 12.8 3 7.8 3 7.9 3 7.9 8 21.1 – – 78 Andorra East Armenia 98 7.3 116 8.6 160 11.8 162 11.9 221 16.2 207 15.1 212 15.4 252 18.2 284 20.5 312 22.4 2 626 Armenia East Azerbaijan 365 8.2 410 9.0 356 7.7 329 7.1 375 7.9 495 10.3 355 7.3 359 7.3 437 8.8 474 9.5 5 847 Azerbaijan East Belarus 563 12.9 621 14.2 659 15.1 802 18.3 1 052 24.0 1 395 31.8 1 490 33.9 1 540 35.0 1 499 34.1 1 354 30.8 17 671 Belarus Centre Bosnia and Herzegovina 1 0.1 23 1.3 23 1.3 2 0.1 20 1.2 14 0.8 22 1.3 15 0.9 22 1.4 27 1.7 289 Bosnia and Herzegovina East Georgia 322 16.5 300 15.4 381 19.7 367 19.0 413 21.4 545 28.4 553 28.8 492 25.7 506 26.5 508 26.7 6 048 Georgia West Israel 288 7.9 298 8.1 353 9.4 347 9.1 330 8.5 292 7.4 257 6.4 297 7.3 297 7.1 268 6.3 6 950 Israel East Kazakhstan 1 252 15.9 1 206 15.1 1 167 14.4 1 203 14.6 1 334 15.9 1 442 16.9 1 684 19.5 1 822 20.8 2 005 22.6 2 416 26.8 25 481 Kazakhstan East Kyrgyzstan 399 14.9 422 15.5 406 14.6 292 10.3 369 12.8 364 12.3 446 14.8 491 16.0 0 0.0 496 15.6 5 666 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.5 1 5.5 0 0.0 3 16.1 0 0.0 – – 26 Monaco Centre Montenegro 15 4.9 8 2.6 12 3.9 11 3.6 17 5.5 17 5.5 32 10.3 25 8.1 21 6.8 24 7.7 266 Montenegro Centre North Macedonia 5 0.5 0 0.0 10 1.0 15 1.4 29 2.8 24 2.3 28 2.7 44 4.2 45 4.3 – – 221 North Macedonia East Republic of Moldova 341 17.4 377 19.2 375 19.1 382 19.5 452 23.1 462 23.6 471 24.1 468 24.0 537 27.6 544 28.1 7 917 Republic of Moldova East Russian Federation 36 172 54.4 39 410 59.2 44 066 66.0 48 025 71.8 55 469 82.8 62 118 92.5 53 689 79.8 53 209 78.9 52 720 78.1 49 177 72.7 529 594 Russian Federation West San Marino 6 39.7 6 39.1 2 12.9 0 0.0 3 18.8 2 12.4 2 12.3 1 6.1 2 12.2 0 0.0 73 San Marino Centre Serbia 135 3.1 116 2.6 124 2.8 142 3.3 120 2.8 177 4.1 164 3.8 175 4.1 174 4.0 196 3.8 3 425 Serbia Centre Serbia excluding Kosovo1 133 4.0 111 3.2 121 3.5 140 4.0 114 3.3 175 5.1 153 4.4 172 5.0 167 4.9 192 4.5 3 331 Serbia excluding Kosovo1 Centre Kosovo1 2 0.2 5 0.6 3 0.3 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 7 0.8 4 0.5 94 Kosovo1 West Switzerland 444 11.5 424 10.9 462 11.7 421 10.5 385 9.5 408 9.9 413 10.0 343 8.2 332 7.9 326 7.7 23 587 Switzerland East Tajikistan 693 18.2 608 15.7 495 12.5 490 12.0 557 13.4 679 15.9 621 14.2 735 16.4 878 19.1 772 16.4 7 700 Tajikistan Centre Turkey 350 1.0 531 1.5 819 2.2 1 072 2.9 1 497 3.9 1 770 4.6 2 065 5.3 2 389 6.0 2 717 6.7 2 748 6.7 18 098 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 9 521 45.0 9 472 45.0 9 400 44.8 10 011 47.8 8 991 43.1 7 519 32.7 8 374 42.5 9 312 47.4 9 543 48.8 9 982 51.3 175 285 Ukraine East Uzbekistan 2 062 14.5 – – – – – – – – – – – – – – – – – – 16 234 Uzbekistan Total non-EU/EEA 53 066 29.1 54 405 32.3 59 330 34.8 64 159 37.4 71 701 41.5 78 001 44.3 70 985 40.8 72 044 41.2 72 103 41.7 69 698 39.4 854 031 Total non-EU/EEA WHO European Region WHO European Region West West 22 472 11.4 22 318 11.3 23 675 11.8 23 564 11.4 23 669 11.4 23 110 11.1 21 822 10.4 20 329 9.6 17 940 8.6 16 104 7.8 485 393 West Centre Centre 2 202 2.4 2 846 3.1 3 357 3.6 3 780 4.0 4 192 4.4 4 742 5.0 5 039 5.3 5 433 5.6 5 590 5.8 5 744 5.9 71 883 Centre East East 52 313 39.2 53 498 44.8 58 006 48.4 62 591 52.1 69 744 57.8 75 777 61.5 68 432 56.8 69 290 57.4 68 880 58.4 66 438 54.7 814 843 East Total WHO European Region 76 987 18.2 78 662 19.2 85 038 20.5 89 935 21.4 97 605 23.1 103 629 24.3 95 293 22.4 95 052 22.2 92 410 21.9 88 286 20.8 1 372 119 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 62 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 3. New HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 67 1.6 74 1.7 73 1.7 46 1.1 63 1.4 41 0.9 47 1.1 46 1.0 29 0.6 35 0.8 2 361 Austria West Belgium 394 7.1 388 6.9 389 6.9 339 6.0 317 5.6 314 5.5 258 4.5 284 4.9 270 4.7 – – 11 125 Belgium Centre Bulgaria 31 0.8 38 1.0 34 0.9 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 35 1.0 41 1.1 647 Bulgaria Centre Croatia 3 0.1 11 0.5 3 0.1 8 0.4 9 0.4 6 0.3 5 0.2 5 0.2 6 0.3 5 0.2 193 Croatia Centre Cyprus 7 1.7 15 3.5 9 2.0 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 13 2.9 31 6.9 345 Cyprus Centre Czechia 21 0.4 14 0.3 27 0.5 24 0.4 23 0.4 18 0.3 24 0.4 23 0.4 22 0.4 29 0.5 497 Czechia West Denmark 74 2.7 74 2.6 54 1.9 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 49 1.7 44 1.5 2 123 Denmark East Estonia 146 20.5 140 19.7 106 15.0 125 17.8 109 15.6 103 14.7 90 12.9 73 10.5 59 8.5 65 9.3 3 325 Estonia West Finland 54 2.0 60 2.2 45 1.6 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 49 1.8 37 1.3 1 170 Finland West France 1 884 5.6 1 826 5.4 1 832 5.4 1 815 5.4 1 841 5.4 1 719 5.0 1 810 5.3 1 808 5.2 1 758 5.1 1 719 5.0 32 834 France West Germany 424 1.0 431 1.0 472 1.1 578 1.4 662 1.6 751 1.8 716 1.7 648 1.5 630 1.5 669 1.6 14 014 Germany West Greece 78 1.4 141 2.5 178 3.1 89 1.6 101 1.8 90 1.6 111 2.0 109 2.0 139 2.5 135 2.4 2 663 Greece Centre Hungary 9 0.2 12 0.2 14 0.3 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 8 0.2 16 0.3 385 Hungary West Iceland 7 4.4 11 6.9 6 3.8 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 14 8.2 5 2.9 123 Iceland West Ireland 89 3.9 89 3.9 98 4.2 85 3.7 104 4.4 110 4.7 115 4.8 121 5.0 104 4.3 134 5.4 2 796 Ireland West Italy 990 3.3 970 3.2 886 2.9 843 2.7 789 2.5 808 2.6 851 2.7 854 2.7 652 2.1 506 1.6 11 852 Italy East Latvia 104 9.0 103 9.1 121 10.9 137 12.5 111 10.2 131 12.2 136 12.8 132 12.5 106 10.1 115 11.1 2 584 Latvia – Liechtenstein 2 11.0 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 23 Liechtenstein East Lithuania 28 1.7 32 1.9 46 2.8 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 42 2.8 41 2.7 693 Lithuania West Luxembourg 19 7.5 15 5.8 18 6.8 14 5.2 32 11.7 15 5.3 19 6.6 19 6.5 16 5.3 11 3.6 477 Luxembourg West Malta 2 1.0 4 1.9 7 3.3 6 2.8 4 1.9 8 3.6 11 4.9 10 4.4 11 4.7 15 6.2 122 Malta West Netherlands 203 2.4 181 2.2 187 2.2 157 1.9 147 1.7 149 1.7 125 1.5 115 1.3 96 1.1 93 1.1 5 396 Netherlands West Norway 85 3.5 79 3.2 76 3.1 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 69 2.6 60 2.3 2 146 Norway Centre Poland 156 0.8 159 0.8 159 0.8 150 0.8 188 1.0 175 0.9 142 0.7 160 0.8 151 0.8 212 1.1 4 664 Poland West Portugal 660 12.0 555 10.1 537 9.7 518 9.4 411 7.5 393 7.2 421 7.7 373 6.9 318 5.9 239 4.4 17 137 Portugal Centre Romania 225 2.2 259 2.5 255 2.5 299 2.9 271 2.7 237 2.3 210 2.1 203 2.0 186 1.9 167 1.7 9 804 Romania Centre Slovakia 3 0.1 3 0.1 6 0.2 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 8 0.3 10 0.4 130 Slovakia Centre Slovenia 4 0.4 7 0.7 3 0.3 6 0.6 4 0.4 7 0.7 2 0.2 2 0.2 1 0.1 6 0.6 106 Slovenia West Spain 696 4.2 641 3.8 610 3.2 631 2.7 647 2.7 580 2.5 635 2.7 567 2.4 380 1.9 357 1.6 9 476 Spain West Sweden 170 3.6 169 3.6 175 3.7 163 3.4 198 4.1 171 3.5 160 3.3 161 3.2 175 3.5 161 3.2 4 458 Sweden West United Kingdom 2 010 6.3 1 754 5.5 1 700 5.3 1 471 4.5 1 589 4.9 1 461 4.4 1 236 3.7 1 177 3.5 1 161 3.5 1 128 3.3 48 290 United Kingdom Total EU/EEA 8 645 3.4 8 255 3.3 8 126 3.2 7 820 3.0 7 928 3.0 7 599 2.9 7 430 2.8 7 168 2.7 6 557 2.5 6 086 2.4 191 959 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 15 1.0 23 1.6 23 1.6 38 2.7 18 1.3 29 2.0 23 1.6 25 1.8 26 1.8 27 1.9 356 Albania West Andorra 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 0 0.0 0 0.0 3 7.7 4 10.2 – – 18 Andorra East Armenia 51 3.3 67 4.4 70 4.6 77 5.0 118 7.6 89 5.7 92 5.9 103 6.6 136 8.7 134 8.6 1 159 Armenia East Azerbaijan 94 2.1 138 3.0 161 3.5 185 3.9 229 4.8 232 4.8 201 4.1 208 4.2 219 4.4 247 4.9 2 282 Azerbaijan East Belarus 506 10.0 575 11.4 564 11.2 731 14.5 759 15.0 910 18.0 901 17.8 928 18.4 887 17.6 783 15.5 11 538 Belarus Centre Bosnia and Herzegovina 0 0.0 4 0.2 2 0.1 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 2 0.1 3 0.2 46 Bosnia and Herzegovina East Georgia 133 6.2 124 5.8 145 6.8 123 5.8 151 7.2 172 8.2 166 7.9 139 6.6 166 7.9 160 7.7 2 054 Georgia West Israel 131 3.5 152 4.0 130 3.4 116 3.0 130 3.3 121 3.0 109 2.7 117 2.8 153 3.6 140 3.3 3 430 Israel East Kazakhstan 730 8.7 791 9.3 837 9.7 928 10.6 1 008 11.3 1 033 11.4 1 214 13.2 1 192 12.8 1 210 12.8 1 257 13.2 13 958 Kazakhstan East Kyrgyzstan 168 6.1 192 6.9 295 10.4 211 7.3 280 9.5 289 9.6 318 10.4 349 11.2 333 10.5 354 10.9 3 467 Kyrgyzstan West Monaco 0 0.0 0 0.0 1 5.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – 14 Monaco Centre Montenegro 0 0.0 1 0.3 1 0.3 0 0.0 3 0.9 2 0.6 2 0.6 1 0.3 2 0.6 2 0.6 37 Montenegro Centre North Macedonia 0 0.0 0 0.0 4 0.4 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 0 0.0 – – 18 North Macedonia East Republic of Moldova 362 17.1 344 16.2 382 18.1 324 15.3 379 17.9 356 16.8 361 17.1 367 17.4 368 17.5 378 18.0 5 762 Republic of Moldova East Russian Federation 26 409 34.3 27 907 36.2 31 642 41.0 33 673 43.5 37 144 47.8 38 102 49.0 33 166 42.5 32 593 41.7 33 275 42.5 30 947 39.5 351 664 Russian Federation West San Marino 0 0.0 2 12.2 3 18.1 1 6.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.8 0 0.0 20 San Marino Centre Serbia 17 0.4 18 0.4 13 0.3 14 0.3 17 0.4 6 0.1 15 0.3 11 0.2 14 0.3 19 0.4 767 Serbia Centre Serbia excluding Kosovo1 16 0.5 17 0.5 12 0.3 13 0.4 17 0.5 5 0.1 15 0.4 11 0.3 13 0.4 18 0.4 735 Serbia excluding Kosovo1 Centre Kosovo1 1 0.1 1 0.1 1 0.1 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 32 Kosovo1 West Switzerland 160 4.0 132 3.3 150 3.7 151 3.7 124 3.0 122 2.9 113 2.7 100 2.3 88 2.0 88 2.0 10 495 Switzerland East Tajikistan 188 5.0 272 7.1 275 7.1 327 8.2 429 10.5 470 11.2 417 9.7 470 10.7 543 12.0 548 11.9 4 286 Tajikistan Centre Turkey 139 0.4 166 0.4 249 0.7 241 0.6 341 0.9 337 0.8 373 0.9 455 1.1 531 1.3 481 1.1 4 367 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 6 915 28.0 7 697 31.3 7 301 29.8 7 722 31.7 6 683 27.6 5 481 27.7 5 867 25.7 6 313 27.7 6 143 27.1 6 375 28.3 117 243 Ukraine East Uzbekistan 1 733 12.1 – – – – – – – – – – – – – – – – 7 783 Uzbekistan Total non-EU/EEA 37 751 19.2 38 605 20.8 42 248 22.5 44 863 24.2 47 816 25.4 47 753 25.6 43 341 22.8 43 374 23.0 44 101 23.0 41 943 21.7 540 765 Total non-EU/EEA WHO European Region WHO European Region West West 8 197 4.0 7 748 3.7 7 627 3.6 7 212 3.3 7 332 3.4 7 046 3.2 6 918 3.2 6 680 3.0 6 166 2.9 5 576 2.6 182 540 West Centre Centre 630 0.7 730 0.8 802 0.8 856 0.9 961 1.0 896 0.9 875 0.9 952 1.0 1 005 1.0 1 049 1.0 22 362 Centre East East 37 567 25.1 38 382 28.3 41 945 30.8 44 615 32.7 47 451 34.7 47 410 35.7 42 978 31.5 42 910 31.4 43 487 31.7 41 404 30.2 527 799 East Total WHO European Region 46 394 10.3 46 860 10.7 50 374 11.3 52 683 11.8 55 744 12.4 55 352 12.3 50 771 11.2 50 542 11.2 50 658 11.2 48 029 10.6 732 701 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 63 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 3. New HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 67 1.6 74 1.7 73 1.7 46 1.1 63 1.4 41 0.9 47 1.1 46 1.0 29 0.6 35 0.8 2 361 Austria West Belgium 394 7.1 388 6.9 389 6.9 339 6.0 317 5.6 314 5.5 258 4.5 284 4.9 270 4.7 – – 11 125 Belgium Centre Bulgaria 31 0.8 38 1.0 34 0.9 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 35 1.0 41 1.1 647 Bulgaria Centre Croatia 3 0.1 11 0.5 3 0.1 8 0.4 9 0.4 6 0.3 5 0.2 5 0.2 6 0.3 5 0.2 193 Croatia Centre Cyprus 7 1.7 15 3.5 9 2.0 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 13 2.9 31 6.9 345 Cyprus Centre Czechia 21 0.4 14 0.3 27 0.5 24 0.4 23 0.4 18 0.3 24 0.4 23 0.4 22 0.4 29 0.5 497 Czechia West Denmark 74 2.7 74 2.6 54 1.9 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 49 1.7 44 1.5 2 123 Denmark East Estonia 146 20.5 140 19.7 106 15.0 125 17.8 109 15.6 103 14.7 90 12.9 73 10.5 59 8.5 65 9.3 3 325 Estonia West Finland 54 2.0 60 2.2 45 1.6 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 49 1.8 37 1.3 1 170 Finland West France 1 884 5.6 1 826 5.4 1 832 5.4 1 815 5.4 1 841 5.4 1 719 5.0 1 810 5.3 1 808 5.2 1 758 5.1 1 719 5.0 32 834 France West Germany 424 1.0 431 1.0 472 1.1 578 1.4 662 1.6 751 1.8 716 1.7 648 1.5 630 1.5 669 1.6 14 014 Germany West Greece 78 1.4 141 2.5 178 3.1 89 1.6 101 1.8 90 1.6 111 2.0 109 2.0 139 2.5 135 2.4 2 663 Greece Centre Hungary 9 0.2 12 0.2 14 0.3 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 8 0.2 16 0.3 385 Hungary West Iceland 7 4.4 11 6.9 6 3.8 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 14 8.2 5 2.9 123 Iceland West Ireland 89 3.9 89 3.9 98 4.2 85 3.7 104 4.4 110 4.7 115 4.8 121 5.0 104 4.3 134 5.4 2 796 Ireland West Italy 990 3.3 970 3.2 886 2.9 843 2.7 789 2.5 808 2.6 851 2.7 854 2.7 652 2.1 506 1.6 11 852 Italy East Latvia 104 9.0 103 9.1 121 10.9 137 12.5 111 10.2 131 12.2 136 12.8 132 12.5 106 10.1 115 11.1 2 584 Latvia – Liechtenstein 2 11.0 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 23 Liechtenstein East Lithuania 28 1.7 32 1.9 46 2.8 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 42 2.8 41 2.7 693 Lithuania West Luxembourg 19 7.5 15 5.8 18 6.8 14 5.2 32 11.7 15 5.3 19 6.6 19 6.5 16 5.3 11 3.6 477 Luxembourg West Malta 2 1.0 4 1.9 7 3.3 6 2.8 4 1.9 8 3.6 11 4.9 10 4.4 11 4.7 15 6.2 122 Malta West Netherlands 203 2.4 181 2.2 187 2.2 157 1.9 147 1.7 149 1.7 125 1.5 115 1.3 96 1.1 93 1.1 5 396 Netherlands West Norway 85 3.5 79 3.2 76 3.1 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 69 2.6 60 2.3 2 146 Norway Centre Poland 156 0.8 159 0.8 159 0.8 150 0.8 188 1.0 175 0.9 142 0.7 160 0.8 151 0.8 212 1.1 4 664 Poland West Portugal 660 12.0 555 10.1 537 9.7 518 9.4 411 7.5 393 7.2 421 7.7 373 6.9 318 5.9 239 4.4 17 137 Portugal Centre Romania 225 2.2 259 2.5 255 2.5 299 2.9 271 2.7 237 2.3 210 2.1 203 2.0 186 1.9 167 1.7 9 804 Romania Centre Slovakia 3 0.1 3 0.1 6 0.2 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 8 0.3 10 0.4 130 Slovakia Centre Slovenia 4 0.4 7 0.7 3 0.3 6 0.6 4 0.4 7 0.7 2 0.2 2 0.2 1 0.1 6 0.6 106 Slovenia West Spain 696 4.2 641 3.8 610 3.2 631 2.7 647 2.7 580 2.5 635 2.7 567 2.4 380 1.9 357 1.6 9 476 Spain West Sweden 170 3.6 169 3.6 175 3.7 163 3.4 198 4.1 171 3.5 160 3.3 161 3.2 175 3.5 161 3.2 4 458 Sweden West United Kingdom 2 010 6.3 1 754 5.5 1 700 5.3 1 471 4.5 1 589 4.9 1 461 4.4 1 236 3.7 1 177 3.5 1 161 3.5 1 128 3.3 48 290 United Kingdom Total EU/EEA 8 645 3.4 8 255 3.3 8 126 3.2 7 820 3.0 7 928 3.0 7 599 2.9 7 430 2.8 7 168 2.7 6 557 2.5 6 086 2.4 191 959 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 15 1.0 23 1.6 23 1.6 38 2.7 18 1.3 29 2.0 23 1.6 25 1.8 26 1.8 27 1.9 356 Albania West Andorra 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 0 0.0 0 0.0 3 7.7 4 10.2 – – 18 Andorra East Armenia 51 3.3 67 4.4 70 4.6 77 5.0 118 7.6 89 5.7 92 5.9 103 6.6 136 8.7 134 8.6 1 159 Armenia East Azerbaijan 94 2.1 138 3.0 161 3.5 185 3.9 229 4.8 232 4.8 201 4.1 208 4.2 219 4.4 247 4.9 2 282 Azerbaijan East Belarus 506 10.0 575 11.4 564 11.2 731 14.5 759 15.0 910 18.0 901 17.8 928 18.4 887 17.6 783 15.5 11 538 Belarus Centre Bosnia and Herzegovina 0 0.0 4 0.2 2 0.1 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 2 0.1 3 0.2 46 Bosnia and Herzegovina East Georgia 133 6.2 124 5.8 145 6.8 123 5.8 151 7.2 172 8.2 166 7.9 139 6.6 166 7.9 160 7.7 2 054 Georgia West Israel 131 3.5 152 4.0 130 3.4 116 3.0 130 3.3 121 3.0 109 2.7 117 2.8 153 3.6 140 3.3 3 430 Israel East Kazakhstan 730 8.7 791 9.3 837 9.7 928 10.6 1 008 11.3 1 033 11.4 1 214 13.2 1 192 12.8 1 210 12.8 1 257 13.2 13 958 Kazakhstan East Kyrgyzstan 168 6.1 192 6.9 295 10.4 211 7.3 280 9.5 289 9.6 318 10.4 349 11.2 333 10.5 354 10.9 3 467 Kyrgyzstan West Monaco 0 0.0 0 0.0 1 5.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – 14 Monaco Centre Montenegro 0 0.0 1 0.3 1 0.3 0 0.0 3 0.9 2 0.6 2 0.6 1 0.3 2 0.6 2 0.6 37 Montenegro Centre North Macedonia 0 0.0 0 0.0 4 0.4 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 0 0.0 – – 18 North Macedonia East Republic of Moldova 362 17.1 344 16.2 382 18.1 324 15.3 379 17.9 356 16.8 361 17.1 367 17.4 368 17.5 378 18.0 5 762 Republic of Moldova East Russian Federation 26 409 34.3 27 907 36.2 31 642 41.0 33 673 43.5 37 144 47.8 38 102 49.0 33 166 42.5 32 593 41.7 33 275 42.5 30 947 39.5 351 664 Russian Federation West San Marino 0 0.0 2 12.2 3 18.1 1 6.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.8 0 0.0 20 San Marino Centre Serbia 17 0.4 18 0.4 13 0.3 14 0.3 17 0.4 6 0.1 15 0.3 11 0.2 14 0.3 19 0.4 767 Serbia Centre Serbia excluding Kosovo1 16 0.5 17 0.5 12 0.3 13 0.4 17 0.5 5 0.1 15 0.4 11 0.3 13 0.4 18 0.4 735 Serbia excluding Kosovo1 Centre Kosovo1 1 0.1 1 0.1 1 0.1 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 32 Kosovo1 West Switzerland 160 4.0 132 3.3 150 3.7 151 3.7 124 3.0 122 2.9 113 2.7 100 2.3 88 2.0 88 2.0 10 495 Switzerland East Tajikistan 188 5.0 272 7.1 275 7.1 327 8.2 429 10.5 470 11.2 417 9.7 470 10.7 543 12.0 548 11.9 4 286 Tajikistan Centre Turkey 139 0.4 166 0.4 249 0.7 241 0.6 341 0.9 337 0.8 373 0.9 455 1.1 531 1.3 481 1.1 4 367 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 6 915 28.0 7 697 31.3 7 301 29.8 7 722 31.7 6 683 27.6 5 481 27.7 5 867 25.7 6 313 27.7 6 143 27.1 6 375 28.3 117 243 Ukraine East Uzbekistan 1 733 12.1 – – – – – – – – – – – – – – – – 7 783 Uzbekistan Total non-EU/EEA 37 751 19.2 38 605 20.8 42 248 22.5 44 863 24.2 47 816 25.4 47 753 25.6 43 341 22.8 43 374 23.0 44 101 23.0 41 943 21.7 540 765 Total non-EU/EEA WHO European Region WHO European Region West West 8 197 4.0 7 748 3.7 7 627 3.6 7 212 3.3 7 332 3.4 7 046 3.2 6 918 3.2 6 680 3.0 6 166 2.9 5 576 2.6 182 540 West Centre Centre 630 0.7 730 0.8 802 0.8 856 0.9 961 1.0 896 0.9 875 0.9 952 1.0 1 005 1.0 1 049 1.0 22 362 Centre East East 37 567 25.1 38 382 28.3 41 945 30.8 44 615 32.7 47 451 34.7 47 410 35.7 42 978 31.5 42 910 31.4 43 487 31.7 41 404 30.2 527 799 East Total WHO European Region 46 394 10.3 46 860 10.7 50 374 11.3 52 683 11.8 55 744 12.4 55 352 12.3 50 771 11.2 50 542 11.2 50 658 11.2 48 029 10.6 732 701 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 64 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 4. New HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 178 184 183 169 155 166 167 184 112 113 4 058 West Belgium 438 435 441 467 400 409 378 336 327 – 8 349 Centre Bulgaria 32 47 59 72 97 111 96 120 170 122 1 040 Centre Croatia 61 47 65 70 79 99 95 97 82 82 1 179 Centre Cyprus 22 27 31 35 39 51 47 47 43 38 586 Centre Czechia 132 113 155 180 171 210 213 182 137 151 2 436 West Denmark 112 113 82 116 132 126 121 123 110 99 3 372 East Estonia 1 2 1 9 3 18 9 16 11 16 179 West Finland 48 36 47 43 55 53 48 32 38 38 1 283 West France 1 524 1 442 1 629 1 616 1 681 1 494 1 375 1 431 1 475 1 317 24 423 West Germany 1 690 1 555 1 777 1 781 1 956 1 890 1 730 1 621 1 421 1 445 34 410 West Greece 404 364 358 399 407 452 316 307 293 247 8 359 Centre Hungary 126 106 149 163 175 134 118 110 145 167 2 331 West Iceland 5 0 1 0 0 0 8 4 15 15 147 West Ireland 134 145 174 156 182 251 277 264 287 131 3 312 West Italy 1 258 1 284 1 590 1 518 1 556 1 458 1 404 1 376 1 176 1 069 17 464 East Latvia 18 20 18 27 28 34 24 24 19 18 432 – Liechtenstein 0 0 0 0 1 0 0 0 0 0 3 East Lithuania 7 12 12 31 12 29 29 21 19 20 296 West Luxembourg 28 34 35 37 31 24 28 18 26 22 708 West Maltac 6 4 8 16 25 45 38 23 38 0 222 West Netherlands 814 809 756 784 665 640 593 536 445 333 16 471 West Norway 85 97 76 98 115 70 87 88 73 61 2 215 Centre Poland 168 318 356 280 336 358 404 383 303 299 4 179 West Portugal 487 539 567 556 479 591 576 502 390 296 11 627 Centre Romania 71 109 95 100 139 133 148 165 162 177 1 607 Centre Slovakia 21 32 28 58 53 55 60 52 60 50 674 Centre Slovenia 28 36 36 28 35 36 49 26 29 20 602 West Spain 1 938 1 885 2 056 2 271 2 488 2 340 2 341 2 132 1 431 1 403 27 259 West Sweden 102 106 137 147 119 118 136 128 158 152 4 398 West United Kingdom 2 739 2 840 3 055 3 039 3 212 3 172 2 538 2 201 2 069 1 697 74 455 Total EU/EEA 12 677 12 741 13 977 14 266 14 826 14 567 13 453 12 549 11 064 9 598 258 076 Non-EU/EEA Centre Albania 5 15 9 11 9 13 11 6 8 9 138 West Andorra 3 1 1 3 4 2 3 2 4 – 38 East Armenia 1 4 5 13 11 12 17 17 40 49 186 East Azerbaijan 7 5 13 11 12 35 18 41 45 50 254 East Belarus 14 29 31 41 53 58 71 72 103 82 601 Centre Bosnia and Herzegovina 0 12 21 2 16 10 18 12 14 21 152 East Georgia 27 25 44 69 67 163 131 131 152 94 958 West Israel 145 159 157 172 151 141 129 150 131 113 2 707 East Kazakhstan 20 26 20 37 47 80 121 144 163 205 936 East Kyrgyzstan 0 0 3 14 17 20 35 45 46 37 219 West Monaco 0 0 0 0 1 1 0 2 0 – 18 Centre Montenegro 11 5 8 6 13 14 25 22 16 15 174 Centre North Macedonia 5 1 7 13 26 21 18 34 37 – 173 East Republic of Moldova 6 5 4 4 9 10 18 29 32 29 172 East Russian Federationc 0 0 0 0 0 0 0 0 0 0 0 West San Marino 0 4 0 0 0 0 0 0 0 0 21 Centre Serbia 84 69 88 100 85 133 114 122 138 173 1 679 Centre Serbia excluding Kosovo1 84 68 86 99 80 131 111 122 136 170 1 654 Centre Kosovo1 1 2 1 5 2 3 – 2 3 25 West Switzerland 245 211 228 198 220 208 233 170 160 152 5 615 East Tajikistan 0 1 1 0 3 3 11 12 22 11 64 Centre Turkey 32 59 142 187 281 350 403 494 540 539 3 213 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 90 143 152 262 277 368 435 490 506 468 3 508 East Uzbekistan 0 – – – – – – – – – 29 Total non-EU/EEA 695 774 934 1 143 1 302 1 642 1 811 1 995 2 157 2 047 20 855 WHO European Region West West 12 383 12 247 13 358 13 586 14 034 13 651 12 526 11 630 10 179 8 703 250 931 Centre Centre 798 996 1 249 1 305 1 554 1 728 1 819 1 872 1 884 1 863 20 163 East East 191 272 304 518 539 830 919 1 042 1 158 1 079 7 834 Total WHO European Region 13 372 13 515 14 911 15 409 16 127 16 209 15 264 14 544 13 221 11 645 278 928 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Data on route of transmission were not reported by Malta or the Russian Federation for 2019. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 65 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 5. New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 48 55 54 27 30 33 18 17 13 19 2 093 West Belgium 17 20 16 19 15 17 5 9 12 – 788 Centre Bulgaria 56 63 40 33 48 29 22 33 34 37 631 Centre Croatia 2 4 0 0 0 2 0 0 0 1 68 Centre Cyprus 0 0 0 0 3 1 2 0 1 3 19 Centre Czechia 5 9 6 6 10 6 7 5 8 6 141 West Denmark 8 10 11 13 11 8 9 6 6 4 563 East Estonia 118 110 86 81 67 55 30 15 24 20 4 214 West Finland 8 8 7 3 7 7 6 10 6 8 418 West France 129 123 131 111 104 78 61 60 68 65 2 142 West Germany 83 84 88 108 131 142 134 116 146 159 4 360 West Greece 28 319 524 270 120 95 101 93 119 72 2 033 Centre Hungary 0 0 0 1 1 2 3 1 1 1 32 West Iceland 9 12 3 1 1 0 9 3 2 2 69 West Ireland 23 18 16 22 30 47 21 18 13 10 1 678 West Italy 269 185 217 183 143 121 108 101 109 147 2 789 East Latvia 86 90 94 77 77 92 62 79 73 44 3 470 – Liechtenstein 0 1 0 0 0 0 0 0 0 0 5 East Lithuania 108 95 68 65 38 46 86 140 55 48 1 905 West Luxembourg 1 1 5 6 17 14 19 10 5 0 221 West Maltac 0 0 0 3 0 0 1 0 0 0 10 West Netherlands 7 9 8 8 2 3 1 4 2 2 807 West Norway 11 10 11 8 7 8 8 7 6 8 648 Centre Poland 47 72 49 47 50 51 38 30 21 19 6 398 West Portugal 227 151 142 121 63 64 46 32 27 16 19 352 Centre Romania 25 191 325 353 209 196 132 99 77 65 1 758 Centre Slovakia 2 1 1 0 1 3 1 0 1 0 18 Centre Slovenia 0 0 1 2 2 1 1 0 0 2 23 West Spain 256 237 209 187 153 119 140 108 74 68 3 717 West Sweden 23 15 22 13 14 15 26 20 23 21 1 311 West United Kingdom 145 133 116 115 144 196 138 137 100 108 6 505 Total EU/EEA 1 741 2 026 2 250 1 883 1 498 1 451 1 235 1 153 1 026 955 68 186 Non-EU/EEA Centre Albania 0 0 1 0 1 0 0 0 0 0 5 West Andorra 0 0 0 0 0 0 0 0 0 – 11 East Armenia 51 42 47 34 43 37 35 39 28 38 733 East Azerbaijan 277 319 218 204 183 183 160 99 105 100 3 291 East Belarus 223 254 247 201 376 790 600 485 391 363 9 566 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 20 East Georgia 211 188 224 172 194 187 205 150 96 114 3 065 West Israel 40 41 78 71 44 39 25 32 35 18 1 310 East Kazakhstan 1 100 923 793 730 779 826 900 901 920 1 203 18 808 East Kyrgyzstan 347 355 255 188 183 172 200 204 136 107 3 968 West Monaco 0 0 0 0 0 0 0 0 0 – 8 Centre Montenegro 0 0 1 0 0 0 0 1 0 0 6 Centre North Macedonia 0 0 0 0 0 0 0 0 0 – 2 East Republic of Moldova 58 62 40 22 61 38 40 42 59 39 2 935 East Russian Federationc 0 0 0 0 0 0 0 0 0 0 0 West San Marino 0 0 0 0 0 0 0 0 0 0 11 Centre Serbia 6 9 5 11 5 4 1 4 2 2 983 Centre Serbia excluding Kosovo1 6 9 5 11 5 4 1 4 2 2 981 Centre Kosovo1 – – – – – – – – – – 2 West Switzerland 20 21 24 13 8 10 13 20 13 12 2 911 East Tajikistan 590 407 257 213 227 247 201 247 193 134 3 696 Centre Turkey 0 6 6 4 10 13 8 14 24 10 178 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 6 934 6 588 5 933 5 847 4 670 3 449 3 694 3 983 3 750 4 214 128 975 East Uzbekistan 1 850 – – – – – – – – – 11 390 Total non-EU/EEA 11 707 9 215 8 129 7 710 6 784 5 995 6 082 6 221 5 752 6 354 191 872 WHO European Region West West 1 352 1 452 1 682 1 302 1 044 1 016 889 803 779 739 53 755 Centre Centre 143 355 435 457 340 308 215 187 169 146 10 282 East East 11 953 9 433 8 262 7 834 6 898 6 122 6 213 6 384 5 830 6 424 196 016 Total WHO European Region 13 448 11 240 10 379 9 593 8 282 7 446 7 317 7 374 6 778 7 309 260 053 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Data on route of transmission were not reported by Malta or the Russian Federation for 2019. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 66 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 6. New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 110 108 112 90 97 102 83 80 58 70 3 200 West Belgium 474 477 509 427 408 365 347 338 309 – 11 783 Centre Bulgaria 71 89 58 70 94 86 84 85 104 98 1 563 Centre Croatia 7 21 7 13 12 13 13 8 10 13 406 Centre Cyprus 15 23 23 16 10 26 27 32 32 47 645 Centre Czechia 38 26 41 45 45 46 53 59 56 56 875 West Denmark 141 132 96 90 102 126 100 93 91 87 3 521 East Estonia 173 146 170 188 162 144 116 89 67 78 1 713 West Finland 94 88 71 67 70 79 83 70 55 44 1 691 West France 2 223 2 075 2 199 2 185 2 189 1 783 1 635 1 668 1 897 1 538 37 379 West Germany 500 539 519 624 817 972 881 789 746 763 16 633 West Greece 123 151 159 125 142 129 141 153 171 169 3 690 Centre Hungary 18 19 24 25 28 22 28 22 13 28 528 West Iceland 10 6 0 0 0 0 9 2 15 6 132 West Ireland 127 126 135 134 128 129 147 173 160 107 3 576 West Italy 1 886 1 822 1 767 1 700 1 664 1 632 1 754 1 642 1 245 1 071 22 611 East Latvia 131 144 112 125 132 152 143 135 111 107 2 266 – Liechtenstein 3 0 0 0 0 0 1 0 0 0 13 East Lithuania 29 39 53 59 74 65 70 70 67 59 819 West Luxembourg 34 26 28 27 35 31 30 33 22 24 750 West Maltac 10 13 15 10 9 15 21 17 14 0 196 West Netherlands 365 309 311 264 248 268 223 198 159 154 8 348 West Norway 157 155 142 123 140 138 120 115 101 100 3 521 Centre Poland 108 93 102 90 109 112 110 103 69 83 1 938 West Portugal 1 228 1 095 1 064 1 045 867 799 840 762 648 433 28 359 Centre Romania 332 369 371 396 430 467 486 517 482 434 8 011 Centre Slovakia 4 12 14 21 18 23 18 15 19 28 254 Centre Slovenia 7 8 4 9 5 10 9 11 7 10 161 West Spain 1 268 1 123 1 150 1 154 1 099 1 016 1 038 1 038 691 798 16 890 West Sweden 222 260 227 218 229 211 202 212 213 204 6 074 West United Kingdom 3 042 2 825 2 582 2 257 2 329 2 067 1 901 1 648 1 668 1 555 71 072 Total EU/EEA 12 950 12 319 12 065 11 597 11 692 11 028 10 713 10 177 9 300 8 164 258 618 Non-EU/EEA Centre Albania 34 60 66 101 62 77 115 87 80 91 1 081 West Andorra 2 1 1 1 0 0 0 2 7 – 30 East Armenia 88 131 166 179 275 238 245 287 340 353 2 726 East Azerbaijan 131 191 244 275 378 440 338 370 469 531 3 915 East Belarus 789 881 919 1 265 1 349 1 416 1 671 1 868 1 861 1 659 18 429 Centre Bosnia and Herzegovina 1 14 4 0 7 4 6 2 10 9 142 East Georgia 203 202 241 240 294 355 372 341 413 449 3 880 West Israel 207 209 200 174 207 201 194 183 215 173 5 269 East Kazakhstan 796 987 1 112 1 268 1 391 1 439 1 743 1 869 2 057 2 125 17 935 East Kyrgyzstan 186 181 307 276 392 404 421 490 530 549 4 417 West Monaco 0 0 1 0 0 0 0 1 0 – 13 Centre Montenegro 3 4 4 2 4 3 9 3 5 4 91 Centre North Macedonia 0 0 7 2 4 4 10 8 6 – 59 East Republic of Moldova 607 612 661 337 616 578 547 561 617 683 8 694 East Russian Federationc 0 0 0 0 0 0 0 0 0 0 0 West San Marino 0 4 3 0 0 0 0 0 0 0 23 Centre Serbia 38 42 28 22 34 28 35 31 34 23 906 Centre Serbia excluding Kosovo1 35 37 27 20 33 28 30 29 29 21 841 Centre Kosovo1 3 5 1 2 1 5 2 5 2 65 West Switzerland 221 211 220 223 174 180 165 136 150 135 7 239 East Tajikistan 272 402 375 474 615 735 691 791 1 042 952 6 845 Centre Turkey 195 263 376 428 495 583 646 775 951 806 7 376 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 9 122 10 248 10 440 11 472 10 648 9 043 10 011 11 036 11 331 11 567 154 148 East Uzbekistan 852 4 711 Total non-EU/EEA 13 747 14 643 15 375 16 739 16 945 15 728 17 219 18 841 20 118 20 109 247 929 WHO European Region West West 12 444 11 755 11 511 10 938 10 954 10 243 9 914 9 353 8 635 7 431 252 000 Centre Centre 871 1 043 1 129 1 240 1 357 1 504 1 649 1 758 1 878 1 730 24 036 East East 13 379 14 164 14 800 16 158 16 326 15 009 16 368 17 907 18 905 19 112 230 498 Total WHO European Region 26 694 26 962 27 440 28 336 28 637 26 756 27 931 29 018 29 418 28 273 506 534 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Data on route of transmission were not reported by Malta or the Russian Federation for 2019. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 67 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 7. New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 1 2 0 0 1 0 1 1 1 0 62 West Belgium 11 18 10 7 10 14 8 5 10 – 452 Centre Bulgaria 4 2 0 5 1 1 0 3 3 1 28 Centre Croatia 0 1 0 0 1 0 0 0 0 0 14 Centre Cyprus 0 0 1 0 0 1 0 0 0 1 5 Centre Czechia 0 0 2 0 1 0 2 0 0 0 9 West Denmark 3 3 4 5 5 4 1 5 2 0 113 East Estonia 3 3 4 2 5 1 0 0 0 0 54 West Finland 1 1 2 2 2 3 2 0 2 4 37 West France 41 35 50 37 53 47 28 24 37 41 637 West Germany 20 14 22 23 26 27 23 18 20 13 473 West Greece 3 4 0 0 1 0 3 1 2 4 67 Centre Hungary 0 0 1 1 1 2 1 2 0 0 17 West Iceland 0 0 0 0 0 0 0 0 2 1 4 West Ireland 9 3 5 3 2 5 3 1 3 2 91 West Italy 13 27 16 13 14 16 10 16 11 3 214 East Latvia 4 2 7 10 4 3 6 3 5 2 82 – Liechtenstein 0 0 0 0 0 0 0 0 0 0 1 East Lithuania 0 1 0 1 2 0 1 1 0 0 7 West Luxembourg 0 0 1 0 2 0 0 0 0 1 15 West Maltac 0 0 0 0 0 0 2 0 2 0 4 West Netherlands 27 16 19 10 14 11 7 4 4 2 368 West Norway 1 4 7 1 3 2 2 2 6 2 93 Centre Poland 11 7 4 4 3 8 1 3 2 5 224 West Portugal 15 12 5 9 7 5 5 4 1 0 489 Centre Romania 27 22 19 24 18 18 6 14 9 11 760 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 0 Centre Slovenia 0 1 0 0 0 0 0 0 0 0 7 West Spain 13 11 7 18 4 3 8 3 4 2 135 West Sweden 13 22 14 7 7 15 10 14 12 12 273 West United Kingdom 109 104 87 92 90 54 40 54 53 60 2 903 Total EU/EEA 329 315 287 274 277 240 170 178 191 167 7 638 Non-EU/EEA Centre Albania 0 3 3 6 3 1 1 1 2 1 36 West Andorra 0 0 0 0 0 0 0 0 0 – 1 East Armenia 3 2 3 5 7 4 1 5 6 3 54 East Azerbaijan 11 9 14 10 18 16 10 10 9 4 132 East Belarus 22 23 16 16 15 26 20 13 4 10 318 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 1 East Georgia 13 6 9 4 5 6 4 3 6 3 108 West Israel 7 8 7 9 9 4 4 6 7 3 265 East Kazakhstan 21 18 30 36 22 25 24 34 24 26 396 East Kyrgyzstan 19 20 33 10 14 25 17 16 24 21 252 West Monaco 0 0 0 0 0 0 0 0 0 – 1 Centre Montenegro 0 0 0 0 0 0 0 0 0 0 4 Centre North Macedonia 0 0 0 0 0 0 0 0 0 – 2 East Republic of Moldova 10 16 11 13 19 14 10 11 13 19 209 East Russian Federationc 0 0 0 0 0 0 0 0 0 0 0 West San Marino 0 0 0 0 0 0 0 0 0 0 1 Centre Serbia – 1 1 4 1 1 2 1 2 53 Centre Serbia excluding Kosovo1 0 1 0 4 1 0 2 0 0 2 48 Centre Kosovo1 – – 1 – – 1 – – 1 – 5 West Switzerland 8 4 2 3 1 4 4 4 2 0 182 East Tajikistan 13 26 38 49 59 55 54 60 53 47 477 Centre Turkey 0 5 12 11 22 23 15 12 13 15 182 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 177 136 149 111 122 98 77 86 71 80 2 301 East Uzbekistan 73 – – – – – – – – – 363 Total non-EU/EEA 377 277 328 287 317 302 243 261 235 234 5 338 WHO European Region West West 295 288 258 239 251 214 161 162 181 150 6 880 Centre Centre 42 42 43 55 51 55 28 35 30 36 1 342 East East 369 262 314 267 292 273 224 242 215 215 4 753 Total WHO European Region 706 592 615 561 594 542 413 439 426 401 12 975 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Data on route of transmission were not reported by Malta or the Russian Federation for 2019. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 68 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 8. HIV diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Sex between men 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 113 113 7 12 19 26 44 70 0 0 0 0 0 0 0 0 0 2 21 23 225 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 122 122 8 29 37 33 65 98 0 1 1 0 0 0 0 0 0 0 0 0 258 Bulgaria Centre Croatia 82 82 0 1 1 4 9 13 0 0 0 0 0 0 0 0 0 1 5 6 102 Croatia Centre Cyprus 38 38 0 3 3 25 22 47 1 0 1 1 0 1 1 1 2 3 5 8 100 Cyprus Centre Czechia 151 151 1 5 6 25 31 56 0 0 0 0 1 1 0 1 1 3 4 7 222 Czechia West Denmark 99 99 0 4 4 44 43 87 0 0 0 0 0 0 0 0 0 0 0 0 190 Denmark East Estonia 16 16 7 13 20 37 41 78 0 0 0 0 0 0 0 0 0 21 43 64 178 Estonia West Finland 38 38 0 8 8 19 25 44 3 1 4 0 1 1 0 0 0 15 39 54 149 Finland West France 1 260 1 317 9 56 65 882 650 1 538 21 20 41 0 0 0 9 3 12 798 1 147 1 950 4 923 France West Germany 1 443 1 445 19 140 159 531 231 763 6 7 13 0 0 0 0 0 0 113 600 713 3 093 Germany West Greece 247 247 9 63 72 98 71 169 3 1 4 0 0 0 0 0 0 25 86 111 603 Greece Centre Hungary 167 167 0 1 1 16 12 28 0 0 0 0 0 0 0 0 0 0 28 42 238 Hungary West Iceland 15 15 0 2 2 3 3 6 1 0 1 0 0 0 0 0 0 1 3 4 28 Iceland West Ireland 130 131 1 9 10 75 31 107 1 1 2 0 0 0 0 0 0 57 225 283 533 Ireland West Italy 1 069 1 069 18 129 147 434 637 1 071 1 2 3 0 0 0 1 0 1 52 188 240 2 531 Italy East Latvia 18 18 6 38 44 57 50 107 1 1 2 0 0 0 0 0 0 51 73 124 295 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 20 20 9 39 48 28 31 59 0 0 0 0 0 0 0 0 0 4 20 24 151 Lithuania West Luxembourg 22 22 0 0 0 10 14 24 1 0 1 0 0 0 0 0 0 0 1 1 48 Luxembourg West Malta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 55 80 80 Malta West Netherlands 320 333 1 1 2 78 76 154 1 1 2 1 4 5 0 0 0 12 54 67 563 Netherlands West Norway 61 61 0 8 8 57 43 100 2 0 2 1 0 1 0 0 0 0 0 0 172 Norway Centre Poland 299 299 5 14 19 34 49 83 2 3 5 1 1 2 0 0 0 170 883 1 060 1 468 Poland West Portugal 296 296 3 13 16 221 212 433 0 0 0 0 0 0 3 1 4 12 17 29 778 Portugal Centre Romania 177 177 7 58 65 152 282 434 5 6 11 0 0 0 0 0 0 3 0 3 690 Romania Centre Slovakia 50 50 0 0 0 7 21 28 0 0 0 0 0 0 0 1 1 3 19 22 101 Slovakia Centre Slovenia 20 20 1 1 2 5 5 10 0 0 0 0 0 0 0 0 0 0 2 2 34 Slovenia West Spain 1 403 1 403 17 51 68 318 480 798 0 2 2 0 0 0 0 2 2 22 188 210 2 483 Spain West Sweden 152 152 5 16 21 117 87 204 6 6 12 0 0 0 4 0 4 29 27 56 449 Sweden West United Kingdom 1 697 1 697 16 92 108 818 733 1 555 33 27 60 3 7 10 16 9 25 242 415 661 4 116 United Kingdom Total EU/EEA 9 525 9 598 149 806 955 4 154 3 998 8 164 88 79 167 7 14 21 34 18 52 1 654 4 148 5 844 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 9 9 0 0 0 27 64 91 0 1 1 0 0 0 0 0 0 0 0 0 101 Albania West Andorra – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Andorra East Armenia 49 49 0 38 38 131 222 353 2 1 3 1 0 1 0 0 0 0 2 2 446 Armenia East Azerbaijan 50 50 4 96 100 232 299 531 1 3 4 0 0 0 0 0 0 10 26 36 721 Azerbaijan East Belarus 82 82 73 290 363 702 957 1 659 4 6 10 0 0 0 0 0 0 4 19 23 2 137 Belarus Centre Bosnia and Herzegovina 21 21 0 0 0 3 6 9 0 0 0 0 0 0 0 0 0 0 0 0 30 Bosnia and Herzegovina East Georgia 94 94 1 113 114 154 295 449 2 1 3 0 0 0 0 2 2 3 3 6 668 Georgia West Israel 113 113 5 13 18 94 79 173 1 2 3 0 0 0 0 0 0 40 61 101 408 Israel East Kazakhstan 205 205 176 1 027 1 203 1 029 1 096 2 125 19 7 26 0 0 0 0 0 0 33 81 114 3 673 Kazakhstan East Kyrgyzstan 37 37 2 105 107 291 258 549 6 15 21 2 6 8 0 0 0 53 75 128 850 Kyrgyzstan West Monaco – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Monaco Centre Montenegro 15 15 0 0 0 1 3 4 0 0 0 0 0 0 0 0 0 1 6 7 26 Montenegro Centre North Macedonia – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 North Macedonia East Republic of Moldova 29 29 8 31 39 300 383 683 9 10 19 0 0 0 0 0 0 61 91 152 922 Republic of Moldova East Russian Federation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 947 49 177 80 124 80 124 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 173 173 – 2 2 15 8 23 1 1 2 – – 0 – – 0 3 12 15 215 Serbia Centre Serbia excluding Kosovo1 170 170 0 2 2 14 7 21 1 1 2 0 0 0 0 0 0 3 12 15 210 Serbia excluding Kosovo1 Centre Kosovo1 3 3 – – 0 1 1 2 – – 0 – – 0 – – 0 – – 0 5 Kosovo1 West Switzerland 151 152 3 9 12 62 73 135 0 0 0 0 0 0 0 0 0 23 93 122 421 Switzerland East Tajikistan 11 11 2 132 134 452 500 952 19 28 47 1 2 3 1 0 1 73 99 172 1 320 Tajikistan Centre Turkey 539 539 1 9 10 146 660 806 6 9 15 0 0 0 1 1 2 327 1 530 1 857 3 229 Turkey East Turkmenistan – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Turkmenistan East Ukraine 468 468 702 3 512 4 214 5 625 5 942 11 567 37 43 80 0 3 3 1 0 1 10 14 24 16 357 Ukraine East Uzbekistan – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Uzbekistan Total non-EU/EEA 2 046 2 047 977 5 377 6 354 9 264 10 845 20 109 107 127 234 4 11 15 3 3 6 31 588 51 289 82 883 111 648 Total non-EU/EEA WHO European Region WHO European Region West West 8 629 8 703 113 626 739 3 887 3 532 7 431 80 70 150 5 12 17 33 15 48 1 458 3 220 4 705 21 793 West Centre Centre 1 863 1 863 23 123 146 493 1 237 1 730 15 21 36 2 2 4 2 4 6 514 2 494 3 029 6 814 Centre East East 1 079 1 079 990 5 434 6 424 9 038 10 074 19 112 100 115 215 4 11 15 2 2 4 31 270 49 723 80 993 107 842 East Total WHO European Region 11 571 11 645 1 126 6 183 7 309 13 418 14 843 28 273 195 206 401 11 25 36 37 21 58 33 242 55 437 88 727 136 449 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 2019 in tables 4–7. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 69 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 8. HIV diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Sex between men 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 113 113 7 12 19 26 44 70 0 0 0 0 0 0 0 0 0 2 21 23 225 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 122 122 8 29 37 33 65 98 0 1 1 0 0 0 0 0 0 0 0 0 258 Bulgaria Centre Croatia 82 82 0 1 1 4 9 13 0 0 0 0 0 0 0 0 0 1 5 6 102 Croatia Centre Cyprus 38 38 0 3 3 25 22 47 1 0 1 1 0 1 1 1 2 3 5 8 100 Cyprus Centre Czechia 151 151 1 5 6 25 31 56 0 0 0 0 1 1 0 1 1 3 4 7 222 Czechia West Denmark 99 99 0 4 4 44 43 87 0 0 0 0 0 0 0 0 0 0 0 0 190 Denmark East Estonia 16 16 7 13 20 37 41 78 0 0 0 0 0 0 0 0 0 21 43 64 178 Estonia West Finland 38 38 0 8 8 19 25 44 3 1 4 0 1 1 0 0 0 15 39 54 149 Finland West France 1 260 1 317 9 56 65 882 650 1 538 21 20 41 0 0 0 9 3 12 798 1 147 1 950 4 923 France West Germany 1 443 1 445 19 140 159 531 231 763 6 7 13 0 0 0 0 0 0 113 600 713 3 093 Germany West Greece 247 247 9 63 72 98 71 169 3 1 4 0 0 0 0 0 0 25 86 111 603 Greece Centre Hungary 167 167 0 1 1 16 12 28 0 0 0 0 0 0 0 0 0 0 28 42 238 Hungary West Iceland 15 15 0 2 2 3 3 6 1 0 1 0 0 0 0 0 0 1 3 4 28 Iceland West Ireland 130 131 1 9 10 75 31 107 1 1 2 0 0 0 0 0 0 57 225 283 533 Ireland West Italy 1 069 1 069 18 129 147 434 637 1 071 1 2 3 0 0 0 1 0 1 52 188 240 2 531 Italy East Latvia 18 18 6 38 44 57 50 107 1 1 2 0 0 0 0 0 0 51 73 124 295 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 20 20 9 39 48 28 31 59 0 0 0 0 0 0 0 0 0 4 20 24 151 Lithuania West Luxembourg 22 22 0 0 0 10 14 24 1 0 1 0 0 0 0 0 0 0 1 1 48 Luxembourg West Malta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 55 80 80 Malta West Netherlands 320 333 1 1 2 78 76 154 1 1 2 1 4 5 0 0 0 12 54 67 563 Netherlands West Norway 61 61 0 8 8 57 43 100 2 0 2 1 0 1 0 0 0 0 0 0 172 Norway Centre Poland 299 299 5 14 19 34 49 83 2 3 5 1 1 2 0 0 0 170 883 1 060 1 468 Poland West Portugal 296 296 3 13 16 221 212 433 0 0 0 0 0 0 3 1 4 12 17 29 778 Portugal Centre Romania 177 177 7 58 65 152 282 434 5 6 11 0 0 0 0 0 0 3 0 3 690 Romania Centre Slovakia 50 50 0 0 0 7 21 28 0 0 0 0 0 0 0 1 1 3 19 22 101 Slovakia Centre Slovenia 20 20 1 1 2 5 5 10 0 0 0 0 0 0 0 0 0 0 2 2 34 Slovenia West Spain 1 403 1 403 17 51 68 318 480 798 0 2 2 0 0 0 0 2 2 22 188 210 2 483 Spain West Sweden 152 152 5 16 21 117 87 204 6 6 12 0 0 0 4 0 4 29 27 56 449 Sweden West United Kingdom 1 697 1 697 16 92 108 818 733 1 555 33 27 60 3 7 10 16 9 25 242 415 661 4 116 United Kingdom Total EU/EEA 9 525 9 598 149 806 955 4 154 3 998 8 164 88 79 167 7 14 21 34 18 52 1 654 4 148 5 844 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 9 9 0 0 0 27 64 91 0 1 1 0 0 0 0 0 0 0 0 0 101 Albania West Andorra – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Andorra East Armenia 49 49 0 38 38 131 222 353 2 1 3 1 0 1 0 0 0 0 2 2 446 Armenia East Azerbaijan 50 50 4 96 100 232 299 531 1 3 4 0 0 0 0 0 0 10 26 36 721 Azerbaijan East Belarus 82 82 73 290 363 702 957 1 659 4 6 10 0 0 0 0 0 0 4 19 23 2 137 Belarus Centre Bosnia and Herzegovina 21 21 0 0 0 3 6 9 0 0 0 0 0 0 0 0 0 0 0 0 30 Bosnia and Herzegovina East Georgia 94 94 1 113 114 154 295 449 2 1 3 0 0 0 0 2 2 3 3 6 668 Georgia West Israel 113 113 5 13 18 94 79 173 1 2 3 0 0 0 0 0 0 40 61 101 408 Israel East Kazakhstan 205 205 176 1 027 1 203 1 029 1 096 2 125 19 7 26 0 0 0 0 0 0 33 81 114 3 673 Kazakhstan East Kyrgyzstan 37 37 2 105 107 291 258 549 6 15 21 2 6 8 0 0 0 53 75 128 850 Kyrgyzstan West Monaco – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Monaco Centre Montenegro 15 15 0 0 0 1 3 4 0 0 0 0 0 0 0 0 0 1 6 7 26 Montenegro Centre North Macedonia – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 North Macedonia East Republic of Moldova 29 29 8 31 39 300 383 683 9 10 19 0 0 0 0 0 0 61 91 152 922 Republic of Moldova East Russian Federation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 947 49 177 80 124 80 124 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 173 173 – 2 2 15 8 23 1 1 2 – – 0 – – 0 3 12 15 215 Serbia Centre Serbia excluding Kosovo1 170 170 0 2 2 14 7 21 1 1 2 0 0 0 0 0 0 3 12 15 210 Serbia excluding Kosovo1 Centre Kosovo1 3 3 – – 0 1 1 2 – – 0 – – 0 – – 0 – – 0 5 Kosovo1 West Switzerland 151 152 3 9 12 62 73 135 0 0 0 0 0 0 0 0 0 23 93 122 421 Switzerland East Tajikistan 11 11 2 132 134 452 500 952 19 28 47 1 2 3 1 0 1 73 99 172 1 320 Tajikistan Centre Turkey 539 539 1 9 10 146 660 806 6 9 15 0 0 0 1 1 2 327 1 530 1 857 3 229 Turkey East Turkmenistan – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Turkmenistan East Ukraine 468 468 702 3 512 4 214 5 625 5 942 11 567 37 43 80 0 3 3 1 0 1 10 14 24 16 357 Ukraine East Uzbekistan – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Uzbekistan Total non-EU/EEA 2 046 2 047 977 5 377 6 354 9 264 10 845 20 109 107 127 234 4 11 15 3 3 6 31 588 51 289 82 883 111 648 Total non-EU/EEA WHO European Region WHO European Region West West 8 629 8 703 113 626 739 3 887 3 532 7 431 80 70 150 5 12 17 33 15 48 1 458 3 220 4 705 21 793 West Centre Centre 1 863 1 863 23 123 146 493 1 237 1 730 15 21 36 2 2 4 2 4 6 514 2 494 3 029 6 814 Centre East East 1 079 1 079 990 5 434 6 424 9 038 10 074 19 112 100 115 215 4 11 15 2 2 4 31 270 49 723 80 993 107 842 East Total WHO European Region 11 571 11 645 1 126 6 183 7 309 13 418 14 843 28 273 195 206 401 11 25 36 37 21 58 33 242 55 437 88 727 136 449 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 2019 in tables 4–7. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 70 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 9. HIV diagnoses in 2019, 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 1 0 1 0 2 2 3 15 18 6 31 37 14 49 63 4 48 52 7 45 52 0 0 0 225 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 0 1 1 4 0 4 3 20 23 7 32 39 14 91 105 7 46 53 6 27 33 0 0 0 258 Bulgaria Centre Croatia 0 0 0 0 3 3 1 10 11 0 11 11 1 35 36 1 30 31 2 8 10 0 0 0 102 Croatia Centre Cyprus 1 0 1 1 0 1 2 6 8 7 10 17 15 35 50 4 11 15 1 7 8 0 0 0 100 Cyprus Centre Czechia 0 1 1 0 0 0 1 21 22 5 45 50 13 55 68 6 50 56 4 21 25 0 0 0 222 Czechia West Denmark 0 0 0 0 1 1 1 7 8 8 29 37 13 35 48 11 36 47 11 38 49 0 0 0 190 Denmark East Estonia 0 0 0 1 1 2 7 2 9 5 8 13 24 45 69 14 33 47 14 24 38 0 0 0 178 Estonia West Finland 1 0 1 1 2 3 1 9 10 5 14 19 9 40 49 6 22 28 14 25 39 0 0 0 149 Finland West France 19 26 45 60 75 136 145 313 465 239 462 717 568 824 1 413 362 657 1 034 326 779 1 113 0 0 0 4 923 France West Germany 2 3 5 11 29 40 76 199 275 113 342 455 219 729 951 127 536 663 118 575 693 3 8 11 3 093 Germany West Greece 4 1 5 4 9 13 10 42 52 25 71 96 43 148 191 32 105 137 17 92 109 0 0 0 603 Greece Centre Hungary 0 0 0 1 3 4 0 28 28 3 50 53 4 62 67 4 40 44 4 23 27 0 2 15 238 Hungary West Iceland 1 0 1 0 0 0 0 2 2 0 4 4 2 10 12 1 5 6 1 2 3 0 0 0 28 Iceland West Ireland 1 1 2 2 6 8 6 24 30 27 98 126 47 142 190 35 77 113 16 48 64 0 0 0 533 Ireland West Italy 1 2 3 12 9 21 38 135 173 61 273 334 142 549 691 116 498 614 135 555 690 1 4 5 2 531 Italy East Latvia 1 1 2 2 2 4 2 14 16 11 17 28 34 68 102 29 41 70 36 37 73 0 0 0 295 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 0 0 0 0 1 1 0 9 9 5 10 15 14 47 61 11 23 34 11 20 31 0 0 0 151 Lithuania West Luxembourg 1 0 1 0 0 0 0 1 1 1 5 6 6 10 16 2 11 13 1 9 10 0 1 1 48 Luxembourg West Malta 0 0 0 0 2 2 3 2 5 3 12 15 3 20 23 1 4 5 3 10 13 2 5 17 80 Malta West Netherlands 4 3 7 1 5 6 10 44 55 13 70 90 28 121 150 17 111 133 20 102 122 0 0 0 563 Netherlands West Norway 1 0 1 2 1 3 2 5 7 9 18 27 21 28 49 14 29 43 11 31 42 0 0 0 172 Norway Centre Poland 3 6 9 3 17 20 14 135 150 23 233 257 81 443 527 58 256 314 25 129 154 5 30 37 1 468 Poland West Portugal 0 0 0 6 8 14 11 61 72 30 91 121 67 139 206 58 119 177 67 121 188 0 0 0 778 Portugal Centre Romania 5 6 11 7 9 16 16 66 82 28 74 102 53 188 241 34 112 146 24 68 92 0 0 0 690 Romania Centre Slovakia 0 0 0 0 4 4 1 9 10 1 18 19 5 30 35 1 24 25 2 6 8 0 0 0 101 Slovakia Centre Slovenia 0 0 0 0 0 0 0 1 1 0 2 2 5 12 17 1 9 10 0 4 4 0 0 0 34 Slovenia West Spain 0 2 2 13 39 52 32 201 233 50 377 427 114 691 805 92 482 574 56 334 390 0 0 0 2 483 Spain West Sweden 6 5 11 5 8 13 4 10 14 16 46 62 59 91 150 48 62 110 23 66 89 0 0 0 449 Sweden West United Kingdom 10 10 20 34 43 77 67 249 316 118 542 660 317 881 1 203 305 635 941 277 620 899 0 0 0 4 116 United Kingdom Total EU/EEA 62 68 130 170 279 450 456 1 640 2 105 819 2 995 3 839 1 935 5 618 7 588 1 401 4 112 5 535 1 232 3 826 5 068 11 50 86 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 1 1 0 3 3 0 8 8 5 13 18 7 18 25 5 18 23 10 13 23 0 0 0 101 Albania West Andorra – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Andorra East Armenia 3 1 4 1 3 4 8 22 30 18 51 69 47 95 142 26 82 108 31 58 89 0 0 0 446 Armenia East Azerbaijan 4 4 8 2 1 3 29 30 59 33 93 126 85 163 248 53 97 150 41 86 127 0 0 0 721 Azerbaijan East Belarus 5 10 15 7 8 15 43 56 99 93 144 237 262 551 813 221 379 600 152 206 358 0 0 0 2 137 Belarus Centre Bosnia and Herzegovina 0 0 0 0 1 1 0 4 4 0 8 8 1 7 8 1 3 4 1 4 5 0 0 0 30 Bosnia and Herzegovina East Georgia 2 1 3 1 10 11 9 55 64 16 60 76 47 140 187 41 138 179 44 104 148 0 0 0 668 Georgia West Israel 1 2 3 3 1 4 3 15 18 8 45 53 47 69 116 51 67 118 27 68 95 0 1 1 408 Israel East Kazakhstan 21 8 29 21 24 45 91 133 224 158 293 451 460 1 005 1 465 302 652 954 204 301 505 0 0 0 3 673 Kazakhstan East Kyrgyzstan 9 23 32 5 6 11 23 40 63 50 49 99 130 195 325 75 115 190 62 68 130 0 0 0 850 Kyrgyzstan West Monaco – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Monaco Centre Montenegro 0 0 0 0 0 0 1 1 2 0 5 5 1 5 6 0 10 10 0 3 3 0 0 0 26 Montenegro Centre North Macedonia – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 North Macedonia East Republic of Moldova 9 9 18 10 8 18 31 29 60 50 59 109 126 226 352 76 130 206 76 83 159 0 0 0 922 Republic of Moldova East Russian Federation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 947 49 177 80 124 80 124 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 San Marino Centre Serbia 1 1 2 1 1 1 20 21 2 30 32 7 72 79 39 39 7 34 41 – – 0 215 Serbia Centre Serbia excluding Kosovo1 1 1 2 1 0 1 1 19 20 2 30 32 6 71 77 0 37 37 7 34 41 0 0 0 210 Serbia excluding Kosovo1 Centre Kosovo1 – – 0 – – 0 – 1 1 – – 0 1 1 2 – 2 2 – – 0 – – 0 5 Kosovo1 West Switzerland 0 0 0 0 1 1 6 26 33 11 41 52 29 85 117 21 76 98 21 97 119 0 0 1 421 Switzerland East Tajikistan 74 110 184 17 7 24 43 45 88 61 91 152 194 239 433 97 194 291 62 86 148 0 0 0 1 320 Tajikistan Centre Turkey 6 9 15 16 99 115 45 439 484 72 532 604 167 781 948 95 467 562 80 421 501 0 0 0 3 229 Turkey East Turkmenistan – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Turkmenistan East Ukraine 41 50 91 86 46 132 323 278 601 667 853 1 520 2 206 4 167 6 373 1 800 3 174 4 974 1 252 1 414 2 666 0 0 0 16 357 Ukraine East Uzbekistan – – 0 – – 0 – – 0 – – 0 0 – – 0 – – 0 – – 0 0 Uzbekistan Total non-EU/EEA 176 229 405 170 218 388 656 1 201 1 858 1 244 2 367 3 611 3 816 7 818 11 637 2 864 5 641 8 506 2 070 3 046 5 117 30 947 49 178 80 126 111 648 Total non-EU/EEA WHO European Region WHO European Region West West 53 55 108 154 241 396 418 1 360 1 787 743 2 571 3 338 1 748 4 661 6 443 1 303 3 580 4 906 1 151 3 617 4 779 6 19 36 21 793 West Centre Centre 16 25 41 33 139 172 85 768 854 153 1 063 1 217 374 1 834 2 212 217 1 115 1 332 166 768 934 5 32 52 6 814 Centre East East 169 217 386 153 117 270 609 713 1 322 1 167 1 728 2 895 3 629 6 941 10 570 2 745 5 058 7 803 1 985 2 487 4 472 30 947 49 177 80 124 107 842 East Total WHO European Region 238 297 535 340 497 838 1 112 2 841 3 963 2 063 5 362 7 450 5 751 13 436 19 225 4 265 9 753 14 041 3 302 6 872 10 185 30 958 49 228 80 212 136 449 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 71 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 9. HIV diagnoses in 2019, 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 1 0 1 0 2 2 3 15 18 6 31 37 14 49 63 4 48 52 7 45 52 0 0 0 225 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 0 1 1 4 0 4 3 20 23 7 32 39 14 91 105 7 46 53 6 27 33 0 0 0 258 Bulgaria Centre Croatia 0 0 0 0 3 3 1 10 11 0 11 11 1 35 36 1 30 31 2 8 10 0 0 0 102 Croatia Centre Cyprus 1 0 1 1 0 1 2 6 8 7 10 17 15 35 50 4 11 15 1 7 8 0 0 0 100 Cyprus Centre Czechia 0 1 1 0 0 0 1 21 22 5 45 50 13 55 68 6 50 56 4 21 25 0 0 0 222 Czechia West Denmark 0 0 0 0 1 1 1 7 8 8 29 37 13 35 48 11 36 47 11 38 49 0 0 0 190 Denmark East Estonia 0 0 0 1 1 2 7 2 9 5 8 13 24 45 69 14 33 47 14 24 38 0 0 0 178 Estonia West Finland 1 0 1 1 2 3 1 9 10 5 14 19 9 40 49 6 22 28 14 25 39 0 0 0 149 Finland West France 19 26 45 60 75 136 145 313 465 239 462 717 568 824 1 413 362 657 1 034 326 779 1 113 0 0 0 4 923 France West Germany 2 3 5 11 29 40 76 199 275 113 342 455 219 729 951 127 536 663 118 575 693 3 8 11 3 093 Germany West Greece 4 1 5 4 9 13 10 42 52 25 71 96 43 148 191 32 105 137 17 92 109 0 0 0 603 Greece Centre Hungary 0 0 0 1 3 4 0 28 28 3 50 53 4 62 67 4 40 44 4 23 27 0 2 15 238 Hungary West Iceland 1 0 1 0 0 0 0 2 2 0 4 4 2 10 12 1 5 6 1 2 3 0 0 0 28 Iceland West Ireland 1 1 2 2 6 8 6 24 30 27 98 126 47 142 190 35 77 113 16 48 64 0 0 0 533 Ireland West Italy 1 2 3 12 9 21 38 135 173 61 273 334 142 549 691 116 498 614 135 555 690 1 4 5 2 531 Italy East Latvia 1 1 2 2 2 4 2 14 16 11 17 28 34 68 102 29 41 70 36 37 73 0 0 0 295 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 0 0 0 0 1 1 0 9 9 5 10 15 14 47 61 11 23 34 11 20 31 0 0 0 151 Lithuania West Luxembourg 1 0 1 0 0 0 0 1 1 1 5 6 6 10 16 2 11 13 1 9 10 0 1 1 48 Luxembourg West Malta 0 0 0 0 2 2 3 2 5 3 12 15 3 20 23 1 4 5 3 10 13 2 5 17 80 Malta West Netherlands 4 3 7 1 5 6 10 44 55 13 70 90 28 121 150 17 111 133 20 102 122 0 0 0 563 Netherlands West Norway 1 0 1 2 1 3 2 5 7 9 18 27 21 28 49 14 29 43 11 31 42 0 0 0 172 Norway Centre Poland 3 6 9 3 17 20 14 135 150 23 233 257 81 443 527 58 256 314 25 129 154 5 30 37 1 468 Poland West Portugal 0 0 0 6 8 14 11 61 72 30 91 121 67 139 206 58 119 177 67 121 188 0 0 0 778 Portugal Centre Romania 5 6 11 7 9 16 16 66 82 28 74 102 53 188 241 34 112 146 24 68 92 0 0 0 690 Romania Centre Slovakia 0 0 0 0 4 4 1 9 10 1 18 19 5 30 35 1 24 25 2 6 8 0 0 0 101 Slovakia Centre Slovenia 0 0 0 0 0 0 0 1 1 0 2 2 5 12 17 1 9 10 0 4 4 0 0 0 34 Slovenia West Spain 0 2 2 13 39 52 32 201 233 50 377 427 114 691 805 92 482 574 56 334 390 0 0 0 2 483 Spain West Sweden 6 5 11 5 8 13 4 10 14 16 46 62 59 91 150 48 62 110 23 66 89 0 0 0 449 Sweden West United Kingdom 10 10 20 34 43 77 67 249 316 118 542 660 317 881 1 203 305 635 941 277 620 899 0 0 0 4 116 United Kingdom Total EU/EEA 62 68 130 170 279 450 456 1 640 2 105 819 2 995 3 839 1 935 5 618 7 588 1 401 4 112 5 535 1 232 3 826 5 068 11 50 86 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 1 1 0 3 3 0 8 8 5 13 18 7 18 25 5 18 23 10 13 23 0 0 0 101 Albania West Andorra – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Andorra East Armenia 3 1 4 1 3 4 8 22 30 18 51 69 47 95 142 26 82 108 31 58 89 0 0 0 446 Armenia East Azerbaijan 4 4 8 2 1 3 29 30 59 33 93 126 85 163 248 53 97 150 41 86 127 0 0 0 721 Azerbaijan East Belarus 5 10 15 7 8 15 43 56 99 93 144 237 262 551 813 221 379 600 152 206 358 0 0 0 2 137 Belarus Centre Bosnia and Herzegovina 0 0 0 0 1 1 0 4 4 0 8 8 1 7 8 1 3 4 1 4 5 0 0 0 30 Bosnia and Herzegovina East Georgia 2 1 3 1 10 11 9 55 64 16 60 76 47 140 187 41 138 179 44 104 148 0 0 0 668 Georgia West Israel 1 2 3 3 1 4 3 15 18 8 45 53 47 69 116 51 67 118 27 68 95 0 1 1 408 Israel East Kazakhstan 21 8 29 21 24 45 91 133 224 158 293 451 460 1 005 1 465 302 652 954 204 301 505 0 0 0 3 673 Kazakhstan East Kyrgyzstan 9 23 32 5 6 11 23 40 63 50 49 99 130 195 325 75 115 190 62 68 130 0 0 0 850 Kyrgyzstan West Monaco – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Monaco Centre Montenegro 0 0 0 0 0 0 1 1 2 0 5 5 1 5 6 0 10 10 0 3 3 0 0 0 26 Montenegro Centre North Macedonia – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 North Macedonia East Republic of Moldova 9 9 18 10 8 18 31 29 60 50 59 109 126 226 352 76 130 206 76 83 159 0 0 0 922 Republic of Moldova East Russian Federation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 947 49 177 80 124 80 124 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 San Marino Centre Serbia 1 1 2 1 1 1 20 21 2 30 32 7 72 79 39 39 7 34 41 – – 0 215 Serbia Centre Serbia excluding Kosovo1 1 1 2 1 0 1 1 19 20 2 30 32 6 71 77 0 37 37 7 34 41 0 0 0 210 Serbia excluding Kosovo1 Centre Kosovo1 – – 0 – – 0 – 1 1 – – 0 1 1 2 – 2 2 – – 0 – – 0 5 Kosovo1 West Switzerland 0 0 0 0 1 1 6 26 33 11 41 52 29 85 117 21 76 98 21 97 119 0 0 1 421 Switzerland East Tajikistan 74 110 184 17 7 24 43 45 88 61 91 152 194 239 433 97 194 291 62 86 148 0 0 0 1 320 Tajikistan Centre Turkey 6 9 15 16 99 115 45 439 484 72 532 604 167 781 948 95 467 562 80 421 501 0 0 0 3 229 Turkey East Turkmenistan – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Turkmenistan East Ukraine 41 50 91 86 46 132 323 278 601 667 853 1 520 2 206 4 167 6 373 1 800 3 174 4 974 1 252 1 414 2 666 0 0 0 16 357 Ukraine East Uzbekistan – – 0 – – 0 – – 0 – – 0 0 – – 0 – – 0 – – 0 0 Uzbekistan Total non-EU/EEA 176 229 405 170 218 388 656 1 201 1 858 1 244 2 367 3 611 3 816 7 818 11 637 2 864 5 641 8 506 2 070 3 046 5 117 30 947 49 178 80 126 111 648 Total non-EU/EEA WHO European Region WHO European Region West West 53 55 108 154 241 396 418 1 360 1 787 743 2 571 3 338 1 748 4 661 6 443 1 303 3 580 4 906 1 151 3 617 4 779 6 19 36 21 793 West Centre Centre 16 25 41 33 139 172 85 768 854 153 1 063 1 217 374 1 834 2 212 217 1 115 1 332 166 768 934 5 32 52 6 814 Centre East East 169 217 386 153 117 270 609 713 1 322 1 167 1 728 2 895 3 629 6 941 10 570 2 745 5 058 7 803 1 985 2 487 4 472 30 947 49 177 80 124 107 842 East Total WHO European Region 238 297 535 340 497 838 1 112 2 841 3 963 2 063 5 362 7 450 5 751 13 436 19 225 4 265 9 753 14 041 3 302 6 872 10 185 30 958 49 228 80 212 136 449 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 72 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 10. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2019, 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 125 55.6 21 9.3 46 20.4 15 6.7 3 1.3 9 4.0 5 2.2 1 0.4 225 Austria West Belgium – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 241 93.4 5 1.9 6 2.3 1 0.4 2 0.8 1 0.4 2 0.8 0 0.0 258 Bulgaria Centre Croatia 94 92.2 0 0.0 4 3.9 1 1.0 0 0.0 0 0.0 1 1.0 2 2.0 102 Croatia Centre Cyprus 35 35.0 10 10.0 11 11.0 42 42.0 1 1.0 1 1.0 0 0.0 0 0.0 100 Cyprus Centre Czechia 149 67.1 3 1.4 50 22.5 5 2.3 10 4.5 4 1.8 1 0.5 0 0.0 222 Czechia West Denmark 83 43.7 24 12.6 23 12.1 22 11.6 13 6.8 13 6.8 12 6.3 0 0.0 190 Denmark East Estonia 102 57.3 1 0.6 17 9.6 0 0.0 1 0.6 0 0.0 1 0.6 56 31.5 178 Estonia West Finland 54 36.2 3 2.0 30 20.1 22 14.8 6 4.0 13 8.7 8 5.4 13 8.7 149 Finland West France 1 343 27.3 64 1.3 145 2.9 1 226 24.9 298 6.1 73 1.5 158 3.2 1 616 32.8 4 923 France West Germany 1 614 52.2 91 2.9 390 12.6 391 12.6 123 4.0 120 3.9 72 2.3 292 9.4 3 093 Germany West Greece 353 58.5 16 2.7 71 11.8 118 19.6 4 0.7 17 2.8 16 2.7 8 1.3 603 Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 3 10.7 2 7.1 5 17.9 3 10.7 3 10.7 1 3.6 11 39.3 0 0.0 28 Iceland West Ireland 56 10.5 13 2.4 20 3.8 110 20.6 57 10.7 14 2.6 4 0.8 259 48.6 533 Ireland West Italy 1 884 74.4 12 0.5 141 5.6 214 8.5 191 7.5 36 1.4 41 1.6 12 0.5 2 531 Italy East Latvia – – – – – – – – – – – – – – – – – Latvia – Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 145 96.0 2 1.3 4 2.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 151 Lithuania West Luxembourg 14 29.2 10 20.8 3 6.3 15 31.3 3 6.3 1 2.1 1 2.1 1 2.1 48 Luxembourg West Malta 80 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 80 Malta West Netherlands 294 52.2 15 2.7 44 7.8 62 11.0 91 16.2 26 4.6 27 4.8 4 0.7 563 Netherlands West Norway 53 30.8 3 1.7 21 12.2 47 27.3 15 8.7 29 16.9 4 2.3 0 0.0 172 Norway Centre Poland 637 43.4 0 0.0 23 1.6 0 0.0 0 0.0 1 0.1 0 0.0 807 55.0 1 468 Poland West Portugal 420 54.0 15 1.9 12 1.5 172 22.1 137 17.6 4 0.5 1 0.1 17 2.2 778 Portugal Centre Romania 681 98.7 1 0.1 1 0.1 2 0.3 0 0.0 0 0.0 1 0.1 4 0.6 690 Romania Centre Slovakia 62 61.4 1 1.0 24 23.8 0 0.0 2 2.0 1 1.0 0 0.0 11 10.9 101 Slovakia Centre Slovenia 21 61.8 1 2.9 8 23.5 2 5.9 1 2.9 0 0.0 0 0.0 1 2.9 34 Slovenia West Spain 1 466 59.0 59 2.4 68 2.7 135 5.4 531 21.4 20 0.8 49 2.0 155 6.2 2 483 Spain West Sweden 90 20.0 33 7.3 63 14.0 158 35.2 39 8.7 35 7.8 22 4.9 9 2.0 449 Sweden West United Kingdom 1 354 32.9 307 7.5 349 8.5 856 20.8 327 7.9 259 6.3 94 2.3 570 13.8 4 116 United Kingdom Total EU/EEA 11 453 47.2 712 2.9 1 579 6.5 3 619 14.9 1 858 7.7 678 2.8 531 2.2 3 838 15.8 24 268 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 101 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 101 Albania West Andorra – – – – – – – – – – – – – – – – – Andorra East Armenia 446 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 446 Armenia East Azerbaijan 686 95.1 1 0.1 34 4.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 721 Azerbaijan East Belarus 2 134 99.9 0 0.0 3 0.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 137 Belarus Centre Bosnia and Herzegovina 26 86.7 0 0.0 1 3.3 0 0.0 2 6.7 0 0.0 1 3.3 0 0.0 30 Bosnia and Herzegovina East Georgia 667 99.9 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 668 Georgia West Israel 120 29.4 9 2.2 135 33.1 74 18.1 7 1.7 8 2.0 55 13.5 0 0.0 408 Israel East Kazakhstan 3 511 95.6 0 0.0 124 3.4 0 0.0 0 0.0 3 0.1 35 1.0 0 0.0 3 673 Kazakhstan East Kyrgyzstan 788 92.7 2 0.2 56 6.6 0 0.0 0 0.0 2 0.2 0 0.0 2 0.2 850 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 25 96.2 0 0.0 1 3.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 26 Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 922 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 922 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia 215 100.0 – – – – – – – – – – – – – – 215 Serbia Centre Serbia excluding Kosovo1 210 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 210 Serbia excluding Kosovo1 Centre Kosovo1 5 100.0 – – – – – – – – – – – – – – 5 Kosovo1 West Switzerland 161 38.2 67 15.9 17 4.0 36 8.6 32 7.6 22 5.2 9 2.1 77 18.3 421 Switzerland East Tajikistan 1 295 98.1 0 0.0 11 0.8 0 0.0 0 0.0 0 0.0 14 1.1 0 0.0 1 320 Tajikistan Centre Turkey 2 716 84.1 43 1.3 183 5.7 69 2.1 11 0.3 43 1.3 101 3.1 63 2.0 3 229 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 16 357 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 16 357 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 30 170 95.7 122 0.4 566 1.8 179 0.6 52 0.2 78 0.2 215 0.7 142 0.5 31 524 Total non-EU/EEA WHO European Region WHO European Region West West 9 567 43.9 764 3.5 1 583 7.3 3 676 16.9 1 880 8.6 700 3.2 589 2.7 3 034 13.9 21 793 West Centre Centre 5 003 76.1 64 1.0 312 4.7 122 1.9 29 0.4 51 0.8 107 1.6 888 13.5 6 576 Centre East East 27 053 98.7 6 0.0 250 0.9 0 0.0 1 0.0 5 0.0 50 0.2 58 0.2 27 423 East Total WHO European Region 41 623 74.6 834 1.5 2 145 3.8 3 798 6.8 1 910 3.4 756 1.4 746 1.3 3 980 7.1 55 792 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 73 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 10. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2019, 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 125 55.6 21 9.3 46 20.4 15 6.7 3 1.3 9 4.0 5 2.2 1 0.4 225 Austria West Belgium – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 241 93.4 5 1.9 6 2.3 1 0.4 2 0.8 1 0.4 2 0.8 0 0.0 258 Bulgaria Centre Croatia 94 92.2 0 0.0 4 3.9 1 1.0 0 0.0 0 0.0 1 1.0 2 2.0 102 Croatia Centre Cyprus 35 35.0 10 10.0 11 11.0 42 42.0 1 1.0 1 1.0 0 0.0 0 0.0 100 Cyprus Centre Czechia 149 67.1 3 1.4 50 22.5 5 2.3 10 4.5 4 1.8 1 0.5 0 0.0 222 Czechia West Denmark 83 43.7 24 12.6 23 12.1 22 11.6 13 6.8 13 6.8 12 6.3 0 0.0 190 Denmark East Estonia 102 57.3 1 0.6 17 9.6 0 0.0 1 0.6 0 0.0 1 0.6 56 31.5 178 Estonia West Finland 54 36.2 3 2.0 30 20.1 22 14.8 6 4.0 13 8.7 8 5.4 13 8.7 149 Finland West France 1 343 27.3 64 1.3 145 2.9 1 226 24.9 298 6.1 73 1.5 158 3.2 1 616 32.8 4 923 France West Germany 1 614 52.2 91 2.9 390 12.6 391 12.6 123 4.0 120 3.9 72 2.3 292 9.4 3 093 Germany West Greece 353 58.5 16 2.7 71 11.8 118 19.6 4 0.7 17 2.8 16 2.7 8 1.3 603 Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 3 10.7 2 7.1 5 17.9 3 10.7 3 10.7 1 3.6 11 39.3 0 0.0 28 Iceland West Ireland 56 10.5 13 2.4 20 3.8 110 20.6 57 10.7 14 2.6 4 0.8 259 48.6 533 Ireland West Italy 1 884 74.4 12 0.5 141 5.6 214 8.5 191 7.5 36 1.4 41 1.6 12 0.5 2 531 Italy East Latvia – – – – – – – – – – – – – – – – – Latvia – Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 145 96.0 2 1.3 4 2.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 151 Lithuania West Luxembourg 14 29.2 10 20.8 3 6.3 15 31.3 3 6.3 1 2.1 1 2.1 1 2.1 48 Luxembourg West Malta 80 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 80 Malta West Netherlands 294 52.2 15 2.7 44 7.8 62 11.0 91 16.2 26 4.6 27 4.8 4 0.7 563 Netherlands West Norway 53 30.8 3 1.7 21 12.2 47 27.3 15 8.7 29 16.9 4 2.3 0 0.0 172 Norway Centre Poland 637 43.4 0 0.0 23 1.6 0 0.0 0 0.0 1 0.1 0 0.0 807 55.0 1 468 Poland West Portugal 420 54.0 15 1.9 12 1.5 172 22.1 137 17.6 4 0.5 1 0.1 17 2.2 778 Portugal Centre Romania 681 98.7 1 0.1 1 0.1 2 0.3 0 0.0 0 0.0 1 0.1 4 0.6 690 Romania Centre Slovakia 62 61.4 1 1.0 24 23.8 0 0.0 2 2.0 1 1.0 0 0.0 11 10.9 101 Slovakia Centre Slovenia 21 61.8 1 2.9 8 23.5 2 5.9 1 2.9 0 0.0 0 0.0 1 2.9 34 Slovenia West Spain 1 466 59.0 59 2.4 68 2.7 135 5.4 531 21.4 20 0.8 49 2.0 155 6.2 2 483 Spain West Sweden 90 20.0 33 7.3 63 14.0 158 35.2 39 8.7 35 7.8 22 4.9 9 2.0 449 Sweden West United Kingdom 1 354 32.9 307 7.5 349 8.5 856 20.8 327 7.9 259 6.3 94 2.3 570 13.8 4 116 United Kingdom Total EU/EEA 11 453 47.2 712 2.9 1 579 6.5 3 619 14.9 1 858 7.7 678 2.8 531 2.2 3 838 15.8 24 268 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 101 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 101 Albania West Andorra – – – – – – – – – – – – – – – – – Andorra East Armenia 446 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 446 Armenia East Azerbaijan 686 95.1 1 0.1 34 4.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 721 Azerbaijan East Belarus 2 134 99.9 0 0.0 3 0.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 137 Belarus Centre Bosnia and Herzegovina 26 86.7 0 0.0 1 3.3 0 0.0 2 6.7 0 0.0 1 3.3 0 0.0 30 Bosnia and Herzegovina East Georgia 667 99.9 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 668 Georgia West Israel 120 29.4 9 2.2 135 33.1 74 18.1 7 1.7 8 2.0 55 13.5 0 0.0 408 Israel East Kazakhstan 3 511 95.6 0 0.0 124 3.4 0 0.0 0 0.0 3 0.1 35 1.0 0 0.0 3 673 Kazakhstan East Kyrgyzstan 788 92.7 2 0.2 56 6.6 0 0.0 0 0.0 2 0.2 0 0.0 2 0.2 850 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 25 96.2 0 0.0 1 3.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 26 Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 922 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 922 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia 215 100.0 – – – – – – – – – – – – – – 215 Serbia Centre Serbia excluding Kosovo1 210 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 210 Serbia excluding Kosovo1 Centre Kosovo1 5 100.0 – – – – – – – – – – – – – – 5 Kosovo1 West Switzerland 161 38.2 67 15.9 17 4.0 36 8.6 32 7.6 22 5.2 9 2.1 77 18.3 421 Switzerland East Tajikistan 1 295 98.1 0 0.0 11 0.8 0 0.0 0 0.0 0 0.0 14 1.1 0 0.0 1 320 Tajikistan Centre Turkey 2 716 84.1 43 1.3 183 5.7 69 2.1 11 0.3 43 1.3 101 3.1 63 2.0 3 229 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 16 357 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 16 357 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 30 170 95.7 122 0.4 566 1.8 179 0.6 52 0.2 78 0.2 215 0.7 142 0.5 31 524 Total non-EU/EEA WHO European Region WHO European Region West West 9 567 43.9 764 3.5 1 583 7.3 3 676 16.9 1 880 8.6 700 3.2 589 2.7 3 034 13.9 21 793 West Centre Centre 5 003 76.1 64 1.0 312 4.7 122 1.9 29 0.4 51 0.8 107 1.6 888 13.5 6 576 Centre East East 27 053 98.7 6 0.0 250 0.9 0 0.0 1 0.0 5 0.0 50 0.2 58 0.2 27 423 East Total WHO European Region 41 623 74.6 834 1.5 2 145 3.8 3 798 6.8 1 910 3.4 756 1.4 746 1.3 3 980 7.1 55 792 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 74 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 11. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2019 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 5 719 59.6 434 4.5 547 5.7 269 2.8 1 284 13.4 325 3.4 257 2.7 763 7.9 9 598 Sex between men Injecting drug use 614 64.3 29 3.0 169 17.7 11 1.2 9 0.9 19 2.0 13 1.4 91 9.5 955 Injecting drug use Heterosexual contact 3 397 41.6 168 2.1 512 6.3 2 831 34.7 433 5.3 224 2.7 161 2.0 438 5.4 8 164 Heterosexual contact Mother-to-child 32 19.2 7 4.2 7 4.2 94 56.3 4 2.4 3 1.8 8 4.8 12 7.2 167 Mother-to-child Haemophiliac/transfusion recipient 5 9.6 2 3.8 7 13.5 23 44.2 2 3.8 8 15.4 3 5.8 2 3.8 52 Haemophiliac/transfusion recipient Nosocomial infection 5 23.8 – – 9 42.9 3 14.3 1 4.8 2 9.5 – – 1 4.8 21 Nosocomial infection Other/undetermined 1 681 28.8 72 1.2 328 5.6 388 6.6 125 2.1 97 1.7 89 1.5 3 064 52.4 5 844 Other/undetermined Total EU/EEA 11 453 46.2 712 2.9 1 579 6.4 3 619 14.6 1 858 7.5 678 2.7 531 2.1 4 371 17.6 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Sex between men 1 883 92.0 38 1.9 39 1.9 4 0.2 22 1.1 13 0.6 32 1.6 16 0.8 2 047 Sex between men Injecting drug use 6 287 98.9 4 0.1 58 0.9 1 0.0 – – 4 0.1 – – 6 354 Injecting drug use Heterosexual contact 19 626 97.6 21 0.1 243 1.2 104 0.5 13 0.1 26 0.1 52 0.3 24 0.1 20 109 Heterosexual contact Mother-to-child 220 94.0 – – 12 5.1 1 0.4 – – – – – – 1 0.4 234 Mother-to-child Haemophiliac/transfusion recipient 4 66.7 – – – – 1 16.7 – – – – 1 16.7 – – 6 Haemophiliac/transfusion recipient Nosocomial infection 12 80.0 – – 3 20.0 – – – – – – – – 15 Nosocomial infection Other/undetermined 2 138 77.5 59 2.1 211 7.6 69 2.5 16 0.6 39 1.4 126 4.6 101 3.7 2 759 Other/undetermined Total non-EU/EEA 30 170 95.7 122 0.4 566 1.8 179 0.6 52 0.2 78 0.2 215 0.7 142 0.5 31 524 Total non-EU/EEA West West Sex between men 5 180 59.5 455 5.2 526 6.0 270 3.1 1 290 14.8 326 3.7 262 3.0 394 4.5 8 703 Sex between men Injecting drug use 444 60.1 30 4.1 175 23.7 11 1.5 10 1.4 19 2.6 13 1.8 37 5.0 739 Injecting drug use Heterosexual contact 2 736 36.8 187 2.5 525 7.1 2 877 38.7 440 5.9 238 3.2 170 2.3 258 3.5 7 431 Heterosexual contact Mother-to-child 18 12.0 7 4.7 7 4.7 94 62.7 4 2.7 3 2.0 8 5.3 9 6.0 150 Mother-to-child Haemophiliac/transfusion recipient 4 8.3 1 2.1 6 12.5 22 45.8 2 4.2 8 16.7 3 6.3 2 4.2 48 Haemophiliac/transfusion recipient Nosocomial infection 4 23.5 – – 6 35.3 3 17.6 1 5.9 2 11.8 – – 1 5.9 17 Nosocomial infection Other/undetermined 1 181 25.1 84 1.8 338 7.2 399 8.5 133 2.8 104 2.2 133 2.8 2 333 49.6 4 705 Other/undetermined Total West 9 567 43.9 764 3.5 1 583 7.3 3 676 16.9 1 880 8.6 700 3.2 589 2.7 3 034 13.9 21 793 Total West Centre Centre Sex between men 1 380 74.1 17 0.9 45 2.4 3 0.2 16 0.9 12 0.6 23 1.2 367 19.7 1 863 Sex between men Injecting drug use 128 87.7 2 1.4 7 4.8 – – – – – – – – 9 6.2 146 Injecting drug use Heterosexual contact 1 482 85.7 2 0.1 78 4.5 58 3.4 5 0.3 8 0.5 12 0.7 85 4.9 1 730 Heterosexual contact Mother-to-child 24 66.7 – – 9 25.0 1 2.8 – – – – 2 5.6 36 Mother-to-child Haemophiliac/transfusion recipient 1 16.7 1 16.7 1 16.7 2 33.3 – – – – 1 16.7 – – 6 Haemophiliac/transfusion recipient Nosocomial infection 1 25.0 – – 3 75.0 – – – – – – – – – – 4 Nosocomial infection Other/undetermined 1 987 65.6 42 1.4 169 5.6 58 1.9 8 0.3 31 1.0 71 2.3 663 21.9 3 029 Other/undetermined Total Centre 5 003 73.4 64 0.9 312 4.6 122 1.8 29 0.4 51 0.7 107 1.6 1 126 16.5 6 814 Total Centre East East Sex between men 1 042 96.6 – – 15 1.4 – – – – – – 4 0.4 18 1.7 1 079 Sex between men Injecting drug use 6 329 98.5 1 0.0 45 0.7 – – – – – – 4 0.1 45 0.7 6 424 Injecting drug use Heterosexual contact 18 805 98.4 – – 152 0.8 – – 1 0.0 4 0.0 31 0.2 119 0.6 19 112 Heterosexual contact Mother-to-child 210 97.7 – – 3 1.4 – – – – – – – – 2 0.9 215 Mother-to-child Haemophiliac/transfusion recipient 4 100.0 – – – – – – – – – – – – – – 4 Haemophiliac/transfusion recipient Nosocomial infection 12 80.0 – – 3 20.0 – – – – – – – – – – 15 Nosocomial infection Other/undetermined 651 74.9 5 0.6 32 3.7 – – 1 0.1 11 1.3 169 19.4 869 Other/undetermined Total East 27 053 97.6 6 0.0 250 0.9 0 0.0 1 0.0 5 0.0 50 0.2 353 1.3 27 718 Total East Total WHO European Region 83 246 73.9 1 668 1.5 4 290 3.8 7 596 6.7 3 820 3.4 1 512 1.3 1 492 1.3 9 026 8.0 112 650 Total WHO European Region 75 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 11. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2019 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 5 719 59.6 434 4.5 547 5.7 269 2.8 1 284 13.4 325 3.4 257 2.7 763 7.9 9 598 Sex between men Injecting drug use 614 64.3 29 3.0 169 17.7 11 1.2 9 0.9 19 2.0 13 1.4 91 9.5 955 Injecting drug use Heterosexual contact 3 397 41.6 168 2.1 512 6.3 2 831 34.7 433 5.3 224 2.7 161 2.0 438 5.4 8 164 Heterosexual contact Mother-to-child 32 19.2 7 4.2 7 4.2 94 56.3 4 2.4 3 1.8 8 4.8 12 7.2 167 Mother-to-child Haemophiliac/transfusion recipient 5 9.6 2 3.8 7 13.5 23 44.2 2 3.8 8 15.4 3 5.8 2 3.8 52 Haemophiliac/transfusion recipient Nosocomial infection 5 23.8 – – 9 42.9 3 14.3 1 4.8 2 9.5 – – 1 4.8 21 Nosocomial infection Other/undetermined 1 681 28.8 72 1.2 328 5.6 388 6.6 125 2.1 97 1.7 89 1.5 3 064 52.4 5 844 Other/undetermined Total EU/EEA 11 453 46.2 712 2.9 1 579 6.4 3 619 14.6 1 858 7.5 678 2.7 531 2.1 4 371 17.6 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Sex between men 1 883 92.0 38 1.9 39 1.9 4 0.2 22 1.1 13 0.6 32 1.6 16 0.8 2 047 Sex between men Injecting drug use 6 287 98.9 4 0.1 58 0.9 1 0.0 – – 4 0.1 – – 6 354 Injecting drug use Heterosexual contact 19 626 97.6 21 0.1 243 1.2 104 0.5 13 0.1 26 0.1 52 0.3 24 0.1 20 109 Heterosexual contact Mother-to-child 220 94.0 – – 12 5.1 1 0.4 – – – – – – 1 0.4 234 Mother-to-child Haemophiliac/transfusion recipient 4 66.7 – – – – 1 16.7 – – – – 1 16.7 – – 6 Haemophiliac/transfusion recipient Nosocomial infection 12 80.0 – – 3 20.0 – – – – – – – – 15 Nosocomial infection Other/undetermined 2 138 77.5 59 2.1 211 7.6 69 2.5 16 0.6 39 1.4 126 4.6 101 3.7 2 759 Other/undetermined Total non-EU/EEA 30 170 95.7 122 0.4 566 1.8 179 0.6 52 0.2 78 0.2 215 0.7 142 0.5 31 524 Total non-EU/EEA West West Sex between men 5 180 59.5 455 5.2 526 6.0 270 3.1 1 290 14.8 326 3.7 262 3.0 394 4.5 8 703 Sex between men Injecting drug use 444 60.1 30 4.1 175 23.7 11 1.5 10 1.4 19 2.6 13 1.8 37 5.0 739 Injecting drug use Heterosexual contact 2 736 36.8 187 2.5 525 7.1 2 877 38.7 440 5.9 238 3.2 170 2.3 258 3.5 7 431 Heterosexual contact Mother-to-child 18 12.0 7 4.7 7 4.7 94 62.7 4 2.7 3 2.0 8 5.3 9 6.0 150 Mother-to-child Haemophiliac/transfusion recipient 4 8.3 1 2.1 6 12.5 22 45.8 2 4.2 8 16.7 3 6.3 2 4.2 48 Haemophiliac/transfusion recipient Nosocomial infection 4 23.5 – – 6 35.3 3 17.6 1 5.9 2 11.8 – – 1 5.9 17 Nosocomial infection Other/undetermined 1 181 25.1 84 1.8 338 7.2 399 8.5 133 2.8 104 2.2 133 2.8 2 333 49.6 4 705 Other/undetermined Total West 9 567 43.9 764 3.5 1 583 7.3 3 676 16.9 1 880 8.6 700 3.2 589 2.7 3 034 13.9 21 793 Total West Centre Centre Sex between men 1 380 74.1 17 0.9 45 2.4 3 0.2 16 0.9 12 0.6 23 1.2 367 19.7 1 863 Sex between men Injecting drug use 128 87.7 2 1.4 7 4.8 – – – – – – – – 9 6.2 146 Injecting drug use Heterosexual contact 1 482 85.7 2 0.1 78 4.5 58 3.4 5 0.3 8 0.5 12 0.7 85 4.9 1 730 Heterosexual contact Mother-to-child 24 66.7 – – 9 25.0 1 2.8 – – – – 2 5.6 36 Mother-to-child Haemophiliac/transfusion recipient 1 16.7 1 16.7 1 16.7 2 33.3 – – – – 1 16.7 – – 6 Haemophiliac/transfusion recipient Nosocomial infection 1 25.0 – – 3 75.0 – – – – – – – – – – 4 Nosocomial infection Other/undetermined 1 987 65.6 42 1.4 169 5.6 58 1.9 8 0.3 31 1.0 71 2.3 663 21.9 3 029 Other/undetermined Total Centre 5 003 73.4 64 0.9 312 4.6 122 1.8 29 0.4 51 0.7 107 1.6 1 126 16.5 6 814 Total Centre East East Sex between men 1 042 96.6 – – 15 1.4 – – – – – – 4 0.4 18 1.7 1 079 Sex between men Injecting drug use 6 329 98.5 1 0.0 45 0.7 – – – – – – 4 0.1 45 0.7 6 424 Injecting drug use Heterosexual contact 18 805 98.4 – – 152 0.8 – – 1 0.0 4 0.0 31 0.2 119 0.6 19 112 Heterosexual contact Mother-to-child 210 97.7 – – 3 1.4 – – – – – – – – 2 0.9 215 Mother-to-child Haemophiliac/transfusion recipient 4 100.0 – – – – – – – – – – – – – – 4 Haemophiliac/transfusion recipient Nosocomial infection 12 80.0 – – 3 20.0 – – – – – – – – – – 15 Nosocomial infection Other/undetermined 651 74.9 5 0.6 32 3.7 – – 1 0.1 11 1.3 169 19.4 869 Other/undetermined Total East 27 053 97.6 6 0.0 250 0.9 0 0.0 1 0.0 5 0.0 50 0.2 353 1.3 27 718 Total East Total WHO European Region 83 246 73.9 1 668 1.5 4 290 3.8 7 596 6.7 3 820 3.4 1 512 1.3 1 492 1.3 9 026 8.0 112 650 Total WHO European Region 76 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 12. New HIV diagnoses, by country of report and probable region of infection, in 2019, 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 11 4.9 0 0.0 0 0.0 2 0.9 2 0.9 2 0.9 0 0.0 208 92.4 225 Austria West Belgium – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria – – – – – – – – – – – – – – – – – Bulgaria Centre Croatia – – – – – – – – – – – – – – – – – Croatia Centre Cyprus 26 26.0 14 14.0 6 6.0 40 40.0 1 1.0 1 1.0 0 0.0 12 12.0 100 Cyprus Centre Czechia 38 17.1 7 3.2 15 6.8 7 3.2 4 1.8 5 2.3 2 0.9 144 64.9 222 Czechia West Denmark 72 37.9 22 11.6 17 8.9 25 13.2 9 4.7 21 11.1 8 4.2 16 8.4 190 Denmark East Estonia 109 61.2 2 1.1 8 4.5 0 0.0 1 0.6 0 0.0 1 0.6 57 32.0 178 Estonia West Finland 26 17.4 12 8.1 30 20.1 20 13.4 2 1.3 20 13.4 6 4.0 33 22.1 149 Finland West France 1 094 22.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 829 77.8 4 923 France West Germany 1 615 52.2 57 1.8 194 6.3 275 8.9 60 1.9 85 2.7 37 1.2 770 24.9 3 093 Germany West Greece – – – – – – – – – – – – – – – – – Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 3 10.7 1 3.6 4 14.3 4 14.3 3 10.7 0 0.0 0 0.0 13 46.4 28 Iceland West Ireland 57 10.7 15 2.8 10 1.9 45 8.4 30 5.6 9 1.7 5 0.9 362 67.9 533 Ireland West Italy – – – – – – – – – – – – – – – – – Italy East Latvia 140 47.5 3 1.0 3 1.0 0 0.0 0 0.0 0 0.0 0 0.0 149 50.5 295 Latvia – Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 0 0.0 2 1.3 4 2.6 0 0.0 0 0.0 0 0.0 0 0.0 145 96.0 151 Lithuania West Luxembourg 20 41.7 3 6.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 25 52.1 48 Luxembourg West Malta – – – – – – – – – – – – – – – – – Malta West Netherlands 298 52.9 8 1.4 17 3.0 28 5.0 17 3.0 24 4.3 10 1.8 161 28.6 563 Netherlands West Norway 28 0.0 13 7.6 20 11.6 46 26.7 16 9.3 39 22.7 6 3.5 4 18.6 172 Norway Centre Poland – – – – – – – – – – – – – – – – – Poland West Portugal 413 53.1 11 1.4 3 0.4 100 12.9 50 6.4 2 0.3 2 0.3 197 25.3 778 Portugal Centre Romania 681 98.7 1 0.1 1 0.1 2 0.3 0 0.0 0 0.0 1 0.1 4 0.6 690 Romania Centre Slovakia 0 0.0 5 5.0 17 16.8 0 0.0 0 0.0 1 1.0 0 0.0 78 77.2 101 Slovakia Centre Slovenia 17 50.0 0 0.0 6 17.6 2 5.9 2 5.9 0 0.0 0 0.0 7 20.6 34 Slovenia West Spain – – – – – – – – – – – – – – – – – Spain West Sweden 78 17.4 38 8.5 57 12.7 147 32.7 34 7.6 52 11.6 19 4.2 24 5.3 449 Sweden West United Kingdom 1 554 37.8 249 6.0 187 4.5 607 14.7 172 4.2 235 5.7 114 2.8 998 24.2 4 116 United Kingdom Total EU/EEA 6 280 36.9 463 2.7 599 3.5 1 350 7.9 403 2.4 496 2.9 211 1.2 7 236 42.5 17 038 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 101 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 101 Albania West Andorra – – – – – – – – – – – – – – – – – Andorra East Armenia 206 46.2 0 0.0 227 50.9 0 0.0 0 0.0 0 0.0 2 0.4 11 2.5 446 Armenia East Azerbaijan 436 60.5 1 0.1 210 29.1 0 0.0 0 0.0 0 0.0 1 0.1 73 10.1 721 Azerbaijan East Belarus 2 137 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 137 Belarus Centre Bosnia and Herzegovina 18 60.0 3 10.0 3 10.0 1 3.3 2 6.7 0 0.0 1 3.3 2 6.7 30 Bosnia and Herzegovina East Georgia 348 52.1 17 2.5 122 18.3 1 0.1 0 0.0 3 0.4 5 0.7 172 25.7 668 Georgia West Israel 191 46.8 5 1.2 87 21.3 51 12.5 4 1.0 7 1.7 6 1.5 57 14.0 408 Israel East Kazakhstan 3 511 95.6 0 0.0 124 3.4 0 0.0 0 0.0 3 0.1 0 0.0 35 1.0 3 673 Kazakhstan East Kyrgyzstan 788 92.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 62 7.3 850 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro – – – – – – – – – – – – – – – – – Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 922 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 922 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia – – – – – – – – – – – – – – – – – Serbia Centre Serbia excluding Kosovo1 – – – – – – – – – – – – – – – – – Serbia excluding Kosovo1 Centre Kosovo1 – – – – – – – – – – – – – – – – – Kosovo1 West Switzerland 128 30.4 24 5.7 9 2.1 31 7.4 18 4.3 20 4.8 7 1.7 184 43.7 421 Switzerland East Tajikistan – – – – – – – – – – – – – – – – – Tajikistan Centre Turkey – – – – – – – – – – – – – – – – – Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine – – – – – – – – – – – – – – – – – Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 8 786 84.7 50 0.5 782 7.5 84 0.8 24 0.2 33 0.3 22 0.2 596 5.7 10 377 Total non-EU/EEA WHO European Region WHO European Region West West 5 588 34.7 458 2.8 635 3.9 1 381 8.6 417 2.6 516 3.2 220 1.4 6 881 42.8 16 096 West Centre Centre 881 68.9 30 2.3 48 3.8 52 4.1 9 0.7 7 0.5 4 0.3 247 19.3 1 278 Centre East East 8 597 85.6 25 0.2 698 7.0 1 0.0 1 0.0 6 0.1 9 0.1 704 7.0 10 041 East Total WHO European Region 15 066 55.0 513 1.9 1 381 5.0 1 434 5.2 427 1.6 529 1.9 233 0.8 7 832 28.6 27 415 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 77 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 12. New HIV diagnoses, by country of report and probable region of infection, in 2019, 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 11 4.9 0 0.0 0 0.0 2 0.9 2 0.9 2 0.9 0 0.0 208 92.4 225 Austria West Belgium – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria – – – – – – – – – – – – – – – – – Bulgaria Centre Croatia – – – – – – – – – – – – – – – – – Croatia Centre Cyprus 26 26.0 14 14.0 6 6.0 40 40.0 1 1.0 1 1.0 0 0.0 12 12.0 100 Cyprus Centre Czechia 38 17.1 7 3.2 15 6.8 7 3.2 4 1.8 5 2.3 2 0.9 144 64.9 222 Czechia West Denmark 72 37.9 22 11.6 17 8.9 25 13.2 9 4.7 21 11.1 8 4.2 16 8.4 190 Denmark East Estonia 109 61.2 2 1.1 8 4.5 0 0.0 1 0.6 0 0.0 1 0.6 57 32.0 178 Estonia West Finland 26 17.4 12 8.1 30 20.1 20 13.4 2 1.3 20 13.4 6 4.0 33 22.1 149 Finland West France 1 094 22.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 829 77.8 4 923 France West Germany 1 615 52.2 57 1.8 194 6.3 275 8.9 60 1.9 85 2.7 37 1.2 770 24.9 3 093 Germany West Greece – – – – – – – – – – – – – – – – – Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 3 10.7 1 3.6 4 14.3 4 14.3 3 10.7 0 0.0 0 0.0 13 46.4 28 Iceland West Ireland 57 10.7 15 2.8 10 1.9 45 8.4 30 5.6 9 1.7 5 0.9 362 67.9 533 Ireland West Italy – – – – – – – – – – – – – – – – – Italy East Latvia 140 47.5 3 1.0 3 1.0 0 0.0 0 0.0 0 0.0 0 0.0 149 50.5 295 Latvia – Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 0 0.0 2 1.3 4 2.6 0 0.0 0 0.0 0 0.0 0 0.0 145 96.0 151 Lithuania West Luxembourg 20 41.7 3 6.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 25 52.1 48 Luxembourg West Malta – – – – – – – – – – – – – – – – – Malta West Netherlands 298 52.9 8 1.4 17 3.0 28 5.0 17 3.0 24 4.3 10 1.8 161 28.6 563 Netherlands West Norway 28 0.0 13 7.6 20 11.6 46 26.7 16 9.3 39 22.7 6 3.5 4 18.6 172 Norway Centre Poland – – – – – – – – – – – – – – – – – Poland West Portugal 413 53.1 11 1.4 3 0.4 100 12.9 50 6.4 2 0.3 2 0.3 197 25.3 778 Portugal Centre Romania 681 98.7 1 0.1 1 0.1 2 0.3 0 0.0 0 0.0 1 0.1 4 0.6 690 Romania Centre Slovakia 0 0.0 5 5.0 17 16.8 0 0.0 0 0.0 1 1.0 0 0.0 78 77.2 101 Slovakia Centre Slovenia 17 50.0 0 0.0 6 17.6 2 5.9 2 5.9 0 0.0 0 0.0 7 20.6 34 Slovenia West Spain – – – – – – – – – – – – – – – – – Spain West Sweden 78 17.4 38 8.5 57 12.7 147 32.7 34 7.6 52 11.6 19 4.2 24 5.3 449 Sweden West United Kingdom 1 554 37.8 249 6.0 187 4.5 607 14.7 172 4.2 235 5.7 114 2.8 998 24.2 4 116 United Kingdom Total EU/EEA 6 280 36.9 463 2.7 599 3.5 1 350 7.9 403 2.4 496 2.9 211 1.2 7 236 42.5 17 038 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 101 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 101 Albania West Andorra – – – – – – – – – – – – – – – – – Andorra East Armenia 206 46.2 0 0.0 227 50.9 0 0.0 0 0.0 0 0.0 2 0.4 11 2.5 446 Armenia East Azerbaijan 436 60.5 1 0.1 210 29.1 0 0.0 0 0.0 0 0.0 1 0.1 73 10.1 721 Azerbaijan East Belarus 2 137 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 137 Belarus Centre Bosnia and Herzegovina 18 60.0 3 10.0 3 10.0 1 3.3 2 6.7 0 0.0 1 3.3 2 6.7 30 Bosnia and Herzegovina East Georgia 348 52.1 17 2.5 122 18.3 1 0.1 0 0.0 3 0.4 5 0.7 172 25.7 668 Georgia West Israel 191 46.8 5 1.2 87 21.3 51 12.5 4 1.0 7 1.7 6 1.5 57 14.0 408 Israel East Kazakhstan 3 511 95.6 0 0.0 124 3.4 0 0.0 0 0.0 3 0.1 0 0.0 35 1.0 3 673 Kazakhstan East Kyrgyzstan 788 92.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 62 7.3 850 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro – – – – – – – – – – – – – – – – – Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 922 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 922 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia – – – – – – – – – – – – – – – – – Serbia Centre Serbia excluding Kosovo1 – – – – – – – – – – – – – – – – – Serbia excluding Kosovo1 Centre Kosovo1 – – – – – – – – – – – – – – – – – Kosovo1 West Switzerland 128 30.4 24 5.7 9 2.1 31 7.4 18 4.3 20 4.8 7 1.7 184 43.7 421 Switzerland East Tajikistan – – – – – – – – – – – – – – – – – Tajikistan Centre Turkey – – – – – – – – – – – – – – – – – Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine – – – – – – – – – – – – – – – – – Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 8 786 84.7 50 0.5 782 7.5 84 0.8 24 0.2 33 0.3 22 0.2 596 5.7 10 377 Total non-EU/EEA WHO European Region WHO European Region West West 5 588 34.7 458 2.8 635 3.9 1 381 8.6 417 2.6 516 3.2 220 1.4 6 881 42.8 16 096 West Centre Centre 881 68.9 30 2.3 48 3.8 52 4.1 9 0.7 7 0.5 4 0.3 247 19.3 1 278 Centre East East 8 597 85.6 25 0.2 698 7.0 1 0.0 1 0.0 6 0.1 9 0.1 704 7.0 10 041 East Total WHO European Region 15 066 55.0 513 1.9 1 381 5.0 1 434 5.2 427 1.6 529 1.9 233 0.8 7 832 28.6 27 415 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 78 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 13. Percentage of new HIV diagnoses (2019) among persons > 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 Sex between menb EU/EEA West Austria 221 98.7 66 29.9 110 49.8 65.2 26.3 42.0 West Belgium – – – – – – – – – Centre Bulgaria 230 89.5 90 39.1 142 61.7 69.8 71.4 53.4 Centre Croatia 4 3.9 1 25.0 2 50.0 – – – Centre Cyprus 93 93.9 84 90.3 85 91.4 91.3 – 91.4 Centre Czechia 210 95.0 51 24.3 84 40.0 55.4 – 31.8 West Denmarkc 134 92.4 42 31.3 80 59.7 68.3 – 54.2 East Estonia 47 26.4 12 25.5 26 55.3 60.0 50.0 – West Finland 115 77.7 37 32.2 57 49.6 56.1 62.5 41.7 West France 2 555 52.4 679 26.6 1 290 50.5 56.0 41.9 41.2 West Germany 894 29.1 320 35.8 499 55.8 62.1 40.0 50.1 West Greece 424 70.9 144 34.0 233 55.0 63.5 52.4 46.4 Centre Hungary – – – – – – – – – West Iceland 20 74.1 4 20.0 4 20.0 – – – West Irelandc 72 16.9 14 19.4 30 41.7 43.3 – 37.0 West Italy 2 221 88.0 883 39.8 1 306 58.8 64.6 60.4 50.9 East Latvia 46 15.7 24 52.2 32 69.6 73.1 40.0 83.3 – Liechtenstein – – – – – – – – – East Lithuania 106 70.2 32 30.2 49 46.2 64.2 25.0 26.3 West Luxembourg 33 71.7 3 9.1 12 36.4 31.3 41.2 West Malta – – – – – – – – – West Netherlands 513 92.3 139 27.1 241 47.0 57.0 – 37.7 West Norway – – – – – – – – – Centre Poland – – – – – – – – – West Portugal 608 78.1 178 29.3 291 47.9 56.5 41.7 34.9 Centre Romania 662 97.5 263 39.7 416 62.8 67.5 69.8 49.7 Centre Slovakia 36 35.6 8 22.2 10 27.8 50.0 – 12.5 Centre Slovenia 29 85.3 10 34.5 15 51.7 66.7 – 41.2 West Spain 2 172 87.5 555 25.6 1 005 46.3 53.2 60.7 41.6 West Sweden 356 81.3 85 23.9 151 42.4 51.4 42.9 29.4 West United Kingdom 3 478 84.9 786 22.6 1 428 41.1 48.3 39.1 33.3 Total EU/EEA 15 279 67.7 4 510 29.5 7 598 49.7 57.0 51.5 41.6 Non-EU/EEA Centre Albania 40 40.0 22 55.0 30 75.0 78.9 – – West Andorra – – – – – – – – – East Armenia 395 89.4 144 36.5 231 58.5 61.4 54.8 39.5 East Azerbaijan 563 79.0 168 29.8 277 49.2 49.7 60.0 30.2 East Belarus 1 817 85.6 426 23.4 795 43.8 44.1 43.1 36.3 Centre Bosnia and Herzegovina 28 93.3 10 35.7 15 53.6 55.6 52.6 East Georgia 595 89.5 200 33.6 338 56.8 57.8 67.7 42.4 West Israel 230 56.9 63 27.4 109 47.4 55.5 58.3 34.8 East Kazakhstan 2 740 75.2 587 21.4 1 286 46.9 52.0 37.8 40.7 East Kyrgyzstan 564 68.9 166 29.4 306 54.3 53.8 65.7 35.5 West Monaco – – – – – – – – – Centre Montenegro 22 84.6 8 36.4 14 63.6 53.8 Centre North Macedonia – – – – – – – – – East Republic of Moldova 736 81.4 220 29.9 384 52.2 53.4 44.7 34.5 East Russian Federation – – – – – – – – – West San Marino – – – – – – – – – Centre Serbia 191 89.7 74 38.7 115 60.2 77.8 – 55.7 Centre Serbia excluding Kosovo1 188 90.4 73 38.8 113 60.1 76.5 – 55.8 Centre Kosovo1 3 60.0 1 33.3 2 66.7 – – – West Switzerland 275 65.5 89 32.4 148 53.8 54.8 90.0 43.8 East Tajikistan 591 52.0 194 32.8 340 57.5 56.7 67.2 60.0 Centre Turkey 489 15.2 87 17.8 209 42.7 49.4 – 38.3 East Turkmenistan – – – – – – – – – East Ukraine 14 941 91.9 5 251 35.1 8 817 59.0 61.1 54.4 48.1 East Uzbekistan – – – – – – – – – Total non-EU/EEA 24 217 77.8 7 709 31.8 13 414 55.4 57.6 51.8 43.9 WHO European Region West West 14 321 67.3 4 087 28.5 6 994 48.8 55.5 49.4 41.1 Centre Centre 2 034 40.1 708 34.8 1 137 55.9 64.9 72.5 47.3 East East 23 141 84.7 7 424 32.1 12 881 55.7 57.7 51.5 43.2 Total WHO European Region 39 496 73.6 12 219 30.9 21 012 53.2 57.5 51.7 42.0 a Country-specific comments are in Annex 5. b There is some variation by country for CD4 cell count completeness by transmission group and numbers of cases by transmission group (sex between men, heterosexual, injecting drug user) and therefore percentages based on five or fewer cases are censored. c 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999).

80 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 14. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 82 1.0 79 0.9 101 1.2 69 0.8 83 1.0 76 0.9 65 0.7 61 0.7 53 0.6 56 0.6 3 307 Austria West Belgium 1983 121 1.1 99 0.9 107 1.0 100 0.9 120 1.1 95 0.8 62 0.5 50 0.4 49 0.4 – – 5 019 Belgium Centre Bulgaria 1987 32 0.4 40 0.5 65 0.9 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 57 0.8 68 1.0 790 Bulgaria Centre Croatia 1986 1 0.0 26 0.6 28 0.7 17 0.4 23 0.5 16 0.4 22 0.5 20 0.5 30 0.7 20 0.5 511 Croatia Centre Cyprus 1986 11 1.3 12 1.4 11 1.3 9 1.0 11 1.3 13 1.5 22 2.6 15 1.8 13 1.5 3 0.3 344 Cyprus Centre Czechia 1986 28 0.3 29 0.3 36 0.3 33 0.3 32 0.3 38 0.4 44 0.4 54 0.5 39 0.4 38 0.4 676 Czechia West Denmark 1980 44 0.8 59 1.1 41 0.7 38 0.7 30 0.5 40 0.7 24 0.4 28 0.5 26 0.4 22 0.4 3 037 Denmark East Estonia 1992 26 2.0 38 2.9 36 2.7 26 2.0 18 1.4 18 1.4 40 3.0 20 1.5 25 1.9 28 2.1 565 Estonia West Finland 1983 31 0.6 24 0.4 19 0.4 20 0.4 20 0.4 18 0.3 30 0.5 18 0.3 21 0.4 18 0.3 742 Finland West France 1982 990 1.5 869 1.3 834 1.3 721 1.1 652 1.0 603 0.9 510 0.8 491 0.7 522 0.8 430 0.6 72 907 France West Germany 1981 527 0.6 518 0.6 511 0.6 441 0.5 393 0.5 362 0.4 310 0.4 295 0.4 242 0.3 74 0.1 32 203 Germany West Greece 1981 103 0.9 102 0.9 123 1.1 140 1.3 128 1.2 139 1.3 139 1.3 120 1.1 102 0.9 86 0.8 4 097 Greece Centre Hungary 1986 28 0.3 32 0.3 48 0.5 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 57 0.6 53 0.5 1 054 Hungary West Iceland 1985 1 0.3 2 0.6 1 0.3 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 2 0.6 4 1.1 77 Iceland West Ireland 1983 38 0.8 47 1.0 38 0.8 30 0.7 33 0.7 21 0.4 14 0.3 21 0.4 14 0.3 6 0.1 1 305 Ireland West Italy 1982 1 149 1.9 1 058 1.8 1 074 1.8 1 078 1.8 931 1.5 872 1.4 873 1.4 800 1.3 716 1.2 571 0.9 71 204 Italy East Latvia 1990 132 6.2 112 5.4 142 6.9 133 6.6 171 8.5 132 6.6 114 5.8 118 6.1 99 5.1 90 4.7 2 077 Latvia – Liechtenstein 1989 0 0.0 1 2.8 1 2.7 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 Liechtenstein East Lithuania 1988 33 1.1 21 0.7 38 1.3 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 37 1.3 21 0.8 610 Lithuania West Luxembourg 1983 8 1.6 12 2.3 8 1.5 11 2.0 9 1.6 10 1.8 12 2.1 6 1.0 4 0.7 3 0.5 334 Luxembourg West Malta 1986 6 1.4 5 1.2 6 1.4 1 0.2 4 0.9 2 0.5 5 1.1 0 0.0 0 0.0 0 0.0 114 Malta West Netherlands 1999 323 1.9 268 1.6 298 1.8 270 1.6 220 1.3 250 1.5 204 1.2 187 1.1 168 1.0 93 0.5 7 575 Netherlands West Norway 1983 22 0.5 19 0.4 25 0.5 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 12 0.2 19 0.4 1 203 Norway Centre Poland 1986 173 0.5 184 0.5 157 0.4 162 0.4 148 0.4 128 0.3 102 0.3 109 0.3 111 0.3 85 0.2 3 771 Poland West Portugal 1985 767 7.3 654 6.2 625 5.9 525 5.0 382 3.7 340 3.3 375 3.6 296 2.9 256 2.5 172 1.7 22 835 Portugal Centre Romania 1985 258 1.3 336 1.7 339 1.7 361 1.8 411 2.1 358 1.8 340 1.7 323 1.6 301 1.5 282 1.5 10 581 Romania Centre Slovakia 1985 2 0.0 4 0.1 7 0.1 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 11 0.2 3 0.1 119 Slovakia Centre Slovenia 1986 7 0.3 15 0.7 12 0.6 11 0.5 17 0.8 11 0.5 10 0.5 7 0.3 10 0.5 7 0.3 276 Slovenia West Spain 1981 1 456 3.1 1 293 2.8 1 175 2.5 858 1.8 678 1.6 607 1.8 539 1.6 510 1.5 367 1.1 251 0.6 88 141 Spain West Sweden 1982 – – – – – – – – – – – – – – – – – – – – 2 170 Sweden West United Kingdom 1981 665 1.1 419 0.7 435 0.7 347 0.5 370 0.6 404 0.6 301 0.5 264 0.4 255 0.4 269 0.4 30 234 United Kingdom Total EU/EEA 7 064 1.4 6 377 1.3 6 341 1.2 5 593 1.1 5 086 1.0 4 706 1.0 4 336 0.9 3 991 0.8 3 599 0.7 2 772 0.5 367 890 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 26 0.9 46 1.6 49 1.7 65 2.2 50 1.7 65 2.2 58 2.0 33 1.1 47 1.6 40 1.4 649 Albania West Andorra 2004 0 0.0 1 1.2 0 0.0 3 3.7 0 0.0 3 3.8 0 0.0 2 2.6 0 0.0 – – 15 Andorra East Armenia 1988 94 3.3 87 3.0 136 4.7 144 5.0 174 6.0 163 5.6 163 5.6 144 4.9 211 7.1 173 5.8 1 866 Armenia East Azerbaijan 1995 250 2.8 195 2.1 235 2.5 189 2.0 200 2.1 193 2.0 161 1.7 168 1.7 182 1.8 196 2.0 2 524 Azerbaijan East Belarus 1991 475 5.0 590 6.3 598 6.4 547 5.8 474 5.0 490 5.2 512 5.4 439 4.6 382 4.0 380 4.0 6 841 Belarus Centre Bosnia and Herzegovina 1986 6 0.2 7 0.2 4 0.1 7 0.2 7 0.2 7 0.2 7 0.2 4 0.1 11 0.3 8 0.2 171 Bosnia and Herzegovina East Georgia 1989 339 8.3 395 9.7 359 8.8 303 7.5 268 6.6 270 6.7 269 6.7 257 6.4 273 6.8 265 6.6 4 266 Georgia West Israel 1981 40 0.5 55 0.7 52 0.7 47 0.6 70 0.9 45 0.6 46 0.6 33 0.4 37 0.4 23 0.3 1 739 Israel East Kazakhstan 1993 252 1.6 241 1.5 237 1.4 258 1.5 250 1.4 272 1.5 348 2.0 361 2.0 433 2.4 441 2.4 4 102 Kazakhstan East Kyrgyzstan 1999 130 2.4 90 1.6 88 1.6 67 1.2 85 1.5 125 2.1 72 1.2 59 1.0 56 0.9 46 0.7 1 040 Kyrgyzstan West Monaco 1985 0 0.0 0 0.0 0 0.0 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 – – 51 Monaco Centre Montenegro 1990 8 1.3 2 0.3 7 1.1 7 1.1 7 1.1 11 1.8 15 2.4 13 2.1 14 2.2 10 1.6 162 Montenegro Centre North Macedonia 1989 6 0.3 8 0.4 10 0.5 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 4 0.2 – – 170 North Macedonia East Republic of Moldova 1989 340 8.3 449 11.0 250 6.1 378 9.3 299 7.3 293 7.2 366 9.0 274 6.7 365 9.0 285 7.0 4 437 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 Russian Federation West San Marino 1986 0 0.0 1 3.2 2 6.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 San Marino Centre Serbia 1985 52 0.6 60 0.7 57 0.6 49 0.5 49 0.6 50 0.6 61 0.7 64 0.7 70 0.8 73 0.7 2 117 Serbia Centre Serbia excluding Kosovo1 1985 51 0.7 53 0.7 55 0.8 46 0.6 48 0.7 47 0.7 56 0.8 58 0.8 62 0.9 68 0.8 2 032 Serbia excluding Kosovo1 Centre Kosovo1 2005 1 0.0 7 0.4 2 0.1 3 0.2 1 0.1 3 0.2 5 0.3 6 0.3 8 0.4 5 0.3 85 Kosovo1 West Switzerland 1980 166 2.1 134 1.7 98 1.2 105 1.3 77 0.9 63 0.8 69 0.8 70 0.8 60 0.7 59 0.7 10 086 Switzerland East Tajikistan 1998 106 1.4 146 1.9 183 2.3 191 2.4 227 2.8 278 3.3 236 2.7 267 3.0 207 2.3 141 1.5 2 181 Tajikistan Centre Turkey 1985 60 0.1 81 0.1 95 0.1 96 0.1 125 0.2 118 0.2 99 0.1 121 0.1 108 0.1 112 0.1 1 797 Turkey East Turkmenistan 2002 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 1988 5 861 12.8 9 189 20.1 10 073 22.2 9 362 20.7 9 844 21.8 8 468 19.8 8 852 20.8 9 308 21.9 8 839 20.9 7 511 17.9 118 557 Ukraine East Uzbekistan 1992 220 0.8 – – – – – – – – – – – – – – – – – – 651 Uzbekistan Total non-EU/EEA 8 431 3.5 11 777 5.6 12 533 5.9 11 828 5.5 12 223 5.6 10 920 5.0 11 343 5.2 11 619 5.2 11 299 5.1 9 763 4.2 163 446 Total non-EU/EEA WHO European Region WHO European Region West West 6 539 1.6 5 718 1.4 5 573 1.3 4 833 1.1 4 246 1.0 3 972 1.0 3 604 0.9 3 266 0.8 2 906 0.7 2 156 0.5 358 418 West Centre Centre 698 0.4 882 0.5 925 0.5 946 0.5 1 015 0.5 917 0.5 894 0.5 875 0.4 883 0.4 802 0.4 23 188 Centre East East 8 258 5.9 11 553 10.4 12 375 11.1 11 642 10.4 12 047 10.7 10 737 9.7 11 181 10.0 11 469 10.2 11 109 9.9 9 577 8.3 149 718 East Total WHO European Region 15 495 2.1 18 153 2.5 18 873 2.6 17 421 2.4 17 308 2.4 15 626 2.2 15 679 2.2 15 610 2.2 14 898 2.0 12 535 1.7 531 324 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 81 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 14. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 82 1.0 79 0.9 101 1.2 69 0.8 83 1.0 76 0.9 65 0.7 61 0.7 53 0.6 56 0.6 3 307 Austria West Belgium 1983 121 1.1 99 0.9 107 1.0 100 0.9 120 1.1 95 0.8 62 0.5 50 0.4 49 0.4 – – 5 019 Belgium Centre Bulgaria 1987 32 0.4 40 0.5 65 0.9 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 57 0.8 68 1.0 790 Bulgaria Centre Croatia 1986 1 0.0 26 0.6 28 0.7 17 0.4 23 0.5 16 0.4 22 0.5 20 0.5 30 0.7 20 0.5 511 Croatia Centre Cyprus 1986 11 1.3 12 1.4 11 1.3 9 1.0 11 1.3 13 1.5 22 2.6 15 1.8 13 1.5 3 0.3 344 Cyprus Centre Czechia 1986 28 0.3 29 0.3 36 0.3 33 0.3 32 0.3 38 0.4 44 0.4 54 0.5 39 0.4 38 0.4 676 Czechia West Denmark 1980 44 0.8 59 1.1 41 0.7 38 0.7 30 0.5 40 0.7 24 0.4 28 0.5 26 0.4 22 0.4 3 037 Denmark East Estonia 1992 26 2.0 38 2.9 36 2.7 26 2.0 18 1.4 18 1.4 40 3.0 20 1.5 25 1.9 28 2.1 565 Estonia West Finland 1983 31 0.6 24 0.4 19 0.4 20 0.4 20 0.4 18 0.3 30 0.5 18 0.3 21 0.4 18 0.3 742 Finland West France 1982 990 1.5 869 1.3 834 1.3 721 1.1 652 1.0 603 0.9 510 0.8 491 0.7 522 0.8 430 0.6 72 907 France West Germany 1981 527 0.6 518 0.6 511 0.6 441 0.5 393 0.5 362 0.4 310 0.4 295 0.4 242 0.3 74 0.1 32 203 Germany West Greece 1981 103 0.9 102 0.9 123 1.1 140 1.3 128 1.2 139 1.3 139 1.3 120 1.1 102 0.9 86 0.8 4 097 Greece Centre Hungary 1986 28 0.3 32 0.3 48 0.5 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 57 0.6 53 0.5 1 054 Hungary West Iceland 1985 1 0.3 2 0.6 1 0.3 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 2 0.6 4 1.1 77 Iceland West Ireland 1983 38 0.8 47 1.0 38 0.8 30 0.7 33 0.7 21 0.4 14 0.3 21 0.4 14 0.3 6 0.1 1 305 Ireland West Italy 1982 1 149 1.9 1 058 1.8 1 074 1.8 1 078 1.8 931 1.5 872 1.4 873 1.4 800 1.3 716 1.2 571 0.9 71 204 Italy East Latvia 1990 132 6.2 112 5.4 142 6.9 133 6.6 171 8.5 132 6.6 114 5.8 118 6.1 99 5.1 90 4.7 2 077 Latvia – Liechtenstein 1989 0 0.0 1 2.8 1 2.7 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 Liechtenstein East Lithuania 1988 33 1.1 21 0.7 38 1.3 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 37 1.3 21 0.8 610 Lithuania West Luxembourg 1983 8 1.6 12 2.3 8 1.5 11 2.0 9 1.6 10 1.8 12 2.1 6 1.0 4 0.7 3 0.5 334 Luxembourg West Malta 1986 6 1.4 5 1.2 6 1.4 1 0.2 4 0.9 2 0.5 5 1.1 0 0.0 0 0.0 0 0.0 114 Malta West Netherlands 1999 323 1.9 268 1.6 298 1.8 270 1.6 220 1.3 250 1.5 204 1.2 187 1.1 168 1.0 93 0.5 7 575 Netherlands West Norway 1983 22 0.5 19 0.4 25 0.5 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 12 0.2 19 0.4 1 203 Norway Centre Poland 1986 173 0.5 184 0.5 157 0.4 162 0.4 148 0.4 128 0.3 102 0.3 109 0.3 111 0.3 85 0.2 3 771 Poland West Portugal 1985 767 7.3 654 6.2 625 5.9 525 5.0 382 3.7 340 3.3 375 3.6 296 2.9 256 2.5 172 1.7 22 835 Portugal Centre Romania 1985 258 1.3 336 1.7 339 1.7 361 1.8 411 2.1 358 1.8 340 1.7 323 1.6 301 1.5 282 1.5 10 581 Romania Centre Slovakia 1985 2 0.0 4 0.1 7 0.1 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 11 0.2 3 0.1 119 Slovakia Centre Slovenia 1986 7 0.3 15 0.7 12 0.6 11 0.5 17 0.8 11 0.5 10 0.5 7 0.3 10 0.5 7 0.3 276 Slovenia West Spain 1981 1 456 3.1 1 293 2.8 1 175 2.5 858 1.8 678 1.6 607 1.8 539 1.6 510 1.5 367 1.1 251 0.6 88 141 Spain West Sweden 1982 – – – – – – – – – – – – – – – – – – – – 2 170 Sweden West United Kingdom 1981 665 1.1 419 0.7 435 0.7 347 0.5 370 0.6 404 0.6 301 0.5 264 0.4 255 0.4 269 0.4 30 234 United Kingdom Total EU/EEA 7 064 1.4 6 377 1.3 6 341 1.2 5 593 1.1 5 086 1.0 4 706 1.0 4 336 0.9 3 991 0.8 3 599 0.7 2 772 0.5 367 890 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 26 0.9 46 1.6 49 1.7 65 2.2 50 1.7 65 2.2 58 2.0 33 1.1 47 1.6 40 1.4 649 Albania West Andorra 2004 0 0.0 1 1.2 0 0.0 3 3.7 0 0.0 3 3.8 0 0.0 2 2.6 0 0.0 – – 15 Andorra East Armenia 1988 94 3.3 87 3.0 136 4.7 144 5.0 174 6.0 163 5.6 163 5.6 144 4.9 211 7.1 173 5.8 1 866 Armenia East Azerbaijan 1995 250 2.8 195 2.1 235 2.5 189 2.0 200 2.1 193 2.0 161 1.7 168 1.7 182 1.8 196 2.0 2 524 Azerbaijan East Belarus 1991 475 5.0 590 6.3 598 6.4 547 5.8 474 5.0 490 5.2 512 5.4 439 4.6 382 4.0 380 4.0 6 841 Belarus Centre Bosnia and Herzegovina 1986 6 0.2 7 0.2 4 0.1 7 0.2 7 0.2 7 0.2 7 0.2 4 0.1 11 0.3 8 0.2 171 Bosnia and Herzegovina East Georgia 1989 339 8.3 395 9.7 359 8.8 303 7.5 268 6.6 270 6.7 269 6.7 257 6.4 273 6.8 265 6.6 4 266 Georgia West Israel 1981 40 0.5 55 0.7 52 0.7 47 0.6 70 0.9 45 0.6 46 0.6 33 0.4 37 0.4 23 0.3 1 739 Israel East Kazakhstan 1993 252 1.6 241 1.5 237 1.4 258 1.5 250 1.4 272 1.5 348 2.0 361 2.0 433 2.4 441 2.4 4 102 Kazakhstan East Kyrgyzstan 1999 130 2.4 90 1.6 88 1.6 67 1.2 85 1.5 125 2.1 72 1.2 59 1.0 56 0.9 46 0.7 1 040 Kyrgyzstan West Monaco 1985 0 0.0 0 0.0 0 0.0 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 – – 51 Monaco Centre Montenegro 1990 8 1.3 2 0.3 7 1.1 7 1.1 7 1.1 11 1.8 15 2.4 13 2.1 14 2.2 10 1.6 162 Montenegro Centre North Macedonia 1989 6 0.3 8 0.4 10 0.5 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 4 0.2 – – 170 North Macedonia East Republic of Moldova 1989 340 8.3 449 11.0 250 6.1 378 9.3 299 7.3 293 7.2 366 9.0 274 6.7 365 9.0 285 7.0 4 437 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 Russian Federation West San Marino 1986 0 0.0 1 3.2 2 6.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 San Marino Centre Serbia 1985 52 0.6 60 0.7 57 0.6 49 0.5 49 0.6 50 0.6 61 0.7 64 0.7 70 0.8 73 0.7 2 117 Serbia Centre Serbia excluding Kosovo1 1985 51 0.7 53 0.7 55 0.8 46 0.6 48 0.7 47 0.7 56 0.8 58 0.8 62 0.9 68 0.8 2 032 Serbia excluding Kosovo1 Centre Kosovo1 2005 1 0.0 7 0.4 2 0.1 3 0.2 1 0.1 3 0.2 5 0.3 6 0.3 8 0.4 5 0.3 85 Kosovo1 West Switzerland 1980 166 2.1 134 1.7 98 1.2 105 1.3 77 0.9 63 0.8 69 0.8 70 0.8 60 0.7 59 0.7 10 086 Switzerland East Tajikistan 1998 106 1.4 146 1.9 183 2.3 191 2.4 227 2.8 278 3.3 236 2.7 267 3.0 207 2.3 141 1.5 2 181 Tajikistan Centre Turkey 1985 60 0.1 81 0.1 95 0.1 96 0.1 125 0.2 118 0.2 99 0.1 121 0.1 108 0.1 112 0.1 1 797 Turkey East Turkmenistan 2002 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 1988 5 861 12.8 9 189 20.1 10 073 22.2 9 362 20.7 9 844 21.8 8 468 19.8 8 852 20.8 9 308 21.9 8 839 20.9 7 511 17.9 118 557 Ukraine East Uzbekistan 1992 220 0.8 – – – – – – – – – – – – – – – – – – 651 Uzbekistan Total non-EU/EEA 8 431 3.5 11 777 5.6 12 533 5.9 11 828 5.5 12 223 5.6 10 920 5.0 11 343 5.2 11 619 5.2 11 299 5.1 9 763 4.2 163 446 Total non-EU/EEA WHO European Region WHO European Region West West 6 539 1.6 5 718 1.4 5 573 1.3 4 833 1.1 4 246 1.0 3 972 1.0 3 604 0.9 3 266 0.8 2 906 0.7 2 156 0.5 358 418 West Centre Centre 698 0.4 882 0.5 925 0.5 946 0.5 1 015 0.5 917 0.5 894 0.5 875 0.4 883 0.4 802 0.4 23 188 Centre East East 8 258 5.9 11 553 10.4 12 375 11.1 11 642 10.4 12 047 10.7 10 737 9.7 11 181 10.0 11 469 10.2 11 109 9.9 9 577 8.3 149 718 East Total WHO European Region 15 495 2.1 18 153 2.5 18 873 2.6 17 421 2.4 17 308 2.4 15 626 2.2 15 679 2.2 15 610 2.2 14 898 2.0 12 535 1.7 531 324 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 82 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 15. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 62 1.5 61 1.5 80 2.0 50 1.2 57 1.4 57 1.4 47 1.1 49 1.1 43 1.0 45 1.0 2 517 Austria West Belgium 70 1.3 58 1.1 66 1.2 70 1.3 79 1.4 59 1.1 38 0.7 35 0.6 32 0.6 – – 3 370 Belgium Centre Bulgaria 21 0.6 38 1.1 47 1.3 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 48 1.4 56 1.6 621 Bulgaria Centre Croatia 1 0.0 25 1.2 26 1.3 14 0.7 21 1.0 15 0.7 21 1.0 19 0.9 28 1.4 18 0.9 456 Croatia Centre Cyprus 8 2.0 7 1.7 9 2.1 5 1.2 10 2.4 9 2.2 17 4.1 9 2.2 8 1.9 2 0.5 260 Cyprus Centre Czechia 21 0.4 20 0.4 28 0.5 27 0.5 23 0.4 30 0.6 38 0.7 44 0.8 35 0.7 28 0.5 550 Czechia West Denmark 34 1.2 40 1.5 35 1.3 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 21 0.7 15 0.5 2 580 Denmark East Estonia 21 3.4 31 5.0 25 4.0 19 3.1 13 2.1 11 1.8 23 3.7 15 2.4 19 3.1 19 3.0 407 Estonia West Finland 22 0.8 17 0.6 16 0.6 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 17 0.6 12 0.4 595 Finland West France 675 2.2 635 2.0 573 1.8 518 1.6 441 1.4 415 1.3 336 1.0 350 1.1 367 1.1 311 1.0 57 112 France West Germany 439 1.1 438 1.1 406 1.0 350 0.9 335 0.8 297 0.7 249 0.6 231 0.6 191 0.5 55 0.1 27 494 Germany West Greece 84 1.5 86 1.6 102 1.9 120 2.2 105 2.0 114 2.2 105 2.0 92 1.8 89 1.7 63 1.2 3 413 Greece Centre Hungary 26 0.5 27 0.6 45 1.0 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 54 1.2 46 1.0 914 Hungary West Iceland 1 0.6 1 0.6 1 0.6 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 0 0.0 3 1.6 65 Iceland West Ireland 27 1.2 34 1.5 27 1.2 22 1.0 23 1.0 16 0.7 11 0.5 15 0.6 13 0.5 4 0.2 1 000 Ireland West Italy 849 3.0 806 2.8 784 2.7 813 2.8 713 2.4 686 2.3 669 2.3 586 2.0 560 1.9 466 1.6 54 918 Italy East Latvia 86 8.9 80 8.4 102 10.9 90 9.7 110 12.0 89 9.8 90 10.0 73 8.2 63 7.1 53 6.0 1 428 Latvia – Liechtenstein 0 0.0 1 5.6 1 5.5 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 11 Liechtenstein East Lithuania 27 1.9 15 1.1 28 2.0 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 29 2.2 16 1.2 493 Lithuania West Luxembourg 4 1.6 8 3.1 5 1.9 10 3.7 6 2.2 6 2.1 10 3.5 5 1.7 3 1.0 1 0.3 255 Luxembourg West Malta 4 1.9 3 1.5 5 2.4 1 0.5 4 1.9 2 0.9 5 2.2 0 0.0 0 0.0 0 0.0 100 Malta West Netherlands 258 3.1 210 2.5 236 2.8 224 2.7 182 2.2 206 2.5 159 1.9 148 1.7 132 1.5 73 0.9 6 064 Netherlands West Norway 20 0.8 17 0.7 23 0.9 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 9 0.3 14 0.5 935 Norway Centre Poland 132 0.7 142 0.8 120 0.7 131 0.7 115 0.6 97 0.5 90 0.5 94 0.5 86 0.5 70 0.4 2 985 Poland West Portugal 538 10.6 484 9.6 443 8.8 364 7.3 295 5.9 244 5.0 268 5.5 215 4.4 171 3.5 112 2.3 17 960 Portugal Centre Romania 148 1.5 207 2.1 211 2.2 245 2.5 291 3.0 249 2.6 245 2.5 240 2.5 218 2.3 196 2.1 6 356 Romania Centre Slovakia 2 0.1 4 0.2 7 0.3 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 11 0.4 3 0.1 106 Slovakia Centre Slovenia 7 0.7 12 1.2 11 1.1 10 1.0 16 1.6 11 1.1 8 0.8 7 0.7 10 1.0 3 0.3 242 Slovenia West Spain 1 136 4.9 1 000 4.3 900 3.9 671 2.9 546 2.8 490 2.9 437 2.6 408 2.4 301 1.8 205 1.1 70 259 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 1 774 Sweden West United Kingdom 430 1.4 284 0.9 301 1.0 247 0.8 249 0.8 301 0.9 226 0.7 188 0.6 189 0.6 205 0.6 23 580 United Kingdom Total EU/EEA 5 153 2.1 4 791 1.9 4 663 1.9 4 195 1.7 3 834 1.6 3 569 1.5 3 290 1.3 2 999 1.2 2 747 1.1 2 094 0.8 288 820 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 18 1.2 35 2.4 34 2.3 50 3.4 36 2.4 50 3.4 50 3.4 24 1.6 35 2.4 26 1.8 497 Albania West Andorra 0 0.0 1 2.4 0 0.0 2 5.0 0 0.0 2 5.2 0 0.0 1 2.6 0 0.0 – – 11 Andorra East Armenia 73 5.4 65 4.8 98 7.3 103 7.6 127 9.3 129 9.4 116 8.4 111 8.0 147 10.6 127 9.1 1 385 Armenia East Azerbaijan 231 5.2 171 3.8 209 4.5 162 3.5 162 3.4 150 3.1 125 2.6 114 2.3 122 2.5 150 3.0 1 981 Azerbaijan East Belarus 291 6.6 365 8.3 375 8.6 369 8.4 308 7.0 278 6.3 311 7.1 274 6.2 229 5.2 241 5.5 4 263 Belarus Centre Bosnia and Herzegovina 6 0.3 4 0.2 4 0.2 6 0.3 7 0.4 7 0.4 6 0.4 4 0.2 11 0.7 6 0.4 143 Bosnia and Herzegovina East Georgia 243 12.4 277 14.2 248 12.8 219 11.3 201 10.4 196 10.2 196 10.2 193 10.1 172 9.0 199 10.4 3 131 Georgia West Israel 24 0.7 37 1.0 37 1.0 36 0.9 48 1.2 26 0.7 28 0.7 23 0.6 27 0.6 15 0.4 1 246 Israel East Kazakhstan 180 2.3 162 2.0 179 2.2 190 2.3 184 2.2 180 2.1 230 2.7 223 2.5 279 3.1 287 3.2 2 811 Kazakhstan East Kyrgyzstan 111 4.1 69 2.5 65 2.3 49 1.7 58 2.0 89 3.0 55 1.8 36 1.2 0 0.0 26 0.8 741 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.5 0 0.0 0 0.0 0 0.0 0 0.0 – – 40 Monaco Centre Montenegro 8 2.6 2 0.6 7 2.3 7 2.3 4 1.3 11 3.5 15 4.8 12 3.9 14 4.5 10 3.2 141 Montenegro Centre North Macedonia 6 0.6 5 0.5 8 0.8 9 0.9 13 1.3 5 0.5 6 0.6 2 0.2 4 0.4 – – 127 North Macedonia East Republic of Moldova 193 9.8 274 14.0 128 6.5 218 11.1 183 9.3 179 9.2 210 10.8 167 8.6 213 11.0 180 9.3 2 689 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 Russian Federation West San Marino 0 0.0 1 6.5 2 12.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 21 San Marino Centre Serbia 45 1.0 50 1.1 51 1.2 41 0.9 43 1.0 47 1.1 57 1.3 58 1.3 62 1.4 57 1.1 1 645 Serbia Centre Serbia excluding Kosovo1 44 1.3 45 1.3 50 1.4 39 1.1 42 1.2 45 1.3 52 1.5 52 1.5 55 1.6 53 1.2 1 579 Serbia excluding Kosovo1 Centre Kosovo1 1 0.1 5 0.6 1 0.1 2 0.2 1 0.1 2 0.2 5 0.6 6 0.7 7 0.8 4 0.5 66 Kosovo1 West Switzerland 124 3.2 96 2.5 68 1.7 73 1.8 61 1.5 51 1.2 47 1.1 52 1.2 47 1.1 50 1.2 7 519 Switzerland East Tajikistan 91 2.4 113 2.9 137 3.4 139 3.4 155 3.7 184 4.3 172 3.9 182 4.1 145 3.2 98 2.1 1 583 Tajikistan Centre Turkey 46 0.1 66 0.2 83 0.2 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 91 0.2 92 0.2 1 494 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 0 Turkmenistan East Ukraine 3 988 18.9 6 141 29.2 6 498 31.0 6 013 28.7 6 119 29.3 5 328 23.2 5 462 27.7 5 612 28.6 5 405 27.6 4 661 24.0 77 354 Ukraine East Uzbekistan 163 1.1 – – – – – – – – – – – – – – – – – – 494 Uzbekistan Total non-EU/EEA 5 841 5.0 7 934 7.7 8 231 8.0 7 763 7.4 7 809 7.4 7 004 6.4 7 172 6.7 7 191 6.7 7 003 6.6 6 225 5.5 109 410 Total non-EU/EEA WHO European Region WHO European Region West West 4 801 2.3 4 317 2.1 4 110 2.0 3 637 1.8 3 219 1.6 3 028 1.5 2 698 1.3 2 444 1.2 2 212 1.1 1 649 0.8 282 828 West Centre Centre 495 0.5 644 0.7 691 0.7 719 0.8 774 0.8 706 0.7 733 0.8 700 0.7 715 0.7 613 0.6 16 537 Centre East East 5 698 8.5 7 763 14.7 8 092 15.3 7 602 14.3 7 649 14.3 6 839 12.2 7 031 13.2 7 046 13.2 6 823 13.5 6 057 11.0 98 854 East Total WHO European Region 10 994 3.0 12 724 3.6 12 893 3.7 11 958 3.4 11 642 3.4 10 573 3.0 10 462 3.0 10 190 2.9 9 750 2.8 8 319 2.3 398 219 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 83 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 15. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 62 1.5 61 1.5 80 2.0 50 1.2 57 1.4 57 1.4 47 1.1 49 1.1 43 1.0 45 1.0 2 517 Austria West Belgium 70 1.3 58 1.1 66 1.2 70 1.3 79 1.4 59 1.1 38 0.7 35 0.6 32 0.6 – – 3 370 Belgium Centre Bulgaria 21 0.6 38 1.1 47 1.3 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 48 1.4 56 1.6 621 Bulgaria Centre Croatia 1 0.0 25 1.2 26 1.3 14 0.7 21 1.0 15 0.7 21 1.0 19 0.9 28 1.4 18 0.9 456 Croatia Centre Cyprus 8 2.0 7 1.7 9 2.1 5 1.2 10 2.4 9 2.2 17 4.1 9 2.2 8 1.9 2 0.5 260 Cyprus Centre Czechia 21 0.4 20 0.4 28 0.5 27 0.5 23 0.4 30 0.6 38 0.7 44 0.8 35 0.7 28 0.5 550 Czechia West Denmark 34 1.2 40 1.5 35 1.3 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 21 0.7 15 0.5 2 580 Denmark East Estonia 21 3.4 31 5.0 25 4.0 19 3.1 13 2.1 11 1.8 23 3.7 15 2.4 19 3.1 19 3.0 407 Estonia West Finland 22 0.8 17 0.6 16 0.6 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 17 0.6 12 0.4 595 Finland West France 675 2.2 635 2.0 573 1.8 518 1.6 441 1.4 415 1.3 336 1.0 350 1.1 367 1.1 311 1.0 57 112 France West Germany 439 1.1 438 1.1 406 1.0 350 0.9 335 0.8 297 0.7 249 0.6 231 0.6 191 0.5 55 0.1 27 494 Germany West Greece 84 1.5 86 1.6 102 1.9 120 2.2 105 2.0 114 2.2 105 2.0 92 1.8 89 1.7 63 1.2 3 413 Greece Centre Hungary 26 0.5 27 0.6 45 1.0 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 54 1.2 46 1.0 914 Hungary West Iceland 1 0.6 1 0.6 1 0.6 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 0 0.0 3 1.6 65 Iceland West Ireland 27 1.2 34 1.5 27 1.2 22 1.0 23 1.0 16 0.7 11 0.5 15 0.6 13 0.5 4 0.2 1 000 Ireland West Italy 849 3.0 806 2.8 784 2.7 813 2.8 713 2.4 686 2.3 669 2.3 586 2.0 560 1.9 466 1.6 54 918 Italy East Latvia 86 8.9 80 8.4 102 10.9 90 9.7 110 12.0 89 9.8 90 10.0 73 8.2 63 7.1 53 6.0 1 428 Latvia – Liechtenstein 0 0.0 1 5.6 1 5.5 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 11 Liechtenstein East Lithuania 27 1.9 15 1.1 28 2.0 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 29 2.2 16 1.2 493 Lithuania West Luxembourg 4 1.6 8 3.1 5 1.9 10 3.7 6 2.2 6 2.1 10 3.5 5 1.7 3 1.0 1 0.3 255 Luxembourg West Malta 4 1.9 3 1.5 5 2.4 1 0.5 4 1.9 2 0.9 5 2.2 0 0.0 0 0.0 0 0.0 100 Malta West Netherlands 258 3.1 210 2.5 236 2.8 224 2.7 182 2.2 206 2.5 159 1.9 148 1.7 132 1.5 73 0.9 6 064 Netherlands West Norway 20 0.8 17 0.7 23 0.9 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 9 0.3 14 0.5 935 Norway Centre Poland 132 0.7 142 0.8 120 0.7 131 0.7 115 0.6 97 0.5 90 0.5 94 0.5 86 0.5 70 0.4 2 985 Poland West Portugal 538 10.6 484 9.6 443 8.8 364 7.3 295 5.9 244 5.0 268 5.5 215 4.4 171 3.5 112 2.3 17 960 Portugal Centre Romania 148 1.5 207 2.1 211 2.2 245 2.5 291 3.0 249 2.6 245 2.5 240 2.5 218 2.3 196 2.1 6 356 Romania Centre Slovakia 2 0.1 4 0.2 7 0.3 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 11 0.4 3 0.1 106 Slovakia Centre Slovenia 7 0.7 12 1.2 11 1.1 10 1.0 16 1.6 11 1.1 8 0.8 7 0.7 10 1.0 3 0.3 242 Slovenia West Spain 1 136 4.9 1 000 4.3 900 3.9 671 2.9 546 2.8 490 2.9 437 2.6 408 2.4 301 1.8 205 1.1 70 259 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 1 774 Sweden West United Kingdom 430 1.4 284 0.9 301 1.0 247 0.8 249 0.8 301 0.9 226 0.7 188 0.6 189 0.6 205 0.6 23 580 United Kingdom Total EU/EEA 5 153 2.1 4 791 1.9 4 663 1.9 4 195 1.7 3 834 1.6 3 569 1.5 3 290 1.3 2 999 1.2 2 747 1.1 2 094 0.8 288 820 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 18 1.2 35 2.4 34 2.3 50 3.4 36 2.4 50 3.4 50 3.4 24 1.6 35 2.4 26 1.8 497 Albania West Andorra 0 0.0 1 2.4 0 0.0 2 5.0 0 0.0 2 5.2 0 0.0 1 2.6 0 0.0 – – 11 Andorra East Armenia 73 5.4 65 4.8 98 7.3 103 7.6 127 9.3 129 9.4 116 8.4 111 8.0 147 10.6 127 9.1 1 385 Armenia East Azerbaijan 231 5.2 171 3.8 209 4.5 162 3.5 162 3.4 150 3.1 125 2.6 114 2.3 122 2.5 150 3.0 1 981 Azerbaijan East Belarus 291 6.6 365 8.3 375 8.6 369 8.4 308 7.0 278 6.3 311 7.1 274 6.2 229 5.2 241 5.5 4 263 Belarus Centre Bosnia and Herzegovina 6 0.3 4 0.2 4 0.2 6 0.3 7 0.4 7 0.4 6 0.4 4 0.2 11 0.7 6 0.4 143 Bosnia and Herzegovina East Georgia 243 12.4 277 14.2 248 12.8 219 11.3 201 10.4 196 10.2 196 10.2 193 10.1 172 9.0 199 10.4 3 131 Georgia West Israel 24 0.7 37 1.0 37 1.0 36 0.9 48 1.2 26 0.7 28 0.7 23 0.6 27 0.6 15 0.4 1 246 Israel East Kazakhstan 180 2.3 162 2.0 179 2.2 190 2.3 184 2.2 180 2.1 230 2.7 223 2.5 279 3.1 287 3.2 2 811 Kazakhstan East Kyrgyzstan 111 4.1 69 2.5 65 2.3 49 1.7 58 2.0 89 3.0 55 1.8 36 1.2 0 0.0 26 0.8 741 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.5 0 0.0 0 0.0 0 0.0 0 0.0 – – 40 Monaco Centre Montenegro 8 2.6 2 0.6 7 2.3 7 2.3 4 1.3 11 3.5 15 4.8 12 3.9 14 4.5 10 3.2 141 Montenegro Centre North Macedonia 6 0.6 5 0.5 8 0.8 9 0.9 13 1.3 5 0.5 6 0.6 2 0.2 4 0.4 – – 127 North Macedonia East Republic of Moldova 193 9.8 274 14.0 128 6.5 218 11.1 183 9.3 179 9.2 210 10.8 167 8.6 213 11.0 180 9.3 2 689 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 Russian Federation West San Marino 0 0.0 1 6.5 2 12.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 21 San Marino Centre Serbia 45 1.0 50 1.1 51 1.2 41 0.9 43 1.0 47 1.1 57 1.3 58 1.3 62 1.4 57 1.1 1 645 Serbia Centre Serbia excluding Kosovo1 44 1.3 45 1.3 50 1.4 39 1.1 42 1.2 45 1.3 52 1.5 52 1.5 55 1.6 53 1.2 1 579 Serbia excluding Kosovo1 Centre Kosovo1 1 0.1 5 0.6 1 0.1 2 0.2 1 0.1 2 0.2 5 0.6 6 0.7 7 0.8 4 0.5 66 Kosovo1 West Switzerland 124 3.2 96 2.5 68 1.7 73 1.8 61 1.5 51 1.2 47 1.1 52 1.2 47 1.1 50 1.2 7 519 Switzerland East Tajikistan 91 2.4 113 2.9 137 3.4 139 3.4 155 3.7 184 4.3 172 3.9 182 4.1 145 3.2 98 2.1 1 583 Tajikistan Centre Turkey 46 0.1 66 0.2 83 0.2 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 91 0.2 92 0.2 1 494 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 0 Turkmenistan East Ukraine 3 988 18.9 6 141 29.2 6 498 31.0 6 013 28.7 6 119 29.3 5 328 23.2 5 462 27.7 5 612 28.6 5 405 27.6 4 661 24.0 77 354 Ukraine East Uzbekistan 163 1.1 – – – – – – – – – – – – – – – – – – 494 Uzbekistan Total non-EU/EEA 5 841 5.0 7 934 7.7 8 231 8.0 7 763 7.4 7 809 7.4 7 004 6.4 7 172 6.7 7 191 6.7 7 003 6.6 6 225 5.5 109 410 Total non-EU/EEA WHO European Region WHO European Region West West 4 801 2.3 4 317 2.1 4 110 2.0 3 637 1.8 3 219 1.6 3 028 1.5 2 698 1.3 2 444 1.2 2 212 1.1 1 649 0.8 282 828 West Centre Centre 495 0.5 644 0.7 691 0.7 719 0.8 774 0.8 706 0.7 733 0.8 700 0.7 715 0.7 613 0.6 16 537 Centre East East 5 698 8.5 7 763 14.7 8 092 15.3 7 602 14.3 7 649 14.3 6 839 12.2 7 031 13.2 7 046 13.2 6 823 13.5 6 057 11.0 98 854 East Total WHO European Region 10 994 3.0 12 724 3.6 12 893 3.7 11 958 3.4 11 642 3.4 10 573 3.0 10 462 3.0 10 190 2.9 9 750 2.8 8 319 2.3 398 219 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 84 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 16. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 20 0.5 18 0.4 21 0.5 19 0.4 26 0.6 19 0.4 18 0.4 12 0.3 10 0.2 11 0.2 790 Austria West Belgium 51 0.9 40 0.7 41 0.7 30 0.5 40 0.7 35 0.6 24 0.4 15 0.3 17 0.3 – – 1 643 Belgium Centre Bulgaria 11 0.3 2 0.1 18 0.5 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 9 0.2 12 0.3 169 Bulgaria Centre Croatia 0 0.0 1 0.0 2 0.1 3 0.1 2 0.1 1 0.0 1 0.0 1 0.0 2 0.1 2 0.1 55 Croatia Centre Cyprus 3 0.7 5 1.2 2 0.5 4 0.9 1 0.2 4 0.9 5 1.1 6 1.4 5 1.1 1 0.2 84 Cyprus Centre Czechia 7 0.1 9 0.2 8 0.1 6 0.1 9 0.2 8 0.1 6 0.1 10 0.2 4 0.1 10 0.2 126 Czechia West Denmark 10 0.4 19 0.7 6 0.2 9 0.3 6 0.2 12 0.4 5 0.2 3 0.1 5 0.2 7 0.2 457 Denmark East Estonia 5 0.7 7 1.0 11 1.6 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 6 0.9 9 1.3 158 Estonia West Finland 9 0.3 7 0.3 3 0.1 3 0.1 6 0.2 5 0.2 5 0.2 8 0.3 4 0.1 6 0.2 147 Finland West France 311 0.9 232 0.7 258 0.8 198 0.6 210 0.6 183 0.5 170 0.5 137 0.4 152 0.4 112 0.3 15 733 France West Germany 88 0.2 80 0.2 105 0.3 91 0.2 58 0.1 65 0.2 61 0.1 64 0.2 51 0.1 19 0.0 4 709 Germany West Greece 19 0.3 16 0.3 21 0.4 20 0.4 23 0.4 25 0.4 34 0.6 28 0.5 13 0.2 23 0.4 684 Greece Centre Hungary 2 0.0 5 0.1 3 0.1 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 3 0.1 7 0.1 140 Hungary West Iceland 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 1 0.6 12 Iceland West Ireland 11 0.5 13 0.6 11 0.5 8 0.3 10 0.4 5 0.2 3 0.1 6 0.2 1 0.0 2 0.1 303 Ireland West Italy 300 1.0 252 0.8 290 0.9 265 0.9 218 0.7 186 0.6 204 0.7 214 0.7 156 0.5 105 0.3 16 286 Italy East Latvia 46 4.0 32 2.8 40 3.6 43 3.9 61 5.6 43 4.0 24 2.3 45 4.3 36 3.4 37 3.6 649 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 0.0 0 0.0 1 Liechtenstein East Lithuania 6 0.4 6 0.4 10 0.6 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 8 0.5 5 0.3 117 Lithuania West Luxembourg 4 1.6 4 1.6 3 1.1 1 0.4 3 1.1 4 1.4 2 0.7 1 0.3 1 0.3 2 0.7 78 Luxembourg West Malta 2 1.0 2 1.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Malta West Netherlands 65 0.8 57 0.7 61 0.7 46 0.5 38 0.4 42 0.5 43 0.5 37 0.4 31 0.4 18 0.2 1 476 Netherlands West Norway 2 0.1 2 0.1 2 0.1 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 3 0.1 5 0.2 268 Norway Centre Poland 41 0.2 42 0.2 37 0.2 31 0.2 33 0.2 31 0.2 12 0.1 15 0.1 25 0.1 15 0.1 786 Poland West Portugal 229 4.2 170 3.1 182 3.3 161 2.9 87 1.6 96 1.8 107 2.0 81 1.5 85 1.6 60 1.1 4 874 Portugal Centre Romania 110 1.1 129 1.2 128 1.2 116 1.1 120 1.2 109 1.1 95 0.9 83 0.8 83 0.8 86 0.9 4 225 Romania Centre Slovakia 0 0.0 0 0.0 0 0.0 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 13 Slovakia Centre Slovenia 0 0.0 3 0.3 1 0.1 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 0 0.0 4 0.4 34 Slovenia West Spain 320 1.4 293 1.2 275 1.2 187 0.8 132 0.7 117 0.7 102 0.6 102 0.6 64 0.4 46 0.2 17 876 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 396 Sweden West United Kingdom 235 0.7 135 0.4 134 0.4 100 0.3 121 0.4 101 0.3 74 0.2 75 0.2 66 0.2 64 0.2 6 650 United Kingdom Total EU/EEA 1 907 0.8 1 582 0.6 1 674 0.7 1 393 0.5 1 250 0.5 1 127 0.4 1 039 0.4 985 0.4 842 0.3 669 0.3 78 953 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 8 0.5 11 0.8 15 1.0 15 1.0 14 1.0 15 1.1 8 0.6 9 0.6 12 0.8 14 1.0 152 Albania West Andorra 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 0 0.0 1 2.6 0 0.0 – – 4 Andorra East Armenia 21 1.4 22 1.4 38 2.5 41 2.7 47 3.0 34 2.2 47 3.0 33 2.1 64 4.1 46 2.9 481 Armenia East Azerbaijan 19 0.4 24 0.5 26 0.6 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 60 1.2 46 0.9 438 Azerbaijan East Belarus 184 3.7 225 4.5 223 4.4 178 3.5 166 3.3 212 4.2 201 4.0 165 3.3 153 3.0 139 2.8 2 578 Belarus Centre Bosnia and Herzegovina 0 0.0 3 0.2 0 0.0 1 0.1 0 0.0 0 0.0 1 0.1 0 0.0 0 0.0 2 0.1 26 Bosnia and Herzegovina East Georgia 96 4.5 118 5.5 111 5.2 84 4.0 67 3.2 74 3.5 73 3.5 64 3.1 101 4.8 66 3.2 1 135 Georgia West Israel 16 0.4 18 0.5 15 0.4 11 0.3 22 0.6 19 0.5 18 0.4 10 0.2 10 0.2 8 0.2 493 Israel East Kazakhstan 72 0.9 79 0.9 58 0.7 68 0.8 66 0.7 92 1.0 118 1.3 138 1.5 154 1.6 154 1.6 1 291 Kazakhstan East Kyrgyzstan 19 0.7 21 0.8 23 0.8 18 0.6 27 0.9 36 1.2 17 0.6 23 0.7 22 0.7 20 0.6 262 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 – – 11 Monaco Centre Montenegro 0 0.0 0 0.0 0 0.0 0 0.0 3 0.9 0 0.0 0 0.0 1 0.3 0 0.0 0 0.0 21 Montenegro Centre North Macedonia 0 0.0 0 0.0 2 0.2 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 0 0.0 – – 36 North Macedonia East Republic of Moldova 147 6.9 175 8.3 122 5.8 160 7.6 116 5.5 114 5.4 156 7.4 107 5.1 152 7.2 105 5.0 1 748 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 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 7 0.2 10 0.2 6 0.1 8 0.2 6 0.1 3 0.1 4 0.1 6 0.1 8 0.2 16 0.3 472 Serbia Centre Serbia excluding Kosovo1 7 0.2 8 0.2 5 0.1 7 0.2 6 0.2 2 0.1 4 0.1 6 0.2 7 0.2 15 0.3 453 Serbia excluding Kosovo1 Centre Kosovo1 – 0.0 2 0.2 1 0.1 1 0.1 – 0.0 1 0.1 – 0.0 – 0.0 1 0.1 1 0.1 19 Kosovo1 West Switzerland 42 1.1 38 0.9 30 0.7 32 0.8 16 0.4 12 0.3 21 0.5 17 0.4 12 0.3 9 0.2 2 563 Switzerland East Tajikistan 15 0.4 33 0.9 46 1.2 52 1.3 72 1.8 94 2.2 64 1.5 85 1.9 62 1.4 43 0.9 598 Tajikistan Centre Turkey 14 0.0 15 0.0 12 0.0 19 0.0 26 0.1 26 0.1 13 0.0 18 0.0 17 0.0 20 0.0 303 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 1 873 7.6 3 048 12.4 3 575 14.6 3 349 13.7 3 725 15.4 3 140 15.9 3 390 14.8 3 696 16.2 3 434 15.2 2 850 12.7 41 203 Ukraine East Uzbekistan 57 0.4 – – – – – – – – – – – – – – – – – – 157 Uzbekistan Total non-EU/EEA 2 590 2.2 3 840 3.6 4 302 4.0 4 065 3.7 4 414 4.0 3 916 3.7 4 169 3.7 4 427 4.0 4 261 3.8 3 538 3.0 53 986 Total non-EU/EEA WHO European Region WHO European Region West West 1 734 0.8 1 397 0.7 1 459 0.7 1 191 0.6 1 025 0.5 934 0.5 898 0.4 814 0.4 683 0.3 498 0.2 75 469 West Centre Centre 203 0.2 235 0.3 234 0.3 227 0.2 241 0.3 211 0.2 160 0.2 175 0.2 168 0.2 189 0.2 6 642 Centre East East 2 560 3.5 3 790 6.5 4 283 7.3 4 040 6.8 4 398 7.4 3 898 7.1 4 150 7.1 4 423 7.5 4 252 7.2 3 520 5.8 50 827 East Total WHO European Region 4 497 1.2 5 422 1.5 5 976 1.7 5 458 1.5 5 664 1.6 5 043 1.4 5 208 1.4 5 412 1.5 5 103 1.4 4 207 1.1 132 938 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 85 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 16. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 20 0.5 18 0.4 21 0.5 19 0.4 26 0.6 19 0.4 18 0.4 12 0.3 10 0.2 11 0.2 790 Austria West Belgium 51 0.9 40 0.7 41 0.7 30 0.5 40 0.7 35 0.6 24 0.4 15 0.3 17 0.3 – – 1 643 Belgium Centre Bulgaria 11 0.3 2 0.1 18 0.5 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 9 0.2 12 0.3 169 Bulgaria Centre Croatia 0 0.0 1 0.0 2 0.1 3 0.1 2 0.1 1 0.0 1 0.0 1 0.0 2 0.1 2 0.1 55 Croatia Centre Cyprus 3 0.7 5 1.2 2 0.5 4 0.9 1 0.2 4 0.9 5 1.1 6 1.4 5 1.1 1 0.2 84 Cyprus Centre Czechia 7 0.1 9 0.2 8 0.1 6 0.1 9 0.2 8 0.1 6 0.1 10 0.2 4 0.1 10 0.2 126 Czechia West Denmark 10 0.4 19 0.7 6 0.2 9 0.3 6 0.2 12 0.4 5 0.2 3 0.1 5 0.2 7 0.2 457 Denmark East Estonia 5 0.7 7 1.0 11 1.6 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 6 0.9 9 1.3 158 Estonia West Finland 9 0.3 7 0.3 3 0.1 3 0.1 6 0.2 5 0.2 5 0.2 8 0.3 4 0.1 6 0.2 147 Finland West France 311 0.9 232 0.7 258 0.8 198 0.6 210 0.6 183 0.5 170 0.5 137 0.4 152 0.4 112 0.3 15 733 France West Germany 88 0.2 80 0.2 105 0.3 91 0.2 58 0.1 65 0.2 61 0.1 64 0.2 51 0.1 19 0.0 4 709 Germany West Greece 19 0.3 16 0.3 21 0.4 20 0.4 23 0.4 25 0.4 34 0.6 28 0.5 13 0.2 23 0.4 684 Greece Centre Hungary 2 0.0 5 0.1 3 0.1 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 3 0.1 7 0.1 140 Hungary West Iceland 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 1 0.6 12 Iceland West Ireland 11 0.5 13 0.6 11 0.5 8 0.3 10 0.4 5 0.2 3 0.1 6 0.2 1 0.0 2 0.1 303 Ireland West Italy 300 1.0 252 0.8 290 0.9 265 0.9 218 0.7 186 0.6 204 0.7 214 0.7 156 0.5 105 0.3 16 286 Italy East Latvia 46 4.0 32 2.8 40 3.6 43 3.9 61 5.6 43 4.0 24 2.3 45 4.3 36 3.4 37 3.6 649 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 0.0 0 0.0 1 Liechtenstein East Lithuania 6 0.4 6 0.4 10 0.6 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 8 0.5 5 0.3 117 Lithuania West Luxembourg 4 1.6 4 1.6 3 1.1 1 0.4 3 1.1 4 1.4 2 0.7 1 0.3 1 0.3 2 0.7 78 Luxembourg West Malta 2 1.0 2 1.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Malta West Netherlands 65 0.8 57 0.7 61 0.7 46 0.5 38 0.4 42 0.5 43 0.5 37 0.4 31 0.4 18 0.2 1 476 Netherlands West Norway 2 0.1 2 0.1 2 0.1 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 3 0.1 5 0.2 268 Norway Centre Poland 41 0.2 42 0.2 37 0.2 31 0.2 33 0.2 31 0.2 12 0.1 15 0.1 25 0.1 15 0.1 786 Poland West Portugal 229 4.2 170 3.1 182 3.3 161 2.9 87 1.6 96 1.8 107 2.0 81 1.5 85 1.6 60 1.1 4 874 Portugal Centre Romania 110 1.1 129 1.2 128 1.2 116 1.1 120 1.2 109 1.1 95 0.9 83 0.8 83 0.8 86 0.9 4 225 Romania Centre Slovakia 0 0.0 0 0.0 0 0.0 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 13 Slovakia Centre Slovenia 0 0.0 3 0.3 1 0.1 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 0 0.0 4 0.4 34 Slovenia West Spain 320 1.4 293 1.2 275 1.2 187 0.8 132 0.7 117 0.7 102 0.6 102 0.6 64 0.4 46 0.2 17 876 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 396 Sweden West United Kingdom 235 0.7 135 0.4 134 0.4 100 0.3 121 0.4 101 0.3 74 0.2 75 0.2 66 0.2 64 0.2 6 650 United Kingdom Total EU/EEA 1 907 0.8 1 582 0.6 1 674 0.7 1 393 0.5 1 250 0.5 1 127 0.4 1 039 0.4 985 0.4 842 0.3 669 0.3 78 953 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 8 0.5 11 0.8 15 1.0 15 1.0 14 1.0 15 1.1 8 0.6 9 0.6 12 0.8 14 1.0 152 Albania West Andorra 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 0 0.0 1 2.6 0 0.0 – – 4 Andorra East Armenia 21 1.4 22 1.4 38 2.5 41 2.7 47 3.0 34 2.2 47 3.0 33 2.1 64 4.1 46 2.9 481 Armenia East Azerbaijan 19 0.4 24 0.5 26 0.6 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 60 1.2 46 0.9 438 Azerbaijan East Belarus 184 3.7 225 4.5 223 4.4 178 3.5 166 3.3 212 4.2 201 4.0 165 3.3 153 3.0 139 2.8 2 578 Belarus Centre Bosnia and Herzegovina 0 0.0 3 0.2 0 0.0 1 0.1 0 0.0 0 0.0 1 0.1 0 0.0 0 0.0 2 0.1 26 Bosnia and Herzegovina East Georgia 96 4.5 118 5.5 111 5.2 84 4.0 67 3.2 74 3.5 73 3.5 64 3.1 101 4.8 66 3.2 1 135 Georgia West Israel 16 0.4 18 0.5 15 0.4 11 0.3 22 0.6 19 0.5 18 0.4 10 0.2 10 0.2 8 0.2 493 Israel East Kazakhstan 72 0.9 79 0.9 58 0.7 68 0.8 66 0.7 92 1.0 118 1.3 138 1.5 154 1.6 154 1.6 1 291 Kazakhstan East Kyrgyzstan 19 0.7 21 0.8 23 0.8 18 0.6 27 0.9 36 1.2 17 0.6 23 0.7 22 0.7 20 0.6 262 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 – – 11 Monaco Centre Montenegro 0 0.0 0 0.0 0 0.0 0 0.0 3 0.9 0 0.0 0 0.0 1 0.3 0 0.0 0 0.0 21 Montenegro Centre North Macedonia 0 0.0 0 0.0 2 0.2 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 0 0.0 – – 36 North Macedonia East Republic of Moldova 147 6.9 175 8.3 122 5.8 160 7.6 116 5.5 114 5.4 156 7.4 107 5.1 152 7.2 105 5.0 1 748 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 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 7 0.2 10 0.2 6 0.1 8 0.2 6 0.1 3 0.1 4 0.1 6 0.1 8 0.2 16 0.3 472 Serbia Centre Serbia excluding Kosovo1 7 0.2 8 0.2 5 0.1 7 0.2 6 0.2 2 0.1 4 0.1 6 0.2 7 0.2 15 0.3 453 Serbia excluding Kosovo1 Centre Kosovo1 – 0.0 2 0.2 1 0.1 1 0.1 – 0.0 1 0.1 – 0.0 – 0.0 1 0.1 1 0.1 19 Kosovo1 West Switzerland 42 1.1 38 0.9 30 0.7 32 0.8 16 0.4 12 0.3 21 0.5 17 0.4 12 0.3 9 0.2 2 563 Switzerland East Tajikistan 15 0.4 33 0.9 46 1.2 52 1.3 72 1.8 94 2.2 64 1.5 85 1.9 62 1.4 43 0.9 598 Tajikistan Centre Turkey 14 0.0 15 0.0 12 0.0 19 0.0 26 0.1 26 0.1 13 0.0 18 0.0 17 0.0 20 0.0 303 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 1 873 7.6 3 048 12.4 3 575 14.6 3 349 13.7 3 725 15.4 3 140 15.9 3 390 14.8 3 696 16.2 3 434 15.2 2 850 12.7 41 203 Ukraine East Uzbekistan 57 0.4 – – – – – – – – – – – – – – – – – – 157 Uzbekistan Total non-EU/EEA 2 590 2.2 3 840 3.6 4 302 4.0 4 065 3.7 4 414 4.0 3 916 3.7 4 169 3.7 4 427 4.0 4 261 3.8 3 538 3.0 53 986 Total non-EU/EEA WHO European Region WHO European Region West West 1 734 0.8 1 397 0.7 1 459 0.7 1 191 0.6 1 025 0.5 934 0.5 898 0.4 814 0.4 683 0.3 498 0.2 75 469 West Centre Centre 203 0.2 235 0.3 234 0.3 227 0.2 241 0.3 211 0.2 160 0.2 175 0.2 168 0.2 189 0.2 6 642 Centre East East 2 560 3.5 3 790 6.5 4 283 7.3 4 040 6.8 4 398 7.4 3 898 7.1 4 150 7.1 4 423 7.5 4 252 7.2 3 520 5.8 50 827 East Total WHO European Region 4 497 1.2 5 422 1.5 5 976 1.7 5 458 1.5 5 664 1.6 5 043 1.4 5 208 1.4 5 412 1.5 5 103 1.4 4 207 1.1 132 938 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 86 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 17. AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 30 34 32 23 25 21 25 24 21 23 1 129 West Belgium 36 34 32 33 40 34 19 18 15 – 1 589 Centre Bulgaria 5 2 8 12 9 12 11 15 17 28 159 Centre Croatia 0 18 22 11 18 12 21 17 25 17 304 Centre Cyprus 5 3 2 4 5 5 10 6 3 1 140 Centre Czechia 10 15 15 16 13 19 24 29 19 17 330 West Denmark 15 13 13 11 10 11 7 8 9 8 1 759 East Estonia 0 0 1 0 1 0 1 1 0 0 29 West Finland 6 6 2 4 6 7 5 3 3 1 312 West France 252 244 194 207 155 159 132 133 143 114 28 778 West Germany 260 232 231 197 183 155 113 115 94 35 18 654 West Greece 64 55 51 53 44 63 55 49 46 29 2 162 Centre Hungary 23 24 37 29 37 33 41 29 47 37 738 West Iceland 0 0 0 0 0 0 1 0 0 3 47 West Ireland 13 17 13 8 12 11 7 10 4 2 415 West Italy 255 266 263 306 271 287 260 213 223 181 12 815 East Latvia 10 7 4 10 7 5 4 10 6 3 135 – Liechtenstein 0 0 0 0 1 0 0 0 0 0 2 East Lithuania 0 2 2 5 3 3 9 7 3 0 93 West Luxembourg 2 6 3 7 3 4 6 2 1 0 142 West Malta 0 1 0 1 1 0 2 0 0 0 44 West Netherlands 148 130 149 145 105 120 93 85 78 44 3 705 West Norway 9 9 10 15 18 4 4 2 6 3 523 Centre Poland 29 45 25 48 40 30 31 23 24 17 758 West Portugal 89 94 92 64 63 69 82 61 40 27 3 065 Centre Romania 13 13 8 17 25 19 24 28 25 35 306 Centre Slovakia 1 3 3 2 2 2 7 5 5 1 63 Centre Slovenia 7 7 9 7 10 10 6 3 6 2 158 West Spain 403 366 358 274 238 212 191 204 135 100 13 979 West Sweden – – – – – – – – – – 1 086 West United Kingdom 196 140 160 113 129 139 106 98 86 87 15 370 Total EU/EEA 1 881 1 786 1 739 1 622 1 474 1 446 1 297 1 198 1 084 815 108 789 Non-EU/EEA Centre Albania 1 5 6 6 8 8 3 1 1 2 63 West Andorra 0 1 0 2 0 1 0 0 0 – 7 East Armenia 2 2 2 4 7 1 3 4 6 7 44 East Azerbaijan 4 1 1 3 2 1 2 0 5 8 33 East Belarus 2 6 3 3 4 3 4 6 4 76 45 Centre Bosnia and Herzegovina 5 2 4 3 6 4 4 1 8 3 54 East Georgia 10 12 10 16 21 24 18 21 26 26 218 West Israel 6 8 7 10 14 4 2 6 2 2 334 East Kazakhstan 1 1 0 4 1 2 2 2 2 6 25 East Kyrgyzstan 0 0 0 0 0 0 0 0 0 1 2 West Monaco 0 0 0 0 1 0 0 0 0 – 22 Centre Montenegro 6 1 4 3 3 8 9 11 11 4 82 Centre North Macedonia 1 4 3 3 5 2 4 2 2 – 47 East Republic of Moldova 2 3 0 2 3 2 1 8 5 3 40 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 1 2 0 0 0 0 0 0 0 11 Centre Serbia 23 22 31 20 27 28 36 30 45 44 580 Centre Serbia excluding Kosovo1 23 21 30 19 27 26 36 30 43 41 565 Centre Kosovo1 1 1 1 2 2 3 15 West Switzerland 62 37 34 32 24 25 26 26 22 15 3 409 East Tajikistan 0 0 0 0 0 0 1 3 0 0 4 Centre Turkey 3 0 0 12 15 12 17 14 12 15 178 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 10 31 45 50 55 72 116 69 81 82 659 East Uzbekistan 0 – – – – – – – – – 1 Total non-EU/EEA 138 137 152 173 196 197 248 204 232 225 5 858 WHO European Region West West 1 846 1 694 1 646 1 505 1 342 1 326 1 136 1 057 928 674 109 357 Centre Centre 132 164 177 193 223 204 248 214 250 223 3 960 East East 41 65 68 97 104 113 161 131 138 143 1 328 Total WHO European Region 2 019 1 923 1 891 1 795 1 669 1 643 1 545 1 402 1 316 1 040 114 645 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 87 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 18. AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 14 13 28 14 21 18 10 10 1 6 904 West Belgium 3 4 1 3 7 1 0 1 0 – 288 Centre Bulgaria 10 17 39 29 26 11 14 17 20 18 215 Centre Croatia 1 1 1 0 0 1 0 2 0 0 26 Centre Cyprus 0 0 0 0 1 0 0 0 0 0 4 Centre Czechia 4 1 2 3 2 3 4 2 4 4 53 West Denmark 4 4 4 5 1 0 1 1 0 0 252 East Estonia 14 20 15 9 6 4 16 3 11 9 284 West Finland 3 0 4 2 0 0 1 1 3 0 60 West France 60 62 45 42 30 31 19 12 19 16 13 953 West Germany 36 41 42 31 26 21 18 13 18 4 4 429 West Greece 3 9 22 41 45 31 25 19 12 9 330 Centre Hungary 0 0 0 0 0 2 2 1 1 1 13 West Iceland 0 0 0 0 0 0 2 0 0 0 7 West Ireland 6 10 3 1 0 0 0 1 2 0 377 West Italy 229 195 180 179 114 101 89 89 78 70 35 267 East Latvia 70 57 70 62 73 51 36 38 30 32 1 022 – Liechtenstein 0 1 0 0 0 0 0 0 0 0 7 East Lithuania 20 9 22 19 16 15 19 23 14 11 278 West Luxembourg 0 1 0 1 1 1 0 1 0 0 46 West Malta 0 0 0 0 1 0 0 0 0 0 4 West Netherlands 8 9 3 4 1 4 4 3 3 2 381 West Norway 3 0 1 1 0 0 1 0 0 1 157 Centre Poland 70 62 59 46 32 34 23 23 10 8 1 601 West Portugal 240 165 165 115 68 47 41 39 22 13 9 553 Centre Romania 14 29 61 82 114 105 103 73 55 37 699 Centre Slovakia 0 0 0 0 0 0 0 0 1 0 2 Centre Slovenia 0 0 0 0 1 0 0 0 0 1 8 West Spain 432 366 301 195 135 87 66 59 44 25 50 514 West Sweden – – – – – – – – – – 242 West United Kingdom 22 12 11 9 13 9 10 5 9 6 1 512 Total EU/EEA 1 266 1 088 1 079 893 734 577 504 436 357 273 122 488 Non-EU/EEA Centre Albania 0 1 0 0 1 0 0 0 0 0 3 West Andorra 0 0 0 0 0 0 0 0 0 – 2 East Armenia 42 33 46 26 35 23 30 18 18 84 2 652 East Azerbaijan 183 148 160 123 109 92 76 52 51 60 1 421 East Belarus 208 266 242 193 150 139 130 116 60 14 2 582 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 18 East Georgia 184 191 161 142 120 99 110 86 50 61 1 982 West Israel 4 7 10 15 12 9 9 6 7 2 272 East Kazakhstan 174 149 152 158 149 154 173 168 192 185 2 395 East Kyrgyzstan 102 58 55 38 40 73 30 23 10 3 596 West Monaco 0 0 0 0 0 0 0 0 0 – 19 Centre Montenegro 0 0 1 0 0 0 0 0 0 0 4 Centre North Macedonia 0 0 0 0 0 0 0 0 0 – 9 East Republic of Moldova 95 102 39 54 42 46 39 31 35 23 1 068 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 0 0 0 0 0 0 0 0 0 6 Centre Serbia 7 12 5 9 5 5 5 1 2 662 Centre Serbia excluding Kosovo1 7 12 5 9 5 5 0 5 1 2 661 Centre Kosovo1 – – – – – – – – – – 1 West Switzerland 11 18 6 11 4 2 5 8 0 4 3 325 East Tajikistan 62 72 86 58 74 97 84 75 39 26 803 Centre Turkey 2 2 1 1 2 0 2 1 0 0 64 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 3 458 4 979 4 933 4 273 3 856 3 050 2 939 2 872 2 343 1 916 51 724 East Uzbekistan 131 – – – – – – – – – 380 Total non-EU/EEA 4 663 6 038 5 897 5 101 4 599 3 789 3 627 3 461 2 806 2 380 67 877 WHO European Region West West 1 078 916 826 669 479 362 301 268 218 158 121 900 Centre Centre 108 125 169 170 184 161 148 124 92 71 3 381 East East 4 743 6 084 5 981 5 155 4 670 3 843 3 682 3 505 2 853 2 424 65 077 Total WHO European Region 5 929 7 125 6 976 5 994 5 333 4 366 4 131 3 897 3 163 2 653 190 358 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 88 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 19. AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 31 29 35 27 34 29 22 22 26 21 971 West Belgium 77 53 68 54 65 50 39 25 27 – 2 635 Centre Bulgaria 14 20 15 20 25 22 17 17 17 22 377 Centre Croatia 0 6 4 6 5 2 1 1 5 2 155 Centre Cyprus 5 9 6 4 3 8 11 9 9 2 175 Centre Czechia 13 13 14 12 16 16 15 22 13 16 252 West Denmark 23 40 22 21 17 27 14 16 16 14 833 East Estonia 7 9 16 10 8 14 16 12 9 14 190 West Finland 12 15 10 12 9 6 16 11 9 11 275 West France 537 444 497 381 377 340 283 253 270 218 21 444 West Germany 128 155 132 129 117 109 107 83 73 19 4 508 West Greece 30 34 42 31 33 38 45 33 29 34 1 117 Centre Hungary 4 7 6 11 12 7 10 19 8 14 210 West Iceland 1 2 1 0 0 0 0 0 1 0 16 West Ireland 12 17 22 17 18 8 7 8 6 3 380 West Italy 561 504 517 502 452 424 451 416 336 266 18 432 East Latvia 36 34 55 37 59 58 51 49 46 46 655 – Liechtenstein 0 0 1 0 0 0 0 0 0 0 3 East Lithuania 11 9 13 15 17 16 18 18 16 9 196 West Luxembourg 6 5 4 2 5 4 4 3 3 3 126 West Malta 6 3 5 0 2 1 3 0 0 0 41 West Netherlands 128 92 108 88 84 87 80 69 54 24 2 511 West Norway 10 9 12 11 27 17 16 11 6 15 462 Centre Poland 53 45 37 35 34 33 18 17 18 17 736 West Portugal 423 388 355 330 244 216 242 181 184 121 9 436 Centre Romania 123 172 155 150 184 179 186 196 203 192 3 234 Centre Slovakia 1 1 3 4 2 3 3 3 2 0 40 Centre Slovenia 0 3 1 3 0 0 4 4 3 3 57 West Spain 448 418 380 272 212 199 185 168 126 96 16 419 West Sweden – – – – – – – – – – 666 West United Kingdom 387 241 244 202 200 222 159 133 136 140 11 033 Total EU/EEA 3 087 2 777 2 780 2 386 2 261 2 135 2 023 1 799 1 651 1 322 97 585 Non-EU/EEA Centre Albania 24 39 40 55 40 52 55 31 46 37 563 West Andorra 0 0 0 1 0 2 0 1 0 – 5 East Armenia 46 51 86 106 125 132 125 117 180 150 1 289 East Azerbaijan 42 44 68 57 85 93 76 112 120 124 982 East Belarus 246 305 348 344 309 333 367 312 313 279 3 858 Centre Bosnia and Herzegovina 1 4 0 3 1 2 3 2 3 5 84 East Georgia 134 180 184 139 123 145 137 145 189 177 1 943 West Israel 27 38 32 21 43 31 34 21 25 19 979 East Kazakhstan 65 81 76 82 93 97 157 168 231 232 1 459 East Kyrgyzstan 24 26 27 24 39 40 35 30 34 35 356 West Monaco 0 0 0 0 0 0 0 0 0 – 7 Centre Montenegro 2 1 2 1 3 1 6 2 2 3 60 Centre North Macedonia 3 3 6 6 10 4 3 0 1 – 92 East Republic of Moldova 232 327 196 217 210 208 275 186 286 226 2 872 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 0 0 0 0 0 0 0 0 0 5 Centre Serbia 12 17 9 9 11 12 7 17 18 16 455 Centre Serbia excluding Kosovo1 11 11 9 7 10 12 5 12 13 14 415 Centre Kosovo1 1 6 – 2 1 – 2 5 5 2 40 West Switzerland 85 69 52 54 32 33 28 27 28 26 2 793 East Tajikistan 41 59 72 90 112 146 124 151 146 91 1 096 Centre Turkey 26 37 35 41 58 39 28 30 37 35 762 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 2 264 3 944 4 873 4 875 5 806 5 250 5 708 6 243 6 306 5 443 57 486 East Uzbekistan 68 – – – – – – – – – 183 Total non-EU/EEA 3 342 5 225 6 106 6 125 7 100 6 620 7 168 7 595 7 965 6 898 77 329 WHO European Region West West 2 932 2 556 2 538 2 155 1 971 1 843 1 735 1 481 1 355 1 030 95 094 Centre Centre 281 377 333 360 404 380 367 370 385 364 7 252 East East 3 216 5 069 6 014 5 996 6 986 6 532 7 089 7 543 7 876 6 826 72 565 Total WHO European Region 6 429 8 002 8 885 8 511 9 361 8 755 9 191 9 394 9 616 8 220 174 911 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 89 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 20. AIDS diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 0 1 0 0 0 0 1 0 1 0 14 West Belgium 0 1 2 1 1 3 1 0 0 – 145 Centre Bulgaria 2 1 0 3 0 0 0 0 3 0 10 Centre Croatia 0 1 0 0 0 0 0 0 0 0 4 Centre Cyprus 0 0 0 0 0 0 0 0 0 0 2 Centre Czechia 0 0 0 0 0 0 1 0 0 0 1 West Denmark 1 0 0 1 0 0 0 1 0 0 26 East Estonia 0 0 0 0 0 0 0 0 0 0 2 West Finland 0 0 0 0 1 0 0 0 0 0 8 West France 5 8 10 10 4 5 5 4 7 3 802 West Germany 1 3 2 1 2 0 0 1 0 0 121 West Greece 1 0 0 0 0 0 0 0 0 0 24 Centre Hungary 0 0 1 0 0 1 0 2 1 0 8 West Iceland 0 0 0 0 0 0 0 0 1 0 1 West Ireland 1 0 0 1 0 0 0 0 0 0 36 West Italy 3 3 4 7 2 0 1 0 0 0 740 East Latvia 0 2 1 2 0 0 2 1 1 1 23 – Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 East Lithuania 0 0 0 1 0 0 0 0 0 0 1 West Luxembourg 0 0 1 0 0 0 0 0 0 0 4 West Malta 0 0 0 0 0 0 0 0 0 0 1 West Netherlands 8 4 2 5 3 4 0 1 2 0 115 West Norway 0 0 0 1 0 0 0 1 0 0 8 Centre Poland 1 3 1 0 1 1 0 0 1 0 70 West Portugal 1 2 1 3 1 1 3 1 1 1 129 Centre Romania 8 12 11 17 8 6 0 8 4 4 327 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 3 3 3 5 1 2 4 1 1 1 989 West Sweden – – – – – – – – – – 22 West United Kingdom 13 14 5 7 5 6 3 3 1 7 734 Total EU/EEA 48 58 44 65 29 29 21 24 24 17 4 369 Non-EU/EEA Centre Albania 0 1 2 4 0 0 0 1 0 1 11 West Andorra 0 0 0 0 0 0 0 0 0 – 0 East Armenia 1 1 0 4 7 2 0 2 3 1 28 East Azerbaijan 1 1 3 3 2 0 1 0 0 1 16 East Belarus 13 12 4 3 9 10 5 2 1 2 126 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 0 East Georgia 11 8 1 3 2 0 0 1 4 1 69 West Israel 1 1 1 1 0 0 0 0 1 0 40 East Kazakhstan 6 4 2 5 1 5 3 7 3 4 62 East Kyrgyzstan 0 3 4 1 0 5 1 2 1 2 22 West Monaco 0 0 0 0 0 0 0 0 0 – 0 Centre Montenegro 0 0 0 0 0 0 0 0 0 0 1 Centre North Macedonia 1 0 1 1 0 0 0 0 0 – 6 East Republic of Moldova 4 7 6 10 8 2 4 5 5 2 82 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 0 0 0 0 0 0 0 0 0 0 Centre Serbia 1 1 1 – 1 – – 1 – 29 Centre Serbia excluding Kosovo1 1 0 0 1 0 0 0 0 0 0 26 Centre Kosovo1 – – 1 – – 1 – – 1 – 3 West Switzerland 2 0 1 1 0 0 0 1 0 0 110 East Tajikistan 1 7 6 15 10 4 6 6 8 2 66 Centre Turkey 0 0 1 0 1 3 0 1 0 4 21 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 129 118 88 59 60 48 67 93 81 57 1 424 East Uzbekistan 8 – – – – – – – – – 22 Total non-EU/EEA 179 163 121 111 100 80 87 121 108 77 2 135 WHO European Region West West 40 40 32 44 20 21 18 14 15 12 4 069 Centre Centre 13 18 18 26 10 12 1 12 10 9 492 East East 174 163 115 106 99 76 89 119 107 73 1 943 Total WHO European Region 227 221 165 176 129 109 108 145 132 94 6 504 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 90 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 21. AIDS diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Sex between men 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 23 23 2 4 6 9 12 21 0 0 0 0 0 0 0 0 2 0 4 4 56 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 28 28 4 14 18 8 14 22 0 0 0 0 0 0 0 0 0 0 0 0 68 Bulgaria Centre Croatia 17 17 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 0 1 1 20 Croatia Centre Cyprus 1 1 0 0 0 1 1 2 0 0 0 0 0 0 0 0 0 0 0 0 3 Cyprus Centre Czechia 17 17 2 2 4 8 8 16 0 0 0 0 1 1 0 0 0 0 0 0 38 Czechia West Denmark 8 8 0 0 0 7 7 14 0 0 0 0 0 0 0 0 0 0 0 0 22 Denmark East Estonia 0 0 1 8 9 5 9 14 0 0 0 0 0 0 0 0 0 3 2 5 28 Estonia West Finland 1 1 0 0 0 4 7 11 0 0 0 0 1 1 0 0 0 2 3 5 18 Finland West France 109 114 1 15 16 91 126 218 1 2 3 0 0 0 1 1 2 18 58 77 430 France West Germany 35 35 1 3 4 13 6 19 0 0 0 0 0 0 0 0 0 5 11 16 74 Germany West Greece 29 29 1 8 9 19 15 34 0 0 0 0 0 0 0 0 0 3 11 14 86 Greece Centre Hungary 37 37 0 0 1 7 7 14 0 0 0 0 0 0 0 1 1 0 0 0 53 Hungary West Iceland 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 4 Iceland West Ireland 2 2 0 0 0 2 1 3 0 0 0 0 0 0 0 0 0 0 1 1 6 Ireland West Italy 181 181 12 58 70 85 181 266 0 0 0 0 0 0 0 0 0 8 46 54 571 Italy East Latvia 3 3 5 27 32 28 18 46 0 1 1 0 0 0 0 0 0 4 4 8 90 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 0 0 2 9 11 3 6 9 0 0 0 0 0 0 0 0 0 0 1 1 21 Lithuania West Luxembourg 0 0 0 0 0 2 1 3 0 0 0 0 0 0 0 0 0 0 0 0 3 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 42 44 1 1 2 11 13 24 0 0 0 1 1 2 0 0 0 5 16 21 93 Netherlands West Norway 3 3 1 1 5 10 15 0 0 0 0 0 0 0 0 0 0 0 0 19 Norway Centre Poland 17 17 1 7 8 6 11 17 0 0 0 0 0 0 0 0 0 8 35 43 85 Poland West Portugal 27 27 2 11 13 52 69 121 0 1 1 0 0 0 2 0 2 4 4 8 172 Portugal Centre Romania 35 35 3 34 37 72 120 192 3 1 4 0 0 0 0 0 0 8 6 14 282 Romania Centre Slovakia 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 3 Slovakia Centre Slovenia 2 2 1 0 1 3 0 3 0 0 0 0 0 0 0 0 0 0 1 1 7 Slovenia West Spain 100 100 7 18 25 37 59 96 0 1 1 0 0 0 0 0 0 2 27 29 251 Spain West Sweden – – – – – – – – – – – – – – – – – – – – – Sweden West United Kingdom 87 87 0 6 6 53 87 140 4 3 7 0 0 0 0– 2 2 7 20 27 269 United Kingdom Total EU/EEA 808 815 46 227 273 533 788 1 322 8 9 17 1 3 4 3 6 9 78 253 332 2 772 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 2 2 – – 0 14 23 37 – 1 1 – – 0 – – 0 – – 0 40 Albania West Andorra – – – – – – – – – – – – – – – – – – – – – Andorra East Armenia 7 7 – 14 14 44 106 150 1 – 1 1 – 1 – – 0 – – 0 173 Armenia East Azerbaijan 8 8 2 58 60 43 81 124 – 1 1 – – 0 – – 0 1 2 3 196 Azerbaijan East Belarus 7 7 20 64 84 118 161 279 – 2 2 – – 0 – – 0 1 7 8 380 Belarus Centre Bosnia and Herzegovina 3 3 – – 0 2 3 5 – – 0 – – 0 – – 0 – – 0 8 Bosnia and Herzegovina East Georgia 26 26 1 60 61 64 113 177 1 – 1 – – 0 – – 0 – – 0 265 Georgia West Israel 2 2 – 2 2 8 11 19 – – 0 – – 0 – – 0 – – 0 23 Israel East Kazakhstan 6 6 33 152 185 109 123 232 4 – 4 1 2 3 – – 0 7 4 11 441 Kazakhstan East Kyrgyzstan 1 1 3 3 16 19 35 2 2 – – 0 – – 0 4 1 5 46 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 4 4 – – 0 3 3 – – 0 – – 0 – – 0 – 3 3 10 Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 3 3 3 20 23 88 138 226 1 1 2 – – 0 – – 0 13 18 31 285 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 San Marino Centre Serbia – 0 – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Serbia Centre Serbia excluding Kosovo1 41 41 1 1 2 11 3 14 – – 0 – – 0 – – 0 3 8 11 68 Serbia excluding Kosovo1 Centre Kosovo1 3 3 0 1 1 2 – – 0 – – 0 – – 0 – – 0 5 Kosovo1 West Switzerland 15 15 – 4 4 9 17 26 – – 0 – – 0 – 1 1 – 13 13 59 Switzerland East Tajikistan 0 1 25 26 31 60 91 1 1 2 – – 0 1 – 1 9 12 21 141 Tajikistan Centre Turkey 15 15 – – 0 7 28 35 2 2 4 1 – 1 – – 0 10 47 57 112 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 82 82 254 1 662 1 916 2 566 2 877 5 443 23 34 57 – – 0 1 – 1 6 6 12 7 511 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 225 225 315 2 065 2 380 3 031 3 667 6 698 33 44 77 3 2 5 2 1 3 54 121 175 9 763 Total non-EU/EEA WHO European Region WHO European Region West West 667 674 27 131 158 407 622 1 030 5 7 12 1 2 3 3 6 9 55 214 270 2 156 West Centre Centre 223 223 12 59 71 142 222 364 5 4 9 1 1 2 0 0 1 29 103 132 802 Centre East East 143 143 322 2 102 2 424 3 115 3 711 6 826 31 42 73 2 2 4 2 0 2 48 57 105 9 577 East Total WHO European Region 1 033 1 040 361 2 292 2 653 3 664 4 555 8 220 41 53 94 4 5 9 5 7 12 132 374 507 12 535 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 91 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 21. AIDS diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Sex between men 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 23 23 2 4 6 9 12 21 0 0 0 0 0 0 0 0 2 0 4 4 56 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 28 28 4 14 18 8 14 22 0 0 0 0 0 0 0 0 0 0 0 0 68 Bulgaria Centre Croatia 17 17 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 0 1 1 20 Croatia Centre Cyprus 1 1 0 0 0 1 1 2 0 0 0 0 0 0 0 0 0 0 0 0 3 Cyprus Centre Czechia 17 17 2 2 4 8 8 16 0 0 0 0 1 1 0 0 0 0 0 0 38 Czechia West Denmark 8 8 0 0 0 7 7 14 0 0 0 0 0 0 0 0 0 0 0 0 22 Denmark East Estonia 0 0 1 8 9 5 9 14 0 0 0 0 0 0 0 0 0 3 2 5 28 Estonia West Finland 1 1 0 0 0 4 7 11 0 0 0 0 1 1 0 0 0 2 3 5 18 Finland West France 109 114 1 15 16 91 126 218 1 2 3 0 0 0 1 1 2 18 58 77 430 France West Germany 35 35 1 3 4 13 6 19 0 0 0 0 0 0 0 0 0 5 11 16 74 Germany West Greece 29 29 1 8 9 19 15 34 0 0 0 0 0 0 0 0 0 3 11 14 86 Greece Centre Hungary 37 37 0 0 1 7 7 14 0 0 0 0 0 0 0 1 1 0 0 0 53 Hungary West Iceland 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 4 Iceland West Ireland 2 2 0 0 0 2 1 3 0 0 0 0 0 0 0 0 0 0 1 1 6 Ireland West Italy 181 181 12 58 70 85 181 266 0 0 0 0 0 0 0 0 0 8 46 54 571 Italy East Latvia 3 3 5 27 32 28 18 46 0 1 1 0 0 0 0 0 0 4 4 8 90 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 0 0 2 9 11 3 6 9 0 0 0 0 0 0 0 0 0 0 1 1 21 Lithuania West Luxembourg 0 0 0 0 0 2 1 3 0 0 0 0 0 0 0 0 0 0 0 0 3 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 42 44 1 1 2 11 13 24 0 0 0 1 1 2 0 0 0 5 16 21 93 Netherlands West Norway 3 3 1 1 5 10 15 0 0 0 0 0 0 0 0 0 0 0 0 19 Norway Centre Poland 17 17 1 7 8 6 11 17 0 0 0 0 0 0 0 0 0 8 35 43 85 Poland West Portugal 27 27 2 11 13 52 69 121 0 1 1 0 0 0 2 0 2 4 4 8 172 Portugal Centre Romania 35 35 3 34 37 72 120 192 3 1 4 0 0 0 0 0 0 8 6 14 282 Romania Centre Slovakia 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 3 Slovakia Centre Slovenia 2 2 1 0 1 3 0 3 0 0 0 0 0 0 0 0 0 0 1 1 7 Slovenia West Spain 100 100 7 18 25 37 59 96 0 1 1 0 0 0 0 0 0 2 27 29 251 Spain West Sweden – – – – – – – – – – – – – – – – – – – – – Sweden West United Kingdom 87 87 0 6 6 53 87 140 4 3 7 0 0 0 0– 2 2 7 20 27 269 United Kingdom Total EU/EEA 808 815 46 227 273 533 788 1 322 8 9 17 1 3 4 3 6 9 78 253 332 2 772 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 2 2 – – 0 14 23 37 – 1 1 – – 0 – – 0 – – 0 40 Albania West Andorra – – – – – – – – – – – – – – – – – – – – – Andorra East Armenia 7 7 – 14 14 44 106 150 1 – 1 1 – 1 – – 0 – – 0 173 Armenia East Azerbaijan 8 8 2 58 60 43 81 124 – 1 1 – – 0 – – 0 1 2 3 196 Azerbaijan East Belarus 7 7 20 64 84 118 161 279 – 2 2 – – 0 – – 0 1 7 8 380 Belarus Centre Bosnia and Herzegovina 3 3 – – 0 2 3 5 – – 0 – – 0 – – 0 – – 0 8 Bosnia and Herzegovina East Georgia 26 26 1 60 61 64 113 177 1 – 1 – – 0 – – 0 – – 0 265 Georgia West Israel 2 2 – 2 2 8 11 19 – – 0 – – 0 – – 0 – – 0 23 Israel East Kazakhstan 6 6 33 152 185 109 123 232 4 – 4 1 2 3 – – 0 7 4 11 441 Kazakhstan East Kyrgyzstan 1 1 3 3 16 19 35 2 2 – – 0 – – 0 4 1 5 46 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 4 4 – – 0 3 3 – – 0 – – 0 – – 0 – 3 3 10 Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 3 3 3 20 23 88 138 226 1 1 2 – – 0 – – 0 13 18 31 285 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 San Marino Centre Serbia – 0 – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Serbia Centre Serbia excluding Kosovo1 41 41 1 1 2 11 3 14 – – 0 – – 0 – – 0 3 8 11 68 Serbia excluding Kosovo1 Centre Kosovo1 3 3 0 1 1 2 – – 0 – – 0 – – 0 – – 0 5 Kosovo1 West Switzerland 15 15 – 4 4 9 17 26 – – 0 – – 0 – 1 1 – 13 13 59 Switzerland East Tajikistan 0 1 25 26 31 60 91 1 1 2 – – 0 1 – 1 9 12 21 141 Tajikistan Centre Turkey 15 15 – – 0 7 28 35 2 2 4 1 – 1 – – 0 10 47 57 112 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 82 82 254 1 662 1 916 2 566 2 877 5 443 23 34 57 – – 0 1 – 1 6 6 12 7 511 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 225 225 315 2 065 2 380 3 031 3 667 6 698 33 44 77 3 2 5 2 1 3 54 121 175 9 763 Total non-EU/EEA WHO European Region WHO European Region West West 667 674 27 131 158 407 622 1 030 5 7 12 1 2 3 3 6 9 55 214 270 2 156 West Centre Centre 223 223 12 59 71 142 222 364 5 4 9 1 1 2 0 0 1 29 103 132 802 Centre East East 143 143 322 2 102 2 424 3 115 3 711 6 826 31 42 73 2 2 4 2 0 2 48 57 105 9 577 East Total WHO European Region 1 033 1 040 361 2 292 2 653 3 664 4 555 8 220 41 53 94 4 5 9 5 7 12 132 374 507 12 535 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 92 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 22. The most common AIDS-indicative diseases diagnosed in 2019,a ordered by frequency Diseases Men Women Children TotalN % N % N % N % EU/EEA Pneumocystis carinii pneumonia 567 21.5 178 21.1 2 4.9 747 21.2 Wasting syndrome due to HIV 307 11.6 88 10.4 10 24.4 405 11.5 Candidiasis; oesophageal 309 11.7 90 10.7 2 4.9 401 11.4 Kaposi's sarcoma 287 10.9 36 4.3 0 0.0 323 9.2 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 180 6.8 77 9.1 2 4.9 259 7.3 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 157 5.9 42 5.0 3 7.3 202 5.7 Toxoplasmosis of brain in a patient over 1 month of age 102 3.9 69 8.2 2 4.9 173 4.9 Mycobacterium tuberculosis; extrapulmonary 102 3.9 47 5.6 0 0.0 149 4.2 Encephalopathy; HIV-related 101 3.8 35 4.1 6 14.6 142 4.0 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 54 2.0 22 2.6 4 9.8 80 2.3 Non-EU/EEA Wasting syndrome due to HIV 247 16.0 123 18.6 18 26.5 388 17.1 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 244 15.9 72 10.9 8 11.8 324 14.3 Candidiasis; oesophageal 216 14.0 81 12.3 5 7.4 302 13.3 Pneumocystis carinii pneumonia 146 9.5 57 8.6 10 14.7 213 9.4 Mycobacterium tuberculosis; extrapulmonary 133 8.6 39 5.9 0 0.0 172 7.6 Encephalopathy; HIV-related 78 5.1 42 6.4 4 5.9 124 5.5 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 41 2.7 21 3.2 5 7.4 67 3.0 Kaposi's sarcoma 42 2.7 7 1.1 0 0.0 49 2.2 Herpes simplex: chronic ulcer(s) (> 1 month duration); or bronchitis; pneumonitis; or oesophagitis in a patient over 1 month of age 20 1.3 10 1.5 5 7.4 35 1.5 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 22 1.4 9 1.4 3 4.4 34 1.5 West Pneumocystis carinii pneumonia 489 23.5 147 24.0 1 10.0 637 23.6 Candidiasis; oesophageal 254 12.2 68 11.1 0 0.0 322 11.9 Kaposi's sarcoma 262 12.6 36 5.9 0 0.0 298 11.0 Wasting syndrome due to HIV 180 8.7 41 6.7 1 10.0 222 8.2 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 146 7.0 41 6.7 1 10.0 188 7.0 Toxoplasmosis of brain in a patient over 1 month of age 91 4.4 51 8.3 0 0.0 142 5.3 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 94 4.5 38 6.2 0 0.0 132 4.9 Mycobacterium tuberculosis; extrapulmonary 81 3.9 40 6.5 0 0.0 121 4.5 Encephalopathy; HIV-related 71 3.4 16 2.6 0 0.0 87 3.2 Lymphoma; Burkitt (or equivalent term) 47 2.3 13 2.1 0 0.0 60 2.2 Centre Wasting syndrome due to HIV 162 21.0 58 22.6 9 23.7 229 21.4 Pneumocystis carinii pneumonia 105 13.6 29 11.3 1 2.6 135 12.6 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 87 11.3 35 13.6 2 5.3 124 11.6 Candidiasis; oesophageal 79 10.2 27 10.5 2 5.3 108 10.1 Encephalopathy; HIV-related 42 5.4 19 7.4 6 15.8 67 6.3 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 30 3.9 15 5.8 3 7.9 48 4.5 Kaposi's sarcoma 44 5.7 2 0.8 0 0.0 46 4.3 Toxoplasmosis of brain in a patient over 1 month of age 15 1.9 15 5.8 2 5.3 32 3.0 Mycobacterium tuberculosis; extrapulmonary 23 3.0 7 2.7 0 0.0 30 2.8 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 23 3.0 3 1.2 3 7.9 29 2.7 East Wasting syndrome due to HIV 212 16.0 112 17.6 18 29.5 342 16.9 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 243 18.3 76 11.9 8 13.1 327 16.1 Candidiasis; oesophageal 192 14.5 76 11.9 5 8.2 273 13.5 Pneumocystis carinii pneumonia 119 9.0 59 9.3 10 16.4 188 9.3 Mycobacterium tuberculosis; extrapulmonary 131 9.9 39 6.1 0 0.0 170 8.4 Encephalopathy; HIV-related 66 5.0 42 6.6 4 6.6 112 5.5 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 30 2.3 18 2.8 5 8.2 53 2.6 Toxoplasmosis of brain in a patient over 1 month of age 14 1.1 15 2.4 0 0.0 29 1.4 Kaposi's sarcoma 23 1.7 5 0.8 0 0.0 28 1.4 Progressive multifocal leukoencephalopathy 19 1.4 8 1.3 0 0.0 27 1.3 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. 93 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 23. AIDS-related deaths,a by geographic area, country and year of death (2010–2019) and cumulative totals in EU/EEA and other countries of the WHO European Region Area Country, territory or areab Year of diagnosis Cumulative totalc2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 40 39 34 41 42 37 32 43 40 24 1 662 West Belgium 19 31 30 37 35 23 29 26 14 2 136 Centre Bulgaria 14 17 16 14 13 8 9 10 9 17 209 Centre Croatia 7 6 9 7 5 15 3 2 2 4 202 Centre Cyprus 3 4 5 5 4 4 5 3 3 2 132 Centre Czechia 10 14 17 13 15 12 18 20 18 7 311 West Denmark 3 6 2 4 0 1 2 – – 2 020 East Estonia 2 7 5 2 2 2 2 4 4 1 121 West Finland 10 6 13 8 5 6 5 9 6 1 238 West France 210 173 158 134 127 103 129 123 174 139 37 067 West Germany 117 126 87 111 101 76 77 71 71 34 14 970 West Greece 48 50 52 43 47 50 42 43 40 36 1 939 Centre Hungary 15 17 11 11 19 11 11 9 18 19 459 West Iceland 0 1 1 0 0 0 1 0 0 0 40 West Ireland 5 4 1 0 0 1 1 1 0 0 417 West Italy 645 644 636 653 573 561 533 511 – – 45 861 East Latvia 57 80 88 107 75 45 41 37 29 30 898 – Liechtenstein 0 0 0 0 0 0 0 0 0 0 6 East Lithuania 12 9 10 18 16 12 23 15 14 5 241 West Luxembourg 1 5 7 3 2 4 4 1 1 4 152 West Malta 0 1 2 0 1 1 3 0 0 0 65 West Netherlands 70 92 89 85 89 90 100 90 82 63 2 074 West Norway 0 1 1 2 3 2 0 2 1 1 634 Centre Poland 53 68 57 48 42 41 27 20 23 15 1 428 West Portugal 338 308 260 273 208 176 189 167 155 91 10 793 Centre Romania 134 216 188 199 239 196 193 190 175 151 4 915 Centre Slovakia 1 1 3 0 0 4 2 1 3 2 51 Centre Slovenia 2 1 2 7 4 6 3 2 1 2 119 West Spain 458 428 375 311 234 185 179 110 76 24 48 991 West Sweden – – – – – – – – – – 1 323 West United Kingdom 313 161 157 161 151 117 106 110 96 101 16 690 Total EU/EEA 2 587 2 516 2 316 2 297 2 052 1 789 1 769 1 621 1 055 774 196 164 Non-EU/EEA Centre Albania 12 11 13 10 13 13 12 4 11 8 184 West Andorra 0 0 0 0 0 3 0 0 0 – 4 East Armenia 23 26 36 45 50 62 53 74 61 59 643 East Azerbaijan 46 44 50 39 51 38 31 26 22 75 1 057 East Belarus 146 159 188 129 170 126 119 80 110 127 3 638 Centre Bosnia and Herzegovina 0 0 0 2 1 4 2 0 2 2 68 East Georgia 80 97 83 82 68 70 132 96 100 77 1 303 West Israel 25 33 31 31 33 26 29 14 14 8 1 035 East Kazakhstan 192 205 189 189 160 207 235 255 283 305 3 045 East Kyrgyzstan 26 19 19 6 9 38 20 27 23 12 318 West Monaco 0 0 0 0 0 0 0 0 0 – 18 Centre Montenegro 5 2 1 1 2 6 2 4 2 4 60 Centre North Macedonia 1 4 0 3 0 0 0 2 1 – 67 East Republic of Moldova 85 98 67 90 98 83 91 82 37 54 1 109 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 0 0 0 0 0 0 0 0 0 8 Centre Serbia 26 33 21 18 10 16 13 14 25 23 1 203 Centre Serbia excluding Kosovo1 26 31 17 17 10 15 10 14 24 21 1 155 Centre Kosovo1 2 4 1 – 1 3 – 1 2 48 West Switzerland 23 13 3 4 5 5 1 4 2 1 5 905 East Tajikistan 55 58 95 94 95 126 128 185 144 108 1 179 Centre Turkey 0 0 0 10 11 4 4 5 8 4 120 East Turkmenistan 0 0 0 – – – – – – – 1 East Ukraine 3 096 3 736 3 870 3 514 3 426 3 032 3 253 3 298 3 448 2 977 51 433 East Uzbekistan 66 – – – – – – – – – 323 Total non-EU/EEA 3 907 4 538 4 666 4 267 4 202 3 859 4 125 4 170 4 293 3 755 71 170 WHO European Region West West 2 325 2 122 1 939 1 901 1 656 1 467 1 462 1 325 772 527 194 042 Centre Centre 283 394 343 348 378 340 304 286 301 260 9 528 East East 3 886 4 538 4 700 4 315 4 220 3 841 4 128 4 179 4 275 3 830 65 309 Total WHO European Region 6 494 7 054 6 982 6 564 6 254 5 648 5 894 5 790 5 348 4 618 268 879 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 persons (ever) diagnosed with AIDS were included. Spain has changing national coverage of AIDS reporting during the period (see Annex 5) and trends should be interpreted with caution. b Country-specific comments are in Annex 5. c Cumulative total is the total number of deaths reported by country since the start of reporting. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 94 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 24. Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2010–2019) and number of tests per 1000 population in 2019, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Number of HIV tests Tests/1 000 population2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria – – – – – – – – – – – West Belgium 651 095 679 655 703 486 695 433 697 684 692 679 726 457 714 382 729 603 – – Centre Bulgaria 160 000 180 000 190 000 – 230 000 290 000 – – 360 000 360 000 51.4 Centre Croatia – – – – – – – – – – – Centre Cyprus 48 385 49 074 54 120 50 235 – – 52 385 – – – – Centre Czechia 353 507 334 569 349 205 341 583 349 448 345 274 350 234 351 650 353 425 359 327 33.7 West Denmark 168 923 137 877 134 709 – – – – – – – – East Estonia 78 054 85 025 73 367 82 279 82 266 87 587 90 136 102 863 112 487 125 273 94.6 West Finland – – – – – – – – – – – West France 5 007 171 5 238 567 5 251 272 5 239 389 5 282 844 5 390 760 5 503 259 5 614 818 5 828 267 6 170 133 92.1 West Germany – – – – – – – – – – – West Greeceb 31 070 31 918 34 622 32 241 240 116 192 150 196 257 176 966 187 627 – – Centre Hungary 89 137 84 464 93 060 95 861 93 289 91 793 – – – – – West Iceland 7 318 – – – – – – – – – – West Irelandb 180 055 184 521 175 488 150 597 168 028 178 267 192 956 223 609 239 571 – – West Italy – – – – – – – – – – – East Latvia 58 826 58 799 60 491 58 302 60 614 65 552 79 715 82 608 90 368 98 651 51.4 – Liechtenstein – – – – – – – – – – – East Lithuania 178 554 102 234 101 042 102 161 108 781 105 486 104 132 113 917 109 825 133 810 47.9 West Luxembourg – – – – – – 71 200 100 529 – – – West Malta – – – – – – – – – – – West Netherlands – – – – – – – – – – – West Norway – – – – – – – – – – – Centre Poland 229 783 317 286 358 953 313 341 272 102 318 458 440 365 430 266 382 953 421 039 11.1 West Portugalb – – – – – – – – 257 485 – – Centre Romania 306 679 293 204 302 898 332 422 346 032 360 893 338 898 323 468 334 410 17.2 Centre Slovakia 109 261 110 025 110 506 114 574 126 187 127 109 104 876 111 340 177 498 Centre Slovenia 36 977 38 110 33 602 33 457 35 498 34 366 35 788 37 315 38 570 40 462 19.4 West Spain – – – – – – – – – – – West Sweden – – – – – – – – – – – West United Kingdom – – – – – – – – – – – Non-EU/EEA Centre Albania 2 168 3 260 3 140 3 063 4 156 5 442 5 582 7 149 – 13 261 4.6 West Andorra 2 678 2 590 2 062 2 310 2 378 2 212 2 340 2 591 2 712 – – East Armenia 60 731 68 449 71 957 83 431 94 122 117 012 99 270 119 628 132 509 164 933 55.8 East Azerbaijan 353 772 365 090 514 434 482 282 612 860 714 621 500 469 657 704 753 568 – – East Belarus 517 625 621 780 683 125 770 136 1 157 072 1 249 712 1 464 386 1 514 635 1 627 169 1 488 199 157.4 Centre Bosnia and Herzegovina 20 793 – – – – – – – – – – East Georgia 25 370 21 799 15 562 18 091 86 290 78 261 119 868 207 175 188 142 441 119 110.4 West Israel 286 995 274 294 233 516 – – – – – – – – East Kazakhstan 1 786 289 1 897 476 2 026 174 2 127 136 2 190 757 2 388 347 2 587 065 2 742 741 2 760 324 2 877 706 155.1 East Kyrgyzstan 297 959 381 295 470 355 370 160 410 331 376 284 331 609 376 431 356 765 384 988 60.0 West Monaco – – – – – – – – – – – Centre Montenegro 6 492 6 914 6 781 6 970 6 571 6 607 6 324 5 606 6 890 6 575 10.5 Centre North Macedonia 18 721 17 811 18 105 24 562 27 430 28 601 30 211 36 248 – – – East Republic of Moldova 207 018 207 830 212 964 146 105 133 476 146 762 124 010 160 947 154 575 182 196 45.1 East Russian Federationb 25 982 486 25 812 467 27 286 151 28 327 314 29 878 681 30 750 547 32 855 597 36 445 059 40 485 246 47 206 251 323.6 West San Marino 5 090 3 961 3 845 4 004 3 427 1 548 3 600 3 685 3 411 2 200 65.0 Centre Serbia – – – – – – – – – – – Centre Serbia excluding Kosovo1 51 727 56 086 64 031 65 829 56 282 61 877 65 827 76 367 76 653 88 490 12.6 Centre Kosovo1 1 141 1 189 1 335 1 250 – 1 312 2 599 4 551 4 877 2 018 1.1 West Switzerland – – – – – – – – – – – East Tajikistan 280 281 438 532 447 636 514 701 634 791 597 426 509 092 612 123 – 1 062 509 114.0 Centre Turkey 5 010 334 5 693 965 5 952 148 6 515 931 6 663 547 7 203 959 6 263 020 7 107 551 7 457 674 9 123 920 109.4 East Turkmenistan – – – – – – – – – – – East Ukraine 2 319 946 2 392 970 2 343 099 2 941 748 1 853 626 1 695 926 1 697 479 1 816 023 1 868 565 1 961 711 46.7 East Uzbekistan 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 refers only to those requested at public primary health-care centres and does not include those requested in hospitals and the private sector. Number of tests in Ireland includes antenatal tests in the total and, for 2018, include community-based rapid testing. HIV tests in the Russian Federation include blood donors. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). Maps 96 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Map 1. New HIV diagnoses, per 100 000 population, 2019 Andorra Luxembourg Malta Monaco San Marino < 2 2 to < 10 10 to < 20 20 to < 50 > 50 Missing or excluded data Note: all data presented were reported to ECDC/the WHO Regional Office for Europe through the European Surveillance System (TESSy). 97 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Map 2. New HIV diagnoses in men, per 100 000 male population, 2019 Andorra Luxembourg Malta Monaco San Marino < 2 2 to < 10 10 to < 20 20 to < 50 > 50 Missing or excluded data Map 3. New HIV diagnoses in women, per 100 000 female population, 2019 Andorra Luxembourg Malta Monaco San Marino < 2 2 to < 10 10 to < 20 20 to < 50 > 50 Missing or excluded data 98 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Map 5. New HIV diagnoses acquired through injecting drug use, per 100 000 population, 2019 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, 2019 Andorra Luxembourg Malta Monaco San Marino < 1 1 to < 3 3 to < 5 > 5 Missing or excluded data 99 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT 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, 2019 Map 7. Percentage of adult (> 14 years) HIV diagnoses with CD4 < 350 cells/mm3 at diagnosis, 2019 Andorra Luxembourg Malta Monaco San Marino < 30 30 to < 40 40 to < 50 > 50 Missing or excluded data 100 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Map 8. AIDS diagnoses reported, per 100 000 population, 2019 Andorra Luxembourg Malta Monaco San Marino < 1 1 to < 3 3 to < 5 > 5 Missing or excluded data Annexes

103 HIV/AIDS surveillance in Europe 2020 – 2019 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 surveillance to work on reporting surveillance data to the joint European Centre for Disease Prevention and Control (ECDC) and 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 or 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. Since 2016, the case definitions have been changed in the Russian Federation. Updated Forms (N61) of the Federal Statistical Surveillance are submitted by medical facilities to the Ministry of Health and include the number of individuals newly diagnosed with HIV infection; 2009–2015 data therefore cannot directly be compared to 2016–2019. A built-in set of validation rules in TESSy ensures verification of the data within the database during the data-uploading process, improving 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 considered of sufficient quality to be used for analysis. Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and Uzbekistan did not report any HIV data through the TESSy system for 2019 (or previous years for some of the countries, see Table 1). Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan did not report any AIDS data for 2019 (or previous years for some of the countries, see Table 14). 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 well as by the quality and coverage of national surveillance. During the early part of the period covered in this report (2010–2019) in particular, 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 2019 The 2019 data submission for HIV and AIDS surveillance took place between 15 March and 11 October 2020. Data presented in this report were extracted from the joint database on 11 October 2020. Individual country datasets Data were uploaded, validated and approved in the joint database for HIV/AIDS surveillance by the reporting countries. Once the data were submitted, individual datasets were reviewed by ECDC and the WHO 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 countries used the joint record type for combined HIVAIDS 2019 reporting, and an additional two used it for HIV-only reporting – an increase on the 33 countries that used it when initially it was implemented in 2014. The joined record type allows understanding of the relationship between the HIV and AIDS events and diagnosis dates. Of the 40 countries that used the joined record type, 27 uploaded all historical data in the new format, allowing for retrospective updates of missing variables, de-duplication of cases, or reporting on outcomes such as death. The remaining countries using the new format uploaded only 2019 data, or data for a few years. Additional details on record type used per country can be found in Annexes 4a and 4b. 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 datasets, reducing the amount of data that can be presented in certain tables and figures. Annex 1. Framework for data collection, validation and presentation 104 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data 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 six countries: Armenia, Belarus, Georgia, Kazakhstan, San Marino 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 10 (stratified by reporting country) and Table 11 (all countries stratified by mode of transmission). Origin of reported cases Cases originating from countries outside of the reporting country are highlighted in some of the analyses 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 10, 11 and in selected figures). As most of the cases originating 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 (2019) and, to a lesser extent, for the two to three years prior to the reporting period. To provide a more precise picture 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. Due to the unprecedented situation of the COVID-19 pandemic, which some European countries report has affected their surveillance capacity and systems from early 2020, the previous approach to adjusting for reporting delay may not fully address additional delays that have arisen as a result of the pandemic. Countries were excluded from reporting delay adjustment when: • they showed an inconsistent and non-stationary pattern in their reporting delay distribution during the period 2010–2019; or • they reported aggregated data during the period 2010–2019. 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 countries with the number of reported diagnoses adjusted for reporting delay are presented in Annex 6. Missing transmission data Data on missing transmission were imputed for EU/EEA countries to provide a more precise picture of trends by transmission mode. This was done following a method described by Rosinska et al. (4) using the ECDC HIV Estimates Accuracy Tool (5). Imputed trends are presented in Fig. 1.13. 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 an additional three countries (Iceland, Liechtenstein and Norway) which are included in the overview of the EU/EEA. Because the report reflects data for 2019, the United Kingdom is presented as part of the EU/EEA. The tables are presented for EU/EEA countries, non- EU/EEA countries and as totals. The 53 Member States of the WHO European Region are also subdivided into three geographical areas, based on epidemiological considerations 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 therefore may not always equal the EU/EEA and non-EU/ EEA totals. Data from Serbia include HIV cases notified in Kosovo33 in all figures although these are stratified in 33 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 105 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT 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.b • Centre, 15 countries: Albania, Bosnia and Herzegovina, Bulgaria,a Croatia,a Cyprus,a Czechia,a Hungary,a Montenegro, North Macedonia, Poland,a Romania,a Serbia, Slovakia,a Slovenia,a 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 2020. b The United Kingdom left the European Union on 31 January 2020. 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 2019 were derived from Eurostat for all EU/EEA countries and from the United Nations Population Division for non-EU/EEA countries (6). The Eurostat data are from May 2020 (7) and the United Nations Population Division statistics are from the 2019 round of estimates (8). 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 historically (see Annex 5 for details). Rates for data presented by gender and age were calculated 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 in that given table. 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 2010–2019, countries reporting data inconsistently (Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and 106 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Uzbekistan) and those reporting on transmission mode inconsistently or incompletely (such as Malta, Poland and Turkey) were excluded from relevant figures reporting trends by transmission mode. Countries with varying geographic coverage of the national surveillance system over time (Italy and Spain) were also excluded from graphs showing HIV trends but are included in graphs presenting rates per population. AIDS trends for 2010–2019 excluded countries not reporting consistently over the period (Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan, Uzbekistan). When presenting trends for AIDS deaths, only countries reporting consistently were included (Andorra, Belgium, Denmark, Italy, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan were not included in the presentation of trends for AIDS). 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 underreporting and reporting delay may influence the country figures and rankings presented in the report. The data in the report for recent years 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 reporting 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, patterns 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 donations) 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 underascertainment bias. Few European countries have evaluated their surveillance systems for underreporting and published the results (9). Previous estimates of underreporting range from 0% to 41% for AIDS cases (Francoise Cazein, Sante Publique France, personal communication, 2020), while national estimates of underreporting for HIV can range from 10% (Iceland and Italy) to around 40% (Germany and the United Kingdom) (10). Estimates on the underreporting of AIDS-related deaths are not available, but according to a country survey from 2006, only about a third of countries were able to comprehensively link HIV and AIDS surveillance death registries with national statistics or death certificate information, which results in underreporting of AIDS-related deaths (Francoise Cazein, Sante Publique France, personal communication, 2020). References34 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. European Commission decision 2002/253/EC laying down case defi- nitions for reporting communicable diseases to the Community net- work 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=1700359 (https://doi.org/10.2807/1560- 7917.ES.2018.23.23.1700359). 5. HIV estimates accuracy tool. In: European Centre for Disease Prevention and Control [website]. Stockholm: ECDC; 2018 (https:// ecdc.europa.eu/en/publications-data/hiv-estimates-accuracy-tool). 6. World population prospects: the 2019 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2019 (https://population.un.org/ wpp/). 7. Eurostat [online database]. Brussels: Eurostat; undated (http:// ec.europa.eu/eurostat/data/database). 8. World population prospects: the 2019 revision, medium variant. In: United Nations Department of Economic and Social Affairs, Population Division [website]. New York (NY): United Nations Department of Economic and Social Affairs, Population Division; 2019 (https://population.un.org/wpp/). 9. 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). 10. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire (French National Institute of Health Surveillance); 2007. 34 All weblinks were accessed on 12 November 2020. 107 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Annex 2 Table A2.1. Completeness of variables for data reported in 2018 and 2019 Variables 2018 2019 Number of countries Completeness % Minimal Maximal Number of countries Completeness % Minimal Maximal EU/EEA countries Age 30 99.7 84.9 100.0 29 99.7 78.8 100.0 Gender 30 99.4 88.6 100.0 29 99.5 87.5 100.0 Date of diagnosis 30 100.0 100.0 100.0 29 100.0 100.0 100.0 Date of notification 28 88.1 80.1 100.0 27 88.6 88.6 100.0 Transmission 30 80.3 32.8 100.0 28 76.4 27.8 100.0 Country of birth 23 52.6 30.4 100.0 22 47.8 30.8 100.0 Region of origin 24 81.8 52.1 100.0 23 78.7 45.0 100.0 CD4 cell counta 26 67.0 14.9 97.5 25 61.8 3.9 98.2 Probable country of infection 22 42.1 2.5 99.5 21 40.0 4.0 99.4 WHO European Region Age 51 40.2 40.2 100.0 47 41.3 41.3 100.0 Gender 52 99.5 38.0 100.0 48 99.9 87.5 100.0 Date of diagnosis 52 100.0 100.0 100.0 48 100.0 100.0 100.0 Date of notification 48 38.0 38.0 100.0 45 39.3 39.3 100.0 Transmission 50 34.8 32.8 100.0 46 35.1 27.8 100.0 Country of birth 41 19.8 19.8 100.0 38 19.2 19.2 100.0 Region of origin 43 34.5 34.5 100.0 40 35.1 35.1 100.0 CD4 cell counta 46 29.0 14.9 100.0 43 29.3 3.9 98.2 Probable country of infection 34 14.6 2.5 100.0 32 14.4 4.0 100.0 a CD4 completeness is calculated on all new diagnoses; Table 13 (see Tables section) completeness calculations are restricted to new diagnoses in countries reporting the variables CD4Cells or FirstCD4Count. 108 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Annex 3 Table A3.1. Completeness by country and variable, 2019 Area Country, territory or areaa Date of diagnosis Age Gender Transmission CD4 cell count Country of birth/region of originb EU/EEA West Austria 100.0 100.0 100.0 89.8 98.2 99.6 West Belgium – – – – – – Centre Bulgaria 100.0 100.0 100.0 100.0 89.5 100.0 Centre Croatia 100.0 100.0 100.0 94.1 3.9 98.0 Centre Cyprus 100.0 100.0 100.0 92.0 94.0 100.0 Centre Czechia 100.0 100.0 100.0 96.8 95.0 100.0 West Denmark 100.0 100.0 100.0 100.0 70.5 100.0 East Estonia 100.0 100.0 100.0 64.0 26.4 68.5 West Finland 100.0 100.0 100.0 63.8 77.9 91.3 West France 100.0 100.0 100.0 60.4 52.2 67.2 West Germany 100.0 99.6 99.9 76.9 29.0 90.6 West Greece 100.0 100.0 100.0 81.6 70.3 98.7 Centre Hungary 100.0 82.5 94.2 82.4 0.0 0.0 West Iceland 100.0 100.0 100.0 85.7 71.4 100.0 West Ireland 100.0 100.0 99.4 46.9 13.5 51.4 West Italy 100.0 94.2 100.0 90.5 87.9 99.5 East Latvia 100.0 100.0 100.0 58.0 16.3 0.0 – Liechtenstein – – – – – – East Lithuania 100.0 100.0 100.0 84.1 70.2 100.0 West Luxembourg 100.0 97.9 100.0 97.9 68.8 97.9 West Malta 100.0 79.7 87.5 0.0 0.0 100.0 West Netherlands 100.0 100.0 97.5 88.1 91.3 99.3 West Norway 100.0 100.0 100.0 100.0 0.0 100.0 Centre Poland 100.0 97.5 99.5 27.8 0.0 45.0 West Portugal 100.0 100.0 100.0 96.3 78.1 97.8 Centre Romania 100.0 100.0 100.0 99.6 97.4 99.4 Centre Slovakia 100.0 100.0 100.0 78.2 35.6 89.1 Centre Slovenia 100.0 100.0 100.0 94.1 85.3 97.1 West Spain 100.0 99.9 100.0 91.5 87.6 93.8 West Sweden 100.0 100.0 100.0 87.5 81.5 98.0 West United Kingdom 100.0 100.0 99.8 83.9 84.7 86.2 Non-EU/EEA Centre Albania 100.0 100.0 100.0 100.0 39.6 100.0 West Andorra – – – – – – East Armenia 100.0 100.0 100.0 99.6 89.5 100.0 East Azerbaijan 100.0 100.0 100.0 95.0 78.8 100.0 East Belarus 100.0 100.0 100.0 98.9 85.7 100.0 Centre Bosnia and Herzegovina 100.0 100.0 100.0 100.0 93.3 100.0 East Georgia 100.0 100.0 100.0 99.1 89.5 100.0 West Israel 100.0 99.7 100.0 75.2 56.6 100.0 East Kazakhstan 100.0 100.0 100.0 96.9 75.3 100.0 East Kyrgyzstan 100.0 100.0 100.0 84.9 68.8 99.8 West Monaco – – – – – – Centre Montenegro 100.0 100.0 100.0 73.1 84.6 100.0 Centre North Macedonia – – – – – – East Republic of Moldova 100.0 100.0 100.0 83.5 81.2 100.0 East Russian Federation 100.0 – 100.0 – – – West San Marino – – – – – – Centre Serbia 100.0 100.0 100.0 92.9 90.5 100.0 Centre Serbia excluding Kosovo1 100.0 100.0 100.0 92.9 90.5 100.0 Centre Kosovo1 100.0 100.0 100.0 100.0 60.0 100.0 West Switzerland 100.0 99.7 98.3 71.0 65.3 81.7 East Tajikistan 100.0 100.0 100.0 86.9 55.1 – Centre Turkey 100.0 100.0 100.0 42.5 15.2 98.0 East Turkmenistan – – – – – – East Ukraine 100.0 100.0 100.0 99.9 91.8 100.0 East Uzbekistan – – – – – – a Completeness not computed on countries, territories or areas with fewer than five diagnoses reported in 2019 (Liechtenstein and San Marino) or countries that reported in the aggregated record type which did not allow reporting of all variables (Russian Federation). b Completeness provided is based on country of birth, region of origin or, for Italy and Switzerland, country of nationality. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 109 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Annex 4a Table A4a.1. HIV surveillance system overview: data source information Country, territory or area HIV data source Record typea for 2018 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-HIV HIVAIDS 1980–2019 V Co – Belgium BE-HIV/AIDS HIVAIDS 1985–2018 V Co Did not report 2019 data Bulgaria BG-HIV HIVAIDS 1986–2019 C Co HIV aggregate record type used through 2006; HIV record type 2007–2013 Cyprus CY-HIV/AIDS HIVAIDS 1986–2019 C Co – Croatia HR-CNIPH HIVAIDS 1985–2019 C Co HIV record type used prior to 2016 Czechia CZ-HIV/AIDS HIVAIDS 1985–2019 C Co – Denmark DK-HIV HIVAIDS 1990–2019 C Co HIV record type used 1990–2013 Estonia EE-NAKIS HIVAIDS 1988–2019 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 1980–2019 C Co HIV record type used prior to 2016 France FR-HIVAIDS HIVAIDS 2003–2019 C Co Although compulsory, HIV diagnoses are not exhaustively reported; underreporting was estimated at 31% in 2018 Germany DE-SURVNET@RKI7.3-HIV 1993–2019 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 1984–2019 C Co – Hungary HU-HIV/AIDS HIVAIDS 1985–2019 C Co – Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1983–2019 C Co HIV record type used prior to 2017 Ireland IE-CIDR HIVAIDS 1985–2019 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 1985–2019 C Co See country comments about historical coverage; HIV aggregate record type used through 2009 Latvia LV-HIV/AIDS HIVAIDS 1987–2019 C Co HIV record type used 1987–2013; HIVAIDS record type used from 2014 Liechtenstein CH-SFOPH-LI HIV 1985–2019 V NS/unk Cases reported through Switzerland's surveillance system using another data source Lithuania LT-AIDS_CENTRE HIVAIDS 1988–2019 C Co – Luxembourg LU-HIVAIDS HIVAIDS 1983–2019 V Co – Malta MT-DISEASE_SURVEILLANCE HIVAIDS 2001–2019 C Co HIV record type used in years 1986–2014 Netherlands NL-HIV/AIDS HIVAIDS 1980–2019 V Co – Norway NO-MSIS_B HIVAIDS 1984–2019 C Co HIV record type used in years 1980–2013 Poland PL-HIV HIVAIDS 1985–2019 C Co – Portugal PT-HIVAIDS HIVAIDS 1985–2019 C Co – Romania RO-RSS HIVAIDS 1987–2019 C Co – Slovakia SK-EPIS HIVAIDS 1985–2019 C Co HIV record type used in years 1985–2013 Slovenia SI-HIVAIDS HIVAIDS 1985–2019 C Co – Spain ES-HIV HIV 2003–2019 C Co See country comments about historical coverage and 2018 coverage Sweden SE-SmiNet HIVAIDS 1983–2019 C Co Data source SE-SweHIVReg used 1983–2009; HIV record type used prior to 2014 United Kingdom UK-HIVAIDS HIVAIDS 1981–2019 V Co – Non-EU/EEA Albania AL-NIoPH HIVAIDS 1993–2019 C Co – Andorra AD-MoHWFH HIVAIDS 2004–2018 V Co – Armenia AM-NAC HIVAIDS 1988–2019 V Co – Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1987–2019 V Se – Belarus BY-NAC HIVAIDS 1981–2019 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 1986–2019 C Co HIV record type used in years 1993–2013 Georgia GE-IDACIRC HIVAIDS 1989–2019 C Co – Israel IL-MOH HIVAIDS 1981–2019 C Co – Kazakhstan KZ-RCfAPC HIVAIDS 1987–2019 NS/unk NS/unk – Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1987–2019 V Co HIV record type used in years 1987–2000 Montenegro ME-IOPH HIVAIDS 1989–2019 C Co – Monaco MC-MoSH-GEN HIV 1987–2018 C Co – North Macedonia MK-NHASS HIVAIDS 1993–2018 C Co HIV record type used in years 1993–2016 Republic of Moldova MD-NAC HIVAIDS 1987–2019 V Other – Russian Federation RU-MOH HIVAGGR 2009-2019 C Co – San Marino SM-AIDS/HIV HIVAGGR 1985–2019 C Co – Serbia1 RS-NAC HIVAIDS 1984–2019 C Co HIV aggregate record type used in years 1984–2001 Switzerland CH-FOPH HIV 1985–2019 C Co – Tajikistan TJ-RHAC HIVAIDS 1991–2019 C Co – Turkey TR-MOH HIV 1985–2019 C Co – Turkmenistan TM-NAC – 1990–2012 V Co – Ukraine UA-NAC HIVAIDS 1987–2019 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). 1 Data from Kosovo, in accordance with Security Council resolution 1244 (1999), were reported through data source XK-HIVAIDS for 1986–2018; HIVAIDS record type used for all years. 110 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Annex 4b Table A4a.1. AIDS surveillance system overview: data source information Country, territory or area AIDS Data source Record typea for 2018 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-AIDS HIVAIDS 1982–2019 V Co – Belgium BE-HIV/AIDS HIVAIDS 1983–2018 V Co Did not report 2019 data Bulgaria BG-AIDS HIVAIDS 1987–2019 C Co AIDS record type was used for cases prior to 2014 Cyprus CY-HIV/AIDS HIVAIDS 1986–2019 C Co – Croatia HR-CNIPH HIVAIDS 1986–2019 C Co AIDS record type used prior to 2016 Czechia CZ-HIV/AIDS HIVAIDS 1986–2019 C Co – Denmark DK-HIV HIVAIDS 1980–2019 C Co AIDS record type from data source DK-MIS used 1980–2013 Estonia EE-NAKIS HIVAIDS 1992–2019 C Co AIDS record type used prior to 2015 Finland FI-NIDR HIVAIDS 1983–2019 C Co AIDS record type used prior to 2016 France FR-HIVAIDS; FR-AIDS HIVAIDS 1982–2019 C Co Additional data from record type AIDS used for cases with HIV diagnosis before 2003 or with unknown date of HIV diagnosis; although compulsory, AIDS diagnoses are not exhaustively reported – underreporting was estimated 41% in 2007–2009 Germany DE-AIDS 1981–2019 V Co Did not report 2017 data, AIDS record type used through 2016 Greece EL-HIV/AIDS HIVAIDS 1981–2019 C Co – Hungary HU-HIV/AIDS HIVAIDS 1986–2019 C Co – Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1985–2019 C Co AIDS record type used prior to 2017 Ireland IE-CIDR HIVAIDS 1983–2019 V Co Data source IE-HIV/AIDS and AIDS record type used for years 1981–2011 Italy IT-COA-ISS AIDS 1982–2019 C Co – Latvia LV-AIDS HIVAIDS 1990–2019 C Co Same data source in AIDS record type used for 1990–2013 Liechtenstein CH-SFOPH-LI AIDS 1989–2019 V NS/unk Cases reported through Switzerland's surveillance system Lithuania LT-AIDS_CENTRE HIVAIDS 1988–2019 C Co – Luxembourg LU-HIVAIDS HIVAIDS 1983–2019 V Co – Malta MT-DISEASE_SURVEILLANCE HIVAIDS 1986–2019 C Co Same data source and AIDS record type used 1986–2014 Netherlands NL-HIV/AIDS HIVAIDS 1999–2019 V Co – Norway NO-MSIS_B HIVAIDS 1983–2019 C Co Data source NO-MSIS-A and record type AIDS used in years 1980–2013 Poland PL-HIV HIVAIDS 1986–2019 C Co – Portugal PT-HIVAIDS HIVAIDS 1985–2019 C Co – Romania RO-RSS HIVAIDS 1985–2019 C Co – Slovakia SK-EPIS HIVAIDS 1985–2019 C Co AIDS record type used in years 1985–2013 Slovenia SI-HIVAIDS HIVAIDS 1986–2019 C Co – Spain ES-AIDS AIDS 1981–2019 C Co See country comments about coverage Sweden – – 1982–2007 V Co AIDS surveillance discontinued in 2008 United Kingdom UK-HIVAIDS HIVAIDS 1981–2019 V Co – Non-EU/EEA Albania AL-NIoPH HIVAIDS 1993–2019 C Co – Andorra AD-MoHWFH HIVAIDS 2004–2018 V Co – Armenia AM-NAC HIVAIDS 1988–2019 V Se – Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1995–2019 V Co – Belarus BY-NAC AIDS 1991–2019 C Co – Bosnia and Herzegovina BA-FMoH-MoHSWRS HIVAIDS 1986–2019 C Co AIDS record type used in years 1986–2013 Georgia GE-IDACIRC HIVAIDS 1989–2019 C Co – Israel IL-MOH HIVAIDS 1981–2019 C Co – Kazakhstan KZ-RCfAPC HIVAIDS 1993–2019 NS NS – Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1999–2019 V Co AIDS record type used in years 1987–2000 Montenegro ME-IOPH HIVAIDS 1990–2019 C Co – Monaco MC-MoSH-GEN AIDS 1985–2018 C Co – North Macedonia MK-NHASS HIVAIDS 1989–2018 C Co AIDS record type used in years 1993–2016 Republic of Moldova MD-NAC HIVAIDS 1989–2019 V Co – Russian Federation – – – – – – San Marino SM-AIDS/HIV AIDS 1986–2019 C Co – Serbia1 RS-NAC HIVAIDS 1985–2019 C Co AIDS record type used in years 1985–2001 Switzerland CH-FOPH AIDS 1980–2019 C Co – Tajikistan TJ-RHAC HIVAIDS 1998–2019 C Co – Turkey TR-MOH AIDS 1985–2019 C Co – Turkmenistan TM-NAC – 2002–2012 V Co – Ukraine UA-NAC AIDSAGGR 1988–2019 V Co HIVAIDS record type used only for HIV reporting (that is, 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). 1 Data from Kosovo, in accordance with Security Council resolution 1244 (1999), were reported through data source XK-HIVAIDS for 1986–2018; HIVAIDS record type used for all years. 111 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Annex 5 Table A5.1. Country-specific comments regarding national HIV and AIDS reporting Country Comments Belgium Belgian data were not reported for 2019 due to technical issues but will be reported in future rounds. Bulgaria Case-based reporting of HIV is available from 2007 onwards. Czechia Foreigners with short-term stays in Czechia 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). 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 31% in 2018 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). Data on new diagnoses adjusted for reporting delay and underreporting are 6 629 (2010), 6 461 (2011), 6 622 (2012), 6 688 (2013), 6 559 (2014), 6 443 (2015), 6 417 (2016), 6 583 (2017) and 6 155 (2018). HIV/AIDS surveillance was changed in 2016. Since then, HIV and AIDS diagnoses should be reported online, and physicians should report HIV diagnoses spontaneously, without waiting for the laboratory report. Probable country of infection is collected as “France/Abroad/Unknown”. In Table 12, the number 3 829 in the “Unknown” column includes 941 cases probably infected abroad, and 2 888 cases with unknown country of infection. 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 so-called previous- positive people, who are transferring their HIV care when moving to Ireland and tested positive and were 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 Data on new HIV diagnoses have been collected since 1985 in some regions of 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 were based on the annual resident population in the regions reporting cases. From 2012, the coverage of the surveillance system has been national, so the total Italian population is used as a denominator. AIDS deaths are not reported after 2017 due to lack of updated data from the national mortality register. 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. 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. 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 in the number of reported cases diagnosed between 1983 and 2012. Spain HIV reporting has existed since the 1980s in some of the 19 Autonomous Regions of Spain. For 2003–2011, HIV data are available only for nine regions: Asturias, Balearic Islands, Basque Country, Canary Islands, Catalonia, Ceuta, Extremadura, La Rioja and Navarre. Since 2004, HIV 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, HIV data are available for 17 regions (+ Cantabria, Castilla-León and Murcia). For 2012, data are available for 18 regions (+ Valencia). For 2013–2017, data are available for all the 19 regions of Spain (+ Andalucía), but for 2018, due to extraction issues, data for Catalonia are not available. Due to the COVID-19 pandemic, some regions have reported provisional data for 2019 and others (Asturias, Aragón, Cantabria and Melilla) have not reported any data. 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 2014–2019, 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 figures presented in the European report are based on a preliminary version of the United Kingdom database which subsequently was updated. Consequently, some totals in the report may differ very slightly to the United Kingdom national totals published. Non-EU/EEA Belarus All data are presented by "date of statistics" (instead of "date of diagnosis"). Bosnia and Herzegovina – Georgia Data are presented by "date of statistics" (instead of "date of diagnosis"). North Macedonia AIDS cases include only people diagnosed with AIDS at the time of HIV diagnosis. Russian Federation The data reported by the Russian Federation (by the Ministry of Health ) was limited to new HIV diagnosis by sex for 2009–2018 and data on HIV testing, which enabled the inclusion of the country’s data in Tables 1–3 and 25 and in the figures showing the trend of HIV diagnosis. Since 2016, case definitions have been changed in the Russian Federation. Updated Forms (N61) of the Federal Statistical Surveillance are submitted by medical facilities to the Ministry of Health and include the number of individuals newly diagnosed with HIV infection. Data for 2009–2015 cannot thefore be compared directly with those for 2016–2018. 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. Tajikistan Due to technical problems, no data export for 2018 from Tajikistan was available. 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"). Ukraine All data are presented by “date of statistics” (instead of “date of diagnosis”). 112 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Annex 6 Table A6.1. New HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients,a 2016–2019 Country, territory or areab 2016 2017 2018 2019 Adjustment coefficientsN Rate N Rate N Rate N Rate 2016 2017 2018 2019 EU/EEA West Austria 325 3.7 348 4.0 237 2.7 283 3.2 1.12 1.15 1.19 1.26 West Belgium 909 8.0 899 7.9 882 7.7 – – 1.00 1.00 1.00 1.00 Centre Bulgaria 202 2.8 241 3.4 311 4.4 258 3.7 1.00 1.00 1.00 1.00 Centre Croatia 109 2.6 106 2.6 94 2.3 102 2.5 1.00 1.00 1.00 1.00 Centre Cyprus 80 9.4 85 9.9 78 9.0 100 11.4 1.00 1.00 1.00 1.00 Centre Czechia 286 2.7 254 2.4 208 2.0 222 2.1 1.00 1.00 1.00 1.00 West Denmark 244 4.3 242 4.2 219 3.8 190 3.3 1.00 1.00 1.00 1.00 East Estonia 229 17.4 219 16.6 190 14.4 178 13.4 1.00 1.00 1.00 1.00 West Finland 180 3.3 158 2.9 153 2.8 149 2.7 1.00 1.00 1.00 1.00 West Francec 5 444 8.2 5 410 8.1 5 164 7.7 5 529 8.2 1.00 1.00 1.02 1.12 West Germany 3 378 4.1 3 155 3.8 2 867 3.5 3 093 3.7 1.00 1.00 1.00 1.00 West Greece 652 6.0 645 6.0 724 6.7 657 6.1 1.00 1.00 1.01 1.04 Centre Hungary 228 2.3 223 2.3 229 2.3 238 2.4 1.00 1.00 1.00 1.00 West Iceland 28 8.4 24 7.1 38 10.9 28 7.8 1.00 1.00 1.00 1.00 West Ireland 511 10.8 499 10.4 508 10.5 533 10.9 1.00 1.00 1.00 1.00 West Italy 3 707 6.1 3 609 5.9 3 113 5.1 2 724 4.5 1.01 1.01 1.04 1.07 East Latvia 369 18.7 376 19.3 328 17.0 295 15.4 1.00 1.00 1.00 1.00 – Liechtenstein 2 5.3 0 0.0 0 0.0 0 0.0 1.00 1.00 1.00 1.00 East Lithuania 214 7.4 263 9.2 160 5.7 151 5.4 1.00 1.00 1.00 1.00 West Luxembourg 92 16.0 80 13.6 75 12.5 70 11.4 1.14 1.20 1.32 1.46 West Malta 63 14.0 45 9.8 73 15.3 80 16.2 1.00 1.00 1.00 1.00 West Netherlands 903 5.3 854 5.0 746 4.3 666 3.9 1.01 1.03 1.08 1.18 West Norway 220 4.2 213 4.1 191 3.6 183 3.4 1.00 1.00 1.00 1.07 Centre Poland 1 319 3.5 1 420 3.7 1 217 3.2 1 585 4.2 1.00 1.00 1.01 1.08 West Portugal 1 725 16.8 1 611 15.7 1 465 14.2 1 344 13.0 1.14 1.21 1.32 1.73 Centre Romania 774 3.9 796 4.1 732 3.7 690 3.6 1.00 1.00 1.00 1.00 Centre Slovakia 88 1.6 72 1.3 102 1.9 114 2.1 1.00 1.00 1.00 1.13 Centre Slovenia 60 2.9 40 1.9 37 1.8 34 1.6 1.00 1.00 1.00 1.00 West Spain 4 175 9.0 3 795 8.2 2 527 6.4 2 483 5.6 1.00 1.00 1.00 1.00 West Sweden 429 4.4 434 4.3 481 4.8 449 4.4 1.00 1.00 1.00 1.00 West United Kingdom 5 231 8.0 4 653 7.1 4 537 6.8 4 116 6.2 1.00 1.00 1.00 1.00 Total EU/EEA 32 293 6.3 30 932 6.0 27 798 5.4 27 231 5.4 1.01 1.02 1.03 1.10 Non-EU/EEA Centre Albania 127 4.4 94 3.3 102 3.5 101 3.5 1.00 1.00 1.00 1.00 West Andorra 3 3.9 6 7.8 12 15.6 – – 1.00 1.00 1.00 1.00 East Armenia 304 10.4 355 12.1 420 14.2 446 15.1 1.00 1.00 1.00 1.00 East Azerbaijan 556 5.7 567 5.8 656 6.6 721 7.2 1.00 1.00 1.00 1.00 East Belarus 2 391 25.3 2 468 26.1 2 386 25.2 2 137 22.6 1.00 1.00 1.00 1.00 Centre Bosnia and Herzegovina 24 0.7 15 0.4 24 0.7 30 0.9 1.00 1.00 1.00 1.00 East Georgia 719 17.9 631 15.7 672 16.8 668 16.7 1.00 1.00 1.00 1.00 West Israel 368 4.5 415 5.0 452 5.4 408 4.8 1.00 1.00 1.00 1.00 East Kazakhstan 2 898 16.3 3 014 16.7 3 215 17.5 3 673 19.8 1.00 1.00 1.00 1.00 East Kyrgyzstan 764 12.6 840 13.6 876 13.9 850 13.2 1.00 1.00 1.00 1.00 West Monaco 0 0.0 3 7.8 0 0.0 – – 1.00 1.00 1.00 1.00 Centre Montenegro 34 5.4 26 4.1 23 3.7 26 4.1 1.00 1.00 1.00 1.00 Centre North Macedonia 30 1.4 44 2.1 45 2.2 – – 1.00 1.00 1.00 1.00 East Republic of Moldova 832 20.5 835 20.6 905 22.3 922 22.8 1.00 1.00 1.00 1.00 East Russian Federation 86 855 59.8 85 802 59.0 85 995 59.0 80 124 54.9 1.00 1.00 1.00 1.00 West San Marino 2 6.0 1 3.0 3 8.9 0 0.0 1.00 1.00 1.00 1.00 Centre Serbia 179 2.0 186 2.1 188 2.1 215 2.0 1.00 1.00 1.00 1.00 Centre Serbia excluding Kosovo1 168 2.4 183 2.6 180 2.6 210 2.4 1.00 1.00 1.00 1.00 Centre Kosovo1 11 0.6 3 0.2 8 0.4 5 0.3 1.00 1.00 1.00 1.00 West Switzerland 533 6.4 446 5.3 425 5.0 421 4.9 1.00 1.00 1.00 1.00 East Tajikistan 1 038 12.0 1 205 13.6 1 421 15.6 1 320 14.2 1.00 1.00 1.00 1.00 Centre Turkey 2 438 3.1 2 844 3.5 3 248 3.9 3 229 3.9 1.00 1.00 1.00 1.00 East Turkmenistan – – – – – – – – 1.00 1.00 1.00 1.00 East Ukraine 14 241 33.4 15 625 36.8 15 686 37.2 16 357 39.0 1.00 1.00 1.00 1.00 East Uzbekistan – – – – – – – – 1.00 1.00 1.00 1.00 Total non-EU/EEA 114 336 31.3 115 422 31.4 116 754 31.6 111 648 30.1 1.00 1.00 1.00 1.00 WHO European Region West 29 200 6.8 27 644 6.4 24 953 5.9 23 971 5.7 1.01 1.02 1.03 1.10 Centre 5 978 3.1 6 447 3.3 6 638 3.4 6 944 3.5 1.00 1.00 1.00 1.04 East 111 410 43.4 112 200 43.6 112 910 43.7 107 845 41.7 1.00 1.00 1.00 1.00 Total WHO European Region 146 588 16.6 146 291 16.5 144 502 16.4 138 760 15.9 1.00 1.00 1.01 1.02 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. The sum of country totals may not equal regional totals due to independent calculation of reporting delay totals for the region from those of some countries. b Country-specific comments are in Annex 5. c French data for 2015–2018 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 113 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Annex 7 Table A7.1. 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 Czechia 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 National Public Health Organization 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 Republican Centre for AIDS Prevention and Control Monaco Ministry of Social Health Montenegro Institute of Public Health of Montenegro North Macedonia Public Health Institute Republic of Moldova National AIDS Centre; National Centre for Preventative Care Russian Federation Ministry of Health of the Russian Federation San Marino Ospedale di Stato Serbia1 Institute of Public Health of Serbia Switzerland Bundesamt für Gesundheit Tajikistan Republican HIV/AIDS Centre 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 1 Data for Kosovo (in accordance with Security Council resolution 1244 (1999)) were provided by the public health institute. 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HIV/AIDS surveillance in Europe 2019 data 2020

HIV/AIDS surveillance in Europe 2019 data 2020 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 the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe that has been summarizing 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 137 000 people were diagnosed with HIV in the European Region in 2019, including 25 000 in the EU/EEA. Keywords ACQUIRED IMMUNODEFICIENCY SYNDROME – EPIDEMIOLOGY AIDS – PREVENTION AND CONTROL DISEASE OUTBREAKS – STATISTICS HIV INFECTIONS – EPIDEMIOLOGY POPULATION SURVEILLANCE © World Health Organization 2020 Some rights reserved. 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ECDC PDF ISBN 978-92-9498-527-9 doi 10.2900/073965 TQ-02-20-965-EN-N WHO ISBN 978-92-8905-534-5 iii Contents Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii This report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viii Overview of HIV and AIDS in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 1. HIV and AIDS in the EU/EEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 1.1 HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 1.2 Trends in HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 1.3 AIDS cases, morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 1.4 HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 1.5 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 2. HIV and AIDS in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 2.1 HIV and AIDS diagnoses in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 2.2 HIV and AIDS diagnoses in the East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 2.3 HIV and AIDS diagnoses in the Centre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 2.4 HIV and AIDS diagnoses in the West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 2.5 HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 2.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 2.7 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Figures Fig. A. Estimated new HIV infections and reported new HIV diagnoses in the EU/EEA and WHO European Region, 2010–2019, and target for 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Fig. B. Rate of new HIV diagnosis per 100 000 population, by year of diagnosis and gender, EU/EEA and WHO European Region, 2010–2019 . . . 3 Fig. C. Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission, WHO European Region, 2019 (n = 39 496) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Рисунок A. Данные по ЕС/ЕЭЗ и Европейскому региону ВОЗ: расчетное число новых случаев ВИЧ-инфекции и число впервые выявленных случаев ВИЧ-инфекции, 2010-2019 гг., а также цель на 2020 год . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Рисунок B. Частота впервые выявленных случаев ВИЧ-инфекции на 100 000 населения (с разбивкой по полу и году постановки диагноза) в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 2009-2018 гг. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Рисунок C. Доля лиц с поздно выявленной ВИЧ-инфекцией (CD4 < 350 клеток/мм3) с разбивкой по полу, возрасту и пути заражения, Европейский регион ВОЗ, 2019 г. (n = 39 496) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Fig. 1.1. Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2019 (n = 24 674) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Fig. 1.2. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2019 (n = 22 318) . . . . . . . . . . . . . . . . . . . . . . . . . 24 Fig. 1.3. New HIV diagnoses, by age group and transmission mode, EU/EEA, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Fig. 1.4. Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2019 (n = 24 715) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Fig. 1.5. Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2019 (n = 18 957) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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, 2019 (n = 20 430) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Fig. 1.7. Acute infection or CD4 cell count per mm3 at HIV diagnosis, overall and by transmission group, EU/EEA, 2018 . . . . . . . . . . . . . . . . . . . . . 27 iv Fig. 1.8. Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Fig. 1.9. Linkage to care after HIV diagnosis, EU/EEA, 2019 (n = 2593) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Fig. 1.10. People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Fig. 1.11a. Age-specific trends in new HIV diagnoses in men, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fig. 1.11b. Age-specific trends in new HIV diagnoses in women, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fig. 1.12. Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2010–2019 . . . . . . . . . . 30 Fig. 1.13a. HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay and missing transmission imputed, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Fig. 1.13b. Percentage of HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Fig. 1.14. New HIV diagnoses, by year of diagnosis, transmission and migration status, adjusted for reporting delay, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Fig. 1.15. Number of people diagnosed late (CD4 < 350 cells/mm3), by year of diagnosis and transmission mode, EU/EEA, 2010–2019 . . . . . . . . 32 Fig. 1.16. Percentage of AIDS diagnoses within 90 days of HIV diagnosis, EU/EEA, 2019 (n = 1763) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Fig. 1.17. AIDS diagnoses, by transmission mode, EU/EEA, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Fig. 1.18. Percentage of people diagnosed with AIDS where TB is an AIDS-defining illness, EU/EEA, 2019 (n = 2650) . . . . . . . . . . . . . . . . . . . . . . . 34 Fig. 2.1. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2019 (n = 37 774) . . . . . . 39 Fig. 2.2. New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Fig. 2.3. New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Fig. 2.4. New AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2010–2019 . . . . . . 41 Fig. 2.5. Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country, East, 2019 (n = 107 842; 19 112) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Fig. 2.6. New HIV diagnoses, by country and transmission mode, East, 2019 (n = 27 718) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Fig. 2.7. New HIV diagnoses, by age group and transmission mode, East, 2019 (n = 27 332) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Fig. 2.8. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2019 (n = 22 984) . . . . . . . . . . . . . . . . . . . . . 44 Fig. 2.9. New HIV diagnoses, by transmission mode and year of diagnosis, East, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Fig. 2.10. Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . 46 Fig. 2.11. New AIDS diagnoses, by transmission mode and year of diagnosis, East, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Fig. 2.12. Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Fig. 2.13. Male-to-female ratio in new HIV diagnoses, by country, Centre, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Fig. 2.14. New HIV diagnoses, by country and transmission mode, Centre, 2019 (n = 6713) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Fig. 2.15. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, Centre, 2019 (n = 1847) . . . . . . . . . . . . . . . . . . . . 50 Fig. 2.16. New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Fig. 2.17. New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Fig. 2.18. New HIV diagnoses, by transmission mode and year of diagnosis, West, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Fig. 2.19. New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2010–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Tables Table A. Characteristics of new HIV and AIDS diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the WHO European Region, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Таблица A. Эпидемиологические характеристики впервые установленных диагнозов ВИЧ-инфекции и СПИДа, зарегистрированных в Европейском регионе ВОЗ, ЕС/ЕЭЗ, а также в западной, центральной и восточной частях Региона, 2019 г. . . . . . .11 Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 2. New HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 3. New HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 4. New HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 5. New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 6. New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 7. New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 8. HIV diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 9. HIV diagnoses in 2019, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . 70 vTable 10. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2019, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 11. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2019 . . . . . . . . 74 Table 12. New HIV diagnoses, by country of report and probable region of infection, in 2019, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 13. Percentage of new HIV diagnoses (2019) among persons > 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 14. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 15. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 16. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table 17. AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 18. AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table 19. AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 20. AIDS diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table 21. AIDS diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Table 22. The most common AIDS-indicative diseases diagnosed in 2019, ordered by frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 23. AIDS-related deaths, by geographic area, country and year of death (2010–2019) and cumulative totals in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Table 24. Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2010–2019) and number of tests per 1000 population in 2019, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . 94 Table A2.1. Completeness of variables for data reported in 2018 and 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Table A3.1. Completeness by country and variable, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Table A4a.1. HIV surveillance system overview: data source information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Table A4a.1. AIDS surveillance system overview: data source information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table A5.1. Country-specific comments regarding national HIV and AIDS reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Table A6.1. New HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients,a 2016–2019 . . . . 112 Table A7.1. HIV/AIDS surveillance in Europe: participating countries and national institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113 Maps Map 1. New HIV diagnoses, per 100 000 population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Map 2. New HIV diagnoses in men, per 100 000 male population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Map 3. New HIV diagnoses in women, per 100 000 female population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Map 4. New HIV diagnoses in men who have sex with men, per 100 000 male population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Map 5. New HIV diagnoses acquired through injecting drug use, per 100 000 population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Map 6. New HIV diagnoses acquired through heterosexual transmission, per 100 000 population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Map 7. Percentage of adult (> 14 years) HIV diagnoses with CD4 < 350 cells/mm3 at diagnosis, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Map 8. AIDS diagnoses reported, per 100 000 population, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Annexes Annex 1. Framework for data collection, validation and presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Annex 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Annex 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Annex 4a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Annex 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Annex 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Annex 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Annex 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113 Acknowledgements The report was coordinated by Anastasia Pharris (European Centre for Disease Prevention and Control (ECDC)) and Giorgi Kuchukhidze (WHO Regional Office for Europe). Review and production support was provided by Nino Berdzuli (WHO Regional Office for Europe), Mike Catchpole (ECDC), Masoud Dara (WHO Regional Office for Europe), Karl Ekdahl (ECDC), Esther Kissling (EpiConcept), Vicky Lefevre (ECDC), Antons Mozalevskis (WHO Regional Office for Europe), Stine Nielsen (freelance consultant), Teymur Noori (ECDC), Adrian Prodan (ECDC), Nicole Seguy (WHO Regional Office for Europe), Marieke J. van der Werf (ECDC) and Elena Vovc (WHO Regional Office for Europe). 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 the HIV/AIDS surveillance 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: Gohar Mirzoyan; Austria: Daniela Schmid, Ziad El-Khatib; Azerbaijan: Farhad Singatulov, Shahin Khasiyev; Belarus: Svetlana Sergeenko; Belgium: Andre Sasse, Dominique Van Beckhoven; Bosnia and Herzegovina: Dušan Kojić; Bulgaria: Tonka Varleva; Croatia: Tatjana Nemeth Blazic; Cyprus: Linos Hadjihannas, Anna Demetriou; Czechia: Marek Maly; Denmark: Susan Cowan; Estonia: Kristi 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: Marianna Thordardottir, Gudrun Aspelund; 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: Carole Devaux, Jean-Claude Schmit; Malta: Jackie Maistre Melillo, Tanya Melillo; Monaco: Dominique De Furst; Montenegro: Alma Cicic; Netherlands: Eline Op de Coul, Ard van Sighem; North Macedonia: Milena Stefanovic, Zarko Karadzovski, Rumena Gerdovska; Norway: Hans Blystad, Hilde Klovstad; Poland: Magdalena Rosinska; Portugal: Isabel Aldir, Helena Cortes Martins; Republic of Moldova: Silvia Stratulat, Stepan Gheorghita; Romania: Mariana Mardarescu; Russian Federation: Inna Kulikova, Oleg Sonin, Lyalya Gabbasova; San Marino: Andrea Gualtieri, Mauro Fiorini; Serbia: Danijela Simic; Slovakia: Peter Truska; Slovenia: Irena Klavs, Tanja Kustec; Spain: Asuncion Diaz; Sweden: Maria Axelsson; Switzerland: Martin Gebhardt; Tajikistan: Kholnazarov Ramshed, Zukhra Nurlaminova; Turkey: Emel Özdemir Şahin; Ukraine: Ihor Kuzin, Violetta Martsynovska; and United Kingdom: Valerie Delpech. For Kosovo:1 Luljeta Gashi. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). vi vii ART antiretroviral treatment EECA Eastern Europe and Central Asia ECDC European Centre for Disease Prevention and Control EU/EEA European Union/European Economic Area MSM men who have sex with men PrEP pre-exposure prophylaxis TB tuberculosis TESSy The European Surveillance System UNAIDS Joint United Nations Programme on HIV/AIDS Abbreviations viii The European Centre for Disease Prevention and Control (ECDC) and the 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 Member States 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 2008. The data presented in the text are augmented by 40 figures and 31 tables: Fig. A–C and Table A in the Overview, Fig. 1.1–2.19 in Chapters 1 and 2, Tables 1–24 in a discrete section towards the end of the report, maps 1–8 and six tables (A2.1–A7.1) in the annexes. The report has three main sections: • an Overview, which effectively summarizes and captures 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, and AIDS cases and their morbidity and mortality; and • Chapter 2, which presents data on HIV and AIDS diagnoses 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, and HIV testing. The data in the report are also augmented by seven annexes: • Annex 1, which presents the framework for data collection, 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 presented by country and area; • Annexes 4 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 systems 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. This report 1HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Overview of HIV and AIDS in Europe Table A. Characteristics of new HIV and AIDS diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the WHO European Region, 2019 WHO European Region West Centre East EU/EEA Reporting countries/number of countriesa 47/53 20/23 14/15 13/15 30/31 Number of new HIV diagnoses 136 449 21 793 6 814 107 842 24 801 Rate of HIV diagnoses per 100 000 populationb 15.6 5.7 3.4 41.7 5.4 Percentage age 15–24 years 8.5% 10.2% 15.0% 5.7% 10.3% Percentage age 50+ years 17.8% 22.0% 13.7% 16.1% 20.4% Male-to-female ratio 1.8 2.9 5.5 1.6 3.1 Transmission mode Sex between men 20.7% 39.9% 27.3% 3.9% 38.7% Heterosexual transmission (men) 26.4% 16.2% 18.2% 36.3% 16.1% Heterosexual transmission (women) 23.8% 17.8% 7.2% 32.6% 16.7% Injecting drug use 13.0% 3.4% 2.1% 23.2% 3.9% Mother-to-child transmission 0.7% 0.7% 0.5% 0.8% 0.7% Unknown 15.3% 21.6% 44.5% 3.1% 23.6% AIDS and late HIV diagnosis Percentage new HIV diagnoses CD4 < 350 cells/mm3 53.2% 48.8% 55.9% 55.7% 49.7% Number of new AIDS diagnosesc 12 535 2156 802 9577 2772 Rate of AIDS diagnoses per 100 000 population 2.0 0.5 0.4 8.3 0.5 a No data received from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and Uzbekistan. b EU/EEA and West rates are adjusted for reporting delay (Annex 6); the corresponding estimated number of new diagnoses adjusted for reporting delay are (27 231 and 23 971 respectively). c No data received from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan. The data in this report present new HIV diagnoses through to the end of 2019, the period just before the global COVID-19 pandemic began. The impact of the pandemic on laboratory, clinical and public health institutions involved in HIV surveillance and response has been felt during the data collection and preparation stages of this report, with several countries requiring more time than usual to submit their 2019 HIV and AIDS data or indicating that reporting delays may increase. Several countries reported that it was not possible to report some variables at all or at levels concordant with the past. The European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe, in collaboration with Member States and partners, will look carefully at the impact of COVID-19 on HIV surveillance to ensure the continuing high standard of European HIV and AIDS data. Although HIV infection is preventable, significant HIV transmission continues across the WHO European Region. In 2019, 136 449 newly diagnosed HIV infections were reported in 47 of the 53 Member States in the Region,2 including 24 801 from countries of the European Union/European Economic Area (EU/EEA). This corresponds to a crude rate of 15.6 newly diagnosed infections per 100 000 population (Table A). The trend that has persisted over the last decade continues, with rates and overall numbers of people diagnosed with HIV highest in the East of the Region 2 No data were received from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan or Uzbekistan. Liechtenstein is an EEA 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. (41.7 per 100 000 population), lower in the West and in the EU/ EEA (5.7 and 5.4 per 100 000, respectively) and lowest in the Centre3 (3.4 per 100 000) (Table A). The main transmission mode also varies 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, while heterosexual transmission and injecting drug use were the main reported transmission modes in the East of the Region. The number of people newly diagnosed with HIV in the WHO European Region increased by 19% over the last decade, while the number of new diagnoses among countries in the EU/EEA declined by 9% over the same period (Fig. A). When comparing the number of new diagnoses to the estimated number of new HIV infections over the last decade in the Region, it is evident that for most of this period, more people became infected with HIV than had been diagnosed, indicating that the number of people living in the Region with undiagnosed HIV is increasing. In contrast, it is estimated that more people in the EU/EEA have been diagnosed than are becoming infected, indicating that the proportion of those living with undiagnosed HIV is decreasing. The rate of new HIV diagnoses in men in the Region overall has increased at a faster pace than in women; by 2019, it was twice as high as the rate in women. The rate of new HIV diagnoses in the EU/EEA has declined in both men and women, but more rapidly in women; by 2019, 3 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, Fig. A1.1 for details. 2SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data the rate of new diagnoses in men was three times higher than that in women (Fig. B). The rate of new diagnoses in the Region was also higher among men than women in all age groups, except for people under 15 years (see Table 9). In 2019, just over half (53%) of those diagnosed with HIV in the European Region were diagnosed at a late stage of infection (CD4 cell count less than 350 cells/mm3 at diagnosis). This percentage was highest in the East (56%) and Centre (56%) and lowest in the West (49%), while 50% were diagnosed late in the EU/EEA (Table A). In 2019, 12 535 people were diagnosed with AIDS, reported in 45 countries4 of the WHO European Region, and the rate of new diagnoses was 1.7 per 100 000 population (Table A; see also Table 14). In the EU/EEA, 2772 people were diagnosed with AIDS in 2019, giving a rate of 0.5 per 100 000 population. The number of AIDS cases continued to decline steadily in the West and the EU/EEA during the last decade (see Fig. 1.17 and 2.4). At the same time, it has been increasing in the East, although it began to stabilize between 2012 and 2018 and even declined in 2019. European Union and European Economic Area In 2019, 24 801 people were diagnosed with HIV in the 30 countries of the EU/EEA, with a rate of 5.4 per 100 000 when adjusted for reporting delay (Table 1, Annex 6). Countries with the highest rates were Malta (16.2; 80 cases), Latvia (15.4; 295) and Estonia (13.4; 178), and the lowest were reported by Slovakia (1.9; 101 cases) and Slovenia (1.6; 34) (Table 1, Map A). The rate of new HIV 4 No data were reported by Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. The Russian Federation reported only data on new HIV diagnoses by sex and data on HIV testing. diagnoses was higher among men (7.5 per 100 000 population; Table 2) than women (2.4 per 100 000 population; Table 3). The overall male-to-female ratio was 3.1 (Table A). This ratio was highest in Croatia (19.4) and Hungary (13.0) and was above one in all countries in the EU/EEA (Fig. 1.1). The predominant mode of transmission in countries with the highest male-to- female ratios was sex between men. Men had higher age-specific rates than women in all age groups except among people under 15 years, where age- specific rates were similarly low (Fig. 1.2). The highest overall age-specific rate of HIV diagnoses for men was in the 20–29-year-old age group (18.0 per 100 000 population), while rates for women were highest in the 30–39 age group (6.1 per 100 000 population) (Fig. 1.2). Young people aged 15–24 years comprised 11% of the EU/EEA population and 11% of HIV diagnoses in 2019. Forty-one per cent of the EU/EEA population consists of older adults (50 years and above), who comprised 21% of the new HIV diagnoses reported in 2019 (Fig. 1.4). Sex between men remains the predominant mode of HIV transmission reported in the EU/EEA, accounting for 39% (9598) of all new HIV diagnoses in 2019 and more than half (51%) of diagnoses where the route of transmission was known (Table 4, Table 8, Fig. 1.5). Among those with known route of HIV transmission, sex between men accounted for more than 60% of new HIV diagnoses in 10 countries (Croatia, Czechia, Germany, Hungary, Iceland, the Netherlands, Poland, Slovakia, Slovenia and Spain) (Fig. 1.5). Heterosexual contact was the second most common reported mode of HIV transmission in the EU/EEA in 2019, accounting for 33% (8164) of HIV diagnoses and 43% of diagnoses where the route of transmission was known (Table 6, Table 8, Fig. 1.5). Heterosexual transmission was the most commonly reported known Fig. A. Estimated new HIV infections and reported new HIV diagnoses in the EU/EEA and WHO European Region, 2010–2019, and target for 2020 20202019201820172016201520142013201220112010 Re op 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 Year of diagnosis 0 50 000 100 000 150 000 200 000 2020 target, EU/EEA 2020 target, WHO European Region EU/EEA estimated infections EU/EEA diagnoses WHO European Region diagnoses WHO European Region estimated infections Note: data from Andorra, Belgium, Italy, Monaco, North Macedonia, Spain, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. 3HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT mode of transmission in nine EU/EEA countries (Cyprus, Estonia, France, Latvia, Luxembourg, Norway, Portugal, Romania and Sweden). Transmission due to injecting drug use accounted for 4% of HIV diagnoses in 2019 and was the probable route of transmission for one quarter or more of the cases reported in Latvia (26%) and Lithuania (38%) (Table 5, Table 8, Fig. 1.5). Vertical transmission accounted for less than 1% of new HIV diagnoses in the EU/EEA in 2019 while the transmission mode was not reported or reported to be unknown for 24% of new HIV diagnoses (Table A). Forty-four per cent of those diagnosed in the EU/EEA in 2019 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, 9% from countries in Latin America and the Caribbean, 8% from other countries in central and eastern Europe, and 3% from other countries in western Europe. The trend in rates of reported HIV diagnoses declined slightly between 2010 and 2019. Rates were 6.6 per 100 000 in the early part of this period, decreasing steadily thereafter to 5.4 per 100 000 in 2019 (Table 1, Fig. 1.10, Annexes 1, 5 and 6). The number of diagnoses in countries reporting consistently over the period declined by 9% between 2010 and 2019. While the overall EU/EEA trend has declined during the past decade, trends at national level vary. Several countries, including Austria, Denmark, Estonia, Finland, France, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom, have also reported a decline in rates of new diagnoses, even after adjusting for changes in population coverage of surveillance and reporting delay. Conversely, and taking reporting delay into account, rates of HIV diagnoses have more than doubled since 2010 in Cyprus, Malta and Slovakia and have increased by more than 50% in Bulgaria and Poland (Table 1, Annex 6). Some countries are affected disproportionately by reporting delay, with the result that decreases in the rates of new HIV diagnoses may be overestimated and increases in rates underestimated. Trends differ by gender and age group. Age-specific rates have declined since 2010 in all age groups except for women 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. 1.11a, Fig. 1.11b). The median age at HIV diagnosis increased from 34 to 37 years among women between 2010 and 2019, while remaining stable in men at 37 years. A larger proportion of diagnoses is being reported in older age groups: 15% of people diagnosed in 2010 were over 50 years on diagnosis, rising to 20% in 2019. The proportion of all HIV diagnoses with known route of transmission that were attributed to sex between men in countries reporting consistently over the period increased from 45% of cases in 2010 to 52% in 2015, then decreased to 47% in 2019 (Fig 1.13). The number of HIV diagnoses reported among men who have sex with men (MSM) in countries reporting consistently increased from 8730 cases in 2010 and peaked at 9839 in 2014. Even after adjusting for reporting delay, fewer cases were reported in 2019 (6888) in this same group of countries. Most of the decline in recent years appears to be due to fewer diagnoses among MSM in Austria, Finland, France, Germany, Greece, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom (Table 4), with substantial increases noted in Bulgaria, Cyprus, Estonia, Lithuania, Poland, Romania and Slovakia in recent years. Cases attributed to MSM born outside of the reporting country increased over the period, declining slightly between 2016 and 2019 but not to the same extent as observed in EU/EEA-native MSM (Fig. 1.14). The number of heterosexually acquired cases decreased steadily over the last decade (Fig. 1.13a), with sharper declines among women and foreign-born heterosexual Fig. B. Rate of new HIV diagnosis per 100 000 population, by year of diagnosis and gender, EU/EEA and WHO European Region, 2010–2019 0 5 10 15 20 25 Men (EU/EEA) Men (WHO European Region) Women (EU/EEA) Women (WHO European Region) 2019201820172016201520142013201220112010 Ne w H IV d ia gn os es p er 10 0 00 0 po pu la to in Year of diagnosis 4SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data people than among men and non-foreign-born people (Fig. 1.13a, Fig. 1.14). Despite the overall decline in heterosexually acquired cases during this period, new diagnoses in Lithuania and Slovakia increased substantially in this group. The number of HIV diagnoses reported as being due to injecting drug use has declined since 2010 in both foreign-born and non-foreign-born groups, but localized outbreaks that affected the EU/EEA trend in this group were seen in 2011–2012, and smaller local outbreaks were also noted in some countries during the last decade (Table 5, Fig. 1.13a, Fig. 1.14). Mother-to-child transmission and transmission through nosocomial infection or blood transfusion also decreased steadily between 2010 and 2019; 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 14% in 2010 to 22% in 2019. Information on CD4 cell count at the time of HIV diagnosis was provided by 25 countries (Table 13). Among all cases diagnosed in 2019 where information on CD4 count or acute HIV infection was available, 12% (1896) of cases were reported as acute infections and 26% (4122) as more recent infection (with a CD4 count above 500 cells per mm3 at diagnosis). Among MSM diagnosed in 2019 where information was available, 15% (1116) were reported as acute infections and 30% (2192) had a CD4 count above 500 cells per mm3 at diagnosis (Fig.1.7). As in previous years, half (50%) of all cases with a CD4 cell count were diagnosed several years after being infected, with a count of less than 350 cells per mm3; 30% of cases were considered to have advanced HIV infection at the time of diagnosis (CD4 less than 200 cells/mm3). The highest proportions of people presenting at a later stage of HIV infection (CD4 less than 350 cells/mm3) were observed among women (53%), older adults (54% in 40–49-year-olds and 65% in people over 50), men or women infected by heterosexual sex (61% and 53%, respectively), people who acquired HIV through injecting drug use (52%), migrants from sub-Saharan Africa (57%) and migrants from south and south-east Asia (54%) (Fig. 1.8, Table 13). In countries reporting consistently on transmission route and CD4 cell count at diagnosis over time, the number of persons diagnosed late (CD4 cell count less than 350 cells/mm3 at diagnosis) decreased by 29%, from 7441 in 2010 to 5265 in 2019. A reduced number was observed in all transmission groups (Fig. 1.15), with a 42% reduction in late diagnoses in heterosexually transmitted HIV in women (2056 in 2010, 1201 in 2019), 40% reduction where the route of transmission was injecting drug use (319 in 2010, 191 in 2019), 29% reduction in heterosexual men (1906 in 2010, 1353 in 2019) and a 24% reduction in transmission due to sex between men (2529 in 2010, 1914 in 2019) (Fig. 1.15). In 2019, 2772 diagnoses of AIDS were reported by 29 EU/EEA countries,5 giving a rate of 0.5 cases per 100 000 population (Table 14). Overall, 74% of these 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. This pattern holds for all transmission groups except people who acquired HIV through injecting drug use, where over half (60%) of the AIDS cases occurred more than 90 days after the HIV diagnosis (Fig. 1.16). Twenty-one countries reported tuberculosis (TB) (pulmonary and/or extrapulmonary) as an AIDS-defining illness in 14% of those newly diagnosed with AIDS in 2019 (Fig. 1.18). In the EU/EEA, the number of AIDS cases more than halved in the past decade (Fig. 1.10). This decline is noted in men and women and in all transmission groups, but appears greatest among cases attributed to injecting drug use (Tables 15–20, Fig. 1.17). Despite the general EU/EEA-wide decline, an increase has been reported in the rate of AIDS diagnoses since 2010 in Czechia and Hungary. AIDS-related deaths have declined steadily in the EU/EEA since the mid-1990s. 5 All EU/EEA countries except Belgium and Sweden. Fig. C. Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission, WHO European Region, 2019 (n = 39 496) 0 10 20 30 40 50 60 70 Percentage 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 Ge nd er Ag e gr ou p (y ea rs ) Tr an sm is si on 5HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT WHO European Region With 136 449 people newly diagnosed with HIV in 2019, corresponding to a rate of 15.6 per 100 000 population, halted growth in new HIV diagnoses continued to be observed in the WHO European Region, mainly due to the continuous decrease in the West and the overall stabilizing trend in the East. One third of countries in the East nevertheless reported annual increases in new HIV diagnoses. Of the 136 449 people diagnosed in 2019, 79% were diagnosed in the East (107 842), 16% in the West (21 793) and 5% in the Centre of the Region (6814) (Table A). The rate was also highest in the East (41.7 per 100 000 population), being disproportionately higher than in the West (5.7 per 100 000 population) and the Centre (3.4 per 100 000 population) (Table A). Rates of newly diagnosed HIV infections for 2019 varied significantly among countries in the WHO European Region, with the highest rates per 100 000 population being observed in the Russian Federation (54.9), Ukraine (39.0), the Republic of Moldova (22.8) and Belarus (22.6), and the lowest in Bosnia and Herzegovina (0.9) and Slovenia (1.6) (Table 1). The overall rate for men was 20.8 per 100 000 population (Table 2) and for women 10.6 per 100 000 population (Table 3). The largest proportion of new diagnoses in the 46 reporting countries6 were in the age group 30–39 years (34%), while 9% were young people aged 15–24 years and 18% were 50 years or older at the time of diagnosis. The male-to-female ratio was 1.8, lowest in the East (1.6), higher in the West (2.9) and highest in the Centre (5.5). The most common form of infection was through heterosexual sex (50%), with 10% of these cases originating from countries outside of the Region that have 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). Among the new diagnoses reported by 12 countries in the East for whom the mode of HIV transmission was known, 71% were infected through heterosexual transmission and 24% through injecting drug use, while reported transmission through sex between men remained low, at 4% of cases (Tables 4–6, 8). Sex between men (49%) and heterosexual sex (46%) were the main reported transmission modes in the Centre, but 44% of the new diagnoses lacked transmission-mode information. Sex between men was the predominant mode of transmission in 10 of the 14 countries in the 6 Data reported by the Russian Federation were limited to new HIV diagnosis by sex for 2009–2019 and data on HIV testing, which enabled the inclusion of the Russian Federation’s data in Tables 1–3 and 25 and in the figures showing the trend in HIV diagnosis. Data on age and modes of transmission presented in this report include countries that provided a full set of data to the joint ECDC/WHO European HIV surveillance system. Centre. In the West, sex between men remained the main transmission mode (40% of cases) followed by heterosexual transmission (34% of cases, among whom 39% originated from generalized epidemic countries). Information was lacking for 22% of new diagnoses. The rate of newly diagnosed HIV infections in the 47 countries with consistent reporting over the past 10 years increased by 9%, from 14.1 per 100 000 population in 2010 (118 726 cases) to 15.4 per 100 000 population in 2019 (136 449 cases) (Fig. 2.2). The increase is driven mainly by the continuing upward trend in the East, where the rate increased by 23%, from 39.9 per 100 000 (86 266 cases) to 41.7 per 100 000 (107 842 cases). In the Centre, the rate increased by 113%, the largest relative increase among the three geographical areas, from 1.6 to 3.4 per 100 000 population between 2010 and 2019, while in the West it decreased by 31%, from 7.5 to 5.7 per 100 000 population over the same period (Fig. 2.2). Consistent data on transmission mode were available from 39 countries for the period 2010–2019 (Fig. 2.3). Transmission in the East was driven by a rise in the number of HIV diagnoses with reported sexual transmission, which increased by 57% for heterosexual transmission and more than five-fold for transmission through sex between men. The increase with heterosexual transmission was considerably larger among men (103%) than women (21%). Transmission through injecting drug use, while still substantial, decreased by 36% (Fig. 2.9). In the Centre, new diagnoses in people infected through sex between men nearly doubled between 2010 and 2019; this was the predominant mode of transmission in 12 of the 14 countries, while heterosexual transmission increased by 48%. Transmission through injecting drug use has levelled off after an outbreak in Romania during 2011–2013. The percentage of new diagnoses attributed to injecting drug use was 6% in both 2010 and 2019 (Fig. 2.16). In the West, heterosexual transmission continued its steady decline and decreased by 37% over the 10-year period overall. Injecting drug use-related transmission decreased by 34% between 2010 and 2019 and is now decreasing again after a peak in 2012 caused by an outbreak in Greece. New diagnoses due to sex between men decreased by 29% compared to 2009. New diagnoses with unknown transmission mode increased by 37% in the West (Fig. 2.18). Late HIV diagnosis remains a challenge in the Region. Among those newly diagnosed people over 14 years for whom information about CD4 cell count at the time of HIV diagnosis was available, over half (53%) were late presenters, with CD4 cell counts below 350 cells per mm3, including 31% with advanced HIV infection (CD4 less than 200 cells/mm3). The percentage of people newly diagnosed who were late presenters (CD4 less than 350/mm3) varied across transmission categories and age groups but was highest for people with reported heterosexual transmission (58%; 60% for men and 55% for women) and injecting drug use (52%), and lowest for 6SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data men infected through sex with men (42%) (Fig. C). The percentage increased with age, ranging from 35% among people aged 15–19 and 20–24 years at diagnosis, to 67% among those aged 50 years or older. In terms of gender, the percentage of late presenters was similar overall (53% 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 mild variation across the Region, with 56% late presenters in the East and in the Centre and 49% in the West. In 2019, 12 535 people were newly diagnosed with AIDS in 45 countries of the WHO European Region,7 corresponding to a rate of 1.7 per 100 000 population. Overall, 76% of AIDS cases were diagnosed in the East, where the rate per 100 000 was also highest (8.3), 18% in the West (with a rate of 0.5 per 100 000) and 6% in the Centre of the Region (0.4 per 100 000) (Table 14). Twenty per cent of people diagnosed with AIDS presented with TB as an AIDS-defining illness, ranging from 13% of cases in the West and 21% in the Centre to 28% in the East. The overall rate of new AIDS diagnoses in the Region decreased by 23% between 2010 and 2019 but the AIDS trends varied greatly across the three geographical areas. In the East, the rate increased by 15%, from 7.2 in 2010 to 8.3 in 2019. 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 69% decrease from 1.6 in 2010 to 0.5 in 2019 (Fig. 2.4). Conclusions HIV transmission is still a major public health concern and affects millions of people in the WHO European Region, particularly in the eastern part of the Region. Over the course of the last three decades, over 2.1 million people have been diagnosed and reported with HIV in the WHO European Region, including over 710 000 people in the EU/EEA. In 2019, more than 136 000 people were diagnosed with HIV, at a rate of 15.6 per 100 000 population. The vast majority of new diagnoses, 79%, were reported from the East of the Region and 16% from the West. Newly diagnosed infections in the Russian Federation contributed 59% of all cases in the WHO European Region and 74% of cases in the East. An increasing trend in new HIV diagnoses has been observed in one third of the reporting countries in the East, although this is at a slower rate than in previous years. Over the last three years, halted growth in reported newly diagnosed HIV has been observed in the Russian Federation and some signs of stabilization have been noted in Ukraine, which contributed to the overall stabilization of the epidemic in the East. The number of people living with undiagnosed HIV is increasing in the WHO European Region. Over the last decade, more people have been estimated to be newly 7 No data were reported from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. infected annually than have been diagnosed. In contrast, the proportion of those living with undiagnosed HIV is decreasing in the EU/EEA. While epidemic patterns and trends vary widely across WHO European Region countries, sustained increases have been seen in the number of newly diagnosed infections within certain transmission groups across parts of the Region: men who have sex with men in the Centre and East, and heterosexual transmission in the East, though some studies suggest that the latter increase needs to be interpreted with caution (1,2). 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 the West in recent years. Transmission through injecting drug use has continued to decrease in many countries, although it still accounted for 24% of reported new diagnoses with a known mode of transmission in the East in 2019. Too many people throughout the WHO European Region are diagnosed late (53%), 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 remains a major challenge. At the same time, the stabilizing AIDS trend observed since 2012 may be the result of a majority of countries having now implemented treat-all policies, which aim to offer anyone living with HIV the opportunity to receive antiretroviral therapy (ART) regardless of the stage of disease. New strategies are required to improve early diagnosis and make more people aware of their infection by expanding diversified and user-friendly approaches to more widely available HIV testing. WHO consolidated guidelines on HIV testing services, including guidelines on HIV self-testing and partner notification, and ECDC public health guidance on an integrated approach to HIV and hepatitis B and C testing recommend implementation of innovative approaches that include self-testing and community testing by lay providers using rapid tests as part of overall HIV testing services (3–5). WHO issued a policy brief on moving away from the use of western blotting and line immunoassays in HIV testing strategies and algorithms towards supporting decentralized testing and rapid linkage to treatment (6). While the provision of HIV testing services has improved over time and self-testing and community-based HIV testing have seen a substantial increase in implementation in recent years, policy-monitoring in the Region indicates that some testing modes remain limited or non-existent in many European countries (7). HIV testing services should focus on reaching the key population groups in the local epidemic context, be tailored to the specific 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 HIV incidence, morbidity and mortality in support of the 90–90–90 goals and other regional and global targets (8–10). 7HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT A robust body of evidence shows that early initiation of ART is beneficial both to the health of the person receiving the treatment and in preventing onward HIV transmission (11–16). Nearly 90% of countries in the WHO European Region have a policy to initiate ART regardless of CD4 cell count (17,18). The WHO Regional Office for Europe organized a regional workshop on advancing implementation science on HIV and viral hepatitis in Eastern Europe and Central Asia (EECA) in February 2020 (19). The workshop aimed to support countries in EECA to conduct and use implementation science and programme data to guide practical implementation of WHO recommendations within their HIV and viral hepatitis programmes, including, but not limited to: assessing the validity of routine surveillance data, with a particular focus on data on modes of HIV transmission; identifying barriers to the target of 90% of all infections being diagnosed and to optimizing testing interventions; implementing and scaling-up pre-exposure prophylaxis (PrEP); and improving linkage to, and retention in, care, quality of care and management of comorbidities. The workshop also aspired to foster collaboration among researchers, scientists, donors and partners to conduct and support implementation science in EECA. Interventions to control the epidemic should be based on evidence and adapted to national and local epidemiology. From the comprehensive epidemiological data presented in this report, the following can be concluded. • 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 current prevention, treatment and care interventions targeting MSM need to be further scaled-up and strengthened and should remain the priority of the HIV response. Countries with declines have demonstrated the impact of changing the culture towards more frequent testing for at-risk gay men and linkage to immediate care and ART for those found to be positive (20). Multicomponent interventions, and the inclusion of PrEP for HIV, screening and treatment for sexually transmitted infections, and self-testing and assisted voluntary partner notification, in the package of prevention and control interventions could help to curb the increasing trends being seen in some countries. In most European countries, reported use of PrEP is well below perceived need (3,21–23). Effective and accessible testing, prevention and care services for the increasingly diverse group of migrants at risk of, and living with, HIV need to be implemented more widely in many countries in the West of the Region. The 2011–2012 increase in HIV cases among people who inject drugs and continued reported local outbreaks in a number of countries (24–28) demonstrate the need to maintain or scale-up harm- reduction programmes. • For the countries in the Centre, new diagnoses 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 13 of the 14 reporting Centre countries. Interventions to address this situation are needed, such as PrEP for high-risk groups, HIV testing by lay providers, HIV rapid diagnostic tests, HIV self- testing and voluntary assisted partner notification, alongside policies and practices to offer ART to all people living with HIV. Some countries have undergone a transition to domestic financing of the HIV response after withdrawal of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. This has posed sustainability challenges, particularly in relation to the 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 prevent the epidemic from accelerating (29). • For the countries in the East, there is an urgent need to continue the scale-up of bold, evidence-based interventions 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 populations. 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. All of these services should be integrated into national policies and programmes and then implemented (3,4,10,30). Community involvement in the design and delivery of services is essential to reducing the rate of new HIV infections and increasing the number of people linked to care and initiated and retained on ART, with the ultimate aim of reducing HIV incidence and AIDS-related deaths. Innovative HIV prevention interventions should address the risk of heterosexual transmission, particularly in couples where one partner is engaged in high-risk behaviour (such as injecting drug use) or is spending longer periods of time working abroad. The large number of new diagnoses in people infected through injecting drug use emphasizes that evidence-based policies focused on key populations and other evidence-based approaches, 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. 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 completeness of data on reported mode of transmission and CD4 cell count at the time of diagnosis is suboptimal in the Region, mainly due to incomplete or no data 8SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data reported from large countries like Germany, Poland, the Russian Federation and Turkey. Some studies conducted in the East found that the information about mode of transmission among newly diagnosed patients may be biased, with many cases registered as heterosexually acquired having a history of injecting drug use or, among male cases, sex with men (1,2). This highlights the importance of assessing the validity of routine surveillance data in relation to mode of transmission, especially in countries where injecting drug use and homosexuality are stigmatized. The number of countries conducting enhanced HIV surveillance and reporting surveillance data at European level has increased gradually over time. In 2019, 41 countries submitted linked HIV and AIDS data, enabling greater understanding of the clinical status of people diagnosed with HIV. This approach increases the possibilities for longer-term monitoring of HIV continuum-of-care outcomes, such as modelling 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 goals and other global and regional targets. In September 2020, reflecting the COVID-19 pandemic situation, the WHO Regional Office for Europe and ECDC organized a joint virtual meeting with major national stakeholders involved in the response to TB, HIV and viral hepatitis, including key partners, donors, affected communities and civil society organizations. The aim was to exchange information and good practices on the maintenance of essential TB, HIV and viral hepatitis services. Countries and partners discussed their experiences in ensuring access to, and continuity of, quality HIV services during the COVID-19 pandemic and on how they monitor the impact of the COVID-19 pandemic on HIV services. Latest WHO policy guidance and recommendations on TB, HIV, viral hepatitis and comorbidities were also discussed during the meeting. References8 1. Dumchev K, Kornilova M, Kulchynska R, Azarskova M, Vitek C. Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk. BMC Public Health 2020;20(1):1288. doi:10.1186/s12889-020-09373-2. PMID:32843008; PMCID: PMC7449084. 2. Čakalo JI, Božičević I, Vitek C, Mandel JS, Salyuk T, Rutherford GW. Misclassification of men with reported HIV infection in Ukraine. AIDS Behav. 2015;19(10):1938–40. doi:10.1007/s10461-015-1112-0. PMID: 26070886. 3. Guidelines on HIV self-testing and partner notification. Supplement to consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2017 (https://www.who.int/hiv/pub/vct/hiv- self-testing-guidelines/en/). 4. Consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2015 (https://www.who.int/hiv/pub/guide- lines/hiv-testing-services/en/). 5. Public health guidance on HIV, hepatitis B and C testing in the EU/ EEA. Stockholm: ECDC; 2018 (https://www.ecdc.europa.eu/en/ publications-data/public-health-guidance-hiv-hepatitis-b-and-c- testing-eueea). 6. WHO recommends countries move away from the use of western blotting and line immunoassays in HIV testing strategies and algo- rithms. Policy brief. Copenhagen: WHO Regional Office for Europe; 8 All weblinks were accessed on 12 November 2020. 2019 (https://www.euro.who.int/en/health-topics/communicable- diseases/hivaids/publications/2019/who-recommends-countries- move-away-from-the-use-of-western-blotting-and-line-immunoas- says-in-hiv-testing-strategies-and-algorithms.-policy-brief-2019). 7. 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). 8. Global health sector strategy on HIV, 2016–2021 – towards ending AIDS. Geneva: World Health Organization; 2016 (https://www.who. int/hiv/strategy2016-2021/ghss-hiv/en/). 9. Ambitious treatment targets: writing the final chapter of the AIDS epidemic. Geneva: UNAIDS; 2014 (http://www.unaids.org/sites/ default/files/media_asset/JC2670_UNAIDS_Treatment_Targets_ en.pdf). 10. 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. Consolidated guidelines on the use of antiretroviral drugs for treat- ing and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2016 (https://www.who.int/hiv/pub/arv/arv-2016/ en/). 12. Guideline on when to start antiretroviral therapy and on pre-expo- sure prophylaxis for HIV. Geneva: World Health Organization; 2015 (https://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/). 13. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016;373(9): 795–807. 14. 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. 15. Guidelines version 10.1. October 2020. In: European AIDS Clinical Society [website]. Brussels: European AIDS Clinical Society; 2020 (https://www.eacsociety.org/files/guidelines-10.1_5.pdf). 16. Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, Degan O et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with HIV-positive partner taking suppressive antiretro- viral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019;393(10189):2428–38. 17. Continuum of HIV care. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2018 (https://www. ecdc.europa.eu/sites/default/files/documents/HIV-continuum-of- care-monitoring-dublin-declaration-progress-report-2018.pdf). 18. 2019 Global AIDS Monitoring (GAM). In: AIDSinfo [website]. New York (NY): UNAIDS; 2019 (https://aidsinfo.unaids.org/). 19. Regional Workshop on Advancing Implementation Science on HIV and Viral Hepatitis in Eastern Europe and Central Asia. Report (10– 11 February 2020, Berlin, Germany). Copenhagen: WHO Regional Office for Europe; 2020 (https://www.euro.who.int/en/health-top- i c s/co mmu ni c a b l e - dis e a s e s/hi v ai d s/p u b l i c a t i o ns/2020/ regional-workshop-on-advancing-implementation-science-on-hiv- and-viral-hepatitis-in-eastern-europe-and-central-asia.-report- 1011-february-2020,-berlin,-germany). 20. 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). 21. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014 (https://www.ecdc.europa.eu/ sites/default/files/media/en/publications/Publications/hiv-sti-pre- vention-among-men-who-have-sex-with-men-guidance.pdf). 22. 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. 23. Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P et al. and the ECDC Dublin Declaration Monitoring Network. Estimating the “PrEP gap”: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019;24(41):pii=1900598 (https://doi.org/10.2807/1560- 7917.ES.2019.24.41.1900598). 24. 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). 25. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015. Euro Surveill. 2015;20(40):pii=30036 (http://dx.doi.org/10.2807/1560-7917.ES.2016.20.40.30036). 26. HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre 9HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT for Drugs and Drug Addiction; 2018 (http://sante.public.lu/fr/ publications/h/hiv-joint-technical-mission/index.html). 27. McAuley A, Palmateer NE, Goldberg DJ, Trayner KMA, Shepherd SJ, Gunson RN et al. Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross-sec- tional analysis. Lancet HIV 2019;6(5):e315–24. 28. Des Jarlais DC, Sypsa V, Feelemyer J, Abagiu AO, Arendt V, Broz D et al. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV 2020;7(6):e434–42. 29. 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/pub- lications/lost- transition). 30. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. 2016 update. Geneva: World Health Organization; 2017 (https://www.who.int/hiv/pub/guidelines/key- populations-2016/en/).

11 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе В настоящем отчете представлены данные о диагностированных случаях ВИЧ-инфекции в период до конца 2019 г. – времени, непосредственно предшествующего началу глобальной пандемии COVID-19. Влияние пандемии на лабораторный потенциал, клинические учреждения и организации общественного здравоохранения, принимающие участие в эпиднадзоре за ВИЧ-инфекцией и ответных мерах в связи с ВИЧ/СПИД, наблюдалось на этапах сбора данных и подготовки настоящего отчета. Нескольким странам для предоставления своих данных по ВИЧ/СПИДу за 2019 г. потребовалось больше времени, чем обычно, а некоторые предупредили об увеличении задержек с подачей отчетности. Ряд стран вовсе заявил о невозможности подать сведения по некоторым переменным или подать их на тех уровнях, что соответствуют прошлой отчетности. Европейский центр профилактики и контроля заболеваний (ECDC) и Европейское региональное бюро ВОЗ в сотрудничестве с государствами-членами и партнерами внимательно изучат воздействие COVID-19 на эпиднадзор за ВИЧ- инфекцией ради обеспечения поддержания высоких стандартов европейских данных по ВИЧ/СПИДу. Несмотря на то, что заражение ВИЧ-инфекцией предотвратимо, показатели ВИЧ-инфицирования в Европейском регионе ВОЗ продолжают оставаться высокими. В 2019 г. в 47 из 53 стран Региона было зарегистрировано 136 449 новых случаев ВИЧ-инфекции,1 включая 24 801 случай в странах Европейского союза/Европейской экономической зоны (ЕС/ЕЭЗ). Это соответствует показателю заболеваемости, равному 15,6 впервые установленных диагнозов ВИЧ-инфекции на 100 000 населения (таблица A). По-прежнему, как и в течение всего последнего десятилетия, частота ВИЧ-инфицирования и общее число впервые выявленных случаев ВИЧ-инфекции были самыми высокими на востоке Региона (41,7 на 100 000 населения), более низкими на западе и в ЕС/ЕЭЗ (5,7 и 5,4 на 100 000, соответственно) и самыми низкими – в центральной его части2 (3,4 на 100 000 населения) (таблица A). Преобладающие пути передачи ВИЧ также различались в зависимости от географической зоны, указывая на неоднородность эпидемиологической ситуации по ВИЧ-инфекции в Европе. Преобладающими путями передачи ВИЧ- инфекции в странах ЕС/ЕЭЗ были половые контакты между мужчинами, а в восточной части Региона 1 Отсутствуют данные по Андорре, Бельгии, Монако, Северной Македонии, Туркменистану и Узбекистану. Лихтенштейн является членом ЕЭЗ, но не государством-членом ВОЗ, поэтому сведения о Лихтенштейне включены в итоговые данные по ЕС/ЕЭЗ, но не включены в итоговые данные по Европейскому региону ВОЗ. 2 Группировка стран Европейского региона ВОЗ на страны западной части Региона (23 страны), центральной его части (15 страны) и восточной (15 стран) основана на эпидемиологических характеристиках и соответствует разделению стран в предыдущих обзорах, опубликованных EuroHIV в период с 1984 г.: подробнее см. приложение 1, рисунок A1.1. Таблица A. Эпидемиологические характеристики впервые установленных диагнозов ВИЧ-инфекции и СПИДа, зарегистрированных в Европейском регионе ВОЗ, ЕС/ЕЭЗ, а также в западной, центральной и восточной частях Региона, 2019 г. Европейский регион ВОЗ Запад Центр Восток ЕС/ЕЭЗ Страны, предоставляющие данные/число странa 47/53 20/23 14/15 13/15 30/31 Number of new HIV diagnoses 136 449 21 793 6 814 107 842 24 801 Число впервые выявленных случаев ВИЧ-инфекцииb 15,6 5,2 3,4 41,7 5,4 Доля случаев в возрастной группе 15-24 лет 8,5% 10,2% 15,0% 5,7% 10,3% Доля случаев в возрастной группе 50+ 17,8% 22,0% 13,7% 16,1% 20,4% Соотношение мужчины/женщины 1,8 2,9 5,5 1,6 3,1 Путь передачи инфекции Половые контакты между мужчинами 20,7% 39,9% 27,3% 3,9% 38,7% Гетеросексуальная передача (мужчины) 26,4% 16,2% 18,2% 36,3% 16,1% Гетеросексуальная передача (женщины) 23,8% 17,8% 7,2% 32,6% 16,7% Употребление инъекционных наркотиков 13,0% 3,4% 2,1% 23,2% 3,9% Передача ВИЧ от матери ребенку (вертикальный путь) 0,7% 0,7% 0,5% 0,8% 0,7% Неизвестный 15,3% 21,6% 44,5% 3,1% 23,6% СПИД и поздняя диагностика ВИЧ-инфекции Доля впервые выявленных случаев ВИЧ-инфекции с числом CD4 <350 клеток/мм3 53,2% 48,8% 55,9% 55,7% 49,7% Число новых случаев СПИДаc 12535 2156 802 9577 2772 Частота новых случаев СПИДа на 100 000 населения 2,0 0,5 0,4 8,3 0,5 a Отсутствуют данные по Андорре, Бельгии, Монако, Северной Македонии, Туркменистану и Узбекистану. b Показатели заболеваемости в ЕС/ЕЭЗ скорректированы с учетом задержки отчетности (приложение 6); Расчетное число новых случаев с учетом задержки отчетности составляет 27 231 и 23 971 , соответственно. c Отсутствуют данные по Северной Македонии, Швеции, Туркменистану и Узбекистану 12 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data – гетеросексуальные контакты и употребление инъекционных наркотиков. В Европейском регионе ВОЗ за последнее десятилетие число людей с впервые выявленной ВИЧ-инфекцией увеличилось на 16%. В то же время в странах ЕС/ЕЭЗ в этот же период число новых диагнозов ВИЧ- инфекции сократилось на 9% (рис. A). При сопоставлении числа новых диагностированных случаев ВИЧ-инфекции с предполагаемым числом новых ВИЧ-инфекций за последнее десятилетие становится очевидным, что в течение большей части этого периода количество людей, заразившихся ВИЧ, превышает количество диагностированных случаев ВИЧ-инфекции, что свидетельствует о росте числа людей, живущих с не диагностированной ВИЧ- инфекцией в Регионе. Напротив, в ЕС/ЕЭЗ, согласно расчетным данным, число впервые выявленных случаев ВИЧ-инфекции превышает число людей, инфицированных ВИЧ, что свидетельствует о сокращении доли людей, живущих с не диагностированной ВИЧ-инфекцией. В Регионе в целом частота новых случаев ВИЧ- инфекции среди мужчин увеличивалась более быстрыми темпами, чем среди женщин; к 2019 г. этот показатель у мужчин был в два раза выше, чем у женщин. В ЕС/ЕЭЗ частота новых диагнозов ВИЧ- инфекции снизилась как у мужчин, так и у женщин, но у женщин темпы снижения были более быстрыми; к 2019 г. этот показатель у мужчин был в три раза выше, чем у женщин (рис. B). Уровень зарегистрированной заболеваемости ВИЧ- инфекцией в Регионе также был выше среди мужчин, чем среди женщин во всех возрастных группах, за исключением лиц моложе 15 лет (таблица 9). В Европейском регионе в 2019 г. чуть более половины (53%) впервые выявленных случаев заражения ВИЧ были диагностированы на поздней стадии инфекции (количество CD4-лимфоцитов < 350 клеток/мм3 на момент установления диагноза). Этот показатель был самым высоким в странах восточной части Региона (56%) и в центре (56%) и самым низким в странах западной его части (49%), в то время как в странах ЕС/ЕЭЗ поздняя диагностика отмечалась в 50% случаев (таблица А). В 2019 г. в 45 государствах-членах в Европейском регионе ВОЗ было зарегистрировано 12 535 новых случаев СПИДа,3 что соответствует показателю заболеваемости СПИДом, равному 1,7 на 100 000 населения (см. таблицу A, а также таблицу 14). В 2019 г. в странах ЕС/ЕЭЗ было зарегистрировано 2 772 случая заболевания СПИДом – 0,5 случаев на 100 000 населения. В течение последнего десятилетия заболеваемость СПИДом в западной части Региона и в странах ЕС/ЕЭЗ продолжала неуклонно снижаться (см. рис. 1.17 и 2.4). В то же время в восточной его части заболеваемость СПИДом продолжала увеличиваться, хотя в период с 2012 по 2018 г. она начала стабилизироваться и даже снизилась в 2019 г. Европейский союз и Европейская экономическая зона В 2019 г. в 30 странах ЕС/ЕЭЗ диагноз ВИЧ-инфекции был поставлен 26 24 801 человеку, что соответствует частоте, равной 5.4 на 100 000 населения с поправкой на задержку отчетности (таблица 1, приложение 6). Самые высокие показатели ВИЧ-инфицирования 3 Отсутствуют данные по Андорре, Бельгии, Монако, Российской Федерации, Северной Македонии, Туркменистану, Узбекистану и Швеции. (Российская Федерация подала сведения только по впервые установленным диагнозам ВИЧ-инфекции с разбивкой по полу и данные о тестировании на ВИЧ). Рисунок A. Данные по ЕС/ЕЭЗ и Европейскому региону ВОЗ: расчетное число новых случаев ВИЧ-инфекции и число впервые выявленных случаев ВИЧ-инфекции, 2010-2019 гг., а также цель на 2020 год 20202019201820172016201520142013201220112010 Чи сл о вп ер вы е вы яв ле нн ы х сл уч ае в ВИ Ч- ин ф ек ци и и ра сч ет но е чи сл о но вы х сл уч ае в ВИ Ч- ин ф ек ци и Год постановки диагноза 0 50 000 100 000 150 000 200 000 Цель на 2020 г., ЕС/ЕЭЗ Цель на 2020 г., Европейский регион ВОЗ Расчетное число новых случаев ВИЧ-инфекции, ЕС/ЕЭЗ Впервые выявленные случаи ВИЧ-инфекции, ЕС/ЕЭЗ Впервые выявленные случаи ВИЧ-инфекции, Европейский регион ВОЗ Расчетное число новых случаев ВИЧ- инфекции в Европейском регионе ВОЗ 13 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT были зарегистрированы на Мальте (16,2; 80 случаев), в Латвии (15,4; 295 случаев) и Эстонии (13,4; 178 случаев), а самые низкие – в Словакии (1,9; 101 случаев) и Словении (1,6; 34 случая) (таблица 1, карта A). Частота новых случаев ВИЧ-инфекции была выше среди мужчин (7,5 на 100 000 населения; таблица 2), чем среди женщин (2,4 на 100 000 населения; таблица 3). Общее процентное соотношение случаев ВИЧ- инфицирования у мужчин и женщин составило 3,1 (таблица A). Это соотношение, которое было самым высоким в Хорватии (19,4) и Венгрии (13,0), превышало 1 во всех странах ЕС/ЕЭЗ (рис. 1.1). Преобладающим путем передачи в странах с наиболее высоким процентным соотношением случаев ВИЧ-инфицирования у мужчин и женщин были половые контакты между мужчинами. Анализ половозрастных показателей указывает на то, что заболеваемость ВИЧ-инфекцией у мужчин была выше, чем у женщин во всех возрастных группах, за исключением возрастной группы до 15 лет, в которой показатели заболеваемости мужчин и женщин были аналогично низкими (рис. 1.2). Наибольший повозрастной показатель впервые выявленных случаев ВИЧ-инфекции отмечался в возрастной группе 25–29 лет (18,0 на 100 000 населения), в то время как наиболее высокий повозрастной показатель у женщин отмечался в возрастной группе 30–39 лет (6,1 на 100 000 населения) (рис. 1.2). Молодые люди в возрасте от 15 до 24 лет составляют 11% населения ЕС/ЕЭЗ, и среди них в 2019 г. было установлено 11% диагнозов ВИЧ- инфекции. Сорок один процент населения ЕС/СЭЗ составляют пожилые люди (50 лет и старше), на долю которых приходится 21% новых случаев ВИЧ- инфекции, зарегистрированных в 2019 г. (рис. 1.4). Половые контакты между мужчинами остаются преобладающим путем передачи ВИЧ-инфекции в ЕС/ ЕЭЗ; на этот путь инфицирования пришлось39% (9598) всех случаев ВИЧ-инфекции, диагностированных в 2019 г., и более половины (51%) таких случаев с известным путем передачи (таблица 4, таблица 8, рис. 1.5). Среди диагнозов ВИЧ- инфекции с известным путем передачи ВИЧ-инфекции преобладали случаи инфицирования при половых контактах между мужчинами, на долю которых приходилось свыше 60% впервые установленных диагнозов ВИЧ-инфекции в 10 странах (Венгрия, Германия, Исландия, Испания, Нидерланды, Польша, Словакия, Словения, Хорватия и Чешская Республика; рис. 1.5). Гетеросексуальные контакты были вторым наиболее распространенным путем передачи ВИЧ-инфекции среди лиц, впервые диагностированных в ЕС/ЕЭЗ в 2019 г.; на этот путь заражения пришлось 33% (8 164 случая) новых диагностированных случаев ВИЧ- инфекции и 43% таких случаев с известным путем передачи (таблица 6, таблица 8, рис. 1.5). Гетеросексуальные контакты были наиболее распространенным известным путем передачи ВИЧ- инфекции в девяти странах ЕС/ЕЭЗ (Кипр, Латвия, Люксембург, Норвегия, Португалия, Румыния, Франция, Швеция и Эстония). На заражение ВИЧ при употреблении инъекционных наркотиков пришлось 4% случаев ВИЧ-инфекции диагностированных в 2019 г.; употребление инъекционных наркотиков является вероятным путем ВИЧ-инфицирования для одной четверти или более новых случаев ВИЧ-инфекции, зарегистрированных в Латвии (26%) и Литве (38%) (таблица 5, таблица 8, рис. 1.5). В 2019 г. в странах ЕС/ЕЭЗ на вертикальную передачу пришлось менее 1% новых диагностированных случаев ВИЧ-инфекции, а в 24% таких случаев путь заражения либо не был указан, либо был указан как неизвестный (таблица A). Сорок четыре процента новых случаев ВИЧ- инфекции, зарегистрированных в ЕС/ЕЭЗ в 2019 г., были диагностированы у мигрантов, родившихся за пределами страны, где им был поставлен диагноз (рис. 1.6). По месту рождения мигрантов Рисунок B. Частота впервые выявленных случаев ВИЧ-инфекции на 100 000 населения (с разбивкой по полу и году постановки диагноза) в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 2009-2018 гг. 0 5 10 15 20 25 Мужчины (ЕС/ЕЭЗ) Мужчины (Европейский регион ВОЗ) Женщины (ЕС/ЕЭЗ) Женщины (Европейский регион ВОЗ) 2019201820172016201520142013201220112010 Ча ст от а вп ер вы е вы яв ле нн ы х сл уч ае в В И Ч- ин ф ек ци и на 1 00 0 00 н ас ел ен ия Год постановки диагноза 14 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data распределение было следующим: 18% – страны Африки к югу от Сахары, 9% – страны Латинской Америки и Карибского бассейна, 8% – другие страны Центральной и Восточной Европы и 3% – другие страны Западной Европы. В период с 2010 г. по 2019 г. наметилась тенденция к незначительному снижению частоты установления диагнозов ВИЧ-инфекции. Данные показатели составляли 6,6 на 100 000 населения в начале этого периода, с последующим постепенным снижением до 4,9 на 100 000 в 2019 г. (таблица 1, рис. 1.10, приложения 1, 5 и 6). Хотя в последнее десятилетие в ЕС/ЕЭЗ отмечено снижение показателей в целом, на страновом уровне наблюдаются различные тенденции. Ряд стран, включая Австрию, Данию, Испанию, Италию, Люксембург, Нидерланды, Норвегию, Португалию, Соединенное Королевство, Финляндию, Францию и Эстонию, также сообщили о снижении частоты впервые диагностированных случаев ВИЧ-инфекции даже после корректировки на изменения в охвате населения эпиднадзором и задержку отчетности. И, наоборот, с учетом задержки отчетности, количество диагнозов ВИЧ более чем удвоилось с 2010 г. на Кипре, Мальте и в Словакии и увеличилось более чем на 50% в Болгарии и Польше (таблица 1, приложение 6). В некоторых странах наблюдаются диспропорционально большие задержки подачи отчетности, что сопряжено с риском как завышения показателей, указывающих на снижение частоты новых случаев ВИЧ-инфекции, так и занижения показателей, указывающих на увеличение частоты таких случаев. Тенденции различаются и по половому, и по возрастному признаку. За период с 2010 г. повозрастные показатели снизились во всех возрастных группах, за исключением женщин старше 50 лет. Сравнение возрастных групп показывает, что показатели частоты выявления новых случаев ВИЧ- инфекции были устойчиво выше в группах 25–29 лет и 30–39 лет на протяжении всего анализируемого периода как у женщин, так и у мужчин (рис. 1.11a, 1.11b). Среди женщин средний возраст на момент установления диагноза ВИЧ-инфекции увеличился с 34 лет в 2010 г. до 37 лет в 2019 г., оставаясь стабильным у мужчин на уровне 37 лет. В старших возрастных группах регистрируется более высокая доля новых диагнозов ВИЧ-инфекции; так, если в 2010 г. 15% лиц, которым был впервые поставлен диагноз ВИЧ-инфекции, были старше 50 лет, то в 2019 г. этот показатель повысился до 20%. В структуре всех впервые выявленных случаев ВИЧ- инфекции доля случаев, обусловленных половыми контактами между мужчинами, увеличилась с 45% случаев в 2010 г. до 52% в 2015 г., а затем уменьшилась до 47% в 2019 г. (рис 1.13). В странах, регулярно подававших сведения, число диагнозов ВИЧ- инфекции среди МСМ стабильно увеличивалось с 8 730 случаев в 2010 г., достигнув в 2014 г. пикового значения, равного 9 839 случаев. В 2019 г. было зарегистрировано меньшее количество новых случаев ВИЧ-инфекции (6688), в этой же группе стран, даже после корректировки на задержку отчетности. Однако главным образом снижение, вероятнее всего, объясняется меньшим количеством новых случаев ВИЧ-инфекции среди мужчин, практикующих секс с мужчинами (МСМ) в Австрии, Германии, Греции, Испании, Италии, Люксембурге, Нидерландах, Норвегии, Португалии, Соединенном Королевстве, Финляндии и Франции (таблица 4) со значительным повышением в последние годы этих показателей, отмеченном в Болгарии, на Кипре, в Литве, Польше, Румынии, Словакии, Эстонии. В анализируемый период число случаев ВИЧ- инфицирования среди МСМ, родившихся за пределами подающей сведения страны, увеличилось, несколько снизившись в 2016-2019 гг., но не в той же степени, что наблюдалась среди МСМ, родившихся в странах ЕС/ЕЭЗ (рис. 1.14). Рисунок C. Доля лиц с поздно выявленной ВИЧ-инфекцией (CD4 < 350 клеток/мм3) с разбивкой по полу, возрасту и пути заражения, Европейский регион ВОЗ, 2019 г. (n = 39 496) 0 10 20 30 40 50 60 70 Процентная доля 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 П ол Во зр ас т П ут ь пе ре да чи 15 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT В течение последнего десятилетия число новых случаев ВИЧ-инфекции с гетеросексуальным путем передачи последовательно снижалось (рис. 1.13а), причем такое снижение было более выраженным среди женщин и гетеросексуалов, родившихся за границей, чем среди мужчин и коренных жителей Региона (рис. 1.13a, 1.14). Несмотря на общее снижение частоты новых случаев ВИЧ-инфекции вследствие гетеросексуальных контактов, в Литве и Словакии было отмечено существенное повышение этого показателя. Число впервые диагностированных случаев ВИЧ- инфекции, обусловленных употреблением инъекционных наркотиков, в период с 2010 г. снизилось как среди лиц, родившихся за границей, так и среди коренных жителей – за исключением локальных вспышек в 2011–2012 гг., повлиявших на тенденцию показателей в этой группе населения в странах ЕС/ЕЭЗ, и менее широких локальных вспышек, отмеченных в этот же период времени в ряде других стран (таблица 5, рис. 1.13a, 1.14). Частота передачи от матери ребенку, внутрибольничного инфицирования и инфицирования при переливании крови также последовательно снижались в период с 2010 г. по 2019 г., и теперь такие пути передачи обусловливают менее 1% впервые диагностированных случаев ВИЧ-инфекции (таблица 8). Число случаев с неизвестным путем передачи увеличился с 14% в 2010 г. до 22% в 2019 г. Информация о количестве CD4-лимфоцитов на момент установления диагноза ВИЧ-инфекции была предоставлена 26 странами (таблица 13). Среди всех случаев ВИЧ-инфекции, диагностированных в 2019 г., по которым имелась информация о количестве CD4- лимфоцитов или об острой стадии ВИЧ-инфекции, 12% (1 896) случаев были зарегистрированы как острая стадия ВИЧ-инфекции и 26% (4 122) – как случаи недавнего заражения ВИЧ (с количеством CD4-лимфоцитов выше 500 клеток/мм3 на момент установления диагноза). Среди тех МСМ, у которых ВИЧ-инфекция была впервые выявлена в 2019 г. и о которых имелась соответствующая информация, 15% (1 116) случаев были зарегистрированы как случаи острой ВИЧ-инфекции, а у 30% (2 192) количество CD4- лимфоцитов было выше 500 клеток/мм3 на момент установления диагноза (рис.1.7). Как и в предыдущие годы, почти в половине (50%) всех случаев ВИЧ-инфекции с определением количества CD4-лимфоцитов диагноз был поставлен через несколько лет после заражения, когда количество CD4-лимфоцитов было менее 350 клеток/мм3; при этом считается, что 30% пациентов на момент установления диагноза были на поздних стадиях ВИЧ-болезни (количество CD4 < 200 клеток/мм3). Наибольшая доля людей с ВИЧ-инфекцией, впервые выявленной на поздних стадиях (CD4 <350/мм3) отмечалась среди женщин (53%), людей среднего и пожилого возраста (54% в возрасте 40–49 лет и 65% в возрасте старше 50) лет, мужчин и женщин, инфицировавшихся при гетеросексуальных контактах (61% и 53%, соответственно), людей, инфицировавшихся ВИЧ вследствие употреблении инъекционных наркотиков (52%), мигрантов из стран Африки, расположенных к югу от Сахары (57%), а также мигрантов из Южной и Юго-Восточной Азии (54%) (рис. 1.8, таблица 13). В странах, регулярно подававших сведения о путях передачи и количестве клеток CD4-лимфоцитов на момент установления диагноза в динамике, количество лиц, которым диагноз был поставлен на поздних стадиях (количество CD4-лифоцитов < 350 клеток/мм3 на момент установления диагноза), сократилось на 29%, с 7 441 в 2010 г. до 5 265 в 2019 г. Снижение числа случаев поздней диагностики наблюдалось при всех путях передачи (рис. 1.15) с сокращением на 42% в группе женщин, инфицировавшихся ВИЧ гетеросексуальным путем (2 056 в 2010 г., 1 201 в 2019 г.), с сокращением на 40% в группе лиц, инфицировавшихся вследствие употребления инъекционных наркотиков (319 в 2010 г., 191 в 2019 г.), с сокращением на 29% среди гетеросексуальных мужчин (1 906 в 2010 г., 1 353 в 2019 г.) и с сокращением на 24% частоты передачи инфекции вследствие половых контактов между мужчинами (2 529 в 2010 г., 1 914 в 2019 г.) (рис. 1.15). В 2019 г. сведения о 2 772 диагнозах СПИДа были поданы 29 странами ЕС/ЕЭЗ,4 что соответствует показателю 0,5 случаев на 100 000 населения (таблица 14). В общей сложности, в 74% этих случаев диагноз СПИДа ставился в период, превышающий 90 дней с момента установления диагноза ВИЧ- инфекции, указывая на то, что большинство случаев СПИДа в странах ЕС/ЕЭЗ являются результатом поздней диагностики ВИЧ-инфекции. Эта закономерность характерна для всех пациентов вне зависимости от путей передачи ВИЧ-инфекции, за исключением людей, инфицировавшихся при употреблении инъекционных наркотиков, среди которых более половины (60%) случаев СПИДа диагностировались в период, превышающий 90 дней с момента установления диагноза ВИЧ-инфекции (рис. 1.16). В 2019 г. двадцать одна страна сообщила о выявлении (легочного и/или внелегочного) туберкулеза (ТБ) как СПИД-индикаторного заболевания у 14% лиц, которым диагноз СПИДа был установлен в 2019 г. (рис. 1.18). В ЕС/ЕЭЗ число случаев заболевания СПИДом за последнее десятилетие сократилось более чем вдвое (рис. 1.10). Такое снижение отмечается и среди мужчин, и среди женщин, а также среди всех категорий инфицированных, сгруппированных по путям передачи, но оно представляется наиболее выраженным у пациентов, заражение которых обусловлено употреблением инъекционных наркотиков (таблицы 15–20, рис. 1.17). Несмотря на общее сокращение частоты случаев СПИДа в масштабах ЕС/ЕЭЗ, в Венгрии и Чешской Республике в период с 2010 г. отмечался рост заболеваемости 4 Все страны ЕС/ЕЭЗ, за исключением Бельгии и Швеции. 16 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data СПИДом. Показатели смертности вследствие СПИДа в ЕС/ЕЭЗ неуклонно снижаются с середины 1990-х годов. Европейский регион ВОЗ В 2019 г. число зарегистрированных новых случаев ВИЧ-инфекции составило 136 449, что соответствует показателю 15,6 на 100 000 населения, то есть в Европейском регионе ВОЗ наблюдалось продолжение сокращения роста новых случаев ВИЧ- инфицирования, главным образом благодаря постоянному снижению этого показателя на западе и общей тенденции к его стабилизации на востоке. Тем не менее, треть стран в восточной части Региона отмечала ежегодный прирост новых случаев установления диагноза ВИЧ. Из 136 449 случаев ВИЧ-инфекции, выявленных в 2019 г., 79% были диагностированы в восточной части (107 842), 16% – в западной части (21 793) и 5% – в центральной части Региона (6 814) (таблица A). Наиболее высокий показатель заболеваемости также зафиксирован на востоке (41,7 на 100 000 населения), будучи диспропорционально выше, чем на западе (5,7 на 100 000 населения) и в центре Региона (3,4 на 100 000 населения) (таблица A). Частота новых диагностированных случаев ВИЧ- инфекции в 2019 г. существенно различались между странами Европейского региона ВОЗ. Самые высокие показатели на 100 000 населения отмечались в Российской Федерации (54,9), Украине (39,0), Республике Молдова (22,8) и Беларуси (22,6), а самые низкие – в Боснии и Герцеговине (0,9) и в Словении (1,6) (таблица 1). Общий показатель ВИЧ-инфицирования среди мужчин составлял 20,8 на 100 000 населения (таблица 2) и среди женщин – 10,6 на 100 000 населения (таблица 3). Наибольшая доля лиц с впервые диагностированной ВИЧ-инфекцией в 46 странах, предоставивших данные,5 на момент установления диагноза принадлежали к возрастной группе 30–39 лет (34%), 9% были молодыми людьми в возрасте 15–24 лет и 18% – людьми в возрасте 50 лет и старше. Соотношение новых случаев ВИЧ-инфекции у мужчин и женщин равнялось 1,8 с самым низким значением в восточной части Региона (1,6), более высоким значением в западной его части (2,9) и наивысшим значением – в центре (5,5). Наиболее распространенным путем передачи инфекции были гетеросексуальные контакты (50%), причем 10% таких случаев отмечены среди выходцев из стран, 5 Данные, предoставленные Российской Федерацией, ограничивались сведениями о новых случаях ВИЧ-инфекции с разбивкой по полу за 2009-2019 гг. и данными о тестировании на ВИЧ, что позволило включить российские данные в таблицы 1-3 и 25 и в рисунки, демонстрирующие динамику показателей ВИЧ-инфицирования. Данные о возрасте пациентов и путях передачи, представленные в настоящем докладе, охватывают страны, подавшие полный набор данных в единую европейскую систему эпиднадзора за ВИЧ-инфекцией ECDC/ВОЗ. расположенных за пределами Региона, с генерализованной эпидемией ВИЧ-инфекции, 21% инфицировались вследствие половых контактов между мужчинами, 13% – вследствие употребления инъекционных наркотиков и 0,7% – в результате передачи инфекции от матери ребенку. В 15% новых случаев ВИЧ-инфекции информация о пути передачи была неизвестна или отсутствовала (таблица A). В восточной части Региона в 12 странах, предоставивших данные о новых случаях ВИЧ- инфекции с известным путем передачи, 71% пациентов инфицировались при гетеросексуальных контактах и 24% – при употреблении инъекционных наркотиков; частота заражения при половых контактах между мужчинами оставалась низкой – на уровне 4% случаев (таблицы 4–6, 8). Основными путями передачи ВИЧ-инфекции в центральной части Региона были половые контакты между мужчинами (49%) и гетеросексуальные контакты (46%), но у 44% пациентов с впервые диагностированной ВИЧ- инфекцией информация о пути передачи отсутствовала. Половые контакты между мужчинами были преобладающим путем передачи ВИЧ-инфекции в 10 из 14 стран центральной части Региона. В западной части Региона основными путями заражения ВИЧ были половые контакты между мужчинами (40% случаев) и гетеросексуальные контакты (34% случаев, среди которых 39% приходилось на выходцев из стран с генерализованной эпидемией ВИЧ-инфекции). По 22% случаев новых диагнозов ВИЧ-инфекции подобная информация отсутствовала. За последние 10 лет в 47 странах, регулярно подававших сведения, частота выявления ВИЧ- инфекции увеличились на 9% с 14,1 на 100 000 населения в 2010 г. (118 726 случаев) до 15,4 на 100 000 населения в 2019 г. (136 449 случаев) (рис. 2.2). Увеличение происходило, главным образом, за счет сохранения восходящей тенденции в восточной части Региона, где этот показатель увеличился на 23%, с 39,9 на 100 000 (86 266 случаев) до 41,7 на 100 000 (107 842 случаев). В период с 2010 г. по 2019 г. в центральной части Региона этот показатель увеличился на 113% – с 1,6 до 3,4 на 100 000 населения (наибольшее относительное увеличение среди всех трех географических зон), в то время как в западной части Региона за тот же период он снизился на 31% – с 7,5 до 5,7 на 100 000 населения (рис. 2.2). В период 2010–2019 гг. сведения о путях передачи ВИЧ-инфекции регулярно подавались 39 странами (рис. 2.3). На востоке общий рост был обусловлен быстрым увеличением числа заражений ВИЧ- инфекцией половым путем – прирост на 57% для передачи при гетеросексуальных половых контактах и пятикратное увеличение для передачи при половых контактах между мужчинами. При гетеросексуальной передаче увеличение показателей было значительно более выраженным среди мужчин (103%), чем среди женщин (21%). Частота передачи инфекции 17 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT вследствие употребления инъекционных наркотиков снизилась на 36%, продолжая при этом оставаться на достаточно высоком уровне (рис. 2.9). В центре в период с 2010 г. по 2019 г. число инфицировавшихся при половых контактах между мужчинами, удвоилось; этот путь передачи преобладал в 12 из 14 стран при параллельном увеличении числа случаев передачи ВИЧ-инфекции гетеросексуальным путем на 48%. Частота передачи ВИЧ при употреблении инъекционных наркотиков стабилизировалась после вспышки, наблюдавшейся в Румынии в 2011– 2013 гг. (рис. 2.1). Доля новых случаев ВИЧ-инфекции вследствие употребления инъекционных наркотиков оставалась на уровне 6% и в 2010 г., и в 2019 г. (рис. 2.16). На Западе частота новых случаев ВИЧ- инфекции, обусловленных гетеросексуальными контактами, продолжала неуклонно снижаться, и в целом за десятилетний период она сократилась на 37%. В период с 2010 г. по 2019 г. частота заражения ВИЧ при употреблении инъекционных наркотиков снизилась на 34% и после пика в 2012 г., вызванного вспышкой в Греции, в настоящее время опять снижается. Число впервые выявленных случаев ВИЧ- инфекции, обусловленных половыми контактами между мужчинами, в сравнении с 2009 г. снизилось на 29%. Число новых диагнозов ВИЧ-инфекции с неизвестным путем передачи увеличилось на Западе на 37% (рис. 2.18). Поздняя диагностика ВИЧ-инфекции в Регионе остается проблемой. Среди людей старше 14 лет с впервые выявленной ВИЧ-инфекцией, по которым имелась информация о количестве CD4-лимфоцитов на момент установления диагноза, более чем у половины (53%) диагноз был поставлен поздно, когда число CD4-лимфоцитов снизилось до менее 350 клеток/мм3, включая 31% пациентов на поздних стадиях ВИЧ-болезни с количеством CD4 <200 клеток/ мм3. Доля людей с впервые выявленной ВИЧ- инфекцией на поздних стадиях (CD4 <350/мм3) варьировала в зависимости от пути передачи и возрастной группы, но была самой высокой среди инфицировавшихся при гетеросексуальных половых контактах (58%; 60% для мужчин и 55% для женщин) и при потреблении инъекционных наркотиков (52%), а самой низкой – среди мужчин, инфицировавшихся при половых контактах с мужчинами (42%) (рис. C). Эта доля повышается с увеличением возраста на момент установления диагноза в диапазоне от 35% среди людей в возрасте 15–19 лет до 67% среди людей в возрасте 50 лет и старше. Каких-либо значительных различий в частоте поздней диагностики в зависимости от пола выявлено не было (53% для мужчин и 54% для женщин), но в отношении мужчин эта схожесть маскирует различие между МСМ (которым, как правило, диагноз ставится раньше) и гетеросексуальными мужчинами (которым, как правило, диагноз ставится позже). Кроме того, отмечались незначительные различия в поздней диагностике и в зависимости от географии внутри Региона – 56% на востоке и в центре и 49% на западе. В 2019 г. в 45 государствах-членах в Европейском регионе ВОЗ6 СПИД был впервые диагностирован у 12 535 человек, и, таким образом, заболеваемость СПИДом составила 1,7 случая на 100 000 населения. В целом по Региону 76% случаев СПИДа были диагностированы на востоке, где показатель заболеваемости на 100 000 населения также был самым высоким (8,3); 18% случаев диагностировались на Западе (показатель 0,5 на 100 000 населения) и 6% – в центре Региона (0,4 на 100 000 населения) (таблица 14). У двадцати одного процента людей с диагностированным СПИДом были выявлен туберкулез как СПИД-индикаторное заболевание, частота которого варьировала от 13% случаев на Западе и 21% в центре до 28% на востоке. В период с 2010 г. по 2019 г. общая частота новых диагнозов СПИДа в Регионе сократилась на 23%, но тенденции развития СПИДа значительно различаются между тремя географическими регионами. На востоке показатель увеличился на 15%, с 7,2 в 2010 г. до 8,3 в 2019 г. В центральной части показатель оставался стабильным на уровне 0,4 на 100 000 населения, в то время как на Западе Региона продолжилась тенденция устойчивого снижения – сокращение на 69% с 1,6 в 2010 г. до 0,5 в 2019 г. (рис. 2.4). Выводы Передача ВИЧ-инфекции остается одной из важнейших нерешенных проблем общественного здравоохранения, которая затрагивает миллионы людей в Европейском регионе ВОЗ, особенно в восточной его части. На протяжении последних трех десятилетий в Европейском регионе ВОЗ ВИЧ- инфекция была диагностирована с официальной регистрацией у 2,1 миллионов, в том числе у свыше 710 000 людей, проживающих в ЕС/ЕЭЗ. В 2019 г. ВИЧ- инфекция была диагностирована более чем у 136 000 человек, что соответствует показателю 15,6 на 100 000 населения. Подавляющее большинство новых случаев ВИЧ-инфекции (79%) были выявлены в восточной части Региона, а 16% – на Западе. На Российскую Федерацию приходится 59% всех новых случаев ВИЧ-инфекции, зарегистрированных в Европейском регионе ВОЗ, и 74% – в восточной части Региона В трети стран в восточной части Европейского региона ВОЗ, подавших сведения, наблюдается тенденция к увеличению числа новых диагнозов ВИЧ-инфекции, хотя и в более медленном, нежели ранее, темпе. В последние три года в Российской Федерации отмечалось приостановление темпов прироста числа зарегистрированных новых случаев ВИЧ-инфекции; некоторые признаки стабилизации наблюдались также в Украине, что способствовало общей стабилизации эпидемии на востоке Региона. 6 Отсутствуют данные по Андорре, Бельгии, Монако, Российской Федерации, Северной Македонии, Туркменистану, Узбекистану и Швеции. 18 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data В Европейском регионе ВОЗ растет число людей, живущих с ВИЧ, с неустановленным диагнозом. По оценкам, за последнее десятилетие ежегодно инфицируется больше людей, чем ставится диагнозов. Напротив, в ЕС/ЕЭЗ доля людей, живущих с ВИЧ, с неустановленным диагнозом, сокращается. Хотя эпидемические модели и тенденции в разных странах Европейского региона ВОЗ варьируют в широких пределах, в некоторых частях Региона наблюдалось стойкое увеличение числа новых случаев заражения, связанных с определенными путями передачи инфекции, а именно: среди мужчин, имеющих половые контакты с мужчинами, в центре и на востоке, а также среди гетеросексуалов на востоке Региона, хотя некоторые исследования дают основания полагать, что последнее утверждение следует интерпретировать с осторожностью (1,2). За прошлые годы частота гетеросексуальной передачи ВИЧ-инфекции существенно сократилась в ЕС/ЕЭЗ и западной части Региона, особенно среди женщин, равно как и частота случаев передачи ВИЧ-инфекции при половых контактах между мужчинами в отдельных странах ЕС/ЕЭЗ и западной части Региона. Во многих странах продолжала снижаться частота передачи ВИЧ при употреблении инъекционных наркотиков, хотя в 2019 г. на этот путь заражения в восточной части Региона по-прежнему приходилось 24% впервые зарегистрированных случаев ВИЧ- инфекции с известным путем передачи. У слишком большого числа людей во всем Европейском регионе ВОЗ диагноз ВИЧ-инфекции ставится на поздних стадиях (53%), что повышает риск ухудшения состояния здоровья, летального исхода и дальнейшего распространения ВИЧ- инфекции. Большое число диагнозов СПИДа на востоке подтверждает, что поздняя диагностика ВИЧ- инфекции остается серьезной проблемой. В то же время тенденция к стабилизации заболеваемости СПИДом, наблюдаемая с 2012 г., может быть результатом того, что большинство стран восточной части Региона в настоящее время проводят политику «Лечить всех», согласно которой возможность получения антиретровирусной терапии (АРТ) предлагается всем людям, живущим с ВИЧ, независимо от стадии заболевания. Для обеспечения ранней диагностики и повышения числа людей, осведомленных о своем ВИЧ-статусе, требуются новые стратегии с расширением диапазона разнообразных и дружественных пользователю подходов к более широкодоступному тестированию на ВИЧ. Сводное руководство ВОЗ по самотестированию на ВИЧ и информированию партнеров и Руководство ECDC по комплексному тестированию на ВИЧ-инфекцию и гепатиты B и C содержат рекомендации по внедрению в практику тестирования инновационных подходов, включая самотестирование и тестирование на уровне местных сообществ, проводимое обученными поставщиками услуг без медицинского образования с использованием быстрых тестов как части общих услуг по тестированию на ВИЧ (3–5). ВОЗ выпустила аналитическую записку об отказе от использования вестерн-блоттинга и линейного иммуноанализа в стратегиях и алгоритмах тестирования на ВИЧ и переходе на поддержку децентрализованного тестирования и незамедлительного направления на лечение (6). Хотя предоставление услуг по тестированию на ВИЧ в Регионе со временем улучшилось и степень внедрения таких подходов, как самотестирование и тестирование на местных сообществ, значительно повысилась в последние годы, результаты мониторинга политики в рамках Региона указывают на то, что во многих европейских странах некоторые подходы к тестированию используются в ограниченных масштабах или вообще не применяются (7). Услуги по тестированию на ВИЧ должны сосредоточиваться на ключевых группах населения с учетом местных эпидемиологических особенностей, адаптироваться к конкретным потребностям этих групп, а также содействовать своевременному охвату такими услугами, как профилактика, лечение и помощь в связи с ВИЧ- инфекцией. Такой подход обеспечит более раннюю диагностику и начало лечения и приведет к улучшению исходов лечения и снижению ВИЧ- ассоциированной заболеваемости, болезненности и смертности, способствуя достижению целей «90-90- 90» и других региональных и глобальных целевых ориентиров (8–10). Имеются убедительные фактические данные о том, что раннее начало АРТ полезно как для здоровья людей, получающих лечение, так и для предотвращения дальнейшей передачи ВИЧ (11–16). Почти в 90% стран Европейского региона ВОЗ существует политика назначения АРТ вне зависимости от количества CD4-лимфоцитов (17,18). В феврале 2020 г. Европейское региональное бюро ВОЗ организовало в Восточной Европе и Центральной Азии (ВЕЦА) региональный семинар, посвященный науке внедрения в практику методов борьбы с ВИЧ- инфекцией и вирусными гепатитами (19). Семинар проводился с целью оказания поддержки странам ВЕЦА в проведении научных исследований и применении научных и программных данных как руководящих указаний при реализации рекомендаций ВОЗ в практике программ по борьбе с ВИЧ и вирусными гепатитами. Помимо прочего, обсуждалась оценка валидности данных планового эпиднадзора с сосредоточением внимания на сведениях о путях передачи ВИЧ и выявление препятствий на пути к достижению цели – 90% всех инфекций должно диагностироваться путем оптимизации вмешательств по тестированию, а также внедрение и расширение масштабов доконтактной профилактики (ДКП). Рекомендовалось улучшение связей с системой оказания помощи и удержания в ней, повышение качества помощи и ведения коморбидных состояний. Семинар был также направлен на содействие сотрудничеству между 19 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT исследователями, учеными, донорами и партнерами для проведения научного поиска и оказания поддержки науки внедрения в странах ВЕЦА. Меры противодействия эпидемии ВИЧ-инфекции должны основываться на научных данных и адаптироваться к национальной и местной эпидемиологической ситуации. На основании исчерпывающих данных эпиднадзора, приведенных в настоящем докладе, можно сделать следующие выводы: • Что касается стран ЕС/ЕЭЗ и западной части Региона, то с учетом преобладания передачи ВИЧ- инфекции среди МСМ и повышения частоты ВИЧ- инфицирования МСМ в некоторых странах представляется, что существующие вмешательства по профилактике, лечению и оказанию помощи в связи с ВИЧ, направленные на МСМ, требуют даль- нейшего расширения и укрепления; они должны оставаться приоритетным направлением ответных мер в связи с ВИЧ. Страны со снижением показате- лей продемонстрировали воздействие изменения характера деятельности, выражающееся в более частом тестировании на ВИЧ подвергающихся риску гомосексуальных мужчин и незамедлитель- ном охвате диспансерным наблюдением и антире- тровирусной терапией всех выявленных ВИЧ-положительных лиц (20). Многокомпонентные вмешательства и включение в комплекс мероприя- тий по профилактике и противодействию таких подходов, как ДКП ВИЧ-инфекции, скрининг и лече- ние инфекций, передаваемых половым путем, самотестирование и содействие добровольному информированию партнера, могли бы помочь оста- новить тенденции к росту показателей, наблюдае- мые в некоторых странах. В большинстве европейских стран уровень использования ДКП значительно ниже предполагаемой потребности (3,21–23). Во многих странах западной части Региона необходимо более широко внедрять эффективные и доступные услуги по тестирова- нию, профилактике и помощи, предназначенные для становящейся все более разнообразной группы мигрантов, подвергающихся риску заражения ВИЧ или живущих с ВИЧ. Увеличение в 2011–2012 гг. числа случаев ВИЧ-инфекции у людей, употребляю- щих инъекционные наркотики, и продолжающиеся в ряде стран местные вспышки (24–28) свидетель- ствуют о необходимости поддержания или расши- рения масштабов программ снижения вреда. • В странах в центральной части Региона заболевае- мость ВИЧ-инфекцией растет быстрее, чем в любой другой части Европейского региона ВОЗ. В центре отмечается очень значительные различия в частоте новых случаев ВИЧ-инфекции между мужчинами и женщинами: среди мужчин, особенно среди МСМ, наблюдается тревожный рост этого показателя по сравнению с довольно стабильной динамикой среди женщин. Половые контакты между мужчи- нами являются преобладающим путем передачи ВИЧ-инфекции в 13 из 14 стран центральной части Региона. Для изменения подобной ситуации необ- ходимы вмешательства, такие как ДКП для групп высокого риска, тестирование на ВИЧ, проводимое поставщиками услуг без медицинского образова- ния; экспресс-тестирование на ВИЧ, самотестиро- вание на ВИЧ и содействие добровольному информированию партнера, наряду с политикой и практикой предложения АРТ всем людям, живущим с ВИЧ. В ряде стран после прекращения финанси- рования со стороны Глобального фонда для борьбы со СПИДом, туберкулезом и малярией произошел переход на практику внутреннего финансирования мер реагирования на ВИЧ. Однако в связи с таким переходом возникла проблема с устойчивостью финансирования, что особенно сказалось на финансировании программ профилактики ВИЧ- инфекции. Для смягчения некоторых возникающих проблем и предотвращения ускорения темпов рас- пространения эпидемии необходимо усиление политической поддержки и помощи наряду с акти- визацией вовлечения гражданского общества (29). • В странах в восточной части Региона существует настоятельная необходимость продолжить расши- рение масштабов смелых, научно-обоснованных вмешательств и обеспечить предоставление более эффективных, комплексных услуг в рамках систем здравоохранения, обращающих больше внимания на социальные детерминанты здоровья. Нужны комплексные и инновационные стратегии тестиро- вания на ВИЧ с особым упором на охват ключевых групп населения. Этого можно достичь с помощью дружественных пользователю услуг по профилак- тике и тестированию, включая содействие инфор- мированию партнера, ДКП, тестирование на ВИЧ, проводимое обученными поставщиками услуг без медицинского образования и самотестирование в соответствие с рекомендациями ВОЗ. Все эти услуги должны быть интегрированы в националь- ную политику и программы, а затем осуществлены на практике (3,4,10,30). Привлечение обществен- ности к разработке и оказанию лечебно-профилак- тических услуг имеет решающее значение для сокращения числа новых случаев инфицирования ВИЧ и увеличения числа людей, охваченных дис- пансерным наблюдением и получающих АРТ, с конечной целью снижения высоких показателей заболеваемости ВИЧ и смертности вследствие СПИДа. Инновационные вмешательства по профи- лактике ВИЧ-инфекции должны быть направлены на снижение риска гетеросексуальной передачи, особенно среди пар, в которых один из партнеров склонен к поведению высокого риска (такого как, например, употребление инъекционных наркоти- ков) или в течение длительных периодов времени работает за рубежом. Большое количество впер- вые диагностированных случаев ВИЧ-инфекции у людей, инфицировавшихся при употреблении инъ- екционных наркотиков, подчеркивает, что научно- обоснованная политика, сосредоточенная на ключевых группах населения и предусматриваю- щая высокий уровень охвата программами 20 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data снижения вреда людей, употребляющих инъекци- онные наркотики, и других научно-обоснованных подходов, по-прежнему играет важнейшую роль в эффективном противодействии ВИЧ-инфекции в восточной части Региона. Надежные данные эпиднадзора имеют решающее значение для мониторинга ситуации и принятия службами общественного здравоохранения информированных решений относительно точных и своевременных мер реагирования на европейскую эпидемию ВИЧ-инфекции. Полнота данных об известных путях передачи и количестве клеток CD4- лимфоцитов на момент установления диагноза в Регионе субоптимальна, главным образом из-за неполноты сведений, подаваемых такими крупными странами, как Германия, Польша, Российская Федерация и Турция, или отсутствия данных. Некоторые исследования, проводившиеся в восточной части Региона, выявили, что информация о путях передачи может содержать погрешность, так как у многих пациентов, зарегистрированных как случаи заражения гетеросексуальным путем, есть анамнез употребления инъекционных наркотиков или, в случае мужчин, – половые контакты между мужчинами (1,2). Это обстоятельство подчеркивает важность оценки достоверности данных планового эпиднадзора, касающихся путей передачи, особенно в странах, где употребление инъекционных наркотиков и гомосексуальность стигматизированы. Постепенно увеличивается число стран, проводящих усиленный эпиднадзор за ВИЧ-инфекцией и подающих собранные сведения об эпидемиологической обстановке на европейский уровень. В 2019 г. 41 страна предоставила сопряженные данные о ВИЧ- инфекции и СПИДе, что позволило лучше понять клиническое состояние людей с диагностированной ВИЧ-инфекцией. Такой подход расширяет возможности более долгосрочного мониторинга конечных результатов оказания преемственной медицинской помощи в связи с ВИЧ-инфекцией, например, путем моделирования доли не диагностированных случаев инфекции и количественной оценки таких параметров, как направление людей с диагностированной ВИЧ- инфекцией в систему оказания помощи и лечения для достижения вирусной супрессии. Кроме того, это может поддержать национальные и глобальные усилия по мониторингу прогресса в достижении целей 90–90–90 и иных глобальных и региональных целевых ориентиров. В сентябре 2020 г., отражая ситуацию с пандемией COVID-19, Европейское региональное бюро ВОЗ и ECDC организовали совместное виртуальное совещание с основными национальными заинтересованными сторонами, участвующими в принятии мер реагирования на туберкулез, ВИЧ и вирусные гепатиты, включая ключевых партнеров, доноров, затронутые сообщества и организации гражданского общества. Цель заключалась в обмене информацией и передовым опытом по поддержанию оказания основных услуг по борьбе с туберкулезом, ВИЧ и вирусными гепатитами. Страны и партнеры обсудили свой опыт в обеспечении доступа к качественным услугам в связи с ВИЧ и преемственности оказания помощи во время пандемии COVID-19, а также о том, как они отслеживают воздействие пандемии COVID-19 на услуги в связи с ВИЧ. В ходе совещания обсуждались также последнее руководство и рекомендации ВОЗ по вопросам политики борьбы с туберкулезом, ВИЧ и вирусными гепатитами и ведения коморбидных состояний. Ссылки7 1. 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23 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT 1.1 HIV diagnoses In 2019, 24 801 new HIV diagnoses were reported in 30 countries of the EU/EEA,9 with a rate of 5.4 per 100 000 when adjusted for reporting delay (Table 1, Annex 6). The highest rates were reported by Malta (16.2; 80 cases), Latvia (15.4; 295) and Estonia (13.4; 178), and the lowest by Slovakia (1.9; 101 cases) and Slovenia (1.6; 34) (Table 1, Map 1). As in previous years, more men than women were diagnosed with HIV in 2019 (18 588 and 6086, respectively), resulting in an overall male-to-female ratio of 3.1 : 1 (Tables 2 and 3, Fig. 1.1). This ratio was highest in Croatia (19.4) and Hungary (13.0) and was above one in all countries in the EU/EEA (Fig. 1.1). The predominant mode of transmission in countries with the highest male-to-female ratios was sex between men. The overall rate of new diagnoses in men was 7.5 per 100 000 population (Table 2) and for women 2.4 per 100 000 population (Table 3). In addition to the 24 674 cases with male or female gender, 127 individuals with 9 Besides Belgium, all EU/EEA countries and the United Kingdom reported data for 2019. unknown or “other” gender were diagnosed with HIV in 2019. Current reporting systems at European level are not able effectively to differentiate how many of these cases are transgender men or women and how many are cases with unknown information reported on gender. Age-specific rates were lowest in persons under 15 years of age (0.2 per 100 000 population for both males and females) (Fig. 1.2). In all other age groups, men had higher age-specific rates than women. The highest overall age-specific rate of HIV diagnoses was observed among 25–29-year-olds (12.0 per 100 000 population), largely because this age group has the highest age- specific rate for men at 18.0 per 100 000 population, while rates for women were highest in the 30–39 age group (6.1 per 100 000 population) (Fig. 1.2). The mean age at diagnosis was lower for MSM (36.4 years) than for cases attributed to injecting drug use (38.8 years) or heterosexual transmission (41.1 years overall, 38.9 in women and 43.4 in men). The 30–39 age group accounted for most HIV diagnoses overall (31%) and in all transmission groups (Fig. 1.3). One third of diagnoses attributed to sex between men were made Fig. 1.1. Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2019 (n = 24 674) 0 4 8 12 16 20 Latvia Estonia Sweden France Norway Cyprus Portugal United Kingdom Lithuania Ireland Finland Total EU/EEA Romania Denmark Luxembourg Greece Germany Malta Italy Iceland Slovenia Netherlands Bulgaria Austria Poland Spain Czechia Slovakia Hungary Croatia Male-to-female ratio Note: Belgium did not report data and Liechtenstein reported zero cases in 2019. 1. HIV and AIDS in the EU/EEA 24 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data before age 30, while 51% of HIV infections due to sex between men and women were diagnosed at 40 years or above, and more than one quarter (26%) at 50 or above. The age pattern among those newly diagnosed with HIV differed across countries, with 30% or more of new diagnoses among persons under 30 years in Czechia, Hungary, Ireland, Malta, Poland, Romania and Slovakia and 50% or more of new diagnoses among persons 40 years and older in Denmark and Italy (Fig. 1.4). Young people aged 15–24 years comprised 11% of the EU/EEA population and 11% of HIV diagnoses in 2019. Romania reported more than 15% of its HIV diagnoses in this age group (Fig. 1.5, Table 9). Forty-one per cent of the EU/EEA population consists of older adults (50 years and above), who comprised 21% of the new HIV diagnoses reported in 2019. Older adults comprised more than 25% of those newly diagnosed with HIV in Denmark, Finland and Italy (Fig. 1.4, Table 9). Data on transmission mode provide information on the groups in the EU/EEA who are most affected by HIV (Tables 4–8, Fig. 1.5). • Sex between men remains the most common mode of HIV transmission reported in the EU/EEA, accounting for 38.7% (9 598) of all new HIV diagnoses in 2019. Sex between men was the predominant route of transmission (50.6%) among those for whom route of transmission was known (Table 4, Table 8, Fig. 1.5) and accounted for more than 60% of new HIV diagnoses in 10 countries (Croatia, Czechia, Germany, Hungary, Iceland, 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% (8164) of all HIV diagnoses and 43% of diagnoses where the route of transmission 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 nine EU/EEA countries (Cyprus, Estonia, France, Latvia, Luxembourg, Norway, Portugal, Romania and Sweden). More than one third (41%; 2346) 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 Cyprus (79%) and Ireland (72%). Fig. 1.2. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2019 (n = 22 318) 0 5 10 15 20 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: this figure does not include Belgium (due to non-reporting) or Spain (due to non-national coverage of the surveillance data for 2019). Fig. 1.3. New HIV diagnoses, by age group and transmission mode, EU/EEA, 2019 0 20 40 60 80 100 Sex between men Heterosexual contact Injecting drug use 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years 50+ years n = 9598 n = 955 n = 8164 Percentage Tr an sm is si on m od e 25 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT • Four per cent (955 cases) of all new HIV diagnoses and 5% of those with known route of HIV transmission were attributed to injecting drug use (Table 5, Table 8, Fig. 1.4). Injecting drug use was the probable route of transmission for one fourth or more of the cases reported in Latvia (26%) and Lithuania (38%) (Fig. 1.5). • Of the remaining cases, 167 diagnoses (less than 1%) were reported as being due to vertical transmission during pregnancy, childbirth or breastfeeding (Table 7); 123 of these cases (74%) were born outside of the country in which the case was reported (Table 11). Fifty-two (0.3%) diagnoses were reported to be due to contaminated transfusion of blood and its products, and 21 cases to hospital-acquired infections (Table 8). The majority of these nosocomial and transfusion- related cases originated from outside of the country where the case was reported (Table 11). • Transmission mode was reported as unknown for 5844 diagnoses (23.6%), with wide variation among countries: less than 5% of diagnoses were reported with unknown transmission mode in Bulgaria, Czechia, Denmark, Luxembourg, Norway and Romania, and over 50% in Ireland and Poland (Table 8). Twenty-six EU/EEA countries provided information on the country of birth, country of nationality or region of origin for 20 430 (82%) HIV diagnoses in 2019 (Fig. 1.6). In the EU/EEA, 8977 diagnoses (44% of those with known information on region of origin) were reported among people originating from outside of the reporting country. Of these, 3619 (18% of those with known information on region of origin), irrespective of transmission mode, were reported among people originating from countries with generalized HIV epidemics in sub-Saharan Africa (Fig. 1.6, Table 10). An additional 26% of new diagnoses with known region of origin (5383 cases) were among people born outside of the reporting country who did not originate from a country experiencing a generalized epidemic, including 9% from countries in Latin America and the Caribbean (1858 cases), 8% from other countries in central and eastern Europe (1579 cases) and 3% from other countries in western Europe (712 cases). The countries with more than half of their new HIV diagnoses among people originating from outside of the reporting country were Cyprus, Denmark, Finland, France, Iceland, Ireland, Luxembourg, Norway, Sweden and the United Kingdom. In 2019, 16 countries reported data on whether the new HIV diagnosis reported had previously been diagnosed with HIV in another country, prior to their 2019 diagnosis in the reporting country. Of the 11 178 new HIV diagnoses in these 16 countries, 954 (8.5%) were previous positives. The proportion of 2019 diagnoses that had previously been diagnosed was higher than the EU/EEA Fig. 1.4. Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2019 (n = 24 715) Note: graph organizes countries in order of proportion of population < 50 years. Belgium did not report data and Liechtenstein reported zero cases in 2019. Unknown route of transmission is excluded from the proportions presented here. 0 20 40 60 80 100 Italy Finland Denmark Latvia Norway Portugal Austria France Germany United Kingdom Netherlands Estonia Luxembourg Malta Lithuania Total EU/EEA Sweden Greece Spain Romania Bulgaria Hungary Ireland Slovenia Czechia Poland Iceland Croatia Cyprus Slovakia 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 2020 – 2019 data Fig. 1.5. Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2019 (n = 18 957) 0 20 40 60 80 100 Latvia Estonia Lithuania Romania Norway Sweden Portugal Finland Cyprus France Italy Luxembourg Bulgaria United Kingdom Greece Total EU/EEA Denmark Ireland Austria Germany Spain Slovenia Iceland Slovakia Netherlands Czechia Poland Hungary Croatia Heterosexual contact (males) Sex between men Heterosexual contact (females) Injecting drug use Other Percentage Note: Belgium did not report data, Liechtenstein reported zero cases and Malta did not report transmission data in 2019. Unknown route of transmission is excluded from the 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, 2019 (n = 20 430) 0 20 40 60 80 100 Romania Poland Lithuania Croatia Bulgaria Estonia Italy Slovakia Czechia Slovenia Spain Greece Germany Total EU/EEA Austria Portugal Netherlands Denmark France Finland United Kingdom Cyprus Norway Luxembourg Sweden Ireland Iceland Percentage Central and eastern Europe Sub-Saharan Africa Western Europe Latin America and Caribbean South and south-east Asia Other Note: Belgium did not report data in 2019 and Hungary, Latvia and Malta did not report data on country of birth or region of origin. 27 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT average in some countries, including Cyprus (21%), Czechia (15%), Denmark (24%), Iceland (32%), Ireland (20%), Malta (16%), Norway (31%), Sweden (43%) and Slovakia (32%). Information on CD4 cell count at the time of HIV diagnosis was provided for 15 279 (68%) adults and adolescents diagnosed in 25 countries (Table 13). All countries reporting such data were able to provide CD4 cell counts for 50% or more of their reported cases, apart from Croatia, Estonia, Germany, Ireland, Latvia and Slovenia, all of which provided data for 35% of cases or fewer. Half (50%) of all cases with a CD4 cell count were considered to have been diagnosed several years after being infected, with a count of less than 350 cells per mm3, including 30% of cases considered to have advanced HIV infection (CD4 cell count less than 200 cells/mm3). The proportion of those diagnosed late (CD4 cell count below 350 cells per mm3) was above 60% among cases with known CD4 cell count at diagnosis in Bulgaria (62%), Cyprus (91%), Latvia (70%) and Romania (63%). Among all cases diagnosed in 2019 where information on CD4 cell count or acute HIV infection was available, 12% (1896) were reported as acute infections and 26% (4122) as more recent infection (with a CD4 cell count above 500 cells per mm3 at diagnosis) (data not shown). Among MSM diagnosed in 2019 where information was available, 15% (1116) were reported as acute infections and 30% (2192) had a CD4 cell count above 500 cells per mm3 at diagnosis (Fig. 1.7). When analysing CD4 cell count, the highest proportions of people presenting at a later stage of HIV infection (CD4 less than 350 cells/mm3) were observed among women (53%), older adults (54% in 40–49-year-olds and 65% in people over 50 years), men or women infected by heterosexual sex (61% and 53% respectively), people who acquired HIV through injecting drug use (52%), and migrants from sub-Saharan Africa (56%) and south and south-east Asia (54%) (Fig. 1.8, Table 13). The lowest proportions of late diagnosis (CD4 less than 350 cells/mm3) were observed among younger age groups (35% of those aged 15–24 years), men who acquired HIV through sex with another man (42%) and migrants from other western European countries (38%) (Fig. 1.8). The interval between the date of diagnosis and the date of the CD4 count was used as a proxy for time to linkage to care and, among cases where CD4 data were reported, 81% of those diagnosed in 2019 were linked to care within four days of HIV diagnosis and 99% were linked to care within three months (Fig. 1.9). 1.2 Trends in HIV diagnoses The trend in reported HIV diagnoses for the period 2010–2019 declined in recent years. Rates in the earlier part of this decade were 6.6 per 100 000 in 2010, increasing to 6.8 in 2012 and decreasing steadily thereafter to 5.4 in 2019 (27 231 cases when adjusted for reporting delay; see Table 1, Fig. 1.10 and Annexes 1 (for reporting delay adjustment methods), 5 (for country comments) and 6 (for results)). While the overall EU/EEA trend appears to have declined during the past decade, trends at national level vary. Several countries, including Austria, Denmark, Estonia, Finland, France, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom, have also reported a decline in rates of new diagnoses, even after adjusting for changes in population coverage of surveillance over time and for reporting delay. In contrast, since 2010, and taking reporting delay into account, rates of HIV diagnoses have more than doubled in Cyprus, Malta and Slovakia and have increased by more than 50% in Bulgaria and Poland (Table 1, Annex 6). Some countries are more affected by reporting delay, meaning that decreases in the rates of new HIV diagnoses may be overestimated and increases in rates underestimated. Trends differ by gender and age group. Age-specific rates have declined since 2010 in all age groups except for female adults over 50 years, where they have remained stable. HIV diagnosis rates in both women and Fig. 1.7. Acute infection or CD4 cell count per mm3 at HIV diagnosis, overall and by transmission group, EU/EEA, 2018 0 20 40 60 80 100 Total EU/EEA Sex between men Pe rc en ta ge Injecting drug useHeterosexual contact Acute infection 500+ 350 to < 500 200 to < 350 < 200 28 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Fig. 1.9. Linkage to care after HIV diagnosis, EU/EEA, 2019 (n = 2593) 0 20 40 60 80 100 0–4 days 5–28 days 29–91 days > 91 days Percentage Total Injecting drug use Sex between men Heterosexual contact Tr an sm is si on m od e Fig. 1.8. Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2019 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 and individuals previously diagnosed abroad are excluded from the proportions presented here. Note: cases with no or missing data on CD4 count or date and those who died within 91 days of diagnoses are excluded here. 29 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Fig. 1.10. People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2010–2019 0 1 2 3 4 5 6 7 8 2019201820172016201520142013201220112010 Year of diagnosis HIV AIDS Deaths Ra te p er 10 0 00 0 po pu la tio n Note: rates exclude countries not reporting consistently over the period: Belgium (HIV, AIDS and AIDS deaths), Sweden (AIDS and AIDS deaths), Italy and Denmark (AIDS deaths). men have consistently been higher among 25–29-year- olds and 30–39-year-olds throughout the period compared to other age groups. Age-specific rates in women have declined most markedly in those under 40 years. Rates among 20–29-year-old men peaked in 2015 and have declined since. Rates in men aged 15–24 and 30–49 years have declined since 2015. Meanwhile, rates in men over 50 have remained stable (Fig. 1.11a and 1.11b). The median age at HIV diagnosis between 2010 and 2019 increased from 36 years to 37 years overall (and from 34 to 37 years among women, while remaining at 37 years in men). The proportion of diagnoses reported in older age groups is growing; 15% of people diagnosed in 2010 were over 50 years at HIV diagnosis, rising to 20% in 2019. In women, 14% of diagnoses in 2010 and 20% in 2019 were among those aged 50 years or above, while in men, 16% of diagnoses in 2010 and 20% in 2019 were among those aged 50 years or above (data not shown). HIV diagnoses among those born outside of the reporting country comprised 40% of all new diagnoses in 2010, decreasing slightly to 37% in 2013 but increasing again in 2019 to 44% (Fig. 1.12). While the proportion of migrants from most regions has remained relatively stable since 2020, new diagnoses among people originating from countries in central and eastern Europe increased from 5% to 8% of all new diagnoses. Since 2010, most EU/EEA countries consistently have reported data on transmission mode. From those countries consistently reporting, and adjusting for reporting delay, the data over the past decade indicate the following. • The proportion of all HIV diagnoses attributed to sex between men increased from 45% of cases in 2010 to 52% in 2015, then decreased to 47% in 2019 (Fig. 1.13a and 1.13b). The number of HIV diagnoses reported among MSM in countries reporting consistently increased from 8730 cases in 2010 and peaked at 9839 in 2014. Even after adjusting for reporting delay, fewer cases were reported in 2019 (6888) in this same group of countries. Most of the decline in recent years appears to be due to fewer diagnoses among MSM in Austria, Finland, France, Germany, Greece, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom. Increases were observed in many EU/EEA countries between 2010 and 2019 (Table 4), with substantial increases noted in Bulgaria, Cyprus, Estonia, Lithuania, Poland, Romania and Slovakia in recent years. Cases attributed to MSM born outside of the reporting country increased during the period, declining slightly between 2016 and 2019 but not to the same extent as observed in MSM who were natives of the EU/EEA (Fig. 1.14). • The number of heterosexually acquired cases decreased steadily in women, from 4948 in 2010 to 3682 in 2019, and from 4118 to 3131 in men during the same decade (Fig. 1.13a). The proportion of all HIV diagnoses attributed to heterosexually acquired infection in women decreased from 22% of cases in 2010 to 19% in 2019, and that attributed to heterosexually acquired infection in men decreased from 19% to 16% during the same period (Fig. 1.13b). Between 2010 and 2019, the number of cases among women and foreign-born heterosexual people decreased at a greater rate than cases among men and non-foreign-born people (Fig. 1.13a and 1.14). The decline in foreign-born cases is due mainly to sharp decreases among migrants originating from countries with generalized HIV epidemics (5441 in 2010 and 3619 in 2019). Despite the overall decline in heterosexually acquired cases during this period, new diagnoses in Lithuania and Slovakia increased substantially in this group. • The number of HIV diagnoses reported among people who inject drugs has also declined since 2010 (from 1120 cases to 812) in both foreign-born and 30 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Fig. 1.12. Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2010–2019 0 10 20 30 40 50 2019201820172016201520142013201220112010 Pe rc en ta ge Year of diagnosis Western Europe Sub-Saharan Africa Central and eastern Europe Latin America and Caribbean South and south-east Asia Other Note: data from Belgium are excluded due to inconsistent reporting during the period. Fig. 1.11b. Age-specific trends in new HIV diagnoses in women, EU/EEA, 2010–2019 Ne w 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 2019201820172016201520142013201220112010 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Note: these figures contain data for 28 countries. Data from Belgium, Italy and Spain are excluded due to incomplete coverage of the surveillance for a portion of the period. Fig. 1.11a. Age-specific trends in new HIV diagnoses in men, EU/EEA, 2010–2019 2019201820172016201520142013201220112010 0 5 10 15 20 25 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 31 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT non-foreign-born people (Fig. 1.13a and 1.14). A temporary 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 downward trend in the number of reported cases continued for the EU/EEA in 2019 (Table 5). Several countries, including Austria, Bulgaria, Estonia, France, Italy, Portugal and Spain, have seen a sharp decrease in the rate of HIV diagnoses due to injecting drug use during the past decade. • The number of diagnoses reported to be due to vertical transmission of HIV decreased from 272 in 2010 to 194 in 2019 (Fig. 1.13a). 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 remained stable over the period, with 14 cases in 2010 and 21 in 2019. The number of cases reported to be due to transfusion of contaminated blood and its products remained stable at 52 in 2010 and 49 in 2019. The majority of these cases were among people who had migrated to the EU/EEA and were later diagnosed in the reporting country (80% in 2010 to 76% in 2019 among nosocomial cases, and 75% in 2010 to 90% in 2019 among transfusion-related cases). The number of cases with an unknown mode of transmission increased significantly from 3009 in 2010 to 3967 in 2019 (14% of cases in 2010 and 22% in 2019). This increase is affected by gaps in reporting and is expected to decrease slightly in future reporting. Fig. 1.13a. HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay and missing transmission imputed, EU/EEA, 2010–2019 0 2000 4000 6000 8000 10 000 Nu m 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 2019201820172016201520142013201220112010 Note: data from 24 EU/EEA countries included. HIV diagnoses reported by Iceland, Ireland, Malta and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Belgium, Italy and Spain excluded due to incomplete reporting during a portion of the period. Fig. 1.13b. Percentage of HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA, 2010–2019 0 20 40 60 80 100 2019201820172016201520142013201220112010 Pe rc en ta ge Year of diagnosis Heterosexual (women) Sex between men Heterosexual (men) Injecting drug use Vertical transmission Note: data from 24 EU/EEA countries included. HIV diagnoses reported by Iceland, Ireland, Malta and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Belgium, Italy and Spain excluded due to incomplete reporting during a portion of the period. 32 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Reporting delays differ significantly among transmission 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. 1.13a and Fig. 1.14 show these adjusted trends). While many people are still being diagnosed several years after being infected with HIV, the median CD4 cell count at HIV diagnosis increased from 341 cells/mm3 in 2010 to 370 cells/mm3 in 2015, declining again to 342 cells/mm3 in 2019. The group with the highest median CD4 cell count at diagnosis is MSM, with 397 cells/mm3 in 2019; this indicates earlier diagnosis in this group compared to others with lower median CD4 cells counts at diagnosis (data not shown). Median CD4 cell count at diagnosis was lower in cases attributed to heterosexual transmission; while there was an increase from 308 cells/mm3 to 325 cells/mm3 in women, median CD4 cell counts at diagnosis in men remained stable at around 260 cells/mm3. In countries reporting consistently on transmission route and CD4 count at diagnosis over time, the number of persons diagnosed late (CD4 cell count less than 350 cells/mm3 at diagnosis) decreased by 29%, from 7441 in 2010 to 5265 in 2019. A reduced number was observed in all transmission groups (Fig. 1.15), with a 42% reduction in late diagnoses in heterosexually transmitted HIV in women (2056 in 2009, 1201 in 2019), 40% reduction where the route of transmission was injecting drug use (319 in 2009, 191 in 2010), 29% reduction in heterosexual men (1906 in 2010, 1352 in 2019) and a 24% reduction in Fig. 1.14. New HIV diagnoses, by year of diagnosis, transmission and migration status, adjusted for reporting delay, EU/EEA, 2010–2019 0 1000 2000 3000 4000 5000 6000 7000 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 2019201820172016201520142013201220112010 Note: data from 26 EU/EEA countries included. HIV diagnoses reported by Malta and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Belgium, Italy and Spain excluded due to incomplete reporting during a portion of the period. Fig. 1.15. Number of people diagnosed late (CD4 < 350 cells/mm3), by year of diagnosis and transmission mode, EU/EEA, 2010–2019 0 500 1000 1500 2000 2500 3000 2019201820172016201520142013201220112010 Nu m be r o f l at e HI V di ag no se s Year of diagnosis Heterosexual (men) Sex between men Heterosexual (women) Injecting drug use Overall Note: data from Iceland, Ireland, Malta and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Belgium, Italy and Spain excluded due to incomplete reporting during a portion of the period. This graph does not account for cases that are missing CD4-count information. 33 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT transmission due to sex between men (2529 in 2010, 1914 in 2019). 1.3 AIDS cases, morbidity and mortality Although there have been improvements in the early diagnosis of HIV, 2772 diagnoses of AIDS were reported by 29 EU/EEA countries10 in 2019 – a crude rate of 0.5 cases per 100 000 population (Table 14). The highest rate was reported by Latvia (4.7 per 100 000 population; 90 cases). Overall, 74% of AIDS diagnoses in 2019 were made within 90 days of the HIV diagnosis, although this is affected by reporting practices in countries that only 10 This includes all EU/EEA countries except Belgium and Sweden. report AIDS at the time of HIV diagnosis. Among people whose HIV infection was attributed to injecting drug use, over half (60%) of AIDS diagnoses were made more than 90 days following the HIV diagnosis (Fig. 1.16). The rate of reported AIDS cases has more than halved in the past decade, down from 1.4 per 100 000 reported in 2010 (Fig. 1.10). This decline is noted in men and women and in all transmission groups, but appears greatest among cases attributed to injecting drug use (Tables 16–20, Fig. 1.17). Despite the general EU/EEA- wide decline, an increase has been reported in the rate of AIDS diagnoses since 2010 in Bulgaria and Hungary (Table 14). The most common AIDS-indicative diseases diagnosed in 2019 in the EU/EEA were Pneumocystis pneumonia Fig. 1.16. Percentage of AIDS diagnoses within 90 days of HIV diagnosis, EU/EEA, 2019 (n = 1763) 0 20 40 60 80 100 Injecting drug use Sex between men Heterosexual transmission (females) Heterosexual transmission (males) Percentage Tr an sm is si on m od e AIDS diagnosis within 90 days of HIV diagnosis AIDS diagnosis > 90 days after HIV diagnosis Fig. 1.17. AIDS diagnoses, by transmission mode, EU/EEA, 2010–2019 0 400 800 1200 1600 2000 AI DS d ia gn os es Year of diagnosis Heterosexual transmission (men) Sex between men Heterosexual transmission (women) Injecting drug use Other/undetermined 2019201820172016201520142013201220112010 Note: data from Belgium and Sweden excluded due to inconsistent reporting during the period. 34 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data (21% of all AIDS-indicative diseases), pulmonary and/or extrapulmonary TB (12%), wasting syndrome due to HIV (12%) and oesophageal candidiasis (11%) (Table 22). Twenty-one countries reported at least one case with TB (pulmonary and/or extrapulmonary) as an AIDS-defining illness in people newly diagnosed with AIDS in 2019. Fourteen per cent of people diagnosed with AIDS in these countries presented with TB as an AIDS-defining illness, ranging from 2% of cases in Austria to more than 60% in Lithuania (Fig. 1.18). Twenty-seven EU/EEA countries (all but Belgium, Denmark, Italy and Sweden, which did not report consistently over the past decade) reported data on deaths of people diagnosed with AIDS. Overall, 774 people were reported to have died due to AIDS-related causes during 2019 (Table 23), although these data are affected by underreporting due to the challenges for many countries in linking to death registries. AIDS- related death reports have been decreasing consistently since 2010, when 1920 deaths were recorded in the countries reporting consistently over time, although delays in reporting affect the latest figures and underreporting has affected AIDS-deaths reporting throughout the period (Fig. 1.10). From the beginning of the HIV epidemic to the end of 2019, the cumulative total of people diagnosed with AIDS in the EU/EEA was 367 890 (Table 14). The cumulative total of cases reported as known to have died due to AIDS-related causes by the end of 2019 was 196 164 (Table 23). 1.4 HIV testing Nine countries reported data on HIV tests performed, excluding unlinked anonymous testing and testing of blood donations. The number of tests increased by 21% in countries reporting consistently over the last decade (Table 24). Changes in overall testing activity do not appear to explain the decrease in cases reported, particularly among MSM, in some European countries. It is important to note that numbers provided are collected in a heterogeneous manner and comparisons between country testing rates should be undertaken with caution, but these data can indicate large changes in overall testing policy or be used to support the interpretation of HIV cases notified. 1.5 Conclusions HIV surveillance data for 2019 continue to underscore important changes in the epidemiology of HIV in EU/EEA countries occurring over the past decade. Rates of AIDS and AIDS-related deaths in the EU/EEA as a whole have decreased substantially over the past decade, reflecting greater access to treatment and better case management, indicating sustained progress towards Fig. 1.18. Percentage of people diagnosed with AIDS where TB is an AIDS-defining illness, EU/EEA, 2019 (n = 2650) 0 10 20 30 40 50 60 70 Austria Germany Hungary Norway Netherlands United Kingdom Italy Poland Denmark Slovenia Estonia Total EU/EEA Spain France Bulgaria Latvia Czechia Portugal Finland Romania Luxembourg Lithuania Percentage Note: countries that did not report AIDS (Belgium and Sweden) or reported no cases of TB as an AIDS-defining illness (Croatia, Cyprus, Greece, Iceland, Ireland and Slovakia) are excluded. 35 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT the Sustainable Development Goal of ending the AIDS epidemic as a public health threat and decreasing AIDS-related deaths. There has been a clear, continuous decline in the rate of new HIV diagnoses per 100 000 population in the EU/EEA overall, with an adjusted rate of 5.4 reported in 2019. 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. Data for 2019 may suffer specifically from this due to non- or incomplete reporting in some countries due to extra workload induced by the COVID-19 pandemic. 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 quarter of EU/EEA countries. Evidence of a decline in diagnoses among MSM in certain EU/EEA countries appears to be the main determinant behind 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 and, until recently, was the only population in the EU/EEA in which HIV cases were increasing for most of the past decade. The decline at EU/EEA level is driven by substantial declines in specific EU/EEA countries – Austria, Finland, France, Germany, Greece, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and the United Kingdom. Reasons for the decrease may include successful programmes to offer more frequent and targeted HIV testing to promote earlier diagnosis, 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 transmission (1,2). 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, as it is noted that PrEP has been made available through the health system or pilot projects in all of these countries (2,3). The positive trends described above nevertheless are countered by the prevailing situation in several EU/EEA countries in which HIV continues to increase among MSM. Substantial increases have been reported in Bulgaria, Cyprus, Estonia, Lithuania, Poland, Romania and Slovakia 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 in people who are not foreign-born. There is an urgent need to significantly scale up 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 providing condoms, peer support and access to PrEP for 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 epidemiological trend observed over the past decade. Heterosexual transmission nevertheless remains the second most common mode of HIV transmission reported in the EU/EEA and, in some countries, is the most common transmission mode. Despite the overall declines, heterosexual transmission increased substantially in Lithuania and Slovakia. The declining trend in heterosexual cases is probably influenced by the decrease (since 2010) in the number of heterosexually acquired cases in migrants originating from countries with generalized HIV epidemics (5). Migrants (or people originating from outside of the reporting country) again constituted a considerable proportion (44%) of new HIV diagnoses in the EU/EEA in 2019. 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 specific HIV-prevention campaigns for migrants from the moment of their arrival, including the offer of HIV testing to newly arrived migrants to the EU (9). Transmission among people who inject drugs continues to decline and remains at a low level in most EU/EEA countries, thanks to well established and effective harm-reduction programmes throughout most of the Region. The most drastic decline is noted in Estonia, where new diagnoses among people who inject drugs in 2019 are one quarter of what they were a decade ago. Increases nevertheless were observed in 2016–2017 in Lithuania, and increases in this population have also been reported from Germany in recent years. There were also outbreaks reported in 2011–2012 in Romania and Greece – countries with previously very low levels of HIV among people who inject drugs (10,11). More localized outbreaks have been reported in Ireland, Luxembourg and the United Kingdom (Scotland) (12–14). This reinforces the importance of maintaining adequate scale and coverage of harm-reduction services and recognizing that trends can change quickly for this group in the absence of effective prevention delivered at scale (15). It is estimated that about 120 000 people are living with undiagnosed HIV in the EU/EEA, implying that about one in seven of those living with HIV are not aware of their status (16). Modelled estimates also indicate that it takes an average of 2.9 years from HIV infection to diagnosis in the EU/EEA, with variation by geographical area from 2.2 to 3.6 years (17). In addition to the clinical and personal benefits for the person diagnosed, early diagnosis and effective ART can also benefit sexual and injecting partners by inhibiting onward HIV transmission. Half of those newly diagnosed (50%) have a CD4 cell count of below 350 cells per mm3, including 30% of cases with advanced HIV infection (CD4 less than 200 cells/mm3), indicating the need to improve testing programmes to diagnose people living with HIV at an earlier stage. These data indicate that the people were 36 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data infected many years previously and suggest problems with access to, and uptake of, HIV testing for some segments of the population 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 having acquired HIV heterosexually. The trend during the past decade has been towards an increasing median age at HIV diagnosis, particularly among women. In 2019, one in five new HIV diagnoses was in 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 (18). To reduce the high proportion of people diagnosed late, it is essential to diversify HIV testing by augmenting 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 notification. 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 (19). 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 for the health of HIV-positive people of introducing ART early (20,21) 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 when they are at an advanced stage of illness. Overall, 74% of AIDS diagnoses were reported to have been 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 in which more than half of the AIDS cases occurred more than 90 days after the initial HIV diagnosis was among people whose HIV infection was attributed to injecting drug use, possibly indicating that AIDS diagnoses in this group are associated with lack of engagement with, or retention in, clinical services. Once tested, rapid linkage to high-quality care (including ART) is essential. Ninety-nine per cent of people diagnosed in 2019 who had evidence of linkage to care were linked to care within three months of HIV diagnosis; those not linked to care, however, are less likely to be included in the data used to calculate this indicator, so this is likely to be an underestimate of poor linkage to care. This bias is slightly countered by the use of the date of the CD4 cell count as a proxy for time to linkage to care, as this would tend to slightly overestimate the time interval. Timely linkage to care following HIV diagnosis is crucial, as delayed access can result in poor patient outcomes (22). Once linked to care, there is evidence that high proportions of people diagnosed with HIV in the EU/EEA have access to ART and achieve viral suppression (23). Recent years have seen a worrying trend of reduced data completeness on the HIV transmission route, with nearly one quarter of cases reported in 2019 lacking this important information. 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 were used in select figures presented in this chapter to partially address this issue (24). The changing epidemiology of HIV infections observed in the EU/EEA over the past decade suggests that some progress has been achieved, particularly in reducing infections attributed to heterosexual transmission and injecting drug use. More recently, progress has also been made in reducing the number of HIV infections resulting from sex between men in selected EU/EEA countries. These epidemiological trends also indicate, however, that it is crucial to sustain, and in some places strengthen, evidence-based HIV prevention interventions tailored to the local epidemiological context and targeting those most at risk. Programmes on the prevention and control of HIV infection 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 epidemics and others, are also a key vulnerable population who need 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 testing, 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 diagnosis and, ultimately, the proportion of people living with undiagnosed HIV in the EU/EEA. The data in this report present new HIV diagnoses through to the end of 2019, the period just before the global COVID-19 pandemic. The impact of the pandemic on human resources in laboratory, clinical and public health institutions has already been observed. One country (Belgium) was unable to report 2019 HIV and/or AIDS data due to the need to focus public health capacity on COVID-19 surveillance and response. The majority of ECDC operational contact points for HIV reported also working on COVID-19 surveillance and response issues 37 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT during 2020. About half of EU/EEA countries needed more time than usual to submit their 2019 HIV and AIDS data and several mentioned that reporting delay may be increased for 2019 data, or that some variables (CD4 at diagnosis, viral load) were not possible to report at all or at concordant levels with the past. The ECDC, in collaboration with EU/EEA Member States, the WHO Regional Office for Europe, and clinical and community partners, will look carefully at the impact on HIV surveillance and prevention response to support the continued high standard of European HIV and AIDS data to guide the response in the Region and to understand how the ongoing pandemic may affect HIV incidence, particularly in regions and groups most at-risk. References11 1. 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). 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. Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P et al. and the ECDC Dublin Monitoring Network. Estimating the “PrEP gap”: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019;24(41):pii=1900598 (https://doi.org/10.2807/1560- 7917.ES.2019.24.41.1900598). 4. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014 (https://www.ecdc.europa.eu/ sites/default/files/media/en/publications/Publications/hiv-sti-pre- vention-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-migra- tion 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. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants in the EU/EEA. Stockholm: ECDC; 2019 (https://www.ecdc.europa.eu/sites/default/files/documents/ Public%20health%20guidance%20on%20screening%20and%20 vaccination%20of%20migrants%20in%20the%20EU%20EEA.pdf). 11 All weblinks were accessed on 12 November 2020. 10. 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). 11. 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). 12. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2016. Euro Surveill. 2016;20(40):pii=30036 (http://dx.doi.org/10.2807/1560-7917.ES.2016.20.40.30036). 13. 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). 14. 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). 15. 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). 16. Brown AE, Hayes R, Noori T, Azad Y, Amato-Gauci AJ, Pharris A et al. and the Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90–90– 90 targets. Euro Surveill. 2018;23(48):pii=1800622 (https://doi. org/10.2807/1560-7917.ES.2018.23.48.1800622). 17. 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). 18. 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. 19. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016:373 (9):795–807 20. Consolidated guidelines on the use of antiretroviral drugs for treat- ing and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2017 (https://www.who.int/hiv/pub/arv/arv-2016/ en/). 21. Public health guidance on HIV, hepatitis B and C testing in the EU/ EEA. Stockholm: ECDC; 2018 (https://ecdc.europa.eu/sites/portal/ fi l e s/d o c u m e n t s/ H I V - h e p a t i t i s - B - a n d - C- t e s t i n g - p u b l i c- healthguidance.Pdf). 22. 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. PLoS One 2018;13(2):e0192403 (https://doi.org/10.1371/journal.pone.0192403). 23. 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. 24. 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=1700 359 (https://doi.org/10.2807/1560-7917.ES.2018.23.23.1700359). 38 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data 2.1 HIV and AIDS diagnoses in the WHO European Region 2.1.1 HIV diagnoses In 2019, 136 449 people in the WHO European Region were newly diagnosed with HIV, corresponding to a rate of 15.6 per 100 000 population (Table A, Table 1). This number includes new diagnoses reported by 47 countries12 to the joint ECDC and WHO Regional Office for Europe surveillance system.13 It brings the cumulative number of reported HIV diagnoses in the Region since reporting began in the 1980s to 2 114 520. As in previous years, most (79%) of the 136 449 people newly diagnosed with HIV in 2019 were from the East of the Region (107 842), 16% from the West (21 793) and 5% from the Centre (6814). The rate was also highest in the East (41.7 per 100 000 population), eight times higher than in the West (5.7 per 100 000, adjusted for reporting delay; see Annex 1 for methods and Annex 6 for results) and 12 times higher than in the Centre (3.4 per 100 000) (Table A, Table 1). For men, the rate was 20.8 per 100 000 population (Table 2) and for women 10.6 per 100 000 population (Table 3). Rates of newly diagnosed HIV infections varied widely across countries in the WHO European Region in 2019. The highest rates per 100 000 population (more than 15.0) were observed in the Russian Federation (54.9) followed by Ukraine (39.0), the Republic of Moldova (22.8), Belarus (22.6), Kazakhstan (19.8), Georgia (16.7), Malta (16.2), Latvia (15.4) and Armenia (15.1). The lowest rates (under 3.0) were reported by Bosnia and Herzegovina (0.9), Slovenia (1.6), Slovakia (1.9), Serbia (2.0), Czechia (2.1), Hungary (2.4), Austria (2.5), Croatia (2.5) and Finland (2.7). No new HIV cases were diagnosed in San Marino in 2019. The male-to-female ratio was 1.8, lowest in the East (1.6), higher in the West (2.9) and highest in the Centre (5.5). The highest male-to-female ratios (more than 15.0) at country level among countries with more than 10 new cases were observed in Croatia (19.4) and the lowest (1.5 or less) in Kyrgyzstan (1.4), Tajikistan (1.4) and the Republic of Moldova (1.4) (see section 1.1 (HIV diagnoses) in Chapter 1 and sections 2.2 (HIV diagnoses in the East) and 2.2.2 (Trends in HIV diagnoses in the East) below). 12 No data were received from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan or Uzbekistan. Liechtenstein is an EEA 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. 13 The data reported by the Russian Federation were limited to new HIV diagnosis by sex for 2010–2019 and data on HIV testing, which enabled the inclusion of the Russian Federation’s data in Tables 1–3 and 25 and in the figures showing the trend of HIV diagnosis. Data on age and modes of transmission presented in this report include countries that provided a full set of data to the joint ECDC/WHO European HIV surveillance system, excluding the Russian Federation. The largest proportion of people newly diagnosed in the 46 countries reporting HIV data by age were in the age group 30–39 years (34%), while 9% were young people aged 15–24 years and 18% were 50 years or older at diagnosis (Table A, Table 9). Data on transmission mode (Table A, Tables 4–8, no data received from the Russian Federation) provide information about risk exposure among people newly diagnosed with HIV and indicate the following for 2019. • Heterosexual contact was still the main reported mode of HIV transmission in the WHO European Region, accounting for half (50%) of people newly diagnosed in 2019 (28 273) and 59% of new HIV diagnoses with a known mode of transmission (Table 6). Among those, 10% originated from countries with generalized epidemics (data not shown). • Sex between men was the second most common transmission mode, accounting for 21% of new diagnoses overall (11 645) and 24% of new HIV diagnoses with a known mode of transmission (Table 4). • Injecting drug use accounted for 13% of new diagnoses (7309) and 15% of new HIV diagnoses with a known mode of transmission (Table 5). • One per cent (0.7%, 401) of cases were infected through mother-to-child transmission (0.8% of those with a known mode of transmission) (Table 7) and 0.2% (94) 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% (8603 cases) (Table 8). Reporting completeness regarding transmission mode varies greatly across the Region, with information lacking for 3% of new diagnoses in the East, 44% in the Centre and 22% in the West. Information about country of birth, country of nationality or region of origin was provided by 43 countries for 55 792 people newly diagnosed in 2019. Among those with known origin (51 812), 20% (10 189) originated from outside of the reporting country, including 14% (7210) from outside the WHO European Region and 6% (2979) from a European country other than the country of report (Table 10). Information about probable country of infection was reported by 32 countries for 27 415 people newly diagnosed. Among people for whom the probable country of infection was known (19 583), 23% (4517) were infected abroad, including 7% in sub-Saharan Africa, 7% in central and eastern Europe, 3% in western 2. HIV and AIDS in the WHO European Region 39 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Europe, 3% in south and south-east Asia and 2% in Latin America (Table 12). Forty-one countries provided information about CD4 cell count at the time of HIV diagnosis in 2019. Information was reported for 39 496 people over 14 years at diagnosis (covering 74% of all new diagnoses in the reporting countries) (Table 13). Just over half (53%) of those newly diagnosed were late presenters, with CD4 cell counts below 350 per mm3 at the time of HIV diagnosis, including 31% with advanced HIV infection (CD4 above 200/mm3). Nineteen per cent had a CD4 cell count of between 350 and 500 cells per mm3 and 27% had a count above 500 per mm3 (data not shown). The percentage of those newly diagnosed who were late presenters (CD4 below 350/mm3) varied across the Region, but was highest in the East and in the Centre (both 56%) and lowest in the West (49%). The countries with the highest percentages of late presenters (over 60%, in countries with more than five cases) were Cyprus (91%), Albania (75%), Latvia (70%), Montenegro (64%), Romania (63%) and Bulgaria (61%). Those with the lowest percentages (less than 40%) were Iceland (20%), Slovakia (28%), Luxembourg (36%) and Czechia (40%). The percentage of late presenters was higher than the regional average of 53% in 19 countries (seven in the East, seven in the Centre and five in the West). The percentage also varied across transmission categories and was highest for people with reported heterosexual transmission (58%; 60% for men and 55% for women) and as a result of injecting drug use (52%), and lowest for men infected through sex with men (42%) (Table 14, Fig. 2.1, Fig. C). The percentage of people diagnosed at or below 350 CD4 cells per mm3 increased with age, ranging from 35% among people aged 15–19 and 20–24 years at diagnosis, respectively, to 67% among people aged 50 years or above. Overall, the percentage of late presenters by gender was similar (53% for men and 54% for women), but this is confounded by transmission mode and conceals, for men, the difference between MSM (who tend to get diagnosed earlier) and men with reported heterosexual transmission (who tend to get diagnosed later) (Fig. C). 2.1.2 Trends in HIV diagnoses The rate of newly diagnosed HIV infections in the WHO European Region14 increased by 9% for the period 2010–2019, from 14.1 per 100 000 population (118 726 cases) to 15.4 per 100 000 population (136 449 cases) (Fig. 2.2). The increase mainly is driven by an upward trend in many countries of the East; overall for the East, the rate increased by 23%, from 33.9 in 2010 (86 266 cases) to 41.7 in 2019 (107 842 cases). In the Centre, the rate increased by 113% – the largest relative increase across the three geographical areas – from 1.6 (3097 cases) to 3.4 (7029 cases); and in the West, the rate decreased by 24%, from 7.5 (29 515 cases) to 5.7 (23 971 cases, adjusted for reporting delay).15 Thirty-nine countries have consistently reported data on transmission mode for the period 2010–2019 (Fig. 2.3). Data from Iceland, Ireland, Poland and Turkey were excluded because over 50% of the data on transmission mode were missing for some years in the period. Data from Spain and Italy were excluded because coverage of the national surveillance system increased during this time period. No data on modes of transmission were reported from the Russian Federation and Malta, and data from Andorra, Belgium, North Macedonia, Monaco, Turkmenistan and Uzbekistan were not consistently reported during the period. Data on transmission mode from the countries with consistent data indicate that: 14 No data were received from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan or Uzbekistan. Liechtenstein is an EEA 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. 15 See Annex 1 for methods and Annex 6 for results (see also section 2.4 (HIV and AIDS diagnoses in the West) below). Fig. 2.1. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2019 (n = 37 774) 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 = 8589 n = 23 300 n = 5885 Percentage Tr an sm is si on m od e Note: no data from Andorra, Belgium, Hungary, Malta, Monaco, North Macedonia, Norway, Poland, the Russian Federation, San Marino, Turkmenistan or Uzbekistan. 40 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Fig. 2.3. New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2010–2019 0 5000 10 000 15 000 20 000 25 000 30 000 2019201820172016201520142013201220112010 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Ne w H IV d ia gn os es Year of diagnosis Note: data from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; data from Iceland, Ireland, Malta, 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. Data were not reported from the Russian Federation. (In total, data from 39 countries are included for Fig. 2.3.) Fig. 2.2. New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region, 2010–2019 0 10 20 30 40 50 2019201820172016201520142013201220112010 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 Note: data from Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. • the number of new diagnoses in people with reported heterosexual transmission increased by 17% in the Region, from 21 762 in 2010 to 25 402 in 2019, while the percentage of all new HIV diagnoses attributed to heterosexual contact increased from 47% of cases in 2010 to 55% in 2019; • the number of new diagnoses in people infected through sex between men decreased by 13%, from 9385 in 2010 to 8189 in 2019, and the percentage of all new HIV diagnoses attributed to sex between men also decreased slightly, from 20% to 18%; • the number of new diagnoses in people infected through injecting drug use decreased by 36%, from 10 977 in 2010 to 7053 in 2019, while the percentage of all HIV diagnoses attributed to injecting drug use decreased from 24% in 2009 to 15% in 2019; • the number of new diagnoses in children infected through mother-to-child transmission decreased by 35%, from 576 in 2010 to 373 in 2019, representing 1.2% of all new HIV diagnoses in 2010 and 0.8% in 2019; • of the new diagnoses in people infected by other means, nosocomial infections increased by 31%, from 26 cases in 2010 to 34 in 2019 (peaking at 105 cases in 2012); new diagnoses attributed to transfusion of blood and its products decreased by 23%, from 69 in 2010 to 53 in 2019; and • the number of new diagnoses for which information on transmission mode was unknown or missing increased by 31%, from 3596 in 2010 to 4869 in 2019 – representing 8% of all new HIV diagnoses in 2010 and 11% in 2019. 41 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Fig. 2.4. New AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2010–2019 0 2 4 6 8 10 12 2019201820172016201520142013201220112010 AI DS d ia gn os es p er 10 0 00 0 po pu la tio n Year of diagnosis West Centre East WHO European Region Note: data from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Fig. 2.5. Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country, East, 2019 (n = 107 842; 19 112) Male-to-female ratio All new diagnoses New diagnoses with heterosexual transmission 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Kyrgyzstan Tajikistan Republic of Moldova Latvia Ukraine Russian Federation East Belarus Estonia Azerbaijan Kazakhstan Armenia Lithuania Georgia Note: no data from Turkmenistan and Uzbekistan. No data on mode of transmission from the Russian Federation. 42 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data 2.1.3 AIDS cases, morbidity and mortality In 2019, 12 535 people in 45 countries of the WHO European Region16 were diagnosed with AIDS, which corresponds to a rate of 1.7 per 100 000 population (Table 14). Of the 12 535 people who received a diagnosis of AIDS in 2019, 76% (9577) were diagnosed in the East, 18% (2156) in the West and 7% (802) in the Centre of the Region. The rate was also highest in the East (8.3 per 100 000 population), 17 times higher than in the West (0.5 per 100 000) and more than 20 times higher than in the Centre (0.4 per 100 000 population). The rate of new AIDS diagnoses varied widely among the countries, with the highest rates (3.0 or above) reported in Ukraine (17.9), the Republic of Moldova (7.0), Georgia (6.6), Armenia (5.8), Latvia (4.7) and Belarus (4.0), and the lowest rates (under 0.3) reported in Turkey (0.1),17 Slovakia (0.1), Germany (0.1), Ireland (0.1), Bosnia and Herzegovina (0.2) and Poland (0.2). Malta and San Marino reported zero cases. TB represented 17% of all reported AIDS-defining illness events in 2019, ranging from 9% of reports in the West and 15% in the Centre to 30% in the East. In the 45 countries with consistent AIDS data,18 the overall rate of new AIDS diagnoses in the Region decreased by 23% between 2010 and 2019, from 2.2 per 100 000 population (15 148 cases) to 1.7 per 100 000 (12 535 cases) (Fig. 2.4). Since there are reporting delays in some countries, this decrease is expected to even out in the coming years. AIDS trends varied greatly across the three geographical areas. In the East, the rate increased by 15%, from 7.2 in 2010 to 8.3 in 2019. 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 69% decrease, from 1.6 in 2010 to 0.5 in 2019 (Fig. 2.4). 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 recorded was provided by 43 countries in the Region19 and included 4618 people who were reported to have died during 2019. This represented a 20% decrease compared with the 5760 deaths reported for the same countries in 2010. Of the 4618 deaths in 2019, 83% were reported from the East of the Region, 11% from the West and 6% from the Centre (Table 23). It is important to note that delays in reporting and underreporting have a significant impact on these numbers at European level, 16 No data were reported from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. 17 AIDS data for Turkey only include those diagnosed with AIDS at the time of HIV diagnosis and are therefore not comparable with AIDS data from other countries. 18 Data from Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan are excluded or not reported. 19 No data were received from Andorra, Belgium, Denmark, Italy, North Macedonia, Monaco, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. particularly when the death occurs long after HIV or AIDS diagnosis. The numbers presented here should therefore not be interpreted 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 HIV/ AIDS registries with their national mortality or vital statistics registries (1). 2.2 HIV and AIDS diagnoses in the East 2.2.1 HIV diagnoses in the East In 2019, 107 842 people were newly diagnosed with HIV across 13 countries20 in the East of the WHO European Region, giving a rate of 41.7 per 100 000 population. This number includes 80 124 new diagnoses reported from the Russian Federation21 and 27 718 from the remaining 12 reporting countries in the East of the Region. The highest rates of HIV diagnoses (more than 20.0) for 2019 were observed in the Russian Federation (54.9 per 100 000 population), Ukraine (39.0), the Republic of Moldova (22.8) and Belarus (22.6), while the lowest (under 10.0) were reported by Azerbaijan (7.2) and Lithuania (5.4). Among the 12 countries in the East22 reporting age distribution, most of those newly diagnosed (38%) were in the age group 30–39 years, while only 6% were young people aged 15–24 years and 16% 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, with 38% of new diagnoses among women in the East in 2019. The male-to-female ratio was highest (over 2.0) in Georgia (3.2), Lithuania (2.7) and Armenia (2.3), and lowest (under 1.5) in the Republic of Moldova (1.4), Tajikistan (1.4) and Kyrgyzstan (1.4) (Fig. 2.5). Among those reported as infected through heterosexual transmission, the male-to-female ratio was 1.5 or above in two countries (Georgia (1.9) and Armenia (1.7)), 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 ruled out that some of these men may in fact have been infected through injecting drug use or sex with other men, but misclassified in the heterosexual category. Heterosexual contact and injecting drug use are still the main modes of HIV transmission reported in the East of the Region. Reported transmission related to sex between men remains relatively low. 20 No data were received from Turkmenistan or Uzbekistan. 21 This year, the Russian Federation has reported data to the surveillance system, including historic data for 2010–2019, but the reporting was limited to the new HIV diagnosis by sex and data on HIV testing. Detailed information on the status of the data submitted by the Russian Federation can be found in Annex 5. 22 Data from the Russian Federation were not included. 43 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Fig. 2.6. New HIV diagnoses, by country and transmission mode, East, 2019 (n = 27 718) Sex between men Injecting drug use Heterosexual transmission Mother-to-child transmission Other Unkown Percentage 0 20 40 60 80 100 Latvia Lithuania Estonia Kazakhstan Kyrgyzstan Georgia Ukraine Tajikistan Azerbaijan Republic of Moldova Belarus Armenia Note: no data were received from the Russian Federation, Turkmenistan and Uzbekistan. In 2019, 27 718 new HIV diagnoses were reported from 12 countries in the East, with data by transmission mode suggesting the following (Table A, Tables 4–8, Fig. 2.6): • 69% of those newly diagnosed and 71% of new HIV diagnoses with a known mode of transmission were infected heterosexually (19 112), making it the main mode of transmission reported in all countries in the East (Table 6); • 23% of those newly diagnosed and 24% of new HIV diagnoses with a known mode of transmission were infected through injecting drug use (6424) (Table 5), with transmission through injecting drug use accounting for 25% or more of new diagnoses with a known transmission mode in four countries (Lithuania (38%), Kazakhstan (34%), Latvia (26%) and Ukraine (26%)); • 4% were infected through sex between men (1079) (Table 4), but five countries (Lithuania, Estonia, Georgia, Armenia and Latvia) reported that sex between men accounted for more than 10% of new diagnoses with a known transmission mode; • 0.8% of those diagnosed were infected through mother-to-child transmission (215) (Table 7) and 0.07% (19) through other transmission routes (nosocomial infection, transfusion or use of other blood products); and • transmission mode was reported as unknown or missing for only 3% of those newly diagnosed across the 12 countries in the East of the Region (869), but at country level, transmission-mode information was lacking for 15% or more of cases in five countries: Latvia (42%), Estonia (36%), Lithuania (16%), the Republic of Moldova (16%) and Kyrgyzstan (15%). Analysis of the new diagnoses by age group and transmission mode for the 12 reporting countries in the East (Fig. 2.7) shows that 30–39-year-olds accounted for most HIV diagnoses across all transmission groups (48% of people infected through injecting drug use, 36% with reported heterosexual transmission and 32% through sex between men). People in the younger age groups tended to be infected through sex between men; among MSM, 51% of adults (aged 15–49 years) were under 30 years at diagnosis, compared with only 12% and 20% among those infected through injecting drug use and heterosexual sex, respectively. People aged 50 years and above were more frequently infected as a result of heterosexual sex (19% compared with 8% and 5% for injecting drug use and MSM, respectively) (Fig. 2.7). Twelve countries in the East provided information about CD4 cell count at the time of HIV diagnosis for 23 141 people above 14 years (covering 85% of the 27 718 new 44 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data diagnoses in the 12 countries (Table 13)). Fifty-six per cent of these people were late presenters, with CD4 cell counts below 350 per mm3, including 32% with advanced HIV infection (CD4 below 200/mm3) at the time of HIV diagnosis. The percentage of people diagnosed with a CD4 count of less than 350/mm3 was higher than 50% in eight of the 12 countries. The percentage of late presenters varied across transmission categories, being highest for people infected heterosexually (58%) and through injecting drug use (52%) and lowest for men infected through sex with men (43%) (Fig. 2.8). Ten countries in the East provided information about the probable country of infection for 10 041 people newly diagnosed in 2019 (Table 12). Among the 9337 cases for whom the probable country of infection was known, only 8% (740 cases) were infected abroad, including 7% in central and eastern Europe. The data suggest that most of those newly diagnosed with HIV in the East of the Region were infected in the reporting country and that those infected abroad were infected in neighbouring countries of central and eastern Europe. 2.2.2 Trends in HIV diagnoses in the East The increasing trend in newly diagnosed HIV infections continued in the East23 over the last decade, with a 31% increase in the rate of new diagnoses per 100 000 population, from 31.8 in 2010 (90 061 cases) to 41.7 in 2019 (107 842 cases) (Fig. 2.2). The decrease in new diagnoses from 2015 to 2016 (Fig. 2.2) coincided with a change in the case definition in the Russian Federation.24 The rate doubled in two countries (Armenia and Belarus) between 2010 and 2019, whereas four countries had an increase of 30–62% over the decade: Kazakhstan (62%), Georgia (50%), Azerbaijan (41%) and the Republic of Moldova (33%). 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 23 For the analysis of trends, data from Turkmenistan and Uzbekistan were excluded. The Russian Federation provided data only for Tables 1–3 and 25 and therefore is included only for overall trends (not by, for instance, age or modes of transmission). Estonia is excluded for the trend analysis regarding modes of transmission due to incomplete reporting on transmission mode during the period. 24 Detailed information on the status of the data submitted by the Russian Federation can be found in Annex 5. Fig. 2.8. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2019 (n = 22 984) 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 = 933 n = 16 643 n = 5 348 Percentage Tr an sm is si on m od e Note: no data from the Russian Federation, Turkmenistan and Uzbekistan. Fig. 2.7. New HIV diagnoses, by age group and transmission mode, East, 2019 (n = 27 332) 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 = 6424 n = 19 111 n = 1079 Percentage Tr an sm is si on m od e Note: no data from the Russian Federation, Turkmenistan and Uzbekistan. 45 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT peak in new diagnoses and continued through to 2019 (Table 1). The number of newly diagnosed women increased by 10% across the 13 countries, from 37 567 in 2010 to 41 404 in 2019, and the number of newly diagnosed men increased by 27%, from 52 313 to 66 438 (Tables 2 and 3). The overall trend largely reflects the situation in the Russian Federation, which accounts for the vast majority of new cases reported in 2019. The other countries have significant variations. Three (Azerbaijan, Kyrgyzstan and Tajikistan) have all experienced much larger increases among women over the decade (11–191%) compared to the increase among men (11–30%). Information about mode of transmission for the period 2010–2019 (Fig. 2.9) from the 12 countries with consistent data suggests the following. • The number of new diagnoses in people with reported heterosexual transmission increased by 57%, from 12 354 in 2010 to 19 034 in 2019. The increase was considerably larger among men with heterosexual transmission (a 103% increase) than women with heterosexual transmission (21% increase). At the same time, the percentage of all new HIV diagnoses attributed to heterosexual contact increased from 53% of cases in 2010 to 69% in 2019. • The number of new diagnoses in people infected through injecting drug use decreased by 36%, from 9985 in 2010 to 6404 in 2019, but a moderate increase was seen between 2018 and 2019 in two countries (Kazakhstan and Ukraine) (Table 5). The percentage of all new HIV diagnoses attributed to injecting drug use decreased from 43% in 2010 to 23% in 2019. • The number of new diagnoses in people infected through sex between men increased more than five- fold, from 190 in 2010 to 1063 in 2019. This is by far the highest relative increase across the various transmission modes and geographical areas. It is Fig. 2.9. New HIV diagnoses, by transmission mode and year of diagnosis, East, 2010–2019 0 5000 10 000 15 000 20 000 Ne w H IV d ia gn os es Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined 2019 201820172016201520142013201220112010 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. Ne w 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 2019 201820172016201520142013201220112010 Arithmetic scale Logarithmic scale 46 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data clearly visible on the logarithmic scale of Fig. 2.9, which facilitates the comparison of rates of change regardless of starting point. Although it has increased, the percentage of all new HIV diagnoses attributed to sex between men nevertheless has remained low at 0.8% in 2010 and 4% in 2019. • The number of children infected through mother-to- child transmission decreased by 27%, from 293 in 2010 to 215 in 2019, representing 1.3% of new HIV diagnoses in 2010 and 0.8% in 2019. • The number of new diagnoses for which the mode of transmission was unknown increased by 71%, from 471 in 2010 to 805 in 2019. The percentage of new HIV diagnoses with unknown mode of transmission remained low and stable at 2–3% in 2010 and 2019. Further analysis of the increase in new diagnoses attributed to heterosexual transmission in the East by gender and age groups (Fig. 2.10) reveals continuing increases in older age groups for both men and women (it is highest in those aged 50 years and above, followed by the 40–49 and 30–39 age groups). Heterosexual transmission nevertheless has continued to decrease among young women aged 15–24 and 25–29 years, by 60% and 48%, respectively. 2.2.3 AIDS cases, morbidity and mortality in the East In 2019, 9577 people were diagnosed with AIDS from the 12 countries in the East that provided AIDS data, giving a rate of 8.3 per 100 000 population. The highest rates (above 5.0) were reported in Ukraine (17.9), the Republic of Moldova (7.0), Georgia (6.6) and Armenia (5.8) (Table 14). The AIDS rate increased by 15% between 2010 and 2019, from 7.2 per 100 000 population (8038 cases) to 8.3 (9577 cases) in the 12 countries (Fig. 2.4). The rate of new AIDS diagnoses increased in five of the 12 countries in the East, most noticeably in Armenia, Kazakhstan and Ukraine. The rate declined over the last decade in seven Fig. 2.10. Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2010–2019 0 1000 2000 3000 4000 15–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Ne w H IV d ia gn os es Year of diagnosis 2019 201820172016201520142013201220112010 Females, East, heterosexual transmission Note: no data by age for the Russian Federation. Data from Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. 0 1000 2000 3000 4000 15–24 years 25–29 years 30–39 years 40–49 years ≥ 50 years Ne w H IV d ia gn os es Year of diagnosis 2019201820172016201520142013201220112010 Males, East, heterosexual transmission 47 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT countries: Azerbaijan, Belarus, Georgia, Kyrgyzstan, Latvia, Lithuania and the Republic of Moldova. By mode of transmission, both in men infected through sex between men and in people infected heterosexually, the number of new AIDS diagnoses more than doubled between 2010 and 2019. AIDS cases in people infected as a result of injecting drug use decreased by 49% in comparison with 2010 (Fig. 2.11). The trend in more recent years, however, has been for the AIDS rate to decline – from 10.2 in 2017 to 8.3 in 2019. The most common AIDS-indicative diseases diagnosed in 2019 were wasting syndrome due to HIV (17% of all disease events reported), pulmonary TB (16%) and oesophageal candidiasis (13%) (Table 22). By transmission mode, wasting syndrome due to HIV, pulmonary TB and Kaposi’s sarcoma were the most common AIDS-defining diseases among people infected through heterosexual sex (the three diseases together accounting for 53% of reported events). The most common AIDS-defining diseases reported among people with AIDS infected through injecting drug use were extrapulmonary TB, pulmonary TB and wasting syndrome due to HIV (together accounting for 56% of reported events). Among the few AIDS cases infected as a result of sex between men, pulmonary TB, Pneumocystis pneumonia and Kaposi’s sarcoma were the most common diseases (Fig. 2.12). AIDS-related mortality remains high in the East, with 3830 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 concerned for 2019. This figure represents 83% of all AIDS-related deaths reported in the Region, a 19% decrease compared with 2012, which had the highest number of deaths reported for the decade (Table 23). Fig. 2.11. New AIDS diagnoses, by transmission mode and year of diagnosis, East, 2010–2019 0 2000 4000 6000 8000 Ne w 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 2019 201820172016201520142013201220112010 Arithmetic scale Note: data from the Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Year of diagnosis 2019 201820172016201520142013201220112010 1 10 100 1000 10 000 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Ne w A ID S di ag no se s Logarithmic scale 48 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data 2.3 HIV and AIDS diagnoses in the Centre 2.3.1 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, particularly in people infected as a result of sex between men. A total of 6814 people were newly diagnosed with HIV in 2019 from the 14 countries in the Centre of the WHO European Region, giving a rate of 3.4 per 100 000 population (Table 1). The highest rates (over 3.0) were reported by Cyprus (11.4), Montenegro (4.1), Poland (3.9), Turkey (3.9), Bulgaria (3.7), Romania (3.6) and Albania (3.5), and the lowest (under 2.0) by Bosnia and Herzegovina (0.9), Slovenia (1.6) and Slovakia (1.9). The most affected age group in 2019 was 30–39-year- olds (32% of cases), while 15% of cases were diagnosed in young people aged 15–24 years – the largest percentage of young people among the three geographical areas (Table A, Table 9). The male-to- female ratio was 5.5, higher than in both the West and the East. This reflects the higher number of young MSM among newly diagnosed cases in the central part of the Region compared with other parts of the Region. The highest male-to-female ratios (over 10.0) were observed in Croatia (19.4), Hungary (13.0), Montenegro (12.0) and Serbia (10.3) (Fig. 2.13). All 14 countries reporting 2019 data provided information on transmission mode, and the 2019 data (Table A, Tables 4–7) indicate the following: • 27% of those newly diagnosed and 49% of new HIV diagnoses with a known route of transmission were infected through sex between men (1863) (Table 4); in 2019, sex between men was the predominant reported mode of transmission in 10 countries (Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Hungary, Montenegro, Serbia, Slovakia, Slovenia and Poland) (Fig. 2.14); • 25% of those newly diagnosed and 46% of new HIV diagnoses with a known route of transmission were infected through heterosexual transmission (1730) (Table 6), which was the main reported mode of transmission in four countries (Albania, Cyprus, Romania and Turkey) (Fig. 2.14); • 2% of those newly diagnosed and 4% of new HIV diagnoses with a known route of transmission were infected through injecting drug use (146) (Table 5); • 1% of those with a known route of transmission were infected through mother-to-child transmission (36) (Table 7); and • transmission mode was unknown for 44% of those newly diagnosed (3029) (Table 8), with the two countries with the highest number of new HIV diagnoses in 2019 (Turkey and Poland – together accounting for 69% of all new HIV diagnoses reported in the Centre in 2019) also having the highest percentage of new HIV diagnoses with an unknown transmission mode (Poland 72% and Turkey 58%). Twelve of 15 countries provided information on CD4 cell count at HIV diagnosis for 2034 people aged over 14 years (covering 30% of all new diagnoses in the Centre countries and 40% in the 14 countries with CD4 cell data) (Table 13). Fifty-six per cent were late presenters, with CD4 cell counts below 350 per mm3 at HIV diagnosis, including 35% with advanced HIV infection (CD4 under 200/mm3). In all, 18% had a CD4 cell count of between 350 and 500 cells per mm3 and 27% had a CD4 cell count above 500 per mm3. The proportion diagnosed with CD4 counts of less than 350/mm3 was 50% or above in nine countries: Cyprus (91%), Albania (75%), Montenegro (64%), Romania (63%), Bulgaria (62%), Serbia (60%), Bosnia and Herzegovina (54%), Slovenia (52%) and Croatia (50%). The percentage of late presenters varied across transmission categories and was highest for Fig. 2.12. Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2019 9 0 5 10 15 20 25 30 35 96 93 79 3 3 201 191 142 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 Russian Federation, Turkmenistan and Uzbekistan. 49 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Fig. 2.13. Male-to-female ratio in new HIV diagnoses, by country, Centre, 2019 0 5 10 15 20 25 Cyprus Albania Romania Slovenia Bulgaria Centre average Turkey Poland Czechia Bosnia and Herzegovina Slovakia Serbia Montenegro Hungary Croatia Male-to-female ratio Fig. 2.14. New HIV diagnoses, by country and transmission mode, Centre, 2019 (n = 6713) 0 20 40 60 80 100 Heterosexual contact Sex between men Injecting drug use Other Unkown Percentage Albania Turkey Poland Romania Centre average Cyprus Bulgaria Slovakia Montenegro Slovenia Czechia Bosnia and Herzegovina Hungary Croatia Serbia 50 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data those infected as a result of injecting drug use (73%) and heterosexually (65%) and lowest for men infected through sex with men (47%) (Table 13, Fig. 2.15). 2.3.2 Trends in HIV diagnoses in the Centre The rate of new HIV diagnoses increased by 113% between 2010 and 2019 in the 14 reporting countries of the Centre, from 1.6 per 100 000 population (2945 cases) to 3.4 (6814 cases) (Fig. 2.2). Rates increased in all countries except Slovenia. The largest increases were in Bosnia and Herzegovina, Slovakia and Turkey. Information on trends by reported mode of HIV transmission for the period 2010–2019 in the 12 countries with consistent data25 (Fig. 2.16) indicates the following. • The number of new diagnoses in those infected as a result of sex between men nearly doubled, from 593 to 1025. The percentage of new HIV diagnoses attributed to sex between men also increased, from 40% in 2010 to 48% in 2019. • The number of new diagnoses in those infected through heterosexual transmission increased by 48%, from 568 to 841. The percentage of new HIV diagnoses attributed to heterosexual transmission decreased slightly from 40% in 2010 to 38% in 2019. • The number of new diagnoses in those infected as a result of injecting drug use increased from 96 to 117. 25 Data from North Macedonia, Poland and Turkey were excluded due to incomplete reporting on transmission mode during the period. Fig. 2.16. New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2010–2019 0 200 400 600 800 1000 Ne w 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 2019201820172016201520142013201220112010 Note: data from North Macedonia, Poland and Turkey excluded due to incomplete reporting on transmission mode during the period. Fig. 2.15. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, Centre, 2019 (n = 1847) 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 = 824 n = 873 n = 102 Percentage Tr an sm is si on m od e Note: no data from Hungary, North Macedonia or Poland. 51 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT 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 diagnoses attributed to injecting drug use was 6% in both 2010 and 2019. • The number of new diagnoses as a result of mother-to- child transmission decreased from 31 cases in 2010 to 16 cases in 2019. • The number of new diagnoses reported with unknown transmission mode in 2019, although still high at 44% for the 15 countries, decreased by 47%, from 211 to 112 in the 12 countries with consistent data on transmission mode. The percentage of new diagnoses with missing information about transmission mode decreased from 14% in 2010 to 5% in 2019 in the 12 countries included in the trend assessment. 2.3.3 AIDS cases, morbidity and mortality in the Centre In 2019, 802 people were diagnosed with AIDS in the 14 reporting countries in the Centre, corresponding to a rate of 0.4 per 100 000 population (Table 14). The highest rates (1.0 or above) were reported by Montenegro (1.6), Romania (1.5), Albania (1.4) and Bulgaria (1.0). AIDS rates remained below 0.8 per 100 000 population in other countries in the Centre. In contrast 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 (52% of new diagnoses) than with sex between men (32% of new diagnoses). The rate of new AIDS diagnoses remained stable at 0.4 per 100 000 between 2010 and 2019, with almost no change during the period (Fig. 2.4). Trends were more heterogeneous at country level. Of the nine countries reporting more than 10 AIDS cases in 2019, the rate increased by more than 50% in four (Albania, Bulgaria, Croatia and Hungary) (Table 14). In terms of the mode of transmission, new AIDS diagnoses increased most among men infected as a result of sex between men (by 93% for the decade) but have been relatively stable or declining since 2014 in those infected heterosexually or through injecting drug use (Fig. 2.17). The most common AIDS-indicative diseases diagnosed in 2019 were wasting syndrome due to HIV (21% of all recorded disease events), Pneumocystis pneumonia (13%) and pulmonary TB (12%) (Table 22). Mortality also remained stable in the Centre, with 282 deaths reported by the 14 countries in 2010 and 260 in 2019 and little variation being seen during the decade (though the numbers were slightly higher during 2011–2015) (Table 23). 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. 2.4 HIV and AIDS diagnoses in the West 2.4.1 HIV diagnoses in the West The epidemiological pattern of HIV infection in the West largely mirrors that of the EU/EEA, as described in Chapter 1. In 2019, 21 793 people were newly diagnosed with HIV in the 20 reporting countries comprising the West of the WHO European Region, giving a rate of 5.2 per 100 000 population (not adjusted for reporting delay) (Table A, Table 1). When adjusting the 2019 West rate for reporting delay,26 it increases to 5.7 per 100 000 population (23 971 cases). In 2019, the highest proportion of newly diagnosed HIV infections (30%) were in 30–39-year-olds, 10% were aged 15–24 years and the male-to-female ratio was 2.9 26 See Annex 1 for methods and Annex 6 for results. Fig. 2.17. New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2010–2019 0 100 200 300 400 Ne w 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 2019201820172016201520142013201220112010 Note: data from North Macedonia, Poland and Turkey excluded due to incomplete reporting during the period. 52 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data (Table A). Sexual transmission between men remained the main transmission mode in 2019, followed by heterosexual transmission, together accounting for 74% of all new diagnoses and 94% of all cases with a known route of transmission. Seventeen countries reported information on CD4 cell count at HIV diagnosis for 14 321 people over 14 years (67% of new diagnoses from the 17 countries reporting information on CD4 cell counts). Of these, 49% were late presenters with CD4 cell counts below 350 per mm3 at HIV diagnosis, including 29% with advanced HIV infection (CD4 under 200/mm3) (Table 13). Late presentation varied by transmission category and was more common in people infected heterosexually (56%) or through injecting drug use (49%) and less common in men infected through sex with men (41%) (Table 13). Information about transmission mode (Table A, Tables 4–7) suggests the following: • 40% of all people newly diagnosed and 51% of those with a known mode of transmission were infected through sex between men (8703) (Table 4); • 34% of all people newly diagnosed and 43% of those with a known mode of transmission were infected heterosexually (7431) (Table 6); of these, 63% were born abroad and 39% originated from generalized epidemic countries (Table 11); • 3% of all people newly diagnosed were infected through injecting drug use (739) (Table 5); • mother-to-child transmission accounted for 0.7% of all new diagnoses and 0.9% of those with a known route of transmission (150 cases) (Table 7); of these, 88% were born abroad and 63% originated from countries with a generalized epidemic (Table 11); and • transmission mode was unknown for 22% of all new diagnoses (4705). Information about country of birth, country of nationality or region of origin was provided for all 21 793 new diagnoses in 2019. Region of origin was unknown for 14% (3034). Among 18 759 persons with known origin (86%), 49% (9192) originated from outside of the reporting country, including 36% (6845) from outside the WHO European Region and 13% (2347) from a European country other than the country of report (Table 11). 2.4.2 Trends in HIV diagnoses in the West The crude rate of new diagnoses in the 20 reporting countries declined by 44% between 2010 and 2019, from 7.5 per 100 000 population (29 515) to 5.2 (21 793) (not adjusted for reporting delay).27 After adjusting the 2019 rate for reporting delay, the decline was 32% (from 7.5 to 5.7 per 100 000 population, with 23 971 cases in 2019). HIV rates increased (by 10% or more in countries with more than 10 cases in both 2010 and 2019) in four countries – Germany, Iceland, Ireland and Malta – and 27 See Annex 1 for methods and Annex 6 for results. decreased (by 10% or more) in 13 (Table 1), not taking into account the impact of reporting delays in several countries. Information about trends by reported transmission mode during the period 2010–2019 in the 15 countries with consistent data28 and taking standardized adjustments for reporting delay into account (Fig. 2.18) suggests the following. • New diagnoses of people infected through sex between men decreased by 27%, from 8601 to 6274. The percentage of new diagnoses attributed to sex between men decreased from 41% in 2010 to 36% in 2019. • New diagnoses of people with reported heterosexual transmission decreased by 30%, from 8667 to 6097, with the steepest decline among women and foreign- born heterosexual people, the latter being due mainly to sharp declines among migrants originating from countries with generalized HIV epidemics (data not shown; see also Fig. 1.11 and 1.12 and section 1.2 (Trends in HIV diagnoses) in Chapter 1). The percentage of new diagnoses attributed to heterosexual contact decreased from 41% of cases in 2010 to 35% in 2019. • New diagnoses of people infected through injecting drug use decreased by 29%, from 778 in 2010 to 554 in 2019, representing 4% of new HIV diagnoses in 2010 and 3% in 2019. • New diagnoses of children infected through mother- to-child transmission decreased by 42%, from 249 in 2010 to 145 in 2019. • The number of new diagnoses with missing information about transmission mode increased by 47%, from 2833 to 4164, corresponding to 13% of new diagnoses in 2010 and 24% in 2019. Delays in the reporting of probable mode of transmission to national and European surveillance systems intensify the increase. 2.4.3 AIDS cases, morbidity and mortality in the West In 2019, 19 of the 23 countries in the West29 reported that 2156 people were diagnosed with AIDS, giving a rate of 0.5 per 100 000 population (Table 14). The steady decline in new AIDS diagnoses that began in the late 1990s continued through to 2019, with a 69% decrease in the rate of new AIDS cases over the decade from 1.6 per 100 000 population (6539 cases) in 2010 to 0.5 (2156 cases) in 2019 (Fig. 2.4). New AIDS diagnoses decreased in all transmission groups but most notably among people who inject drugs (an 85% decline) (Fig. 2.19). The most common AIDS-indicative diseases diagnosed in the West in 2019 were Pneumocystis pneumonia (24% of all disease events reported), oesophageal candidiasis (12%) and Kaposi’s sarcoma (11%) (Table 22). In the West, 527 people were reported to have died in 2019 in the 17 countries for which consistent data were 28 Data from Italy and Spain were excluded due to increasing coverage of national surveillance over the period. 29 No data were available from Andorra, Belgium, Monaco or Sweden. 53 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT available30 (Table 23). The number of AIDS-related deaths has continued to decline during the decade, from 2325 in 2010 to 527 in 2019, representing a 77% decrease. These numbers do not reflect the true burden of AIDS-related mortality in the West of the Region due to reporting delays. In particular, there is a risk of deaths being underreported in those countries that do not have the ability to link their HIV/AIDS registries with their vital statistics registries. 2.5 HIV testing Data on the number of HIV tests can support the interpretation of trends in newly diagnosed HIV infections. In 2019, a total of 66 879 048 HIV tests were 30 No data were available from Andorra, Belgium, Denmark, Italy, Monaco or Sweden. reported by 22 countries (12 East, nine Centre and one West). These tests do not include unlinked anonymous testing and all countries except the Russian Federation also exclude the HIV tests performed as part of blood- donor screening. In 2019, the Russian Federation reported a total of 47 206 251 HIV tests, accounting for 71% of all HIV tests reported in the Region for that year. 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 24). The overall number of tests performed in the Region increased by 77%, from 37 650 358 in 2010 to 66 918 147 in 2019, in the 21 countries with data for both 2010 and 2019. Increases in large countries with high testing numbers, such as Belarus, Kazakhstan, the Russian Fig. 2.19. New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2010–2019 0 1000 2000 3000 2019201820172016201520142013201220112010 Ne w 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: Andorra, Belgium, Monaco and Sweden excluded due to inconsistent reporting during the period. Fig. 2.18. New HIV diagnoses, by transmission mode and year of diagnosis, West, 2010–2019 0 2000 4000 6000 8000 10 000 2019201820172016201520142013201220112010 Year of diagnosis Ne w H IV d ia gn os es Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Note: data from Andorra, Belgium and Monaco excluded due to inconsistent reporting during the period; data from Iceland, Ireland and Malta 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. (In total, data from 45 countries included for Fig 2.18 in 2019.) 54 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Federation and Turkey, had a considerable impact on the overall increase. The number of tests more than doubled in six 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 77%, from 31 793 139 in 2010 to 56 127 346 in 2019 (Table 24). Information about the types of populations tested is not available, but an increasing number 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 nevertheless is possible that increased testing activity has contributed to the observed increase in new diagnoses. The rate of new HIV diagnoses in the Centre more than doubled during the last decade, while the number of HIV tests increased by 76% (from 5 924 413 in 2010 to 10 415 092 in 2019) in the eight countries for which consistent data were available.31 The number of HIV tests conducted in the West is not reported separately here. In contrast 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 being too sparse to allow for meaningful interpretation. 2.6 Conclusions HIV infection continues to affect the health and well- being of millions of people in the WHO European Region and to pose a serious public health concern, particularly in the eastern part of the Region. More than 136 000 people were diagnosed with HIV infection in 2019, at a rate of 15.6 diagnoses per 100 000 population. The vast majority of people newly diagnosed (79%) were from the East, with a rate of 41.7 per 100 000 population, while 16% were diagnosed in the West, with a rate of 5.7 per 100 000 population, and 5% in the Centre, with a rate of 3.4 per 100 000 population. An increasing trend in new HIV diagnoses has been observed in one third of the reporting countries in the East, although this is at a slower rate than in previous years. Halted growth in reported newly diagnosed HIV has been observed in the Russian Federation. Some signs of stabilization have been noted in Ukraine. This contributed to the overall stabilization of the epidemic in the East. The 2019 HIV surveillance data also confirm the great variation in epidemic patterns and trends across the WHO European Region. Overall, among the new diagnoses for which the HIV transmission mode was known, heterosexual transmission accounted for 59%, sex between men for 24% and injecting drug use for 15%. These overall numbers conceal a complex mix of transmission patterns, trends and country contexts in 31 The eight countries are Albania, Bulgaria, Czechia, Montenegro, Poland, Serbia, Slovenia and Turkey. which transmission through sex between men tends to predominate in the western and central parts of the Region, heterosexual transmission remains substantial across large parts of the Region (particularly among migrants, travellers and partners of people who inject drugs) and injecting drug use remains an important risk factor, mainly in the eastern part of the Region. Transmission as a result of injecting drug use continued to decrease during the decade but still accounted for 24% of new diagnoses in the East with a known transmission mode. Although the reported transmission through sex between men remains low in absolute terms in the East, it has increased nearly five-fold during the decade – the largest increase in any transmission category and any geographical area of the Region. There is 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 (2,3). While most new diagnoses (65%) were in men and new diagnoses increased more rapidly among men than women, the proportion of new diagnoses among women was much higher in the East than elsewhere in the Region. The rate of new diagnoses is increasing more rapidly in the central part than anywhere else in the Region, with a strong gender disparity and very steep increases among men (both MSM and heterosexual) compared with a fairly stable rate among women. Sexual transmission outweighs all other types of transmission 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 (4–8) suggest that HIV prevention services for people who inject drugs continue to be important and must be maintained with sufficient coverage 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 treatment 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 coinfections (particularly sexually transmitted infections); and rapid HIV treatment initiation. Services should be patient-centred and provided in a friendly environment, preferably with the involvement of civil society along the entire HIV continuum of services, ranging from HIV prevention to adherence and ART. In the western part of the Region, there has been a clear decline in the overall rate of new HIV diagnoses during 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 among people infected heterosexually, particularly women and people 55 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT originating 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 (9,10) have probably all contributed to the observed decline. While a certain proportion of migrants, even those originating from HIV-endemic areas, are known to acquire HIV after arrival in the EU/EEA (11–13), the extent to which the observed decreases can be explained by lower incidence of HIV in the migrant populations, reduced test-seeking or opportunities, changed migration patterns or a combination of factors, is unclear. Where migration is a common occurrence and takes a variety of forms, the public health challenge of ensuring access to health services for migrant populations (including HIV services and the promotion of 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. Once again, it is significant that the 2019 data provide information about variations in late presentation according to geography, transmission mode and age. Moreover, the data confirm that the proportion diagnosed at a late stage of infection was highest in the East, among people infected heterosexually (particularly men) and as a result of injecting drug use, and among those in older age groups. Late presentation reflects insufficient access to, and uptake of, appropriate HIV testing and counselling by those who have a higher risk of acquiring HIV. HIV testing strategies need to be reconsidered and diversified to include innovative approaches that involve community- based organizations and focus on the key population groups. Multiple entry points to HIV testing should be available through, for example, HIV self-testing, HIV testing performed 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 treatment programmes, sexual and reproductive health clinics and migrant health services, depending on the local context. Support for timely linkage to HIV treatment and care is essential to reduce late presentation and to make progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO 90–90–90 targets, improving treatment outcomes and further reducing HIV transmission. In September 2020, considering the COVID-19 pandemic situation, the WHO Regional Office for Europe and the ECDC organized a joint virtual meeting with major national stakeholders involved in the response to TB, HIV and viral hepatitis, including key partners, donors, affected communities and civil society organizations, to exchange information and good practices on the maintenance of essential TB, HIV and viral hepatitis services. Countries and partners discussed their experiences in ensuring access to, and continuity of, quality HIV services during the COVID-19 pandemic and on how they monitored the impact of the COVID-19 pandemic on HIV services. Latest WHO policy guidance and recommendations on TB, HIV, viral hepatitis and comorbidities were also discussed during the meeting. AIDS trends varied greatly across the three geographical areas. While the rate continued its steady decline in the West, it remained stable in the Centre and, although it increased by 15% over the decade in the East of the Region, overall there was a 23% decrease in the rate of new AIDS diagnoses in the Region between 2010 and 2019. The high number of AIDS cases is indicative of late HIV diagnosis, delayed initiation of life-saving HIV treatment and low treatment coverage. Increasing implementation of a treat-all approach and having policies in place in most countries in the Region to ensure that everyone living with HIV is offered ART regardless of the stage of disease has helped to stabilize AIDS trends and will, ultimately, help reduce AIDS- related deaths in line with global and regional targets (14–17). 2.7 References32 1. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire (French National Institute of Health Surveillance); 2007. 2. 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. 3. Dumchev K, Kornilova M, Kulchynska R, Azarskova M, Vitek C. Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk. BMC Public Health 2020;20(1):1288. doi:10.1186/s12889-020-09373-2. PMID: 32843008. PMCID: PMC7449084. 4. 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). 5. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2016. Euro Surveill. 2016;20(40):pii=30036 (http://dx.doi.org/10.2807/1560-7917.ES.2016.20.40.30036). 6. 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). 7. McAuley A, Palmateer NE, Goldberg DJ, Trayner KMA, Shepherd SJ, Gunson RN et al. Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross-sec- tional analysis. Lancet HIV 2019;6(5):e315–24. 8. Des Jarlais DC, Sypsa V, Feelemyer J, Abagiu AO, Arendt V, Broz D et al. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV 2020;7(6):e434–42. 9. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014 (http://ecdc.europa.eu/en/publi- cations/ Publications/hiv-sti-prevention-among-men-who-havesex- with-men-guidance.pdf). 10. 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. 32 All weblinks were accessed on 12 November 2020. 56 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data unfpa.org/publications/ implementing-comprehensive-hiv-and-sti- programmesmen- who-have-sex-men). 11. 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. 12. Fakoya I, Alvarez-del Arco D, Woode-Owusu M, Monge S, Rivero- Montesdeoca Y, Delpech V et al. A systematic review of postmigra- tion 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. 13. Fakoya I, Alvarez-Del Arco D, Monge S, Copas AJ, Gennotte A-F, Volny-Anne A 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). 14. Ambitious treatment targets: writing the final chapter of the AIDS epidemic. Geneva: UNAIDS; 2014 (www.unaids.org/sites/default/ files/media_asset/JC2670_UNAIDS_Treatment_Targets_en.pdf). 15. Action plan for the health sector response to HIV in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2017 (https://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). 16. Global health sector strategy for HIV 2016–2021. Geneva: World Health Organization; 2016 (https://www.who.int/hiv/strat- egy2016-2021/ghss-hiv/en/). 17. 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). Tables 58 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 363 4.3 361 4.3 365 4.3 307 3.6 304 3.6 324 3.8 291 3.3 302 3.4 199 2.3 225 2.5 10 188 Austria West Belgium 1985 1 184 10.9 1 171 10.6 1 228 11.1 1 128 10.1 1 057 9.5 1 020 9.1 909 8.0 899 7.9 882 7.7 – – 31 540 Belgium Centre Bulgaria 1986 163 2.2 201 2.7 157 2.1 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 311 4.4 258 3.7 3 316 Bulgaria Centre Croatia 1985 71 1.7 74 1.7 73 1.7 85 2.0 92 2.2 117 2.8 109 2.6 106 2.6 94 2.3 102 2.5 1 734 Croatia Centre Cyprus 1986 41 5.0 54 6.4 58 6.7 54 6.2 56 6.5 80 9.4 80 9.4 85 9.9 78 9.0 100 11.4 1 326 Cyprus Centre Czechia 1985 180 1.7 153 1.5 212 2.0 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 208 2.0 222 2.1 3 590 Czechia West Denmark 1990 275 5.0 266 4.8 201 3.6 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 219 3.8 190 3.3 8 000 Denmark East Estonia 1988 376 28.2 366 27.5 315 23.8 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 190 14.4 178 13.4 10 079 Estonia West Finland 1980 184 3.4 172 3.2 156 2.9 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 153 2.8 149 2.7 4 213 Finland West France 2003 5 559 8.6 5 426 8.4 5 680 8.7 5 572 8.5 5 691 8.6 5 313 8.0 5 444 8.2 5 388 8.1 5 078 7.6 4 923 7.3 93 688 France West Germany 1993 2 809 3.4 2 763 3.4 3 027 3.8 3 235 4.0 3 525 4.4 3 642 4.5 3 378 4.1 3 155 3.8 2 867 3.5 3 093 3.7 71 163 Germany West Greece 1984 648 5.8 966 8.7 1 161 10.5 901 8.2 779 7.1 778 7.2 649 6.0 647 6.0 723 6.7 603 5.6 16 171 Greece Centre Hungary 1985 182 1.8 162 1.6 219 2.2 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 229 2.3 238 2.4 4 034 Hungary West Iceland 1983 24 7.6 23 7.2 19 5.9 11 3.4 11 3.4 12 3.6 28 8.4 24 7.1 38 10.9 28 7.8 451 Iceland West Irelandc 1985 330 7.3 328 7.2 350 7.6 343 7.4 378 8.2 483 10.3 511 10.8 499 10.4 508 10.5 533 10.9 9 901 Irelandc West Italy 1985 4 024 6.8 3 898 6.6 4 162 7.0 3 843 6.4 3 831 6.3 3 598 5.9 3 687 6.1 3 579 5.9 3 003 5.0 2 531 4.2 49 882 Italy East Latvia 1987 274 12.9 299 14.4 339 16.6 340 16.8 350 17.5 400 20.1 369 18.7 376 19.3 328 17.0 295 15.4 7 985 Latvia – Liechtenstein 1985 4 11.1 1 2.8 0 0.0 0 0.0 1 2.7 0 0.0 2 5.3 0 0.0 0 0.0 0 0.0 67 Liechtenstein East Lithuania 1988 153 4.9 166 5.4 160 5.3 177 6.0 141 4.8 157 5.4 214 7.4 263 9.2 160 5.7 151 5.4 3 323 Lithuania West Luxembourgc 1983 65 12.9 61 11.9 70 13.3 75 14.0 89 16.2 75 13.3 81 14.1 67 11.3 57 9.5 48 7.8 1 830 Luxembourgc West Malta 2001 18 4.3 21 5.1 30 7.2 36 8.5 40 9.3 61 13.9 63 14.0 45 9.8 73 15.3 80 16.2 585 Malta West Netherlands 1980 1 277 7.7 1 233 7.4 1 167 7.0 1 132 6.7 1 001 5.9 990 5.9 891 5.2 825 4.8 691 4.0 563 3.3 28 083 Netherlands West Norway 1984 258 5.3 269 5.5 242 4.9 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 191 3.6 172 3.2 6 654 Norway Centre Poland 1985 955 2.5 1 113 2.9 1 104 2.9 1 100 2.9 1 134 3.0 1 278 3.4 1 319 3.5 1 419 3.7 1 210 3.2 1 468 3.9 25 591 Poland West Portugal 1985 1 989 18.8 1 821 17.2 1 804 17.1 1 772 16.9 1 454 13.9 1 495 14.4 1 508 14.6 1 336 13.0 1 109 10.8 778 7.6 61 433 Portugal Centre Romania 1987 590 2.9 837 4.1 940 4.7 1 019 5.1 907 4.5 884 4.4 774 3.9 796 4.1 732 3.7 690 3.6 24 990 Romania Centre Slovakia 1985 28 0.5 49 0.9 50 0.9 83 1.5 86 1.6 86 1.6 88 1.6 72 1.3 102 1.9 101 1.9 1 074 Slovakia Centre Slovenia 1985 35 1.7 56 2.7 48 2.3 47 2.3 53 2.6 52 2.5 60 2.9 40 1.9 37 1.8 34 1.6 923 Slovenia West Spain 2003 3 914 11.9 3 676 11.2 3 944 10.4 4 374 9.4 4 429 9.5 4 189 9.0 4 175 9.0 3 795 8.2 2 527 6.4 2 483 5.6 54 673 Spain West Sweden 1983 420 4.5 461 4.9 441 4.7 457 4.8 473 4.9 447 4.6 429 4.4 434 4.3 481 4.8 449 4.4 13 499 Sweden West United Kingdom 1981 6 328 10.1 6 153 9.8 6 190 9.7 5 964 9.3 6 296 9.8 6 198 9.6 5 231 8.0 4 653 7.1 4 537 6.8 4 116 6.2 164 417 United Kingdom Total EU/EEA 32 721 6.6 32 600 6.6 33 912 6.8 33 678 6.6 33 923 6.6 33 385 6.5 31 879 6.2 30 355 5.9 27 015 5.3 24 801 4.9 714 403 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 43 1.5 78 2.7 81 2.8 120 4.1 79 2.7 96 3.3 127 4.4 94 3.3 102 3.5 101 3.5 1 304 Albania West Andorra 2004 6 7.1 2 2.4 2 2.4 5 6.2 5 6.3 3 3.8 3 3.9 6 7.8 12 15.6 – – 96 Andorra East Armeniac 1988 149 5.2 183 6.4 230 8.0 239 8.2 339 11.6 296 10.1 304 10.4 355 12.1 420 14.2 446 15.1 3 785 Armeniac East Azerbaijan 1987 459 5.1 548 6.0 517 5.6 514 5.5 604 6.4 727 7.6 556 5.7 567 5.8 656 6.6 721 7.2 8 129 Azerbaijan East Belarus 1981 1 069 11.3 1 196 12.7 1 223 13.0 1 533 16.3 1 811 19.2 2 305 24.4 2 391 25.3 2 468 26.1 2 386 25.2 2 137 22.6 29 209 Belarus Centre Bosnia and Herzegovinac 1986 1 0.0 27 0.7 25 0.7 2 0.1 23 0.7 15 0.4 24 0.7 15 0.4 24 0.7 30 0.9 338 Bosnia and Herzegovinac East Georgia 1989 455 11.1 424 10.4 526 12.9 490 12.1 564 14.0 717 17.8 719 17.9 631 15.7 672 16.8 668 16.7 8 102 Georgia West Israel 1981 419 5.7 450 6.0 483 6.3 465 6.0 462 5.9 413 5.2 368 4.5 415 5.0 452 5.4 408 4.8 10 495 Israel East Kazakhstan 1987 1 982 12.2 1 997 12.1 2 004 12.0 2 131 12.5 2 342 13.5 2 475 14.1 2 898 16.3 3 014 16.7 3 215 17.5 3 673 19.8 39 439 Kazakhstan East Kyrgyzstan 1987 567 10.5 614 11.1 701 12.5 503 8.8 649 11.1 653 11.0 764 12.6 840 13.6 876 13.9 850 13.2 9 745 Kyrgyzstan West Monaco 1987 0 0.0 0 0.0 1 2.7 0 0.0 1 2.7 1 2.7 0 0.0 3 7.8 0 0.0 – – 40 Monaco Centre Montenegro 1989 15 2.4 9 1.4 13 2.1 11 1.8 20 3.2 19 3.0 34 5.4 26 4.1 23 3.7 26 4.1 303 Montenegro Centre North Macedonia 1993 5 0.2 1 0.0 15 0.7 15 0.7 30 1.4 25 1.2 30 1.4 44 2.1 45 2.2 – – 246 North Macedonia East Republic of Moldova 1987 703 17.2 721 17.7 757 18.6 706 17.3 831 20.4 818 20.1 832 20.5 835 20.6 905 22.3 922 22.8 13 679 Republic of Moldova East Russian Federation 2009 62 581 43.6 67 317 46.8 75 708 52.6 81 698 56.6 92 613 64.0 100 220 69.1 86 855 59.8 85 802 59.0 85 995 59.0 80 124 54.9 881 258 Russian Federation West San Marino 1985 6 19.2 8 25.3 5 15.6 1 3.1 3 9.1 2 6.0 2 6.0 1 3.0 3 8.9 0 0.0 93 San Marino Centre Serbia 1984 152 1.7 134 1.5 137 1.5 156 1.7 137 1.5 183 2.1 179 2.0 186 2.1 188 2.1 215 2.0 4 192 Serbia Centre Serbia excluding Kosovo1 1984 149 2.2 128 1.8 133 1.9 153 2.1 131 1.8 180 2.5 168 2.4 183 2.6 180 2.6 210 2.4 4 066 Serbia excluding Kosovo1 Centre Kosovo1 1999 3 0.1 6 0.3 4 0.2 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 8 0.4 5 0.3 126 Kosovo1 West Switzerland 1985 605 7.7 562 7.1 621 7.8 576 7.1 517 6.3 536 6.5 533 6.4 446 5.3 425 5.0 421 4.9 36 822 Switzerland East Tajikistan 1991 881 11.7 880 11.4 770 9.8 817 10.1 986 11.9 1 149 13.6 1 038 12.0 1 205 13.6 1 421 15.6 1 320 14.2 11 986 Tajikistan Centre Turkey 1985 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 3 248 3.9 3 229 3.9 22 467 Turkey East Turkmenistan 1990 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 2 Turkmenistan East Ukraine 1987 16 617 36.3 17 305 37.9 16 850 37.1 17 844 39.4 15 796 35.0 13 000 30.4 14 241 33.4 15 625 36.8 15 686 37.2 16 357 39.0 294 436 Ukraine East Uzbekistan 1981 3 795 13.3 – – – – – – – – – – – – – – – – – – 24 018 Uzbekistan Total non-EU/EEA 90 999 23.8 93 155 26.2 101 737 28.4 109 139 30.3 119 650 33.0 125 760 34.7 114 336 31.3 115 422 31.4 116 754 31.6 111 648 30.1 1 400 184 Total non-EU/EEA WHO European Region WHO European Region West West 30 705 7.6 30 091 7.4 31 349 7.6 30 820 7.3 31 050 7.3 30 252 7.1 28 825 6.7 27 132 6.3 24 228 5.7 21 793 5.2 673 917 West Centre Centre 2 950 1.6 3 647 1.9 4 200 2.2 4 680 2.4 5 205 2.7 5 706 2.9 5 978 3.1 6 445 3.3 6 631 3.4 6 814 3.4 95 428 Centre East East 90 061 31.8 92 016 36.1 100 100 39.1 107 317 41.8 117 317 45.6 123 187 48.1 111 410 43.4 112 200 43.6 112 910 43.7 107 842 41.7 1 345 175 East Total WHO European Region 123 716 14.1 125 754 14.8 135 649 15.8 142 817 16.4 153 572 17.5 159 145 18.2 146 213 16.6 145 777 16.5 143 769 16.3 136 449 15.6 2 114 520 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 The numbers displayed here may not fully align with the numbers in the country's national statistics as these are presented by the "date of notification" instead of the "date of diagnosis" as here. The national statistics numbers are, for 2019, 448 (Armenia ), 31 (Bosnia and Herzegovina ), 538 (Ireland) and 96 (Luxembourg). 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 59 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 363 4.3 361 4.3 365 4.3 307 3.6 304 3.6 324 3.8 291 3.3 302 3.4 199 2.3 225 2.5 10 188 Austria West Belgium 1985 1 184 10.9 1 171 10.6 1 228 11.1 1 128 10.1 1 057 9.5 1 020 9.1 909 8.0 899 7.9 882 7.7 – – 31 540 Belgium Centre Bulgaria 1986 163 2.2 201 2.7 157 2.1 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 311 4.4 258 3.7 3 316 Bulgaria Centre Croatia 1985 71 1.7 74 1.7 73 1.7 85 2.0 92 2.2 117 2.8 109 2.6 106 2.6 94 2.3 102 2.5 1 734 Croatia Centre Cyprus 1986 41 5.0 54 6.4 58 6.7 54 6.2 56 6.5 80 9.4 80 9.4 85 9.9 78 9.0 100 11.4 1 326 Cyprus Centre Czechia 1985 180 1.7 153 1.5 212 2.0 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 208 2.0 222 2.1 3 590 Czechia West Denmark 1990 275 5.0 266 4.8 201 3.6 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 219 3.8 190 3.3 8 000 Denmark East Estonia 1988 376 28.2 366 27.5 315 23.8 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 190 14.4 178 13.4 10 079 Estonia West Finland 1980 184 3.4 172 3.2 156 2.9 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 153 2.8 149 2.7 4 213 Finland West France 2003 5 559 8.6 5 426 8.4 5 680 8.7 5 572 8.5 5 691 8.6 5 313 8.0 5 444 8.2 5 388 8.1 5 078 7.6 4 923 7.3 93 688 France West Germany 1993 2 809 3.4 2 763 3.4 3 027 3.8 3 235 4.0 3 525 4.4 3 642 4.5 3 378 4.1 3 155 3.8 2 867 3.5 3 093 3.7 71 163 Germany West Greece 1984 648 5.8 966 8.7 1 161 10.5 901 8.2 779 7.1 778 7.2 649 6.0 647 6.0 723 6.7 603 5.6 16 171 Greece Centre Hungary 1985 182 1.8 162 1.6 219 2.2 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 229 2.3 238 2.4 4 034 Hungary West Iceland 1983 24 7.6 23 7.2 19 5.9 11 3.4 11 3.4 12 3.6 28 8.4 24 7.1 38 10.9 28 7.8 451 Iceland West Irelandc 1985 330 7.3 328 7.2 350 7.6 343 7.4 378 8.2 483 10.3 511 10.8 499 10.4 508 10.5 533 10.9 9 901 Irelandc West Italy 1985 4 024 6.8 3 898 6.6 4 162 7.0 3 843 6.4 3 831 6.3 3 598 5.9 3 687 6.1 3 579 5.9 3 003 5.0 2 531 4.2 49 882 Italy East Latvia 1987 274 12.9 299 14.4 339 16.6 340 16.8 350 17.5 400 20.1 369 18.7 376 19.3 328 17.0 295 15.4 7 985 Latvia – Liechtenstein 1985 4 11.1 1 2.8 0 0.0 0 0.0 1 2.7 0 0.0 2 5.3 0 0.0 0 0.0 0 0.0 67 Liechtenstein East Lithuania 1988 153 4.9 166 5.4 160 5.3 177 6.0 141 4.8 157 5.4 214 7.4 263 9.2 160 5.7 151 5.4 3 323 Lithuania West Luxembourgc 1983 65 12.9 61 11.9 70 13.3 75 14.0 89 16.2 75 13.3 81 14.1 67 11.3 57 9.5 48 7.8 1 830 Luxembourgc West Malta 2001 18 4.3 21 5.1 30 7.2 36 8.5 40 9.3 61 13.9 63 14.0 45 9.8 73 15.3 80 16.2 585 Malta West Netherlands 1980 1 277 7.7 1 233 7.4 1 167 7.0 1 132 6.7 1 001 5.9 990 5.9 891 5.2 825 4.8 691 4.0 563 3.3 28 083 Netherlands West Norway 1984 258 5.3 269 5.5 242 4.9 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 191 3.6 172 3.2 6 654 Norway Centre Poland 1985 955 2.5 1 113 2.9 1 104 2.9 1 100 2.9 1 134 3.0 1 278 3.4 1 319 3.5 1 419 3.7 1 210 3.2 1 468 3.9 25 591 Poland West Portugal 1985 1 989 18.8 1 821 17.2 1 804 17.1 1 772 16.9 1 454 13.9 1 495 14.4 1 508 14.6 1 336 13.0 1 109 10.8 778 7.6 61 433 Portugal Centre Romania 1987 590 2.9 837 4.1 940 4.7 1 019 5.1 907 4.5 884 4.4 774 3.9 796 4.1 732 3.7 690 3.6 24 990 Romania Centre Slovakia 1985 28 0.5 49 0.9 50 0.9 83 1.5 86 1.6 86 1.6 88 1.6 72 1.3 102 1.9 101 1.9 1 074 Slovakia Centre Slovenia 1985 35 1.7 56 2.7 48 2.3 47 2.3 53 2.6 52 2.5 60 2.9 40 1.9 37 1.8 34 1.6 923 Slovenia West Spain 2003 3 914 11.9 3 676 11.2 3 944 10.4 4 374 9.4 4 429 9.5 4 189 9.0 4 175 9.0 3 795 8.2 2 527 6.4 2 483 5.6 54 673 Spain West Sweden 1983 420 4.5 461 4.9 441 4.7 457 4.8 473 4.9 447 4.6 429 4.4 434 4.3 481 4.8 449 4.4 13 499 Sweden West United Kingdom 1981 6 328 10.1 6 153 9.8 6 190 9.7 5 964 9.3 6 296 9.8 6 198 9.6 5 231 8.0 4 653 7.1 4 537 6.8 4 116 6.2 164 417 United Kingdom Total EU/EEA 32 721 6.6 32 600 6.6 33 912 6.8 33 678 6.6 33 923 6.6 33 385 6.5 31 879 6.2 30 355 5.9 27 015 5.3 24 801 4.9 714 403 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 43 1.5 78 2.7 81 2.8 120 4.1 79 2.7 96 3.3 127 4.4 94 3.3 102 3.5 101 3.5 1 304 Albania West Andorra 2004 6 7.1 2 2.4 2 2.4 5 6.2 5 6.3 3 3.8 3 3.9 6 7.8 12 15.6 – – 96 Andorra East Armeniac 1988 149 5.2 183 6.4 230 8.0 239 8.2 339 11.6 296 10.1 304 10.4 355 12.1 420 14.2 446 15.1 3 785 Armeniac East Azerbaijan 1987 459 5.1 548 6.0 517 5.6 514 5.5 604 6.4 727 7.6 556 5.7 567 5.8 656 6.6 721 7.2 8 129 Azerbaijan East Belarus 1981 1 069 11.3 1 196 12.7 1 223 13.0 1 533 16.3 1 811 19.2 2 305 24.4 2 391 25.3 2 468 26.1 2 386 25.2 2 137 22.6 29 209 Belarus Centre Bosnia and Herzegovinac 1986 1 0.0 27 0.7 25 0.7 2 0.1 23 0.7 15 0.4 24 0.7 15 0.4 24 0.7 30 0.9 338 Bosnia and Herzegovinac East Georgia 1989 455 11.1 424 10.4 526 12.9 490 12.1 564 14.0 717 17.8 719 17.9 631 15.7 672 16.8 668 16.7 8 102 Georgia West Israel 1981 419 5.7 450 6.0 483 6.3 465 6.0 462 5.9 413 5.2 368 4.5 415 5.0 452 5.4 408 4.8 10 495 Israel East Kazakhstan 1987 1 982 12.2 1 997 12.1 2 004 12.0 2 131 12.5 2 342 13.5 2 475 14.1 2 898 16.3 3 014 16.7 3 215 17.5 3 673 19.8 39 439 Kazakhstan East Kyrgyzstan 1987 567 10.5 614 11.1 701 12.5 503 8.8 649 11.1 653 11.0 764 12.6 840 13.6 876 13.9 850 13.2 9 745 Kyrgyzstan West Monaco 1987 0 0.0 0 0.0 1 2.7 0 0.0 1 2.7 1 2.7 0 0.0 3 7.8 0 0.0 – – 40 Monaco Centre Montenegro 1989 15 2.4 9 1.4 13 2.1 11 1.8 20 3.2 19 3.0 34 5.4 26 4.1 23 3.7 26 4.1 303 Montenegro Centre North Macedonia 1993 5 0.2 1 0.0 15 0.7 15 0.7 30 1.4 25 1.2 30 1.4 44 2.1 45 2.2 – – 246 North Macedonia East Republic of Moldova 1987 703 17.2 721 17.7 757 18.6 706 17.3 831 20.4 818 20.1 832 20.5 835 20.6 905 22.3 922 22.8 13 679 Republic of Moldova East Russian Federation 2009 62 581 43.6 67 317 46.8 75 708 52.6 81 698 56.6 92 613 64.0 100 220 69.1 86 855 59.8 85 802 59.0 85 995 59.0 80 124 54.9 881 258 Russian Federation West San Marino 1985 6 19.2 8 25.3 5 15.6 1 3.1 3 9.1 2 6.0 2 6.0 1 3.0 3 8.9 0 0.0 93 San Marino Centre Serbia 1984 152 1.7 134 1.5 137 1.5 156 1.7 137 1.5 183 2.1 179 2.0 186 2.1 188 2.1 215 2.0 4 192 Serbia Centre Serbia excluding Kosovo1 1984 149 2.2 128 1.8 133 1.9 153 2.1 131 1.8 180 2.5 168 2.4 183 2.6 180 2.6 210 2.4 4 066 Serbia excluding Kosovo1 Centre Kosovo1 1999 3 0.1 6 0.3 4 0.2 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 8 0.4 5 0.3 126 Kosovo1 West Switzerland 1985 605 7.7 562 7.1 621 7.8 576 7.1 517 6.3 536 6.5 533 6.4 446 5.3 425 5.0 421 4.9 36 822 Switzerland East Tajikistan 1991 881 11.7 880 11.4 770 9.8 817 10.1 986 11.9 1 149 13.6 1 038 12.0 1 205 13.6 1 421 15.6 1 320 14.2 11 986 Tajikistan Centre Turkey 1985 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 3 248 3.9 3 229 3.9 22 467 Turkey East Turkmenistan 1990 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 2 Turkmenistan East Ukraine 1987 16 617 36.3 17 305 37.9 16 850 37.1 17 844 39.4 15 796 35.0 13 000 30.4 14 241 33.4 15 625 36.8 15 686 37.2 16 357 39.0 294 436 Ukraine East Uzbekistan 1981 3 795 13.3 – – – – – – – – – – – – – – – – – – 24 018 Uzbekistan Total non-EU/EEA 90 999 23.8 93 155 26.2 101 737 28.4 109 139 30.3 119 650 33.0 125 760 34.7 114 336 31.3 115 422 31.4 116 754 31.6 111 648 30.1 1 400 184 Total non-EU/EEA WHO European Region WHO European Region West West 30 705 7.6 30 091 7.4 31 349 7.6 30 820 7.3 31 050 7.3 30 252 7.1 28 825 6.7 27 132 6.3 24 228 5.7 21 793 5.2 673 917 West Centre Centre 2 950 1.6 3 647 1.9 4 200 2.2 4 680 2.4 5 205 2.7 5 706 2.9 5 978 3.1 6 445 3.3 6 631 3.4 6 814 3.4 95 428 Centre East East 90 061 31.8 92 016 36.1 100 100 39.1 107 317 41.8 117 317 45.6 123 187 48.1 111 410 43.4 112 200 43.6 112 910 43.7 107 842 41.7 1 345 175 East Total WHO European Region 123 716 14.1 125 754 14.8 135 649 15.8 142 817 16.4 153 572 17.5 159 145 18.2 146 213 16.6 145 777 16.5 143 769 16.3 136 449 15.6 2 114 520 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 The numbers displayed here may not fully align with the numbers in the country's national statistics as these are presented by the "date of notification" instead of the "date of diagnosis" as here. The national statistics numbers are, for 2019, 448 (Armenia ), 31 (Bosnia and Herzegovina ), 538 (Ireland) and 96 (Luxembourg). 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 60 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 2. New HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 296 7.3 287 7.0 292 7.1 261 6.3 241 5.8 283 6.7 244 5.7 256 5.9 170 3.9 190 4.4 7 827 Austria West Belgium 788 14.8 783 14.5 837 15.4 789 14.4 738 13.4 701 12.7 649 11.7 601 10.8 603 10.7 – – 20 073 Belgium Centre Bulgaria 132 3.7 163 4.5 123 3.4 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 276 8.1 217 6.4 2 669 Bulgaria Centre Croatia 68 3.3 63 3.0 70 3.4 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 88 4.4 97 4.9 1 541 Croatia Centre Cyprus 34 8.5 39 9.5 49 11.7 46 10.9 49 11.7 72 17.5 65 15.8 65 15.6 65 15.4 69 16.1 981 Cyprus Centre Czechia 159 3.1 139 2.7 185 3.6 211 4.1 209 4.0 248 4.8 262 5.1 231 4.4 186 3.6 193 3.7 3 093 Czechia West Denmark 201 7.3 192 7.0 146 5.3 178 6.4 196 7.0 205 7.3 191 6.7 192 6.7 170 5.9 146 5.1 5 876 Denmark East Estonia 230 37.0 226 36.5 209 33.8 200 32.5 182 29.6 167 27.2 139 22.5 146 23.6 131 21.1 113 18.1 6 742 Estonia West Finland 130 5.0 112 4.2 111 4.2 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 104 3.8 112 4.1 3 043 Finland West France 3 662 11.7 3 597 11.4 3 826 12.1 3 734 11.8 3 823 11.9 3 554 11.0 3 590 11.1 3 517 10.9 3 257 10.1 3 136 9.7 60 406 France West Germany 2 378 5.9 2 326 5.9 2 553 6.5 2 655 6.7 2 861 7.2 2 888 7.2 2 658 6.6 2 502 6.1 2 229 5.5 2 421 5.9 56 345 Germany West Greece 570 10.4 825 15.1 983 18.1 812 15.1 678 12.8 688 13.1 538 10.3 538 10.3 584 11.2 468 9.0 13 501 Greece Centre Hungary 142 3.0 122 2.6 186 3.9 192 4.1 214 4.5 196 4.2 171 3.6 148 3.2 195 4.2 208 4.4 3 115 Hungary West Iceland 17 10.6 12 7.5 13 8.1 8 5.0 9 5.5 10 6.1 22 13.2 21 12.3 24 13.5 23 12.6 328 Iceland West Ireland 241 10.7 239 10.5 252 11.1 258 11.3 274 11.9 372 16.1 396 16.9 375 15.8 399 16.7 396 16.3 5 890 Ireland West Italy 3 030 10.6 2 928 10.2 3 276 11.4 3 000 10.4 3 042 10.3 2 790 9.5 2 836 9.6 2 725 9.3 2 351 8.0 2 025 6.9 38 026 Italy East Latvia 170 17.5 196 20.7 218 23.3 203 21.9 239 26.1 269 29.5 233 25.8 244 27.2 222 25.0 180 20.3 5 401 Latvia – Liechtenstein 2 11.3 1 5.6 0 0.0 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 0 0.0 0 0.0 41 Liechtenstein East Lithuania 125 8.6 134 9.5 114 8.2 125 9.1 90 6.6 115 8.5 165 12.4 220 16.8 118 9.1 110 8.5 2 630 Lithuania West Luxembourg 46 18.4 46 18.1 50 19.1 61 22.7 57 20.7 60 21.3 62 21.4 48 16.2 41 13.6 37 12.0 1 348 Luxembourg West Malta 16 7.8 17 8.2 23 11.1 30 14.3 36 16.8 53 24.0 51 22.5 35 15.1 62 25.8 55 21.8 452 Malta West Netherlands 1 065 13.0 1 043 12.7 972 11.7 963 11.6 848 10.2 825 9.9 763 9.1 701 8.3 581 6.8 456 5.3 22 508 Netherlands West Norway 173 7.1 190 7.7 166 6.6 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 122 4.6 112 4.2 4 508 Norway Centre Poland 712 3.9 914 5.0 924 5.0 937 5.1 933 5.1 1 084 5.9 1 150 6.3 1 256 6.8 1 049 5.7 1 249 6.8 20 291 Poland West Portugal 1 329 26.2 1 266 25.1 1 267 25.2 1 254 25.1 1 043 21.0 1 102 22.4 1 087 22.2 963 19.7 791 16.3 539 11.1 44 288 Portugal Centre Romania 365 3.7 578 5.9 685 7.0 720 7.4 636 6.5 647 6.7 564 5.8 593 6.2 546 5.7 523 5.5 15 186 Romania Centre Slovakia 25 1.0 46 1.8 44 1.7 71 2.7 75 2.8 76 2.9 81 3.1 66 2.5 94 3.5 91 3.4 944 Slovakia Centre Slovenia 31 3.1 49 4.8 45 4.4 41 4.0 48 4.7 45 4.4 58 5.7 38 3.7 36 3.5 28 2.7 816 Slovenia West Spain 3 218 19.9 3 035 18.8 3 334 18.0 3 743 16.3 3 782 16.6 3 609 15.8 3 540 15.5 3 228 14.1 2 147 11.2 2 126 9.8 45 197 Spain West Sweden 250 5.4 291 6.2 265 5.6 293 6.1 273 5.7 276 5.7 269 5.5 273 5.4 306 6.0 288 5.6 9 032 Sweden West United Kingdom 4 318 14.1 4 399 14.2 4 490 14.4 4 493 14.3 4 707 14.9 4 712 14.8 3 973 12.3 3 451 10.6 3 360 10.3 2 980 9.1 116 031 United Kingdom Total EU/EEA 23 923 9.9 24 258 10.1 25 708 10.5 25 776 10.4 25 905 10.4 25 628 10.2 24 310 9.6 23 008 9.1 20 307 8.1 18 588 7.5 518 129 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 28 1.9 55 3.7 58 3.9 82 5.6 61 4.1 67 4.6 104 7.1 69 4.7 76 5.2 74 5.0 948 Albania West Andorra 6 14.4 2 4.8 2 4.9 4 10.1 5 12.8 3 7.8 3 7.9 3 7.9 8 21.1 – – 78 Andorra East Armenia 98 7.3 116 8.6 160 11.8 162 11.9 221 16.2 207 15.1 212 15.4 252 18.2 284 20.5 312 22.4 2 626 Armenia East Azerbaijan 365 8.2 410 9.0 356 7.7 329 7.1 375 7.9 495 10.3 355 7.3 359 7.3 437 8.8 474 9.5 5 847 Azerbaijan East Belarus 563 12.9 621 14.2 659 15.1 802 18.3 1 052 24.0 1 395 31.8 1 490 33.9 1 540 35.0 1 499 34.1 1 354 30.8 17 671 Belarus Centre Bosnia and Herzegovina 1 0.1 23 1.3 23 1.3 2 0.1 20 1.2 14 0.8 22 1.3 15 0.9 22 1.4 27 1.7 289 Bosnia and Herzegovina East Georgia 322 16.5 300 15.4 381 19.7 367 19.0 413 21.4 545 28.4 553 28.8 492 25.7 506 26.5 508 26.7 6 048 Georgia West Israel 288 7.9 298 8.1 353 9.4 347 9.1 330 8.5 292 7.4 257 6.4 297 7.3 297 7.1 268 6.3 6 950 Israel East Kazakhstan 1 252 15.9 1 206 15.1 1 167 14.4 1 203 14.6 1 334 15.9 1 442 16.9 1 684 19.5 1 822 20.8 2 005 22.6 2 416 26.8 25 481 Kazakhstan East Kyrgyzstan 399 14.9 422 15.5 406 14.6 292 10.3 369 12.8 364 12.3 446 14.8 491 16.0 0 0.0 496 15.6 5 666 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.5 1 5.5 0 0.0 3 16.1 0 0.0 – – 26 Monaco Centre Montenegro 15 4.9 8 2.6 12 3.9 11 3.6 17 5.5 17 5.5 32 10.3 25 8.1 21 6.8 24 7.7 266 Montenegro Centre North Macedonia 5 0.5 0 0.0 10 1.0 15 1.4 29 2.8 24 2.3 28 2.7 44 4.2 45 4.3 – – 221 North Macedonia East Republic of Moldova 341 17.4 377 19.2 375 19.1 382 19.5 452 23.1 462 23.6 471 24.1 468 24.0 537 27.6 544 28.1 7 917 Republic of Moldova East Russian Federation 36 172 54.4 39 410 59.2 44 066 66.0 48 025 71.8 55 469 82.8 62 118 92.5 53 689 79.8 53 209 78.9 52 720 78.1 49 177 72.7 529 594 Russian Federation West San Marino 6 39.7 6 39.1 2 12.9 0 0.0 3 18.8 2 12.4 2 12.3 1 6.1 2 12.2 0 0.0 73 San Marino Centre Serbia 135 3.1 116 2.6 124 2.8 142 3.3 120 2.8 177 4.1 164 3.8 175 4.1 174 4.0 196 3.8 3 425 Serbia Centre Serbia excluding Kosovo1 133 4.0 111 3.2 121 3.5 140 4.0 114 3.3 175 5.1 153 4.4 172 5.0 167 4.9 192 4.5 3 331 Serbia excluding Kosovo1 Centre Kosovo1 2 0.2 5 0.6 3 0.3 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 7 0.8 4 0.5 94 Kosovo1 West Switzerland 444 11.5 424 10.9 462 11.7 421 10.5 385 9.5 408 9.9 413 10.0 343 8.2 332 7.9 326 7.7 23 587 Switzerland East Tajikistan 693 18.2 608 15.7 495 12.5 490 12.0 557 13.4 679 15.9 621 14.2 735 16.4 878 19.1 772 16.4 7 700 Tajikistan Centre Turkey 350 1.0 531 1.5 819 2.2 1 072 2.9 1 497 3.9 1 770 4.6 2 065 5.3 2 389 6.0 2 717 6.7 2 748 6.7 18 098 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 9 521 45.0 9 472 45.0 9 400 44.8 10 011 47.8 8 991 43.1 7 519 32.7 8 374 42.5 9 312 47.4 9 543 48.8 9 982 51.3 175 285 Ukraine East Uzbekistan 2 062 14.5 – – – – – – – – – – – – – – – – – – 16 234 Uzbekistan Total non-EU/EEA 53 066 29.1 54 405 32.3 59 330 34.8 64 159 37.4 71 701 41.5 78 001 44.3 70 985 40.8 72 044 41.2 72 103 41.7 69 698 39.4 854 031 Total non-EU/EEA WHO European Region WHO European Region West West 22 472 11.4 22 318 11.3 23 675 11.8 23 564 11.4 23 669 11.4 23 110 11.1 21 822 10.4 20 329 9.6 17 940 8.6 16 104 7.8 485 393 West Centre Centre 2 202 2.4 2 846 3.1 3 357 3.6 3 780 4.0 4 192 4.4 4 742 5.0 5 039 5.3 5 433 5.6 5 590 5.8 5 744 5.9 71 883 Centre East East 52 313 39.2 53 498 44.8 58 006 48.4 62 591 52.1 69 744 57.8 75 777 61.5 68 432 56.8 69 290 57.4 68 880 58.4 66 438 54.7 814 843 East Total WHO European Region 76 987 18.2 78 662 19.2 85 038 20.5 89 935 21.4 97 605 23.1 103 629 24.3 95 293 22.4 95 052 22.2 92 410 21.9 88 286 20.8 1 372 119 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 61 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 2. New HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 296 7.3 287 7.0 292 7.1 261 6.3 241 5.8 283 6.7 244 5.7 256 5.9 170 3.9 190 4.4 7 827 Austria West Belgium 788 14.8 783 14.5 837 15.4 789 14.4 738 13.4 701 12.7 649 11.7 601 10.8 603 10.7 – – 20 073 Belgium Centre Bulgaria 132 3.7 163 4.5 123 3.4 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 276 8.1 217 6.4 2 669 Bulgaria Centre Croatia 68 3.3 63 3.0 70 3.4 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 88 4.4 97 4.9 1 541 Croatia Centre Cyprus 34 8.5 39 9.5 49 11.7 46 10.9 49 11.7 72 17.5 65 15.8 65 15.6 65 15.4 69 16.1 981 Cyprus Centre Czechia 159 3.1 139 2.7 185 3.6 211 4.1 209 4.0 248 4.8 262 5.1 231 4.4 186 3.6 193 3.7 3 093 Czechia West Denmark 201 7.3 192 7.0 146 5.3 178 6.4 196 7.0 205 7.3 191 6.7 192 6.7 170 5.9 146 5.1 5 876 Denmark East Estonia 230 37.0 226 36.5 209 33.8 200 32.5 182 29.6 167 27.2 139 22.5 146 23.6 131 21.1 113 18.1 6 742 Estonia West Finland 130 5.0 112 4.2 111 4.2 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 104 3.8 112 4.1 3 043 Finland West France 3 662 11.7 3 597 11.4 3 826 12.1 3 734 11.8 3 823 11.9 3 554 11.0 3 590 11.1 3 517 10.9 3 257 10.1 3 136 9.7 60 406 France West Germany 2 378 5.9 2 326 5.9 2 553 6.5 2 655 6.7 2 861 7.2 2 888 7.2 2 658 6.6 2 502 6.1 2 229 5.5 2 421 5.9 56 345 Germany West Greece 570 10.4 825 15.1 983 18.1 812 15.1 678 12.8 688 13.1 538 10.3 538 10.3 584 11.2 468 9.0 13 501 Greece Centre Hungary 142 3.0 122 2.6 186 3.9 192 4.1 214 4.5 196 4.2 171 3.6 148 3.2 195 4.2 208 4.4 3 115 Hungary West Iceland 17 10.6 12 7.5 13 8.1 8 5.0 9 5.5 10 6.1 22 13.2 21 12.3 24 13.5 23 12.6 328 Iceland West Ireland 241 10.7 239 10.5 252 11.1 258 11.3 274 11.9 372 16.1 396 16.9 375 15.8 399 16.7 396 16.3 5 890 Ireland West Italy 3 030 10.6 2 928 10.2 3 276 11.4 3 000 10.4 3 042 10.3 2 790 9.5 2 836 9.6 2 725 9.3 2 351 8.0 2 025 6.9 38 026 Italy East Latvia 170 17.5 196 20.7 218 23.3 203 21.9 239 26.1 269 29.5 233 25.8 244 27.2 222 25.0 180 20.3 5 401 Latvia – Liechtenstein 2 11.3 1 5.6 0 0.0 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 0 0.0 0 0.0 41 Liechtenstein East Lithuania 125 8.6 134 9.5 114 8.2 125 9.1 90 6.6 115 8.5 165 12.4 220 16.8 118 9.1 110 8.5 2 630 Lithuania West Luxembourg 46 18.4 46 18.1 50 19.1 61 22.7 57 20.7 60 21.3 62 21.4 48 16.2 41 13.6 37 12.0 1 348 Luxembourg West Malta 16 7.8 17 8.2 23 11.1 30 14.3 36 16.8 53 24.0 51 22.5 35 15.1 62 25.8 55 21.8 452 Malta West Netherlands 1 065 13.0 1 043 12.7 972 11.7 963 11.6 848 10.2 825 9.9 763 9.1 701 8.3 581 6.8 456 5.3 22 508 Netherlands West Norway 173 7.1 190 7.7 166 6.6 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 122 4.6 112 4.2 4 508 Norway Centre Poland 712 3.9 914 5.0 924 5.0 937 5.1 933 5.1 1 084 5.9 1 150 6.3 1 256 6.8 1 049 5.7 1 249 6.8 20 291 Poland West Portugal 1 329 26.2 1 266 25.1 1 267 25.2 1 254 25.1 1 043 21.0 1 102 22.4 1 087 22.2 963 19.7 791 16.3 539 11.1 44 288 Portugal Centre Romania 365 3.7 578 5.9 685 7.0 720 7.4 636 6.5 647 6.7 564 5.8 593 6.2 546 5.7 523 5.5 15 186 Romania Centre Slovakia 25 1.0 46 1.8 44 1.7 71 2.7 75 2.8 76 2.9 81 3.1 66 2.5 94 3.5 91 3.4 944 Slovakia Centre Slovenia 31 3.1 49 4.8 45 4.4 41 4.0 48 4.7 45 4.4 58 5.7 38 3.7 36 3.5 28 2.7 816 Slovenia West Spain 3 218 19.9 3 035 18.8 3 334 18.0 3 743 16.3 3 782 16.6 3 609 15.8 3 540 15.5 3 228 14.1 2 147 11.2 2 126 9.8 45 197 Spain West Sweden 250 5.4 291 6.2 265 5.6 293 6.1 273 5.7 276 5.7 269 5.5 273 5.4 306 6.0 288 5.6 9 032 Sweden West United Kingdom 4 318 14.1 4 399 14.2 4 490 14.4 4 493 14.3 4 707 14.9 4 712 14.8 3 973 12.3 3 451 10.6 3 360 10.3 2 980 9.1 116 031 United Kingdom Total EU/EEA 23 923 9.9 24 258 10.1 25 708 10.5 25 776 10.4 25 905 10.4 25 628 10.2 24 310 9.6 23 008 9.1 20 307 8.1 18 588 7.5 518 129 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 28 1.9 55 3.7 58 3.9 82 5.6 61 4.1 67 4.6 104 7.1 69 4.7 76 5.2 74 5.0 948 Albania West Andorra 6 14.4 2 4.8 2 4.9 4 10.1 5 12.8 3 7.8 3 7.9 3 7.9 8 21.1 – – 78 Andorra East Armenia 98 7.3 116 8.6 160 11.8 162 11.9 221 16.2 207 15.1 212 15.4 252 18.2 284 20.5 312 22.4 2 626 Armenia East Azerbaijan 365 8.2 410 9.0 356 7.7 329 7.1 375 7.9 495 10.3 355 7.3 359 7.3 437 8.8 474 9.5 5 847 Azerbaijan East Belarus 563 12.9 621 14.2 659 15.1 802 18.3 1 052 24.0 1 395 31.8 1 490 33.9 1 540 35.0 1 499 34.1 1 354 30.8 17 671 Belarus Centre Bosnia and Herzegovina 1 0.1 23 1.3 23 1.3 2 0.1 20 1.2 14 0.8 22 1.3 15 0.9 22 1.4 27 1.7 289 Bosnia and Herzegovina East Georgia 322 16.5 300 15.4 381 19.7 367 19.0 413 21.4 545 28.4 553 28.8 492 25.7 506 26.5 508 26.7 6 048 Georgia West Israel 288 7.9 298 8.1 353 9.4 347 9.1 330 8.5 292 7.4 257 6.4 297 7.3 297 7.1 268 6.3 6 950 Israel East Kazakhstan 1 252 15.9 1 206 15.1 1 167 14.4 1 203 14.6 1 334 15.9 1 442 16.9 1 684 19.5 1 822 20.8 2 005 22.6 2 416 26.8 25 481 Kazakhstan East Kyrgyzstan 399 14.9 422 15.5 406 14.6 292 10.3 369 12.8 364 12.3 446 14.8 491 16.0 0 0.0 496 15.6 5 666 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.5 1 5.5 0 0.0 3 16.1 0 0.0 – – 26 Monaco Centre Montenegro 15 4.9 8 2.6 12 3.9 11 3.6 17 5.5 17 5.5 32 10.3 25 8.1 21 6.8 24 7.7 266 Montenegro Centre North Macedonia 5 0.5 0 0.0 10 1.0 15 1.4 29 2.8 24 2.3 28 2.7 44 4.2 45 4.3 – – 221 North Macedonia East Republic of Moldova 341 17.4 377 19.2 375 19.1 382 19.5 452 23.1 462 23.6 471 24.1 468 24.0 537 27.6 544 28.1 7 917 Republic of Moldova East Russian Federation 36 172 54.4 39 410 59.2 44 066 66.0 48 025 71.8 55 469 82.8 62 118 92.5 53 689 79.8 53 209 78.9 52 720 78.1 49 177 72.7 529 594 Russian Federation West San Marino 6 39.7 6 39.1 2 12.9 0 0.0 3 18.8 2 12.4 2 12.3 1 6.1 2 12.2 0 0.0 73 San Marino Centre Serbia 135 3.1 116 2.6 124 2.8 142 3.3 120 2.8 177 4.1 164 3.8 175 4.1 174 4.0 196 3.8 3 425 Serbia Centre Serbia excluding Kosovo1 133 4.0 111 3.2 121 3.5 140 4.0 114 3.3 175 5.1 153 4.4 172 5.0 167 4.9 192 4.5 3 331 Serbia excluding Kosovo1 Centre Kosovo1 2 0.2 5 0.6 3 0.3 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 7 0.8 4 0.5 94 Kosovo1 West Switzerland 444 11.5 424 10.9 462 11.7 421 10.5 385 9.5 408 9.9 413 10.0 343 8.2 332 7.9 326 7.7 23 587 Switzerland East Tajikistan 693 18.2 608 15.7 495 12.5 490 12.0 557 13.4 679 15.9 621 14.2 735 16.4 878 19.1 772 16.4 7 700 Tajikistan Centre Turkey 350 1.0 531 1.5 819 2.2 1 072 2.9 1 497 3.9 1 770 4.6 2 065 5.3 2 389 6.0 2 717 6.7 2 748 6.7 18 098 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 9 521 45.0 9 472 45.0 9 400 44.8 10 011 47.8 8 991 43.1 7 519 32.7 8 374 42.5 9 312 47.4 9 543 48.8 9 982 51.3 175 285 Ukraine East Uzbekistan 2 062 14.5 – – – – – – – – – – – – – – – – – – 16 234 Uzbekistan Total non-EU/EEA 53 066 29.1 54 405 32.3 59 330 34.8 64 159 37.4 71 701 41.5 78 001 44.3 70 985 40.8 72 044 41.2 72 103 41.7 69 698 39.4 854 031 Total non-EU/EEA WHO European Region WHO European Region West West 22 472 11.4 22 318 11.3 23 675 11.8 23 564 11.4 23 669 11.4 23 110 11.1 21 822 10.4 20 329 9.6 17 940 8.6 16 104 7.8 485 393 West Centre Centre 2 202 2.4 2 846 3.1 3 357 3.6 3 780 4.0 4 192 4.4 4 742 5.0 5 039 5.3 5 433 5.6 5 590 5.8 5 744 5.9 71 883 Centre East East 52 313 39.2 53 498 44.8 58 006 48.4 62 591 52.1 69 744 57.8 75 777 61.5 68 432 56.8 69 290 57.4 68 880 58.4 66 438 54.7 814 843 East Total WHO European Region 76 987 18.2 78 662 19.2 85 038 20.5 89 935 21.4 97 605 23.1 103 629 24.3 95 293 22.4 95 052 22.2 92 410 21.9 88 286 20.8 1 372 119 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 62 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 3. New HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 67 1.6 74 1.7 73 1.7 46 1.1 63 1.4 41 0.9 47 1.1 46 1.0 29 0.6 35 0.8 2 361 Austria West Belgium 394 7.1 388 6.9 389 6.9 339 6.0 317 5.6 314 5.5 258 4.5 284 4.9 270 4.7 – – 11 125 Belgium Centre Bulgaria 31 0.8 38 1.0 34 0.9 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 35 1.0 41 1.1 647 Bulgaria Centre Croatia 3 0.1 11 0.5 3 0.1 8 0.4 9 0.4 6 0.3 5 0.2 5 0.2 6 0.3 5 0.2 193 Croatia Centre Cyprus 7 1.7 15 3.5 9 2.0 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 13 2.9 31 6.9 345 Cyprus Centre Czechia 21 0.4 14 0.3 27 0.5 24 0.4 23 0.4 18 0.3 24 0.4 23 0.4 22 0.4 29 0.5 497 Czechia West Denmark 74 2.7 74 2.6 54 1.9 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 49 1.7 44 1.5 2 123 Denmark East Estonia 146 20.5 140 19.7 106 15.0 125 17.8 109 15.6 103 14.7 90 12.9 73 10.5 59 8.5 65 9.3 3 325 Estonia West Finland 54 2.0 60 2.2 45 1.6 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 49 1.8 37 1.3 1 170 Finland West France 1 884 5.6 1 826 5.4 1 832 5.4 1 815 5.4 1 841 5.4 1 719 5.0 1 810 5.3 1 808 5.2 1 758 5.1 1 719 5.0 32 834 France West Germany 424 1.0 431 1.0 472 1.1 578 1.4 662 1.6 751 1.8 716 1.7 648 1.5 630 1.5 669 1.6 14 014 Germany West Greece 78 1.4 141 2.5 178 3.1 89 1.6 101 1.8 90 1.6 111 2.0 109 2.0 139 2.5 135 2.4 2 663 Greece Centre Hungary 9 0.2 12 0.2 14 0.3 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 8 0.2 16 0.3 385 Hungary West Iceland 7 4.4 11 6.9 6 3.8 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 14 8.2 5 2.9 123 Iceland West Ireland 89 3.9 89 3.9 98 4.2 85 3.7 104 4.4 110 4.7 115 4.8 121 5.0 104 4.3 134 5.4 2 796 Ireland West Italy 990 3.3 970 3.2 886 2.9 843 2.7 789 2.5 808 2.6 851 2.7 854 2.7 652 2.1 506 1.6 11 852 Italy East Latvia 104 9.0 103 9.1 121 10.9 137 12.5 111 10.2 131 12.2 136 12.8 132 12.5 106 10.1 115 11.1 2 584 Latvia – Liechtenstein 2 11.0 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 23 Liechtenstein East Lithuania 28 1.7 32 1.9 46 2.8 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 42 2.8 41 2.7 693 Lithuania West Luxembourg 19 7.5 15 5.8 18 6.8 14 5.2 32 11.7 15 5.3 19 6.6 19 6.5 16 5.3 11 3.6 477 Luxembourg West Malta 2 1.0 4 1.9 7 3.3 6 2.8 4 1.9 8 3.6 11 4.9 10 4.4 11 4.7 15 6.2 122 Malta West Netherlands 203 2.4 181 2.2 187 2.2 157 1.9 147 1.7 149 1.7 125 1.5 115 1.3 96 1.1 93 1.1 5 396 Netherlands West Norway 85 3.5 79 3.2 76 3.1 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 69 2.6 60 2.3 2 146 Norway Centre Poland 156 0.8 159 0.8 159 0.8 150 0.8 188 1.0 175 0.9 142 0.7 160 0.8 151 0.8 212 1.1 4 664 Poland West Portugal 660 12.0 555 10.1 537 9.7 518 9.4 411 7.5 393 7.2 421 7.7 373 6.9 318 5.9 239 4.4 17 137 Portugal Centre Romania 225 2.2 259 2.5 255 2.5 299 2.9 271 2.7 237 2.3 210 2.1 203 2.0 186 1.9 167 1.7 9 804 Romania Centre Slovakia 3 0.1 3 0.1 6 0.2 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 8 0.3 10 0.4 130 Slovakia Centre Slovenia 4 0.4 7 0.7 3 0.3 6 0.6 4 0.4 7 0.7 2 0.2 2 0.2 1 0.1 6 0.6 106 Slovenia West Spain 696 4.2 641 3.8 610 3.2 631 2.7 647 2.7 580 2.5 635 2.7 567 2.4 380 1.9 357 1.6 9 476 Spain West Sweden 170 3.6 169 3.6 175 3.7 163 3.4 198 4.1 171 3.5 160 3.3 161 3.2 175 3.5 161 3.2 4 458 Sweden West United Kingdom 2 010 6.3 1 754 5.5 1 700 5.3 1 471 4.5 1 589 4.9 1 461 4.4 1 236 3.7 1 177 3.5 1 161 3.5 1 128 3.3 48 290 United Kingdom Total EU/EEA 8 645 3.4 8 255 3.3 8 126 3.2 7 820 3.0 7 928 3.0 7 599 2.9 7 430 2.8 7 168 2.7 6 557 2.5 6 086 2.4 191 959 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 15 1.0 23 1.6 23 1.6 38 2.7 18 1.3 29 2.0 23 1.6 25 1.8 26 1.8 27 1.9 356 Albania West Andorra 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 0 0.0 0 0.0 3 7.7 4 10.2 – – 18 Andorra East Armenia 51 3.3 67 4.4 70 4.6 77 5.0 118 7.6 89 5.7 92 5.9 103 6.6 136 8.7 134 8.6 1 159 Armenia East Azerbaijan 94 2.1 138 3.0 161 3.5 185 3.9 229 4.8 232 4.8 201 4.1 208 4.2 219 4.4 247 4.9 2 282 Azerbaijan East Belarus 506 10.0 575 11.4 564 11.2 731 14.5 759 15.0 910 18.0 901 17.8 928 18.4 887 17.6 783 15.5 11 538 Belarus Centre Bosnia and Herzegovina 0 0.0 4 0.2 2 0.1 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 2 0.1 3 0.2 46 Bosnia and Herzegovina East Georgia 133 6.2 124 5.8 145 6.8 123 5.8 151 7.2 172 8.2 166 7.9 139 6.6 166 7.9 160 7.7 2 054 Georgia West Israel 131 3.5 152 4.0 130 3.4 116 3.0 130 3.3 121 3.0 109 2.7 117 2.8 153 3.6 140 3.3 3 430 Israel East Kazakhstan 730 8.7 791 9.3 837 9.7 928 10.6 1 008 11.3 1 033 11.4 1 214 13.2 1 192 12.8 1 210 12.8 1 257 13.2 13 958 Kazakhstan East Kyrgyzstan 168 6.1 192 6.9 295 10.4 211 7.3 280 9.5 289 9.6 318 10.4 349 11.2 333 10.5 354 10.9 3 467 Kyrgyzstan West Monaco 0 0.0 0 0.0 1 5.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – 14 Monaco Centre Montenegro 0 0.0 1 0.3 1 0.3 0 0.0 3 0.9 2 0.6 2 0.6 1 0.3 2 0.6 2 0.6 37 Montenegro Centre North Macedonia 0 0.0 0 0.0 4 0.4 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 0 0.0 – – 18 North Macedonia East Republic of Moldova 362 17.1 344 16.2 382 18.1 324 15.3 379 17.9 356 16.8 361 17.1 367 17.4 368 17.5 378 18.0 5 762 Republic of Moldova East Russian Federation 26 409 34.3 27 907 36.2 31 642 41.0 33 673 43.5 37 144 47.8 38 102 49.0 33 166 42.5 32 593 41.7 33 275 42.5 30 947 39.5 351 664 Russian Federation West San Marino 0 0.0 2 12.2 3 18.1 1 6.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.8 0 0.0 20 San Marino Centre Serbia 17 0.4 18 0.4 13 0.3 14 0.3 17 0.4 6 0.1 15 0.3 11 0.2 14 0.3 19 0.4 767 Serbia Centre Serbia excluding Kosovo1 16 0.5 17 0.5 12 0.3 13 0.4 17 0.5 5 0.1 15 0.4 11 0.3 13 0.4 18 0.4 735 Serbia excluding Kosovo1 Centre Kosovo1 1 0.1 1 0.1 1 0.1 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 32 Kosovo1 West Switzerland 160 4.0 132 3.3 150 3.7 151 3.7 124 3.0 122 2.9 113 2.7 100 2.3 88 2.0 88 2.0 10 495 Switzerland East Tajikistan 188 5.0 272 7.1 275 7.1 327 8.2 429 10.5 470 11.2 417 9.7 470 10.7 543 12.0 548 11.9 4 286 Tajikistan Centre Turkey 139 0.4 166 0.4 249 0.7 241 0.6 341 0.9 337 0.8 373 0.9 455 1.1 531 1.3 481 1.1 4 367 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 6 915 28.0 7 697 31.3 7 301 29.8 7 722 31.7 6 683 27.6 5 481 27.7 5 867 25.7 6 313 27.7 6 143 27.1 6 375 28.3 117 243 Ukraine East Uzbekistan 1 733 12.1 – – – – – – – – – – – – – – – – 7 783 Uzbekistan Total non-EU/EEA 37 751 19.2 38 605 20.8 42 248 22.5 44 863 24.2 47 816 25.4 47 753 25.6 43 341 22.8 43 374 23.0 44 101 23.0 41 943 21.7 540 765 Total non-EU/EEA WHO European Region WHO European Region West West 8 197 4.0 7 748 3.7 7 627 3.6 7 212 3.3 7 332 3.4 7 046 3.2 6 918 3.2 6 680 3.0 6 166 2.9 5 576 2.6 182 540 West Centre Centre 630 0.7 730 0.8 802 0.8 856 0.9 961 1.0 896 0.9 875 0.9 952 1.0 1 005 1.0 1 049 1.0 22 362 Centre East East 37 567 25.1 38 382 28.3 41 945 30.8 44 615 32.7 47 451 34.7 47 410 35.7 42 978 31.5 42 910 31.4 43 487 31.7 41 404 30.2 527 799 East Total WHO European Region 46 394 10.3 46 860 10.7 50 374 11.3 52 683 11.8 55 744 12.4 55 352 12.3 50 771 11.2 50 542 11.2 50 658 11.2 48 029 10.6 732 701 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 63 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 3. New HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 67 1.6 74 1.7 73 1.7 46 1.1 63 1.4 41 0.9 47 1.1 46 1.0 29 0.6 35 0.8 2 361 Austria West Belgium 394 7.1 388 6.9 389 6.9 339 6.0 317 5.6 314 5.5 258 4.5 284 4.9 270 4.7 – – 11 125 Belgium Centre Bulgaria 31 0.8 38 1.0 34 0.9 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 35 1.0 41 1.1 647 Bulgaria Centre Croatia 3 0.1 11 0.5 3 0.1 8 0.4 9 0.4 6 0.3 5 0.2 5 0.2 6 0.3 5 0.2 193 Croatia Centre Cyprus 7 1.7 15 3.5 9 2.0 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 13 2.9 31 6.9 345 Cyprus Centre Czechia 21 0.4 14 0.3 27 0.5 24 0.4 23 0.4 18 0.3 24 0.4 23 0.4 22 0.4 29 0.5 497 Czechia West Denmark 74 2.7 74 2.6 54 1.9 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 49 1.7 44 1.5 2 123 Denmark East Estonia 146 20.5 140 19.7 106 15.0 125 17.8 109 15.6 103 14.7 90 12.9 73 10.5 59 8.5 65 9.3 3 325 Estonia West Finland 54 2.0 60 2.2 45 1.6 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 49 1.8 37 1.3 1 170 Finland West France 1 884 5.6 1 826 5.4 1 832 5.4 1 815 5.4 1 841 5.4 1 719 5.0 1 810 5.3 1 808 5.2 1 758 5.1 1 719 5.0 32 834 France West Germany 424 1.0 431 1.0 472 1.1 578 1.4 662 1.6 751 1.8 716 1.7 648 1.5 630 1.5 669 1.6 14 014 Germany West Greece 78 1.4 141 2.5 178 3.1 89 1.6 101 1.8 90 1.6 111 2.0 109 2.0 139 2.5 135 2.4 2 663 Greece Centre Hungary 9 0.2 12 0.2 14 0.3 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 8 0.2 16 0.3 385 Hungary West Iceland 7 4.4 11 6.9 6 3.8 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 14 8.2 5 2.9 123 Iceland West Ireland 89 3.9 89 3.9 98 4.2 85 3.7 104 4.4 110 4.7 115 4.8 121 5.0 104 4.3 134 5.4 2 796 Ireland West Italy 990 3.3 970 3.2 886 2.9 843 2.7 789 2.5 808 2.6 851 2.7 854 2.7 652 2.1 506 1.6 11 852 Italy East Latvia 104 9.0 103 9.1 121 10.9 137 12.5 111 10.2 131 12.2 136 12.8 132 12.5 106 10.1 115 11.1 2 584 Latvia – Liechtenstein 2 11.0 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 23 Liechtenstein East Lithuania 28 1.7 32 1.9 46 2.8 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 42 2.8 41 2.7 693 Lithuania West Luxembourg 19 7.5 15 5.8 18 6.8 14 5.2 32 11.7 15 5.3 19 6.6 19 6.5 16 5.3 11 3.6 477 Luxembourg West Malta 2 1.0 4 1.9 7 3.3 6 2.8 4 1.9 8 3.6 11 4.9 10 4.4 11 4.7 15 6.2 122 Malta West Netherlands 203 2.4 181 2.2 187 2.2 157 1.9 147 1.7 149 1.7 125 1.5 115 1.3 96 1.1 93 1.1 5 396 Netherlands West Norway 85 3.5 79 3.2 76 3.1 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 69 2.6 60 2.3 2 146 Norway Centre Poland 156 0.8 159 0.8 159 0.8 150 0.8 188 1.0 175 0.9 142 0.7 160 0.8 151 0.8 212 1.1 4 664 Poland West Portugal 660 12.0 555 10.1 537 9.7 518 9.4 411 7.5 393 7.2 421 7.7 373 6.9 318 5.9 239 4.4 17 137 Portugal Centre Romania 225 2.2 259 2.5 255 2.5 299 2.9 271 2.7 237 2.3 210 2.1 203 2.0 186 1.9 167 1.7 9 804 Romania Centre Slovakia 3 0.1 3 0.1 6 0.2 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 8 0.3 10 0.4 130 Slovakia Centre Slovenia 4 0.4 7 0.7 3 0.3 6 0.6 4 0.4 7 0.7 2 0.2 2 0.2 1 0.1 6 0.6 106 Slovenia West Spain 696 4.2 641 3.8 610 3.2 631 2.7 647 2.7 580 2.5 635 2.7 567 2.4 380 1.9 357 1.6 9 476 Spain West Sweden 170 3.6 169 3.6 175 3.7 163 3.4 198 4.1 171 3.5 160 3.3 161 3.2 175 3.5 161 3.2 4 458 Sweden West United Kingdom 2 010 6.3 1 754 5.5 1 700 5.3 1 471 4.5 1 589 4.9 1 461 4.4 1 236 3.7 1 177 3.5 1 161 3.5 1 128 3.3 48 290 United Kingdom Total EU/EEA 8 645 3.4 8 255 3.3 8 126 3.2 7 820 3.0 7 928 3.0 7 599 2.9 7 430 2.8 7 168 2.7 6 557 2.5 6 086 2.4 191 959 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 15 1.0 23 1.6 23 1.6 38 2.7 18 1.3 29 2.0 23 1.6 25 1.8 26 1.8 27 1.9 356 Albania West Andorra 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 0 0.0 0 0.0 3 7.7 4 10.2 – – 18 Andorra East Armenia 51 3.3 67 4.4 70 4.6 77 5.0 118 7.6 89 5.7 92 5.9 103 6.6 136 8.7 134 8.6 1 159 Armenia East Azerbaijan 94 2.1 138 3.0 161 3.5 185 3.9 229 4.8 232 4.8 201 4.1 208 4.2 219 4.4 247 4.9 2 282 Azerbaijan East Belarus 506 10.0 575 11.4 564 11.2 731 14.5 759 15.0 910 18.0 901 17.8 928 18.4 887 17.6 783 15.5 11 538 Belarus Centre Bosnia and Herzegovina 0 0.0 4 0.2 2 0.1 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 2 0.1 3 0.2 46 Bosnia and Herzegovina East Georgia 133 6.2 124 5.8 145 6.8 123 5.8 151 7.2 172 8.2 166 7.9 139 6.6 166 7.9 160 7.7 2 054 Georgia West Israel 131 3.5 152 4.0 130 3.4 116 3.0 130 3.3 121 3.0 109 2.7 117 2.8 153 3.6 140 3.3 3 430 Israel East Kazakhstan 730 8.7 791 9.3 837 9.7 928 10.6 1 008 11.3 1 033 11.4 1 214 13.2 1 192 12.8 1 210 12.8 1 257 13.2 13 958 Kazakhstan East Kyrgyzstan 168 6.1 192 6.9 295 10.4 211 7.3 280 9.5 289 9.6 318 10.4 349 11.2 333 10.5 354 10.9 3 467 Kyrgyzstan West Monaco 0 0.0 0 0.0 1 5.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 – – 14 Monaco Centre Montenegro 0 0.0 1 0.3 1 0.3 0 0.0 3 0.9 2 0.6 2 0.6 1 0.3 2 0.6 2 0.6 37 Montenegro Centre North Macedonia 0 0.0 0 0.0 4 0.4 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 0 0.0 – – 18 North Macedonia East Republic of Moldova 362 17.1 344 16.2 382 18.1 324 15.3 379 17.9 356 16.8 361 17.1 367 17.4 368 17.5 378 18.0 5 762 Republic of Moldova East Russian Federation 26 409 34.3 27 907 36.2 31 642 41.0 33 673 43.5 37 144 47.8 38 102 49.0 33 166 42.5 32 593 41.7 33 275 42.5 30 947 39.5 351 664 Russian Federation West San Marino 0 0.0 2 12.2 3 18.1 1 6.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.8 0 0.0 20 San Marino Centre Serbia 17 0.4 18 0.4 13 0.3 14 0.3 17 0.4 6 0.1 15 0.3 11 0.2 14 0.3 19 0.4 767 Serbia Centre Serbia excluding Kosovo1 16 0.5 17 0.5 12 0.3 13 0.4 17 0.5 5 0.1 15 0.4 11 0.3 13 0.4 18 0.4 735 Serbia excluding Kosovo1 Centre Kosovo1 1 0.1 1 0.1 1 0.1 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 32 Kosovo1 West Switzerland 160 4.0 132 3.3 150 3.7 151 3.7 124 3.0 122 2.9 113 2.7 100 2.3 88 2.0 88 2.0 10 495 Switzerland East Tajikistan 188 5.0 272 7.1 275 7.1 327 8.2 429 10.5 470 11.2 417 9.7 470 10.7 543 12.0 548 11.9 4 286 Tajikistan Centre Turkey 139 0.4 166 0.4 249 0.7 241 0.6 341 0.9 337 0.8 373 0.9 455 1.1 531 1.3 481 1.1 4 367 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 6 915 28.0 7 697 31.3 7 301 29.8 7 722 31.7 6 683 27.6 5 481 27.7 5 867 25.7 6 313 27.7 6 143 27.1 6 375 28.3 117 243 Ukraine East Uzbekistan 1 733 12.1 – – – – – – – – – – – – – – – – 7 783 Uzbekistan Total non-EU/EEA 37 751 19.2 38 605 20.8 42 248 22.5 44 863 24.2 47 816 25.4 47 753 25.6 43 341 22.8 43 374 23.0 44 101 23.0 41 943 21.7 540 765 Total non-EU/EEA WHO European Region WHO European Region West West 8 197 4.0 7 748 3.7 7 627 3.6 7 212 3.3 7 332 3.4 7 046 3.2 6 918 3.2 6 680 3.0 6 166 2.9 5 576 2.6 182 540 West Centre Centre 630 0.7 730 0.8 802 0.8 856 0.9 961 1.0 896 0.9 875 0.9 952 1.0 1 005 1.0 1 049 1.0 22 362 Centre East East 37 567 25.1 38 382 28.3 41 945 30.8 44 615 32.7 47 451 34.7 47 410 35.7 42 978 31.5 42 910 31.4 43 487 31.7 41 404 30.2 527 799 East Total WHO European Region 46 394 10.3 46 860 10.7 50 374 11.3 52 683 11.8 55 744 12.4 55 352 12.3 50 771 11.2 50 542 11.2 50 658 11.2 48 029 10.6 732 701 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 64 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 4. New HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 178 184 183 169 155 166 167 184 112 113 4 058 West Belgium 438 435 441 467 400 409 378 336 327 – 8 349 Centre Bulgaria 32 47 59 72 97 111 96 120 170 122 1 040 Centre Croatia 61 47 65 70 79 99 95 97 82 82 1 179 Centre Cyprus 22 27 31 35 39 51 47 47 43 38 586 Centre Czechia 132 113 155 180 171 210 213 182 137 151 2 436 West Denmark 112 113 82 116 132 126 121 123 110 99 3 372 East Estonia 1 2 1 9 3 18 9 16 11 16 179 West Finland 48 36 47 43 55 53 48 32 38 38 1 283 West France 1 524 1 442 1 629 1 616 1 681 1 494 1 375 1 431 1 475 1 317 24 423 West Germany 1 690 1 555 1 777 1 781 1 956 1 890 1 730 1 621 1 421 1 445 34 410 West Greece 404 364 358 399 407 452 316 307 293 247 8 359 Centre Hungary 126 106 149 163 175 134 118 110 145 167 2 331 West Iceland 5 0 1 0 0 0 8 4 15 15 147 West Ireland 134 145 174 156 182 251 277 264 287 131 3 312 West Italy 1 258 1 284 1 590 1 518 1 556 1 458 1 404 1 376 1 176 1 069 17 464 East Latvia 18 20 18 27 28 34 24 24 19 18 432 – Liechtenstein 0 0 0 0 1 0 0 0 0 0 3 East Lithuania 7 12 12 31 12 29 29 21 19 20 296 West Luxembourg 28 34 35 37 31 24 28 18 26 22 708 West Maltac 6 4 8 16 25 45 38 23 38 0 222 West Netherlands 814 809 756 784 665 640 593 536 445 333 16 471 West Norway 85 97 76 98 115 70 87 88 73 61 2 215 Centre Poland 168 318 356 280 336 358 404 383 303 299 4 179 West Portugal 487 539 567 556 479 591 576 502 390 296 11 627 Centre Romania 71 109 95 100 139 133 148 165 162 177 1 607 Centre Slovakia 21 32 28 58 53 55 60 52 60 50 674 Centre Slovenia 28 36 36 28 35 36 49 26 29 20 602 West Spain 1 938 1 885 2 056 2 271 2 488 2 340 2 341 2 132 1 431 1 403 27 259 West Sweden 102 106 137 147 119 118 136 128 158 152 4 398 West United Kingdom 2 739 2 840 3 055 3 039 3 212 3 172 2 538 2 201 2 069 1 697 74 455 Total EU/EEA 12 677 12 741 13 977 14 266 14 826 14 567 13 453 12 549 11 064 9 598 258 076 Non-EU/EEA Centre Albania 5 15 9 11 9 13 11 6 8 9 138 West Andorra 3 1 1 3 4 2 3 2 4 – 38 East Armenia 1 4 5 13 11 12 17 17 40 49 186 East Azerbaijan 7 5 13 11 12 35 18 41 45 50 254 East Belarus 14 29 31 41 53 58 71 72 103 82 601 Centre Bosnia and Herzegovina 0 12 21 2 16 10 18 12 14 21 152 East Georgia 27 25 44 69 67 163 131 131 152 94 958 West Israel 145 159 157 172 151 141 129 150 131 113 2 707 East Kazakhstan 20 26 20 37 47 80 121 144 163 205 936 East Kyrgyzstan 0 0 3 14 17 20 35 45 46 37 219 West Monaco 0 0 0 0 1 1 0 2 0 – 18 Centre Montenegro 11 5 8 6 13 14 25 22 16 15 174 Centre North Macedonia 5 1 7 13 26 21 18 34 37 – 173 East Republic of Moldova 6 5 4 4 9 10 18 29 32 29 172 East Russian Federationc 0 0 0 0 0 0 0 0 0 0 0 West San Marino 0 4 0 0 0 0 0 0 0 0 21 Centre Serbia 84 69 88 100 85 133 114 122 138 173 1 679 Centre Serbia excluding Kosovo1 84 68 86 99 80 131 111 122 136 170 1 654 Centre Kosovo1 1 2 1 5 2 3 – 2 3 25 West Switzerland 245 211 228 198 220 208 233 170 160 152 5 615 East Tajikistan 0 1 1 0 3 3 11 12 22 11 64 Centre Turkey 32 59 142 187 281 350 403 494 540 539 3 213 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 90 143 152 262 277 368 435 490 506 468 3 508 East Uzbekistan 0 – – – – – – – – – 29 Total non-EU/EEA 695 774 934 1 143 1 302 1 642 1 811 1 995 2 157 2 047 20 855 WHO European Region West West 12 383 12 247 13 358 13 586 14 034 13 651 12 526 11 630 10 179 8 703 250 931 Centre Centre 798 996 1 249 1 305 1 554 1 728 1 819 1 872 1 884 1 863 20 163 East East 191 272 304 518 539 830 919 1 042 1 158 1 079 7 834 Total WHO European Region 13 372 13 515 14 911 15 409 16 127 16 209 15 264 14 544 13 221 11 645 278 928 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Data on route of transmission were not reported by Malta or the Russian Federation for 2019. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 65 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 5. New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 48 55 54 27 30 33 18 17 13 19 2 093 West Belgium 17 20 16 19 15 17 5 9 12 – 788 Centre Bulgaria 56 63 40 33 48 29 22 33 34 37 631 Centre Croatia 2 4 0 0 0 2 0 0 0 1 68 Centre Cyprus 0 0 0 0 3 1 2 0 1 3 19 Centre Czechia 5 9 6 6 10 6 7 5 8 6 141 West Denmark 8 10 11 13 11 8 9 6 6 4 563 East Estonia 118 110 86 81 67 55 30 15 24 20 4 214 West Finland 8 8 7 3 7 7 6 10 6 8 418 West France 129 123 131 111 104 78 61 60 68 65 2 142 West Germany 83 84 88 108 131 142 134 116 146 159 4 360 West Greece 28 319 524 270 120 95 101 93 119 72 2 033 Centre Hungary 0 0 0 1 1 2 3 1 1 1 32 West Iceland 9 12 3 1 1 0 9 3 2 2 69 West Ireland 23 18 16 22 30 47 21 18 13 10 1 678 West Italy 269 185 217 183 143 121 108 101 109 147 2 789 East Latvia 86 90 94 77 77 92 62 79 73 44 3 470 – Liechtenstein 0 1 0 0 0 0 0 0 0 0 5 East Lithuania 108 95 68 65 38 46 86 140 55 48 1 905 West Luxembourg 1 1 5 6 17 14 19 10 5 0 221 West Maltac 0 0 0 3 0 0 1 0 0 0 10 West Netherlands 7 9 8 8 2 3 1 4 2 2 807 West Norway 11 10 11 8 7 8 8 7 6 8 648 Centre Poland 47 72 49 47 50 51 38 30 21 19 6 398 West Portugal 227 151 142 121 63 64 46 32 27 16 19 352 Centre Romania 25 191 325 353 209 196 132 99 77 65 1 758 Centre Slovakia 2 1 1 0 1 3 1 0 1 0 18 Centre Slovenia 0 0 1 2 2 1 1 0 0 2 23 West Spain 256 237 209 187 153 119 140 108 74 68 3 717 West Sweden 23 15 22 13 14 15 26 20 23 21 1 311 West United Kingdom 145 133 116 115 144 196 138 137 100 108 6 505 Total EU/EEA 1 741 2 026 2 250 1 883 1 498 1 451 1 235 1 153 1 026 955 68 186 Non-EU/EEA Centre Albania 0 0 1 0 1 0 0 0 0 0 5 West Andorra 0 0 0 0 0 0 0 0 0 – 11 East Armenia 51 42 47 34 43 37 35 39 28 38 733 East Azerbaijan 277 319 218 204 183 183 160 99 105 100 3 291 East Belarus 223 254 247 201 376 790 600 485 391 363 9 566 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 20 East Georgia 211 188 224 172 194 187 205 150 96 114 3 065 West Israel 40 41 78 71 44 39 25 32 35 18 1 310 East Kazakhstan 1 100 923 793 730 779 826 900 901 920 1 203 18 808 East Kyrgyzstan 347 355 255 188 183 172 200 204 136 107 3 968 West Monaco 0 0 0 0 0 0 0 0 0 – 8 Centre Montenegro 0 0 1 0 0 0 0 1 0 0 6 Centre North Macedonia 0 0 0 0 0 0 0 0 0 – 2 East Republic of Moldova 58 62 40 22 61 38 40 42 59 39 2 935 East Russian Federationc 0 0 0 0 0 0 0 0 0 0 0 West San Marino 0 0 0 0 0 0 0 0 0 0 11 Centre Serbia 6 9 5 11 5 4 1 4 2 2 983 Centre Serbia excluding Kosovo1 6 9 5 11 5 4 1 4 2 2 981 Centre Kosovo1 – – – – – – – – – – 2 West Switzerland 20 21 24 13 8 10 13 20 13 12 2 911 East Tajikistan 590 407 257 213 227 247 201 247 193 134 3 696 Centre Turkey 0 6 6 4 10 13 8 14 24 10 178 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 6 934 6 588 5 933 5 847 4 670 3 449 3 694 3 983 3 750 4 214 128 975 East Uzbekistan 1 850 – – – – – – – – – 11 390 Total non-EU/EEA 11 707 9 215 8 129 7 710 6 784 5 995 6 082 6 221 5 752 6 354 191 872 WHO European Region West West 1 352 1 452 1 682 1 302 1 044 1 016 889 803 779 739 53 755 Centre Centre 143 355 435 457 340 308 215 187 169 146 10 282 East East 11 953 9 433 8 262 7 834 6 898 6 122 6 213 6 384 5 830 6 424 196 016 Total WHO European Region 13 448 11 240 10 379 9 593 8 282 7 446 7 317 7 374 6 778 7 309 260 053 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Data on route of transmission were not reported by Malta or the Russian Federation for 2019. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 66 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 6. New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 110 108 112 90 97 102 83 80 58 70 3 200 West Belgium 474 477 509 427 408 365 347 338 309 – 11 783 Centre Bulgaria 71 89 58 70 94 86 84 85 104 98 1 563 Centre Croatia 7 21 7 13 12 13 13 8 10 13 406 Centre Cyprus 15 23 23 16 10 26 27 32 32 47 645 Centre Czechia 38 26 41 45 45 46 53 59 56 56 875 West Denmark 141 132 96 90 102 126 100 93 91 87 3 521 East Estonia 173 146 170 188 162 144 116 89 67 78 1 713 West Finland 94 88 71 67 70 79 83 70 55 44 1 691 West France 2 223 2 075 2 199 2 185 2 189 1 783 1 635 1 668 1 897 1 538 37 379 West Germany 500 539 519 624 817 972 881 789 746 763 16 633 West Greece 123 151 159 125 142 129 141 153 171 169 3 690 Centre Hungary 18 19 24 25 28 22 28 22 13 28 528 West Iceland 10 6 0 0 0 0 9 2 15 6 132 West Ireland 127 126 135 134 128 129 147 173 160 107 3 576 West Italy 1 886 1 822 1 767 1 700 1 664 1 632 1 754 1 642 1 245 1 071 22 611 East Latvia 131 144 112 125 132 152 143 135 111 107 2 266 – Liechtenstein 3 0 0 0 0 0 1 0 0 0 13 East Lithuania 29 39 53 59 74 65 70 70 67 59 819 West Luxembourg 34 26 28 27 35 31 30 33 22 24 750 West Maltac 10 13 15 10 9 15 21 17 14 0 196 West Netherlands 365 309 311 264 248 268 223 198 159 154 8 348 West Norway 157 155 142 123 140 138 120 115 101 100 3 521 Centre Poland 108 93 102 90 109 112 110 103 69 83 1 938 West Portugal 1 228 1 095 1 064 1 045 867 799 840 762 648 433 28 359 Centre Romania 332 369 371 396 430 467 486 517 482 434 8 011 Centre Slovakia 4 12 14 21 18 23 18 15 19 28 254 Centre Slovenia 7 8 4 9 5 10 9 11 7 10 161 West Spain 1 268 1 123 1 150 1 154 1 099 1 016 1 038 1 038 691 798 16 890 West Sweden 222 260 227 218 229 211 202 212 213 204 6 074 West United Kingdom 3 042 2 825 2 582 2 257 2 329 2 067 1 901 1 648 1 668 1 555 71 072 Total EU/EEA 12 950 12 319 12 065 11 597 11 692 11 028 10 713 10 177 9 300 8 164 258 618 Non-EU/EEA Centre Albania 34 60 66 101 62 77 115 87 80 91 1 081 West Andorra 2 1 1 1 0 0 0 2 7 – 30 East Armenia 88 131 166 179 275 238 245 287 340 353 2 726 East Azerbaijan 131 191 244 275 378 440 338 370 469 531 3 915 East Belarus 789 881 919 1 265 1 349 1 416 1 671 1 868 1 861 1 659 18 429 Centre Bosnia and Herzegovina 1 14 4 0 7 4 6 2 10 9 142 East Georgia 203 202 241 240 294 355 372 341 413 449 3 880 West Israel 207 209 200 174 207 201 194 183 215 173 5 269 East Kazakhstan 796 987 1 112 1 268 1 391 1 439 1 743 1 869 2 057 2 125 17 935 East Kyrgyzstan 186 181 307 276 392 404 421 490 530 549 4 417 West Monaco 0 0 1 0 0 0 0 1 0 – 13 Centre Montenegro 3 4 4 2 4 3 9 3 5 4 91 Centre North Macedonia 0 0 7 2 4 4 10 8 6 – 59 East Republic of Moldova 607 612 661 337 616 578 547 561 617 683 8 694 East Russian Federationc 0 0 0 0 0 0 0 0 0 0 0 West San Marino 0 4 3 0 0 0 0 0 0 0 23 Centre Serbia 38 42 28 22 34 28 35 31 34 23 906 Centre Serbia excluding Kosovo1 35 37 27 20 33 28 30 29 29 21 841 Centre Kosovo1 3 5 1 2 1 5 2 5 2 65 West Switzerland 221 211 220 223 174 180 165 136 150 135 7 239 East Tajikistan 272 402 375 474 615 735 691 791 1 042 952 6 845 Centre Turkey 195 263 376 428 495 583 646 775 951 806 7 376 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 9 122 10 248 10 440 11 472 10 648 9 043 10 011 11 036 11 331 11 567 154 148 East Uzbekistan 852 4 711 Total non-EU/EEA 13 747 14 643 15 375 16 739 16 945 15 728 17 219 18 841 20 118 20 109 247 929 WHO European Region West West 12 444 11 755 11 511 10 938 10 954 10 243 9 914 9 353 8 635 7 431 252 000 Centre Centre 871 1 043 1 129 1 240 1 357 1 504 1 649 1 758 1 878 1 730 24 036 East East 13 379 14 164 14 800 16 158 16 326 15 009 16 368 17 907 18 905 19 112 230 498 Total WHO European Region 26 694 26 962 27 440 28 336 28 637 26 756 27 931 29 018 29 418 28 273 506 534 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Data on route of transmission were not reported by Malta or the Russian Federation for 2019. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 67 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 7. New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 1 2 0 0 1 0 1 1 1 0 62 West Belgium 11 18 10 7 10 14 8 5 10 – 452 Centre Bulgaria 4 2 0 5 1 1 0 3 3 1 28 Centre Croatia 0 1 0 0 1 0 0 0 0 0 14 Centre Cyprus 0 0 1 0 0 1 0 0 0 1 5 Centre Czechia 0 0 2 0 1 0 2 0 0 0 9 West Denmark 3 3 4 5 5 4 1 5 2 0 113 East Estonia 3 3 4 2 5 1 0 0 0 0 54 West Finland 1 1 2 2 2 3 2 0 2 4 37 West France 41 35 50 37 53 47 28 24 37 41 637 West Germany 20 14 22 23 26 27 23 18 20 13 473 West Greece 3 4 0 0 1 0 3 1 2 4 67 Centre Hungary 0 0 1 1 1 2 1 2 0 0 17 West Iceland 0 0 0 0 0 0 0 0 2 1 4 West Ireland 9 3 5 3 2 5 3 1 3 2 91 West Italy 13 27 16 13 14 16 10 16 11 3 214 East Latvia 4 2 7 10 4 3 6 3 5 2 82 – Liechtenstein 0 0 0 0 0 0 0 0 0 0 1 East Lithuania 0 1 0 1 2 0 1 1 0 0 7 West Luxembourg 0 0 1 0 2 0 0 0 0 1 15 West Maltac 0 0 0 0 0 0 2 0 2 0 4 West Netherlands 27 16 19 10 14 11 7 4 4 2 368 West Norway 1 4 7 1 3 2 2 2 6 2 93 Centre Poland 11 7 4 4 3 8 1 3 2 5 224 West Portugal 15 12 5 9 7 5 5 4 1 0 489 Centre Romania 27 22 19 24 18 18 6 14 9 11 760 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 0 Centre Slovenia 0 1 0 0 0 0 0 0 0 0 7 West Spain 13 11 7 18 4 3 8 3 4 2 135 West Sweden 13 22 14 7 7 15 10 14 12 12 273 West United Kingdom 109 104 87 92 90 54 40 54 53 60 2 903 Total EU/EEA 329 315 287 274 277 240 170 178 191 167 7 638 Non-EU/EEA Centre Albania 0 3 3 6 3 1 1 1 2 1 36 West Andorra 0 0 0 0 0 0 0 0 0 – 1 East Armenia 3 2 3 5 7 4 1 5 6 3 54 East Azerbaijan 11 9 14 10 18 16 10 10 9 4 132 East Belarus 22 23 16 16 15 26 20 13 4 10 318 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 1 East Georgia 13 6 9 4 5 6 4 3 6 3 108 West Israel 7 8 7 9 9 4 4 6 7 3 265 East Kazakhstan 21 18 30 36 22 25 24 34 24 26 396 East Kyrgyzstan 19 20 33 10 14 25 17 16 24 21 252 West Monaco 0 0 0 0 0 0 0 0 0 – 1 Centre Montenegro 0 0 0 0 0 0 0 0 0 0 4 Centre North Macedonia 0 0 0 0 0 0 0 0 0 – 2 East Republic of Moldova 10 16 11 13 19 14 10 11 13 19 209 East Russian Federationc 0 0 0 0 0 0 0 0 0 0 0 West San Marino 0 0 0 0 0 0 0 0 0 0 1 Centre Serbia – 1 1 4 1 1 2 1 2 53 Centre Serbia excluding Kosovo1 0 1 0 4 1 0 2 0 0 2 48 Centre Kosovo1 – – 1 – – 1 – – 1 – 5 West Switzerland 8 4 2 3 1 4 4 4 2 0 182 East Tajikistan 13 26 38 49 59 55 54 60 53 47 477 Centre Turkey 0 5 12 11 22 23 15 12 13 15 182 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 177 136 149 111 122 98 77 86 71 80 2 301 East Uzbekistan 73 – – – – – – – – – 363 Total non-EU/EEA 377 277 328 287 317 302 243 261 235 234 5 338 WHO European Region West West 295 288 258 239 251 214 161 162 181 150 6 880 Centre Centre 42 42 43 55 51 55 28 35 30 36 1 342 East East 369 262 314 267 292 273 224 242 215 215 4 753 Total WHO European Region 706 592 615 561 594 542 413 439 426 401 12 975 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Data on route of transmission were not reported by Malta or the Russian Federation for 2019. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 68 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 8. HIV diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Sex between men 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 113 113 7 12 19 26 44 70 0 0 0 0 0 0 0 0 0 2 21 23 225 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 122 122 8 29 37 33 65 98 0 1 1 0 0 0 0 0 0 0 0 0 258 Bulgaria Centre Croatia 82 82 0 1 1 4 9 13 0 0 0 0 0 0 0 0 0 1 5 6 102 Croatia Centre Cyprus 38 38 0 3 3 25 22 47 1 0 1 1 0 1 1 1 2 3 5 8 100 Cyprus Centre Czechia 151 151 1 5 6 25 31 56 0 0 0 0 1 1 0 1 1 3 4 7 222 Czechia West Denmark 99 99 0 4 4 44 43 87 0 0 0 0 0 0 0 0 0 0 0 0 190 Denmark East Estonia 16 16 7 13 20 37 41 78 0 0 0 0 0 0 0 0 0 21 43 64 178 Estonia West Finland 38 38 0 8 8 19 25 44 3 1 4 0 1 1 0 0 0 15 39 54 149 Finland West France 1 260 1 317 9 56 65 882 650 1 538 21 20 41 0 0 0 9 3 12 798 1 147 1 950 4 923 France West Germany 1 443 1 445 19 140 159 531 231 763 6 7 13 0 0 0 0 0 0 113 600 713 3 093 Germany West Greece 247 247 9 63 72 98 71 169 3 1 4 0 0 0 0 0 0 25 86 111 603 Greece Centre Hungary 167 167 0 1 1 16 12 28 0 0 0 0 0 0 0 0 0 0 28 42 238 Hungary West Iceland 15 15 0 2 2 3 3 6 1 0 1 0 0 0 0 0 0 1 3 4 28 Iceland West Ireland 130 131 1 9 10 75 31 107 1 1 2 0 0 0 0 0 0 57 225 283 533 Ireland West Italy 1 069 1 069 18 129 147 434 637 1 071 1 2 3 0 0 0 1 0 1 52 188 240 2 531 Italy East Latvia 18 18 6 38 44 57 50 107 1 1 2 0 0 0 0 0 0 51 73 124 295 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 20 20 9 39 48 28 31 59 0 0 0 0 0 0 0 0 0 4 20 24 151 Lithuania West Luxembourg 22 22 0 0 0 10 14 24 1 0 1 0 0 0 0 0 0 0 1 1 48 Luxembourg West Malta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 55 80 80 Malta West Netherlands 320 333 1 1 2 78 76 154 1 1 2 1 4 5 0 0 0 12 54 67 563 Netherlands West Norway 61 61 0 8 8 57 43 100 2 0 2 1 0 1 0 0 0 0 0 0 172 Norway Centre Poland 299 299 5 14 19 34 49 83 2 3 5 1 1 2 0 0 0 170 883 1 060 1 468 Poland West Portugal 296 296 3 13 16 221 212 433 0 0 0 0 0 0 3 1 4 12 17 29 778 Portugal Centre Romania 177 177 7 58 65 152 282 434 5 6 11 0 0 0 0 0 0 3 0 3 690 Romania Centre Slovakia 50 50 0 0 0 7 21 28 0 0 0 0 0 0 0 1 1 3 19 22 101 Slovakia Centre Slovenia 20 20 1 1 2 5 5 10 0 0 0 0 0 0 0 0 0 0 2 2 34 Slovenia West Spain 1 403 1 403 17 51 68 318 480 798 0 2 2 0 0 0 0 2 2 22 188 210 2 483 Spain West Sweden 152 152 5 16 21 117 87 204 6 6 12 0 0 0 4 0 4 29 27 56 449 Sweden West United Kingdom 1 697 1 697 16 92 108 818 733 1 555 33 27 60 3 7 10 16 9 25 242 415 661 4 116 United Kingdom Total EU/EEA 9 525 9 598 149 806 955 4 154 3 998 8 164 88 79 167 7 14 21 34 18 52 1 654 4 148 5 844 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 9 9 0 0 0 27 64 91 0 1 1 0 0 0 0 0 0 0 0 0 101 Albania West Andorra – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Andorra East Armenia 49 49 0 38 38 131 222 353 2 1 3 1 0 1 0 0 0 0 2 2 446 Armenia East Azerbaijan 50 50 4 96 100 232 299 531 1 3 4 0 0 0 0 0 0 10 26 36 721 Azerbaijan East Belarus 82 82 73 290 363 702 957 1 659 4 6 10 0 0 0 0 0 0 4 19 23 2 137 Belarus Centre Bosnia and Herzegovina 21 21 0 0 0 3 6 9 0 0 0 0 0 0 0 0 0 0 0 0 30 Bosnia and Herzegovina East Georgia 94 94 1 113 114 154 295 449 2 1 3 0 0 0 0 2 2 3 3 6 668 Georgia West Israel 113 113 5 13 18 94 79 173 1 2 3 0 0 0 0 0 0 40 61 101 408 Israel East Kazakhstan 205 205 176 1 027 1 203 1 029 1 096 2 125 19 7 26 0 0 0 0 0 0 33 81 114 3 673 Kazakhstan East Kyrgyzstan 37 37 2 105 107 291 258 549 6 15 21 2 6 8 0 0 0 53 75 128 850 Kyrgyzstan West Monaco – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Monaco Centre Montenegro 15 15 0 0 0 1 3 4 0 0 0 0 0 0 0 0 0 1 6 7 26 Montenegro Centre North Macedonia – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 North Macedonia East Republic of Moldova 29 29 8 31 39 300 383 683 9 10 19 0 0 0 0 0 0 61 91 152 922 Republic of Moldova East Russian Federation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 947 49 177 80 124 80 124 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 173 173 – 2 2 15 8 23 1 1 2 – – 0 – – 0 3 12 15 215 Serbia Centre Serbia excluding Kosovo1 170 170 0 2 2 14 7 21 1 1 2 0 0 0 0 0 0 3 12 15 210 Serbia excluding Kosovo1 Centre Kosovo1 3 3 – – 0 1 1 2 – – 0 – – 0 – – 0 – – 0 5 Kosovo1 West Switzerland 151 152 3 9 12 62 73 135 0 0 0 0 0 0 0 0 0 23 93 122 421 Switzerland East Tajikistan 11 11 2 132 134 452 500 952 19 28 47 1 2 3 1 0 1 73 99 172 1 320 Tajikistan Centre Turkey 539 539 1 9 10 146 660 806 6 9 15 0 0 0 1 1 2 327 1 530 1 857 3 229 Turkey East Turkmenistan – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Turkmenistan East Ukraine 468 468 702 3 512 4 214 5 625 5 942 11 567 37 43 80 0 3 3 1 0 1 10 14 24 16 357 Ukraine East Uzbekistan – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Uzbekistan Total non-EU/EEA 2 046 2 047 977 5 377 6 354 9 264 10 845 20 109 107 127 234 4 11 15 3 3 6 31 588 51 289 82 883 111 648 Total non-EU/EEA WHO European Region WHO European Region West West 8 629 8 703 113 626 739 3 887 3 532 7 431 80 70 150 5 12 17 33 15 48 1 458 3 220 4 705 21 793 West Centre Centre 1 863 1 863 23 123 146 493 1 237 1 730 15 21 36 2 2 4 2 4 6 514 2 494 3 029 6 814 Centre East East 1 079 1 079 990 5 434 6 424 9 038 10 074 19 112 100 115 215 4 11 15 2 2 4 31 270 49 723 80 993 107 842 East Total WHO European Region 11 571 11 645 1 126 6 183 7 309 13 418 14 843 28 273 195 206 401 11 25 36 37 21 58 33 242 55 437 88 727 136 449 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 2019 in tables 4–7. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 69 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 8. HIV diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Sex between men 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 113 113 7 12 19 26 44 70 0 0 0 0 0 0 0 0 0 2 21 23 225 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 122 122 8 29 37 33 65 98 0 1 1 0 0 0 0 0 0 0 0 0 258 Bulgaria Centre Croatia 82 82 0 1 1 4 9 13 0 0 0 0 0 0 0 0 0 1 5 6 102 Croatia Centre Cyprus 38 38 0 3 3 25 22 47 1 0 1 1 0 1 1 1 2 3 5 8 100 Cyprus Centre Czechia 151 151 1 5 6 25 31 56 0 0 0 0 1 1 0 1 1 3 4 7 222 Czechia West Denmark 99 99 0 4 4 44 43 87 0 0 0 0 0 0 0 0 0 0 0 0 190 Denmark East Estonia 16 16 7 13 20 37 41 78 0 0 0 0 0 0 0 0 0 21 43 64 178 Estonia West Finland 38 38 0 8 8 19 25 44 3 1 4 0 1 1 0 0 0 15 39 54 149 Finland West France 1 260 1 317 9 56 65 882 650 1 538 21 20 41 0 0 0 9 3 12 798 1 147 1 950 4 923 France West Germany 1 443 1 445 19 140 159 531 231 763 6 7 13 0 0 0 0 0 0 113 600 713 3 093 Germany West Greece 247 247 9 63 72 98 71 169 3 1 4 0 0 0 0 0 0 25 86 111 603 Greece Centre Hungary 167 167 0 1 1 16 12 28 0 0 0 0 0 0 0 0 0 0 28 42 238 Hungary West Iceland 15 15 0 2 2 3 3 6 1 0 1 0 0 0 0 0 0 1 3 4 28 Iceland West Ireland 130 131 1 9 10 75 31 107 1 1 2 0 0 0 0 0 0 57 225 283 533 Ireland West Italy 1 069 1 069 18 129 147 434 637 1 071 1 2 3 0 0 0 1 0 1 52 188 240 2 531 Italy East Latvia 18 18 6 38 44 57 50 107 1 1 2 0 0 0 0 0 0 51 73 124 295 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 20 20 9 39 48 28 31 59 0 0 0 0 0 0 0 0 0 4 20 24 151 Lithuania West Luxembourg 22 22 0 0 0 10 14 24 1 0 1 0 0 0 0 0 0 0 1 1 48 Luxembourg West Malta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 55 80 80 Malta West Netherlands 320 333 1 1 2 78 76 154 1 1 2 1 4 5 0 0 0 12 54 67 563 Netherlands West Norway 61 61 0 8 8 57 43 100 2 0 2 1 0 1 0 0 0 0 0 0 172 Norway Centre Poland 299 299 5 14 19 34 49 83 2 3 5 1 1 2 0 0 0 170 883 1 060 1 468 Poland West Portugal 296 296 3 13 16 221 212 433 0 0 0 0 0 0 3 1 4 12 17 29 778 Portugal Centre Romania 177 177 7 58 65 152 282 434 5 6 11 0 0 0 0 0 0 3 0 3 690 Romania Centre Slovakia 50 50 0 0 0 7 21 28 0 0 0 0 0 0 0 1 1 3 19 22 101 Slovakia Centre Slovenia 20 20 1 1 2 5 5 10 0 0 0 0 0 0 0 0 0 0 2 2 34 Slovenia West Spain 1 403 1 403 17 51 68 318 480 798 0 2 2 0 0 0 0 2 2 22 188 210 2 483 Spain West Sweden 152 152 5 16 21 117 87 204 6 6 12 0 0 0 4 0 4 29 27 56 449 Sweden West United Kingdom 1 697 1 697 16 92 108 818 733 1 555 33 27 60 3 7 10 16 9 25 242 415 661 4 116 United Kingdom Total EU/EEA 9 525 9 598 149 806 955 4 154 3 998 8 164 88 79 167 7 14 21 34 18 52 1 654 4 148 5 844 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 9 9 0 0 0 27 64 91 0 1 1 0 0 0 0 0 0 0 0 0 101 Albania West Andorra – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Andorra East Armenia 49 49 0 38 38 131 222 353 2 1 3 1 0 1 0 0 0 0 2 2 446 Armenia East Azerbaijan 50 50 4 96 100 232 299 531 1 3 4 0 0 0 0 0 0 10 26 36 721 Azerbaijan East Belarus 82 82 73 290 363 702 957 1 659 4 6 10 0 0 0 0 0 0 4 19 23 2 137 Belarus Centre Bosnia and Herzegovina 21 21 0 0 0 3 6 9 0 0 0 0 0 0 0 0 0 0 0 0 30 Bosnia and Herzegovina East Georgia 94 94 1 113 114 154 295 449 2 1 3 0 0 0 0 2 2 3 3 6 668 Georgia West Israel 113 113 5 13 18 94 79 173 1 2 3 0 0 0 0 0 0 40 61 101 408 Israel East Kazakhstan 205 205 176 1 027 1 203 1 029 1 096 2 125 19 7 26 0 0 0 0 0 0 33 81 114 3 673 Kazakhstan East Kyrgyzstan 37 37 2 105 107 291 258 549 6 15 21 2 6 8 0 0 0 53 75 128 850 Kyrgyzstan West Monaco – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Monaco Centre Montenegro 15 15 0 0 0 1 3 4 0 0 0 0 0 0 0 0 0 1 6 7 26 Montenegro Centre North Macedonia – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 North Macedonia East Republic of Moldova 29 29 8 31 39 300 383 683 9 10 19 0 0 0 0 0 0 61 91 152 922 Republic of Moldova East Russian Federation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 947 49 177 80 124 80 124 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 173 173 – 2 2 15 8 23 1 1 2 – – 0 – – 0 3 12 15 215 Serbia Centre Serbia excluding Kosovo1 170 170 0 2 2 14 7 21 1 1 2 0 0 0 0 0 0 3 12 15 210 Serbia excluding Kosovo1 Centre Kosovo1 3 3 – – 0 1 1 2 – – 0 – – 0 – – 0 – – 0 5 Kosovo1 West Switzerland 151 152 3 9 12 62 73 135 0 0 0 0 0 0 0 0 0 23 93 122 421 Switzerland East Tajikistan 11 11 2 132 134 452 500 952 19 28 47 1 2 3 1 0 1 73 99 172 1 320 Tajikistan Centre Turkey 539 539 1 9 10 146 660 806 6 9 15 0 0 0 1 1 2 327 1 530 1 857 3 229 Turkey East Turkmenistan – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Turkmenistan East Ukraine 468 468 702 3 512 4 214 5 625 5 942 11 567 37 43 80 0 3 3 1 0 1 10 14 24 16 357 Ukraine East Uzbekistan – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Uzbekistan Total non-EU/EEA 2 046 2 047 977 5 377 6 354 9 264 10 845 20 109 107 127 234 4 11 15 3 3 6 31 588 51 289 82 883 111 648 Total non-EU/EEA WHO European Region WHO European Region West West 8 629 8 703 113 626 739 3 887 3 532 7 431 80 70 150 5 12 17 33 15 48 1 458 3 220 4 705 21 793 West Centre Centre 1 863 1 863 23 123 146 493 1 237 1 730 15 21 36 2 2 4 2 4 6 514 2 494 3 029 6 814 Centre East East 1 079 1 079 990 5 434 6 424 9 038 10 074 19 112 100 115 215 4 11 15 2 2 4 31 270 49 723 80 993 107 842 East Total WHO European Region 11 571 11 645 1 126 6 183 7 309 13 418 14 843 28 273 195 206 401 11 25 36 37 21 58 33 242 55 437 88 727 136 449 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 2019 in tables 4–7. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 70 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 9. HIV diagnoses in 2019, 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 1 0 1 0 2 2 3 15 18 6 31 37 14 49 63 4 48 52 7 45 52 0 0 0 225 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 0 1 1 4 0 4 3 20 23 7 32 39 14 91 105 7 46 53 6 27 33 0 0 0 258 Bulgaria Centre Croatia 0 0 0 0 3 3 1 10 11 0 11 11 1 35 36 1 30 31 2 8 10 0 0 0 102 Croatia Centre Cyprus 1 0 1 1 0 1 2 6 8 7 10 17 15 35 50 4 11 15 1 7 8 0 0 0 100 Cyprus Centre Czechia 0 1 1 0 0 0 1 21 22 5 45 50 13 55 68 6 50 56 4 21 25 0 0 0 222 Czechia West Denmark 0 0 0 0 1 1 1 7 8 8 29 37 13 35 48 11 36 47 11 38 49 0 0 0 190 Denmark East Estonia 0 0 0 1 1 2 7 2 9 5 8 13 24 45 69 14 33 47 14 24 38 0 0 0 178 Estonia West Finland 1 0 1 1 2 3 1 9 10 5 14 19 9 40 49 6 22 28 14 25 39 0 0 0 149 Finland West France 19 26 45 60 75 136 145 313 465 239 462 717 568 824 1 413 362 657 1 034 326 779 1 113 0 0 0 4 923 France West Germany 2 3 5 11 29 40 76 199 275 113 342 455 219 729 951 127 536 663 118 575 693 3 8 11 3 093 Germany West Greece 4 1 5 4 9 13 10 42 52 25 71 96 43 148 191 32 105 137 17 92 109 0 0 0 603 Greece Centre Hungary 0 0 0 1 3 4 0 28 28 3 50 53 4 62 67 4 40 44 4 23 27 0 2 15 238 Hungary West Iceland 1 0 1 0 0 0 0 2 2 0 4 4 2 10 12 1 5 6 1 2 3 0 0 0 28 Iceland West Ireland 1 1 2 2 6 8 6 24 30 27 98 126 47 142 190 35 77 113 16 48 64 0 0 0 533 Ireland West Italy 1 2 3 12 9 21 38 135 173 61 273 334 142 549 691 116 498 614 135 555 690 1 4 5 2 531 Italy East Latvia 1 1 2 2 2 4 2 14 16 11 17 28 34 68 102 29 41 70 36 37 73 0 0 0 295 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 0 0 0 0 1 1 0 9 9 5 10 15 14 47 61 11 23 34 11 20 31 0 0 0 151 Lithuania West Luxembourg 1 0 1 0 0 0 0 1 1 1 5 6 6 10 16 2 11 13 1 9 10 0 1 1 48 Luxembourg West Malta 0 0 0 0 2 2 3 2 5 3 12 15 3 20 23 1 4 5 3 10 13 2 5 17 80 Malta West Netherlands 4 3 7 1 5 6 10 44 55 13 70 90 28 121 150 17 111 133 20 102 122 0 0 0 563 Netherlands West Norway 1 0 1 2 1 3 2 5 7 9 18 27 21 28 49 14 29 43 11 31 42 0 0 0 172 Norway Centre Poland 3 6 9 3 17 20 14 135 150 23 233 257 81 443 527 58 256 314 25 129 154 5 30 37 1 468 Poland West Portugal 0 0 0 6 8 14 11 61 72 30 91 121 67 139 206 58 119 177 67 121 188 0 0 0 778 Portugal Centre Romania 5 6 11 7 9 16 16 66 82 28 74 102 53 188 241 34 112 146 24 68 92 0 0 0 690 Romania Centre Slovakia 0 0 0 0 4 4 1 9 10 1 18 19 5 30 35 1 24 25 2 6 8 0 0 0 101 Slovakia Centre Slovenia 0 0 0 0 0 0 0 1 1 0 2 2 5 12 17 1 9 10 0 4 4 0 0 0 34 Slovenia West Spain 0 2 2 13 39 52 32 201 233 50 377 427 114 691 805 92 482 574 56 334 390 0 0 0 2 483 Spain West Sweden 6 5 11 5 8 13 4 10 14 16 46 62 59 91 150 48 62 110 23 66 89 0 0 0 449 Sweden West United Kingdom 10 10 20 34 43 77 67 249 316 118 542 660 317 881 1 203 305 635 941 277 620 899 0 0 0 4 116 United Kingdom Total EU/EEA 62 68 130 170 279 450 456 1 640 2 105 819 2 995 3 839 1 935 5 618 7 588 1 401 4 112 5 535 1 232 3 826 5 068 11 50 86 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 1 1 0 3 3 0 8 8 5 13 18 7 18 25 5 18 23 10 13 23 0 0 0 101 Albania West Andorra – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Andorra East Armenia 3 1 4 1 3 4 8 22 30 18 51 69 47 95 142 26 82 108 31 58 89 0 0 0 446 Armenia East Azerbaijan 4 4 8 2 1 3 29 30 59 33 93 126 85 163 248 53 97 150 41 86 127 0 0 0 721 Azerbaijan East Belarus 5 10 15 7 8 15 43 56 99 93 144 237 262 551 813 221 379 600 152 206 358 0 0 0 2 137 Belarus Centre Bosnia and Herzegovina 0 0 0 0 1 1 0 4 4 0 8 8 1 7 8 1 3 4 1 4 5 0 0 0 30 Bosnia and Herzegovina East Georgia 2 1 3 1 10 11 9 55 64 16 60 76 47 140 187 41 138 179 44 104 148 0 0 0 668 Georgia West Israel 1 2 3 3 1 4 3 15 18 8 45 53 47 69 116 51 67 118 27 68 95 0 1 1 408 Israel East Kazakhstan 21 8 29 21 24 45 91 133 224 158 293 451 460 1 005 1 465 302 652 954 204 301 505 0 0 0 3 673 Kazakhstan East Kyrgyzstan 9 23 32 5 6 11 23 40 63 50 49 99 130 195 325 75 115 190 62 68 130 0 0 0 850 Kyrgyzstan West Monaco – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Monaco Centre Montenegro 0 0 0 0 0 0 1 1 2 0 5 5 1 5 6 0 10 10 0 3 3 0 0 0 26 Montenegro Centre North Macedonia – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 North Macedonia East Republic of Moldova 9 9 18 10 8 18 31 29 60 50 59 109 126 226 352 76 130 206 76 83 159 0 0 0 922 Republic of Moldova East Russian Federation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 947 49 177 80 124 80 124 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 San Marino Centre Serbia 1 1 2 1 1 1 20 21 2 30 32 7 72 79 39 39 7 34 41 – – 0 215 Serbia Centre Serbia excluding Kosovo1 1 1 2 1 0 1 1 19 20 2 30 32 6 71 77 0 37 37 7 34 41 0 0 0 210 Serbia excluding Kosovo1 Centre Kosovo1 – – 0 – – 0 – 1 1 – – 0 1 1 2 – 2 2 – – 0 – – 0 5 Kosovo1 West Switzerland 0 0 0 0 1 1 6 26 33 11 41 52 29 85 117 21 76 98 21 97 119 0 0 1 421 Switzerland East Tajikistan 74 110 184 17 7 24 43 45 88 61 91 152 194 239 433 97 194 291 62 86 148 0 0 0 1 320 Tajikistan Centre Turkey 6 9 15 16 99 115 45 439 484 72 532 604 167 781 948 95 467 562 80 421 501 0 0 0 3 229 Turkey East Turkmenistan – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Turkmenistan East Ukraine 41 50 91 86 46 132 323 278 601 667 853 1 520 2 206 4 167 6 373 1 800 3 174 4 974 1 252 1 414 2 666 0 0 0 16 357 Ukraine East Uzbekistan – – 0 – – 0 – – 0 – – 0 0 – – 0 – – 0 – – 0 0 Uzbekistan Total non-EU/EEA 176 229 405 170 218 388 656 1 201 1 858 1 244 2 367 3 611 3 816 7 818 11 637 2 864 5 641 8 506 2 070 3 046 5 117 30 947 49 178 80 126 111 648 Total non-EU/EEA WHO European Region WHO European Region West West 53 55 108 154 241 396 418 1 360 1 787 743 2 571 3 338 1 748 4 661 6 443 1 303 3 580 4 906 1 151 3 617 4 779 6 19 36 21 793 West Centre Centre 16 25 41 33 139 172 85 768 854 153 1 063 1 217 374 1 834 2 212 217 1 115 1 332 166 768 934 5 32 52 6 814 Centre East East 169 217 386 153 117 270 609 713 1 322 1 167 1 728 2 895 3 629 6 941 10 570 2 745 5 058 7 803 1 985 2 487 4 472 30 947 49 177 80 124 107 842 East Total WHO European Region 238 297 535 340 497 838 1 112 2 841 3 963 2 063 5 362 7 450 5 751 13 436 19 225 4 265 9 753 14 041 3 302 6 872 10 185 30 958 49 228 80 212 136 449 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 71 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 9. HIV diagnoses in 2019, 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 1 0 1 0 2 2 3 15 18 6 31 37 14 49 63 4 48 52 7 45 52 0 0 0 225 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 0 1 1 4 0 4 3 20 23 7 32 39 14 91 105 7 46 53 6 27 33 0 0 0 258 Bulgaria Centre Croatia 0 0 0 0 3 3 1 10 11 0 11 11 1 35 36 1 30 31 2 8 10 0 0 0 102 Croatia Centre Cyprus 1 0 1 1 0 1 2 6 8 7 10 17 15 35 50 4 11 15 1 7 8 0 0 0 100 Cyprus Centre Czechia 0 1 1 0 0 0 1 21 22 5 45 50 13 55 68 6 50 56 4 21 25 0 0 0 222 Czechia West Denmark 0 0 0 0 1 1 1 7 8 8 29 37 13 35 48 11 36 47 11 38 49 0 0 0 190 Denmark East Estonia 0 0 0 1 1 2 7 2 9 5 8 13 24 45 69 14 33 47 14 24 38 0 0 0 178 Estonia West Finland 1 0 1 1 2 3 1 9 10 5 14 19 9 40 49 6 22 28 14 25 39 0 0 0 149 Finland West France 19 26 45 60 75 136 145 313 465 239 462 717 568 824 1 413 362 657 1 034 326 779 1 113 0 0 0 4 923 France West Germany 2 3 5 11 29 40 76 199 275 113 342 455 219 729 951 127 536 663 118 575 693 3 8 11 3 093 Germany West Greece 4 1 5 4 9 13 10 42 52 25 71 96 43 148 191 32 105 137 17 92 109 0 0 0 603 Greece Centre Hungary 0 0 0 1 3 4 0 28 28 3 50 53 4 62 67 4 40 44 4 23 27 0 2 15 238 Hungary West Iceland 1 0 1 0 0 0 0 2 2 0 4 4 2 10 12 1 5 6 1 2 3 0 0 0 28 Iceland West Ireland 1 1 2 2 6 8 6 24 30 27 98 126 47 142 190 35 77 113 16 48 64 0 0 0 533 Ireland West Italy 1 2 3 12 9 21 38 135 173 61 273 334 142 549 691 116 498 614 135 555 690 1 4 5 2 531 Italy East Latvia 1 1 2 2 2 4 2 14 16 11 17 28 34 68 102 29 41 70 36 37 73 0 0 0 295 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 0 0 0 0 1 1 0 9 9 5 10 15 14 47 61 11 23 34 11 20 31 0 0 0 151 Lithuania West Luxembourg 1 0 1 0 0 0 0 1 1 1 5 6 6 10 16 2 11 13 1 9 10 0 1 1 48 Luxembourg West Malta 0 0 0 0 2 2 3 2 5 3 12 15 3 20 23 1 4 5 3 10 13 2 5 17 80 Malta West Netherlands 4 3 7 1 5 6 10 44 55 13 70 90 28 121 150 17 111 133 20 102 122 0 0 0 563 Netherlands West Norway 1 0 1 2 1 3 2 5 7 9 18 27 21 28 49 14 29 43 11 31 42 0 0 0 172 Norway Centre Poland 3 6 9 3 17 20 14 135 150 23 233 257 81 443 527 58 256 314 25 129 154 5 30 37 1 468 Poland West Portugal 0 0 0 6 8 14 11 61 72 30 91 121 67 139 206 58 119 177 67 121 188 0 0 0 778 Portugal Centre Romania 5 6 11 7 9 16 16 66 82 28 74 102 53 188 241 34 112 146 24 68 92 0 0 0 690 Romania Centre Slovakia 0 0 0 0 4 4 1 9 10 1 18 19 5 30 35 1 24 25 2 6 8 0 0 0 101 Slovakia Centre Slovenia 0 0 0 0 0 0 0 1 1 0 2 2 5 12 17 1 9 10 0 4 4 0 0 0 34 Slovenia West Spain 0 2 2 13 39 52 32 201 233 50 377 427 114 691 805 92 482 574 56 334 390 0 0 0 2 483 Spain West Sweden 6 5 11 5 8 13 4 10 14 16 46 62 59 91 150 48 62 110 23 66 89 0 0 0 449 Sweden West United Kingdom 10 10 20 34 43 77 67 249 316 118 542 660 317 881 1 203 305 635 941 277 620 899 0 0 0 4 116 United Kingdom Total EU/EEA 62 68 130 170 279 450 456 1 640 2 105 819 2 995 3 839 1 935 5 618 7 588 1 401 4 112 5 535 1 232 3 826 5 068 11 50 86 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 1 1 0 3 3 0 8 8 5 13 18 7 18 25 5 18 23 10 13 23 0 0 0 101 Albania West Andorra – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Andorra East Armenia 3 1 4 1 3 4 8 22 30 18 51 69 47 95 142 26 82 108 31 58 89 0 0 0 446 Armenia East Azerbaijan 4 4 8 2 1 3 29 30 59 33 93 126 85 163 248 53 97 150 41 86 127 0 0 0 721 Azerbaijan East Belarus 5 10 15 7 8 15 43 56 99 93 144 237 262 551 813 221 379 600 152 206 358 0 0 0 2 137 Belarus Centre Bosnia and Herzegovina 0 0 0 0 1 1 0 4 4 0 8 8 1 7 8 1 3 4 1 4 5 0 0 0 30 Bosnia and Herzegovina East Georgia 2 1 3 1 10 11 9 55 64 16 60 76 47 140 187 41 138 179 44 104 148 0 0 0 668 Georgia West Israel 1 2 3 3 1 4 3 15 18 8 45 53 47 69 116 51 67 118 27 68 95 0 1 1 408 Israel East Kazakhstan 21 8 29 21 24 45 91 133 224 158 293 451 460 1 005 1 465 302 652 954 204 301 505 0 0 0 3 673 Kazakhstan East Kyrgyzstan 9 23 32 5 6 11 23 40 63 50 49 99 130 195 325 75 115 190 62 68 130 0 0 0 850 Kyrgyzstan West Monaco – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Monaco Centre Montenegro 0 0 0 0 0 0 1 1 2 0 5 5 1 5 6 0 10 10 0 3 3 0 0 0 26 Montenegro Centre North Macedonia – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 North Macedonia East Republic of Moldova 9 9 18 10 8 18 31 29 60 50 59 109 126 226 352 76 130 206 76 83 159 0 0 0 922 Republic of Moldova East Russian Federation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 947 49 177 80 124 80 124 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 San Marino Centre Serbia 1 1 2 1 1 1 20 21 2 30 32 7 72 79 39 39 7 34 41 – – 0 215 Serbia Centre Serbia excluding Kosovo1 1 1 2 1 0 1 1 19 20 2 30 32 6 71 77 0 37 37 7 34 41 0 0 0 210 Serbia excluding Kosovo1 Centre Kosovo1 – – 0 – – 0 – 1 1 – – 0 1 1 2 – 2 2 – – 0 – – 0 5 Kosovo1 West Switzerland 0 0 0 0 1 1 6 26 33 11 41 52 29 85 117 21 76 98 21 97 119 0 0 1 421 Switzerland East Tajikistan 74 110 184 17 7 24 43 45 88 61 91 152 194 239 433 97 194 291 62 86 148 0 0 0 1 320 Tajikistan Centre Turkey 6 9 15 16 99 115 45 439 484 72 532 604 167 781 948 95 467 562 80 421 501 0 0 0 3 229 Turkey East Turkmenistan – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Turkmenistan East Ukraine 41 50 91 86 46 132 323 278 601 667 853 1 520 2 206 4 167 6 373 1 800 3 174 4 974 1 252 1 414 2 666 0 0 0 16 357 Ukraine East Uzbekistan – – 0 – – 0 – – 0 – – 0 0 – – 0 – – 0 – – 0 0 Uzbekistan Total non-EU/EEA 176 229 405 170 218 388 656 1 201 1 858 1 244 2 367 3 611 3 816 7 818 11 637 2 864 5 641 8 506 2 070 3 046 5 117 30 947 49 178 80 126 111 648 Total non-EU/EEA WHO European Region WHO European Region West West 53 55 108 154 241 396 418 1 360 1 787 743 2 571 3 338 1 748 4 661 6 443 1 303 3 580 4 906 1 151 3 617 4 779 6 19 36 21 793 West Centre Centre 16 25 41 33 139 172 85 768 854 153 1 063 1 217 374 1 834 2 212 217 1 115 1 332 166 768 934 5 32 52 6 814 Centre East East 169 217 386 153 117 270 609 713 1 322 1 167 1 728 2 895 3 629 6 941 10 570 2 745 5 058 7 803 1 985 2 487 4 472 30 947 49 177 80 124 107 842 East Total WHO European Region 238 297 535 340 497 838 1 112 2 841 3 963 2 063 5 362 7 450 5 751 13 436 19 225 4 265 9 753 14 041 3 302 6 872 10 185 30 958 49 228 80 212 136 449 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 72 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 10. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2019, 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 125 55.6 21 9.3 46 20.4 15 6.7 3 1.3 9 4.0 5 2.2 1 0.4 225 Austria West Belgium – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 241 93.4 5 1.9 6 2.3 1 0.4 2 0.8 1 0.4 2 0.8 0 0.0 258 Bulgaria Centre Croatia 94 92.2 0 0.0 4 3.9 1 1.0 0 0.0 0 0.0 1 1.0 2 2.0 102 Croatia Centre Cyprus 35 35.0 10 10.0 11 11.0 42 42.0 1 1.0 1 1.0 0 0.0 0 0.0 100 Cyprus Centre Czechia 149 67.1 3 1.4 50 22.5 5 2.3 10 4.5 4 1.8 1 0.5 0 0.0 222 Czechia West Denmark 83 43.7 24 12.6 23 12.1 22 11.6 13 6.8 13 6.8 12 6.3 0 0.0 190 Denmark East Estonia 102 57.3 1 0.6 17 9.6 0 0.0 1 0.6 0 0.0 1 0.6 56 31.5 178 Estonia West Finland 54 36.2 3 2.0 30 20.1 22 14.8 6 4.0 13 8.7 8 5.4 13 8.7 149 Finland West France 1 343 27.3 64 1.3 145 2.9 1 226 24.9 298 6.1 73 1.5 158 3.2 1 616 32.8 4 923 France West Germany 1 614 52.2 91 2.9 390 12.6 391 12.6 123 4.0 120 3.9 72 2.3 292 9.4 3 093 Germany West Greece 353 58.5 16 2.7 71 11.8 118 19.6 4 0.7 17 2.8 16 2.7 8 1.3 603 Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 3 10.7 2 7.1 5 17.9 3 10.7 3 10.7 1 3.6 11 39.3 0 0.0 28 Iceland West Ireland 56 10.5 13 2.4 20 3.8 110 20.6 57 10.7 14 2.6 4 0.8 259 48.6 533 Ireland West Italy 1 884 74.4 12 0.5 141 5.6 214 8.5 191 7.5 36 1.4 41 1.6 12 0.5 2 531 Italy East Latvia – – – – – – – – – – – – – – – – – Latvia – Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 145 96.0 2 1.3 4 2.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 151 Lithuania West Luxembourg 14 29.2 10 20.8 3 6.3 15 31.3 3 6.3 1 2.1 1 2.1 1 2.1 48 Luxembourg West Malta 80 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 80 Malta West Netherlands 294 52.2 15 2.7 44 7.8 62 11.0 91 16.2 26 4.6 27 4.8 4 0.7 563 Netherlands West Norway 53 30.8 3 1.7 21 12.2 47 27.3 15 8.7 29 16.9 4 2.3 0 0.0 172 Norway Centre Poland 637 43.4 0 0.0 23 1.6 0 0.0 0 0.0 1 0.1 0 0.0 807 55.0 1 468 Poland West Portugal 420 54.0 15 1.9 12 1.5 172 22.1 137 17.6 4 0.5 1 0.1 17 2.2 778 Portugal Centre Romania 681 98.7 1 0.1 1 0.1 2 0.3 0 0.0 0 0.0 1 0.1 4 0.6 690 Romania Centre Slovakia 62 61.4 1 1.0 24 23.8 0 0.0 2 2.0 1 1.0 0 0.0 11 10.9 101 Slovakia Centre Slovenia 21 61.8 1 2.9 8 23.5 2 5.9 1 2.9 0 0.0 0 0.0 1 2.9 34 Slovenia West Spain 1 466 59.0 59 2.4 68 2.7 135 5.4 531 21.4 20 0.8 49 2.0 155 6.2 2 483 Spain West Sweden 90 20.0 33 7.3 63 14.0 158 35.2 39 8.7 35 7.8 22 4.9 9 2.0 449 Sweden West United Kingdom 1 354 32.9 307 7.5 349 8.5 856 20.8 327 7.9 259 6.3 94 2.3 570 13.8 4 116 United Kingdom Total EU/EEA 11 453 47.2 712 2.9 1 579 6.5 3 619 14.9 1 858 7.7 678 2.8 531 2.2 3 838 15.8 24 268 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 101 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 101 Albania West Andorra – – – – – – – – – – – – – – – – – Andorra East Armenia 446 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 446 Armenia East Azerbaijan 686 95.1 1 0.1 34 4.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 721 Azerbaijan East Belarus 2 134 99.9 0 0.0 3 0.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 137 Belarus Centre Bosnia and Herzegovina 26 86.7 0 0.0 1 3.3 0 0.0 2 6.7 0 0.0 1 3.3 0 0.0 30 Bosnia and Herzegovina East Georgia 667 99.9 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 668 Georgia West Israel 120 29.4 9 2.2 135 33.1 74 18.1 7 1.7 8 2.0 55 13.5 0 0.0 408 Israel East Kazakhstan 3 511 95.6 0 0.0 124 3.4 0 0.0 0 0.0 3 0.1 35 1.0 0 0.0 3 673 Kazakhstan East Kyrgyzstan 788 92.7 2 0.2 56 6.6 0 0.0 0 0.0 2 0.2 0 0.0 2 0.2 850 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 25 96.2 0 0.0 1 3.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 26 Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 922 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 922 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia 215 100.0 – – – – – – – – – – – – – – 215 Serbia Centre Serbia excluding Kosovo1 210 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 210 Serbia excluding Kosovo1 Centre Kosovo1 5 100.0 – – – – – – – – – – – – – – 5 Kosovo1 West Switzerland 161 38.2 67 15.9 17 4.0 36 8.6 32 7.6 22 5.2 9 2.1 77 18.3 421 Switzerland East Tajikistan 1 295 98.1 0 0.0 11 0.8 0 0.0 0 0.0 0 0.0 14 1.1 0 0.0 1 320 Tajikistan Centre Turkey 2 716 84.1 43 1.3 183 5.7 69 2.1 11 0.3 43 1.3 101 3.1 63 2.0 3 229 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 16 357 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 16 357 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 30 170 95.7 122 0.4 566 1.8 179 0.6 52 0.2 78 0.2 215 0.7 142 0.5 31 524 Total non-EU/EEA WHO European Region WHO European Region West West 9 567 43.9 764 3.5 1 583 7.3 3 676 16.9 1 880 8.6 700 3.2 589 2.7 3 034 13.9 21 793 West Centre Centre 5 003 76.1 64 1.0 312 4.7 122 1.9 29 0.4 51 0.8 107 1.6 888 13.5 6 576 Centre East East 27 053 98.7 6 0.0 250 0.9 0 0.0 1 0.0 5 0.0 50 0.2 58 0.2 27 423 East Total WHO European Region 41 623 74.6 834 1.5 2 145 3.8 3 798 6.8 1 910 3.4 756 1.4 746 1.3 3 980 7.1 55 792 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 73 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 10. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2019, 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 125 55.6 21 9.3 46 20.4 15 6.7 3 1.3 9 4.0 5 2.2 1 0.4 225 Austria West Belgium – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 241 93.4 5 1.9 6 2.3 1 0.4 2 0.8 1 0.4 2 0.8 0 0.0 258 Bulgaria Centre Croatia 94 92.2 0 0.0 4 3.9 1 1.0 0 0.0 0 0.0 1 1.0 2 2.0 102 Croatia Centre Cyprus 35 35.0 10 10.0 11 11.0 42 42.0 1 1.0 1 1.0 0 0.0 0 0.0 100 Cyprus Centre Czechia 149 67.1 3 1.4 50 22.5 5 2.3 10 4.5 4 1.8 1 0.5 0 0.0 222 Czechia West Denmark 83 43.7 24 12.6 23 12.1 22 11.6 13 6.8 13 6.8 12 6.3 0 0.0 190 Denmark East Estonia 102 57.3 1 0.6 17 9.6 0 0.0 1 0.6 0 0.0 1 0.6 56 31.5 178 Estonia West Finland 54 36.2 3 2.0 30 20.1 22 14.8 6 4.0 13 8.7 8 5.4 13 8.7 149 Finland West France 1 343 27.3 64 1.3 145 2.9 1 226 24.9 298 6.1 73 1.5 158 3.2 1 616 32.8 4 923 France West Germany 1 614 52.2 91 2.9 390 12.6 391 12.6 123 4.0 120 3.9 72 2.3 292 9.4 3 093 Germany West Greece 353 58.5 16 2.7 71 11.8 118 19.6 4 0.7 17 2.8 16 2.7 8 1.3 603 Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 3 10.7 2 7.1 5 17.9 3 10.7 3 10.7 1 3.6 11 39.3 0 0.0 28 Iceland West Ireland 56 10.5 13 2.4 20 3.8 110 20.6 57 10.7 14 2.6 4 0.8 259 48.6 533 Ireland West Italy 1 884 74.4 12 0.5 141 5.6 214 8.5 191 7.5 36 1.4 41 1.6 12 0.5 2 531 Italy East Latvia – – – – – – – – – – – – – – – – – Latvia – Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 145 96.0 2 1.3 4 2.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 151 Lithuania West Luxembourg 14 29.2 10 20.8 3 6.3 15 31.3 3 6.3 1 2.1 1 2.1 1 2.1 48 Luxembourg West Malta 80 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 80 Malta West Netherlands 294 52.2 15 2.7 44 7.8 62 11.0 91 16.2 26 4.6 27 4.8 4 0.7 563 Netherlands West Norway 53 30.8 3 1.7 21 12.2 47 27.3 15 8.7 29 16.9 4 2.3 0 0.0 172 Norway Centre Poland 637 43.4 0 0.0 23 1.6 0 0.0 0 0.0 1 0.1 0 0.0 807 55.0 1 468 Poland West Portugal 420 54.0 15 1.9 12 1.5 172 22.1 137 17.6 4 0.5 1 0.1 17 2.2 778 Portugal Centre Romania 681 98.7 1 0.1 1 0.1 2 0.3 0 0.0 0 0.0 1 0.1 4 0.6 690 Romania Centre Slovakia 62 61.4 1 1.0 24 23.8 0 0.0 2 2.0 1 1.0 0 0.0 11 10.9 101 Slovakia Centre Slovenia 21 61.8 1 2.9 8 23.5 2 5.9 1 2.9 0 0.0 0 0.0 1 2.9 34 Slovenia West Spain 1 466 59.0 59 2.4 68 2.7 135 5.4 531 21.4 20 0.8 49 2.0 155 6.2 2 483 Spain West Sweden 90 20.0 33 7.3 63 14.0 158 35.2 39 8.7 35 7.8 22 4.9 9 2.0 449 Sweden West United Kingdom 1 354 32.9 307 7.5 349 8.5 856 20.8 327 7.9 259 6.3 94 2.3 570 13.8 4 116 United Kingdom Total EU/EEA 11 453 47.2 712 2.9 1 579 6.5 3 619 14.9 1 858 7.7 678 2.8 531 2.2 3 838 15.8 24 268 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 101 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 101 Albania West Andorra – – – – – – – – – – – – – – – – – Andorra East Armenia 446 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 446 Armenia East Azerbaijan 686 95.1 1 0.1 34 4.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 721 Azerbaijan East Belarus 2 134 99.9 0 0.0 3 0.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 137 Belarus Centre Bosnia and Herzegovina 26 86.7 0 0.0 1 3.3 0 0.0 2 6.7 0 0.0 1 3.3 0 0.0 30 Bosnia and Herzegovina East Georgia 667 99.9 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 668 Georgia West Israel 120 29.4 9 2.2 135 33.1 74 18.1 7 1.7 8 2.0 55 13.5 0 0.0 408 Israel East Kazakhstan 3 511 95.6 0 0.0 124 3.4 0 0.0 0 0.0 3 0.1 35 1.0 0 0.0 3 673 Kazakhstan East Kyrgyzstan 788 92.7 2 0.2 56 6.6 0 0.0 0 0.0 2 0.2 0 0.0 2 0.2 850 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 25 96.2 0 0.0 1 3.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 26 Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 922 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 922 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia 215 100.0 – – – – – – – – – – – – – – 215 Serbia Centre Serbia excluding Kosovo1 210 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 210 Serbia excluding Kosovo1 Centre Kosovo1 5 100.0 – – – – – – – – – – – – – – 5 Kosovo1 West Switzerland 161 38.2 67 15.9 17 4.0 36 8.6 32 7.6 22 5.2 9 2.1 77 18.3 421 Switzerland East Tajikistan 1 295 98.1 0 0.0 11 0.8 0 0.0 0 0.0 0 0.0 14 1.1 0 0.0 1 320 Tajikistan Centre Turkey 2 716 84.1 43 1.3 183 5.7 69 2.1 11 0.3 43 1.3 101 3.1 63 2.0 3 229 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 16 357 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 16 357 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 30 170 95.7 122 0.4 566 1.8 179 0.6 52 0.2 78 0.2 215 0.7 142 0.5 31 524 Total non-EU/EEA WHO European Region WHO European Region West West 9 567 43.9 764 3.5 1 583 7.3 3 676 16.9 1 880 8.6 700 3.2 589 2.7 3 034 13.9 21 793 West Centre Centre 5 003 76.1 64 1.0 312 4.7 122 1.9 29 0.4 51 0.8 107 1.6 888 13.5 6 576 Centre East East 27 053 98.7 6 0.0 250 0.9 0 0.0 1 0.0 5 0.0 50 0.2 58 0.2 27 423 East Total WHO European Region 41 623 74.6 834 1.5 2 145 3.8 3 798 6.8 1 910 3.4 756 1.4 746 1.3 3 980 7.1 55 792 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 74 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 11. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2019 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 5 719 59.6 434 4.5 547 5.7 269 2.8 1 284 13.4 325 3.4 257 2.7 763 7.9 9 598 Sex between men Injecting drug use 614 64.3 29 3.0 169 17.7 11 1.2 9 0.9 19 2.0 13 1.4 91 9.5 955 Injecting drug use Heterosexual contact 3 397 41.6 168 2.1 512 6.3 2 831 34.7 433 5.3 224 2.7 161 2.0 438 5.4 8 164 Heterosexual contact Mother-to-child 32 19.2 7 4.2 7 4.2 94 56.3 4 2.4 3 1.8 8 4.8 12 7.2 167 Mother-to-child Haemophiliac/transfusion recipient 5 9.6 2 3.8 7 13.5 23 44.2 2 3.8 8 15.4 3 5.8 2 3.8 52 Haemophiliac/transfusion recipient Nosocomial infection 5 23.8 – – 9 42.9 3 14.3 1 4.8 2 9.5 – – 1 4.8 21 Nosocomial infection Other/undetermined 1 681 28.8 72 1.2 328 5.6 388 6.6 125 2.1 97 1.7 89 1.5 3 064 52.4 5 844 Other/undetermined Total EU/EEA 11 453 46.2 712 2.9 1 579 6.4 3 619 14.6 1 858 7.5 678 2.7 531 2.1 4 371 17.6 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Sex between men 1 883 92.0 38 1.9 39 1.9 4 0.2 22 1.1 13 0.6 32 1.6 16 0.8 2 047 Sex between men Injecting drug use 6 287 98.9 4 0.1 58 0.9 1 0.0 – – 4 0.1 – – 6 354 Injecting drug use Heterosexual contact 19 626 97.6 21 0.1 243 1.2 104 0.5 13 0.1 26 0.1 52 0.3 24 0.1 20 109 Heterosexual contact Mother-to-child 220 94.0 – – 12 5.1 1 0.4 – – – – – – 1 0.4 234 Mother-to-child Haemophiliac/transfusion recipient 4 66.7 – – – – 1 16.7 – – – – 1 16.7 – – 6 Haemophiliac/transfusion recipient Nosocomial infection 12 80.0 – – 3 20.0 – – – – – – – – 15 Nosocomial infection Other/undetermined 2 138 77.5 59 2.1 211 7.6 69 2.5 16 0.6 39 1.4 126 4.6 101 3.7 2 759 Other/undetermined Total non-EU/EEA 30 170 95.7 122 0.4 566 1.8 179 0.6 52 0.2 78 0.2 215 0.7 142 0.5 31 524 Total non-EU/EEA West West Sex between men 5 180 59.5 455 5.2 526 6.0 270 3.1 1 290 14.8 326 3.7 262 3.0 394 4.5 8 703 Sex between men Injecting drug use 444 60.1 30 4.1 175 23.7 11 1.5 10 1.4 19 2.6 13 1.8 37 5.0 739 Injecting drug use Heterosexual contact 2 736 36.8 187 2.5 525 7.1 2 877 38.7 440 5.9 238 3.2 170 2.3 258 3.5 7 431 Heterosexual contact Mother-to-child 18 12.0 7 4.7 7 4.7 94 62.7 4 2.7 3 2.0 8 5.3 9 6.0 150 Mother-to-child Haemophiliac/transfusion recipient 4 8.3 1 2.1 6 12.5 22 45.8 2 4.2 8 16.7 3 6.3 2 4.2 48 Haemophiliac/transfusion recipient Nosocomial infection 4 23.5 – – 6 35.3 3 17.6 1 5.9 2 11.8 – – 1 5.9 17 Nosocomial infection Other/undetermined 1 181 25.1 84 1.8 338 7.2 399 8.5 133 2.8 104 2.2 133 2.8 2 333 49.6 4 705 Other/undetermined Total West 9 567 43.9 764 3.5 1 583 7.3 3 676 16.9 1 880 8.6 700 3.2 589 2.7 3 034 13.9 21 793 Total West Centre Centre Sex between men 1 380 74.1 17 0.9 45 2.4 3 0.2 16 0.9 12 0.6 23 1.2 367 19.7 1 863 Sex between men Injecting drug use 128 87.7 2 1.4 7 4.8 – – – – – – – – 9 6.2 146 Injecting drug use Heterosexual contact 1 482 85.7 2 0.1 78 4.5 58 3.4 5 0.3 8 0.5 12 0.7 85 4.9 1 730 Heterosexual contact Mother-to-child 24 66.7 – – 9 25.0 1 2.8 – – – – 2 5.6 36 Mother-to-child Haemophiliac/transfusion recipient 1 16.7 1 16.7 1 16.7 2 33.3 – – – – 1 16.7 – – 6 Haemophiliac/transfusion recipient Nosocomial infection 1 25.0 – – 3 75.0 – – – – – – – – – – 4 Nosocomial infection Other/undetermined 1 987 65.6 42 1.4 169 5.6 58 1.9 8 0.3 31 1.0 71 2.3 663 21.9 3 029 Other/undetermined Total Centre 5 003 73.4 64 0.9 312 4.6 122 1.8 29 0.4 51 0.7 107 1.6 1 126 16.5 6 814 Total Centre East East Sex between men 1 042 96.6 – – 15 1.4 – – – – – – 4 0.4 18 1.7 1 079 Sex between men Injecting drug use 6 329 98.5 1 0.0 45 0.7 – – – – – – 4 0.1 45 0.7 6 424 Injecting drug use Heterosexual contact 18 805 98.4 – – 152 0.8 – – 1 0.0 4 0.0 31 0.2 119 0.6 19 112 Heterosexual contact Mother-to-child 210 97.7 – – 3 1.4 – – – – – – – – 2 0.9 215 Mother-to-child Haemophiliac/transfusion recipient 4 100.0 – – – – – – – – – – – – – – 4 Haemophiliac/transfusion recipient Nosocomial infection 12 80.0 – – 3 20.0 – – – – – – – – – – 15 Nosocomial infection Other/undetermined 651 74.9 5 0.6 32 3.7 – – 1 0.1 11 1.3 169 19.4 869 Other/undetermined Total East 27 053 97.6 6 0.0 250 0.9 0 0.0 1 0.0 5 0.0 50 0.2 353 1.3 27 718 Total East Total WHO European Region 83 246 73.9 1 668 1.5 4 290 3.8 7 596 6.7 3 820 3.4 1 512 1.3 1 492 1.3 9 026 8.0 112 650 Total WHO European Region 75 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 11. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2019 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 5 719 59.6 434 4.5 547 5.7 269 2.8 1 284 13.4 325 3.4 257 2.7 763 7.9 9 598 Sex between men Injecting drug use 614 64.3 29 3.0 169 17.7 11 1.2 9 0.9 19 2.0 13 1.4 91 9.5 955 Injecting drug use Heterosexual contact 3 397 41.6 168 2.1 512 6.3 2 831 34.7 433 5.3 224 2.7 161 2.0 438 5.4 8 164 Heterosexual contact Mother-to-child 32 19.2 7 4.2 7 4.2 94 56.3 4 2.4 3 1.8 8 4.8 12 7.2 167 Mother-to-child Haemophiliac/transfusion recipient 5 9.6 2 3.8 7 13.5 23 44.2 2 3.8 8 15.4 3 5.8 2 3.8 52 Haemophiliac/transfusion recipient Nosocomial infection 5 23.8 – – 9 42.9 3 14.3 1 4.8 2 9.5 – – 1 4.8 21 Nosocomial infection Other/undetermined 1 681 28.8 72 1.2 328 5.6 388 6.6 125 2.1 97 1.7 89 1.5 3 064 52.4 5 844 Other/undetermined Total EU/EEA 11 453 46.2 712 2.9 1 579 6.4 3 619 14.6 1 858 7.5 678 2.7 531 2.1 4 371 17.6 24 801 Total EU/EEA Non-EU/EEA Non-EU/EEA Sex between men 1 883 92.0 38 1.9 39 1.9 4 0.2 22 1.1 13 0.6 32 1.6 16 0.8 2 047 Sex between men Injecting drug use 6 287 98.9 4 0.1 58 0.9 1 0.0 – – 4 0.1 – – 6 354 Injecting drug use Heterosexual contact 19 626 97.6 21 0.1 243 1.2 104 0.5 13 0.1 26 0.1 52 0.3 24 0.1 20 109 Heterosexual contact Mother-to-child 220 94.0 – – 12 5.1 1 0.4 – – – – – – 1 0.4 234 Mother-to-child Haemophiliac/transfusion recipient 4 66.7 – – – – 1 16.7 – – – – 1 16.7 – – 6 Haemophiliac/transfusion recipient Nosocomial infection 12 80.0 – – 3 20.0 – – – – – – – – 15 Nosocomial infection Other/undetermined 2 138 77.5 59 2.1 211 7.6 69 2.5 16 0.6 39 1.4 126 4.6 101 3.7 2 759 Other/undetermined Total non-EU/EEA 30 170 95.7 122 0.4 566 1.8 179 0.6 52 0.2 78 0.2 215 0.7 142 0.5 31 524 Total non-EU/EEA West West Sex between men 5 180 59.5 455 5.2 526 6.0 270 3.1 1 290 14.8 326 3.7 262 3.0 394 4.5 8 703 Sex between men Injecting drug use 444 60.1 30 4.1 175 23.7 11 1.5 10 1.4 19 2.6 13 1.8 37 5.0 739 Injecting drug use Heterosexual contact 2 736 36.8 187 2.5 525 7.1 2 877 38.7 440 5.9 238 3.2 170 2.3 258 3.5 7 431 Heterosexual contact Mother-to-child 18 12.0 7 4.7 7 4.7 94 62.7 4 2.7 3 2.0 8 5.3 9 6.0 150 Mother-to-child Haemophiliac/transfusion recipient 4 8.3 1 2.1 6 12.5 22 45.8 2 4.2 8 16.7 3 6.3 2 4.2 48 Haemophiliac/transfusion recipient Nosocomial infection 4 23.5 – – 6 35.3 3 17.6 1 5.9 2 11.8 – – 1 5.9 17 Nosocomial infection Other/undetermined 1 181 25.1 84 1.8 338 7.2 399 8.5 133 2.8 104 2.2 133 2.8 2 333 49.6 4 705 Other/undetermined Total West 9 567 43.9 764 3.5 1 583 7.3 3 676 16.9 1 880 8.6 700 3.2 589 2.7 3 034 13.9 21 793 Total West Centre Centre Sex between men 1 380 74.1 17 0.9 45 2.4 3 0.2 16 0.9 12 0.6 23 1.2 367 19.7 1 863 Sex between men Injecting drug use 128 87.7 2 1.4 7 4.8 – – – – – – – – 9 6.2 146 Injecting drug use Heterosexual contact 1 482 85.7 2 0.1 78 4.5 58 3.4 5 0.3 8 0.5 12 0.7 85 4.9 1 730 Heterosexual contact Mother-to-child 24 66.7 – – 9 25.0 1 2.8 – – – – 2 5.6 36 Mother-to-child Haemophiliac/transfusion recipient 1 16.7 1 16.7 1 16.7 2 33.3 – – – – 1 16.7 – – 6 Haemophiliac/transfusion recipient Nosocomial infection 1 25.0 – – 3 75.0 – – – – – – – – – – 4 Nosocomial infection Other/undetermined 1 987 65.6 42 1.4 169 5.6 58 1.9 8 0.3 31 1.0 71 2.3 663 21.9 3 029 Other/undetermined Total Centre 5 003 73.4 64 0.9 312 4.6 122 1.8 29 0.4 51 0.7 107 1.6 1 126 16.5 6 814 Total Centre East East Sex between men 1 042 96.6 – – 15 1.4 – – – – – – 4 0.4 18 1.7 1 079 Sex between men Injecting drug use 6 329 98.5 1 0.0 45 0.7 – – – – – – 4 0.1 45 0.7 6 424 Injecting drug use Heterosexual contact 18 805 98.4 – – 152 0.8 – – 1 0.0 4 0.0 31 0.2 119 0.6 19 112 Heterosexual contact Mother-to-child 210 97.7 – – 3 1.4 – – – – – – – – 2 0.9 215 Mother-to-child Haemophiliac/transfusion recipient 4 100.0 – – – – – – – – – – – – – – 4 Haemophiliac/transfusion recipient Nosocomial infection 12 80.0 – – 3 20.0 – – – – – – – – – – 15 Nosocomial infection Other/undetermined 651 74.9 5 0.6 32 3.7 – – 1 0.1 11 1.3 169 19.4 869 Other/undetermined Total East 27 053 97.6 6 0.0 250 0.9 0 0.0 1 0.0 5 0.0 50 0.2 353 1.3 27 718 Total East Total WHO European Region 83 246 73.9 1 668 1.5 4 290 3.8 7 596 6.7 3 820 3.4 1 512 1.3 1 492 1.3 9 026 8.0 112 650 Total WHO European Region 76 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 12. New HIV diagnoses, by country of report and probable region of infection, in 2019, 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 11 4.9 0 0.0 0 0.0 2 0.9 2 0.9 2 0.9 0 0.0 208 92.4 225 Austria West Belgium – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria – – – – – – – – – – – – – – – – – Bulgaria Centre Croatia – – – – – – – – – – – – – – – – – Croatia Centre Cyprus 26 26.0 14 14.0 6 6.0 40 40.0 1 1.0 1 1.0 0 0.0 12 12.0 100 Cyprus Centre Czechia 38 17.1 7 3.2 15 6.8 7 3.2 4 1.8 5 2.3 2 0.9 144 64.9 222 Czechia West Denmark 72 37.9 22 11.6 17 8.9 25 13.2 9 4.7 21 11.1 8 4.2 16 8.4 190 Denmark East Estonia 109 61.2 2 1.1 8 4.5 0 0.0 1 0.6 0 0.0 1 0.6 57 32.0 178 Estonia West Finland 26 17.4 12 8.1 30 20.1 20 13.4 2 1.3 20 13.4 6 4.0 33 22.1 149 Finland West France 1 094 22.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 829 77.8 4 923 France West Germany 1 615 52.2 57 1.8 194 6.3 275 8.9 60 1.9 85 2.7 37 1.2 770 24.9 3 093 Germany West Greece – – – – – – – – – – – – – – – – – Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 3 10.7 1 3.6 4 14.3 4 14.3 3 10.7 0 0.0 0 0.0 13 46.4 28 Iceland West Ireland 57 10.7 15 2.8 10 1.9 45 8.4 30 5.6 9 1.7 5 0.9 362 67.9 533 Ireland West Italy – – – – – – – – – – – – – – – – – Italy East Latvia 140 47.5 3 1.0 3 1.0 0 0.0 0 0.0 0 0.0 0 0.0 149 50.5 295 Latvia – Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 0 0.0 2 1.3 4 2.6 0 0.0 0 0.0 0 0.0 0 0.0 145 96.0 151 Lithuania West Luxembourg 20 41.7 3 6.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 25 52.1 48 Luxembourg West Malta – – – – – – – – – – – – – – – – – Malta West Netherlands 298 52.9 8 1.4 17 3.0 28 5.0 17 3.0 24 4.3 10 1.8 161 28.6 563 Netherlands West Norway 28 0.0 13 7.6 20 11.6 46 26.7 16 9.3 39 22.7 6 3.5 4 18.6 172 Norway Centre Poland – – – – – – – – – – – – – – – – – Poland West Portugal 413 53.1 11 1.4 3 0.4 100 12.9 50 6.4 2 0.3 2 0.3 197 25.3 778 Portugal Centre Romania 681 98.7 1 0.1 1 0.1 2 0.3 0 0.0 0 0.0 1 0.1 4 0.6 690 Romania Centre Slovakia 0 0.0 5 5.0 17 16.8 0 0.0 0 0.0 1 1.0 0 0.0 78 77.2 101 Slovakia Centre Slovenia 17 50.0 0 0.0 6 17.6 2 5.9 2 5.9 0 0.0 0 0.0 7 20.6 34 Slovenia West Spain – – – – – – – – – – – – – – – – – Spain West Sweden 78 17.4 38 8.5 57 12.7 147 32.7 34 7.6 52 11.6 19 4.2 24 5.3 449 Sweden West United Kingdom 1 554 37.8 249 6.0 187 4.5 607 14.7 172 4.2 235 5.7 114 2.8 998 24.2 4 116 United Kingdom Total EU/EEA 6 280 36.9 463 2.7 599 3.5 1 350 7.9 403 2.4 496 2.9 211 1.2 7 236 42.5 17 038 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 101 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 101 Albania West Andorra – – – – – – – – – – – – – – – – – Andorra East Armenia 206 46.2 0 0.0 227 50.9 0 0.0 0 0.0 0 0.0 2 0.4 11 2.5 446 Armenia East Azerbaijan 436 60.5 1 0.1 210 29.1 0 0.0 0 0.0 0 0.0 1 0.1 73 10.1 721 Azerbaijan East Belarus 2 137 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 137 Belarus Centre Bosnia and Herzegovina 18 60.0 3 10.0 3 10.0 1 3.3 2 6.7 0 0.0 1 3.3 2 6.7 30 Bosnia and Herzegovina East Georgia 348 52.1 17 2.5 122 18.3 1 0.1 0 0.0 3 0.4 5 0.7 172 25.7 668 Georgia West Israel 191 46.8 5 1.2 87 21.3 51 12.5 4 1.0 7 1.7 6 1.5 57 14.0 408 Israel East Kazakhstan 3 511 95.6 0 0.0 124 3.4 0 0.0 0 0.0 3 0.1 0 0.0 35 1.0 3 673 Kazakhstan East Kyrgyzstan 788 92.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 62 7.3 850 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro – – – – – – – – – – – – – – – – – Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 922 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 922 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia – – – – – – – – – – – – – – – – – Serbia Centre Serbia excluding Kosovo1 – – – – – – – – – – – – – – – – – Serbia excluding Kosovo1 Centre Kosovo1 – – – – – – – – – – – – – – – – – Kosovo1 West Switzerland 128 30.4 24 5.7 9 2.1 31 7.4 18 4.3 20 4.8 7 1.7 184 43.7 421 Switzerland East Tajikistan – – – – – – – – – – – – – – – – – Tajikistan Centre Turkey – – – – – – – – – – – – – – – – – Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine – – – – – – – – – – – – – – – – – Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 8 786 84.7 50 0.5 782 7.5 84 0.8 24 0.2 33 0.3 22 0.2 596 5.7 10 377 Total non-EU/EEA WHO European Region WHO European Region West West 5 588 34.7 458 2.8 635 3.9 1 381 8.6 417 2.6 516 3.2 220 1.4 6 881 42.8 16 096 West Centre Centre 881 68.9 30 2.3 48 3.8 52 4.1 9 0.7 7 0.5 4 0.3 247 19.3 1 278 Centre East East 8 597 85.6 25 0.2 698 7.0 1 0.0 1 0.0 6 0.1 9 0.1 704 7.0 10 041 East Total WHO European Region 15 066 55.0 513 1.9 1 381 5.0 1 434 5.2 427 1.6 529 1.9 233 0.8 7 832 28.6 27 415 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 77 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 12. New HIV diagnoses, by country of report and probable region of infection, in 2019, 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 11 4.9 0 0.0 0 0.0 2 0.9 2 0.9 2 0.9 0 0.0 208 92.4 225 Austria West Belgium – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria – – – – – – – – – – – – – – – – – Bulgaria Centre Croatia – – – – – – – – – – – – – – – – – Croatia Centre Cyprus 26 26.0 14 14.0 6 6.0 40 40.0 1 1.0 1 1.0 0 0.0 12 12.0 100 Cyprus Centre Czechia 38 17.1 7 3.2 15 6.8 7 3.2 4 1.8 5 2.3 2 0.9 144 64.9 222 Czechia West Denmark 72 37.9 22 11.6 17 8.9 25 13.2 9 4.7 21 11.1 8 4.2 16 8.4 190 Denmark East Estonia 109 61.2 2 1.1 8 4.5 0 0.0 1 0.6 0 0.0 1 0.6 57 32.0 178 Estonia West Finland 26 17.4 12 8.1 30 20.1 20 13.4 2 1.3 20 13.4 6 4.0 33 22.1 149 Finland West France 1 094 22.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 829 77.8 4 923 France West Germany 1 615 52.2 57 1.8 194 6.3 275 8.9 60 1.9 85 2.7 37 1.2 770 24.9 3 093 Germany West Greece – – – – – – – – – – – – – – – – – Greece Centre Hungary – – – – – – – – – – – – – – – – – Hungary West Iceland 3 10.7 1 3.6 4 14.3 4 14.3 3 10.7 0 0.0 0 0.0 13 46.4 28 Iceland West Ireland 57 10.7 15 2.8 10 1.9 45 8.4 30 5.6 9 1.7 5 0.9 362 67.9 533 Ireland West Italy – – – – – – – – – – – – – – – – – Italy East Latvia 140 47.5 3 1.0 3 1.0 0 0.0 0 0.0 0 0.0 0 0.0 149 50.5 295 Latvia – Liechtenstein – – – – – – – – – – – – – – – – – Liechtenstein East Lithuania 0 0.0 2 1.3 4 2.6 0 0.0 0 0.0 0 0.0 0 0.0 145 96.0 151 Lithuania West Luxembourg 20 41.7 3 6.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 25 52.1 48 Luxembourg West Malta – – – – – – – – – – – – – – – – – Malta West Netherlands 298 52.9 8 1.4 17 3.0 28 5.0 17 3.0 24 4.3 10 1.8 161 28.6 563 Netherlands West Norway 28 0.0 13 7.6 20 11.6 46 26.7 16 9.3 39 22.7 6 3.5 4 18.6 172 Norway Centre Poland – – – – – – – – – – – – – – – – – Poland West Portugal 413 53.1 11 1.4 3 0.4 100 12.9 50 6.4 2 0.3 2 0.3 197 25.3 778 Portugal Centre Romania 681 98.7 1 0.1 1 0.1 2 0.3 0 0.0 0 0.0 1 0.1 4 0.6 690 Romania Centre Slovakia 0 0.0 5 5.0 17 16.8 0 0.0 0 0.0 1 1.0 0 0.0 78 77.2 101 Slovakia Centre Slovenia 17 50.0 0 0.0 6 17.6 2 5.9 2 5.9 0 0.0 0 0.0 7 20.6 34 Slovenia West Spain – – – – – – – – – – – – – – – – – Spain West Sweden 78 17.4 38 8.5 57 12.7 147 32.7 34 7.6 52 11.6 19 4.2 24 5.3 449 Sweden West United Kingdom 1 554 37.8 249 6.0 187 4.5 607 14.7 172 4.2 235 5.7 114 2.8 998 24.2 4 116 United Kingdom Total EU/EEA 6 280 36.9 463 2.7 599 3.5 1 350 7.9 403 2.4 496 2.9 211 1.2 7 236 42.5 17 038 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 101 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 101 Albania West Andorra – – – – – – – – – – – – – – – – – Andorra East Armenia 206 46.2 0 0.0 227 50.9 0 0.0 0 0.0 0 0.0 2 0.4 11 2.5 446 Armenia East Azerbaijan 436 60.5 1 0.1 210 29.1 0 0.0 0 0.0 0 0.0 1 0.1 73 10.1 721 Azerbaijan East Belarus 2 137 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 137 Belarus Centre Bosnia and Herzegovina 18 60.0 3 10.0 3 10.0 1 3.3 2 6.7 0 0.0 1 3.3 2 6.7 30 Bosnia and Herzegovina East Georgia 348 52.1 17 2.5 122 18.3 1 0.1 0 0.0 3 0.4 5 0.7 172 25.7 668 Georgia West Israel 191 46.8 5 1.2 87 21.3 51 12.5 4 1.0 7 1.7 6 1.5 57 14.0 408 Israel East Kazakhstan 3 511 95.6 0 0.0 124 3.4 0 0.0 0 0.0 3 0.1 0 0.0 35 1.0 3 673 Kazakhstan East Kyrgyzstan 788 92.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 62 7.3 850 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – Monaco Centre Montenegro – – – – – – – – – – – – – – – – – Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 922 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 922 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – Russian Federation West San Marino – – – – – – – – – – – – – – – – – San Marino Centre Serbia – – – – – – – – – – – – – – – – – Serbia Centre Serbia excluding Kosovo1 – – – – – – – – – – – – – – – – – Serbia excluding Kosovo1 Centre Kosovo1 – – – – – – – – – – – – – – – – – Kosovo1 West Switzerland 128 30.4 24 5.7 9 2.1 31 7.4 18 4.3 20 4.8 7 1.7 184 43.7 421 Switzerland East Tajikistan – – – – – – – – – – – – – – – – – Tajikistan Centre Turkey – – – – – – – – – – – – – – – – – Turkey East Turkmenistan – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine – – – – – – – – – – – – – – – – – Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 8 786 84.7 50 0.5 782 7.5 84 0.8 24 0.2 33 0.3 22 0.2 596 5.7 10 377 Total non-EU/EEA WHO European Region WHO European Region West West 5 588 34.7 458 2.8 635 3.9 1 381 8.6 417 2.6 516 3.2 220 1.4 6 881 42.8 16 096 West Centre Centre 881 68.9 30 2.3 48 3.8 52 4.1 9 0.7 7 0.5 4 0.3 247 19.3 1 278 Centre East East 8 597 85.6 25 0.2 698 7.0 1 0.0 1 0.0 6 0.1 9 0.1 704 7.0 10 041 East Total WHO European Region 15 066 55.0 513 1.9 1 381 5.0 1 434 5.2 427 1.6 529 1.9 233 0.8 7 832 28.6 27 415 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 78 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 13. Percentage of new HIV diagnoses (2019) among persons > 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 Sex between menb EU/EEA West Austria 221 98.7 66 29.9 110 49.8 65.2 26.3 42.0 West Belgium – – – – – – – – – Centre Bulgaria 230 89.5 90 39.1 142 61.7 69.8 71.4 53.4 Centre Croatia 4 3.9 1 25.0 2 50.0 – – – Centre Cyprus 93 93.9 84 90.3 85 91.4 91.3 – 91.4 Centre Czechia 210 95.0 51 24.3 84 40.0 55.4 – 31.8 West Denmarkc 134 92.4 42 31.3 80 59.7 68.3 – 54.2 East Estonia 47 26.4 12 25.5 26 55.3 60.0 50.0 – West Finland 115 77.7 37 32.2 57 49.6 56.1 62.5 41.7 West France 2 555 52.4 679 26.6 1 290 50.5 56.0 41.9 41.2 West Germany 894 29.1 320 35.8 499 55.8 62.1 40.0 50.1 West Greece 424 70.9 144 34.0 233 55.0 63.5 52.4 46.4 Centre Hungary – – – – – – – – – West Iceland 20 74.1 4 20.0 4 20.0 – – – West Irelandc 72 16.9 14 19.4 30 41.7 43.3 – 37.0 West Italy 2 221 88.0 883 39.8 1 306 58.8 64.6 60.4 50.9 East Latvia 46 15.7 24 52.2 32 69.6 73.1 40.0 83.3 – Liechtenstein – – – – – – – – – East Lithuania 106 70.2 32 30.2 49 46.2 64.2 25.0 26.3 West Luxembourg 33 71.7 3 9.1 12 36.4 31.3 41.2 West Malta – – – – – – – – – West Netherlands 513 92.3 139 27.1 241 47.0 57.0 – 37.7 West Norway – – – – – – – – – Centre Poland – – – – – – – – – West Portugal 608 78.1 178 29.3 291 47.9 56.5 41.7 34.9 Centre Romania 662 97.5 263 39.7 416 62.8 67.5 69.8 49.7 Centre Slovakia 36 35.6 8 22.2 10 27.8 50.0 – 12.5 Centre Slovenia 29 85.3 10 34.5 15 51.7 66.7 – 41.2 West Spain 2 172 87.5 555 25.6 1 005 46.3 53.2 60.7 41.6 West Sweden 356 81.3 85 23.9 151 42.4 51.4 42.9 29.4 West United Kingdom 3 478 84.9 786 22.6 1 428 41.1 48.3 39.1 33.3 Total EU/EEA 15 279 67.7 4 510 29.5 7 598 49.7 57.0 51.5 41.6 Non-EU/EEA Centre Albania 40 40.0 22 55.0 30 75.0 78.9 – – West Andorra – – – – – – – – – East Armenia 395 89.4 144 36.5 231 58.5 61.4 54.8 39.5 East Azerbaijan 563 79.0 168 29.8 277 49.2 49.7 60.0 30.2 East Belarus 1 817 85.6 426 23.4 795 43.8 44.1 43.1 36.3 Centre Bosnia and Herzegovina 28 93.3 10 35.7 15 53.6 55.6 52.6 East Georgia 595 89.5 200 33.6 338 56.8 57.8 67.7 42.4 West Israel 230 56.9 63 27.4 109 47.4 55.5 58.3 34.8 East Kazakhstan 2 740 75.2 587 21.4 1 286 46.9 52.0 37.8 40.7 East Kyrgyzstan 564 68.9 166 29.4 306 54.3 53.8 65.7 35.5 West Monaco – – – – – – – – – Centre Montenegro 22 84.6 8 36.4 14 63.6 53.8 Centre North Macedonia – – – – – – – – – East Republic of Moldova 736 81.4 220 29.9 384 52.2 53.4 44.7 34.5 East Russian Federation – – – – – – – – – West San Marino – – – – – – – – – Centre Serbia 191 89.7 74 38.7 115 60.2 77.8 – 55.7 Centre Serbia excluding Kosovo1 188 90.4 73 38.8 113 60.1 76.5 – 55.8 Centre Kosovo1 3 60.0 1 33.3 2 66.7 – – – West Switzerland 275 65.5 89 32.4 148 53.8 54.8 90.0 43.8 East Tajikistan 591 52.0 194 32.8 340 57.5 56.7 67.2 60.0 Centre Turkey 489 15.2 87 17.8 209 42.7 49.4 – 38.3 East Turkmenistan – – – – – – – – – East Ukraine 14 941 91.9 5 251 35.1 8 817 59.0 61.1 54.4 48.1 East Uzbekistan – – – – – – – – – Total non-EU/EEA 24 217 77.8 7 709 31.8 13 414 55.4 57.6 51.8 43.9 WHO European Region West West 14 321 67.3 4 087 28.5 6 994 48.8 55.5 49.4 41.1 Centre Centre 2 034 40.1 708 34.8 1 137 55.9 64.9 72.5 47.3 East East 23 141 84.7 7 424 32.1 12 881 55.7 57.7 51.5 43.2 Total WHO European Region 39 496 73.6 12 219 30.9 21 012 53.2 57.5 51.7 42.0 a Country-specific comments are in Annex 5. b There is some variation by country for CD4 cell count completeness by transmission group and numbers of cases by transmission group (sex between men, heterosexual, injecting drug user) and therefore percentages based on five or fewer cases are censored. c 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999).

80 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 14. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 82 1.0 79 0.9 101 1.2 69 0.8 83 1.0 76 0.9 65 0.7 61 0.7 53 0.6 56 0.6 3 307 Austria West Belgium 1983 121 1.1 99 0.9 107 1.0 100 0.9 120 1.1 95 0.8 62 0.5 50 0.4 49 0.4 – – 5 019 Belgium Centre Bulgaria 1987 32 0.4 40 0.5 65 0.9 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 57 0.8 68 1.0 790 Bulgaria Centre Croatia 1986 1 0.0 26 0.6 28 0.7 17 0.4 23 0.5 16 0.4 22 0.5 20 0.5 30 0.7 20 0.5 511 Croatia Centre Cyprus 1986 11 1.3 12 1.4 11 1.3 9 1.0 11 1.3 13 1.5 22 2.6 15 1.8 13 1.5 3 0.3 344 Cyprus Centre Czechia 1986 28 0.3 29 0.3 36 0.3 33 0.3 32 0.3 38 0.4 44 0.4 54 0.5 39 0.4 38 0.4 676 Czechia West Denmark 1980 44 0.8 59 1.1 41 0.7 38 0.7 30 0.5 40 0.7 24 0.4 28 0.5 26 0.4 22 0.4 3 037 Denmark East Estonia 1992 26 2.0 38 2.9 36 2.7 26 2.0 18 1.4 18 1.4 40 3.0 20 1.5 25 1.9 28 2.1 565 Estonia West Finland 1983 31 0.6 24 0.4 19 0.4 20 0.4 20 0.4 18 0.3 30 0.5 18 0.3 21 0.4 18 0.3 742 Finland West France 1982 990 1.5 869 1.3 834 1.3 721 1.1 652 1.0 603 0.9 510 0.8 491 0.7 522 0.8 430 0.6 72 907 France West Germany 1981 527 0.6 518 0.6 511 0.6 441 0.5 393 0.5 362 0.4 310 0.4 295 0.4 242 0.3 74 0.1 32 203 Germany West Greece 1981 103 0.9 102 0.9 123 1.1 140 1.3 128 1.2 139 1.3 139 1.3 120 1.1 102 0.9 86 0.8 4 097 Greece Centre Hungary 1986 28 0.3 32 0.3 48 0.5 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 57 0.6 53 0.5 1 054 Hungary West Iceland 1985 1 0.3 2 0.6 1 0.3 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 2 0.6 4 1.1 77 Iceland West Ireland 1983 38 0.8 47 1.0 38 0.8 30 0.7 33 0.7 21 0.4 14 0.3 21 0.4 14 0.3 6 0.1 1 305 Ireland West Italy 1982 1 149 1.9 1 058 1.8 1 074 1.8 1 078 1.8 931 1.5 872 1.4 873 1.4 800 1.3 716 1.2 571 0.9 71 204 Italy East Latvia 1990 132 6.2 112 5.4 142 6.9 133 6.6 171 8.5 132 6.6 114 5.8 118 6.1 99 5.1 90 4.7 2 077 Latvia – Liechtenstein 1989 0 0.0 1 2.8 1 2.7 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 Liechtenstein East Lithuania 1988 33 1.1 21 0.7 38 1.3 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 37 1.3 21 0.8 610 Lithuania West Luxembourg 1983 8 1.6 12 2.3 8 1.5 11 2.0 9 1.6 10 1.8 12 2.1 6 1.0 4 0.7 3 0.5 334 Luxembourg West Malta 1986 6 1.4 5 1.2 6 1.4 1 0.2 4 0.9 2 0.5 5 1.1 0 0.0 0 0.0 0 0.0 114 Malta West Netherlands 1999 323 1.9 268 1.6 298 1.8 270 1.6 220 1.3 250 1.5 204 1.2 187 1.1 168 1.0 93 0.5 7 575 Netherlands West Norway 1983 22 0.5 19 0.4 25 0.5 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 12 0.2 19 0.4 1 203 Norway Centre Poland 1986 173 0.5 184 0.5 157 0.4 162 0.4 148 0.4 128 0.3 102 0.3 109 0.3 111 0.3 85 0.2 3 771 Poland West Portugal 1985 767 7.3 654 6.2 625 5.9 525 5.0 382 3.7 340 3.3 375 3.6 296 2.9 256 2.5 172 1.7 22 835 Portugal Centre Romania 1985 258 1.3 336 1.7 339 1.7 361 1.8 411 2.1 358 1.8 340 1.7 323 1.6 301 1.5 282 1.5 10 581 Romania Centre Slovakia 1985 2 0.0 4 0.1 7 0.1 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 11 0.2 3 0.1 119 Slovakia Centre Slovenia 1986 7 0.3 15 0.7 12 0.6 11 0.5 17 0.8 11 0.5 10 0.5 7 0.3 10 0.5 7 0.3 276 Slovenia West Spain 1981 1 456 3.1 1 293 2.8 1 175 2.5 858 1.8 678 1.6 607 1.8 539 1.6 510 1.5 367 1.1 251 0.6 88 141 Spain West Sweden 1982 – – – – – – – – – – – – – – – – – – – – 2 170 Sweden West United Kingdom 1981 665 1.1 419 0.7 435 0.7 347 0.5 370 0.6 404 0.6 301 0.5 264 0.4 255 0.4 269 0.4 30 234 United Kingdom Total EU/EEA 7 064 1.4 6 377 1.3 6 341 1.2 5 593 1.1 5 086 1.0 4 706 1.0 4 336 0.9 3 991 0.8 3 599 0.7 2 772 0.5 367 890 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 26 0.9 46 1.6 49 1.7 65 2.2 50 1.7 65 2.2 58 2.0 33 1.1 47 1.6 40 1.4 649 Albania West Andorra 2004 0 0.0 1 1.2 0 0.0 3 3.7 0 0.0 3 3.8 0 0.0 2 2.6 0 0.0 – – 15 Andorra East Armenia 1988 94 3.3 87 3.0 136 4.7 144 5.0 174 6.0 163 5.6 163 5.6 144 4.9 211 7.1 173 5.8 1 866 Armenia East Azerbaijan 1995 250 2.8 195 2.1 235 2.5 189 2.0 200 2.1 193 2.0 161 1.7 168 1.7 182 1.8 196 2.0 2 524 Azerbaijan East Belarus 1991 475 5.0 590 6.3 598 6.4 547 5.8 474 5.0 490 5.2 512 5.4 439 4.6 382 4.0 380 4.0 6 841 Belarus Centre Bosnia and Herzegovina 1986 6 0.2 7 0.2 4 0.1 7 0.2 7 0.2 7 0.2 7 0.2 4 0.1 11 0.3 8 0.2 171 Bosnia and Herzegovina East Georgia 1989 339 8.3 395 9.7 359 8.8 303 7.5 268 6.6 270 6.7 269 6.7 257 6.4 273 6.8 265 6.6 4 266 Georgia West Israel 1981 40 0.5 55 0.7 52 0.7 47 0.6 70 0.9 45 0.6 46 0.6 33 0.4 37 0.4 23 0.3 1 739 Israel East Kazakhstan 1993 252 1.6 241 1.5 237 1.4 258 1.5 250 1.4 272 1.5 348 2.0 361 2.0 433 2.4 441 2.4 4 102 Kazakhstan East Kyrgyzstan 1999 130 2.4 90 1.6 88 1.6 67 1.2 85 1.5 125 2.1 72 1.2 59 1.0 56 0.9 46 0.7 1 040 Kyrgyzstan West Monaco 1985 0 0.0 0 0.0 0 0.0 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 – – 51 Monaco Centre Montenegro 1990 8 1.3 2 0.3 7 1.1 7 1.1 7 1.1 11 1.8 15 2.4 13 2.1 14 2.2 10 1.6 162 Montenegro Centre North Macedonia 1989 6 0.3 8 0.4 10 0.5 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 4 0.2 – – 170 North Macedonia East Republic of Moldova 1989 340 8.3 449 11.0 250 6.1 378 9.3 299 7.3 293 7.2 366 9.0 274 6.7 365 9.0 285 7.0 4 437 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 Russian Federation West San Marino 1986 0 0.0 1 3.2 2 6.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 San Marino Centre Serbia 1985 52 0.6 60 0.7 57 0.6 49 0.5 49 0.6 50 0.6 61 0.7 64 0.7 70 0.8 73 0.7 2 117 Serbia Centre Serbia excluding Kosovo1 1985 51 0.7 53 0.7 55 0.8 46 0.6 48 0.7 47 0.7 56 0.8 58 0.8 62 0.9 68 0.8 2 032 Serbia excluding Kosovo1 Centre Kosovo1 2005 1 0.0 7 0.4 2 0.1 3 0.2 1 0.1 3 0.2 5 0.3 6 0.3 8 0.4 5 0.3 85 Kosovo1 West Switzerland 1980 166 2.1 134 1.7 98 1.2 105 1.3 77 0.9 63 0.8 69 0.8 70 0.8 60 0.7 59 0.7 10 086 Switzerland East Tajikistan 1998 106 1.4 146 1.9 183 2.3 191 2.4 227 2.8 278 3.3 236 2.7 267 3.0 207 2.3 141 1.5 2 181 Tajikistan Centre Turkey 1985 60 0.1 81 0.1 95 0.1 96 0.1 125 0.2 118 0.2 99 0.1 121 0.1 108 0.1 112 0.1 1 797 Turkey East Turkmenistan 2002 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 1988 5 861 12.8 9 189 20.1 10 073 22.2 9 362 20.7 9 844 21.8 8 468 19.8 8 852 20.8 9 308 21.9 8 839 20.9 7 511 17.9 118 557 Ukraine East Uzbekistan 1992 220 0.8 – – – – – – – – – – – – – – – – – – 651 Uzbekistan Total non-EU/EEA 8 431 3.5 11 777 5.6 12 533 5.9 11 828 5.5 12 223 5.6 10 920 5.0 11 343 5.2 11 619 5.2 11 299 5.1 9 763 4.2 163 446 Total non-EU/EEA WHO European Region WHO European Region West West 6 539 1.6 5 718 1.4 5 573 1.3 4 833 1.1 4 246 1.0 3 972 1.0 3 604 0.9 3 266 0.8 2 906 0.7 2 156 0.5 358 418 West Centre Centre 698 0.4 882 0.5 925 0.5 946 0.5 1 015 0.5 917 0.5 894 0.5 875 0.4 883 0.4 802 0.4 23 188 Centre East East 8 258 5.9 11 553 10.4 12 375 11.1 11 642 10.4 12 047 10.7 10 737 9.7 11 181 10.0 11 469 10.2 11 109 9.9 9 577 8.3 149 718 East Total WHO European Region 15 495 2.1 18 153 2.5 18 873 2.6 17 421 2.4 17 308 2.4 15 626 2.2 15 679 2.2 15 610 2.2 14 898 2.0 12 535 1.7 531 324 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 81 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 14. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 82 1.0 79 0.9 101 1.2 69 0.8 83 1.0 76 0.9 65 0.7 61 0.7 53 0.6 56 0.6 3 307 Austria West Belgium 1983 121 1.1 99 0.9 107 1.0 100 0.9 120 1.1 95 0.8 62 0.5 50 0.4 49 0.4 – – 5 019 Belgium Centre Bulgaria 1987 32 0.4 40 0.5 65 0.9 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 57 0.8 68 1.0 790 Bulgaria Centre Croatia 1986 1 0.0 26 0.6 28 0.7 17 0.4 23 0.5 16 0.4 22 0.5 20 0.5 30 0.7 20 0.5 511 Croatia Centre Cyprus 1986 11 1.3 12 1.4 11 1.3 9 1.0 11 1.3 13 1.5 22 2.6 15 1.8 13 1.5 3 0.3 344 Cyprus Centre Czechia 1986 28 0.3 29 0.3 36 0.3 33 0.3 32 0.3 38 0.4 44 0.4 54 0.5 39 0.4 38 0.4 676 Czechia West Denmark 1980 44 0.8 59 1.1 41 0.7 38 0.7 30 0.5 40 0.7 24 0.4 28 0.5 26 0.4 22 0.4 3 037 Denmark East Estonia 1992 26 2.0 38 2.9 36 2.7 26 2.0 18 1.4 18 1.4 40 3.0 20 1.5 25 1.9 28 2.1 565 Estonia West Finland 1983 31 0.6 24 0.4 19 0.4 20 0.4 20 0.4 18 0.3 30 0.5 18 0.3 21 0.4 18 0.3 742 Finland West France 1982 990 1.5 869 1.3 834 1.3 721 1.1 652 1.0 603 0.9 510 0.8 491 0.7 522 0.8 430 0.6 72 907 France West Germany 1981 527 0.6 518 0.6 511 0.6 441 0.5 393 0.5 362 0.4 310 0.4 295 0.4 242 0.3 74 0.1 32 203 Germany West Greece 1981 103 0.9 102 0.9 123 1.1 140 1.3 128 1.2 139 1.3 139 1.3 120 1.1 102 0.9 86 0.8 4 097 Greece Centre Hungary 1986 28 0.3 32 0.3 48 0.5 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 57 0.6 53 0.5 1 054 Hungary West Iceland 1985 1 0.3 2 0.6 1 0.3 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 2 0.6 4 1.1 77 Iceland West Ireland 1983 38 0.8 47 1.0 38 0.8 30 0.7 33 0.7 21 0.4 14 0.3 21 0.4 14 0.3 6 0.1 1 305 Ireland West Italy 1982 1 149 1.9 1 058 1.8 1 074 1.8 1 078 1.8 931 1.5 872 1.4 873 1.4 800 1.3 716 1.2 571 0.9 71 204 Italy East Latvia 1990 132 6.2 112 5.4 142 6.9 133 6.6 171 8.5 132 6.6 114 5.8 118 6.1 99 5.1 90 4.7 2 077 Latvia – Liechtenstein 1989 0 0.0 1 2.8 1 2.7 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 Liechtenstein East Lithuania 1988 33 1.1 21 0.7 38 1.3 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 37 1.3 21 0.8 610 Lithuania West Luxembourg 1983 8 1.6 12 2.3 8 1.5 11 2.0 9 1.6 10 1.8 12 2.1 6 1.0 4 0.7 3 0.5 334 Luxembourg West Malta 1986 6 1.4 5 1.2 6 1.4 1 0.2 4 0.9 2 0.5 5 1.1 0 0.0 0 0.0 0 0.0 114 Malta West Netherlands 1999 323 1.9 268 1.6 298 1.8 270 1.6 220 1.3 250 1.5 204 1.2 187 1.1 168 1.0 93 0.5 7 575 Netherlands West Norway 1983 22 0.5 19 0.4 25 0.5 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 12 0.2 19 0.4 1 203 Norway Centre Poland 1986 173 0.5 184 0.5 157 0.4 162 0.4 148 0.4 128 0.3 102 0.3 109 0.3 111 0.3 85 0.2 3 771 Poland West Portugal 1985 767 7.3 654 6.2 625 5.9 525 5.0 382 3.7 340 3.3 375 3.6 296 2.9 256 2.5 172 1.7 22 835 Portugal Centre Romania 1985 258 1.3 336 1.7 339 1.7 361 1.8 411 2.1 358 1.8 340 1.7 323 1.6 301 1.5 282 1.5 10 581 Romania Centre Slovakia 1985 2 0.0 4 0.1 7 0.1 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 11 0.2 3 0.1 119 Slovakia Centre Slovenia 1986 7 0.3 15 0.7 12 0.6 11 0.5 17 0.8 11 0.5 10 0.5 7 0.3 10 0.5 7 0.3 276 Slovenia West Spain 1981 1 456 3.1 1 293 2.8 1 175 2.5 858 1.8 678 1.6 607 1.8 539 1.6 510 1.5 367 1.1 251 0.6 88 141 Spain West Sweden 1982 – – – – – – – – – – – – – – – – – – – – 2 170 Sweden West United Kingdom 1981 665 1.1 419 0.7 435 0.7 347 0.5 370 0.6 404 0.6 301 0.5 264 0.4 255 0.4 269 0.4 30 234 United Kingdom Total EU/EEA 7 064 1.4 6 377 1.3 6 341 1.2 5 593 1.1 5 086 1.0 4 706 1.0 4 336 0.9 3 991 0.8 3 599 0.7 2 772 0.5 367 890 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 26 0.9 46 1.6 49 1.7 65 2.2 50 1.7 65 2.2 58 2.0 33 1.1 47 1.6 40 1.4 649 Albania West Andorra 2004 0 0.0 1 1.2 0 0.0 3 3.7 0 0.0 3 3.8 0 0.0 2 2.6 0 0.0 – – 15 Andorra East Armenia 1988 94 3.3 87 3.0 136 4.7 144 5.0 174 6.0 163 5.6 163 5.6 144 4.9 211 7.1 173 5.8 1 866 Armenia East Azerbaijan 1995 250 2.8 195 2.1 235 2.5 189 2.0 200 2.1 193 2.0 161 1.7 168 1.7 182 1.8 196 2.0 2 524 Azerbaijan East Belarus 1991 475 5.0 590 6.3 598 6.4 547 5.8 474 5.0 490 5.2 512 5.4 439 4.6 382 4.0 380 4.0 6 841 Belarus Centre Bosnia and Herzegovina 1986 6 0.2 7 0.2 4 0.1 7 0.2 7 0.2 7 0.2 7 0.2 4 0.1 11 0.3 8 0.2 171 Bosnia and Herzegovina East Georgia 1989 339 8.3 395 9.7 359 8.8 303 7.5 268 6.6 270 6.7 269 6.7 257 6.4 273 6.8 265 6.6 4 266 Georgia West Israel 1981 40 0.5 55 0.7 52 0.7 47 0.6 70 0.9 45 0.6 46 0.6 33 0.4 37 0.4 23 0.3 1 739 Israel East Kazakhstan 1993 252 1.6 241 1.5 237 1.4 258 1.5 250 1.4 272 1.5 348 2.0 361 2.0 433 2.4 441 2.4 4 102 Kazakhstan East Kyrgyzstan 1999 130 2.4 90 1.6 88 1.6 67 1.2 85 1.5 125 2.1 72 1.2 59 1.0 56 0.9 46 0.7 1 040 Kyrgyzstan West Monaco 1985 0 0.0 0 0.0 0 0.0 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 – – 51 Monaco Centre Montenegro 1990 8 1.3 2 0.3 7 1.1 7 1.1 7 1.1 11 1.8 15 2.4 13 2.1 14 2.2 10 1.6 162 Montenegro Centre North Macedonia 1989 6 0.3 8 0.4 10 0.5 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 4 0.2 – – 170 North Macedonia East Republic of Moldova 1989 340 8.3 449 11.0 250 6.1 378 9.3 299 7.3 293 7.2 366 9.0 274 6.7 365 9.0 285 7.0 4 437 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 Russian Federation West San Marino 1986 0 0.0 1 3.2 2 6.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 San Marino Centre Serbia 1985 52 0.6 60 0.7 57 0.6 49 0.5 49 0.6 50 0.6 61 0.7 64 0.7 70 0.8 73 0.7 2 117 Serbia Centre Serbia excluding Kosovo1 1985 51 0.7 53 0.7 55 0.8 46 0.6 48 0.7 47 0.7 56 0.8 58 0.8 62 0.9 68 0.8 2 032 Serbia excluding Kosovo1 Centre Kosovo1 2005 1 0.0 7 0.4 2 0.1 3 0.2 1 0.1 3 0.2 5 0.3 6 0.3 8 0.4 5 0.3 85 Kosovo1 West Switzerland 1980 166 2.1 134 1.7 98 1.2 105 1.3 77 0.9 63 0.8 69 0.8 70 0.8 60 0.7 59 0.7 10 086 Switzerland East Tajikistan 1998 106 1.4 146 1.9 183 2.3 191 2.4 227 2.8 278 3.3 236 2.7 267 3.0 207 2.3 141 1.5 2 181 Tajikistan Centre Turkey 1985 60 0.1 81 0.1 95 0.1 96 0.1 125 0.2 118 0.2 99 0.1 121 0.1 108 0.1 112 0.1 1 797 Turkey East Turkmenistan 2002 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 1988 5 861 12.8 9 189 20.1 10 073 22.2 9 362 20.7 9 844 21.8 8 468 19.8 8 852 20.8 9 308 21.9 8 839 20.9 7 511 17.9 118 557 Ukraine East Uzbekistan 1992 220 0.8 – – – – – – – – – – – – – – – – – – 651 Uzbekistan Total non-EU/EEA 8 431 3.5 11 777 5.6 12 533 5.9 11 828 5.5 12 223 5.6 10 920 5.0 11 343 5.2 11 619 5.2 11 299 5.1 9 763 4.2 163 446 Total non-EU/EEA WHO European Region WHO European Region West West 6 539 1.6 5 718 1.4 5 573 1.3 4 833 1.1 4 246 1.0 3 972 1.0 3 604 0.9 3 266 0.8 2 906 0.7 2 156 0.5 358 418 West Centre Centre 698 0.4 882 0.5 925 0.5 946 0.5 1 015 0.5 917 0.5 894 0.5 875 0.4 883 0.4 802 0.4 23 188 Centre East East 8 258 5.9 11 553 10.4 12 375 11.1 11 642 10.4 12 047 10.7 10 737 9.7 11 181 10.0 11 469 10.2 11 109 9.9 9 577 8.3 149 718 East Total WHO European Region 15 495 2.1 18 153 2.5 18 873 2.6 17 421 2.4 17 308 2.4 15 626 2.2 15 679 2.2 15 610 2.2 14 898 2.0 12 535 1.7 531 324 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 82 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 15. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 62 1.5 61 1.5 80 2.0 50 1.2 57 1.4 57 1.4 47 1.1 49 1.1 43 1.0 45 1.0 2 517 Austria West Belgium 70 1.3 58 1.1 66 1.2 70 1.3 79 1.4 59 1.1 38 0.7 35 0.6 32 0.6 – – 3 370 Belgium Centre Bulgaria 21 0.6 38 1.1 47 1.3 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 48 1.4 56 1.6 621 Bulgaria Centre Croatia 1 0.0 25 1.2 26 1.3 14 0.7 21 1.0 15 0.7 21 1.0 19 0.9 28 1.4 18 0.9 456 Croatia Centre Cyprus 8 2.0 7 1.7 9 2.1 5 1.2 10 2.4 9 2.2 17 4.1 9 2.2 8 1.9 2 0.5 260 Cyprus Centre Czechia 21 0.4 20 0.4 28 0.5 27 0.5 23 0.4 30 0.6 38 0.7 44 0.8 35 0.7 28 0.5 550 Czechia West Denmark 34 1.2 40 1.5 35 1.3 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 21 0.7 15 0.5 2 580 Denmark East Estonia 21 3.4 31 5.0 25 4.0 19 3.1 13 2.1 11 1.8 23 3.7 15 2.4 19 3.1 19 3.0 407 Estonia West Finland 22 0.8 17 0.6 16 0.6 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 17 0.6 12 0.4 595 Finland West France 675 2.2 635 2.0 573 1.8 518 1.6 441 1.4 415 1.3 336 1.0 350 1.1 367 1.1 311 1.0 57 112 France West Germany 439 1.1 438 1.1 406 1.0 350 0.9 335 0.8 297 0.7 249 0.6 231 0.6 191 0.5 55 0.1 27 494 Germany West Greece 84 1.5 86 1.6 102 1.9 120 2.2 105 2.0 114 2.2 105 2.0 92 1.8 89 1.7 63 1.2 3 413 Greece Centre Hungary 26 0.5 27 0.6 45 1.0 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 54 1.2 46 1.0 914 Hungary West Iceland 1 0.6 1 0.6 1 0.6 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 0 0.0 3 1.6 65 Iceland West Ireland 27 1.2 34 1.5 27 1.2 22 1.0 23 1.0 16 0.7 11 0.5 15 0.6 13 0.5 4 0.2 1 000 Ireland West Italy 849 3.0 806 2.8 784 2.7 813 2.8 713 2.4 686 2.3 669 2.3 586 2.0 560 1.9 466 1.6 54 918 Italy East Latvia 86 8.9 80 8.4 102 10.9 90 9.7 110 12.0 89 9.8 90 10.0 73 8.2 63 7.1 53 6.0 1 428 Latvia – Liechtenstein 0 0.0 1 5.6 1 5.5 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 11 Liechtenstein East Lithuania 27 1.9 15 1.1 28 2.0 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 29 2.2 16 1.2 493 Lithuania West Luxembourg 4 1.6 8 3.1 5 1.9 10 3.7 6 2.2 6 2.1 10 3.5 5 1.7 3 1.0 1 0.3 255 Luxembourg West Malta 4 1.9 3 1.5 5 2.4 1 0.5 4 1.9 2 0.9 5 2.2 0 0.0 0 0.0 0 0.0 100 Malta West Netherlands 258 3.1 210 2.5 236 2.8 224 2.7 182 2.2 206 2.5 159 1.9 148 1.7 132 1.5 73 0.9 6 064 Netherlands West Norway 20 0.8 17 0.7 23 0.9 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 9 0.3 14 0.5 935 Norway Centre Poland 132 0.7 142 0.8 120 0.7 131 0.7 115 0.6 97 0.5 90 0.5 94 0.5 86 0.5 70 0.4 2 985 Poland West Portugal 538 10.6 484 9.6 443 8.8 364 7.3 295 5.9 244 5.0 268 5.5 215 4.4 171 3.5 112 2.3 17 960 Portugal Centre Romania 148 1.5 207 2.1 211 2.2 245 2.5 291 3.0 249 2.6 245 2.5 240 2.5 218 2.3 196 2.1 6 356 Romania Centre Slovakia 2 0.1 4 0.2 7 0.3 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 11 0.4 3 0.1 106 Slovakia Centre Slovenia 7 0.7 12 1.2 11 1.1 10 1.0 16 1.6 11 1.1 8 0.8 7 0.7 10 1.0 3 0.3 242 Slovenia West Spain 1 136 4.9 1 000 4.3 900 3.9 671 2.9 546 2.8 490 2.9 437 2.6 408 2.4 301 1.8 205 1.1 70 259 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 1 774 Sweden West United Kingdom 430 1.4 284 0.9 301 1.0 247 0.8 249 0.8 301 0.9 226 0.7 188 0.6 189 0.6 205 0.6 23 580 United Kingdom Total EU/EEA 5 153 2.1 4 791 1.9 4 663 1.9 4 195 1.7 3 834 1.6 3 569 1.5 3 290 1.3 2 999 1.2 2 747 1.1 2 094 0.8 288 820 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 18 1.2 35 2.4 34 2.3 50 3.4 36 2.4 50 3.4 50 3.4 24 1.6 35 2.4 26 1.8 497 Albania West Andorra 0 0.0 1 2.4 0 0.0 2 5.0 0 0.0 2 5.2 0 0.0 1 2.6 0 0.0 – – 11 Andorra East Armenia 73 5.4 65 4.8 98 7.3 103 7.6 127 9.3 129 9.4 116 8.4 111 8.0 147 10.6 127 9.1 1 385 Armenia East Azerbaijan 231 5.2 171 3.8 209 4.5 162 3.5 162 3.4 150 3.1 125 2.6 114 2.3 122 2.5 150 3.0 1 981 Azerbaijan East Belarus 291 6.6 365 8.3 375 8.6 369 8.4 308 7.0 278 6.3 311 7.1 274 6.2 229 5.2 241 5.5 4 263 Belarus Centre Bosnia and Herzegovina 6 0.3 4 0.2 4 0.2 6 0.3 7 0.4 7 0.4 6 0.4 4 0.2 11 0.7 6 0.4 143 Bosnia and Herzegovina East Georgia 243 12.4 277 14.2 248 12.8 219 11.3 201 10.4 196 10.2 196 10.2 193 10.1 172 9.0 199 10.4 3 131 Georgia West Israel 24 0.7 37 1.0 37 1.0 36 0.9 48 1.2 26 0.7 28 0.7 23 0.6 27 0.6 15 0.4 1 246 Israel East Kazakhstan 180 2.3 162 2.0 179 2.2 190 2.3 184 2.2 180 2.1 230 2.7 223 2.5 279 3.1 287 3.2 2 811 Kazakhstan East Kyrgyzstan 111 4.1 69 2.5 65 2.3 49 1.7 58 2.0 89 3.0 55 1.8 36 1.2 0 0.0 26 0.8 741 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.5 0 0.0 0 0.0 0 0.0 0 0.0 – – 40 Monaco Centre Montenegro 8 2.6 2 0.6 7 2.3 7 2.3 4 1.3 11 3.5 15 4.8 12 3.9 14 4.5 10 3.2 141 Montenegro Centre North Macedonia 6 0.6 5 0.5 8 0.8 9 0.9 13 1.3 5 0.5 6 0.6 2 0.2 4 0.4 – – 127 North Macedonia East Republic of Moldova 193 9.8 274 14.0 128 6.5 218 11.1 183 9.3 179 9.2 210 10.8 167 8.6 213 11.0 180 9.3 2 689 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 Russian Federation West San Marino 0 0.0 1 6.5 2 12.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 21 San Marino Centre Serbia 45 1.0 50 1.1 51 1.2 41 0.9 43 1.0 47 1.1 57 1.3 58 1.3 62 1.4 57 1.1 1 645 Serbia Centre Serbia excluding Kosovo1 44 1.3 45 1.3 50 1.4 39 1.1 42 1.2 45 1.3 52 1.5 52 1.5 55 1.6 53 1.2 1 579 Serbia excluding Kosovo1 Centre Kosovo1 1 0.1 5 0.6 1 0.1 2 0.2 1 0.1 2 0.2 5 0.6 6 0.7 7 0.8 4 0.5 66 Kosovo1 West Switzerland 124 3.2 96 2.5 68 1.7 73 1.8 61 1.5 51 1.2 47 1.1 52 1.2 47 1.1 50 1.2 7 519 Switzerland East Tajikistan 91 2.4 113 2.9 137 3.4 139 3.4 155 3.7 184 4.3 172 3.9 182 4.1 145 3.2 98 2.1 1 583 Tajikistan Centre Turkey 46 0.1 66 0.2 83 0.2 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 91 0.2 92 0.2 1 494 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 0 Turkmenistan East Ukraine 3 988 18.9 6 141 29.2 6 498 31.0 6 013 28.7 6 119 29.3 5 328 23.2 5 462 27.7 5 612 28.6 5 405 27.6 4 661 24.0 77 354 Ukraine East Uzbekistan 163 1.1 – – – – – – – – – – – – – – – – – – 494 Uzbekistan Total non-EU/EEA 5 841 5.0 7 934 7.7 8 231 8.0 7 763 7.4 7 809 7.4 7 004 6.4 7 172 6.7 7 191 6.7 7 003 6.6 6 225 5.5 109 410 Total non-EU/EEA WHO European Region WHO European Region West West 4 801 2.3 4 317 2.1 4 110 2.0 3 637 1.8 3 219 1.6 3 028 1.5 2 698 1.3 2 444 1.2 2 212 1.1 1 649 0.8 282 828 West Centre Centre 495 0.5 644 0.7 691 0.7 719 0.8 774 0.8 706 0.7 733 0.8 700 0.7 715 0.7 613 0.6 16 537 Centre East East 5 698 8.5 7 763 14.7 8 092 15.3 7 602 14.3 7 649 14.3 6 839 12.2 7 031 13.2 7 046 13.2 6 823 13.5 6 057 11.0 98 854 East Total WHO European Region 10 994 3.0 12 724 3.6 12 893 3.7 11 958 3.4 11 642 3.4 10 573 3.0 10 462 3.0 10 190 2.9 9 750 2.8 8 319 2.3 398 219 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 83 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 15. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 62 1.5 61 1.5 80 2.0 50 1.2 57 1.4 57 1.4 47 1.1 49 1.1 43 1.0 45 1.0 2 517 Austria West Belgium 70 1.3 58 1.1 66 1.2 70 1.3 79 1.4 59 1.1 38 0.7 35 0.6 32 0.6 – – 3 370 Belgium Centre Bulgaria 21 0.6 38 1.1 47 1.3 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 48 1.4 56 1.6 621 Bulgaria Centre Croatia 1 0.0 25 1.2 26 1.3 14 0.7 21 1.0 15 0.7 21 1.0 19 0.9 28 1.4 18 0.9 456 Croatia Centre Cyprus 8 2.0 7 1.7 9 2.1 5 1.2 10 2.4 9 2.2 17 4.1 9 2.2 8 1.9 2 0.5 260 Cyprus Centre Czechia 21 0.4 20 0.4 28 0.5 27 0.5 23 0.4 30 0.6 38 0.7 44 0.8 35 0.7 28 0.5 550 Czechia West Denmark 34 1.2 40 1.5 35 1.3 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 21 0.7 15 0.5 2 580 Denmark East Estonia 21 3.4 31 5.0 25 4.0 19 3.1 13 2.1 11 1.8 23 3.7 15 2.4 19 3.1 19 3.0 407 Estonia West Finland 22 0.8 17 0.6 16 0.6 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 17 0.6 12 0.4 595 Finland West France 675 2.2 635 2.0 573 1.8 518 1.6 441 1.4 415 1.3 336 1.0 350 1.1 367 1.1 311 1.0 57 112 France West Germany 439 1.1 438 1.1 406 1.0 350 0.9 335 0.8 297 0.7 249 0.6 231 0.6 191 0.5 55 0.1 27 494 Germany West Greece 84 1.5 86 1.6 102 1.9 120 2.2 105 2.0 114 2.2 105 2.0 92 1.8 89 1.7 63 1.2 3 413 Greece Centre Hungary 26 0.5 27 0.6 45 1.0 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 54 1.2 46 1.0 914 Hungary West Iceland 1 0.6 1 0.6 1 0.6 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 0 0.0 3 1.6 65 Iceland West Ireland 27 1.2 34 1.5 27 1.2 22 1.0 23 1.0 16 0.7 11 0.5 15 0.6 13 0.5 4 0.2 1 000 Ireland West Italy 849 3.0 806 2.8 784 2.7 813 2.8 713 2.4 686 2.3 669 2.3 586 2.0 560 1.9 466 1.6 54 918 Italy East Latvia 86 8.9 80 8.4 102 10.9 90 9.7 110 12.0 89 9.8 90 10.0 73 8.2 63 7.1 53 6.0 1 428 Latvia – Liechtenstein 0 0.0 1 5.6 1 5.5 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 11 Liechtenstein East Lithuania 27 1.9 15 1.1 28 2.0 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 29 2.2 16 1.2 493 Lithuania West Luxembourg 4 1.6 8 3.1 5 1.9 10 3.7 6 2.2 6 2.1 10 3.5 5 1.7 3 1.0 1 0.3 255 Luxembourg West Malta 4 1.9 3 1.5 5 2.4 1 0.5 4 1.9 2 0.9 5 2.2 0 0.0 0 0.0 0 0.0 100 Malta West Netherlands 258 3.1 210 2.5 236 2.8 224 2.7 182 2.2 206 2.5 159 1.9 148 1.7 132 1.5 73 0.9 6 064 Netherlands West Norway 20 0.8 17 0.7 23 0.9 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 9 0.3 14 0.5 935 Norway Centre Poland 132 0.7 142 0.8 120 0.7 131 0.7 115 0.6 97 0.5 90 0.5 94 0.5 86 0.5 70 0.4 2 985 Poland West Portugal 538 10.6 484 9.6 443 8.8 364 7.3 295 5.9 244 5.0 268 5.5 215 4.4 171 3.5 112 2.3 17 960 Portugal Centre Romania 148 1.5 207 2.1 211 2.2 245 2.5 291 3.0 249 2.6 245 2.5 240 2.5 218 2.3 196 2.1 6 356 Romania Centre Slovakia 2 0.1 4 0.2 7 0.3 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 11 0.4 3 0.1 106 Slovakia Centre Slovenia 7 0.7 12 1.2 11 1.1 10 1.0 16 1.6 11 1.1 8 0.8 7 0.7 10 1.0 3 0.3 242 Slovenia West Spain 1 136 4.9 1 000 4.3 900 3.9 671 2.9 546 2.8 490 2.9 437 2.6 408 2.4 301 1.8 205 1.1 70 259 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 1 774 Sweden West United Kingdom 430 1.4 284 0.9 301 1.0 247 0.8 249 0.8 301 0.9 226 0.7 188 0.6 189 0.6 205 0.6 23 580 United Kingdom Total EU/EEA 5 153 2.1 4 791 1.9 4 663 1.9 4 195 1.7 3 834 1.6 3 569 1.5 3 290 1.3 2 999 1.2 2 747 1.1 2 094 0.8 288 820 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 18 1.2 35 2.4 34 2.3 50 3.4 36 2.4 50 3.4 50 3.4 24 1.6 35 2.4 26 1.8 497 Albania West Andorra 0 0.0 1 2.4 0 0.0 2 5.0 0 0.0 2 5.2 0 0.0 1 2.6 0 0.0 – – 11 Andorra East Armenia 73 5.4 65 4.8 98 7.3 103 7.6 127 9.3 129 9.4 116 8.4 111 8.0 147 10.6 127 9.1 1 385 Armenia East Azerbaijan 231 5.2 171 3.8 209 4.5 162 3.5 162 3.4 150 3.1 125 2.6 114 2.3 122 2.5 150 3.0 1 981 Azerbaijan East Belarus 291 6.6 365 8.3 375 8.6 369 8.4 308 7.0 278 6.3 311 7.1 274 6.2 229 5.2 241 5.5 4 263 Belarus Centre Bosnia and Herzegovina 6 0.3 4 0.2 4 0.2 6 0.3 7 0.4 7 0.4 6 0.4 4 0.2 11 0.7 6 0.4 143 Bosnia and Herzegovina East Georgia 243 12.4 277 14.2 248 12.8 219 11.3 201 10.4 196 10.2 196 10.2 193 10.1 172 9.0 199 10.4 3 131 Georgia West Israel 24 0.7 37 1.0 37 1.0 36 0.9 48 1.2 26 0.7 28 0.7 23 0.6 27 0.6 15 0.4 1 246 Israel East Kazakhstan 180 2.3 162 2.0 179 2.2 190 2.3 184 2.2 180 2.1 230 2.7 223 2.5 279 3.1 287 3.2 2 811 Kazakhstan East Kyrgyzstan 111 4.1 69 2.5 65 2.3 49 1.7 58 2.0 89 3.0 55 1.8 36 1.2 0 0.0 26 0.8 741 Kyrgyzstan West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 1 5.5 0 0.0 0 0.0 0 0.0 0 0.0 – – 40 Monaco Centre Montenegro 8 2.6 2 0.6 7 2.3 7 2.3 4 1.3 11 3.5 15 4.8 12 3.9 14 4.5 10 3.2 141 Montenegro Centre North Macedonia 6 0.6 5 0.5 8 0.8 9 0.9 13 1.3 5 0.5 6 0.6 2 0.2 4 0.4 – – 127 North Macedonia East Republic of Moldova 193 9.8 274 14.0 128 6.5 218 11.1 183 9.3 179 9.2 210 10.8 167 8.6 213 11.0 180 9.3 2 689 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 Russian Federation West San Marino 0 0.0 1 6.5 2 12.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 21 San Marino Centre Serbia 45 1.0 50 1.1 51 1.2 41 0.9 43 1.0 47 1.1 57 1.3 58 1.3 62 1.4 57 1.1 1 645 Serbia Centre Serbia excluding Kosovo1 44 1.3 45 1.3 50 1.4 39 1.1 42 1.2 45 1.3 52 1.5 52 1.5 55 1.6 53 1.2 1 579 Serbia excluding Kosovo1 Centre Kosovo1 1 0.1 5 0.6 1 0.1 2 0.2 1 0.1 2 0.2 5 0.6 6 0.7 7 0.8 4 0.5 66 Kosovo1 West Switzerland 124 3.2 96 2.5 68 1.7 73 1.8 61 1.5 51 1.2 47 1.1 52 1.2 47 1.1 50 1.2 7 519 Switzerland East Tajikistan 91 2.4 113 2.9 137 3.4 139 3.4 155 3.7 184 4.3 172 3.9 182 4.1 145 3.2 98 2.1 1 583 Tajikistan Centre Turkey 46 0.1 66 0.2 83 0.2 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 91 0.2 92 0.2 1 494 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 0 Turkmenistan East Ukraine 3 988 18.9 6 141 29.2 6 498 31.0 6 013 28.7 6 119 29.3 5 328 23.2 5 462 27.7 5 612 28.6 5 405 27.6 4 661 24.0 77 354 Ukraine East Uzbekistan 163 1.1 – – – – – – – – – – – – – – – – – – 494 Uzbekistan Total non-EU/EEA 5 841 5.0 7 934 7.7 8 231 8.0 7 763 7.4 7 809 7.4 7 004 6.4 7 172 6.7 7 191 6.7 7 003 6.6 6 225 5.5 109 410 Total non-EU/EEA WHO European Region WHO European Region West West 4 801 2.3 4 317 2.1 4 110 2.0 3 637 1.8 3 219 1.6 3 028 1.5 2 698 1.3 2 444 1.2 2 212 1.1 1 649 0.8 282 828 West Centre Centre 495 0.5 644 0.7 691 0.7 719 0.8 774 0.8 706 0.7 733 0.8 700 0.7 715 0.7 613 0.6 16 537 Centre East East 5 698 8.5 7 763 14.7 8 092 15.3 7 602 14.3 7 649 14.3 6 839 12.2 7 031 13.2 7 046 13.2 6 823 13.5 6 057 11.0 98 854 East Total WHO European Region 10 994 3.0 12 724 3.6 12 893 3.7 11 958 3.4 11 642 3.4 10 573 3.0 10 462 3.0 10 190 2.9 9 750 2.8 8 319 2.3 398 219 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 84 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 16. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 20 0.5 18 0.4 21 0.5 19 0.4 26 0.6 19 0.4 18 0.4 12 0.3 10 0.2 11 0.2 790 Austria West Belgium 51 0.9 40 0.7 41 0.7 30 0.5 40 0.7 35 0.6 24 0.4 15 0.3 17 0.3 – – 1 643 Belgium Centre Bulgaria 11 0.3 2 0.1 18 0.5 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 9 0.2 12 0.3 169 Bulgaria Centre Croatia 0 0.0 1 0.0 2 0.1 3 0.1 2 0.1 1 0.0 1 0.0 1 0.0 2 0.1 2 0.1 55 Croatia Centre Cyprus 3 0.7 5 1.2 2 0.5 4 0.9 1 0.2 4 0.9 5 1.1 6 1.4 5 1.1 1 0.2 84 Cyprus Centre Czechia 7 0.1 9 0.2 8 0.1 6 0.1 9 0.2 8 0.1 6 0.1 10 0.2 4 0.1 10 0.2 126 Czechia West Denmark 10 0.4 19 0.7 6 0.2 9 0.3 6 0.2 12 0.4 5 0.2 3 0.1 5 0.2 7 0.2 457 Denmark East Estonia 5 0.7 7 1.0 11 1.6 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 6 0.9 9 1.3 158 Estonia West Finland 9 0.3 7 0.3 3 0.1 3 0.1 6 0.2 5 0.2 5 0.2 8 0.3 4 0.1 6 0.2 147 Finland West France 311 0.9 232 0.7 258 0.8 198 0.6 210 0.6 183 0.5 170 0.5 137 0.4 152 0.4 112 0.3 15 733 France West Germany 88 0.2 80 0.2 105 0.3 91 0.2 58 0.1 65 0.2 61 0.1 64 0.2 51 0.1 19 0.0 4 709 Germany West Greece 19 0.3 16 0.3 21 0.4 20 0.4 23 0.4 25 0.4 34 0.6 28 0.5 13 0.2 23 0.4 684 Greece Centre Hungary 2 0.0 5 0.1 3 0.1 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 3 0.1 7 0.1 140 Hungary West Iceland 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 1 0.6 12 Iceland West Ireland 11 0.5 13 0.6 11 0.5 8 0.3 10 0.4 5 0.2 3 0.1 6 0.2 1 0.0 2 0.1 303 Ireland West Italy 300 1.0 252 0.8 290 0.9 265 0.9 218 0.7 186 0.6 204 0.7 214 0.7 156 0.5 105 0.3 16 286 Italy East Latvia 46 4.0 32 2.8 40 3.6 43 3.9 61 5.6 43 4.0 24 2.3 45 4.3 36 3.4 37 3.6 649 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 0.0 0 0.0 1 Liechtenstein East Lithuania 6 0.4 6 0.4 10 0.6 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 8 0.5 5 0.3 117 Lithuania West Luxembourg 4 1.6 4 1.6 3 1.1 1 0.4 3 1.1 4 1.4 2 0.7 1 0.3 1 0.3 2 0.7 78 Luxembourg West Malta 2 1.0 2 1.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Malta West Netherlands 65 0.8 57 0.7 61 0.7 46 0.5 38 0.4 42 0.5 43 0.5 37 0.4 31 0.4 18 0.2 1 476 Netherlands West Norway 2 0.1 2 0.1 2 0.1 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 3 0.1 5 0.2 268 Norway Centre Poland 41 0.2 42 0.2 37 0.2 31 0.2 33 0.2 31 0.2 12 0.1 15 0.1 25 0.1 15 0.1 786 Poland West Portugal 229 4.2 170 3.1 182 3.3 161 2.9 87 1.6 96 1.8 107 2.0 81 1.5 85 1.6 60 1.1 4 874 Portugal Centre Romania 110 1.1 129 1.2 128 1.2 116 1.1 120 1.2 109 1.1 95 0.9 83 0.8 83 0.8 86 0.9 4 225 Romania Centre Slovakia 0 0.0 0 0.0 0 0.0 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 13 Slovakia Centre Slovenia 0 0.0 3 0.3 1 0.1 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 0 0.0 4 0.4 34 Slovenia West Spain 320 1.4 293 1.2 275 1.2 187 0.8 132 0.7 117 0.7 102 0.6 102 0.6 64 0.4 46 0.2 17 876 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 396 Sweden West United Kingdom 235 0.7 135 0.4 134 0.4 100 0.3 121 0.4 101 0.3 74 0.2 75 0.2 66 0.2 64 0.2 6 650 United Kingdom Total EU/EEA 1 907 0.8 1 582 0.6 1 674 0.7 1 393 0.5 1 250 0.5 1 127 0.4 1 039 0.4 985 0.4 842 0.3 669 0.3 78 953 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 8 0.5 11 0.8 15 1.0 15 1.0 14 1.0 15 1.1 8 0.6 9 0.6 12 0.8 14 1.0 152 Albania West Andorra 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 0 0.0 1 2.6 0 0.0 – – 4 Andorra East Armenia 21 1.4 22 1.4 38 2.5 41 2.7 47 3.0 34 2.2 47 3.0 33 2.1 64 4.1 46 2.9 481 Armenia East Azerbaijan 19 0.4 24 0.5 26 0.6 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 60 1.2 46 0.9 438 Azerbaijan East Belarus 184 3.7 225 4.5 223 4.4 178 3.5 166 3.3 212 4.2 201 4.0 165 3.3 153 3.0 139 2.8 2 578 Belarus Centre Bosnia and Herzegovina 0 0.0 3 0.2 0 0.0 1 0.1 0 0.0 0 0.0 1 0.1 0 0.0 0 0.0 2 0.1 26 Bosnia and Herzegovina East Georgia 96 4.5 118 5.5 111 5.2 84 4.0 67 3.2 74 3.5 73 3.5 64 3.1 101 4.8 66 3.2 1 135 Georgia West Israel 16 0.4 18 0.5 15 0.4 11 0.3 22 0.6 19 0.5 18 0.4 10 0.2 10 0.2 8 0.2 493 Israel East Kazakhstan 72 0.9 79 0.9 58 0.7 68 0.8 66 0.7 92 1.0 118 1.3 138 1.5 154 1.6 154 1.6 1 291 Kazakhstan East Kyrgyzstan 19 0.7 21 0.8 23 0.8 18 0.6 27 0.9 36 1.2 17 0.6 23 0.7 22 0.7 20 0.6 262 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 – – 11 Monaco Centre Montenegro 0 0.0 0 0.0 0 0.0 0 0.0 3 0.9 0 0.0 0 0.0 1 0.3 0 0.0 0 0.0 21 Montenegro Centre North Macedonia 0 0.0 0 0.0 2 0.2 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 0 0.0 – – 36 North Macedonia East Republic of Moldova 147 6.9 175 8.3 122 5.8 160 7.6 116 5.5 114 5.4 156 7.4 107 5.1 152 7.2 105 5.0 1 748 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 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 7 0.2 10 0.2 6 0.1 8 0.2 6 0.1 3 0.1 4 0.1 6 0.1 8 0.2 16 0.3 472 Serbia Centre Serbia excluding Kosovo1 7 0.2 8 0.2 5 0.1 7 0.2 6 0.2 2 0.1 4 0.1 6 0.2 7 0.2 15 0.3 453 Serbia excluding Kosovo1 Centre Kosovo1 – 0.0 2 0.2 1 0.1 1 0.1 – 0.0 1 0.1 – 0.0 – 0.0 1 0.1 1 0.1 19 Kosovo1 West Switzerland 42 1.1 38 0.9 30 0.7 32 0.8 16 0.4 12 0.3 21 0.5 17 0.4 12 0.3 9 0.2 2 563 Switzerland East Tajikistan 15 0.4 33 0.9 46 1.2 52 1.3 72 1.8 94 2.2 64 1.5 85 1.9 62 1.4 43 0.9 598 Tajikistan Centre Turkey 14 0.0 15 0.0 12 0.0 19 0.0 26 0.1 26 0.1 13 0.0 18 0.0 17 0.0 20 0.0 303 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 1 873 7.6 3 048 12.4 3 575 14.6 3 349 13.7 3 725 15.4 3 140 15.9 3 390 14.8 3 696 16.2 3 434 15.2 2 850 12.7 41 203 Ukraine East Uzbekistan 57 0.4 – – – – – – – – – – – – – – – – – – 157 Uzbekistan Total non-EU/EEA 2 590 2.2 3 840 3.6 4 302 4.0 4 065 3.7 4 414 4.0 3 916 3.7 4 169 3.7 4 427 4.0 4 261 3.8 3 538 3.0 53 986 Total non-EU/EEA WHO European Region WHO European Region West West 1 734 0.8 1 397 0.7 1 459 0.7 1 191 0.6 1 025 0.5 934 0.5 898 0.4 814 0.4 683 0.3 498 0.2 75 469 West Centre Centre 203 0.2 235 0.3 234 0.3 227 0.2 241 0.3 211 0.2 160 0.2 175 0.2 168 0.2 189 0.2 6 642 Centre East East 2 560 3.5 3 790 6.5 4 283 7.3 4 040 6.8 4 398 7.4 3 898 7.1 4 150 7.1 4 423 7.5 4 252 7.2 3 520 5.8 50 827 East Total WHO European Region 4 497 1.2 5 422 1.5 5 976 1.7 5 458 1.5 5 664 1.6 5 043 1.4 5 208 1.4 5 412 1.5 5 103 1.4 4 207 1.1 132 938 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 85 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 16. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 20 0.5 18 0.4 21 0.5 19 0.4 26 0.6 19 0.4 18 0.4 12 0.3 10 0.2 11 0.2 790 Austria West Belgium 51 0.9 40 0.7 41 0.7 30 0.5 40 0.7 35 0.6 24 0.4 15 0.3 17 0.3 – – 1 643 Belgium Centre Bulgaria 11 0.3 2 0.1 18 0.5 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 9 0.2 12 0.3 169 Bulgaria Centre Croatia 0 0.0 1 0.0 2 0.1 3 0.1 2 0.1 1 0.0 1 0.0 1 0.0 2 0.1 2 0.1 55 Croatia Centre Cyprus 3 0.7 5 1.2 2 0.5 4 0.9 1 0.2 4 0.9 5 1.1 6 1.4 5 1.1 1 0.2 84 Cyprus Centre Czechia 7 0.1 9 0.2 8 0.1 6 0.1 9 0.2 8 0.1 6 0.1 10 0.2 4 0.1 10 0.2 126 Czechia West Denmark 10 0.4 19 0.7 6 0.2 9 0.3 6 0.2 12 0.4 5 0.2 3 0.1 5 0.2 7 0.2 457 Denmark East Estonia 5 0.7 7 1.0 11 1.6 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 6 0.9 9 1.3 158 Estonia West Finland 9 0.3 7 0.3 3 0.1 3 0.1 6 0.2 5 0.2 5 0.2 8 0.3 4 0.1 6 0.2 147 Finland West France 311 0.9 232 0.7 258 0.8 198 0.6 210 0.6 183 0.5 170 0.5 137 0.4 152 0.4 112 0.3 15 733 France West Germany 88 0.2 80 0.2 105 0.3 91 0.2 58 0.1 65 0.2 61 0.1 64 0.2 51 0.1 19 0.0 4 709 Germany West Greece 19 0.3 16 0.3 21 0.4 20 0.4 23 0.4 25 0.4 34 0.6 28 0.5 13 0.2 23 0.4 684 Greece Centre Hungary 2 0.0 5 0.1 3 0.1 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 3 0.1 7 0.1 140 Hungary West Iceland 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 1 0.6 12 Iceland West Ireland 11 0.5 13 0.6 11 0.5 8 0.3 10 0.4 5 0.2 3 0.1 6 0.2 1 0.0 2 0.1 303 Ireland West Italy 300 1.0 252 0.8 290 0.9 265 0.9 218 0.7 186 0.6 204 0.7 214 0.7 156 0.5 105 0.3 16 286 Italy East Latvia 46 4.0 32 2.8 40 3.6 43 3.9 61 5.6 43 4.0 24 2.3 45 4.3 36 3.4 37 3.6 649 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 0.0 0 0.0 1 Liechtenstein East Lithuania 6 0.4 6 0.4 10 0.6 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 8 0.5 5 0.3 117 Lithuania West Luxembourg 4 1.6 4 1.6 3 1.1 1 0.4 3 1.1 4 1.4 2 0.7 1 0.3 1 0.3 2 0.7 78 Luxembourg West Malta 2 1.0 2 1.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Malta West Netherlands 65 0.8 57 0.7 61 0.7 46 0.5 38 0.4 42 0.5 43 0.5 37 0.4 31 0.4 18 0.2 1 476 Netherlands West Norway 2 0.1 2 0.1 2 0.1 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 3 0.1 5 0.2 268 Norway Centre Poland 41 0.2 42 0.2 37 0.2 31 0.2 33 0.2 31 0.2 12 0.1 15 0.1 25 0.1 15 0.1 786 Poland West Portugal 229 4.2 170 3.1 182 3.3 161 2.9 87 1.6 96 1.8 107 2.0 81 1.5 85 1.6 60 1.1 4 874 Portugal Centre Romania 110 1.1 129 1.2 128 1.2 116 1.1 120 1.2 109 1.1 95 0.9 83 0.8 83 0.8 86 0.9 4 225 Romania Centre Slovakia 0 0.0 0 0.0 0 0.0 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 13 Slovakia Centre Slovenia 0 0.0 3 0.3 1 0.1 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 0 0.0 4 0.4 34 Slovenia West Spain 320 1.4 293 1.2 275 1.2 187 0.8 132 0.7 117 0.7 102 0.6 102 0.6 64 0.4 46 0.2 17 876 Spain West Sweden – – – – – – – – – – – – – – – – – – – – 396 Sweden West United Kingdom 235 0.7 135 0.4 134 0.4 100 0.3 121 0.4 101 0.3 74 0.2 75 0.2 66 0.2 64 0.2 6 650 United Kingdom Total EU/EEA 1 907 0.8 1 582 0.6 1 674 0.7 1 393 0.5 1 250 0.5 1 127 0.4 1 039 0.4 985 0.4 842 0.3 669 0.3 78 953 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 8 0.5 11 0.8 15 1.0 15 1.0 14 1.0 15 1.1 8 0.6 9 0.6 12 0.8 14 1.0 152 Albania West Andorra 0 0.0 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 0 0.0 1 2.6 0 0.0 – – 4 Andorra East Armenia 21 1.4 22 1.4 38 2.5 41 2.7 47 3.0 34 2.2 47 3.0 33 2.1 64 4.1 46 2.9 481 Armenia East Azerbaijan 19 0.4 24 0.5 26 0.6 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 60 1.2 46 0.9 438 Azerbaijan East Belarus 184 3.7 225 4.5 223 4.4 178 3.5 166 3.3 212 4.2 201 4.0 165 3.3 153 3.0 139 2.8 2 578 Belarus Centre Bosnia and Herzegovina 0 0.0 3 0.2 0 0.0 1 0.1 0 0.0 0 0.0 1 0.1 0 0.0 0 0.0 2 0.1 26 Bosnia and Herzegovina East Georgia 96 4.5 118 5.5 111 5.2 84 4.0 67 3.2 74 3.5 73 3.5 64 3.1 101 4.8 66 3.2 1 135 Georgia West Israel 16 0.4 18 0.5 15 0.4 11 0.3 22 0.6 19 0.5 18 0.4 10 0.2 10 0.2 8 0.2 493 Israel East Kazakhstan 72 0.9 79 0.9 58 0.7 68 0.8 66 0.7 92 1.0 118 1.3 138 1.5 154 1.6 154 1.6 1 291 Kazakhstan East Kyrgyzstan 19 0.7 21 0.8 23 0.8 18 0.6 27 0.9 36 1.2 17 0.6 23 0.7 22 0.7 20 0.6 262 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 – – 11 Monaco Centre Montenegro 0 0.0 0 0.0 0 0.0 0 0.0 3 0.9 0 0.0 0 0.0 1 0.3 0 0.0 0 0.0 21 Montenegro Centre North Macedonia 0 0.0 0 0.0 2 0.2 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 0 0.0 – – 36 North Macedonia East Republic of Moldova 147 6.9 175 8.3 122 5.8 160 7.6 116 5.5 114 5.4 156 7.4 107 5.1 152 7.2 105 5.0 1 748 Republic of Moldova East Russian Federation 0 0.0 – – – – – – – – – – – – – – – – – – 0 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 7 0.2 10 0.2 6 0.1 8 0.2 6 0.1 3 0.1 4 0.1 6 0.1 8 0.2 16 0.3 472 Serbia Centre Serbia excluding Kosovo1 7 0.2 8 0.2 5 0.1 7 0.2 6 0.2 2 0.1 4 0.1 6 0.2 7 0.2 15 0.3 453 Serbia excluding Kosovo1 Centre Kosovo1 – 0.0 2 0.2 1 0.1 1 0.1 – 0.0 1 0.1 – 0.0 – 0.0 1 0.1 1 0.1 19 Kosovo1 West Switzerland 42 1.1 38 0.9 30 0.7 32 0.8 16 0.4 12 0.3 21 0.5 17 0.4 12 0.3 9 0.2 2 563 Switzerland East Tajikistan 15 0.4 33 0.9 46 1.2 52 1.3 72 1.8 94 2.2 64 1.5 85 1.9 62 1.4 43 0.9 598 Tajikistan Centre Turkey 14 0.0 15 0.0 12 0.0 19 0.0 26 0.1 26 0.1 13 0.0 18 0.0 17 0.0 20 0.0 303 Turkey East Turkmenistan 0 0.0 0 0.0 0 0.0 – – – – – – – – – – – – – – 1 Turkmenistan East Ukraine 1 873 7.6 3 048 12.4 3 575 14.6 3 349 13.7 3 725 15.4 3 140 15.9 3 390 14.8 3 696 16.2 3 434 15.2 2 850 12.7 41 203 Ukraine East Uzbekistan 57 0.4 – – – – – – – – – – – – – – – – – – 157 Uzbekistan Total non-EU/EEA 2 590 2.2 3 840 3.6 4 302 4.0 4 065 3.7 4 414 4.0 3 916 3.7 4 169 3.7 4 427 4.0 4 261 3.8 3 538 3.0 53 986 Total non-EU/EEA WHO European Region WHO European Region West West 1 734 0.8 1 397 0.7 1 459 0.7 1 191 0.6 1 025 0.5 934 0.5 898 0.4 814 0.4 683 0.3 498 0.2 75 469 West Centre Centre 203 0.2 235 0.3 234 0.3 227 0.2 241 0.3 211 0.2 160 0.2 175 0.2 168 0.2 189 0.2 6 642 Centre East East 2 560 3.5 3 790 6.5 4 283 7.3 4 040 6.8 4 398 7.4 3 898 7.1 4 150 7.1 4 423 7.5 4 252 7.2 3 520 5.8 50 827 East Total WHO European Region 4 497 1.2 5 422 1.5 5 976 1.7 5 458 1.5 5 664 1.6 5 043 1.4 5 208 1.4 5 412 1.5 5 103 1.4 4 207 1.1 132 938 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 86 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 17. AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 30 34 32 23 25 21 25 24 21 23 1 129 West Belgium 36 34 32 33 40 34 19 18 15 – 1 589 Centre Bulgaria 5 2 8 12 9 12 11 15 17 28 159 Centre Croatia 0 18 22 11 18 12 21 17 25 17 304 Centre Cyprus 5 3 2 4 5 5 10 6 3 1 140 Centre Czechia 10 15 15 16 13 19 24 29 19 17 330 West Denmark 15 13 13 11 10 11 7 8 9 8 1 759 East Estonia 0 0 1 0 1 0 1 1 0 0 29 West Finland 6 6 2 4 6 7 5 3 3 1 312 West France 252 244 194 207 155 159 132 133 143 114 28 778 West Germany 260 232 231 197 183 155 113 115 94 35 18 654 West Greece 64 55 51 53 44 63 55 49 46 29 2 162 Centre Hungary 23 24 37 29 37 33 41 29 47 37 738 West Iceland 0 0 0 0 0 0 1 0 0 3 47 West Ireland 13 17 13 8 12 11 7 10 4 2 415 West Italy 255 266 263 306 271 287 260 213 223 181 12 815 East Latvia 10 7 4 10 7 5 4 10 6 3 135 – Liechtenstein 0 0 0 0 1 0 0 0 0 0 2 East Lithuania 0 2 2 5 3 3 9 7 3 0 93 West Luxembourg 2 6 3 7 3 4 6 2 1 0 142 West Malta 0 1 0 1 1 0 2 0 0 0 44 West Netherlands 148 130 149 145 105 120 93 85 78 44 3 705 West Norway 9 9 10 15 18 4 4 2 6 3 523 Centre Poland 29 45 25 48 40 30 31 23 24 17 758 West Portugal 89 94 92 64 63 69 82 61 40 27 3 065 Centre Romania 13 13 8 17 25 19 24 28 25 35 306 Centre Slovakia 1 3 3 2 2 2 7 5 5 1 63 Centre Slovenia 7 7 9 7 10 10 6 3 6 2 158 West Spain 403 366 358 274 238 212 191 204 135 100 13 979 West Sweden – – – – – – – – – – 1 086 West United Kingdom 196 140 160 113 129 139 106 98 86 87 15 370 Total EU/EEA 1 881 1 786 1 739 1 622 1 474 1 446 1 297 1 198 1 084 815 108 789 Non-EU/EEA Centre Albania 1 5 6 6 8 8 3 1 1 2 63 West Andorra 0 1 0 2 0 1 0 0 0 – 7 East Armenia 2 2 2 4 7 1 3 4 6 7 44 East Azerbaijan 4 1 1 3 2 1 2 0 5 8 33 East Belarus 2 6 3 3 4 3 4 6 4 76 45 Centre Bosnia and Herzegovina 5 2 4 3 6 4 4 1 8 3 54 East Georgia 10 12 10 16 21 24 18 21 26 26 218 West Israel 6 8 7 10 14 4 2 6 2 2 334 East Kazakhstan 1 1 0 4 1 2 2 2 2 6 25 East Kyrgyzstan 0 0 0 0 0 0 0 0 0 1 2 West Monaco 0 0 0 0 1 0 0 0 0 – 22 Centre Montenegro 6 1 4 3 3 8 9 11 11 4 82 Centre North Macedonia 1 4 3 3 5 2 4 2 2 – 47 East Republic of Moldova 2 3 0 2 3 2 1 8 5 3 40 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 1 2 0 0 0 0 0 0 0 11 Centre Serbia 23 22 31 20 27 28 36 30 45 44 580 Centre Serbia excluding Kosovo1 23 21 30 19 27 26 36 30 43 41 565 Centre Kosovo1 1 1 1 2 2 3 15 West Switzerland 62 37 34 32 24 25 26 26 22 15 3 409 East Tajikistan 0 0 0 0 0 0 1 3 0 0 4 Centre Turkey 3 0 0 12 15 12 17 14 12 15 178 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 10 31 45 50 55 72 116 69 81 82 659 East Uzbekistan 0 – – – – – – – – – 1 Total non-EU/EEA 138 137 152 173 196 197 248 204 232 225 5 858 WHO European Region West West 1 846 1 694 1 646 1 505 1 342 1 326 1 136 1 057 928 674 109 357 Centre Centre 132 164 177 193 223 204 248 214 250 223 3 960 East East 41 65 68 97 104 113 161 131 138 143 1 328 Total WHO European Region 2 019 1 923 1 891 1 795 1 669 1 643 1 545 1 402 1 316 1 040 114 645 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 87 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 18. AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 14 13 28 14 21 18 10 10 1 6 904 West Belgium 3 4 1 3 7 1 0 1 0 – 288 Centre Bulgaria 10 17 39 29 26 11 14 17 20 18 215 Centre Croatia 1 1 1 0 0 1 0 2 0 0 26 Centre Cyprus 0 0 0 0 1 0 0 0 0 0 4 Centre Czechia 4 1 2 3 2 3 4 2 4 4 53 West Denmark 4 4 4 5 1 0 1 1 0 0 252 East Estonia 14 20 15 9 6 4 16 3 11 9 284 West Finland 3 0 4 2 0 0 1 1 3 0 60 West France 60 62 45 42 30 31 19 12 19 16 13 953 West Germany 36 41 42 31 26 21 18 13 18 4 4 429 West Greece 3 9 22 41 45 31 25 19 12 9 330 Centre Hungary 0 0 0 0 0 2 2 1 1 1 13 West Iceland 0 0 0 0 0 0 2 0 0 0 7 West Ireland 6 10 3 1 0 0 0 1 2 0 377 West Italy 229 195 180 179 114 101 89 89 78 70 35 267 East Latvia 70 57 70 62 73 51 36 38 30 32 1 022 – Liechtenstein 0 1 0 0 0 0 0 0 0 0 7 East Lithuania 20 9 22 19 16 15 19 23 14 11 278 West Luxembourg 0 1 0 1 1 1 0 1 0 0 46 West Malta 0 0 0 0 1 0 0 0 0 0 4 West Netherlands 8 9 3 4 1 4 4 3 3 2 381 West Norway 3 0 1 1 0 0 1 0 0 1 157 Centre Poland 70 62 59 46 32 34 23 23 10 8 1 601 West Portugal 240 165 165 115 68 47 41 39 22 13 9 553 Centre Romania 14 29 61 82 114 105 103 73 55 37 699 Centre Slovakia 0 0 0 0 0 0 0 0 1 0 2 Centre Slovenia 0 0 0 0 1 0 0 0 0 1 8 West Spain 432 366 301 195 135 87 66 59 44 25 50 514 West Sweden – – – – – – – – – – 242 West United Kingdom 22 12 11 9 13 9 10 5 9 6 1 512 Total EU/EEA 1 266 1 088 1 079 893 734 577 504 436 357 273 122 488 Non-EU/EEA Centre Albania 0 1 0 0 1 0 0 0 0 0 3 West Andorra 0 0 0 0 0 0 0 0 0 – 2 East Armenia 42 33 46 26 35 23 30 18 18 84 2 652 East Azerbaijan 183 148 160 123 109 92 76 52 51 60 1 421 East Belarus 208 266 242 193 150 139 130 116 60 14 2 582 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 18 East Georgia 184 191 161 142 120 99 110 86 50 61 1 982 West Israel 4 7 10 15 12 9 9 6 7 2 272 East Kazakhstan 174 149 152 158 149 154 173 168 192 185 2 395 East Kyrgyzstan 102 58 55 38 40 73 30 23 10 3 596 West Monaco 0 0 0 0 0 0 0 0 0 – 19 Centre Montenegro 0 0 1 0 0 0 0 0 0 0 4 Centre North Macedonia 0 0 0 0 0 0 0 0 0 – 9 East Republic of Moldova 95 102 39 54 42 46 39 31 35 23 1 068 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 0 0 0 0 0 0 0 0 0 6 Centre Serbia 7 12 5 9 5 5 5 1 2 662 Centre Serbia excluding Kosovo1 7 12 5 9 5 5 0 5 1 2 661 Centre Kosovo1 – – – – – – – – – – 1 West Switzerland 11 18 6 11 4 2 5 8 0 4 3 325 East Tajikistan 62 72 86 58 74 97 84 75 39 26 803 Centre Turkey 2 2 1 1 2 0 2 1 0 0 64 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 3 458 4 979 4 933 4 273 3 856 3 050 2 939 2 872 2 343 1 916 51 724 East Uzbekistan 131 – – – – – – – – – 380 Total non-EU/EEA 4 663 6 038 5 897 5 101 4 599 3 789 3 627 3 461 2 806 2 380 67 877 WHO European Region West West 1 078 916 826 669 479 362 301 268 218 158 121 900 Centre Centre 108 125 169 170 184 161 148 124 92 71 3 381 East East 4 743 6 084 5 981 5 155 4 670 3 843 3 682 3 505 2 853 2 424 65 077 Total WHO European Region 5 929 7 125 6 976 5 994 5 333 4 366 4 131 3 897 3 163 2 653 190 358 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 88 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 19. AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 31 29 35 27 34 29 22 22 26 21 971 West Belgium 77 53 68 54 65 50 39 25 27 – 2 635 Centre Bulgaria 14 20 15 20 25 22 17 17 17 22 377 Centre Croatia 0 6 4 6 5 2 1 1 5 2 155 Centre Cyprus 5 9 6 4 3 8 11 9 9 2 175 Centre Czechia 13 13 14 12 16 16 15 22 13 16 252 West Denmark 23 40 22 21 17 27 14 16 16 14 833 East Estonia 7 9 16 10 8 14 16 12 9 14 190 West Finland 12 15 10 12 9 6 16 11 9 11 275 West France 537 444 497 381 377 340 283 253 270 218 21 444 West Germany 128 155 132 129 117 109 107 83 73 19 4 508 West Greece 30 34 42 31 33 38 45 33 29 34 1 117 Centre Hungary 4 7 6 11 12 7 10 19 8 14 210 West Iceland 1 2 1 0 0 0 0 0 1 0 16 West Ireland 12 17 22 17 18 8 7 8 6 3 380 West Italy 561 504 517 502 452 424 451 416 336 266 18 432 East Latvia 36 34 55 37 59 58 51 49 46 46 655 – Liechtenstein 0 0 1 0 0 0 0 0 0 0 3 East Lithuania 11 9 13 15 17 16 18 18 16 9 196 West Luxembourg 6 5 4 2 5 4 4 3 3 3 126 West Malta 6 3 5 0 2 1 3 0 0 0 41 West Netherlands 128 92 108 88 84 87 80 69 54 24 2 511 West Norway 10 9 12 11 27 17 16 11 6 15 462 Centre Poland 53 45 37 35 34 33 18 17 18 17 736 West Portugal 423 388 355 330 244 216 242 181 184 121 9 436 Centre Romania 123 172 155 150 184 179 186 196 203 192 3 234 Centre Slovakia 1 1 3 4 2 3 3 3 2 0 40 Centre Slovenia 0 3 1 3 0 0 4 4 3 3 57 West Spain 448 418 380 272 212 199 185 168 126 96 16 419 West Sweden – – – – – – – – – – 666 West United Kingdom 387 241 244 202 200 222 159 133 136 140 11 033 Total EU/EEA 3 087 2 777 2 780 2 386 2 261 2 135 2 023 1 799 1 651 1 322 97 585 Non-EU/EEA Centre Albania 24 39 40 55 40 52 55 31 46 37 563 West Andorra 0 0 0 1 0 2 0 1 0 – 5 East Armenia 46 51 86 106 125 132 125 117 180 150 1 289 East Azerbaijan 42 44 68 57 85 93 76 112 120 124 982 East Belarus 246 305 348 344 309 333 367 312 313 279 3 858 Centre Bosnia and Herzegovina 1 4 0 3 1 2 3 2 3 5 84 East Georgia 134 180 184 139 123 145 137 145 189 177 1 943 West Israel 27 38 32 21 43 31 34 21 25 19 979 East Kazakhstan 65 81 76 82 93 97 157 168 231 232 1 459 East Kyrgyzstan 24 26 27 24 39 40 35 30 34 35 356 West Monaco 0 0 0 0 0 0 0 0 0 – 7 Centre Montenegro 2 1 2 1 3 1 6 2 2 3 60 Centre North Macedonia 3 3 6 6 10 4 3 0 1 – 92 East Republic of Moldova 232 327 196 217 210 208 275 186 286 226 2 872 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 0 0 0 0 0 0 0 0 0 5 Centre Serbia 12 17 9 9 11 12 7 17 18 16 455 Centre Serbia excluding Kosovo1 11 11 9 7 10 12 5 12 13 14 415 Centre Kosovo1 1 6 – 2 1 – 2 5 5 2 40 West Switzerland 85 69 52 54 32 33 28 27 28 26 2 793 East Tajikistan 41 59 72 90 112 146 124 151 146 91 1 096 Centre Turkey 26 37 35 41 58 39 28 30 37 35 762 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 2 264 3 944 4 873 4 875 5 806 5 250 5 708 6 243 6 306 5 443 57 486 East Uzbekistan 68 – – – – – – – – – 183 Total non-EU/EEA 3 342 5 225 6 106 6 125 7 100 6 620 7 168 7 595 7 965 6 898 77 329 WHO European Region West West 2 932 2 556 2 538 2 155 1 971 1 843 1 735 1 481 1 355 1 030 95 094 Centre Centre 281 377 333 360 404 380 367 370 385 364 7 252 East East 3 216 5 069 6 014 5 996 6 986 6 532 7 089 7 543 7 876 6 826 72 565 Total WHO European Region 6 429 8 002 8 885 8 511 9 361 8 755 9 191 9 394 9 616 8 220 174 911 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 89 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 20. AIDS diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2010–2019) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 0 1 0 0 0 0 1 0 1 0 14 West Belgium 0 1 2 1 1 3 1 0 0 – 145 Centre Bulgaria 2 1 0 3 0 0 0 0 3 0 10 Centre Croatia 0 1 0 0 0 0 0 0 0 0 4 Centre Cyprus 0 0 0 0 0 0 0 0 0 0 2 Centre Czechia 0 0 0 0 0 0 1 0 0 0 1 West Denmark 1 0 0 1 0 0 0 1 0 0 26 East Estonia 0 0 0 0 0 0 0 0 0 0 2 West Finland 0 0 0 0 1 0 0 0 0 0 8 West France 5 8 10 10 4 5 5 4 7 3 802 West Germany 1 3 2 1 2 0 0 1 0 0 121 West Greece 1 0 0 0 0 0 0 0 0 0 24 Centre Hungary 0 0 1 0 0 1 0 2 1 0 8 West Iceland 0 0 0 0 0 0 0 0 1 0 1 West Ireland 1 0 0 1 0 0 0 0 0 0 36 West Italy 3 3 4 7 2 0 1 0 0 0 740 East Latvia 0 2 1 2 0 0 2 1 1 1 23 – Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 East Lithuania 0 0 0 1 0 0 0 0 0 0 1 West Luxembourg 0 0 1 0 0 0 0 0 0 0 4 West Malta 0 0 0 0 0 0 0 0 0 0 1 West Netherlands 8 4 2 5 3 4 0 1 2 0 115 West Norway 0 0 0 1 0 0 0 1 0 0 8 Centre Poland 1 3 1 0 1 1 0 0 1 0 70 West Portugal 1 2 1 3 1 1 3 1 1 1 129 Centre Romania 8 12 11 17 8 6 0 8 4 4 327 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 3 3 3 5 1 2 4 1 1 1 989 West Sweden – – – – – – – – – – 22 West United Kingdom 13 14 5 7 5 6 3 3 1 7 734 Total EU/EEA 48 58 44 65 29 29 21 24 24 17 4 369 Non-EU/EEA Centre Albania 0 1 2 4 0 0 0 1 0 1 11 West Andorra 0 0 0 0 0 0 0 0 0 – 0 East Armenia 1 1 0 4 7 2 0 2 3 1 28 East Azerbaijan 1 1 3 3 2 0 1 0 0 1 16 East Belarus 13 12 4 3 9 10 5 2 1 2 126 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 0 East Georgia 11 8 1 3 2 0 0 1 4 1 69 West Israel 1 1 1 1 0 0 0 0 1 0 40 East Kazakhstan 6 4 2 5 1 5 3 7 3 4 62 East Kyrgyzstan 0 3 4 1 0 5 1 2 1 2 22 West Monaco 0 0 0 0 0 0 0 0 0 – 0 Centre Montenegro 0 0 0 0 0 0 0 0 0 0 1 Centre North Macedonia 1 0 1 1 0 0 0 0 0 – 6 East Republic of Moldova 4 7 6 10 8 2 4 5 5 2 82 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 0 0 0 0 0 0 0 0 0 0 Centre Serbia 1 1 1 – 1 – – 1 – 29 Centre Serbia excluding Kosovo1 1 0 0 1 0 0 0 0 0 0 26 Centre Kosovo1 – – 1 – – 1 – – 1 – 3 West Switzerland 2 0 1 1 0 0 0 1 0 0 110 East Tajikistan 1 7 6 15 10 4 6 6 8 2 66 Centre Turkey 0 0 1 0 1 3 0 1 0 4 21 East Turkmenistan 0 0 0 – – – – – – – 0 East Ukraine 129 118 88 59 60 48 67 93 81 57 1 424 East Uzbekistan 8 – – – – – – – – – 22 Total non-EU/EEA 179 163 121 111 100 80 87 121 108 77 2 135 WHO European Region West West 40 40 32 44 20 21 18 14 15 12 4 069 Centre Centre 13 18 18 26 10 12 1 12 10 9 492 East East 174 163 115 106 99 76 89 119 107 73 1 943 Total WHO European Region 227 221 165 176 129 109 108 145 132 94 6 504 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 90 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 21. AIDS diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Sex between men 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 23 23 2 4 6 9 12 21 0 0 0 0 0 0 0 0 2 0 4 4 56 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 28 28 4 14 18 8 14 22 0 0 0 0 0 0 0 0 0 0 0 0 68 Bulgaria Centre Croatia 17 17 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 0 1 1 20 Croatia Centre Cyprus 1 1 0 0 0 1 1 2 0 0 0 0 0 0 0 0 0 0 0 0 3 Cyprus Centre Czechia 17 17 2 2 4 8 8 16 0 0 0 0 1 1 0 0 0 0 0 0 38 Czechia West Denmark 8 8 0 0 0 7 7 14 0 0 0 0 0 0 0 0 0 0 0 0 22 Denmark East Estonia 0 0 1 8 9 5 9 14 0 0 0 0 0 0 0 0 0 3 2 5 28 Estonia West Finland 1 1 0 0 0 4 7 11 0 0 0 0 1 1 0 0 0 2 3 5 18 Finland West France 109 114 1 15 16 91 126 218 1 2 3 0 0 0 1 1 2 18 58 77 430 France West Germany 35 35 1 3 4 13 6 19 0 0 0 0 0 0 0 0 0 5 11 16 74 Germany West Greece 29 29 1 8 9 19 15 34 0 0 0 0 0 0 0 0 0 3 11 14 86 Greece Centre Hungary 37 37 0 0 1 7 7 14 0 0 0 0 0 0 0 1 1 0 0 0 53 Hungary West Iceland 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 4 Iceland West Ireland 2 2 0 0 0 2 1 3 0 0 0 0 0 0 0 0 0 0 1 1 6 Ireland West Italy 181 181 12 58 70 85 181 266 0 0 0 0 0 0 0 0 0 8 46 54 571 Italy East Latvia 3 3 5 27 32 28 18 46 0 1 1 0 0 0 0 0 0 4 4 8 90 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 0 0 2 9 11 3 6 9 0 0 0 0 0 0 0 0 0 0 1 1 21 Lithuania West Luxembourg 0 0 0 0 0 2 1 3 0 0 0 0 0 0 0 0 0 0 0 0 3 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 42 44 1 1 2 11 13 24 0 0 0 1 1 2 0 0 0 5 16 21 93 Netherlands West Norway 3 3 1 1 5 10 15 0 0 0 0 0 0 0 0 0 0 0 0 19 Norway Centre Poland 17 17 1 7 8 6 11 17 0 0 0 0 0 0 0 0 0 8 35 43 85 Poland West Portugal 27 27 2 11 13 52 69 121 0 1 1 0 0 0 2 0 2 4 4 8 172 Portugal Centre Romania 35 35 3 34 37 72 120 192 3 1 4 0 0 0 0 0 0 8 6 14 282 Romania Centre Slovakia 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 3 Slovakia Centre Slovenia 2 2 1 0 1 3 0 3 0 0 0 0 0 0 0 0 0 0 1 1 7 Slovenia West Spain 100 100 7 18 25 37 59 96 0 1 1 0 0 0 0 0 0 2 27 29 251 Spain West Sweden – – – – – – – – – – – – – – – – – – – – – Sweden West United Kingdom 87 87 0 6 6 53 87 140 4 3 7 0 0 0 0– 2 2 7 20 27 269 United Kingdom Total EU/EEA 808 815 46 227 273 533 788 1 322 8 9 17 1 3 4 3 6 9 78 253 332 2 772 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 2 2 – – 0 14 23 37 – 1 1 – – 0 – – 0 – – 0 40 Albania West Andorra – – – – – – – – – – – – – – – – – – – – – Andorra East Armenia 7 7 – 14 14 44 106 150 1 – 1 1 – 1 – – 0 – – 0 173 Armenia East Azerbaijan 8 8 2 58 60 43 81 124 – 1 1 – – 0 – – 0 1 2 3 196 Azerbaijan East Belarus 7 7 20 64 84 118 161 279 – 2 2 – – 0 – – 0 1 7 8 380 Belarus Centre Bosnia and Herzegovina 3 3 – – 0 2 3 5 – – 0 – – 0 – – 0 – – 0 8 Bosnia and Herzegovina East Georgia 26 26 1 60 61 64 113 177 1 – 1 – – 0 – – 0 – – 0 265 Georgia West Israel 2 2 – 2 2 8 11 19 – – 0 – – 0 – – 0 – – 0 23 Israel East Kazakhstan 6 6 33 152 185 109 123 232 4 – 4 1 2 3 – – 0 7 4 11 441 Kazakhstan East Kyrgyzstan 1 1 3 3 16 19 35 2 2 – – 0 – – 0 4 1 5 46 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 4 4 – – 0 3 3 – – 0 – – 0 – – 0 – 3 3 10 Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 3 3 3 20 23 88 138 226 1 1 2 – – 0 – – 0 13 18 31 285 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 San Marino Centre Serbia – 0 – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Serbia Centre Serbia excluding Kosovo1 41 41 1 1 2 11 3 14 – – 0 – – 0 – – 0 3 8 11 68 Serbia excluding Kosovo1 Centre Kosovo1 3 3 0 1 1 2 – – 0 – – 0 – – 0 – – 0 5 Kosovo1 West Switzerland 15 15 – 4 4 9 17 26 – – 0 – – 0 – 1 1 – 13 13 59 Switzerland East Tajikistan 0 1 25 26 31 60 91 1 1 2 – – 0 1 – 1 9 12 21 141 Tajikistan Centre Turkey 15 15 – – 0 7 28 35 2 2 4 1 – 1 – – 0 10 47 57 112 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 82 82 254 1 662 1 916 2 566 2 877 5 443 23 34 57 – – 0 1 – 1 6 6 12 7 511 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 225 225 315 2 065 2 380 3 031 3 667 6 698 33 44 77 3 2 5 2 1 3 54 121 175 9 763 Total non-EU/EEA WHO European Region WHO European Region West West 667 674 27 131 158 407 622 1 030 5 7 12 1 2 3 3 6 9 55 214 270 2 156 West Centre Centre 223 223 12 59 71 142 222 364 5 4 9 1 1 2 0 0 1 29 103 132 802 Centre East East 143 143 322 2 102 2 424 3 115 3 711 6 826 31 42 73 2 2 4 2 0 2 48 57 105 9 577 East Total WHO European Region 1 033 1 040 361 2 292 2 653 3 664 4 555 8 220 41 53 94 4 5 9 5 7 12 132 374 507 12 535 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 91 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 21. AIDS diagnoses in 2019, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Sex between men 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 23 23 2 4 6 9 12 21 0 0 0 0 0 0 0 0 2 0 4 4 56 Austria West Belgium – – – – – – – – – – – – – – – – – – – – – Belgium Centre Bulgaria 28 28 4 14 18 8 14 22 0 0 0 0 0 0 0 0 0 0 0 0 68 Bulgaria Centre Croatia 17 17 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 0 1 1 20 Croatia Centre Cyprus 1 1 0 0 0 1 1 2 0 0 0 0 0 0 0 0 0 0 0 0 3 Cyprus Centre Czechia 17 17 2 2 4 8 8 16 0 0 0 0 1 1 0 0 0 0 0 0 38 Czechia West Denmark 8 8 0 0 0 7 7 14 0 0 0 0 0 0 0 0 0 0 0 0 22 Denmark East Estonia 0 0 1 8 9 5 9 14 0 0 0 0 0 0 0 0 0 3 2 5 28 Estonia West Finland 1 1 0 0 0 4 7 11 0 0 0 0 1 1 0 0 0 2 3 5 18 Finland West France 109 114 1 15 16 91 126 218 1 2 3 0 0 0 1 1 2 18 58 77 430 France West Germany 35 35 1 3 4 13 6 19 0 0 0 0 0 0 0 0 0 5 11 16 74 Germany West Greece 29 29 1 8 9 19 15 34 0 0 0 0 0 0 0 0 0 3 11 14 86 Greece Centre Hungary 37 37 0 0 1 7 7 14 0 0 0 0 0 0 0 1 1 0 0 0 53 Hungary West Iceland 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 4 Iceland West Ireland 2 2 0 0 0 2 1 3 0 0 0 0 0 0 0 0 0 0 1 1 6 Ireland West Italy 181 181 12 58 70 85 181 266 0 0 0 0 0 0 0 0 0 8 46 54 571 Italy East Latvia 3 3 5 27 32 28 18 46 0 1 1 0 0 0 0 0 0 4 4 8 90 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 0 0 2 9 11 3 6 9 0 0 0 0 0 0 0 0 0 0 1 1 21 Lithuania West Luxembourg 0 0 0 0 0 2 1 3 0 0 0 0 0 0 0 0 0 0 0 0 3 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 42 44 1 1 2 11 13 24 0 0 0 1 1 2 0 0 0 5 16 21 93 Netherlands West Norway 3 3 1 1 5 10 15 0 0 0 0 0 0 0 0 0 0 0 0 19 Norway Centre Poland 17 17 1 7 8 6 11 17 0 0 0 0 0 0 0 0 0 8 35 43 85 Poland West Portugal 27 27 2 11 13 52 69 121 0 1 1 0 0 0 2 0 2 4 4 8 172 Portugal Centre Romania 35 35 3 34 37 72 120 192 3 1 4 0 0 0 0 0 0 8 6 14 282 Romania Centre Slovakia 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 3 Slovakia Centre Slovenia 2 2 1 0 1 3 0 3 0 0 0 0 0 0 0 0 0 0 1 1 7 Slovenia West Spain 100 100 7 18 25 37 59 96 0 1 1 0 0 0 0 0 0 2 27 29 251 Spain West Sweden – – – – – – – – – – – – – – – – – – – – – Sweden West United Kingdom 87 87 0 6 6 53 87 140 4 3 7 0 0 0 0– 2 2 7 20 27 269 United Kingdom Total EU/EEA 808 815 46 227 273 533 788 1 322 8 9 17 1 3 4 3 6 9 78 253 332 2 772 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 2 2 – – 0 14 23 37 – 1 1 – – 0 – – 0 – – 0 40 Albania West Andorra – – – – – – – – – – – – – – – – – – – – – Andorra East Armenia 7 7 – 14 14 44 106 150 1 – 1 1 – 1 – – 0 – – 0 173 Armenia East Azerbaijan 8 8 2 58 60 43 81 124 – 1 1 – – 0 – – 0 1 2 3 196 Azerbaijan East Belarus 7 7 20 64 84 118 161 279 – 2 2 – – 0 – – 0 1 7 8 380 Belarus Centre Bosnia and Herzegovina 3 3 – – 0 2 3 5 – – 0 – – 0 – – 0 – – 0 8 Bosnia and Herzegovina East Georgia 26 26 1 60 61 64 113 177 1 – 1 – – 0 – – 0 – – 0 265 Georgia West Israel 2 2 – 2 2 8 11 19 – – 0 – – 0 – – 0 – – 0 23 Israel East Kazakhstan 6 6 33 152 185 109 123 232 4 – 4 1 2 3 – – 0 7 4 11 441 Kazakhstan East Kyrgyzstan 1 1 3 3 16 19 35 2 2 – – 0 – – 0 4 1 5 46 Kyrgyzstan West Monaco – – – – – – – – – – – – – – – – – – – – – Monaco Centre Montenegro 4 4 – – 0 3 3 – – 0 – – 0 – – 0 – 3 3 10 Montenegro Centre North Macedonia – – – – – – – – – – – – – – – – – – – – – North Macedonia East Republic of Moldova 3 3 3 20 23 88 138 226 1 1 2 – – 0 – – 0 13 18 31 285 Republic of Moldova East Russian Federation – – – – – – – – – – – – – – – – – – – – – Russian Federation West San Marino – 0 – – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 San Marino Centre Serbia – 0 – 0 – – 0 – – 0 – – 0 – – 0 – – 0 0 Serbia Centre Serbia excluding Kosovo1 41 41 1 1 2 11 3 14 – – 0 – – 0 – – 0 3 8 11 68 Serbia excluding Kosovo1 Centre Kosovo1 3 3 0 1 1 2 – – 0 – – 0 – – 0 – – 0 5 Kosovo1 West Switzerland 15 15 – 4 4 9 17 26 – – 0 – – 0 – 1 1 – 13 13 59 Switzerland East Tajikistan 0 1 25 26 31 60 91 1 1 2 – – 0 1 – 1 9 12 21 141 Tajikistan Centre Turkey 15 15 – – 0 7 28 35 2 2 4 1 – 1 – – 0 10 47 57 112 Turkey East Turkmenistan – – – – – – – – – – – – – – – – – – – – – Turkmenistan East Ukraine 82 82 254 1 662 1 916 2 566 2 877 5 443 23 34 57 – – 0 1 – 1 6 6 12 7 511 Ukraine East Uzbekistan – – – – – – – – – – – – – – – – – – – – – Uzbekistan Total non-EU/EEA 225 225 315 2 065 2 380 3 031 3 667 6 698 33 44 77 3 2 5 2 1 3 54 121 175 9 763 Total non-EU/EEA WHO European Region WHO European Region West West 667 674 27 131 158 407 622 1 030 5 7 12 1 2 3 3 6 9 55 214 270 2 156 West Centre Centre 223 223 12 59 71 142 222 364 5 4 9 1 1 2 0 0 1 29 103 132 802 Centre East East 143 143 322 2 102 2 424 3 115 3 711 6 826 31 42 73 2 2 4 2 0 2 48 57 105 9 577 East Total WHO European Region 1 033 1 040 361 2 292 2 653 3 664 4 555 8 220 41 53 94 4 5 9 5 7 12 132 374 507 12 535 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 92 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 22. The most common AIDS-indicative diseases diagnosed in 2019,a ordered by frequency Diseases Men Women Children TotalN % N % N % N % EU/EEA Pneumocystis carinii pneumonia 567 21.5 178 21.1 2 4.9 747 21.2 Wasting syndrome due to HIV 307 11.6 88 10.4 10 24.4 405 11.5 Candidiasis; oesophageal 309 11.7 90 10.7 2 4.9 401 11.4 Kaposi's sarcoma 287 10.9 36 4.3 0 0.0 323 9.2 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 180 6.8 77 9.1 2 4.9 259 7.3 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 157 5.9 42 5.0 3 7.3 202 5.7 Toxoplasmosis of brain in a patient over 1 month of age 102 3.9 69 8.2 2 4.9 173 4.9 Mycobacterium tuberculosis; extrapulmonary 102 3.9 47 5.6 0 0.0 149 4.2 Encephalopathy; HIV-related 101 3.8 35 4.1 6 14.6 142 4.0 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 54 2.0 22 2.6 4 9.8 80 2.3 Non-EU/EEA Wasting syndrome due to HIV 247 16.0 123 18.6 18 26.5 388 17.1 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 244 15.9 72 10.9 8 11.8 324 14.3 Candidiasis; oesophageal 216 14.0 81 12.3 5 7.4 302 13.3 Pneumocystis carinii pneumonia 146 9.5 57 8.6 10 14.7 213 9.4 Mycobacterium tuberculosis; extrapulmonary 133 8.6 39 5.9 0 0.0 172 7.6 Encephalopathy; HIV-related 78 5.1 42 6.4 4 5.9 124 5.5 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 41 2.7 21 3.2 5 7.4 67 3.0 Kaposi's sarcoma 42 2.7 7 1.1 0 0.0 49 2.2 Herpes simplex: chronic ulcer(s) (> 1 month duration); or bronchitis; pneumonitis; or oesophagitis in a patient over 1 month of age 20 1.3 10 1.5 5 7.4 35 1.5 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 22 1.4 9 1.4 3 4.4 34 1.5 West Pneumocystis carinii pneumonia 489 23.5 147 24.0 1 10.0 637 23.6 Candidiasis; oesophageal 254 12.2 68 11.1 0 0.0 322 11.9 Kaposi's sarcoma 262 12.6 36 5.9 0 0.0 298 11.0 Wasting syndrome due to HIV 180 8.7 41 6.7 1 10.0 222 8.2 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 146 7.0 41 6.7 1 10.0 188 7.0 Toxoplasmosis of brain in a patient over 1 month of age 91 4.4 51 8.3 0 0.0 142 5.3 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 94 4.5 38 6.2 0 0.0 132 4.9 Mycobacterium tuberculosis; extrapulmonary 81 3.9 40 6.5 0 0.0 121 4.5 Encephalopathy; HIV-related 71 3.4 16 2.6 0 0.0 87 3.2 Lymphoma; Burkitt (or equivalent term) 47 2.3 13 2.1 0 0.0 60 2.2 Centre Wasting syndrome due to HIV 162 21.0 58 22.6 9 23.7 229 21.4 Pneumocystis carinii pneumonia 105 13.6 29 11.3 1 2.6 135 12.6 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 87 11.3 35 13.6 2 5.3 124 11.6 Candidiasis; oesophageal 79 10.2 27 10.5 2 5.3 108 10.1 Encephalopathy; HIV-related 42 5.4 19 7.4 6 15.8 67 6.3 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 30 3.9 15 5.8 3 7.9 48 4.5 Kaposi's sarcoma 44 5.7 2 0.8 0 0.0 46 4.3 Toxoplasmosis of brain in a patient over 1 month of age 15 1.9 15 5.8 2 5.3 32 3.0 Mycobacterium tuberculosis; extrapulmonary 23 3.0 7 2.7 0 0.0 30 2.8 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over 1 month of age 23 3.0 3 1.2 3 7.9 29 2.7 East Wasting syndrome due to HIV 212 16.0 112 17.6 18 29.5 342 16.9 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 243 18.3 76 11.9 8 13.1 327 16.1 Candidiasis; oesophageal 192 14.5 76 11.9 5 8.2 273 13.5 Pneumocystis carinii pneumonia 119 9.0 59 9.3 10 16.4 188 9.3 Mycobacterium tuberculosis; extrapulmonary 131 9.9 39 6.1 0 0.0 170 8.4 Encephalopathy; HIV-related 66 5.0 42 6.6 4 6.6 112 5.5 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 30 2.3 18 2.8 5 8.2 53 2.6 Toxoplasmosis of brain in a patient over 1 month of age 14 1.1 15 2.4 0 0.0 29 1.4 Kaposi's sarcoma 23 1.7 5 0.8 0 0.0 28 1.4 Progressive multifocal leukoencephalopathy 19 1.4 8 1.3 0 0.0 27 1.3 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. 93 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Table 23. AIDS-related deaths,a by geographic area, country and year of death (2010–2019) and cumulative totals in EU/EEA and other countries of the WHO European Region Area Country, territory or areab Year of diagnosis Cumulative totalc2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria 40 39 34 41 42 37 32 43 40 24 1 662 West Belgium 19 31 30 37 35 23 29 26 14 2 136 Centre Bulgaria 14 17 16 14 13 8 9 10 9 17 209 Centre Croatia 7 6 9 7 5 15 3 2 2 4 202 Centre Cyprus 3 4 5 5 4 4 5 3 3 2 132 Centre Czechia 10 14 17 13 15 12 18 20 18 7 311 West Denmark 3 6 2 4 0 1 2 – – 2 020 East Estonia 2 7 5 2 2 2 2 4 4 1 121 West Finland 10 6 13 8 5 6 5 9 6 1 238 West France 210 173 158 134 127 103 129 123 174 139 37 067 West Germany 117 126 87 111 101 76 77 71 71 34 14 970 West Greece 48 50 52 43 47 50 42 43 40 36 1 939 Centre Hungary 15 17 11 11 19 11 11 9 18 19 459 West Iceland 0 1 1 0 0 0 1 0 0 0 40 West Ireland 5 4 1 0 0 1 1 1 0 0 417 West Italy 645 644 636 653 573 561 533 511 – – 45 861 East Latvia 57 80 88 107 75 45 41 37 29 30 898 – Liechtenstein 0 0 0 0 0 0 0 0 0 0 6 East Lithuania 12 9 10 18 16 12 23 15 14 5 241 West Luxembourg 1 5 7 3 2 4 4 1 1 4 152 West Malta 0 1 2 0 1 1 3 0 0 0 65 West Netherlands 70 92 89 85 89 90 100 90 82 63 2 074 West Norway 0 1 1 2 3 2 0 2 1 1 634 Centre Poland 53 68 57 48 42 41 27 20 23 15 1 428 West Portugal 338 308 260 273 208 176 189 167 155 91 10 793 Centre Romania 134 216 188 199 239 196 193 190 175 151 4 915 Centre Slovakia 1 1 3 0 0 4 2 1 3 2 51 Centre Slovenia 2 1 2 7 4 6 3 2 1 2 119 West Spain 458 428 375 311 234 185 179 110 76 24 48 991 West Sweden – – – – – – – – – – 1 323 West United Kingdom 313 161 157 161 151 117 106 110 96 101 16 690 Total EU/EEA 2 587 2 516 2 316 2 297 2 052 1 789 1 769 1 621 1 055 774 196 164 Non-EU/EEA Centre Albania 12 11 13 10 13 13 12 4 11 8 184 West Andorra 0 0 0 0 0 3 0 0 0 – 4 East Armenia 23 26 36 45 50 62 53 74 61 59 643 East Azerbaijan 46 44 50 39 51 38 31 26 22 75 1 057 East Belarus 146 159 188 129 170 126 119 80 110 127 3 638 Centre Bosnia and Herzegovina 0 0 0 2 1 4 2 0 2 2 68 East Georgia 80 97 83 82 68 70 132 96 100 77 1 303 West Israel 25 33 31 31 33 26 29 14 14 8 1 035 East Kazakhstan 192 205 189 189 160 207 235 255 283 305 3 045 East Kyrgyzstan 26 19 19 6 9 38 20 27 23 12 318 West Monaco 0 0 0 0 0 0 0 0 0 – 18 Centre Montenegro 5 2 1 1 2 6 2 4 2 4 60 Centre North Macedonia 1 4 0 3 0 0 0 2 1 – 67 East Republic of Moldova 85 98 67 90 98 83 91 82 37 54 1 109 East Russian Federation 0 – – – – – – – – – 0 West San Marino 0 0 0 0 0 0 0 0 0 0 8 Centre Serbia 26 33 21 18 10 16 13 14 25 23 1 203 Centre Serbia excluding Kosovo1 26 31 17 17 10 15 10 14 24 21 1 155 Centre Kosovo1 2 4 1 – 1 3 – 1 2 48 West Switzerland 23 13 3 4 5 5 1 4 2 1 5 905 East Tajikistan 55 58 95 94 95 126 128 185 144 108 1 179 Centre Turkey 0 0 0 10 11 4 4 5 8 4 120 East Turkmenistan 0 0 0 – – – – – – – 1 East Ukraine 3 096 3 736 3 870 3 514 3 426 3 032 3 253 3 298 3 448 2 977 51 433 East Uzbekistan 66 – – – – – – – – – 323 Total non-EU/EEA 3 907 4 538 4 666 4 267 4 202 3 859 4 125 4 170 4 293 3 755 71 170 WHO European Region West West 2 325 2 122 1 939 1 901 1 656 1 467 1 462 1 325 772 527 194 042 Centre Centre 283 394 343 348 378 340 304 286 301 260 9 528 East East 3 886 4 538 4 700 4 315 4 220 3 841 4 128 4 179 4 275 3 830 65 309 Total WHO European Region 6 494 7 054 6 982 6 564 6 254 5 648 5 894 5 790 5 348 4 618 268 879 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 persons (ever) diagnosed with AIDS were included. Spain has changing national coverage of AIDS reporting during the period (see Annex 5) and trends should be interpreted with caution. b Country-specific comments are in Annex 5. c Cumulative total is the total number of deaths reported by country since the start of reporting. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 94 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Table 24. Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2010–2019) and number of tests per 1000 population in 2019, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Number of HIV tests Tests/1 000 population2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 EU/EEA West Austria – – – – – – – – – – – West Belgium 651 095 679 655 703 486 695 433 697 684 692 679 726 457 714 382 729 603 – – Centre Bulgaria 160 000 180 000 190 000 – 230 000 290 000 – – 360 000 360 000 51.4 Centre Croatia – – – – – – – – – – – Centre Cyprus 48 385 49 074 54 120 50 235 – – 52 385 – – – – Centre Czechia 353 507 334 569 349 205 341 583 349 448 345 274 350 234 351 650 353 425 359 327 33.7 West Denmark 168 923 137 877 134 709 – – – – – – – – East Estonia 78 054 85 025 73 367 82 279 82 266 87 587 90 136 102 863 112 487 125 273 94.6 West Finland – – – – – – – – – – – West France 5 007 171 5 238 567 5 251 272 5 239 389 5 282 844 5 390 760 5 503 259 5 614 818 5 828 267 6 170 133 92.1 West Germany – – – – – – – – – – – West Greeceb 31 070 31 918 34 622 32 241 240 116 192 150 196 257 176 966 187 627 – – Centre Hungary 89 137 84 464 93 060 95 861 93 289 91 793 – – – – – West Iceland 7 318 – – – – – – – – – – West Irelandb 180 055 184 521 175 488 150 597 168 028 178 267 192 956 223 609 239 571 – – West Italy – – – – – – – – – – – East Latvia 58 826 58 799 60 491 58 302 60 614 65 552 79 715 82 608 90 368 98 651 51.4 – Liechtenstein – – – – – – – – – – – East Lithuania 178 554 102 234 101 042 102 161 108 781 105 486 104 132 113 917 109 825 133 810 47.9 West Luxembourg – – – – – – 71 200 100 529 – – – West Malta – – – – – – – – – – – West Netherlands – – – – – – – – – – – West Norway – – – – – – – – – – – Centre Poland 229 783 317 286 358 953 313 341 272 102 318 458 440 365 430 266 382 953 421 039 11.1 West Portugalb – – – – – – – – 257 485 – – Centre Romania 306 679 293 204 302 898 332 422 346 032 360 893 338 898 323 468 334 410 17.2 Centre Slovakia 109 261 110 025 110 506 114 574 126 187 127 109 104 876 111 340 177 498 Centre Slovenia 36 977 38 110 33 602 33 457 35 498 34 366 35 788 37 315 38 570 40 462 19.4 West Spain – – – – – – – – – – – West Sweden – – – – – – – – – – – West United Kingdom – – – – – – – – – – – Non-EU/EEA Centre Albania 2 168 3 260 3 140 3 063 4 156 5 442 5 582 7 149 – 13 261 4.6 West Andorra 2 678 2 590 2 062 2 310 2 378 2 212 2 340 2 591 2 712 – – East Armenia 60 731 68 449 71 957 83 431 94 122 117 012 99 270 119 628 132 509 164 933 55.8 East Azerbaijan 353 772 365 090 514 434 482 282 612 860 714 621 500 469 657 704 753 568 – – East Belarus 517 625 621 780 683 125 770 136 1 157 072 1 249 712 1 464 386 1 514 635 1 627 169 1 488 199 157.4 Centre Bosnia and Herzegovina 20 793 – – – – – – – – – – East Georgia 25 370 21 799 15 562 18 091 86 290 78 261 119 868 207 175 188 142 441 119 110.4 West Israel 286 995 274 294 233 516 – – – – – – – – East Kazakhstan 1 786 289 1 897 476 2 026 174 2 127 136 2 190 757 2 388 347 2 587 065 2 742 741 2 760 324 2 877 706 155.1 East Kyrgyzstan 297 959 381 295 470 355 370 160 410 331 376 284 331 609 376 431 356 765 384 988 60.0 West Monaco – – – – – – – – – – – Centre Montenegro 6 492 6 914 6 781 6 970 6 571 6 607 6 324 5 606 6 890 6 575 10.5 Centre North Macedonia 18 721 17 811 18 105 24 562 27 430 28 601 30 211 36 248 – – – East Republic of Moldova 207 018 207 830 212 964 146 105 133 476 146 762 124 010 160 947 154 575 182 196 45.1 East Russian Federationb 25 982 486 25 812 467 27 286 151 28 327 314 29 878 681 30 750 547 32 855 597 36 445 059 40 485 246 47 206 251 323.6 West San Marino 5 090 3 961 3 845 4 004 3 427 1 548 3 600 3 685 3 411 2 200 65.0 Centre Serbia – – – – – – – – – – – Centre Serbia excluding Kosovo1 51 727 56 086 64 031 65 829 56 282 61 877 65 827 76 367 76 653 88 490 12.6 Centre Kosovo1 1 141 1 189 1 335 1 250 – 1 312 2 599 4 551 4 877 2 018 1.1 West Switzerland – – – – – – – – – – – East Tajikistan 280 281 438 532 447 636 514 701 634 791 597 426 509 092 612 123 – 1 062 509 114.0 Centre Turkey 5 010 334 5 693 965 5 952 148 6 515 931 6 663 547 7 203 959 6 263 020 7 107 551 7 457 674 9 123 920 109.4 East Turkmenistan – – – – – – – – – – – East Ukraine 2 319 946 2 392 970 2 343 099 2 941 748 1 853 626 1 695 926 1 697 479 1 816 023 1 868 565 1 961 711 46.7 East Uzbekistan 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 refers only to those requested at public primary health-care centres and does not include those requested in hospitals and the private sector. Number of tests in Ireland includes antenatal tests in the total and, for 2018, include community-based rapid testing. HIV tests in the Russian Federation include blood donors. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). Maps 96 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Map 1. New HIV diagnoses, per 100 000 population, 2019 Andorra Luxembourg Malta Monaco San Marino < 2 2 to < 10 10 to < 20 20 to < 50 > 50 Missing or excluded data Note: all data presented were reported to ECDC/the WHO Regional Office for Europe through the European Surveillance System (TESSy). 97 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Map 2. New HIV diagnoses in men, per 100 000 male population, 2019 Andorra Luxembourg Malta Monaco San Marino < 2 2 to < 10 10 to < 20 20 to < 50 > 50 Missing or excluded data Map 3. New HIV diagnoses in women, per 100 000 female population, 2019 Andorra Luxembourg Malta Monaco San Marino < 2 2 to < 10 10 to < 20 20 to < 50 > 50 Missing or excluded data 98 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Map 5. New HIV diagnoses acquired through injecting drug use, per 100 000 population, 2019 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, 2019 Andorra Luxembourg Malta Monaco San Marino < 1 1 to < 3 3 to < 5 > 5 Missing or excluded data 99 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT 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, 2019 Map 7. Percentage of adult (> 14 years) HIV diagnoses with CD4 < 350 cells/mm3 at diagnosis, 2019 Andorra Luxembourg Malta Monaco San Marino < 30 30 to < 40 40 to < 50 > 50 Missing or excluded data 100 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Map 8. AIDS diagnoses reported, per 100 000 population, 2019 Andorra Luxembourg Malta Monaco San Marino < 1 1 to < 3 3 to < 5 > 5 Missing or excluded data Annexes

103 HIV/AIDS surveillance in Europe 2020 – 2019 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 surveillance to work on reporting surveillance data to the joint European Centre for Disease Prevention and Control (ECDC) and 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 or 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. Since 2016, the case definitions have been changed in the Russian Federation. Updated Forms (N61) of the Federal Statistical Surveillance are submitted by medical facilities to the Ministry of Health and include the number of individuals newly diagnosed with HIV infection; 2009–2015 data therefore cannot directly be compared to 2016–2019. A built-in set of validation rules in TESSy ensures verification of the data within the database during the data-uploading process, improving 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 considered of sufficient quality to be used for analysis. Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and Uzbekistan did not report any HIV data through the TESSy system for 2019 (or previous years for some of the countries, see Table 1). Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan did not report any AIDS data for 2019 (or previous years for some of the countries, see Table 14). 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 well as by the quality and coverage of national surveillance. During the early part of the period covered in this report (2010–2019) in particular, 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 2019 The 2019 data submission for HIV and AIDS surveillance took place between 15 March and 11 October 2020. Data presented in this report were extracted from the joint database on 11 October 2020. Individual country datasets Data were uploaded, validated and approved in the joint database for HIV/AIDS surveillance by the reporting countries. Once the data were submitted, individual datasets were reviewed by ECDC and the WHO 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 countries used the joint record type for combined HIVAIDS 2019 reporting, and an additional two used it for HIV-only reporting – an increase on the 33 countries that used it when initially it was implemented in 2014. The joined record type allows understanding of the relationship between the HIV and AIDS events and diagnosis dates. Of the 40 countries that used the joined record type, 27 uploaded all historical data in the new format, allowing for retrospective updates of missing variables, de-duplication of cases, or reporting on outcomes such as death. The remaining countries using the new format uploaded only 2019 data, or data for a few years. Additional details on record type used per country can be found in Annexes 4a and 4b. 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 datasets, reducing the amount of data that can be presented in certain tables and figures. Annex 1. Framework for data collection, validation and presentation 104 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data 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 six countries: Armenia, Belarus, Georgia, Kazakhstan, San Marino 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 10 (stratified by reporting country) and Table 11 (all countries stratified by mode of transmission). Origin of reported cases Cases originating from countries outside of the reporting country are highlighted in some of the analyses 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 10, 11 and in selected figures). As most of the cases originating 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 (2019) and, to a lesser extent, for the two to three years prior to the reporting period. To provide a more precise picture 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. Due to the unprecedented situation of the COVID-19 pandemic, which some European countries report has affected their surveillance capacity and systems from early 2020, the previous approach to adjusting for reporting delay may not fully address additional delays that have arisen as a result of the pandemic. Countries were excluded from reporting delay adjustment when: • they showed an inconsistent and non-stationary pattern in their reporting delay distribution during the period 2010–2019; or • they reported aggregated data during the period 2010–2019. 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 countries with the number of reported diagnoses adjusted for reporting delay are presented in Annex 6. Missing transmission data Data on missing transmission were imputed for EU/EEA countries to provide a more precise picture of trends by transmission mode. This was done following a method described by Rosinska et al. (4) using the ECDC HIV Estimates Accuracy Tool (5). Imputed trends are presented in Fig. 1.13. 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 an additional three countries (Iceland, Liechtenstein and Norway) which are included in the overview of the EU/EEA. Because the report reflects data for 2019, the United Kingdom is presented as part of the EU/EEA. The tables are presented for EU/EEA countries, non- EU/EEA countries and as totals. The 53 Member States of the WHO European Region are also subdivided into three geographical areas, based on epidemiological considerations 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 therefore may not always equal the EU/EEA and non-EU/ EEA totals. Data from Serbia include HIV cases notified in Kosovo33 in all figures although these are stratified in 33 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 105 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT 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.b • Centre, 15 countries: Albania, Bosnia and Herzegovina, Bulgaria,a Croatia,a Cyprus,a Czechia,a Hungary,a Montenegro, North Macedonia, Poland,a Romania,a Serbia, Slovakia,a Slovenia,a 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 2020. b The United Kingdom left the European Union on 31 January 2020. 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 2019 were derived from Eurostat for all EU/EEA countries and from the United Nations Population Division for non-EU/EEA countries (6). The Eurostat data are from May 2020 (7) and the United Nations Population Division statistics are from the 2019 round of estimates (8). 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 historically (see Annex 5 for details). Rates for data presented by gender and age were calculated 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 in that given table. 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 2010–2019, countries reporting data inconsistently (Andorra, Belgium, Monaco, North Macedonia, Turkmenistan and 106 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Uzbekistan) and those reporting on transmission mode inconsistently or incompletely (such as Malta, Poland and Turkey) were excluded from relevant figures reporting trends by transmission mode. Countries with varying geographic coverage of the national surveillance system over time (Italy and Spain) were also excluded from graphs showing HIV trends but are included in graphs presenting rates per population. AIDS trends for 2010–2019 excluded countries not reporting consistently over the period (Andorra, Belgium, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan, Uzbekistan). When presenting trends for AIDS deaths, only countries reporting consistently were included (Andorra, Belgium, Denmark, Italy, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan were not included in the presentation of trends for AIDS). 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 underreporting and reporting delay may influence the country figures and rankings presented in the report. The data in the report for recent years 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 reporting 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, patterns 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 donations) 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 underascertainment bias. Few European countries have evaluated their surveillance systems for underreporting and published the results (9). Previous estimates of underreporting range from 0% to 41% for AIDS cases (Francoise Cazein, Sante Publique France, personal communication, 2020), while national estimates of underreporting for HIV can range from 10% (Iceland and Italy) to around 40% (Germany and the United Kingdom) (10). Estimates on the underreporting of AIDS-related deaths are not available, but according to a country survey from 2006, only about a third of countries were able to comprehensively link HIV and AIDS surveillance death registries with national statistics or death certificate information, which results in underreporting of AIDS-related deaths (Francoise Cazein, Sante Publique France, personal communication, 2020). References34 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. European Commission decision 2002/253/EC laying down case defi- nitions for reporting communicable diseases to the Community net- work 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=1700359 (https://doi.org/10.2807/1560- 7917.ES.2018.23.23.1700359). 5. HIV estimates accuracy tool. In: European Centre for Disease Prevention and Control [website]. Stockholm: ECDC; 2018 (https:// ecdc.europa.eu/en/publications-data/hiv-estimates-accuracy-tool). 6. World population prospects: the 2019 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2019 (https://population.un.org/ wpp/). 7. Eurostat [online database]. Brussels: Eurostat; undated (http:// ec.europa.eu/eurostat/data/database). 8. World population prospects: the 2019 revision, medium variant. In: United Nations Department of Economic and Social Affairs, Population Division [website]. New York (NY): United Nations Department of Economic and Social Affairs, Population Division; 2019 (https://population.un.org/wpp/). 9. 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). 10. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire (French National Institute of Health Surveillance); 2007. 34 All weblinks were accessed on 12 November 2020. 107 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Annex 2 Table A2.1. Completeness of variables for data reported in 2018 and 2019 Variables 2018 2019 Number of countries Completeness % Minimal Maximal Number of countries Completeness % Minimal Maximal EU/EEA countries Age 30 99.7 84.9 100.0 29 99.7 78.8 100.0 Gender 30 99.4 88.6 100.0 29 99.5 87.5 100.0 Date of diagnosis 30 100.0 100.0 100.0 29 100.0 100.0 100.0 Date of notification 28 88.1 80.1 100.0 27 88.6 88.6 100.0 Transmission 30 80.3 32.8 100.0 28 76.4 27.8 100.0 Country of birth 23 52.6 30.4 100.0 22 47.8 30.8 100.0 Region of origin 24 81.8 52.1 100.0 23 78.7 45.0 100.0 CD4 cell counta 26 67.0 14.9 97.5 25 61.8 3.9 98.2 Probable country of infection 22 42.1 2.5 99.5 21 40.0 4.0 99.4 WHO European Region Age 51 40.2 40.2 100.0 47 41.3 41.3 100.0 Gender 52 99.5 38.0 100.0 48 99.9 87.5 100.0 Date of diagnosis 52 100.0 100.0 100.0 48 100.0 100.0 100.0 Date of notification 48 38.0 38.0 100.0 45 39.3 39.3 100.0 Transmission 50 34.8 32.8 100.0 46 35.1 27.8 100.0 Country of birth 41 19.8 19.8 100.0 38 19.2 19.2 100.0 Region of origin 43 34.5 34.5 100.0 40 35.1 35.1 100.0 CD4 cell counta 46 29.0 14.9 100.0 43 29.3 3.9 98.2 Probable country of infection 34 14.6 2.5 100.0 32 14.4 4.0 100.0 a CD4 completeness is calculated on all new diagnoses; Table 13 (see Tables section) completeness calculations are restricted to new diagnoses in countries reporting the variables CD4Cells or FirstCD4Count. 108 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Annex 3 Table A3.1. Completeness by country and variable, 2019 Area Country, territory or areaa Date of diagnosis Age Gender Transmission CD4 cell count Country of birth/region of originb EU/EEA West Austria 100.0 100.0 100.0 89.8 98.2 99.6 West Belgium – – – – – – Centre Bulgaria 100.0 100.0 100.0 100.0 89.5 100.0 Centre Croatia 100.0 100.0 100.0 94.1 3.9 98.0 Centre Cyprus 100.0 100.0 100.0 92.0 94.0 100.0 Centre Czechia 100.0 100.0 100.0 96.8 95.0 100.0 West Denmark 100.0 100.0 100.0 100.0 70.5 100.0 East Estonia 100.0 100.0 100.0 64.0 26.4 68.5 West Finland 100.0 100.0 100.0 63.8 77.9 91.3 West France 100.0 100.0 100.0 60.4 52.2 67.2 West Germany 100.0 99.6 99.9 76.9 29.0 90.6 West Greece 100.0 100.0 100.0 81.6 70.3 98.7 Centre Hungary 100.0 82.5 94.2 82.4 0.0 0.0 West Iceland 100.0 100.0 100.0 85.7 71.4 100.0 West Ireland 100.0 100.0 99.4 46.9 13.5 51.4 West Italy 100.0 94.2 100.0 90.5 87.9 99.5 East Latvia 100.0 100.0 100.0 58.0 16.3 0.0 – Liechtenstein – – – – – – East Lithuania 100.0 100.0 100.0 84.1 70.2 100.0 West Luxembourg 100.0 97.9 100.0 97.9 68.8 97.9 West Malta 100.0 79.7 87.5 0.0 0.0 100.0 West Netherlands 100.0 100.0 97.5 88.1 91.3 99.3 West Norway 100.0 100.0 100.0 100.0 0.0 100.0 Centre Poland 100.0 97.5 99.5 27.8 0.0 45.0 West Portugal 100.0 100.0 100.0 96.3 78.1 97.8 Centre Romania 100.0 100.0 100.0 99.6 97.4 99.4 Centre Slovakia 100.0 100.0 100.0 78.2 35.6 89.1 Centre Slovenia 100.0 100.0 100.0 94.1 85.3 97.1 West Spain 100.0 99.9 100.0 91.5 87.6 93.8 West Sweden 100.0 100.0 100.0 87.5 81.5 98.0 West United Kingdom 100.0 100.0 99.8 83.9 84.7 86.2 Non-EU/EEA Centre Albania 100.0 100.0 100.0 100.0 39.6 100.0 West Andorra – – – – – – East Armenia 100.0 100.0 100.0 99.6 89.5 100.0 East Azerbaijan 100.0 100.0 100.0 95.0 78.8 100.0 East Belarus 100.0 100.0 100.0 98.9 85.7 100.0 Centre Bosnia and Herzegovina 100.0 100.0 100.0 100.0 93.3 100.0 East Georgia 100.0 100.0 100.0 99.1 89.5 100.0 West Israel 100.0 99.7 100.0 75.2 56.6 100.0 East Kazakhstan 100.0 100.0 100.0 96.9 75.3 100.0 East Kyrgyzstan 100.0 100.0 100.0 84.9 68.8 99.8 West Monaco – – – – – – Centre Montenegro 100.0 100.0 100.0 73.1 84.6 100.0 Centre North Macedonia – – – – – – East Republic of Moldova 100.0 100.0 100.0 83.5 81.2 100.0 East Russian Federation 100.0 – 100.0 – – – West San Marino – – – – – – Centre Serbia 100.0 100.0 100.0 92.9 90.5 100.0 Centre Serbia excluding Kosovo1 100.0 100.0 100.0 92.9 90.5 100.0 Centre Kosovo1 100.0 100.0 100.0 100.0 60.0 100.0 West Switzerland 100.0 99.7 98.3 71.0 65.3 81.7 East Tajikistan 100.0 100.0 100.0 86.9 55.1 – Centre Turkey 100.0 100.0 100.0 42.5 15.2 98.0 East Turkmenistan – – – – – – East Ukraine 100.0 100.0 100.0 99.9 91.8 100.0 East Uzbekistan – – – – – – a Completeness not computed on countries, territories or areas with fewer than five diagnoses reported in 2019 (Liechtenstein and San Marino) or countries that reported in the aggregated record type which did not allow reporting of all variables (Russian Federation). b Completeness provided is based on country of birth, region of origin or, for Italy and Switzerland, country of nationality. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 109 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Annex 4a Table A4a.1. HIV surveillance system overview: data source information Country, territory or area HIV data source Record typea for 2018 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-HIV HIVAIDS 1980–2019 V Co – Belgium BE-HIV/AIDS HIVAIDS 1985–2018 V Co Did not report 2019 data Bulgaria BG-HIV HIVAIDS 1986–2019 C Co HIV aggregate record type used through 2006; HIV record type 2007–2013 Cyprus CY-HIV/AIDS HIVAIDS 1986–2019 C Co – Croatia HR-CNIPH HIVAIDS 1985–2019 C Co HIV record type used prior to 2016 Czechia CZ-HIV/AIDS HIVAIDS 1985–2019 C Co – Denmark DK-HIV HIVAIDS 1990–2019 C Co HIV record type used 1990–2013 Estonia EE-NAKIS HIVAIDS 1988–2019 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 1980–2019 C Co HIV record type used prior to 2016 France FR-HIVAIDS HIVAIDS 2003–2019 C Co Although compulsory, HIV diagnoses are not exhaustively reported; underreporting was estimated at 31% in 2018 Germany DE-SURVNET@RKI7.3-HIV 1993–2019 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 1984–2019 C Co – Hungary HU-HIV/AIDS HIVAIDS 1985–2019 C Co – Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1983–2019 C Co HIV record type used prior to 2017 Ireland IE-CIDR HIVAIDS 1985–2019 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 1985–2019 C Co See country comments about historical coverage; HIV aggregate record type used through 2009 Latvia LV-HIV/AIDS HIVAIDS 1987–2019 C Co HIV record type used 1987–2013; HIVAIDS record type used from 2014 Liechtenstein CH-SFOPH-LI HIV 1985–2019 V NS/unk Cases reported through Switzerland's surveillance system using another data source Lithuania LT-AIDS_CENTRE HIVAIDS 1988–2019 C Co – Luxembourg LU-HIVAIDS HIVAIDS 1983–2019 V Co – Malta MT-DISEASE_SURVEILLANCE HIVAIDS 2001–2019 C Co HIV record type used in years 1986–2014 Netherlands NL-HIV/AIDS HIVAIDS 1980–2019 V Co – Norway NO-MSIS_B HIVAIDS 1984–2019 C Co HIV record type used in years 1980–2013 Poland PL-HIV HIVAIDS 1985–2019 C Co – Portugal PT-HIVAIDS HIVAIDS 1985–2019 C Co – Romania RO-RSS HIVAIDS 1987–2019 C Co – Slovakia SK-EPIS HIVAIDS 1985–2019 C Co HIV record type used in years 1985–2013 Slovenia SI-HIVAIDS HIVAIDS 1985–2019 C Co – Spain ES-HIV HIV 2003–2019 C Co See country comments about historical coverage and 2018 coverage Sweden SE-SmiNet HIVAIDS 1983–2019 C Co Data source SE-SweHIVReg used 1983–2009; HIV record type used prior to 2014 United Kingdom UK-HIVAIDS HIVAIDS 1981–2019 V Co – Non-EU/EEA Albania AL-NIoPH HIVAIDS 1993–2019 C Co – Andorra AD-MoHWFH HIVAIDS 2004–2018 V Co – Armenia AM-NAC HIVAIDS 1988–2019 V Co – Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1987–2019 V Se – Belarus BY-NAC HIVAIDS 1981–2019 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 1986–2019 C Co HIV record type used in years 1993–2013 Georgia GE-IDACIRC HIVAIDS 1989–2019 C Co – Israel IL-MOH HIVAIDS 1981–2019 C Co – Kazakhstan KZ-RCfAPC HIVAIDS 1987–2019 NS/unk NS/unk – Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1987–2019 V Co HIV record type used in years 1987–2000 Montenegro ME-IOPH HIVAIDS 1989–2019 C Co – Monaco MC-MoSH-GEN HIV 1987–2018 C Co – North Macedonia MK-NHASS HIVAIDS 1993–2018 C Co HIV record type used in years 1993–2016 Republic of Moldova MD-NAC HIVAIDS 1987–2019 V Other – Russian Federation RU-MOH HIVAGGR 2009-2019 C Co – San Marino SM-AIDS/HIV HIVAGGR 1985–2019 C Co – Serbia1 RS-NAC HIVAIDS 1984–2019 C Co HIV aggregate record type used in years 1984–2001 Switzerland CH-FOPH HIV 1985–2019 C Co – Tajikistan TJ-RHAC HIVAIDS 1991–2019 C Co – Turkey TR-MOH HIV 1985–2019 C Co – Turkmenistan TM-NAC – 1990–2012 V Co – Ukraine UA-NAC HIVAIDS 1987–2019 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). 1 Data from Kosovo, in accordance with Security Council resolution 1244 (1999), were reported through data source XK-HIVAIDS for 1986–2018; HIVAIDS record type used for all years. 110 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Annex 4b Table A4a.1. AIDS surveillance system overview: data source information Country, territory or area AIDS Data source Record typea for 2018 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-AIDS HIVAIDS 1982–2019 V Co – Belgium BE-HIV/AIDS HIVAIDS 1983–2018 V Co Did not report 2019 data Bulgaria BG-AIDS HIVAIDS 1987–2019 C Co AIDS record type was used for cases prior to 2014 Cyprus CY-HIV/AIDS HIVAIDS 1986–2019 C Co – Croatia HR-CNIPH HIVAIDS 1986–2019 C Co AIDS record type used prior to 2016 Czechia CZ-HIV/AIDS HIVAIDS 1986–2019 C Co – Denmark DK-HIV HIVAIDS 1980–2019 C Co AIDS record type from data source DK-MIS used 1980–2013 Estonia EE-NAKIS HIVAIDS 1992–2019 C Co AIDS record type used prior to 2015 Finland FI-NIDR HIVAIDS 1983–2019 C Co AIDS record type used prior to 2016 France FR-HIVAIDS; FR-AIDS HIVAIDS 1982–2019 C Co Additional data from record type AIDS used for cases with HIV diagnosis before 2003 or with unknown date of HIV diagnosis; although compulsory, AIDS diagnoses are not exhaustively reported – underreporting was estimated 41% in 2007–2009 Germany DE-AIDS 1981–2019 V Co Did not report 2017 data, AIDS record type used through 2016 Greece EL-HIV/AIDS HIVAIDS 1981–2019 C Co – Hungary HU-HIV/AIDS HIVAIDS 1986–2019 C Co – Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1985–2019 C Co AIDS record type used prior to 2017 Ireland IE-CIDR HIVAIDS 1983–2019 V Co Data source IE-HIV/AIDS and AIDS record type used for years 1981–2011 Italy IT-COA-ISS AIDS 1982–2019 C Co – Latvia LV-AIDS HIVAIDS 1990–2019 C Co Same data source in AIDS record type used for 1990–2013 Liechtenstein CH-SFOPH-LI AIDS 1989–2019 V NS/unk Cases reported through Switzerland's surveillance system Lithuania LT-AIDS_CENTRE HIVAIDS 1988–2019 C Co – Luxembourg LU-HIVAIDS HIVAIDS 1983–2019 V Co – Malta MT-DISEASE_SURVEILLANCE HIVAIDS 1986–2019 C Co Same data source and AIDS record type used 1986–2014 Netherlands NL-HIV/AIDS HIVAIDS 1999–2019 V Co – Norway NO-MSIS_B HIVAIDS 1983–2019 C Co Data source NO-MSIS-A and record type AIDS used in years 1980–2013 Poland PL-HIV HIVAIDS 1986–2019 C Co – Portugal PT-HIVAIDS HIVAIDS 1985–2019 C Co – Romania RO-RSS HIVAIDS 1985–2019 C Co – Slovakia SK-EPIS HIVAIDS 1985–2019 C Co AIDS record type used in years 1985–2013 Slovenia SI-HIVAIDS HIVAIDS 1986–2019 C Co – Spain ES-AIDS AIDS 1981–2019 C Co See country comments about coverage Sweden – – 1982–2007 V Co AIDS surveillance discontinued in 2008 United Kingdom UK-HIVAIDS HIVAIDS 1981–2019 V Co – Non-EU/EEA Albania AL-NIoPH HIVAIDS 1993–2019 C Co – Andorra AD-MoHWFH HIVAIDS 2004–2018 V Co – Armenia AM-NAC HIVAIDS 1988–2019 V Se – Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1995–2019 V Co – Belarus BY-NAC AIDS 1991–2019 C Co – Bosnia and Herzegovina BA-FMoH-MoHSWRS HIVAIDS 1986–2019 C Co AIDS record type used in years 1986–2013 Georgia GE-IDACIRC HIVAIDS 1989–2019 C Co – Israel IL-MOH HIVAIDS 1981–2019 C Co – Kazakhstan KZ-RCfAPC HIVAIDS 1993–2019 NS NS – Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1999–2019 V Co AIDS record type used in years 1987–2000 Montenegro ME-IOPH HIVAIDS 1990–2019 C Co – Monaco MC-MoSH-GEN AIDS 1985–2018 C Co – North Macedonia MK-NHASS HIVAIDS 1989–2018 C Co AIDS record type used in years 1993–2016 Republic of Moldova MD-NAC HIVAIDS 1989–2019 V Co – Russian Federation – – – – – – San Marino SM-AIDS/HIV AIDS 1986–2019 C Co – Serbia1 RS-NAC HIVAIDS 1985–2019 C Co AIDS record type used in years 1985–2001 Switzerland CH-FOPH AIDS 1980–2019 C Co – Tajikistan TJ-RHAC HIVAIDS 1998–2019 C Co – Turkey TR-MOH AIDS 1985–2019 C Co – Turkmenistan TM-NAC – 2002–2012 V Co – Ukraine UA-NAC AIDSAGGR 1988–2019 V Co HIVAIDS record type used only for HIV reporting (that is, 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). 1 Data from Kosovo, in accordance with Security Council resolution 1244 (1999), were reported through data source XK-HIVAIDS for 1986–2018; HIVAIDS record type used for all years. 111 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Annex 5 Table A5.1. Country-specific comments regarding national HIV and AIDS reporting Country Comments Belgium Belgian data were not reported for 2019 due to technical issues but will be reported in future rounds. Bulgaria Case-based reporting of HIV is available from 2007 onwards. Czechia Foreigners with short-term stays in Czechia 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). 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 31% in 2018 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). Data on new diagnoses adjusted for reporting delay and underreporting are 6 629 (2010), 6 461 (2011), 6 622 (2012), 6 688 (2013), 6 559 (2014), 6 443 (2015), 6 417 (2016), 6 583 (2017) and 6 155 (2018). HIV/AIDS surveillance was changed in 2016. Since then, HIV and AIDS diagnoses should be reported online, and physicians should report HIV diagnoses spontaneously, without waiting for the laboratory report. Probable country of infection is collected as “France/Abroad/Unknown”. In Table 12, the number 3 829 in the “Unknown” column includes 941 cases probably infected abroad, and 2 888 cases with unknown country of infection. 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 so-called previous- positive people, who are transferring their HIV care when moving to Ireland and tested positive and were 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 Data on new HIV diagnoses have been collected since 1985 in some regions of 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 were based on the annual resident population in the regions reporting cases. From 2012, the coverage of the surveillance system has been national, so the total Italian population is used as a denominator. AIDS deaths are not reported after 2017 due to lack of updated data from the national mortality register. 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. 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. 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 in the number of reported cases diagnosed between 1983 and 2012. Spain HIV reporting has existed since the 1980s in some of the 19 Autonomous Regions of Spain. For 2003–2011, HIV data are available only for nine regions: Asturias, Balearic Islands, Basque Country, Canary Islands, Catalonia, Ceuta, Extremadura, La Rioja and Navarre. Since 2004, HIV 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, HIV data are available for 17 regions (+ Cantabria, Castilla-León and Murcia). For 2012, data are available for 18 regions (+ Valencia). For 2013–2017, data are available for all the 19 regions of Spain (+ Andalucía), but for 2018, due to extraction issues, data for Catalonia are not available. Due to the COVID-19 pandemic, some regions have reported provisional data for 2019 and others (Asturias, Aragón, Cantabria and Melilla) have not reported any data. 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 2014–2019, 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 figures presented in the European report are based on a preliminary version of the United Kingdom database which subsequently was updated. Consequently, some totals in the report may differ very slightly to the United Kingdom national totals published. Non-EU/EEA Belarus All data are presented by "date of statistics" (instead of "date of diagnosis"). Bosnia and Herzegovina – Georgia Data are presented by "date of statistics" (instead of "date of diagnosis"). North Macedonia AIDS cases include only people diagnosed with AIDS at the time of HIV diagnosis. Russian Federation The data reported by the Russian Federation (by the Ministry of Health ) was limited to new HIV diagnosis by sex for 2009–2018 and data on HIV testing, which enabled the inclusion of the country’s data in Tables 1–3 and 25 and in the figures showing the trend of HIV diagnosis. Since 2016, case definitions have been changed in the Russian Federation. Updated Forms (N61) of the Federal Statistical Surveillance are submitted by medical facilities to the Ministry of Health and include the number of individuals newly diagnosed with HIV infection. Data for 2009–2015 cannot thefore be compared directly with those for 2016–2018. 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. Tajikistan Due to technical problems, no data export for 2018 from Tajikistan was available. 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"). Ukraine All data are presented by “date of statistics” (instead of “date of diagnosis”). 112 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2020 – 2019 data Annex 6 Table A6.1. New HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients,a 2016–2019 Country, territory or areab 2016 2017 2018 2019 Adjustment coefficientsN Rate N Rate N Rate N Rate 2016 2017 2018 2019 EU/EEA West Austria 325 3.7 348 4.0 237 2.7 283 3.2 1.12 1.15 1.19 1.26 West Belgium 909 8.0 899 7.9 882 7.7 – – 1.00 1.00 1.00 1.00 Centre Bulgaria 202 2.8 241 3.4 311 4.4 258 3.7 1.00 1.00 1.00 1.00 Centre Croatia 109 2.6 106 2.6 94 2.3 102 2.5 1.00 1.00 1.00 1.00 Centre Cyprus 80 9.4 85 9.9 78 9.0 100 11.4 1.00 1.00 1.00 1.00 Centre Czechia 286 2.7 254 2.4 208 2.0 222 2.1 1.00 1.00 1.00 1.00 West Denmark 244 4.3 242 4.2 219 3.8 190 3.3 1.00 1.00 1.00 1.00 East Estonia 229 17.4 219 16.6 190 14.4 178 13.4 1.00 1.00 1.00 1.00 West Finland 180 3.3 158 2.9 153 2.8 149 2.7 1.00 1.00 1.00 1.00 West Francec 5 444 8.2 5 410 8.1 5 164 7.7 5 529 8.2 1.00 1.00 1.02 1.12 West Germany 3 378 4.1 3 155 3.8 2 867 3.5 3 093 3.7 1.00 1.00 1.00 1.00 West Greece 652 6.0 645 6.0 724 6.7 657 6.1 1.00 1.00 1.01 1.04 Centre Hungary 228 2.3 223 2.3 229 2.3 238 2.4 1.00 1.00 1.00 1.00 West Iceland 28 8.4 24 7.1 38 10.9 28 7.8 1.00 1.00 1.00 1.00 West Ireland 511 10.8 499 10.4 508 10.5 533 10.9 1.00 1.00 1.00 1.00 West Italy 3 707 6.1 3 609 5.9 3 113 5.1 2 724 4.5 1.01 1.01 1.04 1.07 East Latvia 369 18.7 376 19.3 328 17.0 295 15.4 1.00 1.00 1.00 1.00 – Liechtenstein 2 5.3 0 0.0 0 0.0 0 0.0 1.00 1.00 1.00 1.00 East Lithuania 214 7.4 263 9.2 160 5.7 151 5.4 1.00 1.00 1.00 1.00 West Luxembourg 92 16.0 80 13.6 75 12.5 70 11.4 1.14 1.20 1.32 1.46 West Malta 63 14.0 45 9.8 73 15.3 80 16.2 1.00 1.00 1.00 1.00 West Netherlands 903 5.3 854 5.0 746 4.3 666 3.9 1.01 1.03 1.08 1.18 West Norway 220 4.2 213 4.1 191 3.6 183 3.4 1.00 1.00 1.00 1.07 Centre Poland 1 319 3.5 1 420 3.7 1 217 3.2 1 585 4.2 1.00 1.00 1.01 1.08 West Portugal 1 725 16.8 1 611 15.7 1 465 14.2 1 344 13.0 1.14 1.21 1.32 1.73 Centre Romania 774 3.9 796 4.1 732 3.7 690 3.6 1.00 1.00 1.00 1.00 Centre Slovakia 88 1.6 72 1.3 102 1.9 114 2.1 1.00 1.00 1.00 1.13 Centre Slovenia 60 2.9 40 1.9 37 1.8 34 1.6 1.00 1.00 1.00 1.00 West Spain 4 175 9.0 3 795 8.2 2 527 6.4 2 483 5.6 1.00 1.00 1.00 1.00 West Sweden 429 4.4 434 4.3 481 4.8 449 4.4 1.00 1.00 1.00 1.00 West United Kingdom 5 231 8.0 4 653 7.1 4 537 6.8 4 116 6.2 1.00 1.00 1.00 1.00 Total EU/EEA 32 293 6.3 30 932 6.0 27 798 5.4 27 231 5.4 1.01 1.02 1.03 1.10 Non-EU/EEA Centre Albania 127 4.4 94 3.3 102 3.5 101 3.5 1.00 1.00 1.00 1.00 West Andorra 3 3.9 6 7.8 12 15.6 – – 1.00 1.00 1.00 1.00 East Armenia 304 10.4 355 12.1 420 14.2 446 15.1 1.00 1.00 1.00 1.00 East Azerbaijan 556 5.7 567 5.8 656 6.6 721 7.2 1.00 1.00 1.00 1.00 East Belarus 2 391 25.3 2 468 26.1 2 386 25.2 2 137 22.6 1.00 1.00 1.00 1.00 Centre Bosnia and Herzegovina 24 0.7 15 0.4 24 0.7 30 0.9 1.00 1.00 1.00 1.00 East Georgia 719 17.9 631 15.7 672 16.8 668 16.7 1.00 1.00 1.00 1.00 West Israel 368 4.5 415 5.0 452 5.4 408 4.8 1.00 1.00 1.00 1.00 East Kazakhstan 2 898 16.3 3 014 16.7 3 215 17.5 3 673 19.8 1.00 1.00 1.00 1.00 East Kyrgyzstan 764 12.6 840 13.6 876 13.9 850 13.2 1.00 1.00 1.00 1.00 West Monaco 0 0.0 3 7.8 0 0.0 – – 1.00 1.00 1.00 1.00 Centre Montenegro 34 5.4 26 4.1 23 3.7 26 4.1 1.00 1.00 1.00 1.00 Centre North Macedonia 30 1.4 44 2.1 45 2.2 – – 1.00 1.00 1.00 1.00 East Republic of Moldova 832 20.5 835 20.6 905 22.3 922 22.8 1.00 1.00 1.00 1.00 East Russian Federation 86 855 59.8 85 802 59.0 85 995 59.0 80 124 54.9 1.00 1.00 1.00 1.00 West San Marino 2 6.0 1 3.0 3 8.9 0 0.0 1.00 1.00 1.00 1.00 Centre Serbia 179 2.0 186 2.1 188 2.1 215 2.0 1.00 1.00 1.00 1.00 Centre Serbia excluding Kosovo1 168 2.4 183 2.6 180 2.6 210 2.4 1.00 1.00 1.00 1.00 Centre Kosovo1 11 0.6 3 0.2 8 0.4 5 0.3 1.00 1.00 1.00 1.00 West Switzerland 533 6.4 446 5.3 425 5.0 421 4.9 1.00 1.00 1.00 1.00 East Tajikistan 1 038 12.0 1 205 13.6 1 421 15.6 1 320 14.2 1.00 1.00 1.00 1.00 Centre Turkey 2 438 3.1 2 844 3.5 3 248 3.9 3 229 3.9 1.00 1.00 1.00 1.00 East Turkmenistan – – – – – – – – 1.00 1.00 1.00 1.00 East Ukraine 14 241 33.4 15 625 36.8 15 686 37.2 16 357 39.0 1.00 1.00 1.00 1.00 East Uzbekistan – – – – – – – – 1.00 1.00 1.00 1.00 Total non-EU/EEA 114 336 31.3 115 422 31.4 116 754 31.6 111 648 30.1 1.00 1.00 1.00 1.00 WHO European Region West 29 200 6.8 27 644 6.4 24 953 5.9 23 971 5.7 1.01 1.02 1.03 1.10 Centre 5 978 3.1 6 447 3.3 6 638 3.4 6 944 3.5 1.00 1.00 1.00 1.04 East 111 410 43.4 112 200 43.6 112 910 43.7 107 845 41.7 1.00 1.00 1.00 1.00 Total WHO European Region 146 588 16.6 146 291 16.5 144 502 16.4 138 760 15.9 1.00 1.00 1.01 1.02 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. The sum of country totals may not equal regional totals due to independent calculation of reporting delay totals for the region from those of some countries. b Country-specific comments are in Annex 5. c French data for 2015–2018 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. 1 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 113 HIV/AIDS surveillance in Europe 2020 – 2019 dataSURVEILLANCE REPORT Annex 7 Table A7.1. 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 Czechia 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 National Public Health Organization 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 Republican Centre for AIDS Prevention and Control Monaco Ministry of Social Health Montenegro Institute of Public Health of Montenegro North Macedonia Public Health Institute Republic of Moldova National AIDS Centre; National Centre for Preventative Care Russian Federation Ministry of Health of the Russian Federation San Marino Ospedale di Stato Serbia1 Institute of Public Health of Serbia Switzerland Bundesamt für Gesundheit Tajikistan Republican HIV/AIDS Centre 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 1 Data for Kosovo (in accordance with Security Council resolution 1244 (1999)) were provided by the public health institute. 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