HIV/AIDS surveillance in Europe 2023: 2022 data

HIV/AIDS surveillance in Europe 2022 data 2023

HIV/AIDS surveillance in Europe 2022 data 2023 ii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data This report has been published jointly by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe. The Regional Office developed the overview of the European Region as a whole and validated the figures of the non-member countries of the European Union (EU)/European Economic Area (EEA) and ECDC developed the overview of the EU/EEA countries and validated the EU/EEA figures. Suggested citation for full report: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2023 – 2022 data. Stockholm: ECDC; 2023. Tables and figures should be referenced: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2023 – 2022 data. This publication follows the ECDC terminological practice which reflects the European Union Inter-institutional Style Guide with regard to names and designations of countries. The names and designations of countries used in this publication should not be understood as an endorsement by WHO of the terminology used in this publication. The designations used do not represent WHO’s official position on the legal status of any country or of its authorities, or the delimitation of its frontiers and boundaries. ECDC has amended the maps supplied by the WHO Regional Office for Europe for this publication. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the WHO Secretariat concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. The WHO Regional Office for Europe is responsible for the accuracy of the translation of the Russian summary. Keywords: ACQUIRED IMMUNODEFICIENCY SYNDROME – EPIDEMIOLOGY AIDS – PREVENTION AND CONTROL DISEASE OUTBREAKS – STATISTICS HIV INFECTIONS – EPIDEMIOLOGY POPULATION SURVEILLANCE © European Centre for Disease Prevention and Control, 2023 Reproduction is authorised, provided the source is acknowledged. © World Health Organization 2023 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecom- mons.org/licenses/by-nc-sa/3.0/igo). Cover picture: NIAID ECDC PDF ISBN 978-92-9498-670-2 ISSN 2363-3085 doi:10.2900/08930 TQ-AL-23-001-EN-N WHO ISBN 978-92-890-6046-2 iii HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT This report was coordinated by Juliana Reyes-Urueña (European Centre for Disease Prevention and Control (ECDC) and Giorgi Kuchukhidze (WHO Regional Office for Europe). ECDC and WHO’s 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: Anna Mergelyan; Austria: Ziad El-Khatib; Irene Kászoni-Rückerl; Azerbaijan: Gunash Jafarova; Natig Zulfugarov; Famil Mammadov; Belarus: Svetlana Sergeenko; Belgium: Dominique Van Beckhoven; Jessika Deblonde; Bosnia and Herzegovina: Dalibor Pejović; Bulgaria: Mariya Tyufekchieva; Nadezhda Vladimirova; Croatia: Tatjana Nemeth Blazic; Mirjana Lana Kosanovic Licina; Cyprus: Anna Demetriou; Elena Xenofontos; George Siakallis; Fani Theofanous; Czechia: Marek Malý; Vratislav Němeček; Hana Zákoucká; Denmark: Anders Koch; Susan Cowan; Maria Wessman; Estonia: Kristi Rüütel; Jevgenia Epstein; Finland: Kirsi Liitsola, Henrikki Brummer-Korvenkontio; France: Françoise Cazein, Florence Lot; Amber Kunkel; Georgia: Otar Chokoshvili, Maia Tsereteli; Germany: Barbara Gunsenheimer-Bartmeyer; Greece: Chrysa Tsiara; Dimitra Paraskeva; Georgia Nikolopoulou; Ioanna Magaziotou; Georgios Ferentinos; Stavros Patrinos; Hungary: Ágnes Galgóczi; Zsuzsanna Molnár; Erika Fogarassy; Iceland: Anna Margret Gudmundsdottir; Erna Milunka Kojic; Ireland: Derval Igoe; Kate O’Donnell; Mary Archibald; Israel: Daniel Chemtob; Yana Roshal; Italy: Barbara Suligoi; Maria Elena Tosti; Kazakhstan: Lolita Ganina; Gulnar Temirkhanov; Kyrgyzstan: Aigul Solpueva; Latvia: Šarlote Konova; Liechtenstein: Esther Walser-Domjan; Lithuania: Oksana Jučienė, Vilnelė Lipnickienė; Giedrė Aleksienė; Jurgita Pakalniškienė; Luxembourg: Patrick Hoffmann; Joël Mossong; Pierre Braquet; Malta: Jackie Maistre Melillo, Tanya Melillo; Elaine Lautier; Monaco: Julie Biga; Montenegro: Alma Cicic; Netherlands: Eline Op de Coul; Ard van Sighem; Birgit van Benthem; North Macedonia: Dragan Kocinski; Norway: Hilde Klovstad; Kathrine Stene-Johansen; Robert Whittaker Poland: Marta Niedźwiedzka-Stadnik; Magdalena Rosinska; Portugal: Helena Cortes Martins; Joana Bettencourt; Pedro Pinto Leite; Vítor Cabral Veríssimo Republic of Moldova: Silvia Stratulat; Romania: Mariana Mardarescu; Russian Federation: Irina Kulikova; Oleg Sonin; Elena Veselova; San Marino: Andrea Gualtieri; Mauro Fiorini; Serbia: Danijela Simic; Slovakia: Alexandra Bražinová; Eva Chmelanova; Danica Valkovičová Staneková Slovenia: Irena Klavs; Tanja Kustec; Spain: Asuncion Diaz; Julia Del Amo; Sweden: Maria Axelsson; Lena Dillner; Anneli Carlander; Lilian van Leest; Switzerland: Thibault Lovey; Tajikistan: Kholnazarov Ramshed; Zukhra Nurlaminova; Türkiye: Burak Tunç; Oğuz Evlice; Nurcan Ersöz; Ukraine: Violetta Martsinovskaya; Ihor Kuzin; Oleksandr Matskov; * Kosovo: Luljeta Gashi * Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. Acknowledgments

vHIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Contents Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix Overview of HIV and AIDS in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxi 1. HIV and AIDS in the EU/EEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1.1. HIV diagnoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1.2. Previous positive diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.3. Trends in HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.4. AIDS cases, morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.5. HIV testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 1.6. Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 2. HIV and AIDS in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 2.1. HIV and AIDS diagnoses in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 2.2. HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 2.3. Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Figures Figure A: Estimated new HIV infections and reported HIV diagnoses in the EU/EEA and WHO European Region, 2013–2022 . . . . . . . . . . . . . . . . . . . . . . . . xii Figure B: Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission mode, WHO European Region, 2022 (n = 28 718) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xii Рисунок A. Оценочное число новых случаев и число зарегистрированных случаев ВИЧ-инфекции в ЕС/ЕЭЗ и Европейском регионе ВОЗ, 2013–2022 гг. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxii Рисунок B. Доля лиц с поздним диагнозом (CD4 < 350 кл/мм3) с разбивкой по полу, возрасту и пути передачи, Европейский регион ВОЗ, 2022 г. (n=28 718) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxii Figure 1.1: Male-to-female ratio in HIV diagnoses, by country, EU/EEA, 2022 (n=22 790) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Figure 1.2: Age- and gender-specific rates of HIV diagnoses per 100 000 population, EU/EEA, 2022 (n=22 734) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure 1.3: HIV diagnoses, by age group (in years) and transmission mode, EU/EEA, 2022 (n=16 368). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure 1.4: Percentage of HIV diagnoses, by country and age group, EU/EEA, 2022 (n = 22 830) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Figure 1.5: Percentage of HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2022 (n = 16 718). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Figure 1.6: Percentage of HIV diagnoses among migrants out of all reported cases with known information on region of origin, by country of report, EU/EEA, 2022 (n = 20 016) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Figure 1.7: Acute infection or CD4 cell count per mm3 at HIV diagnosis, overall and by transmission mode, EU/EEA, 2022 (n=16 507) . . . . . . . . . . . . . . 5 Figure 1.8: Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2022 (n = 6 451) . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Figure 1.9: Linkage to care after HIV diagnosis in the EU/EEA, individuals diagnosed with HIV 2021–2022 (n = 4 389). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Figure 1.10: Percentage of previous positive diagnoses and newly HIV diagnoses by country of report, EU/EEA, 2022 (n = 9 057) . . . . . . . . . . . . . . . . . . . . . .7 Figure 1.11: Temporal trends in HIV diagnoses reported by 14 EU/EEA countries: a comparison including and excluding previous positive cases, 2013–2022 (n = 9 057). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Figure 1.12: Demographic and clinical characteristics of previous positive and new HIV diagnoses from EU/EEA countries which were able to identify the HIV status, 2022 (n = 9 057) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Figure 1.13: People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2013–2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Figure 1.14a: Age-specific trends in HIV diagnoses in women, 2013–2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Figure 1.14b: Age-specific trends in HIV diagnoses in men, 2013–2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Figure 1.15: Percentage of diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2013–2022 . . . . . . . . . . . . . . . . . 11 Figure 1.16a: HIV diagnoses, by year of diagnosis and transmission mode, EU/EEA, 2013–2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 vi SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Figure 1.16b: Percentage of HIV diagnoses, by year of diagnosis and transmission mode, EU/EEA, 2013–2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Figure 1.17: HIV diagnoses, by year of diagnosis, transmission mode and migration status, EU/ EEA, 2013–2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Figure 1.18: Number of HIV diagnoses by acute infection or CD4 cell count at diagnosis, EU/EEA, 2013–2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Figure 1.19: AIDS diagnoses, by transmission mode, EU/EEA, 2013–2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Figure 2.1: Percentage of HIV diagnoses, by country and age group, WHO European Region, 2022 (n=110 402). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Figure 2.2: Percentage of HIV diagnoses with known mode of transmission, by transmission route and country, WHO European Region 2022 . .21 Figure 2.3: HIV diagnoses, by age group and transmission mode, WHO european Region, 2022 (n = 97 650). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Figure 2.4: HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2022 (n = 00 000) . . . . . . . . . . 23 Figure 2.5: HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region, 2013–2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Figure 2.6: HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2013–2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Figure 2.7: HIV diagnoses, by transmission mode and year of diagnosis, East, 2013–2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Figure 2.8: HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2013–2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Figure 2.9: HIV diagnoses, by transmission mode and year of diagnosis, West, 2013–2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Figure 2.10: New AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2013–2022 . . . . 28 Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table A: Characteristics of HIV and AIDS diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the WHO European Region, 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Таблица A. Характеристики случаев ВИЧ-инфекции и СПИДа, зарегистрированных в Европейском регионе ВОЗ, ЕС/ЕЭЗ, а также в западной, центральной и восточной части Европейского региона ВОЗ, 2022 г.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxi Table 1: HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/ EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 2: HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 3: HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 4: HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table 5: HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 Table 6: HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 7: HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 8: HIV diagnoses in 2022, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 9: HIV diagnoses in 2022, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . 46 Table 10: Origin of those diagnosed with HIV in 2022 by country of report or Region, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 11: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 12: Percentage of HIV diagnoses (2022) 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Table 13: AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Table 14: AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 15: AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 16: The most common AIDS-indicative diseases diagnosed in 2022, ordered by frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 17: AIDS-related deaths, by geographic area, country and year of death (2013–2022) and cumulative totals in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 Table 18: Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2013–2022) and number of tests per 1 000 population in 2022, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . 62 vii HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Map 1a: HIV diagnoses per 100 000 population, 2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Map 1b: HIV diagnoses per 100 000 population, 2022, EU/EEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Map 2: HIV diagnoses in men per 100 000 male population, 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Map 3: HIV diagnoses in women per 100 000 female population, 2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Map 4: HIV diagnoses in men who have sex with men per 100 000 male population, 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Map 5: HIV diagnoses acquired through injecting drug use per 100 000 population, 2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Map 6: HIV diagnoses acquired through heterosexual transmission per 100 000 population, 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67 Map 7: AIDS diagnoses reported per 100 000 population, 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67 Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

ix HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT ART antiretroviral treatment ECDC European Centre for Disease Prevention and Control EU/EEA European Union/European Economic Area MSM men who have sex with men MTCT Mother-to-child transmission PrEP pre-exposure prophylaxis SDG Sustainable Development Goal TESSY The European Surveillance System TB tuberculosis UNSCR United Nations Security Council Resolution UNAIDS Joint United Nations Programme on HIV/AIDS Abbreviations

xi HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT This report presents HIV/AIDS surveillance data for 2022, a year marked by increased population movements1 across Europe that have had an impact on HIV trends, particularly in European Union/European Economic Area (EU/EEA) countries. In addition to the increased move- ment of people, the post-COVID-19 recovery of health services and surveillance activities, and the scale-up and introduction of novel testing strategies in many countries resulting in the identification of previously undiagnosed cases, led to a significant rise in HIV diag- noses across the Region. In 2022, 37 of the 49 countries in the Region, including 26 in the EU/EEA, reported an increase in HIV diagnoses compared to 2021, with some countries reporting record-high numbers in a single year. In 2022, 110 486 HIV diagnoses were reported in 49 of the 53 countries in the Region, including 22 995 from the countries of the EU/EEA. This corresponds to a crude rate of 12.4 HIV diagnoses per 100 000 population in the Region overall, a slight increase on the rate for 2021 (11.9 per 100 000 population). However, this represents a substantial decrease on the rate for 2019 (15.6 per 100 000 population), which was the period before the COVID-19 pandemic (Table A, Figure A). When comparing the number of HIV diagnoses to the estimated number of new HIV infections over the past decade, it is evident that an increasingly larger number 1 Population movements in this report include the influx of refugees and the migration of people into European countries from within and outside the WHO European Region. of individuals acquire HIV infection than are diagnosed. This indicates that the population of people living with undiagnosed HIV in the Region is growing (Figure A). Increased movement of people living with a known HIV diagnosis in European countries has increased the num- ber of previously positive individuals2 in the Region. The increase in previous positive cases has had a consider- able impact on the epidemiological profile and trends among HIV diagnoses reported in 2022, particularly for EU/EEA countries from the West and Centre of the Region. As a result, a noticeable shift in trends has emerged in 2022, with HIV rates increasing in the EU/EEA, West and the Centre regions by 30.8%, 21.4% and 40.6%, respec- tively, compared to 2021. In the EU/ EEA, 11 countries have reported the highest number of cases in the past decade. Population movement has also affected the mode of transmission, which varies across geographical areas, underscoring the diversity in HIV epidemiology within Europe. In the EU/EEA, the West, and the Centre, sexual transmission between men remains one of the most common routes of HIV transmission, especially among migrant men from other regions. However, het- erosexual transmission has become more prevalent in the HIV diagnoses reported in 2022, particularly among individuals who have had a previous positive diagnosis. In the East, several countries also recorded the high- est number of HIV diagnoses reported in a single year. 2 This category includes individuals who had previously received an HIV diagnosis, either in another country or within a different setting in the reporting country before the current reporting year. 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, 2022 WHO European Region West Centre East EU/EEA Reporting countries/number of countriesa 49/53 21/23 15/15 13/15 30/30 Number of HIV diagnoses 110 486 22 397 8 945 79 144 22 995 Rate of HIV diagnoses per 100 000 population 12.4 5.1 4.5 30.7 5.1 Percentage age 15–24 years 5.7% 8.9% 11.7% 4.2% 8.9% Percentage age 50+ years 16.7% 21.8% 15.1% 15.5% 19.9% Male-to-female ratio 1.8 2.4 2.9 1.6 2.4 Percentage of migrantsb 26.7% 52.3% 27.0% 2.2% 48.3% Transmission mode Sex between men 11.3% 35.2% 18.7% 3.7% 33.3% Heterosexual transmission (men) 31.7% 15.1% 14.9% 38.3% 14.6% Heterosexual transmission (women) 29.5% 21.0% 10.5% 34.1% 19.0% Injecting drug use 16.1% 3.8% 2.1% 21.1% 4.3% Mother-to-child transmission 0.6% 1.1% 0.8% 0.4% 1.2% Unknown 10.8% 23.6% 52.8% 2.4% 27.3% AIDS and late HIV diagnosis Percentage HIV diagnoses CD4 <350 cells/mm3 50.6 46.2 44.5 55.1 47.9% Number of AIDS diagnosesc 7 220 1 873 825 4 522 2 349 Rate of AIDS diagnoses per 100 000 population 1.1 0.5 0.4 4.4 0.6 a No data reported by Andorra, Monaco, Turkmenistan and Uzbekistan. b Migrants defined as originating from outside of the country in which they were diagnosed c No data reported by Andorra, Bosnia and Herzegovina, Germany, Monaco, North Macedonia, Russian Federation, Sweden, Turkmenistan or Uzbekistan. xii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data However, none of those countries reported a substantial increase in the number of cases originating from out- side the country, and over 90% of their HIV diagnoses originate from the reporting country. The countries in question reported a rebound in HIV testing and case detection since the pandemic subsided because of the focus on increasing case detection and introducing new testing policies to close the gap on undiagnosed people. Heterosexual transmission and injecting drug use were still the main reported transmission modes in the East of the Region. Late HIV diagnosis remains a challenge for most coun- tries in the Region, with about half (50.6%) of those diagnosed in 2022 diagnosed late (CD4 cell count less than 350/mm3). The percentage of people diagnosed late varied across transmission categories and age groups, but was highest for people with reported heterosexual transmission (55.0%) and lowest for men infected through sex with men (41.4%) (Figure B). In 2022, 7 642 people were diagnosed with AIDS, reported in 44 countries of the WHO European Region. (Table  A; see also Table  13). The overall rate of AIDS diagnoses in the Region decreased by 54.2% between 2013 and 2022, from 2.4 per 100 000 population (17 486 cases) to 1.1 per 100 000. This declining trend is evident across all the sub-regions of the Region including the EU/EEA. Figure A: Estimated new HIV infections and reported HIV diagnoses in the EU/EEA and WHO European Region, 2013–2022 Shaded areas represent uncertainty intervals around the best estimate. Note: Data from Andorra, Monaco, Turkmenistan, and Uzbekistan were excluded due to inconsistent reporting during the period. Re op rt ed n ew 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 50 000 100 000 150 000 200 000 250 000 EU/EEA estimated infections EU/EEA diagnoses WHO European Region diagnoses WHO European Region estimated infections 2022202120202019201820172016201520142013 Figure B: Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission mode, WHO European Region, 2022 (n = 28 718) 0 10 20 30 40 50 60 70 Sex between men Injecting drug use Heterosexual transmission (women) Heterosexual transmission (men) 50+ 40–49 30–39 25–29 20–24 15–19 Women Men Total Percentage Ge nd er Ag e gr ou p (y ea rs ) Tr an sm is si on m od e Note: Cases with unknown CD4, acute cases, and previous positives are excluded from this figure. CD4 data from the Russian Federation was excluded as it did not include age, sex, and transmission route breakdowns xiii HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT European Union and European Economic Area In 2022, 22 995 HIV diagnoses were reported in 30 coun- tries of the EU/EEA3, corresponding to a rate of 5.1 per 100 000 population (Table  1), a 30.8% increase com- pared to 2021 but still a 3.8% decrease compared to the 2019 rate. The highest rates were reported by Cyprus (24.1; 218 cases), and Estonia (18.8; 250 cases), and the lowest by Slovenia (2.0; 42 cases) (Table 1; Map 1). As in previous years, the rate of HIV diagnoses in 2022 was higher among men (7.3 per 100 000 population; Table  2; Map  3) than women (2.9 per 100 000 popula- tion; Table  3; Map  4). The overall male-to-female ratio was 2.4:1 (Table A). The predominant mode of transmis- sion in countries with the highest male-to-female ratios was sex between men. In addition to the 22 790 cases with male or female gender, 121 transgender individuals were reported by France, the Netherlands and Ireland. Sex between men remains one of the most common modes of HIV transmission reported in the EU/EEA, accounting for 33.3% (7 656) of all reported HIV diagno- ses in 2022 and 45.8% of diagnoses where the route of transmission was known (Figure  1.5; Table  4, Table  8; Map  5). Most of the men with a reported HIV diagnosis attributed to sex between men (54.7%) were born out- side of the reporting country. For the first heterosexual contact is higher than sex between men as mode of HIV transmission in the EU/EEA in 2022, accounting for 33.7% (7 743) of HIV diagnoses and 46.3% of diagnoses where the route of transmis- sion was known (Figure  1.5; Table  6, Table  8; Map  6). Nearly one-third (28.2%; 2 186) of the reported diagno- ses attributed to heterosexual transmission were among migrants originating from Central and Eastern Europe, followed by migrants from Sub-Saharan Africa (26.4%; 2 046). In addition, 31.1% (2 407) of cases attributed to heterosexual transmission originated from the reporting country. Transmission due to injecting drug use accounted for 4.3% of HIV diagnoses in 2022 (Figure  1.5, Table  5, Table  8, Map  7). More than half of individuals with a reported diagnosis attributed to injecting drug use were born outside of the reporting country, including 43.3% (430 cases) from other countries in Central and Eastern Europe. Transmission as a result of mother-to-child transmission (MTCT) accounted for 1.2% of HIV diagnoses in 2022 (Figure  1.5, Table  7, Table  8). In 2022, among the total number of diagnoses attributed to MTCT of HIV, 81.5% were migrants (220). Among these migrants, 62.3% (137) originated from Central Eastern Europe, and within this group, 83.2% (114) were previous positive diagnoses. In the EU/EEA in 2022, 48.3% of those diagnosed were migrants, defined as originating from outside of the 3 All EU/EEA countries reported data for 2022. country in which they were diagnosed (Figure 1.6), with 22.8% originating from other countries in Central and Eastern Europe, 13.9% from countries in Sub-Saharan Africa, 11.3% from countries in Latin America and the Caribbean, 2.6% from countries in other countries in Western Europe, and 2.3% from countries in South and South-East Asia. The increased rate of reported HIV diagnoses in 2022 may be attributed, among other factors, to the increase in reporting of previous positive diagnoses. In 2022, previ- ous positive diagnoses comprised 16.6% of all reported HIV diagnoses in the EU/EEA, a notable increase on 2021 when this proportion was 8.8%. However, these figures are probably underestimated, as not all countries could report information on whether cases were previously diagnosed. Despite the clear impact of previous positive diagno- ses on the larger case numbers reported in 2022, when trends are adjusted by removing previous positive cases there is still an increase from 2021 to 2022 (Figures 1.11 and 1.13). Despite this recent increase in HIV cases reported in the EU/EEA, overall, during the last decade the rate of new HIV diagnoses has declined, by 3.8% in particular since 2019. When comparing previous positive diagnoses to newly diagnosed people in the 14 countries that could report information on most cases previous diagnosis status, it was found that among the previous positive cases there was a higher proportion of women (44.0% versus 28.9%), people originating from Central and Eastern Europe (44.7% versus 10.9%) and transmission due het- erosexual contact (44.8% versus 42.6%), injecting drug use (6.4% versus 1.8%) and MTCT (3.2% versus 0.6%) compared to newly diagnosed people. The proportion of all HIV diagnoses with known route of transmission in all EU/EEA countries that were attrib- uted to sex between men decreased from 49.5% of cases in 2013 to 45.9% in 2022 (Figure  1.16a, Figure  1.16b). It is important to note that the case numbers among MSM born outside of the reporting country increased in 2022 to 3 168, compared to 2 537 in 2013, marking a 24.9% rise (Figure 1.17). Between 2013 and 2021, the proportion of all HIV diag- noses with known route of transmission, attributed to heterosexually-acquired infection in women remained stable at around 20% of cases. In 2022, both the number and proportion increased, reaching (n=4 249) 26.1% of the HIV diagnoses reported with known information on the route of transmission. During the previous decade, the proportion of all HIV diagnoses attributed to heter- osexually-acquired HIV infection in men was also stable at around 20% (Figure 1.16b). During the period 2013 to 2021, the proportion of all HIV diagnoses with known route of transmission reported among people who inject drugs decreased, from 7.7% to 4.7% (1 747 to 684) (Figure 1.16a, Figure 1.17, Table 5). An increase in the number (963) and proportion of HIV xiv SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data diagnoses among people who inject drugs to 5.9% was then noted for 2022. In countries with consistent reporting throughout the previous decade, the proportion of HIV diagnoses reported to be due to MTCT was stable, at around 0.8% between 2013 and 2021, although the number declined from 188 in 2013 to 119 in 2021. In 2022, the proportion and number increased to 1.2% (252) (Figure 1.16a), with a majority of these cases being previous positive. Information on CD4 cell count at the time of HIV diag- nosis was provided by 27 EU/EEA countries (Table  12). Among all cases diagnosed in 2022 where information on CD4 cell count, or acute HIV infection status was avail- able, 8.4% were reported as acute infections and 30.2% as more recent infections (with a CD4 cell count equal to or above 500 cells per mm3 at diagnosis) (Figure 1.7); 47.9% were considered to have been diagnosed several years after being infected (CD4 cell count of less than 350 cells per mm3). Overall, 28.8% were considered to have advanced HIV infection (CD4 cell count less than 200 cells/mm3) at the time of diagnosis (Table 12). The highest proportions of people presenting at a later stage of HIV infection (CD4 less than 350 cells/ mm3 excluding those previously diagnosed or with evi- dence of acute infection) were observed among women (54.4%); older adults (57.1% in 40–49-year-olds and 68.1% in people over 50 years); men or women infected through heterosexual sex (63.2% and 53.6% respec- tively); people who acquired HIV through injecting drug use (50.7%), and migrants from South and South-East Asia (63.8%) and Sub-Saharan Africa (58.%) (Figure 1.8). In 2022, 2 349 diagnoses of AIDS were reported by 27 EU/EEA countries, giving a rate of 0.6 cases per 100 000 population (Table 13; Map 8). Combined pulmonary and/ or extrapulmonary tuberculosis (TB) made up 12.1% of AIDS-indicative diseases reported in 2022 (Table 16). In the EU/EEA, the number of AIDS cases has more than halved over the past decade across all transmission routes (Figure 1.18). Ten countries consistently reported data on HIV tests performed during the period 2013−2022, excluding unlinked anonymous testing and testing of blood dona- tions. The number of tests performed in the countries reporting consistently has increased by 16.3% compared to 2021, and by 11.8% compared to 2019 (Table 18). WHO European Region In 2022, 110 486 people were diagnosed with HIV in 49 countries of the Region, corresponding to a rate of 12.4 per 100 000 population, a 4.2% increase compared to the 2021 rate but still a 20.5% decrease compared to the 2019 rate. Increased population movements4 across Europe, particularly in EU/EEA countries, as well as the resumption of health services following the COVID-19 4 Population movements in this report include the influx of refugees and the migration of people in European countries from within and outside the WHO European Region. pandemic and the the scale-up and introduction of new testing strategies to detect previously undiagnosed cases, have led to an increase in the number of diag- noses, and the number of people previously diagnosed with HIV among them. All of this makes it challenging to interpret HIV trends for 2019−2022. Of the 110 486 people diagnosed in 2022, 71.6% were diagnosed in the East (79 144), 20.3% in the West (22 397), and 8.1% in the Centre of the Region (8 945) (Table A). The rate was also highest in the East (30.7 per 100 000 population); disproportionately higher than in the West (5.1 per 100 000 population) and the Centre (4.5 per 100 000 population) (Table A). Rates of HIV diagnoses varied widely across countries in the WHO European Region in 2022. The highest rates per 100 000 population (more than 15.0) were observed in the Russian Federation (38.4), followed by Ukraine (29.8), the Republic of Moldova (28.4), Cyprus (24.1), Kazakhstan (20.7), Armenia (19.2), Estonia (18.8), Ireland (17.5) Belarus (17.2), Georgia (16.5) and Kyrgyzstan (16.5). The lowest rates (2.0 and under) were reported by Slovenia (2.0), North Macedonia (2.0), and Bosnia and Herzegovina (1.7) (Table 1, Map 1). The overall rate for men was 16.4 per 100 000 popula- tion and for women 8.5 per 100 000 population (Table 1 and 2; Map 3 and 4); The male-to-female ratio was 1.8, lowest in the East (1.6), higher in the West (2.4), and highest in the Centre (2.9) of the Region. The largest proportion of people diagnosed in the Region was in the age group 30–39 years (36%), while 6% were young people aged 15–24 years, and 17% were 50 years or older at diagnosis. The most common reported mode of transmission was heterosexual sex (61.2%), while 16.1% were infected through injecting drug use, 11.3% through sex between men, and less than one percent through MTCT. Information on transmission mode was unknown or miss- ing for 10.8% of the new diagnoses (Table A, Maps 5−7). Among the HIV diagnoses reported by 13 countries in the East for whom the mode of HIV transmission was known, 74.2% were infected through heterosexual transmission and 21.7% through injecting drug use, while reported transmission through sex between men remained low, at 3.7% of cases. Heterosexual sex (53.8%) and sex between men (39.7%) were the main reported transmis- sion modes in the Centre among cases with known mode of transmission, but 47.2% of the new diagnoses lacked information on the mode of transmission. Sex between men was the predominant transmission mode for eight of the 15 countries in the Centre. In the West, hetero- sexual transmission emerged as the main mode (47.1%); however, of these cases, 17% were previously diag- nosed, 70% were born abroad, and 27% originated from generalised epidemic countries. The second most com- mon transmission mode was sex between men (46.1% of cases). Information was lacking for 23.7% of diagnoses. xv HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Consistent data on transmission mode were avail- able from 40 countries for the period 2013–2022. Transmission in the East was driven by the number of HIV diagnoses with reported heterosexual transmission. Transmission through sex between men increased by almost 150%. Although the number of HIV diagnoses in people infected through injecting drug use decreased by 32% during the period overall, the percentage of all HIV diagnoses attributed to injecting drug use is still 22%. Despite the increasing trend in heterosexual transmis- sion due to the factors described earlier, HIV diagnoses among MSM are on an upward trend in the Centre of the Region. Eight of the fifteen countries in the Centre reported sex between men as the predominant mode of transmission. In the West, there was a clear decline in the overall rate of HIV diagnoses during the previous decade, resulting primarily from decreases in diagnoses among MSM in specific countries and among people infected heterosexually, particularly women and people originating from countries with generalised HIV epidem- ics. However, there was a notable increase in reported HIV diagnoses in 2022. This is due to a combination of factors, mainly increased migration of the refugee population throughout the year and expanded test- ing services during the post-pandemic period to reach undiagnosed people. The share of new diagnoses with unknown transmission route increased from 15% in 2013 to 24% in 2022 in the West. Among those newly diagnosed and over 14 years old for whom information on CD4 cell count at the time of HIV diagnosis was available, just over half (50.6%) were diagnosed late, with CD4 cell counts of less than 350 cells per mm3, including 29.7% with advanced HIV infection (CD4 cell count of less than 200 cells/mm3). However, the regional average does not include data from the Russian Federation, where only 30.8% of those newly diagnosed with HIV are detected5 once their CD4 cell counts have fallen below 350 per mm3 and 15.1% once their counts are below 200 per mm3. Late HIV diagnosis remains a challenge in most of the countries of the Region. The percentage of people newly diagnosed who were diagnosed late (CD4 cell counts of less than 350/mm3) varied across transmission catego- ries and age groups, but was highest for people with reported heterosexual transmission (55%%; 60.9% for men and 53.9% for women) and injecting drug use (47.0%), and lowest for men infected through sex with men (41.0%) (Fig. B). The percentage increased with age, ranging from 35.8% among people aged 20–24 years at diagnosis, to 66.5% among those aged 50 years or above. In terms of gender, the percentage of late diagno- ses was 47.0% for men and 53.0% for women; the lower rate for men is due to a further decrease in late diagno- ses for homosexual transmission. In 2022, 7 642 people in 44 countries of the WHO European Region were diagnosed with AIDS, 5 Data on CD4 cell count reported from the Russian Federation did not include disaggregation by mode of transmission and were therefore excluded from the sub-regional and regional analysis. corresponding to a rate of 1.1 per 100 000 population (Table  13, Map  8). Overall, 64.7% of AIDS cases were diagnosed in the East – where the rate per 100 000 was also highest (4.4) – 24.5% in the West (with a rate of 0.5 per 100 000) and 10.8% in the Centre of the Region (0.4 per 100 000). Twelve percent of those diagnosed with AIDS presented with tuberculosis (TB) as an AIDS- defining illness, ranging from 11% of reports in the West to 12% in the Centre and 14% in the East. Between 2013 and 2022, the overall rate of new AIDS diagnoses in the Region decreased by 57.7%. Conclusions HIV infection continues to affect the health and well- being of millions of people in the WHO European Region. Over the course of the last three decades, over 2.4 mil- lion people have been diagnosed and reported with HIV in the WHO European Region, including nearly 630 000 people in the EU/EEA. In 2022, 110 486 people were reported with an HIV diagnosis. Overall, HIV diagnoses increased in the WHO European Region in 2022, with a rate of 12.4 per 100 000 population, a 4.2% increase compared to the 2021 rate but still a 20.5% decrease compared to the 2019 rate. Nevertheless, several countries recorded the highest number of HIV diag- noses reported in a single year. HIV diagnoses in the Russian Federation contributed 50.3% of all cases in the WHO European Region and 70.2% of cases in the East. Therefore, the HIV trends observed in this country have had a considerable influence on epidemic patterns in the East and in the Region overall. The 2022 HIV surveillance data indicate a wide varia- tion in epidemic patterns and trends across the WHO European Region. The increase in HIV diagnoses in 2022 can be attributed to a range of factors, includ- ing the resumption of normal testing services after the COVID-19 pandemic and expanded HIV testing services in some settings, as well as the implementation of new testing strategies to identify those previously undi- agnosed. Another factor is the increased migration of people living with HIV throughout Europe, especially in the EU/EEA countries. Overall, 16.6% of the diagnoses reported in EU/EEA countries in 2022 were previously positive. However, the number of previous positives is probably underestimated. This category includes indi- viduals who had previously received an HIV diagnosis, either in another country or within a different setting in the reporting country before the current reporting year. Most of these infections were probably acquired abroad and may not reflect a rise in transmission in the report- ing countries. The upsurge in HIV diagnoses, especially the previous positive cases reported in 2022, can largely be attributed to refugees arriving from Ukraine. In the Region overall, the increase in previous posi- tive HIV diagnoses has had a considerable impact on the epidemiological profile and the trends among those reported in 2022 when counted together with the newly diagnosed cases. It is important to understand the distinct epidemiological profiles of both previously xvi SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data diagnosed people and newly diagnosed people in order to adequately guide prevention, healthcare and resource planning [1]. When previous positive individuals are excluded from people diagnosed with HIV in 2022, the population of those newly diagnosed with HIV predominantly consists of younger men, with a higher proportion of diagnosis in the acute and early stages of the infection among MSM and a higher representation of late diagnosis among those infected through heterosexual contact. This indi- cates a need for enhanced prevention and testing in these populations. In the East of the Region several countries, namely Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, and the Republic of Moldova, recorded the highest number of HIV diagnoses ever reported in a single year. None of those countries reported a substantial increase in the number of cases originating from outside the country, and over 90% of their HIV diagnoses originate from the reporting country. These countries have reported a rebound in HIV testing and case detection since the pandemic subsided due to the scale-up and introduction of new testing poli- cies to increase case detection. Heterosexual transmission remains a main transmission route in the East. Although the reported transmission through sex between men remains low in absolute terms, it has increased more than two-fold during the decade – the largest increase in any transmission cat- egory and any sub-region 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 injec- tion who may have been misclassified as heterosexually infected [2, 3]. In the Centre, the highest ever number of HIV diagnoses was reported in 2022. Despite the increasing trend in heterosexual transmission due to the factors described earlier, HIV diagnoses among MSM are on an upward trend in the Centre of the Region. Eight of the fifteen countries in the Centre reported sex between men as the predominant mode of transmission. In the region, just over half (50.6%) of HIV diagnoses have a CD4 cell count below 350 cells per mm3, includ- ing 29.7% of cases with advanced HIV infection (CD4 less than 200 cells/mm3). As in previous years, data from 2022 indicate that late HIV diagnosis is highest among people infected heterosexually (particularly men), among those infected as a result of injecting drug use and among those in older age groups. Data from this report also indicate that the gap between HIV diagnoses and infections is widening in the Region, indicating that it will not reach the 2025 target of 95% of those living with HIV diagnosed. Interventions to control the epidemic should be based on evidence and adapted to national and local epide- miology. This report provides an extensive overview of the epidemiology of HIV, indicating that the following response efforts should be prioritised: • In all countries in the Region: rapid scale-up of HIV testing is of the utmost importance to improve pro- gress towards the 95% target by 2025. WHO has issued a policy brief on moving away from the use of western blotting and line immunoassays in HIV testing strategies and algorithms and towards the support of decentralised testing and rapid linkage to treatment [4]. Guidance from WHO and ECDC recommend innova- tive approaches, including self-testing and community testing by lay providers using rapid tests as part of overall HIV testing services, including easily acces- sible services for migrant populations [5–7]. While the provision of HIV testing services has improved over time, and self-testing and community-based HIV testing have increased substantially in recent years, policy monitoring in the Region indicates that some testing modes remain limited or non-existent in many European countries [8]. 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, resulting in improved treatment outcomes and reduced HIV incidence, morbidity, and mortality in support of the 95–95–95 goals and other regional and global targets [9–11]. A robust body of evidence shows that early ini- tiation of ART is beneficial to the health of the person receiving the treatment and in preventing onward HIV transmission [12–17]. Nearly 90% of countries in the WHO European Region have a policy to initiate ART, irrespective of CD4 cell count [18]. • In the EU/EEA and countries in the West of the Region, the significant upsurge in previous positive HIV diagnoses overall has reshaped the epidemiological landscape. Much of this increase can be attributed to an influx of individuals living with HIV arriving from various countries and regions, including Ukraine, introducing new challenges for HIV care as well as mental health and social support needs [1, 19]. To improve HIV prevention in migrant populations, countries should explore the feasibility of expand- ing primary prevention services, including condom provision programmes and pre-exposure prophy- laxis (PrEP) implementation, to ensure that these are accessible to migrants. Availability of and access to testing and treatment, irrespective of residential and migrant status, can help further improve preven- tion and treatment of HIV infection. Countries should address wider barriers to HIV care and general infor- mation surrounding access to the healthcare systems. Improved monitoring and surveillance, particularly of previous positive cases, is needed to adequately capture and report these cases. Further to migrants, over the past decade, the primary route of transmis- sion in the EU/EEA and West remains sex between men. Improved prevention for MSM should include comprehensive programmes with expanded access xvii HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT to PrEP and the removal of restrictions on who can access PrEP. These programmes should also review and expand the settings in which PrEP is available, to reach a wider population. PrEP provision, combined with enhanced regular testing and linkage to care, can help reduce incidence of HIV among men who have sex with men (MSM) [20, 21]. Strong surveillance and monitoring systems would also enable data on PrEP eligibility, uptake, duration of PrEP, and outcomes to be captured. • In countries in the Centre of the Region, the highest ever number of HIV diagnoses reported in 2022 is mainly due to the increase in previous positive HIV diagnoses in the EU/EEA countries of the Centre, resulting in a change to the predominant mode of transmission from homosexual to heterosexual sex. Nevertheless, sex between men remains the predomi- nant mode of transmission in the majority of countries. Interventions to address this situation are needed, such as condom and lubricant programming; diversi- fied HIV testing services; assisted voluntary partner notification, PrEP; prevention and management of co-infections (particularly sexually transmitted infec- tions); and rapid HIV treatment initiation. Services should be patient-centred and provided in a friendly environment, preferably with the involvement of civil society throughout the entire HIV continuum of ser- vices, ranging from HIV prevention to adherence and ART. Drug-injection-related transmission remains low, but past outbreaks [22–26] suggest that HIV preven- tion services for people who inject drugs continue to be important and these must be maintained with sufficient coverage to prevent such outbreaks. The percentage of young people among HIV diagnoses is also higher in this part of the Region than else- where. Some countries have undergone a transition to domestic financing of the HIV response after the with- drawal of funding from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This has posed sustainabil- ity challenges, particularly as regards the financing of HIV prevention programmes and surveys among key populations, designed and delivered by communi- ties. In addition, ensuring access to health services for refugees and migrant populations, including HIV services and promoting cross-border collaboration and data sharing, remains essential to a robust and people-centred public health response, especially in countries heavily affected by the influx of these popu- lations. Increased political will and attention, and the intensified involvement of civil society is needed to mitigate some of these challenges and prevent the epidemic from accelerating [27]. • In countries in the East of the Region, several coun- tries also recorded the highest number of HIV diagnoses reported in a single year. While these countries reported a rebound in HIV testing and case detection since the pandemic subsided due to the introduction of new testing policies to increase case detection, this is still not enough to close the gap to ensure that people know their HIV status, and more people need to be diagnosed. 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 preven- tion and testing services, including assisted partner notification, PrEP, HIV testing performed by trained lay providers and self-testing in line with WHO rec- ommendations. All of these services should be integrated into national policies and programmes and then implemented [5, 6, 11]. Community involvement in the design and delivery of services is essential for reducing the rate of HIV infections and increas- ing the number of people linked to care and initiated and retained on ART. The ultimate aim is to reduce HIV incidence and AIDS-related deaths. Innovative HIV prevention interventions should address the risk of heterosexual transmission, particularly in couples where one partner engages in high-risk behaviour (such as injecting drug use) or is spending longer periods of time working abroad. A large number of diagnoses in people infected through injecting drug use emphasises the fact that evidence-based policies focused on key populations, including high coverage of harm-reduction programmes for people who inject drugs, remain critical to the HIV response in the east- ern part of the Region. The HIV data for 2022 revealed significant issues with data quality, completeness, and lack of standardisa- tion for the variable, differentiating new HIV diagnoses from previous positives, as well as variables looking at the country of birth and region of origin of cases. This, in combination with the increase in migration of the population and the recovery period after the COVID-19 pandemic, made 2022 data interpretation very challeng- ing. Achieving consensus among countries in the Region on the collection, recording, and reporting of previ- ous positive cases is paramount. This is critical due to the different epidemiological profiles and healthcare needs of refugees, migrants and previously diagnosed individuals. Improving data recording and reporting standards within surveillance systems will ensure accu- racy and help plan tailored prevention strategies. This is the first report to include data on the transgender population. However, due to limited data availability, a more comprehensive understanding of their epidemio- logical profile remains elusive. It is therefore critical to gather more in-depth information, enabling the tailoring of more effective prevention strategies on transgen- der population. Conducting enhanced HIV surveillance increases the possibility 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 diag- nosis. It can also support national and global efforts to monitor progress towards the 95–95–95 goals and other global and regional targets. xviii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data In September 2022, the Member States endorsed Regional Action Plans for Ending AIDS and the Epidemics of Viral Hepatitis and Sexually Transmitted Infections 2022–2030 at the 72nd session of the WHO Regional Committee for Europe [11]. The Plans outline the visions, goals, and actions required to respond to these epi- demics and are designed to strategically combine disease-specific approaches with people at the heart of the responses. They will operationalise the Global Health Sector Strategies on HIV, viral hepatitis, and sexually transmitted infections, 2022–2030 through region-specific actions, and align the responses with the European Programme of Work, 2020–2025 – ‘United Action for Better Health’. The plans set ambitious targets for 2030 and interim targets for 2025. The ambitious tar- gets will be met by: • Using a partnership-based approach with primary healthcare, civil society and public health institutions to deliver quality, differentiated and people-centred services; • Prioritising key populations and focusing on reducing social and structural barriers to accessing services; • Enabling rapid recovery following acute or pro- longed emergencies and future-proofing for health emergencies; • Supporting country-owned sustainability with adequate domestic financing of services and commod- ities, and a community workforce equipped to provide quality care; • Making data-driven decisions based on comprehen- sive surveillance and quality strategic information; • Refocusing testing to advance early diagnosis based on epidemiology and evidence; decentralise and use a full range of testing strategies to advance early, and accurate confirmed diagnosis; • Rapidly scaling up use of the new HIV and viral hepati- tis treatment regimens and models of care; • Using innovative combination prevention approaches via a broad range of service delivery platforms. WHO and ECDC are working with Member States to increase the uptake of HIV testing and treatment guid- ance and innovative combination HIV prevention approaches in key populations and for the elimination of MTCT of HIV, viral hepatitis B and syphilis, improving standards of HIV case, strengthening HIV surveillance and other key priorities as highlighted in the Action Plans. WHO and ECDC, together with partners, will continue to support Member States in their efforts to accelerate pro- gress towards achieving the Sustainable Development Goals for HIV through dedicated guidance, workshops, training, webinars, and other technical support focused on high-impact surveillance, monitoring, treatment, and prevention activities. References 1. Massmann R, Groh T, Jilich D, Bartková D, Bartovská Z, Chmelař J, et al. HIV-positive Ukrainian refugees in the Czech Republic. AIDS. 2023 Oct 1;37(12):1811-1818. doi: 10.1097/ QAD.0000000000003633. 2. 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. 3. 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. 4. World Health Organization (WHO). ‘WHO recommends countries move away from the use of western blotting and line immuno- assays in HIV testing strategies and algorithms’. Policy brief. Copenhagen: WHO Regional Office for Europe; 2019. Available from: 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-immunoassays- in-hiv-testing-strategies-and-algorithms.-policy-brief-2019 5. World Health Organization (WHO). 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Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, Degan O et al. Risk of HIV transmission through condomless sex in serodif- ferent gay couples with HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, pro- spective, observational study. Lancet 2019;393(10189):2428–38. 18. European Centre for Disease Prevention and Control (ECDC). Continuum of HIV care. Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2021 progress report. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/con- tinuum-hiv-care-monitoring-implementation-dublin-declaration- partnership-fight 19. European Centre for Disease Prevention and Control (ECDC). Stigma: survey of people living with HIV. Monitoring implementa- tion of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2022 progress report. Stockholm: ECDC; 2023. 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xxi HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT В настоящем отчете представлены данные эпид- надзора за ВИЧ-инфекцией/СПИДом за 2022 г. Этот год был отмечен увеличением движения насе- ления6 по всей Европе, что оказало влияние на тенденции эпидемиологической ситуации по ВИЧ- инфекции, особенно в странах Европейского cоюза/ Европейской экономической зоны (ЕС/ЕЭЗ). Помимо увеличения масштабов движения населения, восстановление работы медицинских служб и эпид- надзорных мероприятий после пандемии COVID-19, а также увеличение объемов тестирования и вне- дрение инновационных стратегий тестирования во многих странах привели к выявлению ранее недиа- гностированных случаев ВИЧ-инфекции, в результате чего число случаев ВИЧ-инфекции в Европейском регионе ВОЗ значительно возросло. В 2022 г. в 37 из 49 стран Европейского региона ВОЗ, включая 26 стран ЕС/ЕЭЗ, было зарегистрировано увеличение числа случаев ВИЧ-инфекции по сравнению с 2021 г., при этом в некоторых странах отмечалось рекордное число случаев, выявленных в течение одного года. В 2022 г. в 49 из 53 стран Европейского региона ВОЗ было зарегистрировано 110 486 случаев ВИЧ- инфекции, в том числе 22 995 в странах ЕС/ЕЭЗ. Это 6 Движение населения в данном отчете включает в себя беженцев и мигрантов, прибывающих в европейские страны из Европейского региона ВОЗ и других регионов. соответствует заболеваемости на уровне 12,4 слу- чаев на 100 000 населения во всем Европейском регионе ВОЗ, что немного превышает данные 2021 г. (11,9 на 100 000 населения). Вместе с тем, эти данные отражают значительное снижение данного показа- теля с 2019 г. (15,6 на 100 000 населения), в период до пандемии COVID-19 (таблица А, рисунок А). При сравнении числа выявленных случаев ВИЧ- инфекции с оценочным числом новых случаев за последнее десятилетие становится очевидным, что с каждым годом число людей, которые заражаются ВИЧ-инфекцией, все больше превышает число людей, у которых ВИЧ-инфекция диагностируется. Это озна- чает, что в Европейском регионе ВОЗ увеличивается число людей, живущих с недиагностированной ВИЧ- инфекцией (рисунок А). Увеличение масштабов прибытия в европейские страны людей с ранее установленным диагнозом ВИЧ- инфекции стало причиной увеличения числа лиц с ранее установленным положительным ВИЧ-статусом7 в Регионе. Увеличение числа лиц с ранее установ- ленным положительным ВИЧ-статусом оказало 7 Данная категория включает в себя лиц, у которых ВИЧ-инфекция была диагностирована до данного отчетного года, либо в другой стране, либо в других учреждениях страны, предоставляющей отчетные данные. Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе Таблица A. Характеристики случаев ВИЧ-инфекции и СПИДа, зарегистрированных в Европейском регионе ВОЗ, ЕС/ЕЭЗ, а также в западной, центральной и восточной части Европейского региона ВОЗ, 2022 г. Европейский регион ВОЗ Западная часть Центральная часть Восточная часть ЕС/ЕЭЗ Количество стран, предоставивших данные/ общее количество странa 49/53 21/23 15/15 13/15 30/30 Число случаев ВИЧ-инфекции 110 486 22 397 8 945 79 144 22 995 Число случаев ВИЧ-инфекции на 100 000 населения 12,4 5,1 4,5 30,7 5,1 Доля (%) лиц в возрасте 15–24 лет 5,7% 8,9% 11,7% 4,2% 8,9% Доля (%) лиц в возрасте 50+ лет 16,7% 21,8% 15,1% 15,5% 19,9% Соотношение мужчин и женщин 1,8 2,4 2,9 1,6 2,4 Доля (%) мигрантовb 26,7% 52,3% 27,0% 2,2% 48,3% Путь передачи Половые контакты между мужчинами 11,3% 35,2% 18,7% 3,7% 33,3% Гетеросексуальная передача (мужчины) 31,7% 15,1% 14,9% 38,3% 14,6% Гетеросексуальная передача (женщины) 29,5% 21,0% 10,5% 34,1% 19,0% Употребление инъекционных наркотиков 16,1% 3,8% 2,1% 21,1% 4,3% Передача от матери ребенку 0,6% 1,1% 0,8% 0,4% 1,2% Неизвестен 10,8% 23,6% 52,8% 2,4% 27,3% Случаи СПИДа и поздней стадии ВИЧ-инфекции Доля (%) случаев ВИЧ-инфекция, CD4 < 350 кл/мм3 50,6 46,2 44,5 55,1 47,9% Число случав СПИДаc 7 220 1 873 825 4 522 2 349 Число случаев СПИДа на 100 000 населения 1,1 0,5 0,4 4,4 0,6 На Рисунке A1 в Приложении 1 представлено разделение стран Европейского региона ВОЗ на западную, центральную и восточную части Региона. a Отсутствуют данные из следующих стран: Андорра, Монако, Туркменистан, Узбекистан. b Согласно используемому определению, мигранты – это лица, родившиеся за пределами страны, где им был поставлен диагноз. c Отсутствуют данные из следующих стран: Андорра, Босния и Герцеговина, Германия, Монако, Российская Федерация, Северная Македония, Туркменистан, Узбекистан, Швеция. xxii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data значительное влияние на эпидемиологический профиль и тенденции по случаям ВИЧ-инфекции, зарегистрированным в 2022 г., особенно в стра- нах ЕС/ЕЭЗ, западной и центральной части Региона. Как следствие, в 2022 г. наметился заметный сдвиг в тенденциях эпидемиологической ситуации, и по сравнению с 2021 г. заболеваемость ВИЧ-инфекцией в ЕС/ЕЭЗ, западной и центральной части Региона воз- росла на 30,8%, 21,4% и 40,6%, соответственно. В 11 странах ЕС/ЕЭЗ было зарегистрировано рекордное число случаев ВИЧ-инфекции за последнее десятиле- тие. Движение населения также оказало влияние на пути передачи, преобладание которых отличается в разных географических районах, что подчеркивает разнообразие эпидемиологической ситуации по ВИЧ-инфекции в пределах Европы. В ЕС/ЕЭЗ, запад- ной и центральной части Региона половые контакты между мужчинами остаются одним из наиболее распространенных путей передачи ВИЧ-инфекции, особенно среди мужчин-мигрантов из других регио- нов. Вместе с тем, гетеросексуальная передача стала более распространенным путем передачи для слу- чаев ВИЧ-инфекции, зарегистрированных в 2022 г., особенно у лиц с ранее известным положительным ВИЧ-статусом. В восточной части Региона в нескольких странах также было зарегистрировано рекордное число слу- чаев ВИЧ-инфекции, выявленных в течение одного года. Вместе с тем, ни одна из этих стран не сообщала о значительном росте числа случаев, привнесенных из других стран, и более 90% случаев ВИЧ-инфекции диагностированы в стране, предоставляющей отчетные данные. В этих странах после ослабления Рисунок A. Оценочное число новых случаев и число зарегистрированных случаев ВИЧ-инфекции в ЕС/ЕЭЗ и Европейском регионе ВОЗ, 2013–2022 гг. Примечание: затененная область представляет интервалы неопределенности вокруг наилучшей оценки. По причине нерегулярного предоставления данных в отчетном периоде были исключены данные следующих стран: Андорра, Босния и Герцеговина, Испания, Монако, Португалия, Северная Македония, Туркменистан, Узбекистан. Год постановки диагноза 0 50 000 100 000 150 000 200 000 250 000 Оценочное число случаев ВИЧ-инфекции в ЕС/ЕЭЗ Число зарегистрированных новых случаев ВИЧ-инфекции в ЕС/ЕЭЗ Число зарегистрированных новых случаев ВИЧ-инфекции в Европейском регионе ВОЗ Оценочное число случаев ВИЧ-инфекции в Европейском регионе ВОЗ 2022202120202019201820172016201520142013 Чи сл о н ов ы х за ре ги ст ри ро ва нн ы х сл уч ае в ВИ Ч- ин ф ек ци и и оц ен оч но е чи сл о но вы х сл уч ае в ВИ Ч- ин ф ек ци и Рисунок B. Доля лиц с поздним диагнозом (CD4 < 350 кл/мм3) с разбивкой по полу, возрасту и пути передачи, Европейский регион ВОЗ, 2022 г. (n=28 718) 0 10 20 30 40 50 60 70 Половые контакты между мужчинами Употребление инъекционных наркотиков Гетеросексуальная передача (женщины) Гетеросексуальная передача (мужчины) 50+ 40–49 30–39 25–29 20–24 15–19 Женщины Мужчины Всего Процентная доля По л Во зр ас т Пу ть п ер ед ач и Примечание: на данном рисунке исключены случаи с неизвестным количеством CD4-клеток, острые случаи и случаи с ранее известным положительным ВИЧ- статусом. Данные Российской Федерации исключены, т.к. отсутствовала разбивка по возрасту, полу и пути передачи. xxiii HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT пандемии COVID-19 отмечалось восстановление объемов тестирования и выявления случаев ВИЧ- инфекции благодаря мероприятиям, направленным на выявление ВИЧ-инфекции, и внедрению новой политики тестирования для снижения числа лиц с недиагностированной ВИЧ-инфекцией. Согласно отчетным данным, в восточной части Региона гете- росексуальный путь передачи и употребление инъекционных наркотиков по-прежнему являются основными путями передачи ВИЧ-инфекции. Для большинства стран Европейского региона ВОЗ поздняя диагностика ВИЧ-инфекции остается серьез- ной проблемой, и около половины (50,6%) случаев ВИЧ-инфекции в 2022 г. были диагностированы на поздней стадии (CD4 < 350 кл/мм3). Доля лиц с диагно- зом, установленным на поздней стадии, различается по разным путям передачи и возрастным группам, но наибольшую долю представляют лица с гетеросексу- альным путем передачи (55,0%), а наименьшую долю – мужчины, практикующие секс с мужчинами (41,4%) (рисунок В). В 2022 г. в 44 странах Европейского региона ВОЗ у 7 642 лиц был диагностирован СПИД. (таблица  А; см. также таблицу 13). С 2013 г. по 2022 г. число случаев СПИДа в Европейском регионе ВОЗ уменьшилось на 54,2%, с 2,4 на 100 000 населения (17 486 случаев) до 1,1 на 100 000. Данная тенденция к снижению четко прослеживается во всех частях Региона, включая ЕС/ ЕЭС. Европейский союз и Европейская экономическая зона В 2022 г. в 30 странах ЕС/ЕЭС было зарегистрировано 22 995 случаев ВИЧ-инфекции,8 что соответствует 5,1 на 100 000 населения (таблица  1). Это на 30,8% выше по сравнению с 2021 г., но на 3,8% ниже по сравнению с 2019 г. Самый высокий уровень заболе- ваемости ВИЧ-инфекцией был зарегистрирован на Кипре (24,1; 218 случаев) и в Эстонии (18,8; 250 слу- чаев), а самый низкий – в Словении (2,0; 42 случая) (таблица 1; карта 1). Как и в предыдущие годы, заболеваемость ВИЧ- инфекцией в 2022 г. была выше у мужчин (7,3 на 100 000 населения; таблица  2; карта  3), чем у жен- щин (2,9 на 100 000 населения; таблица  3; карта  4). Общее соотношение мужчин и женщин составило 2,4:1 (таблица A). Наиболее распространенным путем передачи инфекции в странах с наибольшем соотно- шением мужчин и женщин являются половые контакты между мужчинами. Во Франции, Нидерландах и Ирландии, помимо 22 790 случаев у мужчин и жен- щин, был зарегистрирован 121 случай ВИЧ-инфекции у трансгендерных лиц. 8 Все страны ЕС/ЕЭС предоставили отчетные данные за 2022 г. Согласно отчетным данным, одним из наиболее рас- пространенных путей передачи ВИЧ-инфекции в ЕС/ ЕЭЗ остаются половые контакты между мужчи- нами: на него приходится 33,3% (7 656) всех случаев ВИЧ-инфекции, выявленных в 2022 г., и 45,8% слу- чаев с известным путем передачи (рисунок  1.5; таблица 4, таблица 8; карта 5). Большинство мужчин, у которых была диагностирована ВИЧ-инфекция, свя- занная с половыми отношениями между мужчинами (54,7%), родились за пределами страны, предостав- ляющей отчетные данные. В 2022 г. в ЕС/ЕЭЗ гетеросексуальный путь передачи ВИЧ-инфекции впервые опередил путь передачи при половых контактах между мужчинами: на гете- росексуальную передачу пришлось 33,7% (7 743) случаев ВИЧ-инфекции и 46,3% случаев с известным путем передачи (рисунок  1.5; таблица  6, таблица  8; карта  6). Почти одна треть новых случаев (28,2%; 2 186), связанных с гетеросексуальным путем пере- дачи, приходится на мигрантов из Центральной и Восточной Европы; после них следуют мигранты из африканских стран южнее Сахары (26,4%; 2 046). Кроме того, 31,1% (2 407) случаев, связанных с гете- росексуальным путем передачи, возникли в стране, предоставляющей отчетные данные. В 2022 г. на передачу ВИЧ-инфекции при употре- блении инъекционных наркотиков пришлось 4,3% случаев ВИЧ-инфекции (рисунок  1.5, таблица  5, таблица  8, карта  7). Более половины лиц, у которых была диагностирована ВИЧ-инфекция, связанная с употреблением инъекционных наркотиков, родились за пределами страны, предоставляющей отчетные данные, включая 43,3% (430 случаев) из других стран Центральной и Восточной Европы. В 2022 г. на передачу ВИЧ-инфекции от матери ребенку (ПМР) пришлось 1,2% случаев ВИЧ-инфекции (рисунок  1.7, таблица  7, таблица  8). В 2022 г. среди общего числа случаев ВИЧ-инфекции, связанных с ПМР, 81,5% приходилось на мигрантов (220). Из этих мигрантов 62,3% (137) происходили из стран Центральной и Восточной Европы, и в данной группе 83,2% (114) имели ранее известный положительный ВИЧ-статус. В 2022 г. в ЕС/ЕЭЗ 48,9% лиц, у которых была диа- гностирована ВИЧ-инфекция, являлись мигрантами, которые определяются как лица, рожденные за пределами страны, в которой у них была диагно- стирована ВИЧ-инфекция (рисунок  1.6), при этом 22.8% происходили из других стран Центральной и Восточной Европы, 13,9% из африканских стран южнее Сахары, 11,3% из стран Латинской Америки и Карибского бассейна, 2,6% из других стран Западной Европы и 2,3% из стран Южной и Юго-Восточной Азии. Повышение числа диагностированных случаев ВИЧ-инфекции в 2022 г. может быть, среди прочих факторов, объяснено предоставлением отчетных дан- ных о случаях ВИЧ-инфекции по мигрантам с ранее xxiv SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data известным положительным ВИЧ-статусом. В 2022 г. в ЕС/ЕЭЗ случаи с ранее известным положительным ВИЧ-статусом составили 16,6% от всех случаев ВИЧ- инфекции, что значительно выше, чем в 2021 г., когда данный показатель составил 8,8%. Вместе с тем эти данные могут быть заниженными, т.к. не все страны смогли предоставить информацию о случаях с ранее известным положительным ВИЧ-статусом. Несмотря на то, что случаи с ранее известным поло- жительным ВИЧ-статусом оказали значительное влияние на увеличение числа случаев ВИЧ-инфекции, зарегистрированных в 2022 г., при корректировке тенденций путем вычитания случаев с ранее извест- ным положительным ВИЧ-статусом, в 2022 г. все равно наблюдается увеличение числа случаев ВИЧ- инфекции по сравнению с 2021 г. (рисунки 1.11 и 1.13). Несмотря на недавнее увеличение числа случаев ВИЧ-инфекции, зарегистрированных в ЕС/ ЕЭЗ, за последнее десятилетие число случаев ВИЧ-инфекции в целом снизилось, в частности с 2019 г. такое сниже- ние составило 3,8%. Для 14 стран, предоставивших информацию о большинстве случаев с ранее известным положи- тельным ВИЧ-статусом, при сравнении случаев с ранее известным положительным ВИЧ-статусом и случаев впервые диагностированной ВИЧ-инфекции было установлено, что среди лиц с ранее известным положительным ВИЧ-статусом более высокую долю составляли женщины (44,0% против 28,9%), лица, происходящие из стран Центральной и Восточной Европы (44,7% против 10,9%), а также были более распространены пути передачи ВИЧ вследствие гете- росексуальных контактов (44,8% против 42,6%), употребления инъекционных наркотиков (6,4% про- тив 1,8%) и ПМР (3,2% против 0,6%). В странах ЕС/ЕЭЗ доля всех случаев ВИЧ-инфекции с известным путем передачи, связанных с поло- выми контактами между мужчинами, снизилась с 49,5% в 2013 г. до 45,9% в 2022 г. (рисунок  1.16а, рисунок  1.16b). Важно отметить, что в 2022 г. число случаев среди МСМ, рожденных за пределами страны, предоставляющей отчетные данные, увели- чилось до 3 168, по сравнению с 2 537 случаями в 2013 г., что соответствует росту на 24,9% (рисунок 1.17). В период 2013–2021 гг. доля всех случаев ВИЧ- инфекции с известным путем передачи, связанных с гетеросексуальными контактами, у женщин оста- валась стабильной на уровне около 20% случаев. В 2022 г. соответствующее количество (n=4 249) и доля увеличились и достигли 26,1% от числа слу- чаев ВИЧ-инфекции с известным путем передачи. За предыдущее десятилетие доля всех случаев ВИЧ- инфекции, относимых на счет гетеросексуальных контактов, у мужчин также была стабильной на уровне 20% (рисунок 1.16b). С 2013 по 2021 г. доля всех случаев ВИЧ-инфекции с известным путем передачи у лиц, употребляющих инъекционные наркотики, снизилась с 7,7% до 4,7% (с 1 747 до 684) (рисунок 1.16a, рисунок 1.17, таблица 5). После этого в 2022 г. у лиц, употребляющих инъекци- онные наркотики, было отмечено увеличение числа (963) и доли (до 5,9%) случаев ВИЧ-инфекции. В странах, за последнее десятилетие регулярно предоставлявших отчетные данные, доля случаев ВИЧ-инфекции, связанных с ПМР, в период 2013–2021 гг. оставалась стабильной на уровне около 0,8%, хотя число случаев снизилось со 188 в 2013 г. до 119 в 2021 г. В 2022 г. доля и число таких случаев увеличились до 1,2% (252) (рисунок  1.16а), и большинство из этих случаев составляли случаи с ранее известным поло- жительным ВИЧ-статусом. Двадцать семь стран ЕС/ЕЭЗ предоставили информа- цию о количестве CD4-клеток на момент установления диагноза ВИЧ-инфекции (таблица  12). Среди всех случаев, диагностированных в 2022 г., по которым имеется информация о количестве CD4-клеток или наличию острой стадии ВИЧ-инфекции, 8,4% случаев представляли острую инфекцию, а 30,2% – более раннюю инфекцию (на момент постановки диагноза CD4 не менее 500 кл/мм3) (рисунок 1,7); у 47,9% ВИЧ- инфекция была диагностирована через несколько лет после заражения (CD4 < 350 кл/мм3). В целом, на момент установления диагноза у 28,8% отмечалась продвинутая стадия ВИЧ-инфекции (CD4 < 200 кл/мм3) (таблица 12). Наибольшая доля лиц, диагноз которым был уста- новлен на поздней стадии ВИЧ-инфекции (CD4 менее 350 кл/мм3, исключая лиц с ранее известным поло- жительным ВИЧ-статусом или с признаками острой инфекции), наблюдалась среди женщин (54,4%); лиц среднего и пожилого возраста (57,1% среди лиц 40–49 лет и 68,1% среди лиц старше 50 лет); мужчин или женщин, инфицированных путем гетеросексуальных половых контактов (63,2% и 53,6% соответственно); лиц, заразившихся ВИЧ-инфекцией при употребле- нии инъекционных наркотиков (50,7%) и мигрантов из Южной и Юго-Восточной Азии (63,8%) и африкан- ских стран к югу от Сахары (58,0%) (рисунок 1.8). В 2022 г. в 27 странах ЕС/ЕЭЗ было выявлено 2 349 случаев СПИДа, что составляет 0,6 на 100 000 насе- ления (таблица  13; карта  8). В 2022 г. на сочетанный легочный и/или внелегочный туберкулез (ТБ) при- шлось до 12,1% заболеваний, указывающих на СПИД (таблица 16). За последнее десятилетие число случаев СПИДа в ЕС/ЕЭЗ по всем путям передачи сократилось более чем в два раза (рисунок 1.18). В 2013–2022 гг. десять стран регулярно предостав- ляли отчетные данные по тестам на ВИЧ-инфекцию, исключая несвязанное анонимное тестирование и тестирование донорских кроводач. Количество тестов, выполненных в странах, регулярно предо- ставлявших отчетные данные, увеличилось на 16,3% по сравнению с 2021 г. и на 11,8% по сравнению с 2019 г. (таблица 18). xxv HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Европейский регион ВОЗ В 2022 г. в 49 странах Европейского региона ВОЗ ВИЧ- инфекция была диагностирована у 110 486 человек, что соответствует 12,4 на 100 000 населения, что на 4,2% выше по сравнению с 2021 г., но на 20,5% ниже по сравнению с 2019 г. Увеличение масштабов движе- ния населения9 по всей Европе, особенно в странах ЕС/ЕЭС, а также восстановление работы медицинских служб после пандемии COVID-19 и внедрение новых стратегий тестирования для выявления ранее не диагностированных случаев ВИЧ-инфекции привели к повышению числа случаев ВИЧ-инфекции, в том числе случаев с ранее известным положительным ВИЧ-статусом. Все это затрудняет интерпретацию тенденций эпидемиологической ситуации по ВИЧ- инфекции для 2019–2022 гг. Из 110 486 человек, у которых в 2022 г. была диа- гностирована ВИЧ-инфекция, 71,6% находились в восточной части (79 144), 20,3% в западной части (22 397) и 8,1% в центральной части Региона (8 945) (таблица  A). Наибольшая заболеваемость также отмечалась в восточной части (30,7 случая на 100 000 населения), что непропорциально выше, чем в запад- ной части (5,1 на 100 000 населения) и в центральной части (4,5 на 100 000 населения) (таблица A). В 2022 г. число случаев ВИЧ-инфекции значительно различалось в разных странах Европейского реги- она ВОЗ. Наибольшая заболеваемость на 100 000 населения (более 15,0 случаев) наблюдалась в сле- дующих странах: Российская Федерация (38,4), Украина (29,8), Республика Молдова (28,4), Кипр (24,1), Казахстан (20,7), Армения (19,2), Эстония (18,8), Ирландия (17,5), Беларусь (17,2), Грузия (16,5) и Кыргызстан (16,5). Наименьшая заболеваемость (2,0 и менее случаев) наблюдалась в Словении (2,0), Северной Македонии (2,0), Боснии и Герцеговине (1,7) (таблица 1, карта 1). Общая заболеваемость у мужчин составила 16,4 на 100 000 населения, а у женщин 8,5 на 100 000 населе- ния (таблицы 1 и 2; карты 3 и 4); соотношение мужчин и женщин составило 1,8, при этом наименьшее соот- ношение отмечалось в восточной части (1,6), более высокое – в западной части (2,4) и наибольшее – в центральной части (2,9) Региона. Наибольшая доля случаев ВИЧ-инфекции в Регионе на момент постановки диагноза относилась к воз- растной группе 30–39 лет (36%), 6% – к возрастной группе 15–24 года и 17% – к возрастной группе 50 лет и старше. Согласно отчетным данным, наиболее распро- страненным путем передачи инфекции был гетеросексуальный секс (61,2%), 16,1% были инфицированы при употреблении инъекционных наркотиков, 11,3% были инфицированы при сексе 9 Движение населения в данном отчете включает в себя беженцев и мигрантов, прибывающих в европейские страны из Европейского региона ВОЗ и других регионов. между мужчинами и менее 1% при ПМР. Информация о пути передачи был неизвестна или отсутствовала для 10,8% случаев (таблица А, карты 5–7). Среди лиц, у которых была диагностирована ВИЧ- инфекция, в 13 странах, где был известен путь передачи, 74,2% были инфицированы путем гете- росексуальной передачи, 21,7% при употреблении инъекционных наркотиков, а передача при сексе между мужчинами оставалось низкой – 3,7% случаев. В центральной части Европейского региона ВОЗ гете- росексуальный секс (53,8%) и секс между мужчинами (39,7%) были основными путями передачи инфекции в случаях с известным путем передачи, но при этом для 47,2% случаев информация о пути передачи отсутствовала. В восьми из 15 стран центральной части Европейского региона ВОЗ преобладающим путем передачи был секс между мужчинами. В запад- ной части Региона преобладающим путем передачи был гетеросексуальный секс (47,1%), но при этом 17% из этого числа имели ранее известный ВИЧ-статус, 70% были рождены за рубежом, а 27% прибыли из стран с генерализованной эпидемией ВИЧ. Вторым наиболее распространенным путем передачи инфек- ции был секс между мужчинами (46,1% случаев). Для 23,7% случаев информация о пути передачи отсутствовала. За период 2013–2022 гг. данные по пути пере- дачи регулярно предоставлялись 40 странами. Преобладающим путем передачи ВИЧ-инфекции в восточной части Европейского региона ВОЗ была гетеросексуальная передача. Передача ВИЧ- инфекции при половых контактах между мужчинами выросла почти на 150%. Хотя за весь период число лиц с диагностированной ВИЧ-инфекцией, заразившихся при употреблении инъекционных наркотиков, снизи- лось на 32%, доля всех диагностированных случаев ВИЧ-инфекции, связанных с употреблением инъек- ционных наркотиков, составила 22%. Несмотря на тенденцию к повышению передачи гетеросексуаль- ным путем по причине описанных выше факторов, в центральной части Региона передача ВИЧ-инфекции у МСМ также демонстрирует тенденцию к повыше- нию. Согласно отчетным данным, в восьми из 15 стран центральной части Региона половые контакты между мужчинами являлись преобладающим путем пере- дачи. За предыдущее десятилетие в западной части Региона отмечалось явное снижение общего числа случаев ВИЧ-инфекции, в основном за счет сниже- ния в определенных странах случаев ВИЧ-инфекции среди МСМ и среди людей, инфицированных гете- росексуальным путем, особенно у женщин и лиц, прибывших из стран с генерализованной эпидемией ВИЧ. Вместе с тем в 2022 г. отмечалось значительное увеличение случаев ВИЧ-инфекции. Причиной этого увеличения стали несколько факторов: преимуще- ственно рост миграции беженцев в течение всего года и увеличение объемов тестирования в период после пандемии COVID-19 для выявления лиц с недиа- гностированной ВИЧ-инфекцией. В западной части Региона доля случаев ВИЧ-инфекции с неизвестным xxvi SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data путем передачи увеличилась с 15% в 2013 г. до 24% в 2022 г. Среди лиц в возрасте 14 лет и старше, у которых ВИЧ-инфекция была диагностирована и по кото- рым на момент постановки диагноза отсутствовала информация о количестве CD4-клеток, чуть более чем в половине случаев (50,6%) диагноз был постав- лен на поздней стадии (CD4 < 350  кл/мм3), включая 29,7% с ВИЧ-инфекцией на продвинутой стадии (CD4 < 200  кл/мм3). При этом среднее значение по Европейскому региону ВОЗ не включает данные из Российской Федерации, где 30,8% лиц с впервые диагностированной ВИЧ-инфекций выявляются10 тогда, когдаколичество CD4-клеток становится менее 350  кл/мм3, и 15,1% – когда количество CD4-клеток становится ниже 200 кл/мм3. Поздняя диагностика ВИЧ-инфекции остается серьез- ной проблемой в большинстве стран Региона. Доля лиц, у которых ВИЧ-инфекция была диагностирована на поздней стадии (CD4 < 350  кл/мм3), разнилась по путям передачи и возрастным группам, но наиболь- шую долю представляли лица с гетеросексуальным путем передачи (55%%; 60,9% для мужчин и 53,9% для женщин), лица, инфицированные при упо- треблении инъекционных наркотиков (47,0%), а наименьшую долю представляли мужчины, инфи- цированные путем половых контактов с мужчинами (41,0%) (рисунок  B). Данная доля увеличивалась с возрастом: от 35,8% среди лиц в возрасте 20–24 лет на момент постановки диагноза до 66,5% среди лиц в возрасте 50 лет и старше. По половой принадлеж- ности доля поздних диагнозов составила 47,0% для мужчин и 53,0% для женщин; более низкая доля у мужчин объясняется дальнейшим снижением числа диагнозов, установленных на поздней стадии, в случаях инфицирования путем половых контактов между мужчинами. В 2022 г. у 7 642 человек в 44 странах Европейского региона ВОЗ был диагностирован СПИД, что соответ- ствует 1,1 на 100 000 населения (таблица 13, карта 8). В восточной части Региона было диагностировано 64,7% от всех случаев СПИДа, а также отмечался наи- более высокий уровень заболеваемости на 100 000 населения (4,4), в западной части было диагностиро- вано 24,5% от всех случаев СПИДа (0,5 на 100 000) и в центральной части – 10,8% от всех случаев СПИДа (0,4 на 100 000). У 12% лиц с диагностированным СПИДом также был выявлен туберкулез (ТБ), кото- рый является заболеванием, определяющим СПИД (от 11% в западной части, до 12% в центральной части и 14% в восточной части Региона). С 2013 по 2022 г. общее число диагностированных случаев СПИДа в Европейском регионе ВОЗ увеличилось на 57,7%. 10 Данные по количеству CD4-клеток из Российской Федерации не включали разбивку по пути передачи и поэтому были исключены из субрегионального и регионального анализа. Выводы В Европейском регионе ВОЗ ВИЧ-инфекция про- должает оказывать отрицательное воздействие на здоровье и благополучие миллионов людей. За последние три десятилетия в Европейском регионе ВОЗ ВИЧ-инфекция была диагностирована у более чем 2,4 миллиона человек, в том числе у 630 000 в ЕС/ЕЭЗ. Согласно отчетным данным, в 2022 г. ВИЧ- инфекция была диагностирована у 110 486 человек. В 2022 г. число случаев ВИЧ-инфекции в Европейском регионе ВОЗ увеличилось; заболеваемость соста- вила 12,4 на 100 000 населения, что на 4,2% выше по сравнению с 2021 г., но на 20,5% ниже по сравнению с 2019 г. Тем не менее, в нескольких странах также было зарегистрировано рекордное число случаев ВИЧ-инфекции, выявленных в течение одного года. На долю Российской Федерации пришлось 50,3% всех диагностированных случаев ВИЧ-инфекции в Регионе и 70,2% случаев в восточной части Региона. Поэтому тенденции эпидемиологической ситуации по ВИЧ-инфекции в данной стране оказали значитель- ной влияние на эпидемиологические тенденции в восточной части Региона и во всем Регионе в целом. Данные эпиднадзора за ВИЧ-инфекцией 2022 г. указывают на значительные различия в эпидемио- логической ситуации и тенденциях в разных странах Европейского региона ВОЗ. Повышение числа диагно- стированных случаев ВИЧ-инфекции в 2022 г. может быть объяснено рядом факторов, включая восстанов- ление нормальной работы служб тестирования после пандемии COVID-19 и расширение услуг тестирова- ния на ВИЧ-инфекцию в некоторых учреждениях, а также внедрение новых стратегий тестирования для выявления лиц с ранее недиагностированной ВИЧ-инфекцией. Еще одним фактором является рост миграции людей, живущих с ВИЧ, по всей Европе, особенно миграции в страны ЕС/ ЕЭЗ. 16,6% случаев ВИЧ-инфекции в странах ЕС/ ЕЭЗ, зарегистрирован- ных в 2022 г., приходились на лиц с ранее известным положительным ВИЧ-статусом. При этом число лиц с ранее известным положительным ВИЧ-статусом, вероятно, недооценивается. Данная категория включает в себя лиц, у которых ВИЧ-инфекция была диагностирована до данного отчетного года, либо в другой стране, либо в других учреждениях страны, предоставляющей отчетные данные. Вероятно, в большинстве таких случаев инфицирование про- изошло за границей и может не отражать повышение показателей распространения инфекции в странах, предоставляющих отчетные данные. Значительный рост регистрации случаев ВИЧ-инфекции в 2022 г., особенно случаев с ранее известным положительным ВИЧ-статусом, может в целом быть объяснено прибы- тием беженцев из Украины. В 2022 г. во всем Европейском регионе ВОЗ рост реги- страции случаев ВИЧ-инфекции за счет лиц с ранее известным положительным ВИЧ-статусом оказал зна- чительное влияние на эпидемиологический профиль и тенденции эпидемиологической ситуации, когда xxvii HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT такие случаи были подсчитаны вместе со случаями ВИЧ-инфекции, диагностированными впервые. Для того чтобы надлежащим образом сориентировать меры профилактики, работу медицинских учреж- дений и планирование ресурсов, важно понимать четкие эпидемиологические характеристики людей, у которых ВИЧ-инфекция была диагностирована ранее, и людей, у которых ВИЧ-инфекция была диа- гностирована впервые [1]. При исключении лиц с ранее известным положитель- ным ВИЧ-статусом из популяции людей, которым диагноз ВИЧ-инфекции был поставлен в 2022 г., становится ясно, что популяция людей, которым диагноз ВИЧ-инфекции был поставлен впервые, преимущественно состоит из молодых мужчин; на нее приходится более высокая доля диагнозов в острой и ранней стадиях инфекции среди МСМ и более высокая доля диагнозов, установленных на поздней стадии, среди лиц, инфицированных гете- росексуальным путем. Это означает, что в данных группах населения необходимо обеспечить усилен- ные меры профилактики и проводить тестирование на ВИЧ-инфекцию. В восточной части Региона в нескольких странах, а именно в Армении, Азербайджане, Казахстане, Кыргызстане и Республике Молдова, было зареги- стрировано рекордное за всю историю число случаев ВИЧ-инфекции, выявленных в течение одного года. Ни одна из этих стран не сообщала о значительном росте числа случаев, привнесенных из других стран, и более 90% диагностированных ими случаев ВИЧ- инфекции происходят из самих этих стран. Согласно отчетным данным, после ослабления пандемии COVID-19 в этих странах отмечалось восстановление объемов тестирования на ВИЧ-инфекцию и вос- становление выявления случаев ВИЧ-инфекции, что было связано с внедрением новой политики в области тестирования, направленной на выявление случаев ранее не диагностированной ВИЧ-инфекции. В восточной части Региона гетеросексуальный путь передачи остается основным путем передачи ВИЧ- инфекции. Хотя уровень передачи ВИЧ-инфекции при половых контактах между мужчинами, согласно отчетным данным, остается низким в абсолютном выражении, за последнее десятилетие он увеличился более чем в два раза, что отражает наибольший рост среди всех путей передачи и во всех частях Региона. Имеются определенные данные, позволя- ющие сделать предположение, что некоторая доля мужчин, классифицированных как мужчины, инфи- цированные гетеросексуальным путем, фактически может представлять мужчин, практикующих секс с мужчинами, или людей с употреблением инъекцион- ных наркотиков в анамнезе, которые были неверно классифицированы как лица, инфицированные гете- росексуальным путем [2, 3]. В 2022 г. в центральной части Региона было зареги- стрировано рекордное за всю историю число случаев ВИЧ-инфекции. Несмотря на тенденцию к повышению передачи гетеросексуальным путем по причине опи- санных выше факторов, в центральной части Региона передача ВИЧ-инфекции у МСМ также демонстри- рует тенденцию к повышению. Согласно отчетным данным, в восьми из пятнадцати стран центральной части Региона половые контакты между мужчинами являются преобладающим путем передачи. В Европейском регионе ВОЗ чуть более чем в поло- вине (50,6%) случаев ВИЧ-инфекции количество CD4-клеток составляет менее 350  кл/мм3, вклю- чая 29,7% случаев продвинутой ВИЧ-инфекции (CD4  <  200  кл/мм3). Как и в предыдущие годы, дан- ные 2022 г. означают, что поздняя диагностика ВИЧ-инфекции наиболее распространена среди лиц, инфицированных гетеросексуальным путем (осо- бенно среди мужчин), среди лиц, инфицированных при употреблении инъекционных наркотиков, и среди лиц старших возрастных групп. Данные насто- ящего отчета также указывают на то, что в Регионе увеличивается разрыв между диагностированными и недиагностированными случаями ВИЧ-инфекции, и на то, что Регион не сможет достичь цели 2025 г. по выявлению 95% лиц, живущих с ВИЧ-инфекцией. Мероприятия по контролю за эпидемией должны быть основаны на доказательных данных и адаптиро- ваны к национальной и местной эпидемиологической ситуации. В настоящем отчете представлен под- робный обзор эпидемиологической ситуации по ВИЧ-инфекции, в соответствии с которым приоритет должен отдаваться следующим мерам реагирования: • Во всех странах Европейского региона ВОЗ быстрое увеличение объемов тестирования на ВИЧ-инфекцию имеет важнейшее значение для ускорения прогресса на пути к достижению цели выявления 95% лиц, инфицированных ВИЧ, к 2025 г. ВОЗ выпустила аналитическую записку, в которой содержится рекомендация отказаться в стратегиях и алгоритмах тестирования на ВИЧ-инфекцию от вестерн-блоттинга и линей- ных иммуноанализов и поддерживать политику децентрализованного тестирования и раннего при- влечения к лечению [4]. В рамках общей политики тестирования на ВИЧ-инфекцию ВОЗ и Европейский центр профилактики и контроля заболеваний (ЕЦКЗ) рекомендуют применять инновационные подходы, включая самотестирование и тестиро- вание на уровне сообществ, проводимое лицами, не имеющими специального образования, а также организацию легкодоступных служб тестирования для мигрантов [5–7]. Хотя качество предоставления услуг по тестированию на ВИЧ с течением времени улучшилось и в последние годы самотестирование и тестирование на уровне сообществ значительно увеличилось, мониторинг политики в Регионе показывает, что в некоторых странах Региона неко- торые виды тестирования по-прежнему остаются ограниченными или отсутствуют [8]. Тестирование на ВИЧ-инфекцию должно быть преимущественно направлено на охват ключевых групп населе- ния в условиях местной эпидемиологической xxviii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data ситуации; оно должно быть адаптировано к кон- кретным потребностям этих групп населения и поддерживать их своевременное привлечение к профилактике, помощи и лечению ВИЧ-инфекции. Это обеспечит более раннюю диагностику и начало лечения, что приведет к улучшению результатов лечения и снижению распространенности, заболе- ваемости и смертности от ВИЧ-инфекции и будет способствовать достижению целей «95-95-95» и других региональных и глобальных целей [9–11]. Значительный массив доказательных данных показывает, что раннее начало АРТ благоприятно влияет на здоровье и на эффективность профилак- тики передачи ВИЧ-инфекции [12–17]. Почти 90% стран в Европейском регионе ВОЗ имеют политику, в рамках которой предписывается начинать АРТ независимо от количества CD4-клеток [18]. • В странах ЕС/ЕЭЗ и западной части Европейского региона ВОЗ значительное увеличение числа лиц с ранее известным положительным ВИЧ-статусом существенно изменило эпидемиологическую ситуацию. Это увеличение может быть объяснено прибытием лиц, живущих с ВИЧ, из различных стран и регионов, включая Украину, что создает новые вызовы для оказания медицинской помощи, связанной с ВИЧ-инфекцией, а также для удов- летворения потребностей в области психического здоровья и социальной поддержки [1, 19]. Для улуч- шения профилактики ВИЧ-инфекции в популяциях мигрантов страны должны изучить возможность расширения первичных услуг профилактики, вклю- чая программы предоставления презервативов и доконтактной профилактики, и обеспечить доступ мигрантов к этим программам. Наличие услуг по тестированию и лечению, а также доступа к ним, независимо от статуса резидента и мигранта, может способствовать дальнейшему улучшению профилактики и лечения ВИЧ-инфекции. Страны должны работать на более широком уровне в целях устранения барьеров на пути к лечению и обеспе- чению общей информации, затрудняющих доступ к услугам систем здравоохранения. Для обеспече- ния надлежащего охвата и отчетности по случаям с ранее известным положительным ВИЧ-статусом необходимо улучшить качество мониторинга и эпиднадзора за этими случаями. Помимо ситуации с притоком мигрантов, в последнее десятилетие основным путем передачи ВИЧ-инфекции в странах ЕС/ЕЭЗ остаются половые контакты между мужчи- нами. Улучшение профилактики для МСМ должно включать комплексные программы с расширенным доступом к услугам доконтактной профилактики (ДКП) и устранением ограничений по доступу к услугам ДКП. Для охвата более широких слоев населения эти программы также должны пересмо- треть и расширить число учреждений, в которых предоставляются услуги ДКП. Предоставление услуг ДКП в сочетании с расширенным регулярным тестированием и привлечением к лечению может помочь снизить заболеваемость ВИЧ-инфекцией среди мужчин, практикующих секс с мужчинами (МСМ) [20, 21]. Наличие качественных систем эпид- надзора и мониторинга также позволит получить данные о соответствии критериям для получения услуг ДКП, приему, длительности приема ДКП и результатам оказания услуг ДКП. • В странах центральной части Европейского региона ВОЗ в 2002 г. отмечалось рекордное за всю историю число диагностированных случаев ВИЧ-инфекции, что, главным образом объясняется увеличе- нием случаев с ранее известным положительным ВИЧ-статусом в странах ЕС/ ЕЭЗ; это привело к изменению преобладающего пути передачи инфек- ции от половых контактов между мужчинами к гетеросексуальному пути передачи. Тем не менее, половые контакты между мужчинами по-прежнему остаются преобладающим путем передачи ВИЧ- инфекции в большинстве стран. Необходимы мероприятия, направленные на решение данной проблемы, такие как программы предоставления презервативов и лубрикантов; диверсификация услуг тестирования на ВИЧ-инфекцию; помощь в добровольном уведомлении партнера о поло- жительном ВИЧ-статусе, услуги ДКП; услуги профилактики и ведения сочетанных инфекций (особенно передаваемых половым путем); раннее начало лечения ВИЧ-инфекции. Услуги должны быть ориентированы на пациента и предоставляться в дружелюбной атмосфере, предпочтительно с при- влечением организаций гражданского общества на протяжении всего каскада предоставления услуг, связанных с ВИЧ-инфекцией – от профи- лактики ВИЧ-инфекции до соблюдения схемы АРТ. Уровень передачи ВИЧ-инфекции при употребле- нии инъекционных наркотиков остается низким, но прошлые вспышки [22–26] предполагают, что услуги профилактики ВИЧ-инфекции для людей, употребляющих инъекционные наркотики, сохра- няют свою актуальность, и для профилактики таких вспышек необходимо продолжать их ока- зание c обеспечением достаточного охвата. Доля молодых людей среди лиц с диагностированной ВИЧ-инфекцией также выше в этой части Региона, чем в других. После прекращения финансирова- ния со стороны Глобального фонда для борьбы со СПИДом, туберкулезом и малярией в некоторых странах произошел переход на внутреннее финан- сирование мер реагирования на ВИЧ-инфекцию. Это создало серьезные проблемы, особенно в области финансирования программ профилактики ВИЧ-инфекции и проведения опросов ключевых групп населения, разрабатываемых и реализуе- мых силами сообществ. Кроме того, обеспечение доступа к услугам здравоохранения для беженцев и мигрантов, включая услуги, связанные с ВИЧ- инфекцией, и содействие сотрудничеству и обмену данными на межнациональном уровне, остаются необходимыми для осуществления надежных и пациентоориентированных мер реагирования, особенно в странах, сильно затронутых прибытием этих групп населения. Для смягчения некоторых из этих проблем и предотвращения обострения xxix HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT эпидемии необходимо усиление политической воли и внимания, а также более активное вовлече- ние гражданского общества. • В восточной части Европейского региона ВОЗ в нескольких странах также отмечалось рекордное число диагностированных случаев ВИЧ-инфекции, выявленных в течение одного года. Хотя, согласно отчетным данным, в этих странах отмечалось вос- становление объемов тестирования и уровня выявления случаев ВИЧ-инфекции после осла- бления пандемии благодаря внедрению новой политики тестирования для повышения выявления случаев ВИЧ-инфекции, этого недостаточно для устранения имеющегося разрыва и обеспечения информированности людей о своем ВИЧ-статусе; также необходимо проводить тестирование боль- шего числа людей. Для стран восточной части Региона ВОЗ существует острая необходимость продолжать расширение охвата соответствую- щих групп инновационными, основанными на доказательных данных мероприятиями и предо- ставления эффективных интегрированных услуг в рамках системы здравоохранения в целях повышения эффективности решения проблем, связанных с социальными детерминантами здо- ровья. Необходимы комплексные стратегии по профилактике и внедрению инновационных мето- дов тестирования на ВИЧ-инфекцию, особенно направленные на обеспечение охвата ключевых групп населения. Это может быть достигнуто с помощью пациентоориентированных услуг по профилактике и тестированию, включая помощь в уведомлении партнера о ВИЧ-статусе, услуги ДКП, тестирование на ВИЧ-инфекцию, проводимое сотрудниками, не имеющими специального обра- зования, и самотестирование в соответствии с рекомендациями ВОЗ. Все эти услуги должны быть включены в национальную политику и программы с их последующим внедрением [5, 6, 11]. В целях снижения заболеваемости ВИЧ-инфекцией и уве- личения числа людей, привлеченных к лечению, а также начавших и обученных АРТ, чрезвычайно важную роль играет вовлечение сообществ в работу по планированию и предоставлению услуг. Конечной целью является снижение заболеваемо- сти ВИЧ-инфекцией и смертности, связанной со СПИДом. Инновационные мероприятия по профи- лактике ВИЧ-инфекции должны быть направлены на снижение риска гетеросексуальной передачи, особенно для пар, в которых один из партнеров склонен к поведению высокого риска (например, употребляет инъекционные наркотики) или рабо- тает за границей в течение длительных периодов времени. Большое число диагностированных слу- чаев ВИЧ-инфекции у людей, употребляющих инъекционные наркотики, подчеркивает тот факт, что политика, основанная на доказательных данных, направленная на ключевые группы насе- ления, включая высокий охват программами снижения вреда людей, употребляющих инъекци- онные наркотики, по-прежнему имеет решающее значение для внедрения мер реагирования на ВИЧ- инфекцию в восточной части Региона. Данные 2022 г. по ВИЧ-инфекции обнажили серьез- ные проблемы, связанные с качеством и полнотой данных, недостаточным уровнем стандартизации переменной, определяющей разделение новых диа- гностированных случаев ВИЧ-инфекции и случаев с ранее известным положительным ВИЧ-статусом, а также проблемы с такими переменными, как страна рождения и регион инфицирования. Эти факторы, в сочетании с ростом миграции населения и восста- новительными периодом после пандемии COVID-19, сильно затруднили интерпретацию данных 2022  г. Достижение консенсуса среди стран Региона по сбору, регистрации и представлению отчетных дан- ных о случаях с ранее известным положительным ВИЧ-статусом имеет первостепенное значение. Это необходимо потому, что беженцы, мигранты и лица с ранее поставленным диагнозом имеют раз- ные эпидемиологические профили и потребности в медицинских услугах. Улучшение стандартов реги- страции данных и предоставления отчетных данных в системах эпидназдора обеспечит точность и поможет в планировании специально адаптирован- ных стратегий профилактики. Это первый отчет, в который включены данные по популяции трансген- дерных людей. Вместе с тем, ввиду ограниченной доступности данных, более полное понимание их эпи- демиологического профиля остается невозможным. Поэтому необходимо собрать больше углубленной информации, которая позволит создать более эффек- тивные адаптированные стратегии профилактики для популяции трансгендерных людей. Проведение уси- ленного эпиднадзора за ВИЧ-инфекцией повышает возможность проведения более долгосрочного мони- торинга результатов каскада лечения ВИЧ-инфекции, моделирования доли недиагностированных слу- чаев и измерения эффективности привлечения к лечению, лечения и подавления вирусной нагрузки после постановки диагноза. Это также может спо- собствовать реализации национальных и глобальных мероприятий по мониторингу прогресса на пути к достижению целей «95–95–95» и другим глобальным и региональным целям. В сентябре 2022 г. на семьдесят второй сессии Европейского регионального комитета ВОЗ государ- ства-члены Европейского региона ВОЗ утвердили Региональные планы действий по ликвидации СПИДа и эпидемий вирусных гепатитов и инфекций, переда- ваемых половым путем, на 2022–2030 гг. [11]. В этих Планах описываются концепции, цели и мероприя- тия, необходимые для обеспечения реагирования на эти эпидемии. Планы способствуют обеспечению стратегического сочетания подходов применительно к конкретным заболеваниям и направлены на обеспечение внедрения мер, в первую очередь ори- ентированных на людей, нуждающихся в них. С помощью этих Планов будет осуществляться реализация Глобальных стратегий сектора здраво- охранения по ВИЧ-инфекции, вирусным гепатитам xxx SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data и инфекциям, передаваемым половым путем, на 2022–2030 гг. с использованием мероприятий, специфичных для Региона, и приведением мер реа- гирования в соответствие с Европейской программой работы на 2020–2025 гг. «Совместные действия для улучшения здоровья». Эти Планы устанавливают амбициозные цели на 2030 г. и промежуточные цели на 2025 г. Достижение данных амбициозных целей будет осуществляться за счет внедрения следующих подходов и мероприятий: • применение партнерского подхода в отношениях с учреждениями первичной медико-санитарной помощи, организациями гражданского общества и учреждениями общественного здравоохранения в целях обеспечения качественных, дифферен- цированных и пациентоориентированных услуг здравоохранения; • приоритизация ключевых групп населения и уде- ление особого внимания снижению социальных и структурных барьеров для получения доступа к услугам здравоохранения; • обеспечение быстрого восстановления после острых и длительных чрезвычайных ситуаций и обеспечение готовности к будущим чрезвычайным ситуациям в сфере здравоохранения; • поддержка устойчивости мер реагирования на национальном уровне с обеспечением достаточ- ного внутреннего финансирования услуг и товаров и обеспечение сообществ необходимыми ресур- сами и средствами для оказания качественной медицинской помощи; • принятие решений в соответствии с дока- зательными данными, основанными на комплексном эпиднадзоре и качественной страте- гической информации; • переопределение задач тестирования в целях содействия ранней диагностике, основанной на эпидемиологии и доказательных данных; децен- трализация и использование полного комплекса стратегий тестирования для содействия ранней, точной и надежной диагностике; • быстрое масштабирование применения новых схем лечения ВИЧ-инфекции и вирусных гепатитов и моделей лечения; • применение инновационных, комбинированных подходов к профилактике за счет широкого ряда платформ оказания услуг. ВОЗ и ЕЦКЗ вместе с государствами-членами рабо- тают над повышением уровня использования рекомендаций по тестированию и лечению ВИЧ- инфекции и инновационных, комбинированных подходов к профилактике ВИЧ в ключевых груп- пах населения и к элиминации ПМР ВИЧ-инфекции, вирусного гепатита В и сифилиса, улучшая стандарты ведения случаев ВИЧ-инфекции, усиливая эпиднад- зор за ВИЧ-инфекцией и решая другие приоритетные задачи, обозначенные в Планах действий. ВОЗ и ЕЦКЗ совместно с партнерскими организациями продолжат оказывать поддержку государствам-чле- нам ВОЗ в их усилиях по ускорению темпов прогресса на пути к достижению Целей в области устойчивого развития, касающихся ВИЧ-инфекции, посредством подготовки специализированных руководящих доку- ментов, проведения семинаров, обучения, вебинаров и реализации других мер технической поддержки, направленных на обеспечение эффективности эпид- надзора, мониторинга, лечения и профилактики. Библиография 1. 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1HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT 1.1. HIV diagnoses In 2022, 22 995 HIV diagnoses were reported in 30 coun- tries of the EU/EEA, resulting in a rate of 5.1 per 100 000 population (Table 1). The highest rates were reported by Cyprus (24.1; 218 cases), and Estonia (18.8; 250 cases), and the lowest by Slovenia (2.0; 42 cases) (Table  1; Map  1). Of the HIV diagnoses reported in 202211, 16.6% (3 824 cases) were among individuals with a previous positive HIV diagnosis12. Section 1.2 will describe previ- ous positive diagnoses in more detail. Unless otherwise specified data presented in this section includes all HIV diagnoses reported, including both individuals with a previous positive HIV diagnosis and those diagnosed for the first time. 11 Reported HIV diagnoses refers to all HIV diagnoses made and reported by a country within a specific year, encompassing both previous positive diagnoses and individuals who were diagnosed with HIV for the first time. 12 Previous positive diagnoses are defined as an HIV diagnosis made either abroad or in another setting within the reporting country on any occasion before the current year of reporting. Some countries report previous positive HIV cases as they enter, re-enter or re-engage with the care system in the reporting country. As in previous years, more men than women were diag- nosed with HIV in 2022 (16 114 and 6 676, respectively), resulting in an overall male-to-female ratio of 2.4:1 (Figure  1.1; Table  2; Table  3). This ratio was highest in Malta (11.0:1), Slovenia (7.4:1) and Hungary (6.9:1) and was above one in all countries in the EU/EEA, except for Czechia, where the ratio was 1:1 (Figure 1.1; Map 2). The predominant mode of transmission in countries with the highest male-to-female ratios was sex between men. The overall rate of diagnoses in men was 7.3 per 100 000 population (Table  2, Map  3) and for women 2.9 per 100 000 population (Table  3; Map  4). In addition to the 22 790 cases with male or female gender, 121 transgen- der individuals and 84 with unknown gender were diagnosed with HIV in 2022. Current reporting systems at European level are not able to effectively identify how many of these cases are transgender men or women, except for the systems in France, the Netherlands and Ireland. Age-specific rates were lowest in persons under 15 years of age (0.3 per 100 000 population for both females and 1. HIV and AIDS in the EU/EEA Figure 1.1: Male-to-female ratio in HIV diagnoses, by country, EU/EEA, 2022 (n=22 790) 0 2 4 6 8 10 12 Czechia Estonia Norway Denmark Sweden Slovakia Lithuania Finland Luxembourgc Poland Bulgaria Ireland France Belgium Latvia Germany Cyprus Total EU/EEA Iceland Portugal Italy Croatia Romania Greece Netherlands Austria Spain Hungary Slovenia Malta Male-to-female ratio Notes: Data from Liechtenstein reported only one case in 2022 and is excluded from the figure. 2SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data males) (Figure  1.2). In all age groups, men had higher age-specific rates than women. The highest overall age-specific rate of HIV diagnoses was observed among 30−39-year-olds (12.5 per 100 000 population), however for men the highest age-specific rate was observed among 25−29-year-olds at 17.5 per 100 000 population, while rates for women were highest in the age group 30–39 years (7.7 per 100 000 population) (Figure  1.2). For transgender individuals (n=121), the mean age at diagnosis was 33.3 years, with 42.5% of the transgender individuals diagnosed in the 30−39 years age group, fol- lowed by 28.9% in the 25−29 years age group. The overall mean age at diagnosis was 39.2 years; the mean age at diagnosis was lower for MSM (36.6 years) than for cases attributed to injecting drug use (41.2 years overall, and similar in both women and men) or heterosexual transmission (41.2 years overall, 39.6 in women and 43.4 in men) (Table 4−8). The age group 30–39 years accounted for most HIV diag- noses overall (31.7%) and in all transmission groups (Figure  1.3). One third (32.8%) of diagnoses attributed to sex between men were made before the age of 30, while over half (52.0% and 57.2%) of the HIV infec- tions resulting from sex between men and women and among people who were infected through injecting drug use, respectively, were diagnosed at 40 years or above. The age distribution of HIV diagnoses varied between countries. In Iceland and Romania, approximately one third of reported HIV diagnoses were among individuals under 30 years old. Conversely, in most countries, over 70% of cases were identified in individuals over 30 years of age. It is interesting to note that, even in countries such as Latvia (64.2%), Italy (57.3%), Lithuania (52.0%) and Norway (51.8%), most HIV cases were among those above 40 years old. (Figure 1.4; Table 9). Figure 1.3: HIV diagnoses, by age group (in years) and transmission mode, EU/EEA, 2022 (n=16 368) 0 20 40 60 80 100 Sex between men Injecting drug use Heterosexual contact 15-19 years 20-24 years 25-29 years 30-39 years 40-49 years 50+ years n = 7 739 n = 992 n = 7 637 Percentage Tr an sm is si on m od e Figure 1.2: Age- and gender-specific rates of HIV diagnoses per 100 000 population, EU/EEA, 2022 (n=22 734) 0 5 10 15 20 50+40-4930-3925-2920-2415-19 < 15 Men Women HI V di ag no se s pe r 10 0 00 0 po pu la tio n Age category (years) 3HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Data on transmission mode provide information on the groups in the EU/EEA who are most affected by HIV (Tables 4–8; Figure 1.5): • Sex between men remains one of the most com- mon modes of HIV transmission reported in the EU/ EEA, accounting for 33.3% (7 656) of all reported HIV diagnoses in 2022. Sex between men was one of the predominant routes of transmission (45.8%) where route of transmission was known (Figure  1.5; Table  4; Table  8; Map  5), and accounted for more than 50% of reported HIV diagnoses in ten countries (Austria, Croatia, Greece, Hungary, Iceland, Ireland, Malta, Netherlands, Slovenia and Spain) (Figure  1.5). While the majority (54.7%; 4 191) of individuals with a reported diagnosis attributed to sex between men were born in the reporting country, 20.0% (1 529) orig- inated from Latin America and the Caribbean, 7.9% (606) from countries in Central or Eastern Europe and 4.0% (306) from other countries in the west of Europe (Table 11). • Sex between men and women is the most reported mode of transmission in the EU/EEA, accounting for 33.7% (7 743) of all HIV diagnoses and 46.3% of diag- noses where the route of transmission was known (Figure  1.5; Table  6; Table  8; Map  6). This proportion is higher among women (26.1%) than men (20.1%). Heterosexual transmission accounts for more than 50% of the reported HIV cases in eleven EU/EEA coun- tries (Bulgaria, Cyprus, Czechia, Denmark, France, Latvia, Lithuania, Norway, Portugal, Romania and Sweden). Nearly one-third (28.2%; 2 186) of the reported diagnoses attributed to heterosexual trans- mission were among migrants originating from Central and Eastern Europe, followed by migrants from Sub- Saharan Africa (26.4%; 2 046). In addition, 31.1% (2 407) of cases attributed to heterosexual transmis- sion originated from the reporting country (Table 11). • Around four per cent (4.3%; 993 cases) of all reported HIV diagnoses and 5.9% of those with a known route of HIV transmission were attributed to injecting drug use (Figure  1.5; Table  5, Table  8). Injecting drug use was the probable route of transmission for 24.8% of cases diagnosed in Latvia, 20.9% of cases diagnosed in Finland and 18.8% in Luxembourg (Figure 1.5; Map 7). More than half of those with a reported diagnosis attributed to injecting drug use were born outside of the reporting country, including 43.3% (430 cases) from other countries in Central and Eastern Europe. • Of the remaining cases, 270 diagnoses (1.2%) were reported as being due to MTCT during pregnancy, childbirth or breastfeeding (Table  7, Table  11); 22.6% and 17.4% of these cases were reported by Germany and France, respectively. Most of the cases were born outside of the reporting country (81.5% 220 cases Figure 1.4: Percentage of HIV diagnoses, by country and age group, EU/EEA, 2022 (n = 22 830) Note: Liechtenstein reported one case for 2022. Unknown age is excluded from the proportions presented here. 0 20 40 60 80 100 Sweden Spain Slovenia Slovakia Romania Portugal Poland Norway Netherlands Malta Luxembourg Lithuania Latvia Italy Ireland Iceland Hungary Greece Germany France Finland EU/EEA Estonia Denmark Czechia Cyprus Croatia Bulgaria Belgium Austria 15-19 years <15 years 20-24 years 25-29 years 30-39 years 40-49 years ≥50 years Percentage 4SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Figure 1.6: Percentage of HIV diagnoses among migrants out of all reported cases with known information on region of origin, by country of report, EU/EEA, 2022 (n = 20 016) 0 20 40 60 80 100 Romania Portugal Spain Italy France Luxembourg Greece Netherlands Cyprus Hungary Belgium Slovenia EU/EEA Ireland Bulgaria Austria Sweden Croatia Germany Finland Iceland Poland Lithuania Denmark Norway Slovakia Estonia Czechia Sub-Saharan Africa Central and Eastern Europe Western Europe Latin America and Caribbean South and South-East Asia Other Percentage Notes: Liechtenstein reported one case for 2022 and is excluded from the figure. Malta and Latvia are not included in the figure as they have more that 50 % of the cases with unknow region of origin. Unknown route of transmission is excluded from the proportions presented here. Figure 1.5: Percentage of HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2022 (n = 16 718) 0 20 40 60 80 100 Latvia Lithuania Czechia Norway Finland Bulgaria Luxembourg Denmark Sweden Romania Cyprus Slovakia France Belgium Germany EU/EEA Italy Portugal Ireland Greece Austria Iceland Netherlands Spain Croatia Malta Slovenia Hungary Heterosexual transmission (men) Heterosexual transmission (women) Injecting drug use Other Percentage Sex between men Notes: Liechtenstein reported one case for 2022 and is excluded from the figure. Estonia and Poland are not included in the figure as they have more that 50 % of the cases with unknow route of transmission. Unknown route of transmission is excluded from the proportions presented here. 5HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT [excluding unknown route of transmission]), with 50.7% (137) coming from Central and Eastern Europe. Forty-six diagnoses (0.2%) were reported to be due to contaminated transfusion of blood and its products, and ten cases due to hospital-acquired infections (Table  8). Most of the transfusion-related cases (45.7%; n=21) and nosocomially acquired infections (80.0%; n=8) were reported in people originating from Central and Eastern Europe (Table 11). • Transmission mode was reported as unknown for 6 277 diagnoses (27.3%), with a wide variation among coun- tries: less than 5% of diagnoses were reported with unknown transmission mode in Bulgaria and Cyprus and over 50% in Estonia and Poland (Table 8). In 2022, twenty-eight EU/EEA countries provided infor- mation on the country of birth, country of nationality or region of origin for 20 016 (88.2%) HIV diagnoses (Table 10). In the EU/EEA, 11 103 diagnoses (48.3% of the total of HIV diagnoses and 55.5% of those with known information on region of origin) were reported among people originating from outside of the reporting coun- try (Figure 1.6). Of these, 4 562 (20.1% of total diagnoses and 22.8% of those with known information on region of origin), irrespective of transmission mode, were reported among people originating from Central and Eastern Europe. Among these cases, 34.5% (1 575) were reported as previous positive diagnoses. Section 1.2 will describe previous positive diagnoses in more detail. An additional 13.9% of the diagnoses with known region of origin (2 781) were reported among people coming from Sub-Saharan Africa (Figure 1.6; Table 10). Of the remain- ing newly-reported diagnoses with a known region of origin, 11.3% originated from Latin America and the Caribbean (2 271), 2.6% from other countries in western Europe (518), and 2.3% from South and South-East Asia (456). The countries with more than half of their HIV diagnoses among people originating from outside of the report- ing country were Austria, Belgium, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Iceland, Ireland, Luxemburg, Netherlands, Norway, Slovakia and Sweden. For HIV diagnosis reported in transgender individuals in 2022, 70.3% (85) originated from Latin America and the Caribbean and 10.7% (13) from the reporting country. Information on CD4 cell count at the time of HIV diagnosis was provided for 13 473 (68.2%) adults and adolescents diagnosed in 27 countries (Table 12). Twenty-four coun- tries were able to provide CD4 cell counts for 50% or more of their reported cases, with the exception of Estonia, Germany, Ireland, Latvia and Slovakia, all of which pro- vided data for less than 35% of cases. Hungary, Malta and Poland did not provide CD4 cell counts for the whole reporting period (2013−2022) (Table 12). About half (47.9%) of all individuals diagnosed in 2022, where a CD4 count at diagnosis was reported and where the case was not determined to be diagnosed during the acute phase of infection or a previous positive diagno- sis, were considered to have been diagnosed several years after being infected, with a count below 350 cells per mm3. This included 28.8% of cases considered to have advanced HIV infection (CD4 cell count below 200 cells/mm3) (Table 12). Among cases with known CD4 cell count at diagnosis, the proportion diagnosed late (CD4 cell count below 350 cells per mm3) was above 60% in Denmark (62.8%), Estonia (66.7%), Latvia (61.9%) and Romania (62.9%). Among all cases diagnosed in 2022 with available information on CD4 cell count (13 473), 8.4% (1 134) were diagnosed during acute infection13, and 30.2% (3 640) were identified as recent infections (with a CD4 cell count of 500 or over 500 cells per mm3 at diagno- sis). Specifically, among MSM diagnosed in 2022 with available CD4 cell count information, 13.9% (804) were 13 Acute infection status was reported by countries using one or more criteria for acute infection, including HIV negative test in the last six months, evidence of seroconversion illness, p24 antigen or an indication based on any other clinical or laboratory criteria. Figure 1.7: Acute infection or CD4 cell count per mm3 at HIV diagnosis, overall and by transmission mode, EU/EEA, 2022 (n=16 507) 0 20 40 60 80 100 Sex between menInjecting drug useHeterosexual contact Pe rc en ta ge HIV infection, overall and by transmission mode 350 to <500 <200 200 to <350 500+ Acute infection 6SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Figure 1.8: Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2022 (n = 6 451) 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 Non-migrants 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 m od e Re gi on o f o rig in Note: This graph excludes cases with unknown CD4 count and individuals with acute infection and those defined as previous positive diagnosed. Figure 1.9: Linkage to care after HIV diagnosis in the EU/EEA, individuals diagnosed with HIV 2021–2022 (n = 4 389). 0 20 40 60 80 100 Total Injecting drug use Sex between men Heterosexual contact 0–4 days 5–28 days 29–91 days >91 days Percentage Tr an sm is si on m od e Note: cases with no or missing data on CD4 count or date, previous positive cases and those who died within 91 days of diagnoses are excluded here. 7HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT reported as acute infections, and 30.1% (1 746) had a CD4 cell count of 500 or over 500 cells per mm3 at diag- nosis (Figure 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, excluding those previ- ously diagnosed or with evidence of acute infection) were among women (54.4%), older adults (57.1% in 40–49-year-olds and 68.1% in people aged 50 years and over), men or women infected through heterosexual sex (63.2% and 53.6% respectively), people who acquired HIV through injecting drug use (50.7%), and migrants from South and South-East Asia (63.8%) and Sub- Saharan Africa (58.9%) (Figure 1.8). Information regarding CD4 cell count was available for 53.7% (n=65) of all transgender people reported (n=121). Of these, 27.7% (n=18) were diagnosed at the stage of acute infection, 32.3% (n=21) were identified as recent infections (with a CD4 count of 500 or more than 500 cells per mm3) and 40.0% (n=26) presented at a late stage of HIV infection (CD4 cells per mm3<350). The lowest proportions of late diagnosis (CD4 cell count below 350 cells/mm3) were observed among younger age groups (37.3% of those aged 20−24 years), men who acquired HIV through sex with another man (46.3%) and migrants from Central and Eastern Europe (47.2%) (Figure 1.8). The interval between the date of diagnosis and the date of the CD4 count was used as a proxy for time to link- age to care and, among cases diagnosed in recent years (2021−2022) where CD4 data and date of diagnosis were reported, 78.5% were linked to care within four days of HIV diagnosis and 97.9% were linked to care within three months (Figure 1.9) 1.2. Previous positive diagnoses In 2022, there was a 30.8% increase in the rate of HIV diagnoses (5.1 per 100 000 population) compared to the rate reported in 2021 (3.9 per 100 000 population) (see Section 1.3). This rise in 2022 may be attributed, among other factors, to the increase in reporting of previous positive diagnoses. In 2022, previous positive diagnoses were 16.6% of all reported HIV diagnoses (3 824/22 995), marking a notable increase on 2021 when this propor- tion was 8.8% (1 648/18 673). However, these figures are probably underestimated, as the variable identifying the HIV status as a previous positive or first-time diagnosis had a completeness of 51.4%. Data from 14 countries were analysed to describe previous positive cases. Sixteen countries were excluded from the analysis due to significant limitations, such as having over 50% of data unknown for the variable identifying HIV status as either a previous positive or a first-time diagnosis. These exclusions were also due to reporting practices, such as considering the date of diagnosis based on the diagnosis date in the country of origin, categoris- ing these cases as incident cases in previous years, or reporting all HIV diagnoses as newly diagnosed cases (Figure  1.10). When only taking the data reported by these 14 countries into consideration, the proportion of previous positive diagnoses increased to 38.9% (3 526) of all HIV diagnoses reported by these countries in 2022. Seven countries reported that over 50% of the HIV diag- noses reported in 2022 were previous positives: Czechia (70.9%), Denmark (55.8%), Slovakia (67.0%), Norway (63.3%), Ireland (60.0%), Estonia (56.0%) and Sweden (55.6%). When analysing the data reported by the 14 EU/EEA countries, a 63.7% increase in HIV diagnoses was observed for 2022, due to the inclusion of previous posi- tive diagnoses in the reporting. When previous positive cases were excluded, there was an increase of 14.6% in HIV diagnoses when comparing data from 2022 against Figure 1.10: Percentage of previous positive diagnoses and newly HIV diagnoses by country of report, EU/EEA, 2022 (n = 9 057) 0 20 40 60 80 100 Ireland Slovakia Finland Czechia Norway Croatia Sweden Estonia Denmark France Slovenia Belgium Iceland Cyprus Average EU/EEU countries Newly HIV diagnosed Previous positive diagnoses Unknown Percentage Notes: Countries with more than 50% unknown cases, or countries reported the date of diagnosis based on the diagnosis date in the country of origin, count these cases as incident cases in previous years or countries reporting all HIV diagnoses as newly diagnoses were excluded from this figure. 8SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data 2021. However, when considering all cases, includ- ing previous positive diagnoses, the increase is 43.1% (Figure 1.11). Demographic and clinical characteristics of individu- als with previous positive diagnoses can be compared to those newly diagnosed using 2022 data from the 14 EU/EEA countries described above (Figure  1.12). It was observed that there as a higher proportion of women among those with previous positive diagnoses than the newly diagnosed group (44.0 versus 28.9%), while the newly diagnosed group had a larger proportion of men than the previous positive group (69.5 versus 53.8%). The overall mean age was 38.7 years, similar in both populations. However, when focusing on previous posi- tive diagnoses, a significant proportion (18.8% and 34.3%) of all cases were under 29 years and within the age range of 30−39 years, respectively. In contrast, among the newly reported diagnoses, (29.0% and 30.4%) were under 29 years or within the 30−49 age range. With regard to the region of origin, among the previous positive diagnoses, 44.7% originated from Central and Eastern Europe, 20.1% from Sub-Saharan Africa, 13.2% from Latin America and the Caribbean and 7.1% from the reporting country. These proportions dif- fered when compared to newly reported diagnoses, with a higher percentage of diagnoses from people originat- ing from the reporting country (40.7%) and Sub-Saharan Africa (25.4%) and lower proportions among those origi- nating from Central and Eastern Europe (10.9%), and Latin America and the Caribbean (6.8%) (Figure 1.12). In terms of the route of transmission in individuals with previous positive diagnoses, heterosexual con- tact was the primary route (44.8%), more prevalent in women (32.1%) than in men (12.7%). Similarly, among newly diagnosed individuals, heterosexual transmis- sion remained the most common route (42.6%), with a higher proportion observed in women (23.3%) than men (19.3%). Transmission through sexual contact between men remains a significant route among newly diagnosed cases (38.9%), although this is less prevalent among individuals with previous positive diagnoses (25.3%). In addition, injecting drug use and MTCT were reported at a higher proportion among those with previous positive diagnoses (6.4% and 3.2%, respectively) than in newly diagnosed individuals (1.8% and 0.6%, respectively). When analysing CD4 cell count among the newly diag- nosed, it was noted that a higher portion of individuals presented with late diagnosis (defined by CD4 counts below 350 cells/mm3) and were diagnosed with AIDS (36.7%, 13.3%, respectively) compared to those with pre- vious positive diagnoses (8.8% and 2.8%, respectively). This variance might be linked to a higher percentage of individuals with previous positive diagnoses being on antiretroviral therapy (ART), 21.6%, in comparison to the 6.9% observed among the newly diagnosed. This indi- cates a swift linkage to care upon diagnosis (see more detailed data in Annex 7). 1.3. Trends in HIV diagnoses Between 2013 to 2019, the trend in reported HIV diag- noses declined when the rate for EU/EEA countries reporting consistently fell from 6.3 to 5.3 per 100 000. In 2020 and 2021, the years affected by the COVID-19 pandemic, the rate declined further, remaining relatively stable in both years (3.8 and 3.9 per 100 000, respec- tively). In 2022, 22 995 HIV diagnoses were reported in 30 EU/EEA14 countries, corresponding to a rate of 5.1 per 100 000 population (Table  1). This represents a 30.8% increase on 2021 but is still a 3.8% decrease compared to the 2019 rate. The highest rates were reported by Cyprus (24.1; 218 cases), and Estonia (18.8; 250 cases), and the lowest by Slovenia (2.0; 42 cases) (Table  1; Map  1). As described in Section  1.2, a noteworthy con- tribution to the increase in the number of cases reported in 2022 are the previous positive cases. Adjusting the 14 All EU/EEA countries reported data for 2022. Figure 1.11: Temporal trends in HIV diagnoses reported by 14 EU/EEA countries: a comparison including and excluding previous positive cases, 2013–2022 (n = 9 057). 0 2000 4000 6000 8000 10000 2022202120202019201820172016201520142013 Including previous positive diagnoses Excluding previous positive diagnoses Nu m be r o f c as es Year of diagnosis Notes: The data for HIV cases reported in 2022 from the following EU/EEA countries have been included in this figure: Belgium, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Iceland, Ireland, Norway, Slovakia, Slovenia, and Sweden. 9HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Figure 1.12: Demographic and clinical characteristics of previous positive and new HIV diagnoses from EU/EEA countries which were able to identify the HIV status, 2022 (n = 9 057) Ge nd er Ag e gr ou p (y ea rs ) Tr an sm is si on m od e CD 4 ce ll co un t AR T Re gi on o f o rig in 0 20 40 60 80 100 Percentage Female Male Unknown < 15 years 15-19 20-24 25-29 30-39 40-49 50+ Sub-Saharan Africa Central and Eastern Europe Western Europe Latin America and Caribbean South and south-east Asia Reporting country Other Unknown Heterosexual contact (males) Heterosexual contact (females) Injecting drug use Sex between men MTCT Nosocomial Transfusion Unknown Acute <200 200 to <350 350 to <500 500+ Unknown AIDS ART Yes ART No unknown Newly HIV diagnosed Previous positive diagnoses Notes: The data for HIV cases reported in 2022 from the following EU/EEA countries have been included in this table: Ireland, Belgium, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Iceland, Norway, Slovakia, Slovenia, and Sweden. ART:Antiretroviral therapy 10 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Figure 1.14a: Age-specific trends in HIV diagnoses in women, 2013–2022 0 5 10 15 20 25 30 35 2022202120202019201820172016201520142013 Di ag no se s pe r 1 00 0 00 p op ul at io n Year of diagnosis 15-19 years 20-24 years 25-29 years 30-39 years 40-49 years ≥50 years Figure 1.14b: Age-specific trends in HIV diagnoses in men, 2013–2022 0 5 10 15 20 25 30 35 2022202120202019201820172016201520142013 Di ag no se s pe r 1 00 0 00 p op ul at io n Year of diagnosis 15-19 years 20-24 years 25-29 years 30-39 years 40-49 years ≥50 years Figure 1.13: People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2013–2022 0 1 2 3 4 5 6 7 2022202120202019201820172016201520142013 HIV HIV excluding previous positive diagnoses from 14 EU/EEA countries AIDS Deaths Ra te p er 10 0 00 0 po pu la tio n Year of diagnosis Note: Rates exclude countries not reporting consistently over the period: Germany and Sweden (AIDS and AIDS deaths); Italy and Denmark (AIDS deaths). . The HIV rate was adjusted by removing previous positive cases from the 14 EU/EEA countries with sufficient reporting on this variable to exclude these cases (see chapter 1.2 for more details). AIDS and deaths rates were not impacted by previous positive cases and these rates are not adjusted. 11 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT 0 10 20 30 40 50 60 2022202120202019201820172016201520142013 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 Figure 1.15: Percentage of diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2013–2022 Notes: Unknown route of transmission is excluded from the proportions presented here. Figure 1.16a: HIV diagnoses, by year of diagnosis and transmission mode, EU/EEA, 2013–2022 0 2000 4000 6000 8000 10000 12000 2022202120202019201820172016201520142013 Nu m be r o f c as es Year of diagnosis Sex between men Heterosexual transmission (women) Heterosexual transmission (men) Injecting drug use Mother to child transmission Notes: HIV diagnoses reported by Poland excluded due to incomplete reporting on transmission mode during some years of the previous decade. Figure 1.16b: Percentage of HIV diagnoses, by year of diagnosis and transmission mode, EU/EEA, 2013–2022 0 20 40 60 80 100 2022202120202019201820172016201520142013 Pe rc en ta ge s Year of diagnosis Sex between men Heterosexual transmission (men) Heterosexual transmission (women) Injecting drug use Mother to child transmission Notes: Cases where transmission route was unknown or other are not presented here. HIV diagnoses reported by Poland excluded due to incomplete reporting on transmission mode during some years of the previous decade. 12 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data 2013−2022 rate to diagnoses only by removing the pre- vious positive cases in the 14 countries that reported sufficiently on the variable yielded an adjusted rate of 4.3 per 100 000 for 2022 (resulting in an 18% decrease in the 2022 rate) (Figure 1.13). It was difficult to correct for reporting delays due to the influence of the COVID-19 pandemic and the inclusion of prior positive diagnoses in the analysis. Consequently, it is likely that the rates of HIV diagnoses are underesti- mated. Thus, the trends outlined in this sub-chapter are preliminary and should be interpreted with caution. Trends differ by gender and age group. Age-specific rates declined between 2013 and 2020, followed by a plateau between 2020 and 2021, and a sudden increase in 2022 in all age groups of women and men. This increase, especially among women, might be explained by the increased proportion of previous positive diagnoses reported in 2022. The increase in rates of HIV diagnosis in men is higher among the age groups 30−39 years and 40−49 years in 2022 than in other age groups when com- pared with rates from 2013. (Figure 1.14a, Figure 1.14b). HIV diagnoses among those born outside of the report- ing country comprised 30.4% of all diagnoses in 2013, increasing over time to 39.1% in 2020, then falling slightly to 37.0% in 2021 before increasing again to 48.3% in 2022. When analysing the data excluding the cases with unknown region of origin, the proportion of migrants increased from 33.9% in 2013 to 55.5% in 2022. Among individuals originating from regions outside the EU/EEA, the trends in HIV diagnoses have remained relatively stable since 2013. However, there has been a notable increase in diagnoses among people coming from countries in Central and Eastern Europe, rising from 5.5% in 2013 to 22.8% in 2022 (Figure 1.15). Since 2013, most of the EU/EEA countries have main- tained consistent reporting on transmission modes. When focusing on data from those countries that have consistently reported over the past decade (2013–2022) Figure 1.18: Number of HIV diagnoses by acute infection or CD4 cell count at diagnosis, EU/EEA, 2013–2022 0 20 40 60 80 100 2022202120202019201820172016201520142013 Pe rc en ta ge o f d ia gn os es Year of diagnosis 350 to <500 <200 200 to <350 500+ Acute infection Figure 1.17: HIV diagnoses, by year of diagnosis, transmission mode and migration status, EU/ EEA, 2013–2022 0 2000 4000 6000 8000 10000 2022202120202019201820172016201520142013 Heterosexual (born in reporting country) Heterosexual (foreign-born) Sex between men (born in reporting country) Sex between men (foreign-born) Injecting drug use (born in reporting country) Injecting drug use (foreign-born) HI V di ag no se s Year of diagnosis Notes: HIV diagnoses reported by Poland excluded due to incomplete reporting on transmission mode during some years of the previous decade. 13 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT and analysed data with known modes of transmission, the following trends become evident: • The proportion of all HIV diagnoses with known mode of transmission, attributed to sex between men decreased from 49.5% of cases in 2013 to 45.9% in 2022 (Figure  1.16a, Figure  1.16b). The number of HIV diagnoses reported among MSM in countries report- ing consistently declined from the end of 2015 until 2020, from 11 365 to 7 129, after which an increase of 53.0% was observed − the highest in the last decade. It is interesting to note that the case numbers among MSM born outside of the reporting country increased in 2022 to 3 168, compared to 2 537 in 2013, marking a 24.9% rise (Figure 1.17). • The overall number of HIV diagnoses reported among people who inject drugs decreased between 2014 and 2021, from 7.7% to 4.7% (1 747 to 684) (Figure  1.16a, Figure 1.17, Table 5). This was followed by an increase in the number of HIV diagnoses to 5.9% in 2022 (n=963). • The proportion of all HIV diagnoses with known route of transmission, attributed to heterosexually-acquired infection in women, remained stable between 2013 and 2021, ranging from 20.9% to 20.6%. In 2022, both the number and proportion increased, reaching (n=4 249) 26.1% of the HIV diagnoses reported with known information on the route of transmission. The proportion of all HIV diagnoses attributed to hetero- sexually-acquired HIV infection in men was also stable during the previous decade, ranging from 20.8% in 2013 to 20.2% in 2022 (Figure  1.16b). Heterosexual contact accounted for 44.8% of all previous positive HIV diagnoses reported in 2022 from the 14 EU/EEA countries which reported consistently. • In countries with consistent reporting throughout the previous decade, the proportion of HIV diagno- ses reported to be due to MTCT of HIV was stable at around 0.8% between 2013 and 2021, although the number declined from 188 in 2013 to 119 in 2021. The proportion increased to 1.5% (n=252) in 2022 (Figure  1.16a). In 2022, among the total number of diagnoses reported to be due to MTCT of HIV, 80.9% (114/141) were previous positive diagnoses. When analysing the trend in the proportion of late diag- noses over time, we observed a gradual decline among individuals with available CD4 count data, decreasing from 51.4% in 2013 to 48.9% in 2022. The highest pro- portion of late diagnosis was found in 2021 (54.9%). (Figure 1.18). 1.4. AIDS cases, morbidity and mortality Although there have been improvements in the early diagnosis of HIV, 2 349 diagnoses of AIDS were reported by 26 EU/EEA countries15 in 2022 – a crude rate of 0.6 cases per 100 000 population (Table  13, Map  8). The highest rate was reported by Cyprus (3.8 per 100 000 population; 34 cases) followed by Latvia (3.1 per 100 000; 58 cases). The rate of reported AIDS cases has halved over the past decade (excluding Germany, Liechtenstein and Sweden who did not report consistently over the period) to 0.6 per 100 000, a significant reduction from the 1.2 per 100 000 reported in 2013 (Table  13; Figure  1.19). This decline is noted in both men and women; how- ever, it is more pronounced in men. Among men, the rate decreased from 1.8 per 100 000 population in 2013 to 1.0 per 100 000 population in 2022, while among women, the decline was from 0.6 per 100 000 popula- tion in 2013 to 0.3 per 100 000 in 2022 (Tables  14–15). When considering different transmission routes, the decrease is observed across all cases with known route of transmission, and higher among men infected through 15 This includes all EU/EEA countries except Germany, Liechtenstein, and Sweden. Figure 1.19: AIDS diagnoses, by transmission mode, EU/EEA, 2013–2022 0 200 400 600 800 1000 2022202120202019201820172016201520142013 Sex between men Heterosexual transmission (females) Heterosexual transmission (males) Injecting drug use Other/undetermined AI DS d ia gn os es Year of diagnosis Notes: Data from Germany, Italy, Liechtenstein, and Sweden are excluded due to inconsistent reporting during the previous decade. HIV diagnoses reported by Poland excluded due to incomplete reporting on transmission mode during some years of the previous decade. 14 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data heterosexual contact (Figure  1.18). There represents an increase in AIDS diagnoses among those with other or undetermined route of transmission. The most common AIDS-indicative diseases diagnosed in 2022 in the EU/EEA were Pneumocystis pneumo- nia (21.2% of all AIDS-indicative diseases), wasting syndrome due to HIV (13.9%) and oesophageal can- didiasis (10.7%) (Table  16). Combined pulmonary and/ or extrapulmonary tuberculosis (TB) made up 12.1% of AIDS-indicative diseases. Twenty-six EU/EEA countries (all but Germany, Italy, Liechtenstein, and Sweden) reported data on deaths of those diagnosed with AIDS. Overall, 767 people were reported to have died due to AIDS-related causes dur- ing 2022 (Table  17), although these data are affected by under-reporting due to the challenges for many countries in linking to death registries. AIDS-related death reports have declined by 44.1% since 2013, when there were 1 373 deaths (excluding data from Germany and Italy, which have not reported consistently over time). However, delays in reporting affect the latest figures and under-reporting affected the reporting of AIDS deaths throughout the previous decade. From the beginning of the HIV epidemic to the end of 2022, the cumulative total of people diagnosed with AIDS in the EU/EEA was 346 712 (Table  13). The cumulative total of cases reported as known to have died from AIDS-related causes by the end of 2022 was 183 383 (Table 17). 1.5. HIV testing Ten countries (Belgium, Czechia, Denmark, Estonia, Greece, Latvia, Lithuania, Poland, Portugal and Slovenia) consistently reported data on HIV tests performed during the period 2013−2022, excluding unlinked anonymous testing and testing of blood dona- tions. The number of tests performed in the countries consistently reporting testing activity has increased by 16.3% against 2021 and 11.8% against 2019 (Table 18). It is important to note that numbers provided are collected in a heterogeneous manner and therefore comparisons between country testing rates should be undertaken with caution. However, these data can indicate large changes in overall testing policy or be used to support the interpretation of HIV cases notified. 1.6. Conclusions Surveillance data for the year 2022 indicate a notable increase in reported HIV diagnoses in the EU/EEA, with a rate of 5.1 per 100 000 population, a 30.8% increase on the 2021 rate, but a slight decrease of 3.8% compared to the 2019 rate. It is crucial to emphasise that 16.6% of the diagnoses reported for 2022 were categorised as ‘previous positive’. This category includes individuals who have previously received an HIV diagnosis, either in another country or within a different setting in the reporting country before the current reporting year. Previous positive diagnoses are counted when individu- als enter, re-enter, or re-engage with the healthcare system within the reporting country and, although data on these cases do not provide an indication of recent HIV infection trends, they do provide important information for healthcare and resource planning. Previous positive cases reported in 2022 are probably underestimated due to a low completeness rate for the variable that identifies HIV status as a previous positive or a first- time diagnosis within EU/EEA countries. However, the increase in HIV cases in 2022 can be attributed to a range of other factors in addition to the reporting of previous positive diagnoses. The lifting of COVID-19 restrictions and ongoing conflicts close to Europe’s borders, including the movement of people from Ukraine, have significantly increased the influx of individuals arriving in EU/EEA countries and movement between EU/EEA countries. In addition, the post-pan- demic period expanded delivery of HIV testing services in some settings, as well as the implementation of new testing strategies to identify those previously undiag- nosed. This may also have contributed to the increase in HIV diagnoses during this period. The increase in HIV previous positive diagnosis has had a considerable impact on the epidemiological pro- file and the trends among those reported in 2022 when counted together with the newly diagnosed cases. However, in order to understand the epidemiology of HIV in EU/EEA countries, it is important to distinguish between people who were previously diagnosed and those who are newly diagnosed, as both populations have a distinct epidemiological profile. Previous posi- tive diagnoses include a higher proportion of women, in older age groups, originating mainly from Central and Eastern Europe, who were primarily infected through heterosexual contact and were on ART, resulting in a lower proportion of late diagnoses. Newly-diagnosed HIV cases are predominantly younger men, with a higher proportion of diagnosis in the acute and early stages of the infection among MSM, and a higher representation of late diagnosis among those infected through hetero- sexual contact. The rates of AIDS and AIDS-related deaths in the EU/ EEA have decreased significantly over the past decade. In 2022, the reported AIDS cases maintained the same rate as in 2021, remaining at 0.6 per 100 000 population. However, when compared to the rate in 2019, this rate reflected a significant reduction of 14%. With regard to AIDS-related deaths, there was a 2.0% decrease against the numbers for 2021, but a more significant decrease of 44.5% compared to 2019. This decline is probably a result of improved access to treatment and enhanced case management. It is important to note that many indi- viduals with previous positive diagnoses were already on ART in their respective countries or regions prior to coming to the EU/EEA countries. Consequently, the increase in the number of these diagnoses in 2022 does not result in an impact on either the AIDS or AIDS-related death rates within the EU/EEA region for this year. Heterosexual contact emerged as the main mode of HIV transmission in 2022. This transmission mode also 15 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT constituted a significant proportion of previous positive diagnoses, particularly among women. The upsurge in HIV diagnoses, especially the previous positive cases, is largely attributed to refugees arriving from Ukraine following the onset of regional conflict. The influx of patients, particularly from Ukraine, has introduced new challenges to HIV care, as this population may have different needs in terms of mental health and social sup- port, requiring special considerations for transitioning to new ART regimens (as many were on treatment regi- mens that are not available in EU/EEA countries) [1]. In addition, individuals who are aware of their HIV-positive status may be hesitant to seek treatment due to chal- lenges in accessing the healthcare system or concerns related to stigma and discrimination [2]. A decline in HIV diagnoses among MSM has been evi- dent across most EU/EEA countries since 2014. However, there has been a slight increase in HIV diagnoses within this population in 2022, particularly among migrants coming from Latin America and the Caribbean, and Central and Eastern Europe. Therefore, it is impor- tant to reinforce and tailor successful prevention and testing programmes targeting this population. These programmes should focus on promoting the uptake of regular, easy-to-access HIV testing, accompanied by immediate linkage to care and treatment for those found positive. They should also provide condoms, peer sup- port and access to PrEP for high-risk HIV-negative men as part of comprehensive sexual health services. This approach has proven to result in higher rates of viral suppression and a subsequent decline in HIV transmis- sion [3, 4]. In addition, expanding and adapting the use of PrEP is crucial for reducing HIV transmission within this population, emphasising the need to extend the strategy to those who would benefit [4–6]. It is noted that in many of the countries with increasing trends in HIV among MSM, PrEP programmes are only being implemented on a very small scale, or not at all [5]. Migrants (or people originating from outside of the reporting country) constituted a considerable propor- tion (48.3%) of HIV diagnoses in the EU/EEA in 2022. While the proportion of migrants from most regions has remained relatively stable since 2013, diagnoses among people originating from countries in Central and Eastern Europe increased from 37.0% in 2021 to 48.3% in 2022. As described above, this includes a high pro- portion of previous positive diagnoses. It is important to highlight that the HIV diagnoses reported not only include previous positive individuals from Central and Eastern Europe, but also those who were newly diag- nosed upon their arrival in the EU/EEA, having been undiagnosed prior to migration. Therefore, Central and Eastern Europe strategies to increase access to testing and linkage to care need to be designed, implemented and scaled-up in hosting countries. It is important to recognise the emerging evidence that a significant pro- portion of migrants, even those originating from areas with high HIV endemicity, acquire HIV after arrival in the EU/EEA [7–9]. This indicates the need for specific and non-stigmatising HIV prevention campaigns for migrants from the moment of their arrival, including the offer of HIV testing to migrants who have recently arrived in the EU/EEA [10]. Transmission of HIV among people who inject drugs continues to remain at a low level across most EU/EEA countries, with a minor uptick in the number of HIV diagnoses noted in 2022. This increase is significantly smaller than the increases observed in other modes of transmission, thanks to the presence of well-estab- lished and effective harm-reduction programmes in most EU/EEA countries. It is worth considering that this slight increase could potentially be attributed to the reporting of previous positive diagnoses, as 24.4% of all individuals infected through drug injection fall into this category. This slight increase was observed in most EU/EEA countries; Austria, Cyprus, Greece, Portugal and Romania have experienced a decline of more than 30% in 2022. Moreover, when considering the entire EU/EEA region, there was a 6% reduction compared to the num- bers reported in 2019. This reinforces the importance of maintaining adequate scale and coverage of harm-reduc- tion services and recognising that trends can change quickly for this group in the absence of effective preven- tion delivered at scale [11, 12]. Furthermore, enhancing access to testing for other blood-transmitted infections, such as HCV and HBV, which are prevalent among this population, serves as an indispensable and integrated preventive strategy towards achieving the Sustainable Development Goal (SDG) among this key population by 2030 [13]. This is the first time that data on HIV diagnoses in transgender individuals is described for the EU/EEA, largely because France, the Netherlands and Ireland have made strides in collecting and reporting data related to this population. It is interesting to note that most HIV diagnoses in transgender individuals were in young people, with a median age of 33.3 years and predominantly originating from Latin America and the Caribbean (70.3%). However, it is still challenging to draw robust conclusions for HIV prevention and control from the limited data currently available on transgender individuals. This limitation arises from the fact that most EU/EEA countries either do not collect specific infor- mation on this population or, in some cases, classify transgender identity as ‘unknown’ gender. Collecting more comprehensive information is imperative to better delineate the epidemiological profile of this population, allowing for the design and tailoring of more effective prevention strategies. It is estimated that about 766 049 people are living with HIV in the EU/EEA, of which around 684 551 (89%) are diagnosed [13]. While a comparison of modelled data on HIV infections with the number of people diagnosed with HIV appears to indicate that, over time, fewer people are living with undiagnosed HIV in the EU/EEA, around one in nine people living with HIV in the EU/EEA are still unaware of their status [14]. Modelled estimates also indicate that it takes an average of 2.9 years from HIV infection to diagnosis in the EU/EEA, varying by 16 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data geographical area from 2.2 to 3.6 years [15]. In addition to the clinical and personal benefits for the person diag- nosed, early diagnosis and effective ART can also help sexual and injecting partners by inhibiting onward HIV transmission [16]. Almost half of those newly diagnosed (49.7%) have a CD4 cell count below 350 cells per mm3, including 28.8% of cases with advanced HIV infection (CD4 below 200 cells/mm3). These data indicate that people would have been infected many years previously, suggesting prob- lems with access to, and uptake of HIV testing for some segments of the population, and indicating the need to improve testing programmes to diagnose people living with HIV at an earlier stage. 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 noti- fication. The development of European Standards of HIV Care and European guidance on setting-based approaches for HIV and viral hepatitis testing, includ- ing best practices for effective implementation, can promote more uniform and improved care quality across the region and can help countries seeking to implement more effective testing programmes [17, 18]. Testing not only provides 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 preven- tion, including PrEP. Despite clear evidence of the benefits for the health of HIV-positive people of introducing ART early [19] 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, at an advanced stage of illness. Overall, more than 95% of AIDS diagno- ses 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. Stigma towards people living with HIV and members of key population groups disproportionately affected by HIV is a documented contributing factor to delayed HIV test- seeking [20]. Stigma reduction efforts within healthcare and community settings could increase care seeking and reduce late diagnosis. Once tested, rapid linkage to high-quality care (includ- ing ART) is essential. In recent years, around 98% of those diagnosed who had evidence of linkage to care were linked to care within three months of HIV diagno- sis [21]. 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 sup- pression [22]. The changing epidemiology of HIV infections observed in the EU/EEA over the last year indicates that it is crucial to sustain, and in some places strengthen, evi- dence-based HIV prevention interventions tailored to the local epidemiological context and targeting those most at risk. ECDC will continue to support EU/EEA countries in their efforts to accelerate progress towards reaching the SDG for HIV through dedicated workshops, webinars, guidance and other technical support focused on high-impact surveillance, monitoring and prevention activities. Programmes for the prevention and control of HIV infec- tion adapted to key populations and maintained to scale remain important in EU/EEA countries. For most EU/ EEA countries, this means a strong focus on women and MSM. Migrants, both those from countries in Central and Eastern Europe, Sub-Saharan Africa and others, are also a key vulnerable population who need specific preven- tion and control efforts in most EU/EEA countries. Given the increasing evidence of post-migration HIV acqui- sition, 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, particu- larly when patterns of drug use change. It is essential to emphasise that one of the limitations encountered during the analysis of HIV data from 2022 pertains to the observed data incompleteness. Recent years have seen a worrying trend in reduced data com- pleteness for the variable HIV transmission route, with more than one quarter (27.3%) of cases reported in 2022 lacking this important information. Information on prob- able 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. The absence of standardisation and consistent collection of the HIV status variable, which distinguishes between first-time diagnoses and previ- ous positive diagnoses, has also presented challenges in interpreting the data from 2022. Achieving a consen- sus among EU/EEA countries regarding the collection, inclusion in surveillance systems, and analysis of pre- vious positive cases is crucial. This is of the utmost importance, considering the distinct epidemiological profile and special healthcare needs of people who were previously diagnosed, compared to those individuals newly diagnosed with HIV. Enhancing the standards of data collection within surveillance systems will not only yield more accurate and actionable data, but also serve as a powerful strategic resource for tailoring prevention strategies to reach those in need. 17 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT References 1. Massmann R, Groh T, Jilich D, Bartková D, Bartovská Z, Chmelař J, et al. HIV-positive Ukrainian refugees in the Czech Republic. AIDS. 2023 Oct 1;37(12):1811-1818. doi: 10.1097/ QAD.0000000000003633. 2. European Centre for Disease Prevention and Control (ECDC). Stigma: survey of people living with HIV. Monitoring implementa- tion of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2022 progress report. Stockholm: ECDC; 2023. Available from: https://www.ecdc.europa.eu/en/ publications-data/hiv-stigma-survey 3. 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). doi:10.2807/1560-7917. 4. Nwokolo N, Whitlock G, MacOwan A. Not just PrEP: other reasons for London’s HIV decline. Lancet HIV 2017;4(4):e153. doi :10.1016/ S2352-3018(17)30044-9. 5. 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). doi.org/10.2807/1560-7917. 6. European Centre for Disease Prevention and Control (ECDC). Monitoring HIV pre-exposure prophylaxis pro- grammes in the EU/EEA. Stockholm: ECDC; 2022. 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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. Available at: https://www.eurosurveil- lance.org/content/10.2807/ese.16.36.19962-en 17. World Health Organization (WHO). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: WHO; 2017. Available from: https://apps.who.int/ iris/handle/10665/208825 18. European Centre for Disease Prevention and Control (ECDC). Public health guidance on HIV, hepatitis B and C test- ing in the EU/EEA. Stockholm: ECDC; 2018. Available from: www.ecdc.europa.eu/en/publications-data/ public-health-guidance-hiv-hepatitis-b-and-c-testing-eueea 19. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016:373(9):795– 807. 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19 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT 2.1. HIV and AIDS diagnoses in the WHO European Region 2.1.1. HIV diagnoses In 2022, 110 486 people in the WHO European Region were diagnosed with HIV, corresponding to a rate of 12.4 per 100 000 population (see Table A, Table 1). This num- ber includes HIV diagnoses reported by 49 countries16 to the joint ECDC and WHO Regional Office for Europe surveillance system. It brings the cumulative number of reported HIV diagnoses in the Region since reporting began in the 1980s to 2 454 878. As in previous years, most (72%) of the 110 486 people diagnosed with HIV in 2022 were from the East of the Region (79 144), 20% were from the West (22 397) and 8% from the Centre (8 945). The rate was also highest in the East (30.7 per 100 000 population); more than six times higher than in the West (5.1 per 100 000) and almost seven times higher than in the Centre (4.5 per 100 000) (see Table A, Table 1). For men, the average rate across the Region was 16.4 per 100 000 population (Table 2) and for women 8.5 per 100 000 population (Table 3). Rates of HIV diagnoses varied widely across countries in the WHO European Region in 2022. The highest rates per 100 000 population (more than 15.0) were observed in the Russian Federation (38.4) followed by Ukraine (29.8), the Republic of Moldova (28.4), Cyprus (24.1), Kazakhstan (20.7), Armenia (19.2), Estonia (18.8), Ireland (17.5) Belarus (17.2), Georgia (16.5) and Kyrgyzstan (16.5). The lowest rates (2.0 and under) were reported by Slovenia (2.0), North Macedonia (2.0), and Bosnia and Herzegovina (1.7). The largest proportion of people diagnosed in the 49 reporting countries was in the age group 30–39 years (36%), while 6% were young people aged 15–24 years, and 17% were 50 years or above at diagnosis (see Table A, Table 9, Figure 2.1). The male-to-female ratio was 1.8, lowest in the East (1.6), higher in the West (2.4), and highest in the Centre (2.9). The highest male-to-female ratios (more than 10.0) at the country level among countries with more than 10 cases were observed in Bosnia and Herzegovina (12.5), Serbia (12.2), and Malta (11.0), and the lowest in Czechia (1.0), Estonia (1.1), Norway (1.3), Republic of Moldova (1.4) and Denmark (1.4). Data on transmission mode, which was available for 48 countries17 (see Table A, Tables 4–8, Figure 2.2) provide 16 No data were received from Andorra, Monaco, 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. 17 Data on transmission mode was not reported by Switzerland in 2022. information on risk exposure among people diagnosed with HIV. The data for 2022 indicate the following: WHO European Region • Heterosexual contact was still the main reported mode of HIV transmission in the WHO European Region, accounting for more than half (61%) of people diagnosed in 2022 (67 588) and 69% of HIV diagnoses in 2022 with a known mode of transmission (Table 6). Among those, 8% originated from countries with gen- eralised epidemics (data not shown). • Injecting drug use was the second most common transmission mode, accounting for 16% of HIV diagno- ses (17 753) and 18% of HIV diagnoses with a known mode of transmission (Table 5). • Sex between men accounted for 11% of diagnoses overall (12 481) and 13% of HIV diagnoses with a known mode of transmission (Table 4). • Less than one percent (0.56%, 615) of cases were infected through MTCT (0.62% of those with a known mode of transmission) (Table 7) and 0.1% (86) through other transmission routes (nosocomial infection, transfusion, or use of other blood products) (Table 8). • Transmission mode was reported as unknown or missing for 11% (11 948 cases) (Table  8). Reporting completeness regarding transmission mode varies greatly across the Region, with information lacking for 2% of HIV diagnoses in the East, 53% in the Centre, and 24% in the West. East • In total, 72% of those diagnosed in 2022 and 74% of diagnoses with a known mode of transmission were infected heterosexually (57 272), making this the main route of transmission reported in all countries in the East (Table 6). • Overall, 21% of those diagnosed in 2022 and 22% of HIV diagnoses with a known route of transmission were infected through injecting drug use (16 724) (Table  5), with transmission through injecting drug use accounting for 30% or more of diagnoses with a known transmission mode in Ukraine (31%). • In total, 4% were infected through sex between men (2 921) (Table  4), however Armenia, Azerbaijan, Georgia, and Lithuania reported that sex between men accounted for 10% or more of HIV diagnoses with a known transmission mode. • The percentage of cases diagnosed as infected through MTCT was 0.4% (297) (Table 7), and only one case was infected through other transmission routes (nosocomial infection, transfusion, or use of other blood products). 2. HIV and AIDS in the WHO European Region 20 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Figure 2.1: Percentage of HIV diagnoses, by country and age group, WHO European Region, 2022 (n=110 402) Romania Türkiye Serbia Iceland Malta Cyprus Serbia Greece Portugal Azerbaijan Centre Belgium Spain France Albania Kyrgyzstan Tajikistan Montenegro Netherlands Hungary West United Kingdom Denmark Poland Bosnia and Herzegovina North Macedonia Slovenia Georgia Slovakia Germany Luxembourg Ireland Sweden Bulgaria Kazakhstan Finland Austria Moldova Italy Croatia Israel Czechia Armenia WHO European Region Estonia Norway East Switzerland Belarus Russian Federation Ukraine Latvia 15-19 years <15 years 20-24 years 25-29 years 30-39 years 40-49 years ≥50 years Percentage 0 20 40 60 80 100 Note: Graph organises countries in order of proportion of population <30 years. Liechtenstein and San Marino reported one case for 2022 and are not included in the graph. Unknown age is excluded from the proportions presented here. 21 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Figure 2.2: Percentage of HIV diagnoses with known mode of transmission, by transmission route and country, WHO European Region 2022 Percentage 0 20 40 60 80 100 Heterosexual contact Sex between men Injecting drug use Mother-to-child transmission Other Moldova Kyrgyzstan Tajikistan Armenia Estonia Azerbaijan Belarus Russian Federation East Kazakhstan WHO European Region Georgia Latvia Lithuania Ukraine Türkiye Czechia Norway Bulgaria Cyprus United Kingdom Albania Sweden Denmark Centre Romania France Israel Portugal Belgium Slovakia Luxembourg Italy West Finland Germany Poland Ireland Iceland Netherlands Austria North Macedonia Spain Slovenia Malta Greece Hungary Croatia Serbia Montenegro Bosnia and Herzegovina Note: No data from Andora, Monaco, Turkmenistan, Uzbekistan. Unknown route of transmission is excluded from the proportions presented here. 22 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data • Transmission mode was reported as unknown or missing for only 2% of those diagnosed across the 13 countries in the East of the Region (1 929). Nevertheless, at the country level, transmission-mode information was lacking for 15% or more of cases in three countries: Estonia (52%), Latvia (38%), and the Republic of Moldova (23%). Centre • In total, 19% of those diagnosed with HIV in 2022 and 40% of HIV diagnoses with a known route of trans- mission were infected through sex between men (1 674) (Table  4). In 2022, sex between men was the predominant mode of transmission reported by eight countries (Bosnia and Herzegovina, Croatia, Hungary, Montenegro, North Macedonia, Serbia, Slovenia and Poland) (Figure 2.2). • Overall, 25% of those diagnosed in 2022 and 54% of diagnoses with a known route of transmission were infected through heterosexual transmission (2 272) (Table  6), which was the main mode of transmis- sion reported by seven countries (Albania, Bulgaria, Cyprus, Czechia, Romania, Slovakia and Türkiye) (Figure  2.2). Of these, 20% were previously diag- nosed, 41% were born abroad and 3% originated from countries with generalised epidemics (Table 11). • A total of 2% of those diagnosed and 4% of HIV diagnoses with a known route of transmission were infected through injecting drug use (189) (Table 5). • Of those with a known route of transmission, 2% were infected through MTCT (75) (Table 7). • Transmission mode was unknown for 53% of those diagnosed in 2022 (4 724) (Table 8). The two countries with the highest number of HIV diagnoses in 2022 (Türkiye and Poland) together accounted for 66% of all HIV diagnoses reported in the Centre and also had the highest percentage of HIV diagnoses with an unknown transmission mode (Poland 79% and Türkiye 67%). West • In total, 35% of all people diagnosed in 2022 and 46% of those with a known mode of transmission were infected through sex between men (7 886) (Table 4). • Overall, 36% of all people diagnosed in 2022 and 47% of those with a known mode of transmission were infected heterosexually (8 044) (Table  6). Of these, 17% were previously diagnosed, 70% were born abroad, and 27% originated from countries with gen- eralised epidemics (Table 11). • Of all those diagnosed in 2022, 4% were infected through injecting drug use (840) (Table 5); • MTCT accounted for 1.1% of all diagnoses and 1.4% of those with a known route of transmission (243 cases) (Table  7). Of these, 17% were previously diagnosed, 92% were born abroad, and 31% originated from coun- tries with a generalised epidemic (Table 11). • Transmission mode was unknown for 24% of all diag- noses in 2022 (5 295). Analysis of the HIV diagnoses by age group and trans- mission mode for the 49 reporting countries in the WHO European Region (Figure  2.3) shows that 30–39-year- olds accounted for most HIV diagnoses among those infected through injecting drug use (41%), reported heterosexual transmission (36%) and sex between men (33%). Conversely, people aged over 50 years accounted for 19% of all heterosexual transmission, but only 13% and 9% of injecting drug use and sex between men, respectively (Figure 2.3). Forty-six countries provided information on the country of birth, country of nationality, or region of origin for 50 696 (92.3%) HIV diagnoses in 2022 (Table 10). In the WHO European Region, 14 602 HIV diagnoses (26.7% of the total HIV diagnoses and 28.8% of those with known information on region of origin) were reported among people originating from outside the reporting country. Figure 2.3: HIV diagnoses, by age group and transmission mode, WHO european Region, 2022 (n = 97 650) 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=17 752 n=67 332 n=12 566 Percentage Tr an sm is si on m od e No data from Andora, Monaco, Turkmenistan and Uzbekistan. 23 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Figure 2.4: HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2022 0 20 40 60 80 100 WHO European Region East Center West <200 cells/mm3 200 to <350 cells/mm3 350 to <500 cells/mm3 ≥500 cells/mm3 n=423 n=63 n=2 927 n=3 413 Percentage In je ct in g dr ug u se 0 20 40 60 80 100 WHO European Region East Center West <200 cells/mm3 200 to <350 cells/mm3 350 to <500 cells/mm3 ≥500 cells/mm3 n=5 419 n=850 n=9 559 n=15 828 Percentage He te ro se xu al tr an sm is si on 0 20 40 60 80 100 WHO European Region East Center West <200 cells/mm3 200 to <350 cells/mm3 350 to <500 cells/mm3 ≥500 cells/mm3 n=5 174 n=867 n=616 n=6 657 Percentage Se x be tw ee n m en No data from No data from Andora, Hungary, malta, Monaco, Poland, San marino, Turkmenistan, Uzbekistan. Data from the Russian Federation excluded due to incomplete reporting on transmission mode. 24 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data This is slightly more than a 50% increase compared to 2021. The same year-on-year increase in diagnoses among people of foreign origin was observed in all sub- regions; it increased from 50.0% to 60.3% in the West, from 15.8% to 29.9% in the Center, and from 0.8% to 2.2% in the East. While there was a substantial increase in the diagno- ses originating from three regions: Central and Eastern Europe, Sub-Saharan Africa, and Latin America, and the Caribbean, the share of diagnoses among those origi- nating from Central and Eastern Europe almost doubled in 2022 compared to 2021 (37.6% in 2022 versus 20.9% in 2021). Of 5 491 HIV diagnoses in 2022 originating from this sub-region, 4 562 (83.0%) were diagnosed in the EU/ EEA countries, and of them, 34.5% (1 575) were reported as having previous positive diagnoses. Section  1.2 describes the characteristics of the previous positive diagnoses from the EU/EEA countries in more detail. Forty-four countries provided information on CD4 cell count at the time of HIV diagnosis in 202218. Information was reported for 36 643 people over 14 years of age at diagnosis (covering 71% of all HIV diagnoses in the reporting countries) (Table  12). More than half (51%) of all individuals diagnosed in 2022, where a CD4 cell count at diagnosis was reported, were considered to have been diagnosed late, with a count of below 350 CD4 cells per mm3, including 30% of cases considered to have advanced HIV infection (CD4 cell count below 200 cells/mm3), which is comparable to the results from previous years, albeit with a slight decrease. However, the regional average excludes data from the Russian Federation, where a CD4 cell count at diagnosis was reported among 95% of HIV diagnoses, and only 30.8% are detected once their CD4 cell counts have fallen below 350 cells/mm3 and 15.1% below 200 cells/mm3. The per- centage of those who were diagnosed late (CD4 cell count of below 350/mm3) varied across the countries. Those countries with the highest percentages of late diagnoses (60% or more, in countries with more than five cases) were Bosnia and Herzegovina (74%), Albania (73%), Estonia (67%), Montenegro (64%) Denmark (63%), Romania (63%), North Macedonia (62%) and Latvia (62). Those with the lowest percentages (40% or less) were Cyprus (22%), Czechia (25%), Iceland (30%), Finland (31%) Belgium (31%), Norway (33%), Azerbaijan (35%), Sweden (36%), Slovakia (37%), the United Kingdom (37%) and Lithuania (38%). The percentage of late diagnoses also varied across transmission categories and was highest for people with reported heterosexual transmission (55%; 61% for men and 54% for women) and as a result of injecting drug use (47%), and lowest for men infected through sex with men (41%) (see Figure  B, Figure  2.4; Table  12). Late diagno- sis was more common in the East (55%) than the Centre (45%) and West (46%). In the Centre, the high proportion 18 Data on CD4 cell count reported from the Russian Federation did not include disaggregation by mode of transmission and were excluded from the sub-regional and regional analysis of late diagnoses is mostly driven by the high proportion among people infected through injecting drug use. The percentage of people diagnosed with less than 350 CD4 cells per mm3 increased with age, ranging from 36% among both people aged 15–19 years and those aged 20–24 years at diagnosis, respectively, to 67% among people aged 50 years or above. Overall, the percent- age of late diagnoses by gender was similar (53% for both men and women), but this is confounded by trans- mission mode and, for men, it conceals the difference between MSM (who tend to be diagnosed earlier) and men with reported heterosexual transmission (who tend to be diagnosed later) (see Figure B). 2.1.2. Trends in HIV diagnoses The rate of HIV diagnoses in the WHO European Region was mostly stable during the period 2013–2019, with minor fluctuations between 16 and 18 per 100 000 popu- lation, however it fell sharply in 2020 and 2021, to 12.0 and 11.9 per 100 000, respectively (Figure  2.5), and then increased slightly in 2022 to 12.4 per 100 000. The decline observed in 2020 and 2021 compared to previous years is probably due, in part, to decreased case detec- tion as a result of the public health and social measures introduced by countries in response to the COVID-19 pandemic. Meanwhile, the increase in 2022 could have been due to a rebound in HIV testing and case detection after the pandemic subsided, and the increased move- ment of people within and from outside of Europe. For this reason, while we still compare 2022 data to the previous years, trends presented in this chapter are pre- liminary and should be interpreted with caution. The number of diagnosed women decreased by 26% in the WHO European Region, from 52 788 in 2013 to 39 070 in 2022, and the number of diagnosed men decreased by 21%, from 90 208 to 71 118 (Tables 2 and 3). The over- all trend largely reflects the situation in the Russian Federation where diagnoses have decreased since 2019 by 31%. The other countries have seen significant varia- tions, particularly in 2022, when several countries had dramatic increases in the number of diagnosed cases originating from Central and Eastern Europe, including previous positive cases. For example, the number of women diagnosed in Czechia was more than ten times higher in 2022 than in 2013 and over twice as high as in 2021. Similar large increases between 2013 and 2022 were observed in Poland, Slovakia, Cyprus, Iceland, and Ireland in both males and females. Conversely, a large (over 50%) decrease among males was observed in Italy, Luxemburg, Netherlands, and Portugal. Among females, the largest decrease between 2013 and 2022 was observed in Italy, the Netherlands, Portugal, and Romania. Forty countries consistently reported data on transmis- sion mode for the period 2013–2022 (Figure 2.6−2.9). Data on transmission mode from the countries with con- sistent data indicate the following (Figures 2.6−2.9). 25 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT WHO European Region • The proportion of all HIV diagnoses attributed to het- erosexual contact increased from 48% of cases in 2013 to 53% in 2022. The number of HIV diagnoses attributed to heterosexual contact in countries report- ing consistently showed an increasing trend between 2011 and 2019, followed by a sharp decline (23%) in 2020 and an increase (15%) in 2022 compared to 2020. • The proportion of all HIV diagnoses attributed to sex between men decreased from 26% to 20% over the same period. Overall, the number of HIV diagnoses reported among MSM in countries reporting con- sistently declined between 2015 and 2020, but has increased slightly since 2021. • While the number of diagnoses in people infected through injecting drug use has shown a stable decline since 2012, it increased by 15% in 2020 compared to 2019, with a reversal and an 11% decrease in 2021. The decreasing trend continued in 2022. Overall, the proportion of all HIV diagnoses attributed to inject- ing drug use remained stable at 17% in both 2013 and 2022. • The number of HIV diagnoses in children infected through MTCT decreased by 17% over the previous decade, from 536 in 2013 to 445 in 2022, representing 0.9% of all diagnoses in both 2013 and 2022. • Of the diagnoses in people infected by other means, nosocomial infections increased from 25 cases in 2013 to 28 in 2022, while HIV diagnoses attributed to trans- fusion of blood and its products decreased from 82 cases in 2013 to 72 cases in 2022. • The number of HIV diagnoses for which informa- tion on transmission mode was unknown or missing increased by 34%, from 4 459 in 2013 to 5 983 in 2022 – representing 8% of all HIV diagnoses in 2013 and 13% in 2022. Figure 2.5: HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region, 2013–2022 0 10 20 30 40 50 2022202120202019201820172016201520142013 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, Monaco, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Figure 2.6: HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2013–2022 0 5000 10000 15000 20000 25000 30000 2022202120202019201820172016201520142013 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Note: data from Andorra, Estonia, Iceland, Israel, Malta, Monaco, Poland,Russian Federation, San Marino, Switzerland, Turkiye, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period 26 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Figure 2.7: HIV diagnoses, by transmission mode and year of diagnosis, East, 2013–2022 0 5000 10000 15000 20000 2022202120202019201820172016201520142013 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Note: data from Estonia, Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Figure 2.8: HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2013–2022 0 500 1000 1500 2022202120202019201820172016201520142013 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Note: data from Poland and Türkiye excluded due to inconsisstent reporting during the period. Figure 2.9: HIV diagnoses, by transmission mode and year of diagnosis, West, 2013–2022 0 5000 10000 15000 2022202120202019201820172016201520142013 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Note: data from Andorra, Monaco, Israel, San Marino, and Switzerland excluded due to incomplete/inconsistent reporting during the period. 27 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT East • The number of HIV diagnoses in people with reported heterosexual transmission increased slightly (1%), from 15 972 in 2013 to 16 055 in 2022. At the same time, the percentage of all HIV diagnoses attributed to heterosexual contact increased from 48% of cases in 2013 to 53% in 2022. • The number of diagnoses in people infected through injecting drug use decreased by 32%, from 7 746 in 2013 to 5 303 in 2022. The percentage of all HIV diag- noses attributed to injecting drug use decreased from 31% in 2013 to 23% in 2022. • The number of diagnoses in people infected through sex between men increased more than two-fold, from 509 in 2013 to 1 128 in 2022. Yet despite this increase, the percentage of all HIV diagnoses attributed to sex between men has remained low, at 2% in 2013 and 5% in 2022. • The number of children infected through MTCT decreased by 39%, from 265 in 2013 to 161 in 2022, representing 1.0% of HIV diagnoses in 2013 and 0.7% in 2022. • The number of HIV diagnoses for which the mode of transmission was unknown decreased by 18%, from 823 in 2012 to 673 in 2022, although the percentage of HIV diagnoses with unknown mode of transmission remained low and stable overall at 3% between 2013 and 2022. Centre • The number of diagnoses in those infected as a result of sex between men increased from 744 to 924. However, the percentage of HIV diagnoses attributed to sex between men decreased slightly, from 34% in 2013 to 32% in 2022. • Following the general decline in reported HIV cases in 2020, the number of HIV diagnoses in those infected through heterosexual transmission increased sharply in 2022, resulting in a 76% increase between 2013 and 2022 (from 715 to 1 258). The percentage of HIV diagnoses attributed to heterosexual transmission was 33% in 2013 and 44% in 2022. The proportion of people infected through heterosexual transmis- sion originating outside the reporting country has increased dramatically in recent years, from 13% in 2021 to 40% in 2022. The share of previously diag- nosed individuals has also increased − from 3% in 2021 to 20% in 2022. • The number of HIV diagnoses in those infected as a result of injecting drug use was 403 in 2013 and 139 in 2022. The percentage of HIV diagnoses attributed to injecting drug use was 19% in 2013 and 5% in 2022. It is interesting to note that in 2021, the proportion of people infected through injection drug use originating outside the reporting country was 14%, while in 2022, this proportion was 48%. • The number of HIV diagnoses as a result of MTCT decreased consistently between 2013 and 2020, before increased rapidly in the last two years, from 14 cases in 2020 to 46 in 2022. • Among countries with consistent reporting, the number of HIV diagnoses reported with unknown transmission mode in 2022 was 508, a dramatic increase compared to 258 in 2013 and 150 in 2021. The percentage of HIV diagnoses with missing information on transmission mode increased from 12% in 2013 to 18% in 2023 for the 13 countries included in the trend assessment. West • HIV diagnoses of people infected through sex between men decreased by 43%, from 13 416 in 2013 to 7 702 in 2022. The percentage of HIV diagnoses attributed to sex between men decreased from 46% in 2013 to 36% in 2022. • HIV diagnoses of people with reported heterosexual transmission decreased by 27%, from 10 682 to 7 841, with the steepest decline among women and foreign- born heterosexual people, the latter being due mainly to sharp decreases among migrants originating from countries with generalised HIV epidemics (data not shown; see also Figures 1.11 and 1.12 and Section 1.2 Trends in HIV diagnoses in Chapter 1). The percentage of HIV diagnoses attributed to heterosexual contact decreased from 37% of cases in 2013 to 36% in 2022. The proportion of people infected through hetero- sexual transmission originating outside the reporting country increased from 66% in 2021 to 73% in 2022. The share of previously diagnosed individuals also increased, from 12% in 2021 to 17% in 2022. • HIV diagnoses of people infected through injecting drug use decreased by 34%, from 1 235 in 2013 to 819 in 2022, representing 4% of HIV diagnoses in both 2013 and 2022. • Diagnoses of children infected through MTCT decreased consistently between 2013 and 2021, but increased dramatically in 2022 to reach levels similar to those in 2013 (238 diagnoses, compared to 235 in 2013). This may be due to the increasing trend among previous positive individuals; however, when ana- lysing data on known previous positive status, the share of previously diagnosed children did not change substantially, increasing from 39% in 2021 to 40% in 2022. • The number of HIV diagnoses with missing information on transmission mode increased from 3 401 in 2013 to 4 803 in 2022, corresponding to 12% of HIV diagno- ses in 2013 and 22% in 2022. Delays in the reporting of probable modes of transmission to national and European surveillance systems intensify the increase. 28 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data 2.1.3. AIDS cases, morbidity and mortality In 2022, 7 642 people in 44 countries of the WHO European Region19 were diagnosed with AIDS, which corresponds to a rate of 1.1 per 100 000 population (Table 13). Of the 7 642 people who received a diagnosis of AIDS in 2022, 65% (4 944) were diagnosed in the East, 24% (1 873) in the West and 11% (825) in the Centre of the Region. The rate was also highest in the East (4.4 per 100 000 population), almost nine times higher than that in the West (0.5 per 100 000) and 11-times higher than in the Centre (0.3 per 100 000 population). The rate of AIDS diagnoses varied widely among the countries, with the highest rates (3.0 or above) reported in Armenia (8.3), the Republic of Moldova (7.9) Ukraine (7.3), Georgia (5.7), Belarus (4.4), Cyprus (3.8) and Latvia (3.1), and the lowest rates (under 0.3) reported in Türkiye (0.1)20, Israel (0.1), Slovakia (0.1), Slovenia (0.3), Finland (0.3), Denmark (0.3), Poland (0.3) and the United Kingdom (0.3). Malta and San Marino reported zero cases. TB represented 12% of all reported AIDS-defining illness events in 2022, ranging from 11% of reports in the West to 12% in the Centre and 14% in the East. In the 43 countries with consistent AIDS data21, the overall rate of AIDS diagnoses in the Region decreased by 58% between 2013 and 2022, from 2.6 per 100 000 population (16 475 cases) to 1.1 per 100 000 (7 168 cases) (Figure 2.10). 19 No data were reported from Andorra, Bosnia and Herzegovina, Germany, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. Data from Portugal not published at the country’s request. 20 AIDS data for Türkiye only include those diagnosed with AIDS at the time of HIV diagnosis and are therefore not comparable with AIDS data from other countries. 21 Data from Andorra, Bosnia and Herzegovina, Germany, Monaco, North Macedonia, Portugal, the Russian Federation, Sweden, Turkmenistan and Uzbekistan are excluded, or not reported. AIDS trends varied across the three sub-regions. Despite the 2021 data representing the first year-on-year increase in the last five years in the East, the decreasing trend, re-established in 2022, and the overall down- ward trend continues, with the rate decreasing by 58%, from 10.4 in 2013 to 4.4 in 2022. In the Centre, the rate decreased by 200%, from 0.5 in 2013 to 0.4 in 2022. However, it should be noted that the rate in Centre has been increasing in past two years – from 0.2 in 2020, to 0.3 in 2021 and 0.4 in 2022. In the West, the steady downward trend continued, with a 58% decrease from 1.2 in 2013 to 0.5 in 2022 (Figure 2.10). A total of 44 countries in the Region22 provided informa- tion on AIDS-related deaths or deaths among people previously diagnosed with AIDS23, with 3 023 people reported to have died during 2022. This represents a 50% decrease compared with the 6 043 deaths reported for the same countries in 2013. Of the 1 629 deaths in 2022, 70% were reported from the East of the Region, 19% from the West, and 11% from the Centre (Table 17). It is important to note that delays in reporting and under- reporting have a significant impact on these numbers at the European level, particularly when the death occurs long after the HIV or AIDS diagnosis. The numbers pre- sented here should therefore not be interpreted as 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]. 22 No data were received from Andorra, Bosnia and Herzegovina, Germany, North Macedonia, Monaco, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. Data from Portugal not published at country request. 23 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. Figure 2.10: New AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2013–2022 0 2 4 6 8 10 12 2022202120202019201820172016201520142013 West Centre East WHO European Region Ca se s pe r 1 00 0 00 p op ul at io n Year of diagnosis Note: No data received from Andorra, Bosnia and Herzegovina, Germany, Monaco, North Macedonia, Russian Federation, Sweden, Turkmenistan and Uzbekistan. 29 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT 2.2. HIV testing Data on the number of HIV tests can support the interpre- tation of trends in diagnosed HIV infections. However, it is worth noting that numbers provided are collected in a heterogeneous manner, and comparisons between coun- try testing rates should be made with caution. In 2022, a total of 76 266 730 HIV tests were reported by 27 coun- tries (13 in the East, eight in the Centre and six in the 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 2022, the Russian Federation reported a total of 47 205 207 HIV tests, accounting for 62% 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 East than the Centre and the West (Table 18). Although the overall number of tests performed in the Region increased by 56%, from 44 429 846 in 2013 to 69 472 112 in 2022, in the 25 countries with data available throughout the decade, the number of tests performed decreased by 16% between 2019 and 2020, but then increased by 30% between 2020 and 2022 (Table 18). This is probably a consequence of a reduction in HIV testing services during 2020 due to the COVID-19 pandemic and the subsequent lift of the COVID-related restrictions in 2021 and 2022. Increases in large coun- tries with high numbers tested, such as Belarus, Kazakhstan, the Russian Federation and Türkiye, have had a considerable impact on the overall increase since 2013. The number of tests more than doubled in a few countries, although information on testing yield or coverage among key populations at higher risk of HIV infection was not collected from countries. The number of HIV tests from the twelve consistently reporting countries in the East of the Region increased by 57%, from 36 005 755 in 2013 to 56 496 428 in 2022 (Table 18). Information on the types of population tested is not available, but an increased number of HIV tests does not necessarily generate higher testing yields if large numbers of HIV tests are performed among people at low risk of HIV infection. Over the last decade, the rate of HIV diagnoses in the Centre increased by 87%, while the number of HIV tests increased by 57% (from 7 305 986 in 2013 to 11 442 944 in 2022) in the eight countries for which consistent data were available24. 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. 24 The nine countries are Czechia, Poland, Romania, Slovakia, Slovenia, Albania, North Macedonia, Serbia and Türkiye. 2.3. Conclusions The 2022 HIV surveillance data indicate a wide varia- tion in epidemic patterns and trends across the WHO European Region. Overall, HIV diagnoses slightly increased in the WHO European Region in 2022, with a rate of 12.4 per 100 000 population, a 4.2% increase compared with the 2021 rate but still a 20.5% decrease compared to the 2019 rate. However, this overall trend masks very different trends across the Region. The over- all trend largely reflects the situation in the Russian Federation where diagnoses have decreased since 2019 by 31%. However, in total, 37 of 49 countries reported an increase in HIV diagnoses in 2022 compared to 2021, and several countries recorded the highest number of HIV diagnoses reported in a single year. When comparing the number of HIV diagnoses with the estimated number of new HIV infections over the past decade, it is evident that more people are becom- ing infected with HIV than are being diagnosed. This indicates that the number of people living with undiag- nosed HIV in the region is increasing. The widening gap between estimated new infections and actual diagnoses can be addressed by further scale-up of testing to reach the right populations. The increase in HIV diagnoses in 2022 can be attributed to a range of factors, including the resumption of normal testing services after the COVID-19 pandemic, expanded and more targeted HIV testing services in some set- tings, and the implementation of new testing strategies to identify those who are undiagnosed. Another factor is the increased movement25 of people living with HIV throughout Europe, especially in EU/EEA countries. In all, 16.6% of the diagnoses reported in EU/EEA countries in 2022 were previously positive. However, the number of previous positives is probably underestimated, as the variable identifying them had a completeness of 51.4% in 2022. This category includes individuals who had previously received an HIV diagnosis, either in another country or within a different setting in the reporting country before the current reporting year. Most of these infections were probably acquired abroad and may not reflect a rise in transmission in the reporting countries. The increase in previously positive individuals has had a considerable impact on the epidemiological profile and the trends among those reported in 2022, specifi- cally for the EU/EEA countries from the West and Centre of the Region. A sub-analysis of the previous positive diagnoses shows that they include a higher proportion of women in older age groups, originating mainly from Central and Eastern Europe, who were primarily infected through heterosexual contact and were on antiretroviral therapy (ART). Their prior access to care resulted in a lower proportion of late diagnoses among this group of people living with HIV (PLHIV). 25 Population movements in this report include the influx of refugees and the migration of people in European countries from within and outside the WHO European Region. 30 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data When excluding previous positive individuals from people diagnosed with HIV in 2022, the population predominantly consists of younger men, with a higher proportion of diagnosis in the acute and early stages of the infection among MSM and a higher representa- tion of late diagnosis among those infected through heterosexual contact. Therefore, although heterosexual contact emerged as the main route of HIV transmission in 2022 in the Centre and the West, this is most prob- ably due to a significant proportion of previous positive diagnoses, particularly among women originating from Central and Eastern Europe. Consequently, trends on reported modes of transmission should be interpreted with caution. In the East, several countries (Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, and the Republic of Moldova) recorded the highest number of HIV diagnoses reported in a single year. None of these countries reported a sub- stantial increase in the number of cases originating from outside the country, and over 90% of their HIV diagno- ses originate from the reporting country. The countries reported a rebound in HIV testing and case detection since the pandemic subsided because of their focus on increasing case detection with introducing new testing policies to close the gap on undiagnosed people. Heterosexual transmission remains the main trans- mission route in the East. Although the reported transmission through sex between men remains low in absolute terms in the East, it has increased more than two-fold during the decade – the largest increase in any transmission category and any sub-region 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]. With the support of the Robert Koch Institute, a WHO Collaborating Centre for viral hepatitis and HIV, WHO’s Regional Office for Europe is supporting countries in conducting studies to assess the quality of the reported modes of transmission. The study is currently being implemented in Kyrgyzstan and is planned to be conducted in other countries in the East. Despite the increasing trend in heterosexual transmis- sion due to the factors described earlier, HIV diagnoses among MSM are seeing an upward trend in the Centre of the Region. Eight of the fifteen countries in the Centre reported sex between men as the predominant mode of transmission. Drug-injection-related transmission remains low, but past 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 further outbreaks. The percentage of young people among the new diagnoses is also higher in this part of the Region than elsewhere. HIV preven- tion, diagnostics and treatment interventions should accommodate the needs of key populations, particu- larly MSM, with relevant evidence-based interventions. These interventions include condom and lubricant pro- gramming; diversified HIV testing services; assisted voluntary partner notification, PrEP; prevention and management of co-infections (particularly sexually transmitted infections) and rapid HIV treatment initia- tion. Services should be patient-centred and provided in a friendly environment, preferably with the involve- ment of civil society along the entire HIV continuum of services, ranging from HIV prevention to adherence and ART. In the West Region, there was a clear decline in the overall rate of HIV diagnoses during the previous dec- ade, resulting primarily from decreases in diagnoses among MSM in specific countries (Austria, Belgium, Denmark, the Netherlands, Norway, Spain, and the United Kingdom) and among people infected heterosex- ually, particularly women and people originating from countries with generalised HIV epidemics. However, surveillance data indicate a considerable increase in reported HIV diagnoses in 2022 from this part of the Region. This is due to a combination of different factors, mainly increased population movement throughout the year and expanded testing services during the post-pan- demic period to find undiagnosed people. In countries where migration is common and takes various forms, the public health challenge of ensuring access to health services for migrant populations, including HIV services and promoting cross-border collaboration and data shar- ing, remains essential to a robust and people-centred public health response. The influx of people living with HIV, particularly from Ukraine, has introduced new chal- lenges to HIV care, as this population may have different needs for mental health and social support and require special considerations around transitioning to new ART regimens (many were on treatment regimens that were not available in EU/EEA countries) [9]. In addition, indi- viduals who are aware of their HIV-positive status may hesitate to seek care in the health system due to chal- lenges to access or concerns related to stigma and discrimination [10]. A little more than half of HIV diagnoses (50.6%) have a CD4 cell count below 350 cells per mm3, including 29.7% of cases with advanced HIV infection (CD4 below 200 cells/mm3). However, the regional average excludes data from the Russian Federation, where a CD4 cell count at diagnosis was reported among 95% of HIV diagnoses, and only 30.8% of those diagnosed with HIV are detected once their CD4 cell counts have fallen below 350 cells/ mm3 and 15.1% below 200 cells/mm3. Once again, it is significant that the 2022 data provide information on variations in late diagnoses according to geography, transmission mode, and age. The data also suggest problems with access to and uptake of HIV testing for some populations, indicating the need to improve test- ing programmes to diagnose people living with HIV at an earlier stage. The data also confirm that the proportion diagnosed at a late stage of infection is highest among people infected heterosexually (particularly men), or as a result of injecting drug use, and among those in older age groups. 31 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Late diagnosis reflects insufficient access to and uptake of appropriate HIV testing and counselling by those at greater risk of acquiring HIV. HIV testing strategies must be reconsidered and diversified to include innovative approaches involving community-based organisations and focusing on key population groups. Multiple entry points to HIV testing should be available through HIV self-testing, HIV testing performed by trained lay provid- ers and civil society, home sampling, routine indicator condition-guided HIV testing offered in the health sys- tem, 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 link- age to HIV treatment and care is essential to reduce late diagnosis and ensure progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO 95–95–95 targets, improving treatment outcomes and reducing HIV transmission. It is estimated that around 3 000 000 [CI 2 600 000 – 3 300 000] people are living with HIV in the WHO European Region, around 2 100 000 (70%) of whom know their status [11]. 2022 HIV data reveals a significant issue with data qual- ity, completeness, and lack of standardisation for the ‘HIV Status’ variable, differentiating new HIV diagnoses from previous positives. This complicates the 2022 data interpretation. Achieving consensus among countries in the Region on the collection, recording, and reporting of previous positive cases is paramount. This is critical due to the different epidemiological profiles and healthcare needs of previously diagnosed individuals. Improving data recording and reporting standards within surveil- lance systems will ensure accuracy and help with the planning of tailored prevention strategies. In September 2022, the Member States endorsed Regional Action Plans for Ending AIDS and the Epidemics of Viral Hepatitis and Sexually Transmitted Infections 2022–2030 at the 72nd session of the WHO Regional Committee for Europe [12]. The Plans outline the visions, goals, and actions required to respond to these epi- demics and are designed to strategically combine disease-specific approaches with people at the heart of the responses. They will operationalise the Global Health Sector Strategies on HIV, viral hepatitis, and sex- ually transmitted infections for the period 2022–2030 through region-specific actions and align the responses with the European Programme of Work, 2020–2025 – ‘United Action for Better Health’. The plans set ambi- tious targets for 2030 and interim targets for 2025. The ambitious targets will be met by: • using a partnership-based approach with primary health care, civil society and public health institutions to deliver quality, differentiated and people-centred services; • prioritising key populations and focusing on reducing social and structural barriers to accessing services; • enabling rapid recovery following acute or pro- longed emergencies and future-proofing for health emergencies; • supporting country-owned sustainability with adequate domestic financing of services and commod- ities, and a community workforce equipped to provide quality care; • making data-driven decisions based on comprehen- sive surveillance and quality strategic information; • refocusing testing to advance early diagnosis based on epidemiology and evidence; decentralising and using a full range of testing strategies to advance early, and accurate confirmed diagnosis; • rapidly scaling up use of the new HIV and viral hepati- tis treatment regimens and models of care; • using innovative combination prevention approaches via a broad range of service delivery platforms. WHO is working with Member States to increase the uptake of HIV testing and treatment guidance and inno- vative combination HIV prevention approaches in key populations. It is also working to eliminate MTCT of HIV viral hepatitis B and syphilis, and to strengthen HIV surveillance and reporting and other key priorities, as highlighted in the Action Plans. WHO Regional Office of Europe, with ECDC and other partners, will continue to support Member States in their efforts to accelerate progress toward reaching the Sustainable Development Goals for HIV through dedicated guidance, workshops, webinars, and other technical support focused on high-impact surveillance, monitoring, treatment, and prevention activities. References26 1. Santé publique France. EuroHIV 2006 survey on HIV and AIDS sur- veillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire (French National Institute of Health Surveillance); 2007. Available from: https://www.santepubliquefrance.fr/mal- adies-et-traumatismes/infections-sexuellement-transmissibles/ vih-sida/documents/rapport-synthese/eurohiv-2006-survey-on- hiv-and-aids-surveillance-in-the-who-european-region 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. doi:10.1007/ s10461-015-1112-0. 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. 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). doi: 10.2807/1560-7917. 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). doi: 10.2807/1560-7917. 6. European Centre for Disease Prevention and Control (ECDC)/ European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm: ECDC/EMCDDA; 2018. Available from: https://sante.public.lu/fr/publications/h/hiv-joint-technical-mis- sion.html 26 All online references were accessed on 26 October 2023. 32 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data 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- sectional analysis. Lancet HIV 2019;6(5):e315–24. doi: 10.1016/ S2352-3018(19)30036-0. 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. doi: 10.1016/ S2352-3018(20)30082-5. 9. Massmann R, Groh T, Jilich D, Bartková D, Bartovská Z, Chmelař J, et al. HIV-positive Ukrainian refugees in the Czech Republic. AIDS. 2023 Oct 1;37(12):1811-1818. doi: 10.1097/ QAD.0000000000003633. 10. WHO Regional Office for Europe (WHO/Europe). Standardized protocol for clinical management and medical data-sharing for people living with HIV among refugees from Ukraine. Copenhagen: WHO Regional Office for Europe; 2022. Available from: https://www.who.int/europe/publications/i/item/ WHO-EURO-2022-5288-45052-64211 11. UNAIDS. The path that ends AIDS: UNAIDS Global AIDS Update 2023. Geneva: Joint United Nations Programme on HIV/AIDS; 2023. Available from: https://www.unaids.org/sites/default/files/ media_asset/2023-unaids-global-aids-update_en.pdf 12. Regional action plans for ending AIDS and the epidemics of viral hepatitis and sexually transmitted infections 2022– 2030. Copenhagen: WHO Regional Office for Europe; 2023. Available from: https://www.who.int/europe/publications/i/ item/9789289058957 33 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Tables 34 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 1: HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 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 325 3.8 316 3.7 336 3.9 306 3.5 323 2.2 222 1.3 251 1.4 173 1.0 188 0.8 189 2.1 10 979 Austria West Belgium 1985 1 201 10.8 1 125 10.1 1 112 9.9 1 003 8.9 960 8.5 957 8.4 989 8.6 765 5.3 791 4.5 1 060 9.1 36 942 Belgium Centre Bulgaria 1986 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 311 4.4 258 3.7 199 2.9 237 3.4 328 4.8 4 080 Bulgaria Centre Croatia 1985 85 2.0 92 2.2 117 2.8 108 2.6 106 2.6 94 2.3 102 2.5 75 1.8 77 1.9 113 2.9 1 998 Croatia Centre Cyprus 1986 54 6.2 56 6.5 80 9.4 80 9.4 85 9.9 78 9.0 100 11.4 106 11.9 149 16.6 218 24.1 1 799 Cyprus Centre Czechia 1985 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 208 2.0 222 2.1 251 2.3 233 2.2 870 8.3 4 944 Czechia West Denmark 1990 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 219 3.8 190 3.3 161 2.8 139 2.4 258 4.4 8 558 Denmark East Estonia 1988 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 190 14.4 178 13.4 147 11.1 125 9.4 250 18.8 10 601 Estonia West Finland 1980 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 153 2.8 148 2.7 134 2.4 162 2.9 273 4.9 4 781 Finland West France 2003 5 579 8.5 5 696 8.6 5 317 8.0 5 443 8.2 5 388 8.1 5 109 7.6 5 129 7.6 3 570 5.3 3 627 5.4 4 158 6.1 105 420 France West Germany 1993 3 245 4.0 3 533 4.4 3 648 4.5 3 396 4.1 3 171 3.8 2 886 3.5 3 126 3.8 2 468 3.0 2 258 2.7 3 239 3.9 79 377 Germany West Greece 1984 899 8.2 785 7.2 783 7.2 654 6.1 645 6.0 725 6.7 669 6.2 623 5.8 572 5.4 565 5.4 17 784 Greece Centre Hungary 1985 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 229 2.3 238 2.4 201 2.1 226 2.3 224 2.3 4 685 Hungary West Iceland 1983 11 3.4 11 3.4 12 3.6 28 8.4 24 7.1 38 10.9 28 7.8 34 9.3 20 5.4 40 10.6 545 Iceland West Ireland 1985 341 7.4 370 8.0 487 10.4 502 10.6 488 10.2 523 10.8 533 10.9 435 8.8 403 8.0 887 17.5 11 601 Ireland West Italy 1985 3 858 6.5 3 854 6.3 3 625 6.0 3 723 6.1 3 610 6.0 3 029 5.0 2 504 4.2 1 406 2.4 1 850 3.1 1 888 3.2 55 189 Italy East Latvia 1987 340 16.8 356 17.8 405 20.4 374 19.0 379 19.4 333 17.2 304 15.8 257 13.5 212 11.2 229 12.2 8 716 Latvia Liechtenstein 1985 0 0.0 1 2.7 0 0 2 5.3 0 0.0 0 0.0 0 0.0 0 0.0 1 2.6 1 2.5 69 Liechtenstein East Lithuania 1988 177 6.0 141 4.8 157 5.4 214 7.4 263 9.2 160 5.7 151 5.4 139 5.0 121 4.3 252 9.0 3 835 Lithuania West Luxembourgc 1983 136 25.3 169 30.7 153 27.2 159 27.6 133 22.5 113 18.8 104 16.9 64 10.2 88 13.9 71 11.0 3 510 Luxembourgc West Malta 2001 36 8.5 40 9.3 61 13.9 63 14.0 45 9.8 73 15.3 80 16.2 82 15.9 45 8.7 60 11.5 772 Malta West Netherlands 1980 1 200 7.2 1 077 6.4 1 090 6.4 996 5.9 959 5.6 839 4.9 733 4.2 509 2.9 486 2.8 431 2.5 30 732 Netherlands West Norway 1984 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 191 3.6 172 3.2 137 2.6 102 1.9 245 4.5 7 138 Norway Centre Poland 1985 1 100 2.9 1 135 3.0 1 278 3.4 1 317 3.5 1 422 3.7 1 213 3.2 1 558 4.1 954 2.5 1 367 3.6 2 050 5.4 30 056 Poland West Portugal 1985 1 844 17.6 1 540 14.8 1 629 15.7 1 593 15.4 1 475 14.3 1 311 12.7 1 295 12.6 967 9.4 1 072 10.4 804 7.8 66 146 Portugal Centre Romania 1987 1 044 5.2 931 4.7 914 4.6 807 4.1 834 4.2 768 3.9 779 4.0 522 2.7 639 3.3 670 3.5 27 190 Romania Centre Slovakia 1985 83 1.5 86 1.6 86 1.6 88 1.6 72 1.3 102 1.9 104 1.9 103 1.9 115 2.1 197 3.6 1 492 Slovakia Centre Slovenia 1985 48 2.3 54 2.6 53 2.6 62 3.0 43 2.1 38 1.8 34 1.6 29 1.4 35 1.7 42 2.0 1 053 Slovenia West Spain 2003 4 378 9.4 4 489 9.7 4 287 9.2 4 364 9.4 4 284 9.2 4 015 8.6 3 879 8.2 2 843 6.0 2 981 6.3 2 937 6.2 66 942 Spain West Sweden 1983 457 4.8 473 4.9 447 4.6 429 4.4 434 4.3 481 4.8 449 4.4 360 3.5 352 3.4 446 4.3 14 657 Sweden Total EU/EEA 28 064 6.3 28 075 6.3 27 783 6.2 27 300 6.1 26 693 5.8 24 608 5.3 24 307 5.3 17 714 3.8 18 673 3.9 22 995 5.1 621 591 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 120 4.2 79 2.7 96 3.3 127 4.4 94 3.3 102 3.5 101 3.5 96 3.3 104 3.6 98 3.4 1 602 Albania West Andorra 2004 5 7.0 5 7.0 3 4.2 3 4.1 6 8.1 12 16.0 - - - - - - - - 96 Andorra East Armeniac 1988 238 8.2 334 11.6 294 10.2 303 10.6 358 12.6 429 15.1 448 15.9 369 13.2 425 15.2 535 19.2 5 114 Armeniac East Azerbaijan 1987 514 5.3 604 6.2 727 7.4 556 5.6 567 5.6 656 6.5 721 7.0 559 5.4 690 6.7 766 7.4 10 144 Azerbaijan East Belarus 1981 1 533 15.8 1 811 18.7 2 305 23.8 2 391 24.6 2 468 25.4 2 386 24.6 2 137 22.1 1 427 14.8 1 496 15.6 1 644 17.2 33 776 Belarus Centre Bosnia and Herzegovina 1986 3 0.1 23 0.6 15 0.4 24 0.7 15 0.4 24 0.7 33 1.0 17 0.5 37 1.1 54 1.7 440 Bosnia and Herzegovina East Georgia 1989 490 12.9 564 14.9 717 19.0 718 19.0 631 16.7 672 17.8 668 17.7 530 14.1 530 14.1 617 16.5 9 779 Georgia West Israel 1981 466 6.0 461 5.9 413 5.2 370 4.5 419 5.0 454 5.4 410 4.8 375 4.3 407 4.6 456 5.0 11 746 Israel East Kazakhstan 1987 2 130 12.3 2 341 13.3 2 475 13.9 2 898 16.0 3 012 16.4 3 213 17.3 3 667 19.6 3 468 18.3 3 589 18.7 4 006 20.7 50 475 Kazakhstan East Kyrgyzstan 1987 500 8.7 648 11.1 620 10.5 749 12.4 836 13.7 868 13.9 844 13.3 674 10.5 841 12.9 1 094 16.5 12 246 Kyrgyzstan East Moldova 1987 706 20.7 831 24.9 818 25.0 832 25.8 835 26.3 905 28.8 922 29.7 680 22.0 792 25.9 929 28.4 16 080 Moldova West Monaco 1987 0 0.0 1 2.8 1 2.7 0 0.0 3 8.1 0 0.0 - - - - - - - - 40 Monaco Centre Montenegro 1993 11 1.7 20 3.2 20 3.2 34 5.4 27 4.3 27 4.3 26 4.1 15 2.4 14 2.2 31 4.9 371 Montenegro Centre North Macedonia 1987 15 0.7 1 0.0 25 1.2 30 1.4 44 2.1 45 2.1 66 3.1 29 1.4 43 2.0 41 2.0 382 North Macedonia East Russian Federationd 2009 81 698 56.8 92 613 64.2 100 220 69.3 86 855 59.9 85 802 59.0 85 995 59.0 80 124 55.0 59 598 40.9 58 340 40.2 55 573 38.4 1 054 769 Russian Federationd West San Marino 1985 1 3.0 3 9.0 2 6.0 2 5.9 1 2.9 3 8.8 0 0.0 0 0.0 0 0.0 1 3.0 94 San Marino Centre Serbia 1984 162 1.7 144 1.5 188 2.0 187 2.0 190 2.1 195 2.1 227 2.5 134 1.5 187 2.1 185 2.1 4 758 Serbia Centre Serbia excluding Kosovoe 1984 159 2.1 138 1.8 185 2.5 176 2.3 187 2.5 187 2.5 222 3.0 132 1.8 178 2.4 164 2.3 4 600 Serbia excluding Kosovoe Centre Kosovoe 1999 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 8 0.4 5 0.3 2 0.1 9 0.5 21 1.2 158 Kosovoe West Switzerland 1985 597 7.4 521 6.4 548 6.6 540 6.4 459 5.4 441 5.2 427 5.0 295 3.4 322 3.7 349 4.0 37 894 Switzerland East Tajikistan 1991 817 10.0 986 11.8 1 149 13.5 1 038 11.9 1 205 13.5 1 421 15.6 1 320 14.1 1 084 11.4 922 9.5 1 037 10.4 15 029 Tajikistan Centre Türkiye 1985 1 313 1.7 1 838 2.4 2 107 2.6 2 437 3.0 2 844 3.5 3 248 3.9 3 229 3.9 2 076 2.5 2 920 3.4 3 824 4.5 31 286 Türkiye East Turkmenistan 1990 - - - - - - - - - - - - - - - - - - - - 2 Turkmenistan East Ukraine 1987 17 844 39.4 15 796 35.0 13 000 30.4 14 233 33.4 15 606 36.8 15 656 37.1 16 239 38.7 15 576 37.3 15 335 37.0 12 212 29.8 337 384 Ukraine West United Kingdom 1981 5 973 9.3 6 336 9.8 6 207 9.5 5 347 8.1 4 770 7.2 4 654 7.0 4 261 6.4 3 335 5.0 3 398 5.1 4 040 6.0 175 831 United Kingdom East Uzbekistan 1981 - - - - - - - - - - - - - - - - - - - - 24 018 Uzbekistan Total non-EU/EEA 115 136 27.1 125 960 29.4 131 950 30.8 119 674 27.7 120 192 27.7 121 406 27.8 115 870 26.5 90 337 20.6 90 392 20.6 87 492 19.9 1 833 356 Total non-EU/EEA WHO European Region WHO European Region West 31 175 7.4 31 509 7.4 30 833 7.2 29 565 6.9 28 210 6.5 26 448 6.0 25 377 5.7 18 736 4.2 19 263 4.2 22 397 5.1 746 774 West Centre 4 713 2.4 5 209 2.7 5 743 2.9 6 017 3.1 6 494 3.3 6 682 3.4 7 077 3.6 4 807 2.4 6 383 3.2 8 945 4.5 116 136 Centre East 107 312 41.9 117 316 45.7 123 157 48.2 111 390 43.5 112 181 43.7 112 884 43.9 107 723 41.8 84 508 32.8 83 418 32.4 79 144 30.7 1 591 968 East Total WHO European Region 143 200 16.4 154 034 17.6 159 733 18.2 146 972 16.7 146 885 16.5 146 014 16.3 140 177 15.6 108 051 12.0 109 064 11.9 110 486 12.4 2 454 878 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. d Due to discrepancies in the methodology used for calculating the population rates by the Russian Federal Statistics Service and the United Nations Population Division, rates on overall HIV diagnoses, as well as data disaggregated by sex, presented in the report in Tables 1,2 and 3 and elsewhere in the report may differ from the data presented in national statistics. e Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 35 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 1: HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 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 325 3.8 316 3.7 336 3.9 306 3.5 323 2.2 222 1.3 251 1.4 173 1.0 188 0.8 189 2.1 10 979 Austria West Belgium 1985 1 201 10.8 1 125 10.1 1 112 9.9 1 003 8.9 960 8.5 957 8.4 989 8.6 765 5.3 791 4.5 1 060 9.1 36 942 Belgium Centre Bulgaria 1986 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 311 4.4 258 3.7 199 2.9 237 3.4 328 4.8 4 080 Bulgaria Centre Croatia 1985 85 2.0 92 2.2 117 2.8 108 2.6 106 2.6 94 2.3 102 2.5 75 1.8 77 1.9 113 2.9 1 998 Croatia Centre Cyprus 1986 54 6.2 56 6.5 80 9.4 80 9.4 85 9.9 78 9.0 100 11.4 106 11.9 149 16.6 218 24.1 1 799 Cyprus Centre Czechia 1985 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 208 2.0 222 2.1 251 2.3 233 2.2 870 8.3 4 944 Czechia West Denmark 1990 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 219 3.8 190 3.3 161 2.8 139 2.4 258 4.4 8 558 Denmark East Estonia 1988 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 190 14.4 178 13.4 147 11.1 125 9.4 250 18.8 10 601 Estonia West Finland 1980 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 153 2.8 148 2.7 134 2.4 162 2.9 273 4.9 4 781 Finland West France 2003 5 579 8.5 5 696 8.6 5 317 8.0 5 443 8.2 5 388 8.1 5 109 7.6 5 129 7.6 3 570 5.3 3 627 5.4 4 158 6.1 105 420 France West Germany 1993 3 245 4.0 3 533 4.4 3 648 4.5 3 396 4.1 3 171 3.8 2 886 3.5 3 126 3.8 2 468 3.0 2 258 2.7 3 239 3.9 79 377 Germany West Greece 1984 899 8.2 785 7.2 783 7.2 654 6.1 645 6.0 725 6.7 669 6.2 623 5.8 572 5.4 565 5.4 17 784 Greece Centre Hungary 1985 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 229 2.3 238 2.4 201 2.1 226 2.3 224 2.3 4 685 Hungary West Iceland 1983 11 3.4 11 3.4 12 3.6 28 8.4 24 7.1 38 10.9 28 7.8 34 9.3 20 5.4 40 10.6 545 Iceland West Ireland 1985 341 7.4 370 8.0 487 10.4 502 10.6 488 10.2 523 10.8 533 10.9 435 8.8 403 8.0 887 17.5 11 601 Ireland West Italy 1985 3 858 6.5 3 854 6.3 3 625 6.0 3 723 6.1 3 610 6.0 3 029 5.0 2 504 4.2 1 406 2.4 1 850 3.1 1 888 3.2 55 189 Italy East Latvia 1987 340 16.8 356 17.8 405 20.4 374 19.0 379 19.4 333 17.2 304 15.8 257 13.5 212 11.2 229 12.2 8 716 Latvia Liechtenstein 1985 0 0.0 1 2.7 0 0 2 5.3 0 0.0 0 0.0 0 0.0 0 0.0 1 2.6 1 2.5 69 Liechtenstein East Lithuania 1988 177 6.0 141 4.8 157 5.4 214 7.4 263 9.2 160 5.7 151 5.4 139 5.0 121 4.3 252 9.0 3 835 Lithuania West Luxembourgc 1983 136 25.3 169 30.7 153 27.2 159 27.6 133 22.5 113 18.8 104 16.9 64 10.2 88 13.9 71 11.0 3 510 Luxembourgc West Malta 2001 36 8.5 40 9.3 61 13.9 63 14.0 45 9.8 73 15.3 80 16.2 82 15.9 45 8.7 60 11.5 772 Malta West Netherlands 1980 1 200 7.2 1 077 6.4 1 090 6.4 996 5.9 959 5.6 839 4.9 733 4.2 509 2.9 486 2.8 431 2.5 30 732 Netherlands West Norway 1984 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 191 3.6 172 3.2 137 2.6 102 1.9 245 4.5 7 138 Norway Centre Poland 1985 1 100 2.9 1 135 3.0 1 278 3.4 1 317 3.5 1 422 3.7 1 213 3.2 1 558 4.1 954 2.5 1 367 3.6 2 050 5.4 30 056 Poland West Portugal 1985 1 844 17.6 1 540 14.8 1 629 15.7 1 593 15.4 1 475 14.3 1 311 12.7 1 295 12.6 967 9.4 1 072 10.4 804 7.8 66 146 Portugal Centre Romania 1987 1 044 5.2 931 4.7 914 4.6 807 4.1 834 4.2 768 3.9 779 4.0 522 2.7 639 3.3 670 3.5 27 190 Romania Centre Slovakia 1985 83 1.5 86 1.6 86 1.6 88 1.6 72 1.3 102 1.9 104 1.9 103 1.9 115 2.1 197 3.6 1 492 Slovakia Centre Slovenia 1985 48 2.3 54 2.6 53 2.6 62 3.0 43 2.1 38 1.8 34 1.6 29 1.4 35 1.7 42 2.0 1 053 Slovenia West Spain 2003 4 378 9.4 4 489 9.7 4 287 9.2 4 364 9.4 4 284 9.2 4 015 8.6 3 879 8.2 2 843 6.0 2 981 6.3 2 937 6.2 66 942 Spain West Sweden 1983 457 4.8 473 4.9 447 4.6 429 4.4 434 4.3 481 4.8 449 4.4 360 3.5 352 3.4 446 4.3 14 657 Sweden Total EU/EEA 28 064 6.3 28 075 6.3 27 783 6.2 27 300 6.1 26 693 5.8 24 608 5.3 24 307 5.3 17 714 3.8 18 673 3.9 22 995 5.1 621 591 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 120 4.2 79 2.7 96 3.3 127 4.4 94 3.3 102 3.5 101 3.5 96 3.3 104 3.6 98 3.4 1 602 Albania West Andorra 2004 5 7.0 5 7.0 3 4.2 3 4.1 6 8.1 12 16.0 - - - - - - - - 96 Andorra East Armeniac 1988 238 8.2 334 11.6 294 10.2 303 10.6 358 12.6 429 15.1 448 15.9 369 13.2 425 15.2 535 19.2 5 114 Armeniac East Azerbaijan 1987 514 5.3 604 6.2 727 7.4 556 5.6 567 5.6 656 6.5 721 7.0 559 5.4 690 6.7 766 7.4 10 144 Azerbaijan East Belarus 1981 1 533 15.8 1 811 18.7 2 305 23.8 2 391 24.6 2 468 25.4 2 386 24.6 2 137 22.1 1 427 14.8 1 496 15.6 1 644 17.2 33 776 Belarus Centre Bosnia and Herzegovina 1986 3 0.1 23 0.6 15 0.4 24 0.7 15 0.4 24 0.7 33 1.0 17 0.5 37 1.1 54 1.7 440 Bosnia and Herzegovina East Georgia 1989 490 12.9 564 14.9 717 19.0 718 19.0 631 16.7 672 17.8 668 17.7 530 14.1 530 14.1 617 16.5 9 779 Georgia West Israel 1981 466 6.0 461 5.9 413 5.2 370 4.5 419 5.0 454 5.4 410 4.8 375 4.3 407 4.6 456 5.0 11 746 Israel East Kazakhstan 1987 2 130 12.3 2 341 13.3 2 475 13.9 2 898 16.0 3 012 16.4 3 213 17.3 3 667 19.6 3 468 18.3 3 589 18.7 4 006 20.7 50 475 Kazakhstan East Kyrgyzstan 1987 500 8.7 648 11.1 620 10.5 749 12.4 836 13.7 868 13.9 844 13.3 674 10.5 841 12.9 1 094 16.5 12 246 Kyrgyzstan East Moldova 1987 706 20.7 831 24.9 818 25.0 832 25.8 835 26.3 905 28.8 922 29.7 680 22.0 792 25.9 929 28.4 16 080 Moldova West Monaco 1987 0 0.0 1 2.8 1 2.7 0 0.0 3 8.1 0 0.0 - - - - - - - - 40 Monaco Centre Montenegro 1993 11 1.7 20 3.2 20 3.2 34 5.4 27 4.3 27 4.3 26 4.1 15 2.4 14 2.2 31 4.9 371 Montenegro Centre North Macedonia 1987 15 0.7 1 0.0 25 1.2 30 1.4 44 2.1 45 2.1 66 3.1 29 1.4 43 2.0 41 2.0 382 North Macedonia East Russian Federationd 2009 81 698 56.8 92 613 64.2 100 220 69.3 86 855 59.9 85 802 59.0 85 995 59.0 80 124 55.0 59 598 40.9 58 340 40.2 55 573 38.4 1 054 769 Russian Federationd West San Marino 1985 1 3.0 3 9.0 2 6.0 2 5.9 1 2.9 3 8.8 0 0.0 0 0.0 0 0.0 1 3.0 94 San Marino Centre Serbia 1984 162 1.7 144 1.5 188 2.0 187 2.0 190 2.1 195 2.1 227 2.5 134 1.5 187 2.1 185 2.1 4 758 Serbia Centre Serbia excluding Kosovoe 1984 159 2.1 138 1.8 185 2.5 176 2.3 187 2.5 187 2.5 222 3.0 132 1.8 178 2.4 164 2.3 4 600 Serbia excluding Kosovoe Centre Kosovoe 1999 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 8 0.4 5 0.3 2 0.1 9 0.5 21 1.2 158 Kosovoe West Switzerland 1985 597 7.4 521 6.4 548 6.6 540 6.4 459 5.4 441 5.2 427 5.0 295 3.4 322 3.7 349 4.0 37 894 Switzerland East Tajikistan 1991 817 10.0 986 11.8 1 149 13.5 1 038 11.9 1 205 13.5 1 421 15.6 1 320 14.1 1 084 11.4 922 9.5 1 037 10.4 15 029 Tajikistan Centre Türkiye 1985 1 313 1.7 1 838 2.4 2 107 2.6 2 437 3.0 2 844 3.5 3 248 3.9 3 229 3.9 2 076 2.5 2 920 3.4 3 824 4.5 31 286 Türkiye East Turkmenistan 1990 - - - - - - - - - - - - - - - - - - - - 2 Turkmenistan East Ukraine 1987 17 844 39.4 15 796 35.0 13 000 30.4 14 233 33.4 15 606 36.8 15 656 37.1 16 239 38.7 15 576 37.3 15 335 37.0 12 212 29.8 337 384 Ukraine West United Kingdom 1981 5 973 9.3 6 336 9.8 6 207 9.5 5 347 8.1 4 770 7.2 4 654 7.0 4 261 6.4 3 335 5.0 3 398 5.1 4 040 6.0 175 831 United Kingdom East Uzbekistan 1981 - - - - - - - - - - - - - - - - - - - - 24 018 Uzbekistan Total non-EU/EEA 115 136 27.1 125 960 29.4 131 950 30.8 119 674 27.7 120 192 27.7 121 406 27.8 115 870 26.5 90 337 20.6 90 392 20.6 87 492 19.9 1 833 356 Total non-EU/EEA WHO European Region WHO European Region West 31 175 7.4 31 509 7.4 30 833 7.2 29 565 6.9 28 210 6.5 26 448 6.0 25 377 5.7 18 736 4.2 19 263 4.2 22 397 5.1 746 774 West Centre 4 713 2.4 5 209 2.7 5 743 2.9 6 017 3.1 6 494 3.3 6 682 3.4 7 077 3.6 4 807 2.4 6 383 3.2 8 945 4.5 116 136 Centre East 107 312 41.9 117 316 45.7 123 157 48.2 111 390 43.5 112 181 43.7 112 884 43.9 107 723 41.8 84 508 32.8 83 418 32.4 79 144 30.7 1 591 968 East Total WHO European Region 143 200 16.4 154 034 17.6 159 733 18.2 146 972 16.7 146 885 16.5 146 014 16.3 140 177 15.6 108 051 12.0 109 064 11.9 110 486 12.4 2 454 878 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. d Due to discrepancies in the methodology used for calculating the population rates by the Russian Federal Statistics Service and the United Nations Population Division, rates on overall HIV diagnoses, as well as data disaggregated by sex, presented in the report in Tables 1,2 and 3 and elsewhere in the report may differ from the data presented in national statistics. e Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 36 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 2: HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2013 2 014 2 015 2 016 2 017 2 018 2 019 2 020 2 021 2022 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 274 6.6 246 5.9 291 6.9 254 5.9 270 6.3 184 4.2 212 4.9 142 3.2 157 3.6 155 3.5 8 446 Austria West Belgium 831 15.2 788 14.3 765 13.8 707 12.7 645 11.5 658 11.7 678 12.0 527 9.3 590 10.4 681 11.9 23 722 Belgium Centre Bulgaria 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 276 8.1 217 6.4 168 5.0 205 6.1 215 6.5 3 257 Bulgaria Centre Croatia 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 88 4.4 97 4.9 66 3.3 71 3.6 89 4.8 1 767 Croatia Centre Cyprus 46 10.9 49 11.7 72 17.5 65 15.8 65 15.6 65 15.4 69 16.1 87 20.0 115 26.3 154 34.9 1 337 Cyprus Centre Czechia 211 4.1 209 4.0 248 4.8 262 5.1 230 4.4 186 3.6 192 3.7 203 3.9 201 3.8 435 8.4 3 930 Czechia West Denmark 178 6.4 196 7.0 205 7.3 191 6.7 192 6.7 170 5.9 146 5.1 133 4.6 115 4.0 149 5.1 6 273 Denmark East Estonia 200 32.5 182 29.6 167 27.2 139 22.5 146 23.6 131 21.1 113 18.1 88 14.0 80 12.7 130 20.5 7 040 Estonia West Finland 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 104 3.8 111 4.1 99 3.6 119 4.4 171 6.2 3 431 Finland West France 3 737 11.8 3 825 11.9 3 559 11.1 3 585 11.1 3 509 10.9 3 269 10.1 3 272 10.1 2 403 7.4 2 421 7.4 2 689 8.2 68 142 France West Germany 2 664 6.8 2 869 7.3 2 891 7.3 2 671 6.6 2 516 6.2 2 237 5.5 2 442 6.0 1 906 4.6 1 799 4.4 2 236 5.4 62 474 Germany West Greece 810 15.1 684 12.9 690 13.1 541 10.4 535 10.2 584 11.2 522 10.0 500 9.6 463 8.9 450 8.8 14 801 Greece Centre Hungary 191 4.1 216 4.6 196 4.2 171 3.6 149 3.2 195 4.2 208 4.4 166 3.5 182 3.9 179 3.9 3 654 Hungary West Iceland 8 5.0 9 5.5 10 6.1 22 13.2 21 12.3 24 13.5 23 12.6 28 15.0 14 7.4 30 15.5 400 Iceland West Ireland 257 11.3 269 11.7 373 16.1 390 16.7 371 15.7 411 17.2 397 16.3 344 14.0 311 12.6 582 23.2 7 114 Ireland West Italy 3 009 10.4 3 061 10.4 2 808 9.5 2 863 9.7 2 741 9.3 2 372 8.1 2 000 6.9 1 120 3.9 1 471 5.1 1 486 5.2 42 214 Italy East Latvia 203 21.9 244 26.6 270 29.6 236 26.1 245 27.4 226 25.4 185 20.9 162 18.4 136 15.5 154 17.7 5 872 Latvia Liechtenstein 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 0 0.0 0 0.0 0 0.0 1 5.2 1 5.1 43 Liechtenstein East Lithuania 125 9.1 90 6.6 115 8.5 165 12.4 220 16.8 117 9.0 110 8.5 97 7.4 93 7.1 152 11.6 2 971 Lithuania West Luxembourgc 111 41.4 112 40.7 118 41.8 123 42.5 99 33.4 83 27.4 78 25.3 48 15.2 69 21.6 45 13.8 2 577 Luxembourgc West Malta 30 14.3 36 16.8 53 24.0 51 22.5 35 15.1 62 25.8 55 21.8 67 25.2 41 15.4 55 20.4 615 Malta West Netherlands 1 020 12.3 901 10.8 909 10.9 844 10.0 808 9.5 699 8.2 587 6.8 400 4.6 392 4.5 339 3.9 24 506 Netherlands West Norway 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 122 4.6 112 4.2 91 3.4 64 2.4 136 5.0 4 799 Norway Centre Poland 937 5.1 933 5.1 1 084 5.9 1 149 6.3 1 258 6.8 1 050 5.7 1 325 7.2 798 4.3 1 122 6.1 1 331 7.3 23 619 Poland West Portugal 1 312 26.3 1 105 22.3 1 210 24.6 1 157 23.6 1 064 21.8 945 19.4 915 18.9 704 14.5 755 15.5 606 12.3 47 719 Portugal Centre Romania 741 7.6 655 6.7 671 6.9 593 6.1 621 6.5 575 6.0 581 6.1 399 4.2 496 5.3 533 5.8 16 882 Romania Centre Slovakia 71 2.7 75 2.8 76 2.9 81 3.1 66 2.5 94 3.5 93 3.5 90 3.4 100 3.8 117 4.4 1 253 Slovakia Centre Slovenia 41 4.0 48 4.7 46 4.5 60 5.9 40 3.9 37 3.6 28 2.7 22 2.1 29 2.7 37 3.5 921 Slovenia West Spain 3 731 16.3 3 828 16.8 3 673 16.1 3 705 16.2 3 649 16.0 3 441 15.0 3 350 14.5 2 451 10.6 2 550 11.0 2 512 10.8 55 729 Spain West Sweden 293 6.1 273 5.7 276 5.7 269 5.5 273 5.4 306 6.0 288 5.6 226 4.3 232 4.4 265 5.0 9 755 Sweden Total EU/EEA 21 529 9.9 21 525 9.8 21 357 9.8 20 847 9.5 20 343 9.2 18 711 8.5 18 406 8.3 13 535 6.1 14 394 6.5 16 114 7.3 455 263 Total EU/EEA Non-EU/EEA Centre Albania 82 5.7 61 4.2 67 4.6 104 7.2 69 4.8 76 5.3 74 5.1 70 4.9 73 5.1 71 5.0 1 162 Albania West Andorra 4 11.1 5 13.8 3 8.3 3 8.2 3 8.0 8 21.0 - - - - - - - - 78 Andorra East Armenia 161 12.1 217 16.4 205 15.6 212 16.3 254 19.6 293 22.8 313 24.6 251 19.8 297 23.6 390 31.2 3 564 Armenia East Azerbaijan 329 7.0 375 7.8 495 10.2 355 7.2 359 7.2 437 8.7 473 9.4 386 7.6 472 9.3 524 10.3 7 227 Azerbaijan East Belarus 802 17.9 1 052 23.5 1 395 31.1 1 490 33.2 1 540 34.3 1 499 33.5 1 354 30.3 899 20.2 926 21.0 1 028 23.4 20 524 Belarus Centre Bosnia and Herzegovina 3 0.2 20 1.1 14 0.8 22 1.3 15 0.9 22 1.3 30 1.8 14 0.9 35 2.2 50 3.1 384 Bosnia and Herzegovina East Georgia 367 20.6 413 23.2 545 30.7 552 31.1 492 27.7 506 28.5 508 28.6 403 22.7 403 22.8 454 25.8 7 308 Georgia West Israel 348 9.1 329 8.4 292 7.3 258 6.4 299 7.2 299 7.1 270 6.3 263 6.0 289 6.5 300 6.7 7 810 Israel East Kazakhstan 1 202 14.5 1 334 15.9 1 442 16.9 1 684 19.5 1 821 20.7 2 004 22.5 2 413 26.8 2 295 25.2 2 346 25.4 2 689 28.8 32 796 Kazakhstan East Kyrgyzstan 289 10.3 366 12.8 343 11.8 435 14.7 490 16.3 537 17.6 491 15.8 383 12.1 513 16.0 660 20.3 7 753 Kyrgyzstan East Moldova 382 23.5 452 28.5 462 29.6 471 30.7 468 30.9 537 35.9 544 36.8 398 27.2 455 31.3 537 34.5 9 307 Moldova West Monaco 0 0.0 1 5.6 1 5.5 0 0.0 3 16.5 0 0.0 - - - - - - - - 26 Monaco Centre Montenegro 11 3.6 17 5.5 18 5.8 32 10.4 24 7.8 24 7.8 24 7.8 14 4.6 13 4.2 28 9.2 325 Montenegro Centre North Macedonia 15 1.4 1 0.1 24 2.3 28 2.7 44 4.2 45 4.3 64 6.1 29 2.8 41 3.9 35 3.4 353 North Macedonia East Russian Federation 48 025 72.0 55 469 82.9 62 118 92.6 53 689 79.8 53 209 78.8 52 720 78.0 49 177 72.6 36 659 54.2 33 543 49.8 33 396 49.7 633 192 Russian Federation West San Marino 0 0.0 3 18.5 2 12.2 2 12.2 1 6.0 2 12.0 0 0.0 0 0.0 0 0.0 1 6.1 74 San Marino Centre Serbia 148 3.3 127 2.8 182 4.0 171 3.8 179 4.0 181 4.1 208 4.7 125 2.8 180 4.1 171 3.9 3 960 Serbia Centre Serbia excluding Kosovod 146 4.0 121 3.3 180 5.0 160 4.5 176 4.9 174 4.9 204 5.7 124 3.5 172 4.9 151 4.4 3 837 Serbia excluding Kosovod Centre Kosovod 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 7 0.8 4 0.5 1 0.1 8 0.9 20 2.3 123 Kosovod West Switzerland 436 10.9 385 9.5 421 10.3 420 10.1 352 8.4 339 8.0 331 7.8 230 5.4 240 5.6 243 5.6 24 375 Switzerland East Tajikistan 490 12.0 557 13.3 680 15.9 620 14.1 735 16.4 875 19.1 771 16.4 645 13.4 574 11.7 662 13.2 9 574 Tajikistan Centre Türkiye 1 072 2.8 1 497 3.8 1 770 4.4 2 065 5.1 2 389 5.8 2 717 6.5 2 748 6.6 1 763 4.2 2 445 5.8 3 181 7.4 25 487 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine 10 011 47.8 8 991 43.1 7 519 32.7 8 369 42.4 9 298 47.3 9 517 48.7 9 906 50.9 9 868 44.1 9 797 51.0 8 095 42.6 202 924 Ukraine West United Kingdom 4 502 14.2 4 730 14.8 4 731 14.7 4 070 12.6 3 532 10.8 3 443 10.5 3 147 9.5 2 450 7.4 2 420 7.3 2 560 7.7 123 999 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 16 234 Uzbekistan Total non-EU/EEA 68 679 33.7 76 402 37.2 82 729 39.6 75 052 36.2 75 576 36.2 76 081 36.3 72 846 34.6 57 145 26.7 55 062 26.1 55 075 26.0 1 138 437 Total non-EU/EEA WHO European Region West 23 815 11.5 23 992 11.5 23 557 11.3 22 404 10.7 21 174 10.0 19 762 9.3 18 936 8.9 14 132 6.6 14 512 6.8 15 691 7.3 539 079 West Centre 3 807 4.0 4 192 4.4 4 773 4.9 5 076 5.2 5 468 5.6 5 631 5.8 5 958 6.1 4 014 4.1 5 308 5.4 6 626 6.8 88 291 Centre East 62 586 52.3 69 742 58.1 75 756 61.8 68 417 57.1 69 277 57.6 69 399 57.6 66 358 54.9 52 534 42.4 49 635 41.1 48 871 40.5 966 287 East Total WHO European Region 90 208 21.4 97 926 23.1 104 086 24.3 95 897 22.4 95 919 22.4 94 792 22.0 91 252 21.2 70 680 16.2 69 455 16.1 71 188 16.4 1 593 657 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. d Without prejudice to positions on status, and in line with UNSCR 1 244 and the ICJ Opinion on the Kosovo Declaration of Independence 37 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 2: HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2013 2 014 2 015 2 016 2 017 2 018 2 019 2 020 2 021 2022 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 274 6.6 246 5.9 291 6.9 254 5.9 270 6.3 184 4.2 212 4.9 142 3.2 157 3.6 155 3.5 8 446 Austria West Belgium 831 15.2 788 14.3 765 13.8 707 12.7 645 11.5 658 11.7 678 12.0 527 9.3 590 10.4 681 11.9 23 722 Belgium Centre Bulgaria 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 276 8.1 217 6.4 168 5.0 205 6.1 215 6.5 3 257 Bulgaria Centre Croatia 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 88 4.4 97 4.9 66 3.3 71 3.6 89 4.8 1 767 Croatia Centre Cyprus 46 10.9 49 11.7 72 17.5 65 15.8 65 15.6 65 15.4 69 16.1 87 20.0 115 26.3 154 34.9 1 337 Cyprus Centre Czechia 211 4.1 209 4.0 248 4.8 262 5.1 230 4.4 186 3.6 192 3.7 203 3.9 201 3.8 435 8.4 3 930 Czechia West Denmark 178 6.4 196 7.0 205 7.3 191 6.7 192 6.7 170 5.9 146 5.1 133 4.6 115 4.0 149 5.1 6 273 Denmark East Estonia 200 32.5 182 29.6 167 27.2 139 22.5 146 23.6 131 21.1 113 18.1 88 14.0 80 12.7 130 20.5 7 040 Estonia West Finland 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 104 3.8 111 4.1 99 3.6 119 4.4 171 6.2 3 431 Finland West France 3 737 11.8 3 825 11.9 3 559 11.1 3 585 11.1 3 509 10.9 3 269 10.1 3 272 10.1 2 403 7.4 2 421 7.4 2 689 8.2 68 142 France West Germany 2 664 6.8 2 869 7.3 2 891 7.3 2 671 6.6 2 516 6.2 2 237 5.5 2 442 6.0 1 906 4.6 1 799 4.4 2 236 5.4 62 474 Germany West Greece 810 15.1 684 12.9 690 13.1 541 10.4 535 10.2 584 11.2 522 10.0 500 9.6 463 8.9 450 8.8 14 801 Greece Centre Hungary 191 4.1 216 4.6 196 4.2 171 3.6 149 3.2 195 4.2 208 4.4 166 3.5 182 3.9 179 3.9 3 654 Hungary West Iceland 8 5.0 9 5.5 10 6.1 22 13.2 21 12.3 24 13.5 23 12.6 28 15.0 14 7.4 30 15.5 400 Iceland West Ireland 257 11.3 269 11.7 373 16.1 390 16.7 371 15.7 411 17.2 397 16.3 344 14.0 311 12.6 582 23.2 7 114 Ireland West Italy 3 009 10.4 3 061 10.4 2 808 9.5 2 863 9.7 2 741 9.3 2 372 8.1 2 000 6.9 1 120 3.9 1 471 5.1 1 486 5.2 42 214 Italy East Latvia 203 21.9 244 26.6 270 29.6 236 26.1 245 27.4 226 25.4 185 20.9 162 18.4 136 15.5 154 17.7 5 872 Latvia Liechtenstein 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 0 0.0 0 0.0 0 0.0 1 5.2 1 5.1 43 Liechtenstein East Lithuania 125 9.1 90 6.6 115 8.5 165 12.4 220 16.8 117 9.0 110 8.5 97 7.4 93 7.1 152 11.6 2 971 Lithuania West Luxembourgc 111 41.4 112 40.7 118 41.8 123 42.5 99 33.4 83 27.4 78 25.3 48 15.2 69 21.6 45 13.8 2 577 Luxembourgc West Malta 30 14.3 36 16.8 53 24.0 51 22.5 35 15.1 62 25.8 55 21.8 67 25.2 41 15.4 55 20.4 615 Malta West Netherlands 1 020 12.3 901 10.8 909 10.9 844 10.0 808 9.5 699 8.2 587 6.8 400 4.6 392 4.5 339 3.9 24 506 Netherlands West Norway 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 122 4.6 112 4.2 91 3.4 64 2.4 136 5.0 4 799 Norway Centre Poland 937 5.1 933 5.1 1 084 5.9 1 149 6.3 1 258 6.8 1 050 5.7 1 325 7.2 798 4.3 1 122 6.1 1 331 7.3 23 619 Poland West Portugal 1 312 26.3 1 105 22.3 1 210 24.6 1 157 23.6 1 064 21.8 945 19.4 915 18.9 704 14.5 755 15.5 606 12.3 47 719 Portugal Centre Romania 741 7.6 655 6.7 671 6.9 593 6.1 621 6.5 575 6.0 581 6.1 399 4.2 496 5.3 533 5.8 16 882 Romania Centre Slovakia 71 2.7 75 2.8 76 2.9 81 3.1 66 2.5 94 3.5 93 3.5 90 3.4 100 3.8 117 4.4 1 253 Slovakia Centre Slovenia 41 4.0 48 4.7 46 4.5 60 5.9 40 3.9 37 3.6 28 2.7 22 2.1 29 2.7 37 3.5 921 Slovenia West Spain 3 731 16.3 3 828 16.8 3 673 16.1 3 705 16.2 3 649 16.0 3 441 15.0 3 350 14.5 2 451 10.6 2 550 11.0 2 512 10.8 55 729 Spain West Sweden 293 6.1 273 5.7 276 5.7 269 5.5 273 5.4 306 6.0 288 5.6 226 4.3 232 4.4 265 5.0 9 755 Sweden Total EU/EEA 21 529 9.9 21 525 9.8 21 357 9.8 20 847 9.5 20 343 9.2 18 711 8.5 18 406 8.3 13 535 6.1 14 394 6.5 16 114 7.3 455 263 Total EU/EEA Non-EU/EEA Centre Albania 82 5.7 61 4.2 67 4.6 104 7.2 69 4.8 76 5.3 74 5.1 70 4.9 73 5.1 71 5.0 1 162 Albania West Andorra 4 11.1 5 13.8 3 8.3 3 8.2 3 8.0 8 21.0 - - - - - - - - 78 Andorra East Armenia 161 12.1 217 16.4 205 15.6 212 16.3 254 19.6 293 22.8 313 24.6 251 19.8 297 23.6 390 31.2 3 564 Armenia East Azerbaijan 329 7.0 375 7.8 495 10.2 355 7.2 359 7.2 437 8.7 473 9.4 386 7.6 472 9.3 524 10.3 7 227 Azerbaijan East Belarus 802 17.9 1 052 23.5 1 395 31.1 1 490 33.2 1 540 34.3 1 499 33.5 1 354 30.3 899 20.2 926 21.0 1 028 23.4 20 524 Belarus Centre Bosnia and Herzegovina 3 0.2 20 1.1 14 0.8 22 1.3 15 0.9 22 1.3 30 1.8 14 0.9 35 2.2 50 3.1 384 Bosnia and Herzegovina East Georgia 367 20.6 413 23.2 545 30.7 552 31.1 492 27.7 506 28.5 508 28.6 403 22.7 403 22.8 454 25.8 7 308 Georgia West Israel 348 9.1 329 8.4 292 7.3 258 6.4 299 7.2 299 7.1 270 6.3 263 6.0 289 6.5 300 6.7 7 810 Israel East Kazakhstan 1 202 14.5 1 334 15.9 1 442 16.9 1 684 19.5 1 821 20.7 2 004 22.5 2 413 26.8 2 295 25.2 2 346 25.4 2 689 28.8 32 796 Kazakhstan East Kyrgyzstan 289 10.3 366 12.8 343 11.8 435 14.7 490 16.3 537 17.6 491 15.8 383 12.1 513 16.0 660 20.3 7 753 Kyrgyzstan East Moldova 382 23.5 452 28.5 462 29.6 471 30.7 468 30.9 537 35.9 544 36.8 398 27.2 455 31.3 537 34.5 9 307 Moldova West Monaco 0 0.0 1 5.6 1 5.5 0 0.0 3 16.5 0 0.0 - - - - - - - - 26 Monaco Centre Montenegro 11 3.6 17 5.5 18 5.8 32 10.4 24 7.8 24 7.8 24 7.8 14 4.6 13 4.2 28 9.2 325 Montenegro Centre North Macedonia 15 1.4 1 0.1 24 2.3 28 2.7 44 4.2 45 4.3 64 6.1 29 2.8 41 3.9 35 3.4 353 North Macedonia East Russian Federation 48 025 72.0 55 469 82.9 62 118 92.6 53 689 79.8 53 209 78.8 52 720 78.0 49 177 72.6 36 659 54.2 33 543 49.8 33 396 49.7 633 192 Russian Federation West San Marino 0 0.0 3 18.5 2 12.2 2 12.2 1 6.0 2 12.0 0 0.0 0 0.0 0 0.0 1 6.1 74 San Marino Centre Serbia 148 3.3 127 2.8 182 4.0 171 3.8 179 4.0 181 4.1 208 4.7 125 2.8 180 4.1 171 3.9 3 960 Serbia Centre Serbia excluding Kosovod 146 4.0 121 3.3 180 5.0 160 4.5 176 4.9 174 4.9 204 5.7 124 3.5 172 4.9 151 4.4 3 837 Serbia excluding Kosovod Centre Kosovod 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 7 0.8 4 0.5 1 0.1 8 0.9 20 2.3 123 Kosovod West Switzerland 436 10.9 385 9.5 421 10.3 420 10.1 352 8.4 339 8.0 331 7.8 230 5.4 240 5.6 243 5.6 24 375 Switzerland East Tajikistan 490 12.0 557 13.3 680 15.9 620 14.1 735 16.4 875 19.1 771 16.4 645 13.4 574 11.7 662 13.2 9 574 Tajikistan Centre Türkiye 1 072 2.8 1 497 3.8 1 770 4.4 2 065 5.1 2 389 5.8 2 717 6.5 2 748 6.6 1 763 4.2 2 445 5.8 3 181 7.4 25 487 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine 10 011 47.8 8 991 43.1 7 519 32.7 8 369 42.4 9 298 47.3 9 517 48.7 9 906 50.9 9 868 44.1 9 797 51.0 8 095 42.6 202 924 Ukraine West United Kingdom 4 502 14.2 4 730 14.8 4 731 14.7 4 070 12.6 3 532 10.8 3 443 10.5 3 147 9.5 2 450 7.4 2 420 7.3 2 560 7.7 123 999 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 16 234 Uzbekistan Total non-EU/EEA 68 679 33.7 76 402 37.2 82 729 39.6 75 052 36.2 75 576 36.2 76 081 36.3 72 846 34.6 57 145 26.7 55 062 26.1 55 075 26.0 1 138 437 Total non-EU/EEA WHO European Region West 23 815 11.5 23 992 11.5 23 557 11.3 22 404 10.7 21 174 10.0 19 762 9.3 18 936 8.9 14 132 6.6 14 512 6.8 15 691 7.3 539 079 West Centre 3 807 4.0 4 192 4.4 4 773 4.9 5 076 5.2 5 468 5.6 5 631 5.8 5 958 6.1 4 014 4.1 5 308 5.4 6 626 6.8 88 291 Centre East 62 586 52.3 69 742 58.1 75 756 61.8 68 417 57.1 69 277 57.6 69 399 57.6 66 358 54.9 52 534 42.4 49 635 41.1 48 871 40.5 966 287 East Total WHO European Region 90 208 21.4 97 926 23.1 104 086 24.3 95 897 22.4 95 919 22.4 94 792 22.0 91 252 21.2 70 680 16.2 69 455 16.1 71 188 16.4 1 593 657 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. d Without prejudice to positions on status, and in line with UNSCR 1 244 and the ICJ Opinion on the Kosovo Declaration of Independence 38 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 3: HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2013 2 014 2 015 2 016 2 017 2 018 2 019 2 020 2 021 2022 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 51 1.2 70 1.6 45 1.0 52 1.2 53 1.2 38 0.8 39 0.9 31 0.7 31 0.7 34 0.7 2 533 Austria West Belgium 368 6.5 336 5.9 341 6.0 296 5.2 311 5.4 294 5.1 307 5.3 230 3.9 193 3.3 345 5.9 12 880 Belgium Centre Bulgaria 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 35 1.0 41 1.1 31 0.9 32 0.9 113 3.2 823 Bulgaria Centre Croatia 8 0.4 9 0.4 6 0.3 4 0.2 5 0.2 6 0.3 5 0.2 9 0.4 6 0.3 23 1.1 230 Croatia Centre Cyprus 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 13 2.9 31 6.9 19 4.2 34 7.4 64 13.8 462 Cyprus Centre Czechia 24 0.4 23 0.4 18 0.3 24 0.4 24 0.4 22 0.4 30 0.6 48 0.9 32 0.6 435 8.2 1 014 Czechia West Denmark 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 49 1.7 44 1.5 28 1.0 24 0.8 109 3.7 2 284 Denmark East Estonia 125 17.8 109 15.6 103 14.7 90 12.9 73 10.5 59 8.5 65 9.3 59 8.4 45 6.4 120 17.2 3 549 Estonia West Finland 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 49 1.8 37 1.3 35 1.3 43 1.5 102 3.6 1 350 Finland West France 1 820 5.4 1 844 5.4 1 718 5.0 1 812 5.3 1 813 5.3 1 765 5.1 1 778 5.1 1 089 3.1 1 115 3.2 1 371 3.9 36 529 France West Germany 580 1.4 662 1.6 754 1.8 721 1.7 651 1.6 641 1.5 680 1.6 560 1.3 458 1.1 997 2.4 16 091 Germany West Greece 89 1.6 101 1.8 93 1.7 113 2.0 110 2.0 141 2.5 147 2.7 123 2.2 109 2.0 115 2.2 2 976 Greece Centre Hungary 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 8 0.2 16 0.3 15 0.3 19 0.4 26 0.5 446 Hungary West Iceland 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 14 8.2 5 2.9 6 3.4 5 2.8 10 5.5 144 Iceland West Ireland 84 3.6 101 4.3 113 4.8 112 4.7 115 4.8 106 4.3 133 5.4 86 3.4 84 3.3 297 11.6 3 251 Ireland West Italy 849 2.8 793 2.5 817 2.6 860 2.8 869 2.8 657 2.1 504 1.6 286 0.9 379 1.2 402 1.3 12 971 Italy East Latvia 137 12.5 112 10.3 135 12.6 138 13.0 134 12.7 107 10.2 119 11.5 95 9.3 76 7.5 75 7.5 2 844 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 23 Liechtenstein East Lithuania 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 43 2.8 41 2.7 42 2.8 28 1.9 100 6.7 864 Lithuania West Luxembourgc 25 9.3 57 20.8 35 12.5 36 12.5 34 11.6 30 10.0 26 8.5 14 4.5 19 6.0 26 8.1 921 Luxembourgc West Malta 6 2.8 4 1.9 8 3.6 11 4.9 10 4.4 11 4.7 15 6.2 15 6.0 4 1.6 5 2.0 146 Malta West Netherlands 167 2.0 168 2.0 160 1.9 144 1.7 136 1.6 120 1.4 126 1.4 93 1.1 81 0.9 77 0.9 5 893 Netherlands West Norway 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 69 2.6 60 2.3 46 1.7 38 1.4 109 4.1 2 339 Norway Centre Poland 150 0.8 189 1.0 175 0.9 141 0.7 161 0.8 153 0.8 226 1.2 149 0.8 226 1.2 704 3.6 5 760 Poland West Portugal 532 9.7 435 8.0 419 7.7 436 8.0 411 7.6 366 6.7 380 7.0 263 4.8 317 5.8 198 3.6 18 419 Portugal Centre Romania 303 3.0 276 2.7 243 2.4 214 2.1 213 2.1 193 1.9 198 2.0 123 1.2 143 1.5 137 1.4 10 308 Romania Centre Slovakia 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 8 0.3 11 0.4 11 0.4 14 0.5 77 2.8 233 Slovakia Centre Slovenia 7 0.7 5 0.5 7 0.7 2 0.2 3 0.3 1 0.1 6 0.6 7 0.7 5 0.5 5 0.5 130 Slovenia West Spain 647 2.7 661 2.8 614 2.6 659 2.8 635 2.7 574 2.4 523 2.2 391 1.6 416 1.7 419 1.7 11 185 Spain West Sweden 163 3.4 198 4.1 171 3.5 160 3.3 161 3.2 175 3.5 161 3.2 134 2.6 119 2.3 181 3.5 4 892 Sweden Total EU/EEA 6 451 2.8 6 461 2.8 6 287 2.7 6 331 2.7 6 200 2.7 5 747 2.5 5 754 2.5 4 038 1.7 4 095 1.8 6 676 2.9 161 490 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 38 2.6 18 1.3 29 2.0 23 1.6 25 1.7 26 1.8 27 1.9 26 1.8 31 2.2 27 1.9 440 Albania West Andorra 1 2.8 0 0.0 0 0.0 0 0.0 3 8.2 4 10.8 - - - - - - - - 18 Andorra East Armenia 77 4.9 117 7.5 89 5.7 91 5.8 104 6.7 136 8.8 135 8.7 118 7.7 128 8.3 145 9.5 1 550 Armenia East Azerbaijan 185 3.8 229 4.6 232 4.6 201 4.0 208 4.1 219 4.3 248 4.8 173 3.3 218 4.2 242 4.6 2 917 Azerbaijan East Belarus 731 14.0 759 14.6 910 17.4 901 17.3 928 17.8 887 17.0 783 15.0 528 10.2 570 11.0 616 12.0 13 252 Belarus Centre Bosnia and Herzegovina 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 2 0.1 3 0.2 3 0.2 2 0.1 4 0.2 53 Bosnia and Herzegovina East Georgia 123 6.1 151 7.6 172 8.6 166 8.3 139 7.0 166 8.3 160 8.0 127 6.4 127 6.4 163 8.2 2 471 Georgia West Israel 116 3.0 130 3.3 121 3.0 110 2.7 119 2.9 154 3.6 140 3.2 112 2.5 118 2.6 156 3.4 3 822 Israel East Kazakhstan 928 10.2 1 007 11.0 1 033 11.1 1 214 12.9 1 191 12.5 1 209 12.5 1 254 12.9 1 173 11.9 1 243 12.5 1 317 13.1 17 679 Kazakhstan East Kyrgyzstan 210 7.2 282 9.5 277 9.2 314 10.2 346 11.1 331 10.4 352 10.9 291 8.9 328 9.9 434 12.9 4 484 Kyrgyzstan East Moldova 324 18.1 379 21.6 356 20.7 361 21.3 367 22.0 368 22.3 378 23.2 282 17.4 337 21.0 392 22.9 6 773 Moldova West Monaco 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 3 0.9 2 0.6 2 0.6 2 0.6 3 0.9 2 0.6 1 0.3 1 0.3 3 0.9 45 Montenegro Centre North Macedonia 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 0 0.0 2 0.2 0 0.0 2 0.2 4 0.4 23 North Macedonia East Russian Federation 33 673 43.6 37 144 48.0 38 102 49.1 33 166 42.6 32 593 41.8 33 275 42.6 30 947 39.7 22 939 29.4 24 797 31.9 22 177 28.6 421 577 Russian Federation West San Marino 1 5.8 0 0.0 0 0.0 0 0.0 0 0.0 1 5.7 0 0.0 0 0.0 0 0.0 0 0.0 20 San Marino Centre Serbia 14 0.3 17 0.4 6 0.1 16 0.3 11 0.2 14 0.3 19 0.4 9 0.2 7 0.1 14 0.3 798 Serbia Centre Serbia excluding Kosovod 13 0.3 17 0.4 5 0.1 16 0.4 11 0.3 13 0.3 18 0.5 8 0.2 6 0.2 13 0.3 763 Serbia excluding Kosovod Centre Kosovod 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 1 0.1 1 0.1 1 0.1 35 Kosovod West Switzerland 155 3.8 128 3.1 121 2.9 113 2.7 102 2.4 97 2.3 89 2.1 60 1.4 77 1.8 103 2.3 10 761 Switzerland East Tajikistan 327 8.1 429 10.3 469 11.0 418 9.6 470 10.6 546 12.0 549 11.8 439 9.3 348 7.2 375 7.6 5 455 Tajikistan Centre Türkiye 241 0.6 341 0.9 337 0.8 372 0.9 455 1.1 531 1.3 481 1.2 313 0.7 475 1.1 643 1.5 5 797 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 7 722 31.7 6 683 27.5 5 481 27.7 5 864 25.6 6 308 27.7 6 139 27.1 6 333 28.1 5 708 29.5 5 538 24.9 4 117 18.7 132 552 Ukraine West United Kingdom 1 471 4.5 1 605 4.9 1 454 4.4 1 255 3.8 1 209 3.6 1 192 3.5 1 100 3.3 879 2.6 967 2.8 1 462 4.3 51 690 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 7 783 Uzbekistan Total non-EU/EEA 46 337 21.2 49 425 22.4 49 193 22.4 44 590 20.0 44 580 20.1 45 300 20.1 43 002 18.9 33 181 14.8 35 314 15.5 32 394 14.2 689 975 Total non-EU/EEA WHO European Region WHO European Region West 7 313 3.4 7 466 3.4 7 177 3.3 7 071 3.2 6 910 3.2 6 547 3.0 6 294 2.9 4 481 2.0 4 597 2.1 6 518 2.9 201 129 West Centre 861 0.9 968 1.0 902 0.9 877 0.9 966 1.0 1 015 1.0 1 098 1.1 764 0.8 1 029 1.0 2 279 2.3 26 562 Centre East 44 614 32.7 47 452 34.7 47 401 35.7 42 973 31.5 42 904 31.4 43 485 31.8 41 364 30.2 31 974 23.9 33 783 24.7 30 273 22.1 623 751 East Total WHO European Region 52 788 11.8 55 886 12.4 55 480 12.3 50 921 11.2 50 780 11.2 51 047 11.2 48 756 10.6 37 219 8.2 39 409 8.6 39 070 8.5 851 442 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 39 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 3: HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2013 2 014 2 015 2 016 2 017 2 018 2 019 2 020 2 021 2022 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 51 1.2 70 1.6 45 1.0 52 1.2 53 1.2 38 0.8 39 0.9 31 0.7 31 0.7 34 0.7 2 533 Austria West Belgium 368 6.5 336 5.9 341 6.0 296 5.2 311 5.4 294 5.1 307 5.3 230 3.9 193 3.3 345 5.9 12 880 Belgium Centre Bulgaria 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 35 1.0 41 1.1 31 0.9 32 0.9 113 3.2 823 Bulgaria Centre Croatia 8 0.4 9 0.4 6 0.3 4 0.2 5 0.2 6 0.3 5 0.2 9 0.4 6 0.3 23 1.1 230 Croatia Centre Cyprus 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 13 2.9 31 6.9 19 4.2 34 7.4 64 13.8 462 Cyprus Centre Czechia 24 0.4 23 0.4 18 0.3 24 0.4 24 0.4 22 0.4 30 0.6 48 0.9 32 0.6 435 8.2 1 014 Czechia West Denmark 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 49 1.7 44 1.5 28 1.0 24 0.8 109 3.7 2 284 Denmark East Estonia 125 17.8 109 15.6 103 14.7 90 12.9 73 10.5 59 8.5 65 9.3 59 8.4 45 6.4 120 17.2 3 549 Estonia West Finland 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 49 1.8 37 1.3 35 1.3 43 1.5 102 3.6 1 350 Finland West France 1 820 5.4 1 844 5.4 1 718 5.0 1 812 5.3 1 813 5.3 1 765 5.1 1 778 5.1 1 089 3.1 1 115 3.2 1 371 3.9 36 529 France West Germany 580 1.4 662 1.6 754 1.8 721 1.7 651 1.6 641 1.5 680 1.6 560 1.3 458 1.1 997 2.4 16 091 Germany West Greece 89 1.6 101 1.8 93 1.7 113 2.0 110 2.0 141 2.5 147 2.7 123 2.2 109 2.0 115 2.2 2 976 Greece Centre Hungary 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 8 0.2 16 0.3 15 0.3 19 0.4 26 0.5 446 Hungary West Iceland 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 14 8.2 5 2.9 6 3.4 5 2.8 10 5.5 144 Iceland West Ireland 84 3.6 101 4.3 113 4.8 112 4.7 115 4.8 106 4.3 133 5.4 86 3.4 84 3.3 297 11.6 3 251 Ireland West Italy 849 2.8 793 2.5 817 2.6 860 2.8 869 2.8 657 2.1 504 1.6 286 0.9 379 1.2 402 1.3 12 971 Italy East Latvia 137 12.5 112 10.3 135 12.6 138 13.0 134 12.7 107 10.2 119 11.5 95 9.3 76 7.5 75 7.5 2 844 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 23 Liechtenstein East Lithuania 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 43 2.8 41 2.7 42 2.8 28 1.9 100 6.7 864 Lithuania West Luxembourgc 25 9.3 57 20.8 35 12.5 36 12.5 34 11.6 30 10.0 26 8.5 14 4.5 19 6.0 26 8.1 921 Luxembourgc West Malta 6 2.8 4 1.9 8 3.6 11 4.9 10 4.4 11 4.7 15 6.2 15 6.0 4 1.6 5 2.0 146 Malta West Netherlands 167 2.0 168 2.0 160 1.9 144 1.7 136 1.6 120 1.4 126 1.4 93 1.1 81 0.9 77 0.9 5 893 Netherlands West Norway 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 69 2.6 60 2.3 46 1.7 38 1.4 109 4.1 2 339 Norway Centre Poland 150 0.8 189 1.0 175 0.9 141 0.7 161 0.8 153 0.8 226 1.2 149 0.8 226 1.2 704 3.6 5 760 Poland West Portugal 532 9.7 435 8.0 419 7.7 436 8.0 411 7.6 366 6.7 380 7.0 263 4.8 317 5.8 198 3.6 18 419 Portugal Centre Romania 303 3.0 276 2.7 243 2.4 214 2.1 213 2.1 193 1.9 198 2.0 123 1.2 143 1.5 137 1.4 10 308 Romania Centre Slovakia 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 8 0.3 11 0.4 11 0.4 14 0.5 77 2.8 233 Slovakia Centre Slovenia 7 0.7 5 0.5 7 0.7 2 0.2 3 0.3 1 0.1 6 0.6 7 0.7 5 0.5 5 0.5 130 Slovenia West Spain 647 2.7 661 2.8 614 2.6 659 2.8 635 2.7 574 2.4 523 2.2 391 1.6 416 1.7 419 1.7 11 185 Spain West Sweden 163 3.4 198 4.1 171 3.5 160 3.3 161 3.2 175 3.5 161 3.2 134 2.6 119 2.3 181 3.5 4 892 Sweden Total EU/EEA 6 451 2.8 6 461 2.8 6 287 2.7 6 331 2.7 6 200 2.7 5 747 2.5 5 754 2.5 4 038 1.7 4 095 1.8 6 676 2.9 161 490 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 38 2.6 18 1.3 29 2.0 23 1.6 25 1.7 26 1.8 27 1.9 26 1.8 31 2.2 27 1.9 440 Albania West Andorra 1 2.8 0 0.0 0 0.0 0 0.0 3 8.2 4 10.8 - - - - - - - - 18 Andorra East Armenia 77 4.9 117 7.5 89 5.7 91 5.8 104 6.7 136 8.8 135 8.7 118 7.7 128 8.3 145 9.5 1 550 Armenia East Azerbaijan 185 3.8 229 4.6 232 4.6 201 4.0 208 4.1 219 4.3 248 4.8 173 3.3 218 4.2 242 4.6 2 917 Azerbaijan East Belarus 731 14.0 759 14.6 910 17.4 901 17.3 928 17.8 887 17.0 783 15.0 528 10.2 570 11.0 616 12.0 13 252 Belarus Centre Bosnia and Herzegovina 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 2 0.1 3 0.2 3 0.2 2 0.1 4 0.2 53 Bosnia and Herzegovina East Georgia 123 6.1 151 7.6 172 8.6 166 8.3 139 7.0 166 8.3 160 8.0 127 6.4 127 6.4 163 8.2 2 471 Georgia West Israel 116 3.0 130 3.3 121 3.0 110 2.7 119 2.9 154 3.6 140 3.2 112 2.5 118 2.6 156 3.4 3 822 Israel East Kazakhstan 928 10.2 1 007 11.0 1 033 11.1 1 214 12.9 1 191 12.5 1 209 12.5 1 254 12.9 1 173 11.9 1 243 12.5 1 317 13.1 17 679 Kazakhstan East Kyrgyzstan 210 7.2 282 9.5 277 9.2 314 10.2 346 11.1 331 10.4 352 10.9 291 8.9 328 9.9 434 12.9 4 484 Kyrgyzstan East Moldova 324 18.1 379 21.6 356 20.7 361 21.3 367 22.0 368 22.3 378 23.2 282 17.4 337 21.0 392 22.9 6 773 Moldova West Monaco 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 3 0.9 2 0.6 2 0.6 2 0.6 3 0.9 2 0.6 1 0.3 1 0.3 3 0.9 45 Montenegro Centre North Macedonia 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 0 0.0 2 0.2 0 0.0 2 0.2 4 0.4 23 North Macedonia East Russian Federation 33 673 43.6 37 144 48.0 38 102 49.1 33 166 42.6 32 593 41.8 33 275 42.6 30 947 39.7 22 939 29.4 24 797 31.9 22 177 28.6 421 577 Russian Federation West San Marino 1 5.8 0 0.0 0 0.0 0 0.0 0 0.0 1 5.7 0 0.0 0 0.0 0 0.0 0 0.0 20 San Marino Centre Serbia 14 0.3 17 0.4 6 0.1 16 0.3 11 0.2 14 0.3 19 0.4 9 0.2 7 0.1 14 0.3 798 Serbia Centre Serbia excluding Kosovod 13 0.3 17 0.4 5 0.1 16 0.4 11 0.3 13 0.3 18 0.5 8 0.2 6 0.2 13 0.3 763 Serbia excluding Kosovod Centre Kosovod 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 1 0.1 1 0.1 1 0.1 35 Kosovod West Switzerland 155 3.8 128 3.1 121 2.9 113 2.7 102 2.4 97 2.3 89 2.1 60 1.4 77 1.8 103 2.3 10 761 Switzerland East Tajikistan 327 8.1 429 10.3 469 11.0 418 9.6 470 10.6 546 12.0 549 11.8 439 9.3 348 7.2 375 7.6 5 455 Tajikistan Centre Türkiye 241 0.6 341 0.9 337 0.8 372 0.9 455 1.1 531 1.3 481 1.2 313 0.7 475 1.1 643 1.5 5 797 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 7 722 31.7 6 683 27.5 5 481 27.7 5 864 25.6 6 308 27.7 6 139 27.1 6 333 28.1 5 708 29.5 5 538 24.9 4 117 18.7 132 552 Ukraine West United Kingdom 1 471 4.5 1 605 4.9 1 454 4.4 1 255 3.8 1 209 3.6 1 192 3.5 1 100 3.3 879 2.6 967 2.8 1 462 4.3 51 690 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 7 783 Uzbekistan Total non-EU/EEA 46 337 21.2 49 425 22.4 49 193 22.4 44 590 20.0 44 580 20.1 45 300 20.1 43 002 18.9 33 181 14.8 35 314 15.5 32 394 14.2 689 975 Total non-EU/EEA WHO European Region WHO European Region West 7 313 3.4 7 466 3.4 7 177 3.3 7 071 3.2 6 910 3.2 6 547 3.0 6 294 2.9 4 481 2.0 4 597 2.1 6 518 2.9 201 129 West Centre 861 0.9 968 1.0 902 0.9 877 0.9 966 1.0 1 015 1.0 1 098 1.1 764 0.8 1 029 1.0 2 279 2.3 26 562 Centre East 44 614 32.7 47 452 34.7 47 401 35.7 42 973 31.5 42 904 31.4 43 485 31.8 41 364 30.2 31 974 23.9 33 783 24.7 30 273 22.1 623 751 East Total WHO European Region 52 788 11.8 55 886 12.4 55 480 12.3 50 921 11.2 50 780 11.2 51 047 11.2 48 756 10.6 37 219 8.2 39 409 8.6 39 070 8.5 851 442 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 40 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 4: HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 EU/EEA West Austria 177 155 172 175 196 122 133 81 101 97 4 447 West Belgium 497 438 447 414 360 362 354 267 311 340 10 482 Centre Bulgaria 72 98 111 96 120 170 122 96 111 106 1 354 Centre Croatia 70 79 99 95 97 82 82 57 63 70 1 369 Centre Cyprus 35 39 51 47 47 44 41 62 80 84 816 Centre Czechia 180 171 211 213 182 137 151 145 143 179 2 906 West Denmark 116 132 126 121 123 110 99 80 60 71 3 583 East Estonia 9 3 18 9 16 11 16 8 9 11 207 West Finland 43 55 53 48 32 38 37 34 37 46 1 399 West France 1 598 1 668 1 471 1 346 1 426 1 495 1 484 1 175 1 144 1 145 27 963 West Germany 1 785 1 968 1 891 1 736 1 626 1 425 1 459 1 011 998 1 047 37 570 West Greece 406 419 462 326 312 306 287 277 258 249 9 234 Centre Hungary 163 176 134 119 111 146 167 128 144 112 2 730 West Iceland 0 0 0 8 4 15 15 19 10 19 195 West Ireland 160 178 251 274 261 296 268 217 187 354 4 202 West Italy 1 526 1 570 1 458 1 418 1 385 1 187 1 111 638 731 773 19 727 East Latvia 27 28 34 24 24 20 18 11 11 9 464 Liechtenstein 0 1 0 0 0 0 0 0 1 0 4 East Lithuania 31 12 29 29 21 19 20 18 21 29 366 West Luxembourgc 68 58 52 57 41 51 40 23 42 21 1 370 West Malta 16 25 45 38 23 38 0 30 20 30 302 West Netherlands 827 709 712 663 622 539 425 304 271 235 17 993 West Norway 98 115 70 87 88 73 61 63 36 59 2 373 Centre Poland 280 337 358 414 394 313 350 196 228 199 4 888 West Portugal 594 525 675 622 565 502 508 414 412 355 13 638 Centre Romania 105 143 140 153 175 168 191 149 202 199 2 217 Centre Slovakia 58 53 55 60 52 60 51 50 49 47 821 Centre Slovenia 28 35 37 50 28 29 20 14 21 26 674 West Spain 2 334 2 567 2 443 2 510 2 517 2 406 2 371 1 642 1 664 1 617 34 917 West Sweden 147 119 118 136 128 158 152 116 119 127 4 760 Total EU/EEA 11 450 11 876 11 723 11 288 10 976 10 322 10 033 7 325 7 484 7 656 212 971 Non-EU/EEA Centre Albania 11 9 13 11 6 8 29 22 18 33 231 West Andorra 3 4 2 3 2 4 - - - - 38 East Armenia 13 10 12 17 17 41 50 35 42 61 325 East Azerbaijan 11 12 35 17 41 45 50 56 64 80 453 East Belarus 41 53 58 71 72 103 82 79 81 88 849 Centre Bosnia and Herzegovina 3 16 10 18 12 14 23 9 16 25 201 East Georgia 69 67 161 131 130 154 97 105 112 110 1 287 West Israel 172 151 141 129 150 133 121 135 143 135 3 130 East Kazakhstan 37 47 82 121 145 163 206 223 273 325 1 761 East Kyrgyzstan 14 18 23 37 45 47 38 42 89 90 456 East Moldova 4 9 10 18 29 32 29 18 19 20 229 West Monaco 0 1 1 0 2 0 - - - - 18 Centre Montenegro 6 13 14 25 22 18 15 11 6 18 211 Centre North Macedonia 13 1 21 18 34 37 48 26 37 25 277 East Russian Federation 0 0 0 0 0 0 0 1 499 1 391 1 782 4 672 West San Marino 0 0 0 0 0 0 0 0 0 0 21 Centre Serbia 106 92 138 120 126 144 182 109 147 106 2 094 Centre Serbia excluding Kosovod 105 87 136 117 126 142 179 108 140 97 2 052 Centre Kosovod 1 5 2 3 - 2 3 1 7 9 42 West Switzerland 0 0 2 0 0 0 0 0 0 0 8 East Tajikistan 0 3 3 11 13 24 11 13 19 27 126 Centre Türkiye 187 281 350 403 494 540 539 297 351 445 4 306 East Turkmenistan - - - - - - - - - - 0 East Ukraine 262 277 368 435 490 506 467 390 428 289 4 614 West United Kingdom 3 040 3 222 3 205 2 626 2 249 2 137 1 877 1 212 1 238 1 166 78 521 East Uzbekistan - - - - - - - - - - 29 Total non-EU/EEA 3 992 4 286 4 649 4 211 4 079 4 150 3 864 4 281 4 474 4 825 103 857 WHO European Region West West 13 607 14 079 13 797 12 737 12 112 11 397 10 802 7 738 7 782 7 886 275 891 Centre Centre 1 317 1 543 1 742 1 842 1 900 1 910 2 011 1 371 1 616 1 674 25 095 East East 518 539 833 920 1 043 1 165 1 084 2 497 2 559 2 921 15 838 Total WHO European Region 15 442 16 161 16 372 15 499 15 055 14 472 13 897 11 606 11 957 12 481 316 824 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 41 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 5: HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 EU/EEA West Austria 30 29 33 18 18 15 21 15 16 11 2 154 West Belgium 21 17 16 8 14 21 14 5 16 37 915 Centre Bulgaria 33 48 29 22 33 34 37 15 14 18 678 Centre Croatia 0 0 2 0 0 0 1 3 1 3 75 Centre Cyprus 0 3 1 2 0 1 3 3 5 2 29 Centre Czechia 6 10 5 7 5 8 8 14 7 60 223 West Denmark 13 11 8 9 6 6 4 1 10 18 592 East Estonia 81 67 55 31 15 24 20 10 5 5 4 235 West Finland 3 7 7 6 10 6 8 4 10 33 465 West France 114 106 80 69 74 76 90 59 52 77 2 401 West Germany 115 131 148 138 119 151 165 171 120 270 4 980 West Greece 268 120 97 101 94 124 89 87 95 67 2 296 Centre Hungary 1 1 2 3 1 1 1 1 0 3 36 West Iceland 1 1 0 9 3 2 2 0 1 1 71 West Ireland 21 27 51 20 18 14 19 11 8 30 1 735 West Italy 181 143 121 114 104 113 104 50 80 82 2 964 East Latvia 77 80 93 63 81 75 45 41 27 35 3 583 Liechtenstein 0 0 0 0 0 0 0 0 0 0 5 East Lithuania 65 39 46 88 143 55 51 31 29 32 2 009 West Luxembourgc 9 35 25 34 16 13 4 5 5 12 419 West Malta 3 0 0 1 0 0 0 0 0 0 10 West Netherlands 8 1 3 5 7 2 9 2 5 5 876 West Norway 8 7 8 8 7 6 8 8 4 24 684 Centre Poland 47 50 51 39 30 22 24 11 14 30 6 463 West Portugal 123 65 66 51 38 37 47 29 27 20 19 590 Centre Romania 361 218 200 139 102 86 76 40 55 42 1 953 Centre Slovakia 0 1 3 1 0 1 0 0 1 9 28 Centre Slovenia 2 2 1 1 0 0 2 1 4 0 31 West Spain 190 159 131 146 127 121 97 65 53 55 4 023 West Sweden 13 14 15 26 20 23 21 13 3 12 1 339 Total EU/EEA 1 794 1 392 1 297 1 159 1 085 1 037 970 695 667 993 64 862 Non-EU/EEA Centre Albania 0 1 0 0 0 0 0 0 1 2 8 West Andorra 0 0 0 0 0 0 - - - - 11 East Armenia 33 42 37 35 39 33 38 22 24 31 811 East Azerbaijan 204 185 184 163 101 108 102 87 96 70 3 560 East Belarus 201 376 790 600 485 391 363 222 221 287 10 296 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 19 East Georgia 172 194 187 204 150 96 115 62 69 79 3 276 West Israel 72 44 39 25 34 34 19 23 12 20 1 368 East Kazakhstan 729 779 826 900 900 920 1 219 1 059 848 809 21 532 East Kyrgyzstan 182 179 162 209 205 138 105 47 37 24 4 018 East Moldova 22 61 38 40 42 59 39 17 29 35 3 016 West Monaco 0 0 0 0 0 0 - - - - 8 Centre Montenegro 0 0 0 0 1 1 0 1 0 0 9 Centre North Macedonia 0 0 0 0 0 0 0 0 0 0 2 East Russian Federation 0 0 0 0 0 0 0 15 203 16 702 11 416 43 321 West San Marino 0 0 0 0 0 0 0 0 0 0 11 Centre Serbia 11 5 4 1 4 2 3 3 3 990 Centre Serbia excluding Kosovod 11 5 4 1 4 2 3 0 3 3 988 Centre Kosovod - - - - - - - - - - 2 West Switzerland 0 0 0 1 0 0 0 0 0 0 1 East Tajikistan 214 227 248 202 252 199 135 83 76 81 3 952 Centre Türkiye 4 10 13 8 14 24 10 14 11 17 220 East Turkmenistan - - - - - - - - - - 0 East Ukraine 5 847 4 670 3 449 3 692 3 975 3 734 4 174 5 938 5 312 3 820 143 979 West United Kingdom 118 151 194 147 144 112 113 85 97 66 6 797 East Uzbekistan - - - - - - - - - - 11 390 Total non-EU/EEA 7 809 6 924 6 171 6 227 6 346 5 851 6 435 22 863 23 538 16 760 258 595 WHO European Region West West 1 311 1 068 1 042 936 853 876 834 633 614 840 53 710 Centre Centre 465 349 311 223 190 180 165 103 116 189 10 764 East East 7 827 6 899 6 115 6 227 6 388 5 832 6 406 22 822 23 475 16 724 258 978 Total WHO European Region 9 603 8 316 7 468 7 386 7 431 6 888 7 405 23 558 24 205 17 753 323 452 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 42 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 6: HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 EU/EEA West Austria 94 110 109 89 92 65 80 64 58 60 3 478 West Belgium 450 433 398 373 380 357 387 272 259 403 14 626 Centre Bulgaria 70 93 86 84 85 104 98 84 110 199 1 955 Centre Croatia 13 12 13 12 8 10 13 11 11 27 454 Centre Cyprus 16 10 26 27 32 32 50 38 59 128 873 Centre Czechia 45 45 46 54 59 56 55 82 70 434 1 462 West Denmark 90 102 126 100 93 91 87 65 48 116 3 750 East Estonia 188 162 144 116 89 67 79 72 34 98 1 918 West Finland 67 70 79 83 70 55 44 40 33 70 1 834 West France 2 206 2 211 1 793 1 658 1 720 1 968 1 902 1 279 1 313 1 459 42 130 West Germany 624 819 973 886 794 757 773 533 447 1 061 18 730 West Greece 126 144 130 147 157 178 194 135 122 124 4 090 Centre Hungary 25 28 22 28 23 13 28 26 22 43 621 West Iceland 0 0 0 9 2 15 6 10 7 13 162 West Ireland 132 127 132 143 168 167 167 100 90 299 4 118 West Italy 1 706 1 668 1 640 1 767 1 658 1 253 1 095 600 814 812 24 917 East Latvia 125 133 156 144 136 112 112 108 67 95 2 549 Liechtenstein 0 0 0 1 0 0 0 0 0 0 13 East Lithuania 60 74 65 70 72 67 59 68 56 152 1 101 West Luxembourgc 48 65 59 59 63 47 51 29 38 31 1 460 West Malta 10 9 15 21 17 14 0 14 7 12 229 West Netherlands 275 271 283 245 225 196 205 154 137 133 9 041 West Norway 123 140 138 120 115 101 100 66 58 138 3 783 Centre Poland 90 110 113 110 103 73 98 63 81 187 2 289 West Portugal 1 072 898 840 869 826 724 695 479 576 383 30 561 Centre Romania 411 434 483 500 534 496 490 314 332 286 9 181 Centre Slovakia 21 18 23 18 15 19 28 16 22 58 350 Centre Slovenia 9 6 10 10 11 8 10 11 9 11 199 West Spain 1 183 1 131 1 055 1 090 1 141 1 047 1 094 697 779 712 20 300 West Sweden 218 229 211 202 212 213 204 148 133 199 6 554 Total EU/EEA 9 497 9 552 9 168 9 035 8 900 8 305 8 204 5 578 5 792 7 743 212 728 Non-EU/EEA Centre Albania 101 62 77 115 87 80 71 73 79 51 1 264 West Andorra 1 0 0 0 2 7 - - - - 30 East Armenia 179 272 236 244 290 343 352 303 352 435 3 832 East Azerbaijan 275 378 445 343 373 475 539 407 513 592 5 455 East Belarus 1 265 1 349 1 416 1 671 1 868 1 861 1 659 1 098 1 159 1 240 21 926 Centre Bosnia and Herzegovina 0 7 4 6 2 10 10 6 3 4 152 East Georgia 240 294 357 372 342 411 445 351 341 415 4 984 West Israel 175 206 201 195 187 218 183 159 180 178 5 807 East Kazakhstan 1 268 1 391 1 439 1 749 1 869 2 061 2 126 2 032 2 286 2 679 24 936 East Kyrgyzstan 277 395 386 425 484 547 561 475 611 881 6 381 East Moldova 337 616 578 547 561 617 683 404 462 650 10 211 West Monaco 0 0 0 0 1 0 - - - - 13 Centre Montenegro 2 4 4 9 4 6 4 2 3 6 106 Centre North Macedonia 2 0 4 10 8 6 17 3 5 11 85 East Russian Federation 0 0 0 0 0 0 0 38 937 38 381 41 119 118 437 West San Marino 0 0 0 0 0 0 0 0 0 0 23 Centre Serbia 22 35 28 35 31 35 24 13 12 38 969 Centre Serbia excluding Kosovod 20 34 28 30 29 30 22 12 12 26 891 Centre Kosovod 2 1 - 5 2 5 2 1 - 12 78 West Switzerland 0 0 0 0 0 0 0 0 0 0 9 East Tajikistan 474 628 751 703 807 1 051 970 884 752 863 9 440 Centre Türkiye 428 495 583 646 775 951 806 536 666 789 9 367 East Turkmenistan - - - - - - - - - - 0 East Ukraine 11 472 10 648 9 043 10 005 11 025 11 317 11 491 9 140 9 526 8 053 180 760 West United Kingdom 2 268 2 359 2 100 1 928 1 708 1 750 1 687 1 200 1 281 1 841 75 924 East Uzbekistan - - - - - - - - - - 4 711 Total non-EU/EEA 18 786 19 139 17 652 19 003 20 424 21 746 21 628 56 023 56 612 59 845 484 822 WHO European Region West West 10 868 10 992 10 282 9 984 9 631 9 223 8 954 6 044 6 380 8 044 271 569 Centre Centre 1 255 1 359 1 522 1 664 1 777 1 899 1 802 1 278 1 484 2 272 29 327 East East 16 160 16 340 15 016 16 389 17 916 18 929 19 076 54 279 54 540 57 272 396 641 Total WHO European Region 28 283 28 691 26 820 28 037 29 324 30 051 29 832 61 601 62 404 67 588 697 537 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 43 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 7: HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 EU/EEA West Austria 0 1 0 1 1 1 0 0 1 0 68 West Belgium 13 15 18 15 9 8 9 11 10 19 902 Centre Bulgaria 5 1 1 0 3 3 1 4 2 5 39 Centre Croatia 0 1 0 0 0 0 0 1 0 1 16 Centre Cyprus 0 0 1 0 0 0 1 0 4 0 9 Centre Czechia 0 1 0 2 0 0 0 0 0 26 35 West Denmark 5 5 4 1 5 2 0 2 3 7 125 East Estonia 2 5 1 0 0 0 0 3 4 7 68 West Finland 2 2 3 2 0 2 4 1 1 2 41 West France 36 54 48 30 27 40 55 25 36 47 771 West Germany 23 26 29 24 18 20 14 11 11 61 561 West Greece 0 1 0 4 1 1 4 3 1 6 79 Centre Hungary 1 1 2 1 2 0 0 0 3 1 21 West Iceland 0 0 0 0 0 2 1 0 0 0 4 West Ireland 3 2 5 3 0 4 3 2 3 12 109 West Italy 13 15 16 11 16 12 3 7 3 7 233 East Latvia 10 4 3 6 3 5 2 5 1 2 90 Liechtenstein 0 0 0 0 0 0 0 0 0 0 1 East Lithuania 1 2 0 1 1 0 0 0 1 15 23 West Luxembourgc 2 3 0 0 0 0 2 1 1 0 32 West Malta 0 0 0 2 0 2 0 1 0 0 5 West Netherlands 12 15 12 7 9 7 6 2 4 0 415 West Norway 1 3 2 2 2 6 2 0 4 5 102 Centre Poland 4 3 8 1 3 2 5 3 1 18 246 West Portugal 10 8 6 5 6 1 0 1 2 1 528 Centre Romania 24 18 18 7 15 9 11 7 7 8 796 Centre Slovakia 0 0 0 0 0 0 0 0 0 2 2 Centre Slovenia 0 0 0 0 0 0 0 1 0 0 9 West Spain 18 4 3 9 4 8 8 0 5 5 157 West Sweden 7 7 15 10 14 12 12 9 12 13 307 Total EU/EEA 192 197 195 144 139 147 143 100 120 270 5 794 Non-EU/EEA Centre Albania 6 3 1 1 1 2 1 1 3 2 42 West Andorra 0 0 0 0 0 0 - - - - 1 East Armenia 5 7 4 1 5 6 3 9 3 3 49 East Azerbaijan 10 18 16 10 11 9 4 2 7 12 154 East Belarus 16 15 26 20 13 4 10 5 5 4 332 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 1 1 East Georgia 4 5 6 4 3 6 3 3 2 6 119 West Israel 9 9 4 4 6 7 3 3 9 5 283 East Kazakhstan 36 22 25 24 34 24 26 23 30 22 471 East Kyrgyzstan 10 18 23 16 16 23 21 12 25 20 313 East Moldova 13 19 14 10 11 13 19 12 12 12 245 West Monaco 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 0 2 East Russian Federation 0 0 0 0 0 0 0 162 153 129 444 West San Marino 0 0 0 0 0 0 0 0 0 0 1 Centre Serbia 4 1 1 2 1 2 - 2 55 Centre Serbia excluding Kosovod 4 1 0 2 0 0 2 0 1 0 49 Centre Kosovod - - 1 - - 1 - - 1 - 6 West Switzerland 0 0 0 0 0 0 0 0 0 0 0 East Tajikistan 49 59 56 54 60 53 47 43 31 30 582 Centre Türkiye 11 22 23 15 12 13 15 12 15 11 220 East Turkmenistan - - - - - - - - - - 0 East Ukraine 111 122 98 77 86 71 79 67 48 35 2 450 West United Kingdom 90 89 50 44 59 58 68 28 35 53 3 008 East Uzbekistan - - - - - - - - - - 363 Total non-EU/EEA 374 409 347 282 317 290 301 382 380 345 9 140 WHO European Region West 244 259 215 174 177 193 194 107 141 243 7 733 Centre 55 51 55 29 36 30 36 29 37 75 1 497 East 267 296 272 223 243 214 214 346 322 297 5 703 Total WHO European Region 566 606 542 426 456 437 444 482 500 615 14 933 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 44 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 8: HIV diagnoses in 2022, 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 97 97 3 8 11 26 34 60 0 0 0 1 0 1 2 1 3 2 15 17 189 Austria West Belgium 323 340 7 30 37 233 153 403 10 9 19 0 0 0 1 3 4 94 163 257 1 060 Belgium Centre Bulgaria 106 106 2 16 18 109 90 199 2 3 5 0 0 0 0 0 0 0 0 0 328 Bulgaria Centre Croatia 69 70 0 3 3 18 9 27 1 0 1 0 0 0 0 0 0 4 8 12 113 Croatia Centre Cyprus 84 84 0 2 2 63 65 128 0 0 0 0 0 0 0 0 0 1 3 4 218 Cyprus Centre Czechia 179 179 27 33 60 303 131 434 12 14 26 2 2 4 4 2 6 87 74 161 870 Czechia West Denmark 71 71 4 14 18 79 37 116 7 0 7 0 0 0 1 1 2 18 26 44 258 Denmark East Estonia 11 11 2 3 5 63 35 98 2 5 7 0 0 0 0 0 0 53 76 129 250 Estonia West Finland 46 46 8 25 33 41 29 70 2 0 2 1 1 2 2 3 5 48 67 115 273 Finland West France 1 145 1 145 19 56 77 879 580 1 459 20 27 47 0 0 0 6 3 9 447 878 1 421 4 158 France West Germany 1 047 1 047 82 188 270 752 308 1 061 33 28 61 0 0 0 0 0 0 130 665 800 3 239 Germany West Greece 249 249 15 52 67 72 52 124 1 5 6 0 0 0 0 0 0 27 92 119 565 Greece Centre Hungary 112 112 0 3 3 20 23 43 0 1 1 0 0 0 0 0 0 6 40 65 224 Hungary West Iceland 19 19 0 1 1 8 5 13 0 0 0 0 0 0 0 0 0 2 5 7 40 Iceland West Ireland 350 354 6 24 30 211 85 299 10 2 12 0 0 0 0 1 1 70 120 191 887 Ireland West Italy 773 773 12 70 82 338 474 812 2 5 7 0 0 0 1 2 3 49 162 211 1 888 Italy East Latvia 9 9 4 31 35 40 55 95 1 1 2 0 0 0 0 0 0 30 58 88 229 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 Liechtenstein East Lithuania 29 29 7 25 32 77 75 152 9 6 15 0 0 0 0 0 0 7 17 24 252 Lithuania West Luxembourgc 21 21 3 9 12 19 12 31 0 0 0 0 0 0 0 0 0 4 3 7 71 Luxembourgc West Malta 30 30 0 0 0 4 8 12 0 0 0 0 0 0 1 0 1 0 17 17 60 Malta West Netherlands 221 235 0 5 5 69 64 133 0 0 0 0 2 2 0 0 0 8 47 56 431 Netherlands West Norway 59 59 9 15 24 90 48 138 2 3 5 1 0 1 0 0 0 7 11 18 245 Norway Centre Poland 199 199 6 24 30 112 75 187 5 13 18 0 0 0 0 0 0 581 1 020 1 616 2 050 Poland West Portugal 355 355 1 19 20 184 199 383 1 0 1 0 0 0 1 0 1 11 33 44 804 Portugal Centre Romania 199 199 6 36 42 84 202 286 3 5 8 0 0 0 0 0 0 44 91 135 670 Romania Centre Slovakia 46 47 4 5 9 38 20 58 1 1 2 0 0 0 0 1 1 34 44 80 197 Slovakia Centre Slovenia 26 26 0 0 0 4 7 11 0 0 0 0 0 0 0 0 0 1 4 5 42 Slovenia West Spain 1 611 1 617 9 46 55 303 409 712 2 3 5 0 0 0 0 3 3 105 440 545 2 937 Spain West Sweden 127 127 1 11 12 122 77 199 8 5 13 0 0 0 2 5 7 48 40 88 446 Sweden Total EU/EEA 7 613 7 656 237 754 993 4 361 3 361 7 743 134 136 270 5 5 10 21 25 46 1 918 4 220 6 277 22 995 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 33 33 0 2 2 27 24 51 0 2 2 0 0 0 0 0 0 0 10 10 98 Albania West Andorra - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Andorra East Armenia 61 61 1 30 31 142 293 435 1 2 3 0 0 0 0 0 0 1 4 5 535 Armenia East Azerbaijan 80 80 3 67 70 223 369 592 11 1 12 0 0 0 0 0 0 5 7 12 766 Azerbaijan East Belarus 88 88 51 236 287 554 686 1 240 1 3 4 0 0 0 0 0 0 10 15 25 1 644 Belarus Centre Bosnia and Herzegovina 25 25 0 0 0 1 3 4 1 0 1 0 0 0 0 0 0 2 22 24 54 Bosnia and Herzegovina East Georgia 110 110 3 76 79 153 262 415 4 2 6 0 0 0 0 0 0 3 4 7 617 Georgia West Israel 135 135 9 11 20 95 83 178 1 4 5 0 0 0 0 0 0 51 67 118 456 Israel East Kazakhstan 325 325 122 687 809 1 125 1 554 2 679 8 14 22 0 0 0 0 0 0 62 109 171 4 006 Kazakhstan East Kyrgyzstan 90 90 2 22 24 396 485 881 12 8 20 1 0 1 0 0 0 23 55 78 1 094 Kyrgyzstan East Moldova 20 20 5 30 35 296 354 650 5 7 12 0 0 0 0 0 0 86 126 212 929 Moldova West Monaco - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Monaco Centre Montenegro 18 18 0 0 0 3 3 6 0 0 0 0 0 0 0 0 0 0 7 7 31 Montenegro Centre North Macedonia 23 25 0 0 0 4 7 11 0 0 0 0 0 0 0 0 0 0 5 5 41 North Macedonia East Russian Federation 1 782 1 782 1 607 9 809 11 416 20 081 21 038 41 119 72 57 129 0 0 0 0 0 0 417 710 1 127 55 573 Russian Federation West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 San Marino Centre Serbia 106 106 1 2 3 12 26 38 - - 0 - - 0 - - 0 1 37 38 185 Serbia Centre Serbia excluding Kosovod 97 97 1 2 3 11 15 26 0 0 0 0 0 0 0 0 0 1 37 38 164 Serbia excluding Kosovod Centre Kosovod 9 9 - - 0 1 11 12 - - 0 - - 0 - - 0 - - 0 21 Kosovod West Switzerland 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 103 243 349 349 Switzerland East Tajikistan 27 27 1 80 81 338 525 863 17 13 30 0 0 0 0 0 0 19 17 36 1 037 Tajikistan Centre Türkiye 445 445 1 16 17 147 642 789 5 6 11 0 0 0 0 0 0 490 2 072 2 562 3 824 Türkiye East Turkmenistan 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Turkmenistan East Ukraine 289 289 612 3 208 3 820 3 480 4 573 8 053 17 18 35 0 0 0 0 0 0 8 7 15 12 212 Ukraine West United Kingdom 1 163 1 166 8 57 66 1 143 692 1 841 31 22 53 6 11 17 15 12 27 259 603 870 4 040 United Kingdom East Uzbekistan 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Uzbekistan Total non-EU/EEA 4 820 4 825 2 426 14 333 16 760 28 220 31 619 59 845 186 159 345 7 11 18 15 12 27 1 540 4 121 5 672 87 492 Total non-EU/EEA WHO European Region WHO European Region West 7 842 7 886 196 641 840 4 668 3 349 8 044 130 113 243 9 14 23 32 34 66 1 483 3 698 5 295 22 397 West Centre 1 670 1 674 47 142 189 945 1 327 2 272 30 45 75 2 2 4 4 3 7 1 251 3 437 4 724 8 945 Centre East 2 921 2 921 2 420 14 304 16 724 26 968 30 304 57 272 160 137 297 1 0 1 0 0 0 724 1 205 1 929 79 144 East Total WHO European Region 12 433 12 481 2 663 15 087 17 753 32 581 34 980 67 588 320 295 615 12 16 28 36 37 73 3 458 8 340 11 948 110 486 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 2022 in tables 4–7. 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 45 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 8: HIV diagnoses in 2022, 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 97 97 3 8 11 26 34 60 0 0 0 1 0 1 2 1 3 2 15 17 189 Austria West Belgium 323 340 7 30 37 233 153 403 10 9 19 0 0 0 1 3 4 94 163 257 1 060 Belgium Centre Bulgaria 106 106 2 16 18 109 90 199 2 3 5 0 0 0 0 0 0 0 0 0 328 Bulgaria Centre Croatia 69 70 0 3 3 18 9 27 1 0 1 0 0 0 0 0 0 4 8 12 113 Croatia Centre Cyprus 84 84 0 2 2 63 65 128 0 0 0 0 0 0 0 0 0 1 3 4 218 Cyprus Centre Czechia 179 179 27 33 60 303 131 434 12 14 26 2 2 4 4 2 6 87 74 161 870 Czechia West Denmark 71 71 4 14 18 79 37 116 7 0 7 0 0 0 1 1 2 18 26 44 258 Denmark East Estonia 11 11 2 3 5 63 35 98 2 5 7 0 0 0 0 0 0 53 76 129 250 Estonia West Finland 46 46 8 25 33 41 29 70 2 0 2 1 1 2 2 3 5 48 67 115 273 Finland West France 1 145 1 145 19 56 77 879 580 1 459 20 27 47 0 0 0 6 3 9 447 878 1 421 4 158 France West Germany 1 047 1 047 82 188 270 752 308 1 061 33 28 61 0 0 0 0 0 0 130 665 800 3 239 Germany West Greece 249 249 15 52 67 72 52 124 1 5 6 0 0 0 0 0 0 27 92 119 565 Greece Centre Hungary 112 112 0 3 3 20 23 43 0 1 1 0 0 0 0 0 0 6 40 65 224 Hungary West Iceland 19 19 0 1 1 8 5 13 0 0 0 0 0 0 0 0 0 2 5 7 40 Iceland West Ireland 350 354 6 24 30 211 85 299 10 2 12 0 0 0 0 1 1 70 120 191 887 Ireland West Italy 773 773 12 70 82 338 474 812 2 5 7 0 0 0 1 2 3 49 162 211 1 888 Italy East Latvia 9 9 4 31 35 40 55 95 1 1 2 0 0 0 0 0 0 30 58 88 229 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 Liechtenstein East Lithuania 29 29 7 25 32 77 75 152 9 6 15 0 0 0 0 0 0 7 17 24 252 Lithuania West Luxembourgc 21 21 3 9 12 19 12 31 0 0 0 0 0 0 0 0 0 4 3 7 71 Luxembourgc West Malta 30 30 0 0 0 4 8 12 0 0 0 0 0 0 1 0 1 0 17 17 60 Malta West Netherlands 221 235 0 5 5 69 64 133 0 0 0 0 2 2 0 0 0 8 47 56 431 Netherlands West Norway 59 59 9 15 24 90 48 138 2 3 5 1 0 1 0 0 0 7 11 18 245 Norway Centre Poland 199 199 6 24 30 112 75 187 5 13 18 0 0 0 0 0 0 581 1 020 1 616 2 050 Poland West Portugal 355 355 1 19 20 184 199 383 1 0 1 0 0 0 1 0 1 11 33 44 804 Portugal Centre Romania 199 199 6 36 42 84 202 286 3 5 8 0 0 0 0 0 0 44 91 135 670 Romania Centre Slovakia 46 47 4 5 9 38 20 58 1 1 2 0 0 0 0 1 1 34 44 80 197 Slovakia Centre Slovenia 26 26 0 0 0 4 7 11 0 0 0 0 0 0 0 0 0 1 4 5 42 Slovenia West Spain 1 611 1 617 9 46 55 303 409 712 2 3 5 0 0 0 0 3 3 105 440 545 2 937 Spain West Sweden 127 127 1 11 12 122 77 199 8 5 13 0 0 0 2 5 7 48 40 88 446 Sweden Total EU/EEA 7 613 7 656 237 754 993 4 361 3 361 7 743 134 136 270 5 5 10 21 25 46 1 918 4 220 6 277 22 995 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 33 33 0 2 2 27 24 51 0 2 2 0 0 0 0 0 0 0 10 10 98 Albania West Andorra - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Andorra East Armenia 61 61 1 30 31 142 293 435 1 2 3 0 0 0 0 0 0 1 4 5 535 Armenia East Azerbaijan 80 80 3 67 70 223 369 592 11 1 12 0 0 0 0 0 0 5 7 12 766 Azerbaijan East Belarus 88 88 51 236 287 554 686 1 240 1 3 4 0 0 0 0 0 0 10 15 25 1 644 Belarus Centre Bosnia and Herzegovina 25 25 0 0 0 1 3 4 1 0 1 0 0 0 0 0 0 2 22 24 54 Bosnia and Herzegovina East Georgia 110 110 3 76 79 153 262 415 4 2 6 0 0 0 0 0 0 3 4 7 617 Georgia West Israel 135 135 9 11 20 95 83 178 1 4 5 0 0 0 0 0 0 51 67 118 456 Israel East Kazakhstan 325 325 122 687 809 1 125 1 554 2 679 8 14 22 0 0 0 0 0 0 62 109 171 4 006 Kazakhstan East Kyrgyzstan 90 90 2 22 24 396 485 881 12 8 20 1 0 1 0 0 0 23 55 78 1 094 Kyrgyzstan East Moldova 20 20 5 30 35 296 354 650 5 7 12 0 0 0 0 0 0 86 126 212 929 Moldova West Monaco - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Monaco Centre Montenegro 18 18 0 0 0 3 3 6 0 0 0 0 0 0 0 0 0 0 7 7 31 Montenegro Centre North Macedonia 23 25 0 0 0 4 7 11 0 0 0 0 0 0 0 0 0 0 5 5 41 North Macedonia East Russian Federation 1 782 1 782 1 607 9 809 11 416 20 081 21 038 41 119 72 57 129 0 0 0 0 0 0 417 710 1 127 55 573 Russian Federation West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 San Marino Centre Serbia 106 106 1 2 3 12 26 38 - - 0 - - 0 - - 0 1 37 38 185 Serbia Centre Serbia excluding Kosovod 97 97 1 2 3 11 15 26 0 0 0 0 0 0 0 0 0 1 37 38 164 Serbia excluding Kosovod Centre Kosovod 9 9 - - 0 1 11 12 - - 0 - - 0 - - 0 - - 0 21 Kosovod West Switzerland 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 103 243 349 349 Switzerland East Tajikistan 27 27 1 80 81 338 525 863 17 13 30 0 0 0 0 0 0 19 17 36 1 037 Tajikistan Centre Türkiye 445 445 1 16 17 147 642 789 5 6 11 0 0 0 0 0 0 490 2 072 2 562 3 824 Türkiye East Turkmenistan 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Turkmenistan East Ukraine 289 289 612 3 208 3 820 3 480 4 573 8 053 17 18 35 0 0 0 0 0 0 8 7 15 12 212 Ukraine West United Kingdom 1 163 1 166 8 57 66 1 143 692 1 841 31 22 53 6 11 17 15 12 27 259 603 870 4 040 United Kingdom East Uzbekistan 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Uzbekistan Total non-EU/EEA 4 820 4 825 2 426 14 333 16 760 28 220 31 619 59 845 186 159 345 7 11 18 15 12 27 1 540 4 121 5 672 87 492 Total non-EU/EEA WHO European Region WHO European Region West 7 842 7 886 196 641 840 4 668 3 349 8 044 130 113 243 9 14 23 32 34 66 1 483 3 698 5 295 22 397 West Centre 1 670 1 674 47 142 189 945 1 327 2 272 30 45 75 2 2 4 4 3 7 1 251 3 437 4 724 8 945 Centre East 2 921 2 921 2 420 14 304 16 724 26 968 30 304 57 272 160 137 297 1 0 1 0 0 0 724 1 205 1 929 79 144 East Total WHO European Region 12 433 12 481 2 663 15 087 17 753 32 581 34 980 67 588 320 295 615 12 16 28 36 37 73 3 458 8 340 11 948 110 486 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 2022 in tables 4–7. 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 46 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 9: HIV diagnoses in 2022, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa <15 years 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years 50+ years Unknown age Totalb Country, territory or areaaFemale Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 0 0 0 1 0 1 0 12 12 3 17 20 10 53 63 9 40 49 11 33 44 0 0 0 189 Austria West Belgium 6 5 11 10 8 18 23 53 80 42 129 179 119 195 329 80 154 239 65 134 201 0 3 3 1 060 Belgium Centre Bulgaria 3 3 6 3 1 4 6 15 21 9 26 35 44 89 133 35 61 96 13 20 33 0 0 0 328 Bulgaria Centre Croatia 0 0 0 1 0 1 1 2 3 2 13 15 9 29 38 6 33 39 4 12 17 0 0 0 113 Croatia Centre Cyprus 0 0 0 2 1 3 7 12 19 16 26 42 28 61 89 7 30 37 4 24 28 0 0 0 218 Cyprus Centre Czechia 9 11 20 4 6 10 12 18 30 30 51 81 157 146 303 154 158 312 69 45 114 0 0 0 870 Czechia West Denmark 7 0 7 1 1 2 5 7 12 14 24 38 28 48 76 34 30 64 20 39 59 0 0 0 258 Denmark East Estonia 2 3 5 1 4 5 4 5 9 9 10 19 48 41 89 37 44 81 18 23 41 1 0 1 250 Estonia West Finland 2 1 3 0 1 1 5 5 10 13 22 35 42 53 95 26 55 81 14 34 48 0 0 0 273 Finland West France 12 33 45 41 66 108 124 241 377 170 378 579 410 732 1 180 322 520 853 292 719 1 016 0 0 0 4 158 France West Germany 24 23 47 23 26 49 54 127 183 92 296 388 357 693 1 051 296 550 846 150 504 654 1 17 21 3 239 Germany West Greece 1 1 2 3 8 11 9 44 53 16 82 98 33 113 146 21 114 135 32 88 120 0 0 0 565 Greece Centre Hungary 0 1 1 0 0 0 1 18 19 1 27 28 9 67 76 11 41 53 4 17 22 0 8 25 224 Hungary West Iceland 0 0 0 0 0 0 1 2 3 0 9 9 5 9 14 3 5 8 1 5 6 0 0 0 40 Iceland West Ireland 6 1 7 4 2 6 9 38 48 18 102 121 118 240 359 97 136 235 45 62 110 0 1 1 887 Ireland West Italy 2 5 7 4 9 13 24 85 109 47 147 194 106 377 483 103 389 492 116 474 590 0 0 0 1 888 Italy East Latvia 1 1 2 0 0 0 1 6 7 2 7 9 23 41 64 25 52 77 23 47 70 0 0 0 229 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 Liechtenstein East Lithuania 8 5 13 0 1 1 3 5 8 4 11 15 32 52 84 35 46 81 18 32 50 0 0 0 252 Lithuania West Luxembourgc 0 0 0 0 0 0 2 3 5 2 7 9 11 21 32 6 7 13 5 4 9 0 3 3 71 Luxembourgc West Malta 0 0 0 0 1 1 0 4 4 2 10 12 2 23 25 1 8 9 0 6 6 0 3 3 60 Malta West Netherlands 0 0 0 1 3 4 14 23 37 12 53 68 18 86 116 14 66 80 18 108 126 0 0 0 431 Netherlands West Norway 0 3 3 2 0 2 5 4 9 8 11 19 41 44 85 36 39 75 17 35 52 0 0 0 245 Norway Centre Poland 8 16 24 14 15 29 28 134 164 60 180 241 254 518 773 234 331 570 102 124 226 4 13 23 2 050 Poland West Portugal 1 0 1 3 11 14 16 75 91 19 100 119 57 171 228 49 117 166 53 132 185 0 0 0 804 Portugal Centre Romania 3 5 8 5 18 23 21 70 91 19 84 103 37 155 192 35 123 158 17 78 95 0 0 0 670 Romania Centre Slovakia 1 1 2 3 3 6 3 9 12 2 19 21 27 40 69 29 34 64 11 11 22 1 0 1 197 Slovakia Centre Slovenia 0 0 0 0 0 0 0 1 1 2 6 8 2 12 14 1 15 16 0 3 3 0 0 0 42 Slovenia West Spain 2 2 4 3 29 32 32 244 276 48 428 476 133 792 925 116 567 687 85 450 537 0 0 0 2 937 Spain West Sweden 3 5 8 4 2 6 4 22 26 19 32 51 65 82 147 52 70 122 33 52 85 1 0 1 446 Sweden Total EU/EEA 101 125 226 133 216 350 414 1 284 1 719 681 2 307 3 032 2 225 4 983 7 278 1 874 3 835 5 738 1 240 3 316 4 570 8 48 82 22 995 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 3 3 0 0 0 1 6 7 3 13 16 11 17 28 4 14 18 8 18 26 0 0 0 98 Albania West Andorra - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Andorra East Armenia 2 3 5 1 3 4 9 12 21 13 43 56 50 135 185 24 96 120 46 98 144 0 0 0 535 Armenia East Azerbaijan 13 2 15 2 7 9 13 43 56 33 101 134 95 189 284 40 106 146 46 76 122 0 0 0 766 Azerbaijan East Belarus 4 3 7 4 4 8 21 46 67 51 54 105 199 400 599 211 347 558 126 174 300 0 0 0 1 644 Belarus Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 3 3 0 9 9 1 20 21 2 12 14 1 6 7 0 0 0 54 Bosnia and Herzegovina East Georgia 3 2 5 4 5 9 9 33 42 10 65 75 45 142 187 41 107 148 51 100 151 0 0 0 617 Georgia West Israel 1 2 3 2 9 11 2 19 21 5 35 40 35 97 132 58 70 128 52 67 119 1 1 2 456 Israel East Kazakhstan 11 16 27 25 47 72 57 160 217 113 335 448 445 955 1 400 380 791 1 171 286 385 671 0 0 0 4 006 Kazakhstan East Kyrgyzstan 13 9 22 9 19 28 30 47 77 42 118 160 135 210 345 107 164 271 98 93 191 0 0 0 1 094 Kyrgyzstan East Moldova 5 7 12 12 5 17 30 17 47 36 48 84 121 198 319 93 155 248 95 107 202 0 0 0 929 Moldova West Monaco - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Monaco Centre Montenegro 0 0 0 0 0 0 0 3 3 0 5 5 3 14 17 0 4 4 0 2 2 0 0 0 31 Montenegro Centre North Macedonia 0 0 0 0 0 1 0 5 5 0 3 3 1 11 13 2 13 15 1 3 4 0 0 0 41 North Macedonia East Russia 240 211 451 243 151 394 909 792 1 701 1 508 1 955 3 463 7 664 12 989 20 653 7 653 12 893 20 546 3 960 4 405 8 365 0 0 0 55 573 Russia West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 San Marino Centre Serbia - - 0 - 1 1 2 16 18 1 40 41 5 58 63 4 40 44 2 16 18 - - 0 185 Serbia Centre Serbia excluding Kosovod 0 0 0 0 0 0 1 11 12 1 35 36 5 53 58 4 37 41 2 15 17 0 0 0 164 Serbia excluding Kosovod Centre Kosovod - - 0 - 1 1 1 5 6 - 5 5 - 5 5 - 3 3 - 1 1 - - 0 21 Kosovod West Switzerland 1 2 3 3 1 4 2 6 8 5 20 26 34 80 115 36 53 89 22 81 104 0 0 0 349 Switzerland East Tajikistan 22 21 43 18 11 29 28 47 75 48 77 125 120 248 368 81 155 236 58 103 161 0 0 0 1 037 Tajikistan Centre Türkiye 5 7 12 10 64 74 58 435 493 87 608 695 176 891 1 067 169 590 759 138 586 724 0 0 0 3 824 Türkiye East Turkmenistan - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Turkmenistan East Ukraine 18 16 34 53 24 77 148 159 307 343 529 872 1 478 3 454 4 932 1 301 2 909 4 210 776 1 004 1 780 0 0 0 12 212 Ukraine West United Kingdom 0 0 0 19 36 55 63 214 278 168 419 592 507 840 1 354 417 537 958 288 514 803 0 0 0 4 040 United Kingdom East Uzbekistan - - 0 - - 0 0 0 - - 0 - - 0 - - 0 - - 0 0 Uzbekistan Total non-EU/EEA 338 304 642 405 387 793 1 382 2 063 3 446 2 466 4 477 6 949 11 125 20 948 32 082 10 623 19 057 29 684 6 054 7 838 13 894 1 1 2 87 492 Total non-EU/EEA WHO European Region WHO European Region West 68 83 151 124 213 338 394 1 228 1 642 703 2 321 3 073 2 131 4 749 6 955 1 776 3 528 5 330 1 319 3 541 4 874 3 28 34 22 397 West Centre 29 47 76 42 109 152 140 747 889 232 1 110 1 343 764 2 128 2 896 693 1 499 2 199 374 965 1 341 5 21 49 8 945 Centre East 342 299 641 372 281 653 1 262 1 372 2 634 2 212 3 353 5 565 10 455 19 054 29 509 10 028 17 865 27 893 5 601 6 647 12 248 1 0 1 79 144 East Total WHO European Region 439 429 868 538 603 1 143 1 796 3 347 5 165 3 147 6 784 9 981 13 350 25 931 39 360 12 497 22 892 35 422 7 294 11 153 18 463 9 49 84 110 486 Total WHO European Region a Country-specific comments are in Annex 5 b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns c 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 47 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 9: HIV diagnoses in 2022, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa <15 years 15–19 years 20–24 years 25–29 years 30–39 years 40–49 years 50+ years Unknown age Totalb Country, territory or areaaFemale Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 0 0 0 1 0 1 0 12 12 3 17 20 10 53 63 9 40 49 11 33 44 0 0 0 189 Austria West Belgium 6 5 11 10 8 18 23 53 80 42 129 179 119 195 329 80 154 239 65 134 201 0 3 3 1 060 Belgium Centre Bulgaria 3 3 6 3 1 4 6 15 21 9 26 35 44 89 133 35 61 96 13 20 33 0 0 0 328 Bulgaria Centre Croatia 0 0 0 1 0 1 1 2 3 2 13 15 9 29 38 6 33 39 4 12 17 0 0 0 113 Croatia Centre Cyprus 0 0 0 2 1 3 7 12 19 16 26 42 28 61 89 7 30 37 4 24 28 0 0 0 218 Cyprus Centre Czechia 9 11 20 4 6 10 12 18 30 30 51 81 157 146 303 154 158 312 69 45 114 0 0 0 870 Czechia West Denmark 7 0 7 1 1 2 5 7 12 14 24 38 28 48 76 34 30 64 20 39 59 0 0 0 258 Denmark East Estonia 2 3 5 1 4 5 4 5 9 9 10 19 48 41 89 37 44 81 18 23 41 1 0 1 250 Estonia West Finland 2 1 3 0 1 1 5 5 10 13 22 35 42 53 95 26 55 81 14 34 48 0 0 0 273 Finland West France 12 33 45 41 66 108 124 241 377 170 378 579 410 732 1 180 322 520 853 292 719 1 016 0 0 0 4 158 France West Germany 24 23 47 23 26 49 54 127 183 92 296 388 357 693 1 051 296 550 846 150 504 654 1 17 21 3 239 Germany West Greece 1 1 2 3 8 11 9 44 53 16 82 98 33 113 146 21 114 135 32 88 120 0 0 0 565 Greece Centre Hungary 0 1 1 0 0 0 1 18 19 1 27 28 9 67 76 11 41 53 4 17 22 0 8 25 224 Hungary West Iceland 0 0 0 0 0 0 1 2 3 0 9 9 5 9 14 3 5 8 1 5 6 0 0 0 40 Iceland West Ireland 6 1 7 4 2 6 9 38 48 18 102 121 118 240 359 97 136 235 45 62 110 0 1 1 887 Ireland West Italy 2 5 7 4 9 13 24 85 109 47 147 194 106 377 483 103 389 492 116 474 590 0 0 0 1 888 Italy East Latvia 1 1 2 0 0 0 1 6 7 2 7 9 23 41 64 25 52 77 23 47 70 0 0 0 229 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 Liechtenstein East Lithuania 8 5 13 0 1 1 3 5 8 4 11 15 32 52 84 35 46 81 18 32 50 0 0 0 252 Lithuania West Luxembourgc 0 0 0 0 0 0 2 3 5 2 7 9 11 21 32 6 7 13 5 4 9 0 3 3 71 Luxembourgc West Malta 0 0 0 0 1 1 0 4 4 2 10 12 2 23 25 1 8 9 0 6 6 0 3 3 60 Malta West Netherlands 0 0 0 1 3 4 14 23 37 12 53 68 18 86 116 14 66 80 18 108 126 0 0 0 431 Netherlands West Norway 0 3 3 2 0 2 5 4 9 8 11 19 41 44 85 36 39 75 17 35 52 0 0 0 245 Norway Centre Poland 8 16 24 14 15 29 28 134 164 60 180 241 254 518 773 234 331 570 102 124 226 4 13 23 2 050 Poland West Portugal 1 0 1 3 11 14 16 75 91 19 100 119 57 171 228 49 117 166 53 132 185 0 0 0 804 Portugal Centre Romania 3 5 8 5 18 23 21 70 91 19 84 103 37 155 192 35 123 158 17 78 95 0 0 0 670 Romania Centre Slovakia 1 1 2 3 3 6 3 9 12 2 19 21 27 40 69 29 34 64 11 11 22 1 0 1 197 Slovakia Centre Slovenia 0 0 0 0 0 0 0 1 1 2 6 8 2 12 14 1 15 16 0 3 3 0 0 0 42 Slovenia West Spain 2 2 4 3 29 32 32 244 276 48 428 476 133 792 925 116 567 687 85 450 537 0 0 0 2 937 Spain West Sweden 3 5 8 4 2 6 4 22 26 19 32 51 65 82 147 52 70 122 33 52 85 1 0 1 446 Sweden Total EU/EEA 101 125 226 133 216 350 414 1 284 1 719 681 2 307 3 032 2 225 4 983 7 278 1 874 3 835 5 738 1 240 3 316 4 570 8 48 82 22 995 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 3 3 0 0 0 1 6 7 3 13 16 11 17 28 4 14 18 8 18 26 0 0 0 98 Albania West Andorra - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Andorra East Armenia 2 3 5 1 3 4 9 12 21 13 43 56 50 135 185 24 96 120 46 98 144 0 0 0 535 Armenia East Azerbaijan 13 2 15 2 7 9 13 43 56 33 101 134 95 189 284 40 106 146 46 76 122 0 0 0 766 Azerbaijan East Belarus 4 3 7 4 4 8 21 46 67 51 54 105 199 400 599 211 347 558 126 174 300 0 0 0 1 644 Belarus Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 3 3 0 9 9 1 20 21 2 12 14 1 6 7 0 0 0 54 Bosnia and Herzegovina East Georgia 3 2 5 4 5 9 9 33 42 10 65 75 45 142 187 41 107 148 51 100 151 0 0 0 617 Georgia West Israel 1 2 3 2 9 11 2 19 21 5 35 40 35 97 132 58 70 128 52 67 119 1 1 2 456 Israel East Kazakhstan 11 16 27 25 47 72 57 160 217 113 335 448 445 955 1 400 380 791 1 171 286 385 671 0 0 0 4 006 Kazakhstan East Kyrgyzstan 13 9 22 9 19 28 30 47 77 42 118 160 135 210 345 107 164 271 98 93 191 0 0 0 1 094 Kyrgyzstan East Moldova 5 7 12 12 5 17 30 17 47 36 48 84 121 198 319 93 155 248 95 107 202 0 0 0 929 Moldova West Monaco - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Monaco Centre Montenegro 0 0 0 0 0 0 0 3 3 0 5 5 3 14 17 0 4 4 0 2 2 0 0 0 31 Montenegro Centre North Macedonia 0 0 0 0 0 1 0 5 5 0 3 3 1 11 13 2 13 15 1 3 4 0 0 0 41 North Macedonia East Russia 240 211 451 243 151 394 909 792 1 701 1 508 1 955 3 463 7 664 12 989 20 653 7 653 12 893 20 546 3 960 4 405 8 365 0 0 0 55 573 Russia West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 San Marino Centre Serbia - - 0 - 1 1 2 16 18 1 40 41 5 58 63 4 40 44 2 16 18 - - 0 185 Serbia Centre Serbia excluding Kosovod 0 0 0 0 0 0 1 11 12 1 35 36 5 53 58 4 37 41 2 15 17 0 0 0 164 Serbia excluding Kosovod Centre Kosovod - - 0 - 1 1 1 5 6 - 5 5 - 5 5 - 3 3 - 1 1 - - 0 21 Kosovod West Switzerland 1 2 3 3 1 4 2 6 8 5 20 26 34 80 115 36 53 89 22 81 104 0 0 0 349 Switzerland East Tajikistan 22 21 43 18 11 29 28 47 75 48 77 125 120 248 368 81 155 236 58 103 161 0 0 0 1 037 Tajikistan Centre Türkiye 5 7 12 10 64 74 58 435 493 87 608 695 176 891 1 067 169 590 759 138 586 724 0 0 0 3 824 Türkiye East Turkmenistan - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Turkmenistan East Ukraine 18 16 34 53 24 77 148 159 307 343 529 872 1 478 3 454 4 932 1 301 2 909 4 210 776 1 004 1 780 0 0 0 12 212 Ukraine West United Kingdom 0 0 0 19 36 55 63 214 278 168 419 592 507 840 1 354 417 537 958 288 514 803 0 0 0 4 040 United Kingdom East Uzbekistan - - 0 - - 0 0 0 - - 0 - - 0 - - 0 - - 0 0 Uzbekistan Total non-EU/EEA 338 304 642 405 387 793 1 382 2 063 3 446 2 466 4 477 6 949 11 125 20 948 32 082 10 623 19 057 29 684 6 054 7 838 13 894 1 1 2 87 492 Total non-EU/EEA WHO European Region WHO European Region West 68 83 151 124 213 338 394 1 228 1 642 703 2 321 3 073 2 131 4 749 6 955 1 776 3 528 5 330 1 319 3 541 4 874 3 28 34 22 397 West Centre 29 47 76 42 109 152 140 747 889 232 1 110 1 343 764 2 128 2 896 693 1 499 2 199 374 965 1 341 5 21 49 8 945 Centre East 342 299 641 372 281 653 1 262 1 372 2 634 2 212 3 353 5 565 10 455 19 054 29 509 10 028 17 865 27 893 5 601 6 647 12 248 1 0 1 79 144 East Total WHO European Region 439 429 868 538 603 1 143 1 796 3 347 5 165 3 147 6 784 9 981 13 350 25 931 39 360 12 497 22 892 35 422 7 294 11 153 18 463 9 49 84 110 486 Total WHO European Region a Country-specific comments are in Annex 5 b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns c 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 48 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 10: Origin of those diagnosed with HIV in 2022 by country of report or Region, in EU/EEA and other countries of the WHO European Region. Area Country, territory or areaa Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-East Asia Other Unknown Totalb Country, territory or areaaN % N % N % N % N % N % N % N % EU/EEA EU/EEA West Austria 88 46.6 12 6.3 57 30.2 9 4.8 7 3.7 9 4.8 5 2.6 2 1.1 189 Austria West Belgium 211 19.9 66 6.2 181 17.1 221 20.8 150 14.2 19 1.8 25 2.4 187 17.6 1 060 Belgium Centre Bulgaria 230 70.1 6 1.8 90 27.4 1 0.3 0 0.0 0 0.0 1 0.3 0 0.0 328 Bulgaria Centre Croatia 65 57.5 3 2.7 38 33.6 0 0.0 4 3.5 1 0.9 2 1.8 0 0.0 113 Croatia Centre Cyprus 59 27.1 18 8.3 37 17.0 91 41.7 0 0.0 4 1.8 8 3.7 1 0.5 218 Cyprus Centre Czechia 126 14.5 5 0.6 719 82.6 2 0.2 13 1.5 4 0.5 1 0.1 0 0.0 870 Czechia West Denmark 51 19.8 21 8.1 121 46.9 19 7.4 14 5.4 23 8.9 6 2.3 3 1.2 258 Denmark East Estonia 31 12.4 0 0.0 130 52.0 2 0.8 0 0.0 3 1.2 1 0.4 83 33.2 250 Estonia West Finland 46 16.8 4 1.5 57 20.9 8 2.9 5 1.8 21 7.7 8 2.9 124 45.4 273 Finland West France 1 179 28.4 80 1.9 245 5.9 1 145 27.5 308 7.4 52 1.3 182 4.4 967 23.3 4 158 France West Germany 1 139 35.2 90 2.8 1 108 34.2 302 9.3 147 4.5 113 3.5 76 2.3 264 8.2 3 239 Germany West Greece 348 61.6 13 2.3 95 16.8 68 12.0 12 2.1 19 3.4 10 1.8 0 0.0 565 Greece Centre Hungary 148 66.1 3 1.3 41 18.3 1 0.4 8 3.6 3 1.3 2 0.9 18 8.0 224 Hungary West Iceland 1 2.5 1 2.5 16 40.0 4 10.0 9 22.5 3 7.5 6 15.0 0 0.0 40 Iceland West Ireland 92 10.4 23 2.6 177 20.0 198 22.3 220 24.8 23 2.6 10 1.1 144 16.2 887 Ireland West Italy 1 292 68.4 22 1.2 143 7.6 198 10.5 155 8.2 31 1.6 37 2.0 10 0.5 1 888 Italy East Latvia - - - - - - - - - - - - - - - - - Latvia Liechtenstein 0 0.0 1 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 Liechtenstein East Lithuania 133 52.8 0 0.0 116 46.0 2 0.8 0 0.0 0 0.0 1 0.4 0 0.0 252 Lithuania West Luxembourgc 11 15.5 15 21.1 10 14.1 21 29.6 5 7.0 2 2.8 7 9.9 0 0.0 71 Luxembourgc West Malta - - - - - - - - - - - - - - - - - Malta West Netherlands 208 48.3 14 3.2 73 16.9 46 10.7 48 11.1 24 5.6 16 3.7 2 0.5 431 Netherlands West Norway 37 15.1 3 1.2 136 55.5 36 14.7 9 3.7 17 6.9 7 2.9 0 0.0 245 Norway Centre Poland 757 36.9 1 0.0 627 30.6 9 0.4 2 0.1 3 0.1 1 0.0 650 31.7 2 050 Poland West Portugal 389 48.4 21 2.6 9 1.1 139 17.3 191 23.8 2 0.2 3 0.4 50 6.2 804 Portugal Centre Romania 650 97.0 2 0.3 4 0.6 2 0.3 0 0.0 0 0.0 0 0.0 12 1.8 670 Romania Centre Slovakia 22 11.2 0 0.0 79 40.1 0 0.0 1 0.5 0 0.0 0 0.0 95 48.2 197 Slovakia Centre Slovenia 29 69.0 0 0.0 9 21.4 1 2.4 0 0.0 1 2.4 0 0.0 2 4.8 42 Slovenia West Spain 1 507 51.3 80 2.7 101 3.4 149 5.1 931 31.7 28 1.0 80 2.7 61 2.1 2 937 Spain West Sweden 64 14.3 14 3.1 143 32.1 107 24.0 32 7.2 51 11.4 20 4.5 15 3.4 446 Sweden Total EU/EEA 8 913 39.3 518 2.3 4 562 20.1 2 781 12.2 2 271 10.0 456 2.0 515 2.3 2 690 11.8 22 706 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 96 98.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 2.0 0 0.0 98 Albania West Andorra - - - - - - - - - - - - - - - - - Andorra East Armenia 535 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 535 Armenia East Azerbaijan 749 97.8 1 0.1 15 2.0 0 0.0 0 0.0 1 0.1 0 0.0 0 0.0 766 Azerbaijan East Belarus 1 644 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 644 Belarus Centre Bosnia and Herzegovina 48 88.9 0 0.0 1 1.9 5 9.3 0 0.0 0 0.0 0 0.0 0 0.0 54 Bosnia and Herzegovina East Georgia 616 99.8 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 617 Georgia West Israel 153 33.6 5 1.1 158 34.6 57 12.5 12 2.6 10 2.2 60 13.2 1 0.2 456 Israel East Kazakhstan 3 879 96.8 0 0.0 107 2.7 0 0.0 0 0.0 1 0.0 19 0.5 0 0.0 4 006 Kazakhstan East Kyrgyzstan 1 006 92.0 3 0.3 77 7.0 0 0.0 0 0.0 4 0.4 0 0.0 4 0.4 1 094 Kyrgyzstan East Moldova 917 98.7 0 0.0 12 1.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 929 Moldova West Monaco - - - - - - - - - - - - - - - - - Monaco Centre Montenegro 30 96.8 0 0.0 1 3.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 31 Montenegro Centre North Macedonia 40 97.6 1 2.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 41 North Macedonia East Russian Federation - - - - - - - - - - - - - - - - - Russian Federation West San Marino - - - - - - - - - - - - - - - - - San Marino Centre Serbia 180 97.3 - - 2 1.1 - - 2 1.1 - - 1 0.5 - - 185 Serbia Centre Serbia excluding Kosovod 160 97.6 0 0.0 2 1.2 0 0.0 2 1.2 0 0.0 0 0.0 0 0.0 164 Serbia excluding Kosovod Centre Kosovod 20 95.2 - - - - - - - - - - 1 4.8 - - 21 Kosovod West Switzerland 86 24.6 34 9.7 54 15.5 31 8.9 13 3.7 5 1.4 6 1.7 120 34.4 349 Switzerland East Tajikistan 1 025 98.8 0 0.0 2 0.2 0 0.0 0 0.0 0 0.0 10 1.0 0 0.0 1 037 Tajikistan Centre Türkiye 3 169 82.9 98 2.6 184 4.8 118 3.1 21 0.5 27 0.7 100 2.6 107 2.8 3 824 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine 12 212 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 212 Ukraine West United Kingdom 796 19.7 106 2.6 315 7.8 1 216 30.1 224 5.5 307 7.6 71 1.8 1 005 24.9 4 040 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - Uzbekistan Total non-EU/EEA 27 181 85.2 248 0.8 929 2.9 1 427 4.5 272 0.9 355 1.1 269 0.8 1 237 3.9 31 918 Total non-EU/EEA WHO European Region WHO European Region West 7 698 34.5 624 2.8 3 199 14.3 3 974 17.8 2 492 11.2 759 3.4 635 2.8 2 955 13.2 22 336 West Centre 5 649 63.2 137 1.5 1 832 20.5 230 2.6 51 0.6 43 0.5 118 1.3 885 9.9 8 945 Centre East 22 747 97.5 4 0.0 460 2.0 4 0.0 0 0.0 9 0.0 31 0.1 87 0.4 23 342 East Total WHO European Region 36 094 66.1 765 1.4 5 491 10.1 4 208 7.7 2 543 4.7 811 1.5 784 1.4 3 927 7.2 54 623 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the variables “country of birth”, “country of nationality” or “region of origin” are excluded and therefore regional totals may not equal those presented in Table 1. b 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 49 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 10: Origin of those diagnosed with HIV in 2022 by country of report or Region, in EU/EEA and other countries of the WHO European Region. Area Country, territory or areaa Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-East Asia Other Unknown Totalb Country, territory or areaaN % N % N % N % N % N % N % N % EU/EEA EU/EEA West Austria 88 46.6 12 6.3 57 30.2 9 4.8 7 3.7 9 4.8 5 2.6 2 1.1 189 Austria West Belgium 211 19.9 66 6.2 181 17.1 221 20.8 150 14.2 19 1.8 25 2.4 187 17.6 1 060 Belgium Centre Bulgaria 230 70.1 6 1.8 90 27.4 1 0.3 0 0.0 0 0.0 1 0.3 0 0.0 328 Bulgaria Centre Croatia 65 57.5 3 2.7 38 33.6 0 0.0 4 3.5 1 0.9 2 1.8 0 0.0 113 Croatia Centre Cyprus 59 27.1 18 8.3 37 17.0 91 41.7 0 0.0 4 1.8 8 3.7 1 0.5 218 Cyprus Centre Czechia 126 14.5 5 0.6 719 82.6 2 0.2 13 1.5 4 0.5 1 0.1 0 0.0 870 Czechia West Denmark 51 19.8 21 8.1 121 46.9 19 7.4 14 5.4 23 8.9 6 2.3 3 1.2 258 Denmark East Estonia 31 12.4 0 0.0 130 52.0 2 0.8 0 0.0 3 1.2 1 0.4 83 33.2 250 Estonia West Finland 46 16.8 4 1.5 57 20.9 8 2.9 5 1.8 21 7.7 8 2.9 124 45.4 273 Finland West France 1 179 28.4 80 1.9 245 5.9 1 145 27.5 308 7.4 52 1.3 182 4.4 967 23.3 4 158 France West Germany 1 139 35.2 90 2.8 1 108 34.2 302 9.3 147 4.5 113 3.5 76 2.3 264 8.2 3 239 Germany West Greece 348 61.6 13 2.3 95 16.8 68 12.0 12 2.1 19 3.4 10 1.8 0 0.0 565 Greece Centre Hungary 148 66.1 3 1.3 41 18.3 1 0.4 8 3.6 3 1.3 2 0.9 18 8.0 224 Hungary West Iceland 1 2.5 1 2.5 16 40.0 4 10.0 9 22.5 3 7.5 6 15.0 0 0.0 40 Iceland West Ireland 92 10.4 23 2.6 177 20.0 198 22.3 220 24.8 23 2.6 10 1.1 144 16.2 887 Ireland West Italy 1 292 68.4 22 1.2 143 7.6 198 10.5 155 8.2 31 1.6 37 2.0 10 0.5 1 888 Italy East Latvia - - - - - - - - - - - - - - - - - Latvia Liechtenstein 0 0.0 1 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 Liechtenstein East Lithuania 133 52.8 0 0.0 116 46.0 2 0.8 0 0.0 0 0.0 1 0.4 0 0.0 252 Lithuania West Luxembourgc 11 15.5 15 21.1 10 14.1 21 29.6 5 7.0 2 2.8 7 9.9 0 0.0 71 Luxembourgc West Malta - - - - - - - - - - - - - - - - - Malta West Netherlands 208 48.3 14 3.2 73 16.9 46 10.7 48 11.1 24 5.6 16 3.7 2 0.5 431 Netherlands West Norway 37 15.1 3 1.2 136 55.5 36 14.7 9 3.7 17 6.9 7 2.9 0 0.0 245 Norway Centre Poland 757 36.9 1 0.0 627 30.6 9 0.4 2 0.1 3 0.1 1 0.0 650 31.7 2 050 Poland West Portugal 389 48.4 21 2.6 9 1.1 139 17.3 191 23.8 2 0.2 3 0.4 50 6.2 804 Portugal Centre Romania 650 97.0 2 0.3 4 0.6 2 0.3 0 0.0 0 0.0 0 0.0 12 1.8 670 Romania Centre Slovakia 22 11.2 0 0.0 79 40.1 0 0.0 1 0.5 0 0.0 0 0.0 95 48.2 197 Slovakia Centre Slovenia 29 69.0 0 0.0 9 21.4 1 2.4 0 0.0 1 2.4 0 0.0 2 4.8 42 Slovenia West Spain 1 507 51.3 80 2.7 101 3.4 149 5.1 931 31.7 28 1.0 80 2.7 61 2.1 2 937 Spain West Sweden 64 14.3 14 3.1 143 32.1 107 24.0 32 7.2 51 11.4 20 4.5 15 3.4 446 Sweden Total EU/EEA 8 913 39.3 518 2.3 4 562 20.1 2 781 12.2 2 271 10.0 456 2.0 515 2.3 2 690 11.8 22 706 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 96 98.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 2.0 0 0.0 98 Albania West Andorra - - - - - - - - - - - - - - - - - Andorra East Armenia 535 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 535 Armenia East Azerbaijan 749 97.8 1 0.1 15 2.0 0 0.0 0 0.0 1 0.1 0 0.0 0 0.0 766 Azerbaijan East Belarus 1 644 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 644 Belarus Centre Bosnia and Herzegovina 48 88.9 0 0.0 1 1.9 5 9.3 0 0.0 0 0.0 0 0.0 0 0.0 54 Bosnia and Herzegovina East Georgia 616 99.8 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 617 Georgia West Israel 153 33.6 5 1.1 158 34.6 57 12.5 12 2.6 10 2.2 60 13.2 1 0.2 456 Israel East Kazakhstan 3 879 96.8 0 0.0 107 2.7 0 0.0 0 0.0 1 0.0 19 0.5 0 0.0 4 006 Kazakhstan East Kyrgyzstan 1 006 92.0 3 0.3 77 7.0 0 0.0 0 0.0 4 0.4 0 0.0 4 0.4 1 094 Kyrgyzstan East Moldova 917 98.7 0 0.0 12 1.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 929 Moldova West Monaco - - - - - - - - - - - - - - - - - Monaco Centre Montenegro 30 96.8 0 0.0 1 3.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 31 Montenegro Centre North Macedonia 40 97.6 1 2.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 41 North Macedonia East Russian Federation - - - - - - - - - - - - - - - - - Russian Federation West San Marino - - - - - - - - - - - - - - - - - San Marino Centre Serbia 180 97.3 - - 2 1.1 - - 2 1.1 - - 1 0.5 - - 185 Serbia Centre Serbia excluding Kosovod 160 97.6 0 0.0 2 1.2 0 0.0 2 1.2 0 0.0 0 0.0 0 0.0 164 Serbia excluding Kosovod Centre Kosovod 20 95.2 - - - - - - - - - - 1 4.8 - - 21 Kosovod West Switzerland 86 24.6 34 9.7 54 15.5 31 8.9 13 3.7 5 1.4 6 1.7 120 34.4 349 Switzerland East Tajikistan 1 025 98.8 0 0.0 2 0.2 0 0.0 0 0.0 0 0.0 10 1.0 0 0.0 1 037 Tajikistan Centre Türkiye 3 169 82.9 98 2.6 184 4.8 118 3.1 21 0.5 27 0.7 100 2.6 107 2.8 3 824 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine 12 212 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 212 Ukraine West United Kingdom 796 19.7 106 2.6 315 7.8 1 216 30.1 224 5.5 307 7.6 71 1.8 1 005 24.9 4 040 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - Uzbekistan Total non-EU/EEA 27 181 85.2 248 0.8 929 2.9 1 427 4.5 272 0.9 355 1.1 269 0.8 1 237 3.9 31 918 Total non-EU/EEA WHO European Region WHO European Region West 7 698 34.5 624 2.8 3 199 14.3 3 974 17.8 2 492 11.2 759 3.4 635 2.8 2 955 13.2 22 336 West Centre 5 649 63.2 137 1.5 1 832 20.5 230 2.6 51 0.6 43 0.5 118 1.3 885 9.9 8 945 Centre East 22 747 97.5 4 0.0 460 2.0 4 0.0 0 0.0 9 0.0 31 0.1 87 0.4 23 342 East Total WHO European Region 36 094 66.1 765 1.4 5 491 10.1 4 208 7.7 2 543 4.7 811 1.5 784 1.4 3 927 7.2 54 623 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the variables “country of birth”, “country of nationality” or “region of origin” are excluded and therefore regional totals may not equal those presented in Table 1. b 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. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 50 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 11: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2022 Transmission mode Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-East Asia Other Unknown Total Transmission modeN % N % N % N % N % N % N % N % EU/EEA EU/EEA Sex between men 4 191 54.7 306 4.0 606 7.9 277 3.6 1 529 20.0 218 2.8 243 3.2 286 3.7 7 656 Men who have sex with men Injecting drug use 419 42.2 19 1.9 430 43.3 7 0.7 18 1.8 14 1.4 11 1.1 75 7.6 993 Injecting drug use Heterosexual contact 2 407 31.1 111 1.4 2 186 28.2 2 046 26.4 419 5.4 135 1.7 145 1.9 294 3.8 7 743 Heterosexual contact Mother-to-child 34 12.6 3 1.1 137 50.7 72 26.7 4 1.5 1 0.4 3 1.1 16 5.9 270 Mother-to-child Haemophiliac/transfusion recipient 3 6.5 3 6.5 21 45.7 7 15.2 4 8.7 1 2.2 3 6.5 4 8.7 46 Haemophiliac/transfusion recipient Nosocomial infection 1 10.0 - - 8 80.0 - - - - 1 10.0 - - - - 10 Nosocomial infection Other/undetermined 1 858 29.6 76 1.2 1 174 18.7 372 5.9 297 4.7 86 1.4 110 1.8 2 304 36.7 6 277 Other/undetermined Total EU-EEA 8 913 38.8 518 2.3 4 562 19.8 2 781 12.1 2 271 9.9 456 2.0 515 2.2 2 979 13.0 22 995 Total EU-EEA Non-EU/EEA Non-EU/EEA Sex between men 2 156 70.9 68 2.2 152 5.0 79 2.6 156 5.1 182 6.0 51 1.7 199 6.5 3 043 Men who have sex with men Injecting drug use 5 264 98.5 1 0.0 61 1.1 2 0.0 3 0.1 3 0.1 3 0.1 7 0.1 5 344 Injecting drug use Heterosexual contact 16 819 89.8 47 0.3 375 2.0 1 049 5.6 54 0.3 101 0.5 62 0.3 219 1.2 18 726 Heterosexual contact Mother-to-child 153 70.8 3 1.4 9 4.2 39 18.1 2 0.9 4 1.9 3 1.4 3 1.4 216 Mother-to-child Haemophiliac/transfusion recipient 2 7.4 - - 10 37.0 8 29.6 1 3.7 2 7.4 1 3.7 3 11.1 27 Haemophiliac/transfusion recipient Nosocomial infection 5 27.8 - - 1 5.6 10 55.6 - - 2 11.1 - - - - 18 Nosocomial infection Other/undetermined 2 782 61.2 129 2.8 321 7.1 240 5.3 56 1.2 61 1.3 149 3.3 806 17.7 4 544 Other/undetermined Total non-EU/EEA 27 181 85.2 248 0.8 929 2.9 1 427 4.5 272 0.9 355 1.1 269 0.8 1 237 3.9 31 918 Total non-EU/EEA West West Sex between men 3 930 49.8 348 4.4 579 7.3 329 4.2 1 654 21.0 381 4.8 277 3.5 388 4.9 7 886 Men who have sex with men Injecting drug use 338 40.2 20 2.4 383 45.6 9 1.1 20 2.4 16 1.9 12 1.4 42 5.0 840 Injecting drug use Heterosexual contact 2 165 26.9 133 1.7 1 503 18.7 3 007 37.4 470 5.8 226 2.8 169 2.1 371 4.6 8 044 Heterosexual contact Mother-to-child 19 7.8 6 2.5 82 33.7 107 44.0 6 2.5 4 1.6 5 2.1 14 5.8 243 Mother-to-child Haemophiliac/transfusion recipient 5 7.6 3 4.5 24 36.4 15 22.7 5 7.6 3 4.5 4 6.1 7 10.6 66 Haemophiliac/transfusion recipient Nosocomial infection 5 21.7 - - 5 21.7 10 43.5 - - 3 13.0 - - - - 23 Nosocomial infection Other/undetermined 1 236 23.3 114 2.2 623 11.8 497 9.4 337 6.4 126 2.4 168 3.2 2 193 41.4 5 294 Other/undetermined Total West 7 698 34.4 624 2.8 3 199 14.3 3 974 17.7 2 492 11.1 759 3.4 635 2.8 3 015 13.5 22 396 Total West Centre Centre Sex between men 1 335 79.7 25 1.5 137 8.2 27 1.6 31 1.9 14 0.8 17 1.0 88 5.3 1 674 Men who have sex with men Injecting drug use 97 51.3 - - 85 45.0 - - 1 0.5 1 0.5 - - 5 2.6 189 Injecting drug use Heterosexual contact 1 336 58.8 22 1.0 764 33.6 87 3.8 3 0.1 6 0.3 14 0.6 40 1.8 2 272 Heterosexual contact Mother-to-child 25 33.3 - - 45 60.0 3 4.0 - - 1 1.3 1 1.3 - - 75 Mother-to-child Haemophiliac/transfusion recipient - - - - 7 100.0 - - - - - - - - - - 7 Haemophiliac/transfusion recipient Nosocomial infection - - - - 4 100.0 - - - - - - - - - - 4 Nosocomial infection Other/undetermined 2 856 60.5 90 1.9 790 16.7 113 2.4 16 0.3 21 0.4 86 1.8 752 15.9 4 724 Other/undetermined Total Centre 5 649 63.2 137 1.5 1 832 20.5 230 2.6 51 0.6 43 0.5 118 1.3 885 9.9 8 945 Total Centre East East Sex between men 1 082 95.0 1 0.1 42 3.7 - - - - 5 0.4 - - 9 0.8 1 139 Men who have sex with men Injecting drug use 5 248 98.9 - - 23 0.4 - - - - - - 2 0.0 35 0.7 5 308 Injecting drug use Heterosexual contact 15 725 97.4 3 0.0 294 1.8 1 0.0 - - 4 0.0 24 0.1 102 0.6 16 153 Heterosexual contact Mother-to-child 143 85.1 - - 19 11.3 1 0.6 - - - - - - 5 3.0 168 Mother-to-child Haemophiliac/transfusion recipient 1 100.0 - - - - - - - - - - - - - - 1 Haemophiliac/transfusion recipient Nosocomial infection 548 68.3 - - 82 10.2 2 0.2 - - - - 5 0.6 165 20.6 802 Nosocomial infection Other/undetermined Other/undetermined Total East 22 747 96.5 4 0.0 460 2.0 4 0.0 0 0.0 9 0.0 31 0.1 316 1.3 23 571 Total East Total WHO European Region 72 188 65.7 1 531 1.4 10 982 10.0 8 416 7.7 5 086 4.6 1 622 1.5 1 568 1.4 8 432 7.7 109 825 Total WHO European Region 51 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 11: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2022 Transmission mode Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-East Asia Other Unknown Total Transmission modeN % N % N % N % N % N % N % N % EU/EEA EU/EEA Sex between men 4 191 54.7 306 4.0 606 7.9 277 3.6 1 529 20.0 218 2.8 243 3.2 286 3.7 7 656 Men who have sex with men Injecting drug use 419 42.2 19 1.9 430 43.3 7 0.7 18 1.8 14 1.4 11 1.1 75 7.6 993 Injecting drug use Heterosexual contact 2 407 31.1 111 1.4 2 186 28.2 2 046 26.4 419 5.4 135 1.7 145 1.9 294 3.8 7 743 Heterosexual contact Mother-to-child 34 12.6 3 1.1 137 50.7 72 26.7 4 1.5 1 0.4 3 1.1 16 5.9 270 Mother-to-child Haemophiliac/transfusion recipient 3 6.5 3 6.5 21 45.7 7 15.2 4 8.7 1 2.2 3 6.5 4 8.7 46 Haemophiliac/transfusion recipient Nosocomial infection 1 10.0 - - 8 80.0 - - - - 1 10.0 - - - - 10 Nosocomial infection Other/undetermined 1 858 29.6 76 1.2 1 174 18.7 372 5.9 297 4.7 86 1.4 110 1.8 2 304 36.7 6 277 Other/undetermined Total EU-EEA 8 913 38.8 518 2.3 4 562 19.8 2 781 12.1 2 271 9.9 456 2.0 515 2.2 2 979 13.0 22 995 Total EU-EEA Non-EU/EEA Non-EU/EEA Sex between men 2 156 70.9 68 2.2 152 5.0 79 2.6 156 5.1 182 6.0 51 1.7 199 6.5 3 043 Men who have sex with men Injecting drug use 5 264 98.5 1 0.0 61 1.1 2 0.0 3 0.1 3 0.1 3 0.1 7 0.1 5 344 Injecting drug use Heterosexual contact 16 819 89.8 47 0.3 375 2.0 1 049 5.6 54 0.3 101 0.5 62 0.3 219 1.2 18 726 Heterosexual contact Mother-to-child 153 70.8 3 1.4 9 4.2 39 18.1 2 0.9 4 1.9 3 1.4 3 1.4 216 Mother-to-child Haemophiliac/transfusion recipient 2 7.4 - - 10 37.0 8 29.6 1 3.7 2 7.4 1 3.7 3 11.1 27 Haemophiliac/transfusion recipient Nosocomial infection 5 27.8 - - 1 5.6 10 55.6 - - 2 11.1 - - - - 18 Nosocomial infection Other/undetermined 2 782 61.2 129 2.8 321 7.1 240 5.3 56 1.2 61 1.3 149 3.3 806 17.7 4 544 Other/undetermined Total non-EU/EEA 27 181 85.2 248 0.8 929 2.9 1 427 4.5 272 0.9 355 1.1 269 0.8 1 237 3.9 31 918 Total non-EU/EEA West West Sex between men 3 930 49.8 348 4.4 579 7.3 329 4.2 1 654 21.0 381 4.8 277 3.5 388 4.9 7 886 Men who have sex with men Injecting drug use 338 40.2 20 2.4 383 45.6 9 1.1 20 2.4 16 1.9 12 1.4 42 5.0 840 Injecting drug use Heterosexual contact 2 165 26.9 133 1.7 1 503 18.7 3 007 37.4 470 5.8 226 2.8 169 2.1 371 4.6 8 044 Heterosexual contact Mother-to-child 19 7.8 6 2.5 82 33.7 107 44.0 6 2.5 4 1.6 5 2.1 14 5.8 243 Mother-to-child Haemophiliac/transfusion recipient 5 7.6 3 4.5 24 36.4 15 22.7 5 7.6 3 4.5 4 6.1 7 10.6 66 Haemophiliac/transfusion recipient Nosocomial infection 5 21.7 - - 5 21.7 10 43.5 - - 3 13.0 - - - - 23 Nosocomial infection Other/undetermined 1 236 23.3 114 2.2 623 11.8 497 9.4 337 6.4 126 2.4 168 3.2 2 193 41.4 5 294 Other/undetermined Total West 7 698 34.4 624 2.8 3 199 14.3 3 974 17.7 2 492 11.1 759 3.4 635 2.8 3 015 13.5 22 396 Total West Centre Centre Sex between men 1 335 79.7 25 1.5 137 8.2 27 1.6 31 1.9 14 0.8 17 1.0 88 5.3 1 674 Men who have sex with men Injecting drug use 97 51.3 - - 85 45.0 - - 1 0.5 1 0.5 - - 5 2.6 189 Injecting drug use Heterosexual contact 1 336 58.8 22 1.0 764 33.6 87 3.8 3 0.1 6 0.3 14 0.6 40 1.8 2 272 Heterosexual contact Mother-to-child 25 33.3 - - 45 60.0 3 4.0 - - 1 1.3 1 1.3 - - 75 Mother-to-child Haemophiliac/transfusion recipient - - - - 7 100.0 - - - - - - - - - - 7 Haemophiliac/transfusion recipient Nosocomial infection - - - - 4 100.0 - - - - - - - - - - 4 Nosocomial infection Other/undetermined 2 856 60.5 90 1.9 790 16.7 113 2.4 16 0.3 21 0.4 86 1.8 752 15.9 4 724 Other/undetermined Total Centre 5 649 63.2 137 1.5 1 832 20.5 230 2.6 51 0.6 43 0.5 118 1.3 885 9.9 8 945 Total Centre East East Sex between men 1 082 95.0 1 0.1 42 3.7 - - - - 5 0.4 - - 9 0.8 1 139 Men who have sex with men Injecting drug use 5 248 98.9 - - 23 0.4 - - - - - - 2 0.0 35 0.7 5 308 Injecting drug use Heterosexual contact 15 725 97.4 3 0.0 294 1.8 1 0.0 - - 4 0.0 24 0.1 102 0.6 16 153 Heterosexual contact Mother-to-child 143 85.1 - - 19 11.3 1 0.6 - - - - - - 5 3.0 168 Mother-to-child Haemophiliac/transfusion recipient 1 100.0 - - - - - - - - - - - - - - 1 Haemophiliac/transfusion recipient Nosocomial infection 548 68.3 - - 82 10.2 2 0.2 - - - - 5 0.6 165 20.6 802 Nosocomial infection Other/undetermined Other/undetermined Total East 22 747 96.5 4 0.0 460 2.0 4 0.0 0 0.0 9 0.0 31 0.1 316 1.3 23 571 Total East Total WHO European Region 72 188 65.7 1 531 1.4 10 982 10.0 8 416 7.7 5 086 4.6 1 622 1.5 1 568 1.4 8 432 7.7 109 825 Total WHO European Region

53 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 12: Percentage of HIV diagnoses (2022) 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 Completeness (%) CD4b CD4 <200 (%) CD4 <350 (%) CD4 < 350 per mm3 blood (%) N % N % Heterosexualb Injecting drug userb Sex between menb EU/EEA West Austria 186 98.4 64 34.4 101 54.3 58.3 90.9 46.3 West Belgium 752 71.9 119 15.8 232 30.9 40.2 20.7 22.7 Centre Bulgaria 245 76.1 73 29.8 116 47.3 47.5 80.0 43.8 Centre Croatia 66 58.4 28 42.4 38 57.6 70.0 - 54.9 Centre Cyprus 198 90.8 27 13.6 44 22.2 29.8 - 12.5 Centre Czechia 705 82.9 90 12.8 173 24.5 25.7 14.0 26.9 West Denmark 94 82.5 39 41.5 59 62.8 68.9 80.0 54.1 East Estonia 15 6.1 6 40.0 10 66.7 72.7 - - West Finland 168 62.2 31 18.5 52 31.0 30.3 28.6 29.3 West France 2 368 57.6 652 27.5 1 193 50.4 55.8 29.0 42.8 West Germany 1 073 33.8 339 31.6 489 45.6 40.7 38.5 43.8 West Greece 377 67.0 126 33.4 198 52.5 74.4 49.0 41.9 Centre Hungary - - - - - - - - - West Iceland 23 57.5 3 13.0 7 30.4 18.2 - 40.0 West Ireland 150 42.7 47 31.3 76 50.6 66.0 75.0 44.3 West Italy 1 813 96.4 739 40.8 1 056 58.2 63.9 50.0 51.1 East Latvia 84 37.0 42 50.0 52 61.9 66.7 38.5 28.6 Liechtenstein 1 100.0 1 100.0 1 100.0 - - - East Lithuania 189 79.1 43 22.8 72 38.1 39.1 21.1 37.0 West Luxembourg 64 94.1 13 20.3 29 45.3 57.1 25.0 38.9 West Malta - - - - - - - - - West Netherlands 392 91.0 121 30.9 203 51.8 61.6 - 42.1 West Norway 234 96.7 44 18.8 76 32.5 32.8 33.3 32.2 Centre Poland - - - - - - - - - West Portugal 654 81.4 215 32.9 367 56.1 61.9 77.8 46.9 Centre Romania 630 95.2 237 37.6 396 62.9 65.1 59.0 52.6 Centre Slovakia 38 19.6 7 18.4 14 36.8 44.4 - 33.3 Centre Slovenia 36 85.7 8 22.2 16 44.4 60.0 - 40.0 West Spain 2 602 88.7 711 27.3 1 262 48.5 57.3 60.0 42.3 West Sweden 316 72.3 61 19.3 115 36.4 38.7 25.0 31.2 Total EU/EEA 13 473 68.2 3 886 28.8 6 451 47.9 52.1 42.2 42.1 Non-EU/EEA Centre Albania 77 81.1 35 45.5 56 72.7 74.4 100.0 67.7 West Andorra - - - - - - - - - East Armenia 391 73.8 167 42.7 233 59.6 61.1 78.3 42.2 East Azerbaijan 663 88.3 126 19.0 234 35.3 36.2 40.0 27.0 East Belarus 1 469 89.7 323 22.0 616 41.9 43.2 35.6 41.4 Centre Bosnia and Herzegovina 35 64.8 19 54.3 26 74.3 100.0 - 100.0 East Georgia 515 84.2 155 30.1 269 52.2 53.7 62.5 41.6 West Israel 281 62.3 59 21.0 113 40.2 44.2 37.5 41.3 East Kazakhstan 3 569 89.7 865 24.2 1 834 51.4 54.4 40.6 50.5 East Kyrgyzstan 842 78.5 260 30.9 459 54.5 56.5 66.7 33.3 East Moldova 794 86.6 274 34.5 465 58.6 59.6 52.9 40.0 West Monaco - - - - - - - - - Centre Montenegro 22 71.0 10 45.5 14 63.6 66.7 - 53.8 Centre North Macedonia 39 95.1 11 28.2 24 61.5 72.7 - 47.8 East Russian Federationc 52 707 95.0 7 952 15.1 16 226 30.8 - - - West San Marino - - - - - - - - - Centre Serbia 165 89.2 59 35.8 94 57.0 51.6 66.7 54.0 Centre Serbia excluding Kosovod 152 92.7 57 37.5 88 57.9 52.0 66.7 54.8 Centre Kosovod 13 61.9 2 15.4 6 46.2 50.0 - 42.9 West Switzerland 202 58.4 66 32.7 119 58.9 - - - East Tajikistan 926 93.2 312 33.7 535 57.8 56.7 66.2 48.1 Centre Türkiye 483 12.7 102 21.1 208 43.1 41.7 100.0 31.5 East Turkmenistan - - - - - - - - - East Ukraine 9 083 74.6 3 384 37.3 5 432 59.8 64.5 49.2 47.7 West United Kingdom 3 615 89.5 760 21.0 1 345 37.2 40.6 59.0 32.9 East Uzbekistan - - - - - - - - - Total non-EU/EEA 23 171 73.0 6 987 30.2 12 076 52.1 56.0 47.5 39.7 WHO European Region West 15 364 71.5 4 209 27.4 7 096 46.2 50.4 45.5 40.9 Centre 2 739 41.4 706 25.8 1 219 44.5 43.7 42.0 41.8 East 18 540 79.3 5 957 32.1 10 211 55.1 58.0 47.2 43.9 Total WHO European Region 36 643 71.2 10 872 29.7 18 526 50.6 55.0 46.8 41.4 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 mode and therefore percentages based on 5 or less cases are censored. c Data on CD4 cell count reported from the Russian Federation do not include disaggregation by mode of transmission and are excluded from the sub-regional and regional totals. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 54 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 13: AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 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 69 0.8 83 1.0 76 0.9 67 0.8 67 0.8 53 0.6 60 0.7 47 0.1 53 0.1 43 0.5 3 471 Austria West Belgium 1983 104 0.9 136 1.2 105 0.9 77 0.7 65 0.6 60 0.5 85 0.7 60 0.5 60 0.1 42 0.4 5 422 Belgium Centre Bulgaria 1987 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 57 0.8 68 1.0 42 0.6 38 0.5 54 0.8 924 Bulgaria Centre Croatia 1986 17 0.4 1 0.0 1 0.0 22 0.5 20 0.5 30 0.7 20 0.5 12 0.3 23 0.6 19 0.5 453 Croatia Centre Cyprus 1986 21 2.4 54 6.3 71 8.4 76 9.0 67 7.8 73 8.4 83 9.5 70 7.9 94 10.5 34 3.8 980 Cyprus Centre Czechia 1986 33 0.3 32 0.3 38 0.4 45 0.4 54 0.5 39 0.4 38 0.4 44 0.4 55 0.5 66 0.6 842 Czechia West Denmark 1980 38 0.7 30 0.5 40 0.7 24 0.4 29 0.5 26 0.4 22 0.4 25 0.4 17 0.3 20 0.3 2 862 Denmark East Estonia 1992 26 2.0 18 1.4 18 1.4 40 3.0 20 1.5 25 1.9 30 2.3 23 1.7 11 0.8 13 1.0 614 Estonia West Finland 1983 20 0.4 20 0.4 19 0.3 30 0.5 18 0.3 21 0.4 18 0.3 12 0.2 16 0.3 15 0.3 787 Finland West France 1982 735 1.1 662 1.0 616 0.9 524 0.8 507 0.8 550 0.8 583 0.9 447 0.7 464 0.7 449 0.7 74 708 France West Germany 1981 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 142 1.3 129 1.2 139 1.3 143 1.3 122 1.1 104 1.0 93 0.9 102 1.0 86 0.8 71 0.7 4 378 Greece Centre Hungary 1986 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 57 0.6 53 0.5 42 0.4 50 0.5 43 0.4 1 189 Hungary West Iceland 1985 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 2 0.6 4 1.1 2 0.5 2 0.5 2 0.5 83 Iceland West Ireland 1983 31 0.7 32 0.7 21 0.4 15 0.3 21 0.4 13 0.3 11 0.2 11 0.2 17 0.3 21 0.4 1 357 Ireland West Italy 1982 1 078 1.8 931 1.5 873 1.4 874 1.4 802 1.3 722 1.2 647 1.1 413 0.7 448 0.8 403 0.7 72 556 Italy East Latvia 1990 133 6.6 171 8.5 132 6.6 114 5.8 118 6.1 99 5.1 90 4.7 55 2.9 39 2.1 58 3.1 2 229 Latvia Liechtenstein 1989 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 - - 12 Liechtenstein East Lithuania 1988 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 37 1.3 21 0.8 23 0.8 38 1.4 25 0.9 697 Lithuania West Luxembourg 1983 19 3.5 15 2.7 18 3.2 19 3.3 9 1.5 8 1.3 5 0.8 14 2.2 19 3.0 7 1.1 593 Luxembourg West Malta 1986 1 0.2 4 0.9 2 0.5 5 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 114 Malta West Netherlands 1999 277 1.7 220 1.3 259 1.5 212 1.2 207 1.2 188 1.1 173 1.0 157 0.9 141 0.8 104 0.6 8 164 Netherlands West Norway 1983 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 12 0.2 19 0.4 11 0.2 23 0.4 20 0.4 1 257 Norway Centre Poland 1986 162 0.4 149 0.4 128 0.3 102 0.3 109 0.3 111 0.3 95 0.3 52 0.1 62 0.2 114 0.3 4 010 Poland West Portugal 1985 538 5.1 392 3.8 351 3.4 395 3.8 307 3.0 278 2.7 242 2.4 215 2.1 239 2.3 138 1.3 23 640 Portugal Centre Romania 1985 365 1.8 416 2.1 367 1.8 354 1.8 330 1.7 323 1.7 312 1.6 202 1.0 211 1.1 276 1.4 11 431 Romania Centre Slovakia 1985 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 11 0.2 3 0.1 4 0.1 3 0.1 8 0.1 134 Slovakia Centre Slovenia 1986 11 0.5 17 0.8 11 0.5 10 0.5 7 0.3 10 0.5 9 0.4 6 0.3 5 0.2 7 0.3 297 Slovenia West Spain 1981 858 1.8 679 1.6 607 1.5 540 1.6 510 1.5 391 1.1 284 0.7 375 0.9 251 0.6 297 0.7 89 123 Spain West Sweden 1982 - - - - - - - - - - - - - - - - - - - - 2 182 Sweden Total EU/EEA 5 311 1.2 4 786 1.1 4 407 1.0 4 177 1.0 3 862 0.9 3 542 0.8 3 142 0.7 2 466 0.6 2 465 0.6 2 349 0.6 346 712 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 65 2.3 50 1.7 65 2.3 58 2.0 33 1.1 47 1.6 38 1.3 18 0.6 48 1.7 46 1.6 759 Albania West Andorra 2004 3 4.2 0 0.0 3 4.2 0 0.0 2 2.7 0 0.0 - - - - - - - - 15 Andorra East Armenia 1988 145 5.0 176 6.1 163 5.7 163 5.7 144 5.0 211 7.4 173 6.1 152 5.4 197 7.1 230 8.3 2 448 Armenia East Azerbaijan 1995 189 2.0 200 2.1 193 2.0 161 1.6 168 1.7 182 1.8 196 1.9 105 1.0 109 1.1 91 0.9 2 829 Azerbaijan East Belarus 1991 547 5.6 474 4.9 490 5.1 512 5.3 439 4.5 382 3.9 380 3.9 220 2.3 286 3.0 422 4.4 7 767 Belarus Centre Bosnia and Herzegovina 1986 7 0.2 8 0.2 8 0.2 8 0.2 4 0.1 13 0.4 10 0.3 - - - - - - 178 Bosnia and Herzegovina East Georgia 1989 303 8.0 268 7.1 270 7.2 269 7.1 257 6.8 273 7.2 264 7.0 181 4.8 217 5.8 215 5.7 4 877 Georgia West Israel 1981 49 0.6 70 0.9 45 0.6 47 0.6 33 0.4 42 0.5 29 0.3 33 0.4 33 0.4 13 0.1 1 833 Israel East Kazakhstan 1993 258 1.5 251 1.4 273 1.5 350 1.9 362 2.0 433 2.3 451 2.4 469 2.5 459 2.4 428 2.2 5 472 Kazakhstan East Kyrgyzstan 1999 62 1.1 70 1.2 65 1.1 36 0.6 44 0.7 60 1.0 51 0.8 53 0.8 73 1.1 94 1.4 958 Kyrgyzstan East Moldova 1989 377 11.0 299 9.0 293 8.9 366 11.3 274 8.6 365 11.6 285 9.2 199 6.5 199 6.5 259 7.9 5 092 Moldova West Monaco 1985 0 0.0 1 2.8 0 0.0 0 0.0 0 0.0 0 0.0 - - - - - - - - 51 Monaco Centre Montenegro 1990 7 1.1 7 1.1 11 1.7 15 2.4 13 2.1 14 2.2 10 1.6 4 0.6 8 1.3 16 2.6 190 Montenegro Centre North Macedonia 1989 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 4 0.2 - - - - - - - - 170 North Macedonia East Russian Federation 2009 - - - - - - - - - - - - - - - - - - - - 0 Russian Federation West San Marino 1986 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 23 San Marino Centre Serbia 1985 50 0.5 49 0.5 50 0.5 61 0.7 65 0.7 70 0.8 77 0.8 34 0.4 53 0.6 58 0.6 2 270 Serbia Centre Serbia excluding Kosovoc 1985 47 0.6 48 0.6 47 0.6 56 0.7 59 0.8 62 0.8 72 1.0 32 0.4 50 0.7 52 0.7 2 174 Serbia excluding Kosovoc Centre Kosovoc 2005 3 0.2 1 0.1 3 0.2 5 0.3 6 0.3 8 0.4 5 0.3 2 0.1 3 0.2 6 0.3 96 Kosovoc West Switzerland 1980 106 1.3 79 1.0 64 0.8 71 0.8 73 0.9 65 0.8 70 0.8 42 0.5 39 0.4 37 0.4 10 239 Switzerland East Tajikistan 1998 192 2.4 229 2.8 281 3.3 238 2.7 265 3.0 212 2.3 157 1.7 110 1.2 128 1.3 99 1.0 2 554 Tajikistan Centre Türkiye 1985 96 0.1 125 0.2 118 0.1 99 0.1 121 0.1 108 0.1 112 0.1 46 0.1 80 0.1 84 0.1 2 007 Türkiye East Turkmenistan 2002 - - - - - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 1988 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 4 139 9.9 4 151 10.0 3 010 7.3 129 857 Ukraine West United Kingdom 1981 347 0.5 369 0.6 403 0.6 298 0.5 261 0.4 256 0.4 263 0.4 184 0.3 248 0.4 191 0.3 30 793 United Kingdom East Uzbekistan 1992 - - - - - - - - - - - - - - - - - - - - 651 Uzbekistan Total non-EU/EEA 12 175 4.3 12 585 4.4 11 269 4.0 11 613 4.1 11 868 4.1 11 576 4.0 10 077 3.5 5 989 2.0 6 328 2.2 5 293 1.7 218 287 Total non-EU/EEA WHO European Region WHO European Region West 4 885 1.2 4 290 1.0 4 025 1.0 3 677 0.9 3 342 0.8 3 033 0.7 2 682 0.6 2 150 0.6 2 156 0.5 1 873 0.5 365 854 West Centre 963 0.5 1 043 0.5 970 0.5 964 0.5 935 0.5 967 0.5 928 0.5 576 0.3 730 0.4 825 0.4 25 834 Centre East 11 638 10.4 12 037 10.7 10 681 9.6 11 149 10.0 11 453 10.3 11 118 9.9 9 609 8.6 5 729 5.1 5 907 5.3 4 944 4.4 173 299 East Total WHO European Region 17 486 2.4 17 370 2.4 15 676 2.2 15 790 2.2 15 730 2.2 15 118 2.1 13 219 1.8 8 455 1.2 8 793 1.2 7 642 1.1 564 987 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 Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 55 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 13: AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 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 69 0.8 83 1.0 76 0.9 67 0.8 67 0.8 53 0.6 60 0.7 47 0.1 53 0.1 43 0.5 3 471 Austria West Belgium 1983 104 0.9 136 1.2 105 0.9 77 0.7 65 0.6 60 0.5 85 0.7 60 0.5 60 0.1 42 0.4 5 422 Belgium Centre Bulgaria 1987 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 57 0.8 68 1.0 42 0.6 38 0.5 54 0.8 924 Bulgaria Centre Croatia 1986 17 0.4 1 0.0 1 0.0 22 0.5 20 0.5 30 0.7 20 0.5 12 0.3 23 0.6 19 0.5 453 Croatia Centre Cyprus 1986 21 2.4 54 6.3 71 8.4 76 9.0 67 7.8 73 8.4 83 9.5 70 7.9 94 10.5 34 3.8 980 Cyprus Centre Czechia 1986 33 0.3 32 0.3 38 0.4 45 0.4 54 0.5 39 0.4 38 0.4 44 0.4 55 0.5 66 0.6 842 Czechia West Denmark 1980 38 0.7 30 0.5 40 0.7 24 0.4 29 0.5 26 0.4 22 0.4 25 0.4 17 0.3 20 0.3 2 862 Denmark East Estonia 1992 26 2.0 18 1.4 18 1.4 40 3.0 20 1.5 25 1.9 30 2.3 23 1.7 11 0.8 13 1.0 614 Estonia West Finland 1983 20 0.4 20 0.4 19 0.3 30 0.5 18 0.3 21 0.4 18 0.3 12 0.2 16 0.3 15 0.3 787 Finland West France 1982 735 1.1 662 1.0 616 0.9 524 0.8 507 0.8 550 0.8 583 0.9 447 0.7 464 0.7 449 0.7 74 708 France West Germany 1981 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 142 1.3 129 1.2 139 1.3 143 1.3 122 1.1 104 1.0 93 0.9 102 1.0 86 0.8 71 0.7 4 378 Greece Centre Hungary 1986 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 57 0.6 53 0.5 42 0.4 50 0.5 43 0.4 1 189 Hungary West Iceland 1985 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 2 0.6 4 1.1 2 0.5 2 0.5 2 0.5 83 Iceland West Ireland 1983 31 0.7 32 0.7 21 0.4 15 0.3 21 0.4 13 0.3 11 0.2 11 0.2 17 0.3 21 0.4 1 357 Ireland West Italy 1982 1 078 1.8 931 1.5 873 1.4 874 1.4 802 1.3 722 1.2 647 1.1 413 0.7 448 0.8 403 0.7 72 556 Italy East Latvia 1990 133 6.6 171 8.5 132 6.6 114 5.8 118 6.1 99 5.1 90 4.7 55 2.9 39 2.1 58 3.1 2 229 Latvia Liechtenstein 1989 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 - - 12 Liechtenstein East Lithuania 1988 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 37 1.3 21 0.8 23 0.8 38 1.4 25 0.9 697 Lithuania West Luxembourg 1983 19 3.5 15 2.7 18 3.2 19 3.3 9 1.5 8 1.3 5 0.8 14 2.2 19 3.0 7 1.1 593 Luxembourg West Malta 1986 1 0.2 4 0.9 2 0.5 5 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 114 Malta West Netherlands 1999 277 1.7 220 1.3 259 1.5 212 1.2 207 1.2 188 1.1 173 1.0 157 0.9 141 0.8 104 0.6 8 164 Netherlands West Norway 1983 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 12 0.2 19 0.4 11 0.2 23 0.4 20 0.4 1 257 Norway Centre Poland 1986 162 0.4 149 0.4 128 0.3 102 0.3 109 0.3 111 0.3 95 0.3 52 0.1 62 0.2 114 0.3 4 010 Poland West Portugal 1985 538 5.1 392 3.8 351 3.4 395 3.8 307 3.0 278 2.7 242 2.4 215 2.1 239 2.3 138 1.3 23 640 Portugal Centre Romania 1985 365 1.8 416 2.1 367 1.8 354 1.8 330 1.7 323 1.7 312 1.6 202 1.0 211 1.1 276 1.4 11 431 Romania Centre Slovakia 1985 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 11 0.2 3 0.1 4 0.1 3 0.1 8 0.1 134 Slovakia Centre Slovenia 1986 11 0.5 17 0.8 11 0.5 10 0.5 7 0.3 10 0.5 9 0.4 6 0.3 5 0.2 7 0.3 297 Slovenia West Spain 1981 858 1.8 679 1.6 607 1.5 540 1.6 510 1.5 391 1.1 284 0.7 375 0.9 251 0.6 297 0.7 89 123 Spain West Sweden 1982 - - - - - - - - - - - - - - - - - - - - 2 182 Sweden Total EU/EEA 5 311 1.2 4 786 1.1 4 407 1.0 4 177 1.0 3 862 0.9 3 542 0.8 3 142 0.7 2 466 0.6 2 465 0.6 2 349 0.6 346 712 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 65 2.3 50 1.7 65 2.3 58 2.0 33 1.1 47 1.6 38 1.3 18 0.6 48 1.7 46 1.6 759 Albania West Andorra 2004 3 4.2 0 0.0 3 4.2 0 0.0 2 2.7 0 0.0 - - - - - - - - 15 Andorra East Armenia 1988 145 5.0 176 6.1 163 5.7 163 5.7 144 5.0 211 7.4 173 6.1 152 5.4 197 7.1 230 8.3 2 448 Armenia East Azerbaijan 1995 189 2.0 200 2.1 193 2.0 161 1.6 168 1.7 182 1.8 196 1.9 105 1.0 109 1.1 91 0.9 2 829 Azerbaijan East Belarus 1991 547 5.6 474 4.9 490 5.1 512 5.3 439 4.5 382 3.9 380 3.9 220 2.3 286 3.0 422 4.4 7 767 Belarus Centre Bosnia and Herzegovina 1986 7 0.2 8 0.2 8 0.2 8 0.2 4 0.1 13 0.4 10 0.3 - - - - - - 178 Bosnia and Herzegovina East Georgia 1989 303 8.0 268 7.1 270 7.2 269 7.1 257 6.8 273 7.2 264 7.0 181 4.8 217 5.8 215 5.7 4 877 Georgia West Israel 1981 49 0.6 70 0.9 45 0.6 47 0.6 33 0.4 42 0.5 29 0.3 33 0.4 33 0.4 13 0.1 1 833 Israel East Kazakhstan 1993 258 1.5 251 1.4 273 1.5 350 1.9 362 2.0 433 2.3 451 2.4 469 2.5 459 2.4 428 2.2 5 472 Kazakhstan East Kyrgyzstan 1999 62 1.1 70 1.2 65 1.1 36 0.6 44 0.7 60 1.0 51 0.8 53 0.8 73 1.1 94 1.4 958 Kyrgyzstan East Moldova 1989 377 11.0 299 9.0 293 8.9 366 11.3 274 8.6 365 11.6 285 9.2 199 6.5 199 6.5 259 7.9 5 092 Moldova West Monaco 1985 0 0.0 1 2.8 0 0.0 0 0.0 0 0.0 0 0.0 - - - - - - - - 51 Monaco Centre Montenegro 1990 7 1.1 7 1.1 11 1.7 15 2.4 13 2.1 14 2.2 10 1.6 4 0.6 8 1.3 16 2.6 190 Montenegro Centre North Macedonia 1989 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 4 0.2 - - - - - - - - 170 North Macedonia East Russian Federation 2009 - - - - - - - - - - - - - - - - - - - - 0 Russian Federation West San Marino 1986 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 23 San Marino Centre Serbia 1985 50 0.5 49 0.5 50 0.5 61 0.7 65 0.7 70 0.8 77 0.8 34 0.4 53 0.6 58 0.6 2 270 Serbia Centre Serbia excluding Kosovoc 1985 47 0.6 48 0.6 47 0.6 56 0.7 59 0.8 62 0.8 72 1.0 32 0.4 50 0.7 52 0.7 2 174 Serbia excluding Kosovoc Centre Kosovoc 2005 3 0.2 1 0.1 3 0.2 5 0.3 6 0.3 8 0.4 5 0.3 2 0.1 3 0.2 6 0.3 96 Kosovoc West Switzerland 1980 106 1.3 79 1.0 64 0.8 71 0.8 73 0.9 65 0.8 70 0.8 42 0.5 39 0.4 37 0.4 10 239 Switzerland East Tajikistan 1998 192 2.4 229 2.8 281 3.3 238 2.7 265 3.0 212 2.3 157 1.7 110 1.2 128 1.3 99 1.0 2 554 Tajikistan Centre Türkiye 1985 96 0.1 125 0.2 118 0.1 99 0.1 121 0.1 108 0.1 112 0.1 46 0.1 80 0.1 84 0.1 2 007 Türkiye East Turkmenistan 2002 - - - - - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 1988 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 4 139 9.9 4 151 10.0 3 010 7.3 129 857 Ukraine West United Kingdom 1981 347 0.5 369 0.6 403 0.6 298 0.5 261 0.4 256 0.4 263 0.4 184 0.3 248 0.4 191 0.3 30 793 United Kingdom East Uzbekistan 1992 - - - - - - - - - - - - - - - - - - - - 651 Uzbekistan Total non-EU/EEA 12 175 4.3 12 585 4.4 11 269 4.0 11 613 4.1 11 868 4.1 11 576 4.0 10 077 3.5 5 989 2.0 6 328 2.2 5 293 1.7 218 287 Total non-EU/EEA WHO European Region WHO European Region West 4 885 1.2 4 290 1.0 4 025 1.0 3 677 0.9 3 342 0.8 3 033 0.7 2 682 0.6 2 150 0.6 2 156 0.5 1 873 0.5 365 854 West Centre 963 0.5 1 043 0.5 970 0.5 964 0.5 935 0.5 967 0.5 928 0.5 576 0.3 730 0.4 825 0.4 25 834 Centre East 11 638 10.4 12 037 10.7 10 681 9.6 11 149 10.0 11 453 10.3 11 118 9.9 9 609 8.6 5 729 5.1 5 907 5.3 4 944 4.4 173 299 East Total WHO European Region 17 486 2.4 17 370 2.4 15 676 2.2 15 790 2.2 15 730 2.2 15 118 2.1 13 219 1.8 8 455 1.2 8 793 1.2 7 642 1.1 564 987 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 Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 56 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 14: AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 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 50 1.2 57 1.4 57 1.4 49 1.1 54 1.3 43 1.0 46 1.1 36 0.8 43 1.0 29 0.7 2 636 Austria West Belgium 67 1.2 85 1.5 63 1.1 44 0.8 44 0.8 35 0.6 58 1.0 39 0.7 34 0.6 23 0.4 3 572 Belgium Centre Bulgaria 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 48 1.4 56 1.6 31 0.9 35 1.0 45 1.4 732 Bulgaria Centre Croatia 14 0.7 1 0.0 1 0.0 21 1.0 19 0.9 28 1.4 18 0.9 11 0.6 22 1.1 18 1.0 409 Croatia Centre Cyprus 16 3.8 51 12.2 63 15.3 64 15.5 49 11.8 63 14.9 58 13.6 56 12.9 71 16.2 18 4.1 772 Cyprus Centre Czechia 27 0.5 23 0.4 30 0.6 39 0.8 44 0.8 35 0.7 27 0.5 36 0.7 45 0.9 50 1.0 681 Czechia West Denmark 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 21 0.7 15 0.5 21 0.7 14 0.5 11 0.4 2 418 Denmark East Estonia 19 3.1 13 2.1 11 1.8 23 3.7 15 2.4 19 3.1 21 3.4 18 2.9 9 1.4 11 1.7 447 Estonia West Finland 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 17 0.6 12 0.4 7 0.3 9 0.3 12 0.4 624 Finland West France 528 1.7 449 1.4 426 1.3 346 1.1 360 1.1 389 1.2 406 1.3 317 1.0 322 1.0 289 0.9 58 342 France West Germany 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 121 2.3 106 2.0 114 2.2 109 2.1 94 1.8 91 1.7 70 1.3 86 1.6 63 1.2 53 1.0 3 634 Greece Centre Hungary 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 54 1.2 46 1.0 35 0.7 39 0.8 32 0.7 1 020 Hungary West Iceland 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 0 0.0 3 1.6 2 1.1 2 1.1 1 0.5 70 Iceland West Ireland 23 1.0 22 1.0 16 0.7 12 0.5 15 0.6 12 0.5 7 0.3 8 0.3 15 0.6 17 0.7 1 043 Ireland West Italy 813 2.8 713 2.4 687 2.3 669 2.3 587 2.0 565 1.9 524 1.8 303 1.0 346 1.2 299 1.0 55 932 Italy East Latvia 90 9.7 110 12.0 89 9.8 90 10.0 73 8.2 63 7.1 53 6.0 39 4.4 24 2.7 42 4.8 1 533 Latvia Liechtenstein 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 - - 11 Liechtenstein East Lithuania 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 29 2.2 16 1.2 18 1.4 29 2.2 17 1.3 558 Lithuania West Luxembourg 18 6.7 10 3.6 10 3.5 16 5.5 7 2.4 7 2.3 3 1.0 9 2.9 15 4.7 5 1.5 447 Luxembourg West Malta 1 0.5 4 1.9 2 0.9 5 2.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 100 Malta West Netherlands 227 2.7 181 2.2 211 2.5 165 2.0 168 2.0 146 1.7 136 1.6 118 1.4 113 1.3 81 0.9 6 489 Netherlands West Norway 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 9 0.3 14 0.5 10 0.4 13 0.5 11 0.4 969 Norway Centre Poland 131 0.7 115 0.6 97 0.5 90 0.5 94 0.5 86 0.5 80 0.4 39 0.2 50 0.3 84 0.5 3 168 Poland West Portugal 374 7.5 302 6.1 252 5.1 283 5.8 220 4.5 184 3.8 161 3.3 159 3.3 157 3.2 105 2.1 18 526 Portugal Centre Romania 248 2.5 294 3.0 256 2.6 257 2.7 243 2.5 236 2.5 217 2.3 148 1.6 149 1.6 221 2.4 6 980 Romania Centre Slovakia 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 11 0.4 3 0.1 4 0.2 3 0.1 5 0.2 118 Slovakia Centre Slovenia 10 1.0 16 1.6 11 1.1 8 0.8 7 0.7 10 1.0 5 0.5 4 0.4 3 0.3 7 0.7 259 Slovenia West Spain 671 2.9 547 2.7 490 2.4 437 2.6 408 2.4 325 1.9 229 1.1 310 1.5 198 1.0 243 1.2 71 059 Spain West Sweden - - - - - - - - - - - - - - - - - - - - 1 781 Sweden Total EU/EEA 3 992 1.8 3 634 1.7 3 348 1.6 3 174 1.5 2 908 1.4 2 717 1.3 2 339 1.1 1 864 1.0 1 823 1.0 1 729 1.0 271 824 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 50 3.5 36 2.5 50 3.5 50 3.5 24 1.7 35 2.4 25 1.7 16 1.1 37 2.6 33 2.3 582 Albania West Andorra 2 5.5 0 0.0 2 5.5 0 0.0 1 2.7 0 0.0 - - - - - - - - 11 Andorra East Armenia 104 7.8 129 9.8 129 9.8 116 8.9 111 8.6 147 11.4 127 10.0 113 8.9 146 11.6 173 13.8 1 820 Armenia East Azerbaijan 162 3.4 162 3.4 150 3.1 125 2.5 114 2.3 122 2.4 150 3.0 77 1.5 82 1.6 63 1.2 2 297 Azerbaijan East Belarus 369 8.2 308 6.9 278 6.2 311 6.9 274 6.1 229 5.1 241 5.4 143 3.2 184 4.2 244 5.4 4 886 Belarus Centre Bosnia and Herzegovina 6 0.3 7 0.4 7 0.4 7 0.4 4 0.2 13 0.8 8 0.5 - - - - - - 148 Bosnia and Herzegovina East Georgia 219 12.3 201 11.3 196 11.0 196 11.0 193 10.9 172 9.7 198 11.2 134 7.6 163 9.2 168 9.5 3 594 Georgia West Israel 38 1.0 48 1.2 26 0.7 29 0.7 23 0.6 32 0.8 20 0.5 25 0.6 24 0.5 5 0.1 1 313 Israel East Kazakhstan 190 2.3 185 2.2 181 2.1 231 2.7 225 2.6 279 3.1 293 3.3 293 3.2 289 3.1 271 2.9 3 676 Kazakhstan East Kyrgyzstan 46 1.6 46 1.6 43 1.5 23 0.8 22 0.7 37 1.2 28 0.9 27 0.9 41 1.3 55 1.7 650 Kyrgyzstan East Moldova 217 13.4 183 11.5 179 11.5 210 13.7 167 11.0 213 14.3 180 12.2 123 8.4 120 8.3 152 9.8 3 083 Moldova West Monaco 0 0.0 1 5.6 0 0.0 0 0.0 0 0.0 0 0.0 - - - - - - - - 40 Monaco Centre Montenegro 7 2.3 4 1.3 11 3.6 15 4.9 12 3.9 14 4.5 10 3.3 3 1.0 7 2.3 15 4.9 166 Montenegro Centre North Macedonia 9 0.9 13 1.2 5 0.5 6 0.6 2 0.2 4 0.4 - - - - - - - - 127 North Macedonia East Russian Federation - - - - - - - - - - - - - - - - - - - - 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 21 San Marino Centre Serbia 42 0.9 43 1.0 47 1.0 57 1.3 59 1.3 62 1.4 61 1.4 28 0.6 52 1.2 53 1.2 1 785 Serbia Centre Serbia excluding Kosovoc 40 1.1 42 1.2 45 1.2 52 1.4 53 1.5 55 1.5 57 1.6 27 0.8 49 1.4 48 1.4 1 710 Serbia excluding Kosovoc Centre Kosovoc 2 0.2 1 0.1 2 0.2 5 0.6 6 0.7 7 0.8 4 0.5 1 0.1 3 0.3 5 0.6 75 Kosovoc West Switzerland 74 1.9 63 1.6 52 1.3 49 1.2 55 1.3 50 1.2 57 1.3 36 0.8 29 0.7 28 0.6 7 638 Switzerland East Tajikistan 140 3.4 157 3.8 187 4.4 173 3.9 182 4.1 149 3.2 109 2.3 87 1.8 97 2.0 70 1.4 1 867 Tajikistan Centre Türkiye 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 91 0.2 92 0.2 33 0.1 73 0.2 71 0.2 1 671 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - - - - 0 Turkmenistan East Ukraine 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 2 479 11.1 2 513 13.1 1 895 10.0 62 615 Ukraine West United Kingdom 247 0.8 250 0.8 299 0.9 223 0.7 185 0.6 190 0.6 202 0.6 148 0.4 179 0.5 124 0.4 23 977 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 494 Uzbekistan Total non-EU/EEA 8 012 5.8 8 054 5.8 7 262 5.1 7 369 5.3 7 368 5.2 7 244 5.1 6 462 4.5 3 765 2.6 4 036 2.8 3 420 2.3 127 051 Total non-EU/EEA WHO European Region WHO European Region West 3 670 1.8 3 247 1.6 3 060 1.5 2 748 1.3 2 498 1.2 2 307 1.1 2 018 1.0 1 634 1.0 1 576 0.9 1 336 0.8 288 136 West Centre 734 0.8 798 0.8 753 0.8 794 0.8 744 0.8 790 0.8 706 0.7 444 0.5 586 0.6 652 0.7 18 618 Centre East 7 600 14.4 7 642 14.4 6 797 12.2 7 001 13.3 7 034 13.3 6 864 13.0 6 077 11.4 3 551 6.3 3 697 6.9 3 161 5.9 92 110 East Total WHO European Region 12 004 3.4 11 687 3.3 10 610 3.0 10 543 3.0 10 276 2.9 9 961 2.8 8 801 2.4 5 629 1.7 5 859 1.8 5 149 1.5 398 864 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 Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 57 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 14: AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 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 50 1.2 57 1.4 57 1.4 49 1.1 54 1.3 43 1.0 46 1.1 36 0.8 43 1.0 29 0.7 2 636 Austria West Belgium 67 1.2 85 1.5 63 1.1 44 0.8 44 0.8 35 0.6 58 1.0 39 0.7 34 0.6 23 0.4 3 572 Belgium Centre Bulgaria 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 48 1.4 56 1.6 31 0.9 35 1.0 45 1.4 732 Bulgaria Centre Croatia 14 0.7 1 0.0 1 0.0 21 1.0 19 0.9 28 1.4 18 0.9 11 0.6 22 1.1 18 1.0 409 Croatia Centre Cyprus 16 3.8 51 12.2 63 15.3 64 15.5 49 11.8 63 14.9 58 13.6 56 12.9 71 16.2 18 4.1 772 Cyprus Centre Czechia 27 0.5 23 0.4 30 0.6 39 0.8 44 0.8 35 0.7 27 0.5 36 0.7 45 0.9 50 1.0 681 Czechia West Denmark 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 21 0.7 15 0.5 21 0.7 14 0.5 11 0.4 2 418 Denmark East Estonia 19 3.1 13 2.1 11 1.8 23 3.7 15 2.4 19 3.1 21 3.4 18 2.9 9 1.4 11 1.7 447 Estonia West Finland 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 17 0.6 12 0.4 7 0.3 9 0.3 12 0.4 624 Finland West France 528 1.7 449 1.4 426 1.3 346 1.1 360 1.1 389 1.2 406 1.3 317 1.0 322 1.0 289 0.9 58 342 France West Germany 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 121 2.3 106 2.0 114 2.2 109 2.1 94 1.8 91 1.7 70 1.3 86 1.6 63 1.2 53 1.0 3 634 Greece Centre Hungary 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 54 1.2 46 1.0 35 0.7 39 0.8 32 0.7 1 020 Hungary West Iceland 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 0 0.0 3 1.6 2 1.1 2 1.1 1 0.5 70 Iceland West Ireland 23 1.0 22 1.0 16 0.7 12 0.5 15 0.6 12 0.5 7 0.3 8 0.3 15 0.6 17 0.7 1 043 Ireland West Italy 813 2.8 713 2.4 687 2.3 669 2.3 587 2.0 565 1.9 524 1.8 303 1.0 346 1.2 299 1.0 55 932 Italy East Latvia 90 9.7 110 12.0 89 9.8 90 10.0 73 8.2 63 7.1 53 6.0 39 4.4 24 2.7 42 4.8 1 533 Latvia Liechtenstein 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 - - 11 Liechtenstein East Lithuania 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 29 2.2 16 1.2 18 1.4 29 2.2 17 1.3 558 Lithuania West Luxembourg 18 6.7 10 3.6 10 3.5 16 5.5 7 2.4 7 2.3 3 1.0 9 2.9 15 4.7 5 1.5 447 Luxembourg West Malta 1 0.5 4 1.9 2 0.9 5 2.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 100 Malta West Netherlands 227 2.7 181 2.2 211 2.5 165 2.0 168 2.0 146 1.7 136 1.6 118 1.4 113 1.3 81 0.9 6 489 Netherlands West Norway 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 9 0.3 14 0.5 10 0.4 13 0.5 11 0.4 969 Norway Centre Poland 131 0.7 115 0.6 97 0.5 90 0.5 94 0.5 86 0.5 80 0.4 39 0.2 50 0.3 84 0.5 3 168 Poland West Portugal 374 7.5 302 6.1 252 5.1 283 5.8 220 4.5 184 3.8 161 3.3 159 3.3 157 3.2 105 2.1 18 526 Portugal Centre Romania 248 2.5 294 3.0 256 2.6 257 2.7 243 2.5 236 2.5 217 2.3 148 1.6 149 1.6 221 2.4 6 980 Romania Centre Slovakia 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 11 0.4 3 0.1 4 0.2 3 0.1 5 0.2 118 Slovakia Centre Slovenia 10 1.0 16 1.6 11 1.1 8 0.8 7 0.7 10 1.0 5 0.5 4 0.4 3 0.3 7 0.7 259 Slovenia West Spain 671 2.9 547 2.7 490 2.4 437 2.6 408 2.4 325 1.9 229 1.1 310 1.5 198 1.0 243 1.2 71 059 Spain West Sweden - - - - - - - - - - - - - - - - - - - - 1 781 Sweden Total EU/EEA 3 992 1.8 3 634 1.7 3 348 1.6 3 174 1.5 2 908 1.4 2 717 1.3 2 339 1.1 1 864 1.0 1 823 1.0 1 729 1.0 271 824 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 50 3.5 36 2.5 50 3.5 50 3.5 24 1.7 35 2.4 25 1.7 16 1.1 37 2.6 33 2.3 582 Albania West Andorra 2 5.5 0 0.0 2 5.5 0 0.0 1 2.7 0 0.0 - - - - - - - - 11 Andorra East Armenia 104 7.8 129 9.8 129 9.8 116 8.9 111 8.6 147 11.4 127 10.0 113 8.9 146 11.6 173 13.8 1 820 Armenia East Azerbaijan 162 3.4 162 3.4 150 3.1 125 2.5 114 2.3 122 2.4 150 3.0 77 1.5 82 1.6 63 1.2 2 297 Azerbaijan East Belarus 369 8.2 308 6.9 278 6.2 311 6.9 274 6.1 229 5.1 241 5.4 143 3.2 184 4.2 244 5.4 4 886 Belarus Centre Bosnia and Herzegovina 6 0.3 7 0.4 7 0.4 7 0.4 4 0.2 13 0.8 8 0.5 - - - - - - 148 Bosnia and Herzegovina East Georgia 219 12.3 201 11.3 196 11.0 196 11.0 193 10.9 172 9.7 198 11.2 134 7.6 163 9.2 168 9.5 3 594 Georgia West Israel 38 1.0 48 1.2 26 0.7 29 0.7 23 0.6 32 0.8 20 0.5 25 0.6 24 0.5 5 0.1 1 313 Israel East Kazakhstan 190 2.3 185 2.2 181 2.1 231 2.7 225 2.6 279 3.1 293 3.3 293 3.2 289 3.1 271 2.9 3 676 Kazakhstan East Kyrgyzstan 46 1.6 46 1.6 43 1.5 23 0.8 22 0.7 37 1.2 28 0.9 27 0.9 41 1.3 55 1.7 650 Kyrgyzstan East Moldova 217 13.4 183 11.5 179 11.5 210 13.7 167 11.0 213 14.3 180 12.2 123 8.4 120 8.3 152 9.8 3 083 Moldova West Monaco 0 0.0 1 5.6 0 0.0 0 0.0 0 0.0 0 0.0 - - - - - - - - 40 Monaco Centre Montenegro 7 2.3 4 1.3 11 3.6 15 4.9 12 3.9 14 4.5 10 3.3 3 1.0 7 2.3 15 4.9 166 Montenegro Centre North Macedonia 9 0.9 13 1.2 5 0.5 6 0.6 2 0.2 4 0.4 - - - - - - - - 127 North Macedonia East Russian Federation - - - - - - - - - - - - - - - - - - - - 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 21 San Marino Centre Serbia 42 0.9 43 1.0 47 1.0 57 1.3 59 1.3 62 1.4 61 1.4 28 0.6 52 1.2 53 1.2 1 785 Serbia Centre Serbia excluding Kosovoc 40 1.1 42 1.2 45 1.2 52 1.4 53 1.5 55 1.5 57 1.6 27 0.8 49 1.4 48 1.4 1 710 Serbia excluding Kosovoc Centre Kosovoc 2 0.2 1 0.1 2 0.2 5 0.6 6 0.7 7 0.8 4 0.5 1 0.1 3 0.3 5 0.6 75 Kosovoc West Switzerland 74 1.9 63 1.6 52 1.3 49 1.2 55 1.3 50 1.2 57 1.3 36 0.8 29 0.7 28 0.6 7 638 Switzerland East Tajikistan 140 3.4 157 3.8 187 4.4 173 3.9 182 4.1 149 3.2 109 2.3 87 1.8 97 2.0 70 1.4 1 867 Tajikistan Centre Türkiye 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 91 0.2 92 0.2 33 0.1 73 0.2 71 0.2 1 671 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - - - - 0 Turkmenistan East Ukraine 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 2 479 11.1 2 513 13.1 1 895 10.0 62 615 Ukraine West United Kingdom 247 0.8 250 0.8 299 0.9 223 0.7 185 0.6 190 0.6 202 0.6 148 0.4 179 0.5 124 0.4 23 977 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 494 Uzbekistan Total non-EU/EEA 8 012 5.8 8 054 5.8 7 262 5.1 7 369 5.3 7 368 5.2 7 244 5.1 6 462 4.5 3 765 2.6 4 036 2.8 3 420 2.3 127 051 Total non-EU/EEA WHO European Region WHO European Region West 3 670 1.8 3 247 1.6 3 060 1.5 2 748 1.3 2 498 1.2 2 307 1.1 2 018 1.0 1 634 1.0 1 576 0.9 1 336 0.8 288 136 West Centre 734 0.8 798 0.8 753 0.8 794 0.8 744 0.8 790 0.8 706 0.7 444 0.5 586 0.6 652 0.7 18 618 Centre East 7 600 14.4 7 642 14.4 6 797 12.2 7 001 13.3 7 034 13.3 6 864 13.0 6 077 11.4 3 551 6.3 3 697 6.9 3 161 5.9 92 110 East Total WHO European Region 12 004 3.4 11 687 3.3 10 610 3.0 10 543 3.0 10 276 2.9 9 961 2.8 8 801 2.4 5 629 1.7 5 859 1.8 5 149 1.5 398 864 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 Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 58 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 15: AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 19 0.4 26 0.6 19 0.4 18 0.4 13 0.3 10 0.2 14 0.3 11 0.2 10 0.2 14 0.3 835 Austria West Belgium 37 0.7 51 0.9 42 0.7 33 0.6 21 0.4 25 0.4 27 0.5 21 0.4 25 0.4 18 0.3 1 847 Belgium Centre Bulgaria 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 9 0.2 12 0.3 11 0.3 3 0.1 9 0.3 192 Bulgaria Centre Croatia 3 0.1 0 0.0 0 0.0 1 0.0 1 0.0 2 0.1 2 0.1 1 0.0 1 0.0 1 0.0 44 Croatia Centre Cyprus 5 1.1 3 0.7 8 1.8 12 2.8 18 4.1 10 2.3 25 5.6 14 3.1 23 5.0 16 3.5 208 Cyprus Centre Czechia 6 0.1 9 0.2 8 0.1 6 0.1 10 0.2 4 0.1 11 0.2 8 0.1 10 0.2 16 0.3 161 Czechia West Denmark 9 0.3 6 0.2 12 0.4 5 0.2 4 0.1 5 0.2 7 0.2 4 0.1 3 0.1 9 0.3 444 Denmark East Estonia 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 6 0.9 9 1.3 5 0.7 2 0.3 2 0.3 167 Estonia West Finland 3 0.1 6 0.2 6 0.2 5 0.2 8 0.3 4 0.1 6 0.2 5 0.2 7 0.3 3 0.1 163 Finland West France 201 0.6 212 0.6 186 0.5 174 0.5 143 0.4 158 0.5 169 0.5 125 0.4 136 0.4 153 0.4 16 277 France West Germany 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 21 0.4 23 0.4 25 0.4 34 0.6 28 0.5 13 0.2 23 0.4 16 0.3 23 0.4 18 0.3 744 Greece Centre Hungary 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 3 0.1 7 0.1 7 0.1 11 0.2 11 0.2 169 Hungary West Iceland 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 1 0.6 0 0.0 0 0.0 1 0.5 13 Iceland West Ireland 8 0.3 10 0.4 5 0.2 3 0.1 6 0.2 1 0.0 4 0.2 3 0.1 2 0.1 4 0.2 312 Ireland West Italy 265 0.9 218 0.7 186 0.6 205 0.7 215 0.7 157 0.5 123 0.4 110 0.4 102 0.3 104 0.3 16 624 Italy East Latvia 43 3.9 61 5.6 43 4.0 24 2.3 45 4.3 36 3.4 37 3.6 16 1.6 15 1.5 16 1.6 696 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 - - 1 Liechtenstein East Lithuania 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 8 0.5 5 0.3 5 0.3 9 0.6 8 0.5 139 Lithuania West Luxembourg 1 0.4 5 1.8 8 2.8 3 1.0 2 0.7 1 0.3 2 0.7 5 1.6 4 1.3 2 0.6 144 Luxembourg West Malta 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 14 Malta West Netherlands 50 0.6 38 0.4 46 0.5 45 0.5 37 0.4 36 0.4 33 0.4 37 0.4 25 0.3 22 0.2 1 605 Netherlands West Norway 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 3 0.1 5 0.2 1 0.0 10 0.4 9 0.3 288 Norway Centre Poland 31 0.2 34 0.2 31 0.2 12 0.1 15 0.1 25 0.1 15 0.1 13 0.1 12 0.1 30 0.2 842 Poland West Portugal 164 3.0 90 1.6 99 1.8 112 2.1 87 1.6 94 1.7 81 1.5 56 1.0 82 1.5 33 0.6 5 113 Portugal Centre Romania 117 1.1 122 1.2 111 1.1 97 1.0 87 0.9 87 0.9 95 1.0 54 0.5 62 0.6 55 0.6 4 451 Romania Centre Slovakia 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 0.1 16 Slovakia Centre Slovenia 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 0 0.0 4 0.4 2 0.2 2 0.2 0 0.0 38 Slovenia West Spain 187 0.8 132 0.6 117 0.6 103 0.6 102 0.6 64 0.4 55 0.3 65 0.3 53 0.3 53 0.3 18 057 Spain West Sweden - - - - - - - - - - - - - - - - - - - - 401 Sweden Total EU/EEA 1 313 0.6 1 150 0.5 1 053 0.5 997 0.5 948 0.4 814 0.4 791 0.4 595 0.3 632 0.3 610 0.3 74 714 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 15 1.0 14 1.0 15 1.0 8 0.6 9 0.6 12 0.8 13 0.9 2 0.1 11 0.8 13 0.9 177 Albania West Andorra 1 2.8 0 0.0 1 2.8 0 0.0 1 2.7 0 0.0 - - - - - - - - 4 Andorra East Armenia 41 2.6 47 3.0 34 2.2 47 3.0 33 2.1 64 4.1 46 3.0 39 2.5 51 3.3 57 3.7 628 Armenia East Azerbaijan 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 60 1.2 46 0.9 28 0.5 27 0.5 28 0.5 532 Azerbaijan East Belarus 178 3.4 166 3.2 212 4.1 201 3.9 165 3.2 153 2.9 139 2.7 77 1.5 102 2.0 178 0.0 2 881 Belarus Centre Bosnia and Herzegovina 1 0.1 1 0.1 1 0.1 1 0.1 0 0.0 0 0.0 2 0.1 - - - - - - 28 Bosnia and Herzegovina East Georgia 84 4.2 67 3.4 74 3.7 73 3.7 64 3.2 101 5.1 66 3.3 47 2.4 54 2.7 47 2.4 1 283 Georgia West Israel 11 0.3 22 0.6 19 0.5 18 0.4 10 0.2 10 0.2 9 0.2 8 0.2 9 0.2 8 0.2 520 Israel East Kazakhstan 68 0.7 66 0.7 92 1.0 119 1.3 137 1.4 154 1.6 158 1.6 176 1.8 170 1.7 157 1.6 1 796 Kazakhstan East Kyrgyzstan 16 0.5 24 0.8 22 0.7 13 0.4 22 0.7 23 0.7 23 0.7 26 0.8 32 1.0 39 1.2 308 Kyrgyzstan East Moldova 160 8.9 116 6.6 114 6.6 156 9.2 107 6.4 152 9.2 105 6.4 76 4.7 79 4.9 107 6.2 2 009 Moldova West Monaco 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 3 0.9 0 0.0 0 0.0 1 0.3 0 0.0 0 0.0 1 0.3 1 0.3 1 0.3 24 Montenegro Centre North Macedonia 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 0 0.0 - - - - - - - - 36 North Macedonia East Russian Federation - - - - - - - - - - - - - - - - - - - - 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 8 0.2 6 0.1 3 0.1 4 0.1 6 0.1 8 0.2 16 0.3 6 0.1 1 0.0 5 0.1 485 Serbia Centre Serbia excluding Kosovoc 7 0.2 6 0.2 2 0.1 4 0.1 6 0.2 7 0.2 15 0.4 5 0.1 1 0.0 4 0.1 464 Serbia excluding Kosovoc Centre Kosovoc 1 0.1 - 0.0 1 0.1 - 0.0 - 0.0 1 0.1 1 0.1 1 0.1 0.0 1 0.1 21 Kosovoc West Switzerland 32 0.8 16 0.4 12 0.3 21 0.5 17 0.4 14 0.3 12 0.3 6 0.1 10 0.2 9 0.2 2 596 Switzerland East Tajikistan 52 1.3 72 1.7 94 2.2 65 1.5 83 1.9 63 1.4 48 1.0 23 0.5 31 0.6 29 0.6 687 Tajikistan Centre Türkiye 19 0.0 26 0.1 26 0.1 13 0.0 18 0.0 17 0.0 20 0.0 13 0.0 7 0.0 13 0.0 336 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 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 1 660 8.6 1 638 7.4 1 115 5.1 36 308 Ukraine West United Kingdom 100 0.3 119 0.4 102 0.3 74 0.2 75 0.2 66 0.2 61 0.2 36 0.1 69 0.2 67 0.2 6 812 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 157 Uzbekistan Total non-EU/EEA 4 163 2.9 4 531 3.1 4 005 2.8 4 241 2.9 4 498 3.1 4 331 3.0 3 614 2.4 2 224 1.5 2 292 1.6 1 873 1.2 60 284 Total non-EU/EEA WHO European Region WHO European Region West 1 209 0.6 1 041 0.5 957 0.5 921 0.4 836 0.4 714 0.3 651 0.3 509 0.3 570 0.3 527 0.3 77 535 West Centre 229 0.2 245 0.3 217 0.2 169 0.2 191 0.2 177 0.2 222 0.2 132 0.1 144 0.2 173 0.2 7 207 Centre East 4 038 6.8 4 395 7.4 3 884 7.0 4 148 7.1 4 419 7.5 4 254 7.2 3 532 6.0 2 178 3.9 2 210 3.7 1 783 3.0 50 255 East Total WHO European Region 5 476 1.5 5 681 1.6 5 058 1.4 5 238 1.4 5 446 1.5 5 145 1.4 4 405 1.2 2 819 0.9 2 924 0.9 2 483 0.7 134 997 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 Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 59 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 15: AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2013–2022) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 19 0.4 26 0.6 19 0.4 18 0.4 13 0.3 10 0.2 14 0.3 11 0.2 10 0.2 14 0.3 835 Austria West Belgium 37 0.7 51 0.9 42 0.7 33 0.6 21 0.4 25 0.4 27 0.5 21 0.4 25 0.4 18 0.3 1 847 Belgium Centre Bulgaria 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 9 0.2 12 0.3 11 0.3 3 0.1 9 0.3 192 Bulgaria Centre Croatia 3 0.1 0 0.0 0 0.0 1 0.0 1 0.0 2 0.1 2 0.1 1 0.0 1 0.0 1 0.0 44 Croatia Centre Cyprus 5 1.1 3 0.7 8 1.8 12 2.8 18 4.1 10 2.3 25 5.6 14 3.1 23 5.0 16 3.5 208 Cyprus Centre Czechia 6 0.1 9 0.2 8 0.1 6 0.1 10 0.2 4 0.1 11 0.2 8 0.1 10 0.2 16 0.3 161 Czechia West Denmark 9 0.3 6 0.2 12 0.4 5 0.2 4 0.1 5 0.2 7 0.2 4 0.1 3 0.1 9 0.3 444 Denmark East Estonia 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 6 0.9 9 1.3 5 0.7 2 0.3 2 0.3 167 Estonia West Finland 3 0.1 6 0.2 6 0.2 5 0.2 8 0.3 4 0.1 6 0.2 5 0.2 7 0.3 3 0.1 163 Finland West France 201 0.6 212 0.6 186 0.5 174 0.5 143 0.4 158 0.5 169 0.5 125 0.4 136 0.4 153 0.4 16 277 France West Germany 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 21 0.4 23 0.4 25 0.4 34 0.6 28 0.5 13 0.2 23 0.4 16 0.3 23 0.4 18 0.3 744 Greece Centre Hungary 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 3 0.1 7 0.1 7 0.1 11 0.2 11 0.2 169 Hungary West Iceland 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 1 0.6 0 0.0 0 0.0 1 0.5 13 Iceland West Ireland 8 0.3 10 0.4 5 0.2 3 0.1 6 0.2 1 0.0 4 0.2 3 0.1 2 0.1 4 0.2 312 Ireland West Italy 265 0.9 218 0.7 186 0.6 205 0.7 215 0.7 157 0.5 123 0.4 110 0.4 102 0.3 104 0.3 16 624 Italy East Latvia 43 3.9 61 5.6 43 4.0 24 2.3 45 4.3 36 3.4 37 3.6 16 1.6 15 1.5 16 1.6 696 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 - - 1 Liechtenstein East Lithuania 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 8 0.5 5 0.3 5 0.3 9 0.6 8 0.5 139 Lithuania West Luxembourg 1 0.4 5 1.8 8 2.8 3 1.0 2 0.7 1 0.3 2 0.7 5 1.6 4 1.3 2 0.6 144 Luxembourg West Malta 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 14 Malta West Netherlands 50 0.6 38 0.4 46 0.5 45 0.5 37 0.4 36 0.4 33 0.4 37 0.4 25 0.3 22 0.2 1 605 Netherlands West Norway 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 3 0.1 5 0.2 1 0.0 10 0.4 9 0.3 288 Norway Centre Poland 31 0.2 34 0.2 31 0.2 12 0.1 15 0.1 25 0.1 15 0.1 13 0.1 12 0.1 30 0.2 842 Poland West Portugal 164 3.0 90 1.6 99 1.8 112 2.1 87 1.6 94 1.7 81 1.5 56 1.0 82 1.5 33 0.6 5 113 Portugal Centre Romania 117 1.1 122 1.2 111 1.1 97 1.0 87 0.9 87 0.9 95 1.0 54 0.5 62 0.6 55 0.6 4 451 Romania Centre Slovakia 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 0.1 16 Slovakia Centre Slovenia 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 0 0.0 4 0.4 2 0.2 2 0.2 0 0.0 38 Slovenia West Spain 187 0.8 132 0.6 117 0.6 103 0.6 102 0.6 64 0.4 55 0.3 65 0.3 53 0.3 53 0.3 18 057 Spain West Sweden - - - - - - - - - - - - - - - - - - - - 401 Sweden Total EU/EEA 1 313 0.6 1 150 0.5 1 053 0.5 997 0.5 948 0.4 814 0.4 791 0.4 595 0.3 632 0.3 610 0.3 74 714 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 15 1.0 14 1.0 15 1.0 8 0.6 9 0.6 12 0.8 13 0.9 2 0.1 11 0.8 13 0.9 177 Albania West Andorra 1 2.8 0 0.0 1 2.8 0 0.0 1 2.7 0 0.0 - - - - - - - - 4 Andorra East Armenia 41 2.6 47 3.0 34 2.2 47 3.0 33 2.1 64 4.1 46 3.0 39 2.5 51 3.3 57 3.7 628 Armenia East Azerbaijan 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 60 1.2 46 0.9 28 0.5 27 0.5 28 0.5 532 Azerbaijan East Belarus 178 3.4 166 3.2 212 4.1 201 3.9 165 3.2 153 2.9 139 2.7 77 1.5 102 2.0 178 0.0 2 881 Belarus Centre Bosnia and Herzegovina 1 0.1 1 0.1 1 0.1 1 0.1 0 0.0 0 0.0 2 0.1 - - - - - - 28 Bosnia and Herzegovina East Georgia 84 4.2 67 3.4 74 3.7 73 3.7 64 3.2 101 5.1 66 3.3 47 2.4 54 2.7 47 2.4 1 283 Georgia West Israel 11 0.3 22 0.6 19 0.5 18 0.4 10 0.2 10 0.2 9 0.2 8 0.2 9 0.2 8 0.2 520 Israel East Kazakhstan 68 0.7 66 0.7 92 1.0 119 1.3 137 1.4 154 1.6 158 1.6 176 1.8 170 1.7 157 1.6 1 796 Kazakhstan East Kyrgyzstan 16 0.5 24 0.8 22 0.7 13 0.4 22 0.7 23 0.7 23 0.7 26 0.8 32 1.0 39 1.2 308 Kyrgyzstan East Moldova 160 8.9 116 6.6 114 6.6 156 9.2 107 6.4 152 9.2 105 6.4 76 4.7 79 4.9 107 6.2 2 009 Moldova West Monaco 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 3 0.9 0 0.0 0 0.0 1 0.3 0 0.0 0 0.0 1 0.3 1 0.3 1 0.3 24 Montenegro Centre North Macedonia 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 0 0.0 - - - - - - - - 36 North Macedonia East Russian Federation - - - - - - - - - - - - - - - - - - - - 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 8 0.2 6 0.1 3 0.1 4 0.1 6 0.1 8 0.2 16 0.3 6 0.1 1 0.0 5 0.1 485 Serbia Centre Serbia excluding Kosovoc 7 0.2 6 0.2 2 0.1 4 0.1 6 0.2 7 0.2 15 0.4 5 0.1 1 0.0 4 0.1 464 Serbia excluding Kosovoc Centre Kosovoc 1 0.1 - 0.0 1 0.1 - 0.0 - 0.0 1 0.1 1 0.1 1 0.1 0.0 1 0.1 21 Kosovoc West Switzerland 32 0.8 16 0.4 12 0.3 21 0.5 17 0.4 14 0.3 12 0.3 6 0.1 10 0.2 9 0.2 2 596 Switzerland East Tajikistan 52 1.3 72 1.7 94 2.2 65 1.5 83 1.9 63 1.4 48 1.0 23 0.5 31 0.6 29 0.6 687 Tajikistan Centre Türkiye 19 0.0 26 0.1 26 0.1 13 0.0 18 0.0 17 0.0 20 0.0 13 0.0 7 0.0 13 0.0 336 Türkiye East Turkmenistan - - - - - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 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 1 660 8.6 1 638 7.4 1 115 5.1 36 308 Ukraine West United Kingdom 100 0.3 119 0.4 102 0.3 74 0.2 75 0.2 66 0.2 61 0.2 36 0.1 69 0.2 67 0.2 6 812 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 157 Uzbekistan Total non-EU/EEA 4 163 2.9 4 531 3.1 4 005 2.8 4 241 2.9 4 498 3.1 4 331 3.0 3 614 2.4 2 224 1.5 2 292 1.6 1 873 1.2 60 284 Total non-EU/EEA WHO European Region WHO European Region West 1 209 0.6 1 041 0.5 957 0.5 921 0.4 836 0.4 714 0.3 651 0.3 509 0.3 570 0.3 527 0.3 77 535 West Centre 229 0.2 245 0.3 217 0.2 169 0.2 191 0.2 177 0.2 222 0.2 132 0.1 144 0.2 173 0.2 7 207 Centre East 4 038 6.8 4 395 7.4 3 884 7.0 4 148 7.1 4 419 7.5 4 254 7.2 3 532 6.0 2 178 3.9 2 210 3.7 1 783 3.0 50 255 East Total WHO European Region 5 476 1.5 5 681 1.6 5 058 1.4 5 238 1.4 5 446 1.5 5 145 1.4 4 405 1.2 2 819 0.9 2 924 0.9 2 483 0.7 134 997 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 Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 60 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 16: The most common AIDS-indicative diseases diagnosed in 2022a, ordered by frequency Diseases Men Women Children TotalN % N % N % N % EU/EEA Pneumocystis carinii pneumonia 479 21.5 160 20.8 4 11.8 643 21.2 Wasting syndrome due to HIV 311 14.0 101 13.1 10 29.4 422 13.9 Candidiasis; oesophageal 240 10.8 83 10.8 1 2.9 324 10.7 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 156 7.0 72 9.3 4 11.8 232 7.7 Cytomegalovirus disease (other than liver; spleen; or nodes) in a patient over one month of age 144 6.5 55 7.1 1 2.9 200 6.6 Kaposi’s sarcoma 169 7.6 17 2.2 0 0.0 186 6.1 Toxoplasmosis of brain in a patient over one month of age 114 5.1 49 6.4 0 0.0 163 5.4 Mycobacterium tuberculosis; extrapulmonary 86 3.9 48 6.2 0 0.0 134 4.4 Encephalopathy; HIV-related 85 3.8 32 4.2 4 11.8 121 4.0 Progressive multifocal leukoencephalopathy 49 2.2 14 1.8 1 2.9 64 2.1 Non-EU/EEA Wasting syndrome due to HIV 124 11.0 55 11.7 2 11.8 181 11.2 Candidiasis; oesophageal 108 9.6 47 10.0 0 0.0 155 9.6 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 102 9.1 34 7.2 2 11.8 138 8.5 Kaposi’s sarcoma 96 8.5 32 6.8 0 0.0 128 7.9 Pneumocystis carinii pneumonia 81 7.2 36 7.6 2 11.8 119 7.4 Encephalopathy; HIV-related 45 4.0 15 3.2 0 0.0 60 3.7 Mycobacterium tuberculosis; extrapulmonary 44 3.9 11 2.3 1 5.9 56 3.5 Candidiasis of bronchi; trachea; or lungs 35 3.1 15 3.2 0 0.0 50 3.1 Toxoplasmosis of brain in a patient over one month of age 19 1.7 11 2.3 0 0.0 30 1.9 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 17 1.5 11 2.3 1 5.9 29 1.8 West Pneumocystis carinii pneumonia 400 23.6 137 21.3 3 33.3 540 23.0 Candidiasis; oesophageal 194 11.5 62 9.7 0 0.0 256 10.9 Kaposi’s sarcoma 190 11.2 38 5.9 0 0.0 228 9.7 Wasting syndrome due to HIV 150 8.9 59 9.2 2 22.2 211 9.0 Cytomegalovirus disease (other than liver; spleen; or nodes) in a patient over one month of age 132 7.8 47 7.3 1 11.1 180 7.7 Toxoplasmosis of brain in a patient over one month of age 92 5.4 51 7.9 0 0.0 143 6.1 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 89 5.3 46 7.2 1 11.1 136 5.8 Mycobacterium tuberculosis; extrapulmonary 73 4.3 46 7.2 0 0.0 119 5.1 Encephalopathy; HIV-related 49 2.9 21 3.3 0 0.0 70 3.0 Cytomegalovirus retinitis (with loss of vision) 31 1.8 15 2.3 0 0.0 46 2.0 Centre Wasting syndrome due to HIV 200 23.4 52 23.5 8 28.6 260 23.6 Pneumocystis carinii pneumonia 106 12.4 25 11.3 1 3.6 132 12.0 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 73 8.5 23 10.4 3 10.7 99 9.0 Candidiasis; oesophageal 59 6.9 27 12.2 1 3.6 87 7.9 Encephalopathy; HIV-related 53 6.2 12 5.4 4 14.3 69 6.3 Kaposi’s sarcoma 54 6.3 4 1.8 0 0.0 58 5.3 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 33 3.9 5 2.3 2 7.1 40 3.6 Mycobacterium tuberculosis; extrapulmonary 24 2.8 9 4.1 0 0.0 33 3.0 Cytomegalovirus disease (other than liver; spleen; or nodes) in a patient over one month of age 25 2.9 7 3.2 0 0.0 32 2.9 Toxoplasmosis of brain in a patient over one month of age 26 3.0 6 2.7 0 0.0 32 2.9 East Candidiasis; oesophageal 95 11.8 41 10.8 0 0.0 136 11.4 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 96 11.9 37 9.8 2 14.3 135 11.3 Wasting syndrome due to HIV 85 10.6 45 11.9 2 14.3 132 11.0 Pneumocystis carinii pneumonia 54 6.7 34 9.0 2 14.3 90 7.5 Encephalopathy; HIV-related 28 3.5 14 3.7 0 0.0 42 3.5 Mycobacterium tuberculosis; extrapulmonary 33 4.1 4 1.1 1 7.1 38 3.2 Kaposi’s sarcoma 21 2.6 7 1.8 0 0.0 28 2.3 Candidiasis of bronchi; trachea; or lungs 15 1.9 9 2.4 0 0.0 24 2.0 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 9 1.1 8 2.1 1 7.1 18 1.5 Toxoplasmosis of brain in a patient over one month of age 15 1.9 3 0.8 0 0.0 18 1.5 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 61 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Table 17: AIDS-related deathsa, by geographic area, country and year of death (2013–2022) and cumulative totals in EU/EEA and other countries of the WHO European Region Area Country, territory or areab Year of diagnosis Cumulative totalc2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 EU/EEA West Austria 41 42 37 32 43 40 42 27 52 15 1 774 West Belgium 36 34 21 27 19 16 31 28 22 32 2 234 Centre Bulgaria 14 13 8 9 10 9 17 6 13 11 239 Centre Croatia 6 0 4 3 2 2 4 4 9 6 172 Centre Cyprus 5 4 3 2 1 0 2 3 5 1 132 Centre Czechia 13 15 12 18 20 18 8 24 23 19 378 West Denmark 4 0 1 2 1 2 1 2 4 4 1 812 East Estonia 2 2 2 2 4 4 1 6 5 2 134 West Finland 8 5 6 5 9 6 1 0 2 2 242 West France 134 127 103 129 129 189 200 190 180 158 37 682 West Germany 111 101 76 77 71 71 34 - - - 14 970 West Greece 43 48 51 42 44 42 37 44 35 30 2 055 Centre Hungary 11 19 11 11 9 18 19 10 15 21 505 West Iceland 0 0 0 1 0 0 0 1 0 0 41 West Ireland 0 0 1 1 1 0 2 2 1 3 425 West Italyb 653 573 561 533 511 505 514 528 - - 47 408 East Latvia 107 75 45 41 37 29 30 13 11 21 943 Liechtenstein 0 0 0 0 0 0 0 0 0 - 6 East Lithuania 18 16 12 23 15 14 5 12 18 16 287 West Luxembourg 5 4 5 7 2 2 7 7 3 8 264 West Malta 0 1 1 3 0 0 0 0 0 0 65 West Netherlands 85 89 90 100 90 82 86 84 94 82 2 359 West Norway 2 3 2 0 2 1 1 0 0 1 635 Centre Poland 48 42 41 27 20 23 15 15 6 23 1 472 West Portugal 273 207 177 189 168 159 115 74 94 68 11 050 Centre Romania 200 240 199 199 201 181 177 149 151 204 5 476 Centre Slovakia 0 0 4 2 1 3 2 1 0 0 52 Centre Slovenia 7 4 6 3 2 1 2 0 2 3 124 West Spainb 311 234 185 179 110 81 29 48 38 37 49 124 West Sweden - - - - - - - - - - 1 323 Total EU/EEA 2 137 1 898 1 664 1 667 1 522 1 498 1 382 1 278 783 767 183 383 Non-EU/EEA Centre Albania 10 13 13 12 4 11 8 4 11 10 209 West Andorra 0 0 3 0 0 0 - - - - 4 East Armenia 45 50 62 53 74 61 61 52 65 52 812 East Azerbaijan 43 54 41 36 29 35 31 25 17 30 1 259 East Belarus 261 291 263 319 278 259 260 229 184 128 4 599 Centre Bosnia and Herzegovina 2 1 5 2 0 2 2 - - - 69 East Georgia 82 68 70 132 96 100 77 106 78 85 1 571 West Israel 33 34 26 31 16 17 13 14 11 6 1 081 East Kazakhstan 190 161 209 235 255 283 306 316 302 278 3 946 East Kyrgyzstan 45 44 40 35 46 43 24 34 51 51 614 East Moldova 141 150 130 125 104 84 100 138 102 87 2 034 West Monaco 0 0 0 0 0 0 - - - - 18 Centre Montenegro 1 2 6 2 4 2 4 1 4 2 67 Centre North Macedonia 3 0 0 0 2 1 - - - - 67 East Russian Federation - - - - - - - - - - 0 West San Marino 0 0 0 0 0 0 0 0 0 0 8 Centre Serbia 21 13 13 14 13 30 24 18 16 20 1 254 Centre Serbia excluding Kosovod 20 13 12 11 13 29 22 18 16 20 1 206 Centre Kosovod 1 - 1 3 - 1 2 - - - 48 West Switzerland 0 0 0 0 0 0 0 0 0 0 0 East Tajikistan 113 105 128 133 186 147 116 102 79 72 1 507 Centre Türkiye 10 11 4 4 5 8 4 1 1 7 129 East Turkmenistan - - - - - - - - - - 1 East Ukraine 3 514 3 426 3 032 3 253 3 298 3 448 2 977 2 114 1 928 1 293 56 768 West United Kingdom 161 150 116 105 110 92 104 129 146 135 17 107 East Uzbekistan - - - - - - - - - - 323 Total non-EU/EEA 4 675 4 573 4 161 4 491 4 520 4 623 4 111 3 283 2 995 2 256 91 447 WHO European Region West 1 900 1 652 1 462 1 463 1 326 1 305 1 217 1 178 682 581 191 681 Centre 351 377 329 308 294 309 288 236 256 327 10 345 East 4 561 4 442 4 034 4 387 4 422 4 507 3 988 3 147 2 840 2 115 74 798 Total WHO European Region 6 812 6 471 5 825 6 158 6 042 6 121 5 493 4 561 3 778 3 023 276 824 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. b Country-specific comments are in Annex 5. Spain has changing national coverage of AIDS reporting during the period (see Annex 5) and trends should be interpreted with caution. Mortality statistics for 2021-2022 were unavailable in Italy c Cumulative total is the total number of cases reported by country since the start of reporting d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 62 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Table 18: Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2013–2022) and number of tests per 1 000 population in 2022, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Number of HIV tests Tests/1 000 population2013 2014 2015 2 016 2 017 2 018 2019 2020 2021 2022 EU/EEA West Austria - - - - - - - - - - - West Belgium 695 433 697 684 692 679 726 457 715 536 734 506 763 413 629 063 694 792 706 294 61 Centre Bulgaria - 230 000 290 000 - - 360 000 360 000 340 000 - - - Centre Croatia - - - - - - - - - - - Centre Cyprus 50 235 - - 52 385 - - - 37 326 41 900 - - Centre Czechia 341 583 349 448 345 274 350 234 351 650 353 425 359 327 329 433 386 943 431 832 41 West Denmark 137 537 151 970 153 050 163 779 158 331 155 609 158 009 144 859 146 263 149 263 25 East Estonia 82 279 82 266 87 587 90 136 102 863 112 487 125 273 105 285 106 051 115 538 87 West Finland - - - - - - - - - - - West France 5 272 434 5 331 924 5 445 116 5 554 910 5 693 655 5 917 179 6 336 669 5 437 180 5 971 751 6 496 118 - West Germany - - - - - - - - - - - West Greeceb 32 241 240 116 192 150 196 257 176 966 187 627 305 433 250 450 263 046 236 911 23 Centre Hungary 95 861 93 289 91 793 - - - - - - - - West Iceland - - - - - - - - - - - West Irelandb 150 597 168 028 178 267 192 956 223 609 239 571 247 490 206 516 224 072 - - West Italy - - - - - - - - - - - East Latvia 58 302 60 614 65 552 79 715 82 608 90 368 98 651 93 036 103 843 119 274 64 Liechtenstein - - - - - - - - - - - East Lithuania 102 161 108 781 105 486 104 132 113 917 109 825 133 810 112 489 125 918 129 082 46 West Luxembourg - - - 71 200 100 529 - - - - - - West Malta - - - - - - - - - - - West Netherlands - - - - - - - - - - - West Norway - - - - - - - - - - - Centre Poland 313 341 272 102 318 458 440 365 430 662 385 173 432 929 432 074 460 882 699 717 19 West Portugalb 248 890 260 437 282 800 281 992 291 305 308 328 352 926 272 310 333 382 437 645 42 Centre Romania 302 898 332 422 346 032 360 893 338 898 323 468 334 410 - - - - Centre Slovakia 114 574 126 187 127 109 104 876 111 340 177 498 - - - - - Centre Slovenia 33 457 35 498 34 366 35 788 37 315 38 570 40 462 23 798 40 147 51 143 24 West Spain - - - - - - - - - - - West Sweden - - - - - - - - - - - Non-EU/EEA Centre Albania 3 063 4 156 5 442 5 582 7 149 11 219 13 261 11 864 10 776 24 972 9 West Andorra 2 310 2 378 2 212 2 340 2 591 2 712 - - - - - East Armenia 83 431 94 122 117 012 99 270 119 628 132 509 164 933 159 281 156 175 208 833 - East Azerbaijan 482 282 612 860 714 621 500 469 657 704 753 568 722 136 665 000 664 614 774 714 78 East Belarus 770 136 1 157 072 1 249 712 1 464 386 1 514 635 1 627 169 1 488 199 1 242 389 1 316 274 1 488 640 156 Centre Bosnia and Herzegovina - - - - - - - - - - - East Georgia 18 091 86 290 78 261 119 868 207 175 188 142 441 119 - 422 900 298 500 80 West Israel - - - - - - - - - - - East Kazakhstan 2 127 136 2 190 757 2 388 347 2 587 065 2 742 741 2 760 324 2 877 706 2 877 706 3 315 560 3 581 123 185 East Kyrgyzstan 370 160 410 331 376 284 331 609 376 431 356 765 424 087 367 948 546 133 612 785 - East Moldova 146 105 133 476 146 762 124 010 160 947 154 575 182 196 152 500 141 100 273 666 84 West Monaco - - - - - - - - - - - Centre Montenegro 6 970 6 571 6 607 6 324 5 606 6 890 6 575 5 375 6 372 6 831 - Centre North Macedonia 24 562 27 430 28 601 30 211 36 248 34 634 40 596 34 439 40 879 39 596 19 East Russian Federationb 28 327 314 29 878 681 30 750 547 32 855 597 36 445 059 40 485 246 41 900 729 36 110 128 41 277 712 47 205 207 326 West San Marino 4 004 3 427 1 548 3 600 3 685 3 411 2 200 1 550 630 2 627 78 Centre Serbia 67 079 56 282 63 189 68 426 80 918 81 530 90 508 64 332 86 166 96 389 - Centre Serbia excluding Kosovoc 65 829 56 282 61 877 65 827 76 367 76 653 88 490 63 090 82 737 89 317 13 Centre Kosovoc 1 250 - 1 312 2 599 4 551 4 877 2 018 1 242 3 429 7 072 4 West Switzerland - - - - - - - - - - - East Tajikistan 514 701 634 791 597 426 509 092 612 123 780 688 1 062 509 836 487 909 536 919 083 92 Centre Türkiye 6 515 931 6 663 547 7 203 959 6 263 020 7 107 551 7 457 674 10 257 015 7 067 571 9 379 998 10 092 464 118 East Turkmenistan - - - - - - - - - - - East Ukraine 2 941 748 1 853 626 1 695 926 1 697 479 1 816 023 1 868 565 1 961 711 1 501 984 1 428 952 1 068 483 26 West United Kingdom - - - - - - - - - - - East Uzbekistan - - - - - - - - - - - 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. The number of tests in Portugal refer to those requested or perfomed at public primary health-care centres and voluntary counselling and testing (public and Nongovernmental organization) and do not include those requested in hospitals and private sector. Number of tests in Ireland include antenatal tests in the total and, for 2018, include community based rapid testing. HIV tests in the Russian Federation include blood donors. c Without prejudice to positions on status, and in line with UNSCR 1 244 and the ICJ Opinion on the Kosovo Declaration of Independence. 63 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Maps 64 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Map 1a: HIV diagnoses per 100 000 population, 2022 < 2 2 to < 10 10 to < 20 20 to < 30 ≥ 30 Missing or excluded data Non-visible countries San Marino Monaco Malta Luxembourg Liechtenstein Andorra 0 1000 2000 km Map 1b: HIV diagnoses per 100 000 population, 2022, EU/EEA Liechtenstein Luxembourg Malta Non-visible countries < 3 3 to < 5 5 to < 10 10 to < 15 ≥ 15 Missing or excluded data 65 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Map 3: HIV diagnoses in women per 100 000 female population, 2022 Map 2: HIV diagnoses in men per 100 000 male population, 2022 < 3 3 to < 5 5 to < 10 10 to < 15 ≥ 15 Missing or excluded data Non-visible countries San Marino Monaco Malta Luxembourg Liechtenstein Andorra 0 1000 2000 km < 5 5 to < 10 10 to < 20 20 to < 30 ≥ 30 Missing or excluded data Non-visible countries San Marino Monaco Malta Luxembourg Liechtenstein Andorra 0 1000 2000 km 66 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Map 4: HIV diagnoses in men who have sex with men per 100 000 male population, 2022 < 3 3 to < 5 5 to < 10 10 to < 15 ≥ 15 Missing or excluded data Non-visible countries San Marino Monaco Malta Luxembourg Liechtenstein Andorra 0 1000 2000 km Map 5: HIV diagnoses acquired through injecting drug use per 100 000 population, 2022 < 0.3 0.3 to < 1 1 to < 3 3 to < 5 ≥ 5 Missing or excluded data Non-visible countries San Marino Monaco Malta Luxembourg Liechtenstein Andorra 0 1000 2000 km 67 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Map 6: HIV diagnoses acquired through heterosexual transmission per 100 000 population, 2022 < 3 3 to < 5 5 to < 10 10 to < 15 ≥ 15 Missing or excluded data Non-visible countries San Marino Monaco Malta Luxembourg Liechtenstein Andorra 0 1000 2000 km Map 7: AIDS diagnoses reported per 100 000 population, 2022 < 0.3 0.3 to < 1 1 to < 3 3 to < 5 ≥ 5 Missing or excluded data Non-visible countries San Marino Monaco Malta Luxembourg Liechtenstein Andorra 0 1000 2000 km

69 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Annexes

71 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT 1. Reporting The Member States’ Coordinating Competent Bodies in European Union (EU) and European Economic Area (EEA) (jointly referred to as EU/EEA) countries have nomi- nated 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 the WHO Regional Office for Europe database for HIV/AIDS surveillance. For non-EU/EEA countries, nominations for national HIV/AIDS surveil- lance 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 recog- nised 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 defi- nitions 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 facili- ties to the Ministry of Health and include the number of individuals newly diagnosed with HIV infection; 2009–2015 data therefore cannot be directly compared to 2016–2022 data. A built-in set of validation rules in TESSy ensures verification of the data within the data- base during the data-uploading process, improving data quality and allowing each country to test their datasets prior to submission. Further validation checks are car- ried out by ECDC and the WHO Regional Office for Europe in collaboration with countries before the data are con- sidered of sufficient quality to be used for analysis. Andorra, Monaco, Turkmenistan and Uzbekistan did not report any HIV data through the TESSy system for 2022 (or previous years for some of the countries − see Table  1). Andorra, Bosnia and Herzegovina, Germany, Liechtenstein, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan did not report any AIDS data for 2022 (or previous years for some of the countries − see Table 13). The 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. 1.1. 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 (detailed in Annex  4a and  4b.) Some cross-country data com- parisons are hampered by differences in surveillance systems, and by the quality and coverage of national surveillance. These issues are detailed in Annex 5 and should be taken into account when interpreting and comparing trends across countries. 2. Data collection and validation 2.1. Data collection 2022 The 2022 data submission for HIV and AIDS surveillance took place between 12 March and 5 October 2023. Data presented in this report were extracted from TESSy on 5 October 2022. 2.2. Individual country datasets Data were uploaded, validated and approved in the joint database for HIV/AIDS surveillance by the report- ing countries. Once the data were submitted, individual datasets were reviewed by ECDC and WHO’s Regional Office for Europe and validated by the 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). The joined record type allows understanding of the relationship between the HIV and AIDS events and diagnosis dates. 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 data- sets, reducing the amount of data that can be presented in certain tables and figures. 3. Data re-coding and adjustments 3.1. 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 Annex 1: Framework for data collection, validation and presentation 72 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data to avoid discrepancies with their national surveillance reports, this date was used instead. This was the case for four countries: Armenia, Belarus, Türkiye and Ukraine. 3.2. 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). 3.3. Origin of reported cases Cases originating from countries outside of the report- ing 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 generalised HIV epidemics (in Tables  10, 11 and in selected figures). 3.4. Reporting delay The data in this report has not been adjusted for report- ing delays. This is primarily due to the impact of the COVID-19 pandemic and the incorporation of previously reported positive diagnoses into the analysis. 4. Data presentation 4.1. Geographical presentation Data are presented for the WHO European Region and the EU/EEA. The EU comprises 27 Member States and the EEA an additional three countries (Iceland, Liechtenstein and Norway) which are included in the overview of the EU/EEA. The tables are presented for EU/EEA countries, non- EU/EEA countries and as totals. The 53 countries of the WHO European Region are also sub-divided into three geographical areas, based on epidemiological consid- erations and in accordance with the division used in Andorra Luxembourg Malta Monaco San Marino West Centre East Figure A1: Geographical/epidemiological division of the WHO European Region The countries covered by the report are grouped as follows: • West, 23 countries: Andorra, Austria*, Belgium*, Denmark*, Finland*, France*, Germany*, Greece*, Iceland, Ireland*, Israel, Italy*, Luxembourg*, Malta*, Monaco, Netherlands*, Norway, Portugal*, San Marino, Spain*, Sweden*, Switzerland, United Kingdom. • Centre, 15 countries: Albania, Bosnia and Herzegovina, Bulgaria*, Croatia*, Cyprus*, Czechia*, Hungary*, the former Yugoslav Republic of Macedonia, Montenegro, Poland*, Romania*, Serbia, Slovakia*, Slovenia*, Türkiye. • East, 15 countries: Armenia, Azerbaijan, Belarus, Estonia*, Georgia, Kazakhstan, Kyrgyzstan, Latvia*, Lithuania*, Republic of Moldova, Russian Federation, Tajikistan, Turkmenistan, Ukraine, Uzbekistan. * Countries constituting the European Union as of 2022. 73 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT previous reports on HIV/AIDS surveillance in Europe: West (23 countries), Centre (15 countries) and East (15 countries) (Figure A1.1). The division reflects similarities in epidemiological dynamics such as epidemic levels, trends over time and transmission patterns. Among the EU/EEA countries, 18 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 Kosovo1 in all figures, although these are stratified in tables to allow separate epidemiological presentation of the reported data. 4.2. Population data and rates Data are presented in absolute numbers and rates as cases per 100 000 population. The population estimates up to 2022 were derived from Eurostat for all EU/EEA countries and from the United Nations Population Division for non-EU/EEA countries2 [3]. The Eurostat data are from May 2022 [4] and the United Nations Population Division statistics are from the 2022 round of estimates [5]. Due to discrepancies in the methodology used for calculating the population rates by the Russian Federal Statistics Service and the United Nations Population Division, rates on overall HIV diagnoses, as well as data disaggregated by sex, pre- sented in the report in Tables 1, 2 and 3 and elsewhere in the report may differ from the data presented in national statistics. The population data used for AIDS in Spain were adjusted according to the extent of sub-national coverage for the relevant years historically (see Annex 5 for details). Rates for data presented by gender and age were cal- culated using relevant male and female population denominators from the sources described above. For maps presenting figures for men who have sex with men, rates were calculated using the male population. Data are presented by year but also as cumulative totals per country. The cumulative total includes all data reported by that particular country since the beginning of national reporting and is not limited to the selected number of years presented in that given table. 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). 2 Due to discrepancies in the methodology used for calculating the population rates by the Russian Federal Statistics Service and the United Nations Population Division, rates on overall HIV diagnoses, as well as data disaggregated by sex presented in the report in Tables 1, 2, 3 and elsewhere in the report may differ from the data presented in national statistics. 4.3. 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 2013−2022, coun- tries reporting data inconsistently (Andorra, Monaco, Turkmenistan and Uzbekistan) and those reporting on transmission mode inconsistently or incompletely (such as Poland, Russia and Türkiye) were excluded from rel- evant figures reporting trends by transmission mode. AIDS trends for 2013−2022 excluded countries not report- ing consistently over the period (Andorra, Germany, Monaco, Russian Federation, Sweden, Turkmenistan, Uzbekistan). When analysing trends for AIDS deaths, only countries reporting consistently were included (Andorra, Germany, Italy, Monaco, the Russian Federation, Sweden, Turkmenistan, and Uzbekistan were not included). 5. Data limitations Surveillance systems are not identical across Europe, and differences in testing policies and data collection methods could affect the results and introduce bias into comparisons between countries. Factors such as under- reporting and reporting delay may influence the country figures and rankings presented in the report. The data in the report for recent years are to be consid- ered 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 HIV diagnoses do not represent true incidence. Reported HIV diagnoses include recently infected individuals, as well as those who were previ- ously positive, or infected several years ago but only recently tested for HIV. These reports are also influenced by several factors, such as the uptake of HIV testing, pat- terns of reporting, the long incubation period and a slow progression of the disease. To better interpret trends in HIV case-reporting data, the total numbers of HIV tests performed annually for diagnostic purposes (excluding unlinked anonymous tests and screening of blood dona- tions) are presented to help provide some background on HIV testing patterns. The absence of standardisa- tion and consistent collection of the HIV status variable, which distinguishes between first-time diagnoses and previous positive diagnoses, has presented challenges in interpreting the data from 2022. In 2022, although it was not feasible to account for reporting delays, it is essential to emphasise that only a limited number of European countries have assessed their surveillance systems for under-reporting and 74 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data subsequently shared the findings [6]. Previous esti- mates of under-reporting range from 0% to 41% for AIDS cases (F. Cazein, personal communication, 2021), while national estimates of under-reporting for HIV can range from 10% (Iceland and Italy) to around 40% (Germany and the United Kingdom) [7]. Estimates on the under- reporting of AIDS-related deaths are not available, but according to a country survey from 2006, only around one third of countries were able to comprehensively link HIV and AIDS surveillance death registries with national statistics or death certificate information, which results in under-reporting of AIDS-related deaths (F. Cazein, personal communication, 2021). References 1. World Health Organization (WHO). WHO case definitions of HIV for surveillance and revised clinical staging and immunologi- cal classification of HIV-related disease in adults and children. Geneva: WHO; 2007. Available from: https://apps.who.int/iris/ handle/10665/43699 2. European Commission (EC). European Commission Decision 2002/253/EC laying down case definitions for reporting com- municable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. OJ L 27.09.12:6–7. Available from: http://eur-lex.europa.eu/LexUriServ/ LexUriServ.do?uri=CONSLEG:2002D0253:20120927:EN:PDF 3. United Nations. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017. 4. Eurostat [online database]. Brussels: Eurostat; 2022. Available from: http://ec.europa.eu/eurostat/data/database 5. United Nations. World population prospects: the 2022 revision, medium variant. In: United Nations Department of Economic and Social Affairs, Population Division. New York (NY): United Nations Department of Economic and Social Affairs, Population Division; 2022. Available from: https://population.un.org/wpp/ 6. United Nations. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017. 7. 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. 75 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Annex 2 Completeness of variables for data reported in 2021 and 2022 2021 2022 Number of countries Completeness % Minimal Maximal Number of countries Completeness % Minimal Maximal EU/EEA Countries Age 30 99.4 89.8 100 30 99.6 88.8 100 Gender 30 99.0 88.9 100 30 99.1 91.5 100 Transmission 30 75.5 23.8 100 29 72.7 21.2 100 Country of birth or region of origin 28 85.7 34.8 100 28 87.1 51.8 100 CD4 cell count 27 64.3 3.9 100 27 68.2 6.0 100 HIV status 21 56.4 0.0 100 23 51.4 0.0 100 WHO European Region Age 48 99.8 89.8 100 48 99.8 88.8 100 Gender 48 99.6 88.9 100 48 99.6 91.5 100 Transmission 47 83.8 0.0 100 47 80.2 0.0 100 Country of birth or region of origin 39 46.4 0.0 100 41 53.0 0.0 100 CD4 cell count 45 74.0 0.0 99.9 45 67.2 0.0 98.4 HIV status 29 21.5 0.0 100 32 26.7 0.0 100 76 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Annex 3 Completeness by country and variable, 2022 Area Countrya Date of diagnosis Age Gender Transmission CD4 cell count Country of birth/region of originb EU/EEA West Austria 100.0 100 91.0 98.4 98.9 100 West Belgium 99.7 96.8 75.8 71.4 82.4 100 Centre Bulgaria 100 100 100 76.5 100 2.1 Centre Croatia 100 99.1 89.4 58.4 100 70.8 Centre Cyprus 100 100 98.2 90.8 99.5 93.1 Centre Czechia 100 100 81.5 83.0 100 99.3 West Denmark 100 100 82.9 36.4 98.8 100 East Estonia 99.6 100 48.4 6.0 66.8 100 West Finland 100 100 57.9 61.9 54.6 68.1 West France 100 100.0 65.8 57.4 76.7 74.7 West Germany 99.4 99.8 75.3 34.1 91.8 100.0 West Greece 100 100 78.9 66.7 100 - Centre Hungary 88.8 91.5 71.0 - 92.0 - West Iceland 100 100 82.5 57.5 100 100 West Ireland 99.9 99.1 78.5 17.0 83.8 78.7 West Italy 100 100 88.8 96.3 99.5 East Latvia 100 100 61.6 37.1 100 Liechtenstein 100 100 - 100.0 100 100 East Lithuania 100 100 90.5 79.8 100 42.9 West Luxembourg 95.8 100 90.1 91.5 100 - West Malta 95.0 100 71.7 - - - West Netherlands 100 96.5 87.0 91.0 99.5 97.2 West Norway 100 100 92.7 96.7 100 92.7 Centre Poland 98.9 99.3 21.2 68.3 - West Portugal 100 100 94.5 81.5 93.8 4.9 Centre Romania 100 100 79.9 94.6 98.2 - Centre Slovakia 99.5 98.5 59.4 19.8 51.8 86.3 Centre Slovenia 100 100 88.1 85.7 95.2 61.9 West Spain 100 99.8 81.4 88.7 97.9 - West Sweden 99.8 100.0 80.3 71.7 96.6 95.1 Non-EU/EEA Centre Albania 100.0 100.0 89.8 81.1 100.0 100.0 West Andorra - - - - - - East Armenia 100.0 100.0 99.1 73.8 100.0 100.0 East Azerbaijan 100.0 100.0 98.4 88.3 100.0 100.0 East Belarus 100.0 100.0 98.5 89.7 100.0 0.0 Centre Bosnia and Herzegovina 100.0 100.0 55.6 64.8 100.0 9.3 East Georgia 100.0 100.0 98.9 84.2 100.0 0.0 West Israel 99.6 100.0 74.1 62.3 100.0 100.0 East Kazakhstan 100.0 100.0 95.7 89.7 100.0 0.0 East Kyrgyzstan 100.0 100.0 92.9 78.5 100.0 0.0 East Moldova 100.0 100.0 77.2 86.6 100.0 0.0 West Monaco - - - - - - Centre Montenegro 100.0 100.0 77.4 71.0 100.0 87.1 Centre North Macedonia 100.0 95.1 87.8 95.1 100.0 0.0 East Russia 100.0 100.0 98.0 95.0 100.0 - West San Marino - - - - - - Centre Serbia 100.0 100.0 79.5 89.2 100.0 0.0 Centre Serbia excluding Kosovoc 100.0 100.0 76.8 92.7 100.0 0.0 Centre Kosovoc 100.0 100.0 100.0 61.9 100.0 0.0 West Switzerland 100.0 99.1 100.0 58.4 100.0 16.9 East Tajikistan 100.0 100.0 96.5 93.2 100.0 0.0 Centre Türkiye 100.0 100.0 33.0 12.7 100.0 0.0 East Turkmenistan - - - - - - East Ukraine 100.0 100.0 99.9 74.6 100.0 0.0 West United Kingdom 100.0 99.6 78.5 89.5 100.0 0.0 East Uzbekistan - - - - - - a Completeness not computed on countries, territories or areas with fewer than five diagnoses reported in 2022 or countries that reported in the aggregated record type which did not allow reporting of all variables (Russia) b Completeness provided is based on country of birth, region of origin or, for Italy and Switzerland, country of nationality. c For the purposes of this publication, all references, including in the bibliography, to “Kosovo” should be understood/read as “Kosovo (in accordance with Security Council resolution 1244 (1999))”. 77 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Annex 4a HIV surveillance system overview: data source information Country HIV data source Record typea for 2022 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-HIV HIVAIDS 1980–2022 V Co Belgium BE-HIV/AIDS HIVAIDS 1985–2022 V Co Bulgaria BG-HIV HIVAIDS 1986–2022 C Co HIV aggregate record type used through 2006; HIV record type 2007–2013 Cyprus CY-HIV/AIDS HIVAIDS 1986–2022 C Co Croatia HR-CNIPH HIVAIDS 1985–2022 C Co HIV record type used prior to 2016 Czechia CZ-HIV/AIDS HIVAIDS 1985–2022 C Co Denmark DK-HIV HIVAIDS 1990–2022 C Co HIV record type used 1990–2013 Estonia EE-NAKIS HIVAIDS 1988–2022 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 1980–2022 C Co HIV record type used prior to 2016 France FR-HIVAIDS HIVAIDS 2003–2022 C Co Although compulsory, HIV diagnoses are not exhaustively reported; underreporting was estimated around 30% until 2018, then increased (48% in 2021 and 43% in 2022). This underreporting is lower in hospitals (23% in 2022). Germany DE-SURVNET@RKI7.3-HIV 1993–2022 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 1984–2022 C Co Hungary HU-HIV/AIDS HIVAIDS 1985–2022 C Co Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1983–2022 C Co HIV record type used prior to 2017 Ireland IE-CIDR HIVAIDS 1985–2022 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 1985–2022 C Co See country comments about historical coverage; HIV aggregate record type used through 2009. Mortality statistics for 2021–2022 were unavailable. Latvia LV-HIV/AIDS HIVAIDS 1987–2022 C Co HIV record type used 1987–2013; HIVAIDS record type used from 2014 Liechtenstein LI-HIVAIDS HIVAIDS 2022 C Co Cases reported through Switzerland's surveillance system using another data source through 2020 Lithuania LT-NPHC HIVAIDS 1988–2022 C Co New data source LT_NPHC (National Public Health Centre under the Ministry of Health) from 2021 Luxembourg LU-HIVAIDS HIVAIDS 1983–2022 V Co Malta MT-DISEASE_SURVEILLANCE HIVAIDS 2001–2022 C Co HIV record type used in years 1986–2014 Netherlands NL-HIV/AIDS HIVAIDS 1980–2022 V Co Norway NO-MSIS_B HIVAIDS 1984–2022 C Co HIV record type used in years 1980–2013 Poland PL-HIV HIVAIDS 1985–2022 C Co Portugal PT-HIVAIDS HIVAIDS 1985–2022 C Co Romania RO-RSS HIVAIDS 1987–2022 C Co Slovakia SK-EPIS HIVAIDS 1985–2022 C Co HIV record type used in years 1985–2013 Slovenia SI-HIVAIDS HIVAIDS 1985–2022 C Co Spain ES-HIV HIV 2003–2022 C Co See country comments about historical coverage Sweden SE-SmiNet HIVAIDS 1983–2022 C Co Data source SE-SweHIVReg used 1983–2009; HIV record type used prior to 2014 non-EU/EEA Albania AL-NIoPH HIVAIDS 1993–2022 C Co Andorra AD-MoHWFH HIVAIDS 2004–2018 V Co Armenia AM-NAC HIVAIDS 1988–2022 V Co Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1987–2022 V Se Belarus BY-NAC HIVAIDS 1981–2022 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 1989–2022 C Co Israel IL-MOH HIVAIDS 1981–2022 C Co Kazakhstan KZ-RCfAPC HIVAIDS 1987–2022 NS/unk NS/unk Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1987–2022 V Co HIV record type used in years 1987–2000 Moldova MD-NAC HIVAIDS 1987–2022 V Other Montenegro ME-IOPH HIVAIDS 1989–2022 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 Russia RU-MOH HIVAGGR 2009-2022 C Co San Marino SM-AIDS/HIV HIVAGGR 1985–2022 C Co Serbiad RS-NAC HIVAIDS 1984–2022 C Co HIV aggregate record type used in years 1984–2001 Switzerland CH-FOPH HIV 1985–2022 C Co Tajikistan TJ-RHAC HIVAIDS 1991–2022 C Co Türkiye TR-MOH HIV 1985–2022 C Co Turkmenistan TM-NAC - 1990–2012 V Co Ukraine UA-NAC HIVAIDS 1987–2022 V Other HIVAIDS record type used only for HIV reporting (no linked HIV and AIDS reporting); HIVAGGR record type used in years 1987–2015. United Kingdom UK-HIVAIDS HIVAIDS 1981–2022 V Co Uzbekistan UZ-RAC - 1981–2010 V Co Did not report data 2011–2020; used HIV record type in years 1981–2010 a Type: HIVAIDS (HIV and AIDS joined case-based record type); HIV (HIV case-based record type); AIDS (AIDS case-based record type); HIVAGGR (HIV aggregate record type); AIDSAGGR (AIDS aggregate record type). b Legal: voluntary reporting (V); compulsory reporting (C); not-specified/unknown (NS/unk). c Coverage: sentinel system (Se); comprehensive (Co); not-specified/unknown (NS/unk). d Data from Kosovo, in accordance with Security Council resolution 1244 (1999), were reported through data source XK-HIVAIDS for 1986–2021; HIVAIDS record type used for all years. 78 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Annex 4b AIDS surveillance system overview: data source information Country AIDS Data source Record typea for 2022 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-AIDS HIVAIDS 1982–2022 V Co Belgium BE-HIV/AIDS HIVAIDS 1983–2022 V Co Did not report 2019 data Bulgaria BG-AIDS HIVAIDS 1987–2022 C Co AIDS record type was used for cases prior to 2014 Cyprus CY-HIV/AIDS HIVAIDS 1986–2022 C Co Croatia HR-CNIPH HIVAIDS 1986–2022 C Co AIDS record type used prior to 2016 Czechia CZ-HIV/AIDS HIVAIDS 1986–2022 C Co Denmark DK-HIV HIVAIDS 1980–2022 C Co AIDS record type from data source DK-MIS used 1980–2013 Estonia EE-NAKIS HIVAIDS 1992–2022 C Co AIDS record type used prior to 2015 Finland FI-NIDR HIVAIDS 1983–2022 C Co AIDS record type used prior to 2016 France FR-HIVAIDS; FR-AIDS HIVAIDS 1982–2022 C Co Additional data from record type AIDS used for the years 1978–2022. Although compulsory, AIDS diagnoses are not exhaustively reported. Underreporting was estimated at 41% in 2007–2009, then increased to 46% in 2016-2017. It was estimated at 44% in 2022. Germany DE-AIDS 1981–2019 V Co Did not report 2020 data, AIDS record type used through 2016 Greece EL-HIV/AIDS HIVAIDS 1981–2022 C Co Hungary HU-HIV/AIDS HIVAIDS 1986–2022 C Co Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1985–2022 C Co AIDS record type used prior to 2017 Ireland IE-CIDR HIVAIDS 1983–2022 V Co Data source IE-HIV/AIDS and AIDS record type used for years 1981–2011 Italy IT-COA-ISS AIDS 1982–2022 C Co Latvia LV-AIDS HIVAIDS 1990–2022 C Co Same data source in AIDS record type used for 1990–2013 Liechtenstein LI-HIVAIDS HIVAIDS 2022 C Co Cases reported through Switzerland's surveillance system using another data source through 2020 Lithuania LT-NPHC HIVAIDS 1988–2022 C Co New data source LT_NPHC (National Public Health Centre under the Ministry of Health) from 2021 Luxembourg LU-HIVAIDS HIVAIDS 1983–2022 V Co Malta MT-DISEASE_SURVEILLANCE HIVAIDS 1986–2022 C Co Same data source and AIDS record type used 1986–2014 Netherlands NL-HIV/AIDS HIVAIDS 1999–2022 V Co Norway NO-MSIS_B HIVAIDS 1983–2022 C Co Data source NO-MSIS-A and record type AIDS used in years 1980–2013 Poland PL-HIV HIVAIDS 1986–2022 C Co Portugal PT-HIVAIDS HIVAIDS 1985–2022 C Co Romania RO-RSS HIVAIDS 1985–2022 C Co Slovakia SK-EPIS HIVAIDS 1985–2022 C Co AIDS record type used in years 1985–2013 Slovenia SI-HIVAIDS HIVAIDS 1986–2022 C Co Spain ES-AIDS AIDS 1981–2022 C Co See country comments about coverage Sweden 1982–2007 V Co AIDS surveillance discontinued in 2008 non-EU/EEA Albania AL-NIoPH HIVAIDS 1993–2022 C Co Andorra AD-MoHWFH HIVAIDS 2004–2018 V Co Armenia AM-NAC HIVAIDS 1988–2022 V Se Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1995–2022 V Co Belarus BY-NAC AIDS 1991–2022 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 1989–2022 C Co Israel IL-MOH HIVAIDS 1981–2022 C Co Kazakhstan KZ-RCfAPC HIVAIDS 1993–2022 NS NS Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1999–2022 V Co AIDS record type used in years 1987–2000 Moldova MD-NAC HIVAIDS 1989–2022 V Co Montenegro ME-IOPH HIVAIDS 1990–2022 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 Russia - - - - - San Marino SM-AIDS/HIV AIDS 1986–2022 C Co Serbiad RS-NAC HIVAIDS 1985–2022 C Co AIDS record type used in years 1985–2001 Switzerland CH-FOPH AIDS 1980–2022 C Co Tajikistan TJ-RHAC HIVAIDS 1998–2022 C Co Türkiye TR-MOH AIDS 1985–2022 C Co Turkmenistan TM-NAC - 2002–2012 V Co Ukraine UA-NAC AIDSAGGR 1988–2022 V Co HIVAIDS record type used only for HIV reporting (i.e. no linked HIV and AIDS reporting). United Kingdom UK-HIVAIDS HIVAIDS 1981–2022 V Co Uzbekistan UZ-RAC - 1992–2010 V Co Did not report data 2011–2020; used AIDS record type in years 1992–2010 a Type: HIVAIDS (HIV and AIDS joined case-based record type); HIV (HIV case-based record type); AIDS (AIDS case-based record type); HIVAGGR (HIV aggregate record type); AIDSAGGR (AIDS aggregate record type). b Legal: voluntary reporting (V); compulsory reporting (C); not-specified/unknown (NS/unk). c Coverage: sentinel system (Se); comprehensive (Co); not-specified/unknown (NS/unk). d 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. 79 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Annex 5 Country-specific comments regarding national HIV and AIDS reporting Country Comments EU/EEA Austria HIV surveillance in Austria is based on the AHIVCOS (HIV cohort study), which in 2021 represented 67 % of peopled who received ART in Austria. 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. There was a 3.7-fold increase in the number of cases in the Czech Republic in 2022 compared to 2021. The increase is clearly due to the arrival of Ukrainian refugees in connection with the 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 Since 2016, HIV and AIDS diagnoses should be reported online, and physicians should report HIV diagnoses spontaneously, without waiting for the laboratory report. 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 COVID-19 pandemic has affected the French HIV surveillance by increasing the underreporting in 2020 and 2021, which affects the reliability of adjusted number of HIV and AIDS diagnoses. The most recent estimates of underreporting in France are 44% in 2022 for AIDS (versus 38% over the 2010–2019 period), and 43% in 2022 for HIV (versus 31% over 2010–2019). Considering only reports in hospitals, HIV underreporting would be estimated at 23% in 2022. 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). The actual numberof new HIV diagnoses, after adjustment, is estimated between 4 233, IC95% [4 139–4 326] and 5 738 [5 588–5 888], depending on wether the underreporting is considered globally or only in hospitals. The actual number of AIDS diagnoses is estimated at 796 [714–877]. 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 is a small country with about 39 000 inhabitants. Due to a customs treaty with Switzerland, Liechtenstein adopted the Swiss Law of Epidemiology in 2015. Since then, all communicable diseases collected in Liechtenstein are reported to a Swiss database. 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. The national Dutch HIV monitoring report publishes slightly different figures than those displayed in the European report because migrants with a documented HIV diagnosis before arrival in Netherlands are excluded in the national report. Poland There were an increased in the number of cases in Poland due to the arrival of Ukraine war refugees, who account for 29,7% of reported cases n 2022 and it was 6-fold increase in the number of cases with information about country of birth for Ukraine citizens. Portugal The PT-HIV database is fully case-based, containing details of HIV and AIDS cases diagnosed from 1983. Strategies to address underreporting and reporting delay implemented in 2013 and 2017, by the Portuguese HIV/AIDS Programme, resulted in a significant increase in the number of reported cases and deaths for all previous years. Data for 2020 and 2021 cases were not included in previous reports at country request and are now included in the report. In the current report, an excess of 85 cases has been found in the cumulative case count for Portugal. A preliminary assessment suggests that this discrepancy may be attributed to an issue regarding the upload. The corrected numbers will be reflected in the next year’s ECDC/WHO report. Meanwhile, the accurate and official figures can be found in the national HIV report.” (present tense because the national HIV report is going to be published and presented on Monday, 27th of November, earlier than the ECDC/WHO 2023 HIV Surveillance report. Romania The Romanian surveillance and reporting system has been implemented since the beginning of the 1990s, in real time. The data is collected in the National HIV/AIDS Registry, where the patients are recorded once-time only, wihout duplicates. Updates in the patients' data are made constantly with changes from HIV to AIDS. The national reporting addressess to the Ministry of Health, the National Public Health Institute, on a quarterly basis. Also, the information is available, in-real time, for the respective year. Annually, the data is transmitted to ECDC and any other international entity involved in the field- UNAIDS, WHO- in the case where they are sollicited. The statistical evaluation is made with SPECTRUM. The national HIV/AIDS Regsitry is stored at The National Institute for Infectious Diseases "Prof. Dr. matei Bals" through the Compartment for Monitoring and Evaluation of HIV/AIDS. Spain HIV reporting has existed since the 1980s in some of the 19 Autonomous Regions of Spain. For 2003–2011 data are available only for 9 Regions: Asturias, Balearic Islands, Basque Country, Canary Islands, Catalonia, Ceuta, Extremadura, La Rioja, and Navarre; since 2004, data are available for 10 Regions (+Galicia); since 2007, data are available for 11 Regions (+Madrid); since 2008, data are available for 14 Regions (+ Aragón, Castilla-La Mancha and Melilla); since 2009, data are available for 17 Regions (+Cantabria, Castilla-León and Murcia); since 2012 data are available for 18 Regions (+Valencia); and since 2013 data are available for all the 19 Regions of Spain (+Andalucía). In 2018, data from Catalonia are not available. AIDS data: For technical reasons, it has not been possible to include AIDS data from one region in 2014 and from two regions from 2015 to 2018. Due to the COVID-19 pandemic, in 2019 and 2020 some regions have reported provisional data and others have not reported HIV and/or AIDS data. Rates are based on the corresponding population for each year. Sweden Due to changes in the HIV/AIDS surveillance system, AIDS reporting has not been mandatory since 2005. Since 2008, AIDS data are not reported from Sweden because the national AIDS surveillance system had been discontinued. 80 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Country Comments Non-EU/EEA Belarus All data are presented by "date of statistics" (instead of "date of diagnosis"). Georgia Data are presented by "date of statistics" (instead of "date of diagnosis"). Montenegro Data on HIV tests refer to the number of people tested and do not include people tested in the private laboratories. North Macedonia AIDS cases include only people diagnosed with AIDS at the time of HIV diagnosis. Russian Federation The Russian Federation reported aggregated dataset with HIV diagnoses registered in 2022 disaggregated by sex, age group and mode of transmission and data on testing for 2009–2022. Whereas data reported for 2009–2019 was limited to HIV diagnoses by sex only. This enabled the inclusion of the country’s data in Tables 1–12 and 18 and in the figures showing the trend of HIV diagnosis but not in the rest of the trend figures due to inconsistent reporting. Country also reported separately information about CD4 cell count at the time of diagnosis. These data were manually entered into the Table 12. 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 therefore be compared directly with those for 2016–2022. Due to discrepancies in the methodology used for calculating the population rates by the Russian Federal Statistics Service and the United Nations Population Division, rates on overall HIV diagnoses, as well as data disaggregated by sex, presented in the report in Tables 1, 2 and 3 and elsewhere in the report may differ from the data presented in national statistics. 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. Türkiye 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 Ukraine’s national HIV and AIDS case notification system was established in 1987. It is a mandatory reporting system where health facilities routinely collect data from all 25 regions of Ukraine and, since 2018, report the data to the information system for monitoring socially significant diseases. The major gap in HIV Surveillance in Ukraine is that there is no HIV case electronic registration right after the confirmation of positive test results, so all data for TESSy are presented by “date of statistics” (instead of “date of diagnosis”). The war in Ukraine starting in 2022 caused a significant population migration, which has had a negative impact on the completeness and quality of data. United Kingdom Data for the UK in 2022 excludes diagnoses made at paediatric services and Northern Ireland services which were not available at the time of publication. Rises in HIV diagnoses in 2022 has been largely driven by increases in people who have been previously diagnosed abroad arriving in the UK and subsequently diagnosed in the UK. The majority of these people were rapidly linked to care, on treatment and virally suppressed. 81 HIV/AIDS surveillance in Europe 2023 – 2022 dataSURVEILLANCE REPORT Annex 6 HIV/AIDS surveillance in Europe: participating countries and national institutions Country National institutions EU/EEA Austria Austrian Agency for Health and Food Safety; Federal Ministry of Social Affairs, Health, Care and Consumer Protection 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 Center for Disease Control and Prevention Hungary National Center 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 National Public Health Center under the Ministry of Health 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 NIH – National Research Institute 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 Epidemiología Sweden Public Health Agency of Sweden Non-EU/EEA Albania National Institute of Public Health Andorra Ministry of Health, Social Welfare and Family Armenia National Center of Infectious Diseases Azerbaijan Azerbaijan AIDS Center 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 Center Israel Ministry of Health Kazakhstan National Center for the Prevention and Control of AIDS Kyrgyzstan Republic Centre for AIDS Prevention and Control Moldova National AIDS Center; National Center for Preventative Care Monaco Ministry of Social Health Montenegro Institute of Public Health of Montenegro North Macedonia Public Health Institute Russian Federation Ministry of Health of the Russian Federation San Marino Ospedale di Stato Serbiaa Institute of Public Health of Serbia Switzerland Bundesamt für Gesundheit Tajikistan Republican HIV/AIDS Center Türkiye General Directorate of Public Health, Ministry of Health Turkmenistan National AIDS Prevention Center Ukraine State Institution "Public Health Center of the Ministry of Health of Ukraine" United Kingdom UK Health Security Agency Uzbekistan Republican AIDS Center a Data for Kosovo (in accordance with Security Council resolution 1244 (1999)) were provided by the National Institute of Public Health of Kosov0. 82 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2023 – 2022 data Annex 7 Demographic and clinical characteristics of previous positive diagnoses and newly HIV diagnosed by EU/EEA countries which were able to identify the HIV status, 2022 Diseases Newly HIV diagnoses Previous positive diagnoses Unknown TotalN % N % N % N Gender Female 1 176 28.9 1 553 44.0 519 35.4 3 248 Male 2 824 69.5 1 896 53.8 945 64.5 5 665 Unknown 65 1.6 77 2.2 2 0.1 144 Age group < 15 years 28 0.7 61 1.7 22 1.5 111 15–19 100 2.5 42 1.2 26 1.8 168 20-24 404 9.9 135 3.8 100 6.8 639 25-29 645 15.9 425 12.1 147 10.0 1 217 30-39 1 234 30.4 1 211 34.3 442 30.2 2 887 40-49 854 21.0 1 012 28.7 360 24.6 2 226 50+ 800 19.7 634 18.0 368 25.1 1 802 Unknown 0 - 6 0.2 1 0.1 7 Region of origin Sub-Saharan Africa 1 033 25.4 710 20.1 91 6.2 1 834 Central and eastern Europe 444 10.9 1 575 44.7 69 4.7 2 088 Western Europe 108 2.7 118 3.3 12 0.8 238 Latin America and Caribbean 275 6.8 467 13.2 23 1.6 765 South and south-east Asia 117 2.9 93 2.6 12 0.8 222 Reporting country 1 653 40.7 251 7.1 109 7.4 2 013 Other 181 4.5 70 2.0 25 1.7 276 Unknown 254 6.2 242 6.9 1 125 76.7 1 621 Route of transmission Heterosexual contact 1 739 42.8 1 591 45.1 123 8.4 3 453 Heterosexual contact (males) 784 19.3 448 12.7 49 3.3 1 281 Heterosexual contact (females) 947 23.3 1 131 32.1 74 5.0 2 152 Injecting drug use 75 1.8 226 6.4 10 0.7 311 Sex between men 1 582 38.9 893 25.3 103 7.0 2 578 MTCT 25 0.6 114 3.2 2 0.1 141 Nosocomial 1 0.0 6 0.2 0 0.0 7 Transfusion 10 0.2 25 0.7 0 0.0 35 Unknown 1 425 35.1 1 131 19.0 1 277 83.8 2 418 Acute infection or CD4 cell count per mm3 at HIV diagnosis Acute 700 17.2 9 0.3 212 14.5 921 <200 894 22.0 134 3.8 78 5.3 1 106 200 to <350 597 14.7 175 5.0 37 2.5 809 350 to <500 542 13.3 272 7.7 25 1.7 839 500+ 786 19.3 945 26.8 51 3.5 1 782 Unknown 546 13.4 1 991 56.5 1 063 72.5 3 600 AIDS 540 13.3 99 2.8 55 3.8 696 ART Yes 282 6.9 762 21.6 31 2.1 1 075 No 43 1.1 6 0.2 1 0.1 50 unknown 3 740 92.0 2 758 78.2 1 434 97.8 4 235 The data for HIV cases reported in 2022 from the following EU/EEA countries have been included in this table: Belgium, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Iceland, Ireland, Norway, Slovakia, Slovenia, and Sweden. 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