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HIV/AIDS surveillance in Europe 2013: surveillance report

27 ноября 2014 г. Всемирная организация здравоохранения

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SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe

2013

www.ecdc.europa.eu www.euro.who.int

HIV/AIDS surveillance in Europe

2013

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Suggested citation for full report: European Centre for Disease Prevention and Control/ WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2013. Stockholm: European Centre for Disease Prevention and Control; 2014. Tables and figures should be referenced: European Centre for Disease Prevention and Control/ WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2013. This publication follows the ECDC terminological practice which reflects the European Union Interinstitutional 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 maps are reproduced with the permission of the WHO Regional Office for Europe. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. WHO keywords: ACQUIRED IMMUNODEFICIENCY SYNDROME – EPIDEMIOLOGY AIDS AND ITS CONTROL DISEASE OUTBREAKS – STATISTICS HIV INFECTIONS – EPIDEMIOLOGY POPULATION SURVEILLANCE

The European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe would like to thank the nominated national operational contact points for HIV/AIDS surveillance from EU/EEA Member States and the national HIV/AIDS surveillance focal points from other countries of the WHO European Region for providing data and valuable comments on this report. The report was coordinated by Anastasia Pharris (ECDC) and Annemarie Stengaard (WHO Regional Office for Europe). Report review and production support were provided by Andrew J. Amato-Gauci, Martin Donoghoe, Nedret Emiroglu, Guenael Rodier, Valentina Lazdina, Mike Catchpole, Julien Beauté, Marc Rondy, Phillip Zucs.

The WHO Regional Office for Europe is responsible for the accuracy of the translation of the Russian summary. © World Health Organization, 2014. Cover picture © Stockxpert ISBN 978-92-9193-608-3 ISSN 2363-3085 doi 10.2900/42271 Catalogue number TQ-AL-14-001-EN-N © European Centre for Disease Prevention and Control, 2014. Reproduction is authorised, provided the source is acknowledged.

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Contents Overview of HIV and AIDS in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii European Union and European Economic Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii Европейский союз и Европейская экономическая зона . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii Европейский регион ВОЗ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Выводы . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi

Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix 1 HIV and AIDS in the European Union and European Economic Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.1 HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1.2 Trends in HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.3 AIDS cases, morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.4 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2 HIV and AIDS in the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 2.1 HIV and AIDS diagnoses in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 HIV and AIDS diagnoses in the East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.3 HIV and AIDS diagnoses in the Centre. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.4 HIV and AIDS diagnoses in the West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.5 Number of HIV tests performed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Tables Table A: Characteristics of HIV diagnoses reported in the WHO European Region, the EU/EEA, and by geographical area, 2013 . . . . . . . . . . . . . . . . . . . .vii Table 1: HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/ EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 1a: HIV diagnoses and rates per 100 000 population, by country and year of statistics (2004–2013) and cumulative totals, in EU/ EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 2: HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 3: HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 4: HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 5: HIV diagnoses in persons infected through injecting drug use, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 6: HIV diagnoses in persons infected through heterosexual contact, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table 7: HIV diagnoses in persons infected through mother-to-child transmission, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 8: HIV diagnoses, by geographical area, sex, transmission group and year of diagnosis (2004–2013) and cumulative totals . . . . . . . . . . . . . . . 34 Table 8a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 8b: Geographical areas, WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

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HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 9: HIV diagnoses, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 9a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 9b: Geographical areas, WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table 10: HIV diagnoses in persons infected through heterosexual contact, by country and transmission subcategory, cases diagnosed in 2013, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 11: HIV diagnoses, by country of report and country or subcontinent of origin, cases diagnosed in 2013, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 12: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, cases reported in 2013 ..............

Table 12a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 12b: Geographical areas, WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 13: HIV diagnoses, by probable region of infection, in 2013, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . 48 Table 14: Percentage of new HIV diagnoses (2013) 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 . . . . . . 51 Table 15: AIDS cases and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 Table 15a: AIDS cases and rates per 100 000 population, by country and year of statistics (2004–2013) and cumulative totals, in EU/ EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Table 16: AIDS cases in males and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Table 17: AIDS cases in females and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

54 56 58

Table 18: AIDS cases in men infected through sex with men, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 19: AIDS cases in persons infected through injecting drug use, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 20: AIDS cases in persons infected through heterosexual contact, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 21: AIDS cases in persons infected through mother-to-child transmission, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 22: AIDS cases, by geographical area, sex, transmission mode and year of diagnosis (2004–2013) and cumulative totals . . . . . . . . . . . . . . . . . . 64

64 Table 22b: Geographical areas, WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 23: AIDS cases, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 23a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 23b: Geographical areas, WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 24: The most common AIDS-indicative diseases diagnosed in 2013, by geographical area ordered by frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 24a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 24b: Geographical areas, WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table22a: EU/EEA and non-EU/EEA countries ...................................................................................................................

Table 25: Deaths among AIDS cases, by country and year of death (2004–2013) and cumulative totals in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Table 26: Deaths among AIDS cases, by geographic area, transmission mode and year of death (2004–2013) and cumulative totals .............

Table 26a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Table 26b: Geographical areas, WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Table 27: Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2004–2013) and number of tests per 1 000 population in 2013, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . .

Figures Figure A: Rate of new HIV diagnoses per 100 000 population, by year of diagnosis, in the EU/EEA and the WHO European Region, 1984–2013 . viii Figure B: Cumulative number of new HIV diagnoses in the EU/EEA and other countries of the WHO European Region, 1984–2013 .................

Figure C: Male-to-female ratio in HIV diagnoses, by country, EU/EEA, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure D: Percentage of new HIV diagnoses, per age group, by transmission mode, EU/EEA, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure E: Percentage of new HIV diagnoses in people between 15 and 24 years old, by country, EU/EEA, 2013 .........................................

Figure F: Percentage of new HIV diagnoses acquired through sex between men out of all reported HIV diagnoses with known mode of HIV transmission, by country, EU/EEA, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Figure G: Percentage of new HIV diagnoses among persons originating from countries with generalised HIV epidemics out of all cases reported as heterosexually acquired, EU/EEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Figure H: Percentage of new HIV diagnoses among migrants out of all reported diagnoses with known region of origin, by country of report, EU/EEA, 2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

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HIV/AIDS surveillance in Europe 2013

5 5 Figure K: New HIV diagnoses, by transmission mode and year of diagnosis, adjusted for reporting delay, EU/EEA, 2004–2013 . . . . . . . . . . . . . . . . . . . . . 6 Figure L: Percentage and number of the most common AIDS-indicative diseases per transmission mode, EU/EEA, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Figure M: Rates of new HIV diagnoses, by geographical area and year of diagnosis, WHO European Region, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Figure N: New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2004–2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Figure O: Rate of AIDS cases per 100 000 population, by geographical area and year of diagnosis, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Figure P: Male-to-female ratio in new HIV diagnoses and heterosexually infected cases, by country, East, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Figure Q: New HIV diagnoses, by transmission mode and year of diagnosis, East, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Figure R: Distribution of the three most common AIDS-indicative diseases per transmission mode, East, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Figure S: Male-to-female ratio in new HIV diagnoses, by country, Centre, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Figure T: New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Figure U: Distribution of the three most common AIDS-indicative diseases per transmission mode, Centre, 2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Figure V: New HIV diagnoses, by transmission mode and year of diagnosis, West, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Figure W: Distribution of the three most common AIDS-indicative diseases per transmission mode, West, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Map 1: HIV diagnoses per 100 000 population, 2013: All cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Map 2: HIV diagnoses per 100 000 male population, 2013: Males . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Map 3: HIV diagnoses per 100 000 female population, 2013: Females . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Map 4: HIV diagnoses per 100 000 population, 2013: Heterosexual transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Map 5: HIV diagnoses per 100 000 population, 2013: Injecting drug use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Map 6: HIV diagnoses per 100 000 population, 2013: Sex between men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Map 7: AIDS cases reported per 100 000 population, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Figure 1: AIDS cases diagnosed, by transmission mode and geographical area, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Figure A1: Geographical/epidemiological division of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Figure I: Percentage of reported cases with a CD4 cell count <350/mm3 and <200/mm3 at presentation, by transmission mode, EU/EEA, 2013 . . . . Figure J: Percentage of reported cases with a CD4 cell count <350/mm3 and <200/mm3 at presentation, by age category, EU/EEA, 2013 . . . . . . . . . . . .

Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 85 89 Annex 3: Completeness of variables for data reported in 2012 and 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Annex 4a: HIV surveillance system overview: data source information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Annex 4b: AIDS surveillance system overview: data source information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Annex 5: Country-specific comments regarding national HIV and AIDS reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Annex 1: Framework for data collection, validation and presentation Annex 2: List of variables for the 2013 HIV/AIDS data collection ....................................................................................... . ..............................................................................................

Annex 6: HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients, EU/EEA countries, 2010–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Annex 7: HIV/AIDS surveillance in Europe: participating countries and national institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Overview of HIV and AIDS in Europe Three decades after the beginning of HIV surveillance in Europe, HIV infection continues to be of major public health importance in the Region. In 2013, 136 235 new HIV infections were diagnosed in 51 of the 53 countries of the WHO European Region1. Of those infections, 56 507 were officially reported to ECDC/WHO Regional Office for Europe by 50 countries including 29 157 infections from the European Union and European Economic Area (EU/EEA)2, while information about 79 728 infections was published by the Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS [1]. Surveillance data suggest an overall rate of 7.8 diagnoses per 100 000 population for the WHO European Region and 5.7 per 100 000 for the EU/EEA (Figure A). When data for Russia are included, the regional rate is 15.7 per 100 000 population. As in recent years, rates are highest in the East of the Region and lowest in the Centre (Table A). The main transmission mode varies by geographical area, illustrating the diversity in the epidemiology of HIV in Europe; heterosexual transmission is the main mode of transmission in the WHO European Region, while sexual transmission between men is the most common mode in the EU/EEA and transmission through injecting drug use remains substantial in the East of the Region. In 2013, 15 789 AIDS cases were diagnosed in 49 countries of the WHO European Region and the rate of new diagnoses was 2.2 per 100 000 population for the WHO European Region and 0.9 per 100 000 for the EU/EEA 3. Although the number of AIDS cases continued its steady decline in the West and the EU/EEA, it has tripled in the East since 2004.

European Union and European Economic Area In 2013, 29 157 HIV diagnoses were reported by 30 EU/ EEA countries, with a rate of 5.7 per 100 000 population (Table 1). Countries with the highest rates of HIV diagnoses in 2013 were Estonia (24.6), Latvia (16.8), Portugal (10.4), Belgium (10.0), and Luxembourg (9.9). The lowest rates were reported by Slovakia (1.5) and Croatia (2.0). Since the start of reporting on the HIV epidemic, 504 455 HIV diagnoses have been reported in the EU/EEA; 361 524 were in men and 139 527 in women (Tables 1–3), 3 404 not having gender information available. In 2013, the male-to-female ratio was 3.3 (Table A). Young people aged 15 to 24 years accounted for 11% of all HIV diagnoses reported, but this varied widely from 6% in Norway to 25% in Romania (Figure E). Similar to recent years, the highest proportion of HIV diagnoses was reported in men who have sex with men (MSM) (42%), with heterosexual transmission the second most common transmission mode (32%). One third (33%) of cases with a heterosexually-acquired infection originated from a country with a generalised HIV epidemic. Transmission due to injecting drug use accounted for 5% of HIV diagnoses, and for nearly 20% of the cases, the transmission mode was unknown (Table A). Despite prevention efforts, there appears to have been no decline in HIV diagnoses per 100 000 population over the last decade, with the rate remaining fairly stable, at 6.5 per 100 000 in 2004 (28 259 cases) compared to 6.2 per 100 000 (31 977 cases) in 2013 when adjusted for reporting delay (Table 1, Annex 6). Trends by transmission mode show that the number of HIV diagnoses

1 No data available from Uzbekistan or Turkmenistan. 2 Liechtenstein is not presented separately in the tables (see Country Comments in Annex 5). 3 No data available from Russia, Sweden, Turkmenistan or Uzbekistan.

Table A: Characteristics of HIV diagnoses reported in the WHO European Region, the EU/EEA, and by geographical area, 2013 Geographical areas Reporting countries/Number of countries Number of HIV diagnoses Rate per 100 000 population Percentage age 15–24 years Male-to-female ratio Transmission mode Men who have sex with men Heterosexual Injecting drug use Mother-to-child transmission Unknown WHO European Region* 50/53 (51/53) 56 507 (136 235) 7.8 (15.7) 10.2% 2.2 (1.7) 23.6% (10.1%) 46.1% (30.6%) 16.2% (21.3%) 0.9% (0.6%) 13% (37.3%) West 23/23 26 847 6.3 10.3% 3.3 43.1% 33.6% 4.1% 0.7% 18.2% Centre 15/15 4166 2.2 14.4% 4.9 30.1% 24.8% 5.9% 1.1% 37.9% East* 12/15 (13/15) 25 494 (105 222) 22.7 (41.2) 9.5% 1.3 (1.4) 2% (0.8%) 62.7% (30.0%) 30.6% (26.3%) 1.1% (0.6%) 3.6% (42.2%) EU/EEA 30/31 29 157 5.7 10.9% 3.3 41.9% 32.4% 5.0% 0.7% 19.7%

No data received from Lichtenstein, Turkmenistan or Uzbekistan. All data presented were reported to ECDC/WHO through the European Surveillance System (TESSy), except for data for Russia which were published by the Russian Federal Scientific and Methodological Center for Prevention and Control of AIDS [1]. * Figures including Russia are presented for the WHO Region and East in (brackets)

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among MSM in countries with consistent reporting have increased by 33% since 2004 (Table 8), with sustained increases over the last decade in all but four EU/EEA countries (Table 4). In contrast, the number of cases among people who inject drugs (PWID) has decreased by 36% over the period (Table 8), although an increase was observed in 2011 and 2012 due to localised outbreaks in Greece and Romania (Table 5). The numbers of HIV diagnoses due to heterosexual transmission decreased by 45% during the last decade, with sharper decreases seen among heterosexuals from countries with generalised HIV epidemics (Table 8, Figure K). Mother-to-child transmission and transmission through blood transfusion have decreased continuously between 2004 and 2013 and remain at less than 1% of cases diagnosed (Table 8). In 2013, information on CD4 cell counts at the time of diagnosis was available in 21 countries for 17 526 cases (61% of all cases reported in 2013) (Table 14). Nearly half of these cases (47%) were diagnosed late (CD4 cell count <350/mm3), including the 27% of cases with advanced HIV infection (CD4 <200/mm3). The proportion of those diagnosed late was highest among heterosexually acquired cases originating from countries with generalised HIV epidemics (59%) and among PWID (52%). The lowest proportions of those diagnosed late were observed in MSM (37%) and in cases of mother-tochild transmission (26%) (Table 14, Figure I). A clear age gradient was seen with increasing proportions of late diagnosis in older age categories (Figure J). In 2013, 4 369 AIDS cases were diagnosed and reported by 29 EU/EEA countries4, which is a rate of 0.9 cases per 100 000 population (Table 15). The highest rates were reported by Latvia (6.6) and Portugal (3.1). In the EU/

EEA, the number of AIDS cases has consistently declined since the mid-1990s.

WHO European Region With inclusion of 136 235 new HIV diagnoses reported in 2013, the cumulative number of infections diagnosed in the WHO European Region increased to 1 715 344, including 914 8135 officially reported to ECDC and the WHO Regional Office for Europe (Figure B) and 800 531 infections diagnosed in Russia [1]. The 136 235 new HIV diagnoses were reported by 51 of the 53 countries of the WHO European Region6, corresponding to a rate of 15.7 per 100 000 population for 2013 and includes 56 507 cases officially reported to ECDC/WHO Regional Office for Europe by 50 countries, corresponding to a rate of 7.8 per 100 000 population; and 79 728 cases from Russia [1]. Among officially reporting countries, forty-five percent of new diagnoses (25 494 cases) were reported in the East, 48% (26 847 cases) in the West and 7% (4 166 cases) in the Centre of the Region, while the rate (cases per 100 000 population) was highest in the East at 22.7, over three times higher than in the West (6.3 per 100 000) and ten times higher than in the Centre (2.2 per 100 000) (Table 1). When data for Russia are included, 77% percent of diagnoses were reported in the East, 20% in the West and 3% in the Centre, and the rate in the East was 41.2. Among reporting countries, the highest rates were reported by Ukraine (39.4), Estonia (24.6) and Moldova (17.3), Latvia (16.8), Belarus (14.6) and Kazakhstan (13.0). In Russia, the rate per 100 000 population was 55.6 in 2013 [1]. The majority of new HIV diagnoses (36%) were reported in the age group 30–39 years old, while 10% were 5 Minus the 62 581 cases officially reported to ECDC/WHO by Russia in 2010.

4 No data available from Sweden.

6 No data available from Uzbekistan or Turkmenistan.

Figure A: Rate of new HIV diagnoses per 100 000 population, by year of diagnosis, in the EU/EEA and the WHO European Region, 1984–2013 9 8 Cases per 100 000 population 7 6 5 4 3 2 1 0 1984 Countries reporting

WHO European Region EU/EEA

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

Year of diagnosis 15 25 27 36 36 39 42 42 42 42 44 43 45 48 48 47 47 49 46 50 52 52 52 51 52 52 53 51 51 50

Rates may increase in the coming years due to reporting delays Data from Russia not included.

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reported among 15–24 year-olds. The male-to-female ratio was 2.2 (1.7 when Russia is included): lowest in the East (1.3) (1.4 when Russia is included), higher in the West (3.3) and highest in the Centre (4.9) (Table A). Most frequently, reported cases were acquired through heterosexual transmission (46%), although the picture is more heterogeneous at sub-regional level. Sixteen percent of the new HIV cases were infected through injecting drug use, 24% through sex between men and 0.9% were due to mother-to-child transmission (MTCT). For 13% of cases, the transmission mode was reported as unknown. When data for Russia are considered, the percentages change as presented in Table A but the overall distribution of transmission modes remains unchanged. In the West, sexual transmission between men remained the main transmission mode (43% of new diagnoses), followed by heterosexual transmission (34% of new diagnoses). In the Centre, the main transmission mode was through sex between men (30%) whereas heterosexual contacts accounted for 25% of new cases. In the East, heterosexual contact (accounting for 63% of new cases, 30% when Russia is included), followed by injecting drug use (31% of new cases, 26% when Russia is included), were the predominant modes of transmission while transmission through sex between men remained very low in absolute terms (2% of cases, 0.8% when Russia is included). Between 2004 and 2013, the rate of newly diagnosed HIV infections per 100 000 population increased by 81% from 8.7 in 2004 (75 812 cases) to 15.7 in 2013 (136 235 cases) in 51 countries7 (Russia included [1]) which corresponds to an 80% increase in the absolute number of cases. The increase is mainly driven by an upward trend in the East where the rate increased by fully 144%, from 16.9 in 2004 (47 332 cases) to 41.2 in 2013 (105 222 cases), corresponding to a 122% increase in the absolute number of cases. In the 50 countries that provided official data

(Russia excluded), the regional rate increased by 16%, from 6.7 (42 405 cases) to 7.8 (56 507 cases), whereas in the East it increased by 80%, from 12.6 in 2004 (13 925 cases) to 22.7 in 2013 (25 494 cases). In the Centre, the rate increased by 175%, from 0.8 (1 577 cases) to 2.2 (4 166 cases), whereas it decreased by 20%, from 7.9 (26 903 cases) to 6.3 (26 847), in the West (Figure M). Trends by transmission mode in the WHO European Region show increases in infections acquired due to heterosexual contact (30% increase), sex between men (40% increase) and mother-to-child transmission (32% increase), whereas infections due to injecting drug use decreased by 3% (Table 8) (Russia excluded). When data for Russia are included, the number of cases in each transmission category increased by 69% for heterosexual transmission (from 22 811 to 38 439), by 42% for injecting drug use (from 20 178 to 28 590), by 43% for sex between men (from 7108 to 10 168) and by 144% for unknown transmission (from 19 941 to 48 565) whereas it decreased by 15% for MTCT (from 988 to 839). In the East, sexual transmission (both heterosexual and through sex between men) increased, two-fold and fourteen-fold, respectively, whereas transmission through injecting drug use remained fairly stable in comparison with 2004 following a period of much higher levels during 2006–2010. At the same time, the number of women newly infected almost doubled between 2004 and 2013 (Table 3). When data for Russia are included, the number of cases in each transmission category in the East increased by 207% for heterosexual transmission (from 10 225 to 31 424), by 48% for injecting drug use (from 18 632 to 27 596), by 427% for sex between men (from 166 to 875) and by 160% for unknown transmission (from 17 076 to 44 346) whereas it decreased by 5% for MTCT (from 671 to 635). In the West, transmission through male-to-male sex increased by 26% and heterosexual transmission decreased by 47%. In the Centre, infections acquired through sex between men increased three-fold, heterosexual transmission by 64% and IDU-related transmission four-fold mainly due to an

7 Data from Turkmenistan and Uzbekistan not included.

Figure B: Cumulative number of new HIV diagnoses in the EU/EEA and other countries of the WHO European Region, 1984–2013 10 EU/EEA Other countries of the WHO European Region Number of cases (100 000s) 8

2 0 1985 1990 1995 2000 2005 2010

Year of diagnosis Data from Russia not included

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outbreak in Romania that started in 2011 and peaked in 2012 (Table 8). In 2013, 35 countries in the WHO European Region provided information on CD4 cell count at the time of diagnosis for 35 383 (48%) cases (Table 14). Of these cases, 49% were reported as late presenters (CD4 cell count <350/mm3), including 27% of cases with advanced HIV infection (CD4 <200/mm3). The percentage of late presenters varied across transmission categories and geographical areas and was highest among people infected through injecting drug use in the East (68%) (Table 14). In 2013, 15 789 AIDS cases were diagnosed in 49 countries of the WHO European Region8, corresponding to a rate of 2.2 per 100 000 population. Seventy-two percent (11 292 cases) were reported by countries in the East, 23% (3 606 cases) in the West and 6% (891 cases) in the Centre of the Region. The number of cases per 100 000 population was 10.0 in the East, eleven times higher than in the West (0.9 per 100 000) and 20 times higher than in the Centre (0.5 per 100 000) (Table 15). Between 2004 and 2013, the rate of new AIDS cases per 100 000 population increased by 10%, from 2.0 in 2004 (12 952 cases) to 2.2 in 2013 (15 789 cases) in the 50 countries with consistent AIDS data. There was, however, substantial variation at sub-regional level with a threefold increase in rates in the East from 3.2 per 100 000 (3 275 cases) to 10.0 (11 292 cases), a 64% decrease in the West from 2.5 per 100 000 (8 915 cases) to 0.9 (3 606 cases) and a 25% increase in the Centre from 0.4 (762 cases) to 0.5 (891 cases).

indicates a delay in HIV testing with nearly half of cases already eligible for treatment when they are diagnosed, based on 2010 WHO criteria of when to initiate ART; this has since been revised to recommend ART initiation at CD4 cell count <500/mm3 [2]. The high and increasing number of AIDS cases in the East is also indicative of late HIV diagnosis, low treatment coverage and delayed initiation of life-saving HIV treatment. The wide availability of treatment and recommendations for earlier initiation [2] have widened the scope of HIV surveillance to include monitoring of access to care and treatment. Improved access to and earlier initiation of treatment, particularly for key populations, is of importance throughout Europe but increasingly needs to be urgently addressed in the East. In order to decrease the number of late diagnoses, the current organisation of HIV counselling and testing services need to be reconsidered, including innovative approaches and services (such as routine offers of counselling and testing in clinical settings, rapid testing and community-based testing [2]), to reach people that are at higher risk. These services should be accessible and targeted toward key populations in order to ensure earlier diagnoses and initiation of HIV treatment and linkage to care. This will result in improved treatment outcomes, reduced morbidity and mortality and will contribute to preventing or further reducing onward HIV transmission. Equal access to HIV prevention, testing, treatment and care for all population groups should be ensured in order for countries to reach the global targets of 90% of people living with HIV diagnosed and enrolled in care; 90% of those diagnosed retained in care; and 90% of people in care being virally suppressed [4]. Interventions to control the epidemic need to be based on evidence and adapted to national and local epidemiology. From the surveillance data presented in this report, the following can be concluded: • For the countries in the EU/EEA and West, interventions to prevent and control HIV among MSM are the cornerstones of the HIV response. Given the persistent increase in cases diagnosed in this key population over the last decade, it would appear that current prevention and control efforts are not yet being delivered with sufficient effect and would need to be significantly strengthened. In addition, as about 30% of all new infections in the EU/EEA are reported among migrants and about one third of the heterosexually acquired HIV cases were reported as originating from high-endemic countries, countries need to ensure that interventions for prevention, treatment and care are accessible to migrants. The observed increase in HIV cases among people who inject drugs in a number of countries [3] in recent years demonstrates the need to maintain or scale up harm reduction programmes in some settings. • For the countries in the Centre, as the epidemic among MSM is increasing, the priority is to strengthen interventions to prevent, test and treat HIV in this group. Stigma reduction efforts will be key to achieving this.

Conclusions HIV infection remains of major public health importance in Europe. A total of 136 235 new HIV infections were diagnosed in 51 of 53 countries in 2013, giving a rate of 15.7 per 100 000 population. The most recent surveillance data indicate that, despite significant efforts dedicated to the prevention and control of HIV, the rate of new HIV diagnoses has not declined in the EU/EEA and has increased substantially over the last decade in the European Region. HIV is mainly concentrated in key populations at higher risk of HIV infection such as men who have sex with men, people originating from generalised epidemic countries (mainly sub-Saharan Africa) and other migrants, and PWID and their sexual partners. At the same time cases among people originating from countries with generalised HIV epidemics appear to be decreasing. People infected through heterosexual transmission in the East, notably women, are increasingly affected. Recent increases of HIV among PWID in some countries in the EU/EEA and West indicate that even low numbers can rapidly evolve into an outbreak when public health interventions are insufficient [3]. The proportion of late diagnoses is high in all countries reporting data on CD4 cell count at diagnosis. This 8 No data available from Russia, Sweden, Turkmenistan or Uzbekistan.

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• For the countries in the East, there is a need to scale up targeted interventions and deliver effective, highquality, integrated services through well-functioning health systems that address the social determinants of health. Comprehensive coverage with effective prevention, early and targeted testing, and access to counselling and integrated care should be provided to all in need. Access to antiretroviral therapy should be used strategically to treat and prevent HIV transmission and reduce the growing number of AIDS cases. Evidence-based policies targeting key populations, particularly people who inject drugs, including harm reduction programmes and early access to treatment, need to remain the cornerstones of the HIV response. In couples where one of the partners is engaged in a high-risk behaviour, including but not limited to injecting drug use, bolder prevention interventions should address the risk of heterosexual transmission [5]. Finally, robust surveillance data are critical to monitor and inform the public health response to the European HIV epidemic in an accurate and timely fashion. The number of countries conducting enhanced HIV surveillance and reporting surveillance data at European level has gradually increased over time; in 2013, 50 of the 53 countries submitted data. Data quality and completeness of key variables such as transmission mode and CD4 cell count at time of diagnosis can be further improved, as can measures of access to, uptake of, and retention in care following diagnosis. In 2014, HIV surveillance will undergo revision in order to be more fit-for-purpose, combining the surveillance of HIV and AIDS and increasing the possibilities for longer-term monitoring of continuum of care outcomes such as linkage to care, treatment, and viral suppression following HIV diagnosis.

References 1 Federal Scientiﬁc and Methodological Center for Prevention and Control of AIDS. Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Geneva: World Health Organization; 2013. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L, et al. Human immunodeﬁciency virus among people who inject drugs: Is risk increasing in Europe? Euro Surveill. 2013;18(48):pii=20648. Available online: http://www.eurosurveillance.org/ViewArticle. aspx?ArticleId=20648 UNAIDS. Ambitious treatment targets: Writing the ﬁnal chapter of the AIDS epidemic. Geneva; 2014. Available online: http://www.unaids.org/en/media/unaids/conte n t a s s e t s/d o c u m e n t s/u n a i d s p u b l i c a t i o n/20 1 4/ JC2670_UNAIDS_Treatment_Targets_en.pdf World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2014.

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Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе Через три десятилетия после начала функционирования системы эпиднадзора за ВИЧ в Европе ВИЧ-инфекция продолжает оставаться важной проблемой общественного здравоохранения для Европейского региона ВОЗ 1. В 2013 г. в 51 из 53 стран Европейского региона ВОЗ было зарегистрировано 136 235 новых случаев ВИЧ-инфекции. Пятьдесят стран официально представили ECDC/Европейскому региональному бюро ВОЗ сведения о 56 507 случаях ВИЧ-инфекции, в том числе о 29 157 случаях в странах – членах Европейского союза и Европейской экономической зоны (ЕС/ЕЭЗ)2, а информация о еще 79 728 случаях была опубликована Федеральным научнометодическим центром по профилактике и борьбе со СПИДом в Российской Федерации [1]. По данным эпиднадзора, общая частота диагностированных случаев ВИЧ-инфекции составила 7,8 случая на 100 000 населения в странах Европейского региона ВОЗ и 5,7 случая на 100 000 населения в странах ЕС/ЕЭЗ (рисунок А). При учете данных по Российской Федерации региональный показатель частоты новых случаев ВИЧ-инфекции составляет 15,7 на 100 000 населения. Как и в предыдущие годы самые высокие показатели были зарегистрированы в восточной части, а самые низкие – в центральной части Региона (таблица А). Основной путь передачи вируса различается в зависимости от географической зоны, что указывает на широкое разнообразие эпидемиологии ВИЧ-инфекции в Европе. Основным путем передачи ВИЧ в Европейском регионе ВОЗ является гетеросексуальный. Однако в странах ЕС/ЕЭЗ доминирует передача ВИЧ при сексуальных контактах между мужчинами, а в восточной части Региона значительный 1 Нет данных из Узбекистана или Туркменистана. 2 Лихтенштейн не представлен отдельно в таблицах (см. замечания по странам в Приложении 5). 3 Нет данных из России, Швеции, Туркменистана или Узбекистана.

вклад в ВИЧ-инфицирование продолжает вносить употребление инъекционных наркотиков. В 2013 г. в 49 странах Европейского региона ВОЗ было диагностировано 15 789 случаев СПИДа, и частота новых случаев СПИДа составила 2,2 на 100 000 населения в Европейском регионе ВОЗ в целом и 0,9 на 100 000 населения в ЕС/ЕЭЗ3. Хотя число новых случаев СПИДа продолжает устойчиво снижаться в западной части Региона и в ЕС/ЕЭЗ, в восточной части Региона за период с 2004 г. оно выросло в три раза.

Европейский союз и Европейская экономическая зона В 2013 г. 30 стран ЕС/ЕЭЗ сообщили о 29 157 новых случаях ВИЧ-инфекции, что составляет 5,7 случаев на 100 000 населения (таблица 1). В 2013 г. самая высокая частота случаев ВИЧ-инфицирования была зарегистрирована в Эстонии (24,6), Латвии (16,8), Португалии (10,4), Бельгии (10,0) и Люксембурге (9,9). Самые низкие показатели ВИЧ-инфицирования были зарегистрированы в Словакии (1,5) и Хорватии (2,0). За период с начала предоставления отчетности по эпидемии ВИЧ-инфекции, в странах ЕС/ЕЭЗ зарегистрировано 504 455 случаев ВИЧ-инфекции – 361 524 случая у мужчин и 139 527 случаев у женщин (таблицы 1 и 3), а в 3 404 случаях информация о половой принадлежности отсутствовала. В 2013 г. соотношение числа случаев среди мужчин и женщин составило 3,3 (таблица А). На молодых людей в возрасте от 15 до 24 лет приходилось 11% всех зарегистрированных случаев ВИЧ-инфекции, но этот

Таблица A: Характеристики новых случаев ВИЧ-инфекции, зарегистрированных в Европейском регионе ВОЗ, в ЕС/ЕЭЗ и в различных географических зонах Региона, 2013 г Географические зоны Страны, предоставляющие данные/Число стран Число новых случаев ВИЧ-инфекции Частота на 100 000 населения Процент случаев в возрастной группе 15–24 года Соотношение мужчин и женщин Путь передачи инфекции Мужчины, имеющие секс с мужчинами (МСМ) Гетеросексуальный Употребление инъекционных наркотиков Передача ВИЧ от матери ребенку Неизвестно Евро-пейский регион ВОЗ* 50/53 (51/53) 56 507 (136 235) 7.8 (15.7) 10.2% 2.2 (1.7) 23.6% (10.1%) 46.1% (30.6%) 16.2% (21.3%) 0.9% (0.6%) 13% (37.3%) Запад 23/23 26 847 6.3 10.3% 3.3 43.1% 33.6% 4.1% 0.7% 18.2% Центр 15/15 4166 2.2 14.4% 4.9 30.1% 24.8% 5.9% 1.1% 37.9% Восток* 12/15 (13/15) 25 494 (105 222) 22.7 (41.2) 9.5% 1.3 (1.4) 2% (0.8%) 62.7% (30.0%) 30.6% (26.3%) 1.1% (0.6%) 3.6% (42.2%) ЕС/ЕЭЗ 30/31 29 157 5.7 10.9% 3.3 41.9% 32.4% 5.0% 0.7% 19.7%

Нет данных по Лихтенштейну, Туркменистану или Узбекистану. Все данные, представленные в ВОЗ и ECDC, были получены через Европейскую систему эпиднадзора (TESSy) – за исключением данных по Российской Федерации, которые были опубликованы Федеральным научно-методическим центром по профилактике и борьбе со СПИДом в Российской Федерации [1] * Цифры, включающие данные по России, представлены в скобках в колонках по Европейскому региону ВОЗ и по его восточной части

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показатель широко варьировался – от 6% в Норвегии до 25% в Румынии (рисунок E). Как и в предыдущие годы, самая высокая доля новых случаев ВИЧ-инфекции была зарегистрирована среди мужчин, имеющих секс с мужчинами (МСМ) (42%), а второе место среди причин ВИЧ-инфицирования занимали гетеросексуальные контакты (32%), Одна треть (33%) новых случаев ВИЧ-инфекции с гетеросексуальным путем передачи была зарегистрирована среди выходцев из стран с генерализованной эпидемией ВИЧ-инфекции. На передачу вируса вследствие употребления инъекционных наркотиков пришлось 5% диагнозов ВИЧ-инфекции, а почти в 20% случаях ВИЧ-инфицирования путь передачи был неизвестен (таблица А). Несмотря на усилия, предпринятые для профилактики ВИЧ-инфекции, за последнее десятилетие частота ВИЧ-инфицирования на 100 000 населения, по-видимому, не снизилась, а остается примерно на том же уровне. Так, в 2004 г. этот показатель составлял 6,5 на 100 000 населения (28 259 случаев), а в 2013 г. он был равен 6,2 на 100 000 населения (31 977 случаев) – с поправкой на задержки в предоставлении данных (таблица 1, приложение 6). Тенденции в отношении путей передачи вируса указывают на то, что за период с 2004 г. число новых случаев ВИЧ-инфекции среди МСМ в странах, регулярно сообщающих данные, выросло на 33% (таблица 8) – с устойчивым ростом в течение последнего десятилетия во всех, кроме четырех стран ЕС/ЕЭЗ (таблица 4). Среди людей, употребляющих инъекционные наркотики (ЛУИН), число новых случаев ВИЧ-инфекции за этот период, наоборот, снизилось на 36% (таблица 8). Однако в 2011 и 2012 гг. было отмечено увеличение этого показателя среди ЛУИН в связи с локальными вспышками в Греции и Румынии (таблица 5). В течение последнего десятилетия число диагнозов

ВИЧ-инфекции, связанной с гетеросексуальной передачей вируса, снизилось на 45%. При этом более выраженное уменьшение было отмечено среди гетеросексуалов из стран с генерализованной эпидемией ВИЧ-инфекции (таблица 8, рисунок K). Число новых случаев ВИЧ-инфекции вследствие передачи ВИЧ от матери ребенку и вследствие переливания крови снижалось непрерывно в период между 2004 и 2013 гг. и остается на уровне менее 1% от всех новых случаев ВИЧ-инфекции (таблица 8) В 2013 г. информация о числе клеток CD4 на момент постановки диагноза ВИЧ-инфекции была получена от 21 страны для 17 526 случаев (61% от всех случаев, зарегистрированных в 2013 г.) (таблица 14). Почти половина из этих случаев (47%) была диагностирована на поздних стадиях (число клеток CD4 <350/ мм³), включая 27% случаев с продвинутой стадией ВИЧ-инфекции (число клеток CD4 <200/мм³). Доля диагнозов, поставленных на поздних стадиях, была самой высокой при заражении гетеросексуальным путем у выходцев из стран с генерализованной эпидемией ВИЧ-инфекции (59%) и среди ЛУИН (52%). Самая низкая доля диагнозов ВИЧ-инфекции, поставленных на поздних стадиях, была зарегистрирована среди МСМ (37%) и в случаях передачи вируса от матери ребенку (26%) (таблица 14, рисунок I). Существует четкий градиент в частоте новых случаев ВИЧ-инфекции, диагностированных на поздних стадиях – с увеличением этого показателя в более старших возрастных категориях (рисунок J). В 2013 г. в 29 странах ЕС/ЕЭЗ4 было диагностировано и зарегистрировано 4 369 случаев СПИДа, что составило 0,9 случая на 100 000 населения (таблица 15). Самые высокие показатели были зарегистрированы в Латвии (6,6) и Португалии (3,1). С середины 1990-х 4 Нет данных из Швеции.

Figure A: Частота зарегистрированных новых случаев ВИЧ-инфекции на 100 000 населения, с разбивкой по году постановки диагноза, в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 1984–2013 гг. – с поправкой на задержки в предоставлении данных 9 8 случаи на 100 000 населения 7 6 5 4 3 2 1 0 1984 Количест во стран, которые подали 15 отчет

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Год постановки диагноза 25 27 36 36 39 42 42 42 42 44 43 45 48 48 47 47 49 46 50 52 52 52 51 52 52 53 51 51 50

Из-за задержки сообщения в ближайшие годы частота может увеличиться. Данные по Российской Федерации не включены.

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гг. в странах ЕС/ЕЭЗ наблюдается постоянное снижение числа новых случаев СПИДа.

Федерации частота новых случаев ВИЧ-инфекции на 100 000 населения в 2013 г. была равна 55,6 [1]. Большинство новых случаев ВИЧ-инфекции (36%) было зарегистрировано в возрастной группе 30–39 лет. В возрастной группе 15–24 года показатель ВИЧинфицирования составил 10%. Соотношение случаев среди мужчин и женщин составило в среднем 2,2 (1,7 при включении данных по России) – с самым низким значением в восточной части Региона (1,3) (1,4 при включении данных по России), более высоким значением в западной части Региона (3,3) и самым высоким значением в центральной части Региона (4,9) (таблица А). Чаще всего заражение происходило при гетеросексуальных контактах (46%), хотя на субрегиональном уровне картина была более разнородной, что демонстрирует широкое разнообразие эпидемиологии ВИЧ-инфекции в Европе. В 16% новых случаев ВИЧ-инфекции заражение произошло при инъекционном употреблении наркотиков, в 24% – при сексуальных контактах между мужчинами и в 0,9% – в результате передачи вируса от матери ребенку (ПМР). В 13% случаев путь заражения был неизвестен. При учете данных по России процентные значения меняются (как это видно из таблицы А), но в целом распределение путей передачи остается неизменным. В западной части Региона основным путем передачи ВИЧ-инфекции оставались сексуальные контакты между мужчинами (43% новых случаев), за которыми следуют гетеросексуальные контакты (34% новых случаев). В центральной части Региона основным путем передачи ВИЧ-инфекции были сексуальные контакты между мужчинами (30% новых случаев), за которыми следовали гетеросексуальные контакты (25%). В восточной части Региона преобладающими путями передачи ВИЧ были гетеросексуальные контакты (63% новых случаев, 30% – при включении данных по России) и употребление инъекционных наркотиков (31% новых случаев – 26% при включении данных по России), в то же время как процент

Европейский регион ВОЗ С включением 136 235 новых случаев ВИЧ-инфекции, диагностированных в 2013 г., кумулятивное число инфекций, диагностированных в Европейском регионе ВОЗ, увеличилась до 1 715 344, включая 914 813 случаев5, официально представленных в ECDC и Европейское региональное бюро ВОЗ, (рисунок B) и 800 531 случай инфекции, диагностированных в России [1]. 136 235 новых случаев ВИЧ-инфекции были диагностированы в 51 из 53 стран Европейского региона ВОЗ6, что составляет 15,7 случая на 100 000 населения в 2013 г. и включает в себя 56 507 случаев официально сообщенных в ECDC/Европейское региональное бюро ВОЗ 50 странами (что составляет 7,8 случая на 100 000 населения), и 79 728 случаев, диагностированных в России [1]. Что касается распределения случаев по странам, предоставляющим данные, то из всех новых случаев ВИЧ-инфекции 45% (25 494) было зарегистрировано на Востоке, 48% (26 847) – на Западе и 7% (4 166) – в Центре Региона; при этом частота (число случаев на 100 000 населения) была самой высокой на Востоке (22,7), где этот показатель был более чем в три раза выше, чем на Западе (6,3 на 100 000) и в 10 раз выше, чем в Центре (2,2 на 100 000) (таблица 1). При включении данных по России распределение значений является следующим: 77% процентов случаев ВИЧ-инфекции было зарегистрировано на Востоке, 20% на Западе и 3% в Центре, а частота случаев на Востоке составила 41,2. Среди стран, предоставляющих данные, самые высокие показатели были зарегистрированы в Украине (39,4), Эстонии (24,6), Молдове (17,3), Латвии (16,8), Беларуси (14,6) и Казахстане (13,0). В Российской

5 За минусом тех случаев, информация о которых была официально представлена в ECDC/ВОЗ Российской Федерацией в 2010 г. (62 581). 6 Нет данных по Узбекистану или Туркменистану.

Рисунок B: Кумулятивное число диагнозов ВИЧ-инфекции в странах ЕС/ЕЭЗ и в других странах Европейского региона ВОЗ, 1984–2013 гг 10 ЕС/ЕЭЗ Другие страны Европейского региона ВОЗ Число случаев (100 000) 8

2 0 1985 1990 1995 2000 2005 2010

Год постановки диагноза Данные по Российской Федерации не включены.

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случаев передачи ВИЧ через секс между мужчинами остается очень низким в абсолютном выражении (2% новых случаев – 0,8% при включении данных по России). В период с 2004 по 2013 год, число новых случаев ВИЧ-инфекции на 100 000 населения увеличилось на 81% с 8,7 в 2004 году (75 812 случаев) до 15,7 в 2013 г. (136 235 случаев) в 51 стране7 (включая Россию [1]), что соответствует увеличению абсолютного числа случаев на 80%. Увеличение происходило, главным образом, за счет восходящей тенденции в восточной части Региона, где этот показатель увеличился на 144% – с 16,9 в 2004 г. (47 332 случая) до 41,2 в 2013 г. (105 222 случая) соответствуя повышению на 122% абсолютного числа новых случаев. В 50 странах, представивших официальные данные (за исключением России), региональный показатель увеличился на 16% – с 6,7 (42 405 случаев) до 7,8 (56 507 случаев), в то же время как в восточной части Региона он увеличился на 80% – с 12,6 в 2004 г. (13 925 случаев) до 22,7 в 2013 г. (25 494 случаев). В центральной части Региона этот показатель увеличился на 175% – от 0,8 (1 577 случаев) до 2,2 (4 166 случаев), в то же время как в западной части Региона он снизился на 20% – с 7,9 (26 903 случая) до 6,3 (26 847 случаев) (рисунок M). Динамика частоты ВИЧ-инфицирования в Европейском регионе ВОЗ с разбивкой по путям передачи вируса показывает увеличение этого показателя на 30%, 40% и 32% – соответственно для гетеросексуальной передачи, передачи среди МСМ и передачи от матери ребенку. С другой стороны, число случаев передачи ВИЧ при употреблении инъекционных наркотиков снизилось на 3% (за исключением России). При включении данных по России, число случаев в разбивке по путям передачи ВИЧ увеличилось на 69% для гетеросексуальной передачи (с 22 811 до 38 439), на 42% для потребления инъекционных наркотиков (с 20 178 до 28 590), на 43% для секса между мужчинами (с 7108 до 10 168) и на 144% для неизвестного пути передачи вируса (с 19 941 до 48 565), в то время как число случаев передачи ВИЧ от матери к ребенку снизилось на 15% (от 988 до 839 случаев). В восточной части Региона частота новых случаев ВИЧ-инфекции, приходящихся на половой путь передачи (как вследствие гетеросексуальных контактов, так и вследствие секса между мужчинами) увеличилась, соответственно, в два и четырнадцать раз, в то время как показатель ВИЧ-инфицирования вследствие употребления инъекционных наркотиков в целом соответствовал уровню 2004 года – после периода гораздо более высоких показателей в период 2006–2010 гг. В то же время число новых случаев ВИЧ-инфекции среди женщин в период между 2004 и 2013 гг. увеличилось почти вдвое (таблица 3). При включении данных по России число случаев в разбивке по путям передачи ВИЧ в восточной части Региона увеличилось на 207% для гетеросексуальной передачи (с 10 225 до 31 424), на 48% для потребления инъекционных наркотиков (с 18 632 до 27 596),

на 427% для секса между мужчинами (с 166 до 875) и на 160% для неизвестного пути передачи ВИЧ (от 17 076 до 44 346), в то время как число случаев передачи ВИЧ от матери к ребенку снизилось на 5% (от 671 до 635 случаев). В западной части Региона показатель ВИЧ-инфицирования вследствие сексуальных контактов между мужчинами увеличился на 26%, а вследствие гетеросексуальных контактов снизился на 47%. В центральной части Региона частота ВИЧинфекций, приобретенных вследствие секса между мужчинами, увеличилась в три раза, вследствие гетеросексуальных контактов на 64% и вследствие употребления инъекционных наркотиков в четыре раза (главным образом, в связи со вспышкой в Румынии, которая началась в 2011 г. и достигла пика в 2012 г.) (таблица 8). В 2013 г. 35 стран Европейского региона ВОЗ предоставили информацию о количестве клеток CD4 на момент постановки диагноза ВИЧ-инфекции для 35 383 случаев (48%) (таблица 14). 49% из этих случаев были зарегистрированы как случаи, выявленные на поздних стадиях (число клеток CD4 <350/ мм³), включая 27% случаев с продвинутой стадией ВИЧ-инфекции (число клеток CD4 <200/мм³). Процент случаев, выявленных на поздних стадиях инфекции, варьировался в зависимости от путей передачи вируса и географических зон. Самым высоким он был среди людей, инфицированных в результате инъекционного употребления наркотиков в восточной части Региона (68%) (таблица 14). В 2013 г. в 49 государствах-членах Европейского региона ВОЗ8, было зарегистрировано 15 789 новых случаев СПИДа, и заболеваемость, таким образом, составила 2,2 случая на 100 000 населения. Семьдесят два процента случаев заболевания СПИДом (11 292) были зарегистрированы в восточной части, 23% (3 606) в западной части и 6% (891) в центральной части Региона. Частота новых случаев на 100 000 населения в восточной части Региона составила 10,0. Этот показатель был более чем в одиннадцать раз выше, чем в западной части Региона (0,9 на 100 000) и в 20 раз выше, чем в центральной части Региона (0,5 на 100 000) (таблица 15). В период с 2004 по 2013 гг. в 50 странах, которые регулярно предоставляли соответствующие данные, частота новых случаев СПИДа на 100 000 населения увеличилась на 10% – с 2,0 в 2004 г. (12 952 случая) до 2,2 в 2013 г. (15 789 случаев). Однако на субрегиональном уровне наблюдались существенные различия, о чем свидетельствуют следующие цифры: увеличение показателя в три раза в восточной части Региона – с 3,2 на 100 000 (3 275 случаев) до 10,0 (11 292 случая); снижение показателя на 64% в западной части – с 2,5 на 100 000 (8 915 случаев) до 0,9 (3 606 случаев); и увеличение показателя на 25% в центральной части – с 0,4 (762 случая) до 0,5 (891 случай).

7 Данные по Туркменистану и Узбекистану не включены.

8 Нет данных из России, Швеции, Туркменистана или Узбекистана.

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Выводы ВИЧ-инфекция продолжает оставаться серьезной проблемой общественного здравоохранения в Европе. В 2013 г. в 51 из 53 государств-членов Европейского региона было зарегистрировано 136 235 новых случаев ВИЧ-инфекции, что составило 15,7 случая на 100 000 населения. Самые последние данные эпиднадзора показывают, что, несмотря на значительные усилия по профилактике и борьбе с ВИЧ-инфекцией, частота ВИЧ-инфицирования в ЕС/ЕЭЗ не уменьшилась, в то время как в Европейском регионе в целом за последние десять лет было зарегистрировано существенное увеличение этого показателя. ВИЧинфекция в Европейском регионе главным образом сосредоточена в ключевых группах населения, подвергающихся более высокому риску заражения ВИЧ, таких как мужчины, имеющие половые контакты с мужчинами, выходцы из высоко эндемичных стран (в основном из стран Африки южнее Сахары) и мигранты из других стран, а также ЛУИН и их половые партнеры. В то же время частота случаев среди выходцев из стран с генерализованной эпидемией ВИЧ-инфекции, по-видимому, сокращается. Кроме того, в восточной части Региона все чаще наблюдаются новые случаи ВИЧ-инфекции, связанные с гетеросексуальной передачей, особенно среди женщин. Недавний рост числа новых случаев ВИЧ-инфекции среди ЛУИН в ЕС/ЕЭЗ и в некоторых странах западной части Европейского региона продемонстрировал, что вспышка ВИЧинфекции вполне возможна даже при небольшом числе ВИЧ-инфицированных, если соответствующие меры служб общественного здравоохранения являются недостаточными [3]. Во всех странах, сообщающих данные о количестве CD4 на момент постановки диагноза, процентная доля случаев поздней диагностики является высокой. Это указывает на задержку с прохождением тестирования на ВИЧ. Например, на момент постановки диагноза почти половина пациентов уже имели право на АРВтерапию согласно критериям ВОЗ от 2010 г., которые были затем пересмотрены, чтобы рекомендовать начало проведения АРТ при количестве CD4-клеток менее 500/мм3 [2]. Высокое и растущее число случаев СПИДа, в особенности в восточной части Региона, также указывает на позднюю постановку диагноза ВИЧ-инфекции, низкий охват АРВ-терапией и на то, что лечение ВИЧ-инфекции, необходимое для спасения жизни пациента, начинают несвоевременно. Увеличение доступности лечения и рекомендации относительно более раннего начала АРВ-терапии [2] расширили задачи эпиднадзора за ВИЧ-инфекцией, в которые теперь входит мониторинг доступа ВИЧинфицированных к помощи и соответствующему лечению. В масштабах всей Европы необходимо обеспечить улучшение показателей доступности лечения и его своевременного назначения, в особенности для ключевых групп населения. Самые срочные меры в этом направлении требуется предпринять в восточной части Региона.

Для того чтобы уменьшить количество поздних диагнозов, следует пересмотреть нынешнюю практику консультирования и тестирования на ВИЧ, с тем чтобы обеспечить охват людей, которые подвергаются более высокому риску (например, с помощью таких подходов, как рутинное предложение пройти консультирование и тестирование на ВИЧ людям, обращающимся в медицинское учреждение, экспресс-тестирование, а также тестирование вне медицинских учреждений [2]). Особое внимание следует уделять ключевым группам населения, с тем чтобы обеспечить среди них более раннюю постановку диагноза ВИЧ-инфекции и своевременное начало АРВ-терапии. Это приведет к улучшению результатов лечения, сокращению заболеваемости и смертности, а также будет способствовать предотвращению или дальнейшему снижению передачи ВИЧ. Необходимо обеспечить равный доступ всех людей к услугам профилактики, тестирования, лечения и ухода в связи с ВИЧ-инфекцией, так как только в этом случае страны смогут реализовать глобальные цели, поставленные в этой области: 90% людей, живущих с ВИЧ, должны быть диагностированы и охвачены медицинской помощью; 90% пациентов с поставленным диагнозом остаются в системе медицинской помощи; и у 90% людей, охваченных медицинской помощью, достигнута вирусная супрессия [4]. Меры по противодействию эпидемии должны основываться на научных данных и быть адаптированы к национальным и местным эпидемиологическим условиям. На основании данных эпиднадзора, представленных в этом докладе, можно сделать следующие выводы: • Для стран ЕС/ЕЭЗ и западной части Региона основой таких мер являются мероприятия по профилактике и борьбе с ВИЧ-инфекцией среди МСМ. Учитывая устойчивое увеличение числа случаев, диагностированных в этой ключевой группе населения в последнее десятилетие, по-видимому, можно сделать вывод, что на данный момент усилия по профилактике и борьбе с ВИЧ-инфекцией все еще не достаточны и должны быть значительно усилены. Поскольку около 30% всех новых случаев ВИЧ-инфицирования в ЕС/ЕЭЗ были зарегистрированы среди мигрантов и около трети случаев ВИЧ-инфекции, приобретенной гетеросексуальным путем, были зарегистрированы среди мигрантов из высоко эндемичных стран, нужно принять меры к тому, чтобы услуги по профилактике, лечению и уходу в связи с ВИЧ-инфекцией были легко доступными для всех мигрантов. В последние несколько лет в ряде стран [3] был отмечен рост числа новых случаев ВИЧ-инфекции среди лиц, употребляющих инъекционные наркотики, что указывает на необходимость дальнейшей реализации или даже расширения мер по снижению вреда в определенных местах и условиях. • Для стран центральной части Региона, где эпидемия среди МСМ расширяется, приоритетом является укрепление мер по профилактике, выявлению (с

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помощью тестирования) и лечению ВИЧ-инфекции в этой группе населения. Важнейшим условием для достижения этой цели являются целенаправленные и эффективные меры по снижению стигматизации. • Странам в восточной части Региона следует расширить масштабы целевых мер и обеспечить предоставление гражданам эффективных, высококачественных и комплексных услуг с помощью хорошо функционирующих систем здравоохранения, одной из задач которых является улучшение социальных детерминант здоровья. Все нуждающиеся граждане должны иметь доступ к эффективной профилактике, раннему и целенаправленному тестированию и консультированию и интегрированной помощи. Следует приложить усилия для стратегического использования АРТ для достижения таких целей, как лечение и профилактика ВИЧ-инфекции и уменьшение растущего числа случаев СПИДа. Основой научно-обоснованных мер противодействия ВИЧ-инфекции должно оставаться расширение мероприятий по профилактике и лечению ВИЧ-инфекции среди ключевых групп населения, особенно среди лиц, употребляющих инъекционные наркотики, в частности, путем проведения программ по снижению вреда и обеспечения раннего доступа граждан к лечению. При оказании помощи парам, в которых один из партнеров практикует поведение высокого риска (употребление инъекционных наркотиков и т.д.), нужно принять более решительные и эффективные меры по снижению риска гетеросексуальной передачи вируса [5]. И наконец, следует отметить, что надежные достоверные эпидемиологические данные имеют исключительно важное значение для тщательного мониторинга ситуации и для создания информационной базы, необходимой для того, чтобы системы общественного здравоохранения могли принимать эффективные меры противодействия эпидемии ВИЧ-инфекции в Европейском регионе. Число стран Европейского региона ВОЗ, которые проводят расширенный эпиднадзор за ВИЧ-инфекцией и предоставляют отчетность, постепенно возрастает. В 2013 г. данные такого эпиднадзора были представлены 50 из 53 стран Региона. Качество данных и их полнота по таким ключевым переменным, как путь передачи ВИЧ и число клеток CD4 на момент постановки диагноза, все еще требуют усовершенствования во многих странах. Кроме того, нужно повысить эффективность мер по повышению показателей доступности и востребованности медицинских услуг, а также удержания пациентов в системе помощи и ухода в период после постановки диагноза. В 2014 г. система эпиднадзора за ВИЧ-инфекцией будет пересмотрена с целью повышения ее эффективности за счет таких подходов, как объединение систем эпиднадзора за ВИЧ-инфекцией и СПИДом и расширение возможностей для долгосрочного мониторинга результатов непрерывной медицинской помощи после постановки диагноза ВИЧ-инфекции, включая такие ее элементы, как

вовлечение пациентов в систему лечения и ухода в связи с ВИЧ-инфекцией и достижение и поддержание вирусной супрессии.

Библиография 1. Федеральный научно-методический центр по профилактике и борьбе со СПИДом, Российская Федерация Ссылка: HIV-infection Newsletter number 39 [информационный бюллетень по ВИЧинфекции 39]. Москва: Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека; 2014 г. Всемирная организация здравоохранения. Сводное руководство по использованию антиретровирусных препаратов для лечения и профилактики ВИЧ-инфекции. Рекомендации с позиции общественного здравоохранения. Женева: Всемирная организация здравоохранения, 2013 г. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L, et al. Human immunodeﬁciency virus among people who inject drugs: Is risk increasing in Europe? Euro Surveill. 2013;18(48):pii=20648. Available online [Имеется на сайте]: http://www.eurosurveillance. org/ViewArticle.aspx?ArticleId=20648 UNAIDS. Ambitious treatment targets: Writing the ﬁnal chapter of the AIDS epidemic. Geneva; 2014. Available online [Имеется на сайте]:http://www.unaids.org/en/media/ unaids/contentasset s/document s/unaidspublication/201 4/ JC2670_UNAIDS_Treatment_Targets_en.pdf World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations [Сводное руководство по профилактике, диагностике, лечению и уходу в связи с ВИЧ-инфекцией среди ключевых групп населения]. Geneva: World Health Organization; 2014.

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Abbreviations AIDS ART ECDC EEA EU HIV ICJ IDU MSM MTCT PWID TESSy UN UNSCR WHO Acquired immunodeficiency syndrome Antiretroviral therapy European Centre for Disease Prevention and Control European Economic Area European Union Human immunodeficiency virus International Court of Justice Injecting drug use Men who have sex with men Mother-to-child transmission People who inject drugs The European Surveillance System United Nations United Nations Security Council Resolution World Health Organization

UNAIDS Joint United Nations Programme on HIV/AIDS

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1 HIV and AIDS in the European Union and European Economic Area 1.1 HIV diagnoses For 2013, 29 157 HIV diagnoses were reported by 30 EU/ EEA countries1 giving a rate of 5.7 per 100 000 population (Table 1). The highest rates were observed in Estonia (24.6; 325 cases), Latvia (16.8; 340 cases), Portugal (10.4; 1093 cases), Belgium (10.0; 1 115 cases) and Luxembourg (9.9; 53 cases). The lowest rates were reported by Slovakia (1.5; 83 cases) and Croatia (2.0; 85 cases). The overall rate for men in the EU/EEA was 8.9 per 100 000 population (Table 2) and for women, 2.6 per 100 000 population (Table 3). The overall male-to-female ratio was 3.3. The ratio was highest in Hungary (11.1), Croatia (9.6), the Czech Republic (8.8) and Greece (8.7) (Figure C). The predominant mode of transmission in these countries was sex between men. Most HIV diagnoses were in the age category 30–39 years (33%). The 30–39-year-olds accounted for most HIV diagnoses among IDU (41% of cases), MSM (34%), heterosexuals from countries with generalised HIV epidemics (39%), and other heterosexual cases (29%). However, MSM tended to predominate in the younger (20–29-year-old) age categories while heterosexuals were the predominant group among those diagnosed over 50 years of age (Figure D). Young people 15 to 24 years of age comprised 12% of the EU/EEA population and 11% of HIV diagnoses in 2013. Romania, Cyprus, Iceland, Slovakia, Bulgaria and Lithuania reported more than 15% of their HIV diagnoses among young people (Figure E). In eleven countries, this proportion was lower than 10%. Data on transmission mode provide information on the groups that are most affected by HIV in the EU/EEA (Table 12a, Tables 4–7): • Sex between men is the predominant mode of HIV transmission in EU/EEA countries, accounting for 42% (12 228) of HIV diagnoses in 2013 (Table 4), and 52% of HIV diagnoses where the route of transmission was known (Figure F). Among those with known route of HIV transmission, MSM accounted for more than half of new diagnoses in fifteen countries (Austria, Belgium, Croatia, Cyprus, the Czech Republic, Denmark, Germany, Hungary, Malta, the Netherlands, Poland, Slovakia, Slovenia, Spain, and the United Kingdom) (Figure F). • Heterosexual contact is the second most commonly reported mode of transmission in the EU/EEA, accounting for 9 449 diagnoses (32%) (Table 6). One third (33%; 3 160) of newly diagnosed cases among heterosexuals originate from countries with generalised HIV epidemics. The highest proportions of heterosexually transmitted cases originating from countries with generalised epidemics were observed in Belgium (52%), France (50%), Ireland (53%), Luxembourg (58%) and Sweden (58%) (Figure G). • Five percent (1 455 cases) of HIV diagnoses were reported among PWID (Table 5). Injecting drug use accounted for more than one quarter of cases in Greece (31%), Lithuania (35%) and Romania (29%). • Of the remainder, 218 (0.7%) diagnoses were reported as mother-to-child transmission (Table 7); 25% of those cases originated from countries with generalised HIV epidemics. Forty-seven diagnoses were reported to be due to transfusion of blood and its products, and 19 cases were hospital-acquired infections (Table 12a). • Transmission mode was reported as ‘unknown’ for 5 741 diagnoses (20%) with a wide variation between countries: less than 5% of diagnoses reported as ‘unknown’ in Croatia, Cyprus, Czech Republic, Denmark, Luxembourg, Norway, Portugal and Slovakia and more than 60% reported as unknown in Iceland and Poland. In 2013, 28 EU/EEA countries provided information on the country of birth, country of nationality, or region of origin. In the EU/EEA, 3 784 diagnoses (15% of those with known information on region of origin), irrespective of transmission mode, were among persons originating from countries with generalised HIV epidemics in 2013 (Figure H, Table 11). An additional 20% of new diagnoses with known information on region of origin (5 248 cases) were among persons originating outside of the country of report, but not from a generalised epidemic country. Countries with more than half of new HIV diagnoses among persons originating from outside of the country of report are Belgium (52%), Denmark (52%), Ireland (55%), Luxembourg (70%), Malta (77%), Norway (63%), Sweden (74%), and the United Kingdom (54%) (Figure H). In 2013, 27 EU/EEA countries were able to provide information on the probable source of infection when the infection was acquired through heterosexual contact (Table 10). This information was reported for 39% of heterosexual cases (3 731). Among those, HIV diagnoses were reported in 776 individuals with a partner originating from a country with a generalised epidemic, 71 with a partner who injects drugs and 26 with a bisexual partner. Information on CD4 cell count at the time of HIV diagnosis was provided by 21 countries (Table 14) for 17 526 HIV diagnoses (61%) in adults and adolescents. All countries

1 Liechtenstein did not report data in 2013 (see country-specific comments in Annex 5).

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Figure C: Male-to-female ratio in HIV diagnoses, by country, EU/EEA, 2013 (n=29 086) Hungary Croatia Czech Republic Greece Slovenia Netherlands Poland Slovakia Cyprus Spain Luxembourg Austria Malta Germany Bulgaria Italy EU/EEA Denmark Ireland United Kingdom Iceland Portugal Lithuania Romania Belgium Norway France Finland Sweden Estonia Latvia 0 2 4 6 Male-to-female ratio 8 10 12

Figure D: Percentage of new HIV diagnoses, per age group, by transmission mode, EU/EEA, 2013 (n=22 472)

Sex between men Heterosexual, excluding countries with generalised HIV epidemics Heterosexual from countries with generalised HIV epidemics

Percentage

30 20

Injecting drug use

0 15-19 20-24 25-29 30-39 40-49 50+ Age category (years) Data from persons <15, other/unknown transmission, mother-to-child transmission, transfusion-related transmission, and nosocomial transmission not shown here. Data from Estonia and Poland excluded.

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Figure E: Percentage of new HIV diagnoses in people between 15 and 24 years old, by country, EU/EEA, 2013 (n=29 157) Romania Cyprus Iceland Slovakia Bulgaria Lithuania Estonia Poland United Kingdom Sweden Austria Hungary Czech Republic Ireland Germany Malta EU/EEA Spain Netherlands Greece Belgium France Latvia Portugal Finland Croatia Luxembourg Italy Denmark Slovenia Norway 0 5 10 Percentage 15 20 25

Figure F: Percentage of new HIV diagnoses acquired through sex between men out of all reported HIV diagnoses with known mode of HIV transmission, by country, EU/EEA, 2013 (n=23 416) Hungary Croatia Czech Republic Slovenia Netherlands Slovakia Germany Poland Cyprus Spain Malta United Kingdom Austria EU/EEA Denmark Belgium Ireland Luxembourg Greece Italy France Norway Bulgaria Sweden Finland Portugal Lithuania Romania Latvia Estonia 0 20 40 Percentage No cases with sex between men as transmission mode were reported in Iceland

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Figure G: Percentage of new HIV diagnoses among persons originating from countries with generalised HIV epidemics out of all cases reported as heterosexually acquired, EU/EEA (n=9 449) Sweden Luxembourg Ireland Belgium France Germany United Kingdom Norway Malta Denmark EU/EEA Netherlands Bulgaria Portugal Austria Finland Spain Italy Hungary Slovenia Greece Cyprus Slovakia Czech Republic 0 10 20 30 40 50 60 70

Percentage No cases reported among persons originating from countries with generalised HIV epidemics in Croatia, Estonia, Latvia, Lithuania, Poland or Romania

Figure H: Percentage of new HIV diagnoses among migrants out of all reported diagnoses with known region of origin, by country of report, EU/EEA, 2013 (n=25 568) Malta Sweden Luxembourg Norway Ireland United Kingdom Belgium Denmark Finland France Iceland Austria EU/EEA Germany Spain Netherlands Czech Republic Portugal Cyprus Italy Greece Bulgaria Slovenia Hungary Slovakia Lithuania Estonia Romania 0 10 20 30 40 Percentage There were no cases reported among migrants in Croatia, Latvia or Poland.

New diagnoses among persons originating from countries with generalised HIV epidemics New diagnoses among persons originating from other countries

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providing this data, with the exception of Estonia, were able to provide CD4 cell counts for more than 50% of their reported cases. Nearly half (47%) of all cases were late presenters with a CD4 cell count less than 350/mm3, including 27% of cases with advanced HIV infection (CD4 <200/mm3). The percentage of late diagnoses (CD4 <350/ mm3) was higher than 50% in eight countries: Estonia (52%), Finland (57%), Greece (55%), Italy (58%), Latvia (54%), Luxembourg (55%), Portugal (58%), and Slovenia (58%). When analysing CD4 cell count by transmission mode, the highest proportion of late diagnoses was observed among heterosexually acquired cases, especially among those originating from countries with generalised HIV epidemics (59%) (Figure I). The lowest proportion with CD4 less than 350/mm3, as well as CD4 less than 200/ mm3, was observed among cases due to mother-to-child transmission (26% and 14%) and MSM (37% and 18%) (Figure I). Nine countries reported late diagnosis in more than half of the cases acquired through injecting drug use and two countries for more than half of the cases in MSM (Table 14).

When analysing CD4 count by age category, there is a clear age gradient with increased proportions of late diagnosis among older age categories. Among those 50 years of age and older, 63% were diagnosed with CD4 <350/mm3 and 44% with CD4 <200/mm3 (Figure J).

1.2 Trends in HIV diagnoses The trend of reported HIV diagnoses for the period 2004–2013 remains relatively stable, although the overall rate of HIV diagnoses per 100 000 population decreased slightly from 6.5 per 100 000 in 2006 (28 259 cases) to 5.7 per 100 000 (29 157 cases) in 2013 (when not adjusted for the reporting delay in a number of countries (Table 1)). However, comparing with the estimated adjusted rate for 2013 that is 6.2 per 100 000 population (31 977 cases) shows less apparent decline, (see Annex 1 for methods; Annex 6 for results). In the previous HIV/ AIDS surveillance report [1], 29 381 HIV diagnoses were reported for 2012, but this number has now increased by over 3 000 cases and may still increase further in the coming one to two years.

Figure I: Percentage of reported cases with a CD4 cell count <350/mm3 and <200/mm3 at presentation, by transmission mode, EU/EEA, 2013 (n=17 526) < 200 Mother-to-child transmission < 350 Transmission mode Sex between men

Injecting drug use

Other heterosexual contact Heterosexual cases from countries with generalised HIV epidemics 0 10 20 30 40 50 60 70

Percentage

Figure J: Percentage of reported cases with a CD4 cell count <350/mm3 and <200/mm3 at presentation, by age category, EU/EEA, 2013 (n=17 526) 80 70 60 Percentage 50 40 30 20 10 0 15-19 20-24 25-29 30-39 40-49 50+ Age category (years) < 200 < 350

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Over the past decade, trends at national level have varied widely. Since 2004, rates of HIV diagnoses have more than doubled in Bulgaria, the Czech Republic, Hungary, Iceland, Malta, Romania and Slovakia and have increased by more than 50% in Croatia, Cyprus, Greece, Lithuania, Poland and Slovenia. The rate of new HIV diagnoses decreased in thirteen countries between 2004 and 2013, with decreases in the rate of new HIV diagnoses of more than 25% observed in Denmark, Estonia, France, Italy, Luxembourg, Portugal, Spain and the United Kingdom (Table 1). Since 2004, 26 EU/EEA countries have consistently reported data on transmission mode. Data from Estonia and Poland were excluded from this analysis because more than 50% of their data on transmission mode was missing. Data from Spain and Italy were also excluded because coverage of the surveillance system increased over this time period. Data on transmission mode from the countries consistently reporting indicate the following (Table 8a, Figure K): • The number of HIV diagnoses among MSM increased by 33% from 6 682 cases in 2004 to 8 864 cases in 2013, with a peak of 9 469 cases in 2012; when adjusted for reporting delay, HIV cases among MSM increased by 43% between 2004 and 2013. Between 2004 and 2013, increases of more than 100% were observed in Bulgaria, Croatia, Cyprus, the Czech Republic, Hungary, Ireland, Latvia, Lithuania, Malta, Romania and Slovakia. Increases of more than 50% were observed in Belgium, Germany and Slovenia. (Table 4). • The number of heterosexually acquired cases decreased by 45% from 12 027 in 2004 to 6 660 in 2013, with a consistently decreasing trend. This was mainly due to a 61% decrease among cases originating from countries with generalised HIV epidemics (6 922 in 2004, 2 732 in 2013).

• The number of HIV diagnoses among PWID has declined by 36% since 2004 (1 628 cases to 1 037 cases). An increase in overall numbers for the EU/ EEA was observed in 2011 and 2012 due to localised outbreaks in Greece and Romania. In Greece, cases diagnosed increased from 14 in 2004 to 513 cases in 2012 and 248 cases in 2013. In Romania, cases increased from 1 in 2004 to 116 in 2011, 170 in 2012 and 149 in 2013. Bulgaria has also seen an increase, though less dramatic, in cases among PWID from 7 in 2004 to 74 in 2009 and then 33 in 2013 (Table 5). • The number of diagnoses of HIV transmitted from mother to child decreased by 37%, from 305 in 2004 to 193 in 2013. • The number of HIV diagnoses due to nosocomial infection has remained stable with 23 cases in 2004 and 19 in 2013. The number of cases due to transfusion of blood and its products has decreased by 55%, from 89 in 2006 to 40 cases in 2013. • The number of cases reported to have an unknown mode of transmission has increased consistently since 2004. Over the period in question, there was an increase of 48%, from 2 740 in 2006 to 4 044 cases in 2013. This increase is an underestimate as some countries reporting higher rates of incomplete data on transmission mode were excluded. • Reporting delays differ significantly between transmission categories for some countries. When adjustments for reporting delay were made, it increased the number of reported HIV cases in all transmission categories by between 8% and 19%, depending on the category. Figure K shows the adjusted trends.

1.3 AIDS cases, morbidity and mortality For 2013, 4 369 diagnoses of AIDS were reported by 29 EU/EEA countries (no data from Sweden), resulting in a

Figure K: New HIV diagnoses, by transmission mode and year of diagnosis, adjusted for reporting delay, EU/EEA, 2004–2013 10000 Heterosexual, excluding cases originating from countries with generalised HIV epidemics Heterosexual, originating from countries with generalised HIV epidemics Sex between men 6000 Injecting drug use Mother-to-child transmission 4000 Other/undetermined

8000 Number of cases

2000

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year of diagnosis Cases from Estonia and Poland excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period

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rate of 0.9 cases per 100 000 population (Table 15). The highest rates were reported by Latvia (6.6, 133 cases) and Portugal (3.1, 322 cases). In the EU/EEA during the last decade, the rate of reported AIDS cases has halved from 2.1 per 100 000 (9 455 cases) reported in 2004. However, since 2004, an increase of 100% or more in the rate of AIDS diagnoses was reported in Bulgaria, the Czech Republic, Hungary and Lithuania. The number of cases also increased in Croatia, Greece and Latvia. In the EU/EEA, the most common AIDS-indicative diseases diagnosed in 2013 were Pneumocystis pneumonia (20%), oesophageal candidiasis (10%), wasting syndrome due to HIV (8%) and pulmonary tuberculosis (8%) (Table 24). The most common indicative diseases for MSM were Pneumocystis pneumonia, Kaposi’s sarcoma and oesophageal candidiasis; for PWID, pulmonary tuberculosis, Pneumocystis pneumonia and HIV wasting syndrome; for cases due to heterosexual transmission, Pneumocystis pneumonia, oesophageal candidiasis and pulmonary tuberculosis (Figure L). In the EU/EEA, 27 countries reported data on deaths among individuals diagnosed with AIDS (Finland, Italy, and Sweden did not provide this data). Overall, 997 individuals with AIDS were reported to have died during 2013 (Table 25). This figure has been consistently decreasing since 2004 (3 067 reported deaths among the same 27 countries reporting deaths in 2013), although delays in reporting affect the latest figures. From the beginning of the HIV epidemic to the end of 2013, a cumulative total of 341 625 individuals had been diagnosed with AIDS in the EU/EEA (Table 15). The cumulative total of cases reported as known to have died by the end of 2013 was 183 953 (Table 25).

HIV surveillance data suggest that the epidemic in EU/ EEA countries remains constant overall, with little fluctuation in the rate of diagnoses per 100 000 population over the last decade. While the actual 2013 rate of 5.7 per 100 000 population is lower than previous years, it is expected to increase in future reporting cycles due to reporting delay which is common for HIV generally, and in some countries in the EU/EEA in particular. Despite the stable rate of HIV in the region, these data provide evidence of important changes in the epidemiology of HIV during the past decade. There has been a sustained increase in HIV diagnoses among men who have sex with men, and this is the population in the EU/ EEA that accounts for most new HIV diagnoses. During the past decade, HIV increases among men who have sex with men were observed in all but four EU/EEA countries, and significant increases were seen in countries with overall low rates of HIV such as Croatia, Cyprus, the Czech Republic, Hungary, Malta, Romania and Slovakia. There has been a substantial decrease in the number of heterosexually acquired HIV infections during the past decade; however, heterosexual transmission still remains the second most common mode of HIV transmission in the EU/EEA. Part of the decline in heterosexual cases is due to the 61% decline during the last decade in the number of heterosexually acquired cases originating from countries with generalised HIV epidemics. Further exploration is required to understand whether these trends are driven by decreased incidence of HIV in these populations, decreased testing, migration or a combination of factors. Both among heterosexual cases and within other transmission groups, migrants, or persons originating from outside of the reporting country, still constitute a considerable proportion (35%) of new HIV diagnoses in the EU/EEA. There is increasing evidence that a proportion of migrants acquire HIV after arrival in the EU/EEA [2, 3].

1.4 Conclusions In 2013, for the first time, HIV surveillance data have national coverage from all participating EU/EEA countries due to increased coverage of the HIV surveillance systems in Italy and Spain in recent years. The 2013

Figure L: Percentage and number of the most common AIDS-indicative diseases per transmission mode, EU/EEA, 2013 (n=4 369) Pneumocystis pneumonia Kaposi's sarcoma Candidiasis, oesophageal Mycobacterium tuberculosis, pulmonary IDU Pneumocystis pneumonia Wasting syndrome due to HIV Pneumocystis pneumonia Candidiasis, oesophageal Mycobacterium tuberculosis, pulmonary 0 5 199 10 15 Percentage MSM: Men having sex with men; IDU: injecting drug use; Hetero: heterosexual transmission.

MSM

393 222 131 152 129 116 500 269

Hetero

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Transmission among people who inject drugs remains at a low level in most countries in the EU/EEA. However, increases have been observed during recent years in Romania and Greece, countries with previously very low levels of HIV among PWID [4, 5], illustrating that patterns can change quickly in the absence of effective prevention delivered at scale. The decreasing number of cases infected through mother-to-child transmission indicate that antenatal screening programmes are operating effectively and that prophylactic treatment is available in most countries in the EU/EEA. Still, strengthened efforts are needed to address the few preventable cases of mother-to-child transmission that still occur in some EU/EEA countries. Despite increasing evidence of the benefits of early treatment for the infected individual, 47% of newly reported HIV cases with information on CD4 cell count are diagnosed as late presenters or with indication of advanced infection, i.e. with unacceptably low CD4 cell counts. This suggests persistent problems with access to, and uptake of, HIV testing and counselling by those most at risk in many countries. There is strong evidence that delayed initiation of antiretroviral treatment leads to increased morbidity and mortality for the person diagnosed. In addition to the clinical and personal benefits to the individual diagnosed, early diagnosis and treatment can also benefit sexual and injecting partners by inhibiting onward HIV transmission. The changes in the pattern of HIV infections observed in the EU/EEA over the last decade indicate that it is crucial to sustain evidence-based HIV prevention interventions that are tailored to the local epidemiological context and targeted at those most at risk. Prevention and control of HIV infection adapted appropriately to key populations, such as MSM, are the cornerstones of HIV prevention in most EU/EEA countries. Migrants, both those from high-endemic countries and other countries, are also a key population for prevention and control efforts in the majority of EU/EEA countries. Given the increasing evidence of post-migration HIV acquisition, it is important that migrant-sensitive services for HIV testing, combined with policies which promote and ensure linkage to and access to care are delivered in all countries across the EU/EEA. Finally, harm reduction programmes among people who inject drugs and their sexual partners are crucial and should be maintained and scaled up in many countries where HIV incidence is high in this population and where service coverage is low.

Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L, et al. Human immunodeﬁciency virus among people who inject drugs: Is risk increasing in Europe?. Euro Surveill. 2013;18(48):pii=20648. Available online: http://www.eurosurveillance.org/ViewArticle. aspx?ArticleId=20648 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 online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19962

References 1 European Centre for Disease Prevention and Control/WHO Regional Oﬃce for Europe. HIV/AIDS surveillance in Europe 2012. Stockholm: ECDC; 2013. Rice BD, Elford J, Yin Z, Delpech VC. A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV. AIDS 2012; 26(15):1961-1966. European Centre for Disease Prevention and Control. Migrant health: Sexual transmission of HIV within migrant groups in the EU/ EEA and implications for eﬀ ective interventions. Stockholm: ECDC; 2013.

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HIV/AIDS surveillance in Europe 2013

2 HIV and AIDS in the WHO European Region 2.1 HIV and AIDS diagnoses in the WHO European Region HIV diagnoses With inclusion of 136 235 new HIV diagnoses reported in 2013, the cumulative number of infections diagnosed in the WHO European Region increased to 1 715 344, including 914 8132 officially reported to ECDC and the WHO Regional Office for Europe (Figure B) and 800 531 diagnoses were reported by Russia [1]. The 136 235 new HIV diagnoses were reported by 51 of the 53 countries of the WHO European Region3, corresponding to a rate of 15.7 per 100 000 population for 2013, and include 56 507 cases officially reported to ECDC/WHO Regional Office for Europe by 50 countries, a rate of 7.8 per 100 000 population; and 79 728 cases from Russia [1]. For men, the rate of new cases was 10.8 per 100 000 population (Table 2) and for women, 4.8 per 100 000 population (Table 3) (Russia not included). Forty-five percent of newly diagnosed infections (25 494 cases) were reported in the East, 48% (26 847 cases) in the West and 7% (4 166 cases) in the Centre of the Region, while the rate of cases per 100 000 population was highest in the East (22.7 per 100 000), over three times higher than in the West (6.3 per 100 000) and ten times higher than in the Centre (2.2 per 100 000) (Table 1). When data for Russia are included, 77% of new cases were reported in the East, 20% in the West and 3% in the Centre while the rate in the East increases to 41.2 per 100 000 population. Rates of HIV infections diagnosed in 2013 also varied widely across countries in the WHO European Region. In Russia the rate was 55.6 per 100 000 population in 2013 [1]. Among reporting countries, the highest rates were reported by Ukraine (39.4), Estonia (24.6), Moldova (17.3), Latvia (16.8), Belarus (14.6), Kazakhstan (13.0), Georgia (10.7), Tajikistan (10.1) and Belgium (10.0) while the lowest rates were reported by Bosnia and Herzegovina (0.7), the former Yugoslav Republic of Macedonia (0.7), Slovakia (1.5), Montenegro (1.6) and Turkey (1.7). Monaco and San Marino reported zero cases in 2013. (Table 1). Among HIV infections diagnosed in 2013 (Russia excluded), the majority (36%) were in the age group 30–39 years (42% with Russia included), while 10% were 15–24-year-olds (Table 9, Table A). The male-tofemale ratio was 2.2 (1.7 with Russia included), lowest in the East (1.3) (1.4 with Russia included), higher in the West (3.3) and highest in the Centre (4.9) (Table A). At country level, the highest male-to-female ratios were 2 Minus the 62 581 cases officially reported to ECDC/WHO by Russia in 2010. 3 No data available from Lichtenstein, Uzbekistan or Turkmenistan.

observed in Serbia (11.3), Hungary (11.1), Croatia (9.6), the Czech Republic (8.8), Greece (8.7) and Slovenia (7.8) and the lowest in Belarus (1.1), Moldova (1.2), Ukraine (1.3), Kazakhstan (1.3), Kyrgyzstan (1.4), and Latvia (1.5) (Figures C, P, S). Data on transmission mode for 2013 indicate the following (Table A, Tables 4–7): • Forty-six percent of cases newly diagnosed were infected through heterosexual transmission (26 047 cases), although the picture is more heterogeneous at sub-regional level (Table 6, Table A). Among cases reported as infected through heterosexual contact, 13% were in persons originating from countries with generalised epidemics (data not shown). • Twenty-four percent were infected through sex between men (13 348 cases) (Table 4). • Sixteen percent of newly diagnosed HIV infections were acquired through injecting drug use (9 135) (Table 5). • Of the remaining cases, 0.9% (509 cases) were infected through mother-to-child transmission (Table 7) and 0.2% (94 cases) through other transmission routes (nosocomial infection, transfusion or use of other blood products). Seventeen percent of children infected through MTCT originated from countries with generalised epidemics (data not shown). • Transmission mode was reported as unknown or missing for 13% (7 374 cases). When data for Russia are included, the percentages and numbers of cases by transmission category change to 31% (41 656 cases) for heterosexual transmission, 21% (29 010 cases) for injecting drug use, 10% (13 719 cases) for sex between men, 0.6% (875 cases) for MTCT and 37% (50 862 cases) for unknown transmission mode. Information about probable country of infection was reported by 27 of the 50 countries, covering 19% of new diagnoses (10 981 cases). Of the cases for whom HIV infection was reported as acquired abroad (1 912 cases) 34% were infected in sub-Saharan Africa (658 cases), 32% in central and eastern Europe (611 cases) and 11% in south and south-east Asia (209 cases) (Table 13). In 2013, 35 countries (15 in the West, 12 in the Centre and eight in the East) provided information on CD4 cell count at the time of HIV diagnosis for 35 383 cases (covering 48% of all new cases) (Table 14). Close to half (49%) of these cases were late presenters with CD4 cell counts below 350/mm3, including 27% with advanced HIV infection (CD4<200/mm3). CD4 cell count data were available for more than 50% of the reported cases in 30 countries. The percentage of late presenters varied

HIV/AIDS surveillance in Europe 2013

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Figure M: Rates of new HIV diagnoses, by geographical area and year of diagnosis, WHO European Region, 2004–2013 Arithmetic scale 25 Cases per 100 000 population West Centre 20 East WHO European Region 15

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year of diagnosis

Logarithmic scale 100 Cases per 100 000 population West Centre East WHO European Region

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year of diagnosis Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period

Figure N: New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2004–2013

25000

Heterosexual Sex between men

20000 Number of cases

Injecting drug use Mother-to-child transmission

15000

Other/undetermined

10000

5000

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year of diagnosis Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Estonia, Poland and Turkey excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Data are not adjusted for reporting delays and numbers of cases reported for recent years are likely to increase in future reports.

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HIV/AIDS surveillance in Europe 2013

across transmission categories and were highest for people infected through heterosexual contact (57%) and injecting drug use (56%) and lower for people infected through sex between men (37%).

Trends in HIV diagnoses Between 2004 and 2013, the rate of newly diagnosed HIV infections per 100 000 population increased by 81%, from 8.7 in 2004 (75 812 cases) to 15.7 in 2013 (136 235 cases) in 51 countries4 (Russia included) which corresponds to an 80% increase in the absolute number of cases. The increase is mainly driven by an upward trend in the East where the rate increased by fully 144% from 16.9 in 2004 (47 332 cases) to 41.2 in 2013 (105 222 cases). In the 50 countries that provided official data to ECDC and WHO (Russia excluded), the regional rate increased by 16%, from 6.7 per 100 000 (42 405 cases) to 7.8 (56 507 cases), whereas the rate in the East increased by 80% from 12.6 in 2004 (13 925 cases) to 22.7 in 2013 (25 494 cases) for those countries consistently reporting for the period. In the Centre, the rate increased by 175%, from 0.8 (1 577 cases) to 2.2 (4 166 cases) whereas it decreased in the West by 20%, from 7.9 (26 903 cases) to 6.3 (26 847), not adjusting for reporting delay (Figure M, Table 1). Presenting the data on a logarithmic scale, allowing better comparison of rates of change regardless of starting point, visually shows that the highest relative increase in rates occurred in the Centre (Figure M). A total of 14 395 148 HIV tests performed for diagnostic purposes were reported by 33 countries for 2013. A majority of countries reported increasing numbers of HIV tests during the period 2004–2013, notably in the East. Higher testing rates were reported by countries in the East, lower rates by countries in the Centre while data from countries in the West showed varying levels and trends (Table 27). The total number of tests performed in the 32 countries with data for both 2004 and 2013 increased by 41%, from 10 106 310 to 14 244 551. Among the 46 countries consistently reporting data on transmission mode for the period 2004–2013 (Table 8, Figure N), not considering variations at sub-regional level: • the number of heterosexually acquired infections (including cases originating from countries with generalised epidemics) increased by 30% from 17 620 in 2004 to 22 830 in 2013; • the number of cases infected through sex between men increased by 40% from 6 975 in 2004 to 9 797 in 2013; • the number of cases infected through injecting drug use decreased by 3% from 8 987 in 2004 to 8 713 in 2013; • the number of children infected through mother-tochild transmission increased by 32%, from 357 cases in 2004 to 473 in 2013;

• of the number of HIV infections transmitted through other means, nosocomial transmission increased by 39% from 23 cases in 2004 to 32 cases in 2013, whereas transmission due to transfusion of blood and its products decreased by 54% from 105 in 2004 to 48 in 2013; and • the number of infections reported with unknown risk factors increased by 48%, from 3 372 in 2004 to 5 001 in 2013. When data for Russia are included, the number of cases in each transmission category increases by 69% for heterosexual transmission (from 22 811 to 38 439), by 42% for injecting drug use (from 20 178 to 28 590), by 43% for sex between men (from 7 108 to 10 168) and by 144% for unknown transmission (from 19 941 to 48 565) whereas it decreased by 15% for MTCT (from 988 to 839 cases).

AIDS cases, morbidity and mortality Since the beginning of the epidemic, at least 472 358 AIDS cases have been diagnosed in the WHO European Region. In addition to the 437 885 cases officially reported to ECDC/WHO by 52 countries, this figure includes cumulative 34 473 AIDS cases diagnosed in Russia as of 31 December 2013 [1]. In 2013, 15 789 new AIDS cases were diagnosed in 49 countries of the WHO European Region5 and the rate of new diagnoses per 100 000 population was 2.2 (Table 15). Of the new AIDS diagnoses, 72% (11 292 cases) were reported by countries in the East, 23% (3 606 cases) in the West and 6% (891 cases) in the Centre of the Region. The number of cases per 100 000 population was 10.0 in the East, eleven times higher than in the West (0.9 per 100 000) and 20 times higher than in the Centre (0.5 per 100 000). The rate of new AIDS diagnoses varied widely between countries. The highest rates were reported in Ukraine (20.6), Georgia (6.8), Latvia (6.6), Moldova (5.7), Belarus (4.7) and Armenia (4.4) and the lowest rates (0.3 or less) were reported in Bosnia and Herzegovina, Cyprus, the Czech Republic, Germany, Iceland, Malta, Slovakia and Turkey. Monaco and San Marino reported zero cases. Between 2004 and 2013, the rate of new AIDS cases per 100 000 population increased by 10%, from 2.0 in 2004 (12 952 cases) to 2.2 in 2013 (15 789 cases) in the 50 countries with consistent AIDS data (Figure O). Reporting delays affect the number of cases reported in 2013, reinforcing the recent apparent decrease. AIDS trends vary greatly at sub-regional level. In the East, the rate increased by 213% from 3.2 (3 275 cases) in 2004 to 10.0 (11 292 cases) in 2013, whereas in the West, the steady downward trend continued with a rate decrease of 64%, from 2.5 (8 915 cases) in 2004 to 0.9 (3 606 cases) in 2013. In the Centre there was a 25% increase from 0.4 (762 cases) in 2004 to 0.5 (891 cases) in 2013. Trends in AIDS cases by mode of transmission 5 No data available from Russia, Sweden, Turkmenistan or Uzbekistan.

Data from Turkmenistan and Uzbekistan not included.

HIV/AIDS surveillance in Europe 2013

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Figure O: Rate of AIDS cases per 100 000 population, by geographical area and year of diagnosis, 2004–2013 12 Cases per 100 000 population 10 8 6 4 2 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year of diagnosis Cases from Sweden, Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period

West Centre East WHO European Region

Figure P: Male-to-female ratio in new HIV diagnoses and heterosexually infected cases, by country, East, 2013 (n=25 494) All cases Georgia Lithuania Armenia Azerbaĳan Tajikistan Estonia Latvia Kyrgyzstan East average Ukraine Kazakhstan Moldova Belarus 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Cases infected through heterosexual transmission

Male-to-female ratio

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HIV/AIDS surveillance in Europe 2013

in the West, Centre and East are presented in Figure 1 on page 82. The cumulative number of people with AIDS reported to have died in the Region by the end of 2013 is 258 631, including 230 370 officially reported to ECDC/WHO and 28 261 in Russia [1]. Some 5 037 deaths among AIDS cases were reported by 47 countries6 in 2013 (Table 25). In those countries, the number of deaths decreased by 4%, from 5 269 in 2004.

by the countries for 2013 indicates the following (Table A, Tables 4–7): • The majority of new infections were acquired through heterosexual contact, accounting for 63% of new HIV infections (15 984 cases). • Injecting drug use was the second most common mode of transmission, contributing 31% of new HIV infections (7 791cases). • Just 2% of cases were acquired through sex between men (510 cases). • 1% of new infections were due to mother-to-child transmission (271 cases). • Transmission mode was unknown for 4% of the new diagnoses (922 cases). When data for Russia are included, the percentages and numbers of cases by transmission mode change to 30% (31 593 cases) for heterosexual transmission, 26% (27 666) for injecting drug use, 0.8% (881 cases) for sex between men, 0.6% (637 cases) for MTCT and 42% (44 435 cases) for unknown transmission mode. In 2013, only five countries in the East provided information on the probable source of infection when the case was infected through heterosexual contact (Armenia, Azerbaijan, Estonia, Georgia and Latvia), and even in those countries, the information was reported as unknown for 86% (833) of the 973 cases (Table 10). Among the cases that did have information, the probable source of infection was reported to be sexual contact with a person who injects drugs for 75% of cases and sexual contact with a person from a generalised epidemic country in 21% of cases. This variable, if well reported, could provide important information on the extent to which the increasing numbers of new cases reported as heterosexually acquired are occurring among sexual partners of people who inject drugs or other high risk groups. Nine countries provided information about the probable country of infection for 4 654 cases diagnosed in 2013 (18% of cases in the East). In that sample, 10% of cases were reported as acquired abroad of which 90% were acquired in other countries of central and eastern Europe.

2.2 HIV and AIDS diagnoses in the East HIV diagnoses in the East In 2013, 12 of the 15 countries in the East reported 25 494 newly diagnosed HIV infections, corresponding to a rate of 22.7 per 100 000 population (Table 1), the highest rate of the three geographical areas and the highest in the East during the past ten years for those 12 countries. An additional 79 728 new HIV diagnoses were reported in Russia [1], increasing the total number of cases in the East to 105 222, giving a rate of 41.2 cases per 100 000 population. In Russia the rate of diagnoses per 100 000 population was 55.6 in 2013 [1]. Among reporting countries, the highest rates in 2013 were reported by Ukraine (39.4), Estonia (24.6), Moldova (17.3), Latvia (16.8), Belarus (14.6), Kazakhstan (13.0), Georgia (10.7 and Tajikistan (10.1) and the lowest rates were reported by Azerbaijan (5.5), Lithuania (6.0) and Armenia (7.3). Among cases with information about age and gender, the majority (40%) were reported in the age group 30–39 years (45% when Russian data are included), while 10% were aged 15–24 years (Table A). The male-to-female ratio was 1.3 (1.4 when Russia is included), the lowest of the three geographical areas, translating into 43% of new cases being women in the East. The number of women newly diagnosed doubled between 2004 and 2013 in countries with consistent data7, from 5 357 to 10 938 (Table 3). Looking only at cases infected through heterosexual transmission, the male-tofemale ratio drops to 0.7 corresponding to 57% of people infected heterosexually being female (Figure P). However, in two countries (Armenia and Georgia) the ratio remains above one, indicating that men remain more affected even among cases infected heterosexually. In the West and the Centre, the average male-to-female ratio among cases infected through heterosexual transmission is 1.0 and 2.0, respectively (data not shown), suggesting that the proportion of women among heterosexually infected cases is highest in the East. In the East, heterosexual contact, followed by injecting drug use, was the predominant mode of HIV transmission. Information about transmission modes as reported

Trends in HIV diagnoses in the East In the 13 countries in the East with consistent data for 2004–2013 the rate of reported HIV diagnoses increased by 80% from 12.6 per 100 000 in 2004 to 22.7 per 100 000 in 2013 (Table 1, Figure M). When data for Russia are considered, the rate increased by 144%, from 16.9 in 2004 (47 332 cases) to 41.2 in 2013 (105 222 cases), corresponding to a 122% increase in the absolute number of cases. Since 2004, all countries with consistent data, except Estonia where rates decreased from 54.4 to 24.6, have reported increasing numbers and rates of HIV diagnoses. Rates of diagnoses per 100 000 population increased more than fourfold in Armenia and Azerbaijan,

6 No data available from Finland, Italy, Russia, Sweden, Turkmenistan or Uzbekistan. 7 Russia, Turkmenistan and Uzbekistan excluded.

HIV/AIDS surveillance in Europe 2013

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Figure Q: New HIV diagnoses, by transmission mode and year of diagnosis, East, 2004–2013 Arithmetic scale Heterosexual Sex between men 15000 Number of cases Injecting drug use Mother-to-child transmission Other/undetermined 10000

20000

5000

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Year of diagnosis

100000

Logarithmic scale Heterosexual Sex between men

10000 Number of cases

Injecting drug use Mother-to-child transmission

1000

Other/undetermined

100

10 1 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Year of diagnosis Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Estonia excluded due to incomplete reporting on transmission mode during the period

Figure R: Distribution of the three most common AIDS-indicative diseases per transmission mode, East, 2013

Wasting syndrome due to HIV MSM Mycobacterium tuberculosis, pulmonary Candidiasis, oesophageal Mycobacterium tuberculosis, pulmonary IDU Wasting syndrome due to HIV 121 4 5

296 160

Mycobacterium tuberculosis, extrapulmonary Mycobacterium tuberculosis, pulmonary Candidiasis, oesophageal Wasting syndrome due to HIV 0 5 10

Hetero

252 184 162 15 Percentage 20 25 30

MSM: Men having sex with men; IDU: injecting drug use; Hetero: heterosexual transmission.

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HIV/AIDS surveillance in Europe 2013

more than threefold in Tajikistan and more than doubled in Georgia, Kazakhstan and Kyrgyzstan (Table 1). During the same period, the number of HIV tests doubled in the 12 countries with consistent data, from 3 300 898 in 2004 to 6 818 803 in 2013 (Table 27). Information on transmission mode in 12 countries in the East with consistent data since 20048 indicates the following (Table 8b, Figure Q): • The number of infections acquired through injecting drug use remained fairly stable with 7 441 cases in 2004 and 7 719 in 2013 following a period of higher levels during 2006–2010, although increasing numbers were reported in some countries. • The number of HIV infections acquired through heterosexual contact tripled from 5 034 cases in 2004 to 15 815 in 2013. In Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan and Tajikistan the number increased by more than five times. • The number of HIV infections acquired through sex between men has increased by more than fifteen times, from 33 in 2004 to 504 in 2013. • The number of children infected through mother-tochild transmission has increased by 19%, from 226 in 2004 to 269 in 2013. • The number of cases for which the mode of transmission was unknown increased by 34%, from 633 in 2004 to 846 in 2013. Considering data for Russia, the number of cases in each transmission category increased by 207% for heterosexual transmission (from 10 225 to 31 424 cases), 48% for injecting drug use (from 18 632 to 27 596 cases), 427% for sex between men (from 166 to 875) and 160% for unknown transmission (from 17 076 to 44 346 cases) whereas it decreased by 5% for MTCT (from 671 to 635 cases). On a logarithmic scale allowing comparison of rates of change regardless of starting point, the data reveal the dramatic relative increase in the rate of infections reported as acquired through sex between men and shows this increase to be much steeper than that of other transmission modes (Figure Q).

(Figure O), corresponding to a 245% increase in the number of cases. The most common AIDS-indicative diseases diagnosed in 2013 were pulmonary tuberculosis (24% of all disease events reported), wasting syndrome due to HIV (14%) and oesophageal candidiasis (13%) (Table 24). By transmission mode, the most common diseases in people infected through heterosexual contact and sex between men were pulmonary tuberculosis, wasting syndrome and oesophageal candidiasis; while for people infected through injecting drug use, pulmonary tuberculosis, wasting syndrome due to HIV and extrapulmonary tuberculosis were the most frequent diagnoses (Figure R). A cumulative 66 606 people with an AIDS diagnosis were reported to have died by the end of 2013 in the East: 38 345 officially reported to ECDC/WHO and 28 261 from Russia [1]. In the East, 4 096 deaths among cases diagnosed with AIDS were reported for 2013 (Table 25). Assessing the change between 2004 and 2013 in countries with complete reporting 10, a 98% increase in the number of deaths is observed (from 2 067 in 2004 to 4 096 in 2013).

2.3 HIV and AIDS diagnoses in the Centre HIV diagnoses in the Centre The HIV epidemic in the Centre remains at a low and stable level although there is evidence of increasing transmission in many countries, especially through sexual contact between men. In 2013, 4 166 new infections were reported from 15 countries; a rate of 2.2 per 100 000 population (Table 1). The highest rates were reported by Cyprus (6.2), Albania (4.1), Poland (2.8) and Bulgaria (2.7) and the lowest by Bosnia and Herzegovina (0.7), the former Yugoslav Republic of Macedonia (0.7), Slovakia (1.5), Montenegro (1.6) and Turkey (1.7). Among cases newly diagnosed in 2013, the most affected age group was the 30–39-year-olds with 36% of cases, whereas 14% were diagnosed among 15–24-year-olds (Table A). The male-to-female ratio was 4.9, the highest male-to-female ratio of the three geographical areas in the WHO European Region. The highest male-to-female ratios were observed in Serbia (11.3), Hungary (11.1), Croatia (9.7), the Czech Republic (8.8) and Slovenia (7.8) (Figure S). Information on transmission modes for 2013 indicates the following (Table A, Tables 4–7): • Men having sex with men accounted for 30% of new diagnoses (1 256 cases). • Twenty-five percent of HIV infections were acquired through heterosexual contact (1 032 cases). • Six percent were infected through injecting drug use (244 cases). • Mother-to-child transmission accounted for 1.1% (47 cases).

AIDS cases, morbidity and mortality in the East In 2013, 11 292 cases of AIDS were diagnosed in 12 of the 15 countries in the East 9 which corresponds to a rate of 10.0 per 100 000 population. In 2013, the highest rates were reported by Ukraine (20.6), Georgia (6.8), Latvia (6.6), Moldova (5.7) and the lowest by Tajikistan (1.1), Kyrgyzstan (1.2), Lithuania (1.5), Kazakhstan (1.6) and Estonia (1.8) (Table 15). Between 2004 and 2013 the rate increased by 213%, from 3.2 cases per 100 000 population in 2004 (3 275 cases) to 10.0 in 2013 (11 292 cases) for countries reporting consistently for the period

8 Data from Estonia, Russia and Uzbekistan not included. 9 No data reported by Russia, Turkmenistan or Uzbekistan. 10 Russia, Turkmenistan and Uzbekistan not included.

HIV/AIDS surveillance in Europe 2013

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Figure S: Male-to-female ratio in new HIV diagnoses, by country, Centre, 2013 (n=4 166)

Serbia Hungary Croatia Czech Republic Slovenia Poland Slovakia Cyprus Turkey Bulgaria Bosnia and Herzegovina Romania Albania 0 2 4 6 Male-to-female ratio Montenegro and the former Yugoslav Republic of Macedonia did not report any female cases in 2013

Figure T: New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2004–2013

1000

Heterosexual Sex between men

800 Number of cases

Injecting drug use Mother-to-child transmission

600

Other/undetermined

400

200

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year of diagnosis Cases from Poland and Turkey excluded due to incomplete reporting on transmission mode during the period

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HIV/AIDS surveillance in Europe 2013

• Transmission mode was unknown for 38% of the new diagnoses (1 579 cases). In 2013, sex between men remained the predominant reported mode of transmission in an increasing majority of countries: Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, the Czech Republic, the former Yugoslav Republic of Macedonia, Hungary, Montenegro, Poland, Serbia, Slovakia and Slovenia; whereas heterosexual transmission was the main mode of transmission in Albania, Romania and Turkey.

heterogeneous. Of the seven countries reporting more than 30 AIDS cases in 2013, the number increased in four: Albania (from 11 to 56), Bulgaria (from 22 to 71), Hungary (from 23 to 42) and Turkey (from 55 to 93); and decreased slightly in three: Poland (from 176 to 160), Romania (from 366 to 338) and Serbia (from 58 to 44) (Table 15). The most common AIDS-indicative diseases diagnosed in 2013 were wasting syndrome due to HIV (18%), pulmonary tuberculosis (11%) and Pneumocystis pneumonia (10%) (Table 24). By transmission mode, the most common diseases for people infected through sex between men are Pneumocystis pneumonia, wasting syndrome due to HIV and Kaposi’s sarcoma; for people infected through injecting drug use, pulmonary tuberculosis, wasting syndrome due to HIV and Pneumocystis pneumonia; and for heterosexuals, wasting syndrome due to HIV, pulmonary tuberculosis and Pneumocystis pneumonia (Figure U). A total of 202 individuals diagnosed with AIDS were reported to have died during 2013 in the Centre (Table 25); a 45% decrease from 365 individuals in 2004.

Trends in HIV diagnoses in the Centre In the 15 countries in the Centre, the rate of new HIV diagnoses increased by 175% between 2004 and 2013, from 0.8 per 100 000 population in 2004 (1 577 cases) to 2.2 in 2013 (4 166 cases) (Figure M). Rates increased in all 15 countries and more than tripled in seven: Albania, Bulgaria, Czech Republic, Hungary, Montenegro, Slovakia and Turkey. Reported data suggest some increase in HIV testing activities, with a reported 30% increase in the number of tests performed in 2013 compared with 2004 in the twelve countries with data for both years (Table 27). Since 2004, information on transmission mode from 13 countries with consistent data (Poland and Turkey not included) shows the following (Table 8b, Figure T): • The number of cases infected through sex between men more than quadrupled, from 179 in 2004 to 809 in 2013. • The number of cases infected through heterosexual transmission increased by 64% (from 318 cases in 2004 to 522 cases in 2013). • The number of cases infected through injecting drug use increased by more than five times (by 458%), from 36 in 2004 to 201 in 2013, mainly due to an outbreak in Romania that started in 2011. • The number of HIV infections transmitted from mother to child increased by 129%, from 14 children in 2004 to 32 in 2013. Four countries contributed to this increase: Albania, Bulgaria, Romania and Serbia. • The number of new cases reported with unknown transmission mode increased by 41% from 141 cases in 2004 to 199 in 2013.

2.4 HIV and AIDS diagnoses in the West HIV diagnoses in the West In the West, 26 847 newly diagnosed HIV infections were reported in 2013 from the 23 countries, giving a rate of 6.3 per 100 000 population, without adjusting for reporting delay (Table 1, Table A). The reported data suggest that sexual transmission between men remains the main transmission mode, followed by heterosexual transmission, together accounting for 77% of new diagnoses. Of newly diagnosed HIV infections in 2013, the majority (32%) were 30–39-year-olds, 10% were 15–24-year-olds and the male-to-female ratio was 3.3 (Table A). The distribution by transmission mode is, as in previous years, influenced by the number of infections diagnosed in individuals originating from countries with generalised epidemics, especially for heterosexually acquired infections. Epidemic patterns by country of origin and mode of transmission largely correspond to those of the EU/EEA and are described in Chapter 1.2. Information about transmission mode for 2013 indicates the following (Table A, Tables 4–7): • Sex between men accounted for 43% of new diagnoses (11 582 cases). • Thirty-four percent of the HIV infections were acquired through heterosexual contact (9 031 cases). • Four percent of HIV infections were acquired through injecting drug use (1 100 cases). • Mother-to-child transmission accounted for 0.7% of diagnoses (191 cases).

AIDS cases, morbidity and mortality in the Centre In 2013, 891 AIDS diagnoses were reported by the 15 countries in the Centre, a rate of 0.5 per 100 000 population (Table 15). The highest rates were reported by Albania (2.0), Romania (1.7), Montenegro (1.1) and Bulgaria (1.0). In the other countries, AIDS rates remained at or below 0.5 per 100 000 population. The rate of new AIDS cases increased by 25%, from 0.4 per 100 000 (762 cases) in 2004 to 0.5 per 100 000 (891 cases) in 2013 (Figure O). At country level trends were

HIV/AIDS surveillance in Europe 2013

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Figure U: Distribution of the three most common AIDS-indicative diseases per transmission mode, Centre, 2013

MSM

Pneumocystis pneumonia Wasting syndrome due to HIV Kaposi's sarcoma Mycobacterium tuberculosis, pulmonary 20

36 36

41 31 13 72 38 31 0 5 10 Percentage 15 20 25

IDU

Wasting syndrome due to HIV Pneumocystis pneumonia Wasting syndrome due to HIV Mycobacterium tuberculosis, pulmonary Pneumocystis pneumonia

MSM: Men having sex with men; IDU: injecting drug use; Hetero: heterosexual transmission

Figure V: New HIV diagnoses, by transmission mode and year of diagnosis, West, 2004–2013 10000

Hetero

Heterosexual, excluding cases originating from countries with generalised HIV epidemics Heterosexual, originating from countries with generalised HIV epidemics Sex between men Injecting drug use Mother-to-child transmission

8000 Number of cases

6000

4000

Other/undetermined

2000

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year of diagnosis Cases from Italy and Spain excluded due to increasing national coverage of reporting during the period. Data are not adjusted for reporting delays and numbers of cases reported for recent years are likely to increase in future reports.

Figure W: Distribution of the three most common AIDS-indicative diseases per transmission mode, West, 2013

MSM

Pneumocystis pneumonia Kaposi's sarcoma Candidiasis, oesophageal Pneumocystis pneumonia 123 114 90 78 484 263 163 0 5 10 15 Percentage 20 25 209

378

IDU

Candidiasis, oesophageal Mycobacterium tuberculosis, pulmonary Pneumocystis pneumonia Candidiasis, oesophageal Mycobacterium tuberculosis, pulmonary

Hetero

MSM: Men having sex with men; IDU: injecting drug use; Hetero: heterosexual transmission

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HIV/AIDS surveillance in Europe 2013

• Transmission mode was unknown for 18% of infections (4 873 cases).

Trends in HIV diagnoses in the West Between 2004 and 2013 in the 23 countries in the West with consistent data, the average rate of newly diagnosed HIV infections declined by 20%, from 7.9 per 100 000 population (26 903 cases) in 2004 to 6.3 (26 847 cases), not taking into account reporting delay for the most recent years. Rates increased in eight and decreased in 15 countries. However, the decreases may be influenced by reporting delays in several countries. The highest rates were reported by Portugal (10.4), Belgium (10.0), Luxembourg (9.9), and the United Kingdom (9.4); and the lowest by Finland (2.9), Austria (3.1), Iceland (3.4), Sweden (3.7) and Denmark (4.2). Since 2004, information on transmission mode in 21 countries (data not included from Italy or Spain) indicates the following (Table 8b, Figure V): • The number of heterosexually acquired infections decreased by 47% (from 12 268 cases in 2004 to 6 493 cases in 2013), with the steepest decline among cases originating from countries with generalised epidemics (see Chapter 1.2 and Figure V). • The number of HIV diagnoses among MSM increased by 26% from 6 760 in 2004 to 8 484 in 2013. • New diagnoses of cases infected through injecting drug use decreased by 47%, from 1 510 in 2004 to 793 in 2013. • Newly diagnosed HIV infections due to mother-to-child transmission decreased by 43% from 303 in 2004 to 172 in 2013. • The number of cases with unknown transmission mode has increased by 49%, with 2 706 cases in 2004 and 4 019 in 2013. The presentation of trends by transmission group largely mirrors the pattern for the EU/EEA as described in Chapter 1.2.

Pneumocystis pneumonia, Kaposi’s sarcoma and oesophageal candidiasis; for people who inject drugs and heterosexually infected cases it was Pneumocystis pneumonia, oesophageal candidiasis and pulmonary tuberculosis (Figure W). In the West, 739 individuals diagnosed with AIDS were reported to have died during 2013 (Table 25), continuing the decreasing trend from 2 837 deaths in 2004 in countries with consistent data (a 74% decrease).

2.5 Number of HIV tests performed The numbers of HIV tests performed annually for diagnostic purposes (i.e. excluding unlinked anonymous tests and screening of blood donations) are presented by country in Table 27. In 2013, 32 countries reported a total of 14 395 148 HIV tests performed. Higher testing rates were generally reported by countries in the East, lower rates by countries in the Centre while data from countries in the West varied considerably. The number of tests increased by 41%, from 10 106 310 in 2004 to 14 244 551 in 2013 in 32 countries with consistent data. The number of tests increased in 27 countries and declined in five. Data on the number of HIV tests can support the interpretation of trends in newly diagnosed HIV infections. The presented data, however, are derived from different sources, ranging from annual reports from national HIV testing sites, to extrapolations from information systematically gathered in laboratory networks performing HIV tests and to estimates based on national surveys. In contrast to the East and the Centre, many countries in the West do not systematically collect data on the number of HIV tests and in some cases only estimates are available. When comparing the reported testing rates across countries, these differences should be kept in mind. Further, the data do not provide detailed information on who is being tested or to what extent testing is targeted at high-risk populations.

2.6 Conclusions HIV infection remains of major public health importance in Europe. In 2013, 136 235 new HIV infections were diagnosed in 51of the 53 countries of the WHO European Region, giving a rate of 15.7 per 100 000 population. Of those, 56 507 were officially reported to ECDC/WHO Regional Office for Europe by 50 countries, while data for 79 728 cases were published by the Russian Federal Scientific and Methodological Center for Prevention and Control of AIDS [1]. The data suggest continuing HIV transmission in many countries and that HIV remains concentrated in key populations at higher risk, such as MSM, people from countries with generalised epidemics and other migrants, and people who inject drugs and their sexual partners. At the same time, cases among people

AIDS cases, morbidity and mortality in the West For 2013, 3 606 AIDS diagnoses were reported by 20 of the 23 countries in the West 11, giving a rate of 0.9 per 100 000 population (Table 15). Between 2004 and 2013, the rate of new AIDS cases decreased by 64%, from 2.5 (8 915 cases) in 2004 to 0.9 (3 606 cases) in 2013 for countries consistently reporting. The most common AIDS-indicative diseases diagnosed in the West in 2013 were Pneumocystis pneumonia (23%) and oesophageal candidiasis (11%) (Table 24). By transmission mode, the most common AIDS-indicative diseases for men infected through sex with men were

11 No data available from Finland, Italy and Sweden.

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originating from countries with generalised HIV epidemics appear to be decreasing. People infected through heterosexual transmission in the East are increasingly affected. Predominant transmission modes and trends over time vary by country and geographical/ epidemiological area, illustrating the diversity of HIV epidemiology in Europe. Recent increases of HIV among PWID in the EU/EEA indicate that even low numbers of infections can rapidly evolve into an outbreak when public health interventions are insufficient. In the western part of the Region, the highest proportion of HIV infections continues to be diagnosed in MSM. HIV responses in this part of Europe need to be based on evidence-informed prevention interventions targeting this key population. In addition, given the relatively high numbers of HIV diagnoses among people originating from countries with generalised epidemics, countries should ensure equal access to prevention, testing, treatment and care services for migrant populations. In the Centre, levels of HIV infection remain at a relatively low level. However, the relative increase in new diagnoses is by far the highest in this part of the Region. The epidemic in this part of Europe is diverse but sexual transmission between men dominates over heterosexual transmission in the majority of countries and recent increasing trends are mostly driven by increasing numbers of diagnosed infections acquired through sex between men. In the East, the number and rate of newly diagnosed HIV infections is the highest in the Region and the number of cases continues to increase. Heterosexual contact, followed by injecting drug use, is the dominant reported mode of transmission (both including and not including Russia). The amount of independent versus PWID-related heterosexual transmission remains unclear as data on the probable source of infection is missing for the majority of heterosexually acquired cases. Information about probable country of infection is poorly reported too, leaving insufficient evidence regarding the extent to which people become infected in their home country or abroad, including during periods of labour migration to neighbouring countries. While men remain disproportionally affected by the epidemic, the maleto-female ratio is lower in the East than in other parts of the Region and women account for more than 40% of new infections overall and for the majority of new cases acquired through heterosexual transmission. HIV transmission from male PWID and males with other high risk behaviours to their female partners likely contributes to this epidemic pattern. Curbing the HIV epidemic in the East will not be possible without implementation of more comprehensive prevention strategies for people who inject drugs, including harm reduction interventions. In couples where one of the partners is engaged in high-risk behaviour, such as injecting drug use, prevention interventions should address the risk of heterosexual transmission [2].

It is a major concern that 49% of newly diagnosed HIV infections with information on CD4 cell counts have a low count (<350/mm3) at the time of diagnosis, including 27% with an even lower count of CD4 <200/mm3. These so-called late presenters reflect the low access to, and uptake of, HIV testing and counselling by those most at risk. Delayed initiation of antiretroviral treatment decreases the clinical benefits, as well as the impact of treatment on preventing further HIV transmission. HIV counselling and testing strategies need to be reconsidered, including through innovative approaches and services such as routine offers of counselling and testing in clinical settings, rapid testing and community-based testing to reach people that are at higher risk and ensure earlier diagnosis and initiation of HIV treatment and linkage to care. This will result in improved treatment outcomes and clinical benefits, as well as contribute to preventing or reducing further HIV transmission. The number of diagnosed AIDS cases continues to decline throughout Europe, except in the East. The high and increasing number of AIDS cases in the countries in the East is indicative of late HIV diagnosis, low treatment coverage and delayed initiation of life-saving HIV treatment. The wide availability of treatment broadens the perspectives of HIV surveillance to include monitoring of access to care and treatment in the future. Improved access to and earlier initiation of treatment, particularly for key populations, is needed throughout Europe but particularly in the East. The number of countries conducting enhanced surveillance for HIV in Europe has increased over recent years. Enhanced HIV surveillance in Europe is essential to provide the strategic information for monitoring the epidemic and guiding the public health response to HIV. Interventions to control the epidemic need to be based on evidence and adapted to national and local epidemiology. In order to achieve this aim, surveillance data should be of high quality and provide complete case reports with information about key variables such as transmission mode, CD4 cell count and probable country and source of infection.

References 1 Russian Federal Scientiﬁc and Methodological Center for Prevention and Control of AIDS. HIV-infection Bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014. World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2014.

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HIV/AIDS surveillance in Europe 2013

Tables

HIV/AIDS surveillance in Europe 2013

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Table 1: HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of start of reporting 1980 1985 1986 1985 1986 1985 1990 1988 1980 2003 1993 1983 1985 1983 1981 2004 1987 1988 1983 2001 1980 1984 1985 1983 1987 1985 1985 2003 1983 1981 2004 N 338 1 004 50 53 25 72 306 743 124 5 774 2 224 493 75 4 358 1 666 323 135 68 16 1 183 251 669 2 201 245 15 24 1 687 437 7 696 28 259 32 1 49 101 786 10 1 157 318 694 161 360 2 2 3 103 749 198 201 0 10 218 2 055 16 201 26 903 1 577 15 980 44 460 Rate 4.2 9.7 0.6 1.2 3.5 0.7 5.7 54.4 2.4 9.3 2.7 4.5 0.7 1.4 8.9 8.7 14.2 4.0 15.0 4.0 7.3 5.5 1.8 21.3 1.1 0.3 1.2 9.7 4.9 13.0 6.5 1 1.4 1.5 1.2 8 0.3 0 3.6 4.9 4.7 3.2 10 6.1 0.3 10.3 1.4 10.2 3 0.3 0.0 21.5 8 7.1 7.9 0.8 11.7 6.7 2005 N 324 1 070 83 68 43 90 264 621 134 5 985 2 508 537 106 8 325 1 490 299 120 53 15 1 221 219 707 2 026 228 21 38 1 648 396 7 888 28 535 33 6 75 206 800 13 1 237 355 958 171 533 0 9 4 103 724 189 271 0 11 464 2 159 18 311 27 200 1 814 17 832 46 846 Rate 4.0 10.2 1.1 1.6 5.9 0.9 4.9 45.7 2.6 9.5 3.1 4.8 1.1 2.7 7.9 7.6 13.3 3.6 11.5 3.7 7.5 4.8 1.9 19.6 1.1 0.4 1.9 9.3 4.4 13.2 6.6 1.1 7.8 2.3 2.5 8.2 0.3 0 5.5 5.4 6.4 3.4 12.8 0 1.4 13.5 1.4 9.8 2.8 0.4 0.0 24.3 8.3 7.9 8 1 13 7 2006 N 328 1 018 91 57 35 91 245 668 191 5 698 2 666 503 81 11 353 2 017 299 100 53 24 1 129 276 818 2 057 187 27 33 1 779 397 7 437 28 669 32 1 67 239 818 11 8 276 336 1 729 244 621 1 5 2 88 760 204 276 0 13 456 2 205 21 379 27 282 1 840 20 926 50 048 Rate 4.0 9.7 1.2 1.3 4.7 0.9 4.5 49.5 3.6 9.0 3.2 4.5 0.8 3.7 8.4 8.4 13.4 3.0 11.3 5.9 6.9 5.9 2.1 19.9 0.9 0.5 1.6 9.9 4.4 12.4 6.5 1 1.3 2.1 2.8 8.5 0.3 0.4 6.3 5 11.4 4.8 15 3 0.8 6.7 1.2 10.2 2.9 0.4 0.0 28.8 8.4 9.2 7.8 1 15.3 7.4 2007 N 345 1 072 126 49 46 121 306 633 187 5 680 2 800 555 119 13 391 2 206 350 106 44 14 1 232 248 802 1 963 173 39 37 2 747 488 7 344 30 236 46 5 107 437 991 4 5 340 365 1 973 409 731 1 11 0 91 757 305 348 0 13 469 3 169 23 564 28 763 2 017 23 020 53 800 Rate 4.2 10.1 1.7 1.1 6.1 1.2 5.6 47.1 3.5 8.9 3.4 5.0 1.2 4.2 9.0 7.1 15.8 3.3 9.2 3.5 7.5 5.3 2.1 19.0 0.8 0.7 1.8 11.3 5.4 12.1 6.7 1.5 6.2 3.3 5.1 10.3 0.1 0.2 7.8 5.3 12.8 8 17.8 3 1.8 0 1.2 10.1 4.3 0.5 0.0 29 11.9 10.2 7.9 1.1 16.7 7.8 2008 N 359 1 092 123 71 37 148 285 545 147 5 764 2 850 609 145 10 404 2 463 358 95 59 28 1 307 299 841 2 050 259 53 48 3 310 426 7 220 31 405 54 3 136 433 900 9 4 353 394 2 321 553 793 0 11 4 118 766 331 395 0 15 544 3 061 26 183 29 849 2 316 25 423 57 588 Rate 4.3 10.2 1.6 1.7 4.8 1.4 5.2 40.7 2.8 9.0 3.5 5.4 1.5 3.2 9.1 6.6 16.3 3.0 12.2 6.9 8.0 6.3 2.2 19.8 1.3 1.0 2.4 11.8 4.6 11.8 6.8 1.7 3.6 4.2 5 9.4 0.2 0.2 8.1 5.5 14.9 10.6 19.3 0 1.8 12.5 1.6 10.1 4.5 0.6 0.0 33.7 11.3 11.2 8 1.2 18.4 8.2

EU/EEA West Austria West Belgium Centre Bulgaria Centre Croatia Centre Cyprus Centre Czech Republic West Denmark East Estonia West Finland West France West Germany West Greece Centre Hungary West Iceland West Ireland West Italy East Latvia East Lithuania West Luxembourg West Malta West Netherlands West Norway Centre Poland West Portugal Centre Romania Centre Slovakia Centre Slovenia West Spain West Sweden West United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Centre former Yugoslav Republic of Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia*** West San Marino Centre Serbia**** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

1993 2004 1988 1987 1981 1986 1993 1989 1981 1987 1987 1987 1985 1989 2010 1985 1984 1985 1991 1985 1990 1987 1981

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about new and cumulative HIV diagnoses were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 33 407 (2004), 35 401 (2005), 39 312 (2006), 45 099 (2007), 54 799 (2008), 58 142 (2009), 58 305 (2010), 62 385 (2011), 70 744 (2012), 79 728 (2013), 800 531 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014. **** Excluding a cumulative 89 cases from Kosovo, including 3 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

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HIV/AIDS surveillance in Europe 2013

2009 N 308 1 132 171 54 38 156 236 411 172 5 450 2 885 600 140 15 395 3 797 275 180 57 19 1 195 282 956 1 864 253 53 48 3 430 431 6 630 31 633 63 2 149 455 1 069 6 6 385 387 2 078 696 704 0 14 1 132 656 418 470 0 16 268 4 055 28 014 29 944 2 560 27 143 59 647 Rate 3.7 10.5 2.3 1.3 4.8 1.5 4.3 30.8 3.2 8.5 3.5 5.4 1.4 4.7 8.7 6.6 12.7 5.7 11.6 4.6 7.2 5.9 2.5 18.0 1.3 1.0 2.4 10.5 4.7 10.8 6.4 2 2.4 4.6 5.1 11.2 0.2 0.3 8.9 5.3 13.2 13.2 17.2 0 2.2 3.2 1.8 8.5 5.6 0.7 0.0 35.4 14.8 11.9 7.5 1.4 19.6 8.2

2010 N 321 1 199 163 70 41 180 275 376 184 5 538 2 723 634 182 24 330 3 980 274 153 52 18 1 187 258 956 1 824 274 28 35 3 666 457 6 329 31 731 44 5 149 459 1 068 7 5 456 425 1 987 567 703 0 15 62 581 6 148 604 1 052 523 0 16 617 3 795 91 216 30 039 2 671 90 237 122 947 Rate 3.8 11.1 2.2 1.6 5.0 1.7 5.0 28.2 3.4 8.6 3.3 5.7 1.8 7.6 7.3 6.7 12.9 4.9 10.4 4.3 7.2 5.3 2.5 17.6 1.4 0.5 1.7 11.2 4.9 10.2 6.4 1.4 5.9 4.6 5.1 11.3 0.2 0.2 10.4 5.7 12.5 10.6 17.2 0 2.4 44.1 19.2 2 7.8 13.8 0.7 0.0 36.3 13.7 24 7.4 1.4 32.1 14.1

2011 N 314 1 183 201 77 54 153 266 366 172 5 414 2 702 946 162 23 327 3 838 299 166 52 21 1 129 269 1 115 1 613 427 49 55 3 390 391 6 165 31 339 75 2 182 548 1 159 27 1 427 453 1 999 614 721 0 9 8 127 557 955 653 0 17 305 25 822 29 235 3 185 24 741 57 161 Rate 3.7 10.8 2.7 1.8 6.4 1.5 4.8 27.5 3.2 8.3 3.3 8.5 1.7 7.2 7.2 6.5 14.4 5.4 10.2 5.1 6.8 5.5 2.9 15.6 2.1 0.9 2.7 10.3 4.2 9.9 6.3 2.6 2.6 5.6 6 12.4 0.7 0 9.7 6 12.4 11.4 17.7 0 1.5 25.1 1.8 7.1 12.2 0.9 0.0 37.9 12.2 7.2 1.7 22.2 8.1

2012 N 320 1 229 157 74 58 212 201 315 156 5 660 2 975 1 133 219 19 351 4 098 339 160 58 30 1 036 242 1 095 1 542 489 50 45 3 611 381 6 238 32 493 82 2 227 517 1 229 25 15 528 487 2 011 701 757 0 14 5 128 622 865 1 068 0 16 847 26 130 30 396 3 731 24 496 58 623 Rate 3.8 11.1 2.1 1.8 6.7 2.0 3.6 23.8 2.9 8.7 3.6 10.2 2.2 5.9 7.7 6.9 16.6 5.3 11.1 7.2 6.2 4.9 2.8 14.6 2.4 0.9 2.2 9.5 4.0 9.8 6.5 2.9 2.6 6.9 5.6 13 0.7 0.7 11.9 6.4 12.4 12.8 18.5 0 2.3 15 1.8 7.8 10.8 1.4 0.0 37.1 12.3 7.4 2 21.9 8.2

2013 N 260 1 115 200 85 54 235 233 325 157 4 002 3 263 807 240 11 332 3 608 340 177 53 36 949 233 1 089 1 093 507 83 44 3 278 354 5 994 29 157 117 5 238 514 1 377 27 15 474 490 2 140 503 706 0 10 0 147 574 825 1 313 17 875 27 350 26 847 4 166 25 494 56 507 Rate 3.1 10.0 2.7 2.0 6.2 2.2 4.2 24.6 2.9 6.1 4.0 7.3 2.4 3.4 7.2 6.0 16.8 6.0 9.9 8.5 5.7 4.6 2.8 10.4 2.5 1.5 2.1 7.0 3.7 9.4 5.7 4.1 6.6 7.3 5.5 14.6 0.7 0.7 10.7 6.3 13 9.1 17.3 0 1.6 0 2 7.1 10.1 1.7 39.4 12.8 6.3 2.2 22.7 7.8

Cumulative Country* total**

EU/EEA 7 942 26 850 1 830 1 111 847 2 122 6 572 8 702 3 218 60 047 48 891 13 627 2 574 310 6 976 29 163 5 867 2 237 1 251 223 22 044 5 370 17 662 47 390 6 077 539 633 29 987 10 787 133 606 504 455 701 68 1 619 4 298 15 711 250 71 4 131 8 008 21 870 5 113 8 540 34 153 62 581 81 3 001 33 946 5 461 6 763 2 203 899 24 057 410 358 496 391 44 334 374 088 914 813 Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Moldova Monaco Montenegro Russia San Marino Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

HIV/AIDS surveillance in Europe 2013

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Table 1a: HIV diagnoses and rates per 100 000 population, by country and year of statistics (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* 2004 N 338 1 004 50 53 25 72 306 743 124 5 774 2 224 441 75 4 358 1 666 323 135 60 16 1 183 251 670 2 201 245 15 24 1 687 429 7 696 28 192 32 31 49 101 778 16 1 163 318 694 161 360 2 2 3 103 749 198 165 0 10 218 2 016 16 160 26 865 1 548 15 939 44 352 2005 N 324 1 070 83 68 43 90 264 621 134 5 985 2 508 565 106 8 325 1 490 299 120 63 15 1 221 219 703 2 026 228 21 38 1 648 388 7 888 28 561 30 10 75 206 751 13 1 242 355 958 171 533 0 9 4 103 724 189 298 0 11 464 2 198 18 334 27 234 1 834 17 827 46 895 2006 N 328 1 018 91 57 35 91 245 668 191 5 698 2 666 573 81 11 353 2 017 299 100 57 22 1 129 276 810 2 057 187 27 33 1 779 385 7 437 28 721 32 1 66 239 733 17 8 276 336 1 729 244 621 1 5 2 88 760 204 260 0 13 456 2 205 21 283 27 342 1 822 20 840 50 004 2007 N 345 1 072 126 49 46 121 306 633 187 5 680 2 800 521 119 13 391 2 206 350 106 47 16 1 232 248 804 1 963 173 39 37 2 747 528 7 344 30 249 44 3 109 437 990 4 5 344 365 1 973 409 731 1 11 0 91 757 305 399 0 13 469 3 169 23 616 28 772 2 068 23 025 53 865 2008 N 359 1 092 123 71 37 148 285 545 147 5 764 2 850 659 145 10 404 2 463 358 95 68 28 1 307 299 840 2 050 259 53 48 3 310 441 7 220 31 478 49 4 136 433 881 9 4 351 394 2 321 551 793 0 11 4 118 766 331 393 0 15 544 3 061 26 154 29 924 2 308 25 400 57 632

Rate 4.2 9.7 0.6 1.2 3.5 0.7 5.7 54.4 2.4 9.3 2.7 4.0 0.7 1.4 8.9 8.7 14.2 4.0 13.2 4.0 7.3 5.5 1.8 21.3 1.1 0.3 1.2 9.7 4.8 13.0 6.5 1.0 42.9 1.5 1.2 7.9 0.4 0.0 3.8 4.9 4.7 3.2 10.0 6.1 0.3 10.3 1.4 10.2 3.0 0.2 0.0 21.5 7.8 7.0 7.9 0.8 11.7 6.7

Rate 4.0 10.2 1.1 1.6 5.9 0.9 4.9 45.7 2.6 9.5 3.1 5.1 1.1 2.7 7.9 7.6 13.3 3.6 13.7 3.7 7.5 4.8 1.8 19.6 1.1 0.4 1.9 9.3 4.3 13.2 6.6 1.0 13.0 2.3 2.5 7.7 0.3 0.0 5.6 5.4 6.4 3.4 12.8 0.0 1.4 13.5 1.4 9.8 2.8 0.4 0.0 24.3 8.4 7.9 8.0 1.0 13.0 7.1

Rate 4.0 9.7 1.2 1.3 4.7 0.9 4.5 49.5 3.6 9.0 3.2 5.2 0.8 3.7 8.4 8.4 13.4 3.0 12.2 5.4 6.9 5.9 2.1 19.9 0.9 0.5 1.6 9.9 4.3 12.4 6.5 1.0 1.3 2.1 2.8 7.6 0.4 0.4 6.3 5.0 11.4 4.8 15.0 3.0 0.8 6.7 1.2 10.2 2.9 0.4 0.0 28.8 8.4 9.1 7.8 1.0 15.2 7.4

Rate 4.2 10.1 1.7 1.1 6.1 1.2 5.6 47.1 3.5 8.9 3.4 4.7 1.2 4.2 9.0 7.1 15.8 3.3 9.9 3.9 7.5 5.3 2.1 19.0 0.8 0.7 1.8 11.3 5.8 12.1 6.7 1.4 3.7 3.4 5.1 10.3 0.1 0.2 7.9 5.3 12.8 8.0 17.8 3.0 1.8 0.0 1.2 10.1 4.3 0.6 0.0 29.0 11.9 10.2 7.9 1.1 16.8 7.8

Rate 4.3 10.2 1.6 1.7 4.8 1.4 5.2 40.7 2.8 9.0 3.5 5.9 1.5 3.2 9.1 6.6 16.3 3.0 14.1 6.9 8.0 6.3 2.2 19.8 1.3 1.0 2.4 11.8 4.8 11.8 6.8 1.5 4.8 4.2 5.0 9.2 0.2 0.2 8.1 5.5 14.9 10.6 19.3 0.0 1.8 12.5 1.6 10.1 4.5 0.6 0.0 33.7 11.3 11.2 8.0 1.2 18.4 8.2

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about new and cumulative HIV diagnoses were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 33 407 (2004), 35 401 (2005), 39 312 (2006), 45 099 (2007), 54 799 (2008), 58 142 (2009), 58 305 (2010), 62 385 (2011), 70 744 (2012), 79 728 (2013), 800 531 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 89 cases from Kosovo, including 3 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

2009 N 308 1 132 171 54 38 156 236 411 172 5 450 2 885 611 141 15 395 3 797 275 180 64 18 1 195 282 958 1 864 253 53 48 3 430 485 6 630 31 707 62 2 149 455 1 072 7 6 385 387 2 078 687 704 0 14 1 132 656 418 470 0 16 268 4 041 27 994 30 015 2 563 27 123 59 701

Rate 3.7 10.5 2.3 1.3 4.8 1.5 4.3 30.8 3.2 8.5 3.5 5.5 1.4 4.7 8.7 6.6 12.7 5.7 13.0 4.4 7.2 5.9 2.5 18.0 1.3 1.0 2.4 10.5 5.2 10.8 6.5 1.9 2.4 4.6 5.1 11.2 0.2 0.3 8.9 5.3 13.2 13.0 17.2 0.0 2.2 3.2 1.8 8.5 5.6 0.7 0.0 35.4 14.8 11.9 7.5 1.4 19.6 8.2

2010 N 321 1 199 163 70 41 180 275 372 184 5 538 2 723 612 182 24 330 3 980 274 153 63 19 1 187 258 955 1 824 274 28 35 3 666 493 6 329 31 752 48 6 148 459 1 069 7 5 455 425 1 987 570 703 0 15 62 581 6 148 604 1 004 489 0 16 617 3 809 91 155 30 066 2 640 90 201 122 907

Rate 3.8 11.1 2.2 1.6 5.0 1.7 5.0 27.9 3.4 8.6 3.3 5.5 1.8 7.6 7.3 6.7 12.9 4.9 12.5 4.6 7.2 5.3 2.5 17.6 1.4 0.5 1.7 11.2 5.3 10.2 6.4 1.5 7.1 4.6 5.1 11.3 0.2 0.2 10.4 5.7 12.5 10.7 17.2 0.0 2.4 44.1 19.2 2.0 7.8 13.2 0.7 0.0 36.3 13.7 24.0 7.4 1.4 32.1 14.1

2011 N 314 1 183 201 77 54 153 266 370 172 5 414 2 703 966 162 23 326 3 838 299 166 73 21 1 129 269 1 118 1 613 427 49 55 3 390 461 6 165 31 457 72 2 182 548 1 196 28 1 424 453 1 999 598 721 0 9 8 127 557 989 699 0 17 305 25 918 29 346 3 232 24 797 57 375

Rate 3.7 10.8 2.7 1.8 6.4 1.5 4.8 27.8 3.2 8.3 3.3 8.7 1.7 7.2 7.1 6.5 14.4 5.4 14.3 5.1 6.8 5.5 2.9 15.6 2.1 0.9 2.7 10.3 4.9 9.9 6.4 2.5 2.6 5.6 6.0 12.8 0.7 0.0 9.6 6.0 12.4 11.1 17.7 0.0 1.5 25.1 1.8 7.1 12.7 0.9 0.0 37.9 12.3 7.2 1.7 22.2 8.1

2012 N 320 1 229 157 74 58 212 201 315 156 5 660 2 976 1 188 219 19 341 4 098 339 160 83 30 1 036 242 1 095 1 542 489 50 45 3 611 441 6 238 32 624 90 2 228 517 1 223 25 14 526 487 2 011 724 757 0 14 5 128 622 828 1 068 0 16 847 26 116 30 527 3 738 24 475 58 740

Rate 3.8 11.1 2.1 1.8 6.7 2.0 3.6 23.8 2.9 8.7 3.6 10.7 2.2 5.9 7.4 6.9 16.6 5.3 15.8 7.2 6.2 4.9 2.8 14.6 2.4 0.9 2.2 9.5 4.7 9.8 6.5 3.2 2.6 7.0 5.6 12.9 0.7 0.7 11.9 6.4 12.4 13.2 18.5 0.0 2.3 15.0 1.8 7.8 10.3 1.4 0.0 37.1 12.3 7.4 2.0 21.8 8.2

2013 N 260 1 115 200 85 54 235 233 325 157 4 002 3 263 920 240 11 343 3 608 340 177 82 36 949 233 1 090 1 093 507 83 44 3 278 458 5 994 29 415 124 7 238 514 1 533 27 16 490 490 2 140 504 706 0 10 0 147 574 876 1 313 17 875 27 584 27 106 4 175 25 718 56 999

Rate 3.1 10.0 2.7 2.0 6.2 2.2 4.2 24.6 2.9 6.1 4.0 8.3 2.4 3.4 7.5 6.0 16.8 6.0 15.3 8.5 5.7 4.6 2.8 10.4 2.5 1.5 2.1 7.0 4.8 9.4 5.7 4.4 9.2 7.3 5.5 16.2 0.7 0.8 11.0 6.3 13.0 9.1 17.3 0.0 1.6 0.0 0.0 2.0 7.1 10.7 1.7 39.4 12.9 6.4 2.2 22.9 7.8

Cumulative Country* total**

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 2: HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* 2004 N 231 588 33 48 13 55 230 497 101 3 395 1 740 392 63 4 194 1 161 207 114 45 12 884 148 477 1 475 132 13 21 1 264 252 4 439 18 228 21 0 36 80 477 8 1 119 216 469 125 199 2 2 3 83 477 164 133 0 6 078 1 687 10 380 17 253 1 103 10 252 28 608 2005 N 235 622 56 58 28 70 193 391 95 3 689 1 988 408 80 5 188 1 067 193 90 30 9 931 122 513 1 401 108 15 35 1 257 229 4 662 18 768 23 5 60 172 432 8 0 171 226 692 122 316 0 9 2 87 478 172 179 0 6 756 1 715 11 625 17 842 1 269 11 282 30 393 2006 N 248 674 71 48 21 71 174 429 134 3 573 2 138 399 49 8 221 1 478 185 78 38 16 907 179 615 1 392 96 20 30 1 382 243 4 487 19 404 21 0 42 213 453 9 2 199 218 1 278 181 369 1 5 2 73 498 155 193 0 7 890 1 683 13 485 18 410 1 324 13 155 32 889 2007 N 266 662 105 44 31 97 224 374 136 3 665 2 324 466 88 6 242 1 597 224 74 33 8 994 166 570 1 312 88 32 35 2 169 304 4 694 21 030 33 5 75 380 529 4 2 242 247 1 391 287 422 1 10 0 75 524 241 248 0 8 201 2 087 15 004 20 045 1 462 14 527 36 034 2008 N 275 745 102 68 24 121 204 315 105 3 744 2 357 506 110 7 258 1 798 231 65 48 17 1 107 182 616 1 410 148 48 45 2 615 267 4 591 22 129 34 3 104 350 467 7 3 251 251 1 642 309 438 0 8 2 98 553 184 273 0 8 644 1 830 15 451 21 045 1 705 14 830 37 580

Rate 5.8 11.6 0.9 2.3 3.7 1.1 8.6 78.2 4.0 11.3 4.3 7.2 1.3 2.8 9.7 12.5 19.8 7.2 20.0 6.1 11.0 6.5 2.6 29.5 1.3 0.5 2.1 14.8 5.7 15.2 8.6 1.4 0.0 2.3 2.0 10.3 0.4 0.1 5.8 6.8 6.6 5.0 11.5 12.6 0.7 20.9 2.3 13.2 4.9 0.4 0.0 27.7 13.1 9.3 10.4 1.2 15.8 8.8

Rate 5.9 12.2 1.5 2.8 7.8 1.4 7.2 61.9 3.7 12.1 5.0 7.5 1.7 3.4 9.2 11.3 18.7 5.8 13.2 4.5 11.5 5.3 2.8 28.0 1.0 0.6 3.6 14.5 5.1 15.9 8.9 1.5 12.5 3.9 4.2 9.4 0.4 0.0 8.4 6.9 9.6 4.9 15.6 0.0 2.9 13.7 2.4 13.2 5.0 0.5 0.0 31.1 13.2 10.4 10.7 1.4 17.3 9.4

Rate 6.2 13.1 1.9 2.3 5.8 1.4 6.5 68.3 5.2 11.7 5.3 7.3 1.0 5.3 10.5 12.6 18.1 5.1 16.4 8.0 11.2 7.8 3.3 27.8 0.9 0.8 3.1 15.7 5.4 15.2 9.0 1.3 0.0 2.7 5.1 10.0 0.5 0.2 9.6 6.5 17.4 7.2 18.3 6.2 1.6 13.6 2.0 13.6 4.4 0.5 0.0 36.6 12.8 11.9 10.8 1.4 20.1 10.0

Rate 6.6 12.8 2.8 2.1 8.3 1.9 8.3 59.9 5.3 11.9 5.8 8.5 1.9 3.8 11.1 10.6 22.1 4.9 14.0 4.0 12.3 7.1 3.1 26.2 0.9 1.2 3.5 18.2 6.7 15.8 9.5 2.1 11.8 4.8 9.0 11.7 0.2 0.2 11.7 7.2 18.8 11.3 21.0 6.2 3.3 0.0 2.1 14.2 6.7 0.7 0.0 38.3 15.7 13.3 11.3 1.6 22.1 10.8

Rate 6.8 14.3 2.8 3.3 6.3 2.4 7.5 50.6 4.0 12.1 5.9 9.2 2.3 4.4 11.6 10.0 22.9 4.4 20.0 8.4 13.6 7.7 3.3 28.1 1.5 1.8 4.6 19.0 5.9 15.3 9.7 2.1 6.9 6.7 8.2 10.4 0.4 0.3 12.1 7.2 21.9 12.0 22.2 0.0 2.6 12.2 2.7 14.8 5.0 0.8 0.0 40.6 13.6 13.6 11.5 1.9 22.5 11.0

EU/EEA West Austria West Belgium Centre Bulgaria Centre Croatia Centre Cyprus Centre Czech Republic West Denmark East Estonia West Finland West France West Germany West Greece Centre Hungary West Iceland West Ireland West Italy East Latvia East Lithuania West Luxembourg West Malta West Netherlands West Norway Centre Poland West Portugal Centre Romania Centre Slovakia Centre Slovenia West Spain West Sweden West United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Centre former Yugoslav Republic of Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia*** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 61 cases from Kosovo, including 2 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

2009 N 240 748 133 48 26 130 179 243 106 3 590 2 404 507 107 6 258 2 862 170 131 41 10 991 183 730 1 273 144 48 40 2 731 281 4 453 22 813 44 2 96 377 551 6 6 276 267 1 393 514 400 0 12 1 122 470 327 344 0 9 096 2 248 16 552 21 603 1 940 15 822 39 365

Rate 5.9 14.2 3.7 2.3 6.7 2.5 6.6 39.1 4.1 11.5 6.0 9.2 2.3 3.7 11.5 10.2 17.1 8.9 16.7 4.9 12.1 7.6 4.0 25.4 1.5 1.8 4.0 16.9 6.1 14.7 9.5 2.8 4.5 6.1 8.7 12.3 0.3 0.6 13.3 7.4 18.4 19.8 20.1 0.0 3.9 6.5 3.4 12.4 8.7 1.0 0.0 42.9 16.5 14.4 11.0 2.1 23.9 11.1

2010 N 259 794 132 67 34 159 201 230 130 3 650 2 308 556 142 17 241 3 002 170 125 36 16 997 173 714 1 239 179 25 31 2 998 277 4 306 23 208 30 5 98 365 566 7 5 323 289 1 254 399 341 0 15 36 172 6 132 443 850 384 0 9 524 2 062 53 270 21 943 2 056 52 479 76 478

Rate 6.3 14.9 3.7 3.3 8.5 3.1 7.3 37.0 5.0 11.7 5.8 10.1 3.0 10.6 10.7 10.5 17.5 8.6 14.4 7.8 12.2 7.1 3.9 24.8 1.8 1.0 3.1 18.6 6.0 14.1 9.6 1.9 11.4 6.2 8.2 12.8 0.4 0.5 15.4 7.9 16.3 15.2 17.2 0.0 4.9 55.1 39.1 3.7 11.6 22.2 1.1 0.0 45.1 14.9 29.3 11.1 2.2 39.7 18.1

2011 N 244 784 163 66 39 140 192 226 112 3 587 2 270 803 122 12 239 2 890 196 134 38 17 966 190 916 1 122 304 46 48 2 803 245 4 391 23 305 54 2 115 410 594 23 0 303 299 1 208 422 377 0 8 6 110 419 672 485 0 9 470 14 977 21 631 2 524 14 127 38 282

Rate 6.0 14.5 4.5 3.2 9.5 2.7 7.0 36.5 4.2 11.4 5.7 14.7 2.6 7.5 10.5 10.0 20.7 9.5 14.9 8.2 11.7 7.7 4.9 22.5 3.1 1.8 4.7 17.4 5.2 14.2 9.6 3.8 5.0 7.3 9.1 13.5 1.2 0.0 14.3 8.0 15.6 15.8 18.9 0.0 2.6 38.4 3.1 10.8 17.1 1.3 0.0 45.0 14.7 10.9 2.7 26.7 11.1

2012 N 257 836 123 71 49 185 146 209 111 3 813 2 520 960 186 13 253 3 227 218 114 43 23 869 166 915 1 092 359 44 42 3 050 231 4 497 24 622 59 2 157 356 664 23 10 382 355 1 169 406 375 0 13 2 117 463 556 819 0 9 394 15 322 22 929 3 015 14 000 39 944

Rate 6.3 15.3 3.4 3.5 11.7 3.6 5.3 33.8 4.2 12.1 6.3 17.6 3.9 8.1 11.1 11.2 23.3 8.2 16.4 11.1 10.5 6.6 4.9 21.7 3.7 1.7 4.1 16.4 4.9 14.4 10.0 4.1 5.0 9.9 7.8 15.1 1.2 1.0 17.9 9.4 14.9 15.0 19.2 0.0 4.2 12.3 3.3 11.8 13.8 2.2 0.0 44.8 14.8 11.4 3.2 26.4 11.5

2013 N 216 777 161 77 46 211 178 200 102 2 692 2 668 724 189 8 248 2 814 203 125 45 30 830 158 933 773 357 71 39 2 785 223 4 471 22 354 79 4 161 329 714 21 15 356 357 1 204 292 381 0 10 0 135 417 509 1 072 10 082 16 138 20 520 3 416 14 556 38 492

Rate 5.2 14.2 4.5 3.8 10.9 4.1 6.4 32.5 3.8 8.5 6.6 13.4 4.0 5.0 10.9 9.7 21.9 9.1 16.8 14.3 10.0 6.2 5.0 15.5 3.7 2.7 3.8 12.1 4.7 14.2 8.9 5.6 10.3 10.1 7.1 16.2 1.1 1.5 16.7 9.3 15.2 10.7 19.5 0.0 3.2 0.0 3.9 10.5 12.4 2.8 47.8 15.4 9.9 3.6 27.1 10.8

Cumulative Country* total**

EU/EEA 5 958 16 827 1 394 954 596 1 764 4 776 5 864 2 336 38 341 38 786 11 194 1 982 219 3 667 21 896 4 014 1 812 936 160 17 595 3 618 13 499 34 520 3 434 461 551 24 151 7 346 92 873 361 524 489 55 1 132 3 353 9 341 201 50 3 039 5 219 14 734 3 500 4 980 21 129 36 172 63 2 347 21 379 3 923 4 912 1 122 477 16 262 253 779 351 936 32 763 230 604 615 303 Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Moldova Monaco Montenegro Russia San Marino Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 3: HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* 2004 N 107 412 17 5 12 17 76 246 23 2 379 455 98 12 164 505 116 21 23 4 299 103 181 726 113 2 3 423 185 3 256 9 983 11 1 13 21 309 2 0 38 102 225 36 158 0 0 0 20 268 34 68 0 4 140 368 5 814 9 609 463 5 725 15 797 2005 N 88 440 27 10 15 20 71 230 39 2 295 484 128 14 3 137 423 106 30 23 6 290 97 175 625 120 6 3 391 167 3 226 9 689 10 1 15 34 368 5 1 66 128 266 49 217 0 0 2 16 242 17 92 0 4 516 444 6 489 9 306 514 6 358 16 178 2006 N 79 338 20 9 14 20 71 239 57 2 116 505 104 13 3 132 539 114 22 15 8 222 97 174 665 91 7 3 397 152 2 950 9 176 11 1 25 26 365 2 5 77 118 451 63 249 0 0 0 15 254 48 83 0 5 366 522 7 681 8 823 467 7 567 16 857 2007 N 78 403 21 5 15 24 82 259 51 1 995 452 88 10 7 149 609 126 32 11 6 238 82 155 651 85 7 2 578 184 2 650 9 055 13 0 32 57 462 0 1 98 116 582 115 309 0 1 0 16 222 64 100 0 5 038 1 082 8 308 8 652 455 8 256 17 363 2008 N 82 343 21 3 13 27 81 230 42 1 999 469 103 9 3 146 665 127 30 11 11 200 117 153 640 111 5 3 694 158 2 629 9 125 20 0 32 83 433 2 1 102 143 679 182 355 0 3 2 20 203 62 122 0 6 683 1 231 10 358 8 741 513 10 229 19 483

Rate 2.6 7.8 0.4 0.2 3.3 0.3 2.8 33.7 0.9 7.4 1.1 1.8 0.2 0.0 8.1 5.1 9.4 1.2 10.0 2.0 3.6 4.5 0.9 13.7 1.0 0.1 0.3 4.8 4.1 10.8 4.5 0.7 2.9 0.8 0.5 5.9 0.1 0.0 1.7 3.1 2.9 1.4 8.4 0.0 0.0 0.0 0.5 7.1 1.0 0.2 0.0 16.2 2.8 5.0 5.5 0.5 8.1 4.7

Rate 2.1 8.2 0.7 0.5 4.0 0.4 2.6 31.6 1.5 7.1 1.2 2.3 0.3 2.0 6.6 4.2 8.7 1.7 9.9 3.0 3.5 4.2 0.9 11.7 1.1 0.2 0.3 4.4 3.7 10.6 4.4 0.6 2.7 0.9 0.8 7.1 0.3 0.1 2.9 3.8 3.4 1.9 10.1 0.0 0.0 13.2 0.4 6.4 0.5 0.3 0.0 17.8 3.4 5.5 5.4 0.5 8.9 4.8

Rate 1.9 6.3 0.5 0.4 3.7 0.4 2.6 33.1 2.1 6.5 1.2 1.8 0.2 2.0 6.3 4.3 9.5 1.2 6.3 3.9 2.7 4.1 0.9 12.5 0.8 0.3 0.3 4.4 3.3 9.6 4.1 0.7 2.7 1.5 0.6 7.1 0.1 0.5 3.4 3.4 5.7 2.5 11.7 0.0 0.0 0.0 0.4 6.7 1.4 0.2 0.0 21.3 3.9 6.5 5.0 0.5 10.6 4.9

Rate 1.8 7.5 0.5 0.2 3.9 0.5 3.0 36.0 1.9 6.1 1.1 1.6 0.2 4.6 6.9 3.8 10.5 1.8 4.6 2.9 2.9 3.5 0.8 12.2 0.8 0.3 0.2 4.7 4.0 8.6 3.9 0.8 0.0 1.9 1.3 9.0 0.0 0.1 4.3 3.3 7.3 4.4 14.7 0.0 0.3 0.0 0.4 5.8 1.8 0.3 0.0 20.1 8.1 7.1 4.7 0.5 11.5 5.0

Rate 1.9 6.3 0.5 0.1 3.3 0.5 2.9 32.1 1.6 6.1 1.1 1.8 0.2 1.9 6.5 3.5 10.7 1.7 4.5 5.4 2.4 4.9 0.8 12.0 1.1 0.2 0.3 4.9 3.4 8.5 3.8 1.3 0.0 1.9 1.9 8.5 0.1 0.1 4.5 4.0 8.4 6.9 16.6 0.0 0.9 12.8 0.5 5.3 1.7 0.3 0.0 26.8 9.1 8.7 4.6 0.5 14.2 5.4

EU/EEA West Austria West Belgium Centre Bulgaria Centre Croatia Centre Cyprus Centre Czech Republic West Denmark East Estonia West Finland West France West Germany West Greece Centre Hungary West Iceland West Ireland West Italy East Latvia East Lithuania West Luxembourg West Malta West Netherlands West Norway Centre Poland West Portugal Centre Romania Centre Slovakia Centre Slovenia West Spain West Sweden West United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Centre former Yugoslav Republic of Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia*** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 28 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

2009 N 68 381 38 6 12 26 57 168 66 1 840 465 93 15 9 137 935 105 49 16 9 204 99 158 591 109 5 8 699 149 2 177 8 694 19 0 53 78 518 0 0 109 120 685 182 304 0 2 0 10 180 91 126 0 7 003 1 807 11 287 8 295 534 11 152 19 981

Rate 1.6 6.9 1.0 0.3 2.9 0.5 2.1 23.5 2.4 5.5 1.1 1.6 0.3 5.7 6.0 3.1 9.0 2.9 6.4 4.4 2.4 4.1 0.8 11.0 1.0 0.2 0.8 4.2 3.2 7.0 3.5 1.2 0.0 3.2 1.7 10.2 0.0 0.0 4.8 3.3 8.4 6.8 14.5 0.0 0.6 0.0 0.3 4.6 2.5 0.4 0.0 28.3 13.1 9.6 4.1 0.6 15.4 5.4

2010 N 62 403 31 3 7 21 74 146 54 1 877 404 78 9 7 89 974 104 28 16 2 190 85 154 585 95 3 4 668 179 2 023 8 375 14 0 51 94 502 0 0 133 136 733 168 362 0 0 26 409 0 16 160 202 139 0 6 916 1 733 37 768 8 066 496 37 581 46 143

Rate 1.4 7.3 0.8 0.1 1.7 0.4 2.7 20.5 2.0 5.6 1.0 1.4 0.2 4.4 3.9 3.2 9.0 1.7 6.3 1.0 2.3 3.5 0.8 10.9 0.9 0.1 0.4 4.0 3.8 6.4 3.3 0.9 0.0 3.1 2.1 9.9 0.0 0.0 5.8 3.6 8.9 6.2 17.3 0.0 0.0 34.6 0.0 0.4 4.0 5.3 0.4 0.0 28.0 12.4 19.4 3.9 0.5 25.2 10.3

2011 N 70 399 38 11 15 13 74 140 60 1 825 425 143 12 11 88 948 103 32 14 4 163 79 157 491 123 3 7 587 146 1 772 7 953 21 0 67 138 565 4 0 124 153 791 192 344 0 1 2 17 132 283 166 0 7 697 10 697 7 586 588 10 476 18 650

Rate 1.6 7.1 1.0 0.5 3.5 0.2 2.6 19.7 2.2 5.4 1.0 2.5 0.2 6.9 3.8 3.1 9.1 1.9 5.4 1.9 1.9 3.2 0.8 9.2 1.2 0.1 0.7 3.5 3.1 5.6 3.1 1.5 0.0 4.0 3.0 11.3 0.2 0.0 5.4 4.0 9.5 7.0 16.4 0.0 0.3 12.3 0.5 3.3 7.3 0.5 0.0 31.3 10.0 3.7 0.6 17.9 5.2

2012 N 63 392 34 3 9 27 54 106 45 1 826 453 173 14 6 98 871 121 46 15 7 167 76 159 450 130 6 3 561 149 1 740 7 804 23 0 70 161 565 2 4 146 132 842 295 382 0 1 3 11 150 309 249 0 7 301 10 646 7 431 675 10 344 18 450

Rate 1.5 6.9 0.9 0.1 2.0 0.5 1.9 15.0 1.6 5.4 1.1 3.0 0.3 3.8 4.2 2.8 10.9 2.8 5.7 3.3 2.0 3.1 0.8 8.2 1.3 0.2 0.3 3.0 3.1 5.4 3.0 1.6 0.0 4.2 3.5 11.2 0.1 0.4 6.3 3.4 10.0 10.6 18.0 0.0 0.3 17.5 0.3 3.7 7.8 0.7 0.0 29.8 9.8 3.5 0.7 17.5 5.0

2013 N 43 338 39 8 8 24 55 125 55 1 296 593 83 17 3 84 794 137 52 8 6 119 75 143 320 150 12 5 488 130 1 522 6 732 38 1 77 185 663 6 0 118 124 936 211 325 0 0 12 153 316 241 7 793 11 199 6 290 703 10 938 17 931

Rate 1 6 1.0 0.4 1.8 0.4 1.9 17.8 2.0 3.8 1.4 1.5 0.3 1.9 3.6 2.6 12.5 3.2 3.0 2.8 1.4 3.0 0.7 5.8 1.5 0.4 0.5 2.1 2.7 4.7 2.6 2.7 2.7 4.6 3.9 13.1 0.3 0.0 5.1 3.2 11.0 7.5 15.3 0.0 0.0 0.0 0.3 3.8 7.7 0.6 31.6 10.3 2.9 0.7 18.4 4.8

Cumulative Country* total**

EU/EEA 1 976 9 740 436 157 251 358 1 795 2 826 882 21 586 9 323 2 387 276 91 2 106 7 263 1 853 425 315 63 4 449 1 752 3 601 12 860 2 643 78 82 5 830 3 434 40 689 139 527 212 13 487 945 6 370 46 16 1 092 2 673 7 048 1 544 3 542 13 24 26 409 18 654 9 863 1 452 1 849 1 81 422 7 794 153 487 139 121 10 683 143 210 293 014 Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Moldova Monaco Montenegro Russia San Marino Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 4: HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of report 2008 2009 162 367 17 52 9 92 133 0 49 1 488 1 576 323 93 2 105 715 21 9 29 0 851 92 62 402 34 33 34 1 512 119 2 755 11 136 10 3 3 2 6 1 0 6 125 13 0 2 0 6 0 66 265 0 0 0 65 0 573 11 073 509 127 11 709 138 376 28 42 9 107 108 0 43 1 429 1 646 330 87 2 138 1 177 14 9 24 4 765 87 79 381 32 35 29 1 556 122 2 745 11 542 8 1 5 2 10 3 3 7 142 20 0 12 0 7 0 84 251 0 2 0 94 1 652 11 465 555 174 12 194 Cumulative total** 2 851 6 405 324 645 321 1 356 2 661 100 1 019 14 905 22 745 6 307 1 478 105 1 918 9 256 285 157 487 53 12 624 1 721 2 011 7 155 393 344 398 13 493 3 586 59 665 174 768 67 24 37 52 162 79 36 217 1 872 187 19 49 14 62 0 21 886 5 291 0 405 0 967 29 10 476 174 178 8 805 2 261 185 244

2004 90 209 0 27 8 33 147 0 46 1 230 1 079 221 45 2 63 373 7 4 24 3 583 70 35 260 7 12 15 489 78 2 419 7 579 1 0 0 4 1 0 0 6 66 2 0 0 2 0 1 31 170 0 11 0 9 9 313 7 625 225 42 7 892

2005 89 256 4 34 16 53 120 0 32 1 371 1 254 245 56 3 60 363 14 3 9 4 640 56 46 271 15 9 31 545 107 2 638 8 344 0 3 2 0 1 3 0 8 92 3 0 5 0 3 0 43 224 0 25 0 20 10 442 8 382 338 66 8 786

2006 130 299 10 37 7 55 100 0 62 1 360 1 385 247 39 2 89 536 15 9 17 7 666 90 51 330 11 14 25 617 102 2 603 8 915 0 0 2 3 1 5 2 4 77 10 1 2 0 2 0 45 263 0 29 0 35 0 481 8 982 332 82 9 396

2007 130 299 24 30 20 77 142 0 72 1 454 1 568 297 63 0 91 593 15 4 19 0 769 77 38 291 6 25 30 1 226 124 2 831 10 315 1 3 2 3 4 0 3 11 123 10 1 1 6 0 40 270 0 25 0 48 0 551 10 380 388 98 10 866

2010 159 398 32 60 22 129 112 0 48 1 503 1 599 367 126 5 134 1 252 18 7 22 6 765 85 164 422 45 21 28 1 813 115 2 727 12 184 4 3 0 7 14 4 5 26 147 22 0 6 0 11 0 81 246 0 32 0 90 698 11 928 764 190 12 882

2011 155 404 47 49 27 113 113 0 36 1 407 1 481 331 106 0 145 1 267 20 9 27 4 742 97 312 434 78 32 35 1 789 94 2 833 12 187 9 1 4 5 27 12 1 25 152 27 0 5 0 5 4 66 209 0 0 0 143 695 11 725 892 265 12 882

2012 154 396 59 65 31 152 82 1 47 1 586 1 707 319 148 1 176 1 560 18 11 27 8 679 76 342 450 69 28 33 1 882 116 3 031 13 254 8 1 4 12 34 21 7 43 155 24 3 4 0 5 0 84 228 0 0 0 152 785 12 681 1 052 306 14 039

2013 132 415 72 70 35 180 116 6 43 1 068 1 735 288 159 0 152 1 420 27 29 25 16 663 98 260 330 72 58 27 1 678 111 2 943 12 228 10 3 13 11 38 13 13 66 162 40 14 4 0 6 0 94 184 0 187 262 1 120 11 582 1 256 510 13 348

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Centre former Yugoslav Republic of Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia*** West San Marino Centre Serbia**** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about HIV diagnoses in men infected through sex with men were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 133 (2004), 178 (2005), 137 (2006), 203 (2007), 278 (2008), 364 (2009), 357 (2010), 380 (2011), 296 (2012), 371 (2013), 3647 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 8 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Table 5: HIV diagnoses in persons infected through injecting drug use, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of report 2008 2009 36 18 54 1 1 8 13 36 7 142 126 9 2 0 40 211 100 44 5 2 8 12 53 365 4 3 0 275 23 177 1 775 0 0 36 285 190 0 0 198 41 1 475 294 136 0 0 0 10 28 157 0 0 7 009 1 561 11 420 1 538 136 11 521 13 195 31 14 74 0 0 4 14 85 13 128 101 15 0 5 30 272 78 118 0 0 6 11 61 247 7 1 0 291 25 155 1 786 1 0 46 292 212 0 0 224 42 1 230 466 62 0 0 0 10 26 232 1 0 7 105 612 10 561 1 426 159 10 762 12 347 Cumulative total** 1 666 852 428 65 9 94 519 3 883 374 1 609 3 292 1 442 23 52 1 530 2 013 3 043 1 468 139 9 761 604 6 028 17 178 476 12 16 2 846 1 192 5 784 57 407 2 13 504 2 444 6 561 22 2 2 121 1 113 13 094 2 966 2 701 8 4 0 11 963 3 759 2 391 99 0 105 979 11 410 156 167 46 766 8 243 158 565 213 574

2004 72 28 7 2 0 7 13 247 10 195 131 14 2 0 74 192 147 101 3 1 13 15 213 608 1 0 0 361 29 155 2 641 0 0 33 45 362 2 0 99 70 463 126 182 0 0 0 15 79 105 3 0 5 778 851 8 213 2 063 252 8 539 10 854

2005 63 14 12 3 1 4 17 192 16 183 140 21 2 0 67 149 115 85 6 0 17 20 158 555 0 0 0 310 20 187 2 357 0 0 46 108 296 2 0 127 61 664 103 228 0 0 0 11 74 142 6 0 6 270 1 120 9 258 1 920 199 9 496 11 615

2006 40 19 34 3 0 5 10 191 10 172 164 12 0 1 59 185 108 62 3 3 15 7 131 474 4 1 0 277 34 192 2 216 0 0 24 172 272 1 1 153 49 1 208 168 236 1 1 0 8 56 99 5 0 7 127 1 454 11 035 1 783 194 11 274 13 251

2007 54 21 43 2 2 12 21 115 12 153 154 12 3 1 55 184 141 59 6 0 13 13 95 393 4 1 0 259 62 174 2 064 0 0 32 316 294 0 0 183 40 1 292 254 224 0 0 0 12 50 138 5 0 7 084 1 816 11 739 1 677 179 11 947 13 803

2010 32 15 56 2 0 5 8 62 8 124 81 24 0 9 23 260 86 107 1 0 6 11 42 221 9 2 0 236 24 148 1 602 0 0 49 272 223 0 0 215 41 1 081 347 59 0 0 0 6 20 556 0 0 6 934 1 850 11 653 1 292 122 11 841 13 255

2011 38 16 63 4 0 9 10 69 8 117 77 309 0 12 17 184 90 86 0 0 6 10 64 137 116 1 0 211 13 130 1 797 0 0 41 319 243 0 0 189 41 903 355 61 0 0 0 9 21 377 5 0 6 588 9 152 1 357 271 9 321 10 949

2012 36 14 40 1 0 6 11 72 7 118 82 513 0 3 13 214 94 63 4 0 7 11 43 134 170 1 1 183 17 113 1 971 1 0 44 215 219 0 0 225 71 774 255 40 0 1 0 5 25 269 6 0 5 933 8 083 1 576 275 8 203 10 054

2013 21 17 33 0 0 6 13 72 3 67 100 248 1 1 18 162 77 62 5 3 5 8 39 78 149 0 2 145 8 112 1 455 0 0 32 203 180 1 0 164 73 719 188 20 0 0 9 13 227 4 5 847 7 680 1 100 244 7 791 9 135

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about HIV diagnoses in people infected through injecting drug use were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 11 191 (2004), 10 988 (2005), 11 893 (2006), 12 429 (2007), 16 689 (2008), 16 009 (2009), 16 308 (2010), 16 937 (2011), 18 029 (2012), 19 875 (2013), 299 923 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 2 cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 6: HIV diagnoses in persons infected through heterosexual contact, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of report 2008 2009 142 401 52 15 22 45 122 3 59 2 478 712 158 17 6 190 1 151 164 28 25 24 359 185 67 1 223 135 8 4 1 226 207 3 911 13 139 40 0 86 100 674 8 3 132 201 682 162 588 0 4 0 28 281 119 274 0 7 880 716 11 978 13 061 722 11 334 25 117 123 421 68 11 27 43 105 17 91 2 250 710 118 23 8 166 1 838 133 36 27 9 343 170 75 1 167 144 9 6 1 218 209 3 269 12 834 47 1 83 116 822 3 2 146 177 750 173 574 0 5 0 23 254 127 218 0 8 541 955 13 017 12 674 704 12 473 25 851 Cumulative total** 2 716 10 495 1 012 335 471 556 2 922 803 1 290 25 383 11 905 2 939 388 100 2 730 13 398 1 486 381 508 120 6 819 2 807 1 264 21 211 2 140 133 104 10 632 4 803 59 493 189 344 569 21 960 1 372 8 605 126 27 1 656 4 097 7 451 1 631 5 082 11 65 23 674 7 133 1 881 3 120 0 91 345 4 730 140 579 191 556 10 984 127 383 329 923

2004 157 472 43 21 17 30 130 0 54 2 851 627 152 13 2 181 779 68 24 39 7 478 163 47 1 273 124 2 4 752 270 4 825 13 605 29 1 15 29 393 7 1 49 161 198 34 169 0 1 0 26 425 14 120 0 4 041 221 5 934 13 799 485 5 255 19 539

2005 152 466 65 26 25 29 110 0 67 2 800 701 175 20 5 172 665 96 20 37 9 462 134 93 1 140 125 12 2 694 208 4 792 13 302 29 2 25 63 456 8 0 81 173 247 58 291 0 4 0 25 364 28 158 0 4 586 364 6 962 13 328 621 6 315 20 264

2006 134 420 46 15 28 25 127 0 93 2 413 697 153 15 7 182 912 87 16 31 10 369 164 76 1 204 99 8 3 750 201 4 329 12 614 25 1 37 41 511 4 5 112 186 334 71 366 0 1 1 24 340 52 153 0 5 646 495 8 405 12 724 527 7 768 21 019

2007 138 439 58 15 21 28 130 0 74 2 315 674 131 15 0 167 1 051 127 27 19 12 371 141 71 1 227 113 12 2 1 045 228 4 010 12 661 36 1 70 77 668 4 2 125 176 504 107 500 0 5 0 23 295 91 295 0 5 736 701 9 416 12 644 700 8 733 22 077

2010 104 436 71 7 15 38 141 71 94 2 186 454 118 18 10 127 1 861 131 28 28 10 339 157 99 1 123 148 4 7 1 226 238 2 994 12 283 38 2 86 130 787 3 0 201 210 819 186 606 0 3 0 35 223 262 202 0 9 122 852 13 767 12 081 688 13 281 26 050

2011 101 438 89 22 23 25 132 56 88 2 022 518 146 19 6 126 1 792 144 32 25 13 292 155 90 1 003 149 12 8 1 062 222 2 814 11 624 63 1 127 188 860 14 0 202 209 1 010 181 613 0 4 4 37 211 356 250 0 10 248 14 578 11 380 805 14 017 26 202

2012 112 457 58 7 23 40 96 127 71 2 106 484 148 23 0 137 1 744 112 48 25 15 282 142 98 925 164 14 4 1 084 198 2 568 11 312 69 1 160 243 949 4 7 243 202 1 138 307 664 0 7 3 27 218 344 376 0 10 440 15 402 11 018 921 14 775 26 714

2013 84 372 70 13 16 44 90 169 67 1 325 593 103 24 0 131 1 605 125 50 19 10 215 123 82 665 192 21 7 933 167 2 134 9 449 99 1 176 267 1 138 12 2 236 182 1 273 276 325 0 1 0 21 212 477 428 11 472 16 598 9 031 1 032 15 984 26 047

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about HIV diagnoses in persons infected through heterosexual transmission were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 5191 (2004), 5653 (2005), 6329 (2006), 7255 (2007), 9910 (2008), 10 526 (2009), 12 230 (2010), 12 785 (2011), 14 038 (2012), 15 604 (2013), 117 389 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 75 cases from Kosovo, including 2 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Table 7: HIV diagnoses in persons infected through mother-to-child transmission, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of report 2008 2009 1 8 0 1 0 0 4 8 1 29 16 1 0 0 7 7 8 0 0 0 19 4 13 15 6 0 0 10 17 107 282 2 0 5 21 0 0 12 16 44 25 17 0 1 0 1 2 4 8 0 217 57 432 264 32 418 714 2 4 1 0 0 0 0 3 2 34 11 0 2 0 5 18 2 0 1 0 17 4 12 15 11 0 0 11 11 120 286 2 0 3 5 9 0 0 4 10 22 16 8 0 0 0 2 4 9 7 0 169 96 366 269 37 346 652 Cumulative total** 54 428 19 13 3 6 96 46 24 388 326 64 11 1 75 136 59 3 7 0 277 76 193 393 243 0 7 86 203 2 399 5 636 28 1 28 65 230 1 2 81 230 243 135 122 1 3 0 1 43 191 144 82 0 3 129 363 5 123 5 457 654 4 648 10 759

2004 0 9 0 0 0 0 5 7 1 37 19 4 0 0 3 30 4 0 0 0 15 1 14 20 10 0 1 3 18 158 359 0 0 1 1 20 0 0 2 9 6 6 0 0 0 3 4 8 0 186 4 250 336 36 237 609

2005 1 8 1 0 1 0 3 4 1 39 24 2 2 0 3 9 2 0 1 0 15 5 7 10 15 0 0 3 12 135 303 0 0 2 3 37 0 1 7 16 9 2 9 0 0 0 1 5 5 0 192 11 300 292 33 278 603

2006 2 6 0 1 0 0 2 4 1 27 20 3 0 2 10 5 0 0 7 6 25 11 11 0 0 4 9 135 291 5 0 4 1 25 1 0 6 13 20 2 14 0 0 0 1 1 3 0 200 31 327 259 46 313 618

2007 4 19 1 1 0 0 7 2 0 38 27 3 2 0 6 4 8 1 0 0 12 9 16 18 5 0 0 10 8 122 323 3 0 3 3 20 0 0 15 11 30 8 7 0 0 0 1 7 7 3 0 230 84 432 305 32 418 755

2010 1 7 4 0 0 0 3 2 1 41 20 3 0 0 9 12 4 0 0 0 21 1 11 17 16 0 0 15 16 106 310 0 0 3 11 27 0 0 13 7 21 19 10 0 0 0 0 7 15 0 0 177 73 383 287 31 375 693

2011 2 10 2 1 0 0 3 2 1 35 16 4 0 0 3 24 2 1 0 0 9 4 7 8 12 0 1 9 13 105 274 3 0 2 9 19 0 0 7 8 18 20 16 0 0 0 1 4 28 4 0 136 275 258 31 260 549

2012 0 8 0 0 1 2 4 4 2 48 20 0 1 0 5 13 7 0 0 0 7 7 4 4 11 0 0 6 8 77 239 2 0 3 14 16 0 0 9 7 30 33 9 0 0 0 0 2 40 12 0 146 323 218 33 311 562

2013 1 5 5 0 0 0 5 2 2 26 21 0 1 0 3 9 10 1 0 0 5 1 4 5 16 0 0 10 3 83 218 6 0 5 10 14 0 0 3 8 36 10 13 0 0 0 4 4 40 11 127 291 191 47 271 509

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about HIV diagnoses in persons infected through mother to child transmission were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 445 (2004), 549 (2005), 581 (2006), 523 (2007), 621 (2008), 557 (2009), 494 (2010), 487 (2011), 446 (2012), 366 (2013), 5964 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 2 cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 8: HIV diagnoses*, by geographical area, sex, transmission group and year of diagnosis (2004–2013) and cumulative totals Table 8a: EU/EEA and non-EU/EEA countries Transmission mode EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total EU/EEA Non-EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total non-EU/EEA Total WHO European Region 2004 Male Unknown 6 682 1 279 4 995 143 36 9 1 685 14 829 293 5 740 2 093 34 8 0 392 8 560 23 389 0 4 12 1 0 0 20 37 0 0 0 186 0 0 7 193 230 2005 Male Unknown 7 388 1 239 4 938 138 42 5 1 790 15 540 407 6 519 2 380 50 5 3 367 9 731 25 271 2 5 20 1 0 0 31 59 0 0 0 192 0 0 5 197 256 2006 Male Unknown 7 701 1 122 4 604 113 38 8 1 914 15 500 451 7 758 2 859 50 9 51 431 11 609 27 109 10 4 13 0 0 0 33 60 1 0 0 200 0 0 12 213 273 2007 Male Unknown 8 438 1 092 4 610 121 32 15 2 012 16 320 524 8 045 3 525 61 4 57 453 12 669 28 989 20 4 20 1 0 29 74 2 3 2 230 0 0 12 249 323

Female 345 7 020 161 53 14 1 035 8 628 1 619 3 500 18 8 0 233 5 378 14 006

Female 304 6 892 141 44 12 1 077 8 470 1 613 4 060 42 13 1 224 5 953 14 423

Female 306 6 259 135 34 11 1 082 7 827 1 818 4 898 43 11 24 282 7 076 14 903

Female 315 5 864 169 30 13 1 063 7 454 1 871 4 893 54 7 35 266 7 126 14 580

Transmission mode EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total EU/EEA Non-EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total non-EU/EEA Total WHO European Region *

Female 282 4 496 105 29 6 1 189 6 107 1 335 8 693 77 7 39 246 10 397 16 504

2012 Male Unknown 9 448 1 177 3 763 107 27 4 2 695 17 221 784 6 742 6 332 88 5 57 495 14 503 31 724 21 0 0 0 0 1 24 46 1 0 1 146 0 0 8 156 202

Female 197 3 618 102 16 9 1 240 5 182 1 241 9 196 63 5 4 378 10 887 16 069

2013 Male Unknown 8 849 840 3 041 90 24 10 2 768 15 622 933 6 435 6 973 90 3 9 550 14 993 30 615 15 0 1 1 0 0 36 53 0 1 127 0 0 29 157 210

Female 9 262 89 877 2 699 1 252 756 16 161 120 007 0 29 404 78 446 693 179 196 7 994 116 912 236 919

Cumulative total** Male Unknown 149 781 32 562 72 832 2 455 3 472 850 34 162 296 114 10 033 114 275 53 850 823 256 284 15 707 195 228 491 342 127 813 538 21 110 1 1 210 2 820 9 979 433 3 162 105 13 2 945 7 646 10 466

Total 149 908 42 637 163 247 5 175 4 834 1 607 51 533 418 941 10 042 144 658 132 729 4 678 540 493 26 646 319 786 738 727

Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Estonia, Poland and Turkey excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 1–7. Cumulative total is the total number of cases reported by country since the start of reporting

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Female 243 5 893 120 25 11 1 091 7 383 1 729 6 860 70 3 38 305 9 005 16 388

2008 Male Unknown 8 825 955 4 779 124 23 9 2 070 16 785 573 8 040 4 098 76 6 36 520 13 349 30 134 22 2 20 0 1 0 33 78 0 90 30 221 0 12 16 369 447

Female 230 5 272 140 18 9 1 065 6 734 1 705 7 316 35 7 16 275 9 354 16 088

2009 Male Unknown 8 709 844 4 405 102 26 12 2 149 16 247 649 8 243 4 528 59 5 25 443 13 952 30 199 21 3 9 0 0 0 25 58 0 0 0 169 0 0 6 175 233

Female 202 4 973 151 35 10 1 062 6 433 1 616 7 579 51 4 7 230 9 487 15 920

2010 Male Unknown 8 944 800 4 048 119 24 12 2 317 16 264 666 8 187 5 134 82 1 9 569 14 648 30 912 11 0 5 0 0 0 40 56 0 0 0 177 0 0 1 178 234

Female 249 4 623 123 28 8 1 090 6 121 1 707 8 481 69 2 23 249 10 531 16 652

2011 Transmission mode Male Unknown EU/EEA 8 817 2 Men who have sex with men 1 020 0 Injecting drug use 3 998 3 Heterosexual contact 107 2 Mother-to-child 19 0 Haemophiliac/transfusion recipient 8 0 Nosocomial infection 2 501 32 Other/undetermined 16 470 39 Total EU/EEA Non-EU/EEA 694 1 Men who have sex with men 7 440 0 Injecting drug use 5 847 0 Heterosexual contact 65 137 Mother-to-child 6 0 Haemophiliac/transfusion recipient 32 0 Nosocomial infection 408 6 Other/undetermined 14 492 144 Total non-EU/EEA 30 962 183 Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 8: HIV diagnoses*, by geographical area, sex, transmission group and year of diagnosis (2004–2013) and cumulative totals Table 8b: Geographical areas, WHO European Region Transmission mode West Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total West Centre Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total Centre East Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total East Total WHO European Region 2004 Male Unknown 6 763 1 182 5 093 144 36 6 1 604 14 828 179 32 176 8 7 3 88 493 33 5,805 1,819 25 1 0 385 8,068 23,389 0 4 12 1 0 0 24 41 0 0 0 0 0 0 0 0 0 0 0 186 0 0 3 189 230 2005 Male Unknown 7 472 1 153 4 980 143 41 2 1 727 15 518 267 30 199 7 4 3 67 577 56 6,575 2,139 38 2 3 363 9,176 25,271 2 5 20 1 0 0 24 52 0 0 0 0 0 0 12 12 0 0 0 192 0 0 0 192 256 2006 Male Unknown 7 819 1 024 4 673 111 41 7 1 875 15 550 251 50 152 11 0 1 51 516 82 7,806 2,638 41 6 51 419 11,043 27,109 10 4 13 0 0 0 22 49 1 0 0 0 0 0 19 20 0 0 0 200 0 0 4 204 273 2007 Male Unknown 8 541 944 4 613 122 32 13 2 014 16 279 323 66 193 4 3 2 53 644 98 8,127 3,329 56 1 57 398 12,066 28,989 20 4 21 1 0 0 20 66 2 0 0 0 0 0 21 23 0 3 1 230 0 0 0 234 323

Female 324 7 163 158 56 10 970 8 681 4 142 6 5 4 53 214 1,636 3,215 15 0 0 245 5,111 14,006

Female 303 6 969 136 45 11 1 028 8 492 5 171 14 5 1 51 247 1,609 3,812 33 7 1 222 5,684 14,423

Female 293 6 376 134 36 11 1 037 7 887 8 146 7 3 46 210 1,823 4,635 37 6 24 281 6,806 14,903

Female 286 5 914 168 33 11 1 053 7 465 13 141 9 2 2 33 200 1,887 4,702 46 2 35 243 6,915 14,580

Transmission mode West Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total West Centre Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total Centre East Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total East Total WHO European Region *

Female 213 4 492 99 29 5 1 161 5 999 46 169 8 1 1 42 267 1 358 8 528 75 6 39 232 10 238 16 504

2012 Male Unknown 9 218 966 3 697 100 29 4 2 638 16 652 709 180 278 9 0 0 105 1 281 305 6 773 6 120 86 3 57 447 13 791 31 724 21 0 1 0 0 1 13 36 1 0 0 0 0 0 19 20 0 0 0 146 0 0 0 146 202

Female 150 3 544 88 19 9 1 198 5 008 36 216 16 0 0 51 319 1 252 9 054 61 2 4 369 10 742 16 069

2013 Male Unknown 8 469 643 2 947 83 26 9 2 744 14 921 809 165 306 16 0 1 114 1 411 504 6 467 6 761 81 1 9 460 14 283 30 615 15 0 2 1 0 0 14 32 0 0 0 0 0 0 34 34 0 0 0 127 0 0 17 144 210

Female 9 631 92 504 2 730 1 245 148 19 770 126 028 229 2 780 173 147 608 844 4 781 28 806 73 039 489 39 196 3 541 106 110 236 919

Cumulative total** Male Unknown 151 304 31 454 74 455 2 483 3 442 151 42 600 305 889 6 382 1 055 3 480 179 253 699 1 332 13 380 2 128 114 328 48 747 616 33 284 5 937 172 073 491 342 125 822 567 22 110 1 3 677 5 324 7 832 340 27 103 0 439 1 748 4 138 64 3 134 2 13 39 3 394 10 466

Total 151 429 41 907 167 526 5 235 4 797 300 66 047 437 241 6 389 2 116 6 600 379 503 1 307 2 615 19 909 2 132 143 434 121 850 4 239 74 493 9 517 281 739 738 889

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Female 221 5 924 126 26 10 1 075 7 382 7 169 5 0 1 56 238 1 744 6 660 59 2 38 265 8 768 16 388

2008 Male Unknown 8 824 829 4 739 121 25 8 2 086 16 632 447 76 212 6 2 1 72 816 127 8 090 3 926 73 2 36 432 12 686 30 134 22 2 21 0 1 0 16 62 0 0 0 0 0 0 26 26 0 90 29 221 0 12 7 359 447

Female 199 5 233 137 23 9 1 060 6 661 14 190 11 0 0 35 250 1 722 7 165 27 2 16 245 9 177 16 088

2009 Male Unknown 8 713 661 4 376 103 29 12 2 116 16 010 472 83 221 7 1 0 82 866 173 8 343 4 336 51 1 25 394 13 323 30 199 19 3 9 0 0 0 15 46 2 0 0 0 0 0 16 18 0 0 0 169 0 0 0 169 233

Female 183 4 991 147 39 9 1 055 6 424 9 149 9 0 1 35 203 1 626 7 412 46 0 7 202 9 293 15 920

2010 Male Unknown 8 852 613 3 998 113 24 12 2 331 15 943 568 71 238 11 1 0 69 958 190 8 303 4 946 77 0 9 486 14 011 30 912 11 0 5 0 0 0 10 26 0 0 0 0 0 0 31 31 0 0 0 177 0 0 0 177 234

Female 198 4 625 122 27 8 1 071 6 051 39 173 8 2 0 43 265 1 719 8 306 62 1 23 225 10 336 16 652

2011 Transmission mode Male Unknown West 8 667 2 Men who have sex with men 764 0 Injecting drug use 3 898 3 Heterosexual contact 100 3 Mother-to-child 22 0 Haemophiliac/transfusion recipient 7 0 Nosocomial infection 2 480 10 Other/undetermined 15 938 18 Total West Centre 579 1 Men who have sex with men 163 0 Injecting drug use 292 0 Heterosexual contact 12 0 Mother-to-child 1 0 Haemophiliac/transfusion recipient 1 0 Nosocomial infection 75 28 Other/undetermined 1 123 29 Total Centre East 265 0 Men who have sex with men 7 533 5 655 60 2 32 354 13 901 30 962 0 Injecting drug use 0 Heterosexual contact 136 Mother-to-child 0 Haemophiliac/transfusion recipient 0 Nosocomial infection 0 Other/undetermined 136 Total East 183 Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 9: HIV diagnoses*, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals Table 9a: EU/EEA and non-EU/EEA countries Age category EU/EEA <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total EU/EEA Non-EU/EEA <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total non-EU/EEA Total WHO European Region 2004 Male Unknown 185 270 1 107 2 163 6 082 3 613 1 962 421 15 803 47 139 324 510 3 351 1 339 332 2 651 8 693 24 496 1 2 5 3 19 5 3 10 48 0 0 2 1 0 0 0 4 7 55 2005 Male Unknown 159 288 1 195 2 333 6 041 3 916 2 189 323 16 444 67 162 317 616 3 875 1 601 379 2 893 9 910 26 354 2 1 3 17 15 9 7 24 78 192 0 0 0 0 1 1 3 197 275 2006 Male Unknown 146 226 1 174 2 348 6 004 4 136 2 164 346 16 544 115 166 372 725 4 856 1 983 483 3 102 11 802 28 346 0 0 5 14 29 10 1 30 89 200 1 0 1 1 2 0 8 213 302 2007 Male Unknown 137 231 1 393 2 627 6 035 4 322 2 432 87 17 264 135 126 499 942 5 498 2 306 611 2 800 12 917 30 181 2 2 9 29 39 24 8 38 151 230 0 2 1 6 2 0 11 252 403

Female 199 478 1 151 2 033 3 168 1 195 666 165 9 055 27 330 283 260 1 495 413 140 2 498 5 446 14 501

Female 160 369 1 100 1 897 3 120 1 326 747 156 8 875 63 400 282 299 1 713 556 149 2 583 6 045 14 920

Female 167 305 903 1 687 2 975 1 285 756 162 8 240 74 397 339 383 2 136 749 200 2 881 7 159 15 399

Female 185 300 914 1 585 2 799 1 359 708 18 7 868 108 446 456 535 2 512 868 264 2 037 7 226 15 094

Age category EU/EEA <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total EU/EEA Non-EU/EEA <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total non-EU/EEA Total WHO European Region * **

Female 111 189 564 1 010 2 238 1 283 963 14 6 372 160 286 1 454 2 267 3 756 1 857 855 11 10 646 17 018

2012 Male Unknown 102 308 1 774 2 821 5 764 4 526 2 990 60 18 345 260 77 783 2 393 6 807 3 528 1 460 14 15 322 33 667 2 0 5 10 16 7 0 27 67 152 0 0 0 2 0 1 7 162 229

Female 86 174 485 856 1 868 1 142 830 9 5 450 112 247 1 347 2 225 4 013 2 121 1 058 76 11 199 16 649

2013 Male Unknown 84 257 1 636 2 703 5 318 3 955 2 768 34 16 755 173 98 917 2 521 6 986 3 746 1 613 84 16 138 32 893 1 1 4 5 10 7 1 37 66 127 0 0 2 4 2 0 5 140 206

Female 3 931 5 690 16 248 26 435 42 906 18 101 11 058 2 065 126 434 1 359 6 078 14 126 18 501 37 204 13 714 5 468 22 382 118 832 245 266

Cumulative total** Male Unknown 4 581 6 602 29 000 52 217 111 607 67 015 38 971 5 484 315 477 1 728 4 263 12 053 25 255 79 148 32 896 10 857 34 173 200 373 515 850 81 32 145 295 495 221 90 2 035 3 394 1 659 17 146 242 351 111 38 3 551 6 115 9 509

Total 8 593 12 324 45 393 78 947 155 008 85 337 50 119 9 584 445 305 4 746 10 358 26 325 43 998 116 703 46 721 16 363 60 035 325 249 770 554

Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Therefore, totals by gender and overall may differ from totals presented in Tables 1–3. Cumulative total is the total number of cases reported by country since the start of reporting

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Female 139 268 813 1 476 2 763 1 423 860 24 7 766 128 404 1 903 2 331 2 937 1 060 347 17 9 127 16 893

2008 Male Unknown 150 272 1 411 2 632 5 939 4 667 2 563 82 17 716 132 98 1 088 2 979 5 965 2 613 720 26 13 621 31 337 0 3 14 17 49 14 1 52 150 234 2 9 27 70 20 3 9 374 524

Female 136 258 727 1 287 2 449 1 305 881 17 7 060 74 387 1 836 2 314 3 157 1 252 452 8 9 480 16 540

2009 Male Unknown 111 264 1 444 2 497 5 656 4 535 2 643 70 17 220 104 91 1 062 2 856 6 511 2 827 833 20 14 304 31 524 0 0 7 22 36 15 4 42 126 169 0 2 0 1 0 3 175 301

Female 147 219 654 1 155 2 254 1 388 906 10 6 733 73 320 1 572 2 369 3 348 1 387 549 8 9 626 16 359

2010 Male Unknown 115 284 1 592 2 447 5 560 4 400 2 757 53 17 208 101 95 1 104 2 764 6 781 3 165 1 013 13 15 036 32 244 0 0 5 15 31 19 7 67 144 177 0 0 0 1 0 0 0 178 322

Female 118 193 643 1 094 2 270 1 253 841 6 6 418 119 296 1 590 2 358 3 788 1 773 765 8 10 697 17 115

2011 Age category Male Unknown EU/EEA 105 2 <15 267 0 15–19 1 587 2 20–24 2 733 1 25–29 5 608 3 30–39 4 430 6 40–49 2 836 2 50+ 46 65 Unknown 17 612 81 Total EU/EEA Non-EU/EEA 145 137 <15 82 0 15–19 930 1 20–24 2 502 0 25–29 6 839 1 30–39 3 289 2 40–49 1 178 1 50+ 12 4 Unknown 14 977 32 589 146 Total non-EU/EEA 227 Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 9: HIV diagnoses*, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals Table 9b: Geographical areas, WHO European Region Age category West <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total West Centre <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total Centre East <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total East Total WHO European Region 2004 Male Unknown 160 176 963 2 022 5 900 3 587 1 956 64 14 828 32 34 129 188 372 194 104 50 1 103 40 199 339 463 3 161 1 171 234 2 958 8 565 24 496 1 1 7 4 16 3 3 6 41 0 1 0 0 3 2 0 5 11 0 0 0 0 0 0 0 3 3 55 2005 Male Unknown 153 187 1 062 2 141 5 840 3 889 2 184 62 15 518 15 44 151 266 416 200 140 37 1 269 58 219 299 542 3 660 1 428 244 3 117 9 567 26 354 2 1 2 13 12 7 7 8 52 0 0 1 4 3 3 1 19 31 192 0 0 0 0 0 0 0 192 275 2006 Male Unknown 128 168 1 035 2 158 5 716 4 095 2 186 64 15 550 28 27 174 276 468 208 105 38 1 324 105 197 337 639 4 676 1 816 356 3 346 11 472 28 346 0 1 3 7 21 7 1 9 49 0 0 2 8 8 5 0 26 49 200 0 0 0 1 0 0 3 204 302 2007 Male Unknown 130 193 1 145 2 269 5 794 4 267 2 417 64 16 279 15 35 191 332 460 228 162 39 1 462 127 129 556 968 5 279 2 133 464 2 784 12 440 30 181 0 1 4 11 18 17 3 12 66 2 1 7 18 22 8 5 37 100 230 0 0 1 5 1 0 0 237 403

Female 175 329 1 079 2 018 3 165 1 201 680 34 8 681 24 57 82 89 123 36 24 28 463 27 422 273 186 1 375 371 102 2 601 5 357 14 501

Female 145 278 1 024 1 852 3 091 1 330 744 28 8 492 24 41 94 118 132 51 37 17 514 54 450 264 226 1 610 501 115 2 694 5 914 14 920

Female 151 223 854 1 638 2 948 1 277 765 31 7 887 20 32 75 122 126 56 30 6 467 70 447 313 310 2 037 701 161 3 006 7 045 15 399

Female 169 223 768 1 468 2 754 1 362 704 17 7 465 24 40 80 98 128 39 41 5 455 100 483 522 554 2 429 826 227 2 033 7 174 15 094

Age category West <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total West Centre <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total Centre East <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total East Total WHO European Region * **

Female 98 161 451 936 2 143 1 249 946 15 5 999 20 28 103 120 214 119 69 2 675 153 286 1 464 2 221 3 637 1 772 803 8 10 344 17 018

2012 Male Unknown 91 264 1 521 2 407 5 084 4 279 2 958 48 16 652 25 59 377 625 1 069 555 285 20 3 015 246 62 659 2 182 6 418 3 220 1 207 6 14 000 33 667 2 0 2 7 13 4 1 7 36 0 0 3 3 5 3 0 27 41 152 0 0 0 0 0 0 0 152 229

Female 69 146 403 751 1 754 1 083 792 10 5 008 24 23 103 134 226 110 80 3 703 105 252 1 326 2 196 3 901 2 070 1 016 72 10 938 16 649

2013 Male Unknown 74 222 1 383 2 246 4 543 3 718 2 703 32 14 921 26 55 414 701 1 287 604 314 15 3 416 157 78 756 2 277 6 474 3 379 1 364 71 14 556 32 893 1 1 1 4 11 8 1 5 32 0 0 3 3 3 1 0 37 47 127 0 0 0 0 0 0 0 127 206

Female 3 182 4 372 15 937 27 281 43 987 18 275 11 256 1 738 126 028 1 171 825 1 998 1 928 2 390 971 666 282 10 231 937 6 571 12 439 15 727 33 733 12 569 4 604 22 427 109 007 245 266

Cumulative total** Male Unknown 3 680 4 645 26 496 50 440 109 738 67 192 39 676 4 022 305 889 1 354 957 4 624 6 417 10 214 4 710 2 606 909 31 791 1 275 5 263 9 933 20 615 70 803 28 009 7 546 34 726 178 170 515 850 121 43 229 421 652 254 109 3 495 5 324 2 4 53 88 117 58 15 1 975 2 312 1 617 2 9 28 77 20 4 116 1 873 9 509

Total 6 983 9 060 42 662 78 142 154 377 85 721 51 041 9 255 437 241 2 527 1 786 6 675 8 433 12 721 5 739 3 287 3 166 44 334 3 829 11 836 22 381 36 370 104 613 40 598 12 154 57 198 288 979 770 554

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Female 132 212 678 1 380 2 707 1 406 844 23 7 382 17 34 90 113 159 47 49 4 513 118 426 1 948 2 314 2 834 1 030 314 14 8 998 16 893

2008 Male Unknown 137 222 1 192 2 286 5 591 4 593 2 542 69 16 632 17 46 197 359 583 299 173 31 1 705 128 102 1 110 2 966 5 730 2 388 568 8 13 000 31 337 0 2 6 6 29 9 1 9 62 0 1 8 11 20 6 0 52 98 234 2 9 27 70 19 3 0 364 524

Female 127 204 597 1 185 2 370 1 288 871 19 6 661 19 35 99 108 163 53 54 3 534 64 406 1 867 2 308 3 073 1 216 408 3 9 345 16 540

2009 Male Unknown 105 212 1 258 2 158 5 182 4 451 2 602 42 16 010 18 50 221 379 706 331 204 31 1 940 92 93 1 027 2 816 6 279 2 580 670 17 13 574 31 524 0 0 3 14 17 7 1 4 46 0 0 4 10 19 9 3 41 86 169 0 0 0 0 0 0 0 169 301

Female 138 185 547 1 085 2 210 1 362 884 13 6 424 15 23 87 101 148 65 53 4 496 67 331 1 592 2 338 3 244 1 348 518 1 9 439 16 359

2010 Male Unknown 101 251 1 335 2 103 5 086 4 307 2 725 35 15 943 19 38 292 415 713 334 222 23 2 056 96 90 1 069 2 693 6 542 2 924 823 8 14 245 32 244 0 0 1 6 9 9 1 0 26 0 0 4 9 23 10 6 67 119 177 0 0 0 0 0 0 0 177 322

Female 111 169 517 990 2 179 1 229 849 7 6 051 15 20 108 115 184 94 49 3 588 111 300 1 608 2 347 3 695 1 703 708 4 10 476 17 115

2011 Age category Male Unknown West 92 3 <15 226 0 15–19 1 342 1 20–24 2 291 0 25–29 4 940 4 30–39 4 244 5 40–49 2 773 3 50+ 30 2 Unknown 15 938 18 Total West Centre 20 0 <15 53 0 15–19 323 2 20–24 522 1 25–29 909 0 30–39 427 3 40–49 250 0 50+ 20 67 Unknown 2 524 138 70 852 2 422 6 598 3 048 991 8 14 127 32 589 73 Total Centre East 136 <15 0 15–19 0 20–24 0 25–29 0 30–39 0 40–49 0 50+ 0 Unknown 136 Total East 227 Total WHO European Region

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Table 10: HIV diagnoses in persons infected through heterosexual contact, by country and transmission subcategory, cases diagnosed in 2013, in EU/EEA and other countries of the WHO European Region Case from country with generalised HIV epidemic N EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region * Country-specific comments are in Annex 5

Area

Country*

% 25.0 51.9 25.7 0.0 12.5 2.3 53.3 0.0 11.9 19.8 56.8 16.5 20.8 0.0 55.0 16.8 0.0 0.0 57.9 40.0 28.8 45.5 0.0 23.8 0.0 4.8 28.6 17.0 58.1 49.4 30.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.3 50.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 25.9 0.0 1.2 0.0 0.0 0.0 0.9 33 3.3 0.0 11.6

Partner from a country with a generalised HIV epidemic N % 17 25 0 0 0 1 20 0 33 587 35 4 0 0 19 0 0 0 0 0 0 6 0 25 0 1 3 0 0 0 776 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 41 0 0 0 0 0 71 812 5 30 847 20.2 6.7 0.0 0.0 0.0 2.3 22.2 0.0 49.3 44.3 5.9 3.9 0.0 0.0 14.5 0.0 0.0 0.0 0.0 0.0 0.0 4.9 0.0 3.8 0.0 4.8 42.9 0.0 0.0 0.0 8.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 12.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 19.3 0.0 0.0 0.0 0.0 0.0 0.4 9 0.5 0.2 3.3

Partner IDU N 4 2 0 0 0 0 2 5 3 10 13 4 0 0 2 0 10 0 0 0 0 0 0 4 12 0 0 0 0 0 71 0 0 10 38 0 0 0 42 4 0 0 0 0 0 0 0 0 1 0 0 0 0 0 95 49 12 105 166 % 4.8 0.5 0.0 0.0 0.0 0.0 2.2 3.0 4.5 0.8 2.2 3.9 0.0 0.0 1.5 0.0 8.0 0.0 0.0 0.0 0.0 0.0 0.0 0.6 6.3 0.0 0.0 0.0 0.0 0.0 0.8 0.0 0.0 5.7 14.2 0.0 0.0 0.0 17.8 2.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.5 0.0 0.0 0.0 0.0 0.0 0.6 0.5 1.2 0.7 0.6

Bisexual partner N 0 0 0 0 0 0 2 1 0 10 10 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 26 0 0 1 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 27 1 2 30 % 0.0 0.0 0.0 0.0 0.0 0.0 2.2 0.6 0.0 0.8 1.7 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.0 0.0 14.3 0.0 0.0 0.0 0.3 0.0 0.0 0.6 0.0 0.0 0.0 0.0 0.0 1.6 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 0.3 0.1 0.0 0.1

Other/ undetermined N 42 152 52 13 14 42 18 163 23 456 198 77 19 0 38 1 336 115 50 8 6 153 61 82 477 180 19 1 774 70 1 079 5 718 99 1 165 229 1 138 12 2 161 83 1 273 276 325 0 1 0 0 21 115 477 423 0 11 472 0 16 273 5 167 980 15 844 21 991 % 50.0 40.9 74.3 100.0 87.5 95.5 20.0 96.4 34.3 34.4 33.4 74.8 79.2 0.0 29.0 83.2 92.0 100.0 42.1 60.0 71.2 49.6 100.0 71.7 93.8 90.5 14.3 83.0 41.9 50.6 60.5 100.0 100.0 93.8 85.8 100.0 100.0 100.0 68.2 45.6 100.0 100.0 100.0 0.0 100.0 0.0 0.0 100.0 54.2 100.0 98.8 0.0 100.0 0.0 98.0 57.2 95.0 99.1 84.4

Total N 84 372 70 13 16 44 90 169 67 1 325 593 103 24 0 131 1 605 125 50 19 10 215 123 82 665 192 21 7 933 167 2 134 9 449 99 1 176 267 1 138 12 2 236 182 1 273 276 325 0 1 0 0 21 212 477 428 0 11 472 0 16 598 9 031 1 032 15 984 26 047

21 193 18 0 2 1 48 0 8 262 337 17 5 0 72 269 0 0 11 4 62 56 0 158 0 1 2 159 97 1 055 2 858 0 0 0 0 0 0 0 3 92 0 0 0 0 0 0 0 0 55 0 5 0 0 0 155 2 976 34 3 3 013

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 11: HIV diagnoses, by country of report and country or subcontinent of origin, cases diagnosed in 2013, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Country of report N 168 400 173 84 41 170 112 295 76 1 406 2 021 578 216 5 140 2 737 111 169 16 7 661 80 897 765 503 78 39 2 214 85 2 289 16 536 116 2 238 494 1 376 27 15 465 176 0 479 700 0 9 0 0 147 202 604 1 126 0 0 0 6 176 14 140 3 641 4 931 22 712 Western Europe N 15 101 1 0 2 9 26 1 5 71 115 2 1 1 16 34 0 0 21 10 46 15 0 14 1 0 0 131 11 501 1 150 0 1 0 0 0 0 0 0 13 0 3 0 0 0 0 0 0 66 0 10 0 0 0 93 1 215 24 4 1 243 Central & Eastern Europe N % 43 43 5 0 8 48 19 9 30 67 306 97 9 0 31 233 0 5 0 3 42 18 0 17 3 3 4 90 22 340 1 495 0 0 0 19 0 0 0 9 131 0 20 6 0 1 0 0 0 19 0 74 0 0 0 279 1 551 155 68 1 774 16.5 3.9 2.5 0.0 14.8 20.4 8.2 2.8 19.1 1.7 9.4 12.0 3.8 0.0 9.3 6.5 0.0 2.8 0.0 8.3 4.4 7.7 0.0 1.6 0.6 3.6 9.1 2.7 6.2 5.7 5.1 0.0 0.0 0.0 3.7 0.0 0.0 0.0 1.9 26.7 0.0 4.0 0.8 0.0 10.0 0.0 0.0 0.0 3.3 0.0 5.6 0.0 0.0 0.0 1.0 5.8 3.7 0.3 3.1 Sub-Saharan Africa N % 20 228 19 0 2 1 41 0 24 832 301 21 8 2 75 312 0 1 12 8 77 57 0 194 0 1 1 182 140 1 225 3 784 0 0 0 0 0 0 0 0 94 0 0 0 0 0 0 0 0 75 0 37 0 0 0 206 3 920 69 1 3 990 7.7 20.4 9.5 0.0 3.7 0.4 17.6 0.0 15.3 20.8 9.2 2.6 3.3 18.2 22.6 8.6 0.0 0.6 22.6 22.2 8.1 24.5 0.0 17.7 0.0 1.2 2.3 5.6 39.5 20.4 13.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 19.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 13.1 0.0 2.8 0.0 0.0 0.0 0.8 14.6 1.7 0.0 7.1

% 64.6 35.9 86.5 98.8 75.9 72.3 48.1 90.8 48.4 35.1 61.9 71.6 90.0 45.5 42.2 75.9 32.6 95.5 30.2 19.4 69.7 34.3 82.4 70.0 99.2 94.0 88.6 67.5 24.0 38.2 56.7

% 5.8 9.1 0.5 0.0 3.7 3.8 11.2 0.3 3.2 1.8 3.5 0.2 0.4 9.1 4.8 0.9 0.0 0.0 39.6 27.8 4.8 6.4 0.0 1.3 0.2 0.0 0.0 4.0 3.1 8.4 3.9 0.0 20.0 0.0 0.0 0.0 0.0 0.0 0.0 2.7 0.0 0.6 0.0 0.0 0.0 0.0 0.0 0.0 11.5 0.0 0.8 0.0 0.0 0.0 0.3 4.5 0.6 0.0 2.2

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Centre former Yugoslav Republic of Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region * Country-specific comments are in Annex 5

99.1 40.0 100.0 96.1 99.9 100.0 100.0 98.1 35.9 0.0 95.2 99.2 0.0 90.0 0.0 0.0 100.0 35.2 73.2 85.8 0.0 0.0 0.0 22.6 52.7 87.4 19.4 40.2

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Latin America & Caribbean N Rate 7 29 0 0 0 0 8 1 1 146 59 3 1 1 35 187 0 0 2 2 64 9 0 61 0 1 0 526 15 259 1 417 0 0 0 0 1 0 0 0 8 0 0 0 0 0 0 0 0 24 0 5 0 0 0 38 1 446 7 2 1 455 2.7 2.6 0.0 0.0 0.0 0.0 3.4 0.3 0.6 3.6 1.8 0.4 0.4 9.1 10.5 5.2 0.0 0.0 3.8 5.6 6.7 3.9 0.0 5.6 0.0 1.2 0.0 16.0 4.2 4.3 4.9 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 1.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.2 0.0 0.4 0.0 0.0 0.0 0.1 5.4 0.2 0.0 2.6

South & South-east Asia N % 5 14 0 0 0 7 22 0 10 42 93 26 2 0 8 31 0 1 2 0 34 32 0 3 0 0 0 0 41 254 627 0 0 0 1 0 0 0 0 6 0 0 0 0 0 0 0 0 17 0 7 0 0 0 31 640 16 2 658 1.9 1.3 0.0 0.0 0.0 3.0 9.4 0.0 6.4 1.0 2.9 3.2 0.8 0.0 2.4 0.9 0.0 0.6 3.8 0.0 3.6 13.7 0.0 0.3 0.0 0.0 0.0 0.0 11.6 4.2 2.2 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.0 1.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.0 0.0 0.5 0.0 0.0 0.0 0.1 2.4 0.4 0.0 1.2

Other N 2 27 2 0 1 0 5 0 0 100 57 29 3 0 5 68 0 1 0 1 25 7 0 1 0 0 0 63 15 147 559 1 0 0 0 0 0 0 0 62 0 1 0 0 0 0 0 0 6 0 32 0 0 0 102 620 39 2 661

% 0.8 2.4 1.0 0.0 1.9 0.0 2.1 0.0 0.0 2.5 1.7 3.6 1.3 0.0 1.5 1.9 0.0 0.6 0.0 2.8 2.6 3.0 0.0 0.1 0.0 0.0 0.0 1.9 4.2 2.5 1.9 0.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 12.7 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 2.4 0.0 0.0 0.0 0.4 2.3 0.9 0.0 1.2

Unknown N 0 273 0 1 0 0 0 19 11 1 338 311 51 0 2 22 6 229 0 0 5 0 15 192 38 0 0 0 72 25 979 3 589 0 2 0 0 0 0 0 0 0 2 140 0 0 0 0 0 0 0 165 221 22 0 17 875 0 20 425 3 315 215 20 484 24 014

% 0.0 24.5 0.0 1.2 0.0 0.0 0.0 5.8 7.0 33.4 9.5 6.3 0.0 18.2 6.6 0.2 67.4 0.0 0.0 13.9 0.0 6.4 17.6 3.5 0.0 0.0 0.0 2.2 7.1 16.3 12.3 0.0 40.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 28.7 26.8 1.7 0.0 100.0 0.0 74.7 12.3 5.2 80.3 42.5

Total Country EU/EEA Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Moldova Monaco Montenegro Russia San Marino Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region

260 1 115 200 85 54 235 233 325 157 4 002 3 263 807 240 11 332 3 608 340 177 53 36 949 233 1 089 1 093 507 83 44 3 278 354 5 994 29 157 117 5 238 514 1 377 27 15 474 490 2 140 503 706 0 10 0 0 147 574 825 1 313 0 17 875 0 27 350 26 847 4 166 25 494 56 507

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 12: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, cases reported in 2013

Table 12a: EU/EEA and non-EU/EEA countries Transmission mode EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total EU/EEA Non-EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total non-EU/EEA Total WHO European Region Country of report N 8 784 1 018 4 223 85 14 7 2 405 16 536 677 983 3 344 107 6 15 1 044 6 176 22 712 Western Europe N 812 42 202 1 3 0 90 1 150 53 5 27 0 1 0 7 93 1 243 Central & Eastern Europe N % 469 202 534 9 11 5 265 1 495 27 72 103 3 1 0 73 279 1 774 3.8 13.9 5.7 4.1 23.4 26.3 4.6 5.1 3.3 6.5 2.7 2.3 7.7 0 5.2 3.8 4.9 Sub-Saharan Africa N 193 17 3 160 84 9 3 318 3 784 4 1 153 4 3 0 41 206 3 990

% 71.8 70.0 44.7 39.0 29.8 36.8 41.9 56.7 82.8 88.2 86.8 83.6 46.2 100.0 74.9 84.2 62.2

% 6.6 2.9 2.1 0.5 6.4 0.0 1.6 3.9 6.5 0.4 0.7 0 7.7 0 0.5 1.3 3.4

% 1.6 1.2 33.4 38.5 19.1 15.8 5.5 13.0 0.5 0.1 4.0 3.1 23.1 0 2.9 2.8 10.9

Table 12b: Geographical areas, WHO European Region Transmission mode West Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total West Centre Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total Centre East Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total East Total WHO European Region Country of report N 8 145 681 3 690 58 14 7 1 545 14 140 1 125 233 924 45 3 2 1 309 3 641 191 1 087 2 953 89 3 13 595 4 931 22 712 Western Europe N 854 44 220 1 4 0 92 1 215 11 1 7 0 0 0 5 24 0 2 2 0 0 0 0 4 1 243 Central & Eastern Europe N % 448 248 554 10 12 4 275 1 551 43 6 46 1 0 1 58 155 5 20 37 1 0 0 5 68 1 774 3.9 22.5 6.1 5.2 23.1 22.2 5.6 5.8 3.4 2.5 4.5 2.1 0.0 33.3 3.7 3.7 1.0 0.3 0.2 0.4 0.0 0.0 0.6 0.3 3.1 Sub-Saharan Africa N 194 17 3 281 88 12 3 325 3 920 2 1 32 0 0 0 34 69 1 0 0 0 0 0 0 1 3 990

% 70.3 61.9 40.9 30.4 26.9 38.9 31.7 52.7 89.6 95.5 89.5 95.7 60.0 66.7 82.9 87.4 37.5 13.9 18.5 32.8 100.0 100.0 65.7 19.4 40.2

% 7.4 4.0 2.4 0.5 7.7 0.0 1.9 4.5 0.9 0.4 0.7 0.0 0.0 0.0 0.3 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.2

% 1.7 1.5 36.3 46.1 23.1 16.7 6.7 14.6 0.2 0.4 3.1 0.0 0.0 0.0 2.2 1.7 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 7.1

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Latin America & Caribbean N % 845 6 434 4 2 1 125 1 417 21 0 11 0 0 0 6 38 1 455 6.9 0.4 4.6 1.8 4.3 5.3 2.2 4.9 2.6 0 0.3 0 0 0 0.4 0.5 4.0

South & South-east Asia N % 263 32 249 4 4 1 74 627 8 1 15 0 0 0 7 31 658 2.2 2.2 2.6 1.8 8.5 5.3 1.3 2.2 1.0 0.1 0.4 0 0 0 0.5 0.4 1.8

Other N 257 33 188 6 2 0 73 559 9 5 19 1 2 0 66 102 661

% 2.1 2.3 2.0 2.8 4.3 0.0 1.3 1.9 1.1 0.4 0.5 0.8 15.4 0 4.7 1.4 1.8

Unknown N 605 105 459 25 2 2 2 391 3 589 19 47 181 13 0 0 387 20 425 24 014

% 4.9 7.2 4.9 11.5 4.3 10.5 41.6 12.3 2.3 4.2 4.7 10.2 0.0 0.0 23.0 74.7 42.5

Total Transmission mode EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total EU/EEA Non-EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total non-EU/EEA Total WHO European Region

12 228 1 455 9 449 218 47 19 5 741 29 157 818 1 114 3 853 128 13 15 1 631 27 350 56 507

Latin America & Caribbean N % 862 6 444 4 2 1 127 1 446 3 0 0 0 0 0 4 7 1 0 1 0 0 0 0 2 1 455 7.4 0.5 4.9 2.1 3.8 5.6 2.6 5.4 0.2 0.0 0.0 0.0 0.0 0.0 0.3 0.2 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.6

South & South-east Asia N % 270 31 258 4 4 1 72 640 1 1 5 0 0 0 9 16 0 1 1 0 0 0 0 2 658 2.3 2.8 2.9 2.1 7.7 5.6 1.5 2.4 0.1 0.4 0.5 0.0 0.0 0.0 0.6 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2

Other N 261 38 198 7 2 114 620 5 0 7 0 2 0 25 39 0 0 2 0 0 0 0 2 661

% 2.3 3.5 2.2 3.7 3.8 2.3 2.3 0.4 0.0 0.7 0.0 40.0 0.0 1.6 0.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2

Unknown N 548 35 386 19 2 2 2 323 3 315 66 2 11 1 0 0 135 215 312 6 683 12 988 181 0 0 320 20 484 24 014

% 4.7 3.2 4.3 9.9 3.8 11.1 47.7 12.3 5.3 0.8 1.1 2.1 0.0 0.0 8.5 5.2 61.2 85.8 81.3 66.8 0.0 0.0 33.7 80.3 42.5

Total Transmission mode West Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total West Centre Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total Centre East Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total East Total WHO European Region

11 582 1 100 9 031 191 52 18 4 873 26 847 1 256 244 1 032 47 5 3 1 579 4 166 510 7 793 15 984 271 3 13 920 25 494 56 507

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 13: HIV diagnoses, by probable region of infection, in 2013, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Country of report N 44 351 0 0 33 2 111 238 0 1 262 0 0 0 2 129 0 255 123 0 0 624 70 1 089 598 452 0 0 0 90 0 5 473 0 0 95 301 1 376 0 0 209 281 0 501 661 0 0 0 0 0 172 0 0 0 0 0 3 596 3 734 1 576 3 759 9 069 Western Europe N 7 38 0 0 10 3 25 6 8 0 0 0 0 0 20 0 3 8 0 6 19 21 0 9 0 0 0 0 22 0 205 0 0 1 0 0 0 0 18 9 0 0 0 0 0 0 0 0 41 0 0 0 0 0 69 225 13 36 274 Central & Eastern Europe N % 2 18 0 0 3 3 16 1 27 0 0 0 0 1 11 0 4 7 0 1 9 14 0 2 13 0 0 0 19 0 151 0 0 126 107 0 0 0 115 56 0 2 45 0 0 0 0 0 9 0 0 0 0 0 460 185 19 407 611 0.8 1.6 0.0 0.0 5.6 1.3 6.9 0.3 17.2 0.0 0.0 0.0 0.0 9.1 3.3 0.0 1.2 4.0 0.0 2.8 0.9 6.0 0.0 0.2 2.6 0.0 0.0 0.0 5.4 0.0 0.5 0.0 0.0 52.9 20.8 0.0 0.0 0.0 24.3 11.4 0.0 0.4 6.4 0.0 0.0 0.0 0.0 0.0 1.6 0.0 0.0 0.0 0.0 0.0 1.7 0.7 0.5 1.6 1.1 Sub-Saharan Africa N % 6 130 0 0 2 2 41 0 18 0 0 0 0 0 54 0 0 0 0 6 23 63 0 53 0 0 0 0 132 0 530 0 0 0 0 0 0 0 0 69 0 0 0 0 0 0 0 0 59 0 0 0 0 0 128 654 4 0 658 2.3 11.7 0.0 0.0 3.7 0.9 17.6 0.0 11.5 0.0 0.0 0.0 0.0 0.0 16.3 0.0 0.0 0.0 0.0 16.7 2.4 27.0 0.0 4.8 0.0 0.0 0.0 0.0 37.3 0.0 1.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 14.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 10.3 0.0 0.0 0.0 0.0 0.0 0.5 2.4 0.1 0 1.2

% 2.7 3.4 0.0 0.0 18.5 1.3 10.7 1.8 5.1 0.0 0.0 0.0 0.0 0.0 6.0 0.0 0.9 4.5 0.0 16.7 2.0 9.0 0.0 0.8 0.0 0.0 0.0 0.0 6.2 0.0 0.7 0.0 0.0 0.4 0.0 0.0 0.0 0.0 3.8 1.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 7.1 0.0 0.0 0.0 0.0 0.0 0.3 0.8 0.3 0.1 0.5

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Centre former Yugoslav Republic of Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region * Country-specific comments are in Annex 5

16.9 31.5 0.0 0.0 61.1 0.9 47.6 73.2 0.0 31.5 0.0 0.0 0.0 18.2 38.9 0.0 75.0 69.5 0.0 0.0 65.8 30.0 100.0 54.7 89.2 0.0 0.0 0.0 25.4 0.0 18.8 0.0 0.0 39.9 58.6 99.9 0.0 0.0 44.1 57.3 0.0 99.6 93.6 0.0 0.0 0.0 0.0 0.0 30.0 0.0 0.0 0.0 0.0 0.0 13.2 13.9 37.8 14.8 16.1

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Latin America & Caribbean N Rate 0 11 0 0 0 1 6 1 2 0 0 0 0 0 15 0 0 0 0 1 18 6 0 9 0 0 0 0 5 0 75 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 8 0 0 0 0 0 10 83 1 1 85 0.0 1.0 0.0 0.0 0.0 0.4 2.6 0.3 1.3 0.0 0.0 0.0 0.0 0.0 4.5 0.0 0.0 0.0 0.0 2.8 1.9 2.6 0.0 0.8 0.0 0.0 0.0 0.0 1.4 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0 0 0.2

South & South-east Asia N % 5 17 0 0 0 1 21 1 22 0 0 0 0 0 5 0 1 1 0 0 11 38 0 2 0 0 0 0 53 0 178 0 0 0 1 0 0 0 1 7 0 0 0 0 0 0 0 0 22 0 0 0 0 0 31 203 1 5 209 1.9 1.5 0.0 0.0 0.0 0.4 9.0 0.3 14.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 0.3 0.6 0.0 0.0 1.2 16.3 0.0 0.2 0.0 0.0 0.0 0.0 15.0 0.0 0.6 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.2 1.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.8 0.0 0.0 0.0 0.0 0.0 0.1 0.8 0 0 0.4

Other N 0 10 0 0 0 1 7 0 0 0 0 0 0 0 4 0 0 0 0 1 7 12 0 0 0 0 0 0 20 0 62 0 0 1 1 0 0 0 0 9 0 0 0 0 0 0 0 0 2 0 0 0 0 0 13 72 1 2 75

% 0.0 0.9 0.0 0.0 0.0 0.4 3.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 0.0 0.0 0.0 0.0 2.8 0.7 5.2 0.0 0.0 0.0 0.0 0.0 0.0 5.6 0.0 0.2 0.0 0.0 0.4 0.2 0.0 0.0 0.0 0.0 1.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0 0 0.1

Unknown N 196 540 200 85 6 222 6 78 80 2 740 3 263 807 240 8 94 3 608 77 38 53 21 238 9 0 420 42 83 44 3 278 13 5 994 22 483 117 5 15 104 1 27 15 131 57 2 140 0 0 0 10 0 0 147 261 825 1 313 0 17 875 0 23 043 21 691 2 551 21 284 45 526

% 75.4 48.4 100.0 100.0 11.1 94.5 2.6 24.0 51.0 68.5 100.0 100.0 100.0 72.7 28.3 100.0 22.6 21.5 100.0 58.3 25.1 3.9 0.0 38.4 8.3 100.0 100.0 100.0 3.7 100.0 77.1 100.0 100.0 6.3 20.2 0.1 100.0 100.0 27.6 11.6 100.0 0.0 0.0 0.0 100.0 0.0 0.0 100.0 45.5 100.0 100.0 0.0 100.0 0.0 84.2 80.8 61.2 83.5 80.6

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Table 14: Percentage of new HIV diagnoses (2013) 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 2013 Area Country* Number of cases with CD4 cell count Completeness (%) CD4 CD4 <200 (%) N 61 129 32 7 29 58 31 39 585 194 73 1 046 63 11 209 276 19 8 11 752 1 117 4 750 36 69 24 10 1 164 66 18 5 47 96 88 31 4 246 4 901 4 712 236 4 703 9 651 % 25.7 19.6 23.9 13.5 14.1 28.3 25.4 35.8 25.9 34.5 24.7 37.7 30.3 27.5 24.5 36.6 4.4 12.1 25.6 27.4 23.4 27.1 47.4 36.5 28.2 38.5 7.7 40.2 23.6 22.8 71.4 36.7 28.7 31.8 26.3 26.8 27.4 27.9 18.2 27.3 27.3 CD4 <350 (%) Hetero N 106 285 63 10 54 99 63 62 1 046 308 146 1 600 112 22 365 438 145 14 25 1 284 1 982 8 229 54 100 42 16 1 269 129 44 6 74 164 152 59 7 991 9 101 8 036 521 8 773 17 330 % 44.7 43.2 47.0 19.2 26.2 48.3 51.6 56.9 46.3 54.7 49.5 57.6 53.8 55.0 42.8 58.0 33.7 21.2 58.1 46.7 41.6 47.0 71.1 52.9 49.4 61.5 7.7 65.9 46.1 55.7 85.7 57.8 49.1 54.9 50.0 50.5 51.0 47.6 40.1 51.0 49.0 55.7 45.8 57.5 20.0 48.6 59.7 54.8 63.6 54.4 64.0 58.3 64.2 51.1 69.2 62.8 63.6 38.8 5.3 100.0 55.0 56.2 57.1 74.3 51.0 40.6 66.7 63.1 55.4 55.8 100.0 77.8 52.6 51.7 55.0 55.8 57.8 50.1 53.9 57.0 61.5 57.1 47.8 60.0 33.3 43.9 43.1 74.6 56.3 60.7 58.6 50.0 50.0 58.8 25.4 55.0 50.0 52.3 68.0 76.2 78.6 40.0 60.0 28.6 40.0 65.2 66.3 57.2 29.0 68.1 56.2 32.5 39.8 40.7 17.1 19.1 42.3 50.0 44.7 33.6 39.4 37.8 48.2 56.5 47.8 33.2 46.1 27.4 24.4 51.9 40.7 30.7 36.7 33.3 36.4 61.5 9.1 46.7 40.3 42.9 75.0 52.3 43.0 52.2 44.6 37.2 32.6 47.6 37.1 50.0 25.0 14.3 100.0 33.3 100.0 43.6 26.2 25.0 50.0 50.0 33.3 33.3 25.0 25.0 20.7 100.0 27.3 29.9 15.0 24.4 26.6 IDU MSM MTCT** CD4 < 350 per mm3 blood in 2013 (%)

EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine*** East Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region

237 659 134 52 206 205 122 109 2 257 563 295 2 778 208 40 853 755 430 66 43 2 747 4 767 17 526 76 189 85 26 13 408 280 79 7 128 334 277 118 15 837 17 857 16 879 1 299 17 205 35 383

91.5 59.6 68.7 96.3 87.7 89.5 37.9 71.2 56.9 70.0 89.7 77.3 63.0 78.4 90.8 69.5 87.8 79.5 97.7 84.2 80.0 60.7 68.5 81.1 17.0 96.3 86.7 86.6 60.7 16.5 70.0 88.9 59.1 39.2 9.1 89.3 40.0 63.4 32.0 40.4 48.3

* Country-specific comments are in Annex 5 ** Includes all ages *** Ukraine reported HIV data through the aggregate reporting format and could therefore not present CD4 cell data by transmission mode Hetero: heterosexual contact; IDU: injecting drug use; MSM: men who have sex with men; MTCT: mother-to-child transmission.

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 15: AIDS cases and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of start of reporting 1982 1983 1987 1986 1986 1986 1980 1992 1983 1980 1981 1981 1986 1985 1983 1982 1990 1988 1983 1986 1999 1983 1986 1983 1985 1985 1986 1981 1982 1981 2004 N 106 128 22 13 2 13 61 29 20 1 416 745 88 23 3 44 1 641 89 21 15 3 290 36 176 927 366 2 10 2 083 66 1 017 9 455 11 1 23 22 90 5 5 112 72 74 14 58 0 1 0 58 219 0 55 0 2 743 22 3 585 8 981 762 3 297 13 040 Rate 1.3 1.2 0.3 0.3 0.3 0.1 1.1 2.1 0.4 2.3 0.9 0.8 0.2 1.0 1.1 8.5 3.9 0.6 3.3 0.8 1.8 0.8 0.5 9.0 1.7 0.0 0.5 4.9 0.7 1.7 2.1 0.4 1.4 0.7 0.3 0.9 0.1 0.2 2.6 1.1 0.5 0.3 1.6 0.0 0.2 0.0 0.8 3.0 0.0 0.1 0.0 5.8 0.1 1.6 2.5 0.4 2.5 1.9 2005 N 117 156 19 21 11 13 44 29 26 1 369 724 102 33 1 42 1 530 119 10 11 3 358 32 153 913 348 3 10 1 868 46 976 9 087 7 39 20 163 6 10 140 122 100 23 60 1 1 1 54 191 0 32 0 4 217 11 5 198 8 633 721 4 931 14 285 Rate 1.4 1.5 0.2 0.5 1.5 0.1 0.8 2.1 0.5 2.2 0.9 0.9 0.3 0.3 1.0 7.9 5.3 0.3 2.4 0.7 2.2 0.7 0.4 8.8 1.6 0.1 0.5 4.3 0.5 1.6 2.0 0.2 0.0 1.2 0.2 1.7 0.2 0.5 3.2 1.8 0.7 0.5 1.4 3.0 0.2 3.4 0.7 2.6 0.0 0.0 0.0 8.9 0.0 2.3 2.4 0.4 3.8 2.1 2006 N 118 105 16 20 8 18 51 32 26 1 177 715 89 22 3 42 1 455 90 27 9 7 289 32 167 803 289 4 5 1 747 55 885 8 306 8 46 21 332 4 10 162 142 132 29 93 0 3 1 52 159 1 30 0 4 723 13 5 961 7 910 656 5 701 14 267 Rate 1.4 1.0 0.2 0.5 1.1 0.2 0.9 2.4 0.5 1.9 0.9 0.8 0.2 1.0 1.0 6.0 4.0 0.8 1.9 1.7 1.8 0.7 0.4 7.8 1.4 0.1 0.2 4.0 0.6 1.5 1.8 0.3 0.0 1.4 0.2 3.4 0.1 0.5 3.7 2.1 0.9 0.6 2.2 0.0 0.5 3.3 0.7 2.1 0.0 0.0 0.0 10.1 0.0 2.6 2.1 0.3 4.2 2.0 2007 N 129 105 21 11 12 23 32 57 33 1 012 645 90 23 0 35 1 404 81 28 11 2 303 9 141 693 288 6 9 1 632 62 841 7 738 18 1 59 200 311 4 10 183 98 175 24 218 0 3 0 42 174 31 30 0 4 573 35 6 189 7 311 641 5 975 13 927 Rate 1.6 1.0 0.3 0.3 1.6 0.2 0.6 4.2 0.6 1.6 0.8 0.8 0.2 0.0 0.8 4.5 3.7 0.9 2.3 0.5 1.9 0.2 0.4 6.7 1.4 0.1 0.4 3.6 0.7 1.4 1.6 0.6 1.2 1.8 2.3 3.2 0.1 0.5 4.2 1.4 1.1 0.5 5.3 0.0 0.5 0.0 0.6 2.3 0.4 0.0 0.0 9.8 0.1 2.7 1.9 0.3 4.3 2.0 2008 N 110 119 29 25 12 29 40 61 27 1 057 575 105 23 2 36 1 338 103 54 8 9 274 18 180 697 281 1 11 1 536 825 7 585 28 2 83 76 387 5 9 232 106 174 36 92 0 5 40 159 43 55 0 4 380 184 6 096 7 043 733 5 905 13 681 Rate 1.3 1.1 0.4 0.6 1.5 0.3 0.7 4.6 0.5 1.7 0.7 0.9 0.2 0.6 0.8 3.6 4.7 1.7 1.7 2.2 1.7 0.4 0.5 6.7 1.4 0.0 0.5 3.4 1.3 1.6 0.9 2.4 2.6 0.9 4.0 0.1 0.4 5.3 1.5 1.1 0.7 2.2 0.0 0.8 0.0 0.5 2.1 0.6 0.1 0.0 9.5 0.7 2.6 1.8 0.4 4.3 1.9

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia*** West San Marino Centre Serbia**** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

1993 2004 1988 1995 1991 1986 1989 1989 1981 1993 1999 1989 1985 1990 1986 1985 1980 1998 1985 2002 1988 1992

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about AIDS cases were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 34 473 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 *** Excluding a cumulative 49 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

2009 N 102 121 30 22 8 23 36 38 23 950 614 100 23 0 35 1 205 101 37 3 1 269 18 130 569 257 4 18 1 411 650 6 798 33 84 109 502 2 2 284 100 173 75 262 0 8 55 149 11 67 0 4 437 129 6 482 6 356 682 6 242 13 280 Rate 1.2 1.1 0.4 0.5 1.0 0.2 0.7 2.8 0.4 1.5 0.8 0.9 0.2 0.0 0.8 2.1 4.7 1.2 0.6 0.2 1.6 0.4 0.3 5.5 1.3 0.1 0.9 3.1 1.1 1.4 1.0 0.0 2.6 1.2 5.2 0.1 0.1 6.5 1.4 1.1 1.4 6.4 0.0 1.3 0.0 0.8 1.9 0.1 0.1 0.0 9.7 0.5 2.8 1.6 0.4 4.5 1.8

2010 N 94 102 32 21 10 26 44 26 32 967 478 103 28 1 38 1 143 132 33 8 6 286 22 173 653 247 2 7 1 193 659 6 566 24 94 210 549 6 6 339 74 264 130 306 0 7 51 161 75 60 0 5 861 220 8 437 6 064 700 8 239 15 003 Rate 1.1 0.9 0.4 0.5 1.2 0.2 0.8 2.0 0.6 1.5 0.6 0.9 0.3 0.3 0.8 1.9 6.2 1.1 1.6 1.4 1.7 0.5 0.5 6.3 1.2 0.0 0.3 2.6 1.1 1.3 0.8 0.0 2.9 2.3 5.8 0.2 0.3 7.7 1.0 1.7 2.4 7.5 0.0 1.1 0.0 0.7 2.1 1.0 0.1 0.0 12.8 3.6 1.5 0.4 5.9 2.0

2011 N 66 86 40 26 5 24 59 38 25 835 473 97 32 2 47 1 049 112 21 11 5 227 19 184 576 299 4 15 1 047 417 5 841 40 1 87 195 593 7 8 395 108 226 90 439 0 2 1 54 123 94 80 0 9 189 11 732 5 274 820 11 479 17 573 Rate 0.8 0.8 0.5 0.6 0.6 0.2 1.1 2.9 0.5 1.3 0.6 0.9 0.3 0.6 1.0 1.8 5.4 0.7 2.1 1.2 1.4 0.4 0.5 5.6 1.5 0.1 0.7 2.3 0.7 1.2 1.4 1.3 2.7 2.1 6.3 0.2 0.4 8.9 1.4 1.4 1.7 10.7 0.0 0.3 3.1 0.7 1.6 1.2 0.1 0.0 20.2 5.6 1.3 0.4 10.3 2.5

2012 N 32 90 65 28 7 29 41 36 19 782 448 120 48 1 35 1 061 142 38 7 6 248 25 157 525 293 7 11 916 424 5 641 40 133 235 616 4 10 359 78 234 88 183 0 7 2 51 84 90 95 0 10 073 12 382 4 944 852 12 227 18 023 Rate 0.4 0.8 0.9 0.7 0.8 0.3 0.7 2.7 0.4 1.2 0.5 1.1 0.5 0.3 0.8 1.8 6.9 1.3 1.3 1.4 1.5 0.5 0.4 5.0 1.5 0.1 0.5 2.0 0.7 1.1 1.4 0.0 4.1 2.5 6.5 0.1 0.5 8.1 1.0 1.4 1.6 4.5 0.0 1.1 6.0 0.7 1.1 1.1 0.1 0.0 22.2 5.8 1.2 0.4 10.9 2.5

2013 N 70 78 71 17 3 26 38 24 20 404 241 118 42 1 26 1 016 133 44 9 1 199 28 160 322 338 6 11 604 319 4 369 56 2 143 189 442 7 10 303 39 260 67 234 0 7 0 44 71 91 93 9 362 11 420 3 606 891 11 292 15 789 Rate 0.8 0.7 1.0 0.4 0.3 0.2 0.7 1.8 0.4 0.6 0.3 1.1 0.4 0.3 0.6 1.7 6.6 1.5 1.7 0.2 1.2 0.6 0.4 3.1 1.7 0.1 0.5 1.6 0.5 0.9 2.0 2.6 4.4 2.0 4.7 0.2 0.5 6.8 0.5 1.6 1.2 5.7 0.0 1.1 0.0 0.6 0.9 1.1 0.1 20.6 5.3 0.9 0.5 10.0 2.2

Cumulative Country* total** 3 866 4 435 465 418 248 400 2 927 414 616 69 004 29 800 3 522 745 67 1 189 66 336 1 353 378 278 103 4 107 1 069 3 082 19 075 13 274 74 212 83 776 2 168 28 224 341 625 311 8 834 1 319 4 070 127 133 2 664 2 869 1 970 597 2 051 49 78 0 23 1 692 9 534 437 1 109 1 65 733 651 90 083 333 045 22 368 82 472 437 885 EU/EEA Austria Belgium Bulgaria Cyprus Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Moldova Monaco Montenegro Russia San Marino Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 15a: AIDS cases and rates per 100 000 population, by country and year of statistics (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* 2004 N 106 128 22 14 2 13 61 29 20 1 416 745 88 23 3 44 1 641 89 21 15 2 290 36 176 927 366 2 10 2 083 65 1 017 9 454 11 3 21 22 90 16 5 112 72 74 14 53 1 0 58 219 47 0 2 743 22 3 583 8 981 766 3 290 13 037 2005 N 117 156 19 21 11 13 44 29 26 1 369 724 102 33 1 42 1 530 119 10 11 4 358 32 153 913 348 3 10 1 868 45 976 9 087 6 0 41 20 163 8 9 140 122 100 23 64 1 1 1 54 191 37 0 4 217 11 5 198 8 633 726 4 931 14 285 2006 N 118 105 16 21 8 18 51 32 26 1 177 715 89 22 3 42 1 455 90 27 9 7 289 32 167 803 289 4 5 1 747 47 885 8 299 8 0 46 21 331 8 9 162 142 132 27 94 0 2 1 52 159 35 0 4 723 13 5 965 7 902 664 5 698 14 264 2007 N 129 105 21 12 12 23 32 57 33 1 012 645 90 23 0 35 1 404 81 28 11 2 303 9 141 693 288 6 9 1 632 73 841 7 750 17 1 59 200 308 4 11 183 98 175 22 214 0 4 0 42 174 32 29 0 4 573 35 6 181 7 322 642 5 967 13 931 2008 N 110 119 29 24 12 29 40 61 27 1 057 575 105 23 2 36 1 338 103 54 8 9 274 18 180 697 281 1 11 1 536 825 7 584 24 1 83 76 351 5 10 232 106 174 36 82 0 7 0 40 159 43 55 0 4 380 184 6 096 7 043 733 5 905 13 681 2009 N 102 121 30 20 8 23 36 38 23 950 614 100 23 0 35 1 205 101 37 3 1 269 18 130 569 257 4 18 1 411 650 6 796 32 0 84 109 532 2 2 284 100 173 77 276 0 6 0 55 149 11 67 0 4 437 129 6 482 6 356 682 6 242 13 280

Rate 1.3 1.2 0.3 0.3 0.3 0.1 1.1 2.1 0.4 2.3 0.9 0.8 0.2 1.0 1.1 8.5 3.9 0.6 3.3 0.5 1.8 0.8 0.5 9.0 1.7 0.0 0.5 4.9 0.7 1.7 2.1 0.4 4.1 0.7 0.3 0.9 0.4 0.2 2.6 1.1 0.5 0.3 1.5 0.0 0.2 0.0 0.8 3.0 0.1 0.0 5.8 0.1 1.6 2.5 0.4 2.5 1.9

Rate 1.4 1.5 0.2 0.5 1.5 0.1 0.8 2.1 0.5 2.2 0.9 0.9 0.3 0.3 1.0 7.9 5.3 0.3 2.4 1.0 2.2 0.7 0.4 8.8 1.6 0.1 0.5 4.3 0.5 1.6 2.0 0.2 0.0 1.3 0.2 1.7 0.2 0.4 3.2 1.8 0.7 0.5 1.5 3.0 0.2 3.4 0.7 2.6 0.1 0.0 8.9 0.0 2.3 2.4 0.4 3.8 2.1

Rate 1.4 1.0 0.2 0.5 1.1 0.2 0.9 2.4 0.5 1.9 0.9 0.8 0.2 1.0 1.0 6.0 4.0 0.8 1.9 1.7 1.8 0.7 0.4 7.8 1.4 0.1 0.2 4.0 0.5 1.5 1.8 0.3 0.0 1.4 0.2 3.4 0.2 0.4 3.7 2.1 0.9 0.5 2.3 0.0 0.3 3.3 0.7 2.1 0.0 0.0 10.1 0.0 2.6 2.1 0.4 4.4 2.1

Rate 1.6 1.0 0.3 0.3 1.6 0.2 0.6 4.2 0.6 1.6 0.8 0.8 0.2 0.0 0.8 4.5 3.7 0.9 2.3 0.5 1.9 0.2 0.4 6.7 1.4 0.1 0.4 3.6 0.8 1.4 1.6 0.5 1.2 1.8 2.3 3.2 0.1 0.5 4.2 1.4 1.1 0.4 5.2 0.0 0.6 0.0 0.6 2.3 0.5 0.0 0.0 9.8 0.1 2.7 1.9 0.3 4.3 2.0

Rate 1.3 1.1 0.4 0.6 1.5 0.3 0.7 4.6 0.5 1.7 0.7 0.9 0.2 0.6 0.8 3.6 4.7 1.7 1.7 2.2 1.7 0.4 0.5 6.7 1.4 0.0 0.5 3.4 1.3 1.6 0.8 1.2 2.6 0.9 3.7 0.1 0.5 5.3 1.5 1.1 0.7 2.0 0.0 1.1 0.0 0.5 2.1 0.6 0.1 0.0 9.5 0.7 2.6 1.8 0.4 4.3 1.9

Rate 1.2 1.1 0.4 0.5 1.0 0.2 0.7 2.8 0.4 1.5 0.8 0.9 0.2 0.0 0.8 2.1 4.7 1.2 0.6 0.2 1.6 0.4 0.3 5.5 1.3 0.1 0.9 3.1 1.1 1.4 1.0 0.0 2.6 1.2 5.6 0.1 0.1 6.5 1.4 1.1 1.5 6.7 0.0 1.0 0.0 0.8 1.9 0.1 0.1 0.0 9.7 0.5 2.8 1.6 0.4 4.5 1.8

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia*** West San Marino Centre Serbia**** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about AIDS cases were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 34 473 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 49 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

2010 N 94 102 32 18 10 26 44 25 32 967 478 103 28 1 38 1 143 132 33 8 6 286 22 173 653 247 2 7 1 193 659 6 562 25 0 94 210 475 6 8 339 74 256 120 290 0 7 0 51 161 75 60 0 5 861 220 8 437 6 064 700 8 239 15 003

Rate 1.1 0.9 0.4 0.4 1.2 0.2 0.8 1.9 0.6 1.5 0.6 0.9 0.3 0.3 0.8 1.9 6.2 1.1 1.6 1.4 1.7 0.5 0.5 6.3 1.2 0.0 0.3 2.6 1.1 1.3 0.8 0.0 2.9 2.3 5.0 0.2 0.4 7.7 1.0 1.6 2.2 7.1 0.0 1.1 0.0 0.7 2.1 1.0 0.1 0.0 12.8 0.8 3.5 1.5 0.4 5.8 2.0

2011 N 66 86 40 26 5 24 59 39 25 835 473 97 32 2 47 1 049 112 21 11 5 227 19 184 576 299 4 15 1 047 417 5 842 38 1 87 195 590 7 6 395 108 234 95 420 0 2 1 54 123 93 80 0 9 189 11 718 5 274 816 11 470 17 560

Rate 0.8 0.8 0.5 0.6 0.6 0.2 1.1 2.9 0.5 1.3 0.6 0.9 0.3 0.6 1.0 1.8 5.4 0.7 2.1 1.2 1.4 0.4 0.5 5.6 1.5 0.1 0.7 2.3 0.7 1.2 1.3 1.3 2.7 2.1 6.3 0.2 0.3 8.9 1.4 1.5 1.8 10.3 0.0 0.3 3.1 0.7 1.6 1.2 0.1 0.0 20.2 5.6 1.3 0.4 10.3 2.5

2012 N 32 90 65 27 7 29 41 36 19 782 448 120 48 1 35 1 061 142 38 7 6 248 25 157 525 293 7 11 916 424 5 640 46 0 133 235 598 4 9 359 78 234 95 222 0 7 2 51 84 87 95 0 10 073 12 412 4 944 856 12 252 18 052

Rate 0.4 0.8 0.9 0.6 0.8 0.3 0.7 2.7 0.4 1.2 0.5 1.1 0.5 0.3 0.8 1.8 6.9 1.3 1.3 1.4 1.5 0.5 0.4 5.0 1.5 0.1 0.5 2.0 0.7 1.1 1.6 0.0 4.1 2.5 6.3 0.1 0.4 8.1 1.0 1.4 1.7 5.4 0.0 1.1 6.0 0.7 1.1 1.1 0.1 0.0 22.2 5.8 1.2 0.5 10.9 2.5

2013 N 70 78 71 16 3 26 38 24 20 404 241 118 42 1 26 1 016 133 44 9 1 199 28 160 322 338 6 11 604 319 4 368 61 2 143 189 547 7 11 303 39 260 67 234 0 7 0 44 71 94 93 9 362 11 534 3 606 896 11 400 15 902

Rate 0.8 0.7 1.0 0.4 0.3 0.2 0.7 1.8 0.4 0.6 0.3 1.1 0.4 0.3 0.6 1.7 6.6 1.5 1.7 0.2 1.2 0.6 0.4 3.1 1.7 0.1 0.5 1.6 0.5 0.9 2.2 2.6 4.4 2.0 5.8 0.2 0.5 6.8 0.5 1.6 1.2 5.7 0.0 1.1 0.0 0.6 0.9 1.1 0.1 20.6 5.4 0.9 0.5 10.1 2.2

Cumulative Country* total** 3 866 4 435 465 418 248 400 2 927 414 616 69 004 29 800 3 522 745 67 1 189 66 336 1 353 378 278 103 4 107 1 069 3 082 19 075 13 274 74 212 83 776 2 168 28 224 341 625 311 8 834 1 319 4 070 127 133 2 664 2 869 1 970 597 2 051 49 78 23 1 692 9 534 437 1 109 1 65 733 651 90 083 333 045 22 368 82 472 437 885 EU/EEA Austria Belgium Bulgaria Cyprus Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Moldova Monaco Montenegro Russia San Marino Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 16: AIDS cases in males and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* 2004 N 68 84 16 12 1 11 41 18 14 951 600 73 19 2 29 1 216 63 17 10 3 225 26 132 740 214 1 9 1 600 46 597 6 838 10 1 19 22 61 4 3 88 48 57 12 46 0 1 0 47 153 46 0 1 823 21 2 462 6 527 526 2 247 9 300 2005 N 88 83 16 19 6 8 30 15 25 922 593 78 29 1 28 1 144 74 7 6 1 271 18 119 722 202 2 8 1 442 35 618 6 610 6 0 30 16 114 4 8 105 88 78 20 49 1 1 1 46 138 27 0 2 986 10 3 728 6 333 501 3 504 10 338 2006 N 95 65 12 14 7 13 31 22 20 813 591 64 15 2 34 1 081 63 22 6 5 229 24 130 595 161 4 5 1 351 33 528 6 035 5 0 37 19 221 3 9 129 106 88 23 53 0 3 1 40 113 1 26 0 3 392 9 4 278 5 787 447 4 079 10 313 2007 N 101 65 18 10 8 18 22 46 22 691 516 69 17 0 18 1 076 59 26 8 2 233 6 108 527 170 4 7 1 275 40 555 5 717 16 1 46 169 210 4 9 138 76 110 24 137 0 3 0 27 125 30 25 0 3 208 27 4 285 5 428 444 4 230 10 102 2008 N 89 76 20 24 10 22 33 44 24 716 480 93 21 2 27 988 77 45 5 9 221 11 139 520 154 0 9 1 168 510 5 537 21 2 62 68 254 4 5 179 68 124 24 59 0 3 0 30 112 35 48 0 3 060 141 4 299 5 154 510 4 172 9 836 2009 N 70 76 22 20 8 17 25 26 15 673 500 80 17 0 27 909 67 28 2 1 228 13 99 416 161 3 16 1 080 442 5 041 25 0 57 90 309 2 2 208 65 111 61 166 0 6 0 47 107 10 60 0 3 019 92 4 437 4 729 505 4 244 9 478

Rate 1.7 1.7 0.4 0.6 0.3 0.2 1.5 2.8 0.5 3.2 1.5 1.3 0.4 1.4 1.4 13.1 6.0 1.1 4.5 1.5 2.8 1.1 0.7 14.8 2.1 0.0 0.9 7.6 1.0 2.1 3.1 0.6 2.7 1.2 0.5 1.3 0.2 0.3 4.3 1.5 0.8 0.5 2.7 0.0 0.3 0.0 1.3 4.2 0.1 0.0 8.3 0.2 2.2 3.7 0.6 3.3 2.8

Rate 2.2 1.6 0.4 0.9 1.7 0.2 1.1 2.4 1.0 3.0 1.5 1.4 0.6 0.7 1.4 12.1 7.2 0.4 2.6 0.5 3.4 0.8 0.6 14.4 2.0 0.1 0.8 6.7 0.8 2.1 2.9 0.4 0.0 1.9 0.4 2.5 0.2 0.8 5.1 2.7 1.1 0.8 2.4 6.2 0.3 6.9 1.3 3.8 0.1 0.0 13.8 0.1 3.2 3.5 0.5 5.2 3.0

Rate 2.4 1.3 0.3 0.7 1.9 0.3 1.2 3.5 0.8 2.7 1.5 1.2 0.3 1.3 1.6 9.2 6.2 1.4 2.6 2.5 2.8 1.0 0.7 11.9 1.6 0.2 0.5 6.2 0.7 1.8 2.6 0.3 0.0 2.4 0.5 4.9 0.2 0.9 6.2 3.2 1.2 0.9 2.6 0.0 1.0 6.8 1.1 3.1 0.0 0.1 0.0 15.8 0.1 3.7 3.2 0.5 6.0 3.0

Rate 2.5 1.3 0.5 0.5 2.2 0.4 0.8 7.4 0.9 2.2 1.3 1.3 0.4 0.0 0.8 7.2 5.8 1.7 3.4 1.0 2.9 0.3 0.6 10.5 1.7 0.2 0.7 5.8 0.9 1.9 2.5 1.0 2.4 3.0 4.0 4.6 0.2 0.9 6.7 2.2 1.5 0.9 6.8 0.0 1.0 0.0 0.8 3.4 0.8 0.1 0.0 15.1 0.2 3.7 2.9 0.5 6.2 2.9

Rate 2.2 1.5 0.5 1.2 2.6 0.4 1.2 7.1 0.9 2.3 1.2 1.7 0.4 1.2 1.2 5.5 7.6 3.0 2.1 4.4 2.7 0.5 0.8 10.4 1.6 0.0 0.9 5.2 1.7 2.4 1.3 4.6 4.0 1.6 5.6 0.2 0.5 8.6 1.9 1.7 0.9 3.0 0.0 1.0 0.0 0.8 3.0 1.0 0.1 0.0 14.4 1.0 3.7 2.7 0.6 6.1 2.8

Rate 1.7 1.4 0.6 1.0 2.1 0.3 0.9 4.2 0.6 2.2 1.2 1.5 0.4 0.0 1.2 3.2 6.7 1.9 0.8 0.5 2.8 0.5 0.5 8.3 1.6 0.1 1.6 4.8 1.5 2.1 1.6 0.0 3.6 2.1 6.9 0.1 0.2 10.0 1.8 1.5 2.3 8.3 0.0 1.9 0.0 1.3 2.8 0.3 0.2 0.0 14.3 0.7 3.8 2.4 0.5 6.2 2.6

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia*** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 32 cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

2010 N 73 59 21 20 7 20 34 21 23 665 395 84 26 1 27 843 86 27 4 4 226 20 132 460 135 2 7 925 433 4 780 17 0 73 195 336 6 6 245 42 194 111 179 0 7 0 44 120 65 46 0 3 988 163 5 837 4 438 496 5 683 10 617

Rate 1.8 1.1 0.6 1.0 1.8 0.4 1.2 3.4 0.9 2.1 1.0 1.5 0.6 0.6 1.2 2.9 8.9 1.9 1.6 1.9 2.8 0.8 0.7 9.2 1.4 0.1 0.7 4.1 1.4 2.0 1.1 0.0 4.6 4.4 7.6 0.3 0.6 11.7 1.1 2.5 4.2 9.0 0.0 2.3 0.0 1.2 3.1 1.7 0.1 0.0 19.0 1.2 4.9 2.2 0.5 8.2 2.9

2011 N 47 54 38 25 2 16 40 31 18 610 400 81 27 1 34 798 80 15 7 3 178 17 142 429 200 4 12 815 286 4 410 31 1 65 171 369 4 5 277 72 150 69 269 0 2 1 47 85 77 65 0 6 141 7 901 3 977 620 7 714 12 311

Rate 1.1 1.0 1.1 1.2 0.5 0.3 1.5 5.0 0.7 1.9 1.0 1.5 0.6 0.6 1.5 2.8 8.4 1.1 2.7 1.5 2.2 0.7 0.8 8.6 2.1 0.2 1.2 3.6 0.9 1.8 2.2 2.5 4.1 3.8 8.4 0.2 0.5 13.1 1.9 1.9 2.6 13.5 0.0 0.7 6.4 1.3 2.2 2.0 0.2 0.0 29.2 7.7 2.0 0.7 14.6 3.6

2012 N 24 54 47 26 6 23 35 25 16 541 356 99 45 1 27 776 102 28 5 5 194 23 120 376 212 7 10 701 293 4 177 27 0 95 209 394 4 8 248 57 180 65 93 0 7 2 45 57 67 83 0 6 498 8 139 3 642 670 8 004 12 316

Rate 0.6 1.0 1.3 1.3 1.4 0.4 1.3 4.0 0.6 1.7 0.9 1.8 1.0 0.6 1.2 2.7 10.9 2.0 1.9 2.4 2.3 0.9 0.6 7.5 2.2 0.3 1.0 3.1 0.9 1.7 1.9 0.0 6.0 4.6 9.0 0.2 0.8 11.7 1.5 2.3 2.4 4.8 0.0 2.3 12.3 1.3 1.5 1.7 0.2 0.0 31.0 7.9 1.8 0.7 15.1 3.5

2013 N 51 56 53 14 2 21 29 18 17 293 190 101 38 1 19 763 90 31 8 1 164 19 130 230 242 6 10 468 232 3 297 40 1 99 162 292 6 9 219 30 191 49 128 0 7 0 38 50 63 74 6 013 7 471 2 723 690 7 355 10 768

Rate 1.2 1.0 1.5 0.7 0.5 0.4 1.0 2.9 0.6 0.9 0.5 1.9 0.8 0.6 0.8 2.6 9.7 2.3 3.0 0.5 2.0 0.7 0.7 4.6 2.5 0.2 1.0 2.5 0.7 1.4 2.8 2.6 6.2 3.5 6.6 0.3 0.9 10.3 0.8 2.4 1.8 6.6 0.0 2.3 0.0 1.1 1.3 1.5 0.2 28.7 7.2 1.4 0.7 13.8 3.1

Cumulative Country* total** 2 982 3 021 348 367 193 326 2 488 306 504 54 412 25 529 2 968 655 58 915 51 154 950 306 218 89 3 220 835 2 429 15 224 7 686 63 185 66 761 1 773 22 150 268 115 234 6 621 1 158 2 622 102 97 1 977 2 082 1 407 477 1 252 38 65 21 1 279 7 097 349 927 0 38 305 494 60 610 263 545 14 956 50 224 328 725 EU/EEA Austria Belgium Bulgaria Cyprus Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Moldova Monaco Montenegro Russia San Marino Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 17: AIDS cases in females and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* 2004 N 38 44 6 1 1 2 20 11 6 465 145 15 4 1 15 425 26 4 5 0 65 10 44 187 152 1 1 483 20 420 2 617 1 0 4 0 29 1 2 24 24 17 2 12 0 0 0 11 66 9 0 920 1 1 123 2 454 236 1 050 3 740 2005 N 29 73 3 2 5 5 14 14 1 446 131 24 4 0 14 386 45 3 5 2 87 14 34 191 146 1 2 426 11 358 2 476 1 0 9 4 49 2 2 35 34 21 3 11 0 0 0 8 53 5 0 1 231 1 1 469 2 299 220 1 426 3 945 2006 N 23 40 4 6 1 5 20 10 6 362 124 25 7 1 8 374 27 5 3 2 60 8 37 208 128 0 0 396 22 357 2 269 3 0 9 2 111 1 1 33 36 44 6 40 0 0 0 12 46 4 0 1 331 4 1 683 2 121 209 1 622 3 952 2007 N 28 40 3 1 4 5 10 11 11 316 129 21 6 0 15 328 22 2 3 0 70 3 33 166 118 2 2 357 22 286 2 014 2 0 13 31 101 0 1 45 22 65 0 81 0 0 0 15 49 1 5 0 1 365 8 1 804 1 876 197 1 745 3 818 2008 N 21 43 9 1 2 7 7 17 3 338 95 12 2 0 9 350 26 9 3 0 53 7 41 177 127 1 2 368 315 2 045 7 0 21 8 133 1 4 53 38 50 9 33 0 2 0 8 47 8 7 0 1 320 43 1 792 1 886 221 1 730 3 837 2009 N 32 45 8 2 6 11 12 8 275 114 20 6 0 8 296 34 9 1 0 41 5 31 153 96 1 2 331 208 1 755 8 0 27 19 193 0 0 76 35 62 14 96 0 2 0 10 42 1 7 0 1 418 37 2 047 1 625 179 1 998 3 802

Rate 0.9 0.8 0.1 0.0 0.3 0.0 0.7 1.5 0.2 1.4 0.3 0.3 0.1 0.7 0.7 4.3 2.1 0.2 2.2 0.0 0.8 0.4 0.2 3.5 1.4 0.0 0.1 2.2 0.4 1.4 1.1 0.1 0.0 0.2 0.0 0.6 0.1 0.2 1.1 0.7 0.2 0.1 0.6 0.0 0.0 0.0 0.3 1.8 0.0 0.0 3.6 0.0 0.9 1.3 0.3 1.4 1.1

Rate 0.7 1.4 0.1 0.1 1.3 0.1 0.5 1.9 0.0 1.4 0.3 0.4 0.1 0.0 0.7 3.8 3.7 0.2 2.1 1.0 1.1 0.6 0.2 3.6 1.3 0.0 0.2 1.9 0.2 1.2 1.1 0.1 0.0 0.5 0.1 0.9 0.1 0.2 1.5 1.0 0.3 0.1 0.5 0.0 0.0 0.0 0.2 1.4 0.0 0.0 4.9 0.0 1.2 1.2 0.2 1.9 1.1

Rate 0.5 0.7 0.1 0.3 0.3 0.1 0.7 1.4 0.2 1.1 0.3 0.4 0.1 0.7 0.4 3.0 2.2 0.3 1.3 1.0 0.7 0.3 0.2 3.9 1.2 0.0 0.0 1.8 0.5 1.2 1.0 0.2 0.0 0.5 0.0 2.2 0.1 0.1 1.4 1.1 0.6 0.2 1.9 0.0 0.0 0.0 0.3 1.2 0.0 0.0 5.3 0.0 1.4 1.1 0.2 2.2 1.1

Rate 0.7 0.7 0.1 0.0 1.0 0.1 0.4 1.5 0.4 1.0 0.3 0.4 0.1 0.0 0.7 2.1 1.8 0.1 1.2 0.0 0.8 0.1 0.2 3.1 1.1 0.1 0.2 1.6 0.5 0.9 0.8 0.1 0.0 0.8 0.7 2.0 0.0 0.1 2.0 0.6 0.8 0.0 3.8 0.0 0.0 0.0 0.4 1.3 0.0 0.0 0.0 4.1 0.1 1.5 1.0 0.2 2.4 1.0

Rate 0.5 0.8 0.2 0.0 0.5 0.1 0.3 2.4 0.1 1.0 0.2 0.2 0.0 0.0 0.4 1.8 2.2 0.5 1.2 0.0 0.6 0.3 0.2 3.3 1.2 0.0 0.2 1.6 1.0 0.8 0.4 0.0 1.3 0.2 2.6 0.1 0.4 2.3 1.1 0.6 0.3 1.5 0.0 0.6 0.0 0.2 1.2 0.2 0.0 0.0 5.3 0.3 1.5 1.0 0.2 2.3 1.0

Rate 0.7 0.8 0.2 0.1 0.0 0.1 0.4 1.7 0.3 0.8 0.3 0.4 0.1 0.0 0.4 1.0 2.9 0.5 0.4 0.0 0.5 0.2 0.2 2.9 0.9 0.0 0.2 1.4 0.7 0.7 0.5 0.0 1.6 0.4 3.8 0.0 0.0 3.3 1.0 0.8 0.5 4.6 0.0 0.6 0.0 0.3 1.1 0.0 0.0 0.0 5.7 0.3 1.7 0.8 0.2 2.7 1.0

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia*** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 17 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

2010 N 21 43 11 1 3 6 10 5 9 300 83 19 2 0 11 300 46 6 4 2 60 2 41 193 112 0 0 268 226 1 784 7 0 21 15 213 0 0 94 32 70 19 127 0 0 0 7 41 10 14 0 1 823 57 2 550 1 624 204 2 506 4 334

Rate 0.5 0.8 0.3 0.0 0.7 0.1 0.4 0.7 0.3 0.9 0.2 0.3 0.0 0.0 0.5 1.0 4.0 0.4 1.6 1.0 0.7 0.1 0.2 3.6 1.1 0.0 0.0 1.1 0.7 0.7 0.4 0.0 1.3 0.3 4.2 0.0 0.0 4.1 0.9 0.8 0.7 6.1 0.0 0.0 0.0 0.2 1.0 0.3 0.0 0.0 7.6 0.4 2.1 0.8 0.2 3.3 1.1

2011 N 19 32 2 1 3 8 19 7 7 224 73 16 5 1 13 251 32 6 4 2 49 2 42 147 99 0 3 232 131 1 430 9 0 22 24 224 3 0 118 36 76 21 170 0 0 0 7 38 17 15 0 3 048 3 828 1 296 197 3 765 5 258

Rate 0.4 0.6 0.1 0.0 0.7 0.1 0.7 1.0 0.3 0.7 0.2 0.3 0.1 0.6 0.6 0.8 2.8 0.4 1.6 1.0 0.6 0.1 0.2 2.7 1.0 0.0 0.3 1.0 0.4 0.6 0.6 0.0 1.3 0.5 4.5 0.2 0.0 5.1 0.9 0.9 0.8 8.1 0.0 0.0 0.0 0.2 1.0 0.4 0.0 0.0 12.4 3.6 0.6 0.2 6.4 1.5

2012 N 8 36 18 2 1 6 6 11 3 239 92 21 3 0 8 285 40 10 2 1 54 2 37 149 81 0 1 215 131 1 462 13 0 38 26 222 0 2 111 21 54 23 90 0 0 0 6 27 23 12 0 3 575 4 243 1 300 182 4 223 5 705

Rate 0.2 0.6 0.5 0.1 0.2 0.1 0.2 1.6 0.1 0.7 0.2 0.4 0.1 0.0 0.3 0.9 3.6 0.6 0.8 0.5 0.6 0.1 0.2 2.7 0.8 0.0 0.1 0.9 0.4 0.6 0.9 0.0 2.3 0.6 4.4 0.0 0.2 4.8 0.5 0.6 0.8 4.2 0.0 0.0 0.0 0.2 0.7 0.6 0.0 0.0 14.6 4.0 0.6 0.2 7.2 1.6

2013 N 19 22 18 3 1 5 9 6 3 109 51 17 4 0 7 253 43 13 1 0 35 9 30 92 96 0 1 136 87 1 070 16 1 44 27 150 1 1 84 9 69 18 106 0 0 0 6 21 28 19 3 349 3 949 881 201 3 937 5 019

Rate 0.4 0.4 0.5 0.1 0.2 0.1 0.3 0.9 0.1 0.3 0.1 0.3 0.1 0.0 0.3 0.8 3.9 0.8 0.4 0.0 0.4 0.4 0.2 1.7 0.9 0.0 0.1 0.7 0.3 0.4 1.1 2.7 2.6 0.6 3.0 0.1 0.1 3.6 0.2 0.8 0.6 5.0 0.0 0.0 0.0 0.2 0.5 0.7 0.1 13.7 3.6 0.4 0.2 6.7 1.4

Cumulative Country* total** 884 1 412 117 51 55 74 439 108 112 14 569 4 271 554 90 9 272 15 182 403 72 60 14 887 234 653 3 850 5 588 11 27 17 015 395 6 074 73 482 77 2 213 161 1 448 23 30 687 787 559 117 799 11 13 0 2 413 2 437 88 182 1 9 972 157 18 179 69 472 7 404 14 785 91 661 EU/EEA Austria Belgium Bulgaria Cyprus Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Moldova Monaco Montenegro Russia San Marino Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan Total non-EU/EEA Geographic area West Centre East Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 18: AIDS cases in men infected through sex with men, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of diagnosis 2008 2009 28 22 4 12 4 7 16 1 10 256 266 56 16 1 8 299 3 7 0 1 130 6 27 86 11 0 7 320 227 1 831 8 1 3 1 0 0 2 7 10 1 0 0 0 2 0 15 48 11 0 10 119 1 791 126 33 1 950 28 34 4 17 4 10 12 0 6 261 275 49 13 0 10 294 7 1 1 0 134 7 26 56 20 1 10 312 188 1 780 7 0 0 1 0 0 1 3 14 0 0 2 0 4 0 25 41 2 0 10 110 1 722 144 24 1 890 Cumulative total** 1 271 1 412 67 220 103 192 1 724 26 286 27 728 17 580 1 935 514 43 368 11 323 100 68 122 41 1 819 486 588 2 397 201 41 115 12 560 1 085 14 766 99 181 31 4 15 14 17 28 32 83 583 3 1 10 21 31 11 357 3 214 0 93 0 189 1 4 738 100 779 2 613 527 103 919

2004 24 27 1 2 0 5 19 2 6 311 372 44 15 2 5 310 5 7 6 0 119 10 23 73 3 1 4 345 16 235 1 992 1 0 0 0 0 0 0 5 8 0 0 1 0 1 0 8 57 2 0 3 86 1 989 66 23 2 078

2005 28 40 7 3 2 6 18 1 10 336 339 49 19 0 6 314 4 0 2 1 150 11 23 78 8 1 5 291 8 248 2 008 0 0 1 0 0 1 3 5 24 0 0 0 1 0 1 16 48 4 0 8 112 2 003 98 19 2 120

2006 33 25 4 11 2 3 17 1 8 292 338 37 10 2 8 309 3 1 2 3 127 11 14 72 8 3 3 302 9 243 1 901 0 0 0 0 0 0 2 3 18 0 0 0 0 2 0 14 43 4 0 8 94 1 899 80 16 1 995

2007 39 25 4 6 4 8 13 0 13 243 309 42 12 0 7 315 3 2 2 0 137 2 19 61 6 2 6 298 17 251 1 846 0 1 1 2 0 0 2 3 10 0 1 2 0 2 0 12 62 5 0 9 112 1 847 88 23 1 958

2010 25 31 5 19 4 10 15 0 7 247 239 63 23 0 13 251 10 0 2 0 129 9 29 75 15 1 7 333 200 1 762 2 0 1 4 2 5 1 10 12 0 0 2 0 5 0 21 60 3 0 10 138 1 711 150 39 1 900

2011 21 29 2 18 0 10 13 0 6 231 208 50 24 0 17 265 7 2 5 1 109 9 45 83 18 3 7 309 146 1 638 2 1 2 1 6 2 4 11 16 1 0 2 0 2 1 22 34 0 31 138 1 554 159 63 1 776

2012 9 22 8 22 1 11 13 1 2 178 195 48 37 0 14 261 4 2 3 0 119 10 25 73 11 3 7 288 152 1 519 2 0 2 1 3 4 3 11 8 0 0 0 0 1 2 28 28 0 45 138 1 425 163 69 1 657

2013 22 20 12 11 2 12 11 0 4 118 102 39 30 0 6 282 10 5 6 1 103 15 44 41 17 2 5 195 105 1 220 4 1 5 3 3 3 3 16 7 1 0 0 0 3 0 20 22 12 50 153 1 100 180 93 1 373

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia*** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 2 cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Table 19: AIDS cases in persons infected through injecting drug use, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of diagnosis 2008 2009 27 8 4 0 0 5 6 41 1 85 50 3 0 0 11 317 60 35 0 0 7 2 74 203 1 0 0 535 27 1 502 0 1 30 50 209 0 0 134 24 118 27 55 0 0 0 5 19 27 1 0 2 868 116 3 684 1 326 90 3 770 5 186 16 5 7 0 0 2 3 26 2 56 47 5 0 0 8 275 49 20 0 0 9 1 55 155 6 0 0 449 19 1 215 0 0 33 69 252 0 0 170 14 104 53 103 0 0 0 13 13 7 4 0 2 732 70 3 637 1 077 87 3 688 4 852 Cumulative total** 937 282 109 25 3 31 253 235 55 13 757 4 245 192 6 5 373 34 636 762 179 39 3 164 155 1 465 8 351 250 1 9 49 562 242 1 488 117 814 0 2 325 909 1 973 18 9 1 457 430 1 043 417 695 19 2 6 652 3 274 183 59 0 38 097 380 49 950 118 470 2 639 46 655 167 764

2004 18 8 1 2 0 3 4 18 5 172 79 2 0 0 7 540 64 5 1 1 12 4 84 374 2 0 1 970 9 35 2 421 0 1 18 19 52 1 76 8 11 43 0 0 0 18 32 1 0 2 018 12 2 310 2 282 113 2 336 4 731

2005 22 9 1 1 0 0 4 16 7 129 60 5 2 0 9 445 71 7 3 0 26 4 79 393 2 0 0 846 4 33 2 178 0 0 25 12 97 1 1 79 8 17 42 0 0 0 11 41 1 0 3 041 3 3 379 2 048 99 3 410 5 557

2006 21 7 0 1 0 4 3 23 1 104 81 5 0 0 9 399 51 17 0 2 10 4 90 297 3 0 1 747 3 25 1 908 0 0 28 13 217 1 2 105 28 102 19 45 0 0 0 9 29 1 0 3 360 9 3 968 1 775 112 3 989 5 876

2007 26 3 1 1 0 3 3 45 8 87 62 3 1 0 10 383 45 21 2 0 13 0 77 224 5 0 0 668 6 30 1 727 0 0 25 131 200 1 1 103 18 95 20 101 0 0 0 14 20 15 2 0 3 086 20 3 852 1 566 106 3 907 5 579

2010 11 3 10 1 0 4 4 14 3 60 32 3 0 0 6 228 70 20 0 0 6 3 70 174 9 0 0 331 27 1 089 0 0 42 160 238 0 0 186 6 185 102 95 0 0 0 8 11 43 2 0 3 660 131 4 869 908 104 4 946 5 958

2011 11 4 17 1 0 1 4 20 0 55 36 8 0 0 10 191 57 9 1 0 7 0 62 136 37 0 0 287 14 968 0 0 33 148 270 0 0 191 14 132 58 101 0 0 0 12 17 35 2 0 4 979 5 992 795 132 6 033 6 960

2012 6 1 39 1 0 2 4 15 4 41 36 22 0 0 2 177 70 21 0 0 4 1 58 121 79 0 0 219 11 934 0 0 42 159 250 0 0 160 15 151 55 17 0 1 0 7 5 32 1 0 4 933 5 828 669 188 5 905 6 762

2013 14 2 29 0 0 2 5 9 2 27 16 37 0 0 1 172 62 19 0 0 3 1 45 74 102 0 0 136 10 768 0 0 22 122 143 0 0 141 14 156 38 22 0 0 0 8 4 23 1 4 273 4 967 518 187 5 030 5 735

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia*** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** There are no cumulative cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 20: AIDS cases in persons infected through heterosexual contact, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of diagnosis 2008 2009 38 75 15 10 7 14 16 17 11 589 147 42 5 0 13 604 25 6 8 5 103 10 34 389 123 1 2 532 515 3 356 20 0 46 14 160 5 4 76 68 38 6 31 0 3 0 11 71 13 32 0 1 342 51 1 991 3 236 286 1 825 5 347 45 73 19 4 4 11 18 10 12 507 152 34 8 0 15 525 32 15 1 1 105 10 24 339 124 1 0 489 385 2 963 25 0 45 34 240 2 1 102 66 55 17 101 0 4 0 12 75 1 28 0 1 509 40 2 357 2 852 267 2 201 5 320 Cumulative total** 943 2 303 257 146 123 144 765 116 213 19 339 3 846 912 140 15 326 16 074 346 101 100 35 1 610 370 586 7 597 2 349 27 42 15 059 665 9 856 84 405 267 2 445 341 1 945 68 74 1 024 1 570 459 143 1 060 6 37 5 346 2 565 159 531 0 25 169 183 36 399 84 176 5 137 31 491 120 804

2004 49 84 20 7 2 5 36 5 9 757 188 34 4 1 27 655 13 6 8 1 115 20 39 462 120 1 3 595 37 691 3 994 10 0 5 2 29 4 5 27 52 0 2 11 0 0 14 122 40 0 628 2 953 3 943 274 730 4 947

2005 45 95 11 14 7 7 22 10 8 723 198 44 8 1 25 660 31 3 5 2 142 16 34 420 130 2 2 578 23 642 3 908 7 0 9 8 51 4 6 41 82 0 5 15 0 1 0 13 94 16 0 941 1 293 3 825 262 1 114 5 201

2006 47 63 12 8 6 9 29 8 15 605 192 41 11 1 22 626 21 3 7 2 109 16 33 420 113 1 0 533 36 562 3 551 8 0 17 6 103 3 6 53 84 19 8 43 0 1 0 13 84 15 0 1 089 2 1 554 3 494 239 1 372 5 105

2007 42 66 16 4 6 11 16 10 11 543 174 35 5 0 14 614 22 4 7 2 111 7 29 397 120 3 2 488 30 507 3 296 13 0 32 55 100 3 4 61 66 33 108 0 1 0 7 84 10 20 0 1 265 6 1 868 3 214 244 1 706 5 164

2010 37 64 14 1 5 12 23 7 12 520 114 31 4 1 12 558 36 11 6 6 119 10 52 387 113 1 0 392 374 2 922 20 0 41 38 289 1 3 132 52 70 24 146 0 2 0 11 82 26 26 0 2 264 68 3 295 2 800 265 3 152 6 217

2011 22 49 20 6 5 12 40 9 15 432 143 33 7 2 17 500 34 9 5 3 84 9 44 348 140 1 3 338 244 2 574 37 0 50 44 305 4 3 181 74 81 26 321 0 0 0 12 65 44 36 0 3 944 0 5 227 2 423 330 5 048 7 801

2012 11 65 15 4 4 12 22 16 10 467 124 38 6 1 19 506 55 13 4 5 95 12 36 318 125 3 2 311 244 2 543 38 0 83 68 358 0 6 184 53 76 27 118 0 4 0 7 46 21 35 0 4 873 5 997 2 351 297 5 892 8 540

2013 27 43 20 6 1 10 21 9 12 204 68 22 10 0 16 477 37 15 2 0 61 11 30 195 125 4 3 202 183 1 814 49 1 103 57 289 3 6 139 17 87 24 139 0 1 0 6 39 44 39 4 875 5 918 1 601 313 5 818 7 732

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia*** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 46 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Table 21: AIDS cases in persons infected through mother-to-child transmission, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of diagnosis 2008 2009 0 4 0 0 0 0 0 0 0 9 0 0 0 0 3 2 5 0 0 0 1 0 5 4 8 0 0 8 21 70 0 0 0 0 14 0 0 10 2 4 2 6 0 0 0 2 0 0 0 0 73 6 119 54 15 120 189 2 1 0 0 0 0 0 0 0 10 0 0 1 0 1 5 1 0 0 0 2 0 7 3 12 0 0 8 19 72 1 0 2 2 8 0 0 4 2 5 0 1 0 0 0 1 1 2 2 0 86 3 120 54 24 114 192 Cumulative total** 47 122 7 4 2 0 25 2 6 772 116 24 4 0 36 735 18 1 3 1 44 7 67 117 438 0 2 970 22 686 4 278 6 0 13 12 97 0 6 61 75 30 11 41 0 1 0 26 108 14 12 0 1 217 22 1 752 3 916 575 1 539 6 030

2004 0 1 0 0 0 0 0 1 0 10 2 2 0 0 1 4 1 0 0 0 2 0 7 3 8 0 0 6 1 35 84 0 0 0 0 8 0 0 2 2 0 0 1 0 0 0 1 0 0 0 0 94 0 108 69 16 107 192

2005 1 0 0 0 1 0 0 0 0 10 3 0 1 0 0 4 1 0 0 0 1 0 3 5 8 0 0 9 1 30 78 0 0 2 0 13 0 0 6 4 0 0 1 0 0 0 1 0 0 1 0 139 0 167 68 15 162 245

2006 0 1 0 0 0 0 2 0 0 6 1 1 0 0 0 9 2 0 0 0 2 0 4 3 8 0 0 7 1 25 72 0 0 1 0 10 0 0 1 4 1 1 4 0 0 0 1 0 0 0 0 122 2 147 62 13 144 219

2007 1 4 0 0 0 0 0 0 1 8 2 0 0 0 1 2 0 0 0 0 5 0 1 3 3 0 0 10 2 26 69 0 0 1 2 7 0 1 13 2 5 0 7 0 0 0 1 1 0 0 0 110 3 153 68 6 148 222

2010 0 0 2 0 0 0 1 0 0 5 1 1 0 0 1 3 0 0 0 0 5 0 1 1 11 0 0 3 9 44 0 0 1 1 13 0 1 11 2 2 0 3 0 0 0 1 2 0 0 0 129 8 174 34 16 168 218

2011 1 0 1 1 0 0 0 0 0 8 2 0 0 0 0 3 2 0 0 0 2 0 3 1 10 0 0 3 3 40 1 0 1 1 12 0 0 8 2 5 3 3 0 0 0 0 0 0 0 0 118 154 25 16 153 194

2012 0 0 0 0 0 0 0 0 0 11 2 0 1 0 0 4 1 0 0 0 1 0 1 1 8 0 0 3 1 34 0 0 0 3 4 0 1 1 0 2 4 1 0 0 0 0 1 1 1 0 88 107 24 12 105 141

2013 0 0 3 0 0 0 1 0 0 5 1 0 0 0 1 6 2 1 0 0 2 1 0 3 7 0 0 1 1 35 3 0 4 3 3 0 1 3 1 6 1 9 0 0 0 1 1 11 0 59 106 24 15 102 141

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia*** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 22: AIDS cases*, by geographical area, sex, transmission mode and year of diagnosis (2004–2013) and cumulative totals Table22a: EU/EEA and non-EU/EEA countries Transmission mode EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total EU/EEA Non-EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total non-EU/EEA Total WHO European Region 2004 Male Unknown 1 976 1 906 2 184 33 40 14 639 6 792 83 240 193 8 3 1 90 618 7 410 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2005 Male Unknown 1 999 1 751 2 147 34 43 8 593 6 575 104 290 207 16 6 0 109 732 7 307 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 2 2006 Male Unknown 1 890 1 526 1 928 40 28 5 585 6 002 86 491 245 15 3 0 37 877 6 879 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 2 2007 Male Unknown 1 823 1 372 1 875 36 14 3 554 5 677 103 628 331 22 3 14 49 1 150 6 827 6 0 1 0 0 0 0 7 0 0 0 0 0 0 0 0 7

Female 506 1 773 50 26 4 238 2 597 40 130 6 3 0 23 202 2 799

Female 423 1 738 43 19 6 236 2 465 45 145 12 2 1 32 237 2 702

Female 379 1 587 31 19 4 227 2 247 108 218 8 1 1 12 348 2 595

Female 349 1 390 31 10 2 210 1 992 118 266 18 1 12 16 431 2 423

Female 187 1 114 19 6 2 134 1 462 69 540 11 1 1 46 668 2 130

2012 Male Unknown 1 517 747 1 429 15 8 0 461 4 177 93 826 584 8 9 1 120 1 641 5 818 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 2

Female 168 749 21 2 1 129 1 070 59 461 20 1 3 56 600 1 670

2013 Male Unknown 1 218 600 1 065 14 4 0 396 3 297 103 635 582 27 2 1 108 1 458 4 755 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 2

Female 0 24 281 36 364 2 096 2 742 2 374 5 230 73 087 0 2 144 5 084 244 112 25 441 8 050 81 137

Cumulative total** Male Unknown 98 073 93 290 47 373 2 160 6 542 3 195 15 709 266 342 4 541 9 325 5 962 268 336 29 1 348 21 809 288 151 23 1 3 0 0 0 1 28 2 3 2 1 0 0 7 15 43

Total 98 096 117 572 83 740 4 256 9 284 5 569 20 940 339 457 4 543 11 472 11 048 513 448 54 1 796 29 874 369 331

Cases from Russia, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 15–21. Cumulative total is the total number of cases reported by country since the start of reporting

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Female 322 1 459 32 13 3 216 2 045 91 289 19 0 2 28 429 2 474

2008 Male Unknown 1 828 1 180 1 897 38 23 5 566 5 537 109 606 309 21 1 1 51 1 098 6 635 3 0 0 0 0 0 0 3 0 3 0 0 0 0 0 3 6

Female 240 1 259 37 12 3 204 1 755 117 419 16 6 2 32 592 2 347

2009 Male Unknown 1 779 975 1 704 35 15 3 530 5 041 100 718 389 15 3 3 97 1 325 6 366 1 0 0 0 0 0 1 2 0 0 0 0 0 0 0 0 2

Female 229 1 320 33 4 5 193 1 784 124 478 18 2 1 47 670 2 454

2010 Male Unknown 1 760 860 1 602 11 15 3 529 4 780 128 954 485 19 1 4 94 1 685 6 465 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 2

Female 174 1 072 21 5 1 157 1 430 118 622 13 0 1 26 780 2 210

2011 Transmission mode Male Unknown EU/EEA 1 637 1 Men who have sex with men 794 0 Injecting drug use 1 502 0 Heterosexual contact 19 0 Mother-to-child 2 0 Haemophiliac/transfusion recipient 1 0 Nosocomial infection 455 0 Other/undetermined 4 410 1 Total EU/EEA Non-EU/EEA 105 2 Men who have sex with men 895 0 Injecting drug use 660 1 Heterosexual contact 23 0 Mother-to-child 9 0 Haemophiliac/transfusion recipient 2 0 Nosocomial infection 66 0 Other/undetermined 1 760 3 Total non-EU/EEA 6 170 4 Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 22: AIDS cases*, by geographical area, sex, transmission mode and year of diagnosis (2004–2013) and cumulative totals Table 22b: Geographical areas, WHO European Region Transmission mode West Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total West Centre Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total Centre East Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total East Total WHO European Region 2004 Male Unknown 1 973 1 800 2 136 30 26 4 512 6 481 66 88 191 5 16 10 150 526 20 258 50 6 1 1 67 403 7 410 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 2005 Male Unknown 1 994 1 660 2 099 31 34 1 479 6 298 98 79 173 6 12 7 126 501 11 302 82 13 3 0 97 508 7 307 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 2006 Male Unknown 1 888 1 416 1 900 34 22 5 489 5 754 80 95 144 9 9 110 447 8 506 129 12 0 0 23 678 6 879 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2007 Male Unknown 1 824 1 242 1 816 37 12 3 454 5 388 88 78 160 2 4 0 112 444 14 680 230 19 1 14 37 995 6 827 6 0 1 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7

Female 473 1 770 38 18 1 134 2 434 25 83 11 11 3 103 236 48 50 7 0 0 24 129 2 799

Female 384 1 703 36 9 2 154 2 288 20 89 9 10 4 88 220 64 91 10 2 1 26 194 2 702

Female 356 1 558 27 11 3 144 2 099 17 95 4 8 1 84 209 114 152 8 1 1 11 287 2 595

Female 318 1 367 29 9 2 129 1 854 28 84 4 1 1 79 197 121 205 16 1 11 18 372 2 423

Female 137 1 039 13 6 1 104 1 300 40 98 8 0 1 35 182 79 517 9 1 1 41 648 2 130

2012 Male Unknown 1 423 532 1 312 11 8 0 356 3 642 163 148 199 4 9 0 147 670 24 893 502 8 0 1 78 1 506 5 818 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

Female 119 671 15 2 1 73 881 35 102 8 0 0 56 201 73 437 18 1 3 56 588 1 670

2013 Male Unknown 1 098 399 930 9 4 0 283 2 723 180 152 211 7 1 0 139 690 43 684 506 25 1 1 82 1 342 4 755 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

Female 0 24 789 36 464 1 958 1 978 51 3 837 69 077 0 566 1 896 245 868 2 324 1 505 7 404 0 1 070 3 088 137 8 24 329 4 656 81 137

Cumulative total** Male Unknown 99 671 93 438 47 044 1 936 5 547 54 14 082 261 772 2 606 2 072 3 240 329 1 318 3 143 2 246 14 954 337 7 105 3 051 163 13 27 729 11 425 288 151 23 1 3 0 0 0 1 28 2 0 2 1 0 0 3 8 0 3 0 0 0 0 4 7 43

Total 99 694 118 228 83 511 3 894 7 525 105 17 920 330 877 2 608 2 638 5 138 575 2 186 5 467 3 754 22 366 337 8 178 6 139 300 21 51 1 062 16 088 369 331

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Female 285 1 419 25 13 3 141 1 886 22 107 7 0 0 85 221 106 222 19 0 2 18 367 2 474

2008 Male Unknown 1 788 1 041 1 817 29 20 4 455 5 154 126 68 179 8 4 1 124 510 23 677 210 22 0 1 38 971 6 635 3 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 3 6

Female 218 1 216 25 16 3 147 1 625 16 96 14 0 0 53 179 123 366 14 2 2 36 543 2 347

2009 Male Unknown 1 721 859 1 636 29 15 3 466 4 729 144 71 171 10 2 0 106 504 14 763 286 11 1 3 55 1 133 6 366 1 0 0 0 0 0 1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

Female 192 1 275 23 6 4 124 1 624 22 98 12 0 1 71 204 139 425 16 0 1 45 626 2 454

2010 Male Unknown 1 709 716 1 525 11 14 3 460 4 438 150 82 167 4 1 0 91 495 29 1 016 395 15 1 4 72 1 532 6 465 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

Female 143 1 030 16 5 1 101 1 296 24 105 6 0 0 62 197 125 559 12 0 1 20 717 2 210

2011 Transmission mode Male Unknown West 1 553 1 Men who have sex with men 652 0 Injecting drug use 1 393 0 Heterosexual contact 9 0 Mother-to-child 3 0 Haemophiliac/transfusion recipient 1 0 Nosocomial infection 366 0 Other/undetermined 3 977 1 Total West Centre 157 2 Men who have sex with men 108 0 Injecting drug use 224 1 Heterosexual contact 10 0 Mother-to-child 7 0 Haemophiliac/transfusion recipient 0 0 Nosocomial infection 114 0 Other/undetermined 620 3 Total Centre East 32 0 Men who have sex with men 929 545 23 1 2 41 1 573 6 170 0 Injecting drug use 0 Heterosexual contact 0 Mother-to-child 0 Haemophiliac/transfusion recipient 0 Nosocomial infection 0 Other/undetermined 0 Total East 4 Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 23: AIDS cases*, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals Table 23a: EU/EEA and non-EU/EEA countries Age category EU/EEA <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total EU/EEA Non-EU/EEA <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total non-EU/EEA Total WHO European Region 2004 Male Unknown 67 70 127 493 2 492 2 238 1 304 1 6 792 10 3 19 96 213 191 79 7 618 7 410 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2005 Male Unknown 42 80 152 451 2 353 2 248 1 243 6 6 575 21 2 23 97 288 193 107 1 732 7 307 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 2 2006 Male Unknown 41 70 123 432 2 039 2 103 1 187 7 6 002 15 4 19 123 408 208 97 3 877 6 879 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 2 2007 Male Unknown 27 69 153 420 1 815 2 011 1 179 3 5 677 42 11 37 146 523 276 115 0 1 150 6 827 0 0 1 1 3 2 0 0 7 0 0 0 0 0 0 0 0 0 7

Female 69 100 139 329 1 078 605 277 0 2 597 6 0 21 34 80 45 16 0 202 2 799

Female 43 85 114 328 957 644 293 1 2 465 13 5 20 47 92 44 16 0 237 2 702

Female 35 79 104 280 840 618 287 4 2 247 10 3 23 70 152 61 27 2 348 2 595

Female 29 57 85 249 720 559 292 1 1 992 37 8 36 78 155 88 29 0 431 2 423

Female 16 14 79 132 465 440 316 0 1 462 20 0 27 96 287 166 72 0 668 2 130

2012 Male Unknown 12 19 143 297 1 180 1 421 1 104 1 4 177 27 3 26 128 685 546 226 0 1 641 5 818 0 0 0 2 0 0 0 0 2 0 0 0 0 0 0 0 0 0 2

Female 12 12 57 88 317 314 269 1 1 070 31 7 23 82 234 138 84 1 600 1 670

2013 Male Unknown 14 13 103 239 885 1 083 958 2 3 297 36 6 29 120 583 466 215 3 1 458 4 755 0 0 0 1 1 0 0 0 2 0 0 0 0 0 0 0 0 0 2

Female 5 496 995 5 024 14 309 28 829 11 584 6 798 52 73 087 305 93 623 1 531 3 419 1 368 699 12 8 050 81 137

Cumulative total** Male Unknown 7 077 1 481 9 917 39 238 112 045 60 394 35 950 240 266 342 375 148 742 2 791 9 455 5 490 2 748 60 21 809 288 151 0 0 1 8 15 3 0 1 28 1 0 2 2 3 1 1 5 15 43

Total 12 573 2 476 14 942 53 555 140 889 71 981 42 748 293 339 457 681 241 1 367 4 324 12 877 6 859 3 448 77 29 874 369 331

Cases from Russia, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 15–17. Cumulative total is the total number of cases reported by country since the start of reporting

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Female 24 55 100 226 691 644 305 0 2 045 21 6 33 85 188 65 29 2 429 2 474

2008 Male Unknown 38 42 128 410 1 728 1 990 1 200 1 5 537 26 12 47 126 485 290 111 1 1 098 6 635 0 0 0 0 2 1 0 0 3 0 0 0 1 2 0 0 0 3 6

Female 32 30 88 183 603 542 277 0 1 755 18 16 53 107 236 117 44 1 592 2 347

2009 Male Unknown 30 17 110 317 1 512 1 841 1 213 1 5 041 21 13 42 166 601 342 137 3 1 325 6 366 0 0 0 1 1 0 0 0 2 0 0 0 0 0 0 0 0 0 2

Female 30 11 114 176 545 556 352 0 1 784 21 9 43 109 304 121 63 0 670 2 454

2010 Male Unknown 12 10 134 311 1 376 1 684 1 252 1 4 780 23 16 65 189 771 439 182 0 1 685 6 465 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 2

Female 18 20 83 142 431 465 270 1 1 430 19 2 51 124 342 164 77 1 780 2 210

2011 Age category Male Unknown EU/EEA 17 0 <15 11 0 15–19 104 0 20–24 321 0 25–29 1 261 1 30–39 1 553 0 40–49 1 140 0 50+ 3 0 Unknown 4 410 1 Total EU/EEA Non-EU/EEA 30 0 <15 3 0 15–19 53 0 20–24 185 0 25–29 798 0 30–39 480 1 40–49 207 0 50+ 4 2 Unknown 1 760 6 170 3 Total non-EU/EEA 4 Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 23: AIDS cases*, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals Table 23b: Geographical areas, WHO European Region Age category West <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total West Centre <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total Centre East <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Total East Total WHO European Region 2004 Male Unknown 34 13 105 451 2 375 2 216 1 286 1 6 481 35 56 13 52 175 116 72 7 526 8 4 28 86 155 97 25 0 403 7 410 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 2005 Male Unknown 29 20 133 397 2 261 2 208 1 244 6 6 298 16 62 20 60 144 122 76 1 501 18 0 22 91 236 111 30 0 508 7 307 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 2 2006 Male Unknown 33 19 95 387 1 955 2 076 1 183 6 5 754 11 54 23 48 145 91 71 4 447 12 1 24 120 347 144 30 0 678 6 879 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2007 Male Unknown 26 21 119 350 1 703 1 978 1 188 3 5 388 3 49 30 51 154 93 64 0 444 40 10 41 165 481 216 42 0 995 6 827 0 0 1 1 3 2 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7

Female 35 35 120 305 1 061 606 272 0 2 434 34 59 21 23 59 23 17 0 236 6 6 19 35 38 21 4 0 129 2 799

Female 30 28 89 299 928 630 283 1 2 288 15 58 18 34 44 35 16 0 220 11 4 27 42 77 23 10 0 194 2 702

Female 26 19 92 253 818 612 275 4 2 099 9 62 12 25 47 28 24 2 209 10 1 23 72 127 39 15 0 287 2 595

Female 27 23 65 220 682 555 281 1 1 854 4 36 15 32 55 30 25 0 197 35 6 41 75 138 62 15 0 372 2 423

Female 10 10 46 109 414 414 297 0 1 300 8 4 30 21 56 40 23 0 182 18 0 30 98 282 152 68 0 648 2 130

2012 Male Unknown 9 12 87 210 961 1 290 1 072 1 3 642 4 7 59 87 236 177 100 0 670 26 3 23 128 668 500 158 0 1 506 5 818 0 0 0 2 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

Female 6 7 36 64 244 276 247 1 881 9 5 20 18 72 37 39 1 201 28 7 24 88 235 139 67 0 588 1 670

2013 Male Unknown 7 3 63 153 647 962 885 3 2 723 8 11 52 103 256 147 111 2 690 35 5 17 103 565 440 177 0 1 342 4 755 0 0 0 1 1 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

Female 2 045 617 4 740 14 333 29 056 11 461 6 771 54 69 077 3 565 419 535 634 1 233 611 399 8 7 404 191 52 372 873 1 959 880 327 2 4 656 81 137

Cumulative total** Male Unknown 2 350 1 110 9 687 39 142 112 460 60 503 36 277 243 261 772 4 857 446 585 1 375 3 727 2 376 1 538 50 14 954 245 73 387 1 512 5 313 3 005 883 7 11 425 288 151 0 0 1 8 15 3 0 1 28 1 0 0 0 0 1 1 5 8 0 0 2 2 3 0 0 0 7 43

Total 4 395 1 727 14 428 53 483 141 531 71 967 43 048 298 330 877 8 423 865 1 120 2 009 4 960 2 988 1 938 63 22 366 436 125 761 2 387 7 275 3 885 1 210 9 16 088 369 331

Cases from Russia, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 15–17. Cumulative total is the total number of cases reported by country since the start of reporting

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HIV/AIDS surveillance in Europe 2013

Female 17 24 70 197 662 622 292 2 1 886 7 30 32 31 63 32 26 0 221 21 7 31 83 154 55 16 0 367 2 474

2008 Male Unknown 28 15 96 346 1 581 1 901 1 186 1 5 154 9 28 37 50 160 145 80 1 510 27 11 42 140 472 234 45 0 971 6 635 0 0 0 0 2 1 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 0 0 3 6

Female 17 22 63 153 564 536 270 0 1 625 16 14 28 25 52 24 20 0 179 17 10 50 112 223 99 31 1 543 2 347

2009 Male Unknown 24 8 80 268 1 389 1 768 1 191 1 4 729 10 9 36 57 161 135 96 0 504 17 13 36 158 563 280 63 3 1 133 6 366 0 0 0 1 1 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

Female 20 10 70 159 501 520 344 0 1 624 12 4 43 21 59 37 28 0 204 19 6 44 105 289 120 43 0 626 2 454

2010 Male Unknown 10 9 103 258 1 236 1 611 1 210 1 4 438 4 5 37 61 166 115 107 0 495 21 12 59 181 745 397 117 0 1 532 6 465 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

Female 11 15 46 126 393 442 262 1 1 296 8 5 41 21 54 37 31 0 197 18 2 47 119 326 150 54 1 717 2 210

2011 Age category Male Unknown West 7 0 <15 7 0 15–19 78 0 20–24 247 0 25–29 1 067 1 30–39 1 475 0 40–49 1 094 0 50+ 2 0 Unknown 3 977 1 Total West Centre 10 0 <15 4 0 15–19 39 0 20–24 81 0 25–29 231 0 30–39 142 1 40–49 111 0 50+ 2 2 Unknown 620 30 3 40 178 761 416 142 3 1 573 6 170 3 Total Centre East 0 <15 0 15–19 0 20–24 0 25–29 0 30–39 0 40–49 0 50+ 0 Unknown 0 Total East 4 Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 24: The most common AIDS-indicative diseases diagnosed in 2013, by geographical area ordered by frequency Table 24a: EU/EEA and non-EU/EEA countries Diseases EU/EEA Pneumocystis pneumonia Candidiasis, oesophageal Wasting syndrome due to HIV Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) Kaposi’s sarcoma Toxoplasmosis of brain in a patient over one month of age Mycobacterium tuberculosis, extrapulmonary Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over one month of age Encephalopathy, HIV-related Progressive multifocal leukoencephalopathy Non-EU/EEA Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) Wasting syndrome due to HIV Candidiasis, oesophageal Mycobacterium tuberculosis, extrapulmonary Pneumocystis pneumonia Encephalopathy, HIV-related Pneumonia, recurrent in an adult or an adolescent (aged 13 years or over) Kaposi’s sarcoma Candidiasis of bronchi, trachea or lungs Herpes simplex: chronic ulcer(s) (>1 months duration); or bronchitis, pneumonitis, or oesophagitis in a patient over one month of age Men N 907 410 368 321 305 172 171 181 144 84 455 277 245 150 100 68 61 35 27 21 Women N 255 164 88 123 33 102 95 68 60 34 129 117 122 43 46 28 28 7 14 17 Total N 1162 574 456 444 338 274 266 249 204 118 584 394 367 193 146 96 89 42 41 38 Children N 4 1 4 1 0 0 0 3 6 0 15 19 13 0 7 2 2 0 12 2

% 21.2 9.6 8.6 7.5 7.1 4.0 4.0 4.2 3.4 2.0 23.7 14.4 12.7 7.8 5.2 3.5 3.2 1.8 1.4 1.1

% 18.1 11.6 6.2 8.7 2.3 7.2 6.7 4.8 4.3 2.4 16.2 14.7 15.3 5.4 5.8 3.5 3.5 0.9 1.8 2.1

% 20.4 10.1 8.0 7.8 5.9 4.8 4.7 4.4 3.6 2.1 21.5 14.5 13.5 7.1 5.4 3.5 3.3 1.5 1.5 1.4

% 13.3 3.3 13.3 3.3 0.0 0.0 0.0 10.0 20.0 0.0 14.7 18.6 12.7 0.0 6.9 2.0 2.0 0.0 11.8 2.0

Table 24b: Geographical areas, WHO European Region Diseases West Pneumocystis pneumonia Candidiasis, oesophageal Kaposi’s sarcoma Wasting syndrome due to HIV Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) Mycobacterium tuberculosis, extrapulmonary Toxoplasmosis of brain in a patient over one month of age Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over one month of age Encephalopathy, HIV-related Progressive multifocal leukoencephalopathy Centre Wasting syndrome due to HIV Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) Pneumocystis pneumonia Candidiasis, oesophageal Toxoplasmosis of brain in a patient over one month of age Encephalopathy, HIV-related Kaposi’s sarcoma Pneumonia, recurrent in an adult or an adolescent (aged 13 years or over) Candidiasis of bronchi, trachea or lungs Lymphoma(s), not specified East Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) Wasting syndrome due to HIV Candidiasis, oesophageal Mycobacterium tuberculosis, extrapulmonary Pneumocystis pneumonia Encephalopathy, HIV-related Pneumonia, recurrent in an adult or an adolescent (aged 13 years or over) Candidiasis of bronchi, trachea or lungs Toxoplasmosis of brain in a patient over one month of age Herpes simplex: chronic ulcer(s) (>1 months duration); or bronchitis, pneumonitis, or oesophagitis in a patient over one month of age Men N 855 367 289 255 210 158 145 170 129 74 142 95 87 64 26 22 33 26 20 18 471 248 224 152 65 61 58 37 23 18 Women N 239 159 33 63 94 83 90 63 50 28 37 19 14 13 10 12 0 6 4 5 139 105 114 48 48 26 29 18 13 15 Total N 1094 526 322 318 304 241 235 233 179 102 179 114 101 77 36 34 33 32 24 23 610 353 338 200 113 87 87 55 36 33 Children N 4 0 0 1 0 0 0 2 5 0 3 1 0 2 0 1 0 0 1 0 15 19 12 0 7 2 2 12 0 2

% 23.6 10.1 8 7 5.8 4.4 4 4.7 3.6 2 18.1 12.1 11.1 8.2 3.3 2.8 4.2 3.3 2.6 2.3 26.3 13.9 12.5 8.5 3.6 3.4 3.2 2.1 1.3 1

% 20.1 13.4 2.8 5.3 7.9 7 7.6 5.3 4.2 2.4 16 8.2 6.1 5.6 4.3 5.2 0 2.6 1.7 2.2 17.7 13.3 14.5 6.1 6.1 3.3 3.7 2.3 1.7 1.9

% 22.7 10.9 6.7 6.6 6.3 5 4.9 4.8 3.7 2.1 17.7 11.2 10 7.6 3.6 3.4 3.3 3.2 2.4 2.3 23.7 13.7 13.1 7.8 4.4 3.4 3.4 2.1 1.4 1.3

% 26.7 0 0 6.7 0 0 0 13.3 33.3 0 15 5 0 10 0 5 0 0 5 0 15.5 19.6 12.4 0 7.2 2.1 2.1 12.4 0 2.1

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HIV/AIDS surveillance in Europe 2013

Table 25: Deaths among AIDS cases, by country and year of death (2004–2013) and cumulative totals in EU/EEA and other countries of the WHO European Region Area EU/EEA West West Centre Centre Centre Centre West East West West West West Centre West West West East East West West West West Centre West Centre Centre Centre West West West Country* Year of diagnosis 2008 2009 34 25 9 7 0 14 3 8 230 115 31 4 0 3 762 58 20 0 0 36 3 71 203 158 0 5 824 308 2 931 2 1 31 43 146 0 1 74 60 137 15 65 0 0 0 22 34 30 0 0 2 710 124 3 495 2 672 293 3 461 6 426 37 27 2 7 3 10 9 0 176 116 29 9 0 5 710 69 17 0 0 37 3 46 193 132 2 1 487 279 2 406 5 0 39 27 151 1 0 63 42 130 21 54 0 2 0 25 39 7 0 0 2 591 40 3 237 2 189 245 3 209 5 643 Cumulative total** 2 008 2 032 143 176 110 202 2 028 106 36 176 14 373 1 796 343 39 414 41 748 641 156 0 60 401 625 1 255 8 229 6 139 39 93 47 275 1 323 16 023 183 953 59 1 252 368 1 405 57 64 761 1 729 1 328 189 643 18 36 8 1 061 5 858 173 84 1 31 999 323 46 417 182 164 9 861 38 345 230 370

2004 47 46 10 2 2 4 31 15 425 211 26 13 1 8 917 23 10 0 1 36 14 66 349 224 3 2 1 196 17 302 4 001 0 0 11 22 59 3 1 49 56 64 8 31 0 1 0 27 88 0 7 0 1 775 22 2 224 3 771 365 2 089 6 225

2005 60 47 12 3 7 11 27 12 400 153 49 6 0 8 852 34 5 0 1 41 15 65 294 234 0 2 1 157 19 357 3 871 1 0 7 20 78 3 4 56 60 77 24 41 0 0 0 25 69 0 4 0 2 188 9 2 666 3 609 377 2 551 6 537

2006 39 33 8 6 4 6 19 18 331 161 38 6 1 8 816 40 9 0 7 33 6 43 235 202 4 0 1 015 8 314 3 410 3 0 15 21 138 5 5 36 74 86 16 45 1 1 0 24 56 0 2 0 2 420 9 2 957 3 195 319 2 853 6 367

2007 56 33 6 2 3 11 20 11 243 160 42 10 0 6 819 47 15 0 1 36 1 61 217 172 3 2 993 6 314 3 290 6 0 22 43 141 1 2 67 80 90 18 68 0 1 0 15 50 11 0 0 2 507 19 3 141 3 077 295 3 059 6 431

2010 43 19 14 10 3 7 3 2 205 104 48 10 0 5 643 57 12 0 0 25 0 53 197 146 1 2 332 305 2 246 6 0 17 45 146 0 1 80 44 168 26 72 0 4 0 26 23 29 0 0 3 096 66 3 849 1 996 283 3 816 6 095

2011 29 31 17 6 4 9 6 7 169 117 53 12 1 4 80 9 0 1 31 1 68 173 221 1 1 249 154 1 454 10 0 22 39 158 0 4 95 60 150 19 127 0 2 0 31 13 47 0 0 3 736 4 513 1 092 386 4 489 5 967

2012 9 27 16 7 5 11 2 5 139 83 49 9 1 1 88 10 0 2 25 1 57 139 121 3 1 213 153 1 177 8 0 36 40 188 0 0 83 32 148 19 11 0 1 0 17 3 25 0 0 3 870 4 481 879 256 4 523 5 658

2013 36 32 14 8 3 12 4 2 85 65 38 7 0 0 107 18 0 0 16 2 45 145 64 0 5 144 145 997 11 0 23 26 126 2 3 82 25 146 6 22 0 1 0 17 2 24 10 3 514 4 040 739 202 4 096 5 037

Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic of Centre former Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia*** West San Marino Centre Serbia**** West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan Total non-EU/EEA Geographical area West Centre East Total WHO European Region

* Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about AIDS related deaths were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 28 261 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 40 cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence)

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 26: Deaths among AIDS cases*, by geographic area, transmission mode and year of death (2004–2013) and cumulative totals

Table 26a: EU/EEA and non-EU/EEA countries Transmission mode EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total EU/EEA Non-EU/EEA Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total non-EU/EEA Total WHO European Region 2004 Male Female 552 1 013 523 4 36 38 219 2 385 37 153 69 1 1 0 60 321 2 706 221 336 8 21 29 67 682 30 57 2 1 0 16 106 788 2005 Male Female 559 970 531 17 29 37 200 2 343 36 165 79 5 3 1 79 368 2 711 215 322 11 17 26 66 657 26 56 3 0 1 15 101 758 2006 Male Female 474 832 473 11 25 40 166 2 021 25 233 110 3 3 0 14 388 2 409 178 287 7 10 24 59 565 57 75 0 0 1 7 140 705 2007 Male Female 447 819 431 12 15 27 159 1 910 20 288 128 3 5 3 22 469 2 379 181 274 3 10 26 61 555 61 75 3 2 0 5 146 701 2008 Male Female 382 667 369 14 25 25 158 1 640 24 291 148 5 1 0 16 485 2 125 176 254 3 7 19 70 529 50 113 4 0 0 8 175 704 2009 Male Female 347 466 296 7 9 25 127 1 277 20 264 123 2 0 1 19 429 1 706 104 227 4 10 14 60 419 49 118 4 0 1 6 178 597

Table 26b: Geographical areas, WHO European Region Transmission mode West Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total West Centre Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total Centre East Men who have sex with men Injecting drug use Heterosexual contact Mother-to-child Haemophiliac/transfusion recipient Nosocomial infection Other/undetermined Total East Total WHO European Region * **

2004 Male Female 549 993 501 4 21 0 172 2 240 28 41 63 1 16 38 50 237 12 132 28 0 0 0 57 229 2 706 220 337 5 9 0 26 597 8 36 3 13 29 39 128 23 20 2 0 0 18 63 788

2005 Male Female 562 934 501 12 14 0 156 2 179 28 42 66 7 18 37 55 253 5 159 43 3 0 1 68 279 2 711 208 304 12 6 1 28 559 9 41 0 11 25 38 124 24 33 2 0 1 15 75 758

2006 Male Female 474 793 455 6 20 0 128 1 876 23 33 66 7 8 40 44 221 2 239 62 1 0 0 8 312 2 409 172 279 4 4 2 34 495 6 34 3 6 22 27 98 57 49 0 0 1 5 112 705

2007 Male Female 434 755 441 7 9 0 125 1 771 30 40 51 5 10 27 40 203 3 312 67 3 1 3 16 405 2 379 177 261 3 6 1 33 481 8 24 0 6 25 29 92 57 64 3 0 0 4 128 701

2008 Male Female 368 598 348 12 16 1 108 1 451 29 38 54 3 10 24 48 206 9 322 115 4 0 0 18 468 2 125 166 244 3 6 1 39 459 8 27 1 1 18 32 87 52 96 3 0 0 7 158 704

2009 Male Female 328 412 274 4 5 2 94 1 119 35 29 42 4 4 23 37 174 4 289 103 1 0 1 15 413 1 706 97 219 3 6 1 34 360 6 25 2 4 13 22 72 50 101 3 0 1 10 165 597

Cases from Italy, Russia, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Table 25. Cumulative total is the total number of cases reported by country since the start of reporting

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HIV/AIDS surveillance in Europe 2013

2010 Male Female 364 334 341 2 19 20 149 1 229 25 312 143 3 1 0 19 503 1 732 81 215 12 5 14 47 374 47 128 3 0 0 7 185 559

2011 Male Female 327 288 296 8 17 20 124 1 080 22 306 199 7 1 0 23 558 1 638 76 201 5 8 25 59 374 33 174 3 0 0 9 219 593

2012 Male Female 272 258 246 3 10 9 106 904 10 292 145 1 0 0 13 461 1 365 74 148 5 3 14 28 272 27 118 2 1 0 2 150 422

2013 Male Female 223 241 197 1 3 0 88 753 17 224 131 7 0 0 22 401 1 154 73 124 2 5 0 40 244 31 79 7 0 0 9 126 370

Male 49 219 39 478 14 016 849 4 427 1 762 6 338 116 089 2 669 4 875 2 240 99 248 5 599 10 735 126 824

Cumulative total** Female Unknown 0 9 736 9 808 722 1 680 1 171 1 752 24 869 0 1 344 1 733 88 70 4 165 3 404 28 273 1 0 0 0 0 0 0 1 0 1 0 1 0 0 4 6 7

Total 49 212 49 177 23 804 1 571 6 107 2 933 8 078 140 882 2 668 6 214 3 955 188 318 9 767 14 119 155 001

2010 Male Female 338 296 299 2 7 0 109 1 051 47 22 54 0 13 20 44 200 4 328 131 3 0 0 15 481 1 732 68 200 8 2 0 24 302 8 31 6 3 14 22 84 52 112 1 0 0 8 173 559

2010 Male Female 297 227 222 3 12 0 82 843 45 43 83 7 5 20 47 250 7 324 190 5 1 0 18 545 1 638 56 168 3 4 0 18 249 13 55 2 4 25 37 136 40 152 3 0 0 13 208 593

2010 Male Female 247 177 216 1 4 0 52 697 29 47 40 2 6 9 52 185 6 326 135 1 0 0 15 483 1 365 46 120 3 1 0 11 181 17 22 2 2 14 14 71 38 124 2 1 0 5 170 422

2010 Male Female 195 162 164 1 3 0 54 579 34 36 39 0 0 0 38 147 11 267 125 7 0 0 18 428 1 154 49 91 1 5 0 14 160 12 22 3 0 0 19 56 43 90 5 0 0 16 154 370

Male 50 660 40 375 14 156 729 3 855 18 5 729 115 522 1 116 1 019 1 013 182 816 1 744 842 6 732 112 2 959 1 087 37 4 5 366 4 570 126 824

Cumulative total** Female Unknown 0 10 348 10 020 679 1 260 20 1 267 23 594 0 263 629 103 489 1 151 515 3 150 0 469 892 28 1 4 135 1 529 28 273 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 2 0 1 0 0 0 0 3 4 7

Total 50 655 50 712 24 170 1 408 5 115 38 6 995 139 093 1 114 1 274 1 636 286 1 305 2 895 1 354 9 864 111

3 405 Injecting drug use 1 953 Heterosexual contact 65 Mother-to-child 5 Haemophiliac/transfusion recipient 9 Nosocomial infection 496 Other/undetermined 6 044 Total East 155 001 Total WHO European Region

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Table 27: Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2004–2013) and number of tests per 1 000 population in 2013, in EU/EEA and other countries of the WHO European Region Area Country* Number of HIV tests 2008 2009 751 749 619 418 110 000 38 996 42 294 342 223 124 935 74 357 186 822 5 043 124 33 558 83 408 9 522 72 444 162 381 13 366 181 118 282 248 66 926 31 183 2 458 60 701 322 525 430 175 18 792 271 641 1 643 938 268 134 355 711 4 229 3 825 44 555 129 330 5 045 319 2 280 442 796 371 770 901 635 150 140 000 40 938 48 158 347 135 112 533 78 735 190 380 5 014 971 35 171 91 181 7 794 184 980 59 331 100 799 13 308 213 138 284 053 132 990 37 105 2 143 2 810 60 103 340 048 459 032 Tests/1000 2013 population 695 433 210 000 29 998 50 235 341 583 137 151 82 279 5 207 559 32 241 95 861 150 597 58 302 102 161 68 020 14522 302 898 114 574 33 457 3 063 2 310 83 431 482 282 770 136 24 562 18 091 2 127 136 370 160 146 105 6 970 4 004 65 829 514 701 2 064 019 62.3 28.8 7.1 58.9 32.5 24.5 62.3 79.4 2.9 9.7 32.8 28.8 34.4 126.7 34.5 15.1 21.2 16.3 1.1 30.3 25.5 51.5 81.4 11.9 4.1 129.4 66.7 35.9 11.2 119.3 9.2 62.7 45.5 -

2004 698 099 593 054 110 000 27 926 38 796 322 267 130 915 59 474 144 613 5 060 329 2 277 000 9 629 109 992 9 001 84 054 59 822 14 794 6 194 187 606 126 738 220 734 94 173 22 014 2 862 1 460 14 415 202 271 449 479 15 755 4 983 24 311 203 537 529 164 144 927 160 978 3 376 17 909 234 4 893 27 021 50 721 1 207 258 121 398 1 521 282 446 317

2005 667 825 591 193 110 000 26 085 38 708 330 233 143 671 61 249 142 427 5 433 719 9 169 70 512 9 397 85 538 58 424 13 975 6 197 193 075 136 040 917 117 188 279 103 718 24 522 3 700 1 884 39 469 237 027 440 675 10 834 7 526 26 026 234 835 621 261 162 075 185 922 3 594 17 744 347 4 723 35 083 72 114 1 881 750 153 090 1 555 511 515 972

2006 659 693 578 717 105 000 26 124 37 763 317 823 154 332 65 861 147 601 5 169 523 9 840 80 168 9 106 85 117 52 988 14 339 10 309 188 550 159 180 191 223 93 426 25 624 3 098 3 077 50 221 237 183 441 299 20 904 11 172 16 989 242 484 862 058 179 407 216 566 3 988 18 535 043 5 061 37 829 91 310 1 908 257 136 145 1 661 600 545 240

2007 777 935 595 394 160 000 32 698 41 913 344 874 141 880 68 478 153 478 5 146 481 17 374 65 980 9 351 63 000 79 279 60 333 13 379 11 957 176 728 220 226 88 520 31 120 1 686 3 546 55 342 293 086 437 983 16 858 10 574 16 989 269 071 1 491 190 186 643 347 709 3 838 3 976 42 573 92 474 1 998 163 211 789 1 937 440 619 130

2010 831 675 651 095 160 000 32 848 48 385 353 507 168 923 78 054 185 114 4 996 825 31 070 89 137 7 318 180 055 58 826 178 554 8 533 229 783 291 915 109 261 36 977 2 168 2 678 60 731 353 772 517 625 20 793 -

2011 826 256 679 655 180 000 32 928 49 074 334 569 137 877 85 025 5 203 501 31 918 84 464 184 521 58 799 102 234 57 685 317 286 306 679 110 025 38 110 3 260 2 590 68 449 365 090 621 780 17 811 21 799 274 294 1 897 476 381 295 207 830 6 914 3 961 56 086 438 532 2 392 970 -

2012 703 486 190 000 40 071 54 120 349 205 134 709 73 367 5 242 020 34 622 93 060 175 488 60 491 101 042 64 778 358 953 293 204 110 506 33 602 3 140 2 062 71 957 514 434 683 125 18 105 15 562 233 516 2 026 174 470 355 212 964 6 781 3 845 64 031 447 636 2 343 099 -

EU/EEA West Austria West Belgium Centre Bulgaria Centre Croatia Centre Cyprus Centre Czech Republic West Denmark East Estonia West Finland West France West Germany West Greece** Centre Hungary West Iceland West Ireland West Italy East Latvia East Lithuania West Luxembourg West Malta West Netherlands West Norway Centre Poland West Portugal Centre Romania Centre Slovakia Centre Slovenia West Spain West Sweden West United Kingdom Non-EU/EEA Centre Albania West Andorra East Armenia East Azerbaijan East Belarus Centre Bosnia and Herzegovina Yugoslav Republic Centre former of Macedonia, the East Georgia West Israel East Kazakhstan East Kyrgyzstan East Moldova West Monaco Centre Montenegro East Russia West San Marino Centre Serbia West Switzerland East Tajikistan Centre Turkey East Turkmenistan East Ukraine East Uzbekistan * **

17 562 25 370 278 887 286 995 1 758 026 1 786 289 325 855 297 959 204 702 207 018 5 812 6 492 - 25 209 546 4 181 5 090 47 734 51 727 214 207 280 281 2 347 084 2 319 946 987 464 1 506 724

Country-specific comments are in Annex 5 HIV tests reported for Greece refer to only to those performed in reference centres and do not include all tests carried out in public hospitals or private laboratories.

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HIV/AIDS surveillance in Europe 2013

Figures

HIV/AIDS surveillance in Europe 2013

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Map 1: HIV diagnoses per 100 000 population, 2013: All cases <2 2 to < 10 10 to < 20 ≥ 20 Missing or excluded data

Andorra Liechtenstein Luxembourg Malta Monaco San Marino

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HIV/AIDS surveillance in Europe 2013

Map 2: HIV diagnoses per 100 000 male population, 2013: Males <2 2 to < 10 10 to < 20 ≥ 20 Missing or excluded data

Andorra Liechtenstein Luxembourg Malta Monaco San Marino

Map 3: HIV diagnoses per 100 000 female population, 2013: Females <2 2 to < 10 10 to < 20 ≥ 20 Missing or excluded data

Andorra Liechtenstein Luxembourg Malta Monaco San Marino

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Map 4: HIV diagnoses per 100 000 population, 2013: Heterosexual transmission <1 1 to < 3 3 to < 5 ≥5 Missing or excluded data

Andorra Liechtenstein Luxembourg Malta Monaco San Marino

Map 5: HIV diagnoses per 100 000 population, 2013: Injecting drug use <1 1 to < 3 3 to < 5 ≥5 Missing or excluded data

Andorra Liechtenstein Luxembourg Malta Monaco San Marino

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HIV/AIDS surveillance in Europe 2013

Map 6: HIV diagnoses per 100 000 population, 2013: Sex between men <1 1 to < 3 3 to < 5 ≥5 Missing or excluded data

Andorra Liechtenstein Luxembourg Malta Monaco San Marino

Map 7: AIDS cases reported per 100 000 population, 2013 <1 1 to < 3 3 to < 5 ≥5 Missing or excluded data

Andorra Liechtenstein Luxembourg Malta Monaco San Marino

HIV/AIDS surveillance in Europe 2013

SURVEILLANCE REPORT

Figure 1: AIDS cases diagnosed, by transmission mode and geographical area, 2004–2013 West 4000 Heterosexual contact Sex between men Injecting drug use 3000 Number of cases Mother-to-child transmission Other/undetermined 2000

1000

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Cases from Sweden excluded due to inconsistent reporting during the period

Centre 400 Heterosexual contact Sex between men Injecting drug use 300 Number of cases Mother-to-child transmission Other/undetermined 200

100

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

East 1500 Heterosexual contact Sex between men Injecting drug use Number of cases 1000 Mother-to-child transmission Other/undetermined

500

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period

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HIV/AIDS surveillance in Europe 2013

Annexes

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HIV/AIDS surveillance in Europe 2013

Annex 1: Framework for data collection, validation and presentation Since 2008, the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization Regional Office for Europe (WHO Regional Office) have carried out the enhanced surveillance of HIV/AIDS in Europe. Both strive to ensure a high quality of standardised HIV/AIDS surveillance data from the 53 countries of the WHO European Region, including the 28 countries of the European Union (EU) and the three countries of the European Economic Area (EEA) (in this report referred to together as EU/EEA).

2 Data collection and validation Data collection 2014 The 2013 data submission for HIV and AIDS surveillance took place between 15 March and 15 September 2014. Data presented in this report were extracted from the joint database on 13 October 2014, although minor corrections were made during subsequent country reviews of the draft report.

1 Reporting In EU/EEA countries, the Member States’ Coordinating Competent Bodies have nominated national operational contact points for HIV/AIDS surveillance to work on reporting surveillance data to the joint ECDC/WHO database for HIV/AIDS surveillance. For non-EU/EEA countries, nominations for national HIV/AIDS surveillance focal points were received directly by the WHO Regional Office via the respective ministries of health. Data are submitted through a web-based platform to a joint database of The European Surveillance System (TESSy). Three types of data are collected: HIV (casebased and aggregate), AIDS (case-based and aggregate) and number of HIV tests performed (aggregate). Data are uploaded directly by the reporting country into the database. When uploading data, a built-in set of validation rules ensures the verification of the data within the database. This verification of the data during the uploading process improves the quality of the data and allows each country to test their datasets prior to submission. Liechtenstein, Russia, Turkmenistan and Uzbekistan did not report any HIV or AIDS data for 2013. HIV data for Russia were therefore obtained through publicly available sources and used to supplement the other countries’ reported data to give a more complete presentation of the epidemiology of HIV and AIDS in Europe.

Individual country datasets Data were uploaded, validated and approved in the joint database for HIV/AIDS surveillance by the reporting countries. Once the data were submitted, individual datasets were validated. Seventeen countries uploaded datasets containing only 2013 data for HIV, whereas the remainder uploaded data concerning longer periods. Two countries (Kazakhstan and Ukraine) reported aggregated HIV data compared with four countries in 2012. Eighteen countries uploaded datasets containing only 2013 data for AIDS. Ukraine reported aggregated AIDS data for the years 2004 to 2013. All other countries reported case-based AIDS data. Reporting of aggregated HIV and AIDS data has an impact on the data presentation and analysis and the epidemiological overview of HIV/AIDS in Europe because fewer variables are available from the aggregated datasets, hence reducing the amount of data that can be presented in certain tables and figures.

3 Data re-coding and adjustments Dates used for data presentation In this report the HIV and AIDS data are presented by ‘date of diagnosis’. If countries could not provide this date, the ‘date of notification’ or ‘date of statistics’ was used instead.

Surveillance systems – data sources To describe the national source of data and specify the national surveillance system from which the reported data originate, the variable ‘data source’ is included as a compulsory part of reporting (Annexes 4 and 4a). Some cross-country comparisons are hampered by differences in surveillance systems as the quality and coverage of national surveillance are not consistent. Particularly in the early part of the period covered in this report (20042013), some countries did not have national HIV/AIDS data and others established or substantially modified the national reporting systems over the course of the reporting period. These issues are detailed in Annex 5.

Region of origin When available, countries were encouraged to provide data on the specific country of origin or nationality of the case. This information was used first and, if absent, the variable ‘region of origin’ was used to group cases into region of origin presented in Table 11 (stratified by reporting country) and Table 12 (all countries stratified by mode of transmission).

Origin of reported cases Cases originating from countries with generalised epidemics are at times separated from other cases, namely in the category of heterosexual transmission.

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This approach is taken to inform epidemiological understanding and to guide public health resource allocation and prevention efforts. In order 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 cases originating from countries with a generalised epidemic (in Tables 11, 12 and in selected Figures). As most of the cases originating from sub-Saharan Africa were reported from West European countries within the EU/EEA, this information is presented in detail in Chapter 1.

In this report, we apply a statistical approach, as described by Heisterkamp, et al [1] to adjust the surveillance data for reporting delays. Yearly reporting delay probabilities were estimated using historical data from 2004 to 2013. Countries were excluded from reporting delay adjustment: 1 when they showed an inconsistent and non-stationary pattern in their reporting delay distribution during the period 2004–2013, 2 when they reported aggregated data during the period 2004–2013, or 3 when the average number of diagnosed HIV cases per year over the period 2004–2013 was lower than 50. Adjusting for reporting delays is a valuable tool to indicate HIV trends more precisely, as well as in monitoring the timeliness of data collection, an important aspect of quality control. Reporting delays were applied for the graphs representing trends for the EU/EEA and by transmission mode. The list of countries with number of reported diagnoses adjusted for reporting delay are presented in Annex 6.

Reporting delay Reporting delays refer to the time delay between HIV/ AIDS diagnosis (or death) and the report of this event at national level, identified by ‘date of notification’. Due to delays in reporting, HIV trends analysed at a European level are often biased downwards for the most recent year (2013) and, to a lesser extent for the 2-3 years prior to the reporting period. Ideally, surveillance data should be corrected to more accurately describe the trends in HIV diagnoses.

Figure A1: Geographical/epidemiological division of the WHO European Region West Centre East

Andorra Luxembourg Malta Monaco San Marino 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*, Czech Republic*, Hungary*, the former Yugoslav Republic of Macedonia, Montenegro, Poland*, Romania*, Serbia, Slovakia*, Slovenia*, Turkey. • East, 15 countries: Armenia, Azerbaijan, Belarus, Estonia*, Georgia, Kazakhstan, Kyrgyzstan, Latvia*, Lithuania*, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan. * Countries which constitute the European Union as of 1 July 2014.

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4 Data presentation Geographical presentation Data are presented for the WHO European Region and the EU/EEA. The EU comprises 28 Member States and the EEA comprises an additional three countries (Norway, Iceland, Liechtenstein), of which Norway and Iceland are included in the overview of the EU/EEA. The tables are presented by EU/EEA countries, non-EU/ EEA countries, by individual countries and by totals. The 53 countries are also subdivided into three geographical areas based on epidemiological considerations and in accordance with the division used in previous reports on HIV/AIDS surveillance in Europe: West (23 countries), Centre (15 countries) and East (15 countries) (see Figure A1). The division reflects similarities in epidemiological dynamics such as epidemic levels, trends over time and transmission patterns. In this report these geographical/epidemiological areas are referred to as ‘by geographical area’. Of the EU/EEA countries, 19 Member States are classified as being in the West, nine in the Centre and three in the East Regions.

When presenting HIV trends for 2004–2013 by transmission mode, countries reporting transmission mode inconsistently or incompletely were excluded (e.g. Estonia, Poland and Turkey) from Table 8 and relevant figures reporting trends by transmission mode. Countries with varying geographic coverage of the national surveillance system over time (Spain and Italy) were also excluded from Tables 8 and 9 and from graphs showing HIV trends. When presenting AIDS death trends, only countries reporting consistently were included (e.g. Italy, Sweden, Ukraine, Uzbekistan were not included in the presentation of AIDS death trends in Table 26 or text description).

5 Data limitations Surveillance systems are not identical across Europe, and differences in data collection methods and testing policies could impact the results and introduce bias in comparisons between countries. Particularly, factors such as underreporting and reporting delay may influence the country figures and rankings presented in the report. The data in the report are to be considered as provisional because they are subject to regular updates (e.g. detection and deletion of duplicate cases, inclusion of new information about cases already reported). The limitations described below need to be taken into account when interpreting the data presented here. Official reports of newly diagnosed cases of HIV do not represent true incidence. Newly reported HIV diagnoses include recently infected individuals as well as those who were infected several years ago but only recently tested for HIV. These reports are also influenced by several factors such as the uptake of HIV testing, patterns of reporting, the long incubation period and a slow progression of the disease. In order to better interpret trends in HIV case reporting data, the total numbers of HIV tests performed annually for diagnostic purposes (excluding unlinked anonymous tests and screening of blood donations) are presented to help provide some background on HIV testing patterns. Although the table in Annex 6 adjusts for reporting delay for those countries where this is possible, no adjustments are made for underreporting or underascertainment bias. Fewer than 40% of European countries have evaluated their surveillance systems for underreporting and only two have published the results [4]. Previous estimates of underreporting range from 0% to 25% for AIDS cases [3], while national estimates of underreporting for HIV can range from 10% (Iceland, Italy) to around 40% (Germany, UK) [4, 5]. Estimates with regard to the underreporting of AIDS-related deaths are not available. When interpreting the data presented in this report, country-specific comments included in Annex 5 should be considered and the following noted:

Population data and rates Data are presented in absolute numbers and rates as cases per 100 000 population. The population estimates up to 2013 were derived from Eurostat for all countries except the five central Asian republics (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) and Israel, for which Eurostat data were not available. United Nations (UN) Population Division data were used for those countries [2]. The Eurostat data are from 31 March 2014 (www.epp. eurostat.ec.europa.eu) and are consistent with the UN population data. The population data used for HIV and AIDS for Spain and for HIV for Italy were adjusted according to the extent of sub-national coverage. For data presented by gender, rates were calculated using relevant male and female population denominators from the source described above. 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. For maps presenting figures for MSM, rates are calculated using the male population.

Trend data For presentation of the overall trends, only countries reporting consistently were included (e.g. data from Russia, Turkmenistan and Uzbekistan were not included in the presentation of HIV trends for 2004–2013). Russia, Sweden, Turkmenistan and Uzbekistan were not included in the presentation of AIDS trends.

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• Data from Kosovo1 are not included in the tables, but as footnotes to Tables 1–7 and 15–21. • More detailed information regarding the country-specific HIV and AIDS case reporting systems is available in Annexes 4 and 5.

References 1 Heisterkmap SH, Jager JC, Ruitenberg EJ, van Druten JAM, Downs AM. Correcting Reported Aids Incidence: A statistical approach. Statistics in Medicine, Vol. 8, 963-976 (1989). United Nations, Department of Economic and Social Aﬀ airs, Population Division, World Population Prospects: The 2012 Revision. New York; 2013. EuroHIV. Completeness of AIDS case reporting in Europe. HIV/AIDS Surveillance in Europe, Quarterly Report 1996. Paris: Institut de médecine et d’épidémiologie africaines; 1996. No.49:30-33. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire; 2007. Personal communication to ECDC. F. Cazein, 08/11/12.

1 This designation is without prejudice to positions on status, and is in line with UNSCR 1244 and the IСJ Opinion on the Kosovo Declaration of Independence.

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Annex 2 List of variables* for the 2013 HIV/AIDS data collection HIV case-based Common set of variables 1. RecordID 2. RecordType 3. RecordTypeVersion 4. Subject 5. Status 6. DataSource 7. ReportingCountry 8. DateUsedForStatistics 9. Age 10. Gender 11. Outcome 12. DateOfOnset 13. DateOfDiagnosis 14. DateOfNotification 15. Classification 16. ClinicalCriteria 17. LaboratoryResult 18. EpiLinked Disease-specific set of variables 19. HIVType 20. Stage 21. Transmission 22. TransmissionHetero 23. TransmissionMTCT 24. HIVStatus 25. DateOfAIDSDiagnosis 26. DateOfDeath 27. CountryOfBirth 28. CountryOfNationality 29. RegionOfOrigin 30. CD4Cells 31. ProbableCountryOfInfection 19. HIVType 20. ARTTreatment 21. Transmission 22. TransmissionHetero 23. TransmissionMTCT 24. DateOfHIVDiagnosis 25. DateOfDeath 26. DateOfReportDeath 27. CountryOfBirth 28. CountryOfNationality 29. RegionOfOrigin 30. AIDSIndicatorDisease 31. AgeClass 11. Transmission 11. Transmission 1. RecordID 2. RecordType 3. RecordTypeVersion 4. Subject 5. Status 6. DataSource 7. ReportingCountry 8. DateUsedForStatistics 7. Age 8. Gender 9. Outcome 10. DateOfOnset 11. DateOfDiagnosis 12. DateOfNotification 15. Classification 16. ClinicalCriteria 17. LaboratoryResult 18. EpiLinked 1. RecordType 2. RecordTypeVersion 3. Subject 4. DataSource 5. AgeClass 6. Gender 7. ReportingCountry 8. DateUsedForStatistics 7. Classification 8. Number of cases 1. RecordType 2. RecordTypeVersion 3. Subject 4. DataSource 5. AgeClass 6. Gender 7. ReportingCountry 8. DateUsedForStatistics* 7. Classification 8. Number of cases 1. RecordType 2. RecordTypeVersion 3. Subject 4. DataSource 5. DateUsedForStatistics 6. ReportingCountry 7. NumberOfTests AIDS case-based HIV aggregated AIDS aggregated HIV tests (aggregated)

* Additional optional variables ‘PlaceOfNotification’ and ‘PlaceOfResidence’ were added from TESSy metadataset 20 for all diseases.

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Annex 3 Completeness of variables for data reported in 2012 and 2013 HIV dataset HIV dataset Age Gender Outcome Date of onset Date of diagnosis Date of notification Date used for statistics HIV type Stage Transmission Transmission/hetero Transmission/MTCT HIV status Date of AIDS diagnosis Date of death Country of birth Country of nationality Region of origin CD4 cell count Probable country of infection AIDS dataset Age Gender Outcome Date of onset Date of diagnosis Date of notification Date used for statistics HIV type ART treatment Transmission Transmission/hetero Transmission/MTCT Date of HIV Date of death Date of reported death Country of birth Country of nationality Region of origin AIDS indicator disease 2012 Completeness % 99.8 99.6 33.0 4.1 100.0 47.1 100.0 67.8 39.4 88.2 70.8 87.9 67.8 37.7 33.0 67.8 62.1 67.8 38.3 54.6 100.0 100.0 70.2 7.0 100.0 99.3 100.0 100.0 94.7 90.4 90.5 90.4 95.2 69.2 67.7 100.0 99.5 100.0 100.0 2013 Completeness % 99.8 99.6 33.0 3.7 100.0 43.7 100.0 64.6 35.1 87.0 65.8 86.7 64.6 33.7 33.0 64.2 58.4 64.6 35.1 51.1 99.9 100.0 75.9 8.4 100.0 99.3 100.0 100.0 95.0 89.3 89.3 89.3 97.1 75.0 74.4 100.0 99.4 100.0 100.0 Number of countries 49 49 40 16 49 41 49 46 44 49 49 49 46 43 40 46 45 46 33 38 46 46 44 11 46 45 46 46 45 46 46 46 43 43 42 46 45 46 46 Minimal 80.0 91.3 0.2 0.4 100.0 15.6 100.0 67.8 5.9 21.1 20.0 21.1 67.8 5.9 0.9 67.8 4.7 67.8 1.2 10.0 83.3 99.7 6.3 0.2 100.0 3.6 100.0 100.0 94.7 48.4 48.4 48.4 28.1 6.3 6.3 98.7 99.5 100.0 100.0 Maximal 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 98.3 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Number of countries 48 48 41 19 48 41 48 46 45 48 48 48 46 45 41 46 45 46 35 37 46 46 45 11 46 45 46 46 45 45 46 45 44 45 45 46 45 46 46 Minimal 83.3 85.8 0.2 0.3 100.0 19.1 100.0 64.6 3.4 9.1 34.9 9.1 64.6 3.4 0.5 64.2 58.4 64.6 7.5 41.7 70.0 99.5 3.7 2.9 100.0 5.9 100.0 100.0 95.0 57.0 57.0 57.0 55.3 3.7 3.7 100.0 99.4 100.0 100.0 Maximal 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 97.7 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100

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Annex 4a HIV surveillance system overview: data source information Country EU/EEA Austria Belgium Bulgaria Cyprus Croatia Czech Republic Denmark Estonia Estonia Finland France Germany Germany Greece Hungary Iceland Ireland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden Sweden United Kingdom Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Kyrgyzstan Moldova, Republic of Moldova, Republic of Moldova, Republic of Montenegro Monaco Russia San Marino Serbia Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan Data source AT-HIV BE-HIV/AIDS BG-HIV CY-HIV/AIDS HR-CNIPH CZ-HIV/AIDS DK-HIV EE-HIV EE-NAKIS FI-NIDR FR-MNOID-HIV DE-HIV-Pre-IfSG DE-SURVNET@RKI7.3-HIV GR-NOTIFIABLE_DISEASES HU-HIV/AIDS IS-SUBJECT_TO_REGISTRATION IE-HIV/AIDS IE-CIDR IT-COA-ISS LV-HIV/AIDS LT-AIDS_CENTRE LU-HIV MT-DISEASE_SURVEILLANCE NL-HIV/AIDS NO-MSIS_B PL-HIV PT-HIV/AIDS RO-RSS SK-EPIS SI-HIVSUR-HIV ES-HIV SE-SweHIVReg SE-SmiNet UK-HIV AL-NIoPH AD-MoHWFH AM-NAC AZ-AIDS-CENTER BY-NAC BA-FMoH-MoHSWRS MK-NHASS GE-IDACIRC IL-MOH KZ-RCfAPC KG-RCfAPC-GEN KG-HIV KG 2008 MD-NAC MD-NAC MD-NAC-NCfPC-GEN ME-IOPH MC-MoSH-GEN RU-MOH SM-AIDS/HIV RS-NAC RS-Kosova NIPH CH-FOPH TJ-RHAC TR-MOH TM-NAC UA-NAC UZ-RAC Type C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C A C C A C C C C A A C C C C C C A C Period 1979–2013 1980–2013 1986–2013 1986–2013 1985–2013 1985–2013 1990–2013 1988–2012 2013 1980–2013 2003–2013 1993–2001 2001–2013 1981–2013 1985–2013 1983–2013 1981–2011 2012–2013 2004–2013 1987–2013 1988–2013 1980–2013 1986–2013 1980–2013 1980–2013 1985–2013 1983–2013 1987–2013 1985–2013 1985–2013 2003–2013 1983–2009 2010–2013 1981–2013 1993–2013 2004–2013 1988–2013 1987–2013 1981–2013 1986–2013 1987–2013 1989–2013 1980–2013 1987–2013 1987–2007 2008–2013 1987–2006 2012–2013 2008–2011 1989–2013 1985–2013 2010–2010 1985–2013 1984–2013 2000–2013 1985–2013 1991–2013 1984–2013 1981–2012 1987–2013 1981–2010 Legal V V C C C C C C C C C C C C C C V C C C C V C V C C C C C C C C C V C V V V C C C C C NS/unk V V V NS/unk C C C C C C C C C V V V Coverage Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Se Co Co Co Co Co NS/unk Co Other Other NS/unk Co Co Co Co Co Co Co Co Co Co Other Co

Type: aggregated (A), case-based (C ) Legal: voluntary reporting (V), compulsory reporting (C ), not specified/unknown (NS/unk) Coverage: sentinel system (Se), comprehensive (Co), not specified/unknown (NS/unk)

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Annex 4b AIDS surveillance system overview: data source information Country EU/EEA Austria Belgium Bulgaria Cyprus Croatia Czech Republic Denmark Estonia Estonia Finland France Germany Greece Hungary Iceland Ireland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia, the Georgia Israel Kazakhstan Kyrgyzstan Kyrgyzstan Moldova, Republic of Moldova, Republic of Moldova, Republic of Monaco Montenegro Russia San Marino Serbia Serbia Switzerland Tajikistan Turkey Turkmenistan Turkmenistan Ukraine Uzbekistan Data source AT-AIDS BE-HIV/AIDS BG-AIDS CY-HIV/AIDS HR-CNIPH CZ-HIV/AIDS DK-MIS EE-AIDS EE-NAKIS FI-NIDR FR-AIDS DE-AIDS GR-NOTIFIABLE_DISEASES HU-HIV/AIDS IS-SUBJECT_TO_REGISTRATION IE-HIV/AIDS IE-CIDR IT-COA-ISS LV-AIDS LT-AIDS_CENTRE LU-AIDS MT-DISEASE_SURVEILLANCE NL-HIV/AIDS NO-MSIS_A PL-AIDS PT-HIV/AIDS RO-RSS SK-EPIS SI-HIVSUR ES-AIDS SE-SweHIVReg UK-AIDS AL-NIoPH AD-MoHWFH AM-NAC AZ-AIDS-CENTER BY-NAC BA-FMoH-MoHSWRS MK-NHASS GE-IDACIRC IL-MOH KZ-RCfAPC KG-RCfAPC-GEN KG-HIV KG 2008 MD-NAC MD-NAC-NCfPC-GEN MD-NAC MC-MoSH-GEN ME-IOPH SM-AIDS/HIV RS-NAC RS-Kosova NIPH CH-FOPH TJ-RHAC TR-MOH TM-NAC TM-NAC UA-NAC UZ-RAC Type C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C Period 1979–2013 1978–2013 1987–2013 1986–2013 1985–2013 1985–2013 1980–2013 1988–2012 2013 1980–2013 1978–2013 1970–2013 1981–2013 1985–2013 1983–2013 1981–2011 2012–2013 1982–2013 1990–2013 1988–2013 1980–2013 1986–2013 1983–2013 1980–2013 1985–2013 1983–2013 1985–2013 1985–2013 1985–2013 1981–2013 1982–2007 1980–2013 1993–2013 2004–2013 1988–2013 1987–2013 1991–2013 1986–2013 1987–2013 1989–2013 1980–2013 1993–2013 1987–2007 2008–2013 1989–2007 2008–2011 2012–2013 1985–2013 1990–2013 – 1985–2013 1985–2013 1986–2013 1980–2013 1998–2013 1984–2013 1981–2006 2008–2012 1988–2013 1992–2010 Legal V V C C C C C C C C C V C C C V V C C C V C V C C C C C C C C V C V V V C C C C C NS V NS V NS V C C C C C C C C V V V V Coverage Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Co Se Co Co Co Co Co NS Co NS Co NS Co Co Co Co Co Co Co Co Co Co Co Co Co

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Annex 5 Country-specific comments regarding national HIV and AIDS reporting Country EU/EEA Bulgaria Czech Republic Estonia France Case-based reporting of HIV is available from 2007 onwards. Foreigners with short-time stays in the Czech Republic are not included in reported data. Surveillance system was substantially modified in 2008. Previously, the probable mode of HIV transmission was not reported by Estonia (from 2003 to 2007 Estonia supplied partial information on PWID only). Case-based data reported through TESSy are not exhaustive, because of reporting delays (cases reported several months or several years after the diagnosis) but also because of underreporting (cases that are diagnosed but never reported). The most recent estimates of underreporting are 41% in 2007–2009 for AIDS and 29% in 2013 for HIV in France. To assess the real the number of HIV and AIDS diagnoses in France it is essential to use adjusted data, which take into account both reporting delays (for 2012–2013) and underreporting (for 2003–2013). Adjusting for these factors, the estimated number of new HIV diagnoses in 2013 is 6220 95%CI [5759-6682] and estimated number of new AIDS diagnoses is 1212 95% CI [1092-1333]. HIV was made a notifiable disease in September 2011. 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. New HIV diagnoses were reported by 10 of the 22 Italian regions between 2004 and 2006, 11 regions in 2007, 12 regions in 2008, 18 regions in 2009, and all of the 22 regions of Italy for 2012 and 2013. Between 2004 and 2011, population denominators are based on the annual resident population in the regions reporting cases. From 2012 the coverage of the surveillance system is national and, thus, the total Italian population is used as a denominator. AIDS deaths for years 2011, 2012, 2013 are not reported due to lack of updated data from the national mortality register. Liechtenstein with only 35 000 inhabitants has small numbers of communicable diseases. Therefore public health authorities refrain from collecting data due to limited public health added value. In 1970 Liechtenstein adopted the Swiss Law of Epidemiology. Since then all communicable disease data are reported to the officials in Switzerland as demanded by the Federal Office of Public Health. HIV tests reported up to 2010 include only tests performed at two major public laboratories and, thus, underestimate the total number of HIV tests performed during those years. From 2011, tests reported include all laboratories in the country. New HIV reporting system started in 2004. New HIV reporting system started in 2002; 2002 data include many cases diagnosed in previous years. Data prior to 2002 are from a national cohort of HIV-positive adults receiving antiretroviral therapy; 1999 data include many cases diagnosed in previous years. PT-HIV database is now fully case-based containing details of cases diagnosed from 1983. In 2013, the Portuguese HIV/AIDS Programme implemented a strategy to address underreporting and reporting delay, resulting in significant increases in the number of reported cases which were diagnosed between 1983 and 2012 which are reflected in the present report. New HIV diagnoses who have AIDS are reported only in in the AIDS database and AIDS tables. The total number of new HIV diagnoses for Romania is a sum of the HIV and AIDS case reports for any given year. Data on AIDS deaths for 2013 are not complete and will be updated in future reporting years. HIV reporting has existed since the 1980s in some of the 19 Autonomous Regions of Spain. For 2003–11 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). Since 2013 data are available for all the 19 Regions of Spain (+ Andalucía). Rates based on the corresponding populations for each year. AIDS reporting, 2013: for technical reasons, it has not been possible to include data from one region. Rates in 2013 are based on the corresponding population. Due to changes in the HIV/AIDS surveillance system, AIDS reporting has not been mandatory since 2000. Since 2008, no AIDS data are reported from Sweden because the national AIDS surveillance system has been discontinued. Comments

Ireland Italy

Liechtenstein

Luxembourg Malta Netherlands Portugal

Romania

Spain

Sweden Non-EU/EEA Andorra Moldova Serbia Ukraine

New HIV reporting system started in 2004; 2004 data include many cases diagnosed in previous years. Official data on incidence rates in the Republic of Moldova may vary from these ones, given that the incidence rate in Moldova is reported for both banks of the Dniester River, while the denominator is not inclusive of the left bank of the river (Transnistrian region). Updated information from national statistics for two AIDS diagnoses was reported as date of diagnosis in 2008 instead of 2009. HIV cases in persons infected through mother-to-child transmission are not available for the years before 2005 while data for 2005–2007 are calculated from best available data, 2008–2011 data are validated and final, and data for 2012 and 2013 are operational and may be adjusted in the coming few years.

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Annex 6 HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients*, EU/EEA countries, 2010–2013 Country** EU/EEA Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France*** Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Total EU/EEA 2010 N 321 1 199 163 54 41 156 275 376 185 6 240 2 723 634 182 24 330 3 980 274 153 52 18 1 209 258 956 1 824 274 35 35 3 666 473 6 476 32 586 2011 N 314 1 183 201 70 54 180 266 366 173 6 085 2 702 960 162 23 327 3 838 299 166 52 21 1 162 269 1 150 1 613 427 55 55 3 390 411 6 392 32 366 2012 N 320 1 229 157 77 58 153 201 315 158 6 217 2 975 1 167 219 19 351 4 098 339 160 58 30 1 093 242 1 153 1 542 489 45 45 3 611 410 6 554 33 485 2013 N 260 1 115 200 74 54 212 233 325 160 6 220 3 263 910 240 11 332 3 608 340 177 53 36 1 078 233 1 279 1 289 507 44 46 3 278 406 5 994 31 977 Adjustment coefficients* 2011 2012 0 0 0 0 0 0 0 0 <0.01 <0.01 0 <0.01 0 0 0 0 0 0 0 0 0.02 0 0.01 0.06 0 0 0 0 0.02 0.02 0.01 0 0 0 0 0 0 0 0 <0.01 0.01 0 0.01 0 0 0 0 0 0 0 0 0.02 0 0.02 0.05 0 0 0 0 0.02 0.03 0.02 Rate 3.8 11.1 2.2 1.2 5.0 1.5 5.0 28.2 3.5 9.7 3.3 5.7 1.8 7.6 7.3 6.7 12.9 4.9 10.4 4.3 7.3 5.3 2.5 17.5 1.4 1.7 1.7 11.2 5.1 10.4 6.6 Rate 3.7 10.8 2.7 1.6 6.4 1.7 4.8 27.5 3.2 9.3 3.3 8.6 1.7 7.2 7.2 6.5 14.4 5.4 10.2 5.1 7.0 5.5 3.0 15.7 2.1 2.7 2.7 10.3 4.4 10.2 6.5 Rate 3.8 11.1 2.1 1.8 6.7 1.5 3.6 23.8 2.9 9.5 3.6 10.5 2.2 5.9 7.7 6.9 16.6 5.3 11.1 7.2 6.5 4.9 3.0 14.7 2.4 2.2 2.2 9.5 4.3 10.3 6.7 Rate 3.1 10.0 2.7 1.7 6.2 2.0 4.2 24.6 2.9 9.4 4.0 8.2 2.4 3.4 7.2 6.0 16.8 6.0 9.9 8.5 6.4 4.6 3.3 12.3 2.5 2.1 2.2 7.0 4.2 9.4 6.2 2010 0 0 0 0 0 0 0 0 <0.01 <0.01 0 <0.01 0 0 0 0 0 0 0 0 <0.01 0 0.01 0.02 0 0 0 0 0.01 0.01 <0.01 2013 0 0 0 0 0 0 0.1 0 0.04 0.26 0 0.08 0 0 0 0 0 0 0 0 0.15 0.15 0.17 0.18 0 0 0.1 0 0.06 0.35 0.07

* The coefficients present the adjustments for the current year of reporting ** Country-specific comments are in Annex 5 *** French data are adjusted for both reporting delay and underreporting. Adjustment coefficients reported are for reporting delay only.

SURVEILLANCE REPORT

HIV/AIDS surveillance in Europe 2013

Annex 7 HIV/AIDS surveillance in Europe: participating countries and national institutions Country EU/EEA Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Non-EU/EEA Albania Andorra Armenia Azerbaijan Belarus Bosnia and Herzegovina former Yugoslav Republic of Macedonia Georgia Israel Kazakhstan Kyrgyzstan Moldova Monaco Montenegro Russia San Marino Serbia Switzerland Tajikistan Turkey Turkmenistan Ukraine Uzbekistan National institutions Federal Ministry of Health, Family and Youth Scientific Institute of Public Health Ministry of Health Croatian National Institute of Public Health Ministry of Health National Institute of Public Health Statens Serum Institut Health Board National Public Health Institute (KTL) Institut de veille sanitaire Robert Koch Institute Hellenic Center for Disease Control and Prevention National Center for Epidemiology (Országos Epidemiológiai Központ) Health Protection Agency Centre for Infections Health Protection Surveillance Centre (HPSC) Ministry of Health DG Prevention - Unit V Centre for Disease Prevention and Control of Latvia Center for Communicable Diseases and AIDS National Service of Infectious Diseases, Centre Hospitalier Department of Health Promotion and Disease Prevention National Institute for Public Health and the Environment (RIVM) Norwegian Institute of Public Health – Department of Infectious Disease Epidemiology National Institute of Public Health – National Institute of Hygiene (NIZP-PZH) National Institute of Health Dr Ricardo Jorge (Instituto Nacional de Saúde Doutor Ricardo Jorge, I.P.) Institute of Public Health and National Institute for Infectious Diseases "Prof. Dr. Matei Bals" Regional Public Health Authority of capital Bratislava National Institute of Public Health Instituto de Salud Carlos III Centro Nacional de Epidemiologia Swedish Institute for Infectious Disease Control Public Health England Institute of Public Health Ministry of Health and Welfare National Center for AIDS Prevention National AIDS Center National Centre for Hygiene, Epidemiology and Public Health Ministry of Health of Federation of Bosnia and Herzegovina; Public Health Institute of the Republika Srpska Public Health Institute Infectious Diseases, AIDS & Clinical Immunology Research Center-IDACIRC Ministry of Health State Committee for Sanitary Epidemiological Surveillance Republican AIDS Centre National Center for Public Health; Hospital for Dermatology and Communicable Diseases Ministry of Health and Social Affairs Institute of Public Health of Montenegro Federal Scientific and Methodological Center for Prevention and Control of AIDS Ospedale di Stato Institute of Public Health of Serbia Bundesamt für Gesundheit Republican HIV/AIDS Center Ministry of Health National AIDS Prevention Center National AIDS Center Republican Center to fight AIDS

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TQ-AL-14-001-EN-N

European Centre for Disease Prevention and Control (ECDC) Postal address: ECDC, SE-171 83 Stockholm, SWEDEN Visiting address: Tomtebodavägen 11a, Solna, SWEDEN Tel. +46 858601000 Fax +46 858601001 http://www.ecdc.europa.eu An agency of the European Union http://www.europa.eu

SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2013 www.ecdc.europa.eu www.euro.who.int

HIV/AIDS surveillance in Europe 2013 ii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Suggested citation for full report: European Centre for Disease Prevention and Control/ WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2013. Stockholm: European Centre for Disease Prevention and Control; 2014. Tables and figures should be referenced: European Centre for Disease Prevention and Control/ WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2013. This publication follows the ECDC terminological prac- tice which reflects the European Union Interinstitutional 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 maps are reproduced with the permission of the WHO Regional Office for Europe. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. WHO keywords: ACQUIRED IMMUNODEFICIENCY SYNDROME – EPIDEMIOLOGY AIDS AND ITS CONTROL DISEASE OUTBREAKS – STATISTICS HIV INFECTIONS – EPIDEMIOLOGY POPULATION SURVEILLANCE The European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe would like to thank the nominated national operational contact points for HIV/AIDS surveillance from EU/EEA Member States and the national HIV/AIDS surveillance focal points from other countries of the WHO European Region for providing data and valuable comments on this report. The report was coordinated by Anastasia Pharris (ECDC) and Annemarie Stengaard (WHO Regional Office for Europe). Report review and production support were provided by Andrew J. Amato-Gauci, Martin Donoghoe, Nedret Emiroglu, Guenael Rodier, Valentina Lazdina, Mike Catchpole, Julien Beauté, Marc Rondy, Phillip Zucs. The WHO Regional Office for Europe is responsible for the accu- racy of the translation of the Russian summary. © World Health Organization, 2014. Cover picture © Stockxpert ISBN 978-92-9193-608-3 ISSN 2363-3085 doi 10.2900/42271 Catalogue number TQ-AL-14-001-EN-N © European Centre for Disease Prevention and Control, 2014. Reproduction is authorised, provided the source is acknowledged. iii HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Contents Overview of HIV and AIDS in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii European Union and European Economic Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viii Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii Европейский союз и Европейская экономическая зона. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii Европейский регион ВОЗ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv Выводы . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvi Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xix 1 HIV and AIDS in the European Union and European Economic Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1.1 HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1.2 Trends in HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.3 AIDS cases, morbidity and mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.4 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2 HIV and AIDS in the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 2.1 HIV and AIDS diagnoses in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 HIV and AIDS diagnoses in the East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.3 HIV and AIDS diagnoses in the Centre. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.4 HIV and AIDS diagnoses in the West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.5 Number of HIV tests performed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 2.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Tables Table A: Characteristics of HIV diagnoses reported in the WHO European Region, the EU/EEA, and by geographical area, 2013 . . . . . . . . . . . . . . . . . . . .vii Table 1: HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/ EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 1a: HIV diagnoses and rates per 100 000 population, by country and year of statistics (2004–2013) and cumulative totals, in EU/ EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 2: HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 3: HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 4: HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 5: HIV diagnoses in persons infected through injecting drug use, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Table 6: HIV diagnoses in persons infected through heterosexual contact, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Table 7: HIV diagnoses in persons infected through mother-to-child transmission, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 8: HIV diagnoses, by geographical area, sex, transmission group and year of diagnosis (2004–2013) and cumulative totals. . . . . . . . . . . . . . . 34 Table 8a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 8b: Geographical areas, WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 iv SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 9: HIV diagnoses, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 9a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 9b: Geographical areas, WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table 10: HIV diagnoses in persons infected through heterosexual contact, by country and transmission subcategory, cases diagnosed in 2013, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 11: HIV diagnoses, by country of report and country or subcontinent of origin, cases diagnosed in 2013, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 12: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, cases reported in 2013 . . . . . . . . . . . . . . 46 Table 12a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 12b: Geographical areas, WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 13: HIV diagnoses, by probable region of infection, in 2013, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . 48 Table 14: Percentage of new HIV diagnoses (2013) 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. . . . . . 51 Table 15: AIDS cases and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 Table 15a: AIDS cases and rates per 100 000 population, by country and year of statistics (2004–2013) and cumulative totals, in EU/ EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Table 16: AIDS cases in males and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 17: AIDS cases in females and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 18: AIDS cases in men infected through sex with men, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 19: AIDS cases in persons infected through injecting drug use, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 Table 20: AIDS cases in persons infected through heterosexual contact, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 21: AIDS cases in persons infected through mother-to-child transmission, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table 22: AIDS cases, by geographical area, sex, transmission mode and year of diagnosis (2004–2013) and cumulative totals. . . . . . . . . . . . . . . . . . 64 Table22a: EU/EEA and non-EU/EEA countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 22b: Geographical areas, WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 23: AIDS cases, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 23a: EU/EEA and non-EU/EEA countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 23b: Geographical areas, WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 24: The most common AIDS-indicative diseases diagnosed in 2013, by geographical area ordered by frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 24a: EU/EEA and non-EU/EEA countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 24b: Geographical areas, WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 25: Deaths among AIDS cases, by country and year of death (2004–2013) and cumulative totals in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Table 26: Deaths among AIDS cases, by geographic area, transmission mode and year of death (2004–2013) and cumulative totals . . . . . . . . . . . . .74 Table 26a: EU/EEA and non-EU/EEA countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Table 26b: Geographical areas, WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Table 27: Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2004–2013) and number of tests per 1 000 population in 2013, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . 76 Figures Figure A: Rate of new HIV diagnoses per 100 000 population, by year of diagnosis, in the EU/EEA and the WHO European Region, 1984–2013 .viii Figure B: Cumulative number of new HIV diagnoses in the EU/EEA and other countries of the WHO European Region, 1984–2013 . . . . . . . . . . . . . . . . . ix Figure C: Male-to-female ratio in HIV diagnoses, by country, EU/EEA, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure D: Percentage of new HIV diagnoses, per age group, by transmission mode, EU/EEA, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure E: Percentage of new HIV diagnoses in people between 15 and 24 years old, by country, EU/EEA, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Figure F: Percentage of new HIV diagnoses acquired through sex between men out of all reported HIV diagnoses with known mode of HIV transmission, by country, EU/EEA, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Figure G: Percentage of new HIV diagnoses among persons originating from countries with generalised HIV epidemics out of all cases reported as heterosexually acquired, EU/EEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Figure H: Percentage of new HIV diagnoses among migrants out of all reported diagnoses with known region of origin, by country of report, EU/EEA, 2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 vHIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Figure I: Percentage of reported cases with a CD4 cell count <350/mm3 and <200/mm3 at presentation, by transmission mode, EU/EEA, 2013 . . . . 5 Figure J: Percentage of reported cases with a CD4 cell count <350/mm3 and <200/mm3 at presentation, by age category, EU/EEA, 2013. . . . . . . . . . . . 5 Figure K: New HIV diagnoses, by transmission mode and year of diagnosis, adjusted for reporting delay, EU/EEA, 2004–2013 . . . . . . . . . . . . . . . . . . . . . 6 Figure L: Percentage and number of the most common AIDS-indicative diseases per transmission mode, EU/EEA, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Figure M: Rates of new HIV diagnoses, by geographical area and year of diagnosis, WHO European Region, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Figure N: New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2004–2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Figure O: Rate of AIDS cases per 100 000 population, by geographical area and year of diagnosis, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Figure P: Male-to-female ratio in new HIV diagnoses and heterosexually infected cases, by country, East, 2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Figure Q: New HIV diagnoses, by transmission mode and year of diagnosis, East, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Figure R: Distribution of the three most common AIDS-indicative diseases per transmission mode, East, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Figure S: Male-to-female ratio in new HIV diagnoses, by country, Centre, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Figure T: New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Figure U: Distribution of the three most common AIDS-indicative diseases per transmission mode, Centre, 2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Figure V: New HIV diagnoses, by transmission mode and year of diagnosis, West, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Figure W: Distribution of the three most common AIDS-indicative diseases per transmission mode, West, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Map 1: HIV diagnoses per 100 000 population, 2013: All cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Map 2: HIV diagnoses per 100 000 male population, 2013: Males. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Map 3: HIV diagnoses per 100 000 female population, 2013: Females. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Map 4: HIV diagnoses per 100 000 population, 2013: Heterosexual transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Map 5: HIV diagnoses per 100 000 population, 2013: Injecting drug use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Map 6: HIV diagnoses per 100 000 population, 2013: Sex between men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 Map 7: AIDS cases reported per 100 000 population, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 Figure 1: AIDS cases diagnosed, by transmission mode and geographical area, 2004–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Figure A1: Geographical/epidemiological division of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Annex 1: Framework for data collection, validation and presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85 Annex 2: List of variables for the 2013 HIV/AIDS data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Annex 3: Completeness of variables for data reported in 2012 and 2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Annex 4a: HIV surveillance system overview: data source information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91 Annex 4b: AIDS surveillance system overview: data source information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Annex 5: Country-specific comments regarding national HIV and AIDS reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Annex 6: HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients, EU/EEA countries, 2010–2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Annex 7: HIV/AIDS surveillance in Europe: participating countries and national institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

vii HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Three decades after the beginning of HIV surveillance in Europe, HIV infection continues to be of major pub- lic health importance in the Region. In 2013, 136 235 new HIV infections were diagnosed in 51 of the 53 coun- tries of the WHO European Region1. Of those infections, 56 507 were officially reported to ECDC/WHO Regional Office for Europe by 50 countries including 29 157 infec- tions from the European Union and European Economic Area (EU/EEA)2, while information about 79 728 infec- tions was published by the Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS [1]. Surveillance data suggest an overall rate of 7.8 diag- noses per 100 000 population for the WHO European Region and 5.7 per 100 000 for the EU/EEA (Figure A). When data for Russia are included, the regional rate is 15.7 per 100 000 population. As in recent years, rates are highest in the East of the Region and lowest in the Centre (Table A). The main transmission mode varies by geographical area, illustrating the diversity in the epi- demiology of HIV in Europe; heterosexual transmission is the main mode of transmission in the WHO European Region, while sexual transmission between men is the most common mode in the EU/EEA and transmission through injecting drug use remains substantial in the East of the Region. In 2013, 15 789 AIDS cases were diagnosed in 49 coun- tries of the WHO European Region and the rate of new diagnoses was 2.2 per 100 000 population for the WHO European Region and 0.9 per 100 000 for the EU/EEA3. Although the number of AIDS cases continued its steady 1 No data available from Uzbekistan or Turkmenistan. 2 Liechtenstein is not presented separately in the tables (see Country Comments in Annex 5). 3 No data available from Russia, Sweden, Turkmenistan or Uzbekistan. decline in the West and the EU/EEA, it has tripled in the East since 2004. European Union and European Economic Area In 2013, 29 157 HIV diagnoses were reported by 30 EU/ EEA countries, with a rate of 5.7 per 100 000 population (Table 1). Countries with the highest rates of HIV diagno- ses in 2013 were Estonia (24.6), Latvia (16.8), Portugal (10.4), Belgium (10.0), and Luxembourg (9.9). The lowest rates were reported by Slovakia (1.5) and Croatia (2.0). Since the start of reporting on the HIV epidemic, 504 455 HIV diagnoses have been reported in the EU/EEA; 361 524 were in men and 139 527 in women (Tables 1–3), 3 404 not having gender information available. In 2013, the male-to-female ratio was 3.3 (Table A). Young people aged 15 to 24 years accounted for 11% of all HIV diagnoses reported, but this varied widely from 6% in Norway to 25% in Romania (Figure E). Similar to recent years, the highest proportion of HIV diagnoses was reported in men who have sex with men (MSM) (42%), with heterosexual transmission the sec- ond most common transmission mode (32%). One third (33%) of cases with a heterosexually-acquired infection originated from a country with a generalised HIV epi- demic. Transmission due to injecting drug use accounted for 5% of HIV diagnoses, and for nearly 20% of the cases, the transmission mode was unknown (Table A). Despite prevention efforts, there appears to have been no decline in HIV diagnoses per 100 000 population over the last decade, with the rate remaining fairly stable, at 6.5 per 100 000 in 2004 (28 259 cases) compared to 6.2 per 100 000 (31 977 cases) in 2013 when adjusted for reporting delay (Table 1, Annex 6). Trends by trans- mission mode show that the number of HIV diagnoses Overview of HIV and AIDS in Europe Table A: Characteristics of HIV diagnoses reported in the WHO European Region, the EU/EEA, and by geographical area, 2013 Geographical areas WHO European Region* West Centre East* EU/EEA Reporting countries/Number of countries 50/53 (51/53) 23/23 15/15 12/15 (13/15) 30/31 Number of HIV diagnoses 56 507 (136 235) 26 847 4166 25 494 (105 222) 29 157 Rate per 100 000 population 7.8 (15.7) 6.3 2.2 22.7 (41.2) 5.7 Percentage age 15–24 years 10.2% 10.3% 14.4% 9.5% 10.9% Male-to-female ratio 2.2 (1.7) 3.3 4.9 1.3 (1.4) 3.3 Transmission mode Men who have sex with men 23.6% (10.1%) 43.1% 30.1% 2% (0.8%) 41.9% Heterosexual 46.1% (30.6%) 33.6% 24.8% 62.7% (30.0%) 32.4% Injecting drug use 16.2% (21.3%) 4.1% 5.9% 30.6% (26.3%) 5.0% Mother-to-child transmission 0.9% (0.6%) 0.7% 1.1% 1.1% (0.6%) 0.7% Unknown 13% (37.3%) 18.2% 37.9% 3.6% (42.2%) 19.7% No data received from Lichtenstein, Turkmenistan or Uzbekistan. All data presented were reported to ECDC/WHO through the European Surveillance System (TESSy), except for data for Russia which were published by the Russian Federal Scientific and Methodological Center for Prevention and Control of AIDS [1]. * Figures including Russia are presented for the WHO Region and East in (brackets) viii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 among MSM in countries with consistent reporting have increased by 33% since 2004 (Table 8), with sustained increases over the last decade in all but four EU/EEA countries (Table 4). In contrast, the number of cases among people who inject drugs (PWID) has decreased by 36% over the period (Table 8), although an increase was observed in 2011 and 2012 due to localised outbreaks in Greece and Romania (Table 5). The numbers of HIV diagnoses due to heterosexual transmission decreased by 45% during the last decade, with sharper decreases seen among heterosexuals from countries with general- ised HIV epidemics (Table 8, Figure K). Mother-to-child transmission and transmission through blood transfu- sion have decreased continuously between 2004 and 2013 and remain at less than 1% of cases diagnosed (Table 8). In 2013, information on CD4 cell counts at the time of diagnosis was available in 21 countries for 17 526 cases (61% of all cases reported in 2013) (Table 14). Nearly half of these cases (47%) were diagnosed late (CD4 cell count <350/mm3), including the 27% of cases with advanced HIV infection (CD4 <200/mm3). The proportion of those diagnosed late was highest among hetero- sexually acquired cases originating from countries with generalised HIV epidemics (59%) and among PWID (52%). The lowest proportions of those diagnosed late were observed in MSM (37%) and in cases of mother-to- child transmission (26%) (Table 14, Figure I). A clear age gradient was seen with increasing proportions of late diagnosis in older age categories (Figure J). In 2013, 4 369 AIDS cases were diagnosed and reported by 29 EU/EEA countries4, which is a rate of 0.9 cases per 100 000 population (Table 15). The highest rates were reported by Latvia (6.6) and Portugal (3.1). In the EU/ 4 No data available from Sweden. EEA, the number of AIDS cases has consistently declined since the mid-1990s. WHO European Region With inclusion of 136 235 new HIV diagnoses reported in 2013, the cumulative number of infections diagnosed in the WHO European Region increased to 1 715 344, including 914 8135 officially reported to ECDC and the WHO Regional Office for Europe (Figure B) and 800 531 infections diagnosed in Russia [1]. The 136 235 new HIV diagnoses were reported by 51 of the 53 countries of the WHO European Region6, corresponding to a rate of 15.7 per 100 000 population for 2013 and includes 56 507 cases officially reported to ECDC/WHO Regional Office for Europe by 50 countries, corresponding to a rate of 7.8 per 100 000 population; and 79 728 cases from Russia [1]. Among officially reporting countries, forty-five per- cent of new diagnoses (25 494 cases) were reported in the East, 48% (26 847 cases) in the West and 7% (4 166 cases) in the Centre of the Region, while the rate (cases per 100 000 population) was highest in the East at 22.7, over three times higher than in the West (6.3 per 100 000) and ten times higher than in the Centre (2.2 per 100 000) (Table 1). When data for Russia are included, 77% per- cent of diagnoses were reported in the East, 20% in the West and 3% in the Centre, and the rate in the East was 41.2. Among reporting countries, the highest rates were reported by Ukraine (39.4), Estonia (24.6) and Moldova (17.3), Latvia (16.8), Belarus (14.6) and Kazakhstan (13.0). In Russia, the rate per 100 000 population was 55.6 in 2013 [1]. The majority of new HIV diagnoses (36%) were reported in the age group 30–39 years old, while 10% were 5 Minus the 62 581 cases officially reported to ECDC/WHO by Russia in 2010. 6 No data available from Uzbekistan or Turkmenistan. Figure A: Rate of new HIV diagnoses per 100 000 population, by year of diagnosis, in the EU/EEA and the WHO European Region, 1984–2013 0 1 2 3 4 5 6 7 8 9 201220102008200620042002200019981996199419921990198819861984 15 25 27 36 36 39 42 42 42 42 44 43 45 48 48 47 47 49 46 50 52 52 52 52 52 53 51 51 5051 Ca se s pe r 1 00 0 00 p op ul at io n WHO European Region EU/EEA Countries reporting Year of diagnosis Rates may increase in the coming years due to reporting delays Data from Russia not included. ix HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT reported among 15–24 year-olds. The male-to-female ratio was 2.2 (1.7 when Russia is included): lowest in the East (1.3) (1.4 when Russia is included), higher in the West (3.3) and highest in the Centre (4.9) (Table A). Most frequently, reported cases were acquired through heterosexual transmission (46%), although the picture is more heterogeneous at sub-regional level. Sixteen percent of the new HIV cases were infected through injecting drug use, 24% through sex between men and 0.9% were due to mother-to-child transmission (MTCT). For 13% of cases, the transmission mode was reported as unknown. When data for Russia are considered, the percentages change as presented in Table A but the overall distribution of transmission modes remains unchanged. In the West, sexual transmission between men remained the main transmission mode (43% of new diagnoses), followed by heterosexual transmission (34% of new diagnoses). In the Centre, the main transmission mode was through sex between men (30%) whereas hetero- sexual contacts accounted for 25% of new cases. In the East, heterosexual contact (accounting for 63% of new cases, 30% when Russia is included), followed by inject- ing drug use (31% of new cases, 26% when Russia is included), were the predominant modes of transmission while transmission through sex between men remained very low in absolute terms (2% of cases, 0.8% when Russia is included). Between 2004 and 2013, the rate of newly diagnosed HIV infections per 100 000 population increased by 81% from 8.7 in 2004 (75 812 cases) to 15.7 in 2013 (136 235 cases) in 51 countries7 (Russia included [1]) which corresponds to an 80% increase in the absolute number of cases. The increase is mainly driven by an upward trend in the East where the rate increased by fully 144%, from 16.9 in 2004 (47 332 cases) to 41.2 in 2013 (105 222 cases), cor- responding to a 122% increase in the absolute number of cases. In the 50 countries that provided official data 7 Data from Turkmenistan and Uzbekistan not included. (Russia excluded), the regional rate increased by 16%, from 6.7 (42 405 cases) to 7.8 (56 507 cases), whereas in the East it increased by 80%, from 12.6 in 2004 (13 925 cases) to 22.7 in 2013 (25 494 cases). In the Centre, the rate increased by 175%, from 0.8 (1 577 cases) to 2.2 (4 166 cases), whereas it decreased by 20%, from 7.9 (26 903 cases) to 6.3 (26 847), in the West (Figure M). Trends by transmission mode in the WHO European Region show increases in infections acquired due to heterosexual contact (30% increase), sex between men (40% increase) and mother-to-child transmission (32% increase), whereas infections due to injecting drug use decreased by 3% (Table 8) (Russia excluded). When data for Russia are included, the number of cases in each transmission category increased by 69% for heterosexual transmission (from 22 811 to 38 439), by 42% for injecting drug use (from 20 178 to 28 590), by 43% for sex between men (from 7108 to 10 168) and by 144% for unknown transmission (from 19 941 to 48 565) whereas it decreased by 15% for MTCT (from 988 to 839). In the East, sexual transmission (both heterosex- ual and through sex between men) increased, two-fold and fourteen-fold, respectively, whereas transmission through injecting drug use remained fairly stable in comparison with 2004 following a period of much higher levels during 2006–2010. At the same time, the number of women newly infected almost doubled between 2004 and 2013 (Table 3). When data for Russia are included, the number of cases in each transmission category in the East increased by 207% for heterosexual transmis- sion (from 10 225 to 31 424), by 48% for injecting drug use (from 18 632 to 27 596), by 427% for sex between men (from 166 to 875) and by 160% for unknown trans- mission (from 17 076 to 44 346) whereas it decreased by 5% for MTCT (from 671 to 635). In the West, transmis- sion through male-to-male sex increased by 26% and heterosexual transmission decreased by 47%. In the Centre, infections acquired through sex between men increased three-fold, heterosexual transmission by 64% and IDU-related transmission four-fold mainly due to an Figure B: Cumulative number of new HIV diagnoses in the EU/EEA and other countries of the WHO European Region, 1984–2013 0 2 4 6 8 10 201020052000199519901985 Other countries of the WHO European Region EU/EEA Nu m be r o f c as es (1 00 0 00 s) Year of diagnosis Data from Russia not included xSURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 outbreak in Romania that started in 2011 and peaked in 2012 (Table 8). In 2013, 35 countries in the WHO European Region provided information on CD4 cell count at the time of diagnosis for 35 383 (48%) cases (Table 14). Of these cases, 49% were reported as late presenters (CD4 cell count <350/mm3), including 27% of cases with advanced HIV infection (CD4 <200/mm3). The percentage of late presenters varied across transmission categories and geographical areas and was highest among people infected through injecting drug use in the East (68%) (Table 14). In 2013, 15 789 AIDS cases were diagnosed in 49 coun- tries of the WHO European Region8, corresponding to a rate of 2.2 per 100 000 population. Seventy-two percent (11 292 cases) were reported by countries in the East, 23% (3 606 cases) in the West and 6% (891 cases) in the Centre of the Region. The number of cases per 100 000 population was 10.0 in the East, eleven times higher than in the West (0.9 per 100 000) and 20 times higher than in the Centre (0.5 per 100 000) (Table 15). Between 2004 and 2013, the rate of new AIDS cases per 100 000 population increased by 10%, from 2.0 in 2004 (12 952 cases) to 2.2 in 2013 (15 789 cases) in the 50 coun- tries with consistent AIDS data. There was, however, substantial variation at sub-regional level with a three- fold increase in rates in the East from 3.2 per 100 000 (3 275 cases) to 10.0 (11 292 cases), a 64% decrease in the West from 2.5 per 100 000 (8 915 cases) to 0.9 (3 606 cases) and a 25% increase in the Centre from 0.4 (762 cases) to 0.5 (891 cases). Conclusions HIV infection remains of major public health importance in Europe. A total of 136 235 new HIV infections were diagnosed in 51 of 53 countries in 2013, giving a rate of 15.7 per 100 000 population. The most recent sur- veillance data indicate that, despite significant efforts dedicated to the prevention and control of HIV, the rate of new HIV diagnoses has not declined in the EU/EEA and has increased substantially over the last decade in the European Region. HIV is mainly concentrated in key populations at higher risk of HIV infection such as men who have sex with men, people originating from gener- alised epidemic countries (mainly sub-Saharan Africa) and other migrants, and PWID and their sexual partners. At the same time cases among people originating from countries with generalised HIV epidemics appear to be decreasing. People infected through heterosexual trans- mission in the East, notably women, are increasingly affected. Recent increases of HIV among PWID in some countries in the EU/EEA and West indicate that even low numbers can rapidly evolve into an outbreak when pub- lic health interventions are insufficient [3]. The proportion of late diagnoses is high in all coun- tries reporting data on CD4 cell count at diagnosis. This 8 No data available from Russia, Sweden, Turkmenistan or Uzbekistan. indicates a delay in HIV testing with nearly half of cases already eligible for treatment when they are diagnosed, based on 2010 WHO criteria of when to initiate ART; this has since been revised to recommend ART initiation at CD4 cell count <500/mm3 [2]. The high and increasing number of AIDS cases in the East is also indicative of late HIV diagnosis, low treatment coverage and delayed ini- tiation of life-saving HIV treatment. The wide availability of treatment and recommendations for earlier initiation [2] have widened the scope of HIV surveillance to include monitoring of access to care and treatment. Improved access to and earlier initiation of treatment, particularly for key populations, is of importance throughout Europe but increasingly needs to be urgently addressed in the East. In order to decrease the number of late diagnoses, the current organisation of HIV counselling and testing services need to be reconsidered, including innovative approaches and services (such as routine offers of coun- selling and testing in clinical settings, rapid testing and community-based testing [2]), to reach people that are at higher risk. These services should be accessible and tar- geted toward key populations in order to ensure earlier diagnoses and initiation of HIV treatment and linkage to care. This will result in improved treatment outcomes, reduced morbidity and mortality and will contribute to preventing or further reducing onward HIV transmis- sion. Equal access to HIV prevention, testing, treatment and care for all population groups should be ensured in order for countries to reach the global targets of 90% of people living with HIV diagnosed and enrolled in care; 90% of those diagnosed retained in care; and 90% of people in care being virally suppressed [4]. Interventions to control the epidemic need to be based on evidence and adapted to national and local epide- miology. From the surveillance data presented in this report, the following can be concluded: • For the countries in the EU/EEA and West, interven- tions to prevent and control HIV among MSM are the cornerstones of the HIV response. Given the persistent increase in cases diagnosed in this key population over the last decade, it would appear that current pre- vention and control efforts are not yet being delivered with sufficient effect and would need to be signifi- cantly strengthened. In addition, as about 30% of all new infections in the EU/EEA are reported among migrants and about one third of the heterosexually acquired HIV cases were reported as originating from high-endemic countries, countries need to ensure that interventions for prevention, treatment and care are accessible to migrants. The observed increase in HIV cases among people who inject drugs in a number of countries [3] in recent years demonstrates the need to maintain or scale up harm reduction programmes in some settings. • For the countries in the Centre, as the epidemic among MSM is increasing, the priority is to strengthen inter- ventions to prevent, test and treat HIV in this group. Stigma reduction efforts will be key to achieving this. xi HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT • For the countries in the East, there is a need to scale up targeted interventions and deliver effective, high- quality, integrated services through well-functioning health systems that address the social determinants of health. Comprehensive coverage with effective prevention, early and targeted testing, and access to counselling and integrated care should be provided to all in need. Access to antiretroviral therapy should be used strategically to treat and prevent HIV transmis- sion and reduce the growing number of AIDS cases. Evidence-based policies targeting key populations, particularly people who inject drugs, including harm reduction programmes and early access to treatment, need to remain the cornerstones of the HIV response. In couples where one of the partners is engaged in a high-risk behaviour, including but not limited to inject- ing drug use, bolder prevention interventions should address the risk of heterosexual transmission [5]. Finally, robust surveillance data are critical to monitor and inform the public health response to the European HIV epidemic in an accurate and timely fashion. The number of countries conducting enhanced HIV surveil- lance and reporting surveillance data at European level has gradually increased over time; in 2013, 50 of the 53 countries submitted data. Data quality and com- pleteness of key variables such as transmission mode and CD4 cell count at time of diagnosis can be further improved, as can measures of access to, uptake of, and retention in care following diagnosis. In 2014, HIV surveillance will undergo revision in order to be more fit-for-purpose, combining the surveillance of HIV and AIDS and increasing the possibilities for longer-term monitoring of continuum of care outcomes such as link- age to care, treatment, and viral suppression following HIV diagnosis. References 1 Federal Scientifi c and Methodological Center for Prevention and Control of AIDS. Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014. 2 World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Geneva: World Health Organization; 2013. 3 Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L, et al. Human immunodefi ciency virus among people who inject drugs: Is risk increasing in Europe? Euro Surveill. 2013;18(48):pii=20648. Available online: http://www.eurosurveillance.org/ViewArticle. aspx?ArticleId=20648 4 UNAIDS. Ambitious treatment targets: Writing the fi nal chapter of the AIDS epidemic. Geneva; 2014. Available online: http://www.unaids.org/en/media/unaids/con- t e n t a s s e t s / d o c u m e n t s / u n a i d s p u b l i c a t i o n / 2 0 1 4 / JC2670_UNAIDS_Treatment_Targets_en.pdf 5 World Health Organization. Consolidated guidelines on HIV preven- tion, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2014. xii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 xiii HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе Через три десятилетия после начала функциони- рования системы эпиднадзора за ВИЧ в Европе ВИЧ-инфекция продолжает оставаться важной проблемой общественного здравоохранения для Европейского региона ВОЗ 1. В 2013 г. в 51 из 53 стран Европейского региона ВОЗ было зарегистрировано 136 235 новых случаев ВИЧ-инфекции. Пятьдесят стран официально представили ECDC/Европейскому региональному бюро ВОЗ сведения о 56 507 случаях ВИЧ-инфекции, в том числе о 29 157 случаях в странах – членах Европейского союза и Европейской эконо- мической зоны (ЕС/ЕЭЗ)2, а информация о еще 79 728 случаях была опубликована Федеральным научно- методическим центром по профилактике и борьбе со СПИДом в Российской Федерации [1]. По данным эпиднадзора, общая частота диагностиро- ванных случаев ВИЧ-инфекции составила 7,8 случая на 100 000 населения в странах Европейского реги- она ВОЗ и 5,7 случая на 100 000 населения в странах ЕС/ЕЭЗ (рисунок А). При учете данных по Российской Федерации региональный показатель частоты новых случаев ВИЧ-инфекции составляет 15,7 на 100 000 населения. Как и в предыдущие годы самые высо- кие показатели были зарегистрированы в восточной части, а самые низкие – в центральной части Региона (таблица А). Основной путь передачи вируса разли- чается в зависимости от географической зоны, что указывает на широкое разнообразие эпидемиологии ВИЧ-инфекции в Европе. Основным путем передачи ВИЧ в Европейском регионе ВОЗ является гетеро- сексуальный. Однако в странах ЕС/ЕЭЗ доминирует передача ВИЧ при сексуальных контактах между муж- чинами, а в восточной части Региона значительный 1 Нет данных из Узбекистана или Туркменистана. 2 Лихтенштейн не представлен отдельно в таблицах (см. замечания по странам в Приложении 5). вклад в ВИЧ-инфицирование продолжает вносить употребление инъекционных наркотиков. В 2013 г. в 49 странах Европейского региона ВОЗ было диагностировано 15 789 случаев СПИДа, и частота новых случаев СПИДа составила 2,2 на 100 000 насе- ления в Европейском регионе ВОЗ в целом и 0,9 на 100 000 населения в ЕС/ЕЭЗ3. Хотя число новых случаев СПИДа продолжает устойчиво снижаться в западной части Региона и в ЕС/ЕЭЗ, в восточной части Региона за период с 2004 г. оно выросло в три раза. Европейский союз и Европейская экономическая зона В 2013 г. 30 стран ЕС/ЕЭЗ сообщили о 29 157 новых случаях ВИЧ-инфекции, что составляет 5,7 случаев на 100 000 населения (таблица 1). В 2013 г. самая высокая частота случаев ВИЧ-инфицирования была зарегистрирована в Эстонии (24,6), Латвии (16,8), Португалии (10,4), Бельгии (10,0) и Люксембурге (9,9). Самые низкие показатели ВИЧ-инфицирования были зарегистрированы в Словакии (1,5) и Хорватии (2,0). За период с начала предоставления отчетности по эпидемии ВИЧ-инфекции, в странах ЕС/ЕЭЗ зареги- стрировано 504 455 случаев ВИЧ-инфекции – 361 524 случая у мужчин и 139 527 случаев у женщин (таблицы 1 и 3), а в 3 404 случаях информация о половой при- надлежности отсутствовала. В 2013 г. соотношение числа случаев среди мужчин и женщин составило 3,3 (таблица А). На молодых людей в возрасте от 15 до 24 лет приходилось 11% всех заре- гистрированных случаев ВИЧ-инфекции, но этот 3 Нет данных из России, Швеции, Туркменистана или Узбекистана. Таблица A: Характеристики новых случаев ВИЧ-инфекции, зарегистрированных в Европейском регионе ВОЗ, в ЕС/ЕЭЗ и в различных географических зонах Региона, 2013 г Географические зоны Евро-пейский регион ВОЗ* Запад Центр Восток* ЕС/ЕЭЗ Страны, предоставляющие данные/Число стран 50/53 (51/53) 23/23 15/15 12/15 (13/15) 30/31 Число новых случаев ВИЧ-инфекции 56 507 (136 235) 26 847 4166 25 494 (105 222) 29 157 Частота на 100 000 населения 7.8 (15.7) 6.3 2.2 22.7 (41.2) 5.7 Процент случаев в возрастной группе 15–24 года 10.2% 10.3% 14.4% 9.5% 10.9% Соотношение мужчин и женщин 2.2 (1.7) 3.3 4.9 1.3 (1.4) 3.3 Путь передачи инфекции Мужчины, имеющие секс с мужчинами (МСМ) 23.6% (10.1%) 43.1% 30.1% 2% (0.8%) 41.9% Гетеросексуальный 46.1% (30.6%) 33.6% 24.8% 62.7% (30.0%) 32.4% Употребление инъекционных наркотиков 16.2% (21.3%) 4.1% 5.9% 30.6% (26.3%) 5.0% Передача ВИЧ от матери ребенку 0.9% (0.6%) 0.7% 1.1% 1.1% (0.6%) 0.7% Неизвестно 13% (37.3%) 18.2% 37.9% 3.6% (42.2%) 19.7% Нет данных по Лихтенштейну, Туркменистану или Узбекистану. Все данные, представленные в ВОЗ и ECDC, были получены через Европейскую систему эпиднадзора (TESSy) – за исключением данных по Российской Федерации, которые были опубликованы Федеральным научно-методическим центром по профилактике и борьбе со СПИДом в Российской Федерации [1] * Цифры, включающие данные по России, представлены в скобках в колонках по Европейскому региону ВОЗ и по его восточной части xiv SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 показатель широко варьировался – от 6% в Норвегии до 25% в Румынии (рисунок E). Как и в предыдущие годы, самая высокая доля новых случаев ВИЧ-инфекции была зарегистрирована среди мужчин, имеющих секс с мужчинами (МСМ) (42%), а второе место среди причин ВИЧ-инфицирования занимали гетеросексуальные контакты (32%), Одна треть (33%) новых случаев ВИЧ-инфекции с гетеро- сексуальным путем передачи была зарегистрирована среди выходцев из стран с генерализованной эпиде- мией ВИЧ-инфекции. На передачу вируса вследствие употребления инъекционных наркотиков пришлось 5% диагнозов ВИЧ-инфекции, а почти в 20% случаях ВИЧ-инфицирования путь передачи был неизвестен (таблица А). Несмотря на усилия, предпринятые для профи- лактики ВИЧ-инфекции, за последнее десятилетие частота ВИЧ-инфицирования на 100 000 населения, по-видимому, не снизилась, а остается примерно на том же уровне. Так, в 2004 г. этот показатель состав- лял 6,5 на 100 000 населения (28 259 случаев), а в 2013 г. он был равен 6,2 на 100 000 населения (31 977 случаев) – с поправкой на задержки в предоставле- нии данных (таблица 1, приложение 6). Тенденции в отношении путей передачи вируса указывают на то, что за период с 2004 г. число новых случаев ВИЧ-инфекции среди МСМ в странах, регулярно сообщающих данные, выросло на 33% (таблица 8) – с устойчивым ростом в течение последнего десятиле- тия во всех, кроме четырех стран ЕС/ЕЭЗ (таблица 4). Среди людей, употребляющих инъекционные нарко- тики (ЛУИН), число новых случаев ВИЧ-инфекции за этот период, наоборот, снизилось на 36% (таблица 8). Однако в 2011 и 2012 гг. было отмечено увеличение этого показателя среди ЛУИН в связи с локальными вспышками в Греции и Румынии (таблица 5). В течение последнего десятилетия число диагнозов ВИЧ-инфекции, связанной с гетеросексуальной пере- дачей вируса, снизилось на 45%. При этом более выраженное уменьшение было отмечено среди гете- росексуалов из стран с генерализованной эпидемией ВИЧ-инфекции (таблица 8, рисунок K). Число новых случаев ВИЧ-инфекции вследствие передачи ВИЧ от матери ребенку и вследствие переливания крови снижалось непрерывно в период между 2004 и 2013 гг. и остается на уровне менее 1% от всех новых слу- чаев ВИЧ-инфекции (таблица 8) В 2013 г. информация о числе клеток CD4 на момент постановки диагноза ВИЧ-инфекции была получена от 21 страны для 17 526 случаев (61% от всех случаев, зарегистрированных в 2013 г.) (таблица 14). Почти половина из этих случаев (47%) была диагностиро- вана на поздних стадиях (число клеток CD4 <350/ мм³), включая 27% случаев с продвинутой стадией ВИЧ-инфекции (число клеток CD4 <200/мм³). Доля диагнозов, поставленных на поздних стадиях, была самой высокой при заражении гетеросексуальным путем у выходцев из стран с генерализованной эпи- демией ВИЧ-инфекции (59%) и среди ЛУИН (52%). Самая низкая доля диагнозов ВИЧ-инфекции, постав- ленных на поздних стадиях, была зарегистрирована среди МСМ (37%) и в случаях передачи вируса от матери ребенку (26%) (таблица 14, рисунок I). Существует четкий градиент в частоте новых слу- чаев ВИЧ-инфекции, диагностированных на поздних стадиях – с увеличением этого показателя в более старших возрастных категориях (рисунок J). В 2013 г. в 29 странах ЕС/ЕЭЗ4 было диагностировано и зарегистрировано 4 369 случаев СПИДа, что соста- вило 0,9 случая на 100 000 населения (таблица 15). Самые высокие показатели были зарегистрированы в Латвии (6,6) и Португалии (3,1). С середины 1990-х 4 Нет данных из Швеции. Figure A: Частота зарегистрированных новых случаев ВИЧ-инфекции на 100 000 населения, с разбивкой по году постановки диагноза, в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 1984–2013 гг. – с поправкой на задержки в предоставлении данных 0 1 2 3 4 5 6 7 8 9 201220102008200620042002200019981996199419921990198819861984 15 25 27 36 36 39 42 42 42 42 44 43 45 48 48 47 47 49 46 50 52 52 52 52 52 53 51 51 5051 сл уч аи н а 10 0 00 0 на се ле ни я Европейский регион ВОЗ ЕС/ЕЭЗ Год постановки диагноза Количест во стран, которые подали отчет Из-за задержки сообщения в ближайшие годы частота может увеличиться. Данные по Российской Федерации не включены. xv HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT гг. в странах ЕС/ЕЭЗ наблюдается постоянное сниже- ние числа новых случаев СПИДа. Европейский регион ВОЗ С включением 136 235 новых случаев ВИЧ-инфекции, диагностированных в 2013 г., кумулятивное число инфекций, диагностированных в Европейском реги- оне ВОЗ, увеличилась до 1 715 344, включая 914 813 случаев5, официально представленных в ECDC и Европейское региональное бюро ВОЗ, (рисунок B) и 800 531 случай инфекции, диагностированных в России [1]. 136 235 новых случаев ВИЧ-инфекции были диагностированы в 51 из 53 стран Европейского региона ВОЗ6, что составляет 15,7 случая на 100 000 населения в 2013 г. и включает в себя 56 507 случаев официально сообщенных в ECDC/Европейское реги- ональное бюро ВОЗ 50 странами (что составляет 7,8 случая на 100 000 населения), и 79 728 случаев, диагностированных в России [1]. Что касается рас- пределения случаев по странам, предоставляющим данные, то из всех новых случаев ВИЧ-инфекции 45% (25 494) было зарегистрировано на Востоке, 48% (26 847) – на Западе и 7% (4 166) – в Центре Региона; при этом частота (число случаев на 100 000 населе- ния) была самой высокой на Востоке (22,7), где этот показатель был более чем в три раза выше, чем на Западе (6,3 на 100 000) и в 10 раз выше, чем в Центре (2,2 на 100 000) (таблица 1). При включении данных по России распределение значений является следу- ющим: 77% процентов случаев ВИЧ-инфекции было зарегистрировано на Востоке, 20% на Западе и 3% в Центре, а частота случаев на Востоке составила 41,2. Среди стран, предоставляющих данные, самые высо- кие показатели были зарегистрированы в Украине (39,4), Эстонии (24,6), Молдове (17,3), Латвии (16,8), Беларуси (14,6) и Казахстане (13,0). В Российской 5 За минусом тех случаев, информация о которых была официально представлена в ECDC/ВОЗ Российской Федерацией в 2010 г. (62 581). 6 Нет данных по Узбекистану или Туркменистану. Федерации частота новых случаев ВИЧ-инфекции на 100 000 населения в 2013 г. была равна 55,6 [1]. Большинство новых случаев ВИЧ-инфекции (36%) было зарегистрировано в возрастной группе 30–39 лет. В возрастной группе 15–24 года показатель ВИЧ- инфицирования составил 10%. Соотношение случаев среди мужчин и женщин составило в среднем 2,2 (1,7 при включении данных по России) – с самым низ- ким значением в восточной части Региона (1,3) (1,4 при включении данных по России), более высоким значением в западной части Региона (3,3) и самым высоким значением в центральной части Региона (4,9) (таблица А). Чаще всего заражение происхо- дило при гетеросексуальных контактах (46%), хотя на субрегиональном уровне картина была более раз- нородной, что демонстрирует широкое разнообразие эпидемиологии ВИЧ-инфекции в Европе. В 16% новых случаев ВИЧ-инфекции заражение произошло при инъекционном употреблении наркотиков, в 24% – при сексуальных контактах между мужчинами и в 0,9% – в результате передачи вируса от матери ребенку (ПМР). В 13% случаев путь заражения был неизвестен. При учете данных по России процентные значения меняются (как это видно из таблицы А), но в целом распределение путей передачи остается неизменным. В западной части Региона основным путем передачи ВИЧ-инфекции оставались сексуальные контакты между мужчинами (43% новых случаев), за которыми следуют гетеросексуальные контакты (34% новых случаев). В центральной части Региона основным путем передачи ВИЧ-инфекции были сексуальные контакты между мужчинами (30% новых случаев), за которыми следовали гетеросексуальные контакты (25%). В восточной части Региона преобладающими путями передачи ВИЧ были гетеросексуальные кон- такты (63% новых случаев, 30% – при включении данных по России) и употребление инъекционных наркотиков (31% новых случаев – 26% при включе- нии данных по России), в то же время как процент Рисунок B: Кумулятивное число диагнозов ВИЧ-инфекции в странах ЕС/ЕЭЗ и в других странах Европейского региона ВОЗ, 1984–2013 гг 0 2 4 6 8 10 201020052000199519901985 Другие страны Европейского региона ВОЗ ЕС/ЕЭЗ Чи сл о сл уч ае в (1 00 0 00 ) Год постановки диагноза Данные по Российской Федерации не включены. xvi SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 случаев передачи ВИЧ через секс между мужчинами остается очень низким в абсолютном выражении (2% новых случаев – 0,8% при включении данных по России). В период с 2004 по 2013 год, число новых случаев ВИЧ-инфекции на 100 000 населения увеличилось на 81% с 8,7 в 2004 году (75 812 случаев) до 15,7 в 2013 г. (136 235 случаев) в 51 стране7 (включая Россию [1]), что соответствует увеличению абсолютного числа случаев на 80%. Увеличение происходило, главным образом, за счет восходящей тенденции в восточной части Региона, где этот показатель увеличился на 144% – с 16,9 в 2004 г. (47 332 случая) до 41,2 в 2013 г. (105 222 случая) соответствуя повышению на 122% абсолютного числа новых случаев. В 50 странах, представивших официальные данные (за исключе- нием России), региональный показатель увеличился на 16% – с 6,7 (42 405 случаев) до 7,8 (56 507 случаев), в то же время как в восточной части Региона он уве- личился на 80% – с 12,6 в 2004 г. (13 925 случаев) до 22,7 в 2013 г. (25 494 случаев). В центральной части Региона этот показатель увеличился на 175% – от 0,8 (1 577 случаев) до 2,2 (4 166 случаев), в то же время как в западной части Региона он снизился на 20% – с 7,9 (26 903 случая) до 6,3 (26 847 случаев) (рису- нок M). Динамика частоты ВИЧ-инфицирования в Европейском регионе ВОЗ с разбивкой по путям передачи вируса показывает увеличение этого пока- зателя на 30%, 40% и 32% – соответственно для гетеросексуальной передачи, передачи среди МСМ и передачи от матери ребенку. С другой стороны, число случаев передачи ВИЧ при употреблении инъекцион- ных наркотиков снизилось на 3% (за исключением России). При включении данных по России, число случаев в разбивке по путям передачи ВИЧ увели- чилось на 69% для гетеросексуальной передачи (с 22 811 до 38 439), на 42% для потребления инъекци- онных наркотиков (с 20 178 до 28 590), на 43% для секса между мужчинами (с 7108 до 10 168) и на 144% для неизвестного пути передачи вируса (с 19 941 до 48 565), в то время как число случаев передачи ВИЧ от матери к ребенку снизилось на 15% (от 988 до 839 случаев). В восточной части Региона частота новых случаев ВИЧ-инфекции, приходящихся на половой путь передачи (как вследствие гетеросексуальных контактов, так и вследствие секса между мужчинами) увеличилась, соответственно, в два и четырнадцать раз, в то время как показатель ВИЧ-инфицирования вследствие употребления инъекционных наркотиков в целом соответствовал уровню 2004 года – после периода гораздо более высоких показателей в период 2006–2010 гг. В то же время число новых слу- чаев ВИЧ-инфекции среди женщин в период между 2004 и 2013 гг. увеличилось почти вдвое (таблица 3). При включении данных по России число случаев в разбивке по путям передачи ВИЧ в восточной части Региона увеличилось на 207% для гетеросексуальной передачи (с 10 225 до 31 424), на 48% для потребле- ния инъекционных наркотиков (с 18 632 до 27 596), 7 Данные по Туркменистану и Узбекистану не включены. на 427% для секса между мужчинами (с 166 до 875) и на 160% для неизвестного пути передачи ВИЧ (от 17 076 до 44 346), в то время как число случаев пере- дачи ВИЧ от матери к ребенку снизилось на 5% (от 671 до 635 случаев). В западной части Региона пока- затель ВИЧ-инфицирования вследствие сексуальных контактов между мужчинами увеличился на 26%, а вследствие гетеросексуальных контактов снизился на 47%. В центральной части Региона частота ВИЧ- инфекций, приобретенных вследствие секса между мужчинами, увеличилась в три раза, вследствие гетеросексуальных контактов на 64% и вследствие употребления инъекционных наркотиков в четыре раза (главным образом, в связи со вспышкой в Румынии, которая началась в 2011 г. и достигла пика в 2012 г.) (таблица 8). В 2013 г. 35 стран Европейского региона ВОЗ пре- доставили информацию о количестве клеток CD4 на момент постановки диагноза ВИЧ-инфекции для 35 383 случаев (48%) (таблица 14). 49% из этих случаев были зарегистрированы как случаи, выяв- ленные на поздних стадиях (число клеток CD4 <350/ мм³), включая 27% случаев с продвинутой стадией ВИЧ-инфекции (число клеток CD4 <200/мм³). Процент случаев, выявленных на поздних стадиях инфек- ции, варьировался в зависимости от путей передачи вируса и географических зон. Самым высоким он был среди людей, инфицированных в результате инъ- екционного употребления наркотиков в восточной части Региона (68%) (таблица 14). В 2013 г. в 49 государствах-членах Европейского региона ВОЗ8, было зарегистрировано 15 789 новых случаев СПИДа, и заболеваемость, таким образом, составила 2,2 случая на 100 000 населения. Семьдесят два процента случаев заболевания СПИДом (11 292) были зарегистрированы в восточной части, 23% (3 606) в западной части и 6% (891) в центральной части Региона. Частота новых случаев на 100 000 населения в восточной части Региона составила 10,0. Этот показатель был более чем в одиннадцать раз выше, чем в западной части Региона (0,9 на 100 000) и в 20 раз выше, чем в центральной части Региона (0,5 на 100 000) (таблица 15). В период с 2004 по 2013 гг. в 50 странах, которые регулярно предоставляли соответствующие данные, частота новых случаев СПИДа на 100 000 населения увеличилась на 10% – с 2,0 в 2004 г. (12 952 случая) до 2,2 в 2013 г. (15 789 случаев). Однако на субрегиональ- ном уровне наблюдались существенные различия, о чем свидетельствуют следующие цифры: увеличение показателя в три раза в восточной части Региона – с 3,2 на 100 000 (3 275 случаев) до 10,0 (11 292 случая); снижение показателя на 64% в западной части – с 2,5 на 100 000 (8 915 случаев) до 0,9 (3 606 случаев); и увеличение показателя на 25% в центральной части – с 0,4 (762 случая) до 0,5 (891 случай). 8 Нет данных из России, Швеции, Туркменистана или Узбекистана. xvii HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Выводы ВИЧ-инфекция продолжает оставаться серьезной про- блемой общественного здравоохранения в Европе. В 2013 г. в 51 из 53 государств-членов Европейского региона было зарегистрировано 136 235 новых слу- чаев ВИЧ-инфекции, что составило 15,7 случая на 100 000 населения. Самые последние данные эпид- надзора показывают, что, несмотря на значительные усилия по профилактике и борьбе с ВИЧ-инфекцией, частота ВИЧ-инфицирования в ЕС/ЕЭЗ не уменьши- лась, в то время как в Европейском регионе в целом за последние десять лет было зарегистрировано существенное увеличение этого показателя. ВИЧ- инфекция в Европейском регионе главным образом сосредоточена в ключевых группах населения, под- вергающихся более высокому риску заражения ВИЧ, таких как мужчины, имеющие половые контакты с мужчинами, выходцы из высоко эндемичных стран (в основном из стран Африки южнее Сахары) и мигранты из других стран, а также ЛУИН и их половые партнеры. В то же время частота случаев среди выходцев из стран с генерализованной эпидемией ВИЧ-инфекции, по-видимому, сокращается. Кроме того, в восточной части Региона все чаще наблюдаются новые случаи ВИЧ-инфекции, связанные с гетеросексуальной пере- дачей, особенно среди женщин. Недавний рост числа новых случаев ВИЧ-инфекции среди ЛУИН в ЕС/ЕЭЗ и в некоторых странах западной части Европейского региона продемонстрировал, что вспышка ВИЧ- инфекции вполне возможна даже при небольшом числе ВИЧ-инфицированных, если соответствующие меры служб общественного здравоохранения явля- ются недостаточными [3]. Во всех странах, сообщающих данные о количестве CD4 на момент постановки диагноза, процентная доля случаев поздней диагностики является высокой. Это указывает на задержку с прохождением тестирования на ВИЧ. Например, на момент постановки диагноза почти половина пациентов уже имели право на АРВ- терапию согласно критериям ВОЗ от 2010 г., которые были затем пересмотрены, чтобы рекомендовать начало проведения АРТ при количестве CD4-клеток менее 500/мм3 [2]. Высокое и растущее число случаев СПИДа, в особенности в восточной части Региона, также указывает на позднюю постановку диагноза ВИЧ-инфекции, низкий охват АРВ-терапией и на то, что лечение ВИЧ-инфекции, необходимое для спа- сения жизни пациента, начинают несвоевременно. Увеличение доступности лечения и рекомендации относительно более раннего начала АРВ-терапии [2] расширили задачи эпиднадзора за ВИЧ-инфекцией, в которые теперь входит мониторинг доступа ВИЧ- инфицированных к помощи и соответствующему лечению. В масштабах всей Европы необходимо обе- спечить улучшение показателей доступности лечения и его своевременного назначения, в особенности для ключевых групп населения. Самые срочные меры в этом направлении требуется предпринять в восточ- ной части Региона. Для того чтобы уменьшить количество поздних диа- гнозов, следует пересмотреть нынешнюю практику консультирования и тестирования на ВИЧ, с тем чтобы обеспечить охват людей, которые подверга- ются более высокому риску (например, с помощью таких подходов, как рутинное предложение пройти консультирование и тестирование на ВИЧ людям, обращающимся в медицинское учреждение, экс- пресс-тестирование, а также тестирование вне медицинских учреждений [2]). Особое внимание следует уделять ключевым группам населения, с тем чтобы обеспечить среди них более раннюю постановку диагноза ВИЧ-инфекции и своевремен- ное начало АРВ-терапии. Это приведет к улучшению результатов лечения, сокращению заболеваемости и смертности, а также будет способствовать предотвра- щению или дальнейшему снижению передачи ВИЧ. Необходимо обеспечить равный доступ всех людей к услугам профилактики, тестирования, лечения и ухода в связи с ВИЧ-инфекцией, так как только в этом случае страны смогут реализовать глобальные цели, поставленные в этой области: 90% людей, живущих с ВИЧ, должны быть диагностированы и охвачены медицинской помощью; 90% пациентов с постав- ленным диагнозом остаются в системе медицинской помощи; и у 90% людей, охваченных медицинской помощью, достигнута вирусная супрессия [4]. Меры по противодействию эпидемии должны осно- вываться на научных данных и быть адаптированы к национальным и местным эпидемиологическим условиям. На основании данных эпиднадзора, пред- ставленных в этом докладе, можно сделать следующие выводы: • Для стран ЕС/ЕЭЗ и западной части Региона основой таких мер являются мероприятия по про- филактике и борьбе с ВИЧ-инфекцией среди МСМ. Учитывая устойчивое увеличение числа случаев, диагностированных в этой ключевой группе насе- ления в последнее десятилетие, по-видимому, можно сделать вывод, что на данный момент уси- лия по профилактике и борьбе с ВИЧ-инфекцией все еще не достаточны и должны быть значительно усилены. Поскольку около 30% всех новых случаев ВИЧ-инфицирования в ЕС/ЕЭЗ были зарегистри- рованы среди мигрантов и около трети случаев ВИЧ-инфекции, приобретенной гетеросексуальным путем, были зарегистрированы среди мигрантов из высоко эндемичных стран, нужно принять меры к тому, чтобы услуги по профилактике, лечению и уходу в связи с ВИЧ-инфекцией были легко доступ- ными для всех мигрантов. В последние несколько лет в ряде стран [3] был отмечен рост числа новых случаев ВИЧ-инфекции среди лиц, употребляю- щих инъекционные наркотики, что указывает на необходимость дальнейшей реализации или даже расширения мер по снижению вреда в определен- ных местах и условиях. • Для стран центральной части Региона, где эпидемия среди МСМ расширяется, приоритетом является укрепление мер по профилактике, выявлению (с xviii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 помощью тестирования) и лечению ВИЧ-инфекции в этой группе населения. Важнейшим условием для достижения этой цели являются целенаправленные и эффективные меры по снижению стигматизации. • Странам в восточной части Региона следует рас- ширить масштабы целевых мер и обеспечить предоставление гражданам эффективных, высо- кокачественных и комплексных услуг с помощью хорошо функционирующих систем здравоохране- ния, одной из задач которых является улучшение социальных детерминант здоровья. Все нуждающи- еся граждане должны иметь доступ к эффективной профилактике, раннему и целенаправленному тестированию и консультированию и интегриро- ванной помощи. Следует приложить усилия для стратегического использования АРТ для дости- жения таких целей, как лечение и профилактика ВИЧ-инфекции и уменьшение растущего числа случаев СПИДа. Основой научно-обоснованных мер противодействия ВИЧ-инфекции должно оста- ваться расширение мероприятий по профилактике и лечению ВИЧ-инфекции среди ключевых групп населения, особенно среди лиц, употребляющих инъекционные наркотики, в частности, путем проведения программ по снижению вреда и обе- спечения раннего доступа граждан к лечению. При оказании помощи парам, в которых один из партнеров практикует поведение высокого риска (употребление инъекционных наркотиков и т.д.), нужно принять более решительные и эффективные меры по снижению риска гетеросексуальной пере- дачи вируса [5]. И наконец, следует отметить, что надежные досто- верные эпидемиологические данные имеют исключительно важное значение для тщательного мониторинга ситуации и для создания информаци- онной базы, необходимой для того, чтобы системы общественного здравоохранения могли принимать эффективные меры противодействия эпидемии ВИЧ-инфекции в Европейском регионе. Число стран Европейского региона ВОЗ, которые проводят расширенный эпиднадзор за ВИЧ-инфекцией и предо- ставляют отчетность, постепенно возрастает. В 2013 г. данные такого эпиднадзора были представлены 50 из 53 стран Региона. Качество данных и их полнота по таким ключевым переменным, как путь передачи ВИЧ и число клеток CD4 на момент постановки диагноза, все еще требуют усовершенствования во многих стра- нах. Кроме того, нужно повысить эффективность мер по повышению показателей доступности и востре- бованности медицинских услуг, а также удержания пациентов в системе помощи и ухода в период после постановки диагноза. В 2014 г. система эпиднадзора за ВИЧ-инфекцией будет пересмотрена с целью повы- шения ее эффективности за счет таких подходов, как объединение систем эпиднадзора за ВИЧ-инфекцией и СПИДом и расширение возможностей для долго- срочного мониторинга результатов непрерывной медицинской помощи после постановки диагноза ВИЧ-инфекции, включая такие ее элементы, как вовлечение пациентов в систему лечения и ухода в связи с ВИЧ-инфекцией и достижение и поддержание вирусной супрессии. Библиография 1. Федеральный научно-методический центр по профилактике и борьбе со СПИДом, Российская Федерация Ссылка: HIV-infection Newsletter number 39 [информационный бюллетень по ВИЧ- инфекции 39]. Москва: Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека; 2014 г. 2. Всемирная организация здравоохранения. Сводное руководство по использованию антиретровирусных препаратов для лечения и профилактики ВИЧ-инфекции. Рекомендации с позиции общественного здравоохранения. Женева: Всемирная организация здравоохранения, 2013 г. 3. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L, et al. Human immunodefi ciency virus among people who inject drugs: Is risk increasing in Europe? Euro Surveill. 2013;18(48):pii=20648. Available online [Имеется на сайте]: http://www.eurosurveillance. org/ViewArticle.aspx?ArticleId=20648 4 UNAIDS. Ambitious treatment targets: Writing the fi nal chap- ter of the AIDS epidemic. Geneva; 2014. Available online [Имеется на сайте]:http://www.unaids.org/en/media/ unaids/contentassets/documents/unaidspublication/2014/ JC2670_UNAIDS_Treatment_Targets_en.pdf 5 World Health Organization. Consolidated guidelines on HIV preven- tion, diagnosis, treatment and care for key populations [Сводное руководство по профилактике, диагностике, лечению и уходу в связи с ВИЧ-инфекцией среди ключевых групп населения]. Geneva: World Health Organization; 2014. xix HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT AIDS Acquired immunodeficiency syndrome ART Antiretroviral therapy ECDC European Centre for Disease Prevention and Control EEA European Economic Area EU European Union HIV Human immunodeficiency virus ICJ International Court of Justice IDU Injecting drug use MSM Men who have sex with men MTCT Mother-to-child transmission PWID People who inject drugs TESSy The European Surveillance System UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNSCR United Nations Security Council Resolution WHO World Health Organization Abbreviations

1HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 1.1 HIV diagnoses For 2013, 29 157 HIV diagnoses were reported by 30 EU/ EEA countries1 giving a rate of 5.7 per 100 000 popu- lation (Table 1). The highest rates were observed in Estonia (24.6; 325 cases), Latvia (16.8; 340 cases), Portugal (10.4; 1093 cases), Belgium (10.0; 1 115 cases) and Luxembourg (9.9; 53 cases). The lowest rates were reported by Slovakia (1.5; 83 cases) and Croatia (2.0; 85 cases). The overall rate for men in the EU/EEA was 8.9 per 100 000 population (Table 2) and for women, 2.6 per 100 000 population (Table 3). The overall male-to-female ratio was 3.3. The ratio was highest in Hungary (11.1), Croatia (9.6), the Czech Republic (8.8) and Greece (8.7) (Figure C). The predominant mode of transmission in these countries was sex between men. Most HIV diagnoses were in the age category 30–39 years (33%). The 30–39-year-olds accounted for most HIV diagnoses among IDU (41% of cases), MSM (34%), heterosexuals from countries with generalised HIV epi- demics (39%), and other heterosexual cases (29%). However, MSM tended to predominate in the younger (20–29-year-old) age categories while heterosexuals were the predominant group among those diagnosed over 50 years of age (Figure D). Young people 15 to 24 years of age comprised 12% of the EU/EEA population and 11% of HIV diagnoses in 2013. Romania, Cyprus, Iceland, Slovakia, Bulgaria and Lithuania reported more than 15% of their HIV diagnoses among young people (Figure E). In eleven countries, this proportion was lower than 10%. Data on transmission mode provide information on the groups that are most affected by HIV in the EU/EEA (Table 12a, Tables 4–7): • Sex between men is the predominant mode of HIV transmission in EU/EEA countries, accounting for 42% (12 228) of HIV diagnoses in 2013 (Table 4), and 52% of HIV diagnoses where the route of transmission was known (Figure F). Among those with known route of HIV transmission, MSM accounted for more than half of new diagnoses in fifteen countries (Austria, Belgium, Croatia, Cyprus, the Czech Republic, Denmark, Germany, Hungary, Malta, the Netherlands, Poland, Slovakia, Slovenia, Spain, and the United Kingdom) (Figure F). • Heterosexual contact is the second most commonly reported mode of transmission in the EU/EEA, account- ing for 9 449 diagnoses (32%) (Table 6). One third 1 Liechtenstein did not report data in 2013 (see country-specific comments in Annex 5). (33%; 3 160) of newly diagnosed cases among hetero- sexuals originate from countries with generalised HIV epidemics. The highest proportions of heterosexually transmitted cases originating from countries with gen- eralised epidemics were observed in Belgium (52%), France (50%), Ireland (53%), Luxembourg (58%) and Sweden (58%) (Figure G). • Five percent (1 455 cases) of HIV diagnoses were reported among PWID (Table 5). Injecting drug use accounted for more than one quarter of cases in Greece (31%), Lithuania (35%) and Romania (29%). • Of the remainder, 218 (0.7%) diagnoses were reported as mother-to-child transmission (Table 7); 25% of those cases originated from countries with gener- alised HIV epidemics. Forty-seven diagnoses were reported to be due to transfusion of blood and its products, and 19 cases were hospital-acquired infec- tions (Table 12a). • Transmission mode was reported as ‘unknown’ for 5 741 diagnoses (20%) with a wide variation between countries: less than 5% of diagnoses reported as ‘unknown’ in Croatia, Cyprus, Czech Republic, Denmark, Luxembourg, Norway, Portugal and Slovakia and more than 60% reported as unknown in Iceland and Poland. In 2013, 28 EU/EEA countries provided information on the country of birth, country of nationality, or region of origin. In the EU/EEA, 3 784 diagnoses (15% of those with known information on region of origin), irrespective of transmission mode, were among persons originating from countries with generalised HIV epidemics in 2013 (Figure H, Table 11). An additional 20% of new diagnoses with known information on region of origin (5 248 cases) were among persons originating outside of the country of report, but not from a generalised epidemic country. Countries with more than half of new HIV diagnoses among persons originating from outside of the country of report are Belgium (52%), Denmark (52%), Ireland (55%), Luxembourg (70%), Malta (77%), Norway (63%), Sweden (74%), and the United Kingdom (54%) (Figure H). In 2013, 27 EU/EEA countries were able to provide infor- mation on the probable source of infection when the infection was acquired through heterosexual contact (Table 10). This information was reported for 39% of heterosexual cases (3 731). Among those, HIV diagnoses were reported in 776 individuals with a partner origi- nating from a country with a generalised epidemic, 71 with a partner who injects drugs and 26 with a bisexual partner. Information on CD4 cell count at the time of HIV diagno- sis was provided by 21 countries (Table 14) for 17 526 HIV diagnoses (61%) in adults and adolescents. All countries 1 HIV and AIDS in the European Union and European Economic Area 2SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Figure D: Percentage of new HIV diagnoses, per age group, by transmission mode, EU/EEA, 2013 (n=22 472) 0 10 20 30 40 50 50+40-4930-3925-2920-2415-19 Heterosexual, excluding countries with generalised HIV epidemics Sex between men Pe rc en ta ge Age category (years) Heterosexual from countries with generalised HIV epidemics Injecting drug use Data from persons <15, other/unknown transmission, mother-to-child transmission, transfusion-related transmission, and nosocomial transmission not shown here. Data from Estonia and Poland excluded. Figure C: Male-to-female ratio in HIV diagnoses, by country, EU/EEA, 2013 (n=29 086) 0 2 4 6 8 10 12 Latvia Estonia Sweden Finland France Norway Belgium Romania Lithuania Portugal Iceland United Kingdom Ireland Denmark EU/EEA Italy Bulgaria Germany Malta Austria Luxembourg Spain Cyprus Slovakia Poland Netherlands Slovenia Greece Czech Republic Croatia Hungary Male-to-female ratio 3HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Figure E: Percentage of new HIV diagnoses in people between 15 and 24 years old, by country, EU/EEA, 2013 (n=29 157) 0 5 10 15 20 25 Norway Slovenia Denmark Italy Luxembourg Croatia Finland Portugal Latvia France Belgium Greece Netherlands Spain EU/EEA Malta Germany Ireland Czech Republic Hungary Austria Sweden United Kingdom Poland Estonia Lithuania Bulgaria Slovakia Iceland Cyprus Romania Percentage Figure F: Percentage of new HIV diagnoses acquired through sex between men out of all reported HIV diagnoses with known mode of HIV transmission, by country, EU/EEA, 2013 (n=23 416) 0 20 40 60 80 100 Estonia Latvia Romania Lithuania Portugal Finland Sweden Bulgaria Norway France Italy Greece Luxembourg Ireland Belgium Denmark EU/EEA Austria United Kingdom Malta Spain Cyprus Poland Germany Slovakia Netherlands Slovenia Czech Republic Croatia Hungary Percentage No cases with sex between men as transmission mode were reported in Iceland 4SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Figure H: Percentage of new HIV diagnoses among migrants out of all reported diagnoses with known region of origin, by country of report, EU/EEA, 2013 (n=25 568) 0 10 20 30 40 50 60 70 80 Romania Estonia Lithuania Slovakia Hungary Slovenia Bulgaria Greece Italy Cyprus Portugal Czech Republic Netherlands Spain Germany EU/EEA Austria Iceland France Finland Denmark Belgium United Kingdom Ireland Norway Luxembourg Sweden Malta New diagnoses among personsoriginating from countries with generalised HIV epidemics New diagnoses among persons originating from other countries Percentage There were no cases reported among migrants in Croatia, Latvia or Poland. No cases reported among persons originating from countries with generalised HIV epidemics in Croatia, Estonia, Latvia, Lithuania, Poland or Romania Figure G: Percentage of new HIV diagnoses among persons originating from countries with generalised HIV epidemics out of all cases reported as heterosexually acquired, EU/EEA (n=9 449) 0 10 20 30 40 50 60 70 Czech Republic Slovakia Cyprus Greece Slovenia Hungary Italy Spain Finland Austria Portugal Bulgaria Netherlands EU/EEA Denmark Malta Norway United Kingdom Germany France Belgium Ireland Luxembourg Sweden Percentage 5HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT providing this data, with the exception of Estonia, were able to provide CD4 cell counts for more than 50% of their reported cases. Nearly half (47%) of all cases were late presenters with a CD4 cell count less than 350/mm3, including 27% of cases with advanced HIV infection (CD4 <200/mm3). The percentage of late diagnoses (CD4 <350/ mm3) was higher than 50% in eight countries: Estonia (52%), Finland (57%), Greece (55%), Italy (58%), Latvia (54%), Luxembourg (55%), Portugal (58%), and Slovenia (58%). When analysing CD4 cell count by transmission mode, the highest proportion of late diagnoses was observed among heterosexually acquired cases, especially among those originating from countries with generalised HIV epidemics (59%) (Figure I). The lowest proportion with CD4 less than 350/mm3, as well as CD4 less than 200/ mm3, was observed among cases due to mother-to-child transmission (26% and 14%) and MSM (37% and 18%) (Figure I). Nine countries reported late diagnosis in more than half of the cases acquired through injecting drug use and two countries for more than half of the cases in MSM (Table 14). When analysing CD4 count by age category, there is a clear age gradient with increased proportions of late diagnosis among older age categories. Among those 50 years of age and older, 63% were diagnosed with CD4 <350/mm3 and 44% with CD4 <200/mm3 (Figure J). 1.2 Trends in HIV diagnoses The trend of reported HIV diagnoses for the period 2004–2013 remains relatively stable, although the overall rate of HIV diagnoses per 100 000 population decreased slightly from 6.5 per 100 000 in 2006 (28 259 cases) to 5.7 per 100 000 (29 157 cases) in 2013 (when not adjusted for the reporting delay in a number of coun- tries (Table 1)). However, comparing with the estimated adjusted rate for 2013 that is 6.2 per 100 000 population (31 977 cases) shows less apparent decline, (see Annex 1 for methods; Annex 6 for results). In the previous HIV/ AIDS surveillance report [1], 29 381 HIV diagnoses were reported for 2012, but this number has now increased by over 3 000 cases and may still increase further in the coming one to two years. Figure I: Percentage of reported cases with a CD4 cell count <350/mm3 and <200/mm3 at presentation, by transmission mode, EU/EEA, 2013 (n=17 526) 0 10 20 30 40 50 60 70 Heterosexual cases from countries with generalised HIV epidemics Other heterosexual contact Injecting drug use Sex between men Mother-to-child transmission < 200 < 350 Percentage Tr an sm is si on m od e Figure J: Percentage of reported cases with a CD4 cell count <350/mm3 and <200/mm3 at presentation, by age category, EU/EEA, 2013 (n=17 526) 0 10 20 30 40 50 60 70 80 50+40-4930-3925-2920-2415-19 Pe rc en ta ge Age category (years) < 200 < 350 6SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Over the past decade, trends at national level have var- ied widely. Since 2004, rates of HIV diagnoses have more than doubled in Bulgaria, the Czech Republic, Hungary, Iceland, Malta, Romania and Slovakia and have increased by more than 50% in Croatia, Cyprus, Greece, Lithuania, Poland and Slovenia. The rate of new HIV diagnoses decreased in thirteen countries between 2004 and 2013, with decreases in the rate of new HIV diagnoses of more than 25% observed in Denmark, Estonia, France, Italy, Luxembourg, Portugal, Spain and the United Kingdom (Table 1). Since 2004, 26 EU/EEA countries have consistently reported data on transmission mode. Data from Estonia and Poland were excluded from this analysis because more than 50% of their data on transmission mode was missing. Data from Spain and Italy were also excluded because coverage of the surveillance system increased over this time period. Data on transmission mode from the countries consistently reporting indicate the follow- ing (Table 8a, Figure K): • The number of HIV diagnoses among MSM increased by 33% from 6 682 cases in 2004 to 8 864 cases in 2013, with a peak of 9 469 cases in 2012; when adjusted for reporting delay, HIV cases among MSM increased by 43% between 2004 and 2013. Between 2004 and 2013, increases of more than 100% were observed in Bulgaria, Croatia, Cyprus, the Czech Republic, Hungary, Ireland, Latvia, Lithuania, Malta, Romania and Slovakia. Increases of more than 50% were observed in Belgium, Germany and Slovenia. (Table 4). • The number of heterosexually acquired cases decreased by 45% from 12 027 in 2004 to 6 660 in 2013, with a consistently decreasing trend. This was mainly due to a 61% decrease among cases originat- ing from countries with generalised HIV epidemics (6 922 in 2004, 2 732 in 2013). • The number of HIV diagnoses among PWID has declined by 36% since 2004 (1 628 cases to 1 037 cases). An increase in overall numbers for the EU/ EEA was observed in 2011 and 2012 due to localised outbreaks in Greece and Romania. In Greece, cases diagnosed increased from 14 in 2004 to 513 cases in 2012 and 248 cases in 2013. In Romania, cases increased from 1 in 2004 to 116 in 2011, 170 in 2012 and 149 in 2013. Bulgaria has also seen an increase, though less dramatic, in cases among PWID from 7 in 2004 to 74 in 2009 and then 33 in 2013 (Table 5). • The number of diagnoses of HIV transmitted from mother to child decreased by 37%, from 305 in 2004 to 193 in 2013. • The number of HIV diagnoses due to nosocomial infec- tion has remained stable with 23 cases in 2004 and 19 in 2013. The number of cases due to transfusion of blood and its products has decreased by 55%, from 89 in 2006 to 40 cases in 2013. • The number of cases reported to have an unknown mode of transmission has increased consistently since 2004. Over the period in question, there was an increase of 48%, from 2 740 in 2006 to 4 044 cases in 2013. This increase is an underestimate as some countries reporting higher rates of incomplete data on transmission mode were excluded. • Reporting delays differ significantly between transmis- sion categories for some countries. When adjustments for reporting delay were made, it increased the number of reported HIV cases in all transmission categories by between 8% and 19%, depending on the category. Figure K shows the adjusted trends. 1.3 AIDS cases, morbidity and mortality For 2013, 4 369 diagnoses of AIDS were reported by 29 EU/EEA countries (no data from Sweden), resulting in a 0 2000 4000 6000 8000 10000 2013201220112010200920082007200620052004 Heterosexual, excluding cases originating from countries with generalised HIV epidemics Heterosexual, originating from countries with generalised HIV epidemics Sex between men Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Figure K: New HIV diagnoses, by transmission mode and year of diagnosis, adjusted for reporting delay, EU/EEA, 2004–2013 Cases from Estonia and Poland excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period 7HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT rate of 0.9 cases per 100 000 population (Table 15). The highest rates were reported by Latvia (6.6, 133 cases) and Portugal (3.1, 322 cases). In the EU/EEA during the last decade, the rate of reported AIDS cases has halved from 2.1 per 100 000 (9 455 cases) reported in 2004. However, since 2004, an increase of 100% or more in the rate of AIDS diagnoses was reported in Bulgaria, the Czech Republic, Hungary and Lithuania. The number of cases also increased in Croatia, Greece and Latvia. In the EU/EEA, the most common AIDS-indicative dis- eases diagnosed in 2013 were Pneumocystis pneumonia (20%), oesophageal candidiasis (10%), wasting syn- drome due to HIV (8%) and pulmonary tuberculosis (8%) (Table 24). The most common indicative diseases for MSM were Pneumocystis pneumonia, Kaposi’s sarcoma and oesophageal candidiasis; for PWID, pulmonary tuberculosis, Pneumocystis pneumonia and HIV wasting syndrome; for cases due to heterosexual transmission, Pneumocystis pneumonia, oesophageal candidiasis and pulmonary tuberculosis (Figure L). In the EU/EEA, 27 countries reported data on deaths among individuals diagnosed with AIDS (Finland, Italy, and Sweden did not provide this data). Overall, 997 indi- viduals with AIDS were reported to have died during 2013 (Table 25). This figure has been consistently decreasing since 2004 (3 067 reported deaths among the same 27 countries reporting deaths in 2013), although delays in reporting affect the latest figures. From the beginning of the HIV epidemic to the end of 2013, a cumulative total of 341 625 individuals had been diagnosed with AIDS in the EU/EEA (Table 15). The cumulative total of cases reported as known to have died by the end of 2013 was 183 953 (Table 25). 1.4 Conclusions In 2013, for the first time, HIV surveillance data have national coverage from all participating EU/EEA coun- tries due to increased coverage of the HIV surveillance systems in Italy and Spain in recent years. The 2013 HIV surveillance data suggest that the epidemic in EU/ EEA countries remains constant overall, with little fluc- tuation in the r ate of diagnoses per 100 000 population over the last decade. While the actual 2013 rate of 5.7 per 100 000 population is lower than previous years, it is expected to increase in future reporting cycles due to reporting delay which is common for HIV generally, and in some countries in the EU/EEA in particular. Despite the stable rate of HIV in the region, these data provide evidence of important changes in the epidemi- ology of HIV during the past decade. There has been a sustained increase in HIV diagnoses among men who have sex with men, and this is the population in the EU/ EEA that accounts for most new HIV diagnoses. During the past decade, HIV increases among men who have sex with men were observed in all but four EU/EEA coun- tries, and significant increases were seen in countries with overall low rates of HIV such as Croatia, Cyprus, the Czech Republic, Hungary, Malta, Romania and Slovakia. There has been a substantial decrease in the number of heterosexually acquired HIV infections during the past decade; however, heterosexual transmission still remains the second most common mode of HIV transmis- sion in the EU/EEA. Part of the decline in heterosexual cases is due to the 61% decline during the last decade in the number of heterosexually acquired cases originating from countries with generalised HIV epidemics. Further exploration is required to understand whether these trends are driven by decreased incidence of HIV in these populations, decreased testing, migration or a combina- tion of factors. Both among heterosexual cases and within other trans- mission groups, migrants, or persons originating from outside of the reporting country, still constitute a con- siderable proportion (35%) of new HIV diagnoses in the EU/EEA. There is increasing evidence that a proportion of migrants acquire HIV after arrival in the EU/EEA [2, 3]. Figure L: Percentage and number of the most common AIDS-indicative diseases per transmission mode, EU/EEA, 2013 (n=4 369) MSM: Men having sex with men; IDU: injecting drug use; Hetero: heterosexual transmission. 0 5 10 15 20 25 30 Mycobacterium tuberculosis, pulmonary Candidiasis, oesophageal Pneumocystis pneumonia Wasting syndrome due to HIV Pneumocystis pneumonia Mycobacterium tuberculosis, pulmonary Candidiasis, oesophageal Kaposi's sarcoma Pneumocystis pneumonia 131 222 393 116 129 152 199 269 500 Percentage He te ro ID U M SM 8SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Transmission among people who inject drugs remains at a low level in most countries in the EU/EEA. However, increases have been observed during recent years in Romania and Greece, countries with previously very low levels of HIV among PWID [4, 5], illustrating that patterns can change quickly in the absence of effective prevention delivered at scale. The decreasing number of cases infected through mother-to-child transmission indicate that antenatal screening programmes are operating effectively and that prophylactic treatment is available in most countries in the EU/EEA. Still, strengthened efforts are needed to address the few preventable cases of mother-to-child transmission that still occur in some EU/EEA countries. Despite increasing evidence of the benefits of early treatment for the infected individual, 47% of newly reported HIV cases with information on CD4 cell count are diagnosed as late presenters or with indication of advanced infection, i.e. with unacceptably low CD4 cell counts. This suggests persistent problems with access to, and uptake of, HIV testing and counselling by those most at risk in many countries. There is strong evidence that delayed initiation of antiretroviral treatment leads to increased morbidity and mortality for the person diagnosed. In addition to the clinical and personal ben- efits to the individual diagnosed, early diagnosis and treatment can also benefit sexual and injecting partners by inhibiting onward HIV transmission. The changes in the pattern of HIV infections observed in the EU/EEA over the last decade indicate that it is crucial to sustain evidence-based HIV prevention interventions that are tailored to the local epidemiological context and targeted at those most at risk. Prevention and control of HIV infection adapted appropriately to key populations, such as MSM, are the cornerstones of HIV prevention in most EU/EEA countries. Migrants, both those from high-endemic countries and other countries, are also a key population for prevention and control efforts in the majority of EU/EEA countries. Given the increasing evi- dence of post-migration HIV acquisition, it is important that migrant-sensitive services for HIV testing, com- bined with policies which promote and ensure linkage to and access to care are delivered in all countries across the EU/EEA. Finally, harm reduction programmes among people who inject drugs and their sexual partners are crucial and should be maintained and scaled up in many countries where HIV incidence is high in this population and where service coverage is low. References 1 European Centre for Disease Prevention and Control/WHO Regional Offi ce for Europe. HIV/AIDS surveillance in Europe 2012. Stockholm: ECDC; 2013. 2 Rice BD, Elford J, Yin Z, Delpech VC. A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV. AIDS 2012; 26(15):1961-1966. 3 European Centre for Disease Prevention and Control. Migrant health: Sexual transmission of HIV within migrant groups in the EU/ EEA and implications for eff ective interventions. Stockholm: ECDC; 2013. 4 Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L, et al. Human immunodefi ciency virus among people who inject drugs: Is risk increasing in Europe?. Euro Surveill. 2013;18(48):pii=20648. Available online: http://www.eurosurveillance.org/ViewArticle. aspx?ArticleId=20648 5 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 online: http://www.eurosurveil- lance.org/ViewArticle.aspx?ArticleId=19962 9HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2.1 HIV and AIDS diagnoses in the WHO European Region HIV diagnoses With inclusion of 136 235 new HIV diagnoses reported in 2013, the cumulative number of infections diagnosed in the WHO European Region increased to 1 715 344, including 914 8132 officially reported to ECDC and the WHO Regional Office for Europe (Figure B) and 800 531 diagnoses were reported by Russia [1]. The 136 235 new HIV diagnoses were reported by 51 of the 53 countries of the WHO European Region3, corresponding to a rate of 15.7 per 100 000 population for 2013, and include 56 507 cases officially reported to ECDC/WHO Regional Office for Europe by 50 countries, a rate of 7.8 per 100 000 pop- ulation; and 79 728 cases from Russia [1]. For men, the rate of new cases was 10.8 per 100 000 population (Table 2) and for women, 4.8 per 100 000 population (Table 3) (Russia not included). Forty-five percent of newly diagnosed infections (25 494 cases) were reported in the East, 48% (26 847 cases) in the West and 7% (4 166 cases) in the Centre of the Region, while the rate of cases per 100 000 population was highest in the East (22.7 per 100 000), over three times higher than in the West (6.3 per 100 000) and ten times higher than in the Centre (2.2 per 100 000) (Table 1). When data for Russia are included, 77% of new cases were reported in the East, 20% in the West and 3% in the Centre while the rate in the East increases to 41.2 per 100 000 population. Rates of HIV infections diagnosed in 2013 also varied widely across countries in the WHO European Region. In Russia the rate was 55.6 per 100 000 population in 2013 [1]. Among reporting countries, the highest rates were reported by Ukraine (39.4), Estonia (24.6), Moldova (17.3), Latvia (16.8), Belarus (14.6), Kazakhstan (13.0), Georgia (10.7), Tajikistan (10.1) and Belgium (10.0) while the lowest rates were reported by Bosnia and Herzegovina (0.7), the former Yugoslav Republic of Macedonia (0.7), Slovakia (1.5), Montenegro (1.6) and Turkey (1.7). Monaco and San Marino reported zero cases in 2013. (Table 1). Among HIV infections diagnosed in 2013 (Russia excluded), the majority (36%) were in the age group 30–39 years (42% with Russia included), while 10% were 15–24-year-olds (Table 9, Table A). The male-to- female ratio was 2.2 (1.7 with Russia included), lowest in the East (1.3) (1.4 with Russia included), higher in the West (3.3) and highest in the Centre (4.9) (Table A). At country level, the highest male-to-female ratios were 2 Minus the 62 581 cases officially reported to ECDC/WHO by Russia in 2010. 3 No data available from Lichtenstein, Uzbekistan or Turkmenistan. observed in Serbia (11.3), Hungary (11.1), Croatia (9.6), the Czech Republic (8.8), Greece (8.7) and Slovenia (7.8) and the lowest in Belarus (1.1), Moldova (1.2), Ukraine (1.3), Kazakhstan (1.3), Kyrgyzstan (1.4), and Latvia (1.5) (Figures C, P, S). Data on transmission mode for 2013 indicate the follow- ing (Table A, Tables 4–7): • Forty-six percent of cases newly diagnosed were infected through heterosexual transmission (26 047 cases), although the picture is more heterogeneous at sub-regional level (Table 6, Table A). Among cases reported as infected through heterosexual contact, 13% were in persons originating from countries with generalised epidemics (data not shown). • Twenty-four percent were infected through sex between men (13 348 cases) (Table 4). • Sixteen percent of newly diagnosed HIV infections were acquired through injecting drug use (9 135) (Table 5). • Of the remaining cases, 0.9% (509 cases) were infected through mother-to-child transmission (Table 7) and 0.2% (94 cases) through other transmis- sion routes (nosocomial infection, transfusion or use of other blood products). Seventeen percent of chil- dren infected through MTCT originated from countries with generalised epidemics (data not shown). • Transmission mode was reported as unknown or miss- ing for 13% (7 374 cases). When data for Russia are included, the percentages and numbers of cases by transmission category change to 31% (41 656 cases) for heterosexual transmission, 21% (29 010 cases) for injecting drug use, 10% (13 719 cases) for sex between men, 0.6% (875 cases) for MTCT and 37% (50 862 cases) for unknown transmission mode. Information about probable country of infection was reported by 27 of the 50 countries, covering 19% of new diagnoses (10 981 cases). Of the cases for whom HIV infection was reported as acquired abroad (1 912 cases) 34% were infected in sub-Saharan Africa (658 cases), 32% in central and eastern Europe (611 cases) and 11% in south and south-east Asia (209 cases) (Table 13). In 2013, 35 countries (15 in the West, 12 in the Centre and eight in the East) provided information on CD4 cell count at the time of HIV diagnosis for 35 383 cases (cov- ering 48% of all new cases) (Table 14). Close to half (49%) of these cases were late presenters with CD4 cell counts below 350/mm3, including 27% with advanced HIV infection (CD4<200/mm3). CD4 cell count data were available for more than 50% of the reported cases in 30 countries. The percentage of late presenters varied 2 HIV and AIDS in the WHO European Region 10 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Figure M: Rates of new HIV diagnoses, by geographical area and year of diagnosis, WHO European Region, 2004–2013 0 5 10 15 20 25 2013201220112010200920082007200620052004 West Centre East WHO European Region Ca se s pe r 1 00 0 00 p op ul at io n Year of diagnosis Arithmetic scale 0 10 100 2013201220112010200920082007200620052004 West Centre East WHO European Region Ca se s pe r 1 00 0 00 p op ul at io n Year of diagnosis Logarithmic scale Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period 0 5000 10000 15000 20000 25000 2013201220112010200920082007200620052004 Heterosexual Sex between men Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Figure N: New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2004–2013 Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Estonia, Poland and Turkey excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Data are not adjusted for reporting delays and numbers of cases reported for recent years are likely to increase in future reports. 11 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT across transmission categories and were highest for people infected through heterosexual contact (57%) and injecting drug use (56%) and lower for people infected through sex between men (37%). Trends in HIV diagnoses Between 2004 and 2013, the rate of newly diagnosed HIV infections per 100 000 population increased by 81%, from 8.7 in 2004 (75 812 cases) to 15.7 in 2013 (136 235 cases) in 51 countries4 (Russia included) which corresponds to an 80% increase in the absolute number of cases. The increase is mainly driven by an upward trend in the East where the rate increased by fully 144% from 16.9 in 2004 (47 332 cases) to 41.2 in 2013 (105 222 cases). In the 50 countries that provided official data to ECDC and WHO (Russia excluded), the regional rate increased by 16%, from 6.7 per 100 000 (42 405 cases) to 7.8 (56 507 cases), whereas the rate in the East increased by 80% from 12.6 in 2004 (13 925 cases) to 22.7 in 2013 (25 494 cases) for those countries consistently reporting for the period. In the Centre, the rate increased by 175%, from 0.8 (1 577 cases) to 2.2 (4 166 cases) whereas it decreased in the West by 20%, from 7.9 (26 903 cases) to 6.3 (26 847), not adjusting for reporting delay (Figure M, Table 1). Presenting the data on a logarithmic scale, allowing bet- ter comparison of rates of change regardless of starting point, visually shows that the highest relative increase in rates occurred in the Centre (Figure M). A total of 14 395 148 HIV tests performed for diagnos- tic purposes were reported by 33 countries for 2013. A majority of countries reported increasing numbers of HIV tests during the period 2004–2013, notably in the East. Higher testing rates were reported by countries in the East, lower rates by countries in the Centre while data from countries in the West showed varying levels and trends (Table 27). The total number of tests per- formed in the 32 countries with data for both 2004 and 2013 increased by 41%, from 10 106 310 to 14 244 551. Among the 46 countries consistently reporting data on transmission mode for the period 2004–2013 (Table 8, Figure N), not considering variations at sub-regional level: • the number of heterosexually acquired infections (including cases originating from countries with gen- eralised epidemics) increased by 30% from 17 620 in 2004 to 22 830 in 2013; • the number of cases infected through sex between men increased by 40% from 6 975 in 2004 to 9 797 in 2013; • the number of cases infected through injecting drug use decreased by 3% from 8 987 in 2004 to 8 713 in 2013; • the number of children infected through mother-to- child transmission increased by 32%, from 357 cases in 2004 to 473 in 2013; 4 Data from Turkmenistan and Uzbekistan not included. • of the number of HIV infections transmitted through other means, nosocomial transmission increased by 39% from 23 cases in 2004 to 32 cases in 2013, whereas transmission due to transfusion of blood and its products decreased by 54% from 105 in 2004 to 48 in 2013; and • the number of infections reported with unknown risk factors increased by 48%, from 3 372 in 2004 to 5 001 in 2013. When data for Russia are included, the number of cases in each transmission category increases by 69% for het- erosexual transmission (from 22 811 to 38 439), by 42% for injecting drug use (from 20 178 to 28 590), by 43% for sex between men (from 7 108 to 10 168) and by 144% for unknown transmission (from 19 941 to 48 565) whereas it decreased by 15% for MTCT (from 988 to 839 cases). AIDS cases, morbidity and mortality Since the beginning of the epidemic, at least 472 358 AIDS cases have been diagnosed in the WHO European Region. In addition to the 437 885 cases officially reported to ECDC/WHO by 52 countries, this figure includes cumulative 34 473 AIDS cases diagnosed in Russia as of 31 December 2013 [1]. In 2013, 15 789 new AIDS cases were diagnosed in 49 countries of the WHO European Region5 and the rate of new diagnoses per 100 000 population was 2.2 (Table 15). Of the new AIDS diagnoses, 72% (11 292 cases) were reported by countries in the East, 23% (3 606 cases) in the West and 6% (891 cases) in the Centre of the Region. The number of cases per 100 000 population was 10.0 in the East, eleven times higher than in the West (0.9 per 100 000) and 20 times higher than in the Centre (0.5 per 100 000). The rate of new AIDS diagnoses varied widely between countries. The highest rates were reported in Ukraine (20.6), Georgia (6.8), Latvia (6.6), Moldova (5.7), Belarus (4.7) and Armenia (4.4) and the lowest rates (0.3 or less) were reported in Bosnia and Herzegovina, Cyprus, the Czech Republic, Germany, Iceland, Malta, Slovakia and Turkey. Monaco and San Marino reported zero cases. Between 2004 and 2013, the rate of new AIDS cases per 100 000 population increased by 10%, from 2.0 in 2004 (12 952 cases) to 2.2 in 2013 (15 789 cases) in the 50 countries with consistent AIDS data (Figure O). Reporting delays affect the number of cases reported in 2013, reinforcing the recent apparent decrease. AIDS trends vary greatly at sub-regional level. In the East, the rate increased by 213% from 3.2 (3 275 cases) in 2004 to 10.0 (11 292 cases) in 2013, whereas in the West, the steady downward trend continued with a rate decrease of 64%, from 2.5 (8 915 cases) in 2004 to 0.9 (3 606 cases) in 2013. In the Centre there was a 25% increase from 0.4 (762 cases) in 2004 to 0.5 (891 cases) in 2013. Trends in AIDS cases by mode of transmission 5 No data available from Russia, Sweden, Turkmenistan or Uzbekistan. 12 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Figure P: Male-to-female ratio in new HIV diagnoses and heterosexually infected cases, by country, East, 2013 (n=25 494) 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Belarus Moldova Kazakhstan Ukraine East average Kyrgyzstan Latvia Estonia Tajikistan Azerbaĳan Armenia Lithuania Georgia All cases Cases infected through heterosexual transmission Male-to-female ratio 0 2 4 6 8 10 12 2013201220112010200920082007200620052004 West Centre East WHO European Region Ca se s pe r 1 00 0 00 p op ul at io n Year of diagnosis Figure O: Rate of AIDS cases per 100 000 population, by geographical area and year of diagnosis, 2004–2013 Cases from Sweden, Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period 13 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT in the West, Centre and East are presented in Figure 1 on page 82. The cumulative number of people with AIDS reported to have died in the Region by the end of 2013 is 258 631, including 230 370 officially reported to ECDC/WHO and 28 261 in Russia [1]. Some 5 037 deaths among AIDS cases were reported by 47 countries6 in 2013 (Table 25). In those countries, the number of deaths decreased by 4%, from 5 269 in 2004. 2.2 HIV and AIDS diagnoses in the East HIV diagnoses in the East In 2013, 12 of the 15 countries in the East reported 25 494 newly diagnosed HIV infections, corresponding to a rate of 22.7 per 100 000 population (Table 1), the highest rate of the three geographical areas and the highest in the East during the past ten years for those 12 countries. An additional 79 728 new HIV diagnoses were reported in Russia [1], increasing the total number of cases in the East to 105 222, giving a rate of 41.2 cases per 100 000 population. In Russia the rate of diagnoses per 100 000 population was 55.6 in 2013 [1]. Among reporting countries, the highest rates in 2013 were reported by Ukraine (39.4), Estonia (24.6), Moldova (17.3), Latvia (16.8), Belarus (14.6), Kazakhstan (13.0), Georgia (10.7 and Tajikistan (10.1) and the lowest rates were reported by Azerbaijan (5.5), Lithuania (6.0) and Armenia (7.3). Among cases with information about age and gender, the majority (40%) were reported in the age group 30–39 years (45% when Russian data are included), while 10% were aged 15–24 years (Table A). The male-to-female ratio was 1.3 (1.4 when Russia is included), the lowest of the three geographical areas, translating into 43% of new cases being women in the East. The number of women newly diagnosed doubled between 2004 and 2013 in countries with consistent data7, from 5 357 to 10 938 (Table 3). Looking only at cases infected through heterosexual transmission, the male-to- female ratio drops to 0.7 corresponding to 57% of people infected heterosexually being female (Figure P). However, in two countries (Armenia and Georgia) the ratio remains above one, indicating that men remain more affected even among cases infected heterosexually. In the West and the Centre, the average male-to-female ratio among cases infected through heterosexual transmission is 1.0 and 2.0, respectively (data not shown), suggesting that the proportion of women among heterosexually infected cases is highest in the East. In the East, heterosexual contact, followed by injecting drug use, was the predominant mode of HIV transmis- sion. Information about transmission modes as reported 6 No data available from Finland, Italy, Russia, Sweden, Turkmenistan or Uzbekistan. 7 Russia, Turkmenistan and Uzbekistan excluded. by the countries for 2013 indicates the following (Table A, Tables 4–7): • The majority of new infections were acquired through heterosexual contact, accounting for 63% of new HIV infections (15 984 cases). • Injecting drug use was the second most common mode of transmission, contributing 31% of new HIV infections (7 791cases). • Just 2% of cases were acquired through sex between men (510 cases). • 1% of new infections were due to mother-to-child transmission (271 cases). • Transmission mode was unknown for 4% of the new diagnoses (922 cases). When data for Russia are included, the percentages and numbers of cases by transmission mode change to 30% (31 593 cases) for heterosexual transmission, 26% (27 666) for injecting drug use, 0.8% (881 cases) for sex between men, 0.6% (637 cases) for MTCT and 42% (44 435 cases) for unknown transmission mode. In 2013, only five countries in the East provided informa- tion on the probable source of infection when the case was infected through heterosexual contact (Armenia, Azerbaijan, Estonia, Georgia and Latvia), and even in those countries, the information was reported as unknown for 86% (833) of the 973 cases (Table 10). Among the cases that did have information, the prob- able source of infection was reported to be sexual contact with a person who injects drugs for 75% of cases and sexual contact with a person from a gener- alised epidemic country in 21% of cases. This variable, if well reported, could provide important information on the extent to which the increasing numbers of new cases reported as heterosexually acquired are occurring among sexual partners of people who inject drugs or other high risk groups. Nine countries provided information about the prob- able country of infection for 4 654 cases diagnosed in 2013 (18% of cases in the East). In that sample, 10% of cases were reported as acquired abroad of which 90% were acquired in other countries of central and eastern Europe. Trends in HIV diagnoses in the East In the 13 countries in the East with consistent data for 2004–2013 the rate of reported HIV diagnoses increased by 80% from 12.6 per 100 000 in 2004 to 22.7 per 100 000 in 2013 (Table 1, Figure M). When data for Russia are considered, the rate increased by 144%, from 16.9 in 2004 (47 332 cases) to 41.2 in 2013 (105 222 cases), corresponding to a 122% increase in the absolute num- ber of cases. Since 2004, all countries with consistent data, except Estonia where rates decreased from 54.4 to 24.6, have reported increasing numbers and rates of HIV diagnoses. Rates of diagnoses per 100 000 population increased more than fourfold in Armenia and Azerbaijan, 14 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Figure Q: New HIV diagnoses, by transmission mode and year of diagnosis, East, 2004–2013 0 5000 10000 15000 20000 2013201220112010200920082007200620052004 Heterosexual Sex between men Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Arithmetic scale 1 10 100 1000 10000 100000 2013201220112010200920082007200620052004 Heterosexual Sex between men Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Logarithmic scale Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Estonia excluded due to incomplete reporting on transmission mode during the period Figure R: Distribution of the three most common AIDS-indicative diseases per transmission mode, East, 2013 0 5 10 15 20 25 30 Wasting syndrome due to HIV Candidiasis, oesophageal Mycobacterium tuberculosis, pulmonary Mycobacterium tuberculosis, extrapulmonary Wasting syndrome due to HIV Mycobacterium tuberculosis, pulmonary Candidiasis, oesophageal Mycobacterium tuberculosis, pulmonary Wasting syndrome due to HIV 184 252 162 121 160 296 5 4 7 Percentage He te ro ID U M SM MSM: Men having sex with men; IDU: injecting drug use; Hetero: heterosexual transmission. 15 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT more than threefold in Tajikistan and more than doubled in Georgia, Kazakhstan and Kyrgyzstan (Table 1). During the same period, the number of HIV tests doubled in the 12 countries with consistent data, from 3 300 898 in 2004 to 6 818 803 in 2013 (Table 27). Information on transmission mode in 12 countries in the East with consistent data since 20048 indicates the fol- lowing (Table 8b, Figure Q): • The number of infections acquired through injecting drug use remained fairly stable with 7 441 cases in 2004 and 7 719 in 2013 following a period of higher levels during 2006–2010, although increasing num- bers were reported in some countries. • The number of HIV infections acquired through het- erosexual contact tripled from 5 034 cases in 2004 to 15 815 in 2013. In Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan and Tajikistan the number increased by more than five times. • The number of HIV infections acquired through sex between men has increased by more than fifteen times, from 33 in 2004 to 504 in 2013. • The number of children infected through mother-to- child transmission has increased by 19%, from 226 in 2004 to 269 in 2013. • The number of cases for which the mode of transmis- sion was unknown increased by 34%, from 633 in 2004 to 846 in 2013. Considering data for Russia, the number of cases in each transmission category increased by 207% for het- erosexual transmission (from 10 225 to 31 424 cases), 48% for injecting drug use (from 18 632 to 27 596 cases), 427% for sex between men (from 166 to 875) and 160% for unknown transmission (from 17 076 to 44 346 cases) whereas it decreased by 5% for MTCT (from 671 to 635 cases). On a logarithmic scale allowing comparison of rates of change regardless of starting point, the data reveal the dramatic relative increase in the rate of infections reported as acquired through sex between men and shows this increase to be much steeper than that of other transmission modes (Figure Q). AIDS cases, morbidity and mortality in the East In 2013, 11 292 cases of AIDS were diagnosed in 12 of the 15 countries in the East9 which corresponds to a rate of 10.0 per 100 000 population. In 2013, the high- est rates were reported by Ukraine (20.6), Georgia (6.8), Latvia (6.6), Moldova (5.7) and the lowest by Tajikistan (1.1), Kyrgyzstan (1.2), Lithuania (1.5), Kazakhstan (1.6) and Estonia (1.8) (Table 15). Between 2004 and 2013 the rate increased by 213%, from 3.2 cases per 100 000 population in 2004 (3 275 cases) to 10.0 in 2013 (11 292 cases) for countries reporting consistently for the period 8 Data from Estonia, Russia and Uzbekistan not included. 9 No data reported by Russia, Turkmenistan or Uzbekistan. (Figure O), corresponding to a 245% increase in the num- ber of cases. The most common AIDS-indicative diseases diagnosed in 2013 were pulmonary tuberculosis (24% of all disease events reported), wasting syndrome due to HIV (14%) and oesophageal candidiasis (13%) (Table 24). By trans- mission mode, the most common diseases in people infected through heterosexual contact and sex between men were pulmonary tuberculosis, wasting syndrome and oesophageal candidiasis; while for people infected through injecting drug use, pulmonary tuberculosis, wasting syndrome due to HIV and extrapulmonary tuber- culosis were the most frequent diagnoses (Figure R). A cumulative 66 606 people with an AIDS diagnosis were reported to have died by the end of 2013 in the East: 38 345 officially reported to ECDC/WHO and 28 261 from Russia [1]. In the East, 4 096 deaths among cases diagnosed with AIDS were reported for 2013 (Table 25). Assessing the change between 2004 and 2013 in coun- tries with complete reporting10, a 98% increase in the number of deaths is observed (from 2 067 in 2004 to 4 096 in 2013). 2.3 HIV and AIDS diagnoses in the Centre HIV diagnoses in the Centre The HIV epidemic in the Centre remains at a low and stable level although there is evidence of increasing transmission in many countries, especially through sexual contact between men. In 2013, 4 166 new infec- tions were reported from 15 countries; a rate of 2.2 per 100 000 population (Table 1). The highest rates were reported by Cyprus (6.2), Albania (4.1), Poland (2.8) and Bulgaria (2.7) and the lowest by Bosnia and Herzegovina (0.7), the former Yugoslav Republic of Macedonia (0.7), Slovakia (1.5), Montenegro (1.6) and Turkey (1.7). Among cases newly diagnosed in 2013, the most affected age group was the 30–39-year-olds with 36% of cases, whereas 14% were diagnosed among 15–24-year-olds (Table A). The male-to-female ratio was 4.9, the highest male-to-female ratio of the three geographical areas in the WHO European Region. The highest male-to-female ratios were observed in Serbia (11.3), Hungary (11.1), Croatia (9.7), the Czech Republic (8.8) and Slovenia (7.8) (Figure S). Information on transmission modes for 2013 indicates the following (Table A, Tables 4–7): • Men having sex with men accounted for 30% of new diagnoses (1 256 cases). • Twenty-five percent of HIV infections were acquired through heterosexual contact (1 032 cases). • Six percent were infected through injecting drug use (244 cases). • Mother-to-child transmission accounted for 1.1% (47 cases). 10 Russia, Turkmenistan and Uzbekistan not included. 16 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Figure S: Male-to-female ratio in new HIV diagnoses, by country, Centre, 2013 (n=4 166) 0 2 4 6 8 10 12 Albania Romania Bosnia and Herzegovina Bulgaria Turkey Cyprus Slovakia Poland Slovenia Czech Republic Croatia Hungary Serbia Male-to-female ratio Montenegro and the former Yugoslav Republic of Macedonia did not report any female cases in 2013 0 200 400 600 800 1000 2013201220112010200920082007200620052004 Heterosexual Sex between men Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Figure T: New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2004–2013 Cases from Poland and Turkey excluded due to incomplete reporting on transmission mode during the period 17 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT • Transmission mode was unknown for 38% of the new diagnoses (1 579 cases). In 2013, sex between men remained the predominant reported mode of transmission in an increasing majority of countries: Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, the Czech Republic, the former Yugoslav Republic of Macedonia, Hungary, Montenegro, Poland, Serbia, Slovakia and Slovenia; whereas heterosexual transmission was the main mode of transmission in Albania, Romania and Turkey. Trends in HIV diagnoses in the Centre In the 15 countries in the Centre, the rate of new HIV diagnoses increased by 175% between 2004 and 2013, from 0.8 per 100 000 population in 2004 (1 577 cases) to 2.2 in 2013 (4 166 cases) (Figure M). Rates increased in all 15 countries and more than tripled in seven: Albania, Bulgaria, Czech Republic, Hungary, Montenegro, Slovakia and Turkey. Reported data suggest some increase in HIV testing activities, with a reported 30% increase in the number of tests performed in 2013 compared with 2004 in the twelve countries with data for both years (Table 27). Since 2004, information on transmission mode from 13 countries with consistent data (Poland and Turkey not included) shows the following (Table 8b, Figure T): • The number of cases infected through sex between men more than quadrupled, from 179 in 2004 to 809 in 2013. • The number of cases infected through heterosexual transmission increased by 64% (from 318 cases in 2004 to 522 cases in 2013). • The number of cases infected through injecting drug use increased by more than five times (by 458%), from 36 in 2004 to 201 in 2013, mainly due to an outbreak in Romania that started in 2011. • The number of HIV infections transmitted from mother to child increased by 129%, from 14 children in 2004 to 32 in 2013. Four countries contributed to this increase: Albania, Bulgaria, Romania and Serbia. • The number of new cases reported with unknown transmission mode increased by 41% from 141 cases in 2004 to 199 in 2013. AIDS cases, morbidity and mortality in the Centre In 2013, 891 AIDS diagnoses were reported by the 15 coun- tries in the Centre, a rate of 0.5 per 100 000 population (Table 15). The highest rates were reported by Albania (2.0), Romania (1.7), Montenegro (1.1) and Bulgaria (1.0). In the other countries, AIDS rates remained at or below 0.5 per 100 000 population. The rate of new AIDS cases increased by 25%, from 0.4 per 100 000 (762 cases) in 2004 to 0.5 per 100 000 (891 cases) in 2013 (Figure O). At country level trends were heterogeneous. Of the seven countries reporting more than 30 AIDS cases in 2013, the number increased in four: Albania (from 11 to 56), Bulgaria (from 22 to 71), Hungary (from 23 to 42) and Turkey (from 55 to 93); and decreased slightly in three: Poland (from 176 to 160), Romania (from 366 to 338) and Serbia (from 58 to 44) (Table 15). The most common AIDS-indicative diseases diagnosed in 2013 were wasting syndrome due to HIV (18%), pulmo- nary tuberculosis (11%) and Pneumocystis pneumonia (10%) (Table 24). By transmission mode, the most com- mon diseases for people infected through sex between men are Pneumocystis pneumonia, wasting syndrome due to HIV and Kaposi’s sarcoma; for people infected through injecting drug use, pulmonary tuberculosis, wasting syndrome due to HIV and Pneumocystis pneu- monia; and for heterosexuals, wasting syndrome due to HIV, pulmonary tuberculosis and Pneumocystis pneumo- nia (Figure U). A total of 202 individuals diagnosed with AIDS were reported to have died during 2013 in the Centre (Table 25); a 45% decrease from 365 individuals in 2004. 2.4 HIV and AIDS diagnoses in the West HIV diagnoses in the West In the West, 26 847 newly diagnosed HIV infections were reported in 2013 from the 23 countries, giving a rate of 6.3 per 100 000 population, without adjusting for report- ing delay (Table 1, Table A). The reported data suggest that sexual transmission between men remains the main transmission mode, followed by heterosexual transmis- sion, together accounting for 77% of new diagnoses. Of newly diagnosed HIV infections in 2013, the majority (32%) were 30–39-year-olds, 10% were 15–24-year-olds and the male-to-female ratio was 3.3 (Table A). The distribution by transmission mode is, as in previous years, influenced by the number of infections diagnosed in individuals originating from countries with general- ised epidemics, especially for heterosexually acquired infections. Epidemic patterns by country of origin and mode of transmission largely correspond to those of the EU/EEA and are described in Chapter 1.2. Information about transmission mode for 2013 indicates the following (Table A, Tables 4–7): • Sex between men accounted for 43% of new diagno- ses (11 582 cases). • Thirty-four percent of the HIV infections were acquired through heterosexual contact (9 031 cases). • Four percent of HIV infections were acquired through injecting drug use (1 100 cases). • Mother-to-child transmission accounted for 0.7% of diagnoses (191 cases). 18 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Figure U: Distribution of the three most common AIDS-indicative diseases per transmission mode, Centre, 2013 0 5 10 15 20 25 Pneumocystis pneumonia Mycobacterium tuberculosis, pulmonary Wasting syndrome due to HIV Pneumocystis pneumonia Wasting syndrome due to HIV Mycobacterium tuberculosis, pulmonary Kaposi's sarcoma Wasting syndrome due to HIV Pneumocystis pneumonia 20 36 36 13 41 31 38 31 72 Percentage He te ro ID U M SM MSM: Men having sex with men; IDU: injecting drug use; Hetero: heterosexual transmission 0 2000 4000 6000 8000 10000 2013201220112010200920082007200620052004 Heterosexual, excluding cases originating from countries with generalised HIV epidemics Heterosexual, originating from countries with generalised HIV epidemics Sex between men Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Figure V: New HIV diagnoses, by transmission mode and year of diagnosis, West, 2004–2013 Cases from Italy and Spain excluded due to increasing national coverage of reporting during the period. Data are not adjusted for reporting delays and numbers of cases reported for recent years are likely to increase in future reports. Figure W: Distribution of the three most common AIDS-indicative diseases per transmission mode, West, 2013 0 5 10 15 20 25 30 Mycobacterium tuberculosis, pulmonary Candidiasis, oesophageal Pneumocystis pneumonia Mycobacterium tuberculosis, pulmonary Candidiasis, oesophageal Pneumocystis pneumonia Candidiasis, oesophageal Kaposi's sarcoma Pneumocystis pneumonia 163 263 484 78 90 114 209 123 378 Percentage He te ro ID U M SM MSM: Men having sex with men; IDU: injecting drug use; Hetero: heterosexual transmission 19 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT • Transmission mode was unknown for 18% of infec- tions (4 873 cases). Trends in HIV diagnoses in the West Between 2004 and 2013 in the 23 countries in the West with consistent data, the average rate of newly diag- nosed HIV infections declined by 20%, from 7.9 per 100 000 population (26 903 cases) in 2004 to 6.3 (26 847 cases), not taking into account reporting delay for the most recent years. Rates increased in eight and decreased in 15 countries. However, the decreases may be influenced by report- ing delays in several countries. The highest rates were reported by Portugal (10.4), Belgium (10.0), Luxembourg (9.9), and the United Kingdom (9.4); and the lowest by Finland (2.9), Austria (3.1), Iceland (3.4), Sweden (3.7) and Denmark (4.2). Since 2004, information on transmission mode in 21 countries (data not included from Italy or Spain) indi- cates the following (Table 8b, Figure V): • The number of heterosexually acquired infections decreased by 47% (from 12 268 cases in 2004 to 6 493 cases in 2013), with the steepest decline among cases originating from countries with generalised epidemics (see Chapter 1.2 and Figure V). • The number of HIV diagnoses among MSM increased by 26% from 6 760 in 2004 to 8 484 in 2013. • New diagnoses of cases infected through injecting drug use decreased by 47%, from 1 510 in 2004 to 793 in 2013. • Newly diagnosed HIV infections due to mother-to-child transmission decreased by 43% from 303 in 2004 to 172 in 2013. • The number of cases with unknown transmission mode has increased by 49%, with 2 706 cases in 2004 and 4 019 in 2013. The presentation of trends by transmission group largely mirrors the pattern for the EU/EEA as described in Chapter 1.2. AIDS cases, morbidity and mortality in the West For 2013, 3 606 AIDS diagnoses were reported by 20 of the 23 countries in the West11, giving a rate of 0.9 per 100 000 population (Table 15). Between 2004 and 2013, the rate of new AIDS cases decreased by 64%, from 2.5 (8 915 cases) in 2004 to 0.9 (3 606 cases) in 2013 for countries consistently reporting. The most common AIDS-indicative diseases diagnosed in the West in 2013 were Pneumocystis pneumonia (23%) and oesophageal candidiasis (11%) (Table 24). By transmission mode, the most common AIDS-indicative diseases for men infected through sex with men were 11 No data available from Finland, Italy and Sweden. Pneumocystis pneumonia, Kaposi’s sarcoma and oesophageal candidiasis; for people who inject drugs and heterosexually infected cases it was Pneumocystis pneumonia, oesophageal candidiasis and pulmonary tuberculosis (Figure W). In the West, 739 individuals diagnosed with AIDS were reported to have died during 2013 (Table 25), continuing the decreasing trend from 2 837 deaths in 2004 in coun- tries with consistent data (a 74% decrease). 2.5 Number of HIV tests performed The numbers of HIV tests performed annually for diag- nostic purposes (i.e. excluding unlinked anonymous tests and screening of blood donations) are presented by country in Table 27. In 2013, 32 countries reported a total of 14 395 148 HIV tests performed. Higher testing rates were generally reported by countries in the East, lower rates by countries in the Centre while data from countries in the West varied considerably. The number of tests increased by 41%, from 10 106 310 in 2004 to 14 244 551 in 2013 in 32 countries with consist- ent data. The number of tests increased in 27 countries and declined in five. Data on the number of HIV tests can support the inter- pretation of trends in newly diagnosed HIV infections. The presented data, however, are derived from different sources, ranging from annual reports from national HIV testing sites, to extrapolations from information sys- tematically gathered in laboratory networks performing HIV tests and to estimates based on national surveys. In contrast to the East and the Centre, many countries in the West do not systematically collect data on the num- ber of HIV tests and in some cases only estimates are available. When comparing the reported testing rates across countries, these differences should be kept in mind. Further, the data do not provide detailed informa- tion on who is being tested or to what extent testing is targeted at high-risk populations. 2.6 Conclusions HIV infection remains of major public health importance in Europe. In 2013, 136 235 new HIV infections were diag- nosed in 51of the 53 countries of the WHO European Region, giving a rate of 15.7 per 100 000 population. Of those, 56 507 were officially reported to ECDC/WHO Regional Office for Europe by 50 countries, while data for 79 728 cases were published by the Russian Federal Scientific and Methodological Center for Prevention and Control of AIDS [1]. The data suggest continuing HIV transmission in many countries and that HIV remains concentrated in key populations at higher risk, such as MSM, people from countries with generalised epidemics and other migrants, and people who inject drugs and their sex- ual partners. At the same time, cases among people 20 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 originating from countries with generalised HIV epidem- ics appear to be decreasing. People infected through heterosexual transmission in the East are increas- ingly affected. Predominant transmission modes and trends over time vary by country and geographical/ epidemiological area, illustrating the diversity of HIV epidemiology in Europe. Recent increases of HIV among PWID in the EU/EEA indicate that even low numbers of infections can rapidly evolve into an outbreak when pub- lic health interventions are insufficient. In the western part of the Region, the highest propor- tion of HIV infections continues to be diagnosed in MSM. HIV responses in this part of Europe need to be based on evidence-informed prevention interventions targeting this key population. In addition, given the relatively high numbers of HIV diagnoses among people originating from countries with generalised epidemics, countries should ensure equal access to prevention, testing, treat- ment and care services for migrant populations. In the Centre, levels of HIV infection remain at a rela- tively low level. However, the relative increase in new diagnoses is by far the highest in this part of the Region. The epidemic in this part of Europe is diverse but sexual transmission between men dominates over het- erosexual transmission in the majority of countries and recent increasing trends are mostly driven by increasing numbers of diagnosed infections acquired through sex between men. In the East, the number and rate of newly diagnosed HIV infections is the highest in the Region and the number of cases continues to increase. Heterosexual contact, followed by injecting drug use, is the dominant reported mode of transmission (both including and not including Russia). The amount of independent versus PWID-related heterosexual transmission remains unclear as data on the probable source of infection is missing for the majority of heterosexually acquired cases. Information about probable country of infection is poorly reported too, leaving insufficient evidence regarding the extent to which people become infected in their home country or abroad, including during periods of labour migra- tion to neighbouring countries. While men remain disproportionally affected by the epidemic, the male- to-female ratio is lower in the East than in other parts of the Region and women account for more than 40% of new infections overall and for the majority of new cases acquired through heterosexual transmission. HIV trans- mission from male PWID and males with other high risk behaviours to their female partners likely contributes to this epidemic pattern. Curbing the HIV epidemic in the East will not be possible without implementation of more comprehensive preven- tion strategies for people who inject drugs, including harm reduction interventions. In couples where one of the partners is engaged in high-risk behaviour, such as injecting drug use, prevention interventions should address the risk of heterosexual transmission [2]. It is a major concern that 49% of newly diagnosed HIV infections with information on CD4 cell counts have a low count (<350/mm3) at the time of diagnosis, including 27% with an even lower count of CD4 <200/mm3. These so-called late presenters reflect the low access to, and uptake of, HIV testing and counselling by those most at risk. Delayed initiation of antiretroviral treatment decreases the clinical benefits, as well as the impact of treatment on preventing further HIV transmission. HIV counselling and testing strategies need to be recon- sidered, including through innovative approaches and services such as routine offers of counselling and testing in clinical settings, rapid testing and community-based testing to reach people that are at higher risk and ensure earlier diagnosis and initiation of HIV treatment and linkage to care. This will result in improved treatment outcomes and clinical benefits, as well as contribute to preventing or reducing further HIV transmission. The number of diagnosed AIDS cases continues to decline throughout Europe, except in the East. The high and increasing number of AIDS cases in the countries in the East is indicative of late HIV diagnosis, low treatment coverage and delayed initiation of life-saving HIV treat- ment. The wide availability of treatment broadens the perspectives of HIV surveillance to include monitoring of access to care and treatment in the future. Improved access to and earlier initiation of treatment, particularly for key populations, is needed throughout Europe but particularly in the East. The number of countries conducting enhanced sur- veillance for HIV in Europe has increased over recent years. Enhanced HIV surveillance in Europe is essential to provide the strategic information for monitoring the epidemic and guiding the public health response to HIV. Interventions to control the epidemic need to be based on evidence and adapted to national and local epide- miology. In order to achieve this aim, surveillance data should be of high quality and provide complete case reports with information about key variables such as transmission mode, CD4 cell count and probable country and source of infection. References 1 Russian Federal Scientifi c and Methodological Center for Prevention and Control of AIDS. HIV-infection Bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014. 2 World Health Organization. Consolidated guidelines on HIV preven- tion, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2014. 21 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Tables 22 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 1: HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of start of reporting 2004 2005 2006 2007 2008 N Rate N Rate N Rate N Rate N Rate EU/EEA West Austria 1980 338 4.2 324 4.0 328 4.0 345 4.2 359 4.3 West Belgium 1985 1 004 9.7 1 070 10.2 1 018 9.7 1 072 10.1 1 092 10.2 Centre Bulgaria 1986 50 0.6 83 1.1 91 1.2 126 1.7 123 1.6 Centre Croatia 1985 53 1.2 68 1.6 57 1.3 49 1.1 71 1.7 Centre Cyprus 1986 25 3.5 43 5.9 35 4.7 46 6.1 37 4.8 Centre Czech Republic 1985 72 0.7 90 0.9 91 0.9 121 1.2 148 1.4 West Denmark 1990 306 5.7 264 4.9 245 4.5 306 5.6 285 5.2 East Estonia 1988 743 54.4 621 45.7 668 49.5 633 47.1 545 40.7 West Finland 1980 124 2.4 134 2.6 191 3.6 187 3.5 147 2.8 West France 2003 5 774 9.3 5 985 9.5 5 698 9.0 5 680 8.9 5 764 9.0 West Germany 1993 2 224 2.7 2 508 3.1 2 666 3.2 2 800 3.4 2 850 3.5 West Greece 1983 493 4.5 537 4.8 503 4.5 555 5.0 609 5.4 Centre Hungary 1985 75 0.7 106 1.1 81 0.8 119 1.2 145 1.5 West Iceland 1983 4 1.4 8 2.7 11 3.7 13 4.2 10 3.2 West Ireland 1981 358 8.9 325 7.9 353 8.4 391 9.0 404 9.1 West Italy 2004 1 666 8.7 1 490 7.6 2 017 8.4 2 206 7.1 2 463 6.6 East Latvia 1987 323 14.2 299 13.3 299 13.4 350 15.8 358 16.3 East Lithuania 1988 135 4.0 120 3.6 100 3.0 106 3.3 95 3.0 West Luxembourg 1983 68 15.0 53 11.5 53 11.3 44 9.2 59 12.2 West Malta 2001 16 4.0 15 3.7 24 5.9 14 3.5 28 6.9 West Netherlands 1980 1 183 7.3 1 221 7.5 1 129 6.9 1 232 7.5 1 307 8.0 West Norway 1984 251 5.5 219 4.8 276 5.9 248 5.3 299 6.3 Centre Poland 1985 669 1.8 707 1.9 818 2.1 802 2.1 841 2.2 West Portugal 1983 2 201 21.3 2 026 19.6 2 057 19.9 1 963 19.0 2 050 19.8 Centre Romania 1987 245 1.1 228 1.1 187 0.9 173 0.8 259 1.3 Centre Slovakia 1985 15 0.3 21 0.4 27 0.5 39 0.7 53 1.0 Centre Slovenia 1985 24 1.2 38 1.9 33 1.6 37 1.8 48 2.4 West Spain 2003 1 687 9.7 1 648 9.3 1 779 9.9 2 747 11.3 3 310 11.8 West Sweden 1983 437 4.9 396 4.4 397 4.4 488 5.4 426 4.6 West United Kingdom 1981 7 696 13.0 7 888 13.2 7 437 12.4 7 344 12.1 7 220 11.8 Total EU/EEA 28 259 6.5 28 535 6.6 28 669 6.5 30 236 6.7 31 405 6.8 Non-EU/EEA Centre Albania 1993 32 1 33 1.1 32 1 46 1.5 54 1.7 West Andorra 2004 1 1.4 6 7.8 1 1.3 5 6.2 3 3.6 East Armenia 1988 49 1.5 75 2.3 67 2.1 107 3.3 136 4.2 East Azerbaijan 1987 101 1.2 206 2.5 239 2.8 437 5.1 433 5 East Belarus 1981 786 8 800 8.2 818 8.5 991 10.3 900 9.4 Centre Bosnia and Herzegovina 1986 10 0.3 13 0.3 11 0.3 4 0.1 9 0.2 Centre former Yugoslav Republic of Macedonia, the 1993 1 0 1 0 8 0.4 5 0.2 4 0.2 East Georgia 1989 157 3.6 237 5.5 276 6.3 340 7.8 353 8.1 West Israel 1981 318 4.9 355 5.4 336 5 365 5.3 394 5.5 East Kazakhstan 1987 694 4.7 958 6.4 1 729 11.4 1 973 12.8 2 321 14.9 East Kyrgyzstan 1987 161 3.2 171 3.4 244 4.8 409 8 553 10.6 East Moldova 1987 360 10 533 12.8 621 15 731 17.8 793 19.3 West Monaco 1985 2 6.1 0 0 1 3 1 3 0 0 Centre Montenegro 1989 2 0.3 9 1.4 5 0.8 11 1.8 11 1.8 East Russia*** 2010 - - - - - - - - - - West San Marino 1985 3 10.3 4 13.5 2 6.7 0 0 4 12.5 Centre Serbia**** 1984 103 1.4 103 1.4 88 1.2 91 1.2 118 1.6 West Switzerland 1985 749 10.2 724 9.8 760 10.2 757 10.1 766 10.1 East Tajikistan 1991 198 3 189 2.8 204 2.9 305 4.3 331 4.5 Centre Turkey 1985 201 0.3 271 0.4 276 0.4 348 0.5 395 0.6 East Turkmenistan 1990 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 1987 10 218 21.5 11 464 24.3 13 456 28.8 13 469 29 15 544 33.7 East Uzbekistan 1981 2 055 8 2 159 8.3 2 205 8.4 3 169 11.9 3 061 11.3 Total non-EU/EEA 16 201 7.1 18 311 7.9 21 379 9.2 23 564 10.2 26 183 11.2 Geographic area West 26 903 7.9 27 200 8 27 282 7.8 28 763 7.9 29 849 8 Centre 1 577 0.8 1 814 1 1 840 1 2 017 1.1 2 316 1.2 East 15 980 11.7 17 832 13 20 926 15.3 23 020 16.7 25 423 18.4 Total WHO European Region 44 460 6.7 46 846 7 50 048 7.4 53 800 7.8 57 588 8.2 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about new and cumulative HIV diagnoses were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 33 407 (2004), 35 401 (2005), 39 312 (2006), 45 099 (2007), 54 799 (2008), 58 142 (2009), 58 305 (2010), 62 385 (2011), 70 744 (2012), 79 728 (2013), 800 531 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014. **** Excluding a cumulative 89 cases from Kosovo, including 3 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 23 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2009 2010 2011 2012 2013 Cumulative total** Country*N Rate N Rate N Rate N Rate N Rate EU/EEA 308 3.7 321 3.8 314 3.7 320 3.8 260 3.1 7 942 Austria 1 132 10.5 1 199 11.1 1 183 10.8 1 229 11.1 1 115 10.0 26 850 Belgium 171 2.3 163 2.2 201 2.7 157 2.1 200 2.7 1 830 Bulgaria 54 1.3 70 1.6 77 1.8 74 1.8 85 2.0 1 111 Croatia 38 4.8 41 5.0 54 6.4 58 6.7 54 6.2 847 Cyprus 156 1.5 180 1.7 153 1.5 212 2.0 235 2.2 2 122 Czech Republic 236 4.3 275 5.0 266 4.8 201 3.6 233 4.2 6 572 Denmark 411 30.8 376 28.2 366 27.5 315 23.8 325 24.6 8 702 Estonia 172 3.2 184 3.4 172 3.2 156 2.9 157 2.9 3 218 Finland 5 450 8.5 5 538 8.6 5 414 8.3 5 660 8.7 4 002 6.1 60 047 France 2 885 3.5 2 723 3.3 2 702 3.3 2 975 3.6 3 263 4.0 48 891 Germany 600 5.4 634 5.7 946 8.5 1 133 10.2 807 7.3 13 627 Greece 140 1.4 182 1.8 162 1.7 219 2.2 240 2.4 2 574 Hungary 15 4.7 24 7.6 23 7.2 19 5.9 11 3.4 310 Iceland 395 8.7 330 7.3 327 7.2 351 7.7 332 7.2 6 976 Ireland 3 797 6.6 3 980 6.7 3 838 6.5 4 098 6.9 3 608 6.0 29 163 Italy 275 12.7 274 12.9 299 14.4 339 16.6 340 16.8 5 867 Latvia 180 5.7 153 4.9 166 5.4 160 5.3 177 6.0 2 237 Lithuania 57 11.6 52 10.4 52 10.2 58 11.1 53 9.9 1 251 Luxembourg 19 4.6 18 4.3 21 5.1 30 7.2 36 8.5 223 Malta 1 195 7.2 1 187 7.2 1 129 6.8 1 036 6.2 949 5.7 22 044 Netherlands 282 5.9 258 5.3 269 5.5 242 4.9 233 4.6 5 370 Norway 956 2.5 956 2.5 1 115 2.9 1 095 2.8 1 089 2.8 17 662 Poland 1 864 18.0 1 824 17.6 1 613 15.6 1 542 14.6 1 093 10.4 47 390 Portugal 253 1.3 274 1.4 427 2.1 489 2.4 507 2.5 6 077 Romania 53 1.0 28 0.5 49 0.9 50 0.9 83 1.5 539 Slovakia 48 2.4 35 1.7 55 2.7 45 2.2 44 2.1 633 Slovenia 3 430 10.5 3 666 11.2 3 390 10.3 3 611 9.5 3 278 7.0 29 987 Spain 431 4.7 457 4.9 391 4.2 381 4.0 354 3.7 10 787 Sweden 6 630 10.8 6 329 10.2 6 165 9.9 6 238 9.8 5 994 9.4 133 606 United Kingdom 31 633 6.4 31 731 6.4 31 339 6.3 32 493 6.5 29 157 5.7 504 455 Total EU/EEA Non-EU/EEA 63 2 44 1.4 75 2.6 82 2.9 117 4.1 701 Albania 2 2.4 5 5.9 2 2.6 2 2.6 5 6.6 68 Andorra 149 4.6 149 4.6 182 5.6 227 6.9 238 7.3 1 619 Armenia 455 5.1 459 5.1 548 6 517 5.6 514 5.5 4 298 Azerbaijan 1 069 11.2 1 068 11.3 1 159 12.4 1 229 13 1 377 14.6 15 711 Belarus 6 0.2 7 0.2 27 0.7 25 0.7 27 0.7 250 Bosnia and Herzegovina 6 0.3 5 0.2 1 0 15 0.7 15 0.7 71 former Yugoslav Republic of Macedonia, the 385 8.9 456 10.4 427 9.7 528 11.9 474 10.7 4 131 Georgia 387 5.3 425 5.7 453 6 487 6.4 490 6.3 8 008 Israel 2 078 13.2 1 987 12.5 1 999 12.4 2 011 12.4 2 140 13 21 870 Kazakhstan 696 13.2 567 10.6 614 11.4 701 12.8 503 9.1 5 113 Kyrgyzstan 704 17.2 703 17.2 721 17.7 757 18.5 706 17.3 8 540 Moldova 0 0 0 0 0 0 0 0 0 0 34 Monaco 14 2.2 15 2.4 9 1.5 14 2.3 10 1.6 153 Montenegro - - 62 581 44.1 - - - - - - 62 581 Russia 1 3.2 6 19.2 8 25.1 5 15 0 0 81 San Marino 132 1.8 148 2 127 1.8 128 1.8 147 2 3 001 Serbia 656 8.5 604 7.8 557 7.1 622 7.8 574 7.1 33 946 Switzerland 418 5.6 1 052 13.8 955 12.2 865 10.8 825 10.1 5 461 Tajikistan 470 0.7 523 0.7 653 0.9 1 068 1.4 1 313 1.7 6 763 Turkey 0 0.0 0 0.0 0 0.0 0 0.0 - - 2 Turkmenistan 16 268 35.4 16 617 36.3 17 305 37.9 16 847 37.1 17 875 39.4 203 899 Ukraine 4 055 14.8 3 795 13.7 - - - - - - 24 057 Uzbekistan 28 014 11.9 91 216 24 25 822 12.2 26 130 12.3 27 350 12.8 410 358 Total non-EU/EEA Geographic area 29 944 7.5 30 039 7.4 29 235 7.2 30 396 7.4 26 847 6.3 496 391 West 2 560 1.4 2 671 1.4 3 185 1.7 3 731 2 4 166 2.2 44 334 Centre 27 143 19.6 90 237 32.1 24 741 22.2 24 496 21.9 25 494 22.7 374 088 East 59 647 8.2 122 947 14.1 57 161 8.1 58 623 8.2 56 507 7.8 914 813 Total WHO European Region 24 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 1a: HIV diagnoses and rates per 100 000 population, by country and year of statistics (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* 2004 2005 2006 2007 2008 N Rate N Rate N Rate N Rate N Rate EU/EEA West Austria 338 4.2 324 4.0 328 4.0 345 4.2 359 4.3 West Belgium 1 004 9.7 1 070 10.2 1 018 9.7 1 072 10.1 1 092 10.2 Centre Bulgaria 50 0.6 83 1.1 91 1.2 126 1.7 123 1.6 Centre Croatia 53 1.2 68 1.6 57 1.3 49 1.1 71 1.7 Centre Cyprus 25 3.5 43 5.9 35 4.7 46 6.1 37 4.8 Centre Czech Republic 72 0.7 90 0.9 91 0.9 121 1.2 148 1.4 West Denmark 306 5.7 264 4.9 245 4.5 306 5.6 285 5.2 East Estonia 743 54.4 621 45.7 668 49.5 633 47.1 545 40.7 West Finland 124 2.4 134 2.6 191 3.6 187 3.5 147 2.8 West France 5 774 9.3 5 985 9.5 5 698 9.0 5 680 8.9 5 764 9.0 West Germany 2 224 2.7 2 508 3.1 2 666 3.2 2 800 3.4 2 850 3.5 West Greece 441 4.0 565 5.1 573 5.2 521 4.7 659 5.9 Centre Hungary 75 0.7 106 1.1 81 0.8 119 1.2 145 1.5 West Iceland 4 1.4 8 2.7 11 3.7 13 4.2 10 3.2 West Ireland 358 8.9 325 7.9 353 8.4 391 9.0 404 9.1 West Italy 1 666 8.7 1 490 7.6 2 017 8.4 2 206 7.1 2 463 6.6 East Latvia 323 14.2 299 13.3 299 13.4 350 15.8 358 16.3 East Lithuania 135 4.0 120 3.6 100 3.0 106 3.3 95 3.0 West Luxembourg 60 13.2 63 13.7 57 12.2 47 9.9 68 14.1 West Malta 16 4.0 15 3.7 22 5.4 16 3.9 28 6.9 West Netherlands 1 183 7.3 1 221 7.5 1 129 6.9 1 232 7.5 1 307 8.0 West Norway 251 5.5 219 4.8 276 5.9 248 5.3 299 6.3 Centre Poland 670 1.8 703 1.8 810 2.1 804 2.1 840 2.2 West Portugal 2 201 21.3 2 026 19.6 2 057 19.9 1 963 19.0 2 050 19.8 Centre Romania 245 1.1 228 1.1 187 0.9 173 0.8 259 1.3 Centre Slovakia 15 0.3 21 0.4 27 0.5 39 0.7 53 1.0 Centre Slovenia 24 1.2 38 1.9 33 1.6 37 1.8 48 2.4 West Spain 1 687 9.7 1 648 9.3 1 779 9.9 2 747 11.3 3 310 11.8 West Sweden 429 4.8 388 4.3 385 4.3 528 5.8 441 4.8 West United Kingdom 7 696 13.0 7 888 13.2 7 437 12.4 7 344 12.1 7 220 11.8 Total EU/EEA 28 192 6.5 28 561 6.6 28 721 6.5 30 249 6.7 31 478 6.8 Non-EU/EEA Centre Albania 32 1.0 30 1.0 32 1.0 44 1.4 49 1.5 West Andorra 31 42.9 10 13.0 1 1.3 3 3.7 4 4.8 East Armenia 49 1.5 75 2.3 66 2.1 109 3.4 136 4.2 East Azerbaijan 101 1.2 206 2.5 239 2.8 437 5.1 433 5.0 East Belarus 778 7.9 751 7.7 733 7.6 990 10.3 881 9.2 Centre Bosnia and Herzegovina 16 0.4 13 0.3 17 0.4 4 0.1 9 0.2 Centre former Yugoslav Republic of Macedonia, the 1 0.0 1 0.0 8 0.4 5 0.2 4 0.2 East Georgia 163 3.8 242 5.6 276 6.3 344 7.9 351 8.1 West Israel 318 4.9 355 5.4 336 5.0 365 5.3 394 5.5 East Kazakhstan 694 4.7 958 6.4 1 729 11.4 1 973 12.8 2 321 14.9 East Kyrgyzstan 161 3.2 171 3.4 244 4.8 409 8.0 551 10.6 East Moldova 360 10.0 533 12.8 621 15.0 731 17.8 793 19.3 West Monaco 2 6.1 0 0.0 1 3.0 1 3.0 0 0.0 Centre Montenegro 2 0.3 9 1.4 5 0.8 11 1.8 11 1.8 East Russia*** - - - - - - - - - - West San Marino 3 10.3 4 13.5 2 6.7 0 0.0 4 12.5 Centre Serbia**** 103 1.4 103 1.4 88 1.2 91 1.2 118 1.6 West Switzerland 749 10.2 724 9.8 760 10.2 757 10.1 766 10.1 East Tajikistan 198 3.0 189 2.8 204 2.9 305 4.3 331 4.5 Centre Turkey 165 0.2 298 0.4 260 0.4 399 0.6 393 0.6 East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 10 218 21.5 11 464 24.3 13 456 28.8 13 469 29.0 15 544 33.7 East Uzbekistan 2 016 7.8 2 198 8.4 2 205 8.4 3 169 11.9 3 061 11.3 Total non-EU/EEA 16 160 7.0 18 334 7.9 21 283 9.1 23 616 10.2 26 154 11.2 Geographic area West 26 865 7.9 27 234 8.0 27 342 7.8 28 772 7.9 29 924 8.0 Centre 1 548 0.8 1 834 1.0 1 822 1.0 2 068 1.1 2 308 1.2 East 15 939 11.7 17 827 13.0 20 840 15.2 23 025 16.8 25 400 18.4 Total WHO European Region 44 352 6.7 46 895 7.1 50 004 7.4 53 865 7.8 57 632 8.2 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about new and cumulative HIV diagnoses were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 33 407 (2004), 35 401 (2005), 39 312 (2006), 45 099 (2007), 54 799 (2008), 58 142 (2009), 58 305 (2010), 62 385 (2011), 70 744 (2012), 79 728 (2013), 800 531 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 89 cases from Kosovo, including 3 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 25 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2009 2010 2011 2012 2013 Cumulative total** Country*N Rate N Rate N Rate N Rate N Rate EU/EEA 308 3.7 321 3.8 314 3.7 320 3.8 260 3.1 7 942 Austria 1 132 10.5 1 199 11.1 1 183 10.8 1 229 11.1 1 115 10.0 26 850 Belgium 171 2.3 163 2.2 201 2.7 157 2.1 200 2.7 1 830 Bulgaria 54 1.3 70 1.6 77 1.8 74 1.8 85 2.0 1 111 Croatia 38 4.8 41 5.0 54 6.4 58 6.7 54 6.2 847 Cyprus 156 1.5 180 1.7 153 1.5 212 2.0 235 2.2 2 122 Czech Republic 236 4.3 275 5.0 266 4.8 201 3.6 233 4.2 6 572 Denmark 411 30.8 372 27.9 370 27.8 315 23.8 325 24.6 8 702 Estonia 172 3.2 184 3.4 172 3.2 156 2.9 157 2.9 3 218 Finland 5 450 8.5 5 538 8.6 5 414 8.3 5 660 8.7 4 002 6.1 60 047 France 2 885 3.5 2 723 3.3 2 703 3.3 2 976 3.6 3 263 4.0 48 891 Germany 611 5.5 612 5.5 966 8.7 1 188 10.7 920 8.3 13 627 Greece 141 1.4 182 1.8 162 1.7 219 2.2 240 2.4 2 574 Hungary 15 4.7 24 7.6 23 7.2 19 5.9 11 3.4 310 Iceland 395 8.7 330 7.3 326 7.1 341 7.4 343 7.5 6 976 Ireland 3 797 6.6 3 980 6.7 3 838 6.5 4 098 6.9 3 608 6.0 29 163 Italy 275 12.7 274 12.9 299 14.4 339 16.6 340 16.8 5 867 Latvia 180 5.7 153 4.9 166 5.4 160 5.3 177 6.0 2 237 Lithuania 64 13.0 63 12.5 73 14.3 83 15.8 82 15.3 1 251 Luxembourg 18 4.4 19 4.6 21 5.1 30 7.2 36 8.5 223 Malta 1 195 7.2 1 187 7.2 1 129 6.8 1 036 6.2 949 5.7 22 044 Netherlands 282 5.9 258 5.3 269 5.5 242 4.9 233 4.6 5 370 Norway 958 2.5 955 2.5 1 118 2.9 1 095 2.8 1 090 2.8 17 662 Poland 1 864 18.0 1 824 17.6 1 613 15.6 1 542 14.6 1 093 10.4 47 390 Portugal 253 1.3 274 1.4 427 2.1 489 2.4 507 2.5 6 077 Romania 53 1.0 28 0.5 49 0.9 50 0.9 83 1.5 539 Slovakia 48 2.4 35 1.7 55 2.7 45 2.2 44 2.1 633 Slovenia 3 430 10.5 3 666 11.2 3 390 10.3 3 611 9.5 3 278 7.0 29 987 Spain 485 5.2 493 5.3 461 4.9 441 4.7 458 4.8 10 787 Sweden 6 630 10.8 6 329 10.2 6 165 9.9 6 238 9.8 5 994 9.4 133 606 United Kingdom 31 707 6.5 31 752 6.4 31 457 6.4 32 624 6.5 29 415 5.7 504 455 Total EU/EEA Non-EU/EEA 62 1.9 48 1.5 72 2.5 90 3.2 124 4.4 701 Albania 2 2.4 6 7.1 2 2.6 2 2.6 7 9.2 68 Andorra 149 4.6 148 4.6 182 5.6 228 7.0 238 7.3 1 619 Armenia 455 5.1 459 5.1 548 6.0 517 5.6 514 5.5 4 298 Azerbaijan 1 072 11.2 1 069 11.3 1 196 12.8 1 223 12.9 1 533 16.2 15 711 Belarus 7 0.2 7 0.2 28 0.7 25 0.7 27 0.7 250 Bosnia and Herzegovina 6 0.3 5 0.2 1 0.0 14 0.7 16 0.8 71 former Yugoslav Republic of Macedonia, the 385 8.9 455 10.4 424 9.6 526 11.9 490 11.0 4 131 Georgia 387 5.3 425 5.7 453 6.0 487 6.4 490 6.3 8 008 Israel 2 078 13.2 1 987 12.5 1 999 12.4 2 011 12.4 2 140 13.0 21 870 Kazakhstan 687 13.0 570 10.7 598 11.1 724 13.2 504 9.1 5 113 Kyrgyzstan 704 17.2 703 17.2 721 17.7 757 18.5 706 17.3 8 540 Moldova 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 34 Monaco 14 2.2 15 2.4 9 1.5 14 2.3 10 1.6 153 Montenegro - - 62 581 44.1 - - - - - 0.0 62 581 Russia 1 3.2 6 19.2 8 25.1 5 15.0 0 0.0 81 San Marino 132 1.8 148 2.0 127 1.8 128 1.8 147 2.0 3 001 Serbia 656 8.5 604 7.8 557 7.1 622 7.8 574 7.1 33 946 Switzerland 418 5.6 1 004 13.2 989 12.7 828 10.3 876 10.7 5 461 Tajikistan 470 0.7 489 0.7 699 0.9 1 068 1.4 1 313 1.7 6 763 Turkey 0 0.0 0 0.0 0 0.0 0 0.0 - - 2 Turkmenistan 16 268 35.4 16 617 36.3 17 305 37.9 16 847 37.1 17 875 39.4 203 899 Ukraine 4 041 14.8 3 809 13.7 - - - - - - 24 057 Uzbekistan 27 994 11.9 91 155 24.0 25 918 12.3 26 116 12.3 27 584 12.9 410 358 Total non-EU/EEA Geographic area 30 015 7.5 30 066 7.4 29 346 7.2 30 527 7.4 27 106 6.4 496 391 West 2 563 1.4 2 640 1.4 3 232 1.7 3 738 2.0 4 175 2.2 44 334 Centre 27 123 19.6 90 201 32.1 24 797 22.2 24 475 21.8 25 718 22.9 374 088 East 59 701 8.2 122 907 14.1 57 375 8.1 58 740 8.2 56 999 7.8 914 813 Total WHO European Region 26 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 2: HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* 2004 2005 2006 2007 2008 N Rate N Rate N Rate N Rate N Rate EU/EEA West Austria 231 5.8 235 5.9 248 6.2 266 6.6 275 6.8 West Belgium 588 11.6 622 12.2 674 13.1 662 12.8 745 14.3 Centre Bulgaria 33 0.9 56 1.5 71 1.9 105 2.8 102 2.8 Centre Croatia 48 2.3 58 2.8 48 2.3 44 2.1 68 3.3 Centre Cyprus 13 3.7 28 7.8 21 5.8 31 8.3 24 6.3 Centre Czech Republic 55 1.1 70 1.4 71 1.4 97 1.9 121 2.4 West Denmark 230 8.6 193 7.2 174 6.5 224 8.3 204 7.5 East Estonia 497 78.2 391 61.9 429 68.3 374 59.9 315 50.6 West Finland 101 4.0 95 3.7 134 5.2 136 5.3 105 4.0 West France 3 395 11.3 3 689 12.1 3 573 11.7 3 665 11.9 3 744 12.1 West Germany 1 740 4.3 1 988 5.0 2 138 5.3 2 324 5.8 2 357 5.9 West Greece 392 7.2 408 7.5 399 7.3 466 8.5 506 9.2 Centre Hungary 63 1.3 80 1.7 49 1.0 88 1.9 110 2.3 West Iceland 4 2.8 5 3.4 8 5.3 6 3.8 7 4.4 West Ireland 194 9.7 188 9.2 221 10.5 242 11.1 258 11.6 West Italy 1 161 12.5 1 067 11.3 1 478 12.6 1 597 10.6 1 798 10.0 East Latvia 207 19.8 193 18.7 185 18.1 224 22.1 231 22.9 East Lithuania 114 7.2 90 5.8 78 5.1 74 4.9 65 4.4 West Luxembourg 45 20.0 30 13.2 38 16.4 33 14.0 48 20.0 West Malta 12 6.1 9 4.5 16 8.0 8 4.0 17 8.4 West Netherlands 884 11.0 931 11.5 907 11.2 994 12.3 1 107 13.6 West Norway 148 6.5 122 5.3 179 7.8 166 7.1 182 7.7 Centre Poland 477 2.6 513 2.8 615 3.3 570 3.1 616 3.3 West Portugal 1 475 29.5 1 401 28.0 1 392 27.8 1 312 26.2 1 410 28.1 Centre Romania 132 1.3 108 1.0 96 0.9 88 0.9 148 1.5 Centre Slovakia 13 0.5 15 0.6 20 0.8 32 1.2 48 1.8 Centre Slovenia 21 2.1 35 3.6 30 3.1 35 3.5 45 4.6 West Spain 1 264 14.8 1 257 14.5 1 382 15.7 2 169 18.2 2 615 19.0 West Sweden 252 5.7 229 5.1 243 5.4 304 6.7 267 5.9 West United Kingdom 4 439 15.2 4 662 15.9 4 487 15.2 4 694 15.8 4 591 15.3 Total EU/EEA 18 228 8.6 18 768 8.9 19 404 9.0 21 030 9.5 22 129 9.7 Non-EU/EEA Centre Albania 21 1.4 23 1.5 21 1.3 33 2.1 34 2.1 West Andorra 0 0.0 5 12.5 0 0.0 5 11.8 3 6.9 East Armenia 36 2.3 60 3.9 42 2.7 75 4.8 104 6.7 East Azerbaijan 80 2.0 172 4.2 213 5.1 380 9.0 350 8.2 East Belarus 477 10.3 432 9.4 453 10.0 529 11.7 467 10.4 Centre Bosnia and Herzegovina 8 0.4 8 0.4 9 0.5 4 0.2 7 0.4 Centre former Yugoslav Republic of Macedonia, the 1 0.1 0 0.0 2 0.2 2 0.2 3 0.3 East Georgia 119 5.8 171 8.4 199 9.6 242 11.7 251 12.1 West Israel 216 6.8 226 6.9 218 6.5 247 7.2 251 7.2 East Kazakhstan 469 6.6 692 9.6 1 278 17.4 1 391 18.8 1 642 21.9 East Kyrgyzstan 125 5.0 122 4.9 181 7.2 287 11.3 309 12.0 East Moldova 199 11.5 316 15.6 369 18.3 422 21.0 438 22.2 West Monaco 2 12.6 0 0.0 1 6.2 1 6.2 0 0.0 Centre Montenegro 2 0.7 9 2.9 5 1.6 10 3.3 8 2.6 East Russia - - - - - - - - - - West San Marino 3 20.9 2 13.7 2 13.6 0 0.0 2 12.2 Centre Serbia*** 83 2.3 87 2.4 73 2.0 75 2.1 98 2.7 West Switzerland 477 13.2 478 13.2 498 13.6 524 14.2 553 14.8 East Tajikistan 164 4.9 172 5.0 155 4.4 241 6.7 184 5.0 Centre Turkey 133 0.4 179 0.5 193 0.5 248 0.7 273 0.8 East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 6 078 27.7 6 756 31.1 7 890 36.6 8 201 38.3 8 644 40.6 East Uzbekistan 1 687 13.1 1 715 13.2 1 683 12.8 2 087 15.7 1 830 13.6 Total non-EU/EEA 10 380 9.3 11 625 10.4 13 485 11.9 15 004 13.3 15 451 13.6 Geographic area West 17 253 10.4 17 842 10.7 18 410 10.8 20 045 11.3 21 045 11.5 Centre 1 103 1.2 1 269 1.4 1 324 1.4 1 462 1.6 1 705 1.9 East 10 252 15.8 11 282 17.3 13 155 20.1 14 527 22.1 14 830 22.5 Total WHO European Region 28 608 8.8 30 393 9.4 32 889 10.0 36 034 10.8 37 580 11.0 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 61 cases from Kosovo, including 2 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 27 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2009 2010 2011 2012 2013 Cumulative total** Country*N Rate N Rate N Rate N Rate N Rate EU/EEA 240 5.9 259 6.3 244 6.0 257 6.3 216 5.2 5 958 Austria 748 14.2 794 14.9 784 14.5 836 15.3 777 14.2 16 827 Belgium 133 3.7 132 3.7 163 4.5 123 3.4 161 4.5 1 394 Bulgaria 48 2.3 67 3.3 66 3.2 71 3.5 77 3.8 954 Croatia 26 6.7 34 8.5 39 9.5 49 11.7 46 10.9 596 Cyprus 130 2.5 159 3.1 140 2.7 185 3.6 211 4.1 1 764 Czech Republic 179 6.6 201 7.3 192 7.0 146 5.3 178 6.4 4 776 Denmark 243 39.1 230 37.0 226 36.5 209 33.8 200 32.5 5 864 Estonia 106 4.1 130 5.0 112 4.2 111 4.2 102 3.8 2 336 Finland 3 590 11.5 3 650 11.7 3 587 11.4 3 813 12.1 2 692 8.5 38 341 France 2 404 6.0 2 308 5.8 2 270 5.7 2 520 6.3 2 668 6.6 38 786 Germany 507 9.2 556 10.1 803 14.7 960 17.6 724 13.4 11 194 Greece 107 2.3 142 3.0 122 2.6 186 3.9 189 4.0 1 982 Hungary 6 3.7 17 10.6 12 7.5 13 8.1 8 5.0 219 Iceland 258 11.5 241 10.7 239 10.5 253 11.1 248 10.9 3 667 Ireland 2 862 10.2 3 002 10.5 2 890 10.0 3 227 11.2 2 814 9.7 21 896 Italy 170 17.1 170 17.5 196 20.7 218 23.3 203 21.9 4 014 Latvia 131 8.9 125 8.6 134 9.5 114 8.2 125 9.1 1 812 Lithuania 41 16.7 36 14.4 38 14.9 43 16.4 45 16.8 936 Luxembourg 10 4.9 16 7.8 17 8.2 23 11.1 30 14.3 160 Malta 991 12.1 997 12.2 966 11.7 869 10.5 830 10.0 17 595 Netherlands 183 7.6 173 7.1 190 7.7 166 6.6 158 6.2 3 618 Norway 730 4.0 714 3.9 916 4.9 915 4.9 933 5.0 13 499 Poland 1 273 25.4 1 239 24.8 1 122 22.5 1 092 21.7 773 15.5 34 520 Portugal 144 1.5 179 1.8 304 3.1 359 3.7 357 3.7 3 434 Romania 48 1.8 25 1.0 46 1.8 44 1.7 71 2.7 461 Slovakia 40 4.0 31 3.1 48 4.7 42 4.1 39 3.8 551 Slovenia 2 731 16.9 2 998 18.6 2 803 17.4 3 050 16.4 2 785 12.1 24 151 Spain 281 6.1 277 6.0 245 5.2 231 4.9 223 4.7 7 346 Sweden 4 453 14.7 4 306 14.1 4 391 14.2 4 497 14.4 4 471 14.2 92 873 United Kingdom 22 813 9.5 23 208 9.6 23 305 9.6 24 622 10.0 22 354 8.9 361 524 Total EU/EEA Non-EU/EEA 44 2.8 30 1.9 54 3.8 59 4.1 79 5.6 489 Albania 2 4.5 5 11.4 2 5.0 2 5.0 4 10.3 55 Andorra 96 6.1 98 6.2 115 7.3 157 9.9 161 10.1 1 132 Armenia 377 8.7 365 8.2 410 9.1 356 7.8 329 7.1 3 353 Azerbaijan 551 12.3 566 12.8 594 13.5 664 15.1 714 16.2 9 341 Belarus 6 0.3 7 0.4 23 1.2 23 1.2 21 1.1 201 Bosnia and Herzegovina 6 0.6 5 0.5 0 0.0 10 1.0 15 1.5 50 former Yugoslav Republic of Macedonia, the 276 13.3 323 15.4 303 14.3 382 17.9 356 16.7 3 039 Georgia 267 7.4 289 7.9 299 8.0 355 9.4 357 9.3 5 219 Israel 1 393 18.4 1 254 16.3 1 208 15.6 1 169 14.9 1 204 15.2 14 734 Kazakhstan 514 19.8 399 15.2 422 15.8 406 15.0 292 10.7 3 500 Kyrgyzstan 400 20.1 341 17.2 377 18.9 375 19.2 381 19.5 4 980 Moldova 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 21 Monaco 12 3.9 15 4.9 8 2.6 13 4.2 10 3.2 129 Montenegro - - 36 172 55.1 - - - - - - 36 172 Russia 1 6.5 6 39.1 6 38.4 2 12.3 0 0.0 63 San Marino 122 3.4 132 3.7 110 3.1 117 3.3 135 3.9 2 347 Serbia 470 12.4 443 11.6 419 10.8 463 11.8 417 10.5 21 379 Switzerland 327 8.7 850 22.2 672 17.1 556 13.8 509 12.4 3 923 Tajikistan 344 1.0 384 1.1 485 1.3 819 2.2 1 072 2.8 4 912 Turkey 0 0.0 0 0.0 0 0.0 0 0.0 - - 1 Turkmenistan 9 096 42.9 9 524 45.1 9 470 45.0 9 394 44.8 10 082 47.8 122 477 Ukraine 2 248 16.5 2 062 14.9 - - - - - - 16 262 Uzbekistan 16 552 14.4 53 270 29.3 14 977 14.7 15 322 14.8 16 138 15.4 253 779 Total non-EU/EEA Geographic area 21 603 11.0 21 943 11.1 21 631 10.9 22 929 11.4 20 520 9.9 351 936 West 1 940 2.1 2 056 2.2 2 524 2.7 3 015 3.2 3 416 3.6 32 763 Centre 15 822 23.9 52 479 39.7 14 127 26.7 14 000 26.4 14 556 27.1 230 604 East 39 365 11.1 76 478 18.1 38 282 11.1 39 944 11.5 38 492 10.8 615 303 Total WHO European Region 28 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 3: HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* 2004 2005 2006 2007 2008 N Rate N Rate N Rate N Rate N Rate EU/EEA West Austria 107 2.6 88 2.1 79 1.9 78 1.8 82 1.9 West Belgium 412 7.8 440 8.2 338 6.3 403 7.5 343 6.3 Centre Bulgaria 17 0.4 27 0.7 20 0.5 21 0.5 21 0.5 Centre Croatia 5 0.2 10 0.5 9 0.4 5 0.2 3 0.1 Centre Cyprus 12 3.3 15 4.0 14 3.7 15 3.9 13 3.3 Centre Czech Republic 17 0.3 20 0.4 20 0.4 24 0.5 27 0.5 West Denmark 76 2.8 71 2.6 71 2.6 82 3.0 81 2.9 East Estonia 246 33.7 230 31.6 239 33.1 259 36.0 230 32.1 West Finland 23 0.9 39 1.5 57 2.1 51 1.9 42 1.6 West France 2 379 7.4 2 295 7.1 2 116 6.5 1 995 6.1 1 999 6.1 West Germany 455 1.1 484 1.2 505 1.2 452 1.1 469 1.1 West Greece 98 1.8 128 2.3 104 1.8 88 1.6 103 1.8 Centre Hungary 12 0.2 14 0.3 13 0.2 10 0.2 9 0.2 West Iceland 0.0 3 2.0 3 2.0 7 4.6 3 1.9 West Ireland 164 8.1 137 6.6 132 6.3 149 6.9 146 6.5 West Italy 505 5.1 423 4.2 539 4.3 609 3.8 665 3.5 East Latvia 116 9.4 106 8.7 114 9.5 126 10.5 127 10.7 East Lithuania 21 1.2 30 1.7 22 1.2 32 1.8 30 1.7 West Luxembourg 23 10.0 23 9.9 15 6.3 11 4.6 11 4.5 West Malta 4 2.0 6 3.0 8 3.9 6 2.9 11 5.4 West Netherlands 299 3.6 290 3.5 222 2.7 238 2.9 200 2.4 West Norway 103 4.5 97 4.2 97 4.1 82 3.5 117 4.9 Centre Poland 181 0.9 175 0.9 174 0.9 155 0.8 153 0.8 West Portugal 726 13.7 625 11.7 665 12.5 651 12.2 640 12.0 Centre Romania 113 1.0 120 1.1 91 0.8 85 0.8 111 1.1 Centre Slovakia 2 0.1 6 0.2 7 0.3 7 0.3 5 0.2 Centre Slovenia 3 0.3 3 0.3 3 0.3 2 0.2 3 0.3 West Spain 423 4.8 391 4.4 397 4.4 578 4.7 694 4.9 West Sweden 185 4.1 167 3.7 152 3.3 184 4.0 158 3.4 West United Kingdom 3 256 10.8 3 226 10.6 2 950 9.6 2 650 8.6 2 629 8.5 Total EU/EEA 9 983 4.5 9 689 4.4 9 176 4.1 9 055 3.9 9 125 3.8 Non-EU/EEA Centre Albania 11 0.7 10 0.6 11 0.7 13 0.8 20 1.3 West Andorra 1 2.9 1 2.7 1 2.7 0 0.0 0 0.0 East Armenia 13 0.8 15 0.9 25 1.5 32 1.9 32 1.9 East Azerbaijan 21 0.5 34 0.8 26 0.6 57 1.3 83 1.9 East Belarus 309 5.9 368 7.1 365 7.1 462 9.0 433 8.5 Centre Bosnia and Herzegovina 2 0.1 5 0.3 2 0.1 0 0.0 2 0.1 Centre former Yugoslav Republic of Macedonia, the 0 0.0 1 0.1 5 0.5 1 0.1 1 0.1 East Georgia 38 1.7 66 2.9 77 3.4 98 4.3 102 4.5 West Israel 102 3.1 128 3.8 118 3.4 116 3.3 143 4.0 East Kazakhstan 225 2.9 266 3.4 451 5.7 582 7.3 679 8.4 East Kyrgyzstan 36 1.4 49 1.9 63 2.5 115 4.4 182 6.9 East Moldova 158 8.4 217 10.1 249 11.7 309 14.7 355 16.6 West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 Centre Montenegro 0 0.0 0 0.0 0 0.0 1 0.3 3 0.9 East Russia - - - - - - - - - - West San Marino 0 0.0 2 13.2 0 0.0 0 0.0 2 12.8 Centre Serbia*** 20 0.5 16 0.4 15 0.4 16 0.4 20 0.5 West Switzerland 268 7.1 242 6.4 254 6.7 222 5.8 203 5.3 East Tajikistan 34 1.0 17 0.5 48 1.4 64 1.8 62 1.7 Centre Turkey 68 0.2 92 0.3 83 0.2 100 0.3 122 0.3 East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 4 140 16.2 4 516 17.8 5 366 21.3 5 038 20.1 6 683 26.8 East Uzbekistan 368 2.8 444 3.4 522 3.9 1 082 8.1 1 231 9.1 Total non-EU/EEA 5 814 5.0 6 489 5.5 7 681 6.5 8 308 7.1 10 358 8.7 Geographic area West 9 609 5.5 9 306 5.4 8 823 5.0 8 652 4.7 8 741 4.6 Centre 463 0.5 514 0.5 467 0.5 455 0.5 513 0.5 East 5 725 8.1 6 358 8.9 7 567 10.6 8 256 11.5 10 229 14.2 Total WHO European Region 15 797 4.7 16 178 4.8 16 857 4.9 17 363 5.0 19 483 5.4 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 28 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 29 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2009 2010 2011 2012 2013 Cumulative total** Country*N Rate N Rate N Rate N Rate N Rate EU/EEA 68 1.6 62 1.4 70 1.6 63 1.5 43 1 1 976 Austria 381 6.9 403 7.3 399 7.1 392 6.9 338 6 9 740 Belgium 38 1.0 31 0.8 38 1.0 34 0.9 39 1.0 436 Bulgaria 6 0.3 3 0.1 11 0.5 3 0.1 8 0.4 157 Croatia 12 2.9 7 1.7 15 3.5 9 2.0 8 1.8 251 Cyprus 26 0.5 21 0.4 13 0.2 27 0.5 24 0.4 358 Czech Republic 57 2.1 74 2.7 74 2.6 54 1.9 55 1.9 1 795 Denmark 168 23.5 146 20.5 140 19.7 106 15.0 125 17.8 2 826 Estonia 66 2.4 54 2.0 60 2.2 45 1.6 55 2.0 882 Finland 1 840 5.5 1 877 5.6 1 825 5.4 1 826 5.4 1 296 3.8 21 586 France 465 1.1 404 1.0 425 1.0 453 1.1 593 1.4 9 323 Germany 93 1.6 78 1.4 143 2.5 173 3.0 83 1.5 2 387 Greece 15 0.3 9 0.2 12 0.2 14 0.3 17 0.3 276 Hungary 9 5.7 7 4.4 11 6.9 6 3.8 3 1.9 91 Iceland 137 6.0 89 3.9 88 3.8 98 4.2 84 3.6 2 106 Ireland 935 3.1 974 3.2 948 3.1 871 2.8 794 2.6 7 263 Italy 105 9.0 104 9.0 103 9.1 121 10.9 137 12.5 1 853 Latvia 49 2.9 28 1.7 32 1.9 46 2.8 52 3.2 425 Lithuania 16 6.4 16 6.3 14 5.4 15 5.7 8 3.0 315 Luxembourg 9 4.4 2 1.0 4 1.9 7 3.3 6 2.8 63 Malta 204 2.4 190 2.3 163 1.9 167 2.0 119 1.4 4 449 Netherlands 99 4.1 85 3.5 79 3.2 76 3.1 75 3.0 1 752 Norway 158 0.8 154 0.8 157 0.8 159 0.8 143 0.7 3 601 Poland 591 11.0 585 10.9 491 9.2 450 8.2 320 5.8 12 860 Portugal 109 1.0 95 0.9 123 1.2 130 1.3 150 1.5 2 643 Romania 5 0.2 3 0.1 3 0.1 6 0.2 12 0.4 78 Slovakia 8 0.8 4 0.4 7 0.7 3 0.3 5 0.5 82 Slovenia 699 4.2 668 4.0 587 3.5 561 3.0 488 2.1 5 830 Spain 149 3.2 179 3.8 146 3.1 149 3.1 130 2.7 3 434 Sweden 2 177 7.0 2 023 6.4 1 772 5.6 1 740 5.4 1 522 4.7 40 689 United Kingdom 8 694 3.5 8 375 3.3 7 953 3.1 7 804 3.0 6 732 2.6 139 527 Total EU/EEA Non-EU/EEA 19 1.2 14 0.9 21 1.5 23 1.6 38 2.7 212 Albania 0 0.0 0 0.0 0 0.0 0 0.0 1 2.7 13 Andorra 53 3.2 51 3.1 67 4.0 70 4.2 77 4.6 487 Armenia 78 1.7 94 2.1 138 3.0 161 3.5 185 3.9 945 Azerbaijan 518 10.2 502 9.9 565 11.3 565 11.2 663 13.1 6 370 Belarus 0 0.0 0 0.0 4 0.2 2 0.1 6 0.3 46 Bosnia and Herzegovina 0 0.0 0 0.0 0 0.0 4 0.4 0 0.0 16 former Yugoslav Republic of Macedonia, the 109 4.8 133 5.8 124 5.4 146 6.3 118 5.1 1 092 Georgia 120 3.3 136 3.6 153 4.0 132 3.4 124 3.2 2 673 Israel 685 8.4 733 8.9 791 9.5 842 10.0 936 11.0 7 048 Kazakhstan 182 6.8 168 6.2 192 7.0 295 10.6 211 7.5 1 544 Kyrgyzstan 304 14.5 362 17.3 344 16.4 382 18.0 325 15.3 3 542 Moldova 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 13 Monaco 2 0.6 0 0.0 1 0.3 1 0.3 0 0.0 24 Montenegro - - 26 409 34.6 - - - - - - 26 409 Russia 0 0.0 0 0.0 2 12.3 3 17.5 - 0.0 18 San Marino 10 0.3 16 0.4 17 0.5 11 0.3 12 0.3 654 Serbia 180 4.6 160 4.0 132 3.3 150 3.7 153 3.8 9 863 Switzerland 91 2.5 202 5.3 283 7.3 309 7.8 316 7.7 1 452 Tajikistan 126 0.4 139 0.4 166 0.5 249 0.7 241 0.6 1 849 Turkey 0 0.0 0 0.0 0 0.0 0 0.0 - - 1 Turkmenistan 7 003 28.3 6 916 28.0 7 697 31.3 7 301 29.8 7 793 31.6 81 422 Ukraine 1 807 13.1 1 733 12.4 - - - - - - 7 794 Uzbekistan 11 287 9.6 37 768 19.4 10 697 10.0 10 646 9.8 11 199 10.3 153 487 Total non-EU/EEA Geographic area 8 295 4.1 8 066 3.9 7 586 3.7 7 431 3.5 6 290 2.9 139 121 West 534 0.6 496 0.5 588 0.6 675 0.7 703 0.7 10 683 Centre 11 152 15.4 37 581 25.2 10 476 17.9 10 344 17.5 10 938 18.4 143 210 East 19 981 5.4 46 143 10.3 18 650 5.2 18 450 5.0 17 931 4.8 293 014 Total WHO European Region 30 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 4: HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of report Cumulative total**2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 90 89 130 130 162 138 159 155 154 132 2 851 West Belgium 209 256 299 299 367 376 398 404 396 415 6 405 Centre Bulgaria 0 4 10 24 17 28 32 47 59 72 324 Centre Croatia 27 34 37 30 52 42 60 49 65 70 645 Centre Cyprus 8 16 7 20 9 9 22 27 31 35 321 Centre Czech Republic 33 53 55 77 92 107 129 113 152 180 1 356 West Denmark 147 120 100 142 133 108 112 113 82 116 2 661 East Estonia 0 0 0 0 0 0 0 0 1 6 100 West Finland 46 32 62 72 49 43 48 36 47 43 1 019 West France 1 230 1 371 1 360 1 454 1 488 1 429 1 503 1 407 1 586 1 068 14 905 West Germany 1 079 1 254 1 385 1 568 1 576 1 646 1 599 1 481 1 707 1 735 22 745 West Greece 221 245 247 297 323 330 367 331 319 288 6 307 Centre Hungary 45 56 39 63 93 87 126 106 148 159 1 478 West Iceland 2 3 2 0 2 2 5 0 1 0 105 West Ireland 63 60 89 91 105 138 134 145 176 152 1 918 West Italy 373 363 536 593 715 1 177 1 252 1 267 1 560 1 420 9 256 East Latvia 7 14 15 15 21 14 18 20 18 27 285 East Lithuania 4 3 9 4 9 9 7 9 11 29 157 West Luxembourg 24 9 17 19 29 24 22 27 27 25 487 West Malta 3 4 7 0 0 4 6 4 8 16 53 West Netherlands 583 640 666 769 851 765 765 742 679 663 12 624 West Norway 70 56 90 77 92 87 85 97 76 98 1 721 Centre Poland 35 46 51 38 62 79 164 312 342 260 2 011 West Portugal 260 271 330 291 402 381 422 434 450 330 7 155 Centre Romania 7 15 11 6 34 32 45 78 69 72 393 Centre Slovakia 12 9 14 25 33 35 21 32 28 58 344 Centre Slovenia 15 31 25 30 34 29 28 35 33 27 398 West Spain 489 545 617 1 226 1 512 1 556 1 813 1 789 1 882 1 678 13 493 West Sweden 78 107 102 124 119 122 115 94 116 111 3 586 West United Kingdom 2 419 2 638 2 603 2 831 2 755 2 745 2 727 2 833 3 031 2 943 59 665 Total EU/EEA 7 579 8 344 8 915 10 315 11 136 11 542 12 184 12 187 13 254 12 228 174 768 Non-EU/EEA Centre Albania 1 0 0 1 10 8 4 9 8 10 67 West Andorra 0 3 0 3 3 1 3 1 1 3 24 East Armenia 0 2 2 2 3 5 0 4 4 13 37 East Azerbaijan 4 0 3 3 2 2 7 5 12 11 52 East Belarus 1 1 1 4 6 10 14 27 34 38 162 Centre Bosnia and Herzegovina 0 3 5 0 1 3 4 12 21 13 79 Centre former Yugoslav Republic of Macedonia, the 0 0 2 3 0 3 5 1 7 13 36 East Georgia 6 8 4 11 6 7 26 25 43 66 217 West Israel 66 92 77 123 125 142 147 152 155 162 1 872 East Kazakhstan 2 3 10 10 13 20 22 27 24 40 187 East Kyrgyzstan 0 0 1 1 0 0 0 0 3 14 19 East Moldova 0 5 2 2 12 6 5 4 4 49 West Monaco 2 0 0 1 0 0 0 0 0 0 14 Centre Montenegro 0 3 2 6 6 7 11 5 5 6 62 East Russia*** - - - - - - - - - - 0 West San Marino 1 0 0 0 0 0 0 4 0 0 21 Centre Serbia**** 31 43 45 40 66 84 81 66 84 94 886 West Switzerland 170 224 263 270 265 251 246 209 228 184 5 291 East Tajikistan 0 0 0 0 0 0 0 0 0 0 0 Centre Turkey 11 25 29 25 0 2 32 0 0 187 405 East Turkmenistan 0 0 0 0 0 0 0 0 0 - 0 East Ukraine 9 20 35 48 65 94 90 143 152 262 967 East Uzbekistan 9 10 0 0 0 1 - - - - 29 Total non-EU/EEA 313 442 481 551 573 652 698 695 785 1 120 10 476 Geographic area West 7 625 8 382 8 982 10 380 11 073 11 465 11 928 11 725 12 681 11 582 174 178 Centre 225 338 332 388 509 555 764 892 1 052 1 256 8 805 East 42 66 82 98 127 174 190 265 306 510 2 261 Total WHO European Region 7 892 8 786 9 396 10 866 11 709 12 194 12 882 12 882 14 039 13 348 185 244 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about HIV diagnoses in men infected through sex with men were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 133 (2004), 178 (2005), 137 (2006), 203 (2007), 278 (2008), 364 (2009), 357 (2010), 380 (2011), 296 (2012), 371 (2013), 3647 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 8 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 31 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Table 5: HIV diagnoses in persons infected through injecting drug use, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of report Cumulative total**2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 72 63 40 54 36 31 32 38 36 21 1 666 West Belgium 28 14 19 21 18 14 15 16 14 17 852 Centre Bulgaria 7 12 34 43 54 74 56 63 40 33 428 Centre Croatia 2 3 3 2 1 0 2 4 1 0 65 Centre Cyprus 0 1 0 2 1 0 0 0 0 0 9 Centre Czech Republic 7 4 5 12 8 4 5 9 6 6 94 West Denmark 13 17 10 21 13 14 8 10 11 13 519 East Estonia 247 192 191 115 36 85 62 69 72 72 3 883 West Finland 10 16 10 12 7 13 8 8 7 3 374 West France 195 183 172 153 142 128 124 117 118 67 1 609 West Germany 131 140 164 154 126 101 81 77 82 100 3 292 West Greece 14 21 12 12 9 15 24 309 513 248 1 442 Centre Hungary 2 2 0 3 2 0 0 0 0 1 23 West Iceland 0 0 1 1 0 5 9 12 3 1 52 West Ireland 74 67 59 55 40 30 23 17 13 18 1 530 West Italy 192 149 185 184 211 272 260 184 214 162 2 013 East Latvia 147 115 108 141 100 78 86 90 94 77 3 043 East Lithuania 101 85 62 59 44 118 107 86 63 62 1 468 West Luxembourg 3 6 3 6 5 0 1 0 4 5 139 West Malta 1 0 3 0 2 0 0 0 0 3 9 West Netherlands 13 17 15 13 8 6 6 6 7 5 761 West Norway 15 20 7 13 12 11 11 10 11 8 604 Centre Poland 213 158 131 95 53 61 42 64 43 39 6 028 West Portugal 608 555 474 393 365 247 221 137 134 78 17 178 Centre Romania 1 0 4 4 4 7 9 116 170 149 476 Centre Slovakia 0 0 1 1 3 1 2 1 1 0 12 Centre Slovenia 0 0 0 0 0 0 0 0 1 2 16 West Spain 361 310 277 259 275 291 236 211 183 145 2 846 West Sweden 29 20 34 62 23 25 24 13 17 8 1 192 West United Kingdom 155 187 192 174 177 155 148 130 113 112 5 784 Total EU/EEA 2 641 2 357 2 216 2 064 1 775 1 786 1 602 1 797 1 971 1 455 57 407 Non-EU/EEA Centre Albania 0 0 0 0 0 1 0 0 1 0 2 West Andorra 0 0 0 0 0 0 0 0 0 0 13 East Armenia 33 46 24 32 36 46 49 41 44 32 504 East Azerbaijan 45 108 172 316 285 292 272 319 215 203 2 444 East Belarus 362 296 272 294 190 212 223 243 219 180 6 561 Centre Bosnia and Herzegovina 2 2 1 0 0 0 0 0 0 1 22 Centre former Yugoslav Republic of Macedonia, the 0 0 1 0 0 0 0 0 0 0 2 East Georgia 99 127 153 183 198 224 215 189 225 164 2 121 West Israel 70 61 49 40 41 42 41 41 71 73 1 113 East Kazakhstan 463 664 1 208 1 292 1 475 1 230 1 081 903 774 719 13 094 East Kyrgyzstan 126 103 168 254 294 466 347 355 255 188 2 966 East Moldova 182 228 236 224 136 62 59 61 40 20 2 701 West Monaco 0 0 1 0 0 0 0 0 0 0 8 Centre Montenegro 0 0 1 0 0 0 0 0 1 0 4 East Russia*** - - - - - - - - - - 0 West San Marino 0 0 0 0 0 0 0 0 0 - 11 Centre Serbia**** 15 11 8 12 10 10 6 9 5 9 963 West Switzerland 79 74 56 50 28 26 20 21 25 13 3 759 East Tajikistan 105 142 99 138 157 232 556 377 269 227 2 391 Centre Turkey 3 6 5 5 0 1 0 5 6 4 99 East Turkmenistan 0 0 0 0 0 0 0 0 0 - 0 East Ukraine 5 778 6 270 7 127 7 084 7 009 7 105 6 934 6 588 5 933 5 847 105 979 East Uzbekistan 851 1 120 1 454 1 816 1 561 612 1 850 - - - 11 410 Total non-EU/EEA 8 213 9 258 11 035 11 739 11 420 10 561 11 653 9 152 8 083 7 680 156 167 Geographic area West 2 063 1 920 1 783 1 677 1 538 1 426 1 292 1 357 1 576 1 100 46 766 Centre 252 199 194 179 136 159 122 271 275 244 8 243 East 8 539 9 496 11 274 11 947 11 521 10 762 11 841 9 321 8 203 7 791 158 565 Total WHO European Region 10 854 11 615 13 251 13 803 13 195 12 347 13 255 10 949 10 054 9 135 213 574 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about HIV diagnoses in people infected through injecting drug use were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 11 191 (2004), 10 988 (2005), 11 893 (2006), 12 429 (2007), 16 689 (2008), 16 009 (2009), 16 308 (2010), 16 937 (2011), 18 029 (2012), 19 875 (2013), 299 923 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 2 cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 32 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 6: HIV diagnoses in persons infected through heterosexual contact, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of report Cumulative total**2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 157 152 134 138 142 123 104 101 112 84 2 716 West Belgium 472 466 420 439 401 421 436 438 457 372 10 495 Centre Bulgaria 43 65 46 58 52 68 71 89 58 70 1 012 Centre Croatia 21 26 15 15 15 11 7 22 7 13 335 Centre Cyprus 17 25 28 21 22 27 15 23 23 16 471 Centre Czech Republic 30 29 25 28 45 43 38 25 40 44 556 West Denmark 130 110 127 130 122 105 141 132 96 90 2 922 East Estonia 0 0 0 0 3 17 71 56 127 169 803 West Finland 54 67 93 74 59 91 94 88 71 67 1 290 West France 2 851 2 800 2 413 2 315 2 478 2 250 2 186 2 022 2 106 1 325 25 383 West Germany 627 701 697 674 712 710 454 518 484 593 11 905 West Greece 152 175 153 131 158 118 118 146 148 103 2 939 Centre Hungary 13 20 15 15 17 23 18 19 23 24 388 West Iceland 2 5 7 0 6 8 10 6 0 0 100 West Ireland 181 172 182 167 190 166 127 126 137 131 2 730 West Italy 779 665 912 1 051 1 151 1 838 1 861 1 792 1 744 1 605 13 398 East Latvia 68 96 87 127 164 133 131 144 112 125 1 486 East Lithuania 24 20 16 27 28 36 28 32 48 50 381 West Luxembourg 39 37 31 19 25 27 28 25 25 19 508 West Malta 7 9 10 12 24 9 10 13 15 10 120 West Netherlands 478 462 369 371 359 343 339 292 282 215 6 819 West Norway 163 134 164 141 185 170 157 155 142 123 2 807 Centre Poland 47 93 76 71 67 75 99 90 98 82 1 264 West Portugal 1 273 1 140 1 204 1 227 1 223 1 167 1 123 1 003 925 665 21 211 Centre Romania 124 125 99 113 135 144 148 149 164 192 2 140 Centre Slovakia 2 12 8 12 8 9 4 12 14 21 133 Centre Slovenia 4 2 3 2 4 6 7 8 4 7 104 West Spain 752 694 750 1 045 1 226 1 218 1 226 1 062 1 084 933 10 632 West Sweden 270 208 201 228 207 209 238 222 198 167 4 803 West United Kingdom 4 825 4 792 4 329 4 010 3 911 3 269 2 994 2 814 2 568 2 134 59 493 Total EU/EEA 13 605 13 302 12 614 12 661 13 139 12 834 12 283 11 624 11 312 9 449 189 344 Non-EU/EEA Centre Albania 29 29 25 36 40 47 38 63 69 99 569 West Andorra 1 2 1 1 0 1 2 1 1 1 21 East Armenia 15 25 37 70 86 83 86 127 160 176 960 East Azerbaijan 29 63 41 77 100 116 130 188 243 267 1 372 East Belarus 393 456 511 668 674 822 787 860 949 1 138 8 605 Centre Bosnia and Herzegovina 7 8 4 4 8 3 3 14 4 12 126 Centre former Yugoslav Republic of Macedonia, the 1 0 5 2 3 2 0 0 7 2 27 East Georgia 49 81 112 125 132 146 201 202 243 236 1 656 West Israel 161 173 186 176 201 177 210 209 202 182 4 097 East Kazakhstan 198 247 334 504 682 750 819 1 010 1 138 1 273 7 451 East Kyrgyzstan 34 58 71 107 162 173 186 181 307 276 1 631 East Moldova 169 291 366 500 588 574 606 613 664 325 5 082 West Monaco 0 0 0 0 0 0 0 0 0 0 11 Centre Montenegro 1 4 1 5 4 5 3 4 7 1 65 East Russia*** - - - - - - - - - - - West San Marino 0 0 1 0 0 0 0 4 3 0 23 Centre Serbia**** 26 25 24 23 28 23 35 37 27 21 674 West Switzerland 425 364 340 295 281 254 223 211 218 212 7 133 East Tajikistan 14 28 52 91 119 127 262 356 344 477 1 881 Centre Turkey 120 158 153 295 274 218 202 250 376 428 3 120 East Turkmenistan 0 0 0 0 0 0 0 0 0 - 0 East Ukraine 4 041 4 586 5 646 5 736 7 880 8 541 9 122 10 248 10 440 11 472 91 345 East Uzbekistan 221 364 495 701 716 955 852 - - - 4 730 Total non-EU/EEA 5 934 6 962 8 405 9 416 11 978 13 017 13 767 14 578 15 402 16 598 140 579 Geographic area West 13 799 13 328 12 724 12 644 13 061 12 674 12 081 11 380 11 018 9 031 191 556 Centre 485 621 527 700 722 704 688 805 921 1 032 10 984 East 5 255 6 315 7 768 8 733 11 334 12 473 13 281 14 017 14 775 15 984 127 383 Total WHO European Region 19 539 20 264 21 019 22 077 25 117 25 851 26 050 26 202 26 714 26 047 329 923 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about HIV diagnoses in persons infected through heterosexual transmission were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 5191 (2004), 5653 (2005), 6329 (2006), 7255 (2007), 9910 (2008), 10 526 (2009), 12 230 (2010), 12 785 (2011), 14 038 (2012), 15 604 (2013), 117 389 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 75 cases from Kosovo, including 2 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 33 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Table 7: HIV diagnoses in persons infected through mother-to-child transmission, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of report Cumulative total**2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 0 1 2 4 1 2 1 2 0 1 54 West Belgium 9 8 6 19 8 4 7 10 8 5 428 Centre Bulgaria 0 1 0 1 0 1 4 2 0 5 19 Centre Croatia 0 0 1 1 1 0 0 1 0 0 13 Centre Cyprus 0 1 0 0 0 0 0 0 1 0 3 Centre Czech Republic 0 0 0 0 0 0 0 0 2 0 6 West Denmark 5 3 2 7 4 0 3 3 4 5 96 East Estonia 7 4 4 2 8 3 2 2 4 2 46 West Finland 1 1 1 0 1 2 1 1 2 2 24 West France 37 39 27 38 29 34 41 35 48 26 388 West Germany 19 24 20 27 16 11 20 16 20 21 326 West Greece 4 2 3 3 1 0 3 4 0 0 64 Centre Hungary 0 2 2 0 2 0 0 1 1 11 West Iceland 0 0 0 0 0 0 0 0 0 0 1 West Ireland 3 3 2 6 7 5 9 3 5 3 75 West Italy 30 9 10 4 7 18 12 24 13 9 136 East Latvia 4 2 5 8 8 2 4 2 7 10 59 East Lithuania 0 0 0 1 0 0 0 1 0 1 3 West Luxembourg 0 1 0 0 1 0 0 0 0 7 West Malta 0 0 0 0 0 0 0 0 0 0 0 West Netherlands 15 15 7 12 19 17 21 9 7 5 277 West Norway 1 5 6 9 4 4 1 4 7 1 76 Centre Poland 14 7 25 16 13 12 11 7 4 4 193 West Portugal 20 10 11 18 15 15 17 8 4 5 393 Centre Romania 10 15 11 5 6 11 16 12 11 16 243 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 0 Centre Slovenia 1 0 0 0 0 0 0 1 0 0 7 West Spain 3 3 4 10 10 11 15 9 6 10 86 West Sweden 18 12 9 8 17 11 16 13 8 3 203 West United Kingdom 158 135 135 122 107 120 106 105 77 83 2 399 Total EU/EEA 359 303 291 323 282 286 310 274 239 218 5 636 Non-EU/EEA Centre Albania 0 0 5 3 2 2 0 3 2 6 28 West Andorra 0 0 0 0 0 0 0 0 0 0 1 East Armenia 1 2 4 3 3 3 2 3 5 28 East Azerbaijan 1 3 1 3 5 5 11 9 14 10 65 East Belarus 20 37 25 20 21 9 27 19 16 14 230 Centre Bosnia and Herzegovina 0 0 1 0 0 0 0 0 0 0 1 Centre former Yugoslav Republic of Macedonia, the 0 1 0 0 0 0 0 0 0 0 2 East Georgia 2 7 6 15 12 4 13 7 9 3 81 West Israel 9 16 13 11 16 10 7 8 7 8 230 East Kazakhstan 6 9 20 30 44 22 21 18 30 36 243 East Kyrgyzstan - 2 2 8 25 16 19 20 33 10 135 East Moldova 6 9 14 7 17 8 10 16 9 13 122 West Monaco 0 0 0 0 0 0 0 0 0 0 1 Centre Montenegro 0 0 0 0 1 0 0 0 0 0 3 East Russia*** - - - - - - - - - - 0 West San Marino 0 0 0 0 0 0 0 0 0 0 1 Centre Serbia**** 3 1 - 1 1 2 0 1 0 4 43 West Switzerland 4 5 1 7 2 4 7 4 2 4 191 East Tajikistan - - 1 7 4 9 15 28 40 40 144 Centre Turkey 8 5 3 3 8 7 0 4 12 11 82 East Turkmenistan 0 0 0 0 0 0 0 0 0 - 0 East Ukraine 186 192 200 230 217 169 177 136 146 127 3 129 East Uzbekistan 4 11 31 84 57 96 73 - - - 363 Total non-EU/EEA 250 300 327 432 432 366 383 275 323 291 5 123 Geographic area West 336 292 259 305 264 269 287 258 218 191 5 457 Centre 36 33 46 32 32 37 31 31 33 47 654 East 237 278 313 418 418 346 375 260 311 271 4 648 Total WHO European Region 609 603 618 755 714 652 693 549 562 509 10 759 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about HIV diagnoses in persons infected through mother to child transmission were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 445 (2004), 549 (2005), 581 (2006), 523 (2007), 621 (2008), 557 (2009), 494 (2010), 487 (2011), 446 (2012), 366 (2013), 5964 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 2 cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 34 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 8: HIV diagnoses*, by geographical area, sex, transmission group and year of diagnosis (2004–2013) and cumulative totals Table 8a: EU/EEA and non-EU/EEA countries Transmission mode 2004 2005 2006 2007 Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown EU/EEA Men who have sex with men - 6 682 0 - 7 388 2 - 7 701 10 - 8 438 20 Injecting drug use 345 1 279 4 304 1 239 5 306 1 122 4 315 1 092 4 Heterosexual contact 7 020 4 995 12 6 892 4 938 20 6 259 4 604 13 5 864 4 610 20 Mother-to-child 161 143 1 141 138 1 135 113 0 169 121 1 Haemophiliac/transfusion recipient 53 36 0 44 42 0 34 38 0 30 32 0 Nosocomial infection 14 9 0 12 5 0 11 8 0 13 15 Other/undetermined 1 035 1 685 20 1 077 1 790 31 1 082 1 914 33 1 063 2 012 29 Total EU/EEA 8 628 14 829 37 8 470 15 540 59 7 827 15 500 60 7 454 16 320 74 Non-EU/EEA Men who have sex with men - 293 0 - 407 0 - 451 1 - 524 2 Injecting drug use 1 619 5 740 0 1 613 6 519 0 1 818 7 758 0 1 871 8 045 3 Heterosexual contact 3 500 2 093 0 4 060 2 380 0 4 898 2 859 0 4 893 3 525 2 Mother-to-child 18 34 186 42 50 192 43 50 200 54 61 230 Haemophiliac/transfusion recipient 8 8 0 13 5 0 11 9 0 7 4 0 Nosocomial infection 0 0 0 1 3 0 24 51 0 35 57 0 Other/undetermined 233 392 7 224 367 5 282 431 12 266 453 12 Total non-EU/EEA 5 378 8 560 193 5 953 9 731 197 7 076 11 609 213 7 126 12 669 249 Total WHO European Region 14 006 23 389 230 14 423 25 271 256 14 903 27 109 273 14 580 28 989 323 Transmission mode 2012 2013 Cumulative total** Female Male Unknown Female Male Unknown Female Male Unknown Total EU/EEA Men who have sex with men - 9 448 21 - 8 849 15 - 149 781 127 149 908 Injecting drug use 282 1 177 0 197 840 0 9 262 32 562 813 42 637 Heterosexual contact 4 496 3 763 0 3 618 3 041 1 89 877 72 832 538 163 247 Mother-to-child 105 107 0 102 90 1 2 699 2 455 21 5 175 Haemophiliac/transfusion recipient 29 27 0 16 24 0 1 252 3 472 110 4 834 Nosocomial infection 6 4 1 9 10 0 756 850 1 1 607 Other/undetermined 1 189 2 695 24 1 240 2 768 36 16 161 34 162 1 210 51 533 Total EU/EEA 6 107 17 221 46 5 182 15 622 53 120 007 296 114 2 820 418 941 Non-EU/EEA Men who have sex with men - 784 1 - 933 - 0 10 033 9 10 042 Injecting drug use 1 335 6 742 0 1 241 6 435 0 29 404 114 275 979 144 658 Heterosexual contact 8 693 6 332 1 9 196 6 973 1 78 446 53 850 433 132 729 Mother-to-child 77 88 146 63 90 127 693 823 3 162 4 678 Haemophiliac/transfusion recipient 7 5 0 5 3 0 179 256 105 540 Nosocomial infection 39 57 0 4 9 0 196 284 13 493 Other/undetermined 246 495 8 378 550 29 7 994 15 707 2 945 26 646 Total non-EU/EEA 10 397 14 503 156 10 887 14 993 157 116 912 195 228 7 646 319 786 Total WHO European Region 16 504 31 724 202 16 069 30 615 210 236 919 491 342 10 466 738 727 * Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Estonia, Poland and Turkey excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 1–7. ** Cumulative total is the total number of cases reported by country since the start of reporting 35 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 Transmission mode Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown EU/EEA - 8 825 22 - 8 709 21 - 8 944 11 - 8 817 2 Men who have sex with men 243 955 2 230 844 3 202 800 0 249 1 020 0 Injecting drug use 5 893 4 779 20 5 272 4 405 9 4 973 4 048 5 4 623 3 998 3 Heterosexual contact 120 124 0 140 102 0 151 119 0 123 107 2 Mother-to-child 25 23 1 18 26 0 35 24 0 28 19 0 Haemophiliac/transfusion recipient 11 9 0 9 12 0 10 12 0 8 8 0 Nosocomial infection 1 091 2 070 33 1 065 2 149 25 1 062 2 317 40 1 090 2 501 32 Other/undetermined 7 383 16 785 78 6 734 16 247 58 6 433 16 264 56 6 121 16 470 39 Total EU/EEA Non-EU/EEA - 573 0 - 649 0 - 666 0 - 694 1 Men who have sex with men 1 729 8 040 90 1 705 8 243 0 1 616 8 187 0 1 707 7 440 0 Injecting drug use 6 860 4 098 30 7 316 4 528 0 7 579 5 134 0 8 481 5 847 0 Heterosexual contact 70 76 221 35 59 169 51 82 177 69 65 137 Mother-to-child 3 6 0 7 5 0 4 1 0 2 6 0 Haemophiliac/transfusion recipient 38 36 12 16 25 0 7 9 0 23 32 0 Nosocomial infection 305 520 16 275 443 6 230 569 1 249 408 6 Other/undetermined 9 005 13 349 369 9 354 13 952 175 9 487 14 648 178 10 531 14 492 144 Total non-EU/EEA 16 388 30 134 447 16 088 30 199 233 15 920 30 912 234 16 652 30 962 183 Total WHO European Region 36 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 8: HIV diagnoses*, by geographical area, sex, transmission group and year of diagnosis (2004–2013) and cumulative totals Table 8b: Geographical areas, WHO European Region Transmission mode 2004 2005 2006 2007 Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown West Men who have sex with men - 6 763 0 - 7 472 2 - 7 819 10 - 8 541 20 Injecting drug use 324 1 182 4 303 1 153 5 293 1 024 4 286 944 4 Heterosexual contact 7 163 5 093 12 6 969 4 980 20 6 376 4 673 13 5 914 4 613 21 Mother-to-child 158 144 1 136 143 1 134 111 0 168 122 1 Haemophiliac/transfusion recipient 56 36 0 45 41 0 36 41 0 33 32 0 Nosocomial infection 10 6 0 11 2 0 11 7 0 11 13 0 Other/undetermined 970 1 604 24 1 028 1 727 24 1 037 1 875 22 1 053 2 014 20 Total West 8 681 14 828 41 8 492 15 518 52 7 887 15 550 49 7 465 16 279 66 Centre Men who have sex with men - 179 0 - 267 0 - 251 1 - 323 2 Injecting drug use 4 32 0 5 30 0 8 50 0 13 66 0 Heterosexual contact 142 176 0 171 199 0 146 152 0 141 193 0 Mother-to-child 6 8 0 14 7 0 7 11 0 9 4 0 Haemophiliac/transfusion recipient 5 7 0 5 4 0 3 0 0 2 3 0 Nosocomial infection 4 3 0 1 3 0 1 0 2 2 0 Other/undetermined 53 88 0 51 67 12 46 51 19 33 53 21 Total Centre 214 493 0 247 577 12 210 516 20 200 644 23 East Men who have sex with men - 33 0 - 56 0 - 82 0 - 98 0 Injecting drug use 1,636 5,805 0 1,609 6,575 0 1,823 7,806 0 1,887 8,127 3 Heterosexual contact 3,215 1,819 0 3,812 2,139 0 4,635 2,638 0 4,702 3,329 1 Mother-to-child 15 25 186 33 38 192 37 41 200 46 56 230 Haemophiliac/transfusion recipient 0 1 0 7 2 0 6 6 0 2 1 0 Nosocomial infection 0 0 0 1 3 0 24 51 0 35 57 0 Other/undetermined 245 385 3 222 363 0 281 419 4 243 398 0 Total East 5,111 8,068 189 5,684 9,176 192 6,806 11,043 204 6,915 12,066 234 Total WHO European Region 14,006 23,389 230 14,423 25,271 256 14,903 27,109 273 14,580 28,989 323 Transmission mode 2012 2013 Cumulative total** Female Male Unknown Female Male Unknown Female Male Unknown Total West Men who have sex with men - 9 218 21 - 8 469 15 - 151 304 125 151 429 Injecting drug use 213 966 0 150 643 0 9 631 31 454 822 41 907 Heterosexual contact 4 492 3 697 1 3 544 2 947 2 92 504 74 455 567 167 526 Mother-to-child 99 100 0 88 83 1 2 730 2 483 22 5 235 Haemophiliac/transfusion recipient 29 29 0 19 26 0 1 245 3 442 110 4 797 Nosocomial infection 5 4 1 9 9 0 148 151 1 300 Other/undetermined 1 161 2 638 13 1 198 2 744 14 19 770 42 600 3 677 66 047 Total West 5 999 16 652 36 5 008 14 921 32 126 028 305 889 5 324 437 241 Centre Men who have sex with men - 709 1 - 809 0 - 6 382 7 6 389 Injecting drug use 46 180 0 36 165 0 229 1 055 832 2 116 Heterosexual contact 169 278 0 216 306 0 2 780 3 480 340 6 600 Mother-to-child 8 9 0 16 16 0 173 179 27 379 Haemophiliac/transfusion recipient 1 0 0 0 0 0 147 253 103 503 Nosocomial infection 1 0 0 0 1 0 608 699 0 1 307 Other/undetermined 42 105 19 51 114 34 844 1 332 439 2 615 Total Centre 267 1 281 20 319 1 411 34 4 781 13 380 1 748 19 909 East Men who have sex with men - 305 0 - 504 0 - 2 128 4 2 132 Injecting drug use 1 358 6 773 0 1 252 6 467 0 28 806 114 328 138 143 434 Heterosexual contact 8 528 6 120 0 9 054 6 761 0 73 039 48 747 64 121 850 Mother-to-child 75 86 146 61 81 127 489 616 3 134 4 239 Haemophiliac/transfusion recipient 6 3 0 2 1 0 39 33 2 74 Nosocomial infection 39 57 0 4 9 0 196 284 13 493 Other/undetermined 232 447 0 369 460 17 3 541 5 937 39 9 517 Total East 10 238 13 791 146 10 742 14 283 144 106 110 172 073 3 394 281 739 Total WHO European Region 16 504 31 724 202 16 069 30 615 210 236 919 491 342 10 466 738 889 * Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Estonia, Poland and Turkey excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 1–7. ** Cumulative total is the total number of cases reported by country since the start of reporting 37 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 Transmission mode Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown West - 8 824 22 - 8 713 19 - 8 852 11 - 8 667 2 Men who have sex with men 221 829 2 199 661 3 183 613 0 198 764 0 Injecting drug use 5 924 4 739 21 5 233 4 376 9 4 991 3 998 5 4 625 3 898 3 Heterosexual contact 126 121 0 137 103 0 147 113 0 122 100 3 Mother-to-child 26 25 1 23 29 0 39 24 0 27 22 0 Haemophiliac/transfusion recipient 10 8 0 9 12 0 9 12 0 8 7 0 Nosocomial infection 1 075 2 086 16 1 060 2 116 15 1 055 2 331 10 1 071 2 480 10 Other/undetermined 7 382 16 632 62 6 661 16 010 46 6 424 15 943 26 6 051 15 938 18 Total West Centre - 447 0 - 472 2 - 568 0 - 579 1 Men who have sex with men 7 76 0 14 83 0 9 71 0 39 163 0 Injecting drug use 169 212 0 190 221 0 149 238 0 173 292 0 Heterosexual contact 5 6 0 11 7 0 9 11 0 8 12 0 Mother-to-child 0 2 0 0 1 0 0 1 0 2 1 0 Haemophiliac/transfusion recipient 1 1 0 0 0 0 1 0 0 0 1 0 Nosocomial infection 56 72 26 35 82 16 35 69 31 43 75 28 Other/undetermined 238 816 26 250 866 18 203 958 31 265 1 123 29 Total Centre East - 127 0 - 173 0 - 190 0 - 265 0 Men who have sex with men 1 744 8 090 90 1 722 8 343 0 1 626 8 303 0 1 719 7 533 0 Injecting drug use 6 660 3 926 29 7 165 4 336 0 7 412 4 946 0 8 306 5 655 0 Heterosexual contact 59 73 221 27 51 169 46 77 177 62 60 136 Mother-to-child 2 2 0 2 1 0 0 0 0 1 2 0 Haemophiliac/transfusion recipient 38 36 12 16 25 0 7 9 0 23 32 0 Nosocomial infection 265 432 7 245 394 0 202 486 0 225 354 0 Other/undetermined 8 768 12 686 359 9 177 13 323 169 9 293 14 011 177 10 336 13 901 136 Total East 16 388 30 134 447 16 088 30 199 233 15 920 30 912 234 16 652 30 962 183 Total WHO European Region 38 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 9: HIV diagnoses*, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals Table 9a: EU/EEA and non-EU/EEA countries Age category 2004 2005 2006 2007 Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown EU/EEA <15 199 185 1 160 159 2 167 146 0 185 137 2 15–19 478 270 2 369 288 1 305 226 0 300 231 2 20–24 1 151 1 107 5 1 100 1 195 3 903 1 174 5 914 1 393 9 25–29 2 033 2 163 3 1 897 2 333 17 1 687 2 348 14 1 585 2 627 29 30–39 3 168 6 082 19 3 120 6 041 15 2 975 6 004 29 2 799 6 035 39 40–49 1 195 3 613 5 1 326 3 916 9 1 285 4 136 10 1 359 4 322 24 50+ 666 1 962 3 747 2 189 7 756 2 164 1 708 2 432 8 Unknown 165 421 10 156 323 24 162 346 30 18 87 38 Total EU/EEA 9 055 15 803 48 8 875 16 444 78 8 240 16 544 89 7 868 17 264 151 Non-EU/EEA <15 27 47 0 63 67 192 74 115 200 108 135 230 15–19 330 139 0 400 162 0 397 166 1 446 126 0 20–24 283 324 2 282 317 0 339 372 0 456 499 2 25–29 260 510 1 299 616 0 383 725 1 535 942 1 30–39 1 495 3 351 0 1 713 3 875 0 2 136 4 856 1 2 512 5 498 6 40–49 413 1 339 0 556 1 601 1 749 1 983 2 868 2 306 2 50+ 140 332 0 149 379 1 200 483 0 264 611 0 Unknown 2 498 2 651 4 2 583 2 893 3 2 881 3 102 8 2 037 2 800 11 Total non-EU/EEA 5 446 8 693 7 6 045 9 910 197 7 159 11 802 213 7 226 12 917 252 Total WHO European Region 14 501 24 496 55 14 920 26 354 275 15 399 28 346 302 15 094 30 181 403 Age category 2012 2013 Cumulative total** Female Male Unknown Female Male Unknown Female Male Unknown Total EU/EEA <15 111 102 2 86 84 1 3 931 4 581 81 8 593 15–19 189 308 0 174 257 1 5 690 6 602 32 12 324 20–24 564 1 774 5 485 1 636 4 16 248 29 000 145 45 393 25–29 1 010 2 821 10 856 2 703 5 26 435 52 217 295 78 947 30–39 2 238 5 764 16 1 868 5 318 10 42 906 111 607 495 155 008 40–49 1 283 4 526 7 1 142 3 955 7 18 101 67 015 221 85 337 50+ 963 2 990 0 830 2 768 1 11 058 38 971 90 50 119 Unknown 14 60 27 9 34 37 2 065 5 484 2 035 9 584 Total EU/EEA 6 372 18 345 67 5 450 16 755 66 126 434 315 477 3 394 445 305 Non-EU/EEA <15 160 260 152 112 173 127 1 359 1 728 1 659 4 746 15–19 286 77 0 247 98 0 6 078 4 263 17 10 358 20–24 1 454 783 0 1 347 917 0 14 126 12 053 146 26 325 25–29 2 267 2 393 0 2 225 2 521 2 18 501 25 255 242 43 998 30–39 3 756 6 807 2 4 013 6 986 4 37 204 79 148 351 116 703 40–49 1 857 3 528 0 2 121 3 746 2 13 714 32 896 111 46 721 50+ 855 1 460 1 1 058 1 613 0 5 468 10 857 38 16 363 Unknown 11 14 7 76 84 5 22 382 34 173 3 551 60 035 Total non-EU/EEA 10 646 15 322 162 11 199 16 138 140 118 832 200 373 6 115 325 249 Total WHO European Region 17 018 33 667 229 16 649 32 893 206 245 266 515 850 9 509 770 554 * Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Therefore, totals by gender and overall may differ from totals presented in Tables 1–3. ** Cumulative total is the total number of cases reported by country since the start of reporting 39 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 Age category Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown EU/EEA 139 150 0 136 111 0 147 115 0 118 105 2 <15 268 272 3 258 264 0 219 284 0 193 267 0 15–19 813 1 411 14 727 1 444 7 654 1 592 5 643 1 587 2 20–24 1 476 2 632 17 1 287 2 497 22 1 155 2 447 15 1 094 2 733 1 25–29 2 763 5 939 49 2 449 5 656 36 2 254 5 560 31 2 270 5 608 3 30–39 1 423 4 667 14 1 305 4 535 15 1 388 4 400 19 1 253 4 430 6 40–49 860 2 563 1 881 2 643 4 906 2 757 7 841 2 836 2 50+ 24 82 52 17 70 42 10 53 67 6 46 65 Unknown 7 766 17 716 150 7 060 17 220 126 6 733 17 208 144 6 418 17 612 81 Total EU/EEA Non-EU/EEA 128 132 234 74 104 169 73 101 177 119 145 137 <15 404 98 2 387 91 0 320 95 0 296 82 0 15–19 1 903 1 088 9 1 836 1 062 1 572 1 104 0 1 590 930 1 20–24 2 331 2 979 27 2 314 2 856 2 2 369 2 764 0 2 358 2 502 0 25–29 2 937 5 965 70 3 157 6 511 0 3 348 6 781 1 3 788 6 839 1 30–39 1 060 2 613 20 1 252 2 827 1 1 387 3 165 0 1 773 3 289 2 40–49 347 720 3 452 833 0 549 1 013 0 765 1 178 1 50+ 17 26 9 8 20 3 8 13 0 8 12 4 Unknown 9 127 13 621 374 9 480 14 304 175 9 626 15 036 178 10 697 14 977 146 Total non-EU/EEA 16 893 31 337 524 16 540 31 524 301 16 359 32 244 322 17 115 32 589 227 Total WHO European Region 40 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 9: HIV diagnoses*, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals Table 9b: Geographical areas, WHO European Region Age category 2004 2005 2006 2007 Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown West <15 175 160 1 145 153 2 151 128 0 169 130 0 15–19 329 176 1 278 187 1 223 168 1 223 193 1 20–24 1 079 963 7 1 024 1 062 2 854 1 035 3 768 1 145 4 25–29 2 018 2 022 4 1 852 2 141 13 1 638 2 158 7 1 468 2 269 11 30–39 3 165 5 900 16 3 091 5 840 12 2 948 5 716 21 2 754 5 794 18 40–49 1 201 3 587 3 1 330 3 889 7 1 277 4 095 7 1 362 4 267 17 50+ 680 1 956 3 744 2 184 7 765 2 186 1 704 2 417 3 Unknown 34 64 6 28 62 8 31 64 9 17 64 12 Total West 8 681 14 828 41 8 492 15 518 52 7 887 15 550 49 7 465 16 279 66 Centre <15 24 32 0 24 15 0 20 28 0 24 15 2 15–19 57 34 1 41 44 0 32 27 0 40 35 1 20–24 82 129 0 94 151 1 75 174 2 80 191 7 25–29 89 188 0 118 266 4 122 276 8 98 332 18 30–39 123 372 3 132 416 3 126 468 8 128 460 22 40–49 36 194 2 51 200 3 56 208 5 39 228 8 50+ 24 104 0 37 140 1 30 105 0 41 162 5 Unknown 28 50 5 17 37 19 6 38 26 5 39 37 Total Centre 463 1 103 11 514 1 269 31 467 1 324 49 455 1 462 100 East <15 27 40 0 54 58 192 70 105 200 100 127 230 15–19 422 199 0 450 219 0 447 197 0 483 129 0 20–24 273 339 0 264 299 0 313 337 0 522 556 0 25–29 186 463 0 226 542 0 310 639 0 554 968 1 30–39 1 375 3 161 0 1 610 3 660 0 2 037 4 676 1 2 429 5 279 5 40–49 371 1 171 0 501 1 428 0 701 1 816 0 826 2 133 1 50+ 102 234 0 115 244 0 161 356 0 227 464 0 Unknown 2 601 2 958 3 2 694 3 117 0 3 006 3 346 3 2 033 2 784 0 Total East 5 357 8 565 3 5 914 9 567 192 7 045 11 472 204 7 174 12 440 237 Total WHO European Region 14 501 24 496 55 14 920 26 354 275 15 399 28 346 302 15 094 30 181 403 Age category 2012 2013 Cumulative total** Female Male Unknown Female Male Unknown Female Male Unknown Total West <15 98 91 2 69 74 1 3 182 3 680 121 6 983 15–19 161 264 0 146 222 1 4 372 4 645 43 9 060 20–24 451 1 521 2 403 1 383 1 15 937 26 496 229 42 662 25–29 936 2 407 7 751 2 246 4 27 281 50 440 421 78 142 30–39 2 143 5 084 13 1 754 4 543 11 43 987 109 738 652 154 377 40–49 1 249 4 279 4 1 083 3 718 8 18 275 67 192 254 85 721 50+ 946 2 958 1 792 2 703 1 11 256 39 676 109 51 041 Unknown 15 48 7 10 32 5 1 738 4 022 3 495 9 255 Total West 5 999 16 652 36 5 008 14 921 32 126 028 305 889 5 324 437 241 Centre <15 20 25 0 24 26 0 1 171 1 354 2 2 527 15–19 28 59 0 23 55 0 825 957 4 1 786 20–24 103 377 3 103 414 3 1 998 4 624 53 6 675 25–29 120 625 3 134 701 3 1 928 6 417 88 8 433 30–39 214 1 069 5 226 1 287 3 2 390 10 214 117 12 721 40–49 119 555 3 110 604 1 971 4 710 58 5 739 50+ 69 285 0 80 314 0 666 2 606 15 3 287 Unknown 2 20 27 3 15 37 282 909 1 975 3 166 Total Centre 675 3 015 41 703 3 416 47 10 231 31 791 2 312 44 334 East <15 153 246 152 105 157 127 937 1 275 1 617 3 829 15–19 286 62 0 252 78 0 6 571 5 263 2 11 836 20–24 1 464 659 0 1 326 756 0 12 439 9 933 9 22 381 25–29 2 221 2 182 0 2 196 2 277 0 15 727 20 615 28 36 370 30–39 3 637 6 418 0 3 901 6 474 0 33 733 70 803 77 104 613 40–49 1 772 3 220 0 2 070 3 379 0 12 569 28 009 20 40 598 50+ 803 1 207 0 1 016 1 364 0 4 604 7 546 4 12 154 Unknown 8 6 0 72 71 0 22 427 34 726 116 57 198 Total East 10 344 14 000 152 10 938 14 556 127 109 007 178 170 1 873 288 979 Total WHO European Region 17 018 33 667 229 16 649 32 893 206 245 266 515 850 9 509 770 554 * Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Therefore, totals by gender and overall may differ from totals presented in Tables 1–3. ** Cumulative total is the total number of cases reported by country since the start of reporting 41 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 Age category Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown West 132 137 0 127 105 0 138 101 0 111 92 3 <15 212 222 2 204 212 0 185 251 0 169 226 0 15–19 678 1 192 6 597 1 258 3 547 1 335 1 517 1 342 1 20–24 1 380 2 286 6 1 185 2 158 14 1 085 2 103 6 990 2 291 0 25–29 2 707 5 591 29 2 370 5 182 17 2 210 5 086 9 2 179 4 940 4 30–39 1 406 4 593 9 1 288 4 451 7 1 362 4 307 9 1 229 4 244 5 40–49 844 2 542 1 871 2 602 1 884 2 725 1 849 2 773 3 50+ 23 69 9 19 42 4 13 35 0 7 30 2 Unknown 7 382 16 632 62 6 661 16 010 46 6 424 15 943 26 6 051 15 938 18 Total West Centre 17 17 0 19 18 0 15 19 0 15 20 0 <15 34 46 1 35 50 0 23 38 0 20 53 0 15–19 90 197 8 99 221 4 87 292 4 108 323 2 20–24 113 359 11 108 379 10 101 415 9 115 522 1 25–29 159 583 20 163 706 19 148 713 23 184 909 0 30–39 47 299 6 53 331 9 65 334 10 94 427 3 40–49 49 173 0 54 204 3 53 222 6 49 250 0 50+ 4 31 52 3 31 41 4 23 67 3 20 67 Unknown 513 1 705 98 534 1 940 86 496 2 056 119 588 2 524 73 Total Centre East 118 128 234 64 92 169 67 96 177 111 138 136 <15 426 102 2 406 93 0 331 90 0 300 70 0 15–19 1 948 1 110 9 1 867 1 027 0 1 592 1 069 0 1 608 852 0 20–24 2 314 2 966 27 2 308 2 816 0 2 338 2 693 0 2 347 2 422 0 25–29 2 834 5 730 70 3 073 6 279 0 3 244 6 542 0 3 695 6 598 0 30–39 1 030 2 388 19 1 216 2 580 0 1 348 2 924 0 1 703 3 048 0 40–49 314 568 3 408 670 0 518 823 0 708 991 0 50+ 14 8 0 3 17 0 1 8 0 4 8 0 Unknown 8 998 13 000 364 9 345 13 574 169 9 439 14 245 177 10 476 14 127 136 Total East 16 893 31 337 524 16 540 31 524 301 16 359 32 244 322 17 115 32 589 227 Total WHO European Region

43 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Table 10: HIV diagnoses in persons infected through heterosexual contact, by country and transmission subcategory, cases diagnosed in 2013, in EU/EEA and other countries of the WHO European Region Area Country* Case from country with generalised HIV epidemic Partner from a country with a generalised HIV epidemic Partner IDU Bisexual partner Other/ undetermined Total N % N % N % N % N % N EU/EEA West Austria 21 25.0 17 20.2 4 4.8 0 0.0 42 50.0 84 West Belgium 193 51.9 25 6.7 2 0.5 0 0.0 152 40.9 372 Centre Bulgaria 18 25.7 0 0.0 0 0.0 0 0.0 52 74.3 70 Centre Croatia 0 0.0 0 0.0 0 0.0 0 0.0 13 100.0 13 Centre Cyprus 2 12.5 0 0.0 0 0.0 0 0.0 14 87.5 16 Centre Czech Republic 1 2.3 1 2.3 0 0.0 0 0.0 42 95.5 44 West Denmark 48 53.3 20 22.2 2 2.2 2 2.2 18 20.0 90 East Estonia 0 0.0 0 0.0 5 3.0 1 0.6 163 96.4 169 West Finland 8 11.9 33 49.3 3 4.5 0 0.0 23 34.3 67 West France 262 19.8 587 44.3 10 0.8 10 0.8 456 34.4 1 325 West Germany 337 56.8 35 5.9 13 2.2 10 1.7 198 33.4 593 West Greece 17 16.5 4 3.9 4 3.9 1 1.0 77 74.8 103 Centre Hungary 5 20.8 0 0.0 0 0.0 0 0.0 19 79.2 24 West Iceland 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 West Ireland 72 55.0 19 14.5 2 1.5 0 0.0 38 29.0 131 West Italy 269 16.8 0 0.0 0 0.0 0 0.0 1 336 83.2 1 605 East Latvia 0 0.0 0 0.0 10 8.0 0 0.0 115 92.0 125 East Lithuania 0 0.0 0 0.0 0 0.0 0 0.0 50 100.0 50 West Luxembourg 11 57.9 0 0.0 0 0.0 0 0.0 8 42.1 19 West Malta 4 40.0 0 0.0 0 0.0 0 0.0 6 60.0 10 West Netherlands 62 28.8 0 0.0 0 0.0 0 0.0 153 71.2 215 West Norway 56 45.5 6 4.9 0 0.0 0 0.0 61 49.6 123 Centre Poland 0 0.0 0 0.0 0 0.0 0 0.0 82 100.0 82 West Portugal 158 23.8 25 3.8 4 0.6 1 0.2 477 71.7 665 Centre Romania 0 0.0 0 0.0 12 6.3 0 0.0 180 93.8 192 Centre Slovakia 1 4.8 1 4.8 0 0.0 0 0.0 19 90.5 21 Centre Slovenia 2 28.6 3 42.9 0 0.0 1 14.3 1 14.3 7 West Spain 159 17.0 0 0.0 0 0.0 0 0.0 774 83.0 933 West Sweden 97 58.1 0 0.0 0 0.0 0 0.0 70 41.9 167 West United Kingdom 1 055 49.4 0 0.0 0 0.0 0 0.0 1 079 50.6 2 134 Total EU/EEA 2 858 30.2 776 8.2 71 0.8 26 0.3 5 718 60.5 9 449 Non-EU/EEA Centre Albania 0 0.0 0 0.0 0 0.0 0 0.0 99 100.0 99 West Andorra 0 0.0 0 0.0 0 0.0 0 0.0 1 100.0 1 East Armenia 0 0.0 0 0.0 10 5.7 1 0.6 165 93.8 176 East Azerbaijan 0 0.0 0 0.0 38 14.2 0 0.0 229 85.8 267 East Belarus 0 0.0 0 0.0 0 0.0 0 0.0 1 138 100.0 1 138 Centre Bosnia and Herzegovina 0 0.0 0 0.0 0 0.0 0 0.0 12 100.0 12 Centre former Yugoslav Republic of Macedonia, the 0 0.0 0 0.0 0 0.0 0 0.0 2 100.0 2 East Georgia 3 1.3 30 12.7 42 17.8 0 0.0 161 68.2 236 West Israel 92 50.5 0 0.0 4 2.2 3 1.6 83 45.6 182 East Kazakhstan 0 0.0 0 0.0 0 0.0 0 0.0 1 273 100.0 1 273 East Kyrgyzstan 0 0.0 0 0.0 0 0.0 0 0.0 276 100.0 276 East Moldova 0 0.0 0 0.0 0 0.0 0 0.0 325 100.0 325 West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 Centre Montenegro 0 0.0 0 0.0 0 0.0 0 0.0 1 100.0 1 East Russia 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 West San Marino 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 Centre Serbia 0 0.0 0 0.0 0 0.0 0 0.0 21 100.0 21 West Switzerland 55 25.9 41 19.3 1 0.5 0 0.0 115 54.2 212 East Tajikistan 0 0.0 0 0.0 0 0.0 0 0.0 477 100.0 477 Centre Turkey 5 1.2 0 0.0 0 0.0 0 0.0 423 98.8 428 East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 East Ukraine 0 0.0 0 0.0 0 0.0 0 0.0 11 472 100.0 11 472 East Uzbekistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 Total non-EU/EEA 155 0.9 71 0.4 95 0.6 4 0.0 16 273 98.0 16 598 Geographical area West 2 976 33 812 9 49 0.5 27 0.3 5 167 57.2 9 031 Centre 34 3.3 5 0.5 12 1.2 1 0.1 980 95.0 1 032 East 3 0.0 30 0.2 105 0.7 2 0.0 15 844 99.1 15 984 Total WHO European Region 3 013 11.6 847 3.3 166 0.6 30 0.1 21 991 84.4 26 047 * Country-specific comments are in Annex 5 44 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 11: HIV diagnoses, by country of report and country or subcontinent of origin, cases diagnosed in 2013, in EU/EEA and other countries of the WHO European Region Area Country* Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa N % N % N % N % EU/EEA West Austria 168 64.6 15 5.8 43 16.5 20 7.7 West Belgium 400 35.9 101 9.1 43 3.9 228 20.4 Centre Bulgaria 173 86.5 1 0.5 5 2.5 19 9.5 Centre Croatia 84 98.8 0 0.0 0 0.0 0 0.0 Centre Cyprus 41 75.9 2 3.7 8 14.8 2 3.7 Centre Czech Republic 170 72.3 9 3.8 48 20.4 1 0.4 West Denmark 112 48.1 26 11.2 19 8.2 41 17.6 East Estonia 295 90.8 1 0.3 9 2.8 0 0.0 West Finland 76 48.4 5 3.2 30 19.1 24 15.3 West France 1 406 35.1 71 1.8 67 1.7 832 20.8 West Germany 2 021 61.9 115 3.5 306 9.4 301 9.2 West Greece 578 71.6 2 0.2 97 12.0 21 2.6 Centre Hungary 216 90.0 1 0.4 9 3.8 8 3.3 West Iceland 5 45.5 1 9.1 0 0.0 2 18.2 West Ireland 140 42.2 16 4.8 31 9.3 75 22.6 West Italy 2 737 75.9 34 0.9 233 6.5 312 8.6 East Latvia 111 32.6 0 0.0 0 0.0 0 0.0 East Lithuania 169 95.5 0 0.0 5 2.8 1 0.6 West Luxembourg 16 30.2 21 39.6 0 0.0 12 22.6 West Malta 7 19.4 10 27.8 3 8.3 8 22.2 West Netherlands 661 69.7 46 4.8 42 4.4 77 8.1 West Norway 80 34.3 15 6.4 18 7.7 57 24.5 Centre Poland 897 82.4 0 0.0 0 0.0 0 0.0 West Portugal 765 70.0 14 1.3 17 1.6 194 17.7 Centre Romania 503 99.2 1 0.2 3 0.6 0 0.0 Centre Slovakia 78 94.0 0 0.0 3 3.6 1 1.2 Centre Slovenia 39 88.6 0 0.0 4 9.1 1 2.3 West Spain 2 214 67.5 131 4.0 90 2.7 182 5.6 West Sweden 85 24.0 11 3.1 22 6.2 140 39.5 West United Kingdom 2 289 38.2 501 8.4 340 5.7 1 225 20.4 Total EU/EEA 16 536 56.7 1 150 3.9 1 495 5.1 3 784 13.0 Non-EU/EEA Centre Albania 116 99.1 0 0.0 0 0.0 0 0.0 West Andorra 2 40.0 1 20.0 0 0.0 0 0.0 East Armenia 238 100.0 0 0.0 0 0.0 0 0.0 East Azerbaijan 494 96.1 0 0.0 19 3.7 0 0.0 East Belarus 1 376 99.9 0 0.0 0 0.0 0 0.0 Centre Bosnia and Herzegovina 27 100.0 0 0.0 0 0.0 0 0.0 Centre former Yugoslav Republic of Macedonia, the 15 100.0 0 0.0 0 0.0 0 0.0 East Georgia 465 98.1 0 0.0 9 1.9 0 0.0 West Israel 176 35.9 13 2.7 131 26.7 94 19.2 East Kazakhstan 0 0.0 0 0.0 0 0.0 0 0.0 East Kyrgyzstan 479 95.2 3 0.6 20 4.0 0 0.0 East Moldova 700 99.2 0 0.0 6 0.8 0 0.0 West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 Centre Montenegro 9 90.0 0 0.0 1 10.0 0 0.0 East Russia 0 0.0 0 0.0 0 0.0 0 0.0 West San Marino 0 0.0 0 0.0 0 0.0 0 0.0 Centre Serbia 147 100.0 0 0.0 0 0.0 0 0.0 West Switzerland 202 35.2 66 11.5 19 3.3 75 13.1 East Tajikistan 604 73.2 0 0.0 0 0.0 0 0.0 Centre Turkey 1 126 85.8 10 0.8 74 5.6 37 2.8 East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 0 0.0 0 0.0 0 0.0 0 0.0 East Uzbekistan 0 0.0 0 0.0 0 0.0 0 0.0 Total non-EU/EEA 6 176 22.6 93 0.3 279 1.0 206 0.8 Geographical area West 14 140 52.7 1 215 4.5 1 551 5.8 3 920 14.6 Centre 3 641 87.4 24 0.6 155 3.7 69 1.7 East 4 931 19.4 4 0.0 68 0.3 1 0.0 Total WHO European Region 22 712 40.2 1 243 2.2 1 774 3.1 3 990 7.1 * Country-specific comments are in Annex 5 45 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Latin America & Caribbean South & South-east Asia Other Unknown Total Country N Rate N % N % N % EU/EEA 7 2.7 5 1.9 2 0.8 0 0.0 260 Austria 29 2.6 14 1.3 27 2.4 273 24.5 1 115 Belgium 0 0.0 0 0.0 2 1.0 0 0.0 200 Bulgaria 0 0.0 0 0.0 0 0.0 1 1.2 85 Croatia 0 0.0 0 0.0 1 1.9 0 0.0 54 Cyprus 0 0.0 7 3.0 0 0.0 0 0.0 235 Czech Republic 8 3.4 22 9.4 5 2.1 0 0.0 233 Denmark 1 0.3 0 0.0 0 0.0 19 5.8 325 Estonia 1 0.6 10 6.4 0 0.0 11 7.0 157 Finland 146 3.6 42 1.0 100 2.5 1 338 33.4 4 002 France 59 1.8 93 2.9 57 1.7 311 9.5 3 263 Germany 3 0.4 26 3.2 29 3.6 51 6.3 807 Greece 1 0.4 2 0.8 3 1.3 0 0.0 240 Hungary 1 9.1 0 0.0 0 0.0 2 18.2 11 Iceland 35 10.5 8 2.4 5 1.5 22 6.6 332 Ireland 187 5.2 31 0.9 68 1.9 6 0.2 3 608 Italy 0 0.0 0 0.0 0 0.0 229 67.4 340 Latvia 0 0.0 1 0.6 1 0.6 0 0.0 177 Lithuania 2 3.8 2 3.8 0 0.0 0 0.0 53 Luxembourg 2 5.6 0 0.0 1 2.8 5 13.9 36 Malta 64 6.7 34 3.6 25 2.6 0 0.0 949 Netherlands 9 3.9 32 13.7 7 3.0 15 6.4 233 Norway 0 0.0 0 0.0 0 0.0 192 17.6 1 089 Poland 61 5.6 3 0.3 1 0.1 38 3.5 1 093 Portugal 0 0.0 0 0.0 0 0.0 0 0.0 507 Romania 1 1.2 0 0.0 0 0.0 0 0.0 83 Slovakia 0 0.0 0 0.0 0 0.0 0 0.0 44 Slovenia 526 16.0 0 0.0 63 1.9 72 2.2 3 278 Spain 15 4.2 41 11.6 15 4.2 25 7.1 354 Sweden 259 4.3 254 4.2 147 2.5 979 16.3 5 994 United Kingdom 1 417 4.9 627 2.2 559 1.9 3 589 12.3 29 157 Total EU/EEA Non-EU/EEA 0 0.0 0 0.0 1 0.9 0 0.0 117 Albania 0 0.0 0 0.0 0 0.0 2 40.0 5 Andorra 0 0.0 0 0.0 0 0.0 0 0.0 238 Armenia 0 0.0 1 0.2 0 0.0 0 0.0 514 Azerbaijan 1 0.1 0 0.0 0 0.0 0 0.0 1 377 Belarus 0 0.0 0 0.0 0 0.0 0 0.0 27 Bosnia and Herzegovina 0 0.0 0 0.0 0 0.0 0 0.0 15 former Yugoslav Republic of Macedonia, the 0 0.0 0 0.0 0 0.0 0 0.0 474 Georgia 8 1.6 6 1.2 62 12.7 0 0.0 490 Israel 0 0.0 0 0.0 0 0.0 2 140 100.0 2 140 Kazakhstan 0 0.0 0 0.0 1 0.2 0 0.0 503 Kyrgyzstan 0 0.0 0 0.0 0 0.0 0 0.0 706 Moldova 0 0.0 0 0.0 0 0.0 0 0.0 0 Monaco 0 0.0 0 0.0 0 0.0 0 0.0 10 Montenegro 0 0.0 0 0.0 0 0.0 0 0.0 0 Russia 0 0.0 0 0.0 0 0.0 0 0.0 0 San Marino 0 0.0 0 0.0 0 0.0 0 0.0 147 Serbia 24 4.2 17 3.0 6 1.0 165 28.7 574 Switzerland 0 0.0 0 0.0 0 0.0 221 26.8 825 Tajikistan 5 0.4 7 0.5 32 2.4 22 1.7 1 313 Turkey 0 0.0 0 0.0 0 0.0 0 0.0 0 Turkmenistan 0 0.0 0 0.0 0 0.0 17 875 100.0 17 875 Ukraine 0 0.0 0 0.0 0 0.0 0 0.0 0 Uzbekistan 38 0.1 31 0.1 102 0.4 20 425 74.7 27 350 Total non-EU/EEA Geographical area 1 446 5.4 640 2.4 620 2.3 3 315 12.3 26 847 West 7 0.2 16 0.4 39 0.9 215 5.2 4 166 Centre 2 0.0 2 0.0 2 0.0 20 484 80.3 25 494 East 1 455 2.6 658 1.2 661 1.2 24 014 42.5 56 507 Total WHO European Region 46 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 12: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, cases reported in 2013 Table 12a: EU/EEA and non-EU/EEA countries Transmission mode Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa N % N % N % N % EU/EEA Men who have sex with men 8 784 71.8 812 6.6 469 3.8 193 1.6 Injecting drug use 1 018 70.0 42 2.9 202 13.9 17 1.2 Heterosexual contact 4 223 44.7 202 2.1 534 5.7 3 160 33.4 Mother-to-child 85 39.0 1 0.5 9 4.1 84 38.5 Haemophiliac/transfusion recipient 14 29.8 3 6.4 11 23.4 9 19.1 Nosocomial infection 7 36.8 0 0.0 5 26.3 3 15.8 Other/undetermined 2 405 41.9 90 1.6 265 4.6 318 5.5 Total EU/EEA 16 536 56.7 1 150 3.9 1 495 5.1 3 784 13.0 Non-EU/EEA Men who have sex with men 677 82.8 53 6.5 27 3.3 4 0.5 Injecting drug use 983 88.2 5 0.4 72 6.5 1 0.1 Heterosexual contact 3 344 86.8 27 0.7 103 2.7 153 4.0 Mother-to-child 107 83.6 0 0 3 2.3 4 3.1 Haemophiliac/transfusion recipient 6 46.2 1 7.7 1 7.7 3 23.1 Nosocomial infection 15 100.0 0 0 0 0 0 0 Other/undetermined 1 044 74.9 7 0.5 73 5.2 41 2.9 Total non-EU/EEA 6 176 84.2 93 1.3 279 3.8 206 2.8 Total WHO European Region 22 712 62.2 1 243 3.4 1 774 4.9 3 990 10.9 Table 12b: Geographical areas, WHO European Region Transmission mode Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa N % N % N % N % West Men who have sex with men 8 145 70.3 854 7.4 448 3.9 194 1.7 Injecting drug use 681 61.9 44 4.0 248 22.5 17 1.5 Heterosexual contact 3 690 40.9 220 2.4 554 6.1 3 281 36.3 Mother-to-child 58 30.4 1 0.5 10 5.2 88 46.1 Haemophiliac/transfusion recipient 14 26.9 4 7.7 12 23.1 12 23.1 Nosocomial infection 7 38.9 0 0.0 4 22.2 3 16.7 Other/undetermined 1 545 31.7 92 1.9 275 5.6 325 6.7 Total West 14 140 52.7 1 215 4.5 1 551 5.8 3 920 14.6 Centre Men who have sex with men 1 125 89.6 11 0.9 43 3.4 2 0.2 Injecting drug use 233 95.5 1 0.4 6 2.5 1 0.4 Heterosexual contact 924 89.5 7 0.7 46 4.5 32 3.1 Mother-to-child 45 95.7 0 0.0 1 2.1 0 0.0 Haemophiliac/transfusion recipient 3 60.0 0 0.0 0 0.0 0 0.0 Nosocomial infection 2 66.7 0 0.0 1 33.3 0 0.0 Other/undetermined 1 309 82.9 5 0.3 58 3.7 34 2.2 Total Centre 3 641 87.4 24 0.6 155 3.7 69 1.7 East Men who have sex with men 191 37.5 0 0.0 5 1.0 1 0.2 Injecting drug use 1 087 13.9 2 0.0 20 0.3 0 0.0 Heterosexual contact 2 953 18.5 2 0.0 37 0.2 0 0.0 Mother-to-child 89 32.8 0 0.0 1 0.4 0 0.0 Haemophiliac/transfusion recipient 3 100.0 0 0.0 0 0.0 0 0.0 Nosocomial infection 13 100.0 0 0.0 0 0.0 0 0.0 Other/undetermined 595 65.7 0 0.0 5 0.6 0 0.0 Total East 4 931 19.4 4 0.0 68 0.3 1 0.0 Total WHO European Region 22 712 40.2 1 243 2.2 1 774 3.1 3 990 7.1 47 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Latin America & Caribbean South & South-east Asia Other Unknown Total Transmission mode N % N % N % N % EU/EEA 845 6.9 263 2.2 257 2.1 605 4.9 12 228 Men who have sex with men 6 0.4 32 2.2 33 2.3 105 7.2 1 455 Injecting drug use 434 4.6 249 2.6 188 2.0 459 4.9 9 449 Heterosexual contact 4 1.8 4 1.8 6 2.8 25 11.5 218 Mother-to-child 2 4.3 4 8.5 2 4.3 2 4.3 47 Haemophiliac/transfusion recipient 1 5.3 1 5.3 0 0.0 2 10.5 19 Nosocomial infection 125 2.2 74 1.3 73 1.3 2 391 41.6 5 741 Other/undetermined 1 417 4.9 627 2.2 559 1.9 3 589 12.3 29 157 Total EU/EEA Non-EU/EEA 21 2.6 8 1.0 9 1.1 19 2.3 818 Men who have sex with men 0 0 1 0.1 5 0.4 47 4.2 1 114 Injecting drug use 11 0.3 15 0.4 19 0.5 181 4.7 3 853 Heterosexual contact 0 0 0 0 1 0.8 13 10.2 128 Mother-to-child 0 0 0 0 2 15.4 0 0.0 13 Haemophiliac/transfusion recipient 0 0 0 0 0 0 0 0.0 15 Nosocomial infection 6 0.4 7 0.5 66 4.7 387 23.0 1 631 Other/undetermined 38 0.5 31 0.4 102 1.4 20 425 74.7 27 350 Total non-EU/EEA 1 455 4.0 658 1.8 661 1.8 24 014 42.5 56 507 Total WHO European Region Latin America & Caribbean South & South-east Asia Other Unknown Total Transmission mode N % N % N % N % West 862 7.4 270 2.3 261 2.3 548 4.7 11 582 Men who have sex with men 6 0.5 31 2.8 38 3.5 35 3.2 1 100 Injecting drug use 444 4.9 258 2.9 198 2.2 386 4.3 9 031 Heterosexual contact 4 2.1 4 2.1 7 3.7 19 9.9 191 Mother-to-child 2 3.8 4 7.7 2 3.8 2 3.8 52 Haemophiliac/transfusion recipient 1 5.6 1 5.6 - - 2 11.1 18 Nosocomial infection 127 2.6 72 1.5 114 2.3 2 323 47.7 4 873 Other/undetermined 1 446 5.4 640 2.4 620 2.3 3 315 12.3 26 847 Total West Centre 3 0.2 1 0.1 5 0.4 66 5.3 1 256 Men who have sex with men 0 0.0 1 0.4 0 0.0 2 0.8 244 Injecting drug use 0 0.0 5 0.5 7 0.7 11 1.1 1 032 Heterosexual contact 0 0.0 0 0.0 0 0.0 1 2.1 47 Mother-to-child 0 0.0 0 0.0 2 40.0 0 0.0 5 Haemophiliac/transfusion recipient 0 0.0 0 0.0 0 0.0 0 0.0 3 Nosocomial infection 4 0.3 9 0.6 25 1.6 135 8.5 1 579 Other/undetermined 7 0.2 16 0.4 39 0.9 215 5.2 4 166 Total Centre East 1 0.2 0 0.0 0 0.0 312 61.2 510 Men who have sex with men 0 0.0 1 0.0 0 0.0 6 683 85.8 7 793 Injecting drug use 1 0.0 1 0.0 2 0.0 12 988 81.3 15 984 Heterosexual contact 0 0.0 0 0.0 0 0.0 181 66.8 271 Mother-to-child 0 0.0 0 0.0 0 0.0 0 0.0 3 Haemophiliac/transfusion recipient 0 0.0 0 0.0 0 0.0 0 0.0 13 Nosocomial infection 0 0.0 0 0.0 0 0.0 320 33.7 920 Other/undetermined 2 0.0 2 0.0 2 0.0 20 484 80.3 25 494 Total East 1 455 2.6 658 1.2 661 1.2 24 014 42.5 56 507 Total WHO European Region 48 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 13: HIV diagnoses, by probable region of infection, in 2013, in EU/EEA and other countries of the WHO European Region Area Country* Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa N % N % N % N % EU/EEA West Austria 44 16.9 7 2.7 2 0.8 6 2.3 West Belgium 351 31.5 38 3.4 18 1.6 130 11.7 Centre Bulgaria 0 0.0 0 0.0 0 0.0 0 0.0 Centre Croatia 0 0.0 0 0.0 0 0.0 0 0.0 Centre Cyprus 33 61.1 10 18.5 3 5.6 2 3.7 Centre Czech Republic 2 0.9 3 1.3 3 1.3 2 0.9 West Denmark 111 47.6 25 10.7 16 6.9 41 17.6 East Estonia 238 73.2 6 1.8 1 0.3 0 0.0 West Finland 0 0.0 8 5.1 27 17.2 18 11.5 West France 1 262 31.5 0 0.0 0 0.0 0 0.0 West Germany 0 0.0 0 0.0 0 0.0 0 0.0 West Greece 0 0.0 0 0.0 0 0.0 0 0.0 Centre Hungary 0 0.0 0 0.0 0 0.0 0 0.0 West Iceland 2 18.2 0 0.0 1 9.1 0 0.0 West Ireland 129 38.9 20 6.0 11 3.3 54 16.3 West Italy 0 0.0 0 0.0 0 0.0 0 0.0 East Latvia 255 75.0 3 0.9 4 1.2 0 0.0 East Lithuania 123 69.5 8 4.5 7 4.0 0 0.0 West Luxembourg 0 0.0 0 0.0 0 0.0 0 0.0 West Malta 0 0.0 6 16.7 1 2.8 6 16.7 West Netherlands 624 65.8 19 2.0 9 0.9 23 2.4 West Norway 70 30.0 21 9.0 14 6.0 63 27.0 Centre Poland 1 089 100.0 0 0.0 0 0.0 0 0.0 West Portugal 598 54.7 9 0.8 2 0.2 53 4.8 Centre Romania 452 89.2 0 0.0 13 2.6 0 0.0 Centre Slovakia 0 0.0 0 0.0 0 0.0 0 0.0 Centre Slovenia 0 0.0 0 0.0 0 0.0 0 0.0 West Spain 0 0.0 0 0.0 0 0.0 0 0.0 West Sweden 90 25.4 22 6.2 19 5.4 132 37.3 West United Kingdom 0 0.0 0 0.0 0 0.0 0 0.0 Total EU/EEA 5 473 18.8 205 0.7 151 0.5 530 1.8 Non-EU/EEA Centre Albania 0 0.0 0 0.0 0 0.0 0 0.0 West Andorra 0 0.0 0 0.0 0 0.0 0 0.0 East Armenia 95 39.9 1 0.4 126 52.9 0 0.0 East Azerbaijan 301 58.6 0 0.0 107 20.8 0 0.0 East Belarus 1 376 99.9 0 0.0 0 0.0 0 0.0 Centre Bosnia and Herzegovina 0 0.0 0 0.0 0 0.0 0 0.0 Centre former Yugoslav Republic of Macedonia, the 0 0.0 0 0.0 0 0.0 0 0.0 East Georgia 209 44.1 18 3.8 115 24.3 0 0.0 West Israel 281 57.3 9 1.8 56 11.4 69 14.1 East Kazakhstan 0 0.0 0 0.0 0 0.0 0 0.0 East Kyrgyzstan 501 99.6 0 0.0 2 0.4 0 0.0 East Moldova 661 93.6 0 0.0 45 6.4 0 0.0 West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 Centre Montenegro 0 0.0 0 0.0 0 0.0 0 0.0 East Russia 0 0.0 0 0.0 0 0.0 0 0.0 West San Marino 0 0.0 0 0.0 0 0.0 0 0.0 Centre Serbia 0 0.0 0 0.0 0 0.0 0 0.0 West Switzerland 172 30.0 41 7.1 9 1.6 59 10.3 East Tajikistan 0 0.0 0 0.0 0 0.0 0 0.0 Centre Turkey 0 0.0 0 0.0 0 0.0 0 0.0 East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 0 0.0 0 0.0 0 0.0 0 0.0 East Uzbekistan 0 0.0 0 0.0 0 0.0 0 0.0 Total non-EU/EEA 3 596 13.2 69 0.3 460 1.7 128 0.5 Geographical area West 3 734 13.9 225 0.8 185 0.7 654 2.4 Centre 1 576 37.8 13 0.3 19 0.5 4 0.1 East 3 759 14.8 36 0.1 407 1.6 0 0 Total WHO European Region 9 069 16.1 274 0.5 611 1.1 658 1.2 * Country-specific comments are in Annex 5 49 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Latin America & Caribbean South & South-east Asia Other Unknown Total Country N Rate N % N % N % EU/EEA 0 0.0 5 1.9 0 0.0 196 75.4 260 Austria 11 1.0 17 1.5 10 0.9 540 48.4 1 115 Belgium 0 0.0 0 0.0 0 0.0 200 100.0 200 Bulgaria 0 0.0 0 0.0 0 0.0 85 100.0 85 Croatia 0 0.0 0 0.0 0 0.0 6 11.1 54 Cyprus 1 0.4 1 0.4 1 0.4 222 94.5 235 Czech Republic 6 2.6 21 9.0 7 3.0 6 2.6 233 Denmark 1 0.3 1 0.3 0 0.0 78 24.0 325 Estonia 2 1.3 22 14.0 0 0.0 80 51.0 157 Finland 0 0.0 0 0.0 0 0.0 2 740 68.5 4 002 France 0 0.0 0 0.0 0 0.0 3 263 100.0 3 263 Germany 0 0.0 0 0.0 0 0.0 807 100.0 807 Greece 0 0.0 0 0.0 0 0.0 240 100.0 240 Hungary 0 0.0 0 0.0 0 0.0 8 72.7 11 Iceland 15 4.5 5 1.5 4 1.2 94 28.3 332 Ireland 0 0.0 0 0.0 0 0.0 3 608 100.0 3 608 Italy 0 0.0 1 0.3 0 0.0 77 22.6 340 Latvia 0 0.0 1 0.6 0 0.0 38 21.5 177 Lithuania 0 0.0 0 0.0 0 0.0 53 100.0 53 Luxembourg 1 2.8 0 0.0 1 2.8 21 58.3 36 Malta 18 1.9 11 1.2 7 0.7 238 25.1 949 Netherlands 6 2.6 38 16.3 12 5.2 9 3.9 233 Norway 0 0.0 0 0.0 0 0.0 0 0.0 1 089 Poland 9 0.8 2 0.2 0 0.0 420 38.4 1 093 Portugal 0 0.0 0 0.0 0 0.0 42 8.3 507 Romania 0 0.0 0 0.0 0 0.0 83 100.0 83 Slovakia 0 0.0 0 0.0 0 0.0 44 100.0 44 Slovenia 0 0.0 0 0.0 0 0.0 3 278 100.0 3 278 Spain 5 1.4 53 15.0 20 5.6 13 3.7 354 Sweden 0 0.0 0 0.0 0 0.0 5 994 100.0 5 994 United Kingdom 75 0.3 178 0.6 62 0.2 22 483 77.1 29 157 Total EU/EEA Non-EU/EEA 0 0.0 0 0.0 0 0.0 117 100.0 117 Albania 0 0.0 0 0.0 0 0.0 5 100.0 5 Andorra 0 0.0 0 0.0 1 0.4 15 6.3 238 Armenia 0 0.0 1 0.2 1 0.2 104 20.2 514 Azerbaijan 0 0.0 0 0.0 0 0.0 1 0.1 1 377 Belarus 0 0.0 0 0.0 0 0.0 27 100.0 27 Bosnia and Herzegovina 0 0.0 0 0.0 0 0.0 15 100.0 15 former Yugoslav Republic of Macedonia, the 0 0.0 1 0.2 0 0.0 131 27.6 474 Georgia 2 0.4 7 1.4 9 1.8 57 11.6 490 Israel 0 0.0 0 0.0 0 0.0 2 140 100.0 2 140 Kazakhstan 0 0.0 0 0.0 0 0.0 0 0.0 503 Kyrgyzstan 0 0.0 0 0.0 0 0.0 0 0.0 706 Moldova 0 0.0 0 0.0 0 0.0 0 0.0 0 Monaco 0 0.0 0 0.0 0 0.0 10 100.0 10 Montenegro 0 0.0 0 0.0 0 0.0 0 0.0 0 Russia 0 0.0 0 0.0 0 0.0 0 0.0 0 San Marino 0 0.0 0 0.0 0 0.0 147 100.0 147 Serbia 8 1.4 22 3.8 2 0.3 261 45.5 574 Switzerland 0 0.0 0 0.0 0 0.0 825 100.0 825 Tajikistan 0 0.0 0 0.0 0 0.0 1 313 100.0 1 313 Turkey 0 0.0 0 0.0 0 0.0 0 0.0 0 Turkmenistan 0 0.0 0 0.0 0 0.0 17 875 100.0 17 875 Ukraine 0 0.0 0 0.0 0 0.0 0 0.0 0 Uzbekistan 10 0.0 31 0.1 13 0.0 23 043 84.2 27 350 Total non-EU/EEA Geographical area 83 0.3 203 0.8 72 0.3 21 691 80.8 26 847 West 1 0 1 0 1 0 2 551 61.2 4 166 Centre 1 0 5 0 2 0 21 284 83.5 25 494 East 85 0.2 209 0.4 75 0.1 45 526 80.6 56 507 Total WHO European Region

51 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Table 14: Percentage of new HIV diagnoses (2013) 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* Number of cases with CD4 cell count 2013 CD4 < 350 per mm3 blood in 2013 (%) Completeness (%) CD4 CD4 <200 (%) CD4 <350 (%) Hetero IDU MSM MTCT** N % N % EU/EEA West Austria 237 91.5 61 25.7 106 44.7 55.7 61.5 32.5 - West Belgium 659 59.6 129 19.6 285 43.2 45.8 57.1 39.8 - Centre Bulgaria 134 68.7 32 23.9 63 47.0 57.5 47.8 40.7 50.0 Centre Croatia - - - - - - - - - - Centre Cyprus 52 96.3 7 13.5 10 19.2 20.0 - 17.1 - Centre Czech Republic 206 87.7 29 14.1 54 26.2 48.6 60.0 19.1 - West Denmark 205 89.5 58 28.3 99 48.3 59.7 33.3 42.3 25.0 East Estonia 122 37.9 31 25.4 63 51.6 54.8 43.9 50.0 - West Finland 109 71.2 39 35.8 62 56.9 63.6 - 44.7 - West France 2 257 56.9 585 25.9 1 046 46.3 54.4 43.1 33.6 14.3 West Germany - - - - - - - - - - West Greece 563 70.0 194 34.5 308 54.7 64.0 74.6 39.4 Centre Hungary - - - - - - - - - - West Iceland - - - - - - - - - - West Ireland 295 89.7 73 24.7 146 49.5 58.3 56.3 37.8 100.0 West Italy 2 778 77.3 1 046 37.7 1 600 57.6 64.2 60.7 48.2 33.3 East Latvia 208 63.0 63 30.3 112 53.8 51.1 58.6 56.5 - East Lithuania - - - - - - - - - - West Luxembourg 40 78.4 11 27.5 22 55.0 69.2 50.0 47.8 - West Malta - - - - - - - - - - West Netherlands 853 90.8 209 24.5 365 42.8 62.8 50.0 33.2 - West Norway - - - - - - - - - - Centre Poland - - - - - - - - - - West Portugal 755 69.5 276 36.6 438 58.0 63.6 58.8 46.1 100.0 Centre Romania 430 87.8 19 4.4 145 33.7 38.8 25.4 27.4 - Centre Slovakia 66 79.5 8 12.1 14 21.2 5.3 - 24.4 - Centre Slovenia 43 97.7 11 25.6 25 58.1 100.0 - 51.9 - West Spain 2 747 84.2 752 27.4 1 284 46.7 55.0 55.0 40.7 - West Sweden - - - - - - - - - - West United Kingdom 4 767 80.0 1 117 23.4 1 982 41.6 56.2 50.0 30.7 43.6 Total EU/EEA 17 526 60.7 4 750 27.1 8 229 47.0 57.1 52.3 36.7 26.2 Non-EU/EEA Centre Albania 76 68.5 36 47.4 54 71.1 74.3 - 33.3 - West Andorra - - - - - - - - - - East Armenia 189 81.1 69 36.5 100 52.9 51.0 68.0 36.4 25.0 East Azerbaijan 85 17.0 24 28.2 42 49.4 40.6 76.2 - 50.0 East Belarus - - - - - - - - - - Centre Bosnia and Herzegovina 26 96.3 10 38.5 16 61.5 66.7 - 61.5 - Centre former Yugoslav Republic of Macedonia, the 13 86.7 1 7.7 1 7.7 - - 9.1 - East Georgia 408 86.6 164 40.2 269 65.9 63.1 78.6 46.7 50.0 West Israel 280 60.7 66 23.6 129 46.1 55.4 40.0 40.3 33.3 East Kazakhstan - - - - - - - - - - East Kyrgyzstan 79 16.5 18 22.8 44 55.7 55.8 60.0 42.9 33.3 East Moldova - - - - - - - - - - West Monaco - - - - - - - - - - Centre Montenegro 7 70.0 5 71.4 6 85.7 100.0 - 75.0 - East Russia - - - - - - - - - - West San Marino - - - - - - - - - - Centre Serbia 128 88.9 47 36.7 74 57.8 77.8 28.6 52.3 25.0 West Switzerland 334 59.1 96 28.7 164 49.1 52.6 40.0 43.0 25.0 East Tajikistan 277 39.2 88 31.8 152 54.9 51.7 65.2 - 20.7 Centre Turkey 118 9.1 31 26.3 59 50.0 55.0 - 52.2 100.0 East Turkmenistan - - - - - - - - - - East Ukraine*** 15 837 89.3 4 246 26.8 7 991 50.5 - - - - East Uzbekistan - - - - - - - - - - Total non-EU/EEA 17 857 40.0 4 901 27.4 9 101 51.0 55.8 66.3 44.6 27.3 Geographical area West 16 879 63.4 4 712 27.9 8 036 47.6 57.8 57.2 37.2 29.9 Centre 1 299 32.0 236 18.2 521 40.1 50.1 29.0 32.6 15.0 East 17 205 40.4 4 703 27.3 8 773 51.0 53.9 68.1 47.6 24.4 Total WHO European Region 35 383 48.3 9 651 27.3 17 330 49.0 57.0 56.2 37.1 26.6 * Country-specific comments are in Annex 5 ** Includes all ages *** Ukraine reported HIV data through the aggregate reporting format and could therefore not present CD4 cell data by transmission mode Hetero: heterosexual contact; IDU: injecting drug use; MSM: men who have sex with men; MTCT: mother-to-child transmission. 52 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 15: AIDS cases and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of start of reporting 2004 2005 2006 2007 2008 N Rate N Rate N Rate N Rate N Rate EU/EEA West Austria 1982 106 1.3 117 1.4 118 1.4 129 1.6 110 1.3 West Belgium 1983 128 1.2 156 1.5 105 1.0 105 1.0 119 1.1 Centre Bulgaria 1987 22 0.3 19 0.2 16 0.2 21 0.3 29 0.4 Centre Croatia 1986 13 0.3 21 0.5 20 0.5 11 0.3 25 0.6 Centre Cyprus 1986 2 0.3 11 1.5 8 1.1 12 1.6 12 1.5 Centre Czech Republic 1986 13 0.1 13 0.1 18 0.2 23 0.2 29 0.3 West Denmark 1980 61 1.1 44 0.8 51 0.9 32 0.6 40 0.7 East Estonia 1992 29 2.1 29 2.1 32 2.4 57 4.2 61 4.6 West Finland 1983 20 0.4 26 0.5 26 0.5 33 0.6 27 0.5 West France 1980 1 416 2.3 1 369 2.2 1 177 1.9 1 012 1.6 1 057 1.7 West Germany 1981 745 0.9 724 0.9 715 0.9 645 0.8 575 0.7 West Greece 1981 88 0.8 102 0.9 89 0.8 90 0.8 105 0.9 Centre Hungary 1986 23 0.2 33 0.3 22 0.2 23 0.2 23 0.2 West Iceland 1985 3 1.0 1 0.3 3 1.0 0 0.0 2 0.6 West Ireland 1983 44 1.1 42 1.0 42 1.0 35 0.8 36 0.8 West Italy 1982 1 641 8.5 1 530 7.9 1 455 6.0 1 404 4.5 1 338 3.6 East Latvia 1990 89 3.9 119 5.3 90 4.0 81 3.7 103 4.7 East Lithuania 1988 21 0.6 10 0.3 27 0.8 28 0.9 54 1.7 West Luxembourg 1983 15 3.3 11 2.4 9 1.9 11 2.3 8 1.7 West Malta 1986 3 0.8 3 0.7 7 1.7 2 0.5 9 2.2 West Netherlands 1999 290 1.8 358 2.2 289 1.8 303 1.9 274 1.7 West Norway 1983 36 0.8 32 0.7 32 0.7 9 0.2 18 0.4 Centre Poland 1986 176 0.5 153 0.4 167 0.4 141 0.4 180 0.5 West Portugal 1983 927 9.0 913 8.8 803 7.8 693 6.7 697 6.7 Centre Romania 1985 366 1.7 348 1.6 289 1.4 288 1.4 281 1.4 Centre Slovakia 1985 2 0.0 3 0.1 4 0.1 6 0.1 1 0.0 Centre Slovenia 1986 10 0.5 10 0.5 5 0.2 9 0.4 11 0.5 West Spain 1981 2 083 4.9 1 868 4.3 1 747 4.0 1 632 3.6 1 536 3.4 West Sweden 1982 66 0.7 46 0.5 55 0.6 62 0.7 - - West United Kingdom 1981 1 017 1.7 976 1.6 885 1.5 841 1.4 825 1.3 Total EU/EEA 9 455 2.1 9 087 2.0 8 306 1.8 7 738 1.6 7 585 1.6 Non-EU/EEA Centre Albania 1993 11 0.4 7 0.2 8 0.3 18 0.6 28 0.9 West Andorra 2004 1 1.4 - 0.0 - 0.0 1 1.2 2 2.4 East Armenia 1988 23 0.7 39 1.2 46 1.4 59 1.8 83 2.6 East Azerbaijan 1995 22 0.3 20 0.2 21 0.2 200 2.3 76 0.9 East Belarus 1991 90 0.9 163 1.7 332 3.4 311 3.2 387 4.0 Centre Bosnia and Herzegovina 1986 5 0.1 6 0.2 4 0.1 4 0.1 5 0.1 Centre former Yugoslav Republic of Macedonia, the 1989 5 0.2 10 0.5 10 0.5 10 0.5 9 0.4 East Georgia 1989 112 2.6 140 3.2 162 3.7 183 4.2 232 5.3 West Israel 1981 72 1.1 122 1.8 142 2.1 98 1.4 106 1.5 East Kazakhstan 1993 74 0.5 100 0.7 132 0.9 175 1.1 174 1.1 East Kyrgyzstan 1999 14 0.3 23 0.5 29 0.6 24 0.5 36 0.7 East Moldova 1989 58 1.6 60 1.4 93 2.2 218 5.3 92 2.2 West Monaco 1985 0 0.0 1 3.0 0 0.0 0 0.0 0 0.0 Centre Montenegro 1990 1 0.2 1 0.2 3 0.5 3 0.5 5 0.8 East Russia*** - - - - - - - - - - West San Marino 1986 0 0.0 1 3.4 1 3.3 0 0.0 - 0.0 Centre Serbia**** 1985 58 0.8 54 0.7 52 0.7 42 0.6 40 0.5 West Switzerland 1980 219 3.0 191 2.6 159 2.1 174 2.3 159 2.1 East Tajikistan 1998 0 0.0 0 0.0 1 0.0 31 0.4 43 0.6 Centre Turkey 1985 55 0.1 32 0.0 30 0.0 30 0.0 55 0.1 East Turkmenistan 2002 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 1988 2 743 5.8 4 217 8.9 4 723 10.1 4 573 9.8 4 380 9.5 East Uzbekistan 1992 22 0.1 11 0.0 13 0.0 35 0.1 184 0.7 Total non-EU/EEA 3 585 1.6 5 198 2.3 5 961 2.6 6 189 2.7 6 096 2.6 Geographic area West 8 981 2.5 8 633 2.4 7 910 2.1 7 311 1.9 7 043 1.8 Centre 762 0.4 721 0.4 656 0.3 641 0.3 733 0.4 East 3 297 2.5 4 931 3.8 5 701 4.2 5 975 4.3 5 905 4.3 Total WHO European Region 13 040 1.9 14 285 2.1 14 267 2.0 13 927 2.0 13 681 1.9 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about AIDS cases were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 34 473 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 *** Excluding a cumulative 49 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 53 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2009 2010 2011 2012 2013 Cumulative total** Country*N Rate N Rate N Rate N Rate N Rate EU/EEA 102 1.2 94 1.1 66 0.8 32 0.4 70 0.8 3 866 Austria 121 1.1 102 0.9 86 0.8 90 0.8 78 0.7 4 435 Belgium 30 0.4 32 0.4 40 0.5 65 0.9 71 1.0 465 Bulgaria 22 0.5 21 0.5 26 0.6 28 0.7 17 0.4 418 Cyprus 8 1.0 10 1.2 5 0.6 7 0.8 3 0.3 248 Cyprus 23 0.2 26 0.2 24 0.2 29 0.3 26 0.2 400 Czech Republic 36 0.7 44 0.8 59 1.1 41 0.7 38 0.7 2 927 Denmark 38 2.8 26 2.0 38 2.9 36 2.7 24 1.8 414 Estonia 23 0.4 32 0.6 25 0.5 19 0.4 20 0.4 616 Finland 950 1.5 967 1.5 835 1.3 782 1.2 404 0.6 69 004 France 614 0.8 478 0.6 473 0.6 448 0.5 241 0.3 29 800 Germany 100 0.9 103 0.9 97 0.9 120 1.1 118 1.1 3 522 Greece 23 0.2 28 0.3 32 0.3 48 0.5 42 0.4 745 Hungary 0 0.0 1 0.3 2 0.6 1 0.3 1 0.3 67 Iceland 35 0.8 38 0.8 47 1.0 35 0.8 26 0.6 1 189 Ireland 1 205 2.1 1 143 1.9 1 049 1.8 1 061 1.8 1 016 1.7 66 336 Italy 101 4.7 132 6.2 112 5.4 142 6.9 133 6.6 1 353 Latvia 37 1.2 33 1.1 21 0.7 38 1.3 44 1.5 378 Lithuania 3 0.6 8 1.6 11 2.1 7 1.3 9 1.7 278 Luxembourg 1 0.2 6 1.4 5 1.2 6 1.4 1 0.2 103 Malta 269 1.6 286 1.7 227 1.4 248 1.5 199 1.2 4 107 Netherlands 18 0.4 22 0.5 19 0.4 25 0.5 28 0.6 1 069 Norway 130 0.3 173 0.5 184 0.5 157 0.4 160 0.4 3 082 Poland 569 5.5 653 6.3 576 5.6 525 5.0 322 3.1 19 075 Portugal 257 1.3 247 1.2 299 1.5 293 1.5 338 1.7 13 274 Romania 4 0.1 2 0.0 4 0.1 7 0.1 6 0.1 74 Slovakia 18 0.9 7 0.3 15 0.7 11 0.5 11 0.5 212 Slovenia 1 411 3.1 1 193 2.6 1 047 2.3 916 2.0 604 1.6 83 776 Spain - - - - - - - - - - 2 168 Sweden 650 1.1 659 1.1 417 0.7 424 0.7 319 0.5 28 224 United Kingdom 6 798 1.4 6 566 1.3 5 841 1.2 5 641 1.1 4 369 0.9 341 625 Total EU/EEA Non-EU/EEA 33 1.0 24 0.8 40 1.4 40 1.4 56 2.0 311 Albania 0.0 - 0.0 1 1.3 - 0.0 2 2.6 8 Andorra 84 2.6 94 2.9 87 2.7 133 4.1 143 4.4 834 Armenia 109 1.2 210 2.3 195 2.1 235 2.5 189 2.0 1 319 Azerbaijan 502 5.2 549 5.8 593 6.3 616 6.5 442 4.7 4 070 Belarus 2 0.1 6 0.2 7 0.2 4 0.1 7 0.2 127 Bosnia and Herzegovina 2 0.1 6 0.3 8 0.4 10 0.5 10 0.5 133 former Yugoslav Republic of Macedonia, the 284 6.5 339 7.7 395 8.9 359 8.1 303 6.8 2 664 Georgia 100 1.4 74 1.0 108 1.4 78 1.0 39 0.5 2 869 Israel 173 1.1 264 1.7 226 1.4 234 1.4 260 1.6 1 970 Kazakhstan 75 1.4 130 2.4 90 1.7 88 1.6 67 1.2 597 Kyrgyzstan 262 6.4 306 7.5 439 10.7 183 4.5 234 5.7 2 051 Moldova 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 49 Monaco 8 1.3 7 1.1 2 0.3 7 1.1 7 1.1 78 Montenegro - - - - - - - - - - 0 Russia - 0.0 - 0.0 1 3.1 2 6.0 0 0.0 23 San Marino 55 0.8 51 0.7 54 0.7 51 0.7 44 0.6 1 692 Serbia 149 1.9 161 2.1 123 1.6 84 1.1 71 0.9 9 534 Switzerland 11 0.1 75 1.0 94 1.2 90 1.1 91 1.1 437 Tajikistan 67 0.1 60 0.1 80 0.1 95 0.1 93 0.1 1 109 Turkey 0 0.0 0 0.0 0 0.0 0 0.0 - - 1 Turkmenistan 4 437 9.7 5 861 12.8 9 189 20.2 10 073 22.2 9 362 20.6 65 733 Ukraine 129 0.5 220 - - - - - - - 651 Uzbekistan 6 482 2.8 8 437 3.6 11 732 5.6 12 382 5.8 11 420 5.3 90 083 Total non-EU/EEA Geographic area 6 356 1.6 6 064 1.5 5 274 1.3 4 944 1.2 3 606 0.9 333 045 West 682 0.4 700 0.4 820 0.4 852 0.4 891 0.5 22 368 Centre 6 242 4.5 8 239 5.9 11 479 10.3 12 227 10.9 11 292 10.0 82 472 East 13 280 1.8 15 003 2.0 17 573 2.5 18 023 2.5 15 789 2.2 437 885 Total WHO European Region 54 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 15a: AIDS cases and rates per 100 000 population, by country and year of statistics (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* 2004 2005 2006 2007 2008 2009 N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA West Austria 106 1.3 117 1.4 118 1.4 129 1.6 110 1.3 102 1.2 West Belgium 128 1.2 156 1.5 105 1.0 105 1.0 119 1.1 121 1.1 Centre Bulgaria 22 0.3 19 0.2 16 0.2 21 0.3 29 0.4 30 0.4 Centre Croatia 14 0.3 21 0.5 21 0.5 12 0.3 24 0.6 20 0.5 Centre Cyprus 2 0.3 11 1.5 8 1.1 12 1.6 12 1.5 8 1.0 Centre Czech Republic 13 0.1 13 0.1 18 0.2 23 0.2 29 0.3 23 0.2 West Denmark 61 1.1 44 0.8 51 0.9 32 0.6 40 0.7 36 0.7 East Estonia 29 2.1 29 2.1 32 2.4 57 4.2 61 4.6 38 2.8 West Finland 20 0.4 26 0.5 26 0.5 33 0.6 27 0.5 23 0.4 West France 1 416 2.3 1 369 2.2 1 177 1.9 1 012 1.6 1 057 1.7 950 1.5 West Germany 745 0.9 724 0.9 715 0.9 645 0.8 575 0.7 614 0.8 West Greece 88 0.8 102 0.9 89 0.8 90 0.8 105 0.9 100 0.9 Centre Hungary 23 0.2 33 0.3 22 0.2 23 0.2 23 0.2 23 0.2 West Iceland 3 1.0 1 0.3 3 1.0 0 0.0 2 0.6 0 0.0 West Ireland 44 1.1 42 1.0 42 1.0 35 0.8 36 0.8 35 0.8 West Italy 1 641 8.5 1 530 7.9 1 455 6.0 1 404 4.5 1 338 3.6 1 205 2.1 East Latvia 89 3.9 119 5.3 90 4.0 81 3.7 103 4.7 101 4.7 East Lithuania 21 0.6 10 0.3 27 0.8 28 0.9 54 1.7 37 1.2 West Luxembourg 15 3.3 11 2.4 9 1.9 11 2.3 8 1.7 3 0.6 West Malta 2 0.5 4 1.0 7 1.7 2 0.5 9 2.2 1 0.2 West Netherlands 290 1.8 358 2.2 289 1.8 303 1.9 274 1.7 269 1.6 West Norway 36 0.8 32 0.7 32 0.7 9 0.2 18 0.4 18 0.4 Centre Poland 176 0.5 153 0.4 167 0.4 141 0.4 180 0.5 130 0.3 West Portugal 927 9.0 913 8.8 803 7.8 693 6.7 697 6.7 569 5.5 Centre Romania 366 1.7 348 1.6 289 1.4 288 1.4 281 1.4 257 1.3 Centre Slovakia 2 0.0 3 0.1 4 0.1 6 0.1 1 0.0 4 0.1 Centre Slovenia 10 0.5 10 0.5 5 0.2 9 0.4 11 0.5 18 0.9 West Spain 2 083 4.9 1 868 4.3 1 747 4.0 1 632 3.6 1 536 3.4 1 411 3.1 West Sweden 65 0.7 45 0.5 47 0.5 73 0.8 - - - - West United Kingdom 1 017 1.7 976 1.6 885 1.5 841 1.4 825 1.3 650 1.1 Total EU/EEA 9 454 2.1 9 087 2.0 8 299 1.8 7 750 1.6 7 584 1.6 6 796 1.4 Non-EU/EEA Centre Albania 11 0.4 6 0.2 8 0.3 17 0.5 24 0.8 32 1.0 West Andorra 3 4.1 0 0.0 0 0.0 1 1.2 1 1.2 0 0.0 East Armenia 21 0.7 41 1.3 46 1.4 59 1.8 83 2.6 84 2.6 East Azerbaijan 22 0.3 20 0.2 21 0.2 200 2.3 76 0.9 109 1.2 East Belarus 90 0.9 163 1.7 331 3.4 308 3.2 351 3.7 532 5.6 Centre Bosnia and Herzegovina 16 0.4 8 0.2 8 0.2 4 0.1 5 0.1 2 0.1 Centre former Yugoslav Republic of Macedonia, the 5 0.2 9 0.4 9 0.4 11 0.5 10 0.5 2 0.1 East Georgia 112 2.6 140 3.2 162 3.7 183 4.2 232 5.3 284 6.5 West Israel 72 1.1 122 1.8 142 2.1 98 1.4 106 1.5 100 1.4 East Kazakhstan 74 0.5 100 0.7 132 0.9 175 1.1 174 1.1 173 1.1 East Kyrgyzstan 14 0.3 23 0.5 27 0.5 22 0.4 36 0.7 77 1.5 East Moldova 53 1.5 64 1.5 94 2.3 214 5.2 82 2.0 276 6.7 West Monaco 0.0 1 3.0 0 0.0 0 0.0 0 0.0 0 0.0 Centre Montenegro 1 0.2 1 0.2 2 0.3 4 0.6 7 1.1 6 1.0 East Russia*** - - - - - - - - - - - - West San Marino 0 0.0 1 3.4 1 3.3 0 0.0 0 0.0 0 0.0 Centre Serbia**** 58 0.8 54 0.7 52 0.7 42 0.6 40 0.5 55 0.8 West Switzerland 219 3.0 191 2.6 159 2.1 174 2.3 159 2.1 149 1.9 East Tajikistan - - - - - - 32 0.5 43 0.6 11 0.1 Centre Turkey 47 0.1 37 0.1 35 0.0 29 0.0 55 0.1 67 0.1 East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 2 743 5.8 4 217 8.9 4 723 10.1 4 573 9.8 4 380 9.5 4 437 9.7 East Uzbekistan 22 0.1 11 0.0 13 0.0 35 0.1 184 0.7 129 0.5 Total non-EU/EEA 3 583 1.6 5 198 2.3 5 965 2.6 6 181 2.7 6 096 2.6 6 482 2.8 Geographic area West 8 981 2.5 8 633 2.4 7 902 2.1 7 322 1.9 7 043 1.8 6 356 1.6 Centre 766 0.4 726 0.4 664 0.4 642 0.3 733 0.4 682 0.4 East 3 290 2.5 4 931 3.8 5 698 4.4 5 967 4.3 5 905 4.3 6 242 4.5 Total WHO European Region 13 037 1.9 14 285 2.1 14 264 2.1 13 931 2.0 13 681 1.9 13 280 1.8 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about AIDS cases were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 34 473 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 49 cases from Kosovo, including 1 diagnosed in 2013 (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 2013SURVEILLANCE REPORT 2010 2011 2012 2013 Cumulative total** Country*N Rate N Rate N Rate N Rate EU/EEA 94 1.1 66 0.8 32 0.4 70 0.8 3 866 Austria 102 0.9 86 0.8 90 0.8 78 0.7 4 435 Belgium 32 0.4 40 0.5 65 0.9 71 1.0 465 Bulgaria 18 0.4 26 0.6 27 0.6 16 0.4 418 Cyprus 10 1.2 5 0.6 7 0.8 3 0.3 248 Cyprus 26 0.2 24 0.2 29 0.3 26 0.2 400 Czech Republic 44 0.8 59 1.1 41 0.7 38 0.7 2 927 Denmark 25 1.9 39 2.9 36 2.7 24 1.8 414 Estonia 32 0.6 25 0.5 19 0.4 20 0.4 616 Finland 967 1.5 835 1.3 782 1.2 404 0.6 69 004 France 478 0.6 473 0.6 448 0.5 241 0.3 29 800 Germany 103 0.9 97 0.9 120 1.1 118 1.1 3 522 Greece 28 0.3 32 0.3 48 0.5 42 0.4 745 Hungary 1 0.3 2 0.6 1 0.3 1 0.3 67 Iceland 38 0.8 47 1.0 35 0.8 26 0.6 1 189 Ireland 1 143 1.9 1 049 1.8 1 061 1.8 1 016 1.7 66 336 Italy 132 6.2 112 5.4 142 6.9 133 6.6 1 353 Latvia 33 1.1 21 0.7 38 1.3 44 1.5 378 Lithuania 8 1.6 11 2.1 7 1.3 9 1.7 278 Luxembourg 6 1.4 5 1.2 6 1.4 1 0.2 103 Malta 286 1.7 227 1.4 248 1.5 199 1.2 4 107 Netherlands 22 0.5 19 0.4 25 0.5 28 0.6 1 069 Norway 173 0.5 184 0.5 157 0.4 160 0.4 3 082 Poland 653 6.3 576 5.6 525 5.0 322 3.1 19 075 Portugal 247 1.2 299 1.5 293 1.5 338 1.7 13 274 Romania 2 0.0 4 0.1 7 0.1 6 0.1 74 Slovakia 7 0.3 15 0.7 11 0.5 11 0.5 212 Slovenia 1 193 2.6 1 047 2.3 916 2.0 604 1.6 83 776 Spain - - - - - - - - 2 168 Sweden 659 1.1 417 0.7 424 0.7 319 0.5 28 224 United Kingdom 6 562 1.3 5 842 1.2 5 640 1.1 4 368 0.9 341 625 Total EU/EEA Non-EU/EEA 25 0.8 38 1.3 46 1.6 61 2.2 311 Albania 0 0.0 1 1.3 0 0.0 2 2.6 8 Andorra 94 2.9 87 2.7 133 4.1 143 4.4 834 Armenia 210 2.3 195 2.1 235 2.5 189 2.0 1 319 Azerbaijan 475 5.0 590 6.3 598 6.3 547 5.8 4 070 Belarus 6 0.2 7 0.2 4 0.1 7 0.2 127 Bosnia and Herzegovina 8 0.4 6 0.3 9 0.4 11 0.5 133 former Yugoslav Republic of Macedonia, the 339 7.7 395 8.9 359 8.1 303 6.8 2 664 Georgia 74 1.0 108 1.4 78 1.0 39 0.5 2 869 Israel 256 1.6 234 1.5 234 1.4 260 1.6 1 970 Kazakhstan 120 2.2 95 1.8 95 1.7 67 1.2 597 Kyrgyzstan 290 7.1 420 10.3 222 5.4 234 5.7 2 051 Moldova 0 0.0 0 0.0 0 0.0 0 0.0 49 Monaco 7 1.1 2 0.3 7 1.1 7 1.1 78 Montenegro - - - - - - - - - Russia 0 0.0 1 3.1 2 6.0 0 0.0 23 San Marino 51 0.7 54 0.7 51 0.7 44 0.6 1 692 Serbia 161 2.1 123 1.6 84 1.1 71 0.9 9 534 Switzerland 75 1.0 93 1.2 87 1.1 94 1.1 437 Tajikistan 60 0.1 80 0.1 95 0.1 93 0.1 1 109 Turkey 0 0.0 0 0.0 0 0.0 - - 1 Turkmenistan 5 861 12.8 9 189 20.2 10 073 22.2 9 362 20.6 65 733 Ukraine 220 0.8 - - - - - - 651 Uzbekistan 8 437 3.5 11 718 5.6 12 412 5.8 11 534 5.4 90 083 Total non-EU/EEA Geographic area 6 064 1.5 5 274 1.3 4 944 1.2 3 606 0.9 333 045 West 700 0.4 816 0.4 856 0.5 896 0.5 22 368 Centre 8 239 5.8 11 470 10.3 12 252 10.9 11 400 10.1 82 472 East 15 003 2.0 17 560 2.5 18 052 2.5 15 902 2.2 437 885 Total WHO European Region 56 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 16: AIDS cases in males and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* 2004 2005 2006 2007 2008 2009 N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA West Austria 68 1.7 88 2.2 95 2.4 101 2.5 89 2.2 70 1.7 West Belgium 84 1.7 83 1.6 65 1.3 65 1.3 76 1.5 76 1.4 Centre Bulgaria 16 0.4 16 0.4 12 0.3 18 0.5 20 0.5 22 0.6 Centre Croatia 12 0.6 19 0.9 14 0.7 10 0.5 24 1.2 20 1.0 Centre Cyprus 1 0.3 6 1.7 7 1.9 8 2.2 10 2.6 8 2.1 Centre Czech Republic 11 0.2 8 0.2 13 0.3 18 0.4 22 0.4 17 0.3 West Denmark 41 1.5 30 1.1 31 1.2 22 0.8 33 1.2 25 0.9 East Estonia 18 2.8 15 2.4 22 3.5 46 7.4 44 7.1 26 4.2 West Finland 14 0.5 25 1.0 20 0.8 22 0.9 24 0.9 15 0.6 West France 951 3.2 922 3.0 813 2.7 691 2.2 716 2.3 673 2.2 West Germany 600 1.5 593 1.5 591 1.5 516 1.3 480 1.2 500 1.2 West Greece 73 1.3 78 1.4 64 1.2 69 1.3 93 1.7 80 1.5 Centre Hungary 19 0.4 29 0.6 15 0.3 17 0.4 21 0.4 17 0.4 West Iceland 2 1.4 1 0.7 2 1.3 0 0.0 2 1.2 0 0.0 West Ireland 29 1.4 28 1.4 34 1.6 18 0.8 27 1.2 27 1.2 West Italy 1 216 13.1 1 144 12.1 1 081 9.2 1 076 7.2 988 5.5 909 3.2 East Latvia 63 6.0 74 7.2 63 6.2 59 5.8 77 7.6 67 6.7 East Lithuania 17 1.1 7 0.4 22 1.4 26 1.7 45 3.0 28 1.9 West Luxembourg 10 4.5 6 2.6 6 2.6 8 3.4 5 2.1 2 0.8 West Malta 3 1.5 1 0.5 5 2.5 2 1.0 9 4.4 1 0.5 West Netherlands 225 2.8 271 3.4 229 2.8 233 2.9 221 2.7 228 2.8 West Norway 26 1.1 18 0.8 24 1.0 6 0.3 11 0.5 13 0.5 Centre Poland 132 0.7 119 0.6 130 0.7 108 0.6 139 0.8 99 0.5 West Portugal 740 14.8 722 14.4 595 11.9 527 10.5 520 10.4 416 8.3 Centre Romania 214 2.1 202 2.0 161 1.6 170 1.7 154 1.6 161 1.6 Centre Slovakia 1 0.0 2 0.1 4 0.2 4 0.2 0 0.0 3 0.1 Centre Slovenia 9 0.9 8 0.8 5 0.5 7 0.7 9 0.9 16 1.6 West Spain 1 600 7.6 1 442 6.7 1 351 6.2 1 275 5.8 1 168 5.2 1 080 4.8 West Sweden 46 1.0 35 0.8 33 0.7 40 0.9 - - - - West United Kingdom 597 2.1 618 2.1 528 1.8 555 1.9 510 1.7 442 1.5 Total EU/EEA 6 838 3.1 6 610 2.9 6 035 2.6 5 717 2.5 5 537 2.4 5 041 2.1 Non-EU/EEA Centre Albania 10 0.6 6 0.4 5 0.3 16 1.0 21 1.3 25 1.6 West Andorra 1 2.7 0 0.0 0 0.0 1 2.4 2 4.6 0 0.0 East Armenia 19 1.2 30 1.9 37 2.4 46 3.0 62 4.0 57 3.6 East Azerbaijan 22 0.5 16 0.4 19 0.5 169 4.0 68 1.6 90 2.1 East Belarus 61 1.3 114 2.5 221 4.9 210 4.6 254 5.6 309 6.9 Centre Bosnia and Herzegovina 4 0.2 4 0.2 3 0.2 4 0.2 4 0.2 2 0.1 Centre former Yugoslav Republic of Macedonia, the 3 0.3 8 0.8 9 0.9 9 0.9 5 0.5 2 0.2 East Georgia 88 4.3 105 5.1 129 6.2 138 6.7 179 8.6 208 10.0 West Israel 48 1.5 88 2.7 106 3.2 76 2.2 68 1.9 65 1.8 East Kazakhstan 57 0.8 78 1.1 88 1.2 110 1.5 124 1.7 111 1.5 East Kyrgyzstan 12 0.5 20 0.8 23 0.9 24 0.9 24 0.9 61 2.3 East Moldova 46 2.7 49 2.4 53 2.6 137 6.8 59 3.0 166 8.3 West Monaco 0 0.0 1 6.2 0 0.0 0 0.0 0 0.0 0 0.0 Centre Montenegro 1 0.3 1 0.3 3 1.0 3 1.0 3 1.0 6 1.9 East Russia - - - - - - - - - - - - West San Marino 0 0.0 1 6.9 1 6.8 0 0.0 0 0.0 0 0.0 Centre Serbia*** 47 1.3 46 1.3 40 1.1 27 0.8 30 0.8 47 1.3 West Switzerland 153 4.2 138 3.8 113 3.1 125 3.4 112 3.0 107 2.8 East Tajikistan - - - - 1 0.0 30 0.8 35 1.0 10 0.3 Centre Turkey 46 0.1 27 0.1 26 0.1 25 0.1 48 0.1 60 0.2 East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 1 823 8.3 2 986 13.8 3 392 15.8 3 208 15.1 3 060 14.4 3 019 14.3 East Uzbekistan 21 0.2 10 0.1 9 0.1 27 0.2 141 1.0 92 0.7 Total non-EU/EEA 2 462 2.2 3 728 3.2 4 278 3.7 4 285 3.7 4 299 3.7 4 437 3.8 Geographic area West 6 527 3.7 6 333 3.5 5 787 3.2 5 428 2.9 5 154 2.7 4 729 2.4 Centre 526 0.6 501 0.5 447 0.5 444 0.5 510 0.6 505 0.5 East 2 247 3.3 3 504 5.2 4 079 6.0 4 230 6.2 4 172 6.1 4 244 6.2 Total WHO European Region 9 300 2.8 10 338 3.0 10 313 3.0 10 102 2.9 9 836 2.8 9 478 2.6 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 32 cases from Kosovo (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 2013SURVEILLANCE REPORT 2010 2011 2012 2013 Cumulative total** Country*N Rate N Rate N Rate N Rate EU/EEA 73 1.8 47 1.1 24 0.6 51 1.2 2 982 Austria 59 1.1 54 1.0 54 1.0 56 1.0 3 021 Belgium 21 0.6 38 1.1 47 1.3 53 1.5 348 Bulgaria 20 1.0 25 1.2 26 1.3 14 0.7 367 Cyprus 7 1.8 2 0.5 6 1.4 2 0.5 193 Cyprus 20 0.4 16 0.3 23 0.4 21 0.4 326 Czech Republic 34 1.2 40 1.5 35 1.3 29 1.0 2 488 Denmark 21 3.4 31 5.0 25 4.0 18 2.9 306 Estonia 23 0.9 18 0.7 16 0.6 17 0.6 504 Finland 665 2.1 610 1.9 541 1.7 293 0.9 54 412 France 395 1.0 400 1.0 356 0.9 190 0.5 25 529 Germany 84 1.5 81 1.5 99 1.8 101 1.9 2 968 Greece 26 0.6 27 0.6 45 1.0 38 0.8 655 Hungary 1 0.6 1 0.6 1 0.6 1 0.6 58 Iceland 27 1.2 34 1.5 27 1.2 19 0.8 915 Ireland 843 2.9 798 2.8 776 2.7 763 2.6 51 154 Italy 86 8.9 80 8.4 102 10.9 90 9.7 950 Latvia 27 1.9 15 1.1 28 2.0 31 2.3 306 Lithuania 4 1.6 7 2.7 5 1.9 8 3.0 218 Luxembourg 4 1.9 3 1.5 5 2.4 1 0.5 89 Malta 226 2.8 178 2.2 194 2.3 164 2.0 3 220 Netherlands 20 0.8 17 0.7 23 0.9 19 0.7 835 Norway 132 0.7 142 0.8 120 0.6 130 0.7 2 429 Poland 460 9.2 429 8.6 376 7.5 230 4.6 15 224 Portugal 135 1.4 200 2.1 212 2.2 242 2.5 7 686 Romania 2 0.1 4 0.2 7 0.3 6 0.2 63 Slovakia 7 0.7 12 1.2 10 1.0 10 1.0 185 Slovenia 925 4.1 815 3.6 701 3.1 468 2.5 66 761 Spain - - - - - - - - 1 773 Sweden 433 1.4 286 0.9 293 0.9 232 0.7 22 150 United Kingdom 4 780 2.0 4 410 1.8 4 177 1.7 3 297 1.4 268 115 Total EU/EEA Non-EU/EEA 17 1.1 31 2.2 27 1.9 40 2.8 234 Albania 0 0.0 1 2.5 0 0.0 1 2.6 6 Andorra 73 4.6 65 4.1 95 6.0 99 6.2 621 Armenia 195 4.4 171 3.8 209 4.6 162 3.5 1 158 Azerbaijan 336 7.6 369 8.4 394 9.0 292 6.6 2 622 Belarus 6 0.3 4 0.2 4 0.2 6 0.3 102 Bosnia and Herzegovina 6 0.6 5 0.5 8 0.8 9 0.9 97 former Yugoslav Republic of Macedonia, the 245 11.7 277 13.1 248 11.7 219 10.3 1 977 Georgia 42 1.1 72 1.9 57 1.5 30 0.8 2 082 Israel 194 2.5 150 1.9 180 2.3 191 2.4 1 407 Kazakhstan 111 4.2 69 2.6 65 2.4 49 1.8 477 Kyrgyzstan 179 9.0 269 13.5 93 4.8 128 6.6 1 252 Moldova 0 0.0 0 0.0 0 0.0 0 0.0 38 Monaco 7 2.3 2 0.7 7 2.3 7 2.3 65 Montenegro - - - - - - - - - Russia 0 0.0 1 6.4 2 12.3 0 0.0 21 San Marino 44 1.2 47 1.3 45 1.3 38 1.1 1 279 Serbia 120 3.1 85 2.2 57 1.5 50 1.3 7 097 Switzerland 65 1.7 77 2.0 67 1.7 63 1.5 349 Tajikistan 46 0.1 65 0.2 83 0.2 74 0.2 927 Turkey 0 0.0 0 0.0 0 0.0 - - 0 Turkmenistan 3 988 19.0 6 141 29.2 6 498 31.0 6 013 28.7 38 305 Ukraine 163 1.2 - - - - - - 494 Uzbekistan 5 837 4.9 7 901 7.7 8 139 7.9 7 471 7.2 60 610 Total non-EU/EEA Geographic area 4 438 2.2 3 977 2.0 3 642 1.8 2 723 1.4 263 545 West 496 0.5 620 0.7 670 0.7 690 0.7 14 956 Centre 5 683 8.2 7 714 14.6 8 004 15.1 7 355 13.8 50 224 East 10 617 2.9 12 311 3.6 12 316 3.5 10 768 3.1 328 725 Total WHO European Region 58 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 17: AIDS cases in females and rates per 100 000 population, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* 2004 2005 2006 2007 2008 2009 N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA West Austria 38 0.9 29 0.7 23 0.5 28 0.7 21 0.5 32 0.7 West Belgium 44 0.8 73 1.4 40 0.7 40 0.7 43 0.8 45 0.8 Centre Bulgaria 6 0.1 3 0.1 4 0.1 3 0.1 9 0.2 8 0.2 Centre Croatia 1 0.0 2 0.1 6 0.3 1 0.0 1 0.0 2 0.1 Centre Cyprus 1 0.3 5 1.3 1 0.3 4 1.0 2 0.5 0.0 Centre Czech Republic 2 0.0 5 0.1 5 0.1 5 0.1 7 0.1 6 0.1 West Denmark 20 0.7 14 0.5 20 0.7 10 0.4 7 0.3 11 0.4 East Estonia 11 1.5 14 1.9 10 1.4 11 1.5 17 2.4 12 1.7 West Finland 6 0.2 1 0.0 6 0.2 11 0.4 3 0.1 8 0.3 West France 465 1.4 446 1.4 362 1.1 316 1.0 338 1.0 275 0.8 West Germany 145 0.3 131 0.3 124 0.3 129 0.3 95 0.2 114 0.3 West Greece 15 0.3 24 0.4 25 0.4 21 0.4 12 0.2 20 0.4 Centre Hungary 4 0.1 4 0.1 7 0.1 6 0.1 2 0.0 6 0.1 West Iceland 1 0.7 0 0.0 1 0.7 0 0.0 0 0.0 0 0.0 West Ireland 15 0.7 14 0.7 8 0.4 15 0.7 9 0.4 8 0.4 West Italy 425 4.3 386 3.8 374 3.0 328 2.1 350 1.8 296 1.0 East Latvia 26 2.1 45 3.7 27 2.2 22 1.8 26 2.2 34 2.9 East Lithuania 4 0.2 3 0.2 5 0.3 2 0.1 9 0.5 9 0.5 West Luxembourg 5 2.2 5 2.1 3 1.3 3 1.2 3 1.2 1 0.4 West Malta 0 0.0 2 1.0 2 1.0 0 0.0 0 0.0 0 0.0 West Netherlands 65 0.8 87 1.1 60 0.7 70 0.8 53 0.6 41 0.5 West Norway 10 0.4 14 0.6 8 0.3 3 0.1 7 0.3 5 0.2 Centre Poland 44 0.2 34 0.2 37 0.2 33 0.2 41 0.2 31 0.2 West Portugal 187 3.5 191 3.6 208 3.9 166 3.1 177 3.3 153 2.9 Centre Romania 152 1.4 146 1.3 128 1.2 118 1.1 127 1.2 96 0.9 Centre Slovakia 1 0.0 1 0.0 0 0.0 2 0.1 1 0.0 1 0.0 Centre Slovenia 1 0.1 2 0.2 0 0.0 2 0.2 2 0.2 2 0.2 West Spain 483 2.2 426 1.9 396 1.8 357 1.6 368 1.6 331 1.4 West Sweden 20 0.4 11 0.2 22 0.5 22 0.5 - - - - West United Kingdom 420 1.4 358 1.2 357 1.2 286 0.9 315 1.0 208 0.7 Total EU/EEA 2 617 1.1 2 476 1.1 2 269 1.0 2 014 0.8 2 045 0.8 1 755 0.7 Non-EU/EEA Centre Albania 1 0.1 1 0.1 3 0.2 2 0.1 7 0.4 8 0.5 West Andorra 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 East Armenia 4 0.2 9 0.5 9 0.5 13 0.8 21 1.3 27 1.6 East Azerbaijan 0 0.0 4 0.1 2 0.0 31 0.7 8 0.2 19 0.4 East Belarus 29 0.6 49 0.9 111 2.2 101 2.0 133 2.6 193 3.8 Centre Bosnia and Herzegovina 1 0.1 2 0.1 1 0.1 0 0.0 1 0.1 0 0.0 Centre former Yugoslav Republic of Macedonia, the 2 0.2 2 0.2 1 0.1 1 0.1 4 0.4 0 0.0 East Georgia 24 1.1 35 1.5 33 1.4 45 2.0 53 2.3 76 3.3 West Israel 24 0.7 34 1.0 36 1.1 22 0.6 38 1.1 35 1.0 East Kazakhstan 17 0.2 21 0.3 44 0.6 65 0.8 50 0.6 62 0.8 East Kyrgyzstan 2 0.1 3 0.1 6 0.2 0 0.0 9 0.3 14 0.5 East Moldova 12 0.6 11 0.5 40 1.9 81 3.8 33 1.5 96 4.6 West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 Centre Montenegro 0 0.0 0 0.0 0 0.0 0 0.0 2 0.6 2 0.6 East Russia - - - - - - - - - - - - West San Marino 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 Centre Serbia*** 11 0.3 8 0.2 12 0.3 15 0.4 8 0.2 10 0.3 West Switzerland 66 1.8 53 1.4 46 1.2 49 1.3 47 1.2 42 1.1 East Tajikistan - - - - - - 1 0.0 8 0.2 1 0.0 Centre Turkey 9 0.0 5 0.0 4 0.0 5 0.0 7 0.0 7 0.0 East Turkmenistan 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 East Ukraine 920 3.6 1 231 4.9 1 331 5.3 1 365 4.1 1 320 5.3 1 418 5.7 East Uzbekistan 1 0.0 1 0.0 4 0.0 8 0.1 43 0.3 37 0.3 Total non-EU/EEA 1 123 0.9 1 469 1.2 1 683 1.4 1 804 1.5 1 792 1.5 2 047 1.7 Geographic area West 2 454 1.3 2 299 1.2 2 121 1.1 1 876 1.0 1 886 1.0 1 625 0.8 Centre 236 0.3 220 0.2 209 0.2 197 0.2 221 0.2 179 0.2 East 1 050 1.4 1 426 1.9 1 622 2.2 1 745 2.4 1 730 2.3 1 998 2.7 Total WHO European Region 3 740 1.1 3 945 1.1 3 952 1.1 3 818 1.0 3 837 1.0 3 802 1.0 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 17 cases from Kosovo, including 1 diagnosed in 2013 (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 2013SURVEILLANCE REPORT 2010 2011 2012 2013 Cumulative total** Country*N Rate N Rate N Rate N Rate EU/EEA 21 0.5 19 0.4 8 0.2 19 0.4 884 Austria 43 0.8 32 0.6 36 0.6 22 0.4 1 412 Belgium 11 0.3 2 0.1 18 0.5 18 0.5 117 Bulgaria 1 0.0 1 0.0 2 0.1 3 0.1 51 Cyprus 3 0.7 3 0.7 1 0.2 1 0.2 55 Cyprus 6 0.1 8 0.1 6 0.1 5 0.1 74 Czech Republic 10 0.4 19 0.7 6 0.2 9 0.3 439 Denmark 5 0.7 7 1.0 11 1.6 6 0.9 108 Estonia 9 0.3 7 0.3 3 0.1 3 0.1 112 Finland 300 0.9 224 0.7 239 0.7 109 0.3 14 569 France 83 0.2 73 0.2 92 0.2 51 0.1 4 271 Germany 19 0.3 16 0.3 21 0.4 17 0.3 554 Greece 2 0.0 5 0.1 3 0.1 4 0.1 90 Hungary 0 0.0 1 0.6 0 0.0 0 0.0 9 Iceland 11 0.5 13 0.6 8 0.3 7 0.3 272 Ireland 300 1.0 251 0.8 285 0.9 253 0.8 15 182 Italy 46 4.0 32 2.8 40 3.6 43 3.9 403 Latvia 6 0.4 6 0.4 10 0.6 13 0.8 72 Lithuania 4 1.6 4 1.6 2 0.8 1 0.4 60 Luxembourg 2 1.0 2 1.0 1 0.5 0 0.0 14 Malta 60 0.7 49 0.6 54 0.6 35 0.4 887 Netherlands 2 0.1 2 0.1 2 0.1 9 0.4 234 Norway 41 0.2 42 0.2 37 0.2 30 0.2 653 Poland 193 3.6 147 2.7 149 2.7 92 1.7 3 850 Portugal 112 1.1 99 1.0 81 0.8 96 0.9 5 588 Romania 0 0.0 0 0.0 0 0.0 0 0.0 11 Slovakia 0 0.0 3 0.3 1 0.1 1 0.1 27 Slovenia 268 1.1 232 1.0 215 0.9 136 0.7 17 015 Spain - - - - - - - - 395 Sweden 226 0.7 131 0.4 131 0.4 87 0.3 6 074 United Kingdom 1 784 0.7 1 430 0.6 1 462 0.6 1 070 0.4 73 482 Total EU/EEA Non-EU/EEA 7 0.4 9 0.6 13 0.9 16 1.1 77 Albania 0 0.0 0 0.0 0 0.0 1 2.7 2 Andorra 21 1.3 22 1.3 38 2.3 44 2.6 213 Armenia 15 0.3 24 0.5 26 0.6 27 0.6 161 Azerbaijan 213 4.2 224 4.5 222 4.4 150 3.0 1 448 Belarus 0 0.0 3 0.2 0 0.0 1 0.1 23 Bosnia and Herzegovina 0 0.0 0 0.0 2 0.2 1 0.1 30 former Yugoslav Republic of Macedonia, the 94 4.1 118 5.1 111 4.8 84 3.6 687 Georgia 32 0.9 36 0.9 21 0.5 9 0.2 787 Israel 70 0.8 76 0.9 54 0.6 69 0.8 559 Kazakhstan 19 0.7 21 0.8 23 0.8 18 0.6 117 Kyrgyzstan 127 6.1 170 8.1 90 4.2 106 5.0 799 Moldova 0 0.0 0 0.0 0 0.0 0 0.0 11 Monaco 0 0.0 0 0.0 0 0.0 0 0.0 13 Montenegro - - - - - - - - 0 Russia 0 0.0 0 0.0 0 0.0 0 0.0 2 San Marino 7 0.2 7 0.2 6 0.2 6 0.2 413 Serbia 41 1.0 38 1.0 27 0.7 21 0.5 2 437 Switzerland 10 0.3 17 0.4 23 0.6 28 0.7 88 Tajikistan 14 0.0 15 0.0 12 0.0 19 0.1 182 Turkey 0 0.0 0 0.0 0 0.0 - - 1 Turkmenistan 1 823 7.6 3 048 12.4 3 575 14.6 3 349 13.7 9 972 Ukraine 57 0.4 - - - - - - 157 Uzbekistan 2 550 2.1 3 828 3.6 4 243 4.0 3 949 3.6 18 179 Total non-EU/EEA Geographic area 1 624 0.8 1 296 0.6 1 300 0.6 881 0.4 69 472 West 204 0.2 197 0.2 182 0.2 201 0.2 7 404 Centre 2 506 3.3 3 765 6.4 4 223 7.2 3 937 6.7 14 785 East 4 334 1.1 5 258 1.5 5 705 1.6 5 019 1.4 91 661 Total WHO European Region 60 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 18: AIDS cases in men infected through sex with men, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of diagnosis Cumulative total**2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 24 28 33 39 28 28 25 21 9 22 1 271 West Belgium 27 40 25 25 22 34 31 29 22 20 1 412 Centre Bulgaria 1 7 4 4 4 4 5 2 8 12 67 Centre Croatia 2 3 11 6 12 17 19 18 22 11 220 Centre Cyprus 0 2 2 4 4 4 4 0 1 2 103 Centre Czech Republic 5 6 3 8 7 10 10 10 11 12 192 West Denmark 19 18 17 13 16 12 15 13 13 11 1 724 East Estonia 2 1 1 0 1 0 0 0 1 0 26 West Finland 6 10 8 13 10 6 7 6 2 4 286 West France 311 336 292 243 256 261 247 231 178 118 27 728 West Germany 372 339 338 309 266 275 239 208 195 102 17 580 West Greece 44 49 37 42 56 49 63 50 48 39 1 935 Centre Hungary 15 19 10 12 16 13 23 24 37 30 514 West Iceland 2 0 2 0 1 0 0 0 0 0 43 West Ireland 5 6 8 7 8 10 13 17 14 6 368 West Italy 310 314 309 315 299 294 251 265 261 282 11 323 East Latvia 5 4 3 3 3 7 10 7 4 10 100 East Lithuania 7 0 1 2 7 1 0 2 2 5 68 West Luxembourg 6 2 2 2 0 1 2 5 3 6 122 West Malta 0 1 3 0 1 0 0 1 0 1 41 West Netherlands 119 150 127 137 130 134 129 109 119 103 1 819 West Norway 10 11 11 2 6 7 9 9 10 15 486 Centre Poland 23 23 14 19 27 26 29 45 25 44 588 West Portugal 73 78 72 61 86 56 75 83 73 41 2 397 Centre Romania 3 8 8 6 11 20 15 18 11 17 201 Centre Slovakia 1 1 3 2 0 1 1 3 3 2 41 Centre Slovenia 4 5 3 6 7 10 7 7 7 5 115 West Spain 345 291 302 298 320 312 333 309 288 195 12 560 West Sweden 16 8 9 17 - - - - - - 1 085 West United Kingdom 235 248 243 251 227 188 200 146 152 105 14 766 Total EU/EEA 1 992 2 008 1 901 1 846 1 831 1 780 1 762 1 638 1 519 1 220 99 181 Non-EU/EEA Centre Albania 1 0 0 0 8 7 2 2 2 4 31 West Andorra 0 0 0 1 1 0 0 1 0 1 4 East Armenia 0 1 0 1 3 0 1 2 2 5 15 East Azerbaijan 0 0 0 2 1 1 4 1 1 3 14 East Belarus 0 0 0 0 0 0 2 6 3 3 17 Centre Bosnia and Herzegovina 0 1 0 0 0 0 5 2 4 3 28 Centre former Yugoslav Republic of Macedonia, the 0 3 2 2 2 1 1 4 3 3 32 East Georgia 5 5 3 3 7 3 10 11 11 16 83 West Israel 8 24 18 10 10 14 12 16 8 7 583 East Kazakhstan 0 0 0 0 1 0 0 1 0 1 3 East Kyrgyzstan 0 0 0 1 0 0 0 0 0 0 1 East Moldova 1 0 0 2 0 2 2 2 0 0 10 West Monaco 0 1 0 0 0 0 0 0 0 0 21 Centre Montenegro 1 0 2 2 2 4 5 2 1 3 31 East Russia - - - - - - - - - - - West San Marino 0 1 0 0 0 0 0 1 2 0 11 Centre Serbia*** 8 16 14 12 15 25 21 22 28 20 357 West Switzerland 57 48 43 62 48 41 60 34 28 22 3 214 East Tajikistan - - - - - - - - - - 0 Centre Turkey 2 4 4 5 11 2 3 - - 12 93 East Turkmenistan 0 0 0 0 0 0 0 0 0 - 0 East Ukraine 3 8 8 9 10 10 10 31 45 50 189 East Uzbekistan - - - - - - - - - - 1 Total non-EU/EEA 86 112 94 112 119 110 138 138 138 153 4 738 Geographical area West 1 989 2 003 1 899 1 847 1 791 1 722 1 711 1 554 1 425 1 100 100 779 Centre 66 98 80 88 126 144 150 159 163 180 2 613 East 23 19 16 23 33 24 39 63 69 93 527 Total WHO European Region 2 078 2 120 1 995 1 958 1 950 1 890 1 900 1 776 1 657 1 373 103 919 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 2 cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 61 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Table 19: AIDS cases in persons infected through injecting drug use, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of diagnosis Cumulative total**2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 18 22 21 26 27 16 11 11 6 14 937 West Belgium 8 9 7 3 8 5 3 4 1 2 282 Centre Bulgaria 1 1 0 1 4 7 10 17 39 29 109 Centre Croatia 2 1 1 1 0 0 1 1 1 0 25 Centre Cyprus 0 0 0 0 0 0 0 0 0 0 3 Centre Czech Republic 3 0 4 3 5 2 4 1 2 2 31 West Denmark 4 4 3 3 6 3 4 4 4 5 253 East Estonia 18 16 23 45 41 26 14 20 15 9 235 West Finland 5 7 1 8 1 2 3 0 4 2 55 West France 172 129 104 87 85 56 60 55 41 27 13 757 West Germany 79 60 81 62 50 47 32 36 36 16 4 245 West Greece 2 5 5 3 3 5 3 8 22 37 192 Centre Hungary 0 2 0 1 0 0 0 0 0 0 6 West Iceland 0 0 0 0 0 0 0 0 0 0 5 West Ireland 7 9 9 10 11 8 6 10 2 1 373 West Italy 540 445 399 383 317 275 228 191 177 172 34 636 East Latvia 64 71 51 45 60 49 70 57 70 62 762 East Lithuania 5 7 17 21 35 20 20 9 21 19 179 West Luxembourg 1 3 0 2 0 0 0 1 0 0 39 West Malta 1 0 2 0 0 0 0 0 0 0 3 West Netherlands 12 26 10 13 7 9 6 7 4 3 164 West Norway 4 4 4 0 2 1 3 0 1 1 155 Centre Poland 84 79 90 77 74 55 70 62 58 45 1 465 West Portugal 374 393 297 224 203 155 174 136 121 74 8 351 Centre Romania 2 2 3 5 1 6 9 37 79 102 250 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 1 Centre Slovenia 1 0 1 0 0 0 0 0 0 0 9 West Spain 970 846 747 668 535 449 331 287 219 136 49 562 West Sweden 9 4 3 6 - - - - - - 242 West United Kingdom 35 33 25 30 27 19 27 14 11 10 1 488 Total EU/EEA 2 421 2 178 1 908 1 727 1 502 1 215 1 089 968 934 768 117 814 Non-EU/EEA Centre Albania 0 0 0 0 0 0 0 0 0 0 0 West Andorra 1 0 0 0 1 0 0 0 0 0 2 East Armenia 18 25 28 25 30 33 42 33 42 22 325 East Azerbaijan 19 12 13 131 50 69 160 148 159 122 909 East Belarus 52 97 217 200 209 252 238 270 250 143 1 973 Centre Bosnia and Herzegovina 1 1 1 1 0 0 0 0 0 0 18 Centre former Yugoslav Republic of Macedonia, the - 1 2 1 0 0 0 0 0 0 9 East Georgia 76 79 105 103 134 170 186 191 160 141 1 457 West Israel 8 8 28 18 24 14 6 14 15 14 430 East Kazakhstan - - 102 95 118 104 185 132 151 156 1 043 East Kyrgyzstan 11 17 19 20 27 53 102 58 55 38 417 East Moldova 43 42 45 101 55 103 95 101 17 22 695 West Monaco 0 0 0 0 0 0 0 0 0 0 19 Centre Montenegro 0 0 0 0 0 0 0 0 1 0 2 East Russia - - - - - - - - - - - West San Marino 0 0 0 0 0 0 0 0 0 0 6 Centre Serbia*** 18 11 9 14 5 13 8 12 7 8 652 West Switzerland 32 41 29 20 19 13 11 17 5 4 3 274 East Tajikistan - - - 15 27 7 43 35 32 23 183 Centre Turkey 1 1 1 2 1 4 2 2 1 1 59 East Turkmenistan 0 0 0 0 0 0 0 0 0 - 0 East Ukraine 2 018 3 041 3 360 3 086 2 868 2 732 3 660 4 979 4 933 4 273 38 097 East Uzbekistan 12 3 9 20 116 70 131 - - - 380 Total non-EU/EEA 2 310 3 379 3 968 3 852 3 684 3 637 4 869 5 992 5 828 4 967 49 950 Geographical area West 2 282 2 048 1 775 1 566 1 326 1 077 908 795 669 518 118 470 Centre 113 99 112 106 90 87 104 132 188 187 2 639 East 2 336 3 410 3 989 3 907 3 770 3 688 4 946 6 033 5 905 5 030 46 655 Total WHO European Region 4 731 5 557 5 876 5 579 5 186 4 852 5 958 6 960 6 762 5 735 167 764 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** There are no cumulative cases from Kosovo (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 2013 Table 20: AIDS cases in persons infected through heterosexual contact, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of diagnosis Cumulative total**2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 49 45 47 42 38 45 37 22 11 27 943 West Belgium 84 95 63 66 75 73 64 49 65 43 2 303 Centre Bulgaria 20 11 12 16 15 19 14 20 15 20 257 Centre Croatia 7 14 8 4 10 4 1 6 4 6 146 Centre Cyprus 2 7 6 6 7 4 5 5 4 1 123 Centre Czech Republic 5 7 9 11 14 11 12 12 12 10 144 West Denmark 36 22 29 16 16 18 23 40 22 21 765 East Estonia 5 10 8 10 17 10 7 9 16 9 116 West Finland 9 8 15 11 11 12 12 15 10 12 213 West France 757 723 605 543 589 507 520 432 467 204 19 339 West Germany 188 198 192 174 147 152 114 143 124 68 3 846 West Greece 34 44 41 35 42 34 31 33 38 22 912 Centre Hungary 4 8 11 5 5 8 4 7 6 10 140 West Iceland 1 1 1 0 0 0 1 2 1 0 15 West Ireland 27 25 22 14 13 15 12 17 19 16 326 West Italy 655 660 626 614 604 525 558 500 506 477 16 074 East Latvia 13 31 21 22 25 32 36 34 55 37 346 East Lithuania 6 3 3 4 6 15 11 9 13 15 101 West Luxembourg 8 5 7 7 8 1 6 5 4 2 100 West Malta 1 2 2 2 5 1 6 3 5 0 35 West Netherlands 115 142 109 111 103 105 119 84 95 61 1 610 West Norway 20 16 16 7 10 10 10 9 12 11 370 Centre Poland 39 34 33 29 34 24 52 44 36 30 586 West Portugal 462 420 420 397 389 339 387 348 318 195 7 597 Centre Romania 120 130 113 120 123 124 113 140 125 125 2 349 Centre Slovakia 1 2 1 3 1 1 1 1 3 4 27 Centre Slovenia 3 2 0 2 2 0 0 3 2 3 42 West Spain 595 578 533 488 532 489 392 338 311 202 15 059 West Sweden 37 23 36 30 - - - - - - 665 West United Kingdom 691 642 562 507 515 385 374 244 244 183 9 856 Total EU/EEA 3 994 3 908 3 551 3 296 3 356 2 963 2 922 2 574 2 543 1 814 84 405 Non-EU/EEA Centre Albania 10 7 8 13 20 25 20 37 38 49 267 West Andorra 0 0 0 0 0 0 0 0 0 1 2 East Armenia 5 9 17 32 46 45 41 50 83 103 445 East Azerbaijan 2 8 6 55 14 34 38 44 68 57 341 East Belarus 29 51 103 100 160 240 289 305 358 289 1 945 Centre Bosnia and Herzegovina 4 4 3 3 5 2 1 4 0 3 68 Centre former Yugoslav Republic of Macedonia, the 5 6 6 4 4 1 3 3 6 6 74 East Georgia 27 41 53 61 76 102 132 181 184 139 1 024 West Israel 52 82 84 66 68 66 52 74 53 17 1 570 East Kazakhstan 0 0 19 33 38 55 70 81 76 87 459 East Kyrgyzstan 2 5 8 6 17 24 26 27 24 143 East Moldova 11 15 43 108 31 101 146 321 118 139 1 060 West Monaco 0 0 0 0 0 0 0 0 0 0 6 Centre Montenegro - 1 1 1 3 4 2 0 4 1 37 East Russia - - - - - - - - - - - West San Marino 0 0 0 0 0 0 0 0 0 0 5 Centre Serbia*** 14 13 13 7 11 12 11 12 7 6 346 West Switzerland 122 94 84 84 71 75 82 65 46 39 2 565 East Tajikistan - - - 10 13 1 26 44 21 44 159 Centre Turkey 40 16 15 20 32 28 26 36 35 39 531 East Turkmenistan 0 0 0 0 0 0 0 0 0 - 0 East Ukraine 628 941 1 089 1 265 1 342 1 509 2 264 3 944 4 873 4 875 25 169 East Uzbekistan 2 - 2 6 51 40 68 0 - - 183 Total non-EU/EEA 953 1 293 1 554 1 868 1 991 2 357 3 295 5 227 5 997 5 918 36 399 Geographical area West 3 943 3 825 3 494 3 214 3 236 2 852 2 800 2 423 2 351 1 601 84 176 Centre 274 262 239 244 286 267 265 330 297 313 5 137 East 730 1 114 1 372 1 706 1 825 2 201 3 152 5 048 5 892 5 818 31 491 Total WHO European Region 4 947 5 201 5 105 5 164 5 347 5 320 6 217 7 801 8 540 7 732 120 804 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** Excluding a cumulative 46 cases from Kosovo, including 1 diagnosed in 2013 (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 63 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Table 21: AIDS cases in persons infected through mother-to-child transmission, by country and year of diagnosis (2004–2013) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country* Year of diagnosis Cumulative total**2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 0 1 0 1 0 2 0 1 0 0 47 West Belgium 1 0 1 4 4 1 0 0 0 0 122 Centre Bulgaria 0 0 0 0 0 0 2 1 0 3 7 Centre Croatia 0 0 0 0 0 0 0 1 0 0 4 Centre Cyprus 0 1 0 0 0 0 0 0 0 0 2 Centre Czech Republic 0 0 0 0 0 0 0 0 0 0 0 West Denmark 0 0 2 0 0 0 1 0 0 1 25 East Estonia 1 0 0 0 0 0 0 0 0 0 2 West Finland 0 0 0 1 0 0 0 0 0 0 6 West France 10 10 6 8 9 10 5 8 11 5 772 West Germany 2 3 1 2 0 0 1 2 2 1 116 West Greece 2 0 1 0 0 0 1 0 0 0 24 Centre Hungary 0 1 0 0 0 1 0 0 1 0 4 West Iceland 0 0 0 0 0 0 0 0 0 0 0 West Ireland 1 0 0 1 3 1 1 0 0 1 36 West Italy 4 4 9 2 2 5 3 3 4 6 735 East Latvia 1 1 2 0 5 1 0 2 1 2 18 East Lithuania 0 0 0 0 0 0 0 0 0 1 1 West Luxembourg 0 0 0 0 0 0 0 0 0 0 3 West Malta 0 0 0 0 0 0 0 0 0 0 1 West Netherlands 2 1 2 5 1 2 5 2 1 2 44 West Norway 0 0 0 0 0 0 0 0 0 1 7 Centre Poland 7 3 4 1 5 7 1 3 1 0 67 West Portugal 3 5 3 3 4 3 1 1 1 3 117 Centre Romania 8 8 8 3 8 12 11 10 8 7 438 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 0 Centre Slovenia 0 0 0 0 0 0 0 0 0 0 2 West Spain 6 9 7 10 8 8 3 3 3 1 970 West Sweden 1 1 1 2 - - - - - - 22 West United Kingdom 35 30 25 26 21 19 9 3 1 1 686 Total EU/EEA 84 78 72 69 70 72 44 40 34 35 4 278 Non-EU/EEA Centre Albania 0 0 0 0 0 1 0 1 0 3 6 West Andorra 0 0 0 0 0 0 0 0 0 0 0 East Armenia 0 2 1 1 0 2 1 1 0 4 13 East Azerbaijan 0 0 0 2 0 2 1 1 3 3 12 East Belarus 8 13 10 7 14 8 13 12 4 3 97 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 0 0 Centre former Yugoslav Republic of Macedonia, the 0 0 0 1 0 0 1 0 1 1 6 East Georgia 2 6 1 13 10 4 11 8 1 3 61 West Israel 2 4 4 2 2 2 2 2 0 1 75 East Kazakhstan 0 0 1 5 4 5 2 5 2 6 30 East Kyrgyzstan 0 0 1 0 2 0 0 3 4 1 11 East Moldova 1 1 4 7 6 1 3 3 1 9 41 West Monaco 0 0 0 0 0 0 0 0 0 0 0 Centre Montenegro 0 0 0 0 0 0 0 0 0 0 1 East Russia - - - - - - - - - - - West San Marino 0 0 0 0 0 0 0 0 0 0 0 Centre Serbia*** 1 1 1 1 2 1 1 0 0 1 26 West Switzerland 0 0 0 1 0 1 2 0 1 1 108 East Tajikistan 0 0 0 0 0 2 0 0 1 11 14 Centre Turkey 0 1 0 0 0 2 0 0 1 0 12 East Turkmenistan 0 0 0 0 0 0 0 0 0 - 0 East Ukraine 94 139 122 110 73 86 129 118 88 59 1 217 East Uzbekistan 0 0 2 3 6 3 8 - - - 22 Total non-EU/EEA 108 167 147 153 119 120 174 154 107 106 1 752 Geographical area West 69 68 62 68 54 54 34 25 24 24 3 916 Centre 16 15 13 6 15 24 16 16 12 15 575 East 107 162 144 148 120 114 168 153 105 102 1 539 Total WHO European Region 192 245 219 222 189 192 218 194 141 141 6 030 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** There are no cumulative cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 64 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 22: AIDS cases*, by geographical area, sex, transmission mode and year of diagnosis (2004–2013) and cumulative totals Table22a: EU/EEA and non-EU/EEA countries Transmission mode 2004 2005 2006 2007 Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown EU/EEA Men who have sex with men - 1 976 0 - 1 999 1 - 1 890 2 - 1 823 6 Injecting drug use 506 1 906 0 423 1 751 0 379 1 526 0 349 1 372 0 Heterosexual contact 1 773 2 184 0 1 738 2 147 0 1 587 1 928 0 1 390 1 875 1 Mother-to-child 50 33 0 43 34 0 31 40 0 31 36 0 Haemophiliac/transfusion recipient 26 40 0 19 43 0 19 28 0 10 14 0 Nosocomial infection 4 14 0 6 8 0 4 5 0 2 3 0 Other/undetermined 238 639 0 236 593 0 227 585 0 210 554 0 Total EU/EEA 2 597 6 792 0 2 465 6 575 1 2 247 6 002 2 1 992 5 677 7 Non-EU/EEA Men who have sex with men - 83 0 - 104 0 - 86 0 - 103 0 Injecting drug use 40 240 0 45 290 0 108 491 0 118 628 0 Heterosexual contact 130 193 0 145 207 0 218 245 0 266 331 0 Mother-to-child 6 8 0 12 16 0 8 15 0 18 22 0 Haemophiliac/transfusion recipient 3 3 0 2 6 0 1 3 0 1 3 0 Nosocomial infection 0 1 0 1 0 0 1 0 0 12 14 0 Other/undetermined 23 90 0 32 109 1 12 37 0 16 49 0 Total non-EU/EEA 202 618 0 237 732 1 348 877 0 431 1 150 0 Total WHO European Region 2 799 7 410 0 2 702 7 307 2 2 595 6 879 2 2 423 6 827 7 Transmission mode 2012 2013 Cumulative total** Female Male Unknown Female Male Unknown Female Male Unknown Total EU/EEA Men who have sex with men - 1 517 2 - 1 218 2 0 98 073 23 98 096 Injecting drug use 187 747 0 168 600 0 24 281 93 290 1 117 572 Heterosexual contact 1 114 1 429 0 749 1 065 0 36 364 47 373 3 83 740 Mother-to-child 19 15 0 21 14 0 2 096 2 160 0 4 256 Haemophiliac/transfusion recipient 6 8 0 2 4 0 2 742 6 542 0 9 284 Nosocomial infection 2 0 0 1 0 0 2 374 3 195 0 5 569 Other/undetermined 134 461 0 129 396 0 5 230 15 709 1 20 940 Total EU/EEA 1 462 4 177 2 1 070 3 297 2 73 087 266 342 28 339 457 Non-EU/EEA Men who have sex with men - 93 0 - 103 0 0 4 541 2 4 543 Injecting drug use 69 826 0 59 635 0 2 144 9 325 3 11 472 Heterosexual contact 540 584 0 461 582 0 5 084 5 962 2 11 048 Mother-to-child 11 8 0 20 27 0 244 268 1 513 Haemophiliac/transfusion recipient 1 9 0 1 2 0 112 336 0 448 Nosocomial infection 1 1 0 3 1 0 25 29 0 54 Other/undetermined 46 120 0 56 108 0 441 1 348 7 1 796 Total non-EU/EEA 668 1 641 0 600 1 458 0 8 050 21 809 15 29 874 Total WHO European Region 2 130 5 818 2 1 670 4 755 2 81 137 288 151 43 369 331 * Cases from Russia, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 15–21. ** Cumulative total is the total number of cases reported by country since the start of reporting 65 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 Transmission mode Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown EU/EEA - 1 828 3 - 1 779 1 - 1 760 2 - 1 637 1 Men who have sex with men 322 1 180 0 240 975 0 229 860 0 174 794 0 Injecting drug use 1 459 1 897 0 1 259 1 704 0 1 320 1 602 0 1 072 1 502 0 Heterosexual contact 32 38 0 37 35 0 33 11 0 21 19 0 Mother-to-child 13 23 0 12 15 0 4 15 0 5 2 0 Haemophiliac/transfusion recipient 3 5 0 3 3 0 5 3 0 1 1 0 Nosocomial infection 216 566 0 204 530 1 193 529 0 157 455 0 Other/undetermined 2 045 5 537 3 1 755 5 041 2 1 784 4 780 2 1 430 4 410 1 Total EU/EEA Non-EU/EEA - 109 0 - 100 0 - 128 0 - 105 2 Men who have sex with men 91 606 3 117 718 0 124 954 0 118 895 0 Injecting drug use 289 309 0 419 389 0 478 485 0 622 660 1 Heterosexual contact 19 21 0 16 15 0 18 19 0 13 23 0 Mother-to-child 0 1 0 6 3 0 2 1 0 0 9 0 Haemophiliac/transfusion recipient 2 1 0 2 3 0 1 4 0 1 2 0 Nosocomial infection 28 51 0 32 97 0 47 94 0 26 66 0 Other/undetermined 429 1 098 3 592 1 325 0 670 1 685 0 780 1 760 3 Total non-EU/EEA 2 474 6 635 6 2 347 6 366 2 2 454 6 465 2 2 210 6 170 4 Total WHO European Region 66 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 22: AIDS cases*, by geographical area, sex, transmission mode and year of diagnosis (2004–2013) and cumulative totals Table 22b: Geographical areas, WHO European Region Transmission mode 2004 2005 2006 2007 Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown West Men who have sex with men - 1 973 0 - 1 994 1 - 1 888 2 - 1 824 6 Injecting drug use 473 1 800 0 384 1 660 0 356 1 416 0 318 1 242 0 Heterosexual contact 1 770 2 136 0 1 703 2 099 0 1 558 1 900 0 1 367 1 816 1 Mother-to-child 38 30 0 36 31 0 27 34 0 29 37 0 Haemophiliac/transfusion recipient 18 26 0 9 34 0 11 22 0 9 12 0 Nosocomial infection 1 4 0 2 1 0 3 5 0 2 3 0 Other/undetermined 134 512 0 154 479 0 144 489 0 129 454 0 Total West 2 434 6 481 0 2 288 6 298 1 2 099 5 754 2 1 854 5 388 7 Centre Men who have sex with men - 66 0 - 98 0 - 80 0 - 88 0 Injecting drug use 25 88 0 20 79 0 17 95 0 28 78 0 Heterosexual contact 83 191 0 89 173 0 95 144 0 84 160 0 Mother-to-child 11 5 0 9 6 0 4 9 0 4 2 0 Haemophiliac/transfusion recipient 11 16 0 10 12 0 8 9 0 1 4 0 Nosocomial infection 3 10 0 4 7 0 1 0 1 0 0 Other/undetermined 103 150 0 88 126 0 84 110 0 79 112 0 Total Centre 236 526 0 220 501 0 209 447 0 197 444 0 East Men who have sex with men - 20 0 - 11 0 - 8 0 - 14 0 Injecting drug use 48 258 0 64 302 0 114 506 0 121 680 0 Heterosexual contact 50 50 0 91 82 0 152 129 0 205 230 0 Mother-to-child 7 6 0 10 13 0 8 12 0 16 19 0 Haemophiliac/transfusion recipient 0 1 0 2 3 0 1 0 0 1 1 0 Nosocomial infection 0 1 0 1 0 0 1 0 0 11 14 0 Other/undetermined 24 67 0 26 97 1 11 23 0 18 37 0 Total East 129 403 0 194 508 1 287 678 0 372 995 0 Total WHO European Region 2 799 7 410 0 2 702 7 307 2 2 595 6 879 2 2 423 6 827 7 Transmission mode 2012 2013 Cumulative total** Female Male Unknown Female Male Unknown Female Male Unknown Total West Men who have sex with men - 1 423 2 - 1 098 2 0 99 671 23 99 694 Injecting drug use 137 532 0 119 399 0 24 789 93 438 1 118 228 Heterosexual contact 1 039 1 312 0 671 930 0 36 464 47 044 3 83 511 Mother-to-child 13 11 0 15 9 0 1 958 1 936 0 3 894 Haemophiliac/transfusion recipient 6 8 0 2 4 0 1 978 5 547 0 7 525 Nosocomial infection 1 0 0 1 0 0 51 54 0 105 Other/undetermined 104 356 0 73 283 0 3 837 14 082 1 17 920 Total West 1 300 3 642 2 881 2 723 2 69 077 261 772 28 330 877 Centre Men who have sex with men - 163 0 - 180 0 0 2 606 2 2 608 Injecting drug use 40 148 0 35 152 0 566 2 072 0 2 638 Heterosexual contact 98 199 0 102 211 0 1 896 3 240 2 5 138 Mother-to-child 8 4 0 8 7 0 245 329 1 575 Haemophiliac/transfusion recipient 0 9 0 0 1 0 868 1 318 0 2 186 Nosocomial infection 1 0 0 0 0 0 2 324 3 143 0 5 467 Other/undetermined 35 147 0 56 139 0 1 505 2 246 3 3 754 Total Centre 182 670 0 201 690 0 7 404 14 954 8 22 366 East Men who have sex with men - 24 0 - 43 0 0 337 0 337 Injecting drug use 79 893 0 73 684 0 1 070 7 105 3 8 178 Heterosexual contact 517 502 0 437 506 0 3 088 3 051 0 6 139 Mother-to-child 9 8 0 18 25 0 137 163 0 300 Haemophiliac/transfusion recipient 1 0 0 1 1 0 8 13 0 21 Nosocomial infection 1 1 0 3 1 0 24 27 0 51 Other/undetermined 41 78 0 56 82 0 329 729 4 1 062 Total East 648 1 506 0 588 1 342 0 4 656 11 425 7 16 088 Total WHO European Region 2 130 5 818 2 1 670 4 755 2 81 137 288 151 43 369 331 * Cases from Russia, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 15–21. ** Cumulative total is the total number of cases reported by country since the start of reporting 67 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 Transmission mode Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown West - 1 788 3 - 1 721 1 - 1 709 2 - 1 553 1 Men who have sex with men 285 1 041 0 218 859 0 192 716 0 143 652 0 Injecting drug use 1 419 1 817 0 1 216 1 636 0 1 275 1 525 0 1 030 1 393 0 Heterosexual contact 25 29 0 25 29 0 23 11 0 16 9 0 Mother-to-child 13 20 0 16 15 0 6 14 0 5 3 0 Haemophiliac/transfusion recipient 3 4 0 3 3 0 4 3 0 1 1 0 Nosocomial infection 141 455 0 147 466 1 124 460 0 101 366 0 Other/undetermined 1 886 5 154 3 1 625 4 729 2 1 624 4 438 2 1 296 3 977 1 Total West Centre - 126 0 - 144 0 - 150 0 - 157 2 Men who have sex with men 22 68 0 16 71 0 22 82 0 24 108 0 Injecting drug use 107 179 0 96 171 0 98 167 0 105 224 1 Heterosexual contact 7 8 0 14 10 0 12 4 0 6 10 0 Mother-to-child 0 4 0 0 2 0 0 1 0 0 7 0 Haemophiliac/transfusion recipient 0 1 0 0 0 0 1 0 0 0 0 0 Nosocomial infection 85 124 0 53 106 0 71 91 0 62 114 0 Other/undetermined 221 510 0 179 504 0 204 495 0 197 620 3 Total Centre East - 23 0 - 14 0 - 29 0 - 32 0 Men who have sex with men 106 677 3 123 763 0 139 1 016 0 125 929 0 Injecting drug use 222 210 0 366 286 0 425 395 0 559 545 0 Heterosexual contact 19 22 0 14 11 0 16 15 0 12 23 0 Mother-to-child 0 0 0 2 1 0 0 1 0 0 1 0 Haemophiliac/transfusion recipient 2 1 0 2 3 0 1 4 0 1 2 0 Nosocomial infection 18 38 0 36 55 0 45 72 0 20 41 0 Other/undetermined 367 971 3 543 1 133 0 626 1 532 0 717 1 573 0 Total East 2 474 6 635 6 2 347 6 366 2 2 454 6 465 2 2 210 6 170 4 Total WHO European Region 68 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 23: AIDS cases*, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals Table 23a: EU/EEA and non-EU/EEA countries Age category 2004 2005 2006 2007 Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown EU/EEA <15 69 67 0 43 42 0 35 41 0 29 27 0 15–19 100 70 0 85 80 0 79 70 0 57 69 0 20–24 139 127 0 114 152 0 104 123 0 85 153 1 25–29 329 493 0 328 451 1 280 432 0 249 420 1 30–39 1 078 2 492 0 957 2 353 0 840 2 039 2 720 1 815 3 40–49 605 2 238 0 644 2 248 0 618 2 103 0 559 2 011 2 50+ 277 1 304 0 293 1 243 0 287 1 187 0 292 1 179 0 Unknown 0 1 0 1 6 0 4 7 0 1 3 0 Total EU/EEA 2 597 6 792 0 2 465 6 575 1 2 247 6 002 2 1 992 5 677 7 Non-EU/EEA <15 6 10 0 13 21 0 10 15 0 37 42 0 15–19 0 3 0 5 2 0 3 4 0 8 11 0 20–24 21 19 0 20 23 0 23 19 0 36 37 0 25–29 34 96 0 47 97 0 70 123 0 78 146 0 30–39 80 213 0 92 288 0 152 408 0 155 523 0 40–49 45 191 0 44 193 0 61 208 0 88 276 0 50+ 16 79 0 16 107 0 27 97 0 29 115 0 Unknown 0 7 0 0 1 0 2 3 0 0 0 0 Total non-EU/EEA 202 618 0 237 732 1 348 877 0 431 1 150 0 Total WHO European Region 2 799 7 410 0 2 702 7 307 2 2 595 6 879 2 2 423 6 827 7 Age category 2012 2013 Cumulative total** Female Male Unknown Female Male Unknown Female Male Unknown Total EU/EEA <15 16 12 0 12 14 0 5 496 7 077 0 12 573 15–19 14 19 0 12 13 0 995 1 481 0 2 476 20–24 79 143 0 57 103 0 5 024 9 917 1 14 942 25–29 132 297 2 88 239 1 14 309 39 238 8 53 555 30–39 465 1 180 0 317 885 1 28 829 112 045 15 140 889 40–49 440 1 421 0 314 1 083 0 11 584 60 394 3 71 981 50+ 316 1 104 0 269 958 0 6 798 35 950 0 42 748 Unknown 0 1 0 1 2 0 52 240 1 293 Total EU/EEA 1 462 4 177 2 1 070 3 297 2 73 087 266 342 28 339 457 Non-EU/EEA <15 20 27 0 31 36 0 305 375 1 681 15–19 0 3 0 7 6 0 93 148 0 241 20–24 27 26 0 23 29 0 623 742 2 1 367 25–29 96 128 0 82 120 0 1 531 2 791 2 4 324 30–39 287 685 0 234 583 0 3 419 9 455 3 12 877 40–49 166 546 0 138 466 0 1 368 5 490 1 6 859 50+ 72 226 0 84 215 0 699 2 748 1 3 448 Unknown 0 0 0 1 3 0 12 60 5 77 Total non-EU/EEA 668 1 641 0 600 1 458 0 8 050 21 809 15 29 874 Total WHO European Region 2 130 5 818 2 1 670 4 755 2 81 137 288 151 43 369 331 * Cases from Russia, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 15–17. ** Cumulative total is the total number of cases reported by country since the start of reporting 69 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 Age category Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown EU/EEA 24 38 0 32 30 0 30 12 0 18 17 0 <15 55 42 0 30 17 0 11 10 0 20 11 0 15–19 100 128 0 88 110 0 114 134 0 83 104 0 20–24 226 410 0 183 317 1 176 311 0 142 321 0 25–29 691 1 728 2 603 1 512 1 545 1 376 2 431 1 261 1 30–39 644 1 990 1 542 1 841 0 556 1 684 0 465 1 553 0 40–49 305 1 200 0 277 1 213 0 352 1 252 0 270 1 140 0 50+ 0 1 0 0 1 0 0 1 0 1 3 0 Unknown 2 045 5 537 3 1 755 5 041 2 1 784 4 780 2 1 430 4 410 1 Total EU/EEA Non-EU/EEA 21 26 0 18 21 0 21 23 0 19 30 0 <15 6 12 0 16 13 0 9 16 0 2 3 0 15–19 33 47 0 53 42 0 43 65 0 51 53 0 20–24 85 126 1 107 166 0 109 189 0 124 185 0 25–29 188 485 2 236 601 0 304 771 0 342 798 0 30–39 65 290 0 117 342 0 121 439 0 164 480 1 40–49 29 111 0 44 137 0 63 182 0 77 207 0 50+ 2 1 0 1 3 0 0 0 0 1 4 2 Unknown 429 1 098 3 592 1 325 0 670 1 685 0 780 1 760 3 Total non-EU/EEA 2 474 6 635 6 2 347 6 366 2 2 454 6 465 2 2 210 6 170 4 Total WHO European Region 70 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 23: AIDS cases*, by geographical area, sex, age and year of diagnosis (2004–2013) and cumulative totals Table 23b: Geographical areas, WHO European Region Age category 2004 2005 2006 2007 Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown West <15 35 34 0 30 29 0 26 33 0 27 26 0 15–19 35 13 0 28 20 0 19 19 0 23 21 0 20–24 120 105 0 89 133 0 92 95 0 65 119 1 25–29 305 451 0 299 397 1 253 387 0 220 350 1 30–39 1 061 2 375 0 928 2 261 0 818 1 955 2 682 1 703 3 40–49 606 2 216 0 630 2 208 0 612 2 076 0 555 1 978 2 50+ 272 1 286 0 283 1 244 0 275 1 183 0 281 1 188 0 Unknown 0 1 0 1 6 0 4 6 0 1 3 0 Total West 2 434 6 481 0 2 288 6 298 1 2 099 5 754 2 1 854 5 388 7 Centre <15 34 35 0 15 16 0 9 11 0 4 3 0 15–19 59 56 0 58 62 0 62 54 0 36 49 0 20–24 21 13 0 18 20 0 12 23 0 15 30 0 25–29 23 52 0 34 60 0 25 48 0 32 51 0 30–39 59 175 0 44 144 0 47 145 0 55 154 0 40–49 23 116 0 35 122 0 28 91 0 30 93 0 50+ 17 72 0 16 76 0 24 71 0 25 64 0 Unknown 0 7 0 0 1 0 2 4 0 0 0 0 Total Centre 236 526 0 220 501 0 209 447 0 197 444 0 East <15 6 8 0 11 18 0 10 12 0 35 40 0 15–19 6 4 0 4 0 0 1 1 0 6 10 0 20–24 19 28 0 27 22 1 23 24 0 41 41 0 25–29 35 86 0 42 91 0 72 120 0 75 165 0 30–39 38 155 0 77 236 0 127 347 0 138 481 0 40–49 21 97 0 23 111 0 39 144 0 62 216 0 50+ 4 25 0 10 30 0 15 30 0 15 42 0 Unknown 0 0 0 0 0 0 0 0 0 0 0 0 Total East 129 403 0 194 508 1 287 678 0 372 995 0 Total WHO European Region 2 799 7 410 0 2 702 7 307 2 2 595 6 879 2 2 423 6 827 7 Age category 2012 2013 Cumulative total** Female Male Unknown Female Male Unknown Female Male Unknown Total West <15 10 9 0 6 7 0 2 045 2 350 0 4 395 15–19 10 12 0 7 3 0 617 1 110 0 1 727 20–24 46 87 0 36 63 0 4 740 9 687 1 14 428 25–29 109 210 2 64 153 1 14 333 39 142 8 53 483 30–39 414 961 0 244 647 1 29 056 112 460 15 141 531 40–49 414 1 290 0 276 962 0 11 461 60 503 3 71 967 50+ 297 1 072 0 247 885 0 6 771 36 277 0 43 048 Unknown 0 1 0 1 3 0 54 243 1 298 Total West 1 300 3 642 2 881 2 723 2 69 077 261 772 28 330 877 Centre <15 8 4 0 9 8 0 3 565 4 857 1 8 423 15–19 4 7 0 5 11 0 419 446 0 865 20–24 30 59 0 20 52 0 535 585 0 1 120 25–29 21 87 0 18 103 0 634 1 375 0 2 009 30–39 56 236 0 72 256 0 1 233 3 727 0 4 960 40–49 40 177 0 37 147 0 611 2 376 1 2 988 50+ 23 100 0 39 111 0 399 1 538 1 1 938 Unknown 0 0 0 1 2 0 8 50 5 63 Total Centre 182 670 0 201 690 0 7 404 14 954 8 22 366 East <15 18 26 0 28 35 0 191 245 0 436 15–19 0 3 0 7 5 0 52 73 0 125 20–24 30 23 0 24 17 0 372 387 2 761 25–29 98 128 0 88 103 0 873 1 512 2 2 387 30–39 282 668 0 235 565 0 1 959 5 313 3 7 275 40–49 152 500 0 139 440 0 880 3 005 0 3 885 50+ 68 158 0 67 177 0 327 883 0 1 210 Unknown 0 0 0 0 0 0 2 7 0 9 Total East 648 1 506 0 588 1 342 0 4 656 11 425 7 16 088 Total WHO European Region 2 130 5 818 2 1 670 4 755 2 81 137 288 151 43 369 331 * Cases from Russia, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Tables 15–17. ** Cumulative total is the total number of cases reported by country since the start of reporting 71 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2008 2009 2010 2011 Age category Female Male Unknown Female Male Unknown Female Male Unknown Female Male Unknown West 17 28 0 17 24 0 20 10 0 11 7 0 <15 24 15 0 22 8 0 10 9 0 15 7 0 15–19 70 96 0 63 80 0 70 103 0 46 78 0 20–24 197 346 0 153 268 1 159 258 0 126 247 0 25–29 662 1 581 2 564 1 389 1 501 1 236 2 393 1 067 1 30–39 622 1 901 1 536 1 768 0 520 1 611 0 442 1 475 0 40–49 292 1 186 0 270 1 191 0 344 1 210 0 262 1 094 0 50+ 2 1 0 0 1 0 0 1 0 1 2 0 Unknown 1 886 5 154 3 1 625 4 729 2 1 624 4 438 2 1 296 3 977 1 Total West Centre 7 9 0 16 10 0 12 4 0 8 10 0 <15 30 28 0 14 9 0 4 5 0 5 4 0 15–19 32 37 0 28 36 0 43 37 0 41 39 0 20–24 31 50 0 25 57 0 21 61 0 21 81 0 25–29 63 160 0 52 161 0 59 166 0 54 231 0 30–39 32 145 0 24 135 0 37 115 0 37 142 1 40–49 26 80 0 20 96 0 28 107 0 31 111 0 50+ 0 1 0 0 0 0 0 0 0 0 2 2 Unknown 221 510 0 179 504 0 204 495 0 197 620 3 Total Centre East 21 27 0 17 17 0 19 21 0 18 30 0 <15 7 11 0 10 13 0 6 12 0 2 3 0 15–19 31 42 0 50 36 0 44 59 0 47 40 0 20–24 83 140 1 112 158 0 105 181 0 119 178 0 25–29 154 472 2 223 563 0 289 745 0 326 761 0 30–39 55 234 0 99 280 0 120 397 0 150 416 0 40–49 16 45 0 31 63 0 43 117 0 54 142 0 50+ 0 0 0 1 3 0 0 0 0 1 3 0 Unknown 367 971 3 543 1 133 0 626 1 532 0 717 1 573 0 Total East 2 474 6 635 6 2 347 6 366 2 2 454 6 465 2 2 210 6 170 4 Total WHO European Region 72 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 24: The most common AIDS-indicative diseases diagnosed in 2013, by geographical area ordered by frequency Table 24a: EU/EEA and non-EU/EEA countries Diseases Men Women Total Children N % N % N % N % EU/EEA Pneumocystis pneumonia 907 21.2 255 18.1 1162 20.4 4 13.3 Candidiasis, oesophageal 410 9.6 164 11.6 574 10.1 1 3.3 Wasting syndrome due to HIV 368 8.6 88 6.2 456 8.0 4 13.3 Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) 321 7.5 123 8.7 444 7.8 1 3.3 Kaposi’s sarcoma 305 7.1 33 2.3 338 5.9 0 0.0 Toxoplasmosis of brain in a patient over one month of age 172 4.0 102 7.2 274 4.8 0 0.0 Mycobacterium tuberculosis, extrapulmonary 171 4.0 95 6.7 266 4.7 0 0.0 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over one month of age 181 4.2 68 4.8 249 4.4 3 10.0 Encephalopathy, HIV-related 144 3.4 60 4.3 204 3.6 6 20.0 Progressive multifocal leukoencephalopathy 84 2.0 34 2.4 118 2.1 0 0.0 Non-EU/EEA Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) 455 23.7 129 16.2 584 21.5 15 14.7 Wasting syndrome due to HIV 277 14.4 117 14.7 394 14.5 19 18.6 Candidiasis, oesophageal 245 12.7 122 15.3 367 13.5 13 12.7 Mycobacterium tuberculosis, extrapulmonary 150 7.8 43 5.4 193 7.1 0 0.0 Pneumocystis pneumonia 100 5.2 46 5.8 146 5.4 7 6.9 Encephalopathy, HIV-related 68 3.5 28 3.5 96 3.5 2 2.0 Pneumonia, recurrent in an adult or an adolescent (aged 13 years or over) 61 3.2 28 3.5 89 3.3 2 2.0 Kaposi’s sarcoma 35 1.8 7 0.9 42 1.5 0 0.0 Candidiasis of bronchi, trachea or lungs 27 1.4 14 1.8 41 1.5 12 11.8 Herpes simplex: chronic ulcer(s) (>1 months duration); or bronchitis, pneumonitis, or oesophagitis in a patient over one month of age 21 1.1 17 2.1 38 1.4 2 2.0 Table 24b: Geographical areas, WHO European Region Diseases Men Women Total Children N % N % N % N % West Pneumocystis pneumonia 855 23.6 239 20.1 1094 22.7 4 26.7 Candidiasis, oesophageal 367 10.1 159 13.4 526 10.9 0 0 Kaposi’s sarcoma 289 8 33 2.8 322 6.7 0 0 Wasting syndrome due to HIV 255 7 63 5.3 318 6.6 1 6.7 Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) 210 5.8 94 7.9 304 6.3 0 0 Mycobacterium tuberculosis, extrapulmonary 158 4.4 83 7 241 5 0 0 Toxoplasmosis of brain in a patient over one month of age 145 4 90 7.6 235 4.9 0 0 Cytomegalovirus disease (other than liver, spleen or nodes) in a patient over one month of age 170 4.7 63 5.3 233 4.8 2 13.3 Encephalopathy, HIV-related 129 3.6 50 4.2 179 3.7 5 33.3 Progressive multifocal leukoencephalopathy 74 2 28 2.4 102 2.1 0 0 Centre Wasting syndrome due to HIV 142 18.1 37 16 179 17.7 3 15 Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) 95 12.1 19 8.2 114 11.2 1 5 Pneumocystis pneumonia 87 11.1 14 6.1 101 10 0 0 Candidiasis, oesophageal 64 8.2 13 5.6 77 7.6 2 10 Toxoplasmosis of brain in a patient over one month of age 26 3.3 10 4.3 36 3.6 0 0 Encephalopathy, HIV-related 22 2.8 12 5.2 34 3.4 1 5 Kaposi’s sarcoma 33 4.2 0 0 33 3.3 0 0 Pneumonia, recurrent in an adult or an adolescent (aged 13 years or over) 26 3.3 6 2.6 32 3.2 0 0 Candidiasis of bronchi, trachea or lungs 20 2.6 4 1.7 24 2.4 1 5 Lymphoma(s), not specified 18 2.3 5 2.2 23 2.3 0 0 East Mycobacterium tuberculosis, pulmonary in an adult or an adolescent (aged 13 years or over) 471 26.3 139 17.7 610 23.7 15 15.5 Wasting syndrome due to HIV 248 13.9 105 13.3 353 13.7 19 19.6 Candidiasis, oesophageal 224 12.5 114 14.5 338 13.1 12 12.4 Mycobacterium tuberculosis, extrapulmonary 152 8.5 48 6.1 200 7.8 0 0 Pneumocystis pneumonia 65 3.6 48 6.1 113 4.4 7 7.2 Encephalopathy, HIV-related 61 3.4 26 3.3 87 3.4 2 2.1 Pneumonia, recurrent in an adult or an adolescent (aged 13 years or over) 58 3.2 29 3.7 87 3.4 2 2.1 Candidiasis of bronchi, trachea or lungs 37 2.1 18 2.3 55 2.1 12 12.4 Toxoplasmosis of brain in a patient over one month of age 23 1.3 13 1.7 36 1.4 0 0 Herpes simplex: chronic ulcer(s) (>1 months duration); or bronchitis, pneumonitis, or oesophagitis in a patient over one month of age 18 1 15 1.9 33 1.3 2 2.1 73 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Table 25: Deaths among AIDS cases, by country and year of death (2004–2013) and cumulative totals in EU/EEA and other countries of the WHO European Region Area Country* Year of diagnosis Cumulative total**2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 47 60 39 56 34 37 43 29 9 36 2 008 West Belgium 46 47 33 33 25 27 19 31 27 32 2 032 Centre Bulgaria 10 12 8 6 9 2 14 17 16 14 143 Centre Croatia 2 3 6 2 7 7 10 6 7 8 176 Centre Cyprus 2 7 4 3 0 3 3 4 5 3 110 Centre Czech Republic 4 11 6 11 14 10 7 9 11 12 202 West Denmark 31 27 19 20 3 9 3 6 2 4 2 028 East Estonia 15 12 18 11 8 0 2 7 5 2 106 West Finland - - - - - - - - - - - West France 425 400 331 243 230 176 205 169 139 85 36 176 West Germany 211 153 161 160 115 116 104 117 83 65 14 373 West Greece 26 49 38 42 31 29 48 53 49 38 1 796 Centre Hungary 13 6 6 10 4 9 10 12 9 7 343 West Iceland 1 0 1 0 0 0 0 1 1 0 39 West Ireland 8 8 8 6 3 5 5 4 1 0 414 West Italy 917 852 816 819 762 710 643 - - - 41 748 East Latvia 23 34 40 47 58 69 57 80 88 107 641 East Lithuania 10 5 9 15 20 17 12 9 10 18 156 West Luxembourg 0 0 0 0 0 0 0 0 0 0 0 West Malta 1 1 7 1 0 0 0 1 2 0 60 West Netherlands 36 41 33 36 36 37 25 31 25 16 401 West Norway 14 15 6 1 3 3 0 1 1 2 625 Centre Poland 66 65 43 61 71 46 53 68 57 45 1 255 West Portugal 349 294 235 217 203 193 197 173 139 145 8 229 Centre Romania 224 234 202 172 158 132 146 221 121 64 6 139 Centre Slovakia 3 0 4 3 0 2 1 1 3 0 39 Centre Slovenia 2 2 0 2 5 1 2 1 1 5 93 West Spain 1 196 1 157 1 015 993 824 487 332 249 213 144 47 275 West Sweden 17 19 8 6 - - - - - - 1 323 West United Kingdom 302 357 314 314 308 279 305 154 153 145 16 023 Total EU/EEA 4 001 3 871 3 410 3 290 2 931 2 406 2 246 1 454 1 177 997 183 953 Non-EU/EEA Centre Albania 0 1 3 6 2 5 6 10 8 11 59 West Andorra 0 0 0 0 1 0 0 0 0 0 1 East Armenia 11 7 15 22 31 39 17 22 36 23 252 East Azerbaijan 22 20 21 43 43 27 45 39 40 26 368 East Belarus 59 78 138 141 146 151 146 158 188 126 1 405 Centre Bosnia and Herzegovina 3 3 5 1 0 1 0 0 0 2 57 Centre former Yugoslav Republic of Macedonia, the 1 4 5 2 1 0 1 4 0 3 64 East Georgia 49 56 36 67 74 63 80 95 83 82 761 West Israel 56 60 74 80 60 42 44 60 32 25 1 729 East Kazakhstan 64 77 86 90 137 130 168 150 148 146 1 328 East Kyrgyzstan 8 24 16 18 15 21 26 19 19 6 189 East Moldova 31 41 45 68 65 54 72 127 11 22 643 West Monaco 0 0 1 0 0 0 0 0 0 0 18 Centre Montenegro 1 0 1 1 0 2 4 2 1 1 36 East Russia*** - - - - - - - - - - - West San Marino 0 0 0 0 0 0 0 0 0 0 8 Centre Serbia**** 27 25 24 15 22 25 26 31 17 17 1 061 West Switzerland 88 69 56 50 34 39 23 13 3 2 5 858 East Tajikistan 0 0 0 11 30 7 29 47 25 24 173 Centre Turkey 7 4 2 0 0 0 0 0 0 10 84 East Turkmenistan 0 0 0 0 0 0 0 0 0 - 1 East Ukraine 1 775 2 188 2 420 2 507 2 710 2 591 3 096 3 736 3 870 3 514 31 999 East Uzbekistan 22 9 9 19 124 40 66 - - - 323 Total non-EU/EEA 2 224 2 666 2 957 3 141 3 495 3 237 3 849 4 513 4 481 4 040 46 417 Geographical area West 3 771 3 609 3 195 3 077 2 672 2 189 1 996 1 092 879 739 182 164 Centre 365 377 319 295 293 245 283 386 256 202 9 861 East 2 089 2 551 2 853 3 059 3 461 3 209 3 816 4 489 4 523 4 096 38 345 Total WHO European Region 6 225 6 537 6 367 6 431 6 426 5 643 6 095 5 967 5 658 5 037 230 370 * Country-specific comments are in Annex 5 ** Cumulative total is the total number of cases reported by country since the start of reporting *** No official data were reported by Russia. Information about AIDS related deaths were published by the Federal Scientific and Methodological Center for Prevention and Control of AIDS: 28 261 (cumulative as of 31 December 2013). Reference: HIV-infection bulletin number 39. Moscow: The Federal Service for Surveillance of Consumer Rights Protection and human well-being; 2014 **** Excluding a cumulative 40 cases from Kosovo (without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence) 74 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 26: Deaths among AIDS cases*, by geographic area, transmission mode and year of death (2004–2013) and cumulative totals Table 26a: EU/EEA and non-EU/EEA countries Transmission mode 2004 2005 2006 2007 2008 2009 Male Female Male Female Male Female Male Female Male Female Male Female EU/EEA Men who have sex with men 552 - 559 - 474 - 447 - 382 - 347 - Injecting drug use 1 013 221 970 215 832 178 819 181 667 176 466 104 Heterosexual contact 523 336 531 322 473 287 431 274 369 254 296 227 Mother-to-child 4 8 17 11 11 7 12 3 14 3 7 4 Haemophiliac/transfusion recipient 36 21 29 17 25 10 15 10 25 7 9 10 Nosocomial infection 38 29 37 26 40 24 27 26 25 19 25 14 Other/undetermined 219 67 200 66 166 59 159 61 158 70 127 60 Total EU/EEA 2 385 682 2 343 657 2 021 565 1 910 555 1 640 529 1 277 419 Non-EU/EEA Men who have sex with men 37 - 36 - 25 - 20 - 24 - 20 - Injecting drug use 153 30 165 26 233 57 288 61 291 50 264 49 Heterosexual contact 69 57 79 56 110 75 128 75 148 113 123 118 Mother-to-child 1 2 5 3 3 0 3 3 5 4 2 4 Haemophiliac/transfusion recipient 1 1 3 0 3 0 5 2 1 0 0 0 Nosocomial infection 0 0 1 1 0 1 3 0 0 0 1 1 Other/undetermined 60 16 79 15 14 7 22 5 16 8 19 6 Total non-EU/EEA 321 106 368 101 388 140 469 146 485 175 429 178 Total WHO European Region 2 706 788 2 711 758 2 409 705 2 379 701 2 125 704 1 706 597 Table 26b: Geographical areas, WHO European Region Transmission mode 2004 2005 2006 2007 2008 2009 Male Female Male Female Male Female Male Female Male Female Male Female West Men who have sex with men 549 - 562 - 474 - 434 - 368 - 328 - Injecting drug use 993 220 934 208 793 172 755 177 598 166 412 97 Heterosexual contact 501 337 501 304 455 279 441 261 348 244 274 219 Mother-to-child 4 5 12 12 6 4 7 3 12 3 4 3 Haemophiliac/transfusion recipient 21 9 14 6 20 4 9 6 16 6 5 6 Nosocomial infection 0 0 0 1 0 2 0 1 1 1 2 1 Other/undetermined 172 26 156 28 128 34 125 33 108 39 94 34 Total West 2 240 597 2 179 559 1 876 495 1 771 481 1 451 459 1 119 360 Centre Men who have sex with men 28 - 28 - 23 - 30 - 29 - 35 - Injecting drug use 41 8 42 9 33 6 40 8 38 8 29 6 Heterosexual contact 63 36 66 41 66 34 51 24 54 27 42 25 Mother-to-child 1 3 7 0 7 3 5 0 3 1 4 2 Haemophiliac/transfusion recipient 16 13 18 11 8 6 10 6 10 1 4 4 Nosocomial infection 38 29 37 25 40 22 27 25 24 18 23 13 Other/undetermined 50 39 55 38 44 27 40 29 48 32 37 22 Total Centre 237 128 253 124 221 98 203 92 206 87 174 72 East Men who have sex with men 12 - 5 - 2 - 3 - 9 - 4 - Injecting drug use 132 23 159 24 239 57 312 57 322 52 289 50 Heterosexual contact 28 20 43 33 62 49 67 64 115 96 103 101 Mother-to-child 0 2 3 2 1 0 3 3 4 3 1 3 Haemophiliac/transfusion recipient 0 0 0 0 0 0 1 0 0 0 0 0 Nosocomial infection 0 0 1 1 0 1 3 0 0 0 1 1 Other/undetermined 57 18 68 15 8 5 16 4 18 7 15 10 Total East 229 63 279 75 312 112 405 128 468 158 413 165 Total WHO European Region 2 706 788 2 711 758 2 409 705 2 379 701 2 125 704 1 706 597 * Cases from Italy, Russia, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. Therefore, totals by transmission mode, gender and overall may differ from totals presented in Table 25. ** Cumulative total is the total number of cases reported by country since the start of reporting 75 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 2010 2011 2012 2013 Cumulative total** Transmission mode Male Female Male Female Male Female Male Female Male Female Unknown Total EU/EEA 364 - 327 - 272 - 223 - 49 219 0 1 49 212 Men who have sex with men 334 81 288 76 258 74 241 73 39 478 9 736 0 49 177 Injecting drug use 341 215 296 201 246 148 197 124 14 016 9 808 0 23 804 Heterosexual contact 2 12 8 5 3 5 1 2 849 722 0 1 571 Mother-to-child 19 5 17 8 10 3 3 5 4 427 1 680 0 6 107 Haemophiliac/transfusion recipient 20 14 20 25 9 14 0 0 1 762 1 171 0 2 933 Nosocomial infection 149 47 124 59 106 28 88 40 6 338 1 752 0 8 078 Other/undetermined 1 229 374 1 080 374 904 272 753 244 116 089 24 869 1 140 882 Total EU/EEA Non-EU/EEA 25 - 22 - 10 - 17 - 2 669 0 0 2 668 Men who have sex with men 312 47 306 33 292 27 224 31 4 875 1 344 1 6 214 Injecting drug use 143 128 199 174 145 118 131 79 2 240 1 733 0 3 955 Heterosexual contact 3 3 7 3 1 2 7 7 99 88 1 188 Mother-to-child 1 0 1 0 0 1 0 0 248 70 0 318 Haemophiliac/transfusion recipient 0 0 0 0 0 0 0 0 5 4 0 9 Nosocomial infection 19 7 23 9 13 2 22 9 599 165 4 767 Other/undetermined 503 185 558 219 461 150 401 126 10 735 3 404 6 14 119 Total non-EU/EEA 1 732 559 1 638 593 1 365 422 1 154 370 126 824 28 273 7 155 001 Total WHO European Region 2010 2010 2010 2010 Cumulative total** Transmission mode Male Female Male Female Male Female Male Female Male Female Unknown Total West 338 - 297 - 247 - 195 - 50 660 0 1 50 655 Men who have sex with men 296 68 227 56 177 46 162 49 40 375 10 348 0 50 712 Injecting drug use 299 200 222 168 216 120 164 91 14 156 10 020 0 24 170 Heterosexual contact 2 8 3 3 1 3 1 1 729 679 0 1 408 Mother-to-child 7 2 12 4 4 1 3 5 3 855 1 260 0 5 115 Haemophiliac/transfusion recipient 0 0 0 0 0 0 0 0 18 20 0 38 Nosocomial infection 109 24 82 18 52 11 54 14 5 729 1 267 0 6 995 Other/undetermined 1 051 302 843 249 697 181 579 160 115 522 23 594 1 139 093 Total West Centre 47 - 45 - 29 - 34 - 1 116 0 0 1 114 Men who have sex with men 22 8 43 13 47 17 36 12 1 019 263 0 1 274 Injecting drug use 54 31 83 55 40 22 39 22 1 013 629 0 1 636 Heterosexual contact 0 6 7 2 2 2 0 3 182 103 1 286 Mother-to-child 13 3 5 4 6 2 0 0 816 489 0 1 305 Haemophiliac/transfusion recipient 20 14 20 25 9 14 0 0 1 744 1 151 0 2 895 Nosocomial infection 44 22 47 37 52 14 38 19 842 515 1 1 354 Other/undetermined 200 84 250 136 185 71 147 56 6 732 3 150 2 9 864 Total Centre East 4 - 7 - 6 - 11 - 112 0 0 111 Men who have sex with men 328 52 324 40 326 38 267 43 2 959 469 1 3 405 Injecting drug use 131 112 190 152 135 124 125 90 1 087 892 0 1 953 Heterosexual contact 3 1 5 3 1 2 7 5 37 28 0 65 Mother-to-child 0 0 1 0 0 1 0 0 4 1 0 5 Haemophiliac/transfusion recipient 0 0 0 0 0 0 0 0 5 4 0 9 Nosocomial infection 15 8 18 13 15 5 18 16 366 135 3 496 Other/undetermined 481 173 545 208 483 170 428 154 4 570 1 529 4 6 044 Total East 1 732 559 1 638 593 1 365 422 1 154 370 126 824 28 273 7 155 001 Total WHO European Region 76 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Table 27: Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2004–2013) and number of tests per 1 000 population in 2013, in EU/EEA and other countries of the WHO European Region Area Country* Number of HIV tests Tests/1000 population2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 EU/EEA West Austria 698 099 667 825 659 693 777 935 751 749 770 901 831 675 826 256 - - - West Belgium 593 054 591 193 578 717 595 394 619 418 635 150 651 095 679 655 703 486 695 433 62.3 Centre Bulgaria 110 000 110 000 105 000 160 000 110 000 140 000 160 000 180 000 190 000 210 000 28.8 Centre Croatia 27 926 26 085 26 124 32 698 38 996 40 938 32 848 32 928 40 071 29 998 7.1 Centre Cyprus 38 796 38 708 37 763 41 913 42 294 48 158 48 385 49 074 54 120 50 235 58.9 Centre Czech Republic 322 267 330 233 317 823 344 874 342 223 347 135 353 507 334 569 349 205 341 583 32.5 West Denmark 130 915 143 671 154 332 141 880 124 935 112 533 168 923 137 877 134 709 137 151 24.5 East Estonia 59 474 61 249 65 861 68 478 74 357 78 735 78 054 85 025 73 367 82 279 62.3 West Finland 144 613 142 427 147 601 153 478 186 822 190 380 185 114 - - - - West France 5 060 329 5 433 719 5 169 523 5 146 481 5 043 124 5 014 971 4 996 825 5 203 501 5 242 020 5 207 559 79.4 West Germany 2 277 000 - - - - - - - - - - West Greece** 9 629 9 169 9 840 17 374 33 558 35 171 31 070 31 918 34 622 32 241 2.9 Centre Hungary 109 992 70 512 80 168 65 980 83 408 91 181 89 137 84 464 93 060 95 861 9.7 West Iceland 9 001 9 397 9 106 9 351 9 522 7 794 7 318 - - - - West Ireland - - - 63 000 - 184 980 180 055 184 521 175 488 150 597 32.8 West Italy - - - - - - - - - - - East Latvia 84 054 85 538 85 117 79 279 72 444 59 331 58 826 58 799 60 491 58 302 28.8 East Lithuania 59 822 58 424 52 988 60 333 162 381 100 799 178 554 102 234 101 042 102 161 34.4 West Luxembourg 14 794 13 975 14 339 13 379 13 366 13 308 8 533 57 685 64 778 68 020 126.7 West Malta 6 194 6 197 10 309 11 957 - - - - - 14522 34.5 West Netherlands - - - - - - - - - - - West Norway 187 606 193 075 188 550 - - - - - - - - Centre Poland 126 738 136 040 159 180 176 728 181 118 213 138 229 783 317 286 358 953 - - West Portugal - 917 117 - - - - - - - - - Centre Romania 220 734 188 279 191 223 220 226 282 248 284 053 291 915 306 679 293 204 302 898 15.1 Centre Slovakia 94 173 103 718 93 426 88 520 66 926 132 990 109 261 110 025 110 506 114 574 21.2 Centre Slovenia 22 014 24 522 25 624 31 120 31 183 37 105 36 977 38 110 33 602 33 457 16.3 West Spain - - - - - - - - - - - West Sweden - - - - - - - - - - - West United Kingdom - - - - - - - - - - - Non-EU/EEA Centre Albania 2 862 3 700 3 098 1 686 2 458 2 143 2 168 3 260 3 140 3 063 1.1 West Andorra 1 460 1 884 3 077 3 546 - 2 810 2 678 2 590 2 062 2 310 30.3 East Armenia 14 415 39 469 50 221 55 342 60 701 60 103 60 731 68 449 71 957 83 431 25.5 East Azerbaijan 202 271 237 027 237 183 293 086 322 525 340 048 353 772 365 090 514 434 482 282 51.5 East Belarus 449 479 440 675 441 299 437 983 430 175 459 032 517 625 621 780 683 125 770 136 81.4 Centre Bosnia and Herzegovina 15 755 10 834 20 904 16 858 - - 20 793 - - - - Centre former Yugoslav Republic of Macedonia, the 4 983 7 526 11 172 10 574 - - - 17 811 18 105 24 562 11.9 East Georgia 24 311 26 026 16 989 16 989 18 792 17 562 25 370 21 799 15 562 18 091 4.1 West Israel 203 537 234 835 242 484 269 071 271 641 278 887 286 995 274 294 233 516 - - East Kazakhstan 529 164 621 261 862 058 1 491 190 1 643 938 1 758 026 1 786 289 1 897 476 2 026 174 2 127 136 129.4 East Kyrgyzstan 144 927 162 075 179 407 186 643 268 134 325 855 297 959 381 295 470 355 370 160 66.7 East Moldova 160 978 185 922 216 566 347 709 355 711 204 702 207 018 207 830 212 964 146 105 35.9 West Monaco - - - - - - - - - - - Centre Montenegro 3 376 3 594 3 988 3 838 4 229 5 812 6 492 6 914 6 781 6 970 11.2 East Russia 17 909 234 17 744 347 18 535 043 - - - 25 209 546 - - - - West San Marino 4 893 4 723 5 061 3 976 3 825 4 181 5 090 3 961 3 845 4 004 119.3 Centre Serbia 27 021 35 083 37 829 42 573 44 555 47 734 51 727 56 086 64 031 65 829 9.2 West Switzerland - - - - - - - - - - - East Tajikistan 50 721 72 114 91 310 92 474 129 330 214 207 280 281 438 532 447 636 514 701 62.7 Centre Turkey 1 207 258 1 881 750 1 908 257 1 998 163 5 045 319 - - - - - - East Turkmenistan 121 398 153 090 136 145 211 789 - - - - - - - East Ukraine 1 521 282 1 555 511 1 661 600 1 937 440 2 280 442 2 347 084 2 319 946 2 392 970 2 343 099 2 064 019 45.5 East Uzbekistan 446 317 515 972 545 240 619 130 796 371 987 464 1 506 724 - - - - * Country-specific comments are in Annex 5 ** HIV tests reported for Greece refer to only to those performed in reference centres and do not include all tests carried out in public hospitals or private laboratories. 77 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Figures 78 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Map 1: HIV diagnoses per 100 000 population, 2013: All cases Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 2 2 to < 10 10 to < 20 ≥ 20 79 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Map 3: HIV diagnoses per 100 000 female population, 2013: Females Map 2: HIV diagnoses per 100 000 male population, 2013: Males Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 2 2 to < 10 10 to < 20 ≥ 20 Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 2 2 to < 10 10 to < 20 ≥ 20 80 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Map 4: HIV diagnoses per 100 000 population, 2013: Heterosexual transmission Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 1 1 to < 3 3 to < 5 ≥ 5 Map 5: HIV diagnoses per 100 000 population, 2013: Injecting drug use Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 1 1 to < 3 3 to < 5 ≥ 5 81 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Map 7: AIDS cases reported per 100 000 population, 2013 Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 1 1 to < 3 3 to < 5 ≥ 5 Map 6: HIV diagnoses per 100 000 population, 2013: Sex between men Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 1 1 to < 3 3 to < 5 ≥ 5 82 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Figure 1: AIDS cases diagnosed, by transmission mode and geographical area, 2004–2013 0 1000 2000 3000 4000 2013201220112010200920082007200620052004 Heterosexual contact Sex between men Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es West 0 100 200 300 400 2013201220112010200920082007200620052004 Heterosexual contact Sex between men Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Centre 0 500 1000 1500 2013201220112010200920082007200620052004 Heterosexual contact Sex between men Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es East Cases from Russia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period Cases from Sweden excluded due to inconsistent reporting during the period 83 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Annexes

85 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Since 2008, the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization Regional Office for Europe (WHO Regional Office) have carried out the enhanced surveillance of HIV/AIDS in Europe. Both strive to ensure a high quality of standard- ised HIV/AIDS surveillance data from the 53 countries of the WHO European Region, including the 28 countries of the European Union (EU) and the three countries of the European Economic Area (EEA) (in this report referred to together as EU/EEA). 1 Reporting In EU/EEA countries, the Member States’ Coordinating Competent Bodies have nominated national opera- tional contact points for HIV/AIDS surveillance to work on reporting surveillance data to the joint ECDC/WHO 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 via the respective ministries of health. Data are submitted through a web-based platform to a joint database of The European Surveillance System (TESSy). Three types of data are collected: HIV (case- based and aggregate), AIDS (case-based and aggregate) and number of HIV tests performed (aggregate). Data are uploaded directly by the reporting country into the data- base. When uploading data, a built-in set of validation rules ensures the verification of the data within the data- base. This verification of the data during the uploading process improves the quality of the data and allows each country to test their datasets prior to submission. Liechtenstein, Russia, Turkmenistan and Uzbekistan did not report any HIV or AIDS data for 2013. HIV data for Russia were therefore obtained through publicly availa- ble sources and used to supplement the other countries’ reported data to give a more complete presentation of the epidemiology of HIV and AIDS in Europe. Surveillance systems – data sources To describe the national source of data and specify the national surveillance system from which the reported data originate, the variable ‘data source’ is included as a compulsory part of reporting (Annexes 4 and 4a). Some cross-country comparisons are hampered by differences in surveillance systems as the quality and coverage of national surveillance are not consistent. Particularly in the early part of the period covered in this report (2004- 2013), some countries did not have national HIV/AIDS data and others established or substantially modified the national reporting systems over the course of the reporting period. These issues are detailed in Annex 5. 2 Data collection and validation Data collection 2014 The 2013 data submission for HIV and AIDS surveillance took place between 15 March and 15 September 2014. Data presented in this report were extracted from the joint database on 13 October 2014, although minor cor- rections were made during subsequent country reviews of the draft report. 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 validated. Seventeen countries uploaded datasets containing only 2013 data for HIV, whereas the remainder uploaded data concerning longer peri- ods. Two countries (Kazakhstan and Ukraine) reported aggregated HIV data compared with four countries in 2012. Eighteen countries uploaded datasets containing only 2013 data for AIDS. Ukraine reported aggregated AIDS data for the years 2004 to 2013. All other countries reported case-based AIDS data. Reporting of aggregated HIV and AIDS data has an impact on the data presentation and analysis and the epidemiological overview of HIV/AIDS in Europe because fewer variables are available from the aggregated data- sets, hence reducing the amount of data that can be presented in certain tables and figures. 3 Data re-coding and adjustments Dates used for data presentation In this report the HIV and AIDS data are presented by ‘date of diagnosis’. If countries could not provide this date, the ‘date of notification’ or ‘date of statistics’ was used instead. Region of origin When available, countries were encouraged to provide data on the specific country of origin or nationality of the case. This information was used first and, if absent, the variable ‘region of origin’ was used to group cases into region of origin presented in Table 11 (stratified by reporting country) and Table 12 (all countries stratified by mode of transmission). Origin of reported cases Cases originating from countries with generalised epidemics are at times separated from other cases, namely in the category of heterosexual transmission. Annex 1: Framework for data collection, validation and presentation 86 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 This approach is taken to inform epidemiological under- standing and to guide public health resource allocation and prevention efforts. In order 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 cases originating from countries with a generalised epidemic (in Tables 11, 12 and in selected Figures). As most of the cases originat- ing from sub-Saharan Africa were reported from West European countries within the EU/EEA, this information is presented in detail in Chapter 1. Reporting delay Reporting delays refer to the time delay between HIV/ AIDS diagnosis (or death) and the report of this event at national level, identified by ‘date of notification’. Due to delays in reporting, HIV trends analysed at a European level are often biased downwards for the most recent year (2013) and, to a lesser extent for the 2-3 years prior to the reporting period. Ideally, surveillance data should be corrected to more accurately describe the trends in HIV diagnoses. In this report, we apply a statistical approach, as described by Heisterkamp, et al [1] to adjust the surveil- lance data for reporting delays. Yearly reporting delay probabilities were estimated using historical data from 2004 to 2013. Countries were excluded from reporting delay adjustment: 1 when they showed an inconsistent and non-stationary pattern in their reporting delay distribution during the period 2004–2013, 2 when they reported aggregated data during the period 2004–2013, or 3 when the average number of diagnosed HIV cases per year over the period 2004–2013 was lower than 50. Adjusting for reporting delays is a valuable tool to indi- cate HIV trends more precisely, as well as in monitoring the timeliness of data collection, an important aspect of quality control. Reporting delays were applied for the graphs represent- ing trends for the EU/EEA and by transmission mode. The list of countries with number of reported diagnoses adjusted for reporting delay are presented in Annex 6. 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*, Czech Republic*, Hungary*, the former Yugoslav Republic of Macedonia, Montenegro, Poland*, Romania*, Serbia, Slovakia*, Slovenia*, Turkey. • East, 15 countries: Armenia, Azerbaijan, Belarus, Estonia*, Georgia, Kazakhstan, Kyrgyzstan, Latvia*, Lithuania*, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan. * Countries which constitute the European Union as of 1 July 2014. 87 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT 4 Data presentation Geographical presentation Data are presented for the WHO European Region and the EU/EEA. The EU comprises 28 Member States and the EEA comprises an additional three countries (Norway, Iceland, Liechtenstein), of which Norway and Iceland are included in the overview of the EU/EEA. The tables are presented by EU/EEA countries, non-EU/ EEA countries, by individual countries and by totals. The 53 countries are also subdivided into three geographi- cal areas based on epidemiological considerations and in accordance with the division used in previous reports on HIV/AIDS surveillance in Europe: West (23 countries), Centre (15 countries) and East (15 countries) (see Figure A1). The division reflects similarities in epidemiologi- cal dynamics such as epidemic levels, trends over time and transmission patterns. In this report these geo- graphical/epidemiological areas are referred to as ‘by geographical area’. Of the EU/EEA countries, 19 Member States are classified as being in the West, nine in the Centre and three in the East Regions. Population data and rates Data are presented in absolute numbers and rates as cases per 100 000 population. The population estimates up to 2013 were derived from Eurostat for all countries except the five central Asian republics (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) and Israel, for which Eurostat data were not available. United Nations (UN) Population Division data were used for those countries [2]. The Eurostat data are from 31 March 2014 (www.epp. eurostat.ec.europa.eu) and are consistent with the UN population data. The population data used for HIV and AIDS for Spain and for HIV for Italy were adjusted according to the extent of sub-national coverage. For data presented by gender, rates were calculated using relevant male and female population denomina- tors from the source described above. 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. For maps presenting figures for MSM, rates are calcu- lated using the male population. Trend data For presentation of the overall trends, only countries reporting consistently were included (e.g. data from Russia, Turkmenistan and Uzbekistan were not included in the presentation of HIV trends for 2004–2013). Russia, Sweden, Turkmenistan and Uzbekistan were not included in the presentation of AIDS trends. When presenting HIV trends for 2004–2013 by trans- mission mode, countries reporting transmission mode inconsistently or incompletely were excluded (e.g. Estonia, Poland and Turkey) from Table 8 and rel- evant figures reporting trends by transmission mode. Countries with varying geographic coverage of the national surveillance system over time (Spain and Italy) were also excluded from Tables 8 and 9 and from graphs showing HIV trends. When presenting AIDS death trends, only countries reporting consistently were included (e.g. Italy, Sweden, Ukraine, Uzbekistan were not included in the presenta- tion of AIDS death trends in Table 26 or text description). 5 Data limitations Surveillance systems are not identical across Europe, and differences in data collection methods and testing policies could impact the results and introduce bias in comparisons between countries. Particularly, factors such as underreporting and reporting delay may influ- ence the country figures and rankings presented in the report. The data in the report are to be considered as provi- sional because they are subject to regular updates (e.g. detection and deletion of duplicate cases, inclusion of new information about cases already reported). The limi- tations described below need to be taken into account when interpreting the data presented here. Official reports of newly diagnosed cases of HIV do not represent true incidence. Newly reported HIV diagnoses include recently infected individuals as well as those who were infected several years ago but only recently tested for HIV. These reports are also influenced by several factors such as the uptake of HIV testing, pat- terns of reporting, the long incubation period and a slow progression of the disease. In order to better interpret trends in HIV case reporting data, the total numbers of HIV tests performed annually for diagnostic purposes (excluding unlinked anonymous tests and screening of blood donations) are presented to help provide some background on HIV testing patterns. Although the table in Annex 6 adjusts for reporting delay for those countries where this is possible, no adjustments are made for underreporting or under- ascertainment bias. Fewer than 40% of European countries have evaluated their surveillance systems for underreporting and only two have published the results [4]. Previous estimates of underreporting range from 0% to 25% for AIDS cases [3], while national estimates of underreporting for HIV can range from 10% (Iceland, Italy) to around 40% (Germany, UK) [4, 5]. Estimates with regard to the underreporting of AIDS-related deaths are not available. When interpreting the data presented in this report, country-specific comments included in Annex 5 should be considered and the following noted: 88 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 • Data from Kosovo1 are not included in the tables, but as footnotes to Tables 1–7 and 15–21. • More detailed information regarding the country-spe- cific HIV and AIDS case reporting systems is available in Annexes 4 and 5. References 1 Heisterkmap SH, Jager JC, Ruitenberg EJ, van Druten JAM, Downs AM. Correcting Reported Aids Incidence: A statistical approach. Statistics in Medicine, Vol. 8, 963-976 (1989). 2 United Nations, Department of Economic and Social Aff airs, Population Division, World Population Prospects: The 2012 Revision. New York; 2013. 3 EuroHIV. Completeness of AIDS case reporting in Europe. HIV/AIDS Surveillance in Europe, Quarterly Report 1996. Paris: Institut de médecine et d’épidémiologie africaines; 1996. No.49:30-33. 4 EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire; 2007. 5 Personal communication to ECDC. F. Cazein, 08/11/12. 1 This designation is without prejudice to positions on status, and is in line with UNSCR 1244 and the IСJ Opinion on the Kosovo Declaration of Independence. 89 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Annex 2 List of variables* for the 2013 HIV/AIDS data collection HIV case-based AIDS case-based HIV aggregated AIDS aggregated HIV tests (aggregated) Common set of variables 1. RecordID 2. RecordType 3. RecordTypeVersion 4. Subject 5. Status 6. DataSource 7. ReportingCountry 8. DateUsedForStatistics 9. Age 10. Gender 11. Outcome 12. DateOfOnset 13. DateOfDiagnosis 14. DateOfNotification 15. Classification 16. ClinicalCriteria 17. LaboratoryResult 18. EpiLinked 1. RecordID 2. RecordType 3. RecordTypeVersion 4. Subject 5. Status 6. DataSource 7. ReportingCountry 8. DateUsedForStatistics 7. Age 8. Gender 9. Outcome 10. DateOfOnset 11. DateOfDiagnosis 12. DateOfNotification 15. Classification 16. ClinicalCriteria 17. LaboratoryResult 18. EpiLinked 1. RecordType 2. RecordTypeVersion 3. Subject 4. DataSource 5. AgeClass 6. Gender 7. ReportingCountry 8. DateUsedForStatistics 7. Classification 8. Number of cases 1. RecordType 2. RecordTypeVersion 3. Subject 4. DataSource 5. AgeClass 6. Gender 7. ReportingCountry 8. DateUsedForStatistics* 7. Classification 8. Number of cases 1. RecordType 2. RecordTypeVersion 3. Subject 4. DataSource 5. DateUsedForStatistics 6. ReportingCountry 7. NumberOfTests Disease-specific set of variables 19. HIVType 20. Stage 21. Transmission 22. TransmissionHetero 23. TransmissionMTCT 24. HIVStatus 25. DateOfAIDSDiagnosis 26. DateOfDeath 27. CountryOfBirth 28. CountryOfNationality 29. RegionOfOrigin 30. CD4Cells 31. ProbableCountryOfInfection 19. HIVType 20. ARTTreatment 21. Transmission 22. TransmissionHetero 23. TransmissionMTCT 24. DateOfHIVDiagnosis 25. DateOfDeath 26. DateOfReportDeath 27. CountryOfBirth 28. CountryOfNationality 29. RegionOfOrigin 30. AIDSIndicatorDisease 31. AgeClass 11. Transmission 11. Transmission * Additional optional variables ‘PlaceOfNotification’ and ‘PlaceOfResidence’ were added from TESSy metadataset 20 for all diseases. 90 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Annex 3 Completeness of variables for data reported in 2012 and 2013 HIV dataset 2012 2013 Number of countries Completeness % Minimal Maximal Number of countries Completeness % Minimal Maximal HIV dataset Age 49 99.8 80.0 100 48 99.8 83.3 100 Gender 49 99.6 91.3 100 48 99.6 85.8 100 Outcome 40 33.0 0.2 100 41 33.0 0.2 100 Date of onset 16 4.1 0.4 100 19 3.7 0.3 100 Date of diagnosis 49 100.0 100.0 100 48 100.0 100.0 100 Date of notification 41 47.1 15.6 100 41 43.7 19.1 100 Date used for statistics 49 100.0 100.0 100 48 100.0 100.0 100 HIV type 46 67.8 67.8 100 46 64.6 64.6 100 Stage 44 39.4 5.9 100 45 35.1 3.4 100 Transmission 49 88.2 21.1 100 48 87.0 9.1 100 Transmission/hetero 49 70.8 20.0 100 48 65.8 34.9 100 Transmission/MTCT 49 87.9 21.1 100 48 86.7 9.1 100 HIV status 46 67.8 67.8 100 46 64.6 64.6 100 Date of AIDS diagnosis 43 37.7 5.9 100 45 33.7 3.4 100 Date of death 40 33.0 0.9 100 41 33.0 0.5 100 Country of birth 46 67.8 67.8 100 46 64.2 64.2 100 Country of nationality 45 62.1 4.7 100 45 58.4 58.4 100 Region of origin 46 67.8 67.8 100 46 64.6 64.6 100 CD4 cell count 33 38.3 1.2 98.3 35 35.1 7.5 97.7 Probable country of infection 38 54.6 10.0 100 37 51.1 41.7 100 AIDS dataset Age 46 100.0 83.3 100 46 99.9 70.0 100 Gender 46 100.0 99.7 100 46 100.0 99.5 100 Outcome 44 70.2 6.3 100 45 75.9 3.7 100 Date of onset 11 7.0 0.2 100 11 8.4 2.9 100 Date of diagnosis 46 100.0 100.0 100 46 100.0 100.0 100 Date of notification 45 99.3 3.6 100 45 99.3 5.9 100 Date used for statistics 46 100.0 100.0 100 46 100.0 100.0 100 HIV type 46 100.0 100.0 100 46 100.0 100.0 100 ART treatment 45 94.7 94.7 100 45 95.0 95.0 100 Transmission 46 90.4 48.4 100 45 89.3 57.0 100 Transmission/hetero 46 90.5 48.4 100 46 89.3 57.0 100 Transmission/MTCT 46 90.4 48.4 100 45 89.3 57.0 100 Date of HIV 43 95.2 28.1 100 44 97.1 55.3 100 Date of death 43 69.2 6.3 100 45 75.0 3.7 100 Date of reported death 42 67.7 6.3 100 45 74.4 3.7 100 Country of birth 46 100.0 98.7 100 46 100.0 100.0 100 Country of nationality 45 99.5 99.5 100 45 99.4 99.4 100 Region of origin 46 100.0 100.0 100 46 100.0 100.0 100 AIDS indicator disease 46 100.0 100.0 100 46 100.0 100.0 100 91 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Annex 4a HIV surveillance system overview: data source information Country Data source Type Period Legal Coverage EU/EEA Austria AT-HIV C 1979–2013 V Co Belgium BE-HIV/AIDS C 1980–2013 V Co Bulgaria BG-HIV C 1986–2013 C Co Cyprus CY-HIV/AIDS C 1986–2013 C Co Croatia HR-CNIPH C 1985–2013 C Co Czech Republic CZ-HIV/AIDS C 1985–2013 C Co Denmark DK-HIV C 1990–2013 C Co Estonia EE-HIV C 1988–2012 C Co Estonia EE-NAKIS C 2013 C Co Finland FI-NIDR C 1980–2013 C Co France FR-MNOID-HIV C 2003–2013 C Co Germany DE-HIV-Pre-IfSG C 1993–2001 C Co Germany DE-SURVNET@RKI7.3-HIV C 2001–2013 C Co Greece GR-NOTIFIABLE_DISEASES C 1981–2013 C Co Hungary HU-HIV/AIDS C 1985–2013 C Co Iceland IS-SUBJECT_TO_REGISTRATION C 1983–2013 C Co Ireland IE-HIV/AIDS C 1981–2011 V Co Ireland IE-CIDR C 2012–2013 C Co Italy IT-COA-ISS C 2004–2013 C Co Latvia LV-HIV/AIDS C 1987–2013 C Co Lithuania LT-AIDS_CENTRE C 1988–2013 C Co Luxembourg LU-HIV C 1980–2013 V Co Malta MT-DISEASE_SURVEILLANCE C 1986–2013 C Co Netherlands NL-HIV/AIDS C 1980–2013 V Co Norway NO-MSIS_B C 1980–2013 C Co Poland PL-HIV C 1985–2013 C Co Portugal PT-HIV/AIDS C 1983–2013 C Co Romania RO-RSS C 1987–2013 C Co Slovakia SK-EPIS C 1985–2013 C Co Slovenia SI-HIVSUR-HIV C 1985–2013 C Co Spain ES-HIV C 2003–2013 C Co Sweden SE-SweHIVReg C 1983–2009 C Co Sweden SE-SmiNet C 2010–2013 C Co United Kingdom UK-HIV C 1981–2013 V Co Non-EU/EEA Albania AL-NIoPH C 1993–2013 C Co Andorra AD-MoHWFH C 2004–2013 V Co Armenia AM-NAC C 1988–2013 V Co Azerbaijan AZ-AIDS-CENTER C 1987–2013 V Se Belarus BY-NAC C 1981–2013 C Co Bosnia and Herzegovina BA-FMoH-MoHSWRS C 1986–2013 C Co former Yugoslav Republic of Macedonia, the MK-NHASS C 1987–2013 C Co Georgia GE-IDACIRC C 1989–2013 C Co Israel IL-MOH C 1980–2013 C Co Kazakhstan KZ-RCfAPC A 1987–2013 NS/unk NS/unk Kyrgyzstan KG-RCfAPC-GEN C 1987–2007 V Co Kyrgyzstan KG-HIV KG 2008 C 2008–2013 - - Moldova, Republic of MD-NAC A 1987–2006 V Other Moldova, Republic of MD-NAC C 2012–2013 V Other Moldova, Republic of MD-NAC-NCfPC-GEN C 2008–2011 NS/unk NS/unk Montenegro ME-IOPH C 1989–2013 C Co Monaco MC-MoSH-GEN C 1985–2013 C Co Russia RU-MOH A 2010–2010 C Co San Marino SM-AIDS/HIV A 1985–2013 C Co Serbia RS-NAC C 1984–2013 C Co Serbia RS-Kosova NIPH C 2000–2013 C Co Switzerland CH-FOPH C 1985–2013 C Co Tajikistan TJ-RHAC C 1991–2013 C Co Turkey TR-MOH C 1984–2013 C Co Turkmenistan TM-NAC C 1981–2012 V Co Ukraine UA-NAC A 1987–2013 V Other Uzbekistan UZ-RAC C 1981–2010 V Co Type: aggregated (A), case-based (C ) Legal: voluntary reporting (V), compulsory reporting (C ), not specified/unknown (NS/unk) Coverage: sentinel system (Se), comprehensive (Co), not specified/unknown (NS/unk) 92 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Annex 4b AIDS surveillance system overview: data source information Country Data source Type Period Legal Coverage EU/EEA Austria AT-AIDS C 1979–2013 V Co Belgium BE-HIV/AIDS C 1978–2013 V Co Bulgaria BG-AIDS C 1987–2013 C Co Cyprus CY-HIV/AIDS C 1986–2013 C Co Croatia HR-CNIPH C 1985–2013 C Co Czech Republic CZ-HIV/AIDS C 1985–2013 C Co Denmark DK-MIS C 1980–2013 C Co Estonia EE-AIDS C 1988–2012 C Co Estonia EE-NAKIS C 2013 C Co Finland FI-NIDR C 1980–2013 C Co France FR-AIDS C 1978–2013 C Co Germany DE-AIDS C 1970–2013 V Co Greece GR-NOTIFIABLE_DISEASES C 1981–2013 C Co Hungary HU-HIV/AIDS C 1985–2013 C Co Iceland IS-SUBJECT_TO_REGISTRATION C 1983–2013 C Co Ireland IE-HIV/AIDS C 1981–2011 V Co Ireland IE-CIDR C 2012–2013 V Co Italy IT-COA-ISS C 1982–2013 C Co Latvia LV-AIDS C 1990–2013 C Co Lithuania LT-AIDS_CENTRE C 1988–2013 C Co Luxembourg LU-AIDS C 1980–2013 V Co Malta MT-DISEASE_SURVEILLANCE C 1986–2013 C Co Netherlands NL-HIV/AIDS C 1983–2013 V Co Norway NO-MSIS_A C 1980–2013 C Co Poland PL-AIDS C 1985–2013 C Co Portugal PT-HIV/AIDS C 1983–2013 C Co Romania RO-RSS C 1985–2013 C Co Slovakia SK-EPIS C 1985–2013 C Co Slovenia SI-HIVSUR C 1985–2013 C Co Spain ES-AIDS C 1981–2013 C Co Sweden SE-SweHIVReg C 1982–2007 C Co United Kingdom UK-AIDS C 1980–2013 V Co Non-EU/EEA Albania AL-NIoPH C 1993–2013 C Co Andorra AD-MoHWFH C 2004–2013 V Co Armenia AM-NAC C 1988–2013 V Co Azerbaijan AZ-AIDS-CENTER C 1987–2013 V Se Belarus BY-NAC C 1991–2013 C Co Bosnia and Herzegovina BA-FMoH-MoHSWRS C 1986–2013 C Co former Yugoslav Republic of Macedonia, the MK-NHASS C 1987–2013 C Co Georgia GE-IDACIRC C 1989–2013 C Co Israel IL-MOH C 1980–2013 C Co Kazakhstan KZ-RCfAPC C 1993–2013 NS NS Kyrgyzstan KG-RCfAPC-GEN C 1987–2007 V Co Kyrgyzstan KG-HIV KG 2008 C 2008–2013 NS NS Moldova, Republic of MD-NAC C 1989–2007 V Co Moldova, Republic of MD-NAC-NCfPC-GEN C 2008–2011 NS NS Moldova, Republic of MD-NAC C 2012–2013 V Co Monaco MC-MoSH-GEN C 1985–2013 C Co Montenegro ME-IOPH C 1990–2013 C Co Russia - - – - - San Marino SM-AIDS/HIV C 1985–2013 C Co Serbia RS-NAC C 1985–2013 C Co Serbia RS-Kosova NIPH C 1986–2013 C Co Switzerland CH-FOPH C 1980–2013 C Co Tajikistan TJ-RHAC C 1998–2013 C Co Turkey TR-MOH C 1984–2013 C Co Turkmenistan TM-NAC C 1981–2006 V Co Turkmenistan TM-NAC C 2008–2012 V Co Ukraine UA-NAC C 1988–2013 V Co Uzbekistan UZ-RAC C 1992–2010 V Co Type: aggregated (A), case-based (C ) Legal: voluntary reporting (V), compulsory reporting (C ), not specified/unknown (NS/unk) Coverage: sentinel system (Se), comprehensive (Co), not specified/unknown (NS/unk) 93 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Annex 5 Country-specific comments regarding national HIV and AIDS reporting Country Comments EU/EEA Bulgaria Case-based reporting of HIV is available from 2007 onwards. Czech Republic Foreigners with short-time stays in the Czech Republic are not included in reported data. Estonia Surveillance system was substantially modified in 2008. Previously, the probable mode of HIV transmission was not reported by Estonia (from 2003 to 2007 Estonia supplied partial information on PWID only). France Case-based data reported through TESSy are not exhaustive, because of reporting delays (cases reported several months or several years after the diagnosis) but also because of underreporting (cases that are diagnosed but never reported). The most recent estimates of underreporting are 41% in 2007–2009 for AIDS and 29% in 2013 for HIV in France. To assess the real the number of HIV and AIDS diagnoses in France it is essential to use adjusted data, which take into account both reporting delays (for 2012–2013) and underreporting (for 2003–2013). Adjusting for these factors, the estimated number of new HIV diagnoses in 2013 is 6220 95%CI [5759-6682] and estimated number of new AIDS diagnoses is 1212 95% CI [1092-1333]. Ireland HIV was made a notifiable disease in September 2011. 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. Italy New HIV diagnoses were reported by 10 of the 22 Italian regions between 2004 and 2006, 11 regions in 2007, 12 regions in 2008, 18 regions in 2009, and all of the 22 regions of Italy for 2012 and 2013. Between 2004 and 2011, population denominators are based on the annual resident population in the regions reporting cases. From 2012 the coverage of the surveillance system is national and, thus, the total Italian population is used as a denominator. AIDS deaths for years 2011, 2012, 2013 are not reported due to lack of updated data from the national mortality register. Liechtenstein Liechtenstein with only 35 000 inhabitants has small numbers of communicable diseases. Therefore public health authorities refrain from collecting data due to limited public health added value. In 1970 Liechtenstein adopted the Swiss Law of Epidemiology. Since then all communicable disease data are reported to the officials in Switzerland as demanded by the Federal Office of Public Health. Luxembourg HIV tests reported up to 2010 include only tests performed at two major public laboratories and, thus, underestimate the total number of HIV tests performed during those years. From 2011, tests reported include all laboratories in the country. Malta New HIV reporting system started in 2004. Netherlands New HIV reporting system started in 2002; 2002 data include many cases diagnosed in previous years. Data prior to 2002 are from a national cohort of HIV-positive adults receiving antiretroviral therapy; 1999 data include many cases diagnosed in previous years. Portugal PT-HIV database is now fully case-based containing details of cases diagnosed from 1983. In 2013, the Portuguese HIV/AIDS Programme implemented a strategy to address underreporting and reporting delay, resulting in significant increases in the number of reported cases which were diagnosed between 1983 and 2012 which are reflected in the present report. Romania New HIV diagnoses who have AIDS are reported only in in the AIDS database and AIDS tables. The total number of new HIV diagnoses for Romania is a sum of the HIV and AIDS case reports for any given year. Data on AIDS deaths for 2013 are not complete and will be updated in future reporting years. Spain HIV reporting has existed since the 1980s in some of the 19 Autonomous Regions of Spain. For 2003–11 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). Since 2013 data are available for all the 19 Regions of Spain (+ Andalucía). Rates based on the corresponding populations for each year. AIDS reporting, 2013: for technical reasons, it has not been possible to include data from one region. Rates in 2013 are based on the corresponding population. Sweden Due to changes in the HIV/AIDS surveillance system, AIDS reporting has not been mandatory since 2000. Since 2008, no AIDS data are reported from Sweden because the national AIDS surveillance system has been discontinued. Non-EU/EEA Andorra New HIV reporting system started in 2004; 2004 data include many cases diagnosed in previous years. Moldova Official data on incidence rates in the Republic of Moldova may vary from these ones, given that the incidence rate in Moldova is reported for both banks of the Dniester River, while the denominator is not inclusive of the left bank of the river (Transnistrian region). Serbia Updated information from national statistics for two AIDS diagnoses was reported as date of diagnosis in 2008 instead of 2009. Ukraine HIV cases in persons infected through mother-to-child transmission are not available for the years before 2005 while data for 2005–2007 are calculated from best available data, 2008–2011 data are validated and final, and data for 2012 and 2013 are operational and may be adjusted in the coming few years. 94 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2013 Annex 6 HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients*, EU/EEA countries, 2010–2013 Country** 2010 2011 2012 2013 Adjustment coefficients* N Rate N Rate N Rate N Rate 2010 2011 2012 2013 EU/EEA Austria 321 3.8 314 3.7 320 3.8 260 3.1 0 0 0 0 Belgium 1 199 11.1 1 183 10.8 1 229 11.1 1 115 10.0 0 0 0 0 Bulgaria 163 2.2 201 2.7 157 2.1 200 2.7 0 0 0 0 Croatia 54 1.2 70 1.6 77 1.8 74 1.7 0 0 0 0 Cyprus 41 5.0 54 6.4 58 6.7 54 6.2 0 0 0 0 Czech Republic 156 1.5 180 1.7 153 1.5 212 2.0 0 0 0 0 Denmark 275 5.0 266 4.8 201 3.6 233 4.2 0 0 0 0.1 Estonia 376 28.2 366 27.5 315 23.8 325 24.6 0 0 0 0 Finland 185 3.5 173 3.2 158 2.9 160 2.9 <0.01 <0.01 <0.01 0.04 France*** 6 240 9.7 6 085 9.3 6 217 9.5 6 220 9.4 <0.01 <0.01 0.01 0.26 Germany 2 723 3.3 2 702 3.3 2 975 3.6 3 263 4.0 0 0 0 0 Greece 634 5.7 960 8.6 1 167 10.5 910 8.2 <0.01 <0.01 0.01 0.08 Hungary 182 1.8 162 1.7 219 2.2 240 2.4 0 0 0 0 Iceland 24 7.6 23 7.2 19 5.9 11 3.4 0 0 0 0 Ireland 330 7.3 327 7.2 351 7.7 332 7.2 0 0 0 0 Italy 3 980 6.7 3 838 6.5 4 098 6.9 3 608 6.0 0 0 0 0 Latvia 274 12.9 299 14.4 339 16.6 340 16.8 0 0 0 0 Lithuania 153 4.9 166 5.4 160 5.3 177 6.0 0 0 0 0 Luxembourg 52 10.4 52 10.2 58 11.1 53 9.9 0 0 0 0 Malta 18 4.3 21 5.1 30 7.2 36 8.5 0 0 0 0 Netherlands 1 209 7.3 1 162 7.0 1 093 6.5 1 078 6.4 <0.01 0.02 0.02 0.15 Norway 258 5.3 269 5.5 242 4.9 233 4.6 0 0 0 0.15 Poland 956 2.5 1 150 3.0 1 153 3.0 1 279 3.3 0.01 0.01 0.02 0.17 Portugal 1 824 17.5 1 613 15.7 1 542 14.7 1 289 12.3 0.02 0.06 0.05 0.18 Romania 274 1.4 427 2.1 489 2.4 507 2.5 0 0 0 0 Slovakia 35 1.7 55 2.7 45 2.2 44 2.1 0 0 0 0 Slovenia 35 1.7 55 2.7 45 2.2 46 2.2 0 0 0 0.1 Spain 3 666 11.2 3 390 10.3 3 611 9.5 3 278 7.0 0 0 0 0 Sweden 473 5.1 411 4.4 410 4.3 406 4.2 0.01 0.02 0.02 0.06 United Kingdom 6 476 10.4 6 392 10.2 6 554 10.3 5 994 9.4 0.01 0.02 0.03 0.35 Total EU/EEA 32 586 6.6 32 366 6.5 33 485 6.7 31 977 6.2 <0.01 0.01 0.02 0.07 * The coefficients present the adjustments for the current year of reporting ** Country-specific comments are in Annex 5 *** French data are adjusted for both reporting delay and underreporting. Adjustment coefficients reported are for reporting delay only. 95 HIV/AIDS surveillance in Europe 2013SURVEILLANCE REPORT Annex 7 HIV/AIDS surveillance in Europe: participating countries and national institutions Country National institutions EU/EEA Austria Federal Ministry of Health, Family and Youth Belgium Scientific Institute of Public Health Bulgaria Ministry of Health Croatia Croatian National Institute of Public Health Cyprus Ministry of Health Czech Republic National Institute of Public Health Denmark Statens Serum Institut Estonia Health Board Finland National Public Health Institute (KTL) France Institut de veille sanitaire 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 Lithuania Center for Communicable Diseases and AIDS Luxembourg National Service of Infectious Diseases, Centre Hospitalier Malta Department of Health Promotion and Disease Prevention Netherlands National Institute for Public Health and the Environment (RIVM) Norway Norwegian Institute of Public Health – Department of Infectious Disease Epidemiology Poland National Institute of Public Health – National Institute of Hygiene (NIZP-PZH) Portugal National Institute of Health Dr Ricardo Jorge (Instituto Nacional de Saúde Doutor Ricardo Jorge, I.P.) Romania Institute of Public Health and National Institute for Infectious Diseases "Prof. Dr. Matei Bals" Slovakia Regional Public Health Authority of capital Bratislava Slovenia National Institute of Public Health Spain Instituto de Salud Carlos III Centro Nacional de Epidemiologia Sweden Swedish Institute for Infectious Disease Control United Kingdom Public Health England Non-EU/EEA Albania Institute of Public Health Andorra Ministry of Health and Welfare Armenia National Center for AIDS Prevention Azerbaijan National AIDS Center Belarus National Centre for Hygiene, Epidemiology and Public Health Bosnia and Herzegovina Ministry of Health of Federation of Bosnia and Herzegovina; Public Health Institute of the Republika Srpska former Yugoslav Republic of Macedonia Public Health Institute Georgia Infectious Diseases, AIDS & Clinical Immunology Research Center-IDACIRC Israel Ministry of Health Kazakhstan State Committee for Sanitary Epidemiological Surveillance Kyrgyzstan Republican AIDS Centre Moldova National Center for Public Health; Hospital for Dermatology and Communicable Diseases Monaco Ministry of Health and Social Affairs Montenegro Institute of Public Health of Montenegro Russia Federal Scientific and Methodological Center for Prevention and Control of AIDS San Marino Ospedale di Stato Serbia Institute of Public Health of Serbia Switzerland Bundesamt für Gesundheit Tajikistan Republican HIV/AIDS Center Turkey Ministry of Health Turkmenistan National AIDS Prevention Center Ukraine National AIDS Center Uzbekistan Republican Center to fight AIDS

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Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Publications

Дата принятия 27 ноября 2014 г.

Источник Всемирная организация здравоохранения