HIV/AIDS surveillance in Europe 2021: 2020 data

HIV/AIDS surveillance in Europe 2020 data 2021

HIV/AIDS surveillance in Europe 2020 data 2021 ii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data This report has been published jointly by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe. The Regional Office developed the overview of the European Region as a whole and validated the figures of the non-member countries of the European Union (EU)/European Economic Area (EEA) and ECDC developed the overview of the EU/EEA countries and validated the EU/EEA figures. Suggested citation for full report: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2021 – 2020 data. Stockholm: ECDC; 2021. Tables and figures should be referenced: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2021 – 2020 data. This publication follows the ECDC terminological practice which reflects the European Union Inter-institutional Style Guide with regard to names and designations of countries. The names and designations of countries used in this publication should not be understood as an endorsement by WHO of the terminology used in this publication. The designations used do not represent WHO’s official position on the legal status of any country or of its authorities, or the delimitation of its frontiers and boundaries. ECDC has amended the maps supplied by the WHO Regional Office for Europe for this publication. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the WHO Secretariat concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. The WHO Regional Office for Europe is responsible for the accuracy of the translation of the Russian summary. Keywords: ACQUIRED IMMUNODEFICIENCY SYNDROME – EPIDEMIOLOGY AIDS AND ITS CONTROL DISEASE OUTBREAKS – STATISTICS HIV INFECTIONS – EPIDEMIOLOGY POPULATION SURVEILLANCE © European Centre for Disease Prevention and Control, 2021 Reproduction is authorised, provided the source is acknowledged. Cover picture: NIAID © World Health Organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecom- mons.org/licenses/by-nc-sa/3.0/igo). The report was coordinated by Anastasia Pharris (European Centre for Disease Prevention and Control (ECDC)) and Giorgi Kuchukhidze (WHO Regional Office for Europe). Review and production support was provided by Mike Catchpole1, Karl Ekdahl1, Esther Kissling3, Vicky Lefevre3, Antons Mozalevskis2, Stine Nielsen4, Teymur Noori1, Adrian Prodan1, Magdalena Rosinska5, Nicole Seguy2, Marieke van der Werf1, and Elena Vovc2. 1. ECDC 2. WHO Regional Office for Europe 3. EpiConcept 4. Freelance consultant 5. National Institute of Public Health NIH - National Research Poland. ECDC and WHO’s Regional Office for Europe would like to thank the nominated operational contact points for HIV/AIDS surveillance from European Union/European Economic Area (EU/EEA) Member States and the HIV/AIDS surveillance focal points from the non-EU/EEA Member States and areas of the WHO European Region for providing data and valuable comments on this report: Albania: Marjeta Dervishi; Andorra: Jennifer Fernández Garcia; Armenia: Marietta Mirzoyan; Austria: Daniela Schmid, Ziad El-Khatib; Azerbaijan: Farhad Singatulov, Shahin Khasiyev; Belarus: Svetlana Sergeenko; Belgium: Dominique Van Beckhoven; Bosnia and Herzegovina: Dušan Kojić; Bulgaria: Tonka Varleva; Croatia: Tatjana Nemeth Blazic; Cyprus: Linos Hadjihannas, Anna Demetriou; Czech Republic: Marek Maly; Denmark: Susan Cowan; Estonia: Kristi Rüütel; Finland: Kirsi Liitsola, Mika Salminen; France: Françoise Cazein, Josiane Pillonel, Florence Lot; Georgia: Otar Chokoshvili, Maia Tsereteli; Germany: Barbara Gunsenheimer-Bartmeyer; Greece: Vasilios Raftopoulos, Stavros Patrinos; Hungary: Maria Dudas; Iceland: Marianna Thordardottir, Gudrun Aspelund; Ireland: Derval Igoe, Kate O’Donnell; Israel: Daniel Chemtob, Yana Levin; Italy: Barbara Suligoi; Kazakhstan: Lolita Ganina, Gulnar Temirkhanov; Kyrgyzstan: Aigul Solpueva; Latvia: Šarlote Konova; Liechtenstein: Silvia Dehler, Esther Walser-Domjan; Lithuania: Rasa Liausėdienė, Brigita Kairienė; Luxembourg: Carole Devaux, Jean-Claude Schmit; Malta: Jackie Maistre Melillo, Tanya Melillo; Moldova: Silvia Stratulat, Stepan Gheorghita; Monaco: Dominique De Furst; Montenegro: Alma Cicic; Netherlands: Eline Op de Coul, Ard van Sighem; North Macedonia: Milena Stefanovic, Zarko Karadzovski, Rumena Gerdovska; Norway: Hilde Klovstad; Poland: Marta Niedźwiedzka-Stadnik, Magdalena Rosinska; Portugal: Margarida Tavares, Helena Cortes Martins; Romania: Mariana Mardarescu; Russian Federation: Irina Kulikova, Oleg Sonin, Alexey Mazus, Grigoriy Kaminskiy; San Marino: Andrea Gualtieri, Mauro Fiorini; Serbia: Danijela Simic; Slovakia: Peter Truska; Slovenia: Irena Klavs, Tanja Kustec; Spain: Asuncion Diaz; Sweden: Maria Axelsson; Switzerland: Martin Gebhardt; Tajikistan: Kholnazarov Ramshed, Zukhra Nurlaminova; Turkey: Emel Özdemir Şahin; Ukraine: Ihor Kuzin, Violetta Martsynovska; and United Kingdom: Valerie Delpech. For Kosovo*: Luljeta Gashi. * For the purposes of this publication, all references to ‘Kosovo’, including in the bibliography, should be understood/read as “Kosovo (in accordance with Security Council resolution 1244 (1999))”. ECDC PDF ISBN 978-92-9498-559-0 ISSN 2363-3085 doi:10.2900/65321 TQ-AL-21-001-EN-N WHO ISBN 978-92-890-5639-7 iii HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Contents Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Overview of HIV and AIDS in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii 1. HIV and AIDS in the EU/EEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1.1. HIV diagnoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1.2. Trends in HIV diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.3. AIDS cases, morbidity and mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.4. HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 1.5. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 2. HIV and AIDS in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.1. HIV and AIDS diagnoses in the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.2. HIV and AIDS diagnoses in the East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 2.3. HIV and AIDS diagnoses in the Centre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 2.4. HIV and AIDS diagnoses in the West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2.5. HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 2.6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Figures Figure A: Is your 2020 HIV/AIDS surveillance data affected by reduced detection of HIV cases compared to data from 2019 or earlier? WHO/ECDC 2021 COVID-19 survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Figure B: Reported new HIV diagnoses in the EU/EEA and WHO European Region, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xii Figure C: Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission, WHO European Region, 2020 (n = 32 336) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii Рис. A: Отразилось ли на ваших данных эпиднадзора за ВИЧ/СПИДом за 2020 г. сокращение выявления случаев ВИЧ-инфекции в сравнении с данными за 2019 г. или более ранними? Опрос ВОЗ/ECDC 2021 г. о COVID-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Рис. B: Новые диагнозы ВИЧ-инфекции, зарегистрированные в ЕС/ЕЭЗ и Европейском регионе ВОЗ, 2011–2020 гг.. . . . . . . . . . . . . . . . . . . . . . . . . . .xx Рис. C: Доля людей, диагностированных на поздних стадиях (количество клеток CD4 < 350 в мм3) с разбивкой по полу, возрасту и путям передачи, Европейский регион ВОЗ, 2020 г. (n = 32 336) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxi Figure 1.1: Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2020 (n=14 844). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Figure 1.2: Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2020 (n=12 903) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure 1.3: New HIV diagnoses, by age group (in years) and transmission mode, EU/EEA, 2020 (n=10 819) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure 1.4: Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2020 (n = 14 971) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Figure 1.5: Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2020 (n = 10 949). . 4 Figure 1.6: Percentage of new HIV diagnoses among migrants out of all reported cases with known information on region of origin, by country of report, EU/EEA, 2020 (n = 12 327) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Figure 1.7: Acute infection or CD4 cell count per mm3 at HIV diagnosis, overall and by transmission group, EU/EEA, 2020 (n=9 194) . . . . . . . . . . . . . . . 5 Figure 1.8: Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2020 (n = 8 617) . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Figure 1.9: Linkage to care after HIV diagnosis in the EU/EEA, 2020 (n = 8297). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Figure 1.10: People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Figure 1.11a: Age-specific trends in new HIV diagnoses in women, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Figure 1.11b: Age-specific trends in new HIV diagnoses in men, 2011–2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Figure 1.12: Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2011–2020. . . . . . . . . . . . . 8 Figure 1.13a: HIV diagnoses, by year of diagnosis and transmission mode, EU/EEA, 2011–2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 iv SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Figure 1.13b: Percentage of HIV diagnoses, by year of diagnosis and transmission mode, EU/EEA, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Figure 1.14: New HIV diagnoses, by year of diagnosis, transmission and migration status, adjusted for reporting delay, EU/EEA, 2011–2020 . . .10 Figure 1.15: Number of HIV diagnoses by acute infection or CD4 cell count at diagnosis, EU/EEA, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Figure 1.16: AIDS diagnoses, by transmission mode, EU/EEA, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Figure 1.17: Proportion of persons diagnosed with AIDS with tuberculosis as an AIDS-defining illness, EU/EEA, 2020 (n = 1 940). . . . . . . . . . . . . . . . . . . 11 Figure 2.1: New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2020 (n = 30 424) . . . . . .16 Figure 2.2: New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Figure 2.3: New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Figure 2.4: New AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2011–2020 . . . . . .18 Figure 2.5: Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country, East, 2020 (n = 84 556; 54 228) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Figure 2.6: New HIV diagnoses, by country and transmission mode, East, 2020 (n = 84 556) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Figure 2.7: New HIV diagnoses, by age group and transmission mode, East, 2020 (n = 79 204) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Figure 2.8: New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2020 (n = 20 092). . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Figure 2.9: New HIV diagnoses, by transmission mode and year of diagnosis, East, 2011–2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Figure 2.10: Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2011–2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Figure 2.11: New AIDS diagnoses, by transmission mode and year of diagnosis, East, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Figure 2.12: Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Figure 2.13: Male-to-female ratio in new HIV diagnoses, by country, Centre, 2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Figure 2.14: New HIV diagnoses by country and transmission mode, Centre, 2020 (n = 4 427) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Figure 2.15: New HIV diagnoses, by CD4 cell count per mm3 category at diagnosis and transmission mode, Centre, 2020 (n = 1 379) . . . . . . . . . . . . . . 26 Figure 2.16: New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Figure 2.17: New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Figure 2.18: New HIV diagnoses, by transmission mode and year of diagnosis, West, 2011–2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Figure 2.19: New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2011–2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Figure A1: Geographical/epidemiological division of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Table A: Characteristics of new HIV and AIDS diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the WHO European Region, 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x Таблица A: Характеристики новых диагнозов ВИЧ-инфекции и СПИДа, зарегистрированных в Европейском регионе ВОЗ, ЕС/ ЕЭЗ, а также в западной, центральной и восточной части Европейского региона ВОЗ, 2020 г. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii Table 1: New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 2: New HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 3: New HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table 4: New HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 5: New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 6: New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 7: New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Table 8: HIV diagnoses in 2020, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 9: HIV diagnoses in 2020, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . 48 Table 10: HIV diagnoses, by country of report and region of origin, cases diagnosed in 2020, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 11: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2020 . . . . . . . . . . . .52 Table 12: New HIV diagnoses, by country of report and probable region of infection, in 2020, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Table 13: Percentage of new HIV diagnoses (2020) among persons >14 years reported with information about CD4 cell count, by CD4 cell count level (<200 and <350 cells per mm3 blood) and by transmission mode in cases with CD4 <350, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57 vHIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 14: AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 15: AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 16: AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 17: AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 18: AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 19: AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 20: AIDS diagnoses in people infected through mother to child transmission, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67 Table 21: AIDS diagnoses in 2020, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 22: The most common AIDS-indicative diseases diagnosed in 2020a, ordered by frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 23: AIDS-related deaths, by geographic area, country and year of death (2011–2020) and cumulative totals in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 24: Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2011–2020) and number of tests per 1 000 population in 2020, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . 72 Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Map 1a: New HIV diagnoses per 100 000 population, 2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Map 1b: New HIV diagnoses per 100 000 population, 2020, EU/EEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Map 2: New HIV diagnoses in men per 100 000 male population, 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Map 3: New HIV diagnoses in women per 100 000 female population, 2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Map 4: New HIV diagnoses in men who have sex with men per 100 000 male population, 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Map 5: New HIV diagnoses acquired through injecting drug use per 100 000 population, 2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Map 6: New HIV diagnoses acquired through heterosexual transmission per 100 000 population, 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 Map 7: Percentage of adult (>14 years) HIV diagnoses with CD4 <350 cells/mm3 at diagnosis, 2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 Map 8: AIDS diagnoses reported per 100 000 population, 2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

vii HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT AIDS acquired immunodeficiency syndrome ART antiretroviral treatment CI confidence interval ECDC European Centre for Disease Prevention and Control EU/EEA European Union/European Economic Area 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 PrEP pre-exposure prophylaxis TB tuberculosis TESSY The European Surveillance System SDGs (United Nations) Sustainable Development Goals UNSCR United Nations Security Council Resolution UNAIDS Joint United Nations Programme on HIV/AIDS WHO World Health Organization Abbreviations

ix HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT This report presents HIV/AIDS surveillance data for 2020, a period marked by the global COVID-19 pan- demic which affected Europe heavily from March 2020 onwards. To better understand the extent to which the pandemic affected 2020 HIV/AIDS surveillance data, the World Health Organization Regional Office for Europe and the European Centre for Disease Prevention and Control conducted a short survey that was sent to all 55 countries, territories and areas of the WHO European Region; 21 responses were received. The survey focused on the issues of reduced detection and reporting of HIV cases and on the issue of completeness of some enhanced variables. Overall, 12 of the 21 respondents, including eight of 15 respondents from the EU/EEA and four of six non-EU/EEA countries, reported reduced testing and detection of HIV cases which had affected their national HIV surveillance data (Fig. A). Countries that reported reduction in case detection were additionally asked to provide estimates of the magnitude of the reduction in HIV testing. On average, they indicated a 20% reduction in case detec- tion in 2020 compared to the earlier years. One-third of countries responding (seven of 21) indicated that limited surveillance capacity had led to reduced reporting of HIV cases in 2020. This was less the case for the EU/EEA countries (4/15) than for the non-EU coun- tries (3/6). Countries that reported limited surveillance capacity affecting HIV surveillance capacity estimated on average a 30% reduction in reporting of HIV cases compared to previous years. Countries were also asked if they had experienced a reduced completeness for some enhanced variables. The most affected variables were CD4 cell count at the time of diagnosis (8/21) and reported mode of HIV transmis- sion (6/21). Through the responses to the open-ended question in the survey, we learned that movement restrictions, as part of the public health and social measures against COVID-19 pandemic, were associated not only with a reduction in the actual testing services, but also with people not being able to seek testing and care services which led to the subsequent decline in the number of people newly diagnosed with HIV during the months of the lockdown. Despite the potential issues of under-diagnosis and under-reporting in 2020, 104 765 newly diagnosed HIV infections were reported in 46 of the 53 countries in the Region, including 14 971 from countries of the European Union/European Economic Area (EU/EEA)1. This corre- sponds to a crude rate of 11.8 newly diagnosed infections per 100 000 population in the Region overall (Table A). The trend that has persisted over the last decade contin- ues, with rates and overall numbers of people diagnosed with HIV highest in the East of the Region (32.6 per 100 000 population), lower in the West and the EU/ EEA (3.7 and 3.3 per 100 000, respectively) and lowest in the Centre (2.3 per 100 000) (Table A). The main transmission mode also varies by geographical area, illustrating the diversity in the epidemiology of HIV in Europe. Sexual transmission between men was the most common mode in the EU/EEA and West, while heterosexual transmission 1 A detailed framework for data collection, validation and presentation in this report can be found in the annex 1 Overview of HIV and AIDS in Europe Figure A: Is your 2020 HIV/AIDS surveillance data affected by reduced detection of HIV cases compared to data from 2019 or earlier? WHO/ECDC 2021 COVID-19 survey 0 20 40 60 80 100 Non-EU/EEA countries (n=6) EU/EEA countries (n=15) WHO European Region (n=21) Yes No Don’t know Percentage xSURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data and injecting drug use were the main reported transmis- sion modes in the East of the Region. Late HIV diagnosis remains a challenge for most coun- tries in the Region. The percentage of people newly diagnosed who were late presenters (CD4 less than 350/ mm3) varied across transmission categories and age groups but was highest for people with reported heterosexual transmission (56%) and lowest for men infected through sex with men (41%) (Fig. C). The per- centage increased with age, ranging from 33% among people aged 15–19 at diagnosis to 65% among those aged 50 years or above. In 2020, 7 721 people were diagnosed with AIDS, reported in 43 countries of the WHO European Region, and the rate of new diagnoses was 1.2 per 100 000 popu- lation (Table A; see also Table 14). In the EU/EEA, 1 760 people were diagnosed with AIDS in 2020; a rate of 0.5 per 100 000 population. The number of AIDS cases has continued to decline steadily in the West and the EU/ EEA over the last decade (see Fig. 1.17 and 2.4). At the same time, it has been increasing in the East, although it did begin to stabilise between 2012 and 2018 and even declined in 2019. In 2020, the rate declined even further, although this was possibly due to the reporting delay caused by the COVID-19 pandemic. European Union and European Economic Area In 2020, 14 971 new HIV diagnoses were reported in 29 countries of the EU/EEA2, with a rate of 3.7 per 100 000 when adjusted for reporting delay (Table 1). The countries with the highest rates were Malta (15.9; 82 cases), Latvia (13.5; 257), Cyprus (11.8; 105), and Estonia (10.8; 143) 2 All EU/EEA reported data for 2020 but Portugal chose not to publish their data; Liechtenstein reported zero cases. and those with the lowest were Slovenia (1.3; 27 cases) and Austria (1.7; 155) (Table 1, Map 1). The rate of new HIV diagnoses was higher among men (5.2 per 100 000 population; Table 2) than women (1.5 per 100 000 popu- lation; Table 3). The overall male-to-female ratio was 3.2 (Table A). This ratio was highest in Hungary (11.1) and Slovakia (8.1) and was above one in all countries in the EU/EEA (Fig. 1.1). The predominant mode of transmission in countries with the highest male-to-female ratios was sex between men. Men had higher age-specific rates than women in all age groups except people under 15 years, where age-specific rates were similarly low (Fig. 1.2). The highest overall age-specific rate of HIV diagnoses was observed among 25–29-year-olds (8.0 per 100 000 population), largely because this age group has the highest age-specific rate for men at 12.1 per 100 000 population, while rates for women were highest in the 30–39 year age group (4.0 per 100 000 population) (Fig. 1.2). Young people aged 15–24 years comprised 11% of the EU/EEA population and 9.9% of HIV diagnoses in 2020 (Fig. 1.4, Table 9). Forty-one per cent of the EU/EEA population consisted of older adults (50 years and above) who comprised 21% of the new HIV diagnoses reported in 2020. Sex between men remains the predominant mode of HIV transmission reported in the EU/EEA, accounting for 39% (5 815) of all new HIV diagnoses in 2020 and more than half (53%) of diagnoses where the route of transmission was known (Table 4, Table 8, Fig. 1.5). Among those with known route of HIV transmission, sex between men accounted for more than 60% of new HIV diagnoses in eight countries (Croatia, Cyprus, Hungary, Iceland, Netherlands, Poland, Slovakia, Spain) (Fig. 1.5). Heterosexual contact was the second most common reported mode of HIV transmission in the EU/EEA in 2020, accounting for 29.6% (4 445) of HIV diagnoses Table A: Characteristics of new HIV and AIDS diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the WHO European Region, 2020 WHO European Region West Centre East EU/EEA Reporting countries/number of countriesa 46/53 20/23 13/15 13/15 29/30 Number of new HIV diagnoses 104 765 15 782 4 427 84 556 14 971 Rate of HIV diagnoses per 100 000 populationb 11.8 3.7 2.3 32.6 3.7 Percentage age 15–24 years 5.4% 9.5% 15.0% 4.2% 9.9% Percentage age 50+ years 14.4% 22.9% 13.8% 12.9% 20.9% Male-to-female ratio 1.9 3.0 5.3 1.6 3.2 Transmission mode Sex between men 9.4% 39.2% 28.0% 2.9% 38.8% Heterosexual transmission (men) 29.7% 14.5% 19.2% 33.1% 14.1% Heterosexual transmission (women) 27.9% 16.9% 8.1% 31.0% 15.5% Injecting drug use 22.4% 3.3% 2.2% 27.0% 3.8% Mother-to-child transmission 0.4% 0.6% 0.6% 0.4% 0.6% Unknown 10.0% 25.0% 41.9% 5.6% 26.9% AIDS and Late HIV Diagnosis Percentage new HIV diagnoses CD4 <350 cells/mm3 36.1% 51.1% 45.6% 34.4% 51.0% Number of new AIDS diagnosesc 7 721 1 549 467 5 705 1 760 Rate of AIDS diagnoses per 100 000 population 1.2 0.5 0.2 5.0 0.5 a No data received from Andorra, Bosnia and Herzegovina, Monaco, North Macedonia, Turkmenistan and Uzbekistan. Data from Portugal not published at country request. b EU/EEA rates are adjusted for reporting delay; the corresponding estimated number of new diagnoses adjusted for reporting delay is 16 917. c No data received from Andorra, Bosnia and Herzegovina, Germany, Monaco, North Macedonia, Russian Federation, Sweden, Turkmenistan and Uzbekistan. Data from Portugal not published at country request. xi HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT and 41% of diagnoses where the route of transmission was known (Table 6, Table 8, Fig. 1.5). Heterosexual transmission was the most commonly reported known mode of transmission in six EU/EEA countries (Estonia, Finland, Latvia, Luxembourg, Romania, Sweden). Transmission due to injecting drug use accounted for 3.8% of HIV diagnoses in 2020 and was the probable route of transmission for one-quarter of the cases diag- nosed in Latvia and 18% of cases diagnosed in Greece (Table 5, Table 8, Fig. 1.5). Vertical transmission accounted for less than 1% of new HIV diagnoses in the EU/EEA in 2020, while the trans- mission mode was not reported or reported as unknown for 26.9% of new HIV diagnoses (Table A). Forty-four per cent of those diagnosed in the EU/EEA in 2020 were migrants, defined as originating from outside of the country in which they were diagnosed (Fig. 1.6), with 15% originating from countries in sub- Saharan Africa, 10% from countries in Latin America and the Caribbean, 9% from other countries in central and eastern Europe and 3% from other countries in western Europe. The trend in rates of reported HIV diagnoses have been on the decline since a peak in 2012. At the begin- ning of this period EU/EEA rates were 6.0 per 100 000, after which they decreased steadily to 5.5 per 100 000 in 2017 and 4.8 in 2019 (Table 1, Fig. 1.10, Annexes 1 and 5). The adjusted rate for 2020 declined sharply to 3.7 per 100 000, however this is probably due in part to decreased case detection as a result of less testing, given the public health restrictions associated with the COVID-19 pandemic. Among the eight EU/EEA coun- tries that reported data on testing rates throughout the period, the number of tests performed declined by 13% in 2020 compared to 2019. While the overall EU/ EEA trend appears to have declined over the past decade, trends at national level vary. About 2/3 of EU/ EEA coun- tries are seeing a decline in rates of new diagnoses, even after adjustment for changes in population cov- erage of surveillance over time and reporting delay. In contrast, since 2011, and taking reporting delay into account, rates of HIV diagnoses have more than dou- bled in Malta and Slovakia and have increased by more than 50% in Cyprus and Czechia (Table 1, Annex 6). The impact of delayed HIV case detection due to COVID-19 measures is not yet fully understood but reporting delay could lead to an overestimation of the decrease in rates of new HIV diagnoses. Trends differ by gender and age group. Age-specific rates have declined since 2011 in all age groups, although some of this reported decline may be due to delayed case detection in 2020 rather than a true decline in the rate. Throughout the period 2011–2020, HIV diagnosis rates in both women and men have consistently been higher among 25–29-year-olds and 30–39-year-olds compared to other age groups. Age-specific rates in women have declined most markedly in those under 40 years, while rates in men have declined substantially in all groups under 50 years. (Fig. 1.11a, 1.11b). The proportion of all HIV diagnoses attributed to sex between men was fairly stable between 2011 and 2020, increasing from 47% of cases in 2011 to 51% in 2016, then decreasing to 49% in 2020 (Figures 1.13a and 1.13b). The number of HIV diagnoses reported among men who have sex with men (MSM) in countries reporting consist- ently has declined since 2014, even after adjusting for reporting delay. However, despite this overall decline, case numbers have largely increased between 2011 and 2020 in one-third of EU/EEA countries (Bulgaria, Croatia, Cyprus, Czechia, Estonia, Hungary, Iceland, Lithuania, Romania, Slovakia) (Table 4). In particular, cases attrib- uted to MSM born outside of the reporting country have increased (Fig. 1.14). The proportion of all HIV cases due to heterosexual transmission was stable over the last decade, although the overall number declined (Fig. 1.13a, 1.14). Yet at the same time in Cyprus and Czechia new diagnoses increased substantially in this group (Table 6). The number of HIV diagnoses reported as being due to injecting drug use has declined since 2011 in both foreign-born and non-foreign-born groups, although localised outbreaks were seen in 2011–2012 that affected the EU/EEA trend in this group, and smaller local out- breaks were also noted in some countries during the last decade (Table 5, Fig. 1.13a, 1.14). Mother-to-child trans- mission and transmission through nosocomial infection or blood transfusion also decreased steadily between 2011 and 2020 and these types of transmission now rep- resent less than 1% of new cases diagnosed (Table 8). Information on CD4 cell count at the time of HIV diag- nosis was provided by 23 countries (Table 13). Among all cases diagnosed in 2020 where information on CD4 count or acute HIV infection was available, 12% (1 141) of cases were reported as acute infections and 25% (2 321) as more recent infection (with a CD4 count above 500 cells per mm3 at diagnosis). Among MSM diagnosed in 2020, where information was available, 16% (695) were reported as acute infections and 29% (1 290) had a CD4 cell count of 500 or above 500 cells per mm3 at diagno- sis (Fig.1.7). As in previous years, about half (51%) of all cases with a CD4 cell count were diagnosed several years after being infected, with a count of less than 350 cells per mm3. Overall, 31% of cases were considered to have advanced HIV infection at the time of diagnosis (CD4 less than 200 cells/mm3). The highest proportions of people presenting at a later stage of HIV infection (CD4 less than 350 cells/mm3) were observed among women (53%), older adults (58% in 40–49-year-olds and 66% in people over 50 years), men or women infected by heterosexual sex (64% and 57% respectively), people who acquired HIV through injecting drug use (52%), and migrants from south and south-east Asia (66%), sub-Saharan Africa (63%), and Central and Eastern Europe (55%) (Fig. 1.8, Table 13). xii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data For 2020, the overall number of people diagnosed with acute infection at each CD4 category was lower than in previous years (Fig. 1.15). Although the proportion of those with an unknown CD4 count was higher in 2020 than the average for the period 2011−2020 (46% vs 42%), the proportions of those with known information on acute infection increased from 17% in 2011 to 21% in 2019, declining slightly to 18% in 2020. In 2020, 1 760 diagnoses of AIDS were reported by 27 EU/EEA countries, giving a rate of 0.5 cases per 100 000 population (Table 14). Fourteen countries reported tuber- culosis (TB) (pulmonary and/or extrapulmonary) as an AIDS-defining illness in 13% of those newly diagnosed with AIDS (Fig. 1.17). In the EU/EEA, the number of AIDS cases more than halved over the past decade (Fig. 1.10). This decline is noted in men and women and in all trans- mission groups, but appears to be largest among cases attributed to injecting drug use (Tables 15–20, Fig. 1.16). WHO European Region Between 2011 and 2019, the rate of newly diagnosed HIV infections in the WHO European Region increased by 5%, mainly driven by an upward trend in many countries of the East. However, over the past three years overall stabilisation of the epidemic has been observed in the East of the Region. In 2020, 104 765 people were newly diagnosed with HIV, corresponding to a rate of 15.6 per 100 000 population. This represents a 24% decline in the rate between 2019 and 2020. However, the drop is due, in part, to decreased case detection as a result of the public health and social measures introduced by countries in response to the COVID-19 pandemic. For this reason, although we still compare 2020 data to that for previous years in the report, trends should be inter- preted with caution. Of the 104 765 people diagnosed in 2020, 81% were diagnosed in the East (84 556), 15% in the West (15 782) and 4% in the Centre of the Region (4 427) (Table A). The rate was also highest in the East (32.6 per 100 000 population), being disproportionately higher than in the West (3.7 per 100 000 population) and the Centre (2.3 per 100 000 population) (Table A). Rates of newly diagnosed HIV infections varied widely across countries in the WHO European Region in 2020. The highest rates per 100 000 population (more than 15.0) were observed in the Russian Federation (40.8) fol- lowed by Ukraine (37.5), Kazakhstan (18.5), the Republic of Moldova (16.7), Malta (15.9) and Belarus (15.1). The lowest rates (under 2.0) were reported by Serbia (1.2), Slovenia (1.3), Austria (1.7), Croatia (1.9), Poland (1.9) and Slovakia (1.9). No new HIV cases were diagnosed in San Marino in 2020. (Table 1). The overall rate for men was 15.7 per 100 000 popula- tion (Table 2) and for women 8.1 per 100 000 population (Table 3). The male-to-female ratio was 1.9, lowest in the East (1.6), higher in the West (3.0) and highest in the Centre (5.3). The largest proportion of people newly diagnosed in the 46 reporting countries were in the age group 30–39 years (40%), while 5% were young people aged 15–24 years and 14% were 50 years or older at diagnosis. The most common form of infection was through hetero- sexual sex (58%), with 10% of these cases originating from countries outside of the Region that have gen- eralised epidemics, while 22% were infected through injecting drug use, 9% through sex between men and 0.4% through mother-to-child transmission. Information about transmission mode was unknown or missing for 10% of the new diagnoses (Table A). Among the new diagnoses reported by 12 countries in the East for whom the mode of HIV transmission was known, 68% were infected through heterosexual transmission and 29% through injecting drug use, while reported transmission through sex between men remained low, at 3% of cases (Tables 4–6, 8). Sex between men (48%) and heterosexual sex (47%) were the main reported Figure B: Reported new HIV diagnoses in the EU/EEA and WHO European Region, 2011–2020 Data from Andorra, Bosnia and Herzegovina, Monaco, North Macedonia, Turkmenistan and Uzbekistan were excluded due to inconsistent reporting during the period. Data from Portugal not published at country request. 0 50 000 100 000 150 000 200 000 2020201920182017201620152014201320122011 EU/EEA WHO European Region Ne w H IV d ia gn os es Year of diagnosis xiii HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT transmission modes in the Centre, but 42% of the new diagnoses lacked transmission-mode information. Sex between men was the predominant mode of transmis- sion for 10 of the 13 countries in the Centre. In the West, sex between men remained the main transmission mode (52% of cases) followed by heterosexual transmission (42% of cases, among whom 39% originated from gen- eralised epidemic countries). Information was lacking for 25% of new diagnoses. Consistent data on transmission mode were available from 37 countries for the period 2011–2020 (Fig. 2.3). Transmission in the East was driven by a rise in the num- ber of HIV diagnoses with reported sexual transmission, which increased by 8% for heterosexual transmis- sion and almost four-fold for transmission through sex between men. The increase in heterosexual transmis- sion was driven by the transmission among men (42% increase), while it decreased among women during the same period (14% decrease). Although the number of new diagnoses in people infected through injecting drug use decreased by 19% during the period overall, it was the only transmission mode that showed an increase in absolute numbers between 2019 and 2020, mainly due to the increase in Ukraine (Fig. 2.9). In the Centre, new diagnoses in people infected through sex between men remained the predominant mode of transmission in 10 of the 13 countries. Although the number of new diagnoses in those infected as a result of heterosexual transmis- sion in 2020 was comparable to the levels of 2011, it still remained the main reported mode of transmission in three countries. The percentage of new diagnoses attrib- uted to injecting drug use was 15% in 2011 and 5% in 2020 (Fig. 2.16). In the West, heterosexual transmission continued its steady decline and decreased by 47% over the 10-year period overall. Injecting drug use-related transmission decreased by 50% between 2011 and 2020. New diagnoses due to sex between men decreased by 47% compared to 2011. The share of new diagnoses with unknown transmission mode increased from 16% in 2011 to 27% in 2020 in the West (Fig. 2.18). Since 64% of new HIV diagnoses with available CD4 cell data were reported from the Russian Federation, where only 27% were reported as late presenters, the overall trend in late diagnosis for the Region largely reflects the situation in the Russian Federation. Among those newly diagnosed over 14 years for whom information on CD4 cell count at the time of HIV diagnosis was avail- able, over a third (36%) were late presenters, with CD4 cell counts below 350 cells per mm3, including 19% with advanced HIV infection (CD4 less than 200 cells/mm3). However, when excluding data from the Russian Federation, half (50%) of those newly diagnosed in the Region are late presenters, which is comparable to the results from previous years. Late HIV diagnosis remains a challenge in most of the countries of the Region. The percentage of people newly diagnosed who were late presenters (CD4 less than 350/mm3) varied across trans- mission categories and age groups, but was highest for people with reported heterosexual transmission (56%; 58% for men and 54% for women) and injecting drug use (43%), and lowest for men infected through sex with men (41%) (Fig. C). The percentage increased with age, ranging from 33% among people aged 15–19 years at diagnosis, to 65% among those aged 50 years or above. In terms of gender, the percentage of late presenters was similar overall (50% for men and 52% for women) which, for men, conceals the difference between MSM (who tend to get diagnosed earlier) and heterosexual men (who tend to get diagnosed later). In 2020, 7 721 people in 43 countries of the WHO European Region were diagnosed with AIDS, which cor- responds to a rate of 1.2 per 100 000 population. Overall, 74% of AIDS cases were diagnosed in the East, where the rate per 100 000 was also highest (5.0), 20% in the West (with a rate of 0.5 per 100 000) and 6% in the Centre of the Region (0.2 per 100 000) (Table 14). Twenty percent of those diagnosed with AIDS presented with tuberculo- sis (TB) as an AIDS-defining illness, ranging from 13% of cases in the West and 21% in the Centre to 28% in Figure C: Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission, WHO European Region, 2020 (n = 32 336) 0 10 20 30 40 50 60 70 Sex between men Injecting drug use Heterosexual transmission (women) Heterosexual transmission (men) 50+ 40–49 30–39 25–29 20–24 15–19 Women Men Total Percentage Ge nd er Ag e gr ou p (y ea rs ) Tr an sm is si on xiv SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data the East. Between 2011 and 2020, the overall rate of new AIDS diagnoses in the Region decreased by 54%. Conclusions HIV infection continues to affect the health and well- being of millions of people in the WHO European Region. Over the course of the last three decades, over 2.2 mil- lion people have been diagnosed and reported with HIV in the WHO European Region, including over 560 000 people in the EU/EEA. In 2020, 104 765 people were newly diagnosed with HIV. The vast majority of people newly diagnosed (81%) were diagnosed in the East, 15% were diagnosed in the West, and 4% in the Centre. Newly diagnosed infections in the Russian Federation contrib- uted 57% of all cases in the WHO European Region. The share of the cases reported from Ukraine was 15% in the Region. A sharp (24%) drop in newly diagnosed HIV cases between 2019 and 2020 was preceded by an overall upward trend in the rate of new HIV diagnoses during 2011−2018, mainly driven by the increasing trend in the East. While additional investigation is needed before making assumptions about the reasons for the sharp decline in the number of new HIV diagnoses observed in 2020, it is probably due, in part, to a decrease in case detection as a result of the public health and social measures introduced by countries in response to the COVID-19 pandemic. Countries responding to the WHO/ ECDC survey reported reduced detection and reporting of HIV cases during the COVID-19 pandemic, mainly due to a reduction in testing services and limited surveil- lance capacity. While epidemic patterns and trends vary widely across WHO European Region countries, sustained increases have been seen in the number of newly diagnosed infec- tions within certain transmission groups across parts of the Region. For example, increased transmission among MSM in the Centre and East, and among heterosexuals in the East, although some studies suggest that the lat- ter increase needs to be interpreted with caution [1,2]. Heterosexual transmission has decreased substantially in the EU/EEA and the West in recent years, particularly among women, as has the number of cases due to sex between men in selected countries in the EU/EEA and the West. While transmission through injecting drug use has declined steadily since 2011, in 2020 it increased by 15% against 2019 in countries reporting consistently, this being the only transmission category that saw an increase in 2020. The overall Regional improvement in late diagnoses is attributed to the Russian Federation, which reported data on CD4 count at HIV diagnosis for the first time and accounts for the vast majority of new HIV diagno- ses with available CD4 cell data in the WHO European Region. As a result, just over one-third (36%) of those newly diagnosed in 2020 had a CD4 cell count below 350 per mm3 at the time of HIV diagnosis, including 19% with advanced HIV infection (CD4 above 200/mm3). However, when excluding data from the Russian Federation, half of those newly diagnosed with HIV were only detected once their CD4 cell counts had declined to below 350 per mm3, which is comparable with the results from the previous years. The relatively high number of AIDS diagnoses in the East confirms that late HIV diagnosis remains a major challenge. At the same time, the stabilising AIDS trend observed since 2012 may be the result of a major- ity of countries having now implemented ‘treat-all’ policies, which aim to offer anyone living with HIV the opportunity to receive antiretroviral therapy (ART) irre- spective of the stage of disease. New strategies are required to improve early diagno- sis and make more people aware of their infection by expanding diversified and user-friendly approaches to more widely available HIV testing. WHO has pro- duced consolidated guidelines on HIV testing services, including guidelines on HIV self-testing and partner notification, and ECDC has published public health guid- ance on an integrated approach to HIV and hepatitis B and C testing. These recommend innovative approaches including self-testing and community testing by lay providers using rapid tests as part of overall HIV test- ing services [3–5]. Rapid scale-up of HIV testing is of the utmost importance, given the negative impact of COVID-19 pandemic on testing services. WHO has issued a policy brief on moving away from the use of western blotting and line immunoassays in HIV testing strategies and algorithms and towards the support of decentral- ised testing and rapid linkage to treatment [6]. While the provision of HIV testing services has improved over time and self-testing and community-based HIV testing have seen a substantial increase in recent years, policy-mon- itoring in the Region indicates that some testing modes remain limited or non-existent in many European coun- tries [7]. HIV testing services should focus on reaching the key population groups in the local epidemic context, be tailored to the specific needs of these groups, and support timely linkage to HIV prevention, treatment and care. This will ensure earlier diagnoses and treatment initiation, resulting in improved treatment outcomes and reduced HIV incidence, morbidity and mortality in support of the 95–95–95 goals and other regional and global targets [8–10]. A robust body of evidence shows that early initiation of ART is beneficial both to the health of the person receiving the treatment and in preventing onward HIV transmission [11–16]. Nearly 90% of countries in the WHO European Region have a policy to initiate ART regardless of CD4 cell count [17,18]. Interventions to control the epidemic should be based on evidence and adapted to national and local epide- miology. From the comprehensive epidemiological data presented in this report, the following can be concluded. • For the countries in the EU/EEA and West, given the predominance of HIV transmission among MSM and increases in some countries, it would appear that current prevention, treatment and care interventions targeting MSM need to be further scaled-up and strengthened and should remain the priority of the xv HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT HIV response. Countries with declines have demon- strated the impact of changing the culture towards more frequent testing for at-risk gay men and link- age to immediate care and ART for those found to be positive [20]. Multicomponent interventions, with the inclusion of PrEP for HIV, screening and treatment for sexually transmitted infections, and self-testing and assisted voluntary partner notification in the package of prevention and control interventions, could help to curb the increasing trends seen in some countries. In most European countries, reported use of PrEP is well below the coverage level expected based on perceived need [3,21–23]. In many countries in the West of the Region, effective and accessible testing, prevention and care services for the increasingly diverse group of migrants at risk of and living with HIV need to be implemented more widely. The 2011–2012 increase in HIV cases among people who inject drugs and con- tinued local outbreaks being reported in a number of countries [24–28] demonstrate the need to maintain or scale-up harm-reduction programmes. • For the countries in the Centre, new diagnoses are increasing faster than in any other part of the WHO European Region. There is a very strong gender dis- parity in the rate of new HIV diagnoses in this part of the Region, with alarming increases among men, particularly MSM, compared with a fairly stable rate among women. Sex between men is the predominant mode of transmission in 10 of the 13 reporting Centre countries. Interventions to address this situation are needed, such as PrEP for high-risk groups, HIV testing by lay providers, HIV rapid diagnostic tests, HIV self- testing and voluntary assisted partner notification, alongside policies and practices to offer ART to all peo- ple living with HIV. Some countries have undergone a transition to domestic financing of the HIV response after withdrawal of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. This has posed sustainability challenges, particularly in relation to the financing of HIV prevention programmes and sur- veys among key populations. Increased political will and attention, alongside intensified involvement of civil society is needed to mitigate some of these chal- lenges and prevent the epidemic from accelerating [29]. • For the countries in the East, there is an urgent need to continue the scale-up of bold, evidence-based interventions and deliver more effective, integrated services through health systems that better address the social determinants of health. Comprehensive combination-prevention and innovative HIV test- ing strategies are needed, with a particular focus on reaching key populations. This can be achieved through user-friendly prevention and testing services, including assisted partner notification, PrEP, HIV test- ing performed by trained lay providers and self-testing in line with WHO recommendations. All of these ser- vices should be integrated into national policies and programmes and then implemented [3,4,10,30]. Community involvement in the design and delivery of services is essential for reducing the rate of new HIV infections and increasing the number of people linked to care and initiated and retained on ART. The ulti- mate aim is to reduce HIV incidence and AIDS-related deaths. Innovative HIV prevention interventions should address the risk of heterosexual transmission, particularly in couples where one partner is engaged in high-risk behaviour (such as injecting drug use) or is spending longer periods of time working abroad. The large number of new diagnoses in people infected through injecting drug use emphasises the fact that evidence-based policies focused on key populations, including high coverage of harm-reduction pro- grammes for people who inject drugs, remain critical to the HIV response in the eastern part of the Region. Some studies conducted in the East found that the infor- mation on mode of transmission among newly diagnosed patients may be biased, with many cases registered as acquired heterosexually having had a history of inject- ing drug use or, among male cases, sex with men [1,2]. This highlights the importance of assessing the validity of routine surveillance data in relation to mode of trans- mission, especially in countries where injecting drug use and homosexuality are stigmatised. The number of countries conducting enhanced HIV sur- veillance and reporting surveillance data at European level has increased gradually over time. However, 2020 data recording and reporting for 2020 was made very challenging due to overstretched clinical and public health surveillance resources in many countries in the WHO European Region during the ongoing COVID-19 pandemic. This has resulted in less HIV case reporting and a reduced possibility to collect enhanced data for those diagnosed. However, some of this information may become available in future reporting rounds, mak- ing interpretation of 2020 trends easier in the future. Conducting enhanced HIV surveillance increases the possibility for longer-term monitoring of HIV continuum- of-care outcomes, such as modelling the undiagnosed fraction, and measurement of linkage to care, treat- ment and viral suppression following diagnosis. It can also support national and global efforts to monitor pro- gress towards the 95–95–95 goals and other global and regional targets. The ‘Action plan for the health sector response to HIV in the WHO European Region’ reaches its terminal date in 2021 and the progress made will be assessed and reported to the WHO Regional Committee for Europe in 2022. The three global health sector strategies (GHSS) on HIV, viral hepatitis and sexually transmitted infec- tions (STIs) are due to end in the same year. To inform the development of the new GHSS on HIV, viral hepatitis and sexually transmitted infections, on 16–17 June 2021 WHO Regional Office for Europe conducted a virtual consultation of the Member States and partners. This consultation was extended to encompass the proposed European Regional action plans for HIV, viral hepatitis and STIs 2022−2030. Feedback from Members States and partners is being used to ensure that the priori- ties of the WHO European Region are addressed in the xvi SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data GHSS and that the Regional action plan 2022−2030 will address the needs of key populations and people living with HIV through people-centred services and a ‘Build Back Better’ strategy after the COVD-19 pandemic. The WHO Regional Office for Europe and ECDC, together with Member States and partners, will look carefully at the impact of COVID-19 on the HIV surveillance and pre- vention response to support the continued high standard of European HIV and AIDS data, guide the response in the Region and understand how the ongoing pandemic may have affected HIV incidence, particularly in those regions and groups most at-risk. References 1. Dumchev K, Kornilova M, Kulchynska R, Azarskova M, Vitek C. Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk. BMC Public Health 2020;20(1):1288. doi:10.1186/s12889-020-09373-2. PMID:32843008; PMCID: PMC7449084. 2. Čakalo JI, Božičević I, Vitek C, Mandel JS, Salyuk T, Rutherford GW. Misclassification of men with reported HIV infection in Ukraine. AIDS Behav. 2015;19(10):1938–40. doi:10.1007/s10461-015-1112-0. PMID: 26070886. 3. Guidelines on HIV self-testing and partner notification. Supplement to consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2017. Available from: https://www.who.int/ hiv/pub/vct/Annex32.pdf 4. Consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2015. Available from: https://apps.who.int/ iris/bitstream/handle/10665/179870/9789241508926_eng.pdf 5. Public health guidance on HIV, hepatitis B and C test- ing in the EU/EEA. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/ public-health-guidance-hiv-hepatitis-b-and-c-testing-eueea 6. WHO recommends countries move away from the use of western blotting and line immunoassays in HIV testing strategies and algorithms. Policy brief. Copenhagen: WHO Regional Office for Europe; 2019. Available from: https://www.euro.who.int/en/ health-topics/communicable-diseases/hivaids/publications/2019/ who-recommends-countries-move-away-from-the-use-of-western- blotting-and-line-immunoassays-in-hiv-testing-strategies-and- algorithms.-policy-brief-2019 7. HIV testing. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017. Available from: https:// ecdc.europa.eu/sites/portal/files/documents/HIV%20testing.pdf. 8. Global health sector strategy on HIV, 2016–2021 – towards ending AIDS. Geneva: World Health Organization; 2016. Available from: https://www.who.int/publications/i/item/WHO-HIV-2016.05 9. Global AIDS Strategy 2021–2026 End Inequalities. End AIDS. Geneva: UNAIDS; 2021. Available from https://www.unaids.org/en/ resources/documents/2021/2021-2026-global-AIDS-strategy 10. Action plan for the health sector response to HIV in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2017. Available from: https://www.euro.who.int/en/health-topics/ communicable-diseases/hivaids/publications/2017/action-plan- for-the-health-sector-response-to-hiv-in-the-who-european- region-2017 11. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2016. Available from: https://www.who.int/ publications/i/item/9789241549684 12. Guidelines on when to start antiretroviral therapy and on pre- exposure prophylaxis for HIV. Geneva: World Health Organization; 2015. Available from: https://www.euro.who.int/en/publications/ abstracts/guideline-on-when-to-start-antiretroviral-therapy-and- on-pre-exposure-prophylaxis-for-hiv-2015 13. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016;373(9):795–807. 14. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. 15. Guidelines Version 9.1. October 2018. In: European AIDS Clinical Society. Brussels: European AIDS Clinical Society; 2018. Available from: www.eacsociety.org/guidelines/eacs-guidelines/eacs-guide- lines.html 16. Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, Degan O et al. Risk of HIV transmission through condomless sex in serodif- ferent gay couples with HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, pro- spective, observational study. Lancet 2019;393(10189):2428–38. 17. Continuum of HIV care. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/ HIV-continuum-of-care-monitoring-dublin-declaration-progress- report-2018.pdf 18. 2019 Global AIDS Monitoring (GAM). In: AIDSinfo. New York (NY): UNAIDS; 2019 Available from: https://aidsinfo.unaids.org/ 19. Regional Workshop on Advancing Implementation Science on HIV and Viral Hepatitis in Eastern Europe and Central Asia. Report (10– 11 February 2020, Berlin, Germany). Copenhagen: WHO Regional Office for Europe; 2020. Available from: www.euro.who.int/en/ health-topics/communicable-diseases/hivaids/publications/2020/ regional-workshop-on-advancing-implementation-science-on-hiv- and-viral-hepatitis-in-eastern-europe-and-central-asia.-report- 1011-february-2020,-berlin,-germany 20. Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveill. 2017;22(25):pii=30553 (https://doi.org/10.2807/1560-7917. ES.2017.22.25.30553). 21. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014. Available from: https:// www.ecdc.europa.eu/sites/default/files/media/en/publications/ Publications/hiv-sti-prevention-among-men-who-have-sex-with- men-guidance.pdf 22. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2017;378:53–60. 23. Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P, et al. and the ECDC Dublin Declaration Monitoring Network. Estimating the “PrEP gap”: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019;24(41):pii=1900598. Available from: https://doi. org/10.2807/1560-7917.ES.2019.24.41.1900598 24. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L et al. Human immunodeficiency virus among people who inject drugs: is risk increasing in Europe? Euro Surveill. 2013;18(48):pii=20648. Available from www.eurosurveillance.org/ViewArticle. aspx?ArticleId=20648 25. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among home- less people who inject drugs in Dublin, Ireland, 2015. Euro Surveill. 2015;20(40):pii=30036 Available from: http://dx.doi. org/10.2807/1560-7917.ES.2016.20.40.30036 26. HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre for Drugs and Drug Addiction; 2018. Available from: http:// sante.public.lu/fr/publications/h/hiv-joint-technical-mission/ index.html 27. McAuley A, Palmateer NE, Goldberg DJ, Trayner KMA, Shepherd SJ, Gunson RN et al. Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross- sectional analysis. Lancet HIV 2019;6(5):e315–24. 28. Des Jarlais DC, Sypsa V, Feelemyer J, Abagiu AO, Arendt V, Broz D et al. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV 2020;7(6):e434–42. 29. Lost in transition. Three case studies of Global Fund withdrawal in south eastern Europe. New York (NY): Open Society Foundations; 2017. Available from: www.opensocietyfoundations.org/ publications/lost-transition 30. Consolidated guidelines on HIV prevention, diagnosis, treat- ment and care for key populations. 2017 update. Geneva: World Health Organization; 2017. Available from: https://www.who.int/ publications/i/item/9789241511124 xvii HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Обзор эпидемиологической ситуации по ВИЧ/СПИДу в Европе В настоящем отчете представлены данные эпид- надзора за ВИЧ/СПИДом за 2020 г. – период, ознаменованный глобальной пандемией COVID-19, которая, начиная с марта 2020 г., серьезно затронула Европу. Чтобы лучше оценить степень воздействия пандемии на данные эпиднадзора за ВИЧ/СПИДом за 2020 г., Европейское региональное бюро Всемирной организации здравоохранения и Европейский центр профилактики и контроля заболеваний (ECDC) про- вели краткий опрос: анкета была разослана во все 55 стран, территорий и районов Европейского реги- она ВОЗ с получением 21 отклика. Данный опрос сосредоточен на вопросах сокращения выявления и регистрации случаев ВИЧ-инфекции, а также пол- ноты некоторых расширенных переменных. В общей сложности 12 из 21 респондентов, включая восемь из 15 респондентов, представлявших страны Европейского союза/Европейской экономической зоны (ЕС/ЕЭЗ), и четырех из шести стран, не входящих в ЕС/ЕЭЗ, сообщили о сокращении объемов тести- рования и выявления случаев ВИЧ-инфекции, что отразилось на национальных данных эпиднадзора за ВИЧ/СПИДом (Рис. A). К странам, сообщившим о сокращении выявления случаев заболевания, обра- тились с дополнительной просьбой – предоставить оценочные значения масштабов сокращения тестиро- вания на ВИЧ. В среднем указывалось 20-процентное сокращение выявления случаев заболевания в 2020 г. по сравнению с предыдущими годами. Треть подавших сведения стран (семь из 21) указали, что ограничение потенциала эпиднадзора привело к сокращению подачи сведений о случаях ВИЧ- инфекции в 2020 г. Это обстоятельство было менее актуальным для стран ЕС/ЕЭЗ (4/15), нежели для стран, не входящих в ЕС (3/6). Страны, отметившие ограничение потенциала эпиднадзора, отразивше- еся на эпиднадзоре за ВИЧ-инфекцией, оценивали его, в среднем, как сокращение регистрации случаев ВИЧ-инфекции на 30% в сравнении с предыдущими годами. Странам также задали вопрос о том, почувствовали ли они снижение полноты некоторых расширенных переменных. Наиболее затронутыми переменными оказались количество клеток CD4 на момент установ- ления диагноза (8/21) и информация о пути передачи ВИЧ (6/21). За счет ответов на вопрос открытого типа мы узнали, что ограничение перемещения – как часть мер по защите общественного здоровья и мер социаль- ного характера, направленных на противодействие пандемии COVID-19, – было связано не только с сокращением фактического объема тестирования, но и с невозможностью обращения за услугами тести- рования и за помощью, что привело к последующему сокращению числа новых случаев ВИЧ-инфекции, диагностированных во время длившегося несколько месяцев локдауна. Несмотря на потенциальные проблемы с заниже- нием диагностики и регистрации в 2020 г., в 46 из 53 стран Региона были зарегистрированы 104 765 новых случаев ВИЧ-инфекции, в том числе 14 971 в странах Европейского союза/Европейской экономической Рис. A: Отразилось ли на ваших данных эпиднадзора за ВИЧ/СПИДом за 2020 г. сокращение выявления случаев ВИЧ-инфекции в сравнении с данными за 2019 г. или более ранними? Опрос ВОЗ/ECDC 2021 г. о COVID-19 0 20 40 60 80 100 Страны не входящиe в ЕС/ЕЭЗ (n=6) Страны ЕС/ЕЭЗ (n=15) Европейский регион ВОЗ (n=21) Да Нет Не знаю Процент xviii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data зоны (ЕС/ЕЭЗ)1, что соответствует общему показателю 11,8 новых диагнозов ВИЧ-инфекции на 100 000 насе- ления в Регионе в целом (Таблица A). Сохраняется та же тенденция, что отмечалась на протяжении последнего десятилетия: показатели и общее количество людей с установленным диагнозом ВИЧ-инфекции наиболее высоки на востоке Региона (32,6 на 100 000 населения), ниже – на западе и в ЕС/ ЕЭЗ (3,7 и 3,3 на 100 000, соответственно) и самые низкие – в центральной его части (2,3 на 100 000) (Таблица A). Основной путь передачи также варьи- рует в зависимости от географической зоны, что свидетельствует о различиях в эпидемиологических особенностях ВИЧ-инфекции в Европе. Наиболее рас- пространенный путь передачи инфекции в ЕС/ЕЭЗ и на западе Региона – половые контакты между мужчи- нами, в то время как гетеросексуальная передача и употребление инъекционных наркотиков – основные отмеченные пути передачи на востоке Региона. Поздняя диагностика ВИЧ-инфекции остается про- блемой для большинства стран в Регионе. Процент людей, которым диагноз был установлен впервые, поздно обратившихся за помощью (CD4 менее 350/ мм3), варьировал в зависимости от категорий путей передачи и возрастных групп, но был самым высо- ким среди людей, инфицировавшихся в результате гетеросексуальной передачи (56%) и самым низким – среди мужчин, инфицировавшихся вследствие половых контактов с мужчинами (41%) (Рис. C). Процент увеличился с возрастом – от 33% среди 1 Подробное описание концептуальной основы сбора, валидации и представления данных в настоящем отчете содержится в Приложении 1. людей в возрасте 15–19 лет на момент установления диагноза до 65% среди людей в возрасте 50 лет и старше. В 2020 г. диагноз СПИДа был поставлен 7 721 лицам в 43 странах Европейского региона ВОЗ, а частота новых диагнозов составила 1,2 на 100 000 населе- ния (Таблица A; см. также Таблицу 14). В ЕС/ЕЭЗ в 2020 г. диагноз СПИДа был поставлен 1 760 лицам, а частота составила 0,5 на 100 000 населения. В тече- ние последнего десятилетия число случаев СПИДа продолжало стабильно снижаться на западе Региона и в ЕС/ЕЭЗ (см. Рис. 1.17 и 2.4). В то же время оно уве- личивалось на востоке Региона, хотя в период с 2012 г. по 2018 г. наметилась стабилизация и даже сниже- ние в 2019 г. В 2020 г. показатель снизился еще более значительно, хотя, возможно, это было связано с задержкой в подаче сведений, вызванной пандемией COVID-19. Европейский Союз и Европейская Экономическая Зона В 2020 г. в 29 странах ЕС/ЕЭЗ [1] было зарегистри- ровано 14 971 новых диагнозов ВИЧ-инфекции, что соответствует показателю 3,3 на 100 000 после кор- ректировки на задержку отчетности (Таблица 1, Приложение 6). Страны с наиболее высокими показа- телями – Мальта (15,9; 82 случая), Латвия (13,5; 257), Кипр (11,8; 105) и Эстония (10,8; 143), а с наиболее низкими – Словения (1,3; 27 случаев) и Австрия (1,7; 155) (Таблица 1, Карта 1). Частота установления новых диагнозов ВИЧ-инфекции была выше среди мужчин Таблица A: Характеристики новых диагнозов ВИЧ-инфекции и СПИДа, зарегистрированных в Европейском регионе ВОЗ, ЕС/ЕЭЗ, а также в западной, центральной и восточной части Европейского региона ВОЗ, 2020 г. Европейский регион ВОЗ Запад Центр Восток ЕС/ЕЭЗ Подающие сведения страны/кол-во странa 46/53 20/23 13/15 13/15 29/30 Количество новых диагнозов ВИЧ-инфекции 104 765 15 782 4 427 84 556 14 971 Частота диагностики ВИЧ на 100 000 населенияb 11.8 3.7 2.3 32.6 3.7 Процент в возрасте 15–24 лет 5.4% 9.5% 15.0% 4.2% 9.9% Процент в возрасте 50+ лет 14.4% 22.9% 13.8% 12.9% 20.9% Соотношение мужчин к женщинам 1.9 3.0 5.3 1.6 3.2 Путь передачи Секс между мужчинами 9.4% 39.2% 28.0% 2.9% 38.8% Гетеросексуальная передача (мужчины) 29.7% 14.5% 19.2% 33.1% 14.1% Гетеросексуальная передача (женщины) 27.9% 16.9% 8.1% 31.0% 15.5% Потребление инъекционных наркотиков 22.4% 3.3% 2.2% 27.0% 3.8% Передача от матери ребенку 0.4% 0.6% 0.6% 0.4% 0.6% Неизвестен 10.0% 25.0% 41.9% 5.6% 26.9% СПИД и поздняя диагностика ВИЧ-инфекции Процент новых диагнозов ВИЧ-инфекции с CD4 < 350 клеток/мм3 36.1% 51.1% 45.6% 34.4% 51.0% Количество новых диагнозов СПИДаc 7 721 1 549 467 5 705 1 760 Частота новых диагнозов СПИДа на 100 000 населения 1.2 0.5 0.2 5.0 0.5 a Не получено сведений oт Андорры, Боснии и Герцеговины, Монако, Северной Македонии, Туркменистана и Узбекистана. Данные из Португалии не публикуются по просьбе страны. b Показатели заболеваемости в ЕС/ЕЭЗ скорректированы с учетом задержки отчетности; Расчетное число новых случаев с учетом задержки отчетности составляет 16 917. c Не получено сведений oт Андорры, Боснии и Герцеговины, Германии, Монако, Российской Федерации, Северной Македонии, Туркменистана, Узбекистана и Швеции. Данные из Португалии не публикуются по просьбе страны. xix HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT (5,2 на 100 000 населения; Таблица 2), чем среди женщин (1,5 на 100 000 населения; Таблица 3). Общее соотношение полов – мужчин и женщин – составило 3,2 (Таблица A). Это соотношение был наибольшим в Венгрии (11,1) и Словакии (8,1) и превышало единицу во всех странах ЕС/ЕЭЗ (Рис. 1.1). Преобладающий путь передачи в странах с наивысшими соотноше- ниями мужчин и женщин – половые контакты между мужчинами. У мужчин по сравнению с женщинами отмечались более высокие повозрастные коэффициенты во всех возрастных группах, за исключением лиц моложе 15 лет, где повозрастные коэффициенты были одина- ково низкими для обоих полов (Рис. 1.2). Наивысший общий повозрастной коэффициент диагностики ВИЧ-инфекции отмечался среди людей в возрасте 25–29 лет (8,0 на 100 000 населения), в основном вследствие того, что этой возрастной группе присущ наивысший повозрастной коэффициент для мужчин – 12,1 на 100 000 населения, в том время как для жен- щин он был наивысшим в возрастной группе 30–39 лет (4,0 на 100 000 населения) (Рис. 1.2). На молодежь в возрасте 15–24 лет, составляющую 11% населения ЕС/ЕЭЗ, пришлось 9,9% диагнозов ВИЧ-инфекции в 2020 г. (Рис. 1.4, Таблица 9). На взрослых пожилого возраста (50 лет и старше), составляющих сорок один процент населения ЕС/ЕЭЗ, пришлось 21% всех новых диагнозов ВИЧ-инфекции, зарегистрированных в 2020 г. Половые контакты между мужчинами остаются доми- нирующим путем передачи ВИЧ в ЕС/ЕЭЗ, являясь причиной 39% (5 815) всех новых диагнозов ВИЧ- инфекции, поставленных в 2020 г., и более чем половины (53%) диагнозов с известным путем пере- дачи (Таблица 4, Таблица 8, Рис. 1.5). Среди случаев с известным путем передачи ВИЧ половые контакты между мужчинами обусловили свыше 60% новых диагнозов ВИЧ-инфекции, зарегистрированных в восьми странах (Венгрия, Исландия, Испания, Кипр, Нидерланды, Польша, Словакия, Хорватия) (Рис. 1.5). Гетеросексуальные контакты были вторым по зна- чимости наиболее распространенным отмеченным путем передачи ВИЧ в ЕС/ЕЭЗ в 2020 г., обусловливая 29,6% (4 445) диагнозов ВИЧ-инфекции и 41% диагно- зов с известным путем передачи (Таблица 6, Таблица 8, Рис. 1.5). Гетеросексуальная передача была наибо- лее распространенным известным путем передачи в шести странах ЕС/ЕЭЗ (Латвия, Люксембург, Румыния, Финляндия, Швеция, Эстония). Передача вследствие употребления инъекционных наркотиков в 2020 г. стала причиной установления 3,8% диагнозов ВИЧ-инфекции, являясь возмож- ным путем передачи в одной четвертой случаев, диагностированных в Латвии, и 18% случаев, диагно- стированных в Греции (Таблица 5, Таблица 8, Рис. 1.5). Вертикальная передача – путь передачи, упомяну- тый менее чем в 1% новых диагнозов ВИЧ-инфекции в ЕС/ЕЭЗ в 2020 г., но следует иметь в виду, что в 26,9% новых диагнозов ВИЧ-инфекции путь передачи либо не был указан, либо был указан как неизвестный (Таблица A). Сорок четыре процента лиц, диагностированных в ЕС/ ЕЭЗ в 2020 г., были мигрантами, определяемыми как выходцы из-за пределов страны, в которой им был поставлен диагноз (Рис. 1.6), причем в 15% случаев страной происхождения были страны Африки, распо- ложенных к югу от Сахары, в 10% – страны Латинской Америки и Карибского бассейна; 9% мигрантов были выходцами из других стран Центральной и Восточной Европы, а 3% – из других стран Западной Европы. Тенденция в отношении числа зарегистрированных диагнозов ВИЧ-инфекции – нисходящая с пикового значения в 2012–2014 гг. В начале этого периода показатели ЕС/ЕЭЗ составляли 6,0 на 100 000, после чего они неуклонно снижались до 5,5 на 100 000 в 2017 г. и 4,8 в 2019 г. (Таблица 1, Рис. 1.10, Приложения 1 и 5). Показатель за 2020 г. резко упал до 3,4 на 100 000; однако есть вероятность того, что отчасти это произошло из-за снижения выявления случаев в результате меньшего объема тестирования с уче- том ограничительных мер по защите общественного здоровья, связанных с пандемией COVID-19. Среди восьми стран ЕС/ЕЭЗ, подававших сведения о частоте тестирования в течение всего отчетного периода, количество выполненных тестов сократилось на 13% в 2020 г. по сравнению с 2019 г. Хотя создается впечатление, что в последнее десятилетие в ЕС/ЕЭЗ отмечался общий нисходящий тренд, тенденции на национальном уровне варьируют. Около 2/3 стран ЕС/ЕЭЗ отмечают снижение частоты установления новых диагнозов даже после корректировки на изме- нения в охвате населения эпиднадзором в динамике и задержку подачи отчетности. В отличие от этого даже с учетом задержек в подаче сведений частота установления диагноза ВИЧ-инфекции с 2011 г. более чем удвоилась на Мальте и в Словакии и увеличи- лась более чем на 50% на Кипре и в Чехии (Таблица 1, Приложение 6). Воздействие задержек в выявлении случаев заражения ВИЧ из-за мер по борьбе с COVID- 19 до сих пор полностью не осмыслено; задержки в подаче сведений способны привести к переоценке степени снижения частоты установления новых диа- гнозов ВИЧ-инфекции. Тенденции различаются в зависимости от пола и возрастной группы. Повозрастные коэффициенты снизились с 2011 г. во всех возрастных группах, хотя в некоторых случаях отмеченное снижение может быть обусловлено задержками в выявлении случаев в 2020 г, а не истинным сокращением показателей. В течение периода 2011–2020 гг. частота диагностики ВИЧ-инфекции как у женщин, так и у мужчин была неизменно выше среди лиц в возрасте 25–29 лет и 30–39 лет по сравнению с другими возрастными группами. Повозрастные коэффициенты для женщин наиболее заметно снизились среди лиц моложе 40 лет, тогда как у мужчин – существенно снизились во xx SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data всех возрастных группах моложе 50 лет (Рис. 1.11a, 1.11b). Доля всех диагнозов ВИЧ-инфекции, относимых за счет половых контактов между мужчинами, была достаточно стабильной в период с 2011 г. по 2020 г., увеличившись с 47% случаев в 2011 г. до 51% в 2016 г., а затем снизившись до 49% в 2020 г. (Рисунки 1.13a и 1.13b). Количество диагнозов ВИЧ-инфекции, зарегистрированных среди мужчин, практикую- щих секс с мужчинами (МСМ), в последовательно подающих сведения странах сократилось с 2014 г. даже после введения корректировки на задержку отчетности. Несмотря на общее снижение, однако, в период с 2011 г. по 2020 г. количество случаев значи- тельно увеличилось в трети стран ЕС/ЕЭЗ (Болгария, Венгрия, Исландия, Кипр, Литва, Румыния, Словакия, Хорватия, Чехия, Эстония) (Таблица 4). В частности, увеличилось количество случаев заражения среди МСМ, родившимся за пределами подающей сведения страны (Рис. 1.14). Доля случаев заболевания ВИЧ-инфекцией вслед- ствие гетеросексуальной передачи в последнее десятилетие оставалось стабильной, хотя общее количество случаев уменьшилось (Рис. 1.13a, 1.14). Но в то же время на Кипре и в Чехии число новых диагнозов в этой группе существенно увеличилось (Таблица 6). Число диагнозов ВИЧ-инфекции, зарегистрирован- ных как связанных с употреблением инъекционных наркотиков, снизилось с 2011 г. как в группах, родив- шихся за рубежом, так и в группах коренных жителей (не родившихся за рубежом), хотя в 2011–2012 гг. отмечались локализованные вспышки, повлиявшие на тенденцию ЕС/ЕЭЗ в этой группе; в последнее десятилетие в некоторых странах возникали и более мелкие местные вспышки (Таблица 5, Рис. 1.13a, 1.14). В период с 2011 г. по 2020 г. частота передачи от матери ребенку и передачи вследствие нозокомиальной инфекции или переливания крови также неуклонно снижалась, так что эти типы передачи в настоящее время представляют менее 1% новых случаев диа- гностики ВИЧ-инфекции (Таблица 8). Информация о количестве клеток CD4 на момент диагностики ВИЧ-инфекции была предоставлена 23 странами (Таблица 13). Среди всех случаев, диагностированных в 2020 г., по которым была доступна информация о количестве CD4 или острой ВИЧ-инфекции, 12% (1 141) случаев были зарегистри- рованы как острая инфекция, а 25% (2 321) – как недавнее заражение (с количеством CD4 выше 500 клеток в мм3 на момент диагностики). Среди МСМ, диагностированных в 2020 г., – там, где информация была доступной, – 16% (695) были зарегистриро- ваны как случаи острой инфекции, а у 29% (1 290) на момент диагностики отмечалось количество CD4 500 или выше 500 клеток в мм3 (Рис.1.7). Как и в пре- дыдущие годы, около половины (51%) всех случаев с известным количеством клеток CD4 были диагности- рованы через несколько лет после заражения при количестве CD4 менее 350 клеток в мм3. В общей сложности 31% случаев рассматривались как диагно- стированные на поздних стадиях ВИЧ-инфекции (CD4 менее 200 клеток/мм3). Наибольшая доля людей, обратившихся за помо- щью на поздних стадиях ВИЧ-инфекции (количество CD4 менее 350 клеток/мм3), отмечена среди женщин (53%), пожилых людей (58% среди лиц в возрасте 40–49 лет и 66% – среди людей старше 50 лет), мужчин и женщин, инфицировавшихся при гетеросексуаль- ных половых контактах (64% и 57%, соответственно), людей, заразившихся ВИЧ вследствие употребления инъекционных наркотиков (52%), и мигрантов из Южной и Юго-Восточной Азии (66%), стран Африки, расположенных к югу от Сахары (63%), и Центральной и Восточной Европы (55%) (Рис. 1.8, Table 13). Рис. B: Новые диагнозы ВИЧ-инфекции, зарегистрированные в ЕС/ЕЭЗ и Европейском регионе ВОЗ, 2011–2020 гг. Примечание: данные из Андорры, Боснии и Герцеговины, Монако, Северной Македонии, Туркменистана и Узбекистана были исключены из-за непоследовательности сведений, поданных за отчетный период. Данные из Португалии не публикуются по просьбе страны. 0 50 000 100 000 150 000 200 000 2020201920182017201620152014201320122011 ЕС/ЕЭЗ Европейский регион ВОЗ Но вы е ди аг но зы В ИЧ -и нф ек ци и Год установления диагноза xxi HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT За 2020 г. общее число людей с установленным диа- гнозом острой ВИЧ-инфекции по каждой категории CD4 было ниже, чем в предыдущие годы (Рис. 1.15). Хотя доля лиц с неизвестным количеством клеток CD4 увеличилась в 2020 г. по сравнению со средним значением за период 2011−2020 гг. (46% в сравнении с 42%), доля лиц с подтвержденной информацией об острой инфекции возросла с 17% в 2011 г. до 21% в 2019 г., несколько сократившись до 18% в 2020 г. В 2020 г. в 27 странах ЕС/ЕЭЗ было зарегистрировано 1 760 диагнозов СПИДа, что соответствует показа- телю 0,5 случаев на 100 000 населения (Таблица 14). Четырнадцать стран сообщили о туберкулезе (ТБ) – легочном и/или внелегочном – как СПИД- индикаторном заболевании среди 13% тех, кому впервые был поставлен диагноз СПИДа (Рис. 1.17). В ЕС/ЕЭЗ за последнее десятилетие число случаев СПИДа уменьшилось более чем наполовину (Рис. 1.10). Подобное снижение отмечено среди мужчин и женщин и во всех группах путей передачи, но созда- ется впечатление о том, что наибольшее снижение относится к категории употребления инъекционных наркотиков (Таблицы 15–20, Рис. 1.16). Европейский регион ВОЗ В период с 2011 г. по 2019 г. частота впервые диагно- стированных случаев ВИЧ-инфекции в Европейском регионе ВОЗ увеличилась на 5%, в основном, за счет восходящего тренда во многих странах восточ- ной части Региона. Однако за последние три года на востоке наметилась общая стабилизация эпиде- мии. В 2020 г. диагноз ВИЧ-инфекции был впервые поставлен 104 765 лицам, что соответствует пока- зателю 15,6 на 100 000 населения – 24-процентное снижение частоты в период 2019–2020 гг. Однако такое снижение отчасти связано с уменьшением выявления случаев заболевания в результате мер по защите общественного здоровья и мер социального характера, введенных странами в ответ на пандемию COVID-19. По этой причине, хотя в данном докладе мы все еще сравниваем данные за 2020 г. с предыду- щими годами, тенденции следует интерпретировать с осторожностью. Из 104 765 человек, которым диагноз установлен в 2020 г., 81% были диагностированы в восточной (84 556), 15% – западной (15 782) и 4% – центральной части Региона (4 427) (Таблица A). Показатель также стал наибольшим на востоке (32,6 на 100 000 насе- ления), будучи диспропорционально выше, чем на западе (3,7 на 100 000 населения) и в центре (2,3 на 100 000 населения) (Таблица A). В 2020 г. в Европейском регионе ВОЗ частота уста- новления новых диагнозов ВИЧ-инфекции широко варьировала между странами. Наибольшие показа- тели на 100 000 населения (выше 15,0) отмечались в Российской Федерации (40,8), за которой следовала Украина (37,5), Казахстан (18,5), Республика Молдова (16,7), Мальта (15,9) и Беларусь (15,1). О самых низ- ких показателях (ниже 2,0) сообщили Сербия (1,2), Словения (1,3), Австрия (1,7), Хорватия (1,9), Польша (1,9) и Словакия (1,9). Ни одного нового случая ВИЧ- инфекции в 2020 г. не было диагностировано в Сан-Марино (Таблица 1). Общий показатель – 15,7 на 100 000 населения для мужчин (Таблица 2) и 8,1 на 100 000 населения для женщин (Таблица 3). Соотношение мужчин и женщин составило 1,9 – самое низкое на востоке (1,6), выше на западе (3,0) и наиболее высокое в центре (5,3). Наибольшая доля людей с впервые установленным диагнозом ВИЧ-инфекции в 46 подающим сведе- ния странах относилась к возрастной группе 30–39 лет (40%) притом, что 5% на момент диагностики были молодежью в возрасте 15–24 лет, а 14% лиц были в возрасте 50 лет и старше. Наиболее рас- пространенной формой заражения выступали гетеросексуальные половые контакты (58%), причем 10% таких случаев были выходцами из стран с гене- рализованными эпидемиями за пределами Региона: Рис. C: Доля людей, диагностированных на поздних стадиях (количество клеток CD4 < 350 в мм3) с разбивкой по полу, возрасту и путям передачи, Европейский регион ВОЗ, 2020 г. (n = 32 336) 0 10 20 30 40 50 60 70 Секс между мужчинами Потребление инъекционных наркотиков Гетеросексуальная передача (женщины) Гетеросексуальная передача (мужчины) 50+ 40–49 30–39 25–29 20–24 15–19 Женщины Мужчины Всего Процент По л Bо зр ас т Пу ть п ер ед ач и xxii SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data 22% инфицировались вследствие употребления инъ- екционных наркотиков, 9% – в результате половых контактов между мужчинами и 0,4% – путем пере- дачи от матери ребенку. По 10% новых диагнозов информация о путях передачи либо была неизвестна, либо не предоставлялась (Таблица A). Среди новых диагнозов с известным путем передачи ВИЧ, зарегистрированных 12 странами в восточной части Региона, 68% инфицировались путем гетеро- сексуальной передачи, а 29% – из-за употребления инъекционных наркотиков; отмеченная передача вследствие половых контактов между мужчинами оставалась низкой, на уровне 3% случаев (Таблицы 4–6, 8). Половые контакты между мужчинами (48%) и гетеросексуальные контакты (47%) – основные отмеченные пути передачи в центре, но по 42% новых диагнозов информация о путях передачи отсутствовала. Половые контакты между мужчи- нами – преобладающий путь передачи для 10 из 13 стран центральной части Региона. На западе половые контакты между мужчинами оставались основным путем передачи (52% случаев), за которым следовала гетеросексуальная передача (42% случаев, среди которых происхождение 39% – из стран с генерали- зованными эпидемиями). По 25% новых диагнозов информация отсутствовала. Сведения о путях передачи за период 2011–2020 гг. последовательно подавались 37 странами (Рис. 2.3). На востоке прирост был обусловлен увеличе- нием числа диагнозов ВИЧ-инфекции с известным половым путем передачи: доля гетеросексуальной передачи увеличилась на 8%, а доля половых кон- тактов между мужчинами – почти четырехкратно. Повышение значимости гетеросексуальной пере- дачи связано с передачей инфекции от мужчины мужчине (увеличение на 42%), поскольку за тот же период частота гетеросексуальной передачи среди женщин снизилась (сокращение на 14%). Хотя число новых диагнозов среди людей, инфицировавшихся в результате употребления инъекционных нарко- тиков, за указанный период сократилась в общей сложности на 19%, это был единственный путь передачи, продемонстрировавший увеличение в 2019–2020 гг. в абсолютных цифрах, главным обра- зом за счет повышения частоты передачи в Украине (Рис. 2.9). В центре заражение людей вследствие половых контактов между мужчинами оставалось доминирующим путем передачи в 10 из 13 стран. Хотя количество новых диагнозов среди инфицированных в результате гетеросексуальной передачи в 2020 г. было сравнимо с уровнями 2011 г., этот путь все же оставался главным известным путем передачи в трех странах. Процент новых инфекций вследствие упо- требления инъекционных наркотиков составил 15% в 2011 г. и 5% в 2020 г. (Рис. 2.16). На западе гетеро- сексуальная передача продолжала последовательно снижаться, сократившись в общей сложности на 47% на протяжении 10-летнего периода. С 2011 г. по 2020 г. передача вследствие употребления инъекцион- ных наркотиков сократилась на 50%. Число новых диагностированных случаев ВИЧ-инфекции, свя- занных с половыми контактами между мужчинами, сократилось на 47% по сравнению с 2011 г. На западе доля новых диагнозов с неизвестным путем передачи увеличилась с 16% в 2011 г. до 27% в 2020 г. (Рис. 2.18). Поскольку 64% новых диагнозов ВИЧ-инфекции с доступными сведениями о количестве клеток CD4 зарегистрированы в Российской Федерации, где только 27% были отнесены к категории поздно обра- тившихся за помощью, общая тенденция поздней диагностики для Региона, в большей степени, отра- жает ситуацию именно в РФ. Среди лиц, впервые диагностированных на протяжении 14 лет, по кото- рым доступна информация о количестве клеток CD4 на момент установления диагноза ВИЧ-инфекции, более трети (36%) поздно обратились за помощью, когда количество CD4 опустилось ниже 350 клеток в мм3, в том числе 19% – на поздних стадиях ВИЧ- инфекции (CD4 менее 200 клеток/мм3). Однако после исключения данных, поданных Российской Федерацией, оказалось, что поздно обратились за помощью половина (50%) всех лиц с впервые установленным диагнозом в Регионе, что сравнимо с результатами за прошлые годы. Поздняя диагностика ВИЧ-инфекции остается проблемой в большинстве стран Региона. Процент людей, поздно обратившихся за помощью (CD4 менее 350 клеток/ мм3), среди людей, которым был впервые установ- лен диагноз, варьировал в зависимости от категорий путей передачи и возрастных групп, но был наивыс- шим среди тех, кто сообщил о гетеросексуальной передаче (56%; 58% для мужчин и 54% для женщин) и передаче из-за употребления инъекционных нар- котиков (43%), и самым низким – среди мужчин, инфицировавшихся вследствие половых контактов между мужчинами (41%) (Рис. C). Процент увеличи- вался с возрастом в диапазоне от 33% среди людей в возрасте 15–19 лет на момент установления диагноза до 65% среди людей в возрасте 50 лет и старше. Что касается разбивки по полу, процент поздно обратив- шихся за помощью был в целом одинаков для обоих полов (50% среди мужчин и 52% среди женщин), что в группе мужчин нивелирует различия между МСМ (среди которых отмечается тенденция к более ран- ней диагностике) и гетеросексуальными мужчинами (среди которых отмечается тенденция к более позд- ней диагностике). В 2020 г. 7 721 лицам в 43 странах Европейского региона ВОЗ был поставлен диагноз СПИДа, что соответствует показателю 1,2 на 100 000 населения. В общей сложности 74% случаев СПИДа были диа- гностированы на востоке, где частота диагностики СПИДа на 100 000 также была наивысшей (5,0), 20% – на западе (с показателем 0,5 на 100 000) и 6% – в центре Региона (0,2 на 100 000) (Таблица 14). Двадцать процентов лиц с диагнозом СПИДа страдали туберкулезом (ТБ) в качестве СПИД-индикаторного заболевания в диапазоне от 13% случаев на западе и xxiii HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT 21% в центре до 28% на востоке. В период с 2011 г. по 2020 г. общая частота установления новых диагнозов СПИДа в Регионе снизилась на 54%. Выводы ВИЧ-инфекция продолжает отражаться на здоровье и благополучии миллионов людей в Европейском реги- оне ВОЗ. На протяжении трех последних десятилетий свыше 2,2 миллионов людей в Европейском регионе ВОЗ были диагностированы и зарегистрированы как ВИЧ-инфицированные, включая свыше 560 000 чело- век в ЕС/ЕЭЗ. ВИЧ-инфекция в 2020 г. была впервые выявлена у 104 765 человек. Подавляющее большин- ство людей с впервые установленным диагнозом (81%) диагностированы на востоке, 15% – на западе и 4% – в центре Региона. Новые случаи инфициро- вания в Российской Федерации составили 57% всех случаев в Европейском регионе ВОЗ. Доля случаев, зарегистрированных в Украине, составила 15% всех случаев в Регионе. Резкому (24%) падению числа диагностирован- ных случаев ВИЧ-инфекции в период 2019−2020 гг. предшествовал в течение 2011−2018 гг. общий восходящий тренд в частоте новых диагнозов ВИЧ- инфекции, в основном вследствие восходящей тенденции на востоке. Хотя для выдвижения пред- положений о причинах резкого падения количества новых диагнозов ВИЧ-инфекции, наблюдавшегося в 2020 г., необходимы дополнительные исследова- ния, скорее всего, отчасти его можно отнести за счет сокращения выявления случаев в результате мер по защите общественного здоровья и мер социального характера, введенных странами в ответ на пандемию COVID-19. Страны, участвовавшие в опросе ВОЗ/ECDC, сообщили о сокращении выявления и регистрации случаев ВИЧ во время пандемии COVID-19, в основ- ном из-за сокращения объема услуг тестирования и ограниченного потенциала эпиднадзора. Хотя закономерности и тенденции эпидемии сильно варьировали между странами Европейского региона ВОЗ, наблюдался устойчивый рост числа впервые диагностированных случаев инфекции в опреде- ленных группах передачи во всех субрегионах. В качестве примеров можно привести повышение частоты передачи среди МСМ в центре и на востоке и среди гетеросексуальных лиц на востоке, хотя неко- торые исследования дают основания полагать, что последнее обстоятельство следует интерпретировать с осторожностью [1,2]. В последние годы передача инфекции гетеросексуальным путем значительно снизилась в ЕС/ЕЭЗ и на западе Европейского региона ВОЗ, особенно среди женщин, равно как и количество случаев заражения в результате половых контактов между мужчинами в отдельных странах ЕС/ЕЭЗ и на западе. Несмотря на неуклонное снижение частоты передачи инфекции вследствие употребления инъек- ционных наркотиков с 2011 г., в 2020 г. в регулярно подающих сведения странах она увеличилась на 15% по сравнению с 2019 г., и это единственная категория передачи, по которой в 2020 г. отмечался рост. Общее улучшение в области поздней диагностики по Региону связано с Российской Федерацией, которая впервые предоставила сведения о количестве CD4 на момент установления диагноза ВИЧ-инфекции, так как на РФ приходится подавляющее большин- ство новых диагнозов ВИЧ-инфекции с доступными данными о количестве клеток CD4 в Европейском регионе ВОЗ. В результате у чуть более трети (36%) лиц, впервые диагностированных в 2020 г., на момент диагностики ВИЧ-инфекции уровень CD4 был ниже 350 в мм3, включая 19%, находившихся на поздних стадиях ВИЧ-инфекции (CD4 ниже 200/мм3). Однако после исключения данных, поданных Российской Федерацией, оказалось, что половина всех лиц с впервые установленным диагнозом ВИЧ-инфекции были выявлены лишь после того, как их количество клеток CD4 снизилось до уровня ниже 350 в мм3, что сравнимо с результатами прошлых лет. Относительно высокое число диагнозов СПИДа в восточной части Региона подтверждает тот факт, что поздняя диагно- стика ВИЧ-инфекции остается большой проблемой. В то же время тенденция к стабилизации в отношении частоты СПИДа, наблюдаемая с 2012 г., может быть результатом того, что большинством стран к настоя- щему времени последовали рекомендации «лечить всех», направленной на предоставление всем живущим с ВИЧ возможности получать антиретро- вирусную терапию (АРТ) вне зависимости от стадии заболевания. Для совершенствования ранней диагностики и повышения числа людей, осведомленных о своем ВИЧ-статусе, требуются новые стратегии с расшире- нием диапазона разнообразных и дружественных к пользователю подходов к более широкодоступному тестированию на ВИЧ. ВОЗ подготовила сводное руководство по услугам тестирования на ВИЧ, вклю- чая руководство по самотестированию на ВИЧ и информированию партнеров, а ECDC опубликовал руководство, составленное с позиций общественного здравоохранения, по комплексному тестированию на ВИЧ-инфекцию и гепатиты B и C. В этих публи- кациях в части общих услуг по тестированию на ВИЧ рекомендуются новаторские подходы, в том числе самотестирование и тестирование на уровне сообщества силами работников без специального образования с использованием экспресс-тестов [3–5]. Быстрое расширение масштабов тестирова- ния на ВИЧ – вопрос, имеющий первостепенное значение, принимая во внимание негативное воздей- ствие пандемии COVID-19 на службы тестирования. ВОЗ выпустила аналитическую записку – краткое изложение политики об отказе от использования вестерн-блоттинга и линейного иммуноанализа в стратегиях и алгоритмах тестирования на ВИЧ и о поддержке децентрализованного тестирования и незамедлительного направления на лечение [6]. Хотя предоставление услуг по тестированию на ВИЧ в Регионе со временем улучшилось, а степень xxiv SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data внедрения таких подходов, как самотестирование и тестирование на уровне общин, в последние годы значительно возросла, результаты мониторинга политики в рамках Региона указывают на то, что во многих европейских странах некоторые подходы к тестированию используются в ограниченных мас- штабах или вообще не применяются [7]. Услуги по тестированию на ВИЧ должны сосредоточиваться на ключевых группах населения с учетом местных эпи- демиологических особенностей, адаптироваться к конкретным потребностям этих, поддерживая сво- евременное направление в систему профилактики, лечения и оказания помощи в связи с ВИЧ. подоб- ный подход призван обеспечить более раннюю диагностику и начало лечения, приводя к улучше- нию исходов лечения и снижению инцидентности ВИЧ-инфекции, показателя заболеваемости и смерт- ности, в поддержку достижения целей 95–95–95 и других региональных и глобальных целевых ориен- тиров [8–10]. Имеется значительный массив убедительных дан- ных о том, что раннее начало АРТ полезно как для здоровья людей, получающих лечение, так и для предотвращения дальнейшей передачи ВИЧ [11–16]. Почти 90% стран Европейского региона ВОЗ придер- живаются политики назначения АРТ вне зависимости от количества клеток CD4 [17,18]. Вмешательства, направленные борьбу с эпидемией, должны быть основаны на фактических данных и адаптированы к национальной и местной эпидемио- логической ситуации. На основании представленных в этом отчете исчерпывающих эпидемиологических данных можно сделать следующие выводы. • Для стран ЕС/ЕЭЗ и западной части Региона с учетом преобладания передачи ВИЧ среди МСМ и роста заболеваемости среди этого контингента в некоторых странах представляется, что текущие вмешательства по профилактике, лечению и оказанию помощи, направленные МСМ, нуждаются в дальнейшем расширении и усилении; они должны оставаться приоритетными мерами в ответ на эпидемию ВИЧ/СПИДа. Страны, в которых наблюдается снижение заболеваемости, продемонстрировали воздействие изменения культуры деятельности, выражающееся в более частом тестировании на ВИЧ подвергающихся риску гомосексуальных мужчин и безотлагательном направлении за получением медицинской помощи и АРТ всех выявленных ВИЧ-положительных лиц [20]. Многокомпонентные подходы и включение в пакет вмешательств, направленных на профилактику и контроль заболевания, таких мер, как ДКП ВИЧ, скрининг и лечение инфекций, передаваемых половым путем, а также самотестирование и добровольное информирование партнеров с сопровождением, могли бы помочь изменить траекторию восходящих тенденций, наблюдаемых в некоторых странах. В большинстве европейских стран фактический уровень использования ДКП значительно ниже уровня охвата, ожидаемого, исходя из предполагаемой потребности [3,21– 23]. Во многих странах западной части Региона необходимо более широко внедрять эффективные и доступные услуги по тестированию, профилактике и помощи, предназначенные для становящейся все более разнообразной группы мигрантов, подвергающихся риску заражения ВИЧ и живущих с ВИЧ. Рост числа случаев ВИЧ-инфекции среди людей, употребляющих инъекционные наркотики, в 2011–2012 гг. и непрекращающиеся в ряде стран местные вспышки заболевания [24–28] демонстрируют необходимость поддержания или расширения масштабов программ снижения вреда. • В странах, расположенных в центре Региона, количество новых диагнозов растет быстрее, чем в любой другой части Европейского региона ВОЗ. В этом субрегионе наблюдается очень сильное – вызывающее тревогу – гендерное неравенство в количестве новых диагнозов ВИЧ-инфекции: среди мужчин, особенно МСМ, отмечается тревожный рост, по сравнению с довольно стабильным показателем среди женщин. Половые контакты между мужчинами являются преобладающим путем передачи в 10 из 13 подающих сведения стран, расположенных в центре Региона. Разрешение сложившейся ситуации требует проведения вмешательств, таких как ДКП для групп высокого риска, тестирование на ВИЧ силами работников без специального образования, диагностическое экспресс-тестирование на ВИЧ, самотестирование на ВИЧ и добровольное информирование партнеров с сопровождением, наряду с политикой и практикой предложения АРТ всем людям, живущим с ВИЧ. После прекращения финансирования, поступавшего из Глобального фонда для борьбы со СПИДом, туберкулезом и малярией, некоторые страны осуществили переход на внутреннее финансирование мер реагирования на ВИЧ. В связи с таким переходом возникли проблемы с устойчивостью финансирования, что особенно сказалось на финансировании программ профилактики ВИЧ-инфекции и проведении опросов среди ключевых групп населения. Для смягчения некоторых из этих проблем и предотвращения ускорения темпов распространения эпидемии требуются сильная политическая воля и повышенное внимание наряду с активным привлечением гражданского общества [29]. • Странам восточной части Региона насущно необходимо продолжить расширение масштабов амбициозных, научно обоснованных вмешательств и предоставлять более эффективные комплексные услуги опосредованно через системы здравоохранения, способные лучшим образом обращаться к социальным детерминантам здоровья. Необходимы всеобъемлющая комбинированная профилактика и инновационные стратегии тестирования на ВИЧ с особым упором на охват ключевых групп населения. Подобная задача может быть решена с помощью xxv HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT предоставления дружелюбных к пользователю услуг по профилактике и тестированию, в том числе информирование партнеров с сопровождением, ДКП, тестирование на ВИЧ, выполняемое подготовленными работниками без специального образования, и самотестирование в соответствии с рекомендациями ВОЗ. Все эти услуги должны быть интегрированы в национальную политику и программы, а затем осуществлены на практике [3,4,10,30]. Для сокращения частоты установления новых диагнозов ВИЧ-инфекции и увеличения числа людей, направленных в систему оказания помощи, начавших и продолживших прием АРТ, исключительно важно вовлечение сообщества на этапах планирования и оказания услуг. Конечная цель заключается в снижении заболеваемости ВИЧ и смертности вследствие СПИДа. Инновационные вмешательства по профилактике ВИЧ должны учитывать риск гетеросексуальной передачи, особенно среди пар, в которых один из партнеров вовлечен в рискованное поведение (например, употребление инъекционных наркотиков) или в течение длительных периодов времени работает за рубежом. Большое количество новых диагнозов среди людей, инфицировавшихся в результате употребления инъекционных наркотиков, подчеркивает, что научно обоснованная политика, сосредоточенная на ключевых группах населения, включая высокий охват программами снижения вреда для людей, употребляющих инъекционные наркотики, по-прежнему имеет решающее значение в успехе мер реагирования на ВИЧ в восточной части Региона. Некоторые исследования, проведенные на вос- токе Региона, выявили, что информация о путях передачи среди впервые диагностированных паци- ентов может содержать погрешность: многие случаи, зарегистрированные как инфицировавшиеся гете- росексуальным путем, имеют анамнез употребления инъекционных наркотиков или, для случаев среди мужчин, – половые контакты между мужчинами [1,2]. Это обстоятельство подчеркивает важность оценки достоверности собираемых в плановом порядке данных эпиднадзора, касающихся путей передачи, особенно в странах, где употребление инъекционных наркотиков и гомосексуальность стигматизированы. Со временем число стран, проводящих усилен- ный эпиднадзор за ВИЧ и представляющих данные эпиднадзора на европейском уровне, постепенно увеличивалось. Однако сбор данных в 2020 г. и подача сведений за 2020 г. во многих странах Европейского региона ВОЗ во время продолжающейся пандемии COVID-19 оказались очень проблематичными из-за чрезмерной потребности в клинических ресурсах и ресурсах эпиднадзора с позиций общественного здравоохранения. Это привело к уменьшению коли- чества сообщений о случаях ВИЧ и сокращению возможности сбора расширенных данных о лицах с установленным диагнозом. Однако часть этой инфор- мации может стать доступной в будущих раундах подачи сведений, что упростит интерпретацию тен- денций 2020 г. в будущем. Проведение усиленного эпиднадзора за ВИЧ повы- шает возможности более долгосрочного мониторинга исходов континуума оказания помощи в связи с ВИЧ, такие как моделирование недиагностиро- ванной фракции и количественное определение направлений в систему оказания помощи, лечения и достижения подавления вирусной нагрузки после установления диагноза. Также можно оказать под- держку национальным и глобальным усилиям по мониторингу прогресса в достижении целей 95–95– 95 и других глобальных и региональных целевых ориентиров. Конечная дата завершения выполнения «Плана действий сектора здравоохранения по борьбе с ВИЧ- инфекцией в Европейском регионе ВОЗ» наступает в 2021 г.; в 2022 г. достигнутый прогресс будет оценен и доведен до сведения Европейского регионального комитета ВОЗ. Срок реализации трех глобальных стратегий в области здравоохранения (ГССЗ) по ВИЧ/ СПИДу, вирусному гепатиту и инфекциям, пере- даваемым половым путем (ИППП), истекает в том же году. Для информирования о разработке новых ГССЗ по ВИЧ/СПИДу, вирусному гепатиту и инфек- циям, передаваемым половым путем, Европейское региональное бюро ВОЗ 16–17 июня 2021 г. про- вело виртуальное консультативное совещание с государствами-членами и партнерами. Повестка совещания была расширена с охватом предложен- ных европейских региональных планов действий по борьбе с ВИЧ/СПИДом, вирусными гепатитами и ИППП на 2022−2030 гг. Отзывы государств-членов и партнеров используются для обеспечения того, что приоритеты Европейского региона ВОЗ отражены в ГССЗ и что в Региональном плане действий на 2022–2030 гг. учтены потребности ключевых групп населения и людей, живущих с ВИЧ, посредством услуг, ориентированных на нужды людей, и стратегии «строить лучше, чем было» после пандемии COVD-19. Европейское региональное бюро ВОЗ и ECDC вместе с государствами-членами и партнерами внимательно изучат воздействие COVID-19 на эпиднадзор и профи- лактические меры в ответ на эпидемию ВИЧ/СПИДа, чтобы поддержать сохраняющийся высокий стан- дарт европейских данных по ВИЧ и СПИДу, направить ответные меры в Регионе и понять, как продолжаю- щаяся пандемия могла повлиять на заболеваемость ВИЧ, особенно в указанных регионах и подвергаю- щихся наибольшему риску группах. Библиография 1. Dumchev K, Kornilova M, Kulchynska R, Azarskova M, Vitek C. Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk. BMC Public Health 2020;20(1):1288. doi:10.1186/s12889-020-09373-2. PMID:32843008; PMCID: PMC7449084. 2. Čakalo JI, Božičević I, Vitek C, Mandel JS, Salyuk T, Rutherford GW. Misclassification of men with reported HIV infection in Ukraine. xxvi SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data AIDS Behav. 2015;19(10):1938–40. doi:10.1007/s10461-015-1112-0. PMID: 26070886. 3. Руководство по самотестированию на ВИЧ и информированию партнеров: дополнение к сводному руководству по услугам тестирования на ВИЧ. Женева: Всемирная организация здраво- охранения; 2016. Доступно по ссылке: https://apps.who.int/iris/ handle/10665/342535 [Guidelines on HIV self-testing and partner notification. Supplement to consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2017. Available from: https://apps.who.int/iris/handle/10665/251655 4. Сводное руководство по услугам тестирования на ВИЧ. Женева: Всемирная организация здравоохранения; 2016. Доступно по ссылке: https://www.euro.who.int/ru/publications/ abstracts/consolidated-guidelines-on-hiv-testing-services-2015 [Consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2015. Available from: www.who.int/hiv/pub/ guidelines/hiv-testing-services/en/] 5. Public health guidance on HIV, hepatitis B and C testing in the EU/EEA. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/ public-health-guidance-hiv-hepatitis-b-and-c-testing-eueea 6. ВОЗ рекомендует странам отказаться от использования вестерн-блоттнига и линейного иммуноанализа в страте- гиях и алгоритмах тестирования на ВИЧ. Краткое изложение политики. Копенгаген: Европейское региональное бюро ВОЗ; 2019. Доступно по ссылке: https://www.euro.who.int/ru/ health-topics/communicable-diseases/hivaids/publications/2019/ who-recommends-countries-move-away-from-the-use-of-western- blotting-and-line-immunoassays-in-hiv-testing-strategies-and- algorithms.-policy-brief-2019 [WHO recommends countries move away from the use of western blotting and line immunoassays in HIV testing strategies and algorithms. Policy brief. Copenhagen: WHO Regional Office for Europe; 2019. Available from: www. euro.who.int/en/health-topics/communicable-diseases/hivaids/ publications/2019/who-recommends-countries-move-away-from- the-use-of-western-blotting-and-line-immunoassays-in-hiv- testing-strategies-and-algorithms.-policy-brief-2019] 7. HIV testing. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017. Available from: https:// ecdc.europa.eu/sites/portal/files/documents/HIV%20testing.pdf. 8. Глобальная стратегия сектора здравоохранения по ликвида- ции ВИЧ: 2016-2021: на пути к ликвидации СПИДа. Женева: Всемирная организация здравоохранения; 2016. Доступно по ссылке: https://apps.who.int/iris/handle/10665/255763 [Global health sector strategy on HIV, 2016–2021 – towards ending AIDS. Geneva: World Health Organization; 2016. Available from: www. who.int/hiv/strategy2016-2021/ghss-hiv/en/] 9. Global AIDS Strategy 2021–2026 End Inequalities. End AIDS. Geneva: UNAIDS; 2021. Available from www.unaids.org/sites/ default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf 10. План действий сектора здравоохранения по борьбе с вирус- ными гепатитами в Европейском регионе ВОЗ. Копенгаген: Европейское региональное бюро ВОЗ; 2017. Доступно по ссылке: https://apps.who.int/iris/handle/10665/342529 [Action plan for the health sector response to HIV in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2017. Available from: https://www.euro.who.int/en/health-topics/ communicable-diseases/hivaids/publications/2017/action-plan- for-the-health-sector-response-to-hiv-in-the-who-european- region-2017] 11. Сводное руководство по использованию антиретровирусных препаратов для лечения и профилактики ВИЧ-инфекции: реко- мендации с позиций общественного здравоохранения. Женева: Всемирная организация здравоохранения; 2013. Доступно по ссылке: https://apps.who.int/iris/handle/10665/112474 [Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2016. Available from: https://www.who.int/ publications/i/item/9789241549684] 12. Руководство о времени назначения антиретровирусной тера- пии и по доконтактной профилактике ВИЧ-инфекции. Женева: Всемирная организация здравоохранения; 2016. Доступно по ссылке: https://www.euro.who.int/ru/publications/abstracts/ guideline-on-when-to-start-antiretroviral-therapy-and-on-pre- exposure-prophylaxis-for-hiv-2015 [Guidelines on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: World Health Organization; 2015. Available from: https:// www.who.int/publications/i/item/9789241509565] 13. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016;373(9):795–807. 14. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. 15. Guidelines Version 9.1. October 2018. In: European AIDS Clinical Society. Brussels: European AIDS Clinical Society; 2018. Available from: www.eacsociety.org/guidelines/eacs-guidelines/eacs- guidelines.html 16. Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, Degan O et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019;393(10189):2428–38. 17. Continuum of HIV care. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications- data/continuum-hiv-care-monitoring-implementation-dublin- declaration-2018-progress 18. 2019 Global AIDS Monitoring (GAM). In: AIDSinfo. New York (NY): UNAIDS; 2019 Available from: https://aidsinfo.unaids.org/ 19. Regional Workshop on Advancing Implementation Science on HIV and Viral Hepatitis in Eastern Europe and Central Asia. Report (10– 11 February 2020, Berlin, Germany). Copenhagen: WHO Regional Office for Europe; 2020. Available from: www.euro.who.int/en/ health-topics/communicable-diseases/hivaids/publications/2020/ regional-workshop-on-advancing-implementation-science-on-hiv- and-viral-hepatitis-in-eastern-europe-and-central-asia.-report- 1011-february-2020,-berlin,-germany 20. Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveill. 2017;22(25):pii=30553 (https://doi.org/10.2807/1560-7917. ES.2017.22.25.30553). 21. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014. Available from: https:// www.ecdc.europa.eu/sites/default/files/media/en/publications/ Publications/hiv-sti-prevention-among-men-who-have-sex-with- men-guidance.pdf 22. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2017;378:53–60. 23. Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P, et al. and the ECDC Dublin Declaration Monitoring Network. Estimating the “PrEP gap”: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019;24(41):pii=1900598. Available from: https://doi. org/10.2807/1560-7917.ES.2019.24.41.1900598 24. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L et al. Human immunodeficiency virus among people who inject drugs: is risk increasing in Europe? Euro Surveill. 2013;18(48):pii=20648. Available from www.eurosurveillance.org/ViewArticle. aspx?ArticleId=20648 25. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015. Euro Surveill. 2015;20(40):pii=30036 Available from: http://dx.doi. org/10.2807/1560-7917.ES.2016.20.40.30036 26. HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre for Drugs and Drug Addiction; 2018. Available from: http:// sante.public.lu/fr/publications/h/hiv-joint-technical-mission/ index.html 27. McAuley A, Palmateer NE, Goldberg DJ, Trayner KMA, Shepherd SJ, Gunson RN et al. Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross- sectional analysis. Lancet HIV 2019;6(5):e315–24. 28. Des Jarlais DC, Sypsa V, Feelemyer J, Abagiu AO, Arendt V, Broz D et al. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV 2020;7(6):e434–42. 29. Lost in transition. Three case studies of Global Fund withdrawal in south eastern Europe. New York (NY): Open Society Foundations; 2017. Available from: www.opensocietyfoundations.org/ publications/lost-transition 30. Сводное руководство по вич-инфекции в ключевых груп- пах населения: профилактика, диагностика, лечение и уход. Женева: Вемирная организация здравоохране- ния; 2014. Доступно по ссылке: https://apps.who.int/iris/ handle/10665/161724 [Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. 2017 update. Geneva: World Health Organization; 2017. Available from: https:// www.who.int/publications/i/item/9789241511124] 1HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT 1.1. HIV diagnoses In 2020, 14 971 new HIV diagnoses were reported in 29 countries of the EU/EEA1, with a rate of 3.7 per 100 000 when adjusted for reporting delay (Table 1). The high- est rates were reported by Malta (15.9; 82 cases), Latvia (13.5; 257), Cyprus (11.8; 105), and Estonia (10.8; 143), and the lowest by Slovenia (1.3; 27 cases) and Austria (1.7; 155) (Table 1, Map 1). As in previous years, more men than women were diagnosed with HIV in 2020 (11 348 and 3 496, respec- tively), resulting in an overall male-to-female ratio of 3.2:1 (Tables 2 and 3, Fig. 1.1). This ratio was highest in Hungary (11.1) and Slovakia (8.1) and was above one in all countries in the EU/EEA (Fig. 1.1). The predominant mode of transmission in countries with the highest male- to-female ratios was sex between men. The overall rate of new diagnoses in men was 5.2 per 100 000 popula- tion (Table 2) and for women 1.5 per 100 000 population (Table 3). In addition to the 14 841 cases with male or 1 With the exception of Portugal, all EU/EEA countries reported data for 2020; Liechtenstein reported zero cases. female gender, 130 individuals with unknown or ‘other’ gender were diagnosed with HIV in 2020. Current report- ing systems at European level are not able to effectively identify how many of these cases are transgender men or women and how many are cases with unknown infor- mation reported on gender. Age-specific rates were lowest in persons under 15 years of age (0.1 per 100 000 population for males and 0.2 for females) (Fig. 1.2). In all other age groups, men had higher age-specific rates than women. The highest overall age-specific rate of HIV diagnoses was observed among 25–29-year-olds (8.0 per 100 000 population), largely because this age group has the highest age-spe- cific rate for men at 12.1 per 100 000 population, while rates for women were highest in the 30–39 age group (4.0 per 100 000 population) (Fig. 1.2). The overall mean age at diagnosis was 38.9 years; the mean age at diagnosis was lower for MSM (37.0 years) than for cases attributed to injecting drug use (38.9 years) or heterosexual transmission (40.7 years overall, 38.8 in women and 42.8 in men). The 30–39 age group accounted for most HIV diagnoses overall (32%) and in 1. HIV and AIDS in the EU/EEA Figure 1.1: Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2020 (n=14 844) 0 2 4 6 8 10 12 Estonia Sweden Latvia Norway France Belgium Lithuania Finland EU/EEA Romania Germany Ireland Italy Greece Austria Czechia Slovenia Malta Cyprus Iceland Denmark Netherlands Luxembourg Spain Bulgaria Poland Croatia Slovakia Hungary Male-to-female ratio Data from Portugal not published at country request and Liechtenstein reported zero cases in 2020. 2SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data all transmission groups (Fig. 1.3). One third of diagno- ses attributed to sex between men were made before the age of 30, while nearly half (49.4%) of HIV infections due to sex between men and women were diagnosed at 40 years or above, and nearly one-quarter (23.6%) at 50 years or above. The age pattern among those newly diagnosed with HIV differed across countries. One-third or more of the total new diagnoses occurring among persons under 30 years were reported from Bulgaria, Croatia, Luxembourg, Poland and Romania and 50% or more of the new diagnoses occurring among persons aged 40 years and older were reported from Denmark, Finland, Latvia and Luxembourg (Fig. 1.4). Young people aged 15–24 years comprised 11% of the EU/EEA population and 9.9% of HIV diagnoses in 2020. Romania reported more than 20% of its HIV diagnoses in this age group (Fig. 1.4, Table 9). Forty-one per cent of the EU/EEA population consists of older adults (50 years and above), who comprised 21% of the new HIV diagnoses reported in 2020. Older adults comprised more than 25% of those newly diagnosed with HIV in Austria, Denmark, Finland, Italy, Luxembourg, and the Netherlands (Fig. 1.4, Table 9). Data on transmission mode provide information on the groups in the EU/EEA who are most affected by HIV (Tables 4–8; Fig. 1.5): • Sex between men remains the most common mode of HIV transmission reported in the EU/EEA, accounting for 38.8% (5 815) of all new HIV diagnoses in 2020. Sex between men was the predominant route of transmission (53.1%) among those for whom route of transmission was known (Table 4, Table 8, Fig. 1.5) and accounted for more than 60% of new HIV diagnoses in eight countries (Croatia, Cyprus, Hungary, Iceland, Netherlands, Poland, Slovakia, Spain) (Fig. 1.5). While the majority (59%;3 435) of the new diagnoses attrib- uted to sex between men were born in the reporting country, 13% (756) originated from Latin America and the Caribbean, 5.6% (324) from countries in Central or East Europe and 4% (254) from other countries in West Europe. Figure 1.3: New HIV diagnoses, by age group (in years) and transmission mode, EU/EEA, 2020 (n=10 819) 0 20 40 60 80 100 Sex between men Injecting drug use Heterosexual contact 15-19 years 20-24 years 25-29 years 30-39 years 40-49 years 50+ years n = 4 439 n = 573 n = 5 807 Percentage Tr an sm is si on m od e Figure 1.2: Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2020 (n=12 903) 0 2 4 6 8 10 12 14 50+40-4930-3925-2920-2415-19 < 15 Men Women Ne w H IV d ia gn os es p er 1 00 0 00 p op ul at io n Age category (years) Data from Portugal not published at country request and data from Spain were excluded due to non-national coverage. 3HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT • Sex between men and women is the second most com- monly reported mode of transmission in the EU/EEA, accounting for 29.7% (4 445) of all HIV diagnoses and 40.6% of diagnoses where the route of transmission was known (Table 6, Table 8, Fig. 1.5). These propor- tions are divided roughly equally between men and women. Heterosexual transmission accounts for half or more than half of cases in six EU/EEA countries (Estonia, Finland, Latvia, Luxembourg, Romania, Sweden). Nearly one-third (31%; 1 397) of the newly diagnosed cases attributed to heterosexual transmis- sion were among migrants originating from countries with generalised HIV epidemics. The highest propor- tions of these were observed in France (53%) and Ireland (62%). Furthermore, 8% (357) of cases attrib- uted to sex between men and women originated from other countries in Central Europe and 6% (282) from countries in Latin America and the Caribbean. • Four per cent (571 cases) of all new HIV diagnoses and 5% of those with known route of HIV transmis- sion were attributed to injecting drug use (Table 5, Table 8, Fig. 1.5). Injecting drug use was the probable route of transmission for 25.0% of cases diagnosed in Latvia and 17.6% of cases diagnosed in Greece (Fig. 1.5). About one-third of new diagnoses attributed to injecting drug use were born outside of the report- ing country, including 23% (129) from other countries in Central Europe. • Of the remaining cases, 91 diagnoses (less than 1%) were reported as being due to vertical transmis- sion during pregnancy, childbirth or breastfeeding (Table 7); 53 of these cases (58.2%) were born out- side of the country in which the case was reported (Table 11). Twenty-two (0.2%) diagnoses were reported to be due to contaminated transfusion of blood and its products, and five cases to hospital-acquired infec- tions (Table 8). The majority of these nosocomial and transfusion-related cases originated from outside of the country where the case was reported (Table 11). • Transmission mode was reported as unknown for 4 022 diagnoses (26.9%), with wide variation among countries: less than 5% of diagnoses were reported with unknown transmission mode in Bulgaria, Croatia, Czechia, Norway and Romania, and over 50% in Ireland and Poland. Malta and Lithuania did not report any data on transmission mode for 2020 (Table 8). Twenty-six EU/EEA countries provided information on the country of birth, country of nationality or region of origin for 12 327 (82%) HIV diagnoses in 2020 (Fig. 1.6). In the EU/EEA, 5 390 diagnoses (36% of total diagnoses and 44% of those with known information on region of origin) were reported among people originating from outside of the reporting country. Of these, 1 852 (12% of total diagnoses and 15% of those with known infor- mation on region of origin), irrespective of transmission mode, were reported among people originating from Figure 1.4: Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2020 (n = 14 971) The graph organises countries in order of proportion of population <30 years. Data from Portugal not published at country request and Liechtenstein reported zero cases in 2020; Lithuania did not report data on age group. Unknown route of transmission is excluded from the proportions presented here. 0 20 40 60 80 100 Iceland Norway Finland Latvia Denmark Estonia Sweden Italy Austria Belgium Germany Ireland Czechia EU/EEA Slovenia Cyprus Greece France Spain Netherlands Slovakia Malta Hungary Croatia Bulgaria Romania Poland Luxembourg 15-19 years <15 years 20-24 years 25-29 years 30-39 years 40-49 years ≥50 years Percentage 4SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Figure 1.6: Percentage of new HIV diagnoses among migrants out of all reported cases with known information on region of origin, by country of report, EU/EEA, 2020 (n = 12 327) 0 20 40 60 80 100 Romania Bulgaria Poland Slovenia Estonia Croatia Italy Slovakia Greece Germany Austria Spain EU/EEA Czechia Netherlands France Cyprus Finland Denmark Norway Luxembourg Belgium Ireland Iceland Sweden Sub-Saharan Africa Central and eastern Europe Western Europe Latin America and Caribbean South and south-east Asia Other Percentage Portugal did not report 2020 data and Hungary, Latvia, Lithuania, and Malta did not report data on country of birth or region of origin or reported all cases as being from the reporting country. Figure 1.5: Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country, EU/EEA, 2020 (n = 10 949) 0 20 40 60 80 100 Latvia Estonia Romania Luxembourg Sweden Finland Norway France Belgium Bulgaria Italy Austria EU/EEA Denmark Greece Slovenia Ireland Germany Czechia Cyprus Spain Iceland Netherlands Poland Slovakia Croatia Hungary Heterosexual transmission (men) Heterosexual transmission (women) Injecting drug use Other Percentage Sex between men Data from Portugal not published at country request, Liechtenstein reported zero cases and Lithuania and Malta did not report transmission data in 2020. Unknown route of transmission is excluded from the proportions presented here. 5HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT countries with generalised HIV epidemics in sub-Saha- ran Africa (Fig. 1.6, Table 10). An additional 29% of new diagnoses with known region of origin (3 538 cases) were among people born outside of the reporting coun- try who did not originate from a country experiencing a generalised epidemic, including 9.5% from countries in Latin America and the Caribbean (1 171 cases), 8.6% from other countries in Central and Eastern Europe (1 059 cases) and 3.4% from other countries in western Europe (422 cases). The countries with more than half of their new HIV diagnoses among people originating from outside of the reporting country were Belgium, Cyprus, Denmark, Finland, France, Iceland, Ireland, Luxembourg, Norway, and Sweden. In 2020, 15 countries reported data on whether the newly-diagnosed HIV cases reported had previously been diagnosed with HIV in another country, prior to their 2020 diagnosis in the reporting country. Of the 6 979 new HIV diagnoses in these 15 countries with infor- mation on previous diagnosis, 1 116 (16%) were previous positives. The proportion of 2020 diagnoses that had previously been diagnosed was higher than the EU/ EEA average in Cyprus (56%), Czechia (34%), Denmark (34%), Iceland (84%), Ireland (66%), Malta (16%), Norway (47%), Slovakia (46%), and Sweden (45%). Information on CD4 cell count at the time of HIV diagno- sis was provided for 8 617 (64%) adults and adolescents diagnosed in 23 countries (Table 13). All countries reporting such data were able to provide CD4 cell counts for 50% or more of their reported cases, apart from Croatia, Estonia, Germany, Ireland, Latvia and Slovakia, all of which provided data for 35% of cases or fewer. Half (51%) of all individuals diagnosed in 2020, where a CD4 count at diagnosis was reported, were considered to have been diagnosed several years after being infected, with a count of less than 350 cells per mm3, including 31% of cases considered to have advanced HIV infection (CD4 cell count less than 200 cells/mm3). The proportion of those diagnosed late (CD4 cell count below 350 cells per mm3) was above 60% among cases with known CD4 cell count at diagnosis in Denmark (61%) and Italy (60%). Among all cases diagnosed in 2020 where information on CD4 cell count or acute HIV infection was available (9 194 cases), 12% (1 141) were reported as acute infec- tions and 25% (2 321) as more recent infection (with a CD4 cell count of 500 or over 500 cells per mm3 at diag- nosis) (data not shown). These figures remain largely similar to proportions noted in 2019. Among MSM diag- nosed in 2020 where information was available, 16% (695) were reported as acute infections and 29% (1 290) had a CD4 cell count of 500 or over 500 cells per mm3 at diagnosis (Fig.1.7). When analysing CD4 cell count, the highest proportions of people presenting at a later stage of HIV infection (CD4 less than 350 cells/mm3) were observed among women (53%), older adults (58% in 40–49-year-olds and 66% in people over 50 years), men or women infected by heterosexual sex (64% and 57% respectively), people who acquired HIV through injecting drug use (52%), and migrants from south and south-east Asia (66%), sub- Saharan Africa (63%), and Central and Eastern Europe (55%) (Fig. 1.8, Table 13). The proportion of late diag- noses noted in these groups of migrants in 2020 was higher than proportions noted in 2019. The lowest proportions of late diagnosis (CD4 less than 350 cells/mm3) were observed among younger age groups (28% of those aged 15–24 years), men who acquired HIV through sex with another man (41%) and migrants from other western European countries (41%) (Fig. 1.8). The interval between the date of diagnosis and the date of the CD4 count was used as a proxy for time to link- age to care and, among cases diagnosed in recent years (2018–2020) where CD4 data were reported, 77% were linked to care within four days of HIV diagnosis and 97% were linked to care within three months (Fig. 1.9). Figure 1.7: Acute infection or CD4 cell count per mm3 at HIV diagnosis, overall and by transmission group, EU/EEA, 2020 (n=9 194) 0 20 40 60 80 100 EU/EEA TotalSex between menInjecting drug useHeterosexual contact Pe rc en ta ge HIV infection, overall and by transmission group 350 to <500 <200 200 to <350 500+ Acute infection 6SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Figure 1.8: Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2020 (n = 8 617) 0 10 20 30 40 50 60 70 Sub-Saharan Africa South and South-East Asia Latin America and Caribbean Central and Eastern Europe Western Europe Non-migrants Sex between men Injecting drug use Heterosexual women Heterosexual men 50+ 40-49 30-39 25-29 20-24 15-19 Women Men Total Percentage Ge nd er Ag e gr ou p (y ea rs ) Tr an sm is si on Re gi on o f o rig in Cases with unknown CD4 count and individuals previously diagnosed abroad are excluded from the proportions presented here. Figure 1.9: Linkage to care after HIV diagnosis in the EU/EEA, 2020 (n = 8297). 0 20 40 60 80 100 Total Injecting drug use Sex between men Heterosexual contact 0–4 days 5–28 days 29–91 days >91 days Percentage Tr an sm is si on m od e Cases with no data or missing data on CD4 count or date, previous positive cases and those who died within 91 days of diagnosis are excluded here. 7HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT 1.2. Trends in HIV diagnoses The trend in reported HIV diagnoses has been on the decline since 2012, when the rate for EU/EEA countries reporting consistently was six per 100 000 population. While rates had dropped to 5.5 per 100 000 in 2017 and 4.8 in 2019, they declined sharply in 2020 to 3.7 per 100 000 (16 917 cases when adjusted for reporting delay; see Table 1, Fig. 1.10 and Annexes 1 (for reporting delay adjustment methods), 5 (for country comments) and 6 (results)). The decline observed in 2020 is probably due, in part, to decreased case detection as a result of less testing, given the public health restrictions associated with the COVID-19 pandemic. For this reason, trends pre- sented in this sub-chapter are preliminary and should be interpreted with caution. While the overall EU/EEA trend appears to have declined over the past decade, trends at national level vary. About 2/3 of EU/EEA countries have seen a decline in rates of new diagnoses, even after adjusting for changes in population coverage of surveillance over time and for reporting delay. In contrast, since 2011, and taking reporting delay into account, rates of HIV diagnoses have more than doubled in Malta and Slovakia and increased by more than 50% in Cyprus and Czechia (Table 1, Annex 6). The impact of delayed HIV case detection due to COVID-19 measures is not yet fully understood, but reporting delay could lead to overesti- mation of decreases in the rates of new HIV diagnoses. Trends differ by gender and age group. Age-specific rates have declined since 2011 in all age groups, although some of this reported decline may be due to delayed case detection in 2020, rather than a true decline in the rate. HIV diagnosis rates in both women and men have consistently been higher among 25–29-year-olds and 30–39-year-olds throughout the period compared to other age groups. Age-specific rates in women have declined most markedly in those under 40 years, while rates in men have declined substantially in all groups under 50 years. (Fig. 1.11a, 1.11b). HIV diagnoses among those born outside of the report- ing country comprised 36% of all new diagnoses in 2011, decreasing slightly to 34% in 2012 but increasing again in 2020 to 44% (Fig. 1.12). While the proportion of migrants from most regions has remained relatively sta- ble since 2011, new diagnoses among people originating from countries in and Eastern Europe increased from 5% to 9% of all new diagnoses. Since 2011, most EU/EEA countries have consistently reported data on transmission mode. After adjusting for reporting delay, the data from those countries reporting consistently over the past decade indicate the following. • The proportion of all HIV diagnoses attributed to sex between men was fairly stable during the period, increasing from 47% of cases in 2011 to 51% in 2016, then decreasing to 49% in 2020 (Figures 1.13a and 1.13b). The number of HIV diagnoses reported among MSM in countries reporting consistently has declined since the end of 2014, even after adjusting for report- ing delay. However, despite this overall decline, case numbers have largely increased during the period in one-third of EU/EEA countries (Bulgaria, Croatia, Cyprus, Czechia, Estonia, Hungary, Iceland, Lithuania, Romania, Slovakia) (Table 4). Cases attributed to MSM born outside of the reporting country increased dur- ing the period (Fig. 1.14). • The proportion of all HIV diagnoses attributed to het- erosexually acquired infection in women remained stable between 2011 and 2020, ranging from 22% to 24%. Rates attributed to heterosexually acquired HIV infection in men were also stable during the period, ranging from 18% to 20% (Fig. 1.13b). Despite the overall decline in heterosexually acquired cases dur- ing this period, new diagnoses in Cyprus and Czechia increased substantially (Table 6). Figure 1.10: People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2011–2020 0 1 2 3 4 5 6 7 2020201920182017201620152014201320122011 HIV AIDS Deaths Ra te p er 10 0 00 0 po pu la tio n Year of diagnosis Rates exclude countries not reporting consistently over the period: Portugal (HIV, AIDS and AIDS deaths), Germany (AIDS), Sweden (AIDS and AIDS deaths), Italy and Denmark (AIDS deaths). 8SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Figure 1.11a: Age-specific trends in new HIV diagnoses in women, 2011–2020 0 1 2 3 4 5 6 7 8 2020201920182017201620152014201320122011 Ne w d ia gn os es p er 10 0 00 0 po pu la tio n Year of diagnosis 15-19 years 20-24 years 25-29 years 30-39 years 40-49 years ≥50 years Figure 1.11b: Age-specific trends in new HIV diagnoses in men, 2011–2020 0 5 10 15 20 25 2020201920182017201620152014201320122011 Ne w d ia gn os es p er 10 0 00 0 po pu la tio n Year of diagnosis 15-19 years 20-24 years 25-29 years 30-39 years 40-49 years ≥50 years These figures contain data for 24 countries. Data from Italy, Lithuania, Portugal and Spain are excluded due to incomplete coverage of the surveillance for a portion of the period. 0 10 20 30 40 50 2020201920182017201620152014201320122011 Pe rc en ta ge Year of diagnosis Western Europe Sub-Saharan Africa Central and Eastern Europe Latin America and Caribbean South and Southeast Asia Other Figure 1.12: Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2011–2020 Data from Latvia, Hungary and Portugal are excluded due to inconsistent reporting during the period. 9HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT • While the overall number of HIV diagnoses reported among people who inject drugs has also declined since 2011 (Fig. 1.13a, 1.14), an increase has been noted in Czechia and in Germany (Table 5). • The number of diagnoses reported to be due to ver- tical transmission of HIV decreased from 152 in 2011 to 82 in 2020 (Fig. 1.13a). Throughout the period, between two thirds and three quarters of these cases originated from outside the reporting country. • The overall number of people diagnosed with acute infection and at each CD4 category was lower in 2020 than in previous years during the period (Fig. 1.15). Although the proportion of those with an unknown CD4 count was higher in 2020 than the average for the period 2011−2020 (46% vs 42%), the proportions of those with known information on acute infection increased from 17% in 2011 to 21% in 2019, declining slightly to 18% in 2020. Reporting delays differ significantly among transmis- sion categories for some countries. When standardised adjustments for reporting delay are introduced, they increase the number of reported HIV cases in all trans- mission categories by between 8% and 19%, depending on the category (Fig. 1.13a and Fig. 1.14 show these adjusted trends). Figure 1.13a: HIV diagnoses, by year of diagnosis and transmission mode, EU/EEA, 2011–2020 0 1000 2000 3000 4000 5000 6000 7000 2020201920182017201620152014201320122011 Nu m be r o f c as es Year of diagnosis Sex between men Heterosexual transmission (women) Heterosexual transmission (men) Injecting drug use Vertical transmission Data from 22 EU/EEA countries included. HIV diagnoses reported by Iceland, Ireland, Lithuania, Malta and Poland are excluded due to incomplete reporting on transmission mode for some years of the period; diagnoses reported by Portugal, Italy and Spain are excluded due to incomplete reporting during a portion of the period. Figure 1.13b: Percentage of HIV diagnoses, by year of diagnosis and transmission mode, EU/EEA, 2011–2020 0 20 40 60 80 100 2020201920182017201620152014201320122011 Pe rc en ta ge s Year of diagnosis Sex between men Heterosexual transmission (men) Heterosexual transmission (women) Injecting drug use Vertical transmission Data from 22 EU/EEA countries included. HIV diagnoses reported by Iceland, Ireland, Lithuania, Malta and Poland are excluded due to incomplete reporting on transmission mode for some years of the period; diagnoses reported by Portugal, Italy and Spain are excluded due to incomplete reporting during a portion of the period. 10 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Figure 1.15: Number of HIV diagnoses by acute infection or CD4 cell count at diagnosis, EU/EEA, 2011–2020 0 5000 10000 15000 20000 2020201920182017201620152014201320122011 Nu m be r o f n ew d ia gn os es Year of diagnosis 350 to <500 <200 200 to <350 500+ Acute infection Unknown Data from Iceland, Ireland, Malta and Poland excluded due to incomplete reporting on transmission mode for some years of the period; diagnoses reported by Italy and Spain are excluded due to incomplete reporting during a portion of the period. This graph does not account for cases that are missing CD4 count information. Figure 1.16: AIDS diagnoses, by transmission mode, EU/EEA, 2011–2020 0 200 400 600 800 1000 1200 1400 2020201920182017201620152014201320122011 Sex between men Heterosexual transmission (females) Heterosexual transmission (males) Injecting drug use Other/undetermined AI DS d ia gn os es Year of diagnosis Data from Germany, Portugal and Sweden are excluded due to inconsistent reporting during the period. Figure 1.14: New HIV diagnoses, by year of diagnosis, transmission and migration status, adjusted for reporting delay, EU/EEA, 2011–2020 0 1000 2000 3000 4000 5000 2020201920182017201620152014201320122011 Heterosexual (born in reporting country) Heterosexual (foreign-born) Sex between men (born in reporting country) Sex between men (foreign-born) Injecting drug use (born in reporting country) Injecting drug use (foreign-born) Ne w H IV d ia gn os es Year of diagnosis Data from 22 EU/EEA countries included. HIV diagnoses reported by Iceland, Ireland, Lithuania, Malta and Poland are excluded due to incomplete reporting on transmission mode for some years of the period; diagnoses reported by Portugal, Italy and Spain are excluded due to incomplete reporting during a portion of the period. 11 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT 1.3. AIDS cases, morbidity and mortality Although there have been improvements in the early diagnosis of HIV, 1 760 diagnoses of AIDS were reported by 27 EU/EEA countries2 in 2020 – a crude rate of 0.5 cases per 100 000 population (Table 14). The highest rate was reported by Latvia (2.9 per 100 000 population; 55 cases). The rate of reported AIDS cases has more than halved in the past decade, down from 1.3 per 100 000 reported in 2011 (Fig. 1.10). This decline is noted in men and women and in all transmission groups, but appears to be greatest among cases attributed to injecting drug use (Tables 16–20, Fig. 1.16). The most common AIDS-indicative diseases diagnosed in 2020 in the EU/EEA were Pneumocystis pneumonia (24% of all AIDS-indicative diseases), pulmonary and/ or extrapulmonary tuberculosis (TB) (12%), wasting syn- drome due to HIV (11%) and oesophageal candidiasis (12%) (Table 22). Thirteen countries reported at least one case with TB (pulmonary and/or extrapulmonary) as an AIDS-defining illness in people newly diagnosed with 2 This includes all EU/EEA countries except Germany, Portugal and Sweden. AIDS in 2020. Thirteen per cent of people diagnosed with AIDS in these countries presented with TB as an AIDS- defining illness, ranging from 5% of cases in Austria to more than 34% in Romania (Fig. 1.17). Twenty-five EU/EEA countries (all but Denmark, Germany, Italy, Sweden and Portugal) reported data on deaths of those diagnosed with AIDS. Overall, 519 people were reported to have died due to AIDS-related causes dur- ing 2020 (Table 23), although these data are affected by underreporting due to the challenges for many coun- tries in linking to death registries, and this was probably exacerbated for 2020 due to reporting issues during the COVID-19 pandemic. AIDS-related death reports have been decreasing consistently since 2011, when 1 272 deaths were recorded in the countries reporting con- sistently over time, although delays in reporting affect the latest figures and underreporting has affected the reporting of AIDS deaths throughout the period (Fig. 1.10). From the beginning of the HIV epidemic to the end of 2020, the cumulative total of people diag- nosed with AIDS in the EU/EEA was 339 830 (Table 14). The cumulative total of cases reported as known to have died from AIDS-related causes by the end of 2020 was 180 458 (Table 23). Figure 1.17: Proportion of persons diagnosed with AIDS with tuberculosis as an AIDS-defining illness, EU/EEA, 2020 (n = 1 940) 0 5 10 15 20 25 30 35 Austria Bulgaria Hungary Italy Netherlands Poland Estonia EU/EEA Czechia Spain France Ireland Latvia Romania Percentage Countries that did not report AIDS data in 2020 or chose not to publish it (Germany, Portugal and Sweden) or that did not report any cases of TB as an AIDS-defining illness are excluded. 12 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data 1.4. HIV testing Ten countries (Belgium, Bulgaria, Czechia, Estonia, France, Latvia, Poland, Portugal, Romania, Slovenia) consistently reported data on HIV tests performed during the period 2011−2020, excluding unlinked anonymous testing and testing of blood donations. The number of tests performed in these countries decreased by 14% between 2019 and 2020 (Table 24), probably as a result of decreased testing activities during part of 2020 due to the COVID-19 pandemic. It is important to note that numbers provided are collected in a heterogeneous manner and comparisons between country testing rates should be undertaken with caution. However, these data can indicate large changes in overall testing policy or be used to support the interpretation of HIV cases notified. 1.5. Conclusions HIV surveillance data for 2020 show a continuing decline in the number and rate of new HIV cases diagnosed in the EU/EEA during the last decade. However, reduced testing and extra demands due to the COVID-19 pan- demic on clinical sectors and public health institutes responsible for reporting and surveillance have likely impacted case detection for 2020. On the other hand, some of the decline observed may be the results of reduced transmission due to the physical distancing measures implemented as a response to the COVID-19 pandemic. This makes the interpretation of HIV trends for 2020 challenging. While the notification rate for 2020 is about 30% lower than that for 2019, it is expected to be revised upwards in future reporting cycles, which is common for HIV generally and for certain countries in the EU/EEA in particular. Prior to 2020, there was evi- dence of a clear, continuous decline in the rate of new HIV diagnoses per 100 000 population in the EU/EEA overall. Despite evidence of some progress in reducing the number of new HIV diagnoses in the EU/EEA overall, rates have increased in five EU/EEA countries. Rates of AIDS and AIDS-related deaths in the EU/EEA as a whole have decreased substantially during the past decade. Although AIDS and AIDS-deaths for 2020 have also probably been affected by reporting issues due to the COVID-19 pandemic, the reduced trends prior to 2020 likely reflect greater access to treatment and bet- ter case management, indicating continued progress towards the Sustainable Development Goal of ending the AIDS epidemic as a public health threat and decreas- ing AIDS-related deaths. Evidence of a decline in diagnoses among MSM in cer- tain EU/EEA countries which had already been observed prior to 2020 appears to be the main determinant behind the overall decline seen in the EU/EEA throughout the decade. This is significant because MSM still account for the largest number of new HIV diagnoses in the EU/EEA and, until recently, they were the only population in the EU/EEA in which HIV cases were increasing. Reasons for the decrease may include successful programmes offer- ing more frequent and targeted HIV testing to promote earlier diagnosis, rapid linkage to care and immediate initiation of ART for those found to be positive, which results in higher rates of viral suppression and a decline in HIV transmission [1,2]. In addition to more frequent testing and linkage to care, the use of formal and infor- mal PrEP may also have played a role in the decline of HIV diagnoses observed, as it is noted that PrEP has been made available through the health system or for generic purchase in 23 countries in the EU/EEA [2–4]. The positive trends in MSM described above are, nev- ertheless, countered by the prevailing situation in one-third of EU/EEA countries (Bulgaria, Croatia, Cyprus, Czechia, Estonia, Hungary, Iceland, Lithuania, Romania, Slovakia) in which HIV continues to increase among MSM. Overall in the EU/EEA, and even in some settings with a decline in rates among MSM, new HIV diagnoses in migrant MSM have not declined at the same rate as in people who are not foreign-born. It is noted that in many of the countries with increasing trends of HIV in MSM, PrEP programmes are only being implemented on very small scale or not at all [4,5]. There is an urgent need to significantly scale up more effective combina- tion-prevention programmes for this at-risk population. This includes promoting the uptake of regular, easy-to- access HIV testing, accompanied by immediate linkage to care and treatment for those found positive, and pro- viding condoms, peer support and access to PrEP for high-risk HIV-negative men [5,6]. The substantial decrease in the number of HIV infec- tions transmitted through heterosexual contact, particularly among women, represents an important epidemiological trend observed over the past dec- ade. Nevertheless, heterosexual transmission remains the second most common mode of HIV transmission reported in the EU/ EEA and, in some countries, is the most common reported transmission mode. Despite the overall declines, heterosexual transmission increased substantially in Cyprus and Czechia. The declining trend in heterosexual cases is probably influenced by the decrease (since 2011) in the number of heterosexually acquired cases in migrants originating from countries with generalised HIV epidemics [7]. Migrants (or people originating from outside of the reporting country) again constituted a considerable proportion (44%) of new HIV diagnoses in the EU/EEA in 2020. The proportion of cases in migrants originat- ing from other countries in Central and Eastern Europe nearly doubled from 2011 to 2020. It is important to recognise the emerging evidence that a significant proportion of migrants, even those originating from high HIV-endemic areas, acquire HIV after arrival in the EU/ EEA [8–10]. This indicates the need for specific HIV- prevention campaigns for migrants from the moment of their arrival, including the offer of HIV testing to newly- arrived migrants to the EU [11]. Transmission among people who inject drugs con- tinues to decline and remains at a low level in most EU/ EEA countries, thanks to well established and effec- tive harm-reduction programmes throughout most of 13 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT the Region. The most drastic decline has been seen in Estonia, where new diagnoses among people who inject drugs are one quarter of what they were a decade ago. However, increases were observed in 2016–2017 in Lithuania and have also been reported in this popula- tion from Czechia and Germany in recent years. There were also outbreaks reported in 2011–2012 in Romania and Greece — countries with previously very low lev- els of HIV among people who inject drugs [12,13]. More localised outbreaks have also been reported in Ireland and Luxembourg [14,15]. This reinforces the importance of maintaining adequate scale and coverage of harm- reduction services and recognising that trends can change quickly for this group in the absence of effective prevention delivered at scale (16). It is estimated that about 780 000 people are living with HIV in the EU/EEA, of which around 692 000 (88%) are diagnosed. This means that one in eight people living with HIV in the EU/EEA are not aware of their status [4]. Modelled estimates also indicate that it takes an aver- age of 2.9 years from HIV infection to diagnosis in the EU/ EEA, varying by geographical area from 2.2 to 3.6 years [17]. In addition to the clinical and personal ben- efits for the person diagnosed, early diagnosis and effective ART can also benefit sexual and injecting part- ners by inhibiting onward HIV transmission [18]. Half of those newly diagnosed (51%) have a CD4 cell count of below 350 cells per mm3, including 31% of cases with advanced HIV infection (CD4 less than 200 cells/mm3). These data indicate that the people were infected many years previously, suggesting problems with access to, and uptake of HIV testing for some segments of the population in these countries, and indicating the need to improve testing programmes to diagnose people liv- ing with HIV at an earlier stage. Enhanced testing is even more crucial to counter the reduced availability of testing services in some settings during 2020, and continuing in 2021, due to the COVID-19 pandemic and associated public health measures [19]. To reduce the high proportion of people diagnosed late, it is essential to diversify HIV testing by augmenting routine testing for health conditions associated with HIV (indicator condition-guided testing), increasing HIV testing during screening for other sexually transmitted infections, and continuing to expand community-based testing, self-testing/home-sampling and partner notifi- cation. European guidance on setting-based approaches for HIV and viral hepatitis testing, including best prac- tices for effective implementation, can help countries seeking to implement more effective testing programmes [20,21]. Testing not only provides a gateway to HIV treat- ment for people found to be positive, but can also serve as an entry point for high-risk HIV-negative people to effective prevention, including PrEP. Despite clear evidence of the benefits for the health of HIV-positive people of introducing ART early [18,21] and the fact that this should serve as an incentive for people to know their HIV status, many continue to be diagnosed with HIV years after becoming infected, at an advanced stage of illness. Overall, 95% of AIDS diagnoses were reported to have been made within 90 days of the HIV diagnosis, indicating that most AIDS cases in the EU/EEA are due to late diagnosis of HIV infection. Once tested, rapid linkage to high-quality care (includ- ing ART) is essential. In recent years, ninety-seven per cent of those diagnosed who had evidence of linkage to care were linked to care within three months of HIV diagnosis. However, those not linked to care are less likely to be included in the data used to calculate this indicator, so this is probably an underestimate of poor linkage to care. This bias is slightly countered by the use of the date of the CD4 cell count as a proxy for time to linkage to care, as this would tend to slightly overesti- mate the time interval. Timely linkage to care following HIV diagnosis is crucial, as delayed access can result in poor patient outcomes [22]. Once linked to care, there is evidence that high proportions of people diagnosed with HIV in the EU/EEA have access to ART and achieve viral suppression [23]. Recent years have seen a worrying trend in reduced data completeness on the HIV transmission route, with more than one-quarter (27%) of cases reported in 2020 lacking this important information. Information on prob- able route of transmission is crucial to better inform HIV-prevention interventions and programme-planning. Greater efforts to improve collaboration with clinicians and follow-up with other data providers may improve the transmission data. Meanwhile, statistical adjust- ments for missing data were used in select figures presented in this chapter to partially address the issue [24]. Nevertheless, HIV surveillance and data interpreta- tion was very challenging for 2020 due to over-stretched clinical and public health surveillance resources in many countries in the EU/EEA, resulting in less HIV case reporting and a reduced possibility to collect enhanced data for those diagnosed. Some of this information may become available in future reporting rounds, making interpretation of 2020 trends easier in the future. The changing epidemiology of HIV infections observed in the EU/EEA over the past decade suggests that some progress has been achieved, particularly in reducing infections attributed to heterosexual transmission and injecting drug use. More recently, progress has also been made in reducing the number of HIV infections resulting from sex between men in selected EU/EEA countries. However, these epidemiological trends also indicate that it is crucial to sustain, and in some places strengthen, evidence-based HIV prevention interven- tions tailored to the local epidemiological context and targeting those most at risk. Programmes on the prevention and control of HIV infec- tion adapted to key populations and maintained to scale remain important in EU/EEA countries. For most EU/EEA countries, this means a strong focus on MSM, including intra-European and other migrant MSM. Other migrants, both those from countries with generalised HIV epidem- ics and others, are also a key vulnerable population who need specific prevention and control efforts in 14 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data most EU/EEA countries. Given the increasing evidence of post-migration HIV acquisition, it is important that migrant-sensitive services for prevention and HIV test- ing, combined with policies that promote and ensure linkage and access to care, are delivered in all EU/EEA countries. Harm-reduction programmes among people who inject drugs and their sexual partners are crucial and should be maintained and scaled up where service coverage is low, particularly when patterns of drug use change. The data in this report present new HIV diagnoses through to the end of 2020, the period of the global COVID-19 pandemic, which heavily affected all countries in the EU/EEA. The impact of the pandemic on human resources in laboratory, clinical and public health insti- tutions has already been observed and is continuing in 2021. More than half of EU/EEA countries responding to a survey indicated that their surveillance data was affected by reduced detection capacity compared to 2019 or earlier. The majority of ECDC operational contact points for HIV reported also working on COVID-19 sur- veillance and response issues during 2020. About half of EU/EEA countries needed more time than usual to sub- mit their 2020 HIV and AIDS data and several mentioned that the reporting delay had increased for 2020 data, or that some variables (CD4 at diagnosis, viral load) could not be reported at all, or not at levels consistent with those achieved in the past. In collaboration with EU/ EEA Members States, ECDC, WHO’s Regional Office for Europe, and clinical and community partners will look carefully at the impact on HIV surveillance and preven- tion response, with the aim of supporting the continued high standard of European HIV and AIDS data, guiding the response in the Region and understanding how the ongoing pandemic may affect HIV incidence, particularly in regions and groups most at-risk. References 1. Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveill. 2017;22(25):pii=30553. Available at: https://doi.org/10.2807/1560- 7917.ES.2017.22.25.30553. 2. Nwokolo N, Whitlock G, MacOwan A. Not just PrEP: other reasons for London’s HIV decline. Lancet HIV 2017;4(4):e153. Available at: http://www.thelancet.com/journals/lanhiv/article/ PIIS2352-3018(17)30044-9/fulltext. 3. Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P et al. and the ECDC Dublin Monitoring Network. Estimating the “PrEP gap”: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019;24(41):pii=1900598. Available at: https://www.eurosurveil- lance.org/content/10.2807/1560-7917.ES.2019.24.41.1900598 4. European Centre for Disease Prevention and Control (ECDC). Dublin Declaration data, 2020. [Publication pending]. 5. European Centre for Disease Prevention and Control. HIV: Combination prevention. Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2020. Available at: www.ecdc.europa.eu/sites/default/files/documents/HIV- combination-prevention-dublin-declaration.docx.pdf 6. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2014. Available at: https:// www.ecdc.europa.eu/sites/default/files/media/en/publications/ Publications/hiv-sti-prevention-among-men-who-have-sex-with- men-guidance.pdf 7. Hernando V, Alvarez-del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T et al. HIV infection in migrant populations in the European Union and European Economic Area in 2007–2012: an epidemic on the move. J Acquir Immune Defic Syndr. 2016;70(2):204–11. 8. Rice BD, Elford J, Yin Z, Delpech VC. A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV. AIDS 2012;26(15):1961–6. 9. Pantazis N, Rosinska M, van Sighem A, Quinten C, Noori T, Burns F, Cortes Martins H, et al. Discriminating Between Premigration and Postmigration HIV Acquisition Using Surveillance Data. J Acquir Immune Defic Syndr. 2021 Oct 1;88(2):117-124. doi: 10.1097/ QAI.0000000000002745. PMID: 34138772 10. Fakoya I, Alvarez-del Arco D, Woode-Owusu M, Monge S, Rivero- Montesdeoca Y, Delpech V et al. A systematic review of post- migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: implications for effectively managing HIV prevention programmes and policy. BMC Public Health 2016;15:561. Available at: www.biomedcentral.com/ content/pdf/s12889-015-1852-9.pdf 11. European Centre for Disease Prevention and Control (ECDC). Public health guidance on screening and vaccination for infectious dis- eases in newly arrived migrants in the EU/EEA. Stockholm: ECDC; 2019. Available at: https://www.ecdc.europa.eu/sites/default/ files/documents/Public%20health%20guidance%20on%20screen- ing%20and%20vaccination%20of%20migrants%20in%20the%20 EU%20EEA.pdf 12. 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 at: www.eurosurveillance.org/ViewArticle. aspx?ArticleId=20648 13. Paraskevis D, Nikolopoulos G, Tsiara C, Paraskeva D, Antoniadou A, Lazanas M et al. HIV-1 outbreak among injecting drug users in Greece, 2011: a preliminary report. Euro Surveill. 2011;16(36):pii=19962. Available at: www.eurosurveillance.org/ ViewArticle.aspx?ArticleId=19962 14. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among home- less people who inject drugs in Dublin, Ireland, 2016. Euro Surveill. 2016;20(40):pii=30036. Available at: http://dx.doi. org/10.2807/1560-7917.ES.2016.20.40.30036 15. HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre for Drugs and Drug Addiction; 2018. Available at: http:// sante.public.lu/fr/publications/h/hiv-joint-technical-mission/ index.html 16. European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Prevention of infections among people who inject drugs. Stockholm: ECDC; 2011. Available at: https://www.ecdc. europa.eu/en/publications-data/ecdc-and-emcdda-technical-guid- ance-prevention-and-control-infectious-diseases-0 17. van Sighem A, Pharris A, Quinten C, Noori T, Amato-Gauci AJ, the ECDC HIV/AIDS Surveillance and Dublin Declaration Monitoring Networks. Reduction in undiagnosed HIV infection in the European Union/European Economic Area, 2012 to 2016. Euro Surveill. 2017;22(48):pii=17-00771. Available at: https://doi. org/10.2807/1560-7917.ES.2017.22.48.17-00771 18. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2016:373(9):795–807. 19. Simões D, Stengaard AR, Combs L, Raben D, The EuroTEST COVID-19 impact assessment consortium of partners. Impact of the COVID-19 pandemic on testing services for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region, March to August 2020. Euro Surveill. 2020;25(47):pii=2001943. https://doi.org/10.2807/1560-7917.ES.2020.25.47.2001943 20. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2017. Available at: https://www.who.int/ publications/i/item/9789241549684 21. Public health guidance on HIV, hepatitis B and C test- ing in the EU/EEA. Stockholm: ECDC; 2018. Available at: https://www.ecdc.europa.eu/en/publications-data/ public-health-guidance-hiv-hepatitis-b-and-c-testing-eueea 22. Croxford S, Yin Z, Burns F, Copas A, Town K, Desai S et al. Linkage to HIV care following diagnosis in the WHO European Region: a systematic review and meta-analysis, 2006–2017. PLoS One 2018;13(2):e0192403. Available at: https://doi.org/10.1371/journal. pone.0192403 23. European Centre for Disease Prevention and Control (ECDC). Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and central Asia: the- matic report on the HIV continuum of care. Stockholm: ECDC. Available at: https://www.ecdc.europa.eu/en/publications-data/ hiv-continuum-care-monitoring-implementation-dublin-declaration 24. Rosinska M, Pantazis N, Janiec J, Pharris A, Amato-Gauci AJ, Quinten C et al. Potential adjustment methodology for missing data and reporting delay in the HIV Surveillance System, European Union/European Economic Area, 2015. Euro Surveill. 2018;23(23):pii=1700359. Available at: https://doi. org/10.2807/1560-7917.ES.2018.23.23.1700359 15 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT 2.1. HIV and AIDS diagnoses in the WHO European Region 2.1.1. HIV diagnoses In 2020, 104 765 people in the WHO European Region were newly diagnosed with HIV, corresponding to a rate of 11.8 per 100 000 population (Table A, Table 1). This number includes new diagnoses reported by 46 countries3 to the joint ECDC and WHO Regional Office for Europe surveillance system. It brings the cumula- tive number of reported HIV diagnoses in the Region since reporting began in the 1980s to 2 222 249. As in previous years, most (81%) of the 104 765 people newly diagnosed with HIV in 2020 were from the East of the Region (84 556), 15% from the West (15 782) and 4% from the Centre (4 427). The rate was also highest in the East (32.6 per 100 000 population), more than eight times higher than in the West (3.7 per 100 000) and 14 times higher than in the Centre (2.3 per 100 000) (Table A, Table 1). For men, the rate was 15.7 per 100 000 popula- tion (Table 2) and for women 8.1 per 100 000 population (Table 3). Rates of newly diagnosed HIV infections varied widely across countries in the WHO European Region in 2020. The highest rates per 100 000 population (more than 15.0) were observed in the Russian Federation (40.8) fol- lowed by Ukraine (37.5), Kazakhstan (18.5), the Republic of Moldova (16.7), Malta (15.9) and Belarus (15.1). The lowest rates (under 2.0) were reported by Serbia (1.2), Slovenia (1.3), Austria (1.7), Croatia (1.9), Poland (1.9) and Slovakia (1.9). No new HIV cases were diagnosed in San Marino in 2020. The male-to-female ratio was 1.9, lowest in the East (1.6), higher in the West (3.0) and highest in the Centre (5.3). The highest male-to-female ratios (more than 10.0) at country level among countries with more than 10 new cases were observed in Serbia (14.4), Montenegro (14.0) and Hungary (11.1) and the lowest (1.5 or less) in Kyrgyzstan (1.3) the Republic of Moldova (1.4), Tajikistan (1.5) and Estonia (1.5) (see section 1.1 HIV diagnoses in Chapter 1 and sections 2.2 HIV diagnoses in the East and 2.2.2 Trends in HIV diagnoses in the East below). The largest proportion of people newly diagnosed in the 46 reporting countries were in the age group 30–39 years (40%), while 5% were young people aged 15–24 years and 14% were 50 years or above at diagnosis (Table A, Table 9). 3 No data were received from Andorra, Bosnia and Herzegovina, Monaco, North Macedonia, Turkmenistan or Uzbekistan. Data from Portugal not published at country request. Liechtenstein is an EEA Member State but not a WHO Member State, so its data are included in the totals for the EU/EEA but not for the WHO European Region. Data on transmission mode which was available for 44 countries4 (Table A, Tables 4–8) provide information on risk exposure among people newly diagnosed with HIV. The data for 2020 indicate the following. • Heterosexual contact was still the main reported mode of HIV transmission in the WHO European Region, accounting for more than half (58%) of people newly diagnosed in 2020 (60 409) and 64% of new HIV diag- noses with a known mode of transmission (Table 6). Among those, 10% originated from countries with gen- eralized epidemics (data not shown). • Injecting drug use was the second most common transmission mode, accounted for 22% of new diag- noses (23 416) and 25% of new HIV diagnoses with a known mode of transmission (Table 5). • Sex between men accounted for 9% of new diagnoses overall (9 897) and 10% of new HIV diagnoses with a known mode of transmission (Table 4). • Less than one per cent (0.4%, 468) of cases were infected through mother-to-child transmission (0.5% of those with a known mode of transmission) (Table 7) and 0.1% (72) through other transmission routes (nosocomial infection, transfusion or use of other blood products) (Table 8). • Transmission mode was reported as unknown or missing for 10% (10 503 cases) (Table 8). Reporting completeness regarding transmission mode varies greatly across the Region, with information lacking for 4% of new diagnoses in the East, 42% in the Centre and 25% in the West. Information on country of birth, country of national- ity or region of origin was provided by 42 countries for 44 709 people newly diagnosed in 2020. Among those with known origin (41 802), 18% (7 618) originated from outside of the reporting country, including 13% (5 267) from outside the WHO European Region and 6% (2 351) from a European country other than the country of report (Table 10). Information on probable country of infection was reported by 30 countries for 21 048 people newly diag- nosed. Among people for whom the probable country of infection was known (14 780), 21% (3 401) were infected abroad, including 6% in sub-Saharan Africa, 6% in central and eastern Europe, 3% in western Europe, 3% in south and south-east Asia and 2% in Latin America (Table 12). Forty countries provided information about CD4 cell count at the time of HIV diagnosis in 2020. Information was reported for 89 407 people over 14 years at 4 Data on transmission mode was not reported in 2020 by Lithuania and Malta. 2. HIV and AIDS in the WHO European Region 16 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Figure 2.2: New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region, 2011–2020 0 10 20 30 40 50 2020201920182017201620152014201320122011 West Centre East WHO European Region Ca se s pe r 1 00 0 00 p op ul at io n Year of diagnosis Note: includes data from 46 countries. Data from Andorra, Bosnia and Herzegovina, Monaco, North Macedonia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting over the decade. Data from Portugal not published at country request. Figure 2.1: New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2020 (n = 30 424) 0 20 40 60 80 100 Injecting drug use Heterosexual Sex between men <200 cells/mm3 200 to <350 cells/mm3 350 to <500 cells/mm3 ≥500 cells/mm3 n=6 323 n=17 328 n=6 773 Percentage Tr an sm is si on m od e No data from Andorra, Bosnia and Herzegovina, Hungary, Lithuania, Malta, Monaco, North Macedonia, Norway, Poland, San Marino, Turkmenistan or Uzbekistan. Data from the Russian Federation excluded due to incomplete reporting on transmission mode. Data from Portugal not published at country request. Figure 2.3: New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2011–2020 0 5000 10000 15000 20000 25000 30000 2020201920182017201620152014201320122011 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Nu m be r o f c as es Year of diagnosis Data from Andorra, Bosnia and Herzegovina, Monaco, North Macedonia, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; data from Iceland, Ireland, Lithuania, Malta, Poland, the Russian Federation and Turkey excluded due to incomplete reporting on transmission mode during the period; data from Italy and Spain excluded due to increasing coverage of national surveillance during the period. (In total data from 37 countries are included for Fig 2.3 in 2020). Data from Portugal not published at country request. 17 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT diagnosis (covering 87% of all new diagnoses in the reporting countries) (Table 13). The Russian Federation reported information on the CD4 cell counts for the first time in 2020 and this affected the Regional average CD4 cell count levels, since this country accounted for 64% of new HIV diagnoses with available CD4 cell data. Just over a third (36%) of those newly diagnosed were late presenters, with CD4 cell counts below 350 per mm3 at the time of HIV diagnosis, including 19% with advanced HIV infection (CD4 above 200/mm3). However, when excluding data from the Russian Federation, half (50%) of those newly diagnosed in the Region were late pre- senters, which is comparable to the results from the previous years. The percentage of those newly diag- nosed who were late presenters (CD4 below 350/mm3) varied across the countries. The countries with the highest percentages of late presenters (60% or more, in countries with more than five cases) were Albania (69%), Armenia (62%), Denmark (61%) and Italy (60%). Those with the lowest percentages (40% or less) were the Russian Federation (27%), Cyprus (30%), Montenegro (30%) and Iceland (33%). The percentage of late presenters also varied across transmission categories5 and was highest for people with reported heterosexual transmission (56%; 58% for men and 54% for women) and as a result of injecting drug use (43%), and lowest for men infected through sex with men (41%) (Table 13, Fig. 2.1, Fig. C). The percentage of people diagnosed at or below 350 CD4 cells per mm3 increased with age, ranging from 33% to 36% among people aged 15–19 years and 20–24 years at diagnosis, respectively, to 65% among people aged 50 years or above. Overall, the percentage of late presenters by gen- der was similar (50% for men and 52% for women), but this is confounded by transmission mode and conceals, for men, the difference between MSM (who tend to get diagnosed earlier) and men with reported heterosexual transmission (who tend to get diagnosed later) (Fig. C). 2.1.2. Trends in HIV diagnoses The rate of newly diagnosed HIV infections in the WHO European Region increased by 5% for the period 2011– 2019, from 14.7 per 100 000 population (125 807 cases) to 15.5 per 100 000 population (104 765 cases) (Fig. 2.2). This increase was mainly driven by an upward trend in many countries of the East. The 24% decline observed in 2020 compared to 2019 is probably due, in part, to decreased case detection as a result of the public health and social measures introduced by countries in response to the COVID-19 pandemic. For this reason, while we will still compare 2020 data to the previous years, trends presented in this sub-chapter are prelimi- nary and should be interpreted with caution. Thirty-seven countries have consistently reported data on transmission mode for the period 2011–2020 (Fig. 2.3). Data from Iceland, Ireland, Lithuania, Malta, Poland and Turkey were excluded because over 50% of 5 While the Russian Federation reported data first time, the country did not provide CD4 numbers by transmission mode and is not included in the analysis. the data on transmission mode were missing for some years in the period. Data from Spain and Italy were excluded because coverage of the national surveillance system increased during this period. Data from Andorra, Belgium, North Macedonia, Monaco, the Russian Federation, Turkmenistan and Uzbekistan were not con- sistently reported during the period. Data on transmission mode from the countries with con- sistent data indicate the following. • The proportion of all new HIV diagnoses attributed to heterosexual contact increased from 48% of cases in 2011 to 51% in 2020. The number of HIV diagnoses attributed to heterosexual contact in countries report- ing consistently showed an increasing trend between 2011 and 2019, followed by a sharp decline (23%) in 2020 compared to 2019. • The proportion of all new HIV diagnoses attributed to sex between men decreased from 20% to 16%. Overall, the number of HIV diagnoses reported among MSM in countries reporting consistently has declined since 2016. • While the number of new diagnoses in people infected through injecting drug use has shown a stable decline since 2011, it increased by 15% in 2020 compared to 2021, injecting drug use being the only transmission mode to increase in 2020. The proportion of all HIV diagnoses attributed to injecting drug use decreased slightly from 22% in 2011 to 21% in 2020. • The number of new diagnoses in children infected through mother-to-child transmission decreased by 46%, from 523 in 2011 to 285 in 2020, representing 1.1% of all new HIV diagnoses in 2011 and 0.7% in 2020. • Of the new diagnoses in people infected by other means, nosocomial infections decreased by 63%, from 67 cases in 2011 to 25 in 2020 (peaking at 104 cases in 2012); new diagnoses attributed to transfu- sion of blood and its products decreased by 41%, from 73 in 2011 to 43 in 2020. • The number of new diagnoses for which informa- tion on transmission mode was unknown or missing increased by 6%, from 3 905 in 2011 to 4 157 in 2020 – representing 8% of all new HIV diagnoses in 2011 and 11% in 2020. 2.1.3. AIDS cases, morbidity and mortality In 2020, 7 721 people in 43 countries of the WHO European Region6 were diagnosed with AIDS, which corresponds to a rate of 1.2 per 100 000 population (Table 14). Of the 7 721 people who received a diagnosis of AIDS in 2020, 74% (5 705) were diagnosed in the East, 20% (1 549) in the West and 6% (467) in the Centre of the Region. The rate was also highest in the East (5.0 per 100 000 population), 10 times higher than in the West 6 No data were reported from Andorra, Bosnia and Herzegovina, Germany, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. Data from Portugal not published at country request. 18 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data (0.5 per 100 000) and more than 20 times higher than in the Centre (0.2 per 100 000 population). The rate of new AIDS diagnoses varied widely among the countries, with the highest rates (3.0 or above) reported in Ukraine (9.9), Armenia (5,1), the Republic of Moldova (4,9) and Georgia (4,5) and the lowest rates (under 0.3) reported in Ireland (0,1), Poland (0,1), Turkey (0.1)7, Slovakia (0.1), Finland (0.2) and Norway (0.2). Malta and San Marino reported zero cases. TB represented 17% of all reported AIDS-defining illness events in 2019, ranging from 12% of reports in the West and 17% in the Centre to 31% in the East. In the 43 countries with consistent AIDS data8, the over- all rate of new AIDS diagnoses in the Region decreased by 54% between 2011 and 2020, from 2.8 per 100 000 population (18 160 cases) to 1.3 per 100 000 (7 705 cases) (Fig. 2.4). AIDS trends varied across the three geographical areas. In the East, the rate decreased by 53%, from 10.4 in 2011 to 4.9 in 2020. In the Centre, the rate decreased by 60%, from 0.5 in 2011 to 0.2 in 2020, while in the West, the steady downward trend continued, with a 64% decrease from 1.4 in 2011 to 0.5 in 2020 (Fig. 2.4). A total of 41 countries in the Region9 provided informa- tion on AIDS-related deaths or deaths among people previously diagnosed with AIDS for countries and years where cause of death (AIDS- or non-AIDS-related) was 7 AIDS data for Turkey only include those diagnosed with AIDS at the time of HIV diagnosis and are therefore not comparable with AIDS data from other countries. 8 Data from Andorra, Bosnia and Herzegovina, Germany, Monaco, North Macedonia, Portugal, the Russian Federation, Sweden, Turkmenistan and Uzbekistan are excluded or not reported. 9 No data were received from Andorra, Bosnia and Herzegovina, Denmark, Germany, Italy, North Macedonia, Monaco, the Russian Federation, Sweden, Turkmenistan or Uzbekistan. Data from Portugal not published at country request. recorded, with 3 506 people reported to have died during 2020. This represented a 41% decrease compared with the 5 963 deaths reported for the same countries in 2011. Of the 3 506 deaths in 2020, 82% were reported from the East of the Region, 13% from the West and 5% from the Centre (Table 23). It is important to note that delays in reporting and underreporting have a significant impact on these numbers at European level, particularly when the death occurs long after HIV or AIDS diagnosis. The numbers presented here should therefore not be inter- preted as representative of the true AIDS mortality burden in the European Region. According to a country survey from 2006, only about one third of countries in the WHO European Region were able to match their HIV/ AIDS registries with their national mortality or vital statistics registries [1]. 2.2. HIV and AIDS diagnoses in the East 2.2.1. HIV diagnoses in the East In 2020, 84 556 people were newly diagnosed with HIV across 13 countries10 in the East of the WHO European Region, giving a rate of 32.6 per 100 000 population. This number includes 59 598 new diagnoses reported from the Russian Federation11 and 24 958 from the remaining 12 reporting countries in the East of the Region. The highest rates of HIV diagnoses (more than 20.0) for 2020 were observed in the Russian Federation (40.8 per 100 000 population) and Ukraine (37.5), while the lowest (under 10.0) were reported by Azerbaijan (5.5) and Lithuania (3.9). Among the 13 countries in the East reporting age distri- bution, most of those newly diagnosed (42%) were in 10 No data were received from Turkmenistan or Uzbekistan. 11 Detailed information on the status of the data submitted by the Russian Federation can be found in Annex 5. Figure 2.4: New AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2011–2020 0 2 4 6 8 10 12 2020201920182017201620152014201320122011 West Centre East WHO European Region Ca se s pe r 1 00 0 00 p op ul at io n Year of diagnosis Data from Andorra, Bosnia and Herzegovina, Germany, Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan are excluded due to inconsistent or no reporting during the period. Data from Portugal not published at country request. 19 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Figure 2.5: Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country, East, 2020 (n = 84 556; 54 228) Kyrgyzstan Moldova Tajikistan Estonia Russian Federation East Belarus Latvia Ukraine Kazakhstan Armenia Azerbaijan Lithuania Georgia 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 All new diagnoses New diagnoses with heterosexual transmission Male-to-female ratio No data from Turkmenistan and Uzbekistan. No data on mode of transmission from Lithuania. Figure 2.6: New HIV diagnoses, by country and transmission mode, East, 2020 (n = 84 556) 0 20 40 60 80 100 Lithuania Latvia Estonia Kazakhstan Ukraine Moldova Russia Federation Georgia Kyrgyzstan Azerbaijan Belarus Tajikistan Armenia Heterosexual contact Sex between men Injecting drug use Mother-to-child transmission Other Unkown PercentageNo data from Turkmenistan and Uzbekistan. 20 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data the age group 30–39 years, while only 4% were young people aged 15–24 years and 13% were 50 years or older at the time of diagnosis (Table A, Table 9). The male-to- female ratio was 1.6, the lowest of the three geographical areas, with 38% of new diagnoses among women in the East in 2020. The male-to-female ratio was highest (over 2.0) in Georgia (3.2), Lithuania (2.6), Azerbaijan (2.2) and Armenia (2.1), and lowest (under 1.5) in Kyrgyzstan (1.3), the Republic of Moldova (1.4) and Tajikistan (1.4) (Fig. 2.5). Among those reported as infected through heterosexual transmission, the male-to-female ratio was 1.5 or above in two countries (Georgia (2,0) and Armenia (1.7)), suggesting that more men than women were reported as infected through heterosexual contact in these countries. As this pattern differs from other countries where more heterosexual cases tend to be in women, it cannot be ruled out that some of these men may in fact have been infected through injecting drug use or sex with other men, but misclassified in the het- erosexual category. Heterosexual contact and injecting drug use are still the main modes of HIV transmission reported in the East of the Region. Reported transmission related to sex between men remains relatively low. In 2020, 84 556 new HIV diagnoses were reported from 13 countries in the East, with data by transmission mode suggesting the following (Table A, Tables 4–8, Fig. 2.6): • in total, 64% of those newly diagnosed and 68% of new HIV diagnoses with a known mode of transmis- sion were infected heterosexually (54 228), making it the main mode of transmission reported in all coun- tries in the East (Table 6); • overall 27% of those newly diagnosed and 29% of new HIV diagnoses with a known mode of transmis- sion were infected through injecting drug use (22 799) (Table 5), with transmission through injecting drug use accounting for 30% or more of new diagnoses with a known transmission mode in two countries (Ukraine (38%) and Kazakhstan (32%)); Figure 2.7: New HIV diagnoses, by age group and transmission mode, East, 2020 (n = 79 204) 0 20 40 60 80 100 Sex between men Heterosexual contact Injecting drug use 15-19 years 20-24 years 25-29 years 30-39 years 40-49 years ≥50 years n=22 799 n=53 932 n=2 473 Percentage Tr an sm is si on m od e No data from Turkmenistan and Uzbekistan. Lithuania excluded as no information on mode of transmission for the 2020 HIV cases. Figure 2.8: New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2020 (n = 20 092) 0 20 40 60 80 100 Injecting drug use Heterosexual Sex between men <200 cells/mm3 200 to <350 cells/mm3 350 to <500 cells/mm3 ≥500 cells/mm3 n=993 n=16 643 n=5 348 Percentage Tr an sm is si on m od e No data on CD4 count by transmission route from Lithuania, the Russian Federation, Turkmenistan ot Uzbekistan. 21 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT • in total, 3% were infected through sex between men (2 474) (Table 4), but two countries (Georgia and Azerbaijan) reported that sex between men accounted for 10% or more of new diagnoses with a known trans- mission mode; • the percentage of cases diagnosed as infected through mother-to-child transmission was 0.4% (345) (Table 7) and 0.02% (13) were infected through other transmis- sion routes (nosocomial infection, transfusion or use of other blood products); • transmission mode was reported as unknown or miss- ing for only 6% of those newly diagnosed across the 13 countries in the East of the Region (4 697), but at coun- try level, transmission-mode information was lacking for 15% or more of cases in five countries: Lithuania (100%), Estonia (37%), Latvia (36%), the Republic of Moldova (34%) and Kyrgyzstan (17%). Analysis of the new diagnoses by age group and trans- mission mode for the 12 reporting countries12 in the East (Fig. 2.7) shows that 30–39-year-olds accounted for most HIV diagnoses among those infected through injecting drug use (53%) and those with reported heterosexual transmission (38%). Conversely, those infected through sex between men were younger, with 25–29-year-olds accounting for 35% of new HIV diagnoses. People aged 50 years and above were more frequently infected as a result of heterosexual sex (17% compared with 4% and 2% for injecting drug use and MSM, respectively) (Fig. 2.7). Twelve countries in the East provided information about CD4 cell count at the time of HIV diagnosis for 77 417 people above 14 years (covering 92% of the 84 452 new diagnoses in the 12 countries (Table 13)). Thirty-four per cent of these people were late presenters, with CD4 cell counts below 350 per mm3, including 18% with advanced HIV infection (CD4 below 200/mm3) at the time of HIV diagnosis. The Russian Federation reported informa- tion on CD4 cell counts for the first time in 2020 and this affected the average CD4 cell count levels for the East, since 74% of new HIV diagnoses with available CD4 cell data were reported from the Russian Federation, where 27% were reported as late presenters. The percent- age of people diagnosed with a CD4 count of less than 350/ mm3 was higher than 50% in six of the 12 countries. Data on CD4 cell count by mode of transmission was not available from the Russian Federation, but in the remain- ing 11 countries the percentage of late presenters varied across transmission categories, being highest for peo- ple infected heterosexually (56%) and through injecting drug use (44%) and lowest for men infected through sex with men (43%) (Fig. 2.8). Nine countries in the East provided information on the probable country of infection for 8 108 people newly diagnosed in 2020 (Table 12). Among the 7 600 cases for whom the probable country of infection was known, only 6% (428 cases) were infected abroad, including 5% 12 Lithuania was excluded from the analysis due to the lack of information on modes of transmission. in central and eastern Europe. The data suggest that most of those newly diagnosed with HIV in the East of the Region were infected in the reporting country and that those infected abroad were infected in neighbour- ing countries of central and eastern Europe. 2.2.2. Trends in HIV diagnoses in the East The upward trend observed during the period 2011−2015 has been followed by an overall stabilisation of the epidemic in the East of the Region. The 22% decline observed in the East in 2020 compared to 2019 is prob- ably due in part to decreased case detection as a result of the public health and social measures introduced by countries in response to the COVID-19 pandemic (Fig. 2.2). For this reason, while we will still compare 2020 data to the previous years, trends presented in this sub-chapter are preliminary and should be interpreted with caution. The number of newly diagnosed women decreased by 17% across the 13 countries, from 38 382 in 2011 to 31 986 in 2020, and the number of newly diagnosed men decreased by 2%, from 53 497 to 52 570 (Tables 2 and 3). The overall trend largely reflects the situation in the Russian Federation, which accounts for the vast majority of new cases reported in 2020. The other countries have significant variations. Three (Azerbaijan, Kyrgyzstan and Tajikistan) have all experienced much larger increases among women over the decade (25–61%) compared to the development among men (-9–6%). Information on mode of transmission for the period 2011–2020 (Fig. 2.9) from the 11 countries13 with consist- ent data suggests the following. • The number of new diagnoses in people with reported heterosexual transmission increased by 8%, from 14 125 in 2011 to 15 291 in 2020. The increase was considerably larger among men with heterosexual transmission (a 42% increase) than women with het- erosexual transmission (14% decrease). At the same time, the percentage of all new HIV diagnoses attrib- uted to heterosexual contact increased from 58% of cases in 2011 to 62% in 2020. • The number of new diagnoses in people infected through injecting drug use decreased by 19%, from 9 338 in 2011 to 7 596 in 2020, but an increase of 59% was seen between 2018 and 2020 in Ukraine (Table 5). The percentage of all new HIV diagnoses attributed to injecting drug use decreased from 38% in 2011 to 31% in 2020. • The number of new diagnoses in people infected through sex between men increased nearly four-fold, from 260 in 2011 to 975 in 2020. This is by far the high- est relative increase across the various transmission modes and geographical areas. It is clearly visible on the logarithmic scale of Fig. 2.9, which facilitates the comparison of rates of change regardless of starting 13 Data from Lithuania, the Russian Federation, Turkmenistan and Uzbekistan are excluded due to inconsistent reporting over the decade. 22 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data point. Although it has increased, the percentage of all new HIV diagnoses attributed to sex between men has nevertheless remained low, at 1.1% in 2011 and 4% in 2020. • The number of children infected through mother-to- child transmission decreased by 30%, from 258 in 2011 to 180 in 2020, representing 1.1% of new HIV diagnoses in 2011 and 0.7% in 2020. • The number of new diagnoses for which the mode of transmission was unknown increased by 51%, from 539 in 2011 to 812 in 2020. The percentage of new HIV diagnoses with unknown mode of transmission remained low and stable, at 2–3% in 2011 and 2020. Further analysis of the increase in new diagnoses attrib- uted to heterosexual transmission in the East by gender and age groups (Fig. 2.10) reveals an increasing trend in older age groups for both men and women during the period 2015−2019, followed by a drop among all age groups in 2020. Nevertheless, heterosexual transmis- sion has continued to decline among young women aged 15–24 years and 25–29 years since 2011. 2.2.3. AIDS cases, morbidity and mortality in the East In 2020, 5 705 people were diagnosed with AIDS from the 12 countries in the East that provided AIDS data, giving a rate of 5.0 per 100 000 population. As with HIV, a sub- stantial decline in newly reported AIDS diagnoses was observed in 2020, most probably linked to the effects of the COVID-19 pandemic on health and surveillance systems. The highest rates (above 5.0) were reported in Ukraine (9.9) and Armenia (5.1) (Table 14). The AIDS rate decreased by 53% between 2011 and 2020, from 10.4 per 100 000 population (11 554 cases) to 4.9 (5 532 cases) in the 12 countries (Fig. 2.4). The rate of Figure 2.9: New HIV diagnoses, by transmission mode and year of diagnosis, East, 2011–2020 0 5000 10000 15000 20000 2020201920182017201620152014201320122011 Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Ne w H IV d ia gn os es Year of diagnosis Data from Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; data from Lithuania excluded due to incomplete reporting on transmission mode during the period. 1 10 100 1000 10000 100000 Ne w H IV d ia gn os es Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined 2018 2019 20202017201620152014201320122011 Arithmetic scale Logarithmic scale 23 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT new AIDS diagnoses increased in two of the 12 countries in the East (Armenia and Kazakhstan). In terms of mode of transmission, decreases in AIDS cases were reported both among people infected heterosexually and people infected as a result of injecting drug use. The number of new AIDS diagnoses among men infected as a result of sex between men increased by 66% in comparison with 2011 (Fig. 2.11). The most common AIDS-indicative diseases diagnosed in 2020 were wasting syndrome due to HIV (17% of all disease events reported), pulmonary TB (16%) and oesophageal candidiasis (13%) (Table 22)14. By transmis- sion mode, wasting syndrome due to HIV, pulmonary TB and Kaposi’s sarcoma were the most common AIDS- defining diseases among people infected through heterosexual sex (the three diseases together accounting 14 Armenia, Azerbaijan, Belarus, Estonia, Georgia, Latvia, Republic of Moldova and Tajikistan reported data on AIDS-indicative diseases in 2020. for 53% of reported events). The most common AIDS- defining diseases reported among people with AIDS infected through injecting drug use were extrapulmo- nary TB, pulmonary TB and wasting syndrome due to HIV (together accounting for 56% of reported events). Among the few AIDS cases infected as a result of sex between men, pulmonary TB, Pneumocystis pneumonia and Kaposi’s sarcoma were the most common diseases (Fig. 2.12). AIDS-related mortality remains high in the East. For 2020 there were 2 877 reported AIDS-related deaths or deaths among people previously diagnosed with AIDS where cause of death (AIDS- or non-AIDS-related) was unknown or could not be reported in the 12 countries concerned. This figure represents 82% of all AIDS- related deaths reported in the Region (Table 23). Figure 2.10: Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2011–2020 0 1000 2000 3000 4000 2020201920182017201620152014201320122011 15-24 years 25-29 years 30-39 years 40-49 years ≥50 years Ne w H IV d ia gn os es Year of diagnosis Data from Lithuania, the Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period. 0 1000 2000 3000 4000 2020201920182017201620152014201320122011 15-24 years 25-29 years 30-39 years 40-49 years ≥50 years Nu m be r o f c as es Year of diagnosis Females East, heterosexual transmission Males East, heterosexual transmission 24 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Figure 2.12: Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2020 0 5 10 15 20 25 30 35 40 Pneumocystis carinii pneumonia Encephalopathy; HIV-related Candidiasis; oesophageal Mycobacterium tuberculosis, pulmonary Candidiasis; oesophageal Wasting syndrome due to HIV Candidiasis; oesophageal Mycobacterium tuberculosis, pulmonary Wasting syndrome due to HIV 3 3 9 50 27 19 84 85 84 Percentage M SM ID U He te ro No data from Russian Federation, Tajikistan, Turkmenistan and Uzbekistan. Hetero: heterosexual transmission; IDU: injecting drug use; MSM: sex between men. Figure 2.11: New AIDS diagnoses, by transmission mode and year of diagnosis, East, 2011–2020 0 2000 4000 6000 8000 2020201920182017201620152014201320122011 Ne w A ID S di ag no si s Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined No data from the Russian Federation, Turkmenistan or Uzbekistan. 1 10 100 1000 10000 2016 2017 2018 2019 202020152014201320122011 Ne w A ID S di ag no si s Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Arithmetic scale Logarithmic scale 25 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT 2.3. HIV and AIDS diagnoses in the Centre 2.3.1. HIV diagnoses in the Centre The HIV epidemic in the Centre remains at a relatively low level compared to other parts of the Region. A total of 4 427 people were newly diagnosed with HIV in 2020 from 13 countries in the Centre of the WHO European Region, giving a rate of 2.3 per 100 000 population (Table 1). The highest rates (over 3.0) were reported by Cyprus (11.8) and Albania (3.3), and the lowest (under 2.0) by Croatia (1.9), Poland (1.9), Slovakia (1.9), Slovenia (1.3) and Serbia (1.2). The most affected age group in 2020 was 30–39-year- olds (31% of cases), while 15% of cases were diagnosed in young people aged 15–24 years – the largest percent- age of young people among the three geographical areas (Table A, Table 9). The male-to-female ratio was 5.3, higher than in both the West and the East. This reflects the higher number of young MSM among newly diag- nosed cases in the central part of the Region compared with other parts. The highest male-to-female ratios (over 10.0) were observed in Serbia (14.4), Montenegro (14.0) and Hungary (11.1) (Fig. 2.13). The 2020 data on transmission mode from the 13 coun- tries in the Centre region (Table A, Tables 4–7) indicate the following: • in total, 28% of those newly diagnosed and 48% of new HIV diagnoses with a known route of transmis- sion were infected through sex between men (1238) (Table 4); in 2020, sex between men was the predomi- nant reported mode of transmission in 10 countries (Bulgaria, Croatia, Cyprus, Czechia, Hungary, Montenegro, Serbia, Slovakia, Slovenia and Poland) (Fig. 2.14); • overall, 27% of those newly diagnosed and 47% of new HIV diagnoses with a known route of transmis- sion were infected through heterosexual transmission (1 210) (Table 6), which was the main reported mode of transmission in three countries (Albania, Romania and Turkey) (Fig. 2.14); • a total of 2% of those newly diagnosed and 4% of new HIV diagnoses with a known route of transmis- sion were infected through injecting drug use (97) (Table 5); • of those with a known route of transmission, 1% were infected through mother-to-child transmission (27) (Table 7); • transmission mode was unknown for 42% of those newly diagnosed (1 853) (Table 8). The two countries Figure 2.13: Male-to-female ratio in new HIV diagnoses, by country, Centre, 2020 0 5 10 15 Albania Romania Czechia Slovenia Cyprus Centre average Bulgaria Poland Turkey Croatia Slovakia Hungary Montenegro Serbia Male-to-female ratio No data from Bosnia and Herzegovina or North Macedonia 26 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data with the highest number of new HIV diagnoses in 2020 (Turkey and Poland) together accounted for 63% of all new HIV diagnoses reported in the Centre in 2020 and also had the highest percentage of new HIV diagnoses with an unknown transmission mode (Poland 73% and Turkey 59%). Eleven of 15 countries provided information on CD4 cell count at HIV diagnosis for 1692 people aged over 14 years (covering 38% of all new diagnoses in the Centre countries and 48% in the 11 countries with CD4 cell data) (Table 13). Forty-six per cent were late presenters, with CD4 cell counts below 350 per mm3 at HIV diagnosis, including 24% with advanced HIV infection (CD4 under 200/mm3). In total, 24% had a CD4 cell count of between Figure 2.14: New HIV diagnoses by country and transmission mode, Centre, 2020 (n = 4 427) 0 20 40 60 80 100 Serbia Croatia Montenegro Hungary Cyprus Czechia Slovenia Slovakia Bulgaria Romania Centre average Poland Turkey Albania Heterosexual contact Sex between men Injecting drug use Other Unkown Percentage Figure 2.15: New HIV diagnoses, by CD4 cell count per mm3 category at diagnosis and transmission mode, Centre, 2020 (n = 1 379) 0 20 40 60 80 100 Injecting drug use Heterosexual Sex between men <200 cells/mm3 200 to <350 cells/mm3 350 to <500 cells/mm3 ≥500 cells/mm3 n=664 n=651 n=64 Percentage Tr an sm is si on m od e No data from Bosnia and Herzegovina, Hungary, North Macedonia or Poland. 27 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT 350 and 500 cells per mm3 and 30% had a CD4 cell count above 500 per mm3. The proportion diagnosed with CD4 counts of less than 350/mm3 was 50% or above in five countries: Albania (69%), Romania (56%), Bulgaria (56%), Serbia (56%) and Slovenia (54%). The percentage of late presenters varied across transmission categories and was highest for those infected as a result of inject- ing drug use and heterosexually (both 55%) and lowest for men infected through sex with men (41%) (Table 13, Fig. 2.15). 2.3.2. Trends in HIV diagnoses in the Centre Although a decline of 34% was observed in the rate of new HIV cases diagnosed in 2020 compared to 2019, overall, the rate of new HIV diagnoses increased by 21% between 2011 and 2020 in the 13 reporting countries of the Centre, from 1.9 per 100 000 population (3 624 cases) to 2.3 (4 427 cases) (Fig. 2.2). Rates increased in nine countries. The largest increases were in Cyprus, Slovakia and Turkey. Information on trends by reported mode of HIV transmis- sion for the period 2011–2020 in the 11 countries with consistent data15 (Fig. 2.16) indicates the following. • The number of new diagnoses in those infected as a result of sex between men increased from 608 to 800. The percentage of new HIV diagnoses attributed to sex between men also increased, from 34% in 2011 to 49% in 2020. • Following the general decline in newly reported HIV cases in 2020, the number of new diagnoses in those infected through heterosexual transmission was similar to the number reported in 2011: 675 and 634 respectively. The percentage of new HIV diagnoses attributed to heterosexual transmission was 37% in 2011 and 39% in 2020. 15 Data from Bosnia and Herzegovina, North Macedonia, Poland and Turkey were excluded due to incomplete reporting on transmission mode during the period. • The number of new diagnoses in those infected as a result of injecting drug use was 278 in 2011 and 74 in 2020. The 2011–2013 outbreak in Romania that caused higher numbers of cases during this period has levelled off, as evidenced by the decrease in new diagnoses since 2013. The percentage of new diagno- ses attributed to injecting drug use was 15% in 2011 and 5% in 2020. • The number of new diagnoses as a result of mother-to- child transmission decreased from 31 cases in 2011 to 14 cases in 2020. • The number of new diagnoses reported with unknown transmission mode in 2020, although still high at 42% for the 13 reporting countries, decreased by 45%, from 216 to 118 in the 11 countries with consistent data on transmission mode. The percentage of new diagno- ses with missing information on transmission mode decreased from 12% in 2011 to 7% in 2020 in the 11 countries included in the trend assessment. 2.3.3. AIDS cases, morbidity and mortality in the Centre In 2020, 467 people were diagnosed with AIDS in the 13 reporting countries in the Centre, corresponding to a rate of 0.2 per 100 000 population (Table 14). The high- est rates (0.5 or above) were reported by Cyprus (2.0), Romania (0.9), Montenegro (0.6), Bulgaria (0.6) and Albania (0.5). In contrast to the distribution of transmis- sion modes for new HIV diagnoses in the Centre (where sex between men is the predominant mode), more AIDS diagnoses are reported in people infected through het- erosexual contact (46% of new diagnoses) than through sex between men (30% of new diagnoses). As mentioned earlier, there was a substantial drop in the reported number of HIV and AIDS diagnoses in 2020 compared to 2019 across all regions. This was also observed in the reported number of new AIDS diagnoses in the Centre which went down from 847 in 2019 to 467 Figure 2.16: New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2011–2020 0 200 400 600 800 1000 1200 2020201920182017201620152014201320122011 Ne w H IV d ia gn os es Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Data from Bosnia and Herzegovina, North Macedonia,Poland and Turkey excluded due to incomplete reporting on transmission mode during the period. 28 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data in 2020. This reduction is closely related to the impact of the COVID-19 pandemic on HIV surveillance. In 2020, the rate of new AIDS diagnoses was 0.2 per 100 000 − a decline from 0.5 in 2011 and 0.4 in 2019 (Fig. 2.4). Trends were more heterogeneous at coun- try level. Of the ten countries reporting more than 10 AIDS cases in 2020, the rate increased in four countries (Bulgaria, Cyprus, Czechia and Hungary), was the same in one (Turkey) and decreased in the remaining five countries (Table 14). In terms of the mode of transmis- sion, new AIDS diagnoses had been increasing among men infected as a result of sex between men until 2018, and had been relatively stable or in decline since 2014 in those infected heterosexually or through injecting drug use. In 2020, a clear drop in the reported number of new AIDS diagnoses was reported across all transmission groups (Fig. 2.17). The most common AIDS-indicative diseases diagnosed in 2020 were wasting syndrome due to HIV (22% of all recorded disease events), Pneumocystis pneumonia (15%) and pulmonary TB (13%) (Table 22). Until 2020, mortality had remained stable in the Centre, with around 300 deaths reported annually over the last four years. In 2020, 185 deaths were reported by the 13 countries (Table 23). However, these numbers do not represent the true burden of AIDS-related mortality due to underreporting of deaths in countries that do not match their HIV/AIDS registries with the national mortal- ity registry. 2.4. HIV and AIDS diagnoses in the West 2.4.1. HIV diagnoses in the West The epidemiological pattern of HIV infection in the West largely mirrors that of the EU/EEA, as described in Chapter 1. In 2020, 15 782 people were newly diagnosed with HIV in the 20 reporting countries comprising the West of the WHO European Region, giving a rate of 3.7 per 100 000 population (Table A, Table 1). In 2020, the highest proportion of newly diagnosed HIV infections (30%) were in 30–39-year-olds, 10% were aged 15–24 years and the male-to-female ratio was 3.0 (Table A). Sexual transmission between men remained the main transmission mode in 2020, followed by heter- osexual transmission, together accounting for 71% of all new diagnoses and 94% of all cases with a known route of transmission. Seventeen countries reported information on CD4 cell count at HIV diagnosis for 10 298 people over 14 years (66% of new diagnoses from the 17 countries reporting information on CD4 cell counts). Of these, 49% were late presenters with CD4 cell counts below 350 per mm3 at HIV diagnosis, including 30% with advanced HIV infec- tion (CD4 under 200/ mm3) (Table 13). Late presentation varied by transmission category and was more com- mon in people infected heterosexually (59%) or through injecting drug use (51%) and less common in men infected through sex with men (41%) (Table 13). Information on transmission mode (Table A, Tables 4–7) suggests the following: • in total, 39% of all people newly diagnosed and 52% of those with a known mode of transmission were infected through sex between men (6 185) (Table 4); Figure 2.17: New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2011–2020 0 100 200 300 400 2020201920182017201620152014201320122011 Ne w A ID S di ag no se s Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Data from Bosnia and Herzegovina, North Macedonia, Poland and Turkey excluded due to incomplete reporting during the period. 29 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT • overall, 31% of all people newly diagnosed and 42% of those with a known mode of transmission were infected heterosexually (4 971) (Table 6). Of these, 64% were born abroad and 40% originated from gen- eralised epidemic countries (Table 11); • of all those newly diagnosed, 4% were infected through injecting drug use (520) (Table 5); • mother-to-child transmission accounted for 0.6% of all new diagnoses and 0.8% of those with a known route of transmission (96 cases) (Table 7). Of these, 78% were born abroad and 57% originated from coun- tries with a generalised epidemic (Table 11); • transmission mode was unknown for 25% of all new diagnoses (3 953). Information on country of birth, country of nationality or region of origin was provided for all 15 782 new diag- noses in 2020. Region of origin was unknown for 16% (2 453). Among 13 329 persons with known origin (84%), 52% (6 878) originated from outside of the reporting country, including 38% (5 049) from outside the WHO European Region and 14% (1 829) from a European coun- try other than the country of report (Table 11). 2.4.2. Trends in HIV diagnoses in the West The trend in reported HIV diagnoses has been on the decline during the period 2015−2019, with an average annual decrease of around 6%. In 2020, it declined sharply to 3.7 per 100 000 population (not adjusted for reporting delay16), a 30% drop compared to 2019. The decline observed in 2020 is probably due, in part, to decreased case detection as a result of the public health and social measures introduced by countries in response to the COVID-19 pandemic. For this reason, while we will still compare 2020 data to the previous 16 See Annex 1 for methods and Annex 6 for results. years, trends presented in this sub-chapter are prelimi- nary and should be interpreted with caution. HIV rates increased (by 10% or more in countries with more than 10 cases in both 2011 and 2020) in three countries – Iceland, Ireland and Malta – and decreased (by 10% or more) in 16 (Table 1), not taking into account the impact of reporting delays in several countries. Information on trends by reported transmission mode during the period 2011–2020 in the 15 countries with consistent data17 (Fig. 2.18) suggests the following. • New diagnoses of people infected through sex between men decreased by 47%, from 8 419 to 4 422. The percentage of new diagnoses attributed to sex between men decreased from 41% in 2011 to 37% in 2020. • New diagnoses of people with reported heterosexual transmission decreased by 50%, from 7 580 to 3 818, with the steepest decline among women and foreign- born heterosexual people, the latter being due mainly to sharp decreases among migrants originating from countries with generalised HIV epidemics (data not shown; see also Fig. 1.11 and 1.12 and section 1.2 Trends in HIV diagnoses in Chapter 1). The percentage of new diagnoses attributed to heterosexual contact decreased from 37% of cases in 2011 to 32% in 2020. • New diagnoses of people infected through injecting drug use decreased by 50%, from 845 in 2011 to 422 in 2020, representing 4% of new HIV diagnoses in both 2011 and in 2020. • New diagnoses of children infected through mother- to-child transmission decreased by 62%, from 231 in 2011 to 88 in 2020. 17 Data from Andorra, Monaco and Portugal are excluded due to inconsistent reporting during the period; data from Iceland, Ireland and Malta are excluded due to incomplete reporting on transmission mode during the period; data from Italy and Spain are excluded due to increasing coverage of national surveillance over the period. Figure 2.18: New HIV diagnoses, by transmission mode and year of diagnosis, West, 2011–2020 0 2000 4000 6000 8000 10000 2020201920182017201620152014201320122011 Ne w H IV d ia gn os es Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Data from Andorra, Monaco and Portugal excluded due to inconsistent reporting during the period; data from Iceland, Ireland and Malta excluded due to incomplete reporting on transmission mode during the period; data from Italy and Spain excluded due to increasing coverage of national surveillance during the period. 30 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Figure 2.19: New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2011–2020 0 500 1000 1500 2000 2020201920182017201620152014201320122011 Ne w A ID S di ag no se s Year of diagnosis Sex between men Heterosexual transmission Injecting drug use Mother-to-child transmission Other/undetermined Data from Andorra, Germany, Monaco, Portugal and Sweden excluded due to inconsistent reporting during the period; data from Iceland excluded due to incomplete reporting on transmission mode during the period; data from Spain excluded due to increasing coverage of national surveillance during the period. • The number of new diagnoses with missing infor- mation on transmission mode was similar in 2011 (3 200) and in 2020 (3 247), corresponding to 16% of new diagnoses in 2011 and 27% in 2020. Delays in the reporting of probable mode of transmission to national and European surveillance systems intensify the increase. 2.4.3. AIDS cases, morbidity and mortality in the West In 2020, 18 of the 23 countries in the West18 reported that 1 549 people were diagnosed with AIDS, giving a rate of 0.5 per 100 000 population (Table 14). The steady decline in new AIDS diagnoses that began in the late 1990s continued through to 2020, with a 64% decrease in the rate of new AIDS cases over the decade from 1.4 per 100 000 population (5 724 cases) in 2011 to 0.5 (1 549 cases) in 2020 (Fig. 2.4). New AIDS diagnoses decreased in all transmission groups but most notably among peo- ple who inject drugs (an 80% decline) (Fig. 2.19). The most common AIDS-indicative diseases diagnosed in the West in 2020 were Pneumocystis pneumonia (24% of all disease events reported), oesophageal candidiasis (12%) and Kaposi’s sarcoma (11%) (Table 22). In the West, 444 people were reported to have died in 2020 in the 16 countries reporting data for 2020 (Table 23). Among the 15 countries for which consist- ent data were available19 for the decade, the number of AIDS-related deaths has continued to decline, from 616 in 2011 to 418 in 2020, representing a 32% decrease. However, these numbers do not reflect the true bur- den of AIDS-related mortality in the West of the Region due to reporting delays. In particular, there is a risk of 18 No AIDS data were available from Andorra, Germany, Monaco or Sweden. Data from Portugal not published at country request. 19 No data were available from Andorra, Denmark, Germany, Italy, Monaco, Spain or Sweden. Data from Portugal not published at country request. deaths being underreported in those countries that do not have the ability to link their HIV/AIDS registries with their vital statistics registries. 2.5. HIV testing Data on the number of HIV tests can support the inter- pretation of trends in newly diagnosed HIV infections. However, it is worth noting that numbers provided are collected in a heterogeneous manner and comparisons between country testing rates should be undertaken with caution. In 2020, a total of 57 671 711 HIV tests were reported by 21 countries (nine East, eight Centre and four West). These tests do not include unlinked anonymous testing and all countries except the Russian Federation also exclude the HIV tests performed as part of blood- donor screening. In 2020, the Russian Federation reported a total of 36 110 128 HIV tests, accounting for 63% of all HIV tests reported in the Region for that year. Countries in the East tended to report higher testing rates than those in the West and Centre, but rates varied greatly across countries from all parts of the Region, and more data were available from countries in the Centre and East than the West (Table 24). Although the overall number of tests performed in the Region increased by 29%, from 44 675 303 in 2011 to 57 671 711 in 2020, in the 21 countries with data for both 2011 and 2020, the number of tests performed in these countries decreased by 16% between 2019 and 2020 (Table 24). This is probably a consequence of a reduc- tion in HIV testing services during parts of 2020 due to COVID-19 pandemic. Increases in large countries with high numbers tested, such as Belarus, Kazakhstan, the Russian Federation and Turkey, have had a considerable impact on the overall increase since 2011. The number of tests more than doubled in two countries, although information on testing yield or coverage among key pop- ulations at higher risk of HIV infection was not collected from countries. 31 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT The number of HIV tests from the nine reporting coun- tries in the East of the Region increased by 36%, from 31 583 328 in 2011 to 43 078 796 in 2020 (Table 24). Information on the types of population tested is not available, but an increased number of HIV tests does not necessarily generate higher testing yields if large num- bers of HIV tests are performed among people at low risk of HIV infection. Over the last decade, the rate of new HIV diagnoses in the Centre increased by 16%, while the number of HIV tests increased by 23% (from 6 877 523 in 2011 to 8 432 771 in 2020) in the seven countries for which con- sistent data were available20. The number of HIV tests conducted in the West is not reported separately here. In contrast to countries in the East and Centre, many in the West do not systematically collect data on the number of HIV tests performed. This results in data being too sparse to allow for meaningful interpretation. 2.6. Conclusions An overall upward trend in the rate of new HIV diagnoses per 100 000 population during the period 2011−2019, mainly driven by the increasing trend in the East, was followed by 24% drop in newly diagnosed HIV cases between 2019 and 2020. While additional investigation is needed before making the assumptions on the reasons for the sharp decline in new HIV diagnoses observed, it is probably due in part to decreased case detection as a result of the public health and social measures introduced by countries in response to the COVID-19 pandemic. Countries responding to the WHO/ ECDC survey indicated the issue of reduced detection and reporting of HIV cases during the COVID-19 pandemic, mainly due to reductions in testing services and limited surveillance capacity. Nevertheless, HIV infection continues to affect the health and well-being of millions of people in the WHO European Region. In 2020, 104 765 people were newly diagnosed with HIV bringing the cumulative number of reported HIV diagnoses in the Region to 2 222 249 since reporting began in the 1980s. The vast majority of peo- ple newly diagnosed (81%) were from the East, with a rate of 32.6 per 100 000 population, while 15% were diagnosed in the West, with a rate of 3.7 per 100 000 population, and 4% in the Centre, with a rate of 2.3 per 100 000 population. The 2020 HIV surveillance data also confirm the wide variation in epidemic patterns and trends across the WHO European Region. Overall, among the new diag- noses for which the HIV transmission mode was known, heterosexual transmission accounted for 64%, injecting drug use for 25% and sex between men for 10%. These numbers conceal a complex mix of transmission pat- terns, trends and country contexts in which transmission 20 The seven countries are Bulgaria, Czechia, Montenegro, Poland, Romania, Slovenia and Turkey. through sex between men tends to predominate in the western and central parts of the Region, heterosexual transmission remains substantial across large parts of the Region (particularly among migrants, travellers and partners of people who inject drugs) and injecting drug use is still an important risk factor in the eastern part of the Region. For the first time in 2020, the reported modes of transmission include data from the Russian Federation, where among the new diagnoses for which HIV transmission mode was known, the predominant mode was heterosexual transmission (70%), followed by injecting drug use (27%) and sex between men (3%). This greatly affected the transmission patterns in the East and the Region overall, making injecting drug use the second most common transmission mode in the Region after heterosexual transmission. Transmission as a result of injecting drug use accounted for 29% of new diagnoses in the East with a known transmission mode. It was the only transmission mode that showed an increase in absolute numbers between 2019 and 2020, mainly due to the increase in Ukraine. Although the reported transmission through sex between men remains low in absolute terms in the East, it has increased nearly four-fold during the decade – the largest increase in any transmission category and any geographical area of the Region. There is some evidence to suggest that a proportion of men reported as het- erosexually infected may in fact be men who have sex with men or people with a history of drug injection who may have been misclassified as heterosexually infected [2,3]. While most new diagnoses (65%) were in men and new diagnoses increased more rapidly among men than women, the proportion of new diagnoses among women was much higher in the East than elsewhere in the Region. During the period 2011−2019, the rate of new diagnoses increased more rapidly in the central part of the Region than anywhere else, with a strong gender disparity and very steep increases among men (both MSM and het- erosexual) compared with a fairly stable rate among women. However, a 34% decline was observed in the rate of new HIV cases diagnosed in 2020 compared to 2019, the most significant fall in all three geographical areas of the Region. Sexual transmission outweighs all other types of transmission in all countries reporting the transmission mode, with sex between men being the predominant mode of transmission in 10 of the 13 Centre countries and reported heterosexual transmission pre- vailing in three. Drug-injection-related transmission remains low, but recent outbreaks [4–8] suggest that HIV prevention services for people who inject drugs continue to be important and must be maintained with sufficient coverage to prevent such outbreaks. The percentage of young people among the new diagnoses is also higher in this part of the Region than elsewhere. HIV prevention, diagnostics and treatment interventions should accom- modate the needs of key populations, particularly MSM, with relevant evidence-based interventions. These inter- ventions include condom and lubricant programming; diversified HIV testing services; assisted voluntary 32 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data partner notification; PrEP; prevention and manage- ment of coinfections (particularly sexually transmitted infections) and rapid HIV treatment initiation. Services should be patient-centred and provided in a friendly environment, preferably with the involvement of civil society along the entire HIV continuum of services, rang- ing from HIV prevention to adherence and ART. In the western part of the Region, there was a clear decline in the overall rate of new HIV diagnoses during the decade, resulting primarily from decreases in new diagnoses among MSM in specific countries (Austria, Belgium, Denmark, the Netherlands, Norway, Spain and the United Kingdom) and among people infected heterosexually, particularly women and people origi- nating from countries with generalised HIV epidemics. Continued strong HIV combination prevention, including the use of formal and informal PrEP, implementation of diversified and user-friendly HIV testing services with more frequent testing to facilitate earlier diagnosis, early linkage to care and rapid initiation of ART, and a strong focus on interventions designed to reach MSM [9,10] have probably all contributed to the observed decline. While a certain proportion of migrants, even those origi- nating from HIV-endemic areas, are known to acquire HIV after arrival in the EU/EEA [11–13], it is unclear to what extent the decreases observed can be explained by lower incidence of HIV in the migrant populations, reduced test-seeking or opportunities, changed migra- tion patterns or a combination of factors. However, as in other parts of the Region, the rates declined sharply in 2020, representing a five-fold decrease compared to the average annual decrease observed during 2015–2019. Reduced testing and extra demands on clinical sectors and public health institutes responsible for reporting and surveillance due to the COVID-19 pandemic have probably had an impact on case detection for 2020 in the West and elsewhere. Where migration is a common occurrence and takes a variety of forms, the public health challenge of ensur- ing access to health services for migrant populations (including HIV services and the promotion of cross-bor- der collaboration and sharing of data) remains essential to a robust and people-centred public health response. The Russian Federation reported information on CD4 cell counts for the first time in 2020 and this affected the Regional average CD4 cell count levels, since 64% of new HIV diagnoses with available CD4 cell data were reported from the Russian Federation. As a result, just over a third (36%) of those newly diagnosed were late presenters, with CD4 cell counts below 350 per mm3 at the time of HIV diagnosis, including 19% with advanced HIV infec- tion (CD4 above 200/mm3). However, when excluding data from the Russian Federation, half (50%) of those newly diagnosed with HIV are only detected once their CD4 cell counts have fallen to below 350 per mm3, which is comparable to the results from the previous years. Once again, it is significant that the 2020 data provide information on variations in late presentation according to geography, transmission mode and age. Moreover, the data confirm that the proportion diagnosed at a late stage of infection was highest among people infected heterosexually (particularly men), as a result of injecting drug use, and among those in older age groups. Late presentation reflects insufficient access to, and uptake of appropriate HIV testing and counselling by those who have a higher risk of acquiring HIV. This has become more challenging during the ongoing COVID-19 pandemic. HIV testing strategies need to be reconsid- ered and diversified to include innovative approaches that involve community-based organisations and focus on key population groups. Multiple entry points to HIV testing should be available through HIV self-testing, HIV testing performed by lay providers and civil society, home sampling, routine indicator condition-guided HIV testing offered in the health system and assisted part- ner notifications. HIV testing should also be available in settings such as prisons, drug-dependence treatment programmes, sexual and reproductive health clinics and migrant health services, depending on the local con- text. Support for timely linkage to HIV treatment and care is essential to reduce late presentation and ensure progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO 95–95–95 targets, improving treatment outcomes and further reducing HIV transmission. AIDS trends varied greatly across the three geographi- cal areas. While the rate continued its steady decline in the West, it remained stable in the Centre and, although rates fluctuated over the decade in the East of the Region, overall, the rate of new AIDS diagnoses declined by 20% in the East between 2011 and 2019. As in case of new HIV diagnoses, the rates dropped sharply between 2019 and 2020 in all geographical areas. Although AIDS and AIDS deaths for 2020 have also probably been impacted by reporting issues due to the COVID-19 pandemic, the reduced trends prior to 2020 are likely to reflect greater access to treatment and better case management, indi- cating progress towards the Sustainable Development Goal of ending the AIDS epidemic as a public health threat and decreasing AIDS-related deaths. The high number of AIDS cases is indicative of late HIV diagnosis, delayed initiation of life-saving HIV treatment and low treatment coverage. Increasing implementation of a treat-all approach and having policies in place in most countries in the Region to ensure that everyone liv- ing with HIV is offered ART irrespective of the stage of disease has helped to stabilise AIDS trends. Ultimately, this will help reduce AIDS-related deaths in line with global and regional targets [14–17]. The data in this report present new HIV diagnoses through to the end of 2020, the period of the global COVID-19 pandemic, which heavily affected all coun- tries in the WHO European Region, thus 2020 data need to be interpreted with caution. Additional inves- tigation is needed before making the assumptions on the reasons behind the sharp decline in the number of new HIV diagnoses observed across the countries. In-depth investigation should focus on the issues of 33 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT under diagnosis and under reporting versus the change in high-risk behaviour leading to the reduced transmis- sion of HIV. In collaboration with the Member States, ECDC, and clin- ical and community partners, WHO’s Regional Office for Europe will look carefully at the impact on HIV surveil- lance and prevention response to support the continued high standard of European HIV and AIDS data. This in turn will help us to guide the response in the Region and understand how the ongoing pandemic may affect HIV incidence, particularly in those regions and groups most at-risk. References21 1. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire (French National Institute of Health Surveillance); 2007. 2. Čakalo JI, Božičević I, Vitek CR, Mandel JS, Salyuk TO, Rutherford GW. Misclassification of men with reported HIV infection in Ukraine. AIDS Behav. 2015;19:1938–40. 3. Dumchev K, Kornilova M, Kulchynska R, Azarskova M, Vitek C. Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk. BMC Public Health 2020;20(1):1288. doi:10.1186/s12889-020-09373-2. PMID: 32843008. PMCID: PMC7449084. 4. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L et al. Human immunodeficiency virus among people who inject drugs: is risk increasing in Europe? Euro Surveill. 2013;18(48):pii=20648 Available at: https://www.eurosurveillance.org/con- tent/10.2807/1560-7917.ES2013.18.48.20648?crawler=true 5. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et al. Injection of new psychoactive substance snow blow associ- ated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2016. Euro Surveill. 2016;20(40):pii=30036. Available at: https://www.eurosurveil- lance.org/content/10.2807/1560-7917.ES.2015.20.40.30036 6. HIV in people who inject drugs – joint technical mission to Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre for Drugs and Drug Addiction; 2018. Available at: https://sante. public.lu/fr/publications/h/hiv-joint-technical-mission/index.html 7. McAuley A, Palmateer NE, Goldberg DJ, Trayner KMA, Shepherd SJ, Gunson RN et al. Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross- sectional analysis. Lancet HIV 2019;6(5):e315–24. 8. Des Jarlais DC, Sypsa V, Feelemyer J, Abagiu AO, Arendt V, Broz D et al. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV 2020;7(6):e434–42. 9. HIV and STI prevention among men who have sex with men. ECDC guidance. Stockholm: ECDC; 2015. Available at: https://www.ecdc. europa.eu/en/publications-data/public-health-guidance-hiv-and- sti-prevention-among-men-who-have-sex-men 10. United Nations Population Fund, Global Forum on MSM and HIV, United Nations Development Programme, World Health Organization, United States Agency for International Development, the US President’s Emergency Plan for AIDS Relief, the Bill & Melinda Gates Foundation. Implementing comprehensive HIV and STI programmes with men who have sex with men. New York (NY): United Nations Population Fund; 2015. Available at: https://www. unfpa.org/publications/implementing-comprehensive-hiv-and-sti- programmes-men-who-have-sex-men 11. Rice BD, Elford J, Yin Z, Delpech VC. A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV. AIDS 2012;26(15):1961–6. 12. Fakoya I, Alvarez-del Arco D, Woode-Owusu M, Monge S, Rivero- Montesdeoca Y, Delpech V et al. A systematic review of postmi- gration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: implications for effectively managing HIV prevention programmes and policy. BMC Public Health 2015;15:561. 13. Fakoya I, Alvarez-Del Arco D, Monge S, Copas AJ, Gennotte A-F, Volny-Anne A et al. HIV testing history and access to treat- ment among migrants living with HIV in Europe. J Int AIDS Soc. 2018;21(Suppl. 4):e25123 https://onlinelibrary.wiley.com/doi/ epdf/10.1002/jia2.25123 14. Ambitious treatment targets: writing the final chapter of the AIDS epidemic. Geneva: UNAIDS; 2014. Available 21 All weblinks were accessed on 8 November 2021. at: www.unaids.org/sites/default/files/media_asset/ JC2670_UNAIDS_Treatment_Targets_en.pdf 15. Action plan for the health sector response to HIV in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2017. Available at: https://www.euro.who.int/en/publications/ abstracts/action-plan-for-the-health-sector-response-to-hiv-in- the-who-european-region-2017 16. Global health sector strategy for HIV 2016–2021. Geneva: World Health Organization; 2016. Available at: https://www.who.int/ publications/i/item/WHO-HIV-2016.05 17. On the fast-track to end AIDS. 2016–2021 strategy. Geneva: UNAIDS; 2015. Available at: https://www.aidsdatahub.org/ resource/unaids-2016-2021-strategy-on-the-fast-track-to-end-aids

35 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Tables 36 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 1: New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 1980 364 4.3 371 4.4 311 3.7 302 3.5 329 3.8 297 3.4 305 3.5 207 2.3 233 2.6 155 1.7 10 401 Austria West Belgium 1985 1 173 10.7 1 230 11.1 1 133 10.2 1 056 9.4 1 024 9.1 910 8.0 906 8.0 887 7.8 926 8.1 727 6.3 33 237 Belgium Centre Bulgaria 1986 201 2.7 157 2.1 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 311 4.4 258 3.7 199 2.9 3 515 Bulgaria Centre Croatia 1985 74 1.7 73 1.7 85 2.0 92 2.2 117 2.8 109 2.6 106 2.6 94 2.3 102 2.5 76 1.9 1 810 Croatia Centre Cyprus 1986 54 6.4 58 6.7 54 6.2 56 6.5 80 9.4 80 9.4 85 9.9 78 9.0 100 11.4 105 11.8 1 431 Cyprus Centre Czech Republic 1985 153 1.5 212 2.0 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 208 2.0 222 2.1 251 2.3 3 841 Czech Republic West Denmark 1990 266 4.8 201 3.6 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 219 3.8 190 3.3 161 2.8 8 161 Denmark East Estonia 1988 366 27.5 315 23.8 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 190 14.4 178 13.4 143 10.8 10 222 Estonia West Finland 1980 172 3.2 156 2.9 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 153 2.8 149 2.7 136 2.5 4 349 Finland West France 2003 5 431 8.4 5 684 8.7 5 580 8.5 5 693 8.6 5 315 8.0 5 436 8.2 5 374 8.0 5 093 7.6 5 091 7.6 3 443 5.1 97 370 France West Germany 1993 2 772 3.5 3 032 3.8 3 238 4.0 3 528 4.4 3 646 4.5 3 383 4.1 3 166 3.8 2 872 3.5 3 111 3.7 2 454 3.0 73 722 Germany West Greece 1984 966 8.7 1 162 10.5 901 8.2 783 7.2 781 7.2 652 6.0 645 6.0 723 6.7 661 6.2 601 5.6 16 762 Greece Centre Hungary 1985 162 1.6 219 2.2 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 229 2.3 238 2.4 201 2.1 4 235 Hungary West Iceland 1983 23 7.2 19 5.9 11 3.4 11 3.4 12 3.6 28 8.4 24 7.1 38 10.9 28 7.8 34 9.3 485 Icelandc West Irelandc 1985 328 7.2 350 7.6 343 7.4 378 8.2 483 10.3 511 10.8 499 10.4 508 10.5 550 11.2 429 8.6 10 346 Irelandc West Italy 2004 3 901 6.7 4 163 6.9 3 846 6.4 3 836 6.4 3 600 6.0 3 693 6.1 3 587 6.0 3 012 5.0 2 473 4.1 1 303 2.2 51 168 Italy East Latvia 1987 299 14.4 339 16.6 347 16.8 347 17.1 393 19.8 365 18.5 371 19.0 326 16.9 295 15.4 257 13.5 8 221 Latvia Liechtenstein 1985 1 2.8 0 0.0 0 0.0 1 2.7 0 0.0 2 5.3 0 0.0 0 0.0 0 0.0 0 0.0 67 Liechtenstein East Lithuania 1988 166 5.4 160 5.3 177 6.0 141 4.8 157 5.4 214 7.4 263 9.2 160 5.7 151 5.4 108 3.9 3 431 Lithuania West Luxembourgc 1983 63 12.3 73 13.9 77 14.3 92 16.7 79 14.0 83 14.4 70 11.9 62 10.3 58 9.4 44 7.0 1 922 Luxembourgc West Malta 2001 21 5.1 30 7.2 36 8.5 40 9.3 61 13.9 63 14.0 45 9.8 73 15.3 80 16.2 82 15.9 667 Malta West Netherlands 1980 1 251 7.5 1 184 7.1 1 158 6.9 1 020 6.1 1 022 6.0 926 5.5 873 5.1 740 4.3 629 3.6 396 2.3 28 891 Netherlands West Norway 1984 269 5.5 242 4.9 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 191 3.6 172 3.2 137 2.6 6 791 Norway Centre Poland 1985 1 113 2.9 1 104 2.9 1 100 2.9 1 134 3.0 1 278 3.4 1 318 3.5 1 420 3.7 1 210 3.2 1 551 4.1 709 1.9 26 383 Poland West Portugal 1985 1 829 17.3 1 821 17.3 1 787 17.0 1 468 14.1 1 511 14.6 1 524 14.7 1 365 13.2 1 160 11.3 902 8.8 61 822 Portugal Centre Romania 1987 842 4.2 944 4.7 1 026 5.1 914 4.6 891 4.5 789 4.0 808 4.1 756 3.9 745 3.8 447 2.3 25 590 Romania Centre Slovakia 1985 49 0.9 50 0.9 83 1.5 86 1.6 86 1.6 88 1.6 72 1.3 102 1.9 104 1.9 102 1.9 1 179 Slovakia Centre Slovenia 1985 56 2.7 49 2.4 47 2.3 53 2.6 52 2.5 61 3.0 40 1.9 37 1.8 34 1.6 27 1.3 955 Slovenia West Spain 2003 3 676 11.2 3 944 10.4 4 374 9.4 4 429 9.5 4 189 9.0 4 175 9.0 3 795 8.2 2 527 6.4 2 483 5.6 1 884 4.3 56 557 Spain West Sweden 1983 461 4.9 441 4.7 457 4.8 473 4.9 447 4.6 429 4.4 434 4.3 481 4.8 449 4.4 360 3.5 13 859 Sweden Total EU/EEA 26 502 6.1 27 783 6.4 27 787 6.2 27 674 6.2 27 259 6.1 26 725 5.9 25 803 5.7 22 647 5.1 22 163 4.9 14 971 3.3 567 386 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 78 2.7 81 2.8 120 4.1 79 2.7 96 3.3 127 4.4 94 3.3 102 3.5 101 3.5 96 3.3 1 400 Albania West Andorra 2004 2 2.4 2 2.4 5 6.2 5 6.3 3 3.8 3 3.9 6 7.8 12 15.6 96 Andorra East Armeniac 1988 182 6.3 228 7.9 238 8.2 334 11.5 294 10.0 303 10.3 358 12.2 429 14.5 448 15.1 369 12.5 4 154 Armeniac East Azerbaijan 1987 548 6.0 517 5.6 514 5.5 604 6.4 727 7.6 556 5.7 567 5.8 656 6.6 721 7.2 559 5.5 8 688 Azerbaijan East Belarus 1981 1 196 12.7 1 223 13.0 1 533 16.3 1 811 19.2 2 305 24.4 2 391 25.3 2 468 26.1 2 386 25.2 2 137 22.6 1 427 15.1 30 636 Belarus Centre Bosnia and Herzegovinac 1986 27 0.7 25 0.7 2 0.1 23 0.7 15 0.4 24 0.7 15 0.4 24 0.7 30 0.9 338 Bosnia and Herzegovinac East Georgia 1989 424 10.4 526 12.9 490 12.1 564 14.0 717 17.8 719 17.9 631 15.7 672 16.8 668 16.7 530 13.3 8 632 Georgia West Israel 1981 450 6.0 483 6.3 466 6.0 461 5.9 413 5.2 368 4.5 416 5.0 452 5.4 410 4.8 363 4.2 10 862 Israel East Kazakhstan 1987 1 997 12.1 2 004 12.0 2 131 12.5 2 342 13.5 2 475 14.1 2 898 16.3 3 014 16.7 3 215 17.5 3 673 19.8 3 472 18.5 42 911 Kazakhstan East Kyrgyzstan 1987 614 11.1 701 12.5 503 8.8 649 11.1 653 11.0 764 12.6 840 13.6 876 13.9 850 13.2 676 10.4 10 421 Kyrgyzstan East Moldova 1987 721 17.7 757 18.6 706 17.3 831 20.4 818 20.1 832 20.5 835 20.6 905 22.3 922 22.8 675 16.7 14 354 Moldova West Monaco 1987 0 0.0 1 2.7 0 0.0 1 2.7 1 2.7 0 0.0 3 7.8 0 0.0 40 Monaco Centre Montenegro 1989 9 1.4 13 2.1 11 1.8 20 3.2 19 3.0 34 5.4 26 4.1 23 3.7 26 4.1 15 2.4 318 Montenegro Centre North Macedonia 1993 1 0.0 15 0.7 15 0.7 30 1.4 25 1.2 30 1.4 44 2.1 45 2.2 246 North Macedonia East Russia 2009 67 317 46.8 75 708 52.6 81 698 56.6 92 613 64.0 100 220 69.1 86 855 59.8 85 802 59.0 85 995 59.0 80 124 54.9 59 598 40.8 940 856 Russia West San Marino 1985 8 25.3 5 15.6 1 3.1 3 9.1 2 6.0 2 6.0 1 3.0 3 8.9 0 0.0 0 0.0 93 San Marino Centre Serbia 1984 134 1.4 137 1.5 156 1.7 137 1.5 183 2.1 179 2.0 186 2.1 188 2.1 223 2.1 123 1.2 4 323 Serbia Centre Serbia excluding Kosovod 1984 128 1.8 133 1.9 153 2.1 131 1.8 180 2.5 168 2.4 183 2.6 180 2.6 218 2.5 121 1.4 4 195 Serbia excluding Kosovod Centre Kosovod 1999 6 0.3 4 0.2 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 8 0.4 5 0.3 2 0.1 128 Kosovod West Switzerland 1985 562 7.1 621 7.8 577 7.1 517 6.3 536 6.5 533 6.4 446 5.3 425 5.0 420 4.9 288 3.3 37 111 Switzerland East Tajikistan 1991 880 11.4 770 9.8 817 10.1 986 11.9 1 149 13.6 1 038 12.0 1 205 13.6 1 421 15.6 1 320 14.2 1 084 11.4 13 070 Tajikistan Centre Turkey 1985 699 1.0 1 068 1.4 1 313 1.7 1 838 2.4 2 107 2.7 2 438 3.1 2 844 3.5 3 248 3.9 3 229 3.9 2 076 2.5 24 543 Turkey East Turkmenistan 1990 0 0.0 0 0.0 2 Turkmenistan East Ukraine 1987 17 305 37.9 16 850 37.1 17 844 39.4 15 796 35.0 13 000 30.4 14 237 33.4 15 614 36.8 15 664 37.1 16 271 38.8 15 658 37.5 309 971 Ukraine West United Kingdom 1981 6 152 9.6 6 192 9.6 5 957 9.2 6 316 9.7 6 238 9.5 5 309 8.0 4 756 7.1 4 656 6.9 4 337 6.4 2 785 4.1 167 847 United Kingdom East Uzbekistan 1981 24 018 Uzbekistan Total non-EU/EEA 99 306 23.6 107 927 25.5 115 097 27.1 125 960 29.4 131 996 30.8 119 640 27.7 120 171 27.7 121 397 27.8 115 910 26.5 89 794 20.6 1 654 930 Total non-EU/EEA WHO European Region WHO European Region West 30 140 7.4 31 407 7.6 30 881 7.3 31 116 7.3 30 364 7.1 28 969 6.7 27 329 6.3 24 494 5.8 23 352 5.4 15 782 3.7 692 559 West Centre 3 652 1.9 4 205 2.2 4 687 2.4 5 212 2.7 5 713 2.9 5 993 3.1 6 458 3.3 6 655 3.4 6 963 3.5 4 427 2.3 100 107 Centre East 92 015 36.1 100 098 39.1 107 316 41.8 117 305 45.6 123 178 48.1 111 401 43.4 112 187 43.6 112 895 43.7 107 758 41.7 84 556 32.6 1 429 583 East Total WHO European Region 125 807 14.8 135 710 15.8 142 884 16.4 153 633 17.5 159 255 18.1 146 363 16.6 145 974 16.5 144 044 16.4 138 073 15.6 104 765 11.8 2 222 249 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c The numbers displayed here may not fully align with the numbers in the country’s national statistics as these are presented by the ‘date of notification’ instead of the ‘date of diagnosis’ as here. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 37 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 1: New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 1980 364 4.3 371 4.4 311 3.7 302 3.5 329 3.8 297 3.4 305 3.5 207 2.3 233 2.6 155 1.7 10 401 Austria West Belgium 1985 1 173 10.7 1 230 11.1 1 133 10.2 1 056 9.4 1 024 9.1 910 8.0 906 8.0 887 7.8 926 8.1 727 6.3 33 237 Belgium Centre Bulgaria 1986 201 2.7 157 2.1 200 2.7 247 3.4 227 3.2 202 2.8 241 3.4 311 4.4 258 3.7 199 2.9 3 515 Bulgaria Centre Croatia 1985 74 1.7 73 1.7 85 2.0 92 2.2 117 2.8 109 2.6 106 2.6 94 2.3 102 2.5 76 1.9 1 810 Croatia Centre Cyprus 1986 54 6.4 58 6.7 54 6.2 56 6.5 80 9.4 80 9.4 85 9.9 78 9.0 100 11.4 105 11.8 1 431 Cyprus Centre Czech Republic 1985 153 1.5 212 2.0 235 2.2 232 2.2 266 2.5 286 2.7 254 2.4 208 2.0 222 2.1 251 2.3 3 841 Czech Republic West Denmark 1990 266 4.8 201 3.6 233 4.2 256 4.5 277 4.9 244 4.3 242 4.2 219 3.8 190 3.3 161 2.8 8 161 Denmark East Estonia 1988 366 27.5 315 23.8 325 24.6 291 22.1 270 20.5 229 17.4 219 16.6 190 14.4 178 13.4 143 10.8 10 222 Estonia West Finland 1980 172 3.2 156 2.9 157 2.9 181 3.3 174 3.2 180 3.3 158 2.9 153 2.8 149 2.7 136 2.5 4 349 Finland West France 2003 5 431 8.4 5 684 8.7 5 580 8.5 5 693 8.6 5 315 8.0 5 436 8.2 5 374 8.0 5 093 7.6 5 091 7.6 3 443 5.1 97 370 France West Germany 1993 2 772 3.5 3 032 3.8 3 238 4.0 3 528 4.4 3 646 4.5 3 383 4.1 3 166 3.8 2 872 3.5 3 111 3.7 2 454 3.0 73 722 Germany West Greece 1984 966 8.7 1 162 10.5 901 8.2 783 7.2 781 7.2 652 6.0 645 6.0 723 6.7 661 6.2 601 5.6 16 762 Greece Centre Hungary 1985 162 1.6 219 2.2 240 2.4 271 2.7 271 2.7 228 2.3 223 2.3 229 2.3 238 2.4 201 2.1 4 235 Hungary West Iceland 1983 23 7.2 19 5.9 11 3.4 11 3.4 12 3.6 28 8.4 24 7.1 38 10.9 28 7.8 34 9.3 485 Icelandc West Irelandc 1985 328 7.2 350 7.6 343 7.4 378 8.2 483 10.3 511 10.8 499 10.4 508 10.5 550 11.2 429 8.6 10 346 Irelandc West Italy 2004 3 901 6.7 4 163 6.9 3 846 6.4 3 836 6.4 3 600 6.0 3 693 6.1 3 587 6.0 3 012 5.0 2 473 4.1 1 303 2.2 51 168 Italy East Latvia 1987 299 14.4 339 16.6 347 16.8 347 17.1 393 19.8 365 18.5 371 19.0 326 16.9 295 15.4 257 13.5 8 221 Latvia Liechtenstein 1985 1 2.8 0 0.0 0 0.0 1 2.7 0 0.0 2 5.3 0 0.0 0 0.0 0 0.0 0 0.0 67 Liechtenstein East Lithuania 1988 166 5.4 160 5.3 177 6.0 141 4.8 157 5.4 214 7.4 263 9.2 160 5.7 151 5.4 108 3.9 3 431 Lithuania West Luxembourgc 1983 63 12.3 73 13.9 77 14.3 92 16.7 79 14.0 83 14.4 70 11.9 62 10.3 58 9.4 44 7.0 1 922 Luxembourgc West Malta 2001 21 5.1 30 7.2 36 8.5 40 9.3 61 13.9 63 14.0 45 9.8 73 15.3 80 16.2 82 15.9 667 Malta West Netherlands 1980 1 251 7.5 1 184 7.1 1 158 6.9 1 020 6.1 1 022 6.0 926 5.5 873 5.1 740 4.3 629 3.6 396 2.3 28 891 Netherlands West Norway 1984 269 5.5 242 4.9 233 4.6 267 5.2 221 4.3 220 4.2 213 4.1 191 3.6 172 3.2 137 2.6 6 791 Norway Centre Poland 1985 1 113 2.9 1 104 2.9 1 100 2.9 1 134 3.0 1 278 3.4 1 318 3.5 1 420 3.7 1 210 3.2 1 551 4.1 709 1.9 26 383 Poland West Portugal 1985 1 829 17.3 1 821 17.3 1 787 17.0 1 468 14.1 1 511 14.6 1 524 14.7 1 365 13.2 1 160 11.3 902 8.8 61 822 Portugal Centre Romania 1987 842 4.2 944 4.7 1 026 5.1 914 4.6 891 4.5 789 4.0 808 4.1 756 3.9 745 3.8 447 2.3 25 590 Romania Centre Slovakia 1985 49 0.9 50 0.9 83 1.5 86 1.6 86 1.6 88 1.6 72 1.3 102 1.9 104 1.9 102 1.9 1 179 Slovakia Centre Slovenia 1985 56 2.7 49 2.4 47 2.3 53 2.6 52 2.5 61 3.0 40 1.9 37 1.8 34 1.6 27 1.3 955 Slovenia West Spain 2003 3 676 11.2 3 944 10.4 4 374 9.4 4 429 9.5 4 189 9.0 4 175 9.0 3 795 8.2 2 527 6.4 2 483 5.6 1 884 4.3 56 557 Spain West Sweden 1983 461 4.9 441 4.7 457 4.8 473 4.9 447 4.6 429 4.4 434 4.3 481 4.8 449 4.4 360 3.5 13 859 Sweden Total EU/EEA 26 502 6.1 27 783 6.4 27 787 6.2 27 674 6.2 27 259 6.1 26 725 5.9 25 803 5.7 22 647 5.1 22 163 4.9 14 971 3.3 567 386 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 78 2.7 81 2.8 120 4.1 79 2.7 96 3.3 127 4.4 94 3.3 102 3.5 101 3.5 96 3.3 1 400 Albania West Andorra 2004 2 2.4 2 2.4 5 6.2 5 6.3 3 3.8 3 3.9 6 7.8 12 15.6 96 Andorra East Armeniac 1988 182 6.3 228 7.9 238 8.2 334 11.5 294 10.0 303 10.3 358 12.2 429 14.5 448 15.1 369 12.5 4 154 Armeniac East Azerbaijan 1987 548 6.0 517 5.6 514 5.5 604 6.4 727 7.6 556 5.7 567 5.8 656 6.6 721 7.2 559 5.5 8 688 Azerbaijan East Belarus 1981 1 196 12.7 1 223 13.0 1 533 16.3 1 811 19.2 2 305 24.4 2 391 25.3 2 468 26.1 2 386 25.2 2 137 22.6 1 427 15.1 30 636 Belarus Centre Bosnia and Herzegovinac 1986 27 0.7 25 0.7 2 0.1 23 0.7 15 0.4 24 0.7 15 0.4 24 0.7 30 0.9 338 Bosnia and Herzegovinac East Georgia 1989 424 10.4 526 12.9 490 12.1 564 14.0 717 17.8 719 17.9 631 15.7 672 16.8 668 16.7 530 13.3 8 632 Georgia West Israel 1981 450 6.0 483 6.3 466 6.0 461 5.9 413 5.2 368 4.5 416 5.0 452 5.4 410 4.8 363 4.2 10 862 Israel East Kazakhstan 1987 1 997 12.1 2 004 12.0 2 131 12.5 2 342 13.5 2 475 14.1 2 898 16.3 3 014 16.7 3 215 17.5 3 673 19.8 3 472 18.5 42 911 Kazakhstan East Kyrgyzstan 1987 614 11.1 701 12.5 503 8.8 649 11.1 653 11.0 764 12.6 840 13.6 876 13.9 850 13.2 676 10.4 10 421 Kyrgyzstan East Moldova 1987 721 17.7 757 18.6 706 17.3 831 20.4 818 20.1 832 20.5 835 20.6 905 22.3 922 22.8 675 16.7 14 354 Moldova West Monaco 1987 0 0.0 1 2.7 0 0.0 1 2.7 1 2.7 0 0.0 3 7.8 0 0.0 40 Monaco Centre Montenegro 1989 9 1.4 13 2.1 11 1.8 20 3.2 19 3.0 34 5.4 26 4.1 23 3.7 26 4.1 15 2.4 318 Montenegro Centre North Macedonia 1993 1 0.0 15 0.7 15 0.7 30 1.4 25 1.2 30 1.4 44 2.1 45 2.2 246 North Macedonia East Russia 2009 67 317 46.8 75 708 52.6 81 698 56.6 92 613 64.0 100 220 69.1 86 855 59.8 85 802 59.0 85 995 59.0 80 124 54.9 59 598 40.8 940 856 Russia West San Marino 1985 8 25.3 5 15.6 1 3.1 3 9.1 2 6.0 2 6.0 1 3.0 3 8.9 0 0.0 0 0.0 93 San Marino Centre Serbia 1984 134 1.4 137 1.5 156 1.7 137 1.5 183 2.1 179 2.0 186 2.1 188 2.1 223 2.1 123 1.2 4 323 Serbia Centre Serbia excluding Kosovod 1984 128 1.8 133 1.9 153 2.1 131 1.8 180 2.5 168 2.4 183 2.6 180 2.6 218 2.5 121 1.4 4 195 Serbia excluding Kosovod Centre Kosovod 1999 6 0.3 4 0.2 3 0.2 6 0.3 3 0.2 11 0.6 3 0.2 8 0.4 5 0.3 2 0.1 128 Kosovod West Switzerland 1985 562 7.1 621 7.8 577 7.1 517 6.3 536 6.5 533 6.4 446 5.3 425 5.0 420 4.9 288 3.3 37 111 Switzerland East Tajikistan 1991 880 11.4 770 9.8 817 10.1 986 11.9 1 149 13.6 1 038 12.0 1 205 13.6 1 421 15.6 1 320 14.2 1 084 11.4 13 070 Tajikistan Centre Turkey 1985 699 1.0 1 068 1.4 1 313 1.7 1 838 2.4 2 107 2.7 2 438 3.1 2 844 3.5 3 248 3.9 3 229 3.9 2 076 2.5 24 543 Turkey East Turkmenistan 1990 0 0.0 0 0.0 2 Turkmenistan East Ukraine 1987 17 305 37.9 16 850 37.1 17 844 39.4 15 796 35.0 13 000 30.4 14 237 33.4 15 614 36.8 15 664 37.1 16 271 38.8 15 658 37.5 309 971 Ukraine West United Kingdom 1981 6 152 9.6 6 192 9.6 5 957 9.2 6 316 9.7 6 238 9.5 5 309 8.0 4 756 7.1 4 656 6.9 4 337 6.4 2 785 4.1 167 847 United Kingdom East Uzbekistan 1981 24 018 Uzbekistan Total non-EU/EEA 99 306 23.6 107 927 25.5 115 097 27.1 125 960 29.4 131 996 30.8 119 640 27.7 120 171 27.7 121 397 27.8 115 910 26.5 89 794 20.6 1 654 930 Total non-EU/EEA WHO European Region WHO European Region West 30 140 7.4 31 407 7.6 30 881 7.3 31 116 7.3 30 364 7.1 28 969 6.7 27 329 6.3 24 494 5.8 23 352 5.4 15 782 3.7 692 559 West Centre 3 652 1.9 4 205 2.2 4 687 2.4 5 212 2.7 5 713 2.9 5 993 3.1 6 458 3.3 6 655 3.4 6 963 3.5 4 427 2.3 100 107 Centre East 92 015 36.1 100 098 39.1 107 316 41.8 117 305 45.6 123 178 48.1 111 401 43.4 112 187 43.6 112 895 43.7 107 758 41.7 84 556 32.6 1 429 583 East Total WHO European Region 125 807 14.8 135 710 15.8 142 884 16.4 153 633 17.5 159 255 18.1 146 363 16.6 145 974 16.5 144 044 16.4 138 073 15.6 104 765 11.8 2 222 249 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c The numbers displayed here may not fully align with the numbers in the country’s national statistics as these are presented by the ‘date of notification’ instead of the ‘date of diagnosis’ as here. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 38 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 2: New HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2011 2 012 2 013 2 014 2 015 2 016 2 017 2 018 2 019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 290 7.1 298 7.3 264 6.4 240 5.8 288 6.9 248 5.8 257 6.0 175 4.0 197 4.5 125 2.9 7 992 Austria West Belgium 784 14.5 838 15.4 792 14.5 737 13.4 704 12.7 649 11.7 604 10.8 607 10.8 623 11.0 510 9.0 21 232 Belgium Centre Bulgaria 163 4.5 123 3.4 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 276 8.1 217 6.4 168 5.0 2 837 Bulgaria Centre Croatia 63 3.0 70 3.4 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 88 4.4 97 4.9 67 3.4 1 608 Croatia Centre Cyprus 39 9.5 49 11.7 46 10.9 49 11.7 72 17.5 65 15.8 65 15.6 65 15.4 69 16.1 86 19.8 1 067 Cyprus Centre Czech Republic 139 2.7 185 3.6 211 4.1 209 4.0 248 4.8 262 5.1 230 4.4 186 3.6 192 3.7 203 3.9 3 294 Czech Republic West Denmark 192 7.0 146 5.3 178 6.4 196 7.0 205 7.3 191 6.7 192 6.7 170 5.9 146 5.1 133 4.6 6 009 Denmark East Estonia 226 36.5 209 33.8 200 32.5 182 29.6 167 27.2 139 22.5 146 23.6 131 21.1 113 18.1 86 13.7 6 828 Estonia West Finland 112 4.2 111 4.2 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 104 3.8 112 4.1 100 3.7 3 143 Finland West France 3 599 11.4 3 828 12.1 3 736 11.8 3 824 11.9 3 555 11.0 3 581 11.1 3 506 10.8 3 263 10.1 3 248 10.0 2 316 7.1 62 860 France West Germany 2 332 6.0 2 558 6.5 2 658 6.7 2 864 7.2 2 890 7.3 2 660 6.6 2 512 6.2 2 233 5.5 2 434 5.9 1 894 4.6 58 320 Germany West Greece 825 15.1 984 18.1 812 15.1 682 12.8 691 13.1 540 10.3 536 10.3 585 11.2 518 9.9 482 9.2 13 985 Greece Centre Hungary 123 2.6 186 3.9 192 4.1 216 4.6 196 4.2 171 3.6 148 3.2 195 4.2 208 4.4 166 3.5 3 291 Hungary West Iceland 12 7.5 13 8.1 8 5.0 9 5.5 10 6.1 22 13.2 21 12.3 24 13.5 23 12.6 28 15.0 356 Iceland West Ireland 239 10.5 252 11.1 258 11.3 274 11.9 372 16.1 396 16.9 375 15.8 399 16.7 412 17.0 338 13.8 6 243 Ireland West Italy 2 931 10.2 3 277 11.4 3 000 10.4 3 046 10.3 2 789 9.5 2 839 9.6 2 730 9.3 2 357 8.0 1 971 6.8 1 041 3.6 39 038 Italy East Latvia 196 20.7 218 23.3 203 21.9 233 25.4 264 29.0 230 25.4 241 26.9 221 24.8 180 20.3 162 18.4 5 545 Latvia Liechtenstein 1 5.6 0 0.0 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 0 0.0 0 0.0 0 0.0 41 Liechtenstein East Lithuania 134 9.5 114 8.2 125 9.1 90 6.6 115 8.5 165 12.4 220 16.8 118 9.1 110 8.5 78 6.0 2 708 Lithuania West Luxembourg 47 18.5 52 19.9 62 23.1 59 21.4 63 22.3 63 21.8 50 16.9 45 14.9 42 13.6 25 7.9 1 404 Luxembourg West Malta 17 8.2 23 11.1 30 14.3 36 16.8 53 24.0 51 22.5 35 15.1 62 25.8 55 21.8 67 25.2 519 Malta West Netherlands 1 059 12.8 988 11.9 985 11.9 867 10.4 853 10.2 788 9.4 738 8.7 622 7.3 508 5.9 319 3.7 23 143 Netherlands West Norway 190 7.7 166 6.6 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 122 4.6 112 4.2 91 3.4 4 599 Norway Centre Poland 914 5.0 924 5.0 937 5.1 933 5.1 1 084 5.9 1 149 6.3 1 257 6.8 1 049 5.7 1 320 7.2 596 3.2 20 958 Poland West Portugal 1 271 25.2 1 277 25.4 1 267 25.4 1 053 21.2 1 116 22.7 1 100 22.4 985 20.2 827 17.0 631 13.0 44 573 Portugal Centre Romania 582 5.9 686 7.0 726 7.4 642 6.6 652 6.7 579 6.0 603 6.3 564 5.9 560 5.9 342 3.6 15 640 Romania Centre Slovakia 46 1.8 44 1.7 71 2.7 75 2.8 76 2.9 81 3.1 66 2.5 94 3.5 93 3.5 89 3.3 1 035 Slovakia Centre Slovenia 49 4.8 46 4.5 41 4.0 48 4.7 45 4.4 59 5.8 38 3.7 36 3.5 28 2.7 22 2.1 843 Slovenia West Spain 3 035 18.8 3 334 18.0 3 743 16.3 3 782 16.6 3 609 15.8 3 540 15.5 3 228 14.1 2 147 11.2 2 126 9.8 1 585 7.3 46 782 Spain West Sweden 291 6.2 265 5.6 293 6.1 273 5.7 276 5.7 269 5.5 273 5.4 306 6.0 288 5.6 226 4.3 9 258 Sweden Total EU/EEA 19 901 9.5 21 264 10.0 21 336 9.8 21 241 9.7 20 974 9.6 20 390 9.3 19 631 8.9 17 071 7.9 16 633 7.6 11 345 5.2 415 151 Total EU/EEA Non-EU/EEA Centre Albania 55 3.7 58 3.9 82 5.6 61 4.1 67 4.6 104 7.1 69 4.7 76 5.2 74 5.0 70 4.8 1 018 Albania West Andorra 2 4.8 2 4.9 4 10.1 5 12.8 3 7.8 3 7.9 3 7.9 8 21.1 78 Andorra East Armenia 115 8.5 158 11.7 161 11.8 217 15.9 205 14.9 212 15.4 254 18.3 293 21.1 313 22.5 251 18.0 2 877 Armenia East Azerbaijan 410 9.0 356 7.7 329 7.1 375 7.9 495 10.3 355 7.3 359 7.3 437 8.8 473 9.4 386 7.6 6 232 Azerbaijan East Belarus 621 14.2 659 15.1 802 18.3 1 052 24.0 1 395 31.8 1 490 33.9 1 540 35.0 1 499 34.1 1 354 30.8 899 20.4 18 570 Belarus Centre Bosnia and Herzegovina 23 1.3 23 1.3 2 0.1 20 1.2 14 0.8 22 1.3 15 0.9 22 1.4 27 1.7 289 Bosnia and Herzegovina East Georgia 300 15.4 381 19.7 367 19.0 413 21.4 545 28.4 553 28.8 492 25.7 506 26.5 508 26.7 404 21.2 6 452 Georgia West Israel 298 8.1 353 9.4 348 9.1 329 8.5 292 7.4 257 6.4 298 7.3 296 7.1 270 6.4 254 5.9 7 207 Israel East Kazakhstan 1 206 15.1 1 168 14.4 1 203 14.6 1 334 15.9 1 442 16.9 1 684 19.5 1 821 20.8 2 005 22.6 2 416 26.8 2 297 25.2 27 778 Kazakhstan East Kyrgyzstan 422 15.5 406 14.6 292 10.3 369 12.8 364 12.3 446 14.8 491 16.0 0 0.0 496 15.6 384 11.9 6 050 Kyrgyzstan East Moldova 377 19.2 375 19.1 382 19.5 452 23.1 462 23.6 471 24.1 468 24.0 537 27.6 544 28.1 394 20.4 8 311 Moldova West Monaco 0 0.0 0 0.0 0 0.0 1 5.5 1 5.5 0 0.0 3 16.1 0 0.0 26 Monaco Centre Montenegro 8 2.6 12 3.9 11 3.6 17 5.5 17 5.5 32 10.3 24 7.7 21 6.8 24 7.7 14 4.5 279 Montenegro Centre North Macedonia 0 0.0 10 1.0 15 1.4 29 2.8 24 2.3 28 2.7 44 4.2 45 4.3 221 North Macedonia East Russia 39 410 59.2 44 066 66.0 48 025 71.8 55 469 82.8 62 118 92.5 53 689 79.8 53 209 78.9 52 720 78.1 49 177 72.7 36 659 54.2 566 253 Russia West San Marino 6 39.1 2 12.9 0 0.0 3 18.8 2 12.4 2 12.3 1 6.1 2 12.2 0 0.0 0 0.0 73 San Marino Centre Serbia 116 2.6 124 2.8 142 3.3 120 2.8 177 4.1 164 3.8 175 4.1 174 4.0 204 3.9 115 2.2 3 548 Serbia Centre Serbia excluding Kosovoc 111 3.2 121 3.5 140 4.0 114 3.3 175 5.1 153 4.4 172 5.0 167 4.9 200 4.7 114 2.7 3 453 Serbia excluding Kosovoc Centre Kosovoc 5 0.6 3 0.3 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 7 0.8 4 0.5 1 0.1 95 Kosovoc West Switzerland 424 10.9 462 11.7 422 10.5 385 9.5 408 9.9 413 10.0 343 8.2 332 7.9 326 7.7 224 5.2 23 812 Switzerland East Tajikistan 608 15.7 495 12.5 490 12.0 557 13.4 680 15.9 621 14.2 735 16.4 876 19.1 771 16.4 646 13.4 8 340 Tajikistan Centre Turkey 531 1.5 819 2.2 1 072 2.9 1 497 3.9 1 770 4.6 2 065 5.3 2 389 6.0 2 717 6.7 2 748 6.7 1 763 4.2 19 861 Turkey East Turkmenistan 0 0.0 0 0.0 1 Turkmenistan East Ukraine 9 472 45.0 9 400 44.8 10 011 47.8 8 991 43.1 7 519 32.7 8 371 42.5 9 304 47.4 9 525 48.7 9 925 51.0 9 924 44.3 185 123 Ukraine West United Kingdom 4 401 14.0 4 489 14.1 4 490 14.0 4 726 14.7 4 745 14.6 4 041 12.4 3 526 10.7 3 448 10.4 3 168 9.5 1 976 5.9 118 514 United Kingdom East Uzbekistan 16 234 Uzbekistan Total non-EU/EEA 58 805 29.5 63 818 31.6 68 650 33.8 76 422 37.3 82 745 39.7 75 023 36.3 75 563 36.3 75 539 36.6 72 818 34.6 56 660 26.7 1 027 147 Total non-EU/EEA WHO European Region West 22 357 11.3 23 718 11.8 23 610 11.4 23 728 11.4 23 201 11.1 21 931 10.4 20 472 9.7 18 134 8.7 17 210 8.1 11 734 5.5 499 166 West Centre 2 851 3.1 3 359 3.6 3 786 4.0 4 200 4.4 4 747 5.0 5 054 5.3 5 442 5.7 5 608 5.8 5 861 6.0 3 701 3.9 75 789 Centre East 53 497 44.8 58 005 48.4 62 590 52.1 69 734 57.8 75 771 61.5 68 426 56.8 69 280 57.4 68 868 58.4 66 380 54.7 52 570 42.2 867 302 East Total WHO European Region 78 705 19.2 85 082 20.5 89 986 21.4 97 662 23.1 103 719 24.3 95 411 22.4 95 194 22.2 92 610 21.9 89 451 20.8 68 005 15.7 1 442 257 Total WHO European Region a Country-specific comments are in Annex 5 b Cumulative total is the total number of cases reported by the country since the start of reporting c Without prejudice to positions on status, and in line with UNSCR 1 244 and the ICJ Opinion on the Kosovo Declaration of Independence 39 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 2: New HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2011 2 012 2 013 2 014 2 015 2 016 2 017 2 018 2 019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 290 7.1 298 7.3 264 6.4 240 5.8 288 6.9 248 5.8 257 6.0 175 4.0 197 4.5 125 2.9 7 992 Austria West Belgium 784 14.5 838 15.4 792 14.5 737 13.4 704 12.7 649 11.7 604 10.8 607 10.8 623 11.0 510 9.0 21 232 Belgium Centre Bulgaria 163 4.5 123 3.4 161 4.5 201 5.7 194 5.5 169 4.9 218 6.3 276 8.1 217 6.4 168 5.0 2 837 Bulgaria Centre Croatia 63 3.0 70 3.4 77 3.7 83 4.0 111 5.4 104 5.1 101 5.0 88 4.4 97 4.9 67 3.4 1 608 Croatia Centre Cyprus 39 9.5 49 11.7 46 10.9 49 11.7 72 17.5 65 15.8 65 15.6 65 15.4 69 16.1 86 19.8 1 067 Cyprus Centre Czech Republic 139 2.7 185 3.6 211 4.1 209 4.0 248 4.8 262 5.1 230 4.4 186 3.6 192 3.7 203 3.9 3 294 Czech Republic West Denmark 192 7.0 146 5.3 178 6.4 196 7.0 205 7.3 191 6.7 192 6.7 170 5.9 146 5.1 133 4.6 6 009 Denmark East Estonia 226 36.5 209 33.8 200 32.5 182 29.6 167 27.2 139 22.5 146 23.6 131 21.1 113 18.1 86 13.7 6 828 Estonia West Finland 112 4.2 111 4.2 102 3.8 138 5.1 131 4.9 121 4.5 101 3.7 104 3.8 112 4.1 100 3.7 3 143 Finland West France 3 599 11.4 3 828 12.1 3 736 11.8 3 824 11.9 3 555 11.0 3 581 11.1 3 506 10.8 3 263 10.1 3 248 10.0 2 316 7.1 62 860 France West Germany 2 332 6.0 2 558 6.5 2 658 6.7 2 864 7.2 2 890 7.3 2 660 6.6 2 512 6.2 2 233 5.5 2 434 5.9 1 894 4.6 58 320 Germany West Greece 825 15.1 984 18.1 812 15.1 682 12.8 691 13.1 540 10.3 536 10.3 585 11.2 518 9.9 482 9.2 13 985 Greece Centre Hungary 123 2.6 186 3.9 192 4.1 216 4.6 196 4.2 171 3.6 148 3.2 195 4.2 208 4.4 166 3.5 3 291 Hungary West Iceland 12 7.5 13 8.1 8 5.0 9 5.5 10 6.1 22 13.2 21 12.3 24 13.5 23 12.6 28 15.0 356 Iceland West Ireland 239 10.5 252 11.1 258 11.3 274 11.9 372 16.1 396 16.9 375 15.8 399 16.7 412 17.0 338 13.8 6 243 Ireland West Italy 2 931 10.2 3 277 11.4 3 000 10.4 3 046 10.3 2 789 9.5 2 839 9.6 2 730 9.3 2 357 8.0 1 971 6.8 1 041 3.6 39 038 Italy East Latvia 196 20.7 218 23.3 203 21.9 233 25.4 264 29.0 230 25.4 241 26.9 221 24.8 180 20.3 162 18.4 5 545 Latvia Liechtenstein 1 5.6 0 0.0 0 0.0 1 5.4 0 0.0 2 10.7 0 0.0 0 0.0 0 0.0 0 0.0 41 Liechtenstein East Lithuania 134 9.5 114 8.2 125 9.1 90 6.6 115 8.5 165 12.4 220 16.8 118 9.1 110 8.5 78 6.0 2 708 Lithuania West Luxembourg 47 18.5 52 19.9 62 23.1 59 21.4 63 22.3 63 21.8 50 16.9 45 14.9 42 13.6 25 7.9 1 404 Luxembourg West Malta 17 8.2 23 11.1 30 14.3 36 16.8 53 24.0 51 22.5 35 15.1 62 25.8 55 21.8 67 25.2 519 Malta West Netherlands 1 059 12.8 988 11.9 985 11.9 867 10.4 853 10.2 788 9.4 738 8.7 622 7.3 508 5.9 319 3.7 23 143 Netherlands West Norway 190 7.7 166 6.6 158 6.2 199 7.8 145 5.6 157 6.0 155 5.9 122 4.6 112 4.2 91 3.4 4 599 Norway Centre Poland 914 5.0 924 5.0 937 5.1 933 5.1 1 084 5.9 1 149 6.3 1 257 6.8 1 049 5.7 1 320 7.2 596 3.2 20 958 Poland West Portugal 1 271 25.2 1 277 25.4 1 267 25.4 1 053 21.2 1 116 22.7 1 100 22.4 985 20.2 827 17.0 631 13.0 44 573 Portugal Centre Romania 582 5.9 686 7.0 726 7.4 642 6.6 652 6.7 579 6.0 603 6.3 564 5.9 560 5.9 342 3.6 15 640 Romania Centre Slovakia 46 1.8 44 1.7 71 2.7 75 2.8 76 2.9 81 3.1 66 2.5 94 3.5 93 3.5 89 3.3 1 035 Slovakia Centre Slovenia 49 4.8 46 4.5 41 4.0 48 4.7 45 4.4 59 5.8 38 3.7 36 3.5 28 2.7 22 2.1 843 Slovenia West Spain 3 035 18.8 3 334 18.0 3 743 16.3 3 782 16.6 3 609 15.8 3 540 15.5 3 228 14.1 2 147 11.2 2 126 9.8 1 585 7.3 46 782 Spain West Sweden 291 6.2 265 5.6 293 6.1 273 5.7 276 5.7 269 5.5 273 5.4 306 6.0 288 5.6 226 4.3 9 258 Sweden Total EU/EEA 19 901 9.5 21 264 10.0 21 336 9.8 21 241 9.7 20 974 9.6 20 390 9.3 19 631 8.9 17 071 7.9 16 633 7.6 11 345 5.2 415 151 Total EU/EEA Non-EU/EEA Centre Albania 55 3.7 58 3.9 82 5.6 61 4.1 67 4.6 104 7.1 69 4.7 76 5.2 74 5.0 70 4.8 1 018 Albania West Andorra 2 4.8 2 4.9 4 10.1 5 12.8 3 7.8 3 7.9 3 7.9 8 21.1 78 Andorra East Armenia 115 8.5 158 11.7 161 11.8 217 15.9 205 14.9 212 15.4 254 18.3 293 21.1 313 22.5 251 18.0 2 877 Armenia East Azerbaijan 410 9.0 356 7.7 329 7.1 375 7.9 495 10.3 355 7.3 359 7.3 437 8.8 473 9.4 386 7.6 6 232 Azerbaijan East Belarus 621 14.2 659 15.1 802 18.3 1 052 24.0 1 395 31.8 1 490 33.9 1 540 35.0 1 499 34.1 1 354 30.8 899 20.4 18 570 Belarus Centre Bosnia and Herzegovina 23 1.3 23 1.3 2 0.1 20 1.2 14 0.8 22 1.3 15 0.9 22 1.4 27 1.7 289 Bosnia and Herzegovina East Georgia 300 15.4 381 19.7 367 19.0 413 21.4 545 28.4 553 28.8 492 25.7 506 26.5 508 26.7 404 21.2 6 452 Georgia West Israel 298 8.1 353 9.4 348 9.1 329 8.5 292 7.4 257 6.4 298 7.3 296 7.1 270 6.4 254 5.9 7 207 Israel East Kazakhstan 1 206 15.1 1 168 14.4 1 203 14.6 1 334 15.9 1 442 16.9 1 684 19.5 1 821 20.8 2 005 22.6 2 416 26.8 2 297 25.2 27 778 Kazakhstan East Kyrgyzstan 422 15.5 406 14.6 292 10.3 369 12.8 364 12.3 446 14.8 491 16.0 0 0.0 496 15.6 384 11.9 6 050 Kyrgyzstan East Moldova 377 19.2 375 19.1 382 19.5 452 23.1 462 23.6 471 24.1 468 24.0 537 27.6 544 28.1 394 20.4 8 311 Moldova West Monaco 0 0.0 0 0.0 0 0.0 1 5.5 1 5.5 0 0.0 3 16.1 0 0.0 26 Monaco Centre Montenegro 8 2.6 12 3.9 11 3.6 17 5.5 17 5.5 32 10.3 24 7.7 21 6.8 24 7.7 14 4.5 279 Montenegro Centre North Macedonia 0 0.0 10 1.0 15 1.4 29 2.8 24 2.3 28 2.7 44 4.2 45 4.3 221 North Macedonia East Russia 39 410 59.2 44 066 66.0 48 025 71.8 55 469 82.8 62 118 92.5 53 689 79.8 53 209 78.9 52 720 78.1 49 177 72.7 36 659 54.2 566 253 Russia West San Marino 6 39.1 2 12.9 0 0.0 3 18.8 2 12.4 2 12.3 1 6.1 2 12.2 0 0.0 0 0.0 73 San Marino Centre Serbia 116 2.6 124 2.8 142 3.3 120 2.8 177 4.1 164 3.8 175 4.1 174 4.0 204 3.9 115 2.2 3 548 Serbia Centre Serbia excluding Kosovoc 111 3.2 121 3.5 140 4.0 114 3.3 175 5.1 153 4.4 172 5.0 167 4.9 200 4.7 114 2.7 3 453 Serbia excluding Kosovoc Centre Kosovoc 5 0.6 3 0.3 2 0.2 6 0.7 2 0.2 11 1.2 3 0.3 7 0.8 4 0.5 1 0.1 95 Kosovoc West Switzerland 424 10.9 462 11.7 422 10.5 385 9.5 408 9.9 413 10.0 343 8.2 332 7.9 326 7.7 224 5.2 23 812 Switzerland East Tajikistan 608 15.7 495 12.5 490 12.0 557 13.4 680 15.9 621 14.2 735 16.4 876 19.1 771 16.4 646 13.4 8 340 Tajikistan Centre Turkey 531 1.5 819 2.2 1 072 2.9 1 497 3.9 1 770 4.6 2 065 5.3 2 389 6.0 2 717 6.7 2 748 6.7 1 763 4.2 19 861 Turkey East Turkmenistan 0 0.0 0 0.0 1 Turkmenistan East Ukraine 9 472 45.0 9 400 44.8 10 011 47.8 8 991 43.1 7 519 32.7 8 371 42.5 9 304 47.4 9 525 48.7 9 925 51.0 9 924 44.3 185 123 Ukraine West United Kingdom 4 401 14.0 4 489 14.1 4 490 14.0 4 726 14.7 4 745 14.6 4 041 12.4 3 526 10.7 3 448 10.4 3 168 9.5 1 976 5.9 118 514 United Kingdom East Uzbekistan 16 234 Uzbekistan Total non-EU/EEA 58 805 29.5 63 818 31.6 68 650 33.8 76 422 37.3 82 745 39.7 75 023 36.3 75 563 36.3 75 539 36.6 72 818 34.6 56 660 26.7 1 027 147 Total non-EU/EEA WHO European Region West 22 357 11.3 23 718 11.8 23 610 11.4 23 728 11.4 23 201 11.1 21 931 10.4 20 472 9.7 18 134 8.7 17 210 8.1 11 734 5.5 499 166 West Centre 2 851 3.1 3 359 3.6 3 786 4.0 4 200 4.4 4 747 5.0 5 054 5.3 5 442 5.7 5 608 5.8 5 861 6.0 3 701 3.9 75 789 Centre East 53 497 44.8 58 005 48.4 62 590 52.1 69 734 57.8 75 771 61.5 68 426 56.8 69 280 57.4 68 868 58.4 66 380 54.7 52 570 42.2 867 302 East Total WHO European Region 78 705 19.2 85 082 20.5 89 986 21.4 97 662 23.1 103 719 24.3 95 411 22.4 95 194 22.2 92 610 21.9 89 451 20.8 68 005 15.7 1 442 257 Total WHO European Region a Country-specific comments are in Annex 5 b Cumulative total is the total number of cases reported by the country since the start of reporting c Without prejudice to positions on status, and in line with UNSCR 1 244 and the ICJ Opinion on the Kosovo Declaration of Independence 40 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 3: New HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2011 2 012 2 013 2 014 2 015 2 016 2 017 2 018 2 019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 74 1.7 73 1.7 46 1.1 62 1.4 41 0.9 49 1.1 46 1.0 30 0.7 36 0.8 30 0.7 2 400 Austria West Belgium 389 6.9 390 6.9 341 6.0 317 5.6 315 5.5 259 4.5 289 5.0 271 4.7 297 5.1 213 3.6 11 654 Belgium Centre Bulgaria 38 1.0 34 0.9 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 35 1.0 41 1.1 31 0.9 678 Bulgaria Centre Croatia 11 0.5 3 0.1 8 0.4 9 0.4 6 0.3 5 0.2 5 0.2 6 0.3 5 0.2 9 0.4 202 Croatia Centre Cyprus 15 3.5 9 2.0 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 13 2.9 31 6.9 19 4.2 364 Cyprus Centre Czech Republic 14 0.3 27 0.5 24 0.4 23 0.4 18 0.3 24 0.4 24 0.4 22 0.4 30 0.6 48 0.9 547 Czech Republic West Denmark 74 2.6 54 1.9 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 49 1.7 44 1.5 28 1.0 2 151 Denmark East Estonia 140 19.7 106 15.0 125 17.8 109 15.6 103 14.7 90 12.9 73 10.5 59 8.5 65 9.3 57 8.1 3 382 Estonia West Finland 60 2.2 45 1.6 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 49 1.8 37 1.3 36 1.3 1 206 Finland West France 1 829 5.5 1 833 5.4 1 821 5.4 1 842 5.4 1 720 5.0 1 810 5.3 1 803 5.2 1 759 5.1 1 766 5.1 1 058 3.0 33 968 France West Germany 434 1.1 472 1.1 578 1.4 662 1.6 753 1.8 719 1.7 650 1.6 631 1.5 673 1.6 558 1.3 14 596 Germany West Greece 141 2.5 178 3.1 89 1.6 101 1.8 90 1.6 112 2.0 109 2.0 138 2.5 143 2.6 119 2.2 2 770 Greece Centre Hungary 12 0.2 14 0.3 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 8 0.2 16 0.3 15 0.3 401 Hungary West Iceland 11 6.9 6 3.8 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 14 8.2 5 2.9 6 3.4 129 Iceland West Ireland 89 3.9 98 4.2 85 3.7 104 4.4 110 4.7 115 4.8 121 5.0 104 4.3 137 5.5 89 3.6 2 888 Ireland West Italy 970 3.2 886 2.9 846 2.7 790 2.5 811 2.6 854 2.7 857 2.8 655 2.1 502 1.6 262 0.9 12 126 Italy East Latvia 103 9.1 121 10.9 137 12.5 110 10.1 129 12.0 135 12.7 130 12.3 105 10.1 115 11.1 95 9.3 2 672 Latvia Liechtenstein 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 Liechtenstein East Lithuania 32 1.9 46 2.8 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 42 2.8 41 2.7 30 2.0 723 Lithuania West Luxembourg 16 6.2 18 6.8 14 5.2 32 11.7 16 5.7 19 6.6 20 6.8 16 5.3 12 3.9 5 1.6 490 Luxembourg West Malta 4 1.9 7 3.3 6 2.8 4 1.9 8 3.6 11 4.9 10 4.4 11 4.7 15 6.2 15 6.0 137 Malta West Netherlands 183 2.2 186 2.2 162 1.9 147 1.7 151 1.8 134 1.6 124 1.4 102 1.2 105 1.2 66 0.8 5 529 Netherlands West Norway 79 3.2 76 3.1 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 69 2.6 60 2.3 46 1.7 2 192 Norway Centre Poland 159 0.8 159 0.8 150 0.8 188 1.0 175 0.9 142 0.7 160 0.8 151 0.8 224 1.1 107 0.5 4 783 Poland West Portugal 558 10.1 544 9.9 520 9.5 415 7.6 395 7.2 424 7.8 380 7.0 333 6.1 271 5.0 17 241 Portugal Centre Romania 260 2.5 258 2.5 300 2.9 272 2.7 239 2.4 210 2.1 205 2.0 192 1.9 185 1.9 105 1.1 9 950 Romania Centre Slovakia 3 0.1 6 0.2 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 8 0.3 11 0.4 11 0.4 142 Slovakia Centre Slovenia 7 0.7 3 0.3 6 0.6 4 0.4 7 0.7 2 0.2 2 0.2 1 0.1 6 0.6 5 0.5 111 Slovenia West Spain 641 3.8 610 3.2 631 2.7 647 2.7 580 2.5 635 2.7 567 2.4 380 1.9 357 1.6 299 1.3 9 775 Spain West Sweden 169 3.6 175 3.7 163 3.4 198 4.1 171 3.5 160 3.3 161 3.2 175 3.5 161 3.2 134 2.6 4 592 Sweden Total EU/EEA 6 515 2.9 6 437 2.9 6 368 2.8 6 344 2.8 6 150 2.7 6 215 2.7 6 014 2.6 5 428 2.4 5 391 2.3 3 496 1.5 147 822 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 23 1.6 23 1.6 38 2.7 18 1.3 29 2.0 23 1.6 25 1.8 26 1.8 27 1.9 26 1.8 382 Albania West Andorra 0 0.0 0 0.0 1 2.4 0 0.0 0 0.0 0 0.0 3 7.7 4 10.2 18 Andorra East Armenia 67 4.4 70 4.6 77 5.0 117 7.6 89 5.7 91 5.9 104 6.7 136 8.7 135 8.6 118 7.5 1 277 Armenia East Azerbaijan 138 3.0 161 3.5 185 3.9 229 4.8 232 4.8 201 4.1 208 4.2 219 4.4 248 4.9 173 3.4 2 456 Azerbaijan East Belarus 575 11.4 564 11.2 731 14.5 759 15.0 910 18.0 901 17.8 928 18.4 887 17.6 783 15.5 528 10.5 12 066 Belarus Centre Bosnia and Herzegovina 4 0.2 2 0.1 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 2 0.1 3 0.2 46 Bosnia and Herzegovina East Georgia 124 5.8 145 6.8 123 5.8 151 7.2 172 8.2 166 7.9 139 6.6 166 7.9 160 7.7 126 6.0 2 180 Georgia West Israel 152 4.0 130 3.4 116 3.0 130 3.3 121 3.0 109 2.7 117 2.8 154 3.7 140 3.3 109 2.5 3 540 Israel East Kazakhstan 791 9.3 836 9.7 928 10.6 1 008 11.3 1 033 11.4 1 214 13.2 1 193 12.8 1 210 12.8 1 257 13.2 1 175 12.2 15 133 Kazakhstan East Kyrgyzstan 192 6.9 295 10.4 211 7.3 280 9.5 289 9.6 318 10.4 349 11.2 333 10.5 354 10.9 292 8.9 3 759 Kyrgyzstan East Moldova 344 16.2 382 18.1 324 15.3 379 17.9 356 16.8 361 17.1 367 17.4 368 17.5 378 18.0 281 13.4 6 043 Moldova West Monaco 0 0.0 1 5.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Monaco Centre Montenegro 1 0.3 1 0.3 0 0.0 3 0.9 2 0.6 2 0.6 1 0.3 2 0.6 2 0.6 1 0.3 38 Montenegro Centre North Macedonia 0 0.0 4 0.4 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 0 0.0 18 North Macedonia East Russia 27 907 36.2 31 642 41.0 33 673 43.5 37 144 47.8 38 102 49.0 33 166 42.5 32 593 41.7 33 275 42.5 30 947 39.5 22 939 29.3 374 603 Russia West San Marino 2 12.2 3 18.1 1 6.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.8 0 0.0 0 0.0 20 San Marino Centre Serbia 18 0.4 13 0.3 14 0.3 17 0.4 6 0.1 15 0.3 11 0.2 14 0.3 19 0.4 8 0.1 775 Serbia Centre Serbia excluding Kosovoc 17 0.5 12 0.3 13 0.4 17 0.5 5 0.1 15 0.4 11 0.3 13 0.4 18 0.4 7 0.2 742 Serbia excluding Kosovoc Centre Kosovoc 1 0.1 1 0.1 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 1 0.1 33 Kosovoc West Switzerland 132 3.3 150 3.7 151 3.7 124 3.0 122 2.9 113 2.7 100 2.3 88 2.0 87 2.0 59 1.4 10 554 Switzerland East Tajikistan 272 7.1 275 7.1 327 8.2 429 10.5 469 11.2 417 9.7 470 10.7 545 12.1 549 11.9 438 9.3 4 730 Tajikistan Centre Turkey 166 0.4 249 0.7 241 0.6 341 0.9 337 0.8 373 0.9 455 1.1 531 1.3 481 1.1 313 0.7 4 680 Turkey East Turkmenistan 0 0.0 0 0.0 1 Turkmenistan East Ukraine 7 697 31.3 7 301 29.8 7 722 31.7 6 683 27.6 5 481 27.7 5 866 25.6 6 310 27.7 6 139 27.1 6 346 28.2 5 734 29.6 122 940 Ukraine West United Kingdom 1 751 5.4 1 703 5.2 1 467 4.4 1 590 4.8 1 471 4.4 1 249 3.7 1 207 3.6 1 192 3.5 1 162 3.4 807 2.3 49 244 United Kingdom East Uzbekistan 7 783 Uzbekistan Total non-EU/EEA 40 356 18.5 43 950 19.9 46 330 21.2 49 405 22.3 49 223 22.4 44 588 19.9 44 580 20.1 45 292 20.0 43 078 18.9 33 127 14.8 622 300 Total non-EU/EEA WHO European Region WHO European Region West 7 758 3.7 7 638 3.6 7 226 3.3 7 338 3.4 7 068 3.2 6 953 3.2 6 732 3.1 6 225 2.9 6 010 2.7 3 939 1.8 187 234 West Centre 731 0.8 805 0.8 857 0.9 962 1.0 898 0.9 875 0.9 955 1.0 1 011 1.0 1 081 1.1 698 0.7 23 117 Centre East 38 382 28.3 41 944 30.8 44 615 32.7 47 449 34.7 47 407 35.7 42 975 31.5 42 907 31.4 43 484 31.7 41 378 30.1 31 986 23.8 559 748 East Total WHO European Region 46 871 10.7 50 387 11.3 52 698 11.8 55 749 12.4 55 373 12.3 50 803 11.2 50 594 11.2 50 720 11.2 48 469 10.6 36 623 8.1 770 099 Total WHO European Region a Country-specific comments are in Annex 5 b Cumulative total is the total number of cases reported by the country since the start of reporting c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 41 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 3: New HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2011 2 012 2 013 2 014 2 015 2 016 2 017 2 018 2 019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 74 1.7 73 1.7 46 1.1 62 1.4 41 0.9 49 1.1 46 1.0 30 0.7 36 0.8 30 0.7 2 400 Austria West Belgium 389 6.9 390 6.9 341 6.0 317 5.6 315 5.5 259 4.5 289 5.0 271 4.7 297 5.1 213 3.6 11 654 Belgium Centre Bulgaria 38 1.0 34 0.9 39 1.0 46 1.2 33 0.9 33 0.9 23 0.6 35 1.0 41 1.1 31 0.9 678 Bulgaria Centre Croatia 11 0.5 3 0.1 8 0.4 9 0.4 6 0.3 5 0.2 5 0.2 6 0.3 5 0.2 9 0.4 202 Croatia Centre Cyprus 15 3.5 9 2.0 8 1.8 7 1.6 8 1.8 15 3.4 20 4.6 13 2.9 31 6.9 19 4.2 364 Cyprus Centre Czech Republic 14 0.3 27 0.5 24 0.4 23 0.4 18 0.3 24 0.4 24 0.4 22 0.4 30 0.6 48 0.9 547 Czech Republic West Denmark 74 2.6 54 1.9 55 1.9 60 2.1 72 2.5 53 1.8 50 1.7 49 1.7 44 1.5 28 1.0 2 151 Denmark East Estonia 140 19.7 106 15.0 125 17.8 109 15.6 103 14.7 90 12.9 73 10.5 59 8.5 65 9.3 57 8.1 3 382 Estonia West Finland 60 2.2 45 1.6 55 2.0 43 1.6 43 1.5 59 2.1 57 2.0 49 1.8 37 1.3 36 1.3 1 206 Finland West France 1 829 5.5 1 833 5.4 1 821 5.4 1 842 5.4 1 720 5.0 1 810 5.3 1 803 5.2 1 759 5.1 1 766 5.1 1 058 3.0 33 968 France West Germany 434 1.1 472 1.1 578 1.4 662 1.6 753 1.8 719 1.7 650 1.6 631 1.5 673 1.6 558 1.3 14 596 Germany West Greece 141 2.5 178 3.1 89 1.6 101 1.8 90 1.6 112 2.0 109 2.0 138 2.5 143 2.6 119 2.2 2 770 Greece Centre Hungary 12 0.2 14 0.3 17 0.3 20 0.4 26 0.5 21 0.4 18 0.4 8 0.2 16 0.3 15 0.3 401 Hungary West Iceland 11 6.9 6 3.8 3 1.9 2 1.2 2 1.2 6 3.6 3 1.8 14 8.2 5 2.9 6 3.4 129 Iceland West Ireland 89 3.9 98 4.2 85 3.7 104 4.4 110 4.7 115 4.8 121 5.0 104 4.3 137 5.5 89 3.6 2 888 Ireland West Italy 970 3.2 886 2.9 846 2.7 790 2.5 811 2.6 854 2.7 857 2.8 655 2.1 502 1.6 262 0.9 12 126 Italy East Latvia 103 9.1 121 10.9 137 12.5 110 10.1 129 12.0 135 12.7 130 12.3 105 10.1 115 11.1 95 9.3 2 672 Latvia Liechtenstein 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 Liechtenstein East Lithuania 32 1.9 46 2.8 52 3.2 51 3.2 42 2.7 49 3.1 43 2.8 42 2.8 41 2.7 30 2.0 723 Lithuania West Luxembourg 16 6.2 18 6.8 14 5.2 32 11.7 16 5.7 19 6.6 20 6.8 16 5.3 12 3.9 5 1.6 490 Luxembourg West Malta 4 1.9 7 3.3 6 2.8 4 1.9 8 3.6 11 4.9 10 4.4 11 4.7 15 6.2 15 6.0 137 Malta West Netherlands 183 2.2 186 2.2 162 1.9 147 1.7 151 1.8 134 1.6 124 1.4 102 1.2 105 1.2 66 0.8 5 529 Netherlands West Norway 79 3.2 76 3.1 75 3.0 68 2.7 76 3.0 63 2.4 58 2.2 69 2.6 60 2.3 46 1.7 2 192 Norway Centre Poland 159 0.8 159 0.8 150 0.8 188 1.0 175 0.9 142 0.7 160 0.8 151 0.8 224 1.1 107 0.5 4 783 Poland West Portugal 558 10.1 544 9.9 520 9.5 415 7.6 395 7.2 424 7.8 380 7.0 333 6.1 271 5.0 17 241 Portugal Centre Romania 260 2.5 258 2.5 300 2.9 272 2.7 239 2.4 210 2.1 205 2.0 192 1.9 185 1.9 105 1.1 9 950 Romania Centre Slovakia 3 0.1 6 0.2 12 0.4 11 0.4 10 0.4 7 0.3 6 0.2 8 0.3 11 0.4 11 0.4 142 Slovakia Centre Slovenia 7 0.7 3 0.3 6 0.6 4 0.4 7 0.7 2 0.2 2 0.2 1 0.1 6 0.6 5 0.5 111 Slovenia West Spain 641 3.8 610 3.2 631 2.7 647 2.7 580 2.5 635 2.7 567 2.4 380 1.9 357 1.6 299 1.3 9 775 Spain West Sweden 169 3.6 175 3.7 163 3.4 198 4.1 171 3.5 160 3.3 161 3.2 175 3.5 161 3.2 134 2.6 4 592 Sweden Total EU/EEA 6 515 2.9 6 437 2.9 6 368 2.8 6 344 2.8 6 150 2.7 6 215 2.7 6 014 2.6 5 428 2.4 5 391 2.3 3 496 1.5 147 822 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 23 1.6 23 1.6 38 2.7 18 1.3 29 2.0 23 1.6 25 1.8 26 1.8 27 1.9 26 1.8 382 Albania West Andorra 0 0.0 0 0.0 1 2.4 0 0.0 0 0.0 0 0.0 3 7.7 4 10.2 18 Andorra East Armenia 67 4.4 70 4.6 77 5.0 117 7.6 89 5.7 91 5.9 104 6.7 136 8.7 135 8.6 118 7.5 1 277 Armenia East Azerbaijan 138 3.0 161 3.5 185 3.9 229 4.8 232 4.8 201 4.1 208 4.2 219 4.4 248 4.9 173 3.4 2 456 Azerbaijan East Belarus 575 11.4 564 11.2 731 14.5 759 15.0 910 18.0 901 17.8 928 18.4 887 17.6 783 15.5 528 10.5 12 066 Belarus Centre Bosnia and Herzegovina 4 0.2 2 0.1 0 0.0 3 0.2 1 0.1 2 0.1 0 0.0 2 0.1 3 0.2 46 Bosnia and Herzegovina East Georgia 124 5.8 145 6.8 123 5.8 151 7.2 172 8.2 166 7.9 139 6.6 166 7.9 160 7.7 126 6.0 2 180 Georgia West Israel 152 4.0 130 3.4 116 3.0 130 3.3 121 3.0 109 2.7 117 2.8 154 3.7 140 3.3 109 2.5 3 540 Israel East Kazakhstan 791 9.3 836 9.7 928 10.6 1 008 11.3 1 033 11.4 1 214 13.2 1 193 12.8 1 210 12.8 1 257 13.2 1 175 12.2 15 133 Kazakhstan East Kyrgyzstan 192 6.9 295 10.4 211 7.3 280 9.5 289 9.6 318 10.4 349 11.2 333 10.5 354 10.9 292 8.9 3 759 Kyrgyzstan East Moldova 344 16.2 382 18.1 324 15.3 379 17.9 356 16.8 361 17.1 367 17.4 368 17.5 378 18.0 281 13.4 6 043 Moldova West Monaco 0 0.0 1 5.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Monaco Centre Montenegro 1 0.3 1 0.3 0 0.0 3 0.9 2 0.6 2 0.6 1 0.3 2 0.6 2 0.6 1 0.3 38 Montenegro Centre North Macedonia 0 0.0 4 0.4 0 0.0 0 0.0 1 0.1 1 0.1 0 0.0 0 0.0 18 North Macedonia East Russia 27 907 36.2 31 642 41.0 33 673 43.5 37 144 47.8 38 102 49.0 33 166 42.5 32 593 41.7 33 275 42.5 30 947 39.5 22 939 29.3 374 603 Russia West San Marino 2 12.2 3 18.1 1 6.0 0 0.0 0 0.0 0 0.0 0 0.0 1 5.8 0 0.0 0 0.0 20 San Marino Centre Serbia 18 0.4 13 0.3 14 0.3 17 0.4 6 0.1 15 0.3 11 0.2 14 0.3 19 0.4 8 0.1 775 Serbia Centre Serbia excluding Kosovoc 17 0.5 12 0.3 13 0.4 17 0.5 5 0.1 15 0.4 11 0.3 13 0.4 18 0.4 7 0.2 742 Serbia excluding Kosovoc Centre Kosovoc 1 0.1 1 0.1 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 1 0.1 33 Kosovoc West Switzerland 132 3.3 150 3.7 151 3.7 124 3.0 122 2.9 113 2.7 100 2.3 88 2.0 87 2.0 59 1.4 10 554 Switzerland East Tajikistan 272 7.1 275 7.1 327 8.2 429 10.5 469 11.2 417 9.7 470 10.7 545 12.1 549 11.9 438 9.3 4 730 Tajikistan Centre Turkey 166 0.4 249 0.7 241 0.6 341 0.9 337 0.8 373 0.9 455 1.1 531 1.3 481 1.1 313 0.7 4 680 Turkey East Turkmenistan 0 0.0 0 0.0 1 Turkmenistan East Ukraine 7 697 31.3 7 301 29.8 7 722 31.7 6 683 27.6 5 481 27.7 5 866 25.6 6 310 27.7 6 139 27.1 6 346 28.2 5 734 29.6 122 940 Ukraine West United Kingdom 1 751 5.4 1 703 5.2 1 467 4.4 1 590 4.8 1 471 4.4 1 249 3.7 1 207 3.6 1 192 3.5 1 162 3.4 807 2.3 49 244 United Kingdom East Uzbekistan 7 783 Uzbekistan Total non-EU/EEA 40 356 18.5 43 950 19.9 46 330 21.2 49 405 22.3 49 223 22.4 44 588 19.9 44 580 20.1 45 292 20.0 43 078 18.9 33 127 14.8 622 300 Total non-EU/EEA WHO European Region WHO European Region West 7 758 3.7 7 638 3.6 7 226 3.3 7 338 3.4 7 068 3.2 6 953 3.2 6 732 3.1 6 225 2.9 6 010 2.7 3 939 1.8 187 234 West Centre 731 0.8 805 0.8 857 0.9 962 1.0 898 0.9 875 0.9 955 1.0 1 011 1.0 1 081 1.1 698 0.7 23 117 Centre East 38 382 28.3 41 944 30.8 44 615 32.7 47 449 34.7 47 407 35.7 42 975 31.5 42 907 31.4 43 484 31.7 41 378 30.1 31 986 23.8 559 748 East Total WHO European Region 46 871 10.7 50 387 11.3 52 698 11.8 55 749 12.4 55 373 12.3 50 803 11.2 50 594 11.2 50 720 11.2 48 469 10.6 36 623 8.1 770 099 Total WHO European Region a Country-specific comments are in Annex 5 b Cumulative total is the total number of cases reported by the country since the start of reporting c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 42 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 4: New HIV diagnoses in men infected through sex with men, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EU/EEA West Austria 184 187 170 154 169 170 188 116 119 72 4 163 West Belgium 435 447 472 402 414 383 343 341 331 243 9 002 Centre Bulgaria 47 59 72 98 111 96 120 170 122 96 1 137 Centre Croatia 47 65 70 79 99 95 97 82 82 58 1 237 Centre Cyprus 27 31 35 39 51 47 47 43 40 61 649 Centre Czech Republic 113 156 180 171 210 212 182 137 151 144 2 580 West Denmark 113 82 116 132 126 121 123 110 99 80 3 452 East Estonia 2 1 9 3 18 9 16 11 16 7 186 West Finland 36 47 43 55 53 48 32 38 38 35 1 318 West France 1 447 1 636 1 616 1 683 1 499 1 382 1 471 1 529 1 507 1 085 25 844 West Germany 1 556 1 780 1 782 1 959 1 891 1 732 1 626 1 423 1 451 1 003 35 456 West Greece 365 359 399 411 454 318 307 297 276 256 8 651 Centre Hungary 107 150 163 177 134 118 110 146 167 127 2 471 West Iceland 0 1 0 0 0 8 4 15 15 19 166 West Ireland 145 174 156 182 251 277 264 287 161 100 3 442 West Italy 1 285 1 591 1 518 1 559 1 457 1 406 1 380 1 177 1 096 596 18 102 East Latvia 20 18 27 28 33 24 24 19 18 11 442 Liechtenstein 0 0 0 1 0 0 0 0 0 0 3 East Lithuaniac 12 12 31 12 29 29 21 19 20 0 296 West Luxembourg 34 36 38 32 25 29 21 27 23 10 734 West Maltac 4 8 16 25 45 38 23 38 0 0 222 West Netherlands 822 769 801 682 663 614 566 475 368 247 16 982 West Norway 97 76 98 115 70 87 88 73 61 63 2 278 Centre Poland 318 356 280 337 358 414 394 313 348 141 4 404 West Portugal 541 570 567 488 604 585 517 416 344 11 809 Centre Romania 110 96 102 143 136 149 169 166 188 133 1 773 Centre Slovakia 32 28 58 53 55 60 52 60 51 50 725 Centre Slovenia 36 37 28 35 36 49 26 29 20 14 619 West Spain 1 885 2 056 2 271 2 488 2 340 2 341 2 132 1 431 1 403 1 048 28 307 West Sweden 106 137 147 119 118 136 128 158 152 116 4 514 Total EU/EEA 9 926 10 965 11 265 11 662 11 449 10 977 10 471 9 146 8 667 5 815 190 964 Non-EU/EEA Centre Albania 15 9 11 9 13 11 6 8 9 8 146 West Andorra 1 1 3 4 2 3 2 4 38 East Armenia 4 5 13 10 12 17 17 41 49 34 220 East Azerbaijan 5 13 11 12 35 18 41 45 50 56 310 East Belarus 29 31 41 53 58 71 72 103 82 79 680 Centre Bosnia and Herzegovina 12 21 2 16 10 18 12 14 21 152 East Georgia 25 44 69 67 163 131 131 153 96 102 1 063 West Israel 159 157 172 151 141 129 150 132 120 122 2 838 East Kazakhstan 26 20 37 47 80 121 144 163 206 221 1 158 East Kyrgyzstan 0 3 14 17 20 35 45 46 37 41 260 East Moldova 5 4 4 9 10 18 29 32 29 18 190 West Monaco 0 0 0 1 1 0 2 0 18 Centre Montenegro 5 8 6 13 14 25 22 16 15 11 185 Centre North Macedonia 1 7 13 26 21 18 34 37 173 East Russia 0 0 0 0 0 0 0 0 0 1 499 1 499 West San Marino 4 0 0 0 0 0 0 0 0 0 21 Centre Serbia 69 88 100 85 133 114 122 138 178 98 1 782 Centre Serbia excluding Kosovod 68 86 99 80 131 111 122 136 175 97 1 756 Centre Kosovod 1 2 1 5 2 3 2 3 1 26 West Switzerland 211 228 198 220 207 233 170 160 152 95 5 709 East Tajikistan 1 1 0 3 3 10 13 22 11 13 77 Centre Turkey 59 142 187 281 350 403 494 540 539 297 3 510 East Turkmenistan 0 0 0 East Ukraine 143 152 262 277 368 435 490 506 467 393 3 900 West United Kingdom 2 854 3 046 3 034 3 213 3 196 2 578 2 233 2 130 1 854 995 75 827 East Uzbekistan 29 Total non-EU/EEA 3 628 3 980 4 177 4 514 4 837 4 388 4 229 4 290 3 915 4 082 99 785 WHO European Region West 12 284 13 388 13 617 14 075 13 726 12 618 11 770 10 377 9 570 6 185 258 893 Centre 998 1 253 1 307 1 562 1 731 1 829 1 887 1 899 1 931 1 238 21 543 East 272 304 518 538 829 918 1 043 1 160 1 081 2 474 10 310 Total WHO European Region 13 554 14 945 15 442 16 175 16 286 15 365 14 700 13 436 12 582 9 897 290 746 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting c Data on route of transmission were not reported by Lithuania or Malta for 2020 d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 43 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 5: New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2011– 2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EU/EEA West Austria 56 55 30 29 32 18 17 13 19 8 2 105 West Belgium 20 16 20 15 16 5 9 13 15 6 814 Centre Bulgaria 63 40 33 48 29 22 33 34 37 14 645 Centre Croatia 4 0 0 0 2 0 0 0 1 3 71 Centre Cyprus 0 0 0 3 1 2 0 1 3 3 22 Centre Czech Republic 9 6 6 10 6 7 5 8 7 14 156 West Denmark 10 11 13 11 8 9 6 6 4 1 564 East Estonia 110 86 81 67 55 31 15 24 20 10 4 225 West Finland 8 7 3 7 7 6 10 6 8 4 422 West France 123 132 113 105 79 64 68 74 83 50 2 237 West Germany 85 89 109 131 144 136 118 149 161 167 4 548 West Greece 319 524 270 120 95 101 92 120 88 81 2 129 Centre Hungary 0 0 1 1 2 3 1 1 1 1 33 West Iceland 12 3 1 1 0 9 3 2 2 0 69 West Ireland 18 16 22 30 47 21 18 13 14 7 1 688 West Italy 181 214 181 143 120 109 101 112 100 44 2 778 East Latvia 90 94 77 73 88 62 78 73 44 41 3 502 Liechtenstein 1 0 0 0 0 0 0 0 0 0 5 East Lithuaniac 95 68 65 38 46 86 140 55 48 0 1 905 West Luxembourg 1 5 6 17 15 19 10 6 1 2 226 West Maltac 0 0 3 0 0 1 0 0 0 0 10 West Netherlands 9 8 8 1 3 1 4 2 4 0 818 West Norway 10 11 8 7 8 8 7 6 8 8 656 Centre Poland 72 50 47 50 51 39 30 21 24 9 6 416 West Portugal 151 143 123 62 65 46 33 31 24 19 377 Centre Romania 192 325 354 209 197 135 99 82 71 37 1 812 Centre Slovakia 1 1 0 1 3 1 0 1 0 0 18 Centre Slovenia 0 1 2 2 1 1 0 0 2 1 24 West Spain 237 209 187 153 119 140 108 74 68 47 3 764 West Sweden 15 22 13 14 15 26 20 23 21 13 1 324 Total EU/EEA 1 892 2 136 1 776 1 348 1 254 1 108 1 025 950 878 571 62 363 Non-EU/EEA Centre Albania 0 1 0 1 0 0 0 0 0 0 5 West Andorra 0 0 0 0 0 0 0 0 11 East Armenia 42 46 33 42 37 35 39 32 38 21 754 East Azerbaijan 319 218 204 183 183 160 99 105 100 89 3 380 East Belarus 254 247 201 376 790 600 485 391 363 222 9 788 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 20 East Georgia 188 224 172 194 187 205 150 96 115 62 3 128 West Israel 41 78 72 44 39 25 33 34 18 19 1 330 East Kazakhstan 923 793 730 779 826 900 901 920 1 215 1 045 19 865 East Kyrgyzstan 355 255 188 183 172 200 204 136 107 46 4 014 East Moldova 62 40 22 61 38 40 42 59 39 17 2 952 West Monaco 0 0 0 0 0 0 0 0 8 Centre Montenegro 0 1 0 0 0 0 1 0 0 1 7 Centre North Macedonia 0 0 0 0 0 0 0 0 2 East Russia 0 0 0 0 0 0 0 0 0 15 203 15 203 West San Marino 0 0 0 0 0 0 0 0 0 0 11 Centre Serbia 9 5 11 5 4 1 4 2 3 984 Centre Serbia excluding Kosovod 9 5 11 5 4 1 4 2 3 0 982 Centre Kosovod 2 West Switzerland 21 24 13 8 10 13 20 13 12 4 2 915 East Tajikistan 407 257 213 227 248 203 251 196 135 83 3 791 Centre Turkey 6 6 4 10 13 8 14 24 10 14 192 East Turkmenistan 0 0 0 East Ukraine 6 588 5 933 5 847 4 670 3 449 3 693 3 979 3 739 4 183 5 960 134 888 West United Kingdom 127 115 120 146 196 139 141 106 109 59 6 573 East Uzbekistan 11 390 Total non-EU/EEA 9 342 8 243 7 830 6 929 6 192 6 222 6 363 5 853 6 447 22 845 221 211 WHO European Region West West 1 444 1 682 1 315 1 044 1 018 896 818 803 759 520 54 377 Centre Centre 356 436 458 340 309 219 187 174 159 97 10 407 East East 9 433 8 261 7 833 6 893 6 119 6 215 6 383 5 826 6 407 22 799 218 785 Total WHO European Region 11 233 10 379 9 606 8 277 7 446 7 330 7 388 6 803 7 325 23 416 283 569 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting c Data on route of transmission were not reported by Lithuania or Malta for 2020 d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 44 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 6: New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EU/EEA West Austria 109 112 90 99 104 86 82 60 73 56 3 280 West Belgium 479 512 432 411 371 352 358 329 362 252 12 492 Centre Bulgaria 89 58 70 93 86 84 85 104 98 85 1 647 Centre Croatia 21 7 13 12 13 13 8 10 13 11 417 Centre Cyprus 23 23 16 10 26 27 32 32 49 34 681 Centre Czech Republic 26 41 45 45 46 54 59 56 56 82 959 West Denmark 132 96 90 102 126 100 93 91 87 65 3 586 East Estonia 146 170 188 162 144 116 89 67 79 70 1 784 West Finland 88 71 67 70 79 83 70 55 44 41 1 732 West France 2 083 2 201 2 198 2 199 1 787 1 646 1 701 1 950 1 818 1 139 38 991 West Germany 543 520 626 819 972 884 792 748 766 528 17 187 West Greece 151 159 125 143 130 142 154 171 182 120 3 813 Centre Hungary 19 24 25 28 22 28 22 13 28 26 556 West Iceland 6 0 0 0 0 9 2 15 6 10 142 West Ireland 126 135 134 128 129 147 173 160 129 63 3 661 West Italy 1 823 1 767 1 704 1 666 1 636 1 757 1 646 1 250 1 085 553 23 200 East Latvia 144 112 125 130 150 139 132 109 107 107 2 360 Liechtenstein 0 0 0 0 0 1 0 0 0 0 13 East Lithuaniac 39 53 59 74 65 70 70 67 59 0 819 West Luxembourg 28 29 27 36 31 30 32 23 28 13 778 West Maltac 13 15 10 9 15 21 17 14 0 0 196 West Netherlands 312 312 266 249 272 230 205 173 182 114 8 537 West Norway 155 142 123 140 138 120 115 101 100 66 3 587 Centre Poland 93 102 90 109 113 110 103 71 96 40 1 993 West Portugal 1 101 1 076 1 046 873 802 846 774 667 495 28 524 Centre Romania 371 376 402 436 473 496 524 497 472 270 8 435 Centre Slovakia 12 14 21 18 23 18 15 19 28 16 270 Centre Slovenia 8 4 9 5 10 10 11 7 10 9 172 West Spain 1 123 1 150 1 154 1 099 1 016 1 038 1 038 691 798 527 17 417 West Sweden 260 227 218 229 211 202 212 213 204 148 6 222 Total EU/EEA 9 523 9 508 9 373 9 394 8 990 8 859 8 614 7 763 7 454 4 445 193 451 Non-EU/EEA Centre Albania 60 66 101 62 77 115 87 80 91 87 1 168 West Andorra 1 1 1 0 0 0 2 7 30 East Armenia 130 165 179 272 236 244 290 344 355 301 3 027 East Azerbaijan 191 244 275 378 440 340 370 470 535 403 4 325 East Belarus 881 919 1 265 1 349 1 416 1 671 1 868 1 861 1 659 1 098 19 527 Centre Bosnia and Herzegovina 14 4 0 7 4 6 2 10 9 142 East Georgia 202 241 240 294 355 372 341 412 446 354 4 230 West Israel 209 200 175 206 201 194 185 218 183 127 5 412 East Kazakhstan 987 1 112 1 268 1 391 1 440 1 746 1 869 2 059 2 124 2 019 19 959 East Kyrgyzstan 181 307 276 392 404 421 490 530 549 461 4 878 East Moldova 612 661 337 616 578 547 561 617 683 401 9 095 West Monaco 0 1 0 0 0 0 1 0 13 Centre Montenegro 4 4 2 4 3 9 3 5 4 2 93 Centre North Macedonia 0 7 2 4 4 10 8 6 59 East Russia 0 0 0 0 0 0 0 0 0 38 937 38 937 West San Marino 4 3 0 0 0 0 0 0 0 0 23 Centre Serbia 42 28 22 34 28 35 31 34 24 12 919 Centre Serbia excluding Kosovod 37 27 20 33 28 30 29 29 22 11 853 Centre Kosovod 5 1 2 1 5 2 5 2 1 66 West Switzerland 211 220 223 174 180 165 136 150 136 82 7 321 East Tajikistan 403 377 474 623 746 695 798 1 047 959 880 7 776 Centre Turkey 263 376 428 495 583 646 775 951 806 536 7 912 East Turkmenistan 0 0 0 East Ukraine 10 248 10 440 11 472 10 648 9 043 10 008 11 029 11 320 11 513 9 197 163 270 West United Kingdom 2 820 2 594 2 255 2 345 2 075 1 901 1 673 1 708 1 626 1 067 72 352 East Uzbekistan 4 711 Total non-EU/EEA 17 463 17 970 18 995 19 294 17 813 19 125 20 519 21 829 21 702 55 964 375 179 WHO European Region West 11 777 11 543 10 964 10 997 10 275 9 953 9 461 8 794 8 304 4 971 258 496 Centre 1 045 1 134 1 246 1 362 1 511 1 661 1 765 1 895 1 784 1 210 25 423 East 14 164 14 801 16 158 16 329 15 017 16 369 17 907 18 903 19 068 54 228 284 698 Total WHO European Region 26 986 27 478 28 368 28 688 26 803 27 983 29 133 29 592 29 156 60 409 568 617 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting c Data on route of transmission were not reported by Lithuania or Malta for 2020 d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 45 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 7: New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EU/EEA West Austria 2 0 0 1 0 1 1 1 0 0 62 West Belgium 18 10 8 11 14 8 5 11 6 11 484 Centre Bulgaria 2 0 5 1 1 0 3 3 1 4 32 Centre Croatia 1 0 0 1 0 0 0 0 0 1 15 Centre Cyprus 0 1 0 0 1 0 0 0 1 0 5 Centre Czech Republic 0 2 0 1 0 2 0 0 0 0 9 West Denmark 3 4 5 5 4 1 5 2 0 2 115 East Estonia 3 4 2 5 1 0 0 0 0 3 57 West Finland 1 2 2 2 3 2 0 2 4 1 38 West France 36 49 37 53 48 28 25 41 53 22 678 West Germany 14 22 23 26 29 23 18 20 14 11 488 West Greece 4 0 0 1 0 4 1 2 4 3 71 Centre Hungary 0 1 1 1 2 1 2 0 0 0 17 West Iceland 0 0 0 0 0 0 0 2 1 0 4 West Ireland 3 5 3 2 5 3 1 3 2 1 92 West Italy 27 16 13 14 16 10 16 11 3 7 221 East Latvia 2 7 10 4 3 6 3 5 2 5 87 Liechtenstein 0 0 0 0 0 0 0 0 0 0 1 East Lithuaniac 1 0 1 2 0 1 1 0 0 0 7 West Luxembourg 0 1 0 2 0 0 0 0 1 1 16 West Maltac 0 0 0 0 0 2 0 2 0 0 4 West Netherlands 16 19 11 15 13 7 9 6 3 1 385 West Norway 4 7 1 3 2 2 2 6 2 0 93 Centre Poland 7 4 4 3 8 1 3 2 5 1 225 West Portugal 12 5 9 7 5 5 4 1 0 491 Centre Romania 23 19 24 18 18 7 15 9 11 7 788 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 0 Centre Slovenia 1 0 0 0 0 0 0 0 0 1 8 West Spain 11 7 18 4 3 8 3 4 2 0 135 West Sweden 22 14 7 7 15 10 14 12 12 9 282 Total EU/EEA 213 199 184 189 191 132 131 145 127 91 4 910 Non-EU/EEA Centre Albania 3 3 6 3 1 1 1 2 1 1 37 West Andorra 0 0 0 0 0 0 0 0 1 East Armenia 2 4 5 7 4 3 6 7 4 9 71 East Azerbaijan 9 14 10 18 16 10 10 9 4 2 134 East Belarus 23 16 16 15 26 20 13 4 10 5 323 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 1 East Georgia 6 9 4 5 6 4 3 6 3 3 111 West Israel 8 7 9 9 4 4 6 7 4 1 267 East Kazakhstan 18 30 36 22 25 24 34 24 26 23 419 East Kyrgyzstan 20 33 10 14 25 17 16 24 21 12 264 East Moldova 16 11 13 19 14 10 11 13 19 11 220 West Monaco 0 0 0 0 0 0 0 0 1 Centre Montenegro 0 0 0 0 0 0 0 0 0 0 4 Centre North Macedonia 0 0 0 0 0 0 0 0 2 East Russia 0 0 0 0 0 0 0 0 0 162 162 West San Marino 0 0 0 0 0 0 0 0 0 0 1 Centre Serbia 1 1 4 1 1 2 1 2 53 Centre Serbia excluding Kosovod 1 0 4 1 0 2 0 0 2 0 48 Centre Kosovod 1 1 1 5 West Switzerland 4 2 3 1 4 4 4 2 0 1 183 East Tajikistan 26 38 49 59 56 54 60 53 47 43 521 Centre Turkey 5 12 11 22 23 15 12 13 15 12 194 East Turkmenistan 0 0 0 East Ukraine 136 149 111 122 98 77 86 71 80 67 2 368 West United Kingdom 99 87 87 91 50 47 55 57 65 25 2 912 East Uzbekistan 363 Total non-EU/EEA 376 416 374 408 353 292 317 293 301 377 8 612 WHO European Region West 284 257 236 254 215 169 169 192 176 96 7 024 Centre 43 43 55 51 55 29 36 30 36 27 1 390 East 262 315 267 292 274 226 243 216 216 345 5 107 Total WHO European Region 589 615 558 597 544 424 448 438 428 468 13 521 a Country-specific comments are in Annex 5. Due to surveillance human resource constraints associated with the COVID-19 pandemic, some countries have higher than normal incomplete data on transmission route for 2019 and trends should be interpreted with care. b Cumulative total is the total number of cases reported by the country since the start of reporting c Data on route of transmission were not reported by Lithuania or Malta for 2020 d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 46 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 8: HIV diagnoses in 2020, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa MSM IDU Hetero MTCT Nosocomial Haemophiliac/transfusion Unknown Totalb Country, territory or areaaMale Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 72 72 2 6 8 27 29 56 0 0 0 0 0 0 0 0 0 1 18 19 155 Austria West Belgium 243 243 1 5 6 136 116 252 7 4 11 0 0 0 3 1 4 66 141 211 727 Belgium Centre Bulgaria 96 96 1 13 14 29 56 85 1 3 4 0 0 0 0 0 0 0 0 0 199 Bulgaria Centre Croatia 58 58 0 3 3 9 2 11 0 1 1 0 0 0 0 0 0 0 3 3 76 Croatia Centre Cyprus 61 61 0 3 3 17 17 34 0 0 0 1 0 1 0 0 0 1 5 6 105 Cyprus Centre Czech Republic 144 144 3 11 14 43 39 82 0 0 0 0 1 1 0 0 0 2 8 10 251 Czech Republic West Denmark 80 80 0 1 1 25 40 65 2 0 2 0 0 0 0 0 0 1 12 13 161 Denmark East Estonia 7 7 2 8 10 34 36 70 2 1 3 0 0 0 0 0 0 19 34 53 143 Estonia West Finland 35 35 0 4 4 21 20 41 0 1 1 1 0 1 0 0 0 14 40 54 136 Finland West France 1 036 1 085 5 45 50 640 487 1 139 11 10 22 0 0 0 2 6 8 400 732 1 139 3 443 France West Germany 1 003 1 003 42 125 167 362 166 528 7 4 11 0 1 1 0 0 0 147 595 744 2 454 Germany West Greece 256 256 10 71 81 68 52 120 2 1 3 0 0 0 1 0 1 38 102 140 601 Greece Centre Hungary 127 127 0 1 1 14 12 26 0 0 0 0 0 0 0 0 0 1 26 47 201 Hungary West Iceland 19 19 0 0 0 5 5 10 0 0 0 0 0 0 0 0 0 1 4 5 34 Iceland West Ireland 99 100 4 3 7 44 19 63 1 0 1 0 0 0 1 0 1 39 217 257 429 Ireland West Italy 596 596 8 36 44 224 329 553 5 2 7 0 0 0 0 0 0 25 78 103 1 303 Italy East Latvia 11 11 6 35 41 58 49 107 3 2 5 0 0 0 0 0 0 28 65 93 257 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 78 108 108 Lithuania West Luxembourg 9 10 0 2 2 5 8 13 0 1 1 0 0 0 0 0 0 0 5 18 44 Luxembourg West Malta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 67 82 82 Malta West Netherlands 239 247 0 0 0 56 57 114 1 0 1 0 1 1 0 0 0 9 22 33 396 Netherlands West Norway 63 63 3 5 8 43 23 66 0 0 0 0 0 0 0 0 0 0 0 0 137 Norway Centre Poland 140 141 0 9 9 23 17 40 1 0 1 0 0 0 0 0 0 83 430 518 709 Poland West Portugal - - - - - - - - - - - - - - - - - - - - - Portugal Centre Romania 133 133 4 33 37 95 175 270 6 1 7 0 0 0 0 0 0 0 0 0 447 Romania Centre Slovakia 50 50 0 0 0 4 12 16 0 0 0 0 0 0 0 0 0 7 27 36 102 Slovakia Centre Slovenia 14 14 0 1 1 5 4 9 0 1 1 0 0 0 0 0 0 0 2 2 27 Slovenia West Spain 1 048 1 048 11 36 47 243 284 527 0 0 0 0 0 0 1 2 3 44 215 259 1 884 Spain West Sweden 116 116 3 10 13 94 54 148 6 3 9 0 0 0 4 1 5 27 42 69 360 Sweden Total EU/EEA 5 755 5 815 105 466 571 2 324 2 108 4 445 55 35 91 2 3 5 12 10 22 998 2 968 4 022 14 971 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 8 8 0 0 0 26 61 87 0 1 1 0 0 0 0 0 0 0 0 0 96 Albania West Andorra 0 0 0 0 0 0 0 0 Andorra East Armenia 34 34 1 20 21 111 190 301 4 5 9 0 0 0 0 0 0 2 2 4 369 Armenia East Azerbaijan 56 56 5 84 89 166 237 403 0 2 2 0 0 0 0 0 0 2 7 9 559 Azerbaijan East Belarus 79 79 43 179 222 475 623 1 098 1 4 5 0 0 0 0 0 0 9 14 23 1 427 Belarus Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 Bosnia and Herzegovina East Georgia 102 102 1 61 62 119 235 354 1 2 3 0 0 0 1 1 2 4 3 7 530 Georgia West Israel 122 122 7 12 19 68 59 127 0 1 1 0 0 0 0 0 0 34 60 94 363 Israel East Kazakhstan 221 221 151 894 1 045 962 1 057 2 019 11 12 23 0 0 0 0 0 0 51 113 164 3 472 Kazakhstan East Kyrgyzstan 41 41 3 43 46 230 231 461 6 6 12 1 0 1 0 0 0 52 63 115 676 Kyrgyzstan East Moldova 18 18 4 13 17 179 222 401 5 6 11 0 0 0 0 0 0 93 135 228 675 Moldova West Monaco 0 0 0 0 0 0 0 0 Monaco Centre Montenegro 11 11 0 1 1 1 1 2 0 0 0 0 0 0 0 0 0 0 1 1 15 Montenegro Centre North Macedonia 0 0 0 0 0 0 0 0 North Macedonia East Russia 1 499 1 499 2 921 12 282 15 203 18 981 19 956 38 937 93 69 162 0 0 0 0 0 0 944 2 853 3 797 59 598 Russia West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 San Marino Centre Serbia 98 98 0 7 5 12 0 0 0 1 12 13 123 Serbia Centre Serbia excluding Kosovoc 97 97 0 0 0 6 5 11 0 0 0 0 0 0 0 0 0 1 12 13 121 Serbia excluding Kosovoc Centre Kosovoc 1 1 0 1 1 0 0 0 0 2 Kosovoc West Switzerland 95 95 0 4 4 34 48 82 1 0 1 0 0 0 0 0 0 24 77 106 288 Switzerland East Tajikistan 13 13 4 79 83 389 491 880 17 26 43 3 3 6 0 0 0 25 34 59 1 084 Tajikistan Centre Turkey 297 297 0 14 14 86 450 536 4 8 12 0 0 0 0 0 0 223 994 1 217 2 076 Turkey East Turkmenistan 0 0 0 0 0 0 0 0 Turkmenistan East Ukraine 393 393 1 175 4 785 5 960 4 509 4 688 9 197 33 34 67 2 2 4 0 0 0 15 22 37 15 658 Ukraine West United Kingdom 994 995 11 48 59 571 496 1 067 10 15 25 5 4 9 8 15 23 202 404 607 2 785 United Kingdom East Uzbekistan 0 0 0 0 0 0 0 0 Uzbekistan Total non-EU/EEA 4 081 4 082 4 326 18 519 22 845 26 914 29 050 55 964 186 191 377 11 9 20 9 16 25 1 681 4 794 6 481 89 794 Total non-EU/EEA WHO European Region WHO European Region West 6 125 6 185 107 413 520 2 666 2 292 4 971 53 42 96 6 6 12 20 25 45 1 087 2 831 3 953 15 782 West Centre 1 237 1 238 8 89 97 359 851 1 210 12 15 27 1 1 2 0 0 0 318 1 508 1 853 4 427 Centre East 2 474 2 474 4 316 18 483 22 799 26 213 28 015 54 228 176 169 345 6 5 11 1 1 2 1 274 3 423 4 697 84 556 East Total WHO European Region 9 836 9 897 4 431 18 985 23 416 29 238 31 158 60 409 241 226 468 13 12 25 21 26 47 2 679 7 762 10 503 104 765 Total WHO European Region a Country-specific comments are in Annex 5 b Totals include transgender and persons with unknown gender and may, therefore, not equal the sum of the columns or may differ slightly from the totals presented for 2020 in Tables 4–7. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence MSM - Men who have sex with men; IDU - Injecting drug use; MTCT - Mother-to-child transmission 47 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 8: HIV diagnoses in 2020, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa MSM IDU Hetero MTCT Nosocomial Haemophiliac/transfusion Unknown Totalb Country, territory or areaaMale Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 72 72 2 6 8 27 29 56 0 0 0 0 0 0 0 0 0 1 18 19 155 Austria West Belgium 243 243 1 5 6 136 116 252 7 4 11 0 0 0 3 1 4 66 141 211 727 Belgium Centre Bulgaria 96 96 1 13 14 29 56 85 1 3 4 0 0 0 0 0 0 0 0 0 199 Bulgaria Centre Croatia 58 58 0 3 3 9 2 11 0 1 1 0 0 0 0 0 0 0 3 3 76 Croatia Centre Cyprus 61 61 0 3 3 17 17 34 0 0 0 1 0 1 0 0 0 1 5 6 105 Cyprus Centre Czech Republic 144 144 3 11 14 43 39 82 0 0 0 0 1 1 0 0 0 2 8 10 251 Czech Republic West Denmark 80 80 0 1 1 25 40 65 2 0 2 0 0 0 0 0 0 1 12 13 161 Denmark East Estonia 7 7 2 8 10 34 36 70 2 1 3 0 0 0 0 0 0 19 34 53 143 Estonia West Finland 35 35 0 4 4 21 20 41 0 1 1 1 0 1 0 0 0 14 40 54 136 Finland West France 1 036 1 085 5 45 50 640 487 1 139 11 10 22 0 0 0 2 6 8 400 732 1 139 3 443 France West Germany 1 003 1 003 42 125 167 362 166 528 7 4 11 0 1 1 0 0 0 147 595 744 2 454 Germany West Greece 256 256 10 71 81 68 52 120 2 1 3 0 0 0 1 0 1 38 102 140 601 Greece Centre Hungary 127 127 0 1 1 14 12 26 0 0 0 0 0 0 0 0 0 1 26 47 201 Hungary West Iceland 19 19 0 0 0 5 5 10 0 0 0 0 0 0 0 0 0 1 4 5 34 Iceland West Ireland 99 100 4 3 7 44 19 63 1 0 1 0 0 0 1 0 1 39 217 257 429 Ireland West Italy 596 596 8 36 44 224 329 553 5 2 7 0 0 0 0 0 0 25 78 103 1 303 Italy East Latvia 11 11 6 35 41 58 49 107 3 2 5 0 0 0 0 0 0 28 65 93 257 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 78 108 108 Lithuania West Luxembourg 9 10 0 2 2 5 8 13 0 1 1 0 0 0 0 0 0 0 5 18 44 Luxembourg West Malta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 67 82 82 Malta West Netherlands 239 247 0 0 0 56 57 114 1 0 1 0 1 1 0 0 0 9 22 33 396 Netherlands West Norway 63 63 3 5 8 43 23 66 0 0 0 0 0 0 0 0 0 0 0 0 137 Norway Centre Poland 140 141 0 9 9 23 17 40 1 0 1 0 0 0 0 0 0 83 430 518 709 Poland West Portugal - - - - - - - - - - - - - - - - - - - - - Portugal Centre Romania 133 133 4 33 37 95 175 270 6 1 7 0 0 0 0 0 0 0 0 0 447 Romania Centre Slovakia 50 50 0 0 0 4 12 16 0 0 0 0 0 0 0 0 0 7 27 36 102 Slovakia Centre Slovenia 14 14 0 1 1 5 4 9 0 1 1 0 0 0 0 0 0 0 2 2 27 Slovenia West Spain 1 048 1 048 11 36 47 243 284 527 0 0 0 0 0 0 1 2 3 44 215 259 1 884 Spain West Sweden 116 116 3 10 13 94 54 148 6 3 9 0 0 0 4 1 5 27 42 69 360 Sweden Total EU/EEA 5 755 5 815 105 466 571 2 324 2 108 4 445 55 35 91 2 3 5 12 10 22 998 2 968 4 022 14 971 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 8 8 0 0 0 26 61 87 0 1 1 0 0 0 0 0 0 0 0 0 96 Albania West Andorra 0 0 0 0 0 0 0 0 Andorra East Armenia 34 34 1 20 21 111 190 301 4 5 9 0 0 0 0 0 0 2 2 4 369 Armenia East Azerbaijan 56 56 5 84 89 166 237 403 0 2 2 0 0 0 0 0 0 2 7 9 559 Azerbaijan East Belarus 79 79 43 179 222 475 623 1 098 1 4 5 0 0 0 0 0 0 9 14 23 1 427 Belarus Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 Bosnia and Herzegovina East Georgia 102 102 1 61 62 119 235 354 1 2 3 0 0 0 1 1 2 4 3 7 530 Georgia West Israel 122 122 7 12 19 68 59 127 0 1 1 0 0 0 0 0 0 34 60 94 363 Israel East Kazakhstan 221 221 151 894 1 045 962 1 057 2 019 11 12 23 0 0 0 0 0 0 51 113 164 3 472 Kazakhstan East Kyrgyzstan 41 41 3 43 46 230 231 461 6 6 12 1 0 1 0 0 0 52 63 115 676 Kyrgyzstan East Moldova 18 18 4 13 17 179 222 401 5 6 11 0 0 0 0 0 0 93 135 228 675 Moldova West Monaco 0 0 0 0 0 0 0 0 Monaco Centre Montenegro 11 11 0 1 1 1 1 2 0 0 0 0 0 0 0 0 0 0 1 1 15 Montenegro Centre North Macedonia 0 0 0 0 0 0 0 0 North Macedonia East Russia 1 499 1 499 2 921 12 282 15 203 18 981 19 956 38 937 93 69 162 0 0 0 0 0 0 944 2 853 3 797 59 598 Russia West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 San Marino Centre Serbia 98 98 0 7 5 12 0 0 0 1 12 13 123 Serbia Centre Serbia excluding Kosovoc 97 97 0 0 0 6 5 11 0 0 0 0 0 0 0 0 0 1 12 13 121 Serbia excluding Kosovoc Centre Kosovoc 1 1 0 1 1 0 0 0 0 2 Kosovoc West Switzerland 95 95 0 4 4 34 48 82 1 0 1 0 0 0 0 0 0 24 77 106 288 Switzerland East Tajikistan 13 13 4 79 83 389 491 880 17 26 43 3 3 6 0 0 0 25 34 59 1 084 Tajikistan Centre Turkey 297 297 0 14 14 86 450 536 4 8 12 0 0 0 0 0 0 223 994 1 217 2 076 Turkey East Turkmenistan 0 0 0 0 0 0 0 0 Turkmenistan East Ukraine 393 393 1 175 4 785 5 960 4 509 4 688 9 197 33 34 67 2 2 4 0 0 0 15 22 37 15 658 Ukraine West United Kingdom 994 995 11 48 59 571 496 1 067 10 15 25 5 4 9 8 15 23 202 404 607 2 785 United Kingdom East Uzbekistan 0 0 0 0 0 0 0 0 Uzbekistan Total non-EU/EEA 4 081 4 082 4 326 18 519 22 845 26 914 29 050 55 964 186 191 377 11 9 20 9 16 25 1 681 4 794 6 481 89 794 Total non-EU/EEA WHO European Region WHO European Region West 6 125 6 185 107 413 520 2 666 2 292 4 971 53 42 96 6 6 12 20 25 45 1 087 2 831 3 953 15 782 West Centre 1 237 1 238 8 89 97 359 851 1 210 12 15 27 1 1 2 0 0 0 318 1 508 1 853 4 427 Centre East 2 474 2 474 4 316 18 483 22 799 26 213 28 015 54 228 176 169 345 6 5 11 1 1 2 1 274 3 423 4 697 84 556 East Total WHO European Region 9 836 9 897 4 431 18 985 23 416 29 238 31 158 60 409 241 226 468 13 12 25 21 26 47 2 679 7 762 10 503 104 765 Total WHO European Region a Country-specific comments are in Annex 5 b Totals include transgender and persons with unknown gender and may, therefore, not equal the sum of the columns or may differ slightly from the totals presented for 2020 in Tables 4–7. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence MSM - Men who have sex with men; IDU - Injecting drug use; MTCT - Mother-to-child transmission 48 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 9: HIV diagnoses in 2020, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Totalb Country, territory or areaaFemale Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 0 0 0 0 2 2 3 10 13 5 14 19 10 34 44 7 26 33 5 39 44 0 0 0 155 Austria West Belgium 3 1 4 6 7 13 15 38 53 32 69 101 72 178 252 49 109 158 34 104 140 2 4 6 727 Belgium Centre Bulgaria 2 3 5 1 3 4 6 14 20 5 34 39 8 60 68 6 40 46 3 14 17 0 0 0 199 Bulgaria Centre Croatia 0 0 0 0 0 0 0 12 12 1 12 13 3 16 19 3 17 20 2 10 12 0 0 0 76 Croatia Centre Cyprus 0 0 0 1 0 1 1 5 6 2 19 21 7 24 31 5 19 24 3 19 22 0 0 0 105 Cyprus Centre Czech Republic 0 0 0 1 1 2 3 19 22 7 32 39 14 78 92 15 52 67 8 21 29 0 0 0 251 Czech Republic West Denmark 0 0 0 1 2 3 1 8 9 3 13 16 9 40 49 7 28 35 7 42 49 0 0 0 161 Denmark East Estonia 2 1 3 1 1 2 5 2 7 8 6 14 19 32 51 14 35 49 8 9 17 0 0 0 143 Estonia West Finland 1 1 2 0 1 1 0 2 2 4 13 17 13 29 42 12 22 34 6 32 38 0 0 0 136 Finland West France 10 16 26 32 45 77 84 234 328 138 346 501 313 588 929 246 481 736 235 606 846 0 0 0 3 443 France West Germany 6 3 9 11 15 26 48 147 195 82 249 331 197 582 779 117 401 518 93 487 582 4 10 14 2 454 Germany West Greece 2 1 3 4 10 14 11 30 41 22 82 104 47 131 178 22 128 150 11 100 111 0 0 0 601 Greece Centre Hungary 0 0 0 0 2 2 0 13 13 1 40 43 5 58 64 6 30 37 2 20 23 1 3 19 201 Hungary West Iceland 0 0 0 0 0 0 1 0 1 0 3 3 4 15 19 0 5 5 1 5 6 0 0 0 34 Iceland West Ireland 0 0 0 0 3 3 3 21 24 9 63 72 40 145 185 24 55 81 13 50 63 0 1 1 429 Ireland West Italy 5 2 7 2 7 9 17 66 83 26 145 171 77 279 356 65 256 321 70 286 356 0 0 0 1 303 Italy East Latvia 3 2 5 3 1 4 9 4 13 9 13 22 26 58 84 20 53 73 25 31 56 0 0 0 257 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 78 108 108 Lithuania West Luxembourg 0 1 1 0 0 0 2 1 3 1 5 7 1 1 2 1 2 3 0 12 12 0 3 16 44 Luxembourg West Malta 0 0 0 0 1 1 2 5 7 1 15 16 6 21 27 3 14 17 1 7 8 2 4 6 82 Malta West Netherlands 0 0 0 2 3 5 4 29 34 10 55 70 17 87 107 14 63 79 19 82 101 0 0 0 396 Netherlands West Norway 0 0 0 0 1 1 3 2 5 3 10 13 21 33 54 11 21 32 8 24 32 0 0 0 137 Norway Centre Poland 1 1 2 2 4 6 7 75 83 15 131 147 45 195 240 25 127 153 11 52 63 1 11 15 709 Poland West Portugal - - - - - - - - - - - - - - - - - - - - - - - - - Portugal Centre Romania 6 1 7 7 7 14 19 51 70 13 49 62 30 115 145 16 80 96 14 39 53 0 0 0 447 Romania Centre Slovakia 0 0 0 0 2 2 0 14 14 2 12 14 3 37 40 5 16 21 1 8 9 0 0 2 102 Slovakia Centre Slovenia 0 1 1 0 1 1 0 2 2 0 3 3 2 6 8 2 7 9 1 2 3 0 0 0 27 Slovenia West Spain 1 0 1 4 26 30 24 156 180 38 267 305 92 504 596 81 349 430 59 283 342 0 0 0 1 884 Spain West Sweden 4 2 6 0 1 1 7 14 21 11 35 46 43 67 110 41 47 88 28 60 88 0 0 0 360 Sweden Total EU/EEA 46 36 82 78 146 224 275 974 1 261 448 1 735 2 209 1 124 3 413 4 571 817 2 483 3 315 668 2 444 3 122 40 114 187 14 971 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 1 1 0 0 0 1 10 11 3 8 11 5 16 21 7 16 23 10 19 29 0 0 0 96 Albania West Andorra - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Andorra East Armenia 4 5 9 2 1 3 8 11 19 16 45 61 36 80 116 29 47 76 23 62 85 0 0 0 369 Armenia East Azerbaijan 0 4 4 2 3 5 13 38 51 29 66 95 59 138 197 28 91 119 42 46 88 0 0 0 559 Azerbaijan East Belarus 3 6 9 10 7 17 32 52 84 58 85 143 186 377 563 140 261 401 99 111 210 0 0 0 1 427 Belarus Centre Bosnia and Herzegovina - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Bosnia and Herzegovina East Georgia 2 2 4 1 5 6 5 51 56 24 49 73 33 115 148 33 110 143 28 72 100 0 0 0 530 Georgia West Israel 0 1 1 0 0 0 2 15 17 8 35 43 41 80 121 36 66 102 21 57 78 1 0 1 363 Israel East Kazakhstan 13 13 26 29 25 54 62 149 211 140 279 419 433 926 1 359 304 645 949 194 260 454 0 0 0 3 472 Kazakhstan East Kyrgyzstan 12 9 21 12 7 19 20 27 47 42 56 98 95 142 237 58 91 149 53 52 105 0 0 0 676 Kyrgyzstan East Moldova 4 7 11 16 4 20 30 16 46 32 45 77 81 159 240 65 105 170 53 58 111 0 0 0 675 Moldova West Monaco - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Monaco Centre Montenegro 0 0 0 0 0 0 0 4 4 0 1 1 1 6 7 0 2 2 0 1 1 0 0 0 15 Montenegro Centre North Macedonia - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 North Macedonia East Russia 245 213 458 217 111 328 966 870 1 836 2 112 2 537 4 649 9 490 16 018 25 508 6 599 12 830 19 429 3 310 4 080 7 390 0 0 0 59 598 Russia West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 San Marino Centre Serbia - - 0 - 2 2 - 15 15 1 14 15 1 45 46 2 24 26 4 15 19 - - 0 123 Serbia Centre Serbia excluding Kosovoc 0 0 0 0 2 2 0 14 14 1 14 15 1 45 46 1 24 25 4 15 19 0 0 0 121 Serbia excluding Kosovoc Centre Kosovoc - - 0 - - 0 - 1 1 - - 0 - - 0 1 - 1 - - 0 - - 0 2 Kosovoc West Switzerland 1 0 1 0 1 1 1 18 19 5 35 41 16 58 75 17 54 72 19 56 75 0 2 4 288 Switzerland East Tajikistan 29 55 84 20 9 29 39 43 82 66 69 135 158 219 377 83 157 240 43 94 137 0 0 0 1 084 Tajikistan Centre Turkey 4 9 13 5 50 55 26 275 301 55 314 369 110 497 607 74 323 397 39 294 333 0 1 1 2 076 Turkey East Turkmenistan - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Turkmenistan East Ukraine 37 34 71 56 51 107 238 260 498 542 851 1 393 2 259 4 262 6 521 1 650 3 297 4 947 952 1 169 2 121 0 0 0 15 658 Ukraine West United Kingdom 5 6 11 16 22 38 48 194 242 87 311 399 247 594 841 220 387 607 184 462 647 0 0 0 2 785 United Kingdom East Uzbekistan - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Uzbekistan Total non-EU/EEA 359 365 724 386 298 684 1 491 2 048 3 539 3 220 4 800 8 022 13 251 23 732 36 984 9 345 18 506 27 852 5 074 6 908 11 983 1 3 6 89 794 Total non-EU/EEA WHO European Region WHO European Region West 38 34 72 78 147 225 276 990 1 277 485 1 765 2 275 1 266 3 466 4 766 973 2 514 3 501 814 2 794 3 618 9 24 48 15 782 West Centre 13 16 29 17 72 89 63 509 573 105 669 777 234 1 153 1 388 166 753 921 98 514 613 2 15 37 4 427 Centre East 354 351 705 369 225 594 1 427 1 523 2 950 3 078 4 101 7 179 12 875 22 526 35 401 9 023 17 722 26 745 4 830 6 044 10 874 30 78 108 84 556 East Total WHO European Region 405 401 806 464 444 908 1 766 3 022 4 800 3 668 6 535 10 231 14 375 27 145 41 555 10 162 20 989 31 167 5 742 9 352 15 105 41 117 193 104 765 Total WHO European Region a Country-specific comments are in Annex 5 b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 49 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 9: HIV diagnoses in 2020, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa <15 15–19 20–24 25–29 30–39 40–49 50+ Unknown Totalb Country, territory or areaaFemale Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 0 0 0 0 2 2 3 10 13 5 14 19 10 34 44 7 26 33 5 39 44 0 0 0 155 Austria West Belgium 3 1 4 6 7 13 15 38 53 32 69 101 72 178 252 49 109 158 34 104 140 2 4 6 727 Belgium Centre Bulgaria 2 3 5 1 3 4 6 14 20 5 34 39 8 60 68 6 40 46 3 14 17 0 0 0 199 Bulgaria Centre Croatia 0 0 0 0 0 0 0 12 12 1 12 13 3 16 19 3 17 20 2 10 12 0 0 0 76 Croatia Centre Cyprus 0 0 0 1 0 1 1 5 6 2 19 21 7 24 31 5 19 24 3 19 22 0 0 0 105 Cyprus Centre Czech Republic 0 0 0 1 1 2 3 19 22 7 32 39 14 78 92 15 52 67 8 21 29 0 0 0 251 Czech Republic West Denmark 0 0 0 1 2 3 1 8 9 3 13 16 9 40 49 7 28 35 7 42 49 0 0 0 161 Denmark East Estonia 2 1 3 1 1 2 5 2 7 8 6 14 19 32 51 14 35 49 8 9 17 0 0 0 143 Estonia West Finland 1 1 2 0 1 1 0 2 2 4 13 17 13 29 42 12 22 34 6 32 38 0 0 0 136 Finland West France 10 16 26 32 45 77 84 234 328 138 346 501 313 588 929 246 481 736 235 606 846 0 0 0 3 443 France West Germany 6 3 9 11 15 26 48 147 195 82 249 331 197 582 779 117 401 518 93 487 582 4 10 14 2 454 Germany West Greece 2 1 3 4 10 14 11 30 41 22 82 104 47 131 178 22 128 150 11 100 111 0 0 0 601 Greece Centre Hungary 0 0 0 0 2 2 0 13 13 1 40 43 5 58 64 6 30 37 2 20 23 1 3 19 201 Hungary West Iceland 0 0 0 0 0 0 1 0 1 0 3 3 4 15 19 0 5 5 1 5 6 0 0 0 34 Iceland West Ireland 0 0 0 0 3 3 3 21 24 9 63 72 40 145 185 24 55 81 13 50 63 0 1 1 429 Ireland West Italy 5 2 7 2 7 9 17 66 83 26 145 171 77 279 356 65 256 321 70 286 356 0 0 0 1 303 Italy East Latvia 3 2 5 3 1 4 9 4 13 9 13 22 26 58 84 20 53 73 25 31 56 0 0 0 257 Latvia Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Liechtenstein East Lithuania 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 78 108 108 Lithuania West Luxembourg 0 1 1 0 0 0 2 1 3 1 5 7 1 1 2 1 2 3 0 12 12 0 3 16 44 Luxembourg West Malta 0 0 0 0 1 1 2 5 7 1 15 16 6 21 27 3 14 17 1 7 8 2 4 6 82 Malta West Netherlands 0 0 0 2 3 5 4 29 34 10 55 70 17 87 107 14 63 79 19 82 101 0 0 0 396 Netherlands West Norway 0 0 0 0 1 1 3 2 5 3 10 13 21 33 54 11 21 32 8 24 32 0 0 0 137 Norway Centre Poland 1 1 2 2 4 6 7 75 83 15 131 147 45 195 240 25 127 153 11 52 63 1 11 15 709 Poland West Portugal - - - - - - - - - - - - - - - - - - - - - - - - - Portugal Centre Romania 6 1 7 7 7 14 19 51 70 13 49 62 30 115 145 16 80 96 14 39 53 0 0 0 447 Romania Centre Slovakia 0 0 0 0 2 2 0 14 14 2 12 14 3 37 40 5 16 21 1 8 9 0 0 2 102 Slovakia Centre Slovenia 0 1 1 0 1 1 0 2 2 0 3 3 2 6 8 2 7 9 1 2 3 0 0 0 27 Slovenia West Spain 1 0 1 4 26 30 24 156 180 38 267 305 92 504 596 81 349 430 59 283 342 0 0 0 1 884 Spain West Sweden 4 2 6 0 1 1 7 14 21 11 35 46 43 67 110 41 47 88 28 60 88 0 0 0 360 Sweden Total EU/EEA 46 36 82 78 146 224 275 974 1 261 448 1 735 2 209 1 124 3 413 4 571 817 2 483 3 315 668 2 444 3 122 40 114 187 14 971 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 0 1 1 0 0 0 1 10 11 3 8 11 5 16 21 7 16 23 10 19 29 0 0 0 96 Albania West Andorra - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Andorra East Armenia 4 5 9 2 1 3 8 11 19 16 45 61 36 80 116 29 47 76 23 62 85 0 0 0 369 Armenia East Azerbaijan 0 4 4 2 3 5 13 38 51 29 66 95 59 138 197 28 91 119 42 46 88 0 0 0 559 Azerbaijan East Belarus 3 6 9 10 7 17 32 52 84 58 85 143 186 377 563 140 261 401 99 111 210 0 0 0 1 427 Belarus Centre Bosnia and Herzegovina - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Bosnia and Herzegovina East Georgia 2 2 4 1 5 6 5 51 56 24 49 73 33 115 148 33 110 143 28 72 100 0 0 0 530 Georgia West Israel 0 1 1 0 0 0 2 15 17 8 35 43 41 80 121 36 66 102 21 57 78 1 0 1 363 Israel East Kazakhstan 13 13 26 29 25 54 62 149 211 140 279 419 433 926 1 359 304 645 949 194 260 454 0 0 0 3 472 Kazakhstan East Kyrgyzstan 12 9 21 12 7 19 20 27 47 42 56 98 95 142 237 58 91 149 53 52 105 0 0 0 676 Kyrgyzstan East Moldova 4 7 11 16 4 20 30 16 46 32 45 77 81 159 240 65 105 170 53 58 111 0 0 0 675 Moldova West Monaco - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Monaco Centre Montenegro 0 0 0 0 0 0 0 4 4 0 1 1 1 6 7 0 2 2 0 1 1 0 0 0 15 Montenegro Centre North Macedonia - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 North Macedonia East Russia 245 213 458 217 111 328 966 870 1 836 2 112 2 537 4 649 9 490 16 018 25 508 6 599 12 830 19 429 3 310 4 080 7 390 0 0 0 59 598 Russia West San Marino 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 San Marino Centre Serbia - - 0 - 2 2 - 15 15 1 14 15 1 45 46 2 24 26 4 15 19 - - 0 123 Serbia Centre Serbia excluding Kosovoc 0 0 0 0 2 2 0 14 14 1 14 15 1 45 46 1 24 25 4 15 19 0 0 0 121 Serbia excluding Kosovoc Centre Kosovoc - - 0 - - 0 - 1 1 - - 0 - - 0 1 - 1 - - 0 - - 0 2 Kosovoc West Switzerland 1 0 1 0 1 1 1 18 19 5 35 41 16 58 75 17 54 72 19 56 75 0 2 4 288 Switzerland East Tajikistan 29 55 84 20 9 29 39 43 82 66 69 135 158 219 377 83 157 240 43 94 137 0 0 0 1 084 Tajikistan Centre Turkey 4 9 13 5 50 55 26 275 301 55 314 369 110 497 607 74 323 397 39 294 333 0 1 1 2 076 Turkey East Turkmenistan - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Turkmenistan East Ukraine 37 34 71 56 51 107 238 260 498 542 851 1 393 2 259 4 262 6 521 1 650 3 297 4 947 952 1 169 2 121 0 0 0 15 658 Ukraine West United Kingdom 5 6 11 16 22 38 48 194 242 87 311 399 247 594 841 220 387 607 184 462 647 0 0 0 2 785 United Kingdom East Uzbekistan - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Uzbekistan Total non-EU/EEA 359 365 724 386 298 684 1 491 2 048 3 539 3 220 4 800 8 022 13 251 23 732 36 984 9 345 18 506 27 852 5 074 6 908 11 983 1 3 6 89 794 Total non-EU/EEA WHO European Region WHO European Region West 38 34 72 78 147 225 276 990 1 277 485 1 765 2 275 1 266 3 466 4 766 973 2 514 3 501 814 2 794 3 618 9 24 48 15 782 West Centre 13 16 29 17 72 89 63 509 573 105 669 777 234 1 153 1 388 166 753 921 98 514 613 2 15 37 4 427 Centre East 354 351 705 369 225 594 1 427 1 523 2 950 3 078 4 101 7 179 12 875 22 526 35 401 9 023 17 722 26 745 4 830 6 044 10 874 30 78 108 84 556 East Total WHO European Region 405 401 806 464 444 908 1 766 3 022 4 800 3 668 6 535 10 231 14 375 27 145 41 555 10 162 20 989 31 167 5 742 9 352 15 105 41 117 193 104 765 Total WHO European Region a Country-specific comments are in Annex 5 b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 50 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 10: HIV diagnoses, by country of report and region of origin, cases diagnosed in 2020, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-east Asia Other Unknown Total Country, territory or areaaN % N % N % N % N % N % N % N % EU/EEA EU/EEA West Austria 86 55.5 12 7.7 20 12.9 15 9.7 2 1.3 10 6.5 6 3.9 4 2.6 155 Austria West Belgium 153 21.0 65 8.9 61 8.4 167 23.0 97 13.3 25 3.4 47 6.5 112 15.4 727 Belgium Centre Bulgaria 186 93.5 5 2.5 5 2.5 1 0.5 0 0.0 2 1.0 0 0.0 0 0.0 199 Bulgaria Centre Croatia 58 76.3 2 2.6 12 15.8 1 1.3 0 0.0 0 0.0 2 2.6 1 1.3 76 Croatia Centre Cyprus 47 44.8 16 15.2 20 19.0 19 18.1 0 0.0 3 2.9 0 0.0 0 0.0 105 Cyprus Centre Czech Republic 141 56.2 5 2.0 75 29.9 6 2.4 10 4.0 11 4.4 3 1.2 0 0.0 251 Czech Republic West Denmark 66 41.0 22 13.7 16 9.9 20 12.4 10 6.2 16 9.9 3 1.9 8 5.0 161 Denmark East Estonia 69 48.3 1 0.7 14 9.8 1 0.7 2 1.4 1 0.7 0 0.0 55 38.5 143 Estonia West Finland 55 40.4 4 2.9 33 24.3 11 8.1 7 5.1 14 10.3 3 2.2 9 6.6 136 Finland West France 1 143 33.2 65 1.9 83 2.4 813 23.6 243 7.1 48 1.4 136 4.0 912 26.5 3 443 France West Germany 1 246 50.8 75 3.1 297 12.1 267 10.9 94 3.8 89 3.6 53 2.2 333 13.6 2 454 Germany West Greece 362 60.2 16 2.7 80 13.3 94 15.6 9 1.5 23 3.8 12 2.0 5 0.8 601 Greece Centre Hungary - - - - - - - - - - - - - - - - - Hungary West Iceland 7 20.6 7 20.6 6 17.6 3 8.8 2 5.9 1 2.9 8 23.5 0 0.0 34 Iceland West Ireland 32 7.5 12 2.8 9 2.1 51 11.9 34 7.9 5 1.2 1 0.2 285 66.4 429 Ireland West Italy 853 65.5 7 0.5 97 7.4 122 9.4 140 10.7 29 2.2 16 1.2 39 3.0 1 303 Italy East Latvia - - - - - - - - - - - - - - - - - Latvia Liechtenstein - - - - - - - - - - - - - - - - - Liechtenstein East Lithuania 108 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 108 Lithuania West Luxembourg 7 15.9 12 27.3 0 0.0 7 15.9 0 0.0 1 2.3 1 2.3 16 36.4 44 Luxembourg West Malta 82 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 82 Malta West Netherlands 216 54.5 14 3.5 41 10.4 40 10.1 56 14.1 13 3.3 13 3.3 3 0.8 396 Netherlands West Norway 37 27.0 5 3.6 34 24.8 24 17.5 11 8.0 20 14.6 6 4.4 0 0.0 137 Norway Centre Poland 394 55.6 1 0.1 44 6.2 1 0.1 0 0.0 1 0.1 0 0.0 268 37.8 709 Poland West Portugal - - - - - - - - - - - - - - - - - Portugal Centre Romania 441 98.7 2 0.4 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 3 0.7 447 Romania Centre Slovakia 19 18.6 0 0.0 8 7.8 0 0.0 2 2.0 0 0.0 0 0.0 73 71.6 102 Slovakia Centre Slovenia 23 85.2 0 0.0 4 14.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 27 Slovenia West Spain 1 041 55.3 52 2.8 55 2.9 71 3.8 423 22.5 8 0.4 190 10.1 44 2.3 1 884 Spain West Sweden 65 18.1 22 6.1 45 12.5 118 32.8 29 8.1 48 13.3 17 4.7 16 4.4 360 Sweden Total EU/EEA 6 937 47.8 422 2.9 1 059 7.3 1 852 12.8 1 171 8.1 368 2.5 518 3.6 2 186 15.1 14 513 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 96 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 96 Albania West Andorra - - - - - - - - - - - - - - - - - Andorra East Armenia 369 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 369 Armenia East Azerbaijan 547 97.9 0 0.0 10 1.8 0 0.0 0 0.0 0 0.0 2 0.4 0 0.0 559 Azerbaijan East Belarus 1 427 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 427 Belarus Centre Bosnia and Herzegovina - - - - - - - - - - - - - - - - - Bosnia and Herzegovina East Georgia 529 99.8 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 530 Georgia West Israel 112 30.9 8 2.2 114 31.4 60 16.5 10 2.8 4 1.1 55 15.2 0 0.0 363 Israel East Kazakhstan 3 336 96.1 0 0.0 114 3.3 0 0.0 0 0.0 1 0.0 21 0.6 0 0.0 3 472 Kazakhstan East Kyrgyzstan 637 94.2 0 0.0 39 5.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 676 Kyrgyzstan East Moldova 675 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 675 Moldova West Monaco - - - - - - - - - - - - - - - - - Monaco Centre Montenegro 14 93.3 0 0.0 1 6.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 15 Montenegro Centre North Macedonia - - - - - - - - - - - - - - - - - North Macedonia East Russia - - - - - - - - - - - - - - - - - Russia West San Marino - - - - - - - - - - - - - - - - - San Marino Centre Serbia 122 99.2 - - 1 0.8 - - - - - - - - - - 123 Serbia Centre Serbia excluding Kosovob 120 99.2 0 0.0 1 0.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 121 Serbia excluding Kosovob Centre Kosovob 2 100.0 - - - - - - - - - - - - - - 2 Kosovob West Switzerland 90 31.3 36 12.5 9 3.1 36 12.5 17 5.9 7 2.4 5 1.7 88 30.6 288 Switzerland East Tajikistan 1 084 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 084 Tajikistan Centre Turkey 1 753 84.4 39 1.9 103 5.0 56 2.7 3 0.1 20 1.0 48 2.3 54 2.6 2 076 Turkey East Turkmenistan - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine 15 658 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 15 658 Ukraine West United Kingdom 798 28.7 185 6.6 210 7.5 587 21.1 203 7.3 173 6.2 50 1.8 579 20.8 2 785 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - Uzbekistan Total non-EU/EEA 27 247 90.2 268 0.9 602 2.0 739 2.4 233 0.8 205 0.7 181 0.6 721 2.4 30 196 Total non-EU/EEA WHO European Region WHO European Region West 6 451 40.9 619 3.9 1 210 7.7 2 506 15.9 1 387 8.8 534 3.4 622 3.9 2 453 15.5 15 782 West Centre 3 294 77.9 70 1.7 273 6.5 84 2.0 15 0.4 37 0.9 54 1.3 399 9.4 4 226 Centre East 24 439 98.9 1 0.0 178 0.7 1 0.0 2 0.0 2 0.0 23 0.1 55 0.2 24 701 East Total WHO European Region 34 184 76.5 690 1.5 1 661 3.7 2 591 5.8 1 404 3.1 573 1.3 699 1.6 2 907 6.5 44 709 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the variables “country of birth”, “country of nationality” or “region of origin” are excluded and therefore regional totals may not equal those presented in Table 1. b Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 51 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 10: HIV diagnoses, by country of report and region of origin, cases diagnosed in 2020, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-east Asia Other Unknown Total Country, territory or areaaN % N % N % N % N % N % N % N % EU/EEA EU/EEA West Austria 86 55.5 12 7.7 20 12.9 15 9.7 2 1.3 10 6.5 6 3.9 4 2.6 155 Austria West Belgium 153 21.0 65 8.9 61 8.4 167 23.0 97 13.3 25 3.4 47 6.5 112 15.4 727 Belgium Centre Bulgaria 186 93.5 5 2.5 5 2.5 1 0.5 0 0.0 2 1.0 0 0.0 0 0.0 199 Bulgaria Centre Croatia 58 76.3 2 2.6 12 15.8 1 1.3 0 0.0 0 0.0 2 2.6 1 1.3 76 Croatia Centre Cyprus 47 44.8 16 15.2 20 19.0 19 18.1 0 0.0 3 2.9 0 0.0 0 0.0 105 Cyprus Centre Czech Republic 141 56.2 5 2.0 75 29.9 6 2.4 10 4.0 11 4.4 3 1.2 0 0.0 251 Czech Republic West Denmark 66 41.0 22 13.7 16 9.9 20 12.4 10 6.2 16 9.9 3 1.9 8 5.0 161 Denmark East Estonia 69 48.3 1 0.7 14 9.8 1 0.7 2 1.4 1 0.7 0 0.0 55 38.5 143 Estonia West Finland 55 40.4 4 2.9 33 24.3 11 8.1 7 5.1 14 10.3 3 2.2 9 6.6 136 Finland West France 1 143 33.2 65 1.9 83 2.4 813 23.6 243 7.1 48 1.4 136 4.0 912 26.5 3 443 France West Germany 1 246 50.8 75 3.1 297 12.1 267 10.9 94 3.8 89 3.6 53 2.2 333 13.6 2 454 Germany West Greece 362 60.2 16 2.7 80 13.3 94 15.6 9 1.5 23 3.8 12 2.0 5 0.8 601 Greece Centre Hungary - - - - - - - - - - - - - - - - - Hungary West Iceland 7 20.6 7 20.6 6 17.6 3 8.8 2 5.9 1 2.9 8 23.5 0 0.0 34 Iceland West Ireland 32 7.5 12 2.8 9 2.1 51 11.9 34 7.9 5 1.2 1 0.2 285 66.4 429 Ireland West Italy 853 65.5 7 0.5 97 7.4 122 9.4 140 10.7 29 2.2 16 1.2 39 3.0 1 303 Italy East Latvia - - - - - - - - - - - - - - - - - Latvia Liechtenstein - - - - - - - - - - - - - - - - - Liechtenstein East Lithuania 108 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 108 Lithuania West Luxembourg 7 15.9 12 27.3 0 0.0 7 15.9 0 0.0 1 2.3 1 2.3 16 36.4 44 Luxembourg West Malta 82 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 82 Malta West Netherlands 216 54.5 14 3.5 41 10.4 40 10.1 56 14.1 13 3.3 13 3.3 3 0.8 396 Netherlands West Norway 37 27.0 5 3.6 34 24.8 24 17.5 11 8.0 20 14.6 6 4.4 0 0.0 137 Norway Centre Poland 394 55.6 1 0.1 44 6.2 1 0.1 0 0.0 1 0.1 0 0.0 268 37.8 709 Poland West Portugal - - - - - - - - - - - - - - - - - Portugal Centre Romania 441 98.7 2 0.4 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 3 0.7 447 Romania Centre Slovakia 19 18.6 0 0.0 8 7.8 0 0.0 2 2.0 0 0.0 0 0.0 73 71.6 102 Slovakia Centre Slovenia 23 85.2 0 0.0 4 14.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 27 Slovenia West Spain 1 041 55.3 52 2.8 55 2.9 71 3.8 423 22.5 8 0.4 190 10.1 44 2.3 1 884 Spain West Sweden 65 18.1 22 6.1 45 12.5 118 32.8 29 8.1 48 13.3 17 4.7 16 4.4 360 Sweden Total EU/EEA 6 937 47.8 422 2.9 1 059 7.3 1 852 12.8 1 171 8.1 368 2.5 518 3.6 2 186 15.1 14 513 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 96 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 96 Albania West Andorra - - - - - - - - - - - - - - - - - Andorra East Armenia 369 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 369 Armenia East Azerbaijan 547 97.9 0 0.0 10 1.8 0 0.0 0 0.0 0 0.0 2 0.4 0 0.0 559 Azerbaijan East Belarus 1 427 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 427 Belarus Centre Bosnia and Herzegovina - - - - - - - - - - - - - - - - - Bosnia and Herzegovina East Georgia 529 99.8 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 530 Georgia West Israel 112 30.9 8 2.2 114 31.4 60 16.5 10 2.8 4 1.1 55 15.2 0 0.0 363 Israel East Kazakhstan 3 336 96.1 0 0.0 114 3.3 0 0.0 0 0.0 1 0.0 21 0.6 0 0.0 3 472 Kazakhstan East Kyrgyzstan 637 94.2 0 0.0 39 5.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 676 Kyrgyzstan East Moldova 675 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 675 Moldova West Monaco - - - - - - - - - - - - - - - - - Monaco Centre Montenegro 14 93.3 0 0.0 1 6.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 15 Montenegro Centre North Macedonia - - - - - - - - - - - - - - - - - North Macedonia East Russia - - - - - - - - - - - - - - - - - Russia West San Marino - - - - - - - - - - - - - - - - - San Marino Centre Serbia 122 99.2 - - 1 0.8 - - - - - - - - - - 123 Serbia Centre Serbia excluding Kosovob 120 99.2 0 0.0 1 0.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 121 Serbia excluding Kosovob Centre Kosovob 2 100.0 - - - - - - - - - - - - - - 2 Kosovob West Switzerland 90 31.3 36 12.5 9 3.1 36 12.5 17 5.9 7 2.4 5 1.7 88 30.6 288 Switzerland East Tajikistan 1 084 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 084 Tajikistan Centre Turkey 1 753 84.4 39 1.9 103 5.0 56 2.7 3 0.1 20 1.0 48 2.3 54 2.6 2 076 Turkey East Turkmenistan - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine 15 658 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 15 658 Ukraine West United Kingdom 798 28.7 185 6.6 210 7.5 587 21.1 203 7.3 173 6.2 50 1.8 579 20.8 2 785 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - Uzbekistan Total non-EU/EEA 27 247 90.2 268 0.9 602 2.0 739 2.4 233 0.8 205 0.7 181 0.6 721 2.4 30 196 Total non-EU/EEA WHO European Region WHO European Region West 6 451 40.9 619 3.9 1 210 7.7 2 506 15.9 1 387 8.8 534 3.4 622 3.9 2 453 15.5 15 782 West Centre 3 294 77.9 70 1.7 273 6.5 84 2.0 15 0.4 37 0.9 54 1.3 399 9.4 4 226 Centre East 24 439 98.9 1 0.0 178 0.7 1 0.0 2 0.0 2 0.0 23 0.1 55 0.2 24 701 East Total WHO European Region 34 184 76.5 690 1.5 1 661 3.7 2 591 5.8 1 404 3.1 573 1.3 699 1.6 2 907 6.5 44 709 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the variables “country of birth”, “country of nationality” or “region of origin” are excluded and therefore regional totals may not equal those presented in Table 1. b Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 52 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 11: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2020 Transmission mode Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-east Asia Other Unknown Total Transmission modeN % N % N % N % N % N % N % N % EU/EEA EU/EEA Sex between men 3 435 59.1 254 4.4 324 5.6 149 2.6 756 13.0 158 2.7 264 4.5 475 8.2 5 815 Men who have sex with men Injecting drug use 306 53.6 15 2.6 129 22.6 9 1.6 5 0.9 11 1.9 23 4.0 73 12.8 571 Injecting drug use Heterosexual contact 1 770 39.8 73 1.6 357 8.0 1 397 31.4 282 6.3 122 2.7 147 3.3 297 6.7 4 445 Heterosexual contact Mother-to-child 29 31.9 4 4.4 4 4.4 42 46.2 1 1.1 2 2.2 9 9.9 91 Mother-to-child Haemophiliac/transfusion recipient 1 4.5 1 4.5 3 13.6 12 54.5 1 4.5 1 4.5 3 13.6 22 Haemophiliac/transfusion recipient Nosocomial infection 1 20.0 2 40.0 1 20.0 1 20.0 5 Nosocomial infection Other/undetermined 1 395 34.7 75 1.9 240 6.0 243 6.0 127 3.2 74 1.8 79 2.0 1 789 44.5 4 022 Other/undetermined Total EU-EEA 6 937 46.3 422 2.8 1 059 7.1 1 852 12.4 1 171 7.8 368 2.5 518 3.5 2 644 17.7 14 971 Total EU-EEA Non-EU/EEA Non-EU/EEA Sex between men 1 883 72.9 125 4.8 126 4.9 43 1.7 161 6.2 83 3.2 48 1.9 114 4.4 2 583 Men who have sex with men Injecting drug use 7 560 98.9 8 0.1 54 0.7 2 0.0 2 0.0 5 0.1 6 0.1 5 0.1 7 642 Injecting drug use Heterosexual contact 15 899 93.4 74 0.4 244 1.4 550 3.2 42 0.2 68 0.4 38 0.2 112 0.7 17 027 Heterosexual contact Mother-to-child 187 87.0 2 0.9 4 1.9 11 5.1 2 0.9 6 2.8 3 1.4 215 Mother-to-child Haemophiliac/transfusion recipient 5 20.0 2 8.0 5 20.0 10 40.0 3 12.0 25 Haemophiliac/transfusion recipient Nosocomial infection 12 60.0 1 5.0 2 10.0 4 20.0 1 5.0 20 Nosocomial infection Other/undetermined 1 701 63.4 56 2.1 167 6.2 119 4.4 26 1.0 39 1.5 86 3.2 490 18.3 2 684 Other/undetermined Total non-EU/EEA 27 247 90.2 268 0.9 602 2.0 739 2.4 233 0.8 205 0.7 181 0.6 721 2.4 30 196 Total non-EU/EEA West West Sex between men 3 478 56.2 356 5.8 393 6.4 189 3.1 905 14.6 232 3.8 299 4.8 333 5.4 6 185 Men who have sex with men Injecting drug use 267 51.3 21 4.0 143 27.5 11 2.1 7 1.3 14 2.7 24 4.6 33 6.3 520 Injecting drug use Heterosexual contact 1 610 32.4 139 2.8 413 8.3 1 910 38.4 321 6.5 181 3.6 169 3.4 228 4.6 4 971 Heterosexual contact Mother-to-child 20 20.8 6 6.3 3 3.1 52 54.2 2 2.1 7 7.3 2 2.1 4 4.2 96 Mother-to-child Haemophiliac/transfusion recipient 4 8.9 3 6.7 8 17.8 22 48.9 1 2.2 4 8.9 3 6.7 45 Haemophiliac/transfusion recipient Nosocomial infection 2 16.7 1 8.3 3 25.0 4 33.3 1 8.3 1 8.3 12 Nosocomial infection Other/undetermined 1 070 27.1 93 2.4 247 6.2 318 8.0 151 3.8 95 2.4 125 3.2 1 854 46.9 3 953 Other/undetermined Total West 6 451 40.9 619 3.9 1 210 7.7 2 506 15.9 1 387 8.8 534 3.4 622 3.9 2 453 15.5 15 782 Total West Centre Centre Sex between men 886 71.6 23 1.9 50 4.0 3 0.2 11 0.9 9 0.7 11 0.9 245 19.8 1 238 Men who have sex with men Injecting drug use 76 78.4 2 2.1 14 14.4 2 2.1 1 1.0 2 2.1 97 Injecting drug use Heterosexual contact 1 011 83.6 7 0.6 74 6.1 36 3.0 2 0.2 9 0.7 6 0.5 65 5.4 1 210 Heterosexual contact Mother-to-child 22 81.5 4 14.8 1 3.7 27 Mother-to-child Haemophiliac/transfusion recipient 1 50.0 1 50.0 2 Haemophiliac/transfusion recipient Nosocomial infection 1 299 70.1 38 2.1 130 7.0 44 2.4 2 0.1 16 0.9 36 1.9 288 15.5 1 853 Nosocomial infection Other/undetermined 3 294 74.4 70 1.6 273 6.2 84 1.9 15 0.3 37 0.8 54 1.2 600 13.6 4 427 Other/undetermined Total Centre Total Centre East East Sex between men 7 523 99.0 26 0.3 4 0.1 43 0.6 7 596 Men who have sex with men Injecting drug use 15 048 98.4 1 0.0 114 0.7 1 0.0 1 0.0 10 0.1 116 0.8 15 291 Injecting drug use Heterosexual contact 174 95.1 1 0.5 3 1.6 5 2.7 183 Heterosexual contact Mother-to-child 2 100.0 2 Mother-to-child Haemophiliac/transfusion recipient 11 100.0 11 Haemophiliac/transfusion recipient Nosocomial infection 727 80.8 30 3.3 2 0.2 4 0.4 137 15.2 900 Nosocomial infection Other/undetermined 24 439 97.9 1 0.0 178 0.7 1 0.0 2 0.0 2 0.0 23 0.1 312 1.3 24 958 Other/undetermined Total East 68 368 75.7 1 380 1.5 3 322 3.7 5 182 5.7 2 808 3.1 1 146 1.3 1 398 1.5 6 730 7.5 90 334 Total East Total WHO European Region 83 246 73.9 1 668 1.5 4 290 3.8 7 596 6.7 3 820 3.4 1 512 1.3 1 492 1.3 9 026 8.0 112 650 Total WHO European Region 53 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 11: HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2020 Transmission mode Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-east Asia Other Unknown Total Transmission modeN % N % N % N % N % N % N % N % EU/EEA EU/EEA Sex between men 3 435 59.1 254 4.4 324 5.6 149 2.6 756 13.0 158 2.7 264 4.5 475 8.2 5 815 Men who have sex with men Injecting drug use 306 53.6 15 2.6 129 22.6 9 1.6 5 0.9 11 1.9 23 4.0 73 12.8 571 Injecting drug use Heterosexual contact 1 770 39.8 73 1.6 357 8.0 1 397 31.4 282 6.3 122 2.7 147 3.3 297 6.7 4 445 Heterosexual contact Mother-to-child 29 31.9 4 4.4 4 4.4 42 46.2 1 1.1 2 2.2 9 9.9 91 Mother-to-child Haemophiliac/transfusion recipient 1 4.5 1 4.5 3 13.6 12 54.5 1 4.5 1 4.5 3 13.6 22 Haemophiliac/transfusion recipient Nosocomial infection 1 20.0 2 40.0 1 20.0 1 20.0 5 Nosocomial infection Other/undetermined 1 395 34.7 75 1.9 240 6.0 243 6.0 127 3.2 74 1.8 79 2.0 1 789 44.5 4 022 Other/undetermined Total EU-EEA 6 937 46.3 422 2.8 1 059 7.1 1 852 12.4 1 171 7.8 368 2.5 518 3.5 2 644 17.7 14 971 Total EU-EEA Non-EU/EEA Non-EU/EEA Sex between men 1 883 72.9 125 4.8 126 4.9 43 1.7 161 6.2 83 3.2 48 1.9 114 4.4 2 583 Men who have sex with men Injecting drug use 7 560 98.9 8 0.1 54 0.7 2 0.0 2 0.0 5 0.1 6 0.1 5 0.1 7 642 Injecting drug use Heterosexual contact 15 899 93.4 74 0.4 244 1.4 550 3.2 42 0.2 68 0.4 38 0.2 112 0.7 17 027 Heterosexual contact Mother-to-child 187 87.0 2 0.9 4 1.9 11 5.1 2 0.9 6 2.8 3 1.4 215 Mother-to-child Haemophiliac/transfusion recipient 5 20.0 2 8.0 5 20.0 10 40.0 3 12.0 25 Haemophiliac/transfusion recipient Nosocomial infection 12 60.0 1 5.0 2 10.0 4 20.0 1 5.0 20 Nosocomial infection Other/undetermined 1 701 63.4 56 2.1 167 6.2 119 4.4 26 1.0 39 1.5 86 3.2 490 18.3 2 684 Other/undetermined Total non-EU/EEA 27 247 90.2 268 0.9 602 2.0 739 2.4 233 0.8 205 0.7 181 0.6 721 2.4 30 196 Total non-EU/EEA West West Sex between men 3 478 56.2 356 5.8 393 6.4 189 3.1 905 14.6 232 3.8 299 4.8 333 5.4 6 185 Men who have sex with men Injecting drug use 267 51.3 21 4.0 143 27.5 11 2.1 7 1.3 14 2.7 24 4.6 33 6.3 520 Injecting drug use Heterosexual contact 1 610 32.4 139 2.8 413 8.3 1 910 38.4 321 6.5 181 3.6 169 3.4 228 4.6 4 971 Heterosexual contact Mother-to-child 20 20.8 6 6.3 3 3.1 52 54.2 2 2.1 7 7.3 2 2.1 4 4.2 96 Mother-to-child Haemophiliac/transfusion recipient 4 8.9 3 6.7 8 17.8 22 48.9 1 2.2 4 8.9 3 6.7 45 Haemophiliac/transfusion recipient Nosocomial infection 2 16.7 1 8.3 3 25.0 4 33.3 1 8.3 1 8.3 12 Nosocomial infection Other/undetermined 1 070 27.1 93 2.4 247 6.2 318 8.0 151 3.8 95 2.4 125 3.2 1 854 46.9 3 953 Other/undetermined Total West 6 451 40.9 619 3.9 1 210 7.7 2 506 15.9 1 387 8.8 534 3.4 622 3.9 2 453 15.5 15 782 Total West Centre Centre Sex between men 886 71.6 23 1.9 50 4.0 3 0.2 11 0.9 9 0.7 11 0.9 245 19.8 1 238 Men who have sex with men Injecting drug use 76 78.4 2 2.1 14 14.4 2 2.1 1 1.0 2 2.1 97 Injecting drug use Heterosexual contact 1 011 83.6 7 0.6 74 6.1 36 3.0 2 0.2 9 0.7 6 0.5 65 5.4 1 210 Heterosexual contact Mother-to-child 22 81.5 4 14.8 1 3.7 27 Mother-to-child Haemophiliac/transfusion recipient 1 50.0 1 50.0 2 Haemophiliac/transfusion recipient Nosocomial infection 1 299 70.1 38 2.1 130 7.0 44 2.4 2 0.1 16 0.9 36 1.9 288 15.5 1 853 Nosocomial infection Other/undetermined 3 294 74.4 70 1.6 273 6.2 84 1.9 15 0.3 37 0.8 54 1.2 600 13.6 4 427 Other/undetermined Total Centre Total Centre East East Sex between men 7 523 99.0 26 0.3 4 0.1 43 0.6 7 596 Men who have sex with men Injecting drug use 15 048 98.4 1 0.0 114 0.7 1 0.0 1 0.0 10 0.1 116 0.8 15 291 Injecting drug use Heterosexual contact 174 95.1 1 0.5 3 1.6 5 2.7 183 Heterosexual contact Mother-to-child 2 100.0 2 Mother-to-child Haemophiliac/transfusion recipient 11 100.0 11 Haemophiliac/transfusion recipient Nosocomial infection 727 80.8 30 3.3 2 0.2 4 0.4 137 15.2 900 Nosocomial infection Other/undetermined 24 439 97.9 1 0.0 178 0.7 1 0.0 2 0.0 2 0.0 23 0.1 312 1.3 24 958 Other/undetermined Total East 68 368 75.7 1 380 1.5 3 322 3.7 5 182 5.7 2 808 3.1 1 146 1.3 1 398 1.5 6 730 7.5 90 334 Total East Total WHO European Region 83 246 73.9 1 668 1.5 4 290 3.8 7 596 6.7 3 820 3.4 1 512 1.3 1 492 1.3 9 026 8.0 112 650 Total WHO European Region 54 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 12: New HIV diagnoses, by country of report and probable region of infection, in 2020, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-east Asia Other Unknown Total Country, territory or areaaN % N % N % N % N % N % N % N % EU/EEA EU/EEA West Austria 8 5.2 1 0.6 2 1.3 1 0.6 1 0.6 0 0.0 0 0.0 142 91.6 155 Austria West Belgium 121 16.6 26 3.6 18 2.5 39 5.4 25 3.4 9 1.2 6 0.8 483 66.4 727 Belgium Centre Bulgaria - - - - - - - - - - - - - - - - - Bulgaria Centre Croatia - - - - - - - - - - - - - - - - - Croatia Centre Cyprus 45 42.9 16 15.2 10 9.5 16 15.2 0 0.0 3 2.9 0 0.0 15 14.3 105 Cyprus Centre Czech Republic 21 8.4 7 2.8 37 14.7 7 2.8 4 1.6 2 0.8 4 1.6 169 67.3 251 Czech Republic West Denmark 57 35.4 15 9.3 7 4.3 22 13.7 8 5.0 19 11.8 3 1.9 30 18.6 161 Denmark East Estonia 74 51.7 2 1.4 7 4.9 1 0.7 1 0.7 2 1.4 1 0.7 55 38.5 143 Estonia West Finland 26 19.1 7 5.1 29 21.3 11 8.1 5 3.7 15 11.0 3 2.2 40 29.4 136 Finland West France 931 27.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 512 73.0 3 443 France West Germany 1 254 51.1 43 1.8 136 5.5 164 6.7 52 2.1 55 2.2 25 1.0 725 29.5 2 454 Germany West Greece - - - - - - - - - - - - - - - - - Greece Centre Hungary - - - - - - - - - - - - - - - - - Hungary West Iceland 8 23.5 8 23.5 5 14.7 3 8.8 1 2.9 1 2.9 2 5.9 6 17.6 34 Iceland West Ireland 9 2.1 8 1.9 4 0.9 14 3.3 12 2.8 3 0.7 2 0.5 377 87.9 429 Ireland West Italy - - - - - - - - - - - - - - - - - Italy East Latvia 101 39.3 6 2.3 2 0.8 0 0.0 0 0.0 0 0.0 1 0.4 147 57.2 257 Latvia Liechtenstein - - - - - - - - - - - - - - - - - Liechtenstein East Lithuania - - - - - - - - - - - - - - - - - Lithuania West Luxembourg 12 27.3 0 0.0 0 0.0 0 0.0 0 0.0 1 2.3 0 0.0 31 70.5 44 Luxembourg West Malta - - - - - - - - - - - - - - - - - Malta West Netherlands 244 61.6 10 2.5 10 2.5 18 4.5 11 2.8 8 2.0 5 1.3 90 22.7 396 Netherlands West Norway 29 21.2 19 13.9 23 16.8 24 17.5 8 5.8 26 19.0 6 4.4 2 1.5 137 Norway Centre Poland - - - - - - - - - - - - - - - - - Poland West Portugal - - - - - - - - - - - - - - - - - Portugal Centre Romania 441 98.7 2 0.4 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 3 0.7 447 Romania Centre Slovakia 0 0.0 0 0.0 7 6.9 0 0.0 0 0.0 0 0.0 0 0.0 95 93.1 102 Slovakia Centre Slovenia 14 51.9 2 7.4 2 7.4 1 3.7 0 0.0 0 0.0 0 0.0 8 29.6 27 Slovenia West Spain - - - - - - - - - - - - - - - - - Spain West Sweden 54 15.0 42 11.7 33 9.2 108 30.0 25 6.9 65 18.1 15 4.2 18 5.0 360 Sweden Total EU/EEA 3 449 35.2 214 2.2 332 3.4 429 4.4 153 1.6 209 2.1 74 0.8 4 948 50.4 9 808 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 96 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 96 Albania West Andorra - - - - - - - - - - - - - - - - - Andorra East Armenia 185 50.1 1 0.3 133 36.0 0 0.0 0 0.0 0 0.0 4 1.1 46 12.5 369 Armenia East Azerbaijan 547 97.9 0 0.0 10 1.8 0 0.0 0 0.0 0 0.0 2 0.4 0 0.0 559 Azerbaijan East Belarus 1 426 99.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.1 1 427 Belarus Centre Bosnia and Herzegovina - - - - - - - - - - - - - - - - - Bosnia and Herzegovina East Georgia 286 54.0 16 3.0 98 18.5 1 0.2 0 0.0 0 0.0 3 0.6 126 23.8 530 Georgia West Israel 198 54.5 4 1.1 54 14.9 32 8.8 8 2.2 4 1.1 7 1.9 56 15.4 363 Israel East Kazakhstan 3 336 96.1 0 0.0 114 3.3 0 0.0 0 0.0 1 0.0 0 0.0 21 0.6 3 472 Kazakhstan East Kyrgyzstan 623 92.2 0 0.0 3 0.4 0 0.0 0 0.0 0 0.0 0 0.0 50 7.4 676 Kyrgyzstan East Moldova 594 88.0 0 0.0 19 2.8 0 0.0 0 0.0 0 0.0 0 0.0 62 9.2 675 Moldova West Monaco - - - - - - - - - - - - - - - - - Monaco Centre Montenegro - - - - - - - - - - - - - - - - - Montenegro Centre North Macedonia - - - - - - - - - - - - - - - - - North Macedonia East Russia - - - - - - - - - - - - - - - - - Russia West San Marino - - - - - - - - - - - - - - - - - San Marino Centre Serbia - - - - - - - - - - - - - - - - - Serbia Centre Serbia excluding Kosovob - - - - - - - - - - - - - - - - - Serbia excluding Kosovob Centre Kosovob - - - - - - - - - - - - - - - - - Kosovob West Switzerland 75 26.0 15 5.2 6 2.1 20 6.9 10 3.5 9 3.1 5 1.7 148 51.4 288 Switzerland East Tajikistan - - - - - - - - - - - - - - - - - Tajikistan Centre Turkey - - - - - - - - - - - - - - - - - Turkey East Turkmenistan - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine - - - - - - - - - - - - - - - - - Ukraine West United Kingdom 924 33.2 181 6.5 108 3.9 432 15.5 107 3.8 169 6.1 54 1.9 810 29.1 2 785 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - Uzbekistan Total non-EU/EEA 8 290 73.8 217 1.9 545 4.8 485 4.3 125 1.1 183 1.6 75 0.7 1 320 11.7 11 240 Total non-EU/EEA WHO European Region WHO European Region West 3 950 33.2 379 3.2 435 3.7 888 7.5 273 2.3 384 3.2 133 1.1 5 470 45.9 11 912 West Centre 617 60.0 27 2.6 56 5.4 24 2.3 4 0.4 5 0.5 5 0.5 290 28.2 1 028 Centre East 7 172 88.5 25 0.3 386 4.8 2 0.0 1 0.0 3 0.0 11 0.1 508 6.3 8 108 East Total WHO European Region 11 739 55.8 431 2.0 877 4.2 914 4.3 278 1.3 392 1.9 149 0.7 6 268 29.8 21 048 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the optional variable “probable country of infection” are excluded and therefore regional totals may not equal those presented in Table 1. b 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 2021 – 2020 dataSURVEILLANCE REPORT Table 12: New HIV diagnoses, by country of report and probable region of infection, in 2020, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Country of report Western Europe Central & Eastern Europe Sub-Saharan Africa Latin America & Caribbean South & South-east Asia Other Unknown Total Country, territory or areaaN % N % N % N % N % N % N % N % EU/EEA EU/EEA West Austria 8 5.2 1 0.6 2 1.3 1 0.6 1 0.6 0 0.0 0 0.0 142 91.6 155 Austria West Belgium 121 16.6 26 3.6 18 2.5 39 5.4 25 3.4 9 1.2 6 0.8 483 66.4 727 Belgium Centre Bulgaria - - - - - - - - - - - - - - - - - Bulgaria Centre Croatia - - - - - - - - - - - - - - - - - Croatia Centre Cyprus 45 42.9 16 15.2 10 9.5 16 15.2 0 0.0 3 2.9 0 0.0 15 14.3 105 Cyprus Centre Czech Republic 21 8.4 7 2.8 37 14.7 7 2.8 4 1.6 2 0.8 4 1.6 169 67.3 251 Czech Republic West Denmark 57 35.4 15 9.3 7 4.3 22 13.7 8 5.0 19 11.8 3 1.9 30 18.6 161 Denmark East Estonia 74 51.7 2 1.4 7 4.9 1 0.7 1 0.7 2 1.4 1 0.7 55 38.5 143 Estonia West Finland 26 19.1 7 5.1 29 21.3 11 8.1 5 3.7 15 11.0 3 2.2 40 29.4 136 Finland West France 931 27.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 512 73.0 3 443 France West Germany 1 254 51.1 43 1.8 136 5.5 164 6.7 52 2.1 55 2.2 25 1.0 725 29.5 2 454 Germany West Greece - - - - - - - - - - - - - - - - - Greece Centre Hungary - - - - - - - - - - - - - - - - - Hungary West Iceland 8 23.5 8 23.5 5 14.7 3 8.8 1 2.9 1 2.9 2 5.9 6 17.6 34 Iceland West Ireland 9 2.1 8 1.9 4 0.9 14 3.3 12 2.8 3 0.7 2 0.5 377 87.9 429 Ireland West Italy - - - - - - - - - - - - - - - - - Italy East Latvia 101 39.3 6 2.3 2 0.8 0 0.0 0 0.0 0 0.0 1 0.4 147 57.2 257 Latvia Liechtenstein - - - - - - - - - - - - - - - - - Liechtenstein East Lithuania - - - - - - - - - - - - - - - - - Lithuania West Luxembourg 12 27.3 0 0.0 0 0.0 0 0.0 0 0.0 1 2.3 0 0.0 31 70.5 44 Luxembourg West Malta - - - - - - - - - - - - - - - - - Malta West Netherlands 244 61.6 10 2.5 10 2.5 18 4.5 11 2.8 8 2.0 5 1.3 90 22.7 396 Netherlands West Norway 29 21.2 19 13.9 23 16.8 24 17.5 8 5.8 26 19.0 6 4.4 2 1.5 137 Norway Centre Poland - - - - - - - - - - - - - - - - - Poland West Portugal - - - - - - - - - - - - - - - - - Portugal Centre Romania 441 98.7 2 0.4 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 3 0.7 447 Romania Centre Slovakia 0 0.0 0 0.0 7 6.9 0 0.0 0 0.0 0 0.0 0 0.0 95 93.1 102 Slovakia Centre Slovenia 14 51.9 2 7.4 2 7.4 1 3.7 0 0.0 0 0.0 0 0.0 8 29.6 27 Slovenia West Spain - - - - - - - - - - - - - - - - - Spain West Sweden 54 15.0 42 11.7 33 9.2 108 30.0 25 6.9 65 18.1 15 4.2 18 5.0 360 Sweden Total EU/EEA 3 449 35.2 214 2.2 332 3.4 429 4.4 153 1.6 209 2.1 74 0.8 4 948 50.4 9 808 Total EU/EEA Non-EU/EEA Non-EU/EEA Centre Albania 96 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 96 Albania West Andorra - - - - - - - - - - - - - - - - - Andorra East Armenia 185 50.1 1 0.3 133 36.0 0 0.0 0 0.0 0 0.0 4 1.1 46 12.5 369 Armenia East Azerbaijan 547 97.9 0 0.0 10 1.8 0 0.0 0 0.0 0 0.0 2 0.4 0 0.0 559 Azerbaijan East Belarus 1 426 99.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.1 1 427 Belarus Centre Bosnia and Herzegovina - - - - - - - - - - - - - - - - - Bosnia and Herzegovina East Georgia 286 54.0 16 3.0 98 18.5 1 0.2 0 0.0 0 0.0 3 0.6 126 23.8 530 Georgia West Israel 198 54.5 4 1.1 54 14.9 32 8.8 8 2.2 4 1.1 7 1.9 56 15.4 363 Israel East Kazakhstan 3 336 96.1 0 0.0 114 3.3 0 0.0 0 0.0 1 0.0 0 0.0 21 0.6 3 472 Kazakhstan East Kyrgyzstan 623 92.2 0 0.0 3 0.4 0 0.0 0 0.0 0 0.0 0 0.0 50 7.4 676 Kyrgyzstan East Moldova 594 88.0 0 0.0 19 2.8 0 0.0 0 0.0 0 0.0 0 0.0 62 9.2 675 Moldova West Monaco - - - - - - - - - - - - - - - - - Monaco Centre Montenegro - - - - - - - - - - - - - - - - - Montenegro Centre North Macedonia - - - - - - - - - - - - - - - - - North Macedonia East Russia - - - - - - - - - - - - - - - - - Russia West San Marino - - - - - - - - - - - - - - - - - San Marino Centre Serbia - - - - - - - - - - - - - - - - - Serbia Centre Serbia excluding Kosovob - - - - - - - - - - - - - - - - - Serbia excluding Kosovob Centre Kosovob - - - - - - - - - - - - - - - - - Kosovob West Switzerland 75 26.0 15 5.2 6 2.1 20 6.9 10 3.5 9 3.1 5 1.7 148 51.4 288 Switzerland East Tajikistan - - - - - - - - - - - - - - - - - Tajikistan Centre Turkey - - - - - - - - - - - - - - - - - Turkey East Turkmenistan - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine - - - - - - - - - - - - - - - - - Ukraine West United Kingdom 924 33.2 181 6.5 108 3.9 432 15.5 107 3.8 169 6.1 54 1.9 810 29.1 2 785 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - Uzbekistan Total non-EU/EEA 8 290 73.8 217 1.9 545 4.8 485 4.3 125 1.1 183 1.6 75 0.7 1 320 11.7 11 240 Total non-EU/EEA WHO European Region WHO European Region West 3 950 33.2 379 3.2 435 3.7 888 7.5 273 2.3 384 3.2 133 1.1 5 470 45.9 11 912 West Centre 617 60.0 27 2.6 56 5.4 24 2.3 4 0.4 5 0.5 5 0.5 290 28.2 1 028 Centre East 7 172 88.5 25 0.3 386 4.8 2 0.0 1 0.0 3 0.0 11 0.1 508 6.3 8 108 East Total WHO European Region 11 739 55.8 431 2.0 877 4.2 914 4.3 278 1.3 392 1.9 149 0.7 6 268 29.8 21 048 Total WHO European Region a Country-specific comments are in Annex 5. Countries that do not report on the optional variable “probable country of infection” are excluded and therefore regional totals may not equal those presented in Table 1. b 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 2021 – 2020 dataSURVEILLANCE REPORT Table 13: Percentage of new HIV diagnoses (2020) among persons >14 years reported with information about CD4 cell count, by CD4 cell count level (<200 and <350 cells per mm3 blood) and by transmission mode in cases with CD4 <350, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Number of cases with CD4 Completeness (%) CD4b CD4 <200 (%) CD4 <350 (%) CD4 < 350 per mm3 blood (%) N % N % Heterob IDUb MSMb EU/EEA West Austria 153 98.7 42 27.5 84 54.9 58.2 75.0 46.5 West Belgium 500 69.7 105 21.0 203 40.6 49.8 33.3 28.4 Centre Bulgaria 158 81.4 52 32.9 89 56.3 64.7 44.4 50.6 Centre Croatia 15 19.7 1 6.7 6 40.0 50.0 - 38.5 Centre Cyprus 104 99.0 22 21.2 31 29.8 35.3 50.0 21.3 Centre Czech Republic 231 92.0 57 24.7 96 41.6 44.9 36.4 38.5 West Denmarkc 95 88.8 46 48.4 58 61.1 78.6 100.0 44.0 East Estonia 25 17.9 8 32.0 12 48.0 52.2 - - West Finland 91 67.9 29 31.9 46 50.5 56.8 50.0 40.6 West France 1 972 57.7 584 29.6 1 025 52.0 58.5 66.7 40.3 West Germany 732 30.1 276 37.7 383 52.3 60.4 31.9 42.2 West Greece 423 70.7 134 31.7 214 50.6 66.0 50.0 36.2 Centre Hungary - - - - - - - - - West Iceland 30 88.2 6 20.0 10 33.3 50.0 - 11.8 West Irelandc 45 13.2 19 42.2 25 55.6 53.3 - 52.4 West Italy 1 223 93.9 502 41.0 734 60.0 67.6 54.8 53.3 East Latvia 87 34.5 34 39.1 51 58.6 61.2 57.1 50.0 Liechtenstein - - - - - - - - - East Lithuania - - - - - - - - - West Luxembourg 24 88.9 9 37.5 12 50.0 80.0 - 10.0 West Malta - - - - - - - - - West Netherlands 371 93.7 108 29.1 190 51.2 63.3 - 41.2 West Norway - - - - - - - - - Centre Poland - - - - - - - - - West Portugal - - - - - - - - - Centre Romania 407 92.5 141 34.6 228 56.0 61.7 67.6 42.3 Centre Slovakia 33 33.0 2 6.1 13 39.4 60.0 - 33.3 Centre Slovenia 24 92.3 7 29.2 13 54.2 75.0 - 42.9 West Spain 1 629 86.5 454 27.9 767 47.1 55.2 54.8 39.6 West Sweden 249 70.3 61 24.5 106 42.6 45.2 36.4 37.3 Total EU/EEA 8 617 63.9 2 699 31.3 4 396 51.0 59.0 51.7 41.1 Non-EU/EEA Centre Albania 36 37.9 12 33.3 25 69.4 76.7 - 33.3 West Andorra - - - - - - - - - East Armenia 297 82.5 136 45.8 184 62.0 63.3 82.4 41.2 East Azerbaijan 459 82.7 100 21.8 186 40.5 41.0 42.3 35.3 East Belarus 1 105 77.9 198 17.9 398 36.0 37.4 37.9 12.0 Centre Bosnia and Herzegovina - - - - - - - - - East Georgia 447 85.0 130 29.1 228 51.0 52.4 56.0 43.3 West Israel 189 52.4 52 27.5 87 46.0 56.3 66.7 35.1 East Kazakhstan 2 884 83.7 591 20.5 1 273 44.1 49.3 31.0 51.0 East Kyrgyzstan 452 69.0 136 30.1 253 56.0 59.0 62.5 32.4 East Moldova 548 82.5 188 34.3 284 51.8 48.7 31.3 38.9 West Monaco - - - - - - - - - Centre Montenegro 10 66.7 2 20.0 3 30.0 - - - Centre North Macedonia - - - - - - - - - East Russia 57 071 95.7 7 658 12.8 16 150 27.1 - - - West San Marino - - - - - - - - - Centre Serbia 109 88.6 46 42.2 61 56.0 66.7 - 54.3 Centre Serbia excluding Kosovod 107 88.4 46 43.0 61 57.0 75.0 - 54.9 Centre Kosovod 2 100.0 - - - - - - - West Switzerland 168 59.4 57 33.9 88 52.4 53.1 33.3 52.2 East Tajikistan 251 25.1 39 15.5 107 42.6 39.2 65.4 25.0 Centre Turkey 565 27.4 70 12.4 207 36.6 45.9 33.3 37.4 East Turkmenistan - - - - - - - - - East Ukraine 13 791 88.5 4 479 32.5 7 513 54.5 60.9 44.5 50.7 West United Kingdom 2 408 86.8 568 23.6 1 005 41.7 47.5 50.0 34.2 East Uzbekistan - - - - - - - - - Total non-EU/EEA 80 790 85.5 14 462 17.9 28 052 34.7 56.1 42.8 44.2 WHO European Region West 10 298 66.5 3 052 29.6 5 037 48.9 59.1 50.6 41.4 Centre 1 692 48.5 412 24.3 772 45.6 55.3 54.7 41.0 East 77 417 92.4 13 697 17.7 26 639 34.4 56.2 42.8 44.5 Total WHO European Region 89 407 87.0 17 161 19.2 32 448 36.3 56.7 43.2 41.8 a Country-specific comments are in Annex 5. b There is some variation by country for CD4 cell count completeness by transmission group and numbers of cases by transmission group (MSM - men who have sex with men, heterosexual, IDU - injecting drug use) and therefore percentages based on 5 or less cases are censored. c People who were previously diagnosed HIV positive abroad are excluded in numbers reported for Denmark and Ireland and the data presented in the Table are therefore not comparable with other countries. d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 58 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 14: AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 1982 79 0.9 102 1.2 69 0.8 83 1.0 75 0.9 68 0.8 63 0.7 53 0.6 58 0.7 43 0.5 3 360 Austria West Belgium 1983 100 0.9 108 1.0 100 0.9 121 1.1 95 0.8 63 0.6 52 0.5 54 0.5 67 0.6 40 0.3 5 151 Belgium Centre Bulgaria 1987 40 0.5 65 0.9 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 57 0.8 68 1.0 43 0.6 833 Bulgaria Centre Croatia 1986 26 0.6 28 0.7 17 0.4 23 0.5 16 0.4 22 0.5 20 0.5 30 0.7 20 0.5 12 0.3 523 Croatia Centre Cyprus 1986 12 1.4 11 1.3 9 1.0 11 1.3 13 1.5 22 2.6 15 1.8 13 1.5 14 1.6 18 2.0 373 Cyprus Centre Czech Republic 1986 29 0.3 36 0.3 33 0.3 32 0.3 38 0.4 44 0.4 54 0.5 39 0.4 38 0.4 43 0.4 719 Czech Republic West Denmark 1980 59 1.1 41 0.7 38 0.7 30 0.5 40 0.7 24 0.4 28 0.5 26 0.4 22 0.4 25 0.4 2 824 Denmark East Estonia 1992 38 2.9 36 2.7 26 2.0 18 1.4 18 1.4 40 3.0 20 1.5 25 1.9 30 2.3 23 1.7 590 Estonia West Finland 1983 24 0.4 19 0.4 20 0.4 20 0.4 18 0.3 30 0.5 18 0.3 21 0.4 18 0.3 12 0.2 755 Finland West France 1982 874 1.3 838 1.3 727 1.1 655 1.0 611 0.9 520 0.8 501 0.7 540 0.8 559 0.8 388 0.6 73 570 France West Germany 1981 518 0.6 511 0.6 441 0.5 393 0.5 362 0.4 310 0.4 295 0.4 242 0.3 74 0.1 - - 32 203 Germany West Greece 1981 101 0.9 123 1.1 141 1.3 128 1.2 139 1.3 142 1.3 120 1.1 102 0.9 92 0.9 100 0.9 4 209 Greece Centre Hungary 1986 32 0.3 48 0.5 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 57 0.6 53 0.5 42 0.4 1 096 Hungary West Iceland 1985 2 0.6 1 0.3 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 2 0.6 4 1.1 2 0.5 79 Iceland West Ireland 1983 47 1.0 38 0.8 30 0.7 33 0.7 21 0.4 14 0.3 21 0.4 15 0.3 7 0.1 6 0.1 1 313 Ireland West Italy 1982 1 058 1.8 1 074 1.8 1 078 1.8 931 1.5 872 1.4 873 1.4 800 1.3 716 1.2 605 1.0 352 0.7 71 591 Italy East Latvia 1990 112 5.4 142 6.9 133 6.6 171 8.5 132 6.6 114 5.8 118 6.1 99 5.1 90 4.7 55 2.9 2 132 Latvia Liechtenstein 1989 1 2.8 1 2.7 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 Liechtenstein East Lithuania 1988 21 0.7 38 1.3 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 37 1.3 21 0.8 15 0.5 625 Lithuania West Luxembourg 1983 12 2.3 8 1.5 11 2.0 10 1.8 10 1.8 12 2.1 6 1.0 4 0.7 4 0.7 5 0.8 340 Luxembourg West Malta 1986 5 1.2 6 1.4 1 0.2 4 0.9 2 0.5 5 1.1 0 0.0 0 0.0 0 0.0 0 0.0 114 Malta West Netherlands 1999 268 1.6 301 1.8 271 1.6 222 1.3 253 1.5 209 1.2 196 1.1 178 1.0 152 0.9 115 0.7 7 786 Netherlands West Norway 1983 19 0.4 25 0.5 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 12 0.2 19 0.4 11 0.2 1 214 Norway Centre Poland 1986 184 0.5 157 0.4 162 0.4 148 0.4 128 0.3 102 0.3 109 0.3 111 0.3 95 0.3 34 0.1 3 815 Poland West Portugal 1985 654 6.2 625 5.9 528 5.0 382 3.7 344 3.3 381 3.7 297 2.9 259 2.5 188 1.8 - - 22 880 Portugal Centre Romania 1985 336 1.7 340 1.7 362 1.8 413 2.1 360 1.8 343 1.7 323 1.6 311 1.6 302 1.6 166 0.9 10 801 Romania Centre Slovakia 1985 4 0.1 7 0.1 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 11 0.2 3 0.1 4 0.1 123 Slovakia Centre Slovenia 1986 15 0.7 12 0.6 11 0.5 17 0.8 11 0.5 10 0.5 7 0.3 10 0.5 9 0.4 6 0.3 285 Slovenia West Spain 1981 1 293 2.8 1 175 2.5 858 1.8 678 1.6 607 1.8 539 1.6 510 1.5 367 1.1 250 0.6 200 0.6 88 340 Spain West Sweden 1982 - - - - - - - - - - - - - - - - - - - - 2 174 Sweden Total EU/EEA 5 963 1.3 5 916 1.3 5 258 1.2 4 725 1.1 4 318 1.0 4 066 0.9 3 751 0.9 3 391 0.8 2 862 0.6 1 760 0.5 339 830 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 46 1.6 49 1.7 65 2.2 50 1.7 65 2.2 58 2.0 33 1.1 47 1.6 40 1.4 15 0.5 664 Albania West Andorra 2004 1 1.2 0 0.0 3 3.7 0 0.0 3 3.8 0 0.0 2 2.6 0 0.0 - - - - 15 Andorra East Armenia 1988 87 3.0 136 4.7 144 5.0 174 6.0 163 5.6 163 5.6 144 4.9 211 7.1 153 5.2 152 5.1 1 998 Armenia East Azerbaijan 1995 195 2.1 235 2.5 189 2.0 200 2.1 193 2.0 161 1.7 168 1.7 182 1.8 196 2.0 105 1.0 2 629 Azerbaijan East Belarus 1991 590 6.3 598 6.4 547 5.8 474 5.0 490 5.2 512 5.4 439 4.6 382 4.0 380 4 220 2.3 7 061 Belarus Centre Bosnia and Herzegovina 1986 7 0.2 4 0.1 7 0.2 7 0.2 7 0.2 7 0.2 4 0.1 11 0.3 8 0.2 - - 171 Bosnia and Herzegovina East Georgia 1989 395 9.7 359 8.8 303 7.5 268 6.6 270 6.7 269 6.7 257 6.4 273 6.8 264 6.6 181 4.5 4 446 Georgia West Israel 1981 55 0.7 52 0.7 47 0.6 70 0.9 45 0.6 47 0.6 33 0.4 39 0.5 24 0.3 29 0.3 1 773 Israel East Kazakhstan 1993 241 1.5 237 1.4 258 1.5 251 1.5 273 1.6 349 2.0 362 2.0 432 2.4 451 2.4 469 2.5 4 585 Kazakhstan East Kyrgyzstan 1999 90 1.6 88 1.6 67 1.2 85 1.5 125 2.1 72 1.2 59 1.0 56 0.9 46 0.7 46 0.7 1 086 Kyrgyzstan East Moldova 1989 449 11.0 250 6.1 377 9.3 299 7.3 293 7.2 366 9.0 274 6.7 365 9.0 285 7.0 194 4.8 4 629 Moldova West Monaco 1985 0 0.0 0 0.0 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 - - - - 51 Monaco Centre Montenegro 1990 2 0.3 7 1.1 7 1.1 7 1.1 11 1.8 15 2.4 13 2.1 14 2.2 10 1.6 4 0.6 166 Montenegro Centre North Macedonia 1989 8 0.4 10 0.5 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 4 0.2 - - - - 170 North Macedonia East Russia 2009 - - - - - - - - - - - - - - - - - - - - 0 Russia West San Marino 1986 1 3.2 2 6.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 San Marino Centre Serbia 1985 60 0.7 57 0.6 49 0.5 49 0.6 50 0.6 61 0.7 65 0.7 70 0.8 75 0.7 34 0.3 2 155 Serbia Centre Serbia excluding Kosovoc 1985 53 0.7 55 0.8 46 0.6 48 0.7 47 0.7 56 0.8 59 0.8 62 0.9 70 0.8 32 0.4 2 068 Serbia excluding Kosovoc Centre Kosovoc 2005 7 0.4 2 0.1 3 0.2 1 0.1 3 0.2 5 0.3 6 0.3 8 0.4 5 0.3 2 0.1 87 Kosovoc West Switzerland 1980 135 1.7 98 1.2 105 1.3 77 0.9 64 0.8 70 0.8 71 0.8 63 0.7 67 0.8 33 0.4 10 139 Switzerland East Tajikistan 1998 147 1.9 183 2.3 191 2.4 227 2.8 279 3.3 236 2.7 265 3.0 208 2.3 155 1.7 106 1.1 2 301 Tajikistan Centre Turkey 1985 81 0.1 95 0.1 96 0.1 125 0.2 118 0.2 99 0.1 121 0.1 108 0.1 112 0.1 46 0.1 1 843 Turkey East Turkmenistan 2002 0 0.0 0 0.0 - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 1988 9 189 20.1 10 073 22.2 9 362 20.7 9 844 21.8 8 468 19.8 8 852 20.8 9 308 21.9 8 839 20.9 7 511 17.9 4 139 9.9 122 696 Ukraine West United Kingdom 1981 419 0.7 435 0.7 348 0.5 369 0.6 404 0.6 300 0.5 263 0.4 256 0.4 270 0.4 188 0.3 30 422 United Kingdom East Uzbekistan 1992 - - - - - - - - - - - - - - - - - - - - 651 Uzbekistan Total non-EU/EEA 12 198 4.4 12 968 4.7 12 175 4.3 12 593 4.4 11 327 4.0 11 646 4.1 11 883 4.1 11 560 4.0 10 047 3.4 5 961 2.1 199 675 Total non-EU/EEA WHO European Region WHO European Region West 5 724 1.4 5 582 1.3 4 845 1.1 4 252 1.0 3 987 1.0 3 633 0.9 3 290 0.8 2 949 0.7 2 480 0.6 1 549 0.5 360 326 West Centre 882 0.5 926 0.5 947 0.5 1 017 0.5 919 0.5 897 0.5 876 0.4 893 0.5 847 0.4 467 0.2 23 737 Centre East 11 554 10.4 12 375 11.1 11 641 10.4 12 048 10.7 10 739 9.7 11 182 10.0 11 468 10.2 11 109 9.9 9 582 8.4 5 705 5.0 155 430 East Total WHO European Region 18 160 2.5 18 883 2.6 17 433 2.4 17 317 2.4 15 645 2.2 15 712 2.2 15 634 2.2 14 951 2.0 12 909 1.7 7 721 1.2 539 493 Total WHO European Region a Country-specific comments are in Annex 5 b Cumulative total is the total number of cases reported by the country since the start of reporting c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 59 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 14: AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of start of reporting 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 1982 79 0.9 102 1.2 69 0.8 83 1.0 75 0.9 68 0.8 63 0.7 53 0.6 58 0.7 43 0.5 3 360 Austria West Belgium 1983 100 0.9 108 1.0 100 0.9 121 1.1 95 0.8 63 0.6 52 0.5 54 0.5 67 0.6 40 0.3 5 151 Belgium Centre Bulgaria 1987 40 0.5 65 0.9 71 1.0 64 0.9 45 0.6 42 0.6 49 0.7 57 0.8 68 1.0 43 0.6 833 Bulgaria Centre Croatia 1986 26 0.6 28 0.7 17 0.4 23 0.5 16 0.4 22 0.5 20 0.5 30 0.7 20 0.5 12 0.3 523 Croatia Centre Cyprus 1986 12 1.4 11 1.3 9 1.0 11 1.3 13 1.5 22 2.6 15 1.8 13 1.5 14 1.6 18 2.0 373 Cyprus Centre Czech Republic 1986 29 0.3 36 0.3 33 0.3 32 0.3 38 0.4 44 0.4 54 0.5 39 0.4 38 0.4 43 0.4 719 Czech Republic West Denmark 1980 59 1.1 41 0.7 38 0.7 30 0.5 40 0.7 24 0.4 28 0.5 26 0.4 22 0.4 25 0.4 2 824 Denmark East Estonia 1992 38 2.9 36 2.7 26 2.0 18 1.4 18 1.4 40 3.0 20 1.5 25 1.9 30 2.3 23 1.7 590 Estonia West Finland 1983 24 0.4 19 0.4 20 0.4 20 0.4 18 0.3 30 0.5 18 0.3 21 0.4 18 0.3 12 0.2 755 Finland West France 1982 874 1.3 838 1.3 727 1.1 655 1.0 611 0.9 520 0.8 501 0.7 540 0.8 559 0.8 388 0.6 73 570 France West Germany 1981 518 0.6 511 0.6 441 0.5 393 0.5 362 0.4 310 0.4 295 0.4 242 0.3 74 0.1 - - 32 203 Germany West Greece 1981 101 0.9 123 1.1 141 1.3 128 1.2 139 1.3 142 1.3 120 1.1 102 0.9 92 0.9 100 0.9 4 209 Greece Centre Hungary 1986 32 0.3 48 0.5 42 0.4 51 0.5 43 0.4 53 0.5 52 0.5 57 0.6 53 0.5 42 0.4 1 096 Hungary West Iceland 1985 2 0.6 1 0.3 1 0.3 0 0.0 0 0.0 4 1.2 0 0.0 2 0.6 4 1.1 2 0.5 79 Iceland West Ireland 1983 47 1.0 38 0.8 30 0.7 33 0.7 21 0.4 14 0.3 21 0.4 15 0.3 7 0.1 6 0.1 1 313 Ireland West Italy 1982 1 058 1.8 1 074 1.8 1 078 1.8 931 1.5 872 1.4 873 1.4 800 1.3 716 1.2 605 1.0 352 0.7 71 591 Italy East Latvia 1990 112 5.4 142 6.9 133 6.6 171 8.5 132 6.6 114 5.8 118 6.1 99 5.1 90 4.7 55 2.9 2 132 Latvia Liechtenstein 1989 1 2.8 1 2.7 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 Liechtenstein East Lithuania 1988 21 0.7 38 1.3 44 1.5 37 1.3 35 1.2 48 1.7 54 1.9 37 1.3 21 0.8 15 0.5 625 Lithuania West Luxembourg 1983 12 2.3 8 1.5 11 2.0 10 1.8 10 1.8 12 2.1 6 1.0 4 0.7 4 0.7 5 0.8 340 Luxembourg West Malta 1986 5 1.2 6 1.4 1 0.2 4 0.9 2 0.5 5 1.1 0 0.0 0 0.0 0 0.0 0 0.0 114 Malta West Netherlands 1999 268 1.6 301 1.8 271 1.6 222 1.3 253 1.5 209 1.2 196 1.1 178 1.0 152 0.9 115 0.7 7 786 Netherlands West Norway 1983 19 0.4 25 0.5 28 0.6 45 0.9 22 0.4 22 0.4 14 0.3 12 0.2 19 0.4 11 0.2 1 214 Norway Centre Poland 1986 184 0.5 157 0.4 162 0.4 148 0.4 128 0.3 102 0.3 109 0.3 111 0.3 95 0.3 34 0.1 3 815 Poland West Portugal 1985 654 6.2 625 5.9 528 5.0 382 3.7 344 3.3 381 3.7 297 2.9 259 2.5 188 1.8 - - 22 880 Portugal Centre Romania 1985 336 1.7 340 1.7 362 1.8 413 2.1 360 1.8 343 1.7 323 1.6 311 1.6 302 1.6 166 0.9 10 801 Romania Centre Slovakia 1985 4 0.1 7 0.1 6 0.1 4 0.1 8 0.1 10 0.2 9 0.2 11 0.2 3 0.1 4 0.1 123 Slovakia Centre Slovenia 1986 15 0.7 12 0.6 11 0.5 17 0.8 11 0.5 10 0.5 7 0.3 10 0.5 9 0.4 6 0.3 285 Slovenia West Spain 1981 1 293 2.8 1 175 2.5 858 1.8 678 1.6 607 1.8 539 1.6 510 1.5 367 1.1 250 0.6 200 0.6 88 340 Spain West Sweden 1982 - - - - - - - - - - - - - - - - - - - - 2 174 Sweden Total EU/EEA 5 963 1.3 5 916 1.3 5 258 1.2 4 725 1.1 4 318 1.0 4 066 0.9 3 751 0.9 3 391 0.8 2 862 0.6 1 760 0.5 339 830 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 1993 46 1.6 49 1.7 65 2.2 50 1.7 65 2.2 58 2.0 33 1.1 47 1.6 40 1.4 15 0.5 664 Albania West Andorra 2004 1 1.2 0 0.0 3 3.7 0 0.0 3 3.8 0 0.0 2 2.6 0 0.0 - - - - 15 Andorra East Armenia 1988 87 3.0 136 4.7 144 5.0 174 6.0 163 5.6 163 5.6 144 4.9 211 7.1 153 5.2 152 5.1 1 998 Armenia East Azerbaijan 1995 195 2.1 235 2.5 189 2.0 200 2.1 193 2.0 161 1.7 168 1.7 182 1.8 196 2.0 105 1.0 2 629 Azerbaijan East Belarus 1991 590 6.3 598 6.4 547 5.8 474 5.0 490 5.2 512 5.4 439 4.6 382 4.0 380 4 220 2.3 7 061 Belarus Centre Bosnia and Herzegovina 1986 7 0.2 4 0.1 7 0.2 7 0.2 7 0.2 7 0.2 4 0.1 11 0.3 8 0.2 - - 171 Bosnia and Herzegovina East Georgia 1989 395 9.7 359 8.8 303 7.5 268 6.6 270 6.7 269 6.7 257 6.4 273 6.8 264 6.6 181 4.5 4 446 Georgia West Israel 1981 55 0.7 52 0.7 47 0.6 70 0.9 45 0.6 47 0.6 33 0.4 39 0.5 24 0.3 29 0.3 1 773 Israel East Kazakhstan 1993 241 1.5 237 1.4 258 1.5 251 1.5 273 1.6 349 2.0 362 2.0 432 2.4 451 2.4 469 2.5 4 585 Kazakhstan East Kyrgyzstan 1999 90 1.6 88 1.6 67 1.2 85 1.5 125 2.1 72 1.2 59 1.0 56 0.9 46 0.7 46 0.7 1 086 Kyrgyzstan East Moldova 1989 449 11.0 250 6.1 377 9.3 299 7.3 293 7.2 366 9.0 274 6.7 365 9.0 285 7.0 194 4.8 4 629 Moldova West Monaco 1985 0 0.0 0 0.0 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 0 0.0 - - - - 51 Monaco Centre Montenegro 1990 2 0.3 7 1.1 7 1.1 7 1.1 11 1.8 15 2.4 13 2.1 14 2.2 10 1.6 4 0.6 166 Montenegro Centre North Macedonia 1989 8 0.4 10 0.5 10 0.5 16 0.8 6 0.3 9 0.4 2 0.1 4 0.2 - - - - 170 North Macedonia East Russia 2009 - - - - - - - - - - - - - - - - - - - - 0 Russia West San Marino 1986 1 3.2 2 6.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 San Marino Centre Serbia 1985 60 0.7 57 0.6 49 0.5 49 0.6 50 0.6 61 0.7 65 0.7 70 0.8 75 0.7 34 0.3 2 155 Serbia Centre Serbia excluding Kosovoc 1985 53 0.7 55 0.8 46 0.6 48 0.7 47 0.7 56 0.8 59 0.8 62 0.9 70 0.8 32 0.4 2 068 Serbia excluding Kosovoc Centre Kosovoc 2005 7 0.4 2 0.1 3 0.2 1 0.1 3 0.2 5 0.3 6 0.3 8 0.4 5 0.3 2 0.1 87 Kosovoc West Switzerland 1980 135 1.7 98 1.2 105 1.3 77 0.9 64 0.8 70 0.8 71 0.8 63 0.7 67 0.8 33 0.4 10 139 Switzerland East Tajikistan 1998 147 1.9 183 2.3 191 2.4 227 2.8 279 3.3 236 2.7 265 3.0 208 2.3 155 1.7 106 1.1 2 301 Tajikistan Centre Turkey 1985 81 0.1 95 0.1 96 0.1 125 0.2 118 0.2 99 0.1 121 0.1 108 0.1 112 0.1 46 0.1 1 843 Turkey East Turkmenistan 2002 0 0.0 0 0.0 - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 1988 9 189 20.1 10 073 22.2 9 362 20.7 9 844 21.8 8 468 19.8 8 852 20.8 9 308 21.9 8 839 20.9 7 511 17.9 4 139 9.9 122 696 Ukraine West United Kingdom 1981 419 0.7 435 0.7 348 0.5 369 0.6 404 0.6 300 0.5 263 0.4 256 0.4 270 0.4 188 0.3 30 422 United Kingdom East Uzbekistan 1992 - - - - - - - - - - - - - - - - - - - - 651 Uzbekistan Total non-EU/EEA 12 198 4.4 12 968 4.7 12 175 4.3 12 593 4.4 11 327 4.0 11 646 4.1 11 883 4.1 11 560 4.0 10 047 3.4 5 961 2.1 199 675 Total non-EU/EEA WHO European Region WHO European Region West 5 724 1.4 5 582 1.3 4 845 1.1 4 252 1.0 3 987 1.0 3 633 0.9 3 290 0.8 2 949 0.7 2 480 0.6 1 549 0.5 360 326 West Centre 882 0.5 926 0.5 947 0.5 1 017 0.5 919 0.5 897 0.5 876 0.4 893 0.5 847 0.4 467 0.2 23 737 Centre East 11 554 10.4 12 375 11.1 11 641 10.4 12 048 10.7 10 739 9.7 11 182 10.0 11 468 10.2 11 109 9.9 9 582 8.4 5 705 5.0 155 430 East Total WHO European Region 18 160 2.5 18 883 2.6 17 433 2.4 17 317 2.4 15 645 2.2 15 712 2.2 15 634 2.2 14 951 2.0 12 909 1.7 7 721 1.2 539 493 Total WHO European Region a Country-specific comments are in Annex 5 b Cumulative total is the total number of cases reported by the country since the start of reporting c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 60 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 15: AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 61 1.5 81 2.0 50 1.2 57 1.4 57 1.4 50 1.2 51 1.2 43 1.0 46 1.1 33 0.8 2 559 Austria West Belgium 59 1.1 67 1.2 70 1.3 80 1.5 59 1.1 39 0.7 35 0.6 32 0.6 47 0.8 28 0.5 3 461 Belgium Centre Bulgaria 38 1.1 47 1.3 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 48 1.4 56 1.6 32 0.9 653 Bulgaria Centre Croatia 25 1.2 26 1.3 14 0.7 21 1.0 15 0.7 21 1.0 19 0.9 28 1.4 18 0.9 11 0.6 467 Croatia Centre Cyprus 7 1.7 9 2.1 5 1.2 10 2.4 9 2.2 17 4.1 9 2.2 8 1.9 9 2.1 13 3.0 280 Cyprus Centre Czech Republic 20 0.4 28 0.5 27 0.5 23 0.4 30 0.6 38 0.7 44 0.8 35 0.7 27 0.5 35 0.7 584 Czech Republic West Denmark 40 1.5 35 1.3 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 21 0.7 15 0.5 21 0.7 2 393 Denmark East Estonia 31 5.0 25 4.0 19 3.1 13 2.1 11 1.8 23 3.7 15 2.4 19 3.1 21 3.4 18 2.9 427 Estonia West Finland 17 0.6 16 0.6 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 17 0.6 12 0.4 7 0.3 603 Finland West France 637 2.0 575 1.8 521 1.6 443 1.4 420 1.3 343 1.1 354 1.1 382 1.2 388 1.2 273 0.8 57 560 France West Germany 438 1.1 406 1.0 350 0.9 335 0.8 297 0.7 249 0.6 231 0.6 191 0.5 55 0.1 27 494 Germany West Greece 85 1.6 102 1.9 121 2.3 105 2.0 114 2.2 108 2.1 92 1.8 89 1.7 69 1.3 84 1.6 3 507 Greece Centre Hungary 27 0.6 45 1.0 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 54 1.2 46 1.0 35 0.7 949 Hungary West Iceland 1 0.6 1 0.6 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 0 0.0 3 1.6 2 1.1 67 Iceland West Ireland 34 1.5 27 1.2 22 1.0 23 1.0 16 0.7 11 0.5 15 0.6 14 0.6 4 0.2 4 0.2 1 005 Ireland West Italy 806 2.8 784 2.7 813 2.8 713 2.4 686 2.3 669 2.3 586 2.0 560 1.9 492 1.7 255 0.9 55 200 Italy East Latvia 80 8.4 102 10.9 90 9.7 110 12.0 89 9.8 90 10.0 73 8.2 63 7.1 53 6.0 39 4.4 1 467 Latvia Liechtenstein 1 5.6 1 5.5 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 11 Liechtenstein East Lithuania 15 1.1 28 2.0 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 29 2.2 16 1.2 0 0.0 493 Lithuania West Luxembourg 8 3.1 5 1.9 10 3.7 7 2.5 6 2.1 10 3.5 5 1.7 3 1.0 2 0.6 2 0.6 258 Luxembourg West Malta 3 1.5 5 2.4 1 0.5 4 1.9 2 0.9 5 2.2 0 0.0 0 0.0 0 0.0 0 0.0 100 Malta West Netherlands 210 2.5 237 2.9 224 2.7 184 2.2 208 2.5 163 1.9 157 1.9 140 1.6 121 1.4 87 1.0 6 223 Netherlands West Norway 17 0.7 23 0.9 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 9 0.3 14 0.5 10 0.4 945 Norway Centre Poland 142 0.8 120 0.7 131 0.7 115 0.6 97 0.5 90 0.5 94 0.5 86 0.5 80 0.4 27 0.1 3 022 Poland West Portugal 484 9.6 443 8.8 367 7.3 295 5.9 248 5.0 271 5.5 215 4.4 174 3.6 122 2.5 17 993 Portugal Centre Romania 207 2.1 211 2.2 246 2.5 292 3.0 251 2.6 248 2.6 240 2.5 226 2.4 210 2.2 119 1.3 6 509 Romania Centre Slovakia 4 0.2 7 0.3 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 11 0.4 3 0.1 4 0.2 110 Slovakia Centre Slovenia 12 1.2 11 1.1 10 1.0 16 1.6 11 1.1 8 0.8 7 0.7 10 1.0 5 0.5 4 0.4 249 Slovenia West Spain 1 000 4.3 900 3.9 671 2.9 546 2.8 490 2.9 437 2.6 408 2.4 301 1.8 204 1.1 158 0.9 70 416 Spain West Sweden - - - - - - - - - - 1 776 Sweden Total EU/EEA 4 509 2.1 4 367 2.0 3 956 1.8 3 592 1.7 3 281 1.6 3 088 1.4 2 826 1.3 2 593 1.2 2 138 1.0 1 301 0.8 266 781 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 35 2.4 34 2.3 50 3.4 36 2.4 50 3.4 50 3.4 24 1.6 35 2.4 26 1.8 13 0.9 510 Albania West Andorra 1 2.4 0 0.0 2 5.0 0 0.0 2 5.2 0 0.0 1 2.6 0 0.0 - - - - 11 Andorra East Armenia 65 4.8 98 7.3 103 7.6 127 9.3 129 9.4 116 8.4 111 8.0 147 10.6 110 7.9 113 8.1 1 481 Armenia East Azerbaijan 171 3.8 209 4.5 162 3.5 162 3.4 150 3.1 125 2.6 114 2.3 122 2.5 151 3.0 77 1.5 2 153 Azerbaijan East Belarus 365 8.3 375 8.6 369 8.4 308 7.0 278 6.3 311 7.1 274 6.2 229 5.2 241 5.5 143 3.3 4 406 Belarus Centre Bosnia and Herzegovina 4 0.2 4 0.2 6 0.3 7 0.4 7 0.4 6 0.4 4 0.2 11 0.7 6 0.4 143 Bosnia and Herzegovina East Georgia 277 14.2 248 12.8 219 11.3 201 10.4 196 10.2 196 10.2 193 10.1 172 9.0 198 10.4 134 7.0 3 264 Georgia West Israel 37 1.0 37 1.0 36 0.9 48 1.2 26 0.7 29 0.7 23 0.6 29 0.7 16 0.4 22 0.5 1 272 Israel East Kazakhstan 162 2.0 179 2.2 190 2.3 185 2.2 180 2.1 230 2.7 225 2.6 278 3.1 293 3.3 293 3.2 3 113 Kazakhstan East Kyrgyzstan 69 2.5 65 2.3 49 1.7 58 2.0 89 3.0 55 1.8 36 1.2 0 0.0 26 0.8 24 0.7 765 Kyrgyzstan East Moldova 274 14.0 128 6.5 217 11.1 183 9.3 179 9.2 210 10.8 167 8.6 213 11.0 180 9.3 121 6.3 2 809 Moldova West Monaco 0 0.0 0 0.0 0 0.0 1 5.5 0 0.0 0 0.0 0 0.0 0 0.0 - - - - 40 Monaco Centre Montenegro 2 0.6 7 2.3 7 2.3 4 1.3 11 3.5 15 4.8 12 3.9 14 4.5 10 3.2 3 1.0 144 Montenegro Centre North Macedonia 5 0.5 8 0.8 9 0.9 13 1.3 5 0.5 6 0.6 2 0.2 4 0.4 - - - - 127 North Macedonia East Russia - - - - - - - - - - - - - - - - - - - - 0 Russia West San Marino 1 6.5 2 12.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 21 San Marino Centre Serbia 50 1.1 51 1.2 41 0.9 43 1.0 47 1.1 57 1.3 59 1.4 62 1.4 59 1.1 28 0.5 1 676 Serbia Centre Serbia excluding Kosovoc 45 1.3 50 1.4 39 1.1 42 1.2 45 1.3 52 1.5 53 1.5 55 1.6 55 1.3 27 0.6 1 609 Serbia excluding Kosovoc Centre Kosovoc 5 0.6 1 0.1 2 0.2 1 0.1 2 0.2 5 0.6 6 0.7 7 0.8 4 0.5 1 0.1 67 Kosovoc West Switzerland 97 2.5 68 1.7 73 1.8 61 1.5 52 1.3 48 1.2 53 1.3 50 1.2 55 1.3 28 0.7 7 561 Switzerland East Tajikistan 114 2.9 137 3.4 139 3.4 155 3.7 184 4.3 172 3.9 181 4.0 145 3.2 107 2.3 84 1.7 1 674 Tajikistan Centre Turkey 66 0.2 83 0.2 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 91 0.2 92 0.2 33 0.1 1 527 Turkey East Turkmenistan 0 0.0 0 0.0 - - - - - - - - - - - - - - - - 0 Turkmenistan East Ukraine 6 141 29.2 6 498 31.0 6 013 28.7 6 119 29.3 5 328 23.2 5 462 27.7 5 612 28.6 5 405 27.6 4 661 24.0 2 479 11.1 79 833 Ukraine West United Kingdom 286 0.9 302 1.0 248 0.8 249 0.8 299 0.9 225 0.7 187 0.6 190 0.6 206 0.6 149 0.4 23 725 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 494 Uzbekistan Total non-EU/EEA 8 222 6.1 8 533 6.3 8 010 5.9 8 059 5.9 7 304 5.2 7 399 5.3 7 381 5.3 7 197 5.2 6 437 4.5 3 744 2.6 136 749 Total non-EU/EEA WHO European Region WHO European Region West 4 322 2.1 4 116 2.0 3 645 1.8 3 225 1.6 3 038 1.5 2 720 1.3 2 459 1.2 2 245 1.1 1 871 0.9 1 163 0.7 284 190 West Centre 644 0.7 691 0.7 720 0.8 775 0.8 708 0.7 736 0.8 701 0.7 723 0.7 647 0.7 357 0.4 16 950 Centre East 7 764 14.7 8 092 15.3 7 601 14.3 7 650 14.3 6 839 12.2 7 031 13.2 7 047 13.2 6 822 13.5 6 057 11.3 3 525 6.4 102 379 East Total WHO European Region 12 730 3.6 12 899 3.7 11 966 3.4 11 650 3.4 10 585 3.0 10 487 3.0 10 207 2.9 9 790 2.8 8 575 2.3 5 045 1.6 403 519 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 61 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 15: AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 61 1.5 81 2.0 50 1.2 57 1.4 57 1.4 50 1.2 51 1.2 43 1.0 46 1.1 33 0.8 2 559 Austria West Belgium 59 1.1 67 1.2 70 1.3 80 1.5 59 1.1 39 0.7 35 0.6 32 0.6 47 0.8 28 0.5 3 461 Belgium Centre Bulgaria 38 1.1 47 1.3 53 1.5 52 1.5 39 1.1 39 1.1 39 1.1 48 1.4 56 1.6 32 0.9 653 Bulgaria Centre Croatia 25 1.2 26 1.3 14 0.7 21 1.0 15 0.7 21 1.0 19 0.9 28 1.4 18 0.9 11 0.6 467 Croatia Centre Cyprus 7 1.7 9 2.1 5 1.2 10 2.4 9 2.2 17 4.1 9 2.2 8 1.9 9 2.1 13 3.0 280 Cyprus Centre Czech Republic 20 0.4 28 0.5 27 0.5 23 0.4 30 0.6 38 0.7 44 0.8 35 0.7 27 0.5 35 0.7 584 Czech Republic West Denmark 40 1.5 35 1.3 29 1.0 24 0.9 28 1.0 19 0.7 25 0.9 21 0.7 15 0.5 21 0.7 2 393 Denmark East Estonia 31 5.0 25 4.0 19 3.1 13 2.1 11 1.8 23 3.7 15 2.4 19 3.1 21 3.4 18 2.9 427 Estonia West Finland 17 0.6 16 0.6 17 0.6 14 0.5 13 0.5 25 0.9 10 0.4 17 0.6 12 0.4 7 0.3 603 Finland West France 637 2.0 575 1.8 521 1.6 443 1.4 420 1.3 343 1.1 354 1.1 382 1.2 388 1.2 273 0.8 57 560 France West Germany 438 1.1 406 1.0 350 0.9 335 0.8 297 0.7 249 0.6 231 0.6 191 0.5 55 0.1 27 494 Germany West Greece 85 1.6 102 1.9 121 2.3 105 2.0 114 2.2 108 2.1 92 1.8 89 1.7 69 1.3 84 1.6 3 507 Greece Centre Hungary 27 0.6 45 1.0 38 0.8 41 0.9 37 0.8 45 1.0 36 0.8 54 1.2 46 1.0 35 0.7 949 Hungary West Iceland 1 0.6 1 0.6 1 0.6 0 0.0 0 0.0 4 2.4 0 0.0 0 0.0 3 1.6 2 1.1 67 Iceland West Ireland 34 1.5 27 1.2 22 1.0 23 1.0 16 0.7 11 0.5 15 0.6 14 0.6 4 0.2 4 0.2 1 005 Ireland West Italy 806 2.8 784 2.7 813 2.8 713 2.4 686 2.3 669 2.3 586 2.0 560 1.9 492 1.7 255 0.9 55 200 Italy East Latvia 80 8.4 102 10.9 90 9.7 110 12.0 89 9.8 90 10.0 73 8.2 63 7.1 53 6.0 39 4.4 1 467 Latvia Liechtenstein 1 5.6 1 5.5 0 0.0 1 5.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 11 Liechtenstein East Lithuania 15 1.1 28 2.0 31 2.3 29 2.1 26 1.9 41 3.1 46 3.5 29 2.2 16 1.2 0 0.0 493 Lithuania West Luxembourg 8 3.1 5 1.9 10 3.7 7 2.5 6 2.1 10 3.5 5 1.7 3 1.0 2 0.6 2 0.6 258 Luxembourg West Malta 3 1.5 5 2.4 1 0.5 4 1.9 2 0.9 5 2.2 0 0.0 0 0.0 0 0.0 0 0.0 100 Malta West Netherlands 210 2.5 237 2.9 224 2.7 184 2.2 208 2.5 163 1.9 157 1.9 140 1.6 121 1.4 87 1.0 6 223 Netherlands West Norway 17 0.7 23 0.9 19 0.7 36 1.4 15 0.6 15 0.6 11 0.4 9 0.3 14 0.5 10 0.4 945 Norway Centre Poland 142 0.8 120 0.7 131 0.7 115 0.6 97 0.5 90 0.5 94 0.5 86 0.5 80 0.4 27 0.1 3 022 Poland West Portugal 484 9.6 443 8.8 367 7.3 295 5.9 248 5.0 271 5.5 215 4.4 174 3.6 122 2.5 17 993 Portugal Centre Romania 207 2.1 211 2.2 246 2.5 292 3.0 251 2.6 248 2.6 240 2.5 226 2.4 210 2.2 119 1.3 6 509 Romania Centre Slovakia 4 0.2 7 0.3 6 0.2 3 0.1 7 0.3 10 0.4 9 0.3 11 0.4 3 0.1 4 0.2 110 Slovakia Centre Slovenia 12 1.2 11 1.1 10 1.0 16 1.6 11 1.1 8 0.8 7 0.7 10 1.0 5 0.5 4 0.4 249 Slovenia West Spain 1 000 4.3 900 3.9 671 2.9 546 2.8 490 2.9 437 2.6 408 2.4 301 1.8 204 1.1 158 0.9 70 416 Spain West Sweden - - - - - - - - - - 1 776 Sweden Total EU/EEA 4 509 2.1 4 367 2.0 3 956 1.8 3 592 1.7 3 281 1.6 3 088 1.4 2 826 1.3 2 593 1.2 2 138 1.0 1 301 0.8 266 781 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 35 2.4 34 2.3 50 3.4 36 2.4 50 3.4 50 3.4 24 1.6 35 2.4 26 1.8 13 0.9 510 Albania West Andorra 1 2.4 0 0.0 2 5.0 0 0.0 2 5.2 0 0.0 1 2.6 0 0.0 - - - - 11 Andorra East Armenia 65 4.8 98 7.3 103 7.6 127 9.3 129 9.4 116 8.4 111 8.0 147 10.6 110 7.9 113 8.1 1 481 Armenia East Azerbaijan 171 3.8 209 4.5 162 3.5 162 3.4 150 3.1 125 2.6 114 2.3 122 2.5 151 3.0 77 1.5 2 153 Azerbaijan East Belarus 365 8.3 375 8.6 369 8.4 308 7.0 278 6.3 311 7.1 274 6.2 229 5.2 241 5.5 143 3.3 4 406 Belarus Centre Bosnia and Herzegovina 4 0.2 4 0.2 6 0.3 7 0.4 7 0.4 6 0.4 4 0.2 11 0.7 6 0.4 143 Bosnia and Herzegovina East Georgia 277 14.2 248 12.8 219 11.3 201 10.4 196 10.2 196 10.2 193 10.1 172 9.0 198 10.4 134 7.0 3 264 Georgia West Israel 37 1.0 37 1.0 36 0.9 48 1.2 26 0.7 29 0.7 23 0.6 29 0.7 16 0.4 22 0.5 1 272 Israel East Kazakhstan 162 2.0 179 2.2 190 2.3 185 2.2 180 2.1 230 2.7 225 2.6 278 3.1 293 3.3 293 3.2 3 113 Kazakhstan East Kyrgyzstan 69 2.5 65 2.3 49 1.7 58 2.0 89 3.0 55 1.8 36 1.2 0 0.0 26 0.8 24 0.7 765 Kyrgyzstan East Moldova 274 14.0 128 6.5 217 11.1 183 9.3 179 9.2 210 10.8 167 8.6 213 11.0 180 9.3 121 6.3 2 809 Moldova West Monaco 0 0.0 0 0.0 0 0.0 1 5.5 0 0.0 0 0.0 0 0.0 0 0.0 - - - - 40 Monaco Centre Montenegro 2 0.6 7 2.3 7 2.3 4 1.3 11 3.5 15 4.8 12 3.9 14 4.5 10 3.2 3 1.0 144 Montenegro Centre North Macedonia 5 0.5 8 0.8 9 0.9 13 1.3 5 0.5 6 0.6 2 0.2 4 0.4 - - - - 127 North Macedonia East Russia - - - - - - - - - - - - - - - - - - - - 0 Russia West San Marino 1 6.5 2 12.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 21 San Marino Centre Serbia 50 1.1 51 1.2 41 0.9 43 1.0 47 1.1 57 1.3 59 1.4 62 1.4 59 1.1 28 0.5 1 676 Serbia Centre Serbia excluding Kosovoc 45 1.3 50 1.4 39 1.1 42 1.2 45 1.3 52 1.5 53 1.5 55 1.6 55 1.3 27 0.6 1 609 Serbia excluding Kosovoc Centre Kosovoc 5 0.6 1 0.1 2 0.2 1 0.1 2 0.2 5 0.6 6 0.7 7 0.8 4 0.5 1 0.1 67 Kosovoc West Switzerland 97 2.5 68 1.7 73 1.8 61 1.5 52 1.3 48 1.2 53 1.3 50 1.2 55 1.3 28 0.7 7 561 Switzerland East Tajikistan 114 2.9 137 3.4 139 3.4 155 3.7 184 4.3 172 3.9 181 4.0 145 3.2 107 2.3 84 1.7 1 674 Tajikistan Centre Turkey 66 0.2 83 0.2 77 0.2 99 0.3 92 0.2 86 0.2 103 0.3 91 0.2 92 0.2 33 0.1 1 527 Turkey East Turkmenistan 0 0.0 0 0.0 - - - - - - - - - - - - - - - - 0 Turkmenistan East Ukraine 6 141 29.2 6 498 31.0 6 013 28.7 6 119 29.3 5 328 23.2 5 462 27.7 5 612 28.6 5 405 27.6 4 661 24.0 2 479 11.1 79 833 Ukraine West United Kingdom 286 0.9 302 1.0 248 0.8 249 0.8 299 0.9 225 0.7 187 0.6 190 0.6 206 0.6 149 0.4 23 725 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 494 Uzbekistan Total non-EU/EEA 8 222 6.1 8 533 6.3 8 010 5.9 8 059 5.9 7 304 5.2 7 399 5.3 7 381 5.3 7 197 5.2 6 437 4.5 3 744 2.6 136 749 Total non-EU/EEA WHO European Region WHO European Region West 4 322 2.1 4 116 2.0 3 645 1.8 3 225 1.6 3 038 1.5 2 720 1.3 2 459 1.2 2 245 1.1 1 871 0.9 1 163 0.7 284 190 West Centre 644 0.7 691 0.7 720 0.8 775 0.8 708 0.7 736 0.8 701 0.7 723 0.7 647 0.7 357 0.4 16 950 Centre East 7 764 14.7 8 092 15.3 7 601 14.3 7 650 14.3 6 839 12.2 7 031 13.2 7 047 13.2 6 822 13.5 6 057 11.3 3 525 6.4 102 379 East Total WHO European Region 12 730 3.6 12 899 3.7 11 966 3.4 11 650 3.4 10 585 3.0 10 487 3.0 10 207 2.9 9 790 2.8 8 575 2.3 5 045 1.6 403 519 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 62 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 16: AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 18 0.4 21 0.5 19 0.4 26 0.6 18 0.4 18 0.4 12 0.3 10 0.2 12 0.3 10 0.2 801 Austria West Belgium 40 0.7 41 0.7 30 0.5 40 0.7 35 0.6 24 0.4 17 0.3 22 0.4 19 0.3 12 0.2 1 683 Belgium Centre Bulgaria 2 0.1 18 0.5 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 9 0.2 12 0.3 11 0.3 180 Bulgaria Centre Croatia 1 0.0 2 0.1 3 0.1 2 0.1 1 0.0 1 0.0 1 0.0 2 0.1 2 0.1 1 0.0 56 Croatia Centre Cyprus 5 1.2 2 0.5 4 0.9 1 0.2 4 0.9 5 1.1 6 1.4 5 1.1 5 1.1 5 1.1 93 Cyprus Centre Czech Republic 9 0.2 8 0.1 6 0.1 9 0.2 8 0.1 6 0.1 10 0.2 4 0.1 11 0.2 8 0.1 135 Czech Republic West Denmark 19 0.7 6 0.2 9 0.3 6 0.2 12 0.4 5 0.2 3 0.1 5 0.2 7 0.2 4 0.1 431 Denmark East Estonia 7 1.0 11 1.6 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 6 0.9 9 1.3 5 0.7 163 Estonia West Finland 7 0.3 3 0.1 3 0.1 6 0.2 5 0.2 5 0.2 8 0.3 4 0.1 6 0.2 5 0.2 152 Finland West France 235 0.7 260 0.8 200 0.6 211 0.6 186 0.5 173 0.5 143 0.4 155 0.4 164 0.5 112 0.3 15 941 France West Germany 80 0.2 105 0.3 91 0.2 58 0.1 65 0.2 61 0.1 64 0.2 51 0.1 19 0.0 - - 4 709 Germany West Greece 16 0.3 21 0.4 20 0.4 23 0.4 25 0.4 34 0.6 28 0.5 13 0.2 23 0.4 16 0.3 702 Greece Centre Hungary 5 0.1 3 0.1 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 3 0.1 7 0.1 7 0.1 147 Hungary West Iceland 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 1 0.6 0 0.0 12 Iceland West Ireland 13 0.6 11 0.5 8 0.3 10 0.4 5 0.2 3 0.1 6 0.2 1 0.0 3 0.1 2 0.1 306 Ireland West Italy 252 0.8 290 0.9 265 0.9 218 0.7 186 0.6 204 0.7 214 0.7 156 0.5 113 0.4 97 0.3 16 391 Italy East Latvia 32 2.8 40 3.6 43 3.9 61 5.6 43 4.0 24 2.3 45 4.3 36 3.4 37 3.6 16 1.6 665 Latvia Liechtenstein 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 Liechtenstein East Lithuania 6 0.4 10 0.6 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 8 0.5 5 0.3 0 0.0 117 Lithuania West Luxembourg 4 1.6 3 1.1 1 0.4 3 1.1 4 1.4 2 0.7 1 0.3 1 0.3 2 0.7 3 1.0 81 Luxembourg West Malta 2 1.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Malta West Netherlands 57 0.7 63 0.7 47 0.6 38 0.4 43 0.5 44 0.5 37 0.4 33 0.4 28 0.3 26 0.3 1 520 Netherlands West Norway 2 0.1 2 0.1 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 3 0.1 5 0.2 1 0.0 269 Norway Centre Poland 42 0.2 37 0.2 31 0.2 33 0.2 31 0.2 12 0.1 15 0.1 25 0.1 15 0.1 7 0.0 793 Poland West Portugal 170 3.1 182 3.3 161 2.9 87 1.6 96 1.8 110 2.0 82 1.5 85 1.6 66 1.2 - - 4 886 Portugal Centre Romania 129 1.2 129 1.3 116 1.1 121 1.2 109 1.1 95 0.9 83 0.8 85 0.9 92 0.9 47 0.5 4 292 Romania Centre Slovakia 0 0.0 0 0.0 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 13 Slovakia Centre Slovenia 3 0.3 1 0.1 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 0 0.0 4 0.4 2 0.2 36 Slovenia West Spain 293 1.2 275 1.2 187 0.8 132 0.7 117 0.7 102 0.6 102 0.6 64 0.4 46 0.2 42 0.2 17 918 Spain West Sweden - - - - - - - - - - - - - - - - - - - - 398 Sweden Total EU/EEA 1 450 0.6 1 545 0.7 1 296 0.6 1 131 0.5 1 029 0.5 972 0.4 919 0.4 788 0.4 713 0.3 439 0.2 72 905 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 11 0.8 15 1.0 15 1.0 14 1.0 15 1.1 8 0.6 9 0.6 12 0.8 14 1.0 2 0.1 154 Albania West Andorra 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 0 0.0 1 2.6 0 0.0 - - - - 4 Andorra East Armenia 22 1.4 38 2.5 41 2.7 47 3.0 34 2.2 47 3.0 33 2.1 64 4.1 43 2.7 39 2.5 517 Armenia East Azerbaijan 24 0.5 26 0.6 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 60 1.2 45 0.9 28 0.6 476 Azerbaijan East Belarus 225 4.5 223 4.4 178 3.5 166 3.3 212 4.2 201 4.0 165 3.3 153 3.0 139 2.8 77 1.5 2 655 Belarus Centre Bosnia and Herzegovina 3 0.2 0 0.0 1 0.1 0 0.0 0 0.0 1 0.1 0 0.0 0 0.0 2 0.1 26 Bosnia and Herzegovina East Georgia 118 5.5 111 5.2 84 4.0 67 3.2 74 3.5 73 3.5 64 3.1 101 4.8 66 3.2 47 2.3 1 182 Georgia West Israel 18 0.5 15 0.4 11 0.3 22 0.6 19 0.5 18 0.4 10 0.2 10 0.2 8 0.2 7 0.2 501 Israel East Kazakhstan 79 0.9 58 0.7 68 0.8 66 0.7 93 1.0 119 1.3 137 1.5 154 1.6 158 1.7 176 1.8 1 472 Kazakhstan East Kyrgyzstan 21 0.8 23 0.8 18 0.6 27 0.9 36 1.2 17 0.6 23 0.7 22 0.7 20 0.6 22 0.7 284 Kyrgyzstan East Moldova 175 8.3 122 5.8 160 7.6 116 5.5 114 5.4 156 7.4 107 5.1 152 7.2 105 5.0 73 3.5 1 820 Moldova West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 - - - - 11 Monaco Centre Montenegro 0 0.0 0 0.0 0 0.0 3 0.9 0 0.0 0 0.0 1 0.3 0 0.0 0 0.0 1 0.3 22 Montenegro Centre North Macedonia 0 0.0 2 0.2 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 0 0.0 - - - - 36 North Macedonia East Russia - - - - - - - - - - - - - - - - - - - - 0 Russia West San Marino 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 San Marino Centre Serbia 10 0.2 6 0.1 8 0.2 6 0.1 3 0.1 4 0.1 6 0.1 8 0.2 16 0.3 6 0.1 479 Serbia Centre Serbia excluding Kosovoc 8 0.2 5 0.1 7 0.2 6 0.2 2 0.1 4 0.1 6 0.2 7 0.2 15 0.3 5 0.1 459 Serbia excluding Kosovoc Centre Kosovoc 2 0.2 1 0.1 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 1 0.1 20 Kosovoc West Switzerland 38 0.9 30 0.7 32 0.8 16 0.4 12 0.3 21 0.5 17 0.4 12 0.3 12 0.3 5 0.1 2 574 Switzerland East Tajikistan 33 0.9 46 1.2 52 1.3 72 1.8 95 2.3 64 1.5 84 1.9 63 1.4 48 1.0 22 0.5 627 Tajikistan Centre Turkey 15 0.0 12 0.0 19 0.0 26 0.1 26 0.1 13 0.0 18 0.0 17 0.0 20 0.0 13 0.0 316 Turkey East Turkmenistan 0 0.0 0 0.0 - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 3 048 12.4 3 575 14.6 3 349 13.7 3 725 15.4 3 140 15.9 3 390 14.8 3 696 16.2 3 434 15.2 2 850 12.7 1 660 8.6 42 863 Ukraine West United Kingdom 133 0.4 133 0.4 100 0.3 120 0.4 103 0.3 74 0.2 75 0.2 66 0.2 64 0.2 39 0.1 6 693 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 157 Uzbekistan Total non-EU/EEA 3 973 2.8 4 435 3.1 4 165 2.9 4 534 3.2 4 021 2.9 4 244 2.9 4 500 3.1 4 328 3.0 3 610 2.5 2 217 1.5 62 872 Total non-EU/EEA WHO European Region WHO European Region West 1 398 0.7 1 462 0.7 1 194 0.6 1 025 0.5 939 0.5 905 0.4 823 0.4 693 0.3 598 0.3 381 0.2 75 999 West Centre 235 0.3 235 0.3 227 0.2 242 0.3 211 0.2 160 0.2 175 0.2 170 0.2 200 0.2 110 0.1 6 778 Centre East 3 790 6.5 4 283 7.3 4 040 6.8 4 398 7.4 3 900 7.1 4 151 7.1 4 421 7.5 4 253 7.2 3 525 6.0 2 165 4.0 52 999 East Total WHO European Region 5 423 1.5 5 980 1.7 5 461 1.5 5 665 1.6 5 050 1.4 5 216 1.4 5 419 1.5 5 116 1.4 4 323 1.1 2 656 0.8 135 776 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 63 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 16: AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Cumulative totalb Country, territory or area a N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate EU/EEA EU/EEA West Austria 18 0.4 21 0.5 19 0.4 26 0.6 18 0.4 18 0.4 12 0.3 10 0.2 12 0.3 10 0.2 801 Austria West Belgium 40 0.7 41 0.7 30 0.5 40 0.7 35 0.6 24 0.4 17 0.3 22 0.4 19 0.3 12 0.2 1 683 Belgium Centre Bulgaria 2 0.1 18 0.5 18 0.5 12 0.3 6 0.2 3 0.1 10 0.3 9 0.2 12 0.3 11 0.3 180 Bulgaria Centre Croatia 1 0.0 2 0.1 3 0.1 2 0.1 1 0.0 1 0.0 1 0.0 2 0.1 2 0.1 1 0.0 56 Croatia Centre Cyprus 5 1.2 2 0.5 4 0.9 1 0.2 4 0.9 5 1.1 6 1.4 5 1.1 5 1.1 5 1.1 93 Cyprus Centre Czech Republic 9 0.2 8 0.1 6 0.1 9 0.2 8 0.1 6 0.1 10 0.2 4 0.1 11 0.2 8 0.1 135 Czech Republic West Denmark 19 0.7 6 0.2 9 0.3 6 0.2 12 0.4 5 0.2 3 0.1 5 0.2 7 0.2 4 0.1 431 Denmark East Estonia 7 1.0 11 1.6 7 1.0 5 0.7 7 1.0 17 2.4 5 0.7 6 0.9 9 1.3 5 0.7 163 Estonia West Finland 7 0.3 3 0.1 3 0.1 6 0.2 5 0.2 5 0.2 8 0.3 4 0.1 6 0.2 5 0.2 152 Finland West France 235 0.7 260 0.8 200 0.6 211 0.6 186 0.5 173 0.5 143 0.4 155 0.4 164 0.5 112 0.3 15 941 France West Germany 80 0.2 105 0.3 91 0.2 58 0.1 65 0.2 61 0.1 64 0.2 51 0.1 19 0.0 - - 4 709 Germany West Greece 16 0.3 21 0.4 20 0.4 23 0.4 25 0.4 34 0.6 28 0.5 13 0.2 23 0.4 16 0.3 702 Greece Centre Hungary 5 0.1 3 0.1 4 0.1 10 0.2 6 0.1 8 0.2 16 0.3 3 0.1 7 0.1 7 0.1 147 Hungary West Iceland 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 1 0.6 0 0.0 12 Iceland West Ireland 13 0.6 11 0.5 8 0.3 10 0.4 5 0.2 3 0.1 6 0.2 1 0.0 3 0.1 2 0.1 306 Ireland West Italy 252 0.8 290 0.9 265 0.9 218 0.7 186 0.6 204 0.7 214 0.7 156 0.5 113 0.4 97 0.3 16 391 Italy East Latvia 32 2.8 40 3.6 43 3.9 61 5.6 43 4.0 24 2.3 45 4.3 36 3.4 37 3.6 16 1.6 665 Latvia Liechtenstein 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 Liechtenstein East Lithuania 6 0.4 10 0.6 13 0.8 8 0.5 9 0.6 7 0.4 8 0.5 8 0.5 5 0.3 0 0.0 117 Lithuania West Luxembourg 4 1.6 3 1.1 1 0.4 3 1.1 4 1.4 2 0.7 1 0.3 1 0.3 2 0.7 3 1.0 81 Luxembourg West Malta 2 1.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 14 Malta West Netherlands 57 0.7 63 0.7 47 0.6 38 0.4 43 0.5 44 0.5 37 0.4 33 0.4 28 0.3 26 0.3 1 520 Netherlands West Norway 2 0.1 2 0.1 9 0.4 9 0.4 7 0.3 7 0.3 3 0.1 3 0.1 5 0.2 1 0.0 269 Norway Centre Poland 42 0.2 37 0.2 31 0.2 33 0.2 31 0.2 12 0.1 15 0.1 25 0.1 15 0.1 7 0.0 793 Poland West Portugal 170 3.1 182 3.3 161 2.9 87 1.6 96 1.8 110 2.0 82 1.5 85 1.6 66 1.2 - - 4 886 Portugal Centre Romania 129 1.2 129 1.3 116 1.1 121 1.2 109 1.1 95 0.9 83 0.8 85 0.9 92 0.9 47 0.5 4 292 Romania Centre Slovakia 0 0.0 0 0.0 0 0.0 1 0.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 13 Slovakia Centre Slovenia 3 0.3 1 0.1 1 0.1 1 0.1 0 0.0 2 0.2 0 0.0 0 0.0 4 0.4 2 0.2 36 Slovenia West Spain 293 1.2 275 1.2 187 0.8 132 0.7 117 0.7 102 0.6 102 0.6 64 0.4 46 0.2 42 0.2 17 918 Spain West Sweden - - - - - - - - - - - - - - - - - - - - 398 Sweden Total EU/EEA 1 450 0.6 1 545 0.7 1 296 0.6 1 131 0.5 1 029 0.5 972 0.4 919 0.4 788 0.4 713 0.3 439 0.2 72 905 Total EU-EEA Non-EU/EEA Non-EU/EEA Centre Albania 11 0.8 15 1.0 15 1.0 14 1.0 15 1.1 8 0.6 9 0.6 12 0.8 14 1.0 2 0.1 154 Albania West Andorra 0 0.0 0 0.0 1 2.4 0 0.0 1 2.5 0 0.0 1 2.6 0 0.0 - - - - 4 Andorra East Armenia 22 1.4 38 2.5 41 2.7 47 3.0 34 2.2 47 3.0 33 2.1 64 4.1 43 2.7 39 2.5 517 Armenia East Azerbaijan 24 0.5 26 0.6 27 0.6 38 0.8 43 0.9 36 0.7 54 1.1 60 1.2 45 0.9 28 0.6 476 Azerbaijan East Belarus 225 4.5 223 4.4 178 3.5 166 3.3 212 4.2 201 4.0 165 3.3 153 3.0 139 2.8 77 1.5 2 655 Belarus Centre Bosnia and Herzegovina 3 0.2 0 0.0 1 0.1 0 0.0 0 0.0 1 0.1 0 0.0 0 0.0 2 0.1 26 Bosnia and Herzegovina East Georgia 118 5.5 111 5.2 84 4.0 67 3.2 74 3.5 73 3.5 64 3.1 101 4.8 66 3.2 47 2.3 1 182 Georgia West Israel 18 0.5 15 0.4 11 0.3 22 0.6 19 0.5 18 0.4 10 0.2 10 0.2 8 0.2 7 0.2 501 Israel East Kazakhstan 79 0.9 58 0.7 68 0.8 66 0.7 93 1.0 119 1.3 137 1.5 154 1.6 158 1.7 176 1.8 1 472 Kazakhstan East Kyrgyzstan 21 0.8 23 0.8 18 0.6 27 0.9 36 1.2 17 0.6 23 0.7 22 0.7 20 0.6 22 0.7 284 Kyrgyzstan East Moldova 175 8.3 122 5.8 160 7.6 116 5.5 114 5.4 156 7.4 107 5.1 152 7.2 105 5.0 73 3.5 1 820 Moldova West Monaco 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 - - - - 11 Monaco Centre Montenegro 0 0.0 0 0.0 0 0.0 3 0.9 0 0.0 0 0.0 1 0.3 0 0.0 0 0.0 1 0.3 22 Montenegro Centre North Macedonia 0 0.0 2 0.2 1 0.1 3 0.3 1 0.1 2 0.2 0 0.0 0 0.0 - - - - 36 North Macedonia East Russia - - - - - - - - - - - - - - - - - - - - 0 Russia West San Marino 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 San Marino Centre Serbia 10 0.2 6 0.1 8 0.2 6 0.1 3 0.1 4 0.1 6 0.1 8 0.2 16 0.3 6 0.1 479 Serbia Centre Serbia excluding Kosovoc 8 0.2 5 0.1 7 0.2 6 0.2 2 0.1 4 0.1 6 0.2 7 0.2 15 0.3 5 0.1 459 Serbia excluding Kosovoc Centre Kosovoc 2 0.2 1 0.1 1 0.1 0.0 1 0.1 0.0 0.0 1 0.1 1 0.1 1 0.1 20 Kosovoc West Switzerland 38 0.9 30 0.7 32 0.8 16 0.4 12 0.3 21 0.5 17 0.4 12 0.3 12 0.3 5 0.1 2 574 Switzerland East Tajikistan 33 0.9 46 1.2 52 1.3 72 1.8 95 2.3 64 1.5 84 1.9 63 1.4 48 1.0 22 0.5 627 Tajikistan Centre Turkey 15 0.0 12 0.0 19 0.0 26 0.1 26 0.1 13 0.0 18 0.0 17 0.0 20 0.0 13 0.0 316 Turkey East Turkmenistan 0 0.0 0 0.0 - - - - - - - - - - - - - - - - 1 Turkmenistan East Ukraine 3 048 12.4 3 575 14.6 3 349 13.7 3 725 15.4 3 140 15.9 3 390 14.8 3 696 16.2 3 434 15.2 2 850 12.7 1 660 8.6 42 863 Ukraine West United Kingdom 133 0.4 133 0.4 100 0.3 120 0.4 103 0.3 74 0.2 75 0.2 66 0.2 64 0.2 39 0.1 6 693 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - 157 Uzbekistan Total non-EU/EEA 3 973 2.8 4 435 3.1 4 165 2.9 4 534 3.2 4 021 2.9 4 244 2.9 4 500 3.1 4 328 3.0 3 610 2.5 2 217 1.5 62 872 Total non-EU/EEA WHO European Region WHO European Region West 1 398 0.7 1 462 0.7 1 194 0.6 1 025 0.5 939 0.5 905 0.4 823 0.4 693 0.3 598 0.3 381 0.2 75 999 West Centre 235 0.3 235 0.3 227 0.2 242 0.3 211 0.2 160 0.2 175 0.2 170 0.2 200 0.2 110 0.1 6 778 Centre East 3 790 6.5 4 283 7.3 4 040 6.8 4 398 7.4 3 900 7.1 4 151 7.1 4 421 7.5 4 253 7.2 3 525 6.0 2 165 4.0 52 999 East Total WHO European Region 5 423 1.5 5 980 1.7 5 461 1.5 5 665 1.6 5 050 1.4 5 216 1.4 5 419 1.5 5 116 1.4 4 323 1.1 2 656 0.8 135 776 Total WHO European Region a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 64 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 17: AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EU/EEA West Austria 34 32 23 25 21 28 25 21 24 12 1 146 West Belgium 34 32 33 41 34 19 18 15 21 12 1 628 Centre Bulgaria 2 8 12 9 12 11 15 17 28 16 175 Centre Croatia 18 22 11 18 12 21 17 25 17 11 315 Centre Cyprus 3 2 4 5 5 10 6 3 4 9 152 Centre Czech Republic 15 16 16 13 19 23 29 19 17 15 345 West Denmark 13 13 11 10 11 7 8 9 8 6 1 608 East Estonia 0 1 0 1 0 1 1 0 0 1 30 West Finland 6 2 4 6 7 5 3 3 1 1 314 West France 244 195 209 156 159 134 135 146 141 96 28 929 West Germany 232 231 197 183 155 113 115 94 35 18 654 West Greece 54 51 54 44 63 57 48 47 33 36 2 205 Centre Hungary 24 37 29 37 33 41 29 47 37 32 770 West Iceland 0 0 0 0 0 1 0 0 3 0 47 West Ireland 17 13 8 12 11 7 10 4 2 3 418 West Italy 266 262 307 272 287 261 213 220 192 94 12 920 East Latvia 7 4 10 7 5 4 10 6 3 1 136 Liechtenstein 0 0 0 1 0 0 0 0 0 0 2 East Lithuania 2 2 5 3 3 9 7 3 0 0 93 West Luxembourg 6 3 7 3 4 6 2 1 0 1 142 West Malta 1 0 1 1 0 2 0 0 0 0 44 West Netherlands 130 149 145 107 121 95 91 82 71 56 3 803 West Norway 9 10 15 18 4 4 2 6 3 3 526 Centre Poland 45 25 48 40 30 31 23 26 21 9 775 West Portugal 94 92 64 63 71 83 61 43 30 3 081 Centre Romania 13 8 17 25 19 24 28 26 38 15 325 Centre Slovakia 3 3 2 2 2 7 5 5 1 4 67 Centre Slovenia 7 9 7 10 10 6 3 6 3 2 162 West Spain 366 358 274 238 212 191 204 135 99 65 14 043 West Sweden - - - - - - - - - - 1 087 Total EU/EEA 1 645 1 580 1 513 1 350 1 310 1 201 1 108 1 009 832 500 93 942 Non-EU/EEA Centre Albania 5 6 6 8 8 3 1 1 2 1 64 West Andorra 1 0 2 0 1 0 0 0 - - 7 East Armenia 2 2 4 7 1 3 4 6 6 9 52 East Azerbaijan 1 1 3 2 1 2 0 5 8 3 36 East Belarus 6 3 3 4 3 4 6 4 7 3 48 Centre Bosnia and Herzegovina 2 4 3 6 4 4 1 8 3 54 East Georgia 12 10 16 21 24 18 21 26 26 22 240 West Israel 8 7 10 14 4 2 6 2 2 6 340 East Kazakhstan 1 0 4 1 2 2 2 2 6 8 33 East Kyrgyzstan 0 0 0 0 0 0 0 0 1 0 2 East Moldova 3 0 2 3 2 1 8 5 3 4 44 West Monaco 0 0 0 1 0 0 0 0 - - 22 Centre Montenegro 1 4 3 3 8 9 11 11 4 2 84 Centre North Macedonia 4 3 3 5 2 4 2 2 - - 47 East Russia - - - - - - - - - - 0 West San Marino 1 2 0 0 0 0 0 0 0 0 11 Centre Serbia 22 31 20 27 28 36 30 45 45 18 599 Centre Serbia excluding Kosovoc 21 30 19 27 26 36 30 43 42 17 583 Centre Kosovoc 1 1 1 2 2 3 1 16 West Switzerland 37 34 32 24 25 26 27 25 16 14 3 428 East Tajikistan 0 0 0 0 0 1 4 0 0 0 5 Centre Turkey 0 0 12 15 12 17 14 12 15 5 183 East Turkmenistan 0 0 - - - - - - - - 0 East Ukraine 31 45 50 55 72 116 69 81 82 58 717 West United Kingdom 144 158 113 129 138 105 99 87 87 50 15 423 East Uzbekistan - - - - - - - - - - 1 Total non-EU/EEA 281 310 286 325 335 353 305 322 313 203 21 440 WHO European Region West 1 697 1 644 1 509 1 347 1 328 1 146 1 067 940 768 455 109 826 Centre 164 178 193 223 204 247 214 253 235 139 4 117 East 65 68 97 104 113 161 132 138 142 109 1 437 Total WHO European Region 1 926 1 890 1 799 1 674 1 645 1 554 1 413 1 331 1 145 703 115 380 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 65 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 18: AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EU/EEA West Austria 13 28 14 21 17 10 10 1 7 5 910 West Belgium 4 1 3 7 1 0 1 0 0 1 289 Centre Bulgaria 17 39 29 26 11 14 17 20 18 5 220 Centre Croatia 1 1 0 0 1 0 2 0 0 0 26 Centre Cyprus 0 0 0 1 0 0 0 0 0 0 4 Centre Czech Republic 1 2 3 2 3 4 2 4 4 3 56 West Denmark 4 4 5 1 0 1 1 0 0 0 231 East Estonia 20 15 9 6 4 16 3 11 11 8 294 West Finland 0 4 2 0 0 1 1 3 0 0 60 West France 65 45 43 31 33 20 12 20 19 9 13 989 West Germany 41 42 31 26 21 18 13 18 4 4 429 West Greece 9 22 41 45 31 25 19 12 9 12 342 Centre Hungary 0 0 0 0 2 2 1 1 1 1 14 West Iceland 0 0 0 0 0 2 0 0 0 0 7 West Ireland 10 3 1 0 0 0 1 2 1 0 378 West Italy 195 179 180 114 101 89 89 78 73 27 35 287 East Latvia 57 70 62 73 51 36 38 30 32 20 1 042 Liechtenstein 1 0 0 0 0 0 0 0 0 0 7 East Lithuania 9 22 19 16 15 19 23 14 11 0 278 West Luxembourg 1 0 1 1 1 0 1 0 1 1 48 West Malta 0 0 0 1 0 0 0 0 0 0 4 West Netherlands 9 3 4 1 4 4 3 3 2 0 387 West Norway 0 1 1 0 0 1 0 0 1 0 157 Centre Poland 62 59 46 32 34 23 23 10 13 2 1 608 West Portugal 165 165 117 67 47 43 39 22 15 - 9 558 Centre Romania 29 61 82 114 106 103 73 57 39 17 721 Centre Slovakia 0 0 0 0 0 0 0 1 0 0 2 Centre Slovenia 0 0 0 1 0 0 0 0 1 0 8 West Spain 366 301 195 135 87 66 59 44 25 17 50 531 West Sweden - - - - - - - - - - 243 Total EU/EEA 1 079 1 067 888 721 570 497 431 351 287 128 121 130 Non-EU/EEA Centre Albania 1 0 0 1 0 0 0 0 0 0 3 West Andorra 0 0 0 0 0 0 0 0 - - 2 East Armenia 33 46 26 35 23 30 18 18 12 11 481 East Azerbaijan 148 160 123 109 92 76 52 51 60 37 1 458 East Belarus 266 242 193 150 139 130 116 60 84 47 2 629 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 18 East Georgia 191 161 142 120 99 110 86 50 61 30 2 012 West Israel 7 10 15 12 9 10 6 7 2 6 279 East Kazakhstan 149 152 158 150 154 173 169 191 189 189 2 590 East Kyrgyzstan 58 55 38 40 73 30 23 10 3 2 598 East Moldova 102 39 54 42 46 39 31 35 23 13 1 080 West Monaco 0 0 0 0 0 0 0 0 - - 19 Centre Montenegro 0 1 0 0 0 0 0 0 0 0 4 Centre North Macedonia 0 0 0 0 0 0 0 0 - - 9 East Russia - - - - - - - - - - 0 West San Marino 0 0 0 0 0 0 0 0 0 0 6 Centre Serbia 12 5 9 5 5 5 1 2 1 663 Centre Serbia excluding Kosovoc 12 5 9 5 5 0 5 1 2 1 662 Centre Kosovoc - - - - - - - - - - 1 West Switzerland 18 6 11 4 2 5 8 0 4 2 3 327 East Tajikistan 72 86 58 75 97 84 76 38 28 18 824 Centre Turkey 2 1 1 2 0 2 1 0 0 1 65 East Turkmenistan 0 0 - - - - - - - - 0 East Ukraine 4 979 4 933 4 273 3 856 3 050 2 939 2 872 2 343 1 916 1 027 52 751 West United Kingdom 12 11 9 14 10 8 4 10 7 7 1 530 East Uzbekistan - - - - - - - - - - 380 Total non-EU/EEA 6 050 5 908 5 110 4 615 3 799 3 636 3 467 2 814 2 391 1 391 70 728 WHO European Region West 919 825 673 480 364 303 267 220 170 87 122 013 Centre 125 169 170 184 162 148 124 94 78 30 3 421 East 6 084 5 981 5 155 4 672 3 843 3 682 3 507 2 851 2 430 1 402 66 417 Total WHO European Region 7 128 6 975 5 998 5 336 4 369 4 133 3 898 3 165 2 678 1 519 191 851 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 66 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 19: AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis (2011– 2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EU/EEA West Austria 29 35 27 34 29 22 24 26 22 15 991 West Belgium 54 69 54 65 50 40 27 33 38 19 2 708 Centre Bulgaria 20 15 20 25 22 17 17 17 22 20 397 Centre Croatia 6 4 6 5 2 1 1 5 2 1 156 Centre Cyprus 9 6 4 3 8 11 9 9 9 5 187 Centre Czech Republic 13 14 12 16 16 16 22 13 16 20 273 West Denmark 40 22 21 17 27 14 16 16 14 17 805 East Estonia 9 16 10 8 14 16 12 9 14 9 199 West Finland 15 10 12 9 6 16 11 9 11 4 279 West France 446 499 383 379 345 288 259 279 292 213 21 806 West Germany 155 132 129 117 109 107 83 73 19 - 4 508 West Greece 34 42 31 33 38 45 34 29 35 25 1 148 Centre Hungary 7 6 11 12 7 10 19 8 14 9 219 West Iceland 2 1 0 0 0 0 0 1 0 1 17 West Ireland 17 22 17 18 8 7 8 7 3 1 382 West Italy 505 517 502 449 423 451 414 338 283 197 18 662 East Latvia 34 55 37 59 58 51 49 46 46 30 685 Liechtenstein 0 1 0 0 0 0 0 0 0 0 3 East Lithuania 9 13 15 17 16 18 18 16 9 0 196 West Luxembourg 5 4 2 6 4 4 3 3 3 3 130 West Malta 3 5 0 2 1 3 0 0 0 0 41 West Netherlands 90 111 89 84 88 81 72 55 47 40 2 579 West Norway 9 12 11 27 17 16 11 6 15 7 469 Centre Poland 45 37 35 34 33 18 17 18 18 6 741 West Portugal 388 355 331 245 218 245 182 184 132 9 460 Centre Romania 173 156 153 185 180 190 196 209 203 118 3 407 Centre Slovakia 1 3 4 2 3 3 3 2 0 0 40 Centre Slovenia 3 1 3 0 0 4 4 3 4 3 61 West Spain 418 380 272 212 199 185 168 126 96 86 16 505 West Sweden - - - - - - - - - - 667 Total EU/EEA 2 539 2 543 2 191 2 063 1 921 1 879 1 679 1 540 1 367 849 87 721 Non-EU/EEA Centre Albania 39 40 55 40 52 55 31 46 37 14 577 West Andorra 0 0 1 0 2 0 1 0 - - 5 East Armenia 51 86 106 125 132 125 117 180 133 126 1 398 East Azerbaijan 44 68 57 85 93 76 112 120 124 63 1 045 East Belarus 305 348 344 309 333 367 312 313 279 168 4 026 Centre Bosnia and Herzegovina 4 0 3 1 2 3 2 3 5 - 84 East Georgia 180 184 139 123 145 137 145 190 176 127 2 070 West Israel 38 32 21 43 31 34 21 27 20 13 996 East Kazakhstan 81 76 82 93 98 158 168 231 238 249 1 716 East Kyrgyzstan 26 27 24 39 40 35 30 34 35 38 394 East Moldova 327 196 217 210 208 275 186 286 226 128 3 000 West Monaco 0 0 0 0 0 0 0 0 - - 7 Centre Montenegro 1 2 1 3 1 6 2 2 3 2 62 Centre North Macedonia 3 6 6 10 4 3 0 1 - - 92 East Russia - - - - - - - - - - 0 West San Marino 0 0 0 0 0 0 0 0 0 0 5 Centre Serbia 17 9 9 11 12 7 17 18 16 7 463 Centre Serbia excluding Kosovoc 11 9 7 10 12 5 12 13 14 6 422 Centre Kosovoc 6 - 2 1 - 2 5 5 2 1 41 West Switzerland 70 52 54 32 34 28 27 28 29 9 2 810 East Tajikistan 61 72 90 113 148 125 149 148 101 79 1 194 Centre Turkey 37 35 41 58 39 28 30 37 35 11 773 East Turkmenistan 0 0 - - - - - - - - 0 East Ukraine 3 944 4 873 4 875 5 806 5 250 5 708 6 243 6 306 5 443 2 989 60 475 West United Kingdom 239 246 202 199 221 161 133 135 141 100 11 120 East Uzbekistan - - - - - - - - - - 183 Total non-EU/EEA 5 467 6 352 6 327 7 300 6 845 7 331 7 726 8 105 7 041 4 123 92 495 WHO European Region West 2 557 2 546 2 159 1 971 1 850 1 747 1 494 1 375 1 200 750 96 100 Centre 378 334 363 405 381 372 370 391 384 216 7 532 East 5 071 6 014 5 996 6 987 6 535 7 091 7 541 7 879 6 824 4 006 76 581 Total WHO European Region 8 006 8 894 8 518 9 363 8 766 9 210 9 405 9 645 8 408 4 972 180 213 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Without prejudice to positions on status, and in line with UNSCR 1 244 and the ICJ Opinion on the Kosovo Declaration of Independence 67 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 20: AIDS diagnoses in people infected through mother to child transmission, by country and year of diagnosis (2011–2020) and cumulative totals, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Year of diagnosis Cumulative totalb2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EU/EEA West Austria 1 0 0 0 0 1 0 1 0 0 14 West Belgium 1 2 1 1 3 1 0 0 1 0 148 Centre Bulgaria 1 0 3 0 0 0 0 3 0 2 12 Centre Croatia 1 0 0 0 0 0 0 0 0 0 4 Centre Cyprus 0 0 0 0 0 0 0 0 0 0 2 Centre Czech Republic 0 0 0 0 0 1 0 0 0 0 1 West Denmark 0 0 1 0 0 0 1 0 0 0 25 East Estonia 0 0 0 0 0 0 0 0 0 1 3 West Finland 0 0 0 1 0 0 0 0 0 0 8 West France 8 11 11 4 6 5 4 7 4 0 811 West Germany 3 2 1 2 0 0 1 0 0 - 121 West Greece 0 0 0 0 0 0 0 0 0 0 24 Centre Hungary 0 1 0 0 1 0 2 1 0 0 8 West Iceland 0 0 0 0 0 0 0 1 0 0 1 West Ireland 0 0 1 0 0 0 0 0 0 0 36 West Italy 3 4 7 2 0 1 0 0 0 0 740 East Latvia 2 1 2 0 0 2 1 1 1 0 23 Liechtenstein 0 0 0 0 0 0 0 0 0 0 0 East Lithuania 0 0 1 0 0 0 0 0 0 0 1 West Luxembourg 0 1 0 0 0 0 0 0 0 0 4 West Malta 0 0 0 0 0 0 0 0 0 0 1 West Netherlands 4 2 5 3 4 0 1 2 1 0 116 West Norway 0 0 1 0 0 0 1 0 0 0 8 Centre Poland 3 1 0 1 1 0 0 1 0 0 70 West Portugal 2 1 3 1 1 3 1 1 1 - 129 Centre Romania 12 11 17 8 6 0 8 4 6 8 348 Centre Slovakia 0 0 0 0 0 0 0 0 0 0 0 Centre Slovenia 0 0 0 0 0 0 0 0 0 1 3 West Spain 3 3 5 1 2 4 1 1 1 0 989 West Sweden - - - - - - - - - - 22 Total EU/EEA 44 40 59 24 24 18 21 23 15 12 3 672 Non-EU/EEA Centre Albania 1 2 4 0 0 0 1 0 1 0 11 West Andorra 0 0 0 0 0 0 0 0 - - 0 East Armenia 1 0 4 7 2 2 3 4 2 4 39 East Azerbaijan 1 3 3 2 0 1 0 0 1 1 17 East Belarus 12 4 3 9 10 5 2 1 2 0 126 Centre Bosnia and Herzegovina 0 0 0 0 0 0 0 0 0 - 0 East Georgia 8 1 3 2 0 0 1 3 1 0 68 West Israel 1 1 1 0 0 0 0 1 0 0 40 East Kazakhstan 4 2 5 1 5 3 7 3 4 5 67 East Kyrgyzstan 3 4 1 0 5 1 2 1 2 1 23 East Moldova 7 6 10 8 2 4 5 5 2 2 84 West Monaco 0 0 0 0 0 0 0 0 - - 0 Centre Montenegro 0 0 0 0 0 0 0 0 0 0 1 Centre North Macedonia 0 1 1 0 0 0 0 0 - - 6 East Russia - - - - - - - - - - 0 West San Marino 0 0 0 0 0 0 0 0 0 0 0 Centre Serbia - 1 1 - 1 - - 1 - - 29 Centre Serbia excluding Kosovoc 0 0 1 0 0 0 0 0 0 0 26 Centre Kosovoc - 1 - - 1 - - 1 - - 3 West Switzerland 0 1 1 0 0 0 1 0 0 0 110 East Tajikistan 7 6 15 10 4 6 6 8 2 4 70 Centre Turkey 0 1 0 1 3 0 1 0 4 1 22 East Turkmenistan 0 0 - - - - - - - - 0 East Ukraine 118 88 59 60 48 67 93 81 57 46 1 470 West United Kingdom 13 5 8 4 6 4 4 2 7 2 741 East Uzbekistan - - - - - - - - - - 22 Total non-EU/EEA 176 126 119 104 86 93 126 111 85 66 2 946 WHO European Region West 39 33 46 19 22 19 15 16 15 2 4 088 Centre 18 18 26 10 12 1 12 10 11 12 517 East 163 115 106 99 76 91 220 107 74 64 2 013 Total WHO European Region 220 166 178 128 110 111 247 133 100 78 6 618 a Country-specific comments are in Annex 5. b Cumulative total is the total number of cases reported by the country since the start of reporting. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 68 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 21: AIDS diagnoses in 2020, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa MSM IDU Hetero MTCT Nosocomial Haemophiliac/transfusion Unknown Totalb Country, territory or areaaMale Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 12 12 1 4 5 9 6 15 - - 0 - - 0 - - 0 - 11 11 43 Austria West Belgium 12 12 - 1 1 9 10 19 - - 0 - - 0 2 - 2 1 5 6 40 Belgium Centre Bulgaria 16 16 2 3 5 8 12 20 1 1 2 - - 0 - - 0 - - 0 43 Bulgaria Centre Croatia 11 11 - - 0 1 1 - - 0 - - 0 - - 0 - - 0 12 Croatia Centre Cyprus 9 9 - - 0 3 2 5 - - 0 - - 0 - - 0 2 2 4 18 Cyprus Centre Czech Republic 15 15 - 3 3 7 13 20 - - 0 - - 0 - - 0 1 4 5 43 Czech Republic West Denmark 6 6 0 4 13 17 - - 0 - - 0 - - 0 - 2 2 25 Denmark East Estonia 1 1 - 8 8 2 7 9 1 - 1 - - 0 - - 0 2 2 4 23 Estonia West Finland 1 1 - - 0 1 3 4 - - 0 - - 0 - - 0 4 3 7 12 Finland West France 95 96 1 8 9 97 114 213 - - 0 - - 0 2 1 3 12 55 67 388 France West Germany - - - - - - - - - - - - - - - - - - - - - Germany West Greece 36 36 - 12 12 12 13 25 - - 0 - - 0 - - 0 4 23 27 100 Greece Centre Hungary 32 32 - 1 1 7 2 9 - - 0 - - 0 - - 0 - - 0 42 Hungary West Iceland - 0 - - 0 - 1 1 - - 0 - - 0 - - 0 - 1 1 2 Iceland West Ireland 3 3 - - 0 1 1 - - 0 - - 0 - - 0 1 1 2 6 Ireland West Italy 94 94 5 22 27 86 111 197 - - 0 - - 0 - - 0 6 28 34 352 Italy East Latvia 1 1 1 19 20 14 16 30 - - 0 - - 0 - - 0 1 3 4 55 Latvia Liechtenstein - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Liechtenstein East Lithuania - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 15 15 Lithuania West Luxembourg 1 1 1 - 1 2 1 3 - - 0 - - 0 - - 0 - - 0 5 Luxembourg West Malta - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Malta West Netherlands 54 56 - - 0 20 20 40 - - 0 - 1 1 - - 0 6 12 18 115 Netherlands West Norway 3 3 - - 0 - 7 7 - - 0 - - 0 - - 0 1 - 1 11 Norway Centre Poland 9 9 - 2 2 2 4 6 - - 0 - - 0 - - 0 5 12 17 34 Poland West Portugal - - - - - - - - - - - - - - - - - - - - Portugal Centre Romania 15 15 4 13 17 36 82 118 4 4 8 2 4 6 - 1 1 1 - 1 166 Romania Centre Slovakia 4 4 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 4 Slovakia Centre Slovenia 2 2 - - 0 2 1 3 - 1 1 - - 0 - - 0 - - 0 6 Slovenia West Spain 65 65 6 11 17 31 55 86 - - 0 - - 0 - - 0 5 27 32 200 Spain West Sweden - - - - - - - - - - - - - - - - - - - - - Sweden Total EU/EEA 497 500 21 107 128 354 493 849 6 6 12 2 5 7 4 2 6 52 191 258 1 760 Total EU/EEA Non-EU/EEA Centre Albania 1 1 - - 0 2 12 14 - - 0 - - 0 - - 0 - - 0 15 Albania West Andorra - - - - - - - - - - - - - - - - - - - - - Andorra East Armenia 9 9 11 11 35 91 126 4 1 5 - - 0 - - 0 - 1 1 152 Armenia East Azerbaijan 3 3 2 35 37 25 38 63 - 1 1 - - 0 - - 0 1 - 1 105 Azerbaijan East Belarus 3 3 13 34 47 64 104 168 - - 0 - - 0 - - 0 - 2 2 220 Belarus Centre Bosnia and Herzegovina - - - - - - - - - - - - - - - - - - - - - Bosnia and Herzegovina East Georgia 22 22 1 29 30 45 82 127 - - 0 - - 0 1 - 1 - 1 1 181 Georgia West Israel 6 6 1 5 6 6 7 13 - - 0 - - 0 - - 0 - 4 4 29 Israel East Kazakhstan 8 8 32 157 189 134 115 249 1 4 5 - - 0 - - 0 9 9 18 469 Kazakhstan East Kyrgyzstan - 0 2 2 18 20 38 - 1 1 - - 0 - - 0 4 1 5 46 Kyrgyzstan East Moldova 4 4 2 11 13 55 73 128 1 1 2 - - 0 - - 0 15 32 47 194 Moldova West Monaco - - - - - - - - - - - - - - - - - - - - Monaco Centre Montenegro 2 2 - - 0 1 1 2 - - 0 - - 0 - - 0 - - 0 4 Montenegro Centre North Macedonia - - - - - - - - - - - - - - - - - - - - - North Macedonia East Russia - - - - - - - - - - - - - - - - - - - - - Russia West San Marino - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 San Marino Centre Serbia - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Serbia Centre Serbia excluding Kosovoc 17 17 1 - 1 4 2 6 - - 0 - - 0 - - 0 - 8 8 32 Serbia excluding Kosovoc Centre Kosovoc 1 1 - - 0 1 - 1 - - 0 - - 0 - - 0 - - 0 2 Kosovoc West Switzerland 14 14 1 1 2 1 8 9 - - 0 - - 0 - - 0 3 5 8 33 Switzerland East Tajikistan 0 - 18 18 18 61 79 2 2 4 - 1 1 - - 0 2 2 4 106 Tajikistan Centre Turkey 5 5 - 1 1 5 6 11 1 - 1 - - 0 - - 0 7 21 28 46 Turkey East Turkmenistan - - - - - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine 58 58 197 830 1 027 1 443 1 546 2 989 13 33 46 - 1 1 - - 0 7 11 18 4 139 Ukraine West United Kingdom 50 50 1 6 7 34 66 100 - 2 2 - - 0 - 2 2 4 23 27 188 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - - Uzbekistan Total non-EU/EEA 203 203 251 1 140 1 391 1 891 2 232 4 123 22 45 67 0 2 2 1 2 3 52 220 172 5 961 Total non-EU/EEA WHO European Region West 452 455 17 70 87 313 435 750 0 2 2 0 1 1 4 3 7 47 200 247 1 549 West Centre 139 139 7 23 30 79 137 216 6 6 12 2 4 6 0 1 1 16 47 63 467 Centre East 109 109 248 1 154 1 402 1 853 2 153 4 006 22 43 65 0 2 2 1 0 1 41 64 120 5 705 East Total WHO European Region 700 703 272 1 247 1 519 2 245 2 725 4 972 28 51 79 2 7 9 5 4 9 104 311 430 7 721 Total WHO European Region a Country-specific comments are in Annex 5 b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence MSM - Men who have sex with men; IDU - Injecting drug use; MTCT - Mother-to-child transmission 69 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 21: AIDS diagnoses in 2020, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa MSM IDU Hetero MTCT Nosocomial Haemophiliac/transfusion Unknown Totalb Country, territory or areaaMale Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb Female Male Totalb EU/EEA EU/EEA West Austria 12 12 1 4 5 9 6 15 - - 0 - - 0 - - 0 - 11 11 43 Austria West Belgium 12 12 - 1 1 9 10 19 - - 0 - - 0 2 - 2 1 5 6 40 Belgium Centre Bulgaria 16 16 2 3 5 8 12 20 1 1 2 - - 0 - - 0 - - 0 43 Bulgaria Centre Croatia 11 11 - - 0 1 1 - - 0 - - 0 - - 0 - - 0 12 Croatia Centre Cyprus 9 9 - - 0 3 2 5 - - 0 - - 0 - - 0 2 2 4 18 Cyprus Centre Czech Republic 15 15 - 3 3 7 13 20 - - 0 - - 0 - - 0 1 4 5 43 Czech Republic West Denmark 6 6 0 4 13 17 - - 0 - - 0 - - 0 - 2 2 25 Denmark East Estonia 1 1 - 8 8 2 7 9 1 - 1 - - 0 - - 0 2 2 4 23 Estonia West Finland 1 1 - - 0 1 3 4 - - 0 - - 0 - - 0 4 3 7 12 Finland West France 95 96 1 8 9 97 114 213 - - 0 - - 0 2 1 3 12 55 67 388 France West Germany - - - - - - - - - - - - - - - - - - - - - Germany West Greece 36 36 - 12 12 12 13 25 - - 0 - - 0 - - 0 4 23 27 100 Greece Centre Hungary 32 32 - 1 1 7 2 9 - - 0 - - 0 - - 0 - - 0 42 Hungary West Iceland - 0 - - 0 - 1 1 - - 0 - - 0 - - 0 - 1 1 2 Iceland West Ireland 3 3 - - 0 1 1 - - 0 - - 0 - - 0 1 1 2 6 Ireland West Italy 94 94 5 22 27 86 111 197 - - 0 - - 0 - - 0 6 28 34 352 Italy East Latvia 1 1 1 19 20 14 16 30 - - 0 - - 0 - - 0 1 3 4 55 Latvia Liechtenstein - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Liechtenstein East Lithuania - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 15 15 Lithuania West Luxembourg 1 1 1 - 1 2 1 3 - - 0 - - 0 - - 0 - - 0 5 Luxembourg West Malta - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Malta West Netherlands 54 56 - - 0 20 20 40 - - 0 - 1 1 - - 0 6 12 18 115 Netherlands West Norway 3 3 - - 0 - 7 7 - - 0 - - 0 - - 0 1 - 1 11 Norway Centre Poland 9 9 - 2 2 2 4 6 - - 0 - - 0 - - 0 5 12 17 34 Poland West Portugal - - - - - - - - - - - - - - - - - - - - Portugal Centre Romania 15 15 4 13 17 36 82 118 4 4 8 2 4 6 - 1 1 1 - 1 166 Romania Centre Slovakia 4 4 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 4 Slovakia Centre Slovenia 2 2 - - 0 2 1 3 - 1 1 - - 0 - - 0 - - 0 6 Slovenia West Spain 65 65 6 11 17 31 55 86 - - 0 - - 0 - - 0 5 27 32 200 Spain West Sweden - - - - - - - - - - - - - - - - - - - - - Sweden Total EU/EEA 497 500 21 107 128 354 493 849 6 6 12 2 5 7 4 2 6 52 191 258 1 760 Total EU/EEA Non-EU/EEA Centre Albania 1 1 - - 0 2 12 14 - - 0 - - 0 - - 0 - - 0 15 Albania West Andorra - - - - - - - - - - - - - - - - - - - - - Andorra East Armenia 9 9 11 11 35 91 126 4 1 5 - - 0 - - 0 - 1 1 152 Armenia East Azerbaijan 3 3 2 35 37 25 38 63 - 1 1 - - 0 - - 0 1 - 1 105 Azerbaijan East Belarus 3 3 13 34 47 64 104 168 - - 0 - - 0 - - 0 - 2 2 220 Belarus Centre Bosnia and Herzegovina - - - - - - - - - - - - - - - - - - - - - Bosnia and Herzegovina East Georgia 22 22 1 29 30 45 82 127 - - 0 - - 0 1 - 1 - 1 1 181 Georgia West Israel 6 6 1 5 6 6 7 13 - - 0 - - 0 - - 0 - 4 4 29 Israel East Kazakhstan 8 8 32 157 189 134 115 249 1 4 5 - - 0 - - 0 9 9 18 469 Kazakhstan East Kyrgyzstan - 0 2 2 18 20 38 - 1 1 - - 0 - - 0 4 1 5 46 Kyrgyzstan East Moldova 4 4 2 11 13 55 73 128 1 1 2 - - 0 - - 0 15 32 47 194 Moldova West Monaco - - - - - - - - - - - - - - - - - - - - Monaco Centre Montenegro 2 2 - - 0 1 1 2 - - 0 - - 0 - - 0 - - 0 4 Montenegro Centre North Macedonia - - - - - - - - - - - - - - - - - - - - - North Macedonia East Russia - - - - - - - - - - - - - - - - - - - - - Russia West San Marino - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 San Marino Centre Serbia - 0 - - 0 - - 0 - - 0 - - 0 - - 0 - - 0 0 Serbia Centre Serbia excluding Kosovoc 17 17 1 - 1 4 2 6 - - 0 - - 0 - - 0 - 8 8 32 Serbia excluding Kosovoc Centre Kosovoc 1 1 - - 0 1 - 1 - - 0 - - 0 - - 0 - - 0 2 Kosovoc West Switzerland 14 14 1 1 2 1 8 9 - - 0 - - 0 - - 0 3 5 8 33 Switzerland East Tajikistan 0 - 18 18 18 61 79 2 2 4 - 1 1 - - 0 2 2 4 106 Tajikistan Centre Turkey 5 5 - 1 1 5 6 11 1 - 1 - - 0 - - 0 7 21 28 46 Turkey East Turkmenistan - - - - - - - - - - - - - - - - - - - - - Turkmenistan East Ukraine 58 58 197 830 1 027 1 443 1 546 2 989 13 33 46 - 1 1 - - 0 7 11 18 4 139 Ukraine West United Kingdom 50 50 1 6 7 34 66 100 - 2 2 - - 0 - 2 2 4 23 27 188 United Kingdom East Uzbekistan - - - - - - - - - - - - - - - - - - - - - Uzbekistan Total non-EU/EEA 203 203 251 1 140 1 391 1 891 2 232 4 123 22 45 67 0 2 2 1 2 3 52 220 172 5 961 Total non-EU/EEA WHO European Region West 452 455 17 70 87 313 435 750 0 2 2 0 1 1 4 3 7 47 200 247 1 549 West Centre 139 139 7 23 30 79 137 216 6 6 12 2 4 6 0 1 1 16 47 63 467 Centre East 109 109 248 1 154 1 402 1 853 2 153 4 006 22 43 65 0 2 2 1 0 1 41 64 120 5 705 East Total WHO European Region 700 703 272 1 247 1 519 2 245 2 725 4 972 28 51 79 2 7 9 5 4 9 104 311 430 7 721 Total WHO European Region a Country-specific comments are in Annex 5 b Totals include persons with unknown gender and may, therefore, not equal the sum of the columns. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence MSM - Men who have sex with men; IDU - Injecting drug use; MTCT - Mother-to-child transmission 70 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 22: The most common AIDS-indicative diseases diagnosed in 2020a, ordered by frequency Diseases Men Women Children TotalN % N % N % N % EU/EEA Pneumocystis carinii pneumonia 408 23.8 139 24.1 4 11.4 551 23.7 Candidiasis; oesophageal 204 11.9 71 12.3 4 11.4 279 12.0 Wasting syndrome due to HIV 187 10.9 48 8.3 8 22.9 243 10.5 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 114 6.7 52 9.0 3 8.6 169 7.3 Toxoplasmosis of brain in a patient over one month of age 93 5.4 51 8.8 1 2.9 145 6.2 Cytomegalovirus disease (other than liver; spleen; or nodes) in a patient over one month of age 109 6.4 32 5.5 1 2.9 142 6.1 Kaposi’s sarcoma 128 7.5 13 2.3 0 0.0 141 6.1 Encephalopathy; HIV-related 84 4.9 23 4.0 6 17.1 113 4.9 Mycobacterium tuberculosis; extrapulmonary 66 3.9 38 6.6 0 0.0 104 4.5 Progressive multifocal leukoencephalopathy 40 2.3 15 2.6 1 2.9 56 2.4 Non-EU/EEA Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 122 12.1 33 10.2 2 9.1 157 11.6 Wasting syndrome due to HIV 114 11.3 29 9.0 4 18.2 147 10.9 Candidiasis; oesophageal 95 9.4 35 10.8 0 0.0 130 9.6 Kaposi’s sarcoma 89 8.8 11 3.4 1 4.5 101 7.5 Pneumocystis carinii pneumonia 65 6.4 25 7.7 5 22.7 95 7.0 Mycobacterium tuberculosis; extrapulmonary 26 2.6 10 3.1 0 0.0 36 2.7 Encephalopathy; HIV-related 26 2.6 6 1.9 2 9.1 34 2.5 Candidiasis of bronchi; trachea; or lungs 26 2.6 7 2.2 0 0.0 33 2.4 Toxoplasmosis of brain in a patient over one month of age 16 1.6 6 1.9 0 0.0 22 1.6 Cytomegalovirus disease (other than liver; spleen; or nodes) in a patient over one month of age 15 1.5 2 0.6 0 0.0 17 1.3 West Pneumocystis carinii pneumonia 350 23.1 120 24.6 0 0.0 470 23.6 Candidiasis; oesophageal 179 11.8 62 12.7 0 0.0 241 11.9 Kaposi’s sarcoma 189 12.5 20 4.1 1 100.0 210 11.0 Toxoplasmosis of brain in a patient over one month of age 87 5.8 46 9.4 0 0.0 133 8.2 Wasting syndrome due to HIV 109 7.2 24 4.9 0 0.0 133 7.0 Cytomegalovirus disease (other than liver; spleen; or nodes) in a patient over one month of age 99 6.5 32 6.6 0 0.0 131 5.3 Mycobacterium tuberculosis; extrapulmonary 73 4.8 35 7.2 0 0.0 108 4.9 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 61 4.0 30 6.2 0 0.0 91 4.5 Encephalopathy; HIV-related 49 3.2 11 2.3 0 0.0 60 3.2 Lymphoma; Burkitt’s lymphoma (or equivalent term) 39 2.6 7 1.4 0 0.0 46 2.2 Centre Wasting syndrome due to HIV 109 23.0 26 17.2 8 22.9 143 21.7 Pneumocystis carinii pneumonia 68 14.4 24 15.9 4 11.4 96 14.6 Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 59 12.5 22 14.6 3 8.6 84 12.7 Encephalopathy; HIV-related 41 8.7 14 9.3 6 17.1 61 9.3 Candidiasis; oesophageal 36 7.6 12 7.9 4 11.4 52 7.9 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 19 4.0 5 3.3 1 2.9 25 3.8 Kaposi’s sarcoma 21 4.4 3 2.0 0 0.0 24 3.6 Toxoplasmosis of brain in a patient over one month of age 13 2.7 7 4.6 1 2.9 21 3.2 Cytomegalovirus disease (other than liver; spleen; or nodes) in a patient over one month of age 19 4.0 0 0.0 1 2.9 20 3.0 Progressive multifocal leukoencephalopathy 14 3.0 4 2.6 1 2.9 19 2.9 East Mycobacterium tuberculosis; pulmonary in an adult or an adolescent (aged 13 years or over) 116 15.8 33 12.6 2 9.5 151 14.8 Candidiasis; oesophageal 84 11.4 32 12.2 0 0.0 116 11.4 Wasting syndrome due to HIV 83 11.3 27 10.3 4 19.0 114 11.2 Pneumocystis carinii pneumonia 55 7.5 20 7.6 5 23.8 80 7.9 Encephalopathy; HIV-related 20 2.7 4 1.5 2 9.5 26 2.6 Mycobacterium tuberculosis; extrapulmonary 16 2.2 8 3.1 0 0.0 24 2.4 Toxoplasmosis of brain in a patient over one month of age 9 1.2 4 1.5 0 0.0 13 1.3 Cytomegalovirus disease (other than liver; spleen; or nodes) in a patient over one month of age 6 0.8 2 0.8 0 0.0 8 0.8 Pneumonia; recurrent in an adult or an adolescent (aged 13 years or over) 5 0.7 3 1.1 0 0.0 8 0.8 Kaposi’s sarcoma 7 1.0 1 0.4 0 0.0 8 0.8 a Numbers and percentages relate to AIDS indicative disease events reported; some people diagnosed with AIDS have more than one event reported at the time of diagnosis 71 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Table 23: AIDS-related deathsa, by geographic area, country and year of death (2011–2020) and cumulative totals in EU/EEA and other countries of the WHO European Region Area Country, territory or areab Year of diagnosis Cumulative totalc2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EU/EEA West Austria 39 34 41 42 37 32 43 40 42 14 1 694 West Belgium 31 31 37 35 23 29 26 14 30 27 2 193 Centre Bulgaria 17 16 14 13 8 9 10 9 17 6 215 Centre Croatia 6 9 7 5 15 3 2 2 4 4 206 Centre Cyprus 4 5 5 4 4 5 3 3 2 4 136 Centre Czech Republic 14 17 13 15 12 18 20 18 7 21 332 West Denmark - - - - - - - - - - - East Estonia 7 5 2 2 2 2 4 4 1 6 127 West Finland 6 13 8 5 6 5 9 6 1 0 238 West France 173 158 134 127 103 129 126 185 186 144 37 275 West Germany 126 87 111 101 76 77 71 71 34 14 970 West Greece 50 52 43 48 50 42 44 42 37 41 1 985 Centre Hungary 17 11 11 19 11 11 9 18 19 10 469 West Iceland 1 1 0 0 0 1 0 0 0 1 41 West Ireland 4 1 0 0 1 1 1 0 1 1 419 West Italy 644 636 653 573 561 533 511 505 - - 46 366 East Latvia 80 88 107 75 45 41 37 29 30 13 911 Liechtenstein 0 0 0 0 0 0 0 0 0 0 6 East Lithuania 9 10 18 16 12 23 15 14 5 0 241 West Luxembourg 5 7 3 2 4 4 1 1 4 4 156 West Malta 1 2 0 1 1 3 0 0 0 0 65 West Netherlands 92 89 85 89 90 100 90 83 81 74 2 166 West Norway 1 1 2 3 2 0 2 1 1 0 634 Centre Poland 68 57 48 42 41 27 20 23 15 11 1 439 West Portugal 308 260 273 208 176 189 167 156 94 10 797 Centre Romania 217 189 199 239 197 197 201 179 167 107 5 060 Centre Slovakia 1 3 0 0 4 2 1 3 2 1 52 Centre Slovenia 1 2 7 4 6 3 2 1 2 0 119 West Spain 428 375 311 234 185 179 110 76 24 28 49 019 West Sweden - - - - - - - - - - 1 323 Total EU/EEA 2 356 2 161 2 136 1 902 1 673 1 667 1 526 1 485 807 519 180 458 Non-EU/EEA Centre Albania 11 13 10 13 13 12 4 11 8 3 187 West Andorra 0 0 0 0 3 0 0 0 - - 4 East Armenia 25 36 46 50 62 53 74 61 61 51 693 East Azerbaijan 44 52 42 54 40 31 26 31 22 8 1 065 East Belarus 159 188 129 170 126 119 80 110 127 59 3 697 Centre Bosnia and Herzegovina 0 0 2 1 4 2 0 2 2 - 68 East Georgia 97 83 82 68 70 132 96 100 77 106 1 409 West Israel 33 31 31 33 26 30 14 14 8 7 1 043 East Kazakhstan 205 189 189 161 208 235 255 280 306 317 3 363 East Kyrgyzstan 19 19 6 9 38 20 27 23 0 5 311 East Moldova 98 67 90 98 83 91 82 37 54 102 1 207 West Monaco 0 0 0 0 0 0 0 0 - - 18 Centre Montenegro 2 1 1 2 6 2 4 2 4 1 61 Centre North Macedonia 4 0 3 0 0 0 2 1 - - 67 East Russia - - - - - - - - - - 0 West San Marino 0 0 0 0 0 0 0 0 0 0 8 Centre Serbia 33 21 18 10 16 13 14 26 23 16 1 220 Centre Serbia excluding Kosovod 31 17 17 10 15 10 14 25 21 16 1 172 Centre Kosovod 2 4 1 1 3 1 2 - 48 West Switzerland 13 3 4 5 5 1 4 2 1 1 5 906 East Tajikistan 65 104 111 101 126 128 186 144 111 96 1 320 Centre Turkey 0 0 10 11 4 4 5 8 4 1 121 East Turkmenistan 0 0 - - - - - - - - 1 East Ukraine 3 736 3 870 3 514 3 426 3 032 3 253 3 298 3 448 2 977 2 114 53 547 West United Kingdom 161 158 161 151 117 106 109 96 101 102 16 849 East Uzbekistan - - - - - - - - - - 323 Total non-EU/EEA 4 738 4 856 4 467 4 373 3 995 4 245 4 294 4 422 3 909 3 005 93 708 WHO European Region West 2 116 1 939 1 897 1 657 1 466 1 461 1 328 1 292 645 444 194 973 Centre 395 344 348 378 341 308 297 306 276 185 9 752 East 4 544 4 711 4 336 4 230 3 844 4 128 4 180 4 281 3 771 2 877 68 215 Total WHO European Region 7 055 6 994 6 581 6 265 5 651 5 897 5 805 5 879 4 692 3 506 272 940 a This table includes deaths reported as due to AIDS and excludes deaths reported as not due to AIDS-related cases. In countries and years for which cause of death (AIDS or non-AIDS related) was unknown or could not be reported, deaths among persons (ever) diagnosed with AIDS were included. Spain has changing national coverage of AIDS reporting during the period (see Annex 5) and trends should be interpreted with caution. b Country-specific comments are in Annex 5 c Cumulative total is the total number of cases reported by country since the start of reporting d Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence 72 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Table 24: Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year (2011–2020) and number of tests per 1 000 population in 2020, in EU/EEA and other countries of the WHO European Region Area Country, territory or areaa Number of HIV tests Tests/1 000 population2011 2012 2013 2 014 2 015 2 016 2017 2018 2019 2020 EU/EEA West Austria - - - - - - - - - - - West Belgium 684 182 692 304 695 222 698 266 699 687 720 104 715 536 639 410 751 122 641 358 55.8 Centre Bulgaria 180 000 190 000 - 230 000 290 000 - - 360 000 360 000 340 000 48.9 Centre Croatia - - - - - - - - - - - Centre Cyprus 49 074 54 120 50 235 - - 52 385 - - - - - Centre Czech Republic 334 569 349 205 341 583 349 448 345 274 350 234 351 650 353 425 359 327 329 433 30.8 West Denmark 137 877 134 709 - - - - - - - - - East Estonia 85 025 73 367 82 279 82 266 87 587 90 136 102 863 112 487 125 273 105 285 79.2 West Finland - - - - - - - - - - - West France 5 238 567 5 251 272 5 239 389 5 282 844 5 390 760 5 503 259 5 614 818 5 828 267 6 170 133 5 243 792 77.9 West Germany - - - - - - - - - - - West Greeceb 31 918 34 622 32 241 240 116 192 150 196 257 176 966 187 627 - - - Centre Hungary 84 464 93 060 95 861 93 289 91 793 - - - - - - West Iceland - - - - - - - - - - - West Irelandb 184 521 175 488 150 597 168 028 178 267 192 956 223 609 239 571 - - - West Italy - - - - - - - - - - - East Latvia 58 799 60 491 58 302 60 614 65 552 79 715 82 608 90 368 98 651 93 036 48.8 Liechtenstein - - - - - - - - - - - East Lithuania 102 234 101 042 102 161 108 781 105 486 104 132 113 917 109 825 133 810 - - West Luxembourg - - - - - 71 200 100 529 - - - - West Malta - - - - - - - - - - - West Netherlands - - - - - - - - - - - West Norway - - - - - - - - - - - Centre Poland 317 286 358 953 313 341 272 102 318 458 440 365 430 266 385 173 432 272 432 074 11.4 West Portugalb 286 553 256 263 248 890 260 437 282 800 281 992 291 305 308 328 352 926 272 202 26.4 Centre Romania 306 679 293 204 302 898 332 422 346 032 360 893 338 898 323 468 334 410 234 520 12.1 Centre Slovakia 110 025 110 506 114 574 126 187 127 109 104 876 111 340 177 498 - - - Centre Slovenia 38 110 33 602 33 457 35 498 34 366 35 788 37 315 38 570 40 462 23 798 11.4 West Spain - - - - - - - - - - - West Sweden - - - - - - - - - - - Non-EU/EEA Centre Albania 3 260 3 140 3 063 4 156 5 442 5 582 7 149 - 13 261 - - West Andorra 2 590 2 062 2 310 2 378 2 212 2 340 2 591 2 712 - - - East Armenia 68 449 71 957 83 431 94 122 117 012 99 270 119 628 132 509 164 933 159 281 54.9 East Azerbaijan 365 090 514 434 482 282 612 860 714 621 500 469 657 704 753 568 - - - East Belarus 621 780 683 125 770 136 1 157 072 1 249 712 1 464 386 1 514 635 1 627 169 1 488 199 1 242 389 131.5 Centre Bosnia and Herzegovina - - - - - - - - - - - East Georgia 21 799 15 562 18 091 86 290 78 261 119 868 207 175 188 142 441 119 - - West Israel 274 294 233 516 - - - - - - - - - East Kazakhstan 1 897 476 2 026 174 2 127 136 2 190 757 2 388 347 2 587 065 2 742 741 2 760 324 2 877 706 2 877 706 153.3 East Kyrgyzstan 381 295 470 355 370 160 410 331 376 284 331 609 376 431 356 765 424 087 - - East Moldova 207 830 212 964 146 105 133 476 146 762 124 010 160 947 154 575 182 196 152 500 37.8 West Monaco - - - - - - - - - - - Centre Montenegro 6 914 6 781 6 970 6 571 6 607 6 324 5 606 6 890 6 575 5 375 8.6 Centre North Macedonia 17 811 18 105 24 562 27 430 28 601 30 211 36 248 - - - - East Russiab 25 812 467 27 286 151 28 327 314 29 878 681 30 750 547 32 855 597 36 445 059 40 485 246 41 900 729 36 110 128 247.4 West San Marino 3 961 3 845 4 004 3 427 1 548 3 600 3 685 3 411 2 200 1 550 45.7 Centre Serbia - - - - - - - - - - - Centre Serbia excluding Kosovoc 56 086 64 031 65 829 56 282 61 877 65 827 76 367 76 653 88 490 - - Centre Kosovoc 1 189 1 335 1 250 - 1 312 2 599 4 551 4 877 2 018 1 242 0.7 West Switzerland - - - - - - - - - - - East Tajikistan 438 532 447 636 514 701 634 791 597 426 509 092 612 123 780 688 1 062 509 836 487 87.7 Centre Turkey 5 693 965 5 952 148 6 515 931 6 663 547 7 203 959 6 263 020 7 107 551 7 457 674 10 257 015 7 067 571 83.8 East Turkmenistan - - - - - - - - - - - East Ukraine 2 392 970 2 343 099 2 941 748 1 853 626 1 695 926 1 697 479 1 816 023 1 868 565 1 961 711 1 501 984 36.0 West United Kingdom - - - - - - - - - - - East Uzbekistan - - - - - - - - - - - a Country-specific comments are in Annex 5. b HIV tests in Greece refer only to those performed in reference centres and do not include all tests carried out in public hospitals or private laboratories. Number of tests in Portugal refer only to those requested at public primary healthcare centres and do not include those requested in hospitals and private sector. Number of tests in Ireland include antenatal tests in the total and, for 2018, community based rapid testing. HIV tests in Russia include blood donors. c Without prejudice to positions on status, and in line with UNSCR 1 244 and the ICJ Opinion on the Kosovo Declaration of Independence. 73 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Maps 74 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Map 1a: New HIV diagnoses per 100 000 population, 2020 Map 1b: New HIV diagnoses per 100 000 population, 2020, EU/EEA Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 2 2 to < 10 10 to < 20 20 to < 50 ≥ 50 Liechtenstein Luxembourg Malta Non-visible countries Missing or excluded data < 2 2 to < 5 5 to < 10 10 to < 20 75 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Map 2: New HIV diagnoses in men per 100 000 male population, 2020 Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 2 2 to < 10 10 to < 20 20 to < 50 ≥ 50 Map 3: New HIV diagnoses in women per 100 000 female population, 2020 Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 2 2 to < 10 10 to < 20 20 to < 50 ≥ 50 76 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Map 5: New HIV diagnoses acquired through injecting drug use per 100 000 population, 2020 Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 1 1 to < 3 3 to < 5 ≥ 5 Map 4: New HIV diagnoses in men who have sex with men per 100 000 male population, 2020 Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 1 1 to < 3 3 to < 5 ≥ 5 77 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 1 1 to < 3 3 to < 5 ≥ 5 Map 6: New HIV diagnoses acquired through heterosexual transmission per 100 000 population, 2020 Map 7: Percentage of adult (>14 years) HIV diagnoses with CD4 <350 cells/mm3 at diagnosis, 2020 Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 30% 30% to < 40% 40% to < 50% ≥ 50% Data for Turkey exclude people diagnosed with AIDS at the time of HIV diagnosis. 78 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Map 8: AIDS diagnoses reported per 100 000 population, 2020 Andorra Liechtenstein Luxembourg Malta Monaco San Marino Missing or excluded data < 1 1 to < 3 3 to < 5 ≥ 5 79 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Annexes

81 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT 1. Reporting The Member States’ Coordinating Competent Bodies in European Union (EU) and European Economic Area (EEA) (jointly referred to as EU/EEA) countries have nominated national operational contact points for HIV/AIDS surveil- lance to work on reporting surveillance data to the joint European Centre for Disease Prevention and Control (ECDC) and WHO Regional Office for Europe database for HIV/AIDS surveillance. For non-EU/EEA countries, nomi- nations for national HIV/AIDS surveillance focal points were received directly by the WHO Regional Office for Europe via the respective ministries of health. Data are submitted directly by reporting countries through a web-based platform to a joint database known as The European Surveillance System (TESSy). Four types of data are collected: HIV (case-based and aggregate), AIDS (case-based and aggregate), HIVAIDS (case-based data that link HIV and AIDS diagnoses) and number of HIV tests performed (aggregate). AIDS- related deaths are reported as part of case-based AIDS or HIVAIDS data. All new HIV diagnoses, irrespective of whether the case is diagnosed simultaneously with AIDS or reported as a new AIDS diagnosis, are classified as HIV cases. Implementation of WHO and EU case definitions for HIV and AIDS surveillance means that only confirmed cases are reported at European level [1,2]. It is recognised that the HIV and AIDS case definitions currently used in a number of countries may differ across the WHO European Region, but the EU and WHO case definitions are compatible for surveillance purposes. Since 2016, the case definitions have been changed in the Russian Federation. Updated Federal Statistical Surveillance forms (N61) are submitted by medical facilities to the Ministry of Health and include the number of individu- als newly diagnosed with HIV infection; 2009–2015 data therefore cannot directly be compared to 2016–2020. A built-in set of validation rules in TESSy ensures veri- fication of the data within the database during the data-uploading process, improving data quality and allowing each country to test their datasets prior to sub- mission. Further validation checks are carried out by ECDC and WHO’s Regional Office for Europe in collabora- tion with the countries before the data are considered of sufficient quality to be used for analysis. Andorra, Bosnia and Herzegovina, Monaco, North Macedonia, Turkmenistan and Uzbekistan did not report any HIV data through the TESSy system for 2020 (or previous years for some of the countries, see Table 1). Andorra, Bosnia and Herzegovina, Germany Monaco, North Macedonia, the Russian Federation, Sweden, Turkmenistan and Uzbekistan did not report any AIDS data for 2020 (or previous years for some of the countries, see Table 14). Due to difficulties with data linkage, Portugal reported partial HIV and AIDS data for 2020 but elected not to have the data included in the report as it was not yet seen as representative of all HIV and AIDS diagnoses. Completeness of key variables is presented for the EU/ EEA and the WHO European Region as a whole in Annex 2 and by country in Annex 3. 1.1. Surveillance systems – data sources To describe the national source of data and specify the national surveillance system from which the reported data originate, information on the country data source is included as a compulsory part of reporting − this is detailed in Annex 4a and 4b. Some cross-country data comparisons are hampered by differences in surveil- lance systems, as well as by the quality and coverage of national surveillance. During the early part of the period covered in this report (2011–2020) in particular, some countries did not have national HIV/AIDS data. These issues are detailed in Annex 5 and should be taken into account when interpreting and comparing trends across countries. 2. Data collection and validation 2.1. Data collection 2020 The 2020 data submission for HIV and AIDS surveillance took place between 15 March and 28 October 2021. Data presented in this report were extracted from TESSy on 28 October 2021. 2.2. Individual country datasets Data were uploaded, validated and approved in the joint database for HIV/AIDS surveillance by the report- ing countries. Once the data were submitted, individual datasets were reviewed by ECDC and the WHO Regional Office and validated by countries. The HIVAIDS record type was used for the first time in 2014 to collect case- based joined HIV and AIDS data (Annex 4a and 4b). The joined record type allows understanding of the relation- ship between the HIV and AIDS events and diagnosis dates. Additional details on record type used per coun- try can be found in Annexes 4a and 4b. Reporting of aggregated HIV and AIDS data has an impact on data presentation and analysis and the epi- demiological overview of HIV/AIDS in Europe because fewer variables are available from the aggregated data- sets, reducing the amount of data that can be presented in certain tables and figures. Annex 1: Framework for data collection, validation and presentation 82 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data 3. Data re-coding and adjustments 3.1. Dates used for data presentation HIV and AIDS data are presented in this report by date of diagnosis. If countries could not provide this date or preferred to present their data by the date of statistics to avoid discrepancies with their national surveillance reports, this date was used instead. This was the case for four countries: Armenia, Belarus, Turkey, Ukraine. 3.2. Region of origin Where available, countries were encouraged to provide data on the specific country of origin or nationality of the case. This information was used first and, if absent, the variable ‘region of origin’ was used to group cases into region of origin, presented in Table 10 (stratified by reporting country) and Table 11 (all countries stratified by mode of transmission). 3.3. Origin of reported cases Cases originating from countries outside of the report- ing country are highlighted in some of the analyses presented here. This approach has been taken to inform epidemiological understanding and guide public health resource allocation and prevention efforts. To compare the impact of the epidemic on all transmission modes, cases reported as originating from regions or countries of sub-Saharan Africa were used as a proxy for countries with generalised HIV epidemics (in Tables 10, 11 and in selected figures). As most of the cases originating from sub-Saharan Africa were reported from west European countries within the EU/EEA, this information is pre- sented in detail in Chapter 1. 3.4. Reporting delay Reporting delays refer to the time delay between HIV/ AIDS diagnosis and the report of this event at national level, identified by date of notification. Due to delays in reporting, HIV trends analysed at European level are often biased downwards for the most recent year (2020) and, to a lesser extent, for the two to three years prior to the reporting period. To provide a more 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*, Republic of Moldova, Russian Federation, Tajikistan, Turkmenistan, Ukraine, Uzbekistan. * Countries constituting the European Union as of 2021. 83 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT precise picture of trends, surveillance data should be corrected to describe the trends in HIV diagnoses more accurately. This report applies a statistical approach used in previ- ous reports, as described by Heisterkamp et al. [3] and adapted by Rosinska et al. [4], to adjust the surveillance data for reporting delays. Annual reporting delay prob- abilities were estimated for the EU/EEA, West region and WHO European Region using historical data from 2011 to 2019. Due to the unprecedented situation with the COVID- 19 pandemic, which some European countries report as having affected their surveillance capacity and systems from early 2020, the previous approach to adjusting for reporting delay may not fully address additional delays that have arisen as a result of the pandemic. Therefore the numbers and rates presented in this report for 2020 are probably under-estimates of the true number of per- sons diagnosed with HIV. Also for this reason, individual country adjustments are not published for this report as was done in previous years. Countries were excluded from reporting delay adjust- ment for the regional data when: • they showed an inconsistent and non-stationary pat- tern in their reporting delay distribution during the period 2010–2019; or • they reported aggregated data during the period 2010–2019. Adjusting for reporting delay can help to indicate HIV trends in recent years more precisely. Adjustments also provide insight into the timeliness of data collection and reporting from subnational to national and European levels. Adjustment for reporting delays was applied to the graphs, showing trends where noted. 4. Data presentation 4.1. Geographical presentation Data are presented for the WHO European Region and the EU/EEA. The EU comprises 27 Member States and the EEA an additional three countries (Iceland, Liechtenstein and Norway) which are included in the overview of the EU/EEA. As of this year’s report, data from the United Kingdom are not presented as part of the EU/EEA and are removed from trends presented to promote comparability. The tables are presented for EU/EEA countries, non-EU/ EEA countries and as totals. The 53 countries of the WHO European Region are also subdivided into three geographical areas, based on epidemiological consid- erations and in accordance with the division used in previous reports on HIV/AIDS surveillance in Europe: West (23 countries), Centre (15 countries) and East (15 countries) (Fig. A1.1). The division reflects similarities in epidemiological dynamics such as epidemic levels, trends over time and transmission patterns. Of the EU/ EEA countries, 18  Member States are classified as being in the West, nine in the Centre and three in the East. Liechtenstein is not a WHO Member State so its data are included in the totals for the EU/EEA but not for the WHO European Region. Therefore, totals for West, Centre and East may not always equal the EU/EEA and non-EU/EEA totals. Data from Serbia include HIV cases notified in Kosovo in all figures, although these are stratified in tables to allow separate epidemiological presentation of the reported data. 4.2. Population data and rates Data are presented in absolute numbers and rates as cases per 100 000 population. The population estimates up to 2020 were derived from Eurostat for all EU/EEA countries and from the United Nations Population Division for non-EU/EEA countries [6]. The Eurostat data are from May 2021 [7] and the United Nations Population Division statistics are from the 2019 round of estimates [8]. The population data used for HIV and AIDS in Spain and for HIV in Italy were adjusted according to the extent of subnational coverage for the relevant years historically (see Annex 5 for details). Rates for data presented by gender and age were cal- culated using relevant male and female population denominators from the sources described above. For maps presenting figures for men who have sex with men, rates were calculated using the male population. Data are presented by year, but also as cumulative totals per country. The cumulative total includes all data reported by that particular country since the beginning of national reporting and is not limited to the selected number of years presented in the given table. 4.3. Trend data Only countries reporting consistently were included for presentation of the overall trends; these are noted in the footnotes to the trend graphs. When presenting HIV trends for the period 2011−2020, countries reporting data inconsistently (Andorra, Bosnia and Herzegovina, Monaco, North Macedonia, Portugal, Turkmenistan and Uzbekistan) and those reporting on transmission mode inconsistently or incompletely (such as Iceland, Ireland, Lithuania, Malta, Poland, Russian Federation and Turkey) were excluded from relevant fig- ures reporting trends by transmission mode. Countries with varying geographical coverage of the national surveillance system over time (Spain and Italy) were also excluded from graphs showing HIV trends, but are included in graphs presenting rates per population. AIDS trends for the period 2011−2020 excluded coun- tries not reporting consistently over the period (Andorra, Bosnia and Herzegovina, Germany, Monaco, North 84 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Macedonia, Portugal, Russian Federation, Sweden, Turkmenistan, Uzbekistan). When analysing trends for AIDS deaths, only coun- tries reporting consistently were included (i.e. Andorra, Denmark, Germany, Italy, Monaco, North Macedonia, Portugal, the Russian Federation, Sweden, Turkmenistan, and Uzbekistan were not included). 5. Data limitations Surveillance systems are not identical across Europe, and differences in testing policies and data-collection methods could affect the results and introduce bias into comparisons between countries. Factors such as under- reporting and reporting delay may influence the country figures and rankings presented in the report. The data in the report for recent years are to be con- sidered provisional because they are subject to regular updates (such as detection and deletion of duplicate cases, and inclusion of new information about cases already reported). The limitations described below, the country comments in Annex 5 and the information on HIV and AIDS case reporting systems available in Annex 4 and 5 should be taken into account when interpreting the data presented here. Official reports of newly diagnosed HIV cases do not represent true incidence. Newly reported HIV diagnoses include recently infected individuals as well as those who were infected several years ago but only recently tested for HIV. These reports are also influenced by several factors, such as the uptake of HIV testing, pat- terns of reporting, the long incubation period and a slow progression of the disease. To better interpret trends in HIV case-reporting data, the total numbers of HIV tests performed annually for diagnostic purposes (excluding unlinked anonymous tests and screening of blood dona- tions) are presented to help provide some background on HIV testing patterns. However, due to under-detec- tion associated with reduced testing for parts of 2020 and 2021, combined with likelihood of a higher reporting delay than usual, numbers and rates presented in this report for 2020 are probably under-estimates of the true number of persons diagnosed with HIV. Although an attempt at reporting delay adjustment is made, it is known that this is likely to under-esti- mate cases diagnosed in 2020 due to difficulties with reporting during the COVID-19 pandemic. Furthermore, no overall regional adjustments are made for under- reporting or under-ascertainment bias. Few European countries have evaluated their surveillance systems for underreporting and published the results [9]. Previous estimates of underreporting range from 0 to 51% for AIDS cases (F. Cazein, personal communication, 2021), while national estimates of underreporting for HIV can range from 10% (Iceland and Italy) to around 40% (France, Germany and the United Kingdom) [10]. Estimates on the underreporting of AIDS-related deaths are not available, but according to a country survey from 2006, only about a third of countries were able to comprehensively link HIV and AIDS surveillance death registries with national statistics or death certificate information, which results in underreporting of AIDS-related deaths. Careful sur- veillance in the years ahead will provide an indication of the true extent to which reporting delay has had an impact on the 2020 data presented here and whether reduced case detection has affected time from infection to HIV diagnoses overall, or within specific sub-groups in Europe. References 1. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva: World Health Organization; 2007 Available at: http://www.who.int/hiv/pub/vct/hivstaging/en/ index.html 2. Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. OJ L 27.09.12:6–7. Available at: http://eur-lex.europa.eu/LexUriServ/ LexUriServ.do?uri=CONSLEG:2002D0253:20120927:EN:PDF 3. Heisterkmap SH, Jager JC, Ruitenberg EJ, van Druten JAM, Downs AM. Correcting reported AIDS incidence: a statistical approach. Stat Med. 1989;8:963–76. 4. Rosinska M, Pantazis N, Janiec J, Pharris A, Amato-Gauci AJ, Quinten C et al. Potential adjustment methodology for missing data and reporting delay in the HIV Surveillance System, European Union/European Economic Area, 2015. Euro Surveill. 2018;23(23):pii=1700359. Available at: https://doi. org/10.2807/1560-7917.ES.2018.23.23.1700359 5. HIV Platform Tool. In: European Centre for Disease Prevention and Control [website]. Stockholm: ECDC; 2021. Available at: https:// www.ecdc.europa.eu/en/publications-data/hiv-platform-tool 6. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017. 7. Eurostat [online database]. Brussels: Eurostat; undated. Available at: http://ec.europa.eu/eurostat/data/database 8. World population prospects: the 2019 revision, medium variant. In: United Nations Department of Economic and Social Affairs, Population Division [website]. New York (NY): United Nations Department of Economic and Social Affairs, Population Division; 2019 Available at: https://population.un.org/wpp/ 9. Total resident population. In: State Statistics Service of Ukraine documents publishing [online database]. Kyiv: State Statistics Service of Ukraine; 2018. Available at: https://ukrstat.org/en/ operativ/operativ2007/ds/nas_rik/nas_e/nas_rik_e.html 10. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the WHO European Region. Saint-Maurice: Institut de veille sanitaire (French National Institute of Health Surveillance); 2007. 85 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Annex 2 Completeness of variables for data reported in 2019 and 2020 2019 2020 Number of countries Completeness % Minimal Maximal Number of countries Completeness % Minimal Maximal EU/EEA Countries Age 30 99.6 78.7 100.0 28 98.7 0.0 100.0 Gender 30 99.4 87.5 100.0 29 99.1 68.2 100.0 Date of diagnosis 30 100.0 100.0 100.0 29 100.0 100.0 100.0 Transmission 30 77.5 0.0 100.0 27 73.1 0.0 100.0 Country of birth or region of origin 27 83.7 0.0 100.0 26 82.3 0.0 100.0 CD4 cell count 25 60.6 3.8 98.0 23 58.4 0.0 99.1 WHO European Region Age 48 42.0 42.0 100.0 47 99.8 0.0 100.0 Gender 49 99.9 87.5 100.0 48 99.9 68.2 100.0 Date of diagnosis 49 100.0 100.0 100.0 48 100.0 100.0 100.0 Transmission 47 36.0 30.6 100.0 46 90.0 0.0 100.0 Country of birth or region of origin 39 20.2 20.2 100.0 38 18.9 0.0 100.0 CD4 cell count 44 30.6 3.9 98.0 42 31.4 0.0 100.0 86 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Annex 3 Completeness by country and variable, 2020 Area Countrya Date of diagnosis Age Gender Transmission CD4 cell count Country of birth/region of originb EU/EEA West Austria 100.0 100.0 100.0 87.7 98.7 97.4 West Belgium 100.0 100.0 99.4 71.0 69.7 84.6 Centre Bulgaria 100.0 100.0 100.0 100.0 81.4 100.0 Centre Croatia 100.0 100.0 100.0 96.1 19.7 98.7 Centre Cyprus 100.0 100.0 100.0 94.3 99.0 100.0 Centre Czech Republic 100.0 100.0 100.0 96.0 92.0 100.0 West Denmark 100.0 100.0 100.0 91.9 88.8 95.0 East Estonia 100.0 100.0 100.0 62.9 17.9 61.5 West Finland 100.0 100.0 100.0 60.3 67.9 93.4 West France 100.0 100.0 98.0 66.9 57.7 73.5 West Germany 100.0 100.0 99.9 69.7 30.1 86.4 West Greece 100.0 100.0 100.0 76.7 70.7 99.2 Centre Hungary 100.0 99.9 90.0 76.6 - 0.0 West Iceland 100.0 100.0 100.0 85.3 88.2 100.0 West Ireland 100.0 100.0 99.5 40.1 13.2 33.6 West Italy 100.0 100.0 100.0 92.1 94.1 97.0 East Latvia 100.0 100.0 100.0 63.8 34.5 0.0 Liechtenstein - - - - - - East Lithuania 100.0 0.0 100.0 0.0 - 100.0 West Luxembourg 100.0 99.6 68.2 59.1 88.9 63.6 West Malta 100.0 99.9 100.0 0.0 - 100.0 West Netherlands 100.0 100.0 97.2 91.7 93.7 99.2 West Norway 100.0 100.0 100.0 100.0 - 100.0 Centre Poland 100.0 100.0 99.2 26.9 - 62.2 West Portugal - - - - - - Centre Romania 100.0 100.0 100.0 100.0 92.5 99.3 Centre Slovakia 100.0 100.0 98.0 64.7 33.0 28.4 Centre Slovenia 100.0 100.0 100.0 92.6 92.3 100.0 West Spain 100.0 100.0 100.0 86.3 86.5 97.7 West Sweden 100.0 100.0 100.0 80.8 70.3 95.6 Non-EU/EEA Centre Albania 100.0 100.0 100.0 100.0 37.9 100.0 West Andorra - - - - - - East Armenia 100.0 100.0 100.0 98.9 82.5 100.0 East Azerbaijan 100.0 100.0 100.0 98.4 82.7 100.0 East Belarus 100.0 100.0 100.0 98.4 77.9 100.0 Centre Bosnia and Herzegovina - - - - - - East Georgia 100.0 100.0 100.0 98.7 85.0 100.0 West Israel 100.0 99.9 100.0 74.1 52.4 100.0 East Kazakhstan 100.0 100.0 100.0 95.3 83.7 100.0 East Kyrgyzstan 100.0 100.0 100.0 83.0 69.0 100.0 East Moldova 100.0 100.0 100.0 66.2 82.5 100.0 West Monaco - - - - - - Centre Montenegro 100.0 100.0 100.0 93.3 66.7 100.0 Centre North Macedonia - - - - - - East Russia 100.0 - 100.0 - 95.7 - West San Marino 100.0 - - - - - Centre Serbia 100.0 100.0 100.0 89.3 88.6 - Centre Serbia excluding Kosovoc 100.0 100.0 100.0 92.9 88.4 100.0 Centre Kosovoc 100.0 100.0 100.0 100.0 100.0 100.0 West Switzerland 100.0 98.6 98.3 63.2 59.4 100.0 East Tajikistan 100.0 100.0 100.0 94.6 25.1 100.0 Centre Turkey 100.0 99.9 100.0 41.4 27.4 97.4 East Turkmenistan - - - - - - East Ukraine 100.0 100.0 100.0 78.2 88.5 100.0 West United Kingdom 100.0 100.0 99.9 91.1 86.8 79.2 East Uzbekistan - - - - - - a Completeness not computed on countries, territories or areas with fewer than five diagnoses reported in 2019 (Liechtenstein and San Marino) or countries that reported in the aggregated record type which did not allow reporting of all variables (Russia) b Completeness provided is based on country of birth, region of origin or, for Italy and Switzerland, country of nationality. c Without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. 87 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Annex 4a HIV surveillance system overview: data source information Country HIV data source Record typea for 2018 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-HIV HIVAIDS 1980–2020 V Co Belgium BE-HIV/AIDS HIVAIDS 1985–2020 V Co Bulgaria BG-HIV HIVAIDS 1986–2020 C Co HIV aggregate record type used through 2006; HIV record type 2007–2013 Cyprus CY-HIV/AIDS HIVAIDS 1986–2020 C Co Croatia HR-CNIPH HIVAIDS 1985–2020 C Co HIV record type used prior to 2016 Czechia CZ-HIV/AIDS HIVAIDS 1985–2020 C Co Denmark DK-HIV HIVAIDS 1990–2020 C Co HIV record type used 1990–2013 Estonia EE-NAKIS HIVAIDS 1988–2020 C Co Data source EE-HIV used 1988–2012; HIV aggregate record type used through 2006; HIV record type prior to 2015 Finland FI-NIDR HIVAIDS 1980–2020 C Co HIV record type used prior to 2016 France FR-HIVAIDS HIVAIDS 2003–2020 C Co Although compulsory, HIV diagnoses are not exhaustively reported; underreporting was estimated around 30% until 2018, then increased (40% in 2020) Germany DE-SURVNET@RKI7.3-HIV 1993–2020 C Co Data source DE-HIV-Pre-IfSG used 1993–2001; HIV recordtype used to report data up to 2016 Greece EL-HIV/AIDS HIVAIDS 1984–2020 C Co Hungary HU-HIV/AIDS HIVAIDS 1985–2020 C Co Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1983–2020 C Co HIV record type used prior to 2017 Ireland IE-CIDR HIVAIDS 1985–2020 C Co Data source IE-HIV/AIDS used for years 1981–2011; HIV aggregate used for reporting through 2002; HIV record type 2003–2011 Italy IT-COA-ISS HIV 1985–2020 C Co See country comments about historical coverage; HIV aggregate record type used through 2009 Latvia LV-HIV/AIDS HIVAIDS 1987–2020 C Co HIV record type used 1987–2013; HIVAIDS record type used from 2014 Liechtenstein CH-SFOPH-LI HIV 1985–2020 V NS/unk Cases reported through Switzerland's surveillance system using another data source Lithuania LT-NPHC HIVAIDS 1988–2020 C Co New data source LT_NPHC (National Public Health Centre under the Ministry of Health) from 2021 Luxembourg LU-HIVAIDS HIVAIDS 1983–2020 V Co Malta MT-DISEASE_SURVEILLANCE HIVAIDS 2001–2020 C Co HIV record type used in years 1986–2014 Netherlands NL-HIV/AIDS HIVAIDS 1980–2020 V Co Norway NO-MSIS_B HIVAIDS 1984–2020 C Co HIV record type used in years 1980–2013 Poland PL-HIV HIVAIDS 1985–2020 C Co Portugal PT-HIVAIDS HIVAIDS 1985–2020 C Co Data reported for 2020 was censored from the report at the request of Portugal Romania RO-RSS HIVAIDS 1987–2020 C Co Slovakia SK-EPIS HIVAIDS 1985–2020 C Co HIV record type used in years 1985–2013 Slovenia SI-HIVAIDS HIVAIDS 1985–2020 C Co Spain ES-HIV HIV 2003–2020 C Co See country comments about historical coverage Sweden SE-SmiNet HIVAIDS 1983–2020 C Co Data source SE-SweHIVReg used 1983–2009; HIV record type used prior to 2014 non-EU/EEA Albania AL-NIoPH HIVAIDS 1993–2020 C Co Andorra AD-MoHWFH HIVAIDS 2004–2018 V Co Armenia AM-NAC HIVAIDS 1988–2020 V Co Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1987–2020 V Se Belarus BY-NAC HIVAIDS 1981–2020 C Co HIVAIDS record type used only for HIV reporting (no linked HIV and AIDS reporting); HIV record type used in years 1981–2013 Bosnia and Herzegovina BA-FMoH-MoHSWRS HIVAIDS 1986–2019 C Co HIV record type used in years 1993–2013 Georgia GE-IDACIRC HIVAIDS 1989–2020 C Co Israel IL-MOH HIVAIDS 1981–2020 C Co Kazakhstan KZ-RCfAPC HIVAIDS 1987–2020 NS/unk NS/unk Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1987–2020 V Co HIV record type used in years 1987–2000 Moldova MD-NAC HIVAIDS 1987–2020 V Other Montenegro ME-IOPH HIVAIDS 1989–2020 C Co Monaco MC-MoSH-GEN HIV 1987–2018 C Co North Macedonia MK-NHASS HIVAIDS 1993–2018 C Co HIV record type used in years 1993–2016 Russia RU-MOH HIVAGGR 2009–2020 C Co San Marino SM-AIDS/HIV HIVAGGR 1985–2020 C Co Serbiad RS-NAC HIVAIDS 1984–2020 C Co HIV aggregate record type used in years 1984–2001 Switzerland CH-FOPH HIV 1985–2020 C Co Tajikistan TJ-RHAC HIVAIDS 1991–2020 C Co Turkey TR-MOH HIV 1985–2020 C Co Turkmenistan TM-NAC - 1990–2012 V Co Ukraine UA-NAC HIVAIDS 1987–2020 V Other HIVAIDS record type used only for HIV reporting (no linked HIV and AIDS reporting); HIVAGGR record type used in years 1987–2015. United Kingdom UK-HIVAIDS HIVAIDS 1981–2020 V Co Uzbekistan UZ-RAC - 1981–2010 V Co Did not report data 2011–2020; used HIV record type in years 1981–2010 a Type: HIVAIDS (HIV and AIDS joined case-based record type); HIV (HIV case-based record type); AIDS (AIDS case-based record type); HIVAGGR (HIV aggregate record type); AIDSAGGR (AIDS aggregate record type). b Legal: voluntary reporting (V); compulsory reporting (C); not-specified/unknown (NS/unk). c Coverage: sentinel system (Se); comprehensive (Co); not-specified/unknown (NS/unk). d Data from Kosovo, without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence, were reported through data source XK-HIVAIDS for 1986–2018; HIVAIDS record type used for all years. 88 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Annex 4b AIDS surveillance system overview: data source information Country AIDS Data source Record typea for 2018 reporting Period Legalb Coveragec Comments EU/EEA Austria AT-AIDS HIVAIDS 1982–2020 V Co Belgium BE-HIV/AIDS HIVAIDS 1983–2020 V Co Did not report 2019 data Bulgaria BG-AIDS HIVAIDS 1987–2020 C Co AIDS record type was used for cases prior to 2014 Cyprus CY-HIV/AIDS HIVAIDS 1986–2020 C Co Croatia HR-CNIPH HIVAIDS 1986–2020 C Co AIDS record type used prior to 2016 Czechia CZ-HIV/AIDS HIVAIDS 1986–2020 C Co Denmark DK-HIV HIVAIDS 1980–2020 C Co AIDS record type from data source DK-MIS used 1980–2013 Estonia EE-NAKIS HIVAIDS 1992–2020 C Co AIDS record type used prior to 2015 Finland FI-NIDR HIVAIDS 1983–2020 C Co AIDS record type used prior to 2016 France FR-HIVAIDS; FR-AIDS HIVAIDS 1982–2020 C Co Additional data from record type AIDS used for the years 1978– 2020. Although compulsory, AIDS diagnoses are not exhaustively reported. Underreporting was estimated at 41% in 2007–2009. Over the 2010–2020 period, it was estimated around 51%. Germany DE-AIDS 1981–2019 V Co Did not report 2020 data, AIDS record type used through 2016 Greece EL-HIV/AIDS HIVAIDS 1981–2020 C Co Hungary HU-HIV/AIDS HIVAIDS 1986–2020 C Co Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1985–2020 C Co AIDS record type used prior to 2017 Ireland IE-CIDR HIVAIDS 1983–2020 V Co Data source IE-HIV/AIDS and AIDS record type used for years 1981–2011 Italy IT-COA-ISS AIDS 1982–2020 C Co Latvia LV-AIDS HIVAIDS 1990–2020 C Co Same data source in AIDS record type used for 1990–2013 Liechtenstein CH-SFOPH-LI AIDS 1989–2020 V NS/unk Cases reported through Switzerland's surveillance system Lithuania LT-NPHC HIVAIDS 1988–2020 C Co New data source LT_NPHC (National Public Health Centre under the Ministry of Health) from 2021 Luxembourg LU-HIVAIDS HIVAIDS 1983–2020 V Co Malta MT-DISEASE_SURVEILLANCE HIVAIDS 1986–2020 C Co Same data source and AIDS record type used 1986–2014 Netherlands NL-HIV/AIDS HIVAIDS 1999–2020 V Co Norway NO-MSIS_B HIVAIDS 1983–2020 C Co Data source NO-MSIS-A and record type AIDS used in years 1980–2013 Poland PL-HIV HIVAIDS 1986–2020 C Co Portugal PT-HIVAIDS HIVAIDS 1985–2020 C Co Data reported for 2020 was censored from the report at the request of Portugal Romania RO-RSS HIVAIDS 1985–2020 C Co Slovakia SK-EPIS HIVAIDS 1985–2020 C Co AIDS record type used in years 1985–2013 Slovenia SI-HIVAIDS HIVAIDS 1986–2020 C Co Spain ES-AIDS AIDS 1981–2020 C Co See country comments about coverage Sweden 1982–2007 V Co AIDS surveillance discontinued in 2008 non-EU/EEA Albania AL-NIoPH HIVAIDS 1993–2020 C Co Andorra AD-MoHWFH HIVAIDS 2004–2018 V Co Armenia AM-NAC HIVAIDS 1988–2020 V Se Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1995–2020 V Co Belarus BY-NAC AIDS 1991–2020 C Co Bosnia and Herzegovina BA-FMoH-MoHSWRS HIVAIDS 1986–2019 C Co AIDS record type used in years 1986–2013 Georgia GE-IDACIRC HIVAIDS 1989–2020 C Co Israel IL-MOH HIVAIDS 1981–2020 C Co Kazakhstan KZ-RCfAPC HIVAIDS 1993–2020 NS NS Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1999–2020 V Co AIDS record type used in years 1987 –2000 Moldova MD-NAC HIVAIDS 1989–2020 V Co Montenegro ME-IOPH HIVAIDS 1990–2020 C Co Monaco MC-MoSH-GEN AIDS 1985–2018 C Co North Macedonia MK-NHASS HIVAIDS 1989–2018 C Co AIDS record type used in years 1993–2016 Russia - - - - - San Marino SM-AIDS/HIV AIDS 1986–2020 C Co Serbiad RS-NAC HIVAIDS 1985–2020 C Co AIDS record type used in years 1985–2001 Switzerland CH-FOPH AIDS 1980–2020 C Co Tajikistan TJ-RHAC HIVAIDS 1998–2020 C Co Turkey TR-MOH AIDS 1985–2020 C Co Turkmenistan TM-NAC - 2002–2012 V Co Ukraine UA-NAC AIDSAGGR 1988–2020 V Co HIVAIDS record type used only for HIV reporting (i.e. no linked HIV and AIDS reporting). United Kingdom UK-HIVAIDS HIVAIDS 1981–2020 V Co Uzbekistan UZ-RAC - 1992–2010 V Co Did not report data 2011–2020; used AIDS record type in years 1992–2010 a Type: HIVAIDS (HIV and AIDS joined case-based record type); HIV (HIV case-based record type); AIDS (AIDS case-based record type); HIVAGGR (HIV aggregate record type); AIDSAGGR (AIDS aggregate record type). b Legal: voluntary reporting (V); compulsory reporting (C); not-specified/unknown (NS/unk). c Coverage: sentinel system (Se); comprehensive (Co); not-specified/unknown (NS/unk). d Data from Kosovo, without prejudice to positions on status, and in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence, were reported through data source XK-HIVAIDS for 1986–2018; HIVAIDS record type used for all years. 89 HIV/AIDS surveillance in Europe 2021 – 2020 dataSURVEILLANCE REPORT Annex 5 Country-specific comments regarding national HIV and AIDS reporting Country Comments EU/EEA Belgium Belgian data were not reported for 2019 due to technical issues but will be reported in future rounds. Bulgaria Case-based reporting of HIV is available from 2007 onwards. Czechia Foreigners with short-term stays in Czechia are not included in cases notified. Estonia The surveillance system was modified substantially in 2008. Previously, the probable mode of HIV transmission was not reported by Estonia (from 2003 to 2007, Estonia supplied partial information on people who inject drugs only). France Case-based data reported through TESSy are not exhaustive because of reporting delays (cases reported several months or years after the diagnosis) and underreporting (cases that are diagnosed but never reported). The most recent estimates of underreporting in France are 51% in 2010–2020 for AIDS, around 30% until 2018 and 40% in 2020 for HIV. To assess the real numbers and trends of HIV and AIDS diagnoses in France, it is essential to use adjusted data, which take into account reporting delays, underreporting and missing data (incomplete reports). However, the COVID-19 pandemic has affected the French HIV surveillance. The reduced HIV reporting affects the reliability of adjusted number of HIV and AIDS diagnoses in 2020. Since 2016, HIV and AIDS diagnoses should be reported online, and physicians should report HIV diagnoses spontaneously, without waiting for the laboratory report. Probable country of infection is collected as “France/Abroad/Unknown”. In Table 12, the number 2 512 in the “Unknown” column includes 557 cases probably infected abroad, and 1 955 cases with unknown country of infection. Ireland HIV was made a notifiable disease in September 2011. The HIV reporting system was modified substantially in 2012. AIDS cases and deaths among AIDS cases are now only reported at the time of HIV diagnosis. HIV diagnoses include a growing proportion of so-called previous- positive people, who are transferring their HIV care when moving to Ireland and tested positive and were notified within the Irish system when moving to the country. There was a change in the implementation of the case definition in 2015 (requiring confirmatory testing on a single sample rather than two samples) which resulted in more people being notified to the surveillance system. Italy Data on new HIV diagnoses have been collected since 1985 in some regions of Italy. New HIV diagnoses were reported by 10 of the 21 Italian regions between 2004 and 2006, 11 regions in 2007, 12 in 2008, 18 in 2009 and all of the 21 regions of Italy since 2012. Between 2004 and 2011, population denominators were based on the annual resident population in the regions reporting cases. From 2012, the coverage of the surveillance system has been national, so the total Italian population is used as a denominator. AIDS deaths are not reported after 2017 due to lack of updated data from the national mortality register. Liechtenstein Liechtenstein is a small country with about 39 000 inhabitants. Due to a customs treaty with Switzerland, Liechtenstein adopted the Swiss Law of Epidemiology in 1970. Since then, all data on communicable diseases collected in Liechtenstein are reported to a Swiss database. Up to 2020 the Liechtenstein data were reported through Switzerland to WHO and ECDC. Lithuania Due to the change of data provider and data adjustment at a later stage, the official number of new HIV/ AIDS cases in national communicable surveillance system in Lithuania for 2020 is 102. Luxembourg HIV tests reported through 2010 include only tests performed at two major public laboratories, and therefore they underestimate the total number of HIV tests performed during those years. From 2011, tests reported include all laboratories in the country. Malta A new HIV reporting system started in 2004. Netherlands HIV surveillance is based on the ATHENA cohort, which includes 98% of people who entered HIV care in the Netherlands. Data collection started from 1996 onwards and HIV diagnoses before 1996 are incomplete. Portugal The PT-HIV database is fully case-based, containing details of HIV and AIDS cases diagnosed from 1983. Strategies to address underreporting and reporting delay implemented in 2013 and 2017, by the Portuguese HIV/AIDS Programme, resulted in a significant increase in the number of reported cases and deaths for all previous years. Because of malfunction of the national software system for HIV continuum of care monitoring and case reporting in a considerable number of hospitals, HIV and AIDS notification was highly affected during 2020 and 2021. Therefore, due to misrepresentation of national new HIV and AIDS cases, data regarding 2020 are not disclosed in this report. Spain HIV reporting has existed since the 1980s in some of the 19 Autonomous Regions of Spain. For 2003–2011 data are available only for 9 Regions: Asturias, Balearic Islands, Basque Country, Canary Islands, Catalonia, Ceuta, Extremadura, La Rioja, and Navarre; since 2004, data are available for 10 Regions (+Galicia); since 2007, data are available for 11 Regions (+Madrid); since 2008, data are available for 14 Regions (+ Aragón, Castilla-La Mancha and Melilla); since 2009, data are available for 17 Regions (+Cantabria, Castilla-León and Murcia); since 2012 data are available for 18 Regions (+Valencia); and since 2013 data are available for all the 19 Regions of Spain (+Andalucía). In 2018, data from Catalonia are not available. AIDS data: for technical reasons, it has not been possible to include AIDS data from one region in 2014 and from two regions from 2015 to 2018. Due to the COVID-19 pandemic, in 2019 and 2020 some regions have reported provisional data and others have not reported HIV and/or AIDS data. Rates are based on the corresponding population for each year. Sweden Due to changes in the HIV/AIDS surveillance system, AIDS reporting has not been mandatory since 2000. Since 2008, AIDS data are not reported from Sweden because the national AIDS surveillance system had been discontinued. Non-EU/EEA Belarus All data are presented by "date of statistics" (instead of "date of diagnosis"). Georgia Data are presented by "date of statistics" (instead of "date of diagnosis"). North Macedonia AIDS cases include only people diagnosed with AIDS at the time of HIV diagnosis. Russian Federation The Russian Federation reported aggregated dataset with new HIV diagnoses registered in 2020 disaggregated by sex, age group and mode of transmission and data on testing for 2009–2020. Whereas data reported for 2009–2019 was limited to new HIV diagnoses by sex only. This enabled the inclusion of the country’s data in Tables 1–12 and 25 and in the figures showing the trend of HIV diagnosis but not in the rest of the trend figures due to inconsistent reporting. The country also reported information on CD4 cell count at the time of diagnosis separately. These data were manually entered into the Table 13. Since 2016, case definitions have been changed in the Russian Federation. Updated Forms (N61) of the Federal Statistical Surveillance are submitted by medical facilities to the Ministry of Health and include the number of individuals newly diagnosed with HIV infection. Data for 2009–2015 cannot therefore be compared directly with those for 2016–2020. Serbia Data on HIV tests refer to the number of people tested and do not include people tested in the reference laboratory or private laboratories. Tajikistan Due to technical problems, no data export for 2018 from Tajikistan was available. Turkey Reported HIV cases exclude people diagnosed with AIDS at the time of HIV diagnosis. Reported AIDS cases only include people diagnosed with AIDS at the time of HIV diagnosis. Table 14 (see Tables section): CD4 cell count data exclude people diagnosed with AIDS at the time of HIV diagnosis. All data are presented by "date of statistics" (instead of "date of diagnosis"). Ukraine All data are presented by “date of statistics” (instead of “date of diagnosis”). United Kingdom The data provided for the UK in 2020 are preliminary and may not match official published statistics. COVID-19 has impacted the reporting from several centres, including the whole of Scotland for which no HIV data could be reported in 2020. Consequently, the figures presented may not reflect the actual number of diagnoses in 2020. 90 SURVEILLANCE REPORTHIV/AIDS surveillance in Europe 2021 – 2020 data Annex 6 HIV/AIDS surveillance in Europe: participating countries and national institutions Country National institutions EU/EEA Austria Federal Ministry of Health, Family and Youth Belgium Scientific Institute of Public Health Bulgaria Ministry of Health Croatia Croatian National Institute of Public Health Cyprus Ministry of Health Czechia National Institute of Public Health Denmark Statens Serum Institut Estonia Health Board Finland National Public Health Institute (KTL) France Santé Publique France (French National Public Health Agency) Germany Robert Koch Institute Greece Hellenic Center for Disease Control and Prevention Hungary National Center for Epidemiology (Országos Epidemiológiai Központ) Iceland Health Protection Agency Centre for Infections Ireland Health Protection Surveillance Centre (HPSC) Italy Ministry of Health DG Prevention - Unit V Latvia Centre for Disease Prevention and Control of Latvia Liechtenstein Principality of Liechtenstein Lithuania National Public Health Center under the Ministry of Health Luxembourg National Service of Infectious Diseases, Centre Hospitalier Malta Department of Health Promotion and Disease Prevention Netherlands National Institute for Public Health and the Environment (RIVM) Norway Norwegian Institute of Public Health – Department of Infectious Disease Epidemiology Poland National Institute of Public Health – National Institute of Hygiene (NIZP-PZH) Portugal Directorate-General of Health (Direção-Geral da Saúde) and National Institute of Health Dr Ricardo Jorge (Instituto Nacional de Saúde Doutor Ricardo Jorge, I.P.) Romania Institute of Public Health and National Institute for Infectious Diseases "Prof. Dr. Matei Bals" Slovakia Regional Public Health Authority of capital Bratislava Slovenia National Institute of Public Health Spain Instituto de Salud Carlos III Centro Nacional de Epidemiologia Sweden Public Health Agency of Sweden Non-EU/EEA Albania National Institute of Public Health Andorra Ministry of Health, Social Welfare and Family Armenia National Center for AIDS Prevention Azerbaijan Azerbaijan AIDS Center Belarus National Centre for Hygiene, Epidemiology and Public Health Bosnia and Herzegovina Ministry of Civil Affairs of Bosnia and Herzegovina; Federal Ministry of Health; Ministry of Health and Social Welfare the Republica Srpska and Public Health Institutes of the Federation of Bosnia and Herzegovina and Republica Srpska Georgia Infectious Diseases, AIDS & Clinical Immunology Research Center Israel Ministry of Health Kazakhstan National Center for the Prevention and Control of AIDS Kyrgyzstan Republic Centre for AIDS Prevention and Control Moldova National AIDS Center; National Center for Preventative Care Monaco Ministry of Social Health Montenegro Institute of Public Health of Montenegro North Macedonia Public Health Institute Russian Federation Ministry of Health of the Russian Federation San Marino Ospedale di Stato Serbiaa Institute of Public Health of Serbia Switzerland Bundesamt für Gesundheit Tajikistan Republican HIV/AIDS Center Turkey General Directorate of Public Health, Ministry of Health Turkmenistan National AIDS Prevention Center Ukraine State Institution "Public Health Center of the Ministry of Health of Ukraine" United Kingdom UK Health Security Agency Uzbekistan Republican AIDS Center a Data for Kosovo (in accordance with Security Council resolution 1244 (1999)) were provided by the National Institute of Public Health of Kosov0. 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