HIV testing in europe, ECDC
© Davide Bonaldo

The European Centre for Disease Control (ECDC) and the World Health Organisation (WHO) found that HIV testing in Europe is not good enough – 53% of diagnosis happens when the immune system is already failing

Director of the ECDC, Dr Andrea Ammon, explained: “Despite the focus on COVID-19 right now, we must not lose sight of other public health issues like HIV. Earlier diagnosis of HIV is an urgent priority. We cannot reach the Sustainable Development Goal target if takes an average of three years for people to find out that they are HIV-positive after infection with the virus.

“Three years during which live-saving treatment is not available to them and during which they can unknowingly pass on HIV. If we want to reduce the high proportion of people diagnosed late, it is essential to diversify our HIV testing strategies as outlined in the ECDC testing guidance, for example.”

The importance of early diagnosis

Every second HIV diagnosis (53%) happens at a late stage of the infection, when the immune system has already started to fail. This is a sign that testing strategies in the Region are not working properly to diagnose HIV early, which means that the HIV testing in Europe is falling well below the standard necessary to stop the AIDS epidemic before 2030.

The number of people diagnosed with AIDS, the end-stage of an untreated HIV infection, has gone down by more than half in the last decade and the Sustainable Development Goal (SDG) target of ending the AIDS epidemic by 2030 is achievable. However, in the EU/EEA for example, 74% of the 2,772 AIDS diagnoses in 2019 were made very soon after the initial HIV diagnosis – within three months.

Late diagnosis contributes to ongoing HIV transmission as, often for years at a time, people do not know they have HIV and are not getting treatment. This suggests there is a significant problem with late diagnosis of HIV infection.

Older adults face the most delayed HIV diagnosis

Across the whole Region, 67% of people aged 50 years and older were diagnosed late in the course of their HIV infection. In 2019, one in five new HIV diagnoses was in a person over 50 years of age.

The reasons for this are not yet fully understood. It may be that older adults themselves, or the healthcare workers looking after them, underestimate the risk of infection. Older adults may be more affected by the stigma associated with the disease and less comfortable asking to be tested – whereas younger adults have grown up in a less openly-hostile environment, both for HIV and the association with non-heterosexual sex.

Rapid HIV testing in Europe could be a solution

Some countries have undergone a transition to domestic financing of the HIV response after withdrawal of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. This has posed sustainability challenges, particularly in relation to the financing of HIV prevention programmes. Increased political will and attention, alongside intensified involvement of civil society, is needed to mitigate some of these challenges and prevent the epidemic from accelerating. However, HIV rapid diagnostic tests and self-testing, are key answers expressed by both medical authorities for the looming question: How can we protect people from contracting AIDS?

WHO Europe and the ECDC both strongly suggest policy and budget allocation on three main areas:

  1. Prioritising a range of prevention measures, such as awareness-raising, promotion of safer sex, condoms, provision of needle exchange programmes and opioid substitution therapy, and pre-exposure prophylaxis for HIV, also known as PrEP;
  2. Providing efficient HIV counselling and testing services, including rapid diagnostic services, community-based HIV testing and HIV self-testing;
  3. And ensuring rapid access to quality treatment and care for those diagnosed.

‘People with HIV can live without fear of AIDS’

Dr Hans Kluge, WHO Regional Director for Europe, says: “I remember when a diagnosis of HIV seemed like a death sentence. Now, with proper treatment, people with HIV can live without fear of AIDS. These data are from 2019, and the question in 2020 has to be what effect the pandemic will have had on testing by the end of 2021.

“For now, our message has to be to protect the progress of the last decade by continuing to prioritize HIV testing and getting treatment to those who need it. We cannot allow the pandemic to rob us of an AIDS-free future that is within our grasp.”

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