GLASGOW — A year after public health officials sounded the alarm about rising rates of HIV in Eastern Europe and Central Asia — which includes the Baltic states, Belarus, Georgia, Romania, Russia, Tajikistan, and Ukraine — the number of new HIV diagnoses in the region is not letting up.
In 2016, the European Centre for Disease Prevention and Control (ECDC) reported that there were 103,438 new HIV diagnoses in Russia, accounting for the vast majority of the 160,453 diagnoses across the region.
The official numbers for 2017 will be released in November, but preliminary data suggest that the new rates will be “even” with 2016 right now, said Anastasia Pharris, PhD, from the ECDC in Stockholm.
“It’s not a big increase, but it’s still about 104,000 new infections,” she told Medscape Medical News.
The news is an unhappy reminder of the past for Linda-Gail Bekker, MBChB, PhD, from the Desmond Tutu HIV Centre at the University of Cape Town in South Africa, who is president of the International AIDS Society.
“I keep thinking, this is sub-Saharan Africa happening all over again,” Bekker said. And it is “on our watch.”
Eastern Europe and Central Asia generally lag behind their central and western European counterparts on each step in the UNAIDS 90-90-90 goals, Pharris reported here at HIV Drug Therapy 2018.
In Western Europe, 6.2 of every 100,000 people were diagnosed with HIV in 2016. In Eastern Europe, that rate is 50.2 per 100,000 people.
Nearly one in four people living with HIV in Eastern Europe don’t know they have the virus. And only 46% of people who have been diagnosed are in care and receiving antiretroviral drugs.
A Way Forward
But Pharris laid out ways that each region of Europe could improve. The list for Eastern Europe and Central Asia was long and included such basics as the implementation of test-and-treat programs.
It wasn’t so long ago that Russia started people on treatment only after their CD4 T-cell counts dropped below 200 cells/µL, she noted. In 2015, they updated their guidelines to recommend treatment when T-cells reach 350 cells/µL.
“Test and treat is now the law of the land in Russia, but it’s not yet followed,” she added.
The recommendations also advise that services be provided for gay men and people who inject drugs. Strikingly, despite nearly half the new HIV diagnoses being attributed to the sharing of used needles (PLoS Med. 2017;14:e1002462), syringe-access programs don’t exist and medication-assisted treatment is available to less than 5% of people in Eastern Europe and Central Asia. And Russia has famously prosecuted many men for being gay.
During an earlier presentation at the meeting, the possibility that there could really be an end to AIDS was considered.
“Clearly not, when there’s a whole region where the virus is actually on the increase,” said Bekker. “The leadership is missing here. The political will is missing here.”
But the news isn’t all bad. Even in Eastern and Central Europe, there have been success stories.
In Kyiv, the capital of Ukraine, a consortium of clinicians, public health policy makers, and community members convened to try to increase access to treatment. They managed to increase the number of access points in the city for people to receive treatment from four to 30. They also initiated a 30-day treatment standard, which resulted in “47% of people being put on treatment within week of diagnosis,” Pharris reported.
“On a local level, there are some really interesting examples of how things are getting worked out,” she noted. But “no setting that has reduced HIV incidence has achieved this through only clinical action, through only public health actions, through only community actions. It’s essential to build partnerships.”
Pharris and Bekker have disclosed no relevant financial relationships.
HIV Drug Treatment 2018: Abstract KL2. Presented October 28, 2018.
By Heather Boerner