World AIDS Day, introduced by the World Health Organisation in 1988, is observed annually on December 1 and raises awareness of the pandemic, which is caused by human immunodeficiency virus (HIV) infection. It was recently preceded by European Testing Week to encourage testing for HIV and hepatitis.
With nearly 160,000 people newly diagnosed with HIV, 2017 was another year of alarming numbers of new diagnoses in the WHO European region. The majority of these cases (over 130,000) were in eastern Europe. There were 25,000 people diagnosed with HIV in 30 of the 31 countries of the EU/EEA. This translates into a decline from a rate of 6.9 per population of 100,000 in 2008, to 6.2 per 100,000 in 2017.
HIV is one of the most prevalent communicable diseases in Europe, with more than two million people now living with the disease in the region. HIV infection remains of major public health significance in the EU and neighbouring countries.
Various factors are fuelling the spread of HIV as more people engage in risky behaviour. Mobile apps and social media have opened new avenues for social encounters, very often with unknown individuals, thus exposing oneself to the risks of HIV.
In Malta, during 2017, there were 45 new cases of HIV reported, with no cases of AIDS. The figures have always shown a higher number of men acquiring the HIV virus than women in the notified cases, and this has remained constant.
Nearly 160,000 people were newly diagnosed with HIV in 2017
Up to 2012 the trend showed the main mode of transmission to be through heterosexual sexual contact, which has increased along the years more than any other way. However, since 2013, there has been a significant increase in men who have sex with men (MSM). This has increased every year since. Vytenis Andriukaitis, the European Commissioner for Health and Food Safety, said: “Advances in antiretroviral therapy have changed the nature of the HIV epidemic in Europe – HIV is no longer a fatal disease. For people who have been diagnosed early and have received effective treatment, HIV has become a chronic condition.
“Despite all the progress in intensive testing efforts over the last decade, estimates show that one in seven of those living with HIV in the EU/EEA are still undiagnosed. We must focus our efforts on reaching these individuals, and in particular, the most vulnerable in society. We must also intensify our efforts in testing for hepatitis B and C, a disease estimated to affect nine million people in the EU.
“We need to address these three diseases together if we are to meet our sustainable development target. This is why I and the European Commission are strong supporters of European Testing Week.”
One reason for the ongoing HIV epidemic in Europe is that late diagnosis remains a challenge. Many are diagnosed late. In fact, every second person diagnosed with HIV has already reached an advanced stage in the infection.
Early diagnosis and linkage to care bring strong individual and public health benefits: effective HIV or viral hepatitis treatment either eliminates or suppresses the viruses significantly, which in turn means that those on treatment interrupt existing transmission chains, preventing further infections. It also provides a better prognosis for the patient.
Prevention is the cornerstone within the comprehensive approach to tackle the challenges presented by HIV/AIDS in Malta. Actions taken include screening of all blood donations; public education campaigns using various mediums; peer to peer programmes; confidential and self-referral HIV testing services; programmes in schools, community and workplace; training of educators and health professionals; a specific website on sexual health and information material for media providers.
Testing is encouraged in various settings. An HIV test is offered to all new attendees at the GU clinic, including the availability of the rapid test. Pregnant women are offered an HIV test as a routine part of antenatal care. Pre- and post-test counselling, testing and contact tracing is offered. Specialist care is provided through the Infection Clinic at Mater Dei Hospital. Treatment is provided free of charge to HIV-positive cases according to eligibility criteria.
Statutory reporting of HIV and sexually transmitted infections was introduced in 2004. All notified cases are investigated, prevention guidance is given and contact tracing is carried out. Contacts are offered preventive counselling, testing and referral to specialist care.
Recent advances in HIV treatments have dramatically altered the nature and progression of HIV/AIDS. It can be safely considered as a ‘chronic’ disease, provided infected patients receive early diagnosis, care and treatment.
Dr Charmaine Gauci is Superintendent of Public Health.