Reduction in undiagnosed HIV infection in the European Union/European Economic Area, 2012 to 2016.

It is well-documented that early HIV diagnosis and linkage to care reduces morbidity and mortality as well as HIV transmission. We estimated the median time from HIV infection to diagnosis in the European Union/European Economic Area (EU/EEA) at 2.9 years in 2016, with regional variation. Despite evidence of a decline in the number of people living with undiagnosed HIV in the EU/EEA, many remain undiagnosed, including 33% with more advanced HIV infection (CD4 < 350 cells/mm3).

Estimating HIV incidence and number of undiagnosed individuals living with HIV in the European Union/European Economic Area, 2015.

Since 2011, human immunodeficiency virus (HIV) incidence appears unchanged in the European Union/European Economic Area with between 29,000 and 33,000 new cases reported annually up to 2015. Despite evidence that HIV diagnosis is occurring earlier post-infection, the estimated number of people living with HIV (PLHIV) who were unaware of being infected in 2015 was 122,000, or 15% of all PLHIV (n=810,000). This is concerning as such individuals cannot benefit from highly effective treatment and may unknowingly sustain transmission.

Sharply rising prevalence of HIV infection in Bali: a critical assessment of the surveillance data.

This study critically examines serological survey data for HIV infection in selected populations in Bali, Indonesia. Sero-survey data reported by the Bali Health Office between 2000 and 2010 were collated, and provincial health staff were interviewed to gain a detailed understanding of survey methods. Analysis of time series restricted to districts that have used the same sampling methods and sites each year indicates that there has been a steady decline in HIV prevalence among prisoners, from 18.7% in 2000 to 4.3% in 2010. In contrast, HIV prevalence among women engaged in sex work increased sharply: from 0.62% in 2000 to 20.2% in 2010 (brothel based), and from 0% in 2000 to 7.2% in 2010 (non-brothel based). The highest prevalence was recorded among people who injected drugs. Recent surveys of gay men and transvestites also found high prevalences, at 18.7% and 40.9%, respectively. Review of the methodology used in the surveys identified inconsistencies in the sampling technique, sample numbers and sites over time, and incomplete recording of individual information about survey participants. Attention to methodological aspects and incorporation of additional information on behavioural factors will ensure that the surveillance system is in the best position to support prevention activities.

Modelling the epidemiological impact of scaling up HIV testing and antiretroviral treatment in China.

BACKGROUND: The HIV epidemic in China has been increasing. In response, a 5-year action plan in China has prioritised the scale-up of HIV testing and treatment. METHODS: We use a mathematical model to reproduce HIV epidemic trends in China and to forecast epidemic trends according to current conditions or increases in the rate of HIV testing or roll-out of antiretroviral therapy. RESULTS: We show that the epidemic in China could be expected to experience a 2.5-fold expansion over the next 5 years such that ~1.8 million people will be infected with HIV in China by 2015. However, increasing testing and treatment rates can have substantial epidemiological benefits. For example, a four-fold increase in testing rates may avert more than 42000 HIV infections and 11000 deaths over the next 5 years. A 10-fold increase in the treatment rate could decrease the number of HIV-related deaths by 58% and the number of new infections by one-quarter by 2015. CONCLUSIONS: Increasing HIV testing and treatment are important public health strategies for prevention.

Estimation of hospital-based HIV seroprevalence as a nationwide scale by novel method; 2002-2008 in Korea.

BACKGROUND: In Korea, approximately 70% of HIV-positive individuals are currently diagnosed in hospitals, while most HIV-positive patients were diagnosed at public health centers in 1980 s and 1990 s. However, there are no reporting systems to identify how many HIV tests are performed in the Korean hospitals different from public health centers and Blood centers. We estimated how many HIV tests were performed in hospitals and analyzed the nationwide hospital-based HIV seroprevalence in the present study. METHODS: Between 2002 and 2008, data included HIV tests on insurance claims in hospitals and the proportion of computerized insurance claims from the Health Insurance Review and Assessment Services. The number of HIV tests from the survey in the External Quality Assurance Scheme for hospital laboratories was collected to calculate the insurance claim proportion. HIV seroprevalence was estimated using data of tested individuals, including infected individuals. Statistical analysis was confirmed with the 95% confidence interval. Statistical significance was defined at p-values < 0.05. RESULTS: The number of HIV tests in hospitals increased from 2.7 million in 2002 to 5.0 million in 2008. The trend of HIV seroprevalence was decrease (1.5-1.3 per 10,000 individuals, P < 0.0028), except in 2002. The number of women tested was greater than men, and the proportion increased in older individuals and in small towns. Men had a higher annual HIV seroprevalence than women (P < 0.0001). The annual seroprevalence decreased in men (P = 0.0037), but was stable in women. The seroprevalence in the 30-39 year age group demonstrated higher than other age groups except 2008. CONCLUSIONS: The nationwide hospital-based number of HIV tests and seroprevalence were estimated using a new method and seroprevalence trends were identified. This information will facilitate improvement in national HIV prevention strategies.

Social capital and the decline in HIV transmission - A case study in three villages in the Kagera region of Tanzania.

We present data from an exploratory case study characterising the social capital in three case villages situated in areas of varying HIV prevalence in the Kagera region of Tanzania. Focus group discussions and key informant interviews revealed a range of experiences by community members, leaders of organisations and social groups. We found that the formation of social groups during the early 1990s was partly a result of poverty and the many deaths caused by AIDS. They built on a tradition to support those in need and provided social and economic support to members by providing loans. Their strict rules of conduct helped to create new norms, values and trust, important for HIV prevention. Members of different networks ultimately became role models for healthy protective behaviour. Formal organisations also worked together with social groups to facilitate networking and to provide avenues for exchange of information. We conclude that social capital contributed in changing HIV related risk behaviour that supported a decline of HIV infection in the high prevalence zone and maintained a low prevalence in the other zones.

Disproportionate and increasing burden of HIV infection among men who have sex with men in Slovenia: surveillance data for 1999-2008.

The report presents data on HIV infection among men who have sex with men (MSM) in Slovenia during 1999-2008. HIV surveillance was based on universal mandatory reporting of HIV/AIDS cases, monitoring HIV infection prevalence among sentinel populations of MSM and STI patients and selected behaviour indicators in a sentinel population of MSM. Among 48 newly diagnosed HIV cases reported for 2008, 34 were MSM. Since 1999, the annual reported rate of HIV diagnoses in MSM rose from 7.1 to 46.8 per million men aged 15-64 years (an increase of more than six times). During 1999-2008, the proportion of MSM diagnosed with AIDS within three months of HIV diagnosis declined from 60% to 21%, however, the corresponding rate per million men aged 15-64 increased from 4.3 to 9.6. During 1999-2008, HIV prevalence among male clients of STI outpatient services tested for syphilis (including a substantial proportion of MSM) increased from 0% to 3.4%, and it remained below 5% in a sentinel population of MSM in Ljubljana. In the same sentinel population of MSM, the proportion reporting HIV test last year increased from 29% in 2003 to 38% in 2008 while the proportion reporting condom use at last anal intercourse decreased from 81% in 2004 to 66% in 2008. The burden of HIV among MSM in Slovenia is disproportionately high and increasing fast. Promotion of safer sexual behaviour and HIV testing among MSM as well as positive prevention among MSM with diagnosed HIV infection are urgently needed.

Patients with severe mental illness: a new approach to testing for HIV.

BACKGROUND: The prevalence of HIV infection in South Africa is approaching 20% of young adults. In severely mentally ill people it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available, it is imperative to diagnose HIV infection early in this high-risk population. METHODS: A literature review established the prevalence of HIV infection in inpatient populations with HIV infection. The pattern of testing for HIV over 3 years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients. RESULTS: The reported HIV seroprevalence in psychiatric inpatients ranges from 0 to 59.3%, with a mean of 10%. Data show a clear trend towards an increase in prevalence: before 1996 the mean HIV seroprevalence was 7.4%, while after 1996 the mean was 15%. State psychiatrists in the Western Cape do not test routinely for HIV infection, mainly owing to ethical constraints: 14.6% of patients at Lentegeur Hospital were tested in 2006. CONCLUSIONS: The high prevalence of HIV infection in South Africa, which is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent), and the availability of effective treatment require debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients.

Masking through averages--intraprovincial heterogeneity in HIV prevalence within the Western Cape.

OBJECTIVE: To measure HIV prevalence at health-district level in the Western Cape (WC) and to compare these findings with those of the National HIV Antenatal Surveys (NHASs). This investigation aimed to estimate the degree of heterogeneity of HIV prevalence within the province in order to inform the design of appropriate and targeted HIV interventions. METHOD: Annual cross-sectional, unlinked district HIV antenatal surveys were implemented in all 25 health districts of the WC for the years 2001 - 2004, concurrently with the NHAS. A stratified proportional sample was drawn for each district, involving all 344 antenatal clinics in the province, and the anonymous screening method as described by the World Health Organization (WHO) was applied. RESULTS: The NHAS revealed a significant increase in HIV prevalence in the WC from 8.6% (95% confidence interval (CI): 5.6 - 11.6) in 2001 to 15.4% (95% CI: 12.5 - 18.2) in 2004. The district-level HIV surveys showed wide variation in HIV prevalence across the health districts, which increased progressively during this period (a range of 0.6 - 22% for the year 2001 increased to 1 - 33% in 2004). Spatial analysis of HIV prevalence by health district for this period also revealed progressive spatial growth of the sub-epidemics, with the highest prevalence observed in districts located in the Cape metropole region. CONCLUSIONS: These concurrent surveys highlight the fact that examining a provincial estimate of HIV prevalence alone has the potential to mask epicentres within the province. This underscores the importance of expanding the surveillance systems to detect heterogeneity sub-provincially, in order to link with local-level planning and resource allocation.

Personal history of voluntary HIV counseling and testing (VCT) among adults aged 19-35 years living in peri-urban communities, Chiang Mai, Northern Thailand.

This study investigates the self-reported history of HIV voluntary counseling and testing (VCT) among adults, aged 19-35 years, in northern Thailand. Participants were interviewed about their HIV testing history and risk behavior. Overall, 47% of 2251 participants had previously been tested, of whom 64% were tested at government clinics. Of those tested at private clinics, 50% reported not receiving pre- and post-test counseling, compared to 15% of those tested in government clinics. Ten percent of those tested had not received their test results. Among those who had never been previously tested for HIV, 66% believed they were not at risk, although 1.5% (2.7% among men) were HIV infected. Although VCT is widely available and utilized by the population of northern Thailand, substantial numbers of HIV infected persons have not been tested for HIV and among those tested many have not received comprehensive counseling. A Thai government policy enforcing effective counseling to accompany HIV testing is urgently needed.

Assessment of increase in perinatal exposure to HIV among Hispanics--20 counties, Georgia, 1994-2002.

CDC recently received reports from clinicians in a specialized pediatric human immunodeficiency virus (HIV) care clinic (clinic A) suggesting that the number of perinatally HIV-exposed Hispanic infants in the Atlanta metropolitan area had increased disproportionately to the growth of Hispanics in the area's population. To assess this increase and characterize trends in perinatal HIV exposure in this population, CDC collaborated with health-care providers at clinic A, which serves residents in 20 Georgia counties, including the Atlanta metropolitan area. This report summarizes the results of that assessment, which suggest that the increase in the number of perinatally HIV-exposed Hispanic infants was associated with multiple factors, including the growth of the Hispanic population, increasing HIV prevalence and fertility among Hispanics, and lower preconception awareness of HIV serostatus among those with HIV. The findings suggest a need for improved access to voluntary HIV counseling and testing and increased opportunities for reducing the risk for unintended pregnancy among Hispanics in these counties.

New data from the CDC confirm HIV is on the rise.

The CDC has unveiled data showing that new HIV diagnoses have increased 5% between 1999 and 2002, and says the statistics likely reflect an increase in HIV cases and not simply increased HIV testing. The recent report offers the strongest evidence to date that the nation's prevention efforts are beginning to fail.

UNAIDS report for 2003: most deaths and new infections ever; some good news.

The global AIDS epidemic is still getting worse. There have been successes, however, and many countries are at a critical stage where they could prevent a major epidemic if they act now; while some are beginning to do so, others are not. Overall there has been a big growth in commitment by governments of rich countries and developing countries alike, though financially the current effort is only about half of what is needed. Stigma remains a major obstacle to stopping the spread of HIV and getting those infected diagnosed and treated.