ECDC Technical Report, 2020 (doi: 10.2900/492423).
Authors: Rosalie Hayes, Yusef Azad, Cheryl Gowar, Alison Brown & Valerie Delpech, in collaboration with Axel J. Schmidt and Ulrich Marcus This report is part of the 2018 progress reports monitoring the implementation of the Dublin Declaration. It presents the situation among men who have sex with men (MSM), a key group affected by HIV in the WHO European Region, and outlines priorities for action. In addition, case studies provided by health authorities highlight developments in public health policy and programme implementation, specific to MSM.
Men who have sex with men have been disproportionately affected by the HIV epidemic since its start in Europe in the 1980s. The burden of HIV on this group has been exacerbated by homophobia and HIV stigmatisation, which hampered the public health response and the availability and accessibility of prevention tools. Today, sex between men remains the main mode of transmission of HIV in Western Europe.
While some countries report a recent decline in HIV incidence among MSM as a result of successful combination prevention efforts, diagnoses have continued to rise in the majority of countries in Europe and Central Asia. In particular, there has been an eight-fold increase (710%) in diagnoses in the East sub-region since 2008.
In the 2018 reporting year, the ECDC survey was used to collect data to monitor implementation of the 2004 Dublin Declaration from the national health authorities in the Region. The survey contained specific questions in relation to the HIV epidemic among men who have sex with men, in addition to questions relating to current national prevention interventions, policies and barriers to the public health response to the epidemic.
Forty-six of the 52 reporting countries prioritise MSM as a key population in their HIV response, with 31 countries selecting MSM as their top priority (17 West; 13 Centre; 1 East). Findings are compared against the global 90-90-90 targets. The report also includes key findings from the European Men who have sex with Men Internet Survey 2017 (EMIS-2017).
The report presents the continuum of HIV care across the region and classifies results according to countries that provided data on: (a) all four stages, (b) no stages, and (c) at least two consecutive stages of the continuum of care nationally as well as disaggregated data, where available, for MSM. Only 19 countries, i.e. less than half of reporting countries, were able to submit two consecutive stages of data for the HIV continuum for MSM. It is hence difficult to gauge what is the real situation for this key population is across Europe and Central Asia.
Based on the findings, priorities for action to address the HIV epidemic among men who have sex with men are outlined in the report.