C 293/40
EN
Official Journal of the European Union
18.8.2023
8.2.
More than 80 % of HIV infections in eastern Europe in 2018 involved drug addicts, mostly very young, and mostly women.
Young women are more affected than men, including due to prostitution, which is closely linked with drug use.
Localised HIV epidemics have also been documented among marginalised populations of injecting-drug users in western Europe.
8.3.
Prisoners have higher rates of drug use and more harmful consumption patterns than the general population, including parenteral consumption, making incarcerated drug addicts particularly vulnerable.
8.4.
Drug addicts have low rates of access to testing, and are more likely to receive late diagnoses.
Even in Italy, drug addicts tested for HIV made up a low percentage of all local addiction-service users, with a low propensity to offer testing in the absence of HIV-related symptoms.
8.5.
Access to treatment for drug users is undeniably very low, although it varies from country to country.
Overall, it is estimated that only 8 % of drug addicts are in antiretroviral treatment, and that of all people in treatment, only 20 % are drug addicts.
In comparison to those with HIV in the general population, drug addicts are also less likely to achieve virological suppression.
This is due to the fact that drug addicts have a lower rate of adhering to treatment and often stop treatment altogether.
This leads to a higher risk of death from AIDS among the HIV-positive population of drug addicts.
8.6.
Programmes aimed at reaching drug addicts more effectively are necessary if we are to aspire to reaching the goal of ensuring universal access to HIV treatment, both within Europe and beyond.
9.
Men who have sex with men, MSM 9.1.
Overall, MSM, or men who have sex with men, are 27 times more at risk of contracting HIV than the general population (6).
Some biological factors make it easier to contract HIV.
Most MSM contract HIV through unprotected anal sex, which poses the most high-risk way of contracting HIV compared to other sexual practices.
In this population group, high numbers of sexual partners and the widespread use of recreational substances, including intravenous drugs (which often involves sex, called ‘chemsex’) can also contribute to the high prevalence of HIV in MSM.
9.2.
The increasing availability of antiretroviral treatment, which has led to a significant decline in the spread of HIV overall, has not had the same effect among MSM.
On the contrary, there has been an increase in HIV prevalence in this population in many western countries over recent years (7) and there has also been a gradual increase in the proportion of cases attributable to MSM transmission.
9.3.
Condoms help to prevent HIV transmission and other sexually transmitted infections as well; however the use of condoms is not that widespread due to cultural, educational and supply barriers that reflect different social contexts and health services.
9.4.
There are various barriers to accessing prevention tools in many countries and in many individual circumstances due to stigma, homophobia and discrimination, which make it difficult to access health services and proper information.
There are many cases whereby punitive laws criminalise those who have sex with people of the same sex, forcing them to go underground and to hide their sexual orientation or, worse yet, their identity.
Even where laws are not openly discriminatory, stigma and fear discourage people from accessing HIV services, leaving them unaware of the tools available for preventing HIV infection.
9.5.
Stigma also has an impact on access to testing and diagnosis.
Many MSM report fearing judgement from healthcare professionals and hold off on testing, often resulting in late diagnoses.
Being unaware of their infection status means they do not have access to antiretroviral drugs which, in addition to having effects on the health of those concerned, would reduce the risk of transmission to sexual partners.
(6) (7)
While the risk of contracting HIV is higher for MSM worldwide, infection rates vary between geographical areas: MSM represent 50 % of all newly reported HIV cases in North America and Western Europe, 47 % of those reported in Latin America, around 20 % of those reported in eastern Europe, Asia, the Middle East and North Africa, and 12 % of those reported in Africa.
In western Europe, the number of HIV-positive people among the MSM population increased by almost 20 % between 2010 and 2014.
Among men in Italy, most new HIV diagnoses are made among the MSM population.