HIV testing strategies across European countries

Abstract

With universal access to effective combination antiretroviral therapy (ART), people in need can gain effective treatment but are only able to benefit from these advances if they are aware of their serostatus and have effectively accessed testing services. Despite the expectation that ART would lead individuals to seek earlier testing, this trend has not been observed in practice, with stable or even increasing rates of late diagnosis in Europe being witnessed. Ahead of a gathering of key European stakeholders in Brussels in November 2007, we reviewed testing strategies across European countries. We show differences in policy and practices. Moreover, HIV testing strategies are changing, in line with new global guidelines issued by World Health Organization headquarters, and a number of countries are promoting an expansion of routine and opt-out testing. However, gaps in our understanding of effective testing strategies remain and, as a consequence, national policies across Europe remain incoherent and often lack an evidence base. This is likely to have serious public health implications.

HIV Epidemics in the European Region: Vulnerability and Response

“…Frequency of needle sharing in the East is more varied, ranging between 2% and 79% [48,85] and in Russia alone between 8% and 79% [85,91]. The estimate of 2% from Vilnius, Lithuania, refers to receptive sharing in the past four weeks [48], and most estimates range between 20% and 30%, with one study estimating sharing (receptive or distributive) in the past 30 days at 98% [92].…”

“…Standardized indicators are currently lacking across the region. An important finding of the review is that access to mainstream sexual health provision for MSM can be impeded by staff hostility borne out of the dual stigma of homosexuality and HIV, and patient fears concerning breaches of confidentiality [90][91][92]. Such concerns appear more acute in the East.…”

“…The studies in Russia and the Netherlands were limited by FSWs were recruited, but sample sizes for previous years were not specified [91]. Eligibility criteria included women with a self-reported history of provision of sex work at least once in the past 6 months and women who were recruited across multiple sites nationally [91,92]. This biobehavioral surveillance survey collected information to monitor the impact of the responses to HIV (with similar surveys among men who have sex with men (MSM) and people who inject drugs (PWID).…”

HIV Stigmatization and Testing

“…A few studies have also identified clinical (previous sexually transmitted infections or history of HIV testing) and organizational factors that are associated with HIV testing [8][9][10]. In addition, social factors such as HIV-related stigmatization or discrimination have been proposed [10]. A recent meta-analysis comparing high-and low-income countries revealed that despite the many differences between the two locations, risky behaviors and stigmatization constitute universal determinants of HIV testing [11].…”

“…These are generally followed by individual factors such as risky behaviors for HIV, perceptions of HIV risk, and knowledge about HIV [7][8][9]. A few studies have also identified clinical (previous sexually transmitted infections or history of HIV testing) and organizational factors that are associated with HIV testing [8][9][10]. In addition, social factors such as HIV-related stigmatization or discrimination have been proposed [10].…”