Survey: HIV cases have stabilized at high level in Estonia

HIV test.
HIV test. Source: ERR

The numbers of new HIV cases have stabilized in Estonia, but at a relatively high level, it appears from a survey on the epidemiological situation of the HIV infection and concomitant infections in Estonia in 2011-2020, compiled by the National Institute for Health Development and the Health Board.

In 2020, a total of 147 new HIV cases, or 11.1 cases per 100,000 people, were diagnosed in Estonia.

Since 1988, a total of 10,226 people have been diagnosed with HIV in Estonia. Between 2011 and 2020, the number of new cases has fallen by 60 percent a year. In 2020, the share of women among new cases was 40 percent. Of the new cases, 52 percent were detected in Tallinn and 27 percent in Ida-Viru County.

In almost half of the cases, the infection was spread by heterosexual means, in 7 percent of cases through intravenous drug use, and in 5 percent through homosexual contacts. For the first time in six years, three cases of mother-to-child transmission were recorded.

"If we consider only HIV cases detected for the first time in Estonia, the decrease in 2020 compared to 2019 was 17 percent. However, the decline may not be due to an actual decrease in HIV prevalence, but also to reduced testing in 2020. At the same time, HIV testing rates in the general population have been gradually increasing and the results, including the very low HIV prevalence among blood donors, suggest that the HIV prevalence in the general population is low," said Kristi Rüütel, senior researcher at the department of epidemiology of drugs and infectious diseases at the National Institute for Health Development.

In 2020, one-tenth fewer HIV tests were performed in Estonia than in 2019. The main reason for the decline in testing was the emergency situation due to the COVID-19 pandemic, during which access to scheduled treatment was limited, as was access to anonymous testing.

"However, the overall level of HIV testing is very good in our country. For example, among the countries of the European Union that collect HIV testing data, we rank among the countries with the highest levels of testing. It is necessary not so much to increase testing extensively, but to better target testing for those who are more likely to be infected," Hanna Sepp, head of the infectious diseases department at the Health Board, said.

The prevalence of HIV is stable among people who inject drugs - the main risk group so far. The number of cases in men who have sex with men (MSM) meanwhile has increased.

Rüütel said that as the absolute numbers are small, it is difficult to assess trends and conjecture whether this reflects an improvement in awareness about pathways of infection or an increase in infections among MSM.

"According to the latest research, the level of risk behavior among MSMs has not decreased in the last 10 years. In the coming years, significantly more attention needs to be paid to the trend of homosexual spread of HIV and the prevention of infection, as in Western Europe the pathway of homosexual infection is the main one and in many countries it is rather on an upward trend," Rüütel said. 

Estonia ranked third in terms of the number of new HIV cases in the European Union in 2019, after Malta and Latvia. The EU average was 4.9 new HIV cases per 100,000 people. Since the end of 2009, the Estonian Health Board has been collecting data on new HIV cases through the Infectious Diseases Information System.

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Editor: Helen Wright

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