Official websites use. Share sensitive information only on official, secure websites. This presentation will review progress in the AIDS response in the overall context of current global health. HIV incidence is increasing in the European region as a whole, although there are large epidemiological differences between Western, Central and Eastern Europe.
While the tools to prevent HIV — including diversified testing strategies, treatment as prevention, PrEP and harm reduction — have multiplied in recent years, their application across Europe is uneven and, in most settings, far lower than needed to impact incidence. Within and beyond Europe, PrEP is undoubtedly contributing to the decline in new diagnoses reported in gay and other MSM, but the public health benefit is difficult to assess precisely and the impressive decline seen in some city clinics is not universal.
In all these settings testing and treatment were already at scale when PrEP was introduced. CROI ; Abs Effective ART remains the cornerstone of successful HIV management, with life expectancy in those successfully treated similar to that of the general population. ART is also an effective means of reducing population HIV transmission with the goal of zero new infections. However, suboptimal engagement in HIV care threatens to derail this success and is associated with serious consequences for both individual and public health.
Engagement in care for any individual is dynamic and disengagement may happen at any time. The population groups most at risk of disengagement are invariably those most marginalised and with the least advocacy. Sustainable engagement will require a combination of biomedical, behavioural and structural strategies that recognise and address individual level factors and create a more enabling environment for health over the life course.
Community participation and partnership in this process will be vital, with peer and social support services playing a key role. To tailor and target interventions appropriately, mechanisms are needed to predict those at risk of subsequent disengagement as well to respond once this occurs. Future investment in research and services to tackle engagement is required to ensure the health inequalities we see across our cohorts reduced.
