HIV epidemics among men who have sex with men in central and eastern Europe

Male-to-male sex is the major route of HIV transmission in high-income countries, and the emerging data from low-income and middle-income countries indicate that men who have sex with men (MSM) bear a substantial burden of HIV epidemics there as well.1 2

It is estimated that 1.5 (range 1.1–1.9) million people were living with HIV in the countries of central and eastern Europe (CCEE) in 2007, with an estimated adult prevalence (15–49 years old) of 0.8% (range 0.6%–1.1%).3 Injecting drug use remains the main mode of HIV transmission in the 15 countries of the former Soviet Union, though there has been an increase in the number of reported heterosexually acquired infections.4 In the other countries of eastern Europe, the main modes of transmission are sexual: both heterosexual and through male-to-male sex.5 MSM remain the group at the greatest risk of HIV in western Europe, because of high levels of HIV-related risk behaviours and increasing incidence of sexually transmitted infections (STIs).6 7

In the CCEE, data on the epidemiology of HIV among MSM are less available compared with other vulnerable groups, which has partly been attributed to specific social conditions and stigmatisation of homosexuality in post-communist, transitional societies.8 9 In the recently published assessment of the quality of HIV sero-surveillance in low-income and middle-income countries, only one country of eastern Europe and central Asia (Ukraine) was assessed as having a fully functioning surveillance system.10 The key weaknesses identified were the over-reliance on HIV and AIDS case reporting in longer-term tracking of the epidemic and few studies conducted among at-risk groups other than injecting drug users. The concerns about insufficient quality of data on population health and their limited usefulness for informed policy decisions, coupled with weak infrastructure for communicable disease control, have been well recognised …