Edited by Feng Zhao, Clemens Benedikt, and David Wilson - World Bank Group

Although only a relatively small proportion of all new human immunodeficiency virus (HIV) infections globally occurs in the Eastern Europe and Central Asia (EECA) region, the trends are a cause for concern. The region saw an estimated 30 percent increase in new infections between 2010 and 2017, and acquired immune deficiency syndrome (AIDS)-related mortality also increased steadily between 2010 and 2016, before dropping in 2017. Moreover, the epidemic, although still concentrated, has now diversified, affecting more key populations in many countries in the region. This diversification has increased the number of people in need, the ways the epidemic can further spread to sexual partners of key populations, and the complexity of formulating an effective strategy.

While the epidemic in the region is on the rise, international funding for the response in many countries in the region is decreasing rapidly, with funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) in the process of ending entirely for many nations. Domestic plans to cover the funding losses are, in many cases, far from complete. Moreover, other long-standing challenges have yet to be adequately addressed in many instances: barriers to access to treatment remain too widespread, as does the weight of social discrimination due to stigmatization of some of the most vulnerable communities, which are also in greatest need of support.

Whereas the absolute numbers for the HIV epidemic in the EECA region are still comparatively small, the trends are a cause for real concern. Thus, although the UNAIDS statistics for 2017 make clear that the region accounts for only a small proportion of global totals—1.4 million of 36.9 million (3.79 percent of the total) people living with HIV (PLHIV), and 7.22 percent of all the new cases globally (130,000 of 1.8 million)1 —the trends paint a different picture. While HIV prevalence and incidence in general have decreased in almost every other region of the world, they are increasing in the EECA region. In 2017, the region saw an estimated 130,000 new infections—30,000 more than the annual total in 2010. This rising rate of new infections (30 percent over that period) represents a worrisome increase and stands in clear contrast to the trends in other regions. During that same time period, new HIV infections declined by 33.3 percent in Eastern and Southern Africa, 9.75 percent in Western and Central Africa, 12.5 percent in Asia and the Pacific, 21.0 percent in the Caribbean, and no change in Latin America; the rate in the Middle East and North Africa increased by 11.1 percent (rising from 16,000 new cases in 2010 to 18,000 in 2017).