HIV Control in Amsterdam and the Netherlands: Success, Challenges, and Strategies for the Future

HIV control in Amsterdam is more effective than in the rest of the country. This is evident from figures published by the HIV Monitoring Foundation (SHM) on Thursday. The organization estimates the national number of HIV infections in 2022 at 141. This represents a significant drop of 85 percent since 2010, but not as strong as in the capital, which announced a spectacular drop of 95 percent earlier this year.

“In Amsterdam, awareness of the HIV prevention pill PrEP is greater,” says Ferdinand Wit, physician-researcher at SHM. “The city also started providing PrEP earlier. In addition, access to STD care is more accessible and general practitioners are more likely to refer patients for an HIV test. We hope that the rest of the Netherlands also understands: prevention measures work if you apply them with desire, zeal and enthusiasm.”

What plays a role, according to Wit, is the population. Relatively many white, Dutch-born gay and bisexual men live in Amsterdam, while other cities have to deal with groups that are more difficult to reach, such as heterosexual risk groups and people with a migration background. “They experience more stigma and barriers to STD care.”

Local approach

“A good approach to HIV should not depend on where you live,” says Mark Vermeulen, director of the Aidsfonds-Soa Aids Nederland in a statement. “A local and regional approach to HIV is therefore necessary.”

While the decline in the number of HIV infections is accelerating, the number of diagnoses is leveling off (there is often a period of years between an infection and a diagnosis): in 2022, 393 people were diagnosed with HIV. In 2019, 2020 and 2021 there were 614, 432 and 410 respectively. “Fewer people may have been tested for HIV during the corona crisis,” says Wit. “As a result, the number of HIV diagnoses in 2020 has probably been lower.” The Ukrainians and Russians who fled to the Netherlands and who already had HIV are not the cause of the leveling off. They are not counted.

An increasingly smaller percentage of HIV diagnoses are made among men who have sex with men, 54 percent in 2022. That was two-thirds for a long time. This decrease is partly due to the provision of PrEP and the awareness campaigns that are specifically aimed at these men. HIV is also diagnosed later in heterosexual men, women and transgender people than in men who have sex with men. A third of people with a late HIV diagnosis – where the immune system has already deteriorated significantly – are admitted to hospital with an HIV-related condition within a year of diagnosis. In 2022, 21 people will have died from AIDS, the disease that HIV causes.

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Virus suppressed

The Netherlands now has approximately 24,400 people with HIV, 94 percent of whom have been diagnosed. Of these, 96 percent are being treated, and in 96 percent of them the virus has been successfully suppressed; they can therefore no longer transmit the virus. The challenge is finding the estimated 1,400 people with an undiagnosed HIV infection.

In the “last mile” of the epidemic, measures are needed that are tailored to subgroups, says researcher Wit. SHM has therefore used CBS microdata for the first time. It turned out that a low income lowers the chance of successfully suppressing the virus. “If someone has many other problems, HIV treatment is not always the highest priority.”

2023-11-22 19:45:01
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