In 2019, 2,600 people in Germany were newly infected with the HI virus. That is 100 infections more than in 2018, reports the Robert Koch Institute (RKI). A year ago, the institute assumed that fewer people would have been infected with the virus between 2017 and 2018 – the RKI reported 2500 new infections for 2017, last year it was assumed that 2400 new infections would occur in 2018.
In the meantime, the RKI has corrected its estimate for the year 2018 to 2500 new infections, as a press spokeswoman for the institute confirmed in the “Ärzte Zeitung”. The slightly falling trend has turned into stagnation, and even more: In 2019, more people in Germany were infected than in the previous year, so the trend is again pointing slightly upwards (Epid Bull 2020; 48).
MSM are not the origin
Why is that? The relationships between the HIV infection process in Germany are complex, but it is clear that the increase in new infections does not come from the high-risk group of men who have sex with men (MSM), but from heterosexuals and drug users.
Among the MSM, the number of new infections has remained more or less constant compared to 2018 at 1,600. In contrast, an estimated 650 people were infected heterosexually, which corresponds to an increase of 120 infections compared to 2018. In addition, there are 360 infections among drug users (an increase of 50 new infections). The RKI writes that new infections have increased at a low level on both transmission routes since 2012.
The number of unreported cases has also increased. The RKI has calculated that of the 90,700 people currently living with HIV in Germany, 10,800 are unaware of their infection. Without a diagnosis, the infection of these HIV-positive people can spread further in the direction of the full picture AIDS, and these patients also potentially infect other people unintentionally.
UNAIDS goals missed
By 2020, Germany had actually planned to meet the international goals of the United Nations AIDS program (UNAIDS). In short, these are “90-90-90”. What this means is that 90 percent of those infected with HIV in the respective country should know their diagnosis, 90 percent of those diagnosed with HIV should receive therapy and again 90 percent of those infected with therapy should be successfully treated so that their viral load is below the detection limit of 50 virus copies per ml of blood.
Although the last two values (proportion of diagnosed infected with therapy, proportion of successful therapies) are good in Germany, the target of “88-96-96” for 2020 is not the right one: around 88 percent of those infected with HIV in Germany have a diagnosis, so an HIV infection is simply too often overlooked in Germany. Warning symptoms are more easily overlooked, especially with older people and heterosexuals, and the sexual history is often not taken.
What to look out for:
Routine response of sexual life in doctor-patient discussions.
Recognizing signs of fresh infection: Lymph node swelling, fever and night sweats of unknown origin, possibly in connection with myalgia, arthralgia and pharyngitis or a maculopapular rash with a pronounced trunk.
Indicator diseases: STIs including hepatitis A, B and C, seborrheic dermatitis (especially on the face), herpes zoster, atypical psoriasis, oral candidiasis, oral hairy leukoplakia or chronic parotitis.
The fact that a lifestyle with a high risk of infection is often only reluctantly addressed in doctor-patient discussions is also due to the fact that many infected people still experience discrimination in the healthcare system. In a survey by Deutsche Aidshilfe (DAH) with 935 HIV-infected people, for example, 56 percent reported at least one discriminatory experience in the healthcare system in the last year – such as the denial of a health service, the third obvious marking of patient files or breaches of confidentiality.
A brochure from the DAH and the German Medical Association shows how things can be done better: On 48 pages there are instructions for non-discriminatory treatment of HIV-positive people in practice, for advice and information on HIV prophylaxis, testing and dealing with positive test results .