Objectives To provide an overview of the current level of development and results from the national HIV surveillance systems of the 23 countries of the Middle East and North Africa (MENA), and to assess the quality of HIV surveillance systems in the period 2007–2011. Methods A questionnaire was used to collect the information about the structure, activities and the results of HIV surveillance systems from the National AIDS Programmes. Assessment of the quality was based on four indicators: timeliness of data collection, appropriateness of populations under surveillance, consistency of the surveillance sites and groups measured over time, and coverage of the surveillance system. Results Only in four countries did surveillance systems enable assessment of epidemic trends in the same populations and locations over time, such as in pregnant women (Morocco, Iran), injecting drug users (Iran, Pakistan), female sex workers (Djibouti, Morocco) and male sex workers (Pakistan). There is increasing evidence of HIV infection being firmly established in at least one of the populations most at risk of HIV in nine MENA countries, while lower risk populations show elevated HIV prevalence in South Sudan, Djibouti and some parts of Somalia. Conclusions The performance of HIV surveillance systems in several of the MENA countries has improved in recent years. The extent of HIV epidemics in the populations most at risk of HIV is still largely unknown in 10 countries. Multiple data sources that most of the countries still lack would enable indirectly estimation not only of the patterns of HIV epidemics but also the effectiveness of HIV responses.

Background: Epidemics of sexually transmitted infections (STI) are a major public health challenge in the World Health Organization (WHO) European Region. Aim: We aimed to provide an overview of case reporting and other surveillance data for syphilis, gonorrhoea and chlamydia for the non-European Union (EU)/European Economic Area (EEA) countries of the Centre and East part of the WHO European Region as per classification used by the WHO Regional Office for Europe (WHO/Europe) and the European Centre for Disease Prevention and Control. Methods: Data were provided by the surveillance agencies of the Member States for the period 2015 to 2019 through the WHO/Europe Communicable Diseases Annual Reporting Form. We analysed reported cases, explored data reported to the WHO Gonococcal Antimicrobial Surveillance Programme (GASP) and performed a review of publications on antimicrobial resistance (AMR) in gonorrhoea in the period 2015 to 2020 using systematic methodology. Results: From 2015 to 2019, in most of the countries with three or more data points, there was a pattern of decrease in reported syphilis, gonorrhoea and chlamydia cases, which is in contrast to the EU/EEA. The number of reported cases per 100,000 population was 0.4–26.5 for syphilis, 0–18.5 for gonorrhoea and 0–43.3 for chlamydia. Four countries reported recent data on AMR in gonorrhoea to GASP, and we identified further publications from Georgia, Russia and Ukraine. Conclusion: We found wide heterogeneity in reported rates of STI. There is a strong need to improve availability and quality of STI surveillance data in the non-EU/EEA countries.

Objective: To determine the prevalence of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) in Zagreb, Croatia, and assess correlates of testing for HIV in the past 12 months.Methods: The authors carried out a bio-behavioural survey using respondent-driven sampling (RDS) from September 2010 to February 2011. Participants completed a questionnaire and were asked to provide blood, urine, oropharyngeal and rectal swabs for the detection of infections. Data were analysed using RDS Analysis Tool 6.0.1 and STATA V.8.0.Results: A total of 387 MSM were recruited at the University Hospital for Infectious Diseases. The age range of recruited men was 18–57 years. HIV prevalence was 2.8% (95% CI 1.1% to 5.1%) (3.6%, unadjusted), lower than that found in the first RDS survey carried out in 2006 (4.5%, 95% 2.2% to 7.3%) (4.9%, unadjusted). The seroprevalence of herpes virus type 2 was 5.9% (6.9, unadjusted) and that of syphilis measured byTreponema pallidumhaemagglutination assay was 7.6% (6.7%, unadjusted). The authors found urethral and/or rectal infections withChlamydia trachomatisin 7.2% (8.5%, unadjusted) of men and gonoccocal in 2.7% (2.1%, unadjusted). HIV testing in the past 12 months was reported by 32.7% (38.9%, unadjusted). In the multivariate analysis, significant correlates of recent HIV testing were having more than three partners in the past 12 months and the knowledge of HIV status of a regular partner.Conclusions: The results indicate that there might have not been a progression of an HIV and STI epidemic in the past 5 years among MSM in Croatia. Prevention should expand by providing better uptake of HIV and STI testing services, thus enabling timely treatment.

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