Amsterdam in the Netherlands is one of the most well-known gay-friendly cities in Europe. It boasts numerous queer bars, clubs, bathhouses and hotels.
The city has acted as a magnet for gay men for decades. Unsurprisingly, it’s also been at the center of the HIV epidemic in its home country. Fortunately, health officials have been working hard to change this. And it appears they’re winning.
Recent statistics revealed that in 2022, Amsterdam had only nine new cases of HIV. That represents a 95% decline in new cases since 2010, when it recorded 201.
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Of those living with HIV in the city, 98% have a diagnosis. Of those, 95% are on treatment and 95% are undetectable. This beats a 95-95-95 target set by UNAIDS for countries to aim for.
As people who are undetectable cannot transmit the virus, the result is a dramatic fall in HIV cases.
Even though Amsterdam is a small city (population 820,000), its reduction in HIV diagnoses is remarkable. It points a way forward for other cities.
By comparison, in New York City (population 7.9 million), there was a 14% increase in the annual number of new HIV diagnoses between 2020 and 2021, from 1,396 to 1,594 cases.
The work to target HIV in the Netherlands capital falls under the remit of the HIV Transmission Elimination Amsterdam (H-TEAM) Initiative.
Its project leader, Dr. Godelieve de Bree, recently spoke to Aidsmap.com. She explained some of the reasons the city had successfully driven down infection rates.
Here are some of the important takeaway points.
1. H-TEAM worked hard to get all of those involved with treating HIV to work together. This included members of the communities most affected, lawmakers, and primary care physicians and hospital teams.
2. They focussed on the fact that 60% of HIV transmission in gay and bi men were traced back to acute infections. This is the earliest stage of the disease, when viral loads are high. In other words, men who were becoming infected were transmitting it to others within weeks of their own infection.
H-TEAM then designed a campaign to highlight the possible symptoms of acute infection. They made sure general physicians, frontline hospital staff, and members of the public, knew them.
“If people recognize the symptoms of an acute infection, they can get an immediate referral to the sexual health clinic,” said de Bree. “There is a dedicated desk at the clinic, where people can get their acute HIV test results in around an hour.
“If the test result is positive, then the clinic contacts one of the hospitals providing HIV treatment and the person can be seen the same day.”
They are then put on treatment with a day.
Treating heterosexuals quicker than in the past
3. De Bree said around three-quarters of HIV cases are in gay and bi men. However, a quarter of cases are in heterosexual people. These individuals typically don’t see help from a doctor until they’ve had HIV for some time or have developed an HIV-related illness.
H-TEAM supported a new training program for GPs to recognize potential signs of HIV illness in traditionally lower-risk communities. It also encouraged them to ask heterosexual patients more upfront questions about their sex lives and offer HIV testing.
4. It encouraged the most at-risk communities to take advantage of PrEP.
5. De Bree says they worked hard to analyze where in the city people are acquiring HIV.
“This is not just in terms of numbers but also trying to gain insight on the geographical distribution of the HIV epidemic. In what parts of the city do people with undiagnosed HIV live and where do people who present late to care live? Can we get insight in their background, maybe in terms of migration, socioeconomics, or language barriers?
“If we want to reach out to people, we have to use a language they understand.”
Reaching out to people who are not getting tested
H-TEAM has consistently produced awareness campaigns to target those who might not relate to past adverts. For example, its latest campaigns targeted those they know are not getting tested. This includes a bisexual young man, an older man who has been traumatized by the AIDS epidemic (see the video below), a Moroccan-Dutch youth and a Latin American youth without residence status.
“These 4 were chosen based on extensive scientific research by the H-TEAM into people who enter HIV care late and their motivations for avoiding testing for a long time,” said H-TEAM in a statement.
De Bree says she knows that Amsterdam is a small city and achieving the same results in big cities will be harder. However, “there are lessons we learned and that may be relevant for other cities … Especially in a larger city, I think early involvement of government organizations would be key, because you need the infrastructure and you need the support.
“They need to help normalize HIV, because that’s by far the largest barrier in all the interventions.”