- HIV and various co-infections like hepatitis B, hepatitis C, tuberculosis, and sexually transmitted infections are a concern in Germany. An estimated 60,000 people are living with HIV in Germany. - Men who have sex with men (MSM) account for 80% of HIV cases and 70% of new HIV infections in Germany. Co-infection rates of hepatitis B, hepatitis C, and syphilis are also high among MSM. - The German government has created an action plan for 2007-2010 to address HIV and STI prevention through expanded testing, prevention campaigns, education, and routine STI screening for at-risk groups like MSM.

1. HIV and Co-infections in Germany Strategies for Prevention Osamah Hamouda Robert Koch-Institute, Berlin, Germany Dept. Infectious Disease Epidemiology www.rki.de

2. Robert Koch-Institut, Berlin

5. Estimated HIV/AIDS Incidence, Prevalence and Deaths in Germany, End 2007 (modell)

7. 72,2 % 3,9% 0 10 20 30 40 50 60 70 80 90 100 antiHBc (n=72/81) antiHCV (n=/113) Percentage Source: RKI: KABaSTI 2007/8 Hepatitis Co-Infections among HIV-positive MSM KABaSTI survey participants

8. % Co-infection /risk factors among TB patients DZK Study 2002-2004 (n=2,364)

9. Newly diagnosed HIV-infections in Germany (02/2008) by transmission group and year of diagnosis

10. HIV Incidence Pilot Study in Berlin, 2005 - 2007: Recency of HIV Infections by Age Groups in MSM Level of significance, Pearson Chi²-Test: p=0.01 0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 20 - 29 30 - 44 >44 Age Groups (years) Proportions crude and adjsuted (%) crude proportion of recent infections adjusted proportion of recent infections

11. Behaviour Trends: Number of sexual partners based on MSM aged 25 years or older, living in cities with more than 500,000 inhabitants Source: Axel J. Schmidt, Stefanie Grote, Michael Bochow: Results of a Follow Up Survey on HIV Risk Reduction & Risk-Taking Among Men Who Have Sex with Men in Germany EACS 2007 P 16.2 / 02

12. Syphilis and HIV co-epidemics in MSM in Germany HIV incidence 1985-2007 estimated based on back-calculation and newly diagnosed infections; Syphilis incidence 1985-2000 estimated, 2001-2007 reported

13. Newly diagnosed Syphilis in men by agegroup, 1997-2006

14. Newly diagnosed HIV-infections in men by agegroup, 1999-2006

16. Incidence of bacterial STIs (previous 12 months) *genital manifestation only 33,6 45,7 8,6 0 5 10 15 20 25 30 35 40 45 50 HIV+/HAART + (n=280) HIV+/HAART- (n=173) HIV- (n=2110) % any bacterial STI

17. HIV/STI-Coinfection in Germany Strategies for prevention Action Plan 2007-2010