Exploring the complex landscape of STIs among HIV patients in Albania, examining the latest research, uncovering barriers to effective care, and highlighting promising solutions taking root in Albanian communities.
Albania, a country known for its stunning Adriatic coastline and rugged mountain landscapes, is facing a less visible but increasingly concerning health challenge. While HIV prevalence remains relatively low compared to other European nations, the country is witnessing a troubling rise in new infections alongside persistent gaps in the management of sexually transmitted infections (STIs) among people living with HIV. This intersection of HIV and other STIs creates a perfect storm for public health, where each condition amplifies the impact of the other.
In Albania, where healthcare systems are evolving and stigma remains a significant barrier, this dual challenge demands urgent attention. As one executive director of an Albanian HIV association starkly warned, without improved prevention efforts, the goal of eliminating HIV by 2030 appears increasingly unattainable 1 .
Albania finds itself at a crossroads in its HIV response. Historically considered a low-prevalence country, recent trends have raised concerns among public health experts. In the first ten months of 2024, 119 new HIV infections were identified, representing an incidence rate of 5 new cases per 100,000 people 1 . Perhaps more alarming is Albania's regional standing—the country now ranks first in the region for the highest HIV infection rate in the population 1 .
119
New HIV Cases (2024)
5
Per 100,000 Incidence
60%
Late Diagnosis
22%
Youth Cases (15-29)
The term "syndemic" describes the synergistic relationship between HIV and other STIs—each condition exacerbating the impact of the other. This phenomenon is particularly relevant in Albania, where limited public awareness and structural barriers to healthcare access create fertile ground for these interconnected health issues.
Research conducted among Albanian university students reveals significant gaps in comprehensive sexual health knowledge. While students showed better knowledge of STIs than their Italian counterparts in one study—with 20% of Albanians recognizing all STIs on a list compared to only 0.5% of students from Genoa and Lecce—knowledge remains unsatisfactory overall 2 . This knowledge gap, combined with behavioral risk factors, creates ideal conditions for the spread of both HIV and other STIs.
A critical turning point in Albania's HIV response came with the expiration of Global Fund support in December 2024. This departure had immediate practical consequences: all services supported by the Global Fund were halted, leading to a total lack of HIV tests and condoms for high-risk groups 1 . The Association of People Living with HIV reported a "complete shortage" of these essential prevention tools, forcing organizations to turn to neighboring countries for help 1 .
The cascade of HIV care in Albania reveals significant losses at each step of the journey from diagnosis to viral suppression. A 2016 study analyzing newly diagnosed cases found that out of 127 new HIV cases reported, only 100 (78.7%) entered care . Among those who entered care, 71% started antiretroviral therapy (ART), but viral load after initiation of ART was assessed in just 25 cases, with only 56% of patients achieving an undetectable HIV-RNA .
| Stage of Care | Percentage of Patients | Remaining Number |
|---|---|---|
| Total diagnosed | 100% | 127 |
| Entered care | 78.7% | 100 |
| Started ART | 71% | 71 |
| Viral load assessed | 35.2% | 25 |
| Achieved viral suppression | 56% | 14 |
To understand the barriers to HIV and STI prevention in Albania, let's examine a crucial 2018 study conducted at the University of Vlora. This cross-sectional investigation aimed to evaluate health beliefs and barriers related to HIV prevention and screening, with an emphasis on the association between voluntary counseling and testing (VCT) uptake and explanatory factors among university students 8 .
The study employed a structured, self-administered questionnaire of the Knowledge, Attitude, Practice and Belief (KAPB) type, comprising four sections:
The researchers used a multi-stage sampling technique:
Sample: 710 participants with a mean age of 20.85 years 8 .
The Vlora study revealed several critical insights into the sexual health behaviors and perceptions of Albanian youth:
| Barrier Category | Specific Finding | Percentage |
|---|---|---|
| Interpersonal | Believe condom use insults partner | 69% |
| Risk perception | Would not avoid sex with multiple partners despite HIV risk | 38% |
| Service utilization | Sexually active students not using VCT services | 78% |
| Geographic | Rural students less likely to use HIV services | 50% reduction |
The study also identified striking differences between health science and non-health science students. Those from non-health sciences demonstrated lower utilization of HIV services, pointing to the protective effect of health education 8 .
Students from non-health sciences demonstrated:
Conclusion: Health education has a protective effect on sexual health behaviors.
Amidst the challenges, promising developments are emerging at the local level. Four Albanian cities—Kolonja, Durrës, Pogradec, and Shkodra—have signed the Paris Declaration on AIDS, committing to ending AIDS as a public health threat by 2030 5 . By joining this Fast-Track Cities initiative, these municipalities have committed to achieving the 95-95-95 targets by 2025 (90% of people living with HIV knowing their status, 90% on antiretroviral treatment, and 90% virally suppressed) 5 .
| City | Primary Focus | Planned Interventions |
|---|---|---|
| Durrës | Injecting drug users | Expand methadone maintenance therapy by 10% annually 5 |
| Pogradec & Kolonja | Migrant populations | Raise awareness to increase HIV testing rates 5 |
| Shkodra | Cross-border collaboration | Partnership with Podgorica (Montenegro) for "Healthy Houses" model 5 |
The interconnected nature of STIs and HIV demands integrated solutions. Research consistently shows that integrated service delivery improves health outcomes and represents a more efficient use of resources. For Albania, this might mean:
During clinical encounters to maximize efficiency
STI prevention messaging into HIV counseling
Training healthcare providers to address both HIV and STIs
Include condoms, PrEP, and STI testing
Global research advances offer hope for strengthening Albania's response to HIV and STIs. Several innovations presented at recent international conferences could potentially benefit the Albanian context:
Twice-yearly lenacapavir for PrEP shows promising pharmacokinetic results, with a phase III trial planned 9 . Such long-acting options could overcome adherence challenges associated with daily PrEP.
Investigational once-weekly and twice-yearly treatment combinations could transform HIV management by reducing the burden of daily pill-taking 6 .
Real-world implementation has been associated with significant declines in bacterial sexually transmitted infections 9 .
Albania stands at a pivotal moment in its response to sexually transmitted infections among HIV patients. The country faces significant challenges—from the withdrawal of international funding to persistent stigma and knowledge gaps—yet also possesses genuine opportunities for meaningful progress. The engagement of municipal governments, the potential for integrated service delivery, and advances in global research collectively offer a path forward.
The syndemic of HIV and STIs represents more than just a biomedical challenge; it reflects broader social, economic, and structural factors that influence health outcomes. As such, an effective response must extend beyond clinics and laboratories to address the underlying determinants of health, including education, stigma, and equitable access to services.
With determined leadership, evidence-based strategies, and community engagement, Albania can still turn the tide on these interconnected health challenges and move closer to making "Sexual Health for All" a reality rather than just an aspiration.