One of the objectives of EMIS was to generate comparable population level data needed for MSM HIV prevention planning across countries. Given that EMIS ultimately covered 38 countries, geographical patterns are difficult to see when looking at tables with 38 rows, or when looking at diagrams with 38 bars. To increase the utility of our graphic presentations, countries are grouped into European sub-regions.
The United Nations provide several different approaches to grouping European sub-regions.
- WHO for example distinguishes three sub-regions within Europe – broadly based on the political history of the second half of the 19th century. Because political structures of countries have an impact on the geographical formation of epidemics, such as the HIV epidemic, this grouping is highly relevant for the analysis of EMIS data. However, the WHO grouping leaves us with only three geographical entities:
- The WHO sub-region of Eastern Europe includes all succession states of the Soviet Union. This means that some countries in that sub-region today are part of the European Union (such as the three Baltic states), or they are located outside Europe. However EMIS-2010 was not funded to include residents of countries in central Asia or in the Caucasus.
- The WHO sub-region of Central Europe too encompasses a wide range of countries, such as all other (non-Soviet Union) European former Comecon members (or their succession states), as well the succession states of Yugoslavia; Turkey and Cyprus.
The WHO sub-region of Western Europe is broadly identical (except for Malta) to the 15 European Union member states as of 1995, plus EEA / EFTA countries such as Norway and Switzerland.
A typical grouping for EU-funded analyses is the distinction between old (as of 1995) and new (as of 2004 / 2007) EU member states, and non-EU / EFTA countries. A problem with this grouping, as with the WHO sub-regions, is the large variance in political histories of the countries within each sub-region. Political and societal systems have a substantial influence on how health care is organised, on the social acceptance of sexual behaviours and identities outside the heterosexual norm, or on the permeability of borders, and hence mobility. All these factors can broadly influence the onset and course of infectious disease epidemics, such as infections with HIV or other sexually transmissible pathogens.
EMIS data covers 18 countries within the WHO sub-region of Western Europe (at, be, ch, de, dk, es, fi, fr, gr, ie, it, lu, mt, nl, no, pt, se, uk); 13 countries within the WHO sub-region of Central Europe (ba, bg, cy, cz, hr, hu, mk, pl, ro, rs, si, sk, tr); and 7 countries within the WHO sub-region of Eastern Europe (by, ee, lt, lv, md, ru, ua).
As for the grouping typical for EU-funded analyses, EMIS data covers the 17 old EU / EFTA countries (as Western Europe above, without Malta); 12 new EU member states (bg, cy, cz, ee, hu, mt, lt, lv, pl, ro, si, sk); and 9 non-EU / EFTA member states (ba, by, hr, md, mk, rs, ru, tr, ua).
Because these two groupings do not match, and because in many analyses of EMIS data they would mask important differences, in this report we use a third classification with nine sub-regions, each consisting of fewer and more comparable countries. Depending on how these nine sub-regions are combined, both the WHO and the EU groupings described above can be re-constructed. The placement of Greece and Malta in our grouping seems geographically counter-intuitive, but is needed to match the WHO and the EU groupings.
The nine sub-regions of Europe used in EMIS publications are:
- West – Belgium (be), France (fr), Republic of Ireland (ie), the Netherlands (nl), and the United Kingdom (uk).
- North West – Denmark (dk), Finland (fi), Norway (no), and Sweden (se).
- Central-West – Austria (at), Switzerland (ch), Germany (de), and Luxembourg (lu).
- South West – Greece (gr), Spain (es), Italy (it), and Portugal (pt).
- North East – Estonia (ee), Lithuania (lt), Latvia (lv).
- Central-East – The Czech Republic (cz), Hungary (hu), Poland (pl), Slovenia (si), and Slovakia (sk).
- South East (EU, as of 2010) – Bulgaria (bg), Cyprus (cy), Malta (mt), and Romania (ro)
- South East (non-EU, as of 2010) – Bosnia and Herzegovina (ba), Croatia (hr), Macedonia (mk), Serbia (rs), and Turkey (tr).
- East – Belarus (by), Moldova (md), Russia (ru), and Ukraine (ua).
The rationale for grouping EMIS countries the way we did is two-fold. First, we wanted to use names that are intuitive to the reader, and used or suggested by international organisations. Second, we thought it useful to base the grouping of sub-regions on data that is crucial for the purpose of our research.
The United Nations Group of Experts on Geographical Names* suggested 6 European sub-regions: North Europe, West Europe, Central Europe, East Europe, South Europe, and South East Europe. Most ambiguity exists with the definition of Central Europe. Out of a plethora of different definitions, WHO is the only organisation that groups Balkan countries, Southeastern European countries such as Bulgaria or Romania, or Turkey or Cyprus as Central Europe. Therefore, in this report, when using WHO regions, we highlight this by referring to “the WHO sub-region of Central Europe”. The EMIS definition of Central Europe is much narrower, and it includes both countries of the WHO sub-region of Western Europe (Austria, Germany, Luxembourg, Switzerland =Central-West) as well as countries of the WHO sub-region of Central Europe (Poland, the Czech Republic, Slovakia, Hungary, and Slovenia =Central-East).
Greece was grouped with South West Europe, while Malta was grouped with South East Europe. The only reason for this geographically counter-intuitive grouping was that by doing so both the WHO regions and the EU-typical grouping can be reconstructed. For the same reason, we further divided South East Europe into EU and non-EU countries. The Baltic countries were labelled North East, whereas the Scandinavian countries and Finland were labelled North West.
*United Nations Group of Experts on Geographical Names (UNGEGN, 2006) Working Paper Number 48: A Subdivision of Europe into Larger Regions by Cultural Criteria. Twenty-third Session Vienna, 28 March - 4 April 2006