Welcome to the December 2018 Sexual Health & HIV Policy EUROBulletin.
Our eFeature in this edition is an interview with Claire Lightley, Head of Training at UK sexual health charity, FPA. For many years, FPA has worked to support the rights of people with learning disabilities to access information and support around relationships and sexual health. We spoke to Claire about FPA’s programme of work supporting professionals who work with people with learning disabilities.
New figures on the European HIV epidemic were released last month by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe. The headline figures show that although new diagnoses are declining in the European Union (EU)/European Economic Area (EEA), the epidemic continues to grow in the east of the region. Late diagnosis remains a problem throughout the region.
The two sides of the European epidemic are also clearly seen in calculations of Europe's progress towards the 90-90-90 HIV targets. UNAIDS set goals for 2020: for 90% of all people with HIV to be diagnosed, for 90% of those diagnosed to be on antiretroviral therapy, and for 90% of those on treatment to have a suppressed viral load. In 2018, progress in the EU/EEA area stands at 86-91-92, but in the Europe and central Asia region as a whole, this falls to 80-64-86.
Other items to look out for in this edition include: new research presented to the HIV Research for Prevention conference and the HIV Glasgow meeting; the Minsk 2 statement on increasing access to medicines and diagnostic technology; new European HIV treatment guidelines; and The State of World Population report on access to reproductive choices around the world.
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Claire Lightley is Head of Training at sexual health charity, FPA.
In this eFeature interview, we spoke to Claire about FPA’s programme of work supporting professionals who work with people with learning disabilities.
Evidence, data & research
New European HIV figures released
The European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe released the latest data on HIV in Europe, last month. The report, HIV/AIDS surveillance in Europe 2018, presents 2017 data and shows that nearly 160,000 people were newly diagnosed with HIV in the WHO European region, a figure they describe as, "alarmingly high". In the European Union/European Economic Area, diagnoses are declining, but in the east of the region, the highest ever number of diagnoses were reported.
Progress towards the 90-90-90 goals in Europe
ECDC and co-authors from Public Health England and the National AIDS Trust published an article in the Eurosurveillance journal, summarising progress towards HIV elimination in 52 countries in Europe and central Asia. UNAIDS set goals for 2020, often referred to as 90-90-90. In 2018, 52 of 55 countries completed a survey indicating their progress. In the European Union/European Economic Area, progress stands at 86-91-92, but in the Europe and central Asia region as a whole, this falls to 80-64-86.
HIV Research for Prevention conference (HIVR4P 2018)
The HIV Research for Prevention conference was held in Madrid in late October, and 'choice' was the buzzword of the week. Activists took to the stage during both the opening and closing sessions to express their concern about decisions by the US National Institutes of Health to reduce funding for the development of microbicides and other topical products, in favour of systemic and long-acting HIV prevention products, such as injectables, implants and vaccines. There is no single HIV prevention technology which suits everyone and activist Lillian Benjamin Mwakyosi told delegates: “The research agenda is moving away from what people want: choices.”
During a plenary on pre-exposure prophylaxis (PrEP), Craig Hendrix of Johns Hopkins University highlighted that the lesson from contraception was clear – an increased range of contraceptive options is associated with higher levels of usage and better health outcomes.
HIV Glasgow conference
The 2018 International Congress on Drug Therapy in HIV Infection (HIV Glasgow 2018) was also held at the end of October. Research presented included a meta-analysis of PrEP studies which found no increased risk of serious side-effects; the results of a study testing online samples of generic PrEP which found all were genuine; and the results of recent safety reviews which found no further evidence of an increased risk of infant neural tube defects related to the use of dolutegravir or other integrase inhibitors in early pregnancy.
Commission on Migration and Health
University College London (UCL) and The Lancet medical journal have published the results of their two-year Commission on Migration and Health. It found that unfounded stereotypes about migrants as carriers of disease and as a burden on public services are widespread and are being used to justify hostile policies. In high-income countries, the evidence shows that migration has a positive economic effect and that migrants make up a significant proportion of the workforce in health care. Migrants in high-income countries were also found to have lower rates of mortality in most disease categories.
Sexual health rights & advocacy
The United Nations Population Fund (UNFPA) has released its 2018 The State of World Population report, and finds that no country is currently enabling full reproductive rights for all its citizens. Hundreds of millions of women around the world still have unmet needs for contraception. In Europe, challenges to full reproductive choice also include couples being unable to afford to have as many children as they would like, due to the high cost of childcare and housing.
Increase in European contributions to sexual and reproductive health funding
European contributions to sexual and reproductive health funding programmes increased by 10% in 2017, according to Countdown 2030 Europe. In the context of the reinstatement of the US Global Gag Rule and worrying anti-rights trends in parts of Europe, this is a welcome achievement from European governments and advocates.
Affirming disability rights in sexual and reproductive health care
The International Women's Health Coalition uses its platform to highlight that young women with disabilities are consistently left behind in terms of access to sexual and reproductive health and rights.
Policy development & guidance
Access to medicines and diagnostics in eastern Europe
At a meeting in Belarus in November, representatives of countries in eastern Europe and central Asia signed the Minsk 2 statement, on expanding access to medicines and diagnostic technologies for HIV, TB and hepatitis. In the statement, the countries commit to ensuring quality of products and reducing prices through using best practices and revising procurement processes.
Provision and monitoring of PrEP
A recent meeting held in Stockholm brought together representatives from 22 European countries to discuss delivery and monitoring of pre-exposure prophylaxis (PrEP). The meeting called for minimum standards of PrEP provision and monitoring in Europe.
Treatment & service guidelines
New European HIV treatment guidelines published
The European AIDS Clinical Society (EACS) has published its annual update of the European HIV treatment guidelines.
New European public health guidance on HIV and hepatitis testing
Coinciding with European Testing Week, the European Centre for Disease Prevention and Control (ECDC) published new public health guidance on HIV, hepatitis B and C testing last month. The guidance aims to support countries to develop and evaluate their national testing guidelines and programmes.
Screening and vaccination guidance for migrant populations
ECDC has published guidance for EU/EEA member states on effective vaccination and screening for infectious diseases, including HIV, in migrant populations. ECDC points out that migrants do not generally pose a health threat but that some subgroups of migrants are particularly vulnerable to infectious diseases and may have worse health outcomes.
Reports & resources
New WHO app to support recommendations for contraception
The World Health Organization (WHO) has launched an app based on its publication, Medical eligibility criteria for contraceptive use. The app aims to support health professionals in recommending safe and effective contraceptive methods for women with medical conditions.
HIV Outcomes compendium
At an event in the European Parliament, the HIV Outcomes collaboration launched an Online Compendium of Good Practices, including case studies from several European countries, intended to inspire and support people working on the long-term health and wellbeing of people living with HIV.
Campaigns & other news
European Harm Reduction Conference
The 4th European Harm Reduction Conference took place in Bucharest in November. The Drug Reporter website created a short video report which you can watch online, alongside their eight key lessons learned at the conference.
Survey: Emergency contraception wheel
The Emergency Contraception Wheel is a counselling tool, which was created by the European Consortium for Emergency Contraception (ECEC), with the support of the European Society of Contraception. If you have used the wheel, ECEC invite you to take part in a short survey.
ILGA-Europe calls on Armenia’s government to protect LGBTI citizens following concerted attacks by conservative groups.
The first HIV pre-exposure prophylaxis (PrEP) study in Belgium reports no HIV transmissions in the three years it has been running.
Bulgarian harm reduction drowns in bureaucracy: interview with Yuliya Georgieva.
Reproductive rights violations in Croatia spark protests.
CD4 count recovery: French study reaffirms why it is important to test and treat HIV early.
Number of new HIV infections declines in Germany, but many still undiagnosed.
The Irish Family Planning Association says the proposed abortion bill must be amended to remove criminal sanctions, if it is to fulfil the promise of the referendum held earlier this year.
The regional director of IPPF Europe reflects on the planned manslaughter trial of seven doctors in Italy, following the death of a woman denied a termination after having a miscarriage.
The Ombudsman of the Republic of Latvia has issued a historic opinion regarding recognition of same-sex partnership.
Training the next generation of Russian doctors on HIV-related stigma and discrimination.
How has Glasgow responded to an outbreak of HIV among people who inject drugs?
The Swedish government has announced it is to withhold funding for UNAIDS until its executive director, Michel Sidibé, stands down. The move follows the publication of a report alleging harassment, favouritism and a patriarchal culture at the agency.
Historic drop in reported HIV cases in Switzerland in 2017.
HIV diagnoses fell in the UK in 2017 for the first time among all risk groups, all ethnicities and in all regions, annual report reveals.