Sexual Health & HIV Policy EUROBulletin, May 2023

Welcome to the May 2023 Sexual Health & HIV Policy EUROBulletin.

In the feature in this edition, we hear from Dr Silvia de Zordo, principal investigator of the Europe Abortion Access Project, about the women in Europe crossing borders to access abortion care and the barriers they face in accessing care at home.  

Reproductive rights are a theme throughout this edition, with the recent UNFPA State of World Population report making the case for rights and choices in the face of national anxieties about population issues; the conviction of Polish abortion rights campaigner Justyna Wydrzyńska; and a public hearing in the European Parliament on the backlash against women’s rights.

Other items to look out for include: a new edition of the European Contraception Atlas; new guidance on management of recurrent pregnancy loss; public health guidance on mpox; new data on hepatitis, gonorrhoea and shigellosis; and an opportunity to apply for the European Hector Research Award in HIV.

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Silvia de Zordo and a map of Europe showing the routes women take to access care.

Many women travel across borders in Europe to access abortion care, even when they live in countries with apparently liberal abortion laws. The Europe Abortion Access Project was a six-year research project which set out to understand the experiences of these women.

We spoke to principal investigator, Dr Silvia de Zordo from the University of Barcelona, about the key findings of the research and what needs to change to overcome barriers to care.

Policy development & guidance

Priorities for action on PrEP

The European Centre for Disease Prevention and Control (ECDC) has published an evidence brief summarising the key issues and priorities for action on HIV PrEP (regular medication to prevent HIV) in the European region.

PrEP is reimbursed by health systems in 23 of the 55 countries covered by the report, but availability and eligibility is limited. Seventeen countries report no formal PrEP implementation.

Actions identified by the report include: developing and implementing national PrEP guidelines; making PrEP more accessible to more people in more settings; and strengthening PrEP monitoring systems.

Prevention measures for mpox

ECDC has published a report highlighting measures for public health authorities to consider during the spring and summer months, to avoid increases in mpox (monkeypox) cases.

The serious outbreak of mpox in Europe in 2022 has been brought under control, with only very low numbers of cases in 2023 to date. In the four weeks to 3 May, 17 cases of mpox were reported in the European region.

Andrea Ammon, ECDC Director said, “... there is risk of an increase [in mpox cases] in the coming spring and summer season due to festivities and increased holiday travel. Early diagnosis, isolation, partner notification and contact tracing remain key for the effective control of this outbreak and should be supported by appropriate vaccination- and behaviour change strategies.”

Sexual health rights & advocacy

Population anxiety and women’s rights

The UN's sexual and reproductive health agency, UNFPA, has published its annual State of World Population report. This year, it shows that anxiety around population is widespread, and governments are increasingly introducing policies which aim to influence fertility rates.

UNFPA highlights that attempts to raise or lower birth rates are often ineffective and can also negatively impact women's rights.

UNFPA executive director, Dr Natalia Kanem, says, "Women’s bodies should not be held captive to population targets. To build thriving and inclusive societies, regardless of population size, we must radically rethink how we talk about and plan for population change."

In eastern Europe, low birth rates and high emigration rates have fuelled anxieties about population decline. In an opinion piece responding to the report, Florence Bauer, director of UNFPA’s regional office for eastern Europe and central Asia, says that policies should shift from a focus on ‘fertility’ to ‘desired fertility’ – expanding policies that support people to have the children they want to have, and which put women’s rights at their heart, such as universal access to sexual and reproductive health and rights, and parental leave.

Recommendations for the EU election campaign

The International Planned Parenthood Federation European Network (IPPF-EN) has published its recommendations for the EU election campaign.

It calls on political parties to "put inclusive feminism at the heart of their electoral programmes, and to commit to further advancing gender equality and women’s rights, including sexual and reproductive health and rights".

HIV criminalisation in EECA

The Eurasian Women’s Network on AIDS (EWNA) has published a new report on HIV criminalisation in the eastern Europe and central Asia (EECA) region.

The research was led by women living with HIV and covers 11 EECA countries.  In the region, criminal cases are sometimes initiated by health authorities and courts often ignore the science on HIV risk.

The report's authors observe that the majority of EECA countries are "legalising stigma" against people living with HIV in their application of HIV-specific criminal laws, and that women living with HIV are bearing the brunt of this criminalisation.

Reports & resources

Map of Europe showing the contraception policy scores

New edition of European Contraception Atlas

The European Parliamentary Forum for Sexual and Reproductive Rights (EPF) has published the sixth edition of the European Contraception Policy Atlas.

The atlas scores 46 countries in geographical Europe on access to modern contraception. In 2023, the best-performing countries are the UK, France, and Belgium, followed by Luxembourg, Sweden, and Ireland. At the bottom of the list are Poland, Bosnia-Herzegovina, and Hungary.

New edition of the Rainbow Europe map

The European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA-Europe) has released its annual Rainbow Europe map. Rainbow Europe ranks countries according to LGBTI rights, assessing the legal and political landscape in each country and making recommendations for continued progress.

This year, ILGA-Europe finds that, “while public discourse is becoming more polarised and violent, particularly against trans people, political determination to advance LGBTI rights is paying off. The largest gains on the map are for countries that introduced legal gender recognition using a self-determination model.”

How to talk about abortion: stigma-free messaging

The International Planned Parenthood Federation (IPPF) has updated its guide on how to talk about abortion. It gives advice on developing stigma-free messaging when creating materials related to abortion. The guide is designed to be used by advocates, policy makers and health professionals and is available in English, French and Spanish.

Infertility affects millions in Europe

A new report from the World Health Organization (WHO) highlights the burden of infertility around the world, with 1 in 6 people affected globally. It estimates lifetime infertility prevalence in the European region at 16.5%.

Fertility care varies a great deal and is often privately funded, meaning there is significant inequality of access. The report highlights fertility care as an important part of sexual and reproductive health care.

Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO, said, "Millions of people face catastrophic healthcare costs after seeking treatment for infertility, making this a major equity issue and all too often, a medical poverty trap for those affected".

Parliament & other European institutions

Justyna Wydrzyńska at the FEMM hearing
Justyna Wydrzyńska at the FEMM hearing © European Union 2023 – Source: EP/ Philippe Buissin

Public hearing on the backlash against women’s rights

The European Parliament hosted a public hearing on 25 April on ‘The backlash against women’s rights’.

It was hosted by the Committee on Women’s Rights and Gender Equality (FEMM) and featured experts and civil society activists considering causes and possible solutions.

Members of the European Parliament (MEPs) heard from Justyna Wydrzyńska, abortion activist (see below); Dr Elżbieta Korolczuk, Associate Professor at the University of Warsaw and Södertörn University; Regina Marques, MDM - Women's Democratic Movement; and Francesca Sanders, Senior Policy Officer at Transgender Europe.

MEPs condemn conviction of Polish abortion rights activist

In March, Polish activist Justyna Wydrzyńska was sentenced to eight months community service for providing abortion medication to another woman, in breach of Poland's abortion ban. The high-profile case has drawn international criticism.

MEPs condemned the sentencing. Robert Biedroń, Chair of the Women’s Rights Committee commented, "The show trial of Justyna Wydrzyńska is yet another shameful example of the backlash against women’s rights in Poland. […] We call, again, on the EU institutions to show solidarity with women in Poland. They are European citizens and deserve the same rights as women in Finland, Spain or France."

Evidence, data & research

PrEP for women in Europe

Women Against Viruses in Europe (WAVE) has completed a systematic literature review on PrEP provision and barriers to uptake for women in Europe, published in the HIV Medicine journal.

The review found there were few published studies on PrEP for women in Europe. Within the studies it reviewed, it found that barriers to PrEP use included: lack of awareness of PrEP; low self-estimation of HIV risk; concerns about stigma; lack of protection against other sexually transmitted infections; and interaction with hormones (for trans women).

The authors highlight the need for more research into the use of PrEP by women.

Last month, NAM aidsmap published a research briefing on PrEP and women. It covers the history of PrEP research and provision for cisgender women.

New data on hepatitis, gonorrhoea and shigellosis

ECDC has published new annual reports on hepatitis B and hepatitis C (2021 data) and on gonorrhoea and shigellosis (2019 data).

For hepatitis C, 14,560 cases were reported in 29 EU/EEA member states in 2021. ECDC highlights that there is no clear long-term trend, with case numbers fluctuating from year to year. Data on the most likely route of transmission were incomplete. In acute cases with information on transmission route, the second most common route of transmission was sex between men (13%).

For hepatitis B, 30 EU/EEA member states reported 16,187 cases in 2021. The rate of acute cases has declined in recent years, which ECDC attributes to the likely impact of vaccination programmes. Among acute cases with information on transmission route, heterosexual transmission was most common (30%), followed by transmission among men who have sex with men (16%)

The report on gonorrhoea cases refers to data from 2019. In total, 117,881 confirmed cases of gonorrhoea were reported by 28 EU/EEA member states. The overall rate increased by 19.2% on the previous year. ECDC reports that rates vary considerably across the region, with higher rates reported in northern Europe. Men who have sex with men accounted for more than half of reported cases (54%) in 2019.

Shigellosis is a gastrointestinal infection and is relatively uncommon in Europe. In 2019, 30 EU/EEA countries reported 8,448 confirmed shigellosis cases. The second highest notification rate was in male adults aged 25-44. Sexual transmission of shigellosis among men who have sex with men is thought to contribute to this.

Sexual health needs of trans men

HIV research and monitoring has historically excluded transgender men, creating blind spots in understanding this group’s sexual wellbeing and happiness.

Two recent studies – one from New York and the other from Germany – suggest that transgender men who have sex with other men have a higher prevalence of HIV than the general population.

The German analysis further finds that transgender men who have sex with other men face a host of inequities compared to cisgender gay and bisexual men, including reduced access to sexual healthcare and less satisfying sex lives.

Professor Annie Luetkemeyer presenting at CROI 2023
Professor Annie Luetkemeyer presenting at CROI 2023. Photo by Liz Highleyman.

News from CROI 2023

The Conference on Retroviruses and Opportunistic Infections (CROI) took place in Seattle, US, from 19 to 22 February.

This year, new research presented included several studies looking at doxyPEP – taking the antibiotic doxycycline as post-exposure prophylaxis against bacterial infections ­– and a vaccine against gonorrhoea, which halved the rate of repeat infections in gay and bisexual men.

NAM aidsmap published news reports on research presented to the conference and four summary bulletins, which are available in English, French, Italian, Portuguese, Russian and Spanish. You can find all our conference coverage on our website.

Treatment & service guidelines

Guideline on management of recurrent pregnancy loss

The European Society of Human Reproduction and Embryology (ESHRE) has published an updated guideline on the management of recurrent pregnancy loss. It includes recommendations for investigation and treatment.

In addition to the full guideline and a summary version, there is also an updated patient leaflet based on the guideline.

Patient-reported outcome measures (PROMs) toolbox

The European AIDS Treatment Group (EATG) has produced a series of resources on patient-reported outcome measures (PROMs) in HIV-related research.

The resulting 'toolbox' is designed for community advocacy around the importance of quality of life issues in HIV research, treatment and care. However, EATG intend that it can also be a useful resource for anyone working in HIV research, or interested in using or developing PROMs.

Campaigns & other news

European Testing Week logo

Spring European Testing Week

Spring European Testing Week is being held from 15-22 May this year.

European Testing Week is a campaign that encourages partner organisations – in community, health care and policy institutions – to unite twice a year to increase testing efforts and promote awareness on the benefits of earlier hepatitis and HIV testing.

As part of activities to mark the week, you can join a free webinar on 17 May on the theme of, ‘HIV, hepatitis B and C and sexually transmitted infections: why is testing important and what can be done to increase testing access and uptake?’.  

Adapting harm reduction services for chemsex users

AIDS Action Europe has announced it will run a three-day train the trainer event on offering and adapting harm reduction services for chemsex users.

The training will take place in Berlin in September, and travel and accommodation expenses are covered for participants.

Applications should be sent by 31 May.

European Hector Research Award in HIV

Any paper on an HIV-related topic that has been accepted or published in a peer-reviewed journal within the last two years (from 18 October 2021 to the start of the 19th European AIDS Conference in October 2023) can be submitted to be considered for the European Hector Research Award in HIV.

There is an award of 20,000 euros for the best clinical and/or epidemiological paper and a second award of 20,000 euros for the best basic science, translational paper. Applications should be made by 15 August.

Country-specific news

Andorra Women's rights defender, Vanessa Mendoza Cortés, could face trial for speaking out on women’s rights and the right to abortion at the United Nations. She has been targeted by her government for criticising the ban on abortion care in Andorra.

Belgium A study has revealed gatekeeping and stigmatising attitudes towards migrant women among HIV prevention professionals in Belgium. Very few migrant women of African origin in Belgium use PrEP. According to the study, low awareness is partly explained by gatekeeping by professionals, who withhold information about PrEP because of beliefs about migrant women’s ability to access and use PrEP.

England Opt-out testing in emergency departments is 'revolutionising' HIV and hepatitis diagnosis, identifying hundreds of people who were previously undiagnosed or out of care.

France A study has revealed large differences in antiretroviral therapy prescriptions between people with HIV living in France who were born in sub-Saharan Africa and those born in France. African migrants living in France were less likely to benefit from antiretroviral innovations than people born in France.

Germany ’The best from Germany’ webinar from the International Union Against Sexually Transmitted Infections (IUSTI) included presentations on interdisciplinary teamwork for sexual health; HIV, STI and hepatitis and integrated molecular surveillance; syphilis maligna in HIV primary infection; and mpox. Recordings of the presentations are available online.

Italy | HIV PrEP will be available free of charge, via the national health service in Italy. The decision was made in April by the Price and Reimbursement Committee of the Italian Medicines Agency.

Luxembourg Contraception is now available free for women of any age, including emergency contraception, under a new policy which came into effect in April.

Romania The emergency contraceptive wheel – a tool for healthcare providers to use in making recommendations to people in their care – has now been translated and adapted for use in Romania.

Russia Analysis has found huge differences in HIV deaths and HIV prevalence between different provinces in Russia, with areas with the highest HIV prevalence in the whole continent next door to areas with some of the lowest prevalence.

Spain New legislation on sexual and reproductive health includes: free hormonal and emergency contraception in public health care; easier access to abortion care; compulsory comprehensive sexual education; a ban on conversion therapy; and menstrual leave for people with painful periods.

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