Welcome to the September 2017 Sexual Health & HIV Policy EUROBulletin.
In this issue, our eFeature interview highlights a project looking at the legal and regulatory barriers to HIV testing and access to care in Europe. We spoke to Lisa Power, who worked with OptTEST on a project to identify these barriers and to explore how they are being overcome in different parts of Europe. Lisa has produced an advocacy toolkit giving examples of good practice and tips for how to make change happen.
Testing for HIV is once again centre-stage this autumn as we approach European HIV-hepatitis testing week in November. In addition to official testing week resources and the advocacy toolkit produced by OptTEST, the Early HIV Diagnosis And Testing in Europe (Euro HIV EDAT) project has produced a toolkit to support people who want to provide testing services for men who have sex with men (MSM checkpoints).
A great deal of interesting research was presented to the IAS Conference on HIV Science (IAS 2017) in Paris in July, notably an update from the Opposites Attract study which has not found a single case of HIV transmission in 16,889 acts of condomless anal sex between gay male couples of different HIV status, when the partner living with HIV is taking HIV treatment.
Other items to look out for in this edition include: more progress on access to PrEP (HIV pre-exposure prophylaxis), now available in Scotland and Wales, with a large trial due to begin in England, a new trial starting in France and access for a small number of people via an organisation in Ukraine; recommendations published this month which say women living with HIV should be offered the choice to avoid treatment with tenofovir and emtricitabine during pregnancy; a resolution from the European Parliament calling on the European Commission to step up its response to HIV, tuberculosis and hepatitis; an online database of laws and policies and a call for mobilisation around abortion rights; and a new contraception teaching and training tool.
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OptTEST is a three-year EU-funded programme, with the aim of reducing late HIV diagnosis and increasing access to treatment and care once people are diagnosed. OptTEST recently launched an advocacy toolkit, focused on addressing and overcoming legal and regulatory barriers to HIV testing and access to HIV care.
Lisa Power worked as an independent consultant on the project, researching legal and regulatory barriers and writing the resulting advocacy tools. Lisa has worked extensively in HIV and LGBT rights throughout her career.
In this eFeature interview, we spoke to Lisa about the advocacy toolkit and the research that underpins it.
Evidence, data & research
IAS Conference on HIV Science
The 9th International AIDS Society Conference on HIV Science (IAS 2017) was held in Paris in late July. As the official online scientific news reporter for the conference, we published news reports on research presented at the conference and daily summary bulletins, which are available in English, French, Italian, Portuguese, Russian and Spanish. We also held a community forum in London to share information from the conference and you can watch some of the presentations from the forum on YouTube.
International study of gay couples reports no transmissions from an HIV-positive partner on treatment
A study of 343 gay couples, where one partner had HIV and the other did not, has not found a single case of HIV transmission in 16,889 acts of condomless anal sex, delegates at IAS 2017 heard. The Opposites Attract study looked at whether HIV is transmitted between gay male couples of different HIV status when the HIV-positive partner is on treatment that fully suppresses HIV.
Western European countries making good progress on UNAIDS 90-90-90 targets – but Eastern Europe lags behind
Many countries in Western and Southern Europe are well on their way to meeting the UNAIDS 90-90-90 targets, according to a study published in Clinical Infectious Diseases. In 2014, UNAIDS called for countries to reach the following goals by 2020: 90% of people living with HIV diagnosed, 90% of people with diagnosed HIV on treatment, and 90% of people on treatment to have fully suppressed viral load. Using data collected to the end of 2013, a survey of eleven countries showed that an estimated 84% of people with HIV were diagnosed, with 84% of diagnosed people on antiretroviral therapy and 85% of people on treatment having an undetectable viral load. The latest data published by UNAIDS underlines this progress, suggesting that several Western European countries and fast-track cities have reached or are close to the goal. However, globally, the least progress towards the targets has been made in Eastern Europe and Central Asia where 63% of people living with HIV know their HIV status but only 43% of those diagnosed are on treatment.
> Visit the aidsmap.com 90-90-90 pages
Call for action as global data show drug-resistant gonorrhoea is widespread
The World Health Organization (WHO) had announced new data on antibiotic-resistant gonorrhoea. WHO reports widespread resistance to older and cheaper antibiotics and a small number of cases of the infection that are untreatable by all antibiotics. Detailed information based on data from 77 countries was published in the open-access journal PLOS Medicine, alongside a call for international collaboration to take action to improve prevention, diagnosis, partner notification and better monitoring and reporting of treatment failure. In the European region, there was encouraging news from the annual European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), which found a decrease in resistance levels to the main antimicrobials used in treating gonorrhoea. However, resistance to azithromycin remains high and threatens the effectiveness of the recommended first-line dual therapy.
Epidemiological update on hepatitis A in Europe
The European Centre for Disease Prevention and Control (ECDC) continues to monitor the ongoing outbreak of hepatitis A, which is particularly affecting men who have sex with men. A recent epidemiological report provides an overview of the current situation. Sixteen European countries have reported hepatitis A cases which belong to three clusters of virus. Hepatitis A vaccination is recommended for men who have sex with men. A shortage of vaccine has been reported in some countries and ECDC has made recommendations for prioritising certain groups based on risk, where necessary.
Treatment & service guidelines
Toolkit for community HIV testing services
The Euro HIV EDAT (Early HIV Diagnosis And Testing in Europe) project has produced an interactive toolkit for people who want to provide community-based, voluntary counselling and testing services for men who have sex with men (‘MSM checkpoints’). It covers developing, providing and evaluating testing services. The toolkit is available in English, French, Spanish, Catalan, Slovenian, German, Portuguese, Romanian and Russian.
New guidelines recommend that women avoid tenofovir & emtricitabine during pregnancy
Women should be offered the choice to avoid treatment with tenofovir and emtricitabine during pregnancy owing to a higher risk of stillbirth and early infant death associated with these drugs, according to new recommendations published this month in the British Medical Journal (BMJ). The authors – a panel of experts in maternal and child health, and of women living with HIV – say that women's strong preferences to avoid early infant death and have a healthy infant are not given sufficient weight in other recommendations, and that in order to reduce this risk, antiretroviral treatment during pregnancy should be based on zidovudine and lamivudine, not tenofovir and emtricitabine, especially when combined with lopinavir/ritonavir.
Policy development & guidance
Access to PrEP
France, which was the first European country to approve HIV pre-exposure prophylaxis (PrEP), back in 2016, plans to begin a new trial to examine the public health benefit of PrEP. The trial will include 3000 people in the Paris region. France was also the home of the Ipergay trial, which examined the effectiveness of intermittent or ‘on-demand’ PrEP use. However, many of the participants in the Ipergay study were taking PrEP so frequently that they were effectively taking it almost daily. A new substudy looking at the participants who took PrEP less often has found that it did protect people who took PrEP less often.
Elsewhere, advocacy for PrEP access continues, with some success. PrEP is now available in Scotland, and Wales has made access available through a three-year trial. Both countries have launched dedicated websites to provide information about PrEP access. In England, a large implementation trial called ‘PrEP Impact’ is due to begin this month, with the aim of including 10,000 participants. The organisations representing HIV and sexual health professionals in the UK have drafted guidelines on the use of PrEP, which are currently open for consultation.
In Ukraine, NGO Alliance Global plans to make PrEP available to its service users before the end of the year.
New online database of laws and policies relating to abortion
The World Health Organization (WHO) and the United Nations Department of Economic and Social Affairs (UNDESA) have launched a web-based global database of laws, policies and health standards on abortion. Restrictive laws are one of the barriers to women accessing safe abortion. The new database enables comparison between countries and aims to improve accountability for the protection of the health and human rights of women and girls. People using the database "are encouraged to use the information to generate evidence on how laws and policies are implemented" and feedback on the database is welcomed.
Using social media in HIV and STI prevention programmes
The European Centre for Disease Prevention and Control (ECDC) has published a technical report for public health programme managers, which describes and analyses social media and its potential use in HIV and STI (sexually transmitted infection) prevention programmes aimed at young people in Europe. It includes an analysis of sexual health content on social media, the findings of interviews with young people and identifies some potential approaches for health programmes.
Reports & resources
New contraception teaching and training tool for health care professionals
The European Society of Contraception and Reproductive Health (ESC) has published a training tool, consisting of presentation slides and notes, to facilitate and improve decision making in routine and complex contraceptive consultations. The tool is designed to be used for teaching or for self-guided study. Key aims are to enable understanding of the importance and application of the World Health Organization Medical Eligibility Criteria and the importance of taking a complete patient history. The tool covers contraception for women with medical conditions, including HIV.
The Pipeline Report
Treatment Action Group (TAG) has launched its annual research and development analysis of drugs and other breakthrough technologies that aim to diagnose, prevent, treat or cure HIV, tuberculosis and hepatitis C virus: The Pipeline Report: Drugs, Diagnostics, Vaccines, Preventive Technologies, Research Toward a Cure, and Immune-Based and Gene Therapies in Development.
Harm reduction workshops
The HA-REACT project (Joint Action on HIV and Co-infection Prevention and Harm Reduction) aims to address gaps in the prevention of HIV and other co-infections among people who inject drugs. Over the next few months, HA-REACT is holding several training workshops in Hungary, Latvia, Lithuania and Poland, as well as a partnership forum at the Addictions 2017 conference in Portugal.
Expert statement on progestin-only contraceptives and mood
The ESC has published an "expert statement on the effects on mood of the natural cycle and progestin-only contraceptives". The statement is in part a response to extensive media coverage across Europe of a study which found an association between hormonal contraception and depression. In media reporting, this was widely presented as proof that contraception causes depression, when there are many other factors involved. The statement considers what is known about mood effects of progestin-only contraceptives and the conclusions that can be drawn from the study.
Parliament & other European institutions
European Parliament resolution urges more action on HIV, TB and hepatitis
The European Parliament has called on the European Commission to step up its response to HIV, tuberculosis (TB) and hepatitis, with an approach which includes neighbouring countries in Eastern Europe and Central Asia. A large majority supported the adoption of a resolution.
Committee for Medicinal Products for Human Use (CHMP)
The European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) met in July and made a recommendation for approval of Symtuza (darunavir / cobicistat / emtricitabine / tenofovir alafenamide) for the treatment of HIV. If approved, it will be the first once-daily single-tablet regimen containing a protease inhibitor. Results from the EMERALD study, a phase 3 clinical trial evaluating the single-tablet regimen, were presented at the recent IAS 2017 conference.
Sexual health rights & advocacy
Launch of OptTEST tools and INTEGRATE
OptTEST is an EU-funded programme that set out to reduce late HIV diagnosis and increase access to treatment and care once people are diagnosed. OptTEST recently launched an advocacy toolkit, focused on addressing and overcoming legal and regulatory barriers to HIV testing and access to HIV care. A new three-year programme, INTEGRATE, will build on this work and aims to integrate early diagnosis and linkage to prevention and care of HIV, viral hepatitis, tuberculosis and sexually transmitted infections in EU member states.
Managing, evaluating and monitoring advocacy projects
The European AIDS Treatment Group (EATG) has published a series of webinars by social science researcher Ian Hodgson on key terms and concepts in project management, change management, monitoring and evaluation in advocacy.
Campaigns & other news
European HIV-Hepatitis Testing Week
European HIV-Hepatitis Testing Week will take place from 17-24 November 2017. The aim is to encourage people who might be at risk of HIV or hepatitis to take a test, and to encourage healthcare professionals to offer testing as part of routine care.
Abortion rights in Europe
In recognition of the continuing, and in some cases worsening, restrictions on access to abortion care in parts of Europe, a cross-Europe day of mobilisation is being planned for 28 September. On that date, a petition will also be presented to the European Parliament, calling for guaranteed abortion rights. Many parts of the world are seeing gains in gender equality being lost or threatened and the United Nations working group on discrimination against women in law and practice has called for resistance, stressing women’s rights to make decisions about their own bodies.
Sudden change of leadership at the Eurasian Harm Reduction Network
The steering committee and staff at the Eurasian Harm Reduction Network have resigned, following a change of co-ownership and the dismissal of the acting executive director. The Eurasian Harm Reduction Network, based in Lithuania, has been an important part of the harm reduction sector internationally.
Community meeting on the path to HIV cure research
The European AIDS Treatment Group (EATG) will host a community meeting immediately prior to the European AIDS Conference in Milan in October. The meeting is focused on research into HIV cure, therapeutic vaccines and innovative approaches for long-term remission of HIV. It is open to people living with HIV, peer educators, community journalists, advocates, researchers and healthcare professionals with an interest in this topic.
From January 2018, Belarus intends to move to a ‘treat all’ policy for HIV treatment. This will bring it in line with the World Health Organization guidelines, by ensuring access to HIV treatment for everyone who is diagnosed with HIV.
The United Nations Committee Against Torture has questioned Ireland about the lack of progress in reforming its abortion laws, which are said to be incompatible with Ireland’s human rights obligations.
An analysis of 440 people switched to generic antiretroviral drugs at an Italian clinic and a matched cohort of patients who remained on their branded medication has found no evidence of generic drugs being less effective or causing more side-effects, researchers report in PLOS ONE.
Sixty delegates from 14 countries gathered in Luxembourg earlier in the summer to participate in a conference on needle exchange and other harm reduction measures in prison settings, which included a study visit to the main prison in Luxembourg.
Sexual health clinics in the Netherlands are seeing increasing numbers of people diagnosed with gonorrhoea, syphilis and chlamydia, but declining numbers of people diagnosed with HIV.
Following the Polish government’s decision to limit access to emergency contraception, through requiring women to have a prescription for the morning-after pill, Dutch MEP Sophie in ’t Veld has written to the European Commission urging it to secure the rights of women and girls in Poland. The European Medicines Agency recommends non-prescription access to the morning-after pill, as it is more effective the sooner it is taken. The right-wing government in Poland is now pushing ahead with plans to further restrict already restrictive access to abortion.
The incidence of anal cancer among HIV-positive gay men peaked in 2009 and will decline substantially by 2030, even with current levels of antiretroviral therapy coverage and no cancer-screening programme, Swiss investigators report in AIDS. Further significant reductions would be achieved with 100% treatment coverage and various screening strategies.
A partnership between the Elena Pinchuk ANTIAIDS Foundation and the city of Kyiv is enabling more people living with HIV to access antiretroviral therapy.
The World Health Organization used World Humanitarian Day in August to highlight the need for more health aid to address the humanitarian crisis in Eastern Ukraine.
English councils have warned that sexual health services are ‘at tipping point’, with more funding needed to cope with rising numbers of visits.
Europe’s largest HIV clinic, 56 Dean Street in London, is on track to report a second large drop in annual HIV diagnoses. Figures for the first half of 2017 show a 40% decrease.