Welcome to the May 2021 Sexual Health & HIV Policy EUROBulletin.
Our Feature in this edition focuses on a recent hearing in the European Parliament on the financing of the anti-gender movement in Europe.
For some years now, there have been reports of an increasingly organised movement in Europe against access to safe abortion and contraception, LGBTI rights, and sex education. This is visible in different forms, from increased violence and hate speech, to regressive law-making.
New investigations into the organisations involved in this movement were presented at the hearing. They found that over half of funding for anti-gender actors in Europe appears to come from within Europe itself, with significant amounts of money also flowing from the US and the Russian Federation.
This edition also provides a round-up of recent work in HIV, sexual and reproductive health. We share the updates and guidance on the implementation of PrEP across Europe, a new overview of European abortion laws from the US Center for Reproductive Rights, and the new edition of the Rainbow Europe map, mapping LGBTI rights. We also share a joint statement from UNAIDS and the European Parliament’s Development Committee on their ambitions for the European Union to take a leading role in ending AIDS.
Other items to look out for in this edition include: the news that the EU plans to move forward with Article 7 proceedings against Poland (for the serious breach of EU values), a new research briefing on PrEP for trans and non-binary people, and an opportunity for young LGBTQI people to join an activist academy programme.
Not your copy of the bulletin? Click the link below to subscribe.
In this Feature, we share highlights from a recent hearing in the European Parliament.
For some years now, there have been reports of an increasingly organised movement in Europe against access to safe abortion and contraception, LGBTI rights, and sex education. This is sometimes referred to as the ‘anti-gender’ movement and is visible in different forms, from increased violence and hate speech, to regressive law-making.
Neil Datta, secretary of the European Parliamentary Forum for Sexual and Reproductive Rights (EPF) and Clare Provost, global investigations editor at political news website OpenDemocracy presented findings from their investigations into the financing of the anti-gender movement in Europe.
Sexual health rights & advocacy
EU to move forward with proceedings against Poland
In January, a near-total ban on abortion came into force in Poland, despite the biggest public protests in its history. The ruling means abortion would be illegal even in a case of foetal defect or illness.
The law also means that someone assisting a woman who terminates a pregnancy, including medical professionals, friends or family members, could face a prison sentence. The European Parliamentary Forum for Sexual and Reproductive Rights (EPF) reported on the case of a woman's boyfriend being sentenced to six months in prison for driving his girlfriend to hospital after she began to bleed heavily from taking an abortion pill at home.
Women’s rights organisations have reported bomb threats and death threats in the wake of protests against the law.
The change is in breach of numerous international laws and agreements.
In April, a group of over 200 civil society organisations from 20 European countries wrote to the Portuguese Presidency of the Council of the EU. The letter called on the EU to address the breaches of the rule of law and violations of women's rights in Poland.
This month, the Portuguese Presidency has confirmed that it will move ahead with hearings relating to Poland and Hungary under article 7(1) of the Treaty of the European Union (TEU). Article 7 relates to “a clear risk of a serious breach of the values of the EU”. The hearings are likely to be held in June.
The Hungarian government adopted emergency laws in 2020, which have enabled it to take more control of the media, as well as undermining the rights of women and the LGBT community.
European abortion laws
The US Center for Reproductive Rights has published a comparative overview of European abortion laws. It highlights that almost all European countries allow abortion on request and only a very small minority maintain highly restrictive laws. The overview includes information on the relevant legal and policy barriers to abortion.
Parliament & other European institutions
A vote for universal access to SRHR
In May, the European Parliament Women’s Rights and Gender Equality Committee (FEMM) voted in favour of a report due to be tabled for a plenary vote at the European Parliament in June. The draft report highlights that the right to health, in particular sexual and reproductive health and rights (SRHR), are fundamental women’s rights. It calls on EU countries to ensure access to a full range of high-quality, comprehensive and accessible SRHR.
The report was welcomed by advocacy organisations, including the International Planned Parenthood Federation (IPPF), which remarked that the report "gives a high level of political importance to SRHR at EU level at a crucial time, with challenges in accessing the whole range of SRHR being compounded by COVID-19 measures and some Member States backsliding on women’s rights."
The European Union’s role in ending AIDS
A joint statement by Winnie Byanyima, UNAIDS Executive Director and Tomas Tobé MEP and Chair of the European Parliament’s Development Committee sets out their ambitions for the EU to take a leading role in ending AIDS. The statement coincides with the launch of the UNAIDS Global AIDS Strategy 2021-2026.
They highlight actions the EU can take, including "supporting partner country efforts to build strong and resilient health systems able to deliver HIV-sensitive universal health coverage, to prioritise health as part of EU-Africa relations and to scale-up investments in UNAIDS and the Global Fund to Fight HIV, Tuberculosis and Malaria."
Evidence, data & research
Implementation of PrEP in Europe
There remains a substantial gap throughout Europe between the need and desire for HIV PrEP (regular medication to prevent HIV infection) and the number of people actually using it, an online workshop convened by the European AIDS Clinical Society (EACS) was told. The PrEP workshop was part of the EACS online Standard of Care meeting.
Over 20 countries in the region still have no systematic PrEP provision. However, the European Centre for Disease Control (ECDC) has calculated that the real gap in PrEP provision is not between countries who do or don't provide PrEP. Rather, the gap is between the number of people whose risk factors show they need PrEP, the number who say in surveys that they would definitely use it, and the number who actually do.
The workshop discussed patient pathways to PrEP, through demedicalisation and referral systems based in community organisations, and better assessments of who needs PrEP and how people use it.
Following the meeting, ECDC published an operational guidance document with key recommendations to support PrEP implementation.
HIV and COVID vaccination
Two studies of immune responses to the Oxford/AstraZeneca COVID-19 vaccine show that the vaccine produced similar immune responses in people with or without HIV. People with HIV did not experience more side effects from the vaccine. The findings have been made available as pre-prints, which means that they have not been peer-reviewed yet.
EuroSIDA study of heavily treatment-experienced people with HIV
Data from the large EuroSIDA cohort study of people living with HIV show that the number of heavily treatment-experienced people in the cohort has increased in recent years, especially in western/central Europe, but much less so in eastern Europe. Most heavily treatment-experienced people maintained good virological control, despite lower CD4 counts.
HIV and accelerated ageing
A European clinical trial explored the potential benefit of antiretroviral therapy in relation to epigenetic ageing in people living with HIV. Epigenetics refers to metabolic processes regulating gene functions. It is key to the understanding of biological ageing and epigenetic age acceleration predicts the occurrence of age-related co-morbidities and mortality in the general population.
The study found that untreated HIV is associated with epigenetic age acceleration, which is more pronounced in individuals with severe immunodeficiency. It also suggests that epigenetic ageing can be partly reversed by antiretroviral therapy only two years after starting it. However, no significant difference was found in epigenetic age between the two antiretroviral regimens taken by the study participants.
News from CROI 2021
The Conference on Retroviruses and Opportunistic Infections (CROI) took place from 6-10 March 2021. CROI 2021 was held virtually this year due to coronavirus. NAM aidsmap published news reports on research presented to the conference and five summary bulletins, which are available in English, French, Italian, Portuguese, Russian and Spanish.
Reports & resources
PrEP and trans and non-binary people
NAM aidsmap has published a new research briefing on PrEP and HIV for trans and non-binary people. It provides a summary of key issues and links to more information on key studies. It covers PrEP awareness, PrEP efficacy in trans people, interactions between PrEP and hormone therapy, and trans-friendly PrEP services.
The World Health Organization (WHO) has published a new factsheet on endometriosis. It is a chronic disease in which tissue similar to the lining of the uterus grows outside the uterus, causing pain and infertility. Lack of awareness means that diagnosis is often delayed. The factsheet sets out key facts including diagnosis and treatment options.
Progress in LGBTI rights at a standstill
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 reports "widespread and almost complete stagnation", with almost no positive legislative changes.
Executive Director of ILGA-Europe, Evelyne Paradis said, “At a juncture in history when anti-LGBTI forces are rife, not only in headline-grabbing countries like Poland and Hungary, but across Europe, LGBTI people need all governments to seize this moment and make sure Europe remains a committed and active leader in the arena of human rights for everyone.”
ILGA-Europe has also launched a funding needs survey for LGBTI organisations in Europe and Central Asia.
Antibiotics to prevent STIs – for or against?
There is ongoing scientific debate regarding how best to prevent, manage and reduce rates of sexually transmitted infections (STIs). A possible future option is STI prophylaxis – taking medications either prior to (pre-), or shortly after (post-), exposure to an STI in order to prevent infection. However, this raises concerns regarding the development of antibiotic resistance, which would render medications less effective at treating STIs.
Experts presented their opposing views to the virtual HIV Research for Prevention (HIVR4P) conference, with Professor Jeanne Marrazzo from the University of Alabama at Birmingham presenting arguments against STI prophylaxis, while Professor Jean-Michel Molina from the University of Paris presented data on instances where it may be beneficial.
Treatment & service guidelines
New WHO HIV service guidelines
The World Health Organization (WHO) has published updated recommendations on service delivery for HIV treatment and care. The international guidance includes new recommendations in areas such as supporting HIV treatment initiation in community settings, testing for infants, and viral load monitoring.
Campaigns & other news
LGBTQI Activist Academy
The International Lesbian, Gay, Bisexual, Transgender, Queer & Intersex (LGBTQI) Youth and Student Organisation (IGLYO) has opened applications for its 2021 Activist Academy. Young people (aged 18-30) who are passionate about LGBTQI rights are invited to apply, ideally in teams of 2-3 people, for the skills-based training. It will take place online this year, with expert-led workshops, real-life challenges and a competition. Apply by 6 June.
Bulgaria | The news website Politico published an in-depth case study on Bulgaria's struggle to transition away from Global Fund support to state-funded HIV services.
Denmark | Researchers in Denmark report a 'strong likelihood' that Campylobacter can be transmitted by sexual contact.
England | An innovative peer-centred outreach project, testing homeless and unstably housed people in London during the height of the COVID pandemic for HIV and viral hepatitis, revealed a significant proportion with HIV who were either undiagnosed, or diagnosed but not in care.
France | Epidemiologists report that hepatitis C is becoming more concentrated in gay and bisexual men with HIV in France as direct-acting antiviral treatment cures hepatitis C in other people with HIV, while hepatitis C transmission between gay and bisexual men increases. They say that elimination is feasible if acute infections can be prevented, or treated early.
Germany | Researchers in Germany found that younger age, problems obtaining PrEP and worries about side effects were among the factors associated with discontinuing HIV PrEP.
Ireland | The Irish government has agreed to introduce free contraception to women and girls aged between 17 and 25, ahead of a planned universal contraceptive scheme.
Kyrgyzstan | People living with HIV in Kyrgyzstan have won the right to adopt, as a result of work by advocates and activists in the region.
Lithuania | Lithuania is increasing contraception access for adolescents, with the addition of hormonal intrauterine devices in the list of reimbursable medicines.
North Macedonia | A pilot programme of comprehensive sexuality education (CSE) in North Macedonia, run by the organisation HERA, has come under attack from anti-gender organisations and far-right political parties. Misinformation about the programme has been spread on social media, claiming HERA is sexualising children and profiting from abortion. HERA plans to take legal action.
Ukraine | The European AIDS Clinical Society (EACS) is hosting a two-day workshop in June for Ukrainian clinicians involved in the care of women living with HIV. The online workshop will be broadcast in Ukrainian, English and Russian.