Welcome to the October 2019 Sexual Health & HIV Policy EUROBulletin.
Our eFeature in this edition is an interview with Alice Lucas, Advocacy and Policy Manager at Refugee Rights Europe. We spoke to Alice about the sexual and reproductive healthcare issues facing displaced people in Europe, in particular in the refugee camps and transit areas in Greece and northern France.
Advocacy activity highlighted in this edition reflects the ongoing concern in civil society over attempts to roll back the rights of women and LGBT communities in Europe. Members of the European Parliament and non-governmental organisations are urging the European Union to stand up for human rights and evidence-based medicine.
Access to PrEP (medication taken to prevent HIV infection) also features this month. Findings from the European MSM Internet Survey (EMIS) 2017 were used to calculate the current ‘PrEP gap’ – the level of unmet need – in Europe. It is estimated that 500,000 men who have sex with men in the European Union currently cannot access PrEP, despite being very likely to use it. Barriers to implementing PrEP were high on the agenda at the recent PrEP in Europe Summit.
Other items to look out for in this edition include: the decriminalisation of abortion in Northern Ireland; materials for the upcoming European HIV-Hepatitis Testing Week; and an update on managing drug-resistant gonorrhoea.
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Alice Lucas is Advocacy and Policy Manager at Refugee Rights Europe, an advocacy organisation defending the human rights of refugees and displaced people in Europe.
In this eFeature interview, we spoke to Alice about the sexual and reproductive healthcare issues facing refugees and displaced people in Europe, particularly in camps in Greece and northern France.
> Alice Lucas – eFeature interview
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Parliament & other European institutions
MEPs urge EU to stand up for the rights of women and girls
Members of the European Parliament (MEPs) and co-chairs of the group MEPs for Sexual and Reproductive Rights have written to the European Commission urging the European Union (EU) to defend the rights of women and girls. The statement follows reports that the US secretary of state has written to governments urging them to join it in opposing the United Nations' policies on sexual and reproductive health.
Over 100 MEPs from 24 countries also signed a letter to the new President of the European Commission on Safe Abortion Day, urging her to support the rights of the millions of women living in the EU who still do not have access to legal and safe abortion.
> Read the statement from MEPs
> Find out more about the letter from the US administration
> Read the letter sent on Safe Abortion Day (PDF)
Acceptance of LGBTI people in the European Union
The 2019 Eurobarometer survey, conducted at the request of the European Commission, asked more than 27,000 people about their perception of discrimination in their country and their attitudes towards different groups at risk of discrimination, including lesbian, gay, bisexual, trans and intersex (LGBTI) people.
Overall, there is positive progress, with 72% of Europeans saying there is nothing wrong in a sexual relationship between two persons of the same sex (up from 67% in 2015). However, there is wide variation between countries, with seven countries polling below 50%.
Responding to the survey, ILGA-Europe drew attention to the backlash against LGBTI rights in some countries and the recorded rise in hate-speech.
> Download the Eurobarometer report
> Read the reaction from ILGA-Europe
Concerns over demography portfolio
Two leading European organisations for sexual and reproductive rights have expressed concerns over the creation of a special portfolio on 'demography' at the European Commission and the nominee portfolio holder. The European Parliamentary Forum for Sexual & Reproductive Rights (EPF) Secretary Neil Datta argues in Open Democracy that while issues of demography, such as fertility, birth rates and the ageing of the population, are important, the term has been appropriated by far-right groups to underpin policies which roll back the rights of women, migrants and LGBT people. Both Datta and International Planned Parenthood Federation (IPPF-Europe) have raised concerns over the nominee, MEP Dubravka Šuica, who has a record of voting against sexual and reproductive health and rights.
> Read the article in Open Democracy
> Read the IPPF Europe blogpost
Sexual health rights & advocacy
Position paper on sexual and reproductive health and rights
The European Society of Contraception and Reproductive Health (ESC) has published a position paper on sexual and reproductive health and rights (the Madrid Declaration). It highlights ESC’s shift from epidemiology and clinical issues to a broader focus on the social and human rights aspects of sexual and reproductive health. ESC acknowledges “ultraconservative forces” working against sexual and reproductive health and rights in Europe and says the paper counters misinformation and stresses the importance of evidence-based medicine and respect for human rights.
> Find out more and download the position paper
> Read an accompanying editorial in the European Journal of Contraception & Reproductive Health Care
PrEP in Europe Summit
The second PrEP in Europe Summit was held in Warsaw, Poland, earlier this month. Attendees discussed the barriers to implementing PrEP in Europe and how key stakeholders can work together to speed up implementation.
> View presentations and recordings on the summit website
> Join the PrEP in Europe Facebook group
Abortion decriminalised in Northern Ireland
Legislation decriminalising abortion and legalising same-sex marriage came into force in Northern Ireland on 22 October. The legislation was passed by parliament in London in July and was set to take effect if the devolved government in Northern Ireland, which collapsed in 2017, did not resume by 22 October. An attempt was made to recall the Northern Ireland Assembly to block the legislation, but it failed when a new speaker could not be elected.
The move removes the threat of prosecution from healthcare workers and from women seeking an abortion. Between now and April, women can legally travel to England for an abortion. From April onwards, services should be available in Northern Ireland.
The first same-sex marriages are due to take place in February.
> Find out more on the BBC website
> Read the reaction from sexual and reproductive health organisation Informing Choices NI
Treatment & service guidelines
Contraception and HIV risk
The World Health Organization (WHO) has updated its recommendations for women at high risk of HIV who want to use contraception. An important change is that Depo-Provera, other progestogen-only injectable forms of contraception, and intrauterine devices (IUDs) are now classed as ‘category 1’ for women at high risk of HIV. Category 1 means there is no restriction for the use of those methods. WHO also launched a related app, which aims to help service providers recommend appropriate contraception for women with medical conditions.
In response to the recommendations, the HIV prevention advocacy organisation AVAC called for WHO to go beyond “incremental adjustments” and work to transform sexual and reproductive health services. They highlight the need for contraception and HIV prevention services to be integrated, stigma free, and designed and delivered with women’s needs in mind.
> Download the updated WHO recommendations
Controlling and managing multidrug-resistant gonorrhoea
The European Centre for Disease Control and Prevention (ECDC) has published an update to its plan to control and manage the threat of multi- and extensively drug-resistant gonorrhoea. The update aims to support EU Member States to develop and implement national strategies and interventions by outlining suggested public health responses.
> Download the plan from the ECDC website
> Download the national STI strategy report from the ECDC website
Evidence, data & research
The 'PrEP gap' in Europe
A survey of close to 128,000 gay and bisexual men living across Europe found that just 3.3% of respondents have ever taken PrEP, although 7% had tried to obtain it and 45% would be likely to use it if it were available and affordable. Findings from the European MSM Internet Survey (EMIS) 2017 were also used to calculate the current ‘PrEP gap’ – the level of unmet need – in Europe, in a paper published in the Eurosurveillance journal this month. The paper estimates that 500,000 men who have sex with men in the European Union currently cannot access PrEP, despite being very likely to use it.
EMIS also found that significant numbers of men do not know that ‘undetectable = untransmittable’; that chemsex is reported by small numbers of men throughout the continent; and that internalised homonegativity and poor mental health are common.
> Read the news report about EMIS on aidsmap.com
> Download the EMIS report from the ECDC website
> Read the ‘PrEP gap’ news report on the ECDC website
> Read the ‘PrEP gap’ paper on the Eurosurveillance website
HIV self-testing vs self-sampling
Given a choice between free online self-testing and online self-sampling for HIV, the majority of people chose self-testing. But self-sampling was chosen by a substantial minority, according to a UK pilot study recently published in the International Journal of STD & AIDS.
Self-testing involves the user collecting their own fingerprick blood sample, performing the test and reading the result themselves. Self-sampling involves the user collecting their own fingerprick blood sample and sending it for analysis by laboratory professionals. Of the 1466 people ordering a test through the pilot scheme, 67% ordered a self-testing kit and 33% a self-sampling kit.
Policy development & guidance
Transparency of drug pricing
AIDS Action Europe has published a statement on the pharmaceutical industry and non-transparency of pricing. It sets out their concerns around trends and developments that influence pricing and affordability of treatment and care, including in relation to the treatment and prevention of HIV. They highlight in particular the case of PrEP pricing in the US and its potential influence on drug pricing in the European region.
Campaigns & other news
European Testing Week
European Testing Week is an initiative that was launched by HIV in Europe in 2013 to increase testing efforts and create awareness of the benefits of early HIV testing. Now in its seventh year, the fifth year hepatitis testing has been included, European Testing Week will take place from 22-29 November 2019.
> Find out more and download materials on the European Testing Week website
Bosnia and Herzegovina
The programme leader of Association XY was interviewed by the International Planned Parenthood Federation about his experiences providing and advocating for relationship and sexuality education in Bosnia and Herzegovina.
Danish research underlines the importance of monitoring kidney function in people doing well on antiretrovirals.
Big falls in new HIV diagnoses in France after achievement of two UNAIDS 90-90-90 targets.
In September, Germany introduced free access to PrEP (covered by statutory health insurance) for people aged 16 and over at risk of acquiring HIV.
PrEP programme to be rolled out in health service from next month.
A bill has been proposed to the Polish parliament which would censor information on sexual and reproductive health.
Swedish sexual health organisation, RFSU, has developed a project providing relationship and sexuality education for young migrants in Sweden.
Prevalence of self-reported neurocognitive impairment falls among people with HIV in Switzerland.
No-deal Brexit threatens the health of UK citizens living with HIV in other European countries.