Welcome to the July 2017 Sexual Health & HIV Policy EUROBulletin.
In this issue we have an eFeature interview with Catherine Cook, Head of Research at Harm Reduction International (HRI). Together with the Eurasian Harm Reduction Network, HRI has led a two-year project which aimed to build the capacity of civil society to advocate for rights-based harm reduction services. A new report from HRI presents the results of detailed research investigating investment in harm reduction, which highlighted funding crises for harm reduction in several European countries.
New research published in The Lancet HIV around life expectancy for people living with HIV was widely reported in the mainstream media. The research, by the Antiretroviral Therapy Cohort Collaboration, found that people in European and North American cohorts who started antiretroviral therapy between 2008 and 2010 and who had CD4 counts over 350 by the end of their first year of therapy had life expectancies approaching that of the general population. However, among people who inject drugs mortality rates in the first three years after starting HIV treatment remain stubbornly high. The International Harm Reduction Conference (HR17), heard in May that HIV care targets for people who inject drugs will be missed without a renewed focus on drug policy issues including rights, access, privacy and criminalisation.
Other items to look out for in this edition include: progress reports from the European Centre for Disease Prevention and Control (ECDC) on the continuum of HIV care in Europe; the 2017 Rainbow Europe Package, which assesses LGBTI rights in each European country; I Decide, a new campaign calling for universal and equitable access to contraception; and updates on the ongoing hepatitis A outbreak among men who have sex with men in Europe.
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Catherine Cook is Head of Research at Harm Reduction International. She recently led a research project investigating investment in harm reduction in the European Union, which highlighted alarming shortfalls in funding for essential harm reduction services in several countries.
In this eFeature interview, Catherine tells us about the research and what it uncovered.
Evidence, data & research
Life expectancy near-normal in people with CD4 counts over 350 a year after starting therapy
A large study has found substantial improvements in life expectancy for people living with HIV who started antiretroviral therapy (ART) after 2008, even in their first year of therapy. People who started ART between 2008 and 2010 and who had CD4 counts over 350 by the end of their first year of therapy had life expectancies approaching normal. The research was published in The Lancet HIV journal and reported widely in the news.
Continuum of HIV care in Europe and Central Asia
The European Centre for Disease Prevention and Control (ECDC) has published its 2017 progress report, Continuum of HIV care: Monitoring implementation of the Dublin Declaration on partnership to fight HIV/HIDS in Europe and Central Asia. The continuum refers to four stages of diagnosis and care for people living with HIV: the estimated number of people living with HIV; the number of people living with HIV who are diagnosed; the number of people with diagnosed HIV who are taking treatment; and the number of people taking HIV treatment who have a suppressed viral load. The report draws on the available data (48 countries were able to provide data on at least part of the continuum) and provides a snapshot of HIV care in each country as well as for the whole region.
HIV treatment targets for people who inject drugs will be missed without focus on rights, privacy and prisons
Reaching ambitious HIV treatment targets for people who use drugs requires efforts to protect privacy, to promote access to opioid substitution treatment and to keep people out of prison, the 25th International Harm Reduction Conference (HR17) in Montréal, Canada, heard in May. Recently published data from Eastern Europe show the extent of the challenge in improving the continuum of care for people who use drugs. Very low rates of HIV testing were compounded by low rates of transition to HIV care.
Continuing hepatitis A outbreak among men who have sex with men in Europe
As previously reported, there is a current and ongoing outbreak of hepatitis A in Europe. ECDC says that almost 1500 cases of hepatitis A have been identified as linked, in three outbreaks, predominantly in men who have sex with men. A further 2660 cases are still being investigated and ten countries have reported an increase in cases compared with 2016. Public authorities in France, Portugal and the United Kingdom have already issued warnings about the hepatitis A outbreak to gay men, recommending that gay men get vaccinated.
European CIPHER study finds complex relationship between cognitive impairment and low mood in people living with HIV
One in five people living with HIV in a European study reported a decline in everyday functioning as a result of cognitive problems such as memory loss, difficulties in solving problems, poor concentration or reduced attention span, researchers from the CIPHER study group report in the Journal of Acquired Immune Deficiency Syndromes. But, researchers say, people who reported these problems were also more likely to have comorbid conditions, to be depressed or anxious, to be unemployed and experiencing difficulties in affording basic needs, and ought to be assessed for these problems first before concluding that the underlying problem is a physical decline in cognitive function.
Policy development & guidance
Harm reduction investment in the European Union
Harm Reduction International and the Eurasian Harm Reduction Network have launched a new report, Harm Reduction Investment in the European Union: Current funding, challenges and successes. It includes a snapshot of the current state of harm reduction funding in 18 EU member states and identifies austerity, international donor retreat and poor political support as factors impeding the sustainable financing of harm reduction responses. In some countries, harm reduction funding is in crisis.
Charting the progress of LGBTI rights in Europe
The European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA-Europe) has released its 2017 Rainbow Europe Package. Rainbow Europe ranks countries according to LGBTI rights, assessing the legal and political landscape in each country and making recommendations for continued progress. A dedicated website presents the Rainbow Europe data in graphic form.
Affordability of medicines
AIDS Action Europe (AAE) is working to engage its members on the issue of the affordability of medicines and to encourage advocacy efforts. AAE has previously developed a training manual on the subject and has delivered training workshops to 28 organisations in 19 countries to date. Future workshops are planned in Russian (in Kiev in September) and in English (in Athens in October).
Reports & resources
Impact of HIV laws, policies, stigma and discrimination
ECDC has published two evidence briefs, also drawing on data from individual countries. The briefs examine the impact of HIV laws and policies in Europe on access to HIV services for key populations, and the perceived impact of stigma and discrimination.
Request for sexuality education programmes and tools
The European Society of Contraception and Reproductive Health (ESC) is asking people to contact them with materials relating to sexuality (sex and relationships) education. ESC intends to expand its online library to make more tools available and is looking for resources for different age groups and in different languages.
Parliament & other European institutions
Committee for Medicinal Products for Human Use (CHMP)
The European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) met in June and made a recommendation for approval of a generic version of Atripla (Efavirenz/Emtricitabine/Tenofovir disoproxil Mylan). It also recommended the extension of the authorisation of lopinavir/ritonavir (Kaletra) to include infants from 14 days and older. At its May meeting, it also made a recommendation for approval of a different generic version of Atripla (Efavirenz/Emtricitabine/Tenofovir disoproxil Zentiva) and a 600mg formulation of raltegravir (Isentress), enabling once-a-day dosing. In its April meeting, it recommended the extension of the authorisation of maraviroc (Celsentri) to include paediatric use.
European Parliament resolution on Chechnya
The European Parliament has passed a resolution condemning the widespread human rights abuses and persecution of men perceived to be gay in the Republic of Chechnya in the Russian Federation.
Sexual health rights & advocacy
I Decide – campaign calls for universal access to contraception
I Decide, a new campaign from the International Planned Parenthood Federation (IPPF) is calling for universal and equitable access to contraception. In the European region, IPPF highlights that women who are the most marginalised often bear the brunt of inadequate sexual and reproductive health policies. Barriers to access in Europe and Central Asia include lack of information and counselling, and issues around affordability, particularly for young and marginalised women, including Roma, refugees and undocumented migrants.
Conference on sexuality education
In May, the German Federal Centre for Health Education hosted an international conference in Berlin, with participants from 33 countries of the World Health Organization (WHO) European region. The conference was entitled Sexuality Education: Lessons Learned and Future Developments in the WHO European Region (SE:LFIE), and included presentations of research, examination of trends, and discussion of future approaches.
Campaigns & other news
Open letter to Gilead Sciences on PrEP
The European AIDS Treatment Group (EATG) and the PrEP in Europe Initiative (PEI) have written an open letter to Gilead Sciences, the manufacturer of Truvada. They request that Gilead make Truvada or its generic equivalent available at a greatly reduced price, so that HIV pre-exposure prophylaxis (PrEP) can be made widely available through European healthcare systems.
International Day against Homophobia, Transphobia and Biphobia (IDAHOT)
The International Day against Homophobia, Transphobia and Biphobia (IDAHOT) was marked by the European Commission, the United Nations, and many civil society organisations across Europe. ILGA-Europe put together a round-up of some of the activities on its website.
Belgium's Ministry of Health has announced a programme to roll out PrEP through its national health system for key populations.
In response to an invitation from the Bulgarian Ministry of Health, ECDC has prepared and published an assessment of Bulgaria's national HIV programme, and its STI and hepatitis surveillance system.
Organisations or groups in Georgia who are carrying out activities supporting the rights of LGBTI people are eligible to apply for a grant from ILGA-Europe. Closing 6 July.
The German HIV organisation Deutsche AIDS-Hilfe has launched a campaign to end AIDS in Germany by 2020. Kein AIDS für Alle aims to encourage key populations to access HIV prevention, testing, treatment and care services and to support health professionals to identify and diagnosis HIV.
Ireland's Citizens' Assembly has voted in favour of reforming Ireland's abortion laws. The Citizen's Assembly was set up to debate important issues and is made up of a representative sample of the Irish electorate. Its recommendations are submitted to the Irish parliament for further debate. Recently released statistics from the the UK's Department of Health showed that over 3000 women travelled from Ireland to access abortion care in 2016.
Undocumented migrants living with HIV have especially poor rates of retention in care and virological suppression after starting antiretroviral therapy, investigators from Italy report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.
A campaign to support children and families affected by HIV has been launched in Kyrgyzstan. The campaign is particularly focused on responding to stigma and discrimination.
Portugal's Ministry of Health announced on 29 May that Portugal would begin to offer PrEP through its national health system for key populations.
A survey of Swiss gay men and men who have sex with men recruited through the Grindr networking app has found that while only 4.3% had taken PrEP, 50% would consider taking it within the next six months and 79% would either take it some time in the future or want to learn more about it.
Brook and FPA are asking people to nominate great examples of innovative relationships and sex education in schools. They plan to present the best examples to policymakers to shape the new mandatory curriculum planned for schools in England. The deadline for nominations is 31 July.
PrEP has been approved for use in the national health service in Scotland.
Epidemiological analysis has confirmed a large fall in HIV diagnoses in London gay men, which has been attributed to combination HIV prevention, including testing, treatment as prevention, and PrEP.
Sexual Health & HIV Policy eBulletin
Supporting those working for high quality sexual health, reproductive health and HIV services
The Sexual Health & HIV Policy eBulletin was launched in October 2012 by MEDFASH to keep commissioners, providers and others in the sexual health, reproductive health and HIV field up-to-date about policy developments during the transition that followed the Health and Social Care Act 2012. Since then the eBulletin has remained a ‘go-to’ source of reliable and useful policy information* with over 38 issues published to date.
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