Welcome to the July 2022 Sexual Health & HIV Policy EUROBulletin.
Our feature in this edition is an interview with Marina Davidashvili, Head of Policy and Research at the European Parliamentary Forum for Sexual and Reproductive Rights (EPF). We spoke to Marina about EPF’s work supporting parliamentarians to make positive change in sexual and reproductive health and rights.
Marina told us, “The rights we have should never be taken for granted. They can be lost, and we have to be vigilant.”
That statement feels all the more relevant in light of the recent decision by the US Supreme Court to overturn Roe v Wade, rolling back abortion rights in the US. Here in Europe, there has been an outpouring of anger about the decision and solidarity with US citizens, clinicians and activists. There is also renewed determination to safeguard rights in Europe. Last week, the Center for Reproductive Rights published a call to action signed by over 70 organisations, urging leaders to protect and improve access to abortion care set out in European laws and policies.
Other items to look out for in this edition include: further information and guidance around monkeypox, an update on treatment and care for Ukrainians living with HIV, new research on contraception preferences, and a new website for the European HIV Legal Forum.
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We regularly include publications from the European Parliamentary Forum for Sexual and Reproductive Rights (EPF) in this bulletin – from their work mapping contraception and abortion policies across Europe, to their investigations of the funding of bodies promoting anti-choice, anti-LGBT and anti-equality views.
We spoke to Marina Davidashvili, Head of Policy and Research at EPF, about its work bringing parliamentarians together, supporting them to understand the key issues in sexual and reproductive health and rights, and ultimately making positive lasting change.
Sexual health rights & advocacy
Call to action: protect and improve access to abortion care
Following the ruling by the US Supreme Court which removed the constitutional right to abortion in the US, over 70 organisations in 28 European countries have issued a call to action on abortion access in Europe.
Although almost all countries in Europe have legalised abortion, there remain procedural and regulatory barriers that impede access to abortion care in practice in many areas.
The document, published by the Center for Reproductive Rights, calls on European leaders to take steps to protect and improve access to abortion care by removing residual barriers to abortion access in national laws and policies.
Leah Hoctor, Senior Regional Director for Europe at the Center for Reproductive Rights, said: "This is an important moment for leaders across Europe who are committed to reproductive rights to lead by example and galvanize action in their own countries to remove legal and policy barriers on abortion that remain in place."
SRHR advocacy for Roma communities
The International Planned Parenthood Federation (IPPF) European Network is working with local partners in Bulgaria, Romania and Serbia to improve sexual and reproductive health care and rights (SRHR) and gender equality for Roma communities.
Partners in the My Body, My Rights project include Roma peer educators, health mediators, activists, teachers, nurses and doctors. The project has reached almost 30,000 people to date.
IPPF is calling on local and national decision-makers to support Roma communities through commitments on access to sexual and reproductive health care and financial investment in providing services and education.
New advocacy forum for HIV prevention research
Global HIV prevention organisation AVAC has launched a new forum for advocacy, called The Choice Agenda.
There are monthly webinars and a moderated listserv to debate HIV prevention topics. The next webinar, on prioritising pleasure in interventions and prevention programming, will take place on 13 July. The August webinar will focus on the global roll-out of the long-acting HIV medication cabotegravir.
Evidence, data & research
Continuing transmission of monkeypox
The World Health Organization (WHO) Regional Office for Europe and the European Centre for Disease Prevention and Control (ECDC) are continuing to closely monitor the ongoing outbreak of monkeypox, also known as MPX, in the region. WHO's Emergency Committee stopped short of declaring the outbreak a Public Health Emergency of International Concern but acknowledged the need for intense response efforts.
A joint ECDC-WHO Europe surveillance bulletin, based on data up to 28 June, reports 4177 cases of monkeypox in the European region. The highest numbers have been reported in the UK (1076), Germany (838), Spain (736) and Portugal (365). The majority of cases are in men who have sex with men.
ECDC and WHO have published advice for public health authorities and event organisers on navigating monkeypox over the summer. It focuses on communicating risk and engaging with communities. ECDC has also published guidance for contact tracing.
ECDC worked with community organisations to publish advice for individuals concerned about exposure to monkeypox. Written for gay and bisexual men, as they are the group most affected by this outbreak, the information is useful for anyone looking to find out more about monkeypox.
Some countries are introducing vaccinations for close contacts of people with monkeypox – sometimes called ring vaccination – and contact tracing and self-isolation remain very important tools. A new strategy for the UK, where cases are particularly high, recommends offering vaccination to gay and bisexual men and trans people considered to be at higher risk of exposure. However, vaccine doses are in short supply.
National hepatitis B and C responses
ECDC has published a report based on its monitoring of progress towards hepatitis elimination targets. However, it found significant data gaps.
According to the ECDC survey, 22 countries in the European Union (EU) or European Economic Area (EEA) reported that there is testing guidance for hepatitis B and/or C, and 19 countries have an action plan for hepatitis prevention and control. Gaps in hepatitis testing policies and programmes were identified for healthcare workers, migrants, men who have sex with men and people in prison.
The estimated number of people living with chronic hepatitis B virus varied 18-fold from 183 to 3312 per 100,000 population. For chronic hepatitis C, the estimate ranged 100-fold from 24 to 2411 per 100,000 population.
ECDC concluded that the lack of robust data meant it was difficult to assess region-wide progress at this point.
Impact of the US ‘gag rule’ on HIV infections and maternal and child deaths
The first large-scale study of the impact of the US anti-abortion Mexico City Policy shows it has led to an estimated 90,000 new HIV infections and almost 30,000 maternal and child deaths annually.
In 1984, Reagan introduced the policy, which blocks US funding to foreign organisations that provide or even discuss abortion. In practice, the policy defunds organisations that may offer abortions but that also provide a range of essential reproductive health services, such as contraception, HIV testing and cervical cancer screening.
Since Reagan, every Republican US President has invoked the policy – often referred to as the ‘global gag rule’ – during their presidencies only to have it revoked by each Democratic successor.
A study published in the journal PNAS is the first to assess the gag rule’s impact on HIV incidence and maternal and child mortality over a quarter of a century.
It found that reintroducing the gag rule led to a 4% increase in national HIV incidence rates in 38 countries highly dependent on US aid. These countries saw an additional 90,000 new HIV infections each year the policy was in place. The policy also resulted in an average of 2700 maternal deaths and 24,000 deaths among children annually.
The study revealed other donors’ potential power to mitigate these effects by providing alternative funding.
New research from WHO examines individuals’ values and preferences around contraception. A series of systematic reviews published in the journal Contraception look at the available literature across several demographics to understand what people want from family planning. The demographics include: sexually active women, women with specific medical conditions, men, young people and adolescents, women living with HIV, healthcare providers and people living in humanitarian contexts such as asylum seekers, refugees, and those living in a post-conflict setting. Preferences vary, but researchers highlight a universal desire for choice, safety and affordability.
Reports & resources
HIV treatment and care for Ukrainians
Several months into the conflict in Ukraine, people living with HIV continue to face serious risks to their health.
Antiretroviral therapy is still available in Ukraine but less accessible in areas with active conflict. Ukrainian HIV clinicians and civil society organisations are working to maintain HIV services, often at considerable risk to their own lives.
Around five million refugees have left Ukraine since the invasion in February. Early estimates suggested that around 28,000 refugees would be people living with HIV, but considerably lower numbers have registered for care in host countries.
Several initiatives have been launched to support Ukrainians living with HIV to access the health care they need in Ukraine or in host countries. These include procedures for sharing medical data, information on how to access HIV treatment and health care, online consultations, and clinician networks.
European abortion laws
The Center for Reproductive Rights has updated its factsheet on abortion laws in Europe. The resource gives a comparative overview of laws, policies and regulation surrounding access to abortion care in Europe.
Almost every country in the European region provides abortion care, but a small number of countries have highly restrictive laws, banning abortion in almost all circumstances.
Policy development & guidance
Meeting family planning needs in eastern Europe and central Asia
UNFPA has published a technical report entitled, Getting to zero unmet need for family planning in Eastern Europe and Central Asia. A key focus of the report is the need to secure supplies of contraceptives. This requires political commitment, funding, coordination and supply chain capacity. The report details commitments and actions required to achieve zero unmet need in the region.
European HIV Legal Forum
AIDS Action Europe has launched a new website for the European HIV Legal Forum (EHLF). The forum maps the legal situation for people living with HIV and key populations affected by HIV including topics such as: access to HIV prevention, testing, care and support for migrants; discrimination against people living with HIV in healthcare settings; and criminalisation of HIV non-disclosure, exposure and transmission.
The aim of the new website is for it to be a useful tool for HIV advocacy. It includes an interactive online map of the information collected by the forum.
Parliament & other European institutions
MEPs react to the overturning of Roe v Wade
Robert Biedroń, Chair of the European Parliament's Committee on Women’s Rights and Gender Equality, released a statement in response to the US Supreme Court's decision to overturn abortion rights.
In it, he drew attention to a resolution passed by the European Parliament in June, condemning the backsliding in women's rights and sexual and reproductive health and rights taking place in the US and in some EU member states.
He said, "We will continue to stand with the women and girls in the US and with all those involved in both the provision of and advocacy for the right and access to legal and safe abortion care in such challenging circumstances”.
In the resolution, members of the European Parliament (MEPs) reaffirmed that sexual and reproductive health and rights are fundamental human rights which should be protected.
The resolution also highlighted concerns that the overturning of Roe v Wade could embolden anti-choice organisations to pressure countries outside the US to roll back abortion rights, including some in Europe.
Committee for Medicinal Products for Human Use
At its meeting in June, the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) recommended the authorisation of lenacapavir (Sunlenca), a new medication for the treatment of HIV which has resistance to other drugs.
Lenacapavir (formerly known as GS-6207) is from a class of antiretroviral medications called capsid inhibitors. Sunlenca will be made available as a solution for injection. A tablet is also available to be taken for a lead-in period before the first injection.
Support for sexual and reproductive health in Ukraine
The European Commission has announced a €1.5 million contribution to UNFPA, to support sexual and reproductive health services in Ukraine. UNFPA is distributing reproductive health supplies and equipment to hospitals and mobile health teams, including for obstetric emergencies and the clinical management of rape.
Campaigns & other news
The 24th International AIDS Conference (AIDS 2022)
The latest HIV research will be presented in Montreal, Canada and online at the 24th International AIDS Conference (AIDS 2022) from 29 July to 2 August.
NAM aidsmap is an official scientific media partner and will be publishing news coverage of the conference on its website, as well as sending out summary bulletins by email in English, French, Italian, Portuguese, Russian and Spanish.
Launch of handbook on SRHR and universal health coverage
WHO is launching a new handbook on reaching universal access to sexual and reproductive health care. Recommended actions are set in the context of achieving universal health coverage through an approach based in primary care.
The launch event will be hosted online on 12 July, 1330 CET.
Don’t burn out – support for activists in eastern Europe
ECOM – the Eurasian Coalition on Health, Rights, Gender and Sexual Diversity – has launched an online course for its members and other activists from eastern Europe and central Asia working with LGBT communities.
The course recognises that activists in the region are at risk of emotional and professional burnout and aims to provide tools for participants to support them to reflect and adopt new strategies.
France | A study in France that matched new HIV diagnoses in adult men who had been taking PrEP (regular medication to prevent HIV infection) with diagnoses in men at similar risk who had not been taking it, has found that the overall effectiveness of PrEP in stopping infection in this high-risk population was 60%.
Georgia | A project funded by the Western-Eastern European Partnership Initiative on HIV, viral hepatitis and TB (WEEPI) has published the results of an investigation into the management of co-morbidities for people living with HIV in Georgia. High cholesterol was found to be more common than in the general population however, unusually, high blood pressure and diabetes were found to be less common in people living with HIV.
Germany | Berlin’s Family Planning Centre, BALANCE, has developed a telemedicine for medical abortion project in cooperation with Doctors for Choice Germany, to improve access to medical abortion.
Ireland | Statistics on access by residents of Ireland to abortion care in England and Wales show that 206 people travelled to access abortion in 2021. Most were over 12 weeks pregnant and therefore ineligible for termination services in Ireland, and 50% were foetal anomaly cases.
Italy | A nationwide survey in Italy found that three-quarters of people living with HIV had heard about Undetectable = Untransmittable (U=U), and just under half of HIV-negative respondents. A high number of infectious disease doctors were aware of U=U. However, in none of the groups sampled did all respondents fully believe in its complete accuracy.
Malta | A group of 135 doctors in Malta have filed a legal protest calling for a review of Malta’s abortion ban. It follows the high-profile case of an American tourist who had to be flown to Spain for treatment after an incomplete miscarriage.
Norway | Peer support provided at outpatient clinics in Norway improves health outcomes, addresses the diverse needs of people living with HIV and improves wellbeing, according to a recent study.
Poland | A bill was put to the Polish Parliament by citizens, having collected over 200,000 signatures, which would have legalised abortion up to 12 weeks. However, at the end of June, members voted against the bill.
The Netherlands | Senators in The Netherlands have voted to abolish the five-day wait for women seeking an abortion. The plan was previously approved in the lower house of parliament.
United Kingdom | A study reported to the recent British HIV Association (BHIVA) conference found that providing gay and bisexual men with packs of PEP (emergency treatment to prevent HIV infection) to keep at home cut the average time between possible exposure and starting PEP from over a day to seven hours.