The European AIDS Conference revisits Warsaw

Dr Esteban Martínez is president of the European AIDS Clinical Society (EACS) and a senior consultant in infectious diseases at Hospital Clínic in Barcelona, Spain. EACS organises the European AIDS Conference every two years. With the next conference taking place from 18 to 21 October, we spoke to Esteban about what to expect.

What was the thinking behind the theme of the conference: ‘It's time to revisit!’?

The theme is about geography and history: remembering the place where the first EACS conference in eastern Europe took place and also remembering how things in the history of the HIV response were achieved. Some things were not easily achieved – it took time, it took pain – and we are still on the path of improvement.

The conference will be held in Warsaw, Poland, 20 years since the last EACS conference in the same city, so in part the theme is about looking back to that conference in 2003. Many things have changed and many things remain the same.

Back in 2003, antiretroviral therapy was already well-known, with triple therapy well-established, but we were still dealing with a lot of side effects and there was still some use of thymidine analogues (such as d4T and AZT), with the risk of lipodystrophy and other toxicities. There had been big achievements, but there were still issues not yet solved.



Social attitudes that suggest that having a particular illness or being in a particular situation is something to be ashamed of. Stigma can be questioned and challenged.


In relation to medicines, a drug manufactured and sold without a brand name, in situations where the original manufacturer’s patent has expired or is not enforced. Generic drugs contain the same active ingredients as branded drugs, and have comparable strength, safety, efficacy and quality.


In pharmacology, a medication which maintains its effects over a long period of time, such as an injection or implant.


A disruption to the way the body produces, uses and distributes fat. Different forms of lipodystrophy include lipoatrophy (loss of subcutaneous fat from an area) and lipohypertrophy (accumulation of fat in an area), which may occur in the same person.


A doctor, nurse or other healthcare professional who is active in looking after patients.

Let’s revisit that time and let’s look at how things have changed for eastern Europe. Some countries have developed more freedom and better standards compared with twenty years ago. But others lag behind, with divergences widening over time.

There are many times in life when you need to stop and look back at what has been done and what effort it took. Sometimes you may feel everything is fine and it has always been this way and other times you may feel everything is awful and nothing is moving forward. If you look at history, you will see things are not always black and white, but shades of grey.

There have been a lot of advances, but there are still many issues to resolve. I was recently at a meeting about stigma and discrimination, issues that are intimately connected with mental health and access to prevention and care. These issues are now important problems, but without effective antiretroviral therapy, effective networks and knowledge, we couldn’t hope to tackle them.

What role does EACS play in the context of the war in Ukraine?

In terms of the HIV epidemic in Europe, Ukraine is the country with the second highest number of people living with HIV. The only country ahead of it is Russia, and both are in the east of the region.

Poland, where the conference will be held, is a neighbouring country to Ukraine and it has done an incredible job of receiving over 1.6 million people from Ukraine, and giving them full access to health care. That is not easy and should be fully acknowledged.

The war in Ukraine unfolded as the preparation for the conference was underway and we have really devoted the conference to eastern Europe and particularly to addressing the gaps in prevention and care in the region.

There will be specific sessions about Ukraine, about access to care, migrants, and the consequences of disruptions to care for other conditions including tuberculosis and sexually transmitted infections. We have offered specific grants for Ukrainian doctors and community representatives, as we want Ukrainian people to be able to attend.

Alongside the conference, EACS has been proactive in supporting Ukraine. We have made two statements condemning the Russian invasion and supporting Ukrainian citizens, doctors and people with HIV. These are not just words; we have devoted ourselves to several initiatives, including providing online webinars as continuing education to our Ukrainian colleagues and also securing antiretroviral therapy for people remaining in Ukraine and those moving across Europe.

In Ukraine, the most common therapy, TLD (tenofovir disoproxil / lamivudine / dolutegravir), is a generic combination. It is not available in western Europe as it isn’t commercially approved and that was a major challenge for the thousands of people with HIV who migrated to Poland. Initially, the generic pharmaceutical companies provided TLD, but that was in conflict with the market and with the law, and the Polish government couldn’t maintain it for long. Migrants had to change their treatment combinations.

EACS has acted in a bridging role with partners, in sourcing HIV medication and also in providing additional help in any way we could. We have also been working with doctors coming from Ukraine to other countries. There are several doctors working here in Barcelona, where I am based, who have learned Spanish and taken up roles in the hospital or the lab. That is also the case in the Netherlands, Italy, Germany, the UK, Poland – and that is something special.

What are your thoughts on holding the conference in a country that is often seen as being hostile to LGBT people?

I must admit that I don’t know the legislation in Poland in great detail, but I understand there are differences between Poland, and other countries, and the most advanced legislations. Again, I would say that things are not simply black or white.

I have witnessed strong community groups representing key populations in Poland, and that means something. Maybe they are facing a lot of difficulties, but they are there, and they have the strength to be there. We have to make them visible and provide support for them.  

I think having the conference in Poland creates discussions which reach the media and create a background which may ultimately be beneficial in terms of human rights for LGBTI communities and also for other populations that may be stigmatised in eastern Europe and indeed in other countries.

I am thinking also of migrants, not just from Ukraine, but also from Africa, from Syria and elsewhere. We want to include everyone and not forget anyone, and we have many communities that need our support.

The real challenge with HIV in Europe is in eastern Europe. In EACS, there are a lot of activities aiming to provide as much support as possible. In particular our work around the standard of care sets a reference of how care should be delivered. A substantial number of eastern European countries are below the average level. That’s usually not because of the spirit of the doctors or the communities, which is strong, but because of historical legacies, political limitations, taboos, and many other limiting things. Having a common international reference of the minimum level of care that should be offered can be very useful for doctors and patients to use as an advocacy tool with their governments.

As EACS president and as a clinician, what’s your vision for the future of HIV care?

What the conference is promoting, the idea of ‘it’s time to revisit’, means reflecting on how things were, particularly for younger generations who may not be aware of the history of HIV.

Over time, HIV care has expanded and we can no longer think of dealing with HIV prevention and care alone – it goes with other medical issues, such as sexually transmitted infections and also neglected diseases like tuberculosis.

In my view, we have to think of the future in terms of looking at these issues together, because that would allow a more realistic and probably more effective way of fighting HIV.

It is also not the right time to fight alone, as stakeholders and governments did in the past. The time has come to create networks and fight together with others. It’s the commitment of many partners that will ultimately lead us to achieve the 95-95-95 targets and hopefully 100% sooner rather than later.

The conference is a few weeks away – what can we expect?

The programme has been launched and is available on the conference website, so people can see what most interests them. Certainly, eastern Europe will be well-represented in many sessions. As always, antiretroviral therapy is there, and co-morbidities and ageing will be important topics.

There have been controversies around breastfeeding, and although breastfeeding was recommended in low-income countries because of a lack of safe alternatives, formula feeding has been recommended to women living with HIV in Europe for a long time. Recently some countries, in particular Switzerland, have been active in promoting breastfeeding, while other countries are reluctant, so I think there will be some good discussions on that topic.

HIV prevention and PrEP (regular medication and care to prevent HIV) will be an important topic, with issues around availability, cost, strategies and policies. In some European countries, PrEP is not only not supported, but it is not even considered.

Long-acting antiretrovirals will also feature, as therapies and as prevention. They are a recent introduction, so there will be experiences from specific cohorts, and I think this will be helpful for others who do not have them. Long-acting antiretrovirals are not available in many eastern European countries. We have to always consider this perspective; some people are talking theoretically and others are talking from real experience.

Since the London conference, we have had a community co-chair and we have some excellent community-led studies, about stigma for instance.

I think the Warsaw conference will be special. It will be the first really in-person conference since the COVID-19 pandemic. In 2021, we were lucky to be able to host the conference in London using a hybrid model, but most people attended online. This time, we will gather in person and the major actors will be the eastern European settings, with special consideration given to Ukraine. I think it will be useful and timely, particularly for this part of Europe and also across the many topics that deserve attention from us all.

For more information on the EACS conference, visit:

This feature first appeared in the September 2023 edition of the Sexual Health and HIV Policy Eurobulletin.