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Please note: This edition of the bulletin was published by MEDFASH. Click here to view the original format.
Welcome to the October issue of the MEDFASH Sexual Health & HIV Policy EUROBulletin. Last month the WHO Regional Committee for Europe formally adopted a new European strategy for women’s health and well-being as well as a set of plans that call for accelerated action and stronger political commitment on sexual and reproductive health, HIV and viral hepatitis. There are links to all the respective Committee resolutions and draft working documents in the policy section below. Minor technical revisions are currently being made and the finalised versions are expected on the WHO Europe website soon.
Other items of note this month include: an open letter to the European Commission calling for a EU level strategy and comprehensive action plan on viral hepatitis, HIV and TB; WHO treatment guidelines for chlamydia, gonorrhoea and syphilis in response to the growing threat of antibiotic resistance; new EASL guidelines on treatment of hepatitis C; IPPF and World Association for Sexual Health guidance for the implementation of young people’s sexual rights and the appointment of a UN human rights expert to monitor and report on levels of violence against LGBT people.
And finally, confirmation of the news that MEDFASH will close at the end of the year. Negotiations are currently underway to ensure that key projects are handed over so they continue to provide the support necessary to stakeholders. It is envisaged that this EUROBulletin and the national MEDFASH Sexual Health & HIV Policy eBulletin will continue in some form in the foreseeable future. See the full press release from MEDFASH in the relevant section below.
The October eFeature interview is with Doortje Braeken, Senior Adviser on Adolescents, Gender and Rights at IPPF.
Doortje Braeken has led IPPF’s youth work since 2002 and currently coordinates programmes across 30 countries implementing a rights-based approach that creates synergies between Comprehensive Sexuality Education (CSE), youth friendly services and advocacy for supportive policies for young people. In 2015 she was awarded the World Association for Sexual Health Gold Medal for her contribution to the sexual rights of young people, particularly in the area of CSE. In this eFeature interview Doortje shares her views on key aspects of sexual and reproductive health and rights (SRHR) for young people across Europe. She identifies some of the ‘big’ SRHR issues and looks at the ways in which countries can best empower young people and support their sexual health and development.
Policy development & guidance
Strategy on women's health and well-being in the WHO European Region
A new strategy on women’s health and well-being in the WHO European Region was adopted by the WHO Regional Committee for Europe at its 66th Session in Copenhagen in September. The Strategy sets priority areas for action in line with Health 2020, and provides guidance to optimise investment in girls’ and women’s health, including by refining existing national policies and strategies to make them more consistent with current evidence and more responsive to women’s health and well-being across the life-course. The Strategy, published in four languages, will also support countries in their commitments to advance women’s health, made through the adoption of the 2030 Agenda for Sustainable Development and its Sustainable Development Goals.
>Regional Committee Resolution – EUR/RC66/R8
>WHO Europe – draft WHWB strategy – Sept 2016
>Strategy (working document in English)
Women's health and well-being in Europe: beyond the mortality advantage
WHO Europe has also launched a new report to support the above strategy with key facts about women’s health and well-being in different parts of the region. It shows the impact of gender based inequalities interacting with social, economic and environmental determinants and it looks at how people-centered health systems can respond to women’s needs across the life-course.
>WHO Europe – publication – Sept 2016
Action plan for the health sector response to HIV in the WHO European Region
Member states adopted a new Action plan for the health sector response to HIV at the WHO Regional Committee for Europe last month. The Action plan, developed through region-wide consultation, calls for an urgent and accelerated “treat all” approach to end the HIV/AIDS epidemic in the WHO European Region by 2030. The Region remains at a critical point with regard to HIV. While new infections are decreasing globally, new diagnoses have increased by 76% in the Region since 2005, more than doubling in countries in eastern Europe and central Asia. Only an estimated 21% of all people living with HIV were receiving treatment in 2015 in the eastern part of the European Region. A final version of the Action plan will be available on the WHO Europe website shortly.
>Regional Committee Resolution – EU/RC66/10
>WHO Europe – draft HIV action plan – Sept 2016
>HIV action plan (working document in English)
Action plan for the health sector response to viral hepatitis in the WHO European Region
Member states also adopted a new Action plan for the health sector response to viral hepatitis. This is the first Action plan for the health sector response to viral hepatitis in the WHO European Region. The overall goal of the Action plan is the elimination of viral hepatitis as a public health threat in the European Region by 2030, by reducing morbidity and mortality due to viral hepatitis and its complications, and ensuring equitable access to recommended prevention, testing, care and treatment services for all. It is aligned with both the 2030 Agenda for Sustainable Development and Health 2020, the European policy for health and well-being. A final version of the Action plan will be available shortly.
>Regional Committee Resolution – EUR/RC66/10
>WHO Europe – draft viral hep action plan – Sept 2016
>Viral hepatitis action plan (working document in English)
WHO Europe Action plan for Sexual and Reproductive Health
The WHO Regional Committee for Europe adopted an Action plan for sexual and reproductive health at the September session. The Action plan for sexual and reproductive health: towards achieving the 2030 Agenda for Sustainable Development in Europe – leaving no one behind focuses on priority action areas and interventions to help Member States achieve the full potential for sexual and reproductive health and well-being for all people.
>Regional Committee Resolution – EUR/RC66/R7
>WHO Europe – SRH action plan – September 2016
>SRH Action Plan (working document in English)
>IPPF European Network statement on new Action Plan
Strategy & action plan for refugee and migrant health in the WHO European Region
This Strategy and action plan for refugee and migrant health focuses on key strategic areas and priority actions to address the public health and health system challenges related to migration, in the spirit of the 2030 Agenda for Sustainable Development, Health 2020, and World Health Assembly resolution on health of migrants.
>Regional Committee Resolution – EUR/RC66/R6
>WHO EUROPE – draft strategy and action plan for refugee and migrant health – Sept 2016
>Strategy document (working document in English)
UN: Tackling AMR
World leaders reaffirmed commitment to addressing the growing global problem of antimicrobial resistance (AMR) at a United Nations (UN) meeting last month. The meeting heard that the impact of AMR is undermining achievement of the Millennium Development Goals, including against HIV/AIDS, tuberculosis, malaria and the survival of mothers and children. Leaders recognized the need for national action plans on AMR and for stronger systems to monitor drug-resistant infections and the volume of antimicrobials used in humans, animals and crops, as well as increased international cooperation and funding.
Parliament & other European institutions
Joint call to European Commission (EC) on viral hepatitis, HIV and TB
On 22 September AIDS Action Europe (AAE), The EU HIV/AIDS Civil Society Forum, European AIDS Clinical Society (EACS), European AIDS Treatment Group (EATG) and thirteen other civil society organisations sent an open letter to the EC Vice- President calling for an EU level strategy and a comprehensive European Commission Action Plan to address the viral hepatitis, HIV and tuberculosis (TB) epidemics in Europe.
EC grants marketing authorisation for Truvada as pre-exposure prophylaxis (PrEP) for HIV
The European Commission (EC) has granted marketing authorisation for Truvada, the first medicine recommended to reduce the risk of HIV infection in the EU. The marketing authorisation allows for the marketing of Truvada for PrEP in all 28 EU countries. It is to be used as part of an overall HIV infection prevention strategy, including condom use.
Treatment & service guidelines
New EASL guidelines on treatment of hepatitis C
The European Association for the Study of the Liver (EASL) has released its latest recommendations on treatment of hepatitis C. The updated guidelines now include highly effective interferon-free options for all hepatitis C virus (HCV) genotypes and for people who are the most challenging to treat. The guidelines – now in press in the Journal of Hepatology – are designed to be flexible enough to be relevant in countries with different approval mechanisms and funding systems.
>EASL – publication – Sept 2016
>Journal of Hepatology - article in press
WHO: New treatment guidelines for chlamydia, gonorrhoea and syphilis
New guidelines for the treatment of three common sexually transmitted infections (STIs) have been issued by WHO in response to the growing threat of antibiotic resistance. Resistance of these STIs to the effect of antibiotics has increased rapidly in recent years and has reduced treatment options, particularly in the case of gonorrhoea. The new recommendations are based on the latest available evidence on the most effective treatments.
>Guidelines for the treatment of Neisseria gonorrhoeae
>Guidelines for the treatment of Treponema pallidum (syphilis)
>Guidelines for the treatment of Chlamydia trachomatis
EMA recommendation on the use of levonorgestrel emergency contraception
On 1 August the European Commission issued an EU-wide legally binding decision to implement the European Medicines Agency (EMA) recommendation that the dose of levonorgestrel emergency contraception (LNG-EC) should be doubled if a women is taking other interacting medicines (including the HIV medicines efavirenz and ritonavir, certain medicines for tuberculosis and epilepsy and herbal medicines containing St John’s wort). This recommendation follows on from a review earlier in the year.
Sexual health rights & advocacy
CoE: Human Rights Comment on protecting women’s sexual and reproductive health and rights
The Council of Europe(CoE) Commissioner for Human Rights, Mr Nils Muižnieks, has published a Human Rights Comment on the need to protect women’s sexual and reproductive health and rights, highlighting that access to sexual and reproductive rights is a precondition for the realisation of other human rights, including in the fields of education and employment. He outlines what steps Member States of the CoE should take to ensure women have full and equal access to sexual and reproductive health rights.
UN human rights expert to monitor and report on levels of violence against LGBT people
The Geneva-based UN Human Rights Council is in the process of appointing an independent expert on protection from violence and discrimination against lesbian, gay, bisexual, transgender (LGBT) people. The UN Expert will be appointed for an initial 3-year term to carry out country visits, monitor and report on levels of violence and discrimination against LGBT people, take up individual allegations with Governments and work to support and protect human rights defenders. United Nations Secretary-General Ban Ki-moon also urged the international community to continue working for equal rights and fair treatment for lesbian, gay, bisexual and transgender (LGBT) people at a high-level side event held by the UN’s LGBT Core Group in New York this month.
>UN Secretary General remarks – 21 Sept 2016
Fulfil! Guidance document for the implementation of young people’s sexual rights
IPPF and the World Association for Sexual Health have developed new guidance which looks at opportunities to implement young people’s sexual rights. It will be of interest to policy makers, health providers and educators. See also this month’s eFeature interview with Doortje Braeken from IPPF who collaborated on this guidance and who shares her views on key aspects of sexual and reproductive health and rights (SRHR) for young people across Europe.
>IPPF – publication – 16 Sept 2016
>Doortje Braeken eFeature interview
International Safe Abortion Day (28 Sept)
Several non-governmental organisations and abortion rights advocates have called for the United Nations to recognise International Safe Abortion Day (28 September) as an official UN day. An Open Letter was sent to to UN Secretary-General Ban Ki-moon and the heads of UN Women, UN Development Programme, UN Population Fund, UN Children’s Fund, UNAIDS, UNESCO and World Health Organization on 17 August.
>International Campaign – news – August 2016
Call to Action for Polish Parliament to uphold women’s rights to safe and legal abortion
Fifty-one civil society organisations have sent a Call to Action statement to the Prime Minister of Poland appealing to him to dismiss the ‘Stop Abortion’ bill and ensure the rights of Polish women to safe and legal abortion are upheld. Women’s groups and human rights campaigners in Poland and other cities in the world have staged protests against a proposed new law that would further tighten the country's abortion laws, already among the strictest in Europe. Click the links to access the Call to Action, see a supportive statement from IPPF and to get an update on the situation.
>International Campaign for Women's Right to Safe Abortion - update - Oct 2016
Evidence & research
Self-administration of injectable contraceptives: a systematic review
This review assessed the continuation rates and safety of self-administration of the contraceptive injection when compared with health provider administration. Findings suggest that, with appropriate information and training, the provision of contraceptive injectables for women to self-administer at home can be an option in some contexts.
What works to improve young people’s sexual and reproductive health
A set of reviews, published in a special supplement to the Journal of Adolescent Health, provide a systematic assessment of evidence from high-quality studies for improving the sexual and reproductive health of young people living in low- and middle-income countries. The reviews focus on three adverse health-related outcomes for young people: unintended and repeat pregnancy; child marriage; and sexually transmitted infections including HIV.
Research from around the world on what young people think about school-based SRE
The results of a synthesis of qualitative studies of young people’s views of their school-based sex and relationships education (SRE) were published in BMJ Open last week (13 Sept). The research concludes that schools should acknowledge that sex is a special subject with unique challenges, as well as the fact and range of young people's sexual activity; otherwise young people will continue to disengage from SRE and opportunities for safeguarding and improving their sexual health will be reduced.
New EU funded project on MSM
The EU has funded a new project on men who have sex with men (MSM), to be coordinated by the Robert Koch Institute in Berlin. The project will undertake new research among MSM as well as with community health workers who work with them. It will also develop a new training package for community health workers to improve HIV, STI, viral hepatitis prevention and healthcare services for MSM in the European Union. Click the link for more detailed information.
Reports & resources
Gonococcal antimicrobial susceptibility surveillance in Europe
This report presents the results from the 2014 gonococcal antimicrobial susceptibility sentinel surveillance. The surveillance of Neisseria gonorrhoeae antimicrobial susceptibility in the European Union/European Economic Area (EU/EEA) has been co-ordinated by the European Centre for Disease Prevention and Control (ECDC) since 2009. This surveillance is essential for detecting emerging and increasing antimicrobial resistance and making quality-assured data available to inform revisions of treatment guidelines.
>ECDC – publication – Aug 2016
PrEP implementation in the EU/EEA Member States: report from expert meeting
A report from an expert meeting hosted by ECDC to discuss practical considerations for PrEP implementation in Europe has been published in Eurosurveillance. The report covers eligibility criteria for PrEP in Europe; appropriate models of service delivery; cost-effectiveness of PrEP, and routine monitoring of people on PrEP.
>Eurosurveillance – Volume 21, Issue 25 - June 2016
Health responses to new psychoactive substances (NPS)
This short report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) provides an overview of the current situation across Europe and reviews the available health and drug-related interventions to reduce and prevent the use and potential harms of NPS. Sexual health settings feature as a relevant intervention setting where potential NPS-related harms and risk behaviours are reported or observed amongst at-risk groups such as men who have sex with men (MSM) and young people.
Hepatitis C among drug users in Europe: epidemiology, treatment and prevention
This report from EMCCDA reviews the epidemiology of hepatitis C virus (HCV) infection in Europe, provides an overview of the way preventive measures are currently implemented in European countries and looks at the opportunities now opening up to tackle this problem decisively.
>EMCDDA – publication – July 2016
Tackling HIV stigma: what works
This paper from the UK based National AIDS Trust looks at HIV stigma and stigma theory and examines the global evidence on what makes an effective stigma intervention. The paper makes a series of recommendations, including that ECDC should work with governments to support the roll-out of existing proven stigma interventions in Europe.
Getting to Outcomes Guide for Teen Pregnancy Prevention
This web-based guide from the RAND Corporation offers an evidence-based model for improving community prevention efforts for teenage pregnancy. It provides tools and instructions to help assess the need for and select strong teenage pregnancy prevention programmes, and identify specific goals and outcomes.
Hepatitis C factsheet on Epclusa
The Treatment Action Group has just released a new hepatitis C factsheet on Epclusa, a fixed-dose combination of two HCV-fighting drugs (sofosbuvir and velpatasvir) in one pill. The factsheet is available in English and Spanish.
Campaigns & other news
International Day of the Girl
October 11 marks the International Day of the Girl, a UN initiative set up to promote the rights of girls around the world and to draw attention to the challenges they face with regards to education, healthcare, child marriage, equal opportunity and sexual violence. UNAIDS issued a press release on the day supporting the initiative and highlighting how empowering girls can advance the HIV response.
>UNAIDS - press release - 11 Oct 2016
PrEP in Europe Initiative (PiEi)
The PrEP in Europe Initiative (PiEi) is a new initiative from a coalition of European organisations and activists concerned with HIV prevention and specifically with ensuring access to PrEP (pre-exposure prophylaxis) among people at high risk of HIV. It is run by a steering committee of pan-European advocacy organisations including AVAC, NAM/aidsmap, EATG, AIDS Action Europe, the National AIDS Trust and AIDES. Click the links for more information on the initiative and what it is setting out achieve.
European HIV-Hepatitis Testing Week 2016
European HIV-Hepatitis Testing Week will take place from 18 to 25 November 2016. The week offers partners across Europe the opportunity to unite to increase awareness of the benefits of HIV and hepatitis testing among those who are at risk. In 2015, more than 400 organisations from across 53 countries took part in testing week. Click the link below to sign up for this year’s campaign and to access a range of materials to support the week.
>European HIV-Hepatitis Testing Week 2016
World Contraception Day 2016
World Contraception Day took place on 26 September 2016. It is an annual event supported by a coalition of 16 international non-governmental organisations (NGOs), governmental organisations and scientific and medical societies with an interest in sexual and reproductive health and is sponsored by Bayer Pharma AG. Click the link to access the campaign website
Global Fund pledges for next 3 years
The Global Fund to fight AIDS, Tuberculosis and Malaria announced donor pledges totalling over US$12.9 billion for the next three years at its Fifth Replenishment conference in Montreal in September. The European Commission pledged €475 million, a 30% increase on previous donations.
>The Global Fund - news – 17 Sept 2016
European Patients Forum (EPF) Survey
In August, EPF launched a survey on access to healthcare in the EU. Designed by patients and patient representatives from within its membership, the questionnaire aims to gather experiences of patients across diseases and Member States. The survey is open to patients with chronic or long term conditions, and informal or family carers, until 31 October.
TGEU Healthcare Survey
Transgender Europe (TGEU) is conducting a survey on healthcare for trans people who are age 16 and older in Georgia, Poland, Serbia, Spain, Sweden. The survey looks into general health and well-being, and the experiences trans people have with general healthcare, and if applicable, with trans-specific healthcare. It is available in six languages.
>TGEU – survey info – Sept 2016
Northern Ireland: policy change for blood donation for gay men
Last month Northern Ireland lifted the lifetime ban on gay men donating blood in favour of a ‘one year deferral system’, bringing it in line with the rest of the UK. The change to policy was announced by Health Minister Michelle O’Neil in June.
Sweden achieves UNAIDS/WHO 90-90-90 target
Research published in HIV Medicine shows that Sweden has become the first country to achieve the UNAIDS/WHO 90-90-90 target. At the end of 2015, 90% of people living with HIV in Sweden were diagnosed, 99.8% of those were linked to care and 95% of people taking antiretrovirals for at least six months had a viral load below 50 copies/ml.
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