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The European plan of action to end AIDS

Submitted by on 14 Jul 2017 – 10:01

The threat of HIV/AIDS has receded in several countries across the world. However, eastern Europe and Central Asia are exceptions to this. The number of newly reported HIV cases are increasing ever so fast in Europe. Hopeful of a possibility to eliminate a killer disease that is set to affect more than one billion people by 2030, the International Centre for Parliamentary Studies recently gathered industry leaders, academics and policy makers to examine current policy guidelines and strategies on combating HIV/AIDS in the EU. Diane Rolland, International Program Manager at ICPS, discusses the major recommendations presented at the roundtable

Nearly 30 years since the first cases of HIV were reported; at least 81 new infections are reported every day in the European region. Whilst effectual treatments for HIV are available, neither cure nor preventative vaccine exists. What’s more worrying is that 1 in 7 people living with HIV within the EU/EEA region do not know they are infected and 1 in 6 people who are diagnosed are not on treatment.

Globally, men who have sex with men (MSM) are 19 times more likely to be living with HIV than the general population. This route is the most prevalent in Europe (42%) followed by heterosexuals (32%), others (20%) and injected drug users (4%).

There is growing evidence of the value of including pre-exposure prophylaxis (PrEP) in the package of combination HIV prevention interventions offered to men who have sex with men. Yet, what factors put men who have sex with men at risk of HIV?  For instance, how progressive are European policies regarding the LGBT community?  In contrast with global decline in new infections, why are the number of newly reported HIV cases in Europe on the rise?

The World Health Organisation has a vision for zero new infections, zero HIV-related deaths and zero HIV-related discrimination. However, how optimistic is Europe in ending AIDS by 2030?

The HIV/ AIDS Europe Roundtable 2017 organised by the International Centre for Parliamentary Studies in March 2017 brought together European policy makers, medical and clinical professionals, academic experts, healthcare players and patient groups, to examine current policy guidelines and strategies on combating HIV/AIDS in the EU.

Chaired by John Bowis OBE, Former Member of European Parliament and Minister of Health (United Kingdom), more than 30 participants from across ten European member countries present at the roundtable discussed what works, what does not work and the greatest challenges in the medium and long term.

Followed by a series of policy updates from the European Centre for Disease Prevention and Control (ECDC), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and members of the European Commission, the delegates at the roundtable discussed a variety of issues, including surveillance and HIV treatment guidelines within Europe, strategies of intervention, testing and diagnosis, prevention, cost of treatment, antiviral drug resistance, the commissioning and provision of Pre Exposure Prophylaxis (PrEP), the need for providing adequate psychological counselling and the latest developments in HIV science.

Evidence-based HIV prevention

Addressing the main route of HIV transmission in Europe, participants at the roundtable agreed that programmes for men who have sex with men should be a cornerstone of HIV prevention in all EU/EEA countries. Given the high proportion of HIV cases among migrants in many EU/EEA countries, and evidence of post-migration HIV-acquisition, migrant-sensitive prevention services are crucial.

While adequate harm reduction levels should continue to prevent HIV among people who inject drugs, expansion of HIV testing and linkage to care should ensure early diagnosis and access to treatment; as this will reduce the number of late presenters and improve treatment outcomes.

Critical areas for fast-track action

Participants at the roundtable voted for a three-pronged approach to ending AIDS in Europe: 1) Sustain the progress that has been made over the last 20 years in Europe i.e., protect what we have achieved; 2) While scaling up HIV testing and treatment toward achieving the 90-90-90 treatment targets by 2020, Europe should aim for a 95-95-95 target over the long term; and 3) Recognise that HIV is only one issue and unless you change the broader sociological context the overall benefit will not be met.

The overall message of the meeting was to stress the importance of taking stock of the situation at hand, incorporate lessons learnt from different member states and respond to long term needs.

Whilst acknowledging that national HIV responses have often failed to focus their intervention strategies on discriminated communities and populations most in need, policymakers agreed that there needs to be a focus in fighting the stigma associated with testing. Leaving it out of the equation might mean battle half lost. Migrating populations in Europe should continue to be high on the agenda.

Some of the major recommendations tabled at the roundtable included:

1. We should ensure all people living with HIV know their status: New testing approaches, including home sampling and self-testing should be more democratised and Europe should increasingly invest in observation studies that can guide further policy;

2. Move to a more holistic approach of support for patient, beyond healthcare: Facilitate access to social protection, psychological support, social care, and education for all priority groups and risk populations;

3. There are substantial disparities in access to treatment and care and this gap must be breached. Europe needs to strengthen disease treatment and infection control;

4. The broader context is key: Lessons can be learned both within the EU and from outside. When we identify a solution that works for one particular region or country, we should be able to seek the means of implementation to others;

5. Try to model HIV care: We need to explore beyond the borders and look at different areas in the world, including the most affected ones (e.g. sub-Saharan Africa) and learn from their current studies;

6. Keeping people healthy and alive through holistic care: We should take the person’s psychological status into consideration and invest more in tailored individual programmes;

7. We should invent new models of care suitable for all populations around the globe;

8. Criminalised behaviour against people affected by HIV should be eradicated;

9. We need a better understanding and implementation of current treatment modalities;

10. Europe requires a more coordinated and holistic approach, adequately addressing existing research gaps and raising awareness.

Delegates at the roundtable included:

Regional Director, Government Affairs EMEA, Abbvie, AAE Steering Committee Member, AIDS Action Europe, Medical Doctor, Dept Infectious Diseases AOU Polyclinic, Public Health Analyst, Centre for Disease Prevention and Control, Consultant Physician, Chelsea and Westminster Hospital, Project Officer, European & Developing Countries Clinical Trials Partnership (EDCTP), Director General, European AIDS Treatment Group, Head of Disease Programme – HIV, Sexually Transmitted Infections & Viral Hepatitis, European Centre for Disease Prevention and Control (ECDC), Scientific officer for HIV/AIDS research, European Commission – DG Research and Innovation, Policy Officer,  European Commission – DG SANTE, Head, Division of Communicable Diseases Federal Office of Public Health, Advocacy Officer, German Foundation for World Population (DSW), Advocacy Officer, German Foundation for World Population (DSW), Chair, Dutch HIV Association, Secretary General, HIV Norway, Director, Scientific Affairs, Hologic, Senior Director, Infectious Diseases & Vaccines, Janssen Pharmaceuticals, Senior Study Responsible Physician, Janssen Vaccines and Prevention, B.V. Pitié Salpêtrière Hospital, Professor of Infectious Diseases and Head of the HIV Clinical Research Unit, Head, Department of Infectious Diseases Saint-Pierre University Hospital, Fund Portfolio Manager, Eastern Europe & Central Asia Team , The Global Fund to Fight AIDS, Tuberculosis and Malaria, Senior Adviser, Tuberculosis and HIV UNAIDS, Team Lead, Strategy UNITAID, Director of Clinical Infectious & Tropical Diseases, University of Milan, ViiV Healthcare, Senior Advisor, Strategy, Policy & Equity, WHO Department of HIV and Global Hepatitis Programme.

The next edition of the HIV/ AIDS Roundtable will be taking place in 2018. If you wish to attend, please contact information@parlicentre.org