Welcome
Please note: This edition of the bulletin was published by MEDFASH. Click here to view the original format.
Welcome to the fifth issue of the MEDFASH Sexual Health & HIV Policy EUROBulletin. Last week all eyes were firmly on Durban, South Africa, which played host to the 21st International AIDS Conference (AIDS 2016). Political commitments, declarations and community statements set the stage as the world came together to acknowledge advances made but also identify barriers to further progress. There is a link to aidsmap.com conference highlights (available in six languages) in the round-up section below.
Other items of particular note in this issue include: WHO Health Sector Strategies for HIV, viral hepatitis and STIs adopted by Member States in May; a Community Consensus Statement released by HIV advocacy groups on access to HIV treatment and its use for prevention; new WHO guidelines on ART, gonorrhoea, chlamydia and FGM complications; and new campaigns on comprehensive sexuality education (CSE), safe abortion and women’s rights. Also, today is World Hepatitis Day – see more on this in the campaign section.
The July eFeature interview is with Dr Ann Sullivan from the UK who looks at the importance of indicator condition-guided testing as part of a broader testing strategy to reduce undiagnosed and late diagnosed HIV.
Finally, thanks to all who completed the EUROBulletin survey last month. We will be giving feedback in the next issue.
eFeature
Dr Ann Sullivan has been a Consultant Physician in HIV and Genitourinary Medicine at the Chelsea and Westminster Hospital NHS Foundation Trust, London, UK, since 2003 and is currently the Service Director for the HIV Outpatient Department there as well as an Honorary Senior Lecturer at Imperial College, London. Ann has a special interest in expanding access to HIV testing through novel solutions using new technology and her recent work focuses on increasing HIV testing and demonstrating cost effectiveness. She is currently lead for HIV testing in indicator conditions in the (EU) CHAFEA funded OptTEST project across Europe and was an author of HIV in Europe’s indicator conditions testing guidance. She also collaborated on the recent ECDC evaluation of its 2010 HIV testing guidance and is part of the consortium to produce the new revised guidelines. In this eFeature interview, Ann reflects on the changing direction of HIV testing approaches and discusses opportunities for normalising HIV testing, and using community and indicator condition-guided testing strategies to reduce late diagnosis.
>Dr Ann Sullivan – eFeature interview (PDF)
Policy development & guidance
IAS: Second Durban Declaration
The International AIDS Society (IAS) released the Second Durban Declaration in advance of AIDS 2016. The Declaration focuses on the five key scientific advances needed to end the epidemic and the five key structural barriers impeding progress. More than 1700 organisations or individuals have signed the Declaration to date. Click the link to access and/or sign the Declaration (available in English, French, Spanish and Russian).
>IAS – Second Durban Declaration – June 2016
Financing the response to HIV in low-and-middle income countries: International Assistance from donor governments in 2015
This report from UNAIDS and the Kaiser Family Foundation provides the latest data on donor government funding to address the HIV epidemic in low-and-middle income countries. Funding from donor governments fell for the first time in five years, decreasing by 13% in 2015. The US remains the largest donor to HIV followed by the UK, France, Germany and the Netherlands.
>KFF - Press release - 15 July 2016
UNAIDS: Global AIDS Update 2016
A new report from UNAIDS shows that the number of people accessing antiretroviral medicines has more than doubled since 2010, with an estimated 17 million people getting this life-saving treatment by the end of 2015. As more countries adopt new guidelines from the World Health Organization (WHO) to treat everyone diagnosed with HIV immediately, the public health benefits are being realised for individuals and for wider society.
>UNAIDS – press release – 31 May 2016
2016 United Nations Political Declaration on Ending AIDS
Last month the UN General Assembly adopted a new political declaration that includes a set of time-bound targets to fast-track the pace of progress in combating HIV and AIDS over the next five years and ending the epidemic as a public health threat by 2030.
>UN – press release – 10 June 2016
IAS Global Scientific Strategy: Towards an HIV Cure 2016
This new strategy from the International AIDS Society (IAS) analyses recent achievements in HIV cure research, including the obstacles to a cure and the strategies and priorities to advance global HIV cure research. The strategy was published online in the journal Nature Medicine and builds on the first roadmap strategy published in 2012.
>IAS - press release - 12 July 2016
Launch of Global Antibiotic Research and Development (GARD) Partnership
A joint initiative by the WHO and the Drugs for Neglected Diseases initiative (DNDi) that seeks to develop new antibiotic treatments to address the major public health threat of antimicrobial resistance was launched on 24 May. At the time of the launch GARD had secured government funding commitments from Germany, the Netherlands, the UK and South Africa. Click the link for more information about the initiative, and also see the recent review on tackling drug-resistant infections globally in the reports section below.
WHO Global Health Sector Strategies for HIV, viral hepatitis and sexually transmitted infections
The Global Health Sector Strategies for HIV, viral hepatitis and sexually transmitted infections (STIs), 2016-2021, were formally adopted by Member States at the 69th World Health Assembly (WHA) at the end of May. This is an important milestone as the three strategies are fully aligned with supporting the attainment of the Sustainable Development Goals (SDGs), which include targets to end the HIV epidemic as a public health threat by 2030 and to combat viral hepatitis and other communicable diseases, including STIs. Final strategy documents are due to be posted on the WHO website shortly.
>WHO – global strategies – 26 May 2016
ECDC policy briefing: Preparing for Zika in the EU
The European Centre for Disease Prevention and Control (ECDC) has produced a policy briefing which highlights preparedness measures to minimise the risk of Zika virus spreading in continental Europe. Imported cases of Zika virus are already being seen in Europe as well as sexual transmission of Zika through travellers returning from affected areas, and this can be expected to continue given the high number of people travelling between the most affected regions and Europe.
>ECDC – publications – 23 June 2016
Pre-exposure prophylaxis (PrEP) in the EU/EEA setting: challenges and opportunities
At the end of April, the ECDC held a meeting with experts to discuss pending issues related to service models of HIV PrEP implementation in the EU/EEA Member States. Topics included appropriate models of care/services, cost-effectiveness, eligibility criteria, drug resistance, and routine monitoring of people on PrEP, including adherence to treatment and regular testing for HIV and other sexually transmitted infections. In the final session, participants were asked to identify priority issues emerging from the meeting and to suggest possible areas where ECDC might provide support to EU/EEA Member States. A report of the meeting is available on request by emailing STIHIVHEP@ecdc.europa.eu
>ECDC PrEP meeting – April 2016
Community Consensus Statement on access to HIV treatment and its use for prevention
Eight global HIV advocacy groups, including the European AIDS Treatment Group, have released a consensus statement spelling out the basic principles to be observed in the provision of HIV testing, treatment and drug-based prevention. The sign-on statement, available in English, French, Spanish, Russian and Portuguese, can be endorsed by people working with and affected by HIV. Click the link for more information.
>Statement - press release - 15 July
Parliament & other European institutions
State of Health in the EU, 2016-17
The European Commission has recently announced a two year initiative to bring together a wide array of country-specific and EU-wide knowledge on health. State of Health in the EU will aim to boost analytical capacity and support Member States with their evidence-based policy making. Click the link for more information.
>EC – State of Health – June 2016
Online Gender Equality Glossary and Thesaurus
This new online tool from the European Institute for Gender Equality (EIGE) features over 400 accurate, up-to-date and gender-sensitive definitions. The Gender Equality Glossary and Thesaurus will allow everyone across the EU and beyond to understand gender equality concepts in the same way and suggest preferred terms of use. The tool is currently available in English but will later be translated into all official EU languages, following an agreement on translations.
>EIGE – new glossary – 29 June
Treatment & service guidelines
Two new combination therapies against chronic hepatitis C
The European Medicines Agency (EMA) has recommended the granting of marketing authorisations in the European Union (EU) for two new combination therapies against chronic (long-term) hepatitis C virus (HCV) infection, Epclusa (sofosbuvir/velpatasvir) and Zepatier (grazoprevir/elbasvir). HCV infection is a major European public health challenge, affecting between 0.4% and 3.5% of the population in different EU Member States.
>EMA – press release – 27 May 2016
Generic manufacturing licenses for HIV and hepatitis C treatments
The Medicines Patent Pool (MPP) has announced new generic manufacturing licences for four HIV antiretrovirals and the hepatitis C direct-acting antiviral daclatasvir. The organisation signed licences with Aurobindo, Desano, Emcure, Hetero Labs, Laurus Labs, Lupin and new partner Zydus Cadila for a total of nine new sub-licensing agreements to produce generic versions of key World Health Organization-priority HIV and hepatitis C treatments.
>MPP – press release – 7 July 2016
WHO - Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach, Second edition
This new edition updates the 2013 consolidated guidelines on the use of antiretroviral (ARV) drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are published in a changing global context for HIV and recommend that all people living with HIV be provided with antiretroviral therapy.
>WHO – publication – June 2016
WHO guidelines for the treatment ofNeisseria gonorrhoeae
WHO has published evidence-based guidance on the treatment recommendations for gonococcal infections in response to changing antimicrobial resistance (AMR) patterns of N gonorrhoeae. The guidelines form one of several modules of guidelines for specific sexually transmitted infections (STIs), including the recently published one below on the treatment of Chlamydia trachomatis.
>WHO – publication – June 2016
WHO guidelines for the treatment of Chlamydia trachomatis
These guidelines provide updated treatment recommendations for common infections caused by C trachomatis based on the most recent evidence. It is strongly recommended that countries take updated global guidance into account as they establish standardised national protocols, adapting this guidance to the local epidemiological situation and antimicrobial susceptibility data.
>WHO - publication - July 2016
WHO guidelines on the management of health complications from FGM
WHO has published guidelines for healthcare professionals involved in the care of girls and women who have been subjected to any form of female genital mutilation (FGM). The guidelines will also help healthcare managers and policymakers in developing national and local healthcare protocols and policies.
ECEC - Emergency Contraception: A guideline for service provision in Europe
The European Consortium for Emergency Contraception (ECEC) has published a second edition of its guideline for emergency contraception service provision in Europe. The new edition takes into account changes in the emergency contraception field over the past two years, including more widely available data on safety and efficacy.
ECEC – An update on access to emergency contraception in European Union countries
This factsheet from ECEC provides a summary of the main changes in access to emergency contraception in Member States up to October 2015.
ECEC: New tool for emergency contraception (EC) counselling
ECEC has also published a counselling tool - Emergency Contraception Methods (the EC Wheel) - for pharmacists and health providers. The tool is inspired by the WHO Medical eligibility criteria for contraceptive use wheel, and based on WHO and the UK Faculty of Sexual and Reproductive Healthcare recommendations for EC use. The methods included are the copper IUD, levonorgestrel EC pills and ulipristal acetate EC pills.
>ECEC – publication – May 2016
Evidence & research
PARTNER Study
The results of a study conducted in 14 European countries to look at the risk of HIV transmission through condomless sex from an HIV-positive person taking suppressive ART have recently been published in the Journal of the American Medical Association (JAMA). Significantly, the PARTNER study found that there were no cases of within-couple transmission in HIV sero-different heterosexual and MSM couples having ongoing condomless sex. Click the link to access the journal article and an HIV i-base Q&A on the study.
Recent articles on impact of UK Government’s Teenage Pregnancy Strategy for England (1999-2010)
Two recent articles have looked at the impact of the UK Government’s 10-year teenage pregnancy strategy for England. An article in the Journal of Adolescent Health analyses the strategy against the WHO-ExpandNet framework and identifies key lessons which are applicable to low- and middle-income countries. A second in The Lancet reports on the impact of the strategy, particularly in deprived areas, and highlights the doubling in proportion of young mothers in education, employment and training.
>Journal of Adolescent Health 59 (2016) 68-74
>The Lancet PIIS0140-6736(16)30449-4
Abortion incidence between 1990-2014: global, regional and subregional levels and trends
A new study, undertaken by the Guttmacher Institute and WHO, indicates that the induced abortion rate declined significantly in more developed countries between 1990 and 2014, but not in developing countries. The continuing high rates of abortion, particularly in developing regions, underscore the need to improve and expand access to effective contraceptive services and safe abortion services. Click the link for more information and to access the study which was published in The Lancet in May.
Reports & resources
UNAIDS: Prevention gap report
This new report by UNAIDS reveals concerning trends in new HIV infections among adults. The Prevention gap report shows that while significant progress is being made in stopping new HIV infections among children (these have declined by more than 70% since 2001 and are continuing to decline), the decline in new HIV infections among adults has stalled. The report shows that HIV prevention urgently needs to be scaled up among this age group.
>UNAIDS – press release – 12 July
Review on Antimicrobial Resistance: Tackling drug-resistant infections globally
The final report and recommendations of a review into antimicrobial resistance was published in May. The report, commissioned by the UK Government in collaboration with the Wellcome Trust, discusses the mounting global problem of resistance and why action is needed to combat it. It also provides an overview of the solutions that the review thinks should be implemented to curtail unnecessary use and increase the supply of new antimicrobials. The report includes a case study analysis of the potential impact of a point-of-care test to distinguish gonorrhoea cases caused by antimicrobial-resistant and susceptible strains of Neisseria gonorrhoeae.
>Review - publication – May 2016
>Supporting paper on gonorrhoea
Social media strategy development: A guide to using social media for public health communication
This guide from ECDC provides public health organisations with a practical approach to integrating social media into their overall communication activities. It focuses on identifying effective ways to use social media to enhance crisis, risk and corporate communication with regard to communicable disease prevention and control.
ECDC Digital Toolkit for MSM HIV/STI prevention – survey
The ECDC, with support from Terrence Higgins Trust and Soa Aids Nederland, is developing a toolkit for effective use of key digital platforms for MSM HIV/STI prevention. A short survey has been developed to get views from staff members, volunteers and individuals who undertake HIV/STI prevention work with MSM in Europe on using social media, smartphone apps and websites and to identify what would be useful in the toolkit. Click the link to take the five minute survey.
Accessing HIV prevention, testing, treatment, care and support in Europe as a migrant with irregular status in Europe: A comparative 10-country legal survey
The European HIV Legal Forum (an AIDS Action Europe project) has published a comparative report which looks at how migrants with irregular status access treatment and care in 10 European countries. The report reviews relevant international regulations and European laws in favour of the right to healthcare.
How to leverage European Union funding for health in Eastern Europe and Central Asia
The TB Coalition has launched a guide for civil society organisations across the European region explaining how to access European Union funding in support of their TB and HIV activities. It provides a snapshot of all the different EU funding instruments and gives examples and tips on the best way to leverage funding.
21st International AIDS Conference, Durban, South Africa
The 21st International AIDS Conference (AIDS 2016) was held in Durban, South Africa, last week (18-22 July). Official scientific news was reported extensively by aidsmap.com where a round-up of all the conference highlights is available in English, French, Italian, Portuguese, Russian and Spanish.
>aidsmap – conference news – July 2016
Sexual health rights & advocacy
ILGA – Annual review of the human rights situation of LGBTI people in Europe
ILGA-Europe has published its annual review of human rights for lesbian, gay, bisexual, trans and intersex people in Europe. It covers the period January – December 2015, provides a snapshot of what happened during the year at national, regional and international levels, and documents progress and trends.
>Review (including country reports) – May 2016
Know it, Own it! Your Sexual Rights Matter! Campaign
Back in May (18 May) the International Planned Parenthood Federation (IPPF) launched its global campaign calling for better quality Comprehensive Sexuality Education (CSE). The campaign urges governments and policymakers to strengthen policies around sexuality education to advance the human rights of young people around the world. IPPF also published Everyone’s right to know: delivering comprehensive sexuality education for all young people to mark the launch of the campaign.
>IPPF - CSE Campaign – May 2016
#WhatWomenWant Campaign
The international #WhatWomenWant Campaign was launched in May by the ATHENA network in partnership with women’s civil society. The campaign engages activists and advocates in social media across issues of gender equality, HIV, gender-based violence, women’s rights and sexual and reproductive health rights.
International Safe Abortion Day
28 September has become an internationally recognised day for grassroots activism in support of safe abortion. It engages advocates from around the world in a united call to countries and health services to respect, protect and fulfil women’s right to safe abortion. This year the International Campaign for Safe Abortion has prepared a letter to send to UN Secretary-General Ban Ki-moon and heads of UN agencies calling on them to declare the date an official UN day. Click the link for more information and to add your support to the campaign.
>International Campaign for Safe Abortion
Other campaigns & news
World Hepatitis Day 2016
Today (28 July) is World Hepatitis Day (WHD). This is a pivotal year as WHO Member States are set to adopt the first ever health sector strategy on viral hepatitis, with targets and goals to eliminate viral hepatitis as a public health threat by 2030. Click for more information on WHD and to download materials and resources.
Hornet Gay Social Network: PrEP survey
The initial results of a survey undertaken by the Hornet Gay Social Network on PrEP use among men who have sex with men (MSM) in Europe are now available in infographic format. The survey was rolled out over three days to Hornet users in Europe in April 2016 in preparation for the ECDC meeting on HIV PrEP implementation in Europe later that month (see more details on this in policy section). Go to the European AIDS Treatment Group (EATG) website for more information.
FLASH! PrEP in Europe Survey
The Flash! PrEP in Europe online survey was officially launched last month (15 June 2016). The survey aims to assess prevention needs in relation to pre-exposure prophylaxis (PrEP), looking at awareness, knowledge and potential and actual use of PrEP amongst people who are HIV negative. It is coordinated by AIDES in France, will cover 11 European countries and is endorsed by the EATG. The survey closed on 15 July and results will be widely disseminated later in the year.
The PrEP in the Wild survey
AIDS Foundation Chicago in collaboration with the University of California, Los Angeles, is also conducting the PrEP in the Wild survey. This is a global survey to find out how many people worldwide are accessing HIV drugs to take as PrEP by buying them online, from friends, from their doctor prescribing them off-label, and in other ways that are not part of a formal study or PrEP programme. Click to access the survey.