Welcome to the December 2019 Sexual Health & HIV Policy EUROBulletin.
Our eFeature in this edition is an interview with Dr Cristian Furau, board member at the European Society for Contraception and Reproductive Health (ESC). We spoke to Cristian about The Madrid Declaration, a recent statement from ESC aimed at improving sexual and reproductive health care in Europe, and how he has used it as an advocacy tool in Romania.
This edition also highlights the wealth of research presented at the European AIDS Clinical Society conference (EACS 2019) and the new European HIV treatment guidelines which were launched there. In the run-up to World AIDS Day on 1 December, the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) also published the latest European HIV statistics.
Other items to look out for in this edition include: reporting from the PrEP in Europe Summit and the European ChemSex Forum; WHO recommendations for rapid HIV testing; and an overview of European abortion laws.
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eFeature
Dr Cristian Furau is a specialist gynaecologist and obstetrician in Arad, Romania, and a board member for the European Society for Contraception and Reproductive Health (ESC).
In this eFeature interview, we spoke to Cristian about the recent ESC publication, ‘The Madrid Declaration: promoting evidence-based SRHR policies with respect for human rights’ and how he has used it as an advocacy tool.
> Dr Cristian Furau – eFeature interview
Evidence, data & research
Half of all women with HIV are diagnosed late in Europe
The latest data released by the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) show that 54% of women diagnosed with HIV in the European region are diagnosed ‘late’ (with a CD4 count below 350). Women in their 40s were more likely to be diagnosed late than younger women.
This headline statistic comes from the new HIV/AIDS Surveillance in Europe 2019 report, based on 2018 data, released ahead of World AIDS Day. Over 140,000 new diagnoses were made in 2018. Trends seen in previous years continue, with wide variation between countries and much higher rates of new transmissions in eastern European countries (61% of all new diagnoses were in Russia). In the last decade, several countries have seen a decline in new diagnoses, while others report an increase of over 50%.
> Read the press release on the WHO website
> Download the full report and infographics from the ECDC website
Progress on 90-90-90 HIV targets shows stark gap between eastern and western Europe
The recent European AIDS Conference (EACS 2019) heard that the 90-90-90 targets for HIV diagnosis, treatment and viral suppression will be missed in much of eastern Europe due to poor access to HIV treatment. About 400 new HIV infections occur each day in the region.
In 2014, UNAIDS adopted the 90-90-90 targets for 2020 – 90% of people with HIV diagnosed; 90% of diagnosed individuals on antiretroviral therapy; 90% of those on antiretrovirals achieving viral suppression. Although late diagnosis is a challenge across Europe, there is wide variation between eastern and western Europe in relation to linkage to care after diagnosis. In eastern Europe, only 65% of people diagnosed with HIV are on antiretroviral treatment.
> Find out more on aidsmap.com
News from the 17th European AIDS Conference
The 17th European AIDS Conference (EACS 2019), organised by the European AIDS Clinical Society, took place in Basel, Switzerland, from 6 to 9 November 2019. As the official online scientific news reporter for the conference, aidsmap.com published news reports on research presented at the conference and daily summary bulletins, which are available in English, French, Italian, Portuguese, Russian and Spanish.
> Visit the EACS 2019 conference pages on aidsmap.com
> Visit the official conference website
European ChemSex Forum
The recent European ChemSex Forum, held in Paris, explored the reasons why gay men do chemsex (using drugs in sexual situations) and the complexity of people's experiences. It also heard that chemsex is an emerging issue in the Middle East and eastern Europe.
> Read Why do gay men do chemsex? on aidsmap.com
> Read Chemsex is an emerging issue in the Middle East and eastern Europe on aidsmap.com
Treatment & service guidelines
New European HIV guidelines cater for multiple needs
The tenth edition of the European AIDS Clinical Society guidelines for the treatment of adults with HIV in Europe was launched at the European AIDS Conference (EACS 2019), in Basel, Switzerland, last month.
It includes new sections on drug interactions, the ageing patient, dose adjustment and HIV treatment during pregnancy. Two new antiretrovirals, bictegravir and doravirine, have been added, and some older medications have been removed.
> Find out more on aidsmap.com
> Download the guidelines from the EACS website
WHO issues strong recommendation for rapid HIV testing
The World Health Organization (WHO) has issued a strong recommendation for services providing HIV testing to use rapid tests. Using rapid, point-of-care test kits means that results can be given straightaway, avoiding the need for people to return for test results.
The recommendation published by WHO follows an analysis of the evidence around testing. A review compared using older western blot and line immunoassay methods for confirmation of HIV diagnosis with the use of rapid tests and enzyme immunoassays. The analysis is summarised in a policy brief, and new consolidated testing guidelines were published ahead of World AIDS Day.
> Read the policy brief on the WHO website
> Read the guidelines on the WHO website
Parliament & other European institutions
European Parliament condemns Polish bill on sexual education
The European Parliament passed a resolution condemning a draft law in Poland. The draft law would criminalise the provision of relationship and sexuality education, including on contraception, prevention of sexually transmitted infections, sexuality and consent. The resolution from the European Parliament, voted through by 471 Members of the European Parliament, reaffirms that relationship and sexuality education is enshrined in human rights law.
> Find out more on the IPPF EN website
Sexual health rights & advocacy
How do we deal with apparent cases of PrEP failure?
The 17th European AIDS Conference (EACS 2019) heard details about a man who acquired HIV despite taking PrEP (regular medication to prevent HIV infection). Dr Hans Hampel presented the case and it prompted discussion of a need to better document possible causes of PrEP failure, so they can be better understood.
PrEP in Europe Summit
The second PrEP in Europe Summit was held in Warsaw, Poland, in October. The summit brought together PrEP users and activists, funders, researchers and clinicians, to discuss the barriers to implementing PrEP in Europe and how key stakeholders can work together to speed up implementation. Catch up on the news from aidsmap.com, including a report on the cost and implementation of PrEP across Europe, and reports on PrEP services in Poland and France.
> Read PrEP services in France are changing in order to engage more people on aidsmap.com
Criminalisation of HIV in Europe
The European HIV Legal Forum (EHLF) has published preliminary findings of its report on criminalisation of HIV in Europe. It looks at the laws under which prosecutions have taken place; characteristics of people being prosecuted; and media reporting around cases. The full report will be published in the new year.
EHLF is part of AIDS Action Europe (AAE) and aims to bring together legal and policy experts to improve access to HIV services. Criminalisation was also the focus of a recent AAE meeting, from which presentations are available online.
> Read the EHLF preliminary findings
> Find out more about the AAE meeting
Policy development & guidance
Report provides overview of European abortion laws
The Center for Reproductive Rights has published a comparative report of European abortion laws. It reveals that 95% of women live in countries where laws allow abortion. However, it also highlights that Europe remains at risk of attempts to rollback abortion rights.
Evidence brief on PrEP in Europe and Central Asia
The European Centre for Disease Prevention and Control (ECDC) has published an evidence brief on key issues in PrEP access in Europe and Central Asia. It found that, since 2016, there has been an increase in the number of countries in the region implementing PrEP, either as national healthcare provision or through research projects. It also found evidence of considerable 'informal' use of PrEP, such as through people buying it online. It concludes that improved data collection and monitoring of PrEP uptake and outcomes is needed to support PrEP implementation.
Campaigns & other news
AIDS Action Europe supports alternative community-led conference in Mexico in 2020
AIDS Action Europe, a regional network of more than 400 non-governmental organisations in Europe, has announced its support for HIV2020, a community-led conference planned to take place in Mexico in July 2020. The conference is being organised by an alliance of networks of people living with HIV and key populations, in response to the announcement that the next International AIDS Society conference (AIDS 2020) will be held in the USA. The conference aims to provide a safe alternative for individuals who cannot or will not enter the USA or who cannot afford to attend AIDS 2020.
> Read the statement from AIDS Action Europe
Country-specific news
England
HIV-positive gay men in England report highest chemsex rates in four-country survey.
France
French study finds one in six participants stops PrEP within 12 months, one in three after 30 months.
Germany
German study finds intermittent and lower-risk PrEP users may not be testing for HIV and sexually transmitted infections.
Ireland
Insurers urged to change their policies to prevent discrimination of people in Ireland living with HIV.
Italy
Italian-led study finds switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) is associated with improvements in bone mineral density in people over 60.
Russia
The World Health Organization and the Russian Federation are working to strengthen collaboration to address HIV drug resistance.
Scotland
Scotland's first addiction service treating people with pharmaceutical grade heroin is set to open in Glasgow. The service will work with the most at-risk heroin users who are in danger of a fatal overdose, or acquiring HIV and hepatitis C.
Slovakia
Slovakia’s Parliament rejects harmful restrictions on safe abortion care.
Spain
The first likely case of sexual transmission of dengue in Europe has been reported in Spain.
The Netherlands
Rates of pneumonia and pneumococcal disease remain high among people with HIV in The Netherlands.