Welcome to the December 2023 Sexual Health & HIV Policy EUROBulletin.
In the feature in this edition, we talk to Dr Godelieve de Bree, project leader of the HIV Transmission Elimination AMsterdam (H-TEAM) Initiative. The work of H-TEAM has contributed to an astonishing 95% decline in HIV in Amsterdam. We spoke to Godelieve about the interventions the H-TEAM focused on and their plans for the future.
World AIDS Day was on 1 December. In the run-up to it, UNAIDS released a new report highlighting the importance of the community HIV response, under the banner ‘Let communities lead’. The European Centre for Disease Prevention and Control (ECDC) published a series of reports on HIV, including its annual HIV surveillance report published jointly with the World Health Organization (WHO).
Other items to look out for in this edition include: a new ECDC report on syphilis; a reflection on progress and threats to abortion care in the last year; a European Parliament debate on access to sexual and reproductive health and rights (SRHR) for Ukrainian refugees; and a free webinar on campaigning for LGBTI rights without fuelling polarisation.
Not your copy of the bulletin? Click the link below to subscribe.
Feature
The Eurosurveillance journal recently published an article titled, A 95% decline in estimated newly acquired HIV infections, Amsterdam, 2010 to 2022. It was written by the HIV Transmission Elimination AMsterdam (H-TEAM) Initiative.
Many factors contributed to the decline in HIV, but the work of the H-TEAM is an inspiring part of the picture. We spoke to Dr Godelieve de Bree, H-TEAM project leader, about what the initiative has done so far and its plans for the future.
Evidence, data & research
New annual report on HIV in Europe
The WHO Regional Office for Europe and ECDC released their joint report on HIV, based on 2022 data, in advance of World AIDS Day on 1 December.
They report a 4.2% increase in HIV diagnoses, which they attribute to improved access to testing. A total of 110,486 HIV diagnoses were reported in the European Region in 2022.
The data highlight regional differences, with 71.6% of new diagnoses reported in eastern Europe.
The authors highlight the importance of expanding access to HIV testing and treatment, as well as addressing stigma and discrimination, as these are barriers to people seeking diagnosis and care.
Together, WHO and ECDC advocate for “evidence-based responses, community involvement, and innovative testing strategies”.
HIV and people who inject drugs
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) marked World AIDS Day by highlighting the latest data on HIV among people who inject drugs.
The 2022 data show an increase in new HIV diagnoses linked to injecting drug use. More than a third of these were late diagnoses (CD4 under 350). EMCDDA highlights the increase in stimulant injecting as a particular concern.
New European report on syphilis
ECDC has published its latest report on syphilis in the region.
In 2021, 25,270 confirmed syphilis cases were reported in 28 EU/EEA countries. Syphilis rates were nine times higher in men than in women and were highest in men aged 25 to 34. The majority (77%) of syphilis cases with information on transmission category were reported in men who have sex with men (MSM).
Between 2015 and 2021, the number of syphilis notifications in HIV-negative MSM increased by 87% (in the eight countries that reported consistently).
HIV research news
The 19th European AIDS Conference (EACS 2023), organised by the European AIDS Clinical Society, was held in Warsaw, Poland, in October. NAM aidsmap was the official scientific news reporter for the conference.
NAM aidsmap published news reports from the conference, short video interviews with researchers, and also sent out summary bulletins by email in English, French, Italian, Portuguese, Russian, Spanish and Ukrainian. All the coverage is freely available online.
HIV and TB in eastern Europe
The rates of tuberculosis (TB) recurrence and mortality in people with HIV in eastern Europe remain concerningly high and continue to be a clinical and public health challenge, according to a paper published in the journal AIDS.
TB cases have been decreasing across Europe since 2000, but two major challenges remain: a high prevalence of multidrug-resistant TB (MDR-TB) and high rates of TB/HIV co-infection, especially in Russia, Belarus and Ukraine.
This is the first study to report on long-term follow-up of people with TB and HIV co-infection in eastern Europe. Clinics in Belarus, Georgia, Latvia, Poland, Romania and Russia contributed data on 375 people in their care. Follow-up time was an average of 4.6 years. One in seven people had TB again and over half of people with recurrent TB died.
Gender-neutral HPV vaccination is the best strategy
In a new study, researchers in Sweden and Finland have found that the most effective way to prevent cervical cancer is to give HPV vaccines to both boys and girls. In some European countries, HPV vaccination is only given to girls, but over the last few years, several countries have begun vaccinating boys and girls.
A previous study in Finland worked with 33 towns, in which communities were randomly assigned to vaccinate boys and girls, vaccinate only girls, or not to have HPV vaccination.
The new study, published in the journal Cell, Host and Microbe, looked at cancer-causing HPV types in these communities, eight years after vaccination. In the 22 towns in which the HPV vaccine had been offered, HPV types 16 and 18 declined significantly. In the towns that vaccinated only girls, there was also a decrease in HPV 31, while in the towns that vaccinated both boys and girls, HPV 31 and 45 also declined.
Lead author, Dr Ville Pimenoff, said, "According to our estimations, it would take 20 years of vaccinating girls to achieve the same effect that can be achieved in eight years with a relatively moderate coverage gender-neutral vaccination.”
Progress towards a new treatment for gonorrhoea
The Global Antibiotic Research and Development Partnership (GARDP) has announced successful results from a phase 3 trial of an oral first-in-class antibiotic called zoliflodacin.
The trial enrolled 930 people with gonorrhoea, including women, adolescents and people living with HIV, at 16 sites in Belgium, the Netherlands, South Africa, Thailand and the US.
Oral zoliflodacin was shown to be non-inferior compared to treatment with an injection of ceftriaxone and oral azithromycin.
If approved by regulatory authorities, zoliflodacin would be the first new antibiotic for gonorrhoea treatment in decades.
Ongoing monitoring of mpox
ECDC and the WHO Regional Office for Europe continue to monitor cases of mpox (formerly known as monkeypox).
In the four weeks to 6 October, 175 cases of mpox were reported in the European region, in 13 countries.
Policy development & guidance
Mapping SRHR policy
The European Parliamentary Forum for Sexual and Reproductive Rights (EPF) has launched the SRHR Policy Hub, a new website that enables people to view, compare, and download national data from the Global Contraception Policy Atlas.
Consensus statement on prescribing emergency contraception
A consensus statement recommending best practice for the dispensing of emergency contraception in community pharmacies, based on evidence and on human rights, has been launched by a group of international organisations.
The European Society of Contraception and Reproductive Health (ESC), the International Federation of Gynecology and Obstetrics (FIGO), the International Planned Parenthood Federation (IPPF), and the European Consortium for Emergency Contraception (ECEC) say their aim is to contribute to the standardisation of access to high-quality emergency contraception services within and across European states; and to provide basic recommendations for emergency contraception dispensing in pharmacy settings, according to the best evidence available and to human rights principles.
Sexual health rights & advocacy
Community manifesto for long-acting PrEP
More than 40 organisations have endorsed a community manifesto calling for the introduction of long-acting injectable PrEP (regular medication to prevent HIV) in Europe.
The organisations agreed four 'pillars', which form the advocacy approach to achieving access to long-acting cabotegravir (LA-CAB) as PrEP.
Pillar one: to push for the introduction of LA-CAB at the earliest opportunity.
Pillar two: to push for national LA-CAB implementation projects while collecting data to inform guidelines for full scale-up.
Pillar three: to advocate for the affordability of LA-CAB regionally and globally.
Pillar four: to challenge the social and structural barriers to the introduction of PrEP.
Call for greater commitment to SRH self-care interventions
In a joint statement, several United Nations agencies and partners have called for greater commitment and investment in self-care interventions for sexual and reproductive health (SRH).
Examples of SRH self-care interventions include self-sampling and self-testing for HIV, pregnancy and sexually transmitted infections; self-administering injectable contraception; and self-managing medical abortion.
Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO and the UN Special Programme of Research, Development and Training on Human Reproduction (HRP), said, “Self-care interventions offer huge potential in ensuring people have access to the sexual and reproductive health services they need.”
Webinar: how to campaign without feeding polarisation
The European branch of the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA-Europe) is hosting a webinar on 13 December with the title, Effective campaigns in support of LGBTI rights: how to avoid instrumentalisation and communicate without playing into polarisation.
The event will include examples from activists in Hungary and Spain.
Reports & resources
HIV monitoring reports – migrants and continuum of care
In addition to its main HIV data report, ECDC has also recently published two further reports on the HIV response in Europe.
The first focuses on migrants, defined as people born outside of the reporting country. Migrants accounted for 48% of those diagnosed with HIV in the EU/EEA in 2022. ECDC recognises that migrants living with HIV, particularly undocumented migrants, experience intersecting stigma and discrimination. Available data vary, but there are some concerning gaps in response. For example, 20% of reporting countries in the European region indicated that national treatment policies exclude undocumented migrants from accessing antiretroviral therapy.
The second report assesses progress on the HIV continuum of care. Current UN targets are for 95% of all people living with HIV to be diagnosed, 95% of those diagnosed to be on antiretroviral treatment and 95% of those on treatment to have achieved viral suppression by 2025.
ECDC reports that the overall performance of the region in 2022 was: 83% of all people living with HIV were diagnosed, 85% of those diagnosed were on treatment and 93% of those on treatment were virally suppressed. There was considerable regional variation: in the west subregion, the results were 90-96-94; in the centre, 85-80-76; and in the east, 78-78-93.
Abortion care in Europe: progress and threats
IPPF-EN has published an overview of the changes to abortion laws and policies in European countries over the last year.
IPPF explains that "the devil is in the detail, and the detail frequently changes", with compulsory counselling, waiting times and gestational limits impacting care.
Alongside regressive changes and threats to care, there have also been positive reforms in some countries in the past year.
‘Let communities lead’
A new report from UNAIDS, released to mark World AIDS Day, shows the critical role played by communities in the HIV response, and explains how underfunding and other barriers are holding back their work.
Robbie Lawlor, Co-Founder of Access to Medicines Ireland, said, “We are the vehicle for change that can end systematic injustices that continue to fuel HIV transmission. We have seen groundbreaking developments with U=U, improved access to medicines, and have made great strides in decriminalisation."
UNAIDS is calling for: communities’ leadership roles to be a core part of HIV plans and programmes; communities’ leadership roles to be fully funded; and for barriers to communities’ leadership roles to be removed.
Parliament & other European institutions
European Parliament debate highlights SRHR for Ukrainian refugees
In a plenary debate, Members of the European Parliament (MEPs) expressed concerns for refugee women from Ukraine, including their access to sexual and reproductive health and rights (SRHR).
In some EU member states, in particular Hungary, Poland, Romania and Slovakia, Ukrainian refugees continue to report being unable to access the health and support services they need.
Under the EU Temporary Protection Directive, which was activated in 2022, member states have clear obligations to ensure access to emergency and essential care and treatment, and to guarantee care for survivors of sexual violence.
Viola von Cramon MEP, said in the plenary, "Without action to renew reproductive healthcare commitments in all member states, we will have broken our promise of safety and sanctuary for Ukrainian refugees."
Commenting on the debate, Leah Hoctor, Senior Regional Director for Europe at the Center for Reproductive Rights, said, "It is vital that the EU live up to its commitments to refugees from Ukraine and take concrete and urgent action to address gaps in the implementation of the Temporary Protection Directive.”
World AIDS Day event in the European Parliament highlights stigma
At an event to mark World AIDS Day, held at the European Parliament, there were calls to eliminate HIV-related stigma and discrimination.
Spain holds the current presidency of the Council of the European Union and has made the elimination of HIV-related stigma and discrimination a priority.
At the event in Brussels, UNAIDS Deputy Executive Director, Christine Stegling, said, "Stigma and discrimination against people most affected by HIV are the biggest barriers to accessing lifesaving HIV prevention and care. We look forward to working with European Union Member States, the European Parliament and the Council of the European Union, to take this agenda forward."
Treatment & service guidelines
Technical manual on diagnostic testing for STIs and HIV
WHO has published an updated version of its laboratory ‘bench manual’ on procedures for isolating, detecting and diagnosing sexually transmitted infections (STIs), including HIV.
The updated version includes the principles of laboratory and point-of-care (POC) testing, as well as antimicrobial susceptibility (resistance) testing.
Men and HIV: a framework to overcome barriers to engagement
Around the world, the majority of new HIV acquisitions are in men. WHO has recognised that improving access to HIV services for men is important, from testing through to treatment and care.
WHO has published a new framework document, which looks at the barriers to services that men currently experience and ways of addressing these and improving outcomes for men.
Campaigns & other news
Webinar: HIV cure research
HIV prevention organisation, AVAC, is hosting a series of webinars on HIV cure research. Its next webinar, on 13 December, will focus on 'how our environment impacts cure', including discussion of how external factors such as time to treatment initiation and co-infections impact approaches.
PrEP campaign in eastern Europe
ECOM – the Eurasian Coalition for Health, Rights, Gender and Sexual Diversity – has launched a campaign to promote PrEP among men who have sex with men in eastern Europe and central Asia.
All the campaign’s promotional materials are available in Russian and English. Selected images are also available in Armenian, Georgian, Kazakh, Kyrgyz, Romanian, Tajik and Ukrainian.
Country-specific news
England | A new research project has been announced, which will evaluate the expansion of an HIV opt-out testing programme in 46 additional emergency departments in England. A pilot programme was extremely successful in identifying people with hepatitis B and C, and HIV, who were previously undiagnosed or had disengaged from care.
France | A poster at EACS 2023 presented the PrEP usage of 161 women in Paris between 2017 and 2023. Most female PrEP users were transgender (60%) and from South America (78%). In common with other PrEP studies, cisgender women were less likely than transgender women to continue PrEP for more than a few months.
Ireland | First-time HIV diagnoses decreased by 16% in Ireland in 2022, compared to 2019. Gay, bisexual and other men who have sex with men made up 58% of first-time diagnoses. However, there was a 68% increase in the overall number of HIV diagnoses, largely attributable to people arriving from outside of Ireland being linked to care.
The Netherlands | PrEP treatment and care is to become available to everyone at increased risk of HIV in the Netherlands from next year, with increased government funding. Currently PrEP is only available to men who have sex with men and transgender people.
Poland | IPPF-EN strongly welcomed the result of Poland's parliamentary elections in October, which saw opposition parties win out over the sitting ultra-conservative party. Their defeat gives new hope for women's rights.
Russia | Russia's Supreme Court has classified what it called the 'International LGBT Public Movement' as extremist, fuelling a fear of prosecution and imprisonment in LGBT communities and those working to support them. ILGA-Europe condemned the move, and called on international organisations to provide support to Russian activists through funding and other practical help.
Spain | A study based on data from the Spanish PISCIS HIV cohort reported to EACS 2023 that people with HIV who were diagnosed with COVID-19 had a 35% higher risk of a major cardiovascular event in the following year compared to other people with HIV.
Sweden | A study of access to contraception in Sweden during the COVID-19 pandemic found that most women felt their access to services was unaffected. Among the remainder, more felt it had deteriorated than improved. Use of telemedicine was low and overall use of contraception fell.
Ukraine | Although there is continuity in the provision of HIV prevention, treatment and care in Ukraine, the country is starting to falter in its provision of some services and has become completely reliant on external funding.