Welcome
Welcome to the June 2019 Sexual Health & HIV Policy EUROBulletin.
Our eFeature in this edition is an interview with Caroline Hickson, Regional Director for the International Planned Parenthood Federation European Network (IPPF EN). We spoke to Caroline about the wide variation in access to abortion care in Europe, the impact of the current political climate, and IPPF EN's advocacy work around abortion and reproductive rights.
We have previously reported on the observed backlash against gender equality and attempts to roll back women's rights through restricting access to reproductive health services. This month we highlight the Rainbow Europe map, devised as a benchmarking tool to measure progress towards equality for LGBTI people, which this year found some countries moving backwards.
In the current political climate, advocacy is more important than ever and this edition includes opportunities to get together with fellow advocates at the PrEP in Europe summit and the Inspire conference. The HIV Justice Network report also highlights the many great grassroots advocacy initiatives working to end HIV criminalisation.
Other items to look out for in this edition include: a rapid risk assessment on false-negative chlamydia test results; a collection of articles dedicated to self-care in sexual and reproductive health; and findings from a large randomised trial, which has provided reassuring evidence to show that long-acting contraceptives do not raise women’s risk of HIV infection.
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eFeature
Caroline Hickson is Regional Director of the International Planned Parenthood Federation European Network (IPPF EN).
In this eFeature interview, we spoke to Caroline about abortion access across the European region and IPPF EN’s advocacy and lobbying work.
> Caroline Hickson – eFeature interview
Policy development & guidance
Rainbow Europe benchmarking tool shows regression in LGBTI equality
The European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA-Europe) has released its 10th annual Rainbow Europe map. Rainbow Europe ranks countries according to LGBTI rights, assessing the legal and political landscape in each country and making recommendations for continued progress. For the first time, some countries are moving backwards.
> Visit the Rainbow Europe website
Criminalisation of HIV transmission
A global review of HIV criminalisation cases, published by HIV Justice Network, has found that HIV-related arrests, investigations, prosecutions and convictions have occurred in at least 72 countries, with recent cases occurring in 49 countries, including 14 in which the law appeared to be applied for the first time.
During the period covered by the report (October 2015-December 2018), the largest numbers of cases were reported in the Russian Federation (at least 314 cases), Belarus (249), United States (158), Ukraine (29), Canada (27), Zimbabwe (16), Czech Republic (15), United Kingdom (13), France (12) and Taiwan (11).
The report also highlights promising developments in case law, law reform and policy, often the result of advocacy from individuals and organisations working to end the inappropriate use of the criminal law to regulate and punish people living with HIV.
HIV prevention cascade proposed
Writing in The Lancet HIV, researchers argue that a simple HIV prevention cascade could be a powerful tool for advocates, policy makers and funders. It could help us understand where the gaps in prevention are, to monitor implementation and to set meaningful targets. They propose a generic HIV prevention cascade which recognises that the use of prevention methods is behavioural, affected by social and structural forces.
> Read the article in The Lancet HIV (free, requires registration)
Treatment & service guidelines
False-negative chlamydia results reported using Aptima Combo 2 Assay
The European Centre for Disease Prevention and Control (ECDC) has released a rapid risk assessment following reports from Finland of false-negative or equivocal results in people tested for chlamydia using a specific test kit – the Aptima Combo 2 Assay (AC2). It is estimated that 6-10% of positive cases may have been missed in Finland as a result of false-negative or equivocal results. The test is widely used in European countries.
Hologic, the company which manufactures the test, has reported that the cause is likely to be a new variant of chlamydia circulating, which includes a mutation in a specific gene which the test targets.
ECDC encourages countries using the test to review chlamydia rates for any unexplained changes, investigate the presence of the new variant and, if the variant is found, to consider recalling people who may have received false-negative results for testing.
> Download the ECDC rapid risk assessment
> Download the Urgent Field Safety Notice from Hologic
Setting auditable standards of care for HIV across Europe
Earlier this year, the European AIDS Clinical Society (EACS) hosted a meeting in Romania to work towards setting auditable standards of care for HIV, co-infection and co-morbidity treatment throughout Europe. The meeting highlighted the huge disparities in care in different countries, with Eastern Europe continuing to have one of the worst HIV epidemics in the world.
Contraceptive choices for women who are overweight
New clinical guidance from the UK's Faculty of Sexual & Reproductive Healthcare (FSRH) reviews the evidence around contraception and weight and focuses on contraceptive choices for women who are overweight and women with obesity.
Reports & resources
Self-care in sexual and reproductive health
The BMJ has published a collection of articles dedicated to self-care inverventions in sexual and reproductive health. In general, there has been a recognition in recent years that self-care is an important aspect of health care, but there has been little focus on self-care in sexual and reproductive health. The BMJ collection covers self-care from different perspectives, including research into self-administration of injectable contraception, self-collection of samples in testing for sexually transmitted infections, and home ovulation kits.
Pilot project monitoring HIV drug resistance
The European Centre for Disease Prevention and Control (ECDC) has published the results of a pilot study on developing a reporting system for HIV drug resistance in Europe. More timely and consistent monitoring of HIV drug resistance in newly diagnosed patients could be used to inform treatment policies.
Parliament & other European institutions
Committee for Medicinal Products for Human Use
So far in 2019, the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) has made recommendations for approval of two treatments for HIV: a generic version of atazanavir (Atazanavir Krka), for the treatment of HIV in adults and children 6 years of age and older; and a combination of dolutegravir and lamivudine (Dovato), which does not need to be taken with a third agent.
> Read the summary of opinion for Atazanavir Krka (PDF)
> Read the summary of opinion for Dovato (PDF)
Sexual health rights & advocacy
PrEP in Europe Summit 2019: applications open
The second PrEP in Europe Summit is being held in Warsaw, Poland from 10-12 October. The theme of this year's Summit is 'The right to PrEP: Getting PrEP right' – ending unequal access to effective HIV prevention in Europe. NAM aidsmap is one of eight partner organisations that make up the PrEP in Europe initiative.
Applications are now open for the Summit. If you are applying for a scholarship, the deadline is 1 July. The non-scholarship application deadline is 1 August.
> Visit the PrEP in Europe website
Trans rights and sexual and reproductive health
As part of a series of blogposts to mark Pride Month, Inspire (formerly EuroNGOs) explores the need for a trans focus within sexual and reproductive health and rights, calling for partners and allies to work to make sexual and reproductive health as inclusive as possible.
The Sexual and Reproductive Health Matters (SRHM) journal has also shared a blogpost on 'framing reproductive justice in the context of institutionalised transphobia'.
Transgender Europe has published its 2019 Trans Rights Europe & Central Asia map, highlighting information on individual countries, including the fact that forced sterilisation of trans people is still a legal requirement for people seeking gender recognition in 16 countries in the region.
> Read the blogpost from Inspire
> Read the blogpost from the SRHM journal
The 2019 Inspire conference
The 2019 conference for Inspire (formerly EuroNGOs) will be held in Athens, Greece, 1-2 October. Covering a range of sexual and reproductive health and rights issues from a policy and advocacy perspective, the three key strands for this year's conference will be: the future agenda to be set at the Nairobi Summit (the International Conference on Population and Development); how to deal with the current attack on gender; and how to increase access to medical abortion.
CSE advocacy toolkit for young people
Four YouAct advocates at the European Parliament. Image credit: YouAct.
YouAct, the European Youth Network on Sexual and Reproductive Rights, has published a toolkit for young people aiming to improve comprehensive sexuality education (CSE) through advocacy with Members of the European Parliament (MEPs). It includes advice on setting advocacy messages, developing an action plan, meeting with MEPs and follow-up steps.
> Find out more about the project's development
Evidence, data & research
New European hepatitis B figures released
This month, the European Centre for Disease Prevention and Control (ECDC) published its 2017 annual epidemiological report on hepatitis B. Of the 27,000 newly reported cases, 58% were classified as chronic infections, continuing an upward trend since 2008, while newly reported acute infections continue to fall. ECDC suggests this is likely to be due to successful vaccination programmes.
ECDC highlights the lack of data around transmission and the difficulty of understanding hepatitis B epidemiology in Europe as a result. Where data were available, 27% of hepatitis B infections were attributed to heterosexual transmission and 13% to sex between men.
> Download the World Health Organization Action Plan for viral hepatitis in the European region
Injectable contraception and HIV
A large trial (the ECHO study) has found no difference in the risk of acquiring HIV for women using three different types of long-acting, reversible contraception. The study, in sub-Saharan Africa, was designed to investigate whether the long-acting contraceptive injection DMPA-IM (intramuscular depot medroxyprogesterone acetate, or Depo Provera) raised the risk of HIV infection for women compared to other widely available and highly effective methods of long-acting contraception. Previous analyses of observational studies had indicated an increased risk, but this large, randomised trial concluded that there was no substantial difference in HIV risk between the contraception methods in the trial: DMPA-IM, copper intrauterine device (IUD) or levenorgestrel (LNG) implant.
Other news
IAS 2019
The 10th International AIDS Society conference (IAS 2019) is being held in Mexico City from 21 to 24 July 2019. NAM is delighted to have been selected as an official scientific media partner for the conference by the International AIDS Society. As a subscriber to the Eurobulletin, you will automatically receive our IAS 2019 news summary bulletins.
16th ESC Congress call for abstracts
The 16th Congress of the European Society of Contraception and Reproductive Health (ESC) will be held in Dublin, Ireland, 13-15 May 2020. Abstract submission is now open until 7 October 2019.
IUSTI 2019 conference
The International Union Against Sexually Transmitted Infections (IUSTI) is holding its annual conference in Tallin, Estonia, 5-7 September.
> Visit the conference website
Country-specific news
Belgium
A new measure going through the Belgian parliament will mean that contraceptive pills and implants are available free to all women in Belgium aged 25 and under.
Bosnia and Herzegovina
With the cost of abortion services significantly lower in Bosnia & Herzegovina, increasing numbers of women from Croatia are crossing the border to access services. This article explores abortion access and 'conscientious objection' from service providers.
Croatia
A panel of UN human rights experts has urged Croatia to act to stop violations of women's sexual and reproductive health rights, following shocking accounts of abuse and violence suffered by women accessing reproductive health care.
Denmark
Fat redistribution in people with HIV who have taken thymidine analogues and/or didanosine can persist through time, while increasing cardiovascular risk factors, according to a Danish study.
Finland
The Family Federation of Finland has published seven podcasts, featuring interviews with young people from Finland, Malawi, Nepal, Mozambique and Norway on issues related to sexual rights.
Georgia
The International Planned Parenthood Federation European Network (IPPF EN) and its Georgian member association HERA XXI have published a series of blogs highlighting the experiences of women accessing abortion care in Georgia and barriers they face.
Hungary
BOCS Foundation has developed a free sex education app called LoveInfo for young people in Hungary.
Iceland
The Icelandic parliament has passed a landmark abortion law legalising abortion within the first 22 weeks of pregnancy, regardless of circumstances.
North Macedonia
Training and a change in medical education has helped extend the delivery of sexual and reproductive health services through primary health care in North Macedonia.
Poland
Media in Poland reacted strongly to the news that Poland was the lowest scoring country in the 2019 Contraception Atlas, which ranks access to contraception across Europe.
Russia
The ministry of health in Russia has proposed legislation which would make it illegal to spread false information about HIV. Russia is stepping up efforts to manage one of the largest epidemics in the region and HIV denialism, often spread on social media, has received significant attention in recent months.
Slovakia
Slovakia has one of the smallest HIV epidemics in Europe, but last year recorded its highest ever number of diagnoses.
Sweden
According to a qualitative study, men living with HIV in Sweden report that when it comes to rules regarding disclosure and legal obligations, clinicians were not always clear with them regarding the meaning of undetectability and whether or not they still needed to disclose or use condoms.
Ukraine
Ukraine has announced that it is to allocate US$16 million to the country’s HIV response for 2019-20, to sustain and expand HIV prevention and support services for key populations, as well as care and support services for people living with HIV. The move is part of Ukraine's transition from funding of HIV services by the Global Fund to domestic funding.
United Kingdom
Prescription of generic versions of antiretroviral drugs for treatment and pre-exposure prophylaxis (PrEP) as soon as they come off patent would save the NHS £7 billion between 2018 and 2033, an analysis led by Public Health England has shown.