Welcome
Welcome to the December 2017 Sexual Health & HIV Policy EUROBulletin.
In this issue, our eFeature interview explores the challenging political context affecting people and organisations working on sexual and reproductive health and rights (SRHR). The recent EuroNGOs conference focused on the rise of populism and its impact on SRHR work, and brought people together to collaborate on a new framing of SRHR messages, rooted in common values. We spoke to Deborah Rubbens, co-ordinator at the EuroNGOs network, about the political background and the conclusions reached by the conference participants.
Last week, in the lead up to World AIDS Day, the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe published their latest HIV surveillance data for the European region. Amid notable success in preventing HIV transmission in some European countries, the statistics also reveal very high rates of new diagnoses in parts of eastern Europe.
WHO has also published an operational framework for linking sexual and reproductive health, drawing together their guiding principles, key interventions and highlighting social and structural factors affecting access and outcomes.
The European AIDS Clinical Society (EACS) conference was held in Milan in October, and NAM was the official online science news provider for the conference. New European HIV treatment guidelines were published to coincide with the conference.
Other items to look out for in this edition include: the new PrEP in Europe website; online surveys for men who have sex with men (MSM) and community health workers; and Speak Act Change, a new platform for SRHR youth advocates in eastern Europe.
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eFeature
In September, EuroNGOs brought together over 200 people from 33 countries to discuss the rise of populism and its impact on sexual and reproductive health and rights (SRHR). Conference participants discussed, debated and navigated their way to a new consensus on how to respond to this challenging context and promote SRHR in the face of populist opposition.
Deborah Rubbens is co-ordinator of the EuroNGOs network, which brings together NGOs and other partners working in SRHR in Europe.
In this eFeature interview, we spoke to Deborah about promoting sexual and reproductive health and rights in this new political context and how the EuroNGOs network is rising to the challenge.
> Deborah Rubbens – eFeature interview
Evidence, data & research
New European HIV data
The European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe have published their annual HIV surveillance figures, presenting data for 2016. More than 160,000 people living in the WHO European region were newly diagnosed with HIV in 2016, including 30,000 people living in EU/EEA countries.
Several countries have reported a decline in new diagnoses. However, in parts of eastern and central Europe, the data continue to show “alarming rates and increases in new diagnoses”.
In a joint statement, ECDC and WHO Europe highlighted the problem of late diagnosis and called for improvements in HIV testing. More than half of people newly diagnosed with HIV in Europe were diagnosed late (defined as having a CD4 count below 350 on diagnosis).
> Download the full surveillance report from the ECDC website
News from the 16th European AIDS Conference
The 16th European AIDS Conference, organised by the European AIDS Clinical Society (EACS), took place in Milan, Italy, from 25 to 27 October 2017. As the official online scientific news reporter for the conference, we 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 2017 conference pages on aidsmap.com
> Visit the official conference website
HIV diagnoses on the rise among over-50s in Europe
Just over one in six people diagnosed with HIV in Europe between 2004 and 2015 was over 50 years of age, and new diagnoses in older people increased in 16 European countries across the same period, a study published in The Lancet HIV shows. The study found that older people (people aged 50 or older) were more likely than younger people (aged 15 to 49 years) to be diagnosed with advanced HIV disease, and acquire HIV through heterosexual sexual contact. Older people diagnosed with HIV were less likely to be migrants. Looking at HIV surveillance data from 31 countries, researchers from the European Centre for Disease Prevention and Control (ECDC) and the EU/EEA HIV Surveillance Network, found that 54,102 people over 50 years of age were diagnosed with HIV between 2004 and 2015.
> Read this report in full on aidsmap.com
> Read about this study on the ECDC website
> View the abstract on the journal website
Survey of dating app users finds that PrEP usage has not increased in Europe in the last year
A study of men who have sex with men conducted by the European Centre for Disease Prevention and Control (ECDC) in collaboration with the gay contact site Hornet has found that pre-exposure prophylaxis (PrEP) usage has not increased, on average, from the proportion reported last year, when a similar survey was carried out. Altogether 12,053 men responded, with replies from every one of the 55 countries of the World Health Organization European region.
> Read this report in full on aidsmap.com
Treatment & service guidelines
A framework for linking sexual and reproductive health
The World Health Organization (WHO) and the United Nations Development Programme/United Nations Population Fund/WHO/World Bank special programme of research, development and research training in human reproduction (HRP) have published a new framework which aims to create broader awareness of comprehensive sexual health interventions. Written for implementers and policy makers, it highlights operational approaches to sexual and reproductive health, recognising their links and differences, and details key guiding principles.
> Download the framework from the WHO website
> Read the commentary in The Lancet
Clinical guidelines for responding to children who have been sexually abused
The World Health Organization has published its first guidelines for healthcare providers on care for children and adolescents who have experienced sexual abuse, assault or rape.
> Read more about the guidelines
New EACS treatment guidelines
The European AIDS Clinical Society (EACS) has published a new edition of its HIV treatment guidelines for adults. The new version is available to download in English, Chinese, French, German, Portuguese, Russian and Spanish. The guidelines are intended to set a standard of care for the entire European region including eastern Europe. Key changes since the previous edition include the recommendation that everyone with HIV and hepatitis C virus co-infection should receive direct-acting antiviral treatment for hepatitis C and should receive the same treatment for hepatitis C as people with hepatitis C monoinfection. The guidelines also recommend vaccination for human papillomavirus (HPV) for everyone living with HIV under 26 and for men living with HIV who have sex with men up to the age of 40.
> Download the guidelines from the EACS website
> Read New EACS treatment guidelines on aidsmap.com
> Read European AIDS Clinical Society strengthens HPV vaccination advice on aidsmap.com
European guidelines on managing pelvic inflammatory disease
The International Union Against Sexually Transmitted Infections (IUSTI) has published new guidelines on the management of pelvic inflammatory disease. These can be downloaded from its website, along with all other current IUSTI European guidelines.
How a London clinic reduced new HIV infections by 90% and why more European cities can do the same
Over the past three years, one clinic in London has seen recent HIV infections among gay and bisexual men using its services fall by around 90%. A presentation at the recent European AIDS Clinical Society conference explained how the service has developed and elements that could be implemented elsewhere. The experience of the 56 Dean Street clinic illustrates how services may need to change to improve rates of HIV diagnosis, increase the numbers of people on treatment and reduce new HIV infections among key populations, especially men who have sex with men. Scaling up HIV testing to reduce undiagnosed HIV infection requires a fundamental re-ordering of HIV testing services to make them more attractive to people at risk, and doing so can bring about enormous changes in HIV incidence and treatment uptake.
> Read this report in full on aidsmap.com
Policy development & guidance
New website: PrEP in Europe
The PrEP in Europe Initiative is a partnership of European organisations (including NAM aidsmap) dedicated to increasing access to pre-exposure prophylaxis (PrEP) throughout the European region. A new website, PrEP in Europe, was officially launched in October. The website provides information on the effectiveness and availability of PrEP, and news and advice to help strengthen advocacy for PrEP throughout Europe.
> Visit the PrEP in Europe website
ECHOES survey for community health workers
The European Community Health Worker Online Survey (ECHOES) is open until 31 December 2017. It is open to you, if you work with men who have sex with men, delivering sexual health support in community settings. The survey is available in 16 languages.
Barriers to health for LGBTI people in Europe
An EU-funded project researching health inequalities for lesbian, gay, bisexual, trans and intersex (LGBTI) people in Europe has published initial results of a review and a series of focus groups exploring the subject. Focus groups were held in Belgium, Bulgaria, Italy, Lithuania, Poland and the UK. The study revealed significant barriers and inequalities, as well as identifying a lack of research in many areas. The project plans to develop related training for health professionals.
> Read more about the study on the ILGA-Europe website
> Visit the project website and download the review
Reports & resources
Diagnosing HIV in dermatology and venereology
The European Academy of Dermatology and Venereology (EADV) has launched a new website to help dermatologists, venereologists, and other clinicians managing skin conditions or sexually transmitted infections, to diagnose HIV. Many people with undiagnosed HIV present with skin conditions. Diagnosing HIV in dermatology and venereology can save lives and prevent the further transmission of HIV. This new resource provides simple information and guidance on how to identify and test for HIV in this context.
New funding for eastern Europe
The Elton John AIDS Foundation (EJAF) has announced it plans to launch new funding for HIV initiatives in eastern Europe and central Asia. The funding will focus on HIV prevention and treatment for key populations: people who use drugs, sex workers, and gay and bisexual men.
Blood-borne viruses and STIs in prison settings
The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have published a systematic review on active case finding of communicable diseases in prison settings in Europe. It includes evidence on HIV, hepatitis B and C and sexually transmitted infections.
Parliament & other European institutions
Committee for Medicinal Products for Human Use
At meetings in September and November, the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) made recommendations for approval of a generic version of ritonavir (Ritonavir Mylan) and two generic versions of darunavir (Darunavir Krka and Darunavir Krka d.d) for the treatment of HIV. The CHMP also made recommendations for the extension of the authorisation for the HIV combination drug Stribild, to apply to people aged 12 and over; and for the extension of the authorisation for the HIV combination drug Genvoya, to apply to children aged 6 years and older who meet certain criteria.
> Read the summary of opinion on Ritonavir Mylan (PDF)
> Read the summary of opinion on Darunavir Krka (PDF)
> Read the summary of opinion on Darunavir Krka d.d. (PDF)
> Read the summary of opinion on Stribild (PDF)
> Read the summary of opinion on Genvoya (PDF)
Sexual health rights & advocacy
A call for the EU to stand up for women’s rights
To mark the Global Day of Action for Access to Safe and Legal Abortion, the Regional Director of the International Planned Parenthood Federation (IPPF) European Network published an opinion piece calling for the European Union to take a stand against the erosion of women’s rights in some member states. Highlighting abuse and refusal of care, IPPF calls on the EU to honour its commitments to gender equality and to stand up for women’s rights and human dignity.
> Read How Poland’s far-right government is pushing abortion underground in The Guardian
Launch of Speak Act Change
The International Institute for Youth Development PETRI-Sofia, in partnership with the United Nations Population Fund, has launched a new advocacy platform, called Speak Act Change. It provides a space for youth advocates working in sexual and reproductive health and rights in eastern Europe and central Asia to share ideas, opinions and information.
Major European MSM survey launched
A major online survey for gay, bisexual and other men who have sex with men (MSM) has been launched across Europe in 33 languages. The European MSM Internet Survey (EMIS 2017) is intended to help with planning HIV prevention and support activity and is open to all MSM in Europe, however they define their sexuality and whatever their HIV status. The survey will generate data required to understand the sexual health needs of MSM populations across Europe and will help direct prevention programmes.
> Find out more on the NAM blog and visit the online survey
Campaigns & other news
Europe unite for CSE rights
The European Youth Network on Sexual and Reproductive Rights (YOUACT) is working on advocacy for comprehensive sexuality education (CSE). In November, youth advocates from Cyprus, Georgia, the Netherlands, Poland and Romania collaborated on an advocacy plan to highlight the need for CSE. They invite interested parties to join them in their campaign to improve and implement CSE throughout Europe.
Undetectable = Untransmittable (U=U) campaign
The Undetectable = Untransmittable consensus statement, issued by the Prevention Access Campaign, has now been endorsed by over 500 organisations in 67 countries. The core message is that “people living with HIV can feel confident that if they have an undetectable viral load and take their medications properly, they will not pass on HIV to sexual partners”. The success of the campaign was recently highlighted in an editorial in The Lancet HIV, and the International Council of AIDS Service Organizations (ICASO) has developed a community brief, available in English and French.
> Read the consensus statement
> Read the editorial in The Lancet HIV
> Read the ICASO U=U community brief in English (PDF)
> Read the ICASO I=I community brief in French (PDF)
Country-specific news
Denmark
The Danish HIV organisation AIDS-Fondet believes Denmark could become the first country in the world to eliminate HIV transmission.
Ireland
Ireland’s first clinic monitoring HIV pre-exposure prophylaxis (PrEP) opens.
Lithuania
The Lithuanian Parliament is to discuss a draft law that would strongly restrict women’s access to legal abortion. If adopted, it would put Lithuania among countries with the strictest laws on abortion in Europe. ASTRA, the Central and Eastern European Women’s Network for Sexual and Reproductive Rights and Health, has called for the outright rejection of the draft.
Macedonia
In an uncertain funding landscape, sexual and reproductive health organisations are working to plug the gaps in Macedonia’s public healthcare system.
The Netherlands
Younger age and shorter duration of viral suppression are risk factors for the development of high-grade pre-cancerous anal lesions in HIV-positive men who have sex with men (MSM), investigators from the Netherlands report. They recommend that all MSM living with HIV should undergo screening.
> Read this report in full on aidsmap.com
Russia
People living with HIV in Russia are working together to overcome medication stockouts.
Slovakia
A new report published by the Center for Reproductive Rights and the Center for Civil and Human Rights has found that Roma women living in Slovakia face discrimination and abuse when accessing reproductive health services.
Spain
The Federación de Planificación Familiar de España (FPFE) created a short film highlighting the barriers to access to contraception for women in Spain.
> Watch the video (in Spanish, with English subtitles)
Switzerland
Swiss study examines which years gay men decided to stop consistent condom use
> Read this report in full on aidsmap.com
United Kingdom
HIV diagnoses in the UK fell in gay men last year for the first time since the mid-1990s, Public Health England confirms