Welcome

Please note: This edition of the bulletin was published by MEDFASH. Click here to view the original format.

Welcome the third issue of the MEDFASH Sexual Health & HIV Policy EUROBulletin. Last week AVAC and EATG issued a statement following the second European HIV Prevention Summit, calling for the accelerated approval and rollout of PrEP as a proven HIV prevention strategy.  It seems the focus on the availability of PrEP will continue during 2016, with France still the only country in Europe to have authorised PrEP for those most at risk of HIV. Other noteworthy round-up items include: the launch of a European Alliance to accelerate new concepts in HIV vaccine research; post-consultation HIV, viral hepatitis and sexually transmitted infections strategies from WHO; new European guideline on the management of chlamydia and up-to-date factsheets on emergency contraception issues.

The eFeature interview is with Dr Mike Youle, who offers insights into sexual health in South-East Europe and talks about some pioneering service developments he and his colleagues have been involved in.

eFeature

Dr Mike Youle is Director of HIV Clinical Research at the Royal Free Centre for HIV Medicine in London, UK.  He is also founder and Director of JUSTRI, a UK- based, internationally focused, not-for-profit organisation, which works with allies in healthcare and patient communities, international agencies and the pharmaceutical industry to build successful responses to HIV and related conditions, such as hepatitis B and C and tuberculosis.  In this eFeature interview, Mike, with input from colleagues Louie Pong in London and Dr Sime Zekan in Zagreb, offers insights into the challenges affecting sexual health services in South-East Europe and provides examples of some of the pioneering work JUSTRI is supporting in this part of the Region, including helping set up the first sexual health clinic for men who have sex with men. 

>Dr Mike Youle interview (PDF)

Policy development & guidance

WHO: Draft strategies on HIV, viral hepatitis and sexually transmitted infections

A three-part set of global health sector strategies on HIV, viral hepatitis and sexually transmitted infections were due to be reviewed by the World Health Organization (WHO) Executive Board at the end of last month. The draft strategies have been developed following extensive consultation and will guide efforts in these major disease areas in 2016–2021, contributing to the attainment of the 2030 Agenda for Sustainable Development, specifically health-related Goal 3. The strategies for HIV and sexually transmitted infections build on previous strategies, while the strategy for viral hepatitis will be the first of its kind.  Click the links below for more information on the process to date, a report from the European Regional consultation and for the three draft strategies (each available in 5 languages).

>WHO - draft strategies 2016-2021 - Jan 2016 

>Report from European Regional Consultation - June 2015 

>Draft HIV strategy - Dec 2015

>Draft viral hepatitis strategy - Nov 2015 

>Draft STI strategy - Dec 2015

European Union Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT)

The new EU HA-REACT held its first Partnership Forum meeting in Lithuania last month.  HA-REACT was launched towards the end of 2015 to address existing gaps in the prevention of HIV and other co-infections, especially tuberculosis (TB) and viral hepatitis, among people who inject drugs (PWID). With core funding from the European Union (EU), it is being coordinated by the Finish National Institute for Health and Welfare and implemented by 23 partners in 18 EU Member States. Twelve collaborating partners are also providing additional expertise including the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

>HA-REACT - Press release - 14 Jan 2016

Stepping up action on refugee and migrant health

Countries in the WHO European Region have agreed to prepare a common framework for coordinated collaboration and action on refugee and migrant health. The reasons for having a common framework and its scope are outlined in this document which summarises discussions between ministers of health, country delegations and partners at the High-level meeting on Refugee and Migrant Health that took place in Rome, Italy, on 23–24 November 2015.  Also see the recently published reviews on public health aspects of migrant health in the evidence section below.

>WHO Europe - news - 21 Jan 2016  

>Document

WHO: HIV and young people technical briefs

WHO has produced a series of technical briefs addressing HIV in four young key populations: young men who have sex with men; young people who sell sex; young people who inject drugs and young transgender people. The briefs offer a concise account of current knowledge concerning the HIV risk and vulnerability in these key populations, the barriers and constraints they face in accessing appropriate services and examples of programmes that may work well in addressing their needs and rights.

>HIV and young MSM - Oct 2015  

>HIV and young people who sell sex - Oct 2015 

>HIV and young people who inject drugs - Oct 2015 

>HIV and young transgender people - Oct 2015

WHO Europe: Good practices in strengthening health systems for the prevention and care of tuberculosis and drug-resistant tuberculosis

This newly published compendium presents examples of good practice in strengthening health systems for the prevention and care of tuberculosis (TB) and multidrug- and extensively drug-resistant tuberculosis (M/XDR-TB) from 21 countries, including 14 countries of high priority for MDR-TB and countries with high and low incidences of TB.  TB remains one of the leading causes of death among people living with HIV, and this combination is increasing in the Region: the prevalence of HIV infection among TB patients increased from 3.4% in 2008 to 7.8% in 2013.

>WHO Europe - new publication - 2015 

> Document (pdf)

Global Platform to fast-track HIV responses among gay men and other men who have sex with men (MSM) around the world

UNAIDS and the Global Forum on MSM & HIV (MSMGF) have launched a new advisory body -  the Global Platform to Fast-Track HIV Responses among Gay Men, Bisexual Men and Other Men Who Have Sex with Men - to provide strategic advice to United Nations agencies and other stakeholders on HIV programme needs and priorities, particularly in response to the accelerated 90-90-90 targets.

>UNAIDS - press release - 14 Jan 2016

EATG: Position paper on HIV prevention

This policy document from the European AIDS Treatment Group (EATG) provides a comprehensive overview of the current state of play in the prevention of HIV transmission, reflecting new advancements in the field. It discusses challenges faced by key affected populations and considers the range of available prevention tools.

>EATG Position paper - Oct 2015

Call for the roll out of PrEP as a proven HIV prevention strategy

AVAC and the EATG have called for the accelerated approval and rollout of PrEP in countries across the region after hosting the second European HIV Prevention Summit in Brussels at the end of January . They have also called for the continuation of research for HIV vaccines, and rectal and vaginal microbicides, along with better surveillance data.

>AVAC/EATG press statement - 1 Feb 2016

Parliament & other European institutions

European Alliance for accelerating new concepts in HIV vaccine research

The European Commission (EC) has granted over 22 million euros to the European HIV Vaccine Alliance (EHVA) to develop a multidisciplinary platform to evaluate novel preventive and therapeutic vaccines. The grant is supplemented with an additional 6 million euros from the Swiss government for the Swiss project partners. EHVA is a 5-year project (starting January 2016) funded by the EU’s Horizon 2020 Research and Innovation Programme.

>Launch of European alliance - HIV vaccine research - 26 Jan 2016

EC approves Daclatasvir (Daklinza) for use in HIV/HCV infection 

The European Commission has approved Daclatasvir (Daklinza)  for the treatment of chronic hepatitis (HCV) in three new patient populations, including those with HIV/HCV coinfection.

>Infohep - news - Feb 2016

European Data Protection Regulation

Last month the European Parliament agreed the final wording for its new European Data Protection Regulation which is set to harmonise data protection laws across EU member states. Earlier drafts of the Regulation included a requirement for under 16s to secure parental consent before using online services.  After concern from a number of groups, including the Family Online Safety Institute (FOSI), that this could have a negative impact on young people’s safety, wellbeing and rights, a provision was included for individual member stsates to set the age ceiling without going below 13 years.  The new Regulation is expected to take effect from spring 2018.

>European Council - press release - 18 December 2015 

>Letter from FOSI - 10 Dec 2015

European Commission: List of actions to advance LGTBI equality

The Commission has published a List of Actions to advance LGBTI equality to be implemented during the period 2016-2019. This includes policies and legislation in key areas such as health. ILGA- Europe welcomed these new developments but also expressed disappointment that Europe was still without a fully-fledged equality strategy.

>European Commission - news - Dec 2015 

>Actions document 

>ILGA news

New version of ECHI data tool

The EC has launched a new version of the European Core Health Indicator (ECHI) data tool.  The new tool presents comparative information on health at European level, including health status data on HIV, chlamydia, hepatitis C and tuberculosis.

>EC - Health & Safety DG - news - Nov 2015  

>ECHI data tool

European Commission: Eurobarometer on Discrimination 2015

This summary presents results from a new Eurobarometer survey on discrimination in the EU. The survey was conducted in June last year amongst 28 000 EU citizens and provides insight into the perceptions, attitudes, knowledge and awareness of discrimination in the EU, including discrimination on the basis of sexual orientation.

>Summary - Oct 2015

>Full report and factsheets in English and other national languages

Evidence & research

HIV/AIDS surveillance in Europe 2014

The WHO European Region has recorded the highest number of newly diagnosed HIV infections in one year since the start of reporting in the 1980s, with HIV infection diagnosed in over 142,000 people in 2014. The most recent surveillance data released by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe indicate that the growth of the HIV epidemic is driven by the eastern part of the Region, where the number of new diagnoses has more than doubled during the past decade. ECDC and WHO call for better prevention, diagnosis and treatment for vulnerable populations, including migrants and refugees.

>WHO/ECDC - joint press release - 26 Nov 2015 

>Report

WHO: Global and regional estimates of the burden of HSV-1 infection

WHO has published the first global and regional estimates of the burden of herpes simplex virus type 1 (HSV-1). The new estimates, published in the journal PLUS ONE last October, indicate that a substantial amount of genital herpes is caused by HSV-1 infection.  It is estimated that some 140 million people aged 15-49 years are infected with genital HSV-1, primarily in the Americas, Europe and Western Pacific. Given young people are at risk of contracting HSV-1 genitally through oral sex, it is essential that they have access to education and information on HSV-1 as well as HSV-2 before they are sexually active. Click the link for more information, an up-to-date factsheet and to access the journal article.

>WHO - new estimates for HSV-1 

>PLUS ONE article - Oct 2015 

>Herpes simples virus factsheet - Jan 2016

Public health aspects of migrant health: reviews of evidence in the European Region

WHO Europe has recently published a series of Health Evidence Network (HEN) evidence reviews on the health status of three distinct migrant groups in the European Region: undocumented migrants, labour migrants and refugees and asylum seekers. The reviews will provide the basis for the development of evidence-informed policies on migrant health.

>WHO/HEN review - undocumented migrants - 2015 

>WHO/HEN review - labour migrants - 2015 

>WHO/HEN - review - refugees and asylum seekers - 2015

EMCDDA: Drug-related infectious diseases in Europe

This report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) provides an update on infectious diseases related to injecting drug use in Europe for the period up to June 2015.  It includes prevalence and trends in HIV and hepatitis C infections.

>EMCDDA - publication - 2015  

>Report 

Treatment & service guidelines

EACS: treatment guidelines updated and new online course

In October last year the European AIDS Clinical Society (EACS) released a guideline update for the treatment of HIV-infected adults in Europe.  The guideline brings the Region into line with the rest of the world by recommending HIV treatment on diagnosis for all patients irrespective of CD4 cell count. The EACS is also offering the first Clinical Management of HIV online course for clinicians who want in-depth understanding of the scope and manifestations of HIV-related diseases, their prevention, management, and care. The course, sponsored by the EACS and supported by WHO Europe, will run for six weeks, beginning at the end of February 2016. It is available to anyone who wishes to participate, free of charge, but is especially aimed at clinicians in Eastern Europe and Central Asia. Click the course link below for more information.

>EACS - guideline update - Oct 2015 

>Updated guideline    

>EACS - new clinical management of HIV online course - Feb 2016

2015 European guideline on the management of Chlamydia trachomatisinfections

This guideline has been produced by the European branch of the International Union against Sexually Transmitted Infections (IUSTI- Europe).  It provides up-to-date guidance regarding broader indications for testing and treatment of Chlamydia trachomatis infections.  It has been published in the International Journal of STD & AIDS and is available via the IUSTI website.

>European guideline on chlamydia - Nov 2015 

>IUSTI guidelines

2016 European guideline on donovanosis

This guideline has also recently been produced by IUSTI Europe and offers recommendations on the test and treatment for the effective management of donovanosis.

>Donovanosis - 2016

Interactive website on providing safe abortion care

A new website has been launched to help make WHO recommendations on health worker roles in providing safe abortion and post-abortion care more accessible. The interactive resource is based on WHO’s guideline, Health worker roles in providing safe abortion care and post-abortion contraception, and is designed to help people working across the health sector access the recommendations more easily.

>WHO - news - 15 Jan 2016 

>Interactive website 

Reports & resources

ICEC: Repeated Use of Emergency Contraception: The Facts

The International Consortium for Emergency Contraception (ICEC) has released an updated version of its fact sheet on repeated use of emergency contraceptive pills (ECPs). Reflecting the latest guidance from WHO, this new fact sheet emphasises that both levonorgestrel and ulipristal acetate ECPs are extremely safe, even when used repeatedly. The factsheet is available in English and French.

>ICEC - news - October 2015

>Factsheet (English) 

>Factsheet (French)

ECEC: Efficacy of emergency contraception and body weight: current understanding and recommendations

The European Consortium for Emergency Contraception (ECEC) has produced a new factsheet on the efficacy of emergency contraception (EC) and body weight.

>ECEC - factsheet - Nov 2015

ECEC: Emergency Contraception accessibility in EU countries

The ECEC has also recently updated information on its website on EC accessibility for 43 European countries.

>ECEC - country information on EC accessibility

EATG: Ageing with HIV Project

This new project was launched by the EATG at the end of last year (18 Dec 2015).  The project will run for 30 months and will look at living and ageing with HIV through the lifecycle.  There is a dedicated website with information on all the planned activities, including a conference in Berlin next month (31 Mar – 3 April 2016) on new challenges and unmet needs of people living with HIV/AIDS aged 50 and over.

>Ageing with HIV website

>Conference in Berlin - March/April 2016

Service under siege: The impact of anti-LGBT violence on HIV programs

The Global Forum on MSM & HIV has released a report which examines levels of violence against lesbians, gay, bisexual and trans (LGBT) people around the world and looks at the impact on access to HIV services. Data on levels of violence towards LGBT people in Europe are included.

>MSMGF - press release - Dec 2015 

>Report

They don’t talk about it enough: report on young people’s views on sexual violence

This report is part of the ‘Our Voices’ project, a three-year pan-European initiative coordinated by the International Centre at the University of Bedfordshire UK.  The project aims to promote the involvement of young people in efforts to prevent sexual violence against children across Europe.  This short report is from consultations held with Youth Advisors across Albania, Bulgaria and the UK.  Click the links for more information about the project and to access the consultation report.

>Our Voices:  pan European project 

>News - consultation report - Oct 2015

>Report (pdf)

Resources to support quality in drug prevention

The European Prevention Standards Partnership has published a range of practical tools and materials for decision-makers, practitioners and others working in drug prevention.  The tools support the European Drug Prevention Quality Standard (EDPQS) published by the EMCDDA in 2011, and have been designed to help those working in drug prevention policy and practice to achieve quality in all their activities.

>Launch of toolkits to support quality standards in drug prevention 

>New tools and resources

Sexuality education – what is it?

This policy brief developed by the European Expert Group on Sexuality Education provides an overview of key issues in sexuality education. It focuses primarily on sexuality education in Europe and Central Asia but is also relevant to countries outside of these regions. The brief covers the benefits of sexuality education as well as the myths and facts.

>Sex Education Journal - Nov 2015

Sexual health rights & advocacy

ILGA-Europe: Call for literature relevant to LGBTI equality in Europe

ILGA-Europe and  Public Interest Research Centre (PIRC) have set up a new project to investigate how best to frame issues of LGBTI equality in a European context and have put out a call for relevant literature from European partners.  They are keen to have any research, reviews, opinion polls and project information to feed in to their investigation.  Click the link for more details.

>ILGA Europe - call for literature and research on LGBTI equality - Jan 2016

SDGs and LGBT inclusion

This short guide from Stonewall looks at seven of the 17 UN Sustainable Development Goals (SDGs) and highlights the challenges LGBT people face. It showcases some of the work that is already being done worldwide to demonstrate ways in which LGBT equality can be achieved. It also suggests practical actions for organisations working on different development issues.

>Stonewall - news - 28 Jan 2016 

>Guide

Campaigns & other news

International Day of Zero Tolerance for FGM

The International Day of Zero Tolerance for FGM took place last week (6 February). The elimination of female genital mutilation (FGM) is a key target under Goal 5 of the UN’s Sustainable Development Goals. A high level event was held at the United Nations in New York to mark the day. The EC has also recently issued a Q&A factsheet on FGM with information on current areas of EU funding and EU legislation protecting girls and women at risk of FGM.

>Statement from Secretary-General of UN - 6 Feb 2016

>International Day of Zero Tolerance for FGM 

>EC - press release - FGM factsheet - Feb 2016

Engaging Europe to end violence against women: White Ribbon campaign

The European Institute for Gender Equality (EIGE) has launched an online platform where anyone wanting to show their commitment to ending violence against women can sign a White Ribbon pledge. The platform was publicised as part of the 2015 White Ribbon Campaign launch held in Luxembourg at the end of November.

>EIGE news - Nov 2015  

>White Ribbon - pledge platform

PrEPWatch

PrEPWatch is a clearing house for PrEP data, research, and advocacy efforts across the globe.  It is an initiative spearheaded by AVAC, a non-profit organisation based in New York that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of new and emerging HIV prevention options as part of a comprehensive response to the HIV/AIDS pandemic.  Click the link to access the PrEPWatch website and to get country updates.

>PrEPWatch

HIVPolicyWatch.org

Last year the International Association of Providers of AIDS Care (IAPAC) launched HIVPolicyWatch.org, a web portal that provides immediate access to published guidelines and recommendations containing HIV policies from 149 countries, representing approximately 90% of the people living with HIV worldwide. The portal will track the HIV policy shift towards ‘test and treat’ following evidence that earlier access to antiretroviral therapy (ART) improves outcomes for people with HIV.

>HIVPolicyWatch

Country-specific news

France approves PrEP for those most at risk of HIV infection

Back in November, the French Minister of Health, Marisol Touraine, announced that pre-exposure prophylaxis (PrEP) is approved for the prevention of HIV along with other risk-reduction strategies including condom use and repeated HIV testing. France is now the second country in the world, after the US, to approve and recommend PrEP for people at risk of HIV.

>NAM - more information on French approval of PrEP

European ChemSex Forum event – 6-8 April 2016, London, UK

The European ChemSex Forum is a preliminary intelligence-gathering and networking event that will provide a platform to engage in international dialogue and discussion around Chemsex.  It will take place in London over three days in April and will look to identify the key trends across Europe and share good practice and examples of effective community responses. Attendance is free of charge but places are limited. Click the link for more information and to see the draft programme.

>ChemSex Forum