Welcome

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

Welcome to the launch issue of the MEDFASH Sexual Health & HIV Policy EUROBulletin. The EUROBulletin will provide a quarterly round-up of selected pan-European policy developments, evidence updates and resources across the field of HIV and sexual and reproductive health. Each issue will also have an eFeature opinion piece offering up-to-date commentary on policy issues of relevance and interest to the wider European community.

The EUROBulletin aims to build on the potential for greater sharing of knowledge about European developments and initiatives and to support a more integrated approach to the prevention of HIV, STIs and unintended pregnancies and the management of HIV and sexual and reproductive health.  Click the link below for more information and background about the development of the EUROBulletin.

> MEDFASH EUROBulletin

This is the first issue of the MEDFASH EUROBulletin.  Please forward it on to colleagues and relevant networks so they are made aware of it and can subscribe to receive it on a regular basis.

eFeature

Dr Gunta Lazdane is Programme Manager for Sexual and Reproductive Health in the Division of Noncommunicable diseases and promoting health through the life-course at the WHO Regional Office for Europe in Copenhagen. In our launch eFeature interview, Dr Lazdane offers her perspective on some of the most pressing sexual and reproductive health challenges facing Europe today. Acknowledging the wide diversity in the shape and scale of SRH issues across the Region, she nevertheless concludes that a continued focus on education and the provision of evidence-based information is critical to providing the basis for citizens across Europe to make full, free and informed choices about their sexual and reproductive health.

> Dr Gunta Lazdane eFeature (PDF)

Parliament & other European institutions

EU Health Programme – annual work plan 2015

The annual work plan for the third EU health programme was published on 2 June 2015. The work plan sets out priority areas (including HIV, TB & hepatitis) and the criteria for funding actions under the programme. Calls for project proposals under the new work plan were also issued on 5 June 2015 with a deadline for submissions by 15 September. Click the links to access the 2015 work plan, the call for proposals and for more information on the overarching health programme (2014-2020).

> European Commission - adoption of 2015 workplan

> Workplan 2015 - Annexe 1

> Call for project proposals

> Third Health Programme Factsheet

Europe commits to strengthening efforts to meet UNAIDS 90-90-90 treatment targets

The Government of Luxembourg and UNAIDS recently hosted a high-level debate on the global 90-90-90 treatment targets as part of the 2015 European Development Days. It was agreed that HIV remains a global challenge, touching all continents, including Europe, where significant HIV transmission persists, and that it was necessary for every country and every region to play a key role in a renewed, multi-layered HIV response.

> UNAIDS - EDD meeting - June 2015

European Parliament votes in favour of new equality strategy post 2015

Last month the European Parliament voted in favour of a resolution for a new strategy for equality between women and men beyond 2015. The non-binding resolution, tabled by German MP Maria Noichl, addresses a range of gender equality issues, including sexual and reproductive health rights, access to contraception and abortion and better sex and relationships education. Click the link to see the relevant press release and the draft resolution report.

> European Parliament - press release - 9 June 2015

> Report

EU statement in support of human rights of LGBTI persons in Europe

The EU members of the Council of Europe issued a joint statement on human rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) persons in Europe following a Committee of Ministers meeting on 17 June. The statement reaffirms EU commitment to supporting activities designed to combat all forms of discrimination on grounds of sexual orientation and gender identity and to advocate measures to combat discrimination and violence against LGBTI persons, and to actively promote their human rights.

> Council of Europe - statement on LGBTI human rights

Combating discrimination on grounds of sexual orientation or gender identity: new online database

The Council of Europe has launched a new online database on best international practices and promising polices for combating discrimination on grounds of sexual orientation or gender identity. The database aims to support policy makers in implementing new policy initiatives at national, regional and local levels.

> Council of Europe - news - 29 June 2015

> Online database

GARDASIL 9 HPV vaccine approved in the EU

The European Commission has granted marketing authorisation for GARDASIL 9. GARDASIL 9 is a 9-valent human papilloma virus (HPV) vaccine for active immunisation of females and males from the age of 9 years against premalignant lesions and cancers affecting the cervix, vulva, vagina or anus and also against genital warts caused by the HPV types covered by the vaccine. The approval follows the positive opinion of the European Committee for Medicinal Products for Human Use (CHMP) granted on March 27th 2015.

> EMA - CHMP - Summary of opinion/Initial authorisation - March 2015

> Sanofi Pasteur MSD - press release - 17 June 2015

Policy development & guidance

ECDC guidance: Preventing HIV and STI among men who have sex with men (MSM)

Guidance to support EU/EEA Member States in their effort to reduce HIV and STI incidence and morbidity has been issued by the European Centre for Disease Prevention and Control (ECDC). MSM are the only key population in the countries of the European Union and European Economic Area that has not seen a decline in new HIV infections during the last decade. The guidance identifies key services to reduce and prevent HIV and other sexually transmitted infections (STI) among MSM and summarises those interventions that have been proven to work: from vaccination, better access to testing and condoms to timely treatment  and targeted health promotion.

> ECDC press release - 17 June 2015

> Guidance document on HIV/STI prevention among MSM

Development of WHO health sector strategies for HIV, viral hepatitis and STIs

The World Health Organization (WHO) is currently developing three global health sector strategies to cover HIV/AIDS, viral hepatitis and sexually transmitted infections (STIs). The strategies will cover 2016-2021 and will be finalised for consideration by the 69th World Health Assembly in 2016. A regional consultation to prepare the European response was held in Denmark in June. Click the links below to see the development timelines and access the draft strategies for all three areas.

> WHO - Health strategy development

> WHO Europe - regional consultation - June 2015

> STI consultation draft

> HIV consultation draft

> Viral hepatitis consultation draft

WHO: Consolidated strategic information guidelines for HIV in the health sector

WHO has recently released new consolidated guidelines on HIV strategic information for the health sector. The guidance aims to revolutionise the way countries monitor and evaluate their HIV responses, recommending 10 global indicators along the cascade of HIV care and treatment and 50 national indicators. Click the links below to access the press release and new guideline document.

> WHO - press release - 11 May 2015

> Guidelines

Brief sexuality-related communication: recommendations for a public health approach

This WHO guideline provides health policy-makers and decision-makers in health professional training institutions with advice on the rationale for healthcare providers’ use of counselling skills to address sexual health concerns in a primary healthcare setting.

> WHO - publications - May 2015

> Guideline document

Stop TB Partnership online consultation

The Stop TB Partnership has launched an online consultation on the first public draft of the Global Plan to Stop TB  2016-2020. The plan is based on the WHO End TB Strategy targets and goals. Its aim is to outline a road towards achieving the final 2035 targets of the Strategy and to estimate the cost of this effort. The consultation process is open until 10 August 2015. Click the link below to go to the dedicated consultation website, which is available in several languages.

> Stop TB Plan 2020

IPPF: Strategic framework 2016-2022

The International Planned Parenthood Federation (IPPF) has published a new strategic framework that sets out its priorities and what it plans to achieve over the next seven years.

> IPPF - publications - May 2015

> Framework

Evidence & research

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool for Europe

The results of two clinical studies assessing the effectiveness of PrEP among men who have sex with men (MSM) in the EU/EEA were released at the annual Conference on Retroviruses and Opportunistic Infections (CROI 2015) in Seattle earlier this year. Overall, PrEP was shown to have a high level of protection among the treated participants, reducing the risk of infection by 86% in both the UK PROUD and French IPERGAY trials. Significantly, the trials used different regimens, building up the evidence base on the effectiveness of both a daily and ‘on demand’ (ie at time of sexual exposure) PrEP regimen. The promising results of the studies are of particular importance in the EU/EEA where the HIV epidemic is largely concentrated among MSM, and newly diagnosed infections in this group have increased by more than 30% during the past decade. A recent statement from the European Centre for Disease Prevention and Control (ECDC) calls for member states to give consideration to integrating pre-exposure prophylaxis (PrEP) into their existing HIV prevention package for those most at risk of infection, starting with MSM 

> PROUD study results 2015

> ANRS IPERGAY STUDY (scroll to bottom for English press release)

> ECDC statement - April 2015

HIV Prevention Manifesto - action on PrEP in Europe

HIV and LGTB community organisations in Europe have also released the HIV Prevention Manifesto calling on key stakeholders (pharmaceutical companies and European and national institutions) to take further action to make PrEP available and accessible in Europe. The manifesto emphasises that, as well as a providing a licence for PrEP, Europe needs urgently to consider how to pay for PrEP; and research needs to be conducted to find out which other populations might benefit from PrEP and how it can best be combined with other HIV and sexually transmitted infection (STI) prevention measures.

> Launch of HIV Manifesto - February 2015

> HIV Manifesto website - for signature

> Existing supporters

START trial finds that early treatment improves outcomes for people with HIV

A major international clinical trial has found that people living with HIV have a considerably lower risk of developing AIDS or other serious illnesses if they start taking antiretroviral treatment (ART) sooner, when their CD4 cell count is above 500 cells/mm³, instead of waiting until it drops below 350 cells/mm3. The Strategic Timing of AntiRetroviral Treatment (START) study was a large-scale randomised clinical trial that tested whether earlier ART benefited all people with HIV, regardless of CD4 cell count. It was expected to end in December 2016, but an interim review of the study data recommended that results be released early. The results are likely to have a major impact on international treatment guidelines.

> NIH - press release - 27 May 2015

> UNAIDS - press release on START - 27 May 2015

> UNAIDS - implications of START study data - 2015

Homophobia and MSM health across Europe

Data recently published by the European MSM Internet Survey (EMIS) show that country-level stigma may have historically limited HIV transmission opportunities among MSM, but by restricting MSM's public visibility, it also reduces their ability to access HIV-preventive services, knowledge and precautionary behaviours.

> LSTHM - press release- 10 June 2015

> AIDS Journal :19 June 2015 - Volume 29 - Issue 10 - p 1239–1246

European briefing tour on IPM’s pivotal Phase III clinical trial

The International Partnership for Microbicides (IPM) has recently held a number of meetings across Europe - in Brussels, Oslo, Copenhagen and London - with NGOs, government agencies, donors and other key stakeholders to increase awareness and support for the development of microbicides as a promising HIV prevention tool in Africa. IPM's Dapivirine Ring Licensure Program includes two large-scale Phase III studies and a package of supporting studies, all designed to provide the data needed for potential product licensing. Efficacy results are expected by early 2016. Click the links to access the latest information update.

> IPM  - The Dapivirine Ring

> Latest update - 2015

HIV infection in migrant populations in the EU/EEA

A study by the Spanish Centre for Epidemiology describes the epidemiology of HIV and distribution of late presentation among migrants within the European Union/European Economic Area during 2007-2012. Migrants represented two-fifths of HIV cases reported and were concentrated in western Europe, with only 5% of diagnoses in central Europe and 1% in eastern Europe. Click the links to access the study abstract and to get more detailed information on this and other migrant related studies from the NAM website.

> Abstract - JAIDS, early online publication

> NAM - aidsmap news - 24 June 2015

Estimation of girls at risk of FGM in the EU

This report from the European Institute for Gender Equality (EIGE) analyses current legal and policy frameworks in the EU Member States and develops a methodology to estimate the number of girls at risk of female genital mutilation (FGM) in Member States. Despite the difficulty of estimating exact numbers of girls at risk of FGM, the effectiveness of continuous prevention efforts and cooperation between concerned communities and regulatory bodies have been identified as influential factors. The report presents recommendations to the Member States on FGM risk assessment and policy development.

> EIGE - press release - 9 June 2015

> Report

HIV pre-test information, discussion or counselling? A review of guidance relevant to the WHO European Region

This recent article in the International Journal of STD & AIDS outlines results from a study which examined recommendations and evidence in current pan-European / global guidelines regarding HIV testing and counselling practice in healthcare settings. The study authors found that current HIV testing and counselling guidelines have inconsistencies regarding the extent and type of information that is recommended during pre-test discussions and highlighted the need for new evidence from a range of European settings to support the process of expert consultation in guideline development.

> Int J STD AIDS OnlineFirst, published on May 4, 2015

Safeguarding Teenage Intimate Relationships (STIR)

STIR is a two-year collaborative research project based in five European countries - England, Bulgaria, Cyprus, Italy and Norway. It aims to map relevant policy, practice and knowledge of interpersonal violence and abuse (IPVA) in teenage intimate relationships and to develop appropriate web-based resources for young people. It is funded by the Daphne III programme of the European Commission. To date the research has shown that across Europe violence and abuse in young people’s relationships, both offline and online, constitutes a major problem yet in most countries it remains unrecognised leaving young people with little support or appropriate services. Click the links below for the STIR website and to access relevant research briefing papers and the STIRitAPP for young people, launched earlier this year.

> STIR website

> Briefing Papers from the research (available in different languages)

> STIRitAPP - 2015

Treatment & service guidelines

2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines

The 2015 PENTA guidelines provide practical recommendations on the management of HIV-1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short-term morbidity and mortality to optimising health status for adult life and minimising the impact of chronic HIV infection on immune system development and health in general. Click the link for more information and to access the new guidance.

> Wiley online library - 2015 PENTA guidelines

EASL Hepatitis C guidelines 2015

The European Association for the Study of the Liver (EASL) released its latest hepatitis C treatment guidelines at the 50th International Liver Congress which took place earlier this year. The guidelines are intended to assist physicians and other healthcare providers, as well as people with hepatitis C and other interested individuals, in clinical decision-making. The new recommendations apply to therapies that have been approved in the European Union, but they are written broadly enough that new drugs can be considered as they become available. The guidelines were published in the April online edition of the Journal of Hepatology and are available on the EASL website. A summary bulletin of other science news from the Congress can be accessed from the NAM website (available in English, French, Russian, Portuguese and Spanish).

> EASL - clinical practice guidelines

> Summary of guidelines - July 2015

> Hepatitis guidelines 2015

> NAM - aidsmap- EASL 2015

WHO: Medical eligibility criteria for contraceptive use (Fifth edition) - Executive Summary

This executive summary contains all the new recommendations that will be incorporated into the fifth edition of the WHO Medical eligibility criteria for contraceptive use. In addition to the recommendations themselves, the summary provides an introduction to the guideline, a description of the methods used to develop the recommendations for this fifth edition, and a summary of changes from the previous edition. It is anticipated that the Medical eligibility criteria for contraceptive use (Fifth edition) will be available online later in July.

> WHO - publication

> Executive summary - fifth edition - 2015

> Medical eligibility criteria wheel 2015

Reports & resources

European Drug Report 2015

Last month the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) released its annual report on trends and developments in drug use across Europe. Latest data show that rises in the number of new HIV diagnoses attributed to injecting in Europe, resulting from outbreaks in Greece and Romania in 2011/12, have now stalled and that the overall EU total has dropped to pre-outbreak levels. Despite progress in this area, the EMCDDA underlines the need for continued vigilance and adequate service provision.

> EMCDDA - press release - 4 June 2015

> Report download (available in 24 languages)

Barometer 2015 - Women’s access to modern contraceptive choice

A second Barometer report was launched by IPPF European Network in March this year. The report analyses how easily women in 16 EU countries can access modern contraception. The 2015 report aims to further build the case for equitable access to modern contraceptives and for re-establishing reproductive health as a policy priority on the EU and national agendas.

> IPPF EN - press release - gaps are unacceptable say MEPs - March 2015

> 2015 Report

Select Proceedings from the International Summit on Reproductive Choice (Lisbon 2014)

This publication brings together key articles from last year’s summit in Lisbon, where more than 70 advocates, service providers and academics from across the globe came together to discuss how best to defend and advance women’s reproductive choices. The articles include difficult issues that have long challenged those in the reproductive health field at national and international level.

> Reproductive Review - new publication - May 2015

> Full document

Human rights & advocacy

WHO: Sexual health, human rights and the law

This new report from WHO demonstrates the relationship between sexual health, human rights and the law. Drawing from a review of public health evidence and extensive research into human rights law at international, regional and national levels, the report shows how states in different parts of the world can and do support sexual health through legal and other mechanisms that are consistent with human rights standards and their own human rights obligations.

> WHO - new publication - June 2015

> Document

STOPAIDS: Sex work, HIV and human rights factsheet

STOPAIDS, a network of UK agencies working to secure an effective global response to HIV and AIDS, has published a new factsheet on Sex work, HIV and human rights to mark International Sex Workers Day (2 June). The factsheet discusses how the decriminalisation of sex work can improve our effectiveness in responding to HIV and AIDS.

> Factsheet - June 2015

Country-specific news

First CE-marked HIV self test kits in UK and France

The first officially licensed HIV self test kits have been available for sale in the UK since May. The HIV home test kit is manufactured by BioSure and is the first to get ‘CE’ marking, indicating that the test complies with essential requirements of the relevant European health, safety and environmental protection legislation. The French company AAZ has also received the ‘CE’ marking for the first self-administered HIV test which will be manufactured under the name of ‘Autotest VIH’. The test is due to be in pharmacies and on pharmacy websites in France from September 2015. Click the links below for more information on the tests and to access the March 2014 supplement to the 2013 WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, which has a section on HIV self testing, including the necessary policy and regulatory considerations.

> BioSure - HIV self test kit

> Autotest VIH

> WHO - Supplementary section on HIV self testing - March 2014

Concern in Europe at proposal to introduce mandatory HIV testing of at risk population in the Czech Republic

The EU Civil Society Forum on HIV/AIDS (CSF) has registered its concern at a proposed amendment to the law on public health in the Czech Republic which would make HIV testing compulsory for some high risks groups, including men who have sex with men. In a letter to the Health Minister the CSF calls on the Government of the Czech Republic to reconsider the proposal which violates fundamental human rights, is not in line with WHO and UNAIDS HIV testing protocols and goes against best public health evidence. 

> EATG - CSF letter to Czech Government - April 2015

Spanish parliament rejects amendments to abortion bill

Last month, the Spanish parliament rejected amendments, submitted by several parties, to an abortion bill proposed by Spain’s ruling Popular Party. The proposed legislative changes would have obligated 16 and 17-year-olds to obtain consent from their parents or legal guardians before terminating a pregnancy, even in cases in which the requirement could place them at risk of serious conflict, violence, or abuse. Campaigners argued that this posed a serious threat to the health and sexual and reproductive rights of girls and created unjustified barriers to safe and legal abortion. Click the links to view a letter that went to the Popular Party Parliamentary Group from international and national NGOs and IPPF EN website for more information on the eventual outcome.

> Letter from NGOs - March 2015

> IPPF EN - update on amendment to Spanish abortion bill - June 2015

Attempts to limit Swedish women’s rights to reproductive healthcare rejected by the European Committee of Social Rights (ECSR)

The ECSR recently rejected claims made by the Federation of Catholic Family Associations in Europe (FAFCE) that healthcare providers in Sweden should be able to claim ‘a right to conscientious objection’ and refuse to provide abortion services under the European Social Charter. The Committee confirmed that states are not obligated to recognise or protect any right of health professionals to refuse care on grounds of personal conscience under the right to health of the Charter. For more information click the link below.

> IPPF EN - news - 2 July 2015