Welcome to the July 2023 Sexual Health & HIV Policy EUROBulletin.

In the feature in this edition, we hear from Nikolay Lunchenkov about the key issues in LGBT health in eastern Europe and central Asia and the challenges facing organisations there. He paints a varied picture, highlighting complex and difficult problems but also the success stories and supportive communities that inspire him.

Eastern Europe is also the focus of a new study which found that women who had left as refugees are returning to Ukraine to access reproductive health services, because of barriers to care in Hungary, Poland, Romania and Slovakia.

Other items to look out for in this edition include: reports of steep increases in gonorrhoea diagnoses; new guidance on unexplained infertility; a new edition of the HPV Prevention Policy Atlas; a new community-led project on reducing inequalities in the HIV response; and a summer school for experts in public health and migration.

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Nikolay Lunchenkov is the Health Projects Coordinator at ECOM – the Eurasian Coalition for Health, Rights, Gender and Sexual Diversity. We spoke to Nikolay about LGBT health in eastern Europe and central Asia (EECA), the challenges faced by organisations working in this area and some of the success stories to be celebrated.

Recent increase in gonorrhoea diagnoses

The European Centre for Disease Prevention and Control (ECDC) has shared reports published in several European countries this year that show increases in gonorrhoea diagnoses, mainly in young heterosexual people. The trend began in 2022 and is continuing in 2023.

For example, a report from the Netherlands showed a 33% increase in gonorrhoea cases in 2022 compared to 2021, continuing in 2023; Denmark observed an increase of almost 44% in heterosexual people; and Ireland an increase of 45% in 2022 compared to 2019, with a particularly steep increase in young women (75%).

ECDC has not observed an increase in drug resistance, and says that the increase appears to be the result of increased transmission rather than increased testing.

Menopause assessment for women living with HIV

A new study published in the AIDS Care journal has looked at the provision of menopause assessment and care across Europe for women living with HIV.

Researchers surveyed 121 HIV healthcare providers in 25 countries about screening practices and management of menopause, psychosocial and sexual wellbeing and age-related co-morbidities in women living with HIV.

Most respondents said they screened for diabetes, cardiovascular disease risk factors, poor mental health and low bone mineral density. Menstrual pattern and menopausal symptoms in women aged 45–54 were assessed by 67% and 59% of respondents. Most respondents stated a need for HIV and menopause guidelines. The researchers conclude that screening for psychosocial and sexual wellbeing and menopausal symptoms could be improved, and that there is a need for international recommendations and training.

Migration and health in EECA

The Regional Expert Group on Migrant Health is organising a ‘summer school’ for experts in migration and public health in countries in the EECA region. It will take place in Yerevan, Armenia, 21-22 August.

The aim of the meeting is to discuss demographic and sociological research methods that are important for understanding the population size of key groups of migrants and refugees in the EECA countries, as well as their healthcare needs, including HIV services.

Continued prevention of mpox

ECDC has published an updated factsheet on mpox (monkeypox) for health professionals. In addition, ECDC and the World Health Organization (WHO) Regional Office for Europe have produced infographics and social media tiles on protective measures for those at increased risk.

Although the number of cases of mpox in Europe remains low, there is an expectation that increased travel and gatherings of large numbers of people over the summer months may increase transmission.

In the four weeks to 6 July, 30 cases of mpox were reported in the European region (in Portugal, the UK, Belgium, Spain, Switzerland, France, the Netherlands and Norway).

Refugees return to Ukraine to access reproductive healthcare

A study has found that women who have left Ukraine as refugees are having to return temporarily to access reproductive health services, because of barriers to care in Hungary, Poland, Romania and Slovakia.

Interviews with more than 80 women and experts in the field informed the report, which shows that many Ukrainian refugees seeking contraception, abortion care and maternal healthcare face delays, financial burdens, institutional racism, and sub-standard care. It also highlights serious gaps in support and services for women who have experienced gender-based violence.

The report includes a series of urgent recommendations for action for the European Union (EU), national governments and humanitarian organisations.

Leah Hoctor, Senior Regional Director for Europe for the Center for Reproductive Rights, said, “Decision makers at the national and EU level must show political leadership and act urgently to address the needs of refugees from Ukraine who need sexual and reproductive healthcare and gender-based violence support services. Without action, Europe will have failed to deliver on its promise of safety and sanctuary pledged to refugees from Ukraine. Severe barriers are jeopardising the health and well-being of refugee women and girls.”

New community-led project to reduce inequalities in HIV

AIDS Action Europe has announced a new EU-funded project, working with partners in 16 member states. The CORE project – COmmunity REsponse to end inequalities – aims to reduce inequalities in the response to HIV, tuberculosis and viral hepatitis by promoting, strengthening and integrating community-led work.

The project is focusing on two areas. One group of countries in central and southeast Europe have relatively low prevalence of HIV, but in recent years the HIV response there has been hampered by a backlash against key populations, lack of political will, and lack of recognition of the role of communities. The second group of countries are in western and southern Europe where there is a generally successful response to HIV, tuberculosis and hepatitis, however, some key populations are being left behind.

Equal access to fertility treatment

Fertility Europe and the European Parliamentary Forum for Sexual & Reproductive Rights (EPF) have published a 'white paper': The imperative of equal access to fertility treatments across Europe, which was launched last month in the European Parliament.

The paper looks at the legal frameworks in different European countries, including political choices that may restrict access to treatment, financial support, and availability of information. It also makes recommendations for measures to support equal access to fertility treatments across Europe.

New edition of HPV Prevention Policy Atlas

EPF and the European Cancer Organisation (ECO) has launched a new edition of the HPV Prevention Policy Atlas, a visual representation of how well European countries are doing at preventing human papillomavirus (HPV). HPV is a very common sexually transmitted infection. Some strains of HPV can cause genital warts and certain types of cancer, including cervical and anal cancers. Vaccinations are available against common strains.

The HPV Prevention Policy Atlas ranks 48 European countries on measures related to the prevention of HPV, including the implementation of gender-neutral vaccination. Overall, 39 countries (81%) offer routine vaccination, and 30 (62%) offer gender-neutral vaccination.

Community-led monitoring of the Dublin Declaration

AIDS Action Europe recently hosted a webinar on past, present and future monitoring of the Dublin Declaration. The declaration was a commitment made in 2004 by countries in Europe and central Asia to act collectively to tackle HIV.

The webinar looked at how the response to HIV and the Dublin Declaration has been monitored in the past, and then focused on community-led monitoring, its principles and potential for the future. The presentations given at the webinar were recorded.

Committees vote on sexual violence bill

In June, two committees of the European Parliament approved changes to a proposed EU directive on violence against women, including supporting a legal definition of rape based on absence of consent. This is not currently consistent in every member state.

Other amendments include the addition of the criminalisation of sexual assault, forced sterilisation and female genital mutilation.

Members of the European Parliament (MEPs) from the Committee on Women’s Rights and Gender Equality (FEMM) and the Committee on Civil Liberties, Justice and Home Affairs (LIBE) voted 71-5 to back the proposed changes.

Frances Fitzgerald, lead MEP for FEMM, said: "Non-consensual sex, i.e. rape, must be included in any Directive on Violence Against Women. [...] Parliament will stand up for women's rights to be safe anywhere in Europe – we call on the member states to do the same."

The next step is for a negotiating mandate to be agreed in the mid-July plenary session.

Council of Europe urges Poland to provide abortion care

In June, the Council of Europe Committee of Members published a decision urging authorities in Poland to ensure effective access to lawful abortion. They also highlighted the importance of providing clarity for women, doctors and hospitals through guidelines for doctors.

The statement noted deep concern over "the apparent absence of meaningful consideration" given to previous decisions by the Committee and Poland's continuing failure to make changes in the face of judgments from the European Court of Human Rights.

Keina Yoshida, Senior Legal Adviser for Europe at the Center for Reproductive Rights (CRR) said, “We welcome the Committee’s decision urging Poland to abide by the European Court’s judgments and emphasize that the Polish authorities must take urgent action to ensure that access to legal abortion is guaranteed.”

MEPs make case for funding HIV vaccine research

In an opinion piece for the Health Policy Watch website, a group of MEPs set out why they believe the EU should invest in HIV vaccine research.

Developing an HIV vaccine would be a significant step towards ending HIV. Additionally, the MEPs highlight the importance of HIV vaccine research for other infectious diseases, including through the strengthening of research institutions and infrastructure.

EESC supports fighting HIV stigma

The European Economic and Social Committee (EESC), the voice of civil society in the EU, has issued a so-called exploratory opinion on HIV stigma, in response to a request from the Spanish presidency.

In the opinion document, the EESC agrees with the Spanish presidency that "the European institutions should issue a high-level declaration on eliminating HIV-related stigma and discrimination in Europe" and undertakes to support such a declaration. It also calls for targets aligned with those of UNAIDS – that at least 95% of people with HIV should have a diagnosis; 95% of those diagnosed should have treatment; and 95% of those on treatment should have an undetectable viral load.

Guidelines on unexplained infertility

The European Society of Human Reproduction and Embryology (ESHRE) has published guidelines for clinicians on best practice in care for people with unexplained infertility. It includes diagnostic procedures and treatment strategies, as well as recommendations for future research in this area.

Supporting access to HIV treatment abroad

Life4me+ has launched a website which aims to support access to antiretroviral therapy (ART) for people travelling across borders in Europe.

The project began during COVID-19, when people living with HIV found themselves away from their home countries and in need of access to ART. Since then, the project has evolved to focus on international migrant and refugee support.

The website answers frequently asked questions and provides step-by-step guidance to obtaining medical care and ART in multiple European countries.

International AIDS Society conference (IAS 2023)

The latest HIV research will be presented at IAS 2023, the 12th International AIDS Society (IAS) Conference on HIV Science, in Brisbane, Australia, and virtually from 23 to 26 July.

NAM aidsmap is an official provider of online science news and will be publishing news coverage of the conference on its website, as well as sending out summary bulletins by email in English, French, Italian, Portuguese, Russian and Spanish.

Belgium | Structural barriers impede migrants living in Belgium from accessing PrEP (regular medication to prevent HIV) despite their willingness to take it. A study showed the country’s healthcare systems and PrEP reimbursement model are barriers for undocumented migrants and those who are experiencing financial hardship.

Denmark | A study in Denmark has found that women living with HIV report more loneliness, lack of sexual desire and sexual dysfunction than their HIV-negative peers. However, the two groups differed significantly demographically, and data were collected at different times, before and after the COVID-19 pandemic.

Ireland | New statistics released by the UK's Department for Health and Social Care show that people resident in Ireland are still travelling to England and Wales to access abortion care. Most (98%) of those travelling for care in 2022 were more than 12 weeks pregnant and therefore ineligible for care in Ireland.

Malta | A new law relating to abortion care has been passed in Malta. The original wording was seen as a positive change, as it was intended to enable abortion care for women in some cases, in a country where abortion is banned. However, a series of last-minute amendments now mean care is only available to women who are at imminent risk of death, when they are in a licensed hospital, and where three specialist doctors consent to the care.

Poland | Further protests against Polish abortion laws were held in June, following the death of Dorota Lalik, who died from sepsis when an abortion procedure could have saved her life.

Slovakia | The caretaker government in Slovakia has stated that it wants to introduce medical abortion (i.e. abortion medication), opening discussions with health professionals about the potential change.

Switzerland | Rising CD4 counts and suppressed viral load on antiretroviral treatment have had a far greater impact on reducing new cases of tuberculosis in people with HIV in Switzerland than testing and preventive treatment for latent tuberculosis, according to research from the Swiss HIV Cohort.

United Kingdom | New data from the UK Health Security Agency shows record levels of gonorrhoea and syphilis diagnoses in 2022. Gonorrhoea diagnoses increased by 50.3% compared to 2021, to the highest level since records began in 1918.