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

In the feature in this edition, we talk to Dr Esteban Martínez, president of the European AIDS Clinical Society (EACS). The European AIDS Conference is being held in Poland next month and we spoke to Esteban about what to expect from the conference, the importance of responding to the HIV epidemic in eastern Europe and the role of EACS in supporting clinicians and people living with HIV from Ukraine.

Last week, the European Centre for Disease Prevention and Control (ECDC) published a series of reports on HIV showing that the Europe and central Asia region is falling short of global HIV targets. This conclusion is echoed in the new headline HIV data from the World Health Organization (WHO) European region and shown starkly in an analysis from ECOM – the Eurasian Coalition for Health, Rights, Gender and Sexual Diversity – of the HIV care cascade for men who have sex with men in six countries.

Progress is assessed against the UNAIDS 95-95-95 targets for 2025 (95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment have a suppressed viral load). ECDC estimates the eastern Europe and central Asia region is at 83-85-93. WHO estimates for the European region are considerably lower, at 72-87-95.

Other items to look out for in this edition include: the new Queers Beyond Borders website for queer migrants moving into or around Europe; reports of multidrug-resistant shigella; a study on reproductive coercion experienced by women living with HIV; and a free webinar marking World Contraception Day next week.

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Dr Esteban Martínez is president of EACS and a senior consultant in infectious diseases in Barcelona, Spain. EACS organises the European AIDS Conference every two years. With the next conference taking place in October, we spoke to Esteban about what to expect.

Falling short of HIV targets

ECDC has published a series of reports monitoring progress on reaching HIV targets in Europe and central Asia.

Its HIV testing report summarises data on the implementation of national HIV testing guidelines, provision and uptake of services, and efforts to reduce late diagnosis.

In 2022, ECDC received data from 51 of the 55 countries in the region. Clinic-based HIV testing interventions remain the most common, and legal and regulatory barriers to HIV testing persist.

It estimates that 83% of people living with HIV in Europe and central Asia know their HIV status, 85% of those are taking treatment, and 93% of people on treatment have achieved viral suppression – far short of the UNAIDS 95-95-95 targets.

ECDC also reports that there are limited data on experiences of HIV-related stigma and discrimination and strongly encourages countries to collect more data at the national level. It reports on an exploratory survey around stigma from 2021, which found many of those responding had not told family or friends about their diagnosis.

New HIV data overview

WHO released an updated summary of the global HIV epidemic in July.

In the European region, an estimated 3 million people were living with HIV in 2022: 72% knew their HIV status; 87% of those diagnosed were receiving treatment; and 95% of those on treatment had suppressed viral load.

An estimated 180,000 people acquired HIV in Europe in 2022; and 52,000 deaths were attributed to HIV-related causes.

Research from community HIV testing network

The COBATEST Network brings together over 100 organisations in Europe and central Asia which provide community-based HIV testing and screening for sexually transmitted infections. Research projects based on data from the network were presented at the recent AIDSImpact conference, and the presentations are now available to download.

The first focused on 20 testing centres in eastern Europe and central Asia, and examined the operational and structural issues involved in running these centres. The majority are dependent on international grants to operate. Challenges identified included lack of funding, stigma and the political environment.

The second presentation focused on 60 centres, through which more than 70,000 people accessed HIV testing over a ten-year period. It found that transgender people, gay men, migrants, people who inject drugs and sex workers had a higher odds of testing positive than non-key populations accessing community testing centres.

HIV research news

The 12th International AIDS Society Conference on HIV Science (IAS 2023) took place from 23 to 26 July.

NAM aidsmap published news coverage of the conference, short video interviews with researchers, and sent out summary bulletins by email in English, French, Italian, Portuguese, Russian and Spanish.

The conference included new research on HIV treatment, HIV prevention, and co-morbidities and co-infections, including high blood pressure, mpox and COVID-19.

Clusters of multidrug-resistant shigella

ECDC has published an epidemiological update on multidrug-resistant shigella.

The 300 cases reported to ECDC are linked to seven microbiological clusters, mainly among gay, bisexual and other men who have sex with men.

Cases have been reported in several European countries, including Spain (more than 60 cases), Ireland (50), Germany (33), Belgium (26), the Netherlands (21), and Denmark (13).

All strains of shigella in these clusters show resistance to first- and second-line antibiotics. Some strains show resistance to azithromycin, which is of particular concern as it limits treatment options.

The Health Protection Surveillance Centre (HPSC) in Ireland has published recommendations on clinical management of shigella in the context of drug-resistant strains affecting gay, bisexual and other men who have sex with men.

Ongoing monitoring of mpox

ECDC and the WHO Regional Office for Europe continue to monitor cases of mpox (formerly known as monkeypox).

In the four weeks to 7 September, 106 cases of mpox were reported in the European region, in 12 countries.

In a report published on 8 September, ECDC highlights that case numbers remain low. Its assessment is that the overall risk of mpox infection is low for men who have sex with men in Europe and very low for the general population.

However, given the recent increase in cases in Portugal (48 cases in the four weeks to 7 September), the risk for men who have sex with men in Portugal is currently assessed as moderate.

A recent case series published in The Lancet Infectious Diseases journal found that over half of new cases of mpox are in people who have been vaccinated or have previously had mpox, but it appears their symptoms are less likely to be severe. The findings show that although people who have had mpox can get it again, and vaccination does not always prevent infection, past infection and vaccines confer partial immunity that reduces the risk of complications. 

Reproductive coercion experienced by women living with HIV

Data gathered from the People Living with HIV Stigma Index 2.0 show that women living with HIV are at increased risk of experiencing reproductive coercion from healthcare professionals in eastern Europe and central Asia (EECA).

A study looked at data from eleven countries in Africa and five countries in EECA: Belarus, Kazakhstan, Kyrgyzstan, Russia and Ukraine.

Participants were asked about reproductive coercion in the previous year. In EECA, 3% of participants reported experiencing forced sterilisation, 4% reported coerced family planning, and 10% experienced coercion related to pregnancy.

Sex workers and women who use drugs were at increased risk of coercion related to contraception, and young women were at increased risk of coercion related to pregnancy.

The research team highlight the urgent need to address coercion and call for non-discrimination protections for women living with HIV to prevent reproductive coercion by healthcare professionals and allow accountability when it occurs.

Violations of the right to health experience by LGBT people

ECOM has published a regional report on violations of the right to health reported by LGBT people in EECA in 2022.

The most common recorded violations were hate speech, physical violence, and abuse of power, including blackmail and threats. Of note, numerous violations relate to the refusal to provide medical care, on the basis of HIV status, sexual orientation or gender identity.

The report also gives an overview of the main changes in relevant legislation in the region.

ECOM makes a series of recommendations around legislation and enforcement, as well as ways to change culture, such as the need to continue educational work with healthcare workers in order to ensure non-discriminatory care.

Regional analysis of HIV targets

ECOM has published an analysis of the HIV care cascade for men who have sex with men (MSM) in six countries of EECA.

In 2021, UN member states adopted new HIV targets and the analysis looks at progress towards the targets, including HIV testing, treatment and legal and social indicators. The countries examined are Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, and Ukraine.

The analysis identifies key gaps, not least in the availability and reliability of data.

The report finds that the biggest gap in achieving the care cascade targets is in HIV diagnosis. The target is 95%, but in the six countries, the realities range from 24% to 68%.

Information on mpox in multiple languages

AIDS Action Europe has co-ordinated a project with its member organisations to translate and adapt information on mpox into several languages.

The original information leaflet was produced by The Love Tank CIC/Prepster. It is now available in Bosnian, Croatian, Greek, Hungarian, Polish, Portuguese, Romanian, Serbian and Slovenian.

Queers beyond borders

A new initiative from The Love Tank CIC and MPact Global aims to support queer migrants moving into and across Europe.

Queers Beyond Borders provides online information to navigate health systems, understand immigration processes, and find communities of other queer migrants.

The multilingual website has launched with a focus on Berlin, Brussels, Lisbon, London, Madrid and Paris. New cities will be added in the coming months.

Dr Will Nutland, Director at The Love Tank CIC, said, "At a time when migration is being used as a political football, and homophobia and transphobia is on the increase, Queers Beyond Borders explicitly celebrates the assets, skills, cultures and joys that queer migrants add to our communities. All of our lives are enriched by the queer migrants who move into and between our cities".

Hearing on reproductive health and rights

Earlier this week, the Women’s Rights and Gender Equality Committee of the European Parliament held a hearing with experts and civil society on women's reproductive health and rights. MEPs heard from medical specialists as well as representatives from the UN Population Fund (UNFPA) and the Center for Reproductive Rights.

EPF and WHO sign memorandum of understanding

WHO, the UN Human Reproduction Programme (HRP), and the European Parliamentary Forum for Sexual and Reproductive Rights (EPF) have signed a memorandum of understanding aiming to strengthen the co-operation between the organisations.

The agreement is intended to work in three key areas of sexual and reproductive health: technical support to promote evidence-based laws and policies aligned with WHO's guidelines; advocacy initiatives aimed at mobilising parliamentarians around sexual and reproductive health; and capacity building to strengthen the collaboration between WHO and parliamentarians.

Professor Pascale Allotey, director of the WHO Department of Sexual and Reproductive Health and Research, said, “Parliamentarians’ political and social capital are powerful levers for defending and advancing progress on health and rights issues which we know can be sensitive and politicised. Our partnership with EPF is a strong commitment to sexual and reproductive health and rights as an evidence-based, accountable, political choice.”

Committee for Medicinal Products for Human Use

At its meeting in July, the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) gave a positive opinion on cabotegravir (Apretude) for HIV PrEP (regular medication to prevent HIV), recommending that it be granted marketing authorisation. This week, it was announced that authorisation had been approved.

Recommendations on self-testing for HIV

WHO has recommended the expansion of the use of HIV self-testing, including in the context of people using PrEP and in promoting testing through social networks.

In settings where there are low levels of HIV testing and diagnosis, self-testing can offer an important route to access and acceptability.

World Contraception Day: webinar

The European Society of Contraception and Reproductive Health (ESC) is hosting a free webinar to mark World Contraception Day on Tuesday 26 September.

The theme is ‘Your Life. Your Choices’. Dr Richard Anderson of the Centre for Reproductive Health, University of Edinburgh, Scotland, will talk about 'Where are we with new methods for men?'

Dr Kristina Gemzell-Danielsson of the Karolinska Institutet, Sweden, will talk about 'Fertility choices for women'.

‘Part of the solution’: conference

To mark World AIDS Day and International Day to End Violence Against Sex Workers, the European Sex Workers’ Rights Alliance and the European Sex Work Research Network are hosting a public conference on sex work, stigma, criminalisation and public health titled, ‘Part of the solution: sex work, public health and (de)criminalisation’.

The event will be held in Brussels, Belgium, from 4-7 December. Attendance is free for community members.

The organisers say the aim of the conference is to bring together sex workers, sex workers’ rights advocates, researchers, service providers and policymakers to exchange, learn from one another and strategise on topics related to sex work and health.

Austria | An Austrian news website reports that care organisations refused to provide home care for an 81-year-old man living with HIV, on the basis of his HIV status.

England | The government has announced significant funding to support local health services in England to create women's health hubs. Hubs will provide services such as long-acting reversible contraception, cervical screening, and management of problems relating to menstruation or menopause.

Finland | New abortion laws came into effect in Finland this month, making accessing abortion services easier and quicker.

Ireland | The national free contraception scheme in Ireland has been expanded from covering people aged 17 to 25, to include people aged up to 30. The Irish Family Planning Association welcomed the announcement, but called for the scheme to be expanded to include people aged 16, as was previously agreed.

Malta | EPF, together with members of the European Parliament and national parliaments, has written to Malta's Prime Minister, Robert Abela, to express deep concern about recent changes to Malta's abortion legislation. In a public letter, they call on him to reconsider the changes, which effectively further restrict already restrictive abortion laws, and to take immediate action to protect reproductive rights.

Moldova | As part of a pilot programme on menstrual health awareness, young women in Moldova were given access to a watch they could use to track their menstrual cycles. Participants also had opportunities to learn about contraception, sexual and reproductive health. Data are stored on the watch itself and it does not connect to the internet, avoiding concerns over period tracking apps.

Romania | The International Planned Parenthood Federation (IPPF) has highlighted the recent death of a woman denied emergency obstetric care in Romania and called for reform and better collaboration with the European Union on improving access to care.

Sweden | A small study interviewed women living with HIV in Sweden about their experiences of sexual and reproductive health and rights. The authors conclude that stigma and discrimination, ambiguous guidance and unequal access to information affect women living with HIV more than the virus itself.