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Questions and answers on EU action on fighting HIV/AIDS

European Commission - MEMO/06/428   15/11/2006

Other available languages: none

MEMO/06/428

Brussels, 15 November 2006

Questions and answers on EU action on fighting HIV/AIDS

A global epidemic

How many people are infected with HIV/AIDS in the world?

HIV/AIDS is the worst pandemic the world has ever faced. According to UNAIDS data, AIDS is the world’s leading cause of premature death among both men and women aged 15-59. In 2005 an estimated 38.6 million people around the world were living with HIV. 4.1 million people became newly infected with HIV and the epidemic claimed an estimated 2.8 million lives in 2005.

What is the economic impact of AIDS world-wide, and especially in Africa?

The World Bank calculates that AIDS may now be costing 24 African countries 0.5% to 1.2% of per capita growth each year. In some countries, conservative estimates indicate that the number of people living in poverty has already increased by 5% as a result of the epidemic. According to UNAIDS, governments are suffering a drain on skills, reduced revenues, lower return on social investment, and reduced national security - while facing vast expenses on health and orphan care.

Businesses face higher costs in training, insurance, benefits, absenteeism, and illness. Reports are common of health care costs rising five- or tenfold within a few years. AIDS is reducing the ratio of healthy workers to dependents and may cut productivity growth by as much as 50% in the hard-hit countries.

HIV/AIDS in the European Union

What is the HIV/AIDS situation in the EU?

According to the latest statistics available, produced by the EU-supported “EuroHIV” network in 2005, in the thirty countries within or acceding to the European Union or within the European Free Trade Area[1], sexual transmission of HIV, both heterosexual and homosexual, continues to dominate.

In 2005, 25,037 newly diagnosed cases of HIV infection were reported from 27 of the 30 countries. Two countries reported rates of more than 200 new HIV diagnoses per million of the population in 2005 (Estonia 467/million and Portugal 251/million). Among the 22 countries with consistent reporting of HIV, there has been nearly a doubling in the number of reported cases since 1998, from 9,264 in 1998 to 17,043 in 2005.

The predominant mode of transmission is heterosexual. Most newly diagnosed HIV cases in 2005 for which transmission route was reported (data missing for 18%) were infected through heterosexual contact (10,639, 55%). Over a third of cases (6,583, 34%) were among homo/bisexual men and 10% (1,870) were in injecting drug users. Since 1998, there has been nearly a threefold increase in the number of cases with a reported heterosexual transmission group (260%), especially among individuals originating from countries with generalised epidemics, and amongst homosexual and bisexual men (65%), whilst there has been a decrease among injecting drug users (20%).

Since 1984 the EuroHIV surveillance network, which is part funded by the European Commission, has been coordinating the surveillance activities on HIV/AIDS within the 52 countries covering the WHO European Region. In 2008 the Stockholm-based European Centre for Disease Prevention and Control (ECDC) will take responsibility for the network.

http://www.euroHIV.org

http://ecdc.eu.int/index.html

Are Europeans well informed about HIV/AIDS?

The latest Eurobarometer on HIV/AIDS prevention shows that, as compared to 4 years ago:

  • Perception: People are less well informed, e.g. 24% of people are wrongly convinced you can be infected by kissing on the mouth, and 30% are unsure on this, meaning almost half of all EU-citizens do not fully understand how AIDS can be passed on. This trend is even more prevalent in the new Member States as well as among younger citizens.
  • Behaviour: only about half of the population is adapting its sexual behaviour as regards taking precautions
  • 88% of respondents acknowledge the need for EU-wide information initiatives.

This indicates there is a vital need for more and better information and communication in this
area, specifically targeting the young and focusing on safer sex.

Why is the European Commission concerned about the resurgence of the AIDS epidemic?

The Commission is concerned about the diminished focus on prevention, which remains the cornerstone for all other activities within the comprehensive approach to tackle HIV/AIDS. Without vigorous promotion of primary prevention measures, like education, the use of condoms and implementation of harm-reduction measures (such as exchange of needles and syringes), any other target (such as the elimination of mother-to-child transmission or universal access to treatment) cannot be achieved.

What is the EU doing to combat HIV/AIDS within the EU and in the neighbouring countries?

HIV/AIDS has been an important focus of EU public health activities since the late 1980’s. The EU helped pool Europe’s knowledge on HIV/AIDS by establishing networks linking experts from the different Member States. HIV/AIDS surveillance was made mandatory in the EU. Another significant step forward was the adoption of a Directive laying down EU-wide standards for the quality and safety of human blood and blood components.

The re-emerging of HIV/AIDS in Europe and its neighbouring countries highlighted the need for immediate European action through the adoption of a specific strategy in these regions. This led to the adoption of a policy document on “Combating HIV/AIDS within the European Union and in the neighbouring countries, 2006-2009” on 15 December 2005, building on the orientations set out in the Commission’s working paper “Coordinated and integrated approach to combat HIV/AIDS within the EU and in its Neighbourhood”.

Within this strategy, the Commission provides for political leadership and advocacy by pushing HIV/AIDS to the top of the political agenda, and helps combating stigma and discrimination, promoting the provision of universal access to prevention services, ARV (anti-retroviral) treatment and harm-reduction services for injecting drug users. A particular attention has been, and continues to be, devoted to addressing the challenges faced by vulnerable groups, such as migrants, sex workers, inmates and young people. The Commission also focuses on best practice in HIV/AIDS prevention and sex education.

The Commission is working with stakeholders, international organisations and Member States to achieve these goals and it is supporting projects through its Public Health programme to encourage exchange of best practices and networking of centres of excellence.

Key areas for action include:

  • Combating stigma and discrimination through capacity building among health care workers and NGOs, promotion of voluntary counselling and testing, and awareness raising;
  • Prevention of new infections through education, awareness raising, and facilitating the implementation of comprehensive prevention programmes reaching also the most vulnerable populations;
  • Improving HIV/AIDS surveillance in close collaboration with the ECDC and the EuroHIV network, Member States, neighbouring countries and other partners;
  • Involving civil society through the HIV/AIDS Civil Society Forum and other relevant fora in the development, implementation and monitoring of HIV/AIDS policies at all levels;
  • Fostering political dialogue with the Russian Federation and other partners under the European Neighbourhood Policy (ENP) to encourage the development of leadership and collaboration between different authorities.

http://ec.europa.eu/health/ph_threats/com/aids/aids_en.htm

Why is the Commission launching an awareness-raising initiative?

Statistics show that many young Europeans think that "safer sex" is not a priority anymore. To dispel this dangerous myth, the Commission is to involve young people in a debate without taboos about HIV/AIDS and safer sex. On November 30th, in the run-up to World AIDS Day on December 1st, it will organise a "night of HIV/AIDS prevention TV commercials” at the Kinepolis movie theatre in Brussels. During the event the Commission will present a selection of HIV/AIDS TV commercials from across Europe and beyond, plus additional video material on HIV/AIDS.

Young Europeans in the audience will have the chance to vote for the best commercial. The evening will also include a cocktail, concerts, and a press conference. The three main partners are the music TV network MTV, Kinepolis, and "La nuit des publivores" (a group that organises regular TV ad screenings in different EU countries). The event will be advertised through posters, postcards, the giant banner on the Berlaymont building, and especially through the website
www.aids-remember-me.eu

Would-be script-writers, aged 15-25 who want to convey their feelings about HIV/AIDS on screen, will have the chance to enter a competition and make their dream come true. They will have the possibility to submit their script for an innovative 30-second video on HIV/AIDS to the “AIDS remember me” website. A high-level panel of HIV/AIDS organisations’ representatives will choose the best film to be produced by the Commission for a total budget of €40.000.

Why is safer sex a key component in containing the spread of HIV/AIDS?

Although condoms are not the last resort against HIV/AIDS, they certainly represent the best and most reliable prevention tool. According to UNAIDS, as the vast majority of HIV infections are sexually transmitted, there are only four ways to prevent sexual transmission of HIV: (1) abstinence, (2) monogamous relations with an uninfected partner, (3) non-penetrative sex, and (4) consistent and correct use of male or female condoms. Studies show that there are many people who are either unable or unwilling to practice abstinence, monogamy and non-penetrative sex. This leaves condoms for protecting these people and their partners.

Are condoms really safe?

International and European Research provide clear proof that the HIV virus cannot penetrate condoms. Questions have in fact arisen in the past over whether the HIV virus can or cannot pass through pores in latex condoms. Scientific projects provide extensive proof that this is not the case: if properly used, condoms are safe. Over the last 15 years, the Commission has supported research initiatives in this field across Europe, as well as in Asia and Africa, the areas most affected by the AIDS pandemic.

EU projects focused on condoms’ potential porosity and quality standards, and included surveys of infection transmission in couples and prostitutes. The results show that condoms are the only effective protection against HIV/AIDS: all EU studies concluded that the male condom was an effective way of preventing the transmission of HIV, with an efficacy close to 100% when the condom is used appropriately.

The security and effectiveness of barrier devices against HIV transmission has also been evaluated in an EU project aimed at evaluating and comparing methods to find holes in condoms. This project analysed water, ion and air permeability for setting quality control standard of condoms. The conclusions were used to standardise the evaluation methods for producing safer and more secure condoms.

Another European multi-centre study, funded by the European Commission through several research projects including “AIDS: heterosexual transmission” and “EC concerted action on the heterosexual transmission of HIV”, followed 563 couples with one seropositive partner over 12-21 months. Out of 123 couples using condoms for each instance of vaginal or anal intercourse, no seroconversions occurred; 12 seroconversions occurred among 122 partners who did not use condoms regularly. The consortium concluded that no HIV transmission occurs among systematic condom users.

Another EU-funded project on 866 female prostitutes from European countries, “HIV infection in female prostitutes”, concluded that the lack of condom use was associated with HIV infections. The study also stated that petroleum-based lubricants could diminish the efficacy of condoms.

Is the EU funding other research projects on HIV/AIDS, including in developing countries?

The EU Sixth Framework Programme for Research and Development (FP6, 2002-2006) allocates a total of €400 million to the three main poverty-related diseases, a four-fold budget increase in comparison with the previous Framework Programme (FP5, 1998-2002). Research on HIV/AIDS will continue being a priority under FP7 (2007-2013).

Projects financed by the European Commission on HIV/AIDS cover both prevention and treatment aspects, including research on new drugs, microbicides and vaccines. EU-funded research projects include:

  • “Highly innovative approaches Proposals” have an average of 5-6 partners and receive about € 1 million during 2-3 years. Both basic and preclinical research on prevention and treatment are financed.
  • “Integrated projects”, covering research up to early human testing. Funded with an average of €10 million, these projects usually include 10-30 partners for a period of 5 years.
  • “Networks of excellence”. Under the 6th Framework Programme, the European Commission will finance three broad networks of European researchers on HIV preventive technologies (vaccines and microbicides), therapeutic clinical trials, and cohort studies. Each of these networks receives funding in the range of € 8-15 million for a period of 4-5 years, and includes more than 100 researchers.

In addition to basic, pre-clinical and early clinical research, the European Union is also financing capacity building and advanced clinical trials in Sub-Saharan Africa through the “European and Developing Countries Clinical Trials Partnership”. The EDCTP is an independent organisation based in The Netherlands, partnering with 14 European Member States plus Norway and Switzerland.

http://ec.europa.eu/research/edctp.html

EU action to combat HIV/AIDS in developing countries

What is the “European Programme for Action to confront HIV/AIDS, Tuberculosis and Malaria”?

In response to the rapid spreading worldwide of the three main communicable diseases linked to poverty, and in particular HIV/AIDS, in April 2005 the European Commission adopted a European Programme for Action covering all developing countries for the period 2007-2011. The Programme for Action was endorsed by EU Member Sates in April 2005.

The Programme for Action foresees that the European Union (European Commission and EU Member States) support country-led programmes confronting the three diseases as well as action at global level in areas where the EU can add value. It also argues for an increasing EU contribution to help fill the financial gap, thus reflecting Europe’s weight as international partner in development.

At country level, the Programme for Action focuses on improving political and policy dialogue on human rights-related issues, needs of vulnerable groups and issues around stigma and discrimination. It puts emphasis on monitoring and data collection, on capacity building in the areas of human resources, clinical research and procurement policy, as well as on the need to create synergies with programmes promoting sexual and reproductive health and rights.

At global level, the Programme for Action aims at strengthening regional networks and cooperation, promoting affordable and safe pharmaceutical products, reinforcing the regulatory capacity of partner countries, addressing the human resource crisis in health and supporting research and development of new preventive and therapeutic tools.

The Programme for Action calls for a strong partnership with key players and initiatives such as the “Global Fund to Fight AIDS, Tuberculosis and Malaria” (GFATM) and highlights the need to promote and defend at the international level the European stance on issues related to these areas. Budget allocations will be made in accordance with the new financial instruments of the EU for 2007-2013.

What is EU funding for HIV/AIDS related actions in developing countries?

The European Commission supports HIV/AIDS related interventions in developing countries through several geographical and thematic financial instruments[2] mainly at country or regional level (through national and regional indicative programmes). Support to HIV/AIDS interventions at country level has to fit into the national or regional indicative programme which outlines the scope and priorities of the EU development assistance with a partner country/region for a given period.

Bilateral country support is the main approach towards improved health in developing countries; the EU supports health sector reforms and health care delivery approaches ensuring improved access to and sustainability of basic services, including AIDS related services. HIV/AIDS aspects are also included into other sector-specific EU initiatives, for instance education, infrastructure and transport.

So far the Commission has funded projects through calls for proposals rather than supporting project proposals on an ad-hoc basis. Through the definition of political priorities, the European Commission sets broad targets while respecting the right of initiative of NGOs and international organisations.

Information concerning calls for proposals is available at http://ec.europa.eu/europeaid/cgi/frame12.pl

What is the EU doing to promote access to affordable medicine?

The EU was at the forefront of efforts within the World Trade Organisation (WTO) to ensure access to cheap medicines for developing countries. A first step was the adoption of the Doha Declaration on the TRIP’s Agreement (agreement on the trade related aspects of intellectual property) and Public Health in November 2001. This declaration called for rules protecting intellectual property rights (TRIPS) to be supportive of the right to protect public health and, in particular, to promote access to medicines for all. In August 2003 the WTO finally agreed on a scheme giving developing countries without production capacity access to generic drugs to treat killer diseases such as HIV/Aids, tuberculosis or malaria.

The EU has also adopted new legislation ensuring the delivery of cheap medicines (tiered priced) to developing countries. This legislation encourages the pharmaceutical industry to make products available at near to cost of production price, preventing the re-importation of reduced-price medicines into the EU, thus ensuring that the medicines reach populations in need. One European pharmaceutical company has now notified its first set of products under article 4 of the Regulation.
For more information on trade-related aspects of access to essential medicines:

http://ec.europa.eu/trade/issues/global/medecine/index_en.htm
For further information, see also:

http://www.unaids.org/en/default.asp


[1] Iceland, Liechtenstein, Norway and Switzerland are members of EFTA. Iceland, Liechtenstein and Norway entered into the Agreement on the European Economic Area (EEA) in 1992, which entered into force in 1994. The current contracting parties are, in addition to the three EFTA states, the European Union and the 25 EU Member States.

[2] “Aid for poverty-related diseases (HIV/AIDS, malaria and tuberculosis)” and “Aid for policies and actions on reproductive and sexual health and rights”


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