Brussels, 26 October 2009
EC communication "Combating Hiv/Aids in the European Union and neighbouring countries, 2009-2013": questions & answers
1. What are the actions proposed in the communication to promote HIV/AIDS policies and how is this realised on a European level?
The new strategy underlines the importance of political commitment and determination, the benefit of coordinated strategies and the spreading of good practice. More specifically it concentrates on providing political support to EU Member States and stakeholders across Europe in order to improve access to prevention, treatment, care and support, to reach migrants from countries with a high prevalence of HIV, to improve policies targeting the populations most at risk. It also underlines the importance of supporting an effective response to HIV/AIDS in priority regions (EU members in Eastern Europe and neighbouring countries) by bringing together European and neighbouring countries to share ideas and exchange models of good practice on how to address HIV/AIDS prevention effectively including non discrimination and the respect of human rights. It also reaffirms the political commitment and determination on working with member countries to develop ways and means to reach the populations most at risk of HIV infection (Men who have sex with men, immigrants from high prevalence countries, sex workers), strengthening the role of the civil society and finally, on collecting data and monitor conditions across Europe, supporting national authorities with information on which to base their policies.
2. What is meant by neighbouring countries?
These are the countries immediately bordering the European Union in the East which have considerable numbers of people living with HIV/AIDS (PLWHA) and high infection rates - Russian Federation, Republic of Moldova and Ukraine.
UNAIDS estimates the number of PLWHA at 940 000 in the Russian Federation (registered cases 370 000), and 377 000 in Ukraine (113 000). Under registration and unknown cases are major problems as well as a lack of resources to effectively tackle the epidemic. Co-infections, such as tuberculosis and hepatitis associated with HIV infections represent another public health concern, in particular in neighbouring countries.
3. Why does the new communication focus on prevention, particular regions and particular most at risk of HIV?
Prevention of transmission is the most important approach to react to the epidemic. The Commission has always been promoting prevention as the key to success. Particular regions in Europe are more affected by HIV/AIDS than others. The Commission reiterates the need to concentrate measures where they are most need. The same counts for most at risk populations. The biggest impact on the epidemic in the region could be achieved through targeted measures in these regions and the respective groups at risk.
4. Is there particular EU funding for the implementation of the new action plan?
Actions planned under the new action plan can receive funding, depending on the priorities in the annual work plan, from the Health Programme. This will also promote synergies between different fields of public health. In addition, as the Commission Communication proposes to find practical ways to harness existing financing instruments to fully address HIV/AIDS and health related issues. This is especially relevant in the case of Structural Funds (within the Member States) and the neighbourhood instruments.
5. What are the key achievements of the first Commission Communication on HIV/AIDS and its action –plan, 2005-2009?
The action plan foresaw about 50 actions to be implemented by major stakeholders. A number of key achievements relate to a stronger involvement of civil society at European level, the operational centralisation of HIV/AIDS surveillance by the European Centre for Disease Control and Prevention (ECDC), efforts to facilitate access to affordable antiretroviral medicines, funding of prevention projects and programmes, investments in research, and a close cooperation between partners.
6. How is the Commission promoting the development of effective vaccine and cure for HIV/AIDS - Is the Commission increasing its research fund regarding HIV vaccines?
In the 7th Research Framework Programme the Commission is pursuing the research priorities started in earlier framework programmes aiming at improving research concerning the prevention of future infections and the treatment of people currently living with HIV/AIDS. Research projects address the development of new HIV vaccines, microbicides, drugs and therapeutic options, as well as HIV/AIDS drug resistance.
In the framework of development of new tools and interventions for the three diseases the Commission has created the European and Developing Countries Clinical Trials Partnership (EDCTP) and the Alliance of ESTHER - ‘Network for Therapeutic Solidarity in Hospitals against AIDS' that represent innovative approaches seeking to involve a large number of research and health institutions and civil society organisations in Member States and partner countries in capacity building through twinning programmes and networking.
7. What is the Commission going to do to ensure the access to affordable antiretroviral treatment?
The provision of medical treatment and services is under the responsibility of Member States. However, the Commission tries to promote universal access through coordination and facilitation of negotiations. While antiretroviral treatment is today widely available across Europe, there is concern in neighbouring countries and even in some EU Member States about the impact of the cost of treatment on healthcare budgets, taking into account the increasing number of new infections and the long term commitment, because treatment is a lifelong necessity. The Commission has been facilitating discussions between pharmaceutical industry, government representatives from concerned countries, and representatives from patient organisations to explore options available to support access to affordable anti-retroviral treatment in the past.
8. Are there any new EU instruments to work with neighbouring countries?
No new instruments are foreseen, but the use of existing ones (e.g. involvement in EU meetings and technical projects, addressing communicable diseases in the context of accession negotiations, addressing HIV in bilateral health agreements, providing pre-accession financial assistance) will be maintained with the aim of even better address the needs of the partner countries. This could lead to enhanced activities based on national strategies as a joint endeavour between the countries in question, the Commission and other relevant partners. The exchange among policy makers and experts of different countries opens ways to underline the European approach of non discrimination and solidarity with people living with HIV/AIDS and adequate treatment. Structural funds can be used for health infrastructure since 2007 in Member States and candidate countries. The European Neighbourhood and Partnership Instrument (ENPI) enables cooperation in a wide range of sectors including public health.
9. Does the Commission foresee the promotion of HIV testing in Europe?
HIV testing was already addressed in the first communication 654/2005 on combating HIV/AIDS in the EU and in neighbouring countries, 2005-2009. The Commission's key interest is to prevent new HIV infections and to improve the quality of live of people living with HIV/AIDS in Europe. HIV testing is crucial for both targets, and testing is already provided in all Member States, usually conform to agreed standards and principles, i.e. voluntary and counselled. What is however apparently missing in several settings is the knowledge on how and where to present for testing, and possibly a trust of confidentiality and psychological/medical support for those which test positive.
The Commission will continue to provide its political support to improve the situation across Europe and to overcome potential barriers for HIV testing. Late diagnosis of HIV is a tragedy for the patient and results in an important cost factor for health care systems.