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Brussels, 29 November 2013
World AIDS Day 2013: The Fight Against HIV/AIDS by the EU
What are the latest figures on HIV/AIDS in the EU and neighbouring countries?
According to the “HIV/AIDS Surveillance in Europe 2012” report1, 2012 saw an 8% increase in new HIV infections since the previous year in the WHO European Region. In Eastern Europe and central Asia, the rise was 9% and in EU and European Economic Area (EEA) countries, almost 5%.
In 2012, nearly 30 000 new cases of HIV were reported in the 30 EU and EEA countries. 49% of those who tested positive for HIV were diagnosed late in the course of their infection. This is worrying, as we know that if a person receives antiretroviral therapy early on, they will have a better health outcome and be less likely to transmit HIV to others.
Similar to recent years, in EU and EEA countries, the highest proportion of HIV diagnoses was reported in men who have sex with men (MSM) (40.4%), followed by heterosexual transmission (33.8%) including heterosexually-acquired cases originating from sub-Saharan African countries. For 18.7% of the cases, the transmission mode was unknown.
For the EU and EEA countries, in 2012, the male-to-female ratio was 3/2. Young people aged 15 to 24 years accounted for 10.6% of all HIV diagnoses reported, but this varied widely from 4.4% in Slovenia to 32.5% in Romania.
What is the situation regarding HIV/AIDS in the world?
Worldwide, the number of people newly infected with HIV dropped 33 per cent between 2001 and 2012. However, 2.3 million people are still newly infected by HIV each year, with 1.6 million of them in sub-Saharan Africa which is the region most affected by the disease and is home to 69% of all people living with HIV worldwide and 91% of all new infections among children. AIDS is the leading cause of death in sub-Saharan Africa and the 6th leading cause of death worldwide.
Since the beginning of the epidemic, more than 65 million people worldwide have been infected with HIV and more than 30 million people have died from AIDS. Today, more than 35 million people are living with HIV/AIDS.
Currently more than 10 million people worldwide, mostly in low and middle income countries, receive life-saving antiretroviral treatment. This is almost 20% more than a year ago. The goal of ensuring treatment for 15 million people - the target set in the 2011 UN political declaration on HIV, is therefore within reach.
How is the European Commission involved in the fight against HIV/AIDS?
A number of policies and funds contribute to fighting HIV/AID, for example:
- Development policy and funding
Promoting human rights and strengthening civil society, are principles that underpin EU development policy. These are basic requirements for successful approaches to preventing and treating HIV/AIDS, particularly in key populations.
The EU supports developing countries in their efforts to improve the health of their citizens – particularly women and children – and to confront major diseases, such as HIV/AIDS. To achieve these goals, EU development policy strengthens health systems in developing countries to provide equitable access to comprehensive health services and to invest in areas outside of health systems that have an impact on health outcomes (e.g. nutrition, sanitation, clean water). The EU spends an average of 500 million EUR of its development funds on health every year.
The European Commission is also a founding member of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), which has helped to achieve impressive results in limiting the spread of these three specific pandemics. Thanks to Global Fund support, 5.3 million people living with HIV are currently receiving life-saving anti-retroviral treatment. The EU collectively is the biggest contributor to the Global Fund, providing more than half of all resources so far. The European Commission alone has contributed more than 1.1 billion EUR to the Global Fund.
Next week (2-3 December), the donors to the Global Fund will assemble in Washington, D.C. to announce their pledges for the 2014-2016 period, including the one from the European Commission. It is expected that contributions will increase considerably.
Health policy, agencies and funding
The 2009 Commission Communication "on combating HIV/AIDS in the EU and neighbouring countries" and its Action Plan set out EU action to address the HIV challenge with a focus on effective prevention, priority groups and priority regions, in particular Eastern Europe. Activities are being implemented in cooperation with Member States, civil society, UN organisations and EU agencies.
The HIV/AIDS Think Tank (national authorities from EU Member States, neighbouring countries and international organisations) and the HIV/AIDS Civil Society Forum (NGOs and networks from all over Europe), bring together national authorities, academia, International organisations and Civil Society to implement the EU HIV action plan. The Commission is currently shaping, together with Member States and civil society, an updated Action Plan to fight HIV/AIDS.
A series of actions and projects are co-funded through the Health Programme fostering cooperation among Member States and enhancing the exchange of good practise, e.g. a Joint action for improving quality in HIV prevention.
The new Health Programme 2014-2020 with a budget proposed of € 446 million is due to be adopted early next year. As with the previous programme, addressing HIV/AIDS, TB and hepatitis, will be a priority, with a focus on up-take of good practices for cost- effective prevention, diagnosis, treatment and care.
Specialised agencies, e.g. the European Centre for Diseases Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) support Member States in efficient surveillance and better prevention and preparedness strategies.
Two reports have been published in 2013 to guide future prevention policies in Europe. The EMIS - Internet Survey on European Men-Who-Have-Sex-With-Men was published in May 2013, and the report on the 2003 Council Recommendation on the prevention and reduction of health related harm associated with drug dependence, was published in October 2013.
- Research and innovation policy and funding
Since 1987, the EU has been supporting research on HIV/AIDS through the multiannual Framework Programme for Research and Technological Development (FP). Under the Seventh FP (FP7 2007-2013), the EU has invested nearly € 160 million on 28 collaborative projects for HIV transnational research for the development, testing or optimisation of treatments, preventive tools and novel diagnostics. Through this programme, the EU structures and integrates European research and creates close partnerships between European scientists and research teams outside the EU.
One EU-funded project - the EuroCoord Network of Excellence, has brought together HIV cohorts and collaborations and unified expertise from over 100 institutions across Europe. This network has created the biggest common virtual database with data from over 280.000 HIV infected individuals. EuroCoord activities optimise HIV patient management & outcomes and improve the quality of life for patients in the long term. The outputs of EuroCoord also inform national and international guidelines for HIV treatment and prevention, the direction of clinical trials as well as the priorities of legislative authorities and interested stakeholders.
The European and Developing Countries Clinical Trial Partnership (EDCTP), was established in 2003 by 16 European Countries, the EU and the Sub-Saharan African countries to fight the three main poverty related diseases HIV/AIDS, tuberculosis and malaria. Its approach is to support capacity building and clinical trials. The partnership has facilitated the acceleration of clinical development of new or unproven products against these diseases, and has so far dedicated €68 million to HIV research allowing the launch of 30 clinical trials on improved treatments and new vaccine candidates.
One noteworthy success is the “Kesho Bora Study of Highly Active Anti-Retroviral Therapy (HAART) during Pregnancy and breastfeeding” which resulted in a 43% reduction in HIV infections in infants and more than a 50% cut in breastfeeding infection. These findings influenced the guidelines on preventing mother to child HIV transmission issued by the World Health Organisation in 2010.
The EU is currently finalising the next research programme, Horizon 2020 (2014-2020) where HIV research will continue to be supported. The 2014-2015 work programme will call for the creation of a large European platform on HIV vaccine research. In H2020, EDCTP will enter into its second phase with a planned EU contribution up to €683 million.
- Trade policy
The EU supports a flexible use of TRIPS (Agreement on Trade Related Aspects of Intellectual Property Rights, 1991, WTO) provisions, to allow low-income countries to procure lifesaving generic medicines (produced under compulsory licences) from third countries. The EU has consistently led efforts to widen access to vital medicines in developing countries and to strike a balance between the intellectual property rights necessary to promote the research of new and improved medicines and the need to ensure that medicines are available for poor countries facing public health crises.
What is the EU doing to combat HIV-related stigma?
People living with HIV often face stigma and discrimination. This applies not only to healthcare settings, but also to the workplace and other everyday life situations such as access to insurance coverage, or banking services. HIV-related stigma and discrimination is a serious hurdle in the fight against HIV-AIDS, as it can discourage people from being tested and seeking treatment. The Commission is committed to taking action to overcome HIV-related stigma and to effectively reach key population groups – to both prevent HIV transmission, and stimulate adequate levels of support from healthcare and social services.
The Commission is endorsing the European HIV Testing Week this year (22-29 November). This initiative aims to reduce HIV-related stigma, normalise testing and increase awareness.
In 2013 the Commission organised two events addressing discrimination and stigma in health: a joint conference with UNAIDS on HIV and Human Rights - "Right to health, right to life” in May, in Brussels, and a workshop at the European Health Forum Gastein, hosted by EU Health Commissioner Tonio Borg, entitled "Improving Access and Combating Discrimination in Healthcare with a focus on vulnerable groups". A conference taking place in Brussels on 18 March 2014 entitled "Health in Europe – making it fairer", will build on these discussions.
EU Strategy on HIV/AIDs – what next?
The Commission Communication on combating HIV/AIDS in the EU and neighbouring countries 2009-2013, and its accompanying Action Plan, focus on measures for effective prevention, addressing key populations and priority regions, in particular Eastern Europe.
An independent evaluation of the Communication is underway. The results will be available in Spring 2014, and will inform discussions on the development of options for a future EU policy framework on combating HIV/AIDS. In parallel, the Commission is currently working jointly with the HIV/AIDS Civil Society Forum, the Think Tank on HIV/AIDS and with international organisations like UNAIDS and WHO to update the current Action Plan. The updated Action Plan shall be available soon and will ensure continuity of EU policy action until a new framework has been developed.
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