EUROPEAN COMMISSION HEALTH & CONSUMERS DIRECTORATE-GENERAL Directorate C - Public Health and Risk Assessment C4 - Health determinants Minutes of the 18 th HIV/AIDS Think Tank Meeting 5 and 6 June 2012, Luxembourg 1. Opening of the full Think Tank meeting - DG SANCO. The main points of discussion to be addressed during the meeting were introduced. The importance of supporting and maintaining the CSF and the Think Tank meeting as good and efficient frameworks for discussing in an open and transparent way the HIV/AIDS situation in EU and in the neighbouring countries was underlined, especially taking into account the economical crisis EU is experiencing and its potential impacts on the health situation. Epidemiological and behavioural surveillance, investing in prevention, access to treatment were indicated as the key points of the EC Communication on HIV/AIDS to be continuously discussed and brought forward. 2. Civil Society Forum (CSF) report The CSF co-chair Mrs Cosmaro and Mrs Zakowicz reported on the main issues of discussion during the CSF. Among them: i) how Civil Society Organizations can act more efficiently in keeping HIV/AIDS in the agenda of EU Presidencies; ii) the access to treatment in times of financial crisis, especially in terms of the stock-out problems; iii) the specific issues of lowprevalence countries; iv) the human rights and the still ongoing problem with criminalization of people infected with HIV. The information on the Oslo Declaration on HIV criminalisation and the legislative changes around criminalisation in Switzerland were presented as positive achievements in this context. By contrast, the anti gay law in St Petersburg raised some questions and worries and will require a close follow-up. Promoting early HIV testing and timely care as well as the situation in Greece represented other important topics of discussion during the CSF. A detailed report of the CSF meeting will be published separately on the website of AIDS Action Europe. 3. Developments in Member States reports
The session was opened with a talk on "The HIV situation in Spain" given by the Spanish representative, and followed by Mr Casabona, of the Centre for Epidemiologic Studies of Sexually Transmitted Diseases and AIDS in Catalonia (CEEISCAT), presenting the results obtained so far in the context of the EC funded project COBATEST. This project is focused on how to improve HIV testing by increasing HIV community based testing practices in Europe. During the discussion the issue of a possible limitation in access to HIV treatment for irregular immigrants in Spain was raised. Mr. Nikolopoulos, representative of KEELPNO (the Greek Center for Disease Control and Prevention), opened the session by addressing the HIV situation in Greece, and by presenting the latest available data based on the national HIV/AIDS reporting system, second generation surveillance sources, and a molecular epidemiology study recently carried out. Overall, the data indicate an ongoing increase in HIV infections among injecting drug users (IDU), in particular in the central part of Athens. It was stated that, according to the HIV/AIDS reporting system, the percentage of migrants among the reported HIV-positives has remained stable. An avidity test conducted on 62 samples has clearly showed that these cases represent recent infections. Moreover, it has been possible to demonstrate the substantial networking of HIV infections in the population of drug injectors in 2011. The measures introduced by public authorities to tackle the situation were presented and in particular the increase in the number of distributed clean needles and syringes was highlighted. Mr. Dedes, representing the Greek Civil Society point of view, confirmed that migrants clearly do not represent the driving force of HIV spreading in Greece and warned against wrong political messages and misinterpretations. Mr. Dedes also reported on the detention and forced HIV testing of women accused of soliciting sex operated by the Greek authorities. Finally, the ECDC reported the first preliminary results and consequent recommendations resulting from a technical mission that ECDC carried on in Athens along with ECMDDA and WHO, upon specific request of the Commission. A representative of the CSF and of the Agency for Fundamental Rights also participated in the mission, the second one as an observer. Moreover, by the end of September October ECDC will deliver a full risk assessment on the situation. The UK representative presented UK initiatives on reaching key populations (especially MSsM) for testing (Reaching key populations for HIV testing) while Mrs Lulei, from BZgA, gave an overview on the German campaign for World AIDS day "Living together positively. Be safe" (Living together positively. Be safe! - The German campaign for World AIDS Day). During discussion the issue of how to measure the impact of awareness campaigns on HIV prevention was raised.
4. HIV in Eastern Europe what about the future During this session an overview of the HIV situation in Eastern Europe, comprising also Central Asia Countries, was given by ECDC and WHO Europe. One of remaining pressing issues is still the difficulty for key populations to reach testing and treatment. Mrs. Kurbatova, from the Estonian National Institute for Health Development, presented in detail the situation in Estonia. Here, IDUs represent the main target group (roughly 70% of all cases). IDU prevalence is mostly confined to two (out of 15) counties Harjumaa including Tallinn and Ida-Virumaa (North-East). Different co-morbidities in particular HIV/IDU, HIV/TB, TB/IDU, IDU/HIV/TB, IDU/HIV/MDR-TB represent an important issue to be further addressed. Estonia has a National HIV and AIDS prevention strategy running 2006-2015 with 3 main objectives: harm reduction programs for people who inject drugs (syringe exchange programs, substitution treatment, counselling); HIV testing (based on risk behaviors and indicator conditions); HIV-related health care services including ARV treatment free of charge for all. In a study published last year (Uusküla A et al. "Expanded syringe exchange programs and reduced HIV infection among new injection drug users in Tallinn, Estonia" BMC Public Health. 2011 Jun 30;11:517) it has been clearly shown that in Estonia a decrease in the HIV prevalence among new injectors and in the numbers of people initiating injection drug use coincided with implementation of large-scale syringe exchange programmes. Of course, further reduction in HIV transmission among IDUs is still required. Also the OSTs have been implemented from 2004 to 2011 and are now provided also in prisons and detention housings. Importantly, the Ministry of Interior has taken over coordination of the national drug policy. This should provide the necessary political commitment towards the implementation of different interventions still needed to tackle HIV among IDUs. The representative of the Russian Federation reported in detail the HIV situation in the RF, showing the constant increase in PLWH and in newly diagnosed cases of infection. The main achievements of the Russian Federation in the fight against HIV/AIDS are represented by 100% testing of donated blood; up to 100% of pregnant women tested for HIV; decrease of HIV transmission from mother to child from 30% to 8.5% in 2011; near 100000 of people (1/5,5 of living with HIV) covered by antiretroviral therapy. Mr. Shukov underlined that Russian Federation is investing on basic science, vaccine development, and research of new targets for therapy, drug development and strategies to increase local production of drugs to
cut down the prices. All these lines of actions are important also in the context of Russian Federation's cooperation with neighbouring Countries on HIV prevention. Both Estonia and Russian Federation reported difficulties related to medical and nursery personal leaving the Country due to economic reasons. 5. HIV/AIDS co-infections open issues During this session the ECMDDA presented data on the transmission of hepatitis among IDUs in Europe. In particular the high prevalence of HCV infection among IDUs represents a serious public health problem for the EU, made worse by the fact that many of those who have contracted the virus are unaware of their infection status was shown. The ECDC gave a short report on the ECDC TB action plan, illustrating the complexity of the TB situation in the EU. Testing and reporting on HIV serostatus of TB cases is still largely incomplete. Indeed, only a limited number of countries currently collect and report data on TB/HIV co-infection. This low coverage is likely related to different kind of barriers. Among them, one of the most important is the lack of collaboration between TB and HIV surveillance systems. Thus, the implementation of a European Reference Laboratory Network for TB should help to make progress. Mr. Lundgren, from University of Copenhagen, addressed the problem of HIV and coinfections focusing on open issues in prevention, treatment and care. In this context, cancer is an increasing problem for people living with HIV/AIDS, not only because of their immune status but also because of co-infection with oncogenic viruses, in particular HPV, HBV and HCV. The rational of employing HPV and HBV vaccination in HIV positive patients was discussed as well as new therapeutic options for HIV/HCV co-infected patients. Moreover, a TB co-infection is still one of the main issues for people living with HIV/AIDS, especially due to the fact that MDR TBs are spreading. Furthermore data show that co-infection with syphilis co-infections is a major problem, especially among MSM. 6. ECDC reports (i) Technical mission in Greece (see point 3) (ii) Overview on the epidemiological situation in Eastern Europe (see point 4) (iii) Short update on the TB plan (see point 5) (iv) Behavioural surveillance project. The overall goals of this projects are: the mapping of HIV/STI behavioural surveillance systems in the EU/EEA; the survey on 8 sub-populations including general population, youth, MSM, migrants, IDU, PLWHA, sex workers, STI clinic
attendees; the harmonisation of indicators and the outline of the methods for implementing behavioural surveillance. The ECDC presented the interim results and the on-going support for countries through regional workshops and addressed possible ways forward on this topic. 7. Health Programme and Research Framework Programme. While Mrs von Rueden, from Bundeszentrale für gesundheitliche Aufklärung (BZgA), presented the outline and the main goals of the Joint Action on QA/QI in HIV prevention, the Commission Directorate General for Research and Innovation, gave an overview on the EUfunded HIV/AIDS projects under the current 7th Framework programme (FP7) and on the future Research Programme Horizon 2020. 8. HIV and co-infection prevention concepts for the future. Mrs Oosterhoff, from the Royal Tropical Institute (KIT), presented the main objectives of the project and the deliverables produced so far. This tender raised profound discussions on the delivery of data and information by Member States as well as on the realisation of the work as such. 9. Conferences The World AIDS conference that will take place in July in Washington, DC and a "HIV and human rights" conference was planned in November in Brussels (now postponed to May 2013). In particular, for the Conference on HIV and Human Rights both, selected Thank Tank and CSF members will be part of the coordinating committee that will elaborate the Conference agenda and main topics for discussion. More information on this topic will be provided in the next regular TT meeting.