Ensuring that HIV/AIDS is in the European Commission’s agenda

The letter was answered by Robert Madelin, Director General of DG SANCO, the Directorate General for Health and Consumer Affairs of the European Commission.

Dear Mr Durão Barroso,
The members of the European AIDS Treatment Group (EATG) would like to express their congratulation to the nomination of the European Commission 2004-2009.

The EATG is a non-profit organization, founded in 1991 as a cooperative structure of people living with HIV and their advocates, from different European nationalities. Since its foundation, the organization has been at the forefront of the development of civil society response to the HIV/AIDS epidemic in Europe, focusing its activity of treatment activism and treatment advocacy.

We would like to make you aware of the following:

More than 20 million people have already died from AIDS and an estimated 42 million people around the world are living with HIV/AIDS. This year alone, AIDS claimed 3 million lives, while five million became infected with the HIV virus. Officials predict that as many as 100 million could become infected by the end of the decade.

Although Africa is the epicentre of the horror, now the world’s fastest growing HIV epidemic is taking place in Eastern Europe and Central Asia, where over 1.8 million people are living with HIV, in comparison to around 600,000 in Western Europe.

Only a decade ago the former Eastern bloc had some of the world’s lowest prevalence of HIV infection and the potential to reverse the trend with relative ease. The failure of government to make use of that opportunity led to the current catastrophic situation, which threatens to affect the prospects for economic growth, human development, and security in the region. The result is glaring and destructive and some of the highest infection rates in the world are now happening in Eastern Europe, primarily in Estonia, Latvia, the Russian Federation and Ukraine where the epidemic continues to spread unchecked.

Fear, ignorance, prejudice, outdated laws (including the criminalization of drug users), and lack of information about HIV prevention and transmission are all fuelling the epidemic.

This is clearly among the responsibilities of the European Union. Some of these countries are now part of the EU, and others like Russia, Ukraine, and Tajikistan may become part of it in the future. It is towards these countries that the wealthy European states hold a special responsibility. If no action will be taken, we will be faced with a larger AIDS epidemic that risks crippling the region’s social and economic development and undermining national and European security.

People need to be educated about the possible impact of risky behaviour and have access to condoms, needle exchange programs and substitution therapy. Targeted awareness-raising campaigns must be carried out to inform people about how to protect themselves from HIV. Countering stigma and discrimination is equally essential, and the specific needs and challenges faced by vulnerable groups, notably women and young people, drug users, migrant populations, sex workers, and prisoners must be addressed comprehensively.

By withholding necessary interventions and failing to allocate adequate funds, inadequate political attention and leadership will contribute to the spread of HIV infection as much as the virus itself. Hence, there is an obligation of the European Community to urgently develop concrete and effective strategies to be employed in Europe, its neighbours, and the non- European nations most affected by the epidemic.

In consideration of the role of the European Union as one of the world’s leading super-powers, we call upon you and other European leaders to fully assume a position in the front line of economical and political response to the epidemic at the following levels:

1. In the enlarged European Union, to exercise your authority for the realisation of specific, effective and adequate prevention and treatment measures, as specified below, guaranteeing the fulfilment of uniform European standard of care by the end of 2006.
2. In the rest of the European continent, and in Central Asia, to help providing financial and technical support and effectively advocate for a rapid up scaling of health services and infrastructure, to enable the neighbouring countries to reach a quality of response to the HIV epidemic, equivalent to that specified in the internationally recognised guidelines.
3. As for its role in the global fight for HIV/AIDS, to effectively and proactively contribute to the minimisation of the health gap by providing both financial assistance, and scientific know-how, and by promoting fair and advanced healthcare and social policies and strategies. The response will depend on fluidity rather than bureaucracy and the target of having three million people receiving antiretroviral treatment by the end of 2005 has to be translated into regionally-specific targets according to relative HIV prevalence. According to current HIV Estimates Europe and Central Asia comprises 3.9% of global HIV prevalence. Based on the same proportion the regional target for people receiving ARV by the end of 2005 should be 116,000. The grim situation is that, in Eastern Europe and Central Asia, only 11,000 individuals (a mere 9% of the indicated) are currently under treatment.

As representatives of people living with HIV/AIDS and their advocates we ask our European leaders and the European Commission in particular to make the fight against HIV/AIDS a sustainable priority in their agenda. We invite them to take strong, visible commitments to effectively address the HIV/AIDS epidemic in Eastern Europe, Central Asia and on a global level. By commitment, we mean measurable outcomes, deadlines & monitoring, and resources.

Emphasis must be put on the lessons from our successes in the past: what was accomplished in Western Europe and the USA holds a strong promise to also be successful in an enlarged EU and in neighbouring countries. Moreover, prevention and testing only work if one has something valid to offer: there can be no positive outcome (access to treatment, pension schemes, social care, etc.) without suppression of repressive or punitive measures (criminalization, deportation, incarceration, stigma, etc.). People living with HIV/AIDS today have the right to be offered what amounts to the definition of good health that was given by Mr David Byrne, i.e. ”a state of physical and mental well-being necessary to live a meaningful, pleasant and productive life“, a life that includes work, care and a purpose to carry on. We henceforth ask your commitment to put words into action and undertake the following specific actions:

1. Access: To secure access to effective treatment and care of HIV infection and illnesses frequently seen in people with HIV, such as hepatitis C and tuberculosis, for all people with HIV living in Europe, regardless of their residential and legal status, including up-to-date diagnostic and monitoring tools.
2. Rights: To commit to a European-wide legislative and regulatory framework, reaffirming the social and civil rights of vulnerable individuals, and in particular to those aiming to eliminate all barriers impairing the full access of all people threatened by HIV, to uniform measures of prevention and treatment. This also applies to all travel and residency restrictions directed against persons living with HIV/AIDS.
3. Inspiration: To guarantee that all decisions, actions and resources deployed for the fight of HIV are dictated by scientific evidence and expertise rather than by ideological points of view and political motivations.
4. PLWHA: To guarantee the meaningful involvement of people living with HIV/AIDS (PLWHA) and their advocates, and in particular representatives of vulnerable populations in all the phases of policy development, and the implementation, monitoring and evaluation of all activities related to HIV and associated infections.
5. Vulnerable groups: To ensure that needs-based activities are addressed to all groups vulnerable to HIV, such as: women, people who inject drugs, men who have sex with men, young people, prison inmates, migrants, sex workers and sexual partners of people living with HIV/AIDS.
6. Harm reduction: To guarantee a European-wide access to evidencebased non judgemental harm reduction services. In the context of injecting drug use these must include: access to opiate substitution therapy, de-penalisation of drug use, availability of sterile injecting equipment and its safe disposal, peer outreach and objective information.
7. Prevention: To render interventions with documented efficacy in reducing the sexual transmission of HIV, widely available to all people living in Europe, including: strategic distribution of affordable condoms, education and empowerment of sex workers, effective and specific prevention campaigns targeted at young people and other vulnerable groups, safe conception services to individuals living with HIV and their sexual partners.
8. Guidelines: To develop and implement European evidence-based guidelines for the prevention, treatment and care of HIV and related infection, such as TB and viral hepatitis, and to ensure that all EU members respect the standards dictated by such guidelines.
9. Funds: To mobilise and commit funds in a measure that is adequate for realising and sustaining the above stated activities in the EU Member States.
10. GFTAM: To increase the financial contribution to the global fight against HIV/AIDS, by both implementing the Resolution of the European Parliament for an increase in the EU’s financial contribution to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) to at least one billion Euro per year on a sustained basis, and by mobilizing the funds potentially available through the European Development Fund for the fight against HIV/AIDS.
11. Trade: To contribute to the financial ability of low income states to confront the HIV-epidemic crisis by ensuring that no trade agreement negotiated by the European Union undermines the principles of the DOHA declaration and by supporting and pursuing a deeper and broader debt cancellation for all impoverished nations.
12. WTO: To encourage the early implementation of the World Trade Organisation (WTO) Decision of 30th August 2003 without further restriction or condition, and in accordance with ” The Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia“.
13. Research: To allocate sufficient funds to public and to publicprivate partnership research, in order to accelerate the development of safe, effective and affordable anti- HIV therapies, diagnostic tools, and preventive measures such as vaccines and microbicides.
14. Co-ordination: To appoint an EU HIV/AIDS Ambassador with specific responsibility for the coordination and reporting on the pandemic throughout the region and for monitoring the implementation of exiting and future projects.

We urge the European Union and its Institutions to renew their efforts to fight HIV/AIDS in Europe, and particularly to assist the most-affected countries in its neighbourhood.

We ask the European Union and its institutions to fully acknowledge that informed individuals and groups, including people living with HIV/AIDS, and representatives of high risk and vulnerable populations are key actors in stimulating and facilitating decisive policy action, and secure greater and meaningful involvement of people living with HIV and their advocates in all the phases of policy development, implementation, monitoring and evaluation of all activities related to HIV and associated infections in the region. By calling our leaders for strong leadership we commit ourselves to establishing open and honest discussions with the European Commission and provide technical assistance and advice through and by our network.

We would be grateful if you would accept to meet an EATG delegation in order to discuss those issues.

Yours sincerely,

Mauro Guarinieri,

Board of Directors, Chair

Response by DG SANCO on January 13th, 2005
Dear Mr Guarinieri,

Thank you for you letter of 8th December 2004 to the President of the European Commission Jose Manuel Barroso on the state of the HIV/AIDS epidemic in Eastern Europe and Central Asia. Mr Barroso has asked me to reply to your letter on his behalf.

The Commission has set out how it intends to address the re-emerging epidemic in Europe in its working paper ”coordinated and integrated approach to combat HIV/AIDS within the European Union and its Neighborhood“ adopted on 8th September 2004. This covers a range of specific commitments in areas such as prevention, addressing vulnerable groups (such as youth, injecting drug users, migrants), treatment and care strengthening research, and building effective partnerships, including the involvement of Civil Society.

Implementing this working paper is a key priority for the Commission. All relevant Commission Services are working together with the Member States, international organizations, and civil society to fulfill the objectives set out in the document. Internal structures are put in place to ensure the coordination of these activities.

As the actions set out in this document will be completed by the end of this year, an assessment of achievements so far will be carried out and on this basis a Communication is foreseen this autumn. It will set out a more focused and longer term strategy to combat HIV/AIDS within the European Union and neighboring countries.

Moreover, on 26th October 2004, the commission adopted a Communication on a coherent European Policy Framework for the external action to confront HIV/AIDS, Malaria and Tuberculosis, accompanied by the Second Progress report on the EC Program for Action on accelerated action HIV/AIDS, Tuberculosis and Malaria in the context of poverty reduction. The main policy areas identified in the Communication are to enhance human resource capacity, to increase resources to confront the three diseases through innovative actions, to advocate affordable and safe pharmaceutical products, to strengthen the research and development of new tools and interventions, and to strengthen partnerships at all levels. The Action Plan to implement these policies is foreseen for April 2005. A Communication covering the EU and neighboring countries will be complementary to this.

Political commitment and leadership in the fight against HIV/AIDS is the prerequisite for taking effective actions. Europe has to take the lead in confronting HIV/AIDS and the Commission is committed to fulfill its responsibilities. Action will only be effective, however, if all actors work together to build a strong partnership to tackle the epidemic. We need continuous and open discussions with each other to ensure that this is effective. My services have already put in place structures and mechanisms to involve Civil Society in all relevant HIV/AIDS activities and I will make sure that also your representatives will be invited.

I hope that building on the broad experience we have already in Europe in addressing the HIV/AIDS epidemic, extracting best practices and learning from failures and sharing knowledge and information with our partners we will achieve a measurable impact on the HIV/AIDS epidemic in Europe and beyond.

Yours sincerely,

Robert Madelin

Director General of DG SANCO

Mauro Guarinieri, EATG Board of Directors, Chair

EATN - European AIDS Treatment News, Volume 13, I – Spring 2005

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