Making the most out of European promises on HIV/AIDS

As European HIV/AIDS activists, we now have an ever-growing collection of high-level commitments [ref 1], starting with the ”Dublin Declaration“ (February 2004) to the latest ”Communication on combating HIV/AIDS within the European Union and in the neighbouring countries“ (December 2005). These fine texts obviously need to lead to concrete new initiatives on HIV/AIDS. Notably, the European Commission needs to focus its resources on the specific fields where it has demonstrated its capacity to make a difference. This includes: (1) promoting evidence-based practices, (2) funding pertinent research on HIV/AIDS, and (3) working directly with HIV/AIDS NGOs which are active at the grassroots level.

Troubles in Brussels
As a whole, the European Union (EU) is now going through difficult times: it is now learning how to accommodate the 10 new member states within its intricate decision mechanisms. The rejection in 2005 of the new constitutional treaty by the French and Dutch voters certainly did not help. Clearly the EU needs to convince many of its own citizens that it is still a pertinent institution! One result of this current state of uncertainty: the global EU budget for the period 2007-2013 will be very limited (as a percentage of GDP, it is smaller than it was ten years ago!). Clearly, the member states have become reluctant to give too much power to the European level. With regards to health specifically, we must take into account also that the EU was granted only a minimal legal mandate: in short the EU can only complement – and certainly not replace – what the national governments are doing. So, if you happen to live in a EU member state which pays little attention to protecting your health and which does not provide you with optimal care, well, sadly, there is not that much that the EU institutions are allowed to do. In 2006, the budget of the EC public health programme for instance only adds up to about 0.20 Euro per person…[ref 2] which is far less than for instance the advertising budget of the fast-food industry.

The European Commission –which is in charge of initiating and implementing EU policies – needs therefore to be very smart on how to use its limited resources: with regards to HIV and AIDS, there are thankfully several specific fields where it can make a difference.

(1) Pooling expertise and knowledge across the continent: what works for drug users in Spain also works in Latvia!
For instance, needle exchange proved it was superbly efficient at stopping HIV infections among drug users already in the 1980s yet it took more than twenty years for harm reduction strategies to become streamlined in Europe - and still today, it remains very difficult in many places to have access to clean injection equipment…. At least, the EU took a strong stand in favour of protecting the health of drug users in 2003 when it officially endorsed ”risk reduction strategies“ which include the provision of ”access to distribution of condoms and of injection materials“, and of ”appropriate substitution treatment“. The EU stated notably that with regards to drug use, ”scientific evidence of effectiveness [should be used] as a main basis to select the appropriate intervention“ (COUNCIL RECOMMENDATION of 18 June 2003 on the prevention and reduction of health-related harm associated with drug dependence.). Today, it is extremely alarming that many HIV-positive drug users in Europe are still being denied access to antiretrovirals – even though it has now been scientifically demonstrated that drug users who take substitution treatment (such as methadone or buprenorphine) are perfectly capable of maintaining a high level of adherence to antiretrovirals (for instance by the studies carried out by the INSERM institute in France with the ”Manif 2000“ cohort). One very concrete step that the EU can take on this issue therefore is to make very sure that successes achieved with regards to providing antiretroviral to drug users are shared across national boundaries. This obviously needs to benefit in priority the Baltic States and our neighbouring countries in Eastern Europe and Central Asia which have been affected over the past five year with a catastrophic increase in HIV infections among drugs users (with more than a million new cases across the region).

(2) Funding pertinent research which matches our needs: suggestions regarding Women and HIV
The European Commission confirmed that ”HIV/AIDS research will continue to be a priority under the Seventh Framework Programme“ (the EU’s new Research Framework Programme for the period 2007-2013). In order to be pertinent, these research efforts need to focus obviously on issues that are most pressing for people living with HIV/AIDS and their peers. For instance, in the recent seminar ”Women Facing HIV in our Wider Europe“ [ref 3], 50 HIV/AIDS NGO delegates (representing 33 NGOs from 20 countries) recommended the following issues as priorities for research efforts:

• to find HIV treatments better suited for women

• to respond better to the health needs of female drug users

• to address the many implications of HIV in terms of reproductive health (this includes better solutions for couples affected by HIV who want to have children)

• to know more about the interactions between hormonal contraceptives and antiretrovirals

• to develop women-initiated prevention tools – such as microbicides – which enable women to become directly involved in their own protection when having sex.

Overall, HIV/AIDS researchers in Europe need to strengthen their relations with community-based HIV/AIDS NGOs… and we count on the European Commission to facilitate such partnerships!

(3) Working directly with NGOs which provide HIV/AIDS prevention and support at the local level
Good news: in the communication released on December 15, 2005, the European Commission makes the clear commitment to ”actively involve civil society, and in particular people living with HIV/AIDS, in policy development, implementation and monitoring. (It is regrettable - obviously - that this most welcome commitment is not legally binding in any way…).

Also, the European Commission recently set up a Civil Society Forum on HIV/AIDS (coordinated jointly with AIDS ACTION EUROPE and EATG), which provides a formal opportunity for European HIV/AIDS NGOs to contribute directly to EU policy-making on HIV/AIDS (twice per year in Brussels). Clearly, upcoming meetings of the Civil Society Forum on HIV/AIDS need to focus on making sure HIV/AIDS remains high on the agenda of our European Institutions (and that the many promises are kept…). To do so, the Forum participants requested that a high-level representative of the European Commission be present during at least a part of these meetings (who could speak on behalf of the many

Directorates-General of EC that are involved in responding to HIV/AIDS).

Finally EC also encourages ”regional and national authorities to facilitate the sustainability of the nongovernmental and community-based organisations and their involvement in policy development, implementation, and monitoring both within the EU and in other European countries.“

This commitment is most welcome because there remain huge differences in between European countries in terms of the scope of the non-governmental involvement on HIV/AIDS. In many countries (France, UK, the Netherlands, the Czech Republic…), HIV/AIDS NGOs are now fully involved in all major decisions related to HIV/AIDS that are made at the governmental level: this ensures that the needs of the communities are fully taken into account. In other European countries (Latvia, Hungary…), there is sadly no such governmental acknowledgement of the added value brought in by NGOs…

To the extent that NGOs are a vital element of mature democratic societies – and specifically – that HIV/AIDS NGOs play an essential role at reaching and mobilizing most vulnerable communities, higher standards need to be set for European governments with regards to the promotion of the development of local NGOs. With this regard, we encourage the European Commission to lead by example. This could mean involving HIV/AIDS NGOs in the definition of key EC policies such as its own structural programmes and its partnerships with neighbouring countries. Such consultations would be yet another good way for the European Commission to make the most out of it resources!

Arnaud Wasson-Simon

References
1 High level commitments about HIV/AIDS in Europe:

– February 24, 2004: The Dublin Declaration : ”Breaking the barriers –Partnership to fight HIV/AIDS in Europe and Central Asia“

– September 2004 :The Vilnius Declaration : ”Europe and HIV/AIDS: New Challenges - New Opportunities“ and release of the working paper ”Coordinated and Integrated Approach to Combat HIV/AIDS in the European Union and in its Neighbourhood“

– December 15, 2005: Communication by the European Commission on ”combating HIV/AIDS within the European Union and in the neighbouring countries, 2006-2009“ These documents are available on the following link : http://europa.eu.int/comm/health/ph_threats/com/aids/aids_en.htm

2 Thanks to EPHA for this calculation !

3 European Seminar ”Women Facing HIV in our wider Europe – hosted by AIDES in Paris on October 6-8, 2005 – organized as part of the AIDS ACTION & INTEGRATION Projects (www.integration-projects.org).

EATN - European AIDS Treatment News, Volume 15, I – Spring 2006

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