EU | EATG http://www.eatg.org European AIDS Treatment Group Sun, 19 Nov 2017 22:29:48 +0000 en-US hourly 1 https://wordpress.org/?v=4.8 A simple ask in 2016: the UN goal of universal HIV treatment http://www.eatg.org/news/a-simple-ask-in-2016-the-un-goal-of-universal-hiv-treatment/ Wed, 04 May 2016 13:11:48 +0000 http://www.eatg.org/?post_type=news&p=513

From Simon Collins blog

This post is about two open meetings I attended this month at the United Nations as part of preparations for the upcoming UN High Level Meeting on HIV/AIDS in June 2016. These meetings were for community input into the next UN declaration on AIDS. 

Last week, the working draft for 2016 UN Political Declaration on HIV/AIDS was released with only a few days for comments. [1]

Called the Zero draft, like previous statements produced every five years, it is a list of observations, comments and goals. [2, 3, 4]

The final document will become a UN resolution at the High Level Meeting on HIV from 8–10 June 2016. [5]

The 15-page statement is a resource to collectively hold countries accountable for their response to HIV/AIDS.

Even though very few people living with HIV are likely to read the document it will be referenced by activists working in very difficult circumstances, especially for the rights of some of the most vulnerable people. For this reason, many of the demands and observations focus on getting international recognition for people who are already marginalised.

But using the UN Statement as a platform of human rights has become disconnected from the scientific and medical advances in HIV over the last five years.

The bulk of the draft document could have been written at any time during the epidemic, certainly most of it could have been written in 2011. There is only one reference to dramatic changes in the WHO 2015 guidelines and only two references to PrEP.

Yesterday, a smaller meeting allowed advocacy groups and individuals a chance to comment on the Zero draft. The comments were limited to three minute statements – and generally covered the similar ground to the current draft. A webcast of this 45 minute meeting in currently online. [2]

My statement is included below.

“Thank you to the chair, honoured delegates, colleagues, comrades and global activists for the opportunity to comment on the collaborative Zero draft.

I am a treatment activist for the last 20 years, based in London, but active with colleagues in several interntional community networks.

As someone living with HIV reading the Zero draft, I expected to see a clear statement on the need for universal access to HIV treatment on the first page – not having to search for this in subpoints of pararaphs 58 and 63.From a scientific and medical perspective, the 2016 Zero document, for all its important demands, could largely have been written in 2011.

As community activists feeding into this process, I cannot imagine any one here who doesn’t see the universal right to treatment as essential.

Or anyone curently on treatment who would volunteer to give it up.

More importantly, ask any person living with HIV, in any country, what they want and their list will include access to good treatment near or at the top.

I would like to therefore propose for consideration a clear and simple new paragraph on the first page – at number 4 or 5 that:

Recognises the importance of universal access to HIV treatment, for all people living with HIV, supported by WHO 2015 consolidated guidelines that state: “antiretroviral therapy (ART) should be initiated in everyone living with HIV at any CD4 cell count”.

This proposal is supported by the “Right to life” in Article 3 of the UN Universal Declaration of Human Rights and in Article 12 (on access to treatment) of the International Covenant on Economic, Social and Cultural Rights.

The current Zero draft document is written showing:

  • Little awareness of the results of the large international START and TEMPRANO studies that showing clinical benefit of universal treatment for all people living with HIV.
  • Little awareness of the current 2015 WHO guidelines recommending universal treatment for all people living with HIV.
  • No awareness of the likely access to generic dolutegravir within a year at the same price as generic efavirenz that will radically change approach to first-line, second-line and third-line ART.
  • Limited awareness of the impact of treatment as prevention.
  • Limited awareness of PrEP research – also supported by WHO guidelines – for using oral PrEP to prevent transmission.

For all vulnerable populations affected by HIV, universal access to ART covers all ages, genders, risk groups for acquiring HIV, economic, geographic and political boundaries.

In 2016, WHO guidelines support this based on randomised clinical studies that provide the highest quality of clincal evidence.

Without treatment HIV is a fatal disease.

In this High Level Meeting, we should be putting together community demands based on best evidence in 2016.

Universal access is an essential part of both 90:90:90 and 2030 goals and as such it should be explicitly included.

Some countries have already achieved 90:90:90, or will do so shortly, and as a community we should be looking beyond this in a document that has a five year shelf life.

We should be stating that 90:90:90 misses almost 30% of people living with HIV and that this is not acceptable.”

Although the comment period for the Zero draft was only two days, the Chair and cofacilitators at the meeting encouraged continued feedback directly to the UN. For this to be most effective this should also be to your country representatives and delegates that are attending the meeting in June.

References

  1. UNAIDS. Zero draft of 2016 Political Declaration.
    http://www.unaids.org/en/resources/documents/2016/HLM_zero_draft
    http://www.unaids.org/sites/default/files/media_asset/HLM_zero_draft_en.pdf  (PDF)
  2. UN Declaration of Commitment on HIV/AIDS (2001)
    http://www.unaids.org/en/aboutunaids/unitednationsdeclarationsandgoals/2001declarationofcommitmentonhivaids
  3. UN Political Declaration on HIV/AIDS, Resolution 60/262. (15 June 2006)
    http://data.unaids.org/pub/Report/2006/20060615_hlm_politicaldeclaration_ares60262_en.pdf  (PDF)
  4. UN Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS, Resolution 65/277. (8 July 2011).
    http://www.unaids.org/sites/default/files/en/media/unaids/contentassets/documents/document/2011/06/20110610_UN_A-RES-65-277_en.pdf  (PDF)
  5. UN High Level Meeting on HIV/AIDS, 8–10 June 2016.
    http://www.hlm2016aids.unaids.org/index.php/en/home
  6. UN WebTV. Webcast of cofacilitators for the high level meeting on HIV/AIDS with stakeholders. (26 April 2016). My comments are approximately 38 minutes in.
    http://webtv.un.org/watch/informal-meeting-of-the-co-facilitators-for-the-high-level-meeting-on-hivaids-with-stakeholders/4864053910001#full-text
Source SourceHIV i-Base
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Multiple social and health factors associated with irregular attendance at London HIV clinics http://www.eatg.org/news/multiple-social-and-health-factors-associated-with-irregular-attendance-at-london-hiv-clinics/ Wed, 04 May 2016 12:58:37 +0000 http://www.eatg.org/?post_type=news&p=510

One-size-fits-all approach to improving engagement with care unlikely to be effective

People who miss appointments for HIV care are more likely to have money problems, childcare responsibilities and a history of depression according to a recent UK study.

While poor attendance was more common in women, other demographic factors including ethnicity and sexual orientation were not associated with poor attendance. And there was little evidence that differences in the way services are provided affected engagement with care – probably reflecting the generally high quality of care provided at specialist HIV clinics in the UK.

Fiona Burns of University College London presented the data to the Public Health England HIV Reporters’ Meeting last week. The study was also presented in a poster at the recent Conference on Retroviruses and Opportunistic Infections (CROI 2016).

A total of 983 patients attending seven London HIV clinics completed a survey on social factors and their experience of care. The data were linked to clinic records of medical issues and of attendance. Because the study was set up to better understand problems with engagement with care, the researchers attempted to recruit a greater proportion of patients with poor attendance than they would normally find.

Five hundred and fifty respondents were regular attenders (had attended all appointments in the past year), 269 were irregular attenders (had missed at least one appointment) and 164 were classified as non-attenders (had recently disengaged with care for at least a year).

Otherwise the sample broadly reflects the patient population in London – six in ten were gay men, just over half were white, over a quarter were women, over a quarter were black African, and six in ten were born outside the UK. Whereas a quarter had been diagnosed in the past five years, half were diagnosed more than ten years ago.

There were statistically significant associations between poor attendance and the following demographic factors:

  • Female sex
  • Younger age
  • Less education
  • More time since diagnosis of HIV

But people born outside the UK, people of different ethnicities, and people of different sexual orientations were no more or less likely to have poor attendance than other people.

Capability

The researchers hypothesised that there could be factors which affect an individual’s physical or psychological ability to attend an appointment. For example, although people who rate their health as poor or fair might have more reason to attend a medical appointment than people in very good health, actually getting to the hospital could be harder.

The data showed that those with poor/fair health were more likely to have irregular attendance. Also, when respondents were directly asked why they had missed appointments, being too tired or too sick to attend was often given as a reason.

People reporting problems with memory or concentration were also significantly more likely to have missed a recent appointment, as were individuals who used recreational drugs. Moreover, simply forgetting was an important reason given for missed appointments.

Motivation

The researchers also looked at factors that could affect someone’s motivation to attend. There were statistically significant associations between poor attendance and low self-esteem, suicidal thoughts, depression and not feeling ‘in charge of life’.

When asked why an appointment had been missed, feeling depressed was one of the most commonly given reasons. Moreover, issues related to internalised stigma such as not wanting to think about having HIV or fear of being seen at an HIV clinic were especially important for those who had had at least a year of non-attendance.

Opportunity

Turning to social factors which could make it easier or harder for people to attend clinical appointments, these showed some striking associations:

  • While 27% of regular attenders had children, 34% of irregular attenders and 41% of non-attenders did.
  • Not always having enough money for basic needs was an extremely common problem for regular attenders (51%), but even more so for irregular attenders (65%) and non-attenders (66%).
  • Likewise, 14% of regular attenders sometimes went hungry, compared to 28% of irregular attenders and 24% of non-attenders.

The importance of these kind of barriers is illustrated by a quote from the qualitative component of the study. This patient had four children, two jobs and an abusive husband who was not working.

“So whenever I had a free time, I was too exhausted even to think of coming to the clinic… I was always tired and the thing overwhelmed me. My mind was just concentrating at the immediate basic things in the house. My children, mortgage, work.”

Possible interventions

Given the multiple and varied underlying drivers of poor clinic attendance, a one-size-fits-all method of improving engagement is unlikely to work, Fiona Burns concluded.

But she suggested that a number of approaches may have potential – taking a systematic approach to identifying and tracing patients with missed appointments; providing multi-disciplinary, holistic support; making services more flexible; providing peer support and patient navigators; sending pre-appointment reminders; and providing transport tickets in advance of the appointment rather than reimbursing later.

By Roger Pebody

References

Burns F et al. Barriers to regular attendance for HIV care: the REACH study. HIV Reporters’ Meeting, Public Health England, April 11 2016.

Howarth A et al. Factors associated with Retention and Engagement in HIV care (the REACH survey). Conference on Retroviruses and Opportunistic Infections (CROI), Boston, abstract 996, 2016.

View the abstract and e-poster on the conference website.

Source: Aidsmap

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Global Fund: Statement on the UN Special Session on world drug problem http://www.eatg.org/news/global-fund-statement-on-the-un-special-session-on-world-drug-problem/ Tue, 03 May 2016 17:30:18 +0000 http://www.eatg.org/?post_type=news&p=509 The Global Fund to Fight AIDS, Tuberculosis and Malaria welcomes the UN General Assembly Special Session on the world drug problem as an opportunity to bring public health and human rights concerns at the center of the current debate.

We welcome this meeting as an opportunity to shape drug policies that facilitate good health outcomes. Good drug policy can help in many ways: by ensuring adequate investment in essential, cost-effective health services for people who use drugs, including comprehensive HIV, TB, and Sexual and Reproductive Health services; by supporting the meaningful participation of people who use drugs in health programs; and by ensuring that resources are used for programs that minimize health harms and protect human rights, rather than incarceration of large numbers of people who use drugs.

People who inject drugs have consistently poor and inequitable access to HIV prevention, treatment, care and support. To compound the issue they often face discrimination, marginalization and abuse. As their behaviors are criminalized in the majority of countries, they often face incarceration (or, in some countries, extrajudicial detention) – settings in which access to comprehensive HIV services is even more limited. Worryingly, NSP provision in prison has significantly decreased, with only eight countries globally providing this harm reduction intervention in at least one of their prisons.

In too many countries, approaches to drug use still focus overwhelmingly on prohibition and criminalization, yet the limits and harms of this approach are becoming increasingly well documented and drug policies need urgent reform to remove barriers to effective HIV prevention, treatment and care. UNAIDS “estimates suggest that 56-90% of people who inject drugs will be incarcerated at some stage during their life”. Often, they will continue using (and injecting) drugs while in closed settings.

Until these maladaptive drug policies are reformed, particular efforts are needed to ensure continuity of ART, TB treatment, needle and syringe programs, and opioid substitution therapy at all stages – upon arrest, pre-trial detention, transfer to prison and within the prison system, and upon release. It is therefore essential to promote alternatives to detention and to provide harm reduction in these settings as well as in the community.

The Global Fund recognizes in its current strategy the importance of human rights-based approaches to addressing HIV, TB and malaria. This is especially true of most-at-risk populations such as people who inject drugs. The denial of essential, and potentially lifesaving, harm reduction interventions is a violation of the human right to the highest attainable standard of health – yet is the practice in too many countries. Discriminatory laws and policies can further stigmatize and marginalize this population – such as rules excluding current drug users from ART.

Source SourceGlobal Fund to Fight AIDS, Tuberculosis and Malaria

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From over 90 000 cases to zero in two decades: the European Region is malaria free http://www.eatg.org/news/from-over-90-000-cases-to-zero-in-two-decades-the-european-region-is-malaria-free/ Tue, 03 May 2016 17:14:26 +0000 http://www.eatg.org/?post_type=news&p=508 The European Region is the first in the world to have achieved interruption of indigenous malaria transmission. The number of indigenous malaria cases dropped from 90 712 in 1995 to zero cases in 2015. Ahead of World Malaria Day 2016, WHO announces that the European Region hit its 2015 target to wipe out malaria, thus contributing to the global goal to “End malaria for good”. Key partners funded malaria elimination efforts in European countries substantially.

“This is a major milestone in Europe’s public health history and in the efforts to eliminate malaria globally. I applaud this achievement as the result of strong political commitment from European leaders with WHO support”, says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “This is not only the time to celebrate our success but is also the opportunity to firmly maintain the malaria-free status we have laboriously attained. Until malaria is eradicated globally, people travelling to and from malaria-endemic countries can import the disease to Europe, and we have to keep up the good work to prevent its reintroduction”.

The path towards malaria elimination: from Tashkent to the Regional Strategy

The 2005 Tashkent Declaration “The Move from Malaria Control to Elimination”, endorsed by malaria-affected countries in the Region, was a turning-point in achieving a malaria-free Europe. The Declaration led the way to the new Regional Strategy 2006–2015, which guided affected European countries to reduce the number of indigenous malaria cases to zero.

This achievement was made possible through a combination of strong political commitment, heightened detection and surveillance of malaria cases, integrated strategies for mosquito control with community involvement, cross-border collaboration and communication to people at risk. When a country has zero locally acquired malaria cases for at least three consecutive years, it is eligible for official certification of malaria elimination by WHO.

Avoiding malaria reintroduction: the Ashgabat high-level meeting

“The European Region has been declared malaria free on the basis of the present situation and the likelihood that elimination can be maintained. This means that we cannot afford to drop our guard on this disease”, concludes Dr Nedret Emiroglu, Director of Communicable Diseases and Health security, WHO Regional Office for Europe. “Experience shows that malaria can spread rapidly, and, if Europe’s countries are not vigilant and responsive, a single imported case can result in resurgence of malaria”.

On 21–22 July 2016, WHO will convene its first high-level meeting on prevention of malaria reintroduction, in Ashgabat, Turkmenistan. European countries at risk of malaria reintroduction will come together to prevent the return of malaria to the European Region through:

  • sustained political commitment;
  • strong vigilance to test and treat all malaria cases promptly;
  • understanding how malaria transmission could be reintroduced and the risk it poses; and
  • immediate action if local malaria transmission resumes.

The meeting outcome will pave the way for preventing malaria from affecting Europe again.

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EATG + AVAC Prevention Webinars online http://www.eatg.org/news/klorem-ispum/ Thu, 28 Apr 2016 12:42:48 +0000 http://www.eatg.org/?post_type=news&p=484 EATG and and AVAC have been working together in a comprehensive HIV prevention portfolio from 2015. Two European Prevention Summits, a series of webinars, workshops, a collection of presentations and talks, press releases, a hugely popular Facebook page, and plenty of advocacy outcomes show the utility and impact of this community-led initiative. Not only PrEP but also other prevention options, such as vaccines and microbicides, are featured. Two key features of this project are the Trans-Atlantic cooperation, and the fact that it brings to the same table all stakeholders: People living with or affected by HIV, people who don’t live with HIV but are at risk from it, and also researchers and policy makers.

Click on these links to access the webinars:

http://www.avac.org/event/eatg-avac-webinar-series-prevention-vaccines-douches-gels-and-injectables

http://www.avac.org/event/eatg-2015-webinar-2-treatment-all-prevention-and-community-implications

http://www.avac.org/event/eatg-2015-webinar-1-update-prep-europe

Click on this link to access the AVAC+EATG Prevention Summary, which also includes a link to the PrEP video produced by Nicholas Feustel in cooperation with the EATG+AVAC prevention team:

http://goo.gl/s1HfLt

 

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