EU Health Policy Platform Thematic Network on ‘HIV, TB, viral hepatitis and STIs’: Targeting inequities in the face of HIV, TB and viral hepatitis in Europe – Joint Statement

On the 11^th of May, the Thematic Network on HIV, TB, viral hepatitis and STIs of the EU Health Policy Platform released a Joint Statement which aims to bring attention to stakeholder priorities in EU policy and lead to follow-up actions.

Led in collaboration with the EU Civil Society Forum on HIV/AIDS, viral hepatitis and TB, which brings together over 60 partner organisations working with these conditions, the EUHPP Thematic Network aims to facilitate the participation of non-governmental organisations, including those representing people living with HIV/AIDS, in policy development and implementation, and in information exchange.

The Statement draws attention to gaps in meeting the needs of people living with or most affected by HIV/AIDS, viral hepatitis and tuberculosis in the EU and the European region and provides examples of, and recommendations for, good practices in standards of care (including cross-border care) and in tackling the stigma and discrimination faced by various key populations.

You can download and read the statement here.

You can find the key points of the statement here below:

Targeting inequities in the face of HIV, TB and viral hepatitis in Europe

1.Background

1.2. The HIV, TB and Viral hepatitis health gaps

The Global AIDS Strategy 2021-2026 and the World Health Organization (WHO) call for renewed focus on viral hepatitis, HIV and TB epidemics within the European Region. As inequalities drive the HIV/AIDS epidemic, ensuring that disadvantaged people can access HIV services is crucial to meeting these targets.

The European region is diverse in terms of epidemiological burden, countries in eastern Europe and central Asia face high burdens of viral hepatitis, HIV and TB.

The 2022-2030 WHO Europe strategy on HIV and viral hepatitis draws attention to the region being off track to meet the 2030 95/95/95 target for HIV. This implies that 85.7% of people with HIV know their status and are virally suppressed. As of 2020, only 60% did.

Dealing with infections and dealing with cancers intertwines. For viral hepatitis, out of 14 million people with chronic hepatitis B and 13 million with hepatitis C, only 19% and 24% respectively know their status. In 2020, 90,000 deaths from liver cancer (out of a total of 107,000 liver related deaths) were recorded in Europe. This signals the scale up hepatitis B vaccination and improving screening and treatment access for both conditions.

The number of people with tuberculosis who are co-infected with HIV is still increasing. TB accounts for about 70,000 deaths a year regionally. The TB plan calls for a decrease relative to 2020 of TB mortality of 65% by 2025, a reduction in TB incidence by 50%, and an increase in successfully treated MDR-TB of 80%.

The EU member states are committed to work towards the 2030 Sustainable Development Goals. The European Commission supports member states to achieve them. While countries are responsible for their health system, the EU has policies and financial and technical support tools to complement member states’ actions and to support cooperation across countries.

2.Improving healthcare, including cross-border

2.1. Improving standards of care and their delivery

The great variation in the quality of and access to care delivered by clinics in Europe needs to be addressed. Prevention and treatment approaches need to evolve to meet the needs of populations at risk and patients in a climate of financial limitation.

Good practices and recommendations:

• Defining, auditing and re-auditing standards of care and prevention
• Participatory approaches can play a key role in defining standards of care and prevention
• Decentralised and outreach testing
• Digital platforms such as the OneImpact Platform for TB
• Standardised Packages of Care in TB provided by civil society
• Making child formulations of the regular TB drugs and Rifapentine available and accessible

2.2. Cross-border care and access gaps for displaced persons, refugees, and other migrants in precarious situations

It is critical to ensure continuity of care for all people displaced access testing, prevention, treatment, and care. Ukraine has a high burden of HIV, TB, multi-drug resistant TB and viral hepatitis and the largest opioid agonist treatment programme in Eastern Europe. For instance, 89.1% of Ukranian refugees who entered care in Poland initiated anti-retroviral treatment in Ukraine, 10.9% were diagnosed in Poland (underreported) and almost 10% reported previous tuberculosis infection.

Good practices and recommendations:

• Cross-sectoral and cross-country platforms
• Integrated approaches and services
• Training of health and social workers
• Hiring Ukrainian speaking peer navigators
• Provide testing (and other prevention tools) at gynaecologist or general practitioner level
• Expand community-based testing provision and HIV self-testing programmes
• Expand harm reduction services and outreach for refugees from Ukraine and other countries
• Include access to medical care, housing, social care, and employment in emergency support
• Low threshold to access to opioid agonist therapy (OAT)
• Increase access to TB treatment
• Enable access to inexpensive Dolutegravir based regimens

3.The importance of tackling stigma

3.1. HIV-related Stigma and discrimination

The ECDC recently presented their first community survey of stigma among people with HIV (the full report is here), the headline findings of the survey are:

• 28% of respondents felt ashamed of having HIV and 58% found it difficult to disclose their HIV status to others.
• People who experienced high levels of stigma were also considerably more likely to suffer from poor physical health and life satisfaction.
• While some people last felt they had experienced stigma some years ago, when the fear of HIV might have been assumed to be worse, just as many had experienced it in the last year.
• One in three individuals reported to avoid healthcare services due to fear of being treated differently. The recency of these experiences indicates that avoidance of healthcare services is more prevalent now than it was ten years ago.

3.2. Stigma and discrimination of key populations

Good Practices and recommendations:

• Recognising that individuals are much more than their circumstances by using language that separates the disease, circumstances, or condition from the individual
• Recognise that key populations are “not hard to reach” and that it is the health system that difficult for some to access

3.3. Stigma and discrimination faced by People who use drugs

Good Practices and recommendations:

• Train for law enforcement, media, and medical professionals to help to increase their awareness, recognise habitual discriminatory attitudes and rhetoric, and work towards their elimination
• Support and enable gender-sensitive peer-led harm reduction service provision
• Provide support for organisations and countries that assist refugees during the war in Ukraine

3.4. Stigma and discrimination faced by LGBTQI+

Good Practice and recommendation:

• Prioritise the needs of marginalised groups within the LGBTQI+ community and train medical professionals to a better understanding their unique needs
• Incorporate intersectionality in research

3.5. Stigma and discrimination faced by Migrants

Good Practices and recommendations:

• Co-develop services with migrant communities
• Meaningful engagement of migrants at all levels of service planning and implementation
• Community-led services that are culturally competent and sensitive to the backgrounds and experiences of migrants

3.6. Criminalisation of People Living with HIV

Good Practices and recommendations:

• Repeal or reform HIV criminalisation laws that have been used against people living with HIV
• Disseminate combination prevention guidelines
• The ECDC or a similar competent body could issue panEuropean guidance

3.7. Working in partnership to achieve zero discrimination

• Provide government support to NGOs and community-based organisations beyond just funding their activities to allow them to decide how best to provide accessible services
• Collaborative data collection with NGOs and community-based organisations
• Policy harmonisation between different branches and ministries (e.g. between justice and health)

List of Endorsing Organisations

Action against AIDS (Aktionsbündnis gegen AIDS)

Africa Advocacy Foundation (Mi Health Europe)

AIDES

AIDS Action Europe

Alliance for Public Health

Association SKUC Center Women and Modern World (CWMW)

Charitable Fund “Hope and Trust”

Charitable Foundation “Second Life”

Correlation-European Harm Reduction

Network Czech AIDS Help

Deutsche Aidshilfe

Digestive Cancers Europe

European AIDS Clinical Society (EACS)

European AIDS Treatment Group (EATG)

European Forum for Primary Care

European Sex Workers’ Rights Alliance (ESWA)

Fundação Portuguesa “A Comunidade Contra a Sida”

Grupo de Ativistas em Tratamentos (GAT)

Harm Reduction

Háttér Society

HIV Justice Network

HIV stigmafighter

HIV-Nordic

ILGA-Europe

Life Quality Improvement Organisation (FLIGHT)

Eurasian harm reduction association (EHRA)

Metzineres (SCCL)

Positiiviset ry

HivFinland

Positive Voice- Greek Association of People Living with HIV

PREKURSOR – Foundation for Social Policy

Romanian Association Against AIDS (ARAS)

Social Charitable Center

Women and Modern World

TB Europe Coalition

The Italian League for Fighting AIDS (LILA)

The Union for Equity and Health

Ukrainian Network of People who Use Drugs (VOLNa)

Ukrainian Network of Women who Use Drugs (UNWUD)

Union Women Center Georgia

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