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European Commission SATELLITE Effective HIV Policies and Measures in Europe

European Commission SATELLITE Effective HIV Policies and Measures in Europe to address key populations Time to promote behavioural change? Irena Klavs National Institute of Public Health , Slovenia. James Chin. The AIDS PANDEMIC, 2007

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European Commission SATELLITE Effective HIV Policies and Measures in Europe

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  1. European Commission • SATELLITE • Effective HIV Policies and Measures in Europe • to address key populations • Time to promote behavioural change? • Irena Klavs • National Institute of Public Health, Slovenia

  2. James Chin. The AIDS PANDEMIC, 2007 HIV is transmitted from person to person primarily via blood and sexual fluids such as semen and any other body fluid that may contain some blood. All published sex partner studies have shown that the risk of HIV transmission via sexual intercourse is a minuscule fraction of the risk associated with most other STD. As a result,extensive epidemic sexual HIV transmission canoccur only in those populations where there are large numbers of persons who have unprotected sex with multiple and concurrentsex partners. How high HIV prevalence may reach in these populations depends on: - the prevalence of facilitating factors such as ulcerative STD and - the prevalence of protective factors such as male circumcision and consistent condom use

  3. Michel Sidibé,Executive director of UNAIDS • Can we prevent the 7400 HIV infections • that occur each day? • Yes. But it will require nothing short of • a prevention revolution. • With new infections outpacing treatment uptake by 5:2, • how can we work smarter and faster to outpace HIV? • More than 80% of transmission is sexual. • It is clear that preventing HIV transmission is not • as simple as ABC - but each proven prevention method • has a pivotal role to play. • Outside of sub-Saharan Africa much HIV transmission takes place in the context of sex between men, sex work and drug use. • UNAIDS OUTLOOK REPORT | 2010

  4. Time to promote behavioural change? • In the absence of • biomedical HIV prevention approaches (vaccine,microbicides), • curative therapy, • promoting sexual behaviour change - central • within the efforts to decrease sexual transmission of HIV. • Obvious and urgent need • to pursue effective strategies to promote safer behaviours. • HIV behavioural risk-reduction interventions • have proved efficacy and effectiveness. • Difficulty is confused with inability. • Are we doing the right thing with sufficient coverage, intensity and duration?

  5. SLAH, 2000USED CONDOM AT FIRST HETEROSEXUAL INTERCOURSE according to period of FHIMen (%) Women (%) Klavs I, et al. AIDS. 2005; 19: 1215-23.

  6. Priority 1 key population in EU ?

  7. WAD 2009: ECDC & Swedish Presidency Scientific seminar at the European Parliament focusing on MSM ECDC Director Zsuzsanna Jakab: “Our report indicates that we have seen a resurgence of high risk sexual behaviour in Europe among men who have sex with men. This is leading to rising rates of HIV infection among these men in EU countries, as well as outbreaks of other sexually transmitted infections. Efforts to promote safer sex in this group have proved difficult and we must continue to support public health experts to devise new and innovative interventions. www.ecdc.europa.eu

  8. The overall objectives of this Communication are: • (i) to reduce new HIV infections across all European countries by 2013, • (ii)to improve access to prevention, treatment, care and support and • (iii) improving the quality of life of people living with, affected by or most • vulnerable to HIV/AIDS in the EU and neighbouring countries. • Future actions to combat HIV/AIDS should concentrrate on most at risk populations to have the bigest impact on the epidemic: • (i) MSM is the main at risk population in the EU • Targeted prevention programmes should be reinforced to reach MSM, and voluntary and counselled HIV testing (along with effective screening and treatment for sexually transmitted infections) needs to be intensified for MSM and risk populations. www.ec.europa.eu/health

  9. Executive Agency for Health and ConsumersPrevention of new HIV infectionsamong MSM 2005314 - EPAA,European Partners in Action on AIDS, Stichting Aids Fonds - Soa Aids Nederland (NL)m http://www.aidsactioneurope.org/index.php?id=190 2007 - SIALON, Capacity building in HIV/Syphilis prevalence estimation using non-invasive methods among MSM in Southern and Eastern Europe, Regione del Veneto (IT) m http://www.crrps.org/?i=visualizza&ids=60&ida=144 2007315 – EVERYWHERE , A European methodological model of HIV prevention in MSM, University of Brighton (UK), http://www.everywhereproject.eu 2008214 – EMIS, European MSM Internet survey on knowledge, attitudes and behaviour as to HIV and STI, Deutsche Gesellschaft fur TechnischeZusammenarbeit (GTZ) GmbH (DE), www.emis.eu.com 2008204 – EUROSUPPORT 6: Developing a training and resource package for improving the sexual and reproductive health of people living with HIV/AIDS, Prince Leopold Institute of Tropical Medicine (BE), http://www.sensoa.be/eurosupport/euro_support.htm

  10. Priority 1 key populatio in Slovenia ?

  11. Klavs I, et al. Euro Surveill. 2009;14(47).

  12. HIV prevalence monitoring with UAT and behavioural surveillanceamong MSM Since 1996: annually repeated oneday cross-sectional study 1 sentinel site – MSM community venue, Ljubljana consecutive sampling; saliva specimens safer sex and condom use promoted information on VCT Behavioural surveillance added in 2000: anonymous SAQ - condom use at anal sex last year - tested for HIV last year Klavs I, et al. Croat Med J. 2006. Klavs I, et al. Euro Surveill. 2009

  13. HIV prevalence among IDU, MSM, STI patients, pregnanciesUAT, Slovenia 2006-2008 MSM - most affected; <5% prevalence

  14. Klavs I, et al. Euro Surveill. 2009;14(47).

  15. Recent increase in • unsafe sex among MSM and • sexual mixing abroad • in 2008 - 130% increase in early syphilis rates • 94% men; of those • 44% MSM • ~ 1 / 3 MSM partner abroad < 3 months • ~ 2 / 3 HIV+

  16. Disproportionate and increasing burden of HIV • some deterioration of safer sex behaviour • among MSM in Slovenia • CHALLENGES • reduction of high risk behaviours among MSM • inrease uptake of HIV testing among MSM • positive prevention among MSM • Translation into policies and measures?

  17. THE REPUBLIC OF SLOVENIA GOVERNMENT OF THE REPUBLIC OF SLOVENIA A STRATEGY FOR PREVENTING AND CONTROLLING HIV INFECTION FOR THE PERIOD 2010-2015 STRATEGY PILLARS AND AIMS Preventing infections (pillar 1): Preventing transmission through sexual intercourse (aim 1), Preventing transmission through blood (aim 2), Preventing mother to child transmission (aim 3); Provision of early detection of infections, preventing transmission and treatment (pillar 2) Decrease in the number of undetected infections (aim 4), Counselling infected persons and informing their contacts (aim 5), Provision of quality treatment (aim 6); Decreasing personal and social impact of HIV infection and AIDS (pillar 3): Integration of infected persons in society (aim 7), Limitation of discrimination and stigmatisation (aim 8).

  18. THE REPUBLIC OF SLOVENIA • GOVERNMENT OF THE REPUBLIC OF SLOVENIA • A STRATEGY FOR PREVENTING AND CONTROLLING HIV INFECTION FOR THE PERIOD 2010-2015 • SUMMARY • The strategy is based on the prevention of HIV infections that is • the most important pillar. • The most frequent route of HIV transmission is through • unprotected sexual intercourse. • Promotion of responsible and safe sexual behaviour is the most • important intervention for the prevention of sexual transmission • of HIV infection. • Prevention of sexual transmissionof HIV infection is especially • important among groups with higher risk behaviour. This is • especially important for men who have sex with men. • For the prevention of new infections, early diagnosis of infections • and counselling for the prevention of further transmission are • of fundamental importance. • www.mz.gov.si

  19. Will the money follow the policies? • prevention scale-up vs treatment scale-up • behaviour change vs biomedical approaches • Will there be a major investment in • behavioural change among MSM • behavioural surveillance / research?

  20. www.msmgf.org

  21. Effective HIV Policies and Measures in Europe • to address key populations • Time to promote behavioural change? • Among MSM? • YES!

  22. Question How will / can Commision facilitate the proces towards universal access of MSM in EU & MS to HIV prevention interventions including promoting behaviour change?

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