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Antonyia Parvanova (ALDE, BG)

said that the current event was particularly important because the EU was lagging behind in the response to HIV/AIDS. The Commission had adopted the EU Communication on combating HIV/AIDS in the EU and neighbouring countries late 2009 focused on HIV prevention and testing, priority groups and priority regions. She had tabled an oral question to the EU Commission together with Michael Cashman (S&D, UK) and Françoise Grossetête (EPP, FR) on the need to have a midterm review of the progress made which would be debated in the European Parliament plenary. She then wondered why in countries such as Bulgaria, the trend of new HIV infections had tripled, whereas in some countries like Denmark and Estonia there had been a 20 % decrease recently.

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Michael Cashman (S&D, UK)

 

Michael Cashman (S&D, UK) called for a coherent European policy on HIV and AIDS, also in relation with third countries as the awareness levels had globally dropped. He then insisted on the importance that FTA agreements with countries such as India ensure the availability of low cost generic drugs.

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Michael Huebel, DG Sanco,

said it was an important week for HIV with stakeholders involved in different high level meetings, and that this particular meeting was important as it addressed the question of political leadership in the EU in terms of health inequalities, hence joining two areas in health in which the Commission had strategies in place, the EU Communication on combating HIV/AIDS in the EU and neighbouring countries (2009-2013) and the EU strategy on solidarity in health. He gave figures on the disease and highlighted the prevailing inequalities in Europe as to HIV, and then underlined the importance to address these inequalities as they contributed to the further spread of HIV. Most HIV infections were to be found in particular groups, such as drug users, which was why the EU communication on HIV/AIDS prioritized these most at groups; and this in turn would help addressing health inequalities. Commenting on the oral question discussed in the ENVI Committee, he stressed that the Commission had put in place a process to have ECDC continue to monitor the agreed outcomes of the Dublin Declaration, in addition to the monitoring ECDC was carrying out in the member states anyway. Furthermore, the ECDC would monitor the actions detailed in the EU strategy on combating HIV/AIDS in the EU and neighbouring countries. “Know your epidemic” is an important principle in the response as it is the very basis to effectively respond to HIV. The result of the monitoring would provide a very good basis not only for the Commission but also for member states to exert political leadership. He also stressed the relevance of the EU 2020 strategy for an effective HIV response, as it strengthens social inclusion and health and social services. He stressed that the Commission is committed to this agenda and that HIV and health inequalities are very high on the policy agenda of the Commissioner.

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Luis Mendao,

EU HIV/AIDS Civil Society Forum, asked more details about the midterm review and made a comment on the importance to focus on migrants in the response. He then mentioned the excellent drug report by the European Parliament from a few years earlier and suggested that the parliament review it as drug policies and harm reduction crucial for an effective HIV response.

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Marisa Matias (GUE/NGL, PT)

suggested that instead of speaking about risks groups, one should rather, as suggested by some HIV NGOs focus on risk behaviour.

 

 

Elisa Ferreira (S&D, PT)

asked about the impact of the economic crisis on the response to HIV in the EU member states as well as the actions the commission foresees to counteract this, especially as some countries are being asked to cut down public expenditure for health. Lastly, she wanted to know more details about the financial perspective proposal by the commission and the priority health was given to, as well as the relevance of the EU2020 strategy to HIV.

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Antonyia Parvanova (ALDE, BG),

commenting on the oral question on the mid-term revision said the answer provided by the commission during the discussion in the ENVI committee had not been satisfactory and that therefore it would probably be put before the plenary. She then spoke of the fact only three quarters of the member states had allocated sufficient funding sources. Unfortunately, member states seemed have forgotten to allocate funds for HIV prevention, and this pointed to the general problem of having the principle of subsidiarity reigns in the well protected area of public health. She said a deeper analysis of the member states’ health care systems and subsidiarity should take place, an idea backed by Commissioner Dalli despite the obvious obstacles.

Commenting on a question on the promotion of public health and the sector reform in Bulgaria addressed to her, she said this also related to the question of subsidiarity in health. However, she said the country had an obligation to have a public health programme in place which complied with the EU strategy for combating HIV/AIDS in the EU and neighbouring countries. She then concluded by expressing her hope that cooperation with the Polish and Danish presidency as well as the Commission and the European parliament on increasing the EU health budget would be fruitful.


 

Michael Huebel, DG Sanco,

explained the EU 2020 had an immediate effect on the commission’s work on health as it requests to ensure healthy aging, etc. On the effect of the economic crisis, he explained that as the EU had not overcome the crisis and that this was expected to have negative effects on national health systems the commission would look into the health reforms of different EU member states. Furthermore, he agreed with Marisa Matias that the definition of risk groups vs risk behaviour was an important discussion. He then finished by saying the commission’s approach in the response was to carefully look into  the epidemiological data available, hence the focus on the priority regions in Eastern Europe and neighbouring countries.


 

Antonyia Parvanova (ALDE, BG)

then talked about the importance that undocumented migrants have access to health care in the EU in general but in particular in the case of HIV and supported to discuss the subject further. In that respect she mentioned a Charter by health professionals launched by Médecins du Monde for a non-discriminatory access to health services which was open for signature.


 

Mika Salminen, European Centre for Disease Prevention and Control,

presented key findings about a report the agency had produced at the request of the commission on the progress made in the implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia. It was based on data from 49 countries and the contributions of a wide range of individuals and organisations. He then presented the current state of the disease in Europe concluding that HIV infection is of major public health importance in Europe, with evidence of continuing transmission and no clear signs of decrease. The face of the epidemic was characterized by large heterogeneity in the EU/EFTA states, the predominant mode of transmission being men having sex with men, with a considerable proportion among heterosexually acquired cases coming from countries with a generalised epidemic, and continued high HIV transmission rates in IDUs in eastern EU countries. The report highlighted that levels of late diagnoses and undiagnosed HIV infections are unacceptably high, with an estimated 30% of people infected with HIV in Europe unaware of their infection, and a considerable proportion of the patients diagnosed late which is a missed opportunity for patients to timely access treatment and care.
 
In terms of political leadership, the report had concluded that the best approach was to take pragmatic, project-like responses to concrete problems within the risk groups rather than merely focusing on the existence of administrative structures in place. He finished by stating that spending had to be targeted in line with the epidemiology and migrants should have an equitable access to services regardless of their legal status.

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Anna Marzec-Boguslawska, Director, National AIDS Centre Poland,

spoke about the need to ensuring universal access to health care systems. She commented on the fact that the High Level meeting in New York had not proposed sufficient measures as to scale up the global response to HIV. At the same time, especially after the High Level Meeting in New York, there is a consensus that current efforts are clearly insufficient. She insisted that not only access to ARV was an ethical imperative, but that prevention, voluntary counseling and testing, and reducing the incidence of opportunistic infections - including TB, hepatitis B and C is imperative likewise.
In Poland,  following the 1996 Vancouver conference, the decision was to offer non-cost ARV treatment In its effort to ensure access for all patients in need, Poland had taken sought to reach out to particular risk groups, and in particular to ensure that prisoners would receive equal access to HIV services. She welcomed the fact that the EU Communication focused on the regions of Eastern Europe, as according to the UNAIDS report 2010 Eastern Europe and Central Asia was the only region in the world in which infections had almost tripled over the last decade. In this regard, she announced that Poland in its upcoming presidency in the UNAIDS Programme Committee Board (UNAIDS PCB) would focus on drawing the interest of the international community to take decisive action. Her last key message was that the private sector and the pharmaceutical industry should collaborate as well  in the area.

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Jan Fouchard, Danish National HIV coordinator,

spoke about the importance to take a rights-based approach to answering the HIV-epidemic. He gave the Danish example of combating major stigma discrimination and violence of human rights, and equally stressed that access to prevention measures like condoms and harm reduction services, as well as the need for behavioural research. He also highlighted an important change in Denmark: for a long time Denmark had an HIV specific law in place criminalizing reckless HIV exposure to HIV and HIV transmission.  Nevertheless, the law has now been suspended and is being reviewed, also taking in consideration the likelihood of transmission when under ARV treatment. He concluded  by insisting on the fundamental measure of providing free services of quality prevention, and this regardless of nationality or drug use.

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Luis Mendao, EU HIV/AIDS Civil Society Forum,

asked the previous speaker whether it would be possible to anticipate the importance of HIV under the Danish presidency. Mr. Fouchard said in terms of infectious diseases the Danish presidency would focus on resistance to antibiotics, but that discussions were ongoing.  He highlighted that given the importance of the subject and recent developments, the Danish Presidency would support a conference on HIV testing organized by the HIV in Europe initiative, this conference under the auspices of the Danish presidency will take place in Spring 2011.

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Henrique Barros, High Commissioner of Health/National Coordination of HIV/AIDS, Portugal,

spoke about the HIV cases in Portugal and said that the legal framework should be adjusted to include specific measures ensuring access to equal services within prisons, opiate substitution therapy and therapy available for those who are infected, as the results of these measures had been very good. He then spoke of the preventive measures and said they needed to be targeted to the most difficult parts of the population, namely undocumented migrants and sexual workers as these groups were particularly affected in Portugal. He then said Portugal had had good results with the use of medicine to treat HIV, however, he stressed that in Portugal there was an urgent need to address the particular problem of tuberculosis in drug users. In that respect, there was an ongoing project in place. He then finished by saying the ARV therapy was increasingly costly for the state. The therapy represented about 40 % of the ontological treatments of hospitals and this figure had to be decreased.

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Henning Mikkelsen, UNAIDS,

highlighted that globally 9 million people do not have access to treatment whilst 6 million do. He then said the EU had an important role in providing leadership in the response to HIV, in particular in upholding human rights, HIV prevention and in approaches known to be efficient like harm reduction. The High Level Meeting in New York had made a target of halving the number of sexual transmission of the virus, amongst other targets. Nevertheless, he feared that the declaration and commitments ensuing from the New York high level meeting would not be strong enough to achieve its target. He deplored that overall EU leadership role in the negotiations had been rather weak
 
During the questions and answers with the audience, one participant pointed out that it was striking that despite the fact that the EU communication and the Dublin Declaration included strong language and a clear commitment to harm reduction measures, the declaration did not refer to harm reduction. Apparently the case for harm reduction had not been defended well enough by the EU during the High Level Meeting negotiations. This was particularly worrying to the HIV and harm reduction community, as it is taken indicative of the fact that because of a minority group of EU member states, previously agreed positions and scientific evidence as to the effectiveness of harm reduction measures are now being ignored, and this was unacceptable also in terms of human rights.   
 
The final part of the event concentrated on the Correlation II Policy Recommendations. The recommendations call on governments to ratify and live up to  the existing conventions and norms embedded therein, focus on upholding safeguarding the human rights of populations most affected by HIV (MSM, IDU, migrants, sex workers  and including sub-populations such as prisoners). Furthermore, states should ensure civil society participation in all aspects of the national response and provide greater accountability for their national HIV policies.  Universal access to HIV services access should be ensured by scaling up efforts to reach out to most affected populations, removing specific barriers to access, and ensuring timely diagnosis as well as subsequent referral to comprehensive services.  Governments should align resources with burden of disease, and ensure that programmes are adequately funded, redeploying resources from programmes that serve to criminalize and increase the vulnerability of populations most affected. States should exert political leadership by ensuring that plans and structures translate into effective actions.

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Marisa Matias, (GUE/NGL, PT)

concluded that the debate had demonstrated the need to act and scale up political leadership in the response to HIV. She very much welcomed the important debate in the ENVI committee relating to the EU communication on combating HIV, as this was an important signal coming at a crucial point in time as to the HIV response of the Commission and across EU member states. In order to show sustained leadership from within the European Parliament, she invited colleagues to collaborate and join forces in an informal intergroup MEPs for universal access to HIV prevention, treatment and care in the EU and neighbouring countries.

 

 

Bryan Teixera, NAZ-Project UK,

on Correlation policy recommendations

 

Presentation: Bryan Teixeira

 

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