“Right to health, right to life”, High Level Meeting on HIV and Human Rights in the European

Union and its neighbouring countries, Brussels, 28 May 2013

Access to HIV prevention, treatment

and care in Europe

Barriers and solutions

Roberto Bertollini MD MPH,

Chief Scientist and WHO Representative to the EU

WHO Regional Office for Europe

Outline of the presentation

• A summary of HIV epidemiology in

the WHO European Region

• Key challenges and Human Rights

concerns

• Options for action

Estimated number of people living with HIV in Europe

1990-2011

Source: UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2012.

Europe (total estimated) 2.4 million

Eastern Europe and central Asia 1.5 million

Western and central Europe 860 000

0,0

0,2

0,4

0,6

0,8

1,0

1,2

1,4

1,6

1,8

2,0

2,2

2,4

2,6

2,8

3,0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Esti

mat

ed

nu

mb

er

of

pe

op

le li

vin

g w

ith

HIV

(M

illio

ns)

HIV infections diagnosed in 2011: transmission

mode by geographical area

Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2011

Estimated ART coverage in eastern Europe and central

Asia among the worst globally (2011)

54%

56%

70%

67%

44%

23%

13%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Global coverage

Sub-Saharan Africa

Latin America

Carribean

Eastern, Southern and South-East Asia

Eastern Europe and Central Asia

North Africa and the Middle East ART also reduces risk of HIV transmission

– Donnell D et al. Lancet, 2010, 375(9731):2092–2098

Source: UNAIDS. Together we will end AIDS. 2012

0

20

40

60

80

100

120

140

160

180

Estonia Lithuania Kyrgyzstan Tajikistan Armenia Georgia Latvia Azerbaijan Uzbekistan Moldova Belarus Kazakhstan

2009

2010

2011

0

100

200

300

400

500

600

700

2009 2010 2011

Ukraine

2009

2010

2011

Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2011

Reported deaths among AIDS cases in selected eastern

European and Central Asian countries 2009, 2010, 2011

Outline of the presentation

• A summary of HIV epidemiology in

the WHO European Region

• Key challenges and Human Rights

concerns

• Options for action

Poor scale up of services and inequalities

Sex workers discrimination and violence increase vulnerability

• Preventing negotiation of condom use

• Reducing access to services (fear of

harassment by law enforcement authorities or

ill treatment by service providers)

• Forced to exchange unpaid and unprotected

sex with law enforcement authorities (to

escape arrest or harassment, obtain release

from prison or avoid being deported)

HIV infection among all TB cases tested for HIV in

the WHO European Region (2006-2011)

Source: ECDC/WHO. Tuberculosis surveillance and monitoring in Europe, 2013

2.8

3.6

2.8

4.8

5.5

6.2

0

1

2

3

4

5

6

7

2006 2007 2008 2009 2010 2011

Perc

en

tag

e

Poor integration of services

tuberculosis

drug dependence

sexual and reproductive health

maternal, child and adolescent health

viral hepatitis

non communicable and chronic

disease

HIV programme source of funding in Europe and

central Asia, 2008 or 2009

Source: UNAIDS/WHO. HIV/AIDS in Europe and central Asia. Progress Report 2011

0%

20%

40%

60%

80%

100%

Monte

negro

Bosn

ia a

nd Her

zegovi

na

Tajik

ista

n

Kyr

gyzst

an

Geo

rgia

Arm

enia

Rep

ublic o

f Mold

ova

Uzb

ekis

tan

Bulg

aria

Bel

arus

Aze

rbai

jan

Kaz

akhst

an

Latvi

a

Rom

ania

Cze

ch R

epublic

Cro

atia

International Public

Percentage of HIV prevention programme spending on

key populations originating from international funding

sources, most recent year

West and centre: Belgium, Bulgaria, Croatia, Czech Republic, Hungary, Montenegro, Poland, Romania, Switzerland, United Kingdom. East: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Ukraine, Uzbekistan.

Source: UNAIDS/WHO. HIV/AIDS in Europe and central Asia. Progress Report 2011

Outline of the presentation

• A summary of HIV epidemiology in

WHO European Region

• Key challenges and Human Rights

concerns

• Options for action

Reduce

vulnerability

and address

structural

barriers to accessing

services

Build strong

and

sustainable

systems

Leverage

broader health

outcomes

through HIV

response

Optimize HIV

prevention, diagnosis,

treatment and care

outcomes

Four actions that can be undertaken

Scale up access to ART and increase early HIV diagnosis and treatment

1. Optimise HIV prevention, diagnosis and care

2. Simpler and low cost treatment regimens

3. Effective delivery systems

4. Eliminate mother to child transmission

5. Scale up testing

6. Harm reduction for people

who inject drugs

Leverage broader health outcomes through the HIV response and build stronger and more sustainable, integrated health systems

Effectively link

HIV with

TB, viral hepatitis

and drug

dependence

services

Reduce vulnerability and marginalisation

Barriers not

insurmountable

Vulnerability and

marginalisation

neither acceptable nor

inevitable

Address human rights in

national AIDS strategies

Partner with civil society

Respond to the funding crisis

•Strategic investment framework

•Targeted and strategic approach to investment

•Apply new science, technologies and approaches to

improve efficiency and effectiveness

Globally 15% reduction in new infections and 22% decline in deaths

Investment could lead to total gains of US$ 34 billion by 2020

European Action Plan for HIV/AIDS 2012-2015

Thank you

www.euro.who.int/aids