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17th EC HIV/AIDS Think Tank Meeting
Luxembourg 8 December 2011
Martin C. DonoghoeProgramme Manager HIV/AIDS, STIs & Viral HepatitisDivision of Communicable Diseases, Health Security and EnvironmentWHO Regional Office for Europe
European Action Plan for HIV/AIDS 2012–2015
HIV epidemic in Europe still not under control
1 418
0
200
400
600
800
1 000
1 200
1 400
1 600
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
abso
lute
num
bers
, tho
usan
ds
Cumulative number of reported cases (in thousands),WHO European Region, 1985–2010
Sources: ECDC/WHO. HIV/AIDS surveillance in Europe 2010. Stockholm: ECDC; 2011. UNGASS country progress reports 2010 for the Russian Federation and Ukraine.
People living with HIV: fast growing numbers in eastern Europe and central AsiaEstimated number of people living with HIV in Europe, 1990-2010
Source: UNAIDS World AIDS Day Report 2011
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
Estimated
peo
ple living with HIV (m
illion)
Europe (total estimated)2 340 000
Eastern Europe and central Asia1.5 million
Western and central Europe840 000
Newly diagnosed HIV infections by mode of transmission and geographical area, 2010
Sources: ECDC/WHO. HIV/AIDS surveillance in Europe 2010. Stockholm: ECDC; 2011
Russian Federation Ministry of Health and Social Development
40%
24%
45%
17%
42%
13%
4%
4%
41%39%
29%
1%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
West Centre East
Men who have sex with men Injecting drug use Heterosexual Other and unknown
Estimated ART coverage in eastern Europe and central Asia among the worst globally
47%
49%
64%
60%
39%
23%
10%
0% 10% 20% 30% 40% 50% 60% 70%
Global coverage
Sub‐Saharan Africa
Latin America
Carribean
Eastern, Southern and South‐East Asia
Eastern Europe and Central Asia
North Africa and the Middle EastART also reduces risk of HIV transmission.
– Donnell D et al. Lancet, 2010, 375(9731):2092–2098
ART also reduces risk of HIV transmission.
– Donnell D et al. Lancet, 2010, 375(9731):2092–2098
Source: WHO/UNAIDS/UNICEF Universal Access Report 2011
Infection increasing faster than treatment
1 418
397
210
559
0
200
400
600
800
1 000
1 200
1 400
1 600
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
abso
lute
num
bers
, tho
usan
ds HIV
AIDS
AIDS deaths
People on ART
Cumulative number of reported cases and deaths (in thousands),WHO European Region, 1985–2010
Sources: ECDC/WHO. HIV/AIDS surveillance in Europe 2010. Stockholm: ECDC; 2011. UNGASS country progress reports 2010 for the Russian Federation and Ukraine. ART data from the WHO/UNICEF/UNAIDS monitoring and reporting on the Health Sector response to HIV/AIDS.
European Action Plan for HIV/AIDS 2012-2015: Framework for urgent action• Addresses priorities and context of the WHO European Region
• Puts into action;
– UNAIDS Getting to Zero HIV/AIDS Strategy for 2011‐2015
– WHO Global Health Sector Strategy for HIV 2011‐2015
– UN Political declaration on HIV/AIDS (2011 New York)
• Contributes to;
– Millennium Development Goals
• Coherent with;
– EC Communication on HIV/AIDS 2009‐2013
– Dublin Declaration (2004)
• Builds on existing European experience; particularly with
integration models and linkages
• Builds on partnership (Global Fund, Civil Society)
European action plan on HIV/AIDS
European vision and goals
The vision for the European Region is zero new HIV infections, zero AIDS‐
related deaths and zero discrimination in a world in which people living
with HIV are able to live long, healthy lives.
The goals for the European Region are, by 2015:
– to immediately halt and reverse the spread of HIV in Europe
– to achieve universal access to comprehensive HIV prevention, treatment,
care and support; and
– to contribute to the attainment of Millennium Development Goal 6 and
other health‐related Millennium Development Goals (3, 4, 5 and 8).
European action plan on HIV/AIDS
European Action Plan for HIV/AIDS 2012-2015Four strategic directions
Reducevulnerabilityand address
structuralbarriers to accessingservices
Build strongand
sustainablesystems
Leveragebroader health
outcomesthrough HIV
response
Optimize HIVprevention, diagnosis,
treatment and care outcomes
Strategic direction 1
Optimize HIVprevention, diagnosis,
treatment and care outcomes
• Universal access and HIV specific goals(Including MDG 6)
European action plan on HIV/AIDS
1.Optimizing HIV prevention, diagnosis, treatment, care and support outcomes
• Expanding HIV testing and counselling
• Preventing HIV transmission through injecting drug use
• Reducing sexual transmission of HIV (including men who have sex with men and sex workers)
• Eliminating mother to child transmission
• Universal access to HIV treatment and care
– To provide care
– To limit transmission
• Eliminating HIV transmission in health care
European action plan on HIV/AIDS
Leveragebroader health
outcomesthrough HIV
response
Strategic direction 2
Optimize HIVprevention, diagnosis,
treatment and care outcomes
• MDG 4: Reduce child mortality• MDG 5: Improve maternal health• Global plan to stop TB 2011-2015 goals
European action plan on HIV/AIDS
2. Leveraging broader health outcomes through HIV response
HIV impacts the control and health outcomes of
other diseases and conditions
European action plan on HIV/AIDS
Build strongand
sustainablesystems
Leveragebroader health
outcomesthrough HIV
response
Strategic direction 3
Optimize HIVprevention, diagnosis,
treatment and care outcomes
• MDG 8: Develop a globalpartnership for development
European action plan on HIV/AIDS
MDG 6 Combat HIV/AIDS, malaria and other diseases (HIV )
3. Building strong and sustainable health systems
European action plan on HIV/AIDS
Medicines, diagnostics and other commodities
Ensure reliable data is collected, analyzed and better used to inform policy decisions and programme planning
Ensure that health services meet the needs of service users through decentralization (when possible), integration
Involve civil society in service delivery
Ensure medicines, diagnostics and other commodities are affordable, quality assured and supplied without interruption
Service deliveryStrategic information Health financing
Improving quality; governance, partnership and alignment;
health workforce
Ensure that financing mechanisms for HIV interventions sustain coverage and reach target populations as efficiently and equitably as possible
Promote sustainability, attract available domestic resources, improve cost‐effectiveness
Reducevulnerabilityand address
structuralbarriers to accessingservices
Build strongand
sustainablesystems
Leveragebroader health
outcomesthrough HIV
response
Strategic direction 4
Optimize HIVprevention, diagnosis,
treatment and care outcomes
• MDG3: Promote gender equality and empower women
European action plan on HIV/AIDS
4. Reducing vulnerability and the structural barriers to accessing services
• Anchored in principles of:
– Equity in health (Health 2020 and the Tallinn
Charter); community participation, and protection of
human rights; evidence informed policies and ethical
public health approaches
• Addresses laws and regulations; stigma, discrimination
and other human rights abuses
• Addresses social determinants
• Strengthening community systems
European action plan on HIV/AIDS
“Current activities to reduce HIV infection rates are not enough to control and reverse the HIV epidemic in Europe. Above all, we need to address the social determinants of health of those who are most at risk, as they are often stigmatized and excluded from health and social services, including HIV treatment. I am delighted that countries in Europe are committed to the new European Action Plan for HIV/AIDS, which addresses these issues and provides comprehensive solutions. Now is the time for action by all stakeholders, including governments and the civil society” .
Zsuzsanna Jakab, WHO Regional Director for Europe
This paper was produced for a meeting organized by Health & Consumers DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumers DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.