“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