Directorate-General for Health & Consumers Communication on combating HIV/AIDS in the EU and the neighbourhood - strategy and second action plan ( ) Com (2001) 569 Adopted on 26 October 2009 Gisela Lange DG SANCO

Why public health in a seminar on freedom of expression of sexual orientation ? Global, EU policies and most Member States HIV strategies show that a policy of respecting human rights is sound public health protection

Relation human rights - public health NGO Report for UNAIDS PCB Stigma and discrimination are main sources for infection judges from more than 15 sub-Saharan African countries: We met in Johannesburg to review the role that judges could play to deal constructively with the harsh impact of the HIV epidemic.

South African Women Judges 1. We recognise that the ability to claim human rights relevant in the context of HIV depends on knowledge of rights, access to courts and affordability of legal services 2. We underline that HIV is having a severe impact on the economic, social and cultural fabric of our societies, with adverse effects on the health, human rights and development gains made in the region. 3. We are deeply concerned that sub-Saharan Africa remains the region most severely affected by HIV, with more than 22 million people living with HIV, more than 1.4 million AIDS-related deaths in 2008, and with women representing approximately 60 per cent of all HIV infections

Structure of the presentation 1.Epidemiological data 2.Strategy 3.Implementation

HIV infections in Member States

HIV Infections in the Balkans and in Turkey

Strategy EU Commission adopted the second Communication on combating HIV/AIDS in the EU and the neighbourhood - strategy and second action plan ( ) Com (2001) 569 on 26 October 2009 First Communication from facilitated cooperation of Member States, candidate States and neighbouring countries, in particular through 2 groups: Think Tank on HIV/AIDS Civil Society Forum Many projects that included several Member States and candidate countries

Priorities of second Communication: prevention – including treatment as component of prevention, Most affected groups – MSM, Injecting drug users, PLWHIV Most affected regions: Eastern Europe: Member States, and Eastern ENP countries Eastern Europe Monitoring and evaluation

Basic principles Political leadership to address the disease and not silence it Non discrimination and respect for PLWHIV and vulnerable groups as responsibility of society at large Universal,ie undiscriminatory access to prevention, treatment and care services -

Prevention (1) Prevention strategies to match changing trends and shifts of epidemics and to adapt prevention messages to new generations who have missed the original "AIDS shock" development, promotion and implementation of innovative elements for novel, effective prevention strategies Promote universal access to prevention

Prevention (2) promote effectively comprehensive sexual education including knowledge about HIV/AIDS strengthen civil society's capacities to reach populations at risk Evidence in Western Europe demonstrate that the unprejudiced naming of transmission modes and most at risk population leads to better knowledge of the disease and preventive behaviour intensified HIV testing of populations most at risk as means of prevention, work towards unveiling the hidden dimension of the epidemics Prison health gas a strong human rights perspective, because the sanction in prison is the restriction of freedom not the destruction of health prison health is public health

Most affected group in Western Europe – Men who have sex with Men – MSM (1) The presence of MSM is still being denied in some States Stigmatization and discrimination prevent these men to accept their behaviour They show high-risk behaviour and can not access the already limited preventive services. Due to social pressure MSM (study from Turkey) in Turkey also have heterosexual relations with the respective risk for their partners

MSM (2) They do not consider themselves as homosexual and therefore do not feel addressed to respective prevention messages If MSM claim infection through drug use it shows the extend of fear

Injecting drug users Unprejudiced treatment of drug users Non criminalisation Needle and syringe exchange in adequate settings including in prisons

Attitudes of health personal many health practitioners lack experience on diagnosis, treatment and counselling skills among the health care workers, the bulk of the knowledge about HIV/AIDS is gained from the media which resulted in the formation of stigmatization and discrimination towards PLHA. Surgeons overestimated the risk for acquiring the HIV. Moreover they had negative attitudes as anger towards PLWHA. Doctors were less willing to interact with AIDS patients and they did not want to work with professionals who had AIDS in the same environment

(i) Eastern Europe – selected because of the high prevalence and incidences (ii) Countries in the Eastern neighbourhood address HIV/AIDS in future negotiations on bi- and multilateral agreements with third countries where necessary invite ENP countries to EU meetings in order to facilitate trans- national cooperation on all levels development of specific programmes setting out first line measures to improve the control of HIV/AIDS particularly in Eastern Europe use financial EU instruments to support health systems and to finance specific measures against the spread of HIV and associated infections Priority regions outside the European Union

Public health messages can only reach people when respecting their way of life and addressing the particular risks – discrimination and – especially criminalization of eg homosexuality or drug use will make people hide and not make their tendency or addiction known. Risk of becoming infected increases when disclosure is linked to sanction or discrimination. It is safer not to test (and possibly infect other people) in order not to be sanctioned Public Health

Commitments foreseen in the Communication Political responsibility fight against stigma and discrimination and promote the respect of basic human rights of PLWHA but also of people particularly vulnerable such as MSM - all stakeholders are invited to accept and to adopt policies in line with UN policies in this respect promote prevention of HIV as the most effective remedy to decrease new infections commit resources and provide support through available EU financial instruments to respond to HIV/AIDS strengthen the coordination of EC policies addressing HIV/AIDS related issues (promotion of health aspects across policies, legislation and agreements, where useful) support efforts to monitor the implementation of commitments of governments, authorities, civil society, and international organisations

Empowerment / partnership (1) Responsibilities of societies respect of human rights of all citizens irrespective of their health status media and organisations representing societal groups, including social partners, to actively address stigma and discrimination in general and to promote special programs to sensitise citizens in all affected countries assure social and health equalities are implemented in a way as to assure a non-discrimination of PLWHA universal access to HIV testing, early state of the art treatment, care and harm reduction measures for all citizens in need across Europe

Empowerment /partnership (2) Civil Society involvement promote involvement of civil society in planning, development, implementation of the response to HIV/AIDS on international, national and regional levels in the European Union and the concerned neighbourhood countries – make PLWHIV actors to address their needs and rights and not objects of actions involve the Civil Society Forum as the principal interface to advice Commission services and the "HIV/AIDS Think Tank" on selected issues Civil Society and other stakeholders to ensure a broad dissemination of developments, sharing experiences policies and good practices on international, national and regional levels and intensify cross-border cooperation of NGOs and networks

Treatment, testing and care Universal access without regard to legal status of a person Specific programmes for migrants (documented and undocumented)

Research provide direct and indirect resources to improve - - biomedical - research focusing on HIV/AIDS and associated and opportunistic infections- vaccines, microbicides promote an integration of multi-sectorial research – social and behavioural science - in response to HIV/AIDS

Surveillance and monitoring/evaluation meaningful surveillance data useful for the development of effective policies and interventions report validated data to the ECDC, and to actively contribute to the regular monitoring of the Dublin declaration commitments install and to maintain effective infrastructures to carry out state of the art surveillance, monitoring and control Priorities

Expected results decrease level of HIV transmission improve quality of live of PLWHA improve education, knowledge and awareness on HIV/AIDS strengthen solidarity in society for PLWHIV and people at risk