Why does the inclusion of migrant populations and ethnic groups make sense? Lisbon, 7 june 2007 Dr Srdan Matic, Regional Adviser STI/HIV & AIDS, WHO Regional Office for Europe

STI/HIV/AIDS Programme WHO/Europe 2 ”I am a migrant and member of an ethnic minority”

STI/HIV/AIDS Programme WHO/Europe 3 Evidence There is limited direct scientific evidence from research demonstrating benefit, or lack of benefit of interventions specifically provided to migrants or ethnic minorities There is plenty of evidence that universal access/coverage has a beneficial impact on health outcomes

STI/HIV/AIDS Programme WHO/Europe 4 Annual number of newly reported cases – all WHO EURO countries, 31/12/06 * Preliminary and incomplete data WHO/UNAIDS estimates, end of 2005: PLWHA: 2,320,000 (1.56 – 3.19m) Estimated prevalence: 0.51% (range: %) Number of cases reported to WHO EURO (31/12/06): New HIV infections: New AIDS cases: New AIDS deaths:

STI/HIV/AIDS Programme WHO/Europe 5 HIV cases by country of origin, 2005 Country of origin Western Europe Central and Eastern Europe SSAOtherUnknown West37.3%2.5%1.6%24.1%5.6%29.1% Centre86.3%0.8%4.6%0.8%1.8%5.7% East99.7%0.0%0.3%0.0%

STI/HIV/AIDS Programme WHO/Europe 6 Impact of HAART on prevention Positive effect (decreased morbidity and mortality; increased survival) of HAART continues, including a lower average amount of circulating virus per infected individual since the introduction of HAART A virus concentration below the detection limit is reached in an increasing number of patients on HAART The HIV transmission probability in the population has decreased as a result of the lower amount of HIV circulating Source: HIV Monitoring Foundation, Amsterdam

STI/HIV/AIDS Programme WHO/Europe 7 Principles of good public health Social justice – giving a just treatment and a just share of societal benefits to all groups and individuals Civil and human rights of individuals (right to life, to health, to education,....) Health as human, social and economic right Principle of non-dicrimination based on race, ethnicity, origin, etc.

STI/HIV/AIDS Programme WHO/Europe 8 Right or wrong? We should do what is right European countries committed to Universal access to HIV prevention, treatment and care (Dublin, Vilnius, Bremen)

STI/HIV/AIDS Programme WHO/Europe 9 1.Exclusion is directly opposed to the objectives of public health approaches to HIV and STI prevention, treatment and care and undermine public health messages 2.It increases stigma and discrimination of people vulnerable to HIV 3.It increases stigma and discrimination of migrants and ethnic minorities 4.It creates disincentives for HIV and STI testing and counselling, and people die as consequence 5.It increases vulnerability and creates incentives for unsafe behaviour 6.It violates fundamental principles of international human rights law 7.Exclusion is not evidence based Conclusions