HIV in Europe, Stockholm 2 November 2009 Developing Regional HIV T&C Policy Framework Lali Khotenashvili Communicable Diseases Unit, WHO Regional Office for Europe

2 November 2009HIV in Europe, Stockholm2 Plan of talk  Development process  Key principles  Ways forward

2 November 2009HIV in Europe, Stockholm3 Process  Comprehensive review and analysis of the evidence  Extensive consultation process

2 November 2009HIV in Europe, Stockholm4 Scaling up HIV T&C must be linked with efforts to achieve UA  HIV testing is never a goal in itself  At the same time as access to testing is increased, access to ART should be improved and equal access guaranteed  Need for OST to support ART  Access to comprehensive HIV prevention

2 November 2009HIV in Europe, Stockholm5 Expanded T&C must be tailored to different settings & populations  T&C scale up efforts should include PITC – for people presenting with signs and symptoms & those with suspected primary HIV infection – implementing PITC in facilities providing STI services; services for most-at-risk populations; antenatal, childbirth & postpartum services

2 November 2009HIV in Europe, Stockholm6 Expanded T&C should be tailored to different settings & populations (cont’d)  T&C scale up efforts should meet the needs of most-at-risk and vulnerable populations – Innovative approaches should be adopted – expanded beyond health care settings  Efforts to increase access & uptake should include prisoners & detainees – UNODC/WHO Policy Brief on “HIV testing and counselling in prisons and other closed settings”

2 November 2009HIV in Europe, Stockholm7  Rapid HIV tests should be used, where appropriate

2 November 2009HIV in Europe, Stockholm8 “3 Cs” should always be observed – Informed, voluntary consent should be obtained – providers should receive training and education – clear legal and policy frameworks that stipulate the specific age and/or circumstances in which minors may consent to HIV testing are needed – privacy and confidentiality laws should be in place

2 November 2009HIV in Europe, Stockholm9 Ensuring supportive social, policy, legal framework  Without the following components, efforts are unlikely to reach their objectives: – Community preparedness and social mobilization – adequate resources & infrastructure – codes of conduct for testing providers – Methods of redress for patients

2 November 2009HIV in Europe, Stockholm10 Critical issues to be considered – Real protection from discrimination & abuse – Costing, budgeting, implementing key initiatives & programmes: legal audits & law reform, legal support services, know your rights campaigns, campaigns against stigma & discrimination, training of health-care professionals, judges, prosecutors, police, prison staff etc.

2 November 2009HIV in Europe, Stockholm11 Key principles (cont’d)  HIV testing policies & practices should be reviewed to eliminate non-voluntary forms of testing  Assessment & consultations to formulate plans for T&C expansion – Status of the epidemic & response (in particular, access to treatment and prevention) – Ensure representation of all stakeholders

2 November 2009HIV in Europe, Stockholm12 M&E  HIV T&C should be carefully monitored & evaluated – Not just scale up, but T&C quality and consequences (linkage to and uptake of services v exclusion) – Capacity building efforts

2 November 2009HIV in Europe, Stockholm13 Ways forward  Preparing final draft  Wide public consultation  Developing final version  Publishing

2 November 2009HIV in Europe, Stockholm14 Acknowledgements  Ralf Jürgens, consultant  Reviewers  Participants in consultation meetings