AIDS has already claimed the lives of more than 25 million people throughout the world, while an estimated 33.2 million live with HIV alarming numbers highlighting the need to remain vigilant vis-à-vis one of the most destructive epidemics in recorded history. To mark World AIDS Day, commemorated every year on December 1 2007, Health Commissioner Markos Kyprianou invited European Health Ministers to join him in a pan-European effort to spread common messages on prevention and increasing the awareness and knowledge about HIV/AIDS among young Europeans. He encouraged ministers to visit schools and 11 countries agreed to participate in this initiative. The Commissioner visited a high school in Cyprus, where he presented a new TV-spot promoting the use of condoms and safer sex and have a chat with teenage students on HIV/AIDS.
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The HIV/AIDS epidemic is a serious and growing health and social problem. It concerns every country in Europe. UNAIDS estimates that 760 000 are infected with HIV in Western and Central Europe and 1,6 million in Eastern Europe and Central Asia. The HIV epidemic in Europe is diverse and therefore a multitude of approaches based on local settings is needed. To simplify the overall picture, in Western and Central Europe the epidemic is mainly driven by sexual contact, while in Eastern Europe it is mostly driven by drug use.
HIV/AIDS in not just a health problem. In many ways it is linked to important social issues. The most vulnerable groups of people are the ones in our societies that are the most marginalised e.g. migrants, drug users, sex workers, etc. Frequently, these people are not able to access services (including treatment) and are even in some cases denied service. In addition, stigma and discrimination against people living with HIV/AIDS is a problem in all European countries, but in different ways and magnitudes.
Main challenges remain to scale up prevention and ensure universal access to treatment and other related services.
The EU is in a unique position as it is able to bring together different actors to exchange experience and to build partnerships to address more effectively the HIV/AIDS epidemic in Europe.
The EU can also play a supportive role to that of its Member States and to that of other European countries. This has already been expressed mainly through the funding of specific activities.
In the past few years, there have been strong voices urging the Commission to play an active role in combating HIV/AIDS in Europe. All of the main actors on HIV/AIDS agree that the Commission has to undertake a proactive role. These calls have been made through Declarations, Conferences, Council Conclusions, and other means. Member States, International Organisations and the civil society have actively supported the Commissions increased focus on HIV/AIDS in Europe.
The Commission has established a clear policy on HIV/AIDS in Europe, which includes the neighbouring countries. The policy is expressed in the Commission Communication . Main aspects of the Communication are prevention; surveillance; treatment, care and support; and involvement of civil society. Annexed to the Communication is an action plan.
Since 2004, the Commission has put in place structures for consultation with main partners in order to formulate and implement its policy on HIV/AIDS. These structures also help build partnerships among the participants. The most important structures are the HIV/AIDS Think Tank and the HIV/AIDS Civil Society Forum. The Think Tank is made up by representatives of: governments from all over Europe, EU agencies (ECDC and EMCDDA), relevant International Organisations (WHO, UNAIDS, ILO, UNDP, UNICEF, IOM), and the civil society. The Civil Society Forum roofs 40 civil society organisations from all over Europe, covering all main themes of the epidemic and all geographical areas. The Commission has considered it a priority in its work on HIV/AIDS to involve those most affected by HIV/AIDS and populations most at risk. Fundamental aspect of the work at EU level has been to build partnerships and to base activities on a coordinated approach.
The Commission uses available funding programmes to support activities to combat HIV. These programs are not all funding activities, which are addressing directly HIV, but are addressing the social aspects of the epidemic. Frequently, these are the same issues that need to be address in a much broader context, such as discrimination in the workplace.
The Commission has also provided support by assisting Member States with challenges in addressing specific aspects of HIV. The most recent example of this is the German Presidency initiative on affordable treatment. The Commission has been involved in the initiative since its launch at the German Presidency Conference on HIV/AIDS in Bremen in March 2007. The Commission has been an observer in number of negotiation meetings with pharmaceutical companies and provided appropriate support at the political and technical level.
The 2006 Eurobarometer on HIV/AIDS prevention showed that, as compared to 2002:
- Perception: People are less well informed, e.g. 24% of people are wrongly convinced you can be infected by kissing on the mouth, and 30% are unsure on this, meaning almost half of all EU-citizens do not fully understand how AIDS can be passed on. This trend is even more prevalent in the new Member States as well as among younger citizens.
- Behaviour: only about half of the population is adapting its sexual behaviour as regards taking precautions
- 88% of respondents acknowledge the need for EU-wide information initiatives.
This indicates there is a vital need for more and better information and communication in this area, specifically targeting the young and focusing on safer sex.
The Commission is concerned about the diminished focus on prevention, which remains the cornerstone for all other activities within the comprehensive approach to tackle HIV/AIDS. Without vigorous promotion of primary prevention measures, like education, the use of condoms and implementation of harm-reduction measures (such as exchange of needles and syringes), any other target (such as the elimination of mother-to-child transmission or universal access to treatment) cannot be achieved.
Although condoms are not the last resort against HIV/AIDS, they certainly represent the best and most reliable prevention tool. According to UNAIDS, as the vast majority of HIV infections are sexually transmitted, there are only four ways to prevent sexual transmission of HIV: (1) abstinence, (2) monogamous relations with an uninfected partner, (3) non-penetrative sex, and (4) consistent and correct use of male or female condoms. Studies show that there are many people who are either unable or unwilling to practice abstinence, monogamy and non-penetrative sex. This leaves condoms for protecting these people and their partners.
Some tasks are for the Commission, other tasks are for Member States or International Organisations and some tasks for Civil Society and others. Funding, therefore, depends on each partner. The Commission is using the tools at its disposal both for supporting actions within the EU and in neighbouring countries. By and large, funding is based on projects and it is under regular review and adjustments.
The work on Sexual Health is linked to work done on HIV, as unprotected sex is one of the ways HIV is transmitted. But sexual health is a much broader topic than HIV and the Commission activities in this area in Europe are mainly focused on young people. The Public Health Action Programme has funded several projects in the past few years, and sexual and reproductive health continues to be a high priority area for the work of the Commission on Public Health.
