We call for international attention to the serious conditions we face due to HIV in Central and South East Europe. The next few years will be crucial in Albania, Bosnia & Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Greece, Hungary, Kosovo, Macedonia, Montenegro, Romania, Serbia, Slovakia, Slovenia and Turkey. Your attention now will support our efforts to avoid a more dangerous situation.
Unlike the high prevalence HIV epidemic raging in North East Europe or the more mature epidemic to the West, the epidemic in our countries is low prevalence. Nonetheless it can be deadly.
With fewer people living with HIV, fewer supporters and fewer medical staff, the capacity to respond to HIV in our countries is muted. With less overall societal impact, the perceived need to respond is less urgent.
Our national governments and the general population don’t yet see HIV as a major problem. However, we encounter the same obstacles as our counterparts in high HIV prevalence countries, including violations of our human rights, treatment access problems and psycho-social burdens which impact on all aspects of our lives.
Most crucially, life-threatening stock-outs – unexpected shortages of treatments or diagnostics - have become commonplace throughout Central and South East Europe. In this emergency situation we need coordinated national, regional and international action to prevent stock-outs, which cause dangerous treatment interruptions and undermine trust between HIV+ people, their health providers and health care systems.
While many of our countries have benefitted with support from the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM), few countries in our regions have implemented coordinated, effective national strategies. The Iron Curtain and recent wars in South East Europe have left us poor and isolated. The current economic crisis has made matters worse.
Non-action now risks fuelling the epidemic here, resulting in higher costs – both in terms of harm to individuals but also the increased burden to national health systems.
Every high HIV prevalence country was once a low HIV prevalence country. With international support and increased coordination using proven prevention and treatment strategies, we can avoid the more deadly high prevalence situations in other parts of the world.
Working together, we believe we can bring more positive attention to the serious HIV conditions in our regions. Through mutual support, information sharing, capacity building and coordinated activities, we hope to overcome the obstacles to quality treatment and care, comprehensive and evidence-based prevention programmes, and successful legislative reforms, which have troubled our regions for so long. With your support, the Network for Low HIV Prevalence Countries can make an important difference for people confronting HIV in Central and South East Europe.
Here are our key areas of concern:
Even though the world has known of HIV for 30 years, it still feels like early days in many of our countries. There is much work to be donenot only to provide life-saving treatments, but also to refine entire national programmes dealing with all aspects of HIV.
In most of our countries, services for people living with HIV and those most vulnerable to HIV infection are underdeveloped and below the standards of most European countries. National coordination is rare and local awareness of HIV is still dangerously low.
Our civil societies, stunted by authoritarian regimes, need empowerment, strengthening and, most important, funding. Poor HIV conditions here are manifestations of deep systemic problems in most of our health care systems.
Thus, we call on the governments and key HIV stakeholders in each of our countries, those international bodies committed to overcoming HIV, the pharmaceutical and diagnostic industries and people fighting HIV around the world, to renew and refocus their attentions on HIV in Central and South East Europe. We ask you to work with us to overcome our shared problems.
Life-threatening drug and diagnostic stock-outs have become commonplace throughout Central and South East Europe.
People living with HIV are often placed on treatment without proper monitoring. Many countries lack important second-line combination therapy important for treatment-experienced people living with HIV. Drug licensure, compounded by the large number of countries relative to the small number of people living with HIV per country in our regions, is cumbersome and costly.
In each country in Central and South East Europe, at the very least, we are committed to minimum standards of treatment and care for people living with HIV. We will work in joint efforts to ensure that governments and other stakeholders are committed to and devote their attention to raising the quality of health and social care for all people affected by HIV. Quality treatment and diagnostics ensure the best care for people living with HIV and also the benefits of treatment as prevention.
Standards of good care include health and social services continuously available for all people living with HIV and those who care for them.
Focussed national, regional and international action to stop stock-outs.
Regardless of the system of payment and existing national procurement legislation, governments to do their best to ensure the sustainable, continuous supply of treatment and diagnostics including first- and second-line combination therapy, paediatric formulations for new-borns, treatment for opportunistic infections and non-HIV related infections and basic diagnostic tests (including CD4, viral load and resistance tests). This ensures the best care for people living with HIV and is likely to reduce the risk of sexual transmission of HIV.
National treatment guidelines to be adopted and applied universally including PMTCT and paediatric guidelines.
Treatment to be available for all those in need with special attention to those in prison or institutions.
All HIV health care providers to be provided, in a supportive environment, quality training and continuous medical education, including ethics and communication.
People living with HIV to have access to treatment literacy programmes and counselling on side effects, nutrition, etc.
Support services for people living with HIV including support groups, psychosocial support, social and legal help, home care, palliative and hospice services to be available and sustainable.
Pharmaceutical companies to cooperate with activists, governments and regulatory agencies to enable optimal access to treatments and diagnostics, including regional registration of drugs in non-EU countries.
Legal institutions in most of our countries need modernisation. In many countries basic legal structures leave HIV stigma and discrimination unchallenged. Criminalization of HIV transmission remains a fact or a threat. Open discussion of HIV is largely taboo. Under these conditions those most vulnerable to HIV are less likely to seek HIV testing and learn about their HIV status, and people living with HIV are less likely to seek medical care.
We are committed to the full implementation of the highest European standards of human rights and all international declarations regarding HIV. Together, we will work to empower those groups most vulnerable to HIV, identify gaps in legislation, and gather evidence and supportive facts to help shape national policies and legislation. Together, we will strive for national and regional policies and laws that encourage the most effective responses to HIV and respect the role and dignity of people living with HIV.
All national responses to HIV to be multi-sectoral and coordinated effectively by the central governments, with the active and meaningful participation of civil society, the community and people living with HIV at all levels of decision- and policy-making.
Implementation of effective anti-discrimination legislation, which outlaws discrimination based on HIV status.
All groups most vulnerable to HIV to be free from threats of penalization and criminalization.
Legal protection for all necessary prevention programmes.
Protection for the human rights of people living with HIV in all areas of prevention, treatment and care.
HIV testing rates in Central and South East Europe are among the lowest in Europe. Some of our governments discourage HIV testing and underfund HIV testing programmes to make HIV rates appear to be low. Because of these policies, HIV positive people are too often diagnosed late with their first opportunistic infections and their immune systems unnecessarily compromised.
Only minimal government resources are expended for HIV prevention campaigns. The messages promoted are often ineffective, outdated and too unfocused to reach those most vulnerable to HIV infection. For most of our country populations, HIV is still viewed, as it was elsewhere in the early days of HIV, as deadly, unmanageable, unstoppable and foreign.
Very little education is provided about STIs, their symptoms
We are committed to targeted prevention programmes to contain HIV and protect those most vulnerable to HIV infection. We will work in joint efforts to communicate accurate and targeted messages that inspire cooperative public health results. We will promote more accessible, low–threshold, widespread testing programmes to identify people living with HIV in the early stages of infection rather than as late presenters.
People living with HIV to play active roles in developing all prevention programmes.
Access to information for all, including non-judgemental sex and health education with effective, targeted HIV media campaigns. Include the important message that untreated STIs increase the risk for HIV transmission.
To focus on risk education, prevention and testing for those most susceptible to HIV infection.
To support civil society organisations in implementing their prevention programmes.
To ensure anonymous, voluntary and confidential counselling and testing offered at no cost to the individual.
Treatment for STIs to be readily available.
Ready access to preventive tools, including condoms, female condoms, lube, and microbicides for those most vulnerable to HIV including prisoners.
Those most affected by HIV are traditionally those most engaged in HIV activism. In our regions, fewer numbers, high stigma and unresponsive local institutions act as key obstacles to people living with HIV and those most vulnerable to HIV infection to engage in HIV activism. It is essential for the response to HIV and HIV activism in Central and South East Europe to enable those of us most impacted by HIV to become more visible and more empowered to play active roles in our communities and throughout our regions.
- To encourage people living with HIV to take greater responsibility for their lives through self-education, openness to training and advocacy, increased mutual support and cooperation.
- To support networking, training and capacity building efforts among people living with HIV and those most vulnerable to HIV infection in our regions.
- To encourage people living with HIV to play meaningful and visible leadership roles in all HIV activities in our localities and in our regions.
- To foster dynamic partnerships between these key populations and other HIV stakeholders in our communities and throughout our regions.
In most of our countries, gay men and other men who have sex with men comprise the highest infected population. Although official data still indicates low prevalence among us, pilot testing projects have shown concentrated epidemics.
Discrimination and intolerance towards lesbian, gay, bisexual and transgender people are very high in our regions. Our pride marches are prohibited or threatened and sometimes attacked by right-wing extremist groups.
- Our governments to finance and support the implementation of community-based testing and counseling for men who have sex with men and to identify the real HIV prevalence in this key population.
- LGBT organizations to put HIV on their agendas or increase and fine-tune their existing prevention programmes according to the newest available scientific evidence and data.
Women, due to their greater vulnerability to HIV and need for special services such as programmes designed to prevent mother-to-child transmission, require special attention when shaping prevention strategies.
- Our governments to address the intersections between HIV vulnerability, gender inequality and violence against women and girls.
- The right to sexual and reproductive health to be prescribed by law.
- Self-determination for pregnant women to make an informed choice whether to be tested for HIV and to decide, if HIV positive, if they want to keep their child.
- Abortion as a choice.
- Effective programmes for the prevention of mother-to-child transmission.
- Governments to fight violence against women and sexual trafficking.
Although prevalence among injecting drug users in our regions is far lower than in North East Europe, drug use is criminalized in most of our countries and injecting drug users are highly marginalized both by the society and by health care service providers.
- Decriminalization of drug use. Punitive drug laws are the biggest obstacle to effective prevention responses.
- Integration of gender-sensitive services for female injecting drug users in harm-reduction programmes.
- Our governments to promote access to effective harm-reduction programmes including those for opioid substitution treatment and needle / syringe exchange, and, where already available, to expand their coverage, especially for those in prisons or institutions.
- Our governments to diminish discrimination in access to HIV and hepatitis C treatment for injecting drug users, where such regulations exist.
Migrants and ethnic minorities, including Roma, have long suffered from discrimination in our regions. Some of our countries still have HIV-specific visa/residence regulations and deportations.
- Our governments to concentrate their resources and efforts to provide information and services to migrants and ethnic minorities and protect against their discrimination by public education and implement and enforce anti-discrimination legislation.
- Our governments to change discriminatory legislation regarding testing policies and visa and residence applications, which exclude people living with HIV.
- Our governments to provide testing, treatment and monitoring services for noncitizens
Sex workers are not only the victims of stigma and discrimination. In some countries in our regions they face punitive laws and are often victims of hate crimes.
- Our governments to de-penalize and de-criminalize sex work and provide access to information, services and prevention programmes for sex workers and their clients.
We are the people most at threat from HIV in these regions. Please give us your support as we develop NeLP, the Network of Low HIV Prevalence Countries in Central and South East Europe.
Sign this declaration and promote it with your colleagues both inside and outside Central and South East Europe. Your action now will help us draw attention to the critical HIV conditions we face in our regions.