The new target for HIV treatment scale up – 90% of all people living with HIV would know their status, 90% of those would be on treatment, and 90% of those would be virally suppressed –
will be an important element of future efforts in the European region, but Martina
Brostrom of UNAIDS told the meeting that many countries in the region –
including some large countries in Western Europe – are falling behind some of
the most successful countries in sub-Saharan Africa in their efforts to
diagnose and treat HIV infection.
A survey of HIV expert physicians conducted by Dr Cristina
Oprea of Victor Babes Hospital, Bucharest, Romania, found low estimated levels
of HIV diagnosis in Eastern Europe, low levels of antiretroviral coverage and a
high frequency of use of antiretroviral drugs no longer recommended by the
World Health Organization (WHO). She expressed scepticism about the likelihood of
achieving the 90 / 90 / 90 target in Eastern Europe and Central Asia, but
revealed that Romania has already achieved treatment coverage above 60%, which
compares favourably with many wealthier countries.
Professor Andrzej Horban of the Hospital for Infectious Diseases,
Warsaw, Poland, agreed that in most central European countries it is possible
to achieve the UNAIDS targets now, due in part to low HIV prevalence. It will
be possible to achieve the targets in Central Asia in the near future, but in
Eastern Europe – especially the Russian Federation – it will take time to
achieve the goals due to lack of political will.
“The lack of political leadership in Eastern Europe is a
real difference from sub-Saharan Africa,” said Prof. Manuel Battegay, President
of the European AIDS Clinical Society (EACS).
Delegates expressed concern over the deep-seated political
and social opposition to harm reduction for people who inject drugs, and the
profound reluctance of Eastern European societies to tackle drug use as a
public health problem rather than a criminal offence.
“The greatest political challenge we face is drug use rather
than HIV or TB” said Dr Fiona Mulcahy of St James’s Hospital, Dublin, Vice-President
of EACS.
“The Russian scientific community are talking about the
scale of the problem; this indicates high-level political awareness that HIV
represents a major challenge for Russia,” said Martin Donoghoe, director of
WHO Europe’s HIV and hepatitis programme.
“It’s important that scientists continue to provide
scientific backing for evidence-based policy making in the European region,” he
said
Prof. Jens Lundgren of the University of Copenhagen, Denmark,
who has led a physician training programme in Eastern Europe on behalf of EACS,
said that a public health approach to treatment – as recommended by WHO Europe
– was needed in Eastern Europe. Regimen simplification is the key to rapid
scale up of treatment in Eastern Europe. Too many potential regimens make it
more difficult for physicians to learn how to use antiretroviral therapy,
increase costs and make it difficult to achieve economies of scale in
purchasing, he told the meeting.
Developing an integrated system of harm reduction, drug
substitution treatment and HIV care is also essential. At present these
programmes are separated in Eastern Europe, meaning that many drug users never
receive the offer of an HIV test, cannot access drug substitution therapy and
are not linked to HIV care due to lack of communication and formal linkages
between programmes. Less than 5% of drug users are able to obtain drug
substitution therapy in Russia, Ukraine, Belarus and Central Asia, and coverage
of needle and syringe programmes is extremely low.
“We need to remember that it took a number of years to gain
acceptance for harm reduction practices in Western Europe, so we need to be
persistent in expert dialogue,” said Martin Donoghoe of WHO Europe.