Women living with HIV are part of response to HIV/AIDS – challenging the Action Plan on HIV/AIDS in the EU and neighbouring countries: 2014-2016
To:
European Commission
Committee on Health (ENVI )
Council of Europe, Steering Group on Gender Equality
European AIDS Clinical Society (EACS)
Global Fund to Fight AIDS, Tuberculosis and Malaria
HIV/AIDS Civil Society Forum (CSF)
Joint United Nations Programme on HIV/AIDS (UNAIDS)
International Federation of Gynecology and Obstetrics (FIGO)
THINK TANK
World Health Organization (WHO)
Decision Makers
Women living with HIV are part of response to HIV/AIDS – challenging the Action Plan on HIV/AIDS in the EU and neighbouring countries: 2014-2016
The undersigned organizations consider the Action Plan on HIV/AIDS in the EU and neighbouring countries a very important document and achievement however we don’t feel represented in this Plan.
Over three decades into this epidemic, the focus in the initial groups of transmission – HSM, IDU, migrants ignoring part of the population infected, as ‘heterosexual’, women, children and the vulnerabilities these population face is ignoring the shifting epidemiology, the reality and the actual data.
The Action Plan on HIV/AIDS in the EU and neighbouring countries[1] is divided in six key issue areas: politics, policies and involvement of civil society, wider society and stakeholders; prevention; priority regions; priority groups; improving the knowledge; monitoring and evaluation, yet women, children, ‘heterosexuals’ and related issues are omitted. Important aspects as ageing, gender based violence and austerity measures that play an important role in Health and HIV are ignored.
The document refer that ‘HIV transmission through heterosexual contacts plays also an important role. In neighboring countries the main transmission modes are heterosexual contacts..” but this population is not addressed in this Plan. In fact the rate of newly diagnosed HIV infections in the WHO European Region in 2012 was 8.8 for men and 3.9 for women per 100 000 population. Forty-six percent of cases newly diagnosed were infected through heterosexual transmission. The highest rate of late diagnoses were observed among heterosexually acquired cases. To highlight that HIV transmission through heterosexual contacts is the main transmission mode in East Europe where the number and rate of newly diagnosed HIV is the highest in the Region and heterosexual contact, followed by injecting drug use, is the dominant reported mode of transmission.2 Also the number of children infected through parent-to-child transmission increased by 61% (from 2006 to 2012) in the European WHO region.[2] Not considering this population and their needs its denying the burden HIV represents and the need to mobilize efforts to keep women, heterosexual men, children and their parents HIV-free towards a generation AIDS-free.
Also according to this report (ECDC, 2012), research shows that women represent one third of new diagnoses of HIV in Europe and in East Europe women account for the majority of heterosexual infections. Despite improved prognosis, HIV remains complex, imposing unique challenges for women living with HIV. Although women are one of the most vulnerable groups to HIV, women are not included in the measures and policies that concern us.
The biological differences between women and men are obvious but besides there are social differences in attitudes and behaviors related to gender. Inequality, individual and social perceptions, gender norms generate behaviors linked to concepts of what is proper to female and male influencing risk behaviors, sexual expression, vulnerability to HIV infection and its impact, in the incorporation of preventive information and in its relation with HIV – in treatment, care and social support.[3] Therefore the inclusion of gender issues is critical in HIV response.
Further to the differences between women and men, women living with HIV face multifactorial and specific challenges[4]:
- The biological, psychological and societal impact of HIV is different for women compared to men3[5][6][7]
- Women are twice as likely as men to acquire HIV through unprotected sex.7
- Women living with HIV may be confronted with a diversity of challenges including, but not limited to: poverty, violence, trafficking, forced prostitution[8] and increased vulnerability to HIV and AIDS.7
- They often face stigma and fear of disclosure, and have poor access to health education.[9]
In regarding to care women living with HIV also may face challenges4:
- HIV can affect women at all stages of their lives.[10]
- Late HIV diagnosis, although commonly associated with males, is also a significant problem in women.[11]
- The pharmacokinetics of antiretroviral therapy appears to differ in men and women, as do response, adherence and adverse reactions.[12]
- Women are more likely to discontinue treatment than men. This may reflect both increased rates of adverse events secondary to ART in women and a complex mix of social and economic factors.5
- The average age of women with HIV is increasing and immunological responses may be poorer. Older women with HIV face issues such as neurocognitive impairment, early menopause, osteoporosis and polypharmacy, which will have the potential to impact on their use of ART.4
- Despite biological differences between women and men, there are few specific data to guide the care and treatment of women with HIV, largely because women have been historically under-represented in clinical trials (20–30% in most trials).[13][14] Consequently, many treatment guidelines contain minimal advice on their care.
Women living with HIV are also under-represented in HIV decision making, e.g. the Think Tank and Civil Society Forum don’t include organizations of women living with HIV creating a bias in the exchange of information and experiences.
Therefore as women living with HIV and as organizations of women and/or HIV we urge to address the urgent needs of women living with HIV in the European Union and neighbouring countries. We call to:
- Promote further political awareness around the specific challenges faced by women living with HIV in Europe and neighbouring countries;
- Respect, protect and promote human rights and gender equality;
- Consider women as a priority group with a focus in our multiple vulnerabilities;
- Take the necessary measures to eliminate the parent-to-child transmission to keep children HIV-free and their parents towards a generation AIDS-free;
- Promote awareness and knowledge around women and HIV in all our cycle of life;
- The inclusion of women and gender issues including gender based violence, with adequate funding, in all plans and national programmes for HIV/AIDS;
- The inclusion of, and adequate funding for, SRH literacy in all national HIV programmes;
- Increase awareness and engagement towards the challenge of HIV discrimination in a gender perspective;
- Consider the impact of austerity measures in health and in the lives of the most vulnerable including women, children and the eldest and promote measures and policies to minimize its impact;
- Improve the knowledge around HIV and ageing in a gender perspective and take the appropriate measures;
- Engage in a dialogue with women’s support groups so as to identify, together, concrete policy measures addressing these issues;
- Endorse and scale up the implementation of equitable and inclusive policy measures that increase women’s chances for better health outcomes, improved access to tailored care including HIV and AIDS prevention, testing and counseling;
- Include women in all measures and policy making related to HIV.
Yours sincerely,
SERES (con) viver com o VIH, Portugal
Salamander Trust, UK
Eurasian Women’s Network on AIDS
Union of Women of Ukraine Affected by HIV “Positive women”
Red Initiatives
Sophia Forum, UK
STOPAIDS, UK
HOPS-Healthy Options Project Skopje, Macedonia
Fundación para Estudio e Investigación de la Mujer (FEIM), Argentina
International AIDS Women’s Caucus (IAWC)
European Coalition of Positive People
[1] European Commission. Action Plan on HIV/AIDS in the EU and neighbouring countries: 2014-2016.http://ec.europa.eu/health/sti_prevention/docs/ec_hiv_actionplan_2014_en.pdf. [Accessed 21 March 2014]
[2] European Centre for Disease Prevention and Control. Annual Epidemiological Report 2012. http:/www.ecdc.europa.eu/en/publications/Publications/Annual-Epidemiological-Report-2012.pdf. [Accessed 21 March 2014]
[3] Nunes, I. (2008). Quality of Life in HIV positive Women: self-esteem, body image and social relations. Master Thesis. University of Coimbra.
[4] SHE Programme. Briefing and Recommendations for Policymakers. Dec 2012
[5] Greig, J. M. and Anderson, J. Optimising antiretroviral therapy for women living with HIV. Co-infectious Diseases 2014; 27:46-52.
[6] Ariz et al. Curr HIV/AIDS Rep. 2012 Jun;9(2):171-8
[7] Avert: “Women and HIV/AIDS.” Available at http://www.avert.org/women-hiv-aids.htm. [Accessed March 2014].
[8] UNAIDS: “Impact of the global economic crisis on women, girls and gender equality,” August 2012. Available at http://www.unaids.org/en/media/unaids/contentassets/documents/document/2012/discussionpapers/JC2368_impact-economic-crisis-women_en.pdf. [Accessed March 2014].
[9] World Health Organization: “Gender, women and health.” Available at: http://www.who.int/gender/hiv_aids/en/.[ Accessed March 2014].
[10] UNAIDS. “Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV.” 2012. Available at http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2010/20100226_jc1794_agenda_for_accelerated_country_action_en. pdf. [Accessed March 2014].
[11] Health Protection Agency: “HIV in the United Kingdom: 2010 Report,” 2010. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1287145367237. [Accessed March 2014].
[12] Ofotokun et al. Gend Med 2007;4:106-19.
[13] Haberl et al. Antivir Ther 2012; in press.
[14] Daar et al. Ann Intern Med 2011;154:445-56.