EG on HIV/AIDS
Eighth Meeting
Tallinn, Estonia
3-4 April, 2008
Reference / HIV/AIDS 8Title / Meeting minutes
Submitted by / HIV/AIDS EG ITA in coordination with the HIV/AIDS EG Chair
Summary / Note / Annex 1 – List of participants
Requested action / Adoption
1. Opening of the meeting and welcome
The Meeting was opened and chaired by Mr. Pauli Leinikki, the Chair of the HIV/AIDS EG.
Ms Kristi Rüütel welcomed the participants on behalf of the National Institute for Health Development which hosted the meeting.
2. Adoption of the Agenda
The Meeting adopted the Provisional Agenda (submitted as document 8/2/1).
3. Country reviews
Participants reported about recent trends and observations concerning HIV/AIDS in their own countries.
Russia
Several important meetings have already been organised at the Russian Federal level during the beginning of this year, e.g. meeting of the Coordination Board under the Ministry of Health and Social Development. Financing for HIV/AIDS has increased every year, and preliminary budget plans cover the period until the end of 2010. The biggest part of financing comes from the national project "Health", some amount from the programme against socially significant diseases, and part from Global Fund and international projects.
In November 2007, there were 417,715 registered cases of HIV in the Russian Federation. According to UNAIDS, the real number is approximately 1,2 million.
Northwest Russia
Altogether 7233 new HIV cases were registered in NW Russia during 2007 (the biggest no of cases was in St. Petersburg – 4,548, and in Leningrad Oblast – 1,165). By the end of 2007, cumulative number of HIV positive people was 57,803 (deaths excluded). Prevalence per 100,000 population was 424.4 in January, 2008.
Transmission routes in NW Russia during 2007 were the following: IDU – 39%, sexual contact – 20,4%, mother-to-child – 1%, not known – 39,6%. Gender balance among newly infected was: men – 62%. By the end of 2007, cumulative number of children born to HIV positive mothers was 5208. In 2006, mother-to-child transmission took place in 9.6% of children born to HIV+ mothers.
In spite of active work against HIV and AIDS, some problems remain in the Russian Federation:
- Exchange of needles and syringes is allowed only in official institutions. There is still no support from legislation to this activity.
- Methadone treatment is still not allowed and it is not probable to see change of attitudes in the near future.
Solid scientific data from various socioeconomic settings around the world have demonstrated that both of these activities are effective in reducing the spread of HIV among IDU:s and their contact population, and efforts should be encouraged to start pilot projects and research to find the best ways for implementation in the region.
Germany
In Germany the most notable trend during past few years is increase of new HIV cases among MSM. It can also be seen that the trend of HIV follows the trend of syphilis. The key population driving this trend is probably those who are infected and whose infection is diagnosed already, but who are not yet receiving antiretroviral treatment. There is increase in heterosexual transmission, too. This may be due to those MSM who are bi-sexual.
IDU transmission trends are different in different parts of Germany. A disproportional increase has been registered in the recent five years in NRW State where Düsseldorf is situated.
If life expectancy after HIV diagnosis is compared for IDU and other groups at risk, IDUs with HIV have longer life expectancy compared to HIV-infected MSM. This may be due to a testing bias: in Germany IDU as a group are tested earlier in the course of infection than MSM because they are in a closer contact with the medical system.
At the moment estimated 59,000 people with HIV infection live in Germany – the officially registered number is close to 40,000.
Poland
Cumulative number of registered HIV infected people is now close to 11,000 in Poland. The estimated total number is between 25,000 and 35,000. Out of PLWHA about 48% have contracted the infection through injecting drug use. Since 2001, sexual transmission has been increasing. By now 912 people have died of AIDS.
Approximately 700 new cases are detected each year (716 in 2007). The biggest age group among infected is 20-29 years. The majority of infected people are men, only 23% are women. Route of transmission was not known in 81% of cases in 2007. Information is collected in VCT centres which offer anonymous testing. According to their data, 80% of those from whom information was available had contracted HIV due to risky sexual behaviour and 20% - by injecting drug use.
ARV treatment has increased each year, 3358 patients were receiving treatment in 2007. Prevention work is carried out actively, but it suffers from lack of financing. In 2008-2009 special campaigns are targeted to travellers.
Norway
Some decrease in new HIV cases could be seen in Norway in 2007. The biggest groups were MSM and immigrants from endemic countries. By now there are approximately 3000 HIV positive people in Norway. According to the report, their psychological and social support should be organised better. Special attention should be paid to MSM and immigrant population.
See comparison between Nordic countries in the slides at the web page http://www.ndphs.org/?mtgs,hiv/aids_8__tallinn
Finland
As can be seen in the slides comparing Nordic countries, increase in infections among MSM has been noted also in Finland. Transmissions through injecting drugs have been strongly reduced during past years thanks to low threshold services. A concomitant rapid decrease in Hepatitis B and C infections have also been observed.
France
110,000 cases of HIV infection have been registered altogether in France. About 50% of them receive ARV treatment. Trends in transmission routes are the following: MSM – increase, IDU – decrease, sexual transmission among immigrants – increase. Proportion of women among newly infected is increasing. This is partly due to the fact that 99% of pregnant women are tested.
Each year about 5000-7000 new HIV cases are detected. Anyhow, there is estimated to be a quite large hidden epidemic – about 35,000 HIV infected people living in the society.
4. Database project.
The secretariat reported about the current stage in the implementation of the project. The following items were discussed:
4.1. Thematic reports
4.2. Database
4.3. Project pipeline
4.1. Thematic report for the HIV/AIDS group.
As part of the database project implementation, a draft version was submitted to the secretariat in January. It was written by Pauli Leinikki with two annexes written by Marja Anttila and Simo Mannila from STAKES. Based on the comments from the members of the group a new version has been produced and submitted.
The report contains concrete proposals for future projects which were discussed based on the chairman´s list (see http://www.ndphs.org/?mtgs,hiv/aids_8__tallinn). Interdisciplinary work between health and social professionals, substitution therapy and VCT were added as topics to the list. The recommendation list will be sent to the participants after meeting, so that they can choose ten most important ones, and give them ranking according to importance. Three or four “winning” priorities for projects will be mentioned in the brochure which will be prepared for the 7th Baltic Sea States Summit in Riga in the beginning of June.
In the future, the Thematic report will be updated regularly with new elements included. A new theme to be considered for the next version might be the epidemiology and risk factors among MSM.
4.2. Database and 4.3. Project pipeline
The head of NDPHS Secretariat introduced to the meeting the NDPHS Database (available at www.ndphs.org/?database) and the NDPHS Project Pipeline (available at www.ndphs.org/?pipeline), both developed within the NDPHS Database Project co-funded by the European Union and 10 NDPHS Partners.
Possible indicators to be used for HIV were discussed on the basis of the presentation of the Chair (see UNGASS indicators list and proposed list of indicators at the meeting web page)
List of proposed indicators will be sent to the group for evaluation. Discussion on indicators will be continued in the next EG meeting.
The head of NDPHS Secretariat encouraged Group members to send news into the web page www.ndphs.org. Also information on important forthcoming events can be sent to the Calendar on the mentioned page – either through ITA or to the address .
There is financing available in the project pipeline – new project proposals are welcome!
The secretariat reminded the meeting participants that the Database is as good as we make it to be. Anybody can add new information (about a project, an organization, a paper, etc) into the database. The Secretariat checks the submitted information, then it is published at the page, if appropriate. Projects financed through the project pipeline come automatically into the database. The database also has a well developed search function (by theme of project, by implementing organization, by years etc.) that helps its use by possible stakeholders and other interested parties.
5. Evaluation of NDPHS
In 2008, i.e. five years since launching of the NDPHS, an evaluation of the programme will be made. The evaluation is conducted by an NDPHS Evaluation Team chaired by Mr. Bob Shearer of Canada. A consultant was chosen through an open tender, to aid the Evaluation Team in its work. Its name is the Center for Evaluation (CEval) of Germany, and the evaluator’s name is Mr. Dirk van den Boom. During the CSR meeting in Brussels he will conduct 16 interviews (EG chairs, ITAs, CSR representatives). A questionnaire will be sent to all EG members in May. The evaluation report of the Evaluation Team will be ready in September and be submitted to the CSR meeting.
6. Themes for forthcoming meetings
6.1. CSR, April 21-22, Brussels
This will be a good opportunity to present the list of recommended projects
6.2. Joint meeting of all EGs (and own EG meeting), September 29-October 1. Suggestions for common themes for the plenary sessions are invited from members of all Groups.
6.3. PAC in November 2008. A side event dealing health problems among indigenous people in the arctic areas is being planned by Canadian experts. Participation and contributions from all expert groups are welcome.
6.4. Spring 2009 meeting of the EG
There are two proposals to host the next EG meetings: by Canada when the meeting would be either in Canada or at the Canadian Embassy in Brussels, and by Poland.
6.5.
Proposals are invited also for a theme for the PAC 2009 meeting.
7. Common projects – ongoing and projects to be planned/submitted
7.1. Presentation of the project list and discussion.
ITA went through the current list of projects (see at the meeting web page). 25 projects are ongoing, 8 projects are under consideration.
The NDPHS Secretariat expressed their recommendation that one project could be chosen as a “lighthouse project” to be presented in the forthcoming general meetings (the CSR, the Baltic Sea States Summit, etc). The meeting agreed that the project “Development of Low Threshold Support Centre in Murmansk Region” should be selected, since it focuses to the most difficult problem in the prevention of HIV in the region and in spite of practical and “political” problems is now being replicated in other cities and regions such as Kandalaksha and even in Leningrad Oblast there is interest to apply the same methodology.
Financing issues were discussed, including the new EU instruments and contributions from Canada and US.
7.2. Presentation of new projects
“Ecochance” - a UNDP project in Poland
An interesting project implemented in Poland was presented: Give yourself a job – Ecochance. Education – therapy – work model.
Target group of the project is people living with AIDS and HIV threatened by social exclusion and those excluded because of their drug or alcohol use. The project aims at improving their situation at the labour market.
The participants were trained in practical skills like breeding pigs and green legged chickens, being expert in mushroom collection etc. Diminishing of discrimination and integration into labour market have been the most important results (more in http://www.ekoszansa.org/aktualnosci.php?news=156&wid=11)
8. Presentation of FILHA activities
Finnish Lung Health Association has been actively involved in TB-prevention and control in collaborative projects covering NW Russia and the Baltic Countries since 1990:s. Main attention is focused to improve control strategies, laboratory services, knowledge and skills of the staff and infection control. HIV is becoming more and more important since both TB and HIV are spreading among same risk groups such as IDU:s prisoners, and other socially excluded people. Both case finding and implementation of proper therapy pose serious challenge to the current health care systems. HIV-infected people are also becoming a significant source of new cases with MDR TB further increasing the economic and social impact of the two infections for the society. TB has become the leading cause of death among HIV positive people.
Special problems in TB field in NW Russia are poor adherence to treatment, emergence drug resistance and poor laboratory services. In particular, the penitentiary system is problematic due to the complexity of the problem.
The combination of HIV and TB in a patient is dangerous in several ways. TB is more difficult to diagnose in a HIV positive patient – there are more atypical forms of TB. Treatment of TB is more demanding when the patient is HIV positive: TB progresses faster, there are more relapses, more possibilities to develop drug-resistant TB.
WHO has given recommendations concerning the collaboration between HIV and TB health care services. In many places this collaboration is difficult, especially in penitentiary care.
The Group saw collaboration between HIV and TB experts of utmost importance. It was decided that the Group will continue inviting TB experts into the EG meetings.
9. Work of the Prison Health Expert Group
The Group (PHEG) started its work in February 2007, and has now employed an ITA, Zaza Tsereteli –very familiar to the HIV EG. The PH EG is still looking for members from some countries, recently Russia has nominated an expert to the Group. The next EG meeting will be in Riga in May 29-30. Representatives from HIV EG are welcome to the meeting. Thematic report of the EG can be read in the address http://www.ndphs.org/?database,view,paper,19