1. Washington D.C., USA, 22-27 July 2012www.aids2012.org The HIV in Europe Initiative IAC presentation July 25 2012 Ton Coenen – co chair on behalf of AIDS Action Europe

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org Agenda 1.The situation in Europe 2.The Initiative 3.Accomplishments 4.Copenhagen 2012 Conference 5.Next steps

3. HIV infections diagnosed in 2010 WHO European Region 3 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010 Characteristics of cases WHO European Region* West*Centre*East Number of HIV cases 118 33525 6592 47890 198 Rate per 100 000 population 13.76.61.331.7 Percentage of cases Age 15–24 years** 11.6%10.0%17%13% Female 38%27%19%42% Transmission mode** Heterosexual 43%24%***24%48% Men who have sex with men 20%39%29%0.7% Injecting drug use 23%4% 43% Unknown 13%16%41%7% *No data from the following countries: Austria, Liechtenstein, Monaco. ** Countries with no data on age or transmission mode excluded. *** Excludes individuals originating from countries with generalised epidemics.

4. HIV infections diagnosed in 2010 per 100 000 population: all cases 4 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org HIV in Europe Initiative Objectives To highlight the rising number of people living with HIV in Europe who are unaware of their serostatus To identify political, structural, clinical and social barriers to achieving optimal testing and counselling, and earlier care for HIV/AIDS To promote public health best practices and guidance found in Europe with regard to HIV testing, counselling and care

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org Structure and content of the initiative Governance: –Steering Committee (8 members, 2 co-chairs) Representation from patient advocacy, policy makers, health professionals and European public health institutions (WHO- Europe and ECDC, Global Fund, UNAIDS, EMCDDA and US CDC) –HIV in Europe Secretariat Political - EATG offices in Brussels Financial – Aids Fonds Nederlands Operational – Copenhagen HIV Programme Key projects since start in 2007 Consensus definition of late presentation Size of infected not yet diagnosed population Indicator condition guided HIV testing People living with HIV Stigma index Criminalization of PLHIV

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org Consensus definition of late presentation HIV Medicine, June 2010 ECDC special report 2010 use the definition and urge member states to report CD4 when reporting surveillance data.

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org Follow-up: ECDC multi-year project contract ”Improving Tools to Estimate HIV Prevalence in European Union and EEA/Efta Countries”. New innovative statistical method to estimate the number of persons with HIV who are undiagnosed and in need of ART under development. HIV in Europe will continue advocating for the improvement of surveillance data on late presenters.

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org Stigma Index – results and phase 2 ”From Evidence to Action” Phase II: Development of advocacy and actions in the 5 phase 1-countries, Estonia, Moldova, Poland, Turkey and Ukraine

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org Phase II (2012-2014): Wider list of clinical conditions (14000 patients to be offered and HIV test) across Europe. Audit system on frequency of HIV testing of persons presenting with AIDS defining events. Guidance on indicator condition guided testing. Final draft ready supported by European Centre for Disease Prevention and Control (ECDC) and WHO Europe. Implementation strategy under development. More information: www.hiveurope.eu Objective: To define indicator conditions with an HIV prevalence of >0.1% (testing cost-effective) and propose routine testing as additional strategy in health care settings to detect undiagnosed HIV infection. Phase I (2009-2011): Showing proof of concept with overall HIV prevalence of 1.8% in the conditions surveyed and acceptability among staff and patients. Manuscript submitted.

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org Other activities 2011 HIV in European Region, Unity and Diversity, Tallinn Conference May 2011 Engagement of EU Civil Society Forum members on advocacy on HIV testing at national level and EU Think Tank members in focused discussion on how to improve HIV testing across Europe Late presentation, project financed by EuroCoord European Parliament Resolution, December 2011 –Press releases, newsletters, distribution of brochures at international conferences

12. Washington D.C., USA, 22-27 July 2012www.aids2012.org Copenhagen 2012 Conference 323 participants from 46 countries Clinicians (74) 25% Community representatives (121) 37% Policymaker (49) 15% Others (social scientists, epidemiologist, statisticiens) (49) 15% Media, Industry etc (30) 9%

13. Washington D.C., USA, 22-27 July 2012www.aids2012.org Call To Action Monitor and share research and best practices on HIV testing standards in order to improve practice and policy; Stimulate the scientific development of activities and events to inform the European agenda on optimal testing and earlier care; Review data and studies on the impact of counselling and HIV/STI testing on risk behaviour and support a consensus process to agree on optimal counselling practices;

14. Washington D.C., USA, 22-27 July 2012www.aids2012.org Call To Action Facilitate the implementation and assessment of HIV indicator condition guided testing; Stimulate an evidence base on and reduce barriers to testing that include human rights, stigmatisation, discrimination and criminalisation; Continue supporting the implementation of novel models to estimate the number of infected but not yet diagnosed individuals; Investigate linkages and collaboration between HIV testing and hepatitis testing and access to care; Support the international institutions and agencies to increase their engagement

15. Washington D.C., USA, 22-27 July 2012www.aids2012.org HIV in Europe moving East The projects of HIV in Europe are to a great extent implemented in Eastern European countries. –The stigma index project builds on data from Estonia, Moldova, Poland, Turkey and Ukraine. –40% of persons enrolled into the pilot phase of the HIV Indicator Diseases across Europe study are from Eastern European countries. –The newly approved HIV-COBATEST project will be implemented in Eastern Europe. The Steering Committee in collaboration with WHO Europe is discussing the possibility of a conference in Eastern Europe on testing to discuss barriers to testing from an Eastern European perspective.

16. Washington D.C., USA, 22-27 July 2012www.aids2012.org Planned activities and fundraising needs 2012-2014 ProjectDescription Period Amount € Coordination, communication, fundraising and political advocacy Secretariat (coordination and political), support for steering committee members, travel, website, fundraising, communication 2013-2014 216.000 Ongoing projects HIDES phase 2 Stigma Index phase 2 COBAtest Finalisation of the projects and dissemination of results 75% of project budgets covered by 2011/2012 budget 100.000 HIV in Europe Eastern Europe Conference 2013 in Moscow or another country 2013 350.000 Others Best practice platform Other projects: to be defined March 2012 2012-2014300.000 Total€ 966.000

17. Washington D.C., USA, 22-27 July 2012www.aids2012.org The HIV in Europe Study Group HIV in Europe Steering Committee: Co-Chairs: Ton Coenen, AIDS Action Europe, Executive Director Aids Fonds & Soa Aids Nederland, Netherlands and Jens Lundgren, Professor & Chief Physician, University of Copenhagen & Rigshospitalet, Director, Copenhagen HIV Programme, Denmark, Members: Jordi Casabona, Scientific Director, Center for HIV/STI Epidemiological Studies of Catalonia Nikos Dedes, Chair, Policy Working Group, European AIDS Treatment Group (EATG), Greece, José Gatell, Head, Infectious Diseases & AIDS Units, Clinical Institute of Medicine & Dermatology, Hospital Clinic, Professor of Medicine, University of Barcelona, Spain, Brian Gazzard, Professor of Medicine, Imperial College School of Medicine, HIV Research Director, Chelsea & Westminster Hospital, UK, Igor Karpov, Professor, Department of Infectious Diseases, Belarus State Medical University, Jürgen Rockstroh, Professor of Medicine University of Bonn and Head of an HIV outpatient clinic, Germany, Jean-Luc Romero, President Elus locaux Contre le Sida, France, Anders Sönnerborg, MD, PhD, Professor, Department of Medicine Karolinska University Hospital, Sweden, John de Wit, Professor of Sociology, Utrecht University, The Netherlands, Observers: WHO Regional Office for Europe, STI/HIV/AIDS Programme, Represented by Lali Kotenashvili, European Centre for Disease Prevention and Control (ECDC), Represented by Marita van de Laar, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Represented by Lucas Wiessing, epidemiologist, principal scientist, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Represented by Jeffrey V. Lazarus, Centers for Disease Control and Prevention (CDC), Represented by Kevin Fenton, UNAIDS Regional Support Team ECA, Represented by Michelle Williams-Sherlock. European Late Presenter Consensus working group: A Antinori, National Institute for Infectious Diseases ‘‘Lazzaro Spallanzani’’ IRCCS, Rome, Italy, T Coenen, Aids Fonds & Soa Aids Nederland, Amsterdam, the Netherlands, D Costagiola, INSERM, Paris, France, N Dedes, European AIDS Treatment Group, Brussels, Belgium, M Ellefson, National University Hospital and Univ. of Copenhagen, Copenhagen HIV Programme, Panum Institute, Denmark, J Gatell, Clinical Institute of Medicine & Dermatology, Hospital Clinic, University of Barcelona, Barcelona, Spain, E Girardi, National Institute for Infectious Diseases ‘‘Lazzaro Spallanzani’’ IRCCS, Rome, Italy, M Johnson, Royal Free Hampstead NHS Trust, London, UK, O Kirk, National University Hospital and Univ. of Copenhagen, Copenhagen HIV Programme, Panum Institute, Denmark, J Lundgren, National University Hospital and Univ. of Copenhagen, Copenhagen HIV Programme, Panum Institute, Denmark, A Mocroft, University College London Medical School, Roylkal Free Campus, London, UK, A d’Arminio Monforte, Department of Medicine, San Paolo Hospital, Milan, Italy, A Phillips, University College London Medical School, Royal Free Campus, London, UK, D Raben, National University Hospital and Univ. of Copenhagen, Copenhagen HIV Programme, Panum Institute, Denmark, J K Rockstroh, Medizinischen Universitätsklinik, Innere-Rheuma-Tropen Ambulanz, Bonn, Germany, C Sabin, University College London Medical School, Royal Free Campus, London, UK, A Sönnerborg, Department of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden, F de Wolf, HIV Monitoring Foundation, Amsterdam, the Netherlands. Working Group on Estimation of HIV Prevalence in Europe (conveners: Andrew Phillips and Rebecca Lodwick, University College London Medical School, Royal Free Campus, London, UK) The HIV Indicator Diseases Across Europe Study Group. Advisory Group: Nathan Clumeck, CHU Saint-Pierre, Brussels, Belgium, Jose Gatell, Hospital Clínic de Barcelona, Barcelona, Spain, Brian Gazzard, Chelsea and Westminster Hospital, London, England, Jens Lundgren, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark, Antonella d’Arminio Monforte, Clinica delle Malattie Infettive, Milan, Italy, Jürgen Rockstroh, Department of Medicine, University of Bonn, Germany, Amanda Mocroft, University College London Medical School, UK. Centres: Austria: R Zangerle, University Hospital Innsbruck, Department of Dermatology and Venereology, Innsbruck. Belarus: A Vassilenko, Minsk Municipal Infectious Diseases Hospital, Minsk. Belgium: A Libois, S Clinic, J André, Department of Dermatology, P Kirkove, Saint-Pierre University Hospital, Brussels. Bosnia: V Hadziosmanovic, Clinical Center, University of Sarajevo, Infectious Diseases Clinic, Sarajevo. Croatia: J Begovac, University Hospital of Infectious Diseases, Zagreb. Denmark: H Sørensen, Bispebjerg Hospital, København. Germany: U Spengler, Outpatient Clinic for Hepatology, Department of Medicine, University of Bonn. I Schmidt-Wolf, Outpatient Clinic for Hepatology Department of Medicine, University of Bonn. S Esser, Uniklinikum Essen, Hautklinik, Essen. Italy: M Zuin, Liver Unit, Dept. of Medicine, San Paolo Hospital, Milan. G Podda, Hermathology Unit, Dept. of Medicine, San Paolo Hospital, Milan. M Cusini, STD Centre, Dermatology department, Milan. Netherlands: K Brinkman, Onze Lieve Vrouwe Gasthuis, Internal Medicine, Amsterdam. Poland: A Grzeszczuk, Medical University of Bialystok, Department of Infectious Diseases and Hepatology, Bialystok. Spain: F Garcia, A Leon, Hospital Clinic Barcelona, Infectious Diseases Unit, Barcelona. I Menacho, Primary Center of les Corts, M Muns, Primary Center of Raval Sur, Barcelona Spain. Sweden: A Sönnerborg, Department of Infectious Diseases, Karolinska University Hospital, Stockholm. United Kingdom: A Sullivan, M Rayment, ChelseaWestminster Hospital, London. Ukraine: M Krasnov, Kharkov Regional Clinic of Infectious Diseases, Kharkov. Coordinating Centre Staff: D Raben, M Ellefson, RS Brandt. The people living with HIV Stigma Index Advisory Group: Wojciech Tomczynski on behalf of ECUO (the Eastern European Network for People living with HIV), Henrik Arildsen on behalf of HIV Europe (the European Network for People living with HIV), Jurek Domaradzki on behalf of the European Aids Treatment Group, Julian Hows on behalf of GNP+, Ton Coenen on behalf of the HIV in Europe Steering Committee.

18. Washington D.C., USA, 22-27 July 2012www.aids2012.org

19. Washington D.C., USA, 22-27 July 2012www.aids2012.org