A large European survey among men who have sex with men

The European Men-Who-Have-Sex-With-Men Internet Survey EMIS-2017 collected comparable data from 127.792 participants – men who have sex with men from 48 countries in Europe. It provides insights on their knowledge of HIV, viral hepatitis and sexually transmitted infections (STI), sexual behaviour, prevention needs and testing habits.

EMIS-2017 was executed by Sigma Research (London School of Hygiene and Tropical Medicine) as part of European Surveys and Training to Improve MSM Community Health (ESTICOM). It was a three-year project (2016-2019) funded by the European Commission Health Programme 2014-2020 through a tender by the Consumers, Health, Agriculture and Food Executive Agency (Chafea).

The results show considerable differences across the countries reflecting Europe’s diversity with respect to sexual health and behaviour of MSM. The report describes both MSM behaviour and needs, alongside resulting morbidities, and the likely value of current services to address these.

The Executive Summary indicates that sex between men remains the predominant mode of HIV transmission in the EU/EEA countries, where the first signs of a decline in reported new cases resulted from a 20% drop in new diagnoses among MSM (2015-2017). Responses to a survey that focused on knowledge about HIV and sexually transmitted infections, sexual behaviour, access to care, HIV-related stigma and the use of services for HIV and sexual health is a strong indication that this group cares about HIV and sexual health issues. For example, every second (56%) respondent had received an HIV test result in the last 12 months and almost half (46%) had tested for other STI during the same period.

To read full Report, follow this link>>>

Measuring HIV stigma and discrimination

To better understand the status of HIV-related stigma and discrimination and progress towards their elimination, support advocacy for addressing HIV-related stigma and discrimination and highlight data gaps, UNAIDS is coordinating the development of summary measures of HIV-related stigma and discrimination.

Starting on 19 August 2019 for a period of three weeks, various elements of the draft measures will be discussed. A few key questions will guide the moderated discussion each week. Inputs and recommendations from each week will be shared at the start of the following week and used to inform the next element of the measures to be discussed.

The virtual consultation is open to everyone. They aim to encourage broad participation, particularly of people living with and affected by HIV, gay men and other men who have sex with men, transgender people, young people, sex workers, people who use drugs and women, from all regions. Contributions through this consultation will be used to inform the development of the measure(s) and ensure they are people-centred, reflecting the lived experiences and realities of people, and meaningful to inform programmatic action.

To get more information and participate in the consultation follow this link>>>

Serbia completed project application to the Global Fund

The National Committee for fighting HIV/AIDS and Tuberculosis, which performs the role of the Country Coordinating Mechanism in Serbia, adopted today the documents which will be submitted to the Global Fund to fight AIDS, Tuberculosis and Malaria. The project is expected to run from July 2019 to June 2022.

Back in 2016, the Global Fund allocated €1,098,351 for HIV and building resilient and sustainable systems for health. The allocation have been determined primarily based on disease burden and income level. Serbia is classified as an upper-middle-income country. Serbia committed to encourage additional domestic investment of 25%. The first amount agreed during the application in already included in the national budget for 2019.

The project seeks to scale-up HIV testing services for all key affected populations (KPs), preventive programs for men who have sex with men and sex workers and needles and syringes program (NSP) and other preventive programs for people who inject drugs. In addition, the project seeks to maintain and extend support provided by organizations of people living with HIV to people on antiretroviral treatment. The project will fund services provided by civil society organisations and will contribute to community system strengthening. In order to reach the maximum impact the majority of prevention and support interventions will be implemented at least in the two regions (Belgrade and Vojvodina) in which majority of KPs are concentrated based on surveillance data..

The civil society organisations, including DPNSEE and our three member organisations from Serbia Prevent, Duga and Timok Youth Centre, actively participated in creating the new national HIV strategy, in the work of the National Committee and the Working group for negotiations with the Global Fund.

Meeting of the Working group for negotiations with the representatives of the Global Fund

Programmatic Mapping to Estimate Size, Distribution, and Dynamics of Key Populations in Kosovo

The burden of an HIV epidemic in Kosovo* lies among the key populations (KPs) of female sex workers (FSWs), men who have sex with men (MSM), and people who inject drugs (PWIDs). The aim of this study was to estimate the size and distribution of these populations to create evidence for developing action plans for HIV prevention.

Results of this Study: Study in Kosovo

Of the estimated 6814 men who have sex with men (range: 6445 to 7117), nearly 4940 operate through the internet owing to the large stigma and discrimination against same-sex relationships. Geo-based men who have sex with men (who operate through physical spots) congregate at a few spots with large spot sizes (13.3 men who have sex with men /spot). Three-fourths of the men who have sex with men are distributed in 5 major municipalities. Fridays and Saturdays are the peak days of operation; however, the number only increases by 5%. A significant number are involved in sex work, that is, provide sex to other men for money. People who inject drugs are largely geo-based; 4973 (range: 3932 to 6015) people who inject drugs of the total number of 5819 (range: 4777 to 6860) visit geographical spots, with an average spot size of 7.1. In smaller municipalities, they mostly inject in residential locations. The numbers stay stable during the entire week, and there are no peak days. Of the 5037 (range: 4213 to 5860) female sex workers, 20% use cell phones, whereas 10% use websites to connect with clients. The number increases by 25% on weekends, especially in larger municipalities where sex work is mostly concentrated. Other than a few street-based spots, most spots are establishments run by pimps, which is reflective of the highly institutionalized, structured, and organized female sex workers network.

This study provides valuable information about the population size estimates as well as dynamics of each KP, which is the key to developing effective HIV prevention strategies. The information should be utilized to develop microplans and effectively provide HIV prevention services to various KPs.

To read more about this study follow this link >>>>

An interesting webinar on social contracting

Health Policy Plus, APMG, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, UNAIDS, UNDP, USAID and others hosted a webinar on 6 March 2019 to discuss social contracting for HIV care, treatment and support. Presenters from around the world discussed how to plan for social contracting as part of a long-term sustainability strategy and how to advocate for it, touching on policy and regulatory challenges, how to develop mechanisms to put social contracting in place and how to implement and monitor social contracting’s success.

To view the recording of the webinar, follow this link>>>>

Slides from the webinar are available following this link>>>>

Health Policy Plus also prepared a factsheet Social Contracting: Supporting Domestic Public Financing for Civil Society’s Role in the HIV Response from which you can learn more about social contracting and how it can support domestic public financing for civil society’s role in the HIV response. You can find the factsheet following this link >>>>

SEE HIV Ministerial Meeting

The Prime Minister and Minister of Health of the Former Yugoslav Republic of Macedonia hosted a South-Eastern European Ministerial Meeting on Sustainable Responses to HIV and TB in Skopje on 7 May 2018. The aim of the Ministerial Meeting was to discuss the progress, challenges and opportunities towards reaching sustainable responses to HIV and TB in South-Eastern Europe. Civil society representatives had an opportunity to join the high level representatives from all SEE countries, donors and global development partners and exchange about progress made and what remains to be done to meet the goal of ending the AIDS and tuberculosis epidemics in the region as part of the 2030 Agenda for Sustainable Development.

The ministers recognized increasing ownership of the national responses to the diseases, as external financial support including from the Global Fund is transitioning to support countries with the highest global burdens of disease and least economic capacity. The ministers expressed commitment to allocating domestic funding for and ensuring access to HIV and tuberculosis treatment for all, guided by governance structures that involve civil society and affected communities along with health professionals and technical partners. Still, a few comments from the civil organisations warned that the situation is far from satisfying and that “behind numbers are people about whom we need to care” – as underlined by the DPNSEE Board member Denis Dedajić.

DPNSEE representatives Vlatko Dekov, Chairman of the Board, Denis Dedajić, Secretary of the Board and Milutin Milošević, Executive Director, met with several Global Fund Board members, country representatives, donors and civil society colleagues. An important meeting was the one with Ekaterina Lukicheva from the Open Society Foundations International Harm Reduction Development Program and Raminta Štuikyte, consultant about the budget advocacy and implementation project and other ideas for future cooperation.

Photo with Peter Sands, the Executive Director of the Global Fund

The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, at its 39th Board meeting, highlighted the importance of strengthening sustainability and supporting successful transition to domestic financing to build long-term solutions and achieve greater health security.

The Global Fund is committed to being a good partner in working toward sustainability, acting as a catalyst to additional investment, filling short-term gaps, and addressing bottlenecks to successful transition to more domestic funding. While shifting financing often includes challenges, including how to effectively fund civil society, transition increases country ownership and is necessary to end epidemics.

An important news for the region is that the Board approved an approach to ineligible upper-middle income countries in crisis where economic and epidemiological metrics are collapsing and where spill overs threaten regional progress against HIV, TB and malaria.

More about the Board meeting is available at the Global Fund website following this link >>>

A dialogue between civil society and donors

The Open Society Foundations convened civil society activists from HIV, harm reduction, sex worker and LGBT communities from South Eastern Europe and health and human rights donors to discuss opportunities for strategic collaboration to sustain HIV prevention services for key populations and facilitate transition to domestic financing of these programs. The half-day meeting was held on 18 January 2018 in Belgrade, Serbia.

The aims of the meeting were:

  • Share examples of civil society advocacy towards domestic financing of HIV services, including efforts to push national governments to commit to provision and financing of services for key populations;
  • Discuss current challenges sustaining programming for key populations in the region with a specific focus on the threats to the human rights movements, programs, and advocates that were directly and indirectly supported by the Global Fund when it was still active in the region;
  • Present examples of how targeted donor support for civil society engagement in transition and sustainability process can bolster government ownership of the HIV response;
  • Discuss strategies and opportunities to address the service gap and enable civil society to navigate the transition process, as well as roles that donors, regional networks and technical agencies can play.

DPNSEE member organisations representatives were panellists: Denis from Margina and Dragos from RHRN presenting situation in Bosnia Herzegovina and Romania, Ivana from Juventas presenting the promising case study of Montenegro and Milutin, together with two other networks (ERA – LGBTI Equal Rights Association for Western Balkans and Turkey and SWAN – Sex Workers’ Rights Advocacy Network) on possibilities for work together to strengthen national and regional advocacy.

Many organisations were at the list of potential invitees. Finally, around 35 CSO participated. Besides DPNSEE, 9 member organisations were present: Aksion Plus, Margina, Viktorija, Labyrinth, Cazas, Juventas, ARAS, RHRN and Prevent.

The meeting was mainly about presenting situation and needs, with not many questions and comments from the floor. Most of the results were achieved in informal exchanges with other participants. Besides OSF and Global Fund representatives, donors included Embassy of France in Serbia, Mama Cash and Reconstruction Women’s Fund (Serbia). Representatives of other Networks included Eurasian Harm Reduction Network and Eurasian coalition on male Health.

Just after the main meeting of the dialogue, an Informal dialogue on LGBTI and HIV in South-Eastern Europe was organised by the ERA – LGBTI Equal Rights Association for Western Balkans and Turkey. Most of the DPNSEE member organisations participated in the meeting that addressed the current work done, gaps and challenges in collaborating towards protecting LGBTI rights and addressing HIV and needs and opportunities for a regional approach and support of this work.

Representatives of the DPNSEE member organisations at the Dialogue

Building a new HIV Strategy in Serbia

Recent National HIV in Serbia expired in 2015 and since then there were no initiatives to design a new one. Finally, this autumn, with revival of the activities around potential Global Fund project support, the Ministry of Health started a process of building a new HIV Strategy.

The process is quite fast – it started in early November with the deadline for the draft set at the end of 2017. A working group of five people was appointed, including one representative of the civil society. Each of the working group members was leading the process of producing the text in one of the priority areas: 1) Prevention, 2) Medical treatment and support to people living with HIV, 3) Stigma and discrimination, 4) Quality standards and 5) Strategic information.

In each of the subgroups, a dialogue between various stakeholders, governmental, civil society, academia and people living with HIV, was productive in analysing the situation and proposing new aims, measures and activities. DPNSEE and member organisations representatives participated actively in this endeavour. And success was achieved: the final meeting of the expert group, held on 25 December 2017, resulted in producing the final draft of the Strategy and the Action plan 2018 – 2021 for implementing it!

Even though the process short and the task challenging, we hope that the result will lay ground for a comprehensive and effective respond to HIV in Serbia.

Senior Level Policy Dialogue

The Senior Level Policy Dialogue “Addressing HIV and TB Challenges: from Donor Support to Sustainable Health Systems” was organised in Tallinn, Estonia on 12 and 13 December 2017 as an official event in the programme of the Estonian Presidency of the Council of the European Union.

The event, organised by the Ministry of Social Affairs and National Institute for Health Development from Estonia, WHO European Region, UNAIDS, and the Global Fund, brought together representatives of the health and financial ministries of Europe, the Balkan and Eastern Partnership countries, representatives of the European Commission, international organisations, as well as community representatives and institutions involved in funding programmes and offering services to tackle HIV and TB.

In Eastern Europe the fight against HIV and tuberculosis has largely been funded through international organisations (such as the Global Fund to Fight AIDS, Tuberculosis and Malaria). However, this kind of funding is not sustainable in the long term.

The participants searched for ways to smoothly transition from funding through foreign aid programmes to sustainable state funding. They outlined the best practices, challenges, opportunities and risks related to integrating HIV and TB programmes into a national health system. The discussions included the role and responsibility of various institutions and organisations in stopping the HIV and TB epidemics.

DPNSEE and 4 participating member organisations representatives (Cazas, Juventas, Margina and Viktorija) actively contributed to the meeting, including two panellists who gave a specific insight in the situation of the region. Both the experiences from South East Europe and challenges we face were presented, emphasized and mentioned by many participants. The meeting was also a good opportunity to establish contacts and generate ideas for future cooperation.

Participation of the SEE representatives was made possible by generous support from the Open Society Foundation.

EECA Civil Society Meeting

Preparing for the regional meeting “Addressing HIV and TB Challenges: from Donor Support to Sustainable Health Systems”, civil society organisations from Eastern Europe and Central Asia met on 11 December in Tallinn. Aim of the meeting was to consolidate and build opportunities for cooperation in advocacy efforts of civil society representatives during and after the meeting.

The pre-meeting gathered 14 representatives from civil society and community organisations mainly from South East European countries and regional community networks. Unfortunately because of heavy snow in the departure airports and delayed flights a lot of participants could not join.

There were two main issues of the meeting which of great importance for civil society and communities: transitioning of services to domestic funding and integration of it into the health and social care system.

The structure of the outcome document was presented and discussed. Next week key points from the document could be used for the plenary meeting of the Civil Society Forum of HIV, Hepatitis and Tuberculosis.