CONFERENCES
European Conference
“The right to HIV/AIDS prevention, treatment, care and support for migrants and ethnic minorities in Europe: The community perspective”
Lisbon 7-8 June 2007
Institute of Hygiene and Tropical Medicine (IHMT), UNL Auditorium, Junqueira Street nº 96, Lisbon, Portugal
Universal access in Europe is not possible if migrants are not included
June 7, Lisbon – More than 200 European community leaders representing 32 organizations are meeting today for the conference “The Right to HIV Prevention, Treatment, Care and Support for Migrants and Ethnic Minorities in Europe: The Community Perspective.” This event begins a series of discussions on health and migration issues that will be highlighted during the Portuguese Presidency of the European Union, which starts on 1 July 2007. Four main issues in terms of mobility, ethnic minorities and HIV/AIDS have been identified. First, there is more than enough documented evidence that universal access to HIV prevention and treatment is the only measure to bring down the AIDS epidemic. Even in countries with good healthcare systems migrants and ethnic minorities are disproportionately at risk for HIV infection as a result of barriers to prevention and treatment. Studies demonstrate that it is cost-efficient to provide prevention and treatment to these populations. Furthermore, access to care to all people living in Europe, despite of their status of residency or citizenship, must be recognised and guaranteed as a basic human right. High level political decisions on migration and health must be agreed during the upcoming Portugal’s Presidency. A common policy on migration and HIV is needed for the benefit of individuals and societies at large.
Background
Today in Europe, as more than 30 countries provide good access to HIV/AIDS treatment, migrants and ethnic minorities, which account for a large and often increasing proportion of new HIV cases, particularly in Western Europe, are the least likely to have access to HIV prevention, treatment and care.
Epidemiological data from different European countries demonstrate that migrants and ethnic minorities are at particular risk to HIV infection. In 2004, 35.5% of new HIV cases in Western Europe were registered among migrants from Europe and abroad, primarily higher-prevalence countries. In some countries of eastern and south-eastern Europe, for example, Russian speaking communities and Roma are disproportionably affected by poverty, injecting drug use and sex work, key drivers for the HIV epidemic there.
Migrant populations are disadvantaged regarding access to services in Europe and Central Asia. Obstacles to treatment and care not only make migrants much more vulnerable to infection but also prevent the effective control of the epidemic. The marginalisation of some migrant groups stresses the need for approaches towards better participation, empowerment and community involvement and the need for increased awareness among policy-makers and health care personnel.
Many migrants are not in contact with any health services. Moreover, accessing state institutions might threaten their presence in the country. Laws addressing migrants need to acknowledge this reality in order to provide essential HIV and other health and social services.
Internal migration in Europe is huge. It is not easy to access healthcare outside the country you are a citizen of. As internal movement of citizens for holidays and work is increasing, the EU countries have to agree on fast steps towards harmonisation and cooperation of national health care system for the benefit of the citizens of the European Union.
“Meeting needs and delivering services for people who are migrants or come from the ethnic minorities is basic human right, of public heath interest and cost effective. This might require not only advancement of services but also changes in legislation and approaches to migrants and in healthcare for foreigners in the EU and overall in our continent,” says Luis Mendao, co-chair of the conference from Portuguese group GAT and European AIDS Treatment Group (EATG).
6th- 7th June 2007; Lisbon, Portugal
REPORT FROM
Technical Consultation for NGOs/CBOs in the WHO European Region “Challenges and
opportunities for scaling-up access to quality T&C services – The NGO/CBO perspectives”
Representatives of 25 European NGOs, numerous international
partners, temporary advisors, WHO Headquarters and regional office for Europe, and
UNAIDS, attended the consultation meeting where major points for discussion were:
What are the key concerns of civil society, NGOs and PLWHA in relation to HIV
T&C?
More specifically, how can the following be ensured:
Voluntary, anonymous/confidential, free, quality
HIV T&C services are available, affordable, acceptable and equal access is guaranteed/secured
Increased availability of and access to HIV T&C
services is not a goal in itself, but it is followed by their increased uptake,
and leads to improved access to prevention, treatment, care and support services
Call for scaling up of HIV Testing is not perceived/understood
as a promotion of mandatory testing and does not lead to increased human rights’
violation, stigma, discrimination and violence
National legislation addresses HIV T&C related
aspects in a rights based manner and protection against stigma, discrimination and
violence is granted
T&C data are protected. Disclosure is voluntary.
Human rights based approach is a basis for partner tracing
Resource constraints are not stopping T&C promotion
and cost effectiveness issues are not influencing public health values
• Which main issues should be addressed/discussed in a European T&C Policy brief that WHO EURO plans to develop in collaboration with national and international partners?
1. In his introductory presentation, the topic of which was “HIV T&C and Universal Access to HIV Prevention, Treatment, Care and Support”, S. Matic defined frameworks for consultations, and pointed to the importance of NG sector in achieving and securing voluntary, anonymous/confidential, free, quality HIV T&C services.
2. Particular interest was aroused by an overview of the recently developed WHO/UNAIDS draft “Guidance on Provider-initiated HIV Testing and Counselling in Health Facilities” (D. Higgins WHO HQ). As the paper is under embargo until May 30th, we shall not present it in detail, but we would like to point to a great number of issues it will undoubtedly uncover. Some of those that we perceive refer to:
• Relation of this initiative and present efforts in promoting
C&T as self-determining activity, i.e. to the notion that it is the most important
PREVENTIVE ACTIVITY
• Effect upon growing discrimination in the health
system, especially during the initial period until the sufficient quantum of knowledge
among physicians is secured
• Training of providers, physicians, for its application.
3. Exposition of Ksenija Turkovic of the Zagreb Law School on “T&C issues to be addressed by national legislation ensuring rights-based approach” has a many-sided meaning to us.
All the issues touched upon in introductory speech and in
discussions are of crucial importance for our milieu. Instead of generalised recommendations
for voluntariness and confidentiality in health system, SPECIFIC ONES RELATED TO
HIV ARE NEEDED, as well as to define behaviour and procedures for health staff.
Training and providing information on the topic via special workshops is necessary
for health workers.
Areas to be regulated are numerous, but it seems to us that the most important ones
are:
• Informed consent, particularly of children and young people:
Cooperation with UNICEF and Children's Rights Centre is prerequisite in this sense.
The matters are to be regulated by laws or decrees
• Providing of information
• Medical charts and case histories
• Mandatory testing (excepting only the strictly defined
ones) in health system
• Revealing information (again, the question of children,
who is supposed to know, who is to be informed)
4. Problems related to drug users, which were mentioned in the paper “Improving
access to T&C services for IDUs: what works/ what does not – most recent experience
from Portugal” delivered by H. Barros, National HIV/AIDS Coordinator, Portugal,
are, no doubt, even more acute in our country.
Portugal succeeded in defining a STANDARDISED APPROACH TO PREVENTION, HEALTH-EDUCATION
WORK, THERAPY, AND TESTING in the sphere of drug addiction FOR THE WHOLE COUNTRY.
Such a manual would be of great help to us.
5. Numerous issues were debated in discussions, and almost all of those are of relevance to us:
• Home tests – quality information pro and con on home test
is required and has to be made accessible in simple language understandable by common
people. Their use has to be regulated by decree
• Issue of counsellor: who can become a counsellor,
who is to be counsellor to work with children
• Notifying the partners
• Confidentiality of information
• Familiarizing the test service and promulgation
of C& T (outreach services, mobile units, more appropriate use of pharmacies,
promotional printed matters in health institutions, propaganda campaigns)
• Sustainability of testing, once donors back out
of some areas (which is essential to us) 6. We managed to inform the audience about
good collaboration among NGO sector and some of governmental health institutions
in the area of testing promotion and about the efforts organized by Students Health
Centre in Belgrade to enlarge the accessibility of testing ( “Night testing “)
7. The conclusion is
• that the meeting in general was in a way too tinged by
experiences from western countries and that experiences from east European countries
were only touched upon lightly, even though eastern countries have enormous problems,
particularly those related to INSUFFICIENT LEGISLATIVE REGULATIONS, violation of
human rights, discrimination, health staff training, accessibility of institutions,
and similar
• that it is necessary to define what each country
is expected to do in order to improve availability of tests
• that the Report on the meeting will be submitted
to all participants for comments and suggestions.
Prof Dr Viktorija Cucić Belgrade , 12 june
HIV/AIDS Control at the highest political level
EU-Conference "Responsibility and Partnership - Together Against AIDS", 12. - 13.
March 2007. Bremen, Germany [Bremen Declaration,
]
Representatives
of 27 European Union and neighbouring countries met in Bremen, Germany to discuss
ways of strengthening political leadership in the response to AIDS.
Over 600 people attended the conference which was organised by the German Federal Government as part of its 2007 European Union Presidency.
Serbian delegation: dr Tomica Milosavljević, president of Republic Commision for Fight Against HIV/AIDS, dr Ivana Mišić, senior consultant in Ministry of Health, dr Dragan Ilić, Member of Republic Commision for Fight Against HIV/AIDS and Director of JAZAS, Jarmila Bujak Stanko from NGO ''Pozitiv'' and Katarina Mitić supervisor of Project Unit for HIV/AIDS in Ministry of Health. German Federal Chancellor, Dr Angela Merkel gave the keynote address and UNAIDS Executive Director Dr Peter Piot spoke on the opening day about the epidemic in the region and actions necessary to curb the epidemic.
The conference comes as a follow-up to the 2004 meetings in Dublin and Vilnius where groundbreaking declarations to step up political action on AIDS were signed by participating European ministers.
The second day of the Conference comprised of workshops covering many key aspects of the AIDS response in the region including presentations on human rights, migration, stigma, gender and issues concerning sex work, injecting drug use and men who have sex with men the attending ministers of health are expected to sign a declaration reaffirming the commitments made in Dublin and Vilnius in a bid to increasing political leadership on AIDS on national, regional and international levels.
At the close of
the conference the representatives of EU Member States, neighbouring countries and
international partners agreed on a joint declaration in their fight against HIV/AIDS
("Bremen Declaration"). In this Declaration, the participants commit to assume political
leadership at national, European and international level to roll back the pandemic.
The principal focus is the universal access to prevention, in particular also for
unborn children and for young people within the scope of sexual education.
Moreover, the declaration obliges the participants, to include partner organizations such as civil organizations, WHO, UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the European Centre for Disease Prevention and Control (ECDC) and the civil society in their fight against HIV/AIDS. They also strive for an improved cooperation to ensure access to affordable medication.
Discrimination against infected persons and vulnerable groups shall be legally prohibited, if necessary. The European Commission is asked to implement the Action Plan already adopted and to set up a Clearing House for models of good practice. In this Declaration the participants reaffirm their intention to implement a number of previous declarations by the United Nations and from the previous conferences in Dublin and Vilnius.
Round table Intervention programmes – possibilities and obstacles, 08.03.2007.
Opening – Viktorija Cucic
JAZAS experiences in intervention programmes, outreach work with sex workers – outreach
team
Introduction of participants
JAZAS experiences in intervention programmes, medical doctors experience – Bogica
Čabak Intervention programmes for sex workers – Marieke Ridder, SOA AIDS Netherlands
VCT on the field – Nataša Cvetković, IAN/ISH HESED experience in coordination of
a network of organisations, working for the Ministry of Health – Violetta Kandjikova,
HESED Bulgaria Outreach activities among MSM population, resultas, lessons learned,
challenges - Danijel Mešković, CCM coordinator secretariat for monitoring Global
Fond projects
Intervention programmes for clients – Frank ten Horn, SOA AIDS Netherlands
Counseling center for youth experiences working with vulnerable populations – Vesna
Kisić, Health Centre Voždovac
Children and young of the street – Milica Djordjevic,
Integration of youth center Intervention programme initiative HPVPI, Slađana Baroš,
JAZAS [photo album]
March 8th.2006 Belgrade Round table programme „Prostitution as a public health issue in Serbia“-summary
Round table was opened with projection of TV- video clip about NGO JAZAS medical mobile unit and positive feedback from both street prostitutes on this type of medical assistance and doctors from JAZAS mobile medical unit.
Prof.dr. Viktorija Cucic, NGO JAZAS Belgrade, welcomed the participants and opened the round table by remembrance on basic principles of 8th of March and neglect ion of human rights of sex workers and their marginalization and discrimination which has direct consequences to their health as well as on public health.
Dr Cucic stressed the need for cooperation on these issues with local government and presented the JAZAS activities in Belgrade and announced the beginning of similar activities in cities throughout Serbia: Nis, Novi Sad, Kosovska Mitrovica, Novi Pazar and Subotica.
Dr. Dragan Ilic from NGO JAZAS-Belgrade, welcomed the participants, introducing them on prostitution scene in Belgrade and up- to date activities of NGO JAZAS’project Power of Prevention realized with the partners from Netherland: NGO SOA- AIDS, Netherland’s government Matra programme, and with assistance of Imperial College –London, HPVPI-network. He pointed the necessity for government institutions to formally start dealing with many problems related to prostitution Later on, ms. Lucie van Mens, project manager of Power of Prevention programme, from Netherlands organization SOA-AIDS, spoke about health services for sex workers and need to deal with this problem comprehensively because of spreading of HIV and STI-s among sex workers and it’s transferring to general population. She stressed the necessity of outreach work with these vulnerable populations, and need of involving more institutions and other association in dealing with this issue; as well as spreading the project to Nis, Novi Pazar. Kosovska Mitrovica, Novi Sad and Subotica.
Mr. Gutic Mijodrag from Serbian Ministry of Internal Affairs stressed the close links of prostitution and trafficking of people. Trafficking of people is sanctioned under criminal law and, as Mr. Gutic said, police continues to widen its activities regarding it He expressed his concerns because of an increase in number of Roma underage children which are most often victims of trafficking, Mr.Gutic expressed the need for continuance of activities like JAZAS does regarding street prostitution and offered further cooperation from the Ministry.
Mr.Budimir Poluga, chief of Palilula police station in Belgrade, confirmed that trafficking of people is the primary goal of police activities, as part of the prostitution issue, and expressed his satisfaction on good practice of cooperation between police and NGO sector.
Gordana Jurican and Milos Stojiljkovic, from Belgrade, JAZAS outreach workers on POP project, presented the activities on the field, challenges they are facing, and stressed the need of active involving of government institutions in solving other issues often connected to the prostitution. Sladjana Baros, from National Office on HIV/AIDS/Belgrade, presented the results of the qualitative research done on street prostitutes in Belgrade, by the Imperial College-London and JAZAS-Belgrade in 2005. She focused on environmental risk factors where prostitutes live and work in, unwritten rules of work, pimps’role, and legislative framework as well as their own perception of client’s health and choice of using or not using condoms.
Dr.Nebojsa Barackov from NGO “Prevent”, Novi Sad, presented the situational analysis on prostitution and drug users. Street prostitution issue, has not been dealt with until recently, except for the police. They collected only relevant data and therefore it is necessary to continue cooperation with NGO’s already dealing with that issue.
Drug issue, is covered with needle exchange programme, and methadone therapy in one government clinic in Novi Sad. He stressed the fact that there is not one institution involved in treatment or any other form of help for people living with HIV/AIDS.
Ivona Markanović, from NGO Crvena Linija Novi Sad, said that, based on their research, there is an increase of indoor prostitution in Novi Sad, and also an increase of number of local girls involved in prostitutioin, compared to previous years, when the most of the prostitutes were from east-european countries. She also presented the results of HIV- prevention lectures done in schools in Vojvodina province.
Dr.Ljiljana Pejin from Global Fund-Belgrade, presented the findings of questionaire done on stigmatization and discrimination on population from 18-70 years of age,wich shows high procentage of discrimination towards voulnerable populations. Igor Kalamar from NGO Youth of JAZAS-Kosovska Mitrovica said that from 1999 and arrival of peace core on Kosovo.there is a huge increase in drug abuse and indoor prostitution.He pointed the need of cooperation and total absence of any form of activities on drug,prostitution and HIVAIDS issue from the government.
Ljiljana Kostić from Red Cross- Novi Pazar,said that in recent years, due to development of private sectors and transit routes from Kosovo to Bosnia, there is an enormous increase of drug abuse.About 4% percents of population of Novi Pazar are using drugs. Red Cross is the only organization dealing with this issue.
Indoor prostitution is also in increase,especially in night clubs and appartments,unfortunately there are no programmes to deal with this ,nor with any kind of help for people living with HIV/AIDS from either of these groups.
Dr Bojana Ilic from Nis, said that prostitution issue in Nis is widely disregarded by the authorities.Only few cases of commercial sex are reported due to Social care centers and was related to minor roma prostitution.
Police treats prostitution as „collateral“ Problem of people trafficking. Thanks to the research of few NGO-s, local government and media, they collected information about indoor prostitution, substance abuse and people living with HIV/AIDS.
There are 900 registered substance abusers, and it is estimated that there are about 4000 altogether. Number of people living with HIV/ AIDS increases slowly, most of them is teenage IDU-s. She said that this is a public health issue, which demands immediate action and welcomed cooperation with NGO-s already dealing with this issue.
Prof.Dr.Viktorija Cucic closed the round table stressing the importance of idea exchange on meetings like this and need for cooperation among local NGO-s in their community as well as with local government on dealing with issues of prostitution.