Teymur Noori, experto en VIH y salud en el colectivo migrante del European Centre for Disease Prevention and Control (ECDC), intervino ayer en la mesa clínico-epidemiológica para exponer el tema ‘HIV response in the EU: what does the Dublin Declaration tell us?
After almost 15 years since its publication, in what percentage would you say that the indications included in the Dublin Declaration have been met?
We actually see the Dublin declaration as a framework for monitoring the HIV response in Europe and Central Asia. By this, we mean that we have set up an advisory group to help us develop the best possible indicators to monitor the HIV response. As the original Dublin Declaration was adopted in 2004, many of the issues that guide the response (i.e. 90-90-90, TasP, PrEP) weren’t considered back then. Having said this, I think the Dublin Declaration was the first time ‘Universal access to HIV treatment’ was mentioned, which was ground breaking at the time. From this perspective, it is fair to say that this is an objective we have failed to reach in our region. In the latest data I will be presenting, I will show that only about 50% of all people living with HIV in Europe and Central Asia are on treatment, and this is nowhere near ‘universal’. The same can be said about prevention, where the Declaration states that 80% of people at highest risk be covered by essential prevention programmes. This target is not met either when it comes to essential interventions such as needle and syringe, opioid substitution or PrEP programmes. I will be showing data. On the brighter side, we have indeed reached the goal of elimination of mother-to-child HIV transmission, which was defined as less than 2% of all new infections acquired ban an infant from his/her infected mother.
Regarding the document, what have been the main objectives achieved and what are the most outstanding points that still need to be solved?
As mentioned above, the outstanding issue in our region is still related to universal access to prevention, testing and treatment. Too few people are reached with proven effective interventions (i.e. NSP, OST, condoms, PrEP, vaccination, etc.). 1 out of 5 people living with HIV do not know that they are infected and almost 50% of all people diagnosed with HIV are diagnosed late. Way too few people living with HIV are on highly effective anti-retroviral therapy (around 50%) and 3 out of 5 people living with HIV are not virally suppressed. So we have major challenges in our region when it comes to effectively responding to HIV.
Taking into account the evolution of HIV in our environment and the time elapsed since the publication of its objectives, should the Declaration’s objectives be updated?
I think there is a general consensus that we have enough Declarations to sustain the HIV response. In recent years, countries have adopted the Sustainable Development goals, and the Fast-Track Targets to eliminate AIDs by 2030. However, we do lack specific targets for the European region and it is quite clear that the HIV is becoming less of a priority in many countries. From this perspective, political declarations are important to remind our new leaders that HIV is still a critical public health issue in our region.
Throughout these almost 15 years of Declaration, how the EU countries have been involved in reaching the objectives? Which countries would you highlight both positively and negatively? If possible, could you explain Spain’s involvement?
Since the adoption of the Dublin Declaration in 2004, countries have played a significant role in monitoring responses according the agreed monitoring framework which is led by ECDC. The European Commission has also adopted three separate Commission Communications and Action Plans on HIV/AIDS and directed funding toward regional projects and Joint Actions. In terms of countries which have responded positively, I think we can see a range of countries that have responded very effectively. In more recent years, we have started to see declines in HIV incidence in some capital cities across Western Europe (i.e. London, Amsterdam, Paris, etc.). Some countries (i.e. Austria, Denmark, France, Netherlands, Sweden, United Kingdom) have already reached the 90-90-90 targets a few years prior to 2020. In other countries (i.e. Russia, Ukraine, Bulgaria, Moldova), major challenges remain.
If we look at of the response offered by the EU countries in recent years and the progress that is being made in HIV research, do you foresee that the eradication of the virus can be achieved in the next decade? What concrete steps should be taken to achieve it?
I think it depends on what the definition of eradication is. I do think we will see more and more people on HIV treatment as treatment policies are being implemented. As a consequence, we will see more and more people reaching viral suppression, which in turn means they will not be able to spread the HIV virus. However, it is quite clear that there are major disparities in HIV treatment and viral suppression in the wider European and Central Asian region. I do fear that these disparities will continue to grow, where treatment coverage and viral suppression will be attainable for more and more people in the West of our region, but that we will continue to see little improvement in the Eastern part of the region. This will lead to even greater disparities and for this reason, we cannot not let the HIV response fall into a sense of false security. So many people are currently not being reach with essential services, including services related to prevention and treatment. Until we have reached the vast majority of people with these services, we will not be able to control the HIV epidemic in the next decade.