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Reaching the "Invisible" Lital Hollander EATG CREAThE [email protected] Centres for REproductive Assistance Techniques in hiv in Europe Vito Russo, AIDS activist, 1988

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Reaching the "Invisible"

Lital Hollander



[email protected]

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Vito Russo, AIDS activist, 1988 Europe

“Living with AIDS is like living through a war which is happening only for those people who happen to be in the trenches. Every time a shell explodes, you look around and you discover that you've lost more of your friends, but nobody else notices. It isn't happening to them.”

True to this day!

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  • Scarce empowerment. No political “lever”

  • Vulnerable

  • Political /management inconvenient truths

  • Ethical “dilemmas” and moral taboos

  • Stigma and prejudice

  • Do not make headlines

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EuropeInvisible” HIV groups

  • IV drug users

  • Sexual partners of PLWHA

  • Immigrants / ethnic minorities / migrating groups

  • Sex worker

  • Trafficked persons

  • Young children

  • Gay & Lesbian

  • Prison inmates

  • Geographical groups (Russian federation, Iran, China)

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“Invisibility points” Europe

HIV information

Prevention interventions / budgets

Access to sexual / reproductive health services

Social support

Access to antiretroviral treatment

Access to clinical trials

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Our Interventions… Europe

  • Information targeted to “invisible” groups

  • Patient education tools (website, printed)

  • Information HC workers, public

  • Civil society / NGO training

  • Advocacy / lobbying vs. authorities

  • Political pressure

  • Debate with pharma companies

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Sex/life partners of individuals with HIV Europe

  • Approx 80% of PLWHA worldwide are heterosexuals in reproductive age

  • Prevention policies are based on abstinence and condom use with no solution for reproduction

  • High risk of intramarital HIV transmission

  • 38%-75% of spouses are infected by their partner (Portugal, India)

  • Limited ability to refuse unprotected sex to conceive

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Sperm washing works Europe

  • Retrospective CREAThE study

  • 3390 treatment cycles

  • 1036 HIV discordant couples

  • Not a single case of infection

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… but outside Europe? Europe

  • US: 1990 - one case of transmission after an IUI with simple semen centrifugation (no separation of leukocytes). CDC recommendation against. Not available

  • South America, South East Asia, Africa – largely not available

Do we think we can actually TELL 20 milion people not to have children?

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Non European patients receiving treatment in Italy Europe

  • USA

  • Brazil

  • Israel

  • Tahiti

  • South Africa

  • Russia

  • Kuwait

  • Japan

  • India

  • Honduras

  • Australia

  • Venezuela

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CREAThE activities for 2008 Europe

  • Website – 1 December 2007

  • SHARE – studying HIV and reproduction in Europe

  • Training of non European health care professionals

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SHARE – Studying HIV And Reproduction in Europe Europe

  • European register of reproductive practices in couples with HIV (assisted reproduction, spontaneous conception)

  • Prospective cohort study

  • Over 12 centres involved

  • Covers Europe, US, Israel, South Africa

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EATG activities with EE citizens - information Europe

  • COPE – Continuing Patient Education – translation of information

  • Organized informative events

    • Patient oriented symposium Glasgow conference

    • Sitges symposium “Research Agenda and Access to Experimental HCV Drugs for HIV/HCV Co-infected Peopleù”

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EATG – Education / training Europe

  • Ttreatment literacy training for Central European Activists

  • Training on clinical trials for Russian activists: basics of clinical trials design - scientific and ethical aspects

  • Regional efforts for universal access to treatment.

  • Joint EATG/EE activists meeting with pharmaceutical companies to discuss access, pricing policies, registration

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EATG – advocacy / lobbying Europe

  • Close follow up of EU presidency agenda

  • In anticipation of the Portuguese EU presidency, who will focus on migrants – organization of a onference on Migrants Health Rights in Lisbon

  • Civil Society Forum – inclusion of EE NGOs

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EATG - political pressure Europe

  • Russian Minister of Healthcare and Social Development: shortcomings in the standard of HIV care

  • Chair of the Commission on Narcotic Drugs and UNODC: NGOs ban from 50th Narcotic Drugs Commission annual session

  • Open letter on discriminatory statements of Ukrainian officials against gay, bisexual and transgender people

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Conclusion Europe

  • Even in Europe, invisible groups suffer neglect

  • NGO and comunication means focus.

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Prison Inmates Europe

  • Characteristics

    • High prevalence of HIV infection (Portugal 11%, Estonia 12%, Russian federation 4%)

    • High rates of drug use (between 22% and 86% in 15 European countries).

    • Common sexual activity (30% of inmates in a Federal Bureau of Prisons study)

    • High frequency of homosexual rape (9-20% of US federal inmates were victims of rape)

  • Problems:

    • cohersive testing

    • Inexistent o lacking prevention/harm reduction programs

    • Stigma / discrimination HIV positive inmates

    • Insufficient access to treatment and care

    • Forced inclusion in research

    • DOT

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Prison inmates - solutions Europe

Recognize that many drug users cannot totally abstain from psychoactive substances in the short term

Information, education and communication on HIV/AIDS

Voluntary testing and counselin

Distribution of condoms

Bleach or other disinfectants

Exchange of needles and syringes

Substitution therapy

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Trafficked women / girls Europe

Frequent and forced sex + untreated STDs

High HIV prevalence (25-70% among rescued women/girls), proportional to time in brothel captivity (each month increases risk by 3-4%)

No power to negotiate safe sex

Detainment / deportation of trafficking victims

Profiling as perpetrators of the epidemic rather than the victims

Imposed medical care to “protect the community”

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Trafficked women/girls Europe

Teaching negotiation and refusal skills to victims

Reporting and direct intervention efforts to facilitate removal

Victim oriented health services including medical assistance, protection from violence, social support, counseling, substance abuse treatment

Education, and job training

Housing/job solutions for victims shunned from returninghome