HIV in Eastern Europe – Time for action!

HIV infection rates are rising, therapy coverage is low, international funding is decreasing: Our chairwoman Sylvia Urban about HIV in Eastern Europe

Speech by Sylvia Urban, Chairwoman Action against AIDS Germany and Chairwoman Deutsche AIDS-Hilfe, held at the press briefing of the conference „HIV in Eastern Europe – The unnoticed epidemic?!“ in Berlin, 17.10.2017

Good morning everybody. And a very warm welcome to all of you. We are happy that so many of you are interested in the topic of today’s conference. Because “HIV in Eastern Europe” is something that should concern everybody very urgently.

Because you can’t really say it any other way: What is happening in the region right now is a catastrophe. The number of newly infected with HIV and the number of patients dying is continuously rising, treatment coverage rates are far too low, prevention measures are flat out failing and funding for the fight against HIV and AIDS is being cut again and again.   

Russia – the country in the region that has been hit the worst – has, for the first time, seen more than 100.000 newly infected in the last year alone.

To put that number in context: Germany has seen 3.200 new infections in the same time frame. While Russia has not even twice as many inhabitans. So you can imagine what a number like that means for a country and its people.     

Our colleague Vadim Pokrovsky will tell us more about that in a few minutes. We are very happy, that he is here today. Thank you, Mr. Pokrovsky. 

The rise in HIV infections – and yes, also in people dying of AIDS in the region – is so alarming, because it goes against every international trend: Since the year 2000 the number of new infections worldwide has been lowered by a third and the number of people dying has been cut in half in the last ten years alone. AIDS and dying from AIDS are preventable everywhere in 2017.     

The reasons for these great improvements are obvious: More and better prevention measures, more HIV-testing and the steadily increasing number of people receiving treatment. HIV-therapy not only keeps patients healthy, but also prevents HIV-transmissions, and is so doing its part in lowering the number of new infections.

But in Eastern Europe, little of that is true. I can see three main reasons for that:

• Firstly: The people who would have most to gain from successful prevention are not being reached by it. Instead they are being marginalized and often persecuted. Intravenous drug users have no access to drug substitution therapy, clean needles or even information about safer use. All of that could and would minimize the impact that HIV and other infections have in this group. Because those measures do not only prevent HIV-infections, but also the transmission of hepatitis. Why is there so much pushback against this, when it is so obvious?
   
• Secondly: Sexuality - especially homosexuality – is not being talked about, for so called “moral” reasons. People who cannot be addressed, cannot be supported by or even be reached by HIV-prevention. It is forced to fail.
   
• The third reason for the catastrophe: The monetary basis for the international fight against HIV and AIDS is eroding. The World Bank classifies more and more countries as being “Middle-Income” and thus forces those countries, to finance a bigger part of their national HIV-prevention themselves, even though the financial situation in those countries has not changed for the better compared to a few years ago. In addition to that the political situation has gotten more and more difficult in many of them. Civil society organizations that receive international funding are facing enormous difficulties. In Russia, for example, they have to register as “foreign agents”.

The outcome of all of this: civil engagement and the ability of communities to help themselves are being completely undermined.

Which is especially concerning, because one of the most important experiences in the 30 year long fight against HIV and AIDS is this: Those communities are our biggest resource. Everyone who ignores them, looses. Everyone who treats them as partners, wins.   

So, the lesson here is a very simple one:

People who use drugs, men who have sex with men and sexworkers of all genders are not the problem, but part of the solution!

There is no alternative to including them and their actual needs in HIV-prevention and treatment strategies in Eastern Europe, if those strategies are to be successful. Germanys very own HIV-prevention programs can be used as a blueprint here: When the government works with communities and partners with civil society organizations, the results are great. Germany’s HIV prevention is very successful.

That’s why it is also important that the German government does more to make the same successes possible in countries in Eastern Europe. Our own experience with strategies of inclusion should teach us as much.

So we don’t understand why such a strategy has not been developed by the German government already. And why is it, that Eastern Europe is hardly mentioned in the German strategy BIS2030 for HIV, hepatitis and STIs? The Federal Ministry for Economic Cooperation and Development and the Society for International Cooperation (GIZ) are not engaged enough in Eastern Europe. That quickly needs to change!

For humanitarian reasons, as well as for the simple fact that epidemics don’t care about borders, they can’t be contained in one region. The Robert Koch Institute has confirmed: The situation in Eastern Europe already influences the number of infections in Germany. The influence is slight, and mostly connected to drug users and their partners, that much is true for the moment. But men who have sex with men are a highly mobile community and it is only a matter of time, until the situation in Eastern Europe has more influence on them as well. We also know: All of humanity is on the move and keeps on being so. 

Our experiences with tuberculosis in Eastern Europe have also taught us the following: Insufficient treatment and inadequate support of treatment lead to the development and transmission of resistant strains. If that happens with HIV, and the chances for that happening daily get bigger, the results would be extremely problematic.  

More people infected and more people dying. Failing prevention. Ignorance and discrimination towards communities whose participation in prevention is vital. And less money, when we need more. Sounds depressing, doesn‘t it? 

But, it doesn’t have to be. Our conference wants to be the starting point to changing all of that. We want to show: We already know, what needs to be done. We already know, what works. Because it already works in Germany and many other countries. And it can also work in Eastern Europe.

UNAIDS wants to put a stop to AIDS by 2030, within the next 13 years. We german overachievers want to get there by 2020 already. The Deutsche AIDS-Hilfe has designed it’s campaign „No AIDS for anybody!“ with exactly that goal in mind.

So how can we accept, that Eastern Europe seems to move backwards? How can we accept the rising number of infections and that more and more people in that region have AIDS, when we could prevent all of it?

How exactly it can be prevented, how to transfer successful strategies to the region and how we all can work together in achieving that, that’s what we want to discuss during this conference.

In the end, the most important thing that is needed for us to be successful is the political will, to let us be successful. That’s why it also is an important signal that so many people from so many different parts Europe have come together here today.

Thank you very much.