Speech – Welcome speech at the Ministerial Policy Dialogue on HIV and related comorbidities in eastern Europe and central Asia

Amsterdam, Netherlands, 23 July 2018, by Dr Zsuzsanna Jakab WHO Regional Director for Europe

Honourable ministers, partners, and civil society representatives,

Ladies and gentlemen,

I warmly welcome you to this Ministerial Policy Dialogue on HIV and related comorbidities in eastern Europe and central Asia. We have organized this meeting jointly with the Government of the Netherlands and UNAIDS back-to-back with the 22nd International AIDS Conference. We take the opportunity to put Europe in the spotlight while global communities of experts, policy-makers and people affected by HIV gather here in Amsterdam this week.

Why is this so urgent? The WHO European Region is the only region worldwide where the number of new HIV infections is rising. For several consecutive years we have recorded the highest-ever number of new cases. The eastern part of the Region hosts almost 80% of these new HIV infections.

An important milestone in addressing this major challenge took place two years ago, when you, the ministers of health, unanimously endorsed the Action Plan for the Health Sector Response to HIV in the WHO European Region, during the 66th Regional Committee for Europe. The implementation of this plan represents your enhanced commitment to reach the 90-90-90 targets through quality HIV prevention, detection, treatment and care accessible and affordable to all.

Let’s look at progress and setbacks.

I will start with “prevention”. Injecting drug use is among the key modes of HIV transmission in our Region. To prevent it, we need countries to scale up comprehensive harm reduction policies and interventions – which is happening in 124 countries worldwide. Moreover, we need to raise public awareness throughout the whole population so that people prioritize protective measures and are conscious of their sexual and reproductive health rights.

As for the three 90 targets:

  • The first target is about detection, namely ensuring that 90% of the people living with HIV know their status. In eastern Europe and central Asia, one quarter of people living with HIV are not aware of their infection and over half of those detected are diagnosed late. This means that treatment is delayed, AIDS-related diseases and deaths increase, and the risk of ongoing HIV transmission rises. This is despite the fact that we have effective tools that can help us reach this important first target, including innovative testing strategies such as community-based testing and HIV self-testing.
  • As for the second target – namely, providing treatment to at least 90% of those diagnosed with HIV – this is currently where we see the biggest challenge in our Region. In eastern Europe and central Asia, half of those diagnosed with HIV and only one third of the estimated number of people living with HIV have access to treatment. This means that we need to do much more to ensure that all those diagnosed with HIV have early access to life-saving treatment, regardless of the stage of infection. To this end, we should ground our efforts in recent achievements. This Region has reached over 95% HIV treatment coverage in pregnant women. Since 2016, three countries in eastern Europe have validated the elimination of mother-to-child transmission of HIV and syphilis, and others may soon qualify for this same milestone.
  • And finally, many countries in the Region are working hard to reach the third target of ensuring that 90% of all people who receive antiretroviral therapy have viral suppression. The good news is that once people have been diagnosed and initiate treatment, four out of five achieve viral suppression. This means a lot in terms of stopping the HIV epidemic as recent evidence shows that people who achieve and maintain an undetectable viral load have no risk of sexually transmitting the virus to an HIV-negative partner. Many more countries have recently revised their treatment policies to encourage all people living with HIV to initiate and adhere to successful treatment regimens, as well as ensuring timely monitoring of treatment outcomes.

Ladies and gentlemen,

HIV infection and coinfections, such as tuberculosis and viral hepatitis, are linked to various determinants and continue to affect our people, particularly the most vulnerable. In this context, WHO has been leading an interagency effort in Europe and central Asia to finalize a UN “common position paper”. This paper – the first of its kind – provides a platform for catalysing multisectoral efforts, and commits all 14 participating UN agencies to work together to help end AIDS, tuberculosis and viral hepatitis.

In the spirit of effective collaboration, let me also express my sincere gratitude to all countries and partners who submitted their good practices, which are now included in the Compendium of good practices for the health sector response to HIV in the WHO European Region.

Ladies and gentlemen,

2018 is an important year, with the 40th anniversary of the Alma-Ata Declaration on Primary Health Care, the first ever UN General Assembly High-level Meeting on Ending Tuberculosis, and the third UN General Assembly High-level Meeting on Noncommunicable Diseases. These events are excellent opportunities to leverage health as a political choice by heads of State, and to ensure adequate resources for, and commitment to, integrated care within the framework of reforming and strengthening health systems.

The time to accelerate our efforts is now. We have done much; we have not done it all. When evidence-based approaches exist to reverse the course of the HIV epidemic in our Region, we cannot afford to do “business as usual”. If we want to achieve the 90-90-90 targets, we need urgent collective action in line with universal health coverage, the Health 2020 European health policy framework and the 2030 Agenda for Sustainable Development. We will never be able to attain the SDGs if we do not manage to reverse the incidence of HIV and curb the HIV epidemic.

Today’s ministerial meeting is one step forward in facilitating the exchange of experiences on removing health system barriers, addressing legal frameworks and putting a human face to HIV. Together with partners, my teams in the Regional Office and in country offices remain fully committed to supporting you in accelerating your efforts to end AIDS by 2030.

Let’s make this meeting a historical turning point that will drastically shift our response to HIV. I trust that we can, and I look forward to a very fruitful dialogue with you and all partners today and in the near future.

Thank you.