POLITICAL LEADERSHIP

How can political action keep HIV on top of the politicalagenda?G Andrejevs

European Parliament, Brussels, Belgium

Since 1981 AIDS has killed more than 25 million peopleworld-wide. According to the latest Joint United NationsProgramme on HIV and AIDS (UNAIDS) Epidemic Update,more than 33.2 million people were living with HIV in2007, and 2.5 million people were newly infected in thatyear. The overwhelming majority of people infected withHIV are living in developing countries but, thanks to theinternational community as well as to private foundations,some progress seems to have been made in improving thedire situation of people living in the most affectedcountries.

However, being confronted with such dramatic dataoften leads us to overlook the increasingly worryingsituation across the European Union (EU), where not onlydoes infection with HIV remain a serious health threat butnew HIV diagnoses are actually rising again. This must notsurprise us if we keep in mind that it is estimated by theEuropean Centre for Disease Prevention and Control (ECDC)that 30% of people infected with HIV within the EU areunaware of their serostatus; and people who are unawareof their HIV status are many times more likely tounknowingly spread the virus. This, again, is likely tohave a huge social and economic impact on our society as awhole and healthcare systems in particular.

There are a multitude of factors that have contributed tothe recent rise in new HIV infections within the EU. I wishto highlight some of them: complacency about this diseaseamong young people, an astonishing lack of knowledgeamong the general population regarding the way in whichHIV is transmitted, and a distressing and misguided beliefthat there is a cure for HIV infection. There is not.

So, what is being done within the EU to counteract thesedevelopments?

An important first step is to show political leadership,make people aware of the magnitude of the problem, talkopenly about how one can avoid infection, and encouragepeople to get tested.

There are several initiatives that the EU could beundertaking: the European Commission can allocateresources to prevention measures within the frameworkof the Public Health Action Programme; there are resourcesto allocate from the Seventh Framework Programme onResearch and Development for the development of newinnovative drugs, vaccines and microbicides. In my reporton ‘Combating HIV/AIDS within the European Union andin the neighbouring countries, 2006-2009’ [1], I also askedthe Commission to clearly define rules governing thepossible use of the Structural Funds and the Social Fundsfor HIV/AIDS-related projects; and I am looking forward tothe potential of the Innovative Medicines Initiative for theresearch and development of new innovative drugs.

I wish to emphasize my firm belief that there is a lot wecan do at a European level. An example of what can bedone at this level was the decision by the GermanGovernment to make HIV/AIDS one of the priorities oftheir EU Presidency. Within this framework they organizeda high-level conference in March 2007 in Bremen. Thisinitiative was a prime example of political leadership atEuropean level, especially taking into account the fact thatChancellor Angela Merkel delivered a very straightforwardkeynote speech on this occasion. The Presidency Conclu-sions of the June 2007 European Council in which HIV/AIDS is mentioned can be considered a direct result of thisinitiative. Therein, the Heads of State and Government‘invite the Commission to implement its action plan oncombating HIV/AIDS within the European Union and in theneighbouring countries 2006–2009. . .’. Only to continue:‘It is for the Member States to provide the politicalleadership to fight this pandemic.’

Where does this leave the European Commission and/orthe European Parliament? It is understood that healthpolicy is a matter of subsidiarity – which means that all27 EU Member States are responsible for theirrespective healthcare systems as well as for setting theirown health agenda. This is a logical course of action

Member of the European Parliament, Member of the Committee on theEnvironment, Public Health and Food Safety, European Parliamentrapporteur for the report on ‘Combating HIV/AIDS within the EU and in theneighbouring countries 2006–2009’.

Correspondence: Prof. Georgs Andrejevs, European Parliament, Bat. AltieroSpinelli, 08G318, 60, rue Wiertz/Wiertzstraat 60, B-1047 Bruxelles/Brussels,Belgium. Tel: 1 32 02 28 45548; fax: 1 32 02 28 49548; e-mail:georgs.andrejevs@europarl.europa.eu

DOI: 10.1111/j.1468-1293.2008.00590.xHIV Medicine (2008), 9 (Suppl. 2), 28–29 r 2008 British HIV Association

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considering that every country has to deal with a differentset of problems and concerns. This is especially true forHIV/AIDS, where the characteristics of the most affectedpopulation groups vary immensely between, for instance,the United Kingdom and Estonia. In this regard theconclusion of the Council is correct. But it is my firmbelief that there are several issues that would be betteraddressed at European level, not the least of which ispolitical leadership.

A co-ordinated approach at European level makes senseand in my opinion would be needed to address thedisparities within Europe concerning HIV testing and careas well as to tackle the issue of continuing discriminationand stigma associated with an HIV infection.

As the example of the ECDC shows, surveillance atEuropean level brings added value. Since the beginning ofthis year, the ECDC and the World Health Organization(WHO) Regional Office for Europe are jointly co-ordinatingHIV/AIDS surveillance in the European Region of WHO,which consists of 53 countries. But the ECDC also has torely on the willingness and co-operation of all MemberStates to report their data, because the national bodies arenot obliged to report their findings. For instance, to thisday, there are no national surveillance data from Spain andItaly available to the ECDC.

The ECDC will tackle this issue in its Action Plan over thenext three years, where they intend to address thefollowing: the improvement and better harmonization ofsurveillance in Europe; the scientific evaluation of key

public interventions; the monitoring and evaluation of HIVprevention; and the identification and sharing of goodpractices across all EU Member States. Every one of thesekey issues from the Action Plan will be better addressed atEuropean level than at Member State level.

I would like to conclude with a quote by the formerHealth Commissioner, Markos Kyprianou, who said duringa plenary debate on the topic of HIV/AIDS on 24 April2007: ‘For us it [HIV/AIDS] is a very high priority. It is notjust about a policy or a strategy. It is a question of moralobligation. I believe that the system as a whole has failedour citizens over the past 20 years and it is now time toresume our efforts and correct our mistakes.’

I agree, but what we, as a European Community, stillneed to do is work to deliver on concrete promises. It istime to take action.

Conflict of interest

The author declares no conflict of interest.

Reference

1 European Parliament report on Combating HIV/AIDS within the

European Union and in the neighbouring countries, 2006–2009.

Available at: www.europarl.europa.eu/sides/

getDoc.do?pubRef=-//EP//NonSGML+REPORT+A6-2007-

0091+0+DOC+PDF+V0//EN&language=EN

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r 2008 British HIV Association HIV Medicine (2008) 9 (Suppl. 2), 28–29