Communication from the Commission to the Council and the European Parliament on combating HIV/AIDS within the European Union and in the neighbouring countries, 2006-2009
Date: 2005-12-15
Institutions: European Commission
Subjects: AIDS, EU Member State, action programme, disease prevention, frontier region, health policy, infectious disease

COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 15.12.2005 
COM(2005) 654 final 

COMMUNICATION FROM THE COMMISSION 
TO THE COUNCIL AND THE EUROPEAN PARLIAMENT 

on combating HIV/AIDS within the European Union and in the neighbouring countries, 
2006-2009 

EN 

   EN 

 
 
 
  
COMMUNICATION FROM THE COMMISSION 
TO THE COUNCIL AND THE EUROPEAN PARLIAMENT 

on combating HIV/AIDS within the European Union and in the neighbouring countries, 
2006-2009 

1. 

INTRODUCTION 

This communication builds on the principles and priorities set out in the Commission 
working  paper  “Coordinated  and  integrated  approach  to  combat  HIV/AIDS  within 
the European Union and in its neighbourhood” and sets out the main lines for action 
until the end of 2009. A more detailed action plan for the present phase is included in 
the Annex. Many of these activities have to be completed with partners and require 
the  close  involvement  of  players  within  Member  States.  This  document  brings 
together  the  relevant  EU  policies  and  instruments  available,  which  play  a  role  in 
combating  HIV/AIDS.  Concerning  external  action,  this  Communication  is  fully 
consistent with and contributes to implementing the overall policy frameworki 

HIV/AIDS strategies are closely linked to strengthening the general European values 
on  human  security  and  the  protection  of  human  rights,  including  sexual  and 
reproductive rights, the rights of minorities and the fundamental rights of migrants, 
refugees and displaced persons. 

In  this  document  the  overall  aims  stated  in  the  thematic  chapters  (Chapters  2  to  6) 
reflect the commitments made in the UNGASSii, Dublin and Vilniusiii Declarations. 
Chapter 7 explores the possibilities to enhance implementation of HIV/AIDS policies 
in  Russia  and  the  area  covered  by  the  European  Neighbourhood  Policy.iv.  The  last 
chapter (Chapter 8) outlines the commitments ahead for all the partners and describes 
the possibilities for monitoring progress. 

The state of the HIV/AIDS epidemic in Europe and the Mediterranean area is shown 
in  Figure  1.  Fuller  details  on  the  evolution  of  the  epidemic  can  be  found  on 
www.eurohiv.org. 

EN 

2 

   EN 

 
The  Commission  is  concerned  about  the  diminished  focus  on  prevention,  which 
remains the cornerstone for all other activities within the comprehensive approach to 
tackle HIV/AIDS. Without vigorous promotion of primary prevention measures, like 
education, the use of condoms and implementation of harm reduction measures (such 
as exchange of needles and syringes), any other targets set (such as the elimination of 
mother-to-child  transmission  or  universal  access  to  treatment)  cannot  be  achieved. 
The  other  areas  of  action  which  need  strengthening  are  human  rights  issues, 
surveillance, and actions targeted at specific vulnerable groupsv. 

Providing  political  leadership  and  advocacy  is  the  main  value  added  of  the  EU 
activities  on  HIV/AIDS.  The  Commission  will  continue  to  keep  HIV/AIDS  and 
related issues on the wide political agenda and provide leadership to combat stigma 
and  discrimination,  and  promote  the  provision  of  universal  access  to  prevention 
services,  ARV  treatment  and  harm  reduction  services  for  injecting  drug  users. 
Coordination, facilitating the development of a common knowledge base, provision 
of  common  tools  for  decision-making  and  additional  funds  to  support  national 
activities  and  research  and  development  programmes  in  this  field  are  other  areas 
where joint action at EU/European level can add value to the work done elsewhere.  

2. 

INVOLVEMENT OF CIVIL SOCIETY  

The aim is to strengthen the involvement of civil society in all aspects of the response 
to  the  epidemic,  including  policy  development,  implementation,  monitoring,  and 
evaluation.  

********** 

Since  Dublin  the  Commission  has  involved  civil  societyvi  organisations  in  the 
HIV/AIDS  Think  Tank,  which  has  now  established  a  HIV/AIDS  Civil  Society 

EN 

3 

   EN 

 
 
Forum which met for the first time in September 2005. This is an informal working 
group  to  facilitate  the  participation  of  non-governmental  organisations,  including 
those  representing  people  living  with  HIV/AIDS,  in  policy  development  and 
implementation  and  in  information  exchange  activities.  The  Forum  includes  30 
organisations from all over Europe representing different fields of activity. 

Action 

The  Commission  will  actively  involve  civil  society,  and  in  particular  people  living 
with  HIV/AIDS,  in  policy  development,  implementation  and  monitoring.  The 
Commission invites regional and national authorities to facilitate the sustainability of 
the non-governmental and community-based organisationsvii and their involvement in 
policy development, implementation, and monitoring both within the EU and in other 
European countries.  

Partnership with the private sector 

is  already  having  an 

For  many  businesses  HIV/AIDS 
their 
competitiveness.  For  others  the  potential  risks  are  significant  no  matter  whether 
HIV/AIDS prevalence is high or low. According to a survey conducted by the World 
Economic  Forumviii  in  2004,  10%  of  executives  in  Western  Europe  believe  that 
HIV/AIDS  will  have  some  impact  on  their  business,  compared  to  19%  in  Eastern 
Europe. 

impact  on 

The  Commission  has  established  partnerships  with  the  Alliance  for  Microbicide 
Development  and  Global  HIV  Vaccine  Enterprise  and  has  initiated  collaboration 
with the Global Business Coalition, the pharmaceutical industry and other supportive 
businesses  in  order  to  define  areas  where  they  could  work  together  to  combat 
HIV/AIDS. 

Action 

The Commission invites European businesses through the Union des Industries de la 
Communauté Européenne1ix (UNICE) and other means, to strengthen their response 
to the epidemic and to play their role in implementing this strategy. 

3. 

SURVEILLANCE 

The aim is: 

•  to improve and harmonise surveillance systems to track and monitor the epidemic, 

risk behaviour and vulnerability to HIV/AIDS; 

•  to  contribute  to  the  provision  of  incidence  and  prevalence  data  and  information 
on other sexually transmitted infections, hepatitis C, hepatitis B and tuberculosis, 
particularly amongst those at the highest risk and most vulnerable; 

•  to support surveillance of HIV testing. 

EN 

********** 

4 

   EN 

 
Surveillance  of  HIV/AIDS  in  Europe  is  currently  coordinated  by  the  EuroHIVx 
surveillance  network  which  is  co-financed  by  the  European  Commission  under  the 
Public Health Programmexi. In 2008 the European Centre for Disease Prevention and 
Control  (ECDC)xii  will  take  responsibility  for  the  network.  As  one  of  the  ECDC’s 
tasks  is  to  operate  the  surveillance  networks  in  an  integrated  way,  overlaps  and 
synergies  between  surveillance  of  HIV,  tuberculosis,  other  sexually  transmitted 
infections (STIs) and hepatitis B (HBV) and hepatitis C (HCV) will be addressed.  

HIV case reporting has evolved into the key instrument for monitoring the epidemic 
in Europe. It is therefore crucial to have data from all European countries, which is 
not the case at the moment. Better strategies and more targeted measures need better 
information on the behavioural risk factors, like condom use or exchanges of needles 
and  syringes.  In  countries  with  low  HIV  prevalence,  surveillance  should  also  be 
organised  in  a  way  to  detect  early  signs  of  the  entry  of  HIV  into  the  population 
groups more exposed to risk of infection. To help plan future treatment and service 
needs, the true number of new HIV infections per year [HIV incidence] should also 
be  known.  At  the  moment  the  majority  of  the  newly  reported  cases  are  in  fact 
infections contracted many years ago. 

The  capacity  for  monitoring  the  susceptibility  of  HIV  to  ARV  drugs  should  be 
developed into an integral part of HIV surveillance at national and European level. 

Action  

The  Commission  will  promote  surveillance  as  an  important  basis  for  any  strategies 
and policies to combat HIV/AIDS. 

The Commission will support, through existing structuresxiii, collection and analysis 
of  susceptibility  data  and,  to  this  end,  facilitate  use  of  the  existing  EU  financial 
instruments. 

Member  States  should  ensure  the  availability  of  resources  [human,  financial, 
equipment]  and  capability  to  achieve  this  and,  to  this  end,  consider  use  of  the  EU 
financial instruments. 

The  Commission  will,  in  close  collaboration  with  the  ECDC,  Member  States, 
neighbouring countries and other partners: 

•  facilitate completion of the geographic coverage of HIV case reporting;  

•  reassess  the  objectives  of  AIDS  surveillance  and  include  its  reporting  in  an 

integrated surveillance system; 

•  design a standardised approach for appropriate prevention indicators; 

•  develop estimates of HIV incidence in Europe; 
•  facilitate the setting-up of sentinel surveillance xiv in high-risk groups; 

•  facilitate  implementation  of  practical  solutions  to  address  the  confidentiality 

obstacles. 

EN 

5 

   EN 

 
4. 

PREVENTION OF NEW HIV INFECTIONS  

The aim is: 

•  to  facilitate  the  implementation  of  population-wide  and  targeted  HIV  prevention 

measures; 

•  to  ensure  that  all  citizens  have  access  to  information,  education  and  services  to 

reduce their vulnerability to HIV/AIDS; 

•  to scale up access to prevention, drug dependence treatment and harm reduction 

services for injecting drug users;  

•  to  address  the  specific  needs  and  requirements  of  migrant  populations  for  non-
discriminating access to information and prevention, treatment, care and support; 

•  to support the monitoring and evaluation of prevention methods. 

********** 

As  there  is  no  vaccine  or  curative  treatment,  prevention  remains  the  cornerstone  in 
the fight against HIV/AIDS. Wide implementation of primary prevention activities, 
education, promotion of condom use, implementation of harm reduction services and 
access  to  voluntary  counselling  and  testing  are  imperative  in  order  to  attain  the 
targets set in other areas. There is evidence from many European countries that the 
spread of HIV can be prevented, curbed or reversed through the implementation of 
proven, evidence-based intervention. 

Based on HIV epidemiology within the EU and in neighbouring countries there is a 
need  for  intensified  prevention  measures  for  the  general  public,  and  targeted  at 
specific groups such as youth, women, injecting drug users, men who have sex with 
men, commercial sex workers, prisoners, and migrant populations.  

It is estimated that comprehensive HIV prevention measures could avert 63% of the 
45 million new infections expected to occur between 2002 and 2010 globallyxv. 

While  the  numbers  of  people  living  with  HIV/AIDS  grow  every  year,  prevention 
services are not growing at the same rate. According to United Nations estimatesxvi 
there are currently 13 million regular injecting drug users (IDU) worldwide, and in 
Russia alone an estimated 1.5 millionxvii - more than 11% of the worldwide estimate. 
Moreover,  according  to  recent  reportsxviii  7.6%  of  IDUs  in  Eastern  Europe  have 
access to harm reduction programmes. 

Prevention  is  closely  linked  with  treatment,  as  greater  access  to  ARV  treatment 
reinforces HIV prevention through increased voluntary counselling and testing. This 
in turn contributes to reducing stigma and discrimination, which are still barriers to 
success. Another hindrance for success can be the effectiveness and overall quality of 
existing prevention programmes, which are still poorly evaluated and monitored. 

The  prevention  of  mother-to-child  transmission  remains  one  of  the  priorities  for 
action.  After  the  Vilnius  Conferencexix  the  Commission  has  consulted  relevant 

EN 

6 

   EN 

 
stakeholders  and  experts  on  the  issue  and  will  continue  to  define  the  areas  where 
action at EU-level is needed. 

Action  

The  Commission  will  promote  the  implementation  of  comprehensive  prevention 
programmes and their expansion to reach the most vulnerable populations. 

The  Commission  will  give  priority  in  work  on  sexual  and  reproductive  health  to 
developing  innovative  strategies  to  promote  safe  sex  and  to  address  the  increase  in 
risk-taking behaviour among young people within the Public Health Programme. 

The  Commission  will  prepare  a  situation  report  on  mother-to-child  transmission  in 
Europe. The need for future action will be assessed on this basis. 

4.1 Reduction of health-related harm associated with drug dependence  

The Council adopted the EU Drug Strategy for 2005-2012 in December 2004 and an 
EU  Drugs  Action  Planxx  for  2005-2008  implementing  the  Strategy  in  June  2005. 
Prevention of HIV/AIDS is a central issue in the Drugs Action Plan, which calls for 
integrated  comprehensive  programmes  to  be  implemented  at  national  and  regional 
levels.  

EU  drugs  policies  should  be  implemented  in  line  with  the  policy  on  HIV/AIDS. 
Synergies can be found, for example, in the area of research, where the Drugs Action 
Plan  calls  for  research  on  effective  intervention  to  prevent  HIV/AIDS  and  research 
on  identifying  protective  factors  in  countries  with  low  HIV/AIDS  prevalence  rates 
among drug users. 

The  Commission  will  prepare  a  progress  report  on  implementation  of  the  2003 
Council  Recommendation  on  the  prevention  and  reduction  of  health-related  harm 
associated  with  drug  dependencexxi.  The  need  for  future  action  will  be  assessed  on 
the basis of this report. 

Action 

The Commission invites the Member States to improve the availability of and access 
to  harm  reduction  services  in  order  to  prevent  health  risks  related  to  drug  use  and 
drug-related deaths.  

The Commission invites the Member States to ensure the availability of substitution 
treatment corresponding to the demand for treatment. 

4.2 Education  

Prevention of HIV and other sexually transmitted infections (STIs) is possible only if 
the  knowledge  is  combined  with  healthy  behavioural  change.  Therefore  it  is  of 
utmost  importance  to  include  schools  and  other  educational  settings  in  HIV/AIDS 
prevention through their life skills health education programmes. Schools and other 
educational settings can also help reducing the stigma and discrimination attached to 
HIV/AIDS.  

EN 

7 

   EN 

 
 
Action 

The Commission will promote the development of tailor-made training curricula for 
health  care  personnel  and  other  professionals  involved  in  services  dealing  with 
people living with HIV/AIDS and with populations that are particularly vulnerable to 
HIV/AIDS (including intravenous drug users and migrants). 

The  Commission  will  facilitate  implementation  of  the  skills-based  approach  to 
promote  effective  behaviour  change  among  youth  in  schools  and  other  appropriate 
settings through the exchange of information and best practices and development of 
training modules. 

5. 

VOLUNTARY COUNSELLING AND TESTING, TREATMENT, CARE AND SUPPORT  

The aim is:  

•  to  combat  stigma  and  discrimination  against  people  living  with  HIV/AIDS  in 

Europe; 

•  to support the provision of universal access to effective, affordable and equitable 

treatment and care, including safe antiretroviral treatment; 

•  to support the promotion of social and labour market integration for those living 

with HIV/AIDS. 

********** 

Affordable  and  accessible  services  and  good  treatment  results  reduce  stigma  and 
social  exclusion  and  promote  responsible  sexual  behaviour  which,  in  turn, 
contributes to preventing the spread of HIV. 

There  is  a  need  for  a  comprehensive  set  of  health  services  to  provide  good  quality 
treatment and care. Voluntary counselling and testing (VCT) is a cornerstone for all 
services  as  it  allows  early  diagnosis  of  HIV  infection  and  ensures  timely  access  to 
appropriate  intervention  for  the  infected.  These  services  should  also  cover  people 
living  with  HIV/AIDS  (PLWHA)  with  hepatitis  B,  hepatitis  C  or  tuberculosis  co-
infection. Drug substitution therapy for injecting drug users (IDUs) is an important 
component of services contributing to effective treatment and care. 

PLWHA  should  play  an  active  role  in  managing  their  condition  (treatment 
preparedness).  The  services  provided  should  be  supportive, 
inclusive  and 
empowering, giving  people more control over their lives.  Social services should  be 
integrated  with  health  services  to  the  extent  possible  and  should  be  sensitive  to 
special vulnerable groups. 

Highly  active  antiretroviral  therapy  (HAART)  makes  a  significant  impact  on  the 
quality  of  life  of  PLWHA.  Successful  use  of  HAART  also  implies  considerable 
efforts  to  maintain  adherence  to  lifelong  treatment  plus  resources  to  monitor 
response, drug toxicities and interactions. In several countries the lack of experienced 

EN 

8 

   EN 

 
service providers to reach certain vulnerable groups, such as injecting drug users and 
migrant populations, can further complicate management of treatment. 

As  the  virus  has  the  capability  to  develop  resistance  to  antiretroviral  agents,  it  is 
increasingly  important  to  monitor  the  development  of  resistant  strains.  Insufficient 
laboratory capacity can be an obstacle to producing relevant susceptibility data. 

Action 

The Commission will support capacity-building among service providers. Priority will 
be  given  to  the  development  of  tailor-made  training  curricula  for  health-care 
personnel  and  other  professionals  involved  in  services  dealing  with  people  living 
with HIV/AIDS and with populations that are particularly vulnerable to HIV/AIDS. 

The  Commission  will  support  Member  States  in  building  up  capacity  in  the  non-
governmental  organisations  active  in  the  field  of  HIV/AIDS  to  provide  treatment 
counselling and support for better treatment preparedness. 

The  Commission  will  facilitate  the  development  of  HIV/AIDS  surveillance  at 
European  level  in  order  to  include  specific  data  sets  on  service  use  and  treatment 
outcome. 

The Commission will facilitate the development of a toolkit for the Member States 
providing a set of possible European models for comprehensive HIV/AIDS services. 
This toolkit could be made available to European Neighbourhood Policy partnersxxii. 

The Commission will support the efforts of the Member States concerned to ensure 
the  availability  of  affordable  ARV.  Moreover,  the  Commission  will  study  further 
possibilities  for  use  in  case  of  a  public  health  emergency,  such  as  a  serious 
HIV/AIDS epidemic. 

6. 

HIV/AIDS RESEARCH  

The aim is: 

•  to  increase  commitments  to  research  and  development  for  vaccines  and 

microbicides; 

•  to  invest  in  development  of  affordable  and  easier-to-use  therapeutics  and 

diagnostics to support expanded access to treatment; 

•  to support research driven by public health needs; 

•  to  support  the  private  sector  (the  small  and  medium  –sized  enterprises  in 

particular) involvement and participation; 

•  to  support  the  development  of  research  into  and  evaluation  of  behavioural 

preventive methods.  

EN 

********** 

9 

   EN 

 
Under  the  Sixth  Framework  Programme  for  research  and  development  activities 
(FP6, 2002-2006), research on HIV/AIDS has become a top priority for the European 
Commission.  Approximately  EUR  50  million  per  year  is  allocated  to  this  topic, 
financing  both  preventive  and  therapeutic  approaches.  Projects  funded  include  big 
consortia, aimed at integrating and networking researchers working on new products 
to prevent and treat HIV/AIDS, and highly innovative approaches and more focussed 
research to develop new concepts for fighting the virus.  

FP6  puts  emphasis  on  the  new  Member  States  and  the  Eastern  European 
neighbouring countries, encouraging them to participate both in EC-funded proposals 
and  in  the  evaluation  process.  One  example  involving  them  is  the  coordination  of 
cohort  studiesxxiii  on  treatment  and  follow-up  of  HIV-infected  adults,  children  and 
pregnant women, HIV resistance and mother-to-child transmission. Another example 
is a Network of Excellence (NoE-new instrument under FP6) on therapeutic clinical 
trials,  where  participation  by  new  Member  States  and  Eastern  European 
neighbouring countries is particularly encouraged. The network is expected to cover 
the  period  2006-2010  and  will  aim  at  designing,  standardising  and  coordinating 
clinical trials on HIV/AIDS at European level. The goal of the network should be to 
define  optimum  strategies  for  management  of  HIV  infection  and  to  develop 
guidelines for more efficient intervention in both Western and Eastern Europe. 

Action 

The  Commission  has  presented  a  proposal  for  the  Seventh  Framework  Programme 
(FP7),  which  will  be  negotiated  with  the  EU  Member  States.  HIV/AIDS  research 
will  continue  to  be  a  priority  under  the  FP7.  The  Commission  has  proposed  an 
increase in funding for the Programme and will continue to stress its importance. The 
health  research  will  concentrate  on  three  main  pillars:  biotechnology  for  human 
health, translational research and delivery of health care to European citizens. 

7. 

NEIGHBOURHOOD  

In  this  document  “neighbourhood”  means  the  Russian  Federation  and  the  partners 
under the umbrella of the European Neighbourhood Policy (ENP). The ENP covers 
16  existing  or  potential  partners:  Algeria,  Armenia,  Azerbaijan,  Belarus,  Egypt, 
Georgia, Israel, Jordan, Lebanon, Libya, Moldova, Morocco, the Palestinian Authority, 
Syria, Tunisia and Ukraine.  

Elsewhere, the candidate countries are involved in the activities through the accession 
process and instruments. The Commission will explore the possibilities and practical 
ways to extend the HIV/AIDS activities to the Western Balkans and Central Asia in 
the future. 

The  general  principles  for  addressing  HIV/AIDS  in  the  neighbouring  countries 
remain the same as stated in the Commission working paper. The Commission will 
support the development of strong and accountable political leadership to tackle the 
HIV/AIDS  epidemic.  The  Commission  will  make  optimum  use  of  all  existing 
instruments  and  future  research  and  development,  in  particular  clinical  research, 
outcomes to address the needs of the partner countries better, while complying with 
the  external  aid  procedures  and  mandate  for  action  agreed  in  the  relevant  country 

EN 

10 

   EN 

 
strategy  papers  and  indicative  programmes.  This  will  allow  the  Commission’s 
operational departments to intervene in order to:  

•  facilitate evidence-based intervention embedded within the national strategy, work 
programme  and  expenditure  framework  jointly  agreed  with  national  authorities 
and other partners involved; 

•  join forces with other partners under such an approach to pave the way for what 

could set an example of good practices for neighbouring countries; 

•  optimise, through stronger EC involvement, use of the existing instruments such 
as  the  Global  Fund  and  the  European  and  Developing  countries  Clinical  Trials 
Partnership (EDCTP) programme.  

The  Commission  furthermore  plans  to  involve  increasingly  the  neighbouring 
countries in the EU’s HIV/AIDS activities in order to exchange information and best 
practices. 

The Commission will ensure that appropriate internal mechanisms are established to 
ensure the coherence of the approached proposed with the interventions of external 
action at bilateral (EC, Member States, and other bilateral partners) and multilateral 
levels  (WHO,  UNAIDS,  Global  Fund),  taking  into  account  lessons  learned  in  the 
past.  

7.1 The Russian Federation  

In  2003  the  EU  and  Russia  agreed  to  reinforce  their  cooperation  by  creating  four 
“common spaces” under the umbrella of the Partnership and Cooperation Agreement. 
The roadmaps for the common spaces were agreed at the EU-Russia Summit in May 
2005 and will form the basis for cooperation between the EU and Russia in the years 
to  come.  HIV/AIDS  is  mentioned  in  the  context  of  drug  prevention  policies  and 
education of youth, which are both crucial elements of a comprehensive HIV/AIDS 
strategy. 

The  Northern  Dimensionxxiv  policy  promotes  dialogue  and  practical  cooperation 
between  the  EU,  Russia,  Norway,  and  Iceland.  Health  is  one  of  the  five  key  areas 
identified, and it has been taken forward under the Northern Dimension Partnership 
in Public Health and Social Wellbeingxxv. HIV/AIDS has been the priority for action 
in  this  context,  as  well  as  within  the  intergovernmental  cooperation  in  the  Barents 
regionxxvi. 

Action 

The primary responsibility for the wellbeing and health of Russian citizens rests with 
the  government  of  the  Russian  Federation.  The  process  of  planning  specific  joint 
action  is  based  on  the  priorities  in  the  common  spaces  roadmaps  and  will  explore 
different options for exchanging best practices and networking in defined areas. 

The  Commission  will  continue  the  dialogue  at  political  level  to  facilitate  the 
development of leadership and the crucial collaboration between different authorities 
to tackle HIV/AIDS. 

EN 

11 

   EN 

 
The  Commission  invites  the  Russian  Federation  to  collaborate  in  organising  joint 
EU-Russia expert seminars on HIV/AIDS and related issues. 

The  Commission  invites  representatives  of  the  Russian  Federation  to  participate  in 
the HIV/AIDS Think Tank and the Civil Society Forum. 

The  Commission  will  continue  to  work  for  the  success  of  the  Northern  Dimension 
policy and to support the activities under the ND Partnership in Public Health. 

7.2 Partners under the European Neighbourhood Policy  

Each of the ENP partners is responsible for leading, designing and implementing its 
national strategies to tackle the HIV/AIDS epidemic. 

In  2004  the  Commission  published  country  reports  concerning  seven  ENP  partners 
(Israel, Jordan, Moldova, Morocco, the Palestinian Authority, Tunisia and Ukraine) 
followed  by  negotiation  of  ENP  Action  Plans,  running  three  to  five  years,  the 
implementation of which is now underway. In 2005, Country Reports were published 
on five more countries (Armenia, Azerbaijan, Egypt, Georgia, and Lebanon) and the 
development  of  ENP  Action  Plans  for  those  countries  is  now  ongoing.  All  these 
Action  Plans  refer  to  cooperation  on  public  health,  while  those  for  Ukraine  and 
Moldova also mention HIV/AIDS-related action. 

Several  seriously  affected  countries  need  substantial  external  resources  to  scale  up 
their intervention and technical assistance to strengthen their health systems, which is 
the prerequisite for adequate response to HIV/AIDS. 

Action 

The Commission invites the ENP partners, in particular those with an Action Plan, to 
participate  in  various  EU  activities  on  HIV/AIDS  such  as  the  Think  Tank  and  the 
Civil Society Forum. 

8. 

ACTION PLAN  

The European Commission proposes that the partners should take the work forward 
within  the  political  framework  outlined  in  the  previous  chapters  and  the  specific 
action in the Action Plan (Annex), which will later be available on line and updated 
by the Commission in consultation with the HIV/AIDS Think Tank, the Civil Society 
Forum, and other relevant stakeholders. 

The Commission will make available on the public health website an overview of the 
possible  financing  instruments  which  could  be  used  for  implementation  of  this 
strategy. 

The  Commission,  together  with  partners  (such  as  the  Think  Tank,  UNAIDS,  and 
WHO), will develop a set of appropriate core indicators for monitoring the process. 
The aim is to monitor not only outcomes but also the impact of these activities. This 
work  will  be  based  on  the  available  tools  and  methods  usedxxvii  and  should  also 
contribute to monitoring the UNGASS Declaration of Commitments on HIV/AIDS, 
as well as the Dublin and Vilnius Declarations. 

EN 

12 

   EN 

 
Annex : Action Plan (as 29/11//2005) 

Area 
action 

for 

Action 

Indicative 
timetable 

Outcome 

Main players 

1. Leadership and advocacy 

Human rights  Establish 

a  working 
to  conceptualise 
group 
problems 
define 
where  action  at  EU  level 
is needed 

and 

Second  half 
of 2006 

Proposal  for  a  list 
of  priorities 
for 
action 

Civil society 

HIV/AIDS 
Tank 

Think 

Organise a Conference on 
HIV/AIDS  and  human 
rights  

Spring 2007 

2. Involvement of civil society 

HIV/AIDS  Civil  Society 
Forum 

Twice 
year 

a 

Commission 

Neighbouring 
countries 

Council  Presidency 
Commission 

Member States 

Neighbouring 
countries 

Partners 

Commission 

HIV/AIDS 
society 
representatives 

civil 

Develop and implement a 
training  programme  for 
NGOs  with  a  view  to 
their 
in 
ARV  treatment  and  in 
prevention programmes 

involvement 

Ready 
mid-2007 

by 

Training 
programme 
treatment 
preparedness 

on 

Commission 

Member States 

Non-governmental 
organisations 

Training 
on 
programme 
prevention 
with 
specific  focus  on 
harm 
reduction 
measures for IDUs 

Implement 
programme  

the 

training 

From  2008 
on 

Number  of  NGO 
representatives 
trained annually 

Commission 

Member States 

NGOs 

Participation  in 
policy 
development 
and 
implementation 

Participation  in 
prevention  and 
treatment 

EN 

13 

   EN 

 
 
 
 
 
 
3. Surveillance 

Outcome 

Main players 

for 

Action 

Area 
action 

Coverage  of 
data 

Complete the geographic 
coverage of HIV case 
reporting within the EU and 
the WHO European region 

Indicative 
timetable 

2006 

Complete the geographic 
coverage of HIV single case 
reporting within the EU and 
the WHO European region 

2008 

Complete 
surveillance data 

HIV-related 
information 

2006 

Reassess the objectives of 
HIV/AIDS surveillance in 
order to gain information on 
severe HIV-related 
morbidity, access to 
diagnosis and treatment 

System 
development 

Develop an integrated 
database for HIV and AIDS 
surveillance 

2007-2008 

Integrated 
database 

Developing 
behavioural 
data 
collection 

Start with establishing an 
inventory of behavioural 
surveys/surveillance already 
existing in each country 

2006 

of 
Inventory 
available methods 

ECDC/EuroHIV 

Member States 

WHO Euro 

ECDC/EuroHIV 

Member States 

WHO Euro 

ECDC/EuroHIV  

Member States 

ECDC/EuroHIV  

ECDC/EuroHIV  

Member States 

UNAIDS 

EMCDDA 

Establish a list of important 
prevention indicators to be 
collected on an annual basis 
(e.g. % of IDUs sharing 
equipment in the past x 
months, % of MSM having 
unprotected anal intercourse 
at last sex) 

2007-2009 

Data 
behavioural 
factors 

on 
risk 

ECDC/EuroHIV  

Member States 

UNAIDS 

EMCDDA 

Sentinel 
surveillance 
for 
warning 

early 

Facilitate the setting-up of 
sentinel surveillance in high-
risk groups in countries with 
a low-level epidemic  

2006 

of 
with 

Number 
countries 
sentinel 
surveillance 

ECDC/EuroHIV  

Countries concerned 

EN 

14 

   EN 

 
 
 
 
 
 
 
 
 
 
HIV 
incidence 

Estimate  HIV  incidence  in 
Europe  

2007 

True 
incidence 
Europe 

HIV 
in 

ECDC/EuroHIV 

WHO Euro 

for 

Area 
action 

HIV 
prevalence 

Data 
protection 

3. Surveillance (cont’d) 

Action 

Indicative 
timetable 

Outcome 

Main players 

Provide HIV prevalence 
estimates for Europe  

2006 

prevalence 
for 

HIV 
estimates 
individual 
countries 

ECDC/EuroHIV 

WHO Euro, UNAIDS 

Work  with 
the  Member 
States  to  identify  possible 
practical  problems  with  the 
protection  of  personal  data 
and  with  the  free  movement 
of such data in the context of 
HIV/AIDS surveillance 

2006-2007  

Commission 

ECDC/EuroHIV  

Member States 

Development 
of resistance 

Facilitate Europe-wide 
surveillance on HIV drug 
resistance  

2007-2008 

of 

Number 
countries 
implementing 
national  HIV  drug 
resistance 
surveillance 

ECDC/EuroHIV  

Commission 

Member States 

4. Prevention of new HIV infections 

                Area for action  Action 

                    Sexual transmission 

1)  Develop 
innovative 
strategy  to  promote  safe 
sex 
the 
risk-taking 
in 
increase 
behaviour among youth 

address 

and 

2) Implement the strategy 

                  Mother-to-child 
                  transmission 

Report  on  the  state  of 
play in Europe 

                  Harm reduction 

Monitor 
of 
Recommendation 

implementation 
Council 
of 

the 

Indicative 
timetable 

2006– 

Outcome/indicator  Main players 

Innovative  safe  sex 

1) 
strategy developed 

Commission 

Member States 

Civil 
organisations 

society 

2009- 

2006 

2)  Number  of  countries 
implementing the strategy 

International 
organisations 

Report 
action plan 

followed  by  an 

Commission  

ECDC/EuroHIV 

2007 

Report  

Commission 

EN 

15 

Member States 

   EN 

 
 
 
 
 
 
 
 
 
                                 Blood 

18 June 2003  

the 

under 

Monitor 
data 
compiled  by  Member 
States 
the 
Commission Directive on 
traceability  and  adverse 
reactions 
events 
(adoption 
in 
September  2005)  related 
to  transmission  of  HIV 
(and  other  diseases)  by 
blood 
blood 
and 
components 

expected 

and 

Report 

to 

Annual 
reporting 
Commission 
to  begin  by 
end of 2007 

Member States 

Commission 

                                  Youth 

as 

Include 
a 
youth 
priority  target  group  for 
the development of public 
health intervention  

2006- 

                                 Prisoners 

Develop  HIV  prevention 
strategies for prisons 

2006- 

HIV  prevention  strategies 
developed for prisons  

Identify best practices for 
HIV prevention in prisons 
in Europe 

Commission 

Member States 

Civil society 
organisations 

International 
organisations 

Commission 

Member States 

Civil 
organisations 

society 

International 
organisations 

                  Population-wide 
                  information 

EBU  “European  health 
information platform” 

2006 

Material for media 

EBU and its partners 

Information  website  with 
updates,  ready  for  use  by 
TV and radio 

Commission 

Member States  

                 Awareness-raising 
                 among general public 

1)  Bring  visibility 
HIV/AIDS in Europe 

to 

2006-2009 

One to three EU-led events 
on HIV/AIDS every year 

Commission  

2)  Link  Europe  into  the 
World AIDS Campaign 

June/July 

May 

3)  Promote  prevention 
and 
Voluntary 
Counselling and Testing 

December 

Member States 

ECDC/EuroHIV 

WAC  

Other partners 

                  Education 

1)  Organise  a  consensus 
meeting  on  best  practice 

2006 

1) Consensus report  

Commission 

EN 

16 

   EN 

 
 
 
 
 
 
on  HIV/AIDS 
education 

peer 

2)  Develop  a 
module 
peer education  

training 
for  HIV/AIDS 

2006-2007 

2) Training module 

Member States 

WHO,  UNAIDS,  other 
partners 

3) Implement the training 
module 

2007-2009 

3)  Number  of  national 
focal  points 
HIV/AIDS 
and 
education 
officials trained 

peer 

5.Treatment, care and support 

Area 
action 

for 

Action 

Indicative 
timetable 

Outcome 

Main players 

Access 
vulnerable 
groups 
services 

of 

to 

a  European 
1)  Prepare 
best 
on 
inventory 
practices/know-how  on  drug 
treatments  

2)  Prepare  guidelines/best 
practices 
to 
treatment 
vulnerable 
populations 

on 
for 

access 

1)  Inventory  of 
best practices  

Commission 

Member States 

2)  Guidelines 
on  access 
to 
treatment  

Support 
capacity-building 
among  service  providers  to 
improve access for vulnerable 
groups 

2006- 

Training 
programme  for 
service 
providers 

Commission  

Member States 

Continue  the  development  of 
European 
curricula/training 
modules 

Treatment 
preparedness 

Develop 
information on treatment 

patient-friendly 

Develop a training module on 
treatment preparedness 

2006- 

Number 
information 
packages 
developed 

of 

Commission  

Member States 

NGOs 

Training 
module 
adherence 

on 

Commission 

Member States 

NGOs 

EN 

17 

   EN 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Service 
standards 

Provide  a  toolkit  for  Member 
developing 
States 
for 
comprehensive 
HIV/AIDS 
services 

2006- 

for 

Toolkit 
service 
standards 

Affordable 
ARV 

Continue  exploring  possible 
solutions 

Feasible 
solution 
to 
reduce  the  cost 
of ARV 

Commission 

Pharmaceutical 
industry 

Laboratory 
capacity 

Training 
personnel 

of 

in 

Integrate 
university 
medical education  

and 

curricula  of 
continuing 

Member 
concerned 

States 

Commission, 
ECDC, 

Universities, 
Medical 
associations, 
ESCMID,  WHO 
Euro 

Networking  of 
laboratories  for 
susceptibility 
testing 

Establish 
of 
network 
laboratories 
[reference] 
HIV susceptibility testing 

a  Europe-wide 
national 
for 

Upgrading 
national 
laboratories 

Assess  the  needs  [training, 
in  HIV 
etc.] 
equipment, 
laboratories at national level 

Network 
specialist 
laboratories 
established 

Number 
national 
inventories 
ready 

of 

ECDC 

Member States 

of 

Member States 

ECDC 

6. Research 

Area for action  Action 

Advance treatment 

a  European 
Establish 
network  of  clinical  trials 
on 
therapeutic 
approaches to HIV/AIDS 

new 

Indicative 
timetable 

2006-2010 

Outcomes 

Main 
players 

New  strategies  for 
the  management  of 
HIV infection 

Member States 

Commission 

Facilitate 
vaccine/microbicide 
research 

a  European 
for 

Establish 
network 
vaccine/microbicide 
research 

2006-2010 

Standardisation 
of 
HIV  research  tools; 
new 
vaccine/microbicide 
candidates; 
closer 
European 
collaboration  with 
research 
global 
and 
initiatives 

Commission 

Member States 

Research 
centres 

Industry, SMEs 

EN 

18 

   EN 

 
 
 
 
 
 
 
 
Cohort studies 

Set  up  a  network  of 
European  cohort  studies 
on HIV/AIDS 

2006-2009 

partnerships 

New 
treatment 
options to overcome 
resistance 
to  HIV 
drugs; PMTCT1 

Commission 

Clinical 
research centres 

1 Prevention of mother-to-child transmission. 

EN 

19 

   EN 

 
 
                                                 
7. Neighbouring countries 

Indicative 
timetable 

Outcomes 

Main players 

Area 
action 

for 

Action 

Russian Federation 

EC  participation 
work 
of 
Coordinating Mechanism  

in 
the 
the  Country 

2006- 

Expert 
meetings 
HIV/AIDS-
related issues 

on 

1)  Organise 
meeting on HIV/AIDS 

an 

expert 

Finnish 

2) 
meeting  

Presidency 

1) 2006  

2) 
September 
2006 

European Neighbourhood Policy partners 

EC  participation 
work 
of 
Coordinating Mechanism 

in 
the 
the  Country 

2006- 

Invite 
ENP 
partners  to  EU 
activities 

1)  Invite  ENP  partners  to 
Think  Tank  meetings  on 
specific topics  

2006- 

Exchange 
of 
information  and 
best practises 

EC Delegation 

Russian Federation 

CCM 

1) Commission 

Russian Federation 

Partners  

2) Council 
Presidency  

EC Delegation 

CCM 

ENP Partners 

Commission 

Member States 

NGOs 

Partners  

2)  Invite  ENP  partners  to 
HIV/AIDS-related 
meetings/conferences 

Surveillance 

Ensure 
networks 
that 
increasingly cover Southern 
Mediterranean countries 

2009 

the 
for 

Explore 
scope 
specific 
HIV/AIDS 
meetings 
targeted 
ENP partners 

at 

Hold  exploratory  meeting 
[in 
with  ENP  Partners 
particular 
those  with  an 
ENP Action Plan] 

2007 

Hold  a  series  of  follow-up 
meetings on specific topics, 

2008- 

Surveillance  data 
available  

ECDC 

Exchange 
of 
information  and 
best practises  

EpiSouth 

Commission 

Member States 

Partners  

EN 

20 

   EN 

 
 
 
 
 
 
 
 
 
 
countries or regions 

i Commission communication “A Coherent European Policy Framework for External Action to Confront 
HIV/AIDS, Malaria and Tuberculosis” (COM(2004)726). Commission communication (COM(2005) 179) “A 
European Programme for Action (PfA) to Confront HIV/AIDS, Malaria and Tuberculosis through External 
Action (2007-2011)”. 
ii http://www.unaids.org/en/events/un+special+session+on+hiv_aids.asp. 
iii http://europa.eu.int/comm/health/ph_threats/com/aids/keydocs_aids_en.htm. 
iv European Neighbourhood Policy, EU/Russia Partnership and Cooperation Agreement (PCA). 
v In this document the specific vulnerable groups are defined for each of the priority areas, but it should be noted 
that they may differ, depending on the state of the HIV/AIDS epidemic and economic and cultural setting in the 
particular area of concern. 
vi The institutional forms of civil society are distinct from those of the state, family and market and civil society 
commonly embraces a diversity of spaces, stakeholders and institutional forms, of varying degrees of formality, 
autonomy and power. Civil societies are often populated by organisations such as registered charities, 
development non-governmental organisations, community groups, women's organisations, faith-based 
organisations, professional associations, trade unions, self-help groups, social movements, business associations, 
coalitions and advocacy groups. http://www.lse.ac.uk/. 
vii These are private, non-profit organisations based in and working in local communities. Normally they are 
created in response to some particular need or situation (high unemployment rate - employment promotion) in 
the community and work is done by local people. 
viii www.weforum.org/globalhealth/globalsurvey. 
ix http://www.unice.org/Content/Default.asp?. 
x http://www.eurohiv.org 
OJ L 271, 09/10/2002, p.1 - 12. 
xiiOJ L 142, 30/04/2004, P. 1 - 11. http://www.ecdc.eu.int. 
xiii European Centre for Disease Prevention and Control, http://www.ecdc.eu.int/ and Research FP5 supported 
SPREAD –programme, http://www.umcutrecht.nl/afdeling/index.asp?dep=9 
xiv Surveillance based on selected population samples chosen to represent the relevant experience of particular 
groups (Last, JM edit A Dictionary of Epidemiology, 4th edition, 2001), such as testing of blood for the purpose 
of monitoring  the prevalence and trends in HIV infection among commercial sex workers in a city during six 
months. 
xv  Stover,  J.,  Walker,  N.,  Garnett,  G.  P.,  et  al.  Can  we  reverse  the  HIV/AIDS  pandemic  with  an  expanded 
response? Lancet 2002; 360(9326):73-77. 
xvi Aceijas, C., Hickman, M., Stimson, G., Rhodes, T. Global overview of HIV among injecting drug users, 
AIDS 2004;18: 2295-2302. 
xvii Global Illicit Drug Trends 2002, UNODC, 2003, Vienna. 
xviii Intensifying HIV prevention. UNAIDS policy position paper. UNAIDS/PCB 05.329, June 2005. 
xix http://www.aids.lt/iac/ 
xx OJ C 169, 8.7.2005, p. 1. http://europa.eu.int/comm/health/ph_determinants/life_style/drug_en.htm. 
xxi OJ L 165, 3.7.2003, p 31. 
xxii See Chapter 7. 
xxiii Research methods that involve observations of the same items [large numbers of people] over a long period 
of time with comparison of incidence rates in groups that differ in exposure levels. 
xxiv http://europa.eu.int/comm/external_relations/north_dim/index.htm. 
xxv http://www.ndphs.org/index.php?cat=29143. 
xxvi http://www.beac.st/. 
xxvii UNAIDS (2005). Monitoring the Declaration of Commitment on HIV/AIDS: guidelines on construction of 
core indicators, Geneva: UNAIDS. 
WHO/UNAIDS (2005). National AIDS programmes: A guide to monitoring and evaluating antiretroviral 
programmes. Geneva: WHO. 
WHO/UNAIDS (2004). National AIDS programmes: A guide to monitoring and evaluating national HIV/AIDS 
care and support. Geneva: WHO. 

EN 

21 

   EN 

 
 
 
                                                 
WHO/UNAIDS (2004). Guide to monitoring and evaluating national HIV/AIDS prevention programmes for 
young people. Geneva: WHO. 
Family Health International (2000). Behavioural Surveillance Surveys: Guidelines for repeated Behavioural 
Surveys in populations at Risk of HIV. Arlington, USA: Family Health International. 

EN 

22 

   EN