Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions - Combating HIV/AIDS in the European Union and neighbouring countries, 2009 -2013 {SEC(2009) 1403} {SEC(2009) 1404} {SEC(2009) 1405}
Date: 2009-10-26
Institutions: European Commission
Subjects: AIDS, action programme, anti-discriminatory measure, cooperation policy, disease prevention, health policy, right to health, third country

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COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 26.10.2009 
COM(2009)569 final 

COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN 
PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL 
COMMITTEE AND THE COMMITTEE OF THE REGIONS 

Combating HIV/AIDS in the European Union and neighbouring countries, 2009 -2013 

{SEC(2009) 1403} 
{SEC(2009) 1404} 
{SEC(2009) 1405} 

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1. 

HIV IN EUROPE 

1.1. 

Introduction 

EU Member States and the European neighbouring countries face a high number of new HIV 
and  associated  infections  and  the  resulting  medical,  social  and  economic  consequences. 
50 000 newly diagnosed HIV cases in the EU and the neighbouring countries alone in 2007 
and  an  estimated  2  million  people  living  with  HIV/AIDS  (PLWHA)  illustrate  the  serious 
dimension of the situation1. 

The  Commission  communication  on  combating  HIV/AIDS  of  20052  provided  a  policy 
instrument  to  address  HIV/AIDS  on  a  European  level  and  has  been  the  basis  for  EU  action 
from  2006  to  2009.  However,  combating  HIV/AIDS  remains  a  public  health  concern  and  a 
political priority for the European Union and neighbouring countries. Effective treatments for 
HIV/AIDS  are  available  but  no  cure.  Intensifying prevention is therefore the key to combat 
HIV/AIDS,  neglecting  prevention  is  a  waste  of  lives  and  resources.  The  Commission  is 
committed to continue to combat the disease and puts forward a new Action Plan, further to 
the previous one, which comes to an end in December 2009.  

This  communication  complements  “A  European  Programme  for  Action  to  confront 
HIV/AIDS,  Malaria  and  Tuberculosis  through  External  Action  (2007-2011)”,  which  covers 
external action related to developing and middle-income countries3.  

After three decades of HIV/AIDS there is still no room for complacency. The best response to 
the epidemic remains a combination of health specific and wider social interventions. People 
will continue to suffer unless prevention is accelerated and universal access to treatment, care 
and support is ensured for all people in need.  

1.2. 

Epidemiological situation and future trends  

Numbers of PLWHA and of new HIV diagnoses differ significantly between countries, as do 
the  prevalence  rates  of  HIV,  in  a  range  from  0,1%  to  1,2%  across  Europe.  Currently  in 
Eastern  Europe  HIV  and  AIDS  are  increasing  at  an  alarming  rate.  The  principal  HIV 
transmission  routes  differ  depending  on  the  geographic  location.  In  the  EU  HIV  is 
predominantly transmitted by heterosexual contacts and Men having Sex with Men (MSM), 
while in European neighbouring countries transmission is mostly a result of injecting drug use 
(57%). In EU/EFTA countries the highest proportion of new HIV cases was reported among 
MSM  (39%).  Heterosexual  HIV  transmissions  are  increasing  in  several  European  countries 
and  around  40%  of  these  were  diagnosed  in  persons  originating  from  countries  with 
generalised  epidemics.  Women  are  often  particularly  vulnerable  to  HIV  infections.  Other 
vulnerable  groups  such  as  commercial  sex  workers  and  prisoners  are  also  considerably 
affected by HIV/AIDS. Between 30% and 50% of HIV infected people in the EU, and up to 
70% in European neighbouring countries, are unaware of their HIV status.  

Early diagnoses of HIV accompanied by counselling and timely treatment play a crucial role 
in reducing transmission of HIV, as well as the morbidity and mortality related to HIV/AIDS. 

1 
2 
3 

ECDC/WHO. HIV/AIDS Surveillance in Europe, 2007. Stockholm, 2008; and UNAIDS report 2008. 
COM(2005) 654. 
COM(2005) 179. 

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The  high  numbers  of  HIV  co-infections  such  as  tuberculosis,  hepatitis  and  other  sexually 
transmitted infections are another serious concern.  

1.3. 

Legal and social situation – obstacles and particularities 

The legislative framework and standards for social and health services for people affected by 
HIV/AIDS in Europe differ considerably between countries. Access to services and medical 
treatment,  as  well  as  to  prevention  or  harm  reduction  measures,  is  often  limited4.  Social 
exclusion,  discrimination  due  to  HIV  status  and  the  non-respect  of  basic  human  rights  of 
PLWHA  still  persist.  In  some  countries  sexual  transmission  of  HIV  can  be  considered  a 
crime. 

HIV/AIDS as an issue of concern for migrants is addressed differently across Europe. Several 
European  countries  maintain  restrictions  on  entry,  stay  and  residence  based  on  HIV  status. 
These provisions are discriminatory and do not protect public health5. 

1.4. 

Political situation – declarations and commitments 

Political  declarations  on  a  European  level  and  global  initiatives6  define  commitments  and 
targets  in  the  response  to  HIV/AIDS.  They  call  upon  the  EU,  national  governments, 
international organisations, and civil society to act and to deliver. There are commitments to 
ensure universal access to HIV prevention, treatment, care and support, to invest into research 
for  the  development  of  novel  preventive  and  therapeutic  tools,  to  promote  support  for  and 
solidarity with PLWHA and most at risk populations, to involve civil society and PLWHA in 
policy making and implementation, and to create a supportive social environment. 

1.5. 

The EU action plan on combating HIV/AIDS (2006-2009) 

The action plan foresaw about 50 actions to be implemented by major stakeholders. A number 
of  key  achievements  relate  to  a  stronger  involvement  of  civil  society  at  European  level,  the 
operational  centralisation  of  HIV/AIDS  surveillance  by  the  European  Centre  for  Disease 
Control  and  Prevention  (ECDC),  efforts  to  facilitate  access  to  affordable  antiretroviral 
medicines,  funding  of  prevention  projects  and  programmes,  investments  in  research,  and  a 
close  cooperation  between  partners.  The  HIV/AIDS  Impact  Assessment  (2009)7  has  a 
comprehensive summary of the achievements of the first Action Plan under point 5.3 and in 
its Annex 4. 

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Progress  on  implementing  the  Dublin  declaration  on  partnership  to  fight  HIV/AIDS  in  Europe  and 
Central Asia. WHO/UNAIDS report. 2008. 
Statement  on  behalf  of  the  European  Union  at  the  63rd  session  of  the  General  Assembly  on  the 
Implementation  of  the  Declaration  of  Commitment  on  HIV/AIDS  and  the  Political  Declaration  on 
HIV/AIDS, New York, 16 June 2009. 
Dublin  2004,  Vilnius  2004,  Bremen  2007,  Council  conclusions  2005  and  2007,  European  Parliament 
report  2007  and  2008,  UNGASS  2001/2006/2008,  Millenium  Development  Goals  2000,  Gleneagles 
2005, Heiligendamm 2007. 
SEC(2009) 1404. 

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2. 

THE RESPONSE  

Actions  to  respond  to  the  challenges  concentrate  on  prevention,  priority  areas,  most  at  risk 
populations  and  an  improved  knowledge  base  through  a  better  cooperation  and  knowledge 
transfer among stakeholders. 

The overall objectives of this Communication are: (i) to reduce new HIV infections across all 
European countries by 2013, (ii) to improve access to prevention treatment, care and support 
and (iii) improving the quality of life of people living with, affected by or most vulnerable to 
HIV/AIDS  in  the  European  Union  and  neighbouring  countries.  All  EU  Member  States, 
candidate  and  potential  candidate  countries,  European  Free  Trade  Agreement  (EFTA) 
countries  and  countries  in  the  European  Neighbourhood  Policy  area  as  well  as  the  Russian 
Federation  are  invited  to  contribute  to  the  implementation  of  these  goals.  The  Commission 
underlines  the  importance  of  mobilising  all  necessary  efforts  and  resources  to  prevent  HIV 
transmission effectively, to promote the human rights of PLWHA and affected communities, 
embedded in the Charter of Fundamental Rights of the EU8, and to deliver high quality HIV 
treatment and care to all who need it. The current HIV epidemic and expected future trends 
are best addressed through: 

(i) 

(ii) 

Scaling up the implementation of prevention strategies, which effectively target local 
realities and needs, while working towards ensuring universal access to prevention, 
treatment, care and support, 

Supporting an effective response to HIV/AIDS in priority regions, such as the mostly 
affected  EU  Member  States,  the  Russian  Federation  and  the  most  affected 
neighbouring countries, and  

(iii) 

Developing  means  to  reach  and  support  the  populations  most-at-risk  and  most 
vulnerable to HIV/AIDS across Europe.  

2.1. 

Political leadership 

Political leadership is an important asset the European Union can provide in the fight against 
HIV/AIDS.  

HIV/AIDS  remains  a  stigmatised  condition  which,  within  the  European  Union  and  its 
neighbouring countries, mainly affects marginalised groups. Not addressing the HIV epidemic 
would  cause  considerable  harm  to  the  individual  and  public  health,  and  increasing  costs  to 
societies. An effective response to HIV requires political leadership to ensure that the health 
and rights of vulnerable and affected groups are promoted. 

Political  leadership  is  important  to  define  and  assure  the  implementation  of  priorities  and 
actions. Unambiguous political advocacy is indispensable to align these priorities to needs and 
resources.  

The Commission 

–  underscores the need to link the response to HIV/AIDS with the socio-economic priorities 

in political strategies at country level 

8 

OJ C 364, 18.12.2000, p. 1. 

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–  continues  to  support  activities  that  aim  at  (1)  to  decreasing  HIV-related  stigma,  (2) 
promoting  respect  for  the  human  rights  of  all  PLWHA  and  (3)  addressing  all  forms  of 
HIV-related discrimination and support the social inclusion of PLWHA 

–  promotes  the  mainstreaming  of  HIV/AIDS-related  issues  across  EU  policies,  legislation 

and agreements 

–  supports  monitoring  the  implementation  of  international  commitments  at  country  and 
European level, and supports international organisations such as UNAIDS in their work to 
mobilise political leadership in Eastern Europe 

–  calls upon the ECDC to continue monitoring the progress in meeting commitments of the 

Dublin, Vilnius and Bremen Declarations 

2.2. 

Involvement of civil society and people living with HIV/AIDS 

Civil  Society  is  a  key  actor  in  combating  HIV/AIDS  at  all  levels  and  it  is  instrumental  in 
keeping HIV/AIDS on the political agenda.  

Civil Society organisations, including those representing PLWHA and affected communities, 
were  instrumental  in  developing  practical  and  political  solutions  to  address  HIV/AIDS.  To 
this  end,  the  Commission  set  up  the  HIV/AIDS  Civil  Society  Forum  (CSF)  in  2005.  Civil 
society  has  undergone  strong  internationalisation  and  professionalisation.  The  Commission 
wants to ensure that civil society stays involved in HIV/AIDS related policy development and 
implementation  and  remains  a  front  line  partner  in  a  coordinated  response,  sharing 
responsibility for meeting commitments. Civil society should have the necessary freedom to 
act and to be involved at all levels in the response to HIV/AIDS across Europe and beyond. 

The Commission 

–  supports  the  involvement  of  civil  society  organisations,  including  those  representing 
PLWHA and affected communities, in planning, implementing and evaluating the response 
to HIV/AIDS in the European Union and neighbouring countries 

–  will  maintain  the  HIV/AIDS  Civil  Society  Forum  as  the  principal  interface  to  advise  the 

Commission and the HIV/AIDS Think Tank 

2.3.  Wider society responsibilities 

Equal treatment and solidarity are key assets of tolerant and open societies. 

Any  form  of  HIV/AIDS  related  discrimination  and  stigmatisation  is  unacceptable.  National 
policies should prioritise improvements across the general population of basic knowledge on 
HIV/AIDS and the prevention of HIV transmission. Unprejudiced attitudes remove potential 
barriers to gaining HIV-related information and may support risk reducing behaviour patterns.  

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HIV/AIDS  associated  stigma  and  discrimination  create  barriers  to  access  HIV  testing, 
treatment and care. The Commission will further address this issue on a political level and in 
its equal treatment policies9. 

The Commission 

–  reiterates the need to ensure the respect for the human rights of all persons irrespective of 

their health status, sexual orientation, lifestyle, national and social origin 

–  will work with all relevant stakeholders and public authorities to step up awareness raising 

efforts and to initiate public campaigns on HIV/AIDS 

–  encourages  wider  professional  training  on  HIV,  in  particular  in  the  health  and  social 

sectors as well as in law enforcement and education  

2.4. 

Universal access to prevention, treatment, care and support 

Adequate  funding  and  political  support  is  necessary  to  achieve  ´universal  access´  across 
Europe. 

HIV  infections  can  be  prevented  and  treated,  and  therefore  effective  health  care 
infrastructures  and  information  must  be  available.  Leaders  of  the  G8  countries  and, 
subsequently,  heads  of  states  and  governments  at  the  2005  UN  General  Assembly  special 
session (UNGASS), endorsed a commitment to "develop and implement a package for HIV 
prevention, treatment and care, with the aim of coming as close as possible to universal access 
to treatment for all those who need it by 2010"10. 

As  countries  are  striving  to  fulfil  their  commitment  to  scale  up  towards  universal  access  to 
HIV  prevention,  treatment,  care  and  support  in  2010,  the  Commission  reiterates  this 
commitment and emphasizes the need to invest towards meeting and sustaining these targets 
in 2010 and beyond.  

Economic operators and public authorities should cooperate to improve the provision of safe 
and  affordable  antiretroviral  medicines  to  all  people  in  need.  Accessible  medicines  are 
essential for reaching universal access across Europe.  

The Commission 

–  will work to support relevant authorities and stakeholders to develop effective approaches 
to ensure the provision of safe and affordable antiretroviral medicines to all people in need 

–  will work alongside international organisations, such as UNAIDS, UNICEF and WHO, in 
their  efforts  towards  reaching  universal  access  in  neighbouring  countries  -  encourages 
Member States' national authorities to assess the possibilities of structural and social funds 
and other instruments to scale up HIV/AIDS related health services  

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10 

Directives  in  the  area  of  anti-discrimination  are:  the  Racial  Equality  Directive,  2000/43/EC,  and  the 
Employment Equality Directive, 2000/78/EC. Council Directive 2000/43/EC implements the principle 
of  equal  treatment  between  persons  irrespective  of  racial  or  ethnic  origin,  and  Council  Directive 
2000/78/EC establishes a general framework for equal treatment in employment and occupation. 
WHO report 2008: Towards universal access by 2010. 

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3. 

PRIORITIES 

Prevention  of  HIV  transmission  is  possible  and  it  is  the  most  effective  way  to  address 
HIV/AIDS. Targeted and evidence-based prevention strategies addressing local realities and 
priority  populations  are  key  to  success.  Effective  prevention  measures  are  cost-effective 
investments with substantial long-term benefits.  

Effective prevention requires a solid evidence base and robust surveillance systems, including 
meaningful behavioural data to ensure that the key forces behind the epidemic are adequately 
addressed. Positive prevention and the sexual and reproductive health and rights of PLWHA 
are  important  aspects  for  national  policy  planning  and  programmes.  Prevention  should 
promote  safer  sexual  behaviour.  Correct  and  consistent  use  of  condoms  remains  the  most 
effective  means  of  HIV  prevention  through  sexual  transmission,  and  provision  of  sterile 
needles  and  injecting  equipment  and  substitution  treatment  are  the  most  effective  means  of 
HIV prevention through injecting drug use. Prevention should properly address the situation 
of  children11  and  young  people.  There  are  also  effective  means  to  avoid  mother-to-child-
transmission, which should be widely applied. Prevention should be linked to voluntary and 
counselled HIV testing, universal access to treatment, care and support.  

In implementing the strategy, EU intervention will primarily target priority regions and most 
at risks populations. 

3.1. 

Priority regions 

The prevalence rate of HIV in several Eastern European neighbouring countries is high, the 
numbers of new infections are still rising or have stabilised at a high rate, access to treatment 
is  limited  to  as  low  as  10%  of  people  needing  it,  co-infections  such  as  tuberculosis  and 
hepatitis  are  a  serious  public  health  threat,  and  most  marginalised  groups  such  as  IDU, 
migrants and MSM are over proportionally affected. 

Although HIV/AIDS concerns most parts of Europe, there is a particular need to address those 
regions  suffering  the  highest  burden.  Factors  contributing  to  this  burden  are:  (i)  size  and 
distribution  of  most  at  risk  populations  (ii)  poverty  and  economic  development  status,  (iii) 
social, medical and economic inequalities, including discrimination. 

The  Commission  recognises  the  need  to  step  up  cooperation  among  EU  Member  States, 
candidate, potential candidate, and other neighbouring countries, and to support countries to 
develop tailor-made strategies. There is a need to introduce effective prevention measures, in 
particular harm reduction measures. Public health and social policies should take into account 
the  needs  of  ethnic  minorities.  Social  inequalities  and  barriers  to  health  care  should  be 
overcome at both political and operational levels.  

This applies particularly to the eastern European Neighbourhood Policy area (ENP) countries 
and  the  Russian  Federation  where  the  HIV  epidemic  is  concentrated  in  most  at  risk 
populations, with a potential to drift into the general population as heterosexual transmission 
is  increasing.  Although  measures  and  strategies  in  response  to  HIV/AIDS  are  generally  in 
place,  access  to  HIV  prevention,  treatment,  care  and  support  still  needs  improvement. 
Supporting  the  efforts  of  neighbouring  countries  will  prevent  the  spread  of  HIV  and 

11 

Cf. the provisions of the UN Convention on the Rights of the Child, that has been ratified by all EU 
Member States. 

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associated  infections  such  as  tuberculosis  into  the  EU  and  to  improve  the  conditions  of 
PLWHA in the region.  

Political commitments should lead to a constructive dialogue and help to overcome existing 
implementation  barriers  of  existing  or  new  strategies.  Building  on  current  cooperation,  the 
Commission is ready to strengthen cooperation through existing mechanisms and instruments. 
With a view to strengthening surveillance, the Commission is ready to gradually promote the 
cooperation between the ECDC and neighbouring countries.  

3.2. 

Priority groups - most at risk populations 

Although  the  highest  absolute  number  of  new  HIV  cases  in  the  EU  occur  through 
heterosexual  transmission,  most  at  risk  groups  are  over  proportionally  affected.  Full 
integration  of  minorities,  marginalised  or  socially  disadvantaged  groups  is  a  key  factor  in 
successful HIV/AIDS policies. Universal access to prevention, treatment, care and support as 
well  as  to  health  and  social  services  and  a  non-discriminatory  legal  environment  should  be 
available to all most at risk groups. Targeted prevention programmes and effective solutions 
should include adapted communication, access to confidential, anonymous and, ideally, free 
testing  and  timely  high-quality  treatment.  Targeted  prevention  should  in  particular  reach 
young people within most at risk populations. A large  proportion of young  people have not 
experienced  the  AIDS  realities  of  the  past  making  them  more  negligent  towards  the  risk  of 
HIV  infection.  Future  actions  to  combat  HIV/AIDS  should  concentrate  on  most  at  risk 
populations to have the biggest impact on the epidemic: 

(i) Men having Sex with Men is the main at risk population in  the EU. The real dimension of 
the  MSM  HIV  epidemic  in  European  neighbouring  countries  is  unknown.  Stigma, 
discrimination  and  homophobia  are  often  associated  with  homosexuality  and  may  lead  to 
biased  surveillance  data  and  subsequent  underestimation  of  this  group  in  the  HIV/AIDS 
epidemic.  

Targeted  prevention  programmes  should  be  reinforced  to  reach  MSM,  and  voluntary  and 
counselled HIV testing (along with effective screening and treatment for sexually transmitted 
infections)  needs  to  be  intensified  for  MSM  and  risk  populations.  Accessible,  non-
discriminatory  and  confidential  HIV  treatment,  care  and  support  services  for  MSM  are 
paramount. 

(ii) Injecting drug use (IDU) is the main driver of HIV transmission in Eastern Europe, where 
it  accounts  for  2/3  of  all  new  infections.  Drug  addiction  calls  for  an  integrated  medical  and 
social  response.  Access  to  sterile  needles,  evidence-based  addiction  treatment,  including 
substitution and other harm reduction measures, have proven to be very effective, including in 
high prevalence areas and in particular settings such as prisons. Investment in comprehensive 
IDU health care should help to decrease the number of new HIV infections among drug users, 
and to alleviate the burden associated with drug use. 

(iii)  Migrants  from  countries  with  a  high  HIV  prevalence  and  mobile  populations  are 
particularly affected by HIV/AIDS, although more data on the relationship between migrants´ 
legal, socio-economic status and access to health services and their vulnerability to HIV/AIDS 
would be needed. Heterosexual HIV transmission among migrants accounts for about 40% of 
all new sexual HIV diagnoses in  the EU. Access to comprehensive prevention measures and 
to  voluntary  and  confidential  HIV  testing  and  counselling  and  to  health  and  social  services 

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needs  to  be  promoted.  The  development  of  public  health  and  social  services  for  migrants 
would constitute an effective measure against the transmission of HIV. 

The Commission 

–  promotes efforts to respect human rights, increase tolerance and solidarity to better include 

marginalised and most at risk populations in society 

–  supports  effective,  adapted  and  ethical  means  of  HIV  prevention  including  improved 
access  to  voluntary  and  counselled  HIV  testing  to  most  at  risk  populations  and  in  areas 
with high prevalence of HIV infection 

–  will  include  HIV/AIDS  and  sexual  health  related  issues  in  its  broader  work  on  youth 

health, in particular towards promoting a better knowledge on HIV/AIDS  

–  asks  the  ECDC  to  provide  data  for  a  more  accurate  understanding  of  the  HIV  epidemic, 
including  HIV  incidence  and  prevalence,  behavioural  data,  and  undiagnosed  HIV 
infections 

–  will  provide  resources  through  existing  programmes  (notably  in  public  health  and 
research,) and EU instruments to improve prevention and to address co-infections such as 
tuberculosis and hepatitis 

–  supports  HIV/AIDS  related  work  realised  in  the  framework  of  the  "Northern  Dimension 

Partnership on Public Health and Social Well-Being"(NDPHS) 

–  will address HIV/AIDS in future negotiations on bi- and multilateral agreements with third 

countries where necessary  

–  will  work  with  the  ECDC  to  gradually  develop  by  2013  the  cooperation  between  the 

ECDC and neighbouring countries to combat HIV/AIDS and associated infections  

–  encourages  Member  States  to  further  develop  and  implement  horizontal  technical 
cooperation  and  exchange  programmes  to  strengthen  the  capacity  of  governmental 
institutions  and  civil  society  organisations  to  develop,  implement  and  evaluate  effective 
national HIV/AIDS programmes  

4. 

IMPROVING THE KNOWLEDGE 

4.1. 

Surveillance, monitoring and evaluation 

All stakeholders should contribute to a solid surveillance system. 

HIV/AIDS  surveillance12  for  Europe  is  carried  out  by  the  ECDC  in  cooperation  with  the 
WHO  Regional  Office  for  Europe,  and  by  UNAIDS.  National  surveillance  systems  should 
become  fully  compatible  with  international  requirements  and  all  countries  should  report 
regularly on their HIV/AIDS epidemics. Second generation and behavioural surveillance must 
be  intensified  to  better  understand  the  dynamics  of  the  epidemic  in  Europe.  Policy 
development and implementation need solid and quality data, hence more behavioural studies 

12 

Cf. Decision No 2119/98/EC. 

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would  be  needed.  Policy  makers  need  better  evidence  on  what  drives  the  epidemic.  The 
contribution  of  sexually  transmitted  infections  (STIs)  to  the  transmission  of  HIV  should  be 
assessed  to  inform  policies  and  result  in  improved  prevention,  diagnosis,  treatment  and 
monitoring. 

The Commission 

–  urges all Member States, building on the surveillance carried out under Decision 2119/98 
EC, to gather even more robust and comprehensive data on HIV/AIDS and STIs, including 
on co-infections 

–  asks  the  ECDC  to  strengthen  the  cooperation  with  neighbouring  countries  and  other 

partners such as UNAIDS 

4.2. 

Research and medicine 

More biological, medical and social science is needed to reach solutions. 

The Commission further encourages long-term public and private investment into research for 
the  development  of  new  and  improved  prevention  technologies  and  treatments  for  HIV  and 
associated infections. The high incidence of tuberculosis and multidrug resistant tuberculosis 
is especially worrying and must be closely monitored and effectively addressed. Broad access 
to  integrated  medical  services  and  investment  in  effective  health  care  infrastructures  are 
critical to control of the spread of these infections. Understanding and responding effectively 
to  the  spread  of  HIV  and  co-infections  requires  more  social,  behavioural  and  economic 
research,  as  well  as  knowledge  translation  into  effective  evidence-informed  policy  and 
programming. 

The Commission 

–  will  further  provide  resources  to  improve  research  focusing  on  HIV  and  associated 

opportunistic infections through the research framework and health programmes 

–  reiterates the need to amplify efforts in vaccine, including new technologies for vaccines, 

microbicides and in new therapeutics, research and development 

–  will  further  support  investments  towards  the  development  and  implementation  of 

innovative preventive and therapeutic interventions 

–  will  work  with  all  stakeholders  to  concentrate  more  efforts  on  HIV/AIDS  related  social 

science research 

5. 

EXPECTED OUTCOMES 

The  Commission  expects  that  actions  realised  in  cooperation  with  Member  States, 
neighbouring countries and all stakeholders across Europe in line with the above mentioned 
priorities will lead to: 

•  A decreased number of in HIV infections, access to HIV testing for anyone at risk, and 
universal access to treatment, care and support through improved cross-border cooperation, 
targeted  prevention  measures,  harm  reduction  measures,  information  on  risk  reduction, 

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universal  access  to  safe  and  affordable  medicines  and  integrated  medical  and  social 
services. Individual risk behaviour shall be minimised in order to avoid HIV transmission.  

•  A real improvement of the quality of life of people living with HIV and most at risk 
populations. PLWHA and most at risk populations should have general access to testing, 
prevention,  treatment  and  care  services,  to  harm  reduction  measures,  to  secondary 
prevention and to social and psychological services. The European Union supports a broad 
integration  of  PLWHA  into  labour  and  social  processes  and  in  HIV/AIDS  policy 
development, implementation and assessment. 

•  Strengthened 

solidarity 

towards  an  unambiguous  response 

to  HIV/AIDS. 
Discrimination  and  stigmatisation  associated  with  HIV/AIDS  must  be  tackled  across 
Europe  and  across  all  layers  of  society.  This  should  result  in  more  evidence  based 
interventions  against  HIV/AIDS,  in  better  infrastructures  and  improved  access  to 
information, testing, treatment, care and support. 

•  Improved education, knowledge and awareness on HIV/AIDS. The inclusion of sexual 
and reproductive health education in school curricula would be beneficial for HIV and STI 
prevention  and  should  receive  broad  political  support.    Young  people  should  also  be 
empowered  and  involved  in  the  shaping  of  information  that  concerns  them,  and  tailored 
information  should  be  developed,  particularly  for  youth  at  risk  of  social  exclusion. 
Restricted  knowledge  and  unawareness  of  facts  around  HIV/AIDS  and  STIs  lead  to 
increased  transmission  rates.  The  knowledge  base  shall  be  assessed  on  a  regular  basis  in 
order to prioritise distinct issues and to keep educational efforts close to the needs of target 
groups. 

6. 

ACTION PLAN, MONITORING AND EVALUATION 

This Commission communication is complemented by an operational action plan to be further 
developed  in  cooperation  with  the  HIV/AIDS  Think  Tank,  the  Civil  Society  Forum  and 
external stakeholders along the lines of the political actions presented here.  

EU  actions  will  be  funded  through  the  2008-13  Health  Programme  and  eligible  countries 
should make use of structural funds. Funding may also be available through the 7th Research 
Framework Programme. 

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An  independent  evaluation  of  the  overall  EU  intervention  to  combat  HIV/AIDS  in  Europe 
will be carried out by 2012 to assess the impact and relevance of the actions. With the support 
of  the  ECDC,  the  HIV/AIDS  Think  Tank,  the  CSF and  selected international organisations, 
the Commission will identify suitable indicators to monitor and assess the implementation of 
this Communication and the action plan. The Commission and its stakeholders will  identify 
organisations  responsible  for 
the 
implementation process.  

implementation  of  attributed  actions  during 

the 

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