Health systems’ responses to 25 years of HIV in Europe: Inequities persist and challenges remain

Atun, Rifat; Coker, Richard; Gurol‐Urganci, Ipek

doi:10.1016/j.healthpol.2007.10.004

Cited by 15 publications

(8 citation statements)

References 164 publications

(160 reference statements)

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“…Los análisis señalan que las barreras de acceso a la prevención y al TARV contribuyen a mayores prevalencias de VIH en la población inmigrante 66 . Es importante realizar esfuerzos para eliminar las barreras de acceso y uso del sistema sanitario en cuanto a la epidemia de VIH se refiere.…”

Section: Discussionunclassified

Infección VIH/Sida y otras infecciones de transmisión sexual en la población inmigrante en España: revisión bibliográfica

Rovirola

Ortiz-Barreda

Montemayor

et al. 2014

Rev. Esp. Salud Publica

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RESUMENFundamentos: Los flujos migratorios tienen la capacidad de dispersar agentes infecciosos y alterar las epidemiologías locales. El objetivo del estudio es describir las características socio-epidemiológicas, clínicas y de microbiología/epidemiología molecular de la infección VIH/Sida en la población inmigrada.. Métodos:Revisión de la literatura científica mediante la metodología de Scoping Review. Se realizó una búsqueda bibliográfica en las bases de datos Medline y MEDES. Se seleccionaron artículos originales realizados en España y publicados entre 1998-2012, en los que participara población procedente de América Latina, África subsahariana, Norte de África, Asia y Europa del Este.Resultados: Se seleccionaron 41 artículos. La población más estudiada fue la de América Latina (48,8%). Se observaron prevalencias mayores de VIH que en autóctonos en los hombres que tienen sexo con hombresde América Latina (18,1%), travestis y transexuales trabajadores del sexo de América Latina (23,3%), mujeres gestantes (0,9%) y hombres y mujeres de África Subsahariana (9,1% y 7,5%). Las conductas de riesgo fueron diferentes en función del país de origen y del sexo. El retraso diagnóstico llegó al 43% de las infecciones VIH, hallándose mayor prevalencia en inmigrantes de África subsahariana, que mostraron retraso diagnóstico en el 41% y resistencias al tratamiento anti-retroviral en el 13%. Las mujeres inmigrantes presentaron más pérdidas de seguimiento, peor respuesta inmunológica al TARV y menor tiempo de fracaso terapéutico.Conclusiones: La mayor prevalencia de VIH la presentan los sujetos procedentes de África subsahariana y los hombres que tienen sexo con hombres y travestis y transexuales trabajadores del sexo de América Latina. También las mujeres gestantes. El retraso diagnóstico y las resistencias al tratamiento son más frecuentes en sujetos de África Subsahariana. Las mujeres inmigrantes respondieron peor al tratamiento antiretroviral. Background: Migration flows have the ability to disperse infectious agents and alter local epidemiologies. The aim of the study is to describe the socio-epidemiological, clinical and microbiology / molecular epidemiology of HIV / AIDS infection in the immigrant population.

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Section: Discussionunclassified

Infección VIH/Sida y otras infecciones de transmisión sexual en la población inmigrante en España: revisión bibliográfica

Rovirola

Ortiz-Barreda

Montemayor

et al. 2014

Rev. Esp. Salud Publica

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“…However, many areas of the world report an increasing HIV-incidence rate among DU [6], [15], [25]–[27]. This epidemiologic discrepancy could be a result of inequalities in access to harm-reduction programmes and treatment services [15]. Coverage of HIV treatment and prevention services is highest in Western Europe, reaching 61% of the injecting DU [28].…”

Section: Discussionmentioning

confidence: 99%

“…Coverage of HIV treatment and prevention services is highest in Western Europe, reaching 61% of the injecting DU [28]. As one of the first countries in Western Europe, the Netherlands initiated harm-reduction programmes in the 1980s [15]. The declining trend in the use of needle exchange, as observed in the ACS, was confirmed by a reduction in the absolute number of exchanged needles per calendar year in Amsterdam, which peaked in 1992 with 1,100,000 needles, whereas since 2007 about 150,000 needles per year were exchanged.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that comprehensive harm-reduction programmes contributed to the stabilisation or even decline of HIV incidence among DU in the Netherlands and other countries in Western Europe and North America [13]–[15]. However, harm-reduction programmes are usually directed at reducing injection risk behaviour and less at reducing sexual risk behaviour [16].…”

Section: Introductionmentioning

confidence: 99%

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Drug Users in Amsterdam: Are They Still at Risk for HIV?

et al. 2013

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Background and AimsTo examine whether drug users (DU) in the Amsterdam Cohort Study (ACS) are still at risk for HIV, we studied trends in HIV incidence and injecting and sexual risk behaviour from 1986 to 2011.MethodsThe ACS is an open, prospective cohort study on HIV. Calendar time trends in HIV incidence were modelled using Poisson regression. Trends in risk behaviour were modelled via generalized estimating equations. In 2010, a screening for STI (chlamydia, gonorrhoea and syphilis) was performed. Determinants of unprotected sex were studied using logistic regression analysis.ResultsThe HIV incidence among 1298 participants of the ACS with a total follow-up of 12,921 person-years (PY) declined from 6.0/100 PY (95% confidence interval [CI] 3.2–11.1) in 1986 to less than 1/100 PY from 1997 onwards. Both injection and sexual risk behaviour declined significantly over time. Out of 197 participants screened for STI in 2010–2011, median age 49 years (IQR 43–59), only 5 (2.5%) were diagnosed with an STI. In multivariable analysis, having a steady partner (aOR 4.1, 95% CI 1.6–10.5) was associated with unprotected sex. HIV-infected participants were less likely to report unprotected sex (aOR 0.07, 95% CI 0.02–0.37).ConclusionsHIV incidence and injection risk behaviour declined from 1986 onwards. STI prevalence is low; unprotected sex is associated with steady partners and is less common among HIV-infected participants. These findings indicate a low transmission risk of HIV and STI, which suggests that DU do not play a significant role in the current spread of HIV in Amsterdam.

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“…Additional efforts are still needed to create prevention programs that not only strengthen the ailing post socialist healthcare system but also fight against human rights abuses among the HIV/AIDS victims. A multi-sectoral approach that elevates the role of civil society while enhancing the role of legal sector and ultimately decriminalizing IDU harm reduction therapy can provides provisions of care as well as access to legal clinics whereby designing an effective interventions program for IDUs that can remove the "policing" out of public health policy aspects of harm reduction [44,45,32,46,47]. The overall obstacles in providing an effective prevention among IDUs and CSWs is the absence of a multi-sectoral effort and if the war on HIV/AIDS epidemic to be won in the near future in CEE a civil society committed to a universal access to treatment, care and in particular harm reduction programs should be addressed [48][49][50].…”

Section: Prevention Strategies Among Risk Groups and Risk Environmentsmentioning

confidence: 99%

The quest for multi-sectoral HIV/AIDS prevention in Central and Eastern Europe and why it matters

Vadiee

2011

HIV & AIDS Review

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a b s t r a c tBackground: The HIV/AIDS epidemic is continuing to expand in Central and Eastern Europe against a background of transition and disparities in welfare. In absence of a multi-sectoral HIV/AIDS prevention strategy among the risk groups in Eastern and central Europe obstacles in reaching the key prevention targets will continue to remain. Method and search strategy: We performed a systematic literature search using key terms such as; HIV/AIDS, Central and Eastern Europe (CEE), multi-sectoral prevention to review studies that reported on extent of multi-sectoral implementation in CEE. Results: The mobilization and capacity building among the communities remains a challenge in CEE. The prevention strategies aimed at IDUs, CSWs and adolescent young women should be formulated with a real understanding of their risk environments. The civil society and the involvements of the broader political system is crucial in decriminalization of harm reduction programs among IDUs. HIV prevention among women and adolescent should be strategized in the context of broader sexual and reproductive health rights. Conclusion: A multidisciplinary and multi-sectoral HIV/AIDS prevention in CEE needed in order to efficiently and effectively address the growing East-West Epidemiological divide.

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Health systems’ responses to 25 years of HIV in Europe: Inequities persist and challenges remain

Cited by 15 publications

References 164 publications

Infección VIH/Sida y otras infecciones de transmisión sexual en la población inmigrante en España: revisión bibliográfica

Infección VIH/Sida y otras infecciones de transmisión sexual en la población inmigrante en España: revisión bibliográfica

Drug Users in Amsterdam: Are They Still at Risk for HIV?

The quest for multi-sectoral HIV/AIDS prevention in Central and Eastern Europe and why it matters

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