WHO Regional Office for Europe

Progress on Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia

In line with the 33rd action of the Dublin Declaration (see Box 1), UNAIDS,under the overall coordination of the WHO Regional Office for Europe Sexually Transmitted Infections/HIV/AIDS programme has developed the following proposal for a Dublin Declaration progress report to be finalised during the German EU presidency (by end June2007).

The Dublin Declarationis a central document that sets out 33 actions related to leadership, prevention,living with HIV/AIDS (including treatment and care) and partnershipin the 53 countries of the European Region.Since the signing of the Declaration in February 2004, in 2005, leaders of the G8 countries agreed to “work with WHO, UNAIDS and other international bodies to develop and implement a package for HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010”. This goal was endorsed by United Nations Member States at the High-Level Plenary Meeting of the 60th Session of the UN General Assembly in September 2005. At the June 2006 General Assembly High Level Meeting on AIDS, UN Member States agreed to work towards the broad goal of “universal access to comprehensive prevention programmes, treatment, care and support” by 2010. The Dublin Declaration progress report fits in with monitoring these and current EU aims on HIV/AIDS.[1]

Matrix of HIV/AIDS indicators

WHO Europe initiated the follow-up process of the Dublin Declaration by convening the major actors to review relevant indicators at a meeting on 2224 March 2006.[2]WHO Europe hassince drafted a matrix which incorporates the information currently collected by each agency and by category, e.g., basic epidemiological indicators, service indicators and indicators related to prevention, behaviour and treatment. The matrix includes the existing indicators employed in current data collection efforts, such as UNGASS and the Millennium Development Goals at the global level, and the WHO, EMCDDA, EUROHIV, UNODC, UNICEF and other efforts at the regional level. It will point out further indicators that are not necessarily being systematically collected but should be in order to monitor progress towards fulfilling the actions set out in the Dublin Declaration.

Thematic sections

In addition to available current data reported in a set of country profiles, the report will contain 15 thematic chapters as outlined on the following pages.They should review progress since February 2004 for their respective topics and include key references. Further, they should draw on the data for each of the 33 actions’ indicators, as set out in the indicator matrix, and critically review these indicators and their data sources, including suggestions for new ones where relevant. Each chapter should be between 2 and 10 pages.

For each chapter there will be a lead agency/author(s) and an advisory group. The former may choose to hire a consultant to assist with the development of the section, but will be responsible for ensuring the timely delivery of the material. The advisory group will include governmental (e.g. HIV/AIDS ministerial focal points) and non-governmental experts in addition to the EU (e.g. from ECDC, EMCDDA and DG Sanco and Research) and UN experts. All members of the EU Civil Society Forum will be invited to join the advisory groups.

In March 2007, during the German Presidency of the European Union, a European HIV/AIDS conference entitled “Responsibility and Partnership  Together Against AIDS” will be held in Bremen, Germany, and WHO has agreed to release the outline of the progress report including the matrix of HIV/AIDS indicators to be included.

Under the auspices of UNAIDS, WHO Europe will be responsible for the overall coordination in addition to specific sections of the report as outlined below.

Contents:

Foreword: 1 page

I.Introduction 23 pages

II. 15 thematic overviews: 210 pages each

Leadership and Partnership

Political leadership(Commitments 1, 3, 5, 6, 22, 26, 30, 32, 33)
Community involvement and the private sector(Commitments 2, 4, 5, 24, 27, 30, 32)
Resource generation(Commitments 1, 7, 8, 9, 13, 17, 29)

Prevention

Injecting drug use and HIV(Commitment 10, 13, 25)
Most vulnerable and high-risk populations(Commitments 9, 13, 18, 25)
Gender equity (Commitments 10, 13, 14, 20, 21)
PMTCT and paediatric AIDS (Commitments 3, 11, 12, 14)
Young people(Commitments 3, 8, 13, 14, 18)
HIV at the workplace (Commitments 2, 15, 28)
Sexually transmitted infections(Commitment 16)
Research and new technologies(Commitments 19, 24, 29)

Living with HIV/AIDS

Treatment and care(Commitments 13, 21, 23, 25, 28)
Stigma, discrimination and human rights(Commitments 1, 20, 31)
Testing and counselling (Commitments 10, 13)
HIV in prisons (Commitments 9, 10, 13, 16, 20, 21)

III. Seven country reports(France, Germany, Poland, Portugal, Republic of Moldova, Ukraine, the United Kingdom): ca. 60 pages. Structured according to the 15 thematic areas

IV. Matrix/statistical annex and chapter on surveillance and quality of the data in the matrix (Commitment 17 on surveillance systems)

Timeline:

12 January2007: Agree on the joint publication and contents
5 January22 January2007: Finalise matrix of indicators to be reported
25 January 2007: Commission thematic material
1213 March 2007 (Bremen HIV/AIDS conference): Present work in progress
4 April: Thematic sections first full draft completed
527 April: Editing of the thematic sections
FebruaryApril2007: Prepare country reports
117 May: Country reviews of country reports
1 May4 June2007: External review and revisions
18 May18 June2007: Copy-editing
1922 June2007: Layout
End June2007: Publication
Summer 2007: Development of a policy brief
Autumn 2007: Discussion at the EU Think Tank and Civil Society Forum and at the Portuguese EU Presidency HIV/AIDS meeting (1213 Oct 2007)
June 2008: Possible inclusion of policy brief at health systems ministerial conference

WHO Europe (Sexually transmitted infections/HIV/AIDS programme) focal points:

Responsible officer: Srdan Matic [
Overall coordination:Jeffrey Lazarus [
Indicator matrix:Ulrich Laukamm-Josten [
Country reports: Stine Nielsen [

Editorial advisory board

Henrique Barros [ (Portuguese Ministry of Health)
Ton Coenen [ (Co-chair EU Civil Society Forum)
Nikos Dedes [ (Co-chair EU Civil Society Forum)
Ian Grubb [ (WHO HQ)
Michael Huebel [ (European Commission)
Gisela Lange [ (German Ministry of Health)
Bertil Lindbland [ (UNAIDS)
TBC: Angus Nicoll [ (ECDC)
Paul Griffiths[ (EMCDDA)

II. The 15 thematic sections:

1. Political leadership

Dublin Declaration commitments:

1, 3, 5, 6, 22, 26, 30, 32, 33

Responsible agency: UNDP Shombi Sharp [

Advisory group:UNAIDSBertil Lindbland [, WHO Europe, DG Sanco, AIDS Action Europe: Ton Coenen[, HIV Europe/HIV-Sweden: Andreas Berglöf [, NAT: Yusef Azad [, EATG: Pedro Silvério Marques [,NGO “DIALOGS” Latvia: Ruta Kaupa [, Union Alternative Georgia: David Otiashvili [, East Europe and Central Asia Union of PLWH (ECUO): Natasha Leonchuk [, All-Ukrainian Network of PLWH: Vladimir Zhovtyak [ & Iryna Borushek [, CEEHRN: Raminta Stuikyte [

Questions to address:

Is strong and accountable leadership at the level of heads of state and government being promoted?
Are human rights promoted and how?Is stigma being addressed and how? (link to section 14 on testing and counselling)
Do political leaders address what puts people at risk, e.g. trafficking, drug use? Are there are alternatives to incarceration?
Are access to education, information and services for all those in need ensured?
Is the implementation of provisions of the Declaration of commitments accelerated related to orphans, boys and girls?
Has HIV/AIDS been made and kept as a regular item on the agendas of regional institutions and organizations?

Issues to address:

EU Think Tank and Civil Society Forum (development)
EU communications (outlined in brief)
Council of Europe resolution
German EU Presidency Bremen HIV/AIDS conference
Country coordinating mechanisms (CCMs)/ three ones principles
G8 in Gleneagles and St. Petersburg (attn to HIV/AIDS)
UN theme groups (how they work in brief, progress since Feb 2004)
National examples of leadership (AIDS ambassador, policies in place, testing of prominent individuals, AIDS on political agenda etc)
Has the active involvement of EU, CIS, OSCE, Council of Europe, WHO, UNAIDS been promoted?(re. commitment 5)
European Commission Civil Society Forum
Establishment of AIDS Action Europe (AAE) and HIV Europe since Dublin
WHO Europe civil society technical planning meeting + Memoranda of Understanding, Regional Committee participation
UNAIDS and CIS PLWHIV network
UNGASS 2006 follow-up involvement
Bremen conference Partnership forum (12-13 March 2007)

2. Community involvement and the private sector

Dublin Declaration commitments:

2, 4, 27, 30, 32

Responsible agency: WHO Europe, Jeffrey Lazarus [ with Misha Hoekstra [

Advisory group: AIDS Action Europe: Ton Coenen [, Deutsche AIDS-Hilfe:Luis Carlos[Dirk Hetzel [, EATG, GNP+, HIV Europe/HIV-Sweden: Andreas Berglöf [, DG Sanco, OSI/IHRD: Mauro Guarinieri [ Daniel Wolfe [, UNAIDS, NGO "DIALOGS Latvia:Ruta Kaupe [, Russian Harm Reduction Network: Vitaly Djuma [, NGO Aksion Plus Albania: Genci Mucollari & Irida Agolli [, East Europe and Central Asia Union of PLWH (ECUO): Natasha Leonchuk [, All-Ukrainian Network of PLWH: Vladimir Zhovtyak [ & Iryna Borushek [, CEEHRN: Catalina Iliuta [ & Raminta Stuikyte [, EATG: Pedro Silvério Marques[, WHO HQ: Ted Karpf [

Questions to address:

Is strong leadership by the civil society encouraged?
Is strong leadership by civil society facilitated?
Is strong leadership by the private sector encouraged?
Is strong leadership by the private sector facilitated?
Is a national partnership forum established involving civil society and PLWHA?
Has the national partnership forum strengthened involving civil society and PLWHA?
Have they been able to take a meaningful role in design, review, monitoring and reporting progress?
Has timely action been taken to identify barriers?
Has timely action been undertaken to remove those barriers?
NGO Code of Conduct
GIPA principle
Mechanism to involve civil society including PLHIV in national AIDS commissions, CCM, etc.

3. Resource generation

Dublin Declaration commitments:

1, 7, 8, 9, 13, 17, 29

Responsible agency: UNAIDS,Bertil Lindbland [

Advisory group: TBC Clinton Foundation, AIDS & Mobility Europe: Georg Bröring [,GFATM TBC Urban Weber, WHO/Europe (Ulrich Laukamm-Josten),NGO Aksion Plus Albania: Genci Mucollari [, East Europe and Central Asia Union of PLWH (ECUO): Natasha Leonchuk [, All-Ukrainian Network of PLWH: Vladimir Zhovtyak [ & Iryna Borushek [, EATG: Wim Vandevelde [, Danish AIDS Fondet: Kirsten Jensen (TBC) [

Question to address:

Have national allocations been increased?
Have regional allocations been increased?
Have allocations to the regional work of UN system for HIV/AIDS in Europe been increased?
Have allocations to GFATM been increased?
Have GFATM allocations in Europe been increased?
Have new public and private partnerships, multilateral and bilateral funding mechanisms been established and maintained?
Have technical resources been provided for scale up?

Issues to address:

National AIDS accounts
Estimates and gaps (national and regional)
Types of resources: financial, institution building
GFATM funding in Europe
Clinton Foundation price negotiations impact in Europe
Canadian and other bilateral funding (for 3 by 5)
Any newly developed public-private partnerships with pharmaceutical industry (re. commitment 29)?

4. Injecting drug use and HIV

Dublin Declaration commitments:

9, 10, 13, 25

Responsible agency: WHO Europe, Martin Donoghoe [,EMCDDA, Paul Griffiths[

Advisory group: AFEW: Robin Montgomery (TBC) & Joost van der Meer (TBC) [, IHRD/OSI:Daniel Wolfe [ &Mauro Guarinieri [,UNODC: Monica Beg [, WHO HQ:Annette Verster [, EMCDDA: Lucas Wiessing [, Mainliners: Nicola Rowan [, Russian Harm Reduction Network: Vitaly Djuma [, Community of PLHIV Russia: Shona Schonning [, Union Alternative Georgia: David Otiashvili [, NGO Aksion Plus Albania: Genci Mucollari & Arjan Harxhi [,CEEHRN: Catalina Iliuta [ & Raminta Stuikyte [, EATG: Luìs Mendão [, Deutsche AIDS-Hilfe: Dirk Schäffer [

Questions to address:

Has access to prevention for IDU been scaled up?
Has access to drug dependence treatment for IDU been scaled up?
Has access to harm reduction for IDU been scaled up?
Has access to prevention, drug dependence treatment and harm reduction for IDU been enabled, strengthened and widespread?
Have national policies been in place to enable, strengthen, and scale up prevention for IDU?
Are national policies in line with international standards and recommendations?

Issues to address:

Access to needle and syringe programmes (NSP)
Access to opioid substitution therapy (OST)
Access to other dependence treatment apart from OST
Voluntary testing and counselling for IDUs
Treatment and adherence
Reproductive health incl. targeted STI prevention and condom programming for IDUs
Targeted information, education and communication (IEC) for IDUs and their sexual partners
HBV vaccination; HCV diagnosis and treatment for IDUs
TB diagnosis and treatment for IDUs
Gaps in surveillance
Differences between east and west Europe

Legislation: What do the laws state on:
Drug use
Drug treatment

5. Most vulnerable and high-risk populations

Dublin Declaration commitments:

9, 13, 18, 25

Responsible agency: Terrence Higgins Trust, UK, Lisa Power [, with GNP+, Julian Hows [

Advisory group: UNFPA: Aleksandar Bodiroza [, IOM Janet Hatcher-Roberts [, [, AFEW: Robin Montgomery (TBC) & Joost van der Meer [, AIDS & Mobility Europe: Georg Bröring [, Deutsche AIDS-Hilfe: Luis Carlos [ Rainer Schilling [ & Silke Klumb [, OSI: Mauro Guarinieri [ & Daniel Wolfe [, UNODC:Paul Williams [ and Fabienne Hariga [, Tampep International Foundation: Licia Brussa [, NAT: Yusef Azad [mailto:,[,WHO/Europe: Martin Donoghoe [mdo.euro.who.int]Monique Munz [, Stop AIDS Denmark: Jakob Haff [, JAZAS Belgrade: Viktorija Cucic [, AIDES France: Arnaud W. Simon [, NGO Aksion Plus Albania: Genci Mucollari & Arjan Harxhi [, CEEHRN: Catalina Iliuta [ & Raminta Stuikyte [, EATG/Deutsche AIDS-Hilfe: Peter Wiessner [, EATG: Luìs Mendão [,

Questions to ask:

Are 80% of MSM covered with a wide range of prevention programmes?
Are 80% of SW covered with a wide range of prevention programmes?
Are 80% of IDU covered with a wide range of prevention programmes (link with thematic section 4)?
Are 80% of ethnic and national minorities covered with a wide range of prevention programmes?
Are 80% of migrant workers covered with a wide range of prevention programmes?
Are 80% of prisoners covered with a wide range of prevention programmes?
Are factors making MSM vulnerable to HIV addressed, their health promoted and protected, and has collaboration been established?
Are factors making SW vulnerable to HIV addressed, their health promoted and protected, and has collaboration been established?
Are factors making IDU vulnerable to HIV addressed, their health promoted and protected, and has collaboration been established? (link with thematic section 4)?
Are factors making ethnic and national minorities vulnerable to HIV addressed, their health promoted and protected, and has collaboration been established?
Are factors making migrant workers vulnerable to HIV addressed, their health promoted and protected, and has collaboration been established?
Are factors making prisoners vulnerable to HIV addressed, their health promoted and protected, and has collaboration been established?

Issues to address:

MSM (e.g. lack of data from eastern Europe and prosecution)
SW (male and female)
Migrants (especially western Europe): estimates, challenges, criminal prosecution
IDUs (addressed in previous section but discuss overlap with e.g. SW)
Prisoners and former inmates
Ethnic minorities

6. Gender equity

Dublin Declaration commitments:

10, 13, 14, 20, 21

Responsible agency: WHO Europe Isabel Yordi [ with Corinne Carey [

Advisory group:

WHO Europe: Martin Donoghoe [Lali Khotenashvili [, Human Rights Watch:Rebecca Schleifer [, Tampep International Foundation: Licia Brussa [,Intl Harm Reduction Development Program: Sophie Pinkham [,CEEHRN: Raminta Stuijyte [, Russian Harm Reduction Network: Anya Sarang [, AIDES France: Aurelie VERNY [, ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Health and Rights: Wanda Nowicka [, NGO Aksion Plus Albania: Irida Agolli [, Deutsche AIDS-Hilfe: Karl Lemmen [,

The chapter should be structured as follows:

Introduction on gender equity and HIV (2-3 pages), explaining that gender equity should be integrated in all of the Dublin actions and the indicators to monitor them, but that this chapter will focus mainly on 4 specific topics:

Harm reduction (action 10)
Sexual and reproductive health (action 13, 14), including the possibility for women and children to protect themselves from the virus, and how to work with men to take responsibility to achieve this.
Stigma and discrimination (action 20)
Treatment (action 21)

Sample for section a: Questions to consider when focusing on harm reduction (in close consultation with thematic section 4):

What are the trends in male/female drug consumption?
Are there differences in how men and women access harm reduction services and how the legal situation influences this?
Are there sex differences in harm reduction data? (e.g. clean needle and syringe provision, and opioid substitution therapy)?
Do existing therapies affect men and women differently?
Are there differences in adherence to treatment?
What is the impact of treatment on pregnancy?
Are there issues in the legal situation that may affect women access to harm reduction services? Social protection, child care…
How is stigma different for female drug users?
Are women more likely to be treated as if they have a mental health problem, or as if they are criminals?
Are harm reduction programmes addressing specific women’s issues, such as reproductive health? Link with reproductive health services.
Service provision: gender sensitivity in programme design, gender awareness of staff.
Links between gender and ethnicity.
Links between IDU and sexual transmission: empowerment of women and girls.

7. PMTCT and paediatric AIDS

Dublin Declaration commitments:

11, 12, 14

Responsible agency: UNICEF, Nina Ferencic [

Advisory group: ASTRA: Wanda Nowicka [, STI AIDS Netherlands:Ajoke ter Meulen [, ICW: Alice Welbourn (TBC) [, IPPF EN: Vickey Claeys (TBC) [, WHO Europe: Mikael Oestergren[, WHO HQ: Ekaterina Filatova [, AIDES France: Aurelie Verny [, East Europe and Central Asia Union of PLWH (ECUO): Natasha Leonchuk [, All-Ukrainian Network of PLWH: Vladimir Zhovtyak [ & Iryna Borushek [,