SPECIAL REPORT Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2010 Progress Report www.ecdc.europa.eu ECDC SPECIAL REPORT Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2010 progress report A summary of this report, entitled ‘Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2010 Progress Report – Summary’, was published by ECDC in June 2010. Suggested citation: European Centre for Disease Prevention and Control. Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2010 progress report. Stockholm: ECDC; 2010. The maps are reproduced with the permission of the WHO Regional Office for Europe. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. Stockholm, September 2010 ISBN 978-92-9193-214-6 doi 10.2900/31283 © European Centre for Disease Prevention and Control, 2010 Reproduction is authorised, provided the source is acknowledged. SPECIAL REPORT Implementing the Dublin Declaration: 2010 progress report Table of contents Abbreviations ................................................................................................................................................. vi Acknowledgements ........................................................................................................................................ viii Executive summary .......................................................................................................................................... 1 Introduction and background ............................................................................................................................ 4 Overview of the HIV epidemic in the region ....................................................................................................... 5 Method ........................................................................................................................................................... 7 Limitations .................................................................................................................................................... 10 1 Leadership and partnership ......................................................................................................................... 11 1.1 Political leadership – planning and coordination ...................................................................................... 11 1.1.1 Introduction .................................................................................................................................. 11 1.1.2 Strategic planning ......................................................................................................................... 11 1.1.3 Political support ............................................................................................................................. 12 1.1.4 Conclusions ................................................................................................................................... 15 1.2 Civil Society .......................................................................................................................................... 17 1.2.1 Introduction .................................................................................................................................. 17 1.2.2 Organisational structures ............................................................................................................... 17 1.2.3 Working relationship between civil society and government ............................................................. 18 1.2.4 Inclusiveness and diversity ............................................................................................................. 19 1.2.5 Outcomes of the relationship between civil society and government ................................................. 19 1.2.6 Conclusions ................................................................................................................................... 21 1.3 Financial resources ............................................................................................................................... 23 1.3.1 Introduction .................................................................................................................................. 23 1.3.2 Financial resources for national responses to HIV and AIDS ............................................................. 23 1.3.3 Financial resources from the countries of Europe and central Asia to HIV-related services in the most affected countries internationally ................................................................................. 30 1.3.4 Conclusions ................................................................................................................................... 35 2 Prevention .................................................................................................................................................. 37 2.1 HIV prevention: an overview ................................................................................................................. 37 2.1.1 Introduction .................................................................................................................................. 37 2.1.2 Policies and strategies ................................................................................................................... 37 2.1.3 Prevention needs ........................................................................................................................... 41 2.1.4 Access to prevention services ......................................................................................................... 42 2.1.5 Implementation: achievements and challenges ............................................................................... 43 2.1.6 Conclusions ................................................................................................................................... 45 2.2 Injecting drug users .............................................................................................................................. 47 2.2.1 Introduction .................................................................................................................................. 47 2.2.2 HIV prevalence in injecting drug users ............................................................................................ 47 2.2.3 HIV testing in injecting drug users .................................................................................................. 52 2.2.4 HIV programme coverage for injecting drug users ........................................................................... 54 2.2.5 HIV-related knowledge of injecting drug users ................................................................................ 61 2.2.6 Condom use by injecting drug users ............................................................................................... 63 2.2.7 Use of sterile injecting equipment ................................................................................................... 65 2.2.8 Conclusions ................................................................................................................................... 69 2.3 Men who have sex with men ................................................................................................................. 71 2.3.1 Introduction .................................................................................................................................. 71 2.3.2 HIV prevalence in men who have sex with men .............................................................................. 71 2.3.3 HIV testing in men who have sex with men .................................................................................... 75 2.3.4 HIV programme coverage for men who have sex with men .............................................................. 78 2.3.5 HIV-related knowledge of men who have sex with men ................................................................... 81 2.3.6 Condom use by men who have sex with men .................................................................................. 84 2.3.7 Conclusions ................................................................................................................................... 88 2.4 Sex workers ......................................................................................................................................... 90 2.4.1 Introduction .................................................................................................................................. 90 2.4.2 HIV prevalence in sex workers ....................................................................................................... 90 2.4.3 HIV testing in sex workers ............................................................................................................. 93 2.4.4 HIV programme coverage for sex workers ...................................................................................... 95 iii Implementing