HIV This Week

Atun RA, McKee M, Coker R, Gurol-Urganci I. Health systems' responses to 25 years of HIV in Europe: Inequities persist and challenges remain. Health Policy. 2008; 86(2-3):181-94.

Europe is currently experiencing the fastest rate of growth of HIV of any region of the world. An analysis of policy and health system responses to the HIV epidemic in Europe and central Asia (hereafter referred to as Europe) over the last 25 years reveals considerable heterogeneity. In general, while noting hazards of broad generalisations and the differences that exist across countries in a particular grouping, effective policies to control HIV have been implemented more widely in western than in central and Eastern Europe. However, the evidence suggests persistence of inequalities in access to preventive and treatment services, with those at highest risk, such as sex workers, prisoners, injecting drug users, and migrants often particularly disadvantaged, despite many targeted programmes. Responses in individual countries, especially in the early stages of the epidemic, were influenced by specific cultural and political factors. Strong leadership and active involvement by civil society organisations emerge as important factors for success but also a limiting factor to the response observed in Eastern Europe, where civil society or Non-Governmental Organization culture is weak as compared to Western Europe. Scaling up of effective responses in many countries in Eastern Europe will be challenging. Increased financial resources will have to be accompanied by broader changes to health system organization with greater involvement of civil society in planning and delivery of client-focused services.

Editors’ note: This desk review combined countries with differing socioeconomic, cultural, and health systems characteristics into four broad groupings: Western, Central, Eastern Europe, and Central Asia. The multi-sectored, client-focused interventions of Western Europe are integrated into mainstream health systems offering broad coverage, but inequities persist for marginalized people. In the countries of Eastern Europe facing HIV, IDU, STI, and TB epidemics, new resources directed at programmatic interventions alone will not be effective in addressing either the HIV epidemic or the persistent inequities that exacerbate it, nor will they be sustainable. The design and implementation of multifaceted and multi-sectored programmes must be shaped by the local, political, economic, social, and legal contexts and serve to strengthen health systems, surveillance, monitoring and evaluation, and civil society engagement.