Stenograma dezbaterilor

Miercuri, 19 noiembrie 2008 - Strasbourg

18. HIV/SIDA: Depistare şi tratament precoce (dezbatere)

  La Présidente. - L'ordre du jour appelle les déclarations du Conseil et de la Commission sur le VIH/SIDA: Dépistage et traitement précoce.

  Jean-Pierre Jouyet, président en exercice du Conseil. − Madame la Présidente, chère Martine Roure, Monsieur le commissaire Potočnik, Mesdames et Messieurs les députés, vingt-cinq années se sont écoulées depuis la découverte du VIH. Aujourd'hui, il est très important, à l'heure où l'épidémie a fauché plus de 25 millions de vies, que l'Union européenne réaffirme son engagement de lutter contre le fléau que représente cette pandémie mondiale qu'est le VIH/SIDA.

L'accès universel à la prévention, au dépistage, au traitement précoce et à l'appui dans ce domaine est essentiel, le Parlement européen, votre Assemblée, l'a bien souligné dans sa résolution du 24 avril 2007. Il est urgent d'accélérer le développement, mais aussi la mise en œuvre, de la prévention, des campagnes d'information, d'éducation et de sensibilisation, ainsi que l'investissement dans la recherche et le développement de nouvelles stratégies de prévention et de dépistage, qui doivent régulièrement s'adapter aux changements de la pandémie.

Il est notamment primordial d'améliorer la précocité du dépistage et du traitement ainsi que la mise à disposition de thérapeutiques antirétrovirales à un coût abordable. En effet, lorsque le diagnostic est réalisé trop tardivement ou lorsque l'immunodépression liée à la maladie est trop avancée, les patients présentent un risque accru de mortalité pendant les quatre années suivant le diagnostic.

Pour améliorer la précocité du dépistage, il paraît nécessaire d'utiliser de nouvelles stratégies et de nouveaux outils, tels que les tests de dépistage rapide. Il serait notamment intéressant d'élargir la proposition de test en la généralisant, sous réserve, bien sûr, de l'accord du patient. Il faut en effet rappeler que ces tests de dépistage rapide peuvent être réalisés en dehors d'un laboratoire d'analyses médicales et que les résultats peuvent être communiqués aux patients dans un délai relativement court.

Pour inciter les personnes vivant avec le VIH/SIDA à se faire dépister précocement, il est également essentiel de surmonter les barrières de la discrimination. La peur d'être stigmatisé en cas de résultat positif du test peut en effet entraver l'accès au dépistage précoce. C'est pourquoi l'Union européenne doit se prononcer clairement et constamment contre toute forme de discrimination à l'encontre des personnes vivant avec le VIH dans le monde entier.

C'est une conviction forte, surtout celle du Président de la République, Nicolas Sarkozy, et du ministre Bernard Kouchner, qui ont attiré l'attention des Nations unies sur ce point. Dès lors, s'agissant d'une maladie transmissible, mais non contagieuse, les restrictions à la liberté d'accès, de séjour, de résidence des personnes séropositives, du fait de leur statut sérologique VIH, sont contreproductives. En effet, une telle pratique dissuaderait les intéressés de recourir au dépistage ou, si nécessaire, d'accéder aux soins, ce qui est préjudiciable à la fois individuellement et collectivement.

En conclusion, je voudrais faire deux observations. La première, c'est que notre finalité commune est la suivante: les personnes dépistées dont le test est positif doivent bénéficier d'une prise en charge de qualité, quelle que soit leur origine, quels que soient leur nationalité, leurs opinions, leur âge, leur sexe, leur orientation sexuelle, leur religion ou tout autre statut.

La deuxième observation, c'est que, dans ce contexte, la coordination internationale est déterminante pour lutter contre la pandémie. Je veux ici rendre hommage au programme EuroHIV qui, depuis 1984, diffuse largement des données essentielles pour une meilleure connaissance du VIH et du SIDA auprès de l'OMS, de l'ONUSIDA et du European Centre for Disease Prevention and Control. Pour que la prévention, le dépistage et le traitement précoce soient accessibles à tous, pour que les personnes infectées ne soient plus ni stigmatisées, ni discriminées, pour que les pays du Sud aient un véritable accès aux médicaments, cette coopération avec les agences de l'ONU et les agences régionales doit s'intensifier.

L'Union européenne doit, plus que jamais, être mobilisée dans ce combat.

  Janez Potočnik, Member of the Commission. − Madam President, I would say to the honourable Members and to Minister Jouyet that, as we approach World AIDS Day on 1 December 2008, this plenary session provides a good opportunity to reflect on some significant achievements in combating HIV/AIDS and to focus on the serious challenges that lie ahead.

This year’s Nobel Prize for Medicine was awarded to two European researchers at the Pasteur Institute – Professor Françoise Barré-Sinoussi and Professor Luc Montagnier, who were the first to isolate the Human Immunodeficiency Virus back in 1983.

That landmark discovery paved the way for many important developments and diagnostics, and the treatment of HIV infections, and allowed us to understand more about the pathogenesis of HIV infections and its devastating consequences.

However, 25 years later we still do not have a cure for HIV/AIDS and still witness millions of new infections per year worldwide, including tens of thousands of new infections in Europe.

How can this happen? It is well known how HIV transmission can be effectively prevented.

Successful campaigns in the 1980s and the early 1990s have shown that awareness and knowledge are essential elements of prevention strategies against HIV infections.

Determined political leadership and civil responsibility are two further elementary prerequisites for successfully combating HIV/AIDS – as is an open and constructive partnership with the stakeholders.

Today’s plenary session is also an excellent time to reaffirm our political commitment – a time to be ambitious. I should add that I appreciate very much the European Parliament’s commitment in keeping HIV/AIDS high on the political agenda.

Indeed, we recently had a very useful exchange of views on HIV/AIDS in a round-table meeting organised by Vice-President Miguel-Angel Martínez Martínez and Zita Gurmai on the need for HIV testing and subsequent early ‘state of the art’ care and support. Experts estimate that an average of 30% of people in Europe infected with HIV are not aware of their status. That incredible figure carries two risks: first for the person concerned, since he or she may not receive treatment and care on time; and second for his or her partner(s), who may be exposed to the infection.

So what can we as politicians do to address and overcome this situation?

Our common humanistic core values and a strong commitment to human values, solidarity and our position against discrimination must be the basis of all policies to fight HIV/AIDS, and should be the foundation for all activities in combating the disease. The European position and response is clear: we concentrate on prevention and raising awareness; we promote HIV testing and access to treatment and care for all in need; we fight for affordable medication; we oppose and fight any form of discrimination or stigmatisation; we seek to identify best practice and support civil society. In areas within our political responsibility we have to create the conditions for effective actions on the ground, serving both society and people living with HIV and AIDS.

Clearly we cannot be complacent. We have to keep up the momentum.

The EU also looks beyond its borders to the devastating impact of HIV/AIDS in sub-Saharan Africa and other developing countries, which represent an exceptional challenge to social growth and development.

Eastern Europe and Central Asia continue to experience the fastest growth of the epidemic in the world.

In this context, we reaffirm our commitment to supporting partner countries in scaling-up towards universal access to HIV prevention, treatment, care and support.

On behalf of the Commission, I welcome the resolution on early diagnosis and early care of HIV/AIDS and fully endorse and support the principle of breaking down barriers to HIV testing, treatment and care.

The Commission further encourages people to use the possibility of HIV testing and reiterates to Member States the need to establish testing centres that meet international standards and operate according to agreed principles.

The Commission is currently developing its second strategy on combating HIV/AIDS in the EU and also our near neighbourhood, which will further concentrate on prevention and will focus on the regions and groups most affected by the epidemics. However, what a successful prevention approach needs most of all is openness and tolerance on a political and societal level: openness to the realities of our lives today, of sexuality and behaviours; openness to means of harm reduction; openness to fight inequalities, discrimination and suppression; and openness to other cultures and habits.

In facing up to the challenge of HIV/AIDS, the Commission will continue to play its role to the full. I know that we have Parliament’s support in this endeavour, and we treasure it highly.

Let us continue together the strong political momentum, together with the Council, to ensure that we all live up to our responsibilities.

  John Bowis, on behalf of the PPE-DE Group. – Madam President, in the United Kingdom we have 80 000 people living with HIV and, as the Commissioner has said, 1 in 3 of those is undiagnosed. We also have 1 in every 360 pregnant women HIV positive. Ten per cent of new cases in Europe are multi-drug resistant strains, and that is heading in the direction of the 20% that we see in America.

We see increasing numbers living with multi-drug resistant TB as well as with AIDS. The ECDC shows new cases of HIV infection doubled between 1999 and 2006. It showed 11% of cases are in young people aged between 15 and 24. We saw 53% heterosexual transmission, largely from people who originate from epidemic countries, but a third are men who have sex with men and, perhaps surprisingly, less than 10% are injecting drug users.

But on top of all this – and I very much welcome what the minister said – we impose stigma. Stigma is a cruel added burden to the pain of the disease and, what is worse, it encourages people to hide and not to come forward for testing and treatment. The solutions stem from these figures, from these facts. We need early diagnosis, as everyone has so far said. We need confidential testing, we need education, we need the understanding that flows from that and can counter that stigma. We need the ongoing research and development, and we need care because fewer people are actually dying of AIDS; more people are living with it.

  Zita Gurmai, on behalf of the PSE Group. – Madam President, I was very happy to hear the Commissioner mention the Round Table which I co-hosted and co-chaired. Miguel Angel Martínez and Commissioner Vassiliou also participated and were actively engaged in it.

AIDS is one of the most serious diseases of our century. Within the European Union alone, 215 000 people were newly infected with HIV in the last 10 years. According to estimates this year almost one third of the AIDS infection – as my good colleague mentioned – still remained undiagnosed, posing a real threat to the health of European citizens. It is high time to take concrete steps so we have put forward practical suggestions on how to combat HIV/AIDS effectively by focusing on evidence based HIV/AIDS early diagnosis and early care.

It is not only a health-related question. It is a strategic matter for the future enlargement of the EU and crucial in the field of neighbourhood and migration policy. We should combine the different EU policies to emphasise the right of each single European citizen for better health and living conditions, not forgetting the role of women. They are the most endangered groups when it comes to HIV/AIDS.

Ensuring accurate monitoring surveillance of the disease is of the highest urgency. Early diagnosis and the reduction of barriers to testing are regarded as an urgent necessity. Steps must be taken to ensure access to free and anonymous testing in order to facilitate more people seeking testing. HIV/AIDS reduction strategies must be worked out in each Member State and these must focus on vulnerable groups and groups known to be at high risk.

The strategy shall also include information and education campaigns on the preventing, testing and treatment of HIV/AIDS. We must recognise that increased investment in research and development for more effective therapeutic and preventive tools, such as vaccines and microbicides, will be essential to securing the long-term success of HIV and AIDS responses.

Discrimination against people living with HIV/AIDS must be effectively outmoded across the European Union. The struggle against HIV/AIDS must not result in any discriminatory effect on HIV-positive citizens, including restrictions that impact on their freedom of movement. The cross-party EP resolution tackles all the situations together. The aim is common and the enlarged Europe can become the initiator of enhanced international cooperation on evidence based HIV/AIDS early diagnosis and early care in the near future.

I am convinced that, if early diagnosis and an early care system work as a pilot programme, it may be possible to use it as a common European tool for other health-related policies. I am really thankful to all my colleagues who supported this initiative and worked on it.

  Georgs Andrejevs, on behalf of the ALDE Group. – Madam President, ever since I had the honour of drafting the report on combating HIV/AIDS within the EU and neighbouring countries, I have been very committed to this issue, with all its implications and ramifications, of people living with HIV.

One year ago in the framework of the conference ‘HIV in Europe 2007’, participants developed a comprehensive call to action on measures how to effectively tackle HIV/AIDS in Europe. Some elements of this call are now also reflected in this joint motion for a resolution.

The aim of this resolution is to contribute to the fight against HIV/AIDS on a political level. Therefore it calls on the Council and the Commission to formulate a comprehensive strategy on HIV to promote early diagnosis, ensure early care and communicate the benefits of earlier care to all European citizens.

It calls on the Commission to commit substantial resources to deliver the above-mentioned strategy as well as asks Member States to step up information and education campaigns on prevention, testing and treatment.

I am aware that the Commission is planning to bring forward a new communication on combating HIV in the EU and the neighbourhood and also that Commissioner Vassiliou confirmed her personal commitment to take further action in this field.

To conclude, this situation needs to be urgently tackled.

  Vittorio Agnoletto, a nome del gruppo GUE/NGL. – Signora Presidente, onorevoli colleghi, sono ventun anni che come medico lavoro nella lotta all'AIDS e ogni anno sento sempre gli stessi discorsi.

La situazione da un punto di vista clinico è molto chiara: abbiamo una trentina di farmaci antiretrovirali che sono in grado di prolungare la vita delle persone sieropositive. Non abbiamo nessun farmaco che è in grado di distruggere il virus, di conseguenza, in Occidente e in Europa, abbiamo una diminuzione della mortalità e un aumento delle persone sieropositive viventi, quelli che tecnicamente si dice dei "potenziali vettori di infezione". Questo significa che oggi noi abbiamo maggior rischio di venire in contatto con persone sieropositive piuttosto che nel passato, perché aumenta il numero di persone sieropositive viventi. E in mezzo a tutto questo cosa si fa? Nulla.

La maggioranza dei paesi europei non hanno alcuna campagna di prevenzione stabile da anni. I profilattici costano moltissimo e diamo alle parole un nome preciso e riconoscibile: i profilattici costano moltissimo e sono una delle vie principali per prevenire il virus HIV.

Per non parlare dei progetti di riduzione del danno rivolti soprattutto ai tossicodipendenti per evitare l'uso promiscuo di siringhe. Quanti sono i paesi che realizzano a livello nazionale progetti di questo tipo? In Italia il 50% delle diagnosi di AIDS conclamato coincidono con le diagnosi di sieropositività, significa che molte persone non sanno di essere sieropositive fino a quando non sono malate.

Quali sono le campagne di diffusione del test, che deve essere gratuito e anonimo? Perché sappiamo che se ci sono discriminazioni le persone tenteranno di nascondersi, non andranno a fare il test, con il rischio per la loro salute e per la salute degli altri.

Un'ultima cosa: il Consiglio ha parlato ancora oggi di aiuti al Sud del mondo, vorrei sapere dove sono finite le proposte che aveva fatto il Parlamento quando abbiamo votato l'ultima versione dei TRIPS che impegnavano Commissione e Consiglio ad aumentare gli stanziamenti per la lotta all'AIDS nel Sud del mondo e in particolare a trasferire le tecnologie e a trasferire anche aiuti farmacologici.

  Avril Doyle (PPE-DE). - Madam President, in 2006 over 86 000 newly-diagnosed HIV cases were reported, and over 13 000 AIDS cases were diagnosed in the WHO European region.

In Western Europe, 10% of the new infections occurred amongst the 15-to-24 age group, and 25% of those newly infected were female. The main route of transmission was heterosexual contact, as the Commissioner has said.

In Eastern Europe, the main route of transmission was via drug injection. Very worryingly, 27% of new infections there occurred in the 15-to-25 age group, and 41% of the newly-infected patients were female.

Currently, 30% of HIV-infected patients do not know that they are infected and are responsible for over a half of all new HIV infections. In addition, late diagnosis implies late use of anti-retroviral therapy, with increasingly limited opportunities for the drugs to have effect.

There is an urgent need for European-level guidance on HIV testing and counselling. We must have comprehensive and flexible guidance on best practice in reporting, in testing, in treatment and in care.

In my own country, Ireland – while data on HIV and AIDS should be interpreted with caution owing to considerable under-reporting and late reporting – the total number of AIDS cases reported up to the end of December 2007 is almost 1 000. That figure is, however, expected to rise owing to that under-reporting. The cumulative number of HIV infections reported in the same period was 4 780. Prevention strategies need yet again to be top of the news, on the front pages of our e-newspapers. Complacency has set in. Fear of infection has evaporated. We need to spell out the facts, in an open and tolerant way. John Bowis is so right when he says that while fewer people are dying of AIDS, more and more are living with it.

  Michael Cashman (PSE). - Madam President, I wish to congratulate the French presidency for its commitment to the fight against AIDS and HIV, and also congratulate those who have spoken in the debate this evening.

It is a late-night debate on an issue that actually affects every single one of us every single minute of every single day. As a gay man living in the 1970s and 1980s, I could so easily have contracted the HIV virus. I was lucky. I did not. However, I watched as swathes of generations were cut down by a virus and cut down by discrimination and stigmatisation.

That is why the message we need to send tonight is that we are committed to making available treatment and to having early testing, but above and beyond all that – and the brilliant and excellent work Mr Bowis did as a Health Minister in a Conservative Government – we have to say that what happens to you is as if it happens to me, or my daughter or my son. People do not go for early testing for one simple reason: fear of the discrimination that they will have to live with – that stigmatisation.

I remember once in the early 1980s visiting a hospital to try and cheer up the patients – which I always failed to do! – and walking into an HIV unit to find that in one of the beds was one of my close friends. He could not even tell me that he was living and dying with an AIDS-related illness. That situation still exists, not only in our countries, but also on other continents. What happens on other continents affects us directly because, unless we engage with the communities most at risk, they will never hear the message. A sex worker who gets trafficked into the EU is as vulnerable as a visitor from the EU to Africa or one of the other continents. That is why I welcome this resolution. 1 December 2008 is the 20th anniversary of International AIDS Day, but little changes except the lives that accumulate, that go past and are destroyed. That is why I congratulate the House, the presidency and the Commission, and all of the speakers, for being here to send a signal that what happens to them happens to us.

  Toomas Savi (ALDE). - Madam President, I have come to realise that the HIV-positive people are sometimes treated like lepers, not knowing that with early diagnosis and care they may be active members of society for a number of years before AIDS develops and the disease starts seriously affecting their lives.

Such prejudice is a sign of ignorance. It is extremely important to promote support and understanding towards the HIV-infected. As a result people would have more courage to have their viral infection diagnosed at an early stage instead of opting for a nuisance that might pose a threat to others.

It is vital that HIV-positive people can be open about their condition with no fear of being discriminated against, so we can increase awareness and tolerance in society of HIV and AIDS.

  Colm Burke (PPE-DE). - Madam President, HIV prevention and treatment capacity varies across different socioeconomic and geopolitical settings. Promoting the early diagnosis of HIV infection should be a component of all comprehensive approaches to addressing AIDS.

Even in countries where anti-retroviral treatment options are severely limited, important contributions to health can be achieved through the diagnosis and treatment of sexually transmitted diseases, tuberculosis and other opportunistic infections among HIV-infected persons.

In a recent US research publication it was found that the time between self-reported dates of HIV diagnosis and presentation for care had in fact increased. The interval between diagnosis and presentation was substantially greater among injection drug users than among other risk groups. Combined with this is a problem of the growing perception that AIDS is now a treatable condition, which undermines the public health message calling for frequent testing and prompt treatment of HIV.

  Mairead McGuinness (PPE-DE). - Madam President, I thank Michael Cashman for the passion he has brought to this debate. I am very glad that I stayed to listen to his words, and I hope that others will hear them and act upon them.

My concern in relation to this issue is that the fear we had in the 1980s has been forgotten, and as a result we are taking our eye off the situation, when there is a whole generation of people who did not grow up in the 1980s who need to hear the message again.

The challenge for us all is to try and bring a message of prevention into the public domain while not bringing back the stigma that sometimes comes with it. We have to be able to do this, because while testing is vital and treatment is absolutely vital for those who have the disease, we also want to stop people getting AIDS, living with it and tragically dying from it.

  Jean-Pierre Jouyet, président en exercice du Conseil. − Madame la Présidente, Monsieur le Commissaire Potočnik, Mesdames et Messieurs les députés, c'est un débat effectivement vraiment passionnant et, à certains égards, émouvant. Je remercie tout particulièrement M. Cashman de son témoignage très fort, je sais qu'il est très souvent en contact avec Mme Bachelot, qui s'excuse de ne pas être là ce soir et qui a dit qu'il fallait effectivement agir comme si nous étions tous concernés et travailler avec les communautés les plus à risque. M. Savi a également dit qu'il fallait parler librement de sa condition. M. Burke a insisté sur les valeurs de tolérance, sur l'égalité d'accès. Mme Guinness a dit très justement qu'il ne fallait pas oublier ce qui s'était passé dans les années 80.

Je voudrais insister – je crois qu'il y a vraiment une approche commune et une volonté certaine – sur ce qu'a indiqué M. Bowis, c'est-à-dire que de plus en plus de gens vivent avec le sida aujourd'hui et qu'il y a une augmentation des résistances aux antiviraux. Nous devons donc vivre avec les deux phénomènes et c'est pour cela que nous devons, pour toutes les raisons que vous avez indiquées, lutter avec plus de fermeté encore contre toutes les formes de discriminations. Deuxièmement, nous devons faire en sorte, et tout le monde l'a dit, d'avoir des diagnostics précoces. Mme Gurmai a eu tout à fait raison d'insister sur la fragilité de la population féminine et sur la nécessité de renforcer surtout les aspects préventifs, Mme Doyle a mis l'accent sur le développement du virus chez les jeunes et sur la nécessité aussi de renforcer l'effort de prévention tout en faisant en sorte, et Mme Gurmai l'a souligné, qu'il n'y ait aucune entrave à la liberté de mouvement. Ce qui veut effectivement dire que la transparence, que ce qu'a dit également M. Cashman sur l'anonymat, sur le fait qu'il y ait gratuité, que l'on doive développer la distribution de préservatifs, développer ces tests dans des conditions d'accès égales pour toutes les populations, tout cela me paraît extrêmement important.

De M. Agnoletto, dont les compétences sont reconnues, j'ai retenu qu'il y avait suffisamment de rétroviraux pour prolonger la vie mais qu'aucun médicament ne guérissait, ce qui faisait que nous devions effectivement renforcer tout ce qui était prévention, quel qu'en soit le coût. M. Bowis a également ajouté qu'il était nécessaire de renforcer la recherche et le développement.

Je crois que c'est véritablement sur ces aspects qu'il faut que nous continuions à travailler ensemble, que nous dégagions les moyens nécessaires et je suis tout à fait d'accord avec M. Andrejevs sur la proposition de résolution visant à développer tout ce qui a trait au traitement précoce.

Je pense que ce débat nous permettra de rester éveillés, vigilants, de lutter contre toutes les formes de discrimination et de faire preuve de mémoire par rapport à tout ce qui s'est passé, de ne pas faire comme si, là aussi, la situation était redevenue normale.

  Janez Potočnik, Member of the Commission. − Madam President, I took part in a conference either at the beginning of this week or last week – sometimes I am probably like you these days, a bit lost in time. It was a conference on poverty-related diseases. Of course, HIV and AIDS are among the three big killers nowadays, malaria and tuberculosis being the second and the third.

Every year five million people still die from these three diseases globally, which is the equivalent of the population of Denmark disappearing every year. The problem is so clearly still present that it would simply be immoral not to give enough attention to it.

We have to do everything possible on the preventive campaigns. We have to do more because we have slept a bit there. We have to do everything possible to ensure early identification if somebody is infected. We have to do more to find a cure; we have to do more about taking care. Since, as you know, I am responsible for financing research in the Commission, I can clearly give a commitment that we will also in the future use our funds to actively search for an HIV-AIDS vaccine.

We have one excellent project which has now been running for many years. It is called the EDCTP. It is the clinical trials partnership with the sub-Saharan countries. It had a lot of problems at the beginning but now it is really running smoothly and only last year, in 2007, we gave a commitment here; the Member States are working here together with the Commission. All the Member States are cooperating with African member states in building their capacity. In one year alone they committed between EUR 80 million and EUR 90 million and this is of course doubled because we commit the other half.

So research should continue in this area too. Just as Commissioner Vassiliou, my colleague, is committed in her area, I am also committed in my area to continue in the search.

One thing which was not mentioned here today, and I think it should be mentioned, is the importance of the neighbourhood policy and structural cohesion policy, because these are precisely the countries in Europe or in our neighbourhood where this is a critical issue. This could and should also be used for these purposes.

To conclude: in simple terms we have a moral obligation as human beings to take action. I am really happy that our voice today was so clear. It was so united and even passionate.

  La Présidente. - J'ai reçu, conformément à l'article 103, paragraphe 2, du règlement six propositions de résolution⁽¹⁾.

Le débat est clos.

Le vote aura lieu jeudi 20 novembre 2008.

(1) Voir procès-verbal.