An interview with Emilis Subata on the European Joint Action’s work on sustainable & long-term funding for HIV, TB and HCV

Emilis Subata, HA-REACT partner and Director of the Vilnius Center for Addictive Disorders

Here’s my interview with Emilis Subata, Director of the Vilnius Center for Addictive Disorders in Lithuania and partner in the HA-REACT Joint Action.

What influenced your decision to become involved with the newly formed Joint Action on HIV and Co-Infection Prevention and Harm Reduction (HA-REACT)?

People who inject drugs (PWID) do not have satisfactory access to quality health care support in some EU countries and access to opioid substitution therapy (OST) and needle and syringe programs (NSP) is often dangerously low. Even if legal acts are in place, sometimes national policies regarding harm reduction are too ambiguous to result in implementation.

HIV, hepatitis C virus and tuberculosis among PWID are not sufficiently controlled. This means that these infections continue spreading within high risk populations and potentially into other population groups.

For example, in Lithuania we see that services for PWID are not adequately funded because they are simply not political priorities. This is a mistake. HIV, hepatitis C virus (HCV) and tuberculosis (TB) among PWID are not sufficiently controlled. This means that these infections continue spreading within high risk populations and potentially into other population groups.

How do you see your role in your particular work package, “Sustainability and long-term funding”?

Lithuania implemented OST and NSP as tools to control outbreaks of HIV in the mid-1990s, i.e. 20 years ago. At that time they were very controversial in many countries and even within the UN system.

Our Ministry of Health played a leading role in paving the way to initial introduction as well as widening the access to harm reduction services in Lithuania. Unfortunately, its policies were often heavily challenged by other political actors. HA-REACT has 3 primary focus countries and is intended to provide effective tools of EU dimension to local stakeholders in order to strengthen HIV, HCV and TB prevention policies among at-risk population groups.

From your perspective, why focus on HIV, TB and viral hepatitis in Europe?

Health problems are no longer confined to one territory; they must be systematically addressed on an EU scale in order to have any chance of combating these infections

In the past 10 years, migration within the EU has reached a very high level within the Schengen area. It is clear that it is not possible to implement effective HIV, TB, and viral hepatitis control systems in just one or only a few EU countries. Young people, including PWID, freely move across the EU to seek better employment, social support, and access to quality medical treatment.

Health problems are no longer confined to one territory; they must be systematically addressed on an EU scale in order to have any chance of combating these infections. HIV, TB, and hepatitis, especially among vulnerable populations, create additional social and financial burdens for all countries concerned. That is why an EU-wide perspective is needed.

What can we expect as a result of your HA-REACT work?

We expect that HA-REACT will bring sustainable results in individual countries after the project ends.  We intend to define national policies of HIV, HCV and TB prevention among PWID or prisoners and establish relevant targets. The focus countries of this project require political support and adequate funding from domestic sources in order to create a lasting impact. In the EU countries there are many barriers of different kinds. Therefore, it is a big challenge that requires engagement on every level in order to reach the desired results.

What does the project hope to achieve over the next 3 years?

The project serves as an opportunity to bring positive change through the exchange of existing tools, knowledge, and best practices

The project serves as an opportunity to bring positive change through the exchange of existing tools, knowledge, and best practices. Considering the limited time, just 3 years, and limited budget (EUR 3.8m), the project will not resolve all the problems in individual countries regarding HIV, HCV and TB prevention among PWID and prisoners. It should, however, contribute to shaping consistent policies across different sectors, e.g. health care and penitentiary and criminal justice.

The Joint Action aims to contribute to the elimination of HIV and reduction of TB and viral hepatitis among PWID in the EU by 2020 and focuses on member states with gaps in effective and evidence-informed interventions. The project also encourages the implementation of comprehensive harm reduction programs in all EU member states as an essential strategy for improving the prevention and treatment of HIV, TB and viral hepatitis. Further information about HA-REACT is available at: www.hareact.eu.

Hepatology, Medicine and Policy is now accepting submissions on this and related issues. For more information, visit: www.hmap.biomedcentral.com.