IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v86y2008i2-3p181-194.html
   My bibliography  Save this article

Health systems' responses to 25 years of HIV in Europe: Inequities persist and challenges remain

Author

Listed:
  • Atun, Rifat A.
  • McKee, Martin
  • Coker, Richard
  • Gurol-Urganci, Ipek

Abstract

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 commercial sex workers, prisoners, intravenous 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 NGO culture is weak as compared to western Europe. Scaling up of effective responses in many countries in eastern Europe will be challenging--where increased financial resources will have to be accompanied by broader changes to health system organization with greater involvement of the civil society in planning and delivery of client-focused services.

Suggested Citation

  • Atun, Rifat A. & McKee, Martin & Coker, Richard & Gurol-Urganci, Ipek, 2008. "Health systems' responses to 25 years of HIV in Europe: Inequities persist and challenges remain," Health Policy, Elsevier, vol. 86(2-3), pages 181-194, May.
  • Handle: RePEc:eee:hepoli:v:86:y:2008:i:2-3:p:181-194
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168-8510(07)00229-1
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Stimson, Gerry V., 1995. "Aids and injecting drug use in the United Kingdom, 1987-1993: The policy response and the prevention of the epidemic," Social Science & Medicine, Elsevier, vol. 41(5), pages 699-716, September.
    2. Smyth, Fiona, 1998. "Cultural constraints on the delivery of HIV/AIDS prevention in Ireland," Social Science & Medicine, Elsevier, vol. 46(6), pages 661-672, March.
    3. Barr, D.A. & Field, M.G., 1996. "The current state of health care in the former Soviet Union: Implications for health care policy and reform," American Journal of Public Health, American Public Health Association, vol. 86(3), pages 307-312.
    4. Kupek, Emil & Dooley, Mary & Whitaker, Luke & Petrou, Stavros & Renton, Adrian, 1999. "Demographic and socio-economic determinants of community and hospital services costs for people with HIV/AIDS in London," Social Science & Medicine, Elsevier, vol. 48(10), pages 1433-1440, May.
    5. Spire, Bruno & Duran, Ségolène & Souville, Marc & Leport, Catherine & Raffi, François & Moatti, Jean-Paul, 2002. "Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach," Social Science & Medicine, Elsevier, vol. 54(10), pages 1481-1496, May.
    6. Danziger, Renee, 1997. "HIV prevention in Hungary," Health Policy, Elsevier, vol. 40(3), pages 231-236, June.
    7. Danziger, Renée, 1996. "Compulsory testing for HIV in Hungary," Social Science & Medicine, Elsevier, vol. 43(8), pages 1199-1204, October.
    8. Smith, E. & Rix, B.A. & Melbye, M., 1994. "Mandatory anonymous HIV surveillance in Denmark: The first results of a new system," American Journal of Public Health, American Public Health Association, vol. 84(12), pages 1929-1932.
    9. Moatti, Jean-Paul & Souville, Marc & Obadia, Yolande & Morina, Michel & Sebbah, Remy & Gamby, Thierry & Gallais, Herve & Gastaut, Jean-Albert, 1995. "Ethical dilemmas in care for HIV infection among French general practitioners," Health Policy, Elsevier, vol. 31(3), pages 197-210, March.
    10. Tulchinsky, T.H. & Varavikova, E.A., 1996. "Addressing the epidemiologic transition in the former Soviet Union: Strategies for health system and public health reform in Russia," American Journal of Public Health, American Public Health Association, vol. 86(3), pages 313-320.
    11. B. G. Evans & A. McCormick, 1994. "Completeness of Reporting Cases of Acquired Immune Deficiency Syndrome by Clinicians," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 157(1), pages 105-114, January.
    12. Davoli, M. & Perucci, C.A. & Abeni, D.D. & Arca, M. & Brancato, G. & Forastiere, F. & Montiroli, P.M. & Zampieri, F., 1995. "HIV risk-related behaviors among injection drug users in Rome: Differences between 1990 and 1992," American Journal of Public Health, American Public Health Association, vol. 85(6), pages 829-832.
    13. Petchey, Roland & Williams, Jacky & Farnsworth, Bill & Starkey, Ken, 1998. "A tale of two (low prevalence) cities: social movement organisations and the local policy response to HIV/AIDS," Social Science & Medicine, Elsevier, vol. 47(9), pages 1197-1208, November.
    14. Danziger, Renée, 1999. "The social impact of HIV testing: a comparative analysis of Britain and Sweden," Social Science & Medicine, Elsevier, vol. 48(3), pages 293-300, February.
    15. Atun, Rifat Ali & Menabde, Nata & Saluvere, Katrin & Jesse, Maris & Habicht, Jarno, 2006. "Introducing a complex health innovation--Primary health care reforms in Estonia (multimethods evaluation)," Health Policy, Elsevier, vol. 79(1), pages 79-91, November.
    16. Haour-Knipe, Mary & Fleury, Francois & Dubois-Arber, Francois, 1999. "HIV/AIDS prevention for migrants and ethnic minorities: three phases of evaluation," Social Science & Medicine, Elsevier, vol. 49(10), pages 1357-1372, November.
    17. Dijkgraaf, Marcel G. W. & Luijben, August H. P. & Postma, Maarten J. & Borleffs, Jan C. C. & Schrijvers, August J. P. & Jager, Johannes C., 1996. "Lifetime hospitalization profiles for symptomatic, HIV-infected persons," Health Policy, Elsevier, vol. 35(1), pages 13-32, January.
    18. Tramarin, A. & Campostrini, S. & Tolley, K. & De Lalla, F., 1997. "The influence of socioeconomic status on health service utilisation by patients with AIDS in North Italy," Social Science & Medicine, Elsevier, vol. 45(6), pages 859-866, September.
    19. Postma, Maarten J. & Tolley, Keith & Leidl, Reiner M. & Downs, Angela M. & Beck, Eduard J. & Tramarin, Andrea M. & Flori, Yves A. & Santin, Miguel & Antonanzas, Fernando & Kornarou, Helen & Paparizos,, 1997. "Hospital care for persons with AIDS in the European Union," Health Policy, Elsevier, vol. 41(2), pages 157-176, August.
    20. Barnett, Tony & Whiteside, Alan & Khodakevich, Lev & Kruglov, Yuri & Steshenko, Valentyna, 2000. "The HIV/AIDS epidemic in Ukraine: its potential social and economic impact," Social Science & Medicine, Elsevier, vol. 51(9), pages 1387-1403, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. A. J. Mercer & B. Jacobs & S. Moon & J. Kynch, 2003. "Prisons and the tuberculosis epidemic in Russia," Journal of International Development, John Wiley & Sons, Ltd., vol. 15(5), pages 559-574.
    2. Zanakis, Stelios H. & Alvarez, Cecilia & Li, Vivian, 2007. "Socio-economic determinants of HIV/AIDS pandemic and nations efficiencies," European Journal of Operational Research, Elsevier, vol. 176(3), pages 1811-1838, February.
    3. Kim, Sang-Weon & Pridemore, William Alex, 2005. "Social support and homicide in transitional Russia," Journal of Criminal Justice, Elsevier, vol. 33(6), pages 561-572.
    4. World Bank, 2014. "Kyrgyz Republic Public Expenditure Review Policy Notes : Health," World Bank Publications - Reports 19313, The World Bank Group.
    5. Karine Lamiraud & Pierre‐Yves Geoffard, 2007. "Therapeutic non‐adherence: a rational behavior revealing patient preferences?," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1185-1204, November.
    6. Natalia Gavrilova & Victoria Semyonova & Elena Dubrovina & Galina Evdokushkina & Alla Ivanova & Leonid Gavrilov, 2008. "Russian Mortality Crisis and the Quality of Vital Statistics," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 27(5), pages 551-574, October.
    7. Ross Taplin, 2007. "Enhancing statistical education by using role‐plays of consultations," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 170(2), pages 267-300, March.
    8. Brainerd, Elizabeth, 2010. "Reassessing the Standard of Living in the Soviet Union: An Analysis Using Archival and Anthropometric Data," The Journal of Economic History, Cambridge University Press, vol. 70(1), pages 83-117, March.
    9. Krumkamp, Ralf & Mounier-Jack, Sandra & Ahmad, Amena & Reintjes, Ralf & Coker, Richard, 2010. "Evaluating health systems' preparedness for emerging infectious diseases: A novel conceptual and analytic framework," Health Policy, Elsevier, vol. 98(2-3), pages 91-97, December.
    10. Lien, Hsien-Ming & Lu, Mingshan & Albert Ma, Ching-To & McGuire, Thomas G., 2010. "Progress and compliance in alcohol abuse treatment," Journal of Health Economics, Elsevier, vol. 29(2), pages 213-225, March.
    11. Postma, Maarten J. & Tolley, Keith & Leidl, Reiner M. & Downs, Angela M. & Beck, Eduard J. & Tramarin, Andrea M. & Flori, Yves A. & Santin, Miguel & Antonanzas, Fernando & Kornarou, Helen & Paparizos,, 1997. "Hospital care for persons with AIDS in the European Union," Health Policy, Elsevier, vol. 41(2), pages 157-176, August.
    12. Groenewegen, Peter P. & Dourgnon, Paul & Greß, Stefan & Jurgutis, Arnoldas & Willems, Sara, 2013. "Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries," Health Policy, Elsevier, vol. 113(1), pages 170-179.
    13. Linda P Bolin & Carolyn E Horne & Patricia B Crane & James R Powell, 2018. "Low‐salt diet adherence in African Americans with hypertension," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(19-20), pages 3750-3757, October.
    14. Tkatchenko-Schmidt, Elena & Renton, Adrian & Gevorgyan, Ruzanna & Davydenko, Ludmila & Atun, Rifat, 2008. "Prevention of HIV/AIDS among injecting drug users in Russia: Opportunities and barriers to scaling-up of harm reduction programmes," Health Policy, Elsevier, vol. 85(2), pages 162-171, February.
    15. Chang, Jamie Suki, 2017. "Health in the Tenderloin: A resident-guided study of substance use, treatment, and housing," Social Science & Medicine, Elsevier, vol. 176(C), pages 166-174.
    16. Evguenii Zazdravnykh & Andrey Aistov & Ekaterina Aleksandrova, 2024. "Total expenditure elasticity of spending on self-treatment and professional healthcare: a case of Russia," International Journal of Health Economics and Management, Springer, vol. 24(1), pages 81-105, March.
    17. Luginaah, Isaac N. & Yiridoe, Emmanuel K. & Taabazuing, Mary-Margaret, 2005. "From mandatory to voluntary testing: Balancing human rights, religious and cultural values, and HIV/AIDS prevention in Ghana," Social Science & Medicine, Elsevier, vol. 61(8), pages 1689-1700, October.
    18. Shuey, Dean A. & Qosaj, Fatime Arenliu & Schouten, Erik J. & Zwi, Anthony B., 2003. "Planning for health sector reform in post-conflict situations: Kosovo 1999-2000," Health Policy, Elsevier, vol. 63(3), pages 299-310, March.
    19. Luger, Lisa, 1998. "HIV, AIDS prevention and class and socio-economic related factors of risk of HIV infection," Discussion Papers, Research Group Public Health P 98-204, WZB Berlin Social Science Center.
    20. Martin T. Schechter, 2002. "Science, Ideology, and Needle Exchange Programs," The ANNALS of the American Academy of Political and Social Science, , vol. 582(1), pages 94-101, July.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:86:y:2008:i:2-3:p:181-194. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.