Identifier
Created
Classification
Origin
05PRAGUE515
2005-04-12 05:44:00
UNCLASSIFIED
Embassy Prague
Cable title:  

HIV/AIDS IN THE CZECH REPUBLIC: PREVENTION AND

Tags:  KHIV PGOV PHUM PREF EZ 
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UNCLAS SECTION 01 OF 04 PRAGUE 000515 

SIPDIS

E.O. 12958: N/A
TAGS: KHIV PGOV PHUM PREF EZ
SUBJECT: HIV/AIDS IN THE CZECH REPUBLIC: PREVENTION AND
PUBLIC EDUCATION PRODUCE ONE OF EUROPE'S LOWEST RATES OF
INFECTION


UNCLAS SECTION 01 OF 04 PRAGUE 000515

SIPDIS

E.O. 12958: N/A
TAGS: KHIV PGOV PHUM PREF EZ
SUBJECT: HIV/AIDS IN THE CZECH REPUBLIC: PREVENTION AND
PUBLIC EDUCATION PRODUCE ONE OF EUROPE'S LOWEST RATES OF
INFECTION



1. Summary: The Czech Republic currently has one of
Europe's lowest rates of HIV infection, despite a
significant problem with prostitution and trafficking.
Officials and NGOs in the country link the low incidence of
HIV with active prevention campaigns, abundant and
accessible anonymous testing, and universal health coverage.
Czech officials are cautiously optimistic that their program
will continue to protect the country from broader spread of
the disease. End summary.

--------------
THE CZECH REPUBLIC BY NUMBERS
--------------


2. In a country of over 10 million people, there are
currently 611 reported cases of living HIV positive people
(of those who are Czech or have Czech residency; there have
also been reports of 218 foreigners, who are not included in
the country's statistics as they are often only passing
through). Since the beginning of reporting in 1987, there
have been 755 HIV infections reported in the country; to
date, 113 have died; 611 is the official number "not known
to be dead." Although the rate of infection grew in the
years after the country opened its borders, the rate of new
reported infections has been fairly steady since 1997; there
were 72 new cases in 2004, as compared with 62 seven years
earlier.


3. Of the 611 infected, 76 have full-blown AIDS. Of the
755 cases reported since 1985, by far the largest group of
infections is amongst homosexuals and/or bisexuals, who
comprise 393 (or approximately 62 percent) of the reported
cases. The next largest group are those who contracted HIV
from heterosexual contact (235, or approximately 37
percent),followed by intravenous drug users. Although
there are 14 cases where the individuals contracted the
virus from blood transfusions, the manager of the National
AIDS Program explained that these cases were prior to 1987,
when blood was not sufficiently tested. Seventeen of the
reported cases are hemophiliacs who were similarly infected.


4. Poloff and PolFSN met with Dr. Marie Bruckova of the
National Reference Laboratory for HIV, which develops most
anonymous (including all those that would indicate positive
results) and all saliva HIV tests and is the central HIV

laboratory. Dr. Bruckova explained that although the Czech
Republic has a reporting system for tracking both HIV
infection and AIDS, this is not true in all European Union
countries. Of course, even with a perfect reporting system,
it is unknown how many cases go untested and therefore
unreported. Dr. Bruckova estimates that there are perhaps 5
to 10 times more HIV infections in the country than
reported. The National Reference Laboratory issues a
monthly report to the Ministry of Health with the current
number of infections.

--------------
GOVERNMENT EFFORTS
--------------


5. The Czech Republic's Ministry of Health established a
commission on HIV prevention in 1990, which was replaced by
a National Committee for HIV/AIDS issues in 1993. The Chair
of the Committee is the Deputy Minister of Health, but the
bulk of the work is done by the Vice Chair, Dr. Jaroslav
Jedlicka, who is also National AIDS Program Manager. Dr.
Jedlicka's career is actually a Fulbright success story: he
originally went to study epidemiology in Ohio, but found an
interesting HIV centre there at just the time the disease
began to be well-known. Deciding to focus on HIV, he
returned to the Czech Republic to found its first HIV
program, and has been in his current position since 1993.
Together with the Committee, he formulates the country's HIV
strategy.


6. Many credit the current low rate of HIV infection in the
Czech Republic to its initial efforts as the country emerged
from communism to address the issue with serious funding for
prevention. The country also received funds from the Swiss
government at this time, as the Swiss viewed the then
practically HIV-free CR as a perfect test environment for
massive prevention efforts. As it opened its borders, the
Czech Republic began public information campaigns, and
needle exchange programs. While Dr. Jedlicka humorously
notes that the thing about prevention campaigns is that, if
they work well, the HIV rate remains low and people do not
think that the disease is a problem in the country, the fact
is that the Czech Republic continues to have one of Europe's
lowest infection rates.


7. The GOCR is in the middle of its latest five-year plan
to combat HIV/AIDS in the country. The plan, which began in
2003, reflects the conclusions drawn by the UN about
HIV/AIDS in 2001. Its overall goals are to first prevent
the spread of infection, and second to help individuals
afflicted by the disease. The plan targets risk groups
within the country (homosexuals, drug addicts, prostitutes,
and those with STDs); citizens who travel to areas with high
HIV infection rates; educational institutions (both civilian
and military); those with heightened risk due to their job
(health workers, tattoo salon employees); and blood donors.


8. Past plans have produced successes such as a national
system of free, readily available and confidential HIV
testing. Much of this testing is carried out by NGOs who
work with the government, and all anonymous tests are done
free of charge. However, most NGOs offering this free
testing are based solely in Prague. Country-wide testing is
available at Public Health Centres; there are 51 such
centers located in all of the different regions. At 29 of
these centers, HIV testing is available free of charge to
those who cannot afford to pay for it; otherwise, tests cost
approximately 300 CZK (13 USD) depending on insurance
compensation. Some tests are verified locally, but all
possibly positive tests are sent to and results verified by
the National Reference Laboratory for HIV.


9. HIV tests in the Czech Republic are done on an
absolutely voluntary basis except in cases where a person
has already tested positive for syphilis. This is true of
prisoners and asylum seekers as well. All blood donors are
tested, but they are given advance notice that this will be
the case. Approximately 500,000 blood donors are tested
every year; from 1996-2000, there were no positives amongst
this group. There have been one or two blood donor
positives in the past several years. Pregnant women are
also routinely tested.


10. Another resource in place in the country is a toll-
free, nationwide AIDS helpline; there are also various
regional helplines and counseling centers. The prevention
of sexually transmitted diseases is included in the
curricula of schools through the equivalent of American high
school, and is also included in teacher training. The
country marks International AIDS Day with public prevention
programs and observes a "Candlelight Memorial Day" to
remember victims.

--------------
NGO INVOLVEMENT
--------------


11. There are 33 NGOs represented on the government's
National Commission to Resolve HIV/AIDS Issues. Of these,
not all are focused solely on HIV; some work primarily with
the risk groups involved. Nearly all of these NGOs
distribute free condoms; some are also part of the
government's 87 needle exchange programs, which in 2003
distributed nearly two million syringes (estimates from 2003
put the number of IV drug users in the CR at approximately
33,000). Foremost amongst these NGOs is the Prague
Lighthouse, operated by the Czech AIDS Help Society, which
opened in 1999 as a haven for those living with HIV and
their families. After a shakey start due to lack of
funding, the Lighthouse moved into its current location in
the heart of downtown Prague, where it has a 20-year lease
from the local mayor for only 1 CZK (approximately US 4
cents) per year. It currently receives nearly 50% of its
funding from the government.


12. The Lighthouse provides both direct help to HIV
positive individuals and does prevention work. The
Lighthouse is divided into a clinic for testing and
treatment and counseling rooms on the ground floor, and a
residence with room for 15 people on the upper floor. When
Poloff and PolFSN visited, the facility's Director, Miroslav
Hlavaty, explained that they do not believe in a "waiting
list," and in the case that they have more than 15 people
who request housing, they simply make do (once stretching
the available space to 19 by putting up beds in the gym).
There are 12 adults and 2 children at the facility
currently. People may stay as long as they like; Hlavaty
commented that one girl stayed with them for four years. In
the event that residents become very ill, they are taken to
Bulovka Hospital, Prague's specialist hospital for HIV
cases.


13. The Lighthouse runs an information stall on one of
Prague's main squares for World AIDS Day (approximately
5,500 people visited the stall last year). The Lighthouse
ran 11 prevention campaigns last year, including reaching
out to all schools in Prague with an offer to have an HIV-
positive person visit the school to speak about the disease.
This program has been popular and the Lighthouse plans to
expand it to all schools in the country in the future. The
Czech Red Cross works together with the Lighthouse in this
school prevention program. The Lighthouse also does
roundtables on HIV and seminars for social workers who deal
with HIV-positive clients.


14. Rozkos Bez Rizika (RR),or "Bliss Without Risk," is an
NGO dealing primarily with commercial sex workers. Their
base is in Prague, but they carry out mobile services to
brothels throughout the country. RR receives funding from
the government, and offers exams to prostitutes for all
diseases (the HIV test is free of charge, paid by the
government). RR's Director, Hana Malinova, told Poloff that
the NGO conducted 1,197 HIV tests on clients last year
(including 400-500 in border areas); none of them were
positive. However, worryingly, the rate of positive tests
for syphilis has increased; there were 46 positive tests
last year.


15. Malinova estimates that 40 percent of RR's clientele
are foreign women, mainly from former Soviet countries and
Slovakia. She says that these women were not generally sex
workers in their home countries, but come to the Czech
Republic, with its rich border neighbors, to make money and
only then turn to prostitution. Malinova speculates that
this is why the HIV rate amongst prostitutes in the CR is
not higher, even though HIV is much more prevalent in their
home countries. She also notes that sometimes brothel
owners will ask for an STD clearance for a prostitute, as it
is bad for business if their brothel gets a reputation for
having "dirty" girls.


16. Lazlo Sumegh deals with the other sex worker community:
as coordinator of "Projekt Sance," The Chance Project,
Sumegh works with the male prostitutes of Prague, often
homeless boys, some as young as thirteen. Sumegh started
the "Dum Sance," or Chance House, in 1995. He says he
currently has about 70-80 clients, but gets as many as 600
during the span of a year. Sumegh distributes condoms and
clean needles, and does free HIV saliva tests (with results
done by the National Reference Laboratory). He says that IV
drug use amongst his clients is growing. Sumegh reported
low numbers of HIV positives, but said that the number of
positive tests for Hepatitis C is growing. Of tests in 50
clients for Hep C, 14 were positive.

--------------
TREATMENT PROGRAMS
--------------


17. The Czech Republic benefits from having an overall
strong, well-established and reliable health system. Health
insurance is mandatory for all Czech residents. Bulovka
Hospital in Prague is the country's best facility for HIV
cases, but there are also seven regional HIV centres. Anti-
retroviral therapy is readily available, and drugs that have
been registered are reimbursed 100% by insurance companies.
There are some complaints that the process of registering
new drugs is done too slowly. Drugs that are not registered
may be used, but will not be reimbursed by the insurance
companies, and their expense comes out of the National AIDS
Program budget. Dr. Jedlicka estimates that currently over
half of the Program's budget is spent on care for patients
with HIV/AIDS, which puts limitations on the Program's
abilities to do prevention work; it does, however, mean that
all needed drugs are available and completely financed for
all patients. Dr. Bruckova from the National Reference
Laboratory is convinced that good treatment is also
prevention, since those that are treated well have low viral
loads, which makes them less infectious.

--------------
SOCIETAL ATTITUDES
--------------


18. Possibly as a result of the small numbers of HIV-
infected people in the country, societal stigma about the
virus does exist. HIV/AIDS is often still viewed as a
disease only of sex workers, drug users, and homosexuals.
As in many countries, public misconceptions about the
disease and how it is transmitted continue. Visits to
schools under the combined Lighthouse and Red Cross
campaigns try to inform the public and reshape their
attitudes about those living with HIV.


19. In an effort to battle public misconceptions, in
addition to the school visits, the Red Cross is organizing a
children's camp for summer 2005 where children from across
Europe will stay in the Czech countryside for two weeks and
learn about HIV infection and prevention. The camp will
include exposure to HIV-positive individuals in order to
learn about the disease and break down societal stigmas
about its victims.

--------------
THE FUTURE OF HIV IN THE CZECH REPUBLIC
--------------


20. Practitioners working with HIV in the Czech Republic
have two worries: since the Hepatitis C and Syphilis
infection rates are increasing amongst the IV drug-using
and/or sex worker populations, if HIV enters these same
populations, the infection rate could skyrocket; and
although the government spent considerably on HIV prevention
in its early years, this has worked too well, and the
decrease now could ultimately have traumatic results.
Neither of these scenarios, however, are thought to be
highly likely. Although possibilities always exist, both
government and NGO, health care and prevention workers think
that the HIV infection rate in the Czech Republic will
remain, for the near future, stable.


21. Although the rates of Hepatitis C and Syphilis are on
the rise, Dr. Bruckova of the National Reference Laboratory
pointed out that both of these diseases are much easier to
transmit than HIV. Particularly because reported HIV cases
in the Czech Republic are all treated by medical
professionals with whatever medication is necessary, they
are less likely to be in conditions where their viral load
is high and therefore they are the most contagious.
Additionally, the continuation of the Czech Republic's
strong government-funded needle exchange programs lessens
the risk of HIV spread amongst the IV drug-using community.

HILLAS