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Response to HIV/AIDS in Croatia Josip Begovac University Hospital of Infectious Diseases, Zagreb, Croatia Budapest, October 2003.

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Presentation on theme: "Response to HIV/AIDS in Croatia Josip Begovac University Hospital of Infectious Diseases, Zagreb, Croatia Budapest, October 2003."— Presentation transcript:

1 Response to HIV/AIDS in Croatia Josip Begovac University Hospital of Infectious Diseases, Zagreb, Croatia Budapest, October 2003

2 HIV/AIDS in Croatia: an overview Croatia Croatia Basic indicators Basic indicators Cases of HIV/AIDS Cases of HIV/AIDS Testing/behavior data Testing/behavior data Response Response

3 Croatia – Basic Indicators Total Population: 4,400,000(2001) Rural/Urban:43/57 (1999) Infant mortality rate: 8 per 1000 live births (2001) Maternal mortality rate: 11 per live births (2000) Life expectancy at birth: 73,3 (1999) Adult literacy rate: 98.2 (1999) Per capita GNP: 4,625.1 $ (2002)

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5 HIV/AIDS in Croatia ( ) AIDS=200; HIV/AIDS=386 Deaths:111

6 Modes of transmission Source: Croatian HIV/AIDS Register

7 Status of the epidemic female male females merchant marines labor migrants New HIV/AIDS cases among MSM are not imported imported 22,5 77,5 males imported Source: Croatian HIV/AIDS Register

8 Number of patients treated at the UHID in in Zagreb, per year in the period Increasing treatment Increasing prevalence of HIV/AIDS

9 Population1998Pos*/tested1999Pos*/tested2000Pos*/tested2001Pos*/tested2002Pos*/testedIVDU9/7616/9845/10475/72410/785 VTC & Clinical settings 46/ / / / /28532 * duplicates not sorted out

10 Behavioral surveillance Today both men and women have the first sexual intercourse at almost the same age. In the past it was the age of 18 and now it is around 17. ( according to dr A. Stulhofer, 2001 ) Today both men and women have the first sexual intercourse at almost the same age. In the past it was the age of 18 and now it is around 17. ( according to dr A. Stulhofer, 2001 ) Age at first sexual intercourse lower in selected populations of young people (16 years, RAR 2002) Age at first sexual intercourse lower in selected populations of young people (16 years, RAR 2002) Up to 25% of young men and 8,6% of young women aged had the first sexual intercourse when they were under 16. (A.Stulhofer 2001) Up to 25% of young men and 8,6% of young women aged had the first sexual intercourse when they were under 16. (A.Stulhofer 2001) -not published in peer reviewed journal

11 Condom use among youth School based surveys indicate 40-50% of regular condom use by young people (High school and University students) School based surveys indicate 40-50% of regular condom use by young people (High school and University students) 9,3% of girls and 13% of boys are using condoms regularly (RAR 2002, conducted among vulnerable youth ) 9,3% of girls and 13% of boys are using condoms regularly (RAR 2002, conducted among vulnerable youth )

12 Patterns of IV Drug Use Behavior favoring the spread of HIV/AIDS Behavior favoring the spread of HIV/AIDS Shooting galleries (places where IDUs can rent injection equipment) Shooting galleries (places where IDUs can rent injection equipment) Dealers works (injection equipment kept by a drug seller, which can be lent to successive drug purchases) Dealers works (injection equipment kept by a drug seller, which can be lent to successive drug purchases) Protective behavior Protective behavior Serial monogamy (e.x. each person changes sharing partners once a year)– new infections occur at a low rate Serial monogamy (e.x. each person changes sharing partners once a year)– new infections occur at a low rate

13 Patterns of IV Drug Use Life time sharing of needles equipment varies from % in various researches Life time sharing of needles equipment varies from % in various researches Variations among cities, depending on availability of Harm Reduction services Variations among cities, depending on availability of Harm Reduction services Fewer sharing noted in Needle Exchange Programs Fewer sharing noted in Needle Exchange Programs source: RAR 2002 RAR(UNDCP) 1998 RAR(UNDCP) 1998

14 Response-past Educational campaign including sex education in schools (1987-) Educational campaign including sex education in schools (1987-) Testing of blood and blood products (1987-) Testing of blood and blood products (1987-) Availability (purchase) of syringes from the pharmacy for IDUs (1987-) Availability (purchase) of syringes from the pharmacy for IDUs (1987-) Establishment of confirmatory HIV-testing sites (1986) Establishment of confirmatory HIV-testing sites (1986) Establishment of treatment Centers on a national level (1986) Establishment of treatment Centers on a national level (1986) National HIV/AIDS Prevention Committee (1992) National HIV/AIDS Prevention Committee (1992) National HIV/AIDS Prevention Program (1993) National HIV/AIDS Prevention Program (1993) First needle exchange program (Help, Split, 1996/97) First needle exchange program (Help, Split, 1996/97) Introduction of HAART thru National Insurance (1998) Introduction of HAART thru National Insurance (1998) Extension of needle exchange programs ( ) Extension of needle exchange programs ( ) Successful global fund application (2002-3) Successful global fund application (2002-3)

15 Country Response - Present National HIVAIDS Committee, -multisectorial- HealthJustice SystemEducation Childrens Hospital HCK-Harm Reduction HUHIV – PLWHA Association Iskorak (G&L) MediaSocial Sector

16 Response present: HIVAIDS – National Action plan Main goal: Main goal: To scale up the national response to HIVAIDS epidemic in Croatia, in order to maintain low level of epidemic and to reduce the risks of increased transmission in the future To scale up the national response to HIVAIDS epidemic in Croatia, in order to maintain low level of epidemic and to reduce the risks of increased transmission in the future To maintain a yearly incidence of new HIV infections below 10 per million To maintain a yearly incidence of new HIV infections below 10 per million However: However: How do I prevent a single case of HIV infection in Croatia? How do I prevent a single case of HIV infection in Croatia?

17 What do we need more? Evidence-based interventions Evidence-based interventions More research, particularly into human behavior More research, particularly into human behavior Constantly collect analyze and disseminate health-related information Constantly collect analyze and disseminate health-related information Monitoring and evaluation Monitoring and evaluation More investment into prevention More investment into prevention

18 Strategic goals To ensure continuity of care and constantly provide counseling for PLWHA To ensure continuity of care and constantly provide counseling for PLWHA To decrease HIVAIDS risks among people involved in risk behaviors (harm reduction, needle exchange, condoms) To decrease HIVAIDS risks among people involved in risk behaviors (harm reduction, needle exchange, condoms) To increase the level of protective behaviors among young people aged (information, education, condoms) To increase the level of protective behaviors among young people aged (information, education, condoms) To increase access to voluntary counseling, testing and referral services To increase access to voluntary counseling, testing and referral services To improve surveillance of HIVAIDS in Croatia To improve surveillance of HIVAIDS in Croatia

19 Strategic goals General public educational efforts (stigma, fear, discrimination) – health care, school and, social sectors General public educational efforts (stigma, fear, discrimination) – health care, school and, social sectors Prevention of mother to child transmission Prevention of mother to child transmission Aim for elimination - 100% (zero or close to zero prevalence) Aim for elimination - 100% (zero or close to zero prevalence) Secure blood supply and universal precautions Secure blood supply and universal precautions STI prevention and treatment STI prevention and treatment

20 Continuity of care for PLWHA Comprehensive health care Comprehensive health care Treatment of HIV (HAART) Treatment of HIV (HAART) Treatment of opportunistic diseases Treatment of opportunistic diseases Psycho-social counseling and long term case management Psycho-social counseling and long term case management

21 To decrease HIVAIDS risks among people involved in risk behaviors-IDU Outreach (peer), needle/syringes/condoms, treatment (methadone) Outreach (peer), needle/syringes/condoms, treatment (methadone) Current outreach 5-50% depending on the location Current outreach 5-50% depending on the location Drug users: to reach out at least 60% of actively injecting IDUs Drug users: to reach out at least 60% of actively injecting IDUs Increase outreach capacity through: Increase outreach capacity through: Increase the capacity of current HR centers Increase the capacity of current HR centers Provide training and capacity building for NGOs and local authorities, where no services are currently available, through training study tours exchange visits Provide training and capacity building for NGOs and local authorities, where no services are currently available, through training study tours exchange visits Provide regional mobile outreach services out of large urban settings Provide regional mobile outreach services out of large urban settings Maintenance of the methadone program (primary care physicians) Maintenance of the methadone program (primary care physicians)

22 To decrease HIVAIDS risks among people involved in risk behaviors- other vulnerable groups Goal: to empower people involved in risk behaviors, to adopt and maintain safe sex practices (NGO) Goal: to empower people involved in risk behaviors, to adopt and maintain safe sex practices (NGO) MSM – peer based prevention, counseling and referral services MSM – peer based prevention, counseling and referral services Migrant workers: risk assessment, information, education, referral Migrant workers: risk assessment, information, education, referral Sex workers – outreach services, condom programming Sex workers – outreach services, condom programming To increase the level of protective behaviors among young people aged To increase the level of protective behaviors among young people aged peer education peer education

23 To increase access to voluntary counseling, testing and referral services Current number of tests performed < (5 per 1000 inhabitants) Current number of tests performed < (5 per 1000 inhabitants) Diversification of testing centers Diversification of testing centers Testing of hard to reach populations Testing of hard to reach populations Confidentiality Confidentiality Introduction of rapid tests Introduction of rapid tests

24 Improving surveillance of HIV/AIDS in Croatia in the period Improving surveillance system including behavior and sentinel HIV surveillance Improving surveillance system including behavior and sentinel HIV surveillance The major research gaps exist among sex workers, and MSM, both behavior surveillance and sentinel The major research gaps exist among sex workers, and MSM, both behavior surveillance and sentinel

25 HIVAIDS Expenditures – 2002 The need to increase prevention and research expenditures Total expenditures: 2.6 millinos USD care: 2.3 millions USD

26 Objective Implementing organizations Peer Education Children's Hospital, Zagreb Andrija Stampar School of Public Health VCT Croatian Youth Council, UHID, HUHIV, CPHI Targeted interventions NGOs (Help, Red Cross, Terra, Iskorak), CPHI Conitnuity of care UHID, HUHIV Surveillance CPHI Abbreviations: UHID= University Hospital of Infectious Diseases HUHIV= Croatian association of people living with HIV CPHI= Croatian Public Health Institute IMPLEMENTING INSTITUTIONS

27 WHAT IS NEEDED FOR HIV/AIDS PREVENTION (a common sense approach) Political good will Political good will Good sex education Good sex education Condom distribution Condom distribution Needle exchange Needle exchange Good general education Good general education Good peer education Good peer education Good care and treatment Good care and treatment Access to information technology Access to information technology Healthy economy Healthy economy


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