1. Reproductive Health of People Living with HIV of People Living with HIV in Poland in Poland Tomasz Niemiec Other STD’s Neoplasmas Family Planning Demography PMTCT Harm Reduction Treatment Policy & Testing HIV/AIDS Epidemiology Antwerpen, 6 May,2005

2. Global Statistical Data HIV Prevalence 0,1/<0,1% Maternal Mortality 8/100.000 Live births Infertility 1,5mln couples Population 38175000 2003 Contraceptive Prevalence Modern methods 19% Adolescence Pregnancy 16% Infant mortality 8,6‰ Fertility rate - 0,04% Reproductive Health of People Living with HIV in Poland Antwerpen, 6 May,2005

3. HIV epidemiology Reproductive Health of People Living with HIV of People Living with HIV in Poland in Poland Antwerpen, 6 May,2005

6. HIV/AIDS epidemics in Poland as of end SEPTEMBER 2004. 9.002 - total number of infections since the beginning of the epidemics (1985) 5.115 - number of infections due to drug injection 1.473 - number of AIDS cases 710 - number of AIDS deaths since the beginning of the epidemics Estimated number of PLWH: 20 – 30.000 Antwerpen, 6 May,2005

7. Treatment policy and testing Reproductive Health of People Living with HIV of People Living with HIV in Poland in Poland Antwerpen, 6 May,2005

8. Treatment and testing Testing: Viral load HIV RNA 4 times/year Testing: CD4/CD8 4 times/year Antenatal testing Anonymous testing Diagnosis of Vertical Transmission of HIV Vaccination Children HIV+ mothers ARV Resistance Testing With No limits

9. Funds allocated for ARV 2001 1272 pt 10 mln Euro 2002 1626 pt 10,5 mln Euro 2003 2100 pt 14,7 mln Euro 2004 2244 pt 19,5 mln Euro 2005 22 mln Euro MTCT Prophylaxis 1,3 mln USD Antwerpen, 6 May,2005

10. PMTCT Reproductive Health of People Living with HIV of People Living with HIV in Poland in Poland Antwerpen, 6 May,2005

11. PMTCT Number of deliveries app. 360.000/ year No data Number of Pregnancies In HIV+ Ca 100 – 200 HIV+ mothers / year No Antenatal HIV testing Ca 110 Children Living with HIV 88 on ARV 12 died Antwerpen, 6 May,2005

12. Risk of vertical transmission Warsaw Study, 2004 *3 infected children received ZDV after delivery; no ARV for mother Since 1994 Children with prophylaxis Children without prophylaxis Total Children HIV- infected 63642 Children not infected 13142173 Total13778215 Risk of vertical transmission 6/137 4 %* 36/7846,15%42/21519,5% Antwerpen, 6 May,2005

13. Family Planning & Infertility Contraceptives Are Not refunded Restricted Abortion law Lack of Educated Medical staff No refund For Assisted reproduction Discordant Couples? Antwerpen, 6 May,2005

14. neoplasmas HIV-infected women at the highest risk for cervical cancer No active Cytological screening Difficult Access: Cytology colposcopy Difficult Access: Gyn dpt. No HPV Test High Rate Cervical cancer Antwerpen, 6 May,2005

15. Thank You !!! Antwerpen, 6 May,2005