Application of Patients’ Rights in Cross-Border Health Care Regional meeting and workshop February 2009 Budapest ŠKUC – Magnus, SLOVENIA Miran Šolinc

● 1. Present epidemic situation in Slovenia The prevalence of HIV in Slovenia remains low. UNAIDS estimates the HIV prevalence rate among adults aged 15 to 49 to be less than 1/1000. A cumulative total of 289 diagnosed cases of HIV/AIDS have been reported up to the 30 th of June 2006 (Source Slovenian Institute of Public Health).

Last year - until  41 new cases of HIV. 20,5 per 1,  39 among men, 29 among MSM, 3 hetero, 1 IDU, 6 unclassified  10 new cases of AIDS. In last ten years:  266 new cases of HIV,  38 patients has died.

2. National HIV/AIDS Strategy Slovenia adopted a national plan on HIV/AIDS for in 96. This plan has not yet been renewed. New strategy is ready to be adopted for NGO's has sent recommendations on patients rights, stigma, mental health etc.

New Strategy Is based on: Prevention of new infections as a main objective. To provide access to quality VCT or early detection, good counseling, treatment and care. Raising awarreness among general population. Preventing stigmatisation, discrimination of PLWHA as part of normalisation of HIV.

3. Know your epidemic  HIV epidemic in Slovenia is MSM driven with low prevalence, less than 5% but number of new HIV cases is growing.  Every year 75-85% of new cases are among MSM.  In 2007 no case among IDU.  In case among IDU.  No cases of newborns with HIV.

4. MSM HIV prevention 3 NGOs working on HIV prevention targeting MSM (3 LGTB orgs. = 3 AIDS orgs.), also IPH National plan and strategies, epidemiology, advocacy and reporting to WHO, UNAIDS; UNGASS, EC. Evidence based researches. Annual survey and anonymous unlinked HIV testing (on saliva) in a gay venue. No Profit Organizations working on HIV prevention targeting MSM Institutional fundings for NGO initiatives on HIV Prevention on a national and city level

MSM Institutional fundings for NGO initiatives on HIV Prevention on a national level – MH € for 3 NGO's and city level – Ljubljana € Funding is not adequate for all necessary activities and to employ staff.

IDU prevention Activities for HIV prevention and drug harm reduction among IDU's are organised according to Resolution on national program of drug prevention  providing conditions for early detection, testing,  NGOs runs low trash programs with neddle exchange, condoms, info, counselling, outreach work with a van  early starts of substitution treatment – metadhone Just as everywhere else in Europe, Hepatitis C remains a serious health problem for injecting drug users: about 30% of the estimated 10,000 drug users in Slovenia are Hepatitis C positive.

6. VCT  One national reference center for free and anonymous VCT in Ljubljana at clinic ID every Monday from 10-14h.  Free VCT also possible in 2 other bigger cities

7.HIV clinic and care 8.HIV specialists  In Slovenia is only one clinic, only one care center for treatment and follow up of HIV/AIDS patients. (Slovenia has 2 M, Ljubljana has inhabitants).  Three HIV specialists: -first has 130 patients, -second 80 patients -and third 50 patients.

9. Outpatient care  Outpatients come every 3 to 4 months;  according to HIV specialist: We follow EACS - European Aids Clinical Guidelines More than 150 people are being provided with antiretroviral treatments (ART)

10. Costs  Insurance system covers all the related costs. The Slovenian health system pays the regular prices of the branded versions of ART – means that overall cost of care per patient is estimated to reach about 16,000€ per person/y.  They closely follow guidelines established at the European and international level – and so far, the high cost of ART has not been an issue (second line and third line regimens are accessible to the people that need it).

10. Cost and care  Problem is when a patient have no basic health insurance which covers all the care.  On rare occasions, foreign patients with HIV who do not have health insurance in Slovenia have come to seek medical care (the few that are cited come from Kosovo and from Croatia). Some have been provided treatment free of charge (this is decided on a case-by-case basis with the Ministry of Health - when their situation is considered to be "life threatening").

11.Medical data of HIV patients  According to doctor at clinic of ID: We have special protected programme, where all patient's data are collected. So, every data are cohort data. Health insurance electronic card – HIV status is not visible, ART therapy is not visible.

Special thanks to: The Peace Institute, Program East East, Ljubljana, Slovenia Dr. Janez TOMAŽIČ, Clinic for infectious diseases in Ljubljana. Janja Križman, Ministry of Health Thank you for your attention! Hvala za pozornost!