Czech health authorities struggle to keep HIV/AIDS under control

The number of HIV cases in the Czech Republic has been steadily rising, and 2009 could see the biggest jump in HIV infection in the country’s history. The Czech health authorities say that the surge is fuelled by ignorance and complacency within high-risk groups. But critics point out that following a recent overhaul of the government’s HIV/AIDS prevention programme, the situation has fast deteriorated.

This month, the Czech AIDS Help Society celebrated 20 years of helping HIV and AIDS victims in the country. The biggest Czech NGO of its kind, it opened Dům světla, or the House of Light ten years ago. The Prague-based community centre assists HIV positive people and provides testing and counselling. Its director Miroslav Hlavatý joined the NGO in 1998.

“My first task back then was to get money to finance the House of Light. The total sum was 13 million crowns, and we got half from the Health Ministry. I needed to get the rest, and I thought it would not be a problem. But it took me a month or so to realize that getting money for HIV/AIDS projects in the Czech Republic was really difficult.”

In the end, the House of Light opened for the public in 1999, and this year, a similar facility was inaugurated in the northern city of Ostrava. But this is only a small success in the struggle against HIV/AIDS in the Czech Republic. Each year, the number of new cases grows. 147 new cases were registered in 2008, while 138 people got infected between January and November this year. 2009 might therefore set a new record of over 150 new cases. Michael Vít is the country’s chief hygiene officer.

“I believe that there is certainly room for improvement. I don’t think that we will ever find an ideal system. We are one of the countries with a relatively low incidence of HIV-positive people. On the other hand, I cannot deny that five years ago, we had some 50 or 60 new cases a year but today, we have 138. So these tendencies do exist in the Czech Republic as well, and we have to talk about why and how to re-start prevention so that we bring the increase under control.”

The need to re-start prevention programmes, as noted by Mr Vít, has become apparent two years after the Czech government streamlined the national AIDS programme as part of a broader health care reform. According the critics, the move brought severe budget cuts and saw the closure of more than 60 free-of-charge testing and counselling sites around the country. Jaroslav Jedlička stepped down in June this year as the manager of the National AIDS Programme in protest of the government’s policies.

“The policy reversed in 2007. When we signed the agreement with the UN, the so called Declaration of Commitments, we were actually doing what the UN asked us to do. At that time, we had many free-of-charge HIV testing and counselling sites and we were covering HIV prevention with 20 million crowns. But since then, we have been doing everything in contradiction to the policies recommended by the UN special programme on AIDS, by the European Commission and gone against the experience gained by NGOs in Europe.”

Mr Jedlička says the Health Ministry critically curtailed its prevention programme, in direct contradiction to the country’s commitments to the UN AIDS programme the Czech Republic adopted in 2001.

“Our government and the Health Ministry did just the opposite and closed 64 testing sites around the country. So after we committed ourselves to provide free HIV testing, we did just the opposite and closed the majority of testing sites at public health centres in all of the regions of the Czech Republic, and absolutely cut the access of risky populations to HIV testing.”

According to Jaroslav Jedlička, the government has also failed to increase funding for HIV/AIDS prevention, as required by the UN.

“The same goes for funding. The 2001 agreement with the UN says that each year, we would increase funding for HIV/AIDS but the government is doing just the opposite. Since then the funding has dropped from about 20 million crowns to 7 million. That does not make any sense and with such funds we can no longer control the HIV epidemic in the country.”

There are now 1335 HIV patients in the Czech Republic and 288 people with full-blown AIDS. Their numbers have tripled since 10 years ago. Health Ministry officials blame this on complacency and ignorance among high-risk groups and on rapidly growing immigration. Džamila Stehlíková is the new manager of the National AIDS programme.

“Unfortunately this is a trend we can observe around the whole of Europe. The cause lies in the risky behaviour of what we call high-risk groups. In the Czech Republic these are primarily men who have sex with men and HIV positive prostitutes, particularly among immigrants. We have also registered the first detected case of HIV transmission which occurred in prison. Another group, which represents about five percent of the cases, are drug users.”

Last year, the government outlined a long-term strategy to combat HIV/AIDS. This involves a greater measure of support for the non-government sector, such as the Czech AIDS Help society. Also, other institutes than the Health Ministry should get involved in prevention programmes the funding of which, according to Ms Stehlíková, has not in fact decreased.

“In 2008, precisely due to the growing numbers of HIV cases, the Czech government approved a resolution which outlined a long-term strategy up until 2012 focusing on these high-risks groups. Funds should be directed wherever the infection is spreading, wherever the greatest risks are. These are primarily prevention activities within the gay community, drug users, migrants and sexual services providers. The plan involves othe r institutions, too, such as the Education Ministry that should intensify prevention programmes in schools and generally among young people who unfortunately take more risks than some 10 or 15 years ago.”

HIV and AIDS patients in the Czech Republic are treated at seven state-run AIDS centres. Marie Staňková is the head of the AIDS centre at Prague’s Na Bulovce hospital. She shares the concerns that replacing state-run facilities with those run by NGOs can backfire.

“It’s a pity that many of these centres have been closed. There are rumours that new testing centres with trained staff will open, but I really don’t know any details. However, it’s definitely a big mistake. In my opinion, it’s very important that such centres function properly. The AIDS centres can’t do everything. Also, there are only seven of them, one in Prague and the rest around the country. It’s necessary that we have many more testing and consultation centres where people can come for preventive testing and for advice, and they should be positioned in places where people can come and get tested.”

In January, the Health Ministry will release a report on how successful the national HIV/AIDS strategy was in 2009, with not much good news expected.