Is AIDS a serious problem in the Czech Republic?
Most Czechs have been fairly confident that AIDS is not a serious problem in the Czech Republic. Then, last week, a random test among 20 prostitutes in the west Bohemian border town of Cheb revealed an alarming state of affairs - 3 of them were diagnosed HIV positive. The news has made many Czechs sit up and think about the risks. What is the AIDS situation in the Czech Republic and do Czechs take effective measures to protect themselves? In this week's edition of Magazine Daniela Lazarova talks to National AIDS Programme Manager Jaroslav Jedlicka .
What is the AIDS situation in the Czech Republic and do Czechs take effective measures to protect themselves?
The Czech health authorities currently register 588 HIV infected persons. 467 of them are men, 121 women. 161 persons have been diagnosed with AIDS, of which 99 have already died.
Do these figures reflect reality or are they merely the tip of the iceberg -as some doctors suggest? There are estimates which put the number of HIV infected persons in the country 5 to 10 times higher than the official figures.
Despite these warnings, most Czechs have been fairly confident that AIDS is not a serious problem in the Czech Republic. Then, last week, a random test among 20 prostitutes in the west Bohemian border town of Cheb revealed an alarming state of affairs - 3 of them were diagnosed HIV positive. The news has made many Czechs sit up and think about the risks. I asked dr. Jaroslav Jedlicka, National AIDS Programme Manager, how he viewed this latest development.
"There are no accurate data concerning the prevalence of HIV among prostitutes in this country. Over the years -since 1987- we have tested about 24 thousand prostitutes in the Czech Republic, both women and men. We found that 15 prostitutes were HIV positive, 6 women and nine men. It is very difficult to draw any general conclusion from testing twenty prostitutes in one border town. So we do not have any accurate data. Of course, three prostitutes out of twenty in one city - it does seem alarming - but we cannot generalize and apply this ratio to all prostitutes in the Czech Republic - of which, according to the police there are some 30, 000. "
The three prostitutes were apparently Ukrainian girls. We have plenty of migrants from the east here -both illegal and legal - does this present a serious problem - because there have been some alarming figures coming out of Russia. 1 to 2 million HIV infected persons and experts warning that this number could double very soon unless effective measures are taken...does this present a serious threat?
"Yes, this is a serious problem. The Czech approach is that no one is tested on entering the country or is required to produce a health certificate. Of course many prostitutes who come to this country from eastern Europe are HIV positive. We have no data on how many of those who enter the country are infected and of course they present a serious problem because they can transmit the infection to their clients on Czech territory."
How do other countries approach this problem?
"It is a recommendation of the World Health Organization that no one should be tested when crossing borders, so the Czech Republic is only following the WHO recommendation in this respect."
So nothing much can be done in this respect-is that what you are saying?
"Exactly, but much depends on the policy of individual states. For instance Russia requests health certificates from people who come to Russia. It is theoretically possible that the Czech Republic will change its policy in this respect and will at some future date require such a certificate from foreigners as well."
Now, those prostitutes were not walking the streets, they were actually working in nightclubs. And some people have suggested that prostitutes working in nightclubs should have regular tests - would you agree with that?
"Yes, they should certainly have regular tests but we need to keep in mind that people in high risk groups such as prostitutes never have definite confirmation that they are healthy because they are permanently at risk of HIV infection and the period between infection and an accurate test result is three months -the so called "window" period - so even if these women have a negative HIV certificate it may be false because they are at permanent risk and in a permanent "window" period."
Who actually gets tested in the Czech Republic? Is it on a voluntary basis?
"Yes, it is on a voluntary basis. Of course blood donors undergo mandatory tests and it is also possible to test pregnant women without their consent and the reason is to prevent so called vertical transmission of the disease from mother to child. But all the rest is on a voluntary basis."
What about high risk groups? Is there anything to encourage people who are at risk to go and get tested?
"Of course we have a network of non-governmental organizations who work with drug users, female and male prostitutes and other so called high risk groups. However, there is no mandatory testing in any of these groups and all the testing in the Czech Republic is performed on a voluntary basis - that is with the person's consent."
Is there an ongoing information campaign in the Czech Republic on AIDS?
"Yes, we have web pages, we produce many leaflets and brochures and there is a free AIDS hotline ."
So you are happy with the situation as it is?
"Quite happy. On European scale the Czech Republic is among the least affected countries but of course we are not forgetting that we are in central Europe and alarming figures in eastern Europe are keeping us very alert. Given this danger we cannot exclude the possibility of a rapid spread of HIV among certain groups of people in the Czech Republic. I would urge everyone who has engaged in risky behavior to get an HIV test at least three months after the risk. We know from behavioral data that at least 50 % of those who do engage in risky sexual behavior do not use condoms. Our population is not used to using condoms even under these circumstances. So I would encourage both the use of condoms and tests - if safe sex precautions fail."
You say Czechs don't use -do not like using condoms -that suggests that your message is not getting through doesn't it?
"Many people underestimate the situation because they recognize that the Czech Republic belongs to the least affected countries. So they think it is not probable they would meet a "risky" partner. So our good epidemiological situation has an adverse effect in that people feel "safe" from infection, both the locals and tourists who come here for so called "safe sex".
Does AIDS still carry a stigma in the Czech Republic?
"Of course. Of course. I think it is the same in every country and we too have reports that suggest that most people consider persons infected with HIV or AIDS as someone who would not make a good neighbour."
What kind of care do AIDS patients get?
"There I can give you an optimistic answer. We spend half of the country's AIDS budget of about 22 million Czech crowns on drugs - the latest drugs available on the Western market for the roughly 400 HIV or AIDS patients treated in the Czech Republic. The standard of care is very similar to what you have in Western countries and we have access to all the drugs which are used in the West."
