US embassy cable - 05PRAGUE515

UNCLAS SECTION 01 OF 04 PRAGUE 000515 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: KHIV, PGOV, PHUM, PREF, EZ 
SUBJECT: HIV/AIDS IN THE CZECH REPUBLIC:  PREVENTION AND 
PUBLIC EDUCATION PRODUCE ONE OF EUROPE'S LOWEST RATES OF 
INFECTION 
 
 
1.  Summary:  The Czech Republic currently has one of 
Europe's lowest rates of HIV infection, despite a 
significant problem with prostitution and trafficking. 
Officials and NGOs in the country link the low incidence of 
HIV with active prevention campaigns, abundant and 
accessible anonymous testing, and universal health coverage. 
Czech officials are cautiously optimistic that their program 
will continue to protect the country from broader spread of 
the disease.  End summary. 
 
----------------------------- 
THE CZECH REPUBLIC BY NUMBERS 
----------------------------- 
 
2.  In a country of over 10 million people, there are 
currently 611 reported cases of living HIV positive people 
(of those who are Czech or have Czech residency; there have 
also been reports of 218 foreigners, who are not included in 
the country's statistics as they are often only passing 
through).  Since the beginning of reporting in 1987, there 
have been 755 HIV infections reported in the country; to 
date, 113 have died; 611 is the official number "not known 
to be dead."  Although the rate of infection grew in the 
years after the country opened its borders, the rate of new 
reported infections has been fairly steady since 1997; there 
were 72 new cases in 2004, as compared with 62 seven years 
earlier. 
 
3.  Of the 611 infected, 76 have full-blown AIDS.  Of the 
755 cases reported since 1985, by far the largest group of 
infections is amongst homosexuals and/or bisexuals, who 
comprise 393 (or approximately 62 percent) of the reported 
cases.  The next largest group are those who contracted HIV 
from heterosexual contact (235, or approximately 37 
percent), followed by intravenous drug users.  Although 
there are 14 cases where the individuals contracted the 
virus from blood transfusions, the manager of the National 
AIDS Program explained that these cases were prior to 1987, 
when blood was not sufficiently tested.  Seventeen of the 
reported cases are hemophiliacs who were similarly infected. 
 
4.  Poloff and PolFSN met with Dr. Marie Bruckova of the 
National Reference Laboratory for HIV, which develops most 
anonymous (including all those that would indicate positive 
results) and all saliva HIV tests and is the central HIV 
laboratory.  Dr. Bruckova explained that although the Czech 
Republic has a reporting system for tracking both HIV 
infection and AIDS, this is not true in all European Union 
countries.  Of course, even with a perfect reporting system, 
it is unknown how many cases go untested and therefore 
unreported.  Dr. Bruckova estimates that there are perhaps 5 
to 10 times more HIV infections in the country than 
reported.  The National Reference Laboratory issues a 
monthly report to the Ministry of Health with the current 
number of infections. 
 
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GOVERNMENT EFFORTS 
------------------ 
 
5.  The Czech Republic's Ministry of Health established a 
commission on HIV prevention in 1990, which was replaced by 
a National Committee for HIV/AIDS issues in 1993.  The Chair 
of the Committee is the Deputy Minister of Health, but the 
bulk of the work is done by the Vice Chair, Dr. Jaroslav 
Jedlicka, who is also National AIDS Program Manager.  Dr. 
Jedlicka's career is actually a Fulbright success story:  he 
originally went to study epidemiology in Ohio, but found an 
interesting HIV centre there at just the time the disease 
began to be well-known.  Deciding to focus on HIV, he 
returned to the Czech Republic to found its first HIV 
program, and has been in his current position since 1993. 
Together with the Committee, he formulates the country's HIV 
strategy. 
 
6.  Many credit the current low rate of HIV infection in the 
Czech Republic to its initial efforts as the country emerged 
from communism to address the issue with serious funding for 
prevention.  The country also received funds from the Swiss 
government at this time, as the Swiss viewed the then 
practically HIV-free CR as a perfect test environment for 
massive prevention efforts.  As it opened its borders, the 
Czech Republic began public information campaigns, and 
needle exchange programs.  While Dr. Jedlicka humorously 
notes that the thing about prevention campaigns is that, if 
they work well, the HIV rate remains low and people do not 
think that the disease is a problem in the country, the fact 
is that the Czech Republic continues to have one of Europe's 
lowest infection rates. 
 
7.  The GOCR is in the middle of its latest five-year plan 
to combat HIV/AIDS in the country.  The plan, which began in 
2003, reflects the conclusions drawn by the UN about 
HIV/AIDS in 2001.  Its overall goals are to first prevent 
the spread of infection, and second to help individuals 
afflicted by the disease.  The plan targets risk groups 
within the country (homosexuals, drug addicts, prostitutes, 
and those with STDs); citizens who travel to areas with high 
HIV infection rates; educational institutions (both civilian 
and military); those with heightened risk due to their job 
(health workers, tattoo salon employees); and blood donors. 
 
8.  Past plans have produced successes such as a national 
system of free, readily available and confidential HIV 
testing.  Much of this testing is carried out by NGOs who 
work with the government, and all anonymous tests are done 
free of charge.  However, most NGOs offering this free 
testing are based solely in Prague.  Country-wide testing is 
available at Public Health Centres; there are 51 such 
centers located in all of the different regions.  At 29 of 
these centers, HIV testing is available free of charge to 
those who cannot afford to pay for it; otherwise, tests cost 
approximately 300 CZK (13 USD) depending on insurance 
compensation.  Some tests are verified locally, but all 
possibly positive tests are sent to and results verified by 
the National Reference Laboratory for HIV. 
 
9.  HIV tests in the Czech Republic are done on an 
absolutely voluntary basis except in cases where a person 
has already tested positive for syphilis.  This is true of 
prisoners and asylum seekers as well.  All blood donors are 
tested, but they are given advance notice that this will be 
the case.  Approximately 500,000 blood donors are tested 
every year; from 1996-2000, there were no positives amongst 
this group.  There have been one or two blood donor 
positives in the past several years.  Pregnant women are 
also routinely tested. 
 
10.  Another resource in place in the country is a toll- 
free, nationwide AIDS helpline; there are also various 
regional helplines and counseling centers.  The prevention 
of sexually transmitted diseases is included in the 
curricula of schools through the equivalent of American high 
school, and is also included in teacher training.  The 
country marks International AIDS Day with public prevention 
programs and observes a "Candlelight Memorial Day" to 
remember victims. 
 
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NGO INVOLVEMENT 
--------------- 
 
11.  There are 33 NGOs represented on the government's 
National Commission to Resolve HIV/AIDS Issues.  Of these, 
not all are focused solely on HIV; some work primarily with 
the risk groups involved.  Nearly all of these NGOs 
distribute free condoms; some are also part of the 
government's 87 needle exchange programs, which in 2003 
distributed nearly two million syringes (estimates from 2003 
put the number of IV drug users in the CR at approximately 
33,000).  Foremost amongst these NGOs is the Prague 
Lighthouse, operated by the Czech AIDS Help Society, which 
opened in 1999 as a haven for those living with HIV and 
their families.  After a shakey start due to lack of 
funding, the Lighthouse moved into its current location in 
the heart of downtown Prague, where it has a 20-year lease 
from the local mayor for only 1 CZK (approximately US 4 
cents) per year.  It currently receives nearly 50% of its 
funding from the government. 
 
12.  The Lighthouse provides both direct help to HIV 
positive individuals and does prevention work.  The 
Lighthouse is divided into a clinic for testing and 
treatment and counseling rooms on the ground floor, and a 
residence with room for 15 people on the upper floor.  When 
Poloff and PolFSN visited, the facility's Director, Miroslav 
Hlavaty, explained that they do not believe in a "waiting 
list," and in the case that they have more than 15 people 
who request housing, they simply make do (once stretching 
the available space to 19 by putting up beds in the gym). 
There are 12 adults and 2 children at the facility 
currently.  People may stay as long as they like; Hlavaty 
commented that one girl stayed with them for four years.  In 
the event that residents become very ill, they are taken to 
Bulovka Hospital, Prague's specialist hospital for HIV 
cases. 
 
13.  The Lighthouse runs an information stall on one of 
Prague's main squares for World AIDS Day (approximately 
5,500 people visited the stall last year).  The Lighthouse 
ran 11 prevention campaigns last year, including reaching 
out to all schools in Prague with an offer to have an HIV- 
positive person visit the school to speak about the disease. 
This program has been popular and the Lighthouse plans to 
expand it to all schools in the country in the future.  The 
Czech Red Cross works together with the Lighthouse in this 
school prevention program.  The Lighthouse also does 
roundtables on HIV and seminars for social workers who deal 
with HIV-positive clients. 
 
14.  Rozkos Bez Rizika (RR), or "Bliss Without Risk," is an 
NGO dealing primarily with commercial sex workers.  Their 
base is in Prague, but they carry out mobile services to 
brothels throughout the country.  RR receives funding from 
the government, and offers exams to prostitutes for all 
diseases (the HIV test is free of charge, paid by the 
government). RR's Director, Hana Malinova, told Poloff that 
the NGO conducted 1,197 HIV tests on clients last year 
(including 400-500 in border areas); none of them were 
positive. However, worryingly, the rate of positive tests 
for syphilis has increased; there were 46 positive tests 
last year. 
 
15.  Malinova estimates that 40 percent of RR's clientele 
are foreign women, mainly from former Soviet countries and 
Slovakia.  She says that these women were not generally sex 
workers in their home countries, but come to the Czech 
Republic, with its rich border neighbors, to make money and 
only then turn to prostitution.  Malinova speculates that 
this is why the HIV rate amongst prostitutes in the CR is 
not higher, even though HIV is much more prevalent in their 
home countries.  She also notes that sometimes brothel 
owners will ask for an STD clearance for a prostitute, as it 
is bad for business if their brothel gets a reputation for 
having "dirty" girls. 
 
16.  Lazlo Sumegh deals with the other sex worker community: 
as coordinator of "Projekt Sance," The Chance Project, 
Sumegh works with the male prostitutes of Prague, often 
homeless boys, some as young as thirteen.  Sumegh started 
the "Dum Sance," or Chance House, in 1995.  He says he 
currently has about 70-80 clients, but gets as many as 600 
during the span of a year.  Sumegh distributes condoms and 
clean needles, and does free HIV saliva tests (with results 
done by the National Reference Laboratory).  He says that IV 
drug use amongst his clients is growing.  Sumegh reported 
low numbers of HIV positives, but said that the number of 
positive tests for Hepatitis C is growing.  Of tests in 50 
clients for Hep C, 14 were positive. 
 
------------------ 
TREATMENT PROGRAMS 
------------------ 
 
17.  The Czech Republic benefits from having an overall 
strong, well-established and reliable health system.  Health 
insurance is mandatory for all Czech residents.  Bulovka 
Hospital in Prague is the country's best facility for HIV 
cases, but there are also seven regional HIV centres.  Anti- 
retroviral therapy is readily available, and drugs that have 
been registered are reimbursed 100% by insurance companies. 
There are some complaints that the process of registering 
new drugs is done too slowly.  Drugs that are not registered 
may be used, but will not be reimbursed by the insurance 
companies, and their expense comes out of the National AIDS 
Program budget.  Dr. Jedlicka estimates that currently over 
half of the Program's budget is spent on care for patients 
with HIV/AIDS, which puts limitations on the Program's 
abilities to do prevention work; it does, however, mean that 
all needed drugs are available and completely financed for 
all patients. Dr. Bruckova from the National Reference 
Laboratory is convinced that good treatment is also 
prevention, since those that are treated well have low viral 
loads, which makes them less infectious. 
 
------------------ 
SOCIETAL ATTITUDES 
------------------ 
 
18.  Possibly as a result of the small numbers of HIV- 
infected people in the country, societal stigma about the 
virus does exist.  HIV/AIDS is often still viewed as a 
disease only of sex workers, drug users, and homosexuals. 
As in many countries, public misconceptions about the 
disease and how it is transmitted continue.  Visits to 
schools under the combined Lighthouse and Red Cross 
campaigns try to inform the public and reshape their 
attitudes about those living with HIV. 
 
19.  In an effort to battle public misconceptions, in 
addition to the school visits, the Red Cross is organizing a 
children's camp for summer 2005 where children from across 
Europe will stay in the Czech countryside for two weeks and 
learn about HIV infection and prevention.  The camp will 
include exposure to HIV-positive individuals in order to 
learn about the disease and break down societal stigmas 
about its victims. 
 
--------------------------------------- 
THE FUTURE OF HIV IN THE CZECH REPUBLIC 
--------------------------------------- 
 
20.  Practitioners working with HIV in the Czech Republic 
have two worries:  since the Hepatitis C and Syphilis 
infection rates are increasing amongst the IV drug-using 
and/or sex worker populations, if HIV enters these same 
populations, the infection rate could skyrocket; and 
although the government spent considerably on HIV prevention 
in its early years, this has worked too well, and the 
decrease now could ultimately have traumatic results. 
Neither of these scenarios, however, are thought to be 
highly likely.  Although possibilities always exist, both 
government and NGO, health care and prevention workers think 
that the HIV infection rate in the Czech Republic will 
remain, for the near future, stable. 
 
21.  Although the rates of Hepatitis C and Syphilis are on 
the rise, Dr. Bruckova of the National Reference Laboratory 
pointed out that both of these diseases are much easier to 
transmit than HIV.  Particularly because reported HIV cases 
in the Czech Republic are all treated by medical 
professionals with whatever medication is necessary, they 
are less likely to be in conditions where their viral load 
is high and therefore they are the most contagious. 
Additionally, the continuation of the Czech Republic's 
strong government-funded needle exchange programs lessens 
the risk of HIV spread amongst the IV drug-using community. 
 
HILLAS