Slovenia facing a concentrated HIV epidemic in vulnerable population
World AIDS Day was marked in Ljubljana, Slovenia, with a national conference on 28 November 2012 to discuss key issues related to HIV/AIDS, such as stigma, prevention and the importance of testing for early detection.
Status of the epidemic in Slovenia
HIV prevalence is low in Slovenia (<1 per 1000), but it is increasing: of the 394 HIV infections detected since 2002, 55 cases were detected in 2011, and 41 in the period January–November 2012. The most affected group of the population is men having sex with men (MSM). The results of HIV prevalence monitoring with unlinked anonymous testing among a small convenience sample of MSM (MSM club, 2011; N=105) showed a prevalence of 7.6% among this group.
All infected persons in Slovenia are entitled to up-to-date therapy free of charge; however in 2012 three-quarters of patients were diagnosed late (already having a CD4 count below 500/mm3). The HIV testing rate is low, with 1.9 tests per 100 inhabitants in 2011. There are no estimates of the number of people who do not know that they are HIV infected, however an informed estimate would be some 200–300 people.
In the first eleven months of 2012, AIDS was diagnosed in 11 persons; in 10 of these persons HIV infection was confirmed as late as in 2012. Over the last 10 years, 21 patients have died due to AIDS.
Following opening remarks by Dr Tomaž Čakš, acting director of the Regional Institute of Public Health Ljubljana, Dr Marija Seljak, acting director of the National Institute of Public Health, and Dr Mojca Gobec, director general, Public Health, Ministry of Health, eminent professionals presented and discussed key factors that could prevent infection, improve early detection of HIV-infected persons and thus secure early treatment for patients in Slovenia. They also discussed issues relevant for combating stigma – of the vulnerable population as well as of HIV-positive individuals.
Professor Ivan Bernik, University of Ljubljana, shared selected key findings and interesting insights on sexual risk behaviour in Slovenia.
Assistant Professor Irena Klavs, National Institute of Public Health, presented the latest epidemiological data for Slovenia, which clearly showed the key challenges as well as the target populations as indicated above.
Professor Janez Tomažič, Clinical Centre Ljubljana, explained that early treatment is important for the course of the disease as well as for prevention of transmission. In his experience, most patients are motivated to receive the therapy and follow the treatment regimen as well as to implement lifestyle recommendations.
Professor Mario Poljak, Medical Faculty of the University of Ljubljana, presented the latest developments in the area of testing. He explained that health care and public health professionals have to remove obstacles for the vulnerable population to increase testing rates. It is important to expand access to testing for key populations and general practitioners should be fully enabled and encouraged to perform such tests. Slovenia will also have to consider introducing screening pregnant women for HIV.
Mr Simon Maljevac represented the nongovernmental organization Legebitra and focused on stigma – which remains the key issue of HIV/AIDS in Slovenia and substantially influences testing rates.
The way forward
Discussions among the experts and other stakeholders at the conference led to consensus on the following key issues:
- HIV/AIDS is a complex issue and can only be addressed through close partnership of all stakeholders (public health and health care, nongovernmental organizations, local communities, etc.).
- Prevention is highly cost effective.
- Safe sex needs to be strongly promoted among vulnerable groups (especially MSM) and young people.
- It is imperative to increase testing rates (through improved accessibility and other measures) to enable early treatment and halt the spread of the virus especially among MSM.
- More needs to be done to fight discrimination and to empower vulnerable populations (mostly MSM).
The conference was moderated by Dr Evita Leskovšek, National Institute of Public Health, and Dr Marijan Ivanuša, Head of the WHO Country Office in Slovenia. It was followed by a press conference, which was also moderated by Dr Leskovšek.