HIV expert doubts Kallas' competence-center plan

Prime Minister Siim Kallas this week met with Estonia's leading AIDS prevention experts to try to find solutions to the rapid spread of the virus, but the experts came away disappointed with the outcome.

After the meeting with AIDS prevention experts and Social Ministry representative on Sept. 11, Kallas stated the AIDS prevention strategy needed restructuring and that a "competence center" should be created to unite and coordinate all prevention programs in the country.

Estonia has experienced a drastic increase in HIV cases in the last two years.

The Cabinet will receive a detailed report on AIDS prevention and related problems at a meeting scheduled for Oct. 22 and will then decide on the precise steps to be taken.

After the meeting Nelli Kalikova, director of the state-run AIDS Prevention Center, doubted the usefulness of the proposed competence center, saying it could become an overly bureaucratic guzzler of state funds.

The existing center should simply be accountable to the minister of social affairs, rather than to the numerous institutions currently involved in its work, said Kalikova.

"We asked the prime minister to create a commission at ministers' level to deal with major decisions relating to AIDS prevention, but he said it would be too difficult to get such a commission together," said Kalikova.

"Our main goal was to complain about excessive bureaucracy we face. Our center has so many bigwigs from other institutions that we can't work normally. They all demand some progress reports and keep telling us what to do," Kalikova said.

The efficiency of the AIDS Prevention Center is best safeguarded by letting it be as independent as possible, said Kalikova.

"International experience shows that AIDS prevention institutions need to stay independent. The World Health Organization recommends it, too," she said.

"People in the ministries and other state institutions we work with are often not so professional. They might be good politicians, but that does not make them good experts," said Kalikova.

Kallas suggested AIDS Prevention Center experts regularly prepare updated documents for presentation at Cabinet sessions.

The government has allocated 8.85 million kroons ($565,500) for the work of the AIDS Prevention Center in 2002, of which 6 million kroons is to be spent on chemicals used for HIV testing. The total is a quarter of what is really needed, said Kalikova.

The last supplementary budget included another 2.5 million kroons for the center, but Kalikova said she had not seen that money yet.

As of Sept. 16, 2,616 people were registered HIV-positive in Estonia, of whom 660 were registered this year, a slight decline compared to last year.

But two years ago there were only 334 people registered HIV positive.

The first case was registered in Estonia in 1998 and so far 47 HIV-positive persons have died.

Those with HIV in Estonia are mainly male drug users aged 15 to 24.

Kalikova warned of an imminent spread of the virus to the wider population if more is not done to combat it.

"Even if it is local, it will soon spread if we fail to prevent it," Kalikova said.

This year's slight decline in the number of newly registered cases is not cause for premature celebration, she added.

"Fewer drug addicts turn to us to have their blood tested because they have no jobs and no social insurance," she said.

The basic AIDS test is free for all, but if HIV is detected, a person needs to take several additional tests to check the status of the virus, and some of that cost about 5,000 kroons for people without social insurance.

Banned drugs are increasingly easy to obtain in the Baltic states according to Saulius Chaplinskas, director of Lithuania's AIDS Prevention Center, which has been hailed as a relative success story in AIDS prevention.

"Why do we consider lectures for adolescent an efficient way for drug prevention? The influence of friends and the street is much higher," said Chaplinskas.

While in Estonia for an AIDS prevention conference last week Chaplinskas emphasized the importance of cooperation between different organizations and institutions.

This chain is only as strong as its weakest link, he warned.

"Lithuania, a country that used to have a low rate of HIV-positive people, faced this truth when about 15 percent of prison inmates turned out to be HIV-positive," said Chaplinskas.

AIDS prevention in Estonia comprises information campaigns to increase awareness and understanding of the problem, care for people who are HIV-positive and their relatives and sexual partners, distribution of syringes and a testing program.

Estonia's AIDS Prevention Center has eight full time employees at its Tallinn office and offices in Tartu, Narva and Parnu. There are also five non-governmental prevention organizations.