The Polish Experience
I asked why he wanted me to speak, to which he replied, ”Because your English is very good.“ Well, I do not know about that, but I did learn a lot about the epidemic in Poland where I have lived for 11 years, eight of those years with HIV.
The history of the HIV/AIDS epidemic in Poland has a lot to do with World events, the personalities in place at the time, and the fact that there was the will to fight against the spread of the virus. Because of the unique aspects of the Polish experience dealing with HIV/AIDS, it would be difficult to duplicate the successful model in other countries.
However, many lessons can be learned from Poland’s model developed to fight the spread of HIV/AIDS.
The numbers
From the beginning of the epidemic in Poland in 1985 to the end of August 2005, there have been 9594 confirmed cases of HIV infection. Infections due to injecting drug use is 5260 persons with 1647 cases of AIDS reported and 770 deaths due to AIDS. The population of Poland is almost 39 million persons, so that makes the prevalence rate officially 0.02%. It is estimated that there may be double the amount infected, or 20,000 persons, but that would still only make the prevalence rate approximately 0.05%. So why have the number of infections remained so low in Poland?
The history
In the early years, Central Europe had a milder epidemic because the countries maintained closed borders with limited links to the West. That is one of the reasons that the first case of HIV was not recognized in Poland until 1985. Therefore, there was time to introduce proper tests in blood banks and hospitals. From 1985-1987 there were more than 645,000 HIV antibody tests performed and during consecutive years as many as 1.1-1.5 million tests carried out annually.
Until 1989 there were a very limited number of patients with HIV –officially only 52. But around that time there was a large outbreak among drug users. So, the spread of the epidemic also coincided with the final days of the Communist regime in Poland. Fortunately, along with a change in the form of government came the opportunity to reorganize the healthcare system. And luckily for the country, there were people in place that had the foresight to realize that an epidemic was on the way.
The government and a national program
What makes the HIV/AIDS situation in Poland different than that in other European countries? One important factor is that the Polish Government’s approach has been different to that in other parts of the region, demonstrating the political will to fight HIV. As long ago as 1985, the government began to address the epidemic. In 1987, the National AIDS Committee was formed. But the situation was far from perfect. The first attempt for a national program was drawn up for 1988-1990, but was never funded or implemented. Nothing substantial ever materialized during the second attempt either. Not until 1993 did the situation began to change.
In 1993, the Minister of Health and Social Welfare set up the National AIDS Prevention Coordinating Office. However, it was still missing a strategy and state policy in the area of HIV/AIDS. Only in 1995 did the Polish Parliament pass an act binding the government to present to the Parliament information about prevention of HIV/AIDS. It was then that the Minister of Health and Social Welfare created a group that consisted of many outstanding specialists who prepared a national strategy.
At the end of 1995, the First National Program for Prevention of HIV and Care for People Living with HIV/AIDS was prepared for 1996- 1998. This program included objectives for improving the existing system of prevention, educating society, creating appropriate attitudes based on contemporary knowledge and human rights and ensuring integrated care for people living with HIV/AIDS. Government partners were defined and responsibilities were assigned for tasks to meet the objectives. The program has continued, and been updated for the periods of 1999-2003 and 2004-2006. One key to the success of developing a comprehensive program was the people and personalities who were involved in the process, including representatives of the Church.
The church
Poland is more than 95% Catholic. Father Arkadiusz Nowak was the first representative of the Polish Catholic Church to speak out in defense of the rights of a group of drug addicts who disclosed their HIV positive status. His activism has sparked wide public discussion regarding HIV/AIDS and the rights of HIV positive people. Father Nowak is regarded as a strong voice in Poland in support of people living with HIV/AIDS and of concern for the challenges they face within society.
As coordinator of the National AIDS Plan, Father Nowak was instrumental in the adoption of a law on Prevention of Drug Addiction, which made methadone treatment officially available in Poland. Also through an initiative funded through the Ministry of Health he succeeded in providing funding to give access to all patients who need antiretroviral therapy. For his work, Father Nowak has been given a special award by UN Secretary General Kofi Annan during a ceremony, under the theme ”Breaking the Silence on HIV/AIDS“.
Other players
During my early involvement with the fight against HIV/AIDS in Poland, I began working with Wojtek Tomczynski, Poland’s leading HIV/AIDS activist. Through him I began to attend various coordination meetings and was amazed that there were representatives from the Church, government, NGOs, and even the pharmaceutical industry in attendance. Everyone worked together toward a common goal, and it could probably be said that there is an initial group of approximately a dozen people who are responsible for Poland’s success in the war against HIV/AIDS.
It seems that the Church took a compassionate view of the problem, especially in the early years before treatment when HIV/AIDS was a death sentence. It used the mighty influence of the Church in Poland to ensure funding for the National Programs, education and treatment.
It also left the government, NGOs and other institutions in society to take care of the other groups at high risk, including homosexuals and sex workers, while of course still preaching abstinence and monogamy for prevention against HIV/AIDS.
Finally, it was also very important that medical staff and doctors were receiving the latest HIV/AIDS education and training making them some of the best trained doctors in Europe.
Systems and ethics committees were soon in place that would allow Poland to be qualified to participate in early clinical trials for new combination therapies. HAART has been available since 1997 in Poland, and since 1999 all antiretroviral medication is paid for by the government within a centralized system.
The future
Despite Poland’s success in treating HIV/AIDS, a 2003 survey shows that a deterioration of public knowledge is both encouraging complacency about HIV and a new outbreak from Eastern Europe. Currently more than 64% of infections are due to the sharing of needles. However, in Poland most drug users are still excluded from treatment even though it has been shown that they can be compliant in taking medication. Budgets are getting tighter, HIV/AIDS education is slowing down, non-residents and migrants are not treated, and new infections are occurring more among younger heterosexuals and homosexuals. There is also still a stigma attached to having the virus which causes many forms of discrimination, especially in smaller towns and villages.
Finally, with the HIV/AIDS situation in some of Poland’s Eastern neighbors literally becoming out of control, many are worried of a new wave of infections. Jolanta Kwasniewska, wife of the current President, has been a long time partner in the fight against HIV/AIDS. But new elections are just around the corner. It is time for the people and upcoming new government not only to take pride in the work of the past that limited the spread of the virus in Poland, but to now make a commitment to continue the battle against HIV/AIDS.
G. Andrew Espinosa, European AIDS Treatment Group, Poland
EATN - European AIDS Treatment News, Volume 14, II – Autumn 2005
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