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Application of Patients’ Rights in Cross-Border Health Care Regional meeting and workshop 26-28 February 2009 Budapest ŠKUC – Magnus, SLOVENIA Miran Šolinc.

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Application of Patients’ Rights in Cross-Border Health CareRegional meeting and workshop26-28 February 2009 BudapestŠKUC – Magnus,SLOVENIA Miran Šolinc

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1. Present epidemic situation in Slovenia The prevalence of HIV in Slovenia remains low. UNAIDS estimates the HIV prevalence rate among adults aged 15 to 49 to be less than 1/1000.A cumulative total of 289 diagnosed cases of HIV/AIDS have been reported up to the 30th of June 2006 (Source Slovenian Institute of Public Health).

last year until 26 11 2008
Last year - until 26.11. 2008

41 new cases of HIV. 20,5 per 1,000 000

39 among men, 29 among MSM, 3 hetero,

1 IDU, 6 unclassified

10 new cases of AIDS.

In last ten years:

266 new cases of HIV,

38 patients has died.

2 national hiv aids strategy

Slovenia adopted a national plan on HIV/AIDS for 1995-2000 in 96. This plan has not yet been renewed.

New strategy is ready to be adopted for 2009-2013. NGO's has sent recommendations on patients rights, stigma, mental health etc.

2. National HIV/AIDS Strategy
new strategy 2009 2013

Is based on:

Prevention of new infections as a main objective.

To provide access to quality VCT or early detection, good counseling, treatment and care.

Raising awarreness among general population.

Preventing stigmatisation, discrimination of PLWHA as part of normalisation of HIV.

New Strategy 2009-2013
3 know your epidemic
3. Know your epidemic

HIV epidemic in Slovenia is MSM driven with low prevalence, less than 5% but number of new HIV cases is growing.

Every year 75-85% of new cases are among MSM.

In 2007 no case among IDU.

In 2008 1 case among IDU.

No cases of newborns with HIV.

4 msm hiv prevention
4. MSM HIV prevention

3 NGOs working on HIV prevention targeting MSM (3 LGTB orgs. = 3 AIDS orgs.), also IPH

National plan and strategies, epidemiology, advocacy and reporting to WHO, UNAIDS; UNGASS, EC.

Evidence based researches. Annual survey and anonymous unlinked HIV testing (on saliva) in a gay venue.

No Profit Organizations working on HIV prevention targeting MSM

Institutional fundings for NGO initiatives on HIV Prevention on a national and city level

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MSM

Institutional fundings for NGO initiatives on HIV Prevention on a national level – MH

30 000€ for 3 NGO's

and city level – Ljubljana

20 000€

Funding is not adequate for all necessary activities and to employ staff.

idu prevention
IDU prevention

Activities for HIV prevention and drug harm reduction among IDU's are organised according to Resolution on national program of drug prevention 2004-2009

providing conditions for early detection, testing,

NGOs runs low trash programs with neddle exchange, condoms, info, counselling, outreach work with a van

early starts of substitution treatment – metadhone

Just as everywhere else in Europe, Hepatitis C remains a serious health problem for injecting drug users: about 30% of the estimated 10,000 drug users in Slovenia are Hepatitis C positive.

6 vct
6. VCT

One national reference center for free and anonymous VCT in Ljubljana at clinic ID every Monday from 10-14h.

Free VCT also possible in 2 other bigger cities

7 hiv clinic and care 8 hiv specialists
7.HIV clinic and care8.HIV specialists

In Slovenia is only one clinic, only one care center for treatment and follow up of HIV/AIDS patients. (Slovenia has 2 M, Ljubljana has 300 0000 inhabitants).

Three HIV specialists:

-first has 130 patients,

-second 80 patients

-and third 50 patients.

9 outpatient care
9. Outpatient care

Outpatients come every 3 to 4 months;

according to HIV specialist: We follow EACS - European Aids Clinical Guidelines

More than 150 people are being provided with antiretroviral treatments (ART)

10 costs
10. Costs

Insurance system covers all the related costs. The Slovenian health system pays the regular prices of the branded versions of ART – means that overall cost of care per patient is estimated to reach about 16,000€ per person/y.

They closely follow guidelines established at the European and international level – and so far, the high cost of ART has not been an issue (second line and third line regimens are accessible to the people that need it).

10 cost and care
10. Cost and care

Problem is when a patient have no basic health insurance which covers all the care.

On rare occasions, foreign patients with HIV who do not have health insurance in Slovenia have come to seek medical care (the few that are cited come from Kosovo and from Croatia). Some have been provided treatment free of charge (this is decided on a case-by-case basis with the Ministry of Health - when their situation is considered to be "life threatening").

11 medical data of hiv patients
11.Medical data of HIV patients

According to doctor at clinic of ID:

We have special protected programme, where all patient's data are collected.

So, every data are cohort data.

Health insurance electronic card – HIV status is not visible, ART therapy is not visible.

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Special thanks to:

The Peace Institute, Program East East, Ljubljana, Slovenia

Dr. Janez TOMAŽIČ, Clinic for infectious diseases in Ljubljana.

Janja Križman, Ministry of Health

Thank you for your attention!Hvala za pozornost!