Report

REPORT OF THE 4th ERNA MEETING
BRATISLAVA, SLOVAK REPUBLIC,

21-23 SEPTEMBER 2000

1 Background: The 4th ERNA meeting was hosted for the 2nd time by the Slovak Red Cross in Bratislava. For the participants see the (ANNEX 1.) Except the member NSs and observer NSs, 6 new NSs expressed their willingness to become new members of the Network.
The theme of the meeting was: Youth-peer education: Towards a comprehensive and coordinated approach to the strenghthening of HIV/AIDS, illicit drugs and STD control.

2 Opening: The 4th ERNA meeting started with a welcome speech. The Secretary General of the Slovak Red Cross pointed out the importance of the fight against the HIV/AIDS pandemic. Dr. Massimo Barra emphasized about the need to take into account the motto of the 13th World AIDS Conference “Break the silence”. After his welcome speech the rapporteur of the meeting was elected. Dr. Pavol Fucek from the RD IFRC accepted this function

3 Knowledge sharing: Experts from WHO European Regional Office, Council of Europe, Slovak Ministry of Health, UNAIDS, ABBOTT USA pharmaceutical company, the Federation Secretariat and other lecturers listed in the programme (ANNEX 2) made presentations on the topics described below and all presentations were followed by discussions in the plenary sessions. The topics include:

Presentation of Dr. Eva MADEROVA:

Prevention efforts in Slovakia:

1. Surveillance
2. Establishment of a Complex national HIV/AIDS prevention programme in Slovak Republic
3. In 1994 re-establishment of the programme in Slovak Republic
4. Establishment of National commission for HIV/AIDS with the aim to coordinate national spheres
5. New national programme establishment-based and compatible with UNAIDS guidelines
6. Establishment of National reference laboratory for HIV/AIDS
7. Anonymous HIV/AIDS blood testing
8. Through:

9. International cooperation and partnership (particularly UNAIDS)
10. National consultation on HIV/AIDS, STD and drugs with NGOs focusing on:

Presentation of Cyrille ORIZET, CoE:

1. Alarming situation in countries of EU – out of 1.500 000,- infected people, 800 000 are IDUs (in Spain 30% of IDUs are HIV positive)
2. Special focus and support directed on countries of Central and Eastern Europe
3. Situation in prisons is an emerging problem being of a common concern
4. In countries of the EU particular attention on IDUs
5. Solutions can be found only through active cooperation of all governmental institutions, NGOs and international organisations

Presentation of Dr. Alexander GROMYKO, WHO:

1. Introduction to the epidemiological situation and statistics with specific focus on diversity between continents´indicators. There are app. 33.6 mill. HIV+ cases throughout the world.
2. Since middle of 90% decline of AIDS cases in Western Europe. This is caused by effective prevention and development of high efficiency drug therapy. On contrary there is no decline in number of HIV+ cases.
3. In Eastern Europe the number of reported AIDS cases is very low
4. 70-90% of HIV+ cases (specifically in former Soviet Union) are IDUs.
5. Statistical indicators of syphillis, as a disease that is well diagnostic and reported, are much higher in Eastern that in Western Europe
6. Development of national policies and strategies is of a high importance, to ensure common approach.

Presentation of Dr. Gabriel GULIS:

1. Slovak National Programme of Health support established in 1991. The programme belongs under the Ministry of Health. General assumptions of the programme is that “Communities/people are responsible for own health”
2. There are wide opportunities of cooperation between the Programme and the Slovak RC.
3. Among the 6 priorities of the Programme there are also STD and HIV/AIDS prevention
4. Cooperation and collaboration with the RC would be of a greatest impact on the following fields:

Presentation of Prof. Vlastimil MAYER and ABBOTT USA:

The presentation introduced new developments in treatment and general approach. Prof. Vlastimil Mayer analyzed the extraordinary favourable epidemiological situation in Slovak Republic. After two decades of the pandemic, in Slovakia with 5,4 million population are registered only 81 cases of HIV/AIDS in Slovak citizens. This unique situation is connected with the intensive work of the National AIDS Reference laboratory established as early as in January 1984, among the first of its kind in Europe. Among the estimated 15.000-20.000 drug abusers in Slovakia, the HIV infection was diagnosed only in two of them (acquired abroad). The main task is to maintain the low spread of the HIV infection in the next years, especially when in Ukraine and Russian Federation are observed explosive outbreaks of infection, reaching several hundreds thousand of cases. In the further fight against this incurable ailment appears of great significance the UN Millenium Summit resolution (September 2000).

Presentation of Dr. Anna ZACHOVA:

1. Introduction of the Slovak National Centre for Human Rights
2. Presentation introduced different international and regional agreements and regulations that are in relation of rights of HIV+ persons and persons suffering from AIDS

Presentation of Dr. Vladimir HLAVNICKA:

1. Introduction to European standards and trends related to health education
2. Health education is targeted at public health leading to health prevention
3. The programme could actively collaborate with the Slovak RC on fields of: – database development – development of lecturing activities

Presentation of Dr. Milos MOKRAS:

1. Therapy and psychological support of HIV+ and persons suffering from AIDS in Slovakia is carried out by three clinics of infectious diseases. Personnel of these Clinics are actively involved in prevention activities, particularly lectures
2. Introduction to specific psychological needs of HIV + and AIDS ill patients
3. “There is no other disease, which could be so effectively fought, than HIV/AIDS”

Presentation of Dr. Lubomir OKRUHLICA:

1. HIV prevention among IDUs
2. Needle exchange being one of the four sub-programmes of the National health protection programme. The programme includes treatment and vaccination.

Discussion on experience with drug abuse prevention programmes in relation with HIV/AIDS Prevention:

1. Croatian RC participating in a syringe exchange programme- no NS participates in a syringe exchange programmes in prison – former toxicomans should actively participate in such programmes (having better access to target groups)
2. Drug abuse prevention programmes carried out in the community have to be well planned and structured, especially when implemented with participation of former IDUs
3. WHO starving to build capacities of governmental institutions since being the most important elements in this sphere

4 NSs presentation: Each NSs, both members and observers which participated in the meeting made presentation about the activities underway geared towards curbing the spread of HIV/AIDS.

AZERBAIJAN Red Crecsent:
1. Introduction of the alarming epidemiological situation
2. Prevention activities on national level are carried out through the National Centre for HIV/AIDS prevention (1990) having 12 regional laboratories
3. RC has a duty to support the prevention programmes
4. Possibilities for involving IDUs and prostitutes in NS prevention activities being considered

ARMENIAN RC:
1. Introduction to the overall epidemiological situation
2. Due to economical situation in the country thus shortage in laboratory supplies, blood testing being limited
3. HIV/AIDS prevention programme with support of the Dutch RC (1997-1998). The programme included:

4. Armenian RC is planning to expand its activities on field of HIV/AIDS prevention by:

5. Armenian RC is actively cooperating with other organisations
6. HIV/AIDS prevention as well as youth related activities being included in the Country Asssistance Strategy

BELARUSSIAN RC:
1. Introduction of overall epidemiological situation
2. Activities include information campaigns targeted at students
3. In future:

CROATIAN RC:
1. Introduction to the overall epidemiological situation. There are in Croatia app. 10.000 – 12.000 IDUs, and about 1% are HIV+. The highest number of IDUs are 21-25 years old.
2. Three Local Branches of the Croatian RC are involved in needle/syringe exchange programme. In frame of the programme they also provide condoms and printed information materials. The programme involves young professional or student volunteers specifically psychologists and sociologists.

FINNISH RC:
1. HIV/AIDS prevention programme is one part of the Public health programme of the Finnish RC. It aims at:

Specific target groups of the programme are young people

2. Representative of the Finnish RC at the end of her presentation addressed several questions to all participants concerning the aims of ERNA and stressed the importance of being a learning network

KAZACHSTAN Red Cross and Red Crescent:
1. Kazakh RC/RC HIV/AIDS prevention activities are carried out by the Youth section. They are targeted at young people utilising peer-education approach. The programme is organised through several steps training, including Training for trainers
2. Kazakhstan RC/RC plans to establish a “free of charge” centre, providing AIDS ill people with specific care (drugs, psychological support, etc.) They are seeking international support for this initiative.
3. Kazakhstan RC/RC has established cooperation with UNAIDS and other different organisations

Red Crescent of KYRGYZSTAN:
1. Introduction of the overall epidemiological situation
2. HIV/AIDS prevention activities of the NS are carried out by its Youth section, in cooperation with other NGOs and the National HIV/AIDS prevention centre. They do include also STD prevention.
3. The activities are focused on peer-education among youth and public actions
4. NS plans to develop a programme with imprisoned young people

LATVIAN RC:
1. Introduction of the overall epidemiological situation
2. HIV/AIDS prevention activities are carried out by the Youth section particularly on local level and are based on peer-education and public actions (1st December)

RUSSIAN RC:
1. Introduction to current epidemiological situation, 90% of HIV+ are IDUs
2. Primary focus of the Russian RC activities is on youth-peer education. The programme is based on the approach and methodology described in the IFRC training manual for Youth. This was adapted to particular needs in the Russian Federation as well as several times revised and updated.
3. Russian RC established 6 prevention centres for young people
4. Russian RC has established partnership with UNICEF, WHO, Swedish RC, Norwegian RC
5. There is a staff person employed at the Headqarters level specifically for HIV/AIDS prevention activities

MONACO RC:
1. Introduction of the epidemiological situation. There are 250 cases of HIV+ people in Monaco, which is almost 1% of the population
2. RC is focusing on prevention activities and targeting specifically young age groups. The programme includes training, workshops and school based peer-education
3. RC in its activities cooperates with the National HIV/AIDS prevention and surveillance centre

ITALIAN RC:
The representative of the Italian RC had a short introduction of the national epidemiological situation.
Activities:
In the previous meeting in Bratislava the Italian Red Cross presented the activities which have taken place at the Villa Maraini Foundation since 1976. At the beginning of 1990 Villa Maraini has started actions to prevent the spreading of HIV. In 1992 a HIV Unit, aiming to sustain HIV positive people has started. It offers anonymous testing, psychological and social support, self-help groups, night shelter, repatriation from abroad (Rome). This service operates in convention together with the Institute of Research and Cure L. Spallanzani (Rome), offering whole social assistance to patients discharged from that hospital. As a matter of fact there is a preferential channel between the two facilities and patients sent by Villa Maraini have a priority in admittance as well.
Since 1997 in Padova (Northern Italy) the Italian RC Volunteers have started a harm reduction intervention directed at drug addicts and sex-workers by a street unit equipped with a van.

2000 development following the peer education method:
During the year 2000 a whole series of actions were conducted to prevent the spreading of HIV/AIDS implementing the peer education method. These actions have been implemented inside discotheques, pubs, social centres, cinemas, concerts, game halls and railway stations, on the road. These actions have been consisting of:

NORWEGIAN RC:
1. Introduction to the epidemiological situation
2. Norwegian RC does not have a national programme focusing specifically on HIV/AIDS prevention. These activities are organised at the local branch level.
3. Norwegian RC is primarily focused on implementation of Strategy 2010 and the core areas of activities, including health and primary care in the community.
4. Norwegian RC is a member of different international and national networks.

SWEDISH RC:
1. Introduction to the epidemiological situation. Overall statistical indicators are showing declining tendency
2. NS carrying out peer-education programs targeted on schools
3. Framework for prevention activities is provided through Health Strategy, Community Health Strategy and Strategy 2010.
4. NS is running telephone ´hot lines´counselling centres
5. Swedish RC is involved in several international projects as a partner organisation

UKRAINIAN RC:
1. Introduction to the epidemiological situation
2. In 1999 beginning of a wide scale, long term targeted programme carried out in cooperation with the IFRC, German RC, national and local media and other NGOs. The programme focuses on:

TAJIKISTAN Red Crescent:
1. There is no specific HIV/AIDS prevention program of the NS
2. NS has a Health prevention programme supported by ECHO. In the framework of this programme HIV/AIDS prevention activities are carried out particularly by young people in the form of lectures and peer-education. Posters, leaflets and other promotional materials are produced.
3. NS has established cooperation with the National AIDS prevention centre and other NGOs.
4. NS plans to establish a telephone ´hot line´.

UZBEKISTAN Red Crescent:
1. Introduction to epidemiological situation and organisation of HIV/AIDS prevention, diagnostic and treatment activities on national level. There are 20 AIDS centres and 92 diagnostic laboratories in the country.
2. NS is participating in the National HIV/AIDS programme, by specific youth-peer education activities as well as with the organisation of exhibitions and workshops.

SLOVAK RC:
The Vice-president of ERNA and the member of the Governing Board of the Slovak RC Dr. Peter Duchaj pointed out all the speeches made previously by the Slovak experts in this field, and as some of them are collaborating or working directly with the NS, the situation of prevention on the field of HIV/AIDS and STD has been explained and presented sufficiently.

5 Workshop on Youth-peer education: The objective of the workshop was to focus on the major aspects of youth peer education so that the participants can have a general understandings of youth peer education (the conceptual framework of youth peer education). Dr. Gizaw made a short presentation on the conceptual framework of youth peer education as a base of guidance for discussion by the participants in the plenary session. The participants were then divided into two working groups – Russian and English speaking. The same topics were given to the groups:

Almost half a day was given to the group work and knowledgeable individuals from Federation and NSs were assigned as resource persons for the groups. The facilitator of the English group was Dr. Cecilia Anshelm from the Swedish Red Cross, of the Russian group Dr. Ophelya Khachatryan from the Armenian RC.

The English group results: Dr. Oana Vasiliu, representative of the RD IFRC was elected as a rapporteur of the group; she made a large presentation on the view of her group on the youth-peer education:

Specific results:

TRAINING:
resources in ERNA:
Croatia: Human resources (HR) – training for IDU people
Finland: HR and MR (Material resources) – training for youth p.e., MR in STD, HIV/AIDS, sex. Education
Italy: HR and MR – training for IDUs p.e and DU p.e, sex workers, specialists
Sweden: HR and MS – youth p.e

The Russian group results: Dr. Ophelya Khachatryan from Armenian RC, rapporteur of the group pointed out:

ORGANISATION: cooperation with NSs, IFRC/RC, ICRC/RC Distribution of materials Generalization of meeting results and activities Advocacy level: to find donor organizations Local level: youth p.e elaborated and applied
It is necessary to have one coordinator in each big district and then to send results to the ERNA secretariat
PROGRAMME PLANNING: opinion polls among the most vulnerable groups especially among the young people Distribution of brochures and booklets among population on transmission modes of AIDS, its main symptoms and methods of prophylaxis To get in collaboration with the Ministry of the health Educational lecturers and talks at high schools, universities and enterprises Propaganda of healthy sexual behaviour among the age groups of 15-25 with the purpose of expanding the initial prophylaxis against AIDS and other STDs TV programmes, internet, press,……. Hot-line for anonymous calls to be organised in the Asian countries Methods of contraception The educational Youth programme must be different in each countries

In general NSs are very interested in organizing and implementing the programme and there was a feeling that in the future a well structured trainig workshop must be organized for the NSs´core staff members who are responsible for planning and organizing the programme. All NSs appreciated very much the 2nd edition of Action with Youth manual that has been prepared and made available by the Health Dpt. of the Federation Secretariat.

As many NSs in Eastern Europe and Central Asia speak Russian, the need for having a Russian version of the manual was expressed and Dr. Gizaw informed them that the Federation in collaboration with the Russian RC is in the process of finalizing the requested version.

6 The ERNA Secretariat and its problems: in this session it was planned to discuss the strenghth and weaknesses of the ERNA Secretariat and also to plan future actions for further strenghthening of the Network. Dr. Peter Duchaj, the Vice-president of the Network, made an oral presentation on the performance of ERNA since the move of the secretariat to Bratislava. The following are the major points mentioned:

Dr. Duchaj spoke also about the available budget for the year 2000 (ANNEX 3) and its utilization and the proposed budget for 2001 (ANNEX 4). The difference of 10% in the budget proposal for the year 2001 represents inflation. He also presented the preliminary financial use of the funds from the Swedish RC (for organizing the 4th ERNA meeting) and the funds for the Secretariat from the Slovak RC and other sources (IFRC, Italian RC). With regard to the problems, the lack of sufficient funding support was described. In consideration of the logistical and organizational problems associated with moving of the secretariat to different NSs every 2 years and also the loss of the experienced staff in the process, the Slovak RC expressed its willingness to host the ERNA secretariat for the years to come.

Discussion about ERNA continued with many remarks from each representatives. Here is the summary:
1. Positive impact of establishment of ERNA Secretariat
2. Reports and information provided to all, not only member NSs, as well as to other partners mentioned above, and also to Presidents and Secretaries General of NSs throughout Europe
3. Introduction to financial background of ERNA and possibilities of financing through UNAIDS, EU and NSs
4. Assessment of general epidemiological and programme situation whithin ERNA member countries was conducted, reported information is not possible to evaluate
5. Proposal for maintaining ERNA Secretariat in Bratislava and for not moving it every two years, as stated in the TOR. This should avoid the lost of institutional memory and disruption of a long term approach.
6. Presentation of budget proposal for 2001
7. Funding situation in 2000 (ANNEX 5)
8. It was proposed by Dr. Barra to elect the new president during the 4th meeting. This decision was not accepted and thus it was post-dated to the 5th ERNA meeting in the year 2001.
9. Swedish RC representative informed about financial support of 200 000 SEK (40 000 CHF) provided to ERNA
10. Call for the preparation of long term strategy and unified approach
11. Norwegian RC and Swedish RC informed about the availability of funding support to HIV/AIDS prevention activities. The representative of the Swedish RC asked all those NSs who needs support to write approximately the sum of their need for these activities.
12. Call for organisation of training/workshops on the new manual of the IFRC
13. Regional Delegation expressed its willingness to support ERNA activities by provision of expertise
14. ERNA will have the key role to play on the next European RC/RC Conference in Berlin and will represent the importance of cooperation and partnership building in international RC/RC context
15. Introduction of Pan-African Conference Statement

7 New members: During the meeting 5 NSs (Latvia, Kyrgyzstan, Tajikistan, Uzbekistan, Azerbaijan) expressed their willingness to become active members of the Network. They have signed the declaration of membership (ANNEX 6)

8 Date and place of the 5th ERNA meeting: It was agreed to hold the 5th ERNA meeting in Kazachstan, in May or September 2001. The president of ERNA asked the representative of the RC/RC of Kazachstan to present to the Secretariat ahead of time the previewed financial expenses needed for organizing the next meeting. The organization of the next meeting in Kazachstan will depend on the expenses and costs. If these expenses will be very high, the alternative to organize the 5th ERNA meeting in Helsinki, Finland, was offered from the representative of the Finnish Red Cross and also there was an offer from the representative of the Armenian Red Cross to organize the meeting in Yerevan.

In conclusion all participants thanked the Slovak RC for the excellent organization of the meeting and for the kind hospitality. The meeting ended in accordance with the time frame of the agenda.