CONCLUSIONS of the Council and the Ministers for Health of the Member States meeting within the Council of 16 May 1989 regarding the prevention of AIDS in intravenous drug users (89/C 185/03)

THE COUNCIL OF THE EUROPEAN COMMUNITIES AND THE MINISTERS FOR HEALTH OF THE MEMBER STATES MEETING WITHIN THE COUNCIL

draw the following conclusions from the exchange of views held on experience acquired in this field: I. INTRODUCTION 1. It is becoming increasingly clear that in all the Member States of the Community intravenous drug users have become the high-risk behaviour group showing the greatest increase in AIDS cases. There is epidemiological evidence that in some Member States they are also the group in which HIV infection has become most widespread.

2. In terms of routes of HIV transmission, intravenous drug users are unique in that they combine the three known channels by which HIV infection can be transmitted, namely: - transmission through the bloodstream, mainly through sharing syringes,

- sexual transmission,

- vertical transmission (mother-baby).

3. These individuals are potentially a very significant source of infection both for each other and for the rest of the community.

4. Therapy has so far made very slow progress and no means of protection for general use has yet been developed.

Most action programmes in this area must therefore concentrate on preventive activities, particularly health education programmes designed to reduce the risk of HIV infection.

5. All the Member States have set various action programmes in motion. Joint assessment of these could be of mutual benefit for the planning of future action.

II. PRECONDITIONS 1. In this particular situation, the need for clearlydefined policies to deal with drug abuse problems is more pressing than ever.

These policies must not only be geared to the ultimate objective (an end to drug use), but must also set out intermediate objectives (lowering of the mortality rate, reduction of the risk of infection by HIV and other agents of infection, reduction of marginalization, etc.), the attainment of which must be viewed as essential.

2. With this in mind, it is becoming increasingly necessary to ensure effective coordination between programmes to combat AIDS and programmes for the treatment and prevention of drug abuse, at both national and international level.

3. Drug users possess very distinctive social characteristics which must be taken into account in any preventive approach since they may hinder the proper implementation of programmes : a high degree of marginalization, behaviour associated with the administration of substances highly dangerous to health, and considerable difficulties in being reached by the medical and social services.

4. Experience acquired to date in various quarters shows that an awareness of the risk of HIV infection helps to motivate addicts to stop taking drugs or change to safer methods of administering them.

5. Provision of this motivation remains difficult and a great deal of imagination is needed in designing action programmes ; every available opportunity for progress in this direction must be seized.

6. Programmes must be designed in such a way that the absence of any element of repression, proximity (in time and space) of assistance to areas most frequented by drug users, rapid provision of health care on request and provision of other additional social measures enable these barriers to be overcome.

7. Any such strategy must encourage participation by all the appropriate professional and social services : public and private welfare services, judicial authorities, voluntary organizations, youth organizations, former drug users, etc.

III. CENTRAL POINTS OF A POLICY FOR THE PREVENTION OF HIV INFECTION

Obviously there can be no definitive, universal solutions, and while a number of measures have proved their effectiveness, they have always paid the greatest attention to the social characteristics of this special sector of the population to which drug addicts belong in each country, region or community.

Each State will therefore consider which solutions seem best suited to its specific situation. A. Health education 1. In addition to the consideration given to measures in general health education programmes, provision must be made for other measures aimed specifically at a particular environment or community, (prisons, the social milieux of drug users, prostitutes, etc.). When these measures are drawn up, the opinion of people who are familiar with these circles and their communication networks (people who have lived or are living in such circles, drug addicts, former drug addicts, etc.) must be sought.

2. Use must be made here of the strategic position of primary health care personnel, since it is known that for various reasons drug addicts frequently consult them before requesting withdrawal treatment. Efforts must be made to make such personnel aware of the importance of their role in altering the risk behaviour associated with drug addiction and sexual practices.

3. A similar process of communication must be initiated with other health care personnel to dispel the negative attitudes to these patients and thus to ensure that all contacts between patients and health care personnel can be put to advantage in furthering health education.

4. Following a diagnosis as HIV positive, in order to prevent the patient, convinced of his incurability, being tempted to adopt irresponsible behaviour with a high risk of transmitting HIV to others, realistic information must be provided on the likelihood of developing the disease, as well as on what the individual himself can do to reduce it by adopting a healthy lifestyle, particularly one which prevents or makes less possible any reinfection from the same source or other carriers.

B. Dependency treatment programmes 1. The various therapeutic options available for withdrawal treatment and the rehabilitation of drug users must be reviewed and assessed in the light of the emergence and spread of HIV infection.

2. It would be desirable to promote alternative approaches in this area where possible under national legislation. For example consideration might be given to implementing or extending methods which - like support programmes using substitutes - enable a transition to be made to drug-taking patterns which do not involve the risk of contracting infectious diseases.

3. Advantage must be taken of all opportunities for contacting drug users and drawing up programmes with differing requirement thresholds, so that each drug user can find one which he can realistically follow at any given moment.

C. Supply of condoms 1. In addition to including information on sexual practices which provide protection against HIV infection in health education programmes, condoms must be made easily available to drug addicts, either free of charge or at very low cost.

2. Information on such matters should be transmitted by health professionals, especially those who are closest to the patient, and their advice in this area must be applied in such a way that the patient accords it the same credibility as any other health measure.

D. Coordination of programmes to monitor pregnant drug addicts

Coordination should be increased between programmes to combat AIDS, drug addiction care and prevention programmes and programmes concerning mothers and children. All such programmes should envisage, from their own standpoint, the adoption of measures aimed at the population of female drug addicts of childbearing age and pregnant women who are drug addicts.

Such programmes should include the following in particular: - information and advice for female drug addicts concerning the risks of HIV infection to themselves, the foetus and the new-born child,

- high-risk pregnancy measures.

E. Diagnosis of HIV-positive individuals 1. Public authorities should create the conditions necessary to make diagnosis and treatment available to all those who require it, irrespective of their financial situation.

2. Tests should be carried out in such a way as to safeguard the voluntary nature of requests for tests and the confidentiality of results. It is also important that health professionals and teams should be in a position to offer advice and psycho-social support.

F. Specific case of prisons 1. Inasmuch as, for a variety of reasons, a large number of drug users spend some time in prison at some stage in their lives, prisons must be regarded as places of special importance for the development of varying prevention and assistance programmes.

2. Where necessary, the various possible measures which have been indicated for the general public should be carefully considered before being implemented in the prison environment, in the light of its very particular social and legal circumstances.

IV. FURTHER ACTION 1. In order to be able to take the fullest possible advantage of the experience acquired in the various Member States and bearing in mind the activities and guidelines of international organizations such as the WHO and the Council of Europe, the ad hoc Working Party on AIDS will exchange information on the basis of assessments of national action programmes.

At the end of its proceedings the Working Party will submit to the Council proposals for joint guidelines.

2. The Commission is requested to prepare and submit to the Council by the end of 1989 a programme in this area which could envisage, in particular, encouragement and funding for meetings of experts and other initiatives which allow for the exchange of knowledge gained in each country by assessing the different strategies and methods of implementation bearing in mind the activities of the international organizations referred to above.

3. Member States should, if appropriate, examine the impact of their national legislation in order to facilitate implementation of the measures put forward above, thus ensuring greater effectiveness in the fight against problems associated with the non-therapeutic use of drugs and HIV infection.