Opinion on the programme of Community action on the prevention of AIDS and certain other communicable diseases within the framework for action in the field of public health () (96/C 100/07)

On 28 November 1994, the Council decided to consult the Committee of the Regions, acting under Article 198c of the Treaty establishing the European Community, on the above-mentioned programme.

Commission 8 for Economic and Social Cohesion, Social Policy and Public Health, which was responsible for drawing up the Committee's work on the subject, adopted its Opinion on 16 March 1995. The Rapporteur was Mr Sileoni.

At its 7th Plenary Session of 20 and 21 April 1995 (meeting of 21 April), the Committee of the Regions adopted the following Opinion.

1. General comments

1.1. The Committee of the Regions welcomes the opportunity to comment once again, under the terms of Articles 3(o) and 129 of the Treaty, on the proposal for a Community programme of action on the prevention of AIDS and certain other communicable diseases (1995-1999), as it did on the previous programme in its Opinion of 17 May 1994 (CdR 44/94).

1.2. The Committee notes that the Commission has heeded a number of the requests made in the above-mentioned Opinion, particularly concerning the extension of the programme, the inclusion of information on AIDS in school education, more stringent blood safety checks and more promotion of blood self-sufficiency, and the exploitation of synergies generated between research centres. It nevertheless regrets that the COR Opinion does not appear among the references given for the legal basis in the financial statement.

1.3. The Committee restates its endorsement of the five-year programme (1995-1999) and of the inclusion of other communicable diseases, while emphasizing the specific character of HIV (human immunodeficiency virus) infection and the continuing need for it to take priority.

1.4. The Committee once again draws attention to the need for a comprehensive Community public health programme, with the aim of coordinating the various specific programmes, such as the AIDS one, and ensuring greater consistency between them. A comprehensive programme would also allow the obligation set out in Article 129 of the Treaty, for health protection to form a constituent part of the Community's other policies, to be fulfilled.

1.5. The COR calls for a Management Committee to be set up, rather than an Advisory Committee, and stresses that the Management Committee should include representatives of regional and local authorities. Moreover, the COR regrets the failure to mention such authorities among the other participants in the consultation, participation and assessment mechanisms. In this connection, it would urge the Commission to give greater encouragement to Member States to set up national coordination committees where they do not yet exist. These committees, with all the interested partners - including local and regional ones - are the guarantee that the principle of subsidiarity will actually be put into practice in any action undertaken.

1.6. The Committee considers the assessment activities to be important elements in the programme, and supports them.

2. Specific comments

The Committee would make the following comments on the measures and actions set out in the draft programme.

2.1. Measures for children and young people

Schools must play an intermediary role between young people, teaching staff and families, involving them in preventive training: active participation is one of the factors ensuring the success of preventive measures.

'Peer education` must also be developed, so that young people contribute to the development of a 'preventive attitude` and so that appropriate assessment methodologies can be applied to preventive programmes.

2.2. Prevention of HIV and STD transmission

The expression 'individuals engaging in high-risk behaviour` should be preferred to 'groups at risk`, which might be interpreted as being restricted to only one section of the population, as it does not seem to relate prevention to individuals with high-risk behaviour.

Prevention campaigns should therefore be directed towards reducing the spread of infections among the population with high-risk behaviour, concentrating either on the infection phase (including HIV-negative individuals at risk), or on the transmission phase (HIV-positive individuals).

Preventive measures should seek to change high-risk behaviour patterns, and should be aimed at the population in general, as well as being specifically targeted.

Future measures should include:

1. information and/or educational campaigns;

2. clinical monitoring of HIV-positive individuals, who would participate directly and actively in educational programmes.

In addition to sufficient information, educational campaigns should comprise psychological elements prompting individuals at risk to modify their behaviour.

These elements should stimulate an awareness of risk and recognition of appropriate means of prevention, by encouraging preventive skills (use of condoms, disposable syringes, syringe cleansing).

Measures to increase information, advice and support for women in general should be devised in the interests of early detection and to prevent late presenting at welfare and medical agencies. These problems are aggravated by the stigma of discrimination.

The absence of specific preventive measures for homosexual and bisexual men is regrettable.

2.3. Transfusion safety and blood self-sufficiency

Without prejudice to the Communication from the Commission on blood safety and self-sufficiency (COM(94) 652 final), it is important to recommend encouragement of blood donation by regular donors and the use of stringent donor selection criteria, based partly on behaviour analysis in order to exclude high-risk individuals who could transmit infection. It is also essential to avoid collecting blood from occasional donors at mobile units.

2.4. Welfare and psychology

People with HIV, once aware of infection, require support: this may be provided by health services or by their family and social environment. The clinical course of the condition naturally generates new psycho-social needs or may intensify those already existing.

The Committee stresses the crucial importance of local authorities in prevention (including secondary prevention) and health promotion, in the context of an active partnership with National Health Services and NGOs.

It is therefore necessary to encourage psycho-social support activities for people with HIV and their families on the part of the public health services and NGOs. Such activities should in particular provide individual counselling, backing up telephone counselling with medical and psychological aid and legal and social assistance.

Funding should be provided for training programmes in counselling for public health and NGO personnel.

Lastly, funding must be earmarked for projects helping such individuals or their partners to find employment, or supporting families where medical circumstances make normal work impossible.

2.5. Countering discrimination

Discrimination of any kind is a contributory factor in health inequality. Practical measures should be taken in this area, e.g. specialist training to assess the needs of people who are repeatedly exposed to prejudice and discrimination.

Done at Brussels, 21 April 1995.

The Chairman of the Committee of the Regions

Jacques BLANC

() OJ No C 333, 29. 11. 1994, p. 34.