No C 191/10 Official Journal of the European Communities 22. 7. 91 
Opinion on the proposal for a Decision of the Council and the Ministers for Health of the 
Member States meeting withing the Council adopting a plan of action in the framework of 
the 1991-1993 Europe against AIDS programme (l) 
(91/C 191/05) 
On 15 January 1991 the Council decided to consult the Economic and Social Committee, 
under Article 198 of the Treaty establishing the European Economic Community, on the 
abovementioned proposal. 
The Section for Protection of the Environment, Public Health and Consumer Affairs, which 
was responsible for preparing the Committee's work on the subject, adopted its Opinion on 
17 May 1991. The Rapporteur was Mrs Rangoni Machiavelli. 
At its 287th plenary session (meeting of 29 May 1991), the Economic and Social Committee 
adopted the following Opinion unanimously. 
1. Introduction 
1.1. The Committee applauds the Commission's 
proposal which arrives on the table after a succession 
of Council of Ministers' statements on the worsening 
AIDS situation (acquired immunodeficiency syndrome). 
The proposal also satisfies the need for greater Euro­
pean-level coordination of public health measures in 
the light of the growth of a people's Europe. It is 
therefore no coincidence that the Council of Health 
Ministers has met regularly over the last few years and 
that at its latest meeting in December 1990 it called for 
a clearer definition of the Community's responsibilities 
in this area. 
1.2. The Committee notes with satisfaction the posi­
tive move towards giving public health a European 
dimension and urges that this be reflected in the forth­
coming revision of the Treaties with the inclusion of a 
specific chapter on health policy. 
1.3. The 'Europe against cancer' programme, which 
is already acting as a catalyst and having knock-on 
effects, is now finally matched by a proposed Europe 
against AIDS programme. Whilst the title and actions 
of the AIDS programme are ambitious, and the global 
approach correct, the funds earmarked for the pro­
gramme are modest. 
1.4. The effectiveness of the AIDS programme will 
obviously depend on (a) the extent to which it stimu­
lates Member State action and succeeds in the coordi­
nation thereof, (b) the increase in the exchange of 
experiences, and (c) the development of common stat­
istical and epidemiological instruments. 
1.5. The Committee would reaffirm the importance 
of promoting European research in this sector and 
notes with satisfaction that in the new research and 
development (R&D) programme on biomedicine and health (2) currently being discussed, a large proportion 
of the funds earmarked for area 2 ('Major health prob­
lems and diseases of great socio-economic impact') is 
allocated to AIDS, and in particular the development 
of a European vaccine against AIDS (EVA). 
1.6. The Committee would therefore recommend 
that the Europe against AIDS programme be coordi­
nated with the R&D programme on biomedicine and 
health—and particularly the latter's section on 'preven­
tion' which concentrates on 'specific epidemiological 
projects, studies of primary and secondary prevention, 
assessment of preventive strategies, behavioral research 
and forecasting' (3). 
1.7. Finally, the Committee urges that the utmost 
importance be attached to protecting the rights and 
guaranteeing the privacy of those with HIV or who have 
developed AIDS. Systematic screening should therefore 
not be carried out unless anonymity is guaranteed. 
1.8. Whilst fully supporting the 1991-1993 Europe 
against Aids programme, the Committee notes that the 
spread of funds over the nine actions will only provide 
for a modest actions at Community level. The Com­
mission should therefore review its action programme 
to consider the best and most efficient use of funds. 
Member States will have an additional responsibility to 
provide funds in their own local, regional and national 
programmes to complement the Community pro­
gramme. 
1.9. The Committee would seek to be involved in 
the programme and therefore the Commission should 
provide assessments, evaluations and reports to the 
ESC, as well as to the European Parliament. 
(2) Doc. COM(90) 676 final — SYN 267. 
(!) OJ No C 13, 19. 1. 1991, p. 6. (3) Ibidem, page 14. 
22. 7. 91 Official Journal of the European Communities No C 191/11 
2. Need for an integrated, multi-sector approach 
2.1. Since 1981 the AIDS epidemic has become one 
of the most disturbing and intractable of public health 
problems. 
2.2. The rapidity of the spread of AIDS is also linked 
to profound social and economic changes and the 
increasing mobility of European society so that there is 
an unfortunate but real risk that the situation will 
deteriorate over the next few years. 
2.3. The spread of AIDS is now no longer limited to 
'risk groups' and there has been a disturbing increase 
in the percentage of the female population affected. 
Repercussions are also being felt in terms of procreation 
so the problem also needs to be seen in the context of 
the 'protective measures needed for both male and 
female reproductive health', as recommended by the 
Committee in its Opinion on the 'protection at work 
of pregnant women or women who have recently given 
birth'',1). 
2.4. From a medical point of view, the prevention 
and treatment of the disease requires an integrated, 
multi-sector approach; this involves a number of differ­
ent factors and courses of action. 
2.5. The most effective method of prevention would 
be a radical change in behaviour, but this can only be 
a long-term goal. 
2.6. Joint efforts therefore need to be stepped up to 
find a vaccine as soon as possible. In the meantime 
AIDS prevention needs to be improved to reduce the 
numbers of those at risk of infection. There are two 
basic instruments for achieving this: information and 
education. 
2.7. Below are a number of suggestions which are 
intended to complement and reinforce the actions pro­
posed under the Commission's draft programme. Com­
munity action cannot, however, in any way replace the 
main effort, which must come from the Member States; 
all Community action can do is stimulate and coordi­
nate national initiatives. 
3. Information 
3.1. There is an urgent need: 
— to devise a system for compiling an objective, stand­
ardized and reliable data bank which would provide 
updated epidemiological statistics on the disease, 
— to provide accurate information on the pathways 
of transmission of the disease, be they classical 
(sexual relations, intravenous drug abuse, etc.) or 
less well-known, and to use videocassettes to pro­
vide such information to potential audiences at a 
variety of levels (schools, medical and paramedical 
staff), 
(l) OJNoC41, 18.2. 1991, p. 29. — to provide clear information on methods of protect­
ing oneself and others (condoms, non-reusable syr­
inges, safe injecting materials, safe methods of dis­
posing of used syringes, essential clinical practices), 
— to provide scientifically accurate information on the 
real damage AIDS can cause, not so much in itself, 
but as a condition conducive to the development of 
secondary illnesses resulting from a reduction of the 
immunological defence capacity, 
— to provide information on HIV infection and the 
potentially devastating effects it can have on repro­
duction and the sexual life of both males and 
females. 
3.2. Such information can be passed on in schools, 
during call-up medical examinations, at family planning 
centres and in sexually transmitted disease clinics, 
where such clinics exist. Sports doctors in gymnasia 
and training centres also have an important role to play 
in the dissemination of information. 
3.3. It is also necessary to improve the exchange of 
information between doctors, including not only gen­
eral practitioners, but all the specialists involved, such 
as paediatricians, andrologists, gynaecologists, derma­
tologists and venereologists. 
3.4. Medical congresses, even those devoted to 
apparently unrelated matters, should be used to height­
en awareness of AIDS-related problems. 
3.5. National associations of doctors and health 
workers can also make an active contribution to AIDS 
information campaigns. 
4. Education, particularly in medical circles 
4.1. In addition to a general AIDS prevention cam­
paign aimed in particular at educating young people, 
health workers should be provided with better peda­
gogical tools for educating people about the risks of 
AIDS, bearing in mind the fundamental role played 
by doctors and nurses in providing the public with 
information. 
4.2. It is also necessary to identify situations where 
doctors, nurses and patients may be particularly at risk 
(e.g. blood transfusions and surgery) so that prevention 
can be improved. 
4.3. At university level, studies of the various aspects 
of the disease with all its possible epidemiological, 
sociological, immunological, clinical, medical and sur­
gical implications, should be combined in multi-disci­
plinary, post-graduate specialist courses. European uni­
versities should be encouraged to undertake pilot 
experiments and exchange information to this end. 
No C 191/12 Official Journal of the European Communities 22. 7. 91 
4.4. Apart from incorporating an AIDS module in 
medical and dentistry courses, a specific course should 
be laid on in faculties specializing in gynaecology and 
obstetrics, andrology, dermatology, surgery, immu­
nology, etc. 
4.5. The training of paramedical staff in out-pati­
ents' departments and hospitals should also be stepped 
up, partly by making use of videocassettes. 
5. Comments on the content of the programme 
5.1. The ambitious title of the programme needs to 
be seen in terms of the intention to adopt a global 
approach and ensure effective media coverage. The 
financial limits evident from Annex II will nevertheless 
have a deleterious effect on the implementation of the 
actions set out in the document. 
5.2. Article 1 clearly defines the role and competence 
of the Member States which are the main partners of the 
Commission in ensuring the effective implementation of 
the action plan. At the same time the Committee would 
like to emphasize the contribution which the social 
partners can make to the success of the proposed 
actions, as has already been underlined in the Opinion 
on Europe against Cancer (1). 
5.3. The Committee welcomes the Commission's 
intention of closely coordinating its work with inter­
national organizations active in this field, such as the 
World Health Organization (WHO) and the Council 
of Europe, bearing in mind the seriousness of the AIDS 
problem in the Third World and the health problems 
of Eastern Europe. The Committee would also rec­
ommend that the International Red Cross be involved. 
Given the likely expansion of travel and the increase in 
migration (both North-South and East-West), AIDS 
prevention will clearly be ineffective if it is confined 
within certain geographical areas. 
5.4. The criteria for evaluating the effectiveness of 
the actions undertaken (Art. 3) must be such that an 
analysis can be made of both individual reactions and 
wider, more objective trends. The purpose would be to 
evaluate the impact of the information campaign, the 
repercussions on behaviour and the impact on epidemi­
ological trends. 
5.5. What is therefore needed are reliable methods 
for making qualitative and quantitative assessments 
based on objective data. 
5.6. Chapter 1—Information and health education 
5.6.1. The introductory first paragraph should make 
it clear that, whilst efforts must be intensified to find 
(') OJNoC329, 30. 12. 1989. an effective form of treatment, priority should neverthe­
less be given to prevention. Moreover, if a vaccine were 
developed, it would have its place in medical prevention 
alongside other health protection measures. 
5.6.2. The sixth paragraph states the need for 'simple 
messages'. This is correct but it is even more important 
for such messages to be 'effective'. This involves, among 
other things, sensitivity to the different ethnic, social 
and cultural backgrounds of the target groups. 
5.63. The proposal for a European Code against 
AIDS needs to be spelt out in more detail. Any such 
Code would be more complex than the European Code 
against Cancer since it would necessarily have to take 
into account the social, ethnic and cultural background 
of the target groups, without departing from the need 
for simplicity. The European Code against AIDS would 
essentially be concerned with putting across a clear 
message about the actual risks of AIDS transmission 
and about methods of self-protection and the protection 
of others, particularly through condoms, non-reusable 
syringes and safe injecting materials. The principle of 
non-discrimination should also be emphasized. 
5.6.4. Actions 1 and 2 are extremely important. The 
Committee nevertheless wonder whether the proposed 
plan of action will be sufficiently effective. The fight 
against the spread of AIDS is not conducted in vitro, 
in an aseptic world, and not everyone is receptive to 
educational and publicity campaigns. 
5.6.5. The Committee would refer to the additional 
recommendations made in point 3 and underlines the 
need to involve the social partners, especially with 
regard to information at the workplace. 
5.7. Chapter 2—Prevention and treatment 
5.7.1. In terms of objectives and actions, a clearer 
distinction should be made between HIV-infected per­
sons and people with AIDS. The ideal would be: 
— to prevent or delay the stage at which HIV carriers 
develop AIDS. 
— to delay, curb and possibly halt the progress of the 
disease and to improve the level of comfort, quality 
of life and conditions of survival of people with 
AIDS. 
5.7.2. Although recognizing the importance of 'rapid 
treatment of multiple infections due to immuno­
deficiency', the Committee feels that it is also important 
to underline the complexity and complications of AIDS 
as the disease advances, as well as the time factor, the 
cost of treatment and the need for home and hospital 
care. 
22. 7. 91 Official Journal of the European Communities No C 191/13 
5.7.3. Whilst medical, social and psychological sup­
port is vital, it should not be limited to the high-risk 
group of 'intravenous drug users'. It is also particularly 
important to give objective information to partners 
and families helping persons with AIDS or living with 
persons with the HIV virus. 
5.7.4. We can endorse the objectives of Chapter 2 
but would make the following comments: 
— the improvement of supportive action should not 
be limited to drug users. 
— the access of people with the HIV virus to treatment 
is extremely important and should not be limited 
to social and psychological counselling; access is 
also needed to therapies in general. 
— action to prevent the spread of HIV-infection cannot 
be limited to drug users, although the latter must 
have access to non-reusable syringes and safe 
injecting materials; witness the relative fall in the 
spread of AIDS among drug users in countries where 
such precautions are taken. 
— measures to reduce HIV transmission (the HIV 
virus) cannot be limited to eliminating risks of trans­
mission in blood and blood products; measures 
must also be taken to reduce risks of transmission by 
encouraging the use of condoms in sexual relations. 
5.7.5. Action 4 (exchanges of experience) is of par­
ticular value. As far as telephone helplines are con­
cerned, emphasis needs to be placed on the motivation 
and competence of the counsellors. 
5.7.6. Mobility is a key factor in Community-wide 
action, whilst the compilation of a 'Community direc­
tory of helplines' might be extremely useful. 
5.7.7. The figures given in Action 5 would appear to 
underestimate reality. It should not be forgotten that 
the costs of preventive medicine and treatment for those 
with the HIV virus are rising. It is vitally important to 
come up with specific cost-assessment models, dis­
tinguishing between people with AIDS and those who 
are HIV positive. 
5.8. Chapter 3—Epidemiological assessments 
5.8.1. This chapter is of the utmost importance so 
its share of appropriations should be greater than the 
20% earmarked in Annex II. 
Done at Brussels, 29 May 1991. 5.8.2. It is essential for the European Community 
and all the Member States to improve data quality and 
adopt reliable, standardized instruments of measure­
ment so that valid comparisons can be made. There 
should be close cooperation between national health 
authorities and the European Centre for the Epidemiol­
ogical Monitoring of AIDS whose effective and valuable 
contribution should be turned to full account and used 
as a model for the European-level monitoring of other 
transmittable diseases. 
5.8.3. Objectives and actions should be geared to the 
following three categories: 
— total population, 
— asymptomatic seropositives, 
— people with AIDS. 
5.9. Chapter 4—Manpower training and development 
5.9.1. In addition to the suggestions already made in 
point 4, the Committee would stress that efforts should 
not be focused solely on universities, but should be 
concentrated on training requirements and the 
exchange of experience at professional level (particu­
larly hospital and home-care services). 
5.9.2. The pharmaceutical industries, which are 
working on the development of methods of prevention 
and treatment, could make a considerable contribution 
to any such action. 
5.9.3. The same is true of professional and trade 
union associations, which must be actively involved in 
training activities and information services. 
5.10. Annex 2—Financial record sheet 
5.10.1. The Committee would reiterate its deep con­
cern that the appropriations fall below what is needed 
to fund the proposed activities. The Committee also 
considers that the share of the appropriations allotted 
to epidemiology is inadequate. 
5.10.2. Priorities should be reordered, bearing in 
mind the need to (a) avoid overlapping with work 
already carried out by other international organizations 
such as WHO, and to (b) determine the most appropri­
ate levels of action for each aspect under consideration, 
thereby ensuring that initiatives at European, national 
and local level are all neatly interwoven. 
The Chairman 
of the Economic and Social Committee 
Francois STAEDELIN