Proposal for a Decision of the Council and the Ministers for Health of the Member States, meeting within the Council, concerning the extension to the end of 1994 of the 1991-1993 plan of action in the framework of the ' Europe against AIDS' programme
Date: 1993-09-29
Institutions: European Commission
Subjects: AIDS, action programme, exchange of information, health control, health education, psychology

COMVIISSION  OF THE EUROPEAN  COMV1UNITIES 

C0M(93)  453  f i n al 

Brussels,  29  September  1993 

Proposal  for  a  Decision  of  the  Council  and  the  Ministers  for  Health 

of  the  Member  States,  meeting  within  the  Council, 

concerning  the  extension  to  the  end  of  1994 of  the  1991-1993  plan  of  action 

in  the  framework  of  the  'Europe  against  AIDS'  programme 

(presented  by  the  Commission) 

EXPLANATORY  MEMORANDUM 

I. 

INTRODUCTION 

AIDS (Acquired  immunodeficiency  syndrome) is a disease caused by a virus (HIV) for  which 
there  is  currently  no  vaccine  or  cure.  Prevention  of  transmission  of  the virus  is therefore  of 
the utmost  importance. 

During  the  1980s  there  was  a  rapid  increase  in  the  number  of  people  with  AIDS  in  the 
European  Community  In  1982,  86 people  were  reported  as being  diagnosed  with  AIDS but 
by  1990  this  number  had  risen  to just  under  14,000.  The  numbers  are  still  continuing  to 
increase  overall.  By  31 March  1993  83,973  AIDS cases had been  reported.  It is not  possible 
to  indicate  precisely  the  number  of  people  infected  with  HIV  in  the  Community,  but  it  is 
estimated  that  there  are  about  500,000. 

The changing pattern  of the epidemic in the Community  which  emerges from  the records and 
surveys made since the early  1980s reflects the modification  of behaviour and Member  States' 
response  to  the  disease  as  well  as  scientific  advances.  Generally  speaking,  the  growth  rate 
among  intravenous  drug  users  (IVDUs)  has  recently  been  slowing  down,  whereas  among 
heterosexuals and those classified  as of  "unknown"  sexual  preference  it is going up. There are 
however  significant,  geographical  variations  in  the  trends  observed  for  the  three  dominant 
categories  (IVDUs,  heterosexuals,  and  homosexuals),  such  as  the  increased  rates  of 
transmission  among IVDUs in southern Member  States, there have also been some impressive 
reductions in transmission  frequency  observed  among  people  with  certain  risk behaviours  in 
some  Member  States,  notably  homosexual  men. 

The present picture  is of a disease which, while not  increasing  at the very  rapid  rate of earlier 
years, is nonetheless continuing  to spread  and  may  well  become  endemic  in certain groups in 
the  absence  of  any  early  medical  breakthrough.  Worrying  trends  of  relatively  high 
transmission  rates  in  particular  settings,  such  as prisons,  and  among  particular  disadvantaged 
groups  such  as  migrants,  and  the  continued  rise  of  cases  through  heterosexual  transmission, 
and  among  women,  serve  as  pointers  of  further  problems  to  come  and  of  areas  where 
additional  efforts  need  to  be  expended.  In  addition,  the  rising  number  of  those  adults  and 
children  living  with  HIV  and  AIDS  will  place  new  burdens  on  service  provision  and  could 
provoke  further  social  problems  of  discrimination  and  stigma. 

Against  this  background,  Member  States  have  developed  programmes  to  combat  the  spread 
of the disease and to deal with its consequences.  In addition,  to support and complement these 
programmes  a  number  of  initiatives  have  been  taken  at  Community  level.  The  Council  and 
the  Ministers  for  Health  of  the  Member  States  meeting  within  the  Council  have  adopted  a 
number of  texts on public health aspects of AIDS (see attached  list)  The Community  has also 
established  an  AIDS  assistance  programme  for  developing  countries  and  included  an  AIDS 
Programme  for  Research  and  Technological 
research  component  in  the  framework 
Development. 

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In  addition,  on  4  June  1991,  the  Council  and  the  Ministers  for  Health,  meeting  within  the 
Council, adopted a Decision  on a plan of action for a 'Europe against AIDS' programme. This 
programme  in  the  field  of  public  health  was  to  run  from  1991  to  1993  and  was  focused 
principally  on  preventive  actions,  such as information  and education.  As provided for in the 
Decision,  the  Commission  sent  to  the  Council  on  10  March  1993  a  report  on  the 
implementation  of  the  plan of  action  in  1991-1992.  In this  the Commission  reported  on the 
means deployed  to achieve the objectives laid down  in the Council  Decision  and commented 
on the early  results obtained  as well  as on the relative  weight  and pertinence  of the activities 
undertaken,  or requiring  to be undertaken,  to give  full  effect  to the aims of the Decision,  set 
against  the  backcloth  of  the  trends described  above.  The  Commission  also  stated  its  view 
that there  would  be  value  in  further  actions  on  the  public  health  aspects  of  HIV  and  AIDS 
being  undertaken  by  the Community  after  the plan  of  action  expired  at the end of  1993. 

Following consideration  of  the Commission's report, the Council  and the Ministers for Health 
at  their  meeting  of  27  May  1993  agreed  to  invite  the  Commission  to  take  the  initiatives 
necessary  for the  pursuit  of  the actions of  the 'Europe against  AIDS' programme in  1994 in 
anticipation  of the coming  into force  of the Treaty  on  European  Union  which  provides in its 
Article  129, for Community  action in the field  of  public health.  The subsequent  evaluation in 
the Council  of the effectiveness  of the work undertaken concluded  that the broad structure of 
the areas of action  contained  in the Council  Decision  could be maintained, but with a number 
of modifications  in the objectives  pursued,  the introduction  of new areas, and the deletion  of 
others in  order  to  retlect  the  changing  needs  of  the  Member  States,  increased  knowledge  of 
the problems posed by the disease, as well  as its evolution  and trends.  In particular, it was felt 
that the old  actions  Nos  1 and 2  would  have  to be amalgamated,  action  6  discontinued  as it 
was conceived  at a time where great fears  had arisen about the possible  economic  impact of 
the disease,  and action  8 pursued as part of other actions of the programme. Old action 7 was 
singled  out  as  the  most  important,  and  it  was  deemed  necessary  to  initiate  new  actions  of 
information  and awareness  for  specific  target groups,  taking account  in particular of migrant 
and other disadvantaged populations, rather than for the population at large. It was agreed that, 
in accordance  with  the  principle  of  subsidiarity  Community  action  should  be so designed  as 
to assist the Member  States in fully  achieving  their objectives  in  the fight  against  AIDS, and 
carried out in a way that maximises the added value accruing from  Community's involvement, 
for example by downgrading  support for conferences and increasing  support for pilot projects 
and  assistance  structures,  and  continuing  activities  which  had  already  demonstrated  their 
worth 

The present proposal  for a Council  Decision takes account of the views expressed by Member 
States  and reflects  the experience  accumulated by the Commission  in  implementing the first 
plan  of action.  As  such  it constitutes  both  an extension  and  a modification  of  the first plan, 
retaining  the  latter's  general  structure,  changing  or  introducing  actions  as  appropriate,  and 
attempting  to describe  as tangibly  as possible  the  results to be  achieved  by  the action  of the 
Community.  Finally  this  proposal  reflects  more  explicitly  than  the  previous  plan  of  action 
compliance  with  the  principle  of  subsidiarity,  recognizes  the  existence  of  diverse  situations 
which  exist  in the  Member  States,  and provides for  appropriate  consultation  and assessment 
mechanisms  concerning  the actions to be undertaken. 

2. 

COMMENTS  ON  THE  PROPOSAL  FOR  A  COUNCIL  DECISION 

Preamble 

This proposal  for  a Decision  is intended  to implement  the conclusions  of the Council  and the 
Ministers for  Health  meeting  within  the Council  of  27 May  1993 on  the  implementation  and 
continuation  of the  "Europe  against  AIDS"  programme.  It consists  of  an  operative  part with 
three  articles,  and  an  annex  listing  the  objectives  of  the  actions  proposed. 

The proposal  responds directly  to the wish of the Council that the programme "Europe against 
AIDS"  should  continue  in  1994,  following  the  expiry  of  the  current  plan  of  action.  It  also 
stresses, however, the need not just to continue with all  the existing activities, but to tailor the 
actions  for  1994  to  reflect  the  results  of  the  evaluation  of  the  implementation  of  the 
programme  and  current  trends  in  the  development  of  the  epidemic. 

Article 1 

This  gives  effect  to the  Council's  wish  to extend  the  plan  of  action  for  one  year. 

Article  2 

This  provides that  the  appropriations  allocated  for  the activities  provided  for  under  the  1994 
plan  of  action  shall  be  adopted  under  the  budgetary  procedure.  As  a  guide,  an  amount  of 
Ecu  9  million  has  been  included  in  the  preliminary  draft  budget  for  1994  which  has been 
approved  by  the  Commission. 

Article  3 

This gives effect  to the Council's  wish  to have  a report on  the implementation  of the plan of 
action. However,  it specifies that this shall be prepared after the actions have been completed. 

Area  of  Activity  1 

This brings together two important areas: measures to establish what people know about AIDS 
and  what  their  attitudes  and  behaviour  are;  and  measures  designed  to  increase  people's 
knowledge  and improve  their appreciation  of  the disease  and its implications. 

A  key  role  at Community  level  is to gather  information  on what  has been  done  in  Member 
States and to assess how successful  their efforts  have been. Member States can thus be helped 
to  put  their  own  experience  into  a  broader  perspective  and  improve  the  impact  of  their 
programmes by  drawing on the experience  gained  elsewhere. 

The Community,  while  not running its own  campaigns,  can  also help Member  States to  co 
ordinate  certain  information  and  education  activities.  Taking  action  on  a  Community-wide 
basis  can  increase  the  visibility  and  impact  of  campaigns,  and  helps  to  ensure  that 
contradictory  messages  are not  put out in  different  States. 

Telephone  helplines,  and  more  recently,  computer  data  networks,  play  a  valuable  role  in 
complementing  public  campaigns  by  giving  individuals  the  information  they  need  on  their 
particular problems.  However,  such  response  mechanisms  are not available everywhere, and 
it is important that those being set up provide a satisfactory  level  of service, for example, that 
their  information  is  factually  accurate  and  that  individual  confidentiality  is  preserved.  The 
Community  can  therefore  play  a role  in  promoting  the  expansion  of  these  services  and  in 
making  available  the  knowledge  and  experience  of  those  that  are  established  to  those just 
getting  underway. 

Area  of  Activity  2 

Children  and young  people  are a key  target  for  prevention,  and it  is important  that as many 
as  possible  are  provided  with  information  about  the  disease  in  a way  that  is  appropriate to 
their level  of maturity  and their cultural  background.  Such information  can be imparted both 
within  a  formal  educational  setting  and  outside  it  (in  social  clubs  and  on  holiday,  for 
example).  But  whatever  the  setting,  information  about  AIDS  should  where  possible  be 
provided in connection  with general  health and sex  education  rather than in a totally  separate 
manner. The Community  can help the exchange of information  in this area and the promotion 
of appropriate educational  materials,  etc.,  and so assist  Member States in the development  of 
their Programmes. 

Area  of  Activity  3 

Increasing  tourism  and  travel  within  the  Community  and  to  and  from  the  Community  and 
other States bring  with them greater  possibilities  for the spread of the disease.  Attempting to 
combat  this  by  controlling  movement  across  borders  has  unacceptable  consequences  and  is 
ineffective  However,  providing  information  and  running  specific  campaigns  can  have  a 
significant  impact  Such  activities  can  often  most  easily  and  effectively  be  carried  out  at 
Community  level  since  of  necessity  a number of  States are involved 

Prisons also represent  an  important  setting  for  the potential  spread  of  HIV by  means of drug 
users  sharing  needles  or  prisoners  having  unprotected  sex.  The  actions  taken  in  response  to 
the threat of AIDS vary enormously  between  prisons, as does the approach taken and the help 
given  to  prisoners  with  HIV  and  AIDS.  Exchange  of  ideas  and  information  and  the 
encouragement  of  new  approaches  can  help to  reduce  the  problem  in  this setting. 

Injecting  drug users are also a key group, and indeed  in some Community  Member States they 
are  the  principal  group  with  the  disease.  Efforts  to  exchange  ideas  about  how  to  reduce  the 
risk  of  infection  and  to  spread  good  practice  can  help  reduce  the  transmission  within  this 
group  and  from  drug  users  to  the  general  population. 

Preventive  measures  can  also  usefully  be  promoted  at  Community  level  aimed  at  women, 
particularly  those in certain target groups, such as prostitutes. Women form  a rising proportion 
of  those  with  HIV  and  AIDS,  and  prevention  work  for  them  needs to be  further  developed. 

In addition  to  such  preventive  measures the Community  can  play  a role with  regard  to those 
children  who  are  themselves  infected  with  HIV.  As  the  epidemic  spreads,  so  there  are 
increasing  numbers  of  babies  and  children  with  HIV,  and  they  and  their  families  need 
considerable  support.  Exchange  of  information  about  the  position  in  the  Member  States  can 
help  identify  problems  and  maximise  the  efficacity  of  the  measures  taken. 

Homosexual  and bisexual  men constitute a large, though  falling,  proportion  of those  infected. 
It is important  to continue  efforts  at preventing  new  infections  within  this group,  particularly 
those targeted  at young  men who may  not have been  exposed to preventive action  previously. 
The  Community  can  promote  such  action  and  help  Member  States  to  exchange  views  and 
information  about  how  it  can  most  effectively  be  undertaken. 

The adoption  of various safety  measures, such as the heat treatment of blood and the screening 
of blood  donors,  means  that  nowadays  the  risk  of  transmission  of  HIV  through  this route in 
the nowadays Community  is minimal  However  it is important  that  any  small  remaining  risks 
be reduced  as far  as  possible.  Work  towards self-sufficiency  in  the Community  represents an 
important  way  of  pursuing  this  objective 

Area  of  Activity  4 

Community  action  cannot  replace  the  work  of  Member  States  in  providing  social  and 
psychological  support for those with the disease  However the Community  can help to promote 
the collection  and dissemination  of information  about the disease and  support  services so that, 
for  example,  those  who  need  specialised  support  know  where  it  is  available,  and  it  can  also 
promote  the  exchange  of  experience  about  how  such  support  can  be  effectively  provided. 

Area  of  Activity  5 

The  availability  of  accurate  epidemiological  data  is  a  pre-requisite  for  the  establishment  of 
effective  strategies  to  combat  the  disease.  In  this  context  the  Community  can  play  an 
important role in supporting the collection  and analysis of data, particularly  at the Community 
level.  This  can  include  helping  to  build  up  the  links  between  the  responsible  centres  in  the 
Community  and  encouraging  the  development  of  specialised  training  in  this  field. 

In  addition,  the  Community  can  also  promote  the  exchange  of  information  on  the  measures 
taken  in Member  States in response to the epidemic.  Such  exchanges can help Member  States 
to gain a broader  perspective on the situation  and to maximise the impact of their own actions. 

Area  of  Activity  6 

Discrimination  against  those  with  HIV  and  AIDS  has  been  vigorously  opposed  by  the 
Community from  the outset as being both morally indefensible and counterproductive in public 
health terms.  At Community  level  experience in the different  Member  States can be reviewed 
and  compared. 

Area  of  Activity  7 

The actions on the public health  aspects of HIV/AIDS  must be undertaken  taking full  account 
of the work being done on other  aspects of  AIDS in the Community,  notably  on research  and 
assistance  to  developing  countries.  Liaison  with  the  other  programmes  can  help  achieve 
synergy  and  avoid  duplication  and  overlaps. 

3. 

LIST OF  EUROPEAN  COMMUNITY  TEXTS  ON  AIDS 

Resolution  of  the  representatives  of  the  Governments  of  the  Member  States,  meeting 
within  the  Council  of  29  May  1986  on  AIDS  (OJ  C  184, 23  July  1986, p. 21) 
Conclusions  of  the  Council  and  of  the  representatives  of 
the  Governments  of  the 
Member  States, meeting  within  the Council  of  15 May  1987 concerning  ADDS (OJ C 
178,  7 July  1987,  p.  1) 
Conclusions  of  the  Council  and  of  the  representatives  of 
the  Governments  of  the 
Member  States,  meeting  within  the  Council  of  31  May  1988  concerning  AIDS  (OJ 
C  197, 27 July  1988, p.  8) 
Resolution  of  the  Council  and  of  the  Ministers  of  Education  meeting  within  the 
Council  of  23  November  1988  concerning  health  education  in  schools  (OJ  C  3,  5 
January  1989, p.  1) 
Conclusions  of  the  Council  and  the  Ministers  for  Health  of  the  Member  States, 
meeting  within  the  Council  on  15  December  1988  concerning  AIDS  (OJ  C  28,  3 
February  1989,  p.  1) 
Conclusions  of  the  Council  and  the  Ministers  for  Health  of  the  Member  States, 
meeting within  the Council  on  15 December  1988 concerning  AIDS  and  the place of 
work  (OJ  C 28,  3 February  1989,  p.  2) 
Resolution  of  the  European  Parliament  of  30  March  1989 on  the  fight  against  AIDS 
(OJ  C  158 of  26.06.89,  p.  477) 
Conclusions  of  the  Council  and  the  Ministers  for  Health  of  the  Member  States, 
meeting  within  the  Council  on  16 May  1989  regarding  the  prevention  of  AIDS  in 
intravenous  drug  users  (OJ  C  185, 22  July  1989, p.  3) 
Conclusions  of  the  Council  and  the  Ministers  for  Health  of  the  Member  States, 
meeting  within  the  Council  on  16 May  1989  on  awareness  measures  for  health  care 
personnel  (OJ  C  185,  22  July  1989,  p. 6) 
Conclusions  of  the  Council  and  the  Ministers  for  Health  of  the  Member  States, 
meeting  within  the  Council  on  16  May  1989  on  the  improvement  of  the  general 
system  for  collecting  epidemiological  data,  including  the  application  of  the  new 
definition  of  AIDS  cases  (OJ  C  185,  22 July  1989,  p.  7) 
Conclusions  of  the  Council  and  the  Ministers  for  Health  of  the  Member  States, 
meeting  within  the  Council  on  16  May  1989  regarding  future  activities  on  AIDS 
prevention  and  control  at  Community  level  (OJ  C  185,  22  July  1989,  p.  8) 
Resolution  of the Council  and  the Ministers for  Health  of the Member  States meeting 
within  the  Council  on  22  December  1989  on  the  fight  against  AIDS  (OJ  C  10,  16 
January  1990,  p.  3) 
Decision  of  the Council  and  the  Ministers  for  Health  of  the  Member  States,  meeting 
within  the Council  on  4 June  1991  adopting  a plan of  action  in  the framework  of the 
1991  to  1991  "Europe  against  AIDS"  programme  (OJ  L  175,  4  July  1991, p.  26) 
Report from  the Commission  on the implementation  of the plan of action in  1991-1992 
of  the  "Europe  against  AIDS"  programme  ((COM193) 42  final,  10 March  1993) 
Conclusions of the meeting of the Council  and the Ministers for  Health meeting within 
the  Council  of  27  May  1993 

Proposal  for  a  Decision  of  the  Council  and  the  Ministers  for  Health  of  the 

Member  States,  meeting  within  the  Council,  concerning  the  extension 

to  the  end  of  1994 of  the  1991-1993 plan  of  action  in  the  framework 

of  the  "Europe  against  AIDS"  programme 

THE  COUNCIL  OF  THE  EUROPEAN  COMMUNITIES  AND  THE  MINISTERS  FOR 

HEALTH  OF  THE  MEMBER  STATES. MEETING  WITHIN  THE  COUNCIL. 

Having  regard  to the  Treaty  establishing  the  European  Economic  Community, 

Having regard  to  the  proposal  from  the Commission,1" 

Having  regard  to  the  opinion  of  the  European  Parliament,'2* 

Having  regard  to  the  opinion  of the  Economic  and  Social  Committee,13' 

Whereas  the  Conclusions  of  the  Council  and  the  Ministers  for  Health,  meeting  within  the 

Council  of  27 S liw.l  stress  that  it  is absolutely  essential  to  continue  the  activities  of  the 

"Europe  against  AIDS"  programme; 

'"OJ  No 

,:'  OJ No 

'•*• OJ NO 

Whereas the plan of  action adopted by  Decision  91/317  of  the Council  and the Ministers 

for  Health  of  the  Member  States,  meeting  within  the  Council(4),  of  4  June  1991  in  the 

framework  of  the  "Europe against  AIDS" programme,  expires at the end of  1993; 

Whereas in future  specific  measures to combat  AIDS  in the framework  of  Article  129 of 

the Treaty on European Union, signed at Maastricht on 7.2.1992, should be undertaken with 

priority given to encouraging  cooperation between the Member States  and support to their 

activities being  provided  where  necessary; 

Whereas transitional  measures are needed in the  intervening period while waiting the entry 

into force of the Treaty  on European  Union  so that activities already  started can continue 

in  1994; 

Whereas  extending  the  1991-1993  plan  of  action  until  the  end  of  1994  will  enable  such 

activities to continue; 

Whereas,  in  extending  the  plan  of  action,  account  is  taken  of  the  content  of  the 

Communication  from  the Commission  to the Council  and the European Parliament on the 

implementation of the plan of action in  1991-1992 in the framework of the "Europe against 

AIDS" programme(5) and of  its evaluation  as provided  for by  the Decision  of the Council 

and the  Ministers  for  Health  of  the  Member  States meeting  within  the Council  of  4 June 

1991 adopting a  1991-1993 plan of action  in the framework  of the "Europe against AIDS" 

programme,  and of  new  factors  which  have  emerged  in the fight  against AIDS; 

<4)0J  L  175 of  4 7  1991,  p. 26. 

'" COM (93)  42  final 

10 

HAVE  DECIDED  AS FOLLOWS 

Article 1 

I 

The  1991-1993  plan  of  action  in  the  framework  of  the  "Europe  against  AIDS" 

programme  shall  be extended  until  31  December  1994. 

2. 

The Commission  shall  implement  the  1994  plan of  action  set  out  in the Annex  in 

close  cooperation  with  the  competent  authorities  of  the  Member  States  in 

accordance  with the  provisions  of  Article  1  of  Decision  91/317/EEC 

Article 2 

The  appropriations  allocated  for  the  activities  provided  for  under  the programme 

shall  be adopted  under the budgetary  procedure 

Article  3 

1 

The Commission, in collaboration with the advisory committee referred to in Article 

1(1) of  Decision  91/317/EEC  shall  continuously  assess  the  action  undertaken and 

the priorities set 

2 

The Council  and the Minister  for  Health of the Member States,  meeting within the 

Council,  shall  carry out an evaluation of the effectiveness  of the action undertaken. 

To  this  end  the  Commission  shall  submit  to  the  Council  a  report  after  the 

termination  of  the  action  plan.  That  report  shall  also  be  sent  to  the  European 

Parliament. 

Done  at 

II 

ANNEX 

1994  PLAN  OF  ACTION 

AREA  OF  ACTIVITY  I. 

Assessment  of  the  knowledge,  attitudes  and  behaviour  of  the  general  public  and 

certain 

target  groups  (populations  with  high-risk 

lifestyles  or 

in  high-risk 

environments,  marginalised  communities), 

information  and  awareness-raising 

campaigns  for  the  public  and  these  groups 

Promotion  and  assessment  of  the results of  surveys on  knowledge,  attitudes and  behaviour 

carried  out  in  the  Member  States  and  at  Community  level. 

Assessment  of  the  need  for  and  desirability  of  undertaking  studies  to  augment  existing 

information  in  particular  areas  at Community  level. 

Studies  of  the  information  campaigns  for  the  general  public  and  target  sections  of  the 

population,  such  as  homosexuals and  biscxuals,  minorities  and  migrants,  dissemination  of 

the  results;  encouragement  of  exchanges  allowing  experience  in  the  Member  States  to  be 

compared. 

Promotion  of developments in methodology  for  measuring changes in  knowledge,  attitudes 

and behaviour,  and for  assessing the impact on the latter of prevention  measures undertaken 

in  Member  States 

a 

Development  of  ways  to  increase  co-ordination  and  links  between  campaigns  in  the 

Member  States,  and  of  possible  Community  measures  which  could  complement  or 

contribute  to  such  campaigns,  including  the use  of  the  media  and production  of  specific 

materials, such as those designed to make information  easily  accessible to opinion formers 

and community  leaders. 

Promotion  of  measures  to  increase  public  understanding  and  awareness  of  the  problems 

caused by the epidemic  for society  as a whole and for the individuals and families directly 

affected. 

Encouragement  of  the  development  of  telephone  and  computerised  response  mechanisms 

in the Community,  and  of  centres  providing  information  to  the  public  or specific  groups, 

and promotion  of  the  exchange  of  experience  between them 

Dissemination  of  the  data  on  knowledge,  attitudes  and  behaviour  and  on  preventive 

measures. 

AREA  OF  ACTIVITY  2. 

Measures  for  children  and  young  people 

Examination and exchange of information  about HIV/AIDS education in schools, and other 

educational  and training  establishments  for young  people  in the  Member  States and about 

how  such  education  fits  into the  provision  of sex  education  and general  health education 

in schools  and other educational  institutions. 

Exchange of  information  on HIV/AIDS  education  programmes  designed  for  children and 

young  people  outside  the  formal  educational  setting,  and  their  interaction  with  general 

health  education  programmes  within  and  outside  of  the  education  system 

13 

Promotion  of  pilot  educational  projects  on  HIV/AIDS  which  fit  into  general  health 

education  and  promotion  for  children  and  young  people  inside  and  outside  the  formal 

education  setting,  including  tailored  programmes  for  minority  groups. 

AREA  OF  ACTIVITY  3. 

Prevention  of  HIV transmission  among  particular 

groups  and  in particular  settings 

Travel  and  tourism 

Studies  and  exchanges  of  information  and  experience  on  problems  related  to  tourism, 

people  travelling  within  the  Community  and  to  and  from  other  countries,  and  to  border 

areas with non-Community  states; promotion  of pilot projects and  networks aimed at taking 

preventive  action  in  tourist  resorts,  frontier  areas  and  other  relevant  locations. 

Prisons 

Examination  and  exchange  of  information  on  the  current  regimes  in  the  Community  for 

people  with  HIV  and  AIDS  in  prisons  and  detention  centres,  including  procedures  on 

admittance,  during  incarceration  and  after  release, education  of  prisoners,  training of  staff 

and  the  possibility  of  specific  prevention  and  harm-reduction  measures. 

Promotion  of pilot projects  in co-operation  with the Member  States, which take account of 

regulations and local circumstances aimed at developing new methods of providing care and 

support  for  those  with  HIV  and  AIDS,  reducing  the  risks  of  transmission  of  HIV  and 

improving  the training  provided  to the staff  concerned  with  health  services  in  prisons . 

'4-

Injecting drug users 

Evaluation  of the knowledge,  attitudes  and behaviour  of  injecting  drug users with regard 

to HIV/AIDS and consideration of HIV prevention strategies; exchange of information and 

sharing  of  experience  on  methods  concerning  the  supply  of  safe 

injecting  equipment; 

assessment  of  the  possible  role  of  methadone  programmes  in  the  prevention  of  HIV 

transmission  and examination  of  the  interaction  of  the measures  taken  in  Member  States 

to combat drug abuse with  those on  HIV/AIDS,  and the consequences  for the epidemic. 

Women  exposed to specific  risks of  infection  by HIV 

Overview and exchange of information  on the situation of women at particular risk of HIV 

in the  Member  States^ including  prostitutes  and  women  drug users,  and of  the preventive 

activities being undertaken  for such women; promotion of pilot projects on prevention and 

support  aimed  at particular groups and settings 

Vertical  transmission  of HIV  from  mothers to children 

Examination  and  exchange  of  information  on  the  transmission  of  HIV  from  mothers  to 

children in Member States and on the situation of children and young people with HIV and 

their families,  including access to educational  institutions and social  and psychological care 

and support; and promotion  of  pilot projects. 

Other groups with high-risk  lifestyles 

Exchange  of  information  among  Member  States  on  prevention  measures  tor groups such 

as young homosexual  men  and bisexuals,  and promotion  of  pilot  projects 

Safety  of  blood  and  blood  products 

Continuation  of  efforts  to  promote  Community  self-sufficiency  from  voluntary  non-

remunerated  blood donations.  Exchange of  information  among  Member  States on progress 

made  towards  this  and  in  people's  knowledge,  attitudes  and  behaviour  with  regard  to 

transfusions. 

AREA  OF  ACTIVITY  4. 

Social  and  psychological  support 

Elaboration  and  dissemination  of manuals,  information  bulletins and  directories  providing 

the  latest  information  on  prevention  of  transmission  of  HIV,  care  and  therapy  and  on 

organisations  providing 

information  and  support;  encouragement  of  networks  of 

organisations,  particularly  in the  non-governmental  sector. 

Exchange  of  experience  about  models of  assistance  and  support  for  people with  HIV  and 

AIDS  and  promotion  of  pilot  projects  and  of  studies  on  the  psycho-social  aspects  of 

HIV/AIDS 

AREA OF  ACTIVITY  5. 

Gathering  data  on  HIV/AIDS 

Appropriate  support  tor  epidemiological  monitoring  systems  in  the  Member  States  to 

improve the quality  and accessibility  of  data at Community  level, and for the work  of  the 

European  Centre  for  the  Epidemiological  Monitoring  of  AIDS  (WHO-EC  Collaborative 

Centre in Paris) in order to ensure the further  development of its work in providing accurate 

surveillance  data  at the Community  level  and  carrying  out  analyses. 

lb 

Encouragement  of  efforts  to  increase  and  improve  epidemiological  training  in  HIV/AIDS 

and  related  fields  in  the  Community  and  to  build  upon  links  between  the  responsible 

institutions  in  the  Member  States 

Examination of the specific circumstances and exchange of information  concerning  infected 

persons who remain  asymptomatic  for  long time  periods,  as well  as issues concerning the 

role of  other  diseases  implicated  in  AIDS. 

Exchange  of  information  on  significant  developments  in  each  Member  State  and  at 

Community  level 

in  the  development  of  the  epidemic  and  related  problems,  including 

economic  issues,  such  as the  costs for  statutory  services  and  on  the  measures being taken 

in  response. 

AREA  OF  ACTIVITY  6. 

Combatting discrimination  against people with  HIV and AIDS and those close to them 

Study  of  the  situation  concerning  the  implementation  in  the  Member  States  of  the 

provisions  on  the  fight  against  discrimination  contained  in  the  Resolution  of  the  Council 

and the Ministers of Health of the Member States of 22 December  1989(6); examination and 

exchange  of  information,  in  co-operation  with  the  Member  States,  of  the  measures taken 

in the  Member  States to  avoid  or  alleviate  discrimination,  notably  in  the above areas. 

Analysis  at  Community  level,  in  co-operation  with  the  Member  States  of  actual  and 

potential  discriminatory  situations  in  the  Member  States,  notably  in  the  fields  of 

employment,  insurance,  housing,  education  and  the  health  care  system. 

(6) O J N oC  10 of  16 1.1990,  p. 3 

AREA  OF  ACTIVITY  7. 

Co-ordination  with  other  programmes  related  to  HIV/AIDS 

Promotion  of  closer  links  with  other  Community  programmes  related  to  HIV/AIDS, 

including  research  and  international  assistance  in  order  to  ensure  complementarity  with 

these programmes  and enhancement  of  Community  added value. 

mmrANTTAI. HECOBD SHEET 

Title of tliê action 

Proposal for  a Decision of the  Council  and the Ministers  for Health of the Member  States» 
meeting within the Council, concerning me extension to the end of 1994 of the 1991-1993 plan 
of action in the framework of the "Europe against AIDS" programme. 

2. 

Budget heading concerned 

ItemB3-4301. 

3. 

Legal bases 

Resolution of the representatives of the Governments of the Member States, meeting within nie 
Council of 29 May 1986 on AIDS (OJ C 184,23 July  1986, p. 21) 
Conclusions of the Council and of the representatives of the Governments of die Member States, 
meeting whhin the Council of  15 May  1987 concerning AIDS (OJ C 178,7 July  1987, p. 1) 
Conclusions of the Council and the representatives of die Governments of the Member  States, 
meeting wfthin die Council of 31 May  1988 concerning AIDS (OJ C 197,27 July  1988, p.8) 
Resolution of die Council and of die Ministers of Education meeting whhin the Council of 23 
November  1988 concerning health education in schools (OJ C 3, 5 January  1989, p.  1) 
Conclusions of the Council and the Ministers for Health of the Member States, meeting within 
the Council on 15 December  1988 concernmg AIDS (OJ C 28,3 February 1989, p. 1) 
Conclusions of die Council and die Ministers for Health of the Member States, meeting within 
die Council on 15 December 1988 concerning AIDS and the place of work (OJ C 28,3 February 
1989, p. 2) 
Resolution of die European Parliament of 30 March 1989 on the fight against AIDS (OJ C 158 
of26.06.89,p.477) 
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 fatravenous drug users (OJ C 
185,22 July 1989, p. 3) 
Conclusions of die Council and the Ministers for Health oftheMenmer  States, meeting widiin 
me Council of 16 May 1989 on awareness measures for health carepersonnel (OJ C185,22 July 
1989, p. 6) 

19 

Conclusions of the Council  and th© Ministers for Health of the Member  States, meeting  within 
the  Council  of  16  May  1989  on  the  improvement  of  the  general  system  for  collecting 
epidemiological  data* including die application of the new definition  of AIDS  cases (OJ C  185, 
22 July  1989, p. 7) 
Conclusions of the Councfl  and the Ministers for Health of the Member States, meeting  within 
die  Council  of  16  May  1989  regarding  future  activities  on  AIDS  prevention  and  control  at 
Community  level  (OJ C  185, 22 July  1989, p.8) 
Resolution of the Council and the Ministers for Healtii of the Member States, mcc&og within the 
Council of 22 December  1989 on the fight against AIDS  (OJ C  10,  16 January  1990, p.  3) 
Decision of the Council  and the Ministers for Health of the Member States, meeting within the 
Council of 4 June 1991 adopting a plan of action in die framework  of tfco 1991 to  1991 °Europe 
against AIDS" programme  (OJ L  175, 4 July  1991, p. 26) 
Report from the Commission  on the plan of action in 1991-1992 of the "Europe against AIDS " 
programme  ((COM 93) 42  final,  10 March 1993) 
Conclusions  of  the  Meeting  of  the  Council  and the  Ministers  for  Health  meeting  within  the 
Council of 27 May  1993 

4. 

Description  of the action 

4.1 

General objective of the action: see Annex I to die proposal for aDecision of the Council 
and  the  Ministers  for  Health  of  the  Member  States  meeting  whhin  the  Council, 
concerning  the  extension  to  die  end of  1994  of  the  1991-1993  plan  of  action  in  the 
framework  of the "Europe against AIDS" programme. 

4.2 

Period covered by the action: from 1 January 1994 to 31 December 1994. Arrangements 
for renewal and extension of the action have not yet been fixed. 

Classification  of the expenditure: non-compulsory. 

Type of expenditure: Subsidy for  co-financing of projects with other sources from the public 
and/or private  sector  (subsidy  not  exceeding  a  certain percentage  of  the  total  amount  of  die 
projects proposed). 

5. 

6. 

10 

7. 

7  T 

financial impact 

Calculation of the total cost of the action: a total of ECU 9 million appeared to be needed  for 
these activities, based on the amount which was scheduled for hnplementation of die "Europe 
against AIDS" programme in 1993 plus the amount required to reinforce certain actions. This 
sum was included In the preliminary draft budget for 1994, but the Council has adopted a budget 
of only ECU 8.3 million. 

7.2 

Breakdown of die cost of die action: 

BREAKDOWN 

L Assessment ot knowledge and benaviour 

"995300—-

i.  intorming and increasing me awareness ot 
the public 

498.000 

996.U0CT 

498.000 

X Meaitn education tor young people' 

913.000 

1.263.0UU 

4. iTeveagûtt ot mv  transmission" 

5. Social support, counselling, treali near 

1.660.000 

1.660.000 

|  o. estimating me cost ot managing mv 

infection 

7. Data collection 

». linnancementotnnman resources 

y. Measures to comnat ajscnmmation 
HIV-infected persons 

TOIAX 

249.000 

249.000 

1.577.000 

415.000 

8300.000 

249.000 

4L5.000 

y.ooo.ooo 

at 

F 

IrSESfflOWN—-

l. Assessment ot Knowledge and behaviour 

996.000 

2.  Measures armed at cniinrea ana young people" 

2.526.000 

3. .Prevention ot JMUV transmission"" 

4.  social support ana counselling 

5. Data collection 

o. Measures to comoat atscrmnnation 

7.  coorrtrnation with, other progiaiiimes 

rorsn 

2.204.000 

1.660.000 

249.0UU 

H5.000 

250.000 

8.300.000 

8. 

9. 

Anti-frand measures planned (and remits of such measures) 

Spot checks on contractors to verify what appropriations have been used, and in precisely what 
manner. Checks were carried out during the 1993 budgetary year and proved to be  effective. 

effectiveness analysis 

9.1 

Specific» quantifiable objectives, and target population: 

Synergy with actions undertaken by die international organisations active in this  field; 
enhancement of drug abuse control measures as a result of AIDS prevention initiatives 
among  drug users; highlighting  of  the necessary  complementarity  of  actions  to  be 
undertaken under nie social, health and economic policies. 

Boost to Member States in the development of their own AIDS prevention measures, In 
their intra^imrmmity cooperation and in access to fefibrmation, through the creation of 
ff*ftn^njtfifwii>i  networks. -

Maintenance of the balance between die economic factoraaM me public health and social 
welfare imperatives. 

23L 

9.2 

Justification for the action: 

Rational use of the budget appropriation based on: 

1) 

practical application of die principle of subsidiarity as regards identifying the actions to 
be undertaken and co-financed; 

2) 

identification of target groups and appropriate information media. 

The Ccanmission wfll be assisted in nnplementmg the programme by an advisory  committee  composed 
of representatives of the Member States. This connnittee wfll  conduct regular examinations of  a broad 
range of  problems  and  advise  die  Commission  on  die  levels  of  priority  to  be  given  to  die  actions 

proposed. 

The programme wiil mainly  involve supporting projects undertaken in die Member States. 

Projects submitted will be selected on the basis of the following criteria: 

conformity  with at least one of the defined objectives» 
examinailon  of  the  project's  "Comnmniry  added  value"  (transnational  participation, 
development cf a model applicable in other Member States, information useable in other 
Member  States» etc.), 
clarity and justification of die stated objectives, 
appropriateness of the methodology chosen, 
die proposing organisation's competence and experience, 
commensurateness of the project's budget with die stated objectives, 

.  support for the project from the national authorities. 

9.3  Monitoring  and evaluation of projects 

Selected performance indicators 

- 

Results  and conclusions of die meetings of experts. 
Analysis  of  proceedings  of  coUoquia and of  die lists  of  participants  (in terms  both  of 
quality and numbers). 
Esthnation of the target population affected,  and media impact 
Evaluation of certain projects by Commission officials and/or collaborators (financial and 
technical aspects). 
Analysis  of  interim reports  on the actions  funded,  so  that  corrective measures  can be 
applied if necessary. 
Entrostment of certain impact studies to outside organisations. 
Appropriateness  of the methodology used by the organisers. 
Commensurateness  of die project's budget with the objectives. 
Clarity of the stated objectives. 
Competence  and experience of the organisations involved. 
Dissemination of the results. 

T^iihiatiftn  «Y**»"*

 and ftwimwBr of  mirations 

PrtaHfrWrnr nf interim and final reports on  the  various actions undertatan. 

Devetooment of a standard "actionem 
with  thWfinal  reports,  and  checking  of  these  forms  by  officials  (either  in  the 
Commission or on  die spot). 

9.4 

Compatibility with the financial programme 

Is the action covered by die DG's financial programme for me years concerned? 

Oiûyme objectives are fixed in advaiice.^ 
to the competent department in die course of the year. 

Actions are selected on  the  basis of criteria such as: 

compatibility with die objectives, 
the  "Community added-valne1^ 
expected effectiveness  and  profitability, 
population targeted or reached by die action. 

10. 

Aà^nist^veerpenifitiire 

Pfrrnml  ne^fld solriv far the action itself 

madoltiontomeexisthigpersonnel (One Aofficial, one Anational expert, and^mreeextra-muros 
staff comprising two at B level and one at C level), mere will need to be four A officials, one 
B official;aiidtwo  C officials. The addMoiial staff could be obtamed by a r e dM 
whhin the Commission's departments. 

Staff rTpmprfations required 

Tne estimated appropriations needed are  693,000 in 1994. 

14 

ISSN 0254-1475 

COM(93) 453 final 

DOCUMENTS 

EN 

05 

Catalogue number : CB-CO-93-500-EN-C 

ISBN 92-77-59544-2 

Office for Official Publications of the European Communities 
L-2985 Luxembourg 

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