CELEX: 51990PC0601
Language: en
Date: 1990-12-13
Title: PROPOSAL FOR A DECISION OF THE COUNCIL AND THE MINISTERS FOR HEALTH OF THE MEMBER STATES MEETING WITHIN THE COUNCIL ADOPTING A PLAN OF ACTION IN THE FRAMEWORK OF THE 1991-1993 " EUROPE AGAINST AIDS " PROGRAMME

No C 13/6                            Official Journal of the European Communities                                 19. 1.91
thirdly, expanding the promotion of cooperation and             of Decision 89/490/EEC, is deemed necessary in order
partnership between enterprises, especially small and           to achieve the aims set out in Article 1.
medium-sized ones, in the different regions of the
Community and the different sectors of economic                The appropriations for implementing the programme
activity, and opening up external markets to them.              shall be determined each year under the budgetary
                                                               procedure.
                        Article 2                                                       Article 3
Consequently, for the period 1990 to 1993, a further           This Decision shall be published in the Official Journal of
amount of ECU 25 million, as provided for in Article 7          the European Communities.
             Proposal for a decision of the Council and the Ministers for Health of the Member States
             meeting within the Council adopting a plan of action in the framework of the 1991 to 1993
                                            'Europe against AIDS' programme
                                                    COM(90) 601 final
                                  (Submitted by the Commission on 11 December 1990)
                                                       (91/C 13/06)
THE COUNCIL AND THE MINISTERS FOR HEALTH OF                    Whereas the conclusions of the Council and Ministers
THE MEMBER STATES, MEETING WITHIN THE                          for Health of the Member States, meeting within the
COUNCIL,                                                       Council of 16 May 1989, regarding the prevention of
                                                               AIDS in intravenous drug users, requested the
Having regard to the Treaty establishing the European          Commission to prepare and submit to the Council a
Economic Community,                                            programme in this area;
Having regard to the proposed decision submitted by the
Commission,                                                    Whereas the conclusions of the Council and the
                                                               Ministers for Health of the Member States, meeting
Having regard     to  the   opinion   of   the   European      within the Council of 16 May 1989, on the improvement
Parliament,                                                    of the general system for collecting epidemiological data,
                                                               including the application of the new definition of AIDS
Having regard to the opinion of the Economic and               cases, asked the Commission to compare the system for
Social Committee,                                              recording notifications of AIDS cases at national and
                                                               Community level in order to pinpoint where the
                                                               improvement of coverage can take place, as well as the
Whereas, the increase in the AIDS epidemic is of major
                                                               reliability and the comparability of the data used;
concern to Member States and the Community;
Whereas the resolution of the European Parliament of
30 March 1989 on the fight against AIDS called on the          Whereas the conclusions of the Council and the
Commission for action in particular in the fields of infor-    Ministers for Health of the Member States, meeting
mation and training of health professionals;                   within the Council of 16 May 1989, regarding future
                                                               activities on AIDS prevention and control at Community
                                                               level called upon the Commission to examine the possi-
Whereas the resolution of the representatives of        the
                                                               bilities for harmonization with regard to condoms and
governments of the Member States, meeting within        the
                                                               HIV self-testing kits;
Council, of 29 May 1986, on AIDS, requested             the
Commission to organize an exchange of information      and
experience;
                                                               Whereas the resolution of the Council and Ministers for
Whereas the resolution of the Council and of the               Health of the Member States, meeting within the
Ministers of Education meeting within the Council of 23        Council of 22 December 1989, on the fight against
November 1988, concerning health education in schools,         AIDS, requested the Commission to develop exchanges
expressed concern about the high incidence of AIDS,            of information and experience defining in priority the
and invited the Commission to undertake a series of            details and contents of an action plan integrating appro-
actions at Community level;                                    priate measures to prevent and control AIDS;
 ---pagebreak---  19. 1. 91                                   Official Journal of the European Communities                                  No C 13/7
Whereas the conclusions of the Council and the                            3.    The Commission will regularly publish technical
Ministers for Health of the Member States, meeting                        information on the progress of the action plan.
within the Council, of 17 May 1990, on medical and
psycho-social care services in relation to the AIDS
epidemic, requested the Commission to examine the
                                                                                                    Article 2
feasibility of developing a consistent approach to costing
the management of care for HIV-seropositive persons;                      1.    The Community funds required for the work to be
                                                                          undertaken under this Decision shall be determined by
"Whereas   the present plan of action for the programme                   the budget authority within the context of the appropri-
'Europe     against AIDS' contains the aforementioned                     ations available for each year.
requests;    whereas it also contains other measures
intended   to contain the AIDS epidemic,
                                                                                                    Article 3
HAVE DECIDED AS FOLLOWS:
                                                                          1.   The Commission will continuously assess the action
                                                                          undertaken and the priorities taking into account
                             Article 1                                    emerging urgencies.
1.    The Commission shall implement the 1991 to 1993
action plan set out in the Annex in close coordination
with the competent authorities of Member States.                          2.   The Council and the Ministers for Health of the
                                                                          Member States meeting within the Council will carry out
2.    The Commission will cooperate with International                    an evaluation of the effectiveness of the actions
Organizations active in this field such as the W H O and                  undertaken. To this end the Commission will submit a
the Council of Europe.                                                    report on the subject during the second half of 1992.
                                                                 ANNEX
                                                               CHAPTER I
                  INFORMATION AND HEALTH EDUCATION IN THE PREVENTION OF HIV INFECTION
              The importance of prevention cannot be stressed enough as there is no vaccine nor effective treatment
               available. The Member States have been active for several years in promoting information and health
               education for the general public in this field. It is of fundamental importance to continue this work in
               order to ensure the success of prevention efforts.
               Different approaches are used in the Member States in preventive strategies and prevention intervention
               methods are under development and evaluation. This diversity of approach can be used to maximum
               benefit if there is an interactive knowledge of what is being done. Therefore, exchanges of information are
               necessary and need to be promoted.
               A key role at Community level is to facilitate exchanges of experience, to evaluate results and to promote
               new approaches, so that the most effective approaches can be promoted taking into account local needs
               and characteristics.
               Health education in schools is an essential part of health promotion, and within the limits of specific
               national educational policies and structures, appropriate arrangements should be made for coordinating
               health-promotion measures, so that health education can be seen by children as a practical part of their
               lives.
 ---pagebreak--- No C 13/8                                  Official Journal of the European Communities                                          19. 1.91
          Repeated efforts are necessary for prevention messages to be retained by the public and relevant target
          groups. This will help them develop a real understanding of AIDS problems and their consequences, in
          order to contribute to a change in their attitudes.
          Simple messages can increase the general public's awareness, and can improve the efficiency of an AIDS
          prevention information campaign, in particular by the use of a European code against AIDS which will
          take into account the work already carried out in the Council of Europe (').
           Objectives:
          — to prevent the spread of the epidemic by providing information on HIV risk factors, and therefore to
                avoid discrimination and stigmatization of HIV seropositive persons,
          — to monitor attitudes towards AIDS in the general population of the Community.
          Action 1: Informing the public about AIDS prevention campaigns
          Member States have already gained valuable experience in the use of publicity campaigns to inform the
          public about AIDS. A survey of current AIDS prevention campaigns will be carried out with a view to
          improving the existing campaigns and to designing more effective ones in the future.
          At Community level, a publicity campaign will need to take into account the experience of the Member
          States in order to ensure maximum impact on the general public, resulting in increased awareness. This
          campaign will also aim at providing information to prevent discrimination against HIV seropositive persons
          and AIDS sufferers.
          The public and private organizations involved in the fight against AIDS will be closely associated with the
          preparation and implementation of this action. Broad coverage will be given to the results of the actions.
          With the help of appropriate experts, the Commission will establish a European code against AIDS and
          ensure its transformation into layman's language. Dissemination of the code will be made in all appropriate
          fora, including schools and the workplace.
          Action 2: Prevention of HIV infection and health education in schools
          Exchanges of information will be encouraged and supported within the framework of health education in
          schools. Specific seminars for teachers from the Member States will provide not only an opportunity for
          exchanging experiences and knowledge but also lay down the foundations for broader cooperation.
          Where appropriate, exchanges of teaching materials produced in Member States on health education
          related to AIDS and HIV infection will be promoted and supported.
          Action 3: Eurobarometer surveys on AIDS and its prevention
          Repeated monitoring of public opinion and attitudes is necessary in order to assess the effectiveness of
          prevention efforts.
          Regular updating of Eurobarometer surveys will be carried out in close cooperation with European
          specialists in this field so as to determine to what extent Europeans are informed about AIDS issues and
          prevention.
          .(') In particular recommendation No R(87) 25 of the Committee of Ministers concerning a common European public
               health policy to fight the Acquired Immunodeficiency Syndrome (AIDS) adopted on 26 November 1987 and recom-
               mendation No R(89) 14 of the Committee of Ministers on the ethical issues of HIV infection in the health care and
               social settings adopted by the Committee of Ministers on 24 October 1989.
 ---pagebreak--- 19. 1.91                              Official J o u r n a l of the E u r o p e a n C o m m u n i t i e s            N o C 13/9
                                                              CHAPTER 2
                        PREVENTION A N D TREATMENT, SOCIAL CARE AND COUNSELLING
         Clinical trials have shown that the available treatments do not cure the disease although they do appear to
         delay its onset. New approaches are under development and evaluation. Persons with AIDS need specific
         care, in particular the rapid treatment of multiple infections due to immunodeficiency.
         Counselling is an important element in both care and preventive strategies. Intravenous drug users are a
         high-risk group for which treatment and social care are of particular importance.
          Objectives:
         — to improve medical and psycho-social support to HIV-positive and AIDS symptomatic drug users,
         — to make counselling more accessible to all HIV-positive people,
         — to prevent the spread of HIV infection among drug users, their sexual partners and offspring,
         — to reduce HIV transmission in blood and blood based products.
         Action 4: Exchanges of experience on counselling and treatment services
         Accessibility to counselling services, as well as telephone directories and other telephone information
         systems, are necessary to assist both HJTV seropositive persons and AIDS sufferers.
         Crisis intervention helplines are increasingly available in Member States. The first European Conference on
         AIDS hotlines, which took place in Amsterdam (April 1989), has demonstrated their effectiveness not only
         in providing support in cases of crisis but also to serve as an anonymous personalized information system.
         This could lead to the establishment of a Community-wide directory of helplines. This should be done in
         close coordination with drug helplines, since HIV-seropositive and AIDS symptomatic drug users may have
         recourse to both systems.
         With the growing mobility of people in the European Community, there is a need to promote exchanges of
         experience between health care professionals on treatment services and medical care, so that they can cope
         better with an increasing number of patients coming from different cultural backgrounds.
         Appropriate means will be established for exchanges of experience, and to develop effective treatment
         methodologies. That could lead to a European guide of medical care and treatment facilities, which can be
         used further by Member States and the Commission to promote exchange visits.
         Action 5: Development of models for the costing of the management of AIDS
         It is foreseen that there could be 150 000 persons with AIDS in the European Community in 1992. The
         average yearly cost for an AIDS patient has been estimated as being of the order of ECU 20 000 for
         medication, hospitalization, home care and psycho-social support. Thus ECU 3 billion will be required in
         1992 to cover these costs, and this amount could be expected to increase yearly as the number of AIDS
         victims rises.
 ---pagebreak--- N o C 13/10                              Official J o u r n a l of the E u r o p e a n C o m m u n i t i e s            19. 1. 91
            The Commission will examine the feasibility of developing models for the costing of the management of
            AIDS, taking account of the available findings of the W H O report on costs, and the conclusions of the
            European Health Committee with regard to the impact of AIDS on the organization of health care.
            Action 6: Reduction of HIV transmission in blood and blood based products
            In the past, a cause of AIDS was the transmission of HIV in blood and blood derived products. Several
            measures have now significantly reduced the risk of transmission.
            Selection of blood and plasma donors and screening of their donation for HIV antibodies is now systemat-
            ically carried out, in accordance with the recommendations of the Council of Europe. Also, Directive
            89/381/EEC relating to medicinal products derived from human blood and plasma lays down requirements
            for manufacturing and purification processes to ensure, insofar as technology permits, the absence of
            specific viral contamination.
            However, the risk of transmission can be reduced still further. The attainment of European self-sufficiency
            in blood and blood derived products has become a Community objective, through the promotion of
            voluntary unpaid blood donations. The Commission will examine carefully the current situation and
            evaluate how best these objectives can be achieved, bearing in mind its current cooperation with the
            Council of Europe in this field.
                                                                 CHAPTER 3
                                               EPIDEMIOLOGICAL ASSESSMENTS
            Although statistics are available on the numbers of AIDS cases, there are no reliable statistics for HIV
            seroprevalence.
            Prevention, treatment and risk reduction strategies and the corresponding allocation of resources require
            knowledge of the patterns and trends of the AIDS epidemic.
            Objectives:
            — to ensure and improve the availability and comparability of data on AIDS, and HIV seroprevalence,
            — to provide through epidemiological studies on AIDS/HIV, appropriate information for preventive
                 policies.
            Action 7: Improvements to the system for gathering the data on AIDS
            The European Centre for the Epidemiological Monitoring of AIDS (WHO-EC Collaborative Centre in
            Paris) is playing a major role in gathering and analysing epidemiological data on AIDS.
            In order to improve the quality of the data, support will be given to national monitoring systems; to the
            accessibility of the Paris Centre's data base; and to improving epidemiological information on the disease.
            Proposals will be made on the establishment of a Community-wide system, with a view to facilitating
            exchanges of information.
            Action 8: Common methodological approaches to ensure the availability and comparability of epidemio-
                         logical data on HIV seroprevalence
            H I V seroprevalence is becoming a central issue in developing strategies for prevention and care. The
            present lack of knowledge is not a sufficient basis on which to establish sound health policies.
 ---pagebreak--- 19. 1.91                             Official J o u r n a l of the E u r o p e a n C o m m u n i t i e s             N o C 13/11
         As a first step, a methodology should be agreed at Community level.
         A survey will be made on current approaches determining HIV seroprevalence in the European
         Community, in order to provide information on the epidemiological situation regarding HIV transmission.
                                                             CHAPTER 4
                                    MANPOWER TRAINING A N D DEVELOPMENT
         The development of the actions contained in this programme in terms of prevention, treatment, risk
         reduction, socioeconomic integration, as well as epidemiological data collection and evaluation, requires
         the presence of adequately trained personnel.
         Adaptation and improvement of traning for health and social care professionals can be ensured through
         exchanges of experience.
          Objectives:
         — to provide health and social care professionals with an adequate knowledge of AIDS prevention and
             primary care of AIDS patients and HIV seropositive persons,
         — to develop an adequate core of specialists in AIDS prevention, treatment and psycho-social care of
             people with HIV or AIDS.
         Action 9: Systems of university training for health care workers; mobility of medical and nursing students
         Universities and bodies involved with professional training courses for health and social care should
         become more involved in the fight against AIDS with adequate information and training on AIDS issues
         being provided.
         T o accelerate the education and continuous training of professionals, the development of appropriate
         teaching materials and supports is necessary.
         A survey will be made on the training and instruction given in university education and training, and
         exchanges of experience will be organized.
         A survey on existing teaching materials will be carried out, and if appropriate, the promotion of exchanges
         of materials, as well as the development of additional training material.