While not a total panacea, quality access to drugs and equipment for treating the disease in Hungary has contributed to keeping the epidemic in check in the past 15 years.

In South Africa, AIDS is prevalent and awareness campaigns attract more attention

Less than 1,000 people in Hungary are registered HIV/AIDS positive. Anti-retroviral drugs and treatment (ART), the set of drugs that tames the virus, are available to Hungarian patients free of charge. This compares to countries in Eastern Europe and Central Asia where, according to World Health Organization figures, only about 9 percent of those in need benefit from ART. This does not mean Hungarians are ready to face the disease head-on. “The medication and drugs are available in Hungary,” says Tibor, a 37-yearold infected with AIDS, who asked to remain anonymous. “But the real problem is the social and societal aspect of the virus. “There is no awareness and people don’t want to acknowledge that there is a problem,” he says. “And because of this, very little money is put toward AIDS prevention.”

Prevention the key

Prevention would keep the virus at bay long-term. Tibor laments that blood tests are only available in select locations in the country and not free of charge. On top of that, Tibor says few doctors will treat patients once the condition has been discovered. And of those doctors, all are in Budapest. Tibor has known of his infection for eight years and currently undergoes treatment at Szent László Hospital in Budapest. He says he lives a fairly normal, healthy life and has not shown outward signs of the disease in over six years.

Dénes Bánhegyi

Hungary’s 2004 budget for anti-retroviral drugs is HUF 700 million, and although the cost of drugs is extremely expensive for most, such treatment gives 80 percent of those receiving ART the chance to work and benefit from a higher life expectancy. In affluent countries, there has been a 70 percent decline in deaths due to ART. Dénes Bánhegyi, head of the Infectious Diseases Department at Szent Lászlo Hospital, says more than 360 patients receive ART in Hungary.

Because of the country’s low rate of infection, some medical professionals do not feel Hungary will see a jump in HIV/AIDS statistics. “If there hasn’t been an explosion in the last decade, I don’t see the reason for an explosion now,” says Péter Makara, deputy general director of the National Institute of Health Development and head of the National AIDS Committee. “Substantial drug use from this point of view is not a problem. The heroine consumption is decreasing in Hungary, and prostitution is not increasing. I don’t see the direct detonator for an explosion.”

Treatment available

Szent László is the only facility in the country dealing with HIV/AIDS treatment. Although far from new, equipment in the hospital’s specialized AIDS ward and laboratories is acceptable, says Bánhegyi. Treatment at the hospital is also in line with Western European standards, since no patients are forced to wait extended periods before receiving AIDS treatment.

But Tibor claims there is stigmatization surrounding the virus which qualifies as a barrier superceding the availability of treatment. He says he knows many Hungarians, especially in the gay community, who might be infected yet are unwilling to even confront the possibility because of such stigmatization. “Because nobody really knows about AIDS, people are very ashamed and embarrassed to talk about it,” says Tibor, who adds he is one of a few in Hungary’s gay community to address his situation openly.

“I am extremely lucky,” he admits. Tibor can finance his treatment and visits to the doctor’s office in Budapest. Tibor has a job he enjoys, a peaceful home in the country, a supportive partner and money for extra vitamins. He takes his drugs regularly - every 12 hours - and can imagine himself getting old. He is also planning a future. Others are not so optimistic.

“Several cannot afford the frequent visits to Szent László, and many don’t even have anywhere to live. Once they received the treatment and are released from hospital, where do they go?” says Tibor. “I know a lot of people who are infected who sleep on park benches or in shelters.

Their health diminishes, leaving them with no energy to work, which means they have no money, no insurance. A lot just give up and die.”

AIDS not in public eye

The United Nations AIDS program (UNAIDS) says that in neighboring countries the lack of an efficient diagnosis system, or blood tests, are only some of the factors that have kept AIDS largely unchecked. And while reported infection rates in Hungary remain low, there are questions about the accuracy of statistics, according to both local and international reports. In light of this, the real total of infections in Hungary, and in the region, may be up to 10 times higher than reported. Observers agree that public awareness is the main issue obstructing efficient AIDS prevention, and with very little information about the virus and its forms of transmission, even Hungarian health care workers are left with nominal instruction.

Péter Makara does not see reasons for a dramatic increase in AIDS

“We have tried to hold AIDS galas and fundraisers,” says Tibor, “yet there was very little interest and support from the media and those in the public eye. In other countries, people proudly come to these events and wear the red ribbon, but here, we pretend AIDS is still not an issue.”

Low-cost awareness measures like a poster campaign, distribution of free condoms and help clinics are a rarity. Even PLUSS, a Hungarian non-governmental organization for HIV-positive people, barely has enough money to publish monthly newsletters, let alone set up a safety network for those with nowhere to go.

Hungary’s AIDS strategy, according to Makara, is focused on maintaining lower levels of infection, and cooperating with independent bodies and NGOs on prevention and social action.

General awareness campaigns, which focus on youth, schools and education for the masses, may be a more effective tool in preventing the disease in the first place. An informal survey conducted by DT found that a number of high school students had heard about HIV/AIDS as part of their curriculum, yet few said they knew very much about it.

An in-depth educational CD-ROM is currently being produced and will be distributed in schools, along with teachers’ and students’ guidebooks. Makara is hopeful that the CD-ROM can also be used in Hungarian-language schools outside of the country for ethnic Hungarian educational institutions.

Hungary’s strategy also highlights the importance of work with high-infection risk groups, such as gays and prostitutes. Like Tibor, many are showing a great interest in containing the disease, and with help from the National AIDS Committee, are slowly beginning to organize condom distribution, lower tariffs for testing, shelters and a mobile bus that would offer social basics, advice and preventive information.

“If we have good methods of prevention and examples of good practice,” says Makara, “we can spread our knowledge and cooperate with neighboring countries, because we are also a former communist country.”

Regional outlook
Hungary and its neighbors – the Czech Republic, Slovakia, Slovenia and Croatia, have similar backgrounds and epidemiological patterns. These countries report low HIV rates, which in the 90s led to a complacency in providing public funds to deal with HIV/AIDS. Health care and laboratory facilities were established, however, with a focus on scaling up prevention programs and public awareness. With EU accession, current challenges for these countries will deal with border issues, migration and international tourism.

Romania, which experienced a phenomenal outburst of pediatric HIV infection through contaminated blood products in the 90s, has declared AIDS a top public health priority. It was the first European country to benefit from price reductions and facilities for ART, with help from the international “universal access” plan. About 5,000 Romanians currently receive ART.

In Poland, Moldova, Ukraine and Russia, AIDS is mainly spread through hypodermic needles from drug users, accounting for 60-90% of new infections. A new stage of the epidemic is also developing, driven by heterosexual transmission and thereby infecting more women. Deteriorated socio-economic conditions and high poverty rates spark the spread of so-called social diseases, such as TB, HIV and hepatitis. The number of HIV infections in Belarus has increased 30 times since 1995, and in Ukraine, an astonishing 1 percent of the adult population is infected.
Although Lithuania is still at a low prevalence level, intravenous drug use and sexually transmitted disease rates are increasing. Latvia is also seeing a great number of infections in young people.

In Estonia, which soared from 12 cases in 1999 to some 1,474 in 2001, has 80% of new cases among people between the ages of 15-24. Estonia, however, is considered a leading example of efficiency and swift implementation of HIV/AIDS response programs, moving from grant signing to first disbursement to implementation of targeted prevention and treatment programs in just 12 weeks. In addition to more local funding, international grants and multilateral organizations are teaming up to fight HIV/AIDS. The World Bank, the EU and the Global Fund to Fight AIDS, Tuberculosis and Malaria has approved over USD 400 million in the last five years. This money was allocated to 22 programs in 16 countries in Eastern Europe and Central Asia and is for prevention and treatment, with programs to control tuberculosis, the biggest killer of people with HIV.

* Sources: UNAIDS National Response Analysis, World Health Organization