TALLINN - Experts from Estonia's oldest AIDS prevention group have criticized the government's strategy for focusing on organizational changes rather than real groundwork in the fight to stop the spread of HIV.
As the government decided on Dec. 23 to commission a relatively new organization with a hefty amount of prevention work, some people have begun to question the logic and strategy of the state approach to dealing with the epidemic.
According to the statistics from the health protection inspectorate, as of early December 2003, 3,580 cases of HIV had been registered in Estonia, with 838 new cases diagnosed in the past year, the State Health Inspectorate reported Jan. 6.
Of the nine people diagnosed with AIDS in 2003 four have since died.
Some argue that as the epidemic continued last year, the government response to the epidemic focused more on organizational matters than on building broad and strong cooperation among state institutions and NGOs.
In August 2003, the Ministry of Social Affairs closed down the AIDS Prevention Center, which had been established in May 1996 and was given the responsibility of planning and coordinating HIV/AIDS prevention. The center provided technical support to the nongovernmental organizations that render services to injecting drug users, sex workers, marginalized youth and other vulnerable groups.
The center was also in charge of data collection and dissemination, research, anonymous testing and counseling. These functions previously carried out by the AIDS Prevention Center are to be taken over to a large extent by the National HIV/AIDS Prevention Program, which operates as part of the National Institute for Health Development under the Ministry of Social Affairs.
Insight into the challenges the government faces were revealed on Sep. 23, 2003 during the creation of a Special Committee in the Parliament to improve the efficiency of the HIV/AIDS and Drug Prevention Activities with a one year mandate. The explanatory note to the parliamentary resolution for creating the committee refers to the "organizational chaos" in which the National HIV/AIDS Program for 2002- 2006 began. The notes also refer to the fact that in the past year the Ministry of Social Affairs changed the program manager twice and the leading institution three times.
Sources also point to the institutional domination of the National Institute for Health Development, which will administer the $10.2 million granted to Estonia by the Global Fund to Fight AIDS, Tuberculosis and Malaria for a four-year period.
Nelli Kalikova, former director of the AIDS Prevention Center and vice-chairperson of the parliament's special committee explained that it was a mistake to change the structure when the epidemic continues.
"Do not change the horses while crossing the river," Kalikova said, quoting a Russian proverb.
According to Kalikova, the "bureaucratic management" of the Institute for Health Development could be an impediment to effective work in the area of HIV and AIDS awareness.
But Tiia Pertel, manager of the National HIV/AIDS Prevention Program, said that the scope of the "strategic work" necessitated the transfer of tasks from the AIDS Prevention Center to the institute.
The efficiency of the prevention work among young people will depend also to a great extent on the cooperation of the Ministry of Education, which according to Pertel has been so far insufficient.
The Institute for Health Development, however, appears unwilling to use the experience of the people from the AIDS Prevention Center to the maximum possible extent. On Dec. 23 the Institute decided to commission the largest amount of prevention work among youth in the coming year to the Estonian Family Planning Union, which reportedly has little experience in AIDS prevention.
The former employees from the closed AIDS Prevention Center were not interested in the rhetoric of the organizational changes but rather in using their previous experience to reach vulnerable people. In December 2003 they registered an NGO with the same name.
What they want, said Sirle Blumberg, one of the former employees of the center, is simply "to do the work."
Blumberg emphasized that their priorities are to work with the most endangered group - young people under 25 and with HIV positive pregnant women - which together with the injecting drug users are the people in the greatest need of help. She also emphasizes that they will aid both Russian speaking and Estonian speaking risk groups.
"Our idea is to become an umbrella organization for other AIDS prevention NGOs and to pass to them our knowledge by giving them methodological support," adds Irina Moroz, a doctor working in the newly registered center.
Though the Estonian Family Planning Union received about 290,000 euros from the Global Fund Grant for realizing prevention campaign in schools throughout the country, the AIDS Prevention Center received a mere 48,000 euros for creating support group for HIV-positive people and for educating students in vocational schools in northern Estonia.