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Cablegate: Croatia Seeks Funding to Continue Aids-

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1.(SBU) Summary: As Global Fund support for
Croatia's AIDS programs ends this year, health
officials are scrambling to continue funding for
testing and treatment as well as education and
prevention programs which have been successful in
changing preconceptions toward HIV/AIDS patients in
this conservative country. Croatia cannot reapply
for funding because its GDP exceeds the Global Fund
limit. While the number of documented HIV/AIDS cases
remains low, Croatia believes it is crucial to
continue these programs as the country draws more
tourists and transient workers, one possible link to
the spread of the disease. HIV/AIDS workers are also
seeking to strengthen legislation to end
discrimination against those who test positive for
HIV. End summary.

Infection rate

2. (U) There are 512 officially documented cases of
HIV in Croatia, about .01 percent of the total
population (5 million). Of those, 234 have developed
into AIDS. People with HIV in Croatia are almost
exclusively members of high-risk groups - primarily
homo/bisexual men and heterosexual men who have
frequent contact with commercial sex workers (these
two populations overlap). There are currently nine9
children who were infected by their mothers and 52
known cases of intravenous drug users.

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3. (U) Currently the number of people voluntarily
seeking testing is five out of every 10,000,
according to Iva Jovovic, National HIV/AIDS Advisor
of the UN Theme Group on HIV/AIDS in Croatia.
Jovovic said that number needs to be 10 out of
10,000 to get a true picture of the number of
HIV/AIDS affected people in Croatia. Jovovic added
that Croatia has moved into the second generation of
HIV surveillance, analyzing behavior and biological
research to determine who is at risk for HIV

4. (U) In 2005, 12 new cases of HIV were reported.
Dr. Josip Begovac, head of the AIDS unit of the
University Hospital for Infectious Diseases,
attributes the increase to more voluntary testing,
rather than the spread of the disease. However,
health officials fear a larger increase is possible
as more transient workers, merchant sailors and
tourists travel to Croatia.


5. (SBU) Croatia's health officials and NGOs have
been working under a three-year, $4.5 million grant
from the Global Fund to establish testing centers
and clinics, treatment, counseling, education and
prevention programs. Dr. Dunja Skoko-Poljak, senior
advisor in the Ministry of Health, said 10 million
Kuna per year ($1.76 million) is needed to continue
all of the programs. She expects the Ministry of
Health to maintain at least the 10 clinics
established throughout Croatia and the treatment
center in Zagreb, but hopes the NGOs will secure
their own funding to continue counseling, education
and prevention.

6. (SBU) A representative from the NGO HUHIV was
surprised to hear there was a chance HIV/AIDS NGOs
wouldn't be included in future government funding.
However, they have also begun looking for outside
funds without much luck. One spokesman said the Bill
and Melinda Gates Foundation turned down HUHIV's
grant application, saying, "Croatia is not a

Centralized care in Zagreb

7. (U) Treatment has been available in Zagreb since
1996. Currently there are 220 patients seeking
treatment. The 10 testing centers operate in Zagreb
(2), Osijek, Zadar, Rijeka, Split, Slavonski Brod,

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Dubrovnik and Korcula. Once diagnosed, patients are
referred to Dr. Begovac in Zagreb for further
testing, treatment and medicine. Dr. Begovac keeps a
record of all HIV/AIDS cases to be reported to the
National Health Insurance, which pays for treatment
and medicine. Patients travel up to four times a
year for exams and prescriptions. Seventeen of 20
existing drugs are available in Croatia. Health
officials said this is adequate. The centralized
treatment center helps HIV patients maintain their
privacy, Dr. Begovac said, because they don't have
to visit neighborhood clinics regularly.

Changing attitudes

8. (SBU) Begovac said it's not as easy for AIDS
patients to find dentists and doctors to treat them
for other ailments because of lingering fear among
medical practitioners. Begovac said he is working
within the University Hospital and medical community
to educate physicians, nurses and dentists about
HIV/AIDS. He said the problem remains with older
medical professionals and expects it to lessen with

9. (U) Croatia's attitude has somewhat improved
since 2002 when the public and press scandalized Ela
and Ina, two girls who were nearly barred from
attending public primary school when it became known
they were HIV positive. Health officials attribute
the positive change to the numerous education and
prevention programs run by five NGOs and backing
from the Ministry of Public Health. They said
testing and treatment is not enough without
community outreach. Since a team of medical experts
went to Kutina to explain that Ela's and Ina's
classmates wouldn't be in danger of contracting the
disease through casual contact, they and a handful
of other HIV infected children have been able to
attend public schools.

10. (U) Educational programs were introduced into
middle and high schools nationwide, targeting the
age group most likely to become sexually active.
School officials resisted at first, mainly due to
the influence of the Roman Catholic Church, HUHIV's
spokesman said, but now 70 percent allow NGOs to
provide HIV/AIDS education programs and materials.
The most resistant areas tend to be in Dalmatia
where the population is most conservative, HUHIV
reports. But even some of those schools have signed
on to the Church's own HIV/AIDS education program.

Anti-discrimination legislation

11. (U) The UN Theme Group on HIV/AIDS analyzed
Croatia's legislation regarding AIDS and anti-
discrimination and published a report in June.
The analysts said Croatia essentially follows
international recommendations regarding testing and
privacy but needs to strengthen its regulations in
those areas as well as in protecting people with
HIV/AIDS and their families from discrimination.

12. (U) Although testing is voluntary by law, there
are exceptions. Testing is mandatory for blood,
organ and tissue donors. It's also mandatory for
those seeking positions as crew on aircraft and
ships and military and civilian bodyguards. The
report also notes that there is discrimination in
the workplace in hiring, promoting and treatment of
employees who are discovered to have HIV/AIDS.

Working with the Media

13. (U) Jovovic said the HIV/AIDS community is
making efforts to work with rather than battle the
media. People discovered with HIV/AIDS are still big
news, but Jovovic said she and her colleagues
respond quickly to media inquiries, when
appropriate, with factual information. Jovovic said
the UN Theme Group has assembled a group of

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journalists and lawyers to review media coverage of
HIV/AIDS in Croatia, with a report to be released in
September. They also are sponsoring a journalism
competition with an award for the most responsible
coverage of HIV/AIDS to be announced in December.

More success stories

14. (U) HIV/AIDS workers point to the AIDS tram,
painted on the outside with contact information for
testing and counseling, as one of their most
successful innovations. The tram has been running
for a year in Zagreb. HUHIV also publishes a
quarterly information bulletin, with a circulation
of 10,000 nationwide, including hospitals, clinics
and testing centers. The NGOs also organize the
annual World AIDS Day on December 1.

15. (U) Dr. Skoko-Poljak noted the inroads made into
the communities of sex workers and intravenous drug
users. She said many are voluntarily going for
testing, accepting condoms and participating in
needle exchange programs through outreach workers at
churches, local governments, NGOs, and police.
She said they are also offering tests in prisons.


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