By Alois Stöger, Minister of Health, Austria

In Austria, the first HIV/AIDS cases were diagnosed in 1983.

In 1983 only very restricted information was available on:

• the real nature of HIV/AIDS
• perspectives considering the development of vaccines
• perspectives considering the development of treatment
• no hope for treatment HIV/AIDS was an untreatable, incurable, deadly disease.

The only possible response was:

• information and consolidation of the available knowledge concerning:
  *possible modes of transmission
  *public health action with a potential to decrease risk
  *activities to decrease individual risk with a focus on behavioural change
  *measures to avoid discrimination of people living with HIV/AIDS
• public health measures to enable vulnerable groups to protect themselves
• public health measures to cut nosocomial infections, transmission by blood transfusions and blood products.

Lessons Learned

• Subsequent implementation of public health measures, combined with information and education of the population, including civil society, on the basis of confidentiality and mutual recognition.
• Special attention has to be given to the inclusion of vulnerable groups.
• Mechanisms to ensure that discrimination is kept under control must be implemented in an early stage.
• Concerning high-risk behaviour groups, low threshold facilities must be put in place, including clean needle exchange facilities and drug substitution programmes whenever needed.

Only by strictly implementing the entire package of these measures has Austria been able to keep the epidemic under control. In Austria, with a population of eight million people, the number of people living with HIV has never exceeded 12,000. The total number of AIDS cases has never exceeded 2,500.

Perspectives
The peak of the epidemic in Austria occurred in 1993 and began to decline after this date due to the availability of first treatments.

After 1997, the number of new cases and deaths was falling dramatically due to the availability and free access to antiretrovirals for everyone.

This free access to the best possible treatment has only been possible due to the fact that there have been effective prevention programmes in place for years to keep the number of people living with HIV low and the financial burden for lifelong treatment affordable for our public health system.

We must always keep in mind that any prevented case is a potential gain for the national public health system and even more for the person that remains healthy and integrated in the workforce.

Cost effective public heath interventions have included:

Blood and Product Safet

Implementation of mechanisms to stop transmission by blood transfusions and blood products:

• education of specialised personal in interviewing potential donors
• self-exclusion systems for people at risk implementation of mechanisms to stop nosocomial infections
• education of health professionals
• education of patients.

General Measures and Education

• peer education of multipliers for vulnerable groups
• provision of tools to complete prevention strategies
• free access to unlinked anonymous test sides including pre- and post-test counselling
• continuity of education programmes for adolescents with respect to must vulnerable groups
• provision of specialised, and if needed, low-threshold services for vulnerable groups must include free access to condoms, and where needed, access to sterile needles and syringes, as well as drug substitution programmes
• prisons and similar sites must be fully included for all prevention packages.

Vertical Transmission

• HIV testing offered on a voluntary basis to all pregnant women
• counselling and training for both negative and positive women
• sustainable provision of antiretrovirals for mother and child, including free access to specialised delivery sites
  for young adolescents, especially girls and young women, implementation of special measures.

Conclusion

Regardless of the availability of antiretrovirals, prevention is still the most important tool for containing the AIDS epidemic. Even if I fully support that free, gender-balanced access to treatment is a fundamental human right, we will not be able to contain the epidemic in any time if we do not implement an integrated approach of prevention, care and treatment. All health care settings must be enabled to take this integrated approach.

Therefore, information, knowledge, prevention, free access to testing, care and treatment must be a single package to fight the disease. Any testing, care or treatment site must take advantage of any patient contact to propagate knowledge on prevention and behaviour. Any pregnant woman, regardless of her serostatus, must be given a fair chance to improve knowledge and should be definitely used as a mediator and multiplier for the health education of their family.

Worldwide the burden of care mainly hits women. This is even stronger for regions where families mainly deliver health care. It is women that care for people living with AIDS. We therefore must empower women to meet this challenge.

The complete health sector must be used to implement a comprehensive and sustainable sector wide prevention and care. Such programmes must be coordinated in a way that they offer complete integrated comprehensive weapon to fight this complex disease, keeping in mind that prevention at whatever stage must clearly be the guiding principle.

Treatment must remain the ultimate weapon for those cases where prevention failed. Austria, where prevention has contained the disease, is ready to share its knowledge with everyone who wants to repeat its success story.