At the ACP/EEC Joint Assembly meeting in Kampala, a Commission expert Dr. Lieve FRANSEN, presented the current situation of its AIDS control programme, created in 1987. Manuel MARIN, Vice-President of the Commission, during his stay in Kampala, donated blood at the Nakasero Blood Bank, founded by the E.C. Although accurate data on the scale of the AIDS epidemic are still lacking, there is nevertheless a consensus that the situation is likely to deteriorate in the years to come. . The estimates of the number of people currently infected are 10 million worldwide and more than 600,000 AIDS cases are reported now. . Two thirds of people infected are between 20 and 45 years old. In several countries not only urban areas but also rural areas are becoming highly infected. . It is estimated that as many as 10 million new infections could occur by the end of the century, of which 90 percent in the developing world. . 50% of these new infections are avoidable with sustained, vigorous efforts. The AIDS Control Programme of the Commission was created in July 1987 by Mr Natali for the benefit of all ACP countries (signatories of Lomé II). In 1988 a parallel programme was created for the other developing countries. The initial budget was 35 million ECU for the benefit of the ACP states, which has been totally committed. For the year 1991 an extra of 4 million ECU was alocated, which has been pledged totally. For the parallel programme (not restricted to ACP countries), an annual budget of 5 million ECU was made available. - 2 - In July 1987 the Commission set up within its own services a special task force on AIDS with public health experts, in order to examine, process and develop requests for assistance from the ACP countries, to liaise with WHO and to manage the programme. Activities of the AIDS Control Programme of the Commission Since the inception of the progamme, it has focused on three intervention strategies (control of sexual transmission, of transmission via blood and of transmission from mother to child). For control of sexual transmission the programme works towards behavioural change where necessary, including prevention of Sexually Transmitted Diseases in general. Prevention of bloodborne trasmission is done through screening of donors and donor blood and through rationalised blood use policies. Prevention of perinatal transmission is done through counselling of seropositive women and making contraception available if necessary. In countries with a high prevalence of HIV, priority is given to safe blood programmes and alleviation of the impact of the disease. In countries with a relatively low prevalence, control of STD and target education for youth and behavioural modification for core transmitters is given priority. Since 1990 another aspect has been included into the programme's strategies: caring for the sick and their families, to alleviate the impact on individuals and society (e.g. a rural development programme in a region where a lot of orphans due to AIDS are living). Up to now, nearly all ACP countries requested repeatedly for support and advice from the AIDS control programme. In total more than 90 projects were identified and developed. Another 50 requests are being dealt with. The average budget for those projects is 300,000 ECU yearly and a mean duration of 3 years. In 37 countries projects are developed to prevent sexual transmission; this includes education. In 23 countries projects to prevent bloodborne transmission are developed. The Commission just started to support 2 programmes to alleviate the impact of the disease. The programme also supports training, operational research and exchange of information and technology between ACP and EEC countries. Main obstacles encountered by the programme A strong political commitment, although improved in the last 2 years, is not as yet apparent on all levels and in all sectors. Human and financial resources are insufficient as compared to the needs and requests. - 3 - Procedures to deliver the programme rapidly and efficiently are not as yet available in all ACP countries, nor in all the responsible authorities in the Community. Decreasing Health and Education budgets in the ACP countries make implementation and integration of AIDS control activities difficult, tedious and costly. There is a growing sense of complacency in Europe, where spread of the disease had been proved to be avoidable, coupled with ignorance of or insensitivity to the scale of the problem in ACP countries. The impact of the programme After 3 years of activities it is very early to be able to evaluate the impact of the programme. It is also dificult in most projects to separately evaluate the impact of the Commission activities from the total and only the coordinated international effort in general is what counts. Some data in Zaire, Uganda and Kenya demonstrate that interventions to achieve risk-reducing behaviour among youth or various other groups of the population is having an effect and increase of incidence is lower than expected in those groups. Recommendations - Increased support should be given by the international community to the countries afflicted by AIDS. - This support should be sustained and planned for a longer period of time. - A better co-ordination between all parties and partners involved in managing this support is needed (health, education, legal, ethical, social, development). - New strategies should be developed to: . alleviate the impact of the disease on the individual, the family and the society (this includes treatment of opportunistic infections and care for orphans). . effectively change high risk groups' behaviour without stigmatisation. . make counselling, testing and contraception available to decrease transmission from women to newborn. - Support regional exchanges and training programmes. - 4 - The Nakasero Blood Bank in Kampala Within the Uganda AIDS Control Programme, formed in 1987, the European Comission pledged 1.5 MECU for a safe blood programme at the central blood bank in Nakasero (Kampala). A further 789.000 ECU have just been committed this year, to extend the programme's activities to the whole of the country. The Nakasero Blood Transfusion Services started operating in 1988. 15.000 usable units of blood per annum are now produced (the original target was 10.000 units by end 1990). The efforts of the bank are concentrated on the least HIV-infested population groups: 50% of transfusions are to children, and 20% to pregnant or delivering women. During his stay in Kampala for the ACP/EEC Joint Assembly meeting, Vice- President MARIN visited the Nakasero Blood Bank on February 27 and donated blood. He expressed the Commission's support, and his personal attachment, to the AIDS control programme and to the task accomplished bythe Nakasero Blood Bank in particular.