Council of Europe, Committee of Ministers, Recommendation No. R (83) 25 Concerning Common European Public Health Policy to Fight the Acquired Immunodeficiency Syndrome (AIDS) (Nov. 26, 1987).
Aware of the growing challenge for public health authorities represented by a new and severe health hazard, the Human Immunodeficiency Virus (HIV) infection, transmissible by sexual intercourse, through the blood, during pregnancy and perinatally, and which can induce a variety of conditions such as AIDS, Aids Related Complex (ARC), various cancers, neurological and other disorders, as well as some problems with respect to healthy carriers;
Conscious that there is at present neither vaccine nor cure for AIDS;
Considering that, under these circumstances, HIV infection will dangerously increase and spread in the population if no immediate and effective preventive action is taken;
Considering that such an epidemic will represent a very heavy burden for health services and social security systems, and will have serious economic consequences;
Considering that it may also pose ethical, legal and social problems in terms of stigmatisation and discrimination;
Bearing in mind the Convention for the Protection of Human Rights and Fundamental Freedoms;
Recalling its Recommendations No. R (83) 8 and No. R (85) 12 concerning the screening of blood donors for AIDS markers;
Judging that the implementation of a harmonised comprehensive preventive policy at European level may effectively limit the spread of the disease,
In the light of present knowledge, recommends the governments of member states to:
Appendix to Recommendation n° R (87) 25
1. Co-ordinating committees
Those governments which have not yet done so, should urgently set up co-ordinating committees at national, regional and local levels in keeping with the size and administrative structure of the country.
The task of the national committee should consist in the drawing up of a public health policy for the prevention of AIDS taking into account the complex implications at strategical level (for the essential elements of this policy, see Item 2 hereafter).
The appointment of regional and local committees should serve as a means of ensuring a regular flow of information and vertical and horizontal co-operation in the implementation of the policy and co-ordination of actions.
The national committee should monitor the implementation of the policy by instituting an appropriate feedback system for permanent revision and adaptation of the policy.
Resources should be made available, both in terms of finance and personnel, to implement the nationally agreed policy at regional and local levels.
Membership of the national committee should include, for example, representatives of relevant governmental sectors: health, social affairs, social security, education, research, etc.
The national committee should seek the advice of experts in various fields, interested parties, health staff, associations and organisations, whether public or private, whose work is relevant to AIDS prevention.
The membership of regional and local committees should include the same representatives at the corresponding level so as to reflect all concerned interests.
The committees, whether national, regional or local, should be set up in such a way as to :
2. Formulation of a public health policy : essentials
The national AIDS committee should draw up a comprehensive policy based on an agreed strategy consisting of a series of coordinated and consistent programmes in a variety of complementary fields, combining :
National health administrations should concentrate their efforts on preventive measures aimed at behavioural change to control the epidemic since these are of singular importance as long as a vaccine and cure have not been found.
To this end, a health communication strategy should be devised at the national level taking account of the views of health education, mass communication and social science experts, professional advertisers, etc. ; such a strategy should be based on the following programmes which will respectively bear short-, medium- and long-term effects:
The objective should consist in counteracting misinformation, prejudice and fear by raising the level of knowledge about the modes of transmission, the spread of the infection and the risk associated with behavioural patterns. The public should be informed of measures to prevent infection and, in particular, that sexual transmission may be prevented by careful selection of sexual partners, by avoiding casual sexual contact and by the use of condoms.
Special attention should be paid to the media, whose role in shaping public opinion is crucial; a strategy should be adopted to favour responsible reporting on the subject; to this end dossiers should be regularly prepared and made available to the press.
Such programmes should be planned on a medium-term basis, as their main objective, behavioural change, cannot be reached overnight.
Three overriding principles should permeate health education activities :
No health education programme (primary prevention) should be initiated if not backed up by secondary and tertiary prevention facilities (that is, sites for voluntary testing, counselling, treatment and psycho-social support services).
Target groups to be considered may vary in size from country to country and programmes and activities should reflect this variability; however, in view of the transmission modes, the following should in any case be taken into account:
Sex education should be integrated in a wider reflection on life-styles and human relationships. Such programmes should encourage individuals to assume responsibility for their health by becoming aware of risks and benefits inherent in various life-styles.
In the light of present knowledge, given the absence of curative treatment and in view of the complexity of the epidemic, the implementation of the following public health measures is to be considered essential to limit the spread of HIV infection.
Flexible plans consistent with the epidemiological projections and capable of efficiently meeting increasing needs should be drawn up; in this respect the responsible health authorities should :
Appropriate training programmes should be organised for all categories of health staff, especially for those working in the field of diagnosis, treatment, control of transmission of infections, psychological support and terminal care.
Staff in the social services should be trained in the implementation of policies and regulations, as well as in patient and family assistance and psychological support.
Staff who may have occupational exposure to infected fluids and secretions should be kept informed of sensible hygienic precautions to be taken both for themselves and for their clients.
Training for teachers should be organised to allow them to integrate AIDS prevention in health education.
Development of research and co-operation at European level through the designation of reference centres in all AIDS-related fields is an urgent priority to combat AIDS, would be of great benefit both in terms of effectiveness of programmes and costs, and should therefore be strongly supported by national health administrations.
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