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Diagnosed cases and transmission
On World AIDS Day, Dr Arjan Harxhi, an infectious disease specialist at the Infectious Diseases Hospital of the Mother Teresa University Hospital Centre, discusses HIV in Albania. He explains that although the number of people diagnosed this year has been lower than last year, the number affected by the human immunodeficiency virus (HIV) is still substantial. The doctor identifies cases of mother-to-child transmission, which continue to occur in Albania, as particularly alarming.
Meanwhile, even though 21 years have passed since the virus was first recorded in Albania, Albanian society continues to associate it with stigma and discrimination. As the doctor himself says, discrimination sometimes comes from healthcare personnel too.
Dr Harxhi, yesterday was World AIDS Day, a day to remember those who have lost their lives to this disease and a day of greater public awareness. But how many people in Albania have actually been diagnosed with HIV, the virus that causes AIDS?
I can tell you that a total of 774 people have been diagnosed with HIV, including 75 new cases recorded in 2014 alone. This is a decline compared with last year, when the number was even higher.
Who is most affected?
Men generally continue to be the most affected, with 56 new cases registered this year and a cumulative total of 543, more than two-thirds of all those diagnosed. I would also like to say that diagnoses among children aged 0–15 are alarming. The total stands at 39 cases, most of whom acquired the virus from their mothers, through vertical transmission.
We continue to see children becoming infected. There have been five new cases this year, and I can say that in four of them the virus was transmitted in precisely this way. This is a very serious problem for our country.
What is the predominant route of transmission?
Sexual transmission predominates, and I can tell you that, fortunately, we have not had cases or outbreaks of infection among drug users of the kind seen in other countries. That would be very bad, because once this virus, HIV, enters that population, there are major outbreaks and widespread infection. This has happened in countries of the former Soviet Union, such as Russia and Ukraine, where transmission among drug users is a particular feature.
Fortunately, we do not see this in Albania.
Testing and preventing transmission
Yet despite this, the number of people affected in Albania rises from year to year…
Yes! There continue to be new cases, although it should be said that their number is lower than a year ago. Generally, these are cases that are diagnosed and reported late because so little testing is carried out in Albania.
Awareness of voluntary testing is low, but the health system is also unprepared to provide sufficient access to testing. For example, when discussing vertical transmission of this virus in Albania, we must say that hospitals do not offer screening, or testing, to pregnant women, something that is standard practice in the West.
So you are saying that pregnant women in Albania are not offered HIV testing?
Yes! Today, a pregnant woman in Albania is not offered an HIV test. If we could diagnose cases during pregnancy, we would be able to intervene with treatment to bring vertical transmission from mother to child down to a minimum.
Doctor, would that mean these children would be in better health, or that transmission would not occur?
In that case, we would not have transmission. If we had been able to screen these four children diagnosed this year, they would not be on this list, because they would have been offered treatment and the risk of transmitting the virus would have been as low as possible. I can say that nowadays it is almost zero.
To prevent this transmission under Albania’s current circumstances, where pregnant women are not offered testing, is there a need to raise awareness of voluntary testing among couples who are thinking of becoming parents in the future?
Experience around the world shows that no couple takes this test on their own initiative. We do not need to reinvent the wheel; others have already invented it. We simply need to implement this process.
International practice is that when a pregnant woman goes for antenatal care at any healthcare institution, she is offered testing. In other words, the conditions must be put in place. Today, in the West, pregnant women are told: “We will do the tests, including an HIV test; do you agree?”
It is that simple, but it is not done in Albania.
Why is that, doctor?
For many reasons. There are logistical and infrastructure issues, and neither the public nor healthcare personnel are prepared. However, we are incorporating screening for pregnant women and the prevention of mother-to-child transmission into the new HIV/AIDS strategy.
Stigma and support for patients
Doctor, the first case of the virus in Albania was recorded in 1993, 21 years ago. In your view, does Albanian society continue to stigmatise this disease?
Of course, circumstances have changed, but stigma persists in Albania: even though this infection appeared here more than 20 years ago, there is still stigmatisation and isolation. There is exclusion and discrimination, not only among the relatives and acquaintances of those affected; I sometimes see it in hospitals, among healthcare personnel, too. Naturally, we need to identify the roots of this behaviour so that we can address it, but I want to say that in this hospital, the Infectious Diseases Hospital, there have been very significant changes compared with the year when the disease first appeared.
Back then, everyone was anxious when working with these patients, whereas today it is a completely different matter. Treating this disease is now considered normal. I could not say the same about other institutions, where staff still feel uncomfortable about it.
We have seen instances of, how shall I put it…, refusal to provide care or services after staff learned that a patient needing surgery or some other intervention was infected. Institutions also need to establish policies to help staff by educating and reassuring them. It should not be necessary to know that a person has this disease.
There needs to be a protocol under which all patients are treated equally and considered a potential risk, so that all healthcare personnel take what are known as universal precautions. Gloves and protective clothing should be available for every patient, and the rules and required conditions should be observed. Naturally, this takes work and substantial investment in protocols and practice.
Generally, do patients’ families stand by them? Among the cases you have treated, have there been any in which families abandoned their relative?
Generally, in Albanian society, the family continues to be supportive. There are rare cases of abandonment, but families are usually supportive, and I always advise patients to share whatever problems they face not only with us, the medical staff, but also with their relatives, who have a considerable psychological influence on them.
Doctor, finally, what is your message for this day?
My message is testing, testing, testing. More testing, because testing means prevention.
21 years of HIV in Albania
The human immunodeficiency virus (HIV) was first recorded in Albania in 1993. There were two cases at the time: one of HIV and another at a more advanced stage, when symptoms had already appeared, AIDS. After 21 years, 774 people had been diagnosed with the virus, 144 of whom had died.
Of these diagnoses, 75 were recorded this year, 2014, during which seven people died. This year marks a decline in diagnoses compared with the 124 cases recorded last year, in 2013. Men account for the largest number, with 543 cases registered.
At least 231 cases have been recorded among women. Meanwhile, the figures for children aged 0–15 who have been diagnosed are particularly alarming. The total is 39, including five cases recorded this year alone.
First published in Shekulli on 2 December 2014.