MDG 6 - Combat HIV/AIDS, Malaria and Other Diseases
BiH is a low HIV prevalence country with an estimated prevalence of <0.1%. According to BiH reports to the European Centre for Disease Prevention and Control (ECDC) the number of AIDS cases in the country has stabilized since 2002. Up until the end of September 2012 a total of 221 cases of HIV infection and 120 cases of AIDS were registered. The infection ratio in BiH is 5:1 (male/female). Monitoring data shows that 81% of those infected with HIV are men and that the most common form of transmission of HIV is through heterosexual sex (52%). To date only one recorded case of mother-to-child transmission (MTCT) has been registered, back in 2006. Currently 74 persons are receiving anti-retroviral therapy. The challenge of a shortage of anti-retroviral therapy in BiH is being addressed through the programme of the Global Fund to Fight AIDS, Tuberculosis and Malaria, implemented by United Nations Development Programme (UNDP). The anti-retroviral treatment began in 2007 through the public health care system.
Substantial effort has been invested in the prevention and detection of HIV/AIDS with pre-testing and post-testing counselling in BiH being established in 2005 through Voluntary Confidential Counselling and Testing Centres (VCCT). VCCT centres have increased the number of people coming in for tests. The increased availability and use of HIV testing is a necessary pre-requisite for diagnosing and providing appropriate treatment and care to people living with HIV (PLHIV). Currently, there are 22 VCCT centres, 14 in the FBiH and 8 in RS. The VCCT centres have been targeting the most-at-risk population groups, IDU, MSM, SWs, through the provision of free voluntary and confidential counselling and testing for HIV/AIDS. Ten drop-in centres regularly provide injecting drug users with sterile needles and syringes and distribute condoms and HIV/AIDS information material as well as referrals to VCCT centres.
Bosnia and Herzegovina is among those countries with an ‘intermediate’ burden of tuberculosis (TB) within the World Health Organization European Region, with TB incidence estimated at 49 per 100,000 of the population in 2011. The TB burden in BiH has remained steady during the last few years. BiH has a fairly developed network of health infrastructure but this infrastructure requires upgrading. In 2011 the estimated prevalence rate was 66 per 100,000 of the population.
At the state level the Ministry of Civil Affairs, Sector for Health, is in charge of the coordination of entity activities and the fulfilment of the international obligations of BiH within the health sector. TB Management in BiH comes under the responsibility of the Ministry of Health and Social Welfare of Republika Srpska, the Ministry of Health of the Federation of Bosnia and Herzegovina and the cantons (in the Federation BiH), and the Department of Health and other Services of Brčko District. Existing TB strategies in the country entirely reflect the WHO promoted Stop TB Strategy, while Directly Observed Therapy Short-Course (DOTS) elements are the cornerstone of the strategy. Improved tuberculosis outcomes expected from these strategies are consistent with the internationally set target to detect at least 70% of new sputum smear-positive TB cases and cure at least 90% of these cases.
Whilst HIV/AIDS incidence in BiH remains low, like other countries in transitions, BiH is facing a number of challenges related to social and demographic change with increased numbers of drug users, sex workers and sexually transmitted diseases. Accessibility to the health system for vulnerable population groups in BiH, especially for individuals not covered by health insurance, incorporating diagnosis and treatment remains a problem that needs to be adequately addressed in order to maintain the current prevalence rates on HIV/AIDS and TB.