“We can draw an imaginary line below Tallinn,” says Irja Lutsar, professor of medical microbiology at the University of Tartu. “Tallinn holds the highest number of HIV-positive individuals in Estonia.”
This is due to the fact that Tallinn also has the largest population in Estonia. Meanwhile, Narva and other northeastern Estonian cities hold the highest number of HIV-infected indidividuals in proportional relation to the population. The epidemic has not spread to southern Estonia.
The results were similar ten years ago, when the first experiments with the HIV-virus in Estonia took place, marking the institute's foray into HIV research on Lutsar's initiative.
Back then, the typical infected individual would have been a Russian-speaking youth in their twenties, or even a 13 or 14-year-old child infected as a result of injecting drugs.
”13 and 14-year-olds are no longer infected as often. Our epidemic is growing older, towards those in their late twenties or even in their early thirties.”
In the early 2000s, around 90 percent of those infected were injecting drug users. Such users currently form around half of all HIV carriers in Estonia, whilst the other half has now contracted the disease as a result of unprotected heterosexual intercourse.
“It all goes to show that public campaigns have been successful to a certain degree. But they have failed to reach an isolated group of HIV-positive individuals in the population.”
The isolation of the infected population is also signified by the type of virus spreading in Estonia, with the epidemic remaining largely unchanged throughout the years. CRF06, the subtype of HIV present only in Estonia, has yet to spread to neighboring countries or elsewhere in the world; similarly, subtypes from elsewhere in the world have not spread here. “Our HIV-positive individuals seem to stay in one place, they are also not likely to be engaging in prostitution,” Lutsar asserted.
A national database of 4,000 patients
In hopes of better understanding the spread and progression of the virus, Estonia established a national database for HIV-positive patients ten years ago. Similar databases exist in the United States, the United Kingdom, Germany, France and Switzerland, whilst neighboring countries lack such devices.
With help from doctors and nurses, the Estonian database currently includes the information and medical records of around 4,000 patients.
The electronic medical records provide an overview of the progression of the disease in patients from diagnosis onwards. The medical records include changes in immunological parameters and viral load over time, as well as treatments and records of response to specific medications.
The database thus provides an overview of individual patients' HIV histories, whilst allowing for the control of the entire epidemic alongside other resources.
At least one positive diagnosis a day
Every working day of the year sees at least one individual diagnosed with the disease, allowing their information to be stored in the database, adding up to around 300 new cases annually.
Those working with the database have come to the conclusion that individuals infected with HIV in Estonia generally reach infectious disease specialists at a very late stage in their disease.
“It's sad, since it is possible to start with the treatments very early on. We have medications that not only signficantly improve the quality of life for those infected, but also help to avoid infecting others. It's a chronic disease, like hypertension or diabetes, but people are coming to see their doctors very late and are quite often lost,” Lutsar admitted.
The database has raised the question of whether Estonia should focus further on the handing out of condoms and syringes or rather make additional efforts in infected individuals reaching out to the doctors as quickly as possible. According to specialists, the latter option would serve as a potential means for decreasing the annual total of those infected down from 300 individuals to as low as 30 in the future.
To mark ten years of HIV research at the Institute of Microbiology at the University of Tartu, a conference entitled E-HIV is set to take place on May 28 at the Meriton Hotel in Tallinn, with researchers slated to discuss the HIV-virus, as well as the HIV-positive population in Estonia.
Despite awareness campaigns, social stigmas reign
Speaking to ERR News, an anonymous source diagnosed as HIV-positive in the beginning of the year positively recognized state support in funding his treatment to combat the virus, but noted social stigmas amongst educational as well as healthcare workers as a cause for concern. As an intriguingly ideal case study for the researchers seeking to promote early detection of the disease, his finding out followed as a result of a gut feeling.
”If you're in doubt, go and find out,” he commented, bringing to attention the fact that his own general practitioner had failed to take proper note of his symptoms during flu season.
”They simply mistook it for stomach flu, prescribing pro- and antibiotics instead. Inevitably, HIV is a problem, and it's definitely a problem that doesn't get enough attention, when even your own GP fails to recognize it as such. I got lucky following a gut feeling, whilst someone else might not have done so,“ he added, noting social stigmas surrounding the disease that promote preconceptions.
”When I think back to sex ed classes from when I was 16, then the feeling you got from those was largely uncomfortable. And that sort of feeling is wrong, because I, too, was convinced that something like this would never happen to me and yet it did. If the state could somehow work to change such stigmatization from early on: to say that this can happen to you, and it's okay if it does, but it would be better if it didn't. For that, of course, you need teachers capable of empathy.”
Positively noting accessible and free treatment to combat the virus in Estonia, the source found himself in a more beneficial position than those having to fund treatments privately elsewhere. ”It's only logical for the Estonian state to fund treatment due to the prevalence of HIV here in terms of the European Union,” he noted, observing that awareness campaigns regarding sexually transmitted diseases were largely bilingual. Regardless, such campaigns were far outnumbered by commercial advertising in his view, thus accenting the continued importance of information regarding the disease being spread.
Editor: A. Kaer