Rauno Vinni: Lessons learned from the HIV epidemic
The HIV virus is extremely prevalent in the Estonian population. What we do not seem to realize, however, is that we are currently living in the middle of an outbreak. The knowledge that we lead Europe in the number of HIV infections in relative to population size has become routine.
Did you know that an epidemic has been raging for years among the people of Estonia? I will give you a hint—I am not talking about the Zika virus or the latest wave of the flu. I am referring to the fact that we have an HIV epidemic. Surely you have heard that the HIV virus is extremely prevalent in the Estonian population. What we do not seem to realize, however, is that we are currently living in the middle of an outbreak. The knowledge that we lead Europe in the number of HIV infections in relative to population size has become routine.
What is unusual, however, was the joint appeal to the Constitutional Committee of the Estonian Parliament filed by the ambassadors of the United Kingdom, Finland, and the United States this week. Together, the diplomats called for Estonia to acknowledge the true extent of the epidemic as well as to form a special committee in parliament dedicated to the task of tackling the problem at hand.
Whether their true motive was to protect tourists of their own citizenship, imperialistically promote humanitarian policy, or just support their pharmaceutical industry is actually of secondary importance. If the goal of the appeal was to draw public attention to the HIV issue, then it succeeded; HIV has indeed been talked about more than usual recently. The main message of the ambassadors’ appeal was that the Estonian state has not managed to curb the spread of HIV. This undermines future prospects for a healthy society, and even affects our neighbors.
Public health authorities do not deny the seriousness of the problem either. In fact, almost all involved parties agree that the situation is dire. Only the decision-makers do not perceive the problem to be big enough to warrant a departure from the beaten path in order to try something different. Everyone has become accustomed to the situation, and sits around like a frog in a pot of water that is slowly boiled alive before it even manages to realize that it should jump out.
Yes, 14 million euros has been allocated this year exclusively for the prevention and treatment of HIV. The issue is being dealt with in a number of different ways—and reasonably well at the patient level, specialists contend. But are the current solutions adequate enough at the societal level? The ambassadors’ letter illustrates that compared to the standards of developed countries, something is very wrong with this situation. The measures being taken are not proportionate to the severity of the problem. In other words, an entire gulf stretches between the needs and the solutions involved.
What, then, should be done? The ambassadors proposed that a special HIV committee be formed in parliament. This idea is by no means novel. Last autumn, a proposal was circulated in parliament calling for the creation of special committees on drug policy and HIV prevention as well as gender equality. Plans were halted due to opposition from the Pro Patria and Res Publica Union (IRL). IRL was against the creation of these study committees because the functions they would perform would be redundant in view of those of existing parliament committees and moreover require further expenditures to the tune of approximately 50,000€ per year per committee. IRL stated that they did not doubt the severity of the issues involved, rather the way they would be handled.
At first glance, IRL’s position on the matter seems incomprehensible. If a problem is recognized, one should contribute in any way possible to its solution. But let’s take a moment in order to avoid one of the most common thinking errors—basing decisions on emotional reactions.
First question: Whose responsibility is it to develop and implement health policy? Answer: The Ministry of Social Affairs and its subordinate bodies. Second question: Who has the most information, resources and know-how in dealing with the problem, as well as existing networks needed to coordinate cooperation between various participants? Answer: The Ministry of Social Affairs.
Accordingly, the problems should be addressed by executive powers. While parliament does make decisions regarding important issues in Estonia, it is the Ministry of Social Affairs that possesses the best instruments for the development and implementation of health policy.
It’s true, merely establishing special committees will not solve any problems. That being said, this idea still has a few positive points. For example, just the establishment of a special committee can be taken as a witness to the political decision-making process. It can also be a sign that parliament takes the task of inspecting its executives’ actions more seriously. Perhaps additional funds can be found with the help of a special committee. But only real change counts, and opportunities for its implementation lie not in the establishment of a new committee, but rather elsewhere.
What now? Logically, opportunities include identifying infected patients, and increasing the amount of medical treatment available so that it would be even more accessible to target populations. We should probably invest more in preventative measures, thus likewise increasing awareness in the target audience as well as better informing the population as a whole. Simple, isn’t it?
Except it isn’t. For one thing, these suggestions are oversimplified. For another, lack of funds remains an obstacle. Unfortunately I cannot say which issues should do without in order to come up with these additional funds. I can, however, frame a few lessons learned. The HIV epidemic demonstrates that simple problems do not usually just disappear on their own—not even then, when you choose to bury your head in the sand. If you let a fire grow big, it can become difficult, if not downright impossible, to extinguish. But the worst thing of all is indifference. Recognizing and dealing with a problem in a timely fashion ends up saving money in the long run.
The spread of HIV could have been halted with the help of activism ten to fifteen years ago. Back then, national budgets blossomed and funding for prevention would have been easier to secure. The responsibility of current leaders is all the greater as a result—we need to make better decisions than before. The recipe for a good decision is as follows: take one part evidence, one part political will and measure out a good dose of aspects of implementation. Mix these components well, and serve with the capable informing of target audiences. Be sure to ask for feedback, and tweak the ratio of ingredients accordingly. Only then can we hope that, in time, anything will change.
Rauno Vinni is the program manager on governance at think tank Praxis.