BORDERNET HIV/AIDS/STI Prevention, Diagnostic and Therapy Across the Old And New EC Borders

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1 Funded by the EU Commission BORDERNET HIV/AIDS/STI Prevention, Diagnostic and Therapy Across the Old And New EC Borders RAR Report, December 2005 University of Zielona Góra

2 I. Background information Question 1. What are the relevant political, socio-economical, cultural and religious aspects in regard to BORDERNET? Lubuskie voivodeship Area: km² Population: people Women: Men: People living in towns: 65% Time of political changes: Autumn 2005 parliament election and president election right sided parties won Lubuskie voivodeship has one of the highest rate of unemployment in Poland 25,8% (average country rate 18%) There are many former PGR areas (State Agriculture Farms) which are broken nowadays and lots of people having lived and worked in such farms stay constantly without work and opportunities for any changes it concerns also a high number of young people (17-30yrs) Various cultures mixed together in Lubuskie voivodeship: Polish, German and Czech ones Religion: Rome-Catholic Church (95%)

3 Question 2. What is the relevant political and legal background in the field of HIV/AIDS/STDs, prostitution and migration in regard to BORDERNET? Polish legislative framework On the Convention of fighting trafficking in people and exploitation of prostitution was opened to signing in Lake Success. 1 The Convention unified regulations of agreements passed to date, and extended them onto a wider group of acts. Crime of trafficking in people was firstly classified in article IX 1 and 2 of regulations introducing the penal code of In 1 the legislator described behaviour involving provision, enticement or abduction of another person in order to induce them to prostitute, even with their consent. Formulation of the regulation implied that the crime stated in article IX 1 of the regulations introducing the penal code did not depend on whether the provision, enticement or abduction of a person in order to induce them to prostitute occurred against the will, without consent, or with the consent of the wronged person. The fact of agreement or the lack thereof might only be of importance at penalty assessment. In 2 behaviour involving trafficking in women even with their consent, and trafficking in children, was described. In this case the reason for trafficking in children was not crucial to the existence of the crime. Therefore, Polish legislation moved further than obliged by the Convention of The crime described in article IX 2 of regulations introducing the penal code was not a directional crime and, as such, did not require the action of the perpetrator of the crime towards prostitution for the occurrence thereof. Trafficking in children for any reason was already a crime. Upon the basis of the penal code of 1969, criminal responsibility was also borne by anyone who has induced another person to prostitute, as well as anyone who has financially benefited from another person s prostitution or, in order to gain financial profits, has eased the conditions for the prostitution thereof. These crimes were described in article and 2 of the penal code of Official Journal of Acts of 21 October 1952 (number 41 item 278) 2 Act of 19 April 1969 Regulations introducing the penal code (Official Journal of Acts, number 13 item 95)

4 The legislator, in the new penal code of , introduced substantial alternations to both instructions and sanctions of legal regulations concerning trafficking in people. 3 The crime stated in article IX 1 of the regulations introducing the penal code of 1969 was incorporated into article of the new penal code. They are not regulations of identical contents whatsoever. The legislator had left out the phrase even with their consent included in article IX 1 of the regulations introducing the penal code of In this way, they must have wished to distance themselves from the wrong interpretation suggesting that abduction with the consent of the abducted person is possible. In case of exploitation of prostitution with the consent of the wronged person perpetrator of the crime shall be subject to the penalty of imprisonment of up to 3 years. In case of enticement or abduction of a person in order to induce them to prostitute, the perpetrator shall be subject to the penalty of imprisonment from 1 to 10 years. Beside the above-mentioned legal regulations, an important role is played by the regulation of article 253 of the new penal code, according to which a person trafficking in people, even with their consent, is subject to the penalty of imprisonment of no less than 3 years. In this case neither the purpose of trafficking in people nor the fact of the wronged person s consent do matter. Formulation of charges most typically involves cumulative qualification of the deed. Indications of two regulations article of the penal code, and article 253 of the penal code, simultaneously aspire to be considered as the same criminal behaviour. On 12 December 2000 in Palermo, on behalf of the Republic of Poland, there was signed the UN Convention against international organized crime, assumed by General Assembly of the United Nations on 15 November On , on behalf of the Republic of Poland, there was also signed the Protocol of prevention, fighting and penalizing trafficking in people, women and children in particular, as assumed by the General Assembly of the UN on 15 November 2002 (Act of ratification was announced in the Official Journal of Acts of 17 February 2003, and became legally binding 14 days of announcement). 3 Official Journal of Acts of 2 August 1997 (Official Journal of Acts, number 88 item 553)

5 In the protocol mentioned the definition of trafficking in people was formulated. In accordance with article 3 letter (a) of the Protocol, trafficking in people means recruitment, transportation, transfer, hiding or hosting persons, with the use of threats or force, or other means of constraint, abduction, swindle, misleading, authority abuse or taking advantage of weakness, handing or accepting payment or other benefit in order to obtain consent of a person having control over another person in order to abuse them. The abuse comprises, as minimum, taking advantage of prostitution of other persons or other forms of sexual abuse, work or service of compulsory nature, slavery or slavery-related practice, captivity, or removal of human organs. According to letter (b) of the aforementioned article, consent of a victim of trafficking in people to intended abuse provided for in letter (a) is of no importance if any of the methods provided for in letter (a) was used. And according to letter (c) of the article, recruitment, transportation, transfer, hiding or hosting a child in order to abuse them is considered as trafficking in people even when it does not involve any of the methods provided for in letter (a). A child then means a person who has yet to become 18 years of age (letter (d) of article 3). Legal binding with regard to the Republic of Poland of the aforementioned Protocol shall result in the fact that the notion of trafficking in people used in of the penal code shall be defined on the grounds of Polish law in compliance with the definition used in article 3 of the aforementioned Protocol. With respect to the legal status, one shall also remember obligations resulting from future membership of Poland in the European Union, that is the necessity to take into consideration legal acts of the EU which, being part of acquis communautaire, shall decide of the shape of Polish legal order. Among numerous acts of the EU on fighting trafficking in people, one shall quote the Outline Decision of the Council of Europe on fighting trafficking in people (2002/629/JAI 19 July 2002) and currently prepared: the Outline Decision of the Council of Europe on fighting sexual abuse of children and child pornography, and the Directive of the Council of Europe on short-term stay permits for persons harmed by crimes of easing the conditions for illegal migration or trafficking in people, and who cooperate with appropriate bodies.

6 Other governmental acts related to BORDERNET activities: 1. Ustawa z dn r. o chorobach zakaźnych i zakażeniach (Rozporządzenie Ministra Zdrowia z dn ) Art. 20, Ustawa z dn r. o Państwowej Inspekcji Sanitarnej (Rozporządzenie Ministra Zdrowia z dn r.) Art.5 3. Regulacje dotyczące ochrony danych osobowych i inne 4. Kodeks Karny z dn r. Art. 161 Question 3. Which infrastructure exists in the region in respect to HIV/AIDS/STDs prevention, diagnostic and therapy and how is it structured and networked? Are the specific conditions for accessing the specific services? Are the specific hindrances (cultural, religious, legal) to make use of those services? In our region there are few ways to receive HIV/AIDS testing: Testing Points governmental (National HIV/AIDS Profilacy Centre) structures in whole Poland (18 Testing Points); one of the Testing Points exists in Zielona Góra at Zielona Góra University (HIV/AIDS Counseling Centre) and one in Gorzów Wlkp. governmental hospitals with Infectious Diseases Departments (in Zielona Góra, Gorzów Wlkp.) Voivodeship Sanitary Inspectorates governmental structures in Zielona Góra and Gorzów Wlkp. (they had run free, but not anonymous HIV/AIDS testing, nowadays they do not provide testing) STDs testing is provided very poorly: private physicians dermatologist, gynaecologist (paid testing and curing) governmental hospitals with Infectious Diseases Departments, Dermatological Departments, Gynaecological Departments STD/HIV/AIDS testing and treating is legally provided to insured persons only. Homeless or unemployed people without insurance do not receive such services, but in practice very often they do up to the physician s decision and good will. Treating is possible in governmental clinics only (most often voivodeship hospitals). In our region patients are cured in Zielona Góra Hospital (Infectious Diseases

7 Department), but in more difficult cases they are directed to the clinics in Szczecin that is specialized in AIDS treating. Testing Points in Zielona Góra is in fact the only opportunity of getting tested freely and anonymously in our region. It has worked for 8 years. Professionally prepared cousellors (medical doctors, sexologist, pedagogues) provide pre- and posttesting counseling to the clients once a week. Similar activities (one Testing Point) exist in Gorzów Wlkp. (slightly shorter open hours, also once a week). I. Data about the epidemiological situation (HIV/AIDS/STDs) and assessment of risk behaviour Question 1. What is the relevant HIV/AIDS/STDs data (syphilis, hepatitis B) in 2004 and how is it documented? Epidemiological data is mandatory reported to National Institute of Hygiene in Warsaw. National Institute of Hygiene in Warsaw Voivodeship Sanitary Inspectorates National HIV/AIDS Profilacy Centre District Sanitary Inspectorates Testing Points Hospitals Private physicians Private Clinics In 2003 and 2004 the worst epidemiological situation in regard to all reported STDs was in Lubuskie voivodshaft, Mazowieckie (Warsaw) one and Dolnośląskie

8 (Wrocław) one. The biggest worsening was noted in Lubuskie, Małopolskie (Cracow) and Śląskie (Katowice). Disease Number of cases in 2004 Incidence per people in 2004 in 2003 syphilis 784 2,05 2,57 gonorrhoea 520 1,36 0,12 HPV ,71 2,65 NGU ,51 4,05 genital herpes 323 0,85 HBV ,86 4,44 Lubuskie region in regard to STDs incidence per people the ranking place in Poland in 2004: Syphilis the third place (3,3) Late syphilis the first place (4 times higher than average in Poland) Gonorrhoea the first place (4,5) HPV the second place (4,6) Genital herpes the third place (1,9) HI/AIDS epidemiological data - from the beginning of epidemy in 1985 till the end of May 2005: 9431 HIV+ cases 1619 AIDS cases 759 mortal cases

9 Year average number of newly discovered HIV+ infected cases in the period of Lubuskie Number of HIV+ cases per people Year average AIDS incidence in the period of Lubuskie Incidence per people

10 Question 2. What is your recent knowledge about risk behaviour within the region? Can you identify specific target groups? Do you have any information about new developments? The research on HIV/AIDS/STDs risk behaviour in Poland is run every four years by prof. Zbigniew Izdebski. It is always carried out on the representative sample of the Poles at the age of The last research was made in Nowadays the new research (2005) is being carried out by prof. Izdebski the data will be soon known. Data about risk behaviour obtained in 2001 research: I. Oral sex Have you ever had oral sexual intercourse with ejaculation into the partner s mouth? N=3200, years old, November 2001, Izdebski 19% had oral contact with ejaculation into the partner s mouth

11 II. Anal sex Have you ever had anal sexual intercourse? N=3200, years old, November 2001, Izdebski 14% of respondents had anal sexual intercourse III. Escort agencies Have you ever used the services of escort agency or any other person who offered commercial sex service? N=3200, years old, November 2001, Izdebski 6,6% used the services of escort agencies ever among them 12% of men and 1% of women respectively

12 IV. Knowledge on HIV/AIDS - WHO indicator WHO indicator: knowing 2 of 3 ways of protection against HIV/AIDS (clean needles, faithful partner, condom using) N=3200, years old, November 2001, Izdebski 1997: WHO indicator : 0, : WHO indicator : 0, : age yrs, WHO indicator: 0,77 V. Unfaithfulness Among respondents having regular partner or spouse N=903, years old, November 2001, Izdebski Every fourth respondent (25%) was unfaithful on at least one occasion in their life. 16% of women and 33% of men admitted having been unfaithful to their spouse or regular partner on at least one occasion in their life. Among respondents at the age of 20-24, the percentage of such Poles reached 21%. 15% of married Poles admitted having the regular partner except their spouse. V. Early sexual initiation The findings are based on survey conducted in 2002 by prof. B. Woynarowska Percentage of 15-year-old respondents who had their sexual initiation at the age of 15.

13 Total 14,8 Respondents at the age of 15 Girls 9,2 Boys 20,9 There are visible changes in the customs among young people. More youth makes experiments with drugs at the disco and behave in a risky way. More often they use alcohol during parties and takes accidental sexual contacts. We can note also the phenomenon of child prostitution when young children make sex for gifts, money or food. It is very important target groups for our region. Specific target groups are: sex workers, youth at the age 15 24, MSM, clients of escort agencies. Question 3. In which areas (prevention, diagnostic, therapy) do you see important needs in the region and why? What will be the future task for the regional networking? 1. establishing regional cross-border networks adjusting and improving HIV/AIDS/STDs prevention services at the Polish-German border, 2. exchange of experiences and best practices in the field of HIV/AIDS/STDs prevention, diagnostic and therapy with Germany and other partner countries,

14 3. lengthening time of testing per week at the Counseling Centre at the Univeristy of Zielona Góra, 4. opening a Testing Point with counseling services in Słubice, 5. improvement and standardisation of pre- and post- test counseling, 6. improvement of prevention measures for special target groups (educational materials), 7. providing the access to information and education sources for young women and men and for especially vulnerable persons like (migrant) sex workers, youth, MSM, 8. gathering epidemiological data especially on STDs, 9. establishing STDs testing (free and anonymous) in Zielona Góra and surroundings, 10. establishing support groups for risky behaviour people, persons with AIDS phobia, MSM. Partners for BORDERNET activities in Lubuskie voivodeship: 1. TADA Zielona Góra 2. Family Planning Association Zielona Góra 3. Testing Point Zielona Góra 4. Testing Point Gorzów Wlkp. 5. Voivodeship Hospital in Zielona Góra: Infectious Diseases Department, Gynaecological Department, Dermatological Department 6. Hospital in Żary 7. Hospital in Krosno Odrz. 8. Hospital in Słubice 9. Private physicians in Zielona Góra: two gynaecologists, one dermatologist We are still expecting answers from: 1. Hospital in Nowa Sól (Gynaecological Department) 2. Hospital in Gubin (Gynaecological Department) 3. Gynaecological Centre in Krosno Odrz. 4. Gynaecological Centre in Skwierzyna 5. Dermatological Centre in Skwierzyna 6. Hospital in Sulęcin: Infectious Diseases Department 7. Hospital in Świebodzin

15 Focus group took place on at University of Zielona Góra - Youth Counseling and Sex Education Unit. There were 13 participants of focus group meeting: four medical doctors (1 dermatologist, 1 gynaecologist, 2 infectious diseases specialists) one TADA worker four workers of Family Planning Association (street workers) three counselors of HIV/AIDS Counseling Centre and Testing Point A. Felińska (BORDERNET, University of Zielona Góra) Topics that were discussed: 1. HIV/AIDS/STDs testing needs - high need, poor access to testing centers 2. Characteristics of sex workers and youth for sentient surveillance 3. Aims and tasks of BORDERNET 4. Ways of cooperation and gathering data contact point UZG Counseling Center 5. Two difficult cases foreigner without insurance diagnose and therapy, young patient under 18 (without permission of his parents) 6. Who can be our partners, which institutions can we invite? 7. Deadline for Part III 30 November Future cooperation The participants elaborated the list of possible partners to collaborate for BORDERNET. They suggested to target on young people (18-24) for WP6 survey and on sex workers. They gave characteristics of these two target groups. Participants expressed also the difficulties and gaps in the field of HIV/AIDS/STDs in our region and special topics concerning difficult cases (young client/patient, without insurance, payment for the treating).

16 This report was produced by a contractor for Health & Consumer Protection Directorate General and represents the views of the contractor or author. These views have not been adopted or in any way approved by the Commission and do not necessarily represent the view of the Commission or the Directorate General for Health and Consumer Protection. The European Commission does not guarantee the accuracy of the data included in this study, nor does it accept responsibility for any use made thereof.