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Working Paper, 17.03.2014
The impact of economic austerity on the HIV response in
Spain: a community perspective
Working Paper
Contents
The impact of economic austerity on the HIV response in Spain: a community perspective....... 1
A Working Paper ....................................................................................................................... 1
1.
Introduction ...................................................................................................................... 2
2. The epidemiological situation in Spain................................................................................... 3
2.1. Reporting ....................................................................................................................... 3
2.2. Key affected and vulnerable groups ................................................................................ 3
3.
Impact of economic austerity measures on the response to the HIV pandemic ................. 4
3.1.
Dilution of political attention and the limited dialogue with civil society .................... 4
3.2. Untransparent and drastic cuts in the HIV/AIDS prevention and treatment
programmes ......................................................................................................................... 6
4.
3.3.
Impact on undocumented migrants and persons in detention ................................... 9
3.4.
Prevention campaigns ............................................................................................. 10
3.5.
Access to treatment and care .................................................................................. 10
3.7.
Loss of research funding .......................................................................................... 11
Current and future actions to respond to the crisis .......................................................... 13
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1. Introduction
The economic crisis and the austerity policies pursued by the Spanish government are
beginning to have a detrimental effect on the major advances that Spain made during the last
thirty years on health, social services and support for the most disadvantaged groups. The
territorial division of Spain into 17 autonomous communities with responsibilities for the
above areas has contributed to a lack of homogeneity in the situation throughout the country.
National legislation and cuts in central government funding have been accepted by the
majority of autonomous governments. However, others have reacted against them and have
either not implemented any of the cuts or have gone to the Constitutional Court to challenge
certain laws, such as law RD 16/2012 which removes universal access to healthcare in Spain,
creates barriers to accessing the healthcare system for people not residing legally in Spain or
Spanish nationals without health insurance, and establishes the principle of co-payment for
certain services and medicines. The situation is not the same throughout the country, thus
accentuating regional inequalities.
Generally it can be said that government funding for public health policies in the area of
HIV/AIDS has been cut drastically by almost 90%. Bodies crucial to the response to the
pandemic, such as the National AIDS Plan, have seen their effectiveness undermined by being
relegated from being a Secretariat within government to being merged with general
directorates. Moreover, civil society participation in formulating prevention and care policies,
including the new multi-sectoral plan currently being drawn up, has being severely limited.
In November 2011, platforms working in the area of HIV/AIDS at national and regional levels
came together under the umbrella of the Alliance of Platforms against HIV/AIDS to form a
coordinated and united voice in political discussions with the government and other actors and
parties. Together with scientific bodies such as GESIDA and SEISIDA, the Alliance has brought
attention to the disastrous effect that cuts may bring about in public health in the immediate
future relative to prevention, care and access to treatment by people with HIV/AIDS, , as well
as to the regional inequalities that are emerging.
This report aims to provide a summary and update from a community perspective on all the
work that various actors have carried out over the last two years to publicise, and to put
forward alternatives to the misguided policies in the areas of health and social services being
implemented by central government and most governments in the autonomous communities
as a result of economic austerity policies. It is based on existing reports and interviews with
different stakeholders in December 2013.
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2. The epidemiological situation in Spain
2.1. Reporting
According to SINIHIV, the register of new HIV infections in Spain that covers 82% of the
population, 3,210 new cases of HIV were notified in 2012 compared to 3,244 new cases in
2011. This is a marginal decrease that does not allow us to draw clear inferences.
Looking at the data from the December 2013 report of the European Centre for Disease
Prevention and Control (ECDC), David Dalmau, specialist at the Mútua de Terrassa Hospital and
president of the governing body of the Spanish Interdisciplinary HIV Society (SEISIDA),
underlines that “Spain is doing it wrong”. According to him, the relevant fact is that the
infection rate per 100,000 inhabitants in Spain remains higher than the average of surrounding
countries (the European Union plus Iceland, Lichtenstein and Norway). Its infection rate puts it
at the sixth worst position of 30 countries.1 Spain’s rate is 85 cases per million inhabitants,
which places it at above the European Union average since the pandemic began. Up to now,
Spain has been unable to reduce these numbers.
The quantitative data provided by SINIHIV does not allow measurement of the impact that the
policy of budget cuts is having on the rise or fall in the number of new infections in Spain.
Thus, relying on the data from some of the autonomous communities showing a plateau or a
fall for certain groups can be misleading. Therefore, this data should not lead the authorities to
arrive at an over-optimistic interpretation and to cut outreach programmes for the most
vulnerable groups. The drop or levelling off could also be explained by the greater difficulty the
most at-risk groups are facing in accessing HIV/AIDS testing due to the lack of awareness
campaigns, the closure of the organisations that acted as links and interface between these
groups and the health service, and the difficulties these groups encounter in accessing
diagnostic tests. Dr Julia del Amo, from the Carlos III Health Institute, advises breaking down
the data by type of transmission “rather than quoting overall figures. In reality there are 3
epidemics: MSM, injecting drug users and heterosexuals. There has been an UNEQUIVOCAL
increase since 2007 in the first category and a clear fall in the latter two. We are also benefiting
from the information collated in cohort studies such as CORIS which will provide us with further
quantifiable and verifiable information on the impact that cuts in health and social services are
having on people with HIV in Spain”.
2.2. Key affected and vulnerable groups
Men account for 85% of new infections, with a median age of 36. Sexual transmission accounts
for 82% of newly diagnosed cases. Infection is most frequent among men who have sex with
men (MSM) at 51%, followed by heterosexuals at 31%, and intravenous drug users (IDU) at 5%.
1
http://sociedad.elpais.com/sociedad/2013/11/27/actualidad/1385585359_221239.html
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People originating from other countries account for 35% of new HIV infection diagnoses. Of all
new cases - 48% - are late diagnoses.2
“Drug-users are especially likely to suffer late diagnosis; within this group, cases of advanced
illness at diagnosis are higher among especially vulnerable groups such as women, MSM and
persons over 50. Moreover, the tuberculosis infection rate in penal institutions has risen to 5%.”
Marisa Fernández, President, FAUDAS
As far as migrants are concerned, according to Julia del Amo, “it would be useful to mention
that the number of HIV cases among immigrants has also fallen; since 2008 in those from SubSaharan Africa and since 2010 in those from Latin America. While monitoring can identify
trends, we hope that studies like the aMASE-Spain study, carried out within the framework of
EuroCoord, will be able to explain these trends.”
3. Impact of economic austerity measures on the response to the
HIV pandemic
3.1.
Dilution of political attention and the limited dialogue with civil society
As a result of cuts applied by the Government, the Secretariat of the National AIDS Plan which
is responsible for coordinating programmes and activities of prevention, care and research
related to HIV and AIDS, has been subsumed into the Sub-Directorate of Health Promotion and
Epidemiology. This has brought about a restructuring that reduceses its influence within the
structure of the Ministry of Health, Social Affairs and Equality.
The loss of funding, of personnel, and a shift in interaction with civil organisations, have led to
serious deficiencies in the evaluation process for the Multisectoral HIV/AIDS Plan 2008-2012,
while the new 2013-2017 Plan is still being developed. The new Plan is already a year behind
schedule.
As a representative from a community organisation noted, “During the last two years there has
been minimal community participation in the formulation, drawing up and evaluating the
Secretariat’s policies: meetings have not taken place or there has been insufficient flexibility in
their timing or format. There has been a lack of interest from the administration in the face of
our calls for a proper framework for communication and coordination and there have been
serious differences over our participation in drawing up the New Strategic Plan. When we have
been allowed to participate actively, it has been only on sections dealing with Stigma and
Discrimination, therefore reducing the role of civil society to that of merely revising the
complete text adopted by the Plan. Participation and consultation institutions and various
2
Epidemiological monitoring of HIV/AIDS in Spain, updated 30 June 2013, Ministry of Health, Social Services and Equality and
Carlos III Health Institute
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ministries with multidisciplinary concern with HIV/AIDS have not been convened for
consultation for several years, e.g., the National Commission for the Coordination and
Monitoring of HIV/AIDS Programmes, the most important national organisation made up of
representatives of scientific societies, the Autonomous Communities, Civil Society – COAC
(Assessment and Consultancy Committee), Penal Institutions, and the Council for Youth. . Not
only economic but also political decisions in key areas, such as access to healthcare for people
with HIV/AIDS and preventative policies, have been taken unilaterally by the Government.” 3
Civil society participation in developing therapeutic guidelines and recommendations for the
management of HIV infection (the Clinical Advisory Committee and scientific bodies such as
GESIDA) have been seriously hampered by, among other things, legislation that makes
accessing information difficult for citizens and professional groups – nurses, psychologists,
social workers and community health educators – who are directly involved in dealing with or
caring for people with HIV/AIDS.4
Hence, interdisciplinary scientific societies such as the Spanish Interdisciplinary Society on AIDS
(SEISIDA), which has played a key role in producing scientific and research material as an aid to
understanding, response and better formulation of policies, have been forced into a situation
of economic underfunding and lack of any role in dialogue; this applies not only in purely
clinical aspects but also in psycho-social, educational and epidemiological areas . This situation
is due in large part to an obsolete legal block placed on the right to information and the
withdrawal of funding by the Ministry.
“SEISIDA has always collaborated closely with the Secretariat of the National Aids Plan (SPNS)
and thanks to joint collaboration and financing it has been able to implement projects,
organise conferences and produce reports which have been useful in evaluating the
Multisectoral Plan. It also made approaches to the previous administration with a view to
modifying those sections of the General Health Law which restrict standard access to
biomedical information of specialised personnel who do not have prescribing or dispensing
rights. This collaboration and joint work has completely vanished and we can state that at the
present time there is no public funding by the Spanish Ministry of Health for psycho-social
research on HIV/AIDS, nor any kind of initiative that suggests there will be any changes to the
legal obstacles to the right to information for professionals without prescribing or dispensing
rights. SEISIDA is not entirely deprived of funding but its research capacity is very restricted and
only survives thanks to the support of private capital, as public and semi-public sources of
funding have dried up.” María José Fuster, SEISIDA manager
3
Julio Gómez, Coordinator, Federación Trabajando en Positivo (Working Positively Federation) and member of the RedHIV
coordinating group.
4
General Health Law No. 14/1986 and Royal Decree No. 1416/1994 on Advertising of Medicines for Human Use
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3.2. Untransparent and drastic cuts in the HIV/AIDS prevention and
treatment programmes
The extensive financial cuts to HIV/AIDS prevention and treatment programmes in Spain over
the last two years have been characterised by a complete lack of transparency and
accountability on the part of the government. This lack relates to the various actors,
communities and representatives of other political parties concerned, as well as to the final
amount of funding for these projects.
“Over and above the statistics, devastating as they are, the most frustrating aspect has been
the lack of transparency and accountability to civil society and the deliberately self-interested
quoting of figures by government representatives to the media”. Julio Gómez, Coordinator,
Federación Trabajando en Positivo (Working Positively Federation) and member of the RedHIV
coordinating group
From 2009 to 2011 the ring-fenced amount granted to the Autonomous Regions by central
government for funding HIV/AIDS projects remained stable at around 4,327,000 Euros. During
the same period, 4,405,000 Euros were awarded to the Secretariat of the National Aids Plan
each year for maintenance and project funding, and the call for applications for funding of
projects undertaken by NGOs rose from 3,736,800 for 2009-2010 to 3,860,000 in 2011. 5 In
2012, this source of ring-fenced financing was removed, and included in the “cohesion funds”
allocated to the Autonomous Regions. The amount allocated to the National AIDS Plan was
3,052,820 Euros and the annual amount allocated to projects undertaken by NGOs was
1,000,000 Euros. 6
In response to requests from civil society and opposition parties on the final destination of
these funds, already markedly reduced compared to previous years, the replies have been
vague and seem to suggest that the money “actually” spent on HIV/AIDS programmes was far
less than the meagre funding contained in the budget presented.
There has been no clear response from the Government to queries as to which HIV/AIDS
programmes have been financed directly from the “cohesion funds” allocated to the
Autonomous Regions. This might suggest that central government has failed to monitor how
these funds are allocated and might be interpreted as showing that some Autonomous
Regions have transferred part of these funds to other budget headings not directly related to
HIV/AIDS, especially since some regions, like the Balearics and the Murcia Autonomous Region,
have already dismantled HIV/AIDS prevention and treatment programmes.
5
Report on the Multisectoral HIV/AIDS Evaluation Plan 2008-2012, General Directorate of Public Health, Quality and Innovation,
July 2013.
6
General State Budget 2012. Budget for Programmes and Report on Objectives, Section XXIII (Public Health Budget can be
consulted at page 51) http://www.sepg.pap.minhap.gob.es/Presup/PGE2012Project/MaestroTomos/PGEROM/doc/L_12_A_G16.PDF
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Furthermore, the Government has confirmed spending of only 500,000 Euros out of the total
amount of 3,052,820 Euros allocated to the National AIDS Plan.7
To summarise, verifiable sources have confirmed that the 2011 budget of 14,000,000 Euros for
maintenance programmes, projects, research and support for civil society bodies was reduced
to 1,500,000 Euros for 2012.
In 2013, although the “allocated funding” for the Autonomous Regions is not yet known, the
budget for the National AIDS Plan is 3,500,000 Euros, although civil society does not know
exactly how much money will be allocated in reality. The budget for funding NGOs has
remained the same at 1,100,000 Euros.
A direct consequence of the above has been a loss of funding for HIV prevention and a loss of
human capital in terms of professionals working in this area. It is estimated that there has
been a 75% reduction in the number of technical personnel working on various parts of the
Multisectoral Plan. This has led to many educational strategies and activities being frozen, such
as training social and health professionals through day schools, seminars and higher degrees
linked to academic institutions; research, e.g. a study of the those working in prostitution in
Spain; prevention in the form of campaigns and pilot projects; epidemiological monitoring,
including studies on vulnerable groups by EPI-HIV and EPI-ITS that have provided significant
data for better managing the epidemic; and health care. All these were in progress under the
now-disbanded Secretariat for the National AIDS Plan.
The delay in publication – 25 September 2012 – of the call for proposals for NGOs for 2012 and
2013, added to the drastic reduction in funding for civil society, have devastated pioneering
projects run by bodies with a proven and recognised track records. It has a serious impact on
the HIV community and NGOs within Spain, particularly the NGO projects based in Catalonia
whose funding from central government has been effectively cancelled.
The withdrawal of ring-fenced funds for HIV prevention activities by administrative bodies
that have the legal competence to do this (i.e. the regional governments of the Autonomous
Regions) has led to the virtual disappearance of existing prevention and treatment
programmes.
“In the Murcia Autonomous Region the situation is dire. The Murcia Anti-AIDS Committee
which has been running projects in Murcia and Cartagena for over 20 years has virtually closed
its doors. In 2012, despite the fact that “in theory” there was funding available, and the
regional government told us that there was central government money for HIV/AIDS from the
“former ring-fenced funds”, we were eventually told in October 2012 that there would be no
7
Response from the Government to the Request for Data, Reports or Documents submitted by Gaspar Llamazares Trigo on the
Breakdown of Expenditure on the 313B HIV/AIDS Prevention Programme. 22 April 2013. [Unpublished]
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money for HIV/AIDS projects in the region. This meant that we were now in debt as our work
had been financed by bank loans until then. In 2013 the amount of money the Region assigned
to the Committee’s projects was 1,000 Euros, while the 2014 budget included the symbolic
figure of 1 Euro to avoid us disappearing completely from budget headings and hopefully to
enable any unspent funding to be transferred from another Department. Every month around
150 people – IDUs (intravenous drug users) who are suffering from social exclusion – were
using the Cartagena Needle Exchange Centre which also offered them a welcoming space
where their basic needs, including emergency food, could be taken care of. Also in Cartagena
around 400 female sex workers were receiving regular care, and in the Murcia Centre over 300
male and female sex workers. All these services have been forced to close, as well as early
detection, counselling and support services for HIV positive people. The shelter for AIDS
sufferers is also being badly affected by the lack of political will to provide funding for
organisations working in the area of HIV/AIDS. The residents can only eat thanks to food banks
and, due to the recent introduction of co-payment for medication commonly used to treat
people with AIDS, such as anti-herpes drugs, many people can no longer access them. We even
have problems getting people to their appointments in hospitals on the outskirts because we
have no budget for public transport. Carers often use their own cars to take residents, work
double shifts and their salary payments are constantly in arrears. This is the HIV/AIDS situation
in the Murcia Region; however, there is public money for grants to the basketball team at the
private Catholic University of the Region. This is a scandal”. Bartolomé de Haro, President,
Murcia Region Anti-AIDS Committee
As a counterpoint to this situation, other autonomous communities, though equally short of
means, have managed to make HIV/AIDS one of their public health priorities. This is a further
example of the widening regional inequalities the cuts are creating in Spain,
“According to recent studies, in the thirty years or more that we have been living with
HIV/AIDS, we have failed spectacularly to reduce the stigma and discrimination surrounding it.
We are facing the “social failure of a healthcare success story”. AIDS is an illness, and therefore
a health problem. But it is seen as a "moral" or "social" sickness rather than a "natural" illness.
Because of this, sufferers face social discrimination. The economic crisis and the resulting cuts
in health and social care have destroyed the few existing programmes aimed at alleviating the
effects of stigma and discrimination on the grounds of HIV. The Autonomous Communities have
received no funding from the Ministry of Health and the almost dismantled National AIDS Plan
since 2012. The 700,000 Euros that Andalucía received every year was basically used to fund:
 Organisations of special interest groups
 Prevention and awareness campaigns aimed at the general population
 Early Diagnosis Programme
We at the Department of Equality, Health and Social Policy are acutely aware of the relevance
and importance of these programmes, which is why we have taken on the totality of their
implementation and running costs”. Carmen Zamora, Technical Consultant on HIV/AIDS.
Department of Equality, Health and Social Policy, Regional Government of Andalusia
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Lastly, as yet another example of its lack of commitment to tackling HIV/AIDS and helping the
most deprived, the current government has backtracked on the decision to contribute 10
million Euros to the Global Fund to Fight AIDS, Tuberculosis and Malaria which it announced in
July 2012.8
3.3.
Impact on undocumented migrants and persons in detention
Dr José A. Pérez Molina and Dr Federico Pulido Ortega, along with other members of SEIMC
and GESIDA, have published an article evaluating how the new health care law RD 16/2012,
which restricts the right to health care of those residing illegally in Spain, may affect
undocumented migrants living with HIV, impact morbidity and mortality rates, and over the
foreseeable medium-term increase costs for the system. This study shows that between 2,700
and 4,600 out of the estimated 459,909 undocumented migrants may be living with HIVi9. Of
these, between 1,800 and 3,220 may be aware of their infection and around 80% will be
receiving antiretroviral treatment. The Royal Decree may have a number of undesirable
consequences for this HIV-infected population: increased mortality, greater likelihood of
opportunistic infections, higher numbers of hospital admissions, increased infection rates of
HIV and other pathogens among the wider population, and more mother to child transmission
of HIV. The authors add that the foreseeable increase in morbidity and mortality will bring
increased health care costs which will be even higher for those with the most severe
immunosuppression. Hence applying this law will bring short-term savings much lower than
expected, and will have a negative impact on public health and especially on that of patients
infected with HIV who will remain untreated; this will increase health costs in the medium to
long term and leave us in default of internationally-agreed health objectives.10
Internationally-renowned experts such as Dr Julio Montaner, director of the Centre for
Excellence in HIV/AIDS in British Columbia, have joined in criticism of this measure, as passed
“for political and probably populist reasons, and having no rational basis”. The Spanish
Government is effectively signing a death sentence for many immigrants and is encouraging
the spread of the virus throughout the entire population, “since in transmission, the virus,
unlike the Government, does not discriminate on the basis of ethnic factors”. 11
Another group of people deserving special mention because of their high degree of
vulnerability in view of the Government’s austerity measures is that of people in detention. In
Spain the HIV infection rate in prisons has remained relatively stable since 2009 at around 6%,
while that of Hepatitis C (HCV) has decreased from 27% in 2008 to 22.2% in 2012. Access of
detainees to antiretroviral therapy has stayed virtually the same – around 2,500 persons –
8
EUROPA PRESS 23 JUL 2012 España destinará diez millones de euros al Fondo Global de la lucha contra el sida, la tuberculosis y la
malaria ,[Spain will give ten million Euros to the Global Fund to Fight AIDS, Tuberculosis and Malaria]; EL MUNDO. 13 JAN 2013.
España incumple su promesa de dar 10 millones al fondo contra el sida [Spain reneges on its promise to give 10 million Euros to
the Global Fund to Fight AIDS]
9
José A. Pérez Molina et al, “Evaluation of the impact of the new health legislation on illegal immigrants in Spain infected by the
human immunodeficiency virus” Revista de Microbiología Clínica 17 July 2012
10
Idem
11
El Diario.es 12/09/2012, http://www.eldiario.es/zonacritica/tratamiento-HIV-politica-sanidad-Rajoy_6_46955308.html
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while the number of those treated for HCV has been almost halved, from 452 persons treated
in 2009 to 278 in 2012. 12
The continual reduction in the budgetary allocation for Penal Institutions (from 1,181.90
million Euros in 2012 to 1,129.74 in 2013) and the removal of Ministry of Health funding to the
General Secretariat of Penal Institutions for the development of HIV/AIDS prevention activities
in penal centres may see these figures worsen over the next few years.13
In fact, according to Dr Antonio López Burgos, President of the Spanish Society for Prisoner
Health, “Health in prisons should be made the responsibility of the autonomous communities
rather than the Ministry of the Interior, although during this economic recession the regional
governments are reluctant to take on the cost this would involve. Up till now only Catalonia
and the Basque Country have done so, which means that interned persons in other regions
suffer double discrimination in that they are unable to access programmes specially developed
for this population by regional health authorities.”14
The removal of duty doctors from these institutions, putting funding approval for ARV drugs in
the hands of committees made up predominantly of non-health professionals, the setting of
quotas for VHC therapies dependent on availability of funding, and the increasing neglect of
inmates with mental illnesses paint a grim picture. The result is major injustice to the prison
population in Spain, whose unequal access to healthcare has become even more
obvious.
3.4.
Prevention campaigns
The Ministry of Health, Social Services and Equality (MSSSI) initiated no awareness campaigns
during 2012-2013, compared to 2010 when three campaigns took place and 2011 when there
were two. The long-lasting agreement with the Spanish Youth Council to run campaigns and
prevention activities targeted at the young has also disappeared.
3.5.
Access to treatment and care
The ending of equal access to basic health care for all citizens, through the introduction of an
insurance-based scheme rather than a universal health care system, became law with the
implementation of Royal Decree-Law 20/2012 of 13 July, on measures aimed at ensuring
budgetary stability and promoting competitiveness. In addition to this radical change to the
healthcare model, new measures were introduced on payment for drugs previously supplied
free of charge which are affecting people who have insurance but few economic means and
are among the most vulnerable. These new measures include the introduction of a limited
12
Evaluation Report on the Multisectoral HIV/AIDS Plan 2008-2012, General Directorate For Public Health, Quality and Innovation,
July 2013.
13
Response from the Government to the Request for Data, Reports or Documents submitted by Gaspar Llamazares Trigo on the
Breakdown of Expenditure on the 313B HIV/AIDS Prevention Programme. 22 April 2013. [Unpublished]
14
Gaceta médica.com 04/12/2013 http://www.gacetamedica.com/gaceta/articulo.aspx?idart=549945&idcat=701&tipo=2
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payment (up to a maximum of 4.20 Euros per medicine) for medicines following hospital
diagnosis and dispensed in hospital pharmacies, such as those used to treat hepatitis C, and
some anti-tumour and antiviral drugs widely used to treat people with compromised immune
systems.15 In addition, introducing limited co-payment for medicines for people above pension
age within the national health system who previously received medication for chronic illnesses
free of charge has affected many people living with AIDS on low pensions who are now paying
part of the cost of widely used medicines for chronic conditions such as anti-hypertension,
anti-nausea and cholesterol-lowering drugs.
In Spain the number of patients receiving ARV therapy has gradually increased, from 81,335 in
2009 to 98,011 in 2012, while expenditure on ARV treatment has stagnated at around 729
million Euros over the last two years. Some regional governments are restricting access to new
ARV treatments, and there have been delays in setting the price of new drugs approved by the
Spanish Medicines and Healthcare Products Agency (AEMPS) and dispensing them in hospitals.
In some cases there has been a gap of 12 months between approval of a drug and its
availability in hospital pharmacies.
Hence certain autonomous communities have decided not to finance some of the new
therapies for purely economic reasons, despite the fact that these medicines have been
approved by the AEMPS.
“In the Basque Country we at Osakidetza – the Basque Health Service – are disadvantaged in
accessing new therapies compared to other regions in Spain. We are engaged in hard
bargaining with pharmaceutical laboratories to try to obtain discounts on their products.
During these negotiations, which in some cases have dragged on for years, data on those
affected is scarce or in some cases contradicts the data held by the laboratories. There is
enormous confusion. But what we can be clear about is that, when considering whether to add
a new drug to the portfolio of services available in the Basque Country, the criterion is purely an
economic one. Those living with HIV are suffering personally in this situation, and they are
being denied better treatments, while the government seems indifferent to the improved
quality of life that advances in ARV can bring for people who are HIV positive” Marco Imbert,
Coordinator, Bideratzen Biopsycosocial Centre
3.7.
Loss of research funding
Spain’s national Research, Development and Innovation programmes have also been affected
by these supposed “austerity” policies that will set research back by over ten years in all fields.
In the specific case of research on HIV it should be noted that the Ministry of Health has
cancelled its agreement with the Spanish Agency for Clinical Trials, GESIDA. This agency brings
15
Official State Bulletin 225, Thursday 12 September 2013
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together the majority of state clinical groups and ever since it was set up it has worked with
the Spanish National Aids Secretariat in producing consensus documents on care and
treatment and drawing up numerous clinical guidelines, and is also the main agency promoting
independent clinical trials.
However, clinical research in general has been affected by the MSSSI’s cancellation of the
2012 Call for Proposals in Independent Clinical Research, which awarded grants totalling over
20 million to projects on HIV and other illnesses in 2011. In addition, the Foundation for AIDS
Research and Prevention (FIPSE), which was heavily dependent on MSSSI institutional and
financial support to carry out relevant epidemiological, clinical and social research projects,
has seen its activities brought to a halt due to lack of funding.
We should point out one more aspect of this gloomy picture: the hold-up in approving the
“Social pact to end discrimination related to HIV and AIDS”, an essential measure to tackle
comprehensively the stigma and discrimination suffered by people with HIV in our country.
Finally, there is the frustration felt by health professionals, and their unwavering supporters in
the community, at the Inter-territorial Council of the National Health System decision not to
recognise Infectious Diseases as a specialisation. This decision clashes head-on with European
recommendations and reduces spending on the National Healthcare System (SNS), which will
lead to worse care for patients and reduction in training for health professionals.
The Ministry of Health is proposing to include Infectious Diseases as a Sub-Specialisation (ACE)
which means an infectious disease specialist will undergo only one year of training: according
to experts from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC)
this is completely unfeasible. Furthermore, it is nonsense that, as determined in the Royal
Decree, infectious disease specialists are to be retrained from specialities such as respiratory
medicine that does not include any training in internal medicine or paediatrics.
On this issue the current president of the SEIMC, Dr José Maria Miró, urges the Government to
“consider making Infectious Diseases a primary specialisation to ensure better quality of care
for patients and bring Spain in line with other EU countries, the majority of whom recognise it
as a specialisation. If this specialisation is not recognised, there will be no handing down of
knowledge to the next generation and we can predict a return to the situation of 40 years ago.
We made a special effort to explain personally to the Director-General of Professional Planning
and to the Health Ministers in the majority of the Autonomous Communities why Infectious
Diseases should have the status of a primary specialisation, and these scientific and technical
arguments persuaded them to support the creation of such a specialisation”. Dr Miro cannot
understand why “when, at the moment of truth, the majority of Regional Health Ministers who
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attended the Inter-territorial Council did not support SEIMC’s justified demand. As professionals
and members of SEIMC we feel disappointed and deceived.” 16
4. Current and future actions to respond to the crisis
In response to the emergency situation the country faces in many areas of social and political
life, civil society has organised itself into separate platforms which, within their specific fields
of activity, have attempted to draw attention to the misguided austerity policies pursued by
the Government and to show that there are different options for tackling this serious
economic and humanitarian situation. The one we should emphasise here is the Alliance of
Platforms against HIV/AIDS, consisting of national and regional platforms working in the areas
of health, human rights and HIV/AIDS. Since its creation two years ago the platform has played
a major role in revealing shortcomings, formulating proposals, and mobilising and unifying the
social response of grass-roots HIV/AIDS organisations in Spain.
Civil society, medical organisations, scientific associations and opposition parties have
demonstrated their joint opposition to the policies imposed by central government, and have
taken action in their own spheres of influence against the decisions that have been made. In a
new attempt to redress the situation, the Spanish Parliament, for the first time in its history, is
holding a conference on Human Rights and Public Policy on HIV/AIDS in the early part of 2014.
This conference will be the outcome of the united efforts of political parties, civil society,
scientific associations and the Alliance of Platforms and we hope it will be a turning point and
will lead to a change of direction in the policies pursued so far.
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Noticias Vademecum.es; 26/07/2013, http://www.vademecum.es/noticia-130726el+consejo+interterritorial+no+reconoce+enfermedades+infecciosas+como+una+especialidad_7280