Пълен протокол на разискванията

Сряда, 12 декември 2007 г. - Страсбург

14. 1 декември, Световен ден за борбата със СПИН (разискване)

  President. The next item is the Commission statement on World AIDS Day, which was on 1 December 2007.

  Markos Kyprianou, Member of the Commission. Mr President, once again we have the opportunity to discuss this serious health threat in the European Parliament. It was only a few months ago that we had the opportunity to discuss the Community Action Plan regarding this health threat. Our concern does not, of course, relate only to the European Community, but also to the whole world.

We are concerned with the rise of infections, with the number of people who are affected and living with HIV worldwide, and the number of 33 million people, for us, is too high. Therefore, we want to take action within the European Union but also coordinate with all the other international players outside the EU to tackle this issue globally. This also matches the new European Community health strategy, which includes a global role for the European Union in the area of health.

Areas we can concentrate on: first of all, to prevent infection – this is very important. At the same time, to make sure that testing is available, and treatment and care where needed. To achieve all this, we need to raise awareness, and this is a very important factor; this is something where we are lagging behind – I will come back to that in a minute. But also the social stigma. This is one of our major concerns, and in a way this works as a vicious circle, because the social stigma prevents people from wanting to test themselves and learning whether they have been infected, and therefore, they could infect others. They do not seek treatment and do not get tested, with all the negative effects. This is more worrying among young people, and this is our main concern and target.

Our studies and polls show that, among young people, there really is a lack of knowledge – one could say there is ignorance when it comes to these health threats. So it is important to show to them in a balanced way, in a way that presents information and on the one hand does not create panic but on the other hand does not lead to complacency, that it is a serious disease; there is no cure for it, but they can protect themselves – and they can be shown how to do that – and at the same time that they should not be afraid of fellow citizens who have the infection, who have the disease.

We have seen two extremes from the Eurobarometer. Some young people think that there is nothing to worry about: you take some antibiotics and it goes away. On the other hand, just by touching infected people or even sharing a glass with them or through a kiss one can catch the disease. So we see two extreme views regarding this health threat, and neither deals effectively with our aim, which is to control the spread and further infections.

World AIDS Day is an important day and gives us an opportunity to discuss and raise awareness; but we should not limit ourselves to this one day, and that is why I am happy that, within the European Union at least, we will be discussing these issues continuously. But when it comes to young people, we have to remind ourselves that we had very active, very effective, very aggressive campaigns in the 1980s which managed to reach the goal of raising awareness, but then we stopped and we forgot that a young generation, a new generation of young people became sexually active after the end of those campaigns. In fact, some of them were born just before the end of those campaigns, and they did not benefit from those awareness-raising initiatives that were taking place then, and that is why we have the results I have just mentioned. We know that, through simple messages, simple methods, role models, celebrities, opinion leaders, giving a good example and explaining the situation, we can achieve the awareness that we would like to achieve.

This year, our initiative was to propose to the health ministers of the European Union that we would all go simultaneously into schools and discuss these problems with young people on World AIDS day, to see what they know, tell them what we know, and have an exchange of views. We had a positive response: more than half the Member State Ministers followed that approach.

We went into schools – I also went – and it was an eye-opener: the debates and discussions with young people, understanding, first of all, what they know or do not know about this disease, and also some practical problems. They know, for example, that the use of condoms is the best protection, but at the same time, how can they get them? They are too embarrassed or they are worried or they are shy. So we see some practical effects that we never thought were problems, never thought we would have to face in Europe. But they are still there.

Also, because we want to talk to young people in language that they understand, the Commission this year took the initiative of producing a new TV spot addressing the prevention of HIV transmission. This was done through a competition among young people, and the best one chosen, the winning entry, was by a Polish student. We produced that, and it was broadcast by several TV channels and was also used in the school visits. This is an important strategy which we must follow: we have to talk to young people in the language they understand.

But, as I said earlier, the challenges arising from HIV and AIDS are present well beyond the European Union boundaries. It is true that, worldwide, there has been some good progress in terms of access to HIV-related services, especially low-middle-income countries. Now, about 95% of people infected with HIV live in those countries.

Thanks to an unprecedented increase in international funding in these countries, the number of people receiving treatment has considerably increased, from 100 000 in 2001 to 2.5 million people in 2007. These are impressive figures; nevertheless, more than 70% of people in need of ARV treatment in these countries do not receive it or do not have access to it. This shows that we still have a long way to go.

The European action is financed through a wide array of financial instruments both at national and global level, such as the global fund, for example. There are also other financing mechanisms through public private partnerships. Progress has been achieved through these joint efforts with the international community, but we still have a long way to go, and this requires strong cooperation among the European institutions.

As I said at the beginning, our principal goal is to bring the number of new HIV infections down and work towards the best possible solutions in terms of support, treatment and care for those who are already living with HIV/AIDS. I therefore want to emphasis this once again: fighting the stigma – the social exclusion, the discrimination of the disease and people suffering from it or being affected by it – is very important and unless we do that we will never be able to control the situation. To do that, we need to raise awareness campaigns and increase them.

This is why the motto of the European Commission in this action against AIDS is ‘Remember me’, because it is a forgotten disease at all levels, or at least it has become one. We will now bring it back to the forefront; but it is not just for the citizens, to remind them of the existence of this disease, but also for the decision-makers, to make sure that they put it back at the top of the political agenda and take all the necessary actions. In this respect I am counting – and I know I have it – on the support of the European Parliament.

  John Bowis, on behalf of the PPE-DE Group. – Mr President, there is so much to be done. Let me start with what the Commissioner really highlighted in his speech, which is the effect on children, because one of the campaigns that is running this year, of course, is Stop Aids in Children. We know that every minute of every day a child is born with HIV; we know that 2.3 million children are living in our world with HIV; that only one in 10 who needs anti-retroviral treatment receives it; in the absence of treatment we know that an estimated one third of infants die in their first year and half die by their second birthday; we know that 15.2 million children under the age of 18 have lost one or both parents to AIDS; and we know that by 2010, that magical year, more than 20 million children will have been orphaned by AIDS.

That is the children's story, that is the challenge regarding children, but of course it is an adult story as well. We know the numbers that we have in our various countries for people being diagnosed, for people living with HIV: all on the up, and the frightening statistic that one in three people do not know they are infected.

That is the challenge, but there are specific challenges I think we should highlight this year, and the Commissioner has hinted at some of them. The level of basic knowledge has actually been going down in the last five years: the public is less aware than it was. Myths and misunderstandings have been growing. One in five people do not know that HIV can be transmitted through sex without a condom. Fewer than half of all sexually active people always use a condom with a new sexual partner.

We know that the number of people diagnosed has trebled since 1997; we know that risk-taking sexual behaviour is on the increase; we know that a quarter of all HIV-related deaths are due to late diagnosis, and a third are preventable. And, specifically, we know that failed asylum seekers living with HIV are too often not eligible for free HIV treatment and so cannot afford lifesaving care, and can go on and infect others. We also know that the rate of HIV among male prisoners is 15 times higher than among the general population.

All those things we know, along with the knowledge we have of the hopeful signs, of research. Recently in Rwanda I saw for myself the research, the ongoing clinical trials and the need for trials in Africa for vaccines for Africans.

But all these things need that urgency, and 2010 is the target year; 2010 is nearly with us. 2010, Commissioner: you and I come to the end of our term of office. I want us not to hide behind that fact and leave it to our successors. I want us to say, in 2009, when you and I may be leaving office, at least we have fulfilled this promise.

  Jan Marinus Wiersma, namens de PSE-Fractie. – Voorzitter, ik wil mijn waardering uitspreken voor de inzet van de Commissie, zoals net uiteengezet door de commissaris. Ik onderstreep vandaag het belang van Wereldaidsdag en van de gezamenlijke verantwoordelijkheid om tegen aids te vechten. Want wereldwijd voltrekt zich een ramp, een ramp die niet de aandacht krijgt die zij verdient.

Om die reden is mijn fractie verheugd over het feit dat we vandaag toch dit debat hebben hier in Straatsburg. De cijfers spreken voor zich. Er zijn wereldwijd 33 miljoen mensen die aan aids lijden of besmet zijn en in totaal zijn wel 25 miljoen mensen in de wereld aan aids overleden.

Toch lijkt de ziekte voor veel mensen niet te bestaan. Omdat aids wordt geassocieerd met seks, praten velen liever niet over dit onderwerp. En dat maakt het moeilijk - de commissaris zei het al - om mensen voor te lichten. De huidige generatie jongeren betaalt daar een hoge prijs voor. De helft van alle nieuwe HIV-infecties betreft namelijk mensen jonger dan 25 jaar. Terwijl ik hier spreek zijn er zes jongeren met een HIV-besmetting bijgekomen en drie kinderen gestorven aan aids. We spreken hier over een generatie die een wereld zonder aids niet heeft gekend.

De ramp beperkt zich niet alleen tot Afrika. De afgelopen zes jaar is het aantal HIV-besmettingen in Europa en Centraal-Azië verdubbeld van 1,25 naar 2,4 miljoen mensen. Het is de hoogste tijd dat de Europese Unie actie onderneemt. Deze vreselijke ziekte, die het leven van miljoenen gezinnen ter wereld ontwricht, is te voorkomen. Aids is te bestrijden door goede voorlichting, door een betere verspreiding van condooms en door betaalbare medicijnen.

De commissaris heeft er terecht op gewezen dat we hebben laten gebeuren dat aids een vergeten ziekte is geworden, met name op ons eigen continent. De huidige Europese jongeren hebben inderdaad de grote publieke voorlichtingsacties van de jaren '90 niet meegemaakt. We moeten daadkrachtig optreden, willen we voorkomen dat het hier echt uit de hand loopt.

Daarom, deels symbolisch en deels omdat we dat echt een belangrijke stap vinden, is mijn fractie vorige maand een campagne gestart om het belastingtarief op condooms te verlagen naar 5% in de hele Europese Unie. Het feit dat de BTW op condooms zo uiteenloopt - met in sommige landen zelfs een tarief van 25% -, toont aan dat wij in Europa geen gemeenschappelijke aanpak voor een gemeenschappelijk probleem hebben, althans daar te weinig aan doen.

Het Portugees voorzitterschap heeft onze actie van harte ondersteund en we verwachten ook een positieve houding van commissaris Kovács, wanneer hij eind volgend jaar het Europese BTW-stelsel ter discussie stelt.

  Holger Krahmer, im Namen der ALDE-Fraktion. – Herr Präsident, Herr Kommissar, verehrte Kollegen! „Ich bin dir treu!“ habe ich vor kurzem gelesen. „Ich bin dir treu für immer – Dein Aids.“ Das war die Aufschrift auf Plakaten zum Welt- Aids -Tag vor knapp zwei Wochen. Die Botschaft heißt: Aids ist behandelbar, aber eben nicht heilbar. Viele Menschen, vor allem jüngere, verlieren das aus den Augen oder wollen es nicht mehr sehen. Die Infektionszahlen, auf die bereits hingewiesen wurde, sprechen für sich. Aufklärung ist das einzige Mittel, um HIV und Aids zu verhindern, und ich bin froh, dass sich die Kommission dieses Ziel auf die Fahnen schreibt.

Aber Aufklärung darf sich nicht in Plakatkampagnen oder Ministerbesuchen in Schulen erschöpfen. So etwas bringt kurze und vielleicht auch mediale Aufmerksamkeit, aber Verhaltensänderungen, zumal bei jungen Menschen, sind damit nicht zu erreichen.

Aids und HIV waren einmal gut für echte Gruselgeschichten in Zeitungen. Viele waren unsicher und hatten Angst davor, weil niemand wusste, wie gefährlich das Virus wirklich ist. Ich wünsche mir diese Zeit nicht zurück, aber mit Gewöhnung an das Thema und besser verträglichen Therapien erregt das Problem heute nicht mehr automatisch die gleiche Aufmerksamkeit wie früher.

Viele Menschen haben sich an diese Botschaften gewöhnt, manche haben sie sogar satt. Das ist irrational, aber real. Aufklärung muss sich diesen geänderten Bedingungen anpassen. Aufklärung muss aktiv um Aufmerksamkeit werben, muss differenzierte Zielgruppen in deren Sprache und mit individuellen Botschaften ansprechen. Wir müssen vor allem die jungen Leute, die HIV als ein vernachlässigbares Risiko missverstehen, geistig dort abholen, wo sie sind, und sie dazu bringen, sich mit den Folgen der Infektion auseinanderzusetzen.

Viele Menschen tun das nach wie vor, sie setzen sich mit den Folgen auseinander, aber leider zu spät, nämlich dann, wenn ihnen ein Arzt oder ein Sozialarbeiter ein positives Testergebnis mitgeteilt hat. Dann ist die Krankheit, die bis dahin so abstrakt daherkam und weit weg erschien, auf einmal ganz real. Nur wenn wir es schaffen, Menschen zur Auseinandersetzung mit dem Thema HIV zu bringen, bevor sie es nicht mehr vermeiden können, dann ist etwas gewonnen.

Dafür ist langfristige und geduldige Arbeit nötig. Mit Angeboten und Projekten, die auf Zielgruppen zugeschnitten sind, je differenzierter und plastischer, desto besser. Die organisierten Aids -Hilfe-Vereine, z. B. in Deutschland, können hier nach wie vor eine wichtige Rolle spielen, wenn sie sich dieser veränderten Herausforderung stellen. Leider passiert das nicht überall.

Wer heute HIV-positiv ist, hat zumindest in Westeuropa gute Chancen auf ein langes Leben. In anderen Gegenden, z. B. in Afrika, ist das anders. Ausruhen sollten wir uns auf dieser komfortablen Situation trotzdem nicht.

  Vittorio Agnoletto, a nome del gruppo GUE/NGL. – Signor Presidente, onorevoli colleghi, sono un medico che da vent'anni lavora sull'AIDS e devo dire che, francamente, mi sarei aspettato dalla Commissione delle proposte molto più precise e pragmatiche. Nell'Unione europea la trasmissione avviene primo, per via sessuale. Allora, per essere molto precisi:

1) La Commissione spinge tutti gli Stati a organizzare i corsi di informazione sessuale all'interno delle scuole?

2) Spinge gli Stati a una calmierizzazione del costo del profilattico, che attualmente è l'unico strumento che può bloccare la trasmissione sessuale?

In Europa, il secondo livello di trasmissione è per via endovenosa, soprattutto per coloro che fanno uso di droghe. Allora, cosa fa la Commissione per spingere gli Stati ad applicare strategie di riduzione del danno, che sono le uniche che possono ridurre la trasmissione per via endovenosa per coloro che non riescono, non possono o non vogliono smettere di assumere sostanze?

Per quanto riguarda il resto del mondo, io mi sarei aspettato che la Commissione venisse qui e ci dicesse: dopo otto mesi di braccio di ferro con il Parlamento, prendiamo atto che il Parlamento ha votato la modifica dell'articolo 6 dei TRIPS, pur dichiarando che non avrebbe portato a nessuna modifica, ma su un impegno della Commissione a battersi per modificare le regole del WTO. Attualmente le regole TRIPS garantiscono per vent'anni il brevetto alle multinazionali con il risultato che in Africa i farmaci non arrivano. Di tutto questo non ho sentito assolutamente nulla! Se non si cambiano queste regole, per il resto parlare dell'Africa è fare solo e unicamente parole!

E da ultimo, ma possibile che mentre tutti parlano di lotta all'AIDS, voi avete un Commissario Mandelson che scrive le lettere al governo tailandese dicendo di non fare delle leggi che permettono di distribuire i generici e andando a sponsorizzare nelle sue lettere aziende, con nomi e cognomi, come la Sanofi-Avensis! Ma io credo che su questo la Commissione qualcosa dovrebbe aver da dire!

  Françoise Grossetête (PPE-DE). – Monsieur le Président, oui, le sida fait trop de victimes. Il en a fait beaucoup trop, il en fait encore et il en fera encore beaucoup. Malheureusement, beaucoup d'enfants seront contaminés avant la naissance. Les chiffres sont alarmants, on les a cités et je ne reviens pas dessus.

Malheureusement, le sida ne cesse de s'accroître dans les États membres de l'Union européenne mais aussi dans les pays tiers et pour combattre cette nouvelle vague de l'épidémie, il est indispensable de renforcer la prévention, les traitements, les soins, ainsi que l'aide, et grâce à des partenariats, lesquels sont absolument indispensables. Parallèlement à la prévention, il faut faciliter l'accès à l'information, faciliter l'accès aux conseils, aux traitements, aux services sociaux. Il faut atténuer l'impact négatif de cette maladie, parce qu'il s'agit encore, malheureusement, d'une maladie tabou dont on n'ose pas parler librement. Donc, pour y parvenir, il importe de mobiliser les ressources et la recherche, de coordonner les efforts, de financer des projets spécifiques. On ne pourra contribuer de manière significative et durable à enrayer cette épidémie que si l'ensemble des acteurs œuvrent de concert à la mise en place d'un partenariat efficace.

Ce qui est frappant, c'est que les jeunes Européens d'aujourd'hui n'ont pas suivi les campagnes de prévention efficace que l'on avait eues dans les années 1980. Les sociétés européennes doivent prendre leurs responsabilités, apporter aux jeunes les informations indispensables sur le virus et le sida. Les dernières enquêtes d'opinion montrent en effet chez les jeunes une méconnaissance stupéfiante de la maladie. Cinquante-quatre pour cent des jeunes des anciens États membres de l'Union européenne pensent que l'on peut contracter le HIV en buvant dans le même verre qu'une personne contaminée. Cela souligne la nécessité de renforcer leur sensibilisation, d'investir dans la prévention et l'information sur l'usage du préservatif. Et à quel coût, ce préservatif? Cela montre également que nous ne devons pas nous arrêter en chemin, oublier cette vieille maladie. Nous devons avoir les bons messages de sensibilisation. Des messages sans doute mieux adaptés. On fait des efforts actuellement. Nous devons diffuser des messages plus modernes qui permettent de vraiment toucher les jeunes. Récemment encore, pour des raisons essentiellement d'ordre éthique, le conseil et le dépistage du VIH se faisaient, avant tout, à l'initiative du patient. Avec un peu de recul, on peut constater aujourd'hui que cette méthode s'est heurtée, d'une part, à la faible disponibilité des services et, d'autre part, à la peur de la stigmatisation et de la discrimination. Dans les pays pauvres, le caractère volontaire du dépistage représente un obstacle sérieux à la lutte contre la pandémie. Quelle est la réelle capacité de patients démunis, peu instruits, à formuler un consentement éclairé? Comment une personne qui n'a jamais entendu parler du virus, pourrait-elle donner ce consentement-là?

Enfin, quel est l'intérêt pour un individu de se faire dépister quand il vit dans un pays qui n'a pas de protection sociale? Selon des enquêtes récentes en Afrique subsaharienne, seulement 12% des hommes et 10% des femmes ont eu un test de dépistage et reçu leurs résultats. Il ne faut pas baisser la garde car le danger est toujours là!

  Pierre Schapira (PSE). – Monsieur le Président, chers collègues, le sida reste l'un des fléaux du XXIe siècle malgré la mobilisation exceptionnelle de la communauté internationale depuis vingt ans même si, quelquefois, la garde a été baissée.

Je tiens à rappeler que parmi la liste des objectifs du Millénaire pour le développement, adoptée en septembre 2000 à l'ONU, le septième point consistait à stopper, d'ici à 2015, la propagation du sida et qu'à cette date, les tendances actuelles aient commencé à s'inverser. Or, la situation actuelle des pays en développement, et en particulier de l'Afrique, où le nombre de personnes décédant du sida a continué d'augmenter, impose que nous redoublions d'efforts pour atteindre cet objectif.

À cet égard, l'intervention européenne peut s'orienter autour de plusieurs axes. Premièrement, le renforcement des coopérations, notamment avec les autorités locales du Sud, qui sont les seules à même de proposer des solutions pérennes pour l'accueil des malades, pour la prévention, pour la fourniture des médicaments, pour la mise en œuvre d'actions d'information et de prévention et pour la gestion globale des services de santé adaptés aux besoins des populations locales.

Deuxièmement, des solutions doivent être proposées pour faire face à la pénurie de personnel de santé dans les pays pauvres. L'Europe doit intervenir par des programmes concrets dotés de fonds nécessaires pour permettre à ces professionnels d'exercer leur métier, dans leur pays dans des conditions et dans des structures adéquates dotées de matériel et de médicaments essentiels.

Enfin, une action de long terme contre le sida est indissociable d'un engagement ferme pour faciliter l'accès à des médicaments abordables par les malades des pays en développement. À l'heure où de nombreux patients des pays du Sud ont déjà développé des résistances aux premières générations de traitements qu'ils ont reçus, il est indispensable de prévoir des mécanismes pour que les dernières thérapies soient disponibles dans la version générique dans ces pays pauvres. C'est pourquoi je me permets d'interpeler tout particulièrement la Commission sur les négociations en cours d'accords bilatéraux et régionaux, en particulier des APE, pour qu'elle n'y intègre aucune disposition susceptible de limiter la capacité des pays du Sud à user de toutes les flexibilités prévues par l'accord ADPIC et par la déclaration de Doha de 2001 afin de protéger leurs malades.

Je termine. La situation inacceptable de ces millions de personnes qui meurent chaque année du sida impose que l'Union européenne prenne ses responsabilités. Nous devons effectivement passer de la parole aux actes.

  Markos Kyprianou, Member of the Commission. Mr President, I shall be brief, because I understand we are under pressure of time.

I just wish to make three or four points. Firstly, this is a problem that affects the whole population and this is the message we try to convey. It is no longer a question of risk groups and that the rest of us need not worry: it is an issue for the general population – young people, women. We must raise awareness about this, and the political message has to go through as well.

In particular – because it was mentioned – on the issue of immigrants we take a particular approach. The Portuguese Presidency had the issues of health and immigration as a theme of its Presidency, and access to treatment, testing and treatment and healthcare of the immigrants – even undocumented ones – is an important aspect. This is something we are discussing not only for their protection and the human rights aspect of it, which, of course, is a priority, but also for the protection of society as a whole.

The issues that were raised, such as the possibility of the exchange of needles for drug-users, promoting condoms, sexual education in schools, the problems in prisons, are all part of our discussions with the Member States and the civil society. We have a think-tank where everybody is involved: they have discussions and exchange best practice and experiences. But, of course, within the European Union we realise that we do not have the competence: it is the responsibility of the Member States to implement these policies. Therefore, we raise the profile at a political level, we hold discussions at technical level but, at the end of the day, it the responsibility of the Member States to take specific initiatives.

On the other issues raised by Mr Agnoletto, I have taken note with great interest of the issue of TRIPS. I have noted that and also the effect it would have on access to medicine in developing countries and all the other issues he raised concerning dealing with countries outside Europe. I will raise them with my colleagues who are responsible for these particular areas and I will inform them of the points raised by the honourable Member.

Finally, when it comes to access to ARV within the European Union, initially – and then hopefully we can extend it to other areas – we are supporting very actively the initiative of the German Presidency after the Bremen Conference to achieve access to cheap and affordable ARV treatment for all patients and those who need it. We already have, if one can call it that, a first success story with Bulgaria. But, of course, we will pursue it in the Presidency, with the support of the Commission, and hopefully once the model is established we can extend this approach outside the European Union. We always have this as a target.

Once again, I should like to thank the Members for a very interesting debate and I have taken note of all the issues raised.

  President. The debate is closed.