HIV / AIDS CASES ACCORDING TO THE YEAR OF DIAGNOSIS AND SELECTED ___ CHA ,__ CTERISTICS OF CASES ____ GISTERED IN THE FEDE -- TION OF BOSNIA AND HE �EGOVINA 1991-2004 }

In the period between 1991-2004, in the Federation of Bosnia and Herzegovina there '"'ere altogether 59 registered HIV positive persons, out of those 43 were clinically diagnosed with AIDS. Gender-wise, 83% of the infected were male, and 17% female. The age groups with the highest risk of being infected with HIV are 20-24 and 40-44. The most frequent way of in­ fection is heterosexual intercourse (46%), followed by intravenous drug use (31%), whilst 23% of the registered were infected through homosexual intercourse. Out of 43 diagnosed AIDS cases, 42% are heterosexuals, 35% intravenous drug users, whilst 21 % are homosexual or bi­ sexual. Out of the total number of registered HIV/ AIDS cases in the Federation of Bosnia and Herzegovina, thirty two died during the mentioned period (54%).


INTRODUCTION
AIDS -Acquired Immune Deficiency Syndrome caused by HIV virus.An AIDS case is a person who has received an AIDS diagnosis.In Bosnia and Herze govina, lil,e other countries members of WHO, AIDS is diagnosed if a person was tested positive for HIV, and has one or more of the clinical illnesses, or indicative diseases that characterize AIDS ( opportunistic infec tions, PCP-pneumonia, tuberculosis, ca11cer such as I<aposi sarcoma etc. (even when the CD4 T-lympho cyte count is above 200 cells mm3;1).HIV is transmit ted via sexual activity, penetration and prenatal-vertical way (2).An increase in number of the HIV infected is a result of risky behaviour within the population and only well-organised health services, with an organised HIV infection monitoring system, can provide effective prevention to those not infected, and also significantly reduce the possibility of transmission among those in fected with HIV.Centre for disease control and preven tion ( CDC) points-out that 51 % of all HIV infections amo11g adolescents and adults occur via sexual activity (30% homosexual-MSM, and 11% heterosexual contact in male cases (3).Among the HIV transmission risk groups intravenous drug users are at the second place.Epidemiological studies show that percentage of in travenous drug users among the HIV infected stands between 24 and 35%, depending on a country (4).How ever, countries with developed programmes of HIV pre vention among IDUs recently record a decrease in the rate of HIV infections in this risk group category.Dur ing 1994-2000 in the USA, !DU-related HIV diagnoses a1:-1ong persons aged 13-19 years, and 30-39 years fell by i 9%.ID Us acquire HIV through sharing drug-injec tio!1 equipment with HIV infected persons followed by other risky behaviour, such as having unprotected sex (s).One of the most substantiated studies on HIV trans mission risk conducted in 25 American states between 1999 and 2000, showed that 23% of virus carriers were infected through needle and syringe sharing, and in 8% of the infected the risk of infection was co11nected to unprotected sexual activity with HIV infected IDUs (6).

SOURCES AND METHODS
This study addresses trend of HIV/ AIDS disease in the Federation of Bosnia and Herzegovina in the period between 1991 and 2004.HIV transmission characteris tics for each registered HIV/ AIDS case are determined on the basis of descriptive epidemiological analysis.The analysis is based on WHO recommended stan dard criteria for defining an HIV positive or AIDS case.

RESULTS
In the period 1991-2004, in the Federation of Bos nia and Herzegovina, there were 59 registered HIV positive cases, with 43 displaying a clinical picture of AIDS.Of the infected, 49 (83%) were male, and 10 (17%) were female.The median age was 38.3, ranging from 19 to 66 years (Graph 1).In the mentioned peri od, out of a total of 59 HIV/ AIDS cases, 32 died (54%).

WAYS OF HIV TRANSMISSION AMONG THE REGISTERED HIV/ AIDS CASES IN THE FED ERATION OF BOSNIA AND HERZEGOVINA
Sexual transmission is currently the most important route.Drug injection was the second factor that was strongly associated with HIV infection.Out of all reg istered HIV/ AIDS cases in the abovementioned pe riod, classified by the mode of HIV transmission, the largest number acquired HIV by sexual activity (62%), i.e. heterosexual 42% and homosexual 20% (Graph 2).In the HIV/ AIDS infected/ ailing structure, intravenous drug users are second when it comes to the frequency of developing symptoms.It is among this population that the developed clinical AIDS manifests itself most fre quently -compared to the rate of HIV infection (83%).This may be due to late diagnosis, weakened immune system, but also multiple risk factors (needle sharing, un protected sex, socio-economic conditions, etc. (Graph 3).Analyzing the trend of the three main HIV transmission modes in the past 14 years in the Federation of Bosnia and Herzegovina, an increase in heterosexual cases is evident.Out of all HIV positive cases, 46% claim hetero sexual activity as the mode of transmission ( Graph 4).Intravenous drug users -as HIV transmission category that make 29% of all registered HIV/ AIDS cases -also show a positive trend in the Federation of Bosnia and Herzegovina, in the period 1991-2004.Currently, about 12% of all cases of HIV infection in the Federation Bos-  -+------),,c----+---+--,___--+-----+-------ir,,C.------i.994 1995 1996 1997 1998 1999  Homosexual/bisexual HIV transmission catego ry, in the analysed 14-year period in the Federa tion Bosnia and Herzegovina, shows rather steady trend.The men who have sex with men, may be at increased risk of spreading HIV if thftY e11gage in risky sexual practices.But use of needles and syringes is not only drug related risk factor for HIV ( Graph 6).

AGE/SEX CHARACTERISTICS OF THE HIV/ AIDS INFECTED/ AILING IN THE FEDERATION BOSNIA AND HERZEGOVINA 1991-2004
There is a slightly higher incidence of HIV in the younger population, aged 25-29, but also among those aged 40-44, notably males ( Graph 7).The relation between age and sex and HIV infection may reflect the cumulative effect of risky behaviour ( Graph 8).In the post-war period, an increase in women diagnosed with HIV is evident (prostitution, trafficking, (Graph 9.).Most of HIV/ AIDS registered cases are imported (53%), whilst 24% of the infections are acquired locally.This concurs with characterisation of the population of Fed eration Bosnia and Herzegovina as unstable and mobile.In the USA, HIV tests is a compulsory part of ev ery in-hospital emergency medical treatment when the patient is received into the ward, with the aim of better monitoring of HIV prevalence (7,8,9).HIV screening of general population, and not just the risk categories, is beco1ning an evermore important monitoring mea sure in primary medical care (10,11,12).Model based cost effectiveness analyses of routine HIV screening in primary health care in the USA and inpatient settings have projected cost effectiveness ratio of $22 000-$ 36 700 per quality-adjusted life year gained, which is more cost effective than screening for colon cancer (13,14,15).New strategies for change are called for, in cluding HIV testing as a routine part of medical care to increase the number of infected persons who are aware of their positive serostatus (16,17).The diagnosis of HIV in HIV infected persons is a priority in the USA (18,19).Routine voluntary HIV screening programs in emergency care wards, especially in areas of high HIV prevalence, can be successful at diagnosing persons with HIV and linking them to appropriate HIV care ( 20) ..

4 'FGRAPH 7 .
BOSNL.W JOURNAL OF BASIC MEDICAL SCIENCES 2006; 6 (2): 42-46 JELEN A RAVLIJA ET AL.: HIV/ AIDS CASES ACCORDING TO THE YEAR OF DIAGNOS1S AND SELECTED CHARACTERISTfCS OF CASES REGlSTERED 1N THE FEDERATlON OF BOSNIA AND HERZEGOVINA 1991-2004 -, :: ..... --. .a .s --a•• -,.... ..,_ .,. _ ] HIV/AIDS in FB&H(l991-2004), by sex/a g e �-"'---_ ..._ _ ...._,____,.I r .I 1991 1992 1993 1994 1995 1996 1997 1998 l999 2000 2001 2002 2003 2004 Years GRAPH 8. HN/AIDS in FB&H(l991-2004),by sex • Male Female A RAVLIJA ET AL.: HfV / AlDS CASES ACCORDING TO THE YEAR OF DIAGNOSIS AN.D SELECTED CHARACTERISTICS OF CASES REGJSTERED IN THE FEDERATION OF BOSNIA AND HERZEGOVINA 1991-2004 0 Other, unknow... 1 (10%) Source: Registered HJV/ AIDS cases, PHJ Federation Bosnia and Herzegovina, EuroHIV GRAPH 2. HIV/AIDS, FB&H (1991-2004) by mode of transmissionJELEN HIV/ AIDS statistics does not reflect the actual state of the infection rate not only because of low rate of regis tration, but also because a large part of the population is not aware of its HIV status.Strictly speaking, the real HIV prevalence state can only be established by means H1Vinfection, FB&H(1991-2004), by ori g in of voluntary blood testing not only of the population engaged in risky behaviour ( which is already being conducted in Federation of Bosnia and Herzegovina by means of VCCT centre for voluntary and confiden tial advice and testing) but of general population too.Therefore, new strategies in HIV monitoring are being implemented with the aim of larger reach with the HIV screening activities not only among those requesting medical care, but during other medical interventions too.