in Germany

Social and health policies presently in force are based on an insurance system. Members as well as employers pay a contribution to health insurance and social security. Those who are not employed are either covered by social security or insured as family members, so that theoretically everybody should have access to health insurance and medical care. However, recently there have been some changes concerning people 55 years and over. Those who were self-employed and were not insured by the national health service during the past five years prior to completing age 55 can not demand to be insured by the national health service again. They have to rely on private insurance, but private insurance companies refuse to accept new members, if they are HIV-positive. For this reason HIV positive patients age 55 and over might find it difficult to get access to health insurance, if they did not have a private insurance prior to being HIV-positive or were ensured by the national health service. 

Apart from that there is another group in the German society which has only limited access to medical care -asylum seekers and refugees which fall under the so called "Asylbewerberleistungsgesetz", an act according to which people who are not granted asylum but are temporarily allowed to stay for humanitarian or other reasons are only entitled to reduced social security benefits. According to this legislation they are only entitled to medical care for acute diseases and diseases which might endanger their life or could lead to serious health problems if not treated immediately. Thus, HIV-patients will get treatment but they won´t get all the benefits people regularly living in Germany will get. HIV-patients who have to rely on social security are for instance entitled to additional benefits for a healthier, enriched diet, however, asylum seekers are usually refused these benefits on the grounds of their legal status.

The same applies to orthodontic treatment, psychotherapy and psychotherapeutic treatment of drug addicts. Another problem faced by migrants is that counselling services in foreign languages for patients in ambulant care or in hospital are hardly ever available. There is a lot of information material in foreign languages concerning the prevention of an HIV-infection or STD´s, but once people contracted it they will find it hard to get psychological support or professional advice in their mother tongue on questions concerning social security benefits, legal rights, pension rights, or any other questions concerning the HIV-infection and related problems. In spite of the fact that migrants account for approximately 20 per cent of the patient population, hardly any specialised counselling services for them are available, and as the German government constantly cuts back on its spending in social services and in the health sector improvements are very unlikely. 

AIDS-Policy Robert Koch Institute, Berlin Reported AIDS cases, AIDS case registry Since 1982 - the year that the first AIDS case was reported in Germany - information on AIDS cases has been collected at the national register at the AIDS Center of the Robert Koch Institute. Reporting of AIDS cases or deaths is not mandatory in Germany. Individual cases are reported voluntarily by clinicians using standardized case report forms. The reports contain information on sex, year of birth, region of residence, transmission route, AIDS defining diseases, date of diagnosis and antiretroviral treatment. Completeness of reporting is estimated to exceed 85% of all cases. HIV-infection: trends New infections continue to be mostly associated with homosexual contacts among men. The rate of new infections among I.V. drug users has been stable. There has been a continued slow increase in the number of infections transmitted by heterosexual contact. Among persons infected heterosexually, most were infected by a contact with a member of a primary risk group. Reports on chains of transmission among heterosexuals have been rare. In the states of the former East Germany, the number of HIV infections has continued to increase, however, at a low level. 

AIDS: trends As a consequence of the recent considerable improvements in therapy for HIV/AIDS, the time period between HIV infection and the onset of AIDS-defining disease has lenghtened. Thus, there has been, at least for the time being, a marked reduction in the number of newly diagnosed persons with AIDS (approximately 500 were expected for 2000). As a result of longer survival periods, the number of patients with advanced immunodeficiency requiring care will continue to increase. Furthermore, the reintegration of patients with HIV and AIDS in the work process has become another up-to-date topic.



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