"A person with HIV can lead a completely normal life today," says Jiří Pavlát, chairman of the Czech AIDS Aid Society. Why doesn't the public still believe this?
HIV is now one of the diseases that medicine can treat very effectively, but not yet cure completely. Yet many myths, fears and social stigmas persist around it, affecting the lives of thousands of people. It is at the intersection of health care, social services and education that the Czech AIDS Aid Society, one of the key organisations in the field of prevention and support for people living with HIV in the Czech Republic, has been working for more than three decades.
Its most visible project is the House of Light, which in addition to shelter and social facilities also offers free anonymous testing, professional counselling and community programmes. The organisation also runs health services registered with health insurance companies, is dedicated to the prevention, testing and treatment of sexually transmitted infections and has long advocated for the rights of patients living with HIV. In this way, it has gradually built a comprehensive support system that links health, social and community care.
Today, the association is headed by Jiří Pavlát, who has shaped the organisation for a long time - he served as its director between 2013 and 2023 and currently holds the role of chairman and director in charge. He originally came to the issue through European projects he prepared for the organisation during his time at the Government Office. Gradually, he became one of the key figures in Czech HIV prevention and care.
In the interview, he talks openly not only about the development of the epidemic in the Czech Republic, but also about the availability of modern treatment, prevention, stigmatisation and why, despite medical progress, the number of new cases has not been reduced in the long term.
In 2025, 293 new HIV cases emerged in the Czech Republic. The number of patients is therefore rising slightly every year. Where do you see the reasons for this increase?
First of all, this figure includes both new cases and cases diagnosed in other countries whose carriers have subsequently moved to the Czech Republic. It is therefore the number of people who have started treatment in the Czech Republic. The number of genuinely domestic cases is 227.
The migration wave of three years ago is playing a role, but it is also evident that the infection is spreading in the heterosexual population. Another factor is the long-term underestimation of prevention and testing by the state. It is the combination of these influences that explains why the numbers in the Czech Republic are currently neither stagnating nor declining.
So what do you think the state should do more of? Should it fund more education and prevention or, for example, testing?
It is a combination of all these measures. In the last 15 to 20 years, the state has not come up with any systematic campaign focused on this issue. Activity is basically limited to European Testing Week, which is commemorated in the media in the autumn before 1 December. However, the overall approach of the state is also crucial. In Western countries, such as the UK, the highest medical authorities are involved in the communication, openly supporting PrEP (a modern way to effectively protect oneself from HIV, editor's note) and safe sexual behaviour. In the Czech Republic, public health authorities tend to distance themselves from these issues. As long as the issue remains marginalised and burdened with stigma, there will be no improvement.
Another factor is the availability of this preventive treatment. In neighbouring countries such as Germany and Slovakia, PrEP is covered by health insurance, whereas in the Czech Republic it represents a financial barrier that limits its wider use. However, it is not just PrEP. For example, in France and many other Western and Nordic countries, post-exposure prophylaxis (PEP) is also commonly available in emergency rooms. In combination with PrEP, it can prevent the development of infection in a high-risk situation, such as condom rupture.
You mentioned that the number of new cases has been increasing in recent years, even in the heterosexual population. What about men who have sex with men? Are they still one of the groups most at risk?
It's twofold. The first has to do with the fact that this is a smaller population. Figuratively speaking, it's not an ocean, it's a pond. When you're looking for a partner, you're more likely to come into contact with someone who has the infection. In the wider heterosexual population, the pool of potential partners is much larger.
The second level relates to the form of sexual intercourse itself. Anal sex is significantly more risky than vaginal sex in terms of transmission of infection. The vaginal mucosa is naturally better adapted to sexual intercourse, whereas anal intercourse is more likely to cause minor injuries. It is through these that infection most often enters the body. Age can also play a role, as the quality of the mucous membrane gradually changes and the susceptibility to damage increases.
If you compare the period around 2012, when you started doing this work, and now, how much has the situation around HIV changed?
Fundamentally. Even back then, there were signs that modern treatments would be very effective, but there was hardly any talk about it in the public space and everything was more in the validation phase. Public awareness was much lower than it is today. When we tried to push our initiatives in official places, we often encountered the fact that we were perceived as a small organisation operating mainly in Prague, which did not provide services across the board and focused only on shelters, prevention or talks.
This was one of the impulses to expand the organisation and its activities - both in the social, patient and health areas. Gradually, we expanded into the regions and today we have several offices all over the country. We have also built up health services registered with health insurance companies so that we can provide them within the public system. We no longer focus only on HIV, but also on other infections, because the system at that time was very rigid and rather discouraged people.
Since then, the legislation has also changed. Today there is a reporting obligation for HIV-positive people to doctors, but previously it also applied to social services. Gradually, some of these measures have been changed. One major difference is that PrEP did not exist then.
The treatment then was probably not as effective as it is today. In fact, nowadays, if a person gets treatment early, he or she can lead a relatively normal life. Is that right?
Yes, he can lead a perfectly normal life today. Modern treatment works by reducing the level of the virus in the blood to undetectable levels. This virtually eliminates the complications associated with HIV. Other health problems or co-morbidities may occur, but the underlying mechanism - the damage to the immune system by the virus - is suppressed by treatment.
The principle of 'undetectable = non-transmissible' also applies. Scientific studies have confirmed that with an undetectable viral load, there is no transmission of infection, which has fundamentally changed the way we look at HIV and the lives of people living with it. PrEP also began to be used around the world after 2012. In the Czech Republic, it began to be used around 2015. Initially, it was imported from abroad and through our organisation, which also sought to change the approach of state institutions. Today, PrEP is available, but not yet fully covered by health insurance.
Could you explain to readers what the term PrEP means and who should consider it?
Anyone who does not have a steady partner and has frequent sex without a condom should consider using it. Men who have sex with men should consider PrEP especially carefully.
PrEP stands for pre-exposure prophylaxis. Simply put, it is a preventive treatment in which a man takes one pill a day to protect himself from contracting HIV. However, it does not protect against other sexually transmitted infections such as gonorrhoea, chlamydia or syphilis.
It is often compared to hormonal contraception. It protects against pregnancy but not against STDs. Therefore, condom use is still recommended. PrEP thus provides an additional layer of protection, especially in situations where the condom fails or is not used correctly.
How does PrEP dosing work and are there any risks or side effects associated with it?
Basic information can be found, for example, on the website chciprep.cz or on the Instagram profile @prepni_se, where the principle is explained in detail.
In the Czech Republic, the approved daily dosage is one tablet per day, which ensures a stable level of the drug and reliable protection. Abroad, the so called bump use before risky contact is also used, which some people practice in the Czech Republic. However, the problem is that the dosage may not always be followed correctly or on time. In addition, sexual activities often cannot be planned precisely and therefore the dose may be missed.
For this reason, regular daily use is recommended in the Czech Republic. At the same time, PrEP is not immediately available. An interested person must first undergo an examination at a PrEP centre, where a doctor will perform a series of tests to assess the health status. The drug is then prescribed for a trial period, usually one to two months, so that any side effects can be evaluated.
These may include, for example, headaches or digestive problems. If these occur, the medication can be adjusted as there are multiple combinations of drugs. In the Czech environment, however, the main problem remains the availability, price and supply of these products, which is not yet ideal.
The injectable form of PrEP is also often discussed. In your opinion, can it fundamentally transform HIV prevention in the future?
Yes, it is an important topic. The injectable form of PrEP already exists abroad and works on the principle of administering one dose every few months. Compared to taking tablets every day, this greatly simplifies the whole prevention regime. The disadvantage so far is the very high price, which is in the tens of thousands of crowns, so that it is hundreds of thousands of crowns a year.
For some users, this can be a major advantage, as the need for daily medication is eliminated. This form is not yet available in the Czech Republic, but its introduction can be expected in the future.
In addition to PrEP, the term DoxyPEP is also sometimes mentioned. What is it actually?
DoxyPEP refers to the use of the antibiotic doxycycline after risky sexual contact to reduce the chance of contracting certain sexually transmitted infections (syphilis, chlamydia) The aim is to prevent infections from developing before they are fully developed.
However, it is important to stress that this is not protection against HIV. The effect is certainly not 100% and only applies to selected bacterial infections. According to studies to date, it is approximately between 30 and 50 per cent.
At the same time, there are concerns about the overuse of antibiotics and the associated risk of antibiotic resistance. Therefore, it is not a standard recommendation in the Czech Republic and DoxyPEP is only available for selected PrEP users.
Has the availability of PrEP and modern treatment changed people's sexual behaviour in any way?
Yes, very significantly. This trend is evident not only in the Czech Republic but also abroad. At a time when HIV infection was perceived as a serious and often fatal disease, the fear of infection was much stronger.
With the advent of modern treatments and the spread of information that a person with an undetectable viral load does not transmit the infection, the perception of HIV has fundamentally changed. For many people, it is no longer as strong an issue as it once was, and this is naturally reflected in sexual behaviour.
Some people are less worried and less likely to use a condom. At the same time, there are new prevention tools that were not available before, such as PrEP or PEP. Prevention has thus moved to a different level and relies on a wider range of options.
Do you still face a stigma around HIV?
Yes, the stigma still persists. It has changed, but it has not disappeared. People living with HIV continue to face rejection, misunderstanding and fear from those around them.
A fundamental problem is the lack of basic information. For example, many people still do not know that a person on treatment who has an undetectable viral load does not transmit the infection. The fears are thus often not based on real facts.
Stigma also has a significant impact on the psyche of people living with HIV. This is why, in addition to treatment itself, systematic work with the public and an emphasis on education are crucial.
What do you think would help reduce the stigma around HIV the most?
If the stigma around HIV is not reduced, people will continue to be afraid to get tested and the infection will continue to spread. Open communication and education is essential. People need to have access to accurate information and understand how HIV works and what the treatment options are today.
The media also has an important role to play in helping to spread the facts and dispel myths. If HIV is presented primarily through fear or sensationalism, stigma tends to be reinforced. Conversely, factual and clear communication can gradually help to change perceptions.
It is also important to involve people living with HIV themselves, who can share their own experiences. If the public can see that these people lead normal lives, work, have relationships and families, this helps to change social perceptions.
Particularly in the gay community, the phenomenon of chemsex is often mentioned today. How big a problem do you think it is?
It's not just a gay community issue, but also a heterosexual issue. Chemsex is a topic that has been intensely discussed in recent years. It refers to the use of specific drugs in the context of sexual activity, often in the context of extended encounters or parties.
These situations carry increased risks. There is more frequent partner swapping, and people are less protective or safer sex under the influence of addictive substances. In addition, some substances affect judgement and reduce the ability to assess risk.
At the same time, it is important to say that this is not a marginal phenomenon. We see this phenomenon quite often in our practice and we see how it can interfere significantly in people's lives.
In our organisation, we address this issue through the Chems Help project, which offers information, support and professional help to people who feel that their substance use is becoming a problem.
Do you find that people come for help specifically because of chemsex?
To be honest, rather less than we need to. People don't usually actively seek help themselves and often don't even acknowledge that their use is becoming a problem. So first contact is more likely to happen when problems start to have a significant impact on their lives - for example, at work, in relationships or on their mental health, or at the suggestion of others.
At the same time, it should be said that change in this area tends to be difficult and long-term. Complete cessation of use is not realistic for everyone, and even periods of restriction or abstinence are often interspersed with relapses.
Our aim is therefore not to moralise or set unrealistic expectations, but to offer a safe space for open communication and the search for an individual path. For some this means gradual reduction, for others it means striving for abstinence.
Our work also includes providing information about the risks and how to minimise them as much as possible.
How big a role does psychological support play for people living with HIV?
Very crucial. An HIV diagnosis is often psychologically challenging, especially in the first few months - there is shock, fear and uncertainty about the future.
Although we now know that with the right treatment a person can live a full life, the first reaction is often intense. This makes it all the more important that, in addition to medical care, psychological and social support is available - whether from professionals or from those close to the person, such as family, partners and colleagues. At the House of Light, we try to provide this support systematically. There are social workers, counsellors and community programmes to help people through difficult times.
Do people living with HIV still face discrimination and prejudice in society today?
Unfortunately, yes. Paradoxically, it often occurs in the health sector. Every year we deal with several cases where people living with HIV are denied health care even though the law does not allow it.
It is disturbing that such situations occur with health professionals who should have sufficient knowledge. Often these are patients who have a long undetectable viral load and are fully treated. While this principle is widely known in HIV centres, outside of them many health workers are not sufficiently aware of it, leading to unnecessary complications.
For example, we are currently handling the case of a client who wanted to start a new job. During the initial medical examination, he presented all the necessary documents, yet he encountered a problem and did not get the job. Even if he had, the work environment would clearly have been unsafe for him, because the assessing doctor failed in this case.
Do we have any hope that HIV will one day be completely curable?
There is hope. The history of medicine shows that major breakthroughs are possible. Just a few years ago, for example, hepatitis C was considered a disease with a very unfavourable prognosis, similar to HIV in the past. Treatments did exist, but they were difficult and not always successful. The disease could lead to severe liver damage and, in extreme cases, death. But then came a major breakthrough and today hepatitis C can be cured in most cases within eight to 12 weeks.
This shows that a similar shift may occur in the future for HIV, but the situation is more complex. So far, despite successful treatment, HIV has managed to hide in the body and we are not yet able to destroy it completely. Therefore, it is not yet possible to estimate when a breakthrough and a complete cure might occur.
If someone wants to get tested for HIV but is worried about it, what would you tell them?
I would advise them not to be afraid. A positive result can be a crucial step in protecting your own health. This is because it allows you to start treatment early, which is crucial for a long term quality and fulfilling life.
