Epid emio l og i c al s tud y AlDS in Zadar area 
K E Y 
WORDS 
AIDS, 
epidemiology, 
Zadararea, 
Croatia 
Epidemiowgic characteristics of AIDS in 
the Zadar area, Croat"ia 
M. Gveric, B. Dželalija, B. Petričic, A. Gveric and A. Medic 
ABSTRACT 
Data on AIDS patients in the Zadar area, Croatia are presented. Since the appearance of the first patient 
in 1990, to the end of 2000, there have been registered 18 patients; 15 of them were males and 3 women. 
It makes total morbidity of 10/100 000 inhabitants. 
It is significantly higher than morbidity level in whole Croatia, which amounts to 3.5/100 000 inhabitants. 
The number of new cases osciliated tram O to 5 annualiy. 
7 patients were heterosexuals, 5 of them were bisexuals, 3 homosexuals and 3 wives infected by their 
husbands. None of them was in risky groups of intravenous drug users or hemophiliac. 
Out of the total number, there were 8 (44,4%) sailors and two of them infected their wives. So, the total 
number of patients connected to this occupation amounts to 1 O (55,5%). Ali diseased sailors contracted 
the infection in overseas harbors tram prostitutes. 
Although the presented data show a lower intensity AIDS epidemic in the Zadar area compared to cer-
tain areas in Europe and worldwide, the incidence is higher than in other areas of Croatia. In view of the 
seriousness of this disease ali necessary measures are to be taken in order to prevent a further spread of 
the epidemic. 
Introduction 
After the first information on an unknown disease 
in 1981, the medica! science and the whole world soon 
realized that we were facing a very serious health prob-
lem. 
The epidemics of AIDS with a great number of in-
fected , diseased and deaths spread throughout the 
whole world , w ith terrifying consequences, especially 
in some countries of Sub-Saharan Africa, Caribbean, 
North America and South and Southeast Asia. In some 
of these countries , data about the number of HIV and 
AIDS cases are really dramatic. Globaily, 36.1 million 
people were living with HIV / AIDS at the end of 2000, 
and since the beginning of the epidemic, there have 
been 21.8 million AIDS deaths (1). 
A few years after the appearance of the disease, in 
1986, the first patient was registered in Croatia. 
Acta Dermatoven APA Vol 11, 2002, No 2 ------------------ 63 
AIDS in Zadar area Ep i c/ e m i o l o g i c a l s t u c/ y 
Table 1. AIDS patients in the Zadar area, Croatia According to estimated number of inhabitants of 
Year M F Total 
1990 1 o 1 
1991 3 o 3 
1992 o o o 
1993 2 1 3 
1994 3 o 3 
1995 1 o 1 
1996 1 o 1 
1997 o o o 
1998 3 2 5 
1999 o o o 
2000 1 o 1 
Total 15 3 18 (10/100 000) 
In this study we want to show some epidemiologic 
characteristics of AIDS in Zadar area, which is situated 
in the middle of Croatian coast. 
Material and methods 
We analyzed AIDS patients in whom the diagnosis 
was made at the General Hospital Zadar, in the period 
from 1990 to the end of 2000. Beside the clinical exami-
nation, in ali patients laboratory tests were performed 
(ELISA Anti HIV 1 HIV 2, Asym test, Abbott). Diagnosis 
was confirmed afte1w ards by Western blot test in «Dr. 
Fran Mihaljevič „ Infectology Clinic, in Zagreb. 
Results 
During the 11-year period, 18 AIDS patients , 15 
(83.3%) males and 3 (16.7%) females we registered in 
General Hospital Zadar. Table 1. 
During the same period, 57 642 tests were made, 
which were positive in 21 (0 .036%) persons. Ali patients 
were adults, 24 to 56 years old. 
Table 2. Risky groups of AIDS patients in Zadar 
area 
n % 
Heterosexuals 7 38,9 
Homosexuals 3 16,7 
Bisexuals 5 27,7 
Wives of diseased husbands 3 16,7 
Total 18 100,0 
64 
Zadar area, total morbidity is 10/ 100,000. During the 
mentioned period, the number of AIDS patients was 
from O to 5 cases annually that is 1.63 patients on an 
average. It makes annual incidence of 0.9/ 100,000. 
Out of the total number, there were 7 heterosexu-
als, 3 homosexuals and 5 bisexuals, while 3 female per-
sons were infected by their husbands. Table 2. 
Our patients had different professions, but the ma-
jority, that is 8 of them, were sailors. Two female pa-
tients were sailors' wives and contracted the disease 
from their husbands. 
By the end of 2000, 10 (55.5%) patients died and 8 
(44.5%)were stillliving. The prevalence was 4.4/100,000. 
Discussion 
Although the number of newly infected HIV cases 
in certain countries of the world is becoming constant 
oris even on the decrease, as in the countries of West-
ern Europe, the epidemic stil! poses the most impor-
tant globa! health p roblem (1 ,2). 
The data presented show that there is a significantly 
lower frequency of AIDS in Zadar area compared to 
Europe and other parts of the world (1-3). According to 
<lata of Croatian Institute of Public Health, morbidity 
for w hole Croatia is even lower, and total morbidity by 
the end of 2000 was 3.5/100,000. 
The incidence in Croatia is about 0.4/ 100,000 annu-
ally C 4-6) . 
All our patients were of promiscuous behavior or 
homosexuals and bisexuals respectively. It is notice-
able that none of them belonged to risk groups, e.g. 
intravenous drug users or blood and blood products re-
cipients, as it is in the rest of Croatia, and elsewhere ( 4-7). 
This is very important because of the great number 
of drug users in Zadar area, w hich has, unfo1tunately 
become a critical problem in our count1y. 
According to their professions the majority of our 
patients were sailors who contracted the infection in 
overseas harbors after having sexual contacts with pros-
titutes. Two of them infected their w ives, so the total 
number of diseased related to this profession is more 
rhan half (55.5%). It is evident that warnings and fear of 
AIDS as well as cany ing out of preventive measures 
have not been accepted by the general population. Sail-
ors should be best advised to use condoms and take 
additional precautions when having intercourse w ith 
prostitutes. 
Conclusions 
In conclusion, we can say that health authorities in 
our count1y were prepared to meet the AIDS epidemic 
Acta Dermatoven APA Vo l 11, 2002, No 2 
Epidemiological stu d y AIDS in Zadar area 
and undertook the necessa1y measures. These include 
education of ali classes of society, early cletection and 
observation of the diseased and infected, as well as of 
persons who had contact with them. Preventive mea-
sures among drug users , strict control of blood and 
bloocl products. Only volunteer blood donors from 
Croatia are accepted. Strict measures for prevention of 
infection are observed in ali health institutions. 
Hopefully, these measures as well as a rational be-
havior of our people will create a successful barrier to 
fmther spreading of HIV infection and of other sexually 
transmitted diseases in Zadar area ancl in whole Croatia. 
REFERENCES 
AUTHORS' 
ADDRESSES 
l. Ul'iAIDS and WHO. AIDS Epidemic Update: December 2000, Geneva, UNAIDS, 2000. 
2. Piot P, Merson MH. Globa! Perspectives on Human Immunodeficiency Virus Infection and Acquired 
Immunodeficiency Syndrome. In: Mandell Gl, Bennett JE, Dolin R. Principles and Practice of Infectious 
Diseases, 5th ed. Philadelphia: Churchill Livingstone 2000; 1332-40. 
3. Begovac J. Rasprostranjenost HIV-infekcije u svijetu. In: Beus I, Begovac J, ed. AIDS : HIV bolest. 
Zagreb: Graphis 1996; 45-53. 
4. Borčič B. AIDS u Hrvatskoj . In: Beus I, BegovacJ, ed. AIDS: HIV bolest. Zagreb: Graphis 1996; 54-8. 
5. Gjenero-Margan I. Epidemiologija HIV infekcije i AIDS-a. In: Zbornik radova stručno-znanstvenog 
skupa Promicanje zdravlja u hrvatskom pučanstvu. Zagreb: Hrvatski zavod za javno zdravstvo, 1999; 36-
41. 
6. Gjenero-Margan I. Izvj ešče Službe za epidemiologiju Hrvatskog zavoda za javno zdravstvo. Zagreb, 
April 2001. 
7. Doherty MC, Garfein RS, Monterroso E, Brown D, Vlahov D. Correlates of HIV infection among young 
adult short-term injection drug users. AIDS 2000; 14: 717-26. 
Mile Gveri6, MD, Msc, General Hospital Zadar, Zadar, Croatia 
Boris Dželalija, MD, same address 
Boris Petriči6, MD, same address 
Andelka Gveri6, MD, Institute oj Puhlic Health, Zadar, Croatia 
Alan Medic, MD, same address 
Acta Dermatoven APA Vol 11, 2002, No 2 --- ----------- - -- 6J