Claudia Ciobanu
BUCHAREST, Jul 31 2008 (IPS) – Poverty and social displacement, increased availability of drugs, and chaos in the healthcare systems that accompanied transition from state socialism to the market economy have contributed to the spread of HIV in Eastern Europe.
Russia and the Central Asian countries that were once a part of the Soviet Union are today the worst hit by large numbers of new HIV infections. According to UNAIDS (the Joint United Nations Programme on HIV/AIDS), between 2001-2007 the number of people living with HIV in Eastern Europe and Central Asia increased by 150 percent, from 630,000 to 1.6 million. More than half of the new cases were diagnosed in Russia, and over 20 percent in Ukraine.
In most other countries in Eastern Europe, the HIV epidemic peaked in 2000-2001. Since then, efforts to stabilise the epidemic have achieved partial success.
Transition has led to economic and social dislocation, creating an environment that allows illicit drug markets, drug injecting, and related HIV risk to thrive, wrote Tim Rhodes, a researcher in public health sociology at the Imperial College London, in a 2005 study on the HIV epidemic in Eastern Europe.
According to Rhodes, heightened availability of injectable drugs like heroin, and the globalisation of western drug cultures coincided with the weakening of public health infrastructures, erosion of local communities, migration and mixing of populations, and increased economic hardship. All this contributed to the rapid spread of HIV.
The Baltic states (Estonia, Latvia and Lithuania) reported eruptions of HIV epidemics around 2001. Most of the cases were discovered among drug users, usually young men from urban areas. While the number of new HIV cases has decreased since, the epidemic has spread to wider sections of society, with women increasingly at risk.
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Of the three Baltic states, Estonia has been worst hit. By the end of 2007, 6,364 HIV cases had been registered in Estonia, which has a population of 1.3 million. UNAIDS estimates that the real number of HIV positive Estonians could be twice that. With 1 percent of the population infected with HIV, the country has the one of the highest proportionate incidence of the virus in Europe.
According to the 2004 study HIV and AIDS in Estonia by Jury Kalikov and Arnaud Wasson-Simon, the exceptionally violent spread of the epidemic in Estonia came because of the late introduction of needle exchange programmes (10 months after the HIV epidemic was declared), lack of continuous treatment for uninsured HIV positive patients, and because government structures left too much of the responsibility with NGOs.
Similar problems in the management of the epidemic can be found in other countries in Eastern Europe, like Bulgaria and Romania.
While Bulgaria has not faced a massive outbreak of HIV, the incidence of new cases has risen from 49 new cases in 2000 (in a population of eight million) to 91 in 2006. Bulgarian NGOs have called for more needle exchange points and for centres offering opiate replacement treatment for heroin users.
Romanian NGOs have made similar demands. Needle exchange programmes are not sufficient as they are conducted only by NGOs with few financial resources, says Nicoleta Dascalu, programme manager at ARAS, the Romanian Association against AIDS. More methadone substitution treatments for heroin users are available lately, but they still do not cover all the needs.
Romania is an exceptional case in Eastern Europe because the first HIV epidemic was discovered there in the early 1990s, forcing authorities and NGOs to mobilise sooner than in other countries. At the time, thousands of children were found to have been infected with HIV in hospitals and orphanages in the period 1987-1991 because of untested drug transfusions and the use of non-sterile syringes. Many of them had been simultaneously transmitted the viruses of hepatitis B or C.
According to the 2008 national report of the HIV/AIDS Monitoring and Evaluation Department in Romania, at the beginning of 2007 health authorities were monitoring 7,000 HIV positive adolescents, considered to be long time survivors after being infected in the period 1987-1991. In all, 16,877 cases of HIV infections had been recorded by 2007, in a population of 23 million. Since 2004, says the report, the epidemic has stabilised, with the incidence of new cases decreasing slightly, and among children, significantly.
But national health institutions still have a long way to go. Nicoleta Dascalu from ARAS told IPS that most of the funds for HIV prevention programmes are currently coming from the Global Fund to Fight HIV, Tuberculosis and Malaria. NGOs remain the most important actors in charge of HIV prevention, and in offering psychological and social assistance.
Many of the country reports on HIV submitted to UNAIDS in 2008 emphasise the need to better coordinate the various state and civil society actors involved in fighting the HIV epidemic. Since a large part of the funds and guidance for HIV prevention and care are now coming from United Nations agencies and the Global Fund, there is concern about the ability of national bodies to fully take charge of these programmes.
While similar risk factors as in Eastern Europe have been present in Central Europe, countries like the Czech Republic and Hungary have managed to prevent large HIV epidemics.
