Romania: AIDS Time Bomb

A combination of fear, ignorance and poor health care is threatening to spark an AIDS epidemic in Romania.

The ministry of health and family last year estimated that more than 12,500 people were either HIV-positive or living with full-blown AIDS - the majority of them young people.

While the health care system has improved over the last decade, it remains in need of reforms and investment - public expenditure on health is the lowest in the region.

Aware of the looming threat of an epidemic, the Bucharest authorities have declared prevention and treatment a priority. They launched an Action Plan for Universal Access to HIV/AIDS Treatment in 2001 as part of a UN initiative to combat the virus, allocating 25 US million dollars for the project.

By March 2003, some 5,000 patients were receiving antiretroviral drugs - the most effective medication for the illness. But even with the discounts the government has managed to negotiate with western drug companies, the treatment remains extremely expensive - as a result, many sufferers go without.

Those lucky enough to be treated often don't get all the medication they need. Since it is so costly, Romanian hospitals often run out, leaving patients with long gaps between doses of certain drugs - allowing them to build up resistance to the treatment.

Dr Daniel Mardare Constantin, an official from the Romanian Public Health Department in the county of Lasi, said that most hospitals are short of medication to control the virus and treat its symptoms. "They also need medicine to treat opportunist infections such as pneumonia, which attacks the sufferer's weakened immune system," he added.

With hospitals already struggling to accommodate current HIV patients, they are unlikely to be able to cope with an epidemic.

A growth in HIV infection could result from intravenous drug use, prostitution and the legions of children who contracted the virus during the Ceaucescu era.

According to figures compiled by UN body dealing with the HIV crisis, UNAIDS, the number of addicts who use syringes has jumped from around 1,000 in 1998 to an alarming 30,000 last year, the majority of whom are in Bucharest, and were found to be carrying the Hepatitis B or C virus.

A small proportion were also HIV positive - prompting UNAIDS to launch and education and prevention programme in the city, with the help of the authorities.

Such programmes are reaching around ten per cent of the intravenous drug users in the capital, but UNAIDS's representative in the capital, Eduard Petrescu, told IWPR that it was hoped that further funding would increase that figure to 40 per cent.

A July 2003 report from the World Bank noted that thousands of Romanian women are working abroad in the sex industry in countries such as Turkey, Greece, Cyprus, the former Yugoslavia and Western Europe.

Very little is known about the infection rate amongst sex workers but there's concern that the figures are high and that the women may spread the virus when they come home.

During the communist era, thousands of children were infected with the disease while undergoing routine surgery at state hospitals - cutbacks had led to the practice of re-using syringes and other medical equipment. Six years ago, nearly 60 per cent of Europe's pediatric HIV infections cases were in Romania. These youngsters are now reaching sexual maturity, many without knowing that they are carrying the deadly virus.

Analysts and NGOs are now pressing the government to invest more heavily in prevention, which they believe is the only way to avert an epidemic.

The Romanian health ministry, in cooperation with officials from other ministries and NGOs, has developed a strategic plan to stop the virus from spreading, but its run into funding problems.

"The objective of giving everyone equal access to treatment and care was achieved although few resources were left over to invest in prevention. This deficit was partially met by UN agencies and other donors but some initiatives were never executed due to underfunding," Petruscu said.

"For instance, currently there is no clear testing policy. Testing at a national level could reveal an even grimmer reality compared to official figures. Consequently, the government is unaware of the real number of infected people and their movements."

Claudia Catana, an information officer with the Romanian Angel Appeal which raises funds for tackling HIV infection, told IWPR, "The real figures are much higher and many people are unknowingly spreading the disease."

The World Bank estimates that the number could be as much as ten times that of all registered cases.

In addition to practical measures such as testing, reducing the stigma attached to those infected with the virus is also seen as a priority.

Psychologist Aurora Liiceanu told IWPR that sufferers are often ostracised by their family and friends, "Romanians in general think that people with HIV or AIDS should stay in hospitals and not mix with the healthy.

"They also believe that it is the duty of the state to take care of those who are infected - hence the high level of social exclusion."

Some NGOs have set up projects to educate organisations and individuals about issues related to HIV.

One such project is Social Exclusion Young People AIDS, established this year in five European countries with a high prevalence of HIV. Its aimed at identifying policy gaps and service shortages and setting up programmes that prevent sufferers being shunned through ignorance.

Children and adults alike are often ostracised when news of their HIV positive status gets out. The head teacher of a secondary school in the north of Romania recently told one of her HIV positive students to leave the classroom because he was "dirty".

Mihai, a teenage sufferer from Bucharest, told IWPR, "At first, I sought comfort with my best friends. But when I told them I was HIV positive, they all started avoiding me. Eventually, we grew apart and my only true friend now is my dog. I don't want people to know my real identity; I have suffered too much already."

Social exclusion project coordinator Mugur Badarau told IWPR that many Romanians don't even know how the virus is transmitted, and some are so misinformed that they avoid any physical contact with infected people.

These attitudes can even be found within the medical profession. Mihai told IWPR that he had been asked to leave several surgeries after staff were told he was a sufferer. "Some doctors ask you politely to leave when they hear you have got the virus, or refuse to see you even though you are sick. I guess they are to terrified they might catch the disease," he said.

Analysts admit that the government has a huge task in front of it not only in terms of finding the necessary funding to treat patients with anti-retroviral drugs but also in the area of primary prevention which will involve changing Romanian attitudes to the illness.

But Petrescu remains optimistic. "Romania has taken important steps to tackle this potential crisis," he said.

"If government resources and international grants are used according to national strategies and policies, Romania has a good chance to avoid the epidemic."

Daniela Tuchel is a Bucharest-based journalist and Camilla Algarheim is a trainee IWPR editor.