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Romania takes high road in AIDS fight

by Cesar Chelala

NEW YORK — The Romanian government’s serious commitment to improve access to treatment, increase outreach activities, build an effective partnership with the private sector and improve health infrastructure has led to dramatic progress in the fight against HIV/AIDS.

According to Dr. Peter Piot, UNAIDS executive director, this progress is one of the big lessons of Romania. Although the percentage of those affected by HIV/AIDS is relatively small compared to other countries, what is happening in Romania can still prove to be a good model for other countries in a similar stage of economic development.

Following the fall of Communism and the collapse of the health infrastructure, it was necessary to revamp the health system to be able to respond to the needs of the Romanian population. During the 1980s, thousands of orphaned infants and small children became infected with HIV. Romania had more children infected with HIV/AIDS than any other nation in Europe. Initially, the epidemic was fueled by children infected in hospitals through blood transfusions given as treatment for anemia and undernourishment, as well as by the large number of youngsters using drugs.

In 2002, there were 341 reported deaths from AIDS among adults and 2,358 deaths among children. The number of HIV-infected adults was 1,322 vs. 4,061 HIV-infected children. As in many other countries, the real number of cases could be five to 10 times higher. The increase in HIV/AIDS has been accompanied by an increase in other sexually transmitted diseases such as syphilis, which has increased from 7.1 cases per 100,000 people in 1986 to 55 cases per 100,000 in 2001.

Although the AIDS epidemic is still growing slowly in the country, it could experience much faster growth due to two reasons: Children infected in hospitals between 1988 and 1991 are becoming sexually active, and there are several high risk-groups in the country. Among those are intravenous drug users, commercial sex workers, highly mobile ethnic minorities such as the Roma, and other marginalized groups. Unless effective prevention strategies are implemented soon, AIDS mortality may significantly increase in the next 10 years.

During the 1990s only a small percentage of patients diagnosed with HIV/AIDS received treatment; fewer than 1 percent were on therapy in accordance with international guidelines. That changed dramatically in the following years.

In 1999, the National HIV/AIDS strategy was developed. An essential component of that strategy is aimed at involving other partners — particularly the private commercial sector — and expanding priorities beyond health-care provision. In 2001, Romania launched the Action Plan for Universal Access to HIV/AIDS treatment. As a result, Romania became the first country in Europe that benefited from price reductions of antiretroviral) drugs. In 2002, the Romanian Parliament passed a special law prescribing basic actions to prevent HIV and protect people living with HIV/AIDS.

Following the increased attention to partnership with the private and commercial sector, Merck & Co. cut the prices of its two AIDS drugs by 86 percent in 2001, and the Global Fund To Fight AIDS, Tuberculosis and Malaria approved a $28 million grant for a five-year HIV/AIDS project in 2003. The same year, the public sector committed $25 million for HIV/AIDS therapy.

All those treated now are included in a national database. They receive not only therapy but also a monthly stipend plus 12 train tickets a year to the nearest city with adequate testing and counseling services. Merk has supported the development of a national AIDS database, donating $1 million toward the creation of a national network of regional AIDS centers with modern diagnostic equipment.

According to Dominic Haazen, a World Bank senior health specialist, the opportunity to control the epidemic lies in catching it in its early stages, and helping governments put in place effective measures to change its growth trajectory among high-risk groups.

What has been done in Romania through a good partnership among patient groups, drug manufacturers and the medical community shows the effectiveness of this approach.