Turning the Tide: HIV/AIDS in Eastern Europe and Central Asia
A three-day conference called "Facing the Challenge," organized by the Russian Government with the support of UNAIDS, the World Bank and other international partners, opens on May 15 against this back-drop. Its goal is to strengthen the collective capacity of Eastern European and Central Asian governments, civil society groups, experts, people living with AIDS and donors to respond to the epidemic, nearly 25 years after HIV/AIDS was first identified.
The event is seen as an important milestone, giving the countries in Eastern Europe and Central Asia an unprecedented opportunity to learn from the experience of the rest of the world in fighting HIV/AIDS.
Drawing from grant resources and contributions from its Global AIDS programme, the World Bank is organizing satellite sessions focusing on strengthening health systems (a critical investment for an effective, large-scale response) and on implementing a successful regional strategy in Central Asia. The World Bank is also supporting the participation of high-level delegations from several countries where it is funding ongoing AIDS projects.
In the last year alone, there were 270,000 new HIV/AIDS cases in Eastern Europe and Central Asia, according to UNAIDS estimates. 1.6 million people in the region live with the disease - a number which has increased almost twenty-fold in the last decade.
This fast-growing epidemic is affecting mostly younger people and an increasing number of them are women. 75% of reported infections between 2000 and 2004 occurred in people under the age of 30 compared with 33% in Western Europe.
There are signs that HIV is spreading from traditionally vulnerable groups such as intravenous drug users and sex workers, to the general population.
Good news from Moscow
Lest complacency or a sense of hopelessness settle in, there is good news coming from Moscow. "In the last two years there's been a major improvement in the way the Russian government is tackling the challenge of HIV/AIDS," says Patricio Marquez, Lead Health Specialist for the World Bank's Europe and Central Asia region and the coordinator of the Bank's contributions to the Moscow event.
Russia is demonstrating a newly supportive approach in several ways. The government's budget allocation for Tuberculosis and HIV/AIDS programs has gone from US$5 million in 2004 to US$100 million in 2005. President Vladimir Putin has spoken openly and repeatedly about the threat of communicable diseases and has made it one of the three priority areas of Russia's upcoming G8 presidency (along with energy security and education). And on 21 April 2006, the presidium of Russia's State Council, chaired by President Putin, decided to set up a special government commission to coordinate efforts against AIDS - a decision which was greeted as "historic" by Russia's chief sanitary doctor Gennady Onishchenko, according to the Russian news agency Itar-Tass.
Besides easing coordination of sometimes scattered or redundant efforts, the new body signals that Russian authorities are no longer seeing the problem as a narrow medical challenge, but as a mainstream political priority.
When the World Bank conducts a mid-term review next fall of the TB and HIV/AIDS Control Project it is supporting in Russia, Marquez expects that close to 60% of allocated resources will be fully disbursed or committed under signed contracts. "The key achievement was the preparation of regional needs assessments which gave us a very good understanding of what was already being done and what was lacking in the 88 regions of this vast country," he says.
Prevention is lagging behind treatment
Although resources for fighting AIDS rose dramatically in Russia in the past two years, the bulk of this money is being spent on treatment, cautions Marquez. "There is a need for a better balance between prevention and treatment," he says. With prevention programs lagging behind treatment, new resources may never catch up with the rate of new infections.
Russia alone accounts for an estimated 1 million of the region's HIV/AIDS cases. It has the biggest HIV'AIDS epidemic in Europe. Although drug injection still accounts for the majority of new infections in Russia, the disease is shifting from vulnerable groups to a bridge group of partners and spouses who may in turn spread the disease to the general population.
According to new research which will be presented at the conference by Shiyan Chao, a Senior Health Economist at the World Bank, Ukraine's pattern of transmission is changing at alarming speed from intravenous infections to heterosexually transmitted infections. According to the most pessimistic scenarios explored in this study, HIV/AIDS in Ukraine could reduce GDP by up to 6% during the 2004-2014 period, reduce investment by 9% and leave up to169,000 children orphaned.
Reaching a political consensus
However there is no consensus on how to prevent the spread of AIDS, be it through the distribution of condoms, school-age sex education, or curbing the sharing of needles by injecting drug users. Should you establish needle exchange programs for intravenous drug users for example or encourage substitution therapy in which patients are moved from one type of dependency to another (methadone)? Do these programs condone addiction? This is where the sharing of best practice examples during the Moscow conference can alter the consensus and address political reservations.
Ultimately, the success of programs "depends on political commitment and ownership," says Marquez. "In some countries you have it. It's starting to be the case in the Russian Federation. In other countries, like Ukraine, given the political turmoil, you don't have it right now." The recent suspension of the World Bank-financed AIDS project there was due to a poor implementation record, aggravated by continuous ministerial turnover in Kyiv. "Programs need to be anchored in well-run systems with a continuity of efforts and funding," says Marquez. "It's a governance issue."