versão impressa ISSN 0042-9686
Bull World Health Organ vol.82 no.4 Genebra Abr. 2004
EU faces world's fastest growing HIV epidemic
Sarah Jane Marshall
Fledgling democracies in Eastern Europe and the former Soviet Union - ten of which are set to join the EU on 1 May - are facing the world's fastest growing HIV epidemic, warned the United Nations Development Programme (UNDP) in a new report released in Moscow on 17 February 2004.
The report was published ahead of a high-level meeting in Dublin on 23 February during which experts on HIV/AIDS warned ministers from 55 countries in Europe and Central Asia that the region's rapidly accelerating HIV/AIDS epidemic could cripple Europe's economic and social development.
According to the report, Reversing the Epidemic: Facts and Policy Options, future members of the EU (such as Estonia, Latvia and Lithuania) along with the Russian Federation and Ukraine are facing increasing growth rates of new HIV infections that are amongst the highest in the world. One in every one hundred adults in these three countries is thought to be carrying the virus - a threshold above which efforts to turn back the epidemic have failed in many other countries.
Examining the epidemic in the 28 countries which compose Eastern Europe, the Baltics and the Commonwealth of Independent States, the 117-page study reported that between 1.2 million and 1.8 million people in the region were infected with the virus last year compared with just 30 000 in 1995. However, only 9% of those in need of antriretroviral treatment are currently receiving it.
UN Secretary-General, Kofi Annan, warned of the grave economic impact posed by an epidemic which, in Eastern Europe, sees 80% of new infections occurring among young people.
"No nation can afford to see its future workers and leaders struck down by AIDS before they reach maturity," said Annan in a video message for the Dublin conference entitled, Breaking the Barriers: Partnership to Fight HIV/AIDS in Europe and Central Asia.
In a joint statement issued at the conference, UN agencies including WHO, UNAIDS and UNICEF, and the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), called on European Ministers to take decisive action to prevent the further spread of AIDS across Europe and to treat those in need.
"There is no time to waste - European Ministers must urgently scale up and roll out effective HIV prevention and treatment programmes," said Dr Peter Piot, UNAIDS Executive Director. "Given that the EU will form the biggest trading bloc in the world, covering more than 500 million people, it is in the EU's best interest to prevent the AIDS epidemic from crippling Europe's social and economic development."
"Europe cannot divide over the issue of AIDS treatment, and only provide treatment in richer countries," said WHO Director-General, Dr LEE Jong-wook. Treatment should be a right for all, including for sex workers and injecting drug users."
Sex-workers and injecting drug users are some of those at highest risk of contracting HIV. Other high-risk groups include men who have sex with men, and prisoners. Experts report a rise in the use of intravenous drugs, the sharing of dirty needles and unsafe sex since the collapse of communism in 1991. Overcrowded and insanitary prisons are also contributing to the problem. Prison reform and the decriminalization of injection drug use are essential in combating the epidemic, says the UNDP report.
The impact of the epidemic has been compounded by insufficient public awareness, frequent stigmatization and lack of adequate policy instruments to cope with the disease, said UNDP in a statement accompanying the release of the report.
"Members of at-risk groups are often subject to social exclusion, poverty, stigmatization or incarceration factors which actually heighten the spread of the disease," said Kalman Mizsei, Assistant UNDP Administrator and Regional Director for Europe and the Commonwealth of Independent States.
According to WHO, the percentage of people reporting premarital sexual relations more than doubled between 1993 and 1999, from 9% to 22%. Lack of education may be the underlying cause - in Tajikistan for example, only 10% of girls have ever heard of HIV/AIDS.
"Schools are the best defence against HIV infection," said Carol Bellamy, Executive Director of UNICEF. "They offer the best mechanism to deliver HIV prevention information."
A draft declaration adopted at the Dublin conference entitled Partnership to Fight HIV/AIDS in Europe and Central Asia, aims to offer 80% of drug users access to treatment and harm reduction services by 2005 and to provide "universal access to HAART [highly active antiretroviral therapy] in Europe and Central Asia by 2010," among other targets.
According to the UNDP report, lessons can be learnt from success stories in countries such as Poland, the Czech Republic and Slovakia which have leveraged progress in building democracies into effective responses to HIV/AIDS.
World Bank figures indicate that funding to tackle the epidemic in the region needs to increase from an estimated US$ 300 million in 2003 to US$ 1.5 billion by 2007.
GFATM, which has approved over US$ 400 million over five years for 22 programmes in 16 countries in Eastern Europe and Central Asia, recently announced the re-launch of its AIDS grant to one of the worst-hit countries - Ukraine. The decision follows the suspension of funding in January 2004 due to the slow pace of the projects which had received GFATM funds and the country's escalating HIV/AIDS crisis. A new fund management structure is now in place to tackle these concerns.
"But money alone is not the issue," warned Shigeo Katsu, World Bank Regional Vice President for Europe and Central Asia. "It is crucial to improve the information base for programs, to support what works against HIV/AIDS, and to break down the policy and social barriers to effective actions across the region."