SOUTHEASTERN EUROPEAN COUNTRIES IN DANGER OF HIV/AIDS EPIDEMIC
New World Bank report calls for urgent measures to halt disease’s spread
Contacts:
Washington
Merrell Tuck (1-202) 473-9516
e-mail
mtuckprimdahl@worldbank.org
Miriam Van Dyck (1-202) 458-2931
e-mail
mvandyck@worldbank.org
WASHINGTON, July 10, 2003
--Immediate action must be taken to prevent an AIDS epidemic in the Balkans, says
HIV/AIDS in Southeastern Europe: Case Studies from Bulgaria, Croatia, and Romania
, a World Bank study released today. The new report reviews the current status of AIDS epidemics in the three countries, evaluates the approaches and strategies currently being used in each country, and makes recommendations both for government strategies and for the Bank’s current and potential future involvement.
The Europe and Central Asia (ECA) region continues to experience the fastest-growing HIV/AIDS epidemic in the world. In 2002, there were an estimated 250,000 new infections, bringing to 1.2 million the number of people in the region living with HIV/AIDS. The Russian Federation and Ukraine remain at the forefront of the HIV/AIDS epidemic in ECA, but many other countries are now experiencing rapidly emerging epidemics.
“The impact of the HIV/AIDS epidemic is only now beginning to be felt in the Europe and Central Asia region,”
says
Dominic Haazen, World Bank Senior Health Specialist and co-author of the report
.
“Without effective preventive efforts, morbidity and mortality caused by HIV/AIDS may grow significantly in the next five to 10 years, placing large demands on the health care systems of all countries in the region.”
HIV/AIDS in Southeastern Europe
follows on the July 2002 Southeastern Europe Conference on HIV/AIDS in Bucharest, Romania, at which the countries of Southeastern Europe re-committed themselves to scale up action on the prevention and treatment of HIV/AIDS in the sub-region.
Bulgaria, Croatia, and Romania share several social conditions that have led to a rapid increase in HIV infection, the report says. These include high unemployment and significant poverty, rapid social changes (including those related to post-conflict situations and emerging democracy), a decrease in the quality of health services and educational opportunities, increased substance abuse and commercial sex work, and high levels of population mobility. The epidemic, driven initially by a nosocomial (acquired in hospital) tragedy in Romania and also by the large numbers of youth who inject drugs throughout the region, now risks spreading more widely as high levels of sexually transmitted infections, increases in sexual risk behavior, and low levels of knowledge about HIV/AIDS set the stage for crossover to those who do not inject drugs.
A key challenge is the fact that the three countries all have a low prevalence of HIV infection in the general population, and thus it is difficult to achieve political recognition of the potential for rapid progression to higher prevalence levels, and to acknowledge the potential impact of HIV/AIDS on health systems, social structures, and individuals. In addition, the approach to HIV/AIDS in the sub-region is complicated by relatively high levels of stigma against vulnerable groups, including intravenous drug users, commercial sex workers, and ethnic minorities such as the Roma.
While the three countries have health systems that through law or policy guarantee access to medical treatment of HIV infection and opportunistic infections, this guarantee may be operative only in a low-prevalence epidemic. In the event of a high-prevalence epidemic, the under-funded health systems in all three countries might not be able to cope with the future demands on treatment or social services, and their economies would suffer from reduced human capital and investment.
“The lessons learned, both within the ECA region, and from other more extensively infected regions, are that with even limited efforts in prevention, huge disease and economic burdens placed on health systems and governments through high rates of HIV infection can be averted,”
says
Thomas Novotny
,
Visiting Professor of Epidemiology and Biostatistics at the University of California, San Francisco
and lead author of the report.
Bulgaria
The reported prevalence of HIV/AIDS in Bulgaria is relatively low, with 366 reported HIV positive persons recorded since 1987. However, the rate of increase accelerated from three new reported cases in 1990 to 30 new reported cases in 2001. Currently, half of new HIV positive persons are below 25 years of age; 91 percent of transmission is sexual, of which 88 percent is heterosexual. The Roma population in Bulgaria presents some special risks for HIV/AIDS, due to lack of access to health care services, cultural barriers, and lower educational attainment. In addition, there is a significant population of guest workers, merchant marines, and mobile prostitutes that may provide an increased risk for HIV spread within the national population.
The World Bank’s involvement in Bulgaria has included two health projects, with the first, on health system restructuring, closing in 2001. The project incorporated activities on rationalizing blood transfusion facilities, with assurance now that the blood supply is safe. Twenty-eight regional processing centers were reduced to five, and there is now little in the way of black market activities involving blood products. The second health project, of which health promotion is a part, is underway, and also involves extensive financing for health insurance development. Future activities to be supported by the World Bank in the country could include improving behavioral surveillance, especially among vulnerable populations; institutionalizing harm reduction programs, including needle exchange, condom distribution, and drug treatment; and developing specific training for general practitioners, medical students, and dental students to recognize and refer for HIV/AIDS services.
Croatia
Croatia has 341 reported cases of HIV and AIDS as of the end of 2001, with 25-35 new cases reported each year. Only about 7 percent are unknown as to mode of transmission, indicating fairly good surveillance and investigation of positive cases. But little is known about the prevalence of HIV among intravenous drug users, homosexuals, and mobile populations. And perception of risk for HIV among young people is lacking. Drug and alcohol use have increased, especially among vulnerable young people, over the last ten years. Tourist destinations, prostitution associated with tourism, and the large number of merchant mariners traveling back and forth to Croatian coastal areas permit the spread of sexually transmitted diseases, including HIV.
The World Bank’s involvement in the health sector of Croatia includes the Health System Project, the second in a planned series of operations in support of the Government’s health sector reform and development program. Future World Bank activities to be considered include developing outreach testing and counseling units to identify HIV-positive persons among high risk groups and to develop skills in HIV prevention; developing specific, targeted promotion activities geared toward high risk groups throughout the country; and supporting a condom social marketing program to tourists and other mobile populations as a public service activity of the Ministry of Health.
Romania
Of the three countries in the study, Romania has the largest number of cumulative reported HIV infections: 12,559 in mid-2002. Of adult HIV/AIDS cases, most were transmitted through heterosexual contact, but most of the national total of HIV/AIDS cases are found among children. The vast majority of these acquired HIV through blood transfusions or nosocomial infection. Although still experiencing slow growth, there appear to be two arms for the epidemic: the nosocomially infected children from 1988-91, who will soon become sexually active, and adult risk groups. In addition, the number of intravenous drug users has increased tremendously in the last several years.
The World Bank currently supports HIV/STD control through an Adaptable Program Loan. This effort is part of a broader reproductive health program of the Ministry of Health. This project aims to develop political support, raise awareness, integrate best practices within government programs, and improve health service models of prevention and treatment. Education of health professionals, community leaders, teachers, and others as to prevention is one focus. Other aims include public information over five years in conjunction with the reproductive health program, improvement of behavioral surveillance through surveys, and improvement of laboratory diagnostic facilities and service delivery for STDs.
Future World Bank support for HIV/AIDS control in Romania may include improving sexually transmitted infection surveillance systems, expanding drug abuse treatment programs, and conducting specific de-stigmatization training for health providers who may work with HIV/AIDS patients and high-risk groups.
The report concludes that the World Bank has a comparative advantage in providing input through an appropriate mix of both lending and non-lending activities that support country-led programs and complement the activities of other development agencies. For example, the World Bank could work with countries, specialized agencies and NGOs to undertake countrywide programs focusing on effective interventions such as harm reduction, which are currently being implemented on a small scale in pilot projects.
“The World Bank is committed to effective policies and interventions that will curb the HIV/AIDS epidemic in this sub-region, and will work closely with local stakeholders to achieve this goal,”
says
Olusoji Adeyi, World Bank Europe and Central Asia Lead Health Specialist and co-author of the report
.
For Press Release in Croatian please click
here
For Press Release in Romanian please click
here
For more information on the World Bank’s work on HIV/AIDS in the ECA region, visit
http://www.worldbank.org/eca/aids
For more information on the Bulgaria Health Sector Projects, visit
http://www4.worldbank.org/sprojects/Project.asp?pid=P055157
and
http://www4.worldbank.org/sprojects/Project.asp?pid=P008318
For more information about the Croatia Health System Project, visit
http://www4.worldbank.org/sprojects/Project.asp?pid=P051273
For more information on the Romania Health Sector Reform project, visit
http://www4.worldbank.org/sprojects/Project.asp?pid=P008797