Positiv Leben Blog

VIENNA, 19 July 2010 - An underground HIV epidemic in Eastern Europe and Central Asia is intensifying at an alarming pace, fueled by drug use, high-risk sexual behavior and high levels of social stigma that discourage people from seeking prevention information and treatment, according to a new report released today by UNICEF.

The report, "Blame and Banishment: The underground HIV epidemic affecting children in Eastern Europe and Central Asia," highlights the issues faced by children living with HIV, adolescents engaged in risky behaviors, pregnant women using drugs, and the more than one million children and young people who live or work on the streets of the region.

Marginalized young people are exposed on a daily basis to multiple risks, including drug use, commercial sex and other exploitation and abuse, putting them at higher risk of contracting HIV. The trends are especially troubling, as the region is home to 3.7 million injecting drug users - almost a quarter of the world total. For many, initiation into drug use begins in adolescence.

Existing health and social welfare services are not tailored to adolescents at greatest risk, who are often exposed to moral judgment, recrimination and even criminal prosecution when they seek treatment and information on HIV.

"Children and adolescents living on the margins of society need access to health and social welfare services, not a harsh dose of disapproval," said Anthony Lake, UNICEF’s Executive Director.

To reach and help young people living with HIV or at risk of HIV infection, medical and civil authorities need to establish non-judgmental, friendly services that address the special needs of marginalized adolescents.

In the Russian Federation, for example, over 100 youth-friendly service facilities have been established, providing reproductive and sexual health services, information, counseling and psychological support. The Atis health center in Moldova is another initiative that is showing promise and saving lives.

"We cannot break the trajectory of the AIDS epidemic in eastern Europe and Central Asia without empowering and protecting children and adolescents," said Michel Sidibé, Executive Director of UNAIDS. "We must not rob them of their childhood."

"It is our responsibility to ensure that they have access to HIV prevention and treatment services."

An HIV prevention and treatment center in Tajikistan is breaking down barriers of mistrust to reach adolescent girls selling sex. As one young client said, "In the beginning, I did not believe that the medical check-up, the treatment and condoms would really be free of charge and anonymous. I thought it was another trap by the police. I agreed to go there with an outreach worker for the first time, but now I go there alone and encourage my friends to use the service as well."

A recent six-country UNDP study conducted in the region showed that many adults living with HIV fear the social stigma attached to seeking treatment more than they fear the disease, thus driving the epidemic further underground.

The stigma associated with HIV is not restricted to adults and adolescents. Young children living with HIV are routinely denied access to school and kindergartens, and when their status is known, they face rejection and abuse. Alla, the foster mother of an HIV-positive child, tells how her son was ostracized when someone leaked his HIV status to other families. "His classmates say that he is ‘disgusting’ and refuse to play with him," she said.

"This report is a call to protect the rights and dignity of all people living with or at risk of exposure to HIV, but especially vulnerable children and young people. We need to build an environment of trust and care, not one of judgment and exclusion," said Lake. "Only by reversing discrimination against people living with HIV, can Eastern Europe and Central Asia begin to reverse the spread of the epidemic."

Press Release from UNICEF, 19 July 2010

UNAIDS concerned that a number of counties in this region are reporting reductions in critical investments in the AIDS response 

VIENNA, 16 July 2010 - Eastern Europe and Central Asia is the only region where HIV incidence clearly remains on the rise. Early indications are that the number of newly diagnosed HIV cases in 2009 has increased since 2008. Russian Federation has reported an 8% increase in reported cases, Georgia a 10% increase and Belarus a 22% increase. 

Injecting drug use remains the primary route of transmission in the region. Use of contaminated equipment during injecting drug use was the source of 57% of newly diagnosed cases in eastern Europe in 2007. An estimated 3.7 million people in the region currently inject drugs, of which one in four are believed to be HIV positive. 

"It should concern all of us that some countries are closing down HIV prevention services for injecting drug users when they should be scaling up," said Mr Michel Sidibé, Executive Director of UNAIDS. "Epidemics driven by injecting drug use can grow rapidly when HIV prevention services are not available." 

In the latest round of country progress reports, coverage of HIV prevention programmes for injecting drug use remains low. In the Russian Federation, coverage was 23.8% in 2007, but only 13.6% in 2009 and Georgia went from 17% down to 11.4% in the same time period. 

As most injecting drug users are sexually active – often with non-injecting partners – the existence of a major injection-driven epidemic has also fuelled a growth in heterosexual transmission of HIV in the region. Ukraine has the highest level of reported HIV cases in the region. The number of new infections in the country has gone up from 18,963 in 2008 to 19,840 in 2009, and heterosexual transmission has eclipsed injection driven transmission. 

The news comes as the global AIDS community gathers in Vienna for the XVIII International AIDS conference. 

"Eastern Europe can not lag behind in the prevention revolution," added Mr Sidibé. "Evidence shows unequivocally, harm reduction programmes save lives and are a smart investment."

Press Release from UNAIDS – 16 July 2010

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09. Juli 2010 - AIDS: erschwingliche Arzneimitteln und Patientendiskriminierung bekämpfen - Pressemitteilung in deutscher Sprache 

08. Juli 2010 - AIDS: ensuring affordable medicines and fighting discrimination - Pressemitteilung in englischer Sprache 

08. Juli 2010 - Die Wiener Erklärung 

08. Juli 2010 - The Vienna Declaration

29. Juni 2010 - The Vienna Declaration: A Global Call to Action

GENEVA, 15 July 2010 – Five United Nations agencies – UNICEF, UNFPA, WHO, UNAIDS, and UNDP – express concern that health and social workers have suffered as a result of their professional activities in the response to HIV in several countries in eastern Europe and central Asia.

Persecution, criminal investigation, arrests and sentencing of HIV activists as well as health and social workers affect not only the lives of the people involved but also discourage other activists and professionals, and deprive societies of some of the most valuable and vital resources in the response to the epidemic – people’s commitment and energy at the community level.

Health, social and outreach workers are at the front line of the response to HIV, providing critical assistance to the hundreds of thousands of people who need it. They also help countries meet their goals and obligations in the HIV response, linking government efforts with the most vulnerable to HIV – young people and populations at high risk of infection.

In several countries of eastern Europe and central Asia, health and social workers and volunteers have been prosecuted because of their professional activities – activities they felt compelled to carry out in order to save lives, as the epidemic does not wait for societies to adjust and re-examine principles and approaches.

The activities of these practitioners have been guided by scientific evidence on how best to achieve good public health outcomes. Often challenging taboos, health and social workers inform adolescents about the behaviours that lead to HIV infection, help injecting drug users through harm reduction activities, support prevention programmes for sex workers and men who have sex with men, and work in oral substitution centres for drug users or in health facilities in conditions that are far from perfect.

Eastern Europe and central Asia is the only region in the world where new HIV infections remain on the rise. The contribution of these front-line practitioners is essential in responding to the epidemic in the region. They need the support and protection of authorities, and their basic human rights must be ensured.

The UN agencies urge governments to acknowledge the critical role of health and social workers in the prevention and treatment of HIV infection and to better understand the complexity of their work. We appeal to the governments of the region to bring an end to counterproductive persecution and harassment, to discontinue procedures that hamper their work and release those who have been detained.

Joint Statement of UN agencies – 15 July 2010

VIENNA, 10 March (UN Information Service) - The rapidly growing HIV/AIDS epidemics in Eastern Europe fuelled primarily by unsafe injecting drug use are topics under the spotlight at the XVIII International AIDS Conference, AIDS 2010, to be held in Vienna in July. The United Nations, through the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Office on Drugs and Crime (UNODC) is supporting the conference from 18 – 23 July 2010 which is organized by the non-governmental organization the International AIDS Society.

The conference will also examine worldwide progress towards the 2010 deadline set by world leaders in the Millennium Development Goals for universal access to treatment for HIV/AIDS and HIV prevention.

Around 25,000 people working in the field of HIV, including policy makers, legislators, researchers, people living with HIV and others committed to ending the pandemic will come to Vienna for AIDS 2010 which has the theme Rights Here, Right Now, emphasizing the central importance of human rights in responding to HIV.

HIV and injecting drug users

By holding the conference in Vienna the organizers will highlight the situation in Eastern Europe and Central Asia, regions experiencing fast growing epidemics largely through unsafe injecting drug use. An estimated 1.5 million people are living with HIV in these regions. Sharing needles and injection equipment is thought to be three times more likely to transmit HIV than sexual intercourse.

"To break the trajectory of the HIV epidemic in Eastern Europe, we must stop new infections among injecting drug users and their partners," said UNAIDS Executive Director Michel Sidibé. "People using drugs have a right to access the best possible options for prevention, care and treatment."

Yet, as the results published in The Lancet last week show, injecting drug users often have little or no access to evidence-informed comprehensive HIV services. Globally, only 2 needles and syringes per injecting drug user are distributed per month, only 8 per cent of injecting drug users receive opioid substitution therapy, and only 4 per cent of HIV positive injecting drug users receive antiretroviral therapy (Mathers et al, 2010).

The United Nations Office on Drugs and Crime (UNODC) is the lead agency within the Joint United Nations Programme on HIV/AIDS (UNAIDS) for HIV prevention, treatment, care and support for injecting drug users and in prison settings. It works in 55 priority countries in Africa, Eastern Europe and Central Asia, South and South East Asia, Latin America and the Caribbean, helping countries to provide drug users, prisoners and people vulnerable to human trafficking with comprehensive evidence-informed HIV services.

"We can and must reverse the HIV epidemic, first of all by preventing the spread of drug use, and then by providing treatment to addicts. In this comprehensive programme, HIV-targeted measures include providing clean injecting equipment, opioid substitution, and antiretroviral therapy," said UNODC Executive Director Antonio Maria Costa.

HIV/AIDS and the Millennium Development Goals (MDGs)

Tackling HIV/AIDS, part of the sixth Millennium Development Goal, sets the specific target of 2010 to achieve universal access to treatment for HIV/AIDS for all those who need it and HIV prevention and by 2015 to have halted and begun to reverse the spread of HIV/AIDS.

Statistics from 2008 show that an estimated 33.4 million people were living with HIV around the world but the number of people newly infected with HIV, after peaking in 1996, had declined to 2.7 million by 2008. However infection rates are continuing to rise in some parts of the world, especially Eastern Europe and Central Asia. Here, HIV prevalence has almost doubled since 2001.

As the coverage of antiretroviral treatment in poorer countries has increased so there has been a decline in the number of AIDS deaths, to 2 million in 2008. So while 4 million people in developing countries were receiving antiretroviral drugs by December 2008, that is still only 42 per cent of those who needed it. And for every two people who start antiretroviral treatment, five new people become infected with HIV. Globally women have equal or greater access to antiretroviral drugs than men, partly through prevention of mother-to-child HIV transmission.

Pushing forward to achieve the Millennium Development Goals is one of the priorities for the United Nations Secretary-General, Ban Ki-moon this year. "The MDGs are too big to fail," the Secretary-General said. "We are ready to act, ready to deliver, and ready to make 2010 a year of results for people." A summit will be held in New York in September to mobilize global action on the MDGs.

The AIDS 2010 conference will also bring benefits to people and organizations in Austria working in the field of HIV/AIDS according to AIDS 2010 Local Co-Chair, Dr. Brigitte Schmied, President of the Austrian AIDS Society: "Whether it be through the identification of priority needs and the way to meet them; understanding and tackling current limitations to universal access to HIV prevention, treatment, care and support; or a renewed sense of purpose and consolidation of efforts to apply interventions based on evidence rather than ideology."

Pressrelease United Nations Information Service 10 March 2010

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