Available data reveals that the former communist countries of Eastern Europe and the Commonwealth of Independent States (CIS) harbour the fastest growing rates of HIV infection in the world. What are the challenges facing the region in formulating a practical response? What can be learned from experience elsewhere? This report, compiled for the United Nations Development Programme (UNDP), examines the principal HIV/AIDS issues and highlights the need for information, leadership and inclusion in building the conditions for change.
AIDS cannot be confronted by the kind of ‘command and control’ approaches that typified public policy in the region during the communist era. Rather, open and democratic structures are essential to encourage comprehensive, multi-sectoral policies aimed at reversing the epidemic. Countries in the region have much to gain from the mistakes and achievements of two decades of international HIV/AIDS policy.
Only sub-Saharan Africa and the Caribbean reported higher HIV prevalence rates in 2003 than Central and Eastern Europe and the CIS. As a human development issue rather than a health care concern, discussions concerning rising rates of HIV/AIDS infection form part of the broader debate about improving human welfare. The main HIV/AIDS issues affecting the region are:
- Closely related to the production and trafficking of opiates destined for Western European markets, HIV/AIDS is predominantly an epidemic among young, urban, male, injecting drug users and their sexual partners.
- Levels of sexually transmitted diseases in some countries in the region are nearly 100 times higher than in Western Europe.
- Rapidly growing numbers of HIV-infected women in the region have caused sharp increases in mother-to-child transmissions.
- With some of the highest incarceration rates in the world and the continued zero tolerance approach to sex work and drug use in many countries, the region’s prisons and detention centres function as HIV incubators.
- As the incidence of new infections is rising the region’s poorest countries, the impacts are not confined to impoverished and overburdened health care systems, but extend to wider socio-economic factors.
Whilst it seems unlikely that the epidemic will be defeated any time soon, the future trajectory of the disease can certainly be managed. Three specific categories of challenges can be identified: information, leadership and inclusion.
- Large scale media, information and education campaigns are required to improve AIDS awareness, reduce stigma and encourage voluntary HIV testing.
- An effective response requires the willingness and ability of diverse social groups to work together in facing the common challenge of HIV/AIDS, including people living with HIV and AIDS, NGOs and the private sector.
- The communist legacy of eroding trust in the state can only be overcome by a concerted effort in terms of building real partnerships among various stakeholders and removing legal and other barriers to participation.
- The marginalisation of people living with HIV and AIDS is an ineffective and potentially harmful public policy approach.
- HIV/AIDS requires inclusive responses which rebalance criminalisation and punitive approaches to drug use and sex work in favour of practical, harm-reduction measures seeking to provide health care and address social intolerance.