“HIV/AIDS is a growing challenge for the entire continent of Europe, from Dublin to Moscow,” Kalman Mizsei, Regional Director for Europe and the CIS of the United Nations Development Programme (UNDP), warned European leaders gathered here to discuss a regional response to the epidemic.

Speaking to government officials and civil society organizers gathered in Dublin for the “Breaking the Barriers: Partnership to Fight HIV/AIDS in Europe and Central Asia” conference convened by the EU Irish Presidency, Mr Mizsei called on the European Union to use its political clout to put more resources into the fight against AIDS.

Infections increased 50 times in less than 10 years
According to a newly published UNDP report “Reversing the Epidemic: Facts and Policy Options,” at least 1.2 million and as many as 1.8 million people are now infected with HIV in Eastern Europe, the Russian Federation and the Central Asian republics. The growth rates in new infections reported over the last several years in Estonia, Russia and Ukraine are among the world’s highest. Upwards of one out of every one hundred adults living in these three countries is now estimated to be carrying the virus—a threshold above which efforts to turn back the epidemic have failed in many other countries.

The report, released last week in Moscow, notes that curbing the disease requires public awareness and information, de-stigmatization, inclusion of vulnerable groups in policy decision-making and, above all, strong and decisive political leadership. The report was co-authored by experts from UNDP, UNAIDS, WHO and the World Bank. It offers detailed HIV/AIDS profiles for the countries of the region, describes vulnerable groups and the behaviours that put them at risk of infection, and discusses why governance and human rights must be considered central elements in the battle against the epidemic.

“We need to rebrand AIDS as a societal development issue, not only a disease of injecting drug users,” said Dr. Peter Piot, Executive Director of UNAIDS.

Region’s youth—most affected by the epidemic
In spite of the wide variety of epidemiological profiles in Eastern Europe and the CIS, the region is characterized by a high prevalence of infection among young people, especially young men: 8 out of every 10 persons living with HIV in this region are under the age of 30. Among the most recently diagnosed cases, the overwhelming majority (70%) are young men, but infection rates among women are increasing.

“This region cannot afford to see its young workers and future leaders infected and unable to contribute to society before they reach maturity” said Mr Mizsei. “The success of the economic and social transition depends on this younger generation.”

HIV/AIDS threatens economic growth
According to the report, the disease threatens to seriously affect the region’s prospects for economic growth, by putting new strains on already overburdened social protection systems. Premature morbidity could reduce annual GDP growth by one full percentage point, a tremendous impact for any country. “To put that in context—1% of GDP is the exact amount the U.S. gave Europe per annum to rebuild itself post-World War II with the Marshall Plan,” said Sir Bob Geldof, addressing the Dublin Conference.

Increased health expenditures associated with treating people living with AIDS could amount to one to three percentage points of annual GDP. These figures represent particular challenges, especially for the poorest countries in the region.

The above-average prevalence of HIV in the region’s over-crowded penal institutions—which the report calls ‘real HIV incubators’—is a particular cause for concern.

The risk of not responding decisively
Of the 80,000 people in the entire region who, according to WHO guidelines, currently require treatment for AIDS, only 7,000 now receive it. The reports note some 70 percent of the approximately 3,000 people in CIS countries who are receiving any form of antiretroviral therapy live in Russia. In this region, the extensive use of mono-therapeutic antiretroviral regimens, instead of the WHO-recommended triple-drug combination, increases the risk of generating a drug-resistant strain of HIV.

“It is high time to dramatically expand access to AIDS treatment and adopt new initiatives to lower the costs of antiretroviral therapy,” says Marc Danzon, WHO Regional Director for Europe. “Treatment, care and prevention must go together and be scaled up to really fight the epidemic.”

A number of countries in Central and South-Eastern Europe, such as Poland, the Czech Republic, and Slovakia have recorded important successes in halting or reversing the spread of the epidemic. They have been able to leverage progress in building vibrant democracies into effective responses to HIV/AIDS. At the same time, a relatively successful transition outcome does not in itself guarantee an effective response, as is apparent in the case of Estonia, which combines one of the region’s most successful transitions with some of its highest HIV rates.

Only twelve years ago South Africa too saw less than 1% of its adult population infected. Now that rate is twenty times higher. It is already too late to speak of avoiding a crisis in Eastern Europe and the CIS. Nevertheless, there is still much that governments and civil societies can do to reduce the social, demographic and economic consequences of HIV/AIDS and even reverse the epidemic.

"Involvement of the European Union in the battle against HIV/AIDS is a powerful push for the region to mobilize all necessary resources in curbing the disease,” Mizsei said.

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