World AIDS Day Poses Challenge for Balkans

Shortages of funding for retroviral drugs, lack of equipment for testing and, most of all, the continuing stigma felt in society by HIV/AIDS sufferers – which inhibits people from being tested – all hamper the struggle to contain the disease and help those who have become infected.

The problems in each country are very different, as is the scale of the problem.

With about 7,000 registered cases of infection, Romania is the region’s giant in terms of HIV/AIDS.  Serbia comes second, a long way behind, with 2,472 cases. Macedonia by contrast has a mere 69. 

While the region does not face an epidemic, certainly not by the standards of some other parts of the world, there is no cause for complacency, principally because low rates of testing conceals the true number of cases.

Some Albanian experts believe the real number of infections in that country could be ten times higher than the official data suggest.

Albania: Too Few Tests

The Institute of Public Institute, ISHP, says that as of December 2009, the country has a total of 365 cases of HIV; 61 new cases were identified during 2009, more than 90 per cent of which occurred due to sexual contact  - 82 per cent heterosexual and 10 per cent homo-bisexual.

The most affected age group is people between 25 and 44. The institute says that in the last two decades Albania has registered 67 AIDS-related deaths.

The Albanian Association of People Living with HIV/AIDS reports 20 new HIV cases so far in 2010, mostly concentrated in Tirana.

But the association warns that few people in Albania get tested, so the real number of cases of HIV could be as much as ten times higher than official statistics. According to the Demographic Health Survey, only 0.2 per cent of females and 0.6 per cent of males took an HIV test in 2009.

Bosnia and Herzegovina: Status, ‘Insecure’

HIV/AIDS has had limited impact so far in Bosnia with only 163 cases of HIV-positive people registered since 1986. Seven new cases were registered in 2009.  

With the support of the Global Fund to fight AIDS, Tuberculosis and Malaria, Bosnia has enacted a number of measures over the past three years to prevent an increase. The country provides free HIV testing, all those infected have access to free antiretroviral therapy and a number of NGOs are included in activities to raise the awareness of risk behaviours.

Despite the small number of cases, Bosnia is considered an epidemiologically insecure country, Dr Ljubica Jandric from the Public Health Institute in Banja Luka told Balkan Insight.

“We are a post-war country with big population migrations and a poor socio-economic situation and all this increases the risk,” Jandric said.

“Not all HIV-infected people register, so the number of cases could be higher [than official data], which is why we focus on raising awareness of this disease and on the fact that with proper therapy infected people can continue with a normal life,” she added.

Zlatko Cardaklija, HIV/AIDS coordinator at the health ministry of Bosnia’s Bosniak-Croat entity, said the authorities needed to remain alert, due to the presence of high-risk groups in the country, including drug addicts.

According to the XY Association for Sexual and Reproductive Health, heterosexual contact is the chief HIV transmission path in Bosnia, accounting for 56.5 per cent of cases, followed by bisexual and homosexual contact with 18.9 per cent and injected drug use with 12.4 per cent.

According to several studies, the number of injection drug users in Bosnia ranges between 8,000 and 15,000. Samir Ibisevic from the Proj Association, said hostility in society was preventing the country from coming to grips with the disease.

“One of the key problems is the stigmatization of HIV infected people and population groups at risk of HIV/AIDS,” Ibisevic said.

Bulgaria: Victims Getting Younger

Statistics in Sofia show a total of 1,252 Bulgarians have been registered as HIV positive, but the ministry of health says the real number of Bulgarians infected with HIV is probably around 4,000 people, as many people do not get tested.

“People are still afraid to get tested. Others haven’t been tested and don’t know their HIV/AIDs status,” Tonka Varleva, head of the ministry’s Prevention and Control of HIV and AIDS programme, told Balkan Insight.

This year, 143 new cases of HIV/AIDS were reported in Bulgaria, ten less than for the same period of 2009. Of those, 119 are men and 24 are women. Over half of this number are between 15 and 29.

“The most worrying trend in recent years is that people getting infected with HIV/AIDS are getting younger and younger,” Varleva said.

Varleva warned about another problem among Bulgarian youth. “Although the number of young people who use condoms is growing, almost half of them don’t use a condom while having sex,” she noted.

The authorities are planning to improve HIV prevention among teenagers by introducing health and sex education classes in schools from next year. At the moment, such classes are optional.

Kosovo: Treatments In Short Supply

The number of people with HIV/AIDS in Kosovo remains relatively small, according to the Infectious Clinic in Pristina hospital.

The Kosovo Association for People with HIV/AIDS, based in Pristina, says 83 persons infected with HIV were registered since 1986. It notes to four cases this year, which they say shows the increase is relatively slow every year.  The average age of HIV persons is from 30 to 45.

Emine Qehaja, head of the Infectious Clinic’s HIV/AIDS department, warned that the real number of persons with HIV in Kosovo is unknown because many people may not visit the clinic and register for help.

Qehaja told Balkan Insight that while Kosovo has the lowest number of infections in the region, securing the right drugs for patients is still a challenge.

“What we need is a bigger quantity of medicines and a greater selection of treatments,” Qehaja said. She said Kosovo lacked a laboratory that can test patient’s immunology systems. “Such tests are done in France,” she noted.

Alban Gjonbalaj, director of the Kosovo Association for People with HIV/AIDS, said that stigma and discrimination continue to be a problem for suffers.

“But the main problem continues to be the very late supply of the medicines dedicated for therapy to those people,” he told Balkan Insight.

Macedonia: Under Control?

Macedonia has only 69 registered cases of people infected with HIV/AIDS.  This year, the Public Health Institute counted 12 new infections, only one of whom is a woman. All are aged between 20 and 39.

Since the first appearance of AIDS, Macedonia has registered 132 cases of HIV/AIDS, of whom 63 have since died.

“All reported patients in Macedonia are receiving anti-viral therapy, thanks to the UN’s five-year global support programme,”  Zarko Karadzoski, head of the Institute’s department in charge of this illness, told Balkan Insight.

Karadzovski noted that most newly infected cases concerned heterosexuals, “although in the last three years the number of newly infected homosexuals has increased”. Six of the 12 newly registered cases this year were infected as a result of homosexual intercourse, he noted.

Romania: Running out of Supplies

Romania has far more cases of HIV/AIDS than any other country in the region - around 7,000 in total.

The main problem is that hospitals in many regions lack the funds to buy the antiretroviral drugs that are needed to keep people with HIV alive and well, according to local organisations.

“In some counties, such as Iasi, Suceava or Vrancea,

there is no money for antiretroviral drugs and people are unable to get their supplies,” Cristian Rosu, president of the National Union of Against AIDS Organisations, UNOPA, said. “If the government does not find a solution, people with HIV will be sentenced to death,” Rosu added.

NGOs want the government to take steps to restore the drug supply. For its part, the government said that money to pay for drugs for December and January 2011 was now secured.

Romania has received support for its HIV/AIDS programmes, mainly from the Global Fund to Fight AIDS, for some years. But this aid was recently stopped, forcing Bucharest to find a solution on its own. Meanwhile, Romania is facing an economic crisis.

Serbia: Raising Awareness

The most recent data from Serbia, for 2009, say 2,472 people are officially registered HIV-positive. Since 1985, 962 people have died of AIDS.

Each year, there are just over 100 new HIV cases, almost half of whom are aged between 15 and 29, the Deputy Health Minister, Ivana Misic, said.

Misic said more needed to be done to raise awareness of the risks to young people.

On the occasion of World AIDS Day, Serbia's association for AIDS, JAZAS, is organising psychological counseling and free testing while the organisation's youth wing is holding a street event in Belgrade’s central Republic Square in Belgrade, attended by many public figures and officials.