By Rachael Hore, RESULTS UK TB Policy Officer

“I’ve known him for years. He watched his father beat his mother to death at 9. After that, he searched the bins for food while his father got drunk. He started injecting drugs at 12. He felt that streets were kinder to him than his family, so that’s where he’s lived ever since.”

This was one story we heard from Dan of a 19-year-old boy as he drove from point to point in Bucharest throughout the night like a well-oiled machine. The van delivers condoms, basic medical care, vaccines, needle-exchange, and testing for HIV and hepatitis. It is a lifeline for Bucharest’s most vulnerable populations: the homeless, drug users and sex workers. The young boy lived on the streets around the city’s main train station, where the sewage network was once home to hundreds of people. The prevention and harm reduction service run by the Romanian Association Against AIDS (ARAS) fills a vital gap in the national HIV response. This was abundantly clear throughout the rainy night; as the van pulled up, people were waiting. ARAS was founded in 1992 by a group of young volunteers with a mission to inform and educate people about HIV and the means of prevention. It also aims to promote and support people affected by HIV, including defending their rights and providing them with support.

Image: ARAS’s ambulance.

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However, funding for future work by ARAS hangs in the balance. Romania lost Global Fund funding for HIV in 2010 and the number of new HIV cases linked to injection drug use rose from 3% in 2010 to about 30% in 2012 and 2013. This spike was largely linked to the lack of funds for targeted prevention interventions. As seen in the graph below, the number of people living with HIV overall has been increasing in Romania, latest figures show that there were 15,212 HIV/AIDS cases as of June 30 2018, but the number of new cases is falling. ARAS’s work continues to be funded by the Global Fund through a grant for tuberculosis (TB), but this funding is coming to an end in Romania.

Graph: estimated number of people living with HIV in Romania.

Source: UNAIDS.

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In contrast to the experience with HIV, the transition away from Global Fund funding for TB over the next couple of years has been anticipated, the risks identified and mitigation activities drawn up, all by a wide range of stakeholders from government to civil society. As such, civil society organisations feel more confident that services, such as that provided by ARAS, will continue.

The challenges Romania faces in tackling HIV are reflected across western and central Europe, where late diagnosis of HIV remains a problem overall; nearly half of newly diagnosed individuals in the European Union and European Economic Area in 2016 had CD4 cell counts below 350 cells per mm3 (a healthy range is 500-1,500: once the CD4 count drops below 200, a person is diagnosed with AIDS). Stigma and discrimination within healthcare settings, particularly for sex workers, gay men and other men who have sex with men, and people who inject drugs persists across western and central Europe and plays a role in preventing these populations from accessing HIV prevention, testing and treatment services.


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