AIDS in Romania

The upheaval that followed the fall of communism in Romania in 1989 was not limited to politics. Like other centralized services, the national health infrastructure collapsed shortly thereafter; and at a particularly inopportune time as the country was in the throes of an HIV/AIDS epidemic.

Yet it has been the involvement of the private sector, impossible under communism, that has helped Romania make dramatic progress in fighting the AIDS epidemic. During the 1980s, thousands of orphaned infants and small children—more than in any other European nation—became infected with HIV. Initially, the epidemic was fueled by tainted blood transfusions given to children in hospitals to treat anemia and malnourishment and by the large number of youngsters using intravenous drugs. Although the total number of cases is small compared to many other neighboring countries, there could be a resurgence of new cases due to two factors.

First, the children who were infected in hospitals between 1988 and 1991 are now becoming sexually active. Second, there are several high-risk populations whose numbers are growing or whose access to health care is limited at best. These include intravenous drug users, prostitutes, ethnic minorities such as the Roma, and other marginalized groups. But the country is much better prepared this time around.

In 1997, only 1.5 percent of Romanian HIV/AIDS patients received triple combination antiretroviral (ARV) therapy in accordance with international guidelines. In 1999, however, the country developed its National HIV/AIDS Strategy and the situation changed dramatically.

By January 2002, Romania became the only country in Eastern Europe to provide access to antiretroviral therapy to all patients who need treatment—a remarkable accomplishment.

Public and Private Funding

A critical component of the government's strategy was involving other partners—particularly the private sector –and expanding its activities beyond direct health-care services.

As a result of an agreement with Merck & Co, in 2001 that company agreed to cut the prices of its AIDS drugs in Romania by 86 percent, making no profit on the sale of these medications. Romania thus became the first country in Europe to benefit from negotiated price reductions for ARV drugs. While Romania continues to seek and receive funding from international agencies such as the United Nations' Global Fund to Fight AIDS, Tuberculosis and Malaria, it also looks to the private sector for help in spending more effectively these funds.

Funding allows financing for both government and nongovernmental organizations to focus on HIV prevention and surveillance, and pay for the training of more than 2,000 doctors working with HIV patients. All HIV/AIDS patients undergoing treatment are now included in a national database that is critical for following the course of the epidemic. Besides supporting this database, Merck has donated $1 million for the creation of a national network of regional AIDS centers with modern diagnostic equipment.

There are now several other examples of public-private partnership in the fight against HIV/AIDS.

In Africa, Bristol-Myers Squibb, Pfizer and Boehringer Ingelheim, among others, have been particularly active. In addition, the Clinton Foundation HIV/AIDS initiative has reached agreements with generic drug companies to cut the prices of antiretroviral AIDS medicine. The opportunity to control the epidemic lies in catching it in its early stages, and by helping governments put in place effective measures to change its growth trajectory. This has been accomplished in Romania through working partnerships among patients groups, drug manufacturers and the medical community.

A non-governmental organization of HIV-infected people has been created and has become an active participant in the decision-making process, and in prevention, support and planning activities. The Romanian Association against AIDS and the Romanian Ministry of Health have carried out a project designed to help prostitutes fight the infection.

Universal access to treatment is critical in the fight against HIV/AIDS. For countries with limited economic resources such as Romania, partnerships that combine political commitment with private sector resources and the efforts of non-governmental organizations are the best way of successfully confronting the HIV/AIDS pandemic.

Dr. César Chelala is an international public health consultant and the author of "AIDS: A Modern Epidemic," a Pan American Health Organization publication.