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					                           Children affected by HIV/AIDS
    in the Central and Eastern Europe and Commonwealth of Independent States

Greetings.

(I) Overview of epidemic situation

Central and Eastern Europe and Commonwealth of Independent States has seen the number of
people living with HIV increase by one quarter to 1.6 million people, since 2003 (To compare
with 1.7 mln in Latin America.) and the number of AIDS deaths almost double to 62,000 in the
same period.

    The bulk of the people living with HIV in the region are in Russia and Ukraine.

    While injecting drug use continues to be a major driver of the epidemic, patterns of the
     epidemic are changing in several countries with sexual transmission of HIV comprising a
     growing share of new diagnoses.

    The epidemic has a young face. More than 80% of those living with HIV are under the age
     of 30 (in Western Europe, only 30% of HIV+ are under the age of 30).

    The epidemic is increasingly affecting women who account for about 30% of all HIV cases. In
     Ukraine, Belarus and Moldova, about 45% of all new cases are among women This gradual
     feminization of the epidemic is visible even among very young women in the Russian
     Federation, for example. In 2004, women in their late teens (15-20) accounted for a bigger
     share of newly reported HIV cases than did men in that age group. Some were infected through
     injecting drug use and many others through unprotected sex with HIV positive men.

    The epidemic also has a child’s face. The number of children born to HIV positive mothers
     doubles every year in Russia and Ukraine.

    We have not yet faced massive deaths due to AIDS and, although much more is needed, access
     to ARVs is slowly increasing.

    We still have a window of opportunity to take decisive actions to halt the epidemic.

(2) Impact on children and young people

    Social and economic upheaval of transition from state-controlled to market economy have
     left children and adolescents more vulnerable to HIV infection as a result of poverty, family
     breakage, stress and collapsing social structures. Injecting drug use has fuelled HIV epidemic
     in many countries in the Eastern Europe and Central Asia. It is estimated that there are over 3,2
     million injecting drug users in the region and 25% of them are under the age of 20. The growth
     of commercial sex work and human trafficking exacerbates vulnerability of young people to
     HIV.



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   Feminisation of HIV inevitably increases the number of children affected by the epidemic. In
    Russia and Ukraine, over 30,000 children were born to HIV+ mothers during the past 5-6
    years. They comprise 7% of the total number of all officially registered HIV-infections in these
    two countries. In 2005, 17% of all new HIV cases were among children born HIV-
    seropositive.

           In Belarus, about 5% of all new HIV cases were among children born HIV-
       seropositive


(III) Response

   For several years, other competing social and economic priorities of the transition to market
    economy have limited governments’ capacity to respond to the epidemic to the scale required.
    The Global Fund, World Bank, EU, DFID, USAID and other donors have provided over
    $600 million to fight HIV epidemic in our region.
   UNAIDS co-sponsors (WHO, UNICEF, UNFPA and other organisations) have provided
    necessary technical support to develop local capacity in the countries.
    NGOs have played a critical role in providing outreach to populations most at risk to HIV.
    Innovative Government and NGO partnerships are emerging in some countries (e.g. Ukraine,
    Romania, South East Europe).
   This made possible to start ARV treatment programmes for children and adults and scaling up
    prevention in several countries in the region.

   In Russia, the Global Fund has allocated over $200 mln for 2004-2008. The Government has
    pledged another $100 million for 2006 alone. In September 2005, President Putin
    acknowledged importance of securing universal access to ARV treatment in Russian
    Federation. HIV prevention and treatment is included into the National Health Care Priority
    Project in Russia.

       o For Belarus(over 6,000 registered HIV-infections) the Global Fund has allocated about
         17$ mln for 5 years. HIV prevention and treatment is included into the routine work of
         health care system.

   The recent launch of the UNICEF’s global campaign on children provided an additional
    impetus to focus attention on children and adolescents affected by HIV and AIDS in the
    region.

   In a number of countries, issues of HIV prevention and treatment have been included in the
    National Plans of Action for Children (e.g. Russia, Ukraine, Albania, Belarus,
    Tajikistan.) This reinforces the existing national laws and programmes on HIV/AIDS and
    proves additional mechanism to meet the needs of affected children.

   In most CIS countries, there are networks of AIDS centres which are responsible for HIV
    surveillance, testing, prevention and treatment. Focused mostly on adults, they still have to
    develop their capacity to provide quality counselling, testing, follow-up and treatment to
    adolescents and children. With the growth of number of people living with HIV, the whole


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      network of primary health care institutions have to gear up their capacity to meet the needs of
      HIV positive clients to make services easy accessible.

     An ongoing challenge is to ensure that the people most at risk to HIV are targeted in
      interventions to increase universal access to prevention, treatment, care and support. This
      requires concerted efforts to address stigma and discrimination.



PMTCT
 The region’s unique combination of long-established health systems, trained professionals,
  near universal literacy and relatively low number of HIV positive women and children makes it
  possible to limit infant HIV infection to levels found in Western Europe. The challenge lies in
  ensuring those women most at risk to HIV, particularly in low prevalence countries, have
  access to timely PMTCT services.

     In some countries PMTCT has been integrated into MCH services which routinely counsel and
      test pregnant women and refer HIV positive women to AIDS centres to receive ARV-
      treatment. National standards and protocols on PMTCT have been adopted. During the past 5
      years, PMTCT coverage has increased in Russia and Ukraine from 11% to 86% and in
      Belarus it has reached 91.2% coverage. (In Russia in 2003, 32% of the Federal AIDS budget
      was allocated for PMTCT). As a result, the rate of HIV-transmission from mother to child has
      dropped from 20-25% to less than 10%, one of the lowest in Eastern Europe. The goal is to
      reach less than 5% during the next 2-3 years.

     PMTCT programmes are being introduced in Central Asian countries.

     In some countries, like Romania, non-governmental organisations play an important role in
      preventing MTCT through provision of voluntary counselling and testing and other services.

HIV-testing in children
 The issue of early identification of HIV-infection in infants is still to be resolved in most of the
   countries in the region. PCR tests are expensive and not always available. Limited laboratory
   capacity is another obstacle for early diagnosis. HIV status of children born to HIV positive
   mothers is only established after 18 months.
 However, good progress has been in Ukraine, where PCR testing for children born to HIV
   positive mothers was introduced at the end of 2005.

Paediatric treatment
 According to UNAIDS, across the region, an estimated 160,000 people need ARV treatment,
   but only 20,000* have access.
 To date, there are over 3,800 children under the age of 15 living with HIV in the three most
   affected countries in the region: Russia (1,986), Ukraine (1,076), Romania (749). (This does
   not include seropositive children born to HIV positive mothers whose HIV status have not been
   established yet).
 Romania and Russia first encountered an outbreak of HIV epidemic over 15 years ago when
   several hundred children were infected in hospitals and residential institutions. To provide
*
    UNAIDS. Epidemic updates 2005.
                                                    3
    treatment and care to these children, a specialised hospital and research centre was
    established in St.Petersburg.
   Significant progress has been made to increase access to ARV treatment for children in
    Ukraine: 407 children are receiving ARV treatment in 2006 to compare with 86 in 2003. In
    Russia, about 500 children are receiving ARV treatment.

Care and support
 Provision of psycho-social support to HIV-affected children and families is yet to be scaled-up.
   However, there are already a few good examples in the region.
 In Ukraine, a network of 11 day care centres (established with UNICEF and GFTAM
   support) provides children affected by HIV an opportunity for socialisation and development in
   early years and also helps prevent child abandonment. UNICEF also supported development
   of the first training module for care providers.
 In Russia, UNICEF and European Commission support several pilot projects to provide
   psycho-social support to HIV-affected families In Belarus, with UNICEF’s support social
   services have become available for HIV-affected children and families in three towns.

   To strengthen the role of social welfare system in provision of comprehensive care and
    support to HIV-affected children and families and other vulnerable groups, a Coordinating
    council has been recently established under auspices of the Ministry of Health and Social
    Development in Russia.

   Role of people living with HIV in provision of peer counselling and social support to HIV-
    affected families is growing. Examples of their engagement include: work in day cares,
    outreach centres for women and children affected by HIV across the region.- much more is
    needed.

Access to education
 Stigmatisation and discrimination of people living with HIV/AIDS is still widespread across
   the region.
 Because of stigma, children born to HIV positive mothers, or living with HIV, are often
   deprived of opportunities to attend preschool, find it difficult to enrol into primary school.
   Separated children often live in hospitals as residential institutions reject them. In Russia, the
   first few cases of foster family care for separated HIV positive children were only registered in
   2005.
 In Romania, fighting stigma and discrimination of HIV positive children and adolescents has
   been introduced into life-skills education and other curricula taught at schools. Children and
   young people living with HIV are empowered to fight for their rights.

Protection of orphans and vulnerable children
Across the region, HIV positive pregnant women face relentless discrimination. Many are
dependent on drugs and have no access to drug treatment. Many more live in poverty. For some,
prospect of caring for a child who may also be HIV positive, without any support network, is just
too much. They abandon, or are separated from, their infants. In Russia and Ukraine, about 10-20
% and in Belarus about 5 % of all children born to HIV positive mothers have been separated
from their mothers at birth.



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Policies and resources must shift from institutionalisation to support for biological or foster
families. To ensure protection of children affected by HIV, it is vital to implement laws to protect
rights of all children to education, to health, to protection.

Challenges
 Limited capacity and expertise to prevent new infections amongst populations most at risk
   to HIV
 Data, including behavioural surveillance, to better inform prevention, treatment, care and
   support interventions
 Monitoring of children born to HIV positive mothers has to be strengthened across the region.
 Data on children exposed to HIV, tested HIV-positive is needed to plan and develop prevention
   and treatment programmes.
 Regular and sustainable supply of HIV tests and ARV drugs to prevent MTCT and provide
   treatment to children and their mothers must be secured.
 Limited expertise in treating children with HIV. Few paediatricians are adequately trained
   in ARV and care of HIV-positive children. Capacity of health workers and social workers must
   be strengthened to provide comprehensive health care and psycho-social support to families
   and children affected by HIV.
 Effective mechanisms for prevention of separation of children born to HIV positive mothers
   are yet to be developed.
 Absence of standards and established mechanisms for social support to families and
   children affected by HIV/AIDS.
 Stigma and discrimination of people living with HIV, including children and of injecting
   drug users, sex workers and MSM.


Key milestones
 In March 2005, ministers of health of CIS countries met in Moscow to discuss and share
   national experiences in fighting the epidemic.
 On March 1-2, representatives of CIS countries will meet in Moscow to discuss what has to
   be done to ensure universal access to treatment and care in the region.
 In mid-May over 1,500 representatives of national authorities, government organisations
   and civil society will meet in Moscow at the first Eastern Europe and Central Asia AIDS
   Conference.
 G8 Summit. In June, leaders of 8 countries will meet in St.Petersburg. Among other issues
   they will discuss challenges posed on nations by spread of infectious diseases, including
   HIV/AIDS.




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