HIV/AIDS in Europe and Eurasia -situation, response,

opportunities and challenges

By

Henning Mikkelsen, Senior Adviser,

UNAIDS Secretariat

Irkutsk, Siberia

“There are about 13,500 HIV-carriers in Irkutsk Region.

Nearly 8,000 of them live in the city of Irkutsk, chief

medical doctor of the regional anti-AIDS centre Yuliya

Rakina told ITAR-TASS.

Every school and college in Irkutsk has HIV-infected

students.”

Age distribution of reported HIV cases in Estonia 2001 (as of 27 September 2001)

0

100

200

300

400

500

0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49

Moscow 181Russia 136Siberia 166

Reported HIV prevalence (per 100,000 persons) in mining territories of Siberia (Russian Federation)

Altai krai96

Kemerovo oblast141

Tomsk oblast53

Khanty-Mansi AO447

Tyumen oblast157

Yamalo-Nenetsky AO118

Republic Buryatia153

Republic Tiva5

RepublicKhakassia

13

Krasnoyarsk krai127

Taimyr AO78

Evenki AO5

Chita oblast68

Irkutsk oblast465

Prevalence of injecting drug use in Central and Eastern Europe and Central Asia

(per 1000 population, 1999 estimate)

>7 6-7 4-5 2-3 < 2 no data

The fastest growth ever….

The scale: Drug use and casual sexual relations involve/affect

very large parts of the population

The dynamic: – injecting drug use, prostitution and casual sexual relations rapidly on

the rise

– the drug injectors are young and highly sexually active

– high proportion of young people who occasionally inject drugs and/or involve themselves in sex trade

Only the beginning - immediate and very high risk for

development of larger scale sexually transmitted HIV epidemics

The impact

Socio-economic: By 2010, GDP cut by 4% in Russia (World Bank 2002)

Demographic:– hits young people in particular– will accelerate the population decline

Security:– Death toll– Reinforces instability and social unrest– Armed forces and police are highly vulnerable

Urgent need for a comprehensive response

To reduce the vulnerability of young people

to enable and empower young people to reduce their

sexual and drug injecting risk behaviour

Additionality: attention to highly vulnerable groups and

to vulnerable young people

Link prevention and care

Growing commitment and partnerships at country level

CIS Programme for Urgent Response to HIV/AIDS

Russia:– Lead role in the CIS on HIV/AIDS – First national NGO meeting hosted by government

Public statements on HIV/AIDS by Heads of States in Ukraine and Romania

Negotiations on ARV price reductions

Around 15 countries have applied for the Global Fund to Fight AIDS, TB and Malaria:

– Country coordination mechanism established– Partnership with people living with HIV/AIDS and other civil society

organizations

The “Checklist” in Europe as of end 2001 –30 countries assessed

0

5

10

15

20

25

NationalStrategic

Framework

Implem. Plan Costed Plan M&E Plan Coord.Mechan.

International assistance by main programme areas, end 2001

28%

16%

4%

17%

24%

11% Injecting drug use

Young People

Other vulnerable groups

STI/condomprogrammingCare

Advocacy, programmedevelopment

Total: US$51.8 million

Growing resource opportunities

Global Fund to Fight AIDS, TB and Malaria

World Bank projects

Increasing bilateral support

European Commission?

Changing gear in a changing context

Expand the framework to support comprehensive responses by governments and civil society

Ensure effective coordination with government and other country actors

Support countries to be accountable through good monitoring and evaluation

Assist intercountry sharing of experiences (e.g. through CIS)

Reminder

The global total for AIDS is $3 billion. We need 10

billion!

International aid overall is going down

The Global Fund is additional

Projected HIV/AIDS resource availability 2002-2005.

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

Unmet Need

GFATM

International

Private

National

* Assumes continuation of 2002 budget levels.