AIDS death rates in Eastern Europe and the former Soviet Union have soared in the last decade while the EU continues to put the brunt of its funding for treatment and prevention in developing nations, according to experts who say this is creating a potential health timebomb on the EU’s eastern frontier.
Efforts over the last decade from the international community to prevent and treat infections in sub-Saharan Africa have delivered tangible results, with the number of AIDS-related deaths dropping significantly in many countries.
In a bid to halt the rise in deaths from readily preventable diseases, leading development donors agreed in 2002 to create the Global Fund to Fight AIDS, Tuberculosis and Malaria as an international financial clearinghouse to support prevention and treatment.
From 2001-2011, Ethiopia reported a 46% drop in the number of people dying of AIDS. In Botswana, the number went down by 77% in the same period and fell by 61% in Zimbabwe, figures from the World Health Organization (WHO) show.
Yet the same results do not hold true in Eastern Europe.
Nicolas Cantau, the Global Fund’s expert on Eastern Europe, told EURACTIV that while HIV is often spread through unprotected sex and mothers passing the virus onto their infants, in Eastern Europe the infection is mainly spread through drug users sharing dirty needles.
“This is why it’s extremely important to do targeted work with what we call the key affected population; drug users, men having sex with men and sex workers in general,” Cantau said.
Though the number of cases in Eastern Europe is relatively small compared to Africa, the percentage increase of people who die of the AIDS-related complications is considerable.
In Ukraine, 21,000 people with AIDS died in 2011 compared to 9,000 people in 2001, a 144% increase.
In Belarus, there were 100 AIDS-related deaths in 2001 while the number reached 1,100 in 2011 – a 1100% increase.
EU member states such as Bulgaria and Romania and the former Soviet Union republics of Armenia, Azerbaijan, Gerogia, Kazakhstan and Kyrgyzstan all experienced a more than 200% rise in the number of people dying of AIDS-related complications between 2001 and 2011.
Mario Raviglione, the director of the WHO Global Tuberculosis Programme, said in an interview that it’s “obviously plausible” that some countries have religious reasons to downplay cases of disease transmitted by unprotected sex or drug use.
This also means that people in these countries might be unaware that they are living with a "taboo" infection, thus putting their health at further risk. Raviglione mentioned Ukraine as a “problematic” example in the past with unsatisfactory disease responses.
There are also problems with discrimination and stigmatisation in the region.
“It takes a lot of political courage to address the epidemics, and say from a government side that they are going to invest in the drug-user population and provide them with sterile needles,” the Global Fund’s Cantau said. “Unfortunately we are not there yet in many of the countries.”
Cantau did applaud Ukraine for now providing services and support to affected populations, with help from the Global Fund.
“This is why you are seeing now changes in the epidemic pattern in Ukraine,” he said.
“It’s stabilising now in Ukraine. This is great news and it’s the proof that doing active prevention work and activities with the most-affected population is the right thing to do because then you can somehow reverse the epidemic.”
In the first quarter of 2013, AIDS-related deaths in Ukraine fell by 12% compared to the same period in 2012.
The decline showed that national policies on HIV/AIDS are effective, a representative of the State Service for Counteraction of HIV/AIDS and Other Socially Dangerous Diseases told EURACTIV.
EU needs a better response
While developing countries in Africa still struggle with infectious diseases, Raviglione advises that the EU’s policy towards its eastern neighbours should also include a plan of action against the diseases.
“Without a proper reaction and help to these former Soviet Union countries, you can expect trouble in the future because infectious diseases do not stop at the border,” the WHO official said.
The EU tends to “misunderstand” the purpose of the Global Fund, Cantau added, as it’s also important to invest in middle-income countries where the incidents are rising.
Separately, the European Union has also faced criticism from some anti-poverty campaigners for its 2012 ‘Agenda for Change’ that aims to focus more European development spending on the world’s least developed countries by shifting some resources away from middle-income nations. Campaign groups that include ActionAid and the European Concord Alliance say this could harm programmes in middle income countries that still have deep pockets of need.
“It’s important also that the EU understands that the Global Fund is not a poverty-reduction instrument,” the Fund’s Cantau said. “It’s important to also invest in middle-income countries including Eastern Europe and Central Asia to tackle the HIV and tuberculosis epidemics that are happening at their border.
“The EU says that the Global Fund should only finance the countries that have the least ability to pay. But the problem is that the HIV epidemic does not go parallel with poverty. You have poor countries that have no or fewer HIV problems while we have upper-income countries that have a huge problem. We are fighting the diseases, we are not fighting poverty here,” Cantau said.
In a speech delivered in April, EU Development Commissioner Andris Piebalgs emphasised that the Global Fund would remain an important instrument for the EU in the fight against HIV/AIDS, tuberculosis and malaria in "poor" countries.
Asked about funding for Eastern Europe, European Commission spokesman Frédéric Vincent referred to a document which states that in several European regions, there remains a shortfall in structures, means and access to HIV prevention, testing and treatment.
The expanding HIV epidemic in neighbouring countries is seen as "very worrying and needs to be curtailed".
"Finally, there is still stigma and discrimination in Europe directed at people living with HIV/AIDS, which drives people away from seeking help and care, fuelling an increase in HIV transmission," the document reads.
As part of its reponse, the Commission organised a conference on HIV/AIDS and human rights in May 2013, in cooperation with the United Nations and with support of members of the European Parliament. But there was not call to a shift in funding to the EU's eastern neighbourhood.