ROMANIA

Monitoting and Evaluation of HIV/AIDS programs

Iona Stancel Sanda

Background

Romania has 22 million inhabitants. The first AIDS case was reported in 1985, but there was no system for reporting HIV/AIDS cases prior to 1990. In 1990 HIV infections among children (orphans and hospitalized children) were reported. All cases were as sociated with medical care-associated infections, largely related to blood transfusions. The epidemic in Romania is either low grade or concentrated, but data on the HIV prevalence in high-risk groups are largely lacking.

National response

There is no comprehensive national AIDS programme. Prevention activities fall under the national STD programme and financed by the state outside the health insurance system. This year, the programme received only 11% of its proposed budget from the sta te. A multi-sectoral AIDS commission was in place during 1994-96, but was not continued.

There is a national AIDS commission under the Ministry of Health. Efforts to activate this commission have not yet succeeded. The UNAIDS theme group has been instrumental in the establishment of an Analysis and Evaluation commission which includes repr esentatives from the government, NGOs and international organizations. Since 1990, donor blood has been tested for HIV and other pathogens. Romania has only one center for voluntary counseling and testing. IEC programmes for adolescents are primarily run by NGOs. There are no prevention programmes for high-risk groups. A condom social marketing programme has been established.

Monitoring and evaluation

Hospital data are still considered the basis for HIV surveillance. This includes data from the country's 41 STD hospitals (one in each state). HIV testing laboratories report the results of HIV tests on a monthly basis. Only about 10% of facilities hav e HIV testing facilities. There is a mandatory system of syphilis testing for those applying for marriage and driver's licenses, on job applications, for admission to military service, and among pregnant women. The reporting system is weak, however, and underreporting is likely. There is a network of blood donation centers and all include HIV testing. Data are reported to the Ministry of Health.

In 1996 a national young adult reproductive health survey was conducted among men and women 15-24 years old, with assistance from CDC-Atlanta. This survey included questions on HIV/AIDS, STD and sexual behaviour.

Input, output and context

There is no systematic monitoring of the IEC and other activities undertaken by the 15 national level and 100 local level NGOs in Romania. The 1996 national reproductive health survey provides baseline information on knowledge of AIDS, STD and condoms among adolescents.

Almost all respondents had heard of AIDS (more than of other STDs) and knew about sexual intercourse as the main mode of transmission. 38% of women and 27% of men did however not believe HIV infection could be asymptomatic.

Proximate determinants

The 1996 national reproductive health survey provides baseline information on sexual behaviour during adolescence. One fourth of female and two-thirds of male respondents had premarital sexual experience. 10% of men reported two or more sexual partners in the last three months (women 1%). 22% of women and 37% of men said they had used a condom use during the last sexual intercourse.

HIV and STD

HIV prevalence among STD patients is about 0.5% (1996). Data from the STD hospitals and some of the other sources suggest an in increase in syphilis incidence in the 1990s, but gonorrhea appears to have declined, although this is thought to be associa ted with underreporting. STD statistics are however of doubtful quality, as the denominators are not well defined.

AIDS impact mitigation

The reported number of pediatric AIDS cases was about 5,000, but cumulative number of children infected through medical care related infections has been estimated at about 10,000.

By 1997 just over 5,000 AIDS cases had been reported. There are only two NGO residential hospices for terminal care of children with a maximum capacity of 120 beds.

Medical care for AIDS patients is provided, including infectious disease hospitals, day clinics and NGO services. Eighty percent of AIDS patients are reported to receive treatment with at least one anti-retroviral drug, but only 10% receive three drugs .

Conclusion

In the early 1990s Romania had an outbreak of HIV infections among children due to medical care associated infections. This was brought under control, but now the country is facing an increase in STDs and probably also HIV infection. The overriding fea tures of the epidemic in Romania are the lack of data and lack of interventions among high-risk groups and general population. There is no HIV surveillance system in place and there are hardly any biological or behavioural data on the population groups th at in most countries provide essential information in the early stages of the epidemic.