Moldova making progress in fight against HIV/AIDS and tuberculosis

Moldova’s early actions to fight HIV/AIDS and tuberculosis are slowing the rise of the country’s dual tuberculosis and AIDS epidemics, the World Bank reports.

While the overall prevalence of HIV continues to increase, its spread among injecting drug users has slowed, thanks to educational and ‘harm reduction’ activities being carried out as part of a nationwide program supported by donors and the government. The sharing of dirty needles and unprotected sex are the two main ways the virus is spread.

Moldova’s overall HIV prevalence rate continues to increase; however, the proportion of injecting drug users among newly detected HIV cases decreased from about 80% in 2000 to less than 55% in 2003. Incidence of HIV cases among injecting drug users fell from 29% in November 2001 to 22% in December 2003. This drop partly reflects the effectiveness of educational and ‘harm reduction’ activities (such as provision of clean needles) in this group.

The National Program for Tuberculosis/AIDS control project is expected to lower the incidence of HIV/AIDS from 4.66 per 100,000 people in 2002 to 4.00 in 2006 and decrease the number of new, active TB infection cases from 83.6 per 100,000 people in 2002 to 64.3 in 2006.

The program is the first nationwide TB & AIDS project in an former Soviet Union country where antiretroviral drugs are being offered free of charge; it is the first state-run program to deliver prevention, treatment and care in prisons; and it is an example of concerted donor coordination by the World Bank, the Global Fund to Fight TB, AIDS, and Malaria as well as USAID and others.

The World Bank is contributing $5.5 million in grant funding through the International Development Association (IDA) toward the National Program for TB/AIDS control and is helping carry out treatment, care and prevention activities. The IDA funding was approved in June 2003.

Financing for the Republic of Moldova’s TB/AIDS/STI program now totals $14.7 million, with $5.5 million from IDA for the AIDS project and $5.2 million from the Global Fund to Fight AIDS, TB and Malaria. Remaining financial support is coming from USAID and the government itself.

A comprehensive HIV/AIDS control program is now in place, with vulnerable groups such as commercial sex workers, prisoners and young people who inject drugs receiving prevention, treatment and care.

Soros Foundation Moldova is managing HIV/AIDS prevention activities among vulnerable groups. About 11,000 clients are served by 28 NGO subprojects. About 90% of the harm reduction subproject clients are injecting drug users (IDUs) who are especially at risk. There are activities targeted at men having sex with men, commercial sex workers and Roma populations.

The prison system is fully covered by prevention activities. These measures include information and education campaigns, condom distribution, disinfection of needles and other measures. In addition, needle exchange is provided in three prisons.

“Both needle exchange and methadone programs are very controversial. But the reason why we do it is because it blocks transmission from the most affected vulnerable groups. It blocks transmission of AIDS from the IDUs,” explains Dumitru Laticevschi, Manager of the Project Implementation Unit.

Results to date from the program are encouraging:

• Increased capacity of laboratory services to diagnose HIV/AIDS, STIs and Tuberculosis has significantly increased, with 80,000 highly sensitive HIV blood screening tests now procured.
• Home and community-based care for people living with HIV/AIDS is being developed.
• The prevention of mother to child transmission (PMTCT) training has been organized across the country, and milk formula for substitution of breast-feeding is available for free to mothers with HIV.
• School curricula has been developed and approved by the Education Ministry.
• A National Monitoring and Surveillance Unit was created to monitor the national programs for control of HIV/AIDS/STIs and TB.

“The leadership commitment at the highest level is extremely important. If the President, and Prime Minister talk about it and take initiative and are constantly working on it, it is going to succeed,” said Ed Brown, Country Manager for the World Bank and member of the UNAIDS coordinating team in Moldova.