Vinay Saldanha
UNAIDS Regional Director for Eastern Europe and Central Asia
Current measures to fight the HIV and AIDS epidemic in Eastern Europe and Central Asia are not working, says Vinay Saldanha, UNAIDS Regional Director. It’s time to think differently.
1. What are the challenges facing Eastern Europe and Central Asia regarding HIV and AIDS?
Unfortunately, this is the only region of the world where both HIV incidence — or new infections — is increasing, as well as AIDS-related mortality.
Now, the only way to drive down incidence is to implement effective HIV prevention programmes. Across this region, programmes do exist; but their coverage is not sufficient to have a decisive impact on reversing HIV trends. Where they are available, they are not of the quality needed to change behaviours over long periods of time.
Programmes do exist in these areas; but their coverage is not sufficient to have a decisive impact.
All countries in the region are doing a lot regarding HIV; but if the epidemic continues to expand it is a clear and ominous sign that current measures are not enough. Put simply, we need to break the trajectory of the epidemic. That might sound hard or ambitious, but other regions of the world have been able to do it.
2. Is it possible to copy the methods of regions that have been successful?
Each region has its own cultural, political and medical peculiarities which need to be taken into consideration — but, yes, if HIV prevention works in one region, it will work in another.
And we can point to some success stories in Eastern Europe. For example, St Petersburg has one of the largest numbers of HIV cases of any urban center in the European region; but effective HIV prevention programmes have meant that for three years in a row there has been a decrease in the city in new HIV infections, even among the most affected populations, including injecting drug users. It’s proof that HIV prevention can work here in Eastern Europe and Central Asia.
3. Why has HIV and AIDS continued to be a problem in the region?
This year, Eastern Europe and Central Asia has been observing a rather grave milestone. It was exactly 30 years ago, in 1987, that the first case of HIV was diagnosed in Moscow, in the old Soviet Union.
While the rest of the world was focused on AIDS, the Soviet Union focused on HIV.
In one way, they were ahead of the curve back then because while the rest of the world was focused on reporting AIDS cases, the Soviet Union and Eastern European countries were focusing on cases of HIV, testing tens of millions of people and looking at the extent of the epidemic. However, the action they took in terms of HIV prevention was not consistent with the magnitude of the growing HIV epidemic in the region.
It’s why Eastern Europe and Central Asia is still moving in the wrong direction today.
4. In the fight against HIV and AIDS, does this feel like a forgotten region?
I wouldn’t say ‘forgotten’ because it’s getting an awful lot of attention in the media. But I would argue that HIV is still perceived both publicly and by policy-makers as only a ‘health issue’.
It’s bigger than that.
We can’t solve this problem without fully mobilising the health sector; but we also need the private sector, pharmaceutical companies, the education sector and high level political engagement and advocacy.
5. How important to the region are organisations such as the Elton John Aids Foundation (EJAF)?
We work with EJAF very closely. It has started a fund for the region focussing on HIV prevention and treatment for both HIV and Hepatitis C, for gay men, sex workers and people who inject drugs.
Until we end the epidemic among these populations, we are never going to end the HIV epidemic in Eastern Europe and Central Asia.
Of course, it’s not the only organisation that’s doing great work in the region. There are other sources and programmes — including local and national governments and The Global Fund to Fight Aids Tuberculosis and Malaria — that are helping countries, organisations and people who desperately need attention and financial support for HIV programmes, but EJAF is a welcome, timely and focused initiative.