Prevention in Romania
Name and Location:
for more than half of the paediatric HIV/AIDS cases in Europe. In
January 1998 there were 5,147 AIDS cases in Romania, almost 90%
of them being children. However, during the past two years there
has been a 59% increase in numbers of AIDS cases for adults. While
there are no reliable data on the number of HIV infected people,
specialists from the Colentina Hospital for Infectious Diseases
- one of Romania's main hospitals for AIDS treatment - estimate
that there may be as many as 45,000 HIV cases, of which quite a
low percentage are children. Youth and adolescents are particularly
vulnerable. Recent data indicate a rapid increase in the number
of adults and young people infected through heterosexual transmission.
Started in 1998 - December 1999, possible extension
of grant from CIDA for January 2000 to December 2001
along with governmental partners and NGOs.
Partner: UNICEF Romania and UNAIDS
with support from Canadian International Development Agency (CIDA).
Ministry of Health, Ministry of Education, Ministry of Justice,
Ministry of Interior, Ministry of Defence, Ministry of Labour
and Social Protection, Ministry of Youth and Sports, Asociatia
Romania Anti-SIDA (ARAS), Societatea de Educatie Contraceptiva
si Sexuala (SECS), Tineri Pentru Tineri (Youth for Youth) and
Source(s) and Overall Budget (US$) Funded
by CIDA with one million Canadian dollars.
To strengthen the coordination and effectiveness of the national
response to HIV/AIDS through the development and implementation
of a National AIDS Strategy
create a supportive environment for youth health and development
improve the health of adolescents and youth, and reduce the
incidence of HIV and other sexually transmitted diseases (STDs)
transmission among Romanians (aged 15 - 25) by empowering them
to make informed decisions and to act on these decisions
- To expand
the national response for HIV/AIDS and STDs through developing
a multi-sectoral National AIDS Strategy based on a thorough situational
analysis and response review
- To raise
the awareness of community leaders, educators, health staff, governmental
staff, and social workers concerning the basic facts of HIV/AIDS,
to enable them to better inform the public and to build a supportive
environment for HIV/AIDS and reproductive health programmes targeting
To develop and implement national communication activities,
based on sound audience research, to support individual behaviour
change and the maintenance of positive behaviour, and to develop
a positive social norm for safe-sex among adolescents and youth
adolescents and youth with accurate knowledge about HIV/AIDS
transmission and safe sexual practices with a focus on peer
adolescents and youth with the life-skills necessary to practice
safe sexual behaviour and to protect their health;
positive behavioural norms amongst the peer groups of youth
and adolescents, which support the form of safe sexual behaviour
chosen by the individual (abstinence, fidelity and protected
that the resources that support behavioural change options,
HIV/STDs and pregnancy testing, and additional counselling,
are accessible to adolescents and youth; and
the awareness of leaders, health staff, educators and other
opinion leaders to create a supportive and informed environment
for all HIV/AIDS programmes.
adolescents in residential institutions participated in IEC
activities. · Over 8,000 young people attended a concert for
HIV/AIDS entitled "There is Room for Everybody: The Same Rights,
the Same Responsibilities".
is believed that hundreds of thousands of young people were
reached with messages through the mass media.
15,000 young people were reached with in-school activities.
Research was conducted to assess the health risks of intravenous
A total of 69 people were trained to be trainers for the HIV/AIDS
Awareness raising course through a national level training,
619 people trained all together. · 14 staff members of children's
institution were trained in reproductive health and a "Facilitators
Manual" was developed on Family Life for use with institutionalised
copies of the "1996 Young Adult Reproductive Health Survey Report"
was translated and distributed; a national conference to review
it resulted in a list of recommendations for policy makers and
for local implementation.
developing an Adolescent Health Resource Book on Sexual and
Reproductive Health, the Society for Contraceptive and Sexual
Education (SECS) developed questionnaires for adolescents and
health educators (government and non-governmental institutions),
in order to collect data on the perceived information needs
of young people.
high schools in three cities (Bucharest, Cluj and Sibu) were
identified to work on developing the health education manual
with Youth-for-Youth staff as well as a Ministry of Education
a highly participatory process involving 8 ministries and key
NGOs, a National HIV/AIDS Situation Analysis and Response Review
was conducted over a period of a year and a half and based on
this, a National Intersectoral HIV/AIDS Strategy was finalised
project hired a local consultant to review the existing legislation
as related to HIV/AIDS. Issues arising from the report will
be integrated into the National Strategic Plan and for follow-up
in Phase II of the project. The final report will be completed
by the end of the year.
project supported an NGO named RICIR (Romanian Information Center)
for the first time with a project entitled "Resource Mobilization
Campaign for the HIV/AIDS Network". The objective of the project
was to increase information sharing between NGOs working on
HIV/AIDS and to support an NGO Fair, which was to bring NGOs
together with potential corporate sponsors.
supported the NGO ARAS, which organised a first ever "Mega-concert"
which involved 29 top Romanian bands contributing their time
free of charge to an evening concert for the purpose of raising
the awareness of young people about HIV/AIDS. The theme of the
concert was "There is Room for Everybody: The Same Rights, the
Same Responsibilities". The project was extremely ambitious
with an element of risk as nothing like it had ever been organised
before. A team of ARAS volunteers distributed announcement posters
and help to coordinate the event itself. Over 8,000 young people
attended and another 2,000 were unable to get into the concert
hall. The event was used as part of a condom social marketing
project organised by Population Services International (PSI)
and ARAS, and all participants were given a pamphlet. The nominal
entrance fee was in fact to buy a condom which was used as the
entrance ticket. For many young people this was the first time
they had bought a condom, or had held one probably. At the beginning
of each band's performance, they shared with the audience a
specific message about HIV/AIDS. The event was televised live,
and a recording of it was repeatedly broadcast nationally by
"Atomic TV", which is the Romanian "MTV". For the TV, additional
interviews were held with the pop stars to discuss youth health
issues. In follow-up, numerous magazines carried articles on
the event. Some positive elements of the event:
demonstrated positive risk taking behavior of an NGO. There
was no assurance of the event's success, but ARAS took a
chance and organized it;
was supported by the private sector which is important to
involve in the national response to HIV/AIDS;
was structured so that youth had to buy a condom (positive
behavior) and gave them a chance to see what one looked
like, if it was new for them;
used well-known pop stars to deliver messages - they modeled
discussing health issues with peers (encouraging such discussion
is an important step in the adoption or maintenance of safe
health behavior by people); and
TV was used to spread the messages.
1997, UNICEF supported PSI and ARAS to conduct a qualitative
study entitled "Sexual and Reproductive Health Behaviour
Among Romanian Adolescents: An Exploratory Narrative Research
Analysis". The narrative research study used a methodology
of "listening to youth" which involved gathering twenty-two
young people aged 17-24, representing all regions of Romania,
for five days in a workshop setting to collectively share and
discuss their insights into the values, behaviours and social
conditions affecting the sexual and reproductive behavior of
young men and women. The research helped increase understanding
of the social issues surrounding youth and adolescent health
in Romania. UNICEF further supported a follow-up national survey
to quantify major findings from the narrative research and to
further explore key issues related to social norm for safe sexual
behaviour. The final report is available and entitled "Dating
in the '90s - Romanian Youth Narrative survey 1998".
The project is working with PSI in conducting a national campaign
targeting young people. More specifically, the project will
develop a series of interactive videos based on the PSI narrative
research also supported by UNICEF, which will be used as discussion
starters by the PSI mobile communication unit. When visiting
different localities, the communication team will train local
NGOs in peer education activities and in this way also strengthen
the capacity of these groups to continue work afterwards
adolescent boys and girls been involved in the project? In what
stages have they been involved - situation assessment, situation
analysis, planning, implementation, monitoring, and/or evaluation?
Young people planned and managed a "Mega-concert" - see above.
people were involved in every stage of a narrative study in
which they identified the typical social situations in the development
of a relationship between hypothetical couples.
adolescents participated in 6 sessions as part of the ongoing
family education programme organised by AURA: 430 boys and 100
girls aged 11-17 in institutions participated.
workshops were held with young people to discuss openly a variety
of topics, to identify their main questions and to solicit their
ideas about what should be included in the adolescent health
group research was conducted with young people with the information
to be used in refining pamphlets and in developing a peer-education
previously used pamphlet was tested by ARAS with 46 young people
to identify how it should be improved before being re-printed.
influence has their involvement had on the project?
were able to attract other young people to help in peer education
and HIV/AIDS related activities.
participated in peer education activities.
helped to design IEC messages and materials.
identified common questions that youth have about sexuality
and reproductive health and reviewed and improved the answers
that are to be included in a book.
the adolescent girls and boys involved in the project been affected
awareness, confidence, knowledge on health, and improved communication
been the achievements of this project to date?
The mechanism and steps of the development of a national strategy
plan were agreed upon by the Ministries and groups involved.
ministries have become actively involved in the strategic planning
A Situational Analysis and Response Review Committee was formed
and meets regularly.
experience in strategic planning in Romania is being used by
UNAIDS Geneva as an example in the region.
dialogue between Ministries on issues related to HIV/AIDS was
technical links have been established with Canada through CPHA
Consultants visiting Romania and through a study visit to Canada.
Has a formal evaluation been performed? Please elaborate.
work in HIV/AIDS from 1992-1999 is being assessed as part of
the end of cycle evaluation.
Strategic Planning Process is being evaluation against its the
increase the number of organisations and individuals involved
in the process ("to expand the response").
increase organisational and individual commitment, of those
involved in the strategic planning process, to develop and
support activities to address HIV/AIDS (to build a basis
of support for the final strategic plan).
expand the response to HIV/AIDS beyond the health sector
by helping those involved seeing that HIV/AIDS is not simply
a health issue.
develop a better and common understanding of the issues
and factors influencing the epidemic.
clarify the activities and positions of organisations and
individuals involved in the national response to HIV/AIDS
develop ownership of the strategic plan
national impact of all efforts are being monitored by national
studies that have been conducted:
Young Adult Reproductive Health Survey Report"
in the '90s - Romanian Youth Narrative survey 1998"
National Reproductive Health Survey Report"
the main constraints in meeting the project objectives?
project has to be highly sensitive to differing views and interpersonal
tensions in the Ministry of Health, as well as the constantly
changing environment within the Ministry of Health due to high
turnover of senior officials
due to the rivalries within the Ministry of Health, they did
not appoint any representatives to the Situational Analysis
and Response Review Committee. UNICEF and UNAIDS therefore requested
two people from the Ministry of Health to participate
project has had to be sensitive to the fact that in broadening
the response to involve other ministries and NGOs, the National
AIDS Commission (Ministry of Health) may feel as though they
are losing their authority
opinions of the most effective way to control HIV have made
the discussions on the approach take longer than was envisioned
at the beginning of the project
the strategic planning process the project has shown that there
are widely differing ideas on what should be done, and conflicting
ideas on priorities
from the gay community or commercial sex workers are not expressly
represented in the process given the legal situation in the
country. Furthermore, there are no people with AIDS on the Situational
Analysis and Response Review Committee and women are not as
well represented as they should in order having women's issues
Ministry of Health is experiencing a severe financial crisis
and those who are involved in politics or who are political
appointees are further distracted.
AURA project conducting family education activities with the
institutionalised children experienced great misunderstanding
on the part of the institution staff about the aims and objectives
of the project
staff have had difficulties not being seen as a threat to the
AURA staff by virtue of "knowing to much" and of being too close
to the children
Learned/Recommendations/What would you do differently if you could
do it over?
approach of working with a wide variety of partners within the
government and the NGO community has proven effective both in
expanding the national response and also in giving balance to
the project during times of rapid political change.
strategy of involving senior officials on the Situational and
Response Review Committee, to oversee a process in which the
fieldwork was performed by contracted national consultants,
worked effectively to keep ministries involved without burdening
there been more time, and perhaps more favourable social conditions,
it would have been ideal to have had more people from the various
sectors involved - commercial sex workers, the gay community,
with a wide range of government and non-government partners
can lead to a wider range of opportunities being identified
for potential follow-up · It took much longer than expected
to understand the full situation and the complex interpersonal
It was extremely important to have objective outsiders involved
in the process, such as the CPHA consultants, who were seen
by everyone as being impartial experts. Their importance increased
as the project progressed and as the strength of differing views
became more apparent. The fact that CPHA sent such highly qualified
people was certainly an advantage and resulted in their recommendations
carrying more weight.
support of the Canadian Embassy was extremely important to the
success of the project.
staff initially spent considerable time with AURA in preparing
their project proposal, which was seen as part of the capacity
building process. Other NGOs mostly wrote their own proposals
after consultation with UNICEF.
support tools/resources were developed that can be used/adapted
by other country offices?
The AURA project
is highly relevant for Romania and perhaps the most challenging
project that is being supported. The training materials and lessons
learned could also be used in other countries in the region.
"Romanian adolescents are educated, smart and enthusiastic.
It is not hard to motivate them to care about their sexual health
when you speak their language and you show them you care about
their values. That is what we are trying to do" - Adolescent
working with a UNICEF supported PSI project
of Information: Timothy Schaffter Health Officer UNICEF Romania