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A New Epidemic

Irina has had to cope with four treatment interruptions already this year. She is asking: Why? Who can answer her question?
Irina has had to cope with four treatment interruptions already this year. She is asking: Why? Who can answer her question?

In the first six months of 2011 there have been 129 new cases of HIV infection in Romania, 62 of which are intravenous drug users (IDU). Compared to only 5 IDU infections the previous year, the figures read like an epidemic.

‘The problem is getting out of control. We have alerted all the national and international watchdogs. We have also communicated with the Ministry of Health.’ Dr Abagiu at Matei Bals hospital in Bucharest is extremely concerned that since funding from international donors ran out in June 2010, the HIV Prevention Programme has been operating only at half capacity. Apart from offering counselling and regular medical checks, mobile units distributed free condoms, disposable needles and wound dressings to those most at risk of HIV and hepatitis infection in Romania’s big cities.

‘This year ARAS (The Romanian Association against AIDS) has been tirelessly trying to keep up the supplies of disposable needles to injecting drug users. Evidently, the quantities are far from sufficient. Dirty needles are in circulation and the HIV is spreading fast. To compound the problem, we have seen a staggering growth in the number of ‘legal’ NSD (new synthetic drug) users. In 2010 around 400,000 individuals had used NSDs at least once. Most of them inject. One of the highest risk groups are fourteen to eighteen-year olds. Furthermore, heroin addicts who switch to NSDs are more likely to die suddenly of heart failure. In Bucharest alone 30.6% of IDUs have switched from heroine to NSDs. Since the beginning of the year we have had eight deaths in our clinic, compared to only one last year.’

Partly linked to the economic crisis, partly, to a market in new drugs fuelled by advances in technology and far-reaching online social networks, the new epidemic is damaging the health and claiming the lives of young people. Many heroin users in Romania are Roma. NSD users are predominantly teenagers from ethnic Romanian middle class families. Nobody has been spared irrespective of ethnic or social background.

The bad news does not end here. The majority of the infected are young people in their late teens or early to mid-twenties. In 2010 there were 65.2% interruptions in HIV treatments. The figures for this year are yet to be published but many patients have already experienced up to four breaks in their treatment. Doctors are embarrassed to look their patients in the eye. They mutter something about insufficient funds but the young men and women who they treat cannot accept such excuses. Romania has a cohort of 7 000 long term HIV survivors, infected in their childhood in Ceausescu’s hospitals. Most of them are currently in their early to mid-twenties.           

‘There is money to build an extension to the Bucharest underground or furnish the offices of politicians. Why don’t they have money for us? I was infected as a little girl in hospital when they used unsterilized equipment to treat me for pneumonia. My life has been tainted once, now they are robbing me of the hope that I can live to at least be forty.’ The pupils of beautiful twenty-four-year-old Irina are dilated with fear.

Lili won a battle with the health system to ensure that HIV would not be transmitted to her baby. How many more battles will she have to fight to stay alive and see her daughter reach adulthood?
Lili won a battle with the health system to ensure that HIV would not be transmitted to her baby. How many more battles will she have to fight to stay alive and see her daughter reach adulthood?

Another young woman is also on edge. Lili gave birth to a beautiful girl last year. Since Lili was infected with the virus as a toddler and was not diagnosed until she was eight, her immune system had taken a real battering. Lili dreads hospitals. The criminal negligence in Ceausescu’s hospitals has more recently been replaced with a prejudice against HIV sufferers which leaves one aghast.

Bucharest had only one maternity hospital in Giulesti designated to assist HIV+ women with deliveries. Caesareans are the norm in such cases as they reduce the risk of virus transmission from mother to baby, which can occur through broken tissues during natural birth. Giulesti hospital closed down in August 2010, following a fire in the neonatal unit. Lili was due in late September. Running out of time, she started doing the rounds of Bucharest’s maternity hospitals. She was turned down in two because the staff believed she would pose the risk of infection to other patients.

‘One nurse asked me how you pass the virus. I could not believe my ears.’ Lili’s hair still stands on end when she remembers the ignorance of some of the health professionals she encountered. She was finally taken on at Cantacuzino maternity hospital but a week after the initial interview, the chief of ward decided to block her. The baby was going to be born any day now so Lili went to the media and spilled the beans. With media pressure she received the treatment that was her right. ‘I was so stressed out that my milk dried up which was the only upside of this dreadful experience since HIV+ mothers cannot breastfeed. The operating doctor and anaesthesiologist were like guardian angels. Fourteen months have passed and it has been confirmed that our girl is healthy. I took every precaution to minimise the risk of her getting infected. I won although it was quite a battle.’

It looks like there are many more battles to come. This week, Lili’s husband has been in hospital every day queuing for hours and failing to get hold of the drugs she needs. Every patient responds to a different combination of pills. Lili’s has had to be changed fourteen times. She is a high-risk patient. So far her treatment has not been interrupted but if there are not sufficient supplies, her condition might become critical very fast. Right now, the left half of her face is paralysed. Even a little cold can cause havoc for an HIV sufferer. ‘I need all my energy to look after my daughter. I can’t afford to slip up. The system is letting me down again but I will fight for my right to life and a family.’

Patients, doctors and NGOs are watching the drama unfold bewildered at claims that there is not enough money to go around to pay for everyone’s medication. Against a backdrop of massive budgetary cuts in all sectors, the budget for HIV treatment grew handsomely this year.

‘The Government won’t admit that there is a problem!’ Dr Abagiu could not be more emphatic as he pauses before adding his signature to a letter drafted by the National Anti-Drug Agency and addressed to the Romanian government. It states the number of new HIV cases and highlights the scale of the crisis. Similarly, UNICEF published a study of treatment interruptions in 2010 and the threat those pose to patients’ lives. For the sake of Irina, Lili and thousands more we can only hope that these early warnings will not fall on deaf ears.

 

 
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