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HIV/AIDS Prevention in Romania

Project Name and Location:

HIV/AIDS Prevention in Romania

Background/Rationale for Project:

Romania accounts 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.

Project Description

Timeframe: Started in 1998 - December 1999, possible extension of grant from CIDA for January 2000 to December 2001

Implementer(s): UNICEF along with governmental partners and NGOs.

Lead Partner: UNICEF Romania and UNAIDS with support from Canadian International Development Agency (CIDA).

Partner(s)/alliances: 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 Aura Foundation.

Funding 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
  • To create a supportive environment for youth health and development activities
  • To 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

Overall strategies:

  • 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 young people
  • 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 by:
  • Providing adolescents and youth with accurate knowledge about HIV/AIDS transmission and safe sexual practices with a focus on peer education activities;
  • Providing adolescents and youth with the life-skills necessary to practice safe sexual behaviour and to protect their health;
  • Encouraging 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 sex);
  • Ensuring that the resources that support behavioural change options, HIV/STDs and pregnancy testing, and additional counselling, are accessible to adolescents and youth; and
  • Increasing the awareness of leaders, health staff, educators and other opinion leaders to create a supportive and informed environment for all HIV/AIDS programmes.
  • 530 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".
  • It is believed that hundreds of thousands of young people were reached with messages through the mass media.
  • Approximately 15,000 young people were reached with in-school activities.
Description of Activities:
  • Research was conducted to assess the health risks of intravenous drug users.
  • 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 adolescents.
  • 1,300 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.
  • Towards 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.
  • Nine 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 consultant.
  • Through 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 and adopted.
  • The 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.
  • The 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.
  • UNICEF 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:
    • it 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;
    • it was supported by the private sector which is important to involve in the national response to HIV/AIDS;
    • it 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;
    • it 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
    • National TV was used to spread the messages.
  • In 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

How have 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.
  • Young 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.
  • 530 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.
  • Two 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 resource book.
  • Focus group research was conducted with young people with the information to be used in refining pamphlets and in developing a peer-education manual.
  • A previously used pamphlet was tested by ARAS with 46 young people to identify how it should be improved before being re-printed.
What influence has their involvement had on the project?
  • They were able to attract other young people to help in peer education and HIV/AIDS related activities.
  • They participated in peer education activities.
  • They helped to design IEC messages and materials.
  • They 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.

How have the adolescent girls and boys involved in the project been affected personally?

Increased awareness, confidence, knowledge on health, and improved communication skills.

What have 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.
  • New ministries have become actively involved in the strategic planning process.
  • A Situational Analysis and Response Review Committee was formed and meets regularly.
  • The experience in strategic planning in Romania is being used by UNAIDS Geneva as an example in the region.
  • A dialogue between Ministries on issues related to HIV/AIDS was initiated.
  • Strong 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.
  • UNICEF's work in HIV/AIDS from 1992-1999 is being assessed as part of the end of cycle evaluation.
  • The Strategic Planning Process is being evaluation against its the process objectives:
    • To increase the number of organisations and individuals involved in the process ("to expand the response").
    • To 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).
    • To expand the response to HIV/AIDS beyond the health sector by helping those involved seeing that HIV/AIDS is not simply a health issue.
    • To develop a better and common understanding of the issues and factors influencing the epidemic.
    • To clarify the activities and positions of organisations and individuals involved in the national response to HIV/AIDS
    • To develop ownership of the strategic plan
  • The national impact of all efforts are being monitored by national studies that have been conducted:
    • "1996 Young Adult Reproductive Health Survey Report"
    • "Dating in the '90s - Romanian Youth Narrative survey 1998"
    • "1999 National Reproductive Health Survey Report"

What were the main constraints in meeting the project objectives?

  • The 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
  • Presumably 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
  • The 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
  • Different 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
  • In the strategic planning process the project has shown that there are widely differing ideas on what should be done, and conflicting ideas on priorities
  • Representatives 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 properly addressed
  • The Ministry of Health is experiencing a severe financial crisis and those who are involved in politics or who are political appointees are further distracted.
  • The 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
  • 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

Lessons Learned/Recommendations/What would you do differently if you could do it over?

  • The 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.
  • The 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 them.
  • Had 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, and corporations.
  • Working 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 relations.
  • 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.
  • The support of the Canadian Embassy was extremely important to the success of the project.
  • UNICEF 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.

What program 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.

Youth Perspective: "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

Source of Information: Timothy Schaffter Health Officer UNICEF Romania