HIV/AIDS in Europe and Eurasia - situation, response, opportunities and challenges By Henning Mikkelsen, Senior Adviser, UNAIDS Secretariat

Irkutsk, Siberia There are about 13,500 HIV-carriers in Irkutsk Region. Nearly 8,000 of them live in the city of Irkutsk, chief medical doctor of the regional anti-AIDS centre Yuliya Rakina told ITAR-TASS. Every school and college in Irkutsk has HIV-infected students.

Age distribution of reported HIV cases in Estonia 2001 (as of 27 September 2001)

Moscow 181 Russia 136 Siberia 166 Reported HIV prevalence (per 100,000 persons) in mining territories of Siberia (Russian Federation) Altai krai 96 Kemerovo oblast 141 Tomsk oblast 53 Khanty-Mansi AO 447 Tyumen oblast 157 Yamalo-Nenetsky AO 118 Republic Buryatia 153 Republic Tiva 5 Republic Khakassia 13 Krasnoyarsk krai 127 Taimyr AO 78 Evenki AO 5 Chita oblast 68 Irkutsk oblast 465

Prevalence of injecting drug use in Central and Eastern Europe and Central Asia (per 1000 population, 1999 estimate) > < 2 no data

The fastest growth ever…. l The scale: Drug use and casual sexual relations involve/affect very large parts of the population l The dynamic: –injecting drug use, prostitution and casual sexual relations rapidly on the rise –the drug injectors are young and highly sexually active –high proportion of young people who occasionally inject drugs and/or involve themselves in sex trade l Only the beginning - immediate and very high risk for development of larger scale sexually transmitted HIV epidemics

The impact l Socio-economic: By 2010, GDP cut by 4% in Russia (World Bank 2002) l Demographic: –hits young people in particular –will accelerate the population decline l Security: –Death toll –Reinforces instability and social unrest –Armed forces and police are highly vulnerable

Urgent need for a comprehensive response l To reduce the vulnerability of young people l to enable and empower young people to reduce their sexual and drug injecting risk behaviour l Additionality: attention to highly vulnerable groups and to vulnerable young people l Link prevention and care

Growing commitment and partnerships at country level l CIS Programme for Urgent Response to HIV/AIDS l Russia: –Lead role in the CIS on HIV/AIDS –First national NGO meeting hosted by government l Public statements on HIV/AIDS by Heads of States in Ukraine and Romania l Negotiations on ARV price reductions l Around 15 countries have applied for the Global Fund to Fight AIDS, TB and Malaria: –Country coordination mechanism established –Partnership with people living with HIV/AIDS and other civil society organizations

The Checklist in Europe as of end 2001 – 30 countries assessed

International assistance by main programme areas, end 2001 Total: US$51.8 million

Growing resource opportunities l Global Fund to Fight AIDS, TB and Malaria l World Bank projects l Increasing bilateral support l European Commission?

Changing gear in a changing context l Expand the framework to support comprehensive responses by governments and civil society l Ensure effective coordination with government and other country actors l Support countries to be accountable through good monitoring and evaluation l Assist intercountry sharing of experiences (e.g. through CIS)

Reminder l The global total for AIDS is $3 billion. We need 10 billion! l International aid overall is going down l The Global Fund is additional