Structural Collapse Sets
the Scene for the Rapid Spread of HIV/AIDS Among Young People
in Eastern Europe
12 May 1999
and young people in Eastern Europe and Central Asia are
increasingly sharing drug-injecting equipment and engaging in
unprotected commercial sex as early as 12 years of age.
With the economy in many countries continuing to
crumble and with unemployment rates soaring, the young are
increasingly relying on alternative sources of economic and
emotional sustenance. Many
escape into alcoholism and drug use; others turn to the
streets, to commercial sex and to criminal activity to earn
money for their needs. Although current rates of HIV infection
in the region are low compared with the shocking rates in some
African countries, the region is ripe for an explosive AIDS
epidemic unless effective preventive measures are urgently put
an attempt to prevent an exponential rise in the region’s
currently low prevalence rates, the Joint United Nations
Programme on HIV/AIDS (UNAIDS) has launched Listen,
Learn, Live!, the World AIDS Campaign with Children and
Young People. The Campaign calls on adults to stop telling
young people what to do, and instead to listen to their
concerns, ideas and aspirations, so as to understand the
realities of their lives and fully engage them in developing
programmes that make the difference.
It is imperative that we
Listen, Learn and Live:
to children and young people, hear their views and concerns,
and understand what is important in their lives.
from one another about respect, participation, support, and
ways to prevent HIV infection.
in a world where the rights of children and young people are
protected and where those living with HIV/AIDS are cared for
and do not suffer from discrimination.
number of HIV infections in Eastern Europe has increased
nine-fold in just three years, growing from less than 30,000
HIV infections in 1995 to an estimated 270,000 infections by
December 1998. Ukraine has had the most dramatic epidemic,
with an estimated 110,000 people living with HIV in December
1997, two-thirds of them injecting drug users. Since then the
epidemic has grown rapidly. Similarly, Belarus, Moldova,
Kazakstan and the Russian Federation have growing HIV
epidemics; over 80% of infections are in individuals with a
history of injecting drugs.
Poverty has become widespread in the region even as the
quality of, and access to, health care have deteriorated, a
combination that is facilitating the spread of HIV.
Poverty and high unemployment rates have led many young
people to lose faith in the education system and in the very
need for education, as they see possibilities for future
employment diminish. Increasingly,
young people are dropping out of school and spending time with
their peers in unstructured environments.
As there are few places such as youth and sports
centres where young people can gather safely, some turn to
drugs, violence and early sexual activity. Meanwhile, with the old safety nets gone and the painful
transition to a free-market economy still continuing, many
parents are spending less time with their children as they
struggle to make ends meet.
Many parents are also turning to alcohol to forget
their dire situation. As
a result, the relationship between parents and children is
are often less available to engage in the kind of open and
caring dialogue that builds bonds of trust between a parent
and a child. It
is now known that such bonds serve to reduce young people’s
risk-taking behaviour, by delaying sexual initiation and
reducing rates of drug use.
Alongside the economic collapse, the region has also
shown signs of startling health care deterioration.
Increasing numbers of curable diseases are left
untreated. From the standpoint of the AIDS epidemic, the most
alarming example is syphilis and the other sexually
transmitted diseases (STDs).
In virtually all parts of the former Soviet Union,
including the Russian Federation, Ukraine, Moldova, and the
Baltic and Central Asian countries, reported syphilis rates
have shown a steep increase since 1991, reaching more than 500
new cases per 100,000 population annually in the city of
Kaliningrad and the Russian Far East. These high STD rates
reflect the absence or inadequacy of STD treatment.
They signal the extent of unsafe sexual behaviour in
the region, because STDs are transmitted through unprotected
sex (intercourse without a condom).
And they have the potential to aggravate the HIV
epidemic: it is
well-established that when either partner has an untreated
STD, there is a significantly greater risk of HIV transmission
rates among young people are dramatically under-reported
because services are not youth-friendly, meaning that many
young people often do not have access to health centres, or
are refused treatment because of their age.
In spite of this, we see high STD rates among those
under 25 in some Eastern European countries.
In 1998 in Moldova, for example, 156 young people per
100,000 population were infected with syphilis.
drug use in the region is also on the rise and the trend is
towards an ever-younger initiation of injecting drug use. In
Ukraine and St Petersburg (Russian Federation), up to 20% of
injecting drug users (IDUs) are teenagers, with the youngest
being around 12 years old.
In Almaty, Kazakstan, surveys among drug users indicate
that of the approximately 40,000 drug users in the city, half
are under the age of 18. Here the average age for initiating
drug use is 15-16 and for injecting drugs is 17-18.
Surveys among IDUs in Almaty show that 76% had their
first try at drug injecting by the age of 19, with 30% first
trying before their 15th birthday.
The potential for HIV spreading through the
drug-injecting community is extremely high.
IDUs in the region overwhelmingly report sharing
syringes and injecting from a common container.
Many also add blood into the drug mixture they prepare
There is also potential for significant HIV spread
outside the drug-injecting community. Drug users also have
sex, and unsafe sexual behaviour is highly associated with
drug use. The
majority of drug users state that they rarely use condoms. One-third of female drug users interviewed in Osh, Kyrgyzstan,
report that they are periodically or constantly engaged in
prostitution to earn their living or to purchase drugs.
An estimated 90% of these commercial sex contacts take
place without the use of condoms.
In Tashkent, Uzbekistan, more than half of drug
users’ sex partners do not use drugs themselves, but
practise unprotected sex with their IDU partners.
In Kiev, Ukraine,
reports indicate that young girls aged 13-15 are increasingly
taking to the streets for prostitution.
Because of their youth, they have neither the skills
nor the experience to resist violence from clients or to
demand condom use. The
older prostitutes react strongly to the competition, which
takes away their bargaining power for insisting that clients
use condoms. In
most of the region, child prostitutes and young working women
or students who receive payment in cash or kind remain a
hidden group, and to date, little information about them is
available. As a
result many of these children and young women do not have
access to HIV prevention programmes.
dramatic example of the impact of poverty and missing
protective bonds between children and significant adults can
be seen among Roma or gypsy children.
Socio-economic and cultural traditions that guide life
decisions have made many Roma children in Bulgaria and Romania
highly vulnerable to HIV infection.
It is estimated that 52% of healthy Roma children aged
7-16 years old in Bulgaria do not attend school, due to
poverty, lack of value placed on education within the
community, and the group’s migratory patterns. Illiteracy and lack of marketable skills make it difficult
for Roma youth to later enter and succeed in the job market.
In parallel, many Roma children grow up not with their
families but in state institutions that provide for basic
survival needs such as food and housing but pay little
attention to emotional needs.
Studies following such children after they leave the
institution show that they often become involved in drug use
and criminal activity, and are unable to maintain healthy
other Roma children work on the streets.
In Romania, for example, most of the 2000-5000 children
working or living on the street, where they are exposed to
sexual abuse, exploitative work and violence, are Roma
children. For them, key relationships tend to be with other
children who use drugs and engage in commercial sex, both of
which increase their risk for HIV infection.
The 1999 World AIDS Campaign, Listen,
Learn, Live! highlights the urgency of listening to
children and young people so as to engage them effectively in
action to protect their rights and reduce their vulnerability
to HIV infection. With
over six new infections occurring worldwide among young people
every minute, and with the increasing numbers of young
injecting drug users and young sex workers in Eastern Europe
and Central Asia, there is an urgent need for governments to
commit to change. To
avert a runaway epidemic, these changes need to include:
education for all children, including those living in poverty;
implementation and expansion of lifeskills education, youth
friendly services, and harm-reduction initiatives such as HIV
education and needle-exchange programmes to reduce risk among
drug users; easy access to condoms and to STD treatment; and
greater economic opportunities for young women so that they
are not forced into prostitution for economic survival.
more information, please contact Anne Winter, UNAIDS, Geneva,
(+41 22) 791.4577, Lisa Jacobs,
UNAIDS, Geneva, (+41 22) 791.3387, Abigail Bing, UNAIDS,
New York, (+1 212) 584.5024 or Andrej Cima, UNAIDS, Kiev,
(+380 44) 253.9323/63. You may also visit the UNAIDS Home Page
on the Internet for more information about the programme