Eve of an HIV Epidemic in Romania

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Photographs by Cristian Movila for TIME

Daily dose Inside a Bucharest squatter house, a heroin addict winces as he injects himself

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Romania's NGOs can't turn to their cash-strapped government for help. Last year its total contributions to ARAS allowed for the purchase of 7,000 syringes — enough for just one day. Now, with Romania mired in recession — its economy shrank by 7% last year — the chances of the government throwing organizations like ARAS a lifeline are slim.

Uncertain Future
Romania's unique history with HIV partly explains its success in fighting the spread of the disease. Unlike in the rest of Eastern Europe, the majority of people living with HIV in Romania did not become infected as adult drug users or sex workers, but as children living in orphanages. In 1987, nurses hoping to cure Romania's orphans of their anemia started injecting them with whole-blood transfusions daily, reusing syringes on multiple children. Some of the blood turned out to be contaminated and at least 10,000 orphans contracted HIV. By 2000, Romania claimed 60% of all the pediatric HIV infections registered in Europe.

International pressure, coupled with a burgeoning activist movement inside the country, compelled the government to act. The infected children began receiving state-provided antiretroviral (ARV) treatment, which still keeps 7,000 of them alive today. In 2001, the government closed a deal with pharmaceutical companies to lower drug prices, paving the way for Romania to become the first country in Eastern Europe — and one of the few in the world — to provide universal coverage to HIV-positive patients. Besides improving the quality of patients' lives, the drugs also reduce their viral load, making them less likely to transmit the disease to others. "At that time, Romania was the model for the region," says Eduard Petrescu, the Romania country coordinator for UNAIDS. "I hope in two or three years it will be seen as a model of how to deal with HIV/AIDS during an economic crisis."

It's not off to a good start. The Ministry of Health used up all of this year's budget to pay for ARVs in August and must now wait for more funding to arrive through bureaucratic channels. The delay could take up to 180 days. ARV shortages have already interrupted treatment for up to 1,000 patients, and forced patients from rural areas to line up outside Bucharest hospitals to receive treatment. "The government has given us no guarantees, and we are scared what will happen in September," says Iulian Petre, the executive director of the National Union of People Living with HIV/AIDS.

With funding in limbo, ARAS worker Luca continues to steer her van into an uncertain future. At yet another squatter complex, a 13-year-old girl stands in line. Bright-eyed and surprisingly cheerful for someone surrounded by homeless men and sex workers, she visits every week to get basic medical care and a dose of attention. Her father is an addict and at home used syringes are scattered around the floor. She stepped on one recently, so wants to get an HIV and hepatitis test. "She's still in school and she's trying to stay clean," Luca says. "Miracles happen everywhere." But if support for Romania's outreach programs disappears, there may not be many left.

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