Based on the World Health Organization (hereinafter WHO) classification, the Republic of Moldova (hereinafter the RM) is in a concentrated stage of the HIV/AIDS epidemic, with heterosexual route of HIV/AIDS transmission prevailing over the last years, as the number of new cases identified among injecting drug users (hereinafter IDU) dropped.
Therefore, given the present epidemic situation, it is critical to design strategies and take actions to advocate for healthy lifestyles, changing risky behaviors that put someone at risk for HIV/AIDS, by developing and implementing measures to prevent and ensure treatment, care and support for the people living with HIV (hereinafter PLHIV).
The Government of RM, through the National Program for HIV/AIDS and STIs Prevention and Control (hereinafter PROGRAM) shall ensure the coordination of HIV and sexually transmitted infections (hereinafter STI) response measures during 2011-2015.
Priority actions under the Program shall be translated in operational plans to steer the implementation process.
RM is a co-signatory to the global commitments set under the Millennium Development Goal no.6 ‘Stop the spread of HIV/AIDS and TB by 2015 and reverse current trends’, Declaration of Commitment of the United Nations (hereinafter UN) General Assembly Special Session (UNGASS) for HIV/AIDS dated 2001, Universal Access initiative and strategic framework of outcomes. At the same time, the Program is developed to support the objectives of the National Development Strategy and the Health System Development Strategy for 2008-2017 and the National Health Policy of the RM.
The HIV infection is a major public health priority in the RM. As of 1 June 2010 there have been 5,999 PLHIV reported overall in the country, including 1,891 – in Transnistria. There was an insignificant drop in the number of new cases reported, i.e. 704 (17.12 per 100,000 population) versus 795 reported in 2008 (19.27 per 100k). The spread of HIV is reported in all districts of the country, although the degree of spread differs. The highest cumulative prevalence per 100,000 people is reported in the municipalities of Balti – 804.86 and Chisinau – 135.86; districts of Glodeni – 141.49, Basarabeasca – 122.03, and Singerei – 109.69. In Transnistria the HIV prevalence rate is 2.73 times higher than in the rest of the country,tallying up to 453.59 inthe city of Tiraspol, and 531.49 – in the district of Ribnita.
HIV is reported among the able-bodied and sexually active young people; hence, 86.02% of the total identified number of PLHIV is from the 15-39 years-old group, 23.77% are 20 - 24 years-old, and another 24.99% are from the 25-29 years-old age group.
There is a steady high level of heterosexual transmission rate of HIV (81.25%), with the number of new cases growing in rural areas (34.9%), among migrants (34%), while the share of new cases among IDUs going down. There are about 80 new HIV cases reported each year among pregnant women. As many as 887 people have been diagnosed with AIDS during 1989-2009. About 500 people died of HIV/AIDS during 1987–2009 in Moldova alone (net of Transnistria data). Another 490 PLHIV died of AIDS during 1989–2009 in Transnistria. Of the most frequently diagnosed AIDS indicator conditions, TB has the highest share - 482 people (54.34% of all AIDS patients).
To day, the burden of HIV is borne by men and women equally. The situation changed somewhat following the shift from IDU-driven epidemic during 1990-2001 (most of whom were men) towards a prevailing sexual route of transmission today. Of all the major areas of suggested interventions, gender issues were reckoned as top priority, streamlined into all actions and underpinning the interventions fit for the roles played by women and men. Therefore, one has to take into account the responsibilities and opportunities for men and women from the social, cultural and political standpoints. Various tools for monitoring, evaluation and oversight have been designed to provide data disaggregated by gender to identify those interventions targeting gender issues, making allowance for gender differences. One may notice that no provisions have been made for gender issues in the HIV control actions taken before, as interventions were targeting general population and vulnerable groups at high risk for infection only. Given that IDU accounted for four-fifths of all new cases of HIV at the beginning of the epidemic, which subsequently spread to lay population via sex and taking into account the major role that women are playing in reproductive health and bringing up children within one’s family and the society in general, the emphasis is made on securing the psychological support, preventing unwanted pregnancy among HIV-positive women, counseling and testing, family planning, social care and support after birth (food parcels, clothing, summer camps for mothers and children).
The epidemiological curves for syphilis and gonorrhea are flat, the incidence per 100,000 people reaching 68.26 in 2006 versus 69.5 in 2009 for syphilis, and 50.7 versus 42.7 respectively for gonorrhea.
The evaluation of the Program 2006-2010, endorsed through Government Decision no.948 as of 5 September 2005, proved this topic relevant, contributing to strengthening and mobilizing the national and foreign resources to implement and scale up HIV prevention, treatment, care and support, surveillance and control strategies and activities for PLHIV and their family members. The activities and provisions of the Program are technically and financially supported by international organizations, GFATM and other donors.
Pursuant to international standards, the national laws and normative acts have been developed and appropriately adjusted on ways to interdict the discrimination of PLHIV or vulnerable to HIV-infection, observing the human rights and dignity approach, acting as the legal basis for the carrying out of comprehensive, team and cross-sector interventions.
The HIV monitoring and surveillance is a hot topic at relevant central-level authorities. In order to improve people’s access to voluntary and confidential counseling and testing (VCT) services, a VCT service was set up within the health care system. As many as 288,783 people have been tested during 2006 and 298,314 people – in 2009. HIV surveillance, antiretroviral (hereinafter, ARV) treatment and management of opportunistic infections, palliative care, prevention of mother-to-child transmission are all done as per the national protocols, developed according to WHO recommendations. PLHIV and AIDS patients are granted universal access to ARV treatment.
In cooperation with civil society, there are 49 harm reduction programs and projects implemented in the country, along with prevention, rehab and psychosocial support, opiate substitution therapy with methadone for IDUs, inmates, migrants and other groups at high risk of infection, as per the standards of WHO, UNAIDS, and UNODC.
Program Goal and Objectives
The goal of the Program is to advocate for a healthy lifestyle to population, adopting safe and harmless behaviors, scaling up HIV prevention in population, including rural population, mobile populations, improving the accessibility of health care services (VCT, early diagnosis, HIV treatment, care and support), while keeping the country’s HIV-infection in check at levels of a concentrated epidemic.