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Contrary to the trend across Europe, the Romanian capital has seen a drastic increase in AIDS cases over the past decade. The crisis is fueled by the use of synthetic drugs and the lack of harm reduction services
There was a moment in the last decade when Bucharest seemed destined to become the new European capital of AIDS. The number of AIDS-related deaths began to rise in 2011, surpassing 100 deaths in 2016, proportional to population, it is higher than any other region in Europe, with the exception of southern Portugal and Latvia. Although the increase has stopped, the number of AIDS-related deaths in the Bucharest region continues to be among the highest in Europe, and is now comparable to suicide or diabetes.
In the EU-28, the number of deaths caused by AIDS has halved over the past twenty years. It is an important success story in the fight against a contagion that certainly spreads more slowly than COVID-19, but which over time has killed about 400,000 people. people in Europe. Complications related to AIDS still cause around 3,300 deaths per year within the European Union. The recent reduction in mortality has been particularly evident in regions such as Lisbon and the southern Iberian coast.
Among the few areas bucking the positive trend, Bucharest clearly stands out, going from 0.5 deaths per 100,000 inhabitants in 2009, to 3.3 per 100,000 in 2017 (the most recent data available). Also in 2017 Bucharest broke a national record, exceeding 4000 hospital admissions for AIDS related cases. What went wrong?
In Europe, AIDS mainly tends to affect middle-aged men and HIV tends to spread through sexual contact (mainly through homosexual contact, but not always). Less than 5% of infections are related to drug addiction. On the contrary, in Romania AIDS tends to affect young people, especially those in their twenties and thirties based in Bucharest. Compared to the rest of Europe, infections in Romania tend to spread much more frequently through heterosexual contact and drug use . It is estimated that about 30 percent of drug addicts in Bucharest are HIV positive.
As sexual activity tends to remain relatively stable, unexpected outbreaks in infections generally tend to be linked to drug use, particularly new forms of use brought about by fluctuations in the drug market and the lack of harm reduction programs. In recent years, drug use has been blamed for serious epidemics in Dublin, Luxembourg and Glasgow, as well as in Bucharest.
The situation in Bucharest began to worsen towards the end of 2010, fueled by the dramatic influx of amphetamines, cathinones and other synthetic stimulants. Thanks to the lower price of these new drugs, they have at least partially supplanted heroin. The use of some of these drugs requires three to ten injections per day, clearly leading to a massive increase in syringe use.
According to Thomas Seyler, an expert in infectious diseases at the European Monitoring Center for Drugs and Drug Addiction , it is necessary to strengthen the public health approach to combat HIV outbreaks related to drug use. This requires focusing on prevention, harm reduction and better access to care for all. Some of the most effective – but not sufficiently available – prevention measures include distributing clean needles and syringes to people who inject drugs and accessing opioid replacement therapy.
The data suggests that this approach has worked in Portugal, where decriminalization of all drug use has also contributed to a sharp reduction in infection rates in the country. As for substitution therapies, Romania continues to lag behind the targets set by the World Health Organization: these therapies cover only about 10 percent of drug addicts in the country, where the target is 40 percent.
In Europe, AIDS-related prevention and treatment programs are left in the hands of national authorities, who often rely on NGOs, while supranational organizations monitor the situation. So all it takes is a change in domestic policy, or cuts in health care or NGO funding, for there to be a crisis in prevention and more outbreaks. Indeed, just before the crisis of the 2010s, Bucharest crossed the line his (already insufficient) schedule for dispensing syringes.
Regarding monitoring and care, Romania can count on decades of experience, linked to an astonishing 13,000 children found positive for HIV in hospitals and orphanages during the Ceauscescu period. A series of laws considered pioneering at the time guaranteed free access to antiretroviral treatment, financial support and social assistance. However, the latest national strategy for managing the health crisis dates back to 2004 . An update was presented by the government in 2018, but has yet to be implemented.
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