Eastern Europe and Central Asia

Eastern Europe and Central Asia

Making the 4Ps Work Prevent infection among adolescents and young people Prevention of mother-to-child transmission Provide paediatric treatment Protection of orphans and vulnerable children United Nations Children s Fund, 2005

The young face of HIV in Eastern Europe and Central Asia The Eastern Europe and Central Asia region has the fastest growing HIV epidemic in the world. An estimated 1.4 million people are now living with HIV, with around 210,000 newly infected in 2004. The epidemic has a young face. More than 80% of those living with HIV are under the age of 30 compared to just 30% in Western Europe. In Ukraine, 25% of those diagnosed HIVpositive are below 20. In the Russian Federation which accounts for 70% of those living with HIV in the region 80% of the 860,000 people known to be infected are aged 15-29. Several countries in Central Asia and the Caucasus are in the early stages of the epidemic. In parts of south-eastern Europe, the conditions are ripe for major epidemics among the young. Social and economic upheaval have left children and adolescents more vulnerable to HIV infection as a result of poverty, family stress and collapsing social structures. They face sexual and economic exploitation, school dropout and deteriorating social services. The growth of trafficking in drugs and in human beings only exacerbates their vulnerability. The epidemic thrives on stigma and discrimination based on gender, ethnicity, disability, citizenship, sexual orientation and HIV status itself. Some people are vulnerable because of the criminalization of sex work, sex between males, and drug use, and because of violence against women. The region faces a deadly combination of HIV and tuberculosis. Multi-drug resistant TB, prevalent in the Russian Federation and Ukraine, is now the leading cause of death among people living with HIV. It preys on the young, the vulnerable and those at greatest risk. Risks are magnified by low awareness among the young about HIV, low condom use, multiple sexual partners, high rates of sexually transmitted infections, and the sharing of contaminated injecting equipment. Those who are the most vulnerable are also the least likely to have the information or services they need to prevent HIV infection. And access to services that do exist is particularly difficult for adolescents at greatest risk the very people we need to reach. While overall funding for HIV in the region has increased twelve-fold since 2001 to $ 600 million through the World Bank, the Global Fund to fight AIDS, TB and Malaria, and major bilateral donors, the World Bank estimates that $ 1.5 billion will be needed annually by 2007. HIV has a devastating impact on children. Yet action for children affected by HIV is too little, too slow, too ad-hoc. It must be scaled up. Why is this not happening? The answer is simple the most vulnerable children and adolescents are missing from the HIV debate. 1

Why this Campaign: Unite for Children. Unite against AIDS? Because children and adolescents in Eastern Europe and Central Asia are: missing from HIV policies. missing from prevention programmes. missing from treatment programmes. missing from society, missing an identity. missing from data. missing from information campaigns and media coverage. missing parents from whom they are separated or who have died. missing out on schooling, health care and good nutrition. missing out on their rights. missing out on childhood itself. The campaign aims to push children and adolescents to the top of the AIDS agenda, to the forefront of the debate, in line with the Convention on the Rights of the Child. It will support efforts to halt and reverse HIV transmission among children and adolescents across the region and ease the impact of infection on those already infected. It will mobilize resources for prevention and treatment programmes for children under 18 years of age and adolescents (defined here as 10-18 years of age) for their care, support and protection. It will boost the efforts of all states to: 1 identify the most vulnerable and disadvantaged children and adolescents, and protect their rights; give families the support they need to rear their children; provide special protection for children and adolescents deprived of a family; strengthen the genuine participation of children in the HIV response; support programmes for HIV prevention and AIDS treatment for children and adolescents as laid out in the UNAIDS Prevention Policy Paper 1 of 2005. UNAIDS (June 2005). Intensifying HIV prevention: UNAIDS policy position paper. Geneva, Switzerland. Endorsed by the 16th meeting of the UNAIDS Programme Coordinating Board. http://www.unaids.org/ NetTools/Misc/DocInfo. aspx?lang=en&href=http://gvadoc-owl/webcontent/documents/ pub/governance/pcb04/pcb_17_05_ 03_en.pdf 2

The Four Ps The campaign will focus on the Four Ps: Prevent infection among adolescents and young people Prevention of motherto-child transmission Provide paediatric treatment Protection of orphans and vulnerable children These reflect the Declaration of Commitment from the UN Special Session on HIV/AIDS in 2001 2 as well as the Millennium Development Goal of halting and beginning to reverse HIV by 2015 3. They build on commitments made by Governments in the region: The Programme of Urgent Response to the HIV/AIDS Epidemic, Commonwealth of Independent States, 2002 4 ; The Dublin Declaration adopted at the Ministerial Conference on Breaking the Barriers Partnership to Fight HIV/AIDS in Europe and Central Asia, February 2004 5 ; The Vilnius Declaration on Measures to Strengthen Responses to HIV/AIDS in the European Union and in Neighbouring Countries. European Commission, Ministerial Conference Europe and HIV/AIDS - New Challenges, New Opportunities, September 2004. 6 The campaign will support the G8 goal of universal access to treatment by 2010, agreed at the Gleneagles Summit in July 2005 7. 2 3 United Nations General Assembly Special Session on HIV/AIDS. The Declaration of Commitment. New York, United States, 25-27 June 2001 http://www.unaids.org/unaids/en/ Events/UN+Special+Session+on+HI V_AIDS/Declaration+of+Commitmen t+on+hiv_aids.asp Millennium Development Goals. Goal 6 http://www.millenniumcampaign. org/site/pp.asp?c=grkvl2nle&b=1 86386 4 5 http://www.unicef.org/ceecis/ media_3058.html http://www.eu2004.ie/templates/ meeting.asp?snavlocator=5,13&list_ id=25 6 7 http://europa.eu.int/comm/archives/ commission_1999_2004/telicka/ vilnius_press_en.pdf The Group of 8 (2005). The Gleneagles Comuniqué. Paragraph 18(d) http://www.fco.gov.uk/files/kfile/ PostG8_Gleneagles_Communique,0. pdf 3

UNICEF/SWZK00233/Pirozzi 1. Prevent infection among adolescents and young people 1.1 What is happening? 4 Across the region there is evidence of earlier sex, unsafe sex and sex with multiple partners. Adolescents are the least likely to know where to get preventive services, and the least likely to seek diagnosis and treatment for sexually transmitted infections, including HIV. Stigma and discrimination block an effective response to the epidemic by stopping adolescents seeking the help they need. The prevalence of sexually transmitted infections among adolescents is alarmingly high. In 2005, 69% of adolescents visiting a clinic in Kiev, Ukraine, had chlamydia, a sign of low condom use. There are an estimated 3.2 million injecting drug users in the region. Conservative estimates suggest that 70% of newly-reported HIV infections in the Commonwealth of Independent States (CIS) are drug-related. Most injecting drug users are young up to 25% are thought to be under 20. In the Russian Federation, children start to inject drugs as young as 11. In Ukraine, the average age when children start injecting has dropped from 17 to 13-15. More adolescents are selling sex. A study in St Petersburg, the Russian Federation, found that 33% of those under 19 who sold sex tested HIV-positive. Sex is a bridge for transmission between those selling sex, injecting drug users, their partners and the wider population. Sexual transmission is on the rise. This may be due to unsafe sex between injecting drug users and their partners. It is also a sign that the epidemic is bridging to the wider population. One study in Almaty, Kazakhstan, found that almost 20% of males who had sex with males were aged 19 or younger and that the lowest rate of condom use was among those under 18. There are fears of a hidden epidemic among this group. Adolescent alcohol and drug use is on the rise, increasing the risks by reducing inhibitions. MOLDOVA: Young people at a UNICEF-supported summer camp for peer educators on HIV/AIDS prevention.

1.2 What must be done? Children and adolescents have the right to information and skills, youth-friendly services for HIV prevention and AIDS treatment, care and support. They have the right to know about HIV and how to protect themselves. They have the right to information that is appropriate for their age in and out of school before they become sexually active and/or use drugs. Such information could include the ABC formula (Abstinence, Be Faithful, Condom use). Peer to peer approaches are known to be particularly effective. Adolescents have the right to youth-friendly services, including voluntary counselling and testing, diagnosis and treatment of sexually transmitted infections, and drugdependence treatment. Adolescents have a right to life-saving commodities: condoms for those who are sexually active, and clean needles and syringes for those who inject drugs to prevent HIV infection; and antiretroviral drugs and treatment for those who are HIV-positive. Children and adolescents need skills in communication, conflict resolution and critical thinking to protect themselves and others. Life-skills-based education, including education on HIV, should be part of school curricula and offered in the community. Sex education does not automatically lead to sex. It is crucial to change discriminatory attitudes towards those who are HIV-positive and those at greatest risk through legal protection, public information, media outreach and education campaigns. Current HIV prevention efforts reach only a few adolescents at risk. A minimum coverage of 80% is needed for adolescents at risk 8. There should be more focus on young injecting drug users, given their HIV prevalence. Action is needed to reduce the number of adolescents initiating drug use, along with large-scale harm-reduction programmes. Harm reduction is proven to reduce risk without promoting drug use. The risks to those selling sex can be reduced through the promotion of condoms, and providing services to prevent, diagnose and treat sexually transmitted infections for sex workers, their partners and clients. The overlap between injecting drug use and sex work requires coordination between services. 8 UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries. http://www.unaids.org/html/ pub/publications/irc-pub06/ resourceneedsreport_en_pdf.pdf 5

1.3 How do we do it? National strategies: Ensure that national AIDS policies prioritize universal access to HIV prevention for children and adolescents, starting with those at greatest risk. Mobilize and coordinate every part of society (public and private) in a multi-sectoral response. Build supportive social and legal environments. Such environments reject HIVrelated stigma and promote gender equality. The legal framework must ensure that life-saving commodities are legally available to adolescents. Integrate HIV prevention efforts for, and by, children and adolescents into national development plans and programmes. Include children and adolescents in the design, implementation, monitoring and evaluation of programmes. Address the social, economic and legal issues that underpin children s and adolescents vulnerability. Scale up what works: Take effective programmes to scale for adolescents at greatest risk. Meet the diverse needs of different children and adolescents through schools, communities, the media and peer education. Use appropriate communication to counter HIV-related stigma and discrimination. More resources: More resources are needed from governments and international donors to scale up HIV prevention. Human, institutional and technical resources must be able to carry out effective, sustainable, nondiscriminatory programmes. Better figures are needed on the costs of programmes for children and adolescents to influence resource allocation, including total costs, costs per person and savings per HIV transmission averted. Monitor and evaluate efforts: National monitoring and evaluation systems are needed for HIV prevention, based on the Guide to Monitoring and Evaluating National HIV/AIDS Prevention Programmes for Young People 9. Regular assessment of the risk behaviours of adolescents, disaggregated by age and gender, is essential. UNICEF will: Support behaviour change among adolescents at greatest risk by providing information, skills and services, in partnership with other UN agencies. In partnership with UNFPA and UNESCO: Promote prevention through school- and communitybased life-skills; Provide information via the mass media and peer-topeer approaches. In partnership with WHO and UNFPA: increase access to youthfriendly health services including voluntary counselling and testing. In partnership with UNODC: Reduce the risk of transmission for injecting drug users through harm reduction programmes such as needle exchanges and drug substitution. In partnership with the UNAIDS Secretariat: Promote policy review and reform. 6 9 UNAIDS, WHO, UNICEF, UNFPA, UNESCO, USAID, MEASURE DHS, World Bank, FHI (2004). Guide to Monitoring and Evaluating National HIV/AIDS Prevention Programmes for Young People. http://www.who.int/hiv/pub/me/en/ me_prev_intro.pdf

UNICEF/SWZK00795/Pirozzi 2. Prevention of mother-to-child transmission 2.1 What is happening? While HIV prevalence among pregnant women remains relatively low in the region, the percentage of women among all registered cases reached 40% for the first time in 2004 in the Russian Federation and Ukraine. Governments aim to eliminate HIV infection in infants by 2010 10. In Ukraine, mother-tochild transmission fell from 27% of births to HIV-positive mothers in 2001, to 12% in 2003. 10 Indicated by less than one HIVinfected infant per 100 000 live births, and less than 2 per cent of infants born to HIV-infected women acquiring HIV infection. WHO (2004). Strategic Framework for the Prevention of HIV Infection in Infants in Europe. http://www.unicef.org/ceecis/ Strategic_framework_for_the_ prevention_of_hiv.pdf The region s unique combination of long-established health systems, trained professionals, near universal literacy and relatively low numbers of HIV-positive women and children makes it possible to limit infant HIV infection to the levels found in Western Europe. RUSSIAN FEDERATION: A counsellor at the UNICEF-supported Regional Centre for AIDS Prevention and Protection in Kaliningrad. 7

2.2 What must be done? Primary prevention is vital to stop the infection of large numbers of infants who would otherwise be orphaned and need treatment, care and support. Every woman has the right to information on protecting herself from HIV and, if HIV-positive, how to prevent transmission to her baby. Preventing HIV infection in women prevents transmission to their children. Prevention programmes must reach a range of women at risk, and their partners, with a focus on adolescent girls. Children born to HIV-positive mothers may be infected during pregnancy, delivery or breast-feeding. Most infections can be prevented by proper treatment during pregnancy and childbirth. Protecting HIV-positive mothers and their children is a human rights priority. Strengthening links between prevention and treatment, care and support services for HIV-positive women and their children ensures that women get the services they need, including access to antiretroviral therapy. Improving a mother s quality of life will also benefit her children. Services to prevent motherto-child transmission include voluntary counselling and testing; antenatal care; antiretroviral therapy and treatment of opportunistic infections; safe delivery practices; replacement feeding and advice on feeding options. It also includes prevention of unintended pregnancies among HIV-positive women. With voluntary HIV testing and counselling, women can learn their HIV status in time to benefit from services. Prevention of mother-tochild transmission must be integrated into maternal and child health services with a focus on early prevention in low prevalence settings. Women who inject drugs (or whose partners do so) are at particular risk. Discrimination against those with HIV is common in health services, which may be why many HIV-positive pregnant women up to 30% in the Russian Federation have no contact with these services until they deliver their babies. Strategies to ensure early access to services and support are vital to prevent mother-to-child transmission. Governments must address the attitudes of health workers towards HIV-positive women. Effective interventions to reduce mother-to-child transmission are available, viable and cost-effective. These must be scaled up to cover all pregnant women. 8

2.3 How do we do it? National strategies: Ensure that national AIDS policies prioritize prevention of mother-to-childtransmission. Mobilize and coordinate all sectors of society (public and private) to ensure a multisectoral response. Ensure that the social, legal and service environment supports all women who are vulnerable and at risk, including those living with HIV. Ensure a special focus on women at greatest risk in low prevalence countries. Scale up what works: Services must be scaled up to eliminate mother-to-child transmission. Prevention of mother-tochild-transmission must be part of all maternal, child and reproductive health services. It must be linked to other services such as drug dependence treatment, harm reduction and peer counselling, and to other public health initiatives, such as the Baby-Friendly Hospital Initiative 11 and youth-friendly services. Prevention must be early enough to make a difference. More resources: More resources are needed from governments and international donors to scale up prevention of mother-tochild-transmission. Mother-to-child transmission must be part of training for health workers. Human, institutional and technical resources must be strengthened to carry out prevention programmes. UNICEF will: Support policies, guidelines, training programmes and referral linkages to ensure national coverage of prevention of mother-to-childtransmission in countries with generalized HIV epidemics. Prioritize HIV prevention, including prevention of mother-to-child-transmission, among women at greatest risk in countries with low or concentrated HIV prevalence. Support data-driven goals, programme plans and strategy reviews based on typology of the epidemic, existing capacities, lessons learnt and global policies. Support integration of prevention of mother-tochild-transmission into health services and strengthen their ability to work appropriately with women and children living with HIV. Where needed, provide procurement services, supply and demand forecasts and technical assistance to supply management systems. 11 The Baby-Friendly Hospital Initiative (BFHI), launched in 1991, is an effort by UNICEF and the World Health Organization to ensure that all maternities, whether free standing or in a hospital, become centers of breastfeeding support. http://www.unicef.org/programme/ breastfeeding/baby.htm 9

UNICEF/SWZK00234 3. Provide paediatric treatment 3.1 What is happening? Effective therapy for people living with HIV is now available. While there is no cure for HIV infection, it is possible to improve the quality of life for HIV-positive children and adolescents. Most can lead healthy and productive lives. Across the region, an estimated 160,000 people need antiretroviral therapy, but only 16,000 people have access. Few paediatricians are adequately trained in antiretroviral therapy or the care of HIV-positive children. Many children born to HIV-positive mothers are not properly monitored or diagnosed by doctors and face discrimination. Countries in this region pay some of the highest prices for antiretroviral drugs in the world, hindering efforts to scale up. RUSSIAN FEDERATION, 2004: A worker and child at the Home for AIDS orphans and abandoned children in Kaliningrad Kindergarten Number 17. 10

3.2 What must be done? States must ensure universal access to sustainable, good quality AIDS treatment, care and support services. Governments must provide children affected by HIV with cotrimoxazole prophylaxis 12, which has proven effective in preventing infections in the first 12-18 months of life. Governments must reduce the prices paid for antiretrovirals by negotiating with pharmaceutical companies, procuring registered generics, reviewing and enforcing patent laws in favour of domestically produced drugs, exempting antiretrovirals from tax and duties, and by buying in bulk. Governments must address the lack of paediatric antiretrovirals. Health workers need training to provide high-quality HIV prevention, and AIDS treatment, care and support for HIV-positive children without discrimination in line with their rights. 12 The prevention and early treatment of infections are the mainstay of the medical management of the majority of HIV-positive or undiagnosed children who live in low income countries without access to antiretroviral drugs. Cotrimoxazole is safe, cheap and effective with relatively few side-effects against a wide range of organisms, including pneumocystis carinii pneumonia (PCP) which is an important cause of death and illness in the first year of life. 3.3 How do we do it? National strategies: Ensure that national AIDS policies prioritize universal access to antiretroviral therapies. Cut the cost of antiretrovirals. This requires cooperation between governments across the region, and cooperation between ministries and local governments. Support the development of paediatric formulations of antiretrovirals by pharmaceutical companies. More resources: More resources are needed from governments and international donors to ensure universal and sustained access to antiretroviral therapy. Human, institutional and technical resources need strengthening to ensure paediatric AIDS treatment, care and support. This should include training for health workers. UNICEF will: Help governments obtain antiretrovirals to scale up treatment. Expand the supply of cotrimoxazole prophylaxis to all infants born to HIVpositive mothers to avert and treat opportunistic infections. Promote a public health approach to paediatric treatment by linking it to child survival programmes such as vitamin A supplementation, nutrition, immunisation, antibiotic treatment for pneumonia, and oral rehydration therapy for diarrhoea. Establish clinical screening and HIV testing for children born to HIV-positive women, linked to antiretroviral therapy where needed. Strengthen community capacity to provide treatment, ensure adherence to treatment regimes, and provide care and support. 11

UNICEF/SWZK00282/Pirozzi 4. Protection of orphans and vulnerable children 4.1 What is happening? Across the region there is a common belief that those at greatest risk of HIV get what they deserve. It is against this backdrop that HIV-positive pregnant women must decide whether or not to keep their children. Shunned by society, they face relentless discrimination. Many are dependent on drugs and have no access to drug treatment. Many more live in poverty. For some, the prospect of caring for a child who may also be HIV-positive, without any support network, is just too much. They abandon, or are separated from, their infants. Up to 20% of children born to HIV-positive mothers in Ukraine may be abandoned by, or separated from, their mothers. These children live in infectious disease wards in hospitals until their HIV status is determined. Ordinary children s homes often refuse to take them and they are isolated from other children. Living in isolated wards, lacking physical contact, emotional warmth and intellectual stimulation, the development of these children is undermined. In the Russian Federation and Ukraine, recent reports indicate that kindergartens and schools are not enrolling HIV-positive children, even though many are now reaching school age. RUSSIAN FEDERATION, 2004: Tatiana and her son Igor (names changed) at the Centre for Prevention of Addictions in Maskoski District in Kaliningrad. 12

4.2 What must be done? Decisions about children born to HIV-positive mothers must be guided by their right to stay with their parents, unless separation is in their best interests. Every child must be registered at birth, in line with their right to a name and nationality and to prevent their invisibility. National child protection systems are needed to collect information on HIVpositive children, orphans and vulnerable children, disaggregated by age, gender and socio-economic status. Family care should be the first option. If a child must be separated from their own family, a permanent, family-based alternative should be found in their own community. Countries with growing numbers of HIV-positive children should build fostering networks. Institutional care should be the last resort. Countries need to establish clear guidelines on referral processes to childcare institutions for children born to HIV-positive mothers. Policies and resources must shift from institutionalization to support for biological families or family-based alternatives such as fostering and adoption. These should be scaled up to meet growing needs, particularly in the Russian Federation and Ukraine. Links should be strengthened between programmes to prevent HIV infection in children, and AIDS treatment, care and support for HIV-positive women. Improving a mother s quality of life allows her to care for her own child. While legislation to protect the rights of children affected by HIV is essential, it is also vital to implement laws to protect the rights of all children to education, to health, to protection. HIV-related stigma and discrimination must be tackled through policies to guarantee social inclusion, access to education, and health and social services for HIV-positive children and their families. Programmes to get children out of institutions and into society must be strengthened and scaled up. 13

4.3 How do we do it? National strategies: Ensure that national AIDS policies prioritize the protection of orphans and vulnerable children. Ensure that the social environment and legal framework prioritizes familybased care and access to education, and health and social services for all vulnerable children. Address the social, economic and legal factors that make children and adolescents so vulnerable. More resources: More resources are needed from governments and international donors to protect orphans and vulnerable children. Human, institutional and technical resources must be strengthened to protect vulnerable children, including training for health workers, child carers and teachers on HIV. Monitor and evaluate the impact: Gather and analyse disaggregated data on children and adolescents affected by HIV. An independent official body, such as an Ombudsperson, should investigate complaints about child rights violations, such as schools refusing to accept children and adolescents affected by HIV, or HIV-positive children and adolescents being refused medical treatment. UNICEF will: UNICEF will follow the Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV/AIDS 13, including: Changing attitudes through advocacy and social mobilization to create a supportive environment for children and families affected by HIV. Helping families care for their own children by providing antiretroviral therapy to parents and providing economic, psychosocial and other support. Mobilizing and supporting community-based responses. Ensuring that vulnerable children have access to essential services. Ensuring that governments protect the most vulnerable children through improved policy and legislation and by channelling resources to families and communities. 13 UNICEF and UNAIDS (July 2004). The Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS. http://www.unicef.org/aids/files/ Framework_English.pdf 14

5. Partnerships No single institution or agency can respond to HIV in isolation. Partnership is essential. UNICEF, as the lead UN agency on children and AIDS and as mandated by the Convention on the Rights of the Child, works with Governments, other UN agencies and NGOs. UNICEF Country Offices in Eastern Europe and Central Asia will act as focal points for the campaign. The UNAIDS Secretariat will facilitate campaign collaboration among UNAIDS Cosponsors. Which partners? Regionally, governments have pledged, in partnership with civil society and people living with HIV, to assess progress against HIV biannually 14. At the national level, government partnership is crucial. Ministries of Health have the power to develop effective programmes on HIV, but partnerships are also needed with, and between, Ministries of Education, Justice and Security. At regional and municipal levels, partnerships are needed with local authorities that put policies into practice. Civil society, including faithbased organizations, can provide care and support to children and families affected by HIV, and by doing so, reduce stigma and discrimination. NGOs are crucial partners, working with those most directly affected, particularly on harm reduction programmes; and advocating for universal access to antiretroviral therapy. The mass media can spread the word on children and AIDS, opening the debate, combating stigma, and advocating for effective policies and their implementation. People living with HIV are critical partners in programme design, implementation, monitoring and evaluation. Who else has their first-hand knowledge of what works and what does not? Children and adolescents must be part of programmatic and advocacy efforts their rights are central to HIV prevention and AIDS treatment, care and support programmes. Strong partnerships between government and people living with HIV; between government and civil society, including faith-based organizations; between parents and adolescents are essential for achieving results for children and adolescents around the 4Ps. UNICEF invites everyone to Unite for Children. Unite against AIDS 14 Dublin Declaration adopted at the Ministerial Conference on Breaking the Barriers Partnership to Fight HIV/AIDS in Europe and Central Asia, February 2004. http://www.eu2004.ie/templates/ meeting.asp?snavlocator=5,13&list_ id=25 15

Figure 1 Estimated number of people living with HIV in Eastern Europe and Central Asia Source: UNAIDS Adult prevalence (%) 15.0% 39.0% 5.0% 15.0% 1.0% 5.0% 0.5% 1.0% 0.1% 0.5% 0.0% 0.1% not available Adults and children living with HIV, end 2003 Country Estimate [low estimate - high estimate] Armenia 2,600 [1,200-4,300] Azerbaijan 1,400 [500-2,800] Belarus [12,000-42,000] Bosnia and Herzegovina 900 [300-1,800] Bulgaria <500 [<1,000] Croatia <200 [<400] Czech Republic 2,500 [800-4,900] Estonia 7,800 [2,600-15,000] Georgia 3,000 [2,000-12,000] Hungary 2,800 [900-5,500] Kazakhstan 16,500 [5,800-35,000] Kyrgyzstan 3,900 [1,500-8,000] Latvia 7,600 [3,700-12,000] Lithuania 1,300 [400-2,600] Poland 14,000 [6,900-23,000] Republic of Moldova 5,500 [2,700-9,000] Romania 6,500 [4,800-8,900] Russian Federation 860,000 [420,000-1,400,000] Slovakia <200 [<400] Tajikistan <200 [<400] Turkmenistan <200 [<400] Ukraine 360,000 [180,000-590,000] Uzbekistan 11,000 [4,900-30,000] Source: UNAIDS

Figure 2 Access to Antiretroviral Therapy, September 2005 RUS* BEL* UKR* KAZ* ARM* AZE* UZB* TKM KGZ* TJK* ALB* Source: WHO no ART very poor access (1-10%) moderate access (50-75%) individuals on ART (<1%) poor access (10-50%) good access (over 75%) * in the process of scaling up ART

The UNICEF/UNAIDS global campaign Unite for Children. Unite against AIDS aims to push children to the forefront of the HIV and AIDS debate over the next five years. For more information on the campaign in Eastern Europe and Central Asia, visit the websites: http://www.unicef.org/ceecis http://www.unaids.org