HIV/AIDS in the Western Balkans : Priorities for Early Prevention in a High-Risk Environment

In recent years, Europe and Central Asia (ECA) has seen the world's fastest growing HIV/AIDS epidemic. The Balkans countries and territories under study - Albania, Bosnia and Herzegovina, Macedonia, Serbia and Montenegro, and the UN-administered Kosovo -- have reported over 2,000 HIV/AIDS cases since the beginning of the epidemic in 1985. In ECA, HIV/AIDS disproportionably affects the youth population: 80 percent of HIV infected people are 30 years old or younger. This study confirms that the Balkans region faces a triple jeopardy: 1) All structural factors are present to drive epidemics transmitted predominantly by heterosexual drug users; 2) Conflict and economic decline handicap the ability of governments and civil society to make an effective response; and 3) Old ideologies and vested interests are set against key elements of intervention known to be effective. Although the low number of cases identified, and lack of reliability of existing data, do not allow future trends of the HIV/AIDS epidemic in the Balkans to be predicted with certainty, a potential epidemic may develop or be halted in one of three ways: Following the pattern of the epidemic in other regional countries, it can become concentrated among intravenous drug users and eventually spread to other groups of the population through sexual contact. If Injecting drug use does not become widespread, sexual transmission can continue to be the most likely route for transmitting the infection and establishing the epidemic. An epidemic is prevented through early concerted efforts by the public sector, nongovernmental organizations, and the international community who closely cooperate with young people at high risk of being infected or that are already infected. In this scenario, highly vulnerable groups reduce the harm of injecting drugs by avoiding associated risky practices such as sharing needles and syringes; and both highly vulnerable groups and vulnerable groups such as youth increase their knowledge about the epidemic and adopt safe sex practices. The study concludes that to decrease the risk of an HIV/AIDS epidemic spreading throughout the Balkans region, and becoming a long-term development problem as it has happened in other regions, requires a mix of interventions aimed at reducing the risk of infection in the short term, and interventions aimed at tackling structural factors in the medium to long term. However, political commitment has to increase for action to occur promptly.