Manoela Grozdanova has been UNAIDS Program Analyst at the UNDP Country Office in Bulgaria since January 2002. Her responsibilities include cooperation with the government and NGOs in awareness raising, prevention and response intervention in the field of HIV/AIDS vulnerability as well as dissemination information on a broad range of HIV/AIDS related issues. Grozdanova is a PhD holder in management from the University of National and World Economy in Sofia. Grozdanova is also a holder of certificates in financial management and business, international business strategy and EU from the London School of Economics and Political Science. She is married with one child.
Ms Grozdanova answered questions of Martina Iovcheva
Q: Do Bulgarians view HIV as a direct threat in their everyday life?
A: Although generally informed about the danger of HIV/AIDS infection the Bulgarian people do not consider HIV/AIDS as direct threat in their daily life. This is to some extent due to the fact that most people have so many problems - economic, family and health problems that are so evident, how to say physically touchable, that people have no time or energy left to think of something that is invisible to them. And HIV is invisible. So people think or prefer to think that this cannot happen to them. Among the dangers are the myths that many people believe in. They say: "I am not sex worker, I am not homosexual, I do not use drugs and I have a serious friend for two years. This is not related to me." Or the other myth "I do not have sexual contacts with unknown people. I know this girl/boy. She/he lives on our street." AIDS has no face. You cannot understand that someone is HIV+ only by looking at him. The truth is that everything is in our hands when using a condom in every sexual contact. This gives you the safety and the freedom to chose your partners. This gives you the self-confidence that you are responsible and modern person. If you are injecting drugs (I hope you don't) or medicine use individual syringes.
Q: Is the situation concerning AIDS in Bulgaria alarming? How many people are HIV positive in Bulgaria? Which groups are most vulnerable to the virus? Is there an increase in the number of the infected during the last several years? Do HIV positive patients are being treated in a suitable manner?
A: Bulgaria is still a country with low prevalence of HIV/AIDS. By July 2002 there are 383 HIV+ officially registered, out of them 101 are living with AIDS. Out of 383 HIV+ 68% are men (260) and 32% are women (123). The dominant mode of transmission is sexual 91%, vertical (mother to child) 1%, and blood 8%. From the sexual mode of transmission 88% is heterosexual and 12% is homosexual. The total number of HIV+ among the IDUs (injection drug users) is 10. However 5-6% of IDUs are infected with hepatitis B and 60% are with hepatitis C. This means that the IDUs are sharing syringes and needles. The data from the recent few years, however, outline a trend of increasing the number of newly infected people. Whereas in 1990 only two new cases were registered, during the current half year their number has increased tenfold up to 24. The newly infected in 2000 were 49, in 2001 40. Since the beginning of 2002 the number of newly infected people is 24, out of them 13 are men and 11 women. Around 71% of HIV+ are young people in the age of 20-39 years. The youngest HIV+ man is 21 years old and the oldest is 56 years old, the youngest woman is 24 and the oldest is 45.
The most vulnerable groups to HIV infections are young people and adolescents, injecting drug users (IDUs), Roma community, commercial sex workers (CSW), men who have sex with men (MSM), isolated groups and imprisoned individuals and mobile population.
There is a special department for treatment of HIV/AIDS patients located in the Infectious Hospital in Sofia. On expert level there is a discussion such a department to be opened in Varna as well. The Ministry of Health has secured for the 2002 1.6 million leva for treatment of PLWHA (People Living With HIV/AIDS). 105 patients with HIV/AIDS receive free of charge tri-component antiretroviral therapy. In addition to the budget secured for treatment 2 million leva are provided by the State budget for testing of donor blood and epidemiological surveillance. For Health promotion and for Health and social services for this year there are only 31 000 and 25 000 leva respectively provided by the State budget to the programme.
Q: How could the spread of the virus be prevented?
A: The main direction is to invest in HIV prevention. Further spread of HIV will be slowed only by a massive expansion of prevention programmes and efforts. Prevention has maximum impact as part of comprehensive interventions. The introduction of health education in the school curriculum is one important and urgent prevention measure that the Bulgarian government has to take. The knowledge, behavior and attitude of children, young people and adolescents towards their own life and health as something valuable, something they have to care for and are responsible for is one important task for the whole society, school, family, and all other government and non-government institutions.
Q: A UNAIDS report released in early July warns that the AIDS epidemic is still in an early phase. "HIV prevalence is climbing higher than previously believed possible in the worst-affected countries and is continuing to spread rapidly into new populations in Africa, Asia, the Caribbean and Eastern Europe," the report says. Do you think there is a threat for epidemic on the Balkans?
A: HIV/AIDS is spreading rapidly through countries in Eastern Europe, which continue to experience the fastest growing epidemic in the world. In 2001 there were 250,000 new infections in Eastern Europe, bringing the number of people living with HIV/AIDS to 1 million. However there is some place for moderate optimism: By scaling up the national response the Polish government has successfully reduced the epidemic among IDU. Prevalence remains low in countries such as Czech Republic, Hungary, and Slovenia, where well designated HIV/AIDS programmes are in operation. There is a growing political commitment in the region.
In countries such as Bulgaria, Romania and Russian federation the budgets for National AIDS programmes have increased considerably. Stronger partnerships are being established between governments, NGO and the private sector. The recently held SEE conference on HIV/AIDS in Bucharest confirmed the commitment of the governments to join efforts in the fight against AIDS. The SEE conference and especially the adopted declaration of commitment once again confirmed the leading role of the governments in the fight against HIV/AIDS supported by the whole society. All the participating countries - Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Federal Republic of Yugoslavia (including the UN Administered Province of Kosovo), Former Yugoslav Republic of Macedonia, Moldova, Romania and Slovenia aimed to co-ordinate country efforts and to develop and share regional expertise in response to HIV/AIDS.
All these countries are still low prevalence countries, which is one more factor for optimism that the spread of the epidemic could be overcome should active prevention programmes targeting young people, and especially the most vulnerable groups are immediately undertaken. What we have to understand is that HIV has no boundaries and is spread in all strata of society. We with our responsible behaviour can save ourselves from being infected. The denial of the problem is not the solution. The answer to the epidemic is in our hands.
Q: Drug firms unveiled more progress in developing innovative AIDS therapies at the international AIDS conference, highlighting a gulf in care between rich and poor. Do you think that in the near future the drugs against HIV will be accessible to the poor people in the world?
A: This is a political decision. It depends on the agreement between the governments and the big pharmaceutical companies.
Q: Is there a chance to create a vaccine against the disease soon?
In Barcelona it was stated that probably in two years time there would be a vaccine. However this was stated in Durban two years ago as well. We all hope that there will be a vaccine soon. But still it is important to understand that the creation of a vaccine does in no ways mean that we have to give up the prevention programmes and efforts.
Q: Is the Bulgarian government committed to fight this problem?
A: The Bulgarian government has demonstrated its commitment by taking the leadership role in the fight against HIV/AIDS in the country with the adoption of the strategy for the prevention and control of HIV/AIDS and STIs and an accompanying National Program (National Action plan.
The government has demonstrated its institutional commitment by establishing the National AIDS Committee - the coordination body of ministries and agencies activities aimed to limit HIV/AIDS and STDs (sexually transmitted infections) spread and mitigation of the health, demographic, social and economic consequences of HIV/AIDS epidemic. The Committee consists of representatives of: Ministry of Foreign Affairs, Ministry of the Interior, Ministry of Health, Ministry of Culture, Ministry of Education and Science, Ministry of Defense, Ministry of Justice, Ministry of Transport and Communication, Ministry of Labour and Social Policy, Ministry of Finance, State Agency for Young People and Sports.
The government has also demonstrated its financial commitment. A national budgetary allocation of 1.6 million USD was secured to support the 2001 year of Strategy and Program implementation and 1.7 million USD are secured for the year 2002. On one hand, we have to admit that the Government support is mainly directed towards treatment and testing. However, on the other hand, we can not and have no right to underestimate the fact that in spite of the extremely difficult financial situation the government is providing free of charge treatment of 105 HIV/AIDS patients and is testing every drop of donor blood and blood products and has actually stopped the HIV/AIDS transmission through blood and blood products transfusion.
Q: What are the most important projects you are currently working on? What are the biggest achievement of UNAIDS in Bulgaria so far?
A: The main achievement of UNAIDS in Bulgaria is the support provided to the development and adoption of the HIV/AIDS Strategy and National Program. Without the financial and technical support from the UNAIDS these two important political documents demonstrating the commitment of the Government to take the necessary actions and stop the HIV/AIDS spread in the country would have not been developed and adopted.
At the moment the UNAIDS supports the following projects: At the national level - the strengthening of the capacity of respective ministries and national level agencies represented in the National AIDS Committee to develop programs and action plans on HIV/AIDS targeting specific areas of intervention falling under their jurisdiction and at the local level - raising awareness and strengthening the capacity of ten selected municipalities to develop programs and action plans utilizing an integrated approach to HIV/AIDS.
With the financial support of UNAIDS 50 policy makers and experts from the Local Civic Committees in Plovdiv, Kazanlak, Shoumen, Targovishte and Pleven were trained in local strategic planning, health promotion, principles of effective intervention, HIV prevention and action plan development. The Local Civic Committees are provided consultancy support in the action plan finalization. Once the action plans are approved by the LCC the implementation of five pilot activities from the local action plans will be financed by UNAIDS.
UNAIDS together with UNICEF and UNFPA is supporting the capacity building of the AntiAIDS Coalition in designing, implementing, monitoring and evaluating specific interventions aimed at reducing the HIV/AIDS vulnerability.
Send to Kindle
