Europe and Central Asia region's progress toward attaining the MDGs is promising, but uneven. The health MDGs present the largest challenge. The region is facing rapidly rising HIV/AIDS and tuberculosis cases. Denial, stigma, and the institutional challenges of providing services to marginalized and vulnerable groups remain serious obstacles to progress in stemming the numbers of people living with—and dying—of AIDS. Child mortality rates of 58 per thousand births across the region also, remain a stubborn challenge, especially as progress may be blocked because many people shun hospitals due to concerns about quality and costs. The best outcomes are noted on MDG for gender equality in schools - because of the region's tradition of equal access to education. Despite the high enrollment rates in primary and secondary schooling, the declining quality of education is of particular concern.