May 7, 2002—The Europe and Central Asia Region (ECA) is in the midst of a health crisis as HIV incidence is rising faster there than anywhere else in the world spreading largely through injecting drug use and commercial sex. But the epidemic is reaching segments of the general population fueled by youths and others engaging in risky behavior.

At the end of 2001, more than one million people in ECA were infected with HIV/AIDS—an increase of 250,000 from just one year earlier. In parallel, the region is experiencing a tuberculosis (TB) epidemic, fueled by poverty, alcoholism, crowded prisons, and outdated diagnostic and treatment paradigms.

In Moldova, efforts to fight HIV/AIDS and other communicable disease are receiving strong support. With 1,500 HIV/AIDS cases, HIV infection is spreading quickest through intravenous drug use and unprotected sex, and is affecting young people at an alarming rate. Similarly, the TB epidemiological situation in the country has been constantly deteriorating over the last decade.

"The human costs of transition for Moldova have been very high. Ninety percent of the population have incomes of less than US$2 a day. Add to that the lack of access to treatment and a drop in life expectancy for people living with AIDS or TB, and the outlook is bleak," said Joana Godinho, Health Program Team Leader.

An important factor is that the government of Moldova deems HIV/AIDS, sexually transmitted infections(STIs,), and TB as major public health care problems requiring important attention due to the health and social impact of these conditions.

Also encouraging is that the burgeoning problem in Moldova is gaining international attention and funding due to the recent approval of a strategy on HIV/AIDS, STIs, and TB by the new Global Fund to Fight AIDS, Tuberculosis, and Malaria, which just announced its first round of grants to programs to prevent and treat the three diseases in severely affected countries.

The Fund awarded a total of US$378 million over two years to 40 programs in 31 countries, a significant increase in international spending to combat the diseases. Among the winners was Moldova, whose proposal, "Support to the National Program for the Prevention and Control of HIV/AIDS and STIs, and to the National Program for Control of TB," was awarded US$1.7 million for the first installment of the total proposal of US$11.7 million.

The World Bank assisted Moldova in the preparation of the Global Fund proposal and has also lent support through its US$20 million Moldova Health Investment Fund which will handle the management of the grant. Financing from the grant will be combined with Bank funding for a Bank HIV/AIDS and TB project, expected to go to the Bank's Board next fiscal year.

"Moldova's health crisis is not simply a health issue, but one that has immense social and economic ramifications as well. Through the National Strategies, the government is focused on the prevention of infection, especially among youth and other vulnerable groups, the prevention of infections originating in a health care setting, and on improving the social, legal, ethical, and human rights aspects of HIV/AIDS, TB and STIs," said Godinho.

 "The Bank is hopeful that these positive steps will pave the way for a more open dialogue on these important issues and a declining rate of HIV/AIDS, TB and STI cases in the near future," she said.

Useful links: Click here for more information on the fund. For more information on the Bank's work in human development in ECA and on HIV/AIDS, go to www.worldbank.org/eca/ecshd or www.worldbank.org/eca/aids.