Although valuable national and local responses to HIV have been mounted, effective HIV treatment and prevention programmes in Eastern Europe and Central Asia have largely failed to reach those who are most vulnerable, in particular young people. The insidious consequence of this has been a hidden epidemic which disproportionately strikes young people, adolescents and children. The central challenge of responding to HIV in most countries of the region is the need to come to terms with an epidemic that mostly affects people deemed by society to be ‘delinquent’ or ‘anti-social’. Every day, children and young people engage in behaviours that put them at risk of HIV infection. In some cases, peer pressure, curiosity or just the natural recklessness of their age leads them to experiment with drugs or sexuality without thinking of the consequences. But many have been driven to the edge by social, economic and family problems. Few educational and employment opportunities, as well as weakening family and social support structures, have led to disillusionment and defiance in many young people, often expressed via increased risk-taking behaviour.
Confronted with economic hardship, rising unemployment, social pressures and the crumbling of established social safety nets, many families found themselves unable to cope with the difficulties of socio-economic change and transition. These constraints, combined with widespread consumption of alcohol and drugs, reduced the capacity of many to protect their children. For some children from troubled families, the streets became their home or source of livelihood, and risk behaviours became a part of their daily lives. At their height, these street children were estimated to number a staggering one to four million.
Currently, the region has the highest rates of family separation in the world, with approximately 1.3 million children deprived of parental care and isolated from family and community, even though the vast majority still have biological parents. The relinquishment of children to institutional care is an established solution for families in distress – a practice that has historic roots and continues to the present day, despite strong evidence of its negative consequences for children’s well-being. The practice is often portrayed as being in the best interests of the child, with pregnant young women who use drugs being convinced that they cannot be good mothers. Relinquishment is in part due to a residual trust placed in these institutions by populations themselves, frontline service providers and policy makers. But it is also due to the lack of support for families under stress and to unfinished reforms in social welfare and protection services. As a result, an increasing number of children in the region have become ‘social orphans’ – children who live in state institutions while their parents are still alive.
Responding effectively to the HIV epidemic in Eastern Europe and Central Asia will require a paradigm shift from blame and exclusion to support and inclusion. A rights-based approach provides the basis for that shift. As stipulated in the Convention on the Rights of the Child, all rights apply to all children without exception, and States have an obligation to protect all children from discrimination and to take positive action to promote their rights. In building and sustaining the response to HIV, governments must take the lead in developing approaches that are firmly rooted in the needs and rights of children and young people. Looking ahead, priority areas for action include the strengthening of integrated health and social support for vulnerable families; expansion of evidence-based prevention efforts for reducing risk, harm and vulnerability among young people; and ensuring universal access to care, treatment and support for those living with and affected by HIV. Positive action by both governments and civil society organizations, working together with people living with HIV and affected communities, will be critical in building the supportive and inclusive.
