Moldova: Out from the shadows

15 October 2008

An MSF doctor examines the HIV/TB patient, in prison colony
© Alexander Gyadyelov

For years, people living with HIV in Moldova’s breakaway enclave of Transnistria remained unassisted. Marginalised in every sense of the term; they often come from high-risk groups living on the fringes of society, suffering a disease few understand yet many shun, in an area void of international recognition. In contrast, since 2005, Moldova has developed a functional HIV/AIDS treatment programme, supported by international donors. Yet the resources officially designated for both Moldova and Transnistria, did not reach the latter, despite one third of all HIV cases coming from Transnistria. The prevalent need was obvious and people's right to health care unquestionable. On this basis Médecins Sans Frontières began the area’s first HIV/AIDS health care programme in 2007. Since then, with the positive engagement of both the Moldovan and Transnistrian authorities, along with international organisations like the Global Fund, the seeds of change have been sown. There remains, however, a long way to go, to ensure the health and dignity of those who have lived in the shadows for so long.

MSF activities
• Since 2007, MSF has worked to set Transnistria’s first HIV/AIDS porgramme, including the establishment of Transnistria’s first National HIV/AIDS Centre (including outreach services): services include the provision of life-prolonging ARV therapy for HIV patients, counselling and testing, health education for patients and their families, rehabilitation and equipment of health facilities and laboratories, and training for local medical personnel.
• Care has been extended into Transnistria’s prisons, where the infection rate is most prevalent.
• Through ongoing advocacy efforts, MSF has highlighted the issue and engaged key actors (Transnistrian and Moldovan authorities, as well as international donors) to work together to support the establishment of a sustainable HIV/AIDS programme for Transnistria.

Seeds of change
• The Centre for Prevention of HIV/AIDS and Infectious Diseases became operational on 1 January 2008
• The Global Fund now supplies life-saving antiretroviral drugs to Transnistria (in 2008)
• 98 patients out of a known 179 HIV-positive cases in prisons have been registered and receive care
• At present, the Ministry of Health and MSF have registered more than 609 positive patients
• At present, 104 patients are on life-prolonging Antiretroviral treatment, including 19 inmates

A long way to go – ongoing needs include:
• Information and Educational campaigns
• Voluntary counselling and testing
• TB Services addressing HIV-TB co-infection
• Drug abuse, drug addiction, harm reduction, and substitution
• PLWHA (people living with HIV and AIDS) involvement
• Home-based care
• Palliative care
• HIV orphans and nutritional support