Community-based and community-led testing services are crucial in the HIV/AIDS, viral hepatitis, and sexually transmitted infections response, particularly in reaching populations where diagnosis and linkage to care are lower than the national average. However, providing these services can be challenging, especially in environments that may be hostile towards community-based and -led service delivery, and where policy and legal barriers exist.
In 2022-2023, the COBATEST Network supported six member organizations in countries where the environment is particularly challenging for community-based and community-led service delivery. In the following interview with Baylor Foundation, one of the 6 organisation supported, we asked the organisation to tell us about their work, the challenges they face, and how they are working to improve community-based testing services for HIV/AIDS, viral hepatitis, and sexually transmitted infections in their communities.
Romania has quite an unique picture of the HIV epidemic, due to its history and that one of the key effect groups is cohort – babies who got HIV through the medical system in 1980s. As part of the small grants programme, Baylor applied with the project focusing on increasing the coverage of HIV testing for young people at risk for HIV in city Constanta County.
Could you tell us more about the characteristics of the HIV epidemic in Romania and in Constanta County and why you decided to focus your project on young people?
Romanian HIV epidemic has some unique characteristics when compared to the other European countries. Romania has a specific group of people living with HIV, called the cohort. They are newborns infected with HIV while receiving health care in hospitals at the end of the 80’s. Now they represent 30% of the people living with HIV in Romania.
Since the beginning, the HIV epidemic has been driven by heterosexual transmission. Even in 2022 for the 60.4% of the newly diagnosed HIV cases the reported transmission route was heterosexual relations.
Constanta county, where Baylor Black Sea Foundation is running its CBVCT program is the county with the highest number of registered people diagnosed with HIV after the capital, Bucharest. Due to the characteristics of the HIV epidemic in Romania the Baylor CBVCT program has always had the general population as its target group.
Why young people? Looking back at our data concerning people coming to us for testing (November 2021-November 2022) we realized that only 26% were people aged 18 to 34 . During the same period, at the national level they represented 44.7% of the newly diagnosed cases in 2021 and 47.52% in 2022.
So, we are trying to raise the awareness of young people about Baylor’s testing service and, thus hoping to increase the number of young people from Constanta county getting tested for HIV.
What is the status of CBVCTs in Romania and how does it affect your work?
CBVCTs do not have a legal framework in Romania but, as Baylor’s program shows, this is not an impediment in implementing such a program. Guidelines for HIV testing and counselling are available both at a national and international level. Nevertheless, there are no funds available at the national level for CBVCT programs so, maybe, having a legal framework would also increase the funding opportunities for such programs, especially targeting high risk groups.
Is there access to self-testing and how popular is it?
Right now, HIV self-testing is legal in Romania, but there is limited access to self-testing as the HIV kits are no longer available for purchasing. For a period of time the kits could be purchased from pharmacies but even then, the high price represented an obstacle. The linkage to care for those with reactive results was also not clear.
There are no data, that we are aware of, about the uptake or the popularity of HIV self-testing. This is why we are trying to gather this information through the project we have under implementation.
What do you plan to achieve with your project?
The general goal is to raise awareness about Baylor Black Sea Foundation’s CBVCT program currently unfolding in Constanta city among young people and, on the long term to increase the percentage of young people coming for HIV testing. Of course, the ultimate goal is to increase the number of people diagnosed early with HIV.
Also, this is an opportunity for Baylor CBVCT program to pilot using self-testing kits, to measure the use, reactions, thus to collect crucial information about whether or not to include self-testing into our HIV testing program.
What are the gaps in HIV prevention in Romania and where could community response play a stronger role given the opportunity?
From 2007 until the end of 2022 Romania had no national HIV strategy, HIV prevention was mainly achieved through HIV treatment. Projects targeting high risk groups, or even testing projects like Baylor’s, were few, implemented by NGOs and always under the threat of being stopped because of lack of funding.
Regardless of the ambitious international objectives set for HIV, the reality shows that HIV is here to stay and, due to the delicate nature of transmission, prevention should be a team effort: government institutions and programs implemented by NGOs. NGOs have the expertise to provide friendly, easy to use services and to work with hard to reach HIV high risk groups.
This support was possible due to small grant programme as part of the In 2022-2023 AIDS Action Europe, LILA Milano, and CEEISCAT in the framework of the COBATEST Network are implementing a project titled Community Led and Based HIV Services - Key to Ending the HIV Epidemic in Europe and Central Asia supported by the "Zeroing In - Ending the HIV Epidemic" Programme funded by Gilead Sciences.