There are 4000 people living with HIV in Bulgaria, the country’s health authorities said on the eve of World AIDS Day, December 1.
 
Of this number, a quarter are officially recorded as having HIV but the rest are not aware of their status, according to Tonka Vurleva, head of Bulgaria’s HIV-AIDS prevention and control programme.
 
The projection that about 3000 people were unaware that they had HIV was based on scientific modelling taking into account factors including the time lapse before symptoms manifest themselves.
 
More than 67 per cent of cases of people registered as newly-infected with HIV are from the group aged 15 and 29 and for this reason, AIDS awareness campaigning is being orientated towards Bulgaria’s younger people.
 
Vurleva said that the group of newly-infected people included three 18-year-olds and a 16-year-old, and a children to which the infection had been transmitted by its mother.
 
About 60 per cent of newly-registered cases in the past 11 months were in Sofia and in Plovdiv, two of the country’s largest cities, Bulgarian news agency Focus said.
 
Among men, the average age of people with HIV was 31 among men and 32 among women, and the average age was continuing to fall, health authorities said.
 
Three days in the year see special anti-AIDS events in Bulgaria: December 1, St Valentine’s Day on February 14 and the International AIDS Candelight Memorial day, on the third Sunday in May.
 
Vurleva said that there were pregnant women among those diagnosed with HIV in Bulgaria, and all pregnant women would be offered HIV tests twice during their pregnancies.
 
In Bulgaria, HIV was spread mainly through intravenous drug abuse and through same-sex and bisexual contacts among men, according to Vurleva.
 
An annual report by the World Health Organisation said that in Eastern Europe and Central Asia, Ukraine and the Russian Federation were experiencing especially severe and growing national epidemics.
 
With adult HIV prevalence higher than 1.6 per cent, Ukraine has the highest inflection level reported in all of Europe.
 
In Eastern Europe and Central Asia, the number of people living with HIV in 2008 was 1.5 million, 66 per cent higher than in 2001.
 
Globally, according to new data in the 2009 AIDS epidemic update, new HIV infections have been reduced by 17 per cent over the past eight years.
 
Since 2001, when the United Nations Declaration of Commitment on HIV/AIDS was signed, the number of new infections in sub-Saharan Africa is about 15 per cent lower, which is about 400 000 fewer infections in 2008.
 
In East Asia, HIV incidence has declined by nearly 25 per cent and in South and South East Asia by 10 per cent in the same time period.
 
"In Eastern Europe, after a dramatic increase in new infections among injecting drug users, the epidemic has leveled off considerably. However, in some countries there are signs that HIV incidence is rising again," WHO said.
 
The report, released on November 24 2009 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO, highlights that beyond the peak and natural course of the epidemic - HIV prevention programmes are making a difference.
 
"The good news is that we have evidence that the declines we are seeing are due, at least in part, to HIV prevention," UNAIDS executive director Michel Sidibe said.
 
"However, the findings also show that prevention programming is often off the mark and that if we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved."
 
Data from the AIDS Epidemic Update also shows that at 33.4 million, there are more people living with HIV than ever before as people are living longer due to the beneficial effects of antiretroviral therapy and population growth.
 
However, the number of AIDS-related deaths has declined by more than 10 per cent over the past five years as more people gained to access to the life saving treatment.
 
UNAIDS and WHO estimate that since the availability of effective treatment in 1996, about 2.9 million lives have been saved.
 
Dr Margaret Chan, Director- General of WHO said: "International and national investment in HIV treatment scale-up has yielded concrete and measurable results. We cannot let this momentum wane. Now is the time to redouble our efforts, and save many more lives."
 
Antiretroviral therapy has also made a significant impact in preventing new infections in children as more HIV- positive mothers gain access to treatment preventing them from transmitting the virus to their children, according to the report. About 200 000 new infections among children have been prevented since 2001, the report said.
 
In Botswana, where treatment coverage is 80 per cent, AIDS-related deaths have fallen by more than 50 per cent over the past five years and the number of children newly orphaned is also coming down as parents are living longer.
 
One of the significant findings of the report is that the impact of the AIDS response is high where HIV prevention and treatment programmes have been integrated with other health and social welfare services.
 
Early evidence shows that HIV may have a significant impact on maternal mortality.
 
Research models using South African data estimate that about 50 000 maternal deaths were associated with HIV in 2008.
 
"AIDS isolation must end," Sidibe said.
 
"Already research models are showing that HIV may have a significant impact on maternal mortality. Half of all maternal deaths in Botswana and South Africa are due to HIV. This tells us that we must work for a unified health approach bringing maternal and child health and HIV programmes as well as tuberculosis programmes together to work to achieve their common goal."
 
The AIDS epidemic is evolving and HIV prevention programmes are not rapidly adjusting to the changes
 
The double report also shows that the face of the epidemic is changing and that prevention efforts are not keeping pace with this shift.
 
For example, the epidemic in Eastern Europe and Central Asia, once characterised by injecting drug use, is now spreading to the sexual partners of people who inject drugs.
 
Similarly, in parts of Asia an epidemic once characterised by transmission through sex work and injecting drug use is now increasingly affecting heterosexual couples.
 
Data show that few HIV prevention programmes exist for people over 25, married couples or people in stable relationships, widowers and divorcees. These are the same groups in which HIV prevalence has been found to be high in many sub-Saharan countries.
 
For example, in Swaziland people over the age of 25 accounted for more than two-thirds of adult infections, yet very few HIV prevention programmes are designed for older people.
 
Funding for HIV prevention has become the smallest percentage of the HIV budgets of many countries, the report said.
 
UNAIDS has launched a social networking site, AIDSspace.org, "building on the need to maximise results and to better connect the 33.4 million people living with HIV and the millions of people who are part of the AIDS response".
 
"AIDSspace.org aims to expand informal and established networks to include more people interested in HIV to maximise resources for a stronger AIDS response," WHO said.