Drug Policy And Health In Romania - Drug Policy Alliance

DRUG POLICY AND HEALTH IN ROMANIA
A Profile Prepared by the Drug Law and Health Policy Resource Network
21 February 2002
Policy Indicators
HIV EPIDEMIC STATUS:
MAIN TRANSMISSION MODE:
DRUG POLICY CONDITIONS:
LAW ENFORCEMENT PRACTICES:
INTERVENTION LEVEL:
___________
INJECTION DRUG USE
___________
___________
___________
CONTENTS
Summary
HIV/AIDS
OTHER INFECTIOUS DISEASES
INJECTION DRUG USE
LAW AND LAW ENFORCEMENT PRACTICES
PUBLIC HEALTH INTERVENTIONS
ECONOMIC AND SOCIAL INDICATORS
Full Report
INTRODUCTION
HIV/AIDS
OTHER INFECTIOUS DISEASES
INJECTION DRUG USE
LAWS AND LAW ENFORCEMENT PRACTICES
PUBLIC HEALTH INTERVENTIONS
SOCIOPOLITICAL ENVIRONMENT
REFERENCES
Romania – 21 February 2002 - 7

Summary
I. HIV/AIDS
Romania has seen an AIDS explosion, especially in the juvenile population. With
almost 9,000 HIV infected children, Romania is the home of over 50% of Europe’s
pediatric HIV/AIDS cases. Those numbers are expected to increase due to increasing
drug use and sexual activity among Romania’s 5,000 street children.
HIV Cases By Mode of Transmission, 2000
15%
0%
84%
0%
1%
Hetero
Homo/Bi
IDU
Perinatal
Other
Source: 13
New HIV Infections per Million
Population
40
30
20
10
0
1993 1994 1995 1996 1997 1998 1999 2000
Source: (13)
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II.
OTHER INFECTIOUS DISEASES
The incidence of tuberculosis in Romania is the worst in this part of Europe.
Growing poverty, natural disasters and worsening social conditions are the root of the
problem.
Cases per 100,000 Population
140
120
100
80
60
40
20
0
Syphilis
TB
1993
1995
1997
1999
Sources: (12) (13)
III.
INJECTION DRUG USE
Drug Use. Drug use is growing, especially among children. It is believed that the
prevalence of drug use among teenagers is about 98%.
Risk Behavior Information. Child drug users have been switching from paint
thinner to heroin. They often put their money together for one syringeful and share the
needle.
Social Attitudes. For many years, drug use did not officially exist in Romania.
The lack of education on the subject led to uninformed fearful parents. Drug users are
seen as weak-willed people.
IV.
LAW AND LAW ENFORCEMENT PRACTICES
Romania is a democracy, which is divided among a parliament, an executive and
a judiciary. In general, rights of the accused are respected and conditions are continually
improving. However, there are several incidents of abuse by police and of prisoners.
Romania – 21 February 2002 - 7

Law on the Books
? The government is divided into a
presidency, a judiciary and a parliament
? Those accused of a crime have the right
to an attorney
? Those being detained on suspicion of a
crime may request a hearing within 24
hours.
Actual practice
? The executive has been known to
exercise some control over the judiciary
? Those accused are not always informed
of their rights
? Detainees have been known to be
beaten at times
V. PUBLIC HEALTH INTERVENTIONS
Harm Reduction Programs Generally. Open Society Institute funds four
programs, all in Bucharest. The Romanian government has tried to distribute condoms
and educate people on drug use, however it lacks resources.
Drug Treatment. There are very few drug treatment programs. The few that
exist are detoxification programs operated out of hospitals.
VI.
ECONOMIC AND SOCIAL INDICATORS
The Transparency Corruption Perceptions Index (CPI) ranks countries in terms of
the degree to which corruption is perceived to exist among public officials and
politicians. In 2001, the rank for Romania was 69 out of 91 countries.
The Human Development Index value is a composite index measuring average
achievement in three basic dimensions of human development-a long and healthy life,
knowledge and a decent standard of living. In 1999, Romania ranked 68 of the 174
countries measured.
The GINI index measures the extent to which the distribution of income (or in some
cases consumption expenditures) among individuals or households within an economy
deviates from a perfectly equal distribution. The GINI index of zero equals perfect
equality, while and index of 100 implies perfect inequality. The GINI index for the most
resent reported year for Romania was unavailable.
Unemployment refers to the share of the labor force without work but available
for and seeking employment. Definitions of labor force and unemployment differ by
country. Romania’s unemployment rate in 1997 was 6.0%.
The Gross Domestic Product (GDP) is the total of all economic activity in one
country, regardless of who owns the productive assets. In 2000, the GDP was
unavailable. The average annual growth of the economy from 1990 to 1999 was
unavailable.
Romania – 21 February 2002 - 7

DRUG POLICY AND HEALTH IN ROMANIA
A Profile Prepared by the Drug Law and Health Policy Resource Network
Full Report
I. INTRODUCTION
The Drug Law and Health Policy Resource Network is an international research
collaboration designed to improve data collection and policy analysis on drug policy and
health in the countries of Eastern Europe and the Former Soviet Union. The information
in this report was gathered by staff at Temple University’s Beasley School of Law and
the University of Connecticut Health Sciences Center. It will be augmented by further
research in 2002 by network collaborators in the study region.
This Report presents available information in six domains: HIV/AIDS, other
infectious diseases, injection drug use, law and law enforcement practices, public health
interventions, and economic and social indicators. It concludes that Romania is in the
early stages of a serious HIV epidemic driven primarily by injection drug use. With
sufficient external support and dramatic internal changes in drug policy and law
enforcement practice, a public health effort against HIV and other blood-borne diseases
could be successful.
II.
HIV/AIDS
Accurate and complete data on HIV in Romania are not available. The data
presented here are from a variety of sources and may not entirely agree. These data
generally do not represent HIV incidence, and depend heavily upon patterns of HIV
testing and reporting that remain very incomplete in the most severely affected countries.
HIV infection is defined as an individual with HIV infection confirmed by a laboratory
according to country definitions and requirements. AIDS cases are reported according to
a uniform AIDS case definition originally published in 1982 and revised in 1985, 1987
and for adults and adolescents (age >13) in 1993. The 1993 European AIDS surveillance
case definition differs from that used in the United States in that it does not include CD4
lymphocyte criteria.
Overall Data. Since 1985, 2,263 children and 288 adults have died from AIDS in
Romania. (5) Most of Romania’s HIV/AIDS cases have been caused by non-sterile
medical equipment and contaminated blood. (3) Romania is home to over 50% of all
pediatric AIDS cases in Europe. (4) Its almost 9,000 infected children is thought to be
caused by Romania’s leader in the 1980’s. In an effort to increase the population, he
outlawed contraception, social workers and HIV screening. Also, many children received
needless blood transfusions during this time period. The problem is expected to worsen
because 85% of Romania’s 5,000 street children are sexually active. The disease moves
Romania – 21 February 2002 - 7

at different rates in different children. Therefore, some parents who merely thought there
children were sick now realize that their children have AIDS. (6)
Data from The European Center for the Epidemiological Monitoring of AIDS
Year
Reported
AIDS cases
Reported
New HIV
infections
# Rate/
Homo/bi
Contact
#
Injection
Drug Use
#
Heterosexual
Contact
#
Perinatal
Transmission
#
# Rate/
HIV AIDS HIV AIDS HIV AIDS HIV AIDS
Million Million
1993 447 19.5 234 10.2 - - - - - - - -
1994 494 21.6 722 31.6 - - - - - - - -
1995 698 30.7 854 37.6 - - - - - - - -
1996 560 24.7 699 30.9 16 1 1 0 77 80 32 19
1997 588 26.1 650 28.8 1 1 1 1 33 30 24 22
1998 638 28.4 648 28.8 3 7 0 0 68 68 19 19
1999 380 17.0 364 16.2 4 6 0 0 74 83 16 16
2000 557 24.9 290 12.9 1 2 0 0 43 221 5 10
(12)(13)
Regional Distribution.
Stigma and Social Attitudes toward HIV/AIDS. People with HIV are held
responsible for the spread of the disease. (3) This leaves children with HIV/AIDS at a
special risk for abandonment. (4) Many Romanians think that punishing gay men will
stop AIDS. School education avoids talking of sexual orientation, venereal diseases and
HIV education. (7)
III.
OTHER INFECTIOUS DISEASES
The spread of HIV is related in important ways to the incidence of other
infectious diseases. Non-sterile injection drug use is a risk factor not only for HIV, but
also Hepatitis. Incarceration in many countries in this region is a risk factor for
tuberculosis. Sexually transmitted diseases may increase the likelihood of HIV
transmission during sex.
Romania – 21 February 2002 - 7

Romania appears to be in the midst of growing epidemics of TB and syphilis.
Public health is worsening due to poverty, natural disasters and worsening social
conditions. The incidence of tuberculosis in Romania is the worst in the region. (9)
Data from (12) (13)
Year TB Syphilis Hepatitis
# Rate/
100,000
Rate/
100,000
Hepatitis Hepatitis
A B C
# # #
1993 - - 26 - - -
1994 - - 29 - - -
1995 23,271 102.4 35 - - -
1996 24,113 106.4 32 - - -
1997 24,350 107.7 32 - - -
1998 25,623 113.5 34 - - -
1999 26,107 116.5 37 - - -
2000 - - 45 - - -
IV.
INJECTION DRUG USE
This section reports available information about drug use levels, trends and risk
behaviors, as well as social attitudes about drug use and information about the problem of
drug overdose. Drug treatment and other interventions to reduce the morbidity and
mortality of drug use are discussed in section V, below. Data about drug use come
primarily from unofficial sources, including more or less rigorous rapid assessments,
consultant reports and the news media.
Summary of situation. Drug use is growing among children. In urban areas,
drug use among teenagers is thought to be 97-98%, especially in the cities that function
as gates for drug traffic, Bucharest, Constanta and Timisoara. Drug use is rare among
children in rural areas, which lack profitable marketplaces for dealers. (10)
Trends in Drug Use. Low salaries earned by most Romanians make narcotics too
expansive. Still, law enforcement officials noted a trend of increasing domestic drug use.
The trend is most noticeable in consumption of cannabis and synthetic drugs as "ecstasy",
among the nation's youth. (1)
Risk Behavior. Child drug users often engage in high-risk behavior. As one
filmmaker put it, “Heroin has replaced (the paint thinner) Aurolac. One child can’t afford
a syringe, so you will have five kids chipping in for one syringeful and then sharing a
needle.” (18)
Romania – 21 February 2002 - 7

Drug Traffic Information. Romania is not a major producer of narcotics.
However, the country lies on a route used to funnel heroin and opium from Afghanistan
through Turkey to Western Europe. This is known as the Northern Balkan route.
Romania is also a used as a depot and transit point for South American cocaine traveling
to Western Europe. A large amount of precursor chemicals transit Romania from Western
European countries south toward Turkey. Drugs are also brought into Romania via the
Black Sea port of Constanta, as well as the country's international airports. Only 20
percent of the drugs moving through Romania are consumed domestically. (1)
Social Attitudes Toward Drug Users. There is a serious lack of knowledge
among the country's youth regarding the dangers of abusing drugs. (1) Officially drug use
did not exist in Romania for many years. However, as the nation’s politics continue to
change, the awareness of drug use is also expected to increase. (3) Romanian teenagers
describe drug users as having a weak personality, as being irresponsible, a coward, stupid
and dirty. Adults say they feel unprepared to handle this problem. They are afraid and
feel as if they have no help. (10)
Drug Overdoses.
V. LAWS AND LAW ENFORCEMENT PRACTICES
A. Drug Law
This section describes what is known about both the drug-related laws on the
books and the way these laws are enforced. The section covers syringe access, drug
possession, drug treatment, drug trafficking, and the handling of drug arrestees and
prisoners within the criminal justice system. It also lists the international drug-related
instruments to which the country is a signatory.
Syringe Access/Needle Exchange Programs - Law.
Syringe Access/Needle Exchange Programs - Practices.
Substitution Therapies.
Drug possession Law.
Drug Possession Law-Practices.
Drug treatment Law.
Compulsory Treatment –Practices.
Romania – 21 February 2002 - 7

Drug Trafficking Law. Law 143/2000, which was passed August 2000, gives
the national police expressed powers to carry out controlled deliveries of narcotics and
allows for the use of undercover police in the investigation of drug-related activities. (1)
Drug Treatment Regulation.
Drug Treatment Regulation-Practices.
Criminal Justice System- Law. Romania is a multi-party democracy. There is a
bicameral parliamentary system, a head of the government, a directly elected head of
state and a judicial branch. No one can be held for more than 24 hours without an arrest
order from the prosecutor. The prosecutor may then order detention for up to 30 days.
However, the accused may ask for bail and hearing from a judge. The request for a
hearing must be granted within 24 hours. The accused has the right to counsel. (19)
Criminal Justice System- Practices. In general, the rights of the accused are
respected. However, in some cases detainees have been beaten and those accused are not
always informed of their rights. Prisons are improving as more money is being allocated
to their budgets. They have instituted training programs. However, the prisons still use a
system in which some prisoners are placed in charge of other prisoners. As a result, there
have been several incidents of abuse reported. (19)
International drug conventions signed. The country is a party to the following
international drug agreements.
? 1988 UN Drug Convention
? Extradition treaty with the United States
? Mutual Legal Assistance Treaty with the United States
? UN Convention on the Trafficking of Illicit Narcotics and Psychotropic
Substances
? UN Convention Against Transnational Organized Crime and its Protocols
(December 2000) (1)
B. Public Health and Human Rights Law
This section describes what is known about public health and human rights law on
the books, as well as the way these laws are enforced. The section covers the rights to
healthcare, privacy, reportability and anti-discrimination generally and for HIV/AIDS
patients. It also lists the international human rights instruments to which the country is a
signatory.
Right to Health Care/ Right to HIV Treatment –Law.
Right to Health Care/ Right to HIV Treatment –Practice. Romanian hospitals
cannot afford to take care of all the nation’s HIV children. Some children live in state
hospitals, but many live with their families in orphanages or in small apartment
Romania – 21 February 2002 - 7

“orphanages” run by a charity named Heart of the Child. The hospitals and charities
cannot afford drugs for all the children. Anti-retroviral cocktails cost $10,000 per child.
In one hospital only 120 of the 400 infected outpatient children are on the cocktails. One
doctor reported, “if he had enough money, 100 more would be (on the cocktails, because
they met Romania’s virus level criteria. If they were in the United States, all 400 would
be.” (6)
Reportability of HIV, AIDS, HCV, HBV – Law and Practice.
HIV Testing Provisions–Law and Practice. HIV testing was made mandatory
for all STD and TB patients. (8)
Anti-Discrimination Provisions based on HIV or drug use – Law and
Practice.
Privacy Generally and HIV in Particular –Law.
Privacy Generally and HIV in Particular –Practice. The media, eager for
scandal, often reveals a person’s HIV status. Medical staff often breach confidentiality
without impunity. The Romanian press is subject to no ethical guidelines for the
confidentiality of a person’s HIV status. (7)
Criminal Penalties for Exposing/Transmitting HIV. Article 309, paragraph 2,
of the Penal code criminalizes “transmission of AIDS” by “a person who knows
him/herself to suffer from that disease.” (11)
Criminalization of Prostitution –Law and Practice.
Criminalization of Homosexuality –Law and Practice. The Orthodox Church
campaigns aggressively against same-sex relationships. The public discourse with sexual
minorities, including their vulnerability to AIDS has been poor. (7)
Status of International Human Right Conventions. Romania’s status in
relation to major international human rights instruments follows.
? International Covenant on Economic, Social and Cultural Rights
(CESCR): signed December 9, 1974
? International Covenant on Civil and Political Rights (CCPR): signed
December 9, 1974
? International Covenant on Civil and Political Rights, Optional Protocol
(CCPR-OP1): signed July 20, 1993
? International Covenant on Civil and Political Rights, Second Optional
Protocol (CCPR-OP2-DP): signed February 27, 1991
Romania – 21 February 2002 - 7

? International Convention on the Elimination of All Forms of Racial
Discrimination (CERD): signed September 15, 1970
? Convention on the Elimination of All Forms of Discrimination Against
Women (CEDAW): signed January 7, 1982
? Convention on the Elimination of All Forms of Discrimination Against
Women, Optional Protocol (CEDAW-OP): signed September, 2000
? Convention Against Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment (CAT): signed December 18, 1990
(2)
VI.
PUBLIC HEALTH INTERVENTIONS
This section provides information on interventions to reduce HIV transmission
and other health problems among drug users, the availability of drug treatment, and HIV
prevention programs.
A. Interventions to Reduce Disease and Other Injuries Associated With
Drug Use
Government Position. The Romanian Ministry of Health maintains some
programs designed to educate young people about the dangers of drug use. These efforts
are hampered by a lack of resources. (1) In 1994, Romania established a Ministerial
Committee on HIV/AIDS. It stopped functioning in 1996 without generating any policy.
Now only the Medical Commission of the Ministry of Health is concerned with
HIV/AIDS. (7)
As on advocate said, “There have been three changes in the minister of health in
four years,” she said. “It’s chaos. Some talk of seizing the patents, but then they leave.”
“No one in the government will do this by themselves,” she said. “Not unless they have a
personal interest, like an HIV infected friend of something. This is Romania. Here the
bureaucrats say: “What HIV people? We need to get rid of them.” (6)
Needle Exchange Programs. Open Society Institute funds four harm reduction
programs all in Bucharest. Some drug dependant people are afraid to make contact. The
programs attempt to reach the people who are afraid through clients they already have.
One of the programs focuses on prisoners, another sex workers. (17)
Drug Treatment Programs/Availability. Detoxification programs are offered
through some hospitals. But they are in very limited supply. (1)
Summary of Situation.
Substitution Therapies.
Romania – 21 February 2002 - 7

B. Public Health Measures to Prevent HIV and other Significant Diseases
Government Efforts/Attitudes. The government has tried to distribute
disposable gloves, condoms and blood-testing kits. (3)
Programmatic Details.
The total number of HIV tests performed, excluding unlinked anonymous testing
and testing of blood donations by year (1996 – 2000) was:
1996:
1997:
1998:
1999:
2000:
The rate of HIV testing /1000 population was
VII.
SOCIOPOLITICAL ENVIRONMENT
A variety of data and data indices are commonly used to characterize social,
political and economic factors in a country. The following are several of these for
Romania.
Perceived corruption in government is measured by the Transparency Corruption
Perceptions Index (CPI) ranked countries in terms of the degree to which corruption is
perceived to exist among public officials and politicians. The most recent measure was
in 2001.
? Country Rank: 69 of 91 countries
? 2001 CPI Score: 2.8 out of a possible 10
? Surveys Used: 5
? Standard Deviation: 0.5
? High-Low Range: 2.0 - 3.4
(14)
The GINI index measures the extent to which the distribution of income (or in
some cases consumption expenditures) among individuals or households within an
economy deviates from a perfectly equal distribution. A Lorenz curve plots the
cumulative percentages of total income received against the cumulative number of
recipients, starting with the poorest individual or household. The GINI index measures
Romania – 21 February 2002 - 7

the area between the Lorenz curve and the hypothetical line of absolute equality,
expressed as a percentage of the maximum area under the line. This the GINI index of
zero equals perfect equality, while and index of 100 implies perfect inequality
? GINI Index, 1998: unavailable
The Human Development Index is a composite index measuring average
achievement in three basic dimensions of human development-a long and healthy life,
knowledge and a decent standard of living.
? Human Development Index Rank (HDI) in 1999 – 68/174 (8)
Unemployment rates refer to the share of the labor force without work but
available for and seeking employment. Definitions of labor force and unemployment
differ by country.
? Unemployment rate (1997) - 6.0 % (8)
Standard & Poor's Insurer Financial Enhancement Rating is a current opinion of
the creditworthiness of an insurer with respect to insurance policies or other financial
obligations that are predominantly used as credit enhancement and/or financial
guarantees. The ratings range from ‘CC’, which is defined as “currently highlyvulnerable”
to a rating of ‘AAA’, which is defined as “extremely strong” capacity to
meet its financial commitments.
? Local Currency:
? Long-Term rating: B+
? Outlook: Positive
? Short-Term Rating: B
? Foreign Currency:
? Long-Term rating: B
? Outlook: Positive
? Short-Term Rating: B
The Social Indicators of Poverty represents the health status of individuals in
different socioeconomic groups within countries for the last survey year (1995).
? Infant Mortality Rate:
Poorest Quintile:
Richest Quintile:
? Child Immunization Rate:
Poorest Quintile:
Richest Quintile:
Romania – 21 February 2002 - 7

? Prevalence of Child Malnutrition:
Poorest Quintile:
Richest Quintile:
? Low Mother’s Body Mass Index:
Poorest Quintile:
Richest Quintile:
? Total Fertility Rate:
Poorest Quintile:
Richest Quintile:
The National Poverty Line is the measurement of the percentage of the population
below the defined income level of poverty. In Romania the percentage of the
population that has an income below the poverty line is unavailable.
? Population Below the Poverty Line, (BPL), 1996: unavailable
The Gross Domestic Product (GDP) is the total of all economic activity in one
country, regardless of who owns the productive assets. The GDP per capita is the total
output divided by the population. This value is then adjusted to convert to a common
currency, which adjusts for national variations in the process paid for goods and services.
There has been a precipitous decline in GDP in Romania during the last decade with an
average annual growth rate in the economy of unavailable
Gross Domestic Product per Capita (PPP US$): Romania
Gross Domestic Product - Average Annual Growth:
1980-1990: ---
1990-1999:
Gross Domestic Product in $ USD Millions:
1990:
2001:
(19)
Romania – 21 February 2002 - 7

VIII.
REFERENCES
1) International Narcotics Control Report, 2001,
http://www.state.gov/g/inl/rls/nrcrpt/2000/index.cfm?docid=892
2) Office of the United nations High Commissioner for Human Rights, Status of
Ratifications of the Principal International Human Rights Treaties, 26 Jun
2001, http://www.unhchr.ch/pdf/report.pdf
3) www.drugtext.org/count/rom.html
4) HIV/AIDS Program, www.kappa.ro/holt/eholt-h.html
5) Fleishman, Jeffrey, "Romania has half Europe's Juvenile AIDS Caseschildren
in Romania bear an AIDS Legacy". Philadelphia Inquirer 12/06/98,
p. A25.
6) Romania's AIDS Children: A Lifeline Lost.
7) Macovei, Monica and Coman, Adrian. "Implications for HIV/AIDS of Laws
Affecting Men Who Have Sex With Men In Romania". http://www.acceptromania.ro/msmeng.html
8) Epidemiological fact Sheet on HIV/AIDS and Sexually Transmitted
Infections, 2000 Update, http://www.unaids.org
9) Sparrows, John. "Romania's Human Challenge". 4 Jul 2001.
http://www.reliefweb.int
10) Stoica-Constantin, Ana; Constantin, Ticu; Rogojina, Didina and Baciu,
Sergiu. "Drug-Use among Teenagers in Romania and the Republic of
Moldavia". http://www.psih.uaic.ro/cticu_drog_engl.html
11) Public Scandals: http://www.ilga.org
12) WHO Europe Communicable Disease, WHO Regional Office for Europe,
1999 - 2001, http://cisid.who.dk/
13) HIV/AIDS Surveillance in Europe, End-year Report 2000, European Centre
for the Epidemiological Monitering of AIDS, 2001, N°64, http://www.eurohiv.org
14) Corruption Perceptions Index 2001, Transparency International,
June 27, 2001,
http://www.transparency.org/documents/cpi/2001/cpi2001.html
15) Sovereign ratings List, Standard & Poor's, August 3, 2001,
Romania – 21 February 2002 - 7

http://www.standardandpoors.com/RatingsActions/RatingsLists/
So…/SoverignsRatingsList.htm
16) CIA -- The World Factbook 2000,
http://wwwcia.goc/cia/publications/factbook/geos/pl.html
17)
http://www.soros.org/harm-reducation/resourceguide/text/IHRD7.html#Romania
18) Sinagra, Laura, “Beneath Bucharest – Edet Belzberg’s Children Underground
goes deep into the world of Romania’s street kids”
http://www.citypages.com/databank/22/1092/article9929.asp
19) U.S. Department of State, Romania Country Report on Human Rights
Practices for 1998. http://www.hri.org/docs/USSD-Rights/1998/Romania.html
Romania – 21 February 2002 - 7