Blame & Banishment - Médecins du Monde

Blame and Banishment: The underground HIV epidemic affecting children in Eastern Europe and Central Asia
Looking ahead
Children and young people are among the most vulnerable in society, but at the same time
represent its greatest hopes for a better future. They need to be nurtured, supported and
protected. Today, however, too many children living in Eastern Europe and Central Asia
find themselves excluded from society and denied equal opportunities to realize their full
potential. HIV is both a cause and a consequence of this exclusion.
As this report documents, the rapid spread of the HIV epidemic in the region is partly a
consequence of social systems that are struggling, and often failing, to cope with rapid change.
But it is also a result of widespread social resistance to acknowledging the rights, needs and
aspirations of children, young people and adults who are at risk, infected, or affected by HIV.
Public prejudice, moralistic judgments and stigma are fuelling the dual epidemics of drug use
and HIV in the region and driving young people – particularly those most at risk and vulnerable
– underground. Major systemic weaknesses are undermining the delivery of quality health
and social services, and punitive approaches are discouraging open discussion of the failures
that need to be addressed. To date, in key areas of policy and of programme implementation,
evidence-based approaches and international protocols have often been slow to take hold.
Strong cultural attitudes about what young people ought to be doing override evidenceinformed
approaches to what they are doing. As a result, services that respond to their real
needs fail to be delivered. In these circumstances, the social challenges for those affected by
HIV are at least as significant as the health implications of the disease.
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
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