BUCHAREST, ROMANIA -- The Romanian government's campaign to combat a growing outbreak of AIDS among children and infants is lagging far behind need, hobbled by a lack of equipment and bureaucratic inertia, according to Romanian health officials and private doctors here.
The number of reported AIDS cases continues to climb -- from six in February to at least 478 on record now. At least 700 more cases have been recorded of children infected with the virus that causes AIDS.
Meanwhile, the Romanian Ministry of Health is still waiting for delivery of essential testing equipment and chemicals; only about 20 percent of donated blood is being screened for the AIDS virus; health care officials disagree about how many people have been tested for the disease, and condoms are available only on the black market.
"It's mostly a program on paper," said Dr. Ion Patrascu, laboratory chief at Bucharest's Institute of Virology and the first doctor to sound the alarm about Romania's AIDS situation. "Theoretically we've done things, but in practice, not really. We still don't know the extent of the problem."
While the AIDS outbreak in Romania is small by the standards of most Western countries, it is unusual because most of the recorded cases are children. According to a recent report by the Ministry of Health, 428 out of the 478 known AIDS cases in Romania are children under the age of 4.
Many of them are believed to have been infected through blood transfusions, which until recently, when the government banned transfusions for infants, were used routinely to treat premature and malnourished babies.
One senior Romanian health official said he expected to see at least "a few thousand" more pediatric cases this year, but the exact numbers are difficult to determine.
Patrascu blames the lack of progress in combating the disease on a business-as-usual approach by bureaucrats in the Ministry of Health. "They are playing with AIDS as if they were playing with the flu," he said.
Dr. Nicolae Beldescu, the physician in charge of the government's AIDS program at the Ministry of Health, acknowledged that progress has been slow.
"Our successes have not been too big," he said. The scant progress, Beldescu said, is the result of shortages of funds and equipment and the fact that Romania began its AIDS prevention program "from zero."
Beldescu's assessment is scarcely an exaggeration. Until the December revolution that overthrew the Communist dictatorship of Nicolae Ceausescu, Romanian doctors who identified the virus were forced by officials to conceal their findings. AIDS was treated as a state secret. Now that doctors are permitted to tackle the problem, they confront a health-care system so antiquated that the number of qualified virologists can be counted on one hand.
Despite the extent of the problem, there is a noticeable lack of urgency at the Ministry of Health, where the anti-AIDS campaign is still discussed mostly in the future tense.
Beldescu said the Ministry of Trade is still working out details of an agreement to import seven blood-testing laboratories from Finland. He said the ministry attended a Bucharest trade fair in May where contacts were made with Western medical supply companies.
Beldescu said lack of money and technology has kept the program sputtering. But critics argue that the government has failed to take even inexpensive measures that could produce big results.
There is still no nationwide media campaign to educate Romanians about the disease. As a result, many people remain ignorant about how the AIDS virus is spread in adults and even about the most basic precautionary measures.
"The government controls the television station. What would it cost to broadcast a public service message several times a week?" asked one foreign doctor.
The standard hospital care for babies with AIDS has improved dramatically since the December revolution, thanks to the intervention of international medical relief organizations. But in the pediatric AIDS wards of the Victor Babes and Colentina hospitals in Bucharest, parents of infected babies often refuse to maintain contact with their children once the disease has been identified.
"When a child has AIDS, parents don't want to see it any more," said a doctor. "The level of understanding is very low." Beldescu said a public information campaign has been prepared, but is being held back until the country receives sufficient supplies of prophylactics.
"I can't say on television, 'Go buy condoms,' when there is nowhere to buy them," Beldescu said. Romania, which has a population of 23 million, is set to import 20 million condoms from China soon.
The printing of AIDS prevention posters, Beldescu said, was impossible during the prelude to elections last month, because all available paper was set aside for newspapers and campaign posters.
Beldescu also said his work has been slowed by a lack of communications equipment. His office is decorated with an Oriental rug but has no fax machine or telex. There are only two telexes in the entire Ministry of Health building. "I have no way to transmit information to the regions," he said.
In May, the government vetoed a proposal by a French relief organization to send Romanian lab technicians to Paris for two-week training sessions. Instead, the government proposed a two-day seminar in Bucharest where 100 technicians will be introduced to new equipment.
"This is typical Communist behavior," said the virology institute's Patrascu. "The attitude of everybody in the Ministry of Health is like in the past. They think the same things, do the same things."
Many regional hospitals still have no reliable supply of disposable hypodermic needles and other supplies considered essential to protect against spread of the disease.
Beldescu said the government has been searching without success for a Western company that would set up a factory in Romania to manufacture needles and syringes. The process could take as long as two years. In the meantime, Romania lacks the hard currency needed to import large quantities of such goods.
Romanian public health officials still use the figure of between 700 and 800 cases of people identified as carrying the AIDS virus -- a statistic they were quoting in February. Tests of several thousand children for AIDS that were performed before the political upheaval last December are now considered unreliable, but those figures are the only recent authoritative report dealing solely with diagnosed AIDS cases. Public health officials disagree over how many children or adults have been tested for the virus since.
Patrascu, who conducted the first AIDS tests on children and now heads a privately funded Romanian AIDS commission, said the government has quietly decided to stop testing, figuring that those infected are "going to die anyway."
Beldescu, however, said testing is still going on, although he was vague on the numbers and admitted that a new voluntary testing center in Bucharest has been under-used.
Patrascu said he worries the money and equipment for AIDS work coming from abroad has attracted a crop of hastily set up laboratories and barely competent technicians. "We had no trained virologists," he said. "Now there are hundreds all at once, with no experience."