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How AIDS Came to Romania

Eight months after the cadaverous images of Romania’s babies with AIDS first shocked people throughout the world, almost every one of Romania’s orphanages and children’s hospitals provides a heartening example of the help being provided by European and American philanthropy. Yet at the same time, each of them continues to bear witness to the grisly legacy of the Ceausescu regime.

This evidence is not difficult to gather, as we found on a trip this summer sponsored by Helsinki Watch.1 After Nicolae Ceausescu’s overthrow on December 22, 1989, a country long sealed-off suddenly opened. Orphanage directors and hospital physicians now allow visitors from abroad into institutions that were once hidden away, and officials of the new National Salvation Front government readily discuss (if, at times, self-servingly) the past record. The consequences of Ceausescu’s systematically oppressive rule over a country that lacked both democratic traditions and independent associations of professionals, such as doctors, can now be seen all the more starkly. It is becoming possible to understand how a country in which families, not strangers, traditionally cared for the young and the old could produce thousands of abandoned children, and how in a country whose isolation and poverty might have insulated it from AIDS, children became afflicted by an HIV epidemic.

Currently there are 683 children between the ages of one and four with AIDS in Romania. At least another 1,000 are HIV positive. They live for the most part in Dickensian institutions built by the Ceausescu government to deal with the consequences of its policy of coercively raising the birth rate. Thousands of young people live in bleak, understaffed orphanages where a visitor seldom sees a child with a toy or a book. The egregious neglect and disease that one observes are not only the product of oversight and inattention (as is often true in developed countries), but of deliberate government policies. Ceausescu, by all accounts, was a simple-minded and doctrinaire Marxist, who made production the goal of the state, and classified citizens by their productive capacities. In October 1966, one year after he took power, he promulgated “pronatalist” laws aimed at compelling women to have children.

In the effort to raise Romania’s low birth rate (in 1965, there were only six thousand more births than deaths), Ceausescu banned all means of contraception, increased the taxes of childless couples, and, most important, prohibited abortion. In Romania, as in Eastern Europe and the Soviet Union, pills, condoms, and IUDs were scarce and expensive, and abortion was the primary means of birth control. In 1965 approximately 1,000,000 abortions are estimated to have been performed in Romania, terminating 80 percent of all pregnancies.2

The immediate impact of the policies intended to encourage childbearing was to increase population growth (which rose to a rate of 18 per 1,000 in 1967). But couples found a variety of ways to limit births (such as using the rhythm method and frequenting prostitutes), and the numbers slid (in 1975 to 10.4 per 1,000, and in 1980, 7.6). During the 1980s births fell by 2.9 per 1,000, during a time of severe economic stagnation and desperate hardship (exacerbated by Ceausescu’s determination to pay off all foreign debt), which gave Romania the lowest per capita income of any European country.3

The regime’s response was to intensify its policies promoting more births. To qualify for a legal abortion, a woman now had to have five, as opposed to four, children at home under the age of eighteen. Nor did Ceausescu try to make things easier for families with children: maternity leaves were the briefest in Eastern Europe, large families received few tax benefits, and day care and kindergarten services were utterly inadequate.

From the start, the regime conscripted the medical profession into its campaign to promote births. Gynecologists were required to conduct periodic examinations of women (every four months at factories, for example) and to take the names of all those who were pregnant; they were prohibited from fitting women with IUDs and were required to report all those who entered hospitals suffering from the complications of crude abortion attempts. On the whole enough doctors cooperated with the regime so that the denials of complicity one now hears ring hollow, and these denials of complicity go only so far. No physician we met admitted to having performed abortions, but they all said they knew of someone who had—perhaps for reasons of principle, more likely for money. A few of them had been caught, tried, and jailed for terms of two to three years. Had the medical profession and its leading members ever taken a stand about the gynecological examinations, we asked, or, for that matter, had they criticized any of Ceausescu’s other brutal medical and social policies? Not that anyone could recall.

Which groups in the population were most affected by the policy promoting births? Not the urban middle class, whose members managed to get contraceptives on the black market—the preference being for an IUD if a doctor could be bribed to fit it. They could also afford medical abortions—a Bucharest student told us that several years ago when his girlfriend became pregnant, the abortion had cost him 5,000 lei (about $50 on the black market). And several women with professional degrees told us matter-of-factly that when the government gynecologist-inspector had come to their offices to examine the female staff, they had simply refused to cooperate, and nothing more was heard about it. Nor were most of the people in the more rural parts of the country deeply affected. The orthodox Christians had long shunned birth control and abortion, and others, like the gypsies, chose not to practice it.

The brunt of the policy fell on the lower middle class, particularly factory workers, single women, urban gypsies, and those from disorganized or troubled families—none of whom had the cash or the connections to circumvent the regulations. The choices open to women were as limited as they were threatening to their lives. Some of the women used dangerous methods to carry out abortions by themselves; others went to cheap back-alley abortionists; others carried their babies to term, and others may have turned to infanticide.

The numbers will never be known, but every physician we spoke to reported that deaths of women from septicemia had been frequent during the Ceausescu years; there are grounds for claiming that abortion-related deaths increased by 600 percent after 1966.4 Indeed, many physicians were certain that botched abortions accounted for a significant number of birth defects and handicaps. (This was not the only cause, for the toxic conditions in workplaces were probably more damaging.)

One point is indisputable: during the 1970s and 1980s, the number of unwanted children increased dramatically. Some women gave birth and abandoned their children immediately. Others took them home, could not feed them, and, demoralized by the demands of work and family, brought their malnourished children to hospitals, and then abandoned them there. As the director of one orphanage put it, every child has its own story, but virtually every story opens with Ceausescu’s pronatalism.

The regime’s response was not to modify its edicts but to create a network of custodial and caretaker institutions that might seem reasonably conceived at first sight but in fact was bizarre and cruel. At the base of the system, serving all children between birth and three years old, are the leagane, as orphanages for the very young are called, with a total of 11,000 to 15,000 residents, under the administration of the Health Ministry. Children considered physically and mentally “normal” go on from there to institutions that house three- to six-year-olds, and then to those that serve six- to eighteen-year-olds. Some 40,000 children between three and eighteen are now under the jurisdiction of the Education Ministry in these institutions.

Children found to be abnormal, that is, those that a team of psychologists and pediatricians diagnose as “irrecuperable,” because of paralysis, blindness, or mental disability, are consigned to separate institutions. Those for children ages three to eighteen hold 15,000 children; the institutions for young people eighteen and over hold another 15,000. By an odd leap of logic, a regime that prized productivity assigned the care of children classified as “unproductive” to the Ministry of Works. To this ministry, of course, these children were of little importance; they and their problems are completely outside the interests of the officials in the ministry, who have no training in setting up educational, workshop, or therapeutic programs for “handicapped” children.

Not surprisingly, conditions in the orphanages run by the Education Ministry for normal children were not as grim as those in the institutions for the handicapped. In fact, a few of the orphanages, such as Leaganu Number 1 in Bucharest, had been showpieces for the regime, not only to fend off foreign criticism but to attract foreign capital: just as Ceausescu was willing to send Jews to Israel and Germans to Germany if he was paid the right price, he sold orphans to would-be parents. They came to Leaganu Number 1, saw the child, paid hard currency (anywhere from $1,000 and up), and took home a white baby. Thus a policy initiated to increase the national birthrate culminated in selling thousands of infants—just how many we probably will never know.

However coercive Ceausescu’s pronatalism and however wretched most of the institutions, the question remains why 683 children between the ages of one and four now have AIDS, and how at least 1,000 became HIV positive. The main cause of the epidemic, to use the technical term, was nosocomial—HIV infection was conveyed through medical treatment. No doubt the political and economic practices of the Ceausescu regime helped create the conditions in which the disease could spread. But Romanian doctors and nurses, through ignorance, incompetence, cowardice, and frustration, were directly responsible for spreading it.

The regime systematically isolated physicians from colleagues abroad and from each other at home. Always hoarding foreign currencies, the government made it nearly impossible for libraries or doctors to subscribe to foreign journals, obtain foreign books and reports, or travel to conferences. (A kind of medical samizdat did exist, with cigarettes bartered for copies of important articles, but the scientific publications were and still are unavailable.) This intellectual quarantine guaranteed that Romanian medicine would be a backwater, while it was training many third-world doctors (since Ceausescu wanted their hard-currency payments), and treated many of its own citizens, however incompetently.

With even graver consequences, the regime refused to acknowledge the presence of AIDS, and tried to prevent information about the disease from circulating among physicians. As late as 1989, medical meetings could not include a session on AIDS.

The most damaging result of the regime’s refusal to acknowledge the threat of AIDS was that no attempt was made to screen the blood supply. By 1985, the technology for screening was widely in use elsewhere, but not in Romania. (Indeed, as of this August, more than half of the country’s districts still cannot screen blood.) The failure to screen blood had devastating consequences, for the epidemic among the children, as we shall see, did not begin until well into 1988. In effect, the outbreak of AIDS among Romania’s institutionalized children was not a cruel accident of fate, a regrettable but unforeseeable contingency, but the result of Ceausescu’s determination to conceal the problem and to devote no resources to preventing its spread.

  1. 1

    We were joined in our interviews by Holly Cartner, staff counsel for Helsinki Watch.

  2. 2

    See Mary Ellen Fischer, Nicolae Ceausescu: A Study in Political Leadership (Lynne Rienner, 1989), particularly chapter 7; John Hale, Ceausescu’s Romania (George Harrup, 1971), p. 142; and Robin Morgan, Sisterhood is Global (Anchor Press, 1984), p. 578.

  3. 3

    Michael Shafir, Romania: Politics, Economics and Society (London: Francis Pinter, 1985), pp. 127–128.

  4. 4

    Robin Morgan, Sisterhood is Global, p. 578.

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