PSI

Since Romania joined the European Union in 2007, it has experienced rapid economic development. However, Romanian health care is not keeping pace. The Central-Eastern European nation’s mortality rate is comparable to Thailand and its burden of some diseases is higher than Vietnam’s. Common causes of death are heart disease and cancer, but sexually transmitted infections (STIs) are a major health problem. And misconceptions about reproductive health remain part of Romanian culture – in the aftermath of pro-fertility policies in the late 1960s to the 1980s that banned modern contraceptive use.

PSI/Romania set out in 1998 to improve the health of low-income and vulnerable populations by drumming up private sector support and promoting health products/services and healthy behaviors. Interventions now include: HIV/AIDS prevention/treatment, reproductive health promotion, iodine deficiency treatment and tobacco cessation.

Pharmaceutical companies have partnered with PSI/Romania to help expand public reproductive health efforts with the use of their products. Contraception prevalence rates rose for women from 40.5% in 1993 to nearly 60% in 2004. Men’s rates rose – from 51% in 1999 to more than 60% in 2004.1 Specifically, condom use increased by 8 points among married women from 1993 to 2004 and 28 points among men from 1999 to 2004.2Today, PSI’s Love Plus brand condoms annually reach about one-third market share and 40 million volume sales. 3

1. 1. Source: 2004 Reproductive Health Survey.
2. 2. Source: 2004 Reproductive Health Survey.
3. 3. Source: Nielsen AC, PSI/Romania database, Oct. 2001-Sept. 2006.

Health Areas

HIV, Reproductive Health

Health Impact

PSI/Romania estimates that in 2010, its products and services helped avert:

• 238 HIV & TB DALYs1
• 805 Reproductive Health DALYs
1. 1. Source: The DALY (Disability-Adjusted Life Year) is a widely-used, credible metric that was first developed by the World Bank and is now routinely relied upon in the public health community.

Health Interventions

• Male Condom
• Oral Contraception
• Men Who Have Sex with Men

Improving Health in Romania

HIV

Love Plus Condoms

PSI/Romania launched the Love Plus condom in 1999. This affordable, fun and sexy brand quickly grew the condom market and has expanded to several lines. More than 55 million Love Plus condoms have been sold to date. The Love Plus brand brings in a self-sustainable stream of funding that PSI/Romania reinvests in health programming.

MSM HIV Program

PSI/Romania began working with men who have sex with men (MSM) in 2004 with a one-year grant from the Elton John HIV/AIDS Foundation. The MSM Program now runs two complementary projects.

With support from The Global Fund against HIV/AIDS, Malaria and Tuberculosis, PSI/Romania has identified and trained MSM popular opinion leaders across the country to adopt safe sexual behaviors and endorse sexual health messages. The project also has an online communication and outreach component, and a support group for HIV-positive MSMs to provide information, emotional and psychological support to create a sense of value, responsibility and involvement in prevention efforts for the MSM community.

A complementary project funded through the EEA Financial Mechanism works on three additional levels:

• Community building and empowerment.
• Reducing the burden of social stigma through communication campaigns.
• Joining the online and real world local communities by adding “pervasive games” web components (location-based games).

Reproductive Health

PSI/Romania was a key partner in the USAID-funded “Romanian Family Health Initiative” project from 2001 to 2006. Responsible for increasing demand and use of modern contraceptives, PSI/Romania was also successful at building BCC capacity among local partners.

Innovative and specifically tailored social marketing activities for condoms and oral contraceptives resulted in providing more than 400,000 CYPs to Romanians. More than 2 million people were reached by PSI/Romania’s family planning and STI prevention campaigns and programming, including:

• Among Us Women, an interpersonal communication model for women in factories.
• A Daily Subject, an initiative that encouraged journalists to write better-informed articles on modern contraception.
• Love Plus Police Academy, a youth-targeted campaign.
• True Women, a TV mini-series that aired on national and regional television in 2006 and won the Population Institute’s Global Media Award for best combined media effort on behalf of population.

Iodine Deficiency Disorders

During 2003-2004 and 2006, PSI Romania ran an UNICEF-funded outreach project to increase awareness of iodine deficiency disorder (IDD) risks and iodized salt use benefits among rural household shoppers, groceries shops, journalists and bread producers. It also improved availability of quality iodized salt in both urban and rural areas and created a quality approval seal for iodized salt packaging and communication materials.

Activities were based on key findings of initial extensive qualitative and quantitative research (only 53% of households had iodized salt) and were evaluated through post-implementation research in 2004 that lead to the second phase of the project in 2006.

The communication strategy had two components:

• Mass media efforts using TV, radio and billboards to promote iodized salt use (during 2003-2004).
• Interpersonal IEC campaigns focusing on consumers and salt sellers (during both phases of the project).

Tobacco Control

Although tobacco control is not among the traditional PSI health areas, smoking is a rampant problem in Romania. Tobacco is the single largest cause for preventable death and disability in Romania – responsible for more than 33,000 premature deaths each year. PSI/Romania is among the first national platforms to recognize and address it.

PSI/Romania’s strategies focus on:

• Advocacy and lobby for tobacco control.
• Smoking cessation.
• Smoking prevention.

Currently, PSI/Romania seeks financial support from the European Structural Funds to implement strategic projects that promote smoke-free workplaces, and prevention and cessation campaigns in schools.

Target Populations

HIV: Nationwide youth aged 15-24, Roma (ethnic minority) males in Bucharest and men who have sex with men; Reproductive Health: Women of reproductive age