An underground HIV epidemic in Eastern Europe and Central Asia is intensifying at an alarming pace, fueled by drug use, high-risk sexual behavior and high levels of social stigma that discourage people from seeking prevention information and treatment, according to a new UNICEF report.

The report, “Blame and Banishment: The underground HIV epidemic affecting children in Eastern Europe and Central Asia,” highlights the issues faced by children living with HIV, adolescents engaged in risky behaviors, pregnant women using drugs, and the more than one million children and young people who live or work on the streets of the region. Its release coincides with the 18th International AIDS conference in Vienna.

Marginalized young people are exposed on a daily basis to multiple risks, including drug use, commercial sex and other exploitation and abuse, putting them at higher risk of contracting HIV. Existing health and social welfare services are not tailored to adolescents at greatest risk, who are often exposed to moral judgment, recrimination and even criminal prosecution when they seek treatment and information on HIV.

“Children and adolescents living on the margins of society need access to health and social welfare services, not a harsh dose of disapproval,” says Anthony Lake, UNICEF’s New York-based Executive Director.

“This report is a call to protect the rights and dignity of all people living with or at risk of exposure to HIV, but especially vulnerable children and young people. We need to build an environment of trust and care, not one of judgment and exclusion. Only by reversing discrimination against people living with HIV, can the region begin to reverse the spread of the epidemic.”

To reach and help young people living with HIV or at risk of HIV infection, medical and civil authorities need to establish non-judgmental, friendly services that address the special needs of marginalized adolescents.

In the Russian Federation, for example, over 100 youth-friendly service facilities have been established, providing reproductive and sexual health services, information, counseling and psychological support.

A recent six-country study conducted in the region showed that many adults living with HIV fear the social stigma attached to seeking treatment more than they fear the disease, thus driving the epidemic further underground. Young children living with HIV are routinely denied access to school and kindergartens, and when their status is known, they face rejection and abuse.