Between 1986 and 1991, at least 10,000 children contracted HIV in Romania.4 The rapid spread of HIV among Romanias children can be directly traced to the policies of Nicolae Ceauşescu, the countrys then dictator.5 Under Ceauşescus leadership Romania saw a steep rise in child malnutrition and abandonment as pronatalist policies were promoted including a virtual ban on contraception, abortion, and divorce, alongside disastrous economic policies that made Romania one of the poorest countries in Europe. As hospital and orphanage staff struggled to keep these children alive, they relied heavily on antibiotic injections and microtransfusions, under the mistaken belief that small transfusions of blood from an apparently healthy person would boost infants nutritional and immunological status.6 But Romania did not begin screening blood and blood products for HIV until 1990, and hospital and orphanage staff often failed to properly sterilize needles to prevent transmission of HIV and other blood-born diseases. According to records from this period, it was not unusual for children in some hospitals and orphanages to receive 120 injections during a four-week period.7
Today, more than 7,200 of the roughly 11,200 people living with HIV in Romania are children and youth age fifteen to nineteen.8 While the numbers of children living with HIV appear small in comparison to those in the countries of sub-Saharan Africa, they are shockingly high for a European country, especially given that Romanias total population is only 22 million.9
There is little government data on basic social protection indicators for many of these children, and what exists is of questionable reliability. The National Authority for the Protection of the Rights of the Child, the government body responsible for monitoring implementation of child protection standards, only collects data on the approximately 3,400 children living with HIV registered with General Directorates for Social Assistance and Child Protection. The National Authority for Persons with Handicap only collects data on an even smaller number of children who have applied for and received certificates of disability, a process that some families forego out of fear of breaches of confidentiality, as we will discuss later.10
Of particular concern is the lack of adequate monitoring of abuse and neglect of children living with HIV who remain in institutions, or who have been de-institutionalized to birth family, extended family, or foster care placements. According to UNICEF, in 1992 67 percent of all children living with HIV lived in institutions, with disastrous effects on the development of these children as they became deprived of other social services and of education.11 Since then the numbers of children placed outside of their birth families has fallen considerably, but according to data from the National Authority for the Protection of the Rights of the Child more than 700 children living with HIV remain in extended family placements, foster care placements, NGO-run group homes, and state-run group homes and orphanages.12 Eduard Petrescu, the national officer for UNAIDS Romania office, told Human Rights Watch,
The process of de-institutionalization of HIV children was not well thought through: children were sent to places without services, sometimes to remote villages, to families that had had no contact with them for years and didnt know anything about AIDS .It was done in a hurry to report that it was solved. From a medical point of view it was probably not a very good idea, and it was probably not even good for family reasonsmost children didnt go to their families.
Petrescu said he was unaware of what had happened to these children because [t]here was no strong group to argue for their rights like there was for children with families, adding, It is hard to raise the case of a few children with HIV in the broader deinstitutionalization contextwe dont have major signals that these children dont have access to services13
 Romania's National Committee for HIV/AIDS Surveillance, Control and Prevention, in its 2006 progress report to UNAIDS states that "Over 7,000 of the children infected in the late 80s are living now and most of them are in the age group 16 18." According to the Ministry of Health's expert committee on HIV/AIDS, as of December 31, 2006 3,622 children had died of AIDS in Romania. The expert committee defines children as persons under 14 at the time of the diagnosis.See National Committee for HIV/AIDS Surveillance, Control and Prevention, Country Indicators, January 2003 December 2005 Reporting Period, [online] http://data.unaids.org/pub/Report/2006/2006_country_progress_report_romania_en.pdf (retrieved May 31, 2006) p. 4; and Ministry of Health, National Commission for Combating AIDS, Prof. Dr. Matei Balş Institute for Infectious Diseases, Date Statistice HIV/SIDA in Romania la 31 Decembrie 2005 (Statistics on HIV/SIDA in Romania on December 31, 2005,) [online] http://www.cnlas.ro/hiv/statistica.htm (retrieved March 9, 2006) . Even today new cases of children infected during this period are still being discovered, and it is impossible to estimate how many children may have succumbed to malnutrition, common childhood illnesses, tuberculosis, and other conditions without having being diagnosed as HIV-positive.
 For a more detailed discussion of these policies and their implication for the spread of HIV/AIDS in Romania, see Human Rights Watch, Romanias Orphans: A Legacy of Repression, A Human Rights Watch Report, vol. 2, no. 15, December 1990.
 Dr. Rodica Mătuşa coordinated care for over 1,700 children living with HIV as director for pediatric AIDS at Constanţas Municipal Hospital from 1989 until 2003. She told Human Rights Watch that 50 percent of these children were infected by transfusions, especially children in orphanages, 30 percent by contaminated needles, and 20 percent by vertical transmission from infected mothers. Sailors spread the disease to prostitutes who spread it through blood donationone vial [of blood] was given to several children because they were just babies so they only needed 50 or 60 ml [of blood]. I can prove that if the child didnt get HIV through vertical transmission all the cases were children who were hospitalized at one hospital. Human Rights Watch interview with Dr. Rodica Mătuşa, president, Asociaţia Speranţa, Constanţa, February 13, 2006.
 Human Rights Watch, Romanias Orphans: A Legacy of Repression, p. 9.
 Ministry of Health, National Commission for Combating AIDS, Prof. Dr. Matei Balş Institute for Infectious Diseases, Statistics on HIV/SIDA in Romania on December 31, 2005.
 The latest EUROHIV surveillance report lists the total number of pediatric AIDS cases for the entire WHO European region to be 10,949 at the end of 2004see European Centre for Epidemiological Monitoring of AIDS (EUROHIV), HIV/AIDS Surveillance in Europe End of the Year Report (Saint-Maurice: Institut de veille sanitaire, October 2005), No. 71, Table 18, p. 34. Romanias statistical data on children living with HIV/AIDS have several significant shortcomings: Romanian HIV/AIDS databases follow the practice of the United States Centers for Disease Control (CDC) of categorizing children over fourteen as adults for statistical purposes, and thus combine data on persons fifteen through nineteen in a single category; new cases of children infected in the 1987-1991 period still are being diagnosed; and little is known about the prevalence of HIV/AIDS among commercial sex workers (a group known to include large numbers of children) and among street-living youth and children, because there has been little testing of these groups, although both groups are known to have high rates of other sexually transmitted infections.
 As of September 30, 2005, the National Authority for Persons with Handicap had in its records 3,108 children living with HIV/AIDS, including seven children in institutions. Statistics of the National Authority for Persons with Handicap, on file with Human Rights Watch.
 See National Agency for the Protection of the Rights of the Child, Consolidated Analytical Country Report Romania 2003, (Draft), 2, 13, 18-19 and UNICEF, et al., The Situation of Child and Family in Romania, (May 1998), p. 88.
 Of the 3,390 children living with HIV registered with the Directorates of Child Protection, 2,680 are living in biological families, 121 in extended family placements, 290 in private placement centers, 244 in public placement centers, and 55 in foster care. Statistical Data on Children with HIV/AIDS registered with the General Directorates for Social Assistance and Child Protection on March 31, 2005, on file with Human Rights Watch.
 Human Rights Watch interview with Eduard Petrescu, national officer, UNAIDS, Bucharest, February 6, 2006.