Romania’s doctors knew the country was at risk of an epidemic, but government officials ignored their pleas. The communist state was projecting a facade of perfection – the best leaders, the best health system – that nothing would be allowed to shatter. To ensure the doctors’ silence, they stationed Special Service agents at their workplaces and monitored their calls. No measures to combat HIV were taken until after the 1989 revolution, when the borders opened and the horrendous situation finally came into public view. Then, journalists and photographers from all over the world showed what life was like for the orphans of Romania. In Constanţa alone, thousands were found to be infected with HIV. Many more did not even make the statistics – they were already in the morgue.

In orphanages all around the country children were getting transfusions to treat colds and malnutrition. Doctors estimate that a single infected donor could pass the virus to up to 80 children.

The situation was compounded by the poor hygiene measures of the time. The same needles were used multiple times for multiple patients in transfusions and vaccinations. Even if needles were sterilised, it was often done improperly – power cuts and shortages were frequent, so there was never any guarantee that sterilisation equipment or procedures had been run properly.

The southern counties of Giurgiu and Constanţa, along with the capital, Bucharest, were among those with the largest numbers of infected children in both orphanages and families. Border areas like the coastal Constanţa were the first to be affected with HIV. Where it came from exactly is unclear, but blood donations played a key part. Under the communist regime, donating blood was seen as a moral obligation. “Constanţa was the opening of the country to the world,” said Rodica Mătușa, who was head of the Paediatric Infectious Disease Division at Constanţa County Hospital in the 1990s. “There were sailors who came from all over, and our sailors who travelled worldwide. There was a coastline where we had foreign tourists. All these groups of people were donating blood.” Romania’s blood stocks were low, and the donations welcome. According to a 1990 Human Rights Watch report , blood was a form of baksheesh in Romania, donated in return for favours done and papers processed. The regime did not coerce donations but there was an ‘official’ exchange rate of a meal or a day or two off work for every donation. Unofficially, donation could get you a driver’s licence, a student visa renewal or a job. “Ordinary citizens, foreign students and workers, including dock workers, had little choice but to comply, and whether through ignorance or self-interest, those who were HIV positive also donated blood,” says the report. But donated blood was never tested for any disease, let alone HIV.

Then in 1985 came the first documented HIV case in Romania. As doctors investigated, they realised there was a massive problem among the country’s children, especially those in orphanages, who needed medical care more frequently than those living with their families. According to reports from the Stefan S Nicolau Institute of Virology in Romania , 1,168 cases of AIDS were reported in December 1990, 99 per cent of which were in children less than four years old. Around 62 per cent were abandoned children living in public institutions.

According to testimony from orderlies and nurses around the country, many orphanage children didn’t even have a change of clothes – clothes were washed and their carers had to decide whether to leave the children sitting around undressed or dress them in wet clothes. These poor conditions made children anaemic and malnourished, so they were given blood transfusions or injections for their frequent colds.

As the number of Decreţei grew, the country’s economy shrank. Orphanages became overcrowded. Living standards had become precarious, with insufficient food in the stores and no heating or warm water in homes. Many children were abandoned at birth and wound up in institutions where living conditions were even more despicable: electricity and heating were supplied sporadically, food was rationed and children frequently fell ill.

Ceaușescu, the country’s communist president, had a wish that became an obsession. He wanted to be the leader of a great number of people, to raise Romania’s population from 19 million to 25 million. Having grown up in the countryside, where poverty hadn’t affected birth rates, and being the third of his parents’ ten children, he couldn’t understand why people wouldn’t want to have large families. So he made it into a law. The decree banned women from having abortions and using any type of contraception. Families with more children were entitled to several benefits, while childless families had to pay additional tax. This, he reasoned, would increase the birth rate of the entire country. The irony was that among these decree children, born out of the ruler’s wish, were the ones who would, as young adults, bring the streets to life in December 1989, ending his rule.

The fall of Nicolae Ceaușescu’s regime left Romania with many orphans, the roots of which lie in Decree No. 770 of 1966. People born around this time were known as Decreţei, the decree children.

© Paul Blow at Handsome Frank

In 1999, Paul Marinescu was working as an infectious-disease specialist in a small hospital in Singureni, a village in Giurgiu county about 30 km from Bucharest. An important part of his work was taking care of children with HIV. Marinescu was head of the local Health Department – a representative of sorts for the Ministry of Health at a county level. Giurgiu was his home. What he saw was a local tragedy.

Many families had seen their children infected in hospitals, but the children in the worst shape were in the orphanages – their disease meant no chance of adoption. And Romania’s orphanages were often isolated on the outskirts of cities, where children with HIV lived hard, lonely, abuse-ridden lives.

Almost everyone avoided contact with the HIV-positive. Although the ways the disease could be transmitted were widely communicated through medical workers, television and newspapers, discrimination was everywhere. Especially frightening to people were children with HIV. They were not welcome in kindergartens or schools. People fled when they saw them in the streets.

Marinescu felt compelled to act. “When I visited them for check-ups, the children didn’t want to let me go,” he recalls. “They called me Daddy, clinging and holding on to my legs with both arms.” He’d had his own two children by then, but wanted to adopt the children from the orphanage where he worked. His lawyers warned of the legal complications adoption would entail. So instead he started a foundation called Saint Mary, named in memory of his mother, taking 16 HIV-positive children under its care. “Legally, I became their tutor,” he says. “I was poor, but I had a lot of dreams for them.” Modest dreams, such as a bigger garden, more food.

Marinescu first housed his children in an isolated ward in the Infectious Disease Hospital in Singureni. A fire forced a move to a small house he built using funds from individual donations. Further donations from local businesses offered basic supplies of food, clothing, fuel for the winter. He visited the children every day, in the morning before going to work or in the afternoon, on his way home. He talked to them and listened to how their day had been.

In the years that followed, other children with HIV came under Marinescu’s wing: a young woman who had been found in the street, another with brain damage. There were times when he was caring for as many as 23 children – most of whom are still alive today, some with their own families. Three of the children died. Two were in the final stage of disease when they came under his care, but he still regrets the third, who could still be alive had he not refused to take his medicine. “When he turned 18, he wanted to live his own life and left the foundation. He also got mixed up with some questionable people, and because of the diseases associated with HIV, he died six months later,” Marinescu laments.

While healthcare reforms meant that blood transfusions were handled much more safely, HIV was still spreading. Today there are around 500 new HIV cases in Romania each year, mostly transmitted through sexual intercourse or contaminated needles used with recreational drugs. There are still children born HIV positive, and there is still popular prejudice against them.

Singureni, a small community with just 3,000 inhabitants and little knowledge of HIV, for years opposed the children’s presence. The locals protested in schools – if a child with HIV joined, parents moved their children to another class or voiced their fears on local TV shows. Teachers made the children feel so bad about themselves that they stayed home.

One of the worst moments came in 2011, when the mayor of Singureni accused the children of giving HIV to others in the village. The doctor stood up for his orphans. “I know what the mayor would have liked,” said Marinescu in a TV interview at the time. “He’d like to have seen them in ghettos. For many years, I tried to teach the people of the village how the disease was transmitted. I did the talking, but I did the listening as well.” The incident was debated on national TV and newspapers. The community became divided.

Marinescu’s story was not an unusual one. In Constanţa, Rodica Mătușa set up her own non-profit NGO – the Speranta Association, meaning ‘hope’, to care for the HIV-positive orphans she had encountered in her hospital. In 1992, they raised the funds to buy a house and land in the village of Mihail Kogălniceanu, 36 km north of Constanţa’s main city. Speranta eventually gained further funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (through the Romanian Angel Appeal Fund) and became something of a model for similar foundations across Romania. Throughout the 1990s, foreign aid poured into the country, from governments, from NGOs, from Italy, Japan, the UK and the USA. Foreign aid could provide orphanages with better food and better clothes, but not social integration.

In Singureni, Saint Mary was a small one-man foundation. Its orphans had little, but its limitation became its strength. Its one man had knowledge of the country and system.

Marinescu decided to enrol his children in a school in Giurgiu City, the county capital, where people were more tolerant. During the week, the children stayed in hospital accommodation in the city, which Marinescu had arranged through his connections. When it came to high school, he advised and supported the children to study practical subjects – nursing, computing – that he hoped would enable them to more easily find jobs in later life.

The children’s lives went on. In 2002, Romania’s government introduced more protection for children with HIV. By law they had the right to education, confidentiality over their HIV status, and disability allowance. Understandably, most of Marinescu’s orphans moved away from Singureni as soon as they were able, to start again in the region’s other surrounding villages, where no one knew their names or their past.