This article was written in September 2017. Since then, thanks to the work of NGOs including our member HERA, Macedonia’s incoming socialist government has committed to providing long-term funding for all HIV programmes for marginalised people.
Two years ago, when he was just 21 years old, Bojan’s life changed forever. His long-term partner revealed that he had been diagnosed with HIV.
Bojan was stunned. “I thought that this only happened in Africa,” he says. At school, at home and in the media, HIV was a taboo subject, off-limits and undiscussed. Growing up, Bojan’s only insight into HIV had been a television advert that framed the disease as being “really scary … a monster”.
Bojan also knew that he was highly likely to have contracted the infection. A month later, his fears were confirmed.
Rising HIV Numbers
HIV prevalence is low in Macedonia, a small Balkan country of just over 2 million people. Between the first case in 1987 and late 2014 there were just 315 registered cases. Today, there are 151 people registered as living with HIV – a tiny figure when you compare it to a country like Latvia, which has a similarly sized population but in 2016 had 6,607 cases registered.
But these small numbers mask a complex picture, and one that is rapidly changing. In 2016, there were 40 new HIV diagnoses in Macedonia. Thirty of these were among men who have sex with men. HIV prevalence among men who have sex with men is at 1.9 per cent, a staggering 271 times higher than among the population at large.
Other marginalised groups like sex workers and people who inject drugs are also at high risk. And in certain ethnic communities like the Roma, who make up 2.6 per cent of Macedonia’s population, cultural and sexual practices make people particularly vulnerable to HIV and STIs.
Macedonia is not alone in facing a rise in HIV cases. In many parts of Central and Eastern Europe, the rate of new infections is growing. Between 2010 and 2015, the region saw a 50 per cent rise in new HIV infections annually.
Another looming problem that threatens to send Macedonian HIV rates spiralling upwards is a funding crisis precipitated by donor cutbacks and political uncertainty.
Between 2004 and 2016, Macedonian HIV programmes received almost $25 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Much of this money was channelled into HIV prevention targeting those deemed most vulnerable to infection – sex workers, people who inject drugs, men who have sex with men and prisoners. These investments meant Macedonia vastly expanded its HIV prevention services, pouring funds into civil society organisations on the front line of care.
But in 2016 the Global Fund phased out funding for Macedonia: the country’s low HIV prevalence and elevation to ‘upper-middle income country’ status meant it was no longer eligible. Without vital support from the Global Fund, many NGOs working to plug the gap will run out of funding at the end of this year. Our member, HERA, is on the frontline providing essential care to those who need it most.
In September this year, the new government, sworn in in June 2017, announced it would keep funding HIV services and prevention programmes for 2018, earmarking around $1 million for civil society organisations (CSOs) propping up HIV prevention – roughly the same amount the Global Fund had pledged to CSOs annually.
But fears remain. Although 13 NGOs have signed a contract on HIV care delivery with the government, some are yet to receive money or confirmation that funds will arrive. Even if the government does uphold its promises, the rise in HIV among men who have sex with men in Macedonia calls for an increase in funding rather than pegging funds at previous levels, in order to improve services.
Although HIV levels are not high in Macedonia, the majority of vulnerable groups rely on NGOs to provide care. The Global Fund cuts have meant that NGO futures are even more uncertain, which simply put, leaves hundreds of people high and dry, putting their health and safety at risk.
Photos: John Spaull/ IPPF EN