The burden of an HIV epidemic in Kosovo* lies among the key populations (KPs) of female sex workers (FSWs), men who have sex with men (MSM), and people who inject drugs (PWIDs). The aim of this study was to estimate the size and distribution of these populations to create evidence for developing action plans for HIV prevention.
Results of this Study:
Of the estimated 6814 men who have sex with men (range: 6445 to 7117), nearly 4940 operate through the internet owing to the large stigma and discrimination against same-sex relationships. Geo-based men who have sex with men (who operate through physical spots) congregate at a few spots with large spot sizes (13.3 men who have sex with men /spot). Three-fourths of the men who have sex with men are distributed in 5 major municipalities. Fridays and Saturdays are the peak days of operation; however, the number only increases by 5%. A significant number are involved in sex work, that is, provide sex to other men for money. People who inject drugs are largely geo-based; 4973 (range: 3932 to 6015) people who inject drugs of the total number of 5819 (range: 4777 to 6860) visit geographical spots, with an average spot size of 7.1. In smaller municipalities, they mostly inject in residential locations. The numbers stay stable during the entire week, and there are no peak days. Of the 5037 (range: 4213 to 5860) female sex workers, 20% use cell phones, whereas 10% use websites to connect with clients. The number increases by 25% on weekends, especially in larger municipalities where sex work is mostly concentrated. Other than a few street-based spots, most spots are establishments run by pimps, which is reflective of the highly institutionalized, structured, and organized female sex workers network.
This study provides valuable information about the population size estimates as well as dynamics of each KP, which is the key to developing effective HIV prevention strategies. The information should be utilized to develop microplans and effectively provide HIV prevention services to various KPs.
France is the first European donor to the Global Fund Against AIDS, Tuberculosis and Malaria with annual contribution of 360 million Euro. The 7% Initiative AIDS, tuberculosis, malaria is the second means whereby France contributes to the Global Fund. The purpose of the 7% Initiative is to respond to requests for high-level technical expertise from GF grant recipient countries, including French-speaking countries, in order to support and build their capacity for design, implementation, monitoring and evaluation and impact measurement relating to GF grants. Eligible SEE countries for this support include Albania, Bulgaria, Kosovo*, Montenegro, Romania and Serbia.
The French Embassy in Belgrade organised a presentation of the Initiative to the representatives on civil society organisations from Serbia working on the issue of AIDS. The presentation was held on 5 March 2018 in the French Cultural Centre.
Christelle Boulanger, Director of the Department for Pandemics at the Initiative and Bertrand Millet, Attaché de cooperation at the Institut français de Serbie presented the Initiative, answered various questions and gave good advice on preparing a project proposal.
As the deadline is 23 March 2018, interested organisations have to be quick in designing the Concept note of the project!
Further survival of harm reduction programs and HIV prevention in the Republic of Macedonia is uncertain. The current financial support from the Global Fund to fight AIDS, Tuberculosis and Malaria ends in June 2017. This will result with leaving over 10,000 people who use drugs as well as their family members without proper social and health care.
Thanks to harm reduction programs, only two new HIV cases have been recorded in Macedonia in the last ten years as a result of drugs injecting and less than 5% of 315 registered cases of HIV were people who inject drugs. These figures are far smaller than in the neighbouring countries. Macedonia can boast with the lowest HIV rate in Southeast Europe, but if these programs are not implemented, there is a risk of HIV epidemics as a result of interaction with the epidemics in neighbouring countries and the possibility of increasing risk behaviours.
There are 17 harm reduction programs in Macedonia (4 in Skopje and 13 in different other cities). These programs are efficient and financially worthwhile. According to the research analyses, the cost for one client in harm reduction programs is approximately 155 € per year. In contrast, the cost only for medicines for a patient with hepatitis C is up to 13.194 €, and the untimely and inappropriate treatment of hepatitis C causes cirrhosis and liver cancer, whose treatment costs more than 30.000 € per patient. Additionally, the costs of treating HIV and hepatitis C financially exhaust the families of people in need of treatment, thereby further multiplying undesirable costs and disrupting overall social well-being.
Therefore, a petition was initiated to request the Ministry of Health and the Government of the Republic of Macedonia to:
Adopt an urgent solution for using funds from the HIV program and the remaining funds from the Global Fund for key programs across the country, which will ensure continued assistance to citizens and the prevention of HIV.
Establish cooperation between the Ministry of Health and the civil society and other stakeholders for adoption of appropriate laws or by-laws and measures that will guarantee transparency, adequate expertise and long-term sustainability and development of HIV prevention programs.
Healthy Options Project Skopje produced advocacy movie in cooperation with Drugreporter to support the campaign and save underfunded harm reduction programmes which are a huge success in the region. Watch the video produced and learn more!