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.

In an increasingly uncertain funding landscape, Macedonia’s sexual and reproductive health and rights NGOs work tirelessly to plug the gap left by the chasm in the country’s public healthcare system.

Whether marginalised because of sexuality, gender identity, occupation or ethnicity, many vulnerable people in Macedonia turn to NGOs for sexual health services, as well as legal advice and support, education, employment guidance, food and clothes.

Our member, HERA, is a leading NGO providing free HIV testing services, sexual health support and advocacy. It works closely with smaller organisations around the country to ensure support for young people, sex workers, people who inject drugs, LGBTI people and men who have sex with men. These NGOs are many people’s first port of call for HIV tests, and many provide care on an ever-expanding shoestring.

“It’s very difficult to go to the state hospital and publicly ask for a test,” says 24-year-old Aleksandar. “I get tested at EGAL [an HIV prevention organisation for LGBTI people and men who have sex with men].”

The services are free, discreet and, unlike state services, clients can remain anonymous, while mobile care units make testing more accessible and convenient.

“I prefer using HERA’s services because they’re very discreet and they allow privacy, which is very important for me, [and] is why I don’t go to my GP,” says 24-year-old Grigor, who works as a caregiver for elderly people in Macedonia’s capital, Skopje, where he grew up.

“My sexual and reproductive health is very important for me,” says 19-year-old Mary, a sex worker who has been working in Skopje for four years. “I use the mobile van that comes to our place of work and I get tested there every three months.”

HERA’s mobile clinics also travel beyond Skopje, to rural, more culturally conservative areas, and test around 250 people a month for HIV, with approximately 60 people tested at the outreach clinic for STIs. “[In these areas], the stigma is even bigger,” says Vojo Ivanov, project coordinator at HERA. “Many are very afraid to go to the regular system for check-ups.”

Living with HIV

NGOs are vital for those living with HIV.

After 23-year-old Bojan discovered he was HIV positive two years ago, he began receiving medical care – as well as psychosocial support – at the Clinic for Infectious Diseases, Macedonia’s only source of antiretroviral therapy for people living with HIV.

But for a support network and “personal touch”, he turns to community organisations. Through Stronger Together, a community based organisation for people living with HIV that grew out of HERA, Bojan met other young people living with HIV.

“This really helped me a lot because, you know, you read those things on the internet that you can manage this, it’s not terrible, you will be ok, you will live a nearly normal [life] but I needed someone to tell me in [my] language – a personal touch.”

Over the last few years, increasing numbers of LGBTI people and men who have sex with men have come to the Clinic for Infectious Diseases, says Rumena Gjerdovska, a social worker at the Clini, and former HERA volunteer. But the clinic still has very few clients from the Roma population, sex workers or people who inject drugs: they are dependent on NGOs to reach these groups – another reason why cutting back NGO HIV programmes would be so devastating.

Expand, Don’t Cut

Workers at NGOs speak of an impending crisis in HIV support and care. “If services stopped, we are afraid of a pandemic,” says Silvana Naumova, Programme Manager at Healthy Options Project Skopje, an NGO supporting people who inject drugs and sex workers. 

Vojo Ivanov agrees. “If they lose the services that [HERA] is offering it will be a total catastrophe for the community,” he says. “Years of work will be thrown away if these kinds of services stop.”

Rather than cutting back services, they need to be expanded to meet current demands and deal with rising HIV numbers among men who have sex with men. A 2013-2014 report by the ministry of health revealed that just 19 per cent of men who have sex with men – the group most affected by HIV – had been tested for HIV in the past 12 months.

The situation is similar at the Clinic for Infectious Diseases. “The number of HIV positive people is rising on a daily basis and the team is too small to be able to meet all the needs,” says Rumena Gjerdovska.

What Next?

The next few years will be pivotal to the fight against HIV in Macedonia. Unless the government steps up and fully commits to both sustaining and increasing funds for HIV services previously bankrolled by the Global Fund, the future could be catastrophic.

Hand-in-hand with hard cash, Macedonia also needs to take a robust look at the role of schools, the media and society at large in suppressing conversations on HIV and enabling dangerous taboos, stigma and misinformation to flourish. The internet has thrown open access to information, which is a double-edged sword. On the one hand it offers access to information cut off by the system, but often means young people get their sexuality education from porn and can leave a lot of issues open to misconception and myths.

Zoran Jordanov, Director of EGAL, an HIV prevention organisation for LGBTI people and men who have sex with men, says the government must act now, to save both lives and cash in the long run. “Take care at the right time – that is the policy,” he says. “It’s much easier to prevent than to treat, and much cheaper.”

Rumena Gjerdovska agrees. “It’s important to know that we are all sexual beings and [HIV] has nothing to do with our sexual orientation,” she says. “It’s a health condition that if approached early can be put under the control.”

Photo: John Spaull/ IPPF EN