Did the state start making "savings" in the budget on the backs of the most marginalized?

In a scandalous and flat way, without any expert discussion, the Ministry of Health cut as much as 40% of the funds provided for HIV prevention in the Program for the protection of the population from HIV infection for 2022, which the Government adopted only a month ago. Thus, the state puts at risk the closure of the established capacities for control of HIV infection in the country and endangers the health of at least 10,000 citizens from the marginalized communities.

Instead of the 46.5 million denars provided in the Program for the protection of the population from HIV infection intended for HIV prevention services implemented by about 14 associations in 12 cities in the country, the Ministry of Health yesterday announced a public call for associations with an amount reduced by even 19 million denars. The National HIV Commission was not consulted regarding this decision.

Thanks to these programs, the Republic of North Macedonia in the past 15 years has maintained full control of the HIV epidemic in populations of people who inject drugs and sex workers and one of the lowest infection rates in the region. In the past 3 months, the entire national response to this epidemic is literally at the expense of 14 civil society organizations, which continue to work without any compensation for their work.

Discontinuation of services for vulnerable groups will mean an increase in new infections and an increase in deaths due to HIV, and on the other hand increased pressure on key health institutions, such as the Infectious Diseases Clinic and addiction treatment centers. Even a small increase in the HIV epidemic will lead to a multiplier increase in the cost of treatment and health care. Hence, the decision to arbitrary cut is simply a bad public health policy.

The HIV services provided by civil society organizations were established by the Ministry of Health from 2005 to 2017 with the support of the Global Fund to Fight AIDS, which has invested $ 25.7 million to build a national response to HIV in the country. These include field and station services for anonymous HIV testing, counselling, distribution of HIV and other blood and sexually transmitted infections, diagnosis and treatment of sexually transmitted infections, mobile gynecological services, and support for people living with HIV and people treated for drug addiction and other complementary services. From 2018, after the end of the external financial support, the Government of the Republic of North Macedonia formally undertook the financing of HIV prevention services for the groups at higher risk and in its policies is committed to guaranteeing sustainability in the future.

In Macedonia, young people are still dying of HIV, and according to the methodology of the European Center for Disease Control, it is estimated that as much as one third (34%) of the total number of people living with HIV in the country are not aware that they have the virus. With this, Macedonia lags significantly behind the world average, which for 2020 was only 16%. The global goal by 2025 is to reduce the percentage of people who are not aware that they have HIV to less than 5%, which will lead to a drastic decline in the transmission of infection and will allow putting an end to the HIV epidemic by 2030.

Aware of the war in Ukraine, where we are losing our friends and colleagues, aware of the consequences of Covid-19 and the energy crisis, we warn that health care must be maintained for all citizens, including the most marginalized, whose health also affects the health of the entire population. Prevention of vulnerable groups and young people must not fall victim to policies to streamline the state budget. Otherwise, the rise of the HIV epidemic will only increase costs, and the state will pay with the loss of human lives.

Given the alarming situation and citing the country’s commitments under the United Nations Policy Declaration on HIV and AIDS of June 2021, including the obligation to end the HIV epidemic, as well as the commitments made by the Government to ensure the continuity of HIV programs, we require:

1. Urgent correction of the announced public call for associations that will implement the activities for HIV prevention in accordance with the amounts provided in the Program for the protection of the population from HIV infection for 2022, adopted by the Government in February this year;

2. The Government and the Parliament should finally guarantee the continuity of the already established system for protection against HIV. This means the following: the Assembly should adopt without delay and in full the amendments to the Law on Health Care which is in parliamentary procedure, and refer to the mechanism of involvement of associations in the implementation of health programs; the Ministry of Health to develop bylaws that will fulfill the obligations from the conclusions adopted by the Government in September 2017 and the obligations from the previous and current Government Strategy for cooperation and development of the civil society sector;

3. Due to the long delay in announcing the public call, the Government and the Ministry of Health through intervention should support to reimburse the costs of the associations for the first quarter of 2022 incurred due to their dedicated maintenance of the national response to HIV.

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