Macedonia's successes in fighting HIV/AIDS

Healthy Options Project Skopje (HOPS) is the recipient of the 2010 International Award for Action on HIV/AIDS and Human Rights, the Canadian HIV/AIDS Legal Network and Human Rights Watch announced this week. The award, which recognizes outstanding individuals and organizations that protect the rights and dignity of people living with or affected by HIV/AIDS, was presented in Vienna, Austria, at the XVIII International AIDS Conference. Here is a description of their program and challenges.

The Republic of Macedonia remains a country with a low rate of HIV. In fact, with 129 cases, it has the lowest reported number among southeastern European countries.

Many partners in the field of HIV/AIDS ask: what is Macedonia's secret? A good part of the answer is early intervention with the most vulnerable groups, along with the introduction of methadone substitution treatment in early 80s followed by the first needle exchange program in 1997, then a program aimed at assisting sex workers in 2000. During the same period, most countries in the region struggled just with these concepts, let alone putting these measures into practice.

In 2003, civil society's best practices and good results were recognized and incorporated into Macedonia's national HIV response. The health ministry worked with nongovernmental organizations in the field, including ours. With financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), they managed to scale up existing services to an impressive point: 15 needle exchange programs in 13 cities serving more than 5,000 people; methadone maintenance programs in nine cities treating 2,300 people in addition to programs serving 220 inmates in two state prisons; four centres in as many cities offering support to approximately 600 sex workers; four outreach programs reaching more than 2,000 men who have sex with men (MSM); Voluntary Counseling and Testing for HIV (VCT) program reaching more than 9,000 vulnerable people; anti-retroviral (ARV) treatment for 29 people; distribution of 1.3 million free condoms throughout the country.

These are huge numbers for a small country (2009 estimates are 2,114,000 people). Yet, still more needs to be done for Macedonia to be recognized as a fully inclusive country where the equality and well-being of its citizens is actively promoted and enjoyed.

In Macedonia, HIV prevention programs have never been a priority for the government. Civil society still does not have any government funding for HIV prevention and treatment.

Transmitting HIV by failing to disclose one's status remains criminalized. Sex work remains illegal. There is no decriminalized allowable quantity of drugs that can be in an individual's possession for personal use. There are not enough treatment options for drug users. Only 20 per cent of drug users manage to get drug treatment. Sexual and reproductive health is not part of the educational curriculum.

There is a law against discrimination, but the final result did not fulfill hopes for an effective tool to promote and protect rights, and the results remain to be seen.

In fact, in mainstream public opinion, sex workers are perceived as carriers of infectious diseases, the LGBT population as mentally ill people and drug users as criminals who do not deserve investment in health treatment.

Discrimination, punishment, prisons, violence, marginalization and exclusion are the reality many Macedonian citizens face if they "dare" or "choose" to be different. Sex workers, gay men, transgender people, women or roma who use drugs; these marginalized groups are still ignored and even their very existence denied.

While Macedonia is well-positioned to tackle HIV prevention, unless the government and leading policymakers work harder to make sure that past achievements are sustainable and unless they fully respect human rights, we can't talk about real success.

Approaches based on ideological and moral grounds rather than on scientific evidence and human rights are doomed to failure.

For this reason, we are urging the government of Macedonia and all parties with legal, political and public responsibilities in the country's fight against HIV/AIDS to uphold their commitment to fulfilling the eight UN Millennium Development Goals, the Dublin declaration on partnerships to fight HIV/AIDS in Europe and Central Asia and Macedonia's national strategy for HIV/AIDS 2003-2006 and 2007-2012. Specifically, we ask them to:

- Promote human rights as an essential part of the response to HIV in Macedonia, and to help reduce stigma and discrimination toward the most marginalized communities, including sex workers, drug users, lesbian/gay/bisexual/transgender individuals and people living with HIV/AIDS;

- Work on effective implementation of the Law for the Protection of Patients' Rights (2008) and the Antidiscrimination Law (2010), which were designed to protects the rights of all, regardless of their social and health status, sexual orientation or gender identity;

- Raise the annual national budget for HIV prevention, treatment and care to ensure the security, sustainability and the continuation of existing programs and activities currently supported only by the Global Fund;

- Include civil society organizations in planning and implementing National Preventive Programs, which still don't recognize the need to deliver services to communities most at risk such as drug users and sex workers;

- Provide options for drug treatment throughout the country, including treatment with methadone and buprenorphine;

- Include sexual education in school curricula, as a proven, effective way to help prevent the spread of HIV, improve sexual and reproductive health, and promote diversity, equality and human rights;

- Decriminalize drug use by introducing an allowable dosage for personal use;

- Implement zero tolerance policies to curtail the harassment and abuse of sex workers and drug users by police and improve police response to violence committed by third parties, as essential to reducing the vulnerability of these populations;

- Establish programs for HIV prevention among inmates with a focus on securing free access to condoms, to clean injecting equipment, to information and to voluntary and confidential counseling and testing for HIV.

If Macedonia takes these steps it will truly be a leader for the region and the world in the fight against HIV/AIDS. Having taken such measures itself, Macedonia would then be able to call on other governments in the region to start on this path.

The Awards for Action on HIV/AIDS and Human Rights were established in 2002 by the Canadian HIV/AIDS Legal Network and Human Rights Watch. An award is presented annually to one Canadian and one international recipient. This year's Canadian award was given in June to Ralf Jürgens, a lawyer and international AIDS and human rights advocate who has worked for more than 25 years to defend and promote human rights.

Marija Tosheva is director of programs in support of sex workers and Hristijan Jankuloski is administrative and financial director at the Healthy Options Project Skopje (HOPS), a non-governmental organization based in Macedonia.

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