Have the budget “savings” by the State been made at the expense of the most marginalised ones?

By curbing the HIV prevention budget by 40%, the Ministry of Health is gambling the health of at least 10,000 affected citizens.

In a quite scandalous and frivolous manner, without any expert discussion taking place, the Ministry of Health cut as much as 40% of the funds allocated to HIV prevention in the 2022 National HIV Prevention Programme [“Programme for Protection of the Population against the HIV Infection], which was adopted by the Government just a month ago. In this way, the State has put the established HIV infection management capacities at risk of extinction and has endangered the health of at least 10,000 citizens from the marginalised communities.

Instead of the expected 46.5 million denars of the National HIV Prevention Programme to be allocated to HIV prevention services that are provided by some 14 civil society organisations in 12 towns across the country, the Ministry of Health published a call for these associations the day before yesterday for an amount reduced by as much as 19 million denars. The National HIV Commission has not been consulted about this decision.

Thanks to these programmes, the Republic of North Macedonia has maintained over the past 15 years a full control over the HIV epidemic in populations of people who inject drugs and sexual workers, and one of the lowest infection rates in the region. Over the past 3 month, the full national response to this epidemic has literally been implemented by 14 civil society organisations, which have continued operating without being compensated for their work.

Termination of services to vulnerable groups will lead to an increased incidence of new infections and greater HIV-related death outcomes and, on the other hand, this will add pressure on the key health facilities, such as the Infectious Disease Clinic and addiction treatment centres, among others. Even a small rise in the HIV epidemic will inevitably lead to a multiple increase in the treatment and healthcare costs. Therefore, this decision for arbitrary reductions simply constitutes a poor public health policy.

HIV services provided by civil society organisations were introduced by the Ministry of Health between 2005 and 2017 with the support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has invested 25.7 million dollars to build the national HIV response. These include outreach and stationary services for anonymous HIV testing, counselling, distribution of prevention supplies for HIV and other blood-borne and sexually transmitted infections, diagnosis and treatment of sexually transmitted infections, mobile gynaecology services, support to people living with HIV and people receiving treatment against drug addiction and other complementary services. Since 2018, when the external financial aid ended, the Government of the Republic of North Macedonia has formally assumed the obligation to finance the HIV prevention services for higher risk groups and has committed in its policies to safeguard their sustainability in the future.

Young people continue to die from HIV in Macedonia and, following the methodology of the European Centre for Disease Prevention and Control, it has been estimated that as many as one-third (34%) of the total number of people living with HIV in the country are not aware of having the virus. In this way, Macedonia is significantly lagging behind the global average, which in 2020 stood at merely 16%. The 2025 global objective is to reduce the number of persons unaware of their HIV status to less than 5%, which will contribute to a drastic drop in the infection transmission, and will allow to finally put an end to the HIV infection by 2030.

Acknowledging the ongoing war in Ukraine, where we lose our friends and colleagues, acknowledging the COVID-19 consequences, and the energy crisis, we raise the alarm that healthcare must be maintained for all citizens, including the most marginalised ones, whose health status reflects on the health of the entire population. Prevention among the vulnerable groups and among youth must not fall victim to the State budget rationalisation policies. Otherwise, the HIV epidemic growth will only increase the costs, and the State will have to pay by losing human lives.

Taking into consideration the alarming situation and calling upon the country’s obligations arising from the United Nations Political Declaration on HIV and AIDS of June 2021, including the obligation to put an end to the HIV epidemic, as well as the obligations assumed by the Government to ensure continuity of the HIV programme, we demand:

1. That the public call for civil society organisation to implement the HIV prevention activities be urgently amended in a way that it corresponds to the amounts provided for in the 2022 National HIV Prevention Programme as adopted by the Government in February this year;
2. That the Government and the Assembly finally guarantee the continuity of the already established HIV protection system. This implies: that the Assembly should, without delay and in full, adopt the amendments to the Law on Health Protection, currently in parliamentary procedure, which concern the mechanism of involving the civil society organisations in the implementation of healthcare programmes, and that the Ministry of Health should develop by-laws to fulfil the obligations arising from the conclusions adopted by the Government in September 2017, and the obligations from the Government’s former and current Civil Sector Development and Cooperation Strategy.
3. On account of the significant delay in publishing the call, that the Government and the Ministry of Health, by way of an interventional support, compensate the costs of the civil society organisations for the first quarter of 2022 arising from their committed maintenance of the national HIV response.