Urgent action is needed to address HIV among GMT in the Balkans

ERA – LGBTI Equal Rights Association for the Western Balkans and Turkey, with the support of Open Society Foundations, is implementing a 26-month project aiming to respond to the HIV epidemic among gay and bi men, men who have sex with men and trans (GMT) persons in the Western Balkans. The initiative aims to strengthen capacities of LGBTI and HIV/AIDS organisations and encourage cooperation between them in order to improve and sustain services for key communities affected by the epidemic, organize joint advocacy efforts and conduct tailor-made internet outreach and other types of campaign activities. 

In the first phase of the project implementation a desk research was conducted by ERA and its member organisations, in order to provide an uP to date picture of the situation in the region as of June 2019 as well as to provide some important conclusions and recommendations which will be shared widely with all relevant stakeholders.  

As of 2019, across the south-eastern European region there is an expanding HIV epidemic among gay and bisexual men which is on the verge of spinning out of control. From 2007 to 2016, the number of new HIV diagnosis has risen over 300% across the region, compared to an average of 13% increase among gay and bisexual men in the European Union.

According to 2018 government reports, the range of essential prevention interventions for gay and bisexual men remain small and patchy in most countries of the Balkans and Turkey and are far from reaching the comprehensive prevention combination package recommended by ECDS, WHO and UNAIDS. Prevention interventions are still extremely weak in most of the countries and not at an adequate scale to impact the epidemics.

With the exception of Slovenia, access to Pre-Exposure Prophylaxis (PrEP), a novel and highly effective intervention against HIV infection, is not adequately available in any country of the region. PrEP is sold in only but a few pharmacies in each country, with extremely high prices and it is not covered by public health insurance. What are lacking, are also support services that address the recent phenomenon of ChemSex (sexualised drug use among some groups of men who have sex with men). Essential prevention interventions such as condom distribution and programmes for health promotion and behaviour change do not exist or have very low coverage in the majority of countries.

Government reports reveal also that gay and bisexual men have limited options for HIV testing, and with a few exceptions (Croatia, Kosovo and Slovenia), testing coverage is low or only medium in most countries of the ERA region.

The region lags behind also in terms of new approaches such as self-sampling or self-testing and only North Macedonia reports a high coverage of community-based HIV testing. Data on HIV treatment is also insufficient, and treatment is reported low in most countries of the region. As a result, low rates of HIV testing among gay/bi men, MSM and trans persons and the generally low rates of HIV treatment coverage and viral suppression implies, that the “test and treat” approach, which along with access to PrEP have led to massive declines of new HIV infections among MSM elsewhere are yet to be properly applied and harnessed in our region.

Conclusions:

  • Governments of the Western Balkans and Turkey should take urgent measures to prevent the HIV epidemic among MSM, gay and bi men, as new HIV diagnosis has increased to 300% in south-eastern Europe; 
  • Basic prevention interventions should be scaled up across the region and new highly effective prevention tools like PrEP should be introduced urgently; 
  • Actions should be taken jointly with the recent efforts to protect and strengthen the fundamental rights of LGBTI persons. The fact that this community is the only one affected by the epidemic reveals a correlation between discrimination, invisibility and high rates of infections; 
  • As the Global Fund and other donors are leaving, countries should increase domestic financing of HIV prevention programmes and work closely with community based organisations;
  • The European Union and other donors should step in and provide time-bound bridge funding to protect the investments and gains made and facilitate transition into government led prevention and treatment programmes;
  • LGBTI community based organisations should be involved in all levels of interventions as they are the most suitable groups which can effectively reach and work with gay, bisexual men and trans persons; 
  • Strengthening community awareness, mobilization and networking through training of trainers programs for LGBTI activists and further increasing their involvement in the region as well as Europe wide projects and activities; 
  • Placing HIV among gay and bi men as well as trans persons on the agenda of Croatia and Slovenia and EU candidate countries in the Western Balkans; 
  • Promoting a comprehensive regional action plan (in line with EU standards) on HIV prevention with a focus on Croatia, Slovenia and six EU candidate countries in the Western Balkans;
  • Make extensive advocacy efforts in strengthening political leadership and support of the European Union (Commission, Parliament etc), national governments, Parliaments and local municipalities in addressing HIV/AIDS
  • All countries of the Western Balkans are recommended to start conducting implementation trials in their country in order to assess how to best deliver PrEP to those who need it;