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Montenegro is one of the countries of the South Eastern Europe region that has significantly benefited from support of the Global Fund from 2006 to 2015. Together with UNDP as the principal recipient (PR), Global Fund provided direct support for the implementation of two national strategies on HIV/AIDS (2005-2009 and 2010-2014) and a national Tuberculosis (TB) strategy (2007-2011). This support resulted in maintaining the low prevalence of HIV in the country and the remarkably low prevalence of HIV among people who inject drugs (PWID). Nevertheless, the country reports a high proportion of patients diagnosed at a late stage of infection, potentially indicating a relatively large number of people - including PWID - unaware of their HIV infection as well as high prevalence of viral hepatitis C (HCV) among PWID. 

This case study analyzes the readiness and risks of the Bosnia and Herzegovina transition from donor to domestic funding, identifying the challenges and recommendations. 

Becoming a member of the European Union in 2007, Romania has seen its Gross Domestic Product (GDP) rise 2.8% in 2014 and 3.7% in 2015, one of the highest in the EU with the World Bank categorising the country as ‘upper middle income’ but with the Government only putting 13% of its resources towards the health sector in 2014. Although Gross National Income (GNI) per capita in 2014 was $9,520, one-quarter of the population were reported to be living below the national poverty line.  

Other

The Republic of Slovenia (Slovenia) is a European Union Member State located in the southern part of Central Europe. In 2015 the population of Slovenia was 2,068,000 people.According to the latest available estimates, there were 6,100 PWID in Slovenia in 2011. HIV prevalence among PWID is 1.4%? hepatitis C is 32.1% and hepatitis B is 5.6%.  Drug use was decriminalized in Slovenia in 2000. Purchasing drugs for private use is not considered a criminal offence. The legal environment for implementing harm reduction programs in Slovenia is highly favorable, because drug use is not criminalized. These programs operate nationwide, providing sterile injecting equipment, information and counseling at nine fixed sites and 178 different outreach locations across the country. The major recent development in NSPs is the piloting of a drug consumption room program in Ljubljana in 2015. Opioid substitution therapy (OST) is currently being provided at 19 sites. There are different treatment options to address different needs of OST clients and their health status. The overall OST coverage in 2013 was 65% of opioid users, which is higher than the minimum World Health Organization (WHO) recommendation (40%). The main funder of the Slovenian HIV response and harm reduction programs is the country’s government. The high levels of service coverage and accessibility for PWID imply that the financial support from the government is sufficient to ensure the continuity and sustainability of harm reduction programs.

Other

The Republic of Serbia (Serbia) is a non-European Union State in the central part of the Balkan Peninsula in Central Southeastern Europe. The estimated number of people who inject drugs (PWID) in Serbia is 20,000. There are no PWID community-driven initiative groups or PWID organizations in Serbia. Drug use in Serbia is criminalized. According to the Criminal Code, a person who possesses a small amount of drugs for personal use can be sentenced for up to three years of imprisonment. The end of Global Fund support and the unsolved service sustainability issue led to a significant deterioration of harm reduction programs in Serbia. There was no transition plan for the Global Fund’s withdrawal and no institutional framework for coordinating the transition to domestic financing for HIV and AIDS in Serbia. Currently there are no alternative mechanisms to ensure sustainable funding for NGOs harm reduction programs in Serbia. Local harm reduction groups have recently come together under the Serbian Coalition of Harm Reduction Organizations to coordinate their fundraising efforts.

Other

Montenegro is a newly emerged sovereign state in Southeastern Europe. It declared independence on 3 June 2006 and in December 2010 was officially granted a candidate status for joining the European Union. The country does not have national-level estimates of the size of the population of people who inject drugs (PWID). Drug use and possession of small amounts of drugs for personal are not a criminal offence. The community of PWUD is actively involved in advocacy efforts and lobbying that aim to mobilize resources for harm reduction activities, which significantly decreased as the Global Fund to Fight AIDS, Tuberculosis and Malaria grant ended in 2015. Since international funding for HIV prevention withdrew from Montenegro, harm reduction services have experienced severe consequences of crises of sustainability and political indifference. Financial support to harm reduction services in Montenegro is insufficient to meet the needs of PWID at least at the level of previous years.  

Other

The Republic of Bulgaria (Bulgaria) is a European Union (EU) country located in the eastern Balkans with a population of approximately 7.2 million people (as of 31 December 2015).  The recent annual report of the Ministry of Health refers to 20,000–30,000 problem heroin users in the country. Heroin and methadone remain the main injected substances. At the same time, there is a growing use of amphetamines and highly addictive non-injecting drugs called ‘spices’. In Bulgaria drug use itself is not prosecuted; however, drug posession is penalized by high fines and/or imprisonment, depending on the substance group. Harm reduction programs in Bulgaria are highly dependent on international financial support currently provided through the Global Fund’s “Prevention and Control of HIV/AIDS” program. Even though the Global Fund’s financial support for NSP ends in July 2016, a solution for this crisis still has not been found.

Other

The Republic of Albania (Albania) is a non-European Union State located in Southern Europe. According to national statistics, the total population of the country was 2,886,026 people in January 2016.  According to the latest available estimates, there are 3,710 people who inject drugs (PWID) in Albania. The legislative and policy environment in Albania appears relatively comprehensive. Drug use itself is not illegal. Possessing a ‘daily dose’ of drugs for personal use is not punished either. However, the country is lacking implementation and enforcement, which has a negative effect on PWID in terms of their human rights and access to harm reduction services.   NSP services are not currently supported by the government. Only OST medication for limited number of patients is provided from domestic sources. Since the end of the Global Fund Round 5 grant in 2012, the Albanian government has failed to support the cost-effective functioning of the HIV and TB programs in the country, resulting in a deterioration of services over recent years. The fledgling harm reduction program nearly collapsed due to the absence of funding. Consequently, access to both NSPs and OST in Albania is poor. There is no information about active PWID community initiative groups or organizations in Albania.

With reductions in Global Fund support and lack of funding available from other donors, the EECA region now faces the challenge of raising domestic resources for these programs. The lack of transition and sustainability planning heightens the risk of countries losing the progress they have made over the last decade with Global Fund support. This case study examines the situation in Macedonia and makes recommendations to the Global Fund, national governments, civil society, and other donors for easing the transition and safeguarding previous gains in HIV prevention in Macedonia.

With reductions in Global Fund support and lack of funding available from other donors, the EECA region now faces the challenge of raising domestic resources for these programs. The lack of transition and sustainability planning heightens the risk of countries losing the progress they have made over the last decade with Global Fund support. This case study examines the situation in Albania and makes recommendations to the Global Fund, national governments, civil society, and other donors for easing the transition and safeguarding previous gains in HIV prevention in Albania.

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