Bosnia and Herzegovina hope that low prevalence means low risk

Author:

Tinatin Zardiashvili

Article Type:

Article Number: 6

The eventual phasing-out of Global Fund support in the country means other sources of income for critical outreach into vulnerable communities must be found, and soon

ABSTRACT Bosnia and Herzegovina will from December 2015 become ineligible for Global Fund financing, presenting a risk to a number of programs that the government has said it may be incapable of finding budgetary resources for. This could have an impact on currently low sero-prevalence rates nationwide, particularly within certain vulnerable populations such as the migrant Roma who live in poverty in informal settlements around the country.

Bosnia and Herzegovina (BiH) will from December 2015 no longer be eligible for Global Fund financing as it is currently designated an upper middle-income country with low burden of disease. With a generalized sero-prevalence rate under 1%, and only 5% prevalence among key affected populations, this phasing-out of Fund support seems to be a reasonable and considered decision for the country, which as of 2012 had reported just 222 cases of HIV and 120 patients with AIDS.

However, according to an independent evaluation of the national HIV program conducted in late 2013, the country has not progressed enough in developing its own effective system of prevention and outreach services — especially among groups such as injected drug users: those who are most at risk in the country currently. This has bolstered fears that without Global Fund support these services will not be taken up as part of the national budget, leading to a possible increase in the number of cases reported in-country.

The country has, however, achieved considerable success in developing a coherent, cooperative strategy that involves government, civil society and other stakeholders, according to the evaluation conducted by the AIDS Project Management Team (APMT).

This, too, has been attributed to the work conducted under the Fund’s Round 9 grant to scale-up HIV prevention services for key populations, which will be closed by December 2015. The grant has helped to streamline and harmonize strategies for outreach around HIV, actively involving stakeholders from across all sectors.

Weaning these activities off of Global Fund support and finding other potential resources will be the primary focus of principal recipient (PR) UN Development Program and implementing partners over the next two years. Government, alongside civil society and other actors, is developing a transition plan for both the HIV and TB response. Despite its income status, however, the government’s financial situation is bleak, which could impinge on efforts to ensure national resources are available to carry on with programming, especially programs targeting IDUs and the Roma population, the most vulnerable minority group in BiH, which lives in impoverished informal settlements that create a significant risk of TB infection.

TB and HIV activities targeting the Roma population may lose budgetary support once it becomes the government’s sole responsibility, Aidspan understands from sources in BiH. The country has been hit hard by two months of popular protests that are infected with backlash against federal spending on anti-poverty programs, when most of the country has been hit hard economically.