The Eurasian Harm Reduction Network has issued the second in a series of reports on the impact on harm reduction programs of the Global Fund withdrawing support for HIV components in a country. The second report, on Bulgaria, reached a similar conclusion as the first report, on Serbia – i.e. that the lack of sustainability and transition preliminary planning has limited the ability of countries to estimate risks of increased HIV-epidemics and to define financial gaps. This has negatively affected preparedness to mobilize alternative financial recourses for harm reduction interventions.
For information on the Serbia report, see GFO article.
Bulgaria was not eligible to receive an allocation under the new funding model. An existing grant that was scheduled to end in 2014 has been extended at no cost to December 2015 to give the country some time for transition planning and alternative funds mobilization.
Bulgaria is a low HIV-prevalence country, but people who inject drugs are disproportionally affected by HIV infection. Between 2004 and 2012, the HIV prevalence among persons who inject drugs increased from 0.6% to 10.7%.
Until now, the major source of funding for the harm reduction program in Bulgaria has been the Global Fund. Harm reduction services were provided by 10 local NGOs. They risk having to stop their harm reduction work if they are not able to mobilize resources from other donors.
Since 2014, civil society has been warning the government and Parliament about the imminent HIV funding crisis. Most officials were not even aware of the fact that the Global Fund was no longer funding programs in Bulgaria and of the consequent risks related to the HIV-epidemic.
As a result of the advocacy efforts of civil society organizations, the harm reduction program will be one of strategic directions of the National Strategic Plan for HIV for 2016-2020. This will be a costed plan and it should become a part of the budget to be voted by the National Assembly in December. However, the NSP is still a draft document and there is no transition plan that would identify the financial gap for harm reduction programming in Bulgaria and the activities that will be undertaken to address this gap.
According to the case study, most respondents doubted that the government will make a political commitment to fund the harm reduction interventions. Respondents identified restrictive drug policies as another barrier.
The report concludes that “Global Fund support of harm reduction programs in Bulgaria has been essential to the country’s HIV response. However, HIV prevalence among PWIDs in Bulgaria has grown substantially over the last decade, and the Global Fund’s sudden withdrawal of funding for HIV activities in-country threatens the sustainability of Bulgaria’s HIV response.”
In the near future, the EHRN hopes to be able to conduct studies and release reports on the impact of the withdrawal of Global Fund support on harm reduction programs in other countries, possibly Bosnia and Herzegovina, Romania and Macedonia.
Meanwhile, the EHRN has published a report on “Sustainability and Transition Planning for Global Fund Harm Reduction Projects” in Belarus.