The Global Fund Board has approved Phase 2 funding for a Round 9 HIV grant in Bosnia and Hercegovina in the amount of $13.5 million. The principal recipient (PR) for the grant is the United Nations Development Programme (UNDP). UNDP is also PR for another HIV grant, which has been essentially completed, and for a TB grant in Bosnia and Hercegovina.
Phase 2 will target people who inject drugs (PWIDs), men who have sex with men (MSM), sex workers, prisoners, Roma, migrants, persons living with HIV, and young people living in institutions. The interventions include needle and syringe programmes; opioid substitution therapy; HIV testing and counselling; antiretroviral therapy; sexual and reproductive health services; behaviour change communication; vaccination, diagnosis and treatment of viral hepatitis; and services for people who are drug dependent or use drugs in prisons.
In addition, Phase 2 includes activities targeting migrant and mobile populations, and young people living in institutions. An effort will be made to ensure that the services are brought close to the beneficiaries – for example, through the establishment of mobile voluntary HIV testing and counselling.
The Bosnia and Hercegovina CCM first submitted its request for continued funding in September 2012. Through an iterative dialogue between the Secretariat and the CCM, it was decided that the CCM should resubmit its request to ensure a greater focus on high-impact interventions and most-at-risk populations. Although the national HIV prevalence remains low (less than 0.1%), the estimated prevalence of HIV amongst PWIDs and MSM in the largest cities is over 1%; and for sex workers, it is estimated at 0.5%.
When the first request for continued funding was submitted, Phase 1 cumulative expenditures were at only 58% of what was budgeted. This is mainly explained by the late contracting of sub-recipients (SRs). Despite the late start, the programme achieved or exceeded its targets, which suggested to the Secretariat that (a) targets were underestimated in Phase 1; and (b) there was room for further efficiencies in Phase 2.
The CCM request excluded the blood safety component from the original proposal because the government will take full responsibility for those activities in Phase 2. Another element of Phase 1, TB/HIV collaborative activities, will not continue in Phase 2 because the CCM has determined that all of the necessary building blocks have already been put in place (establishment of guidelines, referral systems, etc.). The referral network, which is part of the TB/HIV collaborative activities, will continue to be monitored during Phase 2 and reported through an indicator in the performance framework.
The Global Fund said that stigma and discrimination towards most-at-risk populations and people living with HIV/AIDS persists in Bosnia and Herzegovina, and that behaviours of some of the key at-risk populations – such as drug users and sex workers – are criminalised. The funding approved for Phase 2 includes money to enable SRs to address human rights issues, policy and advocacy initiatives, and community systems strengthening; and to scale up of activities in key populations.
To maximise the impact of proposed interventions, the Secretariat will work with UNDP and the country coordinating mechanism to finalise the key population size estimates and to commission an independent programme evaluation in Year 3 of the grant.
Information for this article was taken from Board Decision B28-EDP-14 and from B28-ER-11, the Report of Secretariat Funding Recommendations for February. These documents are not available on the Global Fund website.