Community-based and community-led testing services are crucial in the HIV/AIDS, viral hepatitis, and sexually transmitted infections response, particularly in reaching populations where diagnosis and linkage to care are lower than the national average. However, providing these services can be challenging, especially in environments that may be hostile towards community-based and -led service delivery, and where policy and legal barriers exist.
In 2022-2023, the COBATEST Network supported six member organizations in countries where the environment is particularly challenging for community-based and community-led service delivery. In the following interview with Partnerships in Health, one of the 6 organisation supported, we asked the organisation to tell us about their work, the challenges they face, and how they are working to improve community-based testing services for HIV/AIDS, viral hepatitis, and sexually transmitted infections in their communities.
- Can you describe recent developments in and the current state of HIV prevention and testing programs in Bosnia and Herzegovina?
In Bosnia and Herzegovina, the limited availability of services provided to PLHIV and key affected populations (KAPs) by CSOs, and the limited availability of HIV testing and other prevention programs result in poor detection of new HIV cases, a high rate of late HIV diagnoses, and a high death rate among people living with HIV and AIDS HIV testing availability has dropped severely in the past four years, upon the conclusion of the programs supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria grants . Since then, the country has not found an appropriate procedure to sustain HIV prevention services, including community-based HIV testing, which have received sporadic and insufficient funding from the national budget. CBVCT services have only limited capacity due to budget constraints, while the health care system is not able to secure a sufficient supply of HIV tests.
- Your project focuses mainly on the MSM community, could you tell us more about the role that CBVCT plays in reaching this community?
The largest number of newly diagnosed HIV cases in Bosnia and Herzegovina come from the MSM population. The predominant transmission mode remains sexual transmission within the MSM population. In 2022 MSM represented 75,7% of new HIV cases in the Federation, and 88,9% in Republika Srpska . As reflected in the figure below developed by the Public Health Institute of Bosnia and Herzegovina, a significant increase of HIV transmission within the MSM population started in 2011 and has remained a gravely concerning trend for over ten years.Due to the small community, stigma, and discrimination, this population has a hard time deciding to go to the VCT center located within the infectious diseases clinic. That's why our CBVCT is ideal because it is located among business spaces and does not attract attention to the people who come to this area.
- What is the status of CBVCTs in Bosnia and Herzegovina and how does it affect your work?
CBVCT in Sarajevo was established and exists as part of the non-governmental organization Partnerships in Health. All necessary financial input for the operation of this center is provided by Partnerships in Health through its projects. Unfortunately, so far, we have not had the support of institutions for the operation of this center. We provide tests and testing materials, educational materials, compensation for counselors, as well as costs for utilities and rent for the space where the CBVCT is located.
- Is there access to self-testing and how popular it is?
According to national Protocol for voluntary counselling and testing which is published 2020. It is not allowed to do self-testing.
- What do you plan to achieve with your project?
Our plan is to offer a tailored service of counseling and testing for HIV, hepatitis C, and syphilis to the key affected populations. HIV prevention services (pre and post-test counseling, testing for HIV, hepatitis C, and syphilis), as well as linkage to care (in cases of reactive tests), will be provided to 400 clients over a period of six months. The project will enable access to HIV prevention services in a safe environment, without stigmatization and discrimination, in an anonymous or confidential mode depending on the preference of the clients.
- What are the gaps in HIV prevention in Bosnia and Herzegovina and where community response could play a stronger role given the opportunity?
There are several gaps in HIV prevention in Bosnia and Herzegovina that community response could play a stronger role in addressing. These include:
- Stigma and discrimination: Despite progress in recent years, stigma and discrimination towards people living with HIV remain a significant challenge in Bosnia and Herzegovina. Community-based organizations can play a crucial role in raising awareness and reducing stigma through education and outreach efforts.
- Lack of access to testing and prevention services particularly in rural areas. Community-based organizations can help address this gap by providing testing and prevention services in their communities.
- Limited resources: Many community-based organizations in Bosnia and Herzegovina operate on limited resources, which can make it challenging to provide comprehensive HIV prevention services. More support is needed to strengthen the capacity of these organizations and expand their reach. For example, to reach only 400 people targeted in this project we need to combine several donated resources.
Given the opportunity, community response could play a stronger role in addressing these gaps in HIV prevention in Bosnia and Herzegovina. Community-based organizations can provide targeted education and outreach efforts, increase access to testing and prevention services, and help reduce stigma and discrimination towards people living with HIV.
This support was possible due to small grant programme as part of the project "Community Led and Based HIV Services - Key to Ending the HIV Epidemic in Europe and Central Asia" implemented by AIDS Action Europe, LILA Milano, and CEEISCAT in the framework of the COBATEST Network and supported by the "Zeroing In - Ending the HIV Epidemic" Programme funded by Gilead Sciences.