IAS 2017 IASconference Providing youth friendly services to

#IAS 2017 | @IAS_conference

Providing youth friendly services to women and girls in Macedonia: how is it working? Dr. Milena Stevanovic Health Education and Research Association (HERA), Republic of Macedonia #IAS 2017 | @IAS_Conference

#IAS 2017 | @IAS_conference HIV epidemiology in R. Macedonia • Republic of Macedonia - south eastern European country with a population of around 2 million. • Macedonia is a low prevalence country -according to the Republic Institute for Health Protection (RIHP), a cumulative total of 315 HIV cases have been reported in the period 1987 – 2016 • The first HIV positive case was registered in 1987 and the first AIDS case in 1989; • 262 male ( 83, 1%) and 53 female (16, 9% )

#IAS 2017 | @IAS_conference HIV Transmission MSM Hetero unknown MTCT IDU Hemophilic 147 137 7 6 12 6

#IAS 2017 | @IAS_conference ■In 2016: 40 new cases ■ 184 are on ART Age distribution Under 13 years: 13 -19 years: 20 -29 years: 6 6 102 30 -39 years: 40 -49 years: 50 -59 years: 60 or older: 123 47 23 8

#IAS 2017 | @IAS_conference Services for people living with HIV • Pre/post test counselling • Psychological support • Community support

#IAS 2017 | @IAS_conference Youth friendly services Services 2014 “I Want To 764 Know – Vodno” Youth Centre 1229 “I Want To Know – Šuto Orizari” 2015 2016 757 919 1379 1473

#IAS 2017 | @IAS_conference Type of service • • • HIV testing 4222 Testing for sexually transmitted infections Chlamydia 352 Syphilis 152 Hepatitis B 148 Gonorrhoea 58 Oral contraception dispensed 180 Intrauterine device insertions 14 Condoms distributed 23445 Pap testing 751 Counselling on domestic and gender-based violence 561

#IAS 2017 | @IAS_conference Youth friendly services – quality of care Sensitized staff Confidentiality guaranteed Free of Charge Integrated services- SRH + HIV testing Referral system within the NGO working with Key populations (gatekeepers) • Referral System with state health • • •

#IAS 2017 | @IAS_conference Youth friendly services – key population centered services • Established as safe space for key population (MSM, LGBT, SW, DU, Roma) • Identification of people living with HIV • Positive prevention

#IAS 2017 | @IAS_conference Challenges • Phasing out of Global fund and international support • Absence of national support • A broad specter of SRH and HIV services • Incapability of clients to cover the costs for services

#IAS 2017 | @IAS_conference Next steps Ensuring sustainability after phasing out of Global Fund: • Defining a minimum model – financial benefit study • Integration in the state health system and budget • Support from the business sector. Social responsibility