Growth trends of HIV/AIDS in Macedonia, later known as North Macedonia, from February 2017, display a consistently low prevalence rate of 0.1% from 2005 to present, and more than 600 people currently live with the disease. Rates are higher for men than women. Transmission commonly occurs through sex or sharing of injections.

Data Challenges

Issues in this area include unreliable data due to social stigma, such as that related to drug use. Consequently, people may not want to participate. Other barriers to data collection include a lack of awareness among vulnerable individuals who may contract it, and financial crises that prevent people from volunteering in trials. Unreliable data makes epidemiological patterns harder to predict. Surveillance also lacks focus on vulnerable populations.

In 2005, Macedonia had a low prevalence of HIV/AIDS, with the main mode of infection being sexual contact. Between 5,000 and 6,000 drug users were registered in Macedonia. Injected drug users (IDU) form the majority of these users, leading to potential increases in the risk of the epidemic concentrating around IDUs in the future.

People most vulnerable include youth, injected drug users, prisoners, juvenile delinquents and the mobile population, such as seasonal workers and commercial sex workers (CSW).

Socioeconomic Challenges

Challenges contributing to vulnerability in Macedonia include poverty, with 21.8% living in poverty. Most impoverished individuals reside in rural areas, where mortality rates are higher compared to cities, and education levels, including regarding HIV/AIDS, are lower.

Past Funding – GFATM

In Macedonia, public health expenditure was around 6% from 1999 to 2003. A foreign grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) of $4.4 million was provided from 2004 to 2006, and Macedonia and Serbia were the only countries that received it. Even then, the resource gap was quite large, by $2 million or more.

Funding was crucial during this time, supporting prevention and treatment efforts. This source suggests the government worked across sectors to implement prevention and treatment effectively. However, this GFATM funding did not cover surveillance, thus more resources are necessary to reach the desired outcome of containing the illness. Nonetheless, the country had a robust plan and funding to aid in the fight against HIV/AIDS nationally.

Recent Funding Cuts

Since June 2017, the Global Fund to Fight AIDS, Tuberculosis and Malaria has ceased funding HIV/AIDS in North Macedonia, leaving the Ministry of Health as the main funding source. The low chance of contracting HIV/AIDS led to substantial budget cuts every year for four years by 40% by the Ministry of Health. Due to early implementation of prevention strategies and other initiatives, North Macedonia has not experienced an endemic for HIV/AIDS.

Not only were rates low for contracting HIV/AIDS in North Macedonia, by 2017, it became classified as an upper-middle-income status, making the argument for budget cuts more robust. Nonetheless, the government worked closely with the Global Fund to ensure links between Civil Society Organizations (CSOs) and the government remained strong.

Need for Increased Funding

Many believe that the budget cuts risk undermining infrastructure and capacities built from 2005 to 2017 funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, which provided over $25 million for HIV nationally. There is a risk of closure of HIV prevention programs that have been effective over the last couple of decades. This may further impact the right to access healthcare if cuts continue.

Companies specializing in HIV prevention and treatment highlight the risk of infections rising with cuts to these services, such as the European AIDS Treatment Group. Almost a quarter of the population now lives in poverty in North Macedonia, which could lead to catastrophe if someone living in poverty acquired HIV/AIDS. Economic constraints already limit access to healthcare. Marginalized people, such as those in rural areas and disabled individuals, already have trouble accessing adequate healthcare, which would project a worse outcome for these people. Additionally, there is a lack of key workers to support HIV/AIDS patients. Each patient has a right to health, and these cuts could take that away from them.

For the last four years, there have been substantial budget cuts toward HIV/AIDS. In 2025, more than 1.46 million euros is allocated for HIV prevention, which is less than what the country needed the previous year.

Proposed Solutions

Some have written to the government and ministry officials. Following the budget cut, 16 Macedonian civil society organizations united to create a joint platform to advocate for sustainable financing of HIV programs. This effort focuses on reversing the government budget cuts.

A social worker believes that it is essential to continue pressing the government and policymakers about the importance of funding in this sector of healthcare, so that people with an HIV diagnosis are never denied treatment.

Focusing on treating patients who have HIV/AIDS is important. “Empowering Patients for a Healthier Society – Annual Work Programme 2025” is funded by the European Union and is a project aiming to increase quality of life by making treatment more accessible and encouraging a more inclusive and beneficial healthcare environment. By doing so, this gives those with HIV/AIDS in North Macedonia more control over their lives and more self-confidence. There is also prevention education, early detection education and a supportive community after receiving the diagnosis. The actual results have yet to be published. However, this is a key type of solution that spreads awareness and makes healthcare more accessible.

When the Ministry of Health took over responsibility for funding HIV/AIDS, positive results emerged two years later, with HIV/AIDS in North Macedonia receiving funding completely internally. North Macedonia is a model example for countries to follow when they cut budgets for good reason.

– Emilia Upton

Emilia is based in London and focuses on Global Health for The Borgen Project.

Photo: Wikimedia Commons