We HAVE the support but NOT the finances!!!

We were approaching Macedonia Square with heavy hearts, silently wondering whether it was possible to fall down in obscurity and be forgotten after 12 years at the forefront of the epidemic struggle. Was it possible to lose the defence lines against an epidemic dropping in European countries, whereas here, after decades of successful low HIV prevalence we couldn’t afford to provide the basic services? Was it really possible that the country would simply dismiss its citizens after 12 years?  

It has been several months since the last protest march held by the HIV Platform on December 1, 2016 in Skopje, the last call for action and leadership to stop the closure of all HIV prevention programs in the country, including organizations implementing harm reduction programs. In fact, the march was the last commemoration of the World AIDS Day before the Global Fund ended the financial support of our organizations and thousands of users within the harm reduction programs lost access to the HIV prevention services. There was fear on the concerned faces of colleagues from other towns that the HIV epidemic we have successfully fought for 12 years will finally arrive at our doorstep. The concern was justified and the issues pressing. We were approaching Macedonia Square with heavy hearts, silently wondering whether it was possible to fall down in obscurity and be forgotten after 12 years in the forefront of the epidemic struggle. Was it possible to lose the defence lines against an epidemic dropping in European countries, whereas here, after decades of successful low HIV prevalence we couldn’t afford to provide the basic services? Was it really possible that the country would simply dismiss its own citizens after 12 years?

We must show what we have achieved so far. Leave it in written lest it be forgotten.

In the distant 1996, a group of people opened the first Harm Reduction Program in Macedonia called M.A.S.K.A. The Program later developed into the civil society organization HOPS – Healthy Options Project Skopje, with its founding members later becoming our mentors. We all learned from HOPS. The development of these programs would have been impossible without their unwavering support. From 2000 to 2002, couple of other harm reduction programs were developed in Izbor in Strumica and Via Vita in Bitola. From 2004 to 2007, with the Global Fund’s support, five other new programs were opened within the organizations Pulse from Kumanovo, the Youth Club in Shtip, Zona in Kavadarci, Option in Ohrid and Help in Gostivar. Until 2011, Izbor from Strumica opened similar programs in Gevgelija, and the Centre for Development and Promotion of Public Life Tetovo in Tetovo, also with the support of the Global Fund. Around the same time, the Macedonian Red Cross opened harm reduction programs in Veles, Prilep and Kicevo. At the time of writing this article, there were 15 harm reduction centres in 13 towns in Macedonia, with additional services provided in some. We pray for a miracle to save these programs in future.
I remember well, we started from scratch.

More than a decade ago we participated in the first harm reduction training in order to stand at the forefront of human rights activism for people who use drugs in Macedonia. On the one hand, it was us, the “novices” fresh young activists with new vision about discrimination, stigma and injustice drug users suffered on a daily basis, and on the other, the already experienced colleagues from HOPS – Health Options Project Skopje. Together we set up the harm reduction teams for drug use and HIV prevention. With the newly assigned positions as outreach workers, coordinators, medical and social workers from different towns, we were eagerly waiting to start working.  

In October, 2005, we started building the capacities of our organizations. In Shtip, I personally brought in a desk, chairs, pencil cups, staplers and other office supplies from my home for the new Harm Reduction Program in Shtip. At the time 12 years younger, my colleagues and I managed to create a unique program, never seen before in Shtip. We designed programs with several services under one roof, where people who use drugs can find support without being judged or moralized, in anonymity and confidentiality. With unrestrained enthusiasm, then as an outreach worker, armed with a backpack filled with “injection equipment” and educational booklets, I used to drop by and visit the “girls and guys” (I never liked calling them clients), from door to door, talking to them, explaining the program benefits and services. They welcomed us, understanding our inexperience. We were just beginning after all! It wasn’t easy for them (at the beginning, anyone seen in the vicinity of our organization was labelled a “junky” by the passersby), however, bashfully and with reluctance, the “girls and guys” flocked to our offices to seek the services we offered. We worked hard in order to succeed. We truly did! Only several months later, whenever I returned to the offices from the field, “the gang” would chill with a cup of coffee, discussing different topics in the common room. They adopted their own house rules and respected the joint space. Twice a month, we would patrol around schools to collect needles and syringes left by users, a regular sight at the time but a rarity nowadays. Obviously, it made a difference. They welcomed the program as their own. I was overjoyed with happiness! 

We participated in different platforms, conferences and festivals throughout the country, I apologize if I forget to mention some. Many of those events no longer exist but they boosted cooperation among organizations, introduced the citizens with the programs, gave visibility and helped us create quality services for our “girls and guys”. We did our best in Shtip. Petition threats and verbal abuse were common, but we managed to pull through. Organizations in other towns went through the same ordeal, which only encouraged us in convincing the population how pointless and misdirected the stigma and fear were. Together with the “girls and guys” throughout Macedonia we passed that exam. People started greeting us on the streets, sometimes even dropping by the office to express support. We managed to leave a permanent mark by closing the door shut to discrimination and stigmatization against similar organizations. The changes were imminent.

In Shtip, we initiated voluntary collection of discarded infectious waste that had accumulated for years around schools and nurseries. By ourselves, with our finances and the guys’ dedication we collected hundreds of kilos of potential risk to the local community. We kept in touch with other organizations dealing with the same process, exchanging experiences and ideas. We never boasted or advertised, we simply did what we thought was right. The recognition from the donor motivated us to persevere. The greatest recognition, however, arrived from the “girls and guys” who still frequent our offices and use the services we offer. At the moment, they are anxious about the prospective closure more than us.
Every day we meet new young people surprised to see that a person who has erred in this country can find understanding without being judged, or receive a medical service without having to repeat their medical history to every doctor they meet. They know they can receive a service and advice from a social worker without feeling like being questioned by the Gestapo (I use the word Gestapo because institutions in Macedonia have become interrogation centres with inexperienced doctors and social workers seeking new employment every two weeks). Even if they called in the middle of the night when a friend overdosed, they would receive counsel and assistance on how to save that friend’s life. There is no one else to ask.

How many lives have we saved? How many people have we helped? How many lives changed to the better? We distributed thousands syringes and twice that many needles, hundred thousand condoms and many more educational leaflets and brochures, constantly working with them, reassuring them of their right to a second chance. We worked so hard to build this and now it might disappear forever. But it’s more than the material aspect. It’s about the young lives, the young citizens who, having made the wrong decision, will one day return to society as re-socialized, re-integrated and healthy. THAT is our job, to reduce the harm of every individual, save their health and that of the surrounding. 
I am personally not worried about myself. I am not worried about my livelihood. I can earn the same salary in any of the textile companies or in construction, even receive social and health insurance as a bonus this time, something I sacrificed for the last 12 years, apart from my time of course. For now, however, politicians decided that the 12 years of experience bear no significance. Ten thousands of people are insignificant. The fact that the experience of 100 employees and even more volunteers will go to waste and they will be forced to start anew is also insignificant. But as I said, I will live through it.     

However, when on July 1, 2017, thousands of users of harm reduction programs implemented by HELP from Gostivar, Pulse from Kumanovo, Via Vita from Bitola, Option from Ohrid, Zona from Kavadarci, Izbor from Strumica, the Red Cross from Veles, Prilep and Kicevo, HOPS from Skopje and the Centre for Development and Promotion of Public Life Tetovo will come to find closed doors, after a decade of working and changing views, awareness, and opinions, they will realize that we abandoned them, and no excuse will suffice. What can we say? It’s not our fault? It wasn’t us? They abandoned us and broke the promise, after years of cooperation? It’s their fault? I don’t know. 

They’ll be back on the streets, I know, just like 12 years ago, with no one to appeal to. Wandering through the institutional labyrinths from door to door, marginalized and discriminated against, with no services available to them, their future is doomed. All the hard effort to get to the point we have reached today would go to waste. It’s the same story everywhere, we have come to the same conclusion with the colleagues from other organizations, “We have the support, but not the finances.” We were deceived. The situation with Romania, Serbia and Bulgaria will reprise. There, after all harm reduction programs were closed, the rate of new HIV infections jumped to the ceiling. We were never offered the opportunity Croatia had, where 90% of the services are financed by the state. Why can’t we be leading in such crucial matters? I know that thousands of users will come knocking on the institutions’ doors, asking for what they are entitled to! They will, because the time when drug users were silent is long gone. Now that they are aware of their rights and health, they will seek not only services but rather look for the culprit. The sooner the authorities realize that, the greater the odds to save ourselves from a Titanesque tragedy. Let us not be the iceberg that sank the whole ship!

Our struggle will not suffice, in this I am certain. We need the involvement of all activists, workers, doctors, psychiatrists, social workers, police officers and mayors, everyone familiar with the programs and its benefits. Let’s tell politicians we are fed up! We are fed up with deterioration! We have to move forward! We have to protect Macedonia from a disease developed countries already responded to. For 12 years we also responded, but the authorities comfort us “Don’t worry. You have our support.”, now – the struggle for money continues.

Denis Ampev
The author is the Harm Reduction Program Coordinator and human rights and workers’ rights activist.


The Youth Has the Power
The Harm Reduction Program in Shtip has been functioning within the Youth Club from October, 2005 with a team of 4 people. Their greatest contribution is promotion of the rights of people who use drugs mostly through hard work, sincere and friendly relation and a genuine intention and vision for better health of all citizens.

HELP from Gostivar was established in 2005, with a team of 12 members, working on reducing the rates of HIV infections through harm reduction services for drug users and sex workers. With a positive attitude towards people who use drugs, the organization left a permanent mark in ending the stigma towards clients and maintaining low HIV and Hepatitis C prevalence.
Zona from Kavadarci has been working with harm reduction programs from 2005. Our services helped gain the users’ confidence and contributed towards a change in risk behaviours among people who use drugs, while on the other hand, contacts with the general population and institutions helped raise awareness on addiction issues. People who use drugs recognize and remember us as a trustworthy organization, always working to their best interest. Services like Zona – Kavadarci make them feel safer.
The vision of Healthy Life Styles Association – Pulse from Kumanovo is creating a society where human rights are respected, with special focus on drug users and other marginalized groups. The association, founded in 2008, implements harm reduction programs and cooperates with other organization with similar mission, as well as with the relevant institutions. Our priority is the citizens’ health, however the unequal management of the State Budget threatens our existence.

The Macedonian Red Cross with its municipal organizations in Prilep, Kicevo and Veles have been implementing harm reduction programs from 2006. The Red Cross Harm Reduction Programs in these three towns aim towards respect of human rights and nurturing the health of people who use drugs, raising awareness on drugs issues among young people as well as encouraging the joining of forces. For the past ten years these organizations have been working towards sensitizing local institutions on harm reduction issues, indicating to the problems and needs of the target group. Hard work and lobbying contributed towards introducing the problem to the international Red Cross institutions. Our offices are recognized as places without judgment, discrimination or stigmatization. We sincerely hope that the ten years invested in building capacities and human resources won’t disappear into oblivion due to misguided policies.

The organization for counselling, treatment, reintegration and re-socialization of people addicted to psychoactive substances – Izbor from Strumica has been active from 1997, a leader on regional and national level in drug addiction, alcohol and gambling issues. Izbor implements several prevention programs in Strumica: Harm reduction program for people who inject drugs, Support program for sex workers, the Program for treatment, re-socialization and reintegration of people who have problems with drug addiction, alcohol and gambling – Therapeutic community “Pokrov” and the Free legal help program. Apart from Strumica, the harm reduction program and the support program for sex workers are also implemented in Gevgelija. Through development of social entrepreneurship we aim to provide financial support for our organization as well as opportunities for re-socialization and employment of people treated from drug addiction, alcohol or gambling. Our programs have left a permanent mark in the community. The system connection of the programs has led Izbor to strongly influence the local communities, and, with the support of the competent institutions, provide easier access to the services necessary for marginalized groups/communities. In Izbor we believe that self-financing, in addition to grants from the Municipality of Strumica and other donors will ensure the successful continuation of the programs.

The organization HOPS - Healthy Options Project Skopje actively advocates for financial support of harm reduction programs from the budget of Macedonian national and local institutions. HOPS implements harm reduction programs and services for drug users and sex workers. We have 3 centres and 4 outreach harm reduction teams, 1 re-socialization and rehabilitation centre for drug users and their families and 1 centre with 2 teams working with sex workers. HOPS closely collaborates with the City of Skopje, initiated the Macedonian Harm Reduction Network and the Local Drugs Coordinative Body, and is a member of several other national, regional and international networks. HOPS is the recipient of the 2010 International Award for Action on HIV/AIDS and Human Rights, awarded by the Canadian HIV/AIDS Legal Network and Human Rights Watch.

The organization Option was founded in 2003. It implements harm reduction programs for people who use drugs and sex workers in Ohrid and Struga. It is recognized as the first and only organization in Ohrid and Struga actively pursuing two specific target groups, with a focus on prevention and integration in society. We are happy to have gained the trust of the people who use our services, we remain consistent and dedicated to our goals, and succeed in maintaining professional working standards, discretion and anonymity.

The Centre for Development and Promotion of Public Life Tetovo (CDPPL Tetovo) was founded in 2004, while the Harm Reduction Program has been implemented since 2008. The Centre also offers other services through the Program for Support of Sex Workers (SW, voluntary, confidential HIV and Hepatitis counselling and testing, the Mobile Clinic for Sexual and Reproductive Health, DOT interventions in Macedonia – Tuberculosis and HIV/AIDS). In cooperation with the local self-government units, the Centre managed to develop and implement a local strategy and action plan for prevention of HIV, Hepatitis and Tuberculosis in Municipality Tetovo for 2008 – 2012, 2013 – 2016 and 2017 – 2020. The Centre aims to involve the citizens as active and informed actors in the creation, access and use of quality and efficient health, socio-economic and educational programs. We require services based on prevention, education, and economic development based on the principles of sustainability and respecting the standards for protection of nature and the environment.

The online version you can find it HERE.

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