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

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% )

HIV Transmission MSM 147 Hetero 137 unknown 7 MTCT 6 IDU 12 Hemophilic

In 2016: 40 new cases 184 are on ART Age distribution Under 13 years: 102 30-39 years: 123 40-49 years: 47 50-59 years: 23 60 or older: 8

Services for people living with HIV Pre/post test counselling Psychological support Community support

Youth friendly services 2014 2015 2016 “I Want To Know – Vodno” 764 757 919 Youth Centre “I Want To Know – Šuto Orizari” 1229 1379 1473

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

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 institutions

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

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

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