Problem:

Despite the fact COVID-19 has preoccupied our lives for the past 2 years, we must not forget to live within, and outside of this bubble! This may mean continuing to live our lives, while having access to all possible safety options. Given the lack of any formal PrEP service in North Macedonia, the initiation of a PrEP pilot in our country was long overdue, with initial planning dating back to 2018. Although we were hoping for a much earlier start, Covid-19 happened and everything got delayed, especially since professional human resources and key partner institutions, such as the Clinic for Infectious Diseases were forced to shif their focus towards the new pandemic. Nevertheless, we gave it a try and gave it a push. And we can now proudly say that, while many will remember 2021 for the COVID-19 pandemic, we in the North Macedonia communities of gay and bi men, trans people and others, will also remember it for the introduction of the PrEP.

Solution:

Stronger Together, our community-based organization of people living with HIV, in partnership with the University Clinic for Infectious Diseases and Febrile conditions in Skopje, initiated a PrEP pilot in January 2021, using a window of opportunity when COVID-19 numbers had decreased substantially, as well as the enthusiasm of our committed partners from the Clinic’s side. In our pilot clients are offered a range of new services free of charge, as part of a comprehensive sexual health package. It contains HIV testing, STI testing, PrEP provision, medical follow-up, counselling and prevention resources – condoms and lube. To address the issue related to accessibility, care and support we have developed a strong network of supporters of the PrEP program, becoming a well-known entity among the community. We also organized a mobile PrEP service and managed to reach out to people in need outside of Skopje, the capital. The PrEP and sexual health service was designed and is being led almost exclusively by community members.

Results:

Despite the COVID-19 pandemic, the HIV prevention package in North Macedonia was finally supplemented by a PrEP service. The program is quite successful and well accepted within the community. Since the introduction of the pilot in the country, more than 70 clients have been provided with a complete sexual health follow-up – a tailored package of services which had not been readily available and accessible prior to the pilot and has now been introduced within the HIV Centre at the Clinic for Infectious Diseases. Moreover, it has helped us tackle other aspects of sexual health, such as for example an outbreak of syphilis within the community of gay and bisexual men and other MSM.