SCOPE: Study Trip from Stronger Together (North Macedonia) to GAT (Portugal)

My advocacy efforts on infectious diseases, especially HIV, and their influence on human rights and freedoms began in 2021, as part of the Facts and Norms Institute’s project “Understanding How Infectious Diseases Relate to Human Rights.” Currently, I am an Advocacy assistant in Stronger Together – Skopje, North Macedonia, an association for the support of people living with HIV. My tasks include registering violations of human rights of people living with HIV and providing primary legal support, as well as pushing for better health policies that may affect people living with HIV. In addition, I am a member of the Network for Protection from Discrimination, a network of civil society organisations working on human rights and discrimination. It was these experiences that led me to Lisbon, Portugal and my study trip visit to GAT – Portuguese Activist Group on Treatments, Portugal.

I chose GAT, at the advice of Stronger Together’s Executive Director, because of their considerable expertise on the subject of HIV and key affected groups, as well as their fruitful efforts in Portugal’s national response to HIV. Another reason was that UNAIDS commended Portugal’s national HIV response, in which GAT played a significant role.[1]

All of what I learnt on my trip can be combined in three words: community, adaptation, and practicality. From the receptionist to the executive bodies of the organization, the organization employs members of the community for whom it advocates. I feel that such inclusiveness, and even better, representation, is a critical component in the organization’s trusting connection with the key affected groups. The importance of representation inspired GAT to launch the campaign “Eu sou VIH+ e visível,” in which ten people living with HIV “show their faces,” openly assuming their health status, demonstrating diversity, and conveying the message that their health condition does not define them.[2] Although the social climate in North Macedonia is considerably different from that in Portugal in terms of HIV, it was truly inspirational to see how representation may have an impact in the fight against prejudices, and thus play an important part in HIV prevention. Another fascinating, subtle aspect of GAT’s HIV prevention efforts, and the highlight of my site visit, was the adaptability of their service centers. Why? Because each center is built, designed, and positioned to meet the needs of the key affected groups. GAT Intendente, for example, is a center established to provide services to people involved in sex work and transgender people. It is subtle and unobtrusive, providing a space where, for the first time, sex workers and transgender people can be unfettered and get the services they need. On the other hand, GAT in Mouraria, a harm reduction center focused at providing services to people using drugs, is painted with graffiti and located in a multicultural neighborhood of Lisbon. It is intense, fast-paced, and overwhelming at first. After the first two minutes of my visit, it turned into one of the most fascinating things I witnessed on my visit. The organization has designed each center to be a reflection of the groups for whom services are offered, not just to connect with them, but also to adapt each service so that clients feel at ease. By creating a place where clients may feel comfortable despite the fact that they are being tested for HIV or getting treatment, the organization made it easier to learn about your HIV status. It is that easiness and trust that makes key affected groups use the services of GAT and partake in the combat against HIV.

Ultimately, all of the services, in each and every center, are infused with practicality. The organization has created a triage questionnaire in order to better understand and determine the needs of each client. For example, because hepatitis C spreads predominantly through blood-to-blood contact associated with injection drug use, if a person does not use drugs, there is no reason to perform a hepatitis C test, unless the client asks for it.  In this manner, the employees at GAT would not subject the client to any additional tests or queries beyond those required or preferred. Thus, they would be utilizing human and time resources effectively, allowing them to give as many services as possible.

Keeping all of this in mind, these novel approaches, particularly the adaptability of services and the practicality of providing services, may prove to be very valuable as North Macedonia drafts a new HIV Strategy and aims to enhance its diagnostic efforts.

However, I was dismayed, but not shocked, to realize that HIV preconceptions and stigma are not limited to borders. Although the difficulties of prejudice, stigma, and discrimination differ greatly between North Macedonia and Portugal because of the social context, they share common foundations. People living with HIV in Portugal mostly face barriers in the workplace, the military, and private health insurance. In North Macedonia, however, people living with HIV frequently face stigma and discrimination from those who should be at the forefront of demystifying prejudices – medical professionals.[3] In Portugal, the disclosure of an HIV-status comes from a partner; in North Macedonia, it comes from medical professionals. Therefore, when it comes to HIV prevention, stigma and discrimination remain the most difficult obstacles to address and overcome, as they necessitate ongoing combat. However, it is a battle worth fighting, to achieve the goal set by the United Nations in 2015 – ending the AIDS epidemic by 2030. And it is a battle we are going to win.

[1] https://www.unaids.org/en/resources/presscentre/featurestories/2017/may/checkpointlx

[2] Campaign info and video available at: https://www.gatportugal.org/noticias/10-people-with-hiv-show-their-faces-in-an-unprecedented-campaign_183

[3] From 2009 to 2021, 20 of the 23 formally registered cases of discrimination and human rights violations by the Association involved health rights, with the violators being medical personnel.

When discussing HIV prevention, stigma and discrimination remain the most difficult obstacles to address and overcome, as they necessitate ongoing combat. However, it is a battle worth fighting and it is a battle we are going to win

Atanas Avramov

Advocacy Assistant – Stronger Together

EATG’s SCOPE project aims to strengthen the skills and knowledge of community health workers, advocates and researchers in the field of HIV combination prevention. It focuses on communities that are inadequately served by policies and programmes.

About the study trips

The SCOPE project provided two individual study trips for community health workers and advocates involved in HIV combination prevention service delivery in the WHO European region to carry out individual site visits to local community-based/led organisations.

Study trips provided the opportunity for community health workers and advocates in the area of HIV prevention to:

• Learn from peers about innovative, inclusive, and integrated HIV prevention services that can be adapted to their local setting
• Establish and/or strengthen partnerships with a host organisation(s).

The SCOPE project has been developed by the EATG and was made possible through a grant from ViiV Healthcare Europe Ltd.