However, public health and Roma policies have so far not sufficiently taken into account the vulnerability of members of Roma communities to HIV/AIDS and tuberculosis. The Global Fund offers countries the opportunity to respond quickly and flexibly to the negative consequences of the HIV/AIDS and tuberculosis epidemics.
Involving Roma civil society in Global Fund processes and projects
Support the development of Roma NGOs and networks to increase their capacity to address health issues. Help keep Roma civil society informed about opportunities for involvement in the development and implementation of GFATM and other donor-funded projects;
Improving Global Fund impact on Roma health
Ensure that the most vulnerable groups among Roma communities are specifically targeted through outreach activities and reached by HIV and TB services. Encourage the most vulnerable members of Roma communities to take advantage of available HIV and TB services. Although the HIV/AIDS and tuberculosis epidemics can affect anyone, members of vulnerable communities are usually among the most affected and least protected.
The second aim is to assess how effective the Global Fund has been in reducing the risk of HIV/AIDS and TB in the targeted Roma communities in these four countries.
Assessment Methodology and Report Structure
General Health Indicators
In Serbia, the limited data collected on the Roma population show that the health status of the Roma is much worse than the health status of the general population.10 The causes of this situation are closely related to poverty and exclusion: the unemployment rate among the Roma. it is four times higher than the average in Serbia; 32.5 percent of Roma are uneducated or have less than four years of schooling.11 Furthermore, poor living conditions and discrimination in access to health care services have an additional negative impact on Roma health.
Vulnerability to HIV/AIDS and TB
In Romania, knowledge about contraception is relatively low among Roma compared to the general population. Less than 50 percent of Roma respondents in one survey knew at least one method of contraception, compared to over 99 percent of the total number of respondents.17 Only about 25 percent of Roma respondents stated that they used one of the known methods of contraception. contraception at least once, compared to 48.2 percent of women and 51.3 percent of men overall.18 This suggests that certain groups from the Roma community are at risk for sexual transmission of HIV, such as sex workers and MSM, may have a higher risk of HIV infection than at-risk groups from the general population. There is no specific official information in Serbia about the incidence of HIV/AIDS and TB infection among Roma.
Yet the conditions of deprivation faced by the country's Roma population indicate an increased risk of TB and HIV infection among particularly vulnerable groups, including refugees living in slums, homeless people, street children, sex workers and drug users.
Only the National Action Plan of the Roma Decade for Health specifically mentions TB, HIV/AIDS and sexually transmitted infections (STIs). However, the Draft Strategy for Roma Integration and the National Action Plan of the Roma Decade for Health do not mention TB or HIV/AIDS explicitly. State policies have so far not paid enough attention to the vulnerability of particular members of Roma communities to HIV/AIDS and TB.
The Global Fund has provided significant funding to fight HIV/AIDS and TB in the four target countries.
Global Fund Architecture
The Global Fund offers countries the opportunity to respond quickly and flexibly to the negative consequences of HIV/AIDS and tuberculosis. However, the results of this assessment show that, with some exceptions, relevant national governance structures do not always have sufficient representation of civil society, and in particular Roma. Our assessment shows that this is due to two key factors: the lack of transparency and accessibility of GFATM processes in the countries for Roma organizations and the sometimes limited capacity of Roma organizations to be involved or take a more active role. to play.
The Global Fund collects proposals through funding “rounds”. There is usually one round of funding per year, depending on available resources.
Type and Level of Funding in Target Countries
These funding levels place the Global Fund ahead of all other donors in the region for HIV/AIDS and TB. For example, in Bulgaria, various stakeholders interviewed for this report said that the GFATM HIV/AIDS project brought significant benefits to many small NGOs operating only with GFATM funds, but had a negative impact on NGOs with capacity greater and good international experience and image. This impact occurred because some international donors stopped their support for Bulgaria once GFATM grants entered the country and left some NGOs entirely dependent on GFATM funding through the Ministry of Health, the main recipient of GFATM funds.
Country Level Governance and Project Implementation
Since then, some members of the CCM have changed due to political developments in the country. In Round 3, NGOs that actively participated in the proposal preparation process became sub-recipients; thus, they were pre-selected by the CCM to participate in the implementation of the award. Despite the inclusive nature of the Romanian CCM, Roma organizations are not represented in the CCM or in the executive committee.
Each grant component has staff responsible for the overall design and management of the projects included in the component.
The Benefits of Roma Civil Society Involvement in Project Implementation
No Roma NGO was a sub-recipient or sub-recipient in any round of GFATM grants in Serbia, although some Roma organizations and individuals were informally involved in the work of other sub-recipients.
Barriers to Roma Civil Society Involvement
In Bulgaria, for example, some of the most vulnerable groups in Roma communities have not been reached, despite the involvement of Roma NGOs in implementation. Another barrier to inclusion is the widespread misunderstanding that Roma NGOs can only apply or participate in projects that are directly aimed at Roma communities. The main recipients explained that Roma NGOs were not involved in the implementation of projects aimed at vulnerable groups, such as injecting drug users and sex workers, where some of the clients are also Roma, because they were not interested in doing so.
The lack of information about the Global Fund and transparency of CCM processes in the four countries also present barriers to Roma involvement.
The Need to Increase Participation and Representation
In all countries, many of the Roma civil society representatives interviewed did not have a clear understanding of what the CCM is and does. Many of these representatives indicate that they only became aware of the GFATM projects during the implementation, without having had any opportunity to provide input in advance. The Roma components of the GFATM grants have had a positive impact by increasing access to information and services on HIV/AIDS and tuberculosis in Roma communities at large.
However, this assessment of GFATM grants suggests that the needs of certain groups among the Roma who are at greater risk of contracting HIV/AIDS and TB infection, such as sex workers and drug users, are not always being addressed.
Proposed Project Activities
Trained members from the Roma community will be engaged in 28 regional teams to work among the Roma population and provide such services. In Romania, one of the objectives of the second round of the TB project was to "improve TB control in children and high-risk groups, such as people infected with HIV, prisoners and Roma". The project proposed the development of a strategy for TB control in Roma communities based on the national TB program and the recommendations of EU experts. In the second phase of the third TB grant round (years three to five), CCM and PR have placed the greatest emphasis on TB prevention, care and treatment in the Roma population.
The proposed activities are based on lessons learned and experience so far in dealing with health issues among the Roma population. 40.
Addressing the Higher Vulnerability of Roma to HIV/AIDS and TB
This explains the high marks that many respondents polled to the way in which needs were assessed and the results of the assessment, which reflect the reality of Roma. A significant problem noted in all countries is that the Roma-specific components of the GFATM projects target the whole community, rather than those of its most at-risk members, as is the case for the majority population. In most of the countries, target communities are poorly defined, and as a result the most vulnerable members of the Roma communities are not always reached.
In Bulgaria, for example, results from national surveillance conducted among different groups44 showed that HIV prevalence in Roma communities in 2005 was zero,45 indicating that those most at risk are likely to live outside their communities and thus be abandoned. outside the scope of the project.
Strengthening Coordination to Improve Roma Health
A More Comprehensive Approach for Greater Impact
Ministry of Health of the Republic of Bulgaria, Health strategy for persons in vulnerable positions belonging to ethnic minorities. Sorin Cace and Cristian Vladescu, Health Status of the Roma Population and Access to Health Services (Bucharest: Expert Publishing House, 2004). Interview with Anton Karagiozov, chairman of the Foundation for Regional Development in Plovdiv, Sofia, Bulgaria, February 2, 2007.
Interviews with representatives of the subrecipient organizations in the Bulgarian cities of Plovdiv, Pazardjik, Varna, Sliven, Sofia, Stara Zagora and Burgas, as well as with project managers, January 2007.
Public Health Program
Open Society Institute
This report was published by the Open Society Institute as part of its efforts to conduct research and analysis in support of the Decade of Roma Inclusion. The Decade of Roma Inclusion, launched in February 2005 and endorsed by nine Central and Eastern European countries, is also supported by the European Commission, the Council of Europe, the Council of Europe Development Bank and the United Nations Development Program . The decade is driven by a commitment to shared values of social inclusion, anti-discrimination, equal opportunity and the abolition of segregation.
Central to the decade's values and vision is a commitment to embrace innovative approaches, foster international cooperation and advance transparency.