An interview with Borche Bozhinov, Executive Director at STAR-STAR, the first sex worker collective in the Balkans
What improvements to the delivery of HIV care would you like to see for key populations living with HIV, in particular, sex workers?
There are many things which need to be improved and be included as part of HIV care programmes that we, as a sex worker community, would like to see, such as long-term maintenance of services related to sexual and reproductive health and HIV. Also, upgrading the services for male sex workers and placing a special emphasis on PrEP and PEP treatment that should be available for all sex workers in the future. There is also a need for conducting rapid HIV tests by community members – more precisely, there is a need for the counsellors and those who perform the test to be sex workers.
What improvements to the delivery of HIV prevention would you like to see for key populations, in particular, sex workers? What are some of the innovations around prevention that have made a difference?
We think it is very important for the sex work community to have equal access to health services that are provided by state healthcare institutions and not only from NGOs.
Regarding the HIV prevention programme, it was previously introduced in our country [Macedonia] thanks to the Global Fund. Now, it is partially funded by the Ministry of Health. This means it is necessary to expand the already existing services and provide new ones according to the needs of sex workers and the sub-groups of the community.
How important are peers in differentiated care models for key populations – especially for sex workers?
Peers are key in defining differentiated care models in order to help sex workers get the required services. Mostly because they are part of the community, they can give sex workers the support they need.
Can you tell us about a successful differentiated service delivery model for sex workers? What do you think the key components of successful programmes for sex workers are?
First, a successful service delivery model should be created according to the needs of sex workers and subgroups who are part of the sex work community. At the same time, previously trained people from the community should implement and monitor it in order to increase the number of services provided in the programme.
An example of a successfully implemented HIV prevention programme is the involvement of community members in creating important models, such as voluntary HIV testing and counselling. Members of the community were trained for pre- and post-counselling for HIV testing as well as training for gate keepers responsible for outreach activities that involve community mobilization, motivation and support, and their forwarding to appropriate healthcare institutions or service providers.
STAR-STAR, in collaboration with the Institute for Public Health, has conducted a training workshop for counsellors for HIV. We have six trained sex workers who received licenses by the Ministry of Health to give pretest and post-test counselling for HIV.
Can you tell us about how organizations, such as STAR-STAR, can help advocate for differentiated care?
STAR-STAR advocates for sex workers’ health rights through sensibilization of healthcare workers, researching sex workers’ needs and problems, documenting cases of the violation of health rights, etc.
Based on the research conducted on the needs of sex workers, STAR-STAR is currently establishing the first national health programme run by sex workers which had previously been functioning as a local programme for many years.
STAR-STAR is also part of a male health coalition, which aims to improve healthcare programmes for men who have sex with men. Our organization took part in the process of creating the national strategy for HIV and the local strategy for the city of Skopje. Our goal is to promote and upgrade the current activities in front of important decision-makers.
What do you want people to know about differentiated care in your region?
We would like people to know that the sex workers’ collective constantly advocates for the maintenance of services from HIV prevention programmes and, of course, we strive for expanding and upgrading the services in collaboration with other civic associations in order to provide easier and adequate access for sex workers to services from the non-governmental service providers as well as public health institutions.
