Montenegro

HIV/AIDS

Eight at risk groups have been identified and targeted by the programme and outreach efforts are conducted by 11 implementing partners:

1.  Sex workers (SW)

The extent of sex work in Montenegro is still unclear. Street level prostitution does not exist, nor do brothels. SWs generally operate out of bars and night clubs. Geographically, prostitution is concentrated in the capital, Podgorica. Coastal communities see a substantial influx of SWs during the summer tourism season and prostitution can be found in most, if not all, municipalities in all parts of the country year round.

Prostitution is illegal in Montenegro. However, unlike other countries, where purchasing sexual services is outlawed, Montenegrin law criminalizes the selling of sexual services. This makes outreach efforts aimed at SWs more difficult because they are more reluctant to identify themselves. 

A total of 222 SWs were reached directly as of July 2008. During their field work outreach workers discovered that approximately 10% of SWs are male. Condoms are continually distributed free of charge to SWs and all are offered counseling and directed to health clinics, should they want to be tested for HIV and other sexually transmitted infections (STIs).

Most SWs are doubly at risk of contracting HIV because a significant percentage of them are injecting drug users (IDUs). When field workers realized this they added a needle exchange program to their condom distribution service.

2. Injecting drug users (IDUs)

Harm reduction efforts have centred on opening needle exchange programmes in municipalities. Fourteen needle exchanges points have been established across the country and the effort continues to make it possible for IDUs to exchange needles closer to where they live in order to avoid the sharing of dirty needles. The Podgorica needle exchange within the Primary Health Care Center serves 60 – 70 clients per month. Outreach activities covered more than 250 IDUs. All needle exchange clients are urged to submit to testing and offered counseling and treatment. They are also provided with condoms and education leaflets.

As of January 2009 there were approximately 50 opiate addicts undergoing methadone substitution treatment under the supervision of the Primary Health Care Center in Podgorica. There is still resistance in Montenegrin society, including the mental health profession, to harm reduction and replacement treatment efforts.

3.  Men who have sex with men (MSM)

This group faces considerable stigma and discrimination in a very conservative society. There is no openly gay scene within the country, although many homosexual men from Montenegro use gay facilities in Serbia. Because of this fact, most direct contact with this at risk group has been online. So far 98 people identifying themselves as men who have sex with men have had face to face contact with outreach workers. In 2007, six of nine newly reported cases of HIV in Montenegro have been from this targeted at risk group.

Homosexual activities have not been a criminal offense in Montenegro since 1974. The fact that the republic signed a UN declaration of human rights for people with different sexual orientation is seen as a very positive step forward in the effort to destigmatize gays, lesbians, bisexual and transgendered individuals. It is hoped that legislation specifically banning discrimination against people with different sexual orientations will be considered, debated, drafted, passed and implemented in the future. The Constitution that was passed in 2007 does not specifically state that discrimination based on sexual orientation is illegal.

4. Sailors

There are an estimated 4500 Montenegrin men working as merchant marine sailors. Many are employed by foreign shipping companies and spend long periods away from home. Merchant marine sailors account for 15% of reported HIV cases in Montenegro and if you add their partners the number increases to 24%. Direct outreach efforts to educate sailors and offer them counseling and testing services have reached approximately 3000 sailors since the inception of the programme.

5. Prisoners

There are around 600 prisoners in Montenegro’s two main prisons at any given time. Although officials claim that illicit drug use within penal institutions has been completely eliminated, it is believed that approximately 20% of prisoners are using illegal drugs. Since the programme’s inception approximately 1000 prisoners have been educated and offered counseling and testing services.

6. Roma youth

Montenegro’s Poverty Reduction Strategy Paper (PRSP) estimated that there were 20,000 Roma people living in Montenegro, of whom 5000 were refugees from Kosovo and that they were disproportionately poor. It is widely accepted that Roma start engaging in sexual activities and marry at an earlier age than other segments of Montenegrin society. Thus the programme has targeted Roma youth. Since the programme’s inception close to 3500 Roma youth have been directly educated. There are no known cases of HIV in those communities.
  

7. Workers in the tourism industry

An estimated 1,000,000 tourists visit Montenegro each year. The tourism industry has boomed in recent years creating many low paying jobs, mostly for young people. Tourists are often seeking adventure in any and all forms, including sexual. Tourism industry workers have a much higher exposure to social interaction than workers in most other fields. Approximately 500 tourism industry workers have attended education sessions and almost 2500 have been counseled and/or tested since the programme began.

8. Young people

There are an estimated 200,000 young people in Montenegro. Prevention activities include young people in general. The biggest success since the programme’s inception has been the design and implementation of ‘healthy lifestyles’ course for primary schools. The pilot course, which included a section on HIV, other STIs and safe sex practices, reached 2700 students. The pilot was universally hailed as a success and will be part of the curriculum of all Montenegrin elementary schools in the 2009 – 2010 school year. The course is unique in Montenegro for two reasons: education professionals were not solely responsible for its design (physicians, psychologists, sociologists and other professionals were all instrumental in the effort); and it is the first time in Montenegro that preventative measures health planning has been institutionalized within the education sector.

Unfortunately, there is currently no room within the compulsory curriculum for the course and it will only be offered as an option. However, the whole primary and secondary education system is currently undergoing an ongoing review and there is hope that the course could, one day, become compulsory.

The programme’s implementing partners have reached some 16,000 secondary school students with non-curriculum, peer outreach programmes and a web site aimed at youth has had 4000 + unique visits.

There are eight VCT (voluntary counseling and testing on HIV) facilities in the country, so no one has to travel far to be tested. Testing is free and confidential and 1070 people have been tested.

Treatment is also free, including drugs that can be prohibitively expensive for victims in other countries. It is rare that a patient has to be sent to Belgrade for treatment options that are not available in Montenegro but when it does happen those expenses are also covered for the patient by the National Health Insurance Fund.

A total of 788 health professionals and 249 other professionals and NGO staff have received training in different areas related to HIV/AIDS over the course of the programme.

Fourteen implementing partners have been engaged in the coordinated response to HIV/AIDS at the national level.

The government continues to understand the importance of these efforts. A location for a new centre for the combat of infectious diseases is being scouted.