Unlike in Russia or the Ukraine, where HIV epidemics have been largely driven by policies which put pressure on injecting drug users to share injecting equipment, HIV had been virtually non-existent among Hungarian injecting drug users over the past two decades. This situation is now starting to change, and Hungary may follow the example of Greece and Romania, where we have seen major outbreaks of HIV among drug users in recent years. A number of new injection-related HIV transmissions have been registered this year. We have good reason to suppose that a major HIV epidemic is inevitable, if the government doesn't take immediate action to scale up harm reduction programs. Unfortunately there is no political will and leadership to do so. On the contrary: The largest needle and syringe provider has announced that it will soon shut down, because of its desperate financial situation, and political attacks orchestrated by the local mayor.
This needle and syringe program has been operated by the “Blue Point” NGO in the 8th district of Budapest since 2006. This neighboorhood has the most concentrated drug user population in the country - the majority of them unemployed, homeless and facing systematic discrimination as members of the Roma community. Injecting drug use is on the rise, with the number of Blue Point’s client contacts increasing by 80 percent during 2011 alone. The program serves almost 3000 clients, and provides almost 40% of all the sterile needles distributed among drug users in Hungary. Prevalence of hepatitis C was already very high (more than 70%) among their clients. HepC, dubbed the “silent killer” by epidemiologists, is not as interesting for the public as HIV (even if it is equally dangerous) so it has been overlooked by decision-makers. A dangerous, potentially explosive combination of changes in the drug market and bad political decisions, has provided fertile ground for an HIV epidemic.
Drugreporter has been warning the government and the public for several years about the danger of blood-born infections. From 2009 onwards, we witnessed an unprecedented rise in injecting use of legal highs (mephedrone-like substances) among marginalised drug users in Budapest. These new psychoactive substances are injected much more frequently than opiates - as often as 10-15 times a day. This has led to a growing demand for sterile syringes and needles. Unfortunately, this growing demand has been met by an inadequate supply. Despite a brief period of scaling up in the early 2000s, the availability and accessibility of harm reduction services has remained very low, and during the first term of the Orban government the situation deteriorated in many ways.
While the United States and many other countries are contemplating drug policy reform, Hungary has declared a new war on drugs. The Criminal Code was amended last July, to provide for increased punishments for the simple possession of illicit drugs. The new national anti-drug strategy, adopted last year, subordinates harm reduction to abstinence-only treatment options, and aims to create a drug-free Hungary by 2020 (it is rumoured that it was the prime minister himself who insisted on the inclusion of this unrealistic goal).
Due to dramatic budget cuts in 2012, Blue Point, like other needle exchange programs, had to dismiss staff members and reduce opening hours and needle provision. In addition, the local mayor and his team accused the program of “attracting drug users to the district”, and blamed them for drug litter on the streets. The contract between the NGO and the district council was terminated in November 2013, and they were excluded from the local drug coordination committee. In January, local politicians organised a street protest to shut down the program.
Blue Point announced in June that, due to the hostile political climate and lack of financial resources, they would have to close down the program in September, unless the national government provided them an emergency grant. The Ministry of Human Resources rejected their appeal, saying that they have no extrabudgetary funds for needle exchange. NGOs are unimpressed by the “no money” argument. They point out that last year the government gave 13 million Forints (55,000 USD) to the mayor of the 8th district to fight drug litter on the streets – so why is it impossible to raise the same amount for needle exchange? Not to mention the billions of forints the government spends on arresting and prosecuting drug users every year.
Blue Point argues that the annual budget required to operate its needle exchange program at the current level is approximately 135,000 USD. Medical treatment for a single hepatitis-C or HIV patient can cost thousands of dollars a year, not to mention the loss of health and lives – so if needle exhange prevents only a few cases, it has already covered its costs. If the government fails to see that harm reduction is a good investment for the whole of society, it is taxpayers who will have to pay the price.
The closure of Blue Point’s needle and syringe program may have serious consequences for other service providers as well: These smaller programs will be unable to cope with thousands of new clients coming from the 8th district, so the whole system is liable to collapse. The only thing that will gain from such political short-sightedness, is the HIV epidemic.