At the national harm reduction conference in Budapest, presenters from Greece, Romania and Hungary reported that there are similar problems and challenges in relation to injecting drug use in Southern-Central Europe, but there are huge differences between government responses. Lack of political leadership is leading to growing HIV and hepatitis C infections among drug users all over the region.
In Budapest, on December 16, at the national harm reduction conference organised by the HCLU, a number of service providers, activists, law enforcement professionals, and researchers gathered to discuss the key challenges lying ahead for harm reduction.
The opening speech pointed out that there is a global funding crisis within harm reduction: the UN estimates that 2.3 billion USD are needed to fund HIV prevention programs among injecting drug users, but only 160 million USD are actually being spent. International donors are retreating from middle-income countries, where most IDUs live, and national governments are not providing adequate funding for harm reduction programs. The consequences are obvious: life-saving services are being shut down, access to existing services is restricted, and the risk of blood-born infections is growing.
In Hungary – an EU member state that is not eligible to receive Global Fund money – lack of political and financial support led to the closure of the largest needle and syringe program, and other NSPs are in danger too. This happened in a neighbourhood where eight out of ten IDUs are living with the hepatitis C virus, and new HIV transmissions have been reported as well.
While Hungarian government regulations require NSPs to employ at least 3 full-time and 1 part-time professionals, the annual core grant (appr. 25.000 USD) for these programs is not even enough to pay the salaries of these employees, not to mention growing overhead and equipment costs. Therefore NGOs submitted a proposal for a new progressive funding mechanism for harm reduction programs – suggesting an increase in the core grant, to 50.000 USD, and provision of additional funds for supplementary services, such as drop-in, as well as for supply of good-quality needles and syringes.
Unfortunately, there has so far been no response from the government to our proposal.
We invited Imre Nyitrai, Deputy Secretary at the Ministry of Human Resources, who is in charge of the national drug coordination in Hungary. He promised to give a short presentation about the government’s position and plans. Unfortunately he cancelled his attendance at the last minute, without sending a substitute presenter. This was unfortunate, but not unexpected: the current government has a very bad relationship with civil society (except faith-based organisations) and has failed to protect the needle and syirnge programs from political attacks.
One of the key issues discussed at the conference was the difference between the outdated idea of needle exchange (providing clean needles in exchange for used needles) and the new concept of needle and syringe programs (unlimited access to clean needles). One of our international speakers, Fabienne Hariga from the UN Office on Drugs and Crime, explained that the comprehensive package includes unlimited access to sterile injecting equipment, and that restricting access is not the way to reduce drug litter on the streets, contrary to what many politicians claim in Hungary. Ms Hariga also emphasised the need to build a supportive legal environment, and pointed out that international drug conventions do not require the criminalisation of drug users.
Marianela Kloka from Praksis, an NGO providing harm reduction services for homeless drug users in Athens, explained how NGOs and the government responded to the outbreak of HIV among IDUs there. The financial crisis had devastating consequences on the health and social wellbeing of young people in Greece – one of those consequences being an increase in the injecting use of heroin. Low access to needle and syringe programs, and long waiting lists for opiate substitution, have led to hundreds of new HIV transmissions among IDUs, in a country where the prevalence of infections had previously been low.
Greece is not only a good example of what happens when govenments neglect their duty to provide adequate services for drug users; it also shows us how significant changes in the partnership between government and civil society can impact on a desperate situation. After the outbreak of HIV in 2011, the government, with the involvement of international organisations, built a coalition to fight the epidemic. Coordinated action and targeted investment resulted in a reduction in OST waiting lists and an increase in the number of clean needles distributed among IDUs, as well as the opening of the first drug consumption room, funded by EU structural funds. The rate of new HIV infections is now decreasing in Greece – even though the situation is far from ideal, especially after recent changes in the leadership of the government drug agency, OKANA. The lesson to be learned from all this, is that politicial leadership is key to achieving sustainable change.
Our speaker from Romania, Valentin Simionov (from the Romanian Harm Reduction Network) pointed out that a lack of funding led to a dramatic decline in access to clean needles in 2010. This was followed by the outbreak of a devastating HIV epidemic in 2011-2012. Despite the efforts of NGOs (watch our video!) the government failed to make the strategic interventions required to prevent blood-borne infections among IDUs. With no leadership and no funding, the HIV epidemic is destined to grow further.
Text: Peter Sarosi
Videos: Istvan Gabor Takacs
