Our report, based on the findings of research conducted among the clients of closed needle and syringe programs in Budapest and Belgrade, sheds light on the dire consequences of declining support for harm reduction in Central Eastern Europe.
We wrote several articles and produced videos about the decline of harm reduction and HIV prevention in our region, Central Eastern Europe. Several needle and syringe programs (NSP) closed down in recent years, due to the lack of financial and political support. In Budapest the two largest NSPs were shut down in 2014 because the local mayors accused them of attracting unwanted people (who use drugs) to their neighbourhoods. After the last program of the Global Fund ended, the only NSP operated by the NGO VEZA closed down in Belgrade in 2015. In a period when governments finally decided to end the global HIV epidemic once and for all by 2030, these are very disturbing trends. And it is not only about HIV and Hepatitis C. Thousands of injecting drug users remained without any kind of support; vulnerable and exposed to poverty and social exclusion.
We decided to conduct research, in co-operation with the Serbian NGO ReGeneracija, to follow up the clients of these closed programs to see how they are getting along: did they change their drug use patterns? Do they take extra risks? Where can they access sterile needles? Do they reach any social and health services? Do they attend testing and counselling? We used respondent driven sampling (RDS), a method that makes it possible to reach high-risk, hidden populations.
Click on the image to open the report, or click here.
Some of the lessons learnt from our research:
– Although the demographic characteristics of drug users were the same (mostly men in their mid-thirties, with low educational attainment, and poor labour market position), there were differences in drug use. Whilst in Belgrade most people still inject heroin, in Budapest mostly new psychoactive (cathinone-type) stimulants are injected.
– Access to sterile injecting equipment declined significantly in both cities. In Belgrade 78 percent of drug users bought their clean needles in pharmacies. In Budapest, where a few NSPs remained open, this figure was only 51 percent.
– The overwhelming majority of users share their equipment in both cities. The situation was more severe in Belgrade, where half of our sample practiced seven or more types of risky behaviour (compared to one quarter of the Budapest sample).
– Our research confirmed that injecting drug use is a community activity, shaped by the environment and by mediated drug-sharing practices amongst the same marginalised, criminalised groups. Any future interventions should consider these environmental, structural factors.
– In both cities, fewer people have access to HIV/HCV screening and counselling, vein-care products, and social services (eg. housing, employment). The closure of NSPs severely exacerbated the social isolation of their former clients: they reported significantly less access to “a place to sit for a while” or “speaking with social workers”.
The study was conducted by the Rights Reporter Foundation, in co-operation with the NGO ReGeneracija from Belgrade.
Authors: Robert Csák, Irena Molnar, Péter Sárosi, Jovana Arsenijević, Bojan Arsenijević
