In 2023, Slovakia finally removed the abstinence rules and health insurance debt barriers that had kept thousands of people who use drugs from accessing hepatitis C treatment. In this interview, Dominika Jasekova from the NGO Odyseus explains how the reform changed their work on the ground, what obstacles remain, and why the resilience of their clients continues to drive them forward.
Drugreporter: Could you describe how the situation regarding hepatitis C treatment looked in Slovakia before and after the 2023 law changed?
Dominika Jasekova: Before the 2023 legislative change, access to hepatitis C treatment in Slovakia was highly restricted. People who used drugs had to prove one year of abstinence, documented at three-month intervals, and treatment was denied to anyone with health insurance debt—because treatment for infections was not considered urgent or emergency care. These requirements created significant barriers for marginalized groups.
After the law changed in 2023, these restrictions were removed. Treatment for infections was added to the list of urgent care services, meaning that people with health insurance debts can now access it. Since June 2023, abstinence is no longer a prerequisite. This reform allowed harm reduction organisations like ours to actively link clients to care and initiate treatment without bureaucratic delays.
One of the main barriers to HCV treatment used to be health insurance debt. Can you explain how the Slovak health insurance system works, and why so many people who use drugs end up with large debts?
Slovakia operates a mandatory health insurance system. Contributions are shared between employers and employees, while the state pays for inactive populations (children, pensioners, and unemployed people who are registered with the unemployment office, regularly attending appointments, actively seeking job opportunities, and able to prove it).
However, people who use drugs often work informally/illegally or are unemployed but not registered at the unemployment office, meaning they must pay contributions themselves. If they fail to do so, debts accumulate quickly. Until 2023, these debts excluded them from accessing treatment for infections. This disproportionately affected people experiencing homelessness or unstable income, creating a systemic barrier to care.
Many people owe tens of thousands of euros in health insurance debt. With such debts, they previously had access only to emergency healthcare.
Do you have any personal stories or examples that illustrate how these barriers impacted people’s lives?
Before the legislative change in 2023, many clients were not motivated to address their health needs because systemic barriers—such as unpaid health insurance debts—made treatment inaccessible. After the law changed, we saw a significant shift: many people expressed interest in treatment for infections such as hepatitis or syphilis. For several clients, successfully completing treatment became a powerful motivator to make other positive changes in their lives, such as addressing debts, seeking employment, reducing substance use, or starting individual case work with our social workers. This shows how removing structural barriers can have a ripple effect, improving not only health outcomes but overall quality of life.
What advocacy has Odyseus and other civil society organisations done to improve the conditions of hepatitis C treatment in Slovakia?
Odyseus, together with other NGOs and patient organisations, has consistently advocated for removing discriminatory barriers such as abstinence requirements and health insurance debt restrictions. One major step was a letter sent to the ombudsman that highlighted discriminatory practices regarding access to HCV treatment—this effort was led by another organisation.
On an individual level, continuous advocacy is needed in healthcare settings, especially in specialist practices, to improve access for our clients. This work must be done regularly.
Even with the new law, the path to treatment remains bureaucratic. What are the main obstacles now?
The process from the first appointment to treatment approval remains too long. Treatment is still limited by several practical obstacles. Specialist availability remains low, as hepatitis C care can only be provided by hepatologists or infectologists. There are also hidden costs: procedures like transient elastography (€35) or penicillin for syphilis (€40) are not fully covered, creating financial barriers for clients. In addition, every hepatitis C treatment must be individually approved by the health insurance company. After a positive confirmatory PCR test, the doctor has to submit a formal application on behalf of the patient, and this approval process can take up to 30 days, causing significant delays.
These obstacles slow down linkage to care and require NGOs to provide additional support and funding.
How receptive are healthcare professionals—hepatologists, infectologists, general practitioners—to working with people who use drugs?
Attitudes vary. Some professionals remain stigmatizing, making discriminatory comments or refusing care. However, those we collaborate with are generally supportive. Regular communication and informal education by our team help reduce stigma and build trust. Still, systemic stigma persists in broader healthcare settings.
You participated in the CORE EU project and used CORE resources to strengthen cooperation between harm reduction services and medical specialists. Could you elaborate on how these resources were helpful in practice?
CORE resources provided practical tools and training that significantly improved our internal capacity and competence regarding testing and linkage services. Before the CORE project, our organisation had never implemented a large project specifically focused on testing and linkage to healthcare, so this was not a primary area of work for us.
Thanks to CORE’s resources and the three-year duration of the project, we were able to allocate dedicated time and funding to improve these services. This included building and formalising cooperation with specialists such as infectious disease physicians and hepatologists. CORE allowed us to establish structured referral pathways, maintain regular communication with healthcare providers, and ensure that clients with reactive results could access timely diagnosis and treatment. Without this support, such collaboration would have been extremely difficult.
And on a more personal note: what motivates you to keep going despite the systemic obstacles and slow progress?
What keeps me going is every single client who successfully completes treatment despite all the barriers that still exist. I deeply admire each of them—people living in tents, on the streets, without a phone, and often with other health problems—who manage to show up early in the morning for a doctor’s appointment. Their resilience is inspiring.
I also see a big shift in collaboration with doctors since 2023, and that motivates me too. We now have more healthcare professionals willing to cooperate, processes are better organised, and the doctors themselves are friendlier and more supportive. These changes give me hope and energy to continue.
This interview was produced in the CORE – COmmunity Response to End Inequalities EU project framework. CORE is a 36-month EU Action Grant from January 1st, 2023, to December 31st, 2025, involving 24 partners from 16 EU Member States. The project seeks to reduce inequalities in the responses to HIV, TB, and viral hepatitis by promoting, strengthening, and integrating community responses that have proven essential in reaching communities traditionally underserved by mainstream prevention and healthcare services. Funded by the EU4Health Programme, this project is particularly crucial in countries where these responses remain inadequate compared to the EU average.
Interview by Peter Sarosi
