Chronic underfunding led to a drastic decision: the largest needle and syringe program operated by the NGO ARAS in Bucharest had to close down in February. Read this report from Alina Bocai, Programme Director at ARAS.
Currently, there is no central or local government funding earmarked for HIV prevention services for key populations including for people who inject drugs and no funding mechanism in place for non-governmental organisations in Romania.
As a consequence, ARAS – the main service provider in this field since 2001 with an annual coverage of around 3,500 people who use drugs – publicly announced in early February the closure of its mobile unit service (as of 31 December 2020) due to the lack of funds.
Despite existing evidence on an HIV concentrated epidemic among for people who inject drugs (PWID) in Bucharest, Romania, since the end of the Global Fund Programmes on HIV in 2010, very little resources were allocated to sustain HIV prevention services for PWID and no formal mechanism was developed for subcontracting the harm reduction services performed by civil society organizations.
Additionally, the drop-in centre for vulnerable populations run by the same organisation has also significantly reduced its harm reduction activities for the same reason.
The other service provider – Carusel – is still on the market reaching yet small numbers of drug users on an annual basis and currently facing a huge pressure from a higher number of clients. Also, syringes and needles are hardly accessible through the pharmacies’ network.
The closure of these services has been brought to the attention of central and local authorities, national media and political leaders. National authorities came out with the same excuses we have heard for 20 years, either by blaming the small national/local budget available for health/social services or by blaming the legislation that does not explicitly provide the responsibility of the state to fund such services or the lack of an appropriate funding mechanism.
Poor and sporadic funding has been allocated by the Social Department of the Municipality of Bucharest as well as by other districts’ municipalities of the capital city to NGOs but the funding was rather focused on social assistance instead of health, it reached very low number of people who use drugs (as the major requirement was to have a nominal reporting system of clients based on ID copies) and it did not cover the entire costs of the harm reduction package.
Central authorities such as the Ministry of Health, have never funded HIV prevention services for key populations (including people who inject drugs), but has always counted on external financial aid (e.g. the Global Fund for HIV and TB grants) and on NGOs as service providers in this field.
In the last 10 years, this resulted in variations in coverage, variations in the components of the service package and, finally, in many service delivery interruptions of the only two NGO service providers for people who inject drugs, namely ARAS and Carusel. The COVID-19 pandemic posed additional pressure on harm reduction services, leading to difficulties in running outreach activities and in establishing direct contacts with PWID and an increase in programme costs caused by the COVID-19 protection equipment.