Injecting drug users in Serbia face serious discrimination, in spite of apparent protection from the country's legal system, and its ambitions on the EU stage.
Back in the seventies, when diacetylmorphine, known as heroin, first shyly entered the Belgrade underground scene, it was a choice of drug reserved for an "elite" circle of famous musicians, artists, actors, and the children of politicians. The reason for its exclusivity in Serbia was not just its high price, but also issues of availability, and a restricted circle of users.
Later, in the nineties, Yugoslavs had to finance the civil war, while hyperinflation battered the newly-emergent states. This led to a reduction in prices and quality on the heroin market, and it became available to a much broader range of Serbian society. Today, it represents one of the leading public health issues in the country.
Along with the increased availability of heroin, user profiles have changed too: From being a drug used by the intellectual elite, heroin's status changed, and it became a substance penetrating into the lives of those on the margins of mainstream society. From the villas on Dedinje, and plush apartments in the city centre, it moved into run-down Roma settlements, bringing with it many intractable problems.
There is evidence for this, in data from an internal survey conducted in the first, and so far only, needle exchange program in Belgrade. According to the survey, half of all the program beneficiaries are positive for hepatitis C, while among those who are ethnic Roma, virus penetration has reached as high as 90 % . In addition, about 30-35 % of users are illiterate, 75 % unemployed, over 20 % of clients are engaged in commercial sex work and 80 % have a criminal record. More than 35 % of beneficiaries have no valid documents, and therefore no access to health insurance. All of this means that injecting drug users are vulnerable on several interlinked grounds, making them even more susceptible to discrimination at all levels.
Although the Serbian Republic adopted an anti-discrimination law in 2009, almost half of the survey respondents said that during visits to health facilities they are exposed to various forms of discrimination. Most often, this takes the form of verbal disparagement and labelling; medical personnel use excessive protection measures when dealing with them; their HIV and HCV status is highlighted on all health documents; when admitted to hospital, they are isolated from other patients; and in many cases, medical treatment is made conditional on detoxification and abstinence.
Serbia is the only country in the region that has not yet adopted a law on the Protection of Patient Rights, nor ratified the Treaty of Rome / European Charter of Patients' Rights. The Treaty of Rome regulates patients' rights, such as the right to preventive measures, the right of access to quality healthcare, freedom of choice, access to information, the right to confidentiality and privacy. The Law on Healthcare, enacted in 2005, created the post of Protector of Patient Rights in Medical Institutions. The function of the Protector is to file complaints and provide assistance to patients who have been denied their right to healthcare, or to patients who have a complaint relating to the health service or health workers. The problem is that citizens, especially drug users, are not aware of the rights they enjoy as patients. More than half of drug users do not know that in each health institution they can seek help from the Protector of Patient Rights. An even bigger problem is that Protectors are not independent, their authority is very limited, and they are also not appropriately trained for the task. They are appointed by the directors and are usually lawyers who have worked for years as heads of legal departments in the same institution, raising doubts as to their real independence. There is no job description for the Protector of Patient Rights, they can be summarily dismissed, and they are not paid for their work. A lack of communication between Protectors and the Serbian Ministry of Health makes the situation even more complex.
Discrimination in healthcare is not the only form of discrimination that drug users face on a daily basis. According to the survey cited above, nearly half of respondents said that during the week preceding the survey they had on at least one occasion been pulled up by law enforcement officers; during a quarter of these encounters, they were exposed to some kind of violence, physical or verbal (95 percent of respondents reported verbal violence – verbal humiliation, belittling, cursing, insulting family, insults based on ethnicity; while 85 percent reported that they were subjected to physical violence – forced to disrobe in public places, slapping, kicking, even some torture in police stations – bag suffocation, beating with truncheons on the soles, use of electric prods, sitting on their back, handcuffing while squatting or hanging, and even pressing testicles in a drawer).
An Anti-discrimination Law, enacted in 2009, lays down the procedure for the election of an Equality Commissioner. The Commissioner has a duty to receive and consider complaints on violations of this law, and give opinions and recommendations in specific cases to the complainant; s/he must provide complainants with information on their rights, file accusations on violations of this law, and file misdemeanor charges for violation of rights under the law. The Commissioner must publicise the most common, typical and severe cases of discrimination, and monitor implementation of the relevant laws and regulations designed to provide protection from discrimination. Despite all of this, four-fifths of surveyed drug users never contacted anyone for help despite experiencing severe violence or discrimination. This is not only due to a lack of information on the existence of institutions that could provide them with assistance, but also due to the belief that no one will help them. This belief would seem to be well-grounded: When NGOs or the media have referred complaints Internal Affairs at the Interior Ministry, in most cases the complainants were discredited by police as drug users who are not to be trusted.
Most of those surveyed (82.5 %) had convictions – and for a drug user coming out of prison, a job is almost impossible to find. After release, they easily return to known patterns of behavior, criminal activity, and drug use, in a vicious circle from which they see no escape.
Finally, the question arises, as to whether a state which aspires to join the European Union is making sufficient efforts to combat discrimination against the most vulnerable groups, and provide the constitutionally guaranteed equal human rights for all citizens?
Bojan Arsenijevic, Re Generation, Serbia