Serbia

Unless otherwise referenced, data included in the following overview has been taken from EHRN country profiles and case studies, all of which are available from the Knowledge hub

Overview

The Republic of Serbia (Serbia) is a non-European Union State in the central part of the Balkan Peninsula in Central Southeastern Europe.

The estimated number of people who inject drugs (PWID) in Serbia is 20,000. There are no PWID community-driven initiative groups or PWID organizations in Serbia.

Drug use in Serbia is criminalized. According to the Criminal Code, a person who possesses a small amount of drugs for personal use can be sentenced for up to three years of imprisonment.

The end of Global Fund support and the unsolved service sustainability issue led to a significant deterioration of harm reduction programs in Serbia. There was no transition plan for the Global Fund’s withdrawal and no institutional framework for coordinating the transition to domestic financing for HIV and AIDS in Serbia.

Currently there are no alternative mechanisms to ensure sustainable funding for NGOs harm reduction programs in Serbia. Local harm reduction groups have recently come together under the Serbian Coalition of Harm Reduction Organizations to coordinate their fundraising efforts.

Drug Use and Infectious Diseases

According to the national census conducted in 2011, the total population of the country is 7,186,862.

In 2013 the estimated number of people who inject drugs (PWID) in Serbia was 20,000 (with a range between 10,000 and 25,000), or approximately 0.4% of the total population aged 15–64 years. This is a smaller number than a previous estimate had indicated in 2011: 30,383 PWID, or 0.7% of the population aged 15–59.

The total number of HIV cases registered in Serbia up until 2014 was relatively low (see Table 1). Based on cross-sectional bio-behavioral surveys conducted in three cities — Belgrade, Nis and Novi Sad — HIV prevalence among PWID is also relatively low. Moreover, the results of surveys done in 2008, 2010, 2012, and 2013 suggest that HIV prevalence among PWID is decreasing. For example, in Belgrade it was 4.7% in 2008, 2.4% in 2010, and 1.7% in 2012 and 2013. Among PWID surveyed in Nis it was 1.6% in 2008, 4.5% in 2012, and 1% in 2013, and among PWID in Novi Sad it was between 0 and 0.3%. However, hepatitis C prevalence is relatively high, which indirectly indicates that risky behavior among PWID (e.g. sharing injecting equipment) is still common.

Table 1. Epidemiological data 

Indicator

Data

Year of estimate

Total number of HIV cases registered in the country

 

3175

1987–2014

HIV prevalence among adults (15–49 years old)

0.1%

2013

Cases of HIV transmission due to injecting drug use

971

(30.58% of all HIV cases)

1987–2014

HIV prevalence among PWID

Belgrade: 1.5%

Nis: 1%

Novi Sad: close to 0%

2013

Hepatitis C prevalence among PWID

Belgrade: 61%

Nis: 54.7%

Novi Sad: 50.2%

2014

Hepatitis B prevalence among PWID

Belgrade: 5%

2014

Policies

Drug use in Serbia is criminalized. According to the Criminal Code, a person who possesses a small amount of drugs for personal use can be sentenced for up to three years of imprisonment. At the same time, possession of a small amount of illegal drugs is not legally defined. Illegal drug use is not allowed in any location. The legislation covers all illegal drugs, and penalties are the same for all substances.

Harm reduction policies in Serbia are going through a period of indifference and neglect. Since international funding has finished and the epidemiological data are not threatening, the government and decision-makers are showing no interest in the topics of HIV and drug use. Drug use is considered a medical problem covered by existing medical services and health insurance. 

In December 2014, Serbia adopted the National Drug Strategy for 2014–2021 and an action plan for its implementation. This strategy sets national policy in the field of preventing and countering illicit drugs, and, as such, is a key national instrument in this area. It refers to UNODC and takes into account a study on drug dependence treatment and care in Serbia prepared by UNODC and the World Health Organization. The National HIV/AIDS Strategy for 2011–2015 had been adopted in March 2011 and had to be revised. At the same time, implementation of the political declarations from the strategic documents remains questionable.

There are no PWID community-driven initiative groups or PWID organizations in Serbia. Just one non-governmental organization, Re Generation, does drug policy analysis, research and advocacy. The main reasons for the low level of community activism are strong stigma and discrimination, the criminalization of drug use, and the lack of financial support and funding options for organizing advocacy campaigns. At the same time, Serbian harm reduction non-governmental organisations (NGO) are actively engaged in resource advocacy and advocacy of service access issues for PWID. 

Programs

The Global Fund to Fight AIDS, Tuberculosis and Malaria support allowed Serbia to scale up harm reduction services between 2006 and 2014, including needle exchange programs, OST, and outreach activities. Unfortunately, over the last two years, the Serbian community of PWID has been experiencing severe consequences of the closure of harm reduction programs after the the Global Fund withdrew its funding. The end of Global Fund support and the unsolved service sustainability issue led to a significant deterioration of harm reduction programs in Serbia.

The needle and syringe programs’ (NSP) services were interrupted sharply as soon as the Global Fund grant to the Ministry of Health ended, after more than 10 years of work. They had been introduced for the first time in 2003 in Belgrade. There were three NSPs in three cities before the withdrawal of Global Fund financial support, but all of them have now closed.

In 2014, NSP services covered 14.5% of PWID in Belgrade, but in 2015 they were not available to clients any more. Critical harm reduction interventions, such as the distribution of clean injecting equipment and condoms, community outreach, the provision of targeted informational materials, and active tuberculosis case finding among PWID, have been discontinued.  

NSP Coverage*

After the withdrawal of Global Fund support, NSP services in Serbia were not supported by the government or international donors with the exception of Novi Sad and Vojvodina, where local governments provided small amounts of funding to non-governmental organizations (NGOs) working with people who use drugs.

Opioid substitution therapy (OST) services in Serbia were introduced in 2010. OST is conducted with methadone and buprenorphine. In 2014 there were 25 OST sites (compared to 29 in 2013). According to the bio-behavioral survey of 2013 only 3.6% of PWID were on methadone maintenance treatment in Belgrade and 5% in Nis. In total there were around 3500 OST clients in 2013. Since the end of the Global Fund’s financial support, all OST programs have been funded through the state-run National Health Insurance Fund, which also pays for other types of drug treatment (detox, maintenance therapy, inpatient treatment of drug dependence, and treatment of drug-induced psychosis).

OST Coverage*

Methadone substitution therapy is available in the penitentiary system to opiate-addicted prisoners, but only to those who were receiving substitution treatment prior to incarceration. In 2015, condoms were available in prisons as a part of a pilot project.  

There is neither political nor financial support to harm reduction services for PWID because the social and health consequences of drug use are seen as low-priority issues by the government and decision-makers.  The price for failing to ensure at least minimal sustainability of harm reduction services in the country could be rather high in the short term. Moreover, it is hard to evaluate the real scope of the epidemiological and social consequences of the closure of programs for PWID, as harm reduction used to be a key to accessing the PWID community, so it will be hard to conduct any further assessments.  

*In order to reverse an HIV epidemic, WHO/UNODC/UNAIDS (2014) guidance recommends that 60% of all PWID should be reached regularly by NSP, while 40% of all opiate users should be enrolled in OST.

Funding

There is no available information on current expenditures on harm reduction programs or estimates of harm reduction costs in Serbia. According to the 2014 UNGASS report, a total of EUR10,171,241 has been spent on HIV/AIDS programs in the country. Fifteen per cent of the total amount, EUR1,565,710 was spent between January and September 2014 within an HIV project financed by the Global Fund, including EUR835,912 for prevention programs among most-at-risk populations (MARPs). The remaining financial support has been provided from the national budget, as follows:

EUR6,944,552 for ART;
EUR944,728 for OST;
EUR512,821 for HIV testing of voluntary blood donations;
EUR186,853 for HIV testing and counseling services; and
EUR16,557 for national-level coordination and monitoring and evaluation (M&E) activities.

A national estimate of how much of total spending on HIV prevention has been spent on harm reduction for PWID has never been calculated. Now only medical services for PWID and OST are supported by the state budget — but at a minimal level and without any prospect of an extension of services. Only three percent of the government’s limited HIV budget has been allocated to prevention, and none of this money is for work with key populations.

There were no transition plan for the Global Fund’s withdrawal and no institutional framework for coordinating the transition to domestic financing for HIV and AIDS in Serbia. There has been no coordination from other donors to help Serbia to ensure at least minimal harm reduction service functioning.

Despite its clearly articulated support for HIV and AIDS programming, Serbia’s government had no financing plan for using domestic money to fill the gaps left by the Global Fund’s withdrawal. What’s more, it still remains unclear which sources of funding and what financing mechanisms it can use to fund NGOs and community groups for HIV related work.  

Currently there are no alternative mechanisms to ensure sustainable funding for NGOs harm reduction programs in Serbia. Local harm reduction groups have recently come together under the Serbian Coalition of Harm Reduction Organizations to coordinate their fundraising efforts.

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