The state of harm reduction in South-Eastern Europe

Eurasian Harm Reduction Network (EHRN) is starting to publish a series of country profiles reflecting the general state of harm reduction and presenting the latest available data.

13 July 2016

Eurasian Harm Reduction Network (EHRN) is starting to publish a series of country profiles reflecting the general state of harm reduction and presenting the latest available data on funding, legislative and policy environments, estimated populations of people who inject drugs (PWID), and epidemiological data in the 29 states where EHRN works. The country profiles, developed by EHRN, are intended to provide verified data in a systematic way for comparison, analysis and advocacy purposes.

The first set of profiles is on some of the countries in the subregion of South-Eastern Europe: Albania, Bulgaria, Macedonia, Montenegro, Romania, Serbia, and Slovenia. In general, these countries are transitioning from the Global Fund financing or do not have it at all because of the increasing economic development and low prevalence of HIV among the general population.

To launch the profiles, we had asked the two members of the EHRN Steering Committee, representing South-Eastern Europe, Tijana Zegura from Montenegro and Yuliya Georgieva from Bulgaria, to give us a short overview on the state of harm reduction in the countries of the subregion they represent.

What are the main features of the subregion in terms of harm reduction?

Yuliya Georgieva: In comparison with other Eastern Europe and Central Asia countries, South-Eastern Europe subregion has relatively low prevalence of HIV and at the same time, relatively high prevalence of hepatitis C. For instance, in Bulgaria HIV prevalence among PWID is about 10%, and hepatitis C prevalence – almost 80%. This situation requires special approaches to harm reduction and prevention of disease transmission.

Tijana Zegura: Geographically, Montenegro is in the heart of Europe, but we are not part of the European Union, and we still cannot access lots of funds from the EU. This is the main difference between our countries and other European countries. Compared to Eastern European countries where HIV prevalence is much higher, we are not a priority at all.

We are left alone in the zone between Eastern Europe and Western Europe. Our governments don’t provide enough support (if any at all) to harm reduction services, OST or anything like that. We are a big question mark on the map of Europe at the moment. Most countries are not prepared to prevent HIV and hepatitis C among PWUD, but also we are not ready to provide any kind of psycho-social support; we don’t have good infrastructure for treatment, rehabilitation or resocialization. In most countries of the subregion, legislation is still not very good; or they have good legislation, but it is not implemented properly.

What are the main challenges for the subregion?

Tijana Zegura: We have similar problems in all countries, even in (the EU member states) Bulgaria and Romania: service providers are on their own. Maybe except Croatia and Slovenia, where service providers are part of the public health system and are supported by the government. The infrastructure for service provision was established by the Global Fund project, but in recent years in most countries, after the Global Fund left, these services have shut down or are working on a very small scale. Look at the experience of Bulgaria and Romania — especially Romania, where HIV prevalence has been growing from year to year, not only among people who use drugs but also in prisons. So we still have some sort of infrastructure, but at this moment — or maybe next year or in two years — this infrastructure and everything that was achieved over decades is going to be ruined if we don’t put enough pressure on our governments to persuade them to support harm reduction and OST services. In some countries, such as Albania, OST is provided only by NGOs. On the other hand, we have to put pressure on the main donors to service providers such as the Global Fund or the European Commission, because they are not supporting services at all.

For the countries of our subregion it is critically important to have strong regional and subregional joint initiatives and activities with participation from our governments, our regional partners, and the European Union and the European Commission as well.

Yuliya Georgieva: The Global Fund is leaving the region, but the states are not eager to finance harm reduction programs even if they have official commitments. Civil society, PWUD communities should stimulate the states to fulfill these commitments and to finance harm reduction programs in full. But there is an affined problem: PWUD communities in the subregion are rare and weak.

What are the necessary next steps – from the state and the civil society?

Tijana Zegura: States have to fulfill the obligations they have made; one of these essential obligations is to secure the sustainability of service providers. Civil society has to advocate towards and cooperate with governments. We all have to find a common language; we have to negotiate for the sake of our clients, not for the civil society organizations themselves. But also in most of our countries there is another problem. In countries of the former Yugoslavia most governments are trying to integrate civil society organisations’ service provision within social care system, not public health system, since in most countries there is no existing system of integration within it. Our fear is that harm reduction service provision is going to be licensed only for some sort of psycho-social support, if allowed to be licensed at all. All other services, that are not licensed, are not going to be supported by state at all.

Why are these country profiles important for advocacy?

Yuliya Georgieva: These data will be useful for experts and activists, for all who’s interested in drug policy and harm reduction issues in our region. These country profiles show us the situation at large and help us to see the ways to improve it.